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EL-13-0823Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INS P- 195299 Scheduled Inspection Date: July 18, 2013 Inspector: Devaney, Michael Owner: BROWN, DOROTHY Job Address: 1560 NE 105 Street B -2 Miami Shores, FL Project: <NONE> Contractor: HENRY RODRIGUEZ ELECTRICAL CONTRACTOR, INC Isunaing uepanment comments KITCHEN REMODEL 13'g Zz Permit Number: EL -4 -13 -823 Permit Type: Electrical - Residential Inspection Type: Final Work Classification: Alteration Phone Number Parcel Number 1122300530140 INSPECTOR COMMENTS False Inspector Comments Passed Failed Correction Needed Re- Inspection ❑ Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Phone: (305)554 -5711 July 18, 2013 For Inspections please call: (305)762 -4949 Page 8 of 20 F Miami Shores Village N 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 FBC 20 BUILDING Permit No. L- ►5 -a-23 PERMIT APPLICATION Master Permit No. l '� Permit Type: Electrical JOB ADDRESS: t j CQ 0 Of— �d ��° `�' ' City: Miami Shores County: Miami Dade Zip: 7; Folio/Parcel #: Ik ?,-L'30-0521 Q \LA0 Is the Building Historically Designated: Yes NO Flood Zone: OWNER: Name (Fee Simple Titleholder) o C&VJ--Z' Phone #: 5 0 I — 3d(A ° T-T51 Address: O \®5- 5k° City: A.A V'iw SyNqr&s State: RA Zip: Tenant/Lessee Name: Email: CONTRACTOR: Company Name: 't— !�XC, Phone #: .-514 > 5-:i l Address: I °A& Z Z SW 1SAS., Qk Cl� City: W \ \RYWA —State: IF-6 Zip: Qualifier Name: NU)(3 CQ &Y < p��-Z, Phone #: SW;- State Certification or Registration #: 5--C— 07,E Certificate of Competency #: Contact Phone #: ��CJ —"� ��3 Email Address: DESIGNER: Architect/Engineer: Phone #: Value of Work for this Permit: $ i \C)o 0 Square/Linear Footage of Work: Type of Work: ❑Address alteration ONew ORepair/Replace ❑Demolition Description of Work: �N -f �&q_ Submittal Fee $:50 Permit Fee $ 64° `01�9 CCF $ CO /CC $ Scanning Fee $ Radon Fee $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ DBPR $ Bond $ Technology Fee $ TOTAL FEE NOW DUE $ 102. � F 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 occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. t Signature Signature � ' VA . caner or Agent ontractor ° The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of _, 20 L?, by �.- AA day of , 20 L 3 , by QP� d� ✓` °' �'°"`�`� who is personally known to me or who has produced who is personally�known to me or who has produced F&sideationandwhodid oath. as identification and who did take NOTARY NOTAR Not ry Public State of Florida lic State of Florida mandez o M to Hernandez ssion EE 186275 Commission EE 186275 �n2J2016 _. 1, _ ncnires 0�/02f2018 My Commission Expires: I (L.o My Commission Expires: 11 1 2 1 ?U1 APPROVED BY X-1 ,00Plz Plans Examiner Zoning Structural Review (Revised 3 /12 /2012)(Revised 07 110 /07)(Revised 06 /10/2009)(Revised 3/15/09) Clerk STATE OF FLORIDA wo The FLECTi CA-L, CONTR&MOR Maned below is CEO TlYZE Under the * jrovistO Q- Chapter tag FS'. Expiry ian date AU 3Z,r 2014 ODRI GU'EZ, - REN Y. "THOS' ' FPM FL 3x86 RZCX SCOTT GOVEIMOR* KEN SON sEcREMY ACTO s�aasg $.yy. +� e. :.: X UM :. sp PERM y, Fy •' RENEWAL ...k Y.A�fy y�pE Y �y�p�vy.��yy w'�Ptx' p3 yM �e+- €x�x�iCpR£��Y {£g }Aar, g's; : 9 �` e'r'g' MS II -:- 9w G"inC �3$ TL :. :A� @$3pyy g�LIZ �9yE{EN LY�3i #18:�LxBL l4s2z SW 142 PL CIR .6 UNIN DADS 7Z DWIS�EZ HE flRy otSuairmt- iiiiiufSC TAX AEC fT '.. - DOW rtai � ?itsa^ tW.,DZR To Any $.'L ,i m'? IAM OF IA y� g��nap. p!! }g.�py y�y� 4tl'o Rtlo £' '€#WARIab rV ""r:iS4S�i$��3 �Y adLia xtt3��§ R.-URtGutz HENRY EtEC. " RICAL RODRIOUtZ HENRY fi XUmn ctnpe YTAX T 9 . o ggx $$- $iF$ffi$2r �� g 04/19/2013 15:36 FAX 3052071343 RANALLO ASSURANCE INC 14001 I DATE (MMIDD/YY) �.. CERTIFICATE OF LIABILITY INSURANCE 04_/19/1:3_ _ ur PRODUCER Ramalb Assurance Inc. _ THIS CERTIFICATE 15 ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 12955 S.W. 42nd Strad e HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR Miami, FL 33175 ALTE(i THE COVERAGE AFFORDED BY THE POLICIES BELCW. Phone (305)207 -1332 Fax (305)207 -1343 INSURERS AFFORDING COVERAGE NAIC # INSURER a Ascendant Commercial Ins INSURED Henry Rodriguez State Certified Unlimited Electrical - _ INSURER 8: PrO0reSSive _.._._ . Contractor Inc INSURER ,Ct;,, , ,_ , • , _ •, , • •__,_, _ „, „_ , 14522 SW 142 PI Circle INSURER Miami FI 33186 INSURER S. 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 CONOMON OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFeORDED BY THE POLICIES DESCRIBED HEREIN IS SU13JECTTO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMTTS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, _ _. -• ,. __- INSR AD131 Mm I TYPE OF INSURAtCE POLICY NUMBER y POLICY EFFECTIVE _ DATE MM22 _ POLICY EXPIRATION DATE (M -PR LIMITS -in _ GENERAL UARILITY EACH OCCURRENCE 1,000,000 COMMERCIAL GENERAL LIABILITY' GL- 38163 -1 09/12/12 09/12/13 PREMISES ( e vREMISES Ee tuuxurencel » 100,000 ❑ U CLAIMS MADE ❑ OCCUR MED EXP (Any one person) 5,000 A ❑ ❑ PERSONAL &ADV INJURY — - 1,000,000 ❑ ENAL GER AGGREGATE _ 2,000,000 PRODUCTS - COMP /OP AGG 11000.000 GEML AGGREGATE LIMT APPLIES PER 0 POLICY ❑ PROJECT ❑ LOC _..- -- AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 500,000 ❑ ANY AUTO 75715618 -6 08/23/12 08/23/13 (Ea accident) — p ALL OWNED AUTOS BODILY INJURY B ❑ ® SCHEDULED Aurou (Per P8� - — ❑ HIRED AUTOS BODILY INJURY ❑ NON OWNED AUTOS (Per accident) ❑ PROPERTY DAMAGE GARAGE LIABILITY AUTO ONLY - EA ACCIDENT — ❑ ❑ ANY AUTO OTHER THAN EA ACC ❑ _- _ -- - .�. _— AUTO ONLY: AGO EXCESIMMORELLA LIABILITY EACH OCCURRENCE _ ❑ OCCUR ❑ CUUMS MADE ❑ - -- LJ OEDUCTIBLE __ -- ❑ RETENTION $ WORKERS COMPENSATION ANP — WC STA' ❑ 0TH - EMPLOYERS'LIABILITY wCi- 604774 09/2$/12 09128/13 TO•RYLIMITS „- A ANY PROPRIETOR / PARTNER I I- DIECUTIVE E.L. EACH ACCIDENT - 1,000 OFFICER / MEMBER EXCLUDED If E.L DISEASE.- EA EMPLOYI =E 110-0-0- V yes, describe under SPECIAL PROVISION SIV below „_ „- E.L. DISEASE - POLICY LIMIT` _- 1.000 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS /VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS — Rodriguez, Henry Anthony Licenses Contractor CERTIFICATE HOLDER - MIAMI SHORES VILLAGE 10050 NE 2 AVE MIAMI SHORES FL 33138 ACORD 25 (2001/08) OF _CANCELLATION _ SHOULD ANY OF IE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION E THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL /O WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED r0 THE LE FAILURE TO DO $0 SHALL IMPOSE NO OBLIGATION OR L440I1-ITY OF A K UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. ., ... ,�.. a�e��ee�irsrvc • 0 ACORD CORPORATION 1988