EL-11-491Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP - 159911
Scheduled Inspection Date: May 18, 2011
Inspector: Devaney, Michael
Owner: KOKIEL, JOEL
Job Address: 1431 NE 101 Street
Miami Shores, FL
Project: <NONE>
Contractor: GUILLEN ELECTRIC INC
Permit Number: EL- 3- 11-491
Permit Type: Electrical - Residential
Inspection Type: Final
Work Classification: Alteration
Phone Number
Parcel Number 1132050240280
Phone: (305)888 -8866
Building Department Comments
SERIVCE UPGRADE BURIED SERIVCE
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
/z-
/(-0K2a/
May 17, 2011
For Inspections please call: (305)762 -4949
Page 21 of 27
312�j1 1■ I,o(A,
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949
BUILDING
PERMIT APPLICATION
FBC 20
Permit Type: Electrical
OWNER: Name (Fee Simple Titleholder): U0 el * k/ L Phone #:
Address:.. L/2 o 4,16 /, / S 71—
City: /04741° Shy
Permit No.
Master Permit No. � I Li9
Tenant/Lessee Name:
Email:
,Q/6
State: 6 L •
zip: 32/3
Phone #:
JOB ADDRESS: /L/3/ 106 /0/ S
City: Miami Shores County:
Folio/Parcel #:
Miami Dade
/I- 30)-0 s -off - 0 ;4-6
Is the Building Historically Designated: Yes
Zip: 33/38
Flood Zone:
,,;li -le; ;� 3() gg- 8C 6
CONTRACTOR: Company Name: �,/� .�� Phone #:
Address: IA 2S t') 1 H "' l �'�
City: GI 1 G State: 1 f 49--,71. C Zip: 35 ) ‘ (o
Qualifier Name: P \ r'—‘•/•,..1. -C (0,-:%\\--1—v--1 Phone #:
State Certification or Registration #: EC, 4 300 2 ( 2.-- Certificate of Co etency #: `
Contact Phone #: O li p g V C G Email Address: ,;1\\1,-;-‘ e e. S6,2,11 +kvie 4
DESIGNER: Architect/Engineer: Phone #:
Value of Work for this Permit:_$ 47- o Square/Linear Foo age of Work:
Type of Work: ❑Addre - ° Alteration New •VRepai r/R vC C€ ❑Demolition
Description of Work: ll CL Ope_ ee vied ed.')
* ** ** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Fees************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
Submittal Fee $ m ermit Fee $ AC-0/ -' v CCF $ CO /CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $ Technology Fee $
Double Fee $ Structural Review $
TOTAL FEE NOW DUE $ 11
IV
ill
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 ELECTRICAL WORK, PLUMBING, SIGNS,
WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and 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 s a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs even () days after the building permit is issued. In the absence of such posted notice, the
inspection will nit be approved and a einspe tion fee will be charged.
Signature
Signature
Owner or Agent Contracfior
The foregoing instrument was acknowledged before me this I� The foregoing instrument was acknowledged before a this
day of , 20 It, by 506 d M°1.. , day of i 7 - i° i(I ` 20 if, , by J 't_ Y f C 4i(7.
who is personally known to me or who has produced i D who is personally known to me or who has produced
As identification and who did take an oath. jr. L I , ,v. as i
NOTARY PUBLIC•
Sign:
Print:
!PFL.L11/ ° ° \\\\t� `11I I
My Commission Expires:
APPROVED BY
NOTARY PUB
Sign:
- a� .o°�
iu, . y c : ° - Print:
S��
2 i 1 f Plans Examiner
kitt
a>�1
OLGA PHE3AN
' MY COMMISSION # DD 809741
EXP RES: October 30, 2012
rlilili Pablo Undervrtfters
My Commission Expires: (±< - C -) 1
Zoning
Structural Review Clerk
(Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09)
DRAWP BY: N.G
LAN1J JUHVCY Uttb
SHEET No. 2 OF • 2
L-Toe_L BOUNDARY SURVEY
SCALE = 1" = 20'
(mmou k.te
LOT -5
BLOCK -3
4:g
cT
Fia.,,t PO
N82015'13•E 96.10'
LOT
BLOCK - 3
r
EL-.3
•
C ar.
&or CI..
UPI 59 C
tor4'
n1 .i2
tt , 3
at
14s
I •
CT
• 0
1
4t4z
q
N• 0
k* 0 f I
dMfltAJ
- T
),
-11 I1 ,,---r-
. MAR. 2 1 2011
BY:
NS/
/14CV itt ez,3_17
4.,0 oco se
36'1 1 ( IL
pi ao
scmc
3
ate: 3/17/2011 Time: 1:24 PM To: BUILDING DEPT @ 93057568972 HB
Page: %U
coRti CERTIFICATE OF LIABILITY
INSURANCE OP ID D5 1 DATE 17/11
03/17/11
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 POUCIES
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 ADDIT`J NAL INSURED, the policy(iies) mustbe endorsed. if SUBROGATION IS WAIVED, 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
BROWN & BROWN OF FLORIDA INC
14900 NW 79th Court Suite #200
Miami Lakes FL 33016 -5869
Phone:305- 364 -7800 Fax:305 -822 -5687
- I.IIVTAC.r
NAME:
P 0, No, Ext): I la No):
AD RDREESS:
CCUUSSTOM`ERID#: GUILL -3
INSURER(S) AFFORDING COVERAGE
NAIC#
INSURED
Guillen Electric, Inc.
8125 NW 74 Avenue, Bay 7
Miami FL 33166
INSURERA: *FCC/ Insurance Company*
10178
msuRERB: *6Ces r,aurance Co
Advantage i
12842
INSURERC: *6CCI Comooroial Insurance Co
33472
INSURER D :
MED ESP (My one person)
INSURER E :
GENL
R
INSURER F :
PERSONAL & ADV INJURY
COVERAGES
R:
THIS
INDICATED.
CERTIFICATE
EXCLUSIONS
iiii
IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDMON OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLANS.
TYPE OF INSURANCE
POLICY NUMBER
GL0011102
(MMIDD/YYYY)
02/11/11
(IUIM/DD/YYY•)
02/11/12
LIMITS
EACH OCCURRENCE
$ 1,000,000
A
GENERAL
X
LIABILITY
COMMERCIAL GENERAL
I X
LIABILITY
OCCUR
PREMISES (Ea occurrence)
$ 100,000
CLAIMS-MADE
MED ESP (My one person)
$ 5, 000
GENL
R
PERSONAL & ADV INJURY
$ 1,000,000
GENERAL AGGREGATE
$ 2,000,000
AGGREGATE LIMIT APPLIES PER:
POLICY ■ i ■ LOC
PRODUCTS - COMP/OP AGG
$ 2 , 0 00 , 0 00
$
AUTOMOBILE
LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON -OWNED AUTOS
COMBINED SINGLE LIMIT
(Ea accident)
$
BODILY INJURY (Per person)
$
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
(Per accident)
$
$
$
C
R
UMBRELLALIAB
EXCESS LIAB
g
OCCUR
CLAIMS-MADE
UMI30011610
02/11/11
02/11/12
EACHOCCURRENCE
$ 1000000
AGGREGATE
$ 1000000
X
DEDUCTIBLE
RETENTION $ 10000
$
$
A
•
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y / N
ANY PROP IETOR/PARTNFRIEXECUTIVED
OFFICER/MEMBER EXCLUDED?
(Mandatory In NH)
ITyw d�cnbe under
DES12IPTIONOFOPERATIONS below
•
02/11/11
02/11/12
W LIMITS ER
TORY LIMrS ER
EL EACH ACCIDENT
$ 1000000
El. DISEASE - EA EMPLOYE
$ 1000000
EL DISEASE - POLICY LIMIT
$ 1000000
••
__
H more space Is required)
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101. Additional Remarks Schedule,
'carom rc u.., ..e..
CANCELLATION
MIA -138
MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
10050 NE 2ND AVENUE
MIAMI SHORES FL 33138
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
ACORD 25 (2009 /09) The ACORD name and logo are registered marks of ACORD
PORATION. All rights reserved.