EL-13-2573I'
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-209532 Permit Number: EL -11-13-2573
Scheduled Inspection Date: March 24, 2014 Permit Type: Electrical - Residential
Inspector: Devaney, Michael
Inspection Type: Final
Owner: MIRAMONTES, CARLOS & BARBARA Work Classification: Alteration
Job Address: 674 GRAND Concourse
Miami Shores, FL 33138- Phone Number
Parcel Number 1132060171950
Project: <NONE>
Contractor: MTEL-ONE INC Phone: (866)900-6835
comments
LOW VOLTAGE WIRING FOR SPEAKERS WS AND
SECURITY SYSTEM INSPECTOR COMMENTS False
Inspector Comments
Passed
Failed
Correction ❑
Needed
Re -Inspection ❑
Fee
No Additional Inspections can be scheduled until
re -inspection fee is paid.
March 21, 2014 For Inspections please call: (305)762-4949 Page 25 of 27
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
FBC 20
NOV 13 2013
Permit No. Ell 3 - 622 34
Master Permit No. 11-15 -4 m
JOB ADDRESS: �14
City: Miami Shores County: Miami Dade Zip: 13138
Folio/Parcel#:
Is the Building Historically Designated. Yes NO Flood Zone:
OWNER: Name (Fee Simple Titleholder): [l (\G H 04 Phone#: 0'! 9 � � 19 -
Address: G`+ � �r t® Ce Ac.0jr-Se
City: 1 iut°t°II S�1 n/'Z, State: r Io CtdA� Zip:
Tenant/Lessee Name:
Email: '� mi rc
CONTRACTOR: Company
Address: 1000 7 An
In
City:� 1— L State: _ 1�1 p n a o� Zip: � 3 ` S
Qualifier Name: M c, r% o I" I o a tt t Phone#:
State Certification or Registration #: Gf 000 0 5 5 1.,� Certificate of Competency #:
Contact Phone#: 9 S 9 9 0'3-+`jO Email Address.
DESIGNER: Architect/Engineer: Phone#:
Value of Work for this Permit: $ I 0 0 0 SquarelLinear Footage of Work:
Type of Work: ❑Address ❑Alteration ;Wew ❑Repair/Replace
Description of Work: LOW VUI+AAe_ 0 % f ► Aa f. e- Spe,a1 US .
- � eA _c1� LA^ 2.r�( 1 -11, 1
Submittal Fee $ f)C)` o v Permit Fee $ CCF $ CO/CC $
Scanning Fee $
Radon Fee $
Notary $ Training/Education Fee $
Double Fee $ Structural Review $
DBPR $ Bond
Technology Fee $
❑Demolition
TOTAL FEE NOW DUE $ P-1
4 1
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
Owner or Agent
The foregoing instrument was acknowledged before me this
day of , 20 _, by ,
who is personally known to me or who has produced
As identification and who did take an oath.
r
Signature A A IL
Contractor
The foregoi Tinstrument was acknowledged before me tys
day of 0 , 20 13, by t @�
who is personally kno to me or who has produced
as identification and who did take an oath.
NOTARY PUBLIC: NOTARY P LIC: x.40 Notary Public Stab of Florida
Arany Norstto
My Commission EE 848929
Sign: Sign: 12/14/2018
AL
Print: Print: `-
My Commission Expires: My Commission Ex ires: , Z/ tq I I
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APPROVED BY In' Plans Examiner Zoning
Structural Review Clerk
(Revised 3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09)
Miami Shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
CONTRACTORS' REGISTRATION
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. COPY OF LIABILITY INSURANCE*
D. COPY 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 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 HOLDER AS FOLLOW:
MIAMI SHORES VILLAGE BLDG DEPT
10050 NE 2ND AVE
MIAMI SHORES, FL 33138
COMPLETE CONTRACTOR'S INFORMATION
BUSINESS NAME: N�j O N F—
BUSINESS ADDRESS: �) 2 Lks CITY u "1 0-
STATE (T—e ZIP CODE
BUSINESS PHONE: ( L 6 ) 10 FAX NUMBER �)
CELL PHONE &i) � q ® 7 ;F� ID QUALIFIER'S NAME: H M o PALS
QUALIFIER'S LIC NUMBER: ' o a 0 S S-�
Created on 3119109 BY MLDV I RV 3126109 MLDV I RV 6127111 AS
NOV-13-2013 WED 03:42 PM A & A INSURANCE FAX N0, 954 755 4639
P. 01
t N � CERTIFICATE Off' LIABILITY INSURANCE
DA11`13/2013
11/13/2013
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATWLY AMEND, EXTEND OR AI-TI;R 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 WAiYEd, subject to
the terms and conditlons of the policy, Certain policies may require an endorsement. A statement on this C6rtiflcate does not confer rights to the
certificate holder In lieu of such endorsement a .
