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EL-13-1921Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-214461 Permit Number: EL -8-13-1921 Scheduled Inspection Date: June 19, 2014 Permit Type: Electrical - Residential Inspector: Devaney, Michael Owner: OREJANA, FERNANDO MONEDERO Job Address: 101 NE 105 Street Miami Shores, FL 33138 - Project: <NONE> Inspection Type: Final Work Classification: Alteration Phone Number (786)329-0222 Parcel Number 1121360050090 Contractor: GALAN ELECTRIC Phone: (305)351-6954 comments ELECTRIC FOR GARAGE RENOVATION INSPECTOR COMMENTS False Inspector Comments PassedE�r Failed Correction ❑ l Needed Re -Inspection ❑ Fee No Additional Inspections can be scheduled until re -inspection fee is paid. June 18, 2014 For Inspections please call: (305)762-4949 Page 32 of 39 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-213859 Permit Number: EL -8-13-1921 Scheduled Inspection Date: June 10, 2014 Permit Type: Electrical - Residential Inspector: Devaney, Michael Owner: OREJANA, FERNANDO MONEDERO Job Address: 101 NE 105 Street Miami Shores, FL 33138 - Project <NONE> Contractor: GALAN ELECTRIC awaing Department comments ELECTRIC FOR GARAGE RENOVATION Inspectilon Type: Final Work Classification: Alteration Phone Number (786)329-0222 Parcel Number 1121360050090 INSPECTOR COMMENTS False Inspector Comments Passed ED Failed � p� Correction Needed Re -Inspection ❑ Fee No Additional Inspections can be scheduled until re -inspection fee is paid. Phone: (305)351-6954 June 09, 2014 r For Inspections please call: (305)762-4949 Page 43 of 45 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 JOB ADDRESS: I() 1 05S FBCZOcS Permit No. Master Permit No. I' d City: Miami Shores County: Miami Dade Folio/Parcel#: Is the Building Historically Designated: Yes NO Flood Zone: OWNER: Name (Fee Simple Titleholder): E?) non& IN 10 111e '_ rD Phone#: l� -1 � v� �S 89 3 q City: M l a ani % 1i S State: �� Zip: TenanVUssee Name: CONTRACTOR: Company Name: g j 0, V\ 'tel ��� l C! Phone#: Address: 9(0 s C Q :�t &0 `a &35-1 GI�rq City: 141/ i r k 1 State: Zip: 13 0 13 Qualifier Name: (l Yna'-V J Phone#: j State Certification or Registration #: Certificate of Competency #: ®`f 4C d to Contact Phone#: f? r r'J 3 j 6 5 G/ Email Address: C I e+ �► ,i - 4 , Cat../ DESIGNER: Architect/Engineer: V fl C . Y 3 • AY v C -P Phone#: 305-310-S030 Value of Work for this Permit: $ �L ®C7 Square/Linear Footage of Work: 110 Type of Work: ❑Address {Alteration ONew ORepair/Replace ODemolition Description of Work: 1 T') ^P F, +: C-1 �C X71 ck Y-axi -e Ren a vas ! - l 8c Submittal Fee Scanning Fee $ Permit Fee $ y462 192,0 CCF $ CO/CC $ Radon Fee $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ DBPR $ Bond $ Technology Fee $ TOTAL FEE NOW DUE $ Q_ Y 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 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 be approved and a reinspection fee will be charged Signature �—— — "`�� Signature V( Owner or Agent Contractor The foregoing instrument was acknowledged before me this"�:� The foregoing instrument was acknowledged before me s day of —&ILS 20 0 3 , by Aq�c� nr e4 �ay of v 6 � 20 �, by � W1 �K � - , who is personally knl to me or who has produced who is personally known to me or who has produced fiI/ As identification and who did take an oath. NOTARY PUBLIC: Sign: JnUJ t ' Print: S n My Commission Expires:NOTARY PUBLIC STATE OF FLORIDA 6.).Camn*EE219343 APPROVED BY J 2� �'�.� Plans Examiner 1� A.. ,-Axu-, as identification and who did take an oath. NOTARY PUBLI Sign: ' Print: Structural Review (Revised 3/12/2012)(Revised 07/10/WXRevised 06/10n2009)(Revised 3/15/09) My Commission Expires Carlos Manuel Garcia www.AAAR0N 0TAi%oom Zoning Clerk Miami shores Village 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 $30.00 FEE PER YEAR. IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: A. COPY OF QUALIFIER'S STATE LIC CARD B. COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF LIABILITY INSURANCE (CERTIFICATE HOLDER TO BE MIAMI SHORES VILLAGE BLDG DEPT) D. COPY OF WORKERS COMPENSATION (EITHER CERTIFICATE OR EXEMPTION) IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY: A. COPY OF CERTIFICE OF COMPETENCY OF QUALIFIER B. COPY OF MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT C. COPY OF LIABILITY INSURACE (CERTIFICATE HOLDER MUST BE MIAMI SHORES VILLAGE BLDG DEPT) D. COPY OF WORKER COMP INSURANCE (EITHER CERTIFICATE OR EXEMPTION) YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE HOLDER AS FOLLOW: MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES, FL 33138 ■■wwrwrrawwwwwwwwwwwwwwwwrwwwwwwwwwwwwwrwrrrwwrwwrrwrwwww■■awwwwrwwwwwwwwwwwwwrwww�wwwwr�w� COMPLETE CONTRACTOR'S INFORMATION BUSINESS NAME: Aan+( 'i l . tau - BUSINESS ADDRESS: '5q,) (ov ST- CITY "i r4Ze L2 - STATE --,EL- ZIP CODE 33013 BUSINESS PHONE: FAX NUMBER CELL PHONE S S t'/ 6i 6''Y QUALIFIER'S NAME: X04/ QUALIFIER'S LIC NUMBER: 0 g e 190 0-7 01 E-MAIL ADDRESS (IF APPLICABLE): Crea Wd cm 3M9= BY EDV I RV 3i1 O N DV =��,s. w 41- 051, o U A L i F Y I N G TRADE($) OOD1 ELECTRICAL 655573®5 MMVMs iaEd'1= GALAN ELECTRIC CO 60 ST 33013 HIALEAH ovam GALAN ELECTRIC CO PAVWW- ��Vx 09/2 /2012 0225009081 0000{45.00 SEE OTMM WE TH15 f5 tVV t m piu - .... 602631-0 CC 0 00ED80701 1.. , 1.d E0/S 1 DomoTMMAW GALAN ELECTRIC CO OMAR J GALAN FRES 540 E 60 ST HIALEAH FL 33013 78i�1!!tlltlltitin1itilltt8ill884t�i1lli[}j�iilii�6�i8i�ii ,a►� i� CERTIFICATE OF LIABIILI I Y IMUMAN%or 8i15/201s THIS CER79F1CATE IS ISSUED AS A MATTER OF INFORMATION ONR. THIS LY CONFERS D OR AL� � AGE A CFFOR ED BY THE POLICIES CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEN THE IgSU1NG m(gURER(S� AUTHORIZED BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN REPRRRENTATTVE OR PRODUCER, AND THE CERTIFICATE HOLDER is the Wm WW is If u cem of th holder Icertain s ADDITION-ciI �re an domeinentnA > � On thibe endolseti.S'a�ft � D rWft to t?� tl am! conditions of t� pOlicyi, the rardflced0 holder In Hsu Of such e11dOlSelrietit(S!. err _� n_.� .....sin PROMER Fortun Xnsurance, Inc. 365 Palermo Ave. Carat Cables FL DISURED Calan Electric Co., DSA: 1962 NE 151 ST Miami Beach FL 33134-6607 Royal Elelctri.c of 445-3535 A15-0825 DveKwuca --- - - - _ TO WHICH THIS THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN !SSU-RACT OR OTHER INDICATED. NOTWITHSTAND IVIG ISSUING ANY ED OR MAYEOPERTAIN. THE INSURANCE AFFORDED BY THENT. TERM OR CONDITION OF ANY CE CIES DESCRIBED HEREIN ISSUBJECTS TOTALL THE TERMS, CERT! EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCE PAID CEl1P LIMITS - PARIL OFINSIIRANCE NU EACH OCCURRENCE $ 1,000 GEp1OM LNBIL" $ - - 100 COMMERCIAL GENERAL LIABILITY /26/2013 !26/2014 MED Exp we _ $ 5 A CLAIMSMADE F1 OCCUR 6193M pERtIONAL & AININJURY $ 1,000 GENERAL AGGREGATE $ 2.000 PRODUCTS-COMPlOPAGO $ 2,000 inc. APC,REGATE LIMIT APPLIES PER $ AUTOMOBILE LIABILITY ■ . r ■ - ii Ali'• � ' - OESCR p7= OF OFERAMM I LOCA71010 I V811CM (ARth ACORO 1W, Add R—ft Scl- u B amre epa iequ>ied) MIAMI SHORES VILLAGE 10050 NR 2ND AVE MIAMI SHOMS, FL 33138 gO01LY INJURY (Per Per=) $ gODILY INJURY (Pera=dwm $ PROPERTY DAMA E $ E.L. SHOULD ANY OF THE A1VB DESCRIBED POLICIES BE CANCELLED BEFORE THE OWMTION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. @1 .2010 ACORD CORPORATION. All rights reserved- PLEASE CUT OUT THE CARD BELOW AHO RETAIN FOR FUTURE REFERENCE IA 91MAW P papter 440,M14). F.S.. sn offer of acorPorallon who 0 elm imm to oopter by fift a cot"a to of s Lander tbs motion am w rem btwB� ar D cbw p m C .. Ce 440.05{1?9. F.SdSCO es of t im w mew.- 0* No ftsm of IIIc b maM Or vgb listed E VE mgm of efeeto m be OxSu*t. Etm 440.05(13)' F.S, Madw of a to be and asMi=M of OMW ebst;r to be exert SW t to re++acetia� if, at my time after to fling of the ratios or the of tke coldr4!� pargoo omled the sof aw ificom The me so of fts secftn for woe deporU AM " rete a cwtfic" at any+ *w for fai we of the pw.m nwied t nl WkM to Inset to rear of tNs seetia- Oil 413-160 Cg" botto,,t Portia,, on da job, ke►uppw Par°,, for your rte• DX -252 C£RTWMAM OF ajCM TO BE EXt9rT IE M 01-11