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EL-16-2547Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 c I6 -2s44 Inspection Number: INSP-267366 Permit Number: EL -9-16-2547 Scheduled Inspection Date: December 13, 2016 Inspector: Devaney, Michael Owner: Job Address: 525 NW 111 Street Miami Shores, FL 33138-0000 Project: <NONE> Contractor: APR ELECTRIC CORP Permit Type: Electrical - Residential Inspection Type: Final Work Classification: Addition/Alteration Phone Number , (786)580-8923 Parcel Number 3021360210720 Phone: (305)318-3692 Building Department Comments RELOCATE OUTLETS IN KITCHEN AND PROVIDE ELECTRICAL FOR TITAN WATER HEATER. Infractio Passed Comments INSPECTOR COMMENTS False Passed Failed Correction Needed Re -Inspection Fee No Additional Inspections can be scheduled until re -inspection fee is paid. Inspector Comments December 12, 2016 For Inspections please call: (305)762-4949 Page 8 of 33 Project Address Miami Shores Village 10050 N.E. 2nd Avenue NW Miami Shores, FL 33138-0000 Phone: (305)795-2204 Permit Parcel Number Permit NO. EL -9-16-2547 Permit Type: Electrical - Residential Work Classification: Addition/Alteration Permit Status: APPROVED Issue Date: 9/26/2016 Expiration: 03/25/2017 Applicant 525 NW 111 Street Miami Shores, FL 33138-0000 3021360210720 Block: Lot: DAVID WILLIAM PROPERTIES L Owner Information DAVID WILLIAM PROPERTIES LLC Address 1680 MICHIGAN Avenue MIAMI BEACH FL 33139- 1680 MICHIGAN Avenue MIAMI BEACH FL 33139- Contractor(s) APR ELECTRIC CORP Phone (305)318-3692 Cell Phone Phone (786)580-8923 Cell Valuation: Total Sq Feet: $ 800.00 0 Type of Work: RELOCATE OUTLETS IN KITCHEN AND PRO Additional Info: Classification: Residential Scanning: 1 Fees Due CCF DBPR Fee DCA Fee Education Surcharge Permit Fee - Additions/Alterations Scanning Fee Technology Fee Total: Amount $0.60 $3.38 $3.38 $0.20 $225.00 $3.00 $0.80 $236.36 Pay Date Pay Type Amt Paid Amt Due Invoice # EL -9-16-61348 09/15/2016 Credit Card $ 50.00 $ 186.36 09/26/2016 Credit Card $ 186.36 $ 0.00 Available Inspections: Inspection Type: Final Meter Box Alteration Relocation Fire Alarm Service Change Review Electrical Underground W. W. In 'consideration of the issuance to me of this permit, I agree to perform pertaining thereto and in strict conformity with the plans, drawings, stateme accepting this permit I assume responsibility for all work done by either required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOO work covered hereunder in compliance with all ordinances and regulations specifications submitted to the proper authorities of Miami Shores Village. In elf, my agent, servants, or employes. I understand that separate permits are ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: I certify that all the foregoing information is acand that all work will be done in compliance with all applicable laws regulating construction and zoning. Futhermore, I authorize the above-named c : 'tor to do the work stated. September 26, 2016 Authorized Signature: Owner / Applicant / Building Department Copy Contractor / Agent Date September 26, 2016 1 BUILDING , PERMIT APPLICATION IVIIdI I11 JI IUI CJ village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 RECEIVED SEP 1 5 sots F BBC//201 Master Permit No. O_-�l� ` 7�S 1 Sub Permit No. F(_( c.)^ 2-043- 1 ❑BUILDING 121ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION El RENEWAL El PLUMBING ❑ MECHANICAL El PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS 1 JOB ADDRESS: I City: cZS it/L, /// Miami Shores County: Miami Dade Zip: Folio/Parcel#: // 2 / 34 CaZ / 072 U Is the Building Historically Designated: Yes 1` Occupancy Type: Load: Construction Type: Flood Zone: OWNER: Name (Fee Simple Titleholder): 'Oa el ice.//l eM J'i' y vf�ei Address: %G . Ir e/ fGfn Q,�- - 7 /: 7" 4e., h State: City: 6/Irer.•w BFE: Phone#: 7,4 NO 1.7 FFE: fF22 Tenant/Lessee Name: Phone#: Zip: 3 3 1.37 ' Email: { CONTRACTOR: Company Name: / i/ f/c X; Address: r/ Sr 10-1 City: ///ami Qualifier Name: /Vee, 4 <c �c Phone#: 3( 3/7 3V?2 State Certification or Registration #: t /SO IY0/3 Certificate of Competency #: Phone#: 3of 3/72 State: Zip: 33 ) 2 l DESIGNER: Architect/Engineer: Address: Value of Work for this Permit: $ Type of Work: I:=1. Addition Description of Work: hest. {/,4skjl 4e,'1 City: Phone#: State: Zip: /00. oU Square/Linear Footage of Work: Alteration ov //e4 /P1 /❑ New o ElRepair/Repllacce ❑ Demolition /&'k' unr.� , i'av 44 face/ iC 7;41 Specify color of color thru tile: Submittal Fee $ E5i1' Scanning Fee $ ' W Technology Fee $ Permit Fee $ 7S-1 and CCF $ 6 • Gp Radon Fee $ 3. 3E DBPR $ ' 38 Training/Education Fee $ CJ ' 20 Double Fee $ CO/CC $ Notary $ Structural Reviews $ 0 Bond $ TOTAL FEE NOW DUES 196 . 3 , ' I 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 rei ion fee will be charged. Signature 0 NER or AGENT The foregoing instrument was acknowledged before me this / day of Sy , 20 1I , by 4,Kc! /SO/hc/w , who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: Seal: oxa, ORLANDO SANCHEZ Notary PUDIIc - State of Florida t My Comm. Expires Apr 28, 2018 Commission # FF 117115 on ed Through National Notary Assn. ************* * ************************************************************** Signature CONTRACTOR The foregoing instrument was acknowledged before me this /% day of , 20 /` , by ,`yeyG A 42 , who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: Seal: Bonded Through National Notary Assn. • AN ' SANCHEZ N State of Florida • ':� My Comm. Expires Apr 28, 2018 Commisslon # FF 117115 4 APPROVED BY Plans Examiner Zoning Structural Review Clerk IVI iami Shores Viitage Building Department CONTRACTORS' REGISTRATION IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: 10050 N.E.2nd Avenue Miami Shores, Florida 33138 , Tel: (305) 795.2204 Fax: (305) 756.8972 A. COPY OF QUALIFIER'S STATE LICENCES B. COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF LIABILITY INSURANCE* D. COPY OF WORKERS COMPENSATION INSURANCE* (Workers Compensation EXEMPTION must have NOTICE TO OWNER form and Contractor Affidavit) IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY: A. COPY OF CERTIFICATE OF COMPETENCY OF QUALIFIER B. . COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF STATE REGISTERED CONTRACTOR LICENSE OR MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT. , D. COPY OF LIABILITY INSURACE* E. COPY OF WORKERS COMPENSATION INSURANCE* (Workers Compensation EXEMPTION must have NOTICE TO OWNER form and Contractor Affidavit) *YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE AS FOLLOW: Certificate Holder: MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES, FL 33138 Certificate must specify the description of operations or contractor license number. BUSINESS NAME: I/ (/c/ c BUSINESS ADDRESS: g/ �3 /Or ? 5� CITY /arm BUSINESS PHONE: ( ) CELL PHONE ( 3 o5) 3 / r 365 L FAX NUMBER ( ) QUALIFIER'S NAME: Re)e A zG QUALIFIER'S LIC NUMBER: k /3 0l -/O 93 STATE P1 ZIP 33)2'` 42 � " ZEBU -1 tjL.AIK J I ON t KU/AU TALLAHASSEE FL 32399-0783 DE LA PAZ, ALEX APR ELECTRIC CORP 8183 NW 8TH ST SUITE C-4 MIAMI FL 33126 Congratulations! With this license you become one of the nearly one million Floridians licensed by the Department of Business and Professional Regulation. Our professionals and businesses range from architects to yacht brokers, from boxers to barbeque restaurants, and they keep Florida's economy strong. Every day we work to improve the way we do business in order to serve you better. For information about our services, please log onto www.myfloridalicense.com. There you can find more information about our divisions and the regulations that impact you, subscribe to department newsletters and leam more about the Department's initiatives. Our mission at the Department is: License Efficiently, Regulate Fairly. We constantly strive to serve you better so that you can serve your customers. Thank you for doing business in Florida, and congratulations on your new license! RICK SCOTT. GOVERNOR CTQB Construction -Trades Qualifying Board BUSINESS CERTIFICATE Or COMPETENCY 08E000914 APR ELECTRIC CORP D.B.A.: is DE LA PAZ LEX 1Is certified under the provisions of Chapter 10 of Miami -Dade County STATE OF FLORIDA DEPARTMENT OF BUSINESS AND =`"''" PROFESSIONAL REGULATION ER13014093 ISSUED: 09/07/2016 REG ELECTRICAL CONTRACTOR DE LA PAZ, ALEX; APR ELECTRIC CORP. (INDIVIDUAL MUST°MEETALL LOCAL LICENSING REQUIREMENTS PRIOR TO CONTRACTING INANY HAS REGISTERED under the provisions of Ch.489 FS. Expiration date , AVG 31, 2018 L1809070001863 DETACH HERE KEN LAWSON, SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD LICENSE NUMBER ER13014093 The ELECTRICAL CONTRACTOR Named below HAS REGISTERED Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2018 (INDIVIDUAL MUST MEET ALL LOCAL LICENSING REQUIREMENTS PRIOR TO CONTRACTING IN ANY AREA) DE LA PAZ, ALEX APR ELECTRIC CORP 8183 NW 8TH ST SUITE C-4 MIAMI FL 33126 ISSUED: 09/07/2016 DISPLAY AS REQUIRED BY LAW SEQ # L1609070001863 AC D• CERTIFICATE OF LIABILITY INSURANCE DATE PRODUCER SAFE INSURANCE 7901 NW 2 ST MIAMI 33126 Phone 305-264-8964 Fax 305-267-1576 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC INSURED APR ELECTRIC CORP 8183 NW 8 ST #64 MIAMI FL 33126 ) CPP 0005531 04 9/09/2016 INSURER AACCIDENT INSURANCE COMPANY EACH OCCURRENCE INSURER B. SISES (Ea occurrence) INSURER C: INSURER Cr INSURER E: 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR IADO'Li LTR INSRDI TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MMIDDIYYYY1 POLICY EXPIRATION DATE IMMIDJ)(YYYYI LIMITS A GENERAL X LIABILITY COMMERCIAL GENERAL UABIUTYPR CPP 0005531 04 9/09/2016 9/09/2017 EACH OCCURRENCE $ LOOO,OOQ_ SISES (Ea occurrence) $ 100,000 —1 CLAIMS MADE OCCUR - MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY S 1,000,000 s 2,000,000 GENERAL AGGREGATE GEN.L AGGREGATE LIMIT APPUES PER: PRODUCTS - COMP/OP AGG S_ 2,000,000 POLICY JF O• LOC AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS I SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS COMBINED SINGLE LiM1T (Ea accident) S BODILY INJURY (Per person) S BODILY INJURY (Per accident) S PROPERTY DAMAGE (Per accident) S GARAGE UABIUTY ANY AUTO AUTO ONLY • EA ACCIDENT S OTHER THAN EA ACC S AUTO ONLY: AGG S EXCESS Li /UMBRELLA UABIUTY EACH OCCURRENCE S OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE 1 RETENTION S S S S WORKERSCOMPENSATION WC 1 STATU- I IOTH- IQRY_UMITS.1_._1_ER.r AND EMPLOYERS'YERS'LL ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER (Mandatory It yea, desaiba SPECIAL PROVISIONS IABILITY Yj� EXCLUDED?I ' E.L. EACH ACCIDENT S E.L. DISEASE - EA EMPLOYEE S in NH) under below EL DISEASE - POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES! EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS SUBJECT TO POLICY FORM, CONDITION, ENDORSEMENT, LIMITATIONS AND EXCLUSIONS ELECTRICAL CONTRACTOR LICENSE ER13014093 08E000914 TION VILLAGE OF MIAMI SHORES 10050 NE 2 AVE MIAMI SHORES FL 33138 SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBUGATION OR UABIUTY OF ANY KIND UPON THE INSURER, ITS AGENTS OR ___....—•.--- REPRESENTATIVES�..� __ AUTHORIZED REP 6lCNTAIME _...................................7 ACORD 25 (2009/01) *3 198;-2 099CCORD CQRPORATION: All lights reserved. The ACORD name and logo are registered marks of ACORD APR Electrical Corp 8183 NW 8 ST #64 Miami, FI 33126 9/13/16 State of c/©ri County of ))J Before me this day personally appeared , /e%- h ,fit who,being duly sworn,deposes and says: That he or she will be the only person working on the project located at: c7.c ///sr Sworn to (or affirmed) and subscribed before me this o day of Ser, ,20 it, by ,/e,,% 24 ,,,ere Personally know i/ Or Produced Identification Type of Identification Produced Ita -1111, ORLANDO SANCHEZ 3,'• s Notary PbbIic • e of Ftmida I �,•° Mm. EK a Apr 28, 2018 ml FF 117115 Print,Type or Stamp Name of Notary Miami Shores Viiiage Building Department 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 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 ACKNO DGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. Signature: ner State of Florida County of Miami -Dade The foregoing was acknowledge before me this 13 day of SC ,20/( . By Avrl 0740/10 who is personally known to me or has produced as identification. Notary: SEAL: CHEZ My Comm. Expires Apr 28, 2018 Commission N FF 117115 Bonded Through National Notary Assn. F