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EL-11-288Scheduled Inspection Date: March 07, 2011 Inspector: Devaney, Michael Owner: JOST, TODD Job Address: 9100 NW 1 Avenue Project: <NONE> Contractor: LARRES ENTERPRISES INC Building Department Comments March 04, 2011 Miami Shores, FL 33138- Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 156855 Permit Number: EL -2 -11 -288 Permit Type: Electrical - Residential Inspection Type: Rough Work Classification: Addition /Alteration Phone Number Parcel Number 1131010160060 Phone: (786)443 -1229 REPLACE ELECTRICAL PANEL PLUS SMOKE DETECTORS Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments CREATED AS REINSPEC FOR INS' - 156213. l frh1,22 --iv,/ 0 71 For Inspections please call: (305)762 -4949 Page 27 of 30 BUILDING PERMIT APPLICATION FBC 20 Permit Type: Electrical City: Miami Shores County: Miami Dade Folio/Parcel #: Is the Building Historically Designated: Yes Description of Work: Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 TOTAL FEE NOW DUE $ rECTOMELP La FEB 2 2011 itt Permit No. t I 1 I i K Master Permit No. �� R Ib �y OWNER: Name (Fee Simple Titleholder): / 11 h1 )131 t V` G'MA ' J ' 4 4 Phone #: V �� 96 ( -77 7 6 Address: / ,/� �i W l? D rC /LK 9� . C:.1 l tl City: 1 l State: t Zip: t' 'f D 0 Tenant/Lessee Name: Phone #: Email: JOB ADDRESS: 9/ 0 U 14 W I T1 zip: 3 9/5Y7 NO Flood Zone: CONTRACTOR :: Company Name: C. �- t= ri Ali p 4iti � l'd �'i Phone#: 7 6 6 — 7 ` 3— ) 2 / 2 '9 Address: 7 1 — '1 / ? S. vs 1 11-11'1 City: \A"*"'' State: ' )' 1p Zip: t Qualifier Name: J t) I'M (3') 4/ • Phone: 7 N. - I/ `T 3 - 1/./ 2 .5 1 1 State Certification or Registration #: G / 3 P a 3 ti 3 9 Certificate of Competency #: Contact Phone #: Email Address: DESIGNER: Architect/Engineer: Phone#: Value of Work for this Permit: $ � ° ° Square/Linear F ootage of Work: Type of Work: OAddress D O // Alteration New �IRepair/Replace ODemolition - c -p'ais 1 *************************************** F************* *** * ** * *** * **** ******** *** * **** Submittal Fee $ Permit Fee $ d 4" ©` E' CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ 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 FT.RCTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and 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 comme ement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is r il . ed. In t : nce of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature �._v ?� 7. 41 Owner or Agent The foregoing instrument was acknowledged before me this Signature The foregoing instrument was acknow edged before me this'l✓I✓ day of , 20 _14_, by '1242.. ni et.A. M , day of di- t'�'Clo , 20 by > ''" it'.P� / '1, r who is personally known to me or who has produced tua who is personally know to me or who has produced Lice i..a As identification and who did take an oath. as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commission Expires: Structural Review (Revised 07 /10 /07)(Revised 06/10/2009)(Revised 3/15/09) NOTARY PUBLIC: Sign: Print: My C Contractor J. ANISIA KESE CnmmIs inn no 66; f April 21, 2011 • m Fain Insurance 5&I" g) s k*******NS************ ***sk+ k**+ k**********ffi*******+ k*****+ k******H= ***********+ k*+ k*********** *********+k****** ,: ��% , f , 0 APPROVED BY, � . ; - ; Plans Examiner Zoning Clerk 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR ADD' , . 1f • :_a. POUCY NUMBER POUCY EFFECTIVE D•TE M +1 .iLL POUCY EXPIRATION D 1 MM/DD LIMITS A GENERALUABILITY COMMERCIAL GENERAL LIABILITY 0185E1.00007827 3/21/2010 3/21/2011 EACH OCCURRENCE $ 1,000,000 X DAMAGE TO RENTED PREMISES (Ea occurrence) $ 50,000 CLAIMS MADE X OCCUR MED EXP (Any one person) $ 1, 000 PERSONAL &ADVINJURY $ 1,000,000 $ 1,000,000 GENERAL AGGREGATE GEN'L AGGREGATE UMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ 1,000,000 POLICY PRO- JECT LOC AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON-OWNED AUTOS COMBINED SINGLE LIMIT (Ea accident) BODILY INJURY (Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE (Per accident) GARAGE LIABILITY ANY AUTO AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS /UMBR ELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE RETENTION $ $ $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER /EXECUTIVE Y� OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under SPECIAL PROVISIONS below WCP760114800 3/22/2010 3/22/2011 X WC STATU- OTH- TORY LIMITS ER E.L EACH ACCIDENT $ 100, 000 E.L DISEASE - EA EMPLOYEE $ 100,000 EL DISEASE - POUCY LIMIT $ 500,000 OTHER DESCRIPTION OF OPERATIONS /LOC ATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT /SPECI AL PROVISIONS Electrical Contractor ACO D CERTIFICATE OF LIABILITY INSURANCE PRODUCER (305) 595 -3323 FAX: (305) 595 -7135 Eastern Insurance Group, 9570 SW 107 Avenue Suite 104 Miami Inc. FL 33176 INSURED Larres Enterprises, Inc. 7547 SW 112 Place Miami FL 33173 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE INSURER A Granada Insurance Company INSURER B: CastlePoint Florida Insurance INSURER C: INSURER D: INSURER E: DATE (MM/DD/YYYY) 2/16/2011 NAIC # COVERAGES CERTIFICATE HOLDER ACORD 25 (2009101) INS025 (200901) CANCELLATION Village of Miami Shores Building Department 10050 NE 2 Avenue Miami Shores, FL 33138 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBUGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE David Lopez /AMANDA © 1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD