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EL-13-1454Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 194973 Scheduled Inspection Date: July 15, 2013 Inspector: Devaney, Michael Owner: POWELL, SHANNON Job Address: 78 NW 95 Street Miami Shores, FL 33138- Project: <NONE> Contractor: SUNSHINE ELECTRICAL CONTRACTORS CORP tsunaing uepanment comments I � - 13'6� Permit Number: EL -6 -13 -1454 Permit Type: Electrical - Residential Inspection Type: Rough Work Classification: Alteration Phone Number (786)597 -3705 Parcel Number 1131010340080 Phone: (305)265 -4958 DISCONNECT AND CONNECT AC. REPLACE MAIN Infractio Passed Comments PANEL I INSPECTOR COMMENTS False Inspector Comments Passe Failed Correction ❑ Needed Re- Inspection ❑ Fee No Additional Inspections can be scheduled until re- inspection fee is paid. July 15, 2013 For Inspections please call: (305)762 -4949 Page 20 of 33 Miami Shores Village Building Department Jug, ��� 10050 N,E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fag: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 FBC 20 BUILDING PERMIT APPLICATION Permit Type: Electrical JOB ADDRESS: -7 X 1v W I `3~ r Permit No. 13 1 4S `' Master Permit No. /Y G _(013 -' Y City: Miami Shores County. Miami Dade Zip: Folio/Parcel #: Is the Building Historically Designated: Yes NO Flood Zone: OWNER: Name (Fee Simple Titleholder): `j h'�/����' �f Phone #: Address: " WP 6A"? T'IE S f City: %%%k4- M % S % 0 9 a 5 State: Zip: 33 3 d", Tenant/Lessee Name: Phone# Email CONTRACTOR: Company Name: 5 L-3,A) rB� blA b ,Xj CO 4 Phone#(= 6'19' S� Address: /'aa e, S c.-) 8--� City: State: / Zip: 3 3 ! t Qualifier Name: M!?—a(4)Vo _:5 -AdtJ Phone #: Al (0 V­a is 4-Ts' Sr State Certification or Registration #:,x,,r_R0C) U �EM -7!S Certificate of Competency #: 1 �` `7 3 Contact Phone#: �� `%� X'q��°' Email Address: DESIGNER: Architect/Engineer Phone #: or Value of Work for this Permit: $ ` ' Square/Linear Footage of Work: Type of Work: DAddress ❑Alteration ONew ORepair/Replace ODemolition Description of Work: to G o I ' d_ �' c�R/ "t • / Submittal Fee $ Permit Fee $ I=rO ® ®® Scanning Fee $ Radon Fee $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ CCF $ CO /CC $ DBPR $ Buil $ Technology Fee " „� TOTAL FEE NOWDUE $ r 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 approv d a reinspection fee will be charged. S_igna�re Owner or Agent The foregoing instrument was acknowledged before me this day o 20/1 ,bye S/ 04�p4✓e who is personally known to me or who has produced. As identification and who did take an oath. NOTARY PUB C: Si Print: 40 CCQ 1A COl- )4 My Commissions ExpiresL APPROVED -BY Signatur Contractor The foreg ' g instrument was acknowledged before me this day of 201, who is onally known to me or who has produced -- - -- ANGELIC Structural Review Notary P011C - State of Plaids • My Comm. Exptree Nov 18. 2015 Commission * EE 127825 ed I'Q6 UTRrj[�A Dw ed 06 /10/2009XRevised 3/15/09) m as identification and who did take an oath. NOTARY P C. Print: My Commission E,*94,`% LUIS FER" * MY COMMISSION # EE 898160 * EXPIRES: November 1, 2016 s oQ BuededT41 Budget NoteY $sluices rA�OF F`0�� 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 c/ 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: �.o a MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE `- MIAMI SHORES, FL 33138 r COMPLETE CONTRACTOR'S INFORMATION BUSINESS NAME: �'' `� hl; VP- C U ,0 C v 2„ P. BUSINESS ADDRESS: 060 S ued 96-0-1t7 CITY./—//;:qL "? I STATE fit.- ZIP CODE 3.5 31L4V BUSINESS PHONE: (-'-� USf�j FAX NUMBER 05") CELL PHONE Cs'j 7!RVQUALIFIER'S NAME: d'1= °� 1��'v S /a- �✓t's'`��,q QUALIFIER'S LIC NUMBER: E -MAIL ADDRESS (IF APPLICABLE): Created on 3119109 BY MLDV 1 RV 3126109 MLDV I RV 6127111 AS FIRST-Cl POSTAGE 1 PAID MIMA FL PEF-Off NO. 231 486076-4 THIS IS NOT A BILL - DO NOT PAY RENEWAL SUOR WA191CAL CONTRACTORS CC BPECI NOD493 507309-3 CORP 1300 SW 85 CT 33144 UNIN DADE COUNTY Owf5%SHINE ELECTRICAL.CONTRACTORS SeelWf&&RCAL CONTRACTOR WORKEI THIS IS ONLY A LOCAL BUSINESS TAX RECE ]". IT DOES NOT PERIM THE HOLDER TO VIOLATE ANY OCIO OR °Tr NOT FORWARD MR IM M9 OTA pmw REEQQUIIRED B°gY M SUNSHINE ELECTRICAL CONTRACTORS THE HOLOOM aJIAUPICA. CORP TIM MARIANO SANTIESTEBAN PRES PAWMW RECIMM .1300 SW 85 CT ETA MIAMI FL 33144 10/03/2012 000082.50 01 0 0082.5 00 1 Jii1�iJJIttJ9��i]} i1} 1JiYili tl {} }JIJ�iIfJIJ}}J4.lIJfJi}t1�5 SEE OTHER SIDE DO NOT FORWARD SUNSHINE ELECTRICAL CONTRACTORS CORP MARIANO SANTIESTEBAN PRES 1300 SW 85 CT MIAMI FL 33144 07- 21-2011 .JIFF ATWATER STATE OF FLORIDA Fuaai. oi�fceR DEPARTMENT OF FINANCIAL SERVICES �= DIVISION OF WORKERS' COMPENSATION * * P.ameATE tF, asm TQ a EJlwT FRom RA nA WORKew mAmdAirlon LAW e e This ce ifies that the individual listed below has elected to be exempt from Florida Workers' Compensation taw. EFFECTIVE DATE: 0712112(n1 SANTiESTEBAN FEIN: 651009473 BUSINESS NAME AND ADDRESS: SUNSHINE ELECTRICAL. CONTRAMORS CORP 1300 sill as COURT MIAMI FL 33144 SCOPES OF SWINESS OR TRADE 1- ELECTRICAL. CONTRACTOR EXPIRATION DATE: 07120/2013 MARIANO J OMWANT. Per as Daptor 448 - 0014) F.S.. as officer of a cerpwtttan wb elects exemption from ffifs tie by filing a certfficato Of 810131108 t We sett any an recover beseffts a compeanstim saw We cimpler. Plummet to Ckepter 448A5112L F.S., Cestffic" of election to be exempt— apply only wid is *a cope d am bafoass or trade itn4 an me vatic: of decttne to be exempt. Pinavent to Cater 44GAM13L F.S., Notices nl election to be exempt arm carftcros of election to be exempt ill be subject to revocation H at any tine after the tiling of me amnee ar me Waseca of its comicam the person named an an notice of certificate no too ads die requilmsents al this mrdien for issmilce of a cu irk. The department don make a certificate 0 day than for lofts of the perm named on tee ewtvicate to meat tba regniremoats of this secnea auESno>ws? (sso) 413 -1609 OWC -252 CfRMCATE OF ELECTION TO BE EXERT REVISED 01 -71 PLEASE CUT OUT THE CARD BELOW AND RETAIN FOR FUTURE REFERENCE SCOPE OF BUSNVESS OR TRADE I- e.ECnucan. COUMCTOx IMPORTANT F Pursuot to Cum 440.0504), F.S., an officer of a corpwalka who O elects exemption from this efo pw by filing a cortificee of election L under this section ineV not recap benefits or cant an under this D tarter. Purstiont to Chapw 44(L0512), FS, Certifieates of election to be H exempt— E mly oftecv wits 4t; to scup h of *a bushiest or is listed cat R E Puivie tt to Cllr 440.05113), F S., Notices of ekwum to be exempt will certificates of election to be exampt shall be s'edtject to revm atian if, at any time after the ftlhtg of the notice or the Issuance of the certificate: the person mmned on ffifs notice or cctrtificnte no Im>get• meets the requirements of this soctimt for issuance of a certifiwaW The deparanent sal revoke a cortificste at my tints for fie of the persmt nmtred on the certificate to moo the reclithromentS of this section. aUESTIONS? (850) 413 -1609 Caw bottom portion on the jots, keep upper portion for your reosorde. OWIC -252 CERTIFICATE OF ELECTION TO BE EXENPT REV= 01 -11 Constni on Trodes QuaUfyring Board SINESS CERTIFICATE OF COMPETENCY 02EO00493 NSHINE ELECTRICAL CONTRACTORS CORP. B.A., Is certified under the provisions of Chapter 10 of Miami -Dade JUL /03/2013AED 10:12 AM FAX No, P. 002 A CERTIFICATE -OF LIABILITY INSURANCE DATE(MMlDD1YYYY) 07!03/13 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(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be andorsed. 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 nights to the certificate holder In lieu of Such ondorsament(s). PRODUCER Discovery Entr, Insurance Agency 10733 N.W. 58th Street Miami, FL 33178 Phone (305) 715 -8919 Fax 305 718 -$584 CO TACT Marie L Diaz PHONE (305) 718-8919 � (305) 718-3684 E-MAIL marilu(�tlisCOdor3lins.COm AOQRrSS- INSURfi S AFFORDINOCOV11RAGE NAM INSURER A: Penn America Insurance company GENERAL LIABILITY ® COMMERCIAL GENERAL LIABILITY ❑ ❑ CLAM. $50 . Q OCCUR © P.D. & 6.1.16sao. F-1 INSURED SUNSHINE ELECTRICAL CONTRACTOR, CORP. 1300 S. W, 85 COURT MIAMI, FL 33144 INSURER 2: PAC69114839 INSURER C: 04107!2014 INSURER D: 1.0 OOOAO INSURER E: $ 100,000.00 INSURER F: $ 5,000.00 - -- - - - - -- -- ----- - - - - -- THIS 1STO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE SEEN 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 INSUMNCE 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. ( SR TYPE OF INSURANCE ADD US POLICY NUMBER MpOj /pp PAD EXP OMITS A GENERAL LIABILITY ® COMMERCIAL GENERAL LIABILITY ❑ ❑ CLAM. $50 . Q OCCUR © P.D. & 6.1.16sao. F-1 N PAC69114839 04!07!2013 04107!2014 EACH OCCURRENCE 1.0 OOOAO PDRA M ses° a �,DD nce $ 100,000.00 MED EXP one roof $ 5,000.00 PERSONAL & ADV INJURY $ 1,000,000.00 GENERAL AGGREGATE $ 2,000,000.00 GEN'L AGGREGATE LIMIT'APPLIES PER: ❑ POLICY ❑ PRO- [] LOC JITCT PRODUCTS - OOMPIOP AGG $ 1,000,000.00 $ AUTOMOBILE LIABILITY ❑ ANYAUTO ALL OWNED SC EDULED ❑ AUTOS ❑ AUTOS HIRED AUTOS ❑ q� WNEO COM 1 D INGLE LIT NvI a acci eirt BODLYINJURY(Perpsmn) $ BODILY INJURY (Peeaxidml) $ P EI TY DAMAGE er setidor,t $ $ UMBRELLA LIAB ❑ OCCUR EXCESS LIAR ❑ GLAIMS-MADE EACHOCCURRENCE $ AGGREGATE S DED 0 RETENTION $ WORKERS COMPENSATION YIN AND EMPLOY9M, LIABIuTY OFFICE R/MEMBTEREXOLUD D7EC (Mandatory in NH) If yes deaoribeundor DESCRIPTION OF OPERATIONS below MIA ❑ WC STATU- ❑ OTH• � ER F.L. EACH ACCIDENT E,L,DISEASE - EA EMPLOYE. S E,L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Att -h ACORD 10i, Addltlanal Remarks Schedule, If more epaae to roquved) CFRTIGIC_ATr; Hnl nco MIAMI SHORES VILLAGE BUILDIND DEPARTMENT OF RER 10050 NE 2ND AVE MIAMI, R $3138 FAXA (305)756 -6972 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THIS EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 0 1988-2010 A'ITORD CORPORATION. All rinhtea remorvnrl "" — ``" Iwl I `4r The ACORD name and logo are, registe,rad marks of ACORD