EL-11-102Scheduled Inspection Date: March 28, 2011
Inspector: Devaney, Michael
Owner: CARLSON, SUSAN
Job Address: 1300 NE 104 Street
Project: <NONE>
Miami Shores, FL 33138-
Contractor: MEDALLION ELECTRIC INC
Building Department Comments
March 25, 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 - 155113 Permit Number: EL -1 -11 -102
For Inspections please call: (305)762 -4949
Permit Type: Electrical - Residential
Inspection Type: lytih
Work Classification: Addition /Alteration
Phone Number
Parcel Number 1122320300110
Phone: (954)753 -1599
UPDATE ELECTRICAL PANEL INSIDE THE HOUSE
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
Page 9 of 27
All 13 1
B DING
PE ' I T APPLICATION
FBC
Permi Type: Electrical
Miami Shores Village
Building Department
0 : Name (Fee Simple Titleholder): 31/.941 ) `rte` sb ,r) Phone#: (52<- 8
Ad i / V zK r -- • /'
City: /r / n it.,,,,;47, J' %-v state: i eL_ Zip:
Tenan - Name- Phone#:
Email•
4
JOB DRESS: /'& rr /17 `f
City: Miami Shores
Folio/P 1 #:
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949
Permit No. ' �1
County: Miami Dade
Is the 1 ding Historically Designated: Yes NO Flood Zone:
Master Permit No
CO CTOR: Company Name:
Ad. - ( 52OP, (f o '/?
Cit ,.. 5 State: 4 Zip:
Qualifi. Name: • r j J. r LA i 1; Phone# :9c x-1,5 99
State C fication or ` Registration #: /3 /, / 6 I Certificate of Competency #:
Contact i' hone#:_ 7 ,5 Email Address: /G - /`C.( M)/¼X •/
DESIG ' : Architect/Engineer: Phone#:
Value Work for this Permit: $ /57:0, Square/Linear Footage of Work:
Type o Work: OAdIress ®® ElAlteration ONew p ' Repair/Replace ; , ODemolition
Descri �'on of Work: fd (ft* 61 /Ci-/- /Y / � gl../k)e / a/ -, i Ve -
********* * * * * * * * * * * * * * * * * * * * * * * * * * ** * * *F * * * * * * * * * * * * * *** **** Ern ****** * * * * * * * ** * ** ****
Sub Fee $ Permit Fee $ /- eP'ee - - CC F $ CO/CC $
S g Fee $ Radon Fee $ DBPR $ Bond $
Notary ,: Training/Education Fee $ Technology Fee $ _.._._.._
Double ee.$ Structural Review $
TOTAL FEE NOW DUE $ � Q •777
3.
1"Ir!,0171
BY:
Zip:
Phone#: T 433 / 9�
Bonding Company's Name (if applicable)
Bonding- Company's Address
City
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City State
Application is hereby made to obtain a permit to do the work and installations as indicated. 1 certify that no work or instal
commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws r
construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING,
WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC
OWNER'S Mr WUAVIT: 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 NOTE OF
COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR
IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OE . AIN
FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BE ORE
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 applic must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to person
whose properly is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at th' 'ob site
for the first inspection which occurs seven (7) days after the building permit is issued In the absence of such posted no e, the
inspection will not be approved and a reinspection fee will be charged
Signature / /
Owner or Agent
The foregoing instrument was acknowledged before thi s
day of ,20 ,h SUS hpiGl Oar
who is perso own to me or who has oduced
As identification an who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
My Commissio
w
APPROVED BY
D
C . 732291
Expires RPLbr1U12
Florida Notary Asst„ lan =
m�
**** :*R****sk+K** *** ***** ****Dk**ksfs***K ***ob i+ 4r******# ***** ***** ***k*ck'.dsL• ****k** *** r ° * sFs**
(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09)
Plans Examiner
Structural Review
111 re iMIUN#
rirb
State Zip
Contractor
The foregoing instrument was acknowledged before me s 1 4
day of p ►.ar, -1 , 20 1L, by 121,a n - 4 -) c_ f r
who is personally known to me or who has produced
as identification and who did take
NOTARY PUBLIC:
My Commission Exp
Zip
a
ning
erk
CONTRACTORS' REGISTRATION FORM
ALL CONTRACTORS MUST PROVIDE COPIES OF LICENCES AND INSURANCES EACH TIME A PERMIT IS
SUBMITTED OR THE VILLAGE MAY MAINTAIN A FILE WITH YOUR INFORMATION FOR A $30.00 FEE PER YEAR.
IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR:
A. COPY OF QUALIFIER'S STATE LIC CARD
B. ✓ COPY OF LOCAL BUSINESS TAX RECEIPT
C. COPY OF LIABILITY INSURANCE (CERTIFICATE HOLDER TO BE MIAMI SHORES VILLAGE BLDG DEPT)
D. COPY OF WORKERS COMPENSATION (EITHER CERTIFICATE OR EXCEMPTOON)
IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY:
A. COPY OF CERTIFICE OF COMPETENCY OF QUALIFIER
B. COPY OF MIAMI DADE COUNTY MUNICIPAL CONTRACTORS TAX RECEIPT
C. COPY OF LIABILITY INSURACE (CERTIFICATE HOLDER MUST BE MIAMI SHORES VILLAGE BLDG DEPT)
D. COPY OF WORKER COMP INSURANCE (EITHER CERTIFICATE OR EXEMPTION)
YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE HOLDER AS FOLLOW:
Created on 3119109 BY MO.DV I RV 3120109 MLDV
MIAMI SHORES VILLAGE BLDG DEPT
10050 NE 2ND AVE
MIAMI SHORES, FL 33138
COMPLETE CONTRACTOR'S INFORMATION
BUSINESS NAME: N: . _sue � � d � s'' G_ ; e , C / r c
BUSINESS ADDRESS: 3 -ie, K1.,/ / -/ CITY
STATE CL-- ZIP CODE ?" ,=
E -MAIL ADDRESS (IF APPLICABLE): . L e e-1 , 1 , 4 L - <=
M iami Shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
BUSINESS PHONE: (`I ) r75 5 FAX NUMBER ('35 -/ ) fl 5 3 - 3 % 6
CELL PHONE ( ) QUALIFIER'S NAME:
QUALIFIER'S LIC NUMBER:
THE POUCISS OR INSURANCE LISTED BELOW HAVE REE I ISSUED TO+THE INSURED NA move FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
ANY REOUII{EMENT. TERM OR COhorTION OF ANY COM 1ACT OR. OTHER DOCUMENT bRITN RESPECT TO WWICH THI8 CERTIFICATE MAY SE ISSUED OR
NIAY PENTAIN, TWE INSURANCE AFFORDED 19Y T1E3 POL! .IES DESCRIBED HEREIN I8 SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OP SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN !EDUCED BY PAID CLAIMS.
• • t
TYPE OF INSURANCE
POLICY NUMGQR
��VE
TV AYM (AGM1A PW
01/10/11
&�p��A
Pi g tM1iAAt{ICf T
01 / �.0 / �.2
I 114tNT6
EACH OCCURRENCE
•
$1,000,000
.A
GENERAL
X
. 4,814MKT
GEM
LIABILITY
COMMt=RC!AL GENERAL LIABILITY
_ � CLAWS MADE I X I t)CCUR
CONTRACTUAL
CYf+I 009351 5
ur{alA ! E
PREMI`it�s�'Es oxure�nee;
$300,000
M$4 EXP I Any one pereonl
$ 10 , 0 0 0
PERSONAL &ADV INJURY
$ 1,000,000
ADM INSD
GENERAL AGGREGATE
$ 2 000 , 000
AOG"R8 ATELIMIT POLICY APPL1 SPLR;.
I � PRO, t-
. I t ,IEGT � � LOC
PRODUCTS -COIL /OPA130
4c2
000J000
�1
AUTOMOBILE
LIABILITY
ANY AUTO
ALL OWNEI I AUTOS
I SCHEDULED AUTOS
HIRED AUTt)fi
NON -OWNFO AIA
.._—_: .... . ..._-____
�•
ca f008351 5
01/10/11
01/10/12
COMBINED SINGLE. LIMIT
(gA:>yav tL .
$ 1 O0 0
° _ r000
X
7
X
.—I
EDGILY INJURY
; (P Piton) ant
BODILY INJURY
(Per earA mq
PROPERTY DAMAGE
tPereccltlent)
$
LGARAGE
L _.
UABILITf
ANY AUTO H
AUTO ONLY • EA ACCIDENT
$
EA AOC
$ _. ....
08%11'2
AGG
$
I
EXCE93/UMERELLA
UABILITY ,
pr,C.UR I CLA NS MADE I
DED:JCTIR!.:
RETENTION $
EACH OCCURR&NG$
AGGREGATE I..A - -_ — ~�
$
A
11 K
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
ANYPROPRIETOWPwTNGR /6KF- t:.JTNa
OFFICER/MEMBER EXCLUDED? �
spec tl wL PR U ants below
OTHER
PROPERTY
jSQUIPMENT
.35R 97
MOW an OVERA.TSONS MIX
01/01/11
01/01/12
X 0 WtT I R S R
EL.EACH ACCIDENT .
S 1,000 ,000.
E.L DI$EASB • GA EMPLOYEE
$ 1 , 000 , 0 0 0
E L. DISEASE - POLIOY UMI1
$ 1 000 000
CPC 003235 5
MSC 0028`72 5
01/10/11
01/10/11
01/10/12
01/10/1.2 1
10 DAYS NOTICE YE
CANC. - FOR NON- .
9SSdJIP110N OP OPERATIONS / LOCAT/DNS I VEHI E MUSKIES ADDED BY ENDORSEMENT /SPECIAL PP OV$ONS
INSURED
01/181 2011. 09:07 554:)409456
PRODUCER
INNOVATIVE INSURANCE
CONSULTANTS, INC.
$461 UNIVERSITY DRIVE, #103
CORAL SPRINGS FL 33067
Phone: 954 -340 -9591 Fax: 954 -.40 -3456
COVERAGES
CERTIFICATE HOLDER
ACORD 25 (2001108)
CO RA I , SPRINGGSS AVE 87. 53061 #] �4
MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
10050 NE 2ND AVE
MIAMI SHORES FL 33138
ACORO, CERTIFICA "E OF LIABILITY INSURANCE
1NNL7'; /AT1t,'E IN9_IRANt E PAGE 01102
CANCELLATION
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. PG'CI comanvokt xi"R!Jones GQ,
INSURER B
INSURER C.
INSURER O.
INSURER E;
OP ID TG DAIS (MM/DD/TYYY) I
NODAL -3 I 01/18/11
NAIC
33472
SNOUL7 ANY OP THE MOVE DESCRIBED PQUCIEF QE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, T1IE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN
NOTTC2 TO THE CERTIFICATES HOLDER NAMED TO THE LEFT, BUT PALURE TD DO SO SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS QA
REPRESENTATIVES.
$€I ACORD CORPORATION /SOS
Submitted to:
Berman Construction & Development
Street/Address
1844 N. Nob Hill Road # 144
City. State and Zip Code
Plantation, FL 33322
Contact: David Berman
Load Calculations
General Lighting -
2 Refrigerator Circuit
1 Washer Circuit
1 Dryer Circuit
1 Range Circuit
1 Water Heater Circuit
1 Dishwasher Circuit
2 Small Appliance Circuit
1 Micro Circuit
1 GDO
Total Load
1st 10kw - 100%
Balance 40%
1 A/C -100%
Office -954 -753 -1599
1200 Each
1500 Each
1500 Each
Ronald Ma = cchio - EC13001869
s ti JONELLE T DORSET
,t I i ..'� MY COMMISSION # EE 045750
of EXPIRES: December 20, 2014
;q Bonded Tfw Notary Public Underwriters
low
MEDALLION ELECTRIC, INC.
LICENSE: EC13001869
1200 Each
1200 Each
5000 Each
12000 Each
° I
Fax - 954 - 753 -3878
Phone:
954 -868 -3558
Fax: 954 - 424 -0211
Job Name:
Carlson Residence
Job Location:
1300 NE 104th St
Miami Shores, FL
Approx. 2300 sq ft x 3w = 6900w
10,000 10,000w
28,950w 11,580w
10kw 10,000w
31,5801240v = 131.
2400w
1200w
5000w
12,000w
5000w
1200w
3000w
1500w
750w
2/1/2011
FEB 0 1 2011 Pi
Date:
.00
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