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EL-11-1929i Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: I NSP- 165675 Scheduled Inspection Date: November 16, 2011 Inspector: Devaney, Michael Owner: DIAZ, ANGEL W Job Address: 9500 NE 6 Avenue Miami Shores, FL Project: <NONE> Contractor: AGC ELECTRIC, INC Permit Number: EL -10 -11 -1929 Permit Type: Electrical - Residential Inspection Type: Final Work Classification: Addition /Alteration Phone Number (786)412 -7310 Parcel Number 1132060140770 Building Department Comments REPLACE METER SOCKET Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments /(-/ c(/' 7/ November 15, 2011 For Inspections please call: (305)762 -4949 Page 21 of 43 VAco rPv P.) f vt 1 ._ crres l.)c/4,y4, , gQerz LoS Pipe. C-p-o r NW) NM.. rr Apna i V e Iv P-1 If -2c'7 c.Qp 2a 6mps by �c.4 TD T-c '/2 /0' See. t)c € rt-ede>2 F's 0 L'TG tZ 6 F.((_ 0 Pet e L . C)(71,-, /'1°4\c ,(4,e3 d c vv d V 9 k)tjC :t Se0CP Y2-€ 19 [eLeQvvte.-1/4- I t9 C tiOo tZ F. G9 � f s-6‘. BLS A.Qe Put � (rt E T 62.44A 7g`1 T KJ 4 Miami Shores Village Building Department >0050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 BUILDING PERMIT APPLICATION FBC 2004 Permit No. 51 I — jci2P1 Master Permit N • Permit Type: Electrical Owner's Name (Fee Simple Titleholder) A q Phone # 78 C - -4//2-. 73/ Owner's Address 9560 AJ City /p4.e-e/ 56'adeEs State Zip 33 / 3 Tenant/Lessee Name Phone # E -MAIL: Job Address (where the work is being done) 9�� ,L)& T4 City Miami Shores Vill= e County Miami -Dade FOLIO / PARCEL # Is Building Historically Designated YES NO, Zip 33 /3r- Contractor's Company Name A ( K. S.\ e eV, t C Phone # � � ' Z Z Contractor's Address ft%`� City Vt.' eAN S t a t e Z i p 3 \ ' Qualifier Name E •• Phone # State Certificate or Registration No. E t 00o0 f©4 Certificate of Competency No. E -MAIL: Architect/Engineer's Name (if applicable) Phone # Value of Work For this Permit $ % 'too . Square / Linear Footage Of Work: Type of Work: ['Addition ['Alteration ['New Describe Work: 'Qi (it..441‘. mac$ *IN s Repair/Replace ❑ Demolition ***** ***** **** * * **** **,r*** * ** * **, * ** *** Fees ***,r**** * ** ,t ** * + r, r, r* *,r * *,r *** *,r,r*,r**,r**,r Submittal Fee $ Permit Fee $ /-1—e"'" - e ° CCF $ CO /CC Notary $ Training/Education Fee $ Technology Fee $ Scanning $ Radon $ DPBR $ Zoning $ Bond $ Code Enforcement $ Double Fee $ Structural Review. $ Total Fee Now Due $ See Reverse side -) 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 AI'N'I)AVIT: 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 The for day of Owner or Agent �/ , ' v' Cgfitractor was acknowledg be a me this The foregoin instrument was acknowledged before me this ti l by � / , day of 20 II , by 621Y ` ` % K who is personally known to me or wh has produced who is personally known to me or who has produced As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commission Expires: as identification and who did take an oath. * * * * * * * * * * * * * * * * * * * * * * * ** ** , , ** * ***** *** * * ****** * * * * * * ** APPLICATION APPROVED BY: (Revised 02/08/06) ******* * * * * * * * * * * * * * * * * * * * * * * * ** * * * * ** Plans Examiner Engineer Zoning P(Norchicli Pofe4- di 10644,1.1041- 5 6,40 'v e 6 °'1 / ve GHQ 1 Drek 5e,0 ,,ic e feecQec2 co-'I 124�rzQ 0Fe. LvS. Z MT p►p� r c a:Qp 2a cps 2 Pa c- c 0Val v pi .) -e arc J 1 ') k)c, -v e ; Se-0 P Q &F WOILF ;pc) ow-r QeprtaeQVµe� ( ( -.- 47x,.5 0LS �oc oc e T dua 'rise s) 0144,Q a /vQ .) &19..e-g 00Aucl-err ba)c\'14 a WM wAnw\ v■o6A. \O'(\ \\Ag'\ PN'h D WITH E tONAENTAt. Y FR�E NDi Y L;(tEEN INKS 238210-54 City of Hialeah Business Tax Receipt 1iayl,r CarlosHer__i:idcz (OLD -1731- -807) he person, lirm ter u1rp. listed here 2011 -12 ,mout: $ 150.00 cpt=rate the iri._.- .'. ,o.,°ner :(1:11L0 E_ectrn_ca1 art;- ��_er War.�nq insta? i `lo_: Ccntr_sc ors AGC ELECTRIC IN 26'60 W 79 ST 'I=Art , 17T 9 3316 3'330 L'.A'OT .i B11.I. 260 n 79 ST i:,apir., Sept(' t,cr 30 20122 452878 -3 BUSINESS NAME; LOCATION AGC ELECTRIC INC 2660 W 79 ST 33016 HIALEAH OWNER AGC ELECTRIC INC Sec. ELECTRICAL CONTRACTOR '' ONLY A LOCAL HLL5<,.1cSS TAX RECEIPT. IT T t)U S NOT PERMIT THE Y?iiDER TO VIOLATE ANY t E1.. 1t>dO RELULATORY OR 2GHiNis LAWS Of ! COUNTY OR CITIES, Nth', E DOES IT EXEMPT t HOLDER FROM ANY ■t L PERMIT OR Lfi- sL F 4EOUIRED BY LAW. 1",-,:f; 3E P NOT A CERTIFICATIu,t lli P THE HOLDER'S QUAL:,CA• A TIONS. T RECEIVED MlA,",.PADE COUNTY TAX P CCL.BCTOR: oa 07/13/2011 Ann7nnnatnc RENEWAL RECEIPT NO, 472774 -0 STATE# EC0000764 FIRST-CLASS U.S. POSTAGE PAID MIAMI, FL PERMIT NO. 231 WORKER /S 18 DO NOT FORWARD AGC ELECTRIC INC TOMAS CURBELO PRES 2660 W 79 ST HIALEAH FL 33016 CERTIFICATE OF LIABILITY INSURANCE OP ID: J3 DATE (MM/DD/YYYY) 09/16/11 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 POLICIES --:LOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED PRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be 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. 1201 W Cypress Creek Rd # 130 P.O. Box 5727 Ft. Lauderdale, FL 33310 -5727 Christopher M. Moore, CPCU INSURED 954 - 776 -2222 954 - 776 -4446 CONTACT NAME: PHONE (A/C, No, Ext): E -MAIL ADDRESS: FAX (A/C, No): PRODUCER CUSTOMER ID #: AGCEL-2 A G C Electric Inc. Attn: Farach Bernardin 2660 West 79th Street Hialeah, FL 33016 COVERAGES INSURER(S) AFFORDING COVERAGE INSURER A : Amerisure Mutual Ins. Co.+ NAIC # 23396 INSURER B : *Amerisure Insurance Company+ 19488 INSURER C : *FFVA Mutual Insurance Co.+ 10385 INSURER D : INSURER E : INSURER F : • THIS INDICATED. CERTIFICATE EXCLUSIONS INSR rtGVIJIVN IVUIYItstM: 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 CONDITION 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 CLAIMS. - LTR TYPE OF INSURANCE ADDL INSR SUBR W VD POLICY NUMBER (MM/U/YDDEYYY) (MM/DWYYYY ) OMITS B GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY GL205729800 10/01/11 10/01/12 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES (Ea'occurrence) $ 300,000 CLAIMS -MADE X OCCUR MED EXP (Any one person) $ 10,000 X XCU , PERSONAL & ADV INJURY $ 1,000,000 X Contractual Liab GENERAL AGGREGATE $ 2,000,000 GENT AGGREGATE POLICY X LIMIT APPLIES PE0 PER: LOC PRODUCTS - COMP /OP AGG $ 2,000,000 Emp Ben. $ 1,000,000 B AUTOMOBILE X X X X U ABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS Comp Ded: $500 CA205729600 10/01 /11 10/01/12 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ $ X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE EACH OCCURRENCE $ 4,000,000 AGGREGATE $ 4,000,000 X DEDUCTIBLE RETENTION $ $ $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/N WC8400024984201IA 10/01 /11 10/01/12 X WC STATU- TORY LIMITS OTH- ER ANYIPROPRIETOREXRTNERO ECUTIVE N/A E.L. EACH ACCIDENT $ 1,000,000 (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 A Equipment Floater CPP2057297 10/01/11 10/01/12 Scheduled 69,000 Leased/Re 50,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule If more space Is required) CCDTICIne -r= Li ,...r -" CANCELLATION MIAM Miami Shores Village 10050 N.E. 2 Avenue Miami Shores, FL 33132 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) © 1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD