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EL-10-53Inspection Number: INSP - 133269 Scheduled Inspection Date: July 06, 2010 Inspector: Devaney, Michael Owner: FREIMAN, KEITH Job Address: 1135 NE 99 Street Project: <NONE> Contractor: CREST ELECTRIC INC Building Department Comments July 02, 2010 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 For Inspections please call: (305)762 -4949 Permit Number: EL- 1 -10 -53 Permit Type: Electrical - Residential Inspection Type: Final Work Classification: Addition /Alteration Phone Number (786)547 -9737 Parcel Number 1132050180060 Phone: (954)520 -2748 Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments Page 1 of 16 Project Address 1135 99 Street Miami Shores, FL 33138- 1132050180060 Block: Lot: LUCILLE SUSMAN Owner Information 1135 NE 99 ST MIAMI SHORES FL 33138 -2640 Contractor(s) CREST ELECTRIC INC Phone Cell Phone (954)520 -2748 Type of Work: ADD AC CIRCUIT Additional Info: ELECTRICAL Classification: Residential Fees Due CCF Education Surcharge Permit Fee - Additions/Alterations Scanning Fee Submittal Fee Submittal Reversal Fee Technology Fee Total: Amount $1.20 $0.40 $150.00 $3.00 $50.00 ($50.00) $1.60 $156.20 Authorized Signature: Owner / Applicant / Contractor / Agent Building Department Copy January 25, 2010 Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Address Expiration: 07/20/2010 Parcel Number Phone Invoice # Total Amt Paid Amt Due EL- 1- 10- 36811 $ 156.20 $ 10620 : ( 1 EL -1 -10 -36811 $ 156.20 $ 156.20 $ 0.00 Applicant Cell Date For Inspections please call: (305)762 -4949 Available Inspections: Inspection Type: Final Meter Box Alteration Relocation Fire Alarm Service Change Underground W. W. In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS 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. Futhermore, I authorize the above -named contractor to do the work stated. January 25, 2010 1 BUILDING PERMIT APPLICATION FBC 20 Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Job Address (where the work is being done) it 55 EJ . E 99 44 .• Architect/Engineer's Name (if applicable) Value of Work For this Permit $ J tO0 ' Q.° Type of Work: Addition DAlteration ❑New ❑ Repair/Replace Describe Work: ( r plasielA I n '✓ ; ®7j ; . t S A-1 'r KARI C �✓ Permit No. Master Permit No. Permit Type; ELECTRICAL Owner's Name (Fee Simple Titleholder) � Owner's Address p U.35 �. F. IT City M1'0,1 I or4 S State Fli Zip 3.3 /3 8 Tenant/Lessee Name — Phone # 7g4 -fit/ 7 - 9 73 7 Email fit tr m an Phone # '7 et. . 5 7 - $7 87 City Miami Shores Village County Miami -Dade Zip 33/38 FOLIO / PARCEL # (- T OT- 018 ^ bolo 0 Is Building Historically Designated YES NO r Flood Zone bf® Contractor's Company Name re S 1 te, yt c.." VA Z . Phone # q s 4 <5.-D-6 .2 7 el ? Contractor's Address 5Z3 i FJ 4AI Izi'bc. ( , ,1 1 , - City r 1' 31„,. 1.--‘ . State rL Zip 3't/ 9 O fr Qualifier Name ,,, a t l Plan r W K . ef Phone # 1 5 t � 7 31 $ State Certificate or Registration No. I C' 3 ()C) L-I 14 q Certificate of Competency No. Contact Phonee,SLI S 4 0 3-7 14 0 E -mail La 5 41, 14 -CJry l 6 ('n r, & a-4'- L etd--" IQ IPt Phone # �^ Square / Linear Footage Of Work: ❑ Demolition ** ******************a *** ***** r ***** **** * *** ***,x***** 4 Is/ ** *,** * * *** ** * ***,x+��x:��x�x ******* fNcP � Submittal Fee $ Permit Fee $ / -*--0% . CCF $ 0' j ,0 CO/CC Notary $ Training/Education Fee $ 0.20 Technology Fee $ 0. Scanning $ 64 LJI.J Radon $ Bond $ Code Enforcement $ Double Fee $ Structural Review. $ Total Fee Now Due $ I OP •2.0 Se Reverse side -* DPBR $ Zoning $ 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 ha commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulatin: 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 AtPIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with al 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 he approved and a reinspection fee will be charged. Signature NOTARY PUBLIC: /vf Owner or Agent The foregoing instrument was acknowledged before me this day of ,20 lb, by who is personally known to me or who has produced ff C . met", As identification and who did take an oath. Se. AROSE ,gym MY COMMISSION # DD868439 ry • SXPIRES March 10, zut3 p i1P3 .._- .._. Florldallota see.ca" Sign: pp Print: 2 ttwd L8t My Commission Expires: '311 *** * ** * ** * :kaa * * ** ** *Z w; * e P* 3e *= kd: ek* *d: *ok*3e*rxxes $a2 dexeT4,e*sk**^*. * *nR*>Snk *ek *** * * *** ** RAC ****" ak ** * * **d:* d<*u **** APPLICATION APPROVED BY (Revised 07/10/07) it �/� /, , Plans Examiner Engineer Signature Contractor T `152 (-12-.cg mo e foregoing instrument before me this day of glibi ✓.Kle , 20 L U , by Sra(... •J who is personally known to me or who has produced R'>!.1.0 as identification and who did take an oath. NOTARY PUBLIC: Sign: � � ..',''% f ‘11)11\41 Print: Qi �� . My Commission Expir s: Pat /` ,/ , ' ,�'. . 'sal � oifit, iii 0 1%0 Zoning Clerk checked CIR. EQUIPMENT 1 Gen. Light's,Bedroom 2 Gen. Light's,Kitchen 3 Gen. Light's,Living Room /Dining Room 4 Gen. Light's,Master Bedroom 5 Gen. Light's,Garage 6 Gen. Lights,Bedroom # 2 7 Gen.Light's,Garage Receptacles 8 Gen.Light's,Bath#2/Hall 9 Small Appliances Small Appliances 10 11 Dishwasher 12 Disposal 14 Washer 16 Refrigerator 18,20 DRYER 22,24 WATER HEATER 13,15 Oven /Range 17,19 Air HandlerUti1 VOLTAGE POLE LOAD BREAKER WIRE LIGHTING CIR. ONLY 120 1 1,200 15 14 1,200 120 1 1,200 15 14 1,200 120 1 1,200 15 14 1,200 120 1 1,200 15 14 1,200 120 1 1,200 15 14 1,200 120 1 1,200 15 14 1,200 120 1 1,200 15 14 1,200 120 1 1,500 15 14 1,200 120 1 1,500 20 12 120 1 1,500 20 12 120 1 1,500 20 12 129 1 1,000 20 12 1AI 1 1,500 20 12 p A TE 12 1 1,500 20 12 240 2 5,000 30 10 24d 2 4,500 25 10 21,23 Air H,andl i% n '017 AI i_ FF IR L 240 A/C Unit #1 24d A/C Unit #2 240 24d 2 12,000 50 6 -- -2401 2 200 15 10 2 200 15 10 2 3,600 30 12 2 2,400 25 12 ACTUAL LIGHTING POWER AT 3VA/SQ.FOOT WHOLE HOUSE= 1,890 *3 SQ. FT.= 5,670 ACTUAL TOTAL PANEL LOAD = 46,300 LESS A/C VS HEAT. LESS LIGHTING CIRCUITS INCLUDED ABOVE - 9,600 LESS A/C VS HEAT - 6,400 #1 A/C 100 % = 3,600 TOTAL 35,970 #1 HEAT 65 %= 200 FIRST 10,000 AT 100% 10,000 #2 A/C 100 % = 2,400 REMAINING AT 40% = 10,388 #2 HEAT 65 %= 200 A/C 100 % = 6,000 HEAT 65 %= 400 TOTAL V.A. LOAD / 240 VOLTS = 111.62 AMPERAGE 125 AMP MAIN DISCONNECT/ METER STEP1 220.82(A),(B)(1) &(2) GENERAL LIGHTING STEP2 220.82,(B)(3) APPLIANCES STEP3 MOTORS STEP4 220.82,(C)(5)&220.60 HEATING AND AIR - CONDITIONING STEP5 TABLE220.55 RANGE DEMAND STEP6 310- 15(b)(6) WIRE SIZE STEP? TABLE 250 -122 EQUIPMENT GROUNDING CONDUCTOR O Ju1Qr ' f r i e?. Vnc.h 135 14- 49 �- MiCOmt Ok , F L ITL Ov i I'D t i tt~ o p. W tcH.h Vc 4.A lo • V • 1r I 6 0,01. 3- I wwv, OFFICE (954)- 579 -4271 ELECTRICAL PANEL SCHEDULE 1 e ' Urowi-d Rod CREST ELECTRIC IN • • ,• •'. • •• • •• • • • • •• • • • • • •• • •• • • ••• •• •• •• • • • • • • • • • • • • • ••• • • • • • • • :: FX ($4)$77 • • •.• • • STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION FLANAGAN, JACKIE HAROLD CREST ELECTRIC INC 5234 NW REBA CIRCLE PORT ST LUCIE FL 34986 Congratulations! With this license you become one of the nearly one million Floridians licensed by the Department of Business and Professional Regulation. Our professionals and businesses range from architects to yacht brokers, from boxers to barbeque restaurants, and they keep Florida's economy strong. Every day we work to Improve the way we do business in order to serve you better. For information about our services, please log onto www.myfioridaiicense.com. There you can find more information about our divisions and the regulations that impact you, subscribe to department newsletters and learn more about the Department's initiatives. Our mission at the Department is: License Efficiently, Regulate Fairly. We constantly strive to serve you better so that you can serve your customers. Thank you for doing business in Florida, and congratulations on your new license! AC# 44252 8 3 STATE OF FLORIDA DEPARTMENT OF BUSINESS_ AND PROFESSIONAL REGULATION ELECTRICAL• CONTRACTORS :LICENSING BOARD SEQ# L09060200154 ELECTRICAL CONTRACTORS LICENSING BOARD (850) 487 -1395 1940 NORTH MONROE STREET TALLAHASSEE FL 32399 -0783 DATE BATCH NUMBER CHARLIE CRIST GOVERNOR LICENSE NBR 06/02 /2009 080447726 EC13004199 The ELECTRICAL CONTRACTOR Named below IS CERTIFIED - Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2010 FLANAGAN.,, JACKIE HAROLD CREST ELECTR.I=C.:INC 5234 NW REBA CIR PORT ST LUCIE FL 34986 DETACH HERE DISPLAY AS REQUIRED BY LAW STATE OF FLORIDA AC# 442522 DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION EC13004199 06/02/09 080447726 CERTIFIED ELECTRICAL CONTRACTOR FLANAGAN, JACKIE HAROLD CREST ELECTRIC INC IS CERTIFIED under the provision of Ch.489 i Expiration date: AUG 31, 2010 L09060200154 CHARLES W. DRAGO SECRETARY EFFECTIVE DATE: 07/31/2009 EXPIRATION DATE: 07/31/2011 PERSON: FLANAGAN JACKIE FEIN: 651093959 BUSINESS NAME AND ADDRESS: CREST ELECTRIC INC 5234 NW REBA CIR PORT SAINT LUCIE FL 34986 SCOPES OF BUSINESS OR TRADE: 1- ELECTRICAL CONTRACTOR DWC -262• CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 09 -06 DWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 09 -06 CUT HERE 06 -25 -2009 ALEX SINK STATE OF FLORIDA CHIEF FINANCIAL OFFICER DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION * * CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law. IMPORTANT: Pursuant to Chapter 440 . 05114), F.S., an officer of a corporation who elects exemption from this chapter by filing a certificate of election under this section may not recover benefits or compensation under this chapter. Pursuant to Chapter 440.06112), F.S., Certificates of election to be exempt... apply only within the scope of the business or trade listed on the notice of election to be exempt. Pursuant to Chapter 440.05(13), F.S., Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation if, at any time after the filing of the notice or the issuance of the certificate, the person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate. The department shall revoke a certificate at any time for failure of the person named on the certificate to meet the requirements of this section. QUESTIONS? (850) 413 -16 PLEASE CUT OUT THE CARD BELOW AND RETAIN FOR FUTURE REFERENCE STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS COMPENSATION CONSTRUCTION INDUSTRY CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW EFFECTIVE 07/31/2009 EXPIRATION DATE: 07/31/2011 PERSON: JACKIE FLANAGAN FEIN: 651093959 BUSINESS NAME AND ADDRESS: CREST ELECTRIC INC 5234 NW REBA CIR PORT SAINT LUCIE, FL 349B8 SCOPE OF BUSINESS OR TRADE: 1- ELECTRICAL CONTRACTOR IMPORTANT Pursuant to Chapter 440.05(14), F.S., an officer of a corporation who elects exemption from this chapter by filing a certificate of election L under this section may not recover benefits or compensation under this D chapter. Pursuant to Chapter 440.05(12), F.S., Certificates of election to be H exempt.. apply only within the scope of the business or trade listed on E the notice of election to be exempt R E Pursuant to Chapter 440.05(13), F.S., Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation if, at any time after the filing of the notice or the issuance of the certificate, the person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate. The department shall revoke a certificate at any time for failure of the person named on the certificate to meet the requirements of this section. * Carry bottom portion on the job, keep upper portion for your records. QUESTIONS? (850) 413 -1609 Business Address: 5234 NW REBA CIR daSsifitation::' CONT CONTRACTOR liaised 'CREST ELECTRIC INC 5234 NW REBA CIR Fees: 121.55 Late Fees: 0.00 Total this payment : 121.55 dce aran that ihe s ter t pertc,rn-, paid the re.quired tax arid reo,F:sszi-, ) fcir husiriess.. anj re.uiatd iracie .'icans ciriirrieenc!,. CITY OF PORT LLK,IE LOCAL BUSINESS TAX RECEIPT ret TERM: October 1, 2009 to September 30, 2010 Jij sec ic e receipt hclirer is pcimpe;erit io perform in the business, rha t the holder has paid the required tax. 04* and regulaied trade fc..c.-nses / competency cards ai va!id f thE: , :t.;rrerit fiscal year as required by law. RECEir MKT BE EXHIBITED CONSPICUOUSLY AT YOUR PLACE Of' BUSINESS VALID AT TN'S BUS,INESS ADDRESS ONLY PORT ST LUCIE, FL 34986 THIS iS A RECEIPT FOR TAX PAID AND IS NOT REGULATORY IN NATURE 2bJW / TI-B:; RECEIPT BE EXPairEitrAMAktiati61/6: YO2oo9kat6litikiirr 30 8t� iMss AdOSSOL 34NVy REBA CIR Classification: CONT CONTRACTOR Issued to: THCS2r,StgLECTATCTINCR TAX PAM AND t S7 NOT 5234 NW REBA CIR PORT ST LUCIE, FL 34988 Business Tax 124180 10-1035092 Fee: 121.55 Discount: 0.00 -77 TAX AL R1TY bs Ines 10 92 F 121.56 Discount: 0.00 REGU . t:N NATURE 2010 .0 II • a.ara.ac awn i i Wi..AL IbUS INt55 TAX RECEIPT "" ivvtyci BOB DAVIS, CPA, CGFO, CFC, ST. LUCIE COUNTY TAX COLLECTOR EXPIRES September 30, 201( 0/ 0 ROOMS 0 SEATS 0 EMPLOYEES 1 1731 ELECTRICAL CONTRACTOR / ELECTRICAL CONTRACTOR FACILITIES OR MACHINES TYPE OF BUSINESS BUSINESS Jackie H Flanagan NAME DBA NAME Crest Electric Inc MAILING Jackie H Flanagan ADDRESS 5234 NW Reba Circle Port St Lucie, FL 34986 BUSINESS 5234 NW Reba Circle LOCATION Port St Lucie, FL 34986 City of Pt St Lucie P01000022753 ONLY -- 07/09/2009 21 20090709 - 002674 12.35 Check Law requires this Local Business Tax Receipt to be displayed conspicuously at the place of business in such a manner that it can be open to the view of the public and subject to inspection by all duly authorized officers of the county. Upon failure to do so, th Local Business Taxpayer shall be subject to the payment of another Local Business Tax for the same business, profession, or occupation. Pursuant to State Law, all Local Business Tax Receipts shall be sold by the Tax Collector beginning August 1st of each year and shall expire on September 30th of the succeeding year. Those Local Business Tax Receipts renewed beginning October 1st shall be delinquent and subject to a delinquency penalty of 10% for the month of October, plus an additional 5% penalty for each month of delinquency thereafter until paid; provided that the total delinquency penalty shall not exceed 25% of the Local Business Tax for the delinquent establishment. In addition to the penalty, the Tax Collector shall be entitled to a collection cost fee of from $1.00 to $5.00, based on the amour of the Local Business Tax, which shall be collected from delinquent taxpayers after September 30th, of the business year. This receipt is a Local Business Tax only. It does not permit the Local Business Taxpayer to violate any existing regulatory or zoning laws of the state, county or cities. It also does not exempt the Local Business Taxpayer from any other taxes, licenses or permits that may be required by law. Local Business Taxes are subject to change according to law. Jackie H Flanagan 5234 NW Reba Circle Port St Lucie, FL 34986 PSL05 -6593 x RENEWAL NEW RECEIPT TRANSFER - ORIGINAL TAX $12 AMOUNT $12 PENALTY COLLECTION COST TOTAL $12 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. INbK LTR 4L/L) L NSRC TYPE OF INSURANCE POLICY NUMBER POLICY E1-1-EC I IVI_ DATE (MM/DD/YYYY) I'VLICY EXI'IRA I ION DATE (MM/DD/YYW) LIMITS A GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY FLR36749 05/29/09 05/29/10 EACH OCCURRENCE $1,000,000 X PREMISES (Eaoccuence) $ 100,000 CLAIMS MADE X OCCUR MED EXP (Any one person) $5,000 X $250 DEDUCTIBLE PERSONAL 8 ADV INJURY $1,000,000 GENERAL AGGREGATE $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ 1,000,000 X POLICY PRO- n 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: AGO $ EXCESS / UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE RETENTION $ $ $ WORKERS AND EMPLOYERS' ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER (Mandatory If yes, describe SPECIAL PROVISIONS COMPENSATION LIABILITY Y / N WC blAIU- 0 TORY LIMITS ER EXCLUDED? I ` I E.L. EACH ACCIDENT $ In NH) under below E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS Electrical within Bldgs - subject to the terms, conditions & the policy. Proof of Insurance Only. exclusions of From:Nancy Nocifora FaxID: R CERTIFICATE OF LIABILITY INSURANCE PRODUCER P.J.K. INSURANCE, INC. 2500 NORTH POWERLINE ROAD POMPANO BEACH FL 33069 Phone:954- 979 -5855 Fax:954- 979 -6788 INSURED Crest Electric Inc. 5234 NW Reba Circle Port St. Lucie FL 34986 CREST --1 1 01/12/10 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: American Strategic Ins. Corp INSURER B: INSURER C: INSURER D: INSURER E: DATE (MM/DD/YYYY) NAIC # 10872 COVERAGES Miami Shores Village 10050 NE 2 Avenue Miami Shores FL 33138 MIAMISV 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 ACORD 25 (2009/01) Page 2 of 2 CANCELLATION 9 The ACORD name and logo are registered marks of ACORD Date:01 /12/10 09:24 AM Page:2 of 2 ORPORATION. All rights reserved. Inspection Number: INSP- 134433 Scheduled Inspection Date: July 02, 2010 Inspector: Bruhn, Norman Owner: DAVIS, HERBERT Job Address: 46 NW 105 Street Project: <NONE> Contractor: HOME OWNER Building Department Comments paint exterior of the house Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments e'G July 01, 2010 Miami Shores, FL 33150- 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 Number: PT -1 -10 -140 Permit Type: Paint Inspection Type: Final Work Classification: New Phone Number Parcel Number 1121360131190 Page 3 of 14 Inspection Number: INSP - 134433 Permit Number: PT -1 -10 -140 Scheduled Inspection Date: July 02, 2010 Inspector: Bruhn, Norman Owner: DAVIS, HERBERT Job Address: 46 NW 105 Street Project: <NONE> Contractor: HOME OWNER Building Department Comments paint exterior of the house Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments July 01, 2010 Miami Shores, FL 33150- 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: Paint Inspection Type: Final Work Classification: New Phone Number Parcel Number 1121360131190 Page 3 of 14 Project Address 46 105 Street Miami Shores, FL 33150- 1121360131190 Block: Lot: HERBERT DAVIS Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138-0000 Phone: (305)795 -2204 Fees Due CCF Education Surcharge Notary Fee Permit Fee Technology Fee Total: Amount $0.60 $0.20 $5.00 $60.00 $0.80 $66.60 Parcel Number Contractor(s) HOME OWNER Phone Cell Phone Type: Pain alert: Ne w ROVED Expiration: 08/01/2010 Applicant Valuation: Total Sq Feet: Type of Work: Exterior Color: Additional Info: Classification: Residential Color. _Approved Color. Approved_ Code Comments: OLYMPIC - WALLS, CHIMNEY - LI Color. _Denied Invoice PT - 1 - 10 - 36922 Total Amt Paid Amt Due $ 66.60 $ 66.60 $ 0.00 $ 1,000.00 0 For inspections please call: (305)762 -4949 Available Inspections: Inspection Type: Final In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL PLUMBING, MECHANICAL WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS 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. Futhermore, I authorize the above-named contractor to do the work stated. Authorized Signature: Owner / Applicant / Contractor I Agent Building Department Copy February 02, 2010 Date February 02, 2010 1 Miami Shores Village o Z G TE B d II Building Department 10050 N.E.2nd Avenue. Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 B BUILDING Permit No. 10140 PERMIT APPLICATION FsC.111111 Permit Type: PAINT PERMIT Owner's Name (Fee Simple Titleholder) /lCie /1 D4 v/S Phone # 3 d'S 9 8)-r 7 2 2 2_ Owner's Address / V(p /1J , / d S S -I` City 41/- -r7, S OR eS State FL Zip 3 3 15 Q Tenant/Lessee Name E -MAIL: Job Address (where the work is being done) City Miami Shores Villag,e County Miami -Dade FOLIO / PARCEL # Is Building Historically Designated YES Contractor's Company Name Contractor's Address City State Qualifier Name OWNER BUILDER: Phone # , .` 1, « NO Master Permit No. Zip Zip Phone # State Certificate or Registration No. Certificate of Competency No. Value of Work For this Permit $ 000 `a) Type of Work: ❑ Addition / t Alteration'/ [i14 w?t Repair /Replace Describe Work: !✓---/— s O teJ S i 2 t .I + , _ . Application is hereby made to obtain a permit to do the work and installations as indicated. I bertil,y that po work or installation has prior to t t he issuance of a permit and that all work will We performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a srtiphrace permit Mint he secpr d liar ELECTRICAL. WORK. PLUMBING. SIGNS, WELLS. POOLS. FURNACES, BOILERS. HEATERS. TANKS and AIR CONDITt.O 1ERS, ETC. "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, YOUR LENDER OIL AN ATTORNEY BEFORI! 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 netst promise in good faith that a copy of the notice of commencement and construction hen law brochure will be delivered to the person whose property is subject to attachment. Also. a certified copy of recorded notice of commencement must he 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 he approved and a reinspection fee will be charged. *xxaie********.* is xxde****xxxxx4c*xetdcxxxx*at F nYeYe4*xs4ot'*****xaYxxxxxzxxxz* ****Yxxxzxx Permit Fee $ • 'CO CCF ''1 • / Technology Fee: 1C> - 1111 � T Training /Education Fee $ 0 Notary $ �•3 Code Enforcement $ r,, Double Fee $ Zoning $. Total Fee Now Due .$ Vl (0 See Reverse side - Directions: Please circle corresponding number to appropriate color sample. Wall's: Fascia: Drip Cap /Drip Edge: Softit: I Roof: * PAK *AK OS Flower Bins: Shutters: Awnings: Chimney: Doors and Door Jams: Garage Doors: I Railings: Fences: Any other Stucco Features: day oli 1 ii L. 20 vho is NOTA Sign: Print: My Commission Expires: ation at ******xxxxxxxxxxxxxxxxxxxxxxx PAINT COLOR APPROVAL AND AGREEMENT All elements on the site must be listed and indicate the color to be painted • All brick (simulated or regular): Stucco Bandint: I SignatureV • Owner or Agent The tiire oinginstrument was ad nowl �i :L 3 I efore me this rsonallv known to me or who has produced .2 V B� r� LSD ►� vho did take an oath. 4 4 4 4 4 4 4 4 4 4 Accessory Buildings Other: Attach col LIGHT SAGE c67-3 WHITE SMOKE POPPY PODS pies with name and ber. 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. Signature Contractor The foregoing instrument was acknowledged before me this day or . 20 . by vho is personally known to me or who has produced as identification and who did take an oath. ,VOTARV PUBLIC: . Yi ant: �� , �• Fes G ° M V y Commission Expires: %n•n ' ��tl t xxxxx x • xxx xxx xx*eYdc.**, px xxx xx*.*w xx#&• xx•k+ Ka4v1; 4ru v4xxxxx* x : APPLICATION APPROVED BY: Plaits Examiner • Preservation Board Code Enlorcement (Revised 04/24/0;