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EL-16-1913 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Ila U nspection Number: INSP-269220 Permit Number: EL-7-16-1913 Inspection Date: October 19, 2016 Permit Type: Electrical - Residential Inspector: Devaney, Michael Inspection Type: Final Owner: GLINN, MacDAM & DENISE Work Classification: Alteration Job Address: 1201 NE 102 Street Miami Shores, FL 33138- Phone Number Parcel Number 1132050250160 Project: <NONE> Contractor: ENERGIZER ELECTRIC LLC Phone: (305)308-5061 Building Department Comments LIGHTS AND FAN FOR NEW STRUCTURAL ALUMINUM Infractio Passed comments AWNING. INSPECTOR COMMENTS False Inspector Comments Passed E� Failed Correction ❑ Needed Re-Inspection Fee No Additional Inspections can be scheduled until re-inspection fee is paid. For Inspections please call: (305)762-4949 October 18,2016 Page 1 of 1 s s Miami Shores Villag® tClf71i`lye ��� �slde>rtit 3 10050 N.E.2nd Avenue NE x... .�..� Xs Wr c Ctasstrrrc ra t rt .. It r� Miami Shores,FL 3313&0000 ,, � cm Phone: (305)795-2204 � �ISR_ PFt � ' � Expiration: 01/09/2017 Project Address Parcel Number Applicant 1201 NE 102 Street 1132050250160 Miami Shores, FL 33138- Block: Lot: MacDAM&DENISE GLINN Owner Information Address Phone Cell MacDAM&DENISE GLINN 1201 NE 102 Street MIAMI SHORES FL 33138-2600 Contractor(s) Phone Cell Phone Valuation: $ 1,200.00 ENERGIZER ELECTRIC LLC (305)308-5061 Total Sq Feet: 0 Type of Work:LIGHTS AND FAN FOR NEW STRUCTURAL A Available Inspections: Additional Info: Inspection Type: Classification:Residential Review Electrical Scanning:canning: 1 Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $1.20 Invoice# EL-7-16-60536 DBPR Fee $2'25 07/12/2016 Credit Card $ 160.70 $0.00 DCA Fee $2.25 Education Surcharge $0.40 Permit Fee-Additions/Alterations $150.00 Scanning Fee $3.00 Technology Fee $1.60 Total: $160.70 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 c rtify at all the foregoing infoaRgOon is accurate and that all work will be done in compliance with all applicable laws regulating construction and n' g. ut ore,I authoriz a tractor to do the work stated. July 12,2016 Autho zed S nature: her / pplicant / Contractor / Agent Date Building D artment Copy July 12,2016 1 Miami Shores Village PIECRTI Building Department Y 2011E 10050 N.E.2nd Avenue, Miami Shores,Florida 33138 Tel: (305)795-2204 Fax:(305)756-8972 B�.-` INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 20Ns BUILDING Master Permit No. 4C T- - 1 L 1760 PERMIT APPLICATION Sub Permit No. t�_( � 19 :!; ❑BUILDING ®'ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION [:]RENEWAL ❑PLUMBING ❑ MECHANICAL PUBLIC WORKS ❑ CHANGE OF [:] CANCELLATION ❑ SHOP II CONTRACTOR DRAWINGS JOB ADDRESS: l `�` ` Pj r-- 101 City: Miami Shores County: Miami Dade Zip: >1 '3� Folio/Parcel#: Is the Building Historically Designated:Yes NO Occupancy Type: 1 Load: Construction Type: t Flood Zone: BFE: FFE: OWNER: Name(Fee Simple Titleholder): (�a c (A I,e °� lJr a �• V� Phone#: �� a Address: � �), () 1 DJ �-_ I ®� ° City: f-A, c �- SL_>I- A r State: �L Zip: 3�1 7S Tenant/Lessee Name: Q I A Phone#: Email: ,�..®. `�.. L ��� �� • a CONTRACTOR:Company Name: Phone# J©o Address: �W r l City: ,V/, '-�,iP State: Zip: &3g.2 3 Qualifier Name: rJc'iA•,r 'c Phone#: 3-0 s- ,30.'- .506 i State Certification or Registration#: /2 00 7%e 6 Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ /V0® Square/Linear Footage of Work: Type of Work: ❑ Addition l ❑ Alteration New ❑ Repair/Replace d❑ Demolition � Description of Work: L All—I �0.v� *-,o r e %%j Specify color of color thru tile: Submittal Fee$ {) Permit Fee$ ��` �r®'0 CCF$ I • CO/CC$ Scanning Fee$ �� Radon Fee$ o� r�� DBPR$ o'Z� Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ op Structural Reviews$ Bond$ Q� TOTAL FEE NOW DUE$ �® (Revised02/24/2014) Bonding Company's Name(if applicable) �J Bonding Company's Address Q [A City State Zip Mortgage Lender's Name(if applicable) l Z>r")� �- Mortgage Lender's Address City i w� - Cj� 2% State L 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. A Signature Signature OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day oQ%. it\y ,20 a®, , by day of 20 by I`IACQc\AW\ Q'11 ho is personally known to -01?CjC)rN who is personally known to me or who has producedDL„ (24Sb-!r2V�-7j,- nomas me or who has producedrM , _�--I{,®-t-, identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: Sign: Print:L enor2C),- (ZI (�!s Print: �c Seal: ®,tgr Seal: LEONOR ROSARI® _v`• v AMY COMMISSION#FF971612 LEONOR ROSARIO EXPIRES April 24,2020 ',+��� :.j MY COMMISSION#F�Fc971612 (407)398-0153 FbrydeNate�YServhe.Can APPROVED BY ill/IJ�s-1 Yf/ Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) Bonding Company's Name(if applicable) Bonding Company's Address City State A Zip Mortgage Lender's Name(if applicable)�� 'J e�✓t€ E�= Mortgage Lender's Address City t �j!,,,,e% 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. P Signature Signature OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this —7 day oQ,1L= ,20 1k by -7 day of 20 ( by I`1�1CQc�4vy� Jaa��n C��ho is personally known to l�� c1r1'L��C�.C1aS1�,who is personally known to me or who has producedDL (2L4Sb-6-TN--7t;,-OQb-Das me or who has producedMt,'2,---tA9Q—I 6N�� a� identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: o Sign: Print:L ncsrlc--"- . k>s Print: � U Seal: I. =R09AR10 Seal: r' MY Co•�'!° LIE®IN®Ft DFF971612 EX �: MY COMMISSIO(407)398-0153 APPROVED BY ill/l�Gf��f� Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) k . Aim STATE OF FLORID. . uW ` DEPARTMENT OF BI'-, INES'S A"�, U { PROFESSIONAL. REGUL.ATI N EC 130{)7 6 ISSUED. 11 /18/20 `I � a • a€ CERTIFIED ELECTRICAL CONTRACTOR c3E; .N' SIE, DEOCHA3V ENERGIZER ELETRIC. LLQ. K .IS CERTIFIED under the provisions of Ch . 489 FS . 4 Expiration date AUG 31, 2016 L1511180000478 fi All ��: � a s s'z'� y il { �' �." 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': N; I I� -1.�, 1: "I";',,,_11 � . �. , 11 �� t �. "I"I z3 rs r mss / els' r, t 'a,� ,%�rk �'r ,& �'`�'1 e �" ' T 3 �' s i✓ d s x :c G 'ru ,�p i ! as{.��t�y o- ,�� ,�� t,,,,,. "-,- -A°s,a> til✓ ap y - r�. a.r5d tSY-1 MI', Ms s t v r- s.✓a _ _ b J'y s sz :-'e' k?a1=1 �p�` � DATE(MMIDD/YYYY) ., CERTIFICATE OF LIABILITY INSURANCE 07/07/16 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 WANED,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 CNCAONT CTME Jesus Arbbleya Government Insurance Corp. PHONE ; {305}883 9398 ac No): (305)885-1936 18501 Pines Blvd.,Suite#205 EADDRESS*-MAIL insuranceineed@yahoo.com Pembroke Pines,FL 33029 INSURER(S)AFFORDING COVERAGE NAIC# Phone (954)727-2999 Fax (954)727-2888 INSURER A: Travelers indemnity Company of America INSURED INSURER B: Energizer Electric,LLC INSURER c --- ----------------------_..----------__ -- 7808 Indigo Street INSURER D: Miramar,FL 33023 305 INSURER E: INSURER F: 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 ADD UBR POLICY EFF POLICY EXP LTR TYPE _ INSURANCE I WVD POLICY NUMBER MWDD MMID LIMITS GENERAL LIABILITY EACH OCCURRENCE S 1,000,D00AO DAMAGE TO RENTED r COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence 5 1�.ODO•� ❑ ❑ CLAIMS-MADE W OCCUR 660-6D476609 MED EXP(Any one person $ 5,000.00 A Y 09196/2015 09/16/2016 PERSONAL&ADV INJURY t S 1,000,000.00 ❑ GENERAL AGGREGATE s 2,000,000.00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG 5 2,000,000.00 POLICY ❑ PRO. ❑ LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMB Ea accidenceS ❑ ANY AUTO BODILY INJURY(Per person) S ALL OWNED SCHEDULED❑ BODILY INJURY(Per accitlent) '5 AUTOS ❑.AUTOS HIRED AUTOS NON-OWNED PROPgJY DAMAGE $ ❑ ❑ AUTOS Peracci ent ❑ �__� S ❑ UMBRELLA LIAB ❑OCCUR EACH OCCURRENCE S ❑ EXCESS LIAR ❑CLAIMS-MADE AGGREGATE 5 _ ❑ DED ❑ RETENTION$ $ WORKERS COMPENSATION WC STALIMTU OTH- EMPLOYERS'LIABILITY ER ANY PROFFICEPRIETO R EXCLUDED? Y!N NIA E.L.EACH ACCIDENT ry -------- — —ANY PROPRIETOR/PARTNERlIXECUTIVE _ (Mandato in NH) �, E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S LL DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space is required) EmPower Generators is Additional Insured. License Number EC130CY7186 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 Building Department ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE 2nd Avenue AUTHORIZED REPRESENTATIVE Miami Shores,FL 33138 �� ~ ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 26(2010105)QF The ACORD name and logo are registered marks of ACORD TEB DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE R001 7/7/2016 THIS CERTIFICATEIS 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 pollcy(les)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WANED,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 NAME AX PAYCHEX INSURANCE AGENCY INC A/CNo,EQ): ( .No): (888) 443-6112 210705 P: F: (888) 443-6112 ADDRESS: PO BOX 33015 INSURERS)AFFORDING COVERAGE NAICS SAN ANTONIO TX 78265 INSURERA: Twin City Fire Ins Co 29959 INSURED INSURER B: INSURER C: ENERGIZER ELECTRIC LLC INSURER D: 7808 INDIGO ST INSURER E: HOLLYWOOD FL 33023 INSURER F: 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. IN4R rYPEOFINSURANCE ADDL SUER POLICYNUMBER ��EFF POLICYEXP LIMITS 1,TR 17VSR WVJ) TO COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE ❑OCCUR DAMAGE TO RENTED $ PREMISES(Ea ccnarenoe) MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE POLICY -1 PRO- LOC PRODUCTS-COMP/OP AGG $ JECT OTHER: $ COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY (Ea accident) $ ANY AUTO BODILY INJURY(Per person) OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Per accident) $ UMBRELLA UAB Id OCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMS-MADE AGGREGATE $ S DED RETENTION$ WOMERVCOMMNSATION X PER OTH• AND EMPLOYERS'LL41011rY STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE YM EL EACH ACCIDENT $100,000 OFFICER/MEMBER EXCLUDED? A (Mandatory in NH) N/A 76 WEG NG1286 01/05/2016 01/05/2017 E.L.DISEASE-EA EMPLOYEE $100,000 If yes,describe under EL DISEASE-POLICY LIMIT 1'500,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached H more spew Is required) Those usual to the Insured's Operations. RE: License: EC13007186 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE MIAMI SHORES VILLAGE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. C/0 Building Department AUTHORIZED REPRESENTATIVE ` 10050 NE 2ND AVE _ a � � MIAMI SHORES, FL 33138 O 1988-2016 ACORD CORPORATION.All rights reserved. ACORD 26(2016103) The ACORD name and logo are registered marks of ACORD