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EL-16-2643 .A Inspection Worksheet Miami Shores Village f SO 10050 N.E.2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-268334 Permit Number: EL-9-16-2643 Scheduled Inspection Date: October 26,2016 Permit Type: Electrical- Residential Inspector: Devaney, Michael Inspection Type: Final Owner: ESCOBAR,CARLOS Work Classification: Alteration Job Address:362 NE 92 Street Miami Shores,FL 33138- Phone Number (954)937-1841 Parcel Number 1132060136440 Project: <NONE> Contractor: ELETRICAL SOLUTIONS FOR ALL LLC Phone: (786)663-0025 Building Department Comments REPLACE LIGHTING FIXTURES AND 2 GFI,6 LIGHT Infractio Passed Comments FIXTURES,5 SWITCHES. INSPECTOR COMMENTS False TO REPLACE PERMIT#EL12-872 Inspector Comments Passed CREATED AS REINSPECTION FOR INSP-268257. E� aster bath is O.K. Add 2 receptacles to kitchen counter area. Failed Correction ❑ � /� Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. October 25,2016 For Inspections please call: (305)762-4949 Page 19 of 37 r '4atv�3 44 Miami Shores Village ■ N� 1C1Vq1t4l r� 10050 N.E.2nd Avenue NEorrat� �f10tt AI 10 Miami Shores,FL 3313&000077� x + >,APPR01 h Phone: (305)795-2204 r k� Expiration: 03/29/2017 Project Address Parcel Number Applicant 362 NE 92 Street 1132060136440 CARLOS ESCOBAR Miami Shores, FL 33138- Block: Lot: Owner Information Address Phone Cell CARLOS ESCOBAR 362 NE 92 Street (954)937-1841 MIAMI SHORES FL 33138-3134 362 NE 92 Street MIAMI SHORES FL 33138-3134 Contractor(s) Phone Cell Phone Valuation: $ 1,000.00 ELETRICAL SOLUTIONS FOR ALL LL, (786)663-0025 Total Sq Feet: 0 Type of Work:REPLACE LIGHTING FIXTURES AND 2 GFI Available Inspections: Additional Info: Inspection Type: Classification:Residential Review Electrical Scanning:1 Fees Due Am]50.00 Pay Date Pay Type Amt Paid Amt Due CCF Invoice# EL-9-16-61469 DBPR Fee 09/30/2016 Credit Card $ 159.10 $0.00 DCA Fee Education Surcharge Permit Fee-Additions/Alterations $ Scanning Fee Technology Fee Total: $15 In consideration of the issuance to me of this permit, I agree to perform a work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans,drawings,statemen or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all rk done by er m If, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL,PLUMBING,MECHANICA INDOWS, O O IFING and SWIMMING POOL work. OWNERS AFFIDAVIT: I certify that all the foregoing i fo ation is d that all work will be done in compliance with all applicable laws regulating construction and zoning. Futhermore,I authorize the abc e- med co ra o the work stated. September 30,2016 Authorized Signature:Owner / Applicant / ntra gent Date Building Department Co September 30,2016 1 Miami Shores Village = - Building Department EP 26 2016 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 BY. - Tel:(305)795-2204 Fax:(305)756-8972 T INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 20 N BUILDING Master Permit No. FC- _ 6 ' 130 PERMIT APPLICATION Sub Permit ❑BUILDING K ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL [:]PUBLICWORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP n CONTRACTOR DRAWINGS JOB ADDRESS: -3 C Z JL,,E � d J 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: OWNER:Name(Fee Simple Titleholder):_ GAS L►7 S `✓L0 P1�{1/ Phone#: 'Vy q37 LEY Address: -560 2 N G 92 s f � 2 City: ern i sH dS / State: •kL Zip: 3 3 13 an Tenant/Lessee Name: ® W&')0%7 Phorie#: 01-5,y q 3 7/ 091,/ Email: CONTRACTOR:Company Name: U &c i Ccs./ -r)IdI&tC' rz) �j� (Phone#: �1"� G�®C�- Address: 6'?` F 9m .S' P� 0 City &-a'z/a 4 n State: '' L Zip: -?'?0/0 Qualifier Name: 12dtJQ-V 0(4b C1-7 Q 7:, r Phone#: °-l89 6,,63 cl(32g State Certification or Registration#: rcle 1.3014 7q9 Certificate of Competency#: );E 0®03.3 '6 DESIGNER:Architect/Engineer: 6 Phone#: Address: City: State Zip: Value of Work for this Permit:$ Square/Linear Footage of Work: S2�F Type of Work: ❑ Addition ® Alteration ❑ New ' ❑ Repair/Replace ❑ Demolition e�ription.of lf�tork� � '� tile: Submittal Fee$ Permit Fee$ CCF$ �_ CO/CC$ Scanning Fee$ 3 ' Radon Fee$ 2• DBPR$ ✓ _Notary$, Technology Fee$ dJ '�� Training/Education Fee Double Fee$ m Structural Reviews$ Bond$ ® nn TOTAL FEE NOW DUE$ (ReAsed02/24/2014) 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$2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also,a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature Signature R210L e6 OWNER or AGENT C �T CTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of ham✓ 4 1f1 �y 2-1 day of �e �� 20 ,by , Lr�l, who1s ••••••' ♦ �� Fiel&s ,who is personally known to me or who has produced '��s me or who has producedfl Dl, C13S6 2m,7,0- 330 0 as identification and who did take an oo a h. 20'Zot6 : identification and who did take an oath. + ND.FF 170166 � � ., NOTARY PUBLIC: `,.� p &��G,:'��� NOTARY PUBLIC: OF ••U Sign: _Sign: Print s�� Print e;�, GUSTAVO FOTI t Flor(6a Seal: Seal: Conwssion N GG 010805 a My Com.Expires Jul 12,2x10 APPROVED BY ,�1'���i� Plans Examiner Zoning a i Structural Review Clerk (RevisedO2/24/2014) ,RICK SCOTT,GOVERNOR KEN LAWSON,SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD , IOER�13014798 The ELECTRICAL CONTRACTOR Named below HAS REGISTERED '•N ' Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2018 (INDIVIDUAL MUST MEETALL LOCAL LICENSING REQUIREMENTS-PRIOR TO GO iV 1tACTING INANYAREA) Ow COUTO,EDUARDO f u ELECTRICAL SOLUTION$� R-ALL LLC Y 62.4 E9TH ST - -- --- ,� - - HIAL€AH s ISSUED: 06/29/2016 DISPLAYAS REQUIRED BY L AW SEQ# L1606290001042 CTQB Consiru.''BUSINESS CERTIFICATE TO CF QMFE7 ENCY c O M� rte-- �'m w co mmam = �_ m 0 0 12E000338 0> o rnCr—M M .ter rte- r r TRICAL SOLUTIO FOR ALL LLC g o S o p w p n 3 f/ ammm rlC O r - 'XD.BA.: m ami �-I o _0 ,,_ww m o am Ye �, o OZ z n tnQ �■ m� LA w <nCD 2 C--1 '1'I -n �{ Z GOUT© UARDO ' mt.o °� c o �p Is certified under the provisions of Chapter 10 of Miami-Dade County 3' m m, rDr z W CO) s _ CA E � c m_o F_ r) I m m�� - qeo oO cn ------ '--; z—_ .e m a v m m rF N STATE OF FLORIDA m mCD M' DEPARTMENT OF FINANCIAL SERVICES s. w M 0 DIVISION OF WORKERS'COMPENSATION ; £ 00 O V m TCD " o sc3 W m CONSTRUCTION INDUSTRY EXEMPTION n Z m O B m W �, 9 m m CR 111 cemFlCAreoF a�noN m ee o®oar FR�t Fr aRmA B,u n C pCL ws caaFE�lsAnaa ww ' i mma1*4 DATE: &12/2018 EMPAMON DATE: &11!2018 C !§_ z Z Q a Z • K m o W =0 Mf- resew+: cwm EDUARDo n m o=. D N P �I• FEN: 455623705 ° w N N Q BUSINESS NAME AND ADDRESS: ' cxi o c m ELECTRICAL SOLUTIONS FOR ALL LLC m' 3 Big. g M JRio v i o m a s m6 821 E 9TH STREET m s o t7 S a m HIALEAH FL 33010i m m F» QUA <D m v m SCOPES OF BUSINESS OR TRA f w• m { oo m W o v o D o m» kgm =4 o D o a m ga g_ 2 � V Qi D °cv �rwi o� oom �� mn m wm mP C O< goa � � � wo � � NN O o w rn V I A CERTIFICATE OF LIABILITY INSURANCE DATD/ 088/12//12/201166 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 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: AMELIA REINOSO Estrella Insurance#115 PHONE (305)887-8696 AI No): (305)887-7869 MN 1041 East 8th Avenue • Managerl15@estrellainsurance.com Hialeah,FL 33010 INSURER(S) AFFORDING COVERAGE NAIC# Phone (3_0.5)887-8696 Fax (305)887-7869 INSURERA: ASCENDANT COMMERCIAL INSURANCE INSURED INSURER B: Electrical Solutions For All INSURER C: 2070 Bright Dr Apt 7 INSURER 0: INSURER E: Hialeah FL 33010- 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. IL_T_R TYPE OF INSURANCE ADD SUER POLICY NUMBER MM/UDCY EFF MM/uDCD EXP LIMITS 0 COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000.00 F-1 CLAIMS-MADE 0 OCCUR DAMAGE TO RENTED PREMISES Ea occurrence) $ A - -- GL-47001-1 02/04/2016 02/04/2017 MED EXP(Any one person) $ 5,000.00 PERSONAL&ADV INJURY $ 1,000,000.00 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000.00 ❑ POLICY ❑ PRO-JECT ElLOC PRODUCTS-COMP/OP AGG $ 1,000,000.00 ❑ OTHER FIRE DAMAGE LIABILITY $ 100,000.00 AUTOMOBILE LIABILITY Ea.=,ntSINGLE LIMIT $ ❑ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ ❑ AUTOS ❑ AUTOS NON-OWNED PROPER DAMAGE $ ❑ HIRED AUTOS ❑ AUTOS Per acct 1 ❑ ❑ $ ❑ UMBRELLA LIAR ❑OCCUR EACH OCCURRENCE $ ❑ EXCESS LIAB ❑CLAIMS-MADE AGGREGATE $ ❑ DED _El RETENTION$ _ $ WORKERS COMPENSATION ❑ PER ❑OTH- AND EMPLOYERS'LIABILITY Y/N ER ANY PROPRIETOR/PARTNER/EXECUTIVEN/A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? �f (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space is required) ELECTRICAL SERVICE(COMMERCIAL AND RESIDENTIAL) I CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE D OLICIES BE CANCELLED BEFORE MIAMI SHORES VILLAGE BLDG DEPT THE EXPIRATION DATE TH OF OTI E WILL BE DELIVERED IN ACCORDANCE WITH OLI PROVISIONS. 10050 NE 2ND AVE MIAMI SHORES,FL 33138 AUTHORIZED REPRESENT T AMELIA REINOSO A21 50 ©1988- 0 4 ACODIOPRPORATION. All rights reserved. ACORD 25(2014101)OF The ACO Dname d to o are registered marks of ACORD L, 3bI-1-KI WA 1 t:k CHWEF FINANCIAL OFFICER NATE OF rLOFWA r? QqT"'V=MT OF Film, AW!IA1.'REAVES v'4'v4"!A;C_A MO's'l7"'�:"tds'i�5? 'y f=-�-'-�z.a:?s'�t i'041 *CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS'COMPENSATION LAW CONSTRUCTION INIDUST€3Y EXEMPTION This rerr aas that tiw-ira i—viduai Usted below has e6dad to be a-Aa ipt/rortt lrloi�Wd kars'Ccxnpertsation lazy. EFFECTIVE DATE: 8/92/2096 EXPIRATION DATE: 8/12/2098 P €'- COW O ED?.iARDO FEIN: 455623705 BUSWESS NAME AND ADDRESSe ELECTRICAL SOLUTIONS FOR ALL LLC 621 F_9TH STET Q iVv' ux" I-L 3:w i0 SCOPES OF BUSINESS OR TRADE: LICENSED ELECTRICAL ELECTRICl1L WRING CONTRACTOR MTHIN BUIL Pursuant to Cher 440.05(94),F.S.,an off er of a corporation who elects exemption from Oft chapter by rang a cadmcate of ear under WS sect ietr±Bret?pL-.+ttt!I+wt-fe's[xL*•r.wSxY�ver!;,•:w.Yte••;•r.•Att. :irrgA�r4vv.[r-qrjj,t-.5., :.•.sr:��r•rC••C•••.• n„eIt, "k=e-rrry (-ey, viii In the szopa Gf tha bush-ass or bade Wed or,tie riotza e.elactior.to be axer. t.t'umia'h t to Chapter"o.{igi 3),f.S.,uiorc"of.dor 3n to be exempt and certificates of election to be exempt shall be subject to revocation if,at any ultra after the MV of the notice or Etre Issuance of the c of icate, the parson named on the notice or certficate no longer meets the requirements of this section for issaarrce of a cetictreate.The depaftent shat/revoke a DFS-F2-DWC-252 CERT EFiCATE OF ELECTION TO BE EXEMPT REVISED W13 QUESTIONS?(8W)413-16W , ELECTRICAL SOLUTIONS FOR ALL LLC Date: L,7cj- State of County of LC'M Before me this day personally appearedB ,Z;MVQ 00IV3 k*12,being duly sworn,deposes and says: That he or she will be the only person working on the project located at: aS2— N �(�4t SAvxs Sworn to(or affirmed)andsubscribedbefore me this 11-day of 20 16 by Personally know OR Produced Identification Type of Identification ProducedE_-DP—tA--CEN CR �ar Fie^ Notary Pui);ic State of Florida s `ir dil Aluar�ez Commission FF 15675 YT i+ -ve FxpireS 09!03:201If 8 Print,Type or Stamp Name of Notary alai" Miami Shores Village Building Department s ��pRYgA 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305)795.2204 Fax: (305)756.8972 Notice to Owner — Workers' Compensation Insurance Exemption xF ,_, f 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. Signatur . Owner State of Florida County of Miami-Dade The foregoing was acknowledge before me this Z L day of_;5i4 201. By (r,10:5 F ACO&—L,' who is personally known to me or has produced �L �J i VQ� i C2Yr` as identification. NOtuy R Ric State of Florida SEAL: MY WMINIM Eow 8/11/19 COMMINIon No.FF 9=7