EL-14-900Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-217194
Scheduled Inspection Date: August 05, 2014
Inspector: Devaney, Michael
Owner: BLANCO, JUAN
Job Address: 146 NW 92 Street
Miami Shores, FL 33150 -
Project: <NONE>
Contractor:
MV ELECTRICAL SERVICES
ouuumg uepainment L omments
ELECTRICAL FOR KITCHEN AND 2 BATHROOMS
Permit Number: EL -5-14-900
Permit Type: Electrical - Residential
Inspection Type: Final
Work Classification: Alteration
Phone Number
Parcel Number
INSPECTOR COMMENTS False
Inspector Comments
Passed
Failed
Correction
Needed
Re -Inspection ❑
Fee
No Additional Inspections can be scheduled until
re -inspection fee is paid.
1131010160010
Phone: (305)216-0677
August 04, 2014 For Inspections please call: (305)762-4949 Page 30 of 32
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: (345) 762.4949
BUILDING
PERMIT APPLICATION
Permit Type: Electrical
JOB ADDRESS: 'f-- I
City: Miami Sh
Folio/Parcel#:
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- V/ W -
County:
c EIVE
MAY A 1114
BY: —
FB020 0
Permit No. L"00
Master Permit No.
Is the Building Historically Designated: Yes NO Flood Zone:
OWNER: Name (FeeSimpleeT,it'leb
Address: W
Citre- (A 04A
TenantiLessee Name`t,
Emails4 TU a n Ina r
CONTRACTOR: Company Name:
Address: / A) 6k
City: �qf a 1'(;'CeA
Qualifier Name: /( C
�W.411
State: TL Zip:
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State Certification or Registration #: �' /®05((f0 � � 0Certificate of Competency #:
Contact Phone#: %/ ,'�' l ®6 7 7 Email Address: ?ja ®6 ®��%�� 01
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DESIGNER: Architect/Engineer: Phone#:
Value of Work for this Permit: $ 19ho Square/Linear
of Work:
Submittal Feer=:z " Permit Fee$�',s % o�,� CCF $ CO/CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $ Technology Fee $
Double Fee $ Structural Review $
TOTAL FEE NOW DUE $)- f�
Bonding Company's Name (if applicable)
Bonding Company's Address
City
State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City
State
zip
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 must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issW. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged 1A I
Signature
O Owner or Agent
The foregoing instrument was ackqowledged before me Is
day of , 201, by domArms. (7 G[I L ® ,
who ' y kno me or who has produced
As identification and who did take an oath.
NOTARY PUBLIC:
11 �_ tom l � � •
Bill I
Contractor
The foregoing ' trument was acknowledged before 's �®
day of 4 t !20 Zk,-by Q 1
who is personally known�t me or who has produced
as identification and who did take an oath.
NOTARY PUBLIC:
Plans Examiner
Structural Review
(Revised 3/12/2D12)(Revised 07/10/07)(Revised 0611QrAW)(ReviW 3/15/09)
Sign: F=
io
Print:
My commissi� S: Apt6 6, 2016
QR Nay soon
Zoning
Clerk
STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND
�4% l' PROFESSIONAL. REGULATION
EC13005608 ISSUED: 08/26/2013
CERTIFIED ELECTRICAL CONTRACTOR
VALDES, MARIO.A
M V ELECTRICAL' .SERVICES INC
IS CERTIFIED under. the provisions of Ch.489 FS.
ExpMcgdWe : AUG 31, 2014 L13092600MM
A60Mal CERTIFICATE OF LIABILITY INSURANCEDATB(MMIDDl"M
05/0212014
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 pollcy(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 endomeme s).
PROWASR
CONTACT
NAME: ESTHER VIDAL
MUTUAL INTEREST ASSURANCE
E 305-860-2003 No :305-860-0907
1295 CORAL WAY
AW-WE4=L ;MUTUALA OL.COM
SUITE 3
MIAMI, FL 33145
INSU AFFORDING COVERAGE HMO
INSURERA;ASCENDANT UNDERWRITERS
D
M.V. ELECTRICAL SERVICES, INC
E1summ e: CASTLEPOINT FLORIDA INSURANCE CO.
INSURERC:
INSURERD:
18311 NW 82ND COURT
PRODUCTS -COMPIOPAGG s 11000,000
MIAMI, FL 33015
INSURERS:
AUTOMOEILELIABIUTY
ANY AUTO
ALL OWNED
AUTOS AUTOS�ED
MREDAUTOS AUTOSWNEO
INSURSR F I
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
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 POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
I TRR
TYPE OF INSURANCE
THE EXPIRATION DATE THEREOF OTIC WILL BE DELIVERED IN
MIAMI SHORE VILLAGE
POLICYNUAMM
POLICY EFF
E71P
auTNOR¢EDREPRESENrarnE ,
A
GENERALIJA LITY
X COMMERCIAL GENERAL LIABILITY
CLAIMSaIEADE OCCUR
GL/33643-4
3/201309/2312014
EAcHocmmtmcE $ 1000000
MENSES (FS ACM0119MI $ 100,000
MED EXP (Any one ) $ 5,000
PERSONAL 8 ADV INJURY S 1,000,000
GENERALAGGREGATE $ 1,000,000
GEWL AGGREGATE LIMIT APPLIES PER:
POLICY 7MET F-1 LOC
PRODUCTS -COMPIOPAGG s 11000,000
S
AUTOMOEILELIABIUTY
ANY AUTO
ALL OWNED
AUTOS AUTOS�ED
MREDAUTOS AUTOSWNEO
don:5
BODILY INJURY (Paz person) S
BODILY INJURY (Per awds" S
PROPERTY AG $
S
UMBRELLA LIAR
EXCESS UAB
HOCCUR
CLAIMS -MADE
EACH OCCURRENCE S
AGGREGATE $
DED I I RETENTIONS
S
B
I"o MnoN
AND EMPLOYERS' LIABILITY
ANY PROPRIETORIPARMRMXECUTNE YIN
OFFICERIMEMSER EXCLUDED?
(Maeda w In NH)
If yyea. desalbe unit
DESfAiIPTION OF OPERATIONS below
N I A
WCP761465700
101111201310/11/2014
""� srnn! OTH-
E.L. EACH ACCIDENT $ 100,000
E.L. DISEASE - EA EMPLOYEE $ 100,000
E.L DISEASE - POUCY LIMIT S 500,000
:E
-F
DESCRIPTION OF OPERATIONS! LOCATIONS I VERICLES OUNh ACORD 101, AdMomd Remarlm SohedWe. N more apace Is nw:dred)
ELECTRICAL WORK
n0M'n01^A'M Unl nre f1ANf:I:I I A nnN
(E1 1955-20 Y AGOKU 6UKMUKA I IUM. An ngntS reServeg.
ACORD 25 (20101051 The ACORD name and loco are reaistered marks of ACORD
SHOULD ANY OF THE ABOVE DESCRIVED PO BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF OTIC WILL BE DELIVERED IN
MIAMI SHORE VILLAGE
ACCORDANCE WITH THE POLICY P NS
10050 NE 2ND AVE
auTNOR¢EDREPRESENrarnE ,
MIAMI SHORES VILLAGE, FL 33138
(E1 1955-20 Y AGOKU 6UKMUKA I IUM. An ngntS reServeg.
ACORD 25 (20101051 The ACORD name and loco are reaistered marks of ACORD