EL-13-2277 Inspection Worksheet
Miami Shores Village
10050 N.E.2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972 `
Inspection Number: INSP-204822 Permit Number: EL-10-13-2277
Scheduled Inspection Date: December 20,2013 Permit Type: Electrical- Residential
Inspector: Devaney, Michael Inspection Type: Final
Owner: GEORGE CRAVERO JITRS, RUTH Work Classification: Addition/Alteration
WADI C
Job Address:551 NE 93 Street
Miami Shores, FL 33138-
Phone Number
Parcel Number 1132060141010
Project: <NONE>
Contractor: EMPIRE ELECTRIC MAINTENANCE&SERVICE INC Phone:305-264-9982
Building Department Comments
INSTALL 2 TEMPER RESISTANT GFI OUTLETS AND Infractio Passed Comments
EXISITNG BOXES 1 AT MASTER BATHROOM AND 1 AT INSPECTOR COMMENTS False
HALL BATHROOM
Inspector Comments
Passed
Failed
Correction ❑
Needed
Re-Inspection ❑
Fee
No Additional Inspections can be scheduled until
re-inspection fee is paid.
December 19,2013 For Inspections please call: (305)762-4949 Page 26 of 27
Miami Shores Village
t Building Department
10050 N.E.2nd Avenue,Miami Shores,Florida 33138 C ! WR
Tel: (305)795.2204 Fax: (305)756.8972
INSPECTION'S PHONE NUMBER:(3057 762.4949 OCT 0 8 2013
FBC �`
BUILDING Permit No.R 13
PERMIT APPLICATION Master Permit No. �` � —,2_2-7 .
Permit Type: Electrical (�
JOB ADDRESS: 5 ✓ � V3
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: 1'"✓�� -� ( '—�.'� �a
Is the Building Historically Designated:Yes NO Flood Zone:
OWNER:Name(Fee Simple Titleholder): Phonec o
Address: i° 5l &Y
City: State: Zip: 3.31
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name:�P/1L G 1A e, Azv�Z zAV Phone#: 3V9 6 4g-geew52
Address: /, Z 5;1-L, /G
City: /'y/4=z l Stater Zip: T_
Qualifier Name: ,g//0 g_/ /?" 2 ° Phone#:
State Certificarion or Registration#: f? Z Certificate of Competency#:
Contact Phone#: 3OS— 06 Cl Email Address:�;tV/y O Q bpi-,P,412-%� T
DESIGNER:Architect/Engineer: Phone#:
V _ . - ' ,hermit:$ Square/Linear Footage of Work:
Ty, a of Wdrk:A,'QAddress DAlteration ONew S4Repair/Replace ODemolition
D criptioa.of Work.
Submittal Fee$ Permit Fee$ �
��®o CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Bond$
Notary$ Training/Education Fee$ Technology Fee$
Double Fee$ Structural Review$
TOTAL FEE NOW DUE$
1
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 ap licant ust
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered o the p son
whose property is subject to attachment. Also, a certified copy of the recorded notic nmencement must be posted at the jo site
for the first inspection which occurs seven (7) days after the building permit is is- ! the absenc o ' h po d t' e, the
inspection will not be approved and a reinspection fee will be charged.
/i Signature Signature
` Owner or Agent Co for
The foregoing instrument was acknowledged before me this _ The foregoing instrument was acknowledged before e,this
day of ,201 ,by clay of ,20,by
who is personally known to me or who has produced who is personally known to me or who has pro ced
Croy 6-3(b A -I As identification and who did take an-oath. as identification and>who. id take oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: Sign:
Pu ��`'A'•., SIXTO FERN DO ESCOBAR
Print: Print:
MY COMMISSION#DD OW75
My Commission Expires: * EXPIRES:June 25,2014 My Co si'q � My Comm.Expires Feb S.2017
t0•q ��oe Bonded T= N�S «�p:�� Commi88ibn .EE 854852
ova i �"���•"
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised 3/12/2012XRevised 07/10/07XRevised 06/10/2009XRevised 3/15/09)
10/8/2013 8:49 AM FROM: Fax Empire Electric TO: 3057568972 PAGE: 002 OF 002
CERTIFICATE DATE(MM1DDNYYY)
ATE OF LIABILITY INSURANCE
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 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 NAME�CT PDR eyza Diaz
Fortun Insurance, Inc. (305)445-3535 FAC :(666)415-0825
365 Palermo Ave. eyza.Diaz @fortuninsuranoe.com
INSURERS AFFORDING COVERAGE NAIC f
Coral Gables FL 33134-6607 Libert Mutual Insurance Grou INSURED Wausau In surance Co.
Empire Electric Maintenance & Services, Inc. , :COmmerce and Industry Empire Fire safety Associated Industries Ins 3ery
1041 Slip 67 Avenue :Miami. FL 33144
COVERAGES CERTIFICATE NUMBER:2013-2014 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 POLICY NUMBER M /YYW MPMIDD LIMITS
GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
X COMMERCIAL GENERAL LIABILITY
PREMISES Ea occurrence $ 300,000
A CLAIMS-MADE FxJ OCCUR B2-Z91-451758-012 /31/2013 /31/2014 MEDEXP(Any one person) $ 5,000
PERSONAL&ADV INJURY $ 1,000,000
GENERAL AGGREGATE $ 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000
JECT F-1 MX POLICY PRO- LOC
AUTOMOBILE LIABILITY Ee exlid rDdSINGL LIMIT_ 11000,000
$ IX ANY AUTO BODILY NJURY(Perperson) $
ALL OWNED X SCHEDULED K-Z91-451758-022 /31/2013 /31/2014
AUTOS AUTOS BODILY INJURY(Per accident) $
HIRED AUTOS AUTOSWNED PROPERTY DAMAGE $
Peraccident$1000 CompDed X $1000 Coll Ded Medical payments $ 5,000
X UMBRELLA LIAB X OCCUR EACH OCCURRENCE 3,000,000
C EXCESS LIAR CLAIMS-MADE
AGGREGATE $ 3,000,000
DED I X I RETENTION 9 E026154882 /31/2013 /31/2014
D WORKERS COMPENSATION X VJC STATr' OTH-
AND EMPLOYERS'LIABILITY ER
ANY PROPRIETOR/PARTNER/EXECUTIVE YIN E.L.EACH ACCIDENT $ 500 000
OFFICER/MEMBER EXCLUDED? N/A
(Mandatory In NH) 1014120 /31/2013 /31/2014 E.L.DISEASE-EA EMPLOYE $ 500 000
If yes,describe under
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Addltlonal Remarks Schedule,If more space is required)
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Miami shores Village ACCORDANCE WITH THE POLICY PROVISIONS.
10050 NE 2 AVE
Miami shores, FL 33138 AUTHORIZED REPRESENTATIVE
Hector Fort-6n/ND
ACORD 25(2010108) O 1988-2010 ACORD CORPORATION. All rights reserved
INS025 r9n1 nor,1nl The annRn name anti Innn are renigteretl marltq of arnpn
I
10/8/2013 8:33 AM FROM: Fax Empire Electric TO: 3057568972 PAGE: 002 OF 002
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Expiration date: AUG 31► 2014
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1041 SW 67TA :AVENUM ..
WEST. MIAMI FL 33144
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SECRETARY
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-THIS IS NOT A BILL 'DO NOT PAY'.
2318947 .
RE EIPT NO..
NAN.'
1041 SW 67 AVE 014
:EA01REE1LkTRiCMA1Wt CEkSERVICONCAWN15WAL '30,
24376" St EMBER
UMI Must be displayed at place-of business
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r03144:,'-
:.Pursuant to County Code
Chapter BA=Art:9 fie 10
OWNER— GEM TYPE OF I3U8INE88::.
PAYMENT RECEIVED
EMPIRE ELEC MAINTENAN04 SVC INC.• 196 ELECTRICAL CONTRACTOR
BY TAX COLLECroft
. ,.'.W6*er(s) 5 ECOD01274.1 $45.00-07/05/2013
CREDrrCARD-13-.001572
Busluess Tarr:The R welly.1 Is Dw a llcowz
pmit era ea tine of the Wdo bagism Holder ffim"MplyvOth a"gemsm"W1 or.
flongav"MMMI regain"laws OW regmiremaft which apply to the buslaws. ...
The RECEIPT RIO.Rtmm maille ffisonyed o0mill owwwaial"WNS Cod,See&:-'2*:-'