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EL-11-318T F Inspection Number: INSP - 156533 Scheduled Inspection Date: March 02, 2011 Inspector: Devaney, Michael Owner: RANDLE, MARTIN Job Address: 150 NE 103 Street Project: <NONE> March 01, 2011 Miami Shores, FL 33138- Contractor: JAKE'S ELECTRIC, INC Building Department Comments 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 -2 -11 -318 Permit Type: Electrical - Residential Inspection Type: Rough Work Classification: Alteration Phone Number Parcel Number 1132060131740 ELECTRICAL FOR TANKLESS WATER HEATER INSTALLATION Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments ( I Y a , /Me / Page 39 of 44 BUILDING Permit No. E.., 1 APPLICATION Master Permit No. FBC 20 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 Type: Electrical - OWNER: Name (Fee Simple Titleholder): /1 /" /'�* /Z.A&C L'E Phone #: 3 o� '7 S—y's -3/ Address: 9..8s . . 8 s A) ° H . / 0 3 59_,L14 City: TY\ I POI\ \ Via/8,4S State: FL Zip: 33/3 9 J Tenant/Lessee Name: /0A' Phone #: 30S 7.�Y Email: JOB ADDRESS: / S A) • e G(vd) /0 3?-47st/zEf Is the Building Historically Designated: Yes NO RMOZTVIS hit FEB 242011 City: Miami Shores County: Miami Dade Zip: 3 3/3 Folio/Parcel #: Flood Zone: OJ 0 CONTRACTOR: Company N-�A me: // Gt., s" c ..0_,'-i',4_,` ( Phone# QS ) Q co� Address: 1 1 1 -1 to (A'1' 0 5 City: ?, , C Sta L_ Zip: i /4G Qualifier Name: _J fie_ (l2 _ ..I --/ Phone #: 301- 7 4 - c )--? 7 State Certification or Registration #: J e i'3 () ( - -S 0 2 Certificate of if.J Compettenncy #: / / -/� ) (20 1 1 '7� Contact Phorie #:T) ( � , ; } O � 2 ' `Z) Email Address: J4 4. /K S 4 0 g, %f (/i`1, ,,./d t'` DESIGNER: Architect/Engineer: Phone#: Value of Work for this Permit: $ ) c Square/Linear Footage of Work: Type of Work: UAddress DAlteratio ONew alkepair/Replace ODemolition Description of Work: 7 `V * *******+ r* *. x************ *a: ******** *+ x*** F x*****a:***** **+ x+ x ********* *********x:***** Submittal Fee $ Permit Fee $ CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ � TOTAL FEE NOW DUE $ 6 5 . (&. t Signat The fore day o ho 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, BOB FRS, 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 $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of sucllfjJosted notice, the inspection will not be approved and a reinspection fee will be charged. NO Sign: Print: My Commission Expires: lw �vi�� 1 Owner or Agent strument was o lgdged b; .i, b fj � to me or who has produce. Ire s identification and who did take an oath, (Revised 07 /10 /07)(Revised 06/10/2009)(Revised 3/15/09) Structural Review Signature The f day of h p Contractor ng instrument was ac ,b m or who has produced 4 ation and who did take oath. NOTA PUBLIC: ��C �ti1�'�,ti 1 . 10 a 1. Sign: ti' At '9 4,� O Print: ,y F�.,aaa , o '• 0,5•. V My Commission Expires: %.,„ 40 L1 `l? 4euw Qacea•�(9 He$ askH=* iksk*HaHsHsakHa*ikaksksk**** ak*ak*iksk aIaH: skAeakikiksSae**ikikakakskaksk*aksIasSa$ aaa agskHcakak*sk***ikaF*kskoFSkak ****a: ¢ **akHeokikak %kik=k+k*sk *sk***AYrRsfa*** APPROVED BY , J4/A1'/0 Plans Examiner Zoning Clerk 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 LTR ADD'L INSRD TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MM/DD/YY) POLICY EXPIRATION DATE (MM/DDIYY) LIMITS A INSURER A TAPCO GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY TCNR010577 / / 01/08/2011 / / / / / / 01/08/2012 / / / / EACH OCCURRENCE $ 1,000,000 X DAMAGE TO RENTED PREMISES (Ea occurrence) $ 50,000 1 CLAIMS MADE X OCCUR MED EXP (Any one person) $ 5,000 PERSONAL &ADVINJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER POLICY n ZS: [1 LOC PRODUCTS - COMP /OP AGG $ 1,000,000 7 AUTOMOBILE LABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS / / / / / / / / / / / / / / / / COMBINED SINGLE LIMIT (Ea accident) $ _ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ — PROPERTY DAMAGE (Per accident) $ GARAGE LABILITY ANY AUTO / / / / AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LABILITY / / / / / / / / EACH OCCURRENCE $ 7 OCCUR I I CLAIMS MADE AGGREGATE $ DEDUCTIBLE RETENTION $ $ $ $ B WORKERS COMPENSATION AND EMPLOYERS' LABILITY ANY PROPRIETOR/PARTNER/EXECUTNE OFFICER/MEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below 830 - 31196 / / 01/24/2011 / / 01/24/2012 WC STATU- OTH- I TORY LIMITS I I ER E.L EACH ACCIDENT 100 000 $ , E.L DISEASE - EA EMPLOYEE $ 100,000 E.L DISEASE - POLICY LIMIT $ 500,000 OTHER / / / / / / / / / / / / DESCRIPTION OF OPERATIONS /LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT /SPECIAL PROVISIONS ACORD CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 01/26/2011 FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. PRODUCER (305) 824 -3464 JACKSON AGENCY INC 2075 W 76TH ST HIALEAH, FL 33016 -0006 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 NAIC # INSURED JAKE'S ELECTRIC, INC. 4410 ADAMS AVENUE MIAMI BEACH, FL 33140 INSURER A TAPCO INSURER B: BRIDGEFIELD EMPLOYERS INS INSURER C: INSURER D: INSURER E: ( ) — CITY OF MIAMI SHORES 10050 N.E. 2ND AVE MIAMI (305) 756 -8972 FL 33141 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 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. AUTHORIZED REPRESENTATIVE or °151 COVERAGES CERTIFICATE HOLDER ACORD 25 (2001/08) C 1NS025 (maps CANCELLATION ELECTRONIC LASER FORMS, INC. - (800)327-0545 © ACORD CORPORATION 1988 Page 1 of 2