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EL-12-2212Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 mop Inspection Number: INSP-198368 Scheduled Inspection Date: September 10, 2013 Inspector: Devaney, Michael Owner: LIVINGSTONE, DAVID AND KAREN Job Address: 10560 NE 2 Court Miami Shores, FL 33138 - Project: <NONE> Permit Number: EL -11-12-2212 Permit Type: Electrical - Residential Inspection Type: Final Work Classification: Addition/Alteration Phone Number Parcel Number 1122310130660 Contractor: SUCCESS ELECTRICAL CONTRACTOR INC Phone: (786)296-1404 comments ADD BEDROOM ELECTRICAL OUTLETS AND ELECTRIC FOR NEW SPLIT AC UNIT 07/08/2013 - PERMIT EXTENDED PER LAST APPROVED INSP. INSPECTOR COMMENTS False Inspector Comments Passed CREATED AS REINSPECTION FOR INSP-198117. CREATED AS REINSPECTION FOR INSP-197925. CREATED AS REINSPECTION FOR INSP-181919. No access at 3:30 p. m. on 22 aug 2013. 27 aug. 2013 Failed ❑ Add smoke /carbon monoxide detectors. Receptacles to be tamper resistant. A. H. U. disconnect is not accessible and put a connector on the low voltage cable. Correction ❑ 30 aug.2013 Needed Only one smoke detector installed, 3 are needed. A. H. U. disco not accessable. Re -Inspection Fee � � > No Additional Inspections can be scheduled until reins ction fee is aid. 4, Pe p September 09, 2013 For Inspections please call: (305)762-4949 Page 19 of 31 Miami Shores Village NOV 2 12012, Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 FBC 20 ID BUILDING PERMIT APPLICATION Permit No. LU '4� 1 1 R Master Permit No.1Z-(—_ �R ^ 15 - Permit e: Elec JOB ADDRESS: 10560 !YE- Z Co u. g l - City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: 1 , �C� - O J_3 0 6 D -.00 Is the Building Historically Designated: Yes NO !!!l Zone: OWNER: Name (Fee Simple Titleholder): 18 / S A 0 MGA 0 Phone#: (W0271742 Address: 105&0 N E Z4 r T; City: II�AIM 1-5�4na E st__ State: FL, Name: Email: CONTRACTOR: Company Name: Address: City: Qualifier Name: State Certification or Registration #: A.- K 1 LSP> I N & ! j 7 Certificate of Competency/ #: _ Contact Phone#: 7Z4 - Z U - IYD y Email Address: .-At &I � IrPled -diary, . i� Ao- DESIGNER: Architect/Engineer: t?I�%�2 / r (,� 1: I 4hi / a 1 Phone#: Value of Work for this Permit: $ L . -7 J (/ � Sauare7)E.inear Footage of Work: 244 Type of Work: ❑Address Alteration ❑New ❑Repair/Replace ❑Demolition za' 5 nor EN i1 v (I ' LVIE&IN Submittal Fee $ 5® - Permit Fee $ 6" °' `'9 Scanning Fee $ TY4 Radon Fee $ Notary $ Training/Educadon Fee $ Double Fee $ Structural Review $ CCF CO/CC $ DBPR $ Bond Technology Fee $ TOTAL FEE NOW DUE $ • d 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 $2500, the applicant must promise in good faith that a copy of the notice of commencement.and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged `' Owner or Agent The foregoing instrument was acknowledged before me this L q day of hLftwWe, 24,, by who s personally 1 wn to me or who has produced As identification and who did take an oath. NOTARY PUBLIC: Sign: K W -A - Print: My Commission Expir4 x )DSS: Nwia*w t$ 2014 1.�Dwtsaaur�" ABY � �9 Ao00. C0.' APPROVED BY z;C2 Plans i Igna Contractor The foregoing instrument was acknowledged befor me this-�,� day of 20 -L i, by who i rsonal wn to me or who has produced identification and who did take an oath. NOTARY PUBLIC: SANTIAGO MEDINA kCoUNSSION # DD963497 Sign: RES:Fdmwy2L2DI4 Print: � ova Ca My Commission Expires: Zoning Structural Review Clerk (Revise/121#007/10/07)(Revised 06/10/2009)(Revised 3/15/09) CTQB I . -r , des Qua. i ying Board "onstructron, ifa "t BF 4t - AT E OF 0 M, P E T E N C'V US�NESS CERT:_ SUCCESS ELEC�RiCAL CONTRACTOR INC T rl -c:, nce—i- " —oscns of Q �jf Malm- Dade JAN/03/2013/THU 02;06 PM Attamiami Insurance FAX No,3052339239 P, 001/001 