EL-15-2105 21
Inspection Worksheet l�
Miami Shores Village
10050 N.E.2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-254800 PermitNumber: EL-8-15-2105
Scheduled Inspection Date: March 28,2016 Permit Type: Electrical- Residential
Inspector: Devaney, Michael
Inspection Type: Final
Owner. , MIA411 LLC Work Classification: Alteration
Job Address:901 NE 97 Street
Miami Shores,FL 33138-
Phone Number (305)807-4045
Parcel Number 1132060143310
Project <NONE>
Contractor: MESA BROTHERS INC Phone: (305)345-1974
Building Department Comments
KITCHEN AND BATH GFI &ELCTRIC FOR RELOCATION infractio Passed Comments
OF WASHER&DRYERS HOT WATER HEATER AND INSPECTOR COMMENTS False
SMOKE DETECTORS.
Inspector Comments
Passed5� CREATED AS REINSPECTION FOR INSP-254633.Add arc fault breakers r /
and receptacle to end of counter.
Failed
i
Correction ❑
Needed
Re-Inspection
Fee
No Additional Inspections can be scheduled until
re-inspection fee is paid
March 25,2016 For Inspections please call: (305)762-4949 Page 17 of 31
RICK SCOTT.GOVERNOR
KEN LAWSON, SECRETARY
STATE OF FLORIDA.
.. N 1 = LAI�Tfl#ftFS$S10ML REGutA Eol!
�ell�
ISSUED: 013/10/2014
DISPLAY AS REQUIRED BY LAWS
EO# L1406100001578
Tax 11219ceipt
Miami—Dade County, Mate of Florida
THIS IS NOT A BILL -- 00 NOT PAY
405779 LIBT
t3tf> SS RIARflft aAtTtAN ttlt>T ttap
MEM BRO'IHM INC PMMAL EXPIRES
5215 S-W 103 AVEAPTE S 30, x'16
MIAMI FL 33165 t�6ii�7g Must be dispieyed at piece of busirte$u
* Pursuant to County Code
Chapte!8A-Art,9&10
OWNER sec.TYPE OF sua w ass
MESA BROTHERS INC 138 ELECTRICAL CONTRACTOR PAYMENT Recetvep
wfter(s) 10 EC13001870 By TAX cO"9CTOR
:%5A0 07/15/2015
(HECK21-15-095549
This Local Bositrm Tax Receipt only c"m.paymeat of tha Local Sustnesa Tex.The Receipt,not a license,
PWUK se a aarlificafhta:ol tAa heldar's iifiootftics,M do b"i tells, HolderAug comply with say govetemental
or ttttt latttmeatal twistory lawn aafi teciclremeals wkloh apply to the buslaoft.
The RECEIPT N0.ebeve mutt be disployad an all etmnaerciei vehicles,Mi=ta Cade Cade See So-376.
Fat afore intarotatleae visit
c
Luca! Business Tax Receipt
Miami—Dade County, State of Florida
/'HIS IS NOT A BILL»CU NOT PAY LBT
405779 y S
BUSINESS NAMEILOCATION RECEIPT NO. �CPIRE
MESA BROTHERS INC RENEWAL SEPTEMBER S 201
5215 SW 103 AVE 405779
MIAMI,FL 33165 Must be displayed at Place of business
Pursuant to County Code
Chap r lIA-Art.8&10
OWNER BEC.TYPE OR BUSINBBS
IVISSA BROTHERS INC 196 ELECTRICAL PAYMON't 16091YED
C/O RAUL MESA.OUALIFIERSY TAX COLL90TOR
CC3PITRAC £3R 7b.00 07/15!.2015
Workegs) 10 EC13001870 C HECK21-18-095549
This Loral Business Tax Raoalpt only oontirnts poymanl of she local Huslnese Tex.The Recelyt is not a license,
pot®^oro o Acatia"of de b*WWS do busims.Notdef nnset empty with any goya wneatal
of nem al modistavy laws end tqukemente which apply to rhe businoss.
The RECEIPT h10,above must be dtsplayod on all atunswelef vefdrlea—Mhuni#1Me c"s Seo 116411
own feemets hdott66Rsm,ytslt
MESAB-1 OP ID:YM
- - CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDfYM)
THIS CERTIFICATE IS ISSUED A15
8 A MAT'T'ER 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 Oft PRODUCEP,AND THE CERTIFICATE HOLDER.
IMPORTANT: H Ute certlilrete hiblder IS an ADDITIONAL INSURED,the poi4(iea)mum enrt If SUBROGATION IS WAIVED,subject to
holder Certificate In�of s
the terms shod mBlflotta.sash the policy,certain policies require an endorsem es t, A statement on this certificate donot confer rights to the
endo; n
PRODUCER
Global Risk LLC 002E Yolanda Mendez
$968 Blue -7261
Or Suite t01 E
306.4ti6-7260 rAX _.._. —._.._
Miami FL 33 26 _ _. _ ......_.__ t6+c.l+oj:305-45---
EDUADO R PORTAS ADDREaee real iobairiskilC corn
_._.................._._......__......_.................._..._.__......._......._ _..__......._......._........
__... ___._ INSURERIS� FF ROTNfl COVER 466 ___ NAT;0
INSURER A.WescO Insurance an
e Corn
__.....�:Y._..._..._.._....... _.............. - ...._......_.._.
5215 SW 103 Ave INSURra
Miami,FL 39165 INSURER C
.............
TN9URER EE
COVERAGES INSURER F.
CERTIFICATE AIUMOE REVISION NUMf31~R:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
......
TYPE OF INSURANC@ ;.. Ye7(.. _. __ .....
. _................. ....._. ..
A A COMMERCIAL GENERAL LWKITY POLICY NUMSER LIMITS
CZASIAS•MA1 7!DE OCCUR I , ; P122187400 EAC" _.� ;r 1,000,00
�_. _
01J01f2015 fl110112015 PREMISS$ atE accymence} s _ 100.00
MED_E)P;Any one.persw!i 6100
I
GENE AGGREGATE LIMIT APPLIES PER: I �PEItSONAL UR $ _. 1 OOO POLICY JPERfl- LCA .. ..Acca GA E Y s 2,000,^
v.__. -—
' P 00,O
ENE.
RODUcr r coraaro Acc, s 2 0
? 'OTHER: -_—_ -._...._.�$............__.__..: � _,._...
AUTOMOBILE LIASILOY
AASWI I
¥ -FdMMNED
SINGLE_
L
LIMIT Ms
A ANY AUTO S-
1,000,00C 0--0
SCHEDULED 120IS BODILY INJURY{PefPP122167400 50pawn} $ALLCAUED i01
AUTOS ;BODILY INJURY Per awdent)EDX =DAUTOS
"`—t--
?........_...
_ __.._...
UMBRELLA LIAB IOCCUR
EXCESS tiAe EAGli OCCURRENCE I S
_4..... - DE
_......... _CiAiM5 AOAIAGaGREGATE $
DED ' aTENTION$ �� 9 _ _ _..,_. a,...�. __.__....._._ ..
VIIORKS COMPENSATION $
I AND Ek�LOYER3 LIABILITY YIN $TATtTE ER
ANY Pt20PRIETflR1PARTNERrEXEGUTIVE }— __...................._...... ........
OFFICERIME R EXCLUDED? NIA; ESL EACH AC.CTOENT $
{MaT[datmY in
NH) j -
ygg E L DISEASE-EA EPI OYE $
IDES I21Ptl®TS Kt � RAT! bs�6vr --- -M .......... ..._-__.__...
E.I-DISEASE-POLICY UMT $
I ( t
t
DESCRIPTION OF OPERATION$)r.00ATIONS I VEHICLES(ACORD tat.
Electrical work within buildings-002033&CO2404 A�tlana•BlanketT Rernahedula,may b*afttaahaq K mora syate 3s saqu }
NraAdd� line and
Waiver of Subrogation,when required by written contractisgreem
nt
CERTIFICATE HOLDER CANCELLATION
MIAMIII
SHOULD ANY Of THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
(City Of Miami Shores THE EXPIRATION DATE TI4EREOF, NOTICE WILL BE DELIVERED IN
10060 Northeast 2nd Avenue ACCORDANCE WITH THE POLICY PROVISIONS.
Miami Shores,FL 33138
AUTHORTZTEg3 REPRESE=NTATIVE
ACORD 25 2014100 go ®1988-201d ACORD CORPORATION. All rights reserved.
( ) The ACORO nama and loare registered marks of ACORD
. ' CERTIFICATE OF LIABILITY INSURANCE DATE(MWM/YYYY)
10101,eD1S
THIS CER CiFtCA$E IS ISSUE AS A MATTER OF iNFORMATION ONLY AICD coNFERS Nth RIGHTS UPON THE CERTIFICATE HOLDER.
THIS CERTIFICATE '&NOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE
POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONS71TUTE A CONTRACT BETWEEN TIME ISSUING
INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: N ithe cerNffcate I ►Ider Is an AE3[IiT10NAL iii iitlRED,the p olicy(les)must be endorsed. If SUBROGATION IS WAIVED,
subject to the term and Conditions of the policy,certaln p oftIles may r94UIr8 an Sh dorsemenL A sUftmsffl on this rN3rtiflcate does not
confer rights to the certificate holder In lieu of such endorsement(s).
PRO
Stonehenge Insurance Solutions,Inc. aX o E Rte(blarMapmant "tr"
wd
300 Avenue of the Champions,Suite 222 Arc t j )20634 No): 677 6377-W49
Pairs Beach Gardens,FL 33418 cerisgProwessivearn r.crun
INSURED RISURER 8 AFFORDING WVERAGE MAIC
Progressive Employer Mang INSURER A:Techncl ow Insurance Comp".Inc. 42376
gement Co.,Inc.and all its affiliates and subsidiaries INSURER 8:
For co-employees of Mesa Brothers Inc INSURER C:
6407 Parkland Drive IfgSURER D'
Sarasota,FL 34243 #MRER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
[EXCLUSIONS
HIS IS TO CERTIFY TP4AT THE PCX(CIESCII=INSURANCE LtSTEti BELOYd HAVE BEEN ISSUED TO THE INSU#�EI7 NAMED ABOVE FOR THE POLICY PERIOD
DICATED. hiCITWITFISTANDitdt3 ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
ERTIFICATE MAY SE#$SUED OR MAY PERTAIN. THE INSURANCE AFFORt3lrD BY THE POUCdES DESCRIBED HEREIN #S SUBJECT TO ALL THE TERMS,
AND CONDITICNVS OF SUCH POLICIES.LIMITS SHOWN tViAY HAVE BEEN REDUCED BY PAID CLAIMS. Lynas show""e as requested
jr I TYPE OF
#NSURANC I POLICY roU R PatICY EFP ( POLICY EXP ,
LMM
tiENEFtAL LtAalLlSit CH OCCURRENCE __—
EFICutt t§ENER TYDAMAGE TO RENTED
j' I ! PREMISES(Ea oxwrenw)
CLAIMS-MADE R EXP(Arra one pewmn)
i € PERSONAL&ADV INJURY
i i I
I GENERAL At'.,>",REGATE
GEN L AGGREGATE LINT APPLIES PER!
POLICY PROJECT aLOC
PRODUCTS-COMP/OPAGG
SLE UASILITY M9INE0 SIAL LE LIMIT
ANY AUTO ! Each adsnt)
ODILY INJURY(Per person)
J ALL OWNEDSCHEDULED
AUTOS AUTOS DILY INJURY(Per
HIRED AUTOS NCNB OWNED b'riVr tRTY DAAIAt#E€Per
AUTOS ! i
i �ocidsn$)
I 1 I
t
IHxmwesws
LA uAs aruR °EACH OCCURL=AB CLAIMS-MADE )riGGREGATE
DED RETENTION$
WORKERS COroSAta>ti I ..
A AND E6JfPLOYCrktS`LU1SILdTYWC TATU OTH- —�
Y t N TWC3488277 I TORY LINTS ER
ANY PROPRETaROPAATNEntEXEWTNE r 10t{}1t201b ` 1010112016 .....__
L.EACH ACCIDENT
DR R'{tkdEM LUDW? j N IA [
.L.DISEASE-EA EMPLOYEE $y gpp(ypp
(
It yes,describe ander _
i DESCRIPTION OF OPERATIONS bstov l E.L.DISEASE-POLL LIMIIT $1,( ,0001
i J
aF OPERATIONS 7 LOCA'IMS7 VEHICLES to ob AOORD101.As&a""Rs*n s Szhsduts,a mors � _e
(
dy
8rage is extended to C �ees but not subcoftactors at Mesa Sra#hers Inc
1
416802
_....... __ ... .............._.........
CERTiFiCATE HOLDER: CANCELLATION
City of Miami Shores �DANY
OFRADESCRIBED
IBEDLSBECANEU.ED
BEFORE EXPIRATION EONOVOLLDELIVERED IN ACCORDANCE WiTN THE POLICY PROVISIONS,
10050 NE 2nd Ave AL4Ttto#a12ED REPRESENTATIVE
Miami Shores,FL 33138-2304 QU<YAW
0 1888.2010 ACORD CORPORATION. All rights reserved.
ACORD 25(X110105) The ACORD name and fogo we registered marks of ACORD
AE
Miami Shores Village
10050 N.E.2nd Avenue NE n
�• Miami Shores,FL 33138-0000
F
Phone: (305)795-2204
Expiration: 02/2812016
Project Address Parcel Number Applicant
901 NE 97 Street 1132060143310
MIA41 1 LLC
Miami Shores, FL 33138- Block: Lot:
Owner Information Address Phone Cell
MIA41 1 LLC 9840 NE 2 Avenue (305)807-4045
MIAMI SHORES FL 3313-8
9840 NE 2 Avenue
MIAMI SHORES FL 3313-8
Contractor(s) Phone Cell Phone Valuation: $ 1,500.00
MESA BROTHERS INC (305)345-1974 Total Sq Feet: 0
Type of Work:KITCHEN AND BATH GFI&ELCTRIC FOR Available Inspections:
Additional Info: Inspection Type:
Classification:Residential Review Electrical
Scanning:1
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $1.20 Invoice# EL-8-15-56770
DBPR Fee $3.38 09/01/2015 Credit Card $237.96 $0.00
DCA Fee $3.38
Education Surcharge $0.40
Permit Fee-Additions/Alterations $225.00
Scanning Fee $3.00
Technology Fee $1.60
Total: $237.96
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 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 o i Futh ore,I utho' ove-named contractor to do the work stated.
September 01, 2015
Authorized Signature:Owner. / Appli / Contractor / Agent ate
Building Department Copy
September 01,2015 1
til Miami Shores Village --
Building Department AAUG9201510050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION UNE PHONE NUMBER:(305)762-4949
FBC 20(0
BUILDING Master Permit NO-A7W )! " Z(O:
PERMIT A=ON Sub Permit No. a„) 5" 2-)o S-
❑BUILDING ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION �ENEWAL
PLUMBING [:] MECHANICAL MPUBLICWORKS f--J CHANGE OF CANCELLATION [:] SHOP
(� G}�� CONTRACTOR DRAWINGS
JOB ADDRESS: ! I N. 6 - ` < <"� S 1
City: Miami Shores County: Miami Dade Zig):
Folio/Parcel#: Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
per ' i1` j �ry
OWNER:Name(Fee Simple Titleholder): ` L l�r, 4 l`G Phone#: �C1
Address: 5(8 Ll 1 S 7 )9 44-4
City: \)X"tjt k 167" State: 4:7L— Zip: 33
Tenant/Lessee N-a�tme: Phone#:
Email: -- .J l �=� of
a
CONTRACTOR:Company Name: I,G� >--� Phone#: Sas-b,y,-2Sy 9
Address: 5 Z SW 3
City: Q State: Zip: 33
Qualifier Name: i oM j40, -- Phone#: 3 0.5—630" z q?
State Certification or Registration#: G//--C 1300/8 o Certificate of Competency M 4e.0 x"7 5t
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:i Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New Repair/Replace ❑ Demolition
Deitiori=of Work) ,> r,rs s S v7�1�€ be7r cv� ,mss Cb4j
A/d�✓ le- p v J p�� ® --gyp C.-ost_ uT Il-4
Specify color of color thr_ u dile:
Submittal Fee$ Permit Fee$ ate C'4> CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$2-,2-, - l ro
(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 bsence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature VI;4 Signature
OWNER or AG CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
--�- — day of PxQ a, ,20 S� ,by S day��o//f /4 20 /S ,by
)Uic2 �Mv $N��2,,.who is personally known to F'I,P/.rGt� "who i to
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 C: NOTARY PUBLIC:
Sign: ff�_ Sign:
nt W . e, MICHELLE L JIMENEZ Print: NANCYTEMADA
Seal: r EXPIRES February 25,2Q17 Seal: MY coMaBsslFFOBa75eEXPIRES:JAN 21,2018
*ss*s****s*ass*s*a*s*s*a*s*#*ssaa*s*sas*s***:sass*#**ss$$sssa*ssass*ssasssssss***s**ss******:**sass::**s*ass
APPROVED BY #4?j!f�/moans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)