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EL-13-2220Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 w Inspection Number: INSP- 200246 Scheduled Inspection Date: February 13, 2014 Inspector: Devaney, Michael Owner: CONSOLO, ROBERTO AND FREDI Job Address: 366 NE 93 Street Miami Shores, FL 33138- Project: <NONE> Permit Number: EL -10 -13 -2220 Permit Type: Electrical - Residential Inspection Type: Final Work Classification: Addition /Alteration Phone Number Parcel Number 1132060136320 Contractor: WELL ELECTRIC TECHNOLOGY Phone: (305)726 -7098 Building Department Comments Recessed LIGHTS RECEPTACLES SWITCHES ONE STEAMER HOOK UP INSTALLATION IN TWO BATHROOMS INSPECTOR COMMENTS False Inspector Comments Passed EY Failed 17 �r7 tol. Correction Needed Re- Inspection ❑ Fee No Additional Inspections can be scheduled until re- inspection fee is paid. February 13, 2014 For Inspections please call: (305)762 -4949 Page 3 of 25 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 BUILDING PERMIT APPLICATION FBC 20 acT 0.1 2013 Permit No. 6 l 1 —c24 - Master Permit No. 'P a l ?j " da - 19 Permit Type: Electrical JOB ADDRESS: _5 (�5c �j 9 City: Miami Shores County: Miami Dade Zip: Folio/Parcel #: Is the Building Historically Designated: Yes i OWNER: Name (Fee Simple Titleholder) NO Flood Zone: — _:ffk � City:' State: Zip: >G Tenant/Lessee Name: _ Phone #: Email: CONTRACTOR: Company Name: Wait E & cj- t rG VEC9A,04o 6y /mac Phone #: �'� —rq 9 _ q! go Address: W_ city: .J+ M State: P Zip: Qualifier Name: Phone #: State Certification or Registration #:6c l I 300 l 1 a ` P Certificate of Competency #: Contact Phone #: 306° � (4 (4 — 9 t J 7 Email Address: DESIGNER: Architect/Engineer. Phone #: Value of Work forthis Permit. s. o b Square/Linear footage of Work: Type of Work: Q X� oss ❑Alteration ❑New Repair/Replace Description of Work: Submittal Fee $ Permit Fee $ �e0/� 4CCF $ CO /CC $ Scanning Fee $ Radon Fee $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ DBPR $ Bond Technology Fee $ 3.1-1- ❑Demolition .14 `S'. TOTAL FEE NOW DUE $ 8 6 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. Signature Owner or Agent The foregoing instrument was acknowledged before me t his day of � , 20 %3, by l� 11 e e0la.So %, who is ersonally�jknown to me or who has produced F 1 6/j As identification and who did take an oath. ��,� »�uiuurrrr�r NOTARY PUBLIC: s Sign: _ �® Print: „1 �i:`_ Signature l/ �� Contractor The foregoing instrument was acknowledged before me this dayof s��' ,20a by /011y W who is personally known to me or who has produced My Commission Expires: •�% �.S s,,���rrrrrrre�a A \`?\���`�� �� APPROVED BY � Plans Examiner Structural Review (Revised 3 /12/2012 )(Revised 07 /10 /07XRevised 06 /10/2009XRevised 3/15/09) as identification and who did take an oath. NOTARY PUBLIC: Zoning Clerk 6208325 STATE OF FLORIDA DEPARTMENT:OF­BUSINESS,'AND PROFES1916NAL REGULATION ELECTRICAL CONTRACTORS LICENSING: BOARD SEW L12071801161 . 107/18/201213.26000831 JEC13001181 The_: ELECTRICAL CONTRACTOR Named below IS CERTIFIED' Under the . provisions of; Chapter �489.:FS... Expiration date: AUG 31, 2014 WELL. TONY: WELL ELECTRIC`TLCHNOLOGY' INC 4310 NW 11 STREET .. .' MIAMI FL 33126 1522 RICK .SCOTT GOVERNOR DISPLAY AS REQUIRED BY LAW Local Business Tax Receipt Miami —Dade County, State of Florida THIS IS NOT A BILL — DO NOT PAY 5567087 BUSINESS NAMEILOCATION RECEIPT NO. EXPIRES WELL ELECTRIC TECHNOLOGY INC RENEWAL SEPTEMBER 30, 2014 4312 NW 11 ST 6807087 Must be displayed at place of business MIAMI FL 33126 Pursuant to County Code Chapter 8A — Art. 9 & 1Q SEC. TYPE OF BUSINESS OWNER PAYMENT RECEIVED WELL ELECTRIC TECHNOLOGY INC 196 ELECTRICAL CONTRACTOR By TAX COLLECTOR Worker(s) i EC13001181 $45.00 08/22/2013 CREDITCARD -13- 006121 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 holders qualifieanom, to do business. Holder must Comply with any governmental ur nongovernmental regulatory taws and requirements which apply to the business. The RECEIPT N0. above must be displayed on all commercial vehicles — Miami —Dade Code Sec Sa 27B. KEN LAWSON SECRETARY JEFF ATWATE:R CWW FINANCIAL OFFICER * ar CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law. EFFECTIVE DATE: 11/02/2011 PERSON: WELL FEIN: 352252781 BUSINESS NAME AND ADDRESS: TELL ELECTRIC TECHNOLOGY INC 4312 NW 11TH ST Mimi FL 33126 SCOPES OF BUSINESS OR TRADE. 1— CERTIFIED ELECTRICAL CONTRACTO EXPIRATION DATE: 11/01/2013 TONY IMPORTMT: Parneat to Cbapter "It . MAIO, F.S., an officer of a corporation who $facts exemption from this chapter by filing a certificate of election under this section may not recover benefits or compensation under this chapter. porsuant to Chapter 440.0502), F.S., Certificates of election to be exempt... apply only within the scope of the business or trade listed on the antics of election to be exempt. Pursuant to Chapter 440.0503), F.S., Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation i% at any time after the filing of the notice or the issuance of the certificate, the person named on the notice or certificate no logger meets the requirements of this section for issuance of a certificate. The department mail revoke a certificate at any time for failure of the person named go the certificate to meet the requirements of this section. QUESTIONS? 18501 413-16 OWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01 -11 --sh I - t -!� - Qo(;?3 ---- (�o h --- r�). -f- I -,) �-, - -Z) (� 2013 -10 -25 10:52 >> 1 800 665 7530 P 1l1 ' t �•� Y CQR� DATE (MM0wYYv) � CERTIFICATE OF LIABILITY INSURANCE 8/8/2013 11.0 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHT'S UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAOE AF=FORDED BY THE POLICIES POLICY NUMBER EELOW. THIS CERTIFICATE OF INSURANCE DOES NOT OONSTITUT6 A CONTRACT BETWEEN THE ISSUING INSUR6me), AUTHORIZED M REPRESENTATIVE OR PRODUCER. AND THE OERTIFIOATB HOLDER. IMPORTANT; N the eertlf ele Molder Is an ADDITLONAL INSURED, the poBayllea) must be endorsed. if SUBROGATION 16 WAIVED. :uAJeee to the Isms and Conditions Of Via POW c'arlain polMes may r"UIM an anlersemant Aatelament on aft oortflcats does not ""far lights to the Cardfloes holder In IIeU of such erldwsemvl18el. PRWUQER IMPACT INSMI ANCR SERVICES LLC x,8064 SW 33 Court Miramar, FL 3309 A032618 NAME PAULETTE BROWN _ Ne 9 4 88'3 -3$$%� �.. NoI. (954) 885-9L3$5 � irnpactwervt?msrL.co'in INURM W AFraAMM COVERAGE NA1CN INSURER A �, A INSURANCE CO. Iaeo WELL •ELECTRIC TECHNOLOGY, INC. X MMMERC Wl GENERAL LIABILITY CLAIMS MADE OCCUR INS B 0185FL00045681 4332 NW 11 STREET INSU EA C' H g 1 ov0 MIAMI , FL 33126 INBU Oe $ I00 000 (786)399-9190 INSURER E. tl , INURER F $ 11000,000 GENERAL A(Tar* GATE S 2,000,000 CAVCRAAFA nC071=1^ATCSu,ueeo . -. _._......_____ THIS IS TO CERTIFY THAT THE POURS OP IW9URANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMFp ABOVE R THE POLICY PERIOD INDICATED. NOTWITHSTANDINO ANY REOUIREMENT, TFRM OR 00140TTON OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH T141S CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THF. POLICIES DESCRIBED HEREIN 13 SUBMCt TO ALL THE TERMS, &XCLUSIONB AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED UY PAID CLAIMS 11.0 TYPE OF INSURANCE POLICY NUMBER M YT M LIMITS GENERAL UANUTY A X MMMERC Wl GENERAL LIABILITY CLAIMS MADE OCCUR 0185FL00045681 t27/2013 t27t2024 H g 1 ov0 000 PREMISES (Ee aeanm,ml $ I00 000 HIED EXPLAnyanspelso) g PERSONAL & ADV INJURY $ 11000,000 GENERAL A(Tar* GATE S 2,000,000 OENL ACIfiREOATE LIMIT AFFIISSPSa - . PROAticre caaW�OPAw # 2,000,000 PoLcv -- .. S AUTOMOBILE UABIU'ry ANYAUTO AU.OIINED &�DULED _ AUTOS AUTOS Ee���g BODILY INJURY (Per persehhl S BODILY INJURY (Par ertldenq S FkREDAUTOS ALPIT08 g - - 0w N1fcWht $ w UMBRELLA UAS OCCtei EXCESS UAB EACf/ OCCURRENCE $ HCXAM&MAM AfitiRMGATE g MI5 1 1 RETENTION $ VRS COMPENSATION AND EMPLOYERS' LIABILITY VIN (p�fl WM�eA p EX LUDEW+ wry Q a N rA • ' •' ° y •. •• •• 13 IT PITH- I g E.L. EACH ACCIDENT s E.L DISEASE- EAEMPI.prr n g PTION OF TIINS DBIDW - $ E.L DISEASE - POLICY LIMIT DESCRIPMoN OF'OPLppYIONa r LOCATIONS JV91 MES (Alledh ACORD ICI, Aftfi&ml RemarlmSdIsUa ff marewsw is MUM) Ci?RTIRICATR LIAI AQD _ _ -- - MIAMI SHORES VILLAGE 10050 NE 2nd AVE. MIAMI SHORES, FL. 33138 SHOULD ANY OF THE ABOVE DESCRIBED POUCIF-3 HE CANCELLED RFFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLJCY PROVISIONS. 1OW2010 - -- - _ -� I «e rx.. vmw nafna anG 1090 are registered marks of ACORD reserved.