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ELC-16-1841 Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 I � Inspection Number: INSP-262379 Permit Number: ELC-7-16-1841 Scheduled Inspection Date: August 29, 2016 Permit Type: Electrical-Commercial Inspector: Devaney, Michael Inspection Type: Final Owner: ,BARRY UNIVERSITY Work Classification: Addition/Alteration Job Address:11300 NE 2 Avenue Adrian Hall Miami Shores, FL 33138-0000 Phone Number Parcel Number 1121360010160-07 Project: BARRY UNIVERSITY Contractor: LINDMAR ELECTRIC INC Phone: (305)756-1075 Building Department Comments INTERIOR RENOVATION Infractio Passed Comments INSPECTOR COMMENTS False Inspector Comments Passed 12f— Failed Correction Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. August 26,2016 For Inspections please call: (305)762-4949 Page 16 of 38 \ a Miami Shores Village P � E �mmerlal .,. 10050 N.E.2nd Avenue NE rat y Miami Shores,FL 33138-0000 Phone: (305)795-2204 �l�1g Expiration: 01/04/2017 Project Address Parcel Number Applicant 11300 NE 2 Avenue Number: Adrian Hall 1121360010160-07 Miami Shores, FL 33138-0000 Block: Lot: BARRY UNIVERSITY INC Owner Information Address Phone Cell BARRY UNIVERSITY INC 11300 NE 2 Avenue MIAMI SHORES FL 33161-6628 11300 NE 2 Avenue MIAMI SHORES FL 33161-6628 Contractor(s) Phone Cell Phone Valuation: $ 7,000.00 LINDMAR ELECTRIC INC (305)756-1075 Total Sq Feet: 0 Type of Work:INTERIOR RENOVATION Available Inspections: Additional Info: Inspection Type: Classification:Commercial Final Scanning:1 Meter Box Alteration Relocation Fire Alarm Service Change Review Electrical W.W. Underground Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $4.20 DBPR Fee Invoice# ELC-7-16-60424 $3.38 07/0812016 Credit Card $ 195.96 $50.00 DCA Fee $3.38 Education Surcharge $1.40 07/01/2016 Credit Card $50.00 $0.00 Permit Fee $225.00 Scanning Fee $3.00 Technology Fee $5.60 Total: $245.96 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 that all the foregoing information is a9purate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Futhermore,1 authorize the above-n co tactor to do the work stated. July 08, 2016 Authorized Signature:Owner / Applicant �1 on r ctor / Agent Date Building Department Copy July 08,2016 1 Miami Shores Village Building Department JUL 0 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 I FBC 20 BUILDING Master Permit No. Ce- PERMIT APPLICATION Sub Permit No. Els, BUILDING ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ORENEWAL ❑PLUMBING [--] MECHANICAL PUBLIC WORKS ❑ CHANGE OF CANCELLATION [:] SHOP �+ CONTRACTOR /� DRAWINGS JOB ADDRESS: //e D6 �Ci � � �, �� G L r— City: Miami Shores County: Miami Dade Zip: —7 7/—IW Folio/Parcel#: Is the Building Historically Designated:Yes NO v-� Occupancy Type: Load: ConstructionType: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): Phone#: Address: ,r�//-3 ® ev Wee � 21^ City: //,,�1--er State: �z Zip: Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name: L�� fsLo�� /� WC Phone#: Address: City: �Z- ® t! State: . Zip: Qualifier Name: � C — , � Phone#:, 3' --�IO AV State Certification or Registration#: t: 0 Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ ®� Square/Linear Footage of Work: Type of Work: ❑ Addition DeAlteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: J��D,W Specify color of color thru tile: Submittal Fee$ ®' (AJ* Permit Fee$ ""'a CCF$ .�-10 CO/CC$ Scanning Fee$ Radon Fee$ p DBPR$ 3 �>9 Notary$_ Technology Fee$ ° �® Training/Education Fee$ 9 " ® Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ (Revised02/24/2014) t y � 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 Signature ' OWNER or AGENT CONTRACTOR The fo egoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of SfgG ,20 by day of UrS— .20 /(0 ,by ISI N ,who is Dersonallxknown to ��Gi��717 �.�1\��,who is personally known to me or who has produced as me or who has produced c,— as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Q7 Sig Sign: - Print: Print: Seal: ,° NointY PYW10 ft"Of FWW Seal: joy J Yea c�Pve Notary Public State of Florida w) my Commis M 9 i ? Kioka Boyce 510"11/1212018 ca My Commission EE 862798 OP IV Expires 03/02/2017 APPROVED BY , l,�'GoL y �( Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) I310K SCOTT, GOVERNOR KEN LAWSON,SECRETARY { STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD t EC13007162 The ELECTRICAL CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date:-AUG 31, 2016 - Rol 0 LIND, ORLANDO E • LINDMAR ELECTRIC, I • 496 NE 89TH ST E..; a711 te ; EL MORTAL `} 14S408 . IF ISSUED: 11/09/2015 DISPLAY AS REQUIRED BY LAW SEQ# L1511090000604 Local Business Tic Peceipt Miami-Dade County, State of Florida -THIS IS NOTA BILL-DO NOT PAY 2784305 BUSINESS-NA M EILOGA TION RECEIPT NO. EXPIRE S LINDMAR ELECTRIC INC RENEWAL EXPIRE ass NE 8e ST 2:a1�5s SEPTEMBER 30, 2016 EL PORTAL,FL 33138 Must be displayed at place of business � Pursuant to County.Code Chapter SA-Art.9&10 OWNER SEC.TYPE OF BUSINESS LINDMAR ELECTRIC INC 196 ELECTRICAL- BY T ENT RECEIVED BY TAX COLLECTOR CONTRACTOR 51.75 11/23/2015 Workers) 2EC13007162 0237-16-001290 7Hs Local Bwnms Tax ANWIPtaily cOn"nrepaymsntof the LOW BusinessTWL The Receipt is nota liceu�e pemit,Ora Carti-cation dthOhdd8esguWi"c0iorAtodobusiness.Holder moatcorpiywithawMnry errun l ornorlgmwmywair%WatarylawswWregW-ef!W whichappiytothebudness, The l$BPrNQabove mot bedspiayedanall cmrrfacldvehides_Mjwd-padeoxiaSao ft M ®MMIAMMA % F rmaeirdtnlaSon,visitwww.mianidada. cglector F 0 ®a 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 below has elected to be exempt from Florida Workers'Compensation law. EFFECTIVE DATE: 5/2112015 EXPIRATION DATE: 5/20/2017 PERSON: .IND ORLANDO E FEIN: 650370868 BUSINESS NAME AND ADDRESS: LINDMAR ELECTRIC INC 496 N. E.89 STREET MIAMI FL 33138 SCOPES OF BUSINESS OR TRADE: LICENSED ELECTRICAL CONTRACTOR Pursuant to Chapter 440.05(14),F.S..an officer of a corporation who elects exemption from this chapter by filing a certificate of election under this section may not recover benefits or compensation under this chapter.Pursuant to Chapter 440.05(12),F.S.,Certificates of election to be exempt...apply only within the scope of the business or trade listed on the notice of election to be exempt.Pursuant to Chapter 440.05(13),F.S.,Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation if,at any time after the filing of the notice or the issuance of the certificate, the person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate.The department shall revoke a DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUESTIONS?(850)413-1609 � r r DATE 011INDO" CERTIFICATE OF LIABILITY INSURANCE 06/16/16 e �II� THIS CERTIF�ATE IS ISSUED AS A MATTER OF INFORMATION Ann — PRODUCER ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 18441 N.W.27 Ave HOLDER THIS CERTIFICATE DOES NOT AMEND,EXTEND OR � Miami,FL 33056 ALTER THE COVERAGE AFFORDED BY THE W. _ Phone(305)625-2403 Fax (305)625-6472 INSURERS AFFORDING COVERAGE MAIC# INSURER A: GRANADA INSURANCE COMPANY INSURED LINDMAR ELECTRIC INC INSURER S GRANADA INSURNCE COMPANY i CIO ORLANDO LIND INSURER C: --i 496 NE 89 ST aaSu R . _ j EL PORTAL,FL 33138 INSURER E: -- COVERAGES INSURER F. —_ THE POLIOS OF INSURANCE LISTED HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT.TERM OR CONDITION OF ANY CONTRACT OR OTHER DMINIENT WffH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR I MAY PERTAIN.THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS.EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. -. ---s � _ POU"EFFEC7N� POLICY EXPIRATION MW AWL — TYPE OF INSURANCE - ! POLICY NUMBER _ !DATE I DA -------INum . ..—I j GENERAL LIABILITY t� -�-- I EACH OCCURRENCE 11000,000! 0 COMMERCIAL GENERAL LIABILITY :0185171-00052491 09/09/15 j 09109116 PREMISES Meoccurer�e 100_•�•`' ❑C CLAIMS MADE ® OCCUR MED EXP{Any one Person) 5,000 A ❑ ❑ PERSONAL$ADV INJURY 1,000,000 GENERALAGGREGATE 1,000,000 F1 PRODUCTS-COMPIOP AGG 1,000.000! GEN'L AGGREGATE LIMIT APPLIES PEFt ® POLICY ❑PROJECT ❑ LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT -� [j ANYAUTO 0110FL00012396 09/06/15 09/06/18 Eaaoaa" _ ❑ ALL OWNED AUTOS BODILY INJURY 10,000 y B ❑ R SCHEDULEDAUTOS Perms) ❑ HIRED AUTOS BODILY INJURY 20,000 ❑ NON OWNED AUTOS (Per accident) I ❑ PROPERTY DAMAGE 10,000 j (Per acddenU GARAGE LIABILITY - AUTO ONLY-EA ACCIDENT _! ❑ ANY AUTO OTHER THAN EA ACC _ AUTO ONLY: AGO ! �LIABILITY I EACH OCCURRENCE — ❑ OCCUR ❑ CLAIMS MADE AGGREGATE _a DEDUCTIBLEEj ! RETENTION —r- WORKERS COMPENSATIONAND j ❑ WC ATU- ❑ EMPLOYERS'LIABILITY TO LIMITS ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT OFFICER/MEMBER EXCLUDED? E.1..DISEASE-EA EMPLOYEE If yes,describe unit E.L.DISEASE-POLICY LIMIT _.I SPECIAL PROVISIONS below OTHER ! DESCRIPTION OF OPERATIONS 1 LOCATKNNS i VEH,CLM/EXCLUSIONS ADDED BY ENDORSWENT i SPECIAL PROVISIONS --- .. ELECTRICIAN VEH#1)99 FORD ECONOUNE VIN#IF-TPE2424XH839812 i CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE j EXPIRATION DATE THEREOF.THE ISSUBNG INSURER WILL ENDEAVOR TO MAIL MIAMI SHORES VILLAGE 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO Q 10050 NE 2ND AVENUE THE LEFT.BUT FATO DO So SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,TTS AeEmm OR REPRESENTATIVES, MIAMI SHORES,FL 33138 AUTHORIZED REPRESENTATIVE RD 25(2001108)OF ®ACORD ORATION 1988 LINDMAR ELECTRIC INC 496 NE 89 STREET EL PORTAL, FL 33138 July 4, 2016 State of County of Before me this day personally appeared �/�� //L,�J whom being duly sworn, deposes and says: That he will the only person working on the project located at �Wlf Y 41,4) Sworn to (or affirmed) and subscribed before me this_jday of c Z . 20 by Personally known OR rodu ed Identification Type of Iden ' ation Produced 0� f�otaryPu�lic,Sta4eofFlodde -1 m es o My comm. expires Oct. 8, 2017 Print,Type or Stamp Name of Notary OR I p� t s� Miami shores Village "" Building Department LNrEs to `� 10050 N.E.2nd Avenue LORNp' 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: . 4000 — Owner State of Florida County of Miami-Dade ( The foregoing was acknowledge before me this 2" , day of By SAN PINGW4 A L who is personally known to me or has produced as identification. Notary: SEAL: Notary Public Stots of F GAA i you j My Commission FF 188481 pt+, Expires 11/1=018