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EL-16-1899 (2) i Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-263361 Permit Number: EL-7-16-1899 Scheduled Inspection Date: July 1%2016 Permit Type: Electrical - Residential Inspector. Devaney, Michael Inspection Type: Final Owner. SEMIEN, GEORGE Work Classification: Alteration Job Address:448 NE 96 Street Miami Shores, FI-33138-0000 Phone Number (305)793-7911 Project: <NONE> Parcel Number 1132060140575 Contractor: GLEISY ELECTRIC INC Phone: (305) 970-2796 Building Department Comments INTALLING NEW 50 AMP RECEPTACLE IN CAR GARAGE tnfractio . Passed Comments 240 VOLTS INSPECTOR COMMENTS False Inspector Comments Passed Failed a Correction Needed Re-Inspection Fee No Additional Inspections can be scheduled until re-inspection fee is paid July 15, 2016 For Inspections please call: (305)762-4949 Page 44 of 44 £'d 00000 elggea dt,0:90 9I. 8l, Inf 3 E 9 s�,pc°Rmz t Miami Shores Village lit yj3e � tv'v�.,.: Leslidelt�ail' 3 10050 N.E.2nd Avenue NE �i AAA, i €44n' ' Miami Shores,FL 33138 0000 �x. h � Phone: (305)795-22046��Ij v`6lt �. sF 3�, ,aa^_ 4611s­;',;�I�"2120 16Expiration: 011 12017 Project Address Parcel Number Applicant 448 NE 96 Street 1132060140575 Miami Shores, FL 33138-0000 Block: Lot: GEORGE SEMIEN 3 Owner Information Address Phone Cell GEORGE SEMIEN 448 NE 96 Street (305)793-7911 MIAMI SHORES FL 33138- 448 NE 96 Street MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone Valuation: $ 600.00 GLEISY ELECTRIC INC (305)970-2796 _.__ _......... Total�q Feet: 0 Type of Work: Available Inspections: Additional Info: Inspection Type: Classification:Residential Review Electrical Scanning:2 Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $0.60 Invoice# EL-7-16-60496 DBPR Fee $2.00 07/12/2016 Credit Card $61.60 $60.00 DCA Fee $2.00 Education Surcharge $0.20 07/08/2016 Check#:2987 $50.00 $0.00 Permit Fee-Additions/Alterations $100.00 Scanning Fee $6.00 Technology Fee $0.80 Total: $111.60 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 wor�C. OWNERS AFFID VI I certify/hat all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction i g. F or ,1 aut brize the above-named contractor to do the work stated. July 12, 2016 uthorized Signature:Owner / Applicant / Contractor / Agent Date Building Department Copy July 12,2016 1 r;- Miami Shores Village {f L- - P-A Building Department ;' J 0 2016 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 J�vl FBC 2014 BUILDING Master Permit No. . PERMIT APPLICATION Sub Permit No. (BUILDING © ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL [:]PUBLICWORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 448 NE 96th Street City: Miami Shores County Miami Dade Ilia: Folio/Parcel#:1132060140575 is the Building Historically Designated:Yes NO NO Occupancy Type: RES/SINGLE Load: Construction Type: CBS Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder):George Semien Phone#;(305) 793-7911 Address:448 NE 96th Street City. Miami Shores State: FL Zip: 33138 Tenant/Lessee Name: Phone#: Email: GASEMIEN@GMAIL.COM CONTRACTOR:Company Name: 6` 5' �� ��l G Phone#i� �d� '� 7y Address:: ego 2 ( S L.✓ 1,1'7 �rr ) t o City: 1.