EL-15-2424 Inspection Worksheet
Miami Shores Village e ti c" ` :L'4
10050 N.E.2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-261593 Permit Number: EL-12-15-3183
Scheduled Inspection Date: June 23,2016 Permit Type: Electrical - Residential
Inspector: Devaney, Michael
Inspection Type: Final
Owner: DENTICO,GILDA Work Classification: Pool - Private
Job Address:260 NW 112 Terrace
Miami Shores, FL 33168-3332 Phone Number
Parcel Number 1121360010280
Project: <NONE>
Contractor: ELECTRICAL MASTERS INC Phone: 305-265-7996
Building Department Comments
ELECTRICAL WORK FOR NEW POOL Infractio Passed Comments
INSPECTOR COMMENTS False
Inspector Comments
Passed CREATED AS REINSPECTION FOR INSP-250022.
Failed
Correction
Needed ��
Re-Inspection ❑
Fee
No Additional Inspections can be scheduled until
re-inspection fee is paid.
June 22,2016 For Inspections please call: (305)762-4949 Page 30 of 31
Per�11 EL.�'12- i $
Miami Shores Villagef/teitl- Slir3dl
10050 N.E.2nd Avenue NW _W0 C{asS*0 tfE Pool-Private
Miami Shores,FL 33138-0000 ,
Phone: (305)795-2204 P@l`&fPf
FCORNp' '
f= eDate:1I1.41t}'i , Expiration: 07/12/2016
Project Address Parcel Number Applicant
260 NW 112 Terrace 1121360010280
Miami Shores, FL 33168-3332 Block: Lot: GILDA DENTICO
Owner Information Address Phone Cell
GILDA DENTICO 260 NW 112 Terrace
FL
260 NW 112 Terrace
FL
Contractor(s) Phone Cell Phone Valuation: $ 800.00
ELECTRICAL MASTERS INC 305-265-7996
..... .. ...... Total Sq Feet: 0
Type of Work:ELECTRICAL WORK FOR NEW POOL Available Inspections:
Additional Info: Inspection Type:
Classification:Residential
Final
Scanning: 1
Light Niche
Bonding
Review Electrical
Alarms
Fees Due J$31360
�Date Pay Type Amt Paid Amt Due
CCF
Invoice# EL-12-15-58162
DBPR Fee 12/28/2015 Credit Card $50.00 $263.60
DCA Fee
Education Surcharge 01/14/2016 Credit Card $263.60 $0.00
Permit Fee-Additions/Alterations
Scanning Fee
Technology Fee
Total:
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 pePmit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are
required for ELEC AL,PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work.
OWNERS AFFIDA ' certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
construction and z n uthermore,I authorize the above-named contractor to do the work stated.
January 14, 2016
Authorized i e:Owner / Applicant / Contractor / Agent Date
Building De artment Copy
January 14,2016 1
Miami Shores Village
Building DepartmentRECI
vw
10050 N.E.2nd Avenue,Miami Shores,Florida 33138FBY:-
F
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949 BC 20iq
BUILDING Master Permit Noi B P P 24
PERMIT APPLICATION Sub Permit No. fl IS- I0
❑BUILDING %ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 2�_O_ `C� V6&1A4,--
City:
Miami Shores County: Miami Dade Zip:
Folio/Parcel#: Is the Building Historically Designated:Yes NO
Occupancy Type: Load: ��--Conlst�ruction Type:
���, Flood Zone: BFE: FFE:
OWNER: Name(Fee Simple Titleholder): Elm bfi- inn Phone#:- � 6 rjl Of(/
Address: ^ �n PCO 1(Z ��An OAC C
City: a( State: 9;yl-t- Zip:
Tenant/Lessee Name: Phon :
Email:
CONTRACTOR:Company Name: v�S Phone#: 7L,� -J EZ-72Y,6
Address:
City: State: f�l Zip: o3 ?/44,16 rs
Qualifier Name: ° Phone#:
State Certification or Registration M 711 e b L:_3�t��_ Certificate of Competency#: q--ii'--��,�,off ® am
c
DESIGNER:Architect/Engineer: Phone#:-fi?'t�305- 300
Address: City: State: Zip:
Value of Work for this Permit:$ c'ge�� c'�� Square/Linear Footage of Work:
Type of Work: ❑ Additio/n ❑ Alteration /` ❑ New ❑ Repair/Replace ❑ Demolition
�Ie.:�t
Description of Work: 1(24 �� C1�i�(Z BC L bu 01,o L.
I
Specify color of color thru tile:
Submittal Fee S�i Permit Fee$ CCF$ e CO/CC$
Scanning Fee$ B Radon Fee$ DBPR$ ` 'Notary$
Technology Fee$ Training/Education Fee$ _ Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$ 21
a
(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 not be approved and a reinspection fee will be charged.
Signature ,// 7 �sto� Signature
OWNER or AGENT CONTRACTOR
The forego ng instruIZ-e
was ackno aledged before me this The foregoing instrument was acknowledged before me this
day of Al 20 i S by 0' day of �Q"4.&-X ,20�, by
who is personally known toy5yar,? ,ri t who is personally known to
Peor who has produced as me or who has prod, as
P p
identification and who did to a an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: (� Sign:
Print: /L //U Print: TG-
Seal: Seal: EN iQUE IGLESIAS
Notary Public-State of Florida
PI #EE t :< • •oQ My Comm.Expires Aug 17,2018
Commission 0 FF 115297
APPROVED Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
to
CERTIFICATE OF LIABILITY' INSURANCE 1/12/2016
Proctocort Plymouth Insurance Agency 'shin Certllkate is Issued as a matte of Information only ansa aonfom no
rights upon rite Cerf�Holder. Thio cell imte dam not amend,extetd
2739 U.S. Highway 19 N.
or alter the coverage aMrded by the polities below.
Holiday, FL 34691
(727)9WB562 Insurers Affording Coverage NAIC#
lnsurar A: Lion insurance CornpanY 11075
insured: South East Personnel Leasing, Inc. &Subsidiaries insurer B.
2739 U.S, Highway 19 N. Inaurarc:
Holiday, FL 34691 Insurar D.
Insurer E:
Coverages
w fima Delaw hAve been 1 the hnmd namw 2bftS for P01tCy gm any rep ro mars.term or OD-Im of any pcmuaot M
with reaped to who this ceRifi=te may to mww or may pmisin,the insurance aawded by the poride9 deWted herein Is subirut to all ft W1118.exdWor's,and wnditiona of suph polio".Aggregate
limits shown may hove been reduced by paid calms.
INSR ADDLPolicy Effective Policy Expiration LimitsLTR INMD Type of Insurance Policy Number Date este
(MMIDD/YY) {MMIDD
ENERAL LIABILITY Each ocuTrenOB
Commercial General Liability Damage to renfSC premsms(1A
Claims Made ❑ Occur oo rrarKO)
Mea EYP
Personal Adv Injury
eneral aggregate limit applies per r A
Policy ❑Project ❑ LOC Prodtala-ComPlOp Agg
UTOMOBILE LIABILITY Combined Single Limit
(EA A-danl)
Any Auto Bodily Injury
An Owned Autos (per perm)
Smeduted Autos
(iced Autos Bodily h"
Non-Owned Autoa (Per Ao MKd)
Pr*peny Damap
(Per Acdderit)
EXCEWUMSRELLA LIABILITY Each oommnoe
Q— Claims Mala AW%ate
Deductible
A Workers Compensation and WC 71949 01!012015 01/01/2417 X Wo sbdu- jjqTH-
F-rnplayers•Liability try Lirrtil8 I ER
Arty PrvpriemdPar 1n6t/ex=1ffve otAcsvmember E.L Each Accident $1,000.000
exdudedy No EL Disease-Ea Employee 111.000.000
IF Yq,deSCnY+e under 3W-W provisions below.
EL DLsease-Poncy unfits $1.000.000
outer Lion Insurance Company Is A.M.Best goMpggy ratad A-(EKcellent). AMB#12616
Descriptions of Operationsfi-ooMortWO C1061Exclusions added by Endorsement/Special Provisions: Client ID, 91-68-UB
Coverage only apps to alive employee(s)of Sa t Eat Personryd Leasing,Inv.a Subsidiaries that are lemed to tM folbwing oCIhj t Company":
Electitral"afters,NV-
Coverage
ncCoverage only applies tfi injuries klQmvd by South East Personnel Leastlg,Int-&5utOdWes acute t:mPlOYee(s),while wonting in:FL
Coverage does not apply to statutory employees)or Independent colltrador(s)of the Client Comparry or any other entity,
A list al'the active empicyce(s)Isaasa to the Client company can be obtained by!axing a reouex to(717)937-2138 or by calling(727)938-5562
ISSUE 11-09-15 CTLD)/REISSUE 01-12-1a(rLD)
M Dblia 211112019
M CANCELLATION
VILLAt3E OF MIAMI SHORES Should any of tfiv above derffibad palicias be caneeflod batom the meson dale thereof,the issuing
6UILDiN43 DEPARTMENT Inum win onaaavar to Mau 30 da,,vaetan r=00 to am camoale holder r mnod to the lef.but faflum to
d0 so$iva OVIDS8 rle obllgatim or liabfftty of any kind upon lyre Ineurar,Its agents or rep swnniatMaa.
10060 N[3 2ND AVE
MIAMI SHORES, FL 33139 A