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EL-13-2525Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-202678 Permit Number: EL -11-13-2525 Scheduled Inspection Date: June 27, 2014 Permit Type: Electrical Residential Inspector: Devaney, Michael Inspection Type: Final Owner: TORO JTRS, LUIS Work Classification: Addition/Alteration Job Address: 1270 NE 98 Street Miami Shores, FL 33138 - Phone Number (305)733-3821 Parcel Number 1132050090310 Project: <NONE> Contractor: R.Q ELECTRICAL INC Phone: (305)790-9169 tsunamg Department comments REMODEL CABANA BATH AND MASTER BATH: REPLACEI Infractio Passed Comments ALL FIXTURES INSTALL NEW STEAM MACHINE INSPECTOR COMMENTS False Inspector Comments Passed iz Failed r Correction ❑ Needed Re -Inspection ❑ Fee No Additional Inspections can be scheduled until re -inspection fee is paid. June 27, 2014 For Inspections please call: (305)762-4949 Page 6 of 23 Miami Shores Village Building Department a; 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 KV U 7 2013 Tel: (305) 795.2204 Fax: (305) 756.8972 !✓ R INSPECTION'S PHONE NUMBER: (305) 762.4949 FBC 20 BUILDING PERMIT APPLICATION Permit Type: Electrical JOB ADDRESS: 12 "C) (:5 01 v IS4 Permit No. �7L1 3 —,;)S 2S Master Permit No, 3 - `a52L4 City: Miami Shores County: -DADS Miami Dade Zip: 3 3 3 Folio/Parcel#: ( �) 2.o C) Is the Building Historically Designated: Yes ONO Flood Zone: OWNER: Name (Fee Simple Titleholder): ` PTV L Pj S Q (1-0 Phone#: 305- -433 .392, � Address: 1 X- - O M C— q K � j City:yVt N m l S t,\y(Lr.'S Stater Zip: 3 g Tenant/Lessee Name: Email: cC CONTRACTOR: Company Name: _ Address: CA B O 1 M 0 12 I Q CC IE-' ( iLIG 1 N Phone#: 30S �90 16L City: -State: L Zip: 3 3 (91 $ Qualifier Name: %Q O CU r 0 4" t) r lJ x- Phone#: 161 State Certification or Registration #: LP- ��Q `'t 7j Certificate of Competency #: i E QS Contact Phone#: �5 S 3 Z� Email Address: p 'r e aec kt co" DESIGNER: Architect/Engineer: Value of. Work for'liis I"er`in®� Square/Linear Footage of Work: boo Type of Work: OAddress ':QAlteration ONew epair/Replace. f ❑Demolition Description of Work. Z& CO 4 ba D (0c)17 -Cr Submittal Fee $ Permit Fee $ 2 Z3 'CSU 3 CCF $ CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ Technology Fee $ TOTAL FEE NOW DUE $ 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 b of such posted notice, the inspection will not be approved and a reinspection fee will betVharged. " Signature Signature ( ri&( — Owner or Agent Contractor The foregoing instrument was acknowledged before me this The foregoing instrument was ackno ledged before me this day of , by [ pq,h b i t� b4' f P. � day of 3 , by airy , who is personall own me or who has produced FL who is personally own t me or who has produced <, As identification and who did take an oath. as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commission Expires: km&o, , 0(7 -oft f AMBAR ABET O :ommission N DD 969514 My Commission Expires March 09, 2014 NOTARY Sign: My Commission EXL66-111 Kam 0) i loft f Commission * DD 969514 March 09, 2014 APPROVED BY ?" J,40A� Plans Examiner Zoning Structural Review (Revised 3/12/2012)(Revised-07/10/07)(Revised 06/10/2009)(Revised 3/15/09) Clerk CERTIFICATE OF LIABILITY INSURANCE DATE(MMlDDIYYYY) 1110613 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 INSUREI't(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND TIME CERTIFICATE BOLDER, IMPORTANT: IT the certificate holder Is an ADDITIONAL INSURED, the policy(ies) 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 corder rights to the certificate holder In Ileo of such endorsement(s). PRODUCER — — -- — CONTAME:CT, Silvia Cabezas N Honesty Trust Insurance ' PHONE (30 951-1544 AX 305 675.8112 — E - - -a� --- -- - - -- �� - °r Z _.....-) 428 East 49st I scabezes®bellsouth.net Hleleah, FL 33013 _..Y_ I INSURER($) AFFORDING COVERAGE NA)C Phone 305 951-1544 Fax (305) 675-8112 INSURER A: Granada insurance INSURED INSU R Q Electrical Inc. r wUR9 c: 9801 NW 123 Terrace INSURER D' Hialeah, FL 33018 (305) 231-5578 _.INSURER Ee: INSURER F -- ._---- COVERAGES CERTIFICATE NUMBER: REVISION NUMBER - THIS IS TO CERTIFY THAT THE POL'IC1ES OF NSURANCE LISTED -BELOW -HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS . CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SWECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMrrs SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. I� TYPE OF INSURANCE ADDL UB POLICY NUMBER ffgC LIMEYS GENERAL LIABILITY ® COMMERCIAL GENERAL LIABILITY 0 CLAIMS -MADE R OCCUR © GEN'L AGGREGATE LIMITAPPLIES PER: POLICY 1111 Lac 0185F'L00030912 EACH OCCUR $ 1,000,000,00 DA ME0EXP Anyone person PERSONAL & ADV INJURY _.- $.8,000.(X} $ 1,000,000,00 GENERAL AGGREGATE. $ 2,000,000.00 PRODUCTS - COMPKIP AGG S 2,000,000.00 Fire Damage IintiE (anylfir $ 100,000.00 -- AUTOMOBILE LIABILITY ANY AUTO Q ALL OWNED r --t SCHEDULED AUTOS i..J AUTOS © HIREDAUTOS AUTOS NED 0 UMSRELLA LIAR OCCUR EXCESS LIAa CLAIMS -MADE ---------- N I A ----------- ------- - b I COMSINED SidrillINGLE LIMIT BODILY INJURY (Per person) S 80DiiY INJURY (Per acciden $ ._ acd MAGE _...._.. $ EACH OCCURRENCE $ $ AGGREGATE $ 13 Ell 11 RETENTION WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOWPARTNERIEXECUTiVE OFFICER/MEMBER EXCLUDED?' (Mandatory in NH) Fn] Ifyyea describe under DESCRIPTION OF OPERATIONS below' A H 1 E.L. EACH, ACCIDENT $ E.L. DISEASE- EA EMPLOYE $ E.L. DISEASE- POLICY LIMIT S DESCRIPTION OP OPERATIONS i LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required) — ------------ --- —� — — — —' CERTIFICATE HOLDER CANCELLATION $ I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES 06 CANCELLED BEFORE Miami Shores Village THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN BUILDING DEPARTMENT ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE 2 Ave i AUTHORIZED REPRESENTATIVE /�� Miami Shores Village, Fl. $3138 � e- 'e, 'e, _z ,, 8188&20010 ACO>NO CORPORATION. AN rights reserved. ACORD 25 (2010(05) OF The ACORD name and logo are registered marks of ACORD 5 Consiltl iaa TredtiE�umu Boom tiWMNi MA Vt:NrIFIC 4TH O G�TiNCY 14 EOOO5 5 .D.B.A.: QUINTANA RODOLFO Is cariintd undtr tht provisions of chapter 10 of Mtsmi-Dade County WIMUM CON-TRACTINO UNTIL 0013012011 c Ol QUALIFYING TRADE(S) 0001 ELECTRICAL Sawos ianw+sdo+lars WrASA, RWOLFO HLSLMU CAI. r rac . M 12 3 TNRRkCR L EAR GARDENS FIA, 33018 um M Y • • I w' . ma DETACH i tcR (850) 487-1395 s {w r $a r' ;•1 x f z' sr ER13014693 05/18/12 118187003 REG SLEC'MICAt, Cab-MA.CMR �p��111?`p�1�9]gl A,,t � O1*)f�33.ari�i^ /v (INDIVIDUAL MUST MEET ALL LAXAL LICENSING REQUIREK02T'PS PRIOR TO CowrRACTIM13 I11 Awi A R A ) HAS RWtSTZM ammewr t# prawi mmm at cb.449 smpasatiat data IOC( 31, .2014 rJ.xGSillOi174 5) 1 - STATE OF FLORIDA A C # .S _1•_ 3 _ .. DEPARMCENT OF BUSINESS AND PROFESSIONAL RS.GULATION ELECTRICAL CONTRACTORS LICENSING BOARD SE L12451600934 LICENSE NBR _.__ .__._...__._. 05/18/2001121187 87003 t3R13014693 R _ The ELECTRICAL CONTRACTOR Named below HAS REGISTERED Under the provisions of Ckiapter 489 FS. Expiration crate: AUG 31, 2014 (I ND I',Yi L7U ll!1 US T MEET ALL LOCAL LICENSING REQUI S PRIOR TO CONTRACTING IN ANY ) QCIZNT RODOLPO R. EL (CAL, INC. 9631 123 TERRACE HI GARDENS YL 33018 RZ SCOTT YEF7 I.A.W ;roti GO .RNOR D1SP1.AY A S RF(-)! J1PLF' 1 , j 97x2434 Local Business Tax Receipt Miami -Dade County, State of Florida - r� S I Y" I A Nk - tg�' W,' PAI 6904735 OLMMMSO ftAA46A=ATWft OWCSWT Soo RQ Etfaqck OK im"MAL 9001 W* 123 TEM 7140M HAL EAH GAM)ENS R 530'.6 LBT! EXPIRES SEPTEMBER 30, 2014 OV*V" VQ UCTIKA, NCtb A K C4&j"-r%* lwk Low %WNW To ftc*w 0* "I&= wjw- 81 so L -Al %__ T_ I" "'a - N P&MK W 6 WWA*U" if ft Wft I "NOCOOM ft 6 bWWft VAkW VA" OM M O"W"OVOW S' M"Mwwsw ftedo" w" a" -Oww"Nu V*fts ftl* " " 1SS an j'*NMrVWj POACW S" k�=L $0 New OWWOM vim NII AtWAt1111 CHflra rINANCtA 6"wr.Et tX � } i I STATE CSF, FLOH10A DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMP NSATION 12.02-2011 TE OF ELECTION TO BE EXEMPT FRO FI.OH10A WnaittB5` COMPENSATION jaw III III CONSTRUCJION INDUSTRY EXEMPTION Thiti cerllfiti% thbt tho Ihdividwil ll -.ted bel(Xw ha% eldrle(f it, Ute ltilolllpi trout Elands WolIturr, CO(Ilptnsallon lxw. EFFECTIVE PERSON: FEIN; BUSINESS R 0 ELECTRI 9101 NM 12: NIALEAN f>1A1 DATE: 12/02/2011 QUINTANA 453137567 JAME AND ADDRESS "AL INC TERRACE DENS PL 99011 SCOPES O� BUSINESS OR TRADE, 1- ELECTRI SERVICE EXPIRATION DATE; 1210112013 UgKo 10041011 Rist P!t 01+01 to (beat* ._44p ptal49 t 1 " ani,ot at s ,06081,44 t4a4 414K14 oa4e041N rta4 list$ 4640401 6y (Hist a t41t111teta 41 .1aE110a 4440, tall 011144 wsy 4sf r lona pNllif4 tr, eN4flse 1470 lerir lits ,►eri4r Pralair to t6e61ar 440 obill". t 3 Irtalfltetef e1 41011144 to 6! 4404461 e6kty *sly brtaia lba trellis !t 1►0 64$101 tt et Ire4. 110109 a! 00 ow". 4t 01st $rya t0 G 4aseya Parts" as tiortsr 4/9ordf�t; r %. 14e41tot 4t 016,1144 14 he y.4wrt 444 tyttsflfelof at oletif44 it H 4aa 6t $a l 4. $#01641 Is 1404411" 0 M 441 liar! Nia+ *0 t,itol .f to. 0sn'o 4r ,pa rtl4aata of its collilltole. 460 p0,0ee 4erao$ on t6! Melita At I8ri1141414 44 IlIq#41 nolle fee f4/41r deve14 40 cht6 aeffise t0 t+er4a4♦ J 0 61060$60 oam tpa H4ait4iawa :%sat ry06ae 0 ter ilf li ate et a!y 1140 tat 1041010. ai Ihr pat 044 ae41y4 !e 164 t0110010 10 0441 F64 ale04rees4q$ N M•n+ W,,,. OWC-152 CfRIIFtCA E OF f1tCTIDN to SF (xfwt p4VISID 01 tt QUIS11DNSt (960) 413.1809 PLEASE CUT OUT THE CARD BELOW AND RtfAIN FOR FUTURF REFERENCE STATE 0P PLWlXe OtPARTIABNT OP P NANCIAL S4"KIS IMPORTANT CKVISION OF WOPIX Rs' comp! ",rioo4 �q Vur%s o to r_hpter 440 0504) E S . 4n of fit at lit 6 t;Orporahon who COkSTRUCTt INDUSTRY O 41410% "d AMPtieri front thr9 Chaoler by filing 4 of eletti411 c:ERTMICATE 00'14 1C T104 TO BE EXIMPT P14061 01.011101! L Wide$ tti t lethpn thee! not fpCOrer benelitt or f ainpenteslon under Ihll VI(N1KEX1V COMP21 ISATIO" LAW 9O a;npSat F"rF r(: rlvE 12/D2/2011 EXPIRATION DATE 12/01/2019 I't,rWAW rr, Crispier 440 04112), s'so I :. Cernlieetee of election to be NENS()N ROCOLFID QUINTANA H "'empt lwpiy poly within the tcupe 01 the but,nest or trade listed on I IAN 40 137007 ER 14 $1r• ? R a.F; ,�• The not ..r! of election to ba exempt E3 A NAME AND I01lr3RE.SS 440 051 1 11, 15, Notitet of election to be exempt w! 5@r t;t,r4t(tl1 Of elactipit to be exenipl Shall be subject to reyotition te•.+ tier , a 'inn . t -1, at any tune otter the filing fit the nptico of the itluanre of the „01.901,+ :.,ta ,t MS i 1.T LOtf 9:!Scot•, the Partffn rerred On the notice or ferliliclote no longer triesis re rppurrenentt Of thls taction for itluarlce of a cortifiute. The ie$e w"'ra hull revoke a certificate at any trine for failure of the SCOK, 0101 IJ051 F `,," 0R TRACE: ped°>Ori nerned on the certificate to meet the requirements of this t:rr�ar ^.tar. -t ;,"LRlpn . Ullf �,rl(INS7 ($50) 413 1808 CUT HERE • Carry bottom portion on the job, keep upper portion for your reoords, OWC-242 CERTOICAr lir Fl,KTIGN rf3 aF ExFMvr Rf"ll;Er) (11' ;1