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EL-10-2249Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 164085 Permit Number: EL -12 -10 -2249 Scheduled Inspection Date: September 06, 2011 Inspector: Devaney, Michael Owner: WASHINGTON, TERRANCE Job Address: 10940 NW 2 Avenue Miami Shores, FL 33138- Project: <NONE> Contractor: OUTLOOK INTERNATIONAL Permit Type: Electrical - Residential Inspection Type: Rough Work Classification: Alteration Phone Number Parcel Number 1121360020220 Phone: (305)374 -1005 Building Department Comments REPAIR AND REPLACE EXISITNG BRANCH AROUND WIRES, ADDITIONAL Receptacles AND GFCI Receptacles AS NEEDED. UPGRADE SERVICE RISER AND GROUNDING SYSTEM. 1 Lt Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments CREATED AS REINSPECTION FOR INSP- 161617. CREATED AS REINSPECTION FOR INSP- 161585. Service riser to be 10' to bottom of drip loop. Add arc fault breakers. Bath receptacle ckt. not to leave bathroom. Garage panel to be fed with # 6 . All counter rec. to be G. F. I. protected and 20 amp. dedicated ckt's to have 20 amp .receptacles. No one hom- = P.M. September 02, 2011 For Inspections please call: (305)762 -4949 Page 32 of 36 Miami Shores Village 2 7 2010 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 No. EL, 10 2249 PERMIT APPLICATION Master Permit No. FBC 20 Permit Type: Electrical OWNER: Name (Fee Simple Titleholder): fgroe �, P9"#'evv. Phone#:(3OS) 754-9/3 Address: 109410 N. W. Z. a �a tl�is State: FL , -Zip: z Wir- t`/ 3 o,,3 Tenant/Lessee Name: Phone #: Email: JOB ADDRESS : le 1" f"e..tig ). City: Miami Shores County: ami Dade Zip: '3-51 i.'t'^ V30 3 Folio/Parcel #: Is the Building Historically Designated: Yes NO Flood Zone: C CONTRACTOR: Company Name: 1 r\k -= 4v1% ► A --‘ Phone #: Address: ii b b ps c .tK ■5- 444- City: 'S *' State: -Ct-0 4--v t\ r' 78.6 2-E34c, 3sSc4- Zip: \ 3 2 Qualifier Name: �Q----AV.TZ Phone #: State Certification or Registration #: 00 / 4 i 4-2— Certificate of Competency #: &SL 00 0 4 w Contact Phone #: 7 84, Z8 ( 3 S 8 f Email Address: 3t,d=c>�Ta �,n a.1 -c-o►N DESIGNER: Architect/Engineer: Phone #: Value of Work for this Permit: $ ta> C-0°• °I)%6-- Square/Linear Footage of Work: Type of Work: DAddress OAlteration ONew Ma-pair/Replace ODemolition Description of Work: \ .-, \, - `- `°4-4?-_ �•;A%\-•-•-'\_ 'y�o......� c-Axc....A. - w..,-,..-.5 , msk ..\..%s, -a.% k ccr se.Ck,-41-• .--..i (lire.. - `wt.... 1,- --.-s Al- �A\-.A° L. G.,C�1-2 fit. �_ 9Mfia1 .__.o -.._.± e(t PA-1. 1-..-. -.s, �"lv.`e�... * * * ** ** * ** :****** ** * * * ** x******** ** ** pees* **. x********** ** **. x****** ************** *** ** Submittal Fee $ ++ '.,t— _ , Permit Fee $ 72 tr,3 4> CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ t „5 Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) cMprtrage Lennder's<Address ,t 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, BORERS, HEATERS, TANKS and AIR CONDITIONERS, ETC " i . FS a : ..D :.n' OWNER'S` AFFIISAVIT: t Certify that all the foregoing information is accurate and dial all work will be.done.ii compliapce with all applicable laws regulating construction and zoning. s �•! s "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:" 6 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 reinspectisn fee will be charged. Owner or Agent The fr egoing instrument was acknowledged before me this 1 day o 20 J. by eYICt/JC' �! - �1%(�5�� ZY! who