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EL-12-2333Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FIL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-199851 Permit Number: EL -12-12-2333 Scheduled Inspection Date: September 26, 2013 Permit Type: Electrical - Residential Inspector: Devaney, Michael Owner: GARCIA, JOHN Job Address: 169 NW 104 Street Miami Shores, FL Project: <NONE> Contractor: MAJESTY ELECTRIC SERVICES CORP tsuminA uepartment comments ELECTRICAL WORK FOR GARAGE CONVERSION 04/18/2013 - NEED GFI RECEPTACLES 04/22/13 stop work order realesed Inspection Type: Final Work Classification: Addition/Alteration Phone Number Parcel Number 1121360131370 INSPECTOR COMMENTS False Inspector Comments Passed Ef Failed 4 Correction �� 1-7 Needed 71 ';;' Re -inspection ❑ Fee No Additional Inspections can be scheduled until re -inspection fee is paid. Phone: 305-825-2680 September 25, 2013 For Inspections please call: (305)762-4949 Page 21 of 34 Miami Shores Village Building Department '� 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fag: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 BUILDING PERMIT APPLICATION Permit Type: Electrical JOB ADDRESS: / �! 41141 / © V S� FBC 20 Permit No. Master Permit No. m)2_1q71--� City: Miami Shores County: Miami Dade Folio/Parcel#: Is the Building Historically Designated: Yes NO Flood Zone: OWNER: Name (Fee Simple Titleholder): "rAJ 1L CIA Phone#: Address:_& , % City:14/4111 5 5&a s State: Tenant/Lessee Name: ff Phone#: 3 05-- -13 3 693 Email: CONTRACTOR'N : `Co, lmpany Name: 7� Address: F, 70 t U) // d City: J Qualifier Name: State Certification or Registration #: Contact Phonek Email Address: DESIGNER: Architect/Engineer: IA57A �&2- Certificate #: Value of Work for this Permit: $ ° V Square/Linear Footage of Work: Type of Work: ❑Address ❑Alteration ❑New *epair/Replace Description of Work: Submittal Fee $ Permit Fee $ .:% 7 m -e. CCF $ CO/CC $ Scanning Fee $ Radon Fee $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ DBPR $ Bond Technology Fee $ ❑Demolition ,a TOTAL FEE NOW DUE $ C 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 s 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, CON T WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YO N MICE OF COMMENCEMENT: ' Notice to Applicant. As a c nditio to the issuance of a building permit with an estimated value exceeding $2500, the applicant must promise in good faith that copy the notice of commencement and constfuction lien law brochure will be delivered to the person whose property is subjec an ent. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspe on wh h oc rs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not a appy ed a reinspection fee will be charged. Signature Signature —le�--= or The f e ' ins me ac 1 day o , 20 who is p�rpon%l ato me or who , identification and who did take an oath. Sign: Print: My Commission aksk�k�#sk=k=kikak��ffi'k5k APPROVED BY d PUb,��. ones SeQAso, � opay Mgo � amhs "9h�a�� / `-� Contractor p The foregoing instrument was acknowledged before me this /a day of Qft&-e , 20 L, by ��g who is personally known to me or who has produced as identification and who did take an oath. Plans Examiner Structural Review (Revised 3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09) NOTARY PUBLIC: Sign: Print: "v'a"U GERALDINE D'ESCRIVAN My Co s:' * ,: Notary Public - State of Florida . • My Comm. Expires Dec 17, 2012 =" Commission # DD 846353 Zoning Clerk ACORD CERTIFICATE OF LIABILITY INSURANCE t1/1 012 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION insurance Center of Dade Inc. ONLY AND CONFERS NO RIGHTS UPON THE C8111IFICAT. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 3165 W. 4 Ave Suite B ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Hialeah F1, 33012 INSURERS AFFORDING COVERAGE INSURED MAJ9STY ELECTRIC SERVICE CORP INSURERA ASCENDANT INSURMCE Co. INSURER B: ASCENDANT INS Co. 8701 N.W. 112 ST. INSURER C: HIAZA GARDENS, FL 33018 INSURER D: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREME T, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGR GATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE O INSURANCE POLICY NUMBER POLICY EFFECM DATE MMIDD POLICY EXPIRATION DATE MMIDD LIMITS A GENERAL LIASIL I 7f C07ERC GENERAL LIABILITY � AIM MADE [i] OCCUR GL -56932 1.1/01/12. 