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ELC-11-775Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 C`- Inspection Number: INSP- 160281 Permit Number: ELC -5 -11 -775 Scheduled Inspection Date: May 26, 2011 Inspector: Devaney, Michael Owner: EVERETT, HENRY Job Address: 9636 NE 2 Avenue Miami Shores, FL 33138- Project: <NONE> Contractor: UNLIMITED ELECTRICAL TECHNOLOGIES INC Permit Type: Electrical - Commercial Inspection Type: Final Work Classification: Addition /Alteration Phone Number (727)461 -4370 Parcel Number 1132060132500 Phone: (786)299 -9500 Building Department Comments CCTV CAMERA AND ONE FLOOD LIGHT AT THE BACK OF THE BANK. TO CORRECT VIOLATION Passed 2/ Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments CREATED AS REINSPECTION FOR INSP- 159103. Repair conduit. Temporary lighting not to code. Where is the meter room? May 25, 2011 For Inspections please call: (305)762 -4949 Page 17 of 17 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 BUILDING PERMIT APPLICATION FBC 20 nri 117 ` 1 MAY (3. 201" Ei Permit No. Eb) 5 Master Permit No. Permit Type: Electrical `, OWNER: Name (Fee Simple Titleholder): f, N i� ( 4 FLA W C S EQ5 1 Phone #: 7Z7— 1 6 1- //37.9 Address: 186 bEtJoi bk . 786 - -3g z- 16 City: C C EAR W1 i 13e Ac 6-3, State: f L . Zip: Tenant/Lessee Name: 6 (4 S ZL,& NJ (C Phone #: 7 8 6 - 36 2 — i 61-C; Email: JOB ADDRESS: q 3 b N e 2 AA) tr City: Miami Shores County: Folio/Parcel #: t l 320g -0( 3 2- S ®a Miami Dade Zip: Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name: 6•4 t TT T1(-4- Phone #: r2 q O - Address: l `1 3 8 tt.J 401 PL. City: ( A L -EAE-( IACL DEN S State: F t-- zip: "33048 Qualifier Name: 0 M A C. U (LLAR Phone #:.7864 194 q Soo State Certification or Registration #: L — 000 2 © 5 Contact Phone #: 786 -l9 q -9600 Email Address: DESIGNER: Architect/Engineer: C el f c. J OF C Phone #: Value of Work for this Permit: $ / S Q , 0 0 S i uare/Linear Footage of Work: Certificate of Competency #: L L 000 2-0 5 y V E T �0 1 L I V€ o co M -76'6-382-1 Cc1C Type of Work: DAddress DAlteration Description of Work: Tkt= V (2L 7/Dn/ ew c T A L C t ORepair/Replace IIDemolition A oNc FLco.b Lc tti y NK- co act_ ********* * * * * * * * * * * * * * ************ ***** Fees ****** * ****:x** ** * * ** :x:***** * ******** ** *xis * ** Submittal Fee $ Permit Fee $ / ® 1' CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ Technology Fee $ TOTAL FEE NOW DUE $ 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 ELECTRICAL 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 commencement must be posted at the job site for the first ins :. - : 7) days after the building permit is issued. In the absence of such posted notice, the inspect' i l not be #prove' • reinspe ° tion fee will be charged. Si Signature Owner or Agent The fo eg 11, instrument was a owledged re me this day o " to 1 , 201 , by 11 d who i personally i own to me or who has pr duce identification and who did take an oath. The foregoi ins day of h is personally Contractor ment was ackn ,20 1 l,by NOT RY PUBLIC: Sign: Print: NOTA lto me or who has produced entifcation and who did talc PUBLIC• f My Commission Expires: b�H ' ******* * * ** x**** *Tk**m x: **m+ x******* OV*** **% a**:x:xx:** ** **:x*:*** **a:*x **** *: x**% K**** ******** * ***** ** * ******x:x:****** -92- 3 />'(-e y )1 s Examiner Sign: Print: My Commission Expires: APPROVED BY Structural Review (Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09) Zoning Clerk Aucci ,Ir CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YY) 05/19/11 PRODUCER The Elite Insurance Group P 0 Box 771510 Miami, FL 33177 Phone (305)824-3172 Fax (305)824-3189 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 NAIC # INSURED Unlimited Electrical Technologies Inc. 12888 NW 101 PI Hialeah Gardens, FL 33018 INSURER A: Accident Insurance Co. INSURER B: INSURER C: INSURER D: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED 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'L INSRD TYPE OF INSURANCE POLICY NUMBER AGL -84752 POLICY EFFECTIVE DATE (MM/DDIYYYY 09/03/2010 POLICY EXPIRATION DATE (MM/DD/YYYY) 09/03/2011 LIMITS A ❑ GENERAL LIABILITY EACH OCCURRENCE 1,000,000 V COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES (Ea occurrence) 100,000 ❑ ❑ CLAIMS MADE V OCCUR MED EXP (Any one person) 5,000 ❑ PERSONAL & ADV INJURY 1,000,000 ❑ GENERAL AGGREGATE 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG 1,000,000 V POLICY ❑ PROJECT ❑ 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 / UMBRELLA LIABILITY ❑ OCCUR ❑ CLAIMS MADE ❑ DEDUCTIBLE ❑ RETENTION $ EACH OCCURRENCE AGGREGATE WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/N ANY PROPRIETOR / PARTNER / EXECUTIVE OFFICER / MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under SPECIAL PROVISIONS below n WC STATU- ❑ OTH- TORY LIMITS ER E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE E.L. DISEASE - POLICY LIMIT OTHER ' DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS Electrical Contractor CERTIFICATE HOLDER CANCELLATION MIAMI SHORES VILLAGE 10050 NE 2 AVENUE MIAMI SHORES FL 33138 FAX 305.756.8972 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 OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Raquel Salazar ACORD 25 (2009/01) OF ©1988 -2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD