EL-10-531Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
1
Inspection Number: INSP - 162557 Permit Number: EL -3 -10 -531
Inspection Date: July 28, 2011
Inspector: Devaney, Michael
Owner: SMART, DARIK & MARLENIS
Job Address: 540 GRAND CONCOURSE
Miami Shores, FL 33138-
Project: <NONE>
Contractor: R & A ELECTRIC
Permit Type: Electrical - Residential
Inspection Type: Final
Work Classification: Addition
Phone Number (305)751 -8127
Parcel Number 1132060171411
Phone: (305)331 -3710
Building Department Comments
ADD NEW ELECTRICAL SERVICE TO ADDITION
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
X8' X(rilY 2a//
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July 27, 2011
For Inspections please call: (305)762 -4949
Page 1 of 1
Miami Shores Village
Building Department
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 Type: Electrical
Permit No.E
Master Permit No
OWNER: Name (Fee Simple Titleholder):
Address:
city: /Yl ekne i S h C
State:
1
FEB ,� 1 201'
Y. .........
-ON
10- 402-
Phone #:. ' 7.� / f e�- 7
3'313t
Tenant/Lessee —Name: �," Phone #:
Email: d��V1a.✓'OL uv\�� CQN■ccest. Nee_
JOB ADDRESS:
rj
City: Miami Shores County: Miami Dade
Folio/Parcel #:
Is the Building Historically Designated: Yes NO }(" Flood Zone: A.10
Zip: 3313 .
CONTRACTOR: Company Name: L c».t (,i h9<✓ Fie-4h
Address: -! t ///f- q h r'
City: ,%7g ;/ ./ 6A' 3 State: P
Qualifier Name: My G`l i e ( Le9iv 6- A2d -en/
State Certification or Registration #: 304,3 / 3
Contact Phone #: '2 97a -.234
Phone#: 3 75.$ —1 ;11
Zip: 3) /.
Phone #: 3 "25 I— /02 //
0�,� 7 Certificate of Competency #:
Email Address:
DESIGNER: Architect/Engineer: Phone #:
Value of Work for this Permit: $ 5® 0 Square/Linear Footage of Work:
Type of Work: Address Alteration ONew ORepair/Replace ODemolition
Description of Work:
+x**+x*:x+x*****a ***** **a: x:*********+x*:***** Fees** *: xx: *****+ x**** **: x*+ x**********mn:+x******x:x ***
Submittal Fee $ Permit Fee $
Fee $ Radon Fee $
Notary $ Training/Education Fee $ Technology Fee $
Double Fee $ Structural Review $
TOTAL FEE NOW DUE $
CCF $ CO /CC $
DBPR $ Bond $
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 ELECTRICAL WORK, PLUMBING, SIGNS,
WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDMONERS, ETC
OWNER'S AIFIDAVIT: 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 $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature
The
day of
Owner or Agent
ng instrument was a
20 It ,by
The f
day of
who is personally known to me or who has produced who is
Contractor
instrument was acknowl before ; e
2011 by
o me • who has produced
As identification and who did take an oath.
NOTA ' / -' U '. IC:
/11 , •
Sign: ■J, 1 ,.1..1'
-on ...--
Print:
My Commission Expires:
* * * * * * * * * * * * * * * * * * * * * **
APPROVED BY
4.1, ..t4;t1- '6"
* * * * * **
as identification and who id take an oath.
NOT Y PUBLIC
Sign:
Print:
My Commission Expires: ae;.
s cJ
************************************* * * * * * * * *4** * * * * * * * * * * * * * * **
mile Plans Examiner
Zoning
Structural Review Clerk
(Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09)
r
paaCED Miami Shores Village
fE. ®� /011 Building Department
BYE ...... 0 o060d 00....
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
CHANGE OF CONTRACTOR/ ARCHITECT
Permit N. /0"- LI
Owner's Name (Fee Simple Title Holder:
Owner's Address: of 0
City: f•A I. vvt i S I cy t -S
aF:14,_ (41/(C7r Phone #: o$ 75 710)
0)
eoCcA-rS
State :f Zip Code: .31.3(L.
Job Address (Of where work is being done): ' 0 4-, 6Proe cA'I'SC
City: Miami Shores State: Florida Zip Code: 33138
Contractor's Company Name: L L
Address: 131/ -10 ,1t
City: Ihjetehl a State:fl-r Zip Code. 5 43 ff
Qualifier's Name : a24 `o,e f ' L. & Lic. Number: 16 ) 3 713
Phone #: 3 "f -251-/
Architect/ Engineer of Record Name: 3--r 1, S i fill i one v 1(®• .Sc 1.,t)
Address: w^(.
City: Sep State: i Zip Code: Sct 0
Describe Work: e \c" dc ':t -I-° ct JcL
I hereby certify that the work has been abandoned and/or the contractor/architect is
unable or unwilling to complete the contract. I hold the Building Official and the
I__
ores harmless for all legal involvement.
Signature
The foregoing i
this_ day of
owner or Agent
tru nt was akno
,2001 ,by
dged bef•; e me
Who is personally known to me or who has produced
as indentification.
Nota
Sign:
Seal:
... ate. v: st'.t ►- ='y',1
"1 \IP, 0 '13+ 4G • to f NCO
SOP
Signature Q
Contractor or Architect
The foregoing ins e was aknowledged efor me
this f day of , 200 b
who is personally known to me of who has produced
as indentification.
Notary
Sign:
Seal:
February 2, 2011
R &A Electric, Inc.
P.O. Box 611835
Miami, FL 33261 -1835
305- 751 -9898
Attn: Jorge Arriloa,
ram'l 049 101
Jorge,
This letter is to inform you that you are no longer the electrical contractor for the
540 Grand Concourse residence. You may remove your license from record.
You have been paid:
$300.00 - Check 123 for works performed for electrical demo
$200.00 - Check 1004 8/27/10 for materials for rough exterior
$300.00 - Check 1005 9/2/10 for labor on rough exterior.
All permits that you had for the work above are passed and closed. Our contract is thus
terminated for any works not performed.
Thanks for your time and cooperation concerning this matter:
Regar
Darik Smart
CC: Miami Shores Village Building Department.
7010 1870 0002 5917 3818
0
�I
Label #:
Customer Postage
Subtotal:
Issue PVI:
Total:
Paid by:
Debit Card
Account #:
Approval #:
Transaction #:
23 903520633
Receipt #:
701018700002591738$8.44
$5.10
a =aaacaa
$5.10
$5.10
$5.10
XXXXXXXXXXXX6202
142825
141
000152
Order stamps at USPS.com /shop or call
1- 800- Stamp24. Go to USPS.com /clicknship
to print shipping labels with postage.
For other information call 1- 800 - ASK -USPS.
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Get your mail when and where you want it
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Bi11 #: 1000402510894
Clerk: 06
All sales final on stamps and postage
Refunds for guaranteed services only
Thank you for your business
********* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
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HELP US SERVE YOU BETTER
Go to: https : / /postalexperience.com /Pos
TELL US ABOUT YOUR RECENT
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Customer Copy
acSRji
IR FEB 101
Pt -
BY:- .......... .... .
Miami Shores Village peZEVNI
Building Department '�� MB
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 BY: Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949
BUILDING
PERMIT APPLICATION
FBC 20
Permit No. 'L.
Master Permit No.
Permit Type: ELECTRICAL SP/14CA— Owner's Name (Fee Simple Titleholder) ll( Phone #
Owner's Address 57 (0 ecLJr -C
City li tuna Sk ^ State ` L_ Zip 33 tae
Tenant/Lessee Name
Email C e c5
Phone #
Job Address (where the work is being done) 3-1t0 (art
City Miami Shores Village County Miami -Dade Zip j3 (3
FOLIO / PARCEL #
Is Building Historically designated YES NO (.›C Flood Zone M®
Phone # 3 3 / / C
Contractor's Company Name -, 6"--e— 7 /G
Contractor's Address
e. goX _// cfP3
City Ii/ /,Q / v9 6/ Stat / 4#) Zip ° -3'2-
Qualifier Name ® /2-/� /e, /4 Phone # c3 3 . / r 3 �/ 0 ,_"")
State Certificate or Registration No. _,' lJ (�''-1 l Certificat of Competency No. 606700 54
Contact Phone 505 # 9 ` f /0 E -mail i / 7, C 3305/ �ji .f.m /� �.�0e77
Architect/Engineer's Name (if applicable) Phone #
Value of Work For this Permit $AM Square / Linear Footage Of Work:
Type of Work: ['Addition ❑New El Repair/Replace ❑ Demolition
Describe Work: Stro / 1'04-GSG ( / c1 ,
Submittal Fee $ Permit Fee $30,0e/PP- '' ! /`-.04 CCF $ CO /CC $
Notary $ Training/Education Fee $ Technology Fee $
Scanning $ Radon $ DPBR $ Bond $
Double Fee $ Violation date:
Structural Review. $ Total Fee Now Due $
See Reverse side -*
Bonding Company's Name (if applicable)
Bonding Company's Address
City
State N
Zip
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City State " o 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 ELECTRICAL WORK, PLUMBING, SIGNS,,
WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC
OWNER'S AF141JAVIT: 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
inspectio., ill not be approved and a re- inspection fee will be charged.
Signature
NOSIPP
Owner or Agent
The fore mg instrument was acknowle
day o�. , 20 10, bythY t
ore me
who i personal y kno to me or who has produced
kb41 \1'
NOT
Sign:
Print:
identification and who did take an oath.
PUBLIC:
My Commission Expires:
* * * * * * * * * * * * * * * * * ** **
APPROVED BY
‘Y0
C �R N• �� 1Z
* **//g) ** ** rat ** ** * * **** * *** * * * * *xx***** **
/
Signature No
p..
Contractor
The foregoing instrument was acknowledged before me this
day of ,20 Igby ,
ho is personally known to me or who has produced 1' )
as identification and wha did take an oath.
NOTARY PUBLIC:
Sign:
Print:
My Commission Expires:
.� //2 /d1)1ans Examiner
Engineer
(Revised 07 /10 /07)(Revised 06/10/2009)
6.12012 '°:•
11011A1 PUBLIC
am ission # ;�
% cPJ CD
•. D'T�S901 7il :
** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
Zoning
Clerk checked
0001
r 0002
0004
CTQB
Oonstructim Trades Qualifying Board
BUSINESS CERTIFICATE O'F COMPETENCY
_ -._- .-, ----
QUALIFYING TRADE(S)
°
from: OdaiveGonzalez AL NCFlastrartoe CIO: 19GF its
Tn. Roberto 1 o :Mac:3131am 11 :06 AMt age: 2 of 2
CERTIFICATE OF LIABILITY INSURANCE OP ID �1
NCI' Insurance Associates
8700 West Flagler Street #320
Miami FL 33174
Phone: 305 -446 -5474 Fax : 305-444-8796
DATE'(MMIDD/YY)Yj
0331/10
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND. EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
INSURERS AFFORDING COVERAGE
NAIC #
INSURED
R & A El tric, Inc.
Roberto vero
P.O. Box 611835
Miami F1 33261
COVERAGES
INSLtERA: Granada Insurance Company
16870
INSURER B:
Ssid9etieid Employers Yas. Go.
INSURER C:
INSURER D:
THE POLICIES OF INSURANCE LISTED BELOW HAVE SEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
ANY REQUIREMENT, TERM OR COMMON OF ANY CONTRACT OR 0T1 ER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN, 11-10 INSURANCE AFFORDED B ! THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND COMMONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
DAB (MM!D�DIYYW) D YANM
1NbFr ADD.