11/01/13' EACH OCCURRENCE $11,000,000 FIRE DAMAGE (Any one fire) $ 50,000 MED EXP (Any one p9rson) $ 1,000 PERSONAL a ADV INJURY $100001,000 GENERAL AGGREGATE $ GEN'L AGGREGA LIMIT APPLIES PER: POLICY PRO- JECT LOC PRODUCTS - COMP/OP AGO $ SON . E 2ND AVE ' AUTOMOBILE LIJ BILMY ANY AUTO ALL OWNED AUTOS SCHEDULE AUTOS HIRED AUT S NON-0WNE AUTOS M, SHORES FL. 33138 COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ (Per accident) GARAGE UABIU ANY AUTO REPRESENTATIVES. AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ AUTO ONLY: AGG $ 305-756-8972 EXCESS LIABI OCCUR EICLAIMS MADE DEDUCTIBLE RETENTION, $ AUTHORIZED REPRESENTATIVE EACH OCCURRENCE $ AGGREGATE $ $ $ B WORKERS COM ENSATION AND EMPLOYERS ILITY WC312838 11/01/12 11/01113, X TORY LIMITS ER E.L. EACH ACCIDENT $1001,000 E.L DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $100 P 000 OTHER DESCRIPTION OF OPE tATIONS/LOCATIONSIVEHICLESIEXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS EL CTRICAL WITHIN LIMITS CERTIFICATE HC LDER ADDMONAL INSURED; INSURER LETTER: CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICES BE CANC BEFORE THE EXPIRATIOI z SHORES BLDG. DEPT. DATE THEREOF, THE ISSUING INSURER WILL ENDEAVO O L -- DAYS WRITTEN 1 O SON . E 2ND AVE NOTICE TO THE CERTIFICATE HOLDER NAMED T E UT FAILURE TO DO SO SHALL M, SHORES FL. 33138 IMPOSE NO OBLIGATION OR LIABILITY OF ND U E INSURER, ITS AGENTS OR , REPRESENTATIVES. F 305-756-8972 AUTHORIZED REPRESENTATIVE ACORD 26-S (7/01 ® AC RD CORPORATION 1988 4. OFFICE COPY Permit Holder" e'1� Permit F.B.0 ViolationA�pa X -r Address Date /Z Building Official Construction Trades Qu6lifying Board BUSINESS CERTIFICATE OF COMPETENCY 01 E00-016 A 00 � crF, =C^9 -. - ' | ^� | |' .| i ~-- -' ' QUALIFYING TRAE(S) \ 0001 ELECTRICAL ! � - ' ' / Ch^rW"»=er P.E. BUMMA" LOCATION MAJESTY ELECTRIC SERVICE ZORP 8704 NW 112 ST 33018 HIALEAH GARDENS OWNER SI %fTjyu$ CTRIC SERVICE CORP BUSKS ETRICAL CONTRACTOR DOES NOT PERMIT THE HOLDER TO VIOLATE ANY EXISTING REGULATORY OR ZONING LAWS OF THE COUNTY OR CITIES. NOR DOES IT EXEMPT THE HOLDER FROM ANY OTHER RECEIPTRMEWAL 466676-5 CC # OIEOOO164 WORKER/S 1 DO NOT FORWARD PERMIT LICENSE REQUIRED 13YRLAW. THIS IS MAJESTY ELECTRIC SERVICE CORP NOT A CERTIFICATION OF RAFAEL GUTA PRES THE TIONS. 8704 QUALIFlCA- 8704 NW 112 ST PAYMENT RECEIVED HIALEAH GARDENS FL 33018 MIAMI•DADE COUNTY TAX COLLECTOR: 09/26/2012 60100000432 1,ei11„lietie„,.,Ili,1i1e11.i.ili.Li.,i1.J1ieel,i„1,!11,1 000045.00 162 SEE OTHER SIDE -- — — — — — — — — — — — — — THIS IS NOT A BILL — DO NOT PAY FIRST-CLASS U.S. POSTAGE 1 PAID MIAIfAI, FL PERMrr NO. 231 RECEIPT NO. 30-4666765 CC NO: OIE000164 RECEIPT HOLDER MAY DO BUSINESS NAME / LOCATION BUSINESS AS A CONTRACTOR MAJESTY ELECTRIC SERVICE CORP AS SPECIFIED HEREON. 8704 NW 112 ST OWNER :MAJESTY ELECTRIC SERVICE CORP SEE BACK OF RECEIPT FOR ELECTRICAL CONTRACTOR A LIST OF NON -PARTICIPATING MUNICIPALITIES DO NOT FORWARD Receipt holder must register in the city MAJESTY ELECTRIC SERVICE CORP where work is to be RAFAEL GUTA PRES done. 8704 NW 112 ST HIALEAH GARDENS FL 33018 PAYMENT RECEIVED COLL�E2CO6%2012 60100000433 t �y 000200.00 1e111„11y i,Ill ,ee11111,11111.11.111.1. i.11.,►1111..,1111:T1 e1 STATE OF FLORIDA _ DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD 1940 NORTH MONROE STREET •^owe` TALLAHASSEE FL 32399-0783 GUTA, RAFAEL MAJESTY ELECTRIC SERVICE CORP 8704 NW 112 ST HIALEAH GARDENS FL 33018 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.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 I!censel DETACH HERE (850) 487-1395 I STATE OF FLORIDA AC# . 6 3 5 196 2 j DEPARTMENT OF BUSXNESS ANDj PROFESSIONAL REGULATION j i ER0015382 09/10/32 127013762 i REG"ELECTRICAL CONTRACTOR GUTA, RAFAEL MAJESTY ELECTRIC SERVICE CORP ( INDIVIDUAL KUST MEET ALT+ LOCAL i ' LICENSING REQUIROMANTS PRIOR TO CONTRACTING TN ANY AREA) I HAS REGISTERED under the proninione of Ch.489 i Hapirati= dater AUG 31, 2014 L12091001S80 MIZU-110WOK111 - - 1111_ A STATE OF FLORIDA i DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ! ELECTRICAL CONTRACTORS LICENSING BOARD i SEWL12091001580 � The ELECTRICAL, CONTRACTOR Named below ;HAS REGISTERED Under the provisions of Chapter 48.9 FS. Expiration date: AUG 31, 2014 (INDIVIDUAL MUST MEET ALL LOCAL LICENSING REQUIREMENTS PRIOR TO CONTRACTING.IN ANY AREA)." GUTA, RAFAEL MAJESTY ELECTRIC SERVICE CORP 8704 NW 112 ST HIALEAH GARDENS FL 33018 RI CR SCOTT GOVERNOR DISPLAY AS REQUIRED BY LAW REN LAWSON SECRETARY _