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EL-15-116 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-235961 Permit Number: EL-1-15-116 Scheduled Inspection Date: June 03, 2015 Permit Type: Electrical - Residential Inspector: Devaney, Michael Inspection Type: Final Owner: PUGLISI, MICHALE S SANIBRINA Work Classification: Alteration Job Address: 1020 NE 104 Street MIAMI SHORES, FL 33138- Phone Number Parcel Number 1122320290250 Project: <NONE> Contractor: MIAMI ELECTRIC INC Phone: (954)444-5079 Building Department Comments ELECTRICAL WORK FOR BATHROOM AND CLOSET Infractio Passed Comments INSPECTOR COMMENTS False RENOVATION. se Inspector Comments Passed 1Z /* Failed Correction Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. June 02, 2015 For Inspections please call: (305)762-4949 Page 28 of 28 Miami Shores Village -RECEIVED : Building Department JAO 0 2015 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 BY• Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 201 BUILDING Master Permit No Ro PERMIT APPLICATION Sub Permit No. �1 1C) BUILDING FN� ELECTRIC ❑ ROOFING REVISION EXTENSION RENEWAL ❑PLUMBING ❑ MECHANICAL PUBLIC WORKS ❑ CHANGE OF CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 1020 NE 104 STREET City: Miami Shores County: Miami Dade Zip: Folio/Parcel#:11-2232-029-0250 Is the Building Historically Designated:Yes NO X Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder):MICHAEL AND SABRINA PUGLISI Phone#: Address: 1020 NE 104 STREET City: MIAMI SHORES State: FL Zip: 33138 Tenant/Lessee Name: N/A Phone#:N/A Email: e Cff?'/C / C . CONTRACTOR:Company Name: �l Q1J?/(/(- �l /� Phone#: � Address: ?o/ 5W 195 fi�h'R City: ,soy m VV ESQ R,+Iy c-es State: FL zip: 3.3332- O QualifierName:�Q�1 e Oen�e -z Jr. Phone#: !) q" q 7 -o7/) State Certification or Registration#: G © d 2 d Certificate of Competency#: 2 " 7� DESIGNER:Architect/Engineer: F-le`e Z pI ,9/�P7Z -'/i�/'/\T�L�j Phone#: 3 —3 7 3 /03 3 Address: 2 S SE 2 A J©Q City: /�/ State: f Zip: -? 3/ 3 Value of Work for this Permit:$ 3/ 000 Square/linear Footage of Work: S G Type of Work: ❑ Addition Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: BATHROOM AND CLOSET RENOVATION i '-U- ?(CPL Lknr< Specify color of color thru tile: Submittal Fee$ r -(1) Permit Fee$ xZf,©,0 CCF$ CO/CC$ Scanning Fee$ Radon Fee$ 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 Zip Mortgage Lender's Name(if applicable) Mortgage Lender's Address City State 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 will not a proved and a reinspection fee will be charged. *,, SignatureSignature 0 NER or AGENT CONTRACTOR The foregoing instrument was acknowledged befor me this The foregoing instrument was acknowledged before me this day of ` 20 ,by day of ��Ce-jts4 who is personally known to �r2 �� ,SZ- ally k wn o me or who has produced as me or who has produced as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLI NOTARY PQB1,IC. Pay OBE ARKIN r •c' NOIaf lorida Sign: , S' n: _ . ion#FF 0 9 Print: Print: Seal: Seal: o, MARLING GARCIA .' ' Notary Public•State of Florida My comm.Expires Sep 26,2015 APPROVED BY �f Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) RICK SCOT], GOVERNOR KEN LAWSON.. SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD y .,0 The ELECTRICAL CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date. AUG 31, 2016 GOMEZ, RENE JR MIAMI ELECTRIC INC 5201 SW 195 TERRACE SOUTHWEST RANCHES FL 33332 ♦' ISSUED. 08131/2014 DISPLAY AS REQUIRED BY LAW SEQ# X1408310006721 BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT 115 S. Andrews Ave., Rm. A-100, Ft. Lauderdale, FL 33301-1895—954-831-4000 VALID OCTOBER 1,2014 THROUGH SEPTEMBER 30,2015 DBA: Receipt#:E161--2597 LECT ICAL/f,LARMS/CONTRACTQR Business Name:MIAMI ELECTRIC INC Business Type: (EI-,ECTR7CAL CONTRACTOR) Owner Name:GOMF.z RENT: JR Business Opened:'-2/17/2004 Business Location: 52)1 SW 195 TER State/County/Cert/Reg:Ecou02200 SOUTHWEST FAVCHES Exemption Code: Business Phone: 954-444-50 /9 Rooms Seats Employees Machines Professionals 3 For Vending Business Only Number of Machines: Vending Type: Tax Amount Transfer Fee NSF Fee Penalty Prior Years Collection Cost Total Paid 27.00 0.00 0.00 0.00 0.00 0.00 27.00 THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS THIS BECOMES A TAX RECEIPT This tax is levied for the privilege of doing business within Broward County and is non-regulatory in nature. You must meet all County and/or Municipality planning WHEN VALIDATED and zoning requirements. This Business Tax Receipt must be transferred when the business is sold, business name has changed or you have moved the business location.This receipt does not indicate that the business is legal or that it is in compliance with State or local laws and regulations. Mailing Address: GOME'L RENE JR Receipt #52A-13-00001753 5201 SW 195 TER Paid 09/30/2014 27.00 SCUT'HWEST RANCHES, F'L 33332 2014 - 2015 CERTIFICATE OF LIABILITY INSURANCE JAT[( )7 D1 Y�, 01,I,1 1 r> PRODUCER :�c telt#an Irs_Irarce THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Far: c;"oi y-4aci Blvc HOLDER.THIS CERTIFICATE DOES NOT AMEND.EXTEND OR Holivvtiood. FL 331024 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. PY 9547C 664 �444 a,. r-;q INSURERS AFFORDING COVERAGE NAIC# .._.< N:! X1;M INDr_I`.,1NIr ' INSURED MIAMI ELECTRIC: INC 5201 Sb^J 195TH TFRRA('.F SOUTH'vVESTRAN( HF:fi FL 3)32 N , I•,i COVERAGES :EP O V .'�;fif IN URAN I i,.�.E 1.f ,i.v;� sk Nt ;�;(IEvINI.f,::,iE r % ..I'f �l ;5 V'r w'F::U'-REPAFN( ("F=FIvi ...yNt !:Ni_ '.N• tlTk _ .'�.. .. 7 11 ..'++_ '"tii. .t k _kAT,v r.L, aFRT)%IN FI-it- INSRANGF.ATT f(>Eri `NE P C L'C F,_ r'RI,'[. f RE,N�_ j li i T _ ,L ,�tF- TEt<... LIGIE 3GREi;AtE LIMIT , SW :N',:1. ', E PFtN k!- _Y"F It t R4tS INSR AuoD POLTYPE OF INSURANCE POLICY NUMBER DATE tr Ft_CYV ITIAT r cX°IRAnon LIMITS LTR iNSRD DATE gh•7h7.GprV`i. T)A TE M.d�GG� Y1 GENERAL LIABILITY F-,( '- Nr:F 1 N T E, Dl ll�l GOQ.t�00 :E� F �f>I_ICY" F r ,Ir, AUTOMOBILE LIABILITY �`._�' N_I ` N I LihTl Nt C. L .•rNi-L t „';I i-Y IN,LIF'`, HELULED Al-1 �- - NIktUAiII(I N�-)N+)vlINFFI =ur SRT" GARAGE LIABILITY ?NIY F C;r;![u_NI ,3N;-t EXCESS/UMBRELLA LIABILITY -{ ` =N%F z FTF NTI )N WORKERS COMPENSATION AND H- EMPLOYERS'LIABILITY NI I I a,L P',1,T^!FR ['XE Tr .(r1 ME.ttif.k EXI ENIPI PFS ,I 'Rt .IS()N-1 r•_)tl+.` tFS'! OTHER DESCRIPTION OF OPERATIONS,LOCATIONS;VEHICLES I EXCLUSIONS ADDED BY FNDORSEMENT SPECIAL PROVISIONS ELECTRICAL CONTRACTOR CERTIFICATE HOLDER CANCELLATION SHOU':D ANY OF THE ABOVE DFSCRIBED POLICIES BE CANC.FLt ED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL CITY OF MIAtv1i SHORE• 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO Ilny(� (f F '�(yC; •v LNLF T THE LEFT.BUT FAILUREL TO DO SO SHALL IMPOSE NC OBLIGATION OR LIABIITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES FI AUTHORIZED REPRESENTATIVE ACORD 25(2001108)OF ACORD CORPORATION 1988 .ac`c K i CERTIFICATE OF LIABILITY INSURANCE o1/07ro7/zols 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: It the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. N 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). PRODUCEA OO1t"" Michael D.Holleman R E- Work Comp Associates,Inc, (561)863-9581 (561)881-9745 „"� �, P.O.Box 33297 A� mail@WorkCompAssoc.com Palm Beach Gardens.FL 33420-3297 NSURER S)AFFORDING COVE RADE NAI(I INSURER A. BusinessFirst Insurance Company INSURED INSURER B Miami Electric,Inc. INSURER 5201 S-W. 195th Terrace NSURtR o Southwest Ranches,FL 33332-1215 INSURER E: INSURER F 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,EXC-USIONS AND CONDITIONS OF SUCH POLICES LIMITS SHOVVN MAY HAVE BEEN REDUCED BY PAID CLAIMS TN-SR ADnL SLOP POLICY EFF POLICY EXP GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY a $ CLAIMS-MADE D OCCUR MED EXP(Any one person) $ PERSONAL 3 ADV INJURY S GENERAL AGGREGATE S GENL.AGGREGATE LIMCf APPLIES PER. PRODUCTS-COMP'OP AGG $ POLICY F EIT FLOC $ AUTOMOBILE LIABILITY $ j ANY AUTO BODILY INJURY(Per personi $ ALL OWNED SCHEDULED i BODILY INJURY(Per accident) S AUTOS AUTOS HIRED AUTOS PION-OWNED T7RCWERfY DAVIALilr. $ AUTOS $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAS CLAIMS-MADE AGGREGATE $ DED RETENTION S i $ WORKERS COMPENSATION AND EMPLOYERS LIABILITY Y I N X T Y j ANY PP.OPRIETORIPARTNER/EXECUTIVE E L EACH ACCIDENT $ 1,000,000 A OFFICEWEMBEREXCLUDED' NIA 0521117310000 8/1/2014 8/1/2015 (Mandatory in NH) ( EL DISEASE-EA EMPLOYEE $ 1,000,000 If yes.describe under DESCRIPTION OF OPERATIONS beau E .DISEASE-POLICY LIMIT $ 1.000,000 I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 107,Addiftnal Remarks Schedule,if more space it required) Electrical Contractor CERTIFICATE HOLDER CANCELLATION I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Miami Shores Village Building Dept ACCORDANCE WITH THE POLICY PROVISIONS. 10050 N E 2nd Avenue Miami Shores Village,FL 33138-2382 AUTHORIZED REPRESENTATIVE (EALII ©1918-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010,05) The ACORD name and logo are registered marks of ACORD