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EL-14-1899 Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-222528 Permit Number: EL-8-14-1899 Scheduled Inspection Date: March 14,2016 Permit Type: Electrical - Residential Inspector: Devaney, Michael Inspection Type: Final Owner: MURILLO,SHIRLEY Work Classification: Repair Job Address:147 NW 109 Street Miami Shores, FL 33168- Phone Number Parcel Number 1121360030200 Project: <NONE> Contractor: ELECPLUM ENTERPRISES INC. Phone: (786)295-4004 Building Department Comments NEW ELECTRICAL WIRING Infractio Passed Comments INSPECTOR COMMENTS False Inspector Comments Passed CREATED AS REINSPECTION FOR INSP-218833. CANCELLED BY CLAUDIA 786-302-7937 Failed Correction Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid March 14,2016 For Inspections please call: (305)762-4949 Pagel of 40 a . Miami Shores Village l�'!" EUNTED Building Department AUC 2 9 2014 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel:(305)795.2204 Fax:(305)756.8972 BY- INSPECTION'S PHONE NUMBER: (305)762.4949 FBC 20 to BUILDING Permit No. L --- 14 pq9 PERMIT APPLICATION Master Permit No. Permit Type: ElectricalN' p u1 JOB ADDRESS: lq-4 1N City: Miami Shores County: Miami Dade Zip: al(456 Folio/Parcel#: � ��-� C)O-UA�A_,' Is the Building Historically Designated:Yes NO Flood Zone:� n F OWNER:Name(Fee Simple Titleholder): Phone#: 70 Address: o0 w �Q City: WWA 6 State: E'l, Zip: Tenant/Ussee Name: Phone#: Email: �j// CONTRACTOR:Company Name: �e4L �-°-� ' Phone#:7Fb 2, ®� a3 - 6 Address: g r�� -' �1r e�1v�r►�!J. �"�i`�'�r�rz� fi=n/c� City: � State• �� Zip:�� Z Qualifier Name: Phone#(r- q State Certification or Re ' tration#: ��®®® !z Certificate of Competency#: Contact Phone#:-7R4--;2 ,0 -L- /3_-Q Email Address: DESIGNER:Architect/Engineer: 0Z1vG3a Phone#: C7 Value of Work for this Permit:$ !) 400 Square/Linear Footage of Work: Type of Work: ❑Address UAlteration ❑New *epair/Replace ❑Demolition Description of Work: n(e� �C - A� w ►ri r15 Submittal Fee$ Permit Fee$ W,0 ,0W� CCF$_�� _ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ S, _Bond$ Notary$ Training/Education Fee$G® Technology Fee$ tt14 Double Fee$ Structural Review$ CD _ TOTAL FEE NOW DUE$ f e . 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. I)]"Signature Signature— Olner or Agent Contractor The foregoing instrument was acknowledged before me this -3 The foregoing instrument was acknowledged before me this day of ,20 ,by Vt i✓16.4 14+ day of uc. ,20 by '\ 1 %Ca 'l We se%-N who is personally known to a or who has produced who i4ersonally known to me or who has produced As identification and who did take an oath. as identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: Sign: —l\ Print: L= Print: f7D �f( My Commission Expires: COPLIN My Commission Expires: NOTARY PUs,IC .�. My COMMISSION#EE114162 STATE OF FLORIDA • EXPIRES duly 20,2015 Comm#FFOUM (VW)3 101"1153 FlorWallotarySeiyloi skkkk%��kkk%skk�kkkk�skk�XakXak�kkkkk�kk�a#kkk kk�:k�:kkkkkkkk�% kkk%k:kkkk�k�kskkkk�kkk� k�'� APPROVED BY �' e*11 Plans Examiner Zoning Structural Review Clerk (Revised 3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09) RICK SCOTT, GOVERNOR KEN LAWSON,SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD EC0002727 m ' The ELECTRICAL CONTRACTOR - Named below 1S CERTIFIED .9 Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2016 a v MOREJON, ELPIDIO • ELECPLUMB ENTERPRISES-INC 933 NW 134TH PLACE MIAMI FL 33't82 • ISSUED: 06/24/2014 DISPLAY AS REQUIRED BY LAW SEQ# L1406240001598 Local Business Tax Receipt Miami—Dade County, State of Florida THIS IS NOT ABILL-OO NOT PAY LBT-If 6541$$ v SuSINESS N"Etx.00ATiON RECEIPT NO.ELPEXPIRES 933 IDIO MO��ON IN IMEWA� SEPTEMBER 309 2014 7037583 Must be displayed at plate of business MIAMI,FL 331$2 Pursuant to County Code Chapter 8A-Art.9&10 OWNER SEC.TYPE Of SU$INESS ELPIDIO MOREION INC PAYMENT RECEIVED 196 PLUMBING CONTRACTOR SY TAX COU.ECTOA 75.00 07/68/2013 Workef(s) 1 CFC057942 0221-13-000392 This Local Business Ta x Receipt only eon1bars payment si the Local Business Tax.The Receipt is nota licarAw pornh,or a cohtfication of the holder's gaaliftstions,to do bushhess.Holder mud comply with any,povarmasatal a aanpovoramental reguls"laws and rsgoirements which apply to the business, The RECEIPT NO.above am be displayed on all comerciai vehicles-#iRntai-Dada Coda Sao t MtAM fm more ioforma&14 visit AUG-P-8-2014 23:37 From:Esui-Group 305 226 4864 To:7869534843 Pase:1,'1 A ® CERTIFICATE OF LIABILITY INSURANCE DATH(MM/DDIYYYY} 06/26/14 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: M the Celtlfit atb holder is an ADDITIONAL INSURED,the Dolicy((es)must be endorsed. If SUBROGATION IS WANED,subject to the terns and conditions of the policy,certain policies may require an endorsement, A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s), PRODUCER CONTACT Marta Lopez Diaz Ensurgroup PHONE (305)559.0999 _-MAX No (305)226.4864 12804 S.W.8th Street AIL marta@ensurgroup.Dom Miami,FL 33184 INSURERS AFFORDING COVERAGE NAIC# Phone (305)559-0999 FaX (305)226-4864 INSURER A: GRANADA INSURANCE COMPANY [NSURED INSURER 0: CASTLEPOINT FLORIDA INSURANCE CO. ElecPlumb Enterprises,Inc. INSURER C: 933 NW 134 Place INSURER D: INSURER E MIAMI,FL331B2- INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE SEEN 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 15 SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED SY PAID CLAIMS. NSA TYPE OF INSURANCE ADO UBR POLICY NUMBER M POLICY EFF ML pY E1(P LIMITS LT GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000.00 DAMAGE TO RENTED 100,000.00 0 COMMERCIAL GENERAL LIABILITY PREMIS rn $ F7 ❑ c LA1M8-MADE Q OCCUR y 0185FLOOD40472 MED t7(P An one person) $ 5,000.00 A ❑ 11/10/2013 11/10/2014 PERSONAL&ADV INJURY $ 1,000.000.00 ❑ GENERALAGGREQATE $ 1 000,000.00 GEEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-OOMP/OP AGG $ 9 POLICY ❑ PR ❑ LOC $ AUTOMOBILE LIABILITY CE MBIc tlED SINGLE LIMIT ❑ ANY AUTO BODILY INJURY(Per person) S ALL OWNED SCHEDULED BODILY INJURY(Par accident) S B ❑ AUTOS ❑ AUTOS NON-OWNED PR HIRED $ ❑ HIRED AUTOS ❑ AUTOS P P.29dT 1 ❑ ❑ ❑ UMBRELLA LIAB ❑OCCUR EACH OCCURRENCE $ ❑ EXCESS LIAR ❑CLAIMS-MADE AGGREGATE S ❑ DED ❑ RETENTION $ WORKERS COMPENSATION ❑WC STATU- OT L AND EMPLOYERS'LIABILITY Y/N BANY PRIETEAL `ro9N/A 11/04/2013 11/04/2014 PPARTNE�ECUTWE WCP-760949402 el EACHACC4DENT $ 1,0001000,00 OFFICER (Mandatory In NH) FT E.L.DISEASE•EA EMPL $ 1,000,000.00 If yam,daSCliba under E.L.DISEASE-POLICY LIMIT S 1,000,000,00 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS/LOCATIONS(VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If mero space is required) Electrical Contractor Alarm Installation Subject to forms,conditions,endorsements,limitations and exclusions, CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF TME ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Miami Shores Village THE EXPIRATION DATE THEREOF,NOTIC ILL BE DELIVERED IN ACCORDANCE WITH THE POLI PROVISWNS. Building Department 10050 NE 2nd Ave AUTHORMeDREPR "NTATIVE Miami Shores Village,FL 33138 Fax-766-953-4843 ff AC RATION. All rights reserved. ACORD 25(2010/05)OF ACame and 10g are registered marks of ACORD JEFF ATWATER CHIEF FINANCIAL OFFICER STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS'COMPENSATION CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS'COMPENSATION LAW CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers'Compensation law. EFFECTIVE DATE: 2/2212013 EXPIRATION DATE: 2122/2015 PERSON: MOREJON ELPID10 FEIN: 274044596 BUSINESS NAME AND ADDRESS: ELPIDIO MOREJON INC 933 NW 134 PLACE MIAMI FL 33182 SCOPES OF BUSINESS OR TRADE: PLUMBING NOC AND DRIVERS Pursuant to Chapter 440.05(14),F.S.,an officer of a corporation who elects exemption from this chapter by filing a certificate of election under this section may riot recover benefits or compensation under this chapter.Pursuant to Chapter 440.06(12),F.S.,Certificates of election to be exempt...apply only within the scope of the business or trade listed on the notice of election to be exempt.pursuant to Chapter 440.05(14 F.S.,Notices of election to be exempt and certificates of election to be exempt shelf be subject to revocation if,at any time after the filing of the notice or the Issuance of the certificate,the person named on the notice or certificate no longer meets the requirements of this section for Issuance of a certificate.The department shelf revoke a certificate at any time for failure of the person named on the certificate to meet the requirements of We section. DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 07-12 QUESTIONS?(850)413-1609