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EL-12-1159 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores,FL Phone: (305)795-2204 Fax: (305)756-8972 I I S Inspection Number: INSP-181520 Permit Number: EL-6-12-1159 Scheduled Inspection Date: January 03,2013 Permit Type: Electrical - Residential Inspector: Devaney, Michael Inspection Type: Rough Owner: POLANCO, DEYSI Work Classification: Pool - Private Job Address: 1183 NE 91 Terrace Miami Shores, FL 33138- Phone Number Parcel Number 1132050010200 Project: <NONE> Contractor: PREMIER ELECTRIC LLC Phone: (305)254-7000 Building Department Comments ELECTRICAL WORK FOR POOL INSTALLATION Infractio Passed Comments INSPECTOR COMMENTS False Inspector Comments Passed (/ CREATED AS REINSPECTION FOR INSPA81485. Failed Correction l� Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. January 02,2013 For Inspections please call: (305)762-4949 Page 8 of 26 �"M9 7 v� Miami Shores Village JUN 25 y2 Building Department BYaeeeeeemmeeee°oemeee 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel: (305)795.2204 Fax:(305)756.8972 INSPECTION'S PHONE NUMBER:(305)762.4949 FBC 20 BUILDING Permit No. F-1 19- 1� c PERMIT APPLICATION Master Permit Nod �o�,' cJ Permit Type: Electrical JOB ADDRESS: //93 AJ C 7P,� I�r City: Miami Shores County: /FL Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated:Yes NO °� Flood Zone: I+E OWNER:Name(Fee Simple Titleholder): bg y� 16 LA r,1 W Phone#: A&°-34.9 Address: 2 3-1 Sy n Scl El-ii Q City: State: Zip: 33-3AP— Tenant/L.essee Name: Phone#: Email: 10 In g=Q ezie,1 , CD rv1 'T� CONTRACTOR:Company Name: 1 may( I F_� F'j GHQ��', Y Phone#: 2� Address: 24c) I L 4 Alr'r-, City: State: Qualifier Name: Phone#• State Certification or Registration#: `'•C- ��y4�� Certificate of Competency#: Contact Phone#: Email Address: DESIGNER:Architect/Engineer: Phone#: Value of Work for this Permit:$ Y�m Square/Linear Footage of Work: Type of Work: OAddress OAlte tion ( ONew OR air/Replace ODemolition Description of Work: 1 m !'r Submittal Fee$ Permit Fee$ :3 a�4r-p P e-2 dP CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Bond$ Notary$ Training/Education Fee$ Technology Fee$ Double Fee$ Structural Review$ TOTAL FEE NOW DUE$ 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 esti value exceeding$2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lie w ochure ill be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of c e eme must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issue the b nce of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature Signature Owner or Agent Co ct The fo oin instrumN ac wledged bef this G`\J The foregoing instrument was ackno led before me this day of ' - y day o ,20L,by , who i ersonally knoa or who h s produced w is�ersena113 or who has producedtification and who did take an oath. as identification and who did take an oath. NOTAR UBLIC: NOTARY PUBLIC: Sign: Sign: P A Ct AUDIA�•CUBIL .c o ary ruurrc--Slate ul0 Print: of Florida print: ' ' • M Comm.Expires Sep 12,2014 `"Bp.- Notary u 23. 15 :;� �o Commission#EE 25344 M Commission Expires: ; �• m.Expires Sep My p My Com EE 128810 My Co s P1r�Sitded Through National Notary Assn z` Commission# Assn. %s National Notary bonced ro Ah 2®!'7— APPROVED APPROVED BY -Y�,`'Wlans Examiner Zoning Structural Review Clerk (Revised 3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09) STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD (850) 487-1395 1940 NORTH MONROE STREET •� �. TALLAHASSEE FL 32399-0783 LOZA, FERNANDO R PREMIER ELECTRIC, LLC 4520 SW 74TH AVE MIAMI° FL 33155 4srnTEoo FtowoA ::' , AC# 6 1.9,10 4 4 Congratulations! With this license you become one of the nearly one million i?gPARTMENT 0F` BxTSINE88 AND Floridians licensed by the Department of Business and Professional Regulation PRQFESSIOTAL_,R$GIILATION Our professionals and businesses range from architects to yacht brokers,from ` boxers to barbeque restaurants,and they keep Florida's economy strong. EC13004481 07/07112 110408074 Every day we work to improve the way we do business in order to serve you better For information about our services,please log onto www.m�oridalicense.com CERTIF_3ED '$LECTRICAL, CONTRACTOR There you can find more information about our divisions an the regulations that LOZA,• FSR}�AND0`R impact you,subscribe to department newsletters and learn more about the , PREMIER ELECTRIC,' 1LLC Department's initiatives. Our mission at the Department is:License Efficiently, Regulate Fairly.We constantly strive to serve you better so that you can serve your customers. Thank you for doing business in Florida,and congratulations on your new licensel 1 xs::cxTx�zsn unser the provisions ag ch.4s9 �s apiratioa date,:AUG 31, 2014 L12 0107 0 0345 DETACH HERE %C# 6-1-91044 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD SEWL12070700345 LICENSE NBR 107/07/20121110408074 EC13004481 . The ELECTRICAL CONTRACTOR - Named below IS CERTIFIED Under the provisions of Chapter,..* 9,,-FS. Expiration date: AUG 31, 2014 LOZA, FERNANDO R PREMIER ELECTRIC, LLC 20745 SW 256 ST HOMESTEAD FL 33031 RICK .SCOTTKEN LAWSON GOVERNOR SECRETARY DISPLAY AS REQUIRED BY LAW MIAMI—DADE COUNTY 2011 LOCAL BUSINESS TAX RECEIPT 2012 FIRST—CLASS TAX COLLECTOR MIAMI-DADE COUNTY—STATE OF FLORIDA U.S.POSTAGE 140 W.FLAGLER ST. EXPIRES SEPT.30,2012 PAID 1st FLOOR MUST BE DISPLAYED AT PLACE OF BUSINESS MIAMI,FL MIAMI,FL$3130 PURSUANT TO COUNTY CODE CHAPTER 8A-ART.9&10 PERMIT NO.231 647482-9 THIS IS NOT A BILL—DO NOT PAY RENEWAL Bu sM�I� EELTHRIC LLC STATEIT81504481674410-7 4520 SW 74 AVE 3�3155 UNIN DADE COUNTY OWNER ELECTRIC LLC '1WIErMCAL CONTRACTOR WORK10 THIS IS ONLY A LOCAL BUSINESS TAX RECEIPT.IT DOES NOT PERMIT THE HOLDER TO VIOLATE ANY EXISTING REGULATORY OR ZONING LAWS OF THE DO NOT FORWARD COUNTY OR CITIES. NOR HHOOLDER FROM ANY OTHER PREMIER ELECTRIC LLC LICENE REQUIRED BY LAW.THISSISS FERNANDO LOZA PRES NOT A CERTIFICATION THE HOLDERS OUAUFlCAF 4520 SW 74 AVE TIONS. MIAMI FL 33155 PAYMENT RECEIVED MIAMI-DADE COUNTY TAX COLLECTOR: 08/04/2011 60020000572 000075.00 �atJjrat��tartrratt,rafrfaaIaataIII)aIIHill lra+],III.aalrlal� SEE OTHER SIDE ^,,,...•.� PREMELE-01 ELLAMAS ACU►RDa DATE(MM/DD/YYyy) CERTIFICATE OF LIABILITY INSURANCE 4!1012012 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 CO AC7 NAME: AX BenTrust AIB,LLC PHONE N ;(305}444-8350 RIC, No (305)444-8501 701 Waterford Way -MAIL Suite 300 ADDRESS: Miami,FL 33126 INSUR S)AFFORDING COVERAGE NAIL# INSURER A:Travelers INSURED INSURERS:Guarantee Insurance Company 11398 Premier Electric,LLC INSURER C: 4520 SW 74 Ave INSURER D: Miami,FL 33165 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. LTR TYPE OF IADDLISUBR NSURANCE POLICY NUMBER A POLICY /D Y M�MN Y P LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIALGENERALLIABILnY 1-660-6636R684-PHX-11 7/21/2011 7/21/2012 PREMISES Ea occurrence $ 100,000 CLAIMS-MADE OCCUR MED EXP(Any one person) $ 6,000 PERSONAL R ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 X POLICY PRO r LOC $ AUTOMOBILE LIABILITY EaMBI accciderDdSINGLE IT $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accideni) $ AUTOS AUTOS NON-OWNED Perece�rd E $ HIRED AUTOS AUTOS UMBRELLAILAB H OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ LIMr WORKERS COMPENSATION X WC STA7U- OTR S1H- AND EMPLOYERS'LIABILITY B ANY PROPRIETOR/PARTNER/EXECUTIVE Y/-N NIA GWIC301006141-111 3/29/2012 3/29/2013 E.L.EACH ACCIDENT $ 100,000 OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 100,00 If yesG�describe under RIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 600,000 DES DESCRIPTION OF OPERATIONS/LOCATIONS t VEHICLES(Attach ACORD 101,Additional Remarks Schedule,N more space is required) CERTIFICATE HOLDER CANCELLATION _ SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Ci of Miami Shores Villa THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City Village ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE 2nd Avenue Miami,FL 33138 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 26(2010/06) The ACORD name and logo are registered marks of ACORD rowowbrust 305 444 8501 07/23/2012 10:24 #667 P.002/M2 " 1--ice PREMEL15-M ELLAMAS ,a►�'�'� CERTIFICATE CF LIABILITY INSURANCE �"'� " T>'M=aa THIS CHtTIFICATE M ISSUED AS A MATTER OF INFORMATION ONLY AND CONPERS NO RIGHTS UPON THE CERTIFICATE HOLDER.TM CERTIFICATE DOM NOT AFFMIMATNBLY OR NEGATIVELY AMEND, WrMND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS comFR:ATT OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER.AND THE CERTIFR ATE HOLDER. MAPORTANT: a the astt ftdD holdar Is an ADDITIONAL INSURED.010 001IM9les)MJU be endorsed, If SUBROGATION 18 WAIVED,aubjwA to qat terms and corMiMorrs otthe pelt.attain policies may mgohe an endornoromL A atat"notR on tMs Oermoate dose riot oorftr rwft to the Oa"cals holder in of each endorsetmrlga). PROD= �T Ly PN01m 4444= 3W 4444M Mlaml.Fl.99158 M161A@'Jq�AAORDeiry _ NAIei aastu�t A_Travaten none D mmm o.Quwantest Imurance Compwg 11398 Prnnder Electric,LLC0, 4820 SW 14 Ave NWJM D: Milani,FL 85765 0MAt91 Z! 0ReW0tP: ' COVERAGES CERTIFICATE RUMIWL, 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 DWA NE14T WITH RESPECT TO WHM THIS CER71ACATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT 10 ALL THE TERATS, EXCLUSIONS AND CONDITIONS OF SUCH POUCM$.UMrr8 SHOWN MAY HAVE BEEN REDUCED BY PAID CLAW. TYM OF aaaMAM MAMPpIJCYN Lam Od�W.LRAtILJ1Y EACFIOCCWtReRCE i 11000,000. A x cONIt6RcuLGENER+d LIA®mr P4111115698R684-PHX-12 71212012 TrAWM9 CLAWS-MWF OOCCUR SAID Ew Uanawpewn) i B, PERiTRD1LflAW i 1r , GENERALAARS"TE i 2r�. 4N'LA0eWF"T6 UYRAPPM P6R PROLIICT9=CarmfOPA00 i •2,tI00 x POLICY LOC A■Teapa■,a LIAtWiY ANYAUTO qLq!YI�Pm�I f AUMg arroa.Yw,AnrrftwcIa.0 a atesToe HAU i OCCUR LWHOCCLw"CE 1 mum"W" dAW9YaaE ACO6OATE i --= I 1RUIENT1068 a "c"U bCOMMINaAMN x 1 A . A0WoLovM.UAR LRN yy�,NN MIA 8 ANY PRod'WEROMAW OUOVEn GYYIC90'tO06141112 3")=2 W2erm18 e.LeACHACCIDeNT i 1 LJ AMrd■atY In MR)�� a�+ eAse•Fn s 100 ■ eew- lro OF aao« P.Lo>sP�Lae-RWLICYLaIIi' i IMO CEWWTH a OP OPWA7MMB f LOCATMBI II®aelae XACLehACORD Ia,AdOdMd 14pxvl,t amaduK Amon space n,we■.af CERTIFICATE MOLDER CANCTr].U1T�N SHOULD ANY OF Trac ABOVE DESS POLICIES 09 CANGaLLra BCPata THE CIPIRATION DATE THMOW, NOTICE WILL 0 DELIVERED Nc: reVUg ACCORDANCE WITH THE POLICY PFOVOMM Miami,FL as 38 AHmDROMINIPME MUTPIe 019982019 ACORD CORPORATE K Ars rWft Resoxo& AWRD 26(MGM) The ACORD name am9 logo ars Regtabnd marb of ACORD INSPECTION RECORD STRUCTURAL ZONING PLUMBING INSPECTION DATE IINSPECTION DATE I INSP 2Rt! ION DATE INSP Foundation ZoningFinal Stemwall ZONING COMMENTS Slab rvice Columns 1 st Lift Columns 2nd Lift Top Out Tie Beam Fire Sprinklers Truss/Rafters Septic Tank Roof Sheathing Sewer Hook-up Bucks Roof Drains Windows/Doors ELECTRICAL Gas Interior Framing INSPECTION IDATE INSP I LP Tank Insulation TemporaryPole Well " Ceiling Grid 30 Day Temporary Lawn Sprinklers Drywall Pool Bonding Main Drain Firewall Pool Deck Bonding Pool Piping Wire Lath Pool Wet Niche Backflow Prevento Pool Steel Underground Interceptor Pool Deck Footer Ground Catch Basins Final Pool Slab lCondensate Drains Final Fence Wall Rough HRS Final Screen Enclosure Ceiling Rough FINAL Driveway Rough PLUMBING COMMENTS Driveway Base I Telephone Rough Tin Cap Telephone Final Roof in Progress TV Rough Mop in Progress TV Final Final Roof Cable Rough Shutters Attachment Cable Final Final Shutters Intercom Rough Rails and Guardrails Intercom Final MECHANICAL ADA compliance I Alarm Rough INSPECTION DATE INSP Alarm Final Underground Pipe DOCUMENTS lFire Alarm Rough Soil Bearing Cert lFire Alarm Final Rough Soil Treatment Cert Service Work With Floor Elevation Survey Ventilation Rough Reinf Unit Mas Cert ELECTRICAL COMMENTS Hood Rough Insulation Certificate Pressure Test Spot Survey Final Hood Final Survey Final Ventilation Truss Certification Final Pool Heater STRUCTURAL COMMENTS Final Vacuum MECHANICAL COMMENTS INSPECTION DATE INSP Final Sprinkler Final Alarm