EL-13-701Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-200334
Scheduled Inspection Date: October 03, 2013
Inspector: Devaney, Michael
Owner: BAKER, GOLDIE
Job Address: 9510 NW 1 Avenue
Miami Shores, FL 33138 -
Project: <NONE>
Contractor:
EVOLUTION ELECTRICAL CONTRACTORS
duncling Department comments
INSTALL SMOKE DETECTOR AND RENOVATE TWO
BATHROOMS AND KTICHEN
Passed
Failed
Correction ❑
Needed
Re -Inspection ❑
Fee
No Additional Inspections can be scheduled until
re -inspection fee is paid.
P,c, i3—6W
Permit Number: EL -4-13-701
Permit Type: Electrical - Residential
Inspection Type: Final
Work Classification: Alteration
Phone Number
Parcel Number
INSPECTOR COMMENTS False
or Comments
1131010240260
Phone: (786)351-5784
October 02, 2013 For Inspections please call: (305)762-4949 Page 25 of 27
DATE (MMIDDIYY)
t?'�® CERTIFICATE 4F LIABILITY INSURANCE 04/22/13
PRODUCER Southern Star Insurance Agency, Inc THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
8338 SW 8th Street HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
Miami, FL 33144 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Phone (305)262-2740 Fax (305)262-2647 INSURERS AFFORDING COVERAGE MAIC #
T- INSURER X. ASCENDANT COMMERCIAL INS
INSURED EVOLUTION ELECTRICAL CONTRACTORS INC. INSURER B: —
1 11631 NW 58TH PL INSURER C: —
HIALEAH,FL.33012 INSURER D:
I I I INSURER E:
_CINSURER F -
OVERAGES
THE POLICIES OF INSURANCE LISTED 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
�INOLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS
_SPR ADD'L POLICY EFFECTIVE POLICY EXPIRATION OMITS
Is TYPE OF INSURANCE _ POLICY NUMBER DATE MMIDDJYY DATE MNJDDJ
I GENERAL LIABILITY EACH OCCURRENCE 1,000,000.00
DAMAGET D 100,000.00
�/] COMMERCIAL GENERAL LIABILITY I GL -36537-0 107/29/12 I 07/29/13 PREMISES o=rence _
MED EXP (Any one person) 5,000.00
❑ J CLAIMS MADE CI OCCUR I PERSONAL &ADV INJURY 1,000,000.00_
A
10GENE
RAL AGGREGATE 1,000,000.00
r PRODUCTS - COMP/OP AGG 1,000,000.00
GENT AGGREGATE LIMTi' APPLIES PER:
0 POLICY Lj PROJECT ❑ LOC
I I I COMBINED SINGLE LIMB
AUTOMOBILE LIABILITY (Ea
i I I O ANY AUTO I(Eaaccident)
, I ALL OWNED AUTOS I I I BODILY INJURY
I] ❑ SCHEDULED AUTOS (Per person)
I I r, HIRED AUTOS BODILY INJURY
❑ NON OWNED AUTOS ( I (Per accident)
❑ PROPERTY DAMAGE
r, � Per acxldent)
AUTO ONLY.EAACCIDENT
CERTIFICATE HOLDER
f CITY OF MIAMI SHORES
BUILDING DEPARTMENT
` 10050 NE2ND AVE
I MIAMI SHORES VILLAGE,FL33138
ACORD 26 (2001108) QF
CANCELLATION —
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO
THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY
OF ANY KIND UPON THE INSURFaIJj, ITS AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRES0
ROBERTO OJEDA
TION
I F-1
GARAGE LIABILITY
CI ANY AUTO I
❑
OTHER THAN EA ACC
AUTO ONLY: AGG
—
EACH OCCURRENCE
EXCESSIUM13RELLA LIABILITY
F] OCCUR L� CLAIMS MADE ,
I AGGREGATE
❑
(J DEDUCTIBLE
I
f ❑ RETENTION S
HWORKERS COMPENSATION AND
®Y Lam- ❑ OTH-
EMPLOYERS' LIABILITY
I E.L. EACH ACCIDENT
ANY PROPRIETOR I PARTNER I EXECUTIVE
OFFICER 1 MEMBER EXCLUDED? I
I I E L DISEASE - EA EMPLOYEE
If yes, describe under
EL DISEASE -POLICY LIMIT
_
4 SPECIAL PROVISIONS below
1
OTHER —�
DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
1
CERTIFICATE HOLDER
f CITY OF MIAMI SHORES
BUILDING DEPARTMENT
` 10050 NE2ND AVE
I MIAMI SHORES VILLAGE,FL33138
ACORD 26 (2001108) QF
CANCELLATION —
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO
THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY
OF ANY KIND UPON THE INSURFaIJj, ITS AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRES0
ROBERTO OJEDA
TION
Miami Shores Village
Building Department '1'`�tir1,1
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
C
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949
BUILDING Permit No. 3
PERMIT APPLICATION Master Permit No. zc 13 (099
FBC 20 V)
Permit Type: Electrical
OWNER: Name (Fee Simple Titleholder): Qa wao a f !',Ps&r!i ILolcb ,W Phone#: -2n, J n/ f 119
Address: l !i/W *184'daMfLY)
city: r -nod State: �. Zip: 31�110[9
Tenant/Lessee Name: Phone#:
Email:
JOB ADDRESS: ct 5 % O W.W . 1 N.
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: lel 0 1- Q24-- OLG O
Is the Building Historically Designated: Yes NO Flood Zone:
CONTRACTOR: Company Name: Z:76 c 4 ,jj Cg ` Phone#:
Address: //6-a/ V VV
City:
Qualifier Name:
7=� 8G- 5-1 -5-*-> 6 4
04 State* llz-C- Zip. _?3 O / 2
Phone#• '�,9 G
State Certification or Registration #:, /® C ®O 0 6110 Certificate of Competenc #:
Contact Phone#: Email Address: c (j4 �� U ° Gt? V-)
DESIGNER: Architect/Engineer: Phone#:
Value of Work for this Permit: $ ,S-ZSquare/Linear Footage of Work:
Type of Work: ❑Address ❑Altera?ion ❑New ❑Repair/Replace ❑Demolition
Description
`ofWork:* 1��sy�'a\k 1 kou•r (\Qc.a Saveo\K, Jg_Ve c4i
SAC RCd�\0.�:.@V►@CZc'iCc..\ S�c�n�c.c.�e '�D �Q�w.,��f P�c:�f)��A
Submittal Fee
Scanning Fee $
Notary $
Permit Fee $ /&_0 I of CCF $ CO/CC $
Radon Fee $
Training/Education Fee $
Double Fee $ Structural Review $
DBPR $ Bond $
Technology Fee $
TOTAL FEE NOW DUE $
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.
Signature �� Signature
T�9 Owne r Agent Contractor
The foregoing instrument was acknowledged before me this
day of { �, 201 , by A&&W # ,
N kpr =
who is personally known to me or who has proauced
U -kw As identification and who did take an oath.
NOTARY PUBLIC:
Sign: vcltv '
Print:
e,, 'ruUFsy NO
My Commission Expires: fi:C0MMW [0N#EE146065
•4EXPIRF.S; NOV. 14, 2015
•ql,,,�v NI9AV.ApkONNOTARY.com
The foregoing instrument was acknowledged before me this
day of -4944 '20 by N ,
who is personally known to me or who has produed�
(-41� as identification and who did take an oath.
APPROVED BY 9/¢%'� XPo/-' A/�/LPlans Examiner
Structural Review
(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09)
NOTARY PUBLIC:
�.. a
Sign:
n
Print:'
My Commission
ROSE MARIE LOPEZ
MY COMMISSION # DD860062
EXPIRES May 26, 2013
Zoning
Clerk
Miami shores Village
Building Department
CONTRACTORS' REGISTRATION
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
ALL CONTRACTORS MUST PROVIDE COPIES OF LICENCES AND INSURANCES EACH TIME A PERMIT IS SUBMITTED.
IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR:
A. COPY OF QUALIFIER'S STATE.LICENCES__-A
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 JEITHER CERTIFICATE OR EXCEMPTION)
IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY:
A. COPY OF CERTIFICE OF COMPETENCY OF QUALIFIER
B. COPY OF LOCAL BUSINESS TAX RECEIPT
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 WORKERS 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
COMPLETE CONTRACTOR'S INFORMATION
BUSINESS NAME: CV10C-U1' 0 P Z.vcilv.'� C.&L- Ca .
