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EL-11-809s e Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 go Inspection Number: INSP - 159433 Scheduled Inspection Date: July 21, 2011 Inspector: Devaney, Michael Owner: SANCHEZ, LESLIE Job Address: 480 NE 91 Street Miami Shores, FL 33138- Project . <NONE> Contractor: BI US ELECTRICAL SERVICE INC Permit Number: EL -5 -11 Permit Type: Electrical - Residential Inspection Type: Under nd Work Classification: New Phone Number Parcel Number 1132060190020 Phone: (954)303 -8272 Building Department Comments NEW 200 AMP UNDERGROUND SERVICE AND UPGRADE. 7.Z re171-17— (/ /` "fr Passed 0 Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments X6)7 2/, -aLy 2c' // July 20, 2011 For Inspections please call: (305)762 -4949 Page 5 of 15 ADD SMOKE/CARBON MONOXIDE DETECTORS. ANY AND ALL CLOTH AND RUBBER INSULATED CONDUCTORS TO BE REPLACED. 1 C-71r, dam, L.3 alt MAY 0 6 2011 BY: �..... NO POINT AL i OUNT R 1 B 2 FEET FROM G.F I PROTECTED RECEPTACLE. PUT D RECEPTACLE UNDER SINK. ALL FIXED A' ' LIANCES OIERCATEQaTS. L eL•i), cl • X L 1 riot -r V MOTION S C NSpl S ?ell- S i u N'f{:a4.1,i0 ' 1 7 ) 1 t:xr otZ PANrc� c6t tJe too rsi 1211- Cf,,vex izti44 I A IT%L. ‘,„E44_14- Le,- 2 LonfLE L'c,H1 (S VArtc>l• BATHROOM RECEPTACLE ON 20 AMP CKT AND G.F I PROTECTED 12h- 1tx 2 L.is(ir MbV oN st•ijort.. %IC'o9"S 7-60 >' o vcru 1D ,PflNC CO �x A t1r`• \-11 �� \l Sconce. - i<tk�S al=b wy s1 3(. Ct 4.4. G2-0 fNSli�t PA-Nre L £L.IL oct ° 0 7r, i 1 O© AMj) IN %I etNt Miami Shores Village APPROVED BY DATE ZONING DEPT BLDG DEPT F . , . 7 1/2i," 5err SUII.IFCT TO COMPLIANCE WITH ALL FEDERAL STATE AND COUNTY RULES AND REGULATIONS • • H 1 , . ? 00 •r -� ti ¢_ fir •, .,••� u 7.. sr Fix tp.gt 14.4.3 • '..9 SI it\ 11' 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 BUILDING PERMIT APPLICATION FBC 20 Permit Type: Electrical OWNER: Name (Fee Simple Titleholder): Address: 450 14e tem $r City: MWMl St1O E State: tot/ Tenant/Lessee Name: N %bic (7., r-3 (:‘,..''‘. Email: i s I rnl5i'iiz . I i ZI Cowl 1/5SIAE SP 4CAI i.- Permit No. Master Permit No. Phone #: 6 5- y 5 6- S30') JOB ADDRESS: Zip: 3313f!) Phone #: 30 5.- So - 53 / Q,AN f; Yi10 e‘ 5)\ City: Miami Shores County: Folio/Parcel #: \ a. V b 0 `° 0 0a C Miami Dade Zip: 3 313 Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name: — /S .ilCAC--. vil4/7D . Phone #: 9 s-V 3O3 - -7 Z Address: e9 d/c3/'Rip-2- �' iie /i//' City: Z' ff 4/A ')SL ,,,/� State: P7 Zip: ✓`�.3 ) Qualifier Name: ,���f � 07'1/6 // Phone #: gs `1-7f -73S f State Certification or Registration #: G'C/30,0? b7/ Certificate of Competency #: e Contact Phone #: .9k1-4/- 303- »72 Email Address: /h d e i ' /t'� �L� ' 'c, . C/91,, DESIGNER: Architect/Engineer: Phone #: Value of Work for this Permit: $ i 1 ® Square/Linear.Footage of Work: Type of Work: ❑Address DAlteration UNew tepair/Replace DDemolition Description of W9rk: 4pIO� --GGLC 1� I/# ev /Vs- , s4/Y/7-14-T, A64/(6 S opig /pe FiY //JTI&K * * * * * * * * * * * * * * *** * * * **** ** * * * * * * * * ** * Fees * * * * ** * ***:x********** ** **** * *** * * * * * * * **** Submittal Fee $ J 67 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 $ P 1 3' 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 $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature The for day of Owner or Agent oingl'nstrument was a ow edged be ' 20 , by who is personally known to me or who has produced As identification and who did take an oath. NOTARY P, LIC: Sign: Print: My Commi ; sion Expires: �P 1• N% fr )00 4, tir *** * * * * * * * * * * * * * * * * * * ** * ** *** * * * ** ' * *TFs k**ok*3 ,C**%k`..F%$ak *********i *** * ****** **i % Rik***** * * *%R -'i a`-%$ *akDkDk%k******o$3e%R**** Plans Examiner Zoning Signature Contractor The foregoing instrument was acknowledged before me this;)\ day of 1��+,��. ,20A1 , by +'\-\����� who i ersonally kno me or who has produced as identification and who did th. NOTARY PUBLIC: J;9Y`13� 4 Y n Sign: Print: My Commission Expires: APPROVED BY 1e, ?°/t/e°,>' Structural Review Clerk (Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09) ACOREI CERTIFICATE OF LIABILITY INSURANCE DATE (MM(DDIYYYY) 4/27/2011 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 BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(Ies) must be endorsed. If SUBROGATION 15 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 certificate holder In Ileu of such endorsement(s). PRODUCER The Fairway Insurance Group, LLC 5461 North Federal Highway Fort Lauderdale FL 33308 INSURED Bi -Us Electrical Services, Inc. 2231 NE 40th Court Pompano Beach COVERAGES CONTACT Sexy Sneir NAME: Exn• E -MAIL (954) 772 -9819 ADDRESS: PRODUCER 90 CUSTOMER [0#.000034 INSURER(RAFFORDING COVERAGE INSURER A:Old Dominion Insurance Co. INSURER B:Aeq icap /CastlePoint Risk (FAX . Nol: (954)772-9364 INSURER C: INSURER b : 1 NAIC INSURER E : FL 33064 INSURER F: • 1‘i. • 1V1V1\ 171JIYIPGni THIS IS TO CERTIFY THAT 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. iNSR • TYPE OF INSURANCE IINSR SWVD POUCY NUMBER I (MMM/DDD/YYYY) I (MM /DD/YYYYY) • - -_ ' LIMITS LTR ' GENERAL LIABIU7Y • EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGET RERTE(S PREMISES (Ea coawrenoe.) $ 500,000 A _• j I CLAIMS MADE CX OCCUR �i G97316 6/6/2010 /6/2011 MED EXP (Arry�on®peracn) $ 10,000 t_i - -... _.. PERSONAL8ADVINJURY 1,000,000 _J 1$ GENERAL AGGREGATE $ 2,000,000 GEN'L —1 AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGO 6 2,000,000 POUCYIX!ZS: IT LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE UMIT ANY AUTO (Ea accident) $ ALL OWNED AUTOS BODILY INJURY (Per person) $ l—u "•••. SCHEDULED AUTOS : BODILY INJURY (Per accident) — ...._. $ PROPERTY DAMAGE HIRED AUTOS (Per accident) $ NON -OWNED AUTOS $ UMBRELLA MB I OCCUR EACH OCCURRENCE EXCESS LIAB --- • — CLAIMS -MADE AGGREGATE $ •_„ DEDUCTIBLE $ RETENTION $ 1 $ B WORKERS AND COMPENSATION EMPLOYERS' LIABILITY Y / N WC STATU- •• OT H- X TORY LIMITS • ' ANY OFFICER/MEMBER N/A 11/10/2010 11/10/2011 _ __ E.L EACHACCIDENT $ .000 _........_ .... _.... _.. _.___100 PROPRIETOR/PARTNER/EXECUTIVE EXCLUDED? N (Mandatary M yea. la NH) describe under WCP760672900 E.L. DISEASE -EA EMPLOYE ,•': 6 10010001 E.L. DISEASE - POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS below I DESCRIPTION OF OPERATIONS / LOCATIONS! VEHICLES (Attach ACORD 101, Additional Remarks Schedule, H more space Is required) Certificate is subject to policy forms and endorsements. CERTIFICATE HOLDER CANCELLATION (305)756 -8972 Miami Shores Village Building Department 10050 NE 2nd Avenue Miami Shores, FL 33138 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Edward Brown /ME ACORD 25 (2009/09) INS025 (200909) T0O /TOOIj ©1988 -2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD enusansuj SsM.1TBJ a41 f''958ZLL $'58 IVd ZB :fiT TTOZ /ZT /50