EL-11-1352Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
1 —tV
Inspection Number: INSP - 166179
Permit Number: EL -7 -11 -1352
Scheduled Inspection Date: November 03, 2011
Inspector: Devaney, Michael
Owner: NIETO - WINZEY, TANYA & JAMES
Job Address: 9777 NE 5 Avenue Road
Miami Shores, FL 33138-
Project: <NONE>
Contractor: ARC ELECTRICAL CORP
Permit Type: Electrical - Residential
Inspection Type:
Work Classification: Addition /Alteration
Phone Number (305)606 -2897
Parcel Number 1132060180010
Phone: (305)796 -3672
Building Department Comments
EL WORK FOR BATHROOM REMODEL
ri°1-4A 17,/
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
CREATED AS REINSPECTION FOR INSP- 165923. CREATED AS
REINSPECTION FOR INSP- 165656. CREATED AS REINSPECTION FOR
INSP- 165593.
Bath receptacle to be on 20 amp. ckt.. Add smoke / carbon monoxide
detectors.
Label panel.
Lable panel. Bath receptacle on 20 amp. ckt.
Remove detectors so that wiring can be checked.
pe3-r
November 02, 2011
For Inspections please call: (305)762 -4949
Page 14 of 23
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tell (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949
Permit Ne jl
Master Permit NJ )U
BUILDING ''
PERMIT APPLICATION
FBC 20
Permit Type: Electrical
OWNER: Name (Fee Si ple Titleholder)lk 5 NJ tTheldi `v�
Address: 2101
• tJ�- ��
City: Vi n re3�
Tenant/Lessee Name: Phone #:
Email:
y4
hone#:
State:
305-14-642Z
Zip: -33 I 5.1 .
JOB ADDRESS: 11T) gG A , , • -A " "e__
City: Miami Shores County: Miami Dade
Folio/Parcel #:
Is the Building Historically Designated: Yes NO Flood Zone:
Zip: ;7:3 1 3!
CONTRACTOR: Company Name:
/A1/Lc ��c�c-a"✓����r-
Address: ? 3 4 5 s i A
Si
City: M1 A OA 1 State: F4._ Zip: 331 Ss;
Qualifier Name: Phone#: 34 5 '7 7 - 4' 7 "Z--
State Certification or Registration #: ac c 0 I C 7 T Certificate of Competency #:
Contact Phone# '10 5 i 9 G— 3 4 7 Z Email Address: Q. r G- f- tr Cra. l et _ a (• C rut
DESIGNER: Architect/Engineer. Phone#:
Co gt,P
Phone#: 34:05 ''i `? c - 3 6 7 2_
•
Value of Work for this Permit: $
o Square/Linear Footage of Work:
�� a
Type of Work: °Address farAlteration ONew ORepair/Replace
pl?etnofition
Description of Work: P M op L x3.47. N
+k'&* #*** ******Ile* USN * * *** R******** ** s*t******** **** **** *6* * **+M**** * ****** *+
Submittal Fee $ Permit Fee $ /- 4.-4'" tom' Q''' CCF $ CO/CG $
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 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 $250.0, 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
Owner or Agent
The foregoing �instrument ' was acknowledged before me this
day of '_, 2O . V1� by 16 N 1 � V ~ J
De
who is personal. to me or who has produced
N352-- Ater . 3- °As identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Signat
Contractor
The foregoing instrument was acknowledged before me this 11
day of
20 IL by 414.� 1 de Q,.Ck
who is personally known to me or who has produced
innq let/1214i as identification and who did take an oath.
•�' ° "w Susan Herrera
NOTARY PUBLIC: °�°YpG��'- MMISSION #DD90925e
'LOA
s'
LcLM. �J� @-EXPIRES:JULY21,2013
C ��Fr p�� WWW.AAR0NN0TARRcom
4;11.4; # Susan Herrera
2 '•1, • "COMMISSION #DD909258
i
��Vi=�t�e. WIRES: JULY 21,2013
"� � �� '?n•
WWW.AARONNOTARtcom
0N,a 4 4EZ -P.
My Commission Expires: gitxt.xl ZI 'tea
* * * * * * * * * * * * * * * * * **
Sign:
Print: SaSNO
My Commission Expires: Tsuits
Ili :O
** * * ** ** **************************, e**************** * ** * * * * *** *+t• * * * * * ** *** * ****
APPROVED BY Plans Examiner
Structural Review Clerk
(Revised 07110 /07)(Revised 06/102009)(Revised 3/15109)
Zoning
Miami Shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
CONTRACTORS' REGISTRATION FORM
ALL CONTRACTORS MUST PROVIDE COPIES OF LICENCES AND INSURANCES EACH TIME A PERMIT IS
SUBMITTED OR THE VILLAGE MAY MAINTAIN A FILE WITH YOUR INFORMATION FOR A $30.00 FEE PER YEAR,
IF CONTR ACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: /
A. ✓/ COPY OF QUALIFIER'S STATE LIC CARD
B. ✓ COPY OF LOCAL BUSINESS TAX RECEIPT
C. V" COPY OF LIABILITY INSURANCE (CERTIFICATE HOLDER TO BE MIAMI SHORES VILLAGE BLDG DEPT)
D. t./ COPY OF WORKERS COMPENSATION (EITHER CERTIFICATE OR EXCEMPTION)
IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY:
A. COPY OF CERTIFICE OF COMPETENCY OF QUALIFIER
B. COPY OF MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT
C. COPY OF LIABILITY INSURACE (CERTIFICATE HOLDER MUST BE MIAMI SHORES VILLAGE BLDG DEPT)
D. COPY OF WORKER COMP INSURANCE (EITHER CERTIFICATE OR EXEMPTION)
YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE HOLDER AS FOLLOW:
MIAMI SHORES VILLAGE BLDG DEPT
10050 NE 2ND AVE
MIAMI SHORES, FL 33138
COMPLETE CONTRACTORS INFORMATION,
BUSINESS NAME :��
BUSINESS ADDRESS: 73(€5 5Ai tl t 3T CITY du l A wt
STATE /14- ZIP CODE 33/5:5
BUSINESS PHONE: ( s) ”6"-- 6_ 3 4.71-- FAX NUMBER (°3 d ) 2 G G-9003
CELL PHONE (36S ) 79C- 3 (a L QUALIFIER'S NAME: A 6 F x A v1/400s rL 2- /■ a yt+ ,o 4-42
QUALIFIER'S LIC NUMBER: 5-C ® c ) /A- 7 S/
E -MAIL ADDRESS (IF APPLICABLE): (CO 4'a 7 COS--1
Cry on 31191119 BYURAV!RV91Z6IO9MAV
1.
C■4
• -
• 417' = IUETS 8TAX,.181 OrUITE:1TATOral7inuO
EAMPq. en iftli'l'.
• ' • MUST NIINIPLAVED AT WA.
• JPARMIAMRMROTVC002
TRSIS
366330-6
BUM= uAMEI LOCA170N
ARC ELECTRICAL CORP
7345 SW 41 ST _, •
33155 WHIN DADE-COUNTY
1111a ELECTRICAL CORP .
Typo of fluatinss
96_ CTEICAL CONTRACTOR - 10 .
VA "l.7
NOT A eau — DO NOT PAY.
RENEWAL
RECEIPT NO. 376514-7
STATER EC0001674
• PlIVAT•CLASS
MEI. POSTAGE
PAM
MIAMI R.
PER/MT NO. 281
*WORKER/S.-
TAN
• 00/09/2010.
.09010116001
' -000075.00
SEE OTHER SIDE
00140TFORWARD
ARC ELECTRICAL CORP'
ELENA RONANACH PRES
7345 SW 41 ST
MIAMI FL 33155
lullu1 Ilin1IishhaduhAJJNAL1fl11”JJ1,1101
Aug. 26. 2010 1:02PM .
STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND PROFESSIONAL .REGULATION
ImEcTRicaL CONTRACTORS LICENSING BOARD (850)
1940 NORTH MONROE STREET
TALLAHASSEE FL 32399-0783
No. 6738 P. 1
RONANACH ALEXANDER J
ARC ELECIMICAL CORP.
174:12aSE 41 ST
FL 33155
1 With this Rowse you become one of the nearly one MMIOT1
,.f llcensed by the Department of Business and Professional Regulation.
Our professionals and lashes:ma range from architects to yacht brokers. frem
boxers to barbecue restaurants, and they keep Florida's economy stung.
Every day we work to bnprove the way we do hotness in order to serve you Mater.
For informaticei about our services, please log onkr warwanyTheridanceneacom.
There you can find we information about our clivfrbris and the regulations that
hillsact You, subscdbe to department newsletters led leam more (bout the
Deptutrnenre Initialises.
Our mission at the Department 10 License Efficiently, Regulate Fairly. We
constantly strive to serve you better no lug you can serve your customers.
Thank you for doing tuskless In Honda, and congratultdkrns on your new license/
DETACH HERE
487-1395
•
OP ID: IDHE
1 '°'�,C„°� R° CERTIFICATE OF LIABILITY INSURANCE 1
pyp21
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
BELOW. THIS CERTIRCATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURERS), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) mutt be endorsed. If CATION IS WAIVED, sided to
the terms and conditions of the potty, certain policies may require an endorsement A statement on this certificate does not confer rights to the
certificate holder M lieu of such endosenent(s).
PRODUCER 305-648-7070
Avante insurance Agency, Inc.
7490 Wed Fl her Sheet �64H -7090
Miami, FL3311
Gabrtala F. Dominguez
catirarr
FAX
tea: . I ( , Nor
_.
:": '-
cL sToMERIDS: ARCEL-1
INSURERS) AFFOROMG CAE
NM*
INSURED ARC Electrical Corp
7345 SW 41 Stmt
Miami, FL 33155
simAtER A: Nova Casualty Company
A XIV
,mss :Associated Industries Ins Co.
Inc:
IMAL071958
INS D :
03117112
ICE:
$ 1,000,000
$ 100,000
INSURER F :
DPMASO RTsm are ncel
COVERAGES
CERTIFICATE NUMBER:
REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICES OF INSURANCE
INDICATED. NOTWITHSTANDING ANY REQUIREMENT,
CERTIFCATE MAY BE ISSUED OR MAY PERTAIN,
EXCWSIONS AND CONDITIONS OF SUCH POLICIES.
LISTED BELOW HAVE BEEN ISSJED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THE
THE A SURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
L
TYPE OF E4SURANCE
VI
POLICY MEMBER
��
(Y)
�
A
GENERAL,
LABIUM
COMMERCIAL GENERAL
ICLAIMS-MADE
LIABILITY
OCCUR
IMAL071958
03117111
03117112
EACH OCCURRENCE
$ 1,000,000
$ 100,000
X
DPMASO RTsm are ncel
X
MED EXP (Any one parson)
$ 5,000
PERSONAL & ADV INJURY
$ 1,000,000
GENERAL AGGREGATE
$ 2,0®,000
GEN'L
AGGREGATE LIMIT APPLIES PER:
POLICY n P, n LOC
PRODUCTS - C OMPr )P AGG
$ 1,000,000
—1
$
AUTOMOEJLE
LIABILITY
ANY AUTO
ALL OWNEDAUTOS
SCHEDULED AUTOS
HAM AUTOS
NON -OWNED AUTOS
COMBINED SINGLE LIMB
(Ea c dent)
$
—
BODILY INJURY (Per person)
$
—
BODILY rdJLIRY (Per acddent)
$
—
PROPERTY DAMAGE
(Per occident)
$
_
$
$
IAMBIMLA LIAR
MESS LIAR
OCCUR
CLAIMS -MADE
EACH OCCURRENCE
$
_
AGGREGATE
$
DEDUCTIBLE
RETENTION $
$
_
3
B
WORKERS COMPENSATION
AND EMPLOYER" LA19E/IY
ANY PROPRIETORIPARTNERIEX£C
OFFICER/MEMBER EXCLUDED?
(Mandan NH)
Cm. describe usher
DtSCRPTION OF OPERATIONS
Y l N
NIA
AWC1007902
03121111
03121112
X 1 TORY u U- I I
E.L. EACH AccmENT
$ 100,000
UTIVE
I I
EL E.L. DISEASE - EA EMPLOYEE
$ 100,E
below
EL DISEASE - POLICY LIMIT
$ 500,000
DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES (A ACORD 101, AthlBonat Remarks Sehet Rte, IT more Is required)
MIAMISH
Miami Shores Village
Buliding DSparlmed
10040 NE 2 Avenue
Miami, FL 33130
SHOIA.D ANY OF TIM ABOVE DESCRIBED POLICIES BE M$CELLED BEFORE
THE BMW= DATE THEREOF, NOTICE WE.. BE DE$IIR� IN
ACCORDAPWE WITH THE POLICY P
AUTHORIZED REPRESENTATIVE
ACORD 25 wows)
®1980-2009 ACORD CORPORATION. All rlgltb reserved.
The ACORD name and logo are registered marks of ACORD