EL-11-751Permit Number: EL -4 -11 -751 j
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
nspection Number: I NS P- 168903
Inspection Date: January 26, 2012
Inspector: Devaney, Michael
Owner: CEPERO, ROBERTO
Job Address: 50 NE 91 Street
Miami Shores, FL 33138-
Project: <NONE>
Contractor: CONNECTICUT ENGINEERING INC
Permit Type: Electrical - Residential
Inspection Type: Final
Work Classification: Alteration
Phone Number
Parcel Number 1131010200030
Phone: (305)525 -6382
Building Department Comments
ELECTRICAL WIRING RESIDENTIAL PORCH
Passed
Inspector Comments
CREATED AS REINSPECTION
counter.
GARAGE RECEPTACLES
oUTSIDE RECEPTACLES
2 il,,/''
FOR INSP- 168785. Add 2 receptacles to kit.
TO BE g. f. i. PROTECTED.
TO BE TP/WP.
Failed
Correction
Needed
,/e---
je-te /
Re- Inspection
Fee
No Additional Inspections can be scheduled
re- inspection fee is paid.
until
January 25, 2012
For Inspections please call: (305)762 -4949
Page 1 of 1
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
' '7) 2011
BY:
Permit No. 0-4 i ' 751
Master Permit No. (40- Z( S
Permit Type: Electrical
OWNER: Name (Fee Simple Titleholder): Ro 4a c c —P�iDO f 3A$EL, R.o ott Phone #:
Address: 50 r+B (t 5r
City: Al 4,i State: PL.. Zip: 33 t38
Tenant/Lessee Name: "ItsP Phone #: 0414
Email: N4 1!►
JOB ADDRESS: St-. t►$ e. qt sT
City:
Folio/Parcel #:
Miami Shores
t 1 24.l0 IOZ0cc,
County:
Miami Dade Zip: 331 58
Is the Building Historically Designated: Yes
NO Flood Zone:
CONTRACTOR: Company Name: Gota tc. jr 1E14CM * t NZCa4, tMC.. Phone #: 3 S X525 -4.1eZ.
Address: t1?O w . 4o ST 1151)..1 464
City: AAt..t,.c4t 4 State: 6�.,..
Qualifier Name: %a.. t t►-tEt a 2.
Zip: 33 0iz.
Phone #: 30S'5S ' -4A 4al
State Certification or Registration #: Eta 00 t t8 54 Certificate of Competency #: 0000 l e rl t
Contact Phone #: io5 -.52s-(.5&, . Email Address: J,State* 62. bb i.. A..1 St..% • COP•4
DESIGNER: Architect/Engineer: Nf p. Phone #:
Value of Work for this Permit: $ //✓` 0o, m Square/Linear Footage of Work:
Type of Work: DAddress L9Alteration ❑New DRepair/Replace ODemolition
Description of Work: e, CAL. tx5tR..1t E tIzi nah... `?'O
* * * ** * * * ** * * * ****** **** * *** * * * ** * * ** Fees * * ** ** * * * * * * * * * * * ** * * * ** n * ***x:***** * * * * * ****
Submittal Fee $ Permit Fee $® 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 CotYpany's Address
City State
tv
Mortgage I ?er's Name (if applicable)
Mortgage Lender's Address
City F.1 f A.
alb
Nq/m.
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 MR 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 abse e of such posted notice, the
inspection will not beeaap,• ved and a reinspection fee will be charged.
Signature
Owner or Agent
The foregoing instrument was acknowledged before me this 0
day of •� //(y(� sl, / , 20A, by £berms de /ego ,
who is personally known to me or who has produced D. 1.-
As identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
My Commission Expires.
Signature
C
The foregoing instrument was acknowledged before me this o2°'
day of A ®Kip/ , 20 1/ , by Zdsc TI r,Ie
who is personally known to me or who has produced D , L
as identification and who did take an oath.
NOTARY PUBLIC:
actor
Sign:
•� • •Corr fion #
,. Expires Februaryssi DD 139348 , 2014M Commission
RERA Pr:
Sealed TmuTreyFeinInsumice806395 .7019
• :-- Commission # DD 9348
Expires February 13:2014
..�
Wand Thin Ttdy Finn Insurance 1 'Q9- 395.7919
k*** *** *************** .. . . ****: knk****>! ksk: k: k* ** *ak* skHa*sk* sk*: k**X: *skskiksk: kskx: ***ok*sks k*ik*Hj H: *oksksk*ikik>' k: ksk**skikskskskik***ak >'k******ak
9d 7 /9V Plans Examiner Zoning
APPROVED BY
Structural Review
(Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09)
Clerk
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 CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR:.
A. COPY OF QUALIFIER'S STATE LIC CARD
B. COPY OF LOCAL BUSINESS TAX RECEIPT
C. COPY OF LIABILITY INSURANCE (CERTIFICATE HOLDER TO BE MIAMI SHORES VILLAGE BLDG DEPT)
D. 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 CONTRACTOR'S INFORMATION
BUSINESS NAME: co N •aelcr‘cxwT re�.y� eat a� % Nc_.
BUSINESS ADDRESS: r1"10 w • 440451. ems► CITY +AA1 $
STATE Ft-. ZIP CODE 30%."2-
BUSINESS BUSINESSPHONE:(305) 6.53- 416% FAXNUMBER(3os ) 553 -.1tGl
CELL PHONE (3c5) 525-(.33 a QUALIFIER'S NAME: ..S . i
QUALIFIER'S LIC NUMBER: Eft oocD %SSA , c o°Go teal t
E -MAIL ADDRESS (IF APPLICABLE): u- e z iPmt@ •►+sr.+. Cam+
Cleated on 3119109 BY MLDV 1 RV 3n8109 MLDV
ALEX SINK
CHIEF FINANCIAL OFFICER STATE OF FLORIDA
DEPARTMENT QF 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.
12 -16 -2009
EFFECTIVE DATE:
PERSON:
12/16/2009
JIMENEZ
FEIN: 651138722
BUSINESS NAME AND ADDRESS:
CONNECTICUT ENGINEERING INC
1770 WEST 40 STREET BAY 4
HIALEAH FL 33012
SCOPES OF BUSINESS OR TRADE:
1- CERTIFIED ELECTRICAL CONTRACTO
EXPIRATION DATE: 12/16/2011
JOSEPH A
IMPORTANT: Pursuant to Chapter 440. 05(141 F.5:, 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 et any time for failure of the person
named on the certificate to meet the requirements of this section.
DWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 09 -06
QUESTIONS? (850) 413 -1609
PLEASE CUT OUT THE CARD BELOW AND RETAIN FOR FUTURE REFERENCE
STATE OF FLORIDA
DEPARTMENT OF FINANCIAL SERVICES
DIVISION OF WORKERS' COMPENSATION
CONSTRUCTION INDUSTRY
CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA
WORKERS' COMPENSATION LAW
EFFECTIVE: 12/18/2009 EXPIRATION DATE:
PERSON: JOSEPH A JIMENEZ
FEIN: 851138722
BUSINESS NAME AND ADDRESS:
CONNECTICUT ENGINEERING INC -
1770 WEST 40 STREET BAY 4
HIALEAH, FL 33012 •
SCOPE OF BUSINESS OR TRADE:
1- CERTIFIED ELECTRICAL CONTRACTO
12/19/2011
IMPORTANT
F 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
L under this section may not recover benefits or compensation under this
D chapter.
H
E
R
E
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
CUT HERE
* Carry bottom portion on the Job, keep upper portion for your records.
DWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 09-06
-4-v- .31
SEE OTHER SIDE
DONOTTORWARD
'CONNECTICUT ENGINEERING INC
JOSEPH ANTHONY JIMENEZ PRES
1770 W 40 ST 4
HIALEAH FL 33012
67
3058290594
TO:3057568972
to- 015
MIAMI- DADE.COUNTY TAXtCOLLECTOR
Miami, Florida 33130
Please keep your receipt for
future reference.
Thank you and have a nice day.
5/3/2011 1300/228/001SAKENI 0007 -0001
Last eq.0:0001 WI LBT # :11 687068 -7
Las 5
$100.00
$81.23
CA
CHANGE
MIAMI -DADE COUNTY TAX COLLECTOR
LOCAL BUSINESS TAX SECTION
140 W. Flagler St. - let Floor
Miami, Florida 33130
TEMPORARY RECEIPT
2010 -2011
MUNICIPAL CONTRACTOR TAX
Local Bueinees TaxU:11687064 -7
State/CCH ;000018771
Issued to;
CONNECTICUT ENGINEERING INC
Type of Business:
ELECTRICAL CONTRACTOR
RESTRICTED TO
MIAMI SHORES
THIS RECEIPT
FOR OTYR
IS ISSUED OF
I. BUSINESS
OR PERMIT.
YOUR OFFICIAL RECEIPT WILL BE MAILED
TO YOU WITHIN 10 DAYS FROM THE
VALIDATION DATE ON THIS RECEIPT.
Payment Received as Certified Above
Miami -Dade County Tex Collector
et ti 9■ a s■ a■ a a a o s a s s s
0P0
P.2
MAY -3 -2011 18:28 FROM: 3058290594 TO:3057568972 P.3
s:;IF
I l ,
wr : �_ ���► a .e• ,
Con atl'on TradesOualii i►1g „Board
BUSINESS CER Ii CATE.OF comPETp1f,Cr
oo•o:o�i
J.Q$EPHANTHO.NY
?scentlf%clound'ec theprovl idhs'of ,C•hapteri ocif 1glinii d
VALID FOR CONTRACTING UNTIL 09/30/20'11
Apr. 29. 2011 11:06AM
No. 6808 P. 1,
uate enterer!. vq/ 29/207-1
�'� ° CERTIFICATE
...., ....,..�... _ .. _ _
OF LIABILITY INSURANCE
DATE(MMIDOIYYYY3
4 /29/2011
THIS CERTIFICATE IS ISSUED AS A MATTER
CERTIFICATE DOES NOT AFFIRMATIVELY
BELOW. THIS CERTIFICATE OF INSURANCE
REPRESENTATIVE OR PRODUCER, AND
OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED SY THE POLICIES
DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
I• CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an
the terms and conditions of the policy, certain
certificate holder in lieu of such endorsen(nt(s).
ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to
policies may require an endorsement. A statement on this certificate does not confer rights to the
PRODUCER
FLORIDA BANKERS INSURANCE
JORGE L GONZALEZ
917 SW 122 AVE
MIAMI, FL 33169
4.
• •
,
j
AACT
ME:
NA (305)225 -1243 elith 305)25 -503 _
DRE93 FLORIDA REINSURANCE . COM
ADDRESS;
INSURER{SZAPFORDING.COVERAGE
NAIC11
ASCENDANT INSURANCE CC2+IPANY
INSURER A
INSURED CONNECTICUT ENGINEERING
MR JOSEPH JIMENEZ
1770 W 40 BAY #4
HIALEAH, rL 33012
3INC.
•
INSURER B:
INSURERC:
INSURER D: '
INSURERS:
INSURER F :
COVERAGES CERTIFICATE
NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES Ok1IN$URANCE
INDICATED. NOTWITHSTANDING ANY REQIJ
CERTIFICATE MAY BE ISSUED OR MAY PE
EXCLUSIONS AND CONDITIONS OF SUCH PO
LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
EME NT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
AIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS.
1, IES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
LTR
TYPE OF INSURANCE
AD,LBUHR
, ■
!
I
II.
PQUCYNUMBER
GL-30779-3.
POLICY Er
Mu • •
9/23/2010
PoucYExr
i ' • •Auer
9/23/2011
LINTS .--
GENERAL LIABILITY
EACH OCCURRENCE
31,000,000
XCOMMERCIAL
GENERALUABIUTY
pREMMISES ER( aaTa0B1
$1,000,000
CLAtw$ MADE OCCUR
MED EXP (Any one pawn)
$5 , 000
PERSONAL 8 ADV INJURY
1 000,000
S r
GENERAL AGGREGATE
31,000,000
Gfitd L AGGREGATE LIMIT AP(PLI PER
PRODUCTS - COMPNP AGO
31, 000,000
POLICY
—ES
P CT I
LOG
$
AUTOMOBILE LIABILITY
• i 1
I
lE OWNED SINGLE
—
—
ANY AUTO
BODILY INJURY (Per Femme
$
ALL OWNED
AUTOS
HIREDAUTOS
-
_
SCHEDULED
NON -OWNED
AUTOS
BaILYINJURY (Per accident)
2
PROPERTY DAMAGE
(Per_made+1)
$
3
UMBRELLA LIAR
EXCESS UAH
_
OCCUR
OlAIM8MADE
I '
f '
■ i
I
_
�•-
EACH OCCURRENCE
$
AGGREGATE
S
DED 1] RETENTION $
$
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNERIEXECUTIVE 0
OFFICERAIEMBER EXCLUDED?
(MandatorylnNH)
II ES ResaON undo
DESCRIPTION OF OPERATIONS below
I I
N
•II
f
yy� p I j
I TORYTIMI R f IO
E.L. EACH ACCIDENT
$
E.L DISEASE - EA EMPLOYEE
2
E.L. DISEASE - PDUCY LIMIT
$
DESCRIPTION OF OPERATIONS I LOCATIONS/ VEHICLIIS
ErACTRICAL CONTRACTOR
I4 ttach ACORD 101, MOM Familial Schedule, If mo a Space Is required)
Ii
t•
•
CERTIFICATE HOLDER i
I CANCELLATION
Mind Shores Building I:1kaztment:
i
10050 ne 2 ave
Miami 'Shores, a 33138 I
SAX(305)756 -8972
1 •
,
i
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES SE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
Au7NORB EV REPRESENTATIVE
•
ACORD 26 (2010106)
produced using Forms Boss P(us software. www.FoansBosa
-20111 ACORD CORpvw4TION. All nghts reserved.
The ACORD name and logo are registered marks of ACORD
l:om: Impressive PubUehing 800.208.1977