PRORUCER
A & A INSURANCE AGENCY
9777 W. SAMPLE RD.
CORAL SPRINGS, FL 33065
NT
PN°r+a 954-756.4850 F :954755-4839
PriLiCY E%P
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_
INSUDERM AFFORDINO COVERAGE NATO V
INSURIM ,•,.
MTEL ONE, INC
2000 SANK$ ROAD
SUITE 2116
MARGATE, FL 33063
INSURKRA t SCiOTTSDALE
•--_,�
SHU et,_„
INSUR e, CASTLEPOINT FLORIDA INSURANCE CO.
INSURER D:
IW '
e1SURlet F s
COVFRA=PN WIIYRRM. RFvM1nNI NIIMMIRR.
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 8E 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.
INBR
TVPF OF UMURANOE
D
Bflstil
POI�CY NUY6ER
POLICY �F
PriLiCY E%P
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A
GENERALUAMILM
X COMMERCIALGENERA6LIAeILITY
CLAIMS -MADE a OCCUR
_
X
CLS893445803/02/2013
IW '
FA OCCURRENCE $ 2,000,000
S 50 00
._..
691-_ ,
MED LXP An te aettwt >b 5 000
PERSONAL& ADV INJURY $ 1,000,000
GENERALAGGREGATE $ 2,000,000
oEMLAGGREGATE UMITAPKIFSPER
Fx__1 POLICY F7 P LOO
PRODUOYS-COMPIOPAGG S 1000000
S
AUTOUG "L1ABILMV
ANY AUTO
ALL OWNED AUTOS
SCHEDIJLEO AUTOS
HIRED AUTOS
NON -OWNED AUTOS
COMBINEO SINGLE LIMIT $
(Ea acddenti
BODILY INJURY (gar person) S
BODILY INJURY (Per Udder") $
PROPERTY DAMAGE
(Par adddenn $
8
UNdRELLq WAS
OCCESS LIAR
OCCUR
CLAIMS -MADE
OCOIJRRENCE S
AGGREGATE $
DEDUCTIBLE
RIFFENTION 1,
$
C
WORMISOOMPONSATION
AND gr<PLOYeRs1 L(AsnJTr YYY /// t�N1
ANYPpppppPRRIETORH'ARTNERIF�CUTIVE
OFFIC♦1�(MME1AMH) ExCLttDEOT
yea deadlbl e u dw
DESCRIPTION OF OPERATIONS
N/A
WOP760683802
12/03/201212/03/201
X W BTATU O R
E.LEACHACCIDE ,�..» £ . ti 1Z10,Oa0
E.L. 0I60M - EA EMPLOYEE S 500.000
E.L. OIWSF - POLICY OMIT 100,000
L7EACRU+TION OF QPERATIONS /LOCATIONS / V1i110LE8 (A1geWt ACORD 10I, At1HIUelg1 Reauliu Se1leLule, it mare spSea a rpulratt)
CITY OF MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
10050 NE 2 AVENUE
MIAMI SHORES VILLAGE, FL 3313E
SHOULD AMY OF THE ABOVE DESCRIBED POLICIES 08 CANCELLED BEFORE
THE EX TION DATE THEREOF, NOTICE WILL SE DELIVERED IN
ACCORO4=19 WTrH THE POLICY PROVISIONS.
0 12804 ACORD CORPORATION,
ACORD 2S =011/09) The ACORD name and loan aro real marks of ACORD
S`ep 14 12 03:45p Jorge Benitez
9544180116
STATE OF FLORIDA
DEPARTMENT OF BIISINESS AND PROFESSIONAL REGULATION
vo,—,ELECTRICAL CONTRACTORS LICENSING BOARD
TALLAHASSEE ONROE STREET
TALLAHASSEE
MORALES, MARIO
MTEL - ONE INC
2000 BANKS ROAD
MARGATE
MATTHEW
SUITE 206
FL 33063
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012 47.2 11-2 8 0 6212'7 :EF2 0
ALARA SY$ 'EPIf :CANT CT0
Naaned be:1Qw. 'IS CLRTIFIZO.
Linder the provisions of Ch
Expiration date: AUG..31,,2