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EL-16-1378Project Address Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 Permit Permit NO. EL -5-16-1378 Permit Type: Electrical - Residential Worts Classification: Pool - Private Permit Status: APPROVED Issue Date: 6/2/2016 Expiration: 11/29/2016 Parcel Number Applicant 10025 NE 5 Avenue Miami Shores, FL 1132060171200 Block: Lot: JOSEPH PIPERATO Owner Information Address Phone Cell JOSEPH PIPERATO 10025 NE 5 Avenue MIAMI SHORES FL 33138- 10025 NE 5 Avenue MIAMI SHORES FL 33138- Contractor(s) Phone F JIMENEZ ELECTRICAL CONTRACT( 305/556-5759 Cell Phone Valuation: Total Sq Feet: $ 2,200.00 300 Type of Work: ELECTRIC FOR NEW SPA Additional Info: Classification: Residential Scanning: 1 Fees Due CCF DBPR Fee DCA Fee Education Surcharge Permit Fee - Additions/Alterations Scanning Fee Technology Fee Amount $1.80 $4.50 $4.50 $0.60 $300.00 $3.00 $2.40 Total: $316.80 Pay Date Pay Type Invoice # EL -5-16-59851 05/19/2016 Check #: 18675 06/02/2016 Credit Card Amt Paid Amt Due $ 50.00 $ 266.80 $ 266.80 $ 0.00 Available Inspections: Inspection Type: Final Light Niche Bonding Review Electrical Alarms 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 AFFID : edify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and�zUtpn•. - .re, I authorize the above-named contractor to do the work stated. June 02, 2016 Authorize • ature: Owner / Applicant / Contractor Building Department Copy / Agent Date June 02, 2016 1 Inspection Worksheet Miami Shores Village r 10050 N.E. 2nd Avenue Miami Shores, FL bPP 1 b -- 137, Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number:INSP-270772 Permit Number: EL -5-16-1378 Scheduled Inspection Date: December 15, 2016 Inspector: Devaney, Michael Owner: PIPERATO, JOSEPH Job Address: 10025 NE 5 Avenue Miami Shores, FL Project: <NONE> Contractor: F JIMENEZ ELECTRICAL CONTRACTOR, INC Permit Type: Electrical - Residential Inspection Type: Final Work Classification: Pool - Private Phone Number Parcel Number 1132060171200 Phone: 305/556-5759 Building Department Comments ELECTRIC FOR NEW SPA 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 CREATED AS REIN TION FOR INSP-259243. Alarms not installed. December 14, 2016 For Inspections please call: (305)762-4949 Page 12 of 33 t. BUILDING Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 TR,ECETV--05 MAY 1: 9.2018 BY. Master Permit No. FBC 201` BWl(o S PERMIT APPLICATION Sub Permit No. EL -4t b — 131 S ❑ BUILDING ❑ PLUMBING JOB ADDRESS: / 00 2— 6- / Li /Ire_ City: Miami Shores County: /~-7 Countty:: Folio/Parcel#: 1/` 3 2-(X —6! / - 200 Is the Building Historically Designated: Yes ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS Miami Dade Zip: S3/ 3S Occupancy Type: Load: OWNER: Name j��itn (Fee��Simple Titleholder): Address:�/((�V2-5 /n/ J// City: i !/ / J S%/o, e Construction Type: Flood Zone: Tenant/Lessee Name: Email: IQP/2'2cJee) CONTRACTOR: Company Name: Address: /2 LI City: L4 Vfy/7 (/ i -7[.f `r Qualifier Name: j -Y an Cy(- /o m-72- BFE: NO FFE: C I; Pipe_ r. Phone#: State: 1 Zip: 3 Phone#: ae r . F..1046146'1 /SC .1 %/ ✓ le . ' &#i' Phone#: qO C//— 2Q62/ Zip: Phone#:?J– 7Q5 -2f 6 State Certification or Registration #: DESIGNER: Architect/Engineer: Certificate of Competency #: W/1 Phone#:Address: �� S City: /�/State:/ . Zip:fS-�t Value of Work for this Permit: $ 2, �C/ Square/Linear Footage of Work: a) Type of Work: ❑ Addition ❑ Alteration Description of Work: ❑ New ❑ Repair/Replace ❑ Demolition �ec�r�C J2&4J Spq Specify color of color thru tile: Submittal Fee $a) .6° Permit Fee $ Y''V''U CCF $ CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Notary $ Technology Fee $ Training/Education Fee $ Double Fee $ Structural Reviews $ Bond $ TOTAL FEE NOW DUE $ 2 G 6 - 90 (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 OWNER or AGENT The foregoing instrument was acknowledged before me this fr-14'N day of Nt I T� , 20 t(/ , by ?I (r (z{ C"-0 , who is personally known to me or who has eced identification and who did take an oath. NOTARY PUBLIC: Sign: Print: Seal: A%0 -r‘;4 –Pi r‘ — —, as IN, o ,.,'rnY pu''. MARIA THERESA PINO ? Notary Public - State of Florida Commission # FF 15368 •t4 (**VX m Fx Tres Ma 7 2017 APPROVED BY (Revised02/24/2014) %- /9,yM+V l/. Signature The foregoing instrument was acknowledged before me this I t day of tdi , 20 110 , by f2AIJ5tS to 511' ct P.J Z , who is Pers nown to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: mom,:,,, Print: (n.L (ter. Pc r.p Seal: ****************** NNU,„ �, a►r`r °�¢� MARIA THERESA PINO - 1 _ Notary Public - State of Florida ° Commission # FF 15368 `'*M� 0eMinktopiAes4Asy471201 ,it******** Plans Examiner Zoning Structural Review Clerk A� RIY CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 6/1/2016 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 Dopazo & Associates Inc 8725 NW 18th Terr Ste 300 Miami FL 33172 CONTACT Alexander Dopazo (ac ONE (A/ (305)470-8500 FAX A/C, N01: (866)647-9673 E-MAILADDREs:alex@dopazo.com INSURER(S) AFFORDING COVERAGE NAIC # INSURERAMapfre Ins Co of Florida 34932 INSURED F Jimenez Electrical Contractor Inc 4910 5th West Lehigh Acres FL 33971 INSURER B Bridgefield Employers Ins Co 10701 INSURERC: 9/10/2016 INSURERD: $ 1,000,000 INSURER E : INSURERF: X E CERTIFICATE NUMBERCL161412103 • 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 LTR TYPE OF INSURANCE ADDL INsn SUBR WVD POUCY NUMBER POLICY EFF (MM/DD/VYYY) POLICY EXP`n (MM/DD/YYY LIMITS A X COMMERCIAL GENERAL LIABILITY 4250150021471 9/10/2015 9/10/2016 EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE X OCCUR DAMAGE TO RENTED PREMISES (Ea occurrence) $ 100,000 MEDEXP(Anyoneperson) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L X AGGREGATE POLICY OTHER: LIMIT APPLIES PRO- PRO JECT PER: LOC GENERAL AGGREGATE $ 2,000,000 PRODUCTS -COMP/OP AGG $ 2,000,000 $ AUTOMOBILE _ _ LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS _ SCHEDULED AUTOS NON -OWNED AUTOS COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY(Per accident)$ PROPERTY DAMAGE (Per accident) $ $ UMBRELLA LIAB EXCESS LIAB _ OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENT ON $ $ B WORKERS COMPENSATION AND EMPLOYERS' UABIUTY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y / N Y A 083026529 1/2/2016 1/2/2017 X PER STATUTE OTH- ER E.L. EACH ACCIDENT $ 1,000,000 000 000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) Electrician. CERTIFICATE HOLDER CANCELLATION Miami Shores Village Building Department 10050 NE 2nd Ave Miami Shores Village FL 33138 ACORD 25 (2014/01) 1NS025 (2014011 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 M Dopazo CPIA/MAD © 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD