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EL-13-1024
Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 192380 Permit Number: EL -5 -13 -1024 Scheduled Inspection Date: June 05, 2013 Inspector: Devaney, Michael Owner: Job Address: 359 NE 104 Street Miami Shores, FL Project: <NONE> Contractor: DOKE ELECTRICAL AND GENERAL CONTRACTORS INC Permit Type: Electrical - Residential Inspection Type: Final Work Classification: Alteration Phone Number Parcel Number 1121360130130 Phone: (954)804 -1367 Building Department Comments INSTALL SWITCH AND J BOXES FOR 2 SCONE LIGTHS, RE ROUTING WIRING Infractio Passed Comments INSPECTOR COMMENTS False 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- 192227. CREATED AS REINSPECTION FOR INSP- 192166. BY GLENN DOKE CANCELLED BY GLENN June 05, 2013 For Inspections please call: (305)762 -4949 Page 25 of 47 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 Permit Type: Electrical JOB ADDRESS: 359 NE 104th Street REC I E1 MAY 102013 FBC Permit No. EU 3 - O2- Master Permit No. City: Miami Shores County: Miami Dade Zip: 33138 FoliolParcel #: 11- 2136- 013 -0130 Miami Shores Sec 5 PB 10 -47 Lot 21& E112 LOT 20 BLK 117 Is the Building Historically Designated: Yes NO X Flood Zone: OWNER: Name Simple Titleholder): CARLOS PEREZ- STABLE &W MARIA M ALMANZAR -� j I-258-11 (Fee Sirn le Titleholder : Phone #. Address: 359 NE 104 ST City: MIAMI SHORES State: FL Tenant/Lessee Name: Email: Zip: 33138 Phone #: CONTRACTOR: Company Name: Address: 5637 Sheridan Street City: Hollywood Qualifier Name: William G Doke Doke Electrical and General Contractors Inc. phone #: 954-804 -1367 state: FL Zip: 33021 Phone #: 954 -804 -1367 State Certification or Registration #: ER13014654 Certificate of Competency #: 11 E000345 Contact Phone #: 954-804 -1367 Email Address: dokeelectric @gmail.com DESIGNER: Architect/Engineer: N/A Phone #: N/A Value of Work for this Permit: $ 375 Square/Linear Footage of Work: Type of Work: Address XAlteration UNew ORepair/Replace ODemolition Description of Work: Install Switch and j boxes for 2 sconce lights, re -route wiring * * * * * * ****** *** ***** ************* ***** Fees**** *************mix****** * * ********+x****** ** Submittal Fee $ Permit Fee $ /TO, and CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Technology Fee $ Notary $ Training/Education 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, 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 0 e or Agent Contractor The foregoing instrument was acknowledged before me this 10 The foregoing instrument was acknowledged before me this day of , 2015, by Watt --Sri 3 } f fi%i �y 7 tr , 2013 , by 01/41-Min ) ?i who • personally known to meter who has produced As identification and who did take an oath. as identification and who did take an oath. NOTARY PUBLIC: who is personally known to me or who has produced NOTARY PUBLIC: ```� \��\ ►►ul►►/�,,/,//, j...,,fr0''', Sign: � �s y ?o.{ 9 0 ,i- % Sign: Print: =iii d Q = Print: LI SA co ' " ..c — u-.