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EL-15-1081 lei Inspection Worksheet k Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-234170 Permit Number: EL-5-15-1081 Scheduled Inspection Date: August 27, 2015 Permit Type: Electrical - Residential Inspector: Devaney, Michael Inspection Type: Final Owner: FRONTAL, RAUL Work Classification: Pool - Private Job Address:585 NE 93 Street Miami Shores, FL 33138- Phone Number (305)609-6700 Parcel Number 1132060141030 Project: <NONE> Contractor: MESA BROTHERS INC Phone: (305)345-1974 Building Department Comments HOOK UP ELECTRICAL. POOL LIGHTS INSTALLATION, ISPEC Passed Comments INNSPEC BONDING. ROUGH ELECTRICAL TOR COMMENTS False Inspector Comments Passed Failed Correction � Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. August 26, 2015 For Inspections please call: (305)762-4949 Page 6 of 44 a \ Miami Shores Village 1s"Xj g� 10050 N.E.2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795 2204 \ y \ � ,� , ` g Expiration: 12/09/2015 Project Address Parcel Number Applicant 585 N E 93 Street 1132oso141030 _.. � � Miami Shores, FL 33138- Block: Lot: RAUL FRONTAL Owner Information Address Phone _ Cell RAUL FRONTAL �MIA �3eet r (305)609-6700ES FL 33138- 585 NE 98 Street MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone � $ 2,000.00 Valuation: MESA BROTHERS INC (305)345-1974 w....... ...... ...._,, .... .._ Total Sq Feet: 0 Type of Work:HOOK UP ELECTRICAL.POOL LIGHTS INS Available Inspections: Additional Info: Inspection Type: Classification:Residential Final Scanning: 1 Light Niche Bonding Review Electrical Alarms Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $1.20 Invoice# EL-5-15-55454 DBPR Fee $4.50 05/06/2015 Check#: 1029 $50.00 $265.20 DCA Fee $4.50 Education Surcharge $0.40 06/12/2015 Check#: 12814 $265.20 $0.00 Permit Fee-Additions/Alterations $300.00 Scanning Fee $3.00 Technology Fee $1.60 Total: $315.20 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 AFF I VIT: I certifythat all the foregoing information i g g s accurate and that all work will be done in compliance with all applicable laws regulating construction and z ning. Fu e, I authorize the above-n amed,pontractor to do the work stated. June 12, 2015 Authorized Signature:Owner / Applicant Contractor / Agent Date Building Department Copy June 12,2015 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 B31-- FBC-200 BUILDING Master Permit No.-OPP- PERMIT APPLICATION Sub Permit No. [--]BUILDING ��ELEC ' RIC ❑ ROOFING ❑ REVISION r-] EXTENSION ❑RENEWAL E]PLUMBING �IECHANICAL ❑PUBLICWORKS F-1 CHANGE OF F-1 CANCELLATION F--j SHOP CONTRACTOR DRAWINGS JOB ADDRESS: C)6- City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: i 1C1Cr -C_!I Is the Building Historically Designated:Yes NO rw// Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): —Phone#: Address: LA CC, 11!�_1'4ACII:�? City: State: .... I - zip: Tenant/Lessee Name:—1� A Phone#: Email: CONTRACTOR:Company Name: a- e i4 kc'-S Phone#: _305 3 -c Address: f5,31k L-2 14-13 -Aw- , City: kil CA I-ni - State: JrL zip: 36 V5 Qualifier Name: 1Z C-C N McSG Phone#: State Certification or Registration M a CSC)1-6q Certificate of Competency#: DESIGNER:Architect/Engineer: 0(-V-L'_'0 .PE cc(,-6qj Phone#: Address: Fj)'l rjr 12.0 Av-- City: t-dl e. i -% _!a —State: L zip:_' 5ig L4 Value of Work for this Permit:$ V Square/Linear Footage of Work: Type of Work: F-1 Addition El Alteration New Repair/Replace F-1 Demolition Description of Work: 1+00 In 'ele CA-C C nc-04_ et3 c)c-, Specify color of color thru tile: Submittal Fee$ Permit Fee$ CCF CO/cc$ Scanning Fee$ Radon Fee$ DBPR$ Notary$_ Technology Fee Training/Education Fee$ Double Fee Structural Reviews$ Bond$ TOTAL FEE NOW DUE$tzrsc) (Revised02/24/2014) __ 11 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$2500, the applicant must promise in goad faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also,a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the_absence of such posted notice, the inspection.juW no be_approed and a reinspection fee will be charged. 4~ Signature Signature E OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this �- day of C v<-u— 20 1 _ by � y of �_,2 - by � C'J w i rsonaHy known t , who is personally known to me or who has produced a me or w4 has produced as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign- +,, Sign: Print: MA A N "Z� Print: #FF 008989 ot.........e Seal: a-•Q ' EXPIRES:May 15,2017 Seal: ?` •`^ MISSION#FF084758 ;A t'' Bonded Thru Notary Publio Underwriters PIKES:JAN 21,2018 or Bonded through 1st State Insurance APPROVED BY 1C �' Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) RICK SCOTT. GOVERNOR STATE OF FLORIDAKEN LAWSON, SECRETARY DEPARTMENT OF BUSINESS AND PROFESSIONAL ELECTRICAL CNTRACTORREGULATIONOS LICENSING BOARD EL1.300487Q,_.. - Thi-eCC-CTI CONTRACTOR N Fnsd:belavV I`S CERTJF!Ep .. Ufl d@r.flte proCrisiClj's:of"CapFer 489 FS Expw #io'n�Ctal U-1381, 2016 HE SW JAN ISSUER. 06/10'2014 DISPLAY AS REQUIRED BY LAW SEQ# L140810000157$ � i n Mw �S j'� *x •iI}Ih,�iRU. II OWN MESA ERS NC y" EC.lO, '$7E •RAC}`} r,- H:. P.arrKgyy�~ftgCEi A. TAX CCCLBCT $7500 0$i2;fl014u: ': eHECK2i-14-C53006 TAi; usinos pe tee t irmx e nmen c payment at the ' Business Tux The Kebi is not a tipfe . nmenta the hot 6t1l�cetoot?E t0 bo business. t#otdbrf ittorY to equirbmettts which b t r, tY t!It, an CIIPT bora DDfY to thb ttzc' v save played o!!� bt rehfc {. .., , for :r a Sec "- ."�,. a�t�r> MESAB-1 OP ID:YM CERTIFICATE OF LIABILITY INSURANCE DATE(MMiO[)lYYYY) 1212312014 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((es)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 endomemen s). PRODUCER NAMEC Yolanda Mendez FAX Global Risk LLC PH�NE 305-465-72660 c No:305-456-7261 6959 Blue Lagoon Dr Suite 101 : Miami,FL 33126 ADOREss:mall@globairiskile.com EDUARDO R PORTAS INSURER$ AFFORDING COVERAGE NAIL# INSURER A:WOSCO Insurance CompanyE INSURED Mesa Brothers Inc. INSURERS: 5215 SW 103 Ave INSURER C: Miami,FL 33166 INSURER 0: INSURER E; 1 INSURER F: 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 1 TYPE OF INSURANCE POLICY NUMBER i MMtDD MM/ DO LIMITS LTR i h A r t COMMERCIAL GENERAL LIABILITY i , EACH OCCURRENCE I$ 11000,0001 QF TU RENT D CLAIMS-MADE 7i OCCUR s j #PP122167400 101101/2015!`01101/2016 i PREMDAMI ES Esocowencet I$ 100,00 i I I g j EKED EXP(Any one person) IS 5,00 ## PERSONAL&ADV INJURY IS 1.000,00 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,OOC X;POLICY ECT L j ; PRODUCTS,caarl�IczP AGa I s 2,000,0 OTHER: I I $ CUUM176TIN-735TE LIMIT AUTOMOBILE LIABILITY i{ Ea $ 'tant ANY AUTO }E ` BOOILY INJURY(Per person) S r--ALL OWNED {SCHEDULED t � BODILY INJURY(Per aceideM) $ {...._J AUTOS r- NON-0W NEO i ; j DAMAGE $ HIRED AUTOS ,t AUTOS Per accident I j i S UMBRELLA LIAR !OCCUR i EACH OCCURRENCE Is EXCESS LIAB CLAIMS-MADE AGGREGATE S DED RETENTIONS S WORKERS COMPENSATION ` PTUTE ER H_ t AND EMPLOYERS'LIABILITY Y 1 N ANY PROPR)ETORIPARTNEWEXECUTIVE }N!A € E.L.EA04ACCIDEENT $ OFFICER/MEMBER EXCLUDED? J 1 (Mandatory in NH) €.L.DISEASE_€A EMPLOYE S y S E.L.DISEASE•POLICY LIMIT ,5 DESCRId PTIbs un OPERATIONS below I t I 1 t ? s i DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) Electrical work within buildings CERTIFICATE HOLDER CANCELLATION MIAMII d SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION ATE THEOF, Miami Shores Village ACCORDANCE WWITHQHE POLICY PROVISIIONSE WILL BE DELIVERED IN 10050 Northeast 2nd Avenue Miami Shores,FL 33138 AUTHORIZED REPRESENTATIVE 01988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD r � DATE ,ACO©� CERTIFICATE OF LIABILITY INSURANCE 1 Or13/2014 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 BETWEENTHE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the poilcy(ies)must be endorsed. It 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 NTACT 888-925.2990 Ext,20834 Stonehenge Insurance Soiutions..Inc. NAME: g PHONE {61-746-5027 FAX P.O.Box 3442 (AIC,No,Ext): ' {AIG,No}: 4 Te uesta,FL 33469 E-MAIL' cents@progressweemployer.com INSURER{S AFFORDING COVERAGENAIC# INSURER A.-Technology insurance Company,Inc. 42376-- INSURED INSURER B: -- —_ -_ -_� _-- Progressive Employer Management Co,Inc.and all its affiliates and subsidiaries — --- -For Co-employees of Mesa Brothers Inc INSURER C: 6407 Parkland Dr Sarasota,FL 34243 INSURER 0: INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER:BGXTSSZV 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 SLCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. .__..:._ -_.._._..f.- ___..._�.,... __.�._._.._. .___.-. ..-- "POUdY-EFF., "itioLiCY' XP .-_ ._... ..., _ -._.. tNSf?_,_ ..._.... - .,.i4DDl:s`sU$'tI'_._..__ LIMITS LTR TYPE OF INSURANCE POLICY NUMBER MWDD Y MMlDD YYY GENERAL LIABILITY EACH OCCURRENCE S COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTEDPREMISES(Ea occurrenmS CLAIMS-MADE OCCUR MEC EX-,A-,y one person' S PERSONAL&ADV INJURY GENERAL AGGREGATE 5 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG S. POLICY PR6 LOC _,$ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO :BODILY INJURY(Per person) S ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ NON-OWNED HIRED AUTOS PR 3P RTYDA!J"At�aE`- - --- - AUTOS (Per acc�dent) - S S UMBRELLA LIAR OCCUR EACH OCCURRENCE S EXCESS LIAO CLAIMS-MADE H - _. .. . AGGREGATE $ DED RETENTIONS g A WORKERS COMFENSATiON "TWC3431595 0967 512014 10601)2015 AND EMPLOYERS'LIABILITY YIN T$�RY LIMITS. BR ., ANY PROPRIETORIPARTNER/eXECtJTIVE _-. E.L.EACH ACCIDENT .S 1=000,000 OFFICERfMEMSER EXCLUDED? N f A (Mandatory in NN) - - .L E. •EA EMPLOYEE1S . 0 tf yyas, escribe under __D. .ISE_.ASE 000000 -- DESGRd}PTIQN OF OPERATIONS below E,1-DISEASE-POLICY LIMIT S 1.000,000 5 S S g DESCRIPTION OF OPERATIONS t LOCATIONS t VEHICLES(Attach ACORD tot,Additional Remarks schedule,it more space Is required) Coverage is extended to Co-employees but not subcontractors of Mesa Brothers Inc License#EC13001874 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATETHEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Miami Shares Village AUTHOR12Eo REPRESENTATIVE 10050 Northeast 2nd Avenue i miami,FL 33138 r Page 7 of 1 0 1988-2010 ACORD CORPORATION. Ali rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD