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EL-16-1089 Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores, FIL I �^93 Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-266434 Permit Number: EL-4-16-1089 Scheduled Inspection Date: September 30, 2016 Permit Type: Electrical - Residential Inspector: Devaney, Michael Inspection Type: Final Owner: SPIRK, BRANDON MYLES Work Classification: Alteration Job Address:269 NE 103 Street Miami Shores, FL 33138- Phone Number (305)519-3007 Parcel Number 1121360130430 Project: <NONE> Contractor: AP POWER ELECTRIC CORP Phone: (954)822-4496 Building Department Comments ELECTRICAL TRADE PERMIT. NEW 220V ELECTRIC Infractio Passed Comments SERVICE FOR DUAL FUEL RANGE. 2 NEW GFCI INSPECTOR COMMENTS False OUTLETS 1 NEW STANDARD OUTLET, 1 NEW HARD WIRE CONNECTION TO RANGE HOOD.ALL OTHER ELECTRICAL-EXISTING TO REMAIN SCOPE OF WORK /WPRK AREA LIMITED TO KITCHEN. Inspector Comments Passed CREATED AS REINSPECTION FOR INSP-266336. No rough inspection will ED need an electrician on job site for final. Failed % — Correction 7,L,52 Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. September 29,2016 For Inspections please call: (305)762-4949 Page 13 of 32 -446-1089 Parmitwo, EL Miami Shores Village Pe n it Type:El cal-atus: l�ROM Re�si�ti+at 3 10050 N.E.2nd Avenue NE Ul��Cf�# tiorr.Alterlran Miami Shores,FL 3313&0000 iPerrriit St � y � Phone: (305)795-2204 �r � ' -:, �CORtDp' �, ts:sc� ,©ate:4/, 2010 :" Expiration: 10/19/20161 Project Address Parcel Number Applicant 269 NE 103 Street 1121360130430 BRANDON MYLES SPIRK Miami Shores, FL 33138- Block. Lot: Owner Information Address Phone Cell BRANDON MYLES SPIRK 269 NE 103 Street (305)519-3007 MIAMI SHORES FL 33138- , 269 NE 103 Street MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone Valuation: $ 900.00 AP POWER ELECTRIC CORP (954)822-4496 Total Sq Feet: 0 Type of Work:ELECTRICAL TRADE PERMIT.NEW 220V E Available Inspections: Additional Info: Inspection Type: Classification:Residential Scanning: 1 Review Electrical Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $0.60 DBPR Fee Invoke# EL-4-1E59504 $2.25 DCA Fee $2.25 04/22/2016 Credit Card $309.10 $0.00 Education Surcharge $0.20 Permit Fee-Additions/Alterations $150.00 Scanning Fee $3.00 Technology Fee $0.80 Work without Permit Fee $150.00 Total: $309.10 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 AFF I certiN that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating constructiorrsan rmore,I authorize the above-named contractor to do the work stated. April 22, 2016 Authofized Signature:Owner / Applicant / Contractor / Agent Date Building Department Copy April 22, 2016 1 Miami Shores Village Building Department is 1 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 !� Tel:(305)795-2204 Fax:(305)756-8972 By: 0 INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 201 BUILDING Master Permit No._ i PERMIT APPLICATION Sub Permit No. fl--(6 —1 nsl— F-IBUILDING ❑■ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF [:] CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 269 NE 103rd Street City: Miami Shores County: Miami Dade Zip: Folio/Parcel#:11-2136-013-0430 Is the Building Historically Designated:Yes NO X Occupancy Type: R3 Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder):Brandon M. Spirk Phone#:305-516-3007 Address:269 NE 103rd Street City: Miami Shores State: FL Zip: 33138 Tenant/Lessee Name: N/A Phone#: Email: mylestec@gmail.com CONTRACTOR:Company Name: A.P. Power Electric Phone#: 305-776-0657 Address. 3758 SW 16 Street City: Ft. Lauderdale State: FL Zip: 33312 Qualifier Name: Hector Arzola Phone#: State Certification or Registration#: ER 13014434 Certificate of Competency#: CCIDCME1644012 DESIGNER:Architect/Engineer: N/A Phone#: Address: City: State: Zip: Value of Work for this Permit:$900.00 Square/Linear Footage of work: 250 SF Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: Electrical Trade Permit-New 220v Electric Service for dual fuel range. 