✓ l'!;^ State: _ Zip: 7 l d Qualifier Name: llr" C4Phone#': 3L) lu State Certification or Registration M F-C V )-(to 1 Certificate of Competency M DESIGNER:Architect/Engineer: Phone#: Address: / �q City: State: Zip: Value of Work for this Permit:$ X00•rho Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration Q ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: f A etAl J-4) V ,Ltefxe,(G In CA-r- aLr-!aji° 140 vo t( Specify color of colour tthru We: Submittal Fee$ Permit Fee$ 1-0'-4V1040 CCF$ " /cc$ Scanning Fee Radon Fee$ a " ' DBPR$ I lotary$ Technology Fee$_ C�-J Training/Education Fee$®` 220 Doubl Fee$ Structural Reviews$ 0 Bond TOTAL FEE NOW DUE$ B (Rev1sed02/24/2014) • 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 certifylthat 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 ELECT IC, 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 Ibe 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 flrst 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 CONTRACTOR The foregoing Instrument was acknowledged before me this The foregoing instrument was acknowledged before me this C9"!�day of c�� .20 by F/W day of U Lq .20 I b .by who is personally known to 70ed�!C:L. Dy-Cit; `en�f who is personally known to me or who has produced FL. DIL. 5156D i' D me or who has produced 1 i r Li r1S C as rax ' I 2 -2,6 7,0 n . identification and who did take an oath. identification and who d th. o. t NOTARY PUBLIC: NOTARY PU C: iron Sign{ Sign: a �� Print"1 d"i 1 — Print: " 01 n P ? � a•��wN tALAGROS IM ALVAREZ•PERALTA *: '.*: COMMISSION FF 214031 s m.�O Seal r°` r o°e�'�,s 19 Notary Public-Soo o1 F Seal: ,, 1¢a BondedEXPIRES:Thrh te�PubliMarchc underw ters • My Comm.Expiry Fab 18,2017 Commisslon#EE 87MI iG OF APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) ♦SNORES D� N.•. 11111" Miami shores Village - y41 Buil�ing Department rES 04 FLOR 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CONTRACTORS' REGISTRATION IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: A. COPY OF QUALIFIER'S STATE LICENCES B. COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF LIABILITY INSURANCE* D. COPY OF WORKERS COMPENSATION INSURANCE* (Workers Compensation EXEMPTION must have NOTICE TO OWNER form and Contractor Affidavit) IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY: A. COPY OF CERTIFICATE OF COMPETENCY OF QUALIFIER B. COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF STATE REGISTERED CONTRACTOR LICENSE OR MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT. D. COPY OF LIABILITY INSURACE* E. COPY OF WORKERS COMPENSATION INSURANCE* (Workers Compensation EXEMPTION must have NOTICE TO OWNER form and Contractor Affidavit) *YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE AS FOLLOW: Certificate Holder: MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES, FL 33138 Certificate must specify the description of operations or contractor licen a number. 'BUSINESS NAME:•■LZ■�els....�1�c v.............................�....................... �f BUSINESS ADDRESS: Y02— ( 5 W eI `�e'r� CITY�"I '�'"Q S ATE �1 ZIP 33 NY BUSINESS PHONE: 3 ) q -9-q6 FAX NUMBER(3655 q 1 -�3 9'O CELL PHONE(u� )q —2-� QUALIFIER'S NAME: Ped'-0 cerj-L'7 AV QUALIFIER'S LIC NUMBER: EC-069y )—`7"O RICK SCOTT, GOVERNOR KEPI tAWSON, SECRETARY P ; t ►R '�# BiJS1NSS�►ND f' OSS# ?IGL�iTIQN 41. CTRIGAt G©NTRACTCaRS .OIS � _ r+ tIYV t Thii ELECTRICA ,�".'