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ELC-11-48Inspection Number: IN$P- 154778 Scheduled Inspection Date: January 27, 2011 Inspector: Devaney, Michael Owner: CHURCH, ST ROSE OF LIMA CATHOLIC Job Address: 418 NE 105 Street Miami Shores, FL Project: <NONE> Contractor: SUN POWER ELECTRIC CO Building Department Comments January 26, 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 Number: ELC -1 -11-48 Permit Type: Electrical - Commercial Inspection Type: Final Work Classification: New & moo. mob Phone Number (305)758 -0539 Parcel Number 1122310150060 Phone: (305)297 -6678 TEMPORARY FOR CHURCH CARNIVAL JAN 28 -30 2011 Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments Page 14 of 29 BUILDING PERMIT APPLICATION FBC 2004 Permit Type: Electrical Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 7952204 Fax: (305) 756.8972 JAN 1 ZU1O B Y: ;.�: Permit No. Master Permit No. 4 Owner's Name (Fee Simple Titleholder)Ar chdiocese of Miami Phone # ( 305)727 Owner's Address 9401 Biscayne Blvd. City Miami Shores State FL Zip 33138 TenantlLesseeName St. Rose of Lima Catholic. Churr1 hone# (305) 758 -0539 E -MAIL: Job Address (where the work is being done) 41 8 NE 105th S t r e e t City Miami Shores Village County Miami -Dade Zip FOLIO / PARCEL # Is Building Historically Designated YES NO Contractor's Company Name Sun Power Electric Co., Incphone# ( 305) 297 - 6678 Contractor's Address 1363 NE 1 82 Street City N. Miami Beach State FL Zip 331 62 QualifierName Silvio Medina Phone# (305) 297 - 6678 State Certificate or Registration No. EC 1 3 0 0 2 8 9 7 Certificate of Competency No. E -MAIL: si l vi nmerl ina @ao1 core Architect/Engineer's Name (if applicable) Phone # Value of Work For this Permit $ 400. Square / Linear Footage Of Work: e- Vo —QAddi ion Alt on � 1 Ri"sawlare - -- Demolition - - - New ega � _ Describe Work: Temporary Church Carnival ,Tan_ 28 7011 * * * * * * * * ** ****** *** * * **** ** * *** *** * ***F *** * * * *,r ** ********* * * *Jrir,rJr**** * *,r *** * *r,i**,r Submittal Fee Permit Fee $ /,'a G'© f' D CCF $ CO /CC Notary $ Training/Education Fee $ Technology Fee $ Scanning $ Radon $ DPBR $ Zoning $ Bond $ Code Enforcement $ Double Fee $ 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 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 F6R 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 $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued In the absence of such posted notice, the inspection will not be ;.roved nr reinspection fee will be charged Signature Owner or Age The foregoing instrument was acknowledged before me this day of11.42g, 20JD, by A*frl5..c2.t."-hS , who is personally known to me or who has produced / dA 1))22,05 lie s identification and who did take an oath. . NOTARY P : IC: Sign: My Commission Expires: 3 Z / * * * * *** * * * * * * * * * * * * ** APPLICATION APPRO (Revised 02/08/06) 4 Signature NOTARY PUBLIC: Sign: Print: Contractor The foregoing instrument was acknowledged before me this 6- day of '7 e , 20 /0, by c.3/ / o is tersonally known'to me 31 who has produced as identification and who did take an oath. r It C - STATE OF FLORIDA / /.iY,,% - � / �� � � �� arino Panache . a i My Commission Expires: ] — ZZ — 2 // // J ' /l Plans Examiner Engineer Zoning A RIRIDr CERTIFICATE OF LIABILITY INSURANCE DATE 0DANYYI 10/01/10112010 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the pollcy(les) must be endorsed. 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). PRODUCER War Direct Insurance 16123 Biscayne Blvd Aver t:re FL 33160 CONTACT Joe Mier PHONE (305) 754 -7414 FAX ; (305) 754 -7416 alms Fes j� @alisferdlrectc�m PRODUCER 10537 Cl, TffMI7Rma• INSURER(8)AFFORDING COVERAGE RSURER A : NATION WIDE INSURANCE NAM 0 10872 INSURED Sun Power Electric Co., Inc 1363 NE 182nd St North Miami Beach FL 33162- INSURER e UABIUTY COMMERCIAL GENERAL LIABILITY MEURER0- INSURER 0: ACPGLZ05904653454 INSURER B : 0912512010 INSURER F • EACH OCCURRENCE 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. re TYPE OF INSURANCE , ADDM tiNft POLICY NUMBER POLICY EFF POLICY ®(P 8 A GENERAL UABIUTY COMMERCIAL GENERAL LIABILITY OCCUR ACPGLZ05904653454 0912512010 09/2512011 EACH OCCURRENCE $ 1,000,000 X TO RENTED P E E. = — y $ 50,000 1 GAUNS -MADE X MED DIP (Any one mnson) $ 5,000 PERSONAL 8 ADV INJURY $ 1. GENERAL AGGREGATE $ 2,000,000 GEM AGGREGATE LIMIT APPLIES PER: POLICY n ia% EL !,PC PRODUCTS -COMP/OP AGG $ 1,000,000 S AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEIHJLEDAUTOS HIREDAUTOS NON -OINNEDAUTOS COMBINED SINGLE UM (Ea ecaldent) 8 BODILY INJURY (Pet person) $ BODILY INJURY (Per eodderd) $ PROPERTY DAMAGE (Per accident) $ — _ $ $ UMERELLA UAB EXCESS LIAB — occuR CLAIMS-MAME EACH OCCURRENCE 5 — AGGREGATE _$ $ 8 DEDUCTIBLE RFTFNTtGN A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDE)? (Mandatory In NH) If yea, closenle tallier DESCR OF OPERATIONS belay NIA " O R —`" "" E.L EACH ACCIDENT 5 EL DISEASE- EA EMPLOYEE $ EL DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS! LOCATIONS /VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more apace Is requlred) COVERAGES CERTIFICATE HOLDER Ar:flPfl vn fsnnAN101 CITY OF MIAMI SHORES 1050 NE 2ND AVE MIAMI SHORES CERTIFICATE NUMBER: FL 33138- CANCELLATION AUTHORIZED REPRESENT Tha Aftfl=fl name. an.1 Inns. are renlefera.f merles el AN/1Dfl REVISION NUMBER: Al MORWWI SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. ® 88 2009 ACORD CORPORATION. All rights reserved.