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EL-15-2491 Inspection Worksheets R, Miami Shores Village 10050 N.E.2nd Avenue Miami Shores,FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-244558 Permit Number: EL-9-15-2491 Scheduled Inspection Date: December 16,2015 Permit Type: Electrical - Residential Inspector: Devaney, Michael Inspection Type: Final Owner: FARACH, RUBEN M Work Classification: Pool - Private Job Address:114 NE 109 Street Miami Shores, FL 33161-7042 Phone Number (305)281-7790 Parcel Number 1121360090150 Project: <NONE> Contractor: F JIMENEZ ELECTRICAL CONTRACTOR, INC Phone: 305/556-5759 Building Department Comments POOL PUMP AND POOL SPA LIGHT Infractio Passed Comments INSPECTOR COMMENTS False Inspector Comments Passed EEf Failed Correction ❑ Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. December 15,2015 For Inspections please call: (305)762-4949 Page 20 of 51 Permit No, ��.-9-15-2491 R s ye Miami Shores VillageP Permit Type.Electrical-'Residential 10050 N.E.2nd Avenue NE WorkCiassificat`ion.Pool-private Miami Shores,FL 33138-0000 .. Penri t Status.APPROVED Phone: (305)795-2204 f`R1DA Expiration: 04/23/2 1 Date 10126120166 p� Project Address Parcel Number Applicant i 114 NE 109 Street 1121360090150 Miami Shores, FL 33161-7042 Block: Lot: RUBEN M FARACH Owner Information Address Phone Cell RUBEN M FARACH 114 NE 109 Street (305)281-7790 MIAMI SHORES FL 33161- j i 114 NE 109 Street MIAMI SHORES FL 33161- Contractor(s) Phone Cell Phone Valuation: $ 800.00 F JIMENEZ ELECTRICAL CONTRACT( 305/556-5759 Total Sq Feet: 0 Type of Work:POOL PUMP AND POOL SPA LIGHT 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 $0.60 Invoice# EL-9-15-57263 DBPR Fee $4.50 09/30/2015 Cash $50.00 $263.60 DCA Fee $4.50 Education Surcharge $0.20 10/26/2015 Cash $263.60 $0.00 Permit Fee-Additions/Alterations $300.00 Scanning Fee $3.00 Technology Fee $0.80 Total: $313.60 In consideration of the issuance to me of this perm' agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the ens, wings,statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility fo all work ne by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL,PLUMBING,MEC NICAL,WIN OWS,DOORS,ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: I certify that all the oregoing info a and that all work will be done in compliance with all applicable laws regulating construction and zoning. Futhermore,I auth rize the ab a ed contractor do the work stated. October 26, 2015 Authorized Signature:Owner / Appli n / Contractor Agent ate Building Department Copy October 26,2015 1 Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 SEP , 0 2015 Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 S-kA FBC 20H BUILDING Master Permit PERMIT APPLICATION Sub Permit No. ❑BUILDING ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL V NJ ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP j cq CONTRACTOR DRAWINGS JOB ADDRESS: „ ra e �� City: Miami Shores County: Miami Dade Zip: a ' Folio/Parcel#: -® 31��1 0 t5 Is the Building Historically Designated:Yes NO_ Occupancy Type: Load: Construction Type: Flood Zone:X BFE: FFE:C? OWNER: Name(Fee Simple Titleholder): �� Phone#: 205-2g/ Address: ( � 1�0 r' . alr�1'�'S'T City: CeS State: _ Zip: �6 1 Tenant/Lessee Name: Phone#: , Email: CONTRACTOR:Company Name: 4`Ph e#: �� w�P��Z- \� �c_�,� C�� I Phone#: Address: � /�eA/� 01, 14i City: �� Kf-res State: — Zip:3'1�1 I Qualifier Name:'c�.y��S cl7 �► � Phone#: ��— �� a ��0 State Certification or Registration#: ��s30 r_)�-J Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ 900-- Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration [ New ❑ Repair/Replace ❑ Demolition Description of Work: 0c2 �T T®r2( /%?C, U`)h `I_ 41 It I A hl Specify Oplor of color thru tile;. r� _ Submittal Fie �uPoral$ C Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ 06 3 60 (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 be approved and a reinspection fee will be charged. Signature Signatur GENT CONT CTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of Y ,20 15 , by ;an day of +)e 20 tJ by )&14 who is 6onally know o Y::;vyNt r-A-cD \\i rwi-j--& who is II k w 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 PUBLIC: NOTARY PUBLIC: Sign: 29t-,�� Sign: Print: Print: baa 'All s M sULNE8 • ma,�•` �ULNESSeal: Seal: pi;.. PNotary Public-State of Flordais -State of Florida ?• My Comm.Expires Jun 23,2017 •P fAY Comm. Expires Jun 23,2017 CoMmission.#FF 030252 � :;;F Commission#FF 030252 gs �'' � '• l�ndad Thr a i APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) 09/30/2015 10:41AM 2396749514 F JIMENEZ ELECT CONT PAGE 03103 STATE OF FLORIDA ".� DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD (850) 487-1395 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-'0783 JIMENEZ, FRANCISCO F JIMENEZ ELECTRICAL CONTRACTOR INC 4910 5TH ST WEST LEHIGH ACRES FL 33971 Congratulationst 'With thimerwLryou,beconze'-orre-of the nearly one million Floridians licensed by the Department of Business and Professional Regulation. Our professionals and businesses range STATE.OF FLORIDA from architects to yacht brokers,from boxers to barbeque restaurants, DEPAR •:•OF BUSINESS AND and they keep Florida's economy strong. PROF 6 , ' GULATION Every day we work to improve the way we do business in order to EC13002779,:,,- :, IJ '�-07/28/2015 serve you better. For information about our services,please log onto `•. ;�;='; :•=;.•j www.mylloridaticanse.com, There you can find more information ` CERTIFIED OR about our divisions and the regulations that impact you,subscribe to department newsletters and loam more about the Department's r •. 3IMENEz;F Initiatives. 4 F JIMENEZ E ' vR IN Our mission at the Department is:License Efficiently,Regulate Fairly. We constantly strive to serve you better so that you can serve your customers. Thank you for doing business in Florida, s; _. ' iS:.C�R7lFl•ED under tn,a prdvisions-of Ch,402 ES. and congratulations on your new license! 7 2Vft WA-dske'.Auca1:2o+e ��sffrzsocamso DETACH HERE RICK SCOTT.GOVERNOR KEN LAWSON,SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSIRESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD AZU 1:G1S002779 The.ELECTRICAL CONTRACTOR . .,. ti' ;, ,•' Named-Wow IS CERTIFIED - - Under the provisions_of Chapter 489-FS•_ Expiration date. 'AUG 01.�,•20.16..':. ' :11MENE2;'•FRA�tCFSCO^.:_: - �: �.. - -~�� - •�'�"-- '��'� '"��• • • • • � ;� 0 XMEN8VEEEC�-0 cT ST �:%'� „'•!" " �.•.•..: a w.,:a 1j`�y ,~```,`.,mow, ',,'.` r..nnwa A n nr-ni lln=n nv I n.eJ Den a .isys-"annnngAm 09/30/2015 10:41AM 2396749514 F JIMENEZ ELECT CONT PAGE 02/03 For information regarding Transfer EiCues of Business/Owner,please visit usvs Pottage s www.miamidade.govAaxcotiector/ PAID Miami,EL Tax Col",e 220 NW 3rd Street ,Miami FL 33128 %?W-02 =A 001528 F JIMENEZ ELEC CONTRACTOR INC C/O FRANCISCO JIMENEZ PRES 4910 5 ST W LEHIGH ACRES FL 33971 tacw � darn;-l�at '' C.qunty, Sitae;.<°tfi;>I #a . tS TiOYA 8ltt. - tift AtOF�dY ' 5538062 gilip8.a�wa�aRcva'�1oR�1 $ECL'>�T1Htf. '' .;: ' . l> CONTRACTOR-INC Numaw DOMBBSEM-Iii DA€IE COMW 57781x36 � 46 OWNIM SBC. W OF 6 19ELEL'ITiICAt CO�CtAStiffC -• M PAYFM!RECEMM F d1 2 ELEC CONTRACi•UR:&�1C BY TAX COLLe i' isverker(s) ; EC23002779 $75.00 08/20/2015 CHECCI-15--116056 This Lwd Basin=- is eut a[ICONS% panait.9rscea'SCaBaq.df�aslwlawtfiwrtnaa�:l3 ,... xama�•a ..i&anrgoverae+a�al . araoneai�o�oHoo►y lain•".. ni+o�uea�' �i3o dre he$�5:, 'T><e REC'EIPF RIO.s6u�s�nast ha load on alt cowm�rcial va'plcles-�s��e�e.Se�se-27s. t'os�Ad�xetioo,riaTt LEE COUNTY LOCAL BUSINESS TAX RECEIPT Tax Co m 2015 -2016 ACCOUNT NUMBER: 9504444 ACCOUNT EXPIRES SEPTEMBER 30, 2016 may engage Gm _ � l.ocatioe CERTIrmu ELECTRICAL CONTRACTOR 4910 571-1 ST W 1 LEHIGH ACRES FL 33879 i THIS LOCAL BUSINESS TALC RECCUW'IS NON RMULATORY F J[IiMENEZ ELECTRICAL CONTRACTOR INC F JIMENEZ ELECTRICAL.CONTRACTOR INC THIS iS NOT A 6iLL-DO NOT PAY 4990 ST)i ST W LEHIGH ACRES FL 99871 PAID 38799a10-1 0712911512:97:52 AXKT $50-00 09/30/2015 10:41AM 2396749514 F JIMENEZ ELECT CONT PAGE 01/03 .q►C��® CERTIFICATE OF LIABILITY INSURANCE DAM Q��2o`�s' ;THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, ®(TEINb OR ALTER TI-II; COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S� AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER IMPORTANT: If the Derlificate holder is an ADDITIONAL INSURED,the pollcy(fos)must be endorsed. If SUBROGATION IS WAIVED,Subject to the terms and Condiffons of the policy,certain policies may require an endorsemernt. A statement on this certificate does not confer rights to the certificate holder In lieu of such eLWomemern(a). PRODUCER Alexander Dopazo Dops$e s Associates Ina PHONE (305)470-8500PAX .(866)W7-9673 8725 VW 18th Tarr Ste 300 alex@dopa>: 1.am PM AFMRWM COVRAOB "men NIBM1 rL 33172 wsu ma Pro Ina Co of Florida 34932 INKIRED wstIRCR a$rid coldX=P1CrQr8 Ins Ca 10701 F Jimenez EleCtr3.cal Contractor Inc INS C: 4910 Sth Wiest *4uwn0: ixs~E• Lehigh Acres VL 33971 INSURER F. COVERAGES CERTIFICATE NUM13F.R4=S9911174 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HERFIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, INSR TYPE OF w$URANCE POuGt, POLICY EXP � " R COMMORCIAL eaMMVAL LIAMILITY EACH OCCURRENCE S 11000,000 A CLAIMS-MADE ❑S OCCUR E` nrns<D $ 100,000 4250150021471 9/10/2013 x/10/2016 MED EXP ww gm po,son S 51000 _ PERSONAL aADV INARY $ 1,000,000 GEN'LAGGREGATE UMITAPPLIES PER: CQNRRAL AGGREGATE $ 2,000,000 X POLICY 9 0 LOC PRODUCTS-COMPIOPAGe i 1,000,000 OTHM_ 3 AUTOMOBILE L KEEM $ ANY AUTO 00biLyN.IURY(Per pamn) $ ALLSCHED UT8rF LED AUT O 90DILY INJURY(Per