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EL-10-269 2d Raw's1Y Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138 -0000 APPREa Phone: (305)795 -2204 Expiration: 0 2 201 Project Address Parcel Number Applicant 1190 100 Street 1132050180020 MARK TERRY Miami Shores, FL 33138- Block: Lot: Owner Information Address Phone Cell MARK TERRY 1190 NE 100 ST (786)443 -7720 MIAMI SHORES FL 33138 -2602 Contractor(s) Phone Cell Phone Valuation: $ 1,500.00 DOMINIX ELECTRIC INC (305)944 - 1077 Total Sq Feet: 0 Type of Work: REPLACE ELECTRICAL PANEL For inspections please call: Additional Info: ELECTRICAL (305)762 -4949 Classification: Residential Available Inspections: Inspection Type: Fees Due Amount Invoice # Invoice Total Amt Paid Amt Due CCF $1,20 EL -2 -10 -37096 Education Surcharge $0.40 $156.20 $156.20 $0.00 Permit Fee - Additions/Alterations $150.00 Scanning Fee $3.00 Submittal Fee $50.00 Submittal Reversal Fee ($50.00) Technology Fee $1.60 Total: $156.20 Building Department Copy March 05, 2010 2 yo Miami Shores Village g Building F EB Department 2 2 2 010 p 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 BY� .;.r.�T�t.... INSPECTION'S PHONE NUMBER:.(305), 762.4949 BUILDING Permit No. 9 PERMIT APPLICATION Master Permit No. FBC 20 Permit Type: ELECTRICAL Owner's Name (Fee Simple Titleholder S ,q �. � � � Q Phone # ' 6 05 Owner's Address 4 t �gS •� �. �� I City �/ �£ Stat Zip I Co Tenant/Lessee Name ! C. } Q Phone # 4 62" 4'[ ''Q 5 6 (- lq Email _rA.M 14 R!Do Job Address (where the work is being done) City Miami Shores Village _ County Miami -Dade Zip FOLIO / PARCEL # / 1- 320 5 - - Q19- 00 2 Q Is Building Historically Designated YES NO Flood Zone Contractor's Company Name b ®n t 1-4 I- K �C l � Z, G Phone # 3 0 5 �� /0? Contractor's Address P-0 9, S` e{ City State Zip 2 2 -2 >1 Qualifier Name tZ o6 _ I p f Phone # 30 9 (-/ L( to? State Certificate or Registration No. " 0 0 0 ® n - K j 0 Certificate of Competency No. Contact Phone W A L (6 t2 15Y — 55? — 16'5 (mail Architect/Engineer's Name (if applicable) Phone # Value of Work For this Permit $ C,00 d'Q Square / Linear Foota a Of Work: Type of Work: Addition []Alteration QNew Repair/Replace ❑ Demolition Describe Work: A e4-ra. cvmd Ao/tom S Submittal Fee _ $ , •(� Permit Fee $ � CCF $ �* CO/CC $ Al Notary $ Training/Education Fee $ Technology Fee $ Scanning $ 3 Radon $ DPBR $ Bond $ Double Fee $ Violation date: Structural Review. $ 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 wilfbe done in compliance with all applicable laws regulating construction and zoning. "WARNING T , 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 inspect' n=eand a re- inspection fee will be 'charged. Signature r, Signa Owner or Agent Contractor The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of r6 &,0 , 20 /D , by �t/ MVD T .E'C/�,! day of d 04 - , 20/, by X who is personally known to me or who has produced who is personally known to me or who has produced As identification and who did ta�IW as identification and who did take an oath. NOTARY PUBLI . ��`N© 3 A;pgg NOTARY PUB C: ��` "..�Q� „ Sign: = * • `� `� * _ Sign: Print: M 7h� /� ��L %o NDL1856+17t Print: �G ,a . O`r My Commission Expires: fi ; M y ES: Jum 4, 20t3Wdff**" 0 , 01 0 APPROVED BY 7 -11) �3 Plans Examiner Zoning Engineer Clerk checked (Revised 07 /10 /07)(Revised 06/10/2009) p a : 1..{3 D E -. .� :< - _r , . w 4, v, W - - TT •��j-3 FR� P[�'/' _ - AD {'7. 0 8 RA 2�Of�8. :- `,.'•: CO The ELECT RI CAL. NT :�z: _. N'am @d .},elov�r ..IS CERTIFI- U nder .the -- rovzsxons:O : Cha iration.:'- -.date : .AZTG:::.3:� : t _t ?: IX. BERG` - J ' I10MI .RD DOM N IX. -.. I ECTRIC _ Cl C; .E - - ` 207a._ NE' S T. ..MIAMI- .BEACH;. ' -t = .:- : -J :: :.:..: a .. 5 C FIA�RL I CRI CH14RfitE.SbW'., } J GOVERNO . R _.....:- a= :__.;� :: ".... �)1SPLAY;AS . a�EQU[REC�: BY LAW'` .. .. TAR Y, _ - -: �q 99.}3 P�Pla7■ m�ppgg--..pp.. �ygq��g))yy !Yi.YAi:s .. d�4 ._ .. Oft Err PAW B � ... _ ... .. I,n v k.. � ••-... �. `1ItE V42 �A�( .:....... .'.. }/ 25245- +'...: ......:.:...:.':.":.':.::.:-..:....:.-:'.:..-.....:.-.:-..'........'..:...:.:-:....:.... '....'..............KEt��iWA{-. :.... _..: :......:: :: 0252452- .:��C ?:LNG:::' �'::::::::. ::: 33162_:NOiiTH: �IEdCt.... .. .....:... ............... ... ' IKIX: eLECTR'IC ::Igt :: "BOBB NOT PERMIT THE--..:;....• a::' i:;'.`:-:::.:<. �:-<: r�i::: �<: �:'::--:::':':' is�::::>':-::`:::: �:'>'''".:•_:.:.::::..: :- >':::::;:c. :. ::.- :...:-.�'.�` '...:'•.:� -... HOLDER TO VIOLATE ANY : '.£VINO OR REC3ULATORY: - -- ' ORZONRIGLAWSOFTHE'. DO NOT FORWARD — — : WlffY -oR OMEB. NOR: -DOES IT-.EXEMPT -THE. - .I10�PROMANYOTHER DOMINIX ELECTRIC I PERMITIO ROBERT J DOMINIX PRES :NqT A A cERrRxaAri :RE« WITIRCATI oN'oF: 2075 NE 154 ST - THE.HOLDER S OUALIRC&': N MIAMI BEACH FL 33162 aav�atrirsECd�b .: :. NNAA91^ mm GOUNTYTAx •. :: S: OO1flDt1 11fl6: 7::::' tl�t ttiitts► IttII} tttiettFF�e l�utt�tltt�t�tue�ifell From: Brown & Brown of Florida, Inc. To: 3058911473 Page: 2/3 Date: 2/12!2010 2:27:07 PM ACORD CERTIFICATE OF LIABILITY INSURANCE OP ID C6 DOMIN -1 02/12/10 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE BROWN & BROWN OF FLORIDA INC HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 8000 GOVERNORS SQUARE BLVD 400 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. MIAMI FAKES FL 33016 -1588 Phone: 305 - 364 -7800 Fax:305 -822 -5687 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: BRIDOEFXEW MELOYMS INS CO 10701 INSURER R. FCCI INSURANCE COMPANY 10178 DOMINI% ELECTRIC INC INSURER C: 2075 NE 154TH STREET INSURER D: NORTH MIAMI BEACH EL 33162 INSURER E COVERAGES 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 HEM IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS DATE (MM/DONY) DATE ONY) GENERAL LI UMM EACH OCCURRENCE $ 1000000 • % COMMERCIAL. GENERAL LIABILITY CPP0009927 04/01/09 04/01/10 pREMLSES(EaOCauerxe) $ 100000 CLAIMS MADE ® OCCUR MED EXP (Airy One person) $ 5000 PERSONAL BADV INJURY $ 1000000 % $1000 EMPLY BEN D GENERALAGGREGATE $ 2000000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS- COMP/OP AGO $ 2000000 17 POLICY PECOT LOC Ben. 1/1000000 AUTOMOBILE LIABILITY • % ANYAUTO CA0013271 04/01/09 04/01/10 (Ean rEDSwGLELmnr $ 1000000 (Ea acciderrt) ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per aurclent) GARAGE LIABILITY AUTO ONLY - EAACCIDENT $ / ANY AUTO OTHER THAN EAACC $ AUTO ONLY: AGO $ EXCESBAIMBRELIA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WC STATU- OTI+ WORKERS COMPENSATION AND TORY LIeITS ER A EMPLOYERS'LIABILTTY 0830 -37300 01/01/10 01/01/11 E.LEACHACCIDENr $ 100000 ANY PROPRIETORIPARTNERIEXECUTNE OFFICERIMEMSER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $ 100000 It yes, describe under SPECIAL PROVISIONS below E DISEASE - POLICY LIMIT $ 500000 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS /VEHICLES /EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS ELECTRICAL CONTRACTOR CERTIFICATE HOLDER CANCELLATION MIA -138 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO RIK 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FMAM TO DO SO SHALL MIAMI SHORES VILLAGE 10050 NE 2 AVENUE IMPOSE No OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER ITS AGENTS OR MIAMI SHORES FL 33138 REPRESENTATIVES. REPRESENTATIVE ACORD 25 (2001108) 0 ACORD CORPORATION 1988 From: Brown & Brown of Florida, Inc. To: 3058911473 Page: 3/3 Date: 2112/2010 2:27:07 PM IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). If SUBROGATION IS 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). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25 (2001108) 7 w1ami Shores Village APPROVED BY DATE FEB 2 2 ZONING DEPT BLDG DEPT SUBJECT CO CCMPI.IANCE WITH ALL FEDERAL STATE AND CC UN iY HULES AND REGULATIONS DOMIN1A ELECTRIC ELECTRICAL DRAWING; 2075 NIE 154 ST NOTB REMOVING TWO N.M.B FLA,33162 EXISTING 100 A PNL AND INSTALL TO A 225 A MLO PNL. NO LOAD ADD. METER COMBO 225A MLD • ' PNL • �' 200 A 42 CIR ...... •.. i.. MAIN 96 2 C 3A 210 FPL POLE W.PIPE EXISTING 2° C ' .R 3x3/0 � Dt?LLYE t0�y�� `o,1 MY ary Public . � f Awma commission 0 DD 80895312 Z --- Y t-- - 2..107 DOMINIX ELECTIC 2075 NE 154 ST N.M.B,FLA.33102 JOB SITE] 1190 NE 100 ST NORT 0.00 11 AVE ...... , ..... . .. ...... A i f • • �+ EAST a7 .f.if. • •• T ..w.i .. 0.00• 100 ST HOUSE .. 0 •.. • .wii • • 00 FRONT RNL METER SOUTH COMBO Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 139574 Permit Number: EL -2 -10 -269 Scheduled Inspection Date: April 05, 2010 Permit Type: Electrical Residential Inspector: Devaney, Michael Inspection Type: Final Owner: TERRY, MARK Work Classifcation: Alteration Job Address: 1190 NE 100 Street Miami Shores, FL 33138 - Phone Number (786)443 -7720 Parcel Number 1132050180020 Project: <NONE> Contractor: DOMINIX ELECTRIC INC Phone: (305)944 -1077 Building Department Comments REMOVE EXISITNG ELECTRICAL PANEL INLAUNDRY ROOM AND REPLACE IT WITH A 200 A SURFACE MOUNTED. NO ADDITIONAL LOAD ADDED. Inspector Comments Passed Failed Correction Needed Re- Inspection ❑ Fee No Additional Inspections can be scheduled until re- inspection fee is paid. April 02, 2010 For Inspections please call: (305)762 -4949 Page 12 of 18 s --