EL-12-2388Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP - 186621
Permit Number: EL -12 -12 -2388
Scheduled Inspection Date: March 04, 2013
Inspector: Devaney, Michael
Owner: WILKINS, ROLAND JAMES
Job Address: 726 NE 92 Street 6 -L
Miami Shores, FL
Project: <NONE>
Contractor: AD ELECTRIC SERVICES INC
Permit Type: Electrical - Residential
Inspection Type: Final
Work Classification: Alteration
Phone Number (305)610 -5113
Parcel Number 1132060440440
Phone: (305)896 -3402
Building Department Comments
BATH REMODEL, LIGHT BAR, OUTLET AND SWITCHES
Infractio
Passed Comments
INSPECTOR COMMENTS
False
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
March 04, 2013
For Inspections please call: (305)762 -4949
Page 28 of 32
PERMIT #I o
m
CONTRACTOR: F QD risrLa3--rivrL
SUBMITTAL DATE: 1.2-• ' A
i -0_,
ADDRESS: ., t 4,,
�' �
:
i
3 '
r
NAME:
RESUBMITAL DATES:
PROJECT TYPE: ;'
is j Crn .
-�.L,
ZONING
FIRE
STRUCTU - ,_
IMPACT FEES
ELECTRICAL
HRSIDERM
Y f2'
PLUMBING;
1/
NOC
MECHANICAL
BLD
)
,f
M• • Shores
Building Department 1 D 1 8 201
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949
BUILDING
PERMIT APPLICATION
FBC 20 '
Permit No. 1ZL, Ia^ (N5��
Master Permit No.'ta
Permit Type: Electrical A 9;51-
/
JOB ADDRESS: 7c c U E ; 5 /
City: Miami Shores County: Miami Dade Zip: 77-J 5 t 3,53
Folio/Parcel #: if ^:? A 4T-1-O
Is the Building Historically Designated: Yes NO Flood Zone:
1� 3 "' 1+ s c 13
OWNER: Name (Fee Simple Titleholder): �I � �rY1�?.5 .1 kit 1 161.S Phone #: ��- �J�tS-
Address: .7c)-6 AJZ (� 9-1
g- ( L
City: ts- t∎ON.rn t S (tor -e S State: P L Zip: 3 3 138
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: A D 5l $ r; L - e r-it LC-e- ..9 X p net ,865-116'1'717W 2
Address: 9 1 35 6 W 1 it 2- '1.- �
City: Pori-$ bAl State: PL Zip: 33 yr °1 /
Qualifier Name: tU 1 k t∎ rat m rn D0.1 Y g 0 G Z Phone #:
State Certification or Registration #: (0 ^CYrI ^' 1 a tf PP (a 12 Certificate of Competency #: ( L.t. OW 3 5 2
Contact Phone #: 30S- 896 - 3 of 0 ""2- Email Address:
DESIGNER: Architect/Engineer: Phone #:
4"'1::) Value of Work for this Permit: $ �� 5 d Square/Linear Footage of Work:
Type of Work: ❑Address ❑Alteration ONew
Description of Work: t Ctlt a \r-e_-5
(4
• ' epair/Replace ODemolition
1 b)4te-)
* * * * *,x******* * ** * ****:i<**** * * * * * * ** ** *** Fees * * ** * *** * * *:x** ** :: * *** : * * *****x:*:x*: *** ** ****
Submittal Fee $ Permit Fee $ /,,P-45" ,6'e2
Scanning Fee $ Radon Fee $
Notary $ Training/Education Fee $
Double Fee $ Structural Review $
CCF $ CO /CC $
DBPR $ Bond $
Technology Fee $
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
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, BOIT FRS, 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 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 elK6'
Wr-
Owhe'r or Agent
The foregoing instrument was ackno 1 dged befo ®re�me thisil
day of )4-10t/ 20 , �y o0l t i 1
or who has produced
As identification and who �`, %,tip _ -v,;; oath.
NOTARY P :.LIC:
Sign:
Print:
My Commission Expires. a
* * * * * * * * * * * * * * * * * * * * * ** * * * *** * * * * ** ************************************ * * * **: * * ** * * * * * * * * ** * * * **: * * * **
�0
c
Signature
Contractor
The foregoing instrument was acknowledged before e this j
nl
day of a , 20 L by 14//,&'22 /Pi' 1 .
v o is personally known to r who has produced
as identification and who did take an
NOTARY P IC:
Sign:
Print. A.1
My Commission Expires: 3261f(,
APPROVED BY
/0 c ae-P
Plans Examiner
Structural Review
(Revised 3 /12/2012)(Revised 07 /10 /07)(Revised 06/10/2009)(Revised 3/15/09)
Zoning
Clerk
•'.THIS=IS'I
`•:I E IPT.No: :30 °67: 6:94'8 ".• ". Ci
3 ,> USiNESS:Ny�NIE■'•LCEAiiciN
AD ELECTRICAL '.StR•VI•CES•' INC
• :'91.35 SW 18.2:'ST:,
• OWNER' z AD ELECTRICAL ..SEl VICES :TNC: • •
SEE;'ESAU OF• RECEIPT`
..NO-PA
''.�:NIUW/CIPALITIES •
A LIST OF RT.I•CIPATING
pf tielder,meet
• • •.regtster:UY#he•city
4414rA wont Istvhe
:dank
•
•
PAYI.A"cNT'REOEPIED
• MIAMI-DARE GOWN TAX
°&9101 12012
•:0 25fl. 3100'1'
1.0 2ODA0
ARTOR
0; .
•: E LfECTR:ICAU'Cohl Aditii
•
DO NOT (FORWARD
AD ELECTRICAL SERVICES INC. '
WILLIAM M DOMINGUEZ •PRES .
8860 SW 171 ST
PALMETTO BAY FL 33157
ifiLSIILl119 hhhithiljdti11tihiJi JuJJ:iHu1i!flj
BUSINESS NAME / LOCATION
AD ELECTRICAL SERVICES INC
9135 SW 182 ST
33157 PALMETTO BAY
THis IS NOT MILL — DO NOT PAY
OWNER
AD ELECTRICAL SERVICES INC
Sec.'rypa Of Business
nue IB 1216,,V4.ECTRIcAL CONTRACTOR
RUMNESS TAX RECEIPT. rT
DOES NUT PERMJT
HOLDER TO VIDLATE ANY
ZOOM LAAW .OF THE
COUNTY OR NOR
DOES R
HOLDER PP:9NIO HER
AE 1IIREO OR LAW. T w
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09010162001
000045 00
1 SEE OTHER SIDE
STATE OF FLORIDA L
DEPARTMENT OF FINANCIAL SERVICES
DIVISION OF WORKERS' COMPENSATION
CONSTRUCTION INDUSTRY
CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA
WORKERS' COMPENSATION LAW
EFFECTIVE 03/18/2011 EXPIRATION DATE:
PERSON: WILLIAM M DOMINGLIE2 ,
FEIN: ,•263973253
BUSINESS NAME AND ADDRESS:
AD EI,ECTRII'_AI, 5SRYIC3S INC
5135 5W WEND ST
PALMETTO SAY, PL 32131 -5945
SCOPE OF BUSINESS OR TRADE;
1- ELECTRICAL CONTRACTOR
FIRST -CLASS
U.S. POSTAGE 1
PAID
• MIAMI, FL
PERMIT NO. 231
NO NEWAL
RECEIPT
672694 -8
CC O.. 09E000352
•
•
WORKER /S
• 1
DO NOT FORWAAp
AD ELECTRICAL SERVICES INC
WILLIAM M DOMINGUEZ PRES
9135 SW 182 ST
PALMETTO BAY FL 33157
08/17/2013
33
From:
06/22/2012 12;41 #187 P.001/001
LeSCen-ce
CTQB
Construction Trades Qualifying Baard '
BUSINESS CERTIFICATE OF COMPETENCY
09E000352
AD ELECTRICAL SERVICES INC
_D.B.A.:
co`
DOWIING EZ WILLIAM
ss certified Ceder The pvuvfsbrof ampter 10 of Mierei.Dade
STATE OF FLORIDA
DEPARTMENT OF FiNANciAL, sERVIOES
DIVISION oF woRRERS. COMPENSATION
CONSTRUCTION INDUSTRY
OERTIMATE 0P ELECTION To a Exav-r FROM FLORIDA
women COMPENSATION LAW
EPFECTIVE 08/ i8/20 I I EXPIRATION DATE,: 08/17/2012
PERSON: WILLIAM M DONII3NQUEZ
FEIN; 263973263
BUSINESS NAME AND ADDRESS:
AD SUCTRICAL REPIVICta fN
trilE W IE2NO ST
PALMETTO SAV, rt. 3.117•EU4S
scope OF BUSINESS OR TRADE:
1, ELECTRICAL CONTRACTOR
POO
.*. .:Congretuiatlonsl With.this...11cense you become one of the nearly one million
Y* Floridians iteriped by the uepartment of Business end Professional Regulation.
;Our professionais and businesses range from architects to yacht brokers, front
btAl's to, barbequa restaurants, 'end they keep PlOrtda's ecanoy strong.
:•••Atre.ry.4. 4• e work la improve the way We 00.btrairte la order is serve yoU bet
Forieformation about OW services, please log onto vrww.rinyttorldalicanaccorn.
• L There you can tind more InforroatiOn about our divisions and the recsuiations that
. , .
1.:., ..... •LIFIIPITUY StriVe TO Senie YOU Delaer $0 that you cerraerve your custorne
t....: :... 'Rer _mission* ihe_ be_ Lbarbrient. is; License. ,Effiolently, Regulate Fairly. We , •
ii......: • •
i.... .. manic you for doing business in Florida' and l . TO.rOONTRA.
I.- .
r.)„. ..
... *.
.... •
XX* 1iiitir.•. iitatalk 11, 1
gratulations on your new license!! ••• ". zOs 4414e32. 4e. 44.14.48';'
• triiiti4tra; 31, 2014.. .:440349,44S40. .•.;••
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DISPLAYAS REOU111E6 ECY'. LAIN
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SECRETAR'r • • •
..4ACCP CERTIFICATE OF LIABILITY INSURANCE
DATE(MM/DD/YYYY)
12/12/12
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
Gil & Associates Insurance
9485 S.w 72 St Suite A 120
Miami, FL 33173
Phone (305)279 -7665 Fax (305)279 -9705
CONTACT David Gil
PHONE Ext): (305) 279 -7665 ac. No): (305) 279 -9705
i
ADDRESS: dgilQgilinsurance.com
PRODUCER
CUSTOMER ID #:
INSURER(S) AFFORDING COVERAGE
NAIC#
INSURED
AD Electrical Services, Inc.
9135 SW 182 St.
Palmetto Bay, FL 33157-
INSURER A : The Travelers Insurance Company
1660- 182M4921- TIL -12
INSURER B:
09/25/2013
INSURER C : .
$ 1000,000
INSURER D :
$ 100,000
INSURER E :
• • CLAIMS -MADE 0 OCCUR
INSURER F :
$ 5000
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
ADDL
INSR
SUBfi
WVD
POLICY NUMBER
POLICY EFF
(MM/DDIYYYY)
POLICY EXP
(MM/DD/YYYY)
LIMITS
A
GENERAL LIABILITY
1660- 182M4921- TIL -12
09/25/2012
09/25/2013
EACH OCCURRENCE
$ 1000,000
DAMAGE TO RENTED
PREMISES (Ea occurrence)
$ 100,000
0 COMMERCIAL GENERAL LIABILITY
• • CLAIMS -MADE 0 OCCUR
MED EXP (Any one person)
$ 5000
•
PERSONAL & ADV INJURY
$ 1,000,000
•
GENERAL AGGREGATE
$ 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
• POLICY • PRQ • LOC
PRODUCTS - COMP/OP AGG
$ 2,000,000
$
AUTOMOBILE LIABILITY
II ANY AUTO
COMBINED SINGLE LIMIT
(Ea accident)
$
BODILY INJURY (Per person)
$
III ALL OWNED AUTOS
BODILY INJURY (Per accident)
$
• SCHEDULED AUTOS
PROPERTY DAMAGE
(Per accident)
$
• HIRED AUTOS
II NON -OWNED AUTOS
$
$ ,
•
• UMBRELLA LIAR ■ OCCUR
EACH OCCURRENCE
$
• EXCESS LIAB II CLAIMS -MADE
AGGREGATE
$
• DEDUCTIBLE
$
II RETENTION $
$
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY YIN
� ICRO RIEOR/PEAR UDE/EECUTIVE N
(Mandatory In NH)
pyes describe under
DESG�RIPTION OF OPERATIONS below
N/A
N
WC STATU- OTH-
TORY LIMITS ER
E.L EACH ACCIDENT
$
E.L. DISEASE - EA EMPLOYE
$
E.L DISEASE - POLICY LIMIT
$
DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is requlred)
CERTIFICATE HOLDER
CANCELLATION
MIAMI SHORES VILLAGE BUILDING DEPT
10050 NE 2 AVE
MIAMI SHORES, FL 33138
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
ACORD 26 (2009/09) QF
@ 1988-2009 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD