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.