wad" 3 XON.OVINPROPERTY DALIA9� HIRED AUTOS q � 6 8 UMBRELLA U" OMR EACH O=RRINCE 3 EXCESS LIAR CI am-mA0E AGGREGATE S DED S_ AND EMPLOYLW LIABILITY Y/N g STATUTE R ANY PROPRIETOWARTMRM%KCUTNE E.L.SACH ACCIDENT 3 1,000,000 B (ManOFFIdatory ►8o u NSA 083026529 1/x/2015 1/2/2016 EL,DISEASE-EA EMPLOYE $ 11000,000 OESCRIPTIQN OF OPERATIONS D®taw B,L DISEASE-POLICY LIMIT s 21000,-00.0 DEOOWMN Or OPgPAZIOM t LOCATIDNS I VEMMM(ACORD 101,AdMifflal RwwW 9dh&t%maybe affa*W Ir nim apme is requtlea) 8leotriciaxi. MC13002779 CERTIFICATE HOLDER CANCELiATt (305)634-0937 QN SHOULD ANY OF THE ABOVE DEW149 b POLICIES BE CANCELLED BEFORE City 0f Miami_ Shores THE mwIRATION ACCORDANCEIMIT>•I EFOLIC AOP NOTICE WILL BE DELIVERED IN 10050 = 2nd Avenues Miami ShoreB, FL 33138 AUTHORISED rapma NTATNC Alex,,andex Aopazo/AD ®1988-3014 ACORD CORPORATION. All rights resented. ACORD 25(2014101) The ACORD name and Foga are registered narks of ACORD INS02S M14M% F N.E. 109TH STREET 75' R/W (IMPROVED) C 15' ASHPHALTin �\ r- rz 7777 n-..... _.. ...y.. .. "� ...__.._._._..... SII 5' ALK" SET 1/2' 89"53'13' i :..... ...._.. n \ FOUND 1/2 " IRON ROD 90°0647IRON PIPE LB# 7893 N N10.1• 22.2' 3V9.6' 19.3' CO '3. 0.3 10.4' ^ tO N ao i RESIDENCE ` (h #114 in 14.2' i M 10.2' LOT 6 LOT 8 04 i "d: BLOCK 216 BLOCK 216 N N i i i 16.1 7.0'4.4' i LOT 7 i I i 0.2BLOCK 216 T '� o.o i i FOUND 1/2" FOUND 1/2' 90"09'02' ` R 89°50'56'�, IRON PIPE IRON PIPE - � 0.8'W/0.2'S - 15' ALLEY R/W 75.00' - (IMPROVED) •S•• • • SSSS SSSS•• SSSS•• SSSS SSSS•• • SSSS•• • • • •Soso• 0000 •• •S •S•So • SSSS•• 0000 00000 • so 0 0 see Lot 7,Block 216,DUNNING'S MIAMI SHORES EXTENSION NO.5,according to the Plbl t►eroof,as recorded in Plat Bonk 48,Page 21,of Bre Public Rew ds of M14MI-DADE County,Florida. Comm%Numt>eer.120652 POW:0139 Suft-L Rood Zow:X Field Work:511*2015 Cermw TO. RUBEN M.FARACH AND DOUGLAS C.DREIER;INSURED TITLEAGENCY,LLC;COMMONWEALTH LAND TITLE INSURANCE COMPANY;BBMC MORTGAGE,LLC, Its successors and/or assigns. Property Address: 114 NE 109TH STREET MIAMI SHORES,FL 33161 Survey Number 229722 �.5. LVE L4kE.L4<ti?e"4,uG�Afi:A L'e fc+YY R%sr�TCsFrarl)' o EiISI.,V , '—a W OR CFFIC:Al:�,WX, SA,R 3FT1R0,%1ROD 5 C40 ':0? OR9. a�F•:i4LtiwTk'±;9u"�.K P.F Pt7ivERF01 E F Fe ieat v €`-.r Ui• vTdfT?F4 SF.tF1ri.Q.8 TOP F8a441'Jd W41. WATFRl.1FTFR \F► PR FEiqM4.QvF1VTReFFR7Nw.r4 tat..tV' Pls PA C-E �' :1:C a:7°?vSSiM.•'o:.k :�I.." :ztx�'r'7R1'Er5''iF +S4Ri 01) PIAT .,. 4 P,14 hL.4P:4(KdF( Uri,F7YPC,E FrF1.7doEstSUJ;"ED C CINL ©I`- vF+t%. LfNtS -'� ��`4x=, � ,..:' F +e�_''. ."a:.�""`•,1'ir,:'z4�$`$ri`?:'� Ph dpi?j,;:C�r��',crltzC'.+7 VAItIR& � V�OP1:R7,rAP �:.> Nom° ekl I • • • •••••• • P4!:RTT'r-'IA ER •••• I ti(')a'�j* ARE4 • RL,.r ROLOr 0 oIFAZid",0F..4,vVFNF � c�t7,NEAFTi •• --. :��=��a._.'�:' 4� i,',^R:.,.^ori M R�l,".u��:Ki.L'(.7!% •••.•�- 6}'v�h�tiCF •••••• LEGAL DESCRIPTION AND CERTIFICATI. •. • ••LQ#'893 •••••• ••••• Sz )sEMV9EYJNrj6,sJ&LC SERVING ALL FLORIDA CCSUNYIES .-.. _ a=5; 1..., 114,; » V N: :,I V y 6250 N.MILITARY TRAIL, SUITE 102 WEST PALM BEACH,FL 33407 a }_ . oe,. :.. ,! �. °�::•i�? 4'4:;: �?,L:'_tl'�s� PHONE (561)640-4800 FACSIMILE (561)640.0576 STATEWIDE PHONE (800)226-4807 STATEWIDE FACSIMILE (800)741-0576