BUSINESS ADDRESS: 1163 1 ". �'ff O?L CITY ti�&(.- h
STATE TL ZIP CODE WRO (Z -
BUSINESS PHONE: ( �b ) 3T (S --7'6t FAX NUMBER (_—)
CELL PHONE (_—)
QUALIFIER'S NAME: 4w To o 41 --os'*
QUALIFIER'S LIC NUMBER: (0 e 0.00 (- l 0
E-MAIL ADDRESS (IF APPLICABLE):
"G(c �Ooelecam1c
Created on 3119109 BY MLDV 1 RV 3126109 MLDV I RV 6127111 AS
LOCAL BUSINESS TAX RECEIPT 2013 jpg - Gmail
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THIS S NOT ABILL — DO NOT PA
REME-WAl
RECD 140.
GAL CONTRACTORS CC # 10E0,00610
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WIN DADECOUNTY
:QN ELECTRICAL ONTRACTORS
Isst 9tiIftI#+sssas� a®a x€l9ts fxts1111 11 lttthmimf
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STATE OE FLORIDA REGISTRATION 2014 jpg - GmaU
Page 1 of 1
STATE OF FLORIDA
DEPARTWWT OF BUSINESS AND PROFESSIONAL REGULATION
ELECTRICAL CONTRACTORS LICENSING BOARD (850) 487-1395
1940 NORTH MONROE ' STREET
TALLAHASSEE FL 32399-0783
ACOS -TA, ANTONIO
EVOLUTION ELECTRICAL CONTRACTORS, INC.
11631 NW 58TH PLACE
HIALEAH FL 33012
Congratulationsl With this license you become one of the nearly one million D}:E'AR�'QF B3SS .sD
Floridians licensed by the department of Business and professional Regulation. pRO� GU tf?lT r
Our professionals and businesses range from architects to yacht brokers, from
boxers to barbeque restaurants, and they keep Florida's economy strong. 4
sR13611 R ��7Qi26i9:
Eve da we work to Improve ' ��
Every y p way we do businessin order to serve you be ,
For information about our services,please log ontowwvv myflorldancensewsn
There you. can find more Information about our diutsions the regulations that ACOB i$ v
impact you, subscribe to department newsletters and team more about the O
Departmentsinitiatives.EI%�7IVIDlif &T_' AFu. Lt1OAL
LICEIt+tRtNl1' PRIOIb
Our mission at the Department is: License Efficiently, Regulate Fairly. We �O CONTRAS E� IN tY Ams}'
constantly strive to serve you better so that you can serve your customers. �-� rad of c.48S
Thank you for doing business in Florida, and congratulations on your now ilcenset 3� ! ` 2fr $ Cosa zn Bsp
DETACH HERE
47.W.6.1C1T1 v:
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WORKER'COMP(EXEMP) 2014 jpg - Gmail
.TEFF ATWATER
CHIEF FINANCIAL OFFICER
Page 1 of 1
SMS -7, e.
CONSTRUCTION* * CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKS
INDUSTRY O
This certifies that the individual listed below has elected to be exempt from. Florida
EFFECTIVE DATE: 11/19/2012 EXPIRATION DATE: 11/19/2014
(UPIIRT,hNTt Pursuant to Chapter 440 05(14), T.5., an officer of a corporation who elects exemption from this chapter
section may not recover benefits; or Compensation under this chapter. Pursuant to Chapter 440.0502), F.S., Certificates of
scope of the business or trade listed on the notice of election to be exempt. Pursuant to Chapter 440:05(13), F.S., NOV(
election to be exempt shall be subject to revocation If, at any time after the filing of the notice or the issuance of th
certificate no longer meets the requirements of this section for issuance of a certificate. The department shall revoke
1 namedon the ,certificate to meet the requirements of this section.
OW -C-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01-11
f
PLEASE CUT OUT THE CARD BELOW AND RETAIN FOR FI
STATE OF FLORIDA
6EPARTMINT OF`FINANCIAL SERVICES
DIVISION OF WORKERS' COMPENSATION _ F Pursuant to Chapter 440
CONSTRUCTION INDUSTRY � ®elects exemption from
CERTIFICATE OF ELECTION TQ BE MPT FROM FLORIDA under this 'tin m
WORKERS" COMPENSATION LAW � section may
EFFECTIVIE= 11/19/2012 EXPIRATION DATE: 11/191/2014 chapter.
PERSON -ANTONIO ACOSTk
Pursuant to Chapter 440.
exempt.. apply only. witl
--•-• rrnswr+a.+wnn E this nntirp of alp -tion ti
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