EL-11-2271Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 168534 Permit Number: EL -12 -11 -2271
Scheduled Inspection Date: January 10, 2012
Inspector: Devaney, Michael
Owner:
Job Address: 1360 NE 103 Street
Miami Shores, FL 33138-
Project: <NONE>
Contractor: ELECTRAK LTD INC
Permit Type: Electrical - Residential
Inspection Type: Final
Work Classification: Alteration
Phone Number
Parcel Number 1132050300070
Phone: (786)286 -7515
Building Department Comments
REPLACING ALL TELEPHONES 7 CABLES TV WIRING
UP TROUGH ATTIC. LOW VOLTAGE
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Co
7 0 /2-
January 09, 2012
For Inspections please call: (305)762 -4949
Page 20 of 25
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
RECEIVED
DEC 07 2a11
BY:
Permit No. —
Master Permit No. RC-1— 11 ` s ‘ .-g`�
Permit Type: Electrical
OWNER: Name (Fee Simple Titleholder): IV CA HOVICAIV pa /Q'ffiJ re Phone #:
Address: 13 too NE /b3
City: /'1 ;NMI; ,y'%o.J State: ft
Tenant/Lessee Name:
Phone #:
Zip: 3 1
Email:
JOB ADDRESS: 13 (90 Ne /03-12:
City: Miami Shores County:
Miami Dade
Zip: 3.713
Folio/Parcel #:
Is the Building Historically Designated: Yes
NO Flood Zone:
CONTRACTOR: Company Name: �t,� C3 J2gk LTD INC . Phone #: 610 2 o6 ° 7,s" / s'
Address: / 1/ V ' fa/ y1J 1 f I, /11 4 //
City: � �1 f �l3 0 State: }' � Zip:
r3° /2
Qualifier Name: CtCis4NN/' 6ortp�' 1 • Phone#:
State Certification or Registration #: Certificate of Competency #:
Contact Phone #47 —"VI Email Address:
DESIGNER: Architect/Engineer: Phone#:
Value of Work for this Permit: yoo
®A
Type of Work: ❑Address ❑Alteration
$ Square/Linear Footage of Work:
GKtepair/Replace °Demolition
01 10 7 0rvC ;m 4.1b.1
Description of Work:
06� T 17 04 ts/ �,
*** ***** ******* *** ***********+ u********* Fees******* ** ********* **************** ****x:*****
Submittal Fee $ Permit Fee $ `c2 r ®' CCF $ CO /CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $ Technology Fee $
Double Fee $ Structural Review $
TOTAL FEE NOW DUE $ 104ZS &a J
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.RCTRICAL 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 charged.
Signature
Sher of-Ai- nt .4
The fore • ing ins was ackn ' led ed befo ,, me this 9 The foregoing instrument was acknowledged before me this ?3
day of ,J ��O , b � l� I 144 / 1 , day of 14 Az,r/,0aa , 20 // , by Co' €o,(4} -rrli etCyr7 (Z
t, who s p rs kno me or who has produced i' who is ersona known to me or who has produced
ito dentification and who did take an oath. as identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign:
Print:
My Commission Expires:
4 L4 L 4
. CUP-OS
,a
o ,,P"aY PUte',,4,, N ory Public Sta S ep ' 23. 2015
MY Co # t
%9 oQ� Comizsos9 Naao ,1n%aw Assn
s, P.- 0 ed oo h
APPROVED BY
(f
Plans Examiner
Sign:
Print:
My Commission ' :, sR MY COMMISSION # DD 192104
1›. EXPIRES: July 18, 2012
spt °moo Bondsd Thm Budget Notary Services
Zoning
Structural Review Clerk
(Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09)
1-
MIAMI -DADE COUNTY
TAX COLLECTOR
140 W. FLAGLER ST.
1st � FLOOR
MIAMI, FL 33130
2011 LOCAL BUSINESS TAXRECEIPT 2012
MIAMI -DADE COUNTY - STATE OF FLORIDA
EXPIRES SEPT. 90, 2012
MUST BE DISPLAYED AT PLACE OF BUSINESS
PURSUANT TO COUNTY CODE dHAPTER 8A - ART. 9 & 10
156862-6
FIRST -CLASS
U.S. POSTAGE
PAID
MIAMI, FL
PERMIT NO. 231
THIS IS NOT A 1311.1- D) NOT PAY RENEWAL
BUSINESS NAME / LOCATION RECEIPT NO. 156862-6
ELECTRAK LTD INC CC 8 000016803
1148 W 40 ST
33012 HIALEAH
OWNER
ELECTRAK LTD INC
Sec. Type of Business
196 ELECTRICAL
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 CITIES. NOR
DOES IT EXEMPT THE
HOLDER FROM ANY OTHER
PERMIT OR UCENSE
REQUIRED BY LAW. THIS IS
NOT A CERTIFICATION OF
THE HOLDER'S QUALIFICA-
TIONS.
PAYMENT RECEIVED
MIAMI -DADE COUNTY TAX
COLLECTOR:
09/27/2011
09010142001
000045.00
CONTRACTOR
WORKER /S
10
DO NOT FORWARD
ELECTRAK LTD INC
GEOVANI GOMEZ PRES
1148 W 40 ST
HIALEAH FL 33012
111111111111111 11111111111111 111111111 1111111 11111111111111111
79
From:Mark McAleer FaxID:Al Malins Insurance
Page 2 of 2
Date:12/7/2011 10:41 AM Page:2 of 2
OP ID: MCM
'4� °R °- CERTIFICATE OF LIABILITY INSURANCE
1 °ATE(/07 /1 YY,f'
12/07/11
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
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, 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 941 -377 -7283
Al Matins insurance 941- 927 -8461
3801 Bee Ridge Road, Suite #6
Sarasota, FL 34233
NAME:
PHONE No, Est/: FAX
(NC (Arc, No):
ADDRESS:
PRODUCER ELECT -5
CUSTOMER ID 8:
INSURER(S) AFFORDING COVERAGE
NAIC #
INSURED Electrak Ldt Inc, Inc.
Jorge Perez
1148W 40 ST
Hialeah, FL 33012
INSURER A: Cypress Prop & Cas Ins Co
10953
INSURER B : Southern Insurance Company
GFL1014732
INSURER C
10/14/12
INSURER O:
$ 300,00
INSURER E:
$ 100 00
INSURFR F •
$ 5,00
•
•
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAD
THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
CLAIMS.
1 SR
TYPE OF INSURANCE
r_�■��■
F T7
!''
,i�.
POLICY NUMBER
POLICYEFF
MOD
POUCYEXP
•MIDD
LIMITS
A
GENERAL
X
LIABILITY
COMMERCIAL GENERAL LIABILITY
GFL1014732
10/14/11
10/14/12
EACH OCCURRENCE
$ 300,00
' "
$ 100 00
PREMISES R Ea occurrence
E
MED EXP (Any one person)
$ 5,00
■■
CLAIMS -MADE X OCCUR
■
PERSONAL & ADV INJURY
$ 300,00
GENERAL AGGREGATE
$ 600,00
PRODUCTS - COMP/OP AGG
$ 600,001
GEM. AGGREGATE LIMIT APPLIES PER:
X POLICY Fl j P.-7- I ( 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 (Per accident)
$
PROPERTY DAMAGE
(Per accident)
$
$
$
■
UMBRELLA LIAB
EXCESS LIAB
■
OCCUR
CLAIMS -MADE
EACH OCCURRENCE
$
AGGREGATE
$
$
DEDUCTIBLE
RETENTION $
$
B
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANYPROPRIETOR/PARTNER/EXECUTIVE LC E YN
(Mandatory In NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
N/A
IC0009128 -02
01/21/11
01/21/12
X I ORY TA TI - I T I ER
E.L. EACH ACCIDENT
$ 100,001
E.L. DISEASE - EA EMPLOYE=
$ 100,00 6
E.L. DISEASE - POLICY LIMIT
$ 500,001
DESCRIPTION OF OPERATIONS r LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required)
ELECTRICAL
City of Miami Shores
10050 N.E.2nd Avenue
Miami Shores, FL 33138
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
4'1.41414 /e,
ACORD 25 (2009/09)
@ 1988 -2009 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
CTQB Board
BUSINESS CERTIFICATE OF COMPETENCY
000016803
ELECTRAK LTD INC
D.B.A.:
GOMEZ GEOVANI
Is certified under the provisions of Chapter 10 of Miami -Dade County
VALID FOR CONTRACTING UNTIL 09/30/2013