DATE(MMfDD/YYYY) -%- - CERTIFICATE OF LIABILITY INSURANCE01 /03/13 THIS CERTIFICATE f5 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 policy(19s) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, camaln 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 CONTACT JENNIFER LLULL At Tamiami Insurance Corp. PHONE 305 23a-9223 ac No . {905 133-0239 11362 SW 184 St MAIL attamiamlinsOgma(Lcom Miami, FL 331557 COMBINED SINGLE LIMff Es a¢iden! BODILY INJURY (Per person) $ Phone 305 233-9223 Fax (305) 23S-9239 INSURER(S) AFFORDING COVERAGE NA(C INSURER A : GRANADA INSURANCE COMPANY ❑ UMBRELLA LIAR ❑ OCCUR ❑ EXCESS LIAB ❑ CLAIMS -MADE INSURED SUCESS ELECTRICAL CONTRACTOR, INC INSURER 3, EACH OCCURRENCE $ NIA INSURER C: 14321 SW 147TH CT AGGREGATE $ N ERE' MIAMI, FL 33196 (785) 251-0003 3NSUREft F • E.L. EACH ACCIDENT $ C['1VFRA[:r=S ,.�„�.,-,_ . __ ...._ ____ - — — THIS IS TO CERTIFY mInvialury 1MUM15t;K: 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 ADD 3UHR LT 'TYPE OF INSURANCE POLICY NUMBER POLIG E POLICY EXP LIMITS GENI=RAL LIABILITY Q COMMERCIAL GENERAL LIABILITY A RI El El CLAIMS -MADE ROCCUR DED 500 PDICLAIM 10/24/2012 1024/2013 EACH QQCURRE QO 000.00 DAMAGE TO RENTED $ 100,000.00 PFz0185,FL0003069i MED EXP (Any one person) s 5,000.00 PERSONALBADV INJURY s 1,000,000.00 GEN'L AGGREGATE LIMITAPPLIE$ P=Ij; r• ❑ POLICY ❑ PRO- ❑ LOC GENERALAGGREGATE $ 110001000.00 PRODUCTS - COMP/OP AGG $ 1,000,000.00 $ AUTOMOBILE LIABILITY ❑ ANY AUTO ❑ALL OWNED ULE AUTOS LJ AUTOSD ❑ HIRED AUTOS NON -OWNED ❑ AUTOS ❑ COMBINED SINGLE LIMff Es a¢iden! BODILY INJURY (Per person) $ BODILY INJURY (Per aceldent)l S P OPr.ER- Y DAMAGE $ $ ❑ UMBRELLA LIAR ❑ OCCUR ❑ EXCESS LIAB ❑ CLAIMS -MADE EACH OCCURRENCE $ NIA AGGREGATE $ D ❑ RE'TENTION E WORKERS COMPENSATION AND EMPLOYERS'LIABILITY YIN ANY PROPRIETORIPARTNERIEXECUTNE OFFICER/MEMBEREXCLUDED? ❑ mandatoryin fYYes DESCdeacdbeUnunder RIPTION OF OPERATION8 below S ❑ WC STATUS ❑ OTH- E.L. EACH ACCIDENT $ E.L. DISEASE-EAEMPLOYE $ E.L. DISEASE - POLICY LIMIT S DESCRIPTION OF OPERATIONS 1 LOCATIONS !VEHICLES (Attach ACORb 101, Addition -41 RQM;4rkB Schedule, If more apace to requlred) CERTIFICATE HOLDER MIAMI SHORES VILLAGE 10050 NE 2ND AVE MIAMI SHORES FL 33138 TION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANC,E11i11TH THE POLICY PROVISIONS. 84273.b m p ACORD 25 (2090105) OF 0 1988-2010 AC R6CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Jan 03 13 04:38p Miscellany Leslie Dollar x xx.x x x x x x x x x x x x x x x x s RAMI -DADS COUNTY TAX COLLECTOR -40 V. Flagler Street Miami, Florida 33130 Please kejep your receipt for future reference. Thank you and have a nice day. 1/3/2013 1300/225/001YG18 0016-0001 Last Seq.#:0001 WI LBT#:30 723025-3 Local Business Tax $200.00 CK $200.00 CHANGE $0.00 MIAMI -BADE COUNTY TAX COLLECTOR LOCAL BUSINESS TAX SECTION 140 V. Flagler St. - 1St Floor - Miami, Florida 33130 TEMPORARY RECEIPT 2012-2013 MUNICIPAL CONTRACTOR TAX Local Business Tax0:30723025-3 5ta1e/CC#:11E000547 Issued to: SUCCESS ELECTRICAL CONTRACTOR INC Type of Business: ELECTRICAL CONTRACTOR SEE BACK OF OFFICIAL RECEIPT FOP NONPARTICIPATING MUNICIPALITIES -j HIS RECEIPT IS ISSUED AS EVIDENCE OF PAYMENT FOR YOUR LOCAL BMINESS TAX OR PERMIT. FOUR OFFICIAL RECEIPT WILL BE MAILED TO YOU WITHIN 10 DAYS FROM THE VALIDATION DATE ON THIS RECEIPT, Payment Received as Certified Above Miami -Dade County Tax Collector 3057521814 p.1 JEFF ATWATER CHIEF FINANCIAL OFFICER STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF VIORKEs` COMPENSATION 09-14-2011 * * CERTIFICATE OF ELECTION TO BE E MPT FROM[ FLORIDA WORKERS' COMPENSATION LAW CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from FloridaWorkers` Compensation law. EFFECTIVE DATE: PERSON: FEIN: 09/14/2011 EXPIRATION DATE: 09/13/2013 ROBLETO VICTOR A 4527533519 BUSINESS NAME AND ADDRESS: SUCCESS ELECTRICAL CONTRACTOR INC 14321 SW 147 CT MIAMI FL 33196 SCOPES OF BUSINESS OR TRADE: 1- ELECTRICAL CONTRACTOR IMPORTANT: Pursuant to Chapter 440 . 05(141, F.S., an officer of a etrrporatfon who elects exemption from dile chapter by filing a certificate of election under this section may not recover benefits or compensation under this chapter. Pursuant to Chapter 440.05(12), F.S., Cert rpatles of election to be exempt.-. apply oafy within the scope of the business or trade listed on the notice of election to be exempt. Pursuant to Chapter 440,0603), F.S., Notices of election to be exempt and certificates of election to be exempt shall be stlbjecf to revocation if, at any time after the filing of the notice, or the Issnaate df the certificate, the parson named on the notice or cartificate no longer meets the regefrements of this section for issuance of a certificate. The department shelf revoke a certificate at any time for failure of the person named on the certificate to meet the requirements of tiffs section. QUESTIONS? (850) 413-16(19 DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01-11 PLEASE GUT OUT THE CARD BELOW AND RETAt1tk f " ft1-T#*:'Ftrfe lue STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION CONSTRUCTION INDUSTRY CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW EFFECTIVE: 09/14/2011 EXPIRATION DATE: PERSON: VICTOR A RQBLETO FEIN: 452753359 BUSINESS NAME AND ADDRESS: SUCCESS ELECTRICAL CONTRACTOR INC 14321 SW 147 CT MIAMI, FL 331914 SCOPE OF BUSINESS OR TRADE: 1- ELECTRICAL CONTRACTOR rrw"--"sra r r.""" s © Pursuant to Chapter 440.06(14), F.S, � officer of a corporation who sleets exemption from this chapter by f fittg a certificate of election L under this section may not recover betas€its or compensation under this 0 chapter. 08/13/2013 Pursuant to Chapter 440.05(12), F.S., Cartificates of election to be H exempt... apply only within the scope of the business or trade listed on E the notice of election to be exempt. R E Pursuant to Chapter 440,05(13), F.S., Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation if, at any time after the filing of the notice or the issuance of the certificate, the person named oil the notice or certificate no longer meets the requirements of this section for issuance of a certificate. The department shall revoke a certificate at any time for failure of the person named on the certificate, to meet the requirements of this section, QUESTIONS? (850) 413-1605 CUT HERE * Carry bottom portion on the job, keep upper pion for your records. DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01-11 CTQB Construction Trades Qualifying Board BUSINESS CERTIFICATE OF COMPETENCY IIE000547 ELECTRICAL CONTRACTOR INC MMID.B.A.: �y r VICTOR tscertified under the provisions of Chapter 10 of Miami -Dade County FIRST-CLASS U.S. POSTAGE PAID MIAMI, FL PERMIT NO. 231 695449-0 THIS IS NOT A BILL — DO NOT PAY RENEWAL llyffL&4E fi!ffiff RCAL CONTRACTOR INC CC 4FE�M5%0547 723025-3 14321 SW 147 CT 33196 UNIN DADE COUNTY 0W§%CESS ELECTRICAL CONTRACTOR IN '1W IMCAL CONTRACTOR WORKS/S TH{3 IS ONLY A LOCAL BUSIPUM TAX RECEIPT. IT DOB$ NOT PE(UBT THE HOLDER TO VIOLATE ANY EXWOR ZOKMu REGULAWS F M za�lct Laws oP THE ' D6 NOT FORWARD CWNIY oR CtTIEBWIEN". NSI DOES�MOMAWOl SUCCESS ELECTRICAL CONTRACTOR INC T OR LNxi�E AA 16 VICTOR A ROBLETO NOTCCEPMROOAwnON Or TNM HOLDER'S QUALUMA• 14321 SW 147 CT TION& MIAMI FL 33196 PAYMENT RECEIVED 61IAMI-0ADE COHN{Y TAX 'ORb9/13/2012 02240007001 000075.00 108 SEE OTHER SIDE ROBLETO, VICTOR ALEXANDER SUCCESS ELECTRICAL CONTRACTOR, INC 14321 SW 147TH COURT MIAMI FL 33196 Congratulations! 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.myfforidalicense.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! DETACH HERE (850) 487-1395