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ELC-11-114Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 155197 Permit Number: ELC -1 -11 -114 Scheduled Inspection Date: August 30, 2011 Inspector: Devaney, Michael Owner: UNIVERSITY, BARRY Job Address: 190 NW 111 Street Miami Shores, FL 33168- Project <NONE> Contractor: RING ELECTRIC INC Permit Type: Electrical - Commercial Inspection Type: Final Work Classification: Addition /Alteration Phone Number Parcel Number 1121360030480 Phone: (305)300 -3932 Building Department Comments ELECTRICAL FOR KITCHEN REMODEL Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments August 29, 2011 For Inspections please call: (305)762 -4949 Page 4 of 22 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 r 0I XU 3 JAN 2 4 2011 Permit No. Lc t 1- Master Permit No. OWNER: Name (Fee Simple Titleholder): t7 06 1 C)Q,,r45 ;71 Phone #: O' fack9 -"✓')9 D Address: 11 'boys h/ & 2 J 6 City: t 4wi % el +t..€' State: AL Zip: 33 /6, / Tenant/Lessee Name: Phone #: Email: (1-04••14...01- A.44 -mil.L • 6,4- -t . s-0 to JOB ADDRESS: 1.4)) 0 & GO t 11 '57 City: Folio/Parcel #: Miami Shores County: Miami Dade Zip: � I- Z.t 3 C,o — 003 -- Oct P/O Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name: ii„... (. 6.-Lac )t 4- e, Phone#: 01t� .' 00 i 3? Address: t%2-( (4_ Cac.D (a3 gT' n City: d,- �((tOr 1 State: i� t Zip: 5b Pt), Qualifier Name: SO•t..drfi.„. I L LD Phone #: State Certification or Registration #: fit? „ t 2 0Z0 (442- Certificate of Competency #: Contact Phone #: kO ) DO 71T6 2. Email Address: DESIGNER: Architect/Engineer: Phone #: Value of Work for this Permit: $ 4r00°° Square/Linear Footage of Work: Type of Work: ❑Address ❑Alteration ONew aepair/Replace ❑Demolition Description of Work: L4C- a (Lt 7 Ch 4..7 fL1i Cep-T-19 Zv 467791.1, 54%-t0 1 -4. i cr € C7-o , ** ******+x+ **** * ****+x *********** *** *** Fees**** *********** **+ x**+ x**+ x+ x*********+x***+a***** Submittal Fee $ a Permit Fee $ Z.z i i �b �� C �� CCF $ CO /CC $ VC( Scanning Fee $ °�� Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ Technology Fee $ TOTAL FEE NOW DUE $ \ �\ Lia 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 approv,, i nd a reinspection fee will be charged. Signature Signature Owner or Agent Contractor The foregoing instrument was acknowledged before me this 13 The foregoing instrument was acknowledged before me this I day of !i�/�t_ , 20 // , by b. r a .Y =•�/.. ,.��zd-S , day of 4l 0 �, by e� ®vl jC t t_ who is person y known to me or who has produced w is personally kno o me or who has produced As identification and who did take an oath. NOTARY PUBLIC: A Sign: Print: My Commission Expires: ***************at*ae** APPROVED BY or Notary Public State of Florida .14 Cheryl Saida Gerber My Commies on D0968126 44 �/ Expires 05/08/2014 ag i 1Pti as identification and who did take an oath. NOTARY PUBLIC: , 0..01 ALEXIS ENRIQIJt' � , Comm# DD0B3iat)1 ®'z'' i7U'p4 Pea 4120/2013 Sign: Print: Laws., Inc - ...6.'.,. ».; .ernannutlU■ My Commission Expires: f 120,3 ***** ****** ****sp*******+k+k+k** **** ** +h*+k+k*****+k**+k ***** Plans Examiner Structural Review (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) Zoning Clerk A3RDr CERTIFICATE OF LIABILITY INSURANCE OP ID MA DATE(MM/DD/YYYY) 01/11/11 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 e certificate holder is an ADDITIONAL INSURED, the po(icy(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 thls certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER iSure Insurance Brokers 2700 SW 137 AVE Miami FL 33175 Phone:305- 223 -2533 Fax:305- 220 -0765 k.UN IAk.1 NAME: IA LO, Ext): FAX No): A/ ADDRESS: PRODUCER ID 5: RINGE -1 INSURER(S)AFFORDINGCOVERAGE NAIC0 INSURED Ring Electric Inc. 16214 SW 63 St Miami FL 33193 INSURERA: Scottsdale Ins. 41297 INSURERB: Florida Citrus, Business (0'UB) INSURERC: 08 /19/10 INSURER 0 : EACH OCCURRENCE INSURER E : PRA MISES (Eat occurrence) INSURER F : CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POUCIES 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. ILA TYPE OF INSURANCE AWL WSR $UdH WVD POLICY NUMBER POLICY EFF (MM/DD/YYYY) POUCYE(P (MM/DD/YYYY) LIMITS A GENERAL X LIABILGY COMMERCIAL GENERAL LIABILITY X OCCUR CPS1226484 08 /19/10 08/19/11 EACH OCCURRENCE $ 1,000,000 PRA MISES (Eat occurrence) $ 50,000 CLAIMS -MADE MED EXP (My one person) $ 5,000 GEN'L PERSONAL & ADV INJURY $ 1 , 000 , 000 GENERAL AGGREGATE $ 2,000,000 AGGREGATE UMIT APPLIES PER: POLICY JECOT- LOC PRODUCTS - COMP/OP AGG $ 1,000,000 $ AUTOMOBILE UABIUTY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS COMBINED SINGLE UMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per acddent) $ PROPERTY DAMAGE (Per accident) $ $ $ UMBRELLA LU1B EXCESS LU\B OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DEDUCTIBLE RETENTION $ $ $ B WORKERS COMPENSATION AND EMPLOYERS' UABIUTY ANY PROPRIETOR/PARTNER/EXECUTIV1 OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS Y / N /A 10640008 04/01/10 04/oi/11 X WCSTATU- OTH- TORY LIMITS ER E.L EACH ACCIDENT $ 1 000 000 (N E.L DISEASE - EA EMPLOYEE $1,000,000 below E.L DISEASE - POUCY UMIT $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES Attach ACORD 101, Addltlonal Remarks Schedule, If more space Is required) ELECTRICAL WORK - WITHIN BUILDINGS CERTIFICATE HOLDER CANCELLATION City of Miami Shores Village 2nd972 10050 305-756-8972 10050 NW. 2nd AVE Miami Shores FL 33138 CITYOMS 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 /'/��" -' '#J7 _`�s� ACORD 25 (2009109) ©1988 -2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD t2-DADE COUNTY P.X. 001.L.Z-CTOR •40 W. 7-.A2LER ST. lot LQO ii7S1:11, 71- 32130 2090 LOCAL SUSDIESS TAX RECEPT 2011 FIRST-CLASS IWIADADE COMM STATE OF FLorzei U.S. POSTAGE EXPIRES SEPT- 3.0., 2011 PAID MUST SE DISPLAYED AT PLACE OF BUSINESS ROM, FL PURSUANT TO cotrivrt CODE CHAPTER SA - ART. S a 10 PERROT NO. 231 49723.3-0 :BUSINESS NAME / LOCATION RING ELECTRIC INC 16214 SW 63 ST 33193 UNIN DADE COUNTY OMER RING ELECTRIC INC 2. Type of Business Tem - WORKER'S istp ELECTRICAL LOCAL CONTRACTOR 1 I1EMESS DOM nor rem= Tse nounsa T YIGLATE EOSTINO FIEGULATORY OR name LAWS OP Ma COV:Zit COIES. .08 o"o NOT FORWARD DOM 117 2-415.1",i UE HOLIZEZ FRO= AtIT MOO PZ7.OT /MOM Vat= Err LAW. MIS IS RING ELECTRIC INC nor A. CERTIRCSOOO OF JORGE ANILLO PRES KOLOOTS OliatOncA• 710M- 16214 SW 63 ST MIAMI FL 33193 7:1`03 :A7:7 .d.1:3111 — Nai" . • RENEWAL RECEIPT NO. 519163-0 STATE* EC13801412 L.I.,:x4masmatmr7ux 07/08/2010 60080000499 • 000075.00 SEE OTHER SIDE 311.1:12111.,, VI ,ItIt :1.11111:11I1 :I I.: 11.1: 4241. . STATE OF FLORODA DEPARTMENT OF BUSINSS AND PROFESSIONAL REGULATION :- ELECTRICALsCONTRACTORS LICENSING:BOARD . -MC41W L10062100859 . BER 06/21/2010 090495361 --- The ELECTRICAL CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2012 LICENSE MR..- EC13001412 ANXIILO: JORGEA • RING'ELECTRIC INC. 16214-SW*63RD ST MIAMI qpvgRNoR • FL 33193 DISPLAY AB- kEQUIRED BY LAW •:• • . caARLtEJatk INTERIM SECRETARY.