The URL can be used to link to this page

EL-13-2622Inspection Worksheet oe Miami Shores Village o J 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 205117 Scheduled Inspection Date: December 30, 2013 Inspector: Devaney, Michael Owner: KOHEN, MARCELO Job Address: 1177 NE 100 Street Miami Shores, FL 33138- Project: <NONE> Permit Number: EL -11 -13 -2622 Permit Type: Electrical - Residential Inspection Type: Final Work Classification: Alteration Phone Number Parcel Number 1132050190350 Contractor: CAMAGUEY ELECTRICAL SERVICE Phone: (305)984 -1036 aunaing department comments ADD GFCI TO NEW POWDER ROOM Passed INSPECTOR COMMENTS False Inspector Comments Failed Correction ❑ �� > Needed Re- Inspection ❑ Fee No Additional Inspections can be scheduled until re- inspection fee is paid December 27, 2013 For Inspections please call: (305)762 -4949 Page 28 of 28 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: (3057 762.4949 FBC 20 ( D BUILDING PERMIT APPLICATION Permit Type: lets c Permit No. Ic LA _ 9f0?_?_ Master Permit No. c1 3 — ;� -3 i q JOB ADDRESS: 119 9 N F_ 1 ao ST City: Miami Shores County: Miami Dade Zip: 35 13 Folio/Parcel #: 11-3W5-0'1q -0350 Is the Building Historically Designated: Yes NO x Flood Zone: OWNER: Name (Fee Simple Titleholder): MA19 ' E1.D iZl'.� f}�� Phone #: Address: 91171 NF- 100 S City: MIAMI '&OO tM 9 State: Ft— Zip: 33 13 9 Tenant/Lessee Name: Phone #: Email: �r,grG� IG i�rl�hC',he� �t`�iYl CONTRACTOR: Company Name: CA AAM V U ELF- Clf-I CAL C •y Phone #: • 1 ,94 • W3 Address: Co*0 VU - 2-(,o+-h COUP T- City: MALSAK State: Zip: 3 t Qualifier Name: CAAALAP L • Gi OlA to LE E Phone #: State Certification or Registration #: A C t G 33 p g (e Certificate of Competency #: _ Contact Phone #: 306.1 - j ®? lP Email Address: DESIGNER: Architect/Engineer: o® Value of Work for this Permit: $ 3001'- Square/Linear Footage of Work: Type of Work: DAddress CWteration ONew ORepair/Replace ODemolition Description of Work: ADD C F 0 1`b 1A EW POVq DF�..P. R-00 W . Submittal Fee $ Permit Fee $ /571> o4u> CCF $ CO /CC $ Scanning Fee $ Radon Fee $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ DBPR $ Bond $ Technology Fee $ TOTAL FEE NOW DUE $ • 1(� . Bonding Company's Name (if applicable) Bonding Company's Address City Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State zip 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 tihw, absence of such posted notice, the inspection will not be pprov a d a re' spection fee will be charged. 7 Signature A Signature V ° Owner or Agent Contractor The foregoing instrument was acknowledged before me this day of OCXo O by who is personally known to me or who has produced As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: ft My Commission Expires: �L _ MARIA GON?KEZ MY 00h,.IAISSrN u F.1155991 EXPIRES: December 27, 2015 Bonded Thru Notary Public Undermfters The foregoing instrument was acknowledged before me this I day of 04"b 1 `r(_- , N q2 , by who is personally known to me or who has produced -2,0-17 APPROVED BY . ' ' 2 .7 ,41 N� y Plans Examiner Structural Review (Revised 3 /12/2012 )(Revised 07/10/07 )(Revised 06 /10/2009XRevised 3/15/09) as identification and who did take an oath. NOTARY PUBLIC: Print: A,4Vcll I a j 4' Z P MyCOmmiSSion P MYff}M;t�;� lCPd E? tcSC' 9. 4r EXPcitkS:Lecam� r27 2 .5 •F,.....,5?:`° 6oude�l Ti ?ru N R'EIGIIL Umtsti�r!ters Zoning 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 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 rrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrr� COMPLETE CONTRACTOR'S INFORMATION BUSINESS NAME: BUSINESS ADDRESS: (10� coin- CITY hl � L�br STATE Ll= ° ZIP CODE 3901(v BUSINESS PHONE: () FAX NUMBER L--j CELL PHONE QUALIFIER'S NAME: SWLAC-L, v 99 - GOO -1A 1:;7 QUALIFIER'S LIC NUMBER: Ar- E -MAIL ADDRESS OF APPLICABLE): ��lv�l �� ®'°' �#�� • y Created on 3119M9 BY MLDV 1 RV 3129109 MLDV I RV 612711 1 AS ew ENT HAS A COLORW .