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EL-11-520Inspection Number: INSP - 157557 Permit Number: EL -3 -11 -520 Scheduled Inspection Date: April 04, 2011 Inspector: Devaney, Michael Owner: WILLIAMSON, ROBERT Job Address: 1235 NE 96 Street Miami Shores, FL Project: <NONE> Contractor: LANGER ELECTRIC COMPANY Building Department Comments April 01, 2011 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 For Inspections please call: (305)762 -4949 Permit Type: Electrical - Residential Inspection Type: Final Work Classification: Addition /Alteration Phone Number Parcel Number 1132060143790 Phone: (305)759 -5777 WEATHER HEAD WIRE REPLACEMENT Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments / Page 14 of 26 BUILDING PERMIT APPLICATION FBC 20 Permit Type: Electrical OWNER: Name (Fee Simple Titleholder): it ctio eller r WfU_1AtY190r1 Address: 1 hi E. 4 1/., 5 r City: dAI AMA Ott -O 6 Tenant/Lessee Name: Email: JOB ADDRESS: 1205 NIi~ � 7L9 5T City: Miami Shores County: Folio/Pareel #: 11 3 Zap - 6:4 -3 7 90 Is the Building Historically Designated: Yes Miami Shores Village Building Department 10050 N,E2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 Permit No. 11'0 Master Permit No. State: Fr_ Phone*: NO Miami Dade CONTRACTOR: Company Name: 1..6p46 7151C CO Address: LOSDO L 21 S ti Y -ve. _ t7 t re 1 City: 434.1" L LA 13t? -LtL. State: FL- Qualifier Namc: 12 G C�G2 t:v ia+t✓ {� _ 0 33346-1 Submittal Fee $ 5U' L.t✓ Permit Fee $. /5 ter Scanning Fee $ Radon Fee $ - Notary $ Training/Education Fee $ Double Fee $ Structural Review $ Phone# 4305 60S * Zip: 33 i 3 Zip: ..3.515g Flood Zone: Phone #: IN q' 4 Nil Zip: 3 a3i Phone #: ` q g'f tq State Certification or Registration #: t;.x e fi Certificate ofCompetency #: Contact Phone #: - 6 /1 L( 04n Email Address: „_1 ii Q I ii rd4 (t.(rcJri't DESIGNER: ArchitectiEnginccr: Phone#: Value nf Work for this Permit: $ 45 . 09 Square/Linear Footage of Work: Type of Work: UAddress GIAlteration tJNew 6dRepair /Replace DDemolition Description of Work: �1g t L' L!!CG - * * * * * * * * ** * ** ** * * ** * * * *****: *** * * * ** ** *Fee **** * * * *u * * *** * *x* *axe * *a * **** *Mrs * * ****** **** `'` i 7Li MAR 2 d 2011 ii.3 Y CO /CC $ Bond $ CCF $ DBPR $ Technology Fee $ TOTAL FEE NOW DUE $ ICC1 . 10 Bonding Company's Name (if applicable) Banding Company's Address City State Mortgage Lender's Name (if applicable) Mortgage L,ender's Address City State 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 encement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is iss the a nee of such posted notice, the inspection will not be proved a }• a reinspf cajun fee will be charged. Signatur . �„i / ' ■£ . X1. / Signstu Owner or Agent Contractor The fi,regoing instrument was acknowledged before me this ‘) The foregoing instrument was acknowled ed before me this day o? N'e r a . 20 I1 ,b aa,llo rWrnsue,k h®1 �� day of `LL's■- ,2t) ✓/ ,by O( 1 2_0i79` who is personally known to me or who has produced who is personally known to me or who has produced .. H tom. h., As identification and who did take an oath. as identification and who did take an oath. NOTARY PUBLIC! NOTARY PUBLIC; Sign: Print: My Commi (Revised 07 /10/07)(Reviscd O6/1012(X19)(ReviNed 3115109) Zip Print: My Commission Expires: NOTARY PUBLIC -STATE OF FLORIDA T. B. Plyler D705651 J2 / Vt Expires AUG. 16, 2011 ONDED THRU ATLANTIC BONDING CO., INC. / /6) e * * * *** **** ** ****** ***** **WMe********mope A******* ** Fig+k+N****d ******** s ** ** *.r* **N***** * * * ** ** ******* *bas * * * ** Lv// APPROVED BY , � . ,71 "/ 1 A 4 Plans Examiner Zoning Structural Review Clerk 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. MS TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF (MM /DD/YYYY) POLICY EXP (MM/DD/YYYY) LIMITS A GENERAL UABIUTY COMMERCIAL GENERAL LIABILITY OCCUR 22292 INSURER B : *FFVA Mutual Insurance Co.+ ZZJ765636500 03/10/11 03/10/12 EACH OCCURRENCE $ 1,000,000 X PAMAGE ( PREMISES (Ea RENTED occ urrence) $ 100,000 CLAIMS -MADE X MED EXP (Any one person) $ 5,000 PERSONAL 8 ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 U'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ 2,000,000 POLIC X !VT LOC Emp Ben. $ 1,000,000 C AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS 24CC29166601 03/10/11 03/10/12 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 X BODILY INJURY (Per person) $ X BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ X X $ $ A UMBRELLA UAB EXCESS LIAR X OCCUR CLAIMS -MADE UHJ765636000 03/10/11 03/10/12 EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5,000,000 DEDUCTIBLE RETENTION $ -0- $ X $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER /EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS Y / N N / A WC84000183242011A 01/01/11 01/01/12 WC STATU- OTH- X TORY LIMITS ER E.L. EACH ACCIDENT $ 500,000 E.L. DISEASE - EA EMPLOYEE $ 500,000 below E.L. DISEASE - POLICY LIMIT $ 500,000 A Leased /Rented Eqpt ZZJ765363500 03/10/11 03/10/12 Leased/ 100,000 Rented Eq DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule if more space is required) '4 ` � .. ° RL CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 03/10/11 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 )W. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED A��'RESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the the terms and conditions of the policy, certain policies may require an endorsement. certificate holder in lieu of such endorsement(s). policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to A statement on this certificate does not confer rights to the CONTACT NAME PRODUCER 954 -776 -2222 Brown & Brown of Florida, Inc. 954-7764446 1201 W Cypress Creek Rd # 130 P.O. Box 5727 Ft. Lauderdale, FL 33310 -5727 Andrew Noye, CIC, CRIS PHONE FAX INC. No. Ext): (A/C, No): E -MAIL ADDRESS: PRODUCER LANGE - 2 CUSTOMER ID #: INSURER(S) AFFORDING COVERAGE NAIC # INSURED Langer Electric Company dba Langer Electrical Services Co. 6500 NW 21st Ave, Suite #1 Fort Lauderdale, FL 33309 INSURER A : *Hanover Insurance Co.+ 22292 INSURER B : *FFVA Mutual Insurance Co.+ 10385 INSURER c : General Ins Co of America+ 24732 INSURER D : INSURER E : INSURER F : COVERAGES CERTIFICATE HOLDER Miami Shores Building & Zoning 10050 NE 2nd Ave Miami Shores, FL 33128 CERTIFICATE NUMBER: MIAMI -1 CANCELLATION AUTHORIZED REPRESENTATIVE • OP ID: J9 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. © 1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD