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EL-15-2986 A Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 gcld% Inspection Number: INSP-265008 Permit Number: EL-11-15-2986 Scheduled Inspection Date: August 09, 2016 Permit Type: Electrical- Residential Inspector: Devaney, Michael Inspection Type: Final Owner: , Work Classification: Alteration Job Address:1094 NE 91 Terrace Miami Shores, FL 33138- Phone Number (305)336-7100 Parcel Number 1132050010380 Project: <NONE> Contractor: B.L.F ELECTRICAL INC Phone: (786)380-2509 Building Department Comments INSTALL ANEW CIRCUS IN THE KITCHEN AND ADDING Infractio Passed Comments LIGHTS IN THE CEILING. INSPECTOR COMMENTS False Inspector Comments Passed Failed Correction ❑ Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. August 08,2016 For Inspections please call: (305)762-4949 Page 31 of 35 F f mffivo w V!ft Miami Shores Village . Pe 7 ( G 41=fl htlat, �S. 10050 N.E.2nd Avenue NE ' fas 6(v At O to Miami Shores,FL 33138-0000 , fit Apmd&n' ` .OR � Phone: (305)795-2204r Issue oate.NotueC .j Expiration: 06/28/2016 Project Address Parcel Number Applicant 1094 NE 91 Terrace 1132050010380 Miami Shores, FL 33138- Block: Lot: WATERSEDGE SHORES LLC Owner Information Address Phone Cell WATERSEDGE SHORES LLC 1094 NE 91 Terrace (305)336-7100 MIAMI SHORES FL 33160-3313 72 GOLDEN BEACH Drive GOLDEN BEACH FL 33160- Contractor(s) Phone Cell Phone $ 4,500.00 B.L.F ELECTRICAL INC (786)380-2509 Valuation: _.._.. ..___....._ ,__ __... _....,_.... ....�__. .... . Total Sq Feet: 0 Type of Work:INSTALL A NEW CIRCUS IN THE KITCHEN Available Inspections: Additional Info: Inspection Type: Classification:Residential Review Electrical Scanning:1 Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $3.00 Invoice# EL-11-15-57896 DBPR Fee $3.38 12/07/2015 Credit Card $ 192.76 $50.00 DCA Fee $3.38 Education Surcharge $1.00 11/30/2015 Credit Card $50.00 $0.00 Permit Fee-Additions/Alterations $225.00 Scanning Fee $3.00 Technology Fee $4.00 Total: $242.76 In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans,drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL,PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: I certify t t I the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Futh r Fite the above-named contractor to do the work stated. December 07,2015 Authorized Signat re: ner / Applicant / Contractor / Agent Date Building Dep a ment Copy December 07,2015 1 Miami Shores Village Building Department IN0V 40 2015 10050 N.E.2nd Avenue, Miami Shores,Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 201 BUILDING Master Permit N{o. �� (65 PERMIT APPLICATION Sub Permit No. TL 15 ❑BUILDING �LECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS �lJOB ADDRESS: ® L V L City: Miami Shores County: Miami Dade I' Zip: 3 8 Folio/Parcel#: Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: `OWNER: Na ne(Fee Simple Titleholder): &/j"ratj A, /<_0 hi/OR Phone#: -30 p Address: L (� c tiCity: _ 4 �0 klen P-P0 G h ,State: 1)�:7 Zip: i3 / i( o Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name: j3 L-1- 9��� Pho a#: Address: \/1—) .5,77-et -3 3 City: ' State: _ Zip: 33LU Z Qualifier Name: Phone#: 7L State Certification or Registration#: 00 Certificate of Competency M DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Wor this Permit:$ 5 ® O{ Square/Linear Footage of Work: Type of Woe El Addition [ Alteration F-1 New ❑ Repair/Replace/ !❑ Demolition De=lption .W.El r( l / -P C / /� v l ✓`C�t lci ctoa� d 'h a Speci or of color thru tile: Submittal F e$ Permit Fee$ �7� �� CCF$. CO/CC$ •�Scannfing fe6$ Radon Fee$' DBPR Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Boned$ TOTAL FEE NOW DUE$ G� ,Revised02/24/2014) Bonding Company's Name(if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name(if applicable) Mortgage Lender's Address City State Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRIC, PLUMBING, SIGNS, POOLS, FURNACES,BOILERS,HEATERS,TANKS,AIR CONDITIONERS, ETC..... OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding$2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also,a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature 0194 Signature -=:/�4 OWNER or AGENT CO TRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this Z S day of VO 20 15 by 2 day of I?/64e1420 S by r 04AINe A0A1AA, who is personally known to �� g Q E.c� nuc who is personally known to me or who has produced t�— 2,,066 G. ,2en5il me or who has produced L2 b& 1W"1 Lx-- 45 ,a identification and who did take an oath. identification and who did take an oath. o N i NOTARY PUBLIC: NOTARY PUBLIC: W s a Sign: %2��/ Sign: �+ E 6 Print:" Print: 2 0 �v Seal: .�`,,,YP'•• Seal: YINET CAMPBELL `.�,a °DVINE, r° a,•, _ Ell . Notary Public-State of FloJ _ Notary Public- Mate of Florida a' 9,F Pad;My Comm.Expires Oct 30.2 0, MY Comm.Expires Oct APPROVED BYi�e/�� Plans Examiner _ Zoning Structural Review Clerk (RevisedO2/24/2014) STATE OF FLORIDA ,DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD (850) 487-1395 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 LABRADA,VLADIMIR A B.L.F ELECTRIC. INC 1750 WEST 46TH STREET APT 337 HIALEAH FL 33012 Congratulations! With this license you become one of the nearly one million Floridians licensed by the Department of Business and Professional Regulation. Our professionals and businesses range STATE OF FLORIDA from architects to yacht brokers,from boxers to barbeque restaurants, S DEPARTMENT OF BUSINESS AND and they keep Florida's economy strong. PROFESSIONAL REGULATION Every day we work to improve the way we do business in order to EC13004858 ISSUED: 08/07/2014 serve you better. For information about our services,please log onto www.myfloridalicense.com. There you can find more information CERTIFIED ELECTRICAL CONTRACTOR about our divisions and the regulations that impact you,subscribe LABRADA,VLADII IRA to department newsletters and learn more about the Department's initiatives. B.L.F ELECTRIC. NC Our mission at the Department is:License Efficiently, Regulate Fairly. We constantly strive to serve you better so that you can serve your customers. Thank you for doing business in Florida, IS CERTIFIED under the provisions of Ch.489 FS. and congratulations on your new license! Expiration date:AUG 31,2016 L1408070004116 DETACH HERE RICK SCOTT, GOVERNOR KEN LAWSON,SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION r ELECTRICAL CONTRACTORS LICENSING BOARD o� EC13004858 The ELECTRICAL CONTRACTOR 1U ' Named below IS CERTIFIED `'?A Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2016 LABRADA,VLADIMIR A 0.• JIM B.L.F ELECTRIC. INC r 1750 WEST 46TH STREET APT 337 HIALEAH FL 33012 a ■ ' .moi ISSUED- 08/07/2014 DISPLAY AS REQUIRED BY LAW SEQ# L1408070002116 001863 Local Business Tax Receipt Miami—Dade County, State of Florida -THIS IS NOTA BILL - DO NOT PAY 6253082 \ILBT BUSINESS NAME/LOCATION RECEIPT NO. EXPIRES BLF ELECTRIC INC RENEWAL SEPTEMBER 30, 2016 1750 W 46 ST 337 6617644 Must be displayed at place of business HIALEAH FL 33012 Pursuant to County Code Chapter BA—Art.9&10 OWNER SEC.TYPE OF BUSINESS BLF ELECTRIC INC. 196 ELECTRICAL CONTRACTOR PAYMENT RECEIVED Worker(s) EC13004858 BY TAX COLLECTOR $45.00 09/21/2015 CREDITCARD-15-047961 This Local Business Tax Receipt only confirms payment of the Local Business Tax.The Receipt is not a license, permit,or a certification of the holders qualifications,to do business.Holder must comply with any governmental or nongovernmental regulatory laws and requirements which apply to the business. The RECEIPT N0.above must be displayed on all commercial vehicles—Miami—Dade Code Sec M-27& for more information,visit www miamidade.aovRa�ctor A6E�OR CERTIFICATE OF LIABILITY INSURANCEDATE(MMIDDIYYYY) 11/23/15 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: ff the cerHflcate holder Is an ADDITIONAL INSURED,the policy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to the terns and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: JULIO JIMENEZ Jimenez 8c Co.,Inc. PHONE (305)264-9900 1 a No: (305)2645382 8000 Coral Way E-MAILADDRESS. judo@jimenezandcompany.com Miami,FL 33155 INSURER(S) AFFORDING COVERAGE NAIL p Phone (635)264-9900 Fax (305)2645382 INSURER A: GRANADA INSURANCE COMPANY 09730 INSURED INSURER g: PROGRESSIVE EXPRESS INS COMPANY 02962 BLF ELECTRIC INC INSURER C: 1750 W 46 ST #337 INSURER 0: HIALEAH,FL 33012 INSURER E: INSURER F: COVERAGES - COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR TYPE OF INSURANCE ADD UBR POLICY NUMBER MPOOLICY EFF POLICD IDIP LIMITS GENERAL LIABILITYEACH O ETC 1,000,000.00 Q PREMISES (RENTEDEs Occurrence) $ 100,000.00 A ❑ ElY n 11/09!2015 11/09!2016 CLAIMS-MADE © OCCUR 0185FL00031139 MED EXP(Any one person) $ 5,000.00 ❑ PERSONAL&ADV INJURY $ 1,000,000.00 ❑ GENERAL AGGREGATE $ 2,000,000.00 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG $ 1,000,000.00 ❑tI POLICY ❑ PRO- ❑ LOC $ AUTOMOBILE LIABILITY CEa aOMBIN D nt SINGLE LIMIT ccl e3001000.00 Q ANY AUTO BODILY INJURY(Per person) $ B ❑ ALL SWNED © SAICHHE LED n 02043045-2 02/02/2015 02/02/2016 BODILY INJURY(Par accident) $ F] HIRED AUTOS ❑ AOS NED LPOPERTY DAMAGE $ er axi ent ❑ ❑ $ ❑ UMBRELLA LIAR ❑OCCUR EACH OCCURRENCE $ ❑ EXCESS LIAR ❑CLAIMS-MADE AGGREGATE $ ❑ DED ❑ RETEPmON$ $ WORKERS COMPENSATION ❑WC$TATU- ❑OTH- AND EMPLOYERS'LIABILITY Y/N ER ANY PROPRIETOR/PARTNER/EXECUTIVE N/A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatary In NH) EL.DISEASE-EA EMPLOYEE:$ N es,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ r- D—ESC RIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space is required) Elecrical work**—* CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Miami Shores Village THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDAJIt6E-IAflTii-iFIEPDLI PROV Building Department 10050 NE 2nd Ave AUTHORIZED REPR;ANTATJOE Miami Shores,FI 33138 p4l88-201 ACOfflBfARPORATION. All rights reserved. ACORD 25(2010/05)QF a ACORD na a ogo are registered marks of ACORD • BLF Electric, Inc. Vladimir Labrada Date: Stare of County of "lo-Ai - 1 JCC• . Before me this day personally appeared Aja rnk � Y(Y/ . who, being duly sworn, deposes and says: That he or she will be the only person working on the project located at: f®q4 N&A Tef , Sworn to(or affirmed)and subscribed before me this fS day of 10 wv�rr 20n by 1�IQ�In(11 rod a. Personally known OR Produced Identification a WD'ef'LME Owl'% Type of Identification Produced .t�`p 4 ►MRS MRAK�ii� .O II I •:�o1 Raw 7" �� l �Ir-Q M o• NIF Comm.bo"".30.2018 Print,Type or Stamp N�'me of Notary .�` °� Commission FF iT3169 J SHoREs 193imemo rir� M Miami shores Village Building Department �LOR{pA 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Notice to Owner - Workers' Compensation Insurance Exemption Florida Law requires Workers' Compensation insurance coverage under Chapter 440 of the Florida Statutes. Fla. Stat. § 440.05 allows corporate officers in the construction industry to exempt themselves from this requirement for any construction project prior to obtaining a building permit. Pursuant to the Florida Division of Workers' Compensation Employer Facts Brochure: An employer in the construction industry who employs one or more part-time or full-time employees,including the owner,must obtain workers' compensation coverage. Corporate officers or members of a limited liability company (LLC) in the construction industry may elect to be exempt if: 1. The officer owns at least 10 percent of the stock of the corporation, or in the case of an LLC,a statement attesting to the minimum 10 percent ownership; 2. The officer is listed as an officer of the corporation in the records of the Florida Department of State,Division of Corporations;and 3. The corporation is registered and listed as active with the Florida Department of State,Division of Corporations. No more than three corporate officers per corporation or limited liability company members are allowed to be exempt. Construction exemptions are valid for a period of two years or until a voluntary revocation is filed or the exemption is revoked by the Division. Your contractor is requesting a permit under this workers' compensation exemption and has acknowledge that he or she will not use day labor,part-time employees or subcontractors for your project.The contractor has provided an affidavit stating that he or she will be the only person allowed to work on your project.In these circumstances,Miami Shores Village does not require verification of workers' compensation insurance coverage from the contractor's company for day labor,part-time employees or subcontractors. BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. Signature: �*` r Owner State of Florida County of Miami-Dade / The foregoing was acknowledge before me this day of L By _)o RNAO cF a ? y who is personally known to me or has produced as identification. Notary: ��� ""..••• o,� r n t; CAkMU NoWp Public-8110 al Florida SEAL: My Comm ^�rei 8+6!iQ.;11018 %;;o.���;• Comma FF 113189