EL-14-2216r)
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-221423 Permit Number: EL -10-14-2216
Scheduled Inspection Date: October 14, 2014 Permit Type: Electrical - Residential
Inspector: Devaney, Michael
Inspection Type: Final
Owner: REBELO, ALEJANDRO Work Classification: Alteration
Job Address: 353 NE 94 Street
Miami Shores, FL 33138- Phone Number
Parcel Number 1132060136110
Project: <NONE>
Contractor: F JIMENEZ ELECTRICAL CONTRACTOR, INC Phone: 305/556-5759
Building Department comments
MOVING POOL EQUIPMENT
INSPECTOR COMMENTS False
Inspector Comments
Passed PERMIT WILL BE BY POOL EQUIPMENT
2el IA -1
Failed
Correction `'G �—
Needed
Re -Inspection ❑
Fee
No Additional Inspections can be scheduled until
re -inspection fee is paid.
October 10, 2014 For Inspections please call: (305)762-4949 Page 17 of 24
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 NU BER: (30S) 762-4949
BUILDING
PERMIT APPLICATION
F-IBUILDING ELECTRIC ❑ ROOFING
CP,TNr7
OCT 09 2014
�r0
FBC 20 P
Master Permit No. )2-1
Sub Permit No.—LL—
,-M&
o. L—
EVISION
IN
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS O CHANGE OF
CONTRACTOR
JOB ADDRESS:
❑ EXTENSION ❑RENEWAL
❑ CANCELLATION ❑ SHOP
DRAWINGS
the Building Historically Designated: Yes
Occupancy Type: Load: Construction Type: Flood Zone:
OWNER: Name (Fee Simple TitlE
Address: ?2
City: hA
Tenant/Lessee Name:
Email:
CONTRACTOR: Company� Name:
Address: 1701 gV t,
BFE: FFE:
kgz
City: �� State Zip:
Qualifier Name:, m1) �®;h� gg�� Phone#:
State Certification or Registration #: II ho02 -2f.39 Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $ Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work:
Specify color of coo thru tile:
Submittal Fee $_ Permit Fee $ _ `� : CCF $ r �� CO/CC $ �1
Scanning Fee $ '2> - QZ Radon Fee $ e2-' k) DBPR $ Notary $
Technology Fee $ Training/Education Fee $ Double Fee $
Structural Reviews $ Bond $
TOTAL FEE NOW DUE $
(Revised02/24/2014)
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,gbsence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged. � 1
Signature 4 -. Signature � yr
OWNER or AGENT C TRACTO
The foregoing instrument was acknowledged before me this
day of a4T 20 by
�A 111n
ho is p onally kno to
me or Ab has produced as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:_
Print:
The foregoing instrument has acknowledged before me this
day of ,�- '20 by
fVp� 31
� ho is p sonally o to
me or who has produced as
identification and who did take an oath.
Seal: Seal:
APPROVED BY �Q'G r Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
To: Page 3 of 3 2014-10-10 15:49:26 (GMT) 18883147262 From: Dream Pools
08/29/2014 07:51AM 2396749514
F JIMENEZ ELECT CANT
PAGE 01/01
STATE OF FLORIDA!
DEPARTw1ENT OF BUSINESS AND PROFESSIONAL REGUL nON
ELECTRICAL CONTRACTORS LICENSING BOARD (850) 487-9385
190 NORTH MONROE STREET
TALLAHASSEE FL 32399.0783
JIMENEZ FRANCISCO
F JIMENU ELECTRICAL CONTRACTOR INC
12401 VVEST OKEE0110BEE ROAD # 419
HIALEAH GARDLNS FL 3MIS
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am bec6 q "ofthe i%di .
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and they keep F}orlda's O=WW Wang.
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wwwAY1111 Drfetaliocnsa em. Thera you am Lind nwe mknnwvn
abdut our divisions and this rMAatione that IMpad you, subscribe
ib dE
nOmk#ms and lawn nse abmd the Depwftanrs
Our misafon at"asparbvient is: Lbwm may, Remote FAY
We eongantly shrive to scene yatr better s4 drat ym ®n verve your
C,uSkmw a. Thank you for doing business in Fie da.
SInd cOn®rabriations on yore new Rinse!
DETACH HERE
OF FLOPJDA
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HNI=SS AND
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ORM
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STATE OF PLOA
LEPARTOWT OF SUSIA110114 AND PROFES81124AL RMU A N
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- ... .. _ .
HNI=SS AND
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�8103/201�1
FOR
ORM
t�i± �E�CIF�ioi im •vnder. tine• p'rQvjaions Of Cfi.4Be FS.
''�AId6871ws •• L1AOaJ940p4�!"J
RICK SCOTT. GOVEMOf�
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LEPARTOWT OF SUSIA110114 AND PROFES81124AL RMU A N
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From: Maximo Dopaao Fax: (866) 647-9673 To: +13067668972 Fax: +13067668972 Page 3 of 3 101101201412:14
'4� " CERTIFICATE OF LIABILITY INSURANCE
LTR
TYPE OF INSURANCE
/3/2'�D"""'
9/3/2014
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 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 endorsement(s).
PRODUCER
CONTACT Alexander Dopazo
Dopazo & Associates Inc
PHONE (305) 470-8500FAX (866)697-9673
8725 NW 18th Tern Ste 300
DISI-alex@dopazo.aom
INSURER($) AFFORDING COVERAGE NAIC*
Myami FL 33172
PERSONAL &ADV INJURY $ 1,000,000
INSURERA :Phoenix Insurance Co 25623
INSURED
INSURERB:Brid efield Employers Ins Co 10701
F Jimenez Electrical Contractor Inc
INSURER C :
12401 W Okeechobee RD Lot 419
GENERAL AGGREGATE $ 2,000,000
INSURER D :
INSURER E:
Hialeah FL 33018
INSURER F:
V.. I. V FYI Ll Gly.
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 MAYHAVE BEEN REDUCED BY PAID CLAIMS.
LTR
TYPE OF INSURANCE
POLICY NUMBER
PMO/LDD EF
PO�LDp EXP
LIMITS
A
GENERAL LIABILITY
B COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE ® OCCUR
660431SN411
9/10/2014
9/10/2015
EACH OCCURRENCE $ 1,000,000
PREMISES a occurrence $ 100,000
MED EXP (Any one person) $ 5,000
PERSONAL &ADV INJURY $ 1,000,000
GENERAL AGGREGATE $ 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
PRO El LOC
X1 POLICY I
PRODUCTS - COMP/OP AGG $ 2,000,000
$
AUTOMOBILE
LIABILITY
ANY AUTO
ALL OWNED AUTOS SCHEDULED
HIRED AUTOS AUTOS NON -OWNED
AUTOS
COMBINED SINGLE LIMIT
Ea accident
BODILY INJURY (Per person) $
BODILY INJURY (Per accident) $
PROPERTY DAMAGE $
Per accident
UMBRELLA LIAR
EXCESS LIAR
OCCUR
CLAIMS -MADE
EACH OCCURRENCE $
AGGREGATE $
DED RETENTION $
WORKERS COMPENSATION
EMPLOYERS' LIABILITY Y / N
ANY PROPRIErOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED? ra�71N/A
(Mandatory In NH)
it yes, describe under
$
083026529
/2/2014
/2/2015
$
WC STATU- OTR"
$
E.L. EACH ACCIDENT $ 1,000,000
E.L. DISEASE -EA EMPLOYE $ 1,000,00
DESCRIPTION OF OPERATIONS below
E.L. DISEASE- POLICY LIMIT $ 1,000,00
DESCRIPTION OF OPERATIONS/ LOCATIONS/ VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more apace Is required)
Electrician.
EC13002779
CFRTIRICATC unI neo
(305)634-0957
City of Miami Shores
10050 HE 2nd Avenue
Miami Shores, FL 33138
ACnI7n 9A i-nenrnc�
INS075 r?nann5i ni
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
Dopazo/AD Z:::;�
v 1 ssa3-2010 ACORD CORPORATION. All rights reserved.
TMa iirnRr1 nama anrt Inn^ aro raniofararr marina ^f A[`nRr1
To: Page 2 of 3 2014-10-10 15:49:26 (GMT) 18883147262 From: Dream Pools
09/24/2014 06:12AM 2396749514 F JIMENE7 ELECT CONT PAGE 01/01
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