ELC-14-1398 _JZ
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-215053 Permit Number: ELC-6-14-1398
Scheduled Inspection Date: July 01, 2015 Permit Type: Electrical - Commercial
Inspector: Devaney, Michael
Inspection Type: Final
Owner: MILITANA,JOHN AND ADRIENNE Work Classification: Addition/Alteration
Job Address:8900 BISCAYNE Boulevard
Miami Shores, FL Phone Number
Parcel Number 1132060110160
Project: <NONE>
Contractor: TRIANGLE ELECTRIC & FIRE LLC Phone: (305)592-3011
Building Department Comments
INSTALL ELECTRICAL FOR NEW FRYER HOOD Infractio Passed Comments
INSPECTOR COMMENTS False
Inspector Comments
Passed EO
Failed 1
Correction J
Needed
Re-Inspection ❑
Fee
No Additional Inspections can be scheduled until
re-inspection fee is paid.
June 30,2015 For Inspections please call: (305)762-4949 Page 2 of 40
Miami Shores Village
Building Department � A 14
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949
FBC20 � V
BUILDING Master Permit No. G
PERMIT APPLICATION Sub Permit No. �
❑BUILDING BdELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
PLUMBING MECHANICAL PUBLIC WORKS CHANGE OF CANCELLATION SHOP
Q n 1 CONTRACTOR DRAWINGS
o
JOB ADDRESS: Dc �,ol IGJ U 1�, PLA
A
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: 11"6ac)l/O "�II—Q16 Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name(Fee Simple Titleholder): 1 4n nQ Phone#:
Address: c)( l ( v
City: 5[,,) State: `!]],,� Zip: '33131 6
Tenant/Lessee Name: 1 T Phone#: J(
Email: 16 C{
CONTRACTOR:Company Name:
� 1 c�Q�cn�2 C.l eC.'C`�\� (� Phone#: M_ 6q
Address: :1a\5
City: Ct VYl\ State: Zip: �)�
Qualifier Name: r 6 Phone#:
State Certification or Registration#: Certificate of Competency
DESIGNER:Architect/Engineer: Phone#:
J
Address: Un City: State: _Zip:
d� l�P_f�IT(� I/�
Value of Work for this Permit: _ 120010,0 Square/Linear Foota a of Work:
Type of Work: ❑ Addition Nf Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work: 441 Ccecl(s L- /7tv >--yt2 'd+�
R
Specify color of color thru tile:
Submittal Fee$ Permit Fee$ /✓��e �� CCF$ 7J,J CO/CC$
L
Scanning Fee$� V� Radon Fee$ � 5 DBPR$ QL 25 Notary$
Technology Fee$ (+0 Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$ 9 n
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 sof 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."
n
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
g i
OWNER or ENT CONTRACTOR
The forlioing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
r. t r--7
day of 20 1by ��p t�ay of� CJ11n e- 20 f'y by
%SAIA2,whoispersonallykno LX,IV� ��lJCe ,who is personally known to
moor 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 PUBLIC: NOTARY LIC:
� v
Sign: h-w� Sign:
Printf��b �wl/ �S Print:
....�(I REBECCA GARCIA
Seal: n Notary Pudic Stara of Florida Seal: *4t,
* DIY COMMISSION t FF 108425
'Y Elliot C Tunis ,, EXPIRES:April 3,2018
My Commission EE 174219 � rr k-N1WT1n0WpdN*yWlm
am Expires 02/28/2018
****** * * ***********************************************************************
APPROVED BY � Olans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
RICK SCOTT,GOVERNOR KEN LAWSON,SECRETARY
STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
ELECTRICAL CONTRACTORS LICENSING.BOARD
s _ EC13003645 - - _
The ELECTRICAL:CONTRACTOR .
Named below IS:CERTIFIED
Under the provisions of Chapter 489 FS.
Expiration dater AUG 31,2096"
PRICE, EVERETT DAVID 11
TRIANGLE ELECTRIG&FtC.
"
7720 N:W.,5S STR7
DORAL
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ISSUED: 06/17/2-014 DISPLAY AS REQUIRED BY LAW SEQ# L1406170001281
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CAL CONTRACTQEB PAYMENT R'ECEIVEQ
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,45.00 08/13/2014
(HECK21.-14-049492
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Ta'"Ocelpt o�f(�j c4nUrms pay ent at the Local Business Tex The flecetptis not a hcanse,
pamilZrcemflca[io�aftheholddefiap�ahficaho�s tadobasmess Holder must complywrtlranygoverndletital
or`.11on�,��lalnmenlak�L�hl6tory lawS�grtlDequlremeYfts which applyto the 6u�ilYOSsI
The RECEIPT N1r'e6ove must bdlsplayed oal(eominbc�al vehm�asMjemDatle Coda Sec 8a-276.
for mare IploPmation,vlsUntnhnlw miBmldade govltexcal(bator '
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�C RQ DATE(MMIDD/YYYY)
IFI OF LIABILITY INSURANCE 06,/20114
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(ies)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 305-265-8118 CONTACT
Abacoa Insurance Group-MIAPHONE FAX
8000 NW 7th Street,Suite 202 305-265-8110 A G No Ext: (A/C,No):
Miami,FL 33125 E-MAIL
Kathleen Betancourt ADDRESS;
PRODUCER -TRIAN-3
CUSTOMER ID#:
__ INSURER(SI AFFORDING COVERAGE NAIC_ #
INSURED Triangle Fire Inc INSURER A:Everest Indemnity Ins CO i10851
Triangle Electric&Fire LLC -- - _- ----
INSURER B:Granite State Insurance 23809
Raquel Cano
7720 NW 53 St INSURER C:Philadelphia Insurance Co 18058
Miami, FL 33166 INSURER D:
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.
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR TYPE OF INSURANCE UBR POLICY EFF POLICY EXP LIMITS
LTR POLICY NUMBER MMIDD/YYYY MM/DDIYYYY
GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
A X COMMERCIAL GENERAL.LIABILITY 51GLM01503-131 10102/13 10/02/14 ^G1 C'E'f t)kEPJ'fED 10����
FF.�M ISE S—eeurr2rirei...._.... $
— —_.._.._... —_.-_..._._...._........__..._.....
CLAIk4S-MADE 1:x]OCCUR i t.4ED EXP(firry one,;:e;son) $
5,000
_._ ......... PERSONAL&AEW INJURY 1,000 000
GENERAL AGGREGATE ;$ 2,000 000
..._. .....
-— - --
GEN'L AGGREGATELIMIT APPLIES PER: PRODUCTS-C' NPKJP AGS' �_$ 1,000 000
1----tI PRC- --
_ ._... O
X POLICYLOC DED $ 2,500
AUTOMOBILE LIABILITY COMBINED SINGLE.LIMIT S 1,000,000
.
(Ea accident)
C ANY AUTO PHPK1163335 04122114 04/22/15 -----_...._.._._........___...___--
—_-- GOD�URY(Pene petirson) S
ALL OWNED A!JTOS
BODILY INJURY!Per accident) $
SCHEDULED AUTOS ----._.....---.....---
_..___ PROPERTY DAMAGE
C X HIRED AUTOS PHPK1163335 04122/14 04/22/15 (Per accident) $
-
C X NON-OYJNEDAUTOS PHPK1163335 I 04/22114 04/22/15
-- .._.._...................... --....._
._..__— _..__._... .
I
I$
UMBRELLA LIAB OCCUR EACH OCCURRENCE $
EXCESS LIAB CLAIMS-MACE AGGRL-GAIE $
DEDUCTIBLE S
�... '. RETENTION $ S
WORKERS COMPENSATION
A1EMPLOYERS'
GLIABILITY
X
01/01!14 01/01/15005226864 LI61•1T�6�NT
-
E,L.EACH
$ 1,000,000B ANY POPRIETOR,PARTNER,,EXECUTIVE IWC 0 5226864
OFFI1= RiFAEMBER EXCLUDED? N/A
( tory ) E.L.DISEASE
EMPLOYEE ..^e 1,000,000
If yes,describe under
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT i 1,000,000
I
DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (Attach ACORD 101.Additional Remarks Schedule,if more s ace is re aired)
COMPANY SERVICES AND INSPECTS FIRE EXTINGUISHERS,IN ADDITION,COMPANY ALS�3
PERFORMS ELECTRICAL AND FIRE ALARM WORK.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Miami Shores Village Building THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
9 g ACCORDANCE WITH THE POLICY PROVISIONS.
10050 NE 2nd Ave.
Miami Shores„ FL 33138 AUTHORIZED REPRESENTATIVE
Kathleen Betancourt
U 1988-2009 ACORD CORPORATION. All rights reserved.
ACORD 25(2009109) The ACORD name and logo are registered marks of ACORD