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EL-11-91Inspector: Devaney, Michael Project: <NONE> Contractor: ATLANTIS ELECTRICAL CORP Building Department Comments March 08, 2011 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 156704 Permit Number: EL- 1 -11 -91 Scheduled Inspection Date: March 09, 2011 Permit Type: Electrical - Residential Inspection Type: Final Owner: BELLINSON, JENNIFER Work Classification: Alteration Job Address: 9205 NE 4 Avenue Miami Shores, FL 33138- For Inspections please call: (305)762 -4949 Phone Number Parcel Number 1132060140230 Phone: (305) 551 -4043 REPLACE WIRING THAT IS NOT UP TO CODE Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments Page 14 of 27 BUILDING PERMIT APPLICATION FBC 2004 Permit Type: Electrical Owner's Name (Fee Simple Titleholder) AN3Y-1 4 11Aii 47 - 4 - 1 - 1 [ &rittfhone # Owner's Address '77-0S City R,A % Sf ic�j State r2 Tenant/Lessee Name E -MAIL: Job Address (where the work is being done) City Miami Shores Village County 0� FOLIO / PARCEL # >. - r lac (7 rz t `Zjc Is Building Historically Designated YES Contractor's Company Name kikeek.k.Vi 5 CT`t l C Contractor's Address /Z3 5, c.) • Zr) Cityt State Zip 751 1-r // Qualifier Name iR, 4LIS C c� Phone # C ') r L� z 9 f State Certificate or Registration No 6- fP6`9le/ -Sl t ?p Certificate of Competency No. 77-Eoa Dog7- E -MAIL: Value of Work For this Permit $ 300 �— Architect/Engineer's Name (if applicable) Phone # Type of Work: ❑Addition ❑Alteration ,,,, ['New New etrc � l Repair/Replace Describe Work: 3 rl: f. CtJll2f AI is 7T 99 7TT /S iq t) e TO cDj) xx x*xxx x* *xxxxxxxxxxxxxxxxxxxx *xxxxxxx'k F x*xxxx * *x * *** *x *xxx*xxxxxxxx xx*xx *xx*xxx Submittal Fee $ , 0 Permit Fee $ /,� 7 , 9 ) Bond $ Code Enforcement $ Structural Review. $ Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 NO� Zip Miami -Dade Master Permit No. Phone # Phone # Square / Linear Footage Of Work: CCF$ Notary $ ' 'I taining /Education Fee $ Scanning $ Radon $ DPBR $ Double Fee $ Permit No. £t--1 1-91 Zip &o r) rr7 .'a INEZMYSTIE JAN 1 9 2uii i B ..... CO /CC ❑ Demolition Technology Fee $ Zoning $ Total Fee Now Due $ See Reverse side -+ 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 $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature Sign: Print: (Revised 02/08/06) wner or Agent The foregoing ins rent was acknowledged before me this // day of ,./mr:iertrZf 20 /'r , by tz -At sz )+ .00n who j y d own to me r who has produced As identification and who did take an oath. NOTARY PUBLIC: APPLICATION APPROVED BY: os 9LQQ# AOISSItutuoD r•n %� My Commission Ex e szad� saaoloc Signature Contractor The foregoing instrument was acknowledged before me this /9 day of e i - Ve6te.r , 2041 , by wh : personally down to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: IbIt 6 0n memos MINVIL /1111 MUNCH My Commission ER Q�I#I QO; SrwmoD zado7 sa.dcp Plans Examiner Engineer Zoning e -BoIJ a n, 20. 2011011 44AMM Form Preview ACORDTm CERTIFICATE OF LIABILITY INSURANCE PRODUCER BUTLER, BUCKLEY & DEETS 6161 BLUE LAGOON DRIVE MIAMI, FL 33126 Phone: (305)262 -0086 Fax: (305)262 -0187 INSURED ATLANTIS ELECTRICAL CORP 12803 SN 20TH TERRACE MIAMI, FL 33175 COVERAGE TYPE OF INSURANCE ENERAL LIABIuTY COMMERCIAL GENERAL LIABILITY LAIMSMAOE IX OCCUR ENLAGGREGATE UMTTAPPUES PER POLICY Q PROJECT C] LOC TOMOBILE LIABILITY ANY AUTO ALL GINNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS GE WABILITY ANY AUTO CMS LIABILITY THOR CCUR QCLAIMS MADE EDUCTIBLE ETENTION ORKERS COMPENSATION AND EMPLOYERS LIABDJTy POuOYHUMBER 8090001533 DATE (MWDDIYY) 02/10/2010 DESCRIPTION OF OPERAMONW ILOCATIONSNENICLES/EXCLUSWN$ ADDEO D' ENDORSEMENT/BPECI L PROVISIONS ELECTRICAL CONTRACTOR CERTIFICATE HOLDER ADDITIONAL INSURED:INSURED LETTER, MIAMI SHORES VILLAGE BUILDING & ZONING 10050 NE 2 AVENUE MIAMI SHORES, FL 33130 Faxed to: 305-756 -8972 CANCELLATION THIS CERTIFICATE 1S ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHT UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSU - R Es htt p ://amel ia.e - bode.com/imicare/GL/SendFormPreviewAndSend.cfm 02/10/2011 T INSURERS AFFORDING COVERAGE INSURER A: NoXth Pointe Insurance Company INSURER 0: INSURER C: INSURER D; THE POLICIES OF INSURANCE LISTED BELOW NAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOT WITHSTANDING 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR POLICY EFFECTIVE POLICY EXPIRATION DATE MAW No. 2487 P. 2 Page 1 of2 DATE IMM1DDIYYJ 01/20/11 LIMITS EACH OCCURANCE $ 1,000,000 IRE DAMAGE(Any o:re rQe) MED EXP(Any one person) ERSONALANDADV INJURY GENERAL AGGREGATE PRODUCTS - COMP/OP AGO C OMBINED SINGLE LIMIT ea sootdeM) B ODILY INJURY ( Per pef ) BODILY INJURY ( Persac[aen1) .PROPERTY DAMAGE Per acelden1) AUTO ONLY- EA ACCIDENT OTHER THAN EA ACC AUTO ONLY: AK EACH OCCURANCE OOREGATE ]WC STATUTORY LIMITS QOTHER E.L EACH ACCIDENT E.L.DISEASE -EA EMPLOYEE ELDISEASE - POLICY LIMIT $ $ s S S S S s $ 100,000 $ 5,000 $ 1,000,000 $ 2,000,000 s 2,000,000 SHOULD - ANY of THE ABOVE DESCRIME0 POLICIES 08 CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 1O DAYS WRITTEN NOTICE TO THE CERnFTOATE HOLDER NAMED TO THE LEFT BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LUABIUTY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE 1/20/2011 Jan. 20. 2011 11:43AM ca d CERTIFICATE OF LIABILITY INSURANCE OP ID MA DATE (MMIDDIYYYY) 01/20/11 THIS CER IFICATE 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 aY 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 polloy(Ies) must be endorsed. If SUBROGATION I3 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 INSURED BUTLER, BUCRIEY, DEETS INC. 6161 BLUE LAGOON DR., STE 420 MIAMI FL 33126 Phone1305- 262 -0086 ATLANTIS ELECTRICAL CORP. 12803 SW 20TH TERRACE MIAMI 3'L 33175 N M 41 MARIANA GONZALEZ kS. Em): '786-216-1778 DbRE IS1 CUBT RIDE: ATLEL -1 • INSURER(s)AFFORDING COVERAGES BRIDGEFIELD EMPLOYERS INSURER A INSURER B INSURER C: INSURER O : INSURER E INSURER P (a c, No): 305 - 262 -0187 NAIC COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS 1S TO CERTIFY THAT THE POUGIES 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 SE:SSUEO OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POUCIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCWS1ONS AND CONDITIONS OF SUCH POLICIES. UMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CAMS. R 'ADDrSUB1 I � � TYPE OF INSURANCE INSR WVD POLICY NIJMBER (M ��¢F (MhUDwr P� 1 DmnJ m J GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY I CAMS -MADE OCCUR GEM AGGREGATE OMIT APPUES PER 7 POLICY n n LOC AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULEDAUTOS HIRED AUTOS NON.OWNED AUTOS MMBRELLA UAB ExcESS UAB DEDUCTIBLE RETENTION 9 CERTIFICATE HOLDER EM OCCUR CAMS -MADE /A MIAMI SHORES VILLAGE BUILDING ZONING Fax #305 -756 -8972 10050 N E 2 AVE. MIAMI SHORES VILLAGE 9 830 -30442 10/30/10 DESCRIPTION OF OPERATIONS/ LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, U more apace le required) MIASFNI CANCELLATION ACORD 26 (2009/09) The /CORD name and logo are registered marks of ACORD 10/30/11 AUTHORIZED REPRESENTATIVE EACH OCCURRENCE S MN ILL. PREMISES( Eaogcwrence) S MEDEXP (My one Fawn) PERSONAL AM( INJURY GENERAL AGGREGATE No. 2487 P. 1 LIMITS PRODUCTS - COMP/OP AGO COMBINED SINGLE LIMIT (Ee accident) B ODILY INJURY (Perpetson) B ODILY INJURY (Per eoddenp PROPERTY DAMAGE (Per accident) EACH OCCURRENCE AGGREGATE R IYORYIIMITS I MR EL EACH ACCIDENT $100,000 EL DISEASE - EA EMPLOYEE EL DISEASE -POLICY LIMIT $ S 9 b S S S 5 5 5 $ S S SHOULD ANY OF THE ABOVE DESCRIBED POLI0IES ea OANCELLSD 0PF0RII THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN AOCORDANCE WITH THE POUOY PROVISION& s100,000 s500,000 1988 -2009 A D CORP RATION. A rights reserved.