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EL-10-1647Inspection Number: INSP- 151277 Scheduled Inspection Date: November 09, 2010 Inspector: Devaney, Michael Owner: TORANO, TRACY Job Address: 534 NE 102 Street Miami Shores, FL 33138- Project: <NONE> Contractor: AMPSTRONG ELECTRIC INC Building Department Comments ELECTRICAL SERVICE REPAIR Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments „c/L 9' November 08, 2010 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: EL -9 -10 -1647 Permit Type: Electrical - Residential Inspection Type: Final Work Classification: Addition /Alteration Phone Number (305)498 -1908 Parcel Number 1132060171050 Phone: (305)468 -7988 Page 17 of 33 Miami Shores Village Building Department 10050 NE 2 Avenue Miami Shores, FL 33138 To the Miami Shores Village ;9; AMPSTROIG This letter authorizes Jose Morales to represent the company for pick up of the electrical permit from 534 NE 102 ST for Ampstrong Electric, Inc. Should you have any questions, feel free to contact me at the numbers listed above. Thank you, Sworn to and subscribed before Me this 27 day of September, 2010 k * ";'% MARIA DEL PILAR ROBLEDO `? MY COMMISSION # DD814347' � • EXPIRES August 13, 2012 (407) 39 -0153 FloridallotaryService.com Osvaldo Cardoza Print, Type or stamp name of notary President ./i/ab cede- Notary Signature My commission expires: 1 Personally known to me or Produce identification, type: 6965 NW 43 ST • MIAMI, FL • 33166 PHONE: 305 468 - 7988 • FAX: 305 468 - 7989 September 27, 2010 1 /3, 26/2 BUILDING PERMIT APPLICATION FBC 20 JOB ADDRESS: 3 N 1© P. S t Miami Shores Village Building Department EMERWE SEP 1 5 2010 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 E (j—J41 Master Permit No. Permit Type: Electrical X414.44 gTO,i t g u,� 305 441i-19 OO OWNER: Name (Fee Simple Titleholder): Phone #: Address: t \SZi3 G iei 1 i314 City: B u4 i 5641C State: Zip: 3316 1 Tenant/Lessee Name: Phone #: Email: City: Miami Shores County: Miami Dade Zip: 3 31 31? Folio/Parcel #: I 1 - 3 "a2. ®6 -o B —7 -10 5 Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name: A-144 1 C 4Yriit ebCIY\ L 12444- Phone #: Address: p , N t i (0 u) 4 L )) S T f 3 City:l State: - Z 3 1 4 Qualifier Name: OS VCd l U- (�(J4 2 c. Phone#: - 1U , 4 3 4 '3 1 1 ic State Certification or Registration #: ' t 3 O0 4k 84 Certificate of Competency #: Contact Phone #: 3 0 S - 46 % 1 C (t i Email Address: a v F0 a a vi,,t rs ' 617 o e- 0,1i DESIGNER: Architect/Engineer: Phone #: 305- 46S- 710? Value of Work for this Permit: $ t 't 0 Square/Linear Footage of Work: Type of Work: ❑Address ❑Alteratiion New ARepair/Replace ❑Demolition Description of Work: 19 er� � ` 1 * ' * ** **** **** * ** ** * *** * *** ** * **** * ** F ees °�x* *4.�x>� *** * ****Ix� ****.1.** Nor *4 ** ** ii, *.xa:a�s++ ****4.* v• _ Submittal Fee $ f w Permit Fee $ /4 ® ®e" CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $1 r / /� O �.On .Q 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 Fl RCTRICAL 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 the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the ab• of posted notice, the inspection will not be approved and a reinspection fee will be charged. Signatur The foregoin day of / who is • rs • NOTA i PUBLIC: f d I _�� Sign: ,, i Print: 0 ; ' or Agent ment ac r , wledged . efowe , 20/(/ , by a/40 its nally kn to me or who has produced `i' identification and who did take an oath. My Commission Expires: ********k************* APPROVED BY P T"�?;ac t' c ^3 . l ... � � ci 0 7 1 2 b eer110D 41110 4 AB Signatur Structural Review (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) ontractor The foregoing instrument was acknowledged before me this day of , 20 _, by who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Wou4 M6 Sign: � Print: A� tt ct2-1 t (• My Commission Expire ARIA DEL PILAR ROBLEDO ? : MY COMMISSION # uu814347 4q„. • EXPIRES August 13, 2012 (407) 388.0153 FloridallolaryServIce.com **sN******** •+NON k**+ i• ds. N******* Ki ik*+ H****** ***+ k4++ k+ k+ k+ k****sk**+ k*****iH ****eR*****s[e*** Plans Examiner Zoning Clerk THE POLICIES OF INSURANCE USTED BELOWHAVE 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 POUCIES. AGGREGATE UMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IN SR NSW TYPE OF INSURANCE POLICY NUMBER Pt lryl�l pp C 7��� OA R j YM LIMITS A GENERAL X LIABILITY COMMERCIAL GENERAL UABUTY 04 —GL- 000793354 6/16/2010 6/16/2011 EACH OCCURRENCE $ 1,000,000 DAMAGE P_ II EM (Ea�ocart�encet $ 100,000 CLAIMS MADE X OCCUR MED EXP (Any one person) $ Excluded PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GENT. AGGREGATE U MIT APPLIES PER: POLICY PRO- n LOC PRODUCTS - COMP/OP AGG $ 2,000,000 AUTOMOBILE UABLITY ANY AUTO ALL CRANED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWED AUTOS COMBINED SINGLE U MIT (Ea =Want) $ BODILY INJURY (Per person) BODILY INJURY (Pet accident) $ PROPERTY DAMAGE (Per accident) GARAGE UABIUTY ANY AUTO AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESSIUMBRELLA 7 LIABILITY OCCUR CLAIMS MADE DEDUCTIBLE RETENTION $ EACH OCCURRENCE $ AGGREGATE $ $ $ $ WORKERSCOMPENSATION RS EMPLOYE' LIABILIT1f ANY PROPRIETORIPARTNER/EXECUTIV OFFICER/MEMBER EXCLUDED? (Mandatory In NH) I r yes, describe under SPECIAL PROVISIONS below I TORY UMITB I I ER A AND EL EACH ACCIDENT $ EL DISEASE - EA EMPLOYEE $ El. DISEASE - POLICY UMIT $ OTHER DESCRIPTION OF OPERA TIONS /LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Electrical Contractor (305) 756 -8972 Village of Miami Shores 10050 NE 2 Avenue Miami Shores, FL 33138 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THEE:IP1RATION DATE THEREOF THE ISSUING INSURER WILL ENDEAVORTOMAII . DAYS WRITTEN , NOTICE TO THE CERTIFICA TE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTA TIVES. AUTHORIZED REPRESENTATIVE _ David Lopez /ANA z —= - ACORU CERTIFICA TE OF PRODUCER (305) 595 -3323 FAR: (305) 595 -7135 Eastern Insurance Group, Inc. 9570 SW 107 Avenue Suite 104 Miami FL 33176 INSURED Ampstrong Electric, Inc. 6965 NW 43rd Street Bay #3 Miami 1 FL 33166 LIABILITY INSURANCE I 6/15/2 0 THIS CERTIFICATE IS ISSUED AS A ONLY AND CONFERS NO RIGHTS HOLDER. THIS CERTIFICATE DOES ALTER THE COVERAGE AFFORDED MATTER OF INFORMATION UPON THE CERTIFICATE NOT AMEND, EXTEND OR BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE I NSURER A:Sid Casualty INSURER B: INSURER C: INSURER D: INSURER E NAIC a� CANCELLA TION ACORD 25 (2009/01) 1NS025 (200Eol) The ACORD name and logo are registered marks of ACORD 1988-2009 ACORD CORPORATION. All rights reserved. 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR I TYPE OF INSURANCE I POLICY NUMBER I DATE E DATE (MMPDD /) I LIMITS GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY I I I I EACH OCCURRENCE 8 FIRE DAMAGE (Any one fire) $ CLAIMS MADE 1 I OCCUR MED EXP (Any one person) 8 PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ POLICY I I JECT I I LOC AUT OMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS COMBINED SINGLE LIMIT (Ea accident) 8 BODILY INJURY (Per person) $ BODILY INJURY $ (Per accident) PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY ANY AUTO AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ AUTO ONLY: AGG 8 EXCESS LIABILITY I EACH OCCURRENCE $ _ OCCUR I ICLAIMS MADE AGGREGATE $ DEDUCTIBLE RETENTION $ $ _ 8 $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY 76 WEG TS 3 5 71 06/16/10 0 6 / 16 / 11 X OR ST MIT ER TORY LIMITS I ER E.L. EACH ACCIDENT $100,000 E.L. DISEASE - EA EMPLOYEE 810 0 , 0 0 0 E.L. DISEASE - POLICY LIMIT $500,000 OTHER DESCRIPTION OF OPERATIONS /LOCAT(ONSNEHICLESIEXCLUSIONS ADDED BY ENDORSEMENT /SPECIAL PROVISIONS Those usual to the Insured's Operations. ACORD, CERTIFICATE OF LIABILITY INSURANCE PRODUCER 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. AUTOMATIC DATA PROCESSING INS AGCY 250717 P:(877)287 -9.316 F:(888)443 -6112 PO BOX 33015 SAN ANTONIO TX 78265 INSURED AMPSTRONG ELECTRIC, INC. 6965 N.W. 43 ST. BAY 3 MIAMI FL 33166 COVERAGES CERTIFICATE HOLDER 1 I ADDITIONAL INSURED; INSURER LETTER: Miami Shores Village 10050 NE 2ND AVE MIAMI, FL 33138 ACORD 25 - S (7/97) INSURER A: Twin City Fire Ins C INSURER 5: INSURER C: INSURER D: INSURER E: CANCELLATION INSURERS AFFORDING COVERAGE DATE 04 -26 -2010 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES 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 OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. ACORD CORPORATION 1988