is personally known to me or who has produced 2o(,d2 _ b-€11 As identification and who did take an oath. NOTARY PUBLIC: Sign:O /I' 1) Print: rd re.l :, :AiE OF FLORIDA My Commission Expires: ' °. Kendmil Jackson Commission # EE018488 Expires: AUG. 18, 2014 BONDED THRU ATLANTIC BOND DIG CO., INC. Signatur Co tractor The foregoing instrument was acknowledged before me this day of I~%0v ,20ly ,by Fran who is personally known to me r who has produced as identification and who did take an oath. NOTARY PU Sign: My Co IC: ird:' Pubh 3tats of f4yrida de•,.i, Expos Nov. 30, 2014 No. DD389723 Banded Thru Public Underwr ****** **** **: x****** ***** ************* e: ********** **a: ***** *:x=x=xe:e:e=*e<>k****a:a * ** APPROVED BY Plans Examiner Structural Review (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) Zoning Clerk } Ac9R'5' CERTIFICATE OF LIABILITY INSURANCE �....� DATE(MM/DD/YYYY) 01/03/2011 THIS CERTIFICATE 15 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 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 certificate holder in Ileu of such endorsement(s). PRODUCER 305- 233 -0855 305 -235 -8606 ALL AMERICAN INSURANCE ASSOCIATES 9036 SW 152ND STREET MIAMI FL, 33132- CONTACT KING MCGREGOR PHONE N E,�I; 305 -233 -0855 Fcr°XC.No):305- 235 -8606 EMAIL ADDRESS: PRODUCER CUSTOMER ID #: INSURER(S) AFFORDING COVERAGE NAIC # INSURED OUTLOOK INTERNATIONAL,INC. 1730 BISCAYNE BLVD #201 -B MIAMI FL, 33132 INSURERA: American Safety Indemnity Company 25433 INSURERB: Progressive Express 10193 INSURER C: Commerce and Industry Insurance 19410 INSURERD: Employers Reinsurance Corp. 39845 INSURER E : PREMISES (EaEoccccwmnce) INSURER F : CLAIMS -MADE COVERAGES CERTIFICATE NU 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 AWL INSR SUBR WVD POLICY NUMBER POLICY EFF IMMIDD/YYYYI POLICY EXP (MM/DDIYYYY) LIMITS A GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY OCCUR 23797 03/28/10 03/28/11 EACH OCCURRENCE $ 2,000,000 $ 100,000 $ 5,000 $ 1 ,00.000 $ 2,000,000 $ 1 ,000 000 $ ✓ PREMISES (EaEoccccwmnce) CLAIMS -MADE MED EXP (Any one person) PERSONAL & ADV INJURY GENERAL AGGREGATE GEN'L AGGREGATE LIMIT APPLIES PER: -1 PRODUCTS - COMP /OP AGG POLICY JECT LOC B AUTOMOBILE LIABIUTY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS 04337897 09/04/10 09/04/11 COMBINED SINGLE LIMIT (Ea accident) $ 1 000,000 ✓ BODILY INJURY (Per person) $ ✓ BODILY INJURY (Per accident) $ PROPERTY acc der tDAMAGE ) $ V. ✓ $ $ C UMBRELLA LIAR EXCESS UAB ✓ OCCUR CLAIMS -MADE 46214419 09/05/10 09/05/11 EACH OCCURRENCE $ 4,000,000 AGGREGATE $ DEDUCTIBLE RETENTION $ $ $ D WORKERS COMPENSATION AND EMPLOYERS' UABILITY OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESRIPTION OF OPERATIONS N 1 A WCA002383300 03/28/10 03/28/11 WC STATU- OTH- TORY LIMITS ER E.L. EACH ACCIDENT $ 1,000,000 ECG NN E.L DISEASE - EA EMPLOYEE $ 1,000,000 below E.L DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) CERTIFICATE HOLDER CANCELLATION MIAMI SHORES BUILDING DEPARTMENT 305 795 2204 ATTN. PERMIT COUNTER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AU + - D REPRESENTATIVE ACORD 25 (2009/09) KrII ,O MCGRE OR ©1988 -2009 ACO - % CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD • 1 o' :i. .: ... „ —i410:1 /rd !!.�waWdri":4%(/,/,I'/::l.:.w WIt'f 616144 ypKW. 1n:��74r,'��II� II S1 a ..6�1'il� i� �� 1��8►Ji �Yd�M. 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