• r. 6338696 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD SEQ# L12090501875 D. LICENSE NBR 09/05 2012 127002684 ER13014584 The ELECTRICAL CONTRACTOR Named below HAS REGISTERED Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2014 (INDIVIDUAL MUST MEET ALL LOCAL LICENSING REQUIREMENTS PRIOR TO CONTRACTING IN ANY AREA) GONZALEZ, SAMUEL JORGE CAMAGUEY ELECTRICAL SERVICES CORP. 6160 W 26TH CT HIALEAH FL 33016 RICK SCOTT GOVERNOR DISPLAY AS REQUIRED BY KEN LAWSON SECRETARY THIS DOCUMENT HAS A COLORED BACKGROUND - MICROPRINTING - LINEMARW" PATENTED PAPER Cj # 6338712 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD SEQ# L12090501891 DATE BATCH NUMBER LICENSE NBR 09/05/2 012 128018265 EY12000268 The ALARM SYSTEM CONTRACTOR I Named below HAS REGISTERED Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2014 (INDIVIDUAL MUST MEET ALL LOCAL LICENSING REQUIREMENTS PRIOR TO CONTRACTING IN ANY AREA) GONALEZ, SAMUEL JORGE CAMAGUEY ELECTRICAL SERVICES CORP. 6160 W 26TH CT HIALEAH FL 33016 RICK SCOTT KEN LAWSON 'GOVERNOR DISPLAY AS REQUIRED BY LAW SECRETARY 002131 local Business Tax Receipt Miami —Dade County, State of Florida -THIS IS NOT A BILL - DO NOT PAY 6797840 BUSINESS NAME /LOCATION RECEIPT NO. EXPIRES CAMAGUEY ELECTRICAL SERVICES CORP RENEWAL SEPTEMBER 30, 2014 6160 W 26 CT 7071517 Must be displayed at place of business HIALEAH FL 33016 Pursuant to County Code Chapter 8A - Art. 9 & 10 OWNER SEC. TYPE OF BUSINESS CAMAGUEY ELECTRICAL SERVICES CORP 196 SPEC ELECTRICAL CONTRACTOR PAYMENT RECEIVED 11 E000103 BY TAX COLLECTOR Worker {s} t $45.00 08/29/2013 CREDITCARD -13-- 006622 This local Business Tax Receipt only confirms payment of the Local Business Tax. The Receipt is not a license. permit, or a certification of the holder's qualifications, to do business, Balder must comply with any governmental or nongovernmental regulatory laws and requirements which apply to the business. The RECEIPT NO, above must be displayed on all commercial vehicles - Miami -Dade Code Sec Ba -276. For more information, visit wwtiv.miamidede.gomaxeo lie ctor 10,' 17/21013 04:00 305263664. BARBARA INSURANCE PAGE 31 / 01 ACCT & CERTIFICATE OF LIABILITY INSURANCE Ik,,� 0AY9(MNioof,Yw, j 10113,2012 THIS CERTIFICATE 13 ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO MGMTS UPON THE CERTIFICATE HOLDER, THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER - IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the pottcy(les) must be endorsed. If SUBROGATION IS WAIVED, subleCt to the terms and conditions of the policy, certain policies may require an endorsement A statentont on this Certlfleats does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER BARBARA INSURANCE INC. 7105 SW 5i MIAMI FL 33144 N TAC NI HONE a F :305 263 6640 M1O 305- :93.8041 A M ae L45URER S APPORWNO COVERAOE NAIC e INSURER A : 0 NADA INSURANCE COMPANY ON$UR99 CA.11AGIJEY ELECTRICAL SERVICES CORP, 6160W26C' HIALEAH FL.33016 INSURER ti IvsuILERC: LNS RtRa: UYSURER E INSURER F 7HIS IS IC CERTIFY THAT TI-I! POLICIES OF INSURANCK LISTED BELOW HAVE BEEN ISSUE" 'O THE INSURI?b NA%1EO ABOVE FOR "HE POLICY ZERIOD INDICATED, INOTVVTMSTANOING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMZNT vV1T8 ;RESPECT -0 WHICH THIS CBRTI;:ICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBEO HEREdN IS SUB.EC- TO AL- TriE TERMS EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIM`,'; 5 SHOWN MAY HAVE BEEN REDUCED 3Y PAID CLAIMS. tiR TYPE orCNSUAANCF MIAMI SHORES VILLAGG PoutYNUMOIR bM b mmf LIVITS —� M9111ALUA3ILITY 10050 NE 2ND AVE AUTN REARFSENTAnVE MIAMI SHORES, FL, 33134 EAC- 1OCC'.PRBNCre S �OO,v00 nFNI5E5 CEa OU].ny�u° 3 100,000 . i (,'QMNSCRTIA;, Vft NERA, k.$AVI_IT^ t AIED EXP EFr a pr, c�on� y 5,0D0 CLA 4t5 kP.DE E OCCUR 0145171.00023477 1213012012 12/3012013 PERSCvA;sA v Nzufi- $ 50 ?.000 GENERAL AGGREGATii L 500. ?150 PROO,;CTS , Cowinp Ar, ,, i 500. XQ G °N: AGGREGATE LIMIT APPLIES PER r^ PDXY ' �R6 �O� El I j I AUTOMOeLE UASIUTY ; ^ s a8c;mrntS;N L ! ,k). I 6 800;LY IN,:URY(Fw CePStN^! # I ANY ALTO ? AUTO$ EO 6µCf(EOULED NST 9CD;tY INJURY (Pe, aouos�;) i ,GY�ItG HIRCO AvTes A003 r UMBREI.LA LIAO C3CCUR EwC+� OCCURRENCE d axcaet uaa LCLAIAt6 -MA.01 � 4GGRI MATE t s ° R TION I W0*1(Ei1C COMP€NISATIoN !AND ENPLl7YERS' UA®IUTY ANY PnP;k1T0AtPART41R1EX1CU nVE oF9tCFR,M9491R ex" ,OID> h I A f.1.. EACr+ACCIDENT ; E,L O SCASG . iwA �MPL(jY «Ei' (Nandatoty In NH) (II � daer,Abr smdrr R f; OPQRATIONE pilaw } E.L. O15E'A3E - POL'C'Y L IT s i cEscRiwnoN OF OPERATION# I LOCATIONS. t V£µ,t LES IAn.en aCORO 101, Ad4J6e.rt Rer"a*r Sana&U*. ;t one" space le .rtt+irsdl ELECTRICAL WORK I 0109Yr121w 19701. "10144191 : er_T: 104 in Is 19101: R/ IwnM LJ IiV 1v/4.71 +>r'JWoo -LV1V MvVKU LVKte�7KATION, All rights reserved. The ACORD name and logo are registered marks of ACORD // SHOULD ANY OR TWO ABOVE DESCRIBED POLICIES Bi CANCELLED BEFORE MIAMI SHORES VILLAGG n.r EXPIRATION DATE THeREOP, N"cC W16L oG DELIVERED IN I BUILDING DEPARTMENT ACCORDA CE WITH THE POLICY PROVISIONS, 10050 NE 2ND AVE AUTN REARFSENTAnVE MIAMI SHORES, FL, 33134 v R/ IwnM LJ IiV 1v/4.71 +>r'JWoo -LV1V MvVKU LVKte�7KATION, All rights reserved. The ACORD name and logo are registered marks of ACORD // J}w`�yi�'' �}1 �a 10/17/2013 04:00 3052636641 BARBARA INSURANCE PAGE 01/01 q CERTIFICATE OF LIABILITY INSURANCE bA e(Woo/Ymry 10/03/2012 THIS CERTIFICATE 15 ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS No RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE GOES 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 CERTIPIQATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the poticy(les) must be endorsed. It SUBROGATION 15 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). PR�UCER BARBARA INSURANCE INC. 7105 SW 8 ST MIAMI,FL.33144 CONTACT NAME: P M e E0: 30b -263 -6640 F EL,; 305 - 263 -8641 E-MAIL INSURERS AFFORDING COVERAGE NAICa INSURER A s GRANADA INSURANCE COMPANY INSURED CAMAGUEY ELECTRICAL SERVICES CORP. 6160 W 26 CT HIALEAH.FL.33016 INSURER 6: 92130/2012 INSUhm C: EACH OCCURRENCE INSURER 0 : PReMIM§ WW14ER E! IbEO EXP am Ewrtgp INSURER F p$RSONAL d AOV INJURY COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LIST9D 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. OR TYPEOPIVSURANCE POUCYNUg4M MMIUOO MMlDDtYYN OMITS GENERALLIASIUTY COMMERCtA1. GENERAL LIABILITY CLAIMS -MADE M OCCUR DI OSFL00023477 92130/2012 12+'3012013 EACH OCCURRENCE $ 5001000 PReMIM§ 8 100,000 IbEO EXP am Ewrtgp S 5,000 p$RSONAL d AOV INJURY S 50D,000 GENERAL AGGREGATE S 500.000 GEMLAGGREGATE LIMIT APPLIES PER: POLICY PRO LOC PRODUCTS .COMP/OPAGG S 500.DOO S AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHWULEO AUTOS 0 H R AUTOS INGLE LIMIT S BODILY I"RY (Per owson) S BO DI BDILYINJURY (Per aeddem) S PROPERTY ,dd, s 5 UMBRELLA UAB EXCESS LIM OCCUR CLAIMS -MADE CH OCCURRENCE S AGGREGATE S OED I I RETENTION S WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOMPARWIVEXECUIIYE DFFICERlM R EXCLUDED9 Itland�tory .1? ) 1! =IINd Under DESCRIPTION OF OPERATIONS below NIA WC STATU. I7rH_ $.L. EACH ACCIDENT $ EL. DISEASE - EAEMPLOYE S E.L. DISEASE • POLICY LIMIT $ CEBCRIVnON OF OPERATIONS I LOCATIONS I VENICLES (Aneeh ACCRO 101, Addlllenel Remerlm Sche"a. I more epees is rwired) ELECTRICAL WORK CPH r SHOULD ANY OF THE ABOVE DESCRIBED POLICIES 96 CANCELLED BEFORE MIAMI SHORES VILLAGO THE EXPIRATION DATE THEREOP, NOTICE VOLL, BE DELIVERED IN BUILbING DEPARTMENT ACCORDA CE WITH THE POLICY PROVISIONS. 10050 NE 2ND AVE AU REPRESENTATIVE MIAMI SHORES, FL. 33136 n O ACORD 25 (2010/05) 0111181111-2010 AC The ACORD name and logo are registered marks of ACORD