EL-11-1776Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
--r\(03'A
Inspection Number: INSP- 170290 Permit Number: EL -9 -11 -1776
Scheduled Inspection Date: March 01, 2012
Inspector: Devaney, Michael
Owner: GOLDBERG, JONATHAN
Job Address: 9901 NE 13 Avenue
Miami Shores, FL
Project: <NONE>
Contractor: EMPIRE ELECTRIC MAINTENANCE & SERVICE INC
Permit Type: Electrical - Residential
Inspection Type: Final
Work Classification: Alteration
Phone Number
Parcel Number 1132050090480
Phone: 305 - 264 -9982
Building Department Comments
INTERIOR REMODELING SERVICE UPGRADE
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
CREATED AS REINSPECTION FOR INSP- 169932. CREATED AS
REINSPECTION FOR INSP- 167246.
Progress.
c2-
/(-1/-72-2-‘2-/
February 29, 2012
For Inspections please call: (305)762 -4949
Page 12 of 21
10- 24 -'11 12:46 FROM- Empire Electric 305 -264 -1974
T -958 P002/002 F -093
,ftwicO CERTIFICATE OF LIABILITY INSURANCE
DATE " o
THIS CERTIFICATE 13 15SUED 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 en ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to
the teens and oondirtions 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 endorsarnant(s).
PRODUCER
rortun Is33urance, Inc.
365 Palermo AVe.
Coral Gable's FL 331.34-6607
CQNSAGi
NAms1 Nayza Diaz
_rq4 °; (305) A45 -3535 1 Naf: (666) 415,-0825
AADriaing.000,51.158 DARFSS: Neyza,Die.a @fertuninsurance.com
ENSUREk(S)AFi'ORDINdCOVERAGE
NAIC
INSURED
Empire Electric Maintenance 8 Services, Ina.,
Empire Fire Safety Inc .
1041, SW 67 Avenue
Miami FL 33144
rnvvn w rc. ------ - -- - -- -- --
INSURER A:W$p$a1.1 Underwriters Ins. Co.
INSUREsn Wausau Business Insurance Co.
TBC -291- 431738 -011
INSURER C Chartis
3/31/2012
INSURER D Employers Ins. Co of Wausau
$ 1,000,000
INSURERS:
P EAAIGSES Ea ENTED cccumancel
INSURER F :
THIS
INDICATED.
CERTIFICATE
EXCLUSIONS
ILTR
IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
TYPE OF INSURANCE
INSR
WVD
POLICY NUMBER
(MMIDD/YYYY►
.
IMMIDD
LIMITS
D
GENERALLWBdLIIY
COMMEROIAL GENERAL LIABIUTY
TBC -291- 431738 -011
3/31/2011
3/31/2012
EACH OCCURRENCE
$ 1,000,000
X
P EAAIGSES Ea ENTED cccumancel
$ 300,000
CLIMB -MACE X
00OUR
MED ExP (Anyone person)
5 5,000
PERSONAL &ADV INJURY
$ 1,000,000
GENERAL AGGREGATE
$ 2,000,000
OEN%
AGGREGATE UNIT APPLIESMt
PoUQY n'1R& n LOC
PRODUCTS- CO MP/OP AGO
$ 2,000,000
il
$
8
AUTOMOBILE
LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
FIIREDALfIOS
NON- QWNEDAUTOS
Physical Damage Ded $600
ASA292.- 452.75$ -029
3/31/2011
3/31/2012
COMBINED SINGLE UMIT
(Ea accident)
s 1,000,000
X
BODILY INJURY (Per person)
$
90DiLY INJURY (Peraa idenU
$
_
X
PROPERTY DAMAGE
(Per o:
$
X
$
X
S
C
X
UMBRELLA LIAR
EXCESS ME
X
OcCUIt
CLAIMS -MADE
/3E02.1565694
3/31/2011
3/31/2012
EACH OCCURRENCE
S 2,000,000
AGGREGATE
S 3,000,000
DEDUCTIBLE
RETENTIQN 8 0
ProduttaComprotedQpe
s 3,000,000
X
$
A
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY PROPRIETOPIPARTNEIVE
(FRrdatna9EltWDrt
(Mandatory h: NH)
unveil
DESCRdIPnON OF ORATIONS
Y!N
NIA
WC17- -291- 451738 -039
3/31/2011
3/31/2012
X TQRYLIMILE 5R
ECUTIVE
E.L
5 500,000
below
Est DISEASE -EA EMPLOYEE
5 500,000
S
E.L. DISEASE - POLICY UMIT
500,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ABM ACORD 104. Additional Remarks Schedule, W more space Is required)
CERTIFICATE HOLDER CANCELLATION
Miami Shores Village
10050 NE 2 AVE
Miami Shores, FL 33138
ACORE] 2A f2nnnm01
SHOULD ANY OP THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
•
AUTHORIZED REPRESENTATIVE
r
Hector Fote t/ND
®1988 -2009 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
10- 24 -'11 12:46 FROM- Empire Electric 305 - 264 -1974 T -958 P001/002 F -093
AC#.50 .'$;$4 .
STATE QF FLORIDA
DEPAR P 03+'' 3r#f3S NESS P2 ?I?FSSIONAL REQQLATION
ELECTRI•GAL''CO T R T:91 .., .L. C g•ING• 139AW • ^E( 1#Lioo7a201298
LICENSE "NB'R
07/22•/•20.10:1'118.01.3.880.. •ECO:00a.2.7.4.- •�,,,.
.2? a EL;ECTR C L : CONTRAcTQR• •
. Ngisted 1��.1' i4v::':FS gERTIFIED'
1344er ' �h "p ov�,s:ions o 'Chapter,;;,
Expiration Cate i 'AUG 31, 2012
IERNAND$Z, �:. •ANTONIO • E •• .
'EN T .' ELEC':~14AYN`T• :&`' 'SER INC•` ••..,'.
• 1:04 V: . STPI, ::'4 7.'' 'AVENUE . •
WEST 11IA31/ FL 33144
C%ZE GRIST
DttPLA eik RE:QLI1RED •E•Y.iAW
CE PL EE .'LIEN
ITT' ERIM SECRETi,RY
1
MIAMI -DADE COUNTY
TAX COLLECTOR
140 W. PLAGLER ST.
ML ., FL 33130
2011• LOCAL BUSINESS TAX RECEIPT 2012 FIRST -CLASS
MIAMI -DADE COUNTY - STATE OF FLORIDA U.S. POSTAGE
MUST BE DISPLAYED AT PLACE OF BUSINESS PAID
PURSUANT TO COUNTY CODE CHAPTER 8A - ART. 9 & 1;0 • PERMIT MIAMI, 0.23231
231894-7 TI'!IS IS NOT A SILL - 00 NOT FAY
BUSINESS NAMg LOCATI N RENEWAL
EMPIRE ELECTRIC MAINTENANCE STATE *EC0001274 243764 -8
& SERVICE INC
1041 SW 67 AVE
33144 WEST MIAMI
OWNER
EMPIRE ELEC MAINTENANCE & SVc IN
se 3 96girrAt „O.,T...,.T__ WORKER /S
EUUElME$g TAX REOEIPT. IT
O G * E mOR
COMP!
OOoo EXEee DT' N'/
NO? A CERTW CAT,OE GE
THE IvOLOBR'2 OCAiIPICA.
PAYMENY R name
II44r 2O�, CO:IIVW YAY
07/13/2011
09010138001
080045.00
SEE OTHER SIDE
DO NOT FOBWaRD
EMPIRE ELECTRIC MAINTENANCE
& SERVICE INC
ANTONIO HERNANDEZ
1041 SW 67 AVE
W MIAMI FL 33144
11 „1:1111,11111, 1111111,1, 1, 1,11,i1, iris 11,111111a81
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): 14 S ®!/71 6 ropier Phone#:
Address: f 901 /'Y E %� !Il/Q �° /
City: %ii tarn 1 3 %106'20 State: r( Zip: .3a/ gr
Tenant/Lessee Name: Phone #:
Email:
JOB ADDRESS: 9901 /J E 1314 . /J,
City: Miami Shores County:
Folio/Parcel #: /7— 30205— mg aLi(a
Is the Building Historically Designated: Yes NO Flood Zone:
CONTRACTOR: Company Name: Ein p ire! 8lecirtc, f ef C_Phone #: 319.1--264-938 2
Address: OH 6°W 7 4�
City: l I State: Zip: 33
Qualifier Name: onto L /4-ern a n . ea Phone #: % r- 796 -06/ p. 0
Permit No. EL 1 (`"
Master Permit No. IZe/ I t • (( g
Miami Dade
Zip: 33131
State Certification or Registration #: 000 ®o-'
Contact Phone #: , ' "%96, —Q690 Email Address:
DESIGNER: Architect/Engineer:
Certificate of Competency #:
72:.ny e
Phone#:
Value of Work for this Permit: $ �� ® ®® �® Square/Linear Footage of Work:
Type of Work: ❑Address - Wilteration �OpNew� . ORepairIReplace ODemoo/lition
Description of Work: —I /1f't�'d ®Y r 'eroc // /i'1 /tffewce? ' 7rGC(.�'�
**:x*+x******* * * ** ** x*x : *x:*********+x****** pees***************** **** **:x******* ***x:******* **
Submittal Fee $ ° l' Permit Fee $ ✓r
Scanning Fee $ Radon Fee $
Notary $ Training/Education Fee $ Technology Fee $
Double Fee $ Structural Review $
TOTAL FEE NOW DUE $
O CCF$ CO /CC$
DBPR $ Bond $
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 CONDMONERS, ETC
OWNER'S AI IDAVIT: 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 $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. I, the absence of such posted no
inspection will not bj�ppr+ved and a reinspection fee will be charged.
er or Agent
The for oing instrument was ackno ledged bef e me this
day of t , 2Q&Iby d 1I$ l°!/ ,
who is personally known to me or who has produced
Asi
NOTARY UBL C:
Sign. A1
My Commission Expires:
?e:
on an
": MY COMMISSION # EE032278
EXPIRES October 05, 2014
Ftoridallota rvice.com
{ bkOPPER
7) 308-0163
J! 1'
/d .5 ,i
* * * * * * * * * ** * * * * * * * * * * * * * * * * * * * **
APPROVED BY
s
Signature
Contractor
The foregoing instrument was acknowled ed before - s
day of S.'
' , 20 / f, by rn anae
who is personally known to me or who has produced
as identification and
Examiner
Structural Review
(Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09)
c /1
KARL A t3ROPPER
NOTARY PUBLI < <?' MY COMMISSION # EE032278
./�� EXPIRES October 05, 2014
/i 1 p �i �l/��i 4tr 398.0153,,., floricra m ....sgan..^ �. 2
r��far,
Sign:
Prin
My Commission Expires:
/o
b //
Zoning
Clerk