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EL-10-1413uti 444 Iftdrafr'l,au- BUILDING PERMIT APPLICATION FBC 20 Permit Type: ELECTRICAL Owner's Name (Fee Simple Title Owner's Address 1 n e • City, Tenant/Lessee Name Email Contact Phone Type of Work: UAddition Describe Work: po pqi Scanning $ Radon $ 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 l Co ( (I o - Ste. Contractor's Company Name 4 R4-1? ******** **** * *** * * ** * ** * * ** * *** ******** F ees * * ** * ** * * * * ** ** **** *,�**** * ,� tO Submittal Fee $ �� .0L Permit Fee $ 4b0 e°1'4°9 Notary $ Training/Education Fee $ DPBR $ ° _ . cesess: Permit No. EL 10 L 13 Master Permit No. hone # i Zip 33/3 Phone # .3©S - 'x"43 S Job Address (where the work is being done) City Miami Shores Village County Zip .��/6 FOLIO / PARCEL # Is Building Historically Designated YES NO 1 Zip Phone # Certificate of Competency No. ,3.73,3 yc `7 tI (. ( '-- 13f g E -mail R/Nb RA P.-5 /r e c oL . cows Architect/Engineer's Name (if applicable) Phone # Square / Linear Footage Of Work: DAlteration ONew Repair/Replace 0 Demolition rv� a -{-eft 'ha-5 a iQ.ce face. vzi Bond $ CCF $ CO /CC $ Technology Fee $ Double Fee $ Violation date: c Structural Review. $ Total Fee Now Due $ 4 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: 1 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) d# s after the building permit is issued. In the absence of such posted notice, the inspection will of be approved and a re-insp t* ee will be charged. Signa Owner or Agent The foregoing instrument was acknowledged before me this day 'Z , 20 � , by �,QUIO Ou ri r who is personally known to me or who has produced CLA f NOTARY PUBIC: Sign: e Print: My Commission Expires: * * * * * * ** * * * * * ** APPROVED (Revised 07 /10 /07XRevised 06/10/2009) As identification and who d�i ce an oath. ` �.� `` ,443121 o 7 ,y * * * * * * * * * * * * * * * * * * ** * * * * * * * * * * * * * * * * ** lens Examiner Engineer Contractor The fore ing instrument was ackno edged befo e 20) methi day of W K.J 20�, by , � ��S *�' who is . ersonall known to me or who has roduced Y k P � > Sign: Print: Y PUBLIC: s identification and who did take an oath. MLO 1D/ My Commission Ex NO f; ry ; V 23 �'= commi �i�7 i 20 11 Zoning Clerk checked Scheduled Inspection Date: August 19, 2010 Inspector: Devaney, Michael Owner: BELTON, GWENDOLYN Job Address: 161 NE 110 Street Miami Shores, FL 33161- Project: <NONE> Contractor: #1 R & R ELECTRICAL ALLSTAR Building Department Comments August 18, 2010 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 149757 Permit Number: EL -8 -10 -1413 For Inspections please call: (305)762 -4949 Permit Type: Electrical - Residential Inspection Type: Final Work Classification: Repair Phone Number 305 - 754 -8726 Parcel Number 1121360040180 Phone: (877)621 -8184 REPAIR METER BASE AND CLIPS Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments /A Page 22 of 36 3/5/2010 10:1$ AM FROM: Cap S Caple 1lowdon &ne, Agency, Inc. T0: +1 (907) 679 -9900 PAGE: 001 OF 001 ACORD CERTIFICATE OF LIABILITY INSURANCE PRODUCER Ca& Bowden Insurance Aganey 8911 University Boulevard Winter Park F1. 32792 INSURED # 1 R & R Electrical Allsfar Attn: Richard Hom PO Box 2549 Goldenrod FL 32733 COVERAGES ON Y AND NO RIGHTS HOLDER. THIS CERTIFICATE DOES ALTER THE COVERAGE AFFORDED INSURERS AFFORDING COVERAGE INSURER Gotham Insurance company INSURER B INSURER c INSURER 0: INSURER E: DATE(MM/ODIYYYy) 0810512010 MATTER OF INFORMATION UPON THE CERTIFICATE NOT AMEND, EXTEND OR BY THE POLICIES BELOW. NAIL N A THE POLICIES OF INSURANCE LISTED BELOW HAVE n IEE SSUED TO THE INSURED NAMED ABOVE FOR THE POLIDY 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. n(CLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS sHOWN MAY HAVE BEEN REDUCED By PAID CLAIMS. INSR =ft POLICY NIIII®ER GENERAL LIABILITY X COI ROA. GENERAL Limn:my 0L00523610 05/2712010 0512712011 CLAIMS MADE © OCCUR O>; AGGREGATE TE E LII M MIIT APPLIES PER A I POLICY I I rEdY Lex nU'OM08iLE LIABILITY ANY AUTO ALL OVrpEO AUTOS _ SCHEDULED AUTOS HIRED AUTO$ _ NON-OWNED AUTOS GARAGE LIABILITY R ANY ALTO EXCEssrumaRI.,LA LIABdrry OCCUR 0 CLAIMS MADE DEDUCTIBLE RETENTION $ WORM RSCOMPEN9ATtoNAND EMPLOyg$` LIABILITY ANY PROPRIErOR/PARTNERJExECUrNE OFFICEW•FMBER EXCLUDED byes, describe Under SPFCIAI PepVISrONS eaao. OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES J EXCLUSIONS ADDED BY ENDORSEMENT / 9pEcIAL PROVrsioNs Fax 30: 7624949 Richard Horn License 0EC13002030 POLICY EFF POLICYE7rn1RATION OATH ( mf DATE (MMmofyyl EACH DAMAGE TO PRFMISFF IF., orG oMCei MED EXP Any one person) PERSONAL 8 ADV INJURY GENERALAGGREGA7E PRODUCTS- COMP/OP AGG COM91ID SINGLE LIMIT (Es Occident) BODILY T4JURY (Pe/ person) BODILY INJURY (Per occident) PROPERTY DAMAGE (Per®ccioeM) AUTO ONLY - EA ACCIDENT OTHER THAN ALTO ONLY: EA ACC AGG EACH OCCURRENCE AGGREGATE WC STATU I I . 11i TORY I IuI pp E.I. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE E.L. DISEASE - POLICY LIMIT $ $ 1.000,009 $ 50,000 $ 5,000 s 1,000,000 $ 2,000,000 $ 1,000,0 • S a $ J $ $ CERTIFICATE HOLDER Miami Shores 10050 N E 2nd ACORD 26 (20ov08) Miami Shores, Ft, 33138 CANCELLATION SHOULp ANY OF THE ABOVE OEsCRIBED POucrES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR To MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFlCArE HOLDER &AHED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION DR LIABILtrr OF ANY KIND UPON TTiE INSURER, ITS Aden OR REPRESENTAMBS, AuTHOR7J:D REPRESENTATIVE c$L> (�9 ACORD CORPORATION 1989 Domeye to reeled premien (EA caWnencel t t Med DV 3 3 Personal Adv injury I I General Aggregate $ $ Products • Caron/0p Ado $ $ Centined Single Limit . WV inlay (Per person) $ $ Boddylt wy (Per Accident) $ $ Property Damao fFerAccideml $ $ Fgr)r Ornwanro XI j j I R R E.L. Eseh Accident s sl.gttog00 E.L. Disease• Ea Employee $ $1,000.000 t.L. um:ease _ Honey twists 1 11.1.1 ,uuu tad A- (Excellent). AMB # 12616 Client ID: 2140 -015 lent Company': I in Florida. ttity. r by calling (727) 938-5562, Begin Date: 2 2/26/2002 ore the . the issuing insure( v il 4 0/.11/2U111 1u:41 Lion insurance CERTIFICATE OF LIABILITY INSURANCE Producer: Lion Insurance Company 2739 U.S. Highway 19 N. Holiday, FL 34691 insured: Coverages IAMSR ROD_ L TR NSRO Other CERTIFICATE HOLDER South East Personnel Leasing, Inc. 2739 U.S. Highway 19 N. Holiday, FL 34691 GENERAL uARIUTY Commercial General Liability Claims Made El Occur General aggregate Bruit apples per: Nifty ❑ Project ❑ LOC AUTOMOBILE LIABILITY MINN MEM Any Auto AD Owned fuck Schadtced Autos Phred AWNS Non•O�med Amos a rrcctulII ■ It r uorr mu Dedut4lde Cr •• Workers Compensation and Employers' Liability ri Any A pzup todpannedexac a officer/member if Yes. descnbe under spacial provisions below. CITY OF MIAMI SHORES FAX; 407 -679 -7900 & 305. 762 -4949 / ISSUE 0521 -10 (SD) / REISSUE 08 -05-10 (30) 10050 NE 2ND AVE MIAMI SHORES. FL 33139 Poky Number CANCELLATION LION INSURANCE COMPANY.+ #1 It& RELEC 1/1 D ote 8/5/2010 This Certificate Is Issued as a matter of a:fertnaeon only and confers no rights upon the Certificate Holder. This Certificate does not amend, extend or alter the coverage afforded by the potides below. neuter A; InaUrrar R. Insurer C: Insurer D: Insurer E: Policy Effective Deco (MMIDD1lrY) WC 71949 01/01/2010 01/01/2011 Insurers Affording Coverage Lion Insurance Company NAYC # 11075 p • ctee o 'nsu once f '"ow - - town mop.. to : tow r moo e. , 0 , the pang r • I : = • ` otwRh,7an f Nieceiti celsmay ssuedarmaypenain. aein5usnte iaaubieuroa Gwto i,rermortonm o n srycono-at(w r : ntnt� respect to c paid claims. ano. exclusions, . annd d condidone of soon poidi Aggregate &mils epee may have been remssp by Type of insurance Policy Expiation Data (MM/DDA Y) Lion Insurance Cow is A.M. Best Company ra Descriptions of Operations/Locations/Vehicles/Exclusions added by EndorsemenUSpeefal Provisions: Coverage only applies to active employee(s) of South East Personnel Leasing, Inc. that are leased to the following "Cl #1 R&R Electrical Allster Coverage only applies to Injuries incurred by South East Persornel Leasing, Mc. active employee(s) , while workin Coverage does not apply to statutory employee(s) or independent contractors) of the Client Company or any other e A fist of the active employee(s) leased to the Client Company can be obtained by faxing a request to (727) 937 -2135 Project Name: Should eayo1Me!nova deaenbedpoliciesbe cancelled bei endeavor tomall30 der written noticetorhocej csteher obligation or habiDtyof atytdnd upon the Inner, de agents Limits EachOtcunente L , 08/05/2010 11:18 FAX 5617372382 Date: 9 /a/PiO I hereby name and appoint V&/.)/V /.S 6 &M/ /Al C; etecr fC4 . A'4Sz4'L to be my lawful attorney in fact to act for me and apply to the //1/4/11 I Sf-4DR..:s building department for a C C7Z'C/A permit for the work to be performed at a location described as: Section Township Range Lot Block Subdivision (Address of Job) r ' S? /h/4rni `L. 33i(?, (Owner of Property an nd Address) And sign my name and do all things necessary to this appointment. i Type tore ame of C - • ed Contractor and Contractor's License Number Si - of Certified Contractor The foregoing instrument was acknowledged before me this 2 ndday ofJUnC, 20 I Q , by q 1 rd . 1 who is ersona known Us produced as identification and who did not take oath. State of Florida ' County of 0 va nne LP Notary Publie, Orange ounty,Florida Ot:" : . KOMI CAAFEY NY COMMON 1DD 9�1Q EXPIRES: Muth B0, 2014 a' Daft ThuBuipl ttry Sinl n • FEDEX OFFICE 1072 POWER OF ATTORNEY _ . . of % 12 001/001 4)'