EL-14-486Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 209097
Scheduled Inspection Date: March 19, 2014
Inspector: Devaney, Michael
Owner: SCHAEFER, NORAH & PAUL
Job Address: 47 NE 93 Street
Miami Shores, FL 33138-
Project: <NONE>
Contractor: MIZPAH ELECTRICAL INC
_u
Permit Number: EL- 3- 14-486
Permit Type: Electrical - Residential
Inspection Type: Final
Work Classification: Alteration
Phone Number
Parcel Number 1132060130390
Phone: 305 -620 -2701
tsuiming Department comments
KITCHEN CABINET REMODEL UPGRADE GFI'S Infractio Passed Comments
INSPECTOR COMMENTS False
Inspector Comment
Passed 21
Failed
Correction ❑
Needed
Re- Inspection ❑
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
March 18, 2014 For Inspections please call: (305)762 -4949 Page 37 of 51
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax:1(305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949
BUILDING
PERMIT APPLICATION
Permit Type: Electrical
FBC 20
MAR 1.3 2014
Permit No. c% /�( — y�
Master Permit No.R, ( (A — Cj j S
JOB ADDRESS: -q-7 n E ��
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel #: \Vb3� O
Is the Building Historically Designated: Yes
NO Flood Zone:
OWNER: Name (Fee Simple Titleholder): Phone #: ®� -rZ
Address: N 1�7 51 sr
City: fy) )` (- M; State: Zip: % 3
Tenant/Ussee Name:
Email: t-bra-A
CONTRACTOR: Company Name: _ Ift P4 Phone #: 519 /
Address: ;? a1 3 U) N 1,J
City: 166 vnI 4SOLtC6 State: -F / Zip: 33c�S
Qualifier Name: 05 rr,7 D l OS Phone #:YvS ---1,4�
State Certification or Registration #: J,_ Certificate of Competency #: V�4
Contact Phone #: _�0 yl� �Gf Email Address: 017- ®d 67M h 07 r G 0,% a La ,h4
th DESIGNER: Architect/Engineer: �r� c� �- _ Phone #: �fSCo -�)6 " oo2i
^ P
Value of Work for this Permit: $ ® Square/Linear Footage of Work: %Clip Se,
Type of Work: ❑Address Alteration ❑New ❑Repair/Replace ❑Demolition
Description of Work -%A
-- g/Y'i� G1�,c� � . _ �' ec:;c'SSr�Q Ccsr -►S �es �,
Submittal Fee $ Permit Fee $ 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
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 afier 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 Z"=_a=a_4A1
Owner or Agent
The foregoing instrument was acknowledged before me this 4R_
day ofR4g, 20% , by /I%GI4 Sclig1° -Pcf ,
who is personally known to me or who has produced a /Z
13 /J 3S %�6 As identification and who did take an oath.
NOTARY PUBLIC:
Sign:
My
Joanna M Feliciano
My Commission FF 082763
Expires 01/1212018
Signature
Contractor
The foregoing instrument was acknowledged before me this
day of , 20 by
who is personally known to me or who has producedD"
Q/ `r QQ as identification and who did take an oath.
APPROVED BY Plans Examiner
Structural Review
(Revised 3 /12/2012XRevised 07 /10 /07)(Revised 06 /10/2009 )(Revised 3/15/09)
NOTARY PUBLIC:
Sign:
�+ i C o•
y Co a XI hxw Public State of Florida
r. Joanna M Feliciano
My Commission FF 082753
?prop Expires 01/12/2018
Zoning
Clerk
Congratulation'sl With this license you become one of the nearly one million
Floridians licensed by the Department of Business and Professional Regulation.
s
Our professionals and businesses range from architects to yacht brokers, from
boxers to barbeque restaurants, and they keep Florida's economy strong. 2
Every day we work to improve the way we do business in order to serve you bettey
For Information about our services, please log onto www.myfloridalicense.com. C MtJt� M,
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: License 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!
iraxjoa-a
X%
WC -f
t1 r L
V
Lee County Tax Collector
Detach and display bottom portion and keep upper portion for your records
Veecou„y LEE COUNTY LOCAL BUSINESS TAX RECEIPT
wqbqa 2013-2014
Tax Co Wor
ACCOUNT NUMBER: 0611820 ACCOUNT EXPIRES SEPTEMBER 30, 2014
s4f. o9
of F� am
Location
506 RICHMOND AVE
LEHIGH ACRES FL 33972
MIZPAH ELECTRIC INC
DIAS ALSTON W
506 RICHMOND AVE
LEHIGH ACRES FL 33972
May engage In the business of
CERTIFIED ELECTRICAL CONTRACTOR
THIS LOCAL BUSINESS TAX RECEIPT IS NON REGULATORY
THIS IS NOT A BILL - DO NOT PAY
PAID 335480 -3-1 09/12/1312:14 :35
LYR1 $50.00
PLEASE CUT OUT THE CARD BELOW AND RETAIN FOR FUTURE REFERENCE
STATE OF FLORIDA
DEPARTMENT OF FINANCIAL SERVICES
DIVISION OF WORKERS' COMPENSATION
CONSTRUCTION INDUSTRY
CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA
WORKERS' COMPENSATION LAW 9
=r-cGrT1VF na/18/2012 EXPIRATION DATE: 013/18 /2014
IMPORTANT
F Pursuant to Chapter 440.05(14), F.S., an officer of a corporation who
O elects exemption from this chapter by filing a certificate of election
L under this section may not recover benefits or compensation under this
D chapter.
..Pursuant to Chapter 440.05(12), F.S., Certificates of election to be w� ^^
19
PLEASE CUT OUT THE CARD BELOW AND RETAIN FOR FUTURE REFERENCE
STATE OF FLORIDA
DEPARTMENT OF FINANCIAL SERVICES
DIVISION OF WORKERS' COMPENSATION
CONSTRUCTION INDUSTRY
WORKERS' COMPENSATION LAW EXEMPT FROM FLORIDA
CERTIFICATE OF ELECTION TO BE 0
EFFECTIVE 06/18/2012 EXPIRATION DATE: 06/18/2014
PERSON: ALSTON W DIAS
FEIN: 650485336
BUSINESS NAME AND ADDRESS:
NIIZPAH ELECTRIC INC
512 POINSETTA AVE
LEHIGH ACRES, FL 33972
SCOPE OF BUSINESS OR TRADE
1- ELECTRICAL CONTRACTOR
IMPORTANT
FPursuant to Chapter 440.051141, F.S., an officer of a corporation who
elects exemption from this chapter by filing a certificate of election
I- under this section may not recover benefits or compensation under this
D chapter.
Pursuant to Chapter 440.05021, F.S., Certificates of election to be
H exempt.. apply only within the scope of the business or trade listed on
E the notice of election to be exempt
E Pursuant to Chapter 440.051131, F.S., Notices of election to be exempt
and certificates of election to be exempt shall be subject to revocation
if, at any time after the filing of the notice or the issuance of the
certificate, the person named on the notice or bertificate no longer meets
the requirements of this section for issuance of a certificate. The
department shall revoke a certificate at any time for failure' of the
person named on the certificate to meet the requirements of this
section
QUESTIONS? (850) 413 -1609
CUT HERE
Carry bottom portion on the job, keep upper portion for your records,
DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01-11
Ma r. 13.
2014 11:21AM No. 3421 QP:_,1.IDOm
CERTIFICATE OF LIABILITY INSURANCE 1 .'03/13/14
PRODUCER Annette Willis Insurance THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
18401 N.W. 27 Ave ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
Miami, FL 33056
Phone (305) 626 -2403
INSURED MIZPAH ELECRIC INC
512 POINSETTIA AVE
LEHIGH ACRES„ FL 33972-
fax (305) 825-5472
INSURERS AFFORDING COVERAGE _
INsURER A: Granada Insurance Company
INSUR @R B:
INSURER C: _
INSURER D•
NAIC #
COVERAGES I INSURER F: I
THE POLICIES OF INSURANCE LISTED 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, AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS,
INS R I L TYPS OF INSURANCE POLICY NUMBER
GENERAL LIABILITY
❑V COMMERCIAL GENERAL LIABILITY 0185fl00015912
❑ 1311 CLAIMS MADE (V-1 OCCUR
A ❑
GFN'L AGGREGATE LIMITAPPLILS PER
2 POLICY 0 PROJECT Cl LOO
AUTOMOBILE LIABILITY
❑ ANY AUTO
❑ ALLOWNEDAUTOS
❑ ❑ SCHEOULEDAUTOS
❑ HIREDAUTOS
❑ NON OWNED AUTO$$
n - --
GARAGE LIABILITY
❑ ❑ ANY AUTO
EXCESSIUMBRELLA LIABILITY
❑ Cl OCCUR Cl CLAIMS MADE
❑ DEDUCTIBLE
L7 RETENTION s
ANY PROPRIETOR I PARTNER / EXECUTIVE
OFFICER I MEMBER EXCLUDED?
Ir yea, describe under
OTHER
DESCRIPTION OF OPERATIONS I LOCATIONS
ELECTRICAL CONTRACTOR
CERTIFICATE HOLDER
I1Te MMfi
olATg: MMIt)D
LIMITS _
10/18/13
10/18/14
EACH OCCURRENCE
1
DAMAGE T RENTED
PREMISES Ea occurence)
MED EXP (Anyone person)
PERSONAL &ADV INJURY
_
1
2
GENERALAGGREGATE
PRODUCTS-COMP /OPAGG
-2
COMBINED SINGLE LIMIT
(Ea accident) _
BODILY INJURY
(Per person)
_
BODILY INJURY
(Par amttlenn
PROPERTY DAMAGE
(Per awXenq
AUTO ONLY - EA ACCIDENT
OTHER THAN EA ACC
AUTO ONLY: AGG
EACH OCCURRENCE
I AGGREGATE I I
Q we sT �_ ❑ oR
E.L. EACH ACCIDENT
E.L. DISEASE • EA EMPLOYEI
E.L. DISEASE -POLICY LIMIT
I EXCLUSIONS ADDED BY ENDORSEMENT I
MIAMI SHORES VILLAGE
10050 NE 2 AVE
MIAMI SHORES VILLAGE, FL 33138
QF
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO
THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY
OF ANY KIND UPON THE INSU)qER, ITS AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
0 ACORD CORPORATION 1988
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1240 North Monroe Street Tall- h-ssee FL 32a99 :: Email: Customer Contact Center :: Customer Contact Center: 850.487.1395
The State of Florida is an AA /EEO employer. Copyright 2007 -2010 State of Florida, Privacy Statement
Under Florida law, email addresses are public records. If you do not want your email address released in response to a public- records request, do
not send electronic mail to this entity. Instead, contact the office by phone or by traditional mail. If you have any questions, please contact
850.487.1395. 'Pursuant to Section 455.275(1), Florida Statutes, effective October 1, 2012, licensees licensed under Chapter 455, F.S. must
provide the Department with an email address if they have one. The emaiis provided may be used for official communication with the licensee.
However email addresses are public record. If you do not wish to supply a personal address, please provide the Department with an email address
which can be made available to the public. Please see our Chanter 455 page to determine if you are affected by this change.
https : / /www.myfloridalicense.com/wlll. asp? mode =2 &search= LicNbr &SID= &brd = &typ= 3/13/2014
Name License
License Type Name
Number/
Status /Expires
Type Rank
Certified Electrical DIAS, ALSTON
Prima EC0002175
Primary
Current, Active
Contractor -
Cert Electrical
08/31/2014
License Location Address *:
512 POINSETTIA AVENUE LEHIGH ACRES, FL 33972
Main Address *:
512 POINSETTIA AVENUE LEHIGH ACRES, FL 33972
Certified Electrical MIZPAH ELECTRIC
INC DBA EC0002175
Current, Active
Contractor
Cert Electrical
08/31/2014
License Location Address *:
512 POINSETTIA AVENUE I EHIGH ACRES, FL 33972
Main Address *:
512 POINSETTIA AVENUE LEHIGH ACRES, FL 33972
* denotes
Main Address - This address is the Primary Address on file.
Mailing Address - This is the address where the mall associated with a particular license will be sent (if different from the
Main or License Location addresses).
License Location Address - This is the address where the place of business is physically located.
1240 North Monroe Street Tall- h-ssee FL 32a99 :: Email: Customer Contact Center :: Customer Contact Center: 850.487.1395
The State of Florida is an AA /EEO employer. Copyright 2007 -2010 State of Florida, Privacy Statement
Under Florida law, email addresses are public records. If you do not want your email address released in response to a public- records request, do
not send electronic mail to this entity. Instead, contact the office by phone or by traditional mail. If you have any questions, please contact
850.487.1395. 'Pursuant to Section 455.275(1), Florida Statutes, effective October 1, 2012, licensees licensed under Chapter 455, F.S. must
provide the Department with an email address if they have one. The emaiis provided may be used for official communication with the licensee.
However email addresses are public record. If you do not wish to supply a personal address, please provide the Department with an email address
which can be made available to the public. Please see our Chanter 455 page to determine if you are affected by this change.
https : / /www.myfloridalicense.com/wlll. asp? mode =2 &search= LicNbr &SID= &brd = &typ= 3/13/2014