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EL-15-1534 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 inspection Number: INSP-258747 Permit Number: EL-6-15-1534 Inspection Date: June 07, 2016 Permit Type: Electrical - Residential Inspector: Devaney, Michael Inspection Type: Final Owner: TOVAR,JONATHAN &ANDREA Work Classification: Pool - Private Job Address:464 NE 92 Street Miami Shores, FL Phone Number (786)375-5533 Parcel Number 1132060140030 Project: <NONE> Contractor: AD ELECTRIC SERVICES INC Phone: (786)344-0211 Building Department Comments INSTALL NEW GROUND STAIRS WAY POOL Infractio Passed Comments INSPECTOR COMMENTS False Inspector Comments Passed CREATED AS REINSPECTION FOR INSP-258588. Need door and window alarms or baby fence or pool net. Support time clockproperley. Failed El Correction ❑ _�;� Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. For Inspections please call: (305)762-4949 June 07,2016 Page 1 of 1 SL� $y Miami Shores Villagetft77lt Tj� Etil�lReiiidential . 10050 N.E.2nd Avenue NE � � � ##) � " Miami Shores,FL 33138 0000 0 `ties Phone: (305)795-2204 ' ¢� 8 �PPRt�VEt�. ; Expiration: 1/23/2016 , a < :, . X7`1 712045', Project Address Parcel Number Applicant 464 NE 92 Street 1132060140030 JONATHAN&ANDREATOVAR Miami Shores, FL Block: Lot: Owner Information Address Phone Cell JONATHAN&ANDREA TOVAR 464 NE 92 Street (786)375-5533 (305)610-0914 Miami Shores FL 33138- 464 NE 92 Street Miami Shores FL 33138- Contractor(s) Phone Cell Phone Valuation: $ 400.00 AD ELECTRIC SERVICES INC (305)896-3402 Total Sq Feet: 0 Type of Work:INSTALL NEW GROUND STAIRS WAY POOL Available Inspections: Additional Info: Inspection Type: Classification:Residential Review Electrical Scanning:1 Review Electrical Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $0.60 Invoice# EL-6-15-56054 DBPR Fee $3.38 06/22/2015 Credit Card $50.00 $186.36 DCA Fee $3.38 Education Surcharge $0.20 07/27/2015 Credit Card $ 186.36 $0.00 PermitFjq-Additions/Alterations $225.00 Scanninpo ee $3.00 Techno Fee $0.80 Total: $236.36 -a t� 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 pertaini�thereto and in strict conformity with the plans,drawings,statements or specifications submitted to the proper authorities of Miami Shores Village. In accepti ''this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are requireAr ELECTRICAL,PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work. C*, OWNE AFFIDAVIT: I certify t t foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating constrton and zoning. utherm r I utho the above-named contractor to do the work stated. July 27, 2015 +,Authorized ignatu O e / Appli nt / Contractor / Agent Date Burling Departme t C y July 27,2015 1 Miami Shores Village ®� d Building Department PIFIcIF�TNTFD 10050 N.E.2nd Avenue,Miami Shores, Florida 33138 JUN 2 2015 Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 BY: FBC ��j BUILDING Master Permit No. PO PERMIT APPLICATION Sub Permit No z LS-3 H ❑BUILDING [%ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING F-] MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP /1 a CONTRACTOR DRAWINGS JOB ADDRESS: y(o q /y E R Z 15t City: Miami ShoresCounty: Miami Dade Zip: Folio/Parcel#: 1-�> z a�® I ft (//��0 3® Is the Building Historically Designated:Yes NO x Occupancy Type: Load: Construction Type: � Flood Zone: BFE:�7 `FFE: �� OWNER:Name(Fee Simple Titleholder): �C)/V1�1}�pp1) ICJ ��T�� Phone#: �t/�(00jy Address:9 GY Air— sr City: H 1 hA I S HO(ZG State: Fz Zip: Tenant/Lessee Name: CO Phone#: Email o P4-� e`�"I�/IF, COIL�1 CONTRACTOR:Company Name:A J/ C/ectrtJ " / V' VJ'Ca ,r Phone#: 7?,FO"' 3 <jV`® Address: i ®c4 f4 2. 5tj i Z-A e t City: State: �'—(, Zip: 3 3 8'6 Qualifier Name: a f(4w Phone#: State Certification or Registration M C ('3 0® Certificate of Competency M DESIGNER:Architect/Engineer: Phone#: Address: �y City: State: Zip: Value of Work for this Permit:$ (® Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ 'Alteration ❑ New �] Repair/Replace ❑ Demolition Description of Work: �N CA All N oAW Oi rpL%oA �Ai tr'S UUM S/ 00 Specify color of color thru tile: (QCC .Submittal Fee$ 4 Permit Fee$ Z��s�'� CCF$(�. �� CO/CC$ Scanning Fee$ Radon Fee$ DBPR,�$, � Notary$ Technology Fee$ ®o Training/Education Fee$ 6n . � Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ (Revised02/24/2014) t ' 4 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 Xttachment. Also,a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection wh' h ccurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be appr v an reinspection fee will be charged. Signature 1U1/ Signature00 O NER o AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The fo oing instrument was acknowledged before me this _ t7� day of J l)N'� ,20 by d` day of DONE ,20 5 ,by JONA{N+A Q -r6\jp . ,who is personally known toWJV LIAM M'UW ��,who is personally known to me or who has produced as me or who has produced art. IDiJ\OEQ P�'�as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: Sign: Print: Print: Florida Seal: ;° Pt,�� Notary Public State of Florida Seal: :° S in lvarez ission FF 156750 Sindia Alvarez ��ov�° 9/03/2018 a My Commission FF 156750 oF1'o Expires 09103/2018 ************ ** ******************************************************************************************* APPROVED BY 4,j Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) • 5 tORE, 14 t? y Miami shores Village Building Department 10RtpA 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 allo d to work on your project.In these circumstances,Miami Shores Village does not require verification of workers'compensatio in urance coverage from the contractor's company for day labor,part-time employees or subcontractors. BY SIGNING BEL ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. Signature: Owne State of Florida County of Miami-Dade 1 Nit� The foregoing w " as acknowledge before me this Oday of J V 1 ,201S, —.By 13O A7VAt� IWPle, who is personally known to me or has produced as identification. Notary: SEAL: F4jWp oNotary Public State of Florida Sindia Alvarez My Commission FF 156750 pd`� Expire.09103/2018 -001029 Local Business Tax Receipt Miami-Dade County, State of Florida -THIS IS NOTA BILL - DO NOT PAY 6458418 �LB_ T ) BUSINESS NAME/LOCATION RECEIPT NO. EXPIRES AD ELECTRICAL SERVICES INC RENEWAL SEPTEMBER 30, 2016 10442 SW 129 PL 6726948 Must be displayed at-place of business MIAMI R 33186 Pursuant to County Code Chapter 8A-Art.9&10 OWNER SEC.TYPE OF BUSINESS AD ELECTRICAL SERVICES INC 196 ELECTRICAL CONTRACTOR PAYMENT RECEIVED EC13005157 BY TAX COLLECTOR Worker(s) ] $49.50 10/01/2015 CREDITCARD-16-000533 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 Sac 6a-276. For more information,visityyww.miamidade.novhexcollector ACb LY CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 11%..,.►i 12/30/2015 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: If the certificate holder Is an ADDITIONAL INSURED,the policy(les)must be endorsed.If SUBROGATION IS WAIVED,subject to the terms 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 Sarai Medina NAME: Emmanuel Insurance&Associates,Inc. A N (305)693-0003 ac No): (305)691-4381 2370 E 8TH AVE E-MAIL ADDRESS: joel@emmanuelinsurance.com INSURER(S)AFFORDING COVERAGE NAIC# HIALEAH FL 33013-4236 INSURERA: BusinessFirst Insurance Company 11697 INSURED INSURER 6: TRAVELERS PROPERTY CASUALTY COMPANY AD ELECTRICAL SERVICES,INC. INSURER C: William M.Dominguez INSURER D: 10442 SW 129TH PL INSURER E: MIAMI FL 33186-3548 INSURER F: 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. ITR TYPE OF INSURANCE INSD WVD POLICY NUMBER ADDLSUBR POLICY EFF MM/DD/YYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000.00 CLAIMS-MADE ®OCCUR PREMISES Ea occurrence $ 100,000.00 MED EXP(Any one person) $ 5,000.00 B 1-660-182M4921-TIL-15 09/25/2015 09/25/2016 PERSONAL&ADV INJURY $ 1,000,000.00 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000.00 POLICY❑JE� 7 LOC PRODUCTS-COMP/OP AGG $ 2,000,000.00 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY Per accident AUTOS AUTOS ( ) $ HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER OT - AND EMPLOYERS'LIABILITYY/N STATUTE I ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000.00 A OFFICER/MEMBEREXCLUDED? N/A 0521-12514 03/06/2015 03/06/2016 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000.00 If es,describe under D 1,000,000.00 ns, OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached K more space is required) Electrical Contractor. Any Changes or alterations Done to this document after being issued shall constitute it null and void. CERTIFICATE HOLDER CANCELLATION CITY OF MIAMI SHORE 10050 NE 2 ND AVENUE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE MIAMI SHORW.FL 33138 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. FAX:305 756 8972 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION.All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD