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RC-14-1686 (2) Miami Shores Village . � Building Department Fel + 10050 N.E.2nd Avenue, Miami Shores,Florida 33138 1.7 2016 Tel:(305)795-2204 Fax:(305)756-8972 BY: 1 INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 20 (6 BUILDING Master Permit No.� PERMIT APPLICATION Sub Permit No. }BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP e CONTRACTOR DRAWINGS JOB ADDRESS: �O � , � �nC� FA� \/CrC1y.•e. City: Miami Shores County: Miami Dade Zip: -5 75 S Folio/Parcel#: I ► a 13 ("n' o o 3,0 o(0 o Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name(Fee Simple Titleholder): Qx1SA"1 'C\CJ� ���'v�Z `SCo.\0mPhone#: Address: 'I pCrOSb �S "�-• City: E \ \ C,S O State: 7—x Zip: O Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name: t'}(J'�`c� `J�� lC�'�.r S•�t` Phone#: `1Jy-��yS SO 4 L Address: 3c)LA \ n £. \` I-#— City: OG��C�a•�CS���!-V, State: T Zip:37S �d Qualifier Name: 3��k ��� �1����a�c-�� Phone#: State Certification or Registration#: C,G C.. �S �ay�� 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 ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: Specify color of color thru tile: Submittal Fee$ Permit Fee$ CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ (Revised02/24/2014) Bonding Company's Name(if applicable) Boding 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 on 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. r SignatureOle Signature OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of V-� 20 bye day of T�5r�ar !�5 ,20 by 44 who is personally known to 1� r who is personally known to `����"�O , me or who has produced as me or who has produced as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Cry. S Sign. ' Print: �'^� �1 1 �� Print: Seal: Seal: rz „B MARTIN A WINKLER ��F. .`%�: Notary Puhlir, - State of Florida 0"''"�e' DEBBIE APOLINARIO _ My Comm es Nov 16,2017 Notary Public-State of Florida p�; Comp,ss, t! # FF 050263 p';h *'`&Tat ., ,'i�FOF FS P• Commission#FF 0215 APPR Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) February 15, 2016 To The City of Miami Shores We are asking for an extension due to the fact that the contractor was delayed in starting the job because of previous commitments & scheduling conflicts. We will not be able to secure an inspection to keep permit open before the expiration date. We intend to start the job in March. Thank you, /I - r c) KX'\O� "qv o s MARTIN A WINKLER Notary Public-State of Florida c My Comm ;xP res Nov 16,2017 Conu,s,. i t/ FF 050263 yF"' Bonded Through National Na 9 aryAssn. ILI - I Ag Inspectio Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-246898 Permit Number: EL-10-15-2769 Scheduled Inspection Date: November 04, 2015 Permit Type: Electrical - Residential Inspector: Devaney, Michael Inspection Type: Final Owner: ESCALONA, CRISTINA CRUZ Work Classification: Temp for Construction Job Address: 10616 NW 2 Avenue Miami Shores, FL 33150- Phone Number Parcel Number 1121360020060 Project: <NONE> Contractor: DANCE ELECTRIC INC Phone: (954)236-8824 Building Department Comments PROVIDE ELECTRIC TEMP. SERVICE AND SERVICE infractio Passed Comments OUTLETS. INSPECTOR COMMENTS False Inspector Comments Passed Failedi - Correction �i �� l✓� Needed ❑ Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. November 03, 2015 For Inspections please call: (305)762-4949 Page 27 of 39 Permit No. EL-10-15-2769 SDORE$V,4 Miami Shores Village Permit Type:Electrical -Residential y� 10050 N.E.2nd Avenue NW ' Wort�Classification:Temp for Construction " Miami Shores,FL 33138-0000 Pen Permit Status:APPROVED Phone: (305)795-2204 FLORIDA Issue Date: 11/312015 Expiration: 05/01/2016 Project Address Parcel Number Applicant 10616 NW 2 Avenue 1121360020060 Miami Shores, FL 33150- Block: Lot: CRISTINA CRUZ ESCALONA Owner Information Address Phone Cell CRISTINA CRUZ ESCALONA 619 E CROSBY Avenue EL PASO TX 79902- 619 E CROSBY Avenue EL PASO TX 79902- Contractor(s) Phone Cell Phone Valuation: $ 750.00 DANCE ELECTRIC INC (954)236-8824 _.._...... _.._.�._..�_,....... Total Scl Feet: 0 Type of Work:PROVIDE ELECTRIC TEMP.SERVICE AND Available Inspections: Additional Info: Inspection Type: Classification:Residential Final Scanning:3 Review Electrical Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $0.60 DBPR Fee Invoice# EL-10-15-57607 $2.00 11/03/2015 Credit Card $64.60 $50.00 DCA Fee $2.00 Education Surcharge $0.20 10/29/2015 Credit Card $50.00 $0.00 Permit Fee-Additions/Alterations $100.00 Scanning Fee $9.00 Technology Fee $0.80 Total: $114.60 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 fore oing info r ation is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Futhermore,I authori a he abov n d contractor to do the work stated. November 03, 2015 Authorized Signature:Owner / Applicant / Contractor / Agent Date Building Department Copy November 03, 2015 1 Miami Shores Villa e xA — — g Building Department OCT 2015 t 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305)795-2204 Fax:(305)756-8972 BY:. — INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC20 ( `� BUILDING Master Permit No. 2 (4 — I 62C. PERMIT APPLICATION Sub Permit No.+f ( 15 - ❑BUILDING gELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION [-]RENEWAL ❑PLUMBING ❑ MECHANICAL PUBLIC WORKS ❑ CHANGE OF CANCELLATION ❑ SHOP / CONTRACTOR DRAWINGS JOB ADDRESS: /0G/(� VIA) p� A'e City: Miami Shores County: Miami Dade Zip: Folio arcel#: Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name(Fee Simple Titleholder): 4f/r s/;n f, dv z 6/0j f Phone#: Address: � '6-1 City: F1 AJr7 State: Zip: 7�CI Qo< Tenant/Lessee Name: Phone#: Email: � �^ CONTRACTOR:Company Name: �`� G Lift-:k Phone#: C\Sy Address: 2-�� 3 > 11� City: DPIS�3 �C State: �L Zip: Qualifier Name: FSU\_ -0 Phone#: QS1_1 z5E!�I-} N�2 State Certification or Registration#: E Cr a QOC S D9 Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ •l ACU•yU Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration —19 New ❑ Repair/Replace ❑ Demolition Description of Work: ?P<:�j\Q I, lir C wz C IVB e . sszZ U I Le 0110i to H18ra 3:,Ijq'Vic':4R J I.y T.t E.:t1�1 Specify color of color thru tile: atersa 14 + .,- - Submittal Fee$ Permit Fee$ /4P 49f 494!P CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ �. GO (Revised02/24/2014) Bonding Company's Name(if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name(if applicable) N ' 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 OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this (LO day of O C7C-0\2)C 20 by oZq day of 117( pZ— 20 by who is personally known to AUL 1�1(�^ K6 is personally known to me or who has produced as me or who has produced % 1 C NJ E as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: Sign: Print:\ �i►ONNItRiOr\ Print: ,.? Notary Public•Side of Flory s2�!dx3 3 Seal �;. My Comm.Expires May 27,2017 Seal BWzlcoi60 a o.Lgsl d�uotse!wwo�LW a Commission#}FF 021536 zaa, I e!pws eppiou to alo4s o!igll j h�eloN ***************************************************************** * * ************************************ APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) KtN LAVVJUN, bt:UKt IAKY STATE OF FLORIDA DEPARTMENT,`OF BUSINESS AND PROFESSIONAL REGULATION ? r ELECTRICAL CONTRACTORS LICENSING BOARD EC0000569` The ELECT.RICAL-CONTRACTOR � J �( Named below 1S CERTIFIED 'Under f provisions,of Chapter 489FS _ "S`" '`*� ;'. �� �} cao WE � -Expira'tioli date: AUG�31,2016 �_. `� r-�J' �" ��"�' � *� � {DA13CE--PAUL ARTHl1R',JR:,j D'ANCE.ELECTRIC,INC 2663 E ABIAGA-CIR*%` - ��;` � �►, '' ** AVIE f- „ _EL-3332.8.,_ ISSUED: 08/26/2014 DISPLAY AS REQUIRED BY LAW SEQ# L1408260002240 i BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT 115 S. Andrews Ave., Rm. A-100, Ft. Lauderdale, FL 33301-1895-954-831-4000 VALID OCTOBER 1,2015 THROUGH SEPTEMBER 30,2016 DBA: I 181-163631 DANCE ELECTRIC INC I Receipt#:ELECTRICAL/ALARMS/CONTRACT! Business Name. \. Business Type: (ELECTRICAL CONTR) Owner Name:PAUL A DANCE Business Opened:03/01/198 6 Business Location:830 NE 58 CT State/County/Cert/Reg:E00000569 OAKLAND PARK Exemption Code: Business Phone:771-0707 Rooms Seats Employees Machines Professionals 10 For 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 THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS 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 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: PAUL A DANCE Receipt #10B-14-00011172 I 2663 E ABIAGA CIR Paid 09/17/2015 27.00 DAVIE, FL 33328 i I 2015 - 2016 .4c R CERTIFICATE OF LIABILITY INSURANCE °ATE(MM,DDJYYyy1 THIS CERTIFICATE IS ISSUEp AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE OLDER1THlS 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 pollcy,certain policies m certificate holder in lieu of such endorsement(s). ay require an endorsement.A statement on this certificate does not confer rights to the PRODUCER RICHARD M. GALT INSURANCE AGENCY PHONE T StateFarm 9367 WEST SAMPLE ROAD EMAIL 9'752 42ao LFAX AIC Ne;954-752-4321 A CORAL SPRINGS,FL 33065-4321 ° INSURERS AFFORDING COVERAGE NAICaR INSURED INSURER A-State Farm Florida Insurance Company 10738 DANCE ELECTRIC INC. INSURER B:State Farm Mutual Automobile Insurance Company 25178 2663 EAST ABIACA CIRCLE INSURERC FORT LAUDERDALE, FL 33328 INSURER D: INSURER E: COVERAGES CERTIFICATE NUMBER: INsuReR F: THIS IS ED CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSUR DENAMEOD ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHS ISSUED ANY Y PER WENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYO 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. iLT R TYPE OF INSURANCE POLICY EF POMLICY EXP COMMERCIAL GENERAL LIABILITY POLY NUMBER USUTS CLAIMS-MADE 0 OCCUR EACH OCCURRENCE $ PREMI ES Ee ooW" $ MED EXP(Any one person) $ GEML AGGREGATE LIMIT APPLIES PER PERSONAL&ADV INJURY E POLICY❑JECOT n LOC GENERAL AGGREGATE $ OTHER: PRODUCTS-COMPIOPAGG $ , A AUTOMOBILE LIABNJIY S ANY AUTO Ea Bacadent 1 LE MI $ AUT05M� X SCHEDULED 946 7370-DOS-59C 04105/2015 10/05/2015 BODILY INJURY(Per person) S 250,000 AUTOS AU70S NON-OWNED BODILY INJURY(Per accident) S GE 500,000 HIRED AUTOS PROPER DAMA PeracaideM S 100,000 UMBRELLA UAB OCCUR $ EXCESS LIAR CLAIMS-MADE EACH OCCURRENCE y OED RETENTION$ AGGREGATE $ F WORKERS COMPENSATION >i AND EMPLOYERS,UABILII R OTH- ANYPROPRIETOR/PARTNER�XECIlTIVE YIN STATUTE ER (MaedaOFF ory Jn NH)EXCLUDED? ❑N/A 98-BK_T713-1 08101/2015 08/01/2016 E.L.EACH ACCIDENT y 100,000 (Mandatory In NH) DESCRIPTI NOF OnderPERATIONS below E.L DISEASE-EA EMPLOYE $ 100,000 E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additlorfal Remarks Schedule,nay be attached H more space la regalredI FLORIDA STATE LICENSE#E00000569 Unlimited Electrical Contractor Classification 5190 CERTIFICATE HOLDER CANCELLATION MIAMI SHORES VILLAGE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 10050 NE 2nd Avenue THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Miami Shores, Florida ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 26(2014101) The ACORD name and logo are registered marks 198 f Ado ACORD CORPORATION.All rights reserved. 1001486 132849.9 02-04-2014 ® DATE(MM/DD/YYYY) AC� AC� CERTIFICATE OF LIABILITY INSURANCE 8/31/2015 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 CONTACT Commercial Lines NAME: Bruening Insurance (PAHONE (954)473-1406 aN Ext), /c No:(954)473-1662 2700 S. Commerce Parkway ADDRESS: Shite 210 INSURERS AFFORDING COVERAGE NAIC# Weston FL 33331 INSURER A:Travelers INSURED INSURER B: Dance Electric, Inc. INSURERC: 2663 E Abiaca Circle INSURER D: INSURER E: Davie FL 33328 1 INSURER F: COVERAGES CERTIFICATE NUMBER:CL158504615 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 BR POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER MM/DD/YYYY MM/DD/YYYY X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED A CLAIMS-MADE ❑X OCCUR PREMISES Ea occurrence) $ 100,000 660-1C852844 8/1/2015 8/1/2016 MED EXP(Any one person) $ 5,000 PERSONAL 8 ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY❑ PRO- LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMITaccident $ Ea 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 HOCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ N/A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) Florida State License #EC0000569 Unlimited Electrical Contractor Classification 5190 Please refer to policy for terms, conditions and exclusions. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Miami Shores Village THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 10050 NE 2nd Avenue ACCORDANCE WITH THE POLICY PROVISIONS. Miami Shores, FL 33138 AUTHORIZED REPRESENTATIVE ,l9 J Bradley Bruening/HO �� ���v ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025 onldnn RESIDENTIAL OVERHEAD OR UNDERGROUND SERVICE CHANGE D � j JOB ADDRESS , JJ CONTRACTOR OR OWNER_ D FW- C"C Q�, ►��, . TEMP TYPE OF SERVICE: , 015 OVERMAD OCT 2 g ...... •..• : .... .. .. BY: ...... .... ...... ALL CONDUCTORS SIZED PER NEC ARTICLE 220 • ...... . .. ..... ALL UNDERGROUNDSERYICECONDUGTORSMWTHAVE • A WARNING RIBBON I2"ABOVE CONDUIT 300.5 ••• SERVICE ENTRANCE CONDPIT AND •••••• SIZE CU OR ALUMjNIUa ;••••• • 1 W .�7 „r� . . . ...... SUB PANEL SIZE VOLTAGE RATING AMP RATING At OVERREAD SERVICE CONDUCTORS SHALL MLO 1 /� COMPLY WITH NEC 230 PART Il MCB N .•t"� . rCERATED PANEL �VLCE O vVOLTAOERATING B� 2 tx=> AMP RATING 2.G C� MAIN BREAKER SIZE A.LC.RATING BRANCH SUB PANEL 2 ExIsnNG 000 CIRCUIT —NEW METER OR BREAKER& • _ MAN N . COLD W# SIZE NBC BOND NEC TABLE 2 66 SUB FEEDER: GROUNDING ELECTRQDE CONDUIT SIZE CONDUCTOR SIZE 3 _ CONDUITWIRE SIZE NEC TABLE 250.66 EQUMMENT GROUND WIRE SIZE GROUND RO. W ME TYPE CU OR ALUMINIUM s� nv�j,QFT TYPE CU OR GALV r ' .-.-.---•-•-•-•-•-•-•-•-•---•-•--_--•-.-.---- n.nI APPROVED BY LICENSED ELECTRICAL, i 1 CONTRACTOR:_ A-. 1 ISLff" 1 j OR I -------------- • � j APPROVED BY HOME OWNER: 1 j j 1 1 1 j ELECTRICA D ONd'G ✓ i NOTARY SEAL: j L.-•---•-•-•-•-•-•---• .7�' -�.S _.� ` DATE:----------------------- •_•_•................ 1 RESIDENTIAL OVERHEAD OR UNDERGROUND SERVICE CHANGE ND m ll�w�j JOB ADDRESS CONTRACTOR OR OWNER_ D fNKT Ck IF, TYPE OF SERVICE: RE • ovEUMAD OCT 2015 •• •••• • ...... .... ...... .. BY: .... • . ALL CONDUCTORS SIZED PER NEC ARTICLE 0 **Goo* ... . ..... ...... . .. ..... ALL UNDERGROUND SERVICE CONDUCTORS MUST HAVE ' . .. .. .... ...... A WARNING RIBBON 12"ABOVE CONDUIT 300.5(D)(3) ...... •• . . . ...... SERVICE ENTRANCE COPD AND SIZE CU OR ALUMIPIU1dI :"".' . SUB PANEL SIZE -VOLTAGE RATING AMP RATING OVERHEAD SERVICE CONDUCTORS SHALL MLO COMPLY WITH NEC 230 PART 11 MCB •t"' . tar RATED PANEL SERVICE 0 uVO1.TAOERATING D19C�ONQVELT 2 AMP RATING •2r BREAKER SIZE WRH 101_ A.LC.RATING 0 BRANCH SUB PANEL 2 ODA CIRCUIT -NEW EXISTDJG METEROR BREAKERS, • - MAIN cOhm Emma CLD WATER®OND -NEC TABLE 2$V"— SUB .66SUB FEEDER: rJ �k GROUNDING ELECMQDE CONDUIT SIZE CONDUCTOR SIZE 44.21 CONDUITTYPE NEC TABLE 230.66 WIRE SIZE EQUIPMENT GROUND WIRE SIZE GROUND Its W>RE TWE CU OR ALUMWIUM SIZE IN FT TYPE CU OR GALV -------------------------------------------- - APPROVED BY LICENSED ELECTRICAL, 1 CONTRACTORS 1 I�Uu� 1 OR 1 r------------------------c._ dj APPROVED BY HOME OWNER; 1 i ELECTRICAL MSION �` 1 j NTOTARY SEAL: E eld- S-" DATE: t