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EL-16-673 (2) Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-268874 Permit Number: EL-3-16-673 Scheduled Inspection Date: October 14, 2016 Permit Type: Electrical - Residential Inspector: Devaney, Michael Inspection Type: Final Owner: MUSAFFI, NICOLE&JEFFREY Work Classification: Alteration Job Address: 1178 NE 99 Street Miami Shores, FL 33138- Phone Number (561)414-9398 Parcel Number 1132050180120 Project: <NONE> Contractor: MG ELECTRICAL CONTRACTOR Phone: (786)385-5637 Building Department Comments NEW CEILING LIGHTS, KITCHEN NEW OUTLETS, Infractio Passed Comments REPLACE AND INSTALL NEW CIRCUITS WIRES AND INSPECTOR COMMENTS False DEVICES. NEW ELECTRICAL PANEL AND CIRCUITS. Inspector Comments Passed Failed Correction Needed Re-inspection 4, Fee No Additional Inspections can be scheduled until re-inspection fee is paid. October 13, 2016 For Inspections please call: (305)762-4949 Page 34 of 34 Permit NO. EL-3-16-673 `SK.�c.RiFs Y� Miami Shores Village M Permit Type.,Electrical -Residential 10050 N.E.2nd Avenue NE It Work Classification:Alteration Miami Shores,FL 33138-0000 Per Permit Status:APPROVED fey— Phone: (305)795-2204 coxtt>A Issue Date:3118/2016 Expiration: 09/14/2016 Project Address Parcel Number Applicant 1178 NE 99 Street 1132050180120 Miami Shores, FL 33138- Block: Lot: NICOLE&JEFFREY MUSAFFI Owner Information Address Phone Cell NICOLE&JEFFREY MUSAFFI 1178 NE 99 Street (561)414-9398 (954)993-5151 MIAMI SHORES FL 33138- 1178 NE 99 Street MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone Valuation: $ 17,427.00 VOLT ELECTRIC CORP (305)200-7967 _.. .___. ..,._..._ ..._ ___......__.. .� Total Sq Feet: 0 Type of Work:NEW CEILING LIGHTS,KITCHEN NEW OUT Available Inspections: Additional Info: Inspection Type: Classification:Residential Review Electrical Scanning: 1 Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $10.80 DBPR Fee Invoice# EL-3-16-59014 $9.15 03/18/2016 Credit Card $615.10 $50.00 DCA Fee $9.15 Education Surcharge $3.60 03/15/2016 Credit Card $50.00 $0.00 Notary Fee $5.00 Permit Fee-Additions/Alterations $610.00 Scanning Fee $3.00 Technology Fee $14.40 Total: $665.10 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 FFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construc+Aut in thermore,I authorize the above-named contractor to do the work stated. March 18, 2016 Sign Owner / Applicant / Contractor / Agent ate Builepartment Copy March 18,2016 1 Miami Shores e Villag M R 1 2016 Building Department 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 BY Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 20 Iq BUILDING Master Permit No.y C— (1 d PERMIT APPLICATION Sub Permit No.T:— (C`6—J3 ❑BUILDING XELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL PLUMBING ❑ MECHANICAL [:]PUBLICWORKS ❑ CHANGE OF ❑ CANCELLATION El SHOP CONTRACTOR DRAWINGS JOB ADDRESS: City: Miami Shores County: Miami Dade Zia: Folio/Parcel#: Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: lloodZone:: BFE: rFF(E: OWNER-Name(Fee Simple Titleholder): e—&Ve—, CO le- I IV V l�� Phone#: Sr b (//'[T t 1-tJ—q 3qr Address: ( j '7j .5rt P-�-C City: k I Art-&-j 1 "0­1�'1 State: Zip:�3 I Tenant/LesseeeNName: Phone#: Email: Je (Fy-e,y • I�d �, ��► `C' 0L 1 cae j/ • 60 M-7 0 CONTRACTOR:Company Name: �V.b! 2-0 �il Phone#: 3052 S 3 ?` Address: ?2>1 Vi c5 31 jb City: L0, State: Zip: / e � Qualifier Name: c 4e, Nl S RU cf CIA(0 fC J� 21 Phone#: State Certification or Registration#: �.R O I`'C J 2)Co Certificate of Competency#:i 3E:0o 0 5 3 9 DESIGNER:Architect/Engineer: Phone#: Address: / �) City: State: Zip: T Value of Work for this Permit:$ (1 2,7 Square/linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑�"New //. Pd-,Repair/Replace Demolition Description of Work: Nc� G"4C 1 ��qy�'S g, E�-l�'T C �1� !.1'e C.L� OUT I-e-T S / ZEzl a ce a ri c) i's h j�c l r' ,r iew c,i 2�-s i n.-e S a w C:0 6e-\,A C c S N,�w E1C(2-WICA 26A P-L--- (elj d CA-CA & - Specify color of color thru tile: / Submittal Fee$ a • Permit Fee$ CCF CO/CC$ / Scanning Fee$ ✓ 'c�I a ,\ Radon Fee$ G ! DBPR$Q ( S Notary$ J . Technology Fee$ T. �-V Training/Education Fee$ 3 Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ (Revised02/24/2014) r 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. 4 ' s , Signature Signaturec_,__,, J12�� OWNER or AGENT CONTRACTOR The foregoin instrument was acknowledged beforemethis The foregoing instrument was acknowledged before me this dayof, {�(�-� ' 20 J rQ by dayof Gz 2.� ______,20 1(f by IiNV �yy�m'`�6rsonally known to 0,Je0 l')1S Rode iJ(J�ho is personally known to �L L F a me or who has produced s me or who has produced as identification and who did take an oath. identification and who did take an oath. NOTARY P NOTARY PUBLIC: 1 Sign: Sign: Print: WAQ Print: I`'I C`'9 a r2 11r) Seal. °,►SLY"te Notary Pualic State of Florida Seal: .•� ~'•, MAQALY MARCANO ? �: Sindia Aivarez • = Notary Public-State of Florida My Commission FF 156750 ;N, My Comm.Expires Oct 15,2016 OFn° Expires 09,0312018 %+r °••• ovs.o;;:� Commission#EE 843817 ************ * ** * * * * * * * ****************************** n„1, ************************ APPROVED BY /�� � Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) ACORO� DATE(MMMDNYYY) `� CERTIFICATE OF LIABILITY INSURANCE 3/14/2016 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 terns 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 Maximo Dopazo CPIA Dopazo & Associates Inc NAME:PHONE (305)470-8500 MR Fvc No:(866)647-9673 8725 NW 18th Terr Ste 300 ADDREADORF SS: p max@do azo.com INSURERS AFFORDING COVERAGE NAIC S Miami FL 33172 INSURERA:Wesco Insurance Company 25011 INSURED INSURER B RetailFirst Ins CO 10700 Volt Electric Corp INSURER C: 831 N 53 Terrace INSURER D: INSURER E Hialeah FL 33012 INSURER F: COVERAGES CERTIFICATE NUMBER:CL162212409 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 S B POLICY EFF POUCY EXP LIMITS LT POLICY NUMBER MM/DD MM/DD X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTffb- A CLAIMS-MADE F OCCUR PREMISES Eaoccurrence) $ 100,000 WPP1420280-00 11/26/2015 11/26/2016 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEM.AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 1,000,000 X POLICY FACT ❑ LOC PRODUCTS-COMPIOP AGG $ 1,000,000 JE OTHER: $ AUTOMOBILE LIABILITY (CET aOMBINED SINGLE LIMIT $ cddent AP1Y AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Para ant UMBRELLA LIAB HOCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION $ WORKERS COMPENSATIONPER OTH- AND EMPLOYERS'LIABILITY Y/N X STATUTE ER ANY OFFICERIMEMBEXCR ELUD D7 ECUTIVE a N/A E.L.EACH ACCIDENT $ 1,000,000 13 (Mandatory in NH) 0520-51999 10/7/2015 10/7/2016 E.L.DISEASE-EA EMPLOYEE S 1 000 000 B yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1 000 000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If mon space Is required) Electrical contractor CERTIFICATE HOLDER CANCELLATION (305)756-8972 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Miami Shores Village Building Department THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 10052 NE 2 Avenue ACCORDANCE WITH THE POLICY PROVISIONS. Miami Shores, FL 33138 AUTHORIZED REPRESENTATIVE M Dopazo CPIA/MAD � �- 01988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INSn25 i7niAnli