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EL-11-2025Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 166136 Permit Number: EL -11 -11 -2025 Scheduled Inspection Date: January 03, 2012 Inspector: Devaney, Michael Owner: LLC, MACAII Job Address: 9545 BISCAYNE Boulevard Miami Shores, FL 33138- Project: <NONE> Contractor: G -3 ELECTRIC Permit Type: Electrical - Residential Inspection Type: Final Work Classification: Addition /Alteration Phone Number Parcel Number 1132060143040 Building Department Comments INSTALL 2 GFI AT KITCHEN AREA Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments rfr - December 30, 2011 For Inspections please call: (305)762 -4949 Page 6of19 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 No. RECEIVED NOV 0 2311 BY: Master Permit No. Permit Type: Electrical OWNER: Name (Fee Simple Titleholder): /° % ( "Ce d. /' ' Phone#r%'k9 /� Address: �y 25 7, 0c) 3 - 4�y��, . eco City: /2i i6-641 tr State: Zip: -1,37 -5-3 Tenant/Lessee Name: Phone #: Email: JOB ADDRESS: 95Y5 J /'tt` ye-cc City: Miami Shores County: Miami Dade Zip: a :3 r.� Folio/Parcel #: Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name: 0 —3 !i Phone #: Address: 6-??1? ?iP 5 Z2-- �de, City: i' i , State: L. Zip: 3'5t Qualifier Name: ll. x ' d� Phone #: • P State Certification or Registration #: E (2_ 130 13V Y V V 3 Certificate of Competency #: a� 3 47OD® Contact Phone #: .60 b"— 2.-2... `Fd, Email Address: $ <3i9 e7�72 re 7-4/$6L.: DESIGNER: Architect/Engineer: Phone #: Value of rkfpr-this-Pert fit" S© ®. 0 0 Square/Linear Footage of Work: Type of Work: ❑Address ❑Alteration ❑N w ❑Repair/Replace ❑Demolition ***** **m ******* Fees*********** 13** ******.: x:m *+ x************** ****** Permit Fee $ /-4-2 Scanning Fee $ Radon Fee $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ CCF $ CO /CC $ DBPR $ Bond $ Technology Fee $ TOTAL FEE NOW DUE $_ f U-1 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.F.CTRICAL 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 S „' sence of such posted notice, the inspection will not be approved and a reinspection fee will be charged., Owner or Agent The foregoing instrument was acknowledged before me this ``5 I day of NOV J , 20 / , by - Joe P a M2 . , Who is personally known to me or who has produced fiver j /GLri 'e. As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: 4ari Ana v h14,e. My COMMISSION A EE 014044 EXPIRES: August 3, 2014 My Commission Expires: Signature The fo instrument w al ackno . ledged� �. , 201 , b 1�1lti. <. iI A 0I III known to me or who has produc li ntification and who did take an oath. NtT 'Y 'UBLIC: i, I I J'1� Sign: Print: My Commiss * * * ********** **** ** ** : * * * * *** * * * * * ** * * ****s:** ** * *** * * ** * *** * *** x**** ** 244' a APPROVED BY l `i/ e / A/O' C--” Plans Examiner Structural Review (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) s� ,, Notary Public - State o :; • s_ My Comm. Expires Sep 23, 2015 �� Commission # EE 128810 Bonded Through National Notary Assn. ,ksh *** ***0 * **0*0 *0*00 ** Zoning Clerk 02/16/2006 02:31 3652645382 JIMENEZANDCO PAGE 01 ACCARd CERTIFICATE OF LIABILITY INSURANCE DATE (MWDINYTTY/ 10/28111 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AFID 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: ft the certificate bolder Is an ADDMONAL INSURED, the polIcy(les) must be endorsed. If SUBROGATION 13 WANED, Sobjnot to the terms and Condifftme of the policy, certain penal:fa may inquire an endorsement. A statement an ffde cerffEcate dean mg coffer Mite to the cortlikala holder In Hsu of such endarseffient(S). PRODUCER Manes & Co.. Inc. 8000 Coral Way Miami, FL 33155 Phone (305) 264-9500 . . . — INSURED G3 ELECTRIC CORP 8770 SUNSET DR 0 445 MIMI, FL 33173 Fax 008) 284-8382 Make 60,04. (305) 264-9900 ENIUMENDS AppOSIGING COVERAGE eisumAL GRANADA. INSURANCE . RIR C - INSURER B: INSURER E : INSURER P COVERAGES CERTIFICATE NUMBER : REVISION NUNIGER: 114-I CEFMFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN. ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOtr"-- — INDICATED. NOTWITHSTANDING ANY REOUIREMENT, 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIM AIWA "PM_ A Two OP INSURANCE ACM GENERAL MABILITY g COMMERCIAL GENERAL UABS.ITY CLADAS-MAUE WI OCCUR 0 GENT. AGGREGATE LIMIT APPLIBS PEft • POLICY 0 REs% 0 1.00 AUTOMOBILE LIABILITY • ANY Am° DALL OWNED SCHDXFLED AUTOS Auros NON-OWNED O HIRED AUTOS AurOs El 0 al UMBRELLA LIAR 0 mug O EXCESS LIRE 0 CLAIMS-MADE 0 DEO 0 RETENTION WORKERS COMPENSATION MO EMPLOYERS' LIABILITY Y 15 ERNASECUTIVEr- lkitaggill R4gPERATIOn$ Woo N / A POLICY MINDER 0185FL00030583 11/09/2011 11/09/2012 UMRS =GOrroURRENCE PREMISES Me cmurrtmod EXP (Any one person) PERSONAL 5 AIN INJURY GENERAL AGGREGATE PRODUCTS • COMP/OP AGG GOWNED SiNTlik umr BODILY MAW Ter serosm soppy INJURY (Par ma =00.• ••• DAMAGE EACH OCCURRENCE AGGREGATE 5 1,000,000.00 $ 100,000.00 s 5,000.00 s 1,000,000.00 $ 2,000,000.00 $ 2,000.000-09 $ CISTATTEL E.L EACH ACCIDENT E.L MASS • EA EMPLO E.L. DISEASE POLICY LMT 5 0CSOmPrION OF OPERATIONS 1 LOCATIONS / VEHICLES Obtmb ACORD 101. Malone! Remarks Seendeledi Mare sPaco Ia TwIuMNS CERTIFICATE HOLDER VILLAGE OF MIAMI SHORES 10050 NE 2 AVE MIAMI FL 33138 ACORD 25(2010105) QF E ABOVE DESCISSED POLICIES BE CANCELI.ED BEFORE TE THEREOF, NOTICE WILL BE DELIVERED IN THE POLICY PROvISIONS. ■,.. 1 I \ 988-2010 ACQRD rights reserved "P 7 ACORD dame and logo are registered marks of ACORD 1 MIAMI -DADE COUNTY TAX COLLECTOR 140 W. FLAGLER ST. 1st FLOOR MIAMI, FL 33130 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 498368 -1 BUSINESS NAME / LOCATION G 3 ELECTRIC CORP 4151 SW 87 AVE 33165 UNIN DADE COUNTY FIRST -CLASS U.S. POSTAGE PAID MIAMI, FL PERMIT NO. 231 THIS IS NOT A BILL - DO NOT PAY RENEWAL RECEIPT NO. 520401-1 CC # 03E000049 OWNER G 3 ELECTRIC CORP 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 OR CmE8. NOR DOES IT EXEMPT THE HOLDER FROM ANY OTHER PERMIT OR LICENSE REQUIRED BY LAW. THIS IS NOT A CERTIFICATION OF THE HOLDER'S QUALIFICA- TIONS. PAYMENT RECEIVED MIAMI -DADE COUNTY TAX COLLECTOR: 08/08/2011 02210010001 000075.00 SEE OTHER SIDE WORKER /S 1 DO NOT FORWARD G 3 ELECTRIC CORP GONZALO FERNANDEZ PRES 8770 SW 72 ST 449 MIAMI FL 33173 11111111111111111111111111111111111111111111141111111111111 01 c STATE,OF`FLORIDA DEPARTMENT QF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION CONSTRUCTION INDUSTRY CERTIFICATE QF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW EFFECTIVE: 02/22/2010 EXPIRATION DATE: 02/22/2092 PERSON: GONZALO FERNANDEZ FEIN: 542082896 BUSINESS NAME AND ADDRESS: G -3 ELECTRIC CORP. 8770 SW 72 ST @449 MIAMI. FL 33173 SCOPE OF BUSINESS OR TRADE: 1- REGISTERED ELECTRICAL CONTRACT -CTQB Construction Trades Qualifying Board BUSINESS CERTIFICATE OF COMPETENCY 03E000049 G -3 ELECTRIC CORP D.B.A.: FERNAIVDEZ GONZALO Is certified under the provisions of Chapter 10 of Miami -Dade County • -;-