EL-12-98Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP - 168990
Permit Number: EL- 1 -12 -98
Inspection Date: February 06, 2012
Inspector: Devaney, Michael
Owner: FERNANDEZ, RAUL
Job Address: 262 NE 107 Street
Miami Shores, FL 33161 -7062
Project: <NONE>
Contractor: EVOLUTION ELECTRICAL CONTRACTORS
Permit Type: Electrical - Residential
Inspection Type: Final
Work Classification: Repair
Phone Number
Parcel Number 1122310130561
Phone: (786)351 -5784
Building Department Comments
REPAIR OF WEATHER HEAD
Passed
Inspector Comments
✓/ ,1 % �t_
� e.� 7//
Failed
Correction"
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled
re- inspection fee is paid.
until
For Inspections please call: (305)762 -4949
February 06, 2012
Page 1 of 1
Miami Shores Village
,Oal 12- ANI1Ansta Building Department
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BUILDING
PERMIT APPLICATION
FBC 20
Permit T e: Electrical
L�
OWNER: Name ee imple Titleholder): kalif, re 14lel' Phone#: 7r6 -Zor -T
Address: 2 /vim /07 5-4
City: /41"/ 5-4005 State: /I L zip: 33//9
£t ✓// ' ✓I44i' c' Phone#: 7 G- 27 - /61/7
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949
RECEIVED
JAN 2=0 2012
Permit No. Euz
Master Permit No.
Tenant/Lessee Name:
Email: 4/�A
JOB ADDRESS:
9.1cfa 1 Si
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel #:
Is the Building Historically Designated: Yes NO Flood Zone:
CONTRACTOR: Company Name: 00 khod 66c 6iNkit" Phone #: X6'6" 3-57` ®T
Address: / /Fj 3 / mAil _519,1
City:
®a 6 d► /i State: ice- zip: 330/ 2--
Qualifier Name: /9,-)-414 Y O ,4i4 ..t4 Phone #: 6 3."--/ -596 cl
State Certification or Registration #: /0 6 00 0 6 / 0 Certificate of Competency #:
Contact Phone#: '66 351 Sh Email Address:
DESIGNER: Architect/Engineer: Phone #:
Value of Work for this Permit: $ 'v "O 1/
Square/Linear Footage of Work:
Type of Work: ❑Address ❑Alteration ❑New %Repair/Replace
❑Demolition
Description of Work:
AMIC4 �� CJo Pe , ,e®+
******** **+x**** ** * * * ** **** * * * ****a *** * ** Fees'******* *, x+ x*** ******* *** ****xd+x***+x******+ ***
Submittal Fee $ J ` - rAt9 Permit Fee $ /✓Ck"i'6' 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 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. 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 chnrged.
Owner or Agent
The foregoing instrument was acknowledged` before me this f %
day of✓An 4 /17, 20 /.Z, by 4v/ F/1a4,2dry ,
who is personally known ,to me or who has produced
As identification and who did take an oath.
NOTARY PUBLIC:
S.
Print: EC*6. ASTAItED c e a, t€ C40T4l e 1
j` '�`:• 't GEORGECASTAIEQA
My Commission Expires: . _�\,
EXPIRES: Jury 8 2015 My Commission Expires: i • * my COMlJ�SSIdN t EE 071883
EXPIRES: July 8, 2015
°moo." Bonded 'Mu B t a m Semites
** * * ***** **** **** ��a�x**** *�x�xa� *+ **** x�* x�x�x�x��xx�* �xx�+ x�x* �x�x�x�x*****+ ��x**** �x�x�x�xx� *�x�xx�x� *+x�x�x�xx�x�+x** ***
3� � �' Plans Examiner
Signature
Contractor
The foregoing instrument was acknowledged before men this / 7
,
day of A74404-7 , 20 /Z , by nTOh /U £P57.9
who is personally known to me or who has produced
as identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
A
roe' • • ,bc MY COMMISSION S EE 071693
BaxiedThru B services
Structural Review
(Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09)
Zoning
Clerk
JAN
9\(cS3k_ L1i 31 51
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DATE U
II
SUBJECT /T>CCNPUANCEvWrH ALL FEDERAL
STATE 4NUCr,hN/YA/LE3 AND REGULATIONS
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BLDG DEPT
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COPY
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RECEIVED
JAN 30 2012
C R
CATE OF LIABILITY INSURANCE
DATE (MMIDD/YY)
01/20/12
PRODUCER ER Southern Star Insurance Agency, Inc
8338 SW 6th Street
Miami, FL 33144
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.
Phone (305)262 -2740 Fax (305)262 -2647
INSURERS AFFORDING COVERAGE
NAIC #
INSURED EVOLUTION ELECTRICAL CONTRACTORS INC.
11631 NW 58TH PL
INSURERA ASCENDANT COMMERCIAL INS
•
INSURER B:
INSURER C:
•
L HIALEAH,FL.33012
INSURER D:
INSURER E:
_L_
COVERAGES
INSURER F: .
r THE POLICIES OF INSURANCE, LISTED HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
ANY REQUIREMENT, TERM OR CONDMON 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
IM.
ADD'L
RD
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE I POLICY EXPIRATION
DATE (NIMIDDIYY) • DATE (MMIDDJYY)
LIMITS
GENERAL LJABILITY
GL- 36537 -0
07/29/11
07/29/12
EACH OCCURRENCE 1,000,000.00.
;�
•
COMMERCIAL GENERAL LIABILITY
DAMAGE TO RENTED
ISES (Ea o�rerxs)
PREMISES a
100,000.00
•
n OCCUR
MED EXP (Any one person)
5,000.00
A
• •
•
GEN'LAGGREGATE
trj
CLAIMS MADE
PERSONAL & ADV INJURY
1,000,000.00
GENERAL AGGREGATE
1,000,000.00
PRODUCTS - COMP /OP AGG
1,000,000.00
LIMIT APPLIES PER:
POUCY • PROJECT • LOC
•
•
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
(Peracddent)
PROPERTY DAMAGE
(Per accident)
•
GARAGE UABILJTY
AUTO ONLY - EA ACCIDENT
•
• ANY AUTO
•
OTHER THAN EA ACC
AUTO ONLY: AGO
EXCESS/UMBRELLA LIABILITY
EACH OCCURRENCE
• OCCUR • CLAIMS MADE
AGGREGATE
•
• DEDUCTIBLE
• RETENTION $
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
ANY PROPRIETOR / PARTNER / EXECUTIVE
OFFICER / MEMBER EXCLUDED?
ORY LIMITS • ER
E.L EACH ACCIDENT
E.L. DISEASE - EA EMPLOYEE
If yes, describe under
SPECIAL PROVISIONS below
E.L DISEASE - POLICY OMIT
OTHER
[—
DESCRIPTION OF OPERATIONS / LOCATIONS 1 VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
ELECTRICAL CONTRACTOR
L
CERTIFICATE HOLDER
CANCELLATION
CITY OF MIAMI SHORES
L- I
ACORD 26 (2001/08) QF
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO
THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY
OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRESENTA
ROBERTO OJEDA
ACORD CORPORATION 1988
Miami Shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
Permit No.
Job Name
CRITIQUE SHEET
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