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RC-10-2058Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 (jk Inspection Number: INSP- 153505 Permit Number: RC -11 -10 -2058 Scheduled Inspection Date: June 29, 2011 Inspector: Bruhn, Norman Owner: SUAREZ, MARIO & NATALIA Job Address: 69 NE 102 Street Miami Shores, FL 33138- Project: <NONE> Contractor: P DELTA CONSTRUCTION INC Permit Type: Residential Construction Inspection Type: Final Work Classification: Kitchen Cabinets Phone Number Parcel Number 1132060131680 Phone: (786)395 -2534 Building Department Comments KITCHEN REMODEL Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments June 28, 2011 For Inspections please call: (305)762 -4949 Page 8 of 38 12 /bl� 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: k) OWNER: Name (Fee Simple Titleholder): Address: 69 NE 102 STREET City: Miami Shores Tenant/Lessee Name: n/a Mario Suarez wocTRy3D NOV 172010 BY: Permit No. fG102058 Master Permit No. Phone #: 305 - 788 -0946 State: FL Zip: 33138 Email: mariosuarez @aol.com Phone #: JOB ADDRESS: 69 NE 102 STREET City: Folio/Parcel #: Miami Shores 11- 3206 -013 -1680 County: Miami Dade Zip: 33138 Is the Building Historically Designated: Yes NO X Flood Zone: X CONTRACTOR: Company Name: P_ Pa CbpSrtO Tt oi) WC. Address: 913.S. W • $V &is bun, U City: SOM. (5e State: pc Qualifier Name: ° MT Lepert gn aolik State Certification or Registration #: ca4c 151510B Contact Phone#: Email Address: Ol 'ie. Lhf1(3d6aJ C. Gj eii i t . Coi.'f DESIGNER: Architect/Engineer. Phone #: 1 Phone #:786 -Y5T St Phone # ?8b -Si J .Z S@34 Certificate of Competency #: frc51 Value of Work for this Permit: ♦. g®V'o $ Type of Work: ❑Address Alteration Description of Work: 14:11,14.4". !P ZQ(,Q,r. .. Cg4i1 Zsrpo . Square/Linear Footage of Work: ❑New ❑Repair/Replace ❑Demolition ****** * * **** *** *** * * ******** * * ******** Fees * * * * * * * ***** * ***** * * * * * *** ** * * ** * * ** **** * Submittal Fee $ Permit Fee $ b CCF $ CO /CC $ Scanning Fee $ Radon Fee $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ DBPR $ Bond $ Technology Fee $ TOTAL FEE NOW DUE $ 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 FT ,ECTRICAL 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 attac fain Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first i _ „ h' o� ur7) days after the building permit is issued. In the absence of such posted notice, the inspec ':gin will�n /b • apy ove and a r'inspection fee will be charged. Signature (- -- -`vA Signature • caner or Agent Contractor The foregoing instrument was acknowl ged before me this /i The foregoing instrument was acknowledged before me this L day of dd'' X.,f'0 /4', by a// c) t Z , . day of 7%/ , 20/0 , by (21; r who is personally known to me or who has produced As identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC -STATE OF FLORIDA- / """,,'' Lisa M. Montano ,\ = Commission # DD708085 Expires: AUG. 23, 2011 >. C ATLANTIC BONDING CO..INC, My Commission Expires: 2---CA„/ who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: . Sign: �% di , Print: //7/g r RIDA N? ARY PIIBI:If My Commission Expires: " "'•a Maria Teresa Martin - Garcia Commission DD8S938. y 1 Expires: MAR. 31, 2013 naoa•• # 0 BONDED TI RIIATLANTICBONDINGCO.,aTC. **** *************** *** * * *** ** * * * *** gags*************** **** ** ***** * ** *********** * ***** ******has******** * * ******* APPROVED BY Plans Examiner Structural Review (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) Zoning Clerk 11/02/2010 09:06 FAX 3055547090 The First Ins Akc-csora CERTIFICATE OF LIABILITY INSURANCE PRODUCER First Insurance Group 10957SW40St Miami, FL 33165 Phone (305)221.7876 Fax (305)554 -7090 INSURED P -DELTA CONSTRUCTION LLC 5975 W. SUNRISE BLVD #205 SUNRISE, FLORIDA 33313 II001/001 DATE (MNUDDIYY) 11/02/10 THIS CERTIFICATE 13 ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDERR, THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERA E. AFFORDED BY THE POLIC ES BE I QW INSURERS AFFORDING COVERAGE INSURER A. UNITED SPECIALTY INSURANCE CO INSURER B: INSURER C; INSURER D: COVERAGES THE POLICIES OF INSURANCE LISTED HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDTImON 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 15 SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDI IONS OF SUCH POUCIE$. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED SY PAID CLAIMS. INSR iI TR ACM POLICY EFFECTIVE POLICY EXPIRATION INSRD TYPE OF INSURANCE POLICY NUMBER DATE imMIDD IY DATE (NIMIDDI YYY1 LIMITS GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY © ❑ ❑ CAMS MADE © OCCUR GERI AGGREGATE LIMIT APPLIES PER Q POLICY ❑ PROJECT ❑ LOC AUTOMOaILE LIABILITY ❑ ANY AUTO ❑ ALL OWNED AUTOS 0 SCHEDULED AUTOS HIRED AUTOS NON OWNED AUTOS NS1205848 GARAGE LIABILITY ❑ ❑ ANY AUTO EXCESS / UMBRELLA LIABILITY ❑ r: OCCUR ❑ CLAIMS MADE 0 DEDUCTIBLE ❑ RETENTION 5 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR 1 PARTNER 1 EXECUTIVE YIN OFFICER /MFMSER EXCLUDED? (Mandatory in NH) n describe under SPECIAL PROVISIONS beim OTHER 04128/2010 04/2912011 EACH OCCURRENCE 9,000,000 PREMIISESO(ERENTED I 100, MED EXP (Any one Fawn) 50 000 PERSONAL ,& ADV INJURY 1,000,000 GENERAL AGGREGATE 1,000,000 PRODUCTS - COMP/OP AGG 1,000,000 COMBINED SINGLE LIMIT (Ea accident) BODILY INJURY (Per person) BODILY INJURY (Par accident) PROPERTY DAMAGE (Per acsIdent) AUTO ONLY • EA ACCIDENT OTHER THAN AUTO ONLY: EA ACC AGG EACH OCCURRENCE AGGREGATE Om- TO TA ❑ E- E.L. EACH ACCIDENT E.L DISEASE - EA EMPLOYEE EL DISEASE. POLICY LIMIT DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES / EXCLUSIONS/ ADDED BY ENDORSEMENT 1 SPECIAL PROVISIONS GENERAL CONTRACTOR LIABILITY CERTIFICATE HOLDER CANCELLATION CITY OF MIAMI SHORES, FL 10050 NORTHEAST 2ND AVENUE MIAMI SHORES, FL 33138-2304 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE WE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO NAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE 140 - NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPO NO OBU t. TION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS . - - :�` ATIVES. ACORD 25 (2009/01) CIF @ 1988 -2009 ACORD CO - 4 17 ., � , his reserved. The ACORD name and logo - N.,,' ,/ + +. Ate: .s of ACORD AUTHORIZED REPRESENTATIVE ALEX SINK STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION ;r 0.4 CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSAT10N LAW CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law. CHIEF FINANCIAL OFFICER 03 -09 -2009 EFFECTIVE DATE PERSON: FEIN: 03/09/2009 EXPIRATION DATE 03/09/2011 LAMBOGLIA ORESTE 870809791 BUSINESS NAME AND ADDRESS: P DELTA CONSTRUCTION LLC 288 CAMERON DRIVE WEST WF-STON FL 33326 SCOPES OF BUSINESS OR TRADE: 1- CERTIFIED ORAL CONTRACTOR IMPORTANT: Putman to Chapter 440. 08(14), F.S., to officer of a corporation who elects exemption from this chapter by (fling a certificate of election ender this section may not recover benefits or compensation ender this chapter. Pursuant to Chapter 440.05(12), F.S., CartNicatea of election to he oxampt... apply only within the scope of the hastens or trade listed on the antics of election to be exempt. Pursuant to Chapter 440. 05(14 f.3.. Notices of election to be exempt and certlflcetes of election to be exempt Owl be anbjed 10 revoCatioe 0, a1 any time after the filing of the notice er the issuance of the certificate, the person named on the notice er certificate no longer meats the requirements of this section for issuance of • certificate. The department shall revoke a certificate at any time for failure of the person named on the certificate to meet the requirements of this section. QUESTIONS? (8501 413 -1605 NC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 09 -06 PLEASE CUT OUT THE CARD BELOW AND RETAIN FOR FUTURE REFERENCE STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION CONSTRUCTION IIWRISTRY CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW EFFECTIVE 03/09/2009 EXPIRATION DATE: 03/09/2011 PERSON ORESTE LA.IA FEIN 870809781 BUSINESS NAME AND ADDRESS: P DELTA CONSTRUCTION LLC 203 CAMERON DRIVE WEST WESTON, FL 33320 SCOPE OF BUSINESS OR TRADE 1- CERTIFIED GENERAL. CONTRACTOR F IMPORTANT O 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 L under this section may not recover benefits or compensation under this D deter. Pursuant to Chapter 440.05(12), F.S., Certificates of election to be H exempt.. apply only within the scope of the business or trade listed on E the notice of election to be exempt E Pursuant to Chapter 440.05(131, 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 certificate at any time for failure of the person noised on the certificate to meet the requirements of this section. QUESTIONS? (850) 413 -1609 CUT HERE a: Carry bottom portion on the job, keep upper portion for your records. /C -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 09 -06 sL 7aAk. N Q 9/13/2010 f) 9:50:27 PM MARIO ru N 3' -7' [306.07] 2' -117' 1109,22] 5' -4' C89.54] [107.31] [162.56] [143.51] w r L V N 1 iJI N u• O• , N • N 5 0 4enone 4 P45PLAc6 'S//11f . T` Miami Sho es Village APPROVED a 5' —DATE ZONING DEPT _ [157.48] BLDG DEPT 4. � /439776 FEDERAL SUBJECT TO COMPUANCE WITH ALL STATE AND COUNTY RULES AND REGULATIONS 00 00 O w N 44 rut 0' ru N • N •I • in (• •.i+ .40 • •• • • • • • • • • • � • • • .•'•.• ••• • • • •• 5-.•• • 1' -11• [90.17] [58.42] 0 0 proiec, Suarez Residence 69 NE 102 STREET Miami Shores, FL EtLeIml AOditbns 0 0 0 NOTICE OF COMMENCEMENT A RECORDED COPY MUST BE POSTED ON THE JOB SiTE AT TIME OF FIRST INSPECTION PERMIT NOR e-1I-IO- AXFOUONO. 11- 3206 - 013 -1680 STATE OF FLORIDA COUNTY OF MIAMI -DADE: THE UNDERSIGNED hereby gives notice that improvements will be made to certain real property, and In accordance with Chapter 713, Florida Statutes, the folowing information is provided hi this Notice of Commencement. 111111111111111111111111111111111111111111111 CF h1 2011R003074-3 OR Bk 27553 Ps 3539; (ias) RECORDED 01/13/2011 14:04:33 HARVEY RUVIN? CLERK OF COURT MIAMI -DADE COUNTY? FLORIDA LAST PAGE Space above reserved for use of recording office 1. Legal description of property and street/address: &al PC f O12- 51-? VI ({41 ) 2. Description of improvement: 1417c44.450 0ptgA 3. Owner(s) name and address: Mario Suarez Interest in property: Name and address of fee simple titleholder 4. Contractor's name, address and phone number. 69 NE 102 Street, Miami Shores, FL S -rez 6 0 St -- i -m' hor Lk. ELT Co I —r t9 - n DO 5. Surety: (Payment bond required by owner from contractor, If any) Name, address and phone number. Amount of bond $ 6. Lender's name and address: 7. Persons within the State of Florida designated by Owner upon whom notices or other documents may be served as provided by Section 713.13(1)(47., Florida Statutes, Name, address and phone number. 8. In addition to himself, Owners designates the following person(s) to receive a copy of the Uenor's Notice as provided In Section 713.13(1)(b), Florida Statutes. Name, address and phone number. 9. Expiration date of this Notice of Commencement (the expiration date is 1 year from the date of recording rayless a different date Is specified) WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART I, SECTION 713.13. FLORIDA STATUTES, AND CAN RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. NO E. OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND T LING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR RECORDING YOUR N Signature(s) of Own Prepared By Print Name Title/Office STATE OF FLORIDA cer/Director/Partner/Manager Prepared By Print Name Title/Office COUNTY OF MIAMI -DADE The foregoing nstrument was acknowledged before me this /G day of By i, 40 Jr /.�loz ❑ Individually; or ❑ as for likrersonally known, or ❑ produced the following type of Identifh Signature of Notary Public: Print Name: (SEAL) VERIFICATION PURSUANT TO SECTION 92525, FLORIDA STATUTES Under penalties of perjury, I d I have read the foregoing and that the fa y.- ed in A =- e, to ; best of my knowledge and belief. '!N QTFWRIDA " Lisa M, Montano _" `Conulaission #0D7080115 �aoy 11, „.,...1-,Expo: AUG. 23, 2011 ammo Authorized Officer /Director/Partner /Manager who signed above: By STATE OF FLORIDA, COUt(TY OF DADE HEREBY CERTIFY that this is a. true copy of t I i# , A.D. 20 �rjgine WITNESS HARV By I Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 ( 0 -7,9rY Inspection Number: INSP- 153516 Permit Number: PL -11 -10 -2060 Scheduled Inspection Date: June 08, 2011 Inspector: Hernandez, Rafael Owner: SUAREZ, MARIO & NATALIA Job Address: 69 NE 102 Street Miami Shores, FL 33138- Project: <NONE> Contractor: J&J CARDONA CONSTRUCTION INC Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Addition /Alteration Phone Number Parcel Number 1132060131680 Phone: (305)696 -5112 Building Department Comments removal old sink and re installed new sink for kitchen remodel Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments June 07, 2011 For Inspections please call: (305)762 -4949 Page 2 of 24 Miami Shores Village °' g 5 NOV 1 7 2010 Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Y: ...................... Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 • BUILDING PERMIT APPLICATION FBC 20 Permit No. '" Master Permit No. 1 C�J 1 f 2 Ji Permit Type: Plumbing OWNER: Name (Fee Simple Titleholder): Mari o Suarez Phone#: 3 0 5 - 7 8 8 - 0 94 6 Address: 6 9 NE 102 STREET City Miami Shores Tenant/Lessee Name: n/a Email: State: FL zip: 33138 Phone #: mariosuarez@a01.com JOB ADDRESS: 69 NE 102 STREET City Miami Shores County: Miami Dade zip. 3 313 8 Folio/Parcel #: 11- 3206 - 013 -1680 Is the Building Historically Designated: Yes NO X Flood Zone: X CONTRACTOR: Company Name: .J to C4k. 0 � tO K� a •4 51-"Vier Address: y City: Vv', (Yl 1/27`1(1 State: Fla i Qualifier Name: AbSC I nRt0m1 State Certification or Registration #: ar-6 14-2 30-96/ Zip: 331 (a r Phone#: 1!6 '566(0° ,SOY ' Certificate of Competency #: Contact Phone #: 5 r / Email Address: J. Df ma 11 DESIGNER: Architect/Engineer: Phone #: Value of Work for this Permit: $ Square/Linear Footage of Work: Type of Work: Address Description of Work: Alteration UNew ORepair/Replace ❑Demolition 1/ f92 ******** * * * * * * * *** *** ***** * * * * ** *** * * ** Fees************* * ** **** * * ** ** ****** ***** ** * * * ** Submittal Fee $ Permit Fee $ Scanning Fee $ Radon Fee $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ 7.100 CCF $ CO /CC $ DBPR $ Bond $ Technology Fee $ TOTAL FEE NOW DUE $ 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 FT.FCTRICAL WORK, PLUMBING, SIGNS, WFT.T S, 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 attachme . lso, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which ,ccurr. sev'n (7) days after the building permit is issued. In the absence of such posted notice, the inspection wi._ ro , and rei'spection fee will be charged. Signature Owner or Agent Contractor The foreg • g instrument was acknowledged before me this / I' The foregoing instrument was acknowledged before me this �' t day of,✓1&20/V, by ij' 414/ d .-6-;2.4',60 2- day of liGyV t-20/, by 6746hi2 who is personally known to me or who has produced o 1 ersona i .owe•• me or who has produced As identification and who did take an oath. as identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC-STATE OF FLORIDA NOTARY PUBLIC: f" N Lisa M. Montano ,,,,; ECommission #DD708085 !' Sign- ",7 + -4 !� ' '' es: AUG. 23, 2011 Sign::: �d stj ' AILAa uc BUAllHiG CO., INC Print: � - ! /mil eD Print: 4 / fft7 -' e 4-t - My Commission Expires:?�oTAgy PUBY;IC - FLORIDA Maria Teresa STATE Martin - GarcOF ia $ - Commis s ioM #DD8:93a80 ************ xxx* sss******************************** *** **xxs**** * * * * * * * *** * * * ** xx* ....... � a s� 3 My Commission Expires: APPROVED BY i % 4'— �` -ve7 Plans Examiner Zoning (Revised 07 /10 /07XRevised 06 /10/2009)(Revised 3/15/09) Structural Review Clerk CERTIFICATE OF LIABILITY INSURANCE rm Cert3110 PRODUCER Matafaad MEMO 6089Holtyvned Mud lialgwead,F1.32024 . . Fax 054963.0772 Phan N54)164-6444 116SCEMIROMEISMSUMASANATTSBOFINFMNS N SWAMI:MEND MOBSUFOWIMCERRING06 HOLOOL7141SCIIOESNOTANEND.MO9MON ALTECIRECONMENEOROW_Wr YFRPOIXFS00.05% REMMERS AFFORDING cOvillone MAW* • Natatotft ATLANTCASUALTY : =MD J &JCORNrai Csmstmetion Inc C mum BOLOWNE 00 900 NE1400: Skeet vatRam North Mutt R.33101- • • T.MONSIX L • — aellalEta. • COIS9 NatIRSRP: THE PDXES INSURAMMISFEDNAVEEEEN MUM TO 111MINMEINAMEDADOVEIrate POUCYPER100 MOOED. NOWNINDMONG ANY REIMMENT,,IERMORCONOMOU CERNY COMIRACTOROMMOUNNIENT INITH RESPECIFTOVNICITIMIMIDAW BE aliSUND OR MAY PERIM. 