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EL-13-1171l Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-192217 Permit Number: EL -5-13-1171 Scheduled Inspection Date: August 08, 2014 Permit Type: Electrical - Residential Inspector: Devaney, Michael Owner: ANDREOPOULOS, FOTIOS Job Address: 118 NW 101 Street Miami Shores, FL Project: <NONE> Contractor: QUINTANA ELECTRIC BROTHERS INC comments MASTER SUITE ADDITION AND KITCHEN REMODEL Inspection Type: Final Work Classification: Addition/Alteration Phone Number (305)301-7828 Parcel Number 1131010220200 INSPECTOR COMMENTS False Inspector Comments Passed Failed Correction ❑ Needed Re -Inspection ❑ Fee No Additional Inspections can be scheduled until re -inspection fee is paid. Phone: (305)986-5893 August 07, 2014 For Inspections please call: (305)762-4949 Page 1 of 31 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 FBC 20 13 v_ MAY 2 2013 Permit No. C LI1 3 I 1 Master Permit No.P-C"�> 11-. 0 JOB ADDRESS: 116 OSw 16 I S} ayee-f City: Miami Shores County: Miami Dade Zip: ?�31 S Folio/Parcel#: Is the Building Historically Designated: Yes NO V_.*_� Flood Zone: No OWNER: Name (Fee Simple Titleholder): t h (o5 Pfi' J(P0C0j Las Phnne#- -Aa . �0-' —_ iol - 7 v-8 City: _ K, &ry%� S�Noa s5state L,Zip. . 3315 0 CONTRACTOR: Company Name: �w Phone#: f Address: ® re?'P & C-7° '1�5 'o7 City: o State: Zip: Qualifier Name: A�9 Al V� Phone#: State Certification or Registration #: Certificate of Competency #: _ Contact Phone#: -4-L i� r� 5P Email Address: DESIGNER: Architect/Engineer: Phone#: Value of Work for this Permit: $ 10,901.1" .1" Square/Linear Footage of Work: Type of Work: OAddress Plteration AlONew OR Description of Work: VGr$ jp C c„� r -P_ CP'l t r®P) C' Submittal Fee $ �� Permit Fee $ CCF $ CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ Technology Fee $ TOTAL FEE NOW DUE $ A sbi ° 10 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 noti e, the inspection will not be approved and a reinspection fee will be charged A Signature v '� — Signature Owner or Agent The foregoing instrument was acknowledged before me this The foregoing ins went was acknowledged before me this�� day of .120 , by ttd �/lt� dj� ©�ou�p5 day of 20 f , by who is personally known to me or who has produced f,L a who is pens As identification and who did take an oath. O Fo . eao Print: Q r E • otary�3Assn, my u 11#111- rAPHUS May My Commission x a' oo-`�.- Commission # EE 79 Bonded Through National Nota Zoning Clerk NOTARY PUBLIC: Sign: Print: �,� r °�•,, RAQUEL A. 6CANDROUBii My C $ &ry PUNIC - state of Rorms i Pte, My Comm. Expires Oct 10, 2011 •:$„Q; .,Yq.•� Commission # EE 132379 Structural Review (Revised 3/1212012)(Revised 07/10/07)(Revised 06110rAW)(Revised 3/15/09) pally known to me who has produced � as identification and who did°take "' oath. d TARY P LIC: DEBARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD (850) 487-1395 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 MENDEZ, JUAN M UINTANA ELECTRIC BROTHER'S INC 60 E 60 ST HIALEAH FL 33013 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 bette 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 license! - — — DETACH HERE STATE OF FLORIDA Al✓# : 6 2 6 3 1.10 DEPARTMENT OF BUSINESS AND'. PROFESSIONAL REGULATION 800002546 08/11;(12 120060013 CERTIFIED BLECTRTCAL CONTRACTOR MENDEZ,JUAN M QUINTANA ELECTRIC BR+C iTHER" S INC I3 CRRTIFIE&D under the provisions,of Ch.489 F8 aspiration date, AUG 31, 2014 L12081100938 NC# 6263110 STATE OF FLORIDA DEPARTMENT' OF BUSINESS AND PRO1. S.SIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD SEi L12 6 8110 0 9 3 8 ICENSE NBR 08 11 2012.120060013 1ECO002546 - The:_ELECTRICAL CONTRACTQR RICK SCOTT KEN LAWSON GOVERNOR SECRETARY DISPLAY AS REQUIRED BY LAW CHIEF FINANCIAL OFFICER DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION * CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS COMPENSATION LAZA/ CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law. EFFECTIVE DATE: 05/29/2012 EXPIRATION DATE: 05/29/2014 PERSON: MENDEZ JUAN M FEIN: 650973171 BUSINESS NAME AND ADDRESS: QUINTANA ELECTRIC BROTHERS INC 4801 SW 6 ST MIAMI FL 33134 SCOPES OF BUSINESS OR TRADE: 1- CERTIFIED ELECTRICAL CONTRACTO IMPORTANT: Pursuant to Chapter 440 . 05(14), F.S., an officer of a corporation who elects exemption from this 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., Certificates of election to be exempt., apply only within the scope of the business or trade listed an the notice of election to be exempL 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 on 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) 413-1609 DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01-11 PLEASE CUT OUT THE CARD BELOW AND RETAIN FOR FUTURE REFERENCE 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 05/29/2012 EXPIRATION DATE: 05/29/2014 PERSON: JUAN M MENDEZ FEIN: 650973171 BUSINESS NAME AND ADDRESS: QUINTANA ELECTRIC BROTHERS INC 4801 SW a ST MIAMI, FL 33134 SCOPE OF BUSINESS OR TRADE 1- CERTIFIED ELECTRICAL CONTRACTO IMPORTANT F Pursuant to Chapter 440.05(14), F.S., an officer of a corporation who 0 elects exemption from this chapter by filing a certificate of election L under this Section may not recover benefits or compensation under this D chapter. Pursuant to Chapter 440.05(12), F.S., Certificates 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 440.05113), 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 on 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) 413-1609 CUT HERE * Carry bottom portion on the job, keep upper portion for your records. DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01-11 To: r- ager 2 of a 2014-03-10 17:07:41 (CiMT) From: Eastarn Insurance+ A!Rff CERTIFICATE OF LIABILITY INSURANCE si3%2o13 m THIS CERTIFICATE IS 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($), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certiticate holder is an ADDITIONAL INSURED, the policypes) must be endorsed. It SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In Neu of such endorsement(s). PRODUCER Eastern Insurance Group, Ino. 9570 SW 107 AvenueAopgM Suite 104 Miami rL 33176 CT David M. Lopez PHON o (305) 595-3323 . (903)393-'1133 car@eaaterninsurance.net WSU AFFORDING COVERAGE NAIL I Mid -Continent Casualt INSURED Quintana Electric Brother's, Inc. 4801 SW 6th Street Miami 11% 33134 INSURERS: INSURER C: gaURERD: INSURER E : 1 WSURERF: COVERAGES CERTIFICATE NUMBER Master 13-14 REVISION NUMBER: THIS IS TO CERTIFY 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. LTR TYPE OF INSURANCE RUUL SUM POLICY NUMBER MID PIMALIMITS A GENERAL LIABILITY S COMMERCIAL GENERAL LIABILITY CLAIMS -MADE ® OCCUR 4 -GL -000876789 /28/2013 /29/2014 EACH OCCURRENCE S. l -'0-0-0-'O00 M s omurowel $ 100,000 MEDEXP (Any one person) S Excluded PERSONAL SADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN L AGGREGATE LIMIT APPLES PER: B POLICY PROLOC PRODUCTS - COMPIOP AGG S 2,0 000 $ AUTOMOBILE LIABILITY ANY AUTO ALLOWNED SCHEDULED AUTOS N�OWNED HIRED AUTOS AUTOS e $ BODILY INJURY (Per person) S BODILY INJURY (Per eccidem) $ PROPERTY DAMAGE $ (Per addeMl $ UMBRELLA LIARHCLANS-MADE EXCESS LU1B OCCUR EACH OCCURRENCE S AGGREGATE S RETENTION $ S WORKERS COMPENSATION AND EMPLOYERS' LUIBILRYRYLIMI ANY PROPRIETORIPARTN£RJFOECUTNE ' OFFICERINEMBER EXCLUDED? (MandatoryIn NH) ifyyes desabe�ndel 1) EGI IPTION OF OPERATIONS below NIA C S ATU• O H- FR E.L.EACHACCIDENT $ E.L. DISEASE - EA EIVIPLOYEI S E.L. DISEASE - POLICY LIMIT S DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES Wtaoh ACORD 101, Addlderrel Remarks Schedule, If more space N required) Electrical Contractor City of Miami Shores Building & Zoning Department 10050 NE 2 Avenue Miami Shores, IFL 33138 ACORD25 (2010105) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED BI ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Lopez/AMANDA s �� 01988-2010 ACORD CORPORATION. All rights reserved. INSn7sonimsim Tho Af:ARn name anti Innn ora ronictoratlmar4c of arnnn 0®2755 ji w M x 4 i 01-400"W-1 AoomoohL r F sa oe1r 1 OWN"SEC YPE OF UBiNESSi ' Qljlil 1 ELECTRIC BRO _-IER s INC 196 CTRIC "60NTRAd�t f PAYRAEII�T $EIVEp BY TAXI a iAfor�ti(s) 2 EC00 !cToa ;$45 00 _012/2 { >f 7XH51-063 Th��dcal Busia Tax ReceiptBasitreas Tax The pt is not eaicense: p# r a certi� n of Ure h41 A gaaltli 'dl Wass.Hal �gtlge ommenw,*.og' tory � a w ay M any Wernme6l or Elie RECEIiii abover ' diapla'e pn all coi iel vehio de Sec F r a r!�iatermatiorypieh 1 =;