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EL-14-529Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 209225 Scheduled Inspection Date: April 17, 2014 Inspector: Devaney, Michael Owner: JOSEPH, CELINIS Job Address: 9525 NW 2 Avenue Miami Shores, FL 33138- Project: <NONE> Contractor: MESA ELECTRIC SYSTEMS CORP tiuuamg uepartment comments PROVIDE ELECTRICAL POWER TO AT &T TELEPHONE CABINET. Permit Number: EL -3 -14 -529 Permit Type: Electrical - Residential Inspection Type: Final Work Classification: Addition /Alteration Phone Number Parcel Number INSPECTOR COMMENTS False Inspector Comments Passed Failed Correction ❑ Needed Re- Inspection ❑ Fee No Additional Inspections can be scheduled until re- inspection fee is paid. 1131010240160 Phone: 305 - 279 -5498 April 16, 2014 For Inspections please call: (305)762 -4949 Page 10 of 30 Miami Shores Village ,0 :1 1 Buildin g De artme �� p � 10050 N.E.2nd Avenue, Miami Shores, Florida 33 38 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305 762.49 M FBC 20 `6 BUILDING Permit NoJ7 PERMIT APPLICATION Master Permit N Permit Type: Electrical JOB ADDRESS: 9525 NW 2nd Avenue City: Miami Shores County: Miami Dade Zip: Folio/Parcel #: Is. the Building Historically Designated: Yes NO Flood Zone: OWNER: Name (Fee Simple Titleholder): AT &T Phone#: 305- 222 -8210 Address: 9101 SW 24th Street City: Miami State. Florida Zip: 33165 Tenant/Lessee Name: Phone #: 305 - 222 -8210 Email: CONTRACTOR: Company Name: Mesa Electric Systems, Corp. Phone #: 786 -488 -7968 Address: 117 NW 42nd Avenue Suite # 1506 City: Miami State: Florida Zip: 33126 -5438 Qualifier Name: Carlos A. Mesa phone#- 786 -488 -7968 State Certification or Registration #: EC13005374 Certificate of Competency #: Contact Phone #: 786 - 488-7968 Email Address: carlosjr @mesaelectric.net DESIGNER: Architect/Engineer: Phone #: Value of Work for this Permit: $ 2,400.00 Square/Linear Footage of Work: Type of Work: ❑Address ❑Alteration ❑New ❑Repair/Replace Description of Work: Provide electrical power to AT &T digital telephone cabinet. Submittal Fee Scanning Fee $ Permit Fee $ /�01ow CCF $ CO /CC $ Radon Fee $ DBPR $ Bond Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ ❑Demolition 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 reco notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building pe t sued. 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 this 17th day of March 20 14 , by Carlos A. Mesa who is personally known to me or who has produced As identification and who did take an oath. NOTARY PUBLIC: The foregoing instrument was acknowledged before me this 17th day of Marh 201 Y 4 , b Carlos A. Mesa � who is rsonall known o me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: ,, GONiAtF1 -,2 erg , Sign: Print: Anna Gonza Anna '`W- February 18, 2016 I l XPIRE5: February 16, 201u print ,filth`° " I all My Commission Expir My Commission Expires: APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised 3 /12/2012)(Revised 07 /10/07)(Revised 06110/2009)(Revised 3/15/09) STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD a >>r Local Business Tax Receipt Miami -Dade County; State of Florida THIS IS NOT A BILL DO NOT PAY 2662048 LBT BUSINESS NAME /LOCATION RECEIPT NO. EXPIRES MESA El ECTRICSYSIEMS CORP RENEWAL SEPTEMBER 30, 2014 117 NW 42 AVE 1506 2791110 MIAMI, FL 33126 Must be displayed at place of business' Pursuant to County Code Chapter'8A - Art. 9 &`10 OWNER SEC. TYPE OF BUSINESS PAYMENT RECEIVED MESA ELECTRIC SYSTEMS CORP 196 ELECTRICAL CONTRACTOR BY TAX COLLECTOR 45.00 07/26/2013 WOrker(s) 1 EC13005374 