EL-14-2041 • G -
Inspection Worksheet
Miami Shores Village
10050 N.E.2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-231783 Permit Number: EL-9-14-2041
Scheduled Inspection Date:April 07,2015 Permit Type: Electrical - Residential
Inspector: Devaney, Michael Inspection Type: Final
Owner: TRAVELS&RENTALS CORP,TRAVELS Work Classification: Alteration
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Job Address:37 NW 108 Street
Miami Shores, FL 33168- Phone Number (305)538-8105
Parcel Number 1121360110290
Project: <NONE>
Contractor: CPS ELECTRIC, INC. Phone:305-607-8221
Building Department Comments
INTERIOR RENOVATION Infractio Passed Comments
INSPECTOR COMMENTS False
Inspector Comments
Passed EE
Failed
Correction
Needed
Re-Inspection
Fee
No Additional Inspections can be scheduled until
re-inspection fee is paid
April 06,2016 For Inspections please call: (305)762-4949 Page 58 of 63
" V • _ . Miami Shores Village SEP, r $ 20
14
Building Department By,
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949
FBC 2010
BUILDING Master Permit No
PERMIT APPLICATION Sub Permit No. �4- zoLi
❑BUILDING ® ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: W
City: Miami Shores County: Miami Dade Zip: 53131
Folio/Parcel#: Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: � l Flood Zone:
BFE: FFE:
OWNER:Mame(Fee Simple Titleholder): -F9A 0 G� &,,,t/ AL.S Phone#:
, dross:_' 3_i`� ' Cd&14)3 AV- APJ-. "Y38'
zip: al 132
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Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name: CPS Electric, Inc. Phone#. 3056345570
Address: 1600 NW 28th Ave.
city: Miami State: FI zip: 33125
Qualifier Name: Angel Romero 3056345570
Phone#:
State Certification or Registration#: EC13005401 Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address City State: Zip•
Value of Work for this Permit:$ Square/Unear Footage of Work:
Type of Work: ❑ Addition Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work: '13 4j' e o...._ .,.
Specify color of color thru We:
Submittal Fee$20,00 Permit Fee$ 40Jk-`'0'9 CCF$ `J• CO/CC$
Scanning Fee$ - Radon Fee$ 1 DBPR$ Notary$
Technology Fee$ Trainktg/Education Fee$ _ Double Fee$
Structural Reviews$ (2; Bond$�l
TOTAL FEE NOW DUE$ S l q .
(ReWsedO2/24/2M4)
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Bonding Company's Name(if applicable)
Bonding Company's Address
City State Zip
Mortgage Lenders Name(if applicable)
Mortgage Lenders 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: 1 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.
nature Signatu e
OWNER CONTRACTOR
:The foregoing instrument was acknowledged before me t The foregoing instrument was acknowledged before me this
---Qq„day of al�L_2� ,20 _ by day of ��- 20 .by
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M&M OA 44edm .who,is personally known to AN61 who is personally known to
me or who has produced F)_b-L
as me or who has produced �"R - 00 S I as' 1-0
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUB40 1,18011111411111
111111NIy1
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' Sign: �-- �: Q..• �% 2
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Print: Print: <rCVe)U5 EY
Seal: Seal: r*
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APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(RevisedO2n4n014)
i RICK SCOTT.GOVERNOR KEN LAWSON SECRETARY
STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION i
ELECTRICAL CONTRACTORS LICENSING BOARD
EC1300540+
The ELECTRICAL CONTRACTOR
Named below IS CERTIFIED °�,� all
Under the provisions of Chapter 489 FS
Expiration date AUG 31, 2016
ROMERO,ANGEL
CPS ELECTRIC INC
1600 NW 28TH AVE
MIAMI FL 33125
0 � �
ISSUED DISPLAY AS REQUIRED BY LAW SEO6 11407100001314
STATE OF FLORIDA
DRIVER 1 I US ci DEPARTMENT OF BUSINESS AND
R560 (i r.° 91-0 PROFESSIONAL REGULATION
ANGEL EC 13005401 ISSUED. 07/1012014
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+rMNvvAVE CERTIFIED ELECTRICAL CONTRACTOR
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ROMERO,ANGEL
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IS CERTIFIED undtt trill Prorislonl of Ch 459 FS
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Local Business Tax Receipt
Miami-Dade County, State of Florida
�i -TW S IS NOT A 6XL-DO NOT PAY
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t N O BUSINESS NAME/LOCATION RECEIPT NO EXPIRES
F U C P S ELECMic INIC RENEWAL <MBER 30, 2014
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Sep 15 2014 3: 13PM HP LASERJET FAX p. 1
AC L> 5/15/2014 DATE(MM/D01YYYY)
CERTIFICATE O LIABILITY INSURANCE
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 cerdficate holder Is an ADDITIONAL INSURED,the les) must be endorsed. N SUBROGATION IS WAIVED,subject to
the terms and conditions of the paltry,Certain policies may require an entbrsemenL A statement on this certificate does not confer rights to the
certificate holder in lieu of such endorsement(s).
PRODUCER
MENDEZ INSURANCE/FIN SVCS PHONE AX -
ac Nfl EM: (305) 769-4936 SA/C,No):(305) 769-184,
508 E 49th St tDMAIL
Hialeah, FL 33013 s:mendezlily@hotmail . cam -'
—
INSURER[S) AFFORDING COYERAUe MAIC/
INSURER A:ASCENDANT COMMERCIAL UND.
INSURED C.P.S. ELECTRIC,INC. INSURER B,
1600 NN 28 AVE INSURER C:
MIAMI, FL 33125 INSURER D:
LIC#EC13005401 INSURER E;
INSURER F
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELCW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR COND WON OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POL)CIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
warnR TYPE OF1NStAZWCEraa POLICY N ER MM1L{IHJ/Y1YYY MIWODY LIAITS
X COMMERCIAL aEHERAt tIAERrTY EACH OCCURRENCE $ 1 000 OQC
CLAIMS-MADE OCCUR Itu
PREMISES EaDcarrence $ 100100C
X 5 0 DED MED EXP;Any one person) s _ _5 0
A GL-34425- o9/z3/ia o9/2s/i5 - - J0 C
PERSONAL&ADV INJURY $ 1,000, 00C
GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE s 2, 000, 00C
POLICYO PRo- a LOC
PRODUCTS-COIAPfOP AGG $ 1,000,00C
OTHER:
S
AUTOMOBILE LIABILITY
Ee ecdderrt $
ANYAUTO BODILY INJURY(Par person) $
ALL OWNED SCHEDULED
AUTOS AUTOS BODILY INJURY(Per accident)4
HIRED AUTOS NON-OWNED PROPERTY DAMAGE
AUTOS Per accident) s
UMSREUL LIAB OCCUR EACH OCCURRENCE 5
EXCESS LIAR CLAIMS-MWDE
AGGREGATE ;
DED RETENTION;
WORKERS COMPENSATION
S
AND EMPLOYERS'LLASIL)TY STATUTE ER
A A0MCENY PRR&F:WEROM TR E�DED? NE Y� NIA WC-6217.7— 06/O2/24 06/02/15 E.L.EACHACCIOENT $ 1,OQO, 000
INan deslory In a E.L. DISEASE-EA EMPLOYE $ 1,000,000
If ye describe older
DESCRIPTION OF OPERATIONS I>ebw E.L.DISEASE-POUCY LIMIT $ 1,000,00
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Rernarl s Scheduler may be attached if more space is requ ed)
ELECTRICAL WORK
CERTIFICATE HOLDER CANCELLATION
MIAMI SHORES VILLAGE HALL SHOULD ANY Of T ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
10050 NE 2ND AVE THE DPIRATIO TE THEREOF, NOTICE WILL BE DELIVERED IN
MIAMI SHORES,FL 33138 ACCORDANCE HE POLICY PROVISIONS.
305-756-8972 AUTHORIZED REP EN TfVE
AA
0 1988 O14 ACORO CORP ION. A rights?eserved.
ACORD25(2O14J01) The ACORD name and 1 o are registered marks of AC RD
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