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EL-14-258Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-207006 Permit Number: EL -2-14-258 Scheduled Inspection Date: May 21, 2014 Permit Type: Electrical - Residential Inspector: Devaney, Michael Inspection Type: Final Owner: DENNIS LEYVA, CLARK REYNOLDS Work Classification: Pool - Private Job Address: 69 NE 102 Street Miami Shores, FL 33138 - Project: <NONE> Phone Number Parcel Number 1132060131680 Contractor: ELECTRICAL MASTERS INC Phone: 305-265-7996 comments ELECTRICAL ROUGH POOL INSPECTOR COMMENTS False Inspector Comments Passed Failed c �� Correction ❑ Needed Re -Inspection Fee No Additional Inspections can be scheduled until re -inspection fee is paid. May 20, 2014 For Inspections please call: (305)762-4949 Page 6 of 30 Miami Shores VillagWt- BuildTel: ing Departmen10050 N.E.2nd Avenue, Miami Shores, Florida 33 (305) 795.2204 Fax: (305) 756.8972 ­- �,Al,S-I'm✓ INSPECTION'S PHONE NUMBER: (305) 762.49 FBC ZO BUILDING Permit No. 5�L 2 �® PERMIT APPLICATION Master Permit N —�4 _ Permit Type: Electrical — JOB ADDRESS: )J E/ Q Z s t City: Miami Shores County: Miami Dade 4p: 3 313 9 Folio/Parcelt ( I - 35 2-0 G - ®13 - Ili 8 O Is the Building Historically Designated: Yes NO Flood Zone: OWNER: Name (Fee Simple Titleholder): G l sz t� "aey ru�l �3-D2,ln, s Phone#: Address: r,"3 Oe ? O � f City: State: E- Zip: 3 313 g Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: �iec�''�� `�'� Sys �'`� Phone#: X86 -3 81 �? 1`1r - CONTRACTOR: 8 44.5 0 € -X Aire. City: + , — .rte; State: -To— zip: '3-:) t 3 a Qualifier Name: 06.444I� I Phone#: -296-392 929 4 State Certification or Registration #: c. 2 dlCl c 3 D 57 Certificate of Competency #: Contact Phone#:'28C -3 8 Z 8 2-994, Email Address: DESIGNER: Architect/Engineer: PP-- 6.253 ► Phone#: 5D5 3 -os X63 t Value of Work for this Permit: $ Z. 5dnc!,, = Square/Linear Footage of Work: Type of Wdkk ' ❑Address ❑Alteration 0Kew ❑Repair/Replace ❑Demolition Descriptioitof. Work:,�� Submittal Fee Scanning Fee $ Fee $ 14 o" &zq CCF $ CO/CC $ Radon Fee $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ DBPR $ Bond $ Technology Fee $ TOTAL FEE NOW DUE $ 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 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 issued. In the absence of such posted notice, the inspection will not b proved a reinspection fee will be charged. Signature 1�1Signature wrier r Agent Contractor The foregoing instrument was ac o ledg`edbe ore me this / day of � , 20, by (� who is person Iv own to me or who has produced As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: )Maat lr)N # FF T-80 "XPIRES: May 15. 0J I My Commission p'y� ����y P°A i"0B The foregoing instrument was acknowledged befo� me this day of ate. ,Ian , 20 by ' �(( �G who is personally known to me or who has produced as identification and who did take an oath. APPROVED BY �Z' f/ �� Plans Examiner Structural Review (Revised 3/12/2012)(Revised (Y7/10/07)(Revised 06/10=09)(Revised 3/15/09) NOTARY PUBLIC: Zoning Clerk I% Miami shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 00ITRACTt RS' REGISTRATION Fax: (305) 756.8972 ALL CONTRACTORS MUST PROVIDE COPIES OF LICENCES AND INSURANCES EACH TIME A PERMIT IS SUBMITTED. IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: A. COPY OF QUALIFIER'S STATE LICENCES 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 JEITHER CERTIFICATE OR EXCEMPTION) IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY: A. COPY OF CERTIFICE OF COMPETENCY OF QUALIFIER B. COPY OF LOCAL BUSINESS TAX RECEIPT 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 WORKERS COMP INSURANCE (EITHER CERTIFICATE OR EXEMPTION) Y UR 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: ( rtll,=k _-_.-Re.r.S 1SINESS ADDRESS: 944-5 Of CITY 'E ___11 T- ZIP CODE . 3 313 8 'SS PHONE: I SC } 3& -a 8 a 94 FAX NUMBER ( -39:)S ) 6®3 Iqb61 'INE [_ QUALIFIER'S NAME: 06vtQ18o S LIC NUMBER: E P_ 00 13 ® -5 7 'SS (IF APPLICABLE): OV I RV YAM MLOV 1 RV 6W111 AS STATE OF FLORIDA ,z DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD 1940 NORTH MONROE STREET we TALLAHASSEE FL 32399-0783 RODRIGUEZ, OSVALDO ELECTRICAL MASTERS 8400 SW 14TH ST MIAMI INC FL 33144 Congratulationsl With this license you become one of the nearly one million Floridians licensed by the Department of Business and Professional Regulation. Our professionals and businesses range from architects to yacht brokers, from boxers to barbeque restaurants, and they keep Florida's economy strong. Every day we work to improve the way we do business in order to serve you better. For information about our services, please log onto www.myfloridalicense.com. There you can find more information about our divisions and the regulations that impact you, subscribe to department newsletters and learn more about the Department's initiatives. Our mission at the Department is: License Efficiently, Regulate Fairly. We constantly strive to serve you better so that you can serve your customers. Thank you for doing business in Florida, and congratulations on your new license! L DETACH HERE (850) 487-1395 STATE 06 FLORIDA AC# 6 3 3 5 6 4 7 DEPARTMENT. OF BUSINESS AN!) PROFESSIONAL kE(;ULATION ER0013057' '­'` _1 2 127009317 RBG SLECTRkCAL CONTACTOR. R0DRIGIIB Y C1' iiA iD. f $LECTRICAL D3�1'STBR�C UNDIVID ..ALS 14L1ST M AI+ 1. LOCAL LICENSINQ IS PRIOR iiffi+IBNT TO CONTRACT' ,.iN ANY AREA) HAS, REGISMM.:uudit thegroviaioas.of,eh.489 241i;tioa date:' AUq 31,x;' 2Q14 L120904'02'T06 kC#::63-3-564T1. STATE OF FLORIDA; DLPARTMENT-*OF' BUSINESS AND PROFESSIONAL REGULATION• E.LECTRICAL:CONTRACTORS LICENSING BOARD SEW L12090402106 LICHNSE NB1t k 0Z Z 09 04 2012: 127009317 E1001305fijw�' K • The ELECTRICAL CONTRACTOR ' Names* below HAS REGISTERED - _ - Under the` provisions of Chapter• Expiration date: AUG 31, 2014,r Y ,' ( INDIVIDUAL MUST` MELT ALL LOC'. LICEIISINd REQUIREMENTS PRIOR, TO CONTRACTING IN` ANYr`ARE1} ; RODRIGUEZ OSVALDO :�- ELECTRICAL MASTERS INC 4, 8445 NE 2 AVE MIAMI.„ FL 33138 RICK SCOTT GOVERNOR DISPLAY AS REQUIRED BY LAW REN LAWSON SECRETARY U.S. POA90TA06 MIAMI PL PERMIT ISO: 239 THIS IS NOT A SILL -• DO NOT PAY RECEIPT 140. 30"3857902 CC NO t 97EO00003 BUSINESS NAME J L®CATION RECEIPT HOLDIM MAY DO I ELECTRICAL MASTERS INC BUSINESSASACONTRACTOR I 8400 SW 14 ST AS $I'I"GIPIG'D HEREON. I OWNER :ELECTRICAL MASTERS INC SEE -WAC OF RECEIPT FOR ELECTRICAL CONTRACTOR A LIST OF NON -PARTICIPATING MUNICIPALITIES Rooelpt holder must DO NOT FORWARD roglstorInthedty ELECTRICAL MASTERS INC whero wodt is to bo OSVALDO RODRIGUEZ SR PRES done. 0400 SW 14 ST MIAMI FL 33244 PAYIMW nUMM { Cow VAK/ 7 12 02270023002 000200.00 :M A, p,�COUNTY Mitt . FEpl.. OP EST. 111f1tttiltttllititfill 111111tit1111ttit1llftti1t1111t1 ill 121 W12 CAL SUSINBS9 TAX RECEIPT 2093 FIRST CLASS MI AM AAB COUi*TY -STATE OR FLORIDA U,S. POSTAGE � , EXpIRKS KEPT, so 3099 MST pt0>�LAYED� AT L�I:AfaB OF BUSINESS PAID MIAMI, FL C!URI3UANT Y COUNTY OOD6 CIiAPTI9R SA - AF4T. ®& 90 PERMIT NO. 231 THIS Ig NOT A BILL - DO NOT PAY 369307-5 RENEWAL BUSINESS NAM ILOCATION 1 RECEIPT NO. 305790-2 ELECTRICAL MASTERS INC CC 8 97E000003 8400 SW 14 ST 33244 UNIN DADE COUNTY OWNER ELECTRICAL MASTERS INC CAL CONTRACTOR M °ot °nr rax 09/17/201;?,. WORKER/S 00 NOT FORWARD r ELECiRICAL MASTERS INC OSVALIDO RODRIQUEZ SR PRES 8400 -SW 14 ST MIAM4 FL 33144 111111111111110111Jill III 1111,111111111111111111t111IJIlltl CIP ID: TC AGCl1R 7' t,,,_,..... CERTIFICATE OF LIABILITY INSURANCE �ATE(tnMrDwYYYY) 10/0212013 THIS CERTIFICATE IS ISSUED AS A (MATTER OF INFORMATION ONLY AND CONFERS NO RJGM73 UPON THE CERTIFICATE H)LDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED 13Y 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: N the certificate holder is an ADDITIONAL INSURED, the policy(les) mug be endorsed, h SUBROGATION IS WAIVED. subject to the tens and conditions of the policy, certain pollolss may require an endorsement. A statement on this certificate does not confer fights to the certificate holder in lieu of such endommen s . PRODUCER ISurs Insurance Brokers 2700 SW 137 AVE Munni, FL 33175 Tenses R. Cerm*no, Agent C NAMMTACT ES fA% PIIONE Re , mo, 84h EPic- MAIL _ P' Rode ELECT -1 _ INSURE AFFORDINQ COVERAGE MAIC R INSURED ectrR_a 8tsf8 Ind. 8400 SW 14TH Street Miami, FL 33144 RER Flodd8 Citrus, Business FU9 ROURER B:Travelers Pro Cas.Co. INBURERC:Pr rssslive EXprese Ine.00 ONIURER D: EMI ES Ea o rent TU KM I W $ 100,0 04 INSURER E : X COMMERCIAL GENERAL ILABILffY CLAIMS -MADE FlOCCUR INSURER F: e�.r.n.re w,uvew. WWWM. n M"Mme .c: 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 CLAIM$. L TYPE OF IN9URArICE IMUL Equey N MSER P UMTS GENERAL LIABILITY EACH OCCURRENCE S 1,000,0001 EMI ES Ea o rent TU KM I W $ 100,0 04 8 X COMMERCIAL GENERAL ILABILffY CLAIMS -MADE FlOCCUR 88"A8483B4 10/0912019 10/09/2014 MED Elft/ viv are Perm) S 5.0 00 PERSORAL a AoV I NARY s 1.000-900 BLANKET ADD'L INSURED J( GENERAL AGGREGATE s 2,000,000 GEN'(. AGGREGATE LIMY APPLIES PER: PRODUCTS - COMPIOP AGO $ 2,000,0 00 $ POLICY M wf F7 LOC AVTOMOD" LSAWLITY ANY AUTO 02353502-0 08/1212013 0811212014 CO eBINED SINGLE LIMIT S 1,000,000 BODILY INJURY (Per Person) S ALL OWWl9EDAUTO$ BODILYKuw(PN:rrtaiderd) E C X SCHEDULED AUTOS HIRED AUTO$ NO"WMNEOAIIfOS PROPERTY DAMAGE 4 (PER ACCIOF-NT) PIP S 10,0 S UMBRELLA LIAR SUR EACH OCCURRENCE S AGGREOATE S EXCESS LIAR CLAtNS MAGE DEDUCTIBLE S S X VMC STA O - RETENTION E L EACH ACCCENT 9 1,000,00 A AND EMPLOVERS'L.IAEIL.T,r ,(y ANY PROPRIETOWARTNERJEXEWTIVB � OfRtCERMEMBER EXCLUDED? (MlmldatolY In NH) D 9f:RiPft01lOFOPERATt SbeLav MIA 10W003s 04/OU2013 04i01no1a E.L. DISEASE - LFA EMPLOYE S 1,000.00 E.LDISEAS-POLICY S DE$CRLPTION OP OPEIOATIONS I LOCATIONS r VMNLCLES (ARaeh ACORD 101, Addl ID" R&RUM Saw". Moate epee* a regw"M Slectrioal Contractor City of Miami Shores . Fax:= -758-8972 10050 NE 2 Ave Miami, FL 33138. ACORD 25 (2009/09) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORRED REPRF6ENTAIIVE&74r&14A--- 01999-2009 The ACORD name a'nd logo ars registered marks M ACORD All rights reserved.