EL-13-271Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
—21(a
Inspection Number: INSP - 193623 Permit Number: EL -2 -13 -271
Scheduled Inspection Date: June 17, 2013
Inspector: Devaney, Michael
Owner: HAISCH, CHARLES
Job Address: 160 NW 92 Street
Miami Shores, FL
Project: <NONE>
Contractor: UNITED ELECTRICAL SERVICES INC
Permit Type: Electrical - Residential
Inspection Type: Final
Work Classification: Addition /Alteration
Phone Number 305 - 788 -0416
Parcel Number 1131010000210
Phone: (786)797 -2188
Building Department Comments
ELECTRICAL WORK FOR 2 BATHROOM REMODEL
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
za
June 14, 2013
For Inspections please call: (305)762 -4949
Page 24 of 34
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
rm
PY °oeeeeveeo�ooa_ _v
FBC 20
Permit No. ti 1
Master Permit No J� ')Q
Permit Type: Electrical
JOB ADDRESS: 160
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel #:
Is the Building Historically Designated: Yes NO 62-- Flood Zone:
IX OWNER: Name (Fee Simple Titleholder): C itVa r h /ass Phone #:
Address: 1 6 6 ARV 1,2 • U
City: A' 4. Le e— State:
Tenant/Lessee Name:
Email:
fry"-
Zip: 33®.x®
Phone #:
CONTRACTOR: Company Name: VAtI ref c "lerir) Ca/ 6e/t lt 371-C Phone #: 77L 7l7 — I
Address: 0741/01.3 5%l% 3S' Co tot?"
City: /+9'e5reaJ State: 1<7 Zip: 33b 3
r
Qualifier Name: / A/IcI r( a goerco Phone #: 7'6 -797- Z/ �8
State Certification or Registration #: Certificate of Competency #: `7.6 U0l9Z.
Contact Phone #: 7 ' ' 7q7— iitJ Email Address:
ii
d
DESIGNER: Architect/Engineer: Phone #:
Value of Work for this Permit: $ Square/Linear Footage of Work:
p �litin
Type of Work . `CtAddress OAlteration
Description o Kp °7rt
igAore
New "1Reliair/Replace
S 0t
Kati; "i +, CN Slf:tgahlgelthilNkt,q ,l '!,''41�a .. >
E7 lkilliptam f :fa,{b,tilrfl $.ri•'t?l�t' -': il.i<Ek{lii st!Nii° tt4i"
******** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Fees************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
Submittal Fee $ Permit Fee $ /.i , w CCF $ CO /CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $ Technology Fee $
Double Fee $ Structural Review $
TOTAL FEE NOW DUE $ t/(4:2'3i
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 no be approved and a reinspection fee will be charged.
Signature
0 e or Agent
Signature
Contractor
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this 6
day of Q. i root I " 20 i 3 , by day of Fe..6 A.ftee y , 20 13 , by g..04.°„ <J 1- ' Z ,
who is personally to me or who has produced who is personally known to me or who has produced
As identificatio d w, +o did take an oath. as identification and who did take an oath.
NOTARY PUB C: I NOTARY ' UBLIC:
** * * * * * * * * * * * * * * * * * * * * * * * * ** ****** * * * * * * * * * * * * * * * * * * ** * * * * * * * ** **
//, r6 Plans Examiner
Zoning
Structural Review Clerk
(Revised 3 /12 /2012XRevised 07 /10 /07XRevised 06 /10/2009XRevised 3/15/09)
Q2 /26 /2Q1j TUE ➢1172 FAX
tuietionsi With this license you become one of the nearly one meson
ns Itcensed'by the Department of Business and Pro siorual Regulation.
boxers � roataurants, and they to yacht strong.
from
economy �arrg.
. Every day we work to improve the way + we do Dress in order to serve you better.
For Information about our services, piece log onto www: y� cenae.Rota.
There you can find m information about our � annd the Iegutations that
Impact You, subscribe to depannienet newslethna and team more about the
Department's Initiatives,
Our mission at the Department hi: License Eby, Regulate Fairly. We
conatatrdy strive to serve you better so that you can sew your customers.
Thank you for doing business in Florida, and congratulations on your new gcessed
Up 4 1004
•
42 /26 /X413 TUB 8i 4n FAX
IJ443 /444
IMITOSTAGE
PAID
PERE T NO.23
£983 0-7 THIS 15 NOTA SU..— 00 $AT PAY RENEWAL
13 AL •sE'�tvicEs INC CC D oa 0192
716289-4
26453 SW 135
33032 URN DADE COUNTY
UNITED ELECTRICAL SERVICE`S'.IUC
Ow tips � ' KER/S EL SIC AL CONTRACTOR`
000075.00
.--� GEE WHIM �. .
DO NOT FORWARD
UNITED ELECTRICAL SERVICES•INc
MANUEL 0 GARCIA PRESS
26453 SW 135 CT
H0$ESTAED FL 33032
� urn rr r��r ��r, a r ��rt +�i�r r l +I r( +ru� r�r�rl�r r �r�r r► r'r rr r���
157
02/25/2013 TDE 9102 FAX
05 -03 -2012
,lFFF ATWATER STATE OF FLORIDA
CHIEF FINANCIAL OFFICER DEPARTMENT OF FINANCIAL SERVICES.
DIVISION OF WORKERS" COMPENSATION
s * CERTINCATE OF MUM TO BE Eft FROM RORIOA WORKERS' COMPE NSA11f LAW
CONSTRUCTION IPXUSTRY EXEMPTION
This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law.
EFFECTIVE DATE 10118120f1 EXPIRATION DATE 10/17/2013
PERSON: GARCIA MANUEL.
FEIN: 452848508
BUSIPIESS NAME AND AP ES&
UNITED ELECTRICAL SERVICES MMC
284E3 SW 132 CT
HOMESTEAD FL OBOR2
SCOPES Of t3USINESS OR TRADE;
1- REGISTERED ELECTRICAL CONTRACT
1/2002/404
If4POATARti evasamoo b Clotyba 441 . GSI!If, F.$y, as aaltr of e tocoototbut iabo stems amnion Erma ttia skittle, by NUR t awtfftate of Amin new lots
seams eooy old moss/ Wales or comosoutfoo new tfda fir. Piomlool to Captor 449 .0001), M. Cettlifcmea of shogun to bo o tamp... *PAY may wfbtn the
*caws to WI eft se I tot Mod oil the areal of olottf i to be a i. la Dsaplar 440.051141, P.&. R of Meths* !o b e e yea! C of
atiyec! m rerteutmo IL of my Moo akor too Mg of Oa nate or On etym. of 1110 otatificam, too porno asses on Rye woo or
tleeta 11111 sub 1!a rapefraaorl* of f51a meat for fume of a mmOlclto. Tito towing waft /amts a aattttklde at toy deo tr follow of to perm
ea►wteote (a Ma q10 toothsome, of 1111, aeotlea.
Mi -2E2 CERTIFICATE OF ELIMIRON TO BE UMW REVISED 01 -11
QUESTIONS? 01I01 413 -1809
PLEA6'E CUT OUT TMQ CARD BELOW AND RETAIN FOR FUTURE REFERENCE
STATE +OF ` -- —
aEPAfcn� fT1 MAMMAL r
C M S I O M or WJt
CONSTRUCTION INDUSTRY
r . T i rlstQ/lTE OP f11„NC ON TO DE EXEMPT PROM PLOT41DA
WORKER$ CCEEMMEIMION LAIN
Va 10/110/4011 XRATX0N DATE: 10/17/
pERsoN $MMIEL 'G IA
11K 482242005
BUSINESS NAIVE AND ADDIVESS
UNITED ELECTRICAL itimIcett tN+C
2e4118 SW 1011 cr
KGtlES aAO PI. allotIt
SCOPE OF BUSINESS OR TRAM .
twoomatem E1ECrRICAL COMM
13
IMPORTANT
:noun Chapter 441105(14L P.S. an officer of a � who
ewe ax :Rlpt n from this chapter by a certificate of election
L tsls Section may this room i nefltS W tinder this
H exempt. apply only within s� of the or trade listed an
the aootiee of **daft to be exempt
E Pursuant to Chatter 440:06(13}, RS., Notion of elecdmi to be exempt
and certificates of Madan to be *xenon shall be s0ett to revaomlan
ff, at any time after the ffIfng of tin notice or the Issuance of the
certificate, than pecan named on the notice sr certlf cete no how newts
to reodrentents of this section for Ism of a aprtfloate. The
deportment shall revoke a certificate at any than f*r failure of the
person
�roated on the certificate to moot die requirements of this
moda
OIIESTIONS? {850} 412 -1001
CUT HOLE
* Carry bottom portion on the job, keep upper portion for your records.
WC -252 f4RTM4CATE OF ELECTION TO 1!E E7tEMMT ammo or-11
Feb. 25. 2013 9:50AM FLORIDA BANKERS INSURANCE No. 2254 P. 1/1
' a CERTIFICATE OF LIABILITY INSURANCE
DATE (MMOD/YYYY)
02/26/13
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 po0cyges) must be endorsed IS(BROGATION IS WAIVED, subject to
the terms and conditions ofthe policy, certain poems may require an endorsement. A statement on this certsicate does not confer rights to the
certlticate holder m Ileu of such endorsement(s).
PRODUCER
Florida Bankers Insurance
7278 SW 8 Street
Miami, FL 33144
Phone (305)266 -6493
INSURED
United EleaMcal Services Inc
26453 SW 135 COURT
HOMESTEAD, FL. 33032
COVERAGES
Fax (305)262 -0679
CONTACT
MARTAALONSO
�); (305)266 -6493
ADDRESS: .com
F. No): (305)262 -0679
INSURERISj AFFORDING COVERAGE
INSURER A : FEDERATED NATIONAL INSURANCE CO.
NAIC
(305) 262-6743
INSURER B :
INSURER C :
INSURER D :
INSURER 5 :
INSURER F :
CERTIFICATE NUMBER
THIS
INDICATED.
CERTIFICATE
EXCLUSIONS
REVISION NUMBER:
IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TOTHE INSURED NAMED ABOVE FOR THE POUCY PERIOD
NOTiNITHSTANDINGANYREOUIREMENT, TERM ORCONDMONOFANYCONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BYTHE POLICIES DESCRIBED HEREIN IS SUBJECTTOALL THE TERMS,
AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAYHAVE BEEN REDUCED BYPAID CLAIMS.
LTTRR
TYPE OF INSURANCE
iL4iR
YiiNtVD
POLICY NUMBER
AS A) �p
ihtrrYDW11YY!
�
pM OlYYYY)
LIrIlTS
A
GENERAL. LIABILITY
® COMMERCIAL GENERAL UABIUTY
N
GL-0504008126-00
1012012
1010612013
EACHOCC!JRRENCE
$ 1,000,000.00
SSEST (Ea occurrence)
$ 100,000.00
• cLalaasE iii OCCUR
°P (Any one Person!
$ 5,000.00
:
PERSONAL & ADV INJURY
$ 1,000,000.00
❑
GENERAL. AGGREGATE
$ 2,000,000.00
GEN L AGGREGATE UMpT. APPLIES PER
PRODUCTS - COM' /OP AGO
$ 2,000,000.00
M POLICY ❑ ❑
JE4r LOC
$.
AUTOMOBLE LIABILITY
❑ AM' AUTO
f�ED
Ktreel nSINGLE UMT
BODILY INJURY (Per person)
$
• AUTO • SCI ULED
INJURY (Per accident)
$
■ HIRED AUTOS ■ A �
pBOODDILY
(Per aco7Y AMAGE
❑ ❑
$
■ UMBRELLA LIAR ■ mom
❑ EXCESS UAB ❑ CLAIMS-MADE
EACH OCCURRENCE
5
AGGREGATE
$
• DEO ❑ RETENTION $
$
WORKERS COMPENSATION
AND EMPLOYERS'
A �PMET�P YlN
OFFICER/MEMBER Fl M EXCLUDED' ❑
If yes. describe uncle
DESCRIPTION OF OPERATIONS below
N/A
WC STAT T Oil
❑TOR( LIMITS ❑ ER
E.L. EACH ACCIDENT
$
E.L. DISEASE - EA EMPLOYE
$
E.L. OSEASE -POLICY LIMIT
$
•
DESCRIPTION OF OPERATIONS 1 LOCATIONS t VEHICLES (Aft** ACORD 101, Additional Remarks Schedule, a more specs is required)
CRRTtFICE r uM nee - - - - - - - - - - -- -. -.
VILLAGE OF MIAMI SHORES
BUILDING DEPARMENT
10050 NE 2 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.
AUTHORIZED REPRESENTATIVE
ACORD 25 (2010/05) OF
4) 1 988 -201 0 ACORD CORPORATION. AO rights reserved.
The ACORD name and logo are registered marks of ACORD