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EL-14-293Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-214690 Scheduled Inspection Date: June 25, 2014 Inspector: Devaney, Michael Owner: BECERRA, JACQUELINE Job Address: 401 NE 94 Street Miami Shores, FL 33138 - Project: <NONE> Permit Number: EL -2-14-293 Permit Type: Electrical - Residential Inspection Type: Final Work Classification: Alteration Phone Number Parcel Number 1132060140480 Contractor: ATLANTIS ELECTRICAL CORP Phone: (305) 551-4043 sunamg uepartment comments BATHROOM REMODEL REMOVE AND REPLACE Infractio Passed Comments INSPECTOR COMMENTS False Inspector Comments Passed EZ- Failed Correction '2 l Needed Re -Inspection ❑ Fee No Additional Inspections can be scheduled until re -inspection fee is paid. June 24, 2014 For Inspections please call: (305)762-4949 Page 20 of 35 ATLEL-1 OP ID: MA CERTIFICATE OF LIABILITY INSURANCE INYYY) DATE (M02/24/1 1 TYPE OF INSURANCE 02/224/14/1 4 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 policypes) 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 305-262-0086 BUTLER, BUCKLEY, DEETS INC. 6161 BLUE LAGOON DR., STE 420 MarianFL Gonzalez CONAa"E MARIANA GONZALEZ PNC No • 766-216-1778 21 Nol: 305-262-0187 E-MAIL MARIANA@BBDINS.COM INSURERS AFFORDING COVERAGE NAIC # MIAMI SHORES, FL 33138 INSURER A: FLORIDA CITRUS, BUSINESS & 02/10/14 INSURED ATLANTIS ELECTRICAL CORP. 12803 SW 20TH TERRACE INSURER B:WESCOINSURANCE COMPANY PAMAGE REMISES a oxunTO T $ 100,000 MIAMI, FL 33175 INSURER C: INSURER 0: GENERAL AGGREGATE $ 2,000,00 INSURER E: PRODUCTS - COMP/OP AGO $ 2,000,000 INSURER F: COVERAGES CERTIFICATE NIIMRFR- Rr-VISIAN NIIMRFR- 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. INSR LTR TYPE OF INSURANCE RODL SUOR POLICY NUMBER POLICY EFF M D POLICY EXP M D LIMITS B GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE FKOCCUR AUTHORIZED REPRESENTATIVE MIAMI SHORES, FL 33138 WPP1138623 00 02/10/14 02/10/15 EACH OCCURRENCE $ 1,000,00 PAMAGE REMISES a oxunTO T $ 100,000 MED EXP (Any one person) $ 5,00 PERSONAL & ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY PRO- LOC PRODUCTS - COMP/OP AGO $ 2,000,000 $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNEDSCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS COMBINED SINGLE LIMIT Ea accident BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ UMBRELLA LIAR EXCESS LIAS HOCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED I I RETENTION $ A WORKERS COMPENSATIONX AND EMPLOYERS' UABIUTY ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A 106-50846 10/30/13 10/30/14 WC STATT X ER IT E.L. EACH ACCIDENT $ 500,00 E.L. DISEASE - EA EMPLOYEE $ 500,00 E.L. DISEASE - POLICY LIMIT $ 500,00 DESCRIPTION ELECTRICAL CONTRA 1 LOCATIONS O / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, n more space la required) CERTIFICATE HOLDER CANCELLATION MIASHVI SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE VILLAGE OF MIAMI SHORES THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. BUILDING & ZONING 10050 N E 2 AVE. AUTHORIZED REPRESENTATIVE MIAMI SHORES, FL 33138 rr� 'Z D Q @ 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD ATLEL-1 OP ID: MA '44 R"r CERTIFICATE OF LIABILITY INSURANCE DATE(M1� 02/224/14/1 YY4 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 pollcypes) 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). PRODUCERCONTACT BUTLER, BUCKLEY, DEETS INC. 305.262-0086 6161 BLUE LAGOON DR., STE 420 MIAMI, FL Gonzalez Mariana Gonzalez NAME MARIANA GONZALEZ PHCNN0 Ext ; 786-216-1778 N, :305-262-0187 E-MAIL MARIANAQa BBDINS.COM INSURERS AFFORDING COVERAGE NAIC # 02/10/14 INSURER A: FLORIDA CITRUS, BUSINESS & EACH OCCURRENCE $ 1,000,00 INSURED ATLANTIS ELECTRICAL CORP. 12803 SW 20TH TERRACE INSURER B:WESCOINSURANCE COMPANY PERSONAL&ADV INJURY $ 1,000,00 MIAMI, FL 33175 INSURER C: INSURER 0: PRODUCTS-COMP/OPAGG $ 2,000,00 INSURER E: INSURER F: LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS COVERAGES CFRTIFICOTF NIIMRFR• RFVICIr1N NIIMRFR. 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. ILTR TYPE OF INSURANCE D POLICY NUMBER POLICYEFF POLICYEXP LIMITS B GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR WPP1138623 00 02/10/14 02/10/15 EACH OCCURRENCE $ 1,000,00 PRETO RENTE9-- MISES Ea occurrence) $ 100,00 MED EXP (Any one person) $ 5,00 PERSONAL&ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,000 GEN'LAGGREGATELIMIT APPLIES PER: X POLICY PRO- Ll SPETLOC PRODUCTS-COMP/OPAGG $ 2,000,00 $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS COMBINED SINGLE LIMIT a accident BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE Peraccdant $ $ UMBRELLA LIAR EXCESS LIAR HCLAIMS-MADE OCCUR EACH OCCURRENCE $ AGGREGATE $ DED I I RETENTION $ $ A WORKERS COMPENSATION LIABILITY AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes descrlbe under DESCRIPTION OF OPERATIONS below N / A 106-50846 10/30/13 10/30/14 X TORY LAS X O R E.L. EACH ACCIDENT $ 500,00 E.L. DISEASE - EA EMPLOYEd $ 500,000 E.L. DISEASE - POLICY LIMIT 1 $ 500,00 ERCONTRA�TORTIONS / VEHICLES (Attach ACORD 101, Addrdonal Remarks Schedule, If more space Is requlred) ELECTRICAL OPERATIONS MIASHVI SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE VILLAGE OF MIAMI SHORES THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN BUILDING & ZONING ACCORDANCE WITH THE POLICY PROVISIONS. 10050 N E 2 AVE. AUTHOR® REPRESENTATIVE MIAMI SHORES, FL 33138 ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD Miami Shores Village Building Department 90050 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 FBC 20 Permit No. u / �l �y; Master Permit No 1 %�p42?Zg JOB ADDRESS: °`I®d ck City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: 11- = to MCS 1 y - b4A0,0 Is the Building Historically Designated: Yes NO Flood Zone: OWNER: Name (Fee Simple Titleholder):a��a �e ►� �� Phone#: Address: 4W MF- !EjA4 S'�ree,lt- City: A Q&Aa State: F-I�x _ gip; - 3&t- Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: �"� °� 5 y` Co r(f? Phone#: -? e) (. -3 5�J (o i ?0 Address: v03 SL-) ':- O City: &.-Q. o ( State: Zip. 33/)3— Qualifier 3/),—Qualifier Name: ryi!� 'n c- �. J L0 t s'-� ], Phone#: i uG -3 5j---(. 7 � O State Certification or Registration #: * C-(CI(,Certificate of Competency #: Contact Phone#: _ J S J -�'% �' Email Address: DESIGNER: Architect/Engineer: Phone#: a Value of Work for this Permit: quare/Linear Foota aZf Work•. gc) Type of Work: OAddres OAlteration ❑New OR ' fitep)ace • ODe/molition Description of Work: ��}'� C`i C. f e, :, 2P"P eJA, Submittal Fee Permit Fee $ CCF $ CO/CC $ Scanning Fee $ Notary $ Radon Fee $ Training/Education Fee $ Double Fee $ Structural Review $ DBPR $ Bond $ Technology Fee $ TOTAL FEE NOW DUE $/,� Z �� Bonding Company's Name (if applicable) Bonding Company's Address City State Mortgage Lender's Name (if applicable) Mortgage Lender's Address Zip 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. "WARMING 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 t a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property I su vett t nt. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspecti n wh' o urs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be pp ed a reinspection fee will be charged. er or Agent The foregoing instrum was acknowledged before me this day of , 2 by a - who is person known to m or who has produced As identification and who did take an oath. NOTARY Print: a My Commission Expires: APPROVED BY MY COMMISSION 9 ] HIM EXPIRES: Fdx=ry07.2017 Signature W�2 J Contractor The foregoing instrument was acknowledged before me this A4 day of , 20 j!J, byjupCLSC� who is personally 4own to me or who has produced-MAA—an identification and who did take an oath. 2&V/AI Plans Examiner Structural Review (Revised 3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09) NOTARY PUBLIC: Sign: ASTRANA 1K*t-,c0i WS10N 24 Print: ffiI , M: Felttmry 07,X17 My Commission Expires: Zoning Clerk a