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EL-13-687Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 188774 Permit Number: EL -4 -13 -687 Scheduled Inspection Date: April 24, 2013 Inspector: Devaney, Michael Owner: PEINADO, ULISES Job Address: 391 NE 103 Street Miami Shores, FL 33138 -2432 Project: <NONE> Contractor: HIGH TECH E INC Permit Type: Electrical - Residential Inspection Type: Final Work Classification: Addition /Alteration Phone Number (305)498 -0577 Parcel Number 1121360130290 Phone: (786)251 -9817 Building Department Comments ELECTRICAL SERVICE REPAIR Infractio Passed Comments INSPECTOR COMMENTS False Passed Failed Inspector Comments Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. i/•/w zG, April 23, 2013 For Inspections please call: (305)762 -4949 Page 21 of 43 BUILDING 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 FBC 20 Permit No. PERMIT APPLICATION Master Permit No. Permit Type: Electrical JOB ADDRESS: 3 @( tv l 63i $ 22) City: Miami Shores tj County: / Miami Dade ✓ Zip: 3 ?/ Folio/Parcel #: Is the Building Historically Designated: Yes OWNER: Name (Fee Simple Titlehold Address: °/ City: mil/ /i ' / ' NO X Flood Zone: GI/ LS Phone#: 9(7 375 ?1hz) State: zip: _ ` /3g Tenant/Lessee Name: �+ /} / Phone #: i Bonding Company's Name (if applicable) f 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 Owner or Agent The foregoing instrument was acknowledged before me this day of 20 L, by Ut cs 7 who is personally known to me or who has produced NOTARY P Sign: P M As identification and who did take an oath. ssion Expires: * * * * * * * * * * * * * * * ** APPROVED r, 4GrtCCMMISSION #EE058383 m�•���Q EXPIRES: FEB.15,2015 WWW.AAR0NN0TARltcom Signature The fore day of m Contractor trument was aacknow edged before me this 9 ,20 by (0>i 5 who is persons known to me or who has produced as identification and who did take an oath. O. rc 1 S CO sion Expires ; RES: FEB. 15,2015 °®'O;; pF E'° ° ,NWW.AARONNOTARxcom ** ** * ** * * ** * ** * ****** * * * * ***** * ** r * * ** r*********** * *** ** * * ***** * ** **** ** * ** * * * *** Plans Examiner Structural Review (Revised 3 /12 /2012XRevised 07 /10 /07XRevised 06 /10/2009XRevised 3/15/09) Zoning Clerk THIS DOCUMENT HAS A COLORED BACKGROUND • MICROPRINTING • LINEMARKT° PATENTED PAPER- 't 6167216 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD SEQ #L12061901273 DATE BATCH NUMBER LICENSE NBR /19/2012 118206101 EC13004208 ELECTRICAL CONTRACTOR ned below IS CERTIFIED ier the provisions of Chapter 489 FS. airation date: AUG 31, 2014 GARCIA, CORBARI HI -TECH E INC 10850 NW 21ST STREET #190 MIAMI FL 33172 RICK SCOTT GOVERNOR DISPLAY AS REQUIRED BY LAW KEN LAWSON SECRETARY iAMI -DADS COUNTY lX COLLECT& 9 W. FLAGLER ST. t FLOOR • IAMI, FL 33130 2012 LOCAL BUSINESS TAX RECEIPT 2013 MIAMI- DADE.COUNTY - STATE OF FLORIDA EXPIRES SEPT. 30; 2013 MUST BE DISPLAYED AT PLACE OF BUSINESS PURSUANT TO COUNTY CODE CHAPTER 8A - ART. 9 & 10 664290 -5 THIS IS NOT A BILL - DO NOT PAY RENEWAL 17ESSJAMEL LQcknON FIRST -CLASS U.S. POSTAGE PAID MIAMI, FL I PERMIT NO. 231 STATEI ECEFI3g804208691358 -7 10850 NW 21 ST 190 33172 SWEETWATER VNE TECH E INC Q1 ge eeti IcAL CONTRACTOR ONLY A LOCAL i TAX RECEIPT. IT OT PERMIT THE TO VIOLATE ANY REGULATORY OR LAWS OF THE OR CITIES. NOR t EXEMPT THE FROM ANY OTHER OR LICENSE D BY LAW. THIS IS :ERTIFICATION OF DER'S QUALIFICA- RECEIVED DE COUNTY TAX OR 10/12/2012 60000000075 000049.50 SEE OTHER SIDE WORKER /S 2 DO NOT FORWARD HI TECH E INC ERICKA PEREZ GARCIA PRES P 0 BOX 227008 MIAMI FL 33222 40 HITEC -2 OP ID: RA A Rp CERTIFICATE OF LIABILITY INSURANCE DATE 10/01DiYY1fY) 10/01/12 THIS CERTIFICATE IS ISSUED 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 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: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions 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 endorsement(s). PRODUCER 305 -446- 2271M"ECT Kahn - Carlin & Company, Inc. 3350 S. Dixie Highway 3054484127 Miami, FL 33133 -9984 Michael A. Bonet POLICY NUMBER PHONE FAX INC. No. Ext): (A/C, No): E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : Century Surety Company LIABILITY COMMERCIAL GENERAL LIABILITY INSURED Hi -Tech E, Inc. 11003 NW 33 Street Miami, FL 33172 INSURER B : Scottsdale Indemnity Co 15580 INSURER c:Bridgefield Employers Ins Co 10701 INSURER D : $ 1,000,000 INSURER E : $ 100,000 INSURER F : $ 5,000 COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 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 INSR LTR TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF (MMIDD/YYYY) POLICY EXP (MM/DDIYYYYI O A GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY BIND - 4235 10/01/12 10/01/13 EACH OCCURRENCE $ 1,000,000 DAAE TO RNrcne) $ 100,000 MED EXP (Any one person) $ 5,000 CLAIMS -MADE X OCCUR PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP /OP AGG $ 2,000,000 GEN'L AGGREGATE —1 POLICY X LIMIT APPLIES PRO- JECT PER: LOC $ A AUTOMOBILE X LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS SCHEDULED AUTOS NON -OWNED AUTOS CA10055470 08/09/12 08/09/13 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ A X UMBRELLA LIAB EXCESS UAB X OCCUR CLAIMS -MADE BIBD - 4236 10/01/12 10/01/13 EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5,000,000 $ DED X RETENTION $ 0 WORKERS COMPENSATION AND AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER /EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y / N N 1 A 83046115 10/01/12 10/01/13 X WG STATU- TORY LIMITS OTH- W- E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE -POUCY UMIT $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, it more space Is required) Electrical Contractor CERTIFICATE HOLDER CANCELLATION MIAM -04 Miami Shores Village Attn: Building Dept 10050 N.E. 2nd Avenue Miami Shores, FL 33138 SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATWE ACORD 25 (2010 /05) © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 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 11 �n� Permit No. J 13 �U-7 Master Permit No. BUILDING PERMIT APPLICATION FBC 20 l'itOMET7Myf 0 APR032013 BY :� -oom�e Permit Type: Electrical A - OWNER: Name (Fee Simple Titleholder): S i) 01. Address: ` t( to 2D D ci'T i' e - City: \@ "kof w. ' ct--)\ %L S . State: Phone #: Zip: 6,Q) 3 % Tenant/Lessee Name: Phone #: Email: JOB ADDRESS: City: Miami Shores County: Miami Dade Zip: Folio/Parcel #: Is the Building Historically Designated: Yes CONTRACTOR: Compan Name: i, Address: �g f1 a W 64-s City: h`"1 /P'• NO Flood Zone: vV6cku corm ec.laot Phone #: State: Zip: Qualifier Name: ���'� -� ,e"Ch+, . : r - Phone #: 4-41' 113 -l`' 464) State Certification or Registration #: �l%� Certificate of Compete cy #: Contact Phone #: ���' ` -1-17 3 ® % Email Address: �vW EL-0 1t- c s / U i J- • i o1 K DESIGNER: Architect/Engineer: Phone#: Value of Work for this Permit: $ Q ® °° Square/Linear Footage of Work: Type of Work: ❑Address DAlteration '%New epair/Replace ODemolition Description of Work: 6/ t ° lam- Ads -ja._, ******+ x****** ************************** Fees *** *********** **** ******** *********:u******** Submittal Fee $ Permit Fee $ AC` ® 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 ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOIT FRS, 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 Owner or Agent The foregoing instrument was act nolwledged bef e me this A day of \CY C*YdA , 201 , by \A 1 <S 3 Vit ✓v j , who is personally known to me or who has produced As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commission Expires: ► p"" 4�a ° Melanie James "Tn G0ga44itmti # EE 144681 lEXPIRiES: NOV, 18,2015 WWW.AARONNOTART.com Signature Contractor The foregoing instrument was acknowledged before me thi day of L a'' , 20 I , by / a who is personally known to me or who has produced as identification an . who did take an oath. NOTARY PUBLI Sign: Print: 9! Ida Pereda ;P�;B °O My Commission Expires:O ' y i,COMMiSSON #EE144691 S EXPIPES: DEC. 07, 2015 ,A RONNOTARYcom It ************* *** ****** **********:x** ***x:+x**** * * * ** *******x:x:**** * * ** xx:**** ** ***** *+ x**+ x**********+x****** ******* APPROVED BY ,X60 "plans Examiner Structural Review (Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09) Zoning Clerk