EL-11-1816Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 165573 Permit Number: EL -10 -11 -1816
Scheduled Inspection Date: November 01, 2011
Inspector: Devaney, Michael
Owner: DOUKAS, PATRICIA & HARRY
Job Address: 374 NE 100 Street
Miami Shores, FL 33138 -2421
Project: <NONE>
Contractor: KILOWATT ELECTRIC COMPANY
Permit Type: Electrical - Residential
Inspection Type: Final
Work Classification: Addition /Alteration
Phone Number (305)757 -8550
Parcel Number 1132060135420
Phone: (954)975 -8200
Building Department Comments
REPLACE EXISTING LOAD CENTER AND REPAIR
BONDING SYSTEM
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- 165095. Meter enclousior not
rated for 150 amp..
grounding electrode conduit rusted through.
October 31, 2011
For Inspections please call: (305)762 -4949
Page 9 of 17
Project Address
Miami Shores Village
10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138 -0000
Phone: (305)795 -2204
374 NE 100 Street
Miami Shores, FL 33138 -2421
Owner Information
Address
Parcel Number
1132060135420
Block: Lot:
Phone
Applicant
PATRICIA & HARRY DOUKAS
Cell
PATRICIA & HARRY DOUKAS
374 NE 100 Street
MIAMI SHORES FL 33138 -2421
(305)757 -8550
Contractor(s) Phone
KILOWATT ELECTRIC COMPANY (954)975 -8200
CeII Phone
Valuation:
(305)318 -7108
Total Sq Feet: 0
Type of Work: ELECTRICAL
Additional Info:
Classification: Residential
Scanning: 1
„j Available Inspections:
Fees Due
CCF
DBPR Fee
DCA Fee
Education Surcharge
Permit Fee - Additions/Alterations
Scanning Fee
Technology Fee
Total:
Amount
$1.20
$2.25
$2.25
$0.40
$150.00
$3.00
$1.60
$160.70
Pay Date
Invoice #
10/04/2011
10/05/2011
Pay Type
EL -10 -11 -42186
Check #: 2759
Check #: 2769
Amt Paid Amt Due
$ 50.00 $ 110.70
$ 110.70 $ 0.00
In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in comp)
pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted io the prof
accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or Employes
required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL woi
OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in com
construction and zoning. Futhermore, I authorize the above -named contractor to do the work stated.
Inspection Type:
Final
Meter Box
Alteration
Relocation
Fire Alarm
Service Change
Underground
\A; . 11/ .
ince with all ordinances and regulations
er authorities of Miami Shores Village. In
I understand that separate permits are
diance with all applicable laws regulating
Octc )er 05, 2011
Authorized Signature: Owner / Applicant / Contractor / Agent
Building Department Copy
October 05, 2011
)ate
1
1)
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
taggyn.v9
co 0 4.2t)fl
mmmmm.mmm•s.m• ° ° ° °•mmmm
BUILDING Permit No.` 1 ) 64
PERMIT APPLICATION Master Permit No.
FBC 20
Permit Type: Electrical
OWNER: Name (Fee Simple Titleholder): / A fl ).1 budo..f Phone #: `3v� 33 83d
Address: 3 i Y ot%E /o 644'
City: M. i144. J'J r &1 State: L Zip: 3&
Tenant/Lessee Name: Phone #:
Email:
JOB ADDRESS: 3 "Y / to
City: Miami Shores County: Miami Dade Zip: 3-1/-je€
Folio/Parcel #:
Is the Building Historically Designated: Yes NO Flood Zone:
CONTRACTOR: Company Name:
. kO ] $ CI, e;11.-. L to Phone #: 9r ' - 9) — p3.40
Address: /7 06 tiw R'2- a4. -'E--
City: PD N-ila ...1 3C State: FC. Zip: 13069
Qualifier Name: E.4.0.--, f/a`/'_ Phone #:
State Certification or Registration #: CC 11 dG 114 / Certificate of Competency #:
Contact Phone #: ? Y-- S o t o -91/z- Email Address: /- 'A.,. e /L'%,..i..* -'ei'c'C./4„'r- 1 Pl ei_
DESIGNER: Architect/Engineer: Phone #:
Value of Work for this Permit: $ I 2' ° ®O Square/Linear Footage of Work:
Type of Work: Address OAlteration ONew epair/Replace ODemolition
Description of Work: (a 40 m[_4- (Co X4 /44 Lm.. fie, s„ -4-
******** ** * * * ** ** ** **** * **** * * * ** ****** Fees************* **** * * ***** * ***m**** * ***** * ****
Submittal Fee $ Permit Fee $ l �' �� CCF $ CO /CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $ Technology Fee $
Double Fee $ Structural Review $
TOTAL FEE NOW DUE $
ro
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, BOIT.RRS, 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 c me cemenee'•e posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issue. In e ce of such posted notice, the
inspection will not be approved and a reinspection , ' will be charged.
Signatur
The for
day of
who is pe
NOT
er or Ag
instrumen was ac
, 20 i , by
sonally known to me or who has produced
entification and who did take an oath.
ledged before
Signature
Contractor
The foregoing instrument was acknowledged before me this 76
ed
day of , 20 it , by c vb.Aref frr` `'L
Sign:
Print:
My Commission Expires:
ho is personally kno
who has produced
as identification and who did take an oath.
NOTARY PUBL C:
Slat 15
Nata Y Pm. ExDaee Sep 23, p
?' • i s MY Comm. peen•
• • Seeded 1104
* * * * * * * * * * * * * * * * * * * * **
APPROVED BY
Sign:
Print:
My Commission Expires:
********************************* *****# ********+ N*** *****+k*** *****+%******
C/ Plans Examiner
Structural Review
(Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09)
Zoning
Clerk
P
r
TAX-RECEIPT
115 S. Andrews Ave., Rm. A -100, Ft. Lauderdale, FL 33301 -1895 — 954 - 831 -4000
VALID OCTOBER 12011 THROUGH SEPTEMBER 30, 2012
DBA:
Business Name: KILOWATT ELECTRIC COMPANY
Owner Name: EDWARD D FLACK /QUAL
Business Location: 1700 NW 22 AVE
POMPANO BEACH
Business Phone: 954- 975 -8200
Rooms
Seats
Employees
1
Receipt #:181 -2549
Business Type: E LECTRI CAL/ALARMS/CO
(ELECTRICAL CONTRACTOR)
Business Opened:o4/28/1994
State /County /Cert/Reg:EC13 001961
Exemption Cod @:NONEXEMPT
Machines Professionals
For Vending Business Only
Number of Machines:
Vending Tvae:
Tax Amount
Transfer Fee
NSF Fee
Penalty
Prior Years
Collection Cost
Total Paid
27.00
0.00
0.00
0.00
0.00
0.00
27.00
THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS
THIS BECOMES A TAX RECEIPT
WHEN VALIDATED
Mailing Address:
EDWARD D FLACK /QUAL
1700 NW 22ND AVE
POMPANO BEACH, FL
33069 -1560
This tax is levied for the privilege of doing business within Broward County and is
non - regulatory in nature. You must meet all County and/or Municipality planning
and zoning requirements. This Business Tax Receipt must be transferred when
the business is sold, business name has changed or you have moved the
business location. This receipt does not indicate that the business is legal or that
it is in compliance with State or local laws and regulations.
2011 - 2012
Receipt #033-10-00002463
Paid 07/11/2011 27.00
BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT
115 S. Andrews Ave., Rm. A -100, Ft. Lauderdale, FL 33301 -1895 — 954 -831 -4000
VALID OCTOBER 1, 2011 THROUGH SEPTEMBER 30, 2012
DBA:
Business Name:
Owner Name:
Business Location:
Business Phone:
Rooms
KILOWATT ELECTRIC COMPANY
EDWARD D FLACK /QUAL
1700 NW 22 AVE
POMPANO BEACH
954- 975 -8200
Seats
Employees
1
OR
Receipt #: 181 -2549
Business Type: ELECTRICAL /ALARMS /CONTRACTOR
(ELECTRICAL CONTRACTOR)
Business Opened: 04/28/1994
State /County /Cert/Reg: EC13 0 01961
Exemption Code:NONEXEMPT
Machines
Professionals
Signature
Number of Machines:
For Vending Business Only
•
Tax Amount
Transfer Fee
NSF Fee
Penalty
r
Prior Years
Collection Cost
Total Paid
27.00
0.00
0.00
0.00
0.00
0.00
27.00
Receipt #033 -10- 00002463
Paid 07/11/2011 27.00
CERTIFICATE OF LIABILITY
INSURANCE
10 /03/2011
TYPE OF INSURANCE
PRODUCER (305) 822 -7800 FAX (305) 558 -4294
Coll insworth, Al ter, Fowler & French LLC
8000 Governors Square Blvd
Suite 301
Miami Lakes , FL 33016
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. ATER THE COVERAGE RCAFFO DOES AFFORDED NOT Y THE POLICIES BELOW.
INSURERS AFFORDING COVERAGE
NAIC #
INSURED Kilowatt Electric Company
1700 NW 22nd Avenue
Pompano Beach, FL 33069
INSURER A: Amerisure Insurance Co
19488
INSURER B:
G12010669080011
CONTRACTUAL LIABILITY
INSURER C:
06/02/2012
INSURER D:
$ 1,000,000
INSURER E:
DAMAGE TO RENTED
PRFMI.CFR (F• tururnnrw)
vTHE 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 POLICES DESCRIBED HEREN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
LTRNRRt
ADDL
TYPE OF INSURANCE
POUCY NUM
POLICY EFFECTIVE
nnomnrrn
EXPIRATION
PnA QF / Y N
LIMITS
A
GENERAL
LIABILITY
COMMERCIAL GENERAL LIABILITY
G12010669080011
CONTRACTUAL LIABILITY
06/02/2011
06/02/2012
EACH OCCURRENCE
$ 1,000,000
X
DAMAGE TO RENTED
PRFMI.CFR (F• tururnnrw)
$ 100,000
CLAIMS MADE X OCCUR
MED EXP (Any one person)
$ 5,000
X
Bl kt A/I
PERSONAL & ADV INJURY
$ 1,000,000
X
Blkt Waiver
GENERAL AGGREGATE
$ 2,000,000
GEN'L
AGGREGATE LIMIT APPLIES PER:
POUCY Pi] Ter. n LOC
PRODUCTS - COMP /OP AGG
$ 2,000,000
—I
A
AUTOMOBILE
LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON -OWNED AUTOS
CA20106660701
06/02/2011
06/02/2012
COMBINED SINGLE UMIT
(Ea accident)
$ 1,000,000
X
BODLY INJURY
(Per person)
$
X
BODILY INJURY
(Per accident)
X
PROPERTY DAMAGE
(Per accident)
$
GARAGE
UABILITY
ANY AUTO
AUTO ONLY- EA ACCIDENT
$
OTHER THAN EA ACC
$
7
AUTO ONLY: AGG
$
A
EXCESS/UMBRELLA UABILITY
CU20300960502
06/02/2011
06/02/2012
EACH OCCURRENCE
$ 1,000,000
" I OCCUR CLAIMS MADE
AGGREGATE
$ 1,000,000
DEDUCTIBLE
RETENTION $ 10,000
$
$
$
A
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
OFFFICER/MEMBERPEXC EXCLUDED? PROPRIETOR/PARTNER/EXECUTIVE
If yes, describe under
SPECIAL PROVISIONS below
WC202577805
12/01/2010
12/01/2011
X I �RYUMrrrrS I 10g,-
E.L. EACH ACCIDENT
$ 500 , 000
E.L DISEASE - EA EMPLOYEE
$ 500,000
E.L. DISEASE - POLICY LIMIT
$ 500,000
OTHER
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
l.Grl 1 IrP..M1 G I JL.IG I
Miami Shores Vi 11 age
Bui 1 ding Department
10050 NE 2nd Ave
Miami Shores, FL 33138
�.-.•- ..-- ----^• •�••
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES
EXPIRATION DATE THEREOF, THE ISSUING INSURER
30 DAYS WRITTEN NOTICE TO THE CERTIFICATE
BE CANCELLED BEFORE THE
WILL ENDEAVOR TO MAIL
HOLDER NAMED TO THE LEFT,
IMPOSE NO OBLIGATION OR LIABILITY
OR REPRESENTATIVES.
BUT FAILURE TO MAIL SUCH NOTICE SHALL
OF ANY KIND UPON THE INSURER, ITS AGENTS
AUTHORIZED REPRESENTATIVE
Richard French/TERESA
^i/ %7
�jww''
ACORD 25 (2001/08)
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement
on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
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 lieu of such endorsement(s).
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract between
the issuing insurer(s), authorized 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.
ACORD 25 (2001/08)
D
•
C
•
•
•
•
•
....
....
•
. • .
•
A
CUSTOMER INFO:
374 ne 100th street
miami shores, fl.33138
•
SCOPE OF WORK
REPLACE DAMAGED LOAD CENTER WITH NEW
REPLACEMENT
BRING GROUNDING ELECTRODE SYSTEM UP
TO CODE
tH &i(P
Miami Shores Village
APPROVED
BY
DATE
ZONING DEPT
BLDG DEPT
SUBJECT TO COMPLIANCE WITH ALL FEDERAL
STATE AND COUNTY Mil ES AND REGULATIONS
• • • •
• • •
• • •
• •
•
• •
.. •
PANEL SCHEDULE
2P 100
1
2
2P 60
2P 100
3
4
2P 60
2P 50
5
6
2P 20
2P 50
7
8
2P 20
2P 30
9
10
15
2P 30
11
12
15
2P 15
13
14
15
2P 15
15
16
20
EXISTING 1 }" CONDUIT W 3 # 1 THWN CU
CLOUDED AREA DENOTES
EXISTING TO REMAIN
C
150 amp Toad
center nema 3r
with 150 amp main
breaker
EXISTING METER CAN
replace existing load center that is
damaged
ADD SMOKE/CARBON MONOXIDE DETECTORS.
ANY AND ALL CLOTH AND RUBBER
INSULATED CONDUCTORS TO BE REPLACED.
2 g X 10 FT GRD RODS WITH #4
GRD ELECTRODE CONDUCTOR
B
03,
6
5
3
KILOWATT ELECTRIC COMPANY
1700 NW 22 AVENUE
POMPANO BEACH, FL, 33069
EC 13001961
SU MN M.
OM Kt
Wet
I NUNt