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EL-11-1710Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 170818 Permit Number: EL -9 -11 -1710 Scheduled Inspection Date: March 07, 2012 Inspector: Devaney, Michael Owner: GROSSO, BRYANT Job Address: 133 NE 103 Street Miami Shores, FL 33138 -2328 Project: <NONE> Contractor: TRY -CITY ELECTRIC CO INC Permit Type: Electrical - Residential Inspection Type: Final Work Classification: Alarm Phone Number Parcel Number 1121360130820 Phone: (305)642 -7822 Building Department Comments BURGLAR ALARM INSTALLATION Passed v Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments SQL 16-(://2_2 e • March 06, 2012 For Inspections please call: (305)762 -4949 Page 27 of 27 pi .6. 0'0 'sod oArhrA\ BUILDING PERMIT APPLICATION FBC 20 Miami Shores Village Building Department iiii _r_..67-..1.--E,E,11.\„. _ ,,, A SEP 2.0 2011 Via: 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 —' 1 Permit No .6 1 11 10 Master Permit No. Permit Type: Electrical q OWNER: Name (Fee Simple Titleholder): 1JYy QV1T Grosso Phone#: 0.3°% as 3 1 lol@lp Address: 133 NC 103 ST City: fYl l Q V-lt)IreS State: EL.. Zip: 33 3 D Tenant/Lessee Name: (\) j PC Phone#: Email: 1366 hiey 133 tsA Pt IL. C-01\A JOB ADDRESS: 133 NE 103 3T City: Miami Shores County: Miami Dade Folio/Parcel #: Zip: 33137 Is the Building Historically Designated: Yes NO Flood Zone: JC CONTRACTOR: Company Name: `T-6Z■ - G► 1-� E\ ec-c.‘ c Co. Inc.. Phone #: X0.5-• (otid - % %a a-- Address: (.9 aS t_ ,.D i c ., State: t-'t__. Zip: 33 I S City: Qualifier Name: Z . ,�tY O e � Phone#: • State Certification or Registration #: QO00 1B le Certificate of Competency #: Contact Phone #: 3ct5— Email Address: DESIGNER: Architect/Engineer: Phone#: Value of Work for this Permit: $ 5 S9 "° Square/Linear Footage of Work: J / 0 0 s -Of _ Type of Work: ❑Address ❑Alteration Slew ORepair/Replace ODemolition Description of Work: �o ******** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Fees * *** *x **** *** * ***** ** *** *** **** * ** * **** * * * ** Submittal Fee $ Permit Fee $ /0' £ ` G 4 CCF $ CO /CC $ DBPR $ Bond $ Technology Fee $ Scanning Fee $ Radon Fee $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ ,, •(CO _4e � 9 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 attachm - . Als a certified copy of the recorded notice of commencement must be posted at the job site for the first inspe on . r ven + ) days after the building permit is issued. In the absence of such posted notice, the inspection will not , , i ' Bins, ction fee will be charged. Signature Cont ,ror The foregoing ins ment w ': owledged before me this 3 The foregoing instrument was acknowledged before me this day of , 2011.. by 'e,rldIGtVIT D , day of .-42p) — , 201,1_, by l ...17oiSs- en\31- who me or who has produced who i personally known to n'"i or who has produced As identification and who did take an oath. .......•• ■ ■ ■o as identification and who did take an oath. i••'••••••MEILING ..ENS :Y PUB ,,�. Comm# D� / //x�1211712011 Sig. • : t /.� C- i:'�e:/ Nda�Y Pk: t 1`il��iY , 0 .� mge .i Print: � Fa®.. ..w...... ®s.o.. ®.s••eau•OPCInt: My Commission Expires: %'l My Commission Expires: NOTARY PUBLIC: Cie Nat. Notary Public State of Florida Debra B Damera My Commission EE017280 p� o% Expires 10/19/2014 T T T w N*+N** ** *+h+N****** * *+N**N**N *** ******+NSF+N*****+ NAM* **********+k*** *** * **** **+k*********** ******* **N****+N**+P+h***+NW*** wee r/ APPROVED BY 2e, f ' Plans Examiner Zoning Structural Review Clerk (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) ACORQ CERTIFICATE OF LIABILITY INSURANCE O EF5 305. 558.1101 Xeen Battle Mead & Company 7850 Northwest 146 Street Suite 200 Miami Lakes, FL 33016 INSURED Tri -City Electric Company, Inc 625 NW 16th Avenue Miami, FL 33125 -4611 FAX 305.822.4722 COVERAGES I DATE (MMIDDIYYYY) 07/01/2011 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 INSURERA: Travelers Indemnity Company NAIC d 09490 INSURER B: Charter Oak Fire Inc Co 01205 INSURER C: Travelers Prop Caa Co of Amer 05590 INSURER D: Bridgefield Employers Inc CO 10701 INSURER E: AGCS Marine Insurance Company 22837 THE POUCIES OF INSURANCE USTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR 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. AGGREGATE UMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDIL LTR NSW TYPE OF INSURANCE A B GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY JCLAIMS MADE OCCUR X Blkt Contractual GEM_ AGGREGATE LIMIT APPLIES PER: 1 POLICY n ERC n LOC AUTOMOBILE UABIUTY X ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS POUCY NUMBER CO3664P993TIA11 DATEE etM�D>� 07/01/2011 DATE (MUflDIYYYY) 07/01/2012 LIMITS EACH OCCURRENCE $ 1,000, 000 TO RNTED PRREEMISES (EaaEocaorence) MED EXP (My one person) PERSONAL 8 ADV INJURY GENERAL AGGREGATE PRODUCTS - COMP/OP AGG 8103664P993C0F11 1,000 DED COMP /COLL - rOR PPT & LIGHT TRUCXS $2,000 DED COMP /COLL FOR MEDIUM VEHICLES 07/01/2011 07/01/2012 COMBINED SINGLE LIMIT (Ea accident) $ 300,000 $ 5,000 $ 1,000,000 $ 2,000,000 $ 2,000,000 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per acddent) GARAGE LIABIUTY ANY AUTO AUTO ONLY - EA ACCIDENT OTHER THAN AUTO ONLY: EA ACC C D E EXCESS 1 UMBRELLA UABIUTY ° 1 OCCUR n CLAIMS MADE DEDUCTIBLE X RETENTION $ 10,000 WORKERS COMPENSATION AND EMPLOYERS' LU1BIU Y ANY PROPRIETOR/PARTNEWEXECUTNEn OFFICER/MEMBER EXCLUDED? ' I (Mandatory In NH) If yea describe under SPECIAL PROVISIONS below OTHER Inland Marine CUP3664P993TIL11 07/01/2011 07/01/2012 EACH OCCURRENCE AGG AGGREGATE $ 5,000,000 $ 5,000,000 083045364 07/01/2011 07/01/2012 $ I TORY LIMITS I IOER $ E.L. EACH ACCIDENT E.L DISEASE - EA EMPLOYEE $ 1,000,000 $ 1,000,000 MZI93021023 07/01/2011 07/01/2012 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS *Except 10 days notice of cancellation for non- payment of premium. CERTIFICATE HOLDER E.L. DISEASE - POLICY LIMIT $ 1,000,000 $100,000 Leased /Rented Equip Deductible $2,500 CANCELLATION Miami Shores Village Building & Zoning Department 10050 NW 2nd Avenue Miami, FL 33150 —' ACORD 25 (2009/01) SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 3 0 • DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO 80 SHALL IMPOSE NO OBUGATION OR UABIUTY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Alex Peres /BMB ©1988.2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are reglstered marks of ACORD Ty- 2011 LOCAL Bps*sS TAX REC_ M DA IAI�lt�UE COUNTY = STATt F ORIDA ISPL EXPAIR€SIYED . SEPT MUST BE D A E PLA( OF BUSINESS PURSUANT TO COUNTY COD E t Pi Erb $A ART. 9 & 10 0261 Bu 9 V r 11 IC 625 NW 16 AVE 33125 MIAMI FIRST- CLASSS. U.S. POSTAGE PAID.; MIAMI, FL PERMIT NO, 23' THIS IS NOT ARILL_ DO NOT PAY RENEWAL 026651 -. CO INC STATII' i 01 36 CITY ELECTRIC CO INC see X_ _- CAL CONTRACTOR THIS IS ONLY _ A LOCAL BUSINESS TAX R EIRT, ff DOES NOT PERMIT THE HOLDER TO VIOLATE ANY EXISTING REGULATORY OR ZONING LAWS OF THE cool tor Ott . ITIES. NOR DOES If EXEMPT THE HOLDER FROM ANY OTHER. pERNIT OR R W � IS NOT. =A -CERTIFICATION OF THE:, tioLoEWS QUAUFiGA.- PAYMENT RECEIVED Q TAD IEL,OUN.TY TAX 07/19/2011 64010000019 00135.00 SEE OTHER SIDE ORRKER /S 40 DO NOT FORWARD TRI CITY ELECTRIC CO INC D R BORDEN JR 625 NW 16 AVE MIAMI FL 33125 1d1iI} IhiAI11l ititd,,httdluhi!}i'tiiititilhh All ?1 •)--A-••=14..-_ • . • . T T pF FLOR 7r' C.Wir BATCH NUMBER 94347.. 3911'k 4.1.1qt.- • • z •4.4...mrre • 401 74, igt.11 • kplra 10 date: AXIG 31 -11i` 1,4 ° "4.