LTR INSRD
TYPE OF INSURANCE
POLICY NtadBEER
GENERAL LIABA.ITY
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE X OCCUR
018517.00001335
08/28/09
08/28/10
LIMITS
EACH OCCURRENCE
UAMAUt I U RtNIEL■
PREMISES (Ea occurence)
PERSONAL & ADV INJURY
GENERAL AGGREGATE
PRODUCTS - COMP/OP AGG
1,000,000
$ 50,000
$ 1,000
$1,000,000
$2,000,000
$2,000,000
AUTOMOBILE LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON-OWNED AUTOS
COMBINED SINGLE LIMIT
(Ea accident)
BODILY INJURY
(Per person)
BODILY INJURY
(Per accident)
PROPERTY DAMAGE
(Per accident}
AUTO ONLY- EA ACCIDENT
OTHER THAN
AUTO ONLY:
EA ACC
AGG
EXCESS / UMBRELLA LIAB1LTY
OCCUR CLAIMS MADE
DEDUCTIBLE
RETENTION $
WORKERS COMPENSATION
At EMPLOYERS' UNBILTIY
ANY PROPRIETOR/PARTNEWEXECUTIVE
OFFICEPJMEMBER EXCLUDED?
(Mandatory In NH)
t# yes, describe under
SPECIAL PROVISIONS below
OTHER
Y/N
0830 -43354
10/27/09
10/27/10
Y -LS TORIMI
ER
X
E.L. EACH ACCIDENT
E.L. DISEASE - EA EMPLOYEE
E.L. DISEASE - POLICY LIMIT
100,000
$100,000
$ 500,000
DESCRPTION OF OPERATIONS / LOCATIONS ! VEHICLES EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PM:AU H
Electrician
CERTIFICATE HOLDER
CANCELLATION
CITYMSH
City of Miami Shores Village
10050 NE 2nd Avenue
Miami Shores FL 33138
SHOULD ANY OF THE ABOVE DESCRIM POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE TIREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAC. 10 DAYS Wfdrial
NOTICE TO THE CERTIFICATE HOLDER NAND TO THE LEFT, BUT FAILURE TO DO SO SHALL
IMPOSE NO OBLIGATION OR LIABSJ Y OF ANY KIND UPON THE INSURER. ITS AGENTS OR
REPRESENTATIVES.
ACORD 25 (2009101)
REPRE
988-2009 • RD CORPORA110N. All rights reserved
The ACORD name and logo are registered marks of ACORD
SEE OTHER SIDE
DO NOT FORWARD
R & A ELECTRIC INC
ROBERTO A RIVERO PRES
PO BOX 611835
MIAMI FL 33261
1111111, 111, 1111111111 1111111111111,11111., 11111111,111 LII ,d
TAX
140`
1st_
RECEIPT NO.
BUSINESS NAME OCA
R & A ELECTRIC DIC
1211 NE 82 ST
OWNER- :R & A ELECTRIC
t QTY S E F ORIDA
ANT TO COUNTY OFL10-24
_ T 3a, 20117
1 Hi8 IS NOT A BILL — DO NOT PAY
CC NO: 97E800846
FIRST-CLASS
U.S. POSTAGE I
PAID
MIAMI, FL
PERMIT NO 231
RECEIPT HOLDER MAY DO
BUSINESS AS A CONTRACTOR
AS SPECIFIED HEREON.
SEE BACK OF RECEIPT E ;
A LIST OF NOM�°`I'CIPATING`
MUNICIPALITIES
Receipt holder must
registe" in the city
where work is to be
done.
PAYMENT = RECEIVED
MIAMI•DADE COUNTY
COLLECTOR:
10/27/2009
02230016001
000200.00
DO NOT FORWARD
R & A ELECTRIC INC
ROBERTO A RIVERO PRES
PO BOX 611835
MIAMI FL 33261
1111111, 11,,:1.1'It11i1St1111tl1116111f 1111t1111lliili�i�l�ltli
Permit No:09- %'Z G /s - Po
Job Name:
, 2009
Miami Shores Village
Building Department
ELECTRIC Critique Sheet
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
Page 1 of 1
(0 )-1,--1,'" 4147 Plz-
/bt
a: t,e, = 44- 1 /L ' e-
A-4) 1-ems- J I— A- pox ik .e �r , "e
eridei (A e X12,/76#7
Plan review is not complete, when all items above are corrected, we will do a complete plan
review.
If any sheets are voided, remove them from the plans and replace with new revised sheets and
include one set of voided sheets in the re- submittal drawings.
Mike Devaney
305 - 795 -2204