Loading...
EL-14-1117Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-214339 Scheduled Inspection Date: August 05, 2014 Inspector: Devaney,Michael Owner: KENNETH A CHRISTIANSEN, XAVIER UM00-'1f% Job Address: 155 NW 94 Street Miami Shores, FL 33150 - Project: <NONE> Permit Number: EL -5-14-1117 Permit Type: Electrical - Residential Inspection Type: Final Work Classification: Alteration Phone Number (305)801-4394 Parcel Number 1131010330700 Contractor: CARIBE S ELECTRIC INC Phone: (786)255-6212 tsuiming uepartment comments REPLACE EXISTING GFCI INSPECTOR COMMENTS False Inspector Comments Passed E�f Failed Correction ❑ Needed Re -Inspection Fee No Additional Inspections can be scheduled until re -inspection fee is paid. August 04, 2014 For Inspections please call: (305)762-4949 Page 9 of 32 Miami Shores Village 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 BUILDING PERMIT APPLICATION Permit Type: Electrical MAY 3 0 2014 .-i A. FBC 20 %0 Permit No. )/ � l q – �l -)j— Master Permit No. z G ��� .r JOB ADDRESS: (eL -� City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated: Yes NO e,,� Flood Zone: -�W i OWNER: Name (Fee Simple Titleholder): e , A ��� i /� s e. i �' ` "��� Phone#:� Address: ukl 7— SV City: hl ! CJt 7.7I �'a i �7ti N° State: /�. Zip: Jl Tenant/Lessee Name: Phone#: Email CONTRACTOR: Company Name: B a1 22 �a'17 Phone#: 6i7j) Address: City: State. Zip: Qualifier Name: /74, ? s' t'd> �� e�`�' �- Phone#: �i�� Li41115. State Certification or Registration #: t ®s " c''✓ ' / Certificate of Competency #: Contact Phone#: Email Address: DESIGNER: Architect/Engineer: Phone#: Type dfVNAI �!Uj ddrer ❑Alteration ❑ V6,1041 ,0 sp g ) uPai l pla epp 3 • ❑Demolition till�Y34�?.: rQS 4gbpu,of.Work:2h j 'iW Submittal Fee $ Permit Fee $ XCCF $ CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ 2 L 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 absen a of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature .L y Signature Owner r Agent Contractor The foregoing instrument was ack owledged before me this Y 4 , da of r z , 20 , v'l by l' �i� wh personly kn�p+rt ane or who has produced fication and who did take an oath. NOT The foregoing instrument was acknowledged before me this/ day of is C c , 20 4[ by 2 ®r I? d�.0 who is �on�y knowntoe or who has roduced ,J as identifii n and who did take an oath. IQC171 AMM ' RAY ROQUE RAY NUUM Sign: .ot Sign: _ -tate of Florio Print:'•1 My Comm. Expires Dec 17, 2017 Print: �`, '• My Comm. Expitso Dec 17, '0 MW omm a ; .FF M Commission fires: •� t `'°�'`,� IbRonel A� Y ��� Natlotal tiatary Assn. My Commissio Exp s. ���xx��xx���x�x����x���x�x����x�x�x,�x�x�x��x��x�x�x��x•x�x�x�x��x��xx��m�x�x�xu��x��x�x��x��x���x��x�x���x�x+xx��x���x�x��x���xx�x��x�x�xmx���xx��x�xx��xx•�x��x���x�mx��x�x�x�xm APPROVED BY Plans Examiner Zoning Structural Review (Revised 3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09) 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 B. ✓ COPY OF LOCAL BUSINESS TAX RECEIPT C.PY OF LIABILITY INSURANCE* D. OPY OF WORKERS COMPENSATION INSURANCE 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 STATE REGISTERED CONTRACTOR LICENSE OR MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT. C. COPY OF LIABILITY INSURACE* D. COPY OF WORKERS COMPENSATION INSURANCE* *YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE AS FOLLOW: Certificate Holder: MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES, FL 33138 Certificate must specify the description of operations or contractor license number. ........................................... BUSINESS NAME: nL,& 6 - 9W 7 BUSINESS ADDRESS: k,2 .7 7- CITY 161 STATE 7i ZIP CODE --75302- BUSINESS -75302- BUSINESS PHONE: (r) 0 Pa - FAX NUMBER dL) 0 as -tel 0 CELL PHONE -)( ) 21-r -6 2i2 QUALIFIER'S NAME: I-IVortl�/yah QUALIFIER'S LIC NUMBER: E -C' ` /3096"/ Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Notice to Owner — Workers' Compensation Insurance Exemption Florida Law requires Workers' Compensation insurance coverage under Chapter 440 of the Florida Statutes. Fla. Stat. § 440.05 allows corporate officers in the construction industry to exempt themselves from this requirement for any construction project prior to obtaining a building permit. Pursuant to the Florida Division of Workers' Compensation Employer Facts Brochure: An employer in the construction industry who employs one or more part-time or full-time employees, including the owner, must obtain workers' compensation coverage. Corporate officers or members of a limited liability company (LLC) in the construction industry may elect to be exempt if: The officer owns at least 10 percent of the stock of the corporation, or in the case of an LLC, a statement attesting to the minimum 10 percent ownership; The officer is listed as an officer of the corporation in the records of the Florida Department of State, Division of Corporations; and The corporation is registered and listed as active with the Florida Department of State, Division of Corporations. No more than three corporate officers per corporation or limited liability company members are allowed to be exempt. Construction exemptions are valid for a period of two years or until a voluntary revocation is filed or the exemption is revoked by the Division. Your contractor is requesting a permit under this workers' compensation exemption. In these circumstances, Miami Shores Village does not require verification of workers' compensation insurance coverage from the contractor's company. Therefore,oy u may be personally liable for the worker compensation injuries of anyperson allowed to work under this permit. Please check with your insurance carrier since most property insurance policies DO NOT cover this type of liability. BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. Owner Print Name: v fie Signature: State of Florida ) County of Miami -Dade ) 22 Sworn to and subscribed before me this day of -C �. �y,nnllllliii,,� By I � pb�2(� SEAL Type of Iden ` a on prod _ 41 JW111A gLQZ190� ;' "1 '!194 /!s SO�'\.�`�� 1111111111,\O�� Contractor Print Name: Signature: State of Florida ) County of Miami -Dade ) Sworn to an4 subscrib day of C LIM of before me this 2-J5>1 '_1� 20 1 y . W - State of Florida Expires Dec.17. 2n17 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION • ELECTRICAL CONTRACTORS LICENSING BOARD (850) 487-1395 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 HERNANDEZ, HENRY CARIBE S. ELECTRIC, INC. 289 E 64TH ST HIALEAH FL 33013 Congratulations! With this license you become one of the neany one= 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,myflor'idalicense.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! "vicEggl0i, t4um RjeR, STATE OF FLORIDA QW DEPARTMENT OF BUSINESS AND PROFESSIONALREGULATION EC13005471 ISSUED:. 08/28/2013 CERTIFIED ELECTRICAL CONTRACT OR HERNANDEZ, HENRY. CARIBE S. ELECTRIC, INC, IS CERTIRED under the provisions of Ch.489 FS. ExprWwdale AUG 31;2014 0 The Department of State is leading the commemoration of Florida's 500th anniversary in 2013. For more information, please go to www.VivaFlorida.org, DETACH HERE STATE OF FLORIDA DEPARTMENT OF IBUSINE4J Named below IS CERTIFIED Under the provisions of Chapter 489 FS, Expiration date: AUG 31, 2014 HERNANDEZ, HENRY CARIBE S. ELECTRIC, INC. 1770 WEST 40TH STREET BAY 3-4 HIALEAH FL 33612 RICK SCOTT ISSUED: 0812817013 $EQ# L1308280001295 GOVERNOR DISPLAYAS REQUIRED BY LAW KEN LAWSON SECRETARY SM ..... _............ ._.. Lool Business Miami -Dade County, p tete f Florida THIS IS NOT A FILL -DO NOT F Ai' 5723094 tot BUSINESS t ArAE&*cA I RECEIPT R#O.CARIBESFELECTRICNyp 7 t o ST c RENEWAL ti9u8;71 138871EXPIRES p 2014 HKLEAK, FL 33042 Kart be dmplayed -�t f't+asrst ts �':x�arzf y ��nas Chalieriia;',...Art. 4 -t OWNER SEC TYPE= OF BUSINESS CAME S ELECTRIC INC PAYMENT RECEIVED CCONTRACTORCONTRACTOR� I ELECTRICAL BY TAX COLLECTOR CONTRACTOR k5,00i}9i9t21313 r{5} ? EC1 bQ 1 471 TXHS1..13.071354 This lacol msfnoss Tax RncAP only COMM$ pay€oont of tha local ownesn TAX' Iha Receipt is nova licoese, portrait, or a tofligcalion of the holdar's gnali6tatiau x, to do business, Halder avast tomply with anygovelmngutal or nougovar manfal regnlalory laws and rogairemenls which ,apply to the hnsinoss The RECEIAT 1441, 8I)M mnsf ba displayed on all commercial vehiclos -Miami-sade Code Setsa2x. hOI For mora information, vc*,www miamid;gle R #kgII" r CERTIFICATE OF LIABILITY INSURANCE i DAT 05/2814 I 05/28/14 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVi LY 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 certincote holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. if 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 lieu of such endorsement(s)._____ --- --- CONTACT Lucia Estrella - PRODUCER _ NAME:-._,_____�._...._.....-__. — Accurate PHONE 5 226-8727 FAx (305)226-876 _(AIC, .__ NoExt), _�-30- �- _— -LNC, No), - E-MAIL luciaestrella o@bellsouth.net 8300 West Flagler Suite 114 ADDRESS:-.-_ 11 Miami, FL 33144 INSURER §) AFFORDING COVERAGE —_ _,_ -, _ NAIC Phone (305)226-8727 Fax (305)226-8767 INSURER_A_ Ascendant insurance Company INSURED INSURER B: — ­ ---- Caribe : Caribe S. Electric Inc 1770 West 40th Street Bay 3 & 4 Hialeah, FL 33012- (305) 822-8449 CERTIFICATE NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HA' INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDE EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HA' LTR TYPE OF INSURANCE 'ADDLSUBIR NgR — - POLICY NUMBE_ GENERAL LIABILITY Q COMMERCIAL GENERAL LIABILITY ❑❑ CLAIMS -MADE 0 OCCUR I Y Y GL -42223-0 A GEN'L AGGREGATE LIMIT APPLIES PER: POLICY ❑ ECT..-._ ❑ LOC AUTOMOBILE LIABILITY �T ❑ ANY AUTO OWNED ❑ AUTOSULED ❑ AALL UTOS NON -OWNED ❑ HIRED AUTOS ❑ AUTOS ! ❑ El LIAR ❑ OCCUR � ❑ EXCESS LIAR ❑ CLAIMS -MADE 1 ❑ DED ❑ RETENTIONS— WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ! ANY PROPRIETOR/PARTNER/EXECUTNE OFFICER/MEMBER EXCLUDED? N IA Y (Mandatory In NH) IE qS , describe under DESCRIPTION OF OPERATIONS below I� DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES (Attach ACORD 101, Additional F ELECTRICAL CONTRACTOR — LICENSE# EC -13005471 CERTIFICATE t1ULUEK MIAMI SHORES VILLAGE BUILDING DEPARTMENT 10050 NE 2nd AVE MIAMI SHORES, FL. 33138 ACORD 25 (2010/05) QF INSURER C :--- INSURER 1 INSURER E: INSURER F: REVISION NUMBER: IE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS D BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, IE BEEN REDUCED BY PAID CLAIMS. R POLICY EFF i POLICY EXP I LIMITS _ ;L__ DDIYYYY). LM/ODIYYYY)_!- I EACHOCCURRENCE 1,000,000.00 DAMAGE TO RENTED $ 100 000.00 i -PREMISES LEaocfurrenee) ___�_ . MED EXP (Any one person) s 5,000.00 06/06/2014 06/06/2015 PERSONAL & ADV INJURY i S 1,000,0_00.00_ j GENERAL AGGREGATE S 2,000,000.00 PRODUCTS • COMP/OP AGG $ _1,000,000.00 i Deductible ! $ 500.00 ' BODILY INJURY (Per person) 1 $ BODILY INJURY (Par accidenlj S - PROPERTY DAMAGE Per accident) I S I EACH OCCURRENCES AGGREGATE $s WC STATU-M 0TH- ❑ 70.�Y LIMLTS ER EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE S E.L. DISEASE -POLICY LIMITi S emarks Schedule, if more space is required) CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDA ITH T E POLICY PROVISIONS. AUTHORIZED E 1 T TI Lucia Estrell ©1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD CXr CERTIFICATE OF LIABILITY INSURANCE DAT£(MMIDDIYYYY) '..-' � 08126!13 i THIS CERTIFICATE IS ISSUED ASA 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(les) must be endorsed. If 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 lieu of such endorsement(s). PRODUCER CONTACT First Class Insurance Market PHONE305 1-2997 _ A1C Nos 305)441-6443 14101 NW 9th Street pRSg: fcimc@aol.com _.. Miami, FL 33126 INSURERS) AFFORDING COVERAGE ; - NAtC @ Phone (305)441_2997 Fax (3055441-6443 INSURER A : _SOUTHERN INSURANCE COMPANY INSURED INSURER B. i CARIBE S ELECTRIC 1770 W 40 ST BAY INSURER D, MIAMI, FL 33012 _INSURER E : J,N -.—...._.._....._---._.1 SURER F _ OV - - CERAGES CER_—_TI-'nNUMBER: REVISION NUMBER: THIS IS TO CERTIFYTHAT 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 OFSUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ___..._..... _-------- _ ...._ ......—._� --- __.—.__....._........ — INSR ADD SUER POLICY EFF I POLICY EXP LIMITS TYPE OF INSURANCE - POLICY NUMBER•_ ,_— MMIDD MM DDlYYYY _....,._.....__. _ ......_..—� GENERAL LIABILITYEACHDA- OCCURR M l'0 i2ENTED COMMERCIAL GENERAL LIABILITY ........ ❑ ❑ CLAIMS -MADE ❑ OCCUR MED EXP (Any one p -non $------------ ❑ _PERSONAL & ADV INJURY $ ❑ - GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP AGG $ ❑ POLICY ❑-M ❑ LOC$ -- -- EDtS BODILY AUTOMOBILE LIABILITY RoLE UNIT I OM81N — ❑ ANY AUTO INJURY (Per person) $ ALLUWNtU SUHFUULtU BODILYINJURY(Peraccident)$ E] AUTOS ❑ AUTOS ❑ HIREDAUTOS ❑ AUTOS NON -OWNED FO TYnI AMAGE de $ E 11 $ ❑ UMBRELLA LIAB ❑ OCCURJ --t--EACH OCCURRENCE S — I—I EXCESS LIAB I -I CLAIMS MpOE AGGREGATE — $ CERTIFICATE HOLDER MIAMI SHORES VILLAGE BUILDING DEPARTMENT 10050 NE 2ed AVE MIAMI SHORES, FL. 33138 ACORD 25 (2010/05) QF CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 198f2010ORD CORPORATION. All rights reserved. The AC RD naddll9 and logo are registered marks of ACORD WORKERS COMPENSATION d CRY AND EMPLOYERS' LIABILITY Y I N ANY PROPRIETORIPARTNEPJECECUTIVE NIA PWC006950-13 Q810212013 08/0212014 EACH A OFFICERINEMBER EXCLUDED? j (Mandatory in NH) L� E.L. DISEA Ifdescdbe under DESCRIPTION OF OPERATIONSbdoW i_ - E.L. DISEA __- ...__ . _ ...... ... DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, ff more space is required) ELECTRICAL CONTRACTOR – LICENSE# EC -13005471 CERTIFICATE HOLDER MIAMI SHORES VILLAGE BUILDING DEPARTMENT 10050 NE 2ed AVE MIAMI SHORES, FL. 33138 ACORD 25 (2010/05) QF CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 198f2010ORD CORPORATION. All rights reserved. The AC RD naddll9 and logo are registered marks of ACORD