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EL-13-2374Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 210918 Permit Number: EL -10 -13 -2374 Scheduled Inspection Date: April 16, 2014 Permit Type: Electrical - Residential Inspector: Devaney, Michael Inspection Type: Final Owner: ERIC DIAZ, ROBERT BAKER Work Classification: Alteration Job Address: 260 NW 112 Terrace Miami Shores, FL 31368 -3332 Phone Number Parcel Number 1121360010280 Project: <NONE> Contractor: MESA BROTHERS INC Phone: (305)345 -1974 comments KITCHEN REMODEL ELECTRIC INSPECTOR COMMENTS False Inspector Comments Passed Failed Correction ❑ Needed Re- Inspection ❑ Fee No Additional Inspections can be scheduled until re- inspection fee is paid. April 15, 2014 For Inspections please call: (305)7624949 Page 31 of 32 �t. t Miami Shores Village Building Department°' ,10050 N.E.2nd Avenue, Miami Shores, Florida 33138 OCT 1 S 2013 Tel: (305) 795.2204 Fax: (305) 756.8972 11'�TSPECTION'S PHONE NUMBER: (305) 762.4949 FBC 20 BUILDING PERMIT APPLICATION Permit Type: Electrical JOB ADDRESS: o g Vj I u Zt�' T"" Permit No. C�,j 3 ''—oZJ 1 q Master Permit No. 5 °-�;k3-1 2- City: Miami Shores County: Miami Dade Zip: 3 3 t (0 F Folio/Parcel #: Is the Building Historically Designated: Yes NO Flood Zone: f" `i OWNER: Name (Fee Simple Titleholder): fl t 90'�ey Phone #& /'S ) S��" Address: (0767- V t`3 <<cy.A. O N d�, 5;+4- t10-3 ^ 2.. City: AA ('a rug, Stater- Zip: 3 l Tenant/Lessee Name: Phone #: Email: b a4l 6(@ t I . C® e, CONTRACTOR: Company Name: ° ��- ��� ` Phone #: -,50 Address: City: State: l e Zip: Qualifier Name: Phone #: 36 �' � 3 o'7_ �S State Certification or Registration #: Certificate of Competency #: &(t_ IR7 e) Contact Phone #: 94r- 7 Y _Email Address: DESIGNER: Architect/Engineer: ®W w OIL15 &-f PA Phone #: Value of Work for this kermit :'$ jGo ° Square/Linear Footage of Work: Type of Work: ❑Address LIAlterdtion ONew )Repair/Re /place ODemolition Description of Work: a 1—r �� /'te a /h-s� T� ®u Sayek c C,4.' l It. r 44 . Submittal Fee $ Permit Fee $ �.��� ®® CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ 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 W I" 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 issue ce of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature Si f Owner or Agent The foregoing instrument was acknowledged before me this day of , 20_, by A_ p k% ti`C— , who is personally known to me or who has produced As identification and who did take an oath. NOTARY PUBLIC: 8 ­%W41111 Contractor~a /< The for g ' ent was ackno ked b9fcartr me this 7: y of , 20 , by who is personally known to me or who has produced as identification and who did take an oath. Sign: - - e Print: - IARyp „A,6 = Print: My Commission Expires = `,F�� fss�nn • My Commissi -on 0,0; °, Comr..isslon # EE 79436 V Bonded Through National Notary 'ssn. F! OR\OP�``�. a ��1 APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised 3 /12 /2012XRevised 07/10/07 )(Revised 06 /10/2009 )(Revised 3/15/09) Miami shores Village Building Department CONTRACTORS' REGISTRATION 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 ALL CONTRACTORS MUST PROVIDE COPIES OF LICENCES AND INSURANCES EACH TIME A PERMIT IS SUBMITTED. IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: A. C""" 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 EXCMMPTION) IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY: A. COPY OF CERTIFICE OF COMPETENCY OF QUALIFIER 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: MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES, FL 33138 ■■ rrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrr� COMPLETE CONTRACTOR'S INFORMATION BUSINESS NAME: A-/'e=3 a— -woe-li�G/- e2'° BUSINESS ADDRESS: STATE F4 --e� ZIP CODE R f 4" '57- CITY BUSINESS PHONE: �) 6' `� FAX NUMBER (34� ®'"�S CELL PHONE L-3D ,06)= QUALIFIER'S NAME:�-��� QUALIFIER'S LIC NUMBER: °— 1 e"419 7 E -MAIL ADDRESS (IF APPLICABLE): -7b?d C z Created on 3119109 BY MLDV 1 RV 3126109 MLDV 1 RV 6127111 AS 2014 details - Business Tax Account MESA BROTHERS INC - TaxSys - Miami -Dade C... Page 1 of 1 } fferAda&.Gov { Tax Collector Home Search Reports Shopping Cart 2014 [his --- Business Tax Account MESA BROTHERS INC Business Tax Account #405779 Li Account details jj Account history 2014 X2013 2012 2011 2010 Paid Paid Paid Paid Paid Account number: 405779 Business start date: 08/24/1988 Business address: MESA BROTHERS INC 5215 SW 103 AVE MIAMI, FL 33165 Physical business location: UNIN DADE COUNTY Contracting 10/01/2013 ELECTRICAL — 09/30/2014 CONTRACTOR Additional documentation required: EC 13001870 1 Owner(s): MESA BROTHERS INC 5215 SW 103 AVE MIAMI, FL 33165 Mailing address: MESA BROTHERS INC RAUL MESA PRES 5215 SW 103 AVE MIAMI, FL 33165 1pl Print account application (PDF) Paid 2013 -08 -16 $75.00 NAICS code: Receipt #TXHS1 -13- 046132 23821 Units: 10 License or Certificate IV, Print this bill CATION gEQ#r'.2091501003 4 :ON SEW L. 12.091500 �oo3 KEN LAWSON SECRETARY MESAS -1 OP ID: AG A`111b°RO, CERTIFICATE OF LIABILITY INSURANCE °"' 18 "" 112 ) 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()es) must be endorsed. ff 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 Hsu of such endorsement(s). PRODUCER 305- 3647800 BROWN & BROWN OF FLORIDA INC 305 - 7144401 14900 NW 79th Court Sui19000 Miami Lakes, FL 33016-5899 Ramon A Rodriguez POLICYNUMM PNONe as RIL INOURERM AFFORDING covEw►oE N/UC s INSURER A:FCCI Insurance Company 10178 INSURED Mesa Brothers Inc. 5215 SW 103rd Avenue (Rear) Miami, FL 33165 INSURERS: 01101!13 1211W12 INSURER EACH OCCURRENCE INSURER D D : DAMAGE TO RENTEEr PREMISES a vrre u INSURER E: MED EXP one I INSURER F! PERSONAL &ADVINJuRY 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. am rn+E OF INSURANCE AM= POLICYNUMM POLICY EFF POLICY LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL UABILITY CLAIMS-MADE OCCUR A ITHORDEDREPRESENTATME Miami Shores, FL 33138 GLOO147261 GLOOD31919 01101!13 1211W12 01/01114 01101113 EACH OCCURRENCE $ 1,000,0 DAMAGE TO RENTEEr PREMISES a vrre u $ 100, MED EXP one $ 51 PERSONAL &ADVINJuRY s 1,000, GENERAL AGGREGATE $ 2,000, GENL AGGREGATE LIMIT APPLIES PER. X POLICY PR LOC PRODUCTS - COMPIOP AGG $ Z0001 $ AUTLE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS AU Nth HIREDAUTOS AUTOS CO Ea cddunt BODILY INJURY (Per Person) $ SODILY INJURY (per aodrderrt) $ $ 8 UMBRELLA LUIS OWESSUAB OCCUR a"A MADE EACH OCCURRENCE $ AGGREGATE $ W ORIUM COMPENSATION ANDEINROYEWLIABLnY ANY PROPRIErORiP� YIN N OFFICER1MEIBER EXCLUDED? Lam) ( In NH) below desClbe render MIA STA E.L. EACH ACCIDENT $ E.L. DISEASE - FA EMPLOYE $ E.L. DISEASE - POLICY LIMIT .p [ fPJPYMOFOPERATION$I LOCATIONSI EEHCCLES( A0. hACORD101, AdOWWRemarksSdMduI %ImsnepeeIs rspuirsM CFRTIFICATF HOLDER CANCELLATION MIAMISH SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Miami Shores Village 9 ACCORDANCE i" THE POLICY PROVISIONS. Building Department 10050 Northeast 2nd Avenue A ITHORDEDREPRESENTATME Miami Shores, FL 33138 ®1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD A R° CERTIFICATE OF LIABILITY INSURANCE 1 4122/2013 °A -M `MMIDWYY") THI CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICA'T'E HOLDER. THIS CER FICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BEL W. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REP ESENTATiVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMP RTANT. If the certificate holder Is an ADDITIONAL INSURED, the policy(les) must be endorsed. if SUBROGATION IS WAIVED, subject to the rms and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not confer rights to the Corti Cate holder in lieu of such endorsmmen s). PROD, R Alliance Insurance Solutions, LLC ID: (PEMCO) CONTACT NAME: eon cto Progressive Employer Management Company, Inc. PHONE c No: 6407 Parkland Dr Sarasota, FL 34243 F-MAJL ADDRESS: Pro Employer Management Company I!, Inc. 29 Jessive Pinellas Ave Tar n SDrinas FL 34689 COVERAGES CERTIFICATE NUMBER: 9RnRQdSd REVISION NUMBER: THIS S TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDI TE D. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CE R FICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXC SIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. L TYPE OF INSURANCE POLICY NUMBER MWOD EFF (MMIDDIYYYYl LIMITS e ERAL LIABILITY i EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR i ' I E EaENgurenceEl _ E MED EXP (An one ) $ PERSONAL & ADV INJURY $ 9' GENERAL AGGREGATE 3 G 'L AGGREGATE LIMIT APPLIES PER: I PRODUCTS - COMPIOP AGG $ i ! POLICY I PRO- L� i i t $ At TOMOaILE LIABILITY i i a erk no N L I $ BODILY INJURY (Per person) $ ANY AUTO ALL AUTOS OWNED SCHEDULED HIRED AUTOS 8 NON-OWNED BODILY INJURY (Per accident) g P AM E $ $ $ UMBRELLA LWB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS -MADE AGGREGATE $ DED RETENTION $ !6 $ It A OYERS LIABILITY RIETORIPARTNERIEXECUTIVE EMSER EXCLUDE � FDRIPTION COMPENSATION YIN In NIr) ribe under OF OPERATIONS NIA WCPEOD000163 01 3/6/2013 3/612014 WC STATU• OET 1 TORY I, E.L EACH ACCIDENT S 11000.000 E.L. DISEASE - EA EMPLOYE ES D E.L. DISEASE - POLICY UMrT S 1 DOO rs Compensation This Is for informational purposes s Coverage arld nothing shall create arty right u. JC11ent OF OPERATIONS I LOCATIONS I VP.HICLES (Attach ACORD 101, Additional Remarks Schedule, 0 more spans is regWred) Provided for all leased employees but riot subcontractors of Mesa Brothers Inc ctive:3 /16/2013 CE FICATE OLDER CANCE L T ION 364f 34 Miami Shores Village SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Building Deparment 10050 Northeast 2 avenue THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Miami shores, FL 33138 AUT14ORrZED REPRESENTATIVE Glen J Distefano ©1988 -2010 ACORD CORPORATION. All rights reserved. ACOF D 25 (2010105) The ACORD name and logo are registered marks of ACORD CERT NO. 16089454 Kriati Arthur 4/22/2013 12:07x28 FM Page 1 of 1