EL-12-1536Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 177453 Permit Number: EL -8 -12 -1536
Scheduled Inspection Date: August 20, 2012
Inspector: Devaney, Michael
Owner: BOUCUGNANI, RODOLFO
Job Address: 723 NE 91 Street 1 -C
Miami Shores, FL
Project: <NONE>
Contractor: POWER BRIGHT ELECTRIC LLC
Permit Type: Electrical - Residential
Inspection Type: Final
Work Classification: Alteration
Phone Number
Parcel Number 1132060440090
Phone: (305)305 -3229
Building Department Comments
AFTER THE FACT ACELECTRICAL CONNECTION
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
;41
/4-77? ?//
August 17, 2012
For Inspections please call: (305)762 -4949
Page 23 of 33
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 1
Permit Type: Electrical , j1 32S--6(347?
OWNER: Name (Fee Simple Titleholder): /2Qdrj ''C vC V /�,4ci T / Phone #:7v 6.
Address: � /0 & / ais '!Yee' — (
City: i" 1 ! e - /r( i State: L. Zip: V,C)157'G 1 V
Tenant/Lessee Name: Phone #: —'
Email: a f a. 4,14 / got o 1 • CD m
Permit No. El_ l 2 )5210
Master Permit No.
JOB ADDRESS: 72 3 Aver ?Pc' c' x ee( AA !e
City: Miami Shores County: Miami Dade
Folio/Parcel #: / 1 320 --G4.4V ^ 'c.c%)
Is the Building Historically Designated: Yes NO X Flood Zone:
CONTRACTOR: Company Name: (� v i%, .17146/.17- �P® °�
Phone #: So' 30-5 52
Address: /j/ I %
J U�5
City: .t Q State: ) Zip:
Qualifier Name: CV; (W C9`J(ji Phone #: 3,,,s 595 3729
State Certification or Registration #: 0 it., 13 0 1.€4 .11-)L Certificate of Compe n y #: 0 (. 0 00 2---
Contact Phone #: 1 /1%t
�/� _�` �aJ "3 ��°?S�, Email Address: ��+�f�/%iD��ii�si Pr f7 0�"�S'T
DESIGNER: Architect/Engineer: Phone #:
Zip: 15a
Value of Work for this Permit: $ 0 0 Square/Linear Footage of Work:
Type of Work: DAddress +� Altera ' n ONeeJw Re 'r eplace DDe olition
Descripti of Work: %-� f%�l dze p ®aY /��`^ -'G 6,. /e.I �GJ°��Q�T/'���j
** ** ****** * ** * * ** x**a:**** ************* Fees**** *m *+ x********* ** ************:x ********+ ***
Submittal Fee $ �_ Permit Fee $ m( 6 0 CCF $ CO /CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $ Technology Fee $
Double Fee $ Structural Review $
TOTAL FEE NOW DUE $ . °
Bondiig 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, BOII.FRS, HEATERS, TANKS and AIR CONDITIONERS, ETC
OWN1R'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 iinated•vc l ie exceeding: $2.50b, 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
Owner o gent C %�%
The fore:oing ins ment was acknowled ed,�before me this The foregoi g instrument was acknowledged before me this/ CI
day of _ , 20 J Z, by ` e v� u rt�� % , day of , 20 �C ; by % �%t� °(�4,Z I�?i
who is personally known to me or who has produced L L who is personally known to me or who has produced r/
Contractor
NOTARY PUBLI
As identification and who did take an oath.
Sign: ,\,11.Ca
Print: kV i S R 4/4 41 IN
My Commission Expires:
LUIS FERNANDEZ
* MY COMMISSION # DD 832441
EXPIRES: November 7, 2012
•-0 Bonded That Budget Notary Salvos
* *** *x:*** ** **** :*m*****x:*:x* ***:x*** ** ***** ***** *x:+ x*+ x*+ xx:: x******* **x: ***+ n*********+ x+x+x+xx:***+x******+x**a ***
as identification and who did ttlhik,, / /�,'
NOTARY PUBLIC: •... • •, b'p :
111
/.,,,,,ltf11111 \ \ \ \ \```\\\
Sign:
Print:
My Commission Expires:
APPROVED BY
Zoning
Structural Review Clerk
(Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09)
STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
nat s1 NSING BOARD
no0 spec-pimp 0 � aa',dey,,. �o suolsinad ayl aapun pas}13� f
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311 312113 13 11-10111B 213MOd
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• 9010
MIAMI -DADE COUNTY
TAX COLLECTOR
140 W. FLAGLER ST.
1st FLOOR
MIAMI, FL 33130
2011 MUNICIPAL CONTRACTOR'S 2012
TAX RECEIPT
MIAMI -DADE COUNTY - STATE OF FLORIDA
PURSUANT TO COUNTY CODE\SEC. 10 -24
EXPIRES SEPT. 30, 2012
THIS IS NOT A BILL —. DO NOT PAY
CEIPT NO 30-6938352 CC NO: 10E000267
ISINESS NAME / LOCATION
POWER BRIGHT ELECTRIC LLC
4502 NW 185 ST
OWNER :POWER BRIGHT ELECTRIC LLC
SEE BACK OF RECEIPT FOR
A LIST OF NON— PARTICIPATING
MUNICIPALITIES
ceipt holder must
lister in the city
ere work is to be
le.
MENT RECEIVED
MI -DADS COUNTY TAX
.I4 Q7/2012
02230003001
000200.00
K(.);6208359
FIRST -CLASS
U.S. POSTAGE
PAID
MIAMI, FL
PERMIT NO. 231
RECEIPT HOLDER MAY DO
BUSINESS AS A CONTRACTOR
AS SPECIFIED HEREON.
ELECTRICAL CONTRACTOR
DO NOT FORWARD
POWER BRIGHT ELECTRIC LLC
WILTER CARDOZA PRES
4502 NW 185 ST
MIAMI GARDENS FL 33055
1 „11,,,11,11 „ „1,1 „1,1 „,11,11
8
STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND PROFESSION RE GULATION
ELECTRICAL. CONTRACTORS LICEN IN
(850) 487 -1395
ATE OF FLORIDA AC# 6 2 0 8.3 5 9
?ARTMENT OF BUSINESS AND
tOFESSIONAL REGULATION
1412 07/18/12.117059745
CCTRICAL CONTRACTOR
1, WILIER
1RIGF T ELECTRIC LLC
:DUAL MUST MEET ALL LOCAL
:NG REQUIREMENTS PRIOR
'RACTING IN ANY AREA)
STERED under the provisions of ch.489
Rte: AUG 31, 2014 L12071801202
ENTED PAPER
DATE BATCH NUMBER
LICENSE NBR
SEQ# L12071801202
07/18/2012 117059745 BR1:.3014472
The ELECTRICAL CONTRACTOR
Named below HAS REGISTERED
Under the provisions of Chapter 489 FS.
Expiration date: AUG 31, 2014.
(INDIVIDUAL MUST MEET ALL LOCAL LICENSING
REQUIREMENTS PRIOR TO . CONTRACTING IN ANY AREA).
CARDOZA, WILTER
POWER BRIGHT ELECTRIC LLC
4502 NW 185TH STREET
MIAMI FL 33055
RICK SCOTT
GOVERNOR
DISPLAY AS REQUIRED BY LAW
KEN LAWSON
SECRETARY
08 -13 -2012
TE FLORIDA
CJEFF ATWATER HIEF o to DEPARTMENT OF OF SERVICES
DIVISION OF WORKERS' COMPENSATION
* * CERTIFICATE OF ELECTION TO BE EXEMPT FROM R.O01DA WORKERS' COMPENSATION LAW
CONSTRUCTION INDUSTRY EXEMPTION
This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law.
EFFECTIVE DATE 08/13/2012 EXPIRATION DATE 08/13/2014
PERSOit CARDOZA
FEIN; 272450482
BUSINESS NAME AND ADDRESS:
POWER 11RxaNT ELECTRIC LLC
4502 NM 185 ST
MIAMI FL 33ose
SCOPES OF BUSINESS OR TRADE
1- REGISTERED ELECTRICAL CONTRACT
WILIER
ltM u0tANT: Permaet ti t7nptwr 049. 118114), F.3., es officer of ■ corpastloa who ducts samples lea fres thla chapter by ttnag a ceailirata sf election wader Nis
saOtou way not recover breaths or commotion laden brio chapter. P.taaaat to taap[er 489.05812). F.3., Cettffic8188 of ereateea is 8e exempt... apply aalY w11*1* tae
saws of dm Whom or trade listed a the Mite 01 atectioe to he exempt. Pontoon to Comet 4411.054f31: Fes.. Notices of election to he sxsopt slid certfflta<tes of
Wordier to be firma dial Os WOO N ra.oeatios 11. d tray now altar ma Mew of tai adios a the Waseca of the certificate. cos person Famed as tea notice err
cartifitase as toe5er .ISIS tla ragdraeaats of Nis wade fir issues d a cartlitcpa. MO d.Wraesat ahalf rowel'. a c rtiticat. at oar time for htiwe of the parson
WOW 0s als aarttltade at Wed tae retpareseab d this swats.
QUESTIONS? MG 413 -1609
0V -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01 -11
PLEASE CUT OUT THE cARO BELOW AND RETAIN FoR FUTURE REFERENCE
STATE OF FLORIDA
COMMITMENT OF FINMICIAL SERVICES
DM51=N OF WORD' CONFIRMATION
LION INDUSTRY
CERTiIRCATE OP ELECTION TO CIE EXEMPT FROM FLORIDA
WORICERF CCIMP N SAT10N LAW
EFFECTi'd 08/13/2012 rf'.XPIRATION DATE:
PERSOI& MUTER CARDOZA
FJ1t 2872450482
BUSINESS NAME AND ADDRESS:
PoWEN MIGHT ELECTRIC tit
4502 row 105 ST
YIAMt FL 33055
SCOPE OF BUSINESS OR TRADE=
t- RRGts eaM EsECTRICAi, coatRACT
08/12/2014
QPtrsuant to Chapter 440.05 {14), FA, an officer of a corporation who
elecrs exemption from this chapter by filing a certificate of election
1- under this section truly not recover benefits or compensation under this
I) chapter.
i i Pursuant to Chapter 44005 {12). ES., Certificates of election to be
exempt.., apply only within the scope of the business or trade listed an
,E the notice of election to be exempt
E Pursuant to Chapter 441105(13), F.S., Notices of election to be exempt
and certificates of election to be exempt shall be subject to revprattion
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 loner meets
the requirements of this section der issuance of a certificate. The
department shall revoke a certificate at any time der failure of the
person craned on the certificate to meet the requirements of this
section.
IMPORTANT
QUESTIONS? 015111 413 -1609
CUT HERE
* Carry bottom portion on the Job, keep upper portion for your records.
DwC -2S2 OATIFICATE OF ELECTION TO BE EXIT REVISED 01 -11
(fici 15Y35-7.
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A Q! D. CERTIFICATE OF LIABILITY INSURANCE
PRODUCgR
SAFEGUARD CASUALTY INSURANCE INC
8896 PINES BLVD
PEMBROKE PINES, FL 33024
INSURED
POWER BRIGHT ELECTRICAL INC.
4502 NW 185TH ST
OPA LOCKA. FL 33055
DATE M$ D(Y%YY)
08/14/2012
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
INSURERS AFFORDING COVERAGE
INSURER N. TRAVELERS _
INSU, B: TRAVELERS
suNER
,81ERD •-• --
INSURER E
NAIC 5
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED To THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.
ANY REQUIREMENT, TERM DR OONDI ION of ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE
MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT To ALL THE TERMS, EXCLUSIONS AND CONO1T$ONS
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
NOTWITHSTANDING
MAY BE ISSUED OR
OF SUCH
west
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'NW OFwsuRANCE
POLIOY NUMBER
PairtgToON
06/13/2012
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06/13/20133
EACH OCCURREN E
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X
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PREMISES (E7l ri�M4)
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PERSONAL & ADV INJURY
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AGGREGATE LIMIT APPLIES PER
POUACY I� 17 r _ 1 LOC
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AUTOMOBILE
USEITY
ANY AUTO
ALL OWNED AUTOS
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--
BA- 00034026
06/14/2012
06/14/2013
GOMIaNED SINGLE I.NIBT
(Ea accident)
; 1 �.Q�
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BODILY INJURY
(Per person)
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OfFICER/MEMEER EXCLUDED?
ft yy�e88�� desalbe under
SPECIAL PROVISIONS below
WC S1'A S I I OR—
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EL. DISEASE • POLICY UMIY
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DESCRLPTIOA or OPt°RATLQNS I LOCATIONS 1 VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT 1 SPECIAL PROVISIONS
I
CITY OF MIAMI SHORES VILLAGE
10050 NW 2ND AVE
MIAMI SHORES, FL
SNOULO *War THE ABOVE DE BFD POLICIES BE CANCELLED SWORE THE EXPIRATION
DATE THEREOF, mg ISO INSURER INLI., EWWEAMOR TO MAIL 30 DAYS wr n-rL:N
NOME TO THE CERTWICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO Do SO SHALL
impose NO oBLIOATtoN aR LLABYITY OF ANY HIND UPON THE INSURER, EIG AGENTS OR
NEPRESENTATIVES.
AUTHORIZED REPRESENTATNE '.+-
ACORD 25 (2001108)
TO /T0 30Vd
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LZT99T850E 50 :iz Z'DMA;T/80