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PL-11-1060Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 PL' 11' 1,0 tQO Inspection Number: INSP - 161281 Permit Number: EL -6 -11 -1140 Scheduled Inspection Date: June 29, 2011 Inspector: Devaney, Michael Owner: CUMING, RICHARD Job Address: 436 NE 94 Street Miami Shores, FL 33138- Project: <NONE> Permit Type: Electrical - Residential Inspection Type: Final Work Classification: New Phone Number Parcel Number 1132060140340 Contractor: AB DEPENDABLE SERVICE INC Phone: 305 -254 -7707 Building Department Comments ELECTRIC FOR SPRINLKER PUMP Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments CY' June 28, 2011 For Inspections please call: (305)762 -4949 Page 31 of 38 Miami. Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'N PHONE NUMBER: (305) 762.4949 BUILDING PERMIT APPLICATION FBC 20 Permit Type: Electrical OWNER: Name (Fee Simile Title older Address: h City: 1V \ c)( S ito 3UL2320'i'i Permit No. • 1 9 Master Permit No. Pi-.1) ` 16 66 Phone#: State: Zip: 37 JO Tenant/Lessee Name: Phone #: Email: JOB ADDRESS: " 1 1(0 \I `a 4-- City: Miami Shores County: Miami Dade Zip: 3313q Folio/Parcel #: Is the Building Historically Designated: Yes CONTRACTOR: Company Name: Address: 0 City: Mfb►W1 t Qualifier Name: ANPx _j�CICq State Certification or Registration #: EC_ \3®0 z..�Gi Contact Phone #: 1St; 4 a Cpl Zi A13i b e-0 NO Flood Zone: CiCt \1e S . LC, Phone #: &)S ° Z.s'i a 7'167 State: Email Address: Zip: 33\ S to Phone #: Certificate of Competency #: Aclepenctslit 6 i\11 siack w.+ DESIGNER: Architect/Engineer: Phone #: Value of Work for this Permit: $ Type of Work: ❑Address ❑Alteration Description of Work: 1h5ic t WIT flG Square/Linear Footage of Work: j New ORepair/Replace XI et- ?um i % tee ODemolition * * * * * * * * ** Submittal Fee $ * *** * * ** ** * * * * * * *** * *x: * ** Fees**************** *** * * ** * * *x:*** * * * * *:x * ** * * * *:x Permit Fee $ /0'6.0e, .06) CCF $ CO /CC $ DBPR $ Bond $ Technology Fee $ Scanning Fee $ Radon Fee $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ Bonding Company's Name (if applicable) Bonding Company's Address City State Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip 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 II work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a sepaT e permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, ANKS and AIR CONDITIONERS, ETC information is accurate and that all work will be done in compliance with all OWNER'S AFFIDAVIT: I certify that all the foregoin applicable laws regulating construction and zoning. "WARNING TO OWNER: YO COMMENCEMENT MAY RES IMPROVEMENTS TO YOUR P FINANCING, CONSULT WITH Y RECORDING YOUR NOTICE OF C FAILURE TO RECORD A NOTICE OF LT IN YOUR PAYING TWICE FOR PERTY. IF YOU INTEND TO OBTAIN UR LENDER OR AN ATTORNEY BEFORE MENCEMENT." 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 w e approved and a reinspection fee wi11 ?e charged. Signature Owner or Aeent Contractor knowledged before me this t The foregoing instrument was acknowled ed before me this The for going instrument was , day of 20X, by Cuafrilk who is personally know. tome or who has produced who is personally known to me or who has produced 1M As identification and who did take a oath. as identification and who did take an oath. \\\N���1111I 1111111 /l4,/ - Print: — �� -® .-' �'' _ My Commission Expires 0.. Z. c T. linIttliiimoN Oc-3, ****** ****** * * ****** ***** * * ** ****** ** * * * * ** * * *r?ric*************%**** ***ia****** * ** ***** ***** ******* ** *** ****** ?daY/ Zi/ "eAeC' f' ]ans Examiner NOTARY PUBLIC: NN GONZALEZ ION # EE078108 May 16, 2015 My Commission Expires: OTARY PUBLIC: APPROVED BY (Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09) Zoning uctural Review Clerk A 1® CERTIFICATE OF LIABILITY INSURANCE 1 ATE(M- 11DfY'"" 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 BYTHE POUCIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, ANDTHE CERTIFICATE HOLDER. IMPORTANT: if the certificate holder Is an ADDfnONAL INSURED, the policy(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 certiflcatte holder in lieu of such endorsement(s). PRODUCER — Risk Transfer Programs, LLC 219 East Livingston Street Orlando, FL 32801 CONTACT NAME No, Ems: 886-481-9363 FAX . No): E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A:CastIePoint National Insurance Co. UABILrrY COMMERCIAL GENERAL LABILITY Global Employment Solutions PEO II, Inc. 3350 Bushwood Park Drive Suite 200 Tampa, FL 33618 INSURER B INSURER C : INSURER D : $ INSURER E : $ INSURER F : 1 CLAIMS-MADE ❑ OCCUR COVERAGES CERTIFICATE NUMBER :UTZR52BL REVISION NUMBER: THIS IS TO CERTIFY THAT THE POUCIES OF INSURANCE USTED 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 POUCIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDCSUBIE INSR W VD POUCY NUMBER POUCY EFF (14 1WDD/YYYY) POUCY EXP (MMWDDIYYYY) WETS GENERAL UABILrrY COMMERCIAL GENERAL LABILITY EACH OCCURRENCE $ DAMAGE TO RENTED e) PREMISES occurrence) $ 1 CLAIMS-MADE ❑ OCCUR MED EXP (Any are person) $ PERSONAL & ALAI INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE MDT APPLIES PER n POLICY n mar n LOC PRODUCTS - COMPIOP AGG $ $ AUTOMOBILE — UABIUTY ANY AUTO AUTOS HIRED AUTOS _ LED AAUUTOS NON-OWNED COMBINED SINGLE UMIT (F-a accident) $ BODILY WJURY (Per person) $ JUI BODILY W ((Per e $ PROPERTY $ $ UMBRELLA UAB EXCESS UAB OCCUR CLAIMS-MADE /AGGREGATE EACH OCCURRENCE $ REGA-TE $ $ DID I I RETENTION $ A WORKERS COMPENSATION AND EMPLOYERS' UABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? I (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below N IA WSLTHPE00008207 12/31/2010 01/01/2012 X f I I E�R- TORY Lams EL EACH ACCIDENT $ 1,000,000 EL DISEASE - EA EMPLOYEE $ 1,000,400 EL DISEASE - POUCY LIMIT $ 1,000,000 $ $ $ $ $ DESCRIPTION OF OPERATIONS I LOCATIONS! VONLCCLES (Attach ACORD 101, Add Remarks Schedule, If more space Is regwntc) Coverage is extended to the leased employees of alternate employer (Alabama, Colorado, Florida, Georgia, Illinois, Michigan, Missouri, South Carolina, Tennessee and Texas Operations Only): AB Dependable Service, Inc # 4105069 (Effective 06- 06-05) DISCLAIMER: The Certificate of Insurance does not constitute a contract between the issuing insurer(s), authorized d representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. CERTIFICATE HOLDER CANCELLATION Miami Shores Village Building Department 10050 NE 2nd Ave Miami Shores, FL 33138 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATi ETHEREOF, NOTICE WILL BE DELIVERED FN ACCORDANCE WITH THE POUCY PROVISIONS. AUTHORIZED REPRESENTAIIVE ACORD 25 (2010105) Page 1 of 1 ©1988 -2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ACCO °' CERTIFICATE OF LIABILITY INSURANCE °06/2o200111�'' PRODUCER M Motors Insurance 11934 S.W. 8th Street Miami, FL 33184 Phone (305)559 -8818 Fax (305)227 -0977 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND ALTER THE COVERAGE AFFORDED BY THE POUC OR ES BELOW. INSURERS AFFORDING COVERAGE NAIC # INSURED A.B. DEPENDABLE SERVICES INC. 14048 SW 139 CI Miami, FL 33186- INsuRERp: ASCENDANT COMMERCIAL INS. CO. INSURER B: INSURER C: INSURER D: INSURER E: COVERAGES INSURER F: THE POLICIES OF INSURANCE LISTED 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 OF 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. OMR LTR ADM. RIM TYPE TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DDADDIYY) POLICY CATION DATE [ ,. ' IVY) LIMITS A ❑ GENERAL LIABILITY V COMMERCtAL GENERAL LIABILITY ❑ ❑ CLAIMS MADE LA OCCUR ❑ GL- 51793 -1 09/23/10 � 09/23/11 / ____: / EACH OCCURRENCE 1,000,000 DAMAGE TO RENTED PREMISES (Ea =thence) 100,000 MID EXP (Any one Person) 5,000 PERSONAL & ADV INJURY 1,000,000 GENERAL AGGREGATE 2,000,000 ❑ PRODUCTS - COMP /oP AGG 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: ❑ POLICY ❑ PROJECT ❑ LOC ❑ AUTOMOBILE LIABILITY ❑ 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 LIABILITY ❑ ANY AUTO ❑ AUTO ONLY - EA ACCIDENT OTHER THAN EA ACC AUTO ONLY: AGG ❑ EXCESS/UMBRELLA LIABILITY ❑ OCCUR ❑ CLAIMS MADE ❑ DEDUCTIBLE ❑ RETENTION $ EACH OCCURRENCE AGGREGATE WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR / PARTNER / EXECUTIVE OFFICER / MEMBER EXCLUDED'? If Yes describe under SPECIAL PROVISIONS below ❑ WC STATU- ❑ OTH- TORY LIMITS ER E.L. EACH ACCIDENT E.L DISEASE - EA EMPLOYEE EL. DISEASE - POLICY UMIT OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT 1 SPECIAL PROVISIONS ELECTRICAL CONTRACTOR CERTIFICATE HOLDER CANCELLATION Miami Shores Village Building Dept. 10050 NE 2nd Avenue Miami Shores, FL 33138 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 ACORD 25 (2001108) QF