EL-14-2532 08/01/2018 17:05 FAX 1 800 685 7530 DATA SCAN FIELD SERVICES d 004/004
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Inspection Worksheet c t 4 _ w4
Miami Shores Village
10050 N.E.2nd Avenue Miami Shores,FL.
Phone:(305)795-2204 Fax:(305)756-8972
Inspection Number. INSP-266768 Permit Number
Scheduled Inspection Date: September 02.2016 Permit Type: Electrical- Residential
Inspector- Devaney, Michael Inspection Type: Final
Owner , Work Classification: Alteration
Job Address:2 NHS 108 Street
Miami Shores,FL 33768- Phone Number (305)773-3101
Parcel Number 1121360110090
Project: -<NONE>
Contractor: FRANKIE ELECTRIC CORP Phone: (305)332-7516
Building Department Comments
n raa b AtiOt1 Comr►e9ota
INTEMOR REMODELING iNSPEr;T(j COMMENTS Fame
l"Speator Comments
CREATED AS REINSPECTION FOR INSP,265653. Acid arc fault breakers
Passed i and bathroom receptacle.
Move smoke detectors 3 feet away fr0m AIC vents.
Failed
Correction
Needed
Re-inspection
Fee
No nticlittonal inspertiana can be scheduled until
re•inspedion tee i9 pari.
...................... ................. :........M
September 01.2016 For inspections please call: (306)762.4949 Pain 10 of 21
Miami Shores Village
� CEIVED
Building Department PIOV 1.7 2014
10050 N.E.2nd Avenue,Miami Shores, Florida 33138 BY:
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949
FBC 201
BUILDING Master Permit No. to a
PERMIT APPLICATION Sub Permit No. ECj"-(— S- 3 Z,
❑BUILDING ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
�1 p CONTRACTOR DRAWINGS
�
JOB ADDRESS: d /V W L O
City: Miami Shores County: Miami Dade Zip:.����
Folio/Parcel#: Is the Building Historically Designated:Yes NO
Occupancy Type:_,_Load: Construction Type: Flood Zone: BFE: FFE:
-: ame(Fee Simple Titleholder): 4
Mres :
ate: Zip:
Tenant/Lessee Name: Phone#:
Email: ��►►
CONTRACTOR:Company Name: Phone#: LE�I• • ��
Address: V61 '
,r
City: ,//i State: 47f Zip:
Qualifier Name: Phone#:_ •, g• �Pd
State Certification or Registration#: o Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ ;9 Square/Linear Footage of Work:
�_i �
Type of Work: El Addition LET Alteration [--] New ❑ Repair/Replace ❑ Demolition
Description of Work:
Specify color of coloivih iivle:
Submittal Fee$ Permit Fee$ 2 cw CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$ 1 '
(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"rG"OWNER: YOUR FAILURE TO•RtCORD 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 XQTWE OLC,OMMENCEMENT." • . .
Notice to Applicant: As a condition to the issuance of a building per'nilt i'vith an,esfimated value exceeding,$2500; the applicant must
promise in good faith that a copy of the notice of commencement and.tonstruction lien law5bro'chure will be delivered;a 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.
41 0
,�-gpure' " Signature` .
q ro OWNER or AGENT , CONTRACTbrR
The,foregoing instrument was ac owledged before me this 'Tile foregoing instrument was acknowledged before me this
,!
day'of''0 (fSAQ 54 20 /Y. , by day of e � ''•2�yr by
a,
9 j w chs personally known)o who�is persoto
me or who has pr duced as me or who has produced as
identification and who did take an oath. identification and whp did tale an oath.
R
C; NOTARY PUB r
Sign: Sign:
Print. Print: teary lic o�lUa
• .• My Comm.Expires Jul 16,2018
Seal ; HECTOR J.HALL Seal: =:; ;P�;•' Commission I FF 138265od
Bed ThroughNational Notary Assn.
Notary Public-State of Florida
•: :• My Comm.Expires Jul 16,2018
Commilsi J.FF 138M
*********s * „„u,• *VM%; �hNatior9;Assn ********** ******************************************************
APPROVED BY ill 1A-Wo”- """flans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
ELECTRICAL CONTRACTORS LICENSING BOARD ,
EC13006138 `
The ELECTRICAL CONTRACTOR
Named below IS CERTIFIED
Under the provisions of Chapter 489 FS.
Expiration date: AUG 31,2016
owl*A
'N
PEREZ, FRANCISCO J
FRANKIE ELECTRIC CORP.
6943 NW 168TH STREET''
MIAMI FL.33015
❑ 2 .
ISSUED, 06/03/2014 DISPLAY AS REQUIRED BY LAW SEQI*# L1406030000444
Local business T Receipt
Miarni—Dade County,State of Florida
-HIS IS NOT A BILL-D0 NOT PAY
"5961538 \ LB
BIJSiNEBS KWE/LOCATION RECEIPT NO. EXPIRES
FRA14148ELECTRIC CORP RENEWAL SEPTEMBER 30, 2015
6$43 NW 16iST 6219117 Must be displayed at puce of business
MIAMI,FL 33015 Pursuant to County Code
Chapter SA-Art.9&10
OWI11Eri SEC.TYPE Olr`BUSINESS PAYMENT RECEIVED`
FRANKIE ELECTRIC CORP 196 ELECTRICAL BY TAX COLLECTOR
CONTRACTOR 75,00 07121/2014
Worker(s) 1 EC13006138 0221-14-004657
This Local Basisess Tax ReCflipt only coal payment of the local Busies Tax.The Receipt is set a license.
permk or a cardliceflan of the helder s quaiifmitiom,to do hMiness.Bolder most comply with any pVWUMWW
W sonlIamemagloi moon requiremects which apply tathe 6eshtass.
Mh The RECEIPT N0.above most he dbpkrd oo all commercial ve6h les-fiA ai-Dade Code See 118-M
MIAMUM raramre hdormatiam,vhtiY
JEFF ATWATER
CHIEF FINANCIAL OFFICER STATE OF FLORIDA
DEPARTMENT OF FINANCIAL SERVICES
DIVISION OF WORKERS'COMPENSATION
'*CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS'COMPENSATION LAW'
CONSTRUCTION INDUSTRY EXEMPTION
This certifies that the individual listed glow has elected to be exempt from Florida Workers!Compensation law.
P
R:NWE DATE: 8/2312013 EXPIRATION DATE: 8/23/2015
: PEREZ FRANCISCO J
FEIN: 200894274
BUSINESS NAME AND ADDRESS:
FRANKIE ELECTRIC CORP
8943 NW 168TH STREET
MIAMI FL 33015
SCOPES OF BUSINESS OR TRADE:
LICENSED GENERAL ELECTRICAL WIRING ELECTRIC LIGHT OR
CONTRACTOR WITHIN BUIL POWER UNE C
Pursuant to Chapter 440.05(14).F.S..an officer of a corporation who elects exemption from this chapter by MV a certlfics3te of election under this semen may
not reams beneft or compensation under this cam.Pursuard to Chapter 440.05(12).F.S..Cwtificates ofd to be exempt...a"only wrMM the scope
of the buss or bode rimed at the dice of election to be exempt Pursuant to Chapter 440.05(13),F.S..Notaes of election to be exempt and certificates of
etaction to be exempt Ali be subject to revocation ff.at any time after the MV of the notice orthe isauance of to cert ade.the person named on the nctice or
x
NEMN Miami Shores Village
Building Department
R1DA 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:
I. The officer owns at least 10 percent of the stock of the corporation,or in the oase 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.In these circumstances,Miami Shores Village
does not require verification of workers' compensation insurance coverage from the contractor's company. Therefore, ov u may be
personally liable for the worker compensation injuries of any person allowed to work under this permit. Please check with your
insurance carrier since most property insurance policies DO NOT cover this type of liability.
BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS
CONTENTS.
w $r " � Contractor.
Print Name: Print Name: , •��
Signature: v 12 Signature:
�'3mv
w TI n
State of Florida) State of Florida) N 3 i.
-n 6 aCD
County of Miami-Da e) ,/ County of Miami-Dade)
Sworn to d sub ' ed b fore me this I Y Sworn to and subscribed before me s N o
day of fes( ,20 day of 20 w m
HECTOR J.HALL
By ublic Slate of Florida .�' �n
^, ExpiresJul
13
(SEAL) Commission #FF 138285 sn. (SEAL)
Type of 156ittificati6n' Typel6ftdentification produced