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 $30.00 FEE PER YEAR.
IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR:
A. COPY OF QUALIFIER'S STATE LIC CARD
B. COPY OF LOCAL BUSINESS TAX RECEIPT
C. COPY OF LIABILITY INSURANCE (CERTIFICATE HOLDER TO BE MIAMI SHORES VILLAGE BLDG DEPT)
D. COPY OF WORKERS COMPENSATION (EITHER CERTIFICATE OR EXEMPTION)
IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY:
A. COPY OF CERTIFICE OF COMPETENCY OF QUALIFIER
B. COPY OF MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT
C. COPY OF LIABILITY INSURACE (CERTIFICATE HOLDER MUST BE MIAMI SHORES VILLAGE BLDG DEPT)
D. COPY OF WORKER COMP INSURANCE (EITHER CERTIFICATE OR EXEMPTION)
YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE HOLDER AS FOLLOW:
MIAMI SHORES VILLAGE BLDG DEPT
10050 NE 2ND AVE
MIAMI SHORES, FL 33138
■■wwrwrrawwwwwwwwwwwwwwwwrwwwwwwwwwwwwwrwrrrwwrwwrrwrwwww■■awwwwrwwwwwwwwwwwwwrwww�wwwwr�w�
COMPLETE CONTRACTOR'S INFORMATION
BUSINESS NAME:
Aan+( 'i l . tau -
BUSINESS ADDRESS: '5q,) (ov ST- CITY "i r4Ze L2 -
STATE --,EL- ZIP CODE
33013
BUSINESS PHONE: FAX NUMBER
CELL PHONE S S t'/ 6i 6''Y QUALIFIER'S NAME: X04/
QUALIFIER'S LIC NUMBER: 0 g e 190 0-7 01
E-MAIL ADDRESS (IF APPLICABLE):
Crea Wd cm 3M9= BY EDV I RV 3i1 O N DV
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w 41-
051,
o U A L i F Y I N G TRADE($)
OOD1 ELECTRICAL
655573®5
MMVMs iaEd'1=
GALAN ELECTRIC CO
60 ST
33013 HIALEAH
ovam
GALAN ELECTRIC CO
PAVWW-
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09/2 /2012
0225009081
0000{45.00
SEE OTMM WE
TH15 f5 tVV t m piu - ....
602631-0
CC 0 00ED80701
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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
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mew.- 0* No ftsm of IIIc b
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and asMi=M of OMW
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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