EL-12-848Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)7564972
Inspection Number. I NSP- 173449
Scheduled Inspection Date: May 31, 2012
Inspector: Devaney, Michael
Owner: MUNOZ, JAVIER
Job Address: 75 NE 98 Street
Miami Shores, FL
Permit Number: EL -5 -12 -848
Project <NONE>
Contractor: LS CURTIS INC
Permit Type: Electrical - Residential
Inspection Type: Final
Work Classification: New
Phone Number (305)970 -5368
Parcel Number 1132060131160
Phone: 305492 -0115
Building Department Comments
120 VOLT RECEPTACLE FOR GATE MOTOR
Passed
D
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
�rhmr2G��,
May 30, 2012
For Inspections please call: (305)762 -4949
Page 13 of 26
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
(
BUIL DING
PERMIT APPLICATION
FBC 20 ID
Permit Type: Electrical C��7
OWNER: Name (Fee Simple Titleholder): 7 / 'f 40/ 7 Cg_ Phone #:3°` r 0 - s 3
Address: 73T /V(' ? )' S
City: (1,-2 j �7r�irZ State: /
Zip: ,,,?_7/ ,9
Tenant/Lessee Name: Phone#:
Email:
Permit No. 1 r� _
Master Permit No. (• T
JOB ADDRESS: 7 S /'r( 7 1 S /
City: Miami Shores County: Miami Dade Zip: (2J,/ .%J
Folio/Parcel #:
Is the Building Historically Designated: Yes NO Flood Zone:
CONTRACTOR: Company Name: L S Curtis
Address: 20341 NE 30 Ave #108
City: Aventura
Qualifier Name: Lewis S Curtis
State Certification or Registration #: E C 0 0 0 317 5
Contact Phone #: 786-486-1961
DESIGNER: Architect/Engineer:
inc
Phone #: 786- 486 -1961
State: FL
Zip: 3 318 0
Phone #: 786 - 486 -1961
Certificate of Competency #:
Email Address:
aasteve @aol.com
Phone #:
Value of Work for this Permit: $ 51'0 ` ° c2 Square/Linear Footage of Work:
Type of Work: DAddress DAlteration UNew ORepair/Replace
Description of Work: / 2 c 1, C) Z 2 0 /l y e c / /
DDemolition
*** ** ** *** :******** * * ** *** ************ Fees************ *****:x*** * * *** * ****x:x::x** ********
Submittal Fee $ Permit Fee $ /.0 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 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 absence of such postedtice, the
inspection will not ' approved n4 a rinspection fee will be charged.
Signature
Owner or Agent
The foregoing instrument was acknowledged before me this
day of f4l ,20 2., byj 3�
Signature
Contractor a�
_s
The foregoing instrument was acknowledged before me this )
�` day of , 20 L, by fr1 , i ✓ 1r e
who is personally known to me or who has produced 11 wh is personalh" or who has produced
(i1cNV1 -1 1 s identification and who did take an oath. as identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
My Commission Expires:
8
511 11' OVION c
•
90.1901£0
Sign:
Print:
My Commis s 4
4
j ,il, l'I. l 1 •
otar N Public - State of Florida
Y
I My Comm. Expires May 13, 2014
— z, Commission # DD 991888
''F`�� Bonded Through National Notary Assn.
* * ******* * * * *** * ** * *o* s=ix *s: *a«OP* y ** \ \n * * * ;14 * ** ** * * * * * * * ** * * * * * * * * * * * * * * * *a rRs oar*W *Ins
tdp
'11414,: 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: L S Curtis Inc
BUSINESS ADDRESS: 20341 NE 30 Ave 108 CITY Aventura
STATE FL ZIP CODE 33180
BUSINESS PHONE:( 305 )892 -0115 FAXNUMBER(305 )932 -1009
CELL PHONE (786 ) 486 -1961 QUALIFIER'S NAME: Lewis Curtis
QUALIFIER'S LIC NUMBER:
EC0003175
E -MAIL ADDRESS (IF APPLICABLE):
Created on 3119109 BY MLDV 1 RV 3126109 MLDV
aasteve @aol.com
STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
ELECTRICAL CONTRACTORS LICENSING BOARD
1940 NORTH MONROE STREET
TALLAHASSEE FL 32395-0193
CURTIS, LEWIS STEVEN
L.S. CURTIS INC
20341 A1E 3-0TH AVE
AVENTURA
FL 33180
Congratulations! With this license you become one of the nearly one million
Floridians licensed by the Department of Business and Professional Regulation.
Our professionals and businesses range from architects to yacht brokers, from
boxers to barbeeue restaurants and they keep Florida's economy strong.
lt0003
Every day we work to improve the way we do -business in order to serve you better
For information about our services, please log onto ‘vww.rnyfloridalicerise.corn. CER_ PI
There you can find more information about our divisions and the regulations that
knead you, subscribe to department newsletters and learn more about the
Departments initiatives.
Our MISSiOrlat the Department is: License Efficiently, Regulate Fairly. We
constantly strive to serve you better so that you can serve your customers.
Thank you for doing business In Florida, and congratulations on your new license'
(850} 87-1395
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DATE DATC1-1 NUN'BER
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LEWIS S CURTIS ES
ZOS41 NE 3O AVE 1 0
AVENTURA FL 33188
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CERTIFICATE OF LIABILITY INSURANCE
OATE(MmmmyYY)
11/9/2011
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATWELY 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 CERTIFICATE HOLDER.
IMPORTANT: H the certificate holder Is an ADDITIONAL INSURED, the policytles) must be endorsed. H SUBROGATION IS WANED, subject to
the tens and conrItIonS of the policy, certain polies may require an endorsement. A statement on this certificate does not confer rights to the
certificate holder In lieu of such endorsement($).
PRODUCER
INSURANCE INDUSTRIES INC
953 NE 125th St
N Miami, FL 33161
A200717
ACTSTACY PARKS
P"°"E F,t,; (305) 891 -2808 1 iAC,,o:(305) 891-6367
AE ; Stacy @insuranceindustriesinc.com
INSUREels) AFFORDING *smuts
INSURER A : MACNEILL / SCOTTSDALE INSURANCE
NAM.O
INSURED
LS CURTIS INCORPORATED
20341 NORTHEAST 30 AVENUE
#108-6
AVENTURA, FL 33180
INSURER B :
INSURER C :
INSURER O :
INSURER E :
INSURER F :
•
NUMBER:
t uVCRnWlca vcn..r,vn1 c ••v,•,vr.s. - - - - - THIS IS TO CERTIFY THAT THE POUCIES OF INSURANCE USTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY 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 AU. THE TERMS.
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
MR
LTA
TYPE OF INSURANCE
AWL
WAR
SAW
WAD
POLICY NUMBER
(PO1
pEX�pP
(MMAOD/YYYY)
OMITS
A
GENERAL
Z
UABLITY
COMMERCIAL GENERAL LIABILITY
.
APP148628105
10/26/1110/26/12
EACH OCCURRENCE
$ 1,000,000
$ 100 , 000
KANT um
PREMISES t a occurrence)
MED EXP (Any one person)
$ 5,000,
I CLAIMS -MADE X OCCUR
$ 1,000,000
PERSONAL BADVINJURY
$ 2,000,000
GENERAL. AGGREGATE
$ 2,000,000
PRODUCTS - COMP/OP AGO
GEML AGGREGATE UMR APPUES PER
X (POLICY f . I PP ILOC
$
AUTOMOBILE
_
—
LABILITY
ANYAUTO
ALL OWNED
AUTOS
HIRED AUTOS
SCHEDULED
AUTOS
AUTOS NON-OWNED
MIT
COMBINED LIMIT
tEa accident)
$
BODILY INJURY (Per person)
$
BODILY INJURY (Per accident)
$
( dent) DAMAGE
$
UMBRELLA LAB
EXCESS LAB
OCCUR
CLAIMS-MADE
EACH OCCURRENCE
$
AGGREGATE
$
$
DED I RETENTIONS
I
WORKERS COITION
AND EMPLOYERS LIABIUTY YIN
ANY PROFwETORIPARTNERIE%Et:n1TIVE [J
OFFIcua tsMBER EXCLUDED/
a�y �sq In WA
DESCRIPTION ORATIONS below
NIA
I TORY TATU• I LOT ER
E.L. EACH ACCIDENT
$
E.L. DISEASE • EA EMPLOYEE
$
E.L. DISEASE • POUCY uMIT
$
DESCRIPTION OF OPERATIONS! LOCATIONS / VEHICLES (Attach AGORA 101. AdGilonal Remarks St iedute. if more space Is required)
*ELECTRICAL WORK - WITHIN BUILDINGS
{,:Cr i iri i C r uw
MIAMI SHORES VILLAGE
10050 NE 2ND AVE
MIAMI SHORES, FL 33138
1
w" "' "•"" "..^•'
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 :+ - ' -, ATIVE
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ACORD25(2010/05)
The ACORD name and logo are registered marks of ACORD
nU „M..p , ww •.v.
ACOREP
THIS CERTIFICATEIS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER: 1141S
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATEOF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURERISI, AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder Is an ADDITIONALINSURED, the policyties) must be endorsed. If SUBROt3ATIONIS WAIVED, subject to
the terms and condidals of the policy. certain policies may require an endorsement. A statementon thls certificate does not confer rights to the
certificate holder in lieu of such endorsements).
CERTIFICATE OF LIABILITY INSURANCE
DATE (MM.DDPYYYY)
04 -17 -2012
PRODUCER
AUTOMATIC DATA PROCESSING INS AGCY
250717 P:(877)287-1316 F:(888)443 -6112
PO BOX 33015
SAN ANTONIO TX 78265
NAME: ONTACT
IPHONE
o.Eet): (877)287-1316
E -MAIL
ADDRESS:
PROOUCER
CUSTOMER ID o:
(At. No1: (888) 443 -6112
INSURERISI AFFORDING COVERAGE
1 NAIC
INSURED
L. S. CURTIS INC.
20341 NE 30TH AVE APT 108
AVENTURA FL 333.80
INSURERA: Twin City Fire Ins Co
INSURER B :
INSURER C :
INSURER 0 :
INSURER E :
INSURER F :
•
BER:
GIJVCRAU• C.1 %0G1111 g If7MP%! 1...vri.Y.r...
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY 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.
MN TYPE Of INSURANCE ApyDSp ySUM POLICY NUMBER Ih M DDIIYI YYL It A�A1 a0Y YYYYi LIMITS
AUTHORIZ 7_- ESENTarnE
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. GENERAL LIABILITY
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EACH OCCURRENCE 8
DAMAGE i tfREN I t:a
• PREMISES la occurrence) 8
1 COMMERCIAL GENERAL LIABILITY
MEO EXP Any one Wool 8
1 1 CLAIMS•MADE `_ OCCUR
1 PERSONAL & ADV INJURY i 8
1 1
i GENERAL AGGREGATE • S
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BODILY INJURY leer person) 8
'
BODILY INJURY IPer rccrdent)' S
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' PROPERTY DAMAGE 1 8
I Meer acadent)
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1 1 NON•OWNEO AUTOS
7
UMBRELLA LIAR OCCUR
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EACH OCCURRENCE 8
' . EXCESS UAB y+ CI.AIMS.MADE1
AGGREGATE S
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DESCRIPTION OF OPERATIONS below
I WC STATU• 1 rOTH• •
I X i TORY LIMITS 'I 'VP
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0 0 0
76 WEG TR4954 . 05/0112012 05/01/2013 E.L. DISEASE - EA EMPLOYEE 8 1, 0001
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E.L. DISEASE •POLICY LIMIT $1,000,000
DESCRIPTION OF OPERATIONS i LOCATIONS 8 VEHICLES Kitsch ACORD 101. Additional Rommka Setaduto.11 moo space b tegullod)
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VFf1 t luau,"tG IIVI.VI•I1
Miami Shores Village
Building Department
10050 N.B. 2nd Ave.
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.
AUTHORIZ 7_- ESENTarnE
-7e l`" 4""»
• . Awn AAAA anner■ nneenDArinM All rr1itht a rnRnrvftl_
ACORD 26 12009/09)
The ACORD name and logo are registered marks of ACORD