EL-13-2583\,\,\Vil\\3
UsN)5
BUILDING
Miami Shores Village
Building Department
10050 N.E.2nd Avenue. Miami Shores. Florida 33 138
Tel: (305) 795.2204 Fax: ( 3(5) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949
TED
NOV 14 2013
FBC 20
Permit No. c% 13 -09.r. 3
PERMIT APPLICATION Master Permit No. R C - / 3 --,e7? 7
Permit Type: Electrical
JOB ADDRESS: /2 S it! E /06,
City: Mini i Shores
County:
Miami Dade Zip: 33/ 3 e
Folio/Pareel #:
Is the Building Historically Designated: Yes
NO Flood Zone:
OWNER: Name (Fee Simple Titleholder): 'f/ ,t.t QUE,/4 4 Phone #:
Address:
City: State: Zip:
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name:/�f�e %J (LA.)
eet � _ ..7.---h-e.- Phone #: _> . 6 %�-r
Address: 371 / -2 Lt/ lb o et .
City: S. {ti3 N State: �� Zip: ..3 3f
Qualifier Name: N-t,s (f?/tu 4- 4(o s•4ois Phone #: 7�d —/e i/ro
State Certification or Registration #: .%3OO 24, 6, PI Certificate of Competency #:
Contact Phone #: 7k39,g c41/0 j- Email Address:
DESIGNER: Architect/Engineer: Phone: #:
Value of Work for this Permit: $(3190 0 D Square/Linear Footage of Work:
Type of Work: DAddress DAlteration New DRepair/Replace DDemolition
Descrl tion of Work: /ev..a.i Act ■teCet, ec J' ,/t. C4 /,: 711 4A-c/
******04,0******** **** 'u'V*+'? *** *sg+ .6***o4**F es*W +i********w*** *** pr3W Nr0*p **t9 **Y+H+**s:+NaJa*'u** ***
Submittal Fee $ S '0 Permit Fee $ i'z''‘'.4ePe- CCF $ CO /CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/FAlucation Fee $ Technology Fee $
Double Fee $ Structural Review $
TOTAL FEE NOW DUE $ (7 Vz5C
, 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 he perlormed to meet the Stan dands of all laws regulating
construction in this jurisdiction. I understand that a separate permit must he secured for ELECTRICAL WORK. PLUMBING. SIGNS.
WELLS, P(X)LS. FURNACES. BOILERS. HEATERS. TANKS and AIR CONDITIONERS. ETC
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate inn that all work will he 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 mmniencement and amstruction 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 Signature
Owner or Agent Contractor
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
/
day of ?() . by day of . 20 1 by erui'PIzi4'o 4 !0`TQiliC� a
who is personally known to me or who has produced who iswrsot y known to me )r who has produced
As identification and who did take an oath. as identification and who did take an oath.
NOTARY PUBLIC:
NOTARY PUBLIC:
Sign: Sign:
Print: Print:
My Commission Expires: My Commis
mtme o,,momUq,UWmDo* ***ipt,omm3.6'e0** y5*f3u3** * ****Wd **e...0** } *** tG+ Y# t******%7 #**fj#i✓7N1Ydf?***RymS
APPROVED BY ! !'��1/ /h/ Plans Examiner Zoning
i
F ►�h
• CARLOS P. BLANCO
�•�' MY COMMISSION #FF033427
(� . cgs N(pR�•' p
in
3+�r s6rsrxJjKj
( ) 39e -0153 Ftortdallotayser tce.conn
Structural Review Clerk
(Revised 3 /l2/20121(Revised 07 /10/07)(Revised 06/ 10F2009)(Revised 3115/09:1
8701 W SUNRISE BOULEVARD
LORI PARRISN
http : / /www.bcpa.net/Reclnfo.asp ?URL Folio=494132190010
•
Nov 08 2013 2:43PM HP LASERJET FAX
i3
p.2
tom` CERTIFICATE OF LIABILITY INSURANCE
m
DATEIMN/DDIYYIrY)
11/48/13
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 SY THE POUCIES
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 tote holder is an ADDITIONAL INSURED, the pollcy(les) must be endorsed. If SUBROGATION IS WANED, subject to
the terms and conditions of the policy, certain policies may require an endorsement A statement en this certificate does not confer rights to the
certificate holder In lieu of such endoreement(s).
PRODUCER
US -1 Insurance
9806 S. Dbtie Hwy.
Miami, FL 33156
Phone (306)870 -1422 Fax (306)670-0013
�
Mar YOANYS ARMAS
D. seal: (305)670 -1422 1 ca c. Not: (305)670-0013
ADDRESS: uslinsurancen80602t attnei
INSURER'S) AFFORDING COVERAGE
NAIL 0
INg A: GRANADA INSURANCE COMPANY
INSURED
BIONIC PLUMBING CORP
8011 SW 90 Ct
MIAMI, FL 33173• (305) 299-9741
INSURER H :
11l09f2013
INSURER 0:
EACH OCCURRENCE
INSURER D :
•
INSURER E :
$ 5,000.00
•
I NSUJRER F :
$ 1,000,000.00
COVERAGES
CERTIFICATE NUMBER:
REVISION NUM
THIS IS TO CERTIFY THAT THE POUCIES QF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED MOVE FOR THE POUCY PERIOD
INDICATED. NO1WITHSTANDING ANY REQUIRE LENT; 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,
EXCLUS1ONSAND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED SY�� PAID
I
TYPE OF INSURANCE
INNOR
WVD
POUCY NUMBER
/dM Di rn
ppCL�L�AIIMS.
/WYUD `D/ %
LIMITS
A
GENERAL UMW!,
❑ COMMERCIAL GENERAL LlABILkTY
• ❑ clAIMS BADE • OCCUR
T 3500 •
01135FL000040776
11l09f2013
11/09/2014
EACH OCCURRENCE
$ 1,000,000.00
$
SAES It RENTED
Me occurrence
MED EXP (Any one pennon)
$ 5,000.00
PERSONAL & ADV INJURY
$ 1,000,000.00
❑
GENERAL AGGREGATE
$ 2,000,000.00
' S 2,000,000.00
OEN'L AGGREGATEppUp�M�I�('APPLIES PER
El POLICY POLICY • i• Loc
PRODUCTS - COMP/OP AG G
S
AUTOMOBILE LIABILITY
Q pAN�Y Aura
• TO N ED [] LED
AU
■ HIRED AUTOS If s fdED
❑ ■
bIEU INGLE LIMIT
BODILY INJURY (Per person)
$
BODILY INJURY (Per aeotderg
S
Tyr aoMEeirwrilAGE
a
a
❑ ll1NBAELLA'JAB 0 OCCUR
• eXCE118 LIAB • CLAIMS-MADE
EACH OCCURRENCE
$
AGGREGATE
$
❑ DED ❑ RETEN1ION$
$
WORKERS
AND I LOYE S' LIABRITY Y / N
ANY PROPRIE ISRTNERIEXECUTNE
N l A
❑ lillifRiTaITAYIN ❑ ORTH.
EL. EACH ACCIDENT
$
EXCLUDED?
rgandalary le NM
EL DISEASE - EAEMPLOYEE
$
fie,
DF.tMGRIR f OPEiATIONB below
EL DISEASE - POLICY MT
$
•
DESCRIPTION OF OPERATIONS / LOCATIONS / VENICLES
OL CO', MER CAL / RESIDENTIAL
(Attaeh ACORD 101, Additional Remade Schedule, If more space B mquUsd)
CANCELLATION
MIAMI SHORES VILLAGE
10050 NE 2 AVE
MIAMI SHORES , FL 33138
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVER Ili
ACCORDANCE WITH THE POLICY PROVISI •
AUTHORIZED REPRESENTATIVE
ACORD 25 (2010105) OF
el 1988-2010 ACO v'%" . ON. All rights reserved.
The ACORD name logo are r.; tee marks of ACORD
gc /3- P.74
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 203084 Permit Number: EL -11 -13 -2583
Scheduled Inspection Date: March 17, 2014
Inspector: Devaney, Michael
Owner: QUESADA, HUMBERTO
Job Address: 125 NE 106 Street
Miami Shores, FL 33138 -2036
Project: <NONE>
Contractor: KLEAN POWER ELECTRIC INC
Permit Type: Electrical - Residential
Inspection Type: Final
Work Classification: Addition /Alteration
Phone Number
Parcel Number 1121360060350
Building Department Comments
LOW VOLTAGE RUNNING NEW WIRES FOR CABLE TV
AND PHONE
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.
Inspector C • ents
Sim
Mfrfi--29,E
March 14, 2014
For Inspections please call: (305)762 -4949
Page 7 of 24