The URL can be used to link to this page

EL-14-478Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-228258 Permit Number: EL -3-14-478 Scheduled Inspection Date: February 17, 2015 Permit Type: Electrical - Residential Inspector: Devaney, Michael Inspection Type: Final Owner: LEONE, DEBORAH Work Classification: Alteration Job Address: 5 NW 105 Street Miami Shores, FL Phone Number Parcel Number 1121360050320 Project: <NONE> Contractor: F JIMENEZ ELECTRICAL CONTRACTOR, INC Phone: 3051556-5759 Building Department Comments ELECTRICAL FOR NEW ADA BATHROOM ADDITION' ----- INSPECTOR COMMENTS False Inspector Comments Passed Failed Correction Needed Re -Inspection ❑ Fee No Additional Inspections can be scheduled until re -inspection fee is paid. February 13, 2015 For Inspections please call: (305)762-4949 Page 27 of 30 Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fane: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 BUILDING PERMIT APPLICATION Permit Type: Electrical JOB ADDRESS: 5 NW 105 STREET FBC 20 Permit No. 6_% /I/ — I/ 71F Master Permit NoAol /!Z— !LVd!5_ City: Miami Shores County: Miami Dade Zip: 33150 Folio/Parcel#: 11-2136-005-0320 Is the Building Historically Designated: Yes NO X Flood Zone: X OWNER: Name (Fee Simple Titleholder): DEBORAH LEONE Phone#: 305-778-7774 A.7.7-_ 5 NW 105 STREET City: MIAMI SHORES Tenant/Lessee Name: N/A Email: LEONENWSA@AOL.COM State: FL Zip: 33150 CONTRACTOR: Company Name: F. JIMENEZ ELECTRICAL CONTRACTOR INC. phone#: 786-295-2180 Address: 12401 W OKEECHOBEE RD. #419 City: HIALEAH GARDENS State: FL Zip: 33018 Qualifier Name: FRANCISCO JIMENEZ Phone#: 786-295-2180 State Certification or Registration #: EC13002779 Certificate of Competency #: Contact Phone#: 786-295-2180 Email Address: JIM ENEZ3989@BELLSOUTH.NET DESIGNER: Architect/Engineer: Phone#: Ofd Value of Work for this Permit: $ 9 5D. —` Square/Linear Footage of Work: Type of Work: ❑Address ❑Alteration ❑New ❑Repair/Replace Description of Work: ELECTRICAL FOR NEW ADA BATHROOM ADDITION Submittal Fee $�.$– Q -,04,7 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 $ �) Bonding Company's Name (if applicable) N/A Bonding Company's Address City State Mortgage Lender's Name (if applicable) N/A 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 $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature :�' Signature Owner or Agent The foregoing instrument was acknowledged before me this tx_ day of —, 2014_ by k4,4Tr4 , who is personally known to me or who has produced � -D 1V , l As identification and who did take an oath. NOTARY LI °"'` L® Mendez a�'��Y Pue am ty i; Gn COA"h11SSI0N # EE 1670$ 3°a' ? EXPIRES: PflF R.17, 2b16 o RONNOTARY.cam Sign: I ry�B�sFee• wW1P1.RA Print. l LAP,,;Ao— My COmtm3sYon Expires: S \l I i Contractor The foregoing instrument was acknowledged before me this 7 day of March , 20—, by FRANCISCO JIMENEZ who is personally known to me or who has produced NOTARY Sign: Print: A RY My Commiss� and who did take an oath. 31 1 -1 `1tf Lary MendeZ RES: MR. 17, 2016 APPROVED BY - 11.1- IIAIZ Plans Examiner Zoning Structural Review (Revised 3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09) Clerk Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shares, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CONTRACTORS' REGISTRATION FORM L CONTRACTORS MUST PROVIDE COPIES OF LICENCES AND INSURANCES EACH TIME A PERMIT IS IITTED OR THE VILLAGE MAY MAINTAIN A FILE WITH YOUR INFORMATION FOR A $30.00 FEE PER YEAR. A. /COPY OF QUALIFIER'S STATE LIC CARD B. COPY OF LOCAL BUSINESS TAX RECEIPT 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 B. COPY OF MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT C. COPY OF LIABILITY INSURACE (CERTIFICATE HOLDER MUST BE MIAMI SHORES VILLAGE BLDG DEPT) D. COPY OF WORKER COMP INSURANCE (EITHER CERTIFICATE OR EXEMPTION) YOUR INSURANCE COMPANY DUST ISSUE A CERTIFICATE HOLDER AS FOLLOW(: MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES, FL 33138 vmmmmmmmmmmmmnmmmmmmmammmmm©mmmomo®mmoomommonmmmmmmmmmmmemmmmmmmmmame■a�mmmmmmm®®emmm COMPLETE CONTRACTOR'S INFORMATION BUSINESS NAME: I �2 de 2 6[e C'A ( c� � Cry RK G I tl P— �� BUSINESS ADDRESS: 17101.(` 6 gj(diol5e��ITY l%AICIA� �°' � ?iii STATE FL ZIP CODE ® 19 BUSINESS PHONE:3(O ) �j � `y FAX NUMBER(._) CELL PHONE QUALIFIER'S NAME: QUALIFIER'S LIC NUMBER: 6 E-MAIL ADDRESS (IF APPLICABLE): Created on 3119109 BY MLDV I RV 3126109 MLDV STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 JIMENEZ FRANCISCO F JIME Z ELECTRICAL CONTRACTOR INC HI4ALIEAH GARD�SC80BEEFL 33D3 018419 Congratumonst With this license you become one of the nearly one million Floridians licensed by the Department of Business and Professional Regulation. Our professionals and businesses range from architects W yacht brokers, from boxers to barbeque restaurants, and they keep Florida's economy strong. Every day *a work to improve the way we do business in order to serve you better. For informaltion about our services, please lag onto �+ww.myfioridalicense corn. Then: you can find more inibrmation about aur divisions and the regulations that impact you subscribe to department newsletters and learn more about the Departs initiatives. Our mission at the Department is: Ucense Efficiently, Regulate Few. We constantly strive to serve you better so that you can serve your customers. Thank you for doing business in Florida, and congratulations on your now license! DETACH HERE STATE. OF FLORIDA (850) 487-1395 STATE OF FLORtDA DEPARTMENT OF PROFESSIONAL REQ -_=ZX EC13002779 07/17/12 CERTIFIED ELECTRICAL JI Z, FRANCISCO F JIMENEZ ELECTRICAr, e;C IS CERTIFI&D under the =429 Rq,,,eti. ante. AIIG n, 2014 ==93 SEt# L12V73702593 KEN LAWSON SECRETARY _nntbtb Local Business Tax Receipt Miami—Dade County, State of Florida —THIS IS NOTA BILL— DO NOT PAY 5538062 BUSINESS NAMEILOCAMON RECEIPT NO. EXPIRES JIMENEZ F ELECTRICAL CONTRACTOR INC RENEWAL 30 -Sep -14 9002 BIRD RD 5778536 Must be displayed at place of business MIAMI FL 33165 Pursuant to County Code Chapter 8A — Art. 9 & 10 SEC. TYPE OF BUSINESS PAYMENT RECEIVED OWNER F JIMENEZ ELEC CONTRACTOR INC 196 ELECTRICAL CONTRACTOR 13Y TAX COLLECTOR EC13002779 $75 7/16/2013 Worker(s) 1 TXH51-13-029774 This Local Business Tax Receipt only confirms payment of the Local Business Tax. The Receipt is not a license, ngqualifications, to do business. comply vth any govetametrtal ar noovernmental regulatory laws and rit, or a certification of the holder's uimen whi h ap lyto the The RECEIPT N0. above must be displayed on all commercial vehicles — Mhuni—Bade Code Sec 8a-276. For more information, visit www miamidade amrftaxcollector aDATE (mmwr rrM A� ®CERTIFICATE F LIABILITY INSURANCE 1/8/2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. to IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policypes) must be endorsed, If gUBROGATIQN IS WAIVED, subject the terms and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not confer rights to the rarHAt!2t'a heidar In lieu of Such endomement(3). PRODUCER Dopazo and Associates 8725 NW 18th Tarr Bts 300 Miami FL 33172 INSURED F Jimenez Electrical Contractor Inc 12401 W Okeechobee RD Lot 419 Hialeah FL 3 Alezaader Dapaz, a,.(305)470-8500 Al�c(ddooazo . aom �L11� 'l�1AAI 'htl l®flJa G.�• (866)647-9673 COVERAGES GERTIFiGeATta IUUMt$rJq%VJ1-Lm.l-0vvv77 _-•_ - - TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES Building department AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. 10050 N.E. 2nd avenue Miami fl 331380 EXCLUSIONS u Y F Po ESCP UMITS .c�.T.s�arLder Dopa.za/AD S TYPE OF INSURANCE POLICY NUMBER D L!Tl rnMf MAY•telhf AH-; kfaz wantad 2 DOD OOO GENERAL UAINUTY EACH OCCURRENCE ,� 3 D A . 7 EN'i'EO _ , 100, 000 X COMMERCIAL GENERAL UABILIIY 560-9318@5911 E9/10/2013 9/1012014 Q PRESE 'a A Pm ) i S I MED EXP (Any one 22=11)_ 1 S 5,000 t� CLAIMS -MADE OCCUR PERSONAL & ADV INJURY S 1,000,000 GENERAL AGGREGATE S 2,000,000 PRODUCTS - COMP/OP AGG S 2,000,000 GIN'L AGGREGATE LIMIT APPLIES PER: J X PRO POLICY LOC IND S LI AUTOM0131LE LIABILITY BODILY INJURY (Per person) S ANY AUTO BODILY INJURY (Par acddeM) S ALL OWNEC SCHEDULED � 1 AUTOS NON epERF{ DAMAGE y -OWNED , HIRED AUTOS AUTOS S CE $ UMBRELLA �� OCCUR j EXCESS LIAO CLAIMS MADE I SOED aAGGREGATE - — RETENTION S ! B VJORXERS COMPENSATION EL EACH ACCIDENT S 1 000,000 AND EMPLOYERS' LIABILITY Y { N ( ANy PROPRIETOR(PARTNER(ttECUrIVE ® OFFICERRAEABER EXCLUDED'? NrA� 83026529 .1/2/2019 /2/2015 E.L. DISEASE .EA EYIPLOYS S 1 D00 000 E.L. DISEASE • POLICY LIMIT S 3-000,000 Waluls" 1n NH) If yes, de=bs tmder DESCRIPTION OF OPERA TIONS below DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORO fel, AddMonel Remelits Schedule, if moye space Is rogWmd) Electrician.-EC13002779 ACORD25(LIU10/05) V IJVV 4Vlv!•.va• m u v.v w•w... ___ IN5025 ontnnst ni 'rnn 9P.ngn names anA lnnn awa vania8ararl mar)ea n¢ Af''t'tp 1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Miami shores village THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Building department AUTHOMMI)RWFMEWAnVE 10050 N.E. 2nd avenue Miami fl 331380 � .� , .c�.T.s�arLder Dopa.za/AD rnMf MAY•telhf AH-; kfaz wantad ACORD25(LIU10/05) V IJVV 4Vlv!•.va• m u v.v w•w... ___ IN5025 ontnnst ni 'rnn 9P.ngn names anA lnnn awa vania8ararl mar)ea n¢ Af''t'tp 1