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EL-12-1677Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 178285 Permit Number: EL -9 -12 -1677 Inspection Date: September 13, 2012 Inspector: Devaney, Michael Owner: BERMUDEZ, PABLO Job Address: 9700 N MIAMI Avenue Miami Shores, FL Project: <NONE> Contractor: WILLIAMS POWER E. CONTROL Permit Type: Electrical - Residential Inspection Type: Final Work Classification: Addition /Alteration Phone Number Parcel Number 1131010330180 Phone: (786)313 -0355 Building Department Comments REPLACE THE ELECTRICAL METER, AND UPDATE ELECTRICAL SERVICE 200 AMP Passed 17' Inspector Comments PLEASE CALL HOME OWNER TO VERIFY IF HE IS HOME PABLO 786.355.3365 -! .... o/d FA- S `®� 2-e" Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled re- inspection fee is paid. until For Inspections please call: (305)762 -4949 September 13, 2012 Page 1 of 1 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 /DING PERMIT AFPLIGATION RIVED SEP07201Z FBC 20 Permit No.t, Master Permit No. 1071. Permit Type: Electrical �q ply � JOB ADDRESS: 9 6 �J C D s C 6/ ,; City: Miami Shores County: Miami Dade Folio/Parcel#: Is the Building Historically Designated: Yes NO e; /V® OWNER: Name (Fee Simple Titleholder): (R1O L b e YIA Lkde Z- Phone#: 7 5-,5--- 336S— Address: q''®O m, m,:c0,44,6 ARe, _ City: 1, .a 11* C u J. d'--) State: ft--- Zip: r i'S--0 Tenant/Lessee Name: n�1/j% Email: Cj (� 6elk®u2,'vl. ,At,t- Zip: /3V CONTRACTOR: Company Name: Address: /6'91 60 7 City: / g }-k• \ Qualifier Name: W / l //01 /in co ` l i Gt yrt s 5 State: Phone#: p6 c49 ey FL zip:. O/2 Phone#: 9- g 6 --SAC ._6 9 t Certificate of Competency #: Phone#: ft6 `1 g/J State Certification or Registration #: E C 1 3 190 27- J 9 Contact Phone#: Email Address: 4%//i A ri■S P L' 6-ZQ(l S0 0 °1 , aie t DESIGNER: Architect/Engineer: Phone#: Value of Work for this Permit: $ S.00 p sl 0 Square/Linear Footage of Work: Type of Work: °Address 1 °Alteration New epair/Replace °Demo ilion Description o Work: ° % if Q A XII 671,4 up q ***** **+ x********+x****+x*******w*********F ***** *** * *** *+s *e **** * *** ********** ********** Submittal Fee $ Permit Fee $ 4.1—i9 ' 6'4' 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 jutisdic on.- I understand that u separate permit must -be secured-for ELECTRICAL WORK PLUMBINe; 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 isolisu , \ e absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged Signature /— _– ..�eee -- Signature ' Owner or Agent Norllentractor The foregoing instrument was acknowledged before me this / The foregoing instrument was acknowledgedd before me this 7 day of .50, n17 , 20 LL, by I46% 4��,Ntie' ,e , day of , 20 , by eI ill [ Osras .'",R who is personally known to me, or who has produced who is personal y known to me or who has produced ( 6 ZD As identification and who did take an oath. $1750 0 --Gct —4/WI: identification and who did take an oath. NOTARY P ' : I NOTARY PUBLIC: Sign: c. ` ,'C& a�G�✓�fI Print: 264' //-4 f. 42 3� My Commission Expires: LAURA J RAMSAY MY COMMISSION +REE167817 EXPIRES: MAR 25, 2016 Bonded thraugll1 et State Insi rudlee **** *** **** *e<**x. e< *** * *a�� * **** *+ * ******** *** *** *** * *s<*+i<*****+e**** **** * * * ** Plans Examiner Zoning Structural Review Clerk (Revised 3 /12/2012)(Revised 07110 /07)(Revised 06/10/2009)(Revised 3/15/09) 09/07/2012 16:31 FAX 1 800 685 7530 DATA SCAN FIELD SERVICES Z001 TRANSMISSION OK TX /RX NO RECIPIENT ADDRESS DESTINATION ID ST. TIME TIME USE PAGES SENT RESULT *** TX REPORT *** **** x**** *****axe ***** 2905 93057707996 09/07 16:31 00'32 1 OK 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 From: To: Michael A. Devaney Sr. FP &L N.E Service Center Re: Work With inspection O.K Address: Permit Number: Additional Information: Cell Phone: 305- 986 -7028 Fax: 305- 770 -7996 Approved by (1K-/ .1 1 )r'b,io9 aoirmot 1 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 Date: 1 From: Michael A. Devaney Sr. Cell Phone: 305- 986 -7028 To: FP &L N.E Service Center Fax: 305- 770 -7996 Re: Work With inspection O.K Address: Cr) NI litACULi Permit Number: El \ d�� 1jf'l1. Additional Information: Approved by : Qk/' dtdklC,2 Michael A. Devaney Sr. Chief Electrical Inspector MIAMI -DADE COUNTY TAX COLLECTOR 140 W. FLAGLER ST. 1st FLOOR MIAMI, FL 33130 554969 -7 BUSINESS NAME / LOCATION WILLIAMS POWER & CONTROL INC 1691 W 37 ST 33012 HIALEAH 2011 LOCAL BUSINESS TAX RECEIPT 2012 MIAMI -DADE COUNTY - STATE OF FLORIDA EXPIRES SEPT. 30, 2012 MUST PURSUANT BE TO COUNTY CODE-CHAPTER 8A -ART. 9 & 10 THIS IS NOT A BILL — DO NOT PAY RENEWAL OWNER WILLIAMS POWER Sec. Type of Business 196 ELECTRICAL THIS 1S ONLY A LOCAL. BUSINESS TAX RECEIPT. IT DOES NOT PERMIT THE HOLDER TO VIOLATE ANY EXISTING REGULATORY OR ZONING LAWS OF THE COUNTY OR CMES. NOR DOES IT EXEMPT THE HOLDER FROM ANY OTHER PERMIT OR LICENSE REQUIRED BY LAW. THIS IS NOT A CERTIFICATION OF THE HOLDER'S QUALIFICA- TIONS. PAYMENT RECEIVED MIAMI -DADS COUNTY TAX COLLECTOR: 07/25/2011 60010000075 000045.00 SEE OTHER SIDE & CONTROL INC 35 FIRST -CLASS U.S. POSTAGE PAID MIAMI, FL PERMIT NO. 231 CC iECEI0002719 579019 -2 CONTRACTOR WORKER /S 1 DO NOT FORWARD • WILLIAMS POWER & CONTROL INC .WILLIAMS GARCIA PRES 1691 W 37 ST 35 ' HIALEAH FL" 33012 1„I11„JI,Ill,,,,,111,11I,1,-,1, ,11,11,1,,,1, I „III, ALEX SINK STATE OF FLORIDA CHIEF FINANCIAL OFFICER DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION 12 -27 -2010 * * 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: PERSON: 02/06/2011 GARCIA FEIN: 611475017 BUSINESS NAME AND ADDRESS: WILLIAMS POWER & CONTROL INC 1691 W 37TH ST STE 35 HIALEAH FL 33012 SCOPES OF BUSINESS OR TRADE: 1- CERTIFIED ELECTRICAL CONTRACTO EXPIRATION DATE: 02/05/2013 WILLIAMS IMPORTANT: 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 440.05112), 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 tiling 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. QUESTIONS? (850) 413 -1609 DWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 09 -06 PLEASE CUT OUT THE CARD BELOW AND RETAIN FOR FUTURE REFERENCE STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION CONSTRUCTION INDUSTRY CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW EFFECTIVE: 02/06/2011 EXPIRATION DATE: PERSON: WILLIAMS GARCIA FEIN: 611475017 BUSINESS NAME AND ADDRESS: WILLIAMS POWER & CONTROL INC 1691 W 37TH ST STE 35 HIALEAH, FL 33012 SCOPE OF BUSINESS OR TRADE: 1- CERTIFIED ELECTRICAL CONTRACTO 02/05/2013 IMPORTANT nPursuant to Chapter 440.05114), F.S., an officer of a corporation who elects exemption from this chapter by filing a certificate of election I- under this section may not recover benefits or compensation under this D chapter. Pursuant to Chapter 440.05112), F.S., Certificates of election to be H exempt.. apply only within the scope of the business or trade listed on E the notice of election to be exempt. R E 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. QUESTIONS? (850) 413 -1609 CUT HERE * Carry bottom portion on the job, keep upper portion for your records. OWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 09 -06 '' ,4oR° CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYY) 01/10/12 PRODUCER Southwestern Insurance 4375 Palm Ave. Hialeah, FL 33012 Phone (305)556 -7399 Fax (305)556 -5469 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 NAIC # INSURED Williams Power & Control, InC 1691 W 37 St # 35 Hialeah, FL 33012 INSURER A: ATLANTIC CASUALTY INS CO INSURER B: INSURER C: INSURER D: INSURER E: COVERAGES INSURER F: THE POLICIES OF INSURANCE LISTED 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 BYTHE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR INSRD TYPE OF INSURANCE POLICY NUMBER DM DR ATE ( D EXPIRATION POLICY LIMITS A 1 GENERAL n in n GENT ❑ COMMERCIAL III LIABILITY GENERAL LIABILITY CLAIMS MADE F OCCUR L144000636 -02 01/12/12 01/12/13 EACH OCCURRENCE 1,000,000 DAMAGE TO RENTED PREMISES (Ea occurence) 100,000 MED EXP (Any one person) 5,000 PERSONAL & ADV INJURY 1,000,000 GENERAL AGGREGATE 1,000,000 250 PD DED PRODUCTS - COMP /OP AGG 1, 000,000 AGGREGATE LIMIT APPLIES PER: POLICY 1 PROJECT ❑ LOC ❑ AUTOMOBILE • 1 • 1 1 1 Ft LIABILITY ANYAUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON OWNED AUTOS COMBINED SINGLE LIMIT (Ea accident) BODILY (P r p INJURY BODILY INJURY (Per accident) PROPERTY DAMAGE (Per accident) 1 GARAGE LIABILITY ❑ ANY AUTO 1 AUTO ONLY - EA ACCIDENT OTHER THAN EA ACC AUTO ONLY: AGG • EXCESSIUIIABRELLA LIABILITY 1 OCCUR ❑ CLAIMS MADE ❑ DEDUCTIBLE • RETENTION $ EACH OCCURRENCE AGGREGATE WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR / PARTNER f EXECUTIVE OFFICER/ MEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below IN WC STATU- ❑ OTH- TORY LIMITS ER E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE E.L. DISEASE - POLICY LIMIT OTHER DESCRIPTION OF OPERATIONS / LOCATIONS 1 VEHICLES l EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS ELECTRICAL CONTRACTOR CERTIFICATE HOLDER CANCELLATION 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, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAI • • • • _ POSE NO OBLIGATION OR LIABILITY OF AN • f PON THE INSURER ITS AGENTS OR REP - TIVES. REPRESENTATIVE ACORD 25 (2001/08) QF © ACORD CORPORATION 1988