EL-14-1253C�
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 - Fax: (305)756-8972
Inspection Number: INSP-222869
Scheduled Inspection Date: November 06, 2014
Inspector: Devaney, Michael
Owner: CLEEK, RONALD
Job Address: 882 NE 97 Street
Miami Shores, FL
Project: <NONE>
r
Permit Number: EL -6-14-1253
Permit Type: Electrical - Residential
Inspection Type: Final
Work Classification: Alteration
Phone Number
Parcel Number
1132060142700
Contractor: M & C ELECTRICAL INC Phone: (305)751-9286
5unoimg Department comments
2 BATHROOM REMODEL AND ADJACENT CLOSETS
INSPECTOR COMMENTS False
Inspector Comments
PassedLIA®r-�
p
Failed
Correctionr��
Needed
Re -Inspection ❑
Fee
No Additional Inspections can be scheduled until
re -inspection fee is paid.
November 05, 2014 For Inspections please call: (305)762-4949 Page 22 of 35
Miami Shores VillageJJUNL32014
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 3313817
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
FBC 2011
BUILDING
PERMIT APPLICATION
❑BUILDING PS ELECTRIC ❑ ROOFING
r-1 PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS
JOB ADDRESS: �fe
Master Permit No. �� /Z- "/d w
Sub Permit No. oL- / / l —,
❑ REVISION
❑ CHANGE OF
�rCONTRACTOR
�
J
❑ EXTENSION ❑ RENEWAL
❑ CANCELLATION ❑ SHOP
DRAWINGS
City Miami Shoresii,, County Miami Dade Zip• �� v
Folio/Parcel#: (` c3 a o toV qQ 7 OC) Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder)
GP'eme -% H .' + eft" ,
Tenant/Lessee Name: Az A Phone#:
Email:
CONTRACTOR: Company Name: /i:4:- !- G �� C"/ au G
Address: 9250 Avv'if4� ue 9I�,5, t, koi
ri
78t� 9- o''93 2S'�
City: &&Q, //�� State: �� Zip: :33 2-
Qualifier Name: kA /lam, c4
Fee, e 2 Phone#: 3-1a6 -'-03 —Z5 -4d
State Certification or Registration #: �` C�i� F-1 Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $ k I zX30 Square/Linear Footage of Work:
Type of Work: ❑ Addition Eq' Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work:C`�� €,- 2 �+� C d &-Swy-NC�T-
G�-z s
� iA�, S' Ffli3�9 �Pj s
Su mittal Fee
Scanning Fee $
Technology Fee
Structural Reviews $
(Revised02/24/2014)
Fee $ CC �3 ®� S $ �
Radon Fee $
Training/Education Fee $
DBPR $
CO/CC $
Notary $
Double Fee $
Bond $ _
TOTAL FEE NOW DUE $ yo
Bonding Company's Name (if applicable)
Bonding Company's Address
City
State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
Zip
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 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 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 V %--,, Signature
OWNER or AGENT
The foregoing instrument was acknowledged beforemethis
1l L_J,l day of m 20 1 I . by
who is personally known to
me or who has produced L- 1 '17) as
identification and who did take an oath.
NOTARY PUBLIC:
Sign: �` ',,k.' ..
Print: z' c°'
CONTRACTOR
The foregoing instrunt was acknowledged before me this
day of m 20 14 , by
y1�,�j�j, who is personally known to
me or who has produced _ DAXJR as
identification and who did take an oath.
NOTARY PUBLIC,;
Sign:_
Print:
C®
Seal:= m `� jam'% �'� : os Seal:
,O'
APPROVED B ' Plans Examiner
Structural Review
(Revised02/24/2014)
CLIFFORD BLANFM
No" - sto of ifs
'•:'�F op myCommissim 0 FF 119050
18
11f0S8
Zoning
Clerk
-
31.,- 2014
Zxp
ROD
IRM
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9,250 M- -ART -405.
FL 33172
SRCRrZARY
VL*VAS-RE-OUWMi3YkLAW-'
r
JEFF ATWATER WE
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: 7/9/2014 EXPIRATION DATE: 7/8/2016
PERSON: RODRIGUEZ ROBERTO SR
FEIN: 455238895
BUSINESS NAME AND ADDRESS:
M & C ELECTRICAL INC
9250 FONTAINEBLEAU BLDV
MIAMI FL 33172
SCOPES OF BUSINESS OR TRADE:
LICENSED ELECTRICAL
CONTRACTOR
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 listed on the notice of election to be exempt Pursuant to Chapter 440.05(13), F.S., Notices of election to be exempt and certificates of
election to be exempt shag 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
certgicate no longer meets the requirements of this section for Issuance of a certhicate. The department shall revoke a certificate at any time for tailure 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? (850)413-1609
06-13—'14 15:39 FROM— T-947 P0001/0001 F-557
CERTIFICATE OF LIABILITY INSURANCEF 0611312014
DAYE(MMIODNYYY)
THIS CERTIFICATE IS ISSUED AS A 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 endorsements .
PROPUCER Phone.- 305-221-2400 CONTAC
Tropical Insurance Agency Inc.
8700 West Flagler St Ste 230 Fax: 305-552-5350 a�F �,;
Miami, PL 33174 -SIL ,� --•- .. =NOR
Connie Lageyro ADDR1 •—'-
PRO OME r • .M&CELEC —'—
fNSUR(rp M
—&C EIBCtrICal Ino INSURERIS) tFORDINtaCOVStyA(;E
iNSURERA:F _ AIC ft
_
Granada Insurance COm an
9250 Fontainebleau Blvd., #205—��!
Miami, FL 33172 INSURER B: _
INSURER C : - — — —
INSURERD: —i- — —
INSURER
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSUREDNAMEDABOVE 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.
INSR� - AQDL SU —^
TYPE OF INSURANCE POLICY NUM705/1512014
POLICY P —
GENERAL LIABILITY A7M/DD/YYYy LNAIY$
A �X cpn1nMeRcwL GENERAL LIABILITY 0185FL00036214 05/951209Is E4CN OCCURRENCE $ 1,000,0
Q rd'9S niTrD -
CLAIMS -MADE ] OCCUR ISES.(Farrst�tg� -j—.. --j00,01
f MED EXP (Any arlg persons $ 5,01
PERSONAL 8 ADV INJURY $ 1,000,01
GENER/U-AGGREQATE _ $ _ 2.000,01
GEN'L AGGRECATE LIMIT APPLIES PER: PRODUCTS - COMPlOP AGG $ Z,OOOlOI
POLICY �I PRO• i — LOC
AUTOMOBILE LIABILITY
ANY AUTO
ALL OWN15DAUTOS
SCHEOULEDAUTOS
HIRED AUTOS
NON -OWNED AUTOS
UmxRrxLLA UABOCCUR
EXCESS LiAB._ =CLAIMS
DEDUCTIBLE
WORKERS COMPENSATION —�—
AND EMPLOYERS' LIABILITY
0 FICANY ERIMEMBER EXCLUDED? £CiJ71VE Y�^`� ! N / A
(Mandatory in kiwI u f
OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORo 1Gi, Additional Remarks schedule, if more space Is re"veq)
al Sexvi.cses .
MIAMISH
Miami Shores Village
NX -305-559-9193
10050 NIX 2nd Avenue
Miami Shores, FL 33138
COMBINED SINGLE LIMIT $
(E5 sCtid�U
BODILY INJURY (Perp EW) gg
BODILY INJURY (Pet 8odd,: U S
PROPERTY UAMAG@� —
(Per ucidsnt) j $
AGGREGATE
E.L. EACHACCIOE
L.L. DISEASE - EA
E.L. OISFASF - Rn
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICe WILL ESE DELIVEREEp IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIzEa
Connie L
ACORD 25 (2009!09) The ACORD name and logo are registered marks o ACORD CORPORATION. All rights reserved.
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