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EL-16-1437 Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores, Fl- Phone: LPhone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-260811 Permit Number: EL-5-16-1437 Scheduled Inspection Date:June 13,2016 Permit Type: Electrical- Residential Inspector: Devaney, Michael Inspection Type: Final Owner: SEOANE,SAMUEL Work Classification: Alteration Job Address:241 NW 91 Street Miami Shores,FL 33150- Phone Number (305)775-0170 Parcel Number 1131010331340 Project: <NONE> Contractor: QUINTANA ELECTRIC BROTHERS INC Phone: (305)986-5893 Building Department Comments RE-WIRING OUTLETS Infractio Passed Comments INSPECTOR COMMENTS False Inspector Comments Passed Failed Correction ❑ Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid June 10,2016 For Inspections please call: (305)762-4949 Page 33 of 33 A {n Miami Shores Village 10050 N.E.2nd Avenue NWS Miami Shores,FL 33138-0000 t r Phone: (305)795-2204 �$ Expiration: 1 2016 Project Address Parcel Number Applicant 241 NW 91 Street 1131010331340 SAMUEL SEOANE Miami Shores, FL 33150- Block: Lot: Owner Information Address Phone Cell SAMUEL SEOANE 241 NW 91 Street (305)775-0170 MIAMI SHORES FL 33150- Contractor(s) Phone Cell Phone $ 1,500.00 QUINTANA ELECTRIC BROTHERS IN( (305)986-5893 (305)681-5317 Valuation: F...............w., .m�..__ . �._._ _m.� ��_. Total Sq Feet: 0 Type of Work:RE-WIRING OUTLETS Available Inspections: Additional Info: Inspection Type: Classification:Residential Review Electrical Scanning:3 Review Electrical Review Electrical Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $1.20 Invoice# EL-5-16-59914 DBPR Fee $4.50 06/07/2016 Check#:2696 $271.20 $50.00 DCA Fee $4.50 Education Surcharge $0.40 05/24/2016 Credit Card $50.00 $0.00 Permit Fee-Additions✓Aiterations $300.00 Scanning Fee $9.00 Technology Fee $1.60 Total: $321.20 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 _pKWfining thereto and in strict conformity with the plans,drawings,statements or specifications submitted to the proper authorities of Miami Shores Village. In ting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are for ELECTRICAL,PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work. O N DAVIT I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating con n in Futhermore,I authorize the above-named contractor to do the work stated. June 07,2016 A gnature:Owner / Applicant Contractor / Agent Date Building Department Copy June 07,2016 1 Miami Shores Village �• Building Department 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 MAY 2 4 2016 Tel:(305)795-2204 Fax:(305)756-8972 ICY. INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 20 Il<44t BUILDING Master Permit No. T u 14,3q PERMIT A=ON Sub Permit No. r-1 BUILDING ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL [-]PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP 2 ' r p ' CONTRACTOR DRAWINGS 4JOB ADDRESS: lA�l 1`�J Ih�T City: Miami Shores ? / County: Miami Dade Zip: Folio/Parcel#: 'i 5 1 f)10 33 j J"'I® Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construct)o Type: Flood Zone: BFE: FFE: OWNER:Name(F a SImplq Titl h der):- PhoneM_X�?113 hA) Address 1�6 City: UWAW State: PL_ Zip: Tenant/Lessee Name: Phone#: Email: ,f') _ Q_�r CONTRACTOR:Company Name:I Y A& f�.(.�d'�G Qaft�ho�I aS L rir,Phone#:(/30S Z0-gp Address: '811 S City:/�? State: Zip: 3'37 3 Qualifier Name:5Gtavl A&'rl&z_ Phone#•��3 3W_3 g& State Certification or Registration#: Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: is Perm $ SC3� Square/Linear Footage of Work: e. ❑ AdditionAlteration [:1 New R&epair/Replace El Demolition Description of Work: Specify co/orofcolpr ft tile: 406 a'tap Submittal Fee$ V Permit Fee$ CCF$ CO/CC$ Scanning Fee$ '` Radon Fee$ DBPR$ �.:� Notary$ Technology Fee$ Training/Education Fee$in— 6 Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ (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 no pproved and a reinspection fee will be charged. Signature Signature OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of ✓` &L4 120 1() by `day of 20 by 1)wg I SeOd►'Le, ,who is personally known to J (/qci/ who is personally known to me or who has produced astmewhtoas produced as e ification and who did take an oath. and who did take an path. PUBLIC: LIC: Sign• Print: Print.g4VW 0,944"" Seal: Seal: ti. ROBERT QUINTANA ROBERT t314ITANA = NOWYMMM-81MEOFFUDIfVA • CONBAISSMOFFOM12 NaTARYPIJBLIC-81A7EGFFid1� �.; � � EXPIRES 11�/�1�3/Z017 ****** **** * s* *******sss*s*e****s*******s EXPIRE 11113=7 BDI�TNiri11�NGi➢ARw APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) I Iliili!liil illl!i!I!!III!!hili Bill l!!I illl CFN 2016RO293357 OR SK 30081 Pas 274-275 (2Pss) RECORDED 05/18/2016 15:02:39 Prepared by: DEED DOC TAX $1►788.00 Law Office of Pina Brito&Associates HARVEY RUVINP CLERK OF COURT 8900 SW 107 Avenue,Suite 200 MIAMI-DADE COUNTY► FLORIDA Miami,Florida 33176 Parcel/Account ID Number: 1131010331340 WARRANTY DEED THIS WARRANTY DEED Made the_l I day of May,2016,by DANIEL F. WEIR NACHT,a single man,hereinafter called the grantor,whose post office address is 4019 Golf Village Loop#2,to SAMUEL SEOANE,a single man,whose post office address is 241 NW 91812 Miami Shores,Florida 33150-2258,hereinafter called the pwitee(s): (Wherever used herein the terms"grantor"and"grantee"include all the parties to this instrument and the heirs,legal representatives and assigns of individuals,and the successors and assigns of.... corporations.) WITNESSETH: That the grantor,for and in consideration of the sum of$ 10.00 and other valuable considerations,receipt whereof is hereby acknowledged,hereby grants,bargains, sells,aliens,remises,releases,conveys and confirms unto the grantee,all that certain land situate in MIAMI-DADE County,Florida,viz: Lot 19 and the West 1/2 of Lot 20,Block 136,M]AMI SHORES SECTION NO.6,according to the plat thereof,as recorded in Plat Book 10,Page(s)39, Public Records of Miami-Dade County,Florlda. SUBJECT TO: 1. Conditions,restrictions,limitations and easements of record,if any,without reimposing same, applicable zoning and other governmental ordinances and laws,if any. 2. Real property taxes for 2016 and subsequent years. TOGETHER with all the tenements,hereditaments and appurtenances thereto belonging or in anywise appertaining. TO HAVE AND TO HOLD,the same in fee simple forever. AND the grantor hereby covenants with said grantee that the grantor is lawfully seized of said land in fee simple;that the grantor has good right and lawful authority to sell and convey said land;that the grantor hereby fully warrants the title to said land and will defend the some against the lawful claims of all persons whomsoever,and that said land is free of all encumbrances,except taxes accruing subsequent to December 31,2015. 2 Book30081/Page274 CFN#20160293357 Page 1 of 2 s OR BK 30081 PG 275 VAST PAGE IN WITNESS WHEREOF,the said grantor has signed and sealed these presents the day and year first above written. Witnessed by: _ 9�Mwrl WA40e�l,( ' Signature:,�h &"0 F_g4aee k cseal) Daniel F.Weibnacht Printed name: 16440" .fie(.n Signature: Printed name: Q t3 A STATE OF FLORIDA COUNTY OF E{�d r-FC The foregoing instrument was acknowledged before me this 1 .7 day of May,2016, by DANIEL F.WEIHNACHT.,who produced F)L as Identification WiU1NEY0WA NOTARY P ,_STATE OF FLORIDA 9:M10, o s w of tea wn low ra My Commission Expires: -Gl 1,r Book30081/Page275 CFN#20160293357 Page 2 of 2 DATE(�dDpPf mm AcoRO® CERTIFICATE OF LIABILITY INSURANCE f,� • 1 5/23/2016 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: U the cerliflcate holler is an ADDITIONAL INSURED,the pol)cy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holler in lieu of such endorsement(s). PRODUCER W&Acr David M. Lopez Eastern Insurance Group, Inc. PHONE (305)595-3323 FM& (305)595-7135 9570 SW 107 Avenue amanda@east:erninsurance.net Suite 104 s AFFORDING COVERAGE NAM 0 Miami FL 33176 INBIWWRA blid-Continent Casualty INSURED INSURER B Quintana Electric Brother's, Inc. INSURER C: 4801 SK 6th Street INSURER D: INSURER E: Miami SL 33134 INSUREFt F: COVERAGES CERTIFICATE NUMBER91aster 16/17 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 HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. R Elm TYPE OF INSURANCE WVn POLICY NUMBER, OVABDrfym LTEXp Lam B COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLmsmAm ®OCCUR DAMAGE TO RENT10— $ 100,000 04-CM-000953606 5/29/2016 5/29/2017 MED EXp(Any Ong person) $ Excluded PERSONAL&ADV INJURY $ 1,000,000 GEWL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY❑JPE`CT F--]Loc PRODUCTS-COMPIOP AGG $ 2,000,000 OTHER $ AUTOMOBILE LIABILITYIff— a a,dentl $ ANY AUTO SOOILY INJURY(Per person) $ ALL ED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS (per Goddam UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCEBS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION $ WORKERS COMPENSATM TH- AND EMPLOYERS'LIABILITY YIN R ANYOFFiCERPROPRETOR/PAVAF3NBER /U2TNEEXCLUDED?R/D(ECUTNE F-] L.NIA E. EACH ACCIDENT $ (Ma�rX,islory In NH) E.L DISEASE-EA EMPL $ DESCRI OF OPERATIONS below E L DISEASE-POLICY LIMIT I$ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Addidonal Reawlts Schedule.nuy be atfacbed H mors space is required) Electrical Contractor CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Miami Shores THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Building a Zoning Department ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NZ 2 Avenue Miami Shores, SL 33138 AUT"ORLM REPRESENTATIVE David Lopez/DAVID ®1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD IN3025(muni 6J3/2016 Report Viewer =/I , l Co -- I�c3 .TEFF ATWATER CHIEF FINANCIAL OFFICER STATE OF FLORDA 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: 51112016 EXPIRATION DATE: 5/11/2018 PERSON: MENDEZ JUAN M FEIN: 650973171 BUSINESS NAME AND ADDRESS: QUINTANA ELECTRIC BROTHER'S INC. 660 E 60TH ST HIALEAH FL 33013 SCOPES OF BUSINESS OR TRADE: LICENSED ELECTRICAL CONTRACTOR mF10f"rnotr1eDoCa1aq*bern4e40l014).FpeAre.aenande whodstMe bbMQaeeWdWbd ude4e 8samy . CdsoderGs Pu =tt*U; 4460M,FB. edn bb9umMp—ap*a* wifiMlhedcwd ftdn artradslh�dm6enatloedeledlantra6emmmpLRa8uad6oC6ie�o�440.68(1 .F JLNo6ossddecdwbhe Wsuawedft OR 6�Pe wrmdon a ard8ra6srol rrequlr d6d eeaeWwfefor dem 1 Ths dwHrawime OFS-F2-DWC-=CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUESTIONS?(SM)1131609 hIlpsJ/apps8.flcft.com/crreporMewer/rqx rMewerasp Odatff--kdvpgnc9D7CO06TER6eP11U1A ekeESoPifylv4NPOPN42)WrDRGXVWI... V2 a � a Ul 000 *00 . .. . . . . . . . 0 .. . . . ... . . . . . . . . . . . . . . .. .. . . . .. .. ... . . . ... . . \n bS'k #Q-4 ves& J Quintana Electric Brothers Inc. Electrical Panel Schedule 4801 SW 6th STti��� Mian*FL 33134 CCK DESCRIPTION TRIP VOLTS COND. WIRE WATTS GLW CC.W REFRIGERATOR 1/20 120 12 1500 G.LIGHTS 1/15 120 14 1200 WASHING MACHINE 1/20 120 12 1500 WATER HEATER 2/30: 240 10 4000 DRYER 2/30 240 10 5000 RANGE 2/50 240 6 8000 A/C CENTRAL 260 240 6 8000 SMALL APPLIANCES 1/20 120 8 9000 ••' :••• •' ...... .. . ...... SMALL APPLIANCES 1/20 120 12 1500 LIGHTS&RECEPTACLES 1/15 120 12 1500 •••• ::.. LIGHTS&RECEPTACLES 1/15 120 14 1200 DISHWASHER 1/20 120 14 1200 • .. .. . .. ...... DISPOSAL 1/20 120 12 1500 •••••• •� 240 12 1500 •••••• SUBTOTAL: 1 A/C @ 100% 8000 8 KW @ 100% 8000 J56 , 40%Balance 9640 X10 —k0'��"'�s 24100 @ 40% 25640 .. ELECTRICAL RE W ,�u�IG APPROVE DATE______ �C" t . i4 't •• �,_.;,'j� . au M3,r a ",$ •�, 1 r•, `��lrr ci'6� :4 -.�� a�y�t4Y°.�A. �•, t - �' .�, ' • ..-t �1 S,y'fn.. - •^ ..•� �- - ' 'h ♦ f+14 I 0*w NO POINT ALONG COUNTER TO BE MORE THAN r"""•C 2 FEET FROM G.F I PROTECTED RECEPTACLE. �y PUT D/W RECEPTACLE UNDER SINK. ALL FIXED APPLIANCES ON DEDICATED CKTS. A00 SMOK&CARBON MONOXIDE D ITS Ld AN�'AND ALL CLOTH �ECrORS. INSULATED CON U AND RUBBER *-No o� rc$ D. �• 1 /2 Uff f w WT 20 BLOCK 136 Mtn a BLOCK 136 BATHROOM RECEPTACLE ON 20 AMP CKT AND G.F.I PROTECTED CONC N 0,0• STEPS 1 .t� �,- bt 40 CON ,\ Cc A/C- or 19*0 STEPS c © M, d-C) G° 7. - �• . . 999 9999V 9• 9 999 9 ,�..... 99990. cJ • .99999 to 0.31 9999 .. .9... .9.... 9. 9999. 3 I 9 9999.. i n CBS + � - •• L REQ? �, STEP 1 �t3 -4 �. mn i•shores Village •"'-'?�1/'FD BY DATE 40 A - x + 77r PT EDER � - COMPLIANCE WITH ALL F . C;rll INIY RULES AND REGULATIONS 7.tlJ _ JUN 64 2016=A 50002' STEP01 i a Miami shores Village Building Department �j,QRe'�p►. 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305)795.2204 Fax: (305)756.8972 RECEIPT �/ J PERMIT#:� � (� ��3 DAT I, ame) contractor o Owner o Architect .�Q Picked u 2 se of Lam, (YDG11� II) p is plans and (other] � 1 a ��� Address:�q 1 W q(g� From the building department on this date in order to have corrections done to plans A / t unty stamps. I understand that the plans need to be brought back to Miami Sho a �g epartment to continue permitting process. v Signature: (SIGNATURE) PERMIT CLERK INITIAL: RESUBMITTED DATE: PERMIT CLERK INITIAL: