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EL-15-845Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-233990 Scheduled Inspection Date: May 06, 2015 Inspector: Devaney, Michael Owner: JOSE MARTINEZ TRUSTEE INC., ALEX D DADP1ll Toe Job Address: 525 NW 111 Street Miami Shores, FL 33138-0000 Project: <NONE> Contractor: PINAR ELECTRIC CONRACTOR CORP. Building Department Comments RE WIRE ENTIRE HOUSE Permit Number: EL -4-15-845 Permit Type: Electrical - Residential Inspection Type: Final Work Classification: Alteration Phone Number Parcel Number 3021360210720 INSPECTOR COMMENTS False Phone: 305-500-9669 Inspector Comments Passed CREATED AS REINSPECTION FOR INSP-233804. O. K. to have F P L connect service. Add 20 amp G. F. I. protected receptacle next to each bathroom sink. Change frount receptacle to G. F. I. with a bubble cover and add the same Failed under the panel in the back. Correction Needed ❑ Re -Inspection ❑ Fee No Additional Inspections can be scheduled until re -inspection fee is paid. May 05, 2015 For Inspections please call: (305)762-4949 Page 33 of 50 , Miami Shores Village CCF 10050 N.E. 2nd Avenue NW "" Miami Shores, FL 33138-0000 ` Phone: (305)795-2204 Education Surcharge $0.60 Project Address Parcel Number Applicant 525 NW 111 Street 3021360210720 ALEX R. PARDO TRS JOSE MAF Miami Shores, FL 33138-0000 Block: Lot: Owner Information Address Phone Cell ALEX R. PARDO TRS JOSE MARTINEZ 13876 SW 56 Street -- ---- - MIAMI FL 33175- 13876 SW 56 Street MIAMI FL 33175- Contractor(s) Phone Cell Phone PINAR ELECTRIC CONRACTOR CORF 305-500-9669 of Work: RE WIRE ENTIRE HOUSE onal Info: ification: Residential iing: 3 Fees Due Amount CCF $1.80 DBPR Fee $2.25 DCA Fee $2.25 Education Surcharge $0.60 Permit Fee - Additions/Alterations $150.00 Scanning Fee $9.00 Technology Fee $2.40 Total: $168.30 Valuation: $ 3,000.00 Total Sq Feet: 1000 Pav Date Pav Tvve Amt Paid Amt Due I Invoice # EL -4-15.55162 04/10/2015 Credit Card 04/15/2015 Credit Card $ 50.00 $ 118.30 $ 118.30 $ 0.00 Available Inspections: Inspection Type: Review Electrical L) In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS AFFIDAVI . 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 zon(riglKi6rmore, I authorize the above-named contractor to do the work stated. 6 Authorized S/ure: Owner / Applicant / Contractor / Agent April 15, 2015 Building Department Copy April 15, 2015 1 Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 BUILDING PERMIT A=ON ❑BUILDING ELECTRIC ❑ ROOFING FBC 20 0 Master Permit No. '=X-// Sub Permit No. ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑ PLUMBING ❑ MECHANICAL ❑ PUBLIC WORKS ❑ CHANGE OF CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: <'2- ZS- /1 W 1 I I - City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): � s--- GIA hone#: Address: oS Z� n W � \ 1 - City: `-\ V*T-A) <<'r`- State: �— Zip: 3-v l Tenant/Lessee Name: Email hone#: CONTRACTOR: Company Name: d I-V4k 6�7A-Ie '�'t�hC Phone#: 7a2 6 ��� Address: _�l a �,f/� dZ �'Q. A!D'Z City: ,�.,�, State: Zip: 3 3/ %4f Qualifier Name: 'ecqAlz�2& oxze?l Phone#: 304"�? l �� State Certification or Registration #: Certificate of Competency #: e(f/30SCk1 Z DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: $ :3 f ®a 4 Square/Linear Footage of Work: Type of Work: ❑ Addition Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: Spe , ; fy+LW1br aftefo -thria �.. Submittal` Fee $ Permit Fee $ I O104P CCF $ CO/CC $ Scanning Fee $ Technology Fee Structural Reviews $ (Revised02/24/2014) Radon Fee $ Training/Education Fee $ DBPR $ Notary $, Double Fee $ Bond $ rtrt TOTAL FEE NOW DUE $ V 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 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 wjA4ffl!Ze-a-p-p—r6-ve# and a reinspection fee will be charged. Sign OWNER or The foregoing instrument was acknowledged before me this tV day of20 t ��, by v` S�•,c ha 2 JAv0-- c ho is personally known)o me or who has produced identification and who did take an oath. NOTARY PUBLIC: as Signature CONTRACTOR The foregoing instrument was acknowledged before me this Z Z day of 20 /6 , by /4A/t7-10Gd1' 00—?W , who is personally known to me or who has prod uced.4�&g*10Vl7-4)OMWO as identification and who did take an oath. NOTARY PUBLIC: Structural Review Clerk (Revised02/24/2014) .- Sign: Sign: ..�s Print: Print: J Seal: =OSjRYP`B�(L ANDRES CRUZ Seal:• Ogle al FIor1Qa �. Notary Public - State of Florida' C 17' ;1017 SON aPc My Comm. Expires Sep 21, 2015 ' �''•. Corttm�sl �► FF 038787 ; Commission # EE 132342 APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) RICK SCOTT, GOVERNOR STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION KEN LAWSON, SECRETARY ELECTRICAL CONTRACTORS LICENSING BOARD EC13005412 rhe ELECTRICAL CONTRACTOR -THIS 15 NOT A BILL - DO NOTRAY' 5325602 MiarAi-Dade county, State o Florida 4HIt,19 NOTA BILL — 0O'1VOT',PAY, . MIAM Formreitttammtion,visit YMENT R TAX COL PAYMENT." REGI BY TAX Cbt!El 240.00 439/ i 0226-14-0070 U411.1/12015 10:49 fAX? 'P.0011001 IE9M'� CERTIFICATE OF LIABILITY INSURANCE I DATE04/0715 PRODUCER Excellence Insurance Agency THIS CEKnFICATE IS ISSUED AS A MATTER OF INFORMATIOI 3801 SW 107 Avenue ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR Miami, FL 33165 ALTER THE. COVERAGE AFFORDED,BY.T.HE POLICIES SELOV Phone (305)226-3900 Fax (305)22&3997 INSURERS AFFORDING COVERAGE NAIC # INSURED Pinar Electric, INC INSURER A: Granada Insuance Company 00334 INSURER B: Technol Insurance 491 o NW 1 oa Ave #102 Dora], FL 33178- INS RER C: COVERAGES INSURER P 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. INORZA NSAD TYPE OF INSURANCE POLICY NUMBERPOLICY EFFECTIVE POLICY EXPIRATION DATE D DATE Ipp LIMITS GENERAL LIABILITY EACH OCCURRENCE 1,000,000 COMMERCIAL flENERAL LIABILITY 01 BBFL00001837-0 08/09/14 08/09/15 PREMISES Ea gMLmne ja_ 100,000 ® ❑❑ CLAIMS MADE © OCCUR MED EXP (Anyone person) 5,000 A ❑ PERSONAL & ADV INJURY 1,000,000 ❑ GENERAL AGGREGATE 2,000,000 ❑ GARAGE LIABILITY Q ANY AUTO GEML AGGREGATE LIMIT APPLIES PER: AUTO ONLY - EA ACCIDENT PRODUCTS - COMP/OP AGG El EXCESSIUMBRELLA LIABILITY OCCUR ❑ CLAIMS MADE © POLICY ❑ PROJECT ❑ Loc AUTOMOBILE LIABILITY ED ANY AUTO EACH OCCURRENCE $500 Ded Prop.Demage ❑ DEDUCTIBLE COMBINED SINGLE LIMIT ❑ RETENTION S (Ea aecldent) ❑ ALL OWNED AUTOS 13 n 1:1SCHEDULEDAUTOS BODILY INJURY �r Person) U HIRED AUTOS BODILY INJURY ❑ NON OWNED AUTOS (Per accident) PROPERTY DAMAGE ❑ GARAGE LIABILITY Q ANY AUTO AUTO ONLY - EA ACCIDENT OTHER THAN EA ACC �.— AUTO ONLY: AGG El EXCESSIUMBRELLA LIABILITY OCCUR ❑ CLAIMS MADE EACH OCCURRENCE AGGREGATE ❑ DEDUCTIBLE ❑ RETENTION S EMPLOYERS' LIABILITY JUN gsvU WCC 0043627 00 11/15/14 11/15/15 © C T ❑ TH- i3 ANY PROPRIETOR / PARTNER / EXECUTIVE E,L, EACH ACCIDENT OFFICER / MEMBER EXCLUDED? If yes, deserribe under E.L, DISEASE - EA EMPLOYEE 1 SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT 1 OTHER DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES / EXCI Number 12219 Contract MCC 7040 Plan, MCC 7360 Plan Electrical contractor. CERTIFICATE HOLDER Miami Shores Vlliage Building Department 10050 NorthEast 2nd Ave Miami Shores Florida 33138 305-756-8972 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO' THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON TH SURER, RS AGENTS OR REPRESENTATIVES. ALIAHQRI BE ATIVE L7