EL-13-2021Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INS P- 198651
Scheduled Inspection Date: June 24, 2014
Inspector: Devaney, Michael
Owner: JENKINS, THOMAS
Job Address: 46 NE 92 Street
Miami Shores, FL 33138-
Permit Number: EL -9 -13 -2021
Project: <NONE>
Contractor: MASTER ELECTRICAL CONTRACTING INC
Permit Type: Electrical - Residential
Inspection Type: Final
Work Classification: Addition /Alteration
Phone Number (305)754 -6072
Parcel Number 1132060130040
Phone: (954)570 -9486
Building Department Comments
ELECTRICAL WORK FOR BATHROOM REMODEL
Infractio
Passed Comments
INSPECTOR COMMENTS
False
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
f a 'fey (/
June 23, 2014
For Inspections please call: (305)762 -4949
Page 1 of 35
ft
Miami 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) 7614949
BUILDING
PERMIT APPLICATION
Permit Type: Electrical
JOB ADDRESS: 41 NC ell 4d S�
SAP 062013 ^�'T
Y:
FBC2OjO
Permit No. El I ) 2-IJVl
Master Permit Nor-CA 3-ZOL
City: Miami Shores County:
Folio/Parcel #: // "3200, —012 ° it°
Miami Dade Zip:
Is the Building Historically Designated: Yes
NO Flood Zone:
OWNER: Name (Fee Simple Titleholder): 7 a to , c,-6 4; o Phone#•
Address: y/a /UC q 2 —r1 .
City: /yl•-i+�►r.Shrr. State: Zip:
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: 1' V `� 1-eit f✓ �p_L C
Address: 5 6( N a, 4 Dtk' I- Wt
City: C4.4 C,a,,,r State: N.
Qualifier Name: £*} M 1 tip 1"d 11270
State Certification or Registration #: (Ci /30024 .0 Y
Contact Phone#: q"i 4 Z-t'( - Q Y J. % Email Address:
DESIGNER: Architect/Engineer:
Cept,, p/ C. Phone#: 5 S70 -111e6
Zip: 330)3
Phone#:
Certificate of Competency #:
e9Ag tit - eje `-1/t ► c. hel/sa4 -4. deaf
Phone#:
Value of Work for this Permit: $
Type of Work: °Address
Description of Work: 24sh.
' Square/Linear Footage of Work:
Iteration °New °Repair/Replace
ei ` .1-1,5 lz l/ , , f/xtw2
°Demolition
*************************************** F************* * * * * * * * * * * * * * * * * * * * *** * * * * * * * **
Submittal Fee $ Permit Fee $ 4(2 e ®C
Scanning Fee $ Radon Fee $
Notary $ Training/Education Fee $
Double Fee $ Structural Review $
CCF $ CO /CC $
DBPR $ Bond $
Technology Fee $
TOTAL FEE NOW DUE $ k
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 FJ FCTRICAL 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 after 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
Owner or Agent
veP
The foregoin instrument was acknowledged before me this'3
day of % , 20 13 by gorrh Jew, k'wij
who is personally known to me o who has prod G D
As identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Signature 1401.1,1
Contractor
The foregoing instrument was acknowledged before me this
, day of 2 1 , 2013 , by i t 0
is personally known tom r who has produced
My Commission Expires: o "( r`; 'I MY COMMISSION # EE008608
EXPIRES July 14, 2014
(407) 3984153 PloridoNotarvrWoe.wm
APPROVED BY
as identification and who did take an oath.
NOTARY PUB.
9 a Plans Examiner
Structural Review
(Revised 3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/i5/09)
Sign:
Print
My Commission Expirs:
GIUSEPPE MANGIAFICO
*c MY COMMISSION 0 EE008606
***ill 414214
"-
(407) 398.0153 FloridaMotaryt3ery Ice.aom
Zoning
Clerk
AC
T rt,E, a ro
7001 STATE OF FLORIDA
DEFAR
AR9'ra, PAT E'8�''t?L`APc4'i„
TION
SEQ# L12 63100957
�C�tICAL CONTRACTOR
Need below IN C'ZFYD
r the Provisions Of Chapter
Expiration date: AUO 31, 2014
P
ERR ELECTRICAL
55 61 t 40 TER
COCONUT .EEK
RI
COT'S
OR
DISPLAY AS REQUIRED BY LAW
KEN LAWSO
SECRETARY
le 1 TM A e Imiont
115 S. Andrews Ave., Rm. A-100. Ft. Lauderdale, FL 33301-1895 — 9548314000
VALID OCTOBER 1, 2013 THROUGH SEPTEMBER 30, 2014
DBA:
Business Name: MASTER ELECTRICAL CONTRACTING INC
Owner Name: CA,XILLO POERIO
Business Location: 5561 NW 40 TERR
COCONUT CREEK
Business Phone:
Receipt - .31a,,,ALAms
Business Type: f ELECTRICAL CAL CONTR)
Business Opened: 8 / 01 19 9 6
StatelCounty/Cert/Reg:EC13C 02654
Exemption Code:
Veiterso 9 ' Only Type:
THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS
THIS BECOMES A TAX RECEIPT This tax is levied for the privilege of doing business within Broward County and is
non-regulatory in nature. You must meet all County and/or Municipality planning
WHEN VALIDATED and zoning requirements. This Business Tax Receipt must be transferred when
the business is sold, business name has changed or you have moved the
business location. This receipt does not indicate that the business is legal or that
it is in compliance with State or fowl laws and regulations.
Mailing Address:
CAM .7: LLO POERI 0
5561 NW 40 TERR
COCONUT CREEK , FL 33073
2013 - 2014
Receipt 901A-12-00011167
Paid 08/06/2013 27.00
City of Coconut Creek
BUSINESS TAX RECEIPT
Name cif Business: MASTER ELECTRICAL CONTRACTING
Business Addre.ss:
5561 NW 40 TER
COCONUT CREEK, FL
Business 070000020
EXPIRES 9/30/2013
DESCRIPTION CATEGORY LICENSE FEE AMT
HOME BASED BUSINESS-OFFICE ONLY
NO COMMERCIAL VEHICLES PERMITTED
BUSINESS TAX RECEIPT MUST BE READILY AVAILALE.
096000
HL07000079
Exempt Arrt;
Delinquert Arnt:
Transfer Amt:
102,10
TOTAL TAX: 102,10
Su Still Deveiop I Designee
A3 R° CERTIFICATE OF LIABILITY INSURANCE I
9/ATE( 13
THIS dERTIFICATE 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 pollcyges) 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
Keen Battle Mead & Company
7850 Northwest 146th Street
Suite 200
Miami Lakes FL 33016
"TACT Jeanette Banos
PHME . (305)558 -1101 I Mt No). (305)822-4722
ADDREss, jbanes @kbmco.com
INSURER(S) AFFORDING COVERAGE
NAIC #
INSURERAFCCI Insurance Company
10178
INSURED
Master Electrical Contracting, Inc.
5561 NW 40 Terr
Coconut Creek FL 33073 -4017
INSURER B FCCI Commercial Insurance Co
33472
INSURER C:
EACH OCCURRENCE
INSURER D :
DAMAGE TO RENTED
PREMISES (Ea occurrence)
INSURER E :
MF_DEXP(Any one person)
INSURER F:
PERSONAL & ADV INJURY
13213
--- --- -- a ........v... W., narrlL.n.
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POUCY 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. UMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
LWTBR
TYPE OF INSURANCE
SUBR
POLICY NUMBER
(MMM/�DDIY YF1JI M DD Y)
LIMITS
A
GENERAL
X
uABIUTY
COMMERCIAL GENERAL LIABILITY
ICLAIMS -MADE X OCCUR
GL0009694
1/1/2013
1/1/2014
EACH OCCURRENCE
$ 1,000,000
DAMAGE TO RENTED
PREMISES (Ea occurrence)
$ 100,000
MF_DEXP(Any one person)
$ 5,000
PERSONAL & ADV INJURY
$ 1,000,000
GENERAL AGGREGATE
$ 2 , 000, 000
GEN'L AGGREGATE LIMIT APPLIES PER
TI POLICY rim n LOC
PRODUCTS - COMP/OP AGG
$ 1,000,000
$
B
AUTOMOBILE
Ti
—
%
LIABILITY
ANY AUTO
A OS
HIRED AUTOS
_
%
—
—
CHI LED
NON -OWNED
AUTOS
CA0015075
1/1/2013
1/1/2014
COMBINED SINGLE LIMIT
e
$ 500, 000
BODILY INJURY (Per person)
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
(Pereccldentl
$
Non-owned
$ 500,000
$
UMBRELLA UAB
EXCESS LIAR
—
OCCUR
CLAIMS -MADE
EACH OCCURRENCE
AGGREGATE
$
DED I I RETENTION$
$
A
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE YIN
OFFICER/MEMBER EXCLUDED?
(Mandatory In NH)
Ny d under
DESCRIPTION OF OPERATIONS below
N/A
001WC13A63330
1/1/2013
1/1/2014
_
ITORYLIIM SI I ER
EL EACH ACCIDENT
$ 100, 000
EL. DISEASE - EA EMPLOYF_E
$ 100, 000
EL. DISEASE - POLICY LIMIT
$ 500,000
DESCRIPTION OF OPERATIONS/ LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remote Schedule, If more space is required)
CANCELLATION
Miami Shores Village
10050 NE 2nd Ave
Miami Shores, FL 33138
ACORD 25 (2010/05)
INROOS Mfllrrra rn
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
Miguel Poza /DARL
`� --�- --
®1988-2010 ACORD CORPORATION. All rights reserved.
Tha Artnar1 name, and Inren aro ranietarai marts of AnARrt