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EL-14-2585 v Inspection Worksheet Miami Shores Village t �' 2 SSS 10050 N.E.2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-256401 Permit Number: EL-11-14-2585 Scheduled Inspection Date:April 08,2016 Permit Type: Electrical- Residential Inspector: Devaney, Michael Inspection Type: Final Owner: GUGUEN,ALICE Work Classification: Addition Job Address:10601 NE 6 Avenue Miami Shores,FL 33138- Phone Number Parcel Number 1122310120020 Project: <NONE> Contractor: ATLANTIS ELECTRICAL CORP Phone: (305)551-4043 Building Department Comments ELECTRICAL WORK FOR MASTER SUITE Infractio Passed Comments INSPECTOR COMMENTS False Inspector Comments Passed Failed D 49W OL A7 Correction ❑ Needed Re-Inspection Fee No Additional Inspections can be scheduled until re-inspection fee is paid April 07,2016 For Inspections please call: (305)762-4949 Page 17 of 27 Miami Shores Village 10050 N.E.2nd Avenue NES 3 �r Miami Shores,FL 33138-0000 Phone: (305)795-2204x ,',u Expiration: 0 1/1 2016 Project Address Parcel Number Applicant 10601 NE 6 Avenue 1122310120020 ALICE GUGUEN Miami Shores, FL 33138- Block: Lot: Owner Information Address Phone Cell ALICE GUGUEN 10601 NE 6 Avenue MIAMI SHORES FL 33138- 10601 NE 6 Avenue MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone Valuation $ 3,000.00 ATLANTIS ELECTRICAL CORP (305)551-4043 Total Sq Feet: 571 Type of Work:ELECTRICAL WORK FOR MASTER SUITE Available Inspections: Additional Info: Inspection Type: Classification:Residential Scanning:3 Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $1.60 Invoice# EL-11-14-53703 DBPR Fee $3.38 07/16/2015 Credit Card $245.56 $0.00 DCA Fee $3.38 Education Surcharge $0.60 Permit Fee-Addrdons/Alterations $225.00 Scanning Fee $9.00 Technology Fee $2.40 Total: $245.56 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 that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zonin ermore,I authorize the above-named contractor to do the work stated. July 16, 2015 Autho ature:Omer / Applicant / Contractor / Agent Date Building Department Copy July 16,2015 1 Miami Shores Village � �, Building Department ,�! NOV 26 01 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(30S)762-4949 FBC 20 l BUILDING Master Permit No. PERMIT APPLICATION Sub Permit No. ❑BUILDING P<ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP � ��pp CONTRACTOR DRAWINGS JOB ADDRESS: 1 13`00\ �� (oic City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: U'='31 ` cozo is the Building Historically Designated:Yes NO X Occupancy Type: Load: j^��Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): 1�'�� GV&Uwo Phone#: -271 `Si- 4 Address: L®l�� b M" City: it- .i State: fil— Zip: 93tl® Tenant/Lessee Name: Phone#: Email: r CONTRACTOR:Company Name: 3( s, � c Phone#:O6 �' �` 1" to Address: 2500 So G , ZO i 460 - �7 City: ( State: V Zip: ��+� Qualifier Name: fgMuV--az' Phone#: State Certification or Registration#: K, 130L) 1914 Certificate of Competency M DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ .f3w a Square/Linear Footage of Work: Type of Work: kAddition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: 67 Vgy4G t,jDayr- rVIL- P S`LYL-'SAJ f TJe A� /J&K- &1t:5 Specify color of color thru tile: 1l Submittal Fee$ Permit Fee$�Z�,�O� 3 ` CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ .Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ , t 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 inspectio which occurs seven (7) days after the building permit is issued. in the absence of such posted notice, the inspection will not be proved 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 20 144 ,by day of �I Vae,(" ,20 L4 .by 4\10-e-- C1 QCkL* Q ,who is personally known tol6on —,t;�CPZ ,who is Fe-r—sonally knowk to me or who has produced �1� - cY1j� as me or who has produced as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sig ,,11 ll Sign- Print: W\- Print- Seal: ,p�`"°' REBECA M PASTRANA Seal + REBECA M.PASTRANA MY COMMISSION 9 EE872624 MY COMMISSION d EE9=4 °� EXPIRES:Febraary 07,2017 'OorEXPIRES:February 07,2017 w as ******************** ************************************************************************************ A o/Al APPROVED B !/ti a��r Plans Examiner Zoning Structural Review Clerk (RevisedO2/24/2014) E(MMIDD/YYYY) CERTIFICATE OF LIABILITY INSURANCE °A'111/21/20140/2014 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 certificate holder Is an ADDITIONAL INSURED,the pol)cy(ies)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 holder in lieu of such endorsement(s). PRODUCER BUTLER BUCKLEY DEETS INC IJAAATE CT LAURENCE A DEETS PHONE FAX 6161 BLUE LAGOON DR#420 c No): -MAIL ADDRESS: INSURER(S)AFFORDING COVERAGE NAIL 9 MIAMI FL 33144 INSURER A:FWCJ A INSURED ATLANTIS ELECTRICAL CORP. INSURER 8: 12803 SW 20TH TERRACE INSURER C: INSURER D• MIAMI FL 33175 INSURER E: FEIN:650739013 INSURER F: COVERAGES CERTIFICATE NUMBER:1411210026 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. INSR POLICY EFF POLICY EXP LIMITS LTRTYPE OF INSURANCE POLICY NUMBER WDD MMD GENERAL LIABILITY EACH OCCURRENCE $ DAMAZ4E'T6'R'2gT9 S.............................................................-- COMMERCIAL GENERAL LIABILITY PREMISES Ee occurrence $ -M CLAIMSADE F OCCUR MED EXP one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'_AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ JFC 17 POLICY PRO LOC $ AUTOMOBILE LIABILITYEs accNED ident)1 I ff ANY AUTO BODILY INJURY(Per perm) $ ALL OWNED SCHEDULED BODILY INJURY(Per acc1dent) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS (Peraccident) UMBRELLA I" OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ —VOi RS COM SATION X FTWC STATU 0 AND EMPLOYERS'LIABILITY YIN� 70760298 jt A ANY PROPRIETORIPARTNERIEXECUTNE�,,� {� 11/11/2014 11/11/2015 EJ..EACH ACCIDENT $5� OFFICE/MEMBER EXCLUDED? 1 N I N t A (Mandatory In NH) �� E.L.DISEASE-EA EMPLOYEE $500 000.00 Ryes,describe under E.L.— RIPTION OF OPERATIONS below DISEASE-POLICY LIMIT $500,000.00 I ::Elio DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,H more space is required) Electgrical Contractor- License#EC13001914 CERTIFICATE HOLDER CANCELLATION VILLAGE OF MIAMI SHORES SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE BUILDING&ZONING THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE 2ND AVENUE MIAMI SHORES FL 33138 AUTHORIZED REPRESENTATIVE Phone Number 305-795-2207 ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD r�-Zsws ATLEL-1 OP ID:MA CERTIFICATE OF LIABILITY INSURANCE °^111/12/20112J20 5 15 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 certificate holder is an ADDITIONAL INSURED,the policy(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 holder in lieu of such endorsement(s). PRODUCER CONTACT BUTLER,BUCKLEY,DEETS INC. NAME: MARU\NA GONZALEZ 6161 BLUE LAGOON DR.,STE 420 acNN Exc:786-216-1778 AIC No):305-262-0187 MIAMI,FL Gonzalez pp�D�:MARIANA BBDINS.COM Mariana Gonzalez INSURER(S)AFFORDING COVERAGE MAIC# INSURERA:WESCO INSURANCE COMPANY INSURED ATLANTIS ELECTRICAL CORP. INSURER B:GUARANTEE INSURANCE COMPANY 11398 12803 SW 20TH TERRACE MIAMI,FL 33175 INSURER C: INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 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. INSR I TYPE OF INSURANCE DDL POLICY EFF POLICY EXP LTR POLICY NUMBER MMIDD MM/DD LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY WPP1138623 01 02110/2015 02/10/2016 PREMISES Ea occurrence $ 100,00 CLAIMS MADE I OCCUR MED FRCP(Any one person) $ 5,00 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,00 X POLICY PRO- LOC $ AUTOMOBILE LIABILITY Ea COMBcollINED SINGLE LIMIT $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS NON-AUTOOWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS PER ACCIDE $ UMBRELLA L" OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ HDED I I RETENTION$ $ WORKERS COMPENSATIONX WC STATU- X OTH- AND EMPLOYERS'LIABILITY YIN T RY LIMIT R B ANY PROPRIETOR/PARTNER/EXECUTIVE WCP101432001GIC 11/11/2015 11/11/2016 E.L.EACH ACCIDENT $ 500,00 OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ 500,00 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1$ 500,00 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,I more space Is required) ELECTRICAL CONTRACTOR CERTIFICATE HOLDER CANCELLATION MIASHVI SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE VILLAGE OF MIAMI SHORES THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN BUILDING 8a ZONING ACCORDANCE WITH THE POLICY PROVISIONS. 10050 N E 2 AVE. AUTHORIZED REPRESENTATIVE MIAMI SHORES,FL 33138 �-0t, ap �� ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 26(2010105) The ACORD name and logo are registered marks of ACORD Local Business Tax Receipt8s Miami—Dade County, State of Florida -THIS IS NOT ABILL-DO NOT PAY � LBTJ 3726750 BUSINESS NAME/LOCATION RECEIPT NO. EXPIRES ATLANTIS ELECTRICAL CORP RENEWAL SEPTEMBER 30, 2016 12803 SW 20 TERR 3891646 MIAMI,FL 33175 Must be displayed at piece of business Pursuant to County Code Chapter 8A-Art.9&10 OWNER SEC.TYPE OF BUSINESS PAYMENT RECEIVED ATLANTIS ELECTRICAL.CORP 196 ELECTRICAL BY TAX COLLECTOR CONTRACTOR 75.00 07/15/2015 Worker(s) 1 EC13001914 CHECK21-15-095019 This Local Basins,Tax Receipt only corms payment of the Local Business Tax.The Receipt Is not a license, permit,or a certification of the holders guali foatms,to do business.Holder must comply with any governmental or nongovernmental regulatory lows and requirements which apply to the business. The RECEIPT N0.above most be displayed on all commercial vehicles-Miami-Dade Code Sac Sa-276. MIAMAN For more information,visit www.mhmidade aorhaxcoilectar a