EL-13-2613Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
r
Inspection Number: INSP- 213616
Scheduled Inspection Date: June 05, 2014
Inspector: Devaney, Michael
Permit Number: EL -11 -13 -2613
Owner: MARCELO BORODOWSKI, AAM
Mgr 1 1 r
Job Address: 10659 NE 11 Avenue
Miami Shores, FL 33138-
Project: <NONE>
Contractor: RELIABLE ELECTRIC CORP
Permit Type: Electrical - Residential
Inspection Type: Final
Work Classification: Alteration
Phone Number (305)466 -4243
Parcel Number 1122320280320
Phone: (305)218 -8653
Building Department Comments
REPLACE RECEPTACLES
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 Comme,
/r
June 04, 2014
For Inspections please call: (305)762 -4949
Page 15 of 18
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) 762.4949
BUILDING
PERMIT APPLICATION
Permit Type: Electrical /�
JOB ADDRESS: lot 5� W C 1 ' y A-VE
RECEIVED
NOV 19 2013
BY
FBC 201,3
Permit No. E-L 4 3 —2')
Master Permit No.)2C.■ i3— 9,612_
City: Miami Shores County:
Folio/Parcel #: ` `- 2 2'2— 028 - 032 0
Miami Dade Zip: 3a( 38
Is the Building Historically Designated: Yes NO Flood Zone:
OWNER: Name (Fee Simple Titleholder): AA* 1l / / 57 l "r�✓ r £ Phone#:✓t✓ - 46e 42 '3 �, � 0 2
Address: 0701 NE 3o r7v
City: 'E?V I State: Zip: 3318®
Tenant/Lessee Name: N/A Phone#:
66-1—ocit £ LDVJ pc- L.OPE s-
Email:
CONTRACTOR: Company Name:
2EL V L E i.1. C ety49,
Phone #: 3®5- 218 -56.53
Address:
City: State: Zip: p
Qualifier Name: D --11V %� L '►D C R t U EP—ON Phone#: 3c6 -z i 8 - G� 65 3
State Certification or Registration #: — )3CC) /70 6 Certificate of Competency #:
Contact Phone #: 2_12 —26S 3
Email Address:
b y C D 'OtV/EU0P4 2S
DESIGNER: Architect/Engineer: Phone#:
Value of Work for this Permit: $ 2 ° °- Square/Linear Footage of Work:
Type of Work: ❑Address ❑Alteration ❑New ARepair/Replace ❑Demolition
Description of Work: P-c —' '
******** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** gees************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
_Ye :4 4T
Submittal Fee $ Permit Fee $ CCF $ CO /CC $
Scanning Fee $ Radon Fee $
Notary $ Training/Education Fee $
Double Fee $ Structural Review $
DBPR $ Bond $
Technology Fee $
TOTAL FEE NOW DUE $ / 891.
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
AVA
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 Al'1H'llAVIT: 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, 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 suc posted notice, the
inspection will not be pproved and a reinspec n fee will be charged.
Owner or Agent
The foregoing instrument was acknowledged before me this "l
day of 1aoik 2- , 20 1.'), by i 0
wjo is personally known to me or who has produced
As identification and who did take an oath.
NOTARY PUBLIC:
Sign: —__ -�, _ _, . • u A
OT
Print:�STt�t ®E018480 trit . :COnntssz
My Commission Expires: `'. "'``,c Ex Tres: AUG.18, 2014
BANDED p NTIC BONDL`IGCO.,INC.
�NpgD TEIRC A'CL'-
Signature
Contractor
The foregoing instrument was acknowledged before me thiiS
day of KO , 20 3, by 121- fki1taD 24tlr12 -®
who is personally known to me or who has produced
as identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
My Co
Gustavo Gomez
sion Commission # EE018480
%,,.«,,,•` Expires: AUG. 18, 2014
BONDED TFRI' ATLANT C BONDING Co.,INC.
•
1 Tt'i
********************* ****+ k**+ k*%+ N+ k** ******* *+ R***+ k**+kN*********M**** * *At*+ N*Be, A, k*********** ************+b****** **
/3
,/ a4'
APPROVED BY �!� // / /U /9/440/"Plans Examiner Zoning
Structural Review
(Revised 3 /12/2012)(Revised 07 /10 /07)(Revised 06/10/2009)(Revised 3/15/09)
Clerk
Miami Shores Vitiage
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
CONTRACTORS' REGISTRATION FORM
ALL CONTRACTORS MUST PROVIDE COPIES OF LICENCES AND INSURANCES EACH TIME A PERMIT IS
SUBMITTED OR THE VILLAGE MAY MAINTAIN A FILE WITH YOUR INFORMATION FOR A $30.00 FEE PER YEAR.
IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR:
A. COPY OF QUALIFIER'S STATE LIC CARD
B. COPY OF LOCAL BUSINESS TAX RECEIPT
C. COPY OF LIABILITY INSURANCE (CERTIFICATE HOLDER TO BE MIAMI SHORES VILLAGE BLDG DEPT)
D. COPY OF WORKERS COMPENSATION (EITHER CERTIFICATE OR EXCEMPTION)
IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY:
A. COPY OF CERTIFICE OF COMPETENCY OF QUALIFIER
B. COPY OF MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT
C. COPY OF LIABILITY INSURACE (CERTIFICATE HOLDER MUST BE MIAMI SHORES VILLAGE BLDG DEPT)
D. COPY OF WORKER COMP INSURANCE (EITHER CERTIFICATE OR EXEMPTION)
YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE HOLDER AS FOLLOW:
MIAMI SHORES VILLAGE BLDG DEPT
10050 NE 2ND AVE
MIAMI SHORES, FL 33138
COMPLETE CONTRACTOR'S INFORMATION
BUSINESS NAME: uA t. C. COIF
BUSINESS ADDRESS: Lks / / ?% CITY (.."(,)2/A .S(14
STATE Pi k ZIP CODE ,940 ® ��
BUSINESS PHONE: (?5) •' /Id ' s3 FAX NUMBER
PHONE ) ';r•% %�6 QUALIFIER'S NAME: Al Asl�O �t V ®IU
QUALIFIER'S LIC NUMBER: f®/
E -MAIL ADDRESS (IF APPLICABLE):
Created on 3119/09 BY MLDV 1 RV 3128109 MLDV
AQ# 6221J699
THIS DOCUMENT HAS A "COLORED BACKGROUND ,.MICROPRINTING • LINEMARK'" PAT,ENTED'PAPER
STATE OF FLORIDA
DEPARTMENT O BUSINESS AND PROFESSIONAL REGULATION
ELECTRICAL CONTRACTORS LICENSING BOARD
DATE BATCH NUMBER
LICENSE NBR
07/20/2012 12.6001029 EC13001785
The ELECTRICAL CONTRACTOR
Named below IS CERTIFIED
Under the provisions of Chapter 489 FS.
Expiration date: AUG 31, 2014
RIVERON, REINALDO.
RELIABLE ELECTRIC' CORP
1701 99TH AVENUE
RAM `
FL 33025
RICK SCOTT
GOVERNOR
DISPLAY AS REQUIRED BY LAW
SEQ# L1207200105E
KEN LAWSON
SECRETARY
115 S. Andrews Ave., Rm. A -100, Ft. Lauderdale, FL 33301 -1895 — 954 - 831 -4000
VALID OCTOBER 1, 2013 THROUGH SEPTEMBER 30, 2014
Receipt #:ELECTRISCAL /ALARMS /CO TOR
Business Type: (ELECTRICAL CONTRACTOR)
DBA:
Business Name: RELIABLE ELECTRIC CORP
Owner Name: REINALDO RIVERON Business Opened:11 /17/2011
Business Location: 1701 SW 99 AVE State /County /Cert/Reg:EC13001786
MIRAMAR Exemption Code:
Business Phone: 305- 218 -8653
Rooms
Seats
Employees
3
Machines Professionals
For Vending Business Only
•
Vending Type:
Tax Amount
- - - - - -- -- - - - --
Transfer Fee
- - - - - -
NSF Fee
Penalty
Prior Years
Collection Cost
Total Paid
27.00
0.00
0.00
0.00
0.00
0.00
27.00
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 local laws and regulations.
Mailing Address:
RELIABLE ELECTRIC CORP
1701 SW 99 AVE
MIRAMAR, FL 33025
Receipt #02B -12- 00002086
Paid 09/23/2013 27.00
11- 18 -'13 11:53 FROM -ROYAL CARIBBEAN INS. 3056421087 T -514 P0001/0001 F -403
e CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY)
1/4..�
11/18/2013
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 ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(iess 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 CONL
NAME• LAYDA TUNON
ROYAL CARIBBEAN INS. AGENCY II, CORP
1772 WEST FLAGLER STREET
MIAMI, FL 33135
RIgN,E, - pit 305-642-4541
E-MAIL t LT UNONROYALII2{cGMAIL.COM
1 gin%- nail 305- 6421087
INSURERS AFFORDING COVERAGE
NATO C
INSURFA
RELIABLE ELECTRIC CORP.
1701 SW 99 AVENUE
MIRAMAR, FLORIDA 33025
INSURER A: CAPACITY INSURANCE COMPANY
INSURER B :ASCENDANT INSURANCE COMPANY
INSURER 0 I
INSURER D :
COVERAGES
INSURERS :
INSURER F 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 OFt 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
ADDL
INSR
SUBR
wvo
POLICY NUMBER
POLLICYEFF
IMMED/YYYY)
pONII
IMy i�.
07/23/2014
Limn
A
GENERAL
X
LIABILITY
COMMERCIAL GEN£RALLIABILITY
ICLAIMS-MADE X OCCUR
CLM01002934A
07/23/2013
EACH OCCURRENCE
$ 1 000 000.00
PREMISES .t£X
100,000.00
MEO EXP Om one person)
$ 5 000.00
PERSONAL & AOV INJURY
$ 1,000,000.00
GENERAL AGGREGATE
$ 2,000,000.00
Gam AGGREGATE. LIMIT APPLES PER:
—1 POLICY —I !Pk I 1 LOC
PRODUJ TS - COMP/OP AGO
S 1.000,000,00
$
AUTOMOBILE
_
ANY AUTO
OWNED
AUTOS
NIREOAUTOS
AUTOS SCHEDULED
AUTOS
RIVEUtGIN6''''Mm
$
BODILY INJURY (Per person)
I
BODILY INJURY (Per accident)
$
(per (perseerdeso)AMAOE
$
$
w--.
UMBRELLA LIAR
EXCESS WAS
OCCUR
CLAIMS-DE
EACH OCCURRENCE
$
AGGREGATE
S
CEO I { RETENT ON $
$
B
WORKER$COMFEN$M10N
AND EMPLOYERS' LIABILITY Y/ N
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFF(CERIMEMBER EXCLUDED,
(Mya�mamary pIn� NH)
DESCRON OF OPERATIONS how
N /A
WC`62258-3
07/23/2013
07/23/2014
STATIh II II.
T(SItV 1 IMIT3 IFR
EL EACH ACCIDENT
$ 100,000.00
E.L. DISEASE • EA EMPLOYEE
I ' 0Q 000.00
E.L. DISEASE - POLICY LIMIT
5 500,000.00
DESCRIPTION OF OPERATION& / LOCATIONS I VEHICLES (Attach ACORD 101, AddItlonal Remarks Schedule if mare space IS mqulreH)
ELECTRIC CONTRACTOR.
•
•
l- COriCI,', A r6' un, nm,. - -
LATION
MIAMI SHORES VILLAGE
BUIDLING DEPARTMENT
10050 NE 2 AVENUE
MIAMI SHORES, FL 33138
FAX 305 - 758 -8972
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH r _ . _ -; • UCY PROVISIONS.
® s 88 -2010 ACORD CORPORATION. All rights reserved.
ACORD 25 (2010/05) The ACORD name and loco are registered marks of ACORD