11W INSICIEDBVIIREPOLICESTIESCOMED MON ISSMEGTVAIL THETOGRIVENASSAONSANSI WHAJMOISWItell POLICHNE AMPIEGMLIMITSSICIO NAY NAVE BEEMBIKSIP BY PMEMAIMM 6111111=01.. snugly altaistastowicE PCIIKTNLENUN " GENERNLIIMALIN i . I IMICROAIGENEINAL MASK CLANS MOE 53. occure U ••••■•■ . o • 1ELTA MMO Ed parr I "fracusor Et Loc Ainomoraz MUM :0 AMMO :0 Ammo:warm a ri F1 STOMMAXED AVMS Hissamince Nomormauswas 0 . .n GARAGEuseinv o ANTRUM EXCESSUBBREUM UMW =an 0 cuesiotom • i in Diamicraff -- mum= . iwordencompaafmn- AND emonsoruminstr • 0 - ANT PMFMIGIt/PARDIETUBIBNITIVE • OFRCER/1/0AMERIXCLECEOP dessulaR user SITCIAL MUM= Wart Livonia t ODER OA 07/121.10 rancirsonamos owuni LIBIDS EACROCCURFIENCE 1,0110;0D0 IMAGER) RENTED WOO P R BO 945.-LEURkz BM 1.— UrrDEEPWaYalaDasora = 5,000 PERSONAL &AIN UMW MOOG- I WOOL AG6REGUE ; 2.000.000 PaounTs-comnowtera 1.000,00 lur:quasi • CUOMO SOME LEW 1 a teds2801) DOOLYNNURY EMILY KRIM Parauskkati PRIWBUY RAMAGE (fistacklool) AUTO ONLY-EAACCireir ; anerearsi AUTOONLY: AGO i EACH =MOM ACGRECA/E •••■•••-■ S 08/08,10 MUM •■•••■•■•••• -71 roec= ID A4m EACH AIMPIIM: $112"301 EL.01SEASEEMEiRkilial 519CM DEEASE -Mk= UNIT IgnI,9_014 ossompncw4wareiraiintnirriarciertynctsi. temtaminteeorreemoRmithiiswampRavoKno ReedcemALI coradamal nen comaugnom a Rtimod Miami Shores Village Building Department 10050 NE 2" Ave Miami Shores, Florida 33138 Fax 305-756-8972 ACOND 25 (INVID*CF GANCELLA1Ket smouppiwopTHEAsummEsaawszrouciesenemessaiDameaThE gapataMONLYBETIMMOKIHENSIARBItaREERNIU.BUISINUR1P9SAL - - 30 Dms sommToTheastmcwatimaatumffino sialovaur TOINISOSHALLISPOSENDODUORRORORWRIAT 1 OPNWINOMR szsamensonturozsemums. diC0161CORPORRINE41168 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 to- 2o58 Inspection Number: INSP- 153513 Permit Number: EL -11 -10 -2059 Scheduled Inspection Date: June 01, 2011 Inspector: Devaney, Michael Owner: SUAREZ, MARIO & NATALIA Job Address: 69 NE 102 Street Miami Shores, FL 33138- Project: <NONE> Contractor: ELECPLUM ENTERPRISES iNC. Permit Type: Electrical - Residential Inspection Type: Final Work Classification: Addition /Alteration Phone Number Parcel Number 1132060131680 Phone: (786)295 -4004 Building Department Comments INSTALLATION OF NEW GFI TO UPGRADE EL SERVICE FOR KITCHEN REMODEL Passed Failed Inspector Comments Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. May 31, 2011 For Inspections please call: (305)762 -4949 Page 2 of 25 Miami Shores Village �4a t E IE V Building Department NOV 1 7 2010 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 E1: Permit No. C\ 10 aO59 Master Permit No.' V - Zu00 Permit Type: Electrical OWNER: Name (Fee Simple Titleholder): Mario Suarez Phone#: 3 0 5 - 7 8 8 - 0 94 6 Address: 69 NE 102 STREET City: Miami Shores State: FL Zip: 3 313 8 Tenant/Lessee Name: n/a Phone #: mariosuarez@aol.com JOB ADDRESS: 69 NE 102 STREET City: Miami Shores County: Miami Dade zip: 3 313 8 Folio/Parcel #: 11 -3206 -013 -1680 Is the Building Historically Designated: Yes NO X Flood Zone: X CONTRACTOR: Company Name: E1.� - ,,c - , t. C-" Phone #:( // aq v� Address: 4 3 3 / `r /N 1 3 L% ��! / �j City: C G.a State: '' Zip: J 3 /12— Qualifier Name : .$ 1 ,%. v Phone #: State Certification or Registration #: Z—e b lie? 2c2--7 Certificate of Competency #: Contact Phone #: ( 2.431 ea i y Email Address: DESIGNER: Architect/Engineer: 11J Phone #: Value of Work for this Permit: $ ) 2.00 • on - Square/Linear Footage of Work: Type of Work: ❑Address Descriptioii?Work:. ,'��I�1 r � ❑Alteration UNew 2epair/Replace ❑Demolition , AT /RA c' ) 11ti ILL Submittal Fee $ Permit Fee $ " 6"/ ezd CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ 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 Al F1DAVIT: 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 occur:' en (7) days after the building permit is issued. In the absence such posted notice, the inspection will n• . ' app a �' % n fee will be charged. O r or Agent The foregoing i trument/was acknowledged before me this S day of atOCK20 l 0, by RctiAc Sao e 2— , ctor The foregoing ' r� ment was acknowledged before me this g day of Ok�!� , 20 I 0 , by < 1 �►1r�� who is personally known to me or who has produced A) (/ who is personall known to me or who has produced As identification and who did take an oath. as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: QQ IA ,4 YG� tv1 c) �416411� " SANDRA G. FRANCO Sio Rrp" � Nutury Public - State of Florida a,1 n *Compassion Expires Feb 8, 2012 =,p iTfi 723569 • My Commission Expires: OZ forq /Z_ NOTARY ' LIC: Sign: Print: My Co �o�r Commission # DD 2356 ub�m - Statot Bonded ThroughNadonalNotary Assn. i1r %ary F Oct28.2Ol2 t My Comms �nr DO 828208 �` Camm t gyp. Bonded Through t(atlonal �x.: �x��x:: x, ��x: rm�n* ���: xx., x�: xx., x: x�* ���� ,x,x:x:x:xx.,x,x:r��,x��r�._ Plans Examiner • Structural Review (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) * * * * * * * * * * * * * * * * ** Zoning Clerk AWREP PRODUCER SAFE INSURANCE,INC. 7901 NW 2ST MIAMI,FL. CERTIFICATE OF LIAEt1 ITY INSURANCE 33128 -0000 INSURED ELEC PLUMB ENTERPRISES, INC PO BOX 772515 MIAMI,FL 33177 Phone 305- 264 -8964 Fax 305- 267 -1576 DATE (MM/DDIYYYY) 1/03/2011 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 INSURERAASCENDANT UNDERWRITERS,LLC INSURER BNATIONAL GROUP INSURANCE CO INSURER C: INSURER IT INSURER E: NAIC # DVERAGES THE POLICIES OF INSURANCE INSURED NAMED PERIOD INDICATED. ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICHTH S MA E ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDEb 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. POUCY EFFECTIVE IN §RTADD LT — SI • ■ c :. y - POLICY NUMBER M u J! . GENERAL LIABILITY f3M0000003409 11/20/2010 1I COMMERCIAL GENERAL LIABILITY .._4___I CLAIMS MADE ! X j, OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: ?POLICY PRO LOC AUTOMOBILE LIAINUTY ANY AUTO ALL OWNED AUTOS 1 SCHEDULED AUTOS HIRED AUTOS I NON -OWNED AUTOS GARAGE UABIUTY ANY AUTO POUCY EXPIRATION 11/20/2011 MED EXP (Any one person) PERSONAL & ADV INJURY GENERAL AGGREGATE PRODUCTS • COMP/OP AGG S $ 0 $ 100,000 $ 5000 $ 1000,000 S 2,000,000 EXCESS / UMBRELLA LIABILITY OCCUR IL-1 CLAIMS MADE I I DEDUCTIBLE I I RETENTION S I WORKERS COMPENSATION A AND EMPLOYERS' LIABILITY Y I ANY PROPRIETORFPARTNERIEXECUTIVE 603303 ( OFFICER/MEMBER EXCLUDED? I ' (Mandatory in NH) If yes, describe under SPECIAL PROVISIONS below OTHER 11/18/2010 11/18/2011 DESCRIPTION OF OPERATIONS /LOCATIONS 1 VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT 1 SPECIAL PROVISIONS ELECTRICAL SUB CONTRACTOR SUBJECT TO POLICY FORM, CONDITIONS ,ENDORSEMENTS,LIMITATIONS AND EXCLUSIONS PROPERTY DAMAGE (Per accident) S AUTO ONLY - EA ACCIDENT $ OTHER THAN AUTO ONLY EA ACC $ AGG S EACH OCCURRENCE S AGGREGATE $ S $ S X TORY LIM1TTS I IOTH- ER E.L EACH ACCIDENT i $ 100,000 E.L DISEASE • EA EMPLOYEE S 100,000 E.L DISEASE - POUCY LIMIT s 500.000 CERTIFICATE HOLDER CANCELLATION CITY OF MIAMI SHORES 10050 NE 2 AV MIAMI SHORES, FL 33138 ACORD 25 (2009101) SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLEDBEFORETHE 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 OBLIGATION OR UABIUTY 0 Y KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVE AUTHORIZED REP ©1988- 200(ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD A CORN® CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YY) 10/08/10 PRODUCER First Insurance Group 10967 SW 40 St Miami, FL 33165 Phone (305)221 -7878 Fax (305)554-7090 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERT FICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC # INSURED Elecplum Enterprise, Inc. 13370 SW 131st Street #111 Miami, FL 33186- INSURER A: SCOTTSDALE INSURANCE INSURER B: INSURER C: INSURER D: INSURER E: COVERAGES INSURER F: THE POLICIES OF INSURANCE LISTED 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 TR ADD•L IN RD TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE MM/DD POLICY EXPIRATION DATE MM/DD LIMITS A v GENERAL V ❑ ❑ LIABIUTY COMMERCIAL GENERAL LIABILITY ❑ CLAIMS MADE OCCUR CPS1149916 12/16/09 12/16/10 EACH OCCURRENCE 1,000,000 DAMAGE TO RENTED PREMISES (Ea occurence) 100,000 MED EXP (Any one person) 5,000 PERSONAL & ADV INJURY 1,000,000 GENERAL AGGREGATE 1,000,000 ❑ PRODUCTS - COMP /OP AGG 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: ❑ POLICY ❑ PROJECT ❑ LOC ❑ AUTOMOBILE LIABILITY ❑ ANY AUTO ❑ ALL OWNED AUTOS ❑ SCHEDULED AUTOS ❑ HIRED AUTOS ❑ NON OWNED AUTOS ❑ N/A COMBINED SINGLE LIMIT (Ea accident) BODILY INJURY (Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE (Per accident) ❑ ❑ GARAGE LIABIUTY ❑ ANY AUTO ❑ AUTO ONLY - EA ACCIDENT OTHER THAN EA ACC AUTO ONLY: AGG ❑ EXCESS/UMBRELLA LIABILITY ❑ OCCUR ❑ CLAIMS MADE • DEDUCTIBLE ❑ RETENTION $ EACH OCCURRENCE AGGREGATE X WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR / PARTNER / EXECUTIVE OFFICER / MEMBER EXCLUDED? It yes, describe under SPECIAL PROVISIONS below Exempt ❑ TORY LIM S ❑ ERH E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE E.L. DISEASE - POLICY LIMIT OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS ALARM & ALARM SYSTEM INSTALLATIONS, SERVICING AND REPAIR. °HE FIRST INSUPANcE GROUP ELECTRICAL CONTRACTOR. CORP 10967 Bird Rd Miami, FL 33165 305'94 .7.- CERTIFICATE HOLDER CANCELLATION • MIAMI SHORES VILLAGE BUILDING DEPARTMENT 10050 NE 2 AVE MIAMI SHORES, FLORIDA 33138 I SHOULD ANY OF THE ABOVE DESCRIBED POUCIES EXPIRATION DATE THEREOF, THE ISSUING INSUR 30 DAYS WRITTEN NOTICE TO THE CERTIFI BE CANCELLE EFORE THE WILL ENDEAVOR TO MAIL HOLDER NAMED TO "•c LIGATION OR LIABIUTY R `P''- SENTATIVES. THE LEFT, BUT FAILURE TO DO SO S ALL IM 0 E OF ANY KIND UPON THE INSURER, IT �` AUTHORIZED REPRESENTATIVE Ralph N. Rodriguez ACORD 25 (2001/08) QF 02 -24 -2010 ALEX SINK STATE OF FLORIDA CHIEF FINANCIAL OFFICER 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: PERSON: FEIN: 02/24/2010 EXPIRATION DATE: 02/24/2012 MOREJON 650952626 BUSINESS NAME AND ADDRESS: ELECPLUMB ENTERPRISES INC 933 NW 134TH PLACE MIAMI FL 33182 SCOPES OF BUSINESS OR TRADE: 1- CERTIFIED ELECTRICAL CONTRACTO ELPIDIO * IMPORTANT: Pursuant to Chapter 440 . 05114), 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 440.05112), F.S., Conti (cotes 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 440.061131, 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 certificate at any time for failure of the person named on the certificate to meet the requirements of this section. QUESTIONS? (850) 413 -1609 DWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 09 -06