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EL-13-1090 /2( Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-204711 Permit Number: EL-5-13-1090 Scheduled Inspection Date: December 18, 2013 Permit Type: Electrical - Residential Inspector: Devaney, Michael Inspection Type: Final Owner: VILLAMIZAR, FELIPE Work Classification: Alteration Job Address:547 NE 94 Street Miami Shores, FL 33138- Phone Number (786)371-4869 Parcel Number 1132060140880 Project: <NONE> Contractor: AC ELECTRICAL CONTRACTOR Phone: (305)970-2024 Building Department Comments NEW LIGHTS ADDES IN BEDROOM AND MASTER BATH Infractio Passed Comments INSPECTOR COMMENTS False Inspector Comments Passed 21 Failed Correction Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. December 17,2013 For Inspections please call: (305)762-4949 Page 26 of 31 Miami Shores Village Building Department 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 MAY Tel: (305)795.2204 Fax: (305)756.8972 INSPECTION'S PHONE NUMBER: (305)762.4949 FBC 20 BUILDING Permit No. CL 13 — of PERMIT APPLICATION Master Permit No. )ZC 13 Permit Type: Electrical , JOB ADDRESS: 5X7 APA7/1 IX-5T q-$/ Ci ty: Miami Shores County: Miami Dade i : �a Folio/Parcel#: N " _5206- 014 -0990 Is the Building Historically Designated: Yes NO Flood Zone: OWNER:Name(Fee Simple Titleholder): ��`� l � V) m 1 Zed( r Phone#: 7 6 b D -le(4�j Address: 5,q -7 A/ el -YL City: 0''j � I t l /1 f Z C'i 4's State: a" Zip: J Tenant/Lessee Name: Phone#: Email: �L� I 1�� _ lo`d �/�7 fd'� �C�� yid hry. a f7) PL CONTRACTOR: Company Name: �//Q C-- �� 'h ✓�t G Phone#: 9/J�17� Address: 4- �e City: %G��C- �/ State: �� Zip: (� Qualifier Name: o s e 1_ Phone#: 3 05—T),o 2,0 2 T' State Certification or Registration#: .3,0® /3 TW Certificate of Com etZy #: /: Contact Phone#: ®� P .2® Email Address: ®S ✓� 14� l go" DESIGNER: Architect/Engineer: /43 1/1 r L1 Phone#: Value of o k for his Permit• $ 04Ole• D Square/Linear Footage of Work: 80 O pe of dress ration ONew ❑Repair/Replace ❑Demolition owl Tr-4ns17)v ii�l (Y1 Asfff b,4-th 6da/y) Mid hey, 00drad rr► , A'a /V w wi.ndews r A�dr- I✓eW u0his ��/0 Submittal Fee$ � Permit Fee$ 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) 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 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. 7 Signature Signature Owner or Agent Contractor The foregoing instrument was acknowledged before me this The foregoing ins went was acknowledged before me this P day of 92017;,,by_-TelLpp day of ,20 t3 by who is personally known to me or wke-lwAtred}teed who is personally know�to me or who has produced As identificatiy I�-4�asidentificahon and who did take an oath. M VIOLET 1�8®111 NOTARY PUBLIC: "" Y Cpp �SStON#EE091822 NOTARY PUBLIC: EXPIRES L40Y 14.2015 • .cam 153. Fbride� Sign Sign: Print: 6 — Print: My Commission Expires: �,w 11 (L� ZU 5 My CommissiUN� l 11111M z as /7 APPROVED BY / *ell Y Plans Examiner Zoning Structural Review Clerk (Revised 3/12/2012XRevised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09) ACC>V CERTIFICATE OF LIABILITY INSURANCEDAM'MMf°D""YY' k..-- 6/18/2013 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 endorsemenL A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsemen s. PRODUCER CONYE. T Lissette Hernandez Gil, Garden, Avetrani Insurance Group PHONE (305)630-4777 P A� .(305)279-3022 10689 N. Kendall Drive t-MAIL .lhernandez@ggaig.com Suite 208 INSURMS1 AFFORDING COVERAGE NAICo Miami FL 33176 INSURERA:Travelers Indem Co of America 25666 INSURED INSURERB:RetailFirst Insurance Company A.C. Electrical Contractor, Inc. INSURER C: 3451 NW 48th Street INSURER 0: INSURER E: Miami FL 33142 rINSURJER F: COVERAGES CERTIFICATE NUMBER:CL1332603726 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. IL SR TYPE OF INSURANCE POLICY NUMBER POLICY EFF POLICY EXP OMITS GENERAL LL48JUTY EACH OCCURRENCE $ 1,000,000 X COMJAERCIAL GENERAL LIABILITY PREMISE Ea occurrence S 100,000 A CLAIMS-MADE OCCUR -660-4RS77418-nW-12 /17/2013 /17/2014 MED EXP(Ary wepersonh $ 5,000 PERSONAL 8 ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMPIOP AGG S 2,000,000 X POLICY 7 AV-rTPRO- LOC S AUTOMOBILE LIABILITY CO 18INEO SINGLE LIMP — 2 wipa nt1 T ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per amdent) $ NON-OHIRED AUTOS AUTOS+/NED PROP RTY DAMAGE AUTOS g Per aCtsdent $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAVd .IADE AGGREGATE $ DED I I RETENTIONS B WORKERS COMPENSATION $ OTH- AND EMPLOYERS'LIABILITY L'UC S U- ANY PROPRIETORIPARTNERIEXECUTIVE YIN OFFICERNEMBER EXCLUDED? NIA E L EACH ACCIDENT $ 100,000 (MendaWry in NH) 520-43246 1/29/2012 1/29/2013 E L DISEASE-EA EMPLOYE S 100 000 If yea,desa.be under DESCRIPTION OF OPERATIONS below E L DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Almch ACORD 101.AddlUanal Remarks Schedule,I MOM spaco Is►equlred) CERTIFICATE HOLDER CANCELLATION (305)756-8972 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. Building Department 10050 Northeast 2 Avenue AUTHOROEDREPRESENTATNE Miami Shores, FL 33138 Joe Avetrani/LISSET ^`- ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025(201om)aI The ACORD name and logo are registered marks of ACORD TAXgI 10 U.S.POSTAGE # PAID # + Y S*10 PERM MO. 31 618870-0 RENEWAL RUSINEss NAME t LOCATION RST NO. 645323-7 A C ELECTRICAL CONTRACTOR INC STATES EC13001345 3451 NW 48 ST 33142 UNIN DADE COUNTY OWER A C ELECTRICAL CONTRACTOR INC Sec.Type of Shy WORKER/S 196 ELECTRICAL CONTRACTOR 3 TIM Ai ONLY A LOCM. TAIL REOEWr.IT DOES NOT Pmw THE NOLOER TO VIOLATE ANY EXINM WEGULATORY OR ZOIONe LAWS OF THE DO NOT FORWARD coulf" OR cmm mm OM IT EXEMPT THE HOLUM ANY OTIUM PERMIT OR R LICEMM RIMMED BY LAW Tam 18 NOT A CMTiF=TKM OF A C ELECTRICAL CONTRACTOR INC THE HOLIN"Tfow °UpL" DAYIRA HERNANDEZ PRES 3451 NW 48 ST PAYMMTRECEIMAx MIAMI FL 33142 arougcrm 08/21/2012 60010000248 aae taat a�aa taxa at rs:�t.aiia,�:alsitiaaaai�aa�Idi 21 000075.00 r SEE OTHER SIDE kC# 6230655 STATE OF FLORIDA DEPARTMENT —op---S BIIINBSS AND PROFESSIONAL R$GULATION ELECTRICAL CONTRACTORS LICSNSING BOARD LICENSE NBR SEQ#L12072701289 07 27 2012 120022439 EC13001345 The ELECTRICAL CONTRACTOR Named below I3 CERTIFIED Under the provisions of Chapter Ogg FSe Expiration date; AUG 31, 2014 VIVO, JOSE A A C ELECTRICAL CONTRACTOR INC MIAMI NW 48TH STREET FL 33142 RICK SCOTT GOVERNOR REN LAWSON DISPLAY AS REQUIRED BY LAW SECRETARY