EL-11-913Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 162065 Permit Number: EL -5 -11 -913
Scheduled Inspection Date: July 18, 2011
Inspector: Devaney, Michael
Owner: , BARRY UNIVERSITY
Job Address: 9701 NE 5 Avenue Road
Miami Shores, FL
Project <NONE>
Contractor: JULIANA ENTERPRISE, INC DBA POWER PRO
Permit Type: Electrical - Residential
Inspection Type: Final
Work Classification: Alteration
Phone Number
Parcel Number 1132060171450
Phone: (305)687 -7080
Building Department Comments
DISCONNECT /RECONNECT REPALCE BAD WEATHER
HEAD WIRES
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
July 15, 2011
For Inspections please call: (305)762 -4949
Page 30 of 35
1
Project Address
Miami Shores Village
10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138 -0000
Phone: (305)795 -2204
Parcel Number
Applicant
9701 NE 5 Avenue Road
Miami Shores, FL
1132060171450
Block: Lot:
BARRY UNIVERSITY INC
Owner Information
Address
11300 NE 2 Avenue
MIAMI SHORES FL 33161 -6628
Phone
Cell
Contractor(s) Phone Cell Phone
JULIANA ENTERPRISE, INC DBA PON (305)687 -7080 (786)208 -3493
Valuation:
Total Sq Feet:
$ 2,100.00
0
1
Type of Work: REPALCE BAD WEATHER HEAD WIRES
Additional Info:
Classification: Residential
Scanning: 1
Fees Due
CCF
DBPR Fee
DCA Fee
Education Surcharge
Permit Fee - Additions/Alterations
Scanning Fee
Technology Fee
Total:
Amount
$1.80
$2.25
$2.25
$0.60
$150.00
$3.00
$2.40
$162.30
Pay Date Pay Type Amt Paid Amt Due
Invoice # EL -5-11 -40984
06/29/2011 Cash
$ 162.30 $ 0.00
Available Inspections:
Inspection Type:
In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In
accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are
required for ELECTRICAL, PLUMBING, MECHANICAL WINDOWS, DOORS, ROOFING and SWIMMING POOL work.
OWNERS 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. Futhermore, I authorize the above -named contractor to do the work stated.
June 29, 2011
Authorized Signature: Owner / Applicant / Contractor / Agent
Building Department Copy
Date
June 29, 2011 1
((f(! - 18k21-14-4
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
NAY 13RD
BUILDING Permit No. 1L(
PERMIT APPLICATION
FBC 20
Master Permit No.
Permit Type: Electrical
OWNER: Name (Fee Simple Titleholder): Or/tf/ ,LJ Q ,1 ` e-il j
C
Address.
City: /2) f'Gri1 <C Or f/) State: !` Cf Zip:
Tenant/Lessee Name: Phone #:
Email:
Phone #:
JOB ADDRESS:
City: Miami Shores
Folio/Parcel #:
County:
Miami Dade
Zip:
Is the Building Historically Designated: Yes
CONTRACTOR: Company Name:
NO
Flood Zone:
OI .)JL/Ef f J L //J C' Phone #: -rce6 -4-D - 3 7
Address: Gt/ c ) i. �/%2�i7
City: 4 f
Qualifier Name: %s eC ,7 ,7P %Pk /'
State Certification or Registration #: EC' - 0 6) 0 / % 0 3 Certificate of Competency #:
Contact Phone -TOY) PI) - 4'93 Email Address:
State:
Zip:
Phone #: %(6 -2.0 ef"— ?If 7 3
DESIGNER: Architect/Engineer:
/v/LW--
Value of Work for this Permit: $/CJ��
� Square/Linear Footage of Work:
Phone #:
Type of Work: ❑Address ❑Alteratio
Description of Work:
UNew air/Replace
❑Demolition
G p e 9 CC4--CrV -
* * * * * * * * * * * * * ** * * * * * * * * * ** * * * * * * * * ** Fees************* * * * * * * * * * * * * * * * * * * * * * * * ** * * * * **
Submittal Fee $ Permit Fee $ �`��� CCF $ CO /CC $
Scanning Fee $ Radon Fee $
Notary $ Training/Education Fee $ Technology Fee $
Double Fee $ Structural Review $
TOTAL FEE NOW DUE $ 1 2 (02 .. 7
DBPR $ Bond $
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 a *nspection fee will be charged.
Signature
Owner or Agent
The forego' g instrument was acknowledged before me this d ��
day of t b , 20 L , by�Cj
who is personally known to me or who has produced
As identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
My Commission Expires: (1 /
* * * * * * * * * * ** * ** * * * * * * * * * * **
APPROVED BY
Contractor
The foregoing instrument was acknowledged before me this fr
day of tie( , 20 i(, byPE6 i4lL gat-1 I
who is personally known to me or who has produced 14-- (
as identification and who did take an oath. -
NOTARY PUBLI :
Sign:
Print:
'2 4 A 1 i
-` ii./
My Commission Expires:
p!` �'
4
® 0 • _
'(4'��i
,- /s▪ '.• rdx
/ /ea Y Plans Examiner Zoning
Structural Review
(Revised 07 /10 /07)(Revised 06 /10 /2009XRevised 3/15/09)
Clerk
05/20/2011 15:15 FAX
Ij 002/003
ACORDTM CERTIFICATE
OF LIABILITY INSURANCE
DATE (MWDDmrr)
05 20 2011
TYPE OF INSURANCE
PRODUCER (904) 285 -6469
Hvshpng Insurance Associates,
P.O. Box 1399
Ponta Vedra Beach FL 32004-
Inc.
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 8
INSURED
Juliana Enterprises, Inc.
P.O. Box 170328
Hialeah FL 33017 -032
INSURER A, AS9ociated Industries Inc
GENERAL LIADILI1Y
INSURER E:
/ /
/ /
/ /
/ /
INSURER C:
EACH OCCURRENCE
INSURER D:
INSURERS
COMMERCIAL GENERAL LIABILITY
COVE
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY
REQUIREMENT. TERM OR CONNDMON 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 CONDf11ONS OF SUCH POLICIES.
AGGREGATE LIMITS SHOWN MAY HAVE 8 n REDUCED BY PAID CLAIMS.
INSR
i;
ADD L
:,_; D
TYPE OF INSURANCE
POUCY NUMBER
P(IUCY EFFECTWE
DATE M
FOUL EXPIRATION
LIMRs
GENERAL LIADILI1Y
/ /
/ /
/ /
/ /
/ /
/ /
/ /
/ /
EACH OCCURRENCE
S
COMMERCIAL GENERAL LIABILITY
DAMAGE TO RENTED
PREMISES (Ea ocom nce)
S
1 CLAIMS MADE EJ OCCUR
MED EXP (Any ene per: en)
S
PERSONAL & ADV INJURY
S
GENERAL AGGREGATE
5
GEN'L AGGREGATE LIMIT APPLIES PER
PRODUCTS . COMP/OP AC,G
5
POLICY . JEC . LOC
.
,---.
AUTOMOBILE
LIABILITY
ANY AUTO
AU. OWNED AUTOS
SCHEDULED AUTOS
NON-OWNED
NON -OWNED AUTOS
/ /
/ /
/ /
/ /
/ /
/ /
/
/ /
COMBINED SINGLE LIMIT
(Eeeeeidera)
BODILY INJURY
(Per Parson)
BODILY INJURY
(Per midst)
—
PROPERTY DAMAGE
(Per seed eet)
GARAGELWBIUTY
ANY AUTO
/ /
/ /
AUTO ONLY -EA ACCIDENT
S
OTHERTHAN EA ACC
8
AUTO ONLY: AGG
8
EXCESSNMBRELLA
LIABILITY
OCCUR E1 CLAIMS MADE
DEDUCTIBLE
RETENTION $
/ /
/ /
/ /
/ /
EACH OCCURRENCE
S
AGGREGATE
S
--
S
8
WORT CRSCOMPENSATION'AND
EMPLOYERS LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/NEWER EXCLUDED?
gym, dwcr�ba wd r
SPECIAL PROVISIONS below
MC100777E1
05/09/2011
/ /
05/09/2012
TSyLIife
E.L. EACH ACCIDENT
S
100,000
/ /
EL, DISEASE - EA EMF�LO
YEE s
100, 000
E.L. DISEASE - POLICY LIMIT $
500,000
OTHER
/ /
/ /
/ /
/ /
/ /
/ /
DESCRIPTION OF OPERATIONSRACATIONSNEHICLESIEXCLUSIONS ADDED By ENDOfifENE USPECIA{. PROVISIONS
CANCELLATION
(305) 756--8972
Nisei Shores Village
10050 N.E. End Ave
Miami Shores FL 33138-
ACORD 25 (2001108)
SHOULD ANY of THE ABOVE DESCRIBED POLICIES Be CANCELLED BEFORE THE
EEPIRATON DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
30 Days WRUTTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT
FAILURE TO DO SO $HALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE
INSURER ITE
OR REPRESENTATIVES.
AUTHORIZED HEPREEE►8ATEVE
S ACORD CORPORATION 1908