EL-16-487 Inspection Worksheet
Miami Shores Village 0/-
10050 N.E.2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-258361 Permit Number: EL-2-16-487
Scheduled Inspection Date: May 09,2016 Permit Type: Electrical- Residential
Inspector: Devaney, Michael Inspection Type: Final
Owner: TREVISA,SUSAN Work Classification: Alteration
Job Address:100 NE 105 Street
Miami Shores,FL 33138-2033 Phone Number (305)992-3134
Parcel Number 1121360130690
Project <NONE>
Contractor. JTV SERVICES CORP Phone: (786)413-6379
Building Department Comments
PARTIAL REMODELING NEW HIGH HATS ON MASTER infractlo Passed Comments
BEDROOM WALKING CLOSET AND BATHROOM. NEW INSPECTOR COMMENTS False
SMOKE DETECTORS IN ALL BEDROOMS
nspector Comments
Passed
Failed
Correction ❑
Needed
Re-Inspection ❑
Fee
No Additional Inspections can be scheduled until
re-inspection fee is paid
May 06,2016 For Inspections please call: (305)7624949 Page 30 of 45
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Miami Shores Village
ny 6d a ` ,� R -m ...
10050 N.E.2nd Avenue NE
Miami Shores FL 33138-0000
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Phone: (305)795-2204
Expiration: 08/2912016
Project Address Parcel Number Applicant
100 NE 105 Street 1121360130690
Miami Shores, FL 33138-2033 Block: Lot: SUSAN TREVISA
Owner Information Address Phone Cell
SUSAN TREVISA 100 NE 105 Street (305)992-3134
MIAMI SHORES FL 33138-
100 NE 105 Street
MIAMI.SHORES FL 33138-
Contractor(s) Phone Cell Phone Valuation: $ 2,240.00
JTV SERVICES CORP (786)413-6379
_ Total Sq Feet: 0
Type of Work:PARTIAL REMODELING NEW HIGH HATS ON Available Inspections:
Additional Info: Inspection Type:
Classification:Residential Review Electrical
Scanning:1
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $1.80 Invoice# EL-2-16-58774
DBPR Fee $2.25 02/22/2016 Check#:1012 $50.00 $112.30
DCA Fee $2.25
Education Surcharge $0,80 03/02/2016 Check#:1221 $112.30 $0.00
Permit Fee-Additions✓Alterations $150.00
Scanning Fee $3.00
Technology Fee $2.40
Total: $162.30
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 ume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are
required for ELE T CAL,PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work.
OWNERS AFFI IT: certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
constru an z ni . Fut ore,I authorize the above-named contractor to do the work stated.
March 02,2016
A o Signature er / Applicant / Contractor / Agent Date
Building Department Copy
March 02,2016 1
Miami Shores Village ,
Building Department 7:. oy
10050 N.E.2nd Avenue,Miami Shares,Florida 33138
Tel:(305)795-2204 Fax:(305)'756-9972
INSPECTION UNE PHONE NUMBER:(30S)762.4949
FBC 20H
BUILDING Master permit No. V— G 1 S 2�3�
PERMIT APPLICATION sub Permit No. E-L-1 L
❑BUILDING ±"ELECTRIC ❑ ROOFING REVISION ❑EXTENSION ❑RENEWAL
[]PLUMBING ❑MECHANICAL ❑PUBLIC WORKS [:] CHANGE OF ❑CANCELLATION ❑SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS. 100 X)E' O-Cr f S-7- 140 1-rNU&49
City Miami Shores County: Miami Dade Zip:
FoNo/Parcelp: is the Building Historira8y Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: c FFFE:1 r D
OWNER:Name(Fee Simple Titleholder):
Address: A0
City: State: Zip:
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name: ,T Ty fG 1z ✓` cw'f Oo a—to, Phone#: Ot6 'Fl 3 03 j 9
Address: 4412-5- fw 7-7 cT
City: /l/A-^4/ State: JL. zip: 33 165-
qualifier Name: L--75 Ukn4 ® P-A t4 o,#? ?o/'.(Z^e-- j3A S Phone#• 6�)yy3 C"3 f 9
State Certification or Registration#: 3 0/A-O C�- Certificate of Competency#: 11-16"1000 21 4/
DESIGNER:Architect/Engineer. Phone#:
Address City: State• Zip:
Value of Work for thb Permit:$ 'P/ Square/Linear Footage of Work:
Type of Work: ❑ Addition Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Desa"on of Work: Attx/Az L. "I-tV Dd9 L(04 o og-w m(6N6wTS o d A(A-r Tc-�
6 A00/-1 , LA/A c..tee n!Gr Cc..u1'6F 6670 24 O rt. A. _r^-4 a(e-f tr'W<'-r0 f Lj
o t-6- COO-12D 3,D /AI AL L- &Er) /LZ K�f'►
Specify color of color thru tile:
Submittal Fee$ Permit Fee$ /,�®.e', CCF$ co/cc S
Scannhg Fee$ Radon Fee$ DBPR$ 'off "a� Notary$
Technology Fee$ 6 Trainhrg/Education Fee$ Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$ `
(RwAsed02/24/2M4)
t
t
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. 1 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$2$w,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) da*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.
'2
Signature _ — ) Signature
OWNER or AGENT c0 OR
The foregoing instrumer �was acknowledged before me this The foregoing instrument was acknowledged before me this
c� day of 20_ l by �?-� daa–y of �' .20�ilJ,by
Z -- o�Oa k,who is personally known to who its personally known to
me or who has produced as me or who has produced RL Nk. UC as
identification and who did take an oath. identification andMho did take an oath.
NOTARY G NOTARY PUBLI
Sign: '� Sign:
Print: Print:
,,ot p., o, Afelda J.Guevara rc�=C:JrrihiSSiu;i#FF025143 Sea ° X717
DPIRES.APA 0.3,2017
%s'• �°-`"EXPIRES:JUN.06 2p17 g
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********s******srrrrrrr*rr****s*s*ss*rrrssrssrrsrssss4rrssrsrr*rsrrsr*sr*rrrr*rr*:*s*sr*r*rs***r*r**s***r***
APPROVED BY �fp� Pians Examiner Zoning
Structural Review Clerk
(Rev1sW02/24/2M4)
ones Miami shores Village
Building rpt
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305)795.2204
Fax: (305)756.8972
CONTRACTORS' REGISTRATION
IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR:
A. COPY OF QUALIFIER'S STATE LICENCES
B. COPY OF LOCAL BUSINESS TAX RECEIPT
C. COPY OF LIABILITY INSURANCE*
D. COPY OF WORKERS COMPENSATION INSURANCE*
(Workers Compensation EXEMPTION must have NOTICE TO OWNER form and Contractor Affidavit)
IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY:
A. COPY OF CERTIFICATE OF COMPETENCY OF QUALIFIER
B. COPY OF LOCAL BUSINESS TAX RECEIPT
C. y COPY OF STATE REGISTERED CONTRACTOR LICENSE OR MIAMI DADE COUNTY MUNICIPAL
CONTRACTOR'S TAX RECEIPT.
D. COPY OF LIABILITY INSURACE*
E. COPY OF WORKERS COMPENSATION INSURANCE*
(Workers Compensation EXEMPTION must have NOTICE TO OWNER form and Contractor Affidavit)
*YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE AS FOLLOW:
Certificate Holder:
MIAMI SHORES VILLAGE BLDG DEPT
10050 NE 2ND AVE
MIAMI SHORES,FL 33138
Certificate must specify the description of operations or contractor license number.
aaneaaeaeamaasamamaaaammaaaaaamsaanamaoamammgaamaaoomamaaaaaaomaoamaooaas®aaaatamaaaeamaaamr
BUSINESS NAME: Z T V S;-d <ltr3 S Ca ip.t°.
BUSINESS ADDRESS: '4(,Lc;; SW 9-4 c.r CITY �f A� l STATE-C. ZlP_ -73 l 6�
BUSINESS PHONE: 40-36341 FAX NUMBER(_ _)
CELL PHONE(�) QUALIFIER'S NAME:�3U A-A.j-,z3 (z afq-.A L.. CaA- P
QUALIFIER'S LIC NUMBER: iR'00"D 2-4 1
ESPERO QUE CON ESTOS DOCUMENTOS PUEDA PULL THE CONSTRCUTION
PERMIT.
SALUDOS,
EDUARDO TORRALBAS CORTES, ENG.
OWNER/QUALIFIER
JTV SERVICES, CORP.
(786) 413-6379
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STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
ELECTRICAL CONTRACTORS LICENSING BOARD (850) 487-135,5
,vB 1940 NORTH MONROE STREET
TALLAHASSEE FL 32399-0783
TORRALBAS, EDUARDO RAMON
JTV SERVICES,CORP
4125 SW 97 CT
MIAMI FL 33165
Congratulationsl With this license you become one 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, DEPARTMENT OF BUSINESS AND -
and they keep Florida's economy strong. PROFESSIONAL REGULATION
Every day we work to improve the way we do business in order to ER13015000 ISSUEp: 0711
serve you better. For information about our services,please log onto
www.inyfloddelicense.com. There you can find more information REQ;ELECTRICAL CONTRACTOR'
about our divisions and the regulations that impact you,subscribe
TORPJUJEIAS,EtaUARbO"RAMON'
to department newsletters and learn more about the Department's ES CORP
initiatives. JTV
IND x, MUST MEETALL LOCAL
Our mission at the Department is:License Efficiently,Regulate Fairly. U REQUIREMEN TS ORIOR
We constantly strive to serve you better so that you can serve your TOCONTRACTING IN ANYAREA)
Customers. Thank you for doing business in Florida, HAS RiGISTERED under the provisions of Ch-469 IrS_
and congratulations on your new licensel EXpnftnaM AUG31.2016 L1407143X=
DETACH HERE
RICK SCOTT,GOVERNOR KEN LAWSON,SECRETARY
STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
ELECTRICAL CONTRACTORS LICENSING BOARD
The ELECTRICAL CONTRACTORJ '
Named below 14AS REGISTERED +' .
Under the provisions of Chapter 489 FS.
Expiration date: AUG 31,2016
(INDIVIDUAL MUST MEETALL LOCAL LICENSING
REQUIREMENTS PRIOR TO CONTRACTING IN ANY AREA)
TORRALBAS, EDUARDO RAMON
JTV SERVICES,CORP
4125 SW 97 CT
MIAMI FL 33165
1
y
ISSUED: 07/14/2014 DISPLAY AS REQUIRED BY LAW SEC)# L1407140000212
Local Business Tax Receipt
Miami-Dade County, State of Florida
-THIS IS NOT A BILL-DO NOT PAY
7171098
BUSINESS NAMBILACATION RECEIPT NO. EXPIRES
,ITV SERVICES CORP RENEWAL SEPTEMBER 30, 2016
4125 SW 97 CT 7449949 Must be displayed at Pian®of business
MIAMI,FL 33165 Pursuant to county cod®
Chapter 8A-Art 9&10
OWNER SEC.TYPE OF BUSINESS PAYMENT RECEIVED
JTV SERVICES CORP 198 ELECTRICAL BY TAX COLLECTOR
CIO EDUARDO R TORRALBAS CONTRACTOR 75,00 09/13/2015
Wolker(s) 1 14E000241 CREDITCARD-15-045758
This Lail Badness Tax Rawipt oag+=*_pq_"aldw Local BMIa—Tax TIN Receipt IS 00 a ft"as,
paste,w a afffigastlaa olthehoida's quanaedgmN do bwiCess,Holdw axe#axaply with asy Bares MW
orcougavenstanIaln gola"laws sal caqdr9weals whh:h apply to dw boahoom
TM RECEIPT N0.abaw sant be dtsplayal on all Coas>wrcial v"In Mbaad-Dade Code Seo 88-M
Eft Fa mm h lonvatfo0.visit
A CERTIFICATE OF LIABILITY INSURANCEDATE(ppMMWYYM
02/12/16
THIS CERTIFICATE IS ISSUED AS A MA17ER 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: It the cerdfleate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. if SUBROGATION IS WANED,subject to
the terns,and condition of the posey,certain policies may require an endorsement.A statement on this cerdflcate does not confer rights to the
certificate holder in Hsu of such endorsemefit(s).
