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ELC-13-1973Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number. INSP- 202096 Permit Number: ELC -8 -13 -1973 Scheduled Inspection Date: October 30, 2013 Permit Type: Electrical - Commercial Inspector: Devaney, Michael Owner: , Job Address: 9899 NE 2 Avenue Miami Shores, FL Project: <NONE> Contractor: FIALLO ELECTRIC CORP isunaing Department comments INTERIOR RENOVATION AS PER PLAN Inspection Type. Final Work Classification: Addition /Alteration Phone Number Parcel Number 1132060134360 INSPECTOR COMMENTS False Inspector Comments Passed [Ef Failed �} �G Correction Needed Re- Inspection ❑ Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Phone: (786)399 -0832 October 29, 2013 For Inspections please call: (305)762 -4949 Page 23 of 26 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 Permit Type: Electrical JOB ADDRESS: 9899 NE 2nd AVE AUG 9 26 , �.y FBC 20 Permit No. iC, -iF ;� _ Master Permit No. City: Miami Shores County: Miami Dade zip. 33138 Folio/Parcel #: Is the Building Historically Designated: Yes NO X Flood Zone: X OWNER: Name (Fee Simple Titleholder): Wells Fargo / Gil Veliz Phone #: 954-596 -6883 Address: 1950 Hillsboro Blvd City: Deerfield Beach State: FL Zip: 33445 Tenant/Lessee Name: Email: CONTRACTOR: Company Name: Fiallo M.J.Electrical Corporation Phone#: 305 -232 -5275 _ Address: 7025 SW 17 Terr city: Miami State. FL Zip: 33155 Qualifier Name: Luis A. Salas Phone #: 786-229-0983 State Certification or Registration #: EC0003163 Certificate of Competency #: Contact Phone #: Email Address: DESIGNER: Architect/Engineer: R.S & Hills, Inc Phone #: 954 -474 -3005 Value of Work for this Permit: $1 50 Square/Linear Footage of Work: �J� of Work: DAddress ®Alteration ONew ORe air/Re lace ODemolition Type P P Description of Work: Interior Renovation cx-S ?&L 01 QAIS Submittal Fee $ Permit Fee $ ?�'v'° r ®' el CCF $ CO /CC $ Scanning Fee $ Notary Radon Fee $ Training/Education Fee $ Double Fee $ Structural Review $ DBPR $ Bond $ Technology Fee $ TOTAL FEE NOW DUE $ Bonding Company's Name (if applicable) Bonding Company's Address City State 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 o seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approve and a reinspection fee will be charged. qQ Signature Signature t V Owner or Agent The foreg ing instrument was acknowled b ore me this day o who is personally known to me or who has produced As identification and who did take an oath. NnTARV PT TRY J( Contractor The foreg ' g instrument was acknowl before e day o v , 20 L6, by C> - :S who is personally known to me or who has produced as identification and who did take an oath. VnTARV PTTRT.TV- Structural Review Clerk (Revised 3 /12/2012)(Revised 07 /10/(Y7)(Revised 06 /10/2009)(Revised 3/15/09) 09/18/2013 14:10 Page 2/2 - *1101R." CERTIFICATE OF LIABILITY INSURANCE DA1E(MM/DD/YYYY) .16 - •' 1 09/18/13 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(SJ, AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: Vthe certificate holder Is an ADDITIONAL INSURED, the policypes) must be endorsed. K 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 endorsemen s . PRODUCER NAME: MARTA M ALONSO Florida Bankers Insurance ALONE Ext : (305) 266-6493- (A/C, No): (305) 262 -0679 7278 SW 8 Street ADDRESS: martap_floddabankersinsurance.com Miami, FL 33144 MWUMAM Phone (305)266 -6493 Fax (305)262 -0679 CUSTOMER ID is $ 5.000.00 PERSONAL & ADV INJURY $ 300.000.00 INSURERS) AFFORDING COVERAGE NAIC • INSURED INSURER A: FEDERATED NATIONAL INSURANCE COMPAN PRODUCTS - COMP /OP AGG Fiallo M.J. Electric Corp. INSURER B: PROGRESSIVE EXPRESS INS. COMPANY 7025 SW 17 Terr INSURER C: INSURER D: MIAMI, FL 33155- INSURER E: COMBINED SINGLE LIMIT (Ea accident) (786) 389 -7152 INSURER F $ 10,000.00 rrnveoararo __ 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 REQUI REMENT, 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. LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER MM/DD (MMIDDN" LIMITS A GENERAL LIABILITY © COMMERCIAL GENERAL LIABILITY F-1 El CLAIMS -MADE RJ OCCUR ❑ N GL- 0504004673 -03 04/182013 04/182014 EACH OCCURRENCE $ 300.000.00 PREMISES Ee occurrence $ 100.000.00 MED EXP (Any one person) $ 5.000.00 PERSONAL & ADV INJURY $ 300.000.00 ❑ GENERAL AGGREGATE $ 300.000.00 GEN'L AGGREGATE LIMIT APPLIES PER: © POLICY ❑ PRO- ❑ LOC PRODUCTS - COMP /OP AGG $ 300.000.00 AUTOMOBILE LIABILITY ❑ ANY AUTO COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ 10,000.00 B F-] ALL OWNED Auros © SCHEDULED AUTOS 01898091 -0 10/12/2012 10/12/2013 BODILY INJURY (Per accident) $ 20,000.00 El HIRED AUTOS El(Per NON -OWNED AUTOS 1:1 PROPERTY DAMAGE accident) $ 10,000.00 $ $ ❑ UMBRELLA LIAB ❑OCCUR ❑ EXCESS LIAR ❑ CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ ❑ DEDUCTIBLE RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY OFFICEOR/MEM ER EXC UL DF�D?ECUTIVE Y / (Mandatory In NH) If yes, describe undo DESCRIPTION OF OPERATIONS below NIA WC STATU- OTH TORY LIMITS ER $ E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ E.L. DISEASE - POLICY LIMIT $ -7 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additlonal Remarks Schedule, if more apace Is required) CERTIFICATE Nnl noo MIAMI SHORES VILLAGE 10050 NE 2 AVE MIAMI SHORES, FL 33138 305 - 756 -8972 ACORD 25 (2009109) OF SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED M ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE �R .. ..... ... :::::.:.:'; . W 7 ass zoos ACORD CORPORATION. All rights reserved The ACORD name and logo are registered marks of ACORD