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EL-13-2241Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-212377 Scheduled Inspection Date: May 14, 2014 Inspector: Devaney, Michael Owner: LLERENA, MARK Job Address: 1550 NE 103 Street Miami Shores, FL 33138 - Project: <NONE> Contractor: RAVEN ELECTRIC INC Building Department comments Permit Number: EL -10-13-2241 Permit Type: Electrical - Residential Inspection Type: Final Work Classification: Alteration Phone Number (786)290-8051 Parcel Number 1132050310110 Phone: 305-221-3339 INTERIOR REMODEL FOR 4 BEDROOMS AND 4 Infractio Passed Comments BATHROOMS I INSPECTOR COMMENTS False Inspector Comments Passed E]�_ Failed E] Correction / Pig// Needed Re -Inspection ❑ Fee No Additional Inspections can be scheduled until re -inspection fee is paid. May 13, 2014 For Inspections please call: (305)762-4949 Page 25 of 35 Miami Shores Village° - Building Department C,'CT 10050 N.E.2nd Avenue, Miami Shores, Florida 33138_, foo®®ao��' Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 VA 1 FBC 20 1� NuumqNG Permit No. F_L_i 3 PERMIT APPLICATION Master Permit No. 7,d) R . Permit Type: BUILDING ROOFING JOB ADDRESS: 122 C City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated: Yes NO Zone: OWNER: Name (Fee Simple 1Titleholder): k I— tou&_ Le" Phone#:%/ 'WO Address: t� City: _an. State: Zip: � i Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: Address: _f4 ff City: State: Qualifier Name: State Certification or Registration #: Contact Phone#: Email Address: 0 cap: Phone#: of Competency #: DESIGNER: Architect/Engineer: Phone#: 0040 It Value of Work for this Permit: $ S43are/Linear Footage of Work: Type of Work: ❑Addition ❑Alteration ONew ❑Repair/Replace DDemolition Description of Work: Color thru tile: Submittal Fee . Permit Fee $ YXZ ° 604- CCF $ CO/CC $ Scanning Fee $ Notary $ Radon Fee $ Training/Education Fee $ Double Fee $ Structural Review $ DBPR $ Bond _ Technology Fee $ TOTAL FEE NOW DUE $ T '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 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 agproved and a reinspection fee will be charged. Signature ° Signature" 1�l ECr< (,V- Zs"i _Owner or Agent g ( ��CW¢..v�G�42(�,�'ic., Contractor The foreoing instrument was acknowledged before me this 16i The foregoing instrument was acknowledged before me this -LJ day ofLk"L4,-20(3 , byRC C-Y.-�. L _Q (� day of , 20 a, by N Q- F - who is personally known to me or who has produced who is personally known to me or who has produced As identification and who did take an oath. M101 11 F4\;Al_; i1 t SQA Sign: �✓ Pring&& My Commission Expires: APPROVED BY identification and who did take an oath. PUBLIC: Sign: MY COMMISSION # EE 066066 if MY COMMISSION # EE 066066 EXPIRES: April 1, 2015 My Commission Ex ' EXPIRES: April 1, 2015 Bonded Thru Notary Public Underwriters Bonded Thru Notary Public Underwriters Plans Examiner Structural Review (Revised 3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09) Zoning Clerk i CERT IFIL 4TE :OF` LIABILITY I1�SURi4`NCE :' . DATE (MNUpDIYYYY) �oio1/�3' 'THIS CERTIFICATE IS ISSUED ASA, MATTER OF INFORMATION ONLY AND CONFERS NO, RIGHTS UPON THE CERTIFICATE HOLDER, TMS 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 pollcy(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 G & E Insurance Consultants,inc. 9880 S.W.40th StreetLADDRESS:griceIS620@comcasLnet Miami, FL 33165 Phone (305)228-8988 Fax (305)228-8969 CONTACT GRICEL GONZALEZ NAME: PHONE (305)228-8988 No): (305)228-8969 MMMIUDD EXP INSURER(S) AFFORDING COVERAGE NAIC d INSURER A: UNDERWRITERS AT LLOYD'S OF LONDON INSURED Raven Electric Inc 3913 SW 90 Ave Miami, FL 33165 (305) 951-1210 INSURER B: INSURER C: INSURER D: INSURER E: INSURER F : GWtKAUt:b GERTIFIGATE NUMBER: 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. ILTSRR TYPE OF INSURANCE ADD 1 ND POLICY NUMBER MPOMIDDLICY EFF MMMIUDD EXP LIMITS A GENERAL LIABILITY 0 COMMERCIAL GENERAL LIABILITY ❑ ❑ CLAIMS -MADE ❑ OCCUR AMTE021294 09/09/209 3 09/09/2014 EACH OCCURRENCE $ 1,000,000.00 DAMAGE TO RENTED 100,000.00 PREMISES Ea occurrence)$ MED EXP (Any one person) $ 1,000,000.00 PERSONAL & ADv INJURY $ 2,000,000.00 F GENERAL AGGREGATE $ 1,000,000.00 GEN'L AGGREGATE LIMIT APPLIES PER ❑ POLICY ❑ PRO- ❑ LOC PRODUCTS - COMP/OP AGG $ $ AUTOMOBILE LIABILITY ❑ ANY AUTO ❑ ALOWNED ❑ SCHEDULED AOSNON-OWNED F-1HIRED AUTOS ❑ AUTOS ❑ ❑ COMBINED tSINGLE LIMB $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ Per accident $ ❑ UMBRELLA LIAR ❑ OCCUR ❑ EXCESS LIAB ❑ CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ ❑ DED ❑ RETENTIONS $ WORKERS COMPENSATION❑ AND EMPLOYERS' LIABILITY Y / NER ANY PROPRIETOR/PARTNERIMCUTIVE OFFICERIMEMBER EXCLUDED?F7NIA (Mandatory In NH) WEdescribeundo RIPTION OF OPERATIONS below VTATU- ❑ OTH- E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE S E.L DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remariu; Schedule, K more space Is required) CERTIFICATE HOLDER CANCELLATION MIAMI SHORES 10050 NE 2 AVE MIAMI,FL 33138 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE g v. ©1988-2010 All rights reserved. AGORD 25 (201=5) RF The ACORD name and logo are registered marks of ACORD JEFF ATWATER •�Q°D "1e`�• CHIEF FINANCIAL OFFICER STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION * * CERTIFICATE OF ELECTION TO BE.EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers'•Compensation law.• EFFECTIVE DATE, 9/23/2013 EXPIRATION DATE: 9/23/2015 PERSON: HERNANDEZ OSCAR , FEIN: 481261518 BUSINESS NAME AND ADDRESS: RAVEN ELECTRIC INC 3913 SW 90 AVE MIAMI FL 33165 SCOPES OF BUSINESS OR TRADE: ELECTRICAL WIRING WITHIN BUIL 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 fisted on 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 revolve a certificate at any time for failure of the person named on the certificate to meet the requirements of this section. DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 07-12 QUESTIONS? (1350)413-1609