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EL-16-1183 (2) Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-257993 Permit Number: EL-5-16-1183 Scheduled Inspection Date: May 16,2016 Permit Type: Electrical - Residential Inspector: Devaney, Michael Inspection Type: Final Owner: CADILLA,ARTURO Work Classification: Repair Job Address:841 NE 95 Street Miami Shores, FL Phone Number Parcel Number 1132060142940 Project: <NONE> Contractor: NY ELECTRIC SERVICES, LLC Phone: (305)934-0809 Building Department Comments REPAIR/REPLACE LANDSCAPE LIGHT 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. May 13,2016 For Inspections please call: (305)762-4949 Page 16 of 34 s \� A t �1`� Miami Shores Village Building Department 0 2 201 10050 N.E.2nd Avenue, Miami Shores,Florida 33138 MAY Tel:(305)795-2204 Fax:(305)756-8972 _ INSPECTION LINE PHONE NUMBER:(305)762-4949 — FBC 2014 BUILDING Master Permit No. PERMIT APPLICATION Sub Permit No. L i it Qs ❑BUILDING -ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: I City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: / o OWNER: Name(Fee Simple TitleholdAer): �D r0 6. kt&, Phone#: Address: S� P City: i s C..ov iii State: Zip: Tenant/Lessee Name: Phone#: Email: p�lT CONTRACTOR:Company Name: "FIL—rC�"� C-�L%�� i�- S Phone#: 3 0 Address: ` {�� Z_S i City: P\"� State: Zip: 33tZ42 Qualifier Name: 3l)AD"j R' aP-2r_1_ Phone#: State Certification or Registration#: IZC. `j0 0 Certificate of Competency#: DESIGNER:Architect/Engineer: Phone# Address: City: State: Zip: Value of Work for this Permit:$ ow 0�� Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New R�epair/R�eplace-�; ❑ Demolition Description of Work: R'e 0,-"'y i�m Ie►ce �_�v� s GQyy� a „E�0 L.. Specify color of color thru tile: Submittal Fee$ � Gib Permit Fee$ . ! y �� CCF$ ® CO/CC$ _ Scanning Fee$ C43 Radon Fee$ DBPR$ Notary$ Technology Fee$ l GO Training/Education Fee$ (1 • 40 Double Fee$ 10 --ictural Reviews$ Bond$ TOTAL FEE NOW DUE$ 0 " ised02/24/2014) 1 c Bonding Company's Name(if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name(if applicable) Mortgage Lender's Address City 1•. 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 ex$eeding$2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brichure will be delivered to the person whose property is subject to attachment. Also,a certified copy of the iecorded notice of commencement must be posted bt 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 Signature OWNER or AGENT CON A OR Theforoinq instrument was acknowledged before me this The foregoing instrument was acknowledged before me this S day of ( 20 L by11 day of (G-4�^'l 120 16 , by who is personally known to s��?�R rQ O��u� ,who is personally known to me or who has produced as me or who has produced as identification and who did take an oath. identification-and who did take an oath. e• NOTARY P C: NOTARY PUB IC: Sign: f Sign: Print: Print: ��" HOSUANY Seal: MY COMMISSION#FF211866 Seal: MY COMMISSION#FF211866 EXPIRES April 04.2019 , EXPIRES April 04,2019 ��fl..riP!I�•�7 FMx¢u�NiYa•ySr•:aeaar �aC��.�YE•J'�:� i►a«�aNrra•rSc•:yrcrcm APPROVED BY U Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) RICK SCOTT, GOVERNOR KEN LAWSON,SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD EC13006255 The ELECTRICAL CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31,2016 PEDRAZA, JOHAN NY ELECTRIC SERVICES, LLC 1445 NW 23RD STREET ' r; MIAMI FL 331.42` M a • ISSUED: 08/12/2014 DISPLAY AS REQUIRED BY LAW SEQ# L1408120000317 s Local Business Tax Receipt Miami-Dade County,State of Florida -THIS IS NOT A BILL-DO NOT PAY LBT 6454896 BUSINESS NAMMOCATION RECEIPT NO. EXPIRES NY ELECTRIC SERVICES LLC RENEWAL SEPTEMBER 30, 2016 1445 NW 23 ST 6723325 MIAMI,FL 33142 Must be displayed at place of business Pursuant to County Code Chapter 8A-Art.9&10 OWNER SEC.TYPE OF BUSINESS PAYMENT RECEIVED NY ELECTRIC SERVICES LLC 196 ELECTRICAL BY TAX COLLECTOR CONTRACTOR 45.00 07/03/2015 Workers) 1 EC13006255 CREDITCARD-15-032381 This Local Business Tax Receipt only confirms payment of the Local Business Tax.The Receipt is not a license, permit,or a'certification ofthe holder's qualifications,to do business.Holder must comply with any governmental or nongovernmental regulatory laws and requirements which apply to the business. The RECEIPT N0.above must be displayed an all commercial vehicles-Miami-Dade Code Sec 6a-276. NtANI I7AD For more irdormation,visit www miamidetleaovRaxcollector 8 A' ' '' " CERTIFICATE OF LIABILITY INSURANCE DATE /02/1/YYYY► 055/02/16 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 NAME: MARIA ELENA HERNANDEZ Sunshine Insurance Agency PHONE (305)559-7873 ac No): (305)559-2237 2595 SW 87th Avenue -MAILADDRIESSO sunins@bellsouth.net Miami,FL 33165 INSURERS AFFORDING COVERAGE NAIC# Phone (305)559-7873 Fax (305)559-2237 INSURER A: SCOTTSDALE INSURANCE COMPANY INSURED INSURER B: SCOTTSDALE INSURANCE COMPANY NY ELECTRIC SERVICES LLC INSURER C: GUARD INSURANCE COMPANY 1445 NW 23 Street INSURER D: UNDERWRITING AT LLOYDS MIAMI,FL 33142 (305)934-0809 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 TYPE OF INSURANCE ADD UB POLICY EFF POLICY EXP LIMITS LTR IN it POLICY NUMBER MM/DD MM/DD GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000.00 A AGE To COMMERCIAL GENERAL LIABILITY PREM SES Ea oNccu encs $ 100,000.00 ❑ ❑ A CLAIMS-MADE 0 Y Y 12/01/2015 12/01/2016 OCCUR CPS2311070 MED EXP(Any one person $ 5,000.00 ❑ PERSONAL&ADV INJURY $ 1,000,000.00 ❑ GENERAL AGGREGATE $ 2,000,000.00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000.00 ❑ POLICY d❑ JECT PRO ❑ LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident ❑ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident $ ❑ AUTOS ❑ AUTOS ❑ HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ ❑ AUTOS paraccdent ❑ ❑ $ ❑ UMBRELLA LIAB Y1 OCCUR EACH OCCURRENCE $ 5,000,000.00 EXCESS LIAB XBS005$047 B D Ll 12/01/2015 12/01/2016 AGGREGATE $ 5,000,000.00 ❑ DED ❑ RETENTION$ $ WORKERS COMPENSATION WCRS LATU ❑OTH- AND EMPLOYERS'LIABILITY Y/NER ANY PROPRIETOR/PARTNER/EXECUTIVE NYWC634193 E.L.EACH ACCIDENT $ 1,000,000.00 C OFFICERIMEMBER EXCLUDED? N/A Y 05/31/2015 05/31/2016 (Mandatory in NH) El E.L.DISEASE-EA EMPLOYEI $ 1,000,000.00 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000.00 D PROPERTY 77MCW-3912 12/16/2015 12/16/2016 Business Personal Property $350,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,it more space Is required) ELECTRICIAN Contractor Lincense#EC13006255 (Johan Pedraza) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIED POLICIES BE CANCELLED BEFORE Miami Shores Village Bldg.Dept. THE EXPIRATION DATE THEREOF,NO CE WILL BE DELIVERED IN 10050 NE 2nd Avenue ACCORDANCE WITH THE POLICY PROVISIONS. Miami Shores,A 33138 AUTHORIZED REPRESENTATIVE MARIA E HERNANDEZ ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05)QF The ACORD name and logo are registered marks of ACORD