EL-14-462Miami 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
FBC 20
BUILDING Permit No. Z/ /L /6�
PERMIT APPLICATION Master Permit No. P(! /z/- 3
Permit Type: Electrical
JOB ADDRESS: 8705 NE 4th Avenue Road #8705
City: Miami Shores County: Miami Dade zip: 33138
Folio/Parcel #: 11- 3206 - 046 -0680
Is the Building Historically Designated: Yes NO Flood Zone:
OWNER: Name (Fee Simple Titleholder): Rafael Feliz Phone #:
Address: 6100 N Bay Road
City: Miami Beach
Tenant/Lessee Name: Patricia A. Hemandez
State: FL
zip: 33140
Phone#: 305 - 7944927
Email. CONTRACTOR: Company Name: ‘4,,,,, '/ if/044 0714, Phone#: ,3•45-W,6 SW 7
Address: 4,0 /v() /€ .7-
City: fr 1 ali State: Zip: JV 7
Qualifier Name: a .®/ Phone #:
State Certification or Registration #: ete4Rod 907` Certificate of Competency #:
Contact Phone#: -( 5t7 Email Address:
DESIGNER: Architect/Engineer:
r./29 • a a. £dx t
hone #:
Value of Work for this Permit: $ 6 °50 ' Square/Linear Footage of Work:
Type of Work: ❑Address ❑Alteration ❑New Ig(Repair/Replace ❑Demolition
Description of Work: Remove and reinstall new kitchen top (granite)
Submittal Fee $ v C) •C2C;j Permit Fee $ /4 Q'^efl� CCF $ CO /CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $ Technology Fee $
Double Fee $ Structural Review $
TOTAL FEE NOW DUE $ 0/./ U
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 FLFCTRICAL 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 subje t to attachment. Also, a certified copy of the recorded notice of commencement must be posted at t ob site
for the first inspectio ' hich occurs seven (7) days after the building permit is issued. In the abse o h poste ' ' 'ce, the
inspection will not be r roved and a ' ec fee will be charged.
Signature
Owner or A ent
The foregoing instrument was acknowledged before me this oN
day of / , 20., by /Zi,Q)
who is personally known to me or who has produced
As identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
My Commissio
Signature
ctor
The foregoing instrument was acknowledged before me this </
day of 1‘1,-+A-." , 20 2 %y /��f' itAig04
who is personally known to me or who has produced
as identification and who did take an oath.
APPROVED B /O-% fie° Plans Examiner
Structural Review
(Revised 3 /12/2012)(Revised 07 /10/07)(Revised 06/10/2009)(Revised 3/15/09)
NOTARY PUBLIC:
Sign:
Print:
My Co r;. xpires:.;47,,c, stiee of Florida
o�ani t :91078
alc1),• OS, 2016
mARIJAIR RAVELO
f
Commission #EE91 078
Expo gay. 08, 2016
Zoning
Clerk
From: GCM
Fax: (306) 617 -3848 To:
Fax: +1 (306) 766 -8972 Page 2 of 2 03/11 /2014 11:40
A e Certificate of Liability Insurance
1011 NDCSNYYYj
10/10/2013
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.AIMEND, 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 WAIVED, 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)..
PRODUCER
Progressive Employer Insurance Agency, Inc.
8407 Parkland (Ave
Sarasota, FL 34243
N contact
PH 888-925 -2690 I FAX
ai81: Fiat, NO
.. -: < certs@progreasiveemployer.com
INSURERS) AFFORDING COVERAGE
NAIC 0
InsurerA Guarantee Insurance Company
11398
INSURED
Progressive Employer Management Company, Inc.
0407 Parkland Drive
Sarasota, FL 34243
Insurer B
Insurer C
Insurer II
$
Insurer E
MED ES. (M one per )
Insurer F:
■
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 POUCIES. LIMITS SHOWN MAY HAVE
BEEN REDUCED BY PAID CLAIMS.
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE
POLICY PROVISIONS.
TYPE mP INSURANCE
,'•'E
POLICY NUMBER
±■
- • ^:37-
LIMITS
GENERAL ET s "�
■ COMMERCIAL GENERAL UABILITY
EACH OCCURRENCE
DAMAGE TO RENTED
$
Mill CLAIMS-MADE ❑OCCUR
MED ES. (M one per )
$
■
PERSONAL & ADV INJURY
$
■
GENERAL AGGREGATE
$
GEN9. AGGREGATE LIMIT APPLIES PER:
. POLICY . PRO- . LOC
PRODUCTS- COMP/OP AGO
$
$
- AUTO
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5
BODILY INJURY (Per person)
$
Eli ALL own D
gi HIRED AUTOS
-
SCHEDULED
AUT OS
BODILY INJURY Per aoddant)
$
- - -�.7 =�'• - s7.T�'/
$
UMBRELLA LIAR
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OCCUR
ciAffimatAoe
:
EACH OCCURRENCE
S
• BxCESSUAB
AGGREGATE
S
IS
OED RETENTIONS
•
AND
REIFF cOMPBNSATON
EMPLOYHRW LAWN Y
N/A
WCPSOOtXtO i01CSC
09)2912013
i19/29rd014
WC 6T�+14L °Yid
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$
O PROPELiETORR�AR�CLTNE CUTiVE
€MANOA� TORY �j
DE RIPTION Ou OPERATIONS b*w
E.L. EACH ACCIDENT
81,000.009
H.L. =Ease EA ACCIDENT
81.009.000
E.L. DISEASE • POLICY LIAR
81,000.000
S
$
DESCRIPTION OF OPERATIONS / LOC •
Coverage is extended to leased employees,
fdoCT1E1P_6TC Lira I4CG,
TIC NS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more $
apace is req date: 09/29/2013
but not subcontractors of General Construction Master Corp Location coverage effective date; 06/29/2013
— - - - --- - - — - __
Miami Siteres Vamps
Blr8ding Department
10050 NE 2nd Ave
Miami Shores VIOage . FL 33138
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE
POLICY PROVISIONS.
AutEmlzed Representative
_.•......_....._
.• :;Z:..: ,'`. .' -"Mill.
ACORD 25 (2010/05)
tir7 1888.2010 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 215340
Permit Number: EL- 3- 14-462
Scheduled Inspection Date: July 03, 2014
Inspector: Devaney, Michael
Owner: FELIZ, RAFAEL
Job Address: 8705 NE 4 Avenue Road
Miami Shores, FL
Project: <NONE>
Contractor: GENERAL CONSTRUCTION MASTER COMPANY IIC
Permit Type: Electrical - Residential
Inspection Type: Final
Work Classification: Alteration
Phone Number
Parcel Number 1132060460680
Phone: (305)216 -5617
Building Department Comments
REMOVE AND REINSTALL NEW KITCHEN TOP GRANITE
Infractlo Passed Comments
INSPECTOR COMMENTS
False
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
J
July 03, 2014
For Inspections please call: (305)762-4949
Page 32 of 33