ELC-16-1 Inspection Worksheet
Miami Shores Village
10080 N.E.2nd Avenue Miami Shores,FL
Phone:(308)798-2204 Fax:(308)786.8872
Inspection Number. INSP-250272 Permit Number: EI-C-1-16-1
Scheduled Inspection Date: March 14,2016 Permit Type: Electrical-Commercial
Inspector Devaney,Michael inspection Type: Final
Owner: ,SHORES SQUARE INVESTMENTS Work Classification: Addition/Aiteration
Job Address:9017 Biscayne Boulevard
Miami Shores,FL 33138-0000 Phone Number
Parcel Number 113206011007047
Project <NONE>
Contractor. APC ENGINEERING ENTERPRISES INC Phone.(308)2194267
Building Department Comm
ALL ELECTRICAL WORK AS PER PIANS h*uctlo Passed rnents
INSPECTOR COMMENTS Faire
Inspector Comments
Passed �
Failed
Correction
Needed
Re-inspection
Fee
No AddMonai inspecUons can be scheduled until
re4nspecdon The Is paid
Manch 14,2016 For inspections please calk(30762-4949
Page 17 of 40
Muni Shores VNO
10050 N.E.2nd Avenue
Miami Shores,FL 33138.0000
Phone: (305)795-2204
Expiration:07/09f2016
ProjectAWress Parcel umber Applicant
8017 Biscayne Boulevard 113206011007047 SNORES SQUARE INVESTMENT
Miami Shores, FL 33138-0000 Block: Lot:
Owner information Address P110110 Cell
SNORES SQUARE INVESTMENTS 3880 BIRD Road
MIAMI FL 33146-
i
Contrac�r(s) Phone Cell Phare :To:ftWeI87qF8M9t
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j
APC ENGINEERING ENTERPRISES IN (305)218-8287
ype of Work:ALL ELECTRICAL WORK AS PER PLANS Available tpectlons:
Additional Into: Inspection Type
Classilication:Commercial Final
Scanning:3 Motor Box
Alteration
Relocation
Fire Alarm
Service Change
Review Ere i"n i",
Underground
W.W.
Fees Due Amount Pay Date Pay Type Amt Pald Amt Due
CCF $3.80 Invoice# ELC-146.58206
DSPR Fee $3.80 01/11/2018 Check#:1581 $449.80 $80.00
DCA Fee $3.80
Education Surctarpe $1.20 01/048016 Credo Card $50.00 $0.00
Penh fee $240.00
Scanning Fee $3.00
Teduhdogy Fee $4.80
Work wbout Permit Fee $240.00
Totak $488.80
i
In consideration of the Issuance to me of this permit, I agree to perform the work covered hereunder In compliance with all ordinances and ;;ulwoffi
pertaining thereto and in staid conformity with the plans,drawings,statements or spedtic adons submitted to the proper authorities of Miami Shores Village. In j
accepting this permit I assume resp lily for all work done by either myself, my agent, servants, or employee. 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 accurate and that all work will be done in compliance with at applicable laws regulating
construction and zoning. Futhermore,I authorize the above-named contactor to do the work stated.
January 11,2016
prized 81griftwellOwner c-'/ Applicant / Contractor / Agent Date
Building Department Copy
January 11,2016 1
I
Miami Shores Village
g JAN 0 4 2015
Building Department BY:
10050 N.E.2nd Avenue,Miami shores,Florida 33138
Tel:(305)795.2204 Fax:(305)756-8972
INSPECTION UNE PHONE NUMBER:(305)7624949
FBC 20/�
BUILDING Master Permit No/w,/L�2�6/?_,_/�
PERMIT APPLICATION Sub Permit No.a ZA--I
❑BUILDING �CTRIC ❑ ROOFING E] REVISION EXTENSION [RENEWAL
❑PLUMBING [-]MECHANICAL (PUBLIC WORKS [-] CHANGE OF [CANCELLATION [ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: �D!7 - / B/SGS y/!P.. B�a®•
City: Miami Shores County: Miami Dade Zia:
FoUo/Paraai#: is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder): g2 o+ !90vqg-g- j r+jjc Ld.4Phone#:As)ns ffgff
Address: 164!e !f f &' ST
city: K. m(afill State: F_� Zip:.�.��f'e�
Tenant/Lessee Name: Phone#:_
Email:
CONTRACTOR:Company Name: j%ft � ,G� + Phone#:L&,r941-hod-6 7
Address:Z t SD 0° 10+* Gl ve°
City: 8i a/zA h state: FG Zip: 334Of10
Qualifier Name:�3QMW.C, P. &r.(I&Ac f Phone#•
State Certification or Registration M E C C 3 dD(s7 Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for thb Permit:$ Square/Unear Footage of Work:
Type of Work: ❑ Addition Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work: A4 1g&&ldi cf l lye e k- Q S O&OL Ply h .
Specify color of color thru We:
Submittal Fee$ -46 Permit Fee$ /e� �9• CCF$, 3 ° 60 CO/CC$
Scarming Fee$ Radon Fee$_ 3° 6 v mm$ R -2 ) Notary!' 09
Tedmology Fee$ �LC0 Trahring/Edumdon Fee$ ,• Double Fee$ a 40.Q
Structural Reviews$ Bond$_
TOTAL FEE NOW DUE$ %4 0
(RevbeMn4/2014)
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 AFFIDAW: 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$250, 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 in on fee will be charged.
Signature Signature
Ow R GENT CONTRACTOR
The foregoing instrume knowiedged before me this The foregoin instrument was acknowledged before me this
0. _day of 20 f� ,by day of a'� 20 by
in I� .who Is personal known to MLS S ?j&&94 C ,who i ersonall know
me or who has produced as me or who has produced as
Identification and who did take an oath. Identification and who did take an oath.
NOTARY PUBLIC: . NOTARY PUBLIC:
Sign: Sign:
Print: Print:
1%V ��!►�
Seal: eo«aean�arsoya�2017 Seal:
APPROVED BY �40!-' Plans Examiner i „ Zoning
Structural Review Clerk
(ReWseMZ/24/2014) .''•••'n�
C Engluarift Eaterprhms, .
2150 West 100 Ave
Wakak FL 33010
Pb: 71
Fnxz 305405-M3
January 4,2016
St�o of
County of Wam
Before me dfls day pmonally, appewed. whoi Being duly
su►orn, and says:
That he or At"1 pmon wow on the projea loc. . : at: 104liar -id �.
Sworn to(or aftned)and su mai .,t1a1s *tda
y of 420JV by
PersoaWly Know .
OR Produced Idenfification
Type of Identification Pa duced.
a No i A!n�w
�. r.
HMOSMi FL 3=00 1a )M073 a fa011i
Pte 1 of 1
Miami Shores Village
-- Building Department
tOR1p�► 10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tei: (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,parttime employees or subcontractors.
BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS
CONTENTS.
Signature. , wt!=�
Owner
State of Florida
County of Miami-Dade
The foregoing was acknowledge before me this� day of ,20 It.
c
Bylnim 4e1Pc1&y4ez who is personally known to me or has produced
as idea ification.
Notary:
SEAL: m ,y ggRos8R0
Rotary per..
God 1' s
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