2 New GFCI outlets 1 new standard outlet, 1 new hard wire connection to range hood. All other electrical - existing to remain Scope of work/work area limited to kitchen Specify color of color thru tile: Submittal Fee$ ° J�J Permit Fee$ t�®�®® CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ $ Technology Fee$ Training/Education Fee$ Double Fee Structural Reviews$ Bondj TOTAL FEE NOW DUE$ (Revised02/24/2014) I4 Bonding Company's Name(if applicable) N/A 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$2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also,a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signat Signature OWNER or AGENT CONTRACTOR The foregoing instrument/�1'�w,as acknowledged before me this The foregoing instrument was acknowledged before me this ,,r s I day of ('`L ,20 14 .by day of AIS PPS 20 /� .by Ziu"oN Z pt sr K who is personally known to -44J1,T-0 40' ,who Is personally known to me or who has produced as me or who has produced as identification and who did take an oath. identification and*Ok 1 NOTARY PUBLIC: NOTARY PUBLICACiUNA OMMISSION*FF1 OW3 RRg1,2018 Sign:-LA�� Sign: #xm Print: /V,4 L.2 A'd ? Print: �� 1re. ; C, Seal: Seal: 0�"5 NA "a*�"'•� ANA L CH APARRO ''" '� MY COMMI$StUN#FF155623 ,* *? Commission# FF 108556 cF• zd, a.F My Commission Expires EXPIRES September !.2018 a!„..' no��� April 01._201 I67�398-0159 Moridallotarysenww.�um 9c&8�8�8�5�9�i ##1K 1k 8�rF i�A�i�My,A,9g A,i�B#R##af,k +EA�8�S9�St�A� APPROVED BY Aft Plans Examiner Zoning Structural Review Clerk (RevisedO2/24/2014) CERTIFICATE OF LIABILITY INSURANCE DATE(MMMMPYYY) 04/06/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS EERTIFICATE 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 certiffcate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WANED,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 786-573-4485 786-573-4486 NAMI Ma leen Blandon Insurance NOW Agency PHONE 786_573,•-4485 FAI�c No;786-573-4486 12915 SW 132 Street suite 4-B Eo"', :mayleen@insurancenowagency.com Miami, FL 33186 PRODUCER D INSUR S AFFORDING COVERAGE NAIC 0 INSURED INSURER A.Endurance American SWjafty Ins Co AP Power Electric Corp. INSURER 8: 3758 SW 16th Street INSURER C: Fort Lauderdale, FL 33312 INSURER D: INSURER E: 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. INSTR TYPE OF INSURANCE D POLICY NUMBER pPOLICY EFF EXP LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 0 000 ACUWWX TO RENTED COMMERCIAL GENERAL LIABILITY PREMISES Ea o $ 100,000 CLAIMS-MADE ©OCCUR j 7MED EXP(Any one person) $ C BC20001204500 3/16/2016 3/16/2017 PERSONAL&ADV INJURY $ i GENERALAGGREGATE $ GEWL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ 2,000,000 POLICY PRCT F]O- LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Per acddent) S SCHEDULED AUTOS PROPERTY DAMAGE HIRED AUTOS (Pet accktant) $ NON-01MVED AUTOS $ S UMBRELLA I" OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETEN-nON $ $ WORKERS COMPENSATIONWC TATO OTH- AND EMPLOYERS'LIABILr Y YIN ANY PROPRIETORIPARTNERIEXECUTWE OFFICERIMEMBER EXCLUDED? El NIA E.L.EACH ACCIDENT $ (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS bedm . E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,N more space Is requk" License#E000121 / ER 13014434 CERTIFICATE HOLDER CANCELLATION Village of Miami Shores SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Building Department THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN g p ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE 2nd Ave Miami Shores Village, FL 33138 AUTHORIZED REPRESENTATIVE Mayleen Blandon rfl ©198&2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009!09) The ACORD name and logo are registered marks of ACORD 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: 4/12/2016 EXPIRATION DATE: 4/12/2018 PERSON: ARZOLA HECTOR A SR FEIN: 271635909 BUSINESS NAME AND ADDRESS: AP POWER ELECTRIC CORP 3758 SW 16TH ST FORT LAUDERDALE FL 33312 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 AP POWER ELECTRIC CORP April 02 2016 State of Florida Miami Dade County Before me this day personally appeared " k%1AA"* who being duly sworn, deposes and says: That he will be the only person working on the project located at 269 NE 103 St Miami Shores FI 33138 Sworn to and subscribed before me this�_day of,2016, by Personally know OR Produced Identification Type of Identification Produced f Print Name of Notary o` rP`B GELKA ACUNA My COMMISSION#FF155823 , adi;•' EXPIRES September 1,2018 (407)38"153 Floridallota service.com Is Miami shores Y I ' Building Department 10050 N.E.2nd Avenue CpRp�A 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 budding 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. f1. 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. Signar Owner State of Florida County of Miami-Dade The foregoing was acknowledge before me this day of I P 1�Lm ,20 By aA-111 11.AJ who is personally known to me or has produced as identification. Notary / SEAL: ;a�'"�;�. ANA L CHAPARRO =•° Commission#FF 108556 nny Commission Expires °•mnnaa� P