Loading...
EL-13-2258Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-227029 Permit Number: EL -10-13-2258 Scheduled Inspection Date: March 05, 2015 Permit Type: Electrical - Residential Inspector: Devaney, Michael Inspection Type: Final Owner: OLIVA, TERESA Job Address: 301 GRAND CONCOURSE Miami Shores, FL 33138 - Project: <NONE> Work Classification: Alteration Phone Number (305)807-1210 Parcel Number 1132060133850 Contractor: MIKES CUSTOM ELECTRIC SERVICE INC Phone: (305)969-5460 sunaing uepartment comments ELECTRIC FOR POOL INSPECTOR COMMENTS False Inspector Comments Passed CREATED AS REINSPECTION FOR INSP-226949. CREATED AS 1Z I REINSPECTION FOR INSP-211994. Remove 120 volt receptacle or convert to G. F. I.. Pool water line covers existing A/C disconnect. Failed ❑ Not ready for final. Alarm or fence installed. Water in pool. 23 jan 2015 Pool water line still covers the A/C disconnect. Correction ❑ Need pool fence ,net or alarms. Needed Re -Inspection ❑ Fee No Additional Inspections can be scheduled until re -inspection fee is paid March 04, 2015 For Inspections please call: (305)762-4949 Page 13 of 38 CERTIFICATE OF PRODUCER Galloway Insurance 17354 South Dixie Highway Miami, FL 33157 Phone (305)255-1661 Fax (786)206-7066 INSURED Mike's Custom Electric Service, Inc. 10871 SW 188th Street, #19 Miami, Florida 33157 LIABILITY INSURANCE I OA 3/14/1 04NY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES_ BELOW_ . iINSURERS AFFORDING COVERAGE NAIC # INSURER A: Federated National Insurance CO. INSURER B: INSURER C: INSURER D: INSURER E COVERAGES THE POLICIES OF INSURANCE LISTED 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSRADVL TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION; LTR .IN$RD, OATE(MMMONYYY) DATE(MM/DD/YYYY)) LIMITS GENERAL LIABILITY EACH OCCURRENCE $1,000,000 © COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED GL -17436-0 06/28/2013 06/28/2014 i PREMISES -tea occurrertce $13,0W ❑❑ CLAIMS MADE ❑J OCCUR MED EXP (Any one person) $5,000 PD: Ded: $500 PERSONAL & ADV INJURY $1,000,000 ❑ GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: j PRODUCTS - COMP/OP AGG $2,000,000 d POLICY ❑ PROJECT ❑ LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ❑ ANY AUTO i (Ea accident) ❑ DEDUCTIBLE ❑ RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR / PARTNER / EXECUTIVE OFFICER / MEMBER EXCLUDED? (Mandatory in NH) If yesdescribe under SPECIAL PROVISIONS below OTHER BODILY INJURY (Per person) BODILY INJURY (Per accident) I PROPERTY DAMAGE -- (Per accident) - +AUTO ONLY - EA ACCIDENT OTHER THAN EA ACC i AUTO ONLY. AGG EACH OCCURRENCE AGGREGATE — TORY LIMITS ❑ ERH E. L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE E.L. DISEASE - POLICY LIMIT DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS Electrical Contractor/'Work..... The Certificate Holder is listed as an Additonal Insured which includes Waiver of Subrogation in favor of Jaxi Builders. CERTIFICATE HOLDER Miami Shores Village 10050 NE 2nd Avenue Miami Shores, Florida 33138 Attn: Building Dept Fax # 305-756-8972 ACORD 25 (2009/01) QF CANCELLATION ❑ ALL OWNED AUTOS ❑ ❑ SCHEDULED AUTOS 30 DAYS WRITTEN NOTICE TO THE CE I.... A 4HOLDER NAMED TO ❑ HIRED AUTOS OF ANY KIND UPON THE INSURER, ITS AGENTS O ❑ NON OWNED AUTOS Jose H Romero, Licensed Agent -A225234 ©1986-2009 ACORD CO ION. All rights reserved. The ACORD name and logo registered marks of ACORD GARAGE LIABILITY ❑ ❑ ANY AUTO EXCESS / UMBRELLA LIABILITY ❑ OCCUR ❑ CLAIMS MADE ❑ ❑ DEDUCTIBLE ❑ RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR / PARTNER / EXECUTIVE OFFICER / MEMBER EXCLUDED? (Mandatory in NH) If yesdescribe under SPECIAL PROVISIONS below OTHER BODILY INJURY (Per person) BODILY INJURY (Per accident) I PROPERTY DAMAGE -- (Per accident) - +AUTO ONLY - EA ACCIDENT OTHER THAN EA ACC i AUTO ONLY. AGG EACH OCCURRENCE AGGREGATE — TORY LIMITS ❑ ERH E. L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE E.L. DISEASE - POLICY LIMIT DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS Electrical Contractor/'Work..... The Certificate Holder is listed as an Additonal Insured which includes Waiver of Subrogation in favor of Jaxi Builders. CERTIFICATE HOLDER Miami Shores Village 10050 NE 2nd Avenue Miami Shores, Florida 33138 Attn: Building Dept Fax # 305-756-8972 ACORD 25 (2009/01) QF CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES E CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURE WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CE I.... A 4HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE O B GATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS O ENTATIVES. AUTHORIZED REPRESENTATIVE Jose H Romero, Licensed Agent -A225234 ©1986-2009 ACORD CO ION. All rights reserved. The ACORD name and logo registered marks of ACORD MIKECUS-02 KSKA CERTIFICATE OF LIABILITY INSURANCE DAT3/3/2 D/YYY17 13/3/2014 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 policypes) 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 Automatic Data Processing Insurance Agency, Inc 1 ADP Boulevard Roseland, NJ 07068 CONTACT NAME: PHONE FAX C No Ext): A/C No): ADDRESS: INSURERS AFFORDING COVERAGE NAIC d INSURERA:CASTLEPOINT OF FLORIDA 13599 EACH OCCURRENCE $ INSURED Mikes Custom Electric Service Inc INSURER B: INSURER C: 10871 SW 188 St Miami, FL 33157 INSURER D: INSURER E: INSURER F: AUTOMOBILE COVERAGES CERTIFICATE 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. 1�TR TYPE OF INSURANCE ADDLSLIBR INSR WVD POLICY NUMBER PMND EFF POLICY Mu D/ EXP LIMITS GENERAL LIABILITY HCOMMERCIAL GENERAL LIABILITY CLAIMS -MADE 7 OCCUR EACH OCCURRENCE $ IIA AGE To PREMISES Ea occurrence $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: O LOC POLICY PRCi F PRODUCTS - COMP/OP AGG $ $ AUTOMOBILE LIABILITY ANY AUTO ALL OW NEDSCHEDULED AUTOS AUTOS HIRED AUTOS NON -OWNED AUTOS COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ Per sccident UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED I I RETENTION $ $ A WORKERS COMPENSATIONX AND EMPLOYERS' LIABILITYLIMITSER ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N OFFICER/MEMBER EXCLUDED? � (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A WCP761515400 2/19/2014 2/19/2015 TORY TATA- T E. L. EACH ACCIDENT $ 100,000 E.L. DISEASE - EA EMPLOYEE $ 100,000 E.L. DISEASE - POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, H more space is required) "ELECTRICAL CONTRACTORS" CERTIFICATE HO1LnFR CANCFI I ATInN ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE The Village Of Miami Shores g THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 10050 North East 2nd Avenue Miami Shores, FL 33138- AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD 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 V_ B. COPY OF LOCAL BUSINESS TAX RECEIPT d C. COPY OF LIABILITY INSURANCE (CERTIFICATE HOLDER TO BE MIAMI SHORES VILLAGE BLDG DEPT) D. COPY OF WORKERS COMPENSATION (EITHER CERTIFICATE OR EXCEMPTION) IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY: A. COPY OF CERTIFICE OF COMPETENCY OF QUALIFIER t" B. COPY OF LOCAL BUSINESS TAX RECEIPT w' B. COPY OF MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT f*" C. COPY OF LIABILITY INSURACE (CERTIFICATE HOLDER MUST BE MIAMI SHORES VILLAGE BLDG DEPT) D. COPY OF WORKERS COMP INSURANCE (EITHER CERTIFICATE OR EXEMPTION) 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:� tilt fS Co.s 4r1 yv? S A�iPiw L BUSINESS ADDRESS: �o� [ s cz m� S `[L—f-n CITY l STATE_ ZIP CODE BUSINESS PHONE: (3-06 6 r %�} FAX NUMBER Q) '?6 F S- f %d CELL PHONE Co,<-) 2,9 -7 01 QUALIFIER'S NAME: QUALIFIER'S LIC NUMBER: C, ct 0 D b -I E-MAIL ADDRESS (IF APPLICABLE): j0d , U_ 0 M,11c sc Created on 3119109 BY MLDV I RV 3126109 MLDV I RV 6127111 AS STATE OF FLORIDA AC# 6 {, ,? Q 9 16 OEFARTMENT OF BUSINESS An PROFESSIONAL REGVLATTON ER0014743 10%18%12 127021409 REG ELECTRICAL'CONTRACTOR. THOMAS, MICHAEL F MIRE'S CUS, X ALECTR.IC SERVICE I E INDIVIDLiAL J+L ST , MSET ALL LOCAL LICENSING R$Q TREMRNTS PRIOR TO CONTRACTINQ IN I ANY AREA) HAS REGISTERED under the provisions of cu.489 Expiration dater AUG 31, 2014 L11101602481 gionTra9desBConstruQualifying r Board BUSINESS CERTIFICATE OF COMPETENCY 98E000275 MIKE'S CUSTOM ELECTRIC SERVICE INC D.B.A.: THOMAS MICHAEL Is certified under the provisions of Chapter 10 of Miami -Dade County jj Municipal Contractor's Tax Receipt Miami—Dade County, State of Florida THIS IS NOT A BILL -DO NOT PAY CC NO: 98E000275 BUSINESS NAMEILOCATION MIKES CUSTOM ELECTRIC SERVICE INC 10871 SW 188 ST 19 MIAMI, FL 33157 MC RECEIPT NO- EXPIRES NEW BUSINESS SEPTEMBER 309 2014 7438984 Must be displayed at place of business Pursuant to County Code Chapter SA -Art. 9 & 10 OWNER TYPE OF BUSINESS MIKES CUSTOM ELECTRIC SERVICE INC ELECTRICAL CONTRACTOR ®! For more information,visitwww.miamidade.govitexcollector Local Business Tax Receipt Miami—Dade County, State of Florida -THIS IS NOTA BILL -DO NOT PRY 3980001 BUSINESS NAME&OCATION MIKES CUSTOM ELECrRIC SERVICE INC 10871 SW 188 ST 19 MIAMI, FL 33157 PAYMENT RECEIVED BY TAX COLLECTOR 200.00 10/08/2013 0228-14-000164 RECEIPT NO, EXPIRES RENEWAL. SEPTEMBER 30, 2014 4163722 Must be displayed at place of business Pursuant to County Code Chapter SA - An. 9 & 10 OWNER SEC. TYPE OF BUSINESS MIKES CUSTOM ELECTRIC SERVICE INC 196 ELECTRICAL CONTRACTOR Worker(s) 98E000275 PAYMENT RECEIVED BY TAX COLLECTOR 82.50 10/07/2013 0227-14-000145 This Local Business Tax Receipt only 40116ums paymentof the Local Business Tax. The Receipt 6 not a license, permit, or a certi8catioa of the holder's gsalibcatims,to do business, holder must comply with any goverumestal or uougoversmeotal regulatory laws and requirements which apply to the business. The RECEIPT N0. above mast be displayed on a0 commercial vehicles -Miami-Dade Code Sec Ba -276. Mhkm For more information, visit w_Ww.miamldade.goW4 collector 3 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 1 `� Permit NoFL 13 —cPD5 Master Permit No.Sm 3 — 2zs �- JOB ADDRESS: d D G CQ Y1 GO 1A,r5C• City: Miami Shores County: Miami Dade Zip: 3 3 1 3 Folio/Parcel#: Is the Building Historically Designated: Yes NO Flood Zone: OWNER: Name (Fee Simple Titleholder): �,� &.�f 1 LAZOy Phone#:3 OS • SO% • Z - y Tenant/Lessee Name: Email: 0 State: 33138 CONTRACTOR: Company Name: ke.s CAAxF[DM V &J (� C-- Phone#:3C6—%95'5 4 Address: City: NAI&4yUA State: Zip: 3315 7 Qualifier Name: Phone#: 3 Q g6!' fi-q 6 Q State Certification oar, Regist ration #: �� �t�t sL� �� �� Certificate of Competency #: C R60/'� 911 Contact Phone#: 50 a ri�G.2'Email Address: d d e �i ��� sJ(P �C�J� dr�l • tJ DESIGNER: Architect/Engineer: Value of Work for this Permit: $ % C' 0 b Square/Linear Footage of Work: Type of Work: ❑.Address UAl/teration ANew ❑Repair/Replace ❑Demolition Description of Work: 4 i 1 j W1 -P b) U r CZ 1, � Ukl d < d o a r' oo�- 2, p uilV d r Submittal Fee $ Permit Fee $ CCF $ CO/CC $ Scanning Fee $ Notary Radon Fee $ Training/Education Fee $ Double Fee $ Structural Review $ DBPR $ Bond $ Technology Fee $ TOTAL FEE NOW DUE $ OCT s FBC 20 1 `� Permit NoFL 13 —cPD5 Master Permit No.Sm 3 — 2zs �- JOB ADDRESS: d D G CQ Y1 GO 1A,r5C• City: Miami Shores County: Miami Dade Zip: 3 3 1 3 Folio/Parcel#: Is the Building Historically Designated: Yes NO Flood Zone: OWNER: Name (Fee Simple Titleholder): �,� &.�f 1 LAZOy Phone#:3 OS • SO% • Z - y Tenant/Lessee Name: Email: 0 State: 33138 CONTRACTOR: Company Name: ke.s CAAxF[DM V &J (� C-- Phone#:3C6—%95'5 4 Address: City: NAI&4yUA State: Zip: 3315 7 Qualifier Name: Phone#: 3 Q g6!' fi-q 6 Q State Certification oar, Regist ration #: �� �t�t sL� �� �� Certificate of Competency #: C R60/'� 911 Contact Phone#: 50 a ri�G.2'Email Address: d d e �i ��� sJ(P �C�J� dr�l • tJ DESIGNER: Architect/Engineer: Value of Work for this Permit: $ % C' 0 b Square/Linear Footage of Work: Type of Work: ❑.Address UAl/teration ANew ❑Repair/Replace ❑Demolition Description of Work: 4 i 1 j W1 -P b) U r CZ 1, � Ukl d < d o a r' oo�- 2, p uilV d r Submittal Fee $ Permit Fee $ CCF $ CO/CC $ Scanning Fee $ Notary Radon Fee $ Training/Education Fee $ Double Fee $ Structural Review $ DBPR $ Bond $ 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 $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature' / Signature Owner or Agent The foregoing instrument was acknowledged before me this 2 day of , 20 13, by loe6 61404 , who is personally known to me or who has produced- _� As identification and who did take an oath. NOTARY Sign: Print: 11 My Commission Expires: Contractor The foregoing instrument was acknowledged me this0 day of o _,20 1.x , by AGA% T#M44-S , who is personally known to me or who has produced 44_4 k4liA�� as identification and who did take an oath. NOTARY Sign: Print: Commission # EE 048775WMAM wva E> January 24, 2015 My Co ' irdAY o><i$ff073183 eamean.or�yr ,e•eoo�srmo '� D(PIFIES:Jul11,2015 Bonded 7hru Noby Pubo Uridw4r m �gap !�4 Plans Examiner Structural Review Clerk (Revised 3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09)