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EL-16-2852 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 - 2a2 G Inspection Number: INSP-273159 Permit Number: EL-10-16-2852 Scheduled Inspection Date: December 16,2016 Permit Type: Electrical - Residential Inspector: Devaney, Michael Inspection Type: Final Owner: PIERRINE LEONEL AND ALFRED Work Classification: Alteration 1 vnsiC1 rows1r4k1C o1=ooe 1 n1 ne Job Address:20 NE 104 Street Miami Shores, FL Phone Number Parcel Number 1121360130910 Project: <NONE> Contractor: JERUSALEM ELECTRICAL INC Phone: (305)206-5564 Building Department Comments ELECTRIC FOR KITCHEN REMODELING Infractio Passed Comments INSPECTOR COMMENTS False 10/19/2016-APPLICATION MISSING OWNER SIGNATURE. AS. 10/24/2016 APPLICATION COMPLETED Inspector Comments Passed EE/ Failed Correction A!! Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. December 15,2016 For Inspections please call: (305)762-4949 Page 24 of 30 gem$i, Miami Shores Village 10050 N.E.2nd Avenue NE 15W r Miami Shores,FL 33138-0000 � Phone: (305)795-2204 -- tE7�cp i � a13112t1 `, Expiration: 04129/2017 Project Address Parcel Number Applicant 20 NE 104 Street 1121360130910 FRANCINE PIERRE LOUIS PIERI Miami Shores, FL Block: Lot: Owner Information Address Phone Cell FRANCINE PIERRE LOUIS PIERRINE 20 NE 104 Street -- - - ---- - - MIAMI SHORES FL 33138-2027 Contractor(s) Phone Cell Phone Valuation: $ 1,400.00 JERUSALEM ELECTRICAL INC (305)206-5564 _. ... . _. .._.., m...,... -.... __.....,, Total Sq Feet: 0 Type of Work:ELECTRIC FOR KITCHEN REMODELING Available Inspections: Additional Info: Inspection Type: Classification:Residential Review Electrical Scanning:1 Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $1.20 Invoice# EL-10-16-61720 DBPR Fee $2'25 10/24/2016 Credit Card $50.00 $115.70 DCA Fee $2.25 Education Surcharge $0.40 10/31/2016 Credit Card $115.70 $0.00 Notary Fee $5.00 Permit Fee-Additions/Alterations $150.00 Scanning Fee $3.00 Technology Fee $1.60 Total: $165.70 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 certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoni5or,Futhermore,I authorize the above-named contractor to do the work stated. October 31,2016 Authorize ignature:Owner / Applicant / Contractor / Agent Date Building Department Copy October 31,2016 1 Miami Shores Village g RECEIVED Building Department LBYT- g 2/01610050 N.E.2nd Avenue,Miami Shores,Florida 33138 —,— Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 2 �'� � � BUILDING Master Permit No.. CIT -2 Z� PERMIT A=ON Sub Permit No. �((o' _295 Z ❑BUILDING ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP �J OO CONTRACTOR DRAWINGS JOB ADDRESS: i � /49 4 1HicOn� 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: OWNER:Name(Fee Simple Titleholder): O Phone#: Address:.-© to, E L© � City: P1 state: zip: 3 1 3 e Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name:JC p,y�A-le X."7F,, Lamf c.QP 7-;,c Phone#: ®`�_)adv 6.� 50 Address:J_-_SD JA) G 12.Y, ..,V City:10D )C4 /1 &A2,rA, State: /Y_ Zip: 4(, Qualifier Name: Phone#: f3QJ)20G�� (� S6 State Certification or Registration#: Le G Z 3 0 D 2D 5-a Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ Square/Linear Footage of Work: Type of Work: ❑ Addition eAlteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: a S 1 I Specify co or of color thru tile: Submittal Fee$ 'Z'�J Q Permit Fee$ /6-'0.6 CCF$ CO . `S 2� 25 Scanning Fee$ 3 Radon Fee$ DBPR$ Notary$ Technology Fee$ I Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ I I • (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 Signature f OWNER or AGENT CO RACTOR The foregoing instrument Vas acknowledged before me this The foregoing instrument was acknowledged before me this day of \o 2`r .20 by day of �Z 20.1 by M-r-Te. T\who is personally known to -1-U?4n J �� ,who is personally known to me or who has produced 1'b \J Y 1V• 1�C as me or who has produced r-L-J;;)2NCd-Z' as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: Sign:_ Print: v Print: Q:Q� �r8,20� % Seal: r �, Seal: ;� d°AIP :e_ Oan�Mrr�1,7A2o X20• c�: } 8�' WNW n�a+trittblrr�nfer� �'>q•••''' �'�•c''•�•,\,\�•((��!!�``�\ r 4*ger MNe * �x ** �x*�x*w****s * �k4i�k* #* kir * *k4 k �'vg` ******�x**• * //i�nnAlad+�,90 APPROVED BY �l��`/4�e/ ��Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) YM "A� CERTIFICATE OF LIABILITY INSURANCE DATE/01/2 Y3 10/01/2013 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 WANED,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 endomement(s). PRODUCER ANE cr ESTHER VIDAL MUTUAL INTEREST ASSURANCE AHI N 305 860 2003 a No):305-860-0907 E-MAIL ELIZABETH VERDURA ADDRESS•MUTUALAS OL.COM 1295 CORAL WAY INSURER(S)AFFORDING COVERAGE NAIC# MIAMI, FL 33145 INSURER A:ASCENDANT UNDERWRITERS LLC INSURED INSURER B:ASCENDANT UNDERWRITERS, LLC HI-TECH ELECTRIC&FIRE CORP INSURER C 1500 SW 101 AVE INSURER D MIAMI, FL 33174 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. I TR TYPE OF INSURANCE ADDL SUER POLICY NUMBER M0na/uDONM WDD EXP LIMITS GENERAL LIABILITY GL-33642-3 9/23/2013 9/23/2014 EACH OCCURRENCE $ 1000000 A TO RENTE15- X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ 100,000 CLAIMS-MADE 7 OCCUR MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERALAGGREGATE $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 1,000,000 X POLICY CT LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $HIRED AUTOS AUTOS Per accident UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ B WORKERS COMPENSATION WC-60808-3 9/23/2013 9/23/2014 X T RYTA IT OTH- AND EMPLOYERS'LLABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE NIA A E.L.EACH ACCIDENT $ 100,000 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,H more space Is required) ELECTRICAL CONTRACTOR: CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN CITY OF MIAMI SHORES ACCORDANCE WITH THE POLICY PROVISIONS. BLDG DEPT. 10050 NE 2ND AVE AurHORIZE MIAMI SHORES, FL. 33138 ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and loao are registered marks of ACORD ,r ,a _y. 5 In. Yi; my r e,n':yah € +ae, Ulm =SS TY LOCAWkL ` 115 S. Andrews Ave., Rm. A-100, Ft. Lauderdale, FL 33301-1895—954-831-4000 +' VALID OCTOBER 1,2013 THROUGH SEPTEMBER 3o,2014 DBA: Receipt#:fiLECTRIICAL/ALARMS/CONT OR Business Name:HI TECH ELECTRIC & FIRE CORP Business Type:(ELECTRICAL CONTRACTOR) Owner Name:EDMUNDO I JARQUIN Business Opened:12/20/2004 j Business Location:1500 SW 101 AVE State/County/Cert/Reg:EC 13 0 0 2 6 0 8 s' MIAMI DADE COUNTY Exemption Code: Business Phone:786-543-5216 i Rooms Seats Employees Machines Professionals 3 i ° yFor Vending Business Only Number of Machines: Vending Type: Tax Amount Transfer Fee NSF Fee Penalty Prior Years Collection Cost Total Paid 27.00 0.00 0.00 0.00 0.00 0.00 27.00 i i i THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS f THIS BECOMES A TAX RECEIPT This tax is levied for the privilege of doing business within Broward County and is non-regulatory in nature.You must meet all County and/or Municipality planning N' g ry ty P �Y p 9 WHEN VALIDATED and zoning requirements. This Business Tax Receipt must be transferred when the business is sold, business name has changed or you have moved the business location.This receipt does not indicate that the business is legal or that it is in compliance with State or local laws and regulations. i Mailing Address: j EDMUNDO I JARQUIN Receipt #03A-12-00012547 1500 SW 101 AVE Paid 09/23/2013 27.00 MIAMI, FL 33174 2013 - 2014 STATE OF FLORIDA AC#6 2 3 j 1,,G DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION EC13002608 07/31/12 128024843 CERTIFIED ELECTRICAL CONTRACTOR , JARQUIN, EDMUNDO I HI-TECH ELECTRIC & FIRE CORP IS CERTIFIED under the provisions of Ch.489 r 8xpiration date: AUG 31, 2014 L12073102759 IiMllll MM ��II µlp d . 621. 9 �IIIIII 1 EWUNDO" UAROWN 1500 Sly 131 AVE Ll IIIA M+AMI I"L S3t 74 28"2 fl2�+aa 1957 s�� plum .u, w 2009 •WII!!PI ,II 201 E r 41 C12 4C V ZONING RAL E AL e ti JAN 072014 AECHANICAL _ BLDG. ' SUBJECT TO COMPLIANCE WITHAL ED RAL `ATE AND COUNTY RULES AND R c a. X0 6 D D 2 ) lel 6 - 10 /l Wit` � A w 5 hazp,-�; FIA 33133 S co Pe, d r cki,zlC : �Lc�4�� ,� � u�• ,5 pis 2 . SNS{4G �.1�.v �' V'�4� �2r,2 S� L!� s r Aw- (3Adf,o,.,�s Gz v r d y Poo.— i NAV, 020a— Ait � � , �! eh Qjo� todWl- Q ntQ,,a I�rtlt P►I b tL A4 ul -12, I ,e �� oil � lZvv -f-0a BQe i A0 /l2u) m . A,4ccd- o cif Se�rirce nA0_4 ' Hi6n 144- L/6ol-s AZE 10- ZATEP- ADD SMOKE/CARBON MONOXIDE DETECTORS. ANY AND ALL CLOTH AND RUBBER INSULATED CONDUCTORS TO BE REPLACED. 02,02. 12W NO POINT ALONG COUNTER TO BE MORE THAN d Q z 2v d 3. 2 FEET FROM G.F.I PROTECTED RECEPTACLE. PUT D/W RECEPTACLE UNDER SINK. APPLIA N DEDICATED CKTS. ` -TEC N EL ec-mi C + Co" T,4-, A 4 r",eP Ub MO Obb l 0 MPcS'S'GR�UEC,T(Ll C.IPC