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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.