EL-10-1410Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP - 152445 Permit Number: EL -8 -10 -1410
Scheduled Inspection Date: October 20, 2010
Inspector: Devaney, Michael
Owner: HUNTER, MARK
Job Address: 1245 NE 93 Street
Miami Shores, FL
Project <NONE>
Contractor: DJ ELECTRICAL SERVICES OF S FLORIDA
Permit Type: Electrical - Residential
Inspection Type: Final
Work Classification: Alteration
Phone Number (917)604 -8328
Parcel Number 1132050270070
Building Department Comments
NEW KITCHEN CAB, UPDATE ELECTRICAL IN KITCHEN
AND DEN.
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
October 19, 2010
For Inspections please call: (305)762 -4949
Page 19of24
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
Permit No. 0
BUILDING
PERMIT APPLICATION
FBC 20
Permit Type: Electrical
flogazw3n
at AUG 0 5 201C
Master Permit No.
OWNER: Name (Fee Simple Titleholder):cM P W K. b. j- Ufl ter
it
Address: 1245 N. G G. `I,g ST- .
City: M I f 4%4 1 S+IOTE'S . State: Ft,
Tenant/Lessee Name:
Phone#:'? f'tDo4 .. 83 208
Zip:33138
Phone#:
Email:
JOB ADDRESS: 12-45 M. E • q3 -
City: Miami Shores County:
Folio/Parcel #: 1 I -32. 05 - 02"1 -- QCs t G
Is the Building Historically Designated: Yes NO
Miami Dade
zip :3318B
x
Flood Zone:
CONTRACTOR: Company Name: W E 1 eCill Cc I SepiKeS, OV S.A. Phone#: O5 -2.10 - ci /q
Address: 82.1/405 S i/a 11 R th 51- .
City: 1"11 P- M I State: t'-L. Zip: ‘33 15.5
Qualifier Name: I /irk'N 1 h.1 A-rON1 OTT' Phone#:
State Certification or Registration #: cc 000 2.4.O 1 Certificate of Competency #: N,
Contact Phone#:18t0 1355 -1(,081 Email Address: d AV Id d j eiec-rr t dery i Ce.S . COm
DESIGNER: Architect/Engineer: set f d5 1 C9ned - °w on eY Phone#:
Value of Work for this Permit: $ 2. , 8i.45 • OO Square/Linear Footage of Work:
Type of Work: OAddress *Alteration ONew ❑Repair/Replace ODemolition
Description of Work: New 1( 11 tan en Can , updci -1-e e J ectric a J In K ITC n e n
and den.
**** n*********. r***x• x• w+ x**x.************** Fees*x. ********. u**** ******** * * ********** * ***** ***
Submittal Fee $I Permit Fee $ X,5"."; ` 1/ ~41CCF $ CO /CC $
i
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $ Technology Fee $
Double Fee $ Structural Review $
TOTAL FEE NOW DUE $ I 1,1•
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 ' a reinspection fee will be charged.
Signature
f
Owner or Agent
The foregoing instrument was acknowledged before me this 3
day of \ ,20 10, by !°u�`+ Ruttli v
who is perRonally known to me or who has produced
As identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
My Commission ' pires:
MY COMMISSION 5 DDS54159
EXPIRES: January 25, 2013
1400.3440ymy F7. Notary Diaconal AMC Co.
Signature
Contractor
The foregoing strument was acknowledged before me this c2
)V
day of (/ /U! , 20 /0, by /// //9 am 1 D
who is personality known to me or who has produced Dc--
as identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print
ei�ESHET(E
My Commission Expires: 4 ®: Mawr "'•. . ° M COMMISSION iDD92D459
at-9: ,7 a-,/3 *
EXPIRES: August 27
27, 2013
d'Fo ThNBtrige J Bonded
** * ************* ***** _************************ ** Hd********* ***************** ************* ****************
APPROVED BY <� , — ��� Plans Examiner
Structural Review
(Revised 07 /10/07)(Revised 06 /10/2009)(Revised 3/15/09)
Zoning
Clerk
•. r.
CERTIFI ATE OF LIABILITY INSU N 7/28/201
Producer. Lion Insurance Company
2739 U.S, Highway 19 N.
Holiday, FL 34691
r his Certificate is issued tte AtitiDeicif Inketitatkia tatty attd dnfe s tie
tghtaupon the certtflcateHolt* T sic itrate doeta ant amerat,*WO
or alter the tankage W lucerepeleares bataw
Insurers
NAIC #.
nsured: South East Personnel Leasing, Inc:
2739 U.S. Highway 19 N.
Holiday, FL. 34691
Insurer A: Lion Insuvanc
Insurer B:
Insurer C:
Insurer D:
Insurer E:
11075
Coveratjett
The pohmes:of minente
i&Iil respeci 10 vench d9s
(Inns shown mynas been reduced typed
ort Wad P> 6atds�dfir a fe uit�rt rO, Satr nc o W
8� A
4iSR
LIR
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Type of
CIOms
General aggregate in*
icy Prqiest
AUTOMOBILE LIAI
Any Alto
AnodAis�s
tti�,s
'os
Palmy ttes1sra,
Date
(MMJDDm)
Ply
Data
EXCESSABBBRELLA ....
Cairns
Workers 0
Employsr�
Yes,
WC 71949
01101/2010
Insurance Compann�r
01/01/201
Ea tli i Id9nt $1:At e0
8:1, Luse- Ea : ODOM
t ,1 IAs ease - Lar is st,o ;Lnv
A {EaceRent). AMI 1 2616
Descdptta ns of Operatlons/Looatiousi fellcles/Exclusians added by Endorsement/Special PrOVIsie= Oient101 2465-3t15
Coverage only applies to active employee(s) of South East Persormet Leasing, Inc. that are leased to the *Aiming "went Cempar"i
D7 Electrical Services of South Florida, Inc.
Coverage only applies to injiries fired by South East Personnel Leasing, Inc. active emplayee(s) min Rorer
Coverage does not apply to statutory mss) or Independent contractor(s) of the Client Company or any other entity.
A List of the active employee(s) leased to the Client Company can be obtained by fazing a request to (727) 937-2138 or by calling (727) 9
Project Name:
FAX: 305- 397 -2571 I ISSUE 07- 28-10 (om)
CERTIFICA1EHOLDER
CAh10ELLAVION
SHORES VILLA E9U1LD1N 0EPAR
10050t4E2NDAVEME
FL.
any of the &awl
mstaer w`J ende owe to mall 3C
do ea shat impose io obkjetion
Dar: 3/2s7
to
s3tm r»Preses.
CERTIFICATE OF LIABILITY INSURANCE 1 DIrran 0
-- -
THIS ClOtTIRCATE L a M AS A MATTER OF A , re,
ONLY AND CONFERS NO ROMS UPON TM CETIVICATE
9787 SW 72nd HOLDER. ` CERTIFICATE DOES NOT
FL 33173 ALTER THE COVERAGE AFFORDED , POLICES MOW,
DER GO 8 des Insurance
Fax (305)279 -9705
of South Frorida INC
THE POUGIES OT 1NSURANGE t
ANY REQUIREMENT. TERM QR
MAY PERTAIN. THEE tRA
POLICIES A..
INSURERS AFFORDING COVERAGE
INSURER A: Max St:today Insurance
INSURER B:
INSURER C:
INSURER D:
SURER 'E:.
ED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD I .
Y CONTRACTOR OTHER DOCUMENT WrTH RESPECT TO,WHCH THIS
D BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCi t
iY VE BEEN REDUCED BY PAID CLAIMS,
0
GARAGE LUtBR.ITY
0 ANY AUTO
0
POLICY EFFECTIVE
DATE [tDDIYYYY
03/27/2010
EACH OCCURRENCE 1.,000;000
MEO EXP (Airy ens Pte)
UC
- COIVMPiOP AGG
1,000
RY
1,000,000
2,000,000
1000;000
BODILY INJURY
(far moo►)
BODILY T ARM
(PerotOdent)
PROPERTY:DAMADE
( emu)
AUTO COY- EAACC/D IT
OTHER
OTHER THAN EA ACC
AUTO ONLY
EACH OcCURREIGE
AGGREGATE
E.L, Dl
E.L.
CERT RCATE HOLDER
ACORD 2$ (2009W01) Cif
CANCELLATION
SHOULD ANY OF THE MOW 5 SE cAtiaiLLED :Beim Tim
EXPIRATION DATE THEREOF, THE osuon oeURERvOLLetosAvat TO*AL
30 DAYS NOTICE TO THE O ATE HOLDER NAMEO TO
' R7-EFT',. ERR FAtLURE TO Do so suAu.2.055NoOSUGATIONM LIABILITY
OP ANY Pm uPON THE INSURER, BTS ARENTS OR RiginmENTATNEE.
AuTHORREDREPRESENTATivE .
et 19I84t ACORD CORPORATION, A0 rights reserve!.
TITS ACORD moo and loo Ise registered mots of ACORD