EL-10-1276BUILDING
PERMIT APPLICATION
FBC 20
Permit Type: ELECTRICAL
0) .-46 /- f2
Owner's Name (Fee Simple Titleholder) #111.4 /9 r -1 Phone # 'S"'s f 0/ 7
Owner's Address f f' e1 Pi' / b 4-
City /6 j` ,5 State Pt
Zip 3 9/6
Tenant/Lessee Name (I4 Phone #
Email o pet 1,100 e Gocy-2 ; -, 4/ ---1
Job Address (where the work is being done) g9 MP ! 144 Of
City Miami Shores Village County Miami- Dade Zip 13 1 4
FOLIO / PARCEL # ft A. /6;4 " Ge 1 -- 0 Y66
Is Building Historically Designated YES NO Id
Submittal Fee $
Miami Shores Village
Building Department
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 Fee $
Permit No. Et- I0— r2-7c41
Master Permit No.
Flood Zone lira
Contractor's Company Name .Z)45' 574L 4'LECTR/C- //14C, Phone # 305- a 1( -3/73
Contractor's Address /d! E / .a.advb sr
City /(/4 fll /A M 1 State /= t. Zip 33 1(.o
Qualifier Name STe.CrE A d' c..b ER0,..) Phone# t2.5 -a /( - 3/')3
State Certificate or Registration No. ,Eieo 01 Y 141? Certificate of Competency No. Do o o / ( 4 U 5
Contact Phone 365= S a 1G-3 / 1 3 E -mail
Architect/Engineer's Name (if applicable) Phone #
Value of Work For this Permit $ 900.00 Square / Linear Footage Of Work: /00 FT
Type of Work: ' '❑Addition Alteration :New ❑ Repair/Replace ep 0 Demolition
Describe Work :" .ZNS1711.-L.. .5 0cstT°f C TS ) 0 N6 fl) /CRoec.J.4V re- ET" A/ E. ZISKt.0
OUT�� A01) 2, /eEc. €ss LIri- (T5. /li/ AirCK
Notary $ Training/Education Fee $ 0 - 2.0
Scanning $ Radon $ ( Sfl DPBR $ 0•SO
Double Fee $ Violation date:
fr5.11"1
CCF $
Structural Review. $ Total Fee Now Due $
Technology Fee $ 0.80
Bond $
1
Ip'
CO /CC $
.con
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 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 be approved and a re- inspection fee will be charged.
O'yner or Agent , , ,, ; ` \ Contractor
The foregoing instrument was acknowledged before me this The foregoing ins tpent was acknowledged before me this 6th.
day of 20 IL) by Art ICJ` - l A. 4J % 4 ' d a of July 2010 b
y c�✓Y , y 'P Y , by 5ot? ®.00 /66119p,
who is personally known to me or who has produced f Lt 0 who is persona ly known to me or who has produced
����►n n wyNi,. -
As identification and who did take an oath.
, ;`es►�L AwA me•
Print: =1
My CoNissienf,x)ffregi;
STATE
�
y v�
APPROVED BY /`— "G/- riive Plans Examiner Zoning
(Revised 07 /10 /07)(Revised 06/10/2009)
PeetteC6
Si aura '(�.. - � �---
NOTARY P
Sign:
P
as i. ntification and who did take an oath.
LIC:
N ,,,
r pp 0
X00362 ,
Engineer Clerk checked
Scheduled Inspection Date: August 30, 2010
Inspector: Devaney, Michael
Owner: BISHOP, PATRICIA
Job Address: 89 NE 107 Street
Project: <NONE>
Contractor: DAY STAR ELECTRIC INC
Building Department Comments
August 27, 2010
Miami Shores, FL
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 149920 Permit Number: EL -7 -10 -1276
For Inspections please call: (305)762 -4949
Permit Type: Electrical - Residential
Inspection Type: Final
Work Classification: Alteration
Phone Number
Parcel Number 1121360070400
install 5 outlets one microwave outlet one dishwasher outlet
and 2 recess lights in kitchen.
Passed
12'
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
Page 20 of 34
07/08/2010 13:41 9549688307
AGGRO CERTIFICATE OF LIABILITY INSURANCE
PRODUOER
API Group
P.O. Box 934125
BROOKSIE PEEPLES #A203142
MaT ate FL 33093
MUM DAY STAR ELECTRIC INC
830 NE 122ND ST
HENRY GOCKEN AOH
N MIAMI FL 33161
COVERAGES
MEW,
CIAL
CLANG MADE
'ABILITY
occuR
07/31/2010
(A_ny en
NAL A ACV
N e D NUCLEI LIMIT
PROPERTY DAMAGE
(Per a I e t)
500 000
$ 1
5,000
500 000
$1,'" 000
1 000 000
■■
5
NIAGGREr TE LIMIT A .
PO L 5 N''-
A • , QBILEUA ILNY
ANY AUTO
ALL DWNED AUTOS
SCH6DUU3lAUTQ�fi
• MIRED ALRpB
i IIII
ANY AUTO
II III
EI�CE33NMBR6LLA
OCCUR L_ JI
. DEOIIS:iIBLEi
5 R �1IDN s
07/31/2009
P P 1 4 4 ICti'*1`
CAN TION
WOAD ANYOP ?REMOVE DEEDINEED MOUSSES OANCELLED BEFORE THE EfPIRATON
DATE THSNEOP. TNH IEEE= INSURER IND& ENDEAVOR TO MAIL 10 DAYS worm
N
LEFT, BUT immune TO !MOO SHALL
IMPOSE = TION OR LIABILITY DR . > K UPON THE INSURER, ITS AGENTS OR
NONCE TO THE OEINVIDATE HOLDER RAM
LLD.
1118 POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITMSTAKENG
ANY WEOUIREMENT, TERM OR COMMON OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS swam' TO ALL THE TERMS, EXCLUSIONS AND CONDITION$ OP SUCH
POLICIES. AGGREGATE UMITS SHOWN MAY HAVE BEEN REDUCED BY PALM CLAIMS.
CERTIFICATE HOLDER
MIAMI SHORES, FL 33138
ACORD 25 (2001/08)
2002 - 09 - 28 13:40
VILLAGE OF MIAMI SHORES
10050 NE 2ND AVENUE
P
09AL086813
9549688307
API GROUP
THIS CERTIFICATE 18 ISSUED AS A
ONLY AND CONFERS NO RIGHTS
HOLDER. THIS CERTIFICATE DOES
ALTER THE COVERAGE AFFORDED
INSURERS AFFORDING COVERAGE
uvsuRRA; NOVA CASUALTY CO
INSLIIR B:
I IOURER ;
INSURER IX • •
INSURER E:
PAGE 01/01
DATEIMMiDD1YYYV)
07/0$/2010
MATTER OF INFORMATION
UPON THE CERTIFICATE
NOT AMEND EXTEND OR
BY THE POLICIES BELOW.
NAIC 0
Page 1
ACORD CORPORATION 1908
Jul 06 2018 17:23:58 Via Fax
Mrs
DAY STAR ELECTRIC
830 N.E. 122ND ST.
NORTH MIAMI FL 33161
INSURERS AFFORDING COVERAGE
INSURERAHartford Underwriters In Co
INSURERS:
INSURER c
INSURER DI
INSURER E:
ACORD CERTIFICATE OF LIABILITY INSURANCE
PAYCHEX INSURANCE AGENCY INC /PHS
210703 P:(877)287 -1312 F:(888)443 -6112
PO BOX 33015
SAN ANTONIO TX 78265
COVERAGES
THE POUCIES OF INSURANCE USTED BELOW HAVE BEEN ISSUED TO THEINSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH 14I8 CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POUCIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POUCIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
OESERI TIONGPOPERATIOPENODA780AWYEHA {88irEX AMIDST B{WOR8EMENT/ PEGALPROVW.ON8
Those usual to the Insureds Operations. RE: Patricia Bishop 89 NE 107TH St.
Miami Shores, FL 33161.
CERTIFICATE HOLDER
City of Miami Shores
10050 NE 2ND AVE
MIAMI SHORES, FL 33138
ACORD 26 -S (7/97?
-> DAY STAR ELECTRIC IN The Hartford Fax Page 884 Of
AODRA7NALMGfRED; MENU LETTER: CANOELLATION
2002 - 09-26 18:18 1115 LEGAL SERV 860 -547 -5000
Kite DATE
P1DC 07 -06 -2010
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 POUCIES BELOW.
SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
30 DAYS WRITTEN NOTICE (10 DAYS FOR NON - PAYMENT) TO THE CERTIFICATE
HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO
OBUGATION OR UABIUTY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
REPRESENTATIVES.
AN.17A�� A7 -`
@ ACORD CORPORATION 1988
Page 4
TYPE OFM IAIYCD
POLICY MEM
A4R1RRM7M /YY/
W.
LENTS
GEAMM
LIABBITY
COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE
8
FIRE DAMAGE (Any OAB (118)
8
CLAIMS MADE D OCCUR
MED EXP (Arty one person)
B
PERSONAL & ADV INJURY
8
GENERAL AGGREGATE
8
GEWL
AGGREGATE LIMIT APPLIES PER:
POLICY n fit n LOC
PRODUCTS - COMP /OP AGG
8
7
AMMONIA
LIABILITY
ANY AUTO
AU. OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON -OWNED AUTOS
COMBINED SINGLE LIMIT
8
—
BODILY INJURY
(Per person)
e
—
_
BODILY INJURY
ITV g pg8�)
8
—
PROPERTY DAMAGE
(Pee eeeidern)
y
DAME,.
124881f Y
ANY AUTO
AUTO ONLY • EA ACCIDENT
8
OTHER THAN EA ACC
8
—
AUTO ONLY: AGO
NESTS
MINUTE
OCCUR _I CLAIMS MADE
DEDUCTIBLE
RETENTION 8
EACH OCCURRENCE
8
AGGREGATE
8
8
*
_�
8
A
WOMBS COMPENSATION MO
EMPLOYERS' uaEm►tY
76 WEG EZ8317
07/27/09
07/27/10
X I WC BTAT U- I 1 ER
TORY LIMEM 1 ER
E.L. EACH ACCIDENT
8100, 000
EL. DISEASE • EA EMPLOYEE
.100,000
E.L. DISEASE -POLICY LIMIT
0500,000
0778IR
Jul 06 2018 17:23:58 Via Fax
Mrs
DAY STAR ELECTRIC
830 N.E. 122ND ST.
NORTH MIAMI FL 33161
INSURERS AFFORDING COVERAGE
INSURERAHartford Underwriters In Co
INSURERS:
INSURER c
INSURER DI
INSURER E:
ACORD CERTIFICATE OF LIABILITY INSURANCE
PAYCHEX INSURANCE AGENCY INC /PHS
210703 P:(877)287 -1312 F:(888)443 -6112
PO BOX 33015
SAN ANTONIO TX 78265
COVERAGES
THE POUCIES OF INSURANCE USTED BELOW HAVE BEEN ISSUED TO THEINSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH 14I8 CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POUCIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POUCIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
OESERI TIONGPOPERATIOPENODA780AWYEHA {88irEX AMIDST B{WOR8EMENT/ PEGALPROVW.ON8
Those usual to the Insureds Operations. RE: Patricia Bishop 89 NE 107TH St.
Miami Shores, FL 33161.
CERTIFICATE HOLDER
City of Miami Shores
10050 NE 2ND AVE
MIAMI SHORES, FL 33138
ACORD 26 -S (7/97?
-> DAY STAR ELECTRIC IN The Hartford Fax Page 884 Of
AODRA7NALMGfRED; MENU LETTER: CANOELLATION
2002 - 09-26 18:18 1115 LEGAL SERV 860 -547 -5000
Kite DATE
P1DC 07 -06 -2010
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 POUCIES BELOW.
SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
30 DAYS WRITTEN NOTICE (10 DAYS FOR NON - PAYMENT) TO THE CERTIFICATE
HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO
OBUGATION OR UABIUTY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
REPRESENTATIVES.
AN.17A�� A7 -`
@ ACORD CORPORATION 1988
Page 4