EL-13-1216 Inspection Worksheet
Miami Shores Village
10050 N.E.2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-192656 Permit Number: EL-6-13-1216
Scheduled Inspection Date:August 06,2013 Permit Type: Electrical'- Residential
Inspector: Devaney,Michael
Inspection Type: Final
Owner: GOMEZ,LINA Work Classification: Addition/Alteration
Job Address:10109 N MIAMI Avenue
Miami Shores,FL 33150- Phone Number
Parcel Number 1132060131510
Project: <NONE>
Contractor: APR ELECTRIC CORP Phone: (305)318-3692
Building Department Comments
ELECTRICAL WORK FOR KITCHEN REMODEL Infractio Passed Comments
INSPECTOR COMMENTS False
Inspector Comments
Passed
Failed
Correction ❑
Needed
Re-Inspection
Fee
No Additional Inspections can be scheduled until
re-inspection fee is paid.
August 05,2013 For Inspections please call: (305)762-4949 Page 12 of 37
I
t
Miami Shores Village
Buildin g Department
artment
10050 N.E.2nd Avenue,Miami Shores,Florida 33138 JUN 0 3 2013
Tel:(305)795.2204 Fax:(305)756.8972 •
INSPECTION'S PHONE NUMBER:(305)762A949
FBC 20
WELDING Permit No. ,- I ° I Z`
PERMIT APPLICATION Master Permit No. 92 1 LIS
Permit Tape:Electrical
JOB ADDRESS: -/ rot og Iy Fl r p{ r tV6
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: !l �v�D /a�� 510-
Is.the Building Historically Designated:Yes NO X Flood Zone: /U®
OWNER:Name(Fee Simple Titleholder): L/pj q- �� �� Phone#:
Address: j or oq N rYtAwt ev6
city: 8 r AW f C7 fLV 42 state:
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name: /`"Tf l`4 !P cA-1 e arp Phone#:
Address: at A_�? NA) A 4-11 G"4
City: Al
1.4 xt/ rZ- 33 126 state: �'L Zip:
Qualifier Name• -ale X ele 1-4 ADZ Phone#• 3®rJ 3 6 9 F
State Certification or Registration#: R /30 y l Certificate of Competency#: 0 0 6 1900 9/
Contact Phone#: 30:5 3/9 3 6 Email Address: a P a e%c-kl?c- ID V
DESIGNER AtchitectJPng eer: Phone#:
Value of Work for tWPermit:$ Square/I,inear Footage of Work,
Type of Work: ClAddress 'LlAheration ONew ORepair/Replace ODemolition
Description of Work: ®/e c,4 a Ov7A1 e f S r-,O r r-j fr_4e h
Submittal Fee$ Permit Fee$ Zj6? <°e," CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Bond$
Notary$ Training/Education Fee$ Technology Fee$
Double Fee$ Structural Review$ y
TOTAL FEE NOW DUE$ I U 0
f
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'prier tq 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 o5purs seven (7) days after the building permit is issued In the absence of such posted notice, the
inspection will not rov and a reinspection fee will be charged
Signature Signature
o ent Contractor
The foreg instrument was acknowledged before me this 31 The foregoing instrument was acknowledged before me this
day of ,20�by I-t tJ A- �o Yvt®Z day of 20 ia,by A x 4-e 1'..
who is personally known to me or who has produced D2. E1. , who is personally known to me or who has produced p
65205-221l/0 As identification and who did take an oath. �7`/�l?�o C��X05 4s identification and who did take an oath.
NOTARY PUBLIC: '►'% JACQUELINE TAPANES NOTARY
JACQIFELNE TAPANEB
z•: '�` MY COMMISSIONS EE167169 r MY Cpapy{IS9ldV#EE187159
Sign: ,� .. Fabluary 07.2018 Sign. 07.2018
Print: ,J- , Print: XC4D,x�l
My Commission Expires: 2 _ 0-7 — 2016 My Commission Expires: 2 •- 0'7
APPROVED BY '� _ /� G�/ /�� Plans Examiner Zoning
Structural Review Clerk
(Revised 3/12nO12)tRevlsed 07/10/(Y)(Revised 061ion009)(Revised 3/15/09)
r
t
SIRS
Miami shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
CONTRACTORS' REGISTRATION
ALL CONTRACTORS MUST PROVIDE COPIES OF LICENCES AND INSURANCES EACH TIME A PERMIT IS SUBMITTED.
IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR:
A. COPY OF QUALIFIER'S STATE LICENCES
B. COPY OF LOCAL BUSINESS TAX RECEIPT
C. COPY OF LIABILITY INSURANCE (CERTIFICATE HOLDER TO BE MIAMI SHORES VILLAGE BLDG DEPT)
D. COPY OF WORKERS COMPENSATION JEITHER CERTIFICATE OR EXCEMPTION)
IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY:
A. COPY OF CERTIFICE OF COMPETENCY OF QUALIFIER
B. COPY OF LOCAL BUSINESS TAX RECEIPT
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 WORKERS 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: � tl'6crp ( C (20A p
BUSINESS ADDRESS: ety 3 -N u-) ej 9T 0 t� CITY &.&g /
STATE L ZIP CODE
BUSINESS PHONE: 0_0�) ��6AO,2, FAX NUMBER�)
CELL PHONE QUALIFIER'S NAME:
QUALIFIER'S LIC NUMBER: /,t',�2 D61,2--:�0,2-60'
E-MAIL ADDRESS(IF APPLICABLE): t a .c®
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APR ELECTRIC CORP
k� = ALEX DE LA PAZ PRES
{ 8183 NW 8 ST C-4
j� MIAMI FL.33126
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1
09-17-2012
JET ATWATER STATE OF FLORIDA
CHEF Ri NXIAL OFFMM DEPARTMENT OF FINANCIAL SERVICES
DIVISION OF WORKERS..COMPENSATION
CEWIFICATIti OF ILECTION TO BE EXEMPT FROM FLORIDA WORKERS` COMPENSATION LAW
CONSTRUCTION>IIPJSTRY EXEMPTION
This certifies that the indv[dual listed below has elected to be exempt from Florida Workers' Compensation law.
EFFECTIVE DATA.: 09117/2012 EXPIRATION DATE: 09117/2014
PERSON: DE LA PAZ ALEX
FEIN: 262663989
BUSINESS NAME AND ADDRESS:
APR ELECTRIC CORD
8183 NW 8 ST APT C4
MIAMI FL 33128
SCOFE$ OF BUSINESS-OR TRADE
1; ELECTRICAL #t 3Mti WIT- 14 N BUILD
immitmir Porsuaet to:chapter 440 . 0rA14k F$.,ao O ficer Of a carporaUsn who sleds exemption from this chapter by filing a certificate of election under this
section may not recover hemefits or coition under this dmpter. Pursuant to Chapter 440.0502► F.S., Certificates of election to be exempL.. apply only within the
Scapa of the business or trade listed on the notice of afection to be exempt Pmsaant to Chapter 440.05031 F.S., Notices of election to be exempt and cortificates of
election to be exempt shall be subject to revocation it at any than after the filing of the notice or the issuance of the certificate, the person aemed no the notice or
certilicate an longer meets tile requirements of this section for issuance of a certificate. The deparnaeut shall revoke a certificate at any time far failure of the person
named on the certificate to mat the requirements of this section.
QUESTIONS? (850) 413-1609
O1NC 25Z;;OERMCATE OF ELECTION TO BE EX8WT REVISED 01-11
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4:f.:
05/31/2013 11:52 3052671576 SAFE INS PAGE 01/01
(CERTIFICATE OF LIABILITY INSURANCE CA-M `AVEI -M
Prtomn=R 5/31/2013
SAFE INSURANCE GROUP I Phone THIS CERTIFICATE IS ISSUED AS A MATTER OI° INFORMATION
305-264-8964 ONLY AND CONFERS NO RIGHTS URON THE CERnF1CATE
7901 NW 29T HOLDER. THIS CERTIFICATE DOES NO'r AMEND, p(TENO OR
MIAMI,FL 33126-0000 Fax ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
yww negroup oom 30x287-1576
_ INSURERS AFFORDING COVERAGE NAK;�
APR ELECTRIC CARP INWMRAAC_CICENT INSURANCE coMPANY�
8183 NW 8 ST#C4 INSURE or
MIAMI FL 33126 1N5IAIR c.
0011579 INSURS"o: —
CO AGE (NOURER M b. —
THE POLIDIES OF INSURANCE LI3TED BELOW HAVE E EEN ISSUED TO THE INSURED NAMEDABOW FOR THE POLICY PERIOD ININ E0.NOTWITHSTANDING
ANY REQUIREMENT,TERM OR•;ONDITION OF ANY•IONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICgTE MAy BE ISSUED OR
MAY PERTAIN,THE INSURANCE AFFORDED BY THE F 3LIDIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,OCCLUSIONS AND CONDITIONS OF SUCH
POLICIES.AGGREGATE UMITS SHOWN MAY HAVE BE EN REDUCED BY PAID CLAIMS.
nv�q '
M=NUMBER voucY ePPEt�
A Goal.w1�LerY ure
X WM6fP1lmurf AIERAL t1aBRITY CPP OC[50100 9/0912012 9MO12013 EAA0N RRr3w � E
CIAINIBiNADE ��oocuR aenee)� E 100,00 0
MEOV --1 y 5000
PERSONAL&ADV INJURY S 1.000.000
OENERALAt�RLCATE $ 2,000,000
API�LIE9 PRODUCTS.COWMPAQO s -- Z 000 000
a►rorloeae LwEn.ITY
ANYACITO t� ED�MNGLEuw E
ALL OWNED AUT08 M•••-
CO iEDUMAUTOS M )R E
HGiEDAUTOS -
NON•OWNWAUTO$ I E
�. �o nAnraoe �
GARAAELTY
ANYAUTO AUTOCMLY-EAMLIDENT $
OTHERO p YM FA ACC $
EXCe88JU{MRM,I,ALAZU'V AUU1Tbb AGG E
EACH CC:MMrM CE $ _
OCCUR CLAffiI$MAdE A gR-EGA �:
DEDUOTIO6E –, E
IiETEIPrfON S I S
YYOIiKER61�NYk�gAflQN $
ANY PROP Y/N ATII. Or,,
a NHI wa ❑ £.L.EACH ACCa Nr $
berme
E. IMAGE-EA EMPLOYEE 3
otraER E.1-.OISEABE.POWOYUMTT S
D68CRU�71CN OF OPFRATKIN9!LOCaT�C#/VENIQLES!EJao.IBR�ApOLO EY ENDORBEMF�vr r spepal,PRGV131oN8
SUBJECT TO POLICY FORM,CONDITIONS,END iRSEMENTS,LIMITATIONS AND EXCLUSIONS,
Ela*W!W Sub.ContracWT
CERTIFICATE HOLDER CANCELLATION
MIAMI SHORE VILLAGE l J4AANYOFTHHARMEWSMO oPOUCIMSECANaN1�, �,�T o�aeanoN
BATE THEREOF.THE MUM n45MR WILL ENDEAVM rLl VM 10���T�
BUILDING 60 DEPARTMENT to raTro c0"gyp,=� --ron�fir,WTPauuWTo0osoWML
10060 N E Z E F orP09E 010 OEILIM aN oR LIABILITY OF my KIND UPON illp
MAIMI SHORE Fl 33138 awmma Trs AGENTS DR
ITaTnrrs
AUTNOMmo
ACORD ae(ROC9107) sas-,2008 ACORD CORPORA^rypN
The AC ORD name and logo ara rsgiewred marks of ACORD ghts rYSeTVHTL