EL-13-2702Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 205568
Scheduled Inspection Date: January 13, 2014
Inspector: Devaney, Michael
Owner: MUNOZ, JAVIER
Job Address: 75 NE 98 Street
Miami Shores, FL
Project: <NONE>
Permit Number: EL -12 -13 -2702
Permit Type: Electrical - Residential
Inspection Type: Final
Work Classification: Alteration
Phone Number (305)970 -5368
Parcel Number 1132060131160
Contractor: LS CURTIS INC Phone: 305 - 892 -0115
Buiming Department comments
SERVICE UPGRADE
INSPECTOR COMMENTS False
Inspector Comments
Passed ET
Failed
Correction
Needed ❑ �j
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
January 10, 2014 For Inspections please call: (305)762 -4949 Page 20 of 23
Miami Shores Village M ,r ; a _W, r�` \✓ / ".
Buildin g Department
artment L W ®12 013
9
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
\S Tel: (305) 795.2204 Fax: (305) 756.8972 om O0p u
1 ZIP\ `yM1 INSPECTIONS PHONE NUMBER: (305) 762.4949
\WELDING Permit No. ° 2:10 Z
PERMIT APPLICATION Master Permit No.
FBC 20
Permit Type: Electrical
OWNER: Name (Fee Simple Titleholder): Luis Javier Munoz Trujillo Phone #:
AAA —...75 NE 98 Street
City: Miami Shores State: F1 Zip: 33138
Tenant/Lessee Name: Phone #:
Email:
JOB ADDRESS: 75 NE 98 Street
City: Miami Shores County:
Miami Dade Zip: 33138
Folio/Parcel #:
Is the Building Historically Designated: Yes NO
Flood Zone:
CONTRACTOR: Company Name: L S Curtis inc
Phone#: 786-486-1961
Address: 20341 NE 30 Ave #108
City: Aventura State: FL
Zip: 33180
Qualifier Name: Lewis S Curtis
Phone#: 786-486-1961
State Certification or Registration #: EC 0 0 0 317 5
Certificate of Competency #:
Contact Phone#: 786-486-1961 Email Address: aas
eve@ao 1 com
DESIGNER: Architect/Engineer:
Phone #:
Value of Work for this Permit: $ 1, 2 0 0.0 0 Square/Linear Footage of Work:
Type of Work: OAddress DAlteration UNew
O epair/Replace ODemolition
Description of Work: Service upgrade
Submittal Fee $ ' c�J Permit Fee $ l� ®` ®�
CCF $ CO /CC $
Scanning Fee $ Radon Fee $
DBPR $ Bond $
Notary $ Training/Education Fee $
Technology Fee $
Double Fee $ Structural Review $
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
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 e, the
inspection will not be approW and a reinspection fee will be charged.
L .
Signature Signature L
Owner or Agent Contractor
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this .-3 0
day of NC>4 .20 2%y aA l�j day of November ,2013, by Lewis Curtis ,
who is personally known to me or who has produced wh is �personally t o me or who has produced
As identification and who did take an oath.
NOTARY PUBLIC:
Sign: ,e
Print:
My Commission Expires:
APPROVED BY
(Revised 07 /10/07)(Revised 06 /10/2009)(Revised 3/15/09)
Plans Examiner
Structural Review
identification and who did take an oath.
NOTARY
Sign: —in qmvwqgqww
Printp _ z..,, : I:j yZL•'
Zoning
Miami Shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
CONTRACTORS' REGISTRATION FORM
ALL CONTRACTORS MUST PROVIDE COPIES OF LICENCES AND INSURANCES EACH TIME A PERMIT IS
SUBMITTED OR THE VILLAGE MAY MAINTAIN A FILE WITH YOUR INFORMATION FOR A $30.00 FEE PER YEAR.
IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR:
A. COPY OF QUALIFIER'S STATE LIC CARD
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 (EITHER CERTIFICATE OR EXEMPTION)
IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY:
A. COPY OF CERTIFICE OF COMPETENCY OF QUALIFIER
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 WORKER COMP INSURANCE (EITHER CERTIFICATE OR EXEMPTION)
YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE HOLDER AS FOLLOW:
BUSINESS NAME:
L S Curtis Inc
MIAMI SHORES VILLAGE BLDG DEPT
10050 NE 2ND AVE
MIAMI SHORES, FL 33138
COMPLETE CONTRACTOR'S INFORMATION
BUSINESS ADDRESS: 20341 NE 30 Ave #108 CITyAventura
STATE FL ZIP CODE 331180
BUSINESS PHONE: 3( 05 ) 933 -0683 FAX NUMBER 3( 05 1 932 -1009
CELL PHONE 7( 86 ) 486 -1961 QUALIFIER'S NAME:
QUALIFIER'S LIC NUMBER: EC0003175
E -MAIL ADDRESS (IF APPLICABLE): aasteve @aol.com
Created on 3!19109 BY MLDV I RV 3126109 MLDV
Lewis Curtis
CERTIFICATE OF LIABILITY INSURANCE 04-17-2013
THIS CERTIiICATEIS ISSUED AS A MATTER OF INFORMATIM ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOUR. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND. EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATEOF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUNIIG INSUREWSI. AUTHORIZED
(REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the cwft ate hoMer Is as ADDITIONALWSURED, the poftyfles) must be endwsed. If SUBROGATIONIS WAIVED, sAgm to
the terms mW Imndhions of the ply. cwtah► poSdes map r"uhe an eat t. A statement on " m0flcate does not confer rights to the
MOUG" i '
AUTOMATIC DATA PROCESSING INS AGCY PHM � � ♦NeI;
250717 P: { }- F:()-
PO BOX 33015 ss:
SAN ANTONIO TX 782 65 INSURERas} AFFORDING COVERAGE NAIL p
INSUMRA: Turin city Fire Ins Co
musm INSURER 0:
... _ _.....
INSURER C ;
L. S. CURTIS INC. INSURER 0
203+41 NE 30TH AVE APT 108 INSURER E
AVENTURA FL 33180
INSUIRR F!
60UEtiar 099 CERTIFICATE NUMBER: REVISION NUMBIER:
THIS IS TO CERTCIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. AIOTWITHSTANOM ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WtM RESPECT TO WMM THIS
CERTiACAi'E MAY BE IBS" OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HUM IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
lYI4< OP pMURAN POLICY NVIAM
( UN IM
Gain" UAOIUw
--^
EACH OCCUIKNCE
E
r
COMMMM GENERAL L#ASIUTY
PREMISES tee oetwe4w,
Y
i CLAINISMADE :�. OCCUR
MEO EXP IAnj one perwo
S
FF,�••ff
I ' PERSONAL & ADV INJURY
S
i
GENERAL AGOREGATE
5
�Ml AGORIaM LIMIT PfEw PER:
I PRODUCTS • COMPW AGO
i S
POLICY' } LOC
AuioatO UADILITY
I COMBINED SINGLE LIMIT
E
1 5
IEc accwww
1
j BODILY INJURY Opel pmocn}
�8
ANYALITO
AIL OVdfNEio j I SCiI II i D u „
L. i
y BODILY INJURY (Pet eeeoden }}l 8
IUD AUTOS NON•OWNED
H
PROPERTY DAMAGE
I I (Per t+eaderul
$
�1 AUTOS
g
..__ LIAB 6ccuR
4
k EACH O£CURma£E
s
.._.i
R LW$ i CLAWS•MADEJ
[j U
s AQMGATt
$ _
11tOAIIRit8�TiDN
-
X> W£STAi� ! rOTH•
.
Et+IPtO1tEItS' t1A81LttY
@
E•t.EACHACp
S , , Q(j� 0
A AaY T EDEA�7it;CLIiIV 1J
NIA!
Fj WEG TR4954
OS /01/201
05/01/2014
-^ --DINT
176
E.L. DISEASE • EA 2 L0Y
$1,000,000
Urdu
%MMOX OF 00MMOPS Dour
E.L. DISEASE • POLICY Lu4UT
$ 1, 000, 000
E
t
/ ♦
tte�
Those usual to the Insured's operations.
Miami Shores Village
Building Department
10050 N.E. 2nd Ave.
Miami Shores, FL 33138
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED
BEFORE THE EXPIRATION DATE THEREOF. NOTICE WILL BE
ACORD 25 f20101051 The ACORD name mW Imia are reglatared amtke of ACORD
ST ATE OF FLORIDA
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
ELECTRICAL CONTRACTORS LICENSING BOARD (850) 487-1395
1940 NORTH MON.-ROE STREET
TALLAHASSEE FL 32399 -0783
CURTIS r LEWIS STEVEN
L.S. CURTI S INC
20341 NE 30TH AVE
AFT 108
AVENTURA FL 33180
Corrgratuletionst With this license you become one of the raearty one million
Fteidians Ncensed by the Department of Business and rofessional Regulation.
four professionals and businesses range_from architects to yacht brokers, from
bolters to barbeque restaurants. and th€sy keep Florida's economy strong.
Every day we work to improve the way we do business in order to serve you better.
For information about our services, please tog onto www.m flortdalicense.com.
There you can find more information about our divisions and the regulations that
impact you, subscribe to department newsletters and learn more about the
Department "s. initiatives.
Our mission at the Department is: Ucense Efficiently, Regulate Fairly. We
constantly strive to serve you better so that you can serve your customers.
Thank you for doing business in Florida, and congratulations on your new license!
DETACH HERE
v idE47AA6E R TOF FLORIDA
O
F
PROPESSI9NAL
ECO003175 Q�
t.l
10i12 118186995
KEN LAWSON
SECRETARY"
wll�l
/1l
A;.. ! CERTIFICATE OF LIABILITY INSURANCE
DATE 1r20D/1mrY)
11/20!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 cerdficeW holder is an ADDITIONAL INSURED, the policypes) must be endorsed. if SUBROGATION IS WANED, 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 endorsernent(s).
PRODUCER
Insurance Industries
CONTACT STACY PARKS
NAME:
PN (305)891 -2808 q go: NE ' f No; (305)891 -6367
ADDR L Stacy @insuranceindustriesinc.com
953 N.E. 125th St
INSURER(S) AFFORDING COVERAGE
NAIC 0
N. Miami, FL 33161
INSURERA: SCOTTSDALE INSURANCE CO
PREMISES RENTED 0euarence
Phone (305891 -2808 Fax (305)891 -6367
INSURED
INSURER B:
PERSONAL & ADV NJURY
INSURERC:
❑
LS CURTIS INC.
INSURER 0:
GERL AGGREGATE LIMIT APPLIES PER:
❑ POUCY ❑ PRO- ❑ LOC
20341 NE 30 Ave #108 -6
INSURER E:
AVENTURA, FL 33180- (305) 892 -0115
INSURER F:
AUTOMOBILE LIABILITY
F1 ANY AUTO
❑ DOWNED ❑ SCHEDULED
❑ HIRED AUTOS ❑ AUTOS ED
❑ 0
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
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 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.
I R
TYPE OF INSURANCE
ADD
UB
POLICY NUMBER
MMMIIDDDf EFF
MMfLIDD EXP
LIMITS
A
GENERAL LI MLITY
Q COMMERCIAL GENERAL LIABILITY
❑ CLAIMS -MADE 0 OCCUR
❑
Y
CPS1880 37
11/18/2013
11/18/2014
EACH OCCURRENCE
$ 1,000,000.00
PREMISES RENTED 0euarence
$ 100,000.00
MED EXP (Any one person
$ 5,000.00
PERSONAL & ADV NJURY
$ 1,000,000.00
❑
GENERAL AGGREGATE
$ 2,000,000.00
GERL AGGREGATE LIMIT APPLIES PER:
❑ POUCY ❑ PRO- ❑ LOC
PRODUCTS - COMP /OP AGG
$ 1,000,000.00
$
AUTOMOBILE LIABILITY
F1 ANY AUTO
❑ DOWNED ❑ SCHEDULED
❑ HIRED AUTOS ❑ AUTOS ED
❑ 0
a SINE n, INGLE LIMIT
dINJURY
BODILY (Per person)
$
BODILY INJURY (Peracddent
$
P�or am Y DAMAGE
er am
$
$
❑ UMBRELLA LIAS ❑ OCCUR
❑ EXCESS LIAB ❑ CLAIMS -MADE
EACH OCCURRENCE
$
AGGREGATE
$
❑ DED ❑ RETENTION
$
WORD COMPENSATION
AND EMPLOYERS' LIABILITY YIN
ANY PROPRIETORIPARTNERIEXECUTIVE
Planda ooryIn NH) EXCLUDED? ❑
if yy� describe under
DESG�RIPTION OF OPERATIONS below
NIA
❑ WC STATUS ❑ OTH
ER
E.L. EACH ACCIDENT
$
E.L. DISEASE - EA EMPLOYE
$
E.L DISEASE - POLICY LIMIT
$
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, V more space Is required)
ELECTRICIAN
CERTIFICATE HOLDER IS ALSO ADDITIONAL INSURED
CERTIFICATE HOLDER CANCELLATION
C 1988 -2010 ACORD CORPORATION. All rights reserved.
ACORD 26 (2010105) QF The ACORD name and logo am registered marks of ACORD
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
MIAMI SHORES VILLAGE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
10050 NE 2 AVE
MIAMI SHORES, FL. 33138
AUTHORIZED REPRESENTATIVE
C 1988 -2010 ACORD CORPORATION. All rights reserved.
ACORD 26 (2010105) QF The ACORD name and logo am registered marks of ACORD
1
O
Ivily, 6lp;57- I
STRUCTURAL
ELECTR:G :
PLUMBING
ECHAN CAL
DG.
6 tVrrlI
COUNTY RULES AND
J
RECEIVED
DECS�13
CL, - 7:-? c-)Z.
L S Curtis
20341 NE 30 Ave #108
FEDERAL, Aventura, FL 33180
ULATIONS . EC0003175
:z AS�A�f6RA N NE�B[A
_� •= W Connl�IlssloN # > 1941s
r "' •$•� .. EXPIRES .kdy 25.2x18
-� �,�
�///J//