PRODUCER a MARTAALONSO
1 Florida Bankers Insurance 305)286.8493 F- 305 262-0679
7278 SW 8 Street mana@floddabanlcersinsvranCe.00m
Miami,FL 33144 INsu AFFORDINS COVQRAeg NAIOs
Phone (305)266-6483 fax 305)262.0679 . FEDERATED NATIONAL INSURANCE CO.
wsURED
suR>=R e
JTV SERVICES CORP. I s
URM
4125 SW 97 IN$ R D
Miami,FL 331W 305 INSURER i
COVERAGE$ CERTIFICATE NUMBER: wsu F: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO TtiB INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING WITHSTANDING ANY REQUIREMENT,TERM OR CONDITION Of ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS i
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.
IN . :' ,TYPE OF INSURANCE ADDURR POLICYNUMBER rM&WA1 J,.P8MQM
LIMITS
' GENERAL LABILITY EA&H OC C 300 000.00
® cOMMERCI,u GENERAL LIABILITY I D E r0 RENrED
CLAIMa.MADE _ER
t _ _ is 100,000.ao
A ❑ O ®'OCCUR ,GL-0504012099.01 ' MED EXP one rear s 5,000,00
�]' 05/1 6/2015 05/16/2016,
PERSONAL 8 ADV INJURY s 300,000.00
❑ GENERAL AOGREOATE IS 300 000.00
OENL AGGREGATR LIMIT APPLIES PER PRODUCTS-COMP/OP AGO I S 300,000.00
® POUCY 11 M— ❑ too is
AUTOMONA LIABILITY I OteBfiU1ED Wt"sLE LIMIT! M
❑
ANY AUTO BODILY INJURY(Per"fftn) 9
g
❑ AUTOS NG❑ SLIT USD ED BODILY IPUURY(Pet eocltl S
❑ HIRED AUTOS ❑ AUTOSTOS PRpP@ n B $
� S
❑ UMBRELLA LIAR ❑OCCUR i H OCCURRENCE S
❑ EXOBSS LIAB CLAI sm-nE : + AGGREGATE S
E0 0 RETENTIO
WORKERSCOMPENSATION S ATV• !
AND EMPLOYERS LIABILITY Y/N MTO1CLi11/.S`..
I ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.W14ACCI T $ ;
F1 EMBER EXCLUDED? MIA,
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06SCRIPTION OF OPERATIONS 1 LOCATIONS/VEHICLES(Attwh AOORD 101,Addi WW R6nw1%8dtcduI%H ntm*pato is rMlreQ
14EO00241
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CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIOS BE CANCE"ED BEFORE
MIAMI SHORES VILLAGE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN
BUILDING DEPARTMENT I ACCORDANCE WITH THE POLICY PROVISIONS.
10050 N.E.2nd AVENUE AVTNORIM REPRESENTATIVE
MIAMI SHORES,FL,33138 ���'•`��� i
01988-2010 ACORD CORPORATION. All rights reserved.
ACORD 26(2010105)OF The ACORD name and logo are ragistvred marks of ACORD
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JEFF AT UR CHEF FINANCIAL CFFK=t STATE F1. Ak
EWARTRUM OF FINANCIAL SEMIRCES
MISM OF WORKERS'CONP13MAIM
•'CeRypWATE OF ELjECWH TC 13E EXEMPT FRON r-LORIDA VpoFdMW COMMMIM LAW••
CONSTRUCTION wotmm EXENIPTION
This coMm Oketthe kugvWW Noted bdw hay elected to beeml ftmFI0nd8lAbkmWCWnPW*abDnlGw
EFFECTWE DATE 5119=14 8~71ON DATE: 5mome
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4125 SW 97CT
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