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EL-15-921Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 C 15- G ZVn Inspection Number: INSP-266143 Scheduled Inspection Date: August 26, 2016 Inspector: Devaney, Michael Owner: COWAN, PATRICK Job Address: 87 NE 92 Street Miami Shores, FL 33138 - Project: <NONE> Permit Number: EL -4-15-921 Permit Type: Electrical - Residential Inspection Type: Final Work Classification: Addition Phone Number (786)547-3255 Parcel Number 1132060130290 Contractor: ATLANTIS ELECTRICAL CORP Phone: (305) 551-4043 tsuiiaing uepartment comments NEW SERVICE AND METER COMBO. ELECTRICAL FOR 1633 SF ADDITION RELOCATED KITCHEN & LAUNDRY. INSPECTOR COMMENTS False Inspector Comments Passed Failed 7 Correction Needed Re -Inspection Fee No Additional Inspections can be scheduled until re -inspection fee is paid. August 25, 2016 For Inspections please call: (305)762-4949 Page 33 of 36 Project Address Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 Parcel Number Permit NO. EL -4-15-921 Permit Type: Electrical - Residential Work Classification: Addition Permit Status: APPROVED issue Date: 7/3112015 1 Expiration: 01/27/2016 Applicant 87 NE 92 Street 1132060130290 Miami Shores, FL 33138- Block: Lot: PATRICK COWAN Dwner Information Address Phone Cell PATRICK COWAN 87 NE 92 Street (786)547-3255 MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone ATLANTIS ELECTRICAL CORP (305) 551-4043 pe of Work: NEW SERVICE AND METER COMBO. ELECTR dditional Info: lassification: Residential anning: 1 Fees Due Amount CCF 21.00 DBPR Fee 18.24 DCA Fee 18.24 Education Surcharge 7.00 PermitFee- Additions/Alterations 1,216.25 Scanning Fee 3.00 Technology Fee 28.00 Total: 1,311.73 Valuation: $ 34,750.00 Total Sq Feet: 1633 Pay Date Pay Type Amt Paid Amt Due Invoice # EL -4-15-55249 07/31/2015 Credit Card $ 1,311.73 $ 0.00 Available Inspections: Inspection Type: Review Electrical 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 AFFIDAVn/lkertify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating constructio4fq. uthermore, I authorize the above-named contractor to do the work stated. July 31, 2015 Authorized Signature: Owner / Applicant / Contractor / Agent uate Building Department Copy July 31, 2015 1 Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 BUILDING PERMIT APPLICATION BUILDING ELECTRIC ROOFING APR 2 0 L j FBC 201 o Master Permit No. PC I S — 12-01 Sub Permit No.F—L--I S -q2-) REVISION EXTENSION RENEWAL F-1 PLUMBING MECHANICAL PUBLIC WORKS CHANGE OF CANCELLATION SHOP CONTRACTOR DRAWINGS JOB ADDRESS: ?gam UE 92"`I ree- City: Miami Shores County: Miami Dade zip: 33138 Folio/Parcel#: At 320(, 013 62 9 L-> Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): iC. 0[SwC3. kit Phone#: 979 S 7 ' 3 Z S Sr Address: V- :F U C '2"4 C-6rr, City: 6A"C>'M" State: Zip: Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: Gic C 1 lee n . Phone#: Address: 127,6,-2, Q (-. City:""nMI State: `F'(_ Zip: IZ1 Qualifier Name: -i= c r&'6n_ Z Phone#: State Certification or Registration #: .6Q, 1304 Iq/ 1 Certificate of Competency #: _ DESIGNE . rchitec ngineer: 1/M. Ci1`^2 ( (mac Phone#: _ Address: ` h/ C( 2 ) City: r -L _State 3 S 17 S9 -V3(1E il- Zip: 3 17!6 Value of Work for this Permit: $ -'!I . T— Square/Linear Footage of Work: Type of Work: toAddition Alteration New Repair/Replace Demolition Description of Work: N S 4 G'm Wl ( yi cc&D . C,.ITzV-Jc-- Q wL 1(1$3 S / /» in d W s Rh'L JT-W r- G4Z441 7AJ Specify color of col thru tile: Submittal Fee $ Permit Fee $ 14,0 26 Scanning Fee $ Radon Fee $ Technology Fee $ Structural Reviews $ Revised02/24/2014) Training/Education Fee $ CCF $ CO/CC $ DBPR $ Notary $ Double Fee $ Bond $ TOTAL FEE NOW DUE $ 'I 9 C 1.75 Bonding Company's Name (if applicable) Bonding Company's Address City dr State Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State WE 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. t 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 CSig nature OWNER or AGENT The foregoing instrument was acknowledged before me this day of 1-T{\ 1 20 tS by C C6%3,3o -) who is personally known to me or who has produced p%-. G(1 \4—, as CONTRACTOR The foregoing instrument was acknowledged before me this day of Y-tpi\' I' 20 1 `7 , by E,Cht\C.l--Z who ' ersonally kno to me or who has produced identification and who did take an oath. identification and who did take an oath. as NOTARY PUBLIC: NOTARY PUBLIC: Sign: Si7n: ];I Print: <V\r2lItQ f2_ Print iLGI 10.,ng Seal: REBECA M. PASTRANA Seal: MY COMMISSION #EE872624 =EBECAAEXPIRES: Ftbrumy 07, 2017 62417 APPROVED BY Plans Examiner Zoning Structural Review Clerk Revised02/24/2014) e Z 1 16 -1 `z l ATLEL-1 OP ID: MA A -RO,> CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YY" 02/26/2016 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 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 BUTLER, BUCKLEY, DEETS INC. 6161 BLUE LAGOON DR., STE 420 MIAMI, FL 33126 Mariana Gonzalez CONTACT NAME: MARIANA GONZALEZ PNCNNo, Ext):786-216-1778 C No): 305-262-0187 E-MAIL MARIANA@BBDINS.COMADDRESS: INSURER(S) AFFORDING COVERAGE NAIC N INSURER A:WESCO INSURANCE COMPANY INSURED ATLANTIS ELECTRICAL CORP. 12803 SW 20TH TERRACE MIAMI, FL 33175 INSURER B: GUARANTEE INSURANCE COMPANY 11398 INSURER C: INSURER D: 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. ILTR TYPE OF INSURANCE DDL VD POLICY NUMBER MMDID/ EFF POLICYEXP LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE FXI OCCUR WPP1138623 02 02/10/2016 02/10/2017 EACH OCCURRENCE $ 1,000,00 PREMISES Ea occurrence $ 100,00 MED EXP (Any one person) $ 5,000 PERSONAL &ADV INJURY $ 1,000,00 GENERALAGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: 7X POLICY Roi Ll LOC PRODUCTS - COMP/OP AGG $ 2,000,00 AUTOMOBILE J LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS NON -OWNED AUTOSL 1 COMBINED SINGLE LIMIT Ea accident BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ PER ACCIDEN UMBRELLA UAB EXCESS UAB HCLAIMS-MADE OCCUR EACH OCCURRENCE $ AGGREGATE $ DED I RETENTION$ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE// N OFFICER/MEMBER EXCLUDED? Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A WCP101432001GIC 11/11/2015 11/11/2016 X WC STATU- X OTH- TORYLIMITS ER E.L. EACH ACCIDENT $ 500,00 E.L. DISEASE - EA EMPLOYEE $ 500,00 E.L. DISEASE - POLICY LIMIT $ 500,00 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) ELECTRICAL CONTRACTOR — LICENSE #EC13001914 L;LH I If-IL:A I t HULULH UAN(:tLLA I IUN MIASHVI SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE VILLAGE OF MIAMI SHORES THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN BUILDING & ZONING ACCORDANCE WITH THE POLICY PROVISIONS. 10050 N E 2 AVE. AUTHORIZED REPRESENTATIVEMIAMISHORES, FL 33138 @ 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD ATLEL-1 OP ID: MA a v CERTIFICATE OF LIABILITY INSURANCE DA02/26/ 2016Y) 02/26/2016 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 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 BUTLER, BUCKLEY, DEETS INC. 6161 BLUE LAGOON DR., STE 420 MIAMI, FL GonzalezMarianaGonzalez CONTACT NAME: MARIANA GONZALEZ PA No E>n:786-216-1778 ac No:305-262-0187 ADDRESS: MARIANA@BBDINS.COM INSURER(S) AFFORDING COVERAGE NAIC # 02/10/2017 INSURER A:WESCO INSURANCE COMPANY PREMISES Ea occurrence $ 100,00 INSURED ATLANTIS ELECTRICAL CORP. 12803 SW 20TH TERRACE INSURER B: GUARANTEE INSURANCE COMPANY 11398 MIAMI, FL 33175 INSURER C: INSURER D: INSURER E: AUTOMOBILE INSURER F: COVERAGES CERTIFICATE NIIMRFR- RFVICInN NUIUR1=Q- 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. INSRLTR TYPE OF INSURANCE POLICY NUMBER POLICY EFF MM DD POLICY EXP MM DD LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE Fx_ OCCUR WPP7138623 02 02/10/2016 02/10/2017 EACH OCCURRENCE $ 1,000,00 PREMISES Ea occurrence $ 100,00 MED EXP (Any one person) $ 5,00 PERSONAL &ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY PRO LOC PRODUCTS - COMP/OP AGG $ 2,000,00 AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS NON -OWNED AUTOS COMBINED SINGLE LIMIT Ea accident BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ PER ACCIDENT) UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED I I RETENTION $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITYANYPROPRIETOR/PARTNER/EXECUTIVE Y/ N OFFICER/MEMBER EXCLUDED? Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A WCP101432001GIC 11/11/2015 11/11/2016 X TWC STATU- X OTH- DRY LIMIT ER E.L. EACH ACCIDENT $ 500,00 E.L. DISEASE - EA EMPLOYEE $ 500,00 E.L. DISEASE - POLICY LIMIT $ 500,00 DESCRIPTION OF OPERATIONS/ LOCATIONS/ VEHICLES (Attach ACORD 101, Additional Remarks Schedule, H more space is required) ELECTRICAL CONTRACTOR - LICENSE #EC13001914 MIASHVI VILLAGE OF MIAMI SHORES BUILDING & ZONING 10050 N E 2 AVE. MIAMI SHORES, FL 33138 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE @ 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD