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EL-11-361Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 I/21� Inspection Number: INSP - 156616 Permit Number: EL -3 -11 -361 Scheduled Inspection Date: September 21, 2011 Inspector: Devaney, Michael Owner: RIVERA, PETION Job Address: 10639 NE 11 Court Miami Shores, FL 33138 -2122 Project: <NONE> Contractor: INDUSTRIAL ELECTRICAL SYSTEM CORP Permit Type: Electrical - Residential Inspection Type: Final Work Classification: Addition /Alteration Phone Number Parcel Number 1122320280250 Phone: 305/228 -1384 Building Department Comments RELOCATE 6 LIGHTS FIXTURES AND 5 RECEPTACLES FOR KITCHEN AND BATHROOM REMODEL Passed D Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments September 20, 2011 For Inspections please call: (305)762 -4949 Page 2 of 34 Miami Shores Village "frS/ Building Department r t 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 BUILDING PERMIT APPLICATION FBC 2004 JLG 42 Permit Type: Electrical Owner's Name (Fee Simple Titleholder) Petion Rivera Owner's Address 10639 NE 11 CT BY: : •o 000 •a •ooaeaaeaf' " Permit No..\ Master Permit No. Phone # City Miami Tenant/Lessee Nance E -MAIL: State FL zip 33138 Phone # Job Address (where the work is being done)10639 NE 11 Ct City Miami Shores Village County 1Vfiami- -Dade zip 33138 FOLIO / PARCEL # Is Building Historically Designated YES NO x Contractor's Company Name Industrial Electrical Systems Corp Phone # 305 228 1384 Contractor'sAddress 10257 NW 9th St Cir # 205 City Miami State Florida Qualifier Name Nestor I. Corvea Zip 33172 Phone # 305 228 1384 State Certificate or Registration No. EC 13002182 E -MAIL: iesmiami @comcast.net Certificate of Competency No. Architect/Engineer's Name (if applicable) Phone # Value of Work For this Permit $ $500.00 Square / Linear Footage Of Work Type of Work: ['Addition ['Alteration ['New Describe Work; Relocate 6 Light Fixtures + 5 receptacles SM oe snag miaa3 Mil NMI M % nolertattno3 olition ***************************************F , ** **** **** * * * * **** * * **** ****** ** *anus **** * Submittal Fee $ Permit Fee $ /f2 < 4'4' CCF $ CO /CC Notary $ Training/Education Fee $ Technology Fee $ Scanning $ Radon $ DPBR $ Zoning $ Bond $ Code Enforcement $ Double Fee $ _ Structural Review. $ Total Fee Now Due $ See Reverse side -, 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 charged Signature 9 Y Si /�- •- ' `'-4'W /Q�� Signature "/ Owner or Agent Contractor The foregoing instrument was acknowledged 'amore .m, a this The foregoing instrument was acknowledged before me this 02nd day of (,�/ + , 20/ / , by E�t day of March , 20 11, by o is personally known t r s r who has produced who is personally known to me or who has produced As identification and who did take an oath. as identificata , , (H.-oho' Rs 14, ;ales NOTAR PUBLIC: NOTARY PUBLIC: Notary Public, - State of Florida comma* +I on 913453 MY irN 11 -17 -2013 *tunic Bond Co. Inc. Sign: " APPLICATION APPROVED BY: (Revised 02/08/066) Print: Francisco P Morales My Comminion Expires: 11/17/2013 **************************** * * * * * * *** * * * * * * *** * * * * * *** * **** Plans Examiner Engineer Zoning A QRD CERTIFICATE OF LIABILITY INSURANCE 03 m1�'1 PRODUCER OVERSEAS INSURANCE AGENCY P. O. BOX 1 MIAMI, FLORIDA 33116 THIS CER RFICATE 1S ISSUED AS A MATTER ONLY AND CONFERS NO RIGHTS UPON THE DOES NOT AMEND CORDED OF INFORMATION CERTIFICATE EXTEND POLiCIES BELOWQ . AL ER THE CO BY THE INSURERS AFFORDING COVERAGE . ENSURED INDUSTRIAL ELECTRICAL SYSTEMS CORP 10257 N.W. 9 ST CIRCLE #205 MIAMI, FLORIDA 33172 - L I INSURER A: NOVA CASUALTY COMPANY INSURER e: INSURER e: ®ISURER D: _ INSURER E COVERAGES THE POLICIES OF INSURANCE LISTED BELOIN HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTV$1THSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POUCIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITB SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. _ MISR LTR TYPE OP OMURA= FOXY WEBER POLICY EFFECTIVE BAIR RAVARTRIVYt GENERAL LIABILITY A X coMMERCmy. GENERAL uABILITY MAIMS MADE 1 X 1 OCCUR -250 DED OWL AG REGA1E umir APPUJE$ PEIr X POLICY f ACT fl LOC AUi ILELIABB37Y ANY AUTO ALL. OARED AUTQ8 SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS 09 ALL39093 05112/10 05/12/11 OCCURRENCE $ 500,000 FIRE DAMAGE (An' meets) $ 100.000 MED EXP (Any c preen) PERSONAL 8 ADV INJURY $ 500,000 GEBERALAGGREWE $ 1,000,000 PRoot TS- COMP P s 1,000,000 COMBINED ALE LEST (Ea meldent) BODILY INJURY (Perper ) BODILY INJURY (Pet $ PROPEITT Y DAMAI (Pe $ GARAGE UABB.ITY ANY AUTO AUTO ONLY - EA ACCIDENT E OTHER THAN AUTO ONLY: EAACC $ AGO $ i___,ECCESS LIABILITY OCCUR p CLAIMS MADE DEDUCTIBLE RETENTION $ EACH OCCURRENCE $ AEGATE $ $ WORIUBLS4:061PENSATKIN AND WOLIN 1 4i 8T{CIUU- 1 ICSiH 1 TORY L MUS 1 ER E.L EACH ACCEIBD 6 ELDICCADE- EA. Eb$LOYEE $ E.L. DISEASE - POLICY LIMIT $ DEBCRip$Met CIF OPERATIONSiLOCATIDIEWEHICLESIEXCLUSIONS ADDED BY EMXISSBEENCEPECIAL DESCRIPTION OF OPERATION ELECTRICAL WIRING: ..a.�......�..�..�M�.. - � .............�...,.. M..,,..�....o..�_ _�., Village of Miami Shores 9 10050 NE 2ndAVe Miami Shores, FL. 33138 Fax:: 305 756 -8872 - -- --- - — N mawaIE POL sBE I THEIDOMIATUMI DATE THEREOF, THE ISSUINO INSURER VW- mammon TO MAIL 30 DAYS WRITTEN NOD= TOME CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SNALI. IMPOSE NO DBUDATIDN OR aIABU ITV OF ANY KIND UPON THE INSURER, ITS AGENTS OR REMMEITATIVES. _ �wwwR www..ww�.eaw�e awna ACORD 254 (7197) ,a o,RL CERTIFICATE OF LIABILITY INSURANCE 03 2-' 011 1 THIS CERTIFICATES ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIRCATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POUCIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER'S). AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIRCATE HOLDER. . IMPORTANT: If the certificate holder Is an ADDITIONALMISURED, the policy/lies) must he endorsed. If SUBROGATION'S WAIVED, subject to the terms and titian of the policy, certain policies may require an endorsement. A stetementan this cerdf sate does not confer its to the certificate holler in lieu of such endorsementls). PRODUCER PAYCHEX INSURANCE AGENCY INC . 210705 P:()- F:(888)443-6112 P O BOX 33015 SAN ANTONIO TX 78265 CAE CT PHONE - Fax No at; �INC.Ne): (8Ba }443 -61 2 ADDRESS: cuusTTU IJ)B: INS) AFFORDING COVERAGE NAIC t p1MD INDUSTRIAL ELECTRICAL SYSTEMS CORP 10257 N.W. 9TH STREET CIR. APT. 205 MIAMI FL 33172 INSURER A : Twin City Fire Ins Co INSURER g. INSURER C: EACH OCCURRENCE INSURER D : INSURER E : 8 INSURER F ; I CLAIMS -MADE U OCCUR COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED RFI.OW.HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POUCY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT. 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. OMR LTR TYPE OF INSURANCE NSRC� POLICY MUM II mVYYY) IM POLICY' UMJTB WIRRAL LIAMLJTY COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ RtNitD PRE�MI� �) 8 I CLAIMS -MADE U OCCUR MED EXP (Any one person) 8 PERSONAL & ADV INJURY 8 GENERAL AGGREGATE $ GE AGGREGAE OMIT APPLIES PE& PRODUCTS - COMP/OP AGG $ _111. POLICY U LOC 8 AUTOMOBILE LIABILITY ANY AUTO ALL OWED AUTOS SCHEDULED AUTOS HRB AUTOS NON-OWNED AUTOS COMBINED SINGLE LIMIT (Ea accident) 8 — BODILY INJURY Per person) $ -- — BODILY INJURY iPer accident) $ PROPERTY DAMAGE 1 $ — _ $ a U JA UAS U OCCUR UAS I 1 MADE EACH OCCURRENCE $ — _ AGGREGATE $ DE3UCTIBLE RETENTION s $ $ A AND ANFlCER/4 (Harr If COMP6�ISAT�N �IOYERS' LtANun Y / N N/ _ 7 6 WEG F0618 8 of/24/2011 Ol/24/2012 TH- X L I I _ E .EACH ACCIDENT 8 1,000,000 $ 11000,000 BER CLUDNED cLmvE EJ DISEASE - EA EMPLOYEE kr NHJ -- PTION a OPERATIONS trefaw E.. DISEASE -POLICY ut rr $ 1, 000,000 DESCAI PION OF OPERATIONS / LOCATIONS/veer-um (Attach ACORN 101. Additional Remake She. U more space Is required) Those usual to the Insured's Operations. Village of Miami Shores 10050 NE 2 ndAVe Miami Shores, FL. 33138 Fax: 305 756 -8972 ) SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE THE E(M THEREOF. RATION DATE NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POUCY PROVISIONS. AUTOO ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD