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DEMO-15-2223 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-242608 Permit Number: DEMO-8-15-2223 Scheduled Inspection Date: October 20,2015 Permit Type: Demolition Inspector: Devaney, Michael Inspection Type: Final Owner: WOLLOWICK,JOSH Work Classification: Electric Job Address:1255 NE 99 Street Miami Shores, FL 33138-2642 Phone Number (305)531-0970 Parcel Number 1132050090100 Project: <NONE> Contractor: WINGLOAD ELECTRICAL CONTRACTOR CORP Phone: (305)431-6685 Building Department Comments ALL INTERIOR CONNECTION PANEL Infractio Passed Comments INSPECTOR COMMENTS False Inspector Comments Passed Failed Correction ❑ Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. October 19,2015 For Inspections please call: (305)762-4949 Page 19 of 42 nro_ DEMO-8-15-2228 Miami Shores Village Pennit'7)pis=Demolition, _ �a 10050 N.E.2nd Avenue NE work CJasII6etrid Miami Shores,FL 33138-0000 W Phone: (305)795 2204 Permit�Itu APPROVED ry'�ORIDAay `. issue Date:�015 Expiration: 02/29/2016 Project Address Parcel Number Applicant 1255 NE 99 Street 1132050090100 JOSH WOLLOWICK Miami Shores, FL 33138-2642 Block: Lot: Owner Information Address Phone Cell JOSH WOLLOWICK 1255 NE 99 Street FL 33142- (305)531-0970 1255 NE 99 Street FL 33142- Contractor(s) Phone Cell Phone Valuation: $ 500.00 WINGLOAD ELECTRICAL CONTRACT (305)431-6685 Total Sq Feet: 00 Type of Demo:Electric Available Inspections: Additional Info:ALL INTERIOR CONNECTION PANEL Inspection Type: Classification:Residential Final Scanning:3 Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $0.60 Invoice# DEMO-8-15-56911 DBPR Fee $2.00 DCA Fee $2.00 09102/2015 Credit Card $64.60 $50.00 Education Surcharge $0.20 08/31/2015 Credit Card $50.00 $0.00 Permit Fee $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 00 ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: I certify that all the foregoing informatio is accurat and that all w ill be done in compliance with all applicable laws regulating construction and zoning. Futhermore, I authorize th above-nam d contr r to do wor ted. ber 02, 2015 Authorized Signature:Owner / Applicant / C ntractor / Agent ate Building Department Copy September 02,2015 1 Miami Shores Village ��,�� Building Department7B . UG 1.2015 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 �� Tel:(305)795-2204 fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 Li FBC 20 /1/ BUILDING Master Permit ft. DEA a PERMIT APPLICATION Sub Permit No.L104z & 222 3 ®BUILDING �LECTRIC ® ROOFING ® REVISION ®EXTENSION ®RENEWAL ®PLUMBING ❑ MECHANICAL ®PUBLIC WORKS ❑ CHANGE OF ®CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOBADDRESS: /zs*h- AAE 414144 6'7, City: Miami Shores County: Miami Dade Zi : ��✓ (`� Folio/Parcel#: Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: \ Flood Zone: BFE:?�--� FFE: OWNER:Name(Fee Simple Titleholder): c l� �/�l`�1�11J� Phone#: Address: WL, 5w (l`C_- City: 1 d l 1 i i State: Zip: 3 Tenant/Lessee Name: Phone#: fes' Email: ' CTOR:Company Name: /®� ��, �di_��/ G"�, �t�r� Phone# Address: lff6, 71 5r J(41i0 LwiA9, L-�K-C CC 141 City: a-trr�'�f .a State: Zip: Y16-1- Qualifier Name: ��t0 69,A 4/2 Phone#: 3 as- State Certification or Registration M d5dl i30 t'�f q Yef 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: Aft I1r IJAI.Or CC),`1 ^ 1 Spec*color of color /thm tile° Submittal Fee$ t/ Permit Fee$ jE ®19 CCF$ CO/Cc$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$_ TOTAL FEE NOW DUE$_ (Rev6edW/24/2014) z 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,BEATERS,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$2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also,a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days ofter the building permit is issued. In the absen a of such posted notice, the inspection will not be approved and a reinspection fee will be charged. 7::� Signature Signature ___ ._ �WNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of t� .20�by day of '20 ,by who is personally known to J U l 0 A. Q� NQ ,who is`person_ally known to me or who has produced yyav 18574'@'VWbas me or who has produced as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: � � • Sign' Sign: -C a Print Print (ba f Q, A V'evza e Seal: Ott Iff'o Seal: CARMEN DE BERNARDI e » Notary Public-State of Florida My Comm.Expires Mar 9,2018 ; �9� 299 +RIRIR�si�d�:B$�/IAta>wMlla�taB\3�F�,1j \�s1tIBAt�� f1` `�1` 11�IR�1t�1,�IsE1RIR��s#sIRa�AtAgE.A$ , �$�k , �,'��>$#a1RblAIAt7R91�61Ai� APPROVED BY � �/�lans Examiner Zoning Structural Review Clerk (RevLwd02/24/2014) DATE(WXDD/YYYY) CERTIFICATE OF LIABILITY INSURANCE4�.•/ 08/2812015 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(ies)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 endorsemen s. PRODUCER cONTJ.JANULIONIS _ .._...__ .. . .-'--.... .._ �._ FIRST SOLUTION INSURANCE PHONE 305-667-6530 -___..____—__.._�tt t�o1- x-740-8211 Aft6530 CORAL WAY E-MAIL INFO@FSIMIAMLCOM _. _ .. ........ MIAMI,FL 33155pYSURER(S)AFFORI)INGCOVERAGE_......._.__..._._ NAIC>I— �RERA: GRANADA INSURANCE CO, _..... .. .._.........._.._.._...._........._. __._ _._ __ __ . INSURED .... �INSURERB WINGLOAD ELECTRICAL CONTRACTOR CORPORATION INSURER C: 14672 SW 99 5T ._.........._. ___. _.__ . INSURER D MIAMI,FL 33186 INSURER E: INSURER l:: 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. TYPE OF INSURANCE POLICY NUMBER POLICv EFF POLICY EXP LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 COMMERCIAL GENERAL LIABILITY PREMISES(Ea ocaunencal----- $ 100 000 j r CLAIMS-MADE ^J OCCUR I..MED EXP/Any one person} $ 5,000 A i 0185FL00067324-0 06/03/2015 06/03/2016 PERSONAL&ADV INJURY $ 1,000000 _ _.._...._......._....__._. II GENERAL AGGREGATE $ 2,000,000 GEN'L.AGGREGATE LIMIT APPLIES PER, PRODUCTS.COMP/OP AGG 1$ 2,000,000 X POLICYO I LOC AUTOMOBILE LIABILrrY COMBINED SINGLE LIMIT S Me02440t).____—._.____.€-._.__._.___......._.._._.......... -- ANY AUTO BODILY INJURY(Per Person) I$ — ALL OWNED f SCHEDULED BODILY INJURY(Per accident)`$ AUTOS L AUTOS . .._ NON-OWNED ? PROPERTY DAMAGE I S HIRED AUTOS _--' AUTOS LPAdeMl ................_....._....i_. .... _ $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS UAB f-.._ I AGGREGATE $ CLAIMS-MADE _.. _._..._.....-- _ _ ...__..___ _._.... ... .._...__-.........._..___,_.,._..... OED RETENTIONS S.... ... WORKERS COMPENSATIONWC STATU- O rH AND EMPLOYERS'LIABILITY L 1 TORY UM TS IN AIdY PROPRIETORIPARTNER CUTIYE YIN N t A E.L.EACH ACCIDENT $ OF1-ICERW--MBEREXCLUDED? (Mandatory In NH) E L DISEASE-EA EMPLOYEE.-_ $.._..__ H Yes,describe under _.....-- DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS t VEHICLES(Attach ACORD 101,Additional Relnaft Schedule,U more space Is requlrst ELECTRICAL WORK IN/OUT RESIDENTIAL AND COMMERCIAL. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Villas of Miami Shores ACCORDANCE WITH THE POLIQY PR VISIONS. 1255 NE 99th st AUTHORIZED REPRESENTATIVE Miami Shores,FL ®1988. oft CO TION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACOR13 70w(28/2015 E MM/DD/Y" • � CERTIFICATE OF LIABILITY INSURANCE 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 thecertificate 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 NAME: PHONE A/C,No,Ext: 1-600-277-1620 x4800 FAX A/C,N.): 72 797-0704 FrankCrum Insurance Agency,Inc. E-MAILADDRESS: 100 South Missouri Avenue INSURERS AFFORDING COVERAGE NAICH Clearwater,FL 33756 INSURER A: Frank Winston Crum Insurance Co. 11600 INSURED INSURER B: INSURER C: FrankCrum L/C/F Wingload Electrical Contractor Corporation INSURER D: 100 South Missouri Avenue INSURER E: Clearwater FL 33756 INSURER F: COVERAGES CERTIFICATE NUMBER: 323389 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAME 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 ADOL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR TYPE WVD (MM/DD/YYYY) (MM/DD/YYYY) GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY PREM SES E Ea000u _e $ CLAIMS-MADE =OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ POLICY PROJECT LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMB $ a ANY AUTO BODILY INJURY Per arson $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS er accident UMBRELLA LIAR OCCUR EACH OCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION AND WC201500000 01/01/2015 01/01/2016 X WCS IM SoaY OER A EMPLOYERS'LIABILITY ANY PROPRIETOWPARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? N/A E.L.EACH ACCIDENT $1.000,000 (Mandatory In NH) If yes,describe under E.L.DISEASE-EA EMPLOYEE $1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1.000.000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks,Schedule,If more space is required) Effective 07/07/2014,coverage is for 100%of the employees of FrankCrum leased to Wingload Electrical Contractor Corporation(Client)for whom the client is reporting hours to FrankCrum.Coverage is not extended to statutory employees. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Villas of Miami Shores AUTHORIZED REPUSENTATIVE 1255 NE 99th St. Miami,FL 33138 ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD Penwt No DEIM04- 5-2223 � ° s TMami Shores Village mt pe.,Demolition, alcavan r(d f-"" 10050 N.E.2nd Avenue NE ) O {Class Miami Shores,FL 33138-0000 he PAtmit Status:APPROVI b Phone: (305)795-2204 Expiration: 29/201 Project Address Parcel Number Applicant 1255 NE 99 Street 1132050090100 JOSH WOLLOWICK Miami Shores, FL 33138-2642 Block: Lot: Owner Information Address Phone Cell JOSH WOLLOWICK 1255 NE 99 Street (305)531-0970 FL 33142- 1255 NE 99 Street FL 33142- Contractor(s) Phone Cell Phone Valuation: $ 500.00 WINGLOAD ELECTRICAL CONTRACT (305)431-6685 Total Sq Feet: 00 Type of Demo:Electric Available Inspections: Additional Info:ALL INTERIOR CONNECTION PANEL Inspection Type: Classification:Residential Final Scanning:3 Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $0.60 Invoice# DEMO-8-15-56911 DBPR Fee $2.00 09/02/2015 Credit Card $64.60 $50.00 DCA Fee $2.00 Education Surcharge $0.20 08/31/2015 Credit Card $50.00 $0.00 Permit Fee $100.00 Scanning Fee $9.00 Technology Fee $0.60 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 foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Futhermore,I authorize the above-named contractor to do the work stated. September 04, 2015 Authorized Signature:Owner / Applicant / Contractor / Agent Date Building Department Copy September 04,2015 1