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EL-13-2727.0-�,l)_76 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 210044 Permit Number: EL -12 -13 -2727 Scheduled Inspection Date: April 01, 2014 Inspector: Devaney, Michael Owner: GAVIRIA, JAIRO Job Address: 615 NE 97 Street Miami Shores, FL Project: <NONE> Permit Type: Electrical - Residential Inspection Type: Final Work Classification: Alteration Phone Number Parcel Number 1132060171850 Contractor: JAKE'S ELECTRIC, INC Phone: (305)796 -6237 tsunaing uepartment comments INSTALL SMOKE DETECTOR AND GFCI INSPECTOR COMMENTS False Inspector Comments Passed Ef_ Failed Correction ❑ Needed Re- Inspection ❑ Fee No Additional Inspections can be scheduled until re- inspection fee is paid. March 31, 2014 For Inspections please call: (305)762.4949 Page 36 of 50 Miami Shores Village Building Department 90050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 BUILDING PERMIT APPLICATION Permit Type: Electrical ,4 -K 04.2013 FBC 20 10 Permit No. Master Permit No.�I JOB ADDRESS: C, A)', City: " Miami Shores County: Miami Dade Zip: 3-3/ 3 Folio/Parcel #: 3 2-DZ 0/7 /V 0 Is the Building Historically Designated: Yes NO Flood Zone: OWNER: Name (Fee Simple Titleholder): Phone #: Address: i--" 9 7 S Z ` City: � -1 f l �� 9 �i State: Zip: S 2 J 1 3 Tenant/Lessee Name: Phone #: Email: CONTRACTOR: Company Name: JL- ` L'S C_ (C c d V-' k' C -L Address: U `( l 0 City: 6 � k C�� b \' d ' cc_ cl--�'- -�O5-- 7Ej�'-6C) 3? l C' C� t Zip: 75 C) Qualifier Name: _ : Cc �) (:� cl I-) -c ` 1 Phone #: State Certification or Registration #: �` Certificate of Competency #: Contact Phone #: -3 CAS- -T4 6 $ cY 3j Email Address: S 6 s �� C k ct S-Q �' It Su v 4 DESIGNER: Architect/Engineer: Phone #: Value of Work for this Permit: $ C , C10 Square/Linear Footage of Work: Type of Work: ❑Address ❑Alteration ❑New UIER �� air/Replace Description of Work: ::�7r is \r E ' a i 1 C 1--% vc- ❑Demolition Submittal Fee $ Permit Fee $ ly 8'r® d Scanning Fee $ Radon Fee $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ CCF $ CO /CC $ DBPR $ Bond 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 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 axeinvection fee will be charged. Signature Signature Owner or Agent Contractor The foregoing instrument was acknowledged before me this day of , 20 e, by TD ) /1.-5 C-4&-f who is personally known to me or who has produced As identification at 4 ►whaid*/take an oath. The foregoing instrument was acknowledged before me this / day of RE"G , 2013, by 7 /7e-03 COPYI'7^' who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: 4 ' -, NOTARY PUBLIC: 4......... ►►►u►u �� , � Sign: wy ,'c cn = Sign: ' Print: Print: -� �= v o ` My Commission Expires: ''i� ®�1 My Commission Expires: • Ste'. . ��`� /��1/l111l► ►111 \��``\\ ��i •• �..... •�O� ?r , r •• Y�Y�4r& Y:Ytk4r Yk�4rFroYoY4etkkkkak4e4r4e4e4toY4t9tk�ktk4rde4rdetk 'x4e� Y4t4e4e4toYktk4ttk #�Y4t�Y�YvY4t &4t�YvYoYoY4r4nY�Y k4t &ktk�Y9nY9t�sYsYsY4t Y Y3e: YFrk4e9etR�k�Y��4e�e3eaF3r &�Y &3nY�Y ' APPROVED BY %� � Plans Examiner �sl/ '° Zoning Structural Review (Revised 3 /12/2012 )(Revised 07 /10 /07)(Revised 06 /10/2009 )(Revised 3/15/09) Clerk 2 Mgnicipal Contractor's Tax Receipt Miami —Dade County, State of Florida -THIS IS NOT A BILL - DO NOT PAY CC NO: 94E000475 BUSINESS NAME/LOCATION JAKES ELECTRIC INC OPERATING IN DADE COUNTY MIAMI, FL 33999 OWNER JAKES ELECTRIC INC i oU MC RECEIPT NO. EXPIRES NEW BUSINESS SEPTEMBER 30, 2014 7434500 Must be displayed at place of business Pursuant to County Code r Chapter BA - Art. 9 & 10 TYPE OF BUSINESS ELECTRICAL CONTRACTOR For more information, visit www r,miamidade.govkaxcollector Local Business Tax Receipt Miami —Dade County, State of Florida -THIS IS NOT A BILL - DO NOT PAY 1270212 PAYMENT RECEIVED BY TAX COLLECTOR 200.00 07/10/2013 0222 -13 -000438 Ica] IUSINESS NAME/LOCATION RECEIPT NO. EXPIRES AKES ELECTRIC INC RENEWAL: SEPTEMBER 30, 2014 AAMI FL )PERAT 3 DARE COUNTY 3406840 Must be displayed at place of business 339 999 Pursuant to County Code Chapter 8A - Art. 9 & 10 )WNER SEC. TYPE OF BUSINESS PAYMENT RECEIVED WES ELECTRIC INC 196 ELECTRICAL CONTRACTOR BY TAX COLLECTOR Vorker(s) 2 94E000475 $75.00 07/05/2013 CREDITCARD -13- 001433 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 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 NO. above must be displayed on all commercial vehicles - Miami -Dade Code Sec 8m -276. For more information, visit ma8a miamidade.govRexcollector U Z W LLi v F. ma �O cV Wd w Cya U C go ~ t �o U � m m ul m O 'Cr Ca o m z a E .v o W J � W t `o c fn g Ct �` a d LU $� LU U t C) a t ' t1t I` OD O N Ch r�l U_ao m ofO CQ:H OD P4 to VHL" v 1 w 'Q coo rf'' PTO U , �na o n p;'i3 ` � a;a in N W ?.04_ . 1-I . 04 ., H rsl'fat o W .CI 1-4 a o I rn E11140. y r fJ W C7 i4; � •` Arm � CERTIFICATE OF LIABILITY INSURANCE DATE(MlWDD/YYYY) WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT T 06/05/13 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 certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WANED, subject to the terns 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 endorsement(s). PRODUCER CONTACT Fannie Baez PHONE Jackson Insurance Agency aiC. No. E#); (305) 8243464 FAX (ac NJ_. (305) 17 - 8 1610 2075 West 76tth Street E-MAIL -- .____.. — Fbaez @Jacksonagency.com - - Hialeah, FL 33016 Phone (305) 8243464 Fax 305 822 -8535 ( ) INSURERS AFFORDING COVERAGE NAIC a INSURER A Ascendant Commerdal Insurance INSURED INSURER B : Travelers Insurance Jake's Electric, Inc. INSURER C: Bridgefield Insurance DAMAGE S 4410 Adams Ave INSURER D: CLAIMS -MADE Q OCCUR N Miami Beach, FL 33140 305 -532 -5070 CAVFRArFS nrerra..�........�..- INSURER F: SET T 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 W WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT T TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. I raR T TYPE OF WSURANCE P INSR POLICY NUMBER M MPmaCY y'r M MP p EXP L LIMITS GENERAL LIABILITY I COMMERCIAL GENERAL LIABILITY D EACH OCCURRENCE $ $ 1,000,000.00 DAMAGE S CLAIMS -MADE Q OCCUR N SET T $ 1 �,000•� MED EXP (Any one person $ $ 5,000.00 A C I 0 N N N G GL- 42477 -1 M 06!0112013 0 06/01/2014 P PERSONAL & ADV INJURY $ $ 1,000,000.00 -� -- - - -- - - - - - -- - -- - G GENERAL AGGREGATE $ $ 2,0_00,000.00 GEML AGGREGATE LIMIT APPLIES PER' P PRODUCTS - COMP/OP AGG $ $ 1,000,000.00 $ F FCT AUTOMOBILE LIABILITY C COMBINED SINGLE LIMIT I. ANY AUTO B Ea a.dent $ $ BODILY INJURY (Per person) $ $ 100,000.00 B I ALL OWNED SCHEDULED B BA- 9470767A- 13 -SEL BODILY INJURY (Per accident $ $ 300,000.00 -� A 03/28/2013 0 03/28/2014 B denDAMAGE $ $ 300,000.00 _ H UMBRELLA L"A" F] OCCUR E C I I- EXCESS LIAB �. I CLAIMS -MADE A EACH OCCURRENCE $ $ AGGREGATE $ $ I_ DED T J. RETENTION-$ WORKERS COMPENSATION _ Y __ ._.._. -- � T WC STATIf OTH- C O ANY PROPRIETOR/PARTNER/EXECUTIVE 8 NIA E 830 -31196 01/24/2013 0 01/24/2014 E.L. EACH ACCIDENT $ $ 100,000.00 E.L. DISEASE - EA EMPLOYE $ $ 100,000.00 (Mandatory In NH) 0 E.L. DISEASE - POLICY LIMIT $ $ 500,000.00 DESCRIPTION OF OPERATIONS below E DESCRIPTION OF OPERATIONS I LOCATIONS t VEHICLES (AMach ACORD 101, Additional Remarks Schedule, if more space Is required) EVIDENCING COVERAGE AS PER POLICY TERMS AND CONDITIONS CERTIFICATE u01 DER MIAMI SHORES VILLAGE BUILDING DEPARTMENT 10050 NE 2ND AVE MIAMI SHORES, FL 33138 ACORD 25 (2010105) QF CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE –�– ©1988 -2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD