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EL-15-2229 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-244475 Permit Number: EL-9-15-2229 Scheduled Inspection Date: September 30, 2015 Permit Type: Electrical - Residential Inspector: Devaney, Michael Inspection Type: Final Owner: FEBLES, CARLOS Work Classification: Alteration Job Address:431 NE 94 Street Miami Shores, FL 33138- Phone Number Parcel Number 1132060140500 Project: <NONE> Contractor: EMPIRE ELECTRIC MAINTENANCE&SERVICE INC Phone: 305-264-9982 Building Department Comments METER REPAIR Infractio Passed Comments INSPECTOR COMMENTS False Inspector Com,.. Passed Failed Correction Q� Needed ❑ Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. September 29,2015 For Inspections please call: (305)762-4949 Page 35 of 41 ME _15- , Miami Shores Village 10050 N.E.2nd Avenue NE Miami Shores,FL 33138-0000 fN» � Phone: (305)795-2204 � t LORl4p' r ?\ y Expiration: 3/22/2016 Project Address Parcel Number Applicant 431 NE 94 Street 1132060140500 CARLOS FEBLES Miami Shores, FL 33138- Block: Lot: Owner Information Address Phone Cell CARLOS FEBLES 431 NE 94 Street MIAMI SHORES FL 33138-2845 Contractor(s) Phone Cell Phone Valuation: $ 1,200.00 EMPIRE ELECTRIC MAINTENANCE& 305-264-9982 _.., __ _... .,..... Total Sq Feet: 0 Type of Work:METER REPAIR Available Inspections: Additional Info: Inspection Type: Classification:Residential Review Electrical Scanning:3 Review Electrical Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $1.20 DBPR Fee Invoice# EL-9-15-56917 $2.25 09/01/2015 Credit Card $50.00 $ 116.70 DCA Fee $2.25 Education Surcharge $0.40 09/24/2015 Credit Card $ 116.70 $0.00 Permit Fee-Additions/Alterations $150.00 Scanning Fee $9.00 Technology Fee $1.60 Total: $166.70 In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans,drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL,PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction Hing Fut mo the above-named contractor to do the work stated. °- September 24, 2015 Authorized Sign re:Owner / Applicant / Contractor / Agent ate Building Department Copy September 24,2015 1 m Miami Shores Village I Building Department ` ti 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 1 S E P Q1 2 a i 5 Tel: (305)795.2204 Fax: (305)756.8972 INSPECTION'S PHONE NUMBER: (305)762.4949 O V-OL FBC20 BUILDING Permit No. PERMIT APPLICATION Master Permit No.-F—L Permit Type: Electrical JOB ADDRESS: City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: , t — 37—%— 14 0500 Is the Building Historically Designated: Yes V NO Flood Zone: OWNER: Name(Fee Simple Titleholder (O� + ��b te� Phone#:D,9' 95 I 9-71-3 Address: Ct l City: Ye S State: Zip: 7 Tenant/Lessee NaPhone#: Email: - COM CONTRACTOR: Company Name: Empire Electric Maintenance and Service, Inc. Phone#: 305-264-9982 Address: 1041 SW 67th Ave City: West Miami State: FL Zip: 33144 Qualifier Name: Antonio E. Hernandez Phone#: 305-264-9982 State Certification or Registration#: EC-0001274 Certificate of Competency#: Contact Phone#: 305-264-9982 Email Address: tony@empireelectric.net DESIGNER: Architect/Engineer: Phone#: Value of Work for this Permit:$ wo Jf Square/Linear Footage of Work: Type of Work: ❑Address ❑Alteration ❑New ❑Repair/Replace ❑Demolition Description of Work: HAIcrzA._/ Submittal Fee Permit Fee$ p'/PO CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Bond$ Notary$ Training/Education Fee$ Technology Fee$ Double Fee$ Structural Review$ TOTAL FEE NOW DUE$ Bonding Company's Name(if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name(if applicable) Cj 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 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 thy J b site for the first inspection w 'ch occurs seven (7) days after the building permit is issued poste e, the inspection wi n t be app v and a reinspection fee will be charged. Signature Signature Owner or Agent ��'' n a 2 The fore ing ins ument was ackn wle/dged before me thisdt The fo+ppenally ' s ent was acknowledg d before me this 3l day of 20 by al'l Q S F4 ITday of20�,by r &dq who is p r onally known to me or who has produced who is known to me or who has produced As identification and who did take an oath. as identification and who did take an oath. NOTARY PUBLIC• I NOTARY PUB C: Sign: RNAt90 ESCODAi, Sign: ;,L ary Public ° i�:e rj r Irl ( �.,'�, SIXTO FERNkhDO E 08Aa Print: °� - r >' Print: f Comm �If!Ct .`�' Notary Public-Jai 0. tY My Commission Expired a My Comma � 4 Expires eh 6 i r M, Comm.Ex LJ'7 Commission # EE 8543rD f APPROVED BY Plans Examiner Zoning Structural Rtview Clerk (Revised 3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09) RICK SCOTT,GOVERNOR KEN LAWSON,SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD EC0001274 IF s t The ELECTRICAL CONTRACTOR Named below IS CERTIFIEDY Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2016 HERNANDEZ,ANTONIO E EMPIRE ELEC MAINT&SER INC 1041 SW 67TH AVENUE �� WEST MIAMI FL 33144 Q ISSUED: 05/29/2014 DISPLAY AS REQUIRED BY LAW SEQ# L1405290002909 ...._...._.__,__ _ __ ______ _-.___ _ roua u4 Local Business Tax Receipt Miami-Dade County, State of Florida -THIS IS NOTA BILL - DONOT PAY �LBT ) 2318947 BUSINESS NAME&OCATION RECEIPT NO. EXPIRES EMPIRE ELECTRIC MAINTENANCE&SERVICE INC RENEWAL SEPTEMBER 30, 2015 1041 SW 67 AVE 2437648 Must be displayed at place of business WEST MIAMI FL 33144 Pursuant to County Code Chapter BA-Art.9&10 OWNERSEC.TYPE OF BUSINESS PAYMENT RECEIVED EMPIRE ELEC MAINTENANCE 1&SVC INC 196 ELECTRICAL CONTRACTOR BY TAX COLLECTOR Worker(s) 5 ECO001274 $45.00 07/09/2014 CREDITCARD-14-025539 This Local BusinenTax Receipt only acefimn payment of the Local Busism Tax.The Receignis nota license, penult,or a certiyicaBop of the holder's qualification,to do business.Holder must comply with any govemmeMal or longovernme�l regulatory laws and requiramenis which apply to the beds. The RECEIPT NO.above mud be displayed on all commercial vehicles-Mismi-Dade Code Sac 6a-Y76. For more iulormation,visit ACS CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 8/28/2015 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 endorsemen s. CONTACT PRODUCER NAME: FOrtun InsurancePHONE0. - ItF A/C No):866-415-0825 365 Palermo Ave. E-MAIL Coral Gables FL 33134-6607 ADDRESS: INSURERS AFFORDING COVERAGE NAIC# INSURER A: • Mutual Insurance Group INSURED 51158 INSURER B:Al Empire Electric Maintenance&Service, Inc. INSURER Associated Industries Ins. Co. Inc. Empire Fire Safety, LLC INSURER D: 1041 SW 67 Avenue Miami FL 33144 INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER:2908672 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. INSR TYPE OF INSURANCE ADDL UBR POLICY EFF POLICY EXP LTR INR WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS A GENERAL LIABILITY TB2-Z91-451758-014 3/31/2015 3/31/2016 EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED X D COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $300,000 CLAIMS-MADE FXI OCCUR MED EXP(Any one person) $5,000 PERSONAL 8 ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 X POLICY JE PRO- LOC $ A AUTOMOBILE LIABILITY ASK-Z91-451758-024 3/31/2015 3/3112016Ea accident 1,000,000 X ANY AUTO BODILY INJURY(Per person) $ ALL OWNEDX SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNEDPROPERTY DAMAGE $ HIRED AUTOS AUTOS X X Per accident Medical Payments $5,000 B X UMBRELLA LIABX OCCUR EBU 061234761 3/31/2015 3/31/2016 EACH OCCURRENCE $5,000,000 EXCESS UAB CLAIMS-MADE AGGREGATE $5,000,000 DED I X I RETENTION$0 $ C WORKERS COMPENSATION AWC1043891 3/31/2015 3/31/2016 W YLIMIT-S DER AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE❑ N/A E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) Electrical Contractor-State License EC#0001274 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Miami Shores Village ACCORDANCE WITH THE POLICY PROVISIONS. 10050 N.E. 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 x y I I 4 L I� l