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EL-14-368Miami Shores Village Building Department 10050 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 FBC20 fL Permit No. 12NG Master Permit No. EL I Li (0 Permit Type:( Electrical JOB ADDRESS: 143 40 i/U ST City: Miami Shores County: Miami Dade Zip: S3((0 Folio/Parcel #: Is the Building Historically Designated: Yes NO Flood Zone: OWNER: Name (Fee Simple Titleholder): Tl Z Ii2c-r).-Qf r k Aq Phone #: 3E15 362 16S ) Address: k pCAvW o DA (;Lick 2S0 City: NO DD d State: Zip: 33 0 r.0 Tenant/Lessee Name: Phone #: Email: CONTRACTOR: Company Name: AN e4 64 C lCc. 71titc / i< Phone#: 9,rY wO 6.56 f( Address: 357 let% tZ 71.44P City: Ai( 4.4-1 ! State: Zip: 2,3 /2 . Qualifier Name: B i M ✓t G cc Phone#: State Certification or Registration #: d D ® 0 /341r / ^ Certificate of Com etgncy Contact Phone#:gf SC W® 6 3 t Email Address: t� Tom! P�� c %, C ' CJC D 6k e4 ,sd. c 0 xi DESIGNER: Architect/Engineer: Phone#: Value of Work for this Permit: $ 500 Square/Linear Footage of Work: S-0 ..7.9, f % Type of Work: DAddress ItdA1teration ❑New ❑Repair/Replace ODemolition Description of Work: bnn5 uf kc WN:A 4n curl e NA- e.L 4t i cat cps , Submittal Fee $.5-0 0 Permit Fee $ ices,' Co e, 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 Zip 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 be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. he abs notice, the inspection will not be approved and a reinspection fee will be charged. wner or Agent The foregoing instrument was acknowledged before me thisc41 The foregoin instrument was acknowledged before me day of F d Q -, 20I'1- , by Ravfall _ Ada , day of , 20 64, by i.S ,r rt who is personally known to me or who has produced As identification and who did take an oath. NOTARY PUBLIC• Contractor Sign: Print: My Commission Expires: who is personally known to me or who has produced and who did take an oath. * * * * * * * * * * * * * * * * * * ** APPROVED BY 0?637.1%. JANICE AIMEE MATOS MY COMMISSION #FF011193 * * * EXPIRES April 23 2017 i a Jotar,senr e*. * Sign: Print: My Commission Expires: Notary pub Oonmisaton 6 EE 167413 My roles e>prm Feb. 7, 2616 ********************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** 9d1PL Q4"/ Plans Examiner Zoning Structural Review Clerk (Revised 3 /12/2012)(Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) t7.0. Lot L014 lb: 1b 30b: b89395 • $iiEi4:iUAL ELECTRIC IN PAGE °V ; 5 -- mkasAursarez. vtr ssa+dtiVS93' ID ffills IXILAT10 CONSTRUCinc04. TNDi ritY SEQ# 1.120'F i7 0.112 . DATE E,aT, 14 :V' 'LIMPER I 1B •407 17 20.12 12802 539 The GENaRAL CONTRACTOR Named below IS - CRRTTB'IED Under the provisions oE.' CSapter..48.9 FS Expiration date: AUG 31, 2014 Ctacoo310 051 201r12TE TRRR • ranaa GO MOR FL 33126 DISMAY REQUIRED BY LAW KEN 5T° Local Business Tax Receipt Miami —Dade County, State of Florida -THIS IS ARRA SILL -00 NOT PAY 554724 ENNUNLOONAANWLOOATiott ANIENGUAL a4t 3851 NW 12IERK'es" norm K33126 . mamma AMEHGUAL ELECTRIC INC Worker(s) t0 tintempT No. RENEWAL 354724 E iPIRES SEPTEMBER 30, 2014 m216 ellsldayee etpteaa °nosiness Ptaswnt.to- Caanty Cosh C bidder WV* Arts 81. td SEC. reps OF Bus . 198 GENERAL. BEUi.UiNG CCAImRACIme PAY MEifr REC"ED sr TAX OOLLECTaR 345.00 07/24/2013 CREDIiCARD- 13- 003860 Iles bed BtsissesTmcRes11 oak esnese payment adds Meal dooms te. The lessipaw net •Braise. ass% or essalases se es s blob. m! emoRlwDtlodts shah btlebr issac eaari►rsidsas!D er The T 10.Am aim be displayed erascoenseekrvowel— Erase- i3Ad■CodeSegga -176 Yet A! eariemdwr,risfl esseesidedidsdempizemetisays SEQ# L12071701672 H 04 aOmoa CO '11 m -Q SH Local Business Tax Receipt Miami —Dade County, State of Florida -THIS IS NOT A BILL - DO NOT PAY 576679 BUSINESS NAME/LOCATION AMENGUAL ELECTRIC INC 3851 NW 12 TERR MIAMI, FL 33126 OWNER AMENGUAL ELECTRIC INC Worker(s) RECEIPT NO. RENEWAL 576679 EXPIRES „mod W SEPTEMBER 30, 2014 gl Must be displayed at place of business �g Pursuant to County Code Chapter BA - Art. 9 & 10 SEC. TYPE OF BUSINESS 196 ELECTRICAL CONTRACTOR 10 000013851 PAYMENT RECEIVED BY TAX COLLECTOR 45.00 09/25/2013 0222 - 13-001556 This Local Business Tex Receipt only confirms payment of the Local Business Tax. The Receipt is not .a license. permit or a codification 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 8a -276. 4qs "" MIAMH7d1DE For more information, visit www.miamidade.gev/taxcollector ,�`� Municipal Contractor's Tax Receipt Miami —Dade County, State of Florida -THIS IS NOT A RILL - DO NOT PAY CC NO: 000013851 BUSINESS NAME/LOCATION AMENGUAL ELECTRIC INC 3851 NW 12 TERR MIAMI, FL 33126 OWNER AMENGUAL ELECTRIC INC RECEIPT NO. NEW BUSINESS 7437958 TYPE OF BUSINESS ELECTRICAL CONTRACTOR 0 z MENGUAL ELECTRIC 1 EXPIRES SEPTEMBER 30, 2014 Must be displayed at place of business Pursuant to County Code Chapter 8A - Art. 9 & 10 For more information, visit www.miamidade govhaxceUMM PAYMENT RECEIVED BY TAX COLLECTOR 200.00 09/25/2013 0222 -13- 001556 CERTIFICATE OF LIABILITY INSURANCE DATE tMOTID/TYYY) 1/14/2013 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 ISSUINGINSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. `IMPORTANT: • °f t " cl rtifcate' holder is au ADDITIONAL INSURED, the policy. ) must be endorser& If SUBROGATION IS WAIVED, subject to the turbo 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 Wu of such endorsementts j. PRODUCER Insurance Office of America-LNG 1858 West State Road. 434 Longwood, FL 32750 CONTACT NAME: PHONE AP. N .,fix {4OT} 788 3000 ADORESS: I f, No) (407) 788 -7033 INSURER/SI AFFORDING COVERAGE INSURER a: Star Insurance Company 18023• INSURED Amengual Electric, 3861 NW 12Terrace Miami, FL 33126 INSURERS : INSURER C: INSURER D : INSURER E : INSURER COVERAGES CERTIFICATE NUMBER: REVISION NUMBER• THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED AtIOVE 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 FOLIC ES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. r.. GEi ERAL-LIABWY OOMMERCIALGENERAL UAEILiTY CLAIMS•MADE E OCCUR GEN'L AGGREGATE UNIT APPLIES, PER: poucY f ZLElkoc AUTOnoatELIAINLI Y ANYAUTO ALL OWNED AUTOS HIRED AUTOS USWIREtaA LIB LIAO EFF hiet ., AU• TOS O • OWNED AUTOS' OCCUR CLAIMS-MADE UNITS EACH OCCURRENCE DAMAGE TO RENTED. PREMISES Me hence) S S D EXP(Any one person S PERSONAL S A V INJURY $ GENERAL AGGREGATE S PRODUCTS - COMP/OP AGG S $ ' IEa arrldeM) BODILY INJURY (Per person) S BODILY INJURY (Per accident) $ S X A S 1,000,000 1,000,00 U N OF OPERATIONS I LOCATIONS/ VEHICLES (AttachACO General Contractor / Electric: G TIFICATE'HOLDEI CANCELLATION Miami Shores Village Building Department 10050 NE 2 Ave Miami Shores FL 33138 SHOULD ANY OP THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHOR/ZED REPRESENTATIVE 1i/1e- 4i ACCORD 25 (2010105) The ACORD name and logo are rag 01888 -2010 ACORD CORPORATION. All rights reserved. red marks of ACORD 4 R d� CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDIYYYY) 02/26/14 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. TH(s 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 poiicy(ies) 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 endorsement(s). NCT PRODUCER NNAAMME GRETELL GONZALEZ .» Use General Insurance 5841 S.W. 137th Ave. Miami, FL 33183 Phone (305) 386 -3305 Fax (888) 330 -1123 INSURED BERNARD AMENGUALlJOSE ROUSSEAU DBA AMEN OUAL ELECTRIC IN 3851 NW 12TERR Miami, FL 33128 (954) 410 -8384 COVERAGES CERTIFICATE NUMBER: E No. Exti (305) 386. 3305/' MAX ADD RESS• GRETELL@USAGENERAUNSURANcE,COM INSURERS) AFFORDING COVERAGE Na: 888 330 -1123 INSURER A : INTERNATIONAL INSURANCE CO OF HANNOVER LTD INSURER 0: PROGRESSIVE INSURANCE COMPANY NAIL $ INSURER C • INSURER 0: INSURER E; INSURER F REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED MOVE 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 COND111ONS OF SUCH POL9ES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTggR TYPE OF INSURANCE Iii POI POLICY .; IL• POLICY NUMEER +,11A&Ai M' '• LIMITS A GENERAL LIABIUTY ® COMMERCIAL. GENERAL UAWUTY ❑ ❑ CLAIMS -MADE ® OCCUR 0 GENL AGGREGATE LIMIT APPLIES PER Q PQuoY ❑ , f 7 Lf 7 oc AUTOMOBILE LIABILITY ❑ ANY AUTO ❑ AUTOS ❑ SqCUHTEDULED ❑ HIRED AUTOS ❑ Amos ❑ ❑ p UMBRELLA LAB 0 OCCUR • EXCESS LIAR ❑ CLAD -MADE DED RETENDON 16 N N WORKERS COMPENSATION AND EMPLOYERS' LIABILITY N ANY PROPRIETOR/PARTNER/EXECUTIVE `O��FFII C�� yER EXCLUDE)? DE>ROF OPERATIONS below 1006C002214-0O 12/18/2013 12/18/2014 EACH OCCURRENCE DAMAGE TO RENTED PREMISES (Ea occurrence) MED EXP (Any one person PERSONAL & ADV INJURY GENERAL AGGREGATE PRODUCTS • COMP/OP AGO 023669790 08/23/2013 08/23/2014 (Ea acxM GLE LIMIT $ 1,000,000,00 s 100,000.00 $ 5,000.00 S 1,000,000.00 $ 2,000,000,00 a 2,000 ,000,00 S BODILY INJURY (Per person) BODILY INJURY (per scoiden0y ROM:. . __ §AMAGE EACH OCCURRENCE AGGREGATE N/A DESCRIPTION OF OPERATIONS 1 LOCATIONS / VEHICLES (A11d ACORD 101, Additional Remarks Schedule, If more space Is required) GENERAL CONTRACTOR/ELECTRICAL CERTIFICATE HOLDER CANCELLATION ❑.IOTS s❑ - EL EACH ACCIDENT S 10,000.00 $ 2,000,00 $ 10,000.00 S $ a S $ EL DISEASE - EA EMPLOYE S EL DISEASE - POLICY LIMIT S CITY OF MIAMI SHORES 10050 NE 2 ND AVE MIAMI SHORES FL 33138 FAX 305- 756 -8972 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE wail THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 26 (2010105) QF ®18882010 ACORD CORPORATION. All rights resew The ACORD name and logo are registered marks of AC Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 207941 Permit Number: EL- 2- 14-368 Scheduled Inspection Date: May 07, 2014 Inspector: Devaney, Michael Owner: Job Address: 143 NW 110 Street Miami Shores, FL 33168- Project: <NONE> Contractor: AMENGUAL ELECTRIC INC Permit Type: Electrical - Residential Inspection Type: Final Work Classification: Addition /Alteration Phone Number Parcel Number 1121360030530 Building Department Comments BRING UP KITCHEN TO CURRENT ELECTRICAL CODE Infractio Passed Comments INSPECTOR COMMENTS False Passed Li Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments / o /-• May 06, 2014 For Inspections please call: (305)762 -4949 Page 7 of 34