EL-14-2198Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-221115
Scheduled Inspection Date: October 10, 2014
Inspector: Devaney, Michael
Owner: RODRIGUEZ, MIQUEL
Job Address: 149 NW 105 Street
Miami Shores, FL
Project: <NONE>
Contractor:
Building Department Comments
Permit Number: EL -10-14-2198
Permit Type: Electrical - Residential
Inspection Type: Final
Work Classification: Addition/Alteration
Phone Number
Parcel Number
1121360080120
SERVICE CHANGE (TO CLOSE PERMIT# EL2005-305) Infractio Passed Comments
INSPECTOR COMMENTS False
Inspector Comments
Passed1Z_ 4 P,4
Failed
Correction ❑
Needed
Re -Inspection ❑
Fee
No Additional Inspections can be scheduled until
re -inspection fee is paid.
:tober 09, 2014 For Inspections please call: (305)762-4949 page 12 of 22
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
BUILDING
PERMIT A=ON
BUILDING ELECTRIC F� ROOFING
OCT 0 7 2014
Master Permit No. = @ 14 -22 9
Sub Permit No.
❑ REVISION ❑ EXTENSION ❑ RENEWAL
❑PLUMBING ❑ MECHANICAL F-1 PUBLIC WORKS k216HANGE OF ❑ CANCELLATION F_� SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS:
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: f7®$—®i -0 Is the Building Historically Designated: Yes NO
Occupancy Type: !�< oad:-d Construction Type: Flood Zone: BFE: FFE:
i`l ���AA z
OWNER: Name (Fee Simple Titleh(older): RC)rJVt_ 4 ZA_ W' �(sPhone#:
Address: :3-315-0
City: i &v-vn t 5 it ®ie S State: - ZIP:
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name:.- /4. 'r--1 echn-ca Phone#: t5y_ — LfD b r)
Address: I U?� ' '5' 0- 1 14 ye -
City: 1+0 f (td L� t> ®� State: r -z' zip: --33 a 0-0
Qualifier Name: J-0 A P, L tPhone#:q' t/-1 G.7 _ tt` D (0-0
State Certification or Registration #: ge— 0<3 ® 0 33p / Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $ Square/Linear Footage of Work:
Type of Work:
❑ Addition ❑ AlterationF , (_\ New ElRepair/Replace Demolition
Description of Work: --� �' tL _�
Specify color of color thru tile;
Submittal Fee $-to Permit Fee $4�
�O CCF $ a ° CO/CC $
Scanning Fee $ Radon Fee $ DBPR $ �.
" F � Notary $
Technology Fee $ C) Training/Education Fee $� Double Fee $
Structural Reviews $ 2P Bond $
TOTAL FEE NOW DUE $ 3
(Revised02/24/2014)
Bonding Company's Name (if applicable)
Bonding Company's Address
City
State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City
Zip
State 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 ELECTRIC, PLUMBING, SIGNS, POOLS,
FURNACES, BOILERS, HEATERS, TANKS, 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�Rtt
ditio issuance of a building permit with an estimated value exceeding $2500, the applicant must
promise in goo f 'th thaopy of the no . e of commencement and construction lien law brochure will be delivered to th person
whose grope is bjedachmentAls , a certified copy of the recorded notice of co enceme mus apo ted a e jo site
for the first i` spe 'on hick ochrs seven 7) days after the building permit is iss d. In he enc f su p d no e, the
inspection wi not a ap roved an a reins ection fee will be charged.
AGENT
The foregoing instrument was acknowledged before me this
0_ dayof On 20. by
is personally known to
me or o has prod ucedat&Ary as
Identification and who did take an oath.
NOT
Sign
Prini
Seal
The foregoing Ihst
_ day of
me or who has produced
was acknowledged before me this
20 �_, by
who is personaliy known to
as
identification and who did take an oath.
NOTARY PUBLIC:
Print:
Seal:
i
b
Po r, 9N
�/�-' �Cv ✓x1
APPROVED BYPlans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
RICK SCOTT, GOVERNOR
KEN LAWSON, SECRETARY
STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
ELECTRICAL CONTRACTORS LICENSING BOARM
EC130033dl ADDITIONAL BUSINESS QUALIFICATION
The ELECTRICAL CONTRACTOR
Named below IS CERTIFIED
Under the provisions of Chapter 489 FS.
Expiration date: AUG 31, 2018
LIPKA, JOHN S
JTTDBS EOU ERPP SE� F° M'LYWQ,OD LI C DIL EH WHITSON ELECTRICAL
HOLLYWOOD - FL'33020
ISSUED: 08/10/2014 DISPLAY AS REQUIRED BY LAW SE®# L1408100=104
BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT
115 S. Andrews Ave., Rm. A-100, Ft. Lauderdale, FL 33301-1895 — 954-831-4000
VAUD OCTOBER 1, 2014 THROUGH SEPTEMBER 3o,2015
DBA: Receipt#:�ciicAL/ALARNS/CONTRACTOR
Business Name: JTDB ENTERPRISES OF HOLLYWOOD LLC DBA EH WHITSON ELECTRICAL Business Type: (ELECTRICAL CONTRACTOR)
Owner Name: JOHN S LIPKA
Business Location: 421 S 21 AVE
HOLLYWOOD
Businew Phone:954-927-4060
Business Openedm./01/2006
State/C0U ffty1CertR9g:EC13 0 0 3 3 01
Exemption Cade:
Roams Sam Employe" Machines professionals
3
For Vending 8usloess oar
Number of Machines: Vending Type:
Tax Amount
Transfer Fee I
NSF Fee I
Penalty
Prior Years
Collection Cost
I Total Palo
27.00
I 0.00
0.00 1
0.00
0.00
0.00
27.00
THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS
THIS BECOMES A TAX RECEIPT This tax is levied for the privilege of doing business within Broward County and Is
non -regulatory in nature. You must meet all County and/or Municipality planning
WHEN VALIDATED and zoning requirements. This Business Tax Receipt mast be transferred when
the business is sold, business name has changed or you have moved the
business location. This receipt does not indicate that the business is legal or that
it is in compliance with State or local laws and regulations.
Mailing Address:
JOHN S LIPKA
423 S 21 AVE
HOLLYWOOD, FL
33020
2014 -2015
Receipt #ICP -13-00013315
Paid 00/22/2014 27.00
A� Ro CERTIFICATE OF LIABILITY INSURANCE
1 i2oDD�
THIS CERTIFICATE IS ISSUED AS A NATTER 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: ff the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. ff SUBROGATION IS WANED, 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
Keyes Coverage Insurance
5900 Hiatus Road
Tamarac FL 33321
CONTACT
NAME: Suzie B.
PHONE FAX
A/C Ext 954-724-7000 %1C hft- -
ADDRESS: Suzieb@ke escovera e.com
Y
PROcusp MER m 12193
INSURER(S) AFFORDING COVERAGE MAIC #
3/7/2014
INSURED
E. H. Whitson Electric
JTDB Enterprises of Hollywood LLC
INSURERA:Allied Property & Casualty Ins Co 42579
INSURERB:Associated Industries Ins. Co. 23140
wsuRERc:Philadelphia Insurance Co ani
423 S. 21st Avenue
INSURER D: Commerce and Industry Ins. Co 19410
Hollywood FL 33020
INSURER E:
PRODUCTS -COMp/OpAGG $2.000,000
INSURER F:
C
COVERAGES CERTIFICATE NUMBER. -1 -41 '44A774-4 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.
INSLTR
TYPE
TYPE OF INSURANCE
ADDL
N
SUER
POLICY NUMBER
POLICY EFF
POLICY EXP
LtMrrS
A
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
CLAIM84IADE FTI OCCUR
Y
Y
ACP GLPO 5924902956
3/7/2014
3/7/2015
EACH OCCURRENCE $1,000,000
PREMISES Me o=rre=)$100,000
MED EXP (Arty one person) $Excluded
PERSONAL 8 ADV INJURY $1,000,000
GENERAL AGGREGATE $2,000,000
GEN'LAGGREGATE LIMIT APPLIES PER:
X POLICY X PRO LOC
PRODUCTS -COMp/OpAGG $2.000,000
$
C
AUTOMOBILE
X
X
X
LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NOWOWNED AUTOS
Y
Y
PHPK1142682
3/7/2014
3/7/2015
COMBINED SINGLE LIMIT $1,000.000
(Ea accident)
BODILY INJURY (Per person) $
BODILY INJURY (Per accident) $
PROPERTY DAMAGE $
(Per scoident)
$
D
X
UMBRELLA LIAB
EXCESS LIAS
X
OCCUR
CLAIMS -MADE
080610367
3/7/2014
3/7/2015
EACH OCCURRENCE $1,000,000
AGGREGATE $1,000,000
X
DEDUCTIBLE
RETENTION $0
Uaderl in : GL/AL/EL $
Follow Form $
B
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY YIN
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED? ❑
(Mandatory In NH)
If yyes, describe under
DESG JPTI�V OF OPERATIONS below
N I A
Y
ANC2437041
3/5/2014
3/5/2015
X WCSTATU X OTH
1141I$
E.L. EACH ACCIDENT $500,000
E.L. DISEASE - EA EMPLOYE $500, 000
E.L. DISEASE - POLICY LIMIT 1 $500, 000
DESCRIPTION OF OPERATIONS ! LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, H more space Is required)
Certificate holder is included as an additional insured when required by written contract
CERTIFICATE HOLDER CANCELLATION
O 1988-2009 ACORD CORPORATION. All rights reserved.
ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED
BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED
IN ACCORDANCE WITH THE POLICY PROVISIONS.
MIAMI SHORES VILLAGE
10050 N.E. 2ND AVENUE
MIAMI SHORES FL 33138
AUTHORIZED REPRESENTATME
I
* Kf
O 1988-2009 ACORD CORPORATION. All rights reserved.
ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD
Property Search Application - Miami -Dade County
Pagel of 5
.e
�.:off _
Detailed Report
Property Information
Folio:
11-2136-008-0120
Property Address:
149 NW 105 ST
Owner
MIQUEL RODRIGUEZ &W ELSA
Mailing Address
149 NW 105 ST
MIAMI SHORES, FL 33150-1243
Primary Zone
0800 SGL FAMILY -1701-1900 SQ
Primary Land Use
0101 RESIDENTIAL - SINGLE
FAMILY: 1 UNIT
Beds / Baths / Half
2/1/0
Floors
1
Living Units
1
Actual Area
1,902 Sq.Ft
Living Area
1,306 Sq.Ft
Adjusted Area
1,582 Sq.Ft
Lot Size
9,150 Sq.Ft
Year Built
1950
Assessment Information
Year
2014
2013
2012
Land Value
$98,074
$44,981
$44,981
Building Value
$107,260
$107,260
$118,170
XF Value
$2,063
$21093
$2,514
Market Value
$207,397
$154,334
$165,665
Assessed Value
$98,827
$97,367
$95,740
Benefits Information
Benefit
Type
2014
2013
2012
Save Our Homes
Cap
Assessment
Reduction
$108,570
$56,967
$69,925
Homestead
Exemption
$25,000
$25,000
$25,000
Second Homestead
Exemption
1 $25,000
$25,000
$25,000
Note: Not all benefits are applicable to all Taxable Values (i.e. County,
School Board, City, Regional).
Generated On: 10/2/201A
Taxable Value Information
2014
2013
2012
County
Exemption Value
1 $50,000 $50,000
$50,000
Taxable Value
1 $48,827 $47,367
$45,740
School Board
Exemption Value
1 $25,000
$25,000
$25,000
Taxable Value
1 $73,827
$72,367
$70,740
City
Exemption Value
$50,000
$50,000
$50,000
Taxable Value
$48,827
$47,3671
$45,740
Regional
Exemption Value
$50,000 $50,000
$50,000
Taxable Value
$48,827 $47,367
$45,740
The Office of the Property Appraiser is continually editing and updating the tax roll. This website may not reflect the most current information on record. The Property
Appraiser and Miami -Dade County assumes no liability, see full disclaimer and User Agreement at httoJ/www.miamidade.aovfinfo/disclaimer.asp
Version:
http://www.miamidade.gov/propertysearch/ 10/2/2014
Property Information
Folio: 11-2136-008-0120
Property Address: 149 NW 105 ST
Full Legal Description
DUNNINGS MIAMI SHORES EXT 4
PB 48-20
LOT 12 BLK 204
LOT SIZE 75.000 X 122
OR 11472-812 0682 1
Sales Information
Previous Sale Price OR Book -Page Qualification Description
06/01/1982 $60,000 11472-0812 12008 and prior year sales; Qua[ by exam of deed
The Office of the Property Appraiser is continually editing and updating the tax roll. This website may not reflect the most current information on record. The Property
Appraiser and Miami -Dade County assumes no liability, see full disclaimer and User Agreement at httoJ/www.miamidade.aovfinfo/disclaimer.aso
Version:
http://www.miamidade.gov/propertysearch/ 10/2/2014
Miami horesVillage
Building Department
OCT47 2014 10050 N.E.2nd Avenue
Miami Shores, Florida 33138
°-� Tel: (305) 795.2204
Fax: (305) 756.8972
CHANGE OF CONTRACTOR /ARCHITECT
:Permit N. 0 L g ®®,5-- 3 0,5-
Owner's Name .(Fee simple Tills Holder): rni I r,Z ► phone #:
Owners Address: t 0 6+
City: M i i vvI C 511®rts
state: FL Zip Code, -!50)5Q
Job Address (of where work is being done): 1 Ll 01 /V to / 0� 6 F
City: Miami Shores State,—Florida
Tip Code:2�� %�C�
Contractor's Company Name: e, 14, L
Address: q a- 3
City:. -
Qualifier's Name:
o d State: Zip Code: –33®-�--a
h v� 5 • Li D k Lic. Number
Architect/ Engineer of Record Name: Phone #:
Address:
City: State: Zip Code:
Describe
I hereby
Signature
The foregoing it
this ( day of
& word as been abandoned and/or the col
to co late the contract. l hold the 8 In
nl S res harmless for all legal lnv omen
Signature wedged be re me The foregoPng in ent was
this I day o
who known to a or D
has produced
`�Y-'�Y-- as indenticaiion.
`v0 � o•�
Sign' �0t 5,20
' �Q.0 Cho
Seal: a :� ,®
@FF
0
a�
Who Is personally known me or who has produced
as indentiflcadon.