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EL-11-2032Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 u.. v,W Inspection Number: INSP - 168492 Permit Number: EL -11 -11 -2032 Scheduled Inspection Date: January 09, 2012 Inspector: Devaney, Michael Owner: MILLER, EDWARD Job Address: 142 NW 100 Street Miami Shores, FL 33150- Project: <NONE> Contractor: LES FAUNCE INC Permit Type: Electrical - Residential Inspection Type: Final Work Classification: Alteration Phone Number (305)807 -4045 Parcel Number 1131010220340 Phone: (305)606 -1853 Building Department Comments REPLACE WIRING FOR OUTLETS, KITCHEN , WASHER & DRYER HOT WATER & BATHROOM GFI Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments J1--k January 06, 2012 For Inspections please call: (305)762 -4949 Page 42 of 47 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): Address: !' 0 ,V // 5Te e r City: M,�i4-M, 56 R P j State: Permit No. NOV 21 2011 1 1 a 2 _. Master Permit No.� C ` I/ ` - 0203 e S ®1`anf ��! i �'i P Aeafe/?Y!/'Phone #: Tenant/Lessee Name: Email: ?6c= gy 7-DY�" Zip: .� 3/� / Phone#: JOB ADDRESS: / 2 JTJ G) / 0 0 5 UU C� City: Miami Shores County: Folio/Parcel #: ,/ ( 31 0 10 r2�. Is the Building Historically Designated: Yes Miami Dade Zip: ,73/s---45 NO Flood Zone: Al D CONTRACTOR: Company Name: Del- DPi°16tir 61�CT4lOiG c014 /26cr Phone #; 46b-1•73- �� S Address: 5` 6 reit A0116A City: ,1 «ll Qualifier Name: State: Zip: 331 t' 3 Phone #: 7766 Z-4 3 O©Z r State Certification or Registration #: Contact Phone#: DESIGNER: Archit�n3e ;) Value of Work Type of Word Descriptid# afsV-: � diNf :$ Email Address: Certificate of Competency #: J i 50c:00008 %is- ei4,14.870 aka -co Phone#: DAlteration 6 Square/Linear F�ootaagg of Work: ONew Cie air/Re lace P P P ODemolition a — /**a�***.ix.�x�x*** nix+ x�xa� ****�x+x�x�x�x *�n�:�xa� ******* Fees*** ***** s*.k2 * *** * ** * * * * *e * * ** * ***a.** ** *** ** TM • SubmittatJFee $ Permit Fee $ /fP' i't# Scanning Fee $ Radon Fee $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ 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 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 attachm for the first inspection which inspection will not be approv a certified copy of the recorded notice of commencement must be posted at the job site ays after the building permit is issued. In the absence of such posted notice, the fee will be charged. Owner or Agen The foregoing instrument was acknowl ged - ore + e this /1 l� n day ofA`,20 LL, by L who is personally known to me or who has produced POL • As identification and who did take an oath. NOTARY PUBLIC• Sign: My Commission Expir Signature Contractor The foregoing "insstrument was acknowl ' ged befog- a this /9 day of /AV v /'�` a—x, , 20 % � , by L..i<.....e who is personally known to me or who has produced 1' / M626-521-0.-3402 identification and who did take an oath. ****** ******x•******* ** * ***x .:< ....... * ** 2cQl� 2 2 /Z-' o6"Plans Examiner Zoning Structural Review Clerk (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) K) • T. v ‹Ikt 41 ss ete r � 0 It sf- 4 1 Rios+ 54-q5 0 -- ftlashee 4 Ti7ek owe' tAce r_ep 6.1A1 5kowe A 02000 £b% bok Ki+dken/ CAbineff _�cP %ce God._ — $howek -/45, C C ppn,n 1 "°),N Doti sPc f-lo oisvi• 4' 1 IMMEM °`OO I Q lce SiPP��ocIDyP.e x ;sf k� w e a all , k e4 �) EA Eelo e' "? %v rn 121 /1 '? O LAbot- l a C I /1141-e1"4, X/P?5/ w/ L't ) Ace 12.tiv,--tv 1F s1-o a i al /AA PCR I O /}.5 /iec ' -aQyet e 1'61 yep Cj DUeR T le 1 e-1yk'Ae) V A-A/ 0( T i ref" /eel 12; e4f 3 x(00 L*tot --firw g;,i1 — l?e flAce 6-P3-5 iv glckenl 4- 844 2- er%c '1/Z∎C'►"ae 10045 gnilyek — Key ; R , Dvf (ei5 A Ant. .1-d,. �� 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 No. PERMIT APPLICATION Master Permit No. FBC 20 Permit Type: Electrical UA�N LL C OWNER: Name (Fee Simple Titleholder): A Rm: &yeti! COIL) �l ogf Phone #: JO ri - P7- 90 ys Address: 190 N 4 /lr MPPe City: ' * . 0,<e/ State: /:—/ Zip: 3 3/ i; Tenant/Lessee Name4: �) / Phone #: Email: od e !% �l /i/�/t/vesly,/ r co JOB ADDRESS: /(42 A./4) /O SYtee F City: Miami Shores County: Miami Dade Zip: 33/ $ 0 Folio/Parcel #: // " 3/a / .2 o3 f/ d Is the Building Historically Designated: Yes NO Flood Zone: / V to CONTRACTOR: Company Name: RE✓a to/',cfe,0T EL6 7 (/GdL g ftei 4P ne #: 7& 2 73 00' _ Address: „1,S 21 SF) 7E M/,6�/ / AL a3.2 q 3 City: /✓74.4.1-0-1/ State: Zip: ' 3 Qualifier Name: GUIs 6F. Z Phone #: -7136 Z 7 ,6 00 Z State Certification or Registration #: E' . 130.1 I/6 P3 Certificate of Competency #: d1 E 09000 8 Contact Phone #: TAG Z -7.3 002 r Email Address: A0/5. encrvc 67a ))4400.c o-0-2 DESIGNER: Architect/Engineer: Phone#: Value of Work for this Permit: $ / 0 0 Square/Linear Foots ye of Work: Type of Work: ❑Address ❑Alteration ❑New Cla epair/Replace ❑Demolition Description of Work: /�, 1 �1 - el /,4Ce w�Q %nay -Po R G/u f /e75 j4.fCAPI/ Mt5 b 1' 7 PR eRI r' 7`7 0 No ,r c A 7'/PR c Z.4 4 irce, /dt �T IC / 1 * **********m***** **** ***m *a: ******* ****** Fees*****m ****** *+ x**** ***** ********************* Submittal Fee $ 8. nob Permit Fee $ /J 0 ' e% el 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 , 7) days after the building permit is issued. inspection will not be approved an reins . ' do ee will be charged. Signature (` Owner or Agent The foregoing instrument was acknowledged before me this t day of 1 , 20 , by vn 1 who is personally known to me or who has produl J As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: 4,� E tt7; •• ,i, el' % 0., .0> e � •• (OR I D P ,‘''` �' VP /1111111/1 APPROVED BY �,�eeP Plans Examiner My Commission Expires: Signature In the absence of such posted notice, the Contractor The foregoing instrument w s acknowledged before of INN( , 20 � , by lilt,) Fir "�®"III� who is personally known to me or who has produced as identification and who did take an oath. Structural Review (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) NOTARY PUBLIC: Sign: Print: My Commission Expires: 0111111111 • o 4-'1 az Zoning Clerk 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 ,fiB`111,*°z6c, f`Y CRITIQUE SHEET g'u'ff / /2 ®A✓ f ®,--e Va 7a-2 a- 419,t7 T, NO POINT ALONG COUNTER TO BE MORE THAN 2 FEET FROM G.CI PROTECTED RECW-TACLE PUT DAN RECEPTACLE UNDER SINK. ALL FIXED APPLIANCES ON UtUIUAI to LA I b. InP9 sNotzic, 8 "" ".,.., BE;ECTORS. ANY AND ALL CLOTH AND RUBBER Nesturrui t,wigUCTUHS TO BE REPLACED. EFF ATWATER HIEF FINANCIAL OFFICER STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION * * CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' )NSTRUCTION INDUSTRY EXEMPTION his certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law. 03 -23 -2011 COMPENSATION LAW * * FFECTIVE DATE: ERSON: EIN: 03/23/2011 MUNOZ 274013230 USINESS NAME AND ADDRESS: IEVELOPMENT ELECTRICAL CONTRACTOR 250 SW 40 ST #89 IIAMI FL 33155 COPES OF BUSINESS OR TRADE: - REGISTERED ELECTRICAL CONTRACT INC' PORTANT: Pursuant to Chapter 440. 05(14 F.S., an officer 1 ction may not recover benefits or compensation under this chap ape of the business or trade listed on the notice of election t ection to be exempt shall be subject to revocation if, at any I rtificate no longer meets the requirements of this section for i ned on the certificate to meet the requirements of this section 252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISE AUVIMIORS walrl SIrI2iVHD EXPIRATION DATE: 03/22/2013 LUIS E MIAMI -DADE COUNTY TAX COLLECTOR 140 W. FLAGLER ST. 1st FLOOR MIAMI, FL 33130 684268 -7 BUSINESS NAME / LOCATION DEVELO INC 15711 SW 59 TERR 33193 UNIN DADE COUNTY OWNER DEVELOPMENT ELECTRICAL CONTRACTO Sec. Type of Business 196 ELECTRICAL CONTRACTOR THIS IS ONLY A LOCAL BUSINESS TAX RECEIPT. IT DOES NOT PERMIT THE HOLDER TO VIOLATE ANY EXISTING REGULATORY OR ZONING ,;LAWS OF THE COUNTY DOES I OR EXEMPT THE HOLDER FFFRRRO CMES. NOR M ANY OTHER PERMIT OR LICENSE REQUIRED BY LAW. THIS IS NOT A CERTIFICATION OF DEVELOPMENT ELECTRICAL CONTRACTOR THE HOLDER'S QUALIFICA- INC TIONS. 2011 LOCAL BUSINESS TAX RECEIPT 2012 MIAMI -DADE COUNTY - STATE OF FLORIDA EXPIRES SEPT. 30, 2012 MUST BE DISPLAYED AT PLACE OF BUSINESS PURSUANT TO COUNTY CODE CHAPTER 8A - ART. 9 & 10 FIRST -C U.S. POE PAII MIAMI PERMIT 11 THIS IS NOT A BILL — DO NOT PAY NEW RECEIPT NO. 711668 -4 PMENT ELECTRICAL CONTRACTOR CC # 11E000008 WORKER /S 1 DO NOT FORWARD PAYMENT RECEIVED MIAMI -DADE COUNTY TAX COLLECTOR: 07/13/2011 02250012001 000150.00 SEE OTHER SIDE LUIS E MUNOZ PRES 15711 SW 59 TERR MIAMI FL 33193 WIII IIIIII IIIIoIIIIIIIIIIIIIIIrIIIIlllll M`dl A8 a3NIno32:1 SV AVldSIa n a suolslnad eij Japun payl}Jao sl �t}utm0 a#20-lWelW >tio 0l �aide4O >S 3 slnM Z nW 3NI 21013YM1N001tl0R1103 131N3WdO13A30 80000031.1. AON313dV ®O JO 31V luo S3NISf18 pi�B ftu!/Il.DIdi AS solo IIIIIIJ 41Ilyl HONEHAOD &ZOOS x3I2I SST £ £ Z3 IWVIW 6H I8V LS 0r MS OSZ9 ' ONI ' 2io1LOVUINOO rIFIOnuoarla INawdo'IaAaa anoilma sznri ' zoNnW (vSiiv A NI ONISIOVI NO0 os uoiaa S3,iSSL152%Inoau DNISNaDI'I 'I ZOO'I `TrIV =RN Ism.' 'lYnaIAIaNI) ZTOZ 'T£ :eqvp uo qeiTdxE ' S3 68fii asgdeuD go suoTsTAOId etm .zapun aSaa LSTm SKH MOT9q pemeN HO3;J"d2W NO0 r1V0IIIZDSrIS aqs E8Si,IOEflIS 69Z09I80T TTOZ /tZ /Z0 II8N SSNSDI'I 1138Wf1N HOlVB 09t0Ovzzottrl #03S a2IVos oHISHSOIrl S2IOZDK2IJN00 'I�iOI2ISD3'IS NOIIVrinDHE 'IVNOISS53OIld CINV ssaNiSna 30 ,I,Hayti,ZuNpaSa YORIOlh AO 31VIS 03 -23 -2011 JEFF ATWATER 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: 03/23/2011 EXPIRATION DATE: 03/22/2013 MUNOZ LUIS E 274013230 BUSINESS NAME AND ADDRESS: DEVELOPMENT ELECTRICAL CONTRACTOR INC 6250 SW 40 ST #89 MIAMI FL 33155 SCOPES OF BUSINESS OR TRADE: 1- REGISTERED ELECTRICAL CONTRACT IMPORTANT: 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 under this section may not recover benefits or compensation under this chapter. Pursuant to Chapter 440.05(12), F.S., Certificates 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 440.05(13), 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 01 -11 Nov. 1. 2011 2:43PM No. 2827 P. 1 AC-CM CERTIFICATE OF LIABILITY INSURANCE �� DATE(MMR7tUYYYYJ 11/0112011 THIS CERTIFICATE 15 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 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 ADDITIONAL INSURED, tha pollcy(lea) 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(.). PRODUCER Roxana Solo Insurance Agency, Inc. 8 230 Coral Way MIamI, FL 33155 CONTACT PP NE °x1): Fu , N°)' ADDRESS. WSUKER(c) AFFOROINO COVERAGE NAIC II INSURERA: WESTERN WORLD INSURANCE COMPANY EACH occuRRENcs INSURED DEVELOPMENT ELECTRICAL CONTRACTOR INC 6250 SW 40 STREET #139 MIAMI, FL 33155 INSURER B: _ COMMERCIAL 6E7JERALLEABIUTY INSURER C; _ INSURERD: $ 300,000 INSURER E : CulnL5.MACE ✓ OCCUR INSURER F : MEDEXP(MY one CERTIFICATE NUMBER: • THIS 15 TO CERTIFY THAT THE POLICIES OP INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIRE=MENT, 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, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ,sta 7YP1: DF INSURANCE DDL S SUER WO POLICY NUMBER NPP1292958 POLI6 HPF IMM10D 12123(2010 mimic EXP 1YYYY) 12/2312011 LIMITS A GENERAL LIAaIUYY EACH occuRRENcs s 300 000 ✓ COMMERCIAL 6E7JERALLEABIUTY j� $ 300,000 CulnL5.MACE ✓ OCCUR . . ;,1•.,, MEDEXP(MY one a 5,000 parson) PERSONAL aAnv, l RY $ 300,000 ■ GENERAL AGGREGATE S 000,000 A'3 c UMITAFFLIES PER PRODUC7e- COMP /O ➢AGC $ 300,000 PRO- POLICY • LOO $ AUTOMOBILE LIABILITY ■ ■ •re R11 -INO u E• :cenr. ANYpAvto AUTOS ED A ! HIRED AUTOS BODILY INJURY (Per person) $ — SCHEDULED LED OS BODILY INJURY (Per N) $ PFOFERTYDAh1AeE $ ■ UMBRELLA UAB E *Ma a UAU OCCUR CLAIMS -MADE u EACH OCCURRENCE S AGGREGATE $ DED RETENTIONS $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/N AND PROPRIETOR/ PARTNER/EXECUTNE OFFICER/MEMBER EXCLUDED? (Myya�enaad.atory I NH) DESORPTION OF OPERATIONS below N 1A ■ WO "°' 0 H- E.L EACH ACCIDENT $ E_LL- p1SEAA$E- EAEMPLOYE: 5 EL DISEASE - POLICY LIMIT $ I♦ DESCRIPTION OF OPERATIONS I LOCATIONS 1 VJ HIhLES (AHach ACoRb 101, Aad:denal Remarks ealreduie, If more ewe Is required) ELECTRICIAN CANCELLATION Miami Shores Village 10050 NE 2nd Avenue Miami Shores, PI 33138 ACORD 26 (2010/06) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 1980.2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Produced usher Forms an Web software. www.FormeBoea.eo= 0ImpreeWe Publishing 300 -20B -1977