0226 -13- 000601 This local Business Tax Receipt only confirms payment of the local Business Tax. The Receipt's note license, permit, or a certification of the holder's qualifications, to do business. Holder must comply with any governmental or nongovernmental regulatory laws and requirements which apply to the business. The RECEIPT N0. above most be displayed on all commercial vehicles - Miami -Dade Code Sec 83-276. htt ®� For more information, visit www.miamidade,gov /taxcolloc or- MESAE01 OP ID: EA Akk ° CERTIFICATE OF LIABILITY INSURANCE DATE D/YYYY) 02/04/14 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(les) 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 Ileu of such endorsement(s). PRODUCER Phone: 305-270 -2100 FILER INSURANCE, INC. 9440 S.W. 77 Avenue Fax: 305- 270 -2195 FL 33156 Miami Miller Keith IL CONTACT Amy Mencia PHONE FAX ac No E,t :305- 270 -2169 ac No): 305- 270 -2195 E-MAIL amencla@filerins.com ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC 0 INSURERA:FCCI Insurance Company 10178 INSURED Mesa Electric System Corp 117 NW 42nd Ave., Suite 1506 Miami, FL 33126 INSURER B: Commerce & Industry Ins. Co. 19410 INSURER C: EACH OCCURRENCE INSURER D PREMISES Me occurrence INSURER E : MED EXP (Any one person) INSURER F PERSONAL & ADV INJURY 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. INSR LTR TYPE OF INSURANCE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Miami Shores 10050 NE 2 Avenue POLICY NUMBER POLICY EFF MM/DD POLICY EXP MMIDD LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE F] OCCUR GL0000159 02120114 02/20115 EACH OCCURRENCE $ 1,000,00 PREMISES Me occurrence $ 100,000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 GEWL AGGREGATE LIMIT APPLIES PER: PRO- LOC POLICY X PRODUCTS - COMP /OP AGG $ 2,000,000 $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON-OWNED NON-OWNED HIREDAUTOS Ee eBIBINEDitSINGLE LIMIT $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY AGE (Per accident) $ B X UMBRELLA UA13 EXCESS LUU3 X OCCUR CLAIMS -MADE EBU028190879 10126113 10126114 EACH OCCURRENCE $ 5,000,00 AGGREGATE $ 5,000,00 DED I I RETENTION $ 0 $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y I N OFFICER/MEMBER EXCLUDED? El (Mandatory In NH) If yes, describe wider DESCRIPTION OF OPERATIONS below NIA 001 WC11A33848 04101113 04101114 X WC STATU- OTH- T TS E E.L EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,00 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, H more space Is requIred) Electrical Contractor CERTIFICATE HOLDER CAkI(1=1 I ATIr%M CITY066 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Miami Shores 10050 NE 2 Avenue THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Miami Shores, FL 33138 AUTHORIZED REPRESENTATIVE A4,& ELENA ANDRES -A ©1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD AT &T Job address: 9525 NW 2nd Avenue Job number: 4MP05002N SERVICE SCHEDULE 8i MAIN CO DUCTORS' CRQUNDINO CONDUIT SIC,. CflldDliCTf}II I ,g� AMPS r 1arc�er CIrtl�bli 'r L104 Fact: pan; HIM 3 # 3 THVWNl drier nt( <. ;I�12 �AIaIIt_�� 6I Si'RUCTURAL ELECTRICAL PLUMBING DATE /9 /WA`s A, Earth meta, to anchor, concrete pad OR concrete slab for cabinet placement AT&T Job address: 9525 NW 2nd Avenue Job number: 4MP05002N I CER! NbE *� 0 W* AT&T Job address: 9525 NW 2nd Avenue Job number: 4MP05,002N t0l If- 1,04C F 77.77 --1 rz T-' R -1 Ca HOS A., Misa I (Qui! I i fre�) 00 j3B40 A S%OIN 4 -COM 6,2016 EC13W5374 pubW Unda Mesa Electric-, SVstems Cdrp, 117 NW42M" F te. "Avenue'Sul 15,06 Mlaml� FlorWaI3,8126-54138 '786-48�&79681 ad ' ' esae n b O-SI, r@ m learic Lit