• V,, My Commission Expires: �' "G'• a 5,: My Commission Ex �' \ /', /, //,/,,,, 1j111 1111111 \ \ \``\\\`; "2Cv /Y /ale, Y Plans Examiner Zoning Structural Review (Revised 3 /12/2012)(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. v' COPY OF QUALIFIER'S STATE LIC CARD B. V COPY OF LOCAL BUSINESS TAX RECEIPT C. V' 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. V 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: \DKE E�Ec-rR� j9L (-3/ENFRlit- 0-akiktiC-70aS, 14C. BUSINESS ADDRESS: 5 1,e 3q 5I -vEQ I c1( $T cirri-too-1 \( u oo j STATE FL- ZIP CODE 330x1 BUSINESS PHONE: ( 9514 ) 1613 -3(6 FAX NUMBER (54 ) to 4 -1 'L (' CELL PHONE (-1j ) goo - I blP � QUALIFIER'S NAME: LEI LUA-m G, JKE QUALIFIER'S LIC NUMBER: PR) ) 30 (if s-y E -MAIL ADDRESS (IF APPLICABLE): c.takee- ledT; C(� Q CnaCt (.. eo r Created on 3119109 BY MLDV 1 RV 3126109 MLDV STATE OF FLORIDA ` DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD (850) 487 -1395 1940 NORTH MONROE STREET • TALLAHASSEE FL 32399 -0783 DOKE, WILLIAM GLENN DOKE ELECTRICAL AND GENERAL CONTRACTORS INC. 5637 SHERIDAN STREET HOLLYWOOD FL 33021 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 barbeque restaurants, and they keep Florida's economy strong. 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 www.myfloridaticense.com. There you can find more information about our divisions and the regulations that impact you, subscribe to department newsletters and leant more about the Department's initiatives. Our mission at 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! DETACH HERE 1RI3O 465 3 OR i) .483 THIS DOCUMENT HAS A COLORED BACKGROUND • MICROPRINTING • LINEMARK• • PATENTED PAPER BATCH NUMBER 8.i• 1a�:dT. i 689114 -8 BUSINESS NAME / LOCATION DOKE ELECTRICAL CONTRACTOR INC DOING BUS OWNER DOKE ELECTRICAL Sec. Ty of Business 196 ELECTRICAL THIS IS ONLY A LOCAL BUSINESS TAX RECEIPT. IT DOES NOT PERMIT THE HOLDER TO VIOLATE ANY EXISTING REGULATORY OR ZONING LAWS OF THE COUNTY OR CITIES. NOR DOES IT EXEMPT THE HOLDER FROM ANY OTHER PERMIT OR LICENSE REQUIRED BY LAW. THIS IS NOT A CERTIFICATION OF THE HOLDER'S OUAUFICA- TIONS. PAYMENT RECEIVED MIAMI -DADE COUNTY TAX COLLECTOR: 09/18/2012 09010362001 000075.00 SEE OTHER SIDE THIS IS NOT A BILL - DO NOT PAY RENEWAL RECEIPT NO. 716669 -7 CC B 11E000345 AND GENERAL IN DADE CO & GEN CONTR INC CONTRACTOR FIRST -CLASS U.S. POSTAGE E PAID MIAMI, FL PERMIT NO. 231 WORKER /S 1 DO NOT FORWARD DOKE ELECTRICAL AND GENERAL CONTRACTOR INC WILLIAM G DOKE PRES 5637 SHERIDAN ST jj HOLLYWOOD FL 33021 i£ Iff££ f# i4}#£ f£ flfEiF}} JE £!iE£EFilfEI8f3EfFEtfiff£fi££il 57 CITY OF HOLLYWOOD TREASURY SERVICES DIVISION LOCAL BUSINESS TAX RECEIPTING 2600 HOLLYWOOD BLVD, ROOM 103 HOLLYWOOD, FL 33020 DOKE ELECTRICAL AND GENERAL CO 5637 SHERIDAN ST HOLLYWOOD FL 33021 CITY OF HOLLYIN 356 41944 PRINT DATE: 9/28/12 IS IS YOUR LOCAL BUSINESS TIC. RECEIPT. PLEASE DETACH AND POST IN A CONSPICUOUS. LACE AT THE BUSINESS LOCATION PLEASE DO NOT REMIT ANY PAYMENT THIS IS NOT A BILL. Business Name: Business Location: Business Class: Tax Basis: Receipt Number: Receipt Year: iration. Date:`: DOKE ELECTRICAL AND. GENERAL 5637 SHERIDAN ST CONTRACTOR /ELECTRICAL 1 WORKER. (OWNER) 13 00050290 10/01/12 09/30/13 NEW CHARGES: (Itemized Below) Base Fee Adcf ianal Charges: TOTAL NEW CHARGES: Penalty Amount: Previous Balance Due: TOTAL AMOUNT PAID: 190.00. .00 0.0 190.00 PURSUANT. TO STATE LAW, THE LOCAL BUSINESS TAX IS. LEVIED ON THE PRIVILEGE OF DOING BUSINESS WITHIN A CITY'S LIMITS, AND IS. NON - REGULATORY IN NATURE. ISSUANCE OF A LOCAL BUSINESS TAX RECEIPT BY THE CITY Of HOLLYWOOD DOES NOT MEAN THAT THE CITY HAS DETERMINED. THAT THE. EXISTING OR PROPOSED USE OF A LOCATION } IS . LAWFUL. ISSUANCE OF A LOCAL BUSINESS TAX RECEIPT DOES NOT LEGALIZE OR CONDONE THE . NATURE OF THE BUSINESS BEING CONDUCTED IF GARi RYTO ANY LOCAL, STATE OR FEDERAL LAWS OR REGULATIONS. ACCORD- 'i CERTIFICATE OF LIABILITY INSURANCE DATE /YYYY) 055 /09//09/13 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 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 an ADDITIONAL INSURED, the poticy(ies) 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 Mabe And Associates, Inc. 5493 Wiles Rd #103 Coconut Creek, FL 33073 Phone (954) 968 -8111 Fax (954) 968 -8233 NCONTACT Ashley Mabe INC N . Extl: (954) 968 -8111 FAX , No): (9 54) 968-8233 E-MAIL SS. agency@mabeassociates.com INSURER(S) AFFORDING COVERAGE NAIC d INSURER A : Republic Vanguard Insurance Co INSURED Doke Electrical and General Contractors Inc 5637 Sheridan St Hollywood, FL 33021 INSURER B : 02/21/2013 INSURER C : EACH OCCURRENCE INSURER D : DAMAGE TO RENTED PREMISES (Ea occurrence) INSURER E : MED EXP (Any one person INSURER F : PERSONAL &ADVINJURY 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 ADDLSUBR INSR WVD POUCY NUMBER POLICY EFF (MM/DD/YYYY) POLICY MP (MM/DDIYYYY) LJMITS A GENERAL LIABILITY If COMMERCIAL GENERAL UABIUTY • • CLAIMS -MADE 0 OCCUR ❑ PGL003406 -13 02/21/2013 02/21/2014 EACH OCCURRENCE $ 1,000,000.00 DAMAGE TO RENTED PREMISES (Ea occurrence) $ 100,000.00 MED EXP (Any one person $ 5,000.00 PERSONAL &ADVINJURY $ 1,000,000.00 ❑ GENERAL AGGREGATE $ 2,000,000.00 GEM. AGGREGATE UMIT APPLIES PER: ❑ POUCY • JE 0. ❑ LOC PRODUCTS - COMP /OP AGG $ 2,000,000.00 $ AUTOMOBILE UABILITY ❑ ANY AUTO ❑ ALL OOWNED ■ SSUCHHEEDULED HIRED AUTOS M NON-OWNED ❑ . COMBINED (E SINGLE OMIT $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ (PeraEldentt)AMAGE $ ❑ UMBRELLA MB ❑ OCCUR • EXCESS UAB ❑ CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ ❑ DED . RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE N / A • TORY MTITS • RIP- E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E.L DISEASE - EA EMPLOYE $ If Yes describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POUCY UMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, K more space Is required) CERTIFICATE HOLDER CANCELLATION I Miami Shores Village Bldg Dept 10050 NE 2nd Avenue 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. AUTHORIZED REPRESENTATIVE AAJZAAejtt". ACORD 25 (2010/05) QF ©1988 -2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD JEFF ATWATER CHIEF FINANCIAL OFFICER STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION * * CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA 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: 3/6/2013 EXPIRATION DATE: 3/6/2015 PERSON: DOKE WILLIAM G FEIN: 364680782 BUSINESS NAME AND ADDRESS: DOKE ELECTRICAL AND GENERAL CONTRACTORS INC 5637 SHERIDAN STREET HOLLYWOOD FL 33021 SCOPES OF BUSINESS OR TRADE: LICENSED GENERAL ELECTRICAL WIRING CONTRACTOR- PROJECT CONTRACTOR WITHIN BUIL MANAGER, CO Pursuant to Chapter 440.05(14), F.S., an officer of a corporation who elects exemption from this chapter by filing a certificate of election under this section may not recover benefits or compensation under this chapter. Pursuant to Chapter 440.05(12), F.S., Certificates of election to be exempt.. apply only within the scope of the business or trade listed on the notice of election to be exempt. Pursuant to Chapter 440.05(13), F.S., Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation 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 longer meets the requirements of this section for issuance of a certificate. The department shall revoke a certificate at any time for failure of the person named on the certificate to meet the requirements of this section. DFS- F2 -DWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 07 -12 QUESTIONS? (850)413 -1609