.. + t R ry Y �W PE©R©JOS .:,y t � '��.� !V-t •� sY4 SH= t�#6 �sSua; vsrzo4a 13iSPLA�f5 RE( UER © BY klllt Q ttaostoorri ? 3 i 000885 Local Business Tax Receipt Miami—Dade County, State of Florida —THIS IS NOTA BILL — DONOT PAY [LBT 4355095 BUSINESS NAME/LOCATION RECEIPT NO. EXPIRES GLEW ELECTRIC INC RENEWAL SEPTEMBER 30, 2016 8031 SW 197 TERR 4545548 Must be displayed at place of business CUTLER BAY FL 33189 Pursuant to County Code Chapter BA—Art.9&10 ^WNER SEC.TYPE OF BUSINESS PAYMENT RECEIVED ciLEISY ELECTRIC INC 196 ELECTRICAL CONTRACTOR BY TAX COLLECTOR ..urker(s) 3 EC0002401 $45.00 08/17/2015 CREDITCARD-15-041295 This local Business Tax Receipt only cmdirms payment of the Local Business Tax The Receipt Is not a license, permit ore coMficadon of the holder s quaiflcadons,m do business. Holder must comply with any governmental or nongovernmental regulatory laws and requirements which apply to the business. The RECEIPT NO.above must be displayed on all commercial vehicles—Miami—Dade Code Sec Ba-276. For more information,visit www.miamidade gamfluxcollector DATE(MM1DDNYYY) CERTIFICATE OF LIABILITY INSURANCE 07/08/16 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(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 CONTACT NAME: ILIANA CASTANEDA Jvs Insurance Agency PHONE (305)552-5250- ac No): (305)552-5292 9600 SW 8th St,Suite 27 E-Mall S: ILI@JVSINS.COM Miami,FL 33174 INSURERS AFFORDING COVERAGE NAIC# Phone (305)552-5250 Fax (305)552-5292 INSURER A: GRANANDA INSURANCE COMPANY INSURED INSURER B: ASSOCIATED INDUSTRIES INSURANCE COMPANY GLEISY ELECTRIC INC. INSURER C; 8021 SW 197 TERR INSURER D: CUTLER BAY,FL 33189 305 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. INR TYPE OF INSURANCE INS ADD UBR POLICY NUMBER POLICY EFF PMMIDD EXP LIMBS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000.00 COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED 100,000.00 PREMIS FS(E occurcence $ A ❑ ❑ CLAIMS-MADE W OCCUR 0185FL00055969 01/20(2016 01/20/2017 MED EXP(Any one person) $ 5,000.00 ❑ PERSONAL a 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 ❑ PRO- ❑ LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident ❑ ANY AUTO BODILY INJURY(Per person) $ ALL❑ AUTOS OWNED ❑ AUTOS ( ) q BODILY INJURY Per accident $ ❑ HIRED AUTOS ❑ NON-OWNED PROPERTY DAMAGE $ AUTOS Per acct, ❑ UMBRELLA LIAB ❑OCCUR EACH OCCURRENCE $ ❑ EXCESS LIAB ❑CLAIMS-MADE AGGREGATE $ ❑ DED ❑ RETENTION$ $ WORKERS COMPENSATION W C STATU- OTH- AND EMPLOYERS'LIABILITY Y/N ❑ LI T ❑ER ANY PROPRIETOR/PARTNER/EXECUTIVE AWC1026356 E.L.EACH ACCIDENT $ 1,000,000.00 B OFFICERIMEMBER EXCLUDED? ❑ NIA 10/17/2015 10/17/2016 (Mandatory in NH) E.L.DISEASE-EA EMPLOYE'$ 1,000,000.00 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1 $ 1,000,000.00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,K more space is required) GLEISY ELECTRIC INC. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF T ABOV DESC OLICIES BE CANCELLED BEFORE MIAMI SHORES VILLAGE THE EXPIRATIO ATE TH EOF WILL BE DELIVERED IN BUILDING DEPARTMENT ACCORDANC TH THE LI ISIONS. 10050 NE 2ND AVENUE AUTHORIZED EPRESEN MIAMI SHORES,FLORIDA 33138 ©1910 ACO CORPORATION. All rights reserved. ACORD 25(2010105)OF The AC RD na and logo are registered marks of ACORD