EL-11-849Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP - 159661
Scheduled Inspection Date: March 21, 2012
Inspector: Devaney, Michael
v-1r
Permit Number: EL -5 -11 -849
Owner: HUBER, PATRICK & XIMENA
Job Address: 1150 NE 100 Street
Miami Shores, FL 33138-
Project: <NONE>
Contractor: DAW ELECTRIC, INC
Permit Type: Electrical - Residential
Inspection Type: Final
Work Classification: Pool - Private
Phone Number
Parcel Number 1132050190420
Building Department Comments
ELECTRICAL WORK, POOL HOOK UP & HEATER HOOK
UP
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
March 20, 2012
For Inspections please call: (305)762 -4949
Page 3 of 23
1
Project Address
Miami Shores Village
10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138 -0000
Phone: (305)795 -2204
Parcel Number
rival
Expiration: 03/14/2012
Applicant
1150 NE 100 Street
Miami Shores, FL 33138-
1132050190420
Block: Lot:
PATRICK & XIMENA HUBER
Owner Information
Address
Phone
CeII
PATRICK & XIMENA HUBER
1150 NE 100 Street
MIAMI SHORES FL 33138-
Contractor(s)
DAW ELECTRIC, INC
Phone
Cell Phone
Valuation:
Total Sq Feet:
$ 1,200.00
422
1
Type of Work: ELECTRICAL
Additional Info: SWIMMING POOL
Classification: Residential
Scanning: 1
Fees Due
CCF
DBPR Fee
DCA Fee
Education Surcharge
Permit Fee - Additions/Alterations
Scanning Fee
Technology Fee
Total:
Amount
$1.20
$4.50
$4.50
$0.40
$300.00
$3.00
$1.60
$315.20
Pay Date Pay Type
Invoice # EL -5-11 -40907
09/16/2011 Check #: 36382 $ 265.20 $ 50.00
05/11/2011 Check #: 36055 $ 50.00 $ 0.00
Amt Paid Amt Due
Available Inspections:
Inspection Type:
Final
Light Niche
Alarms
Bonding
In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In
accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are
required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work.
OWNERS 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. Futhermore, I authorize the above -named contractor to do the work stated.
September 16, 2011
Authorized Signature: Owner / Applicant / Contractor / Agent
Building Department Copy
Date
September 16, 2011 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
BUILDING
PERMIT APPLICATION
FBC 20
Permit Type: Electrical
OWNER: Name (Fee Simple Titleholder):
Permit No.
Master Permit No.
L `1,all
Phone#:
Address: 1 d S® e 1 ®® s a
City: ro rrm s State: ,
Tenant/Lessee Name: Phone#:
Email:
Zip: I "
JOB ADDRESS: a 1
f
I ,* S -T
City: Miami Shores County: Miami Dade Zip: % u % t
Folio/Parcel #: 1 9 — "a°2-....5 ° 019 m' 0 4' 2
Is the Building Historically Designated: Yes NO Flood Zone:
CONTRACTOR: Company Name: r4. W -"` 4Z-
Address: �° �-1 a� �-� - ^a
City:d 11. o State:
Qualifier Name: IR-� A . %.0.1 d °A b
State Certification or Registration #: & C 1 is b
tzt��
Contact Phone #: zL� `9 sS- 'e®Email Address:
DESIGNER: Architect/Engineer: Phone#:
Phone#: was v '9 — S o -1
Zip: -3305-4*
Phone #: —s ° — x'®241
�-. Certificate of Competency #:
Value of Work for this Permit: $ I ° Square/Linear Footage of Work:
Type of Work: UAddress ❑Alteration
Description of Work:
yNew URepair/Replace
❑Demolition
* * * ** * ** * * * * * * * * * * ** * ** ***•x**•x *********Fees** ** ** ******** ****** **** *** ******** * ***** ***
Submittal Fee $ Permit Fee 0400 e'er®
Scanning Fee $ Radon Fee $
Notary $ Training/Education Fee $
Double Fee $ Structural Review $
CCF $ CO /CC $
DBPR $ Bond $
Technology Fee $
11 j �� /
TOTAL FEE NOW DUE $ GX ��
Bonding Company's Name (if applicable)
Bonding Company's Address f�
City State Zip
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
fA
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 and a reinspection fee will be charged.
ea
4/7
O er or Agent Contractor
The foregoing instrument as owledged before me this 2- The foregoing instrument was acknowledged before m(e r&-/a/ / 20 b :� h - Gekti U�'A Y of , 20 , by � C` 2 `�"
day of ��. �> y
who is per onally known to me or who has produced who is personally known to me or who has produced
As identification and who did take an oath. as identification and who did take an oath.
Signature j7 1(
NOTAR P IC:
411 I
711.0."
Sig
Pri
My Commission Expire
My Commission Expi
* * * * *** * * * * * * * * * * * ** > x** ****s:* **, xx:: x** ************* s: ***+ x*, x**> x> x> x************ ** **a, ********* ** * * * ** ****:x*
Plans Examiner Zoning
APPROVED BY
Structural Review
(Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09)
Clerk
MIAMgDADE COUNTY
TAX COLLECTOR
. 140 Y�►► FLAGLER ST, '
let FLOOR
MIAMI, FL 33130 "
•
2010 MUNICIPAL CONTRACTOR'S 2011
• TAX RECEIPT
• ' MIAMI- DADECOUNTY -. STATE QF FLORIDA
PURSUANT TO COUNTY. CODE SEC. 10-24.
. EXPIRES SEPT. 30, 2011:
•
RECEIPT NO. 30. 5700704
BUSINESS NAME / LOCATION
D A W ELECTRIC INC
20200 NW 2 AVE •
OWNER ID A W ELECTRIC INC
THIS I5 NOT A f31Li_ — ! 1:'s NOI PAY
CC NO: 04E001146
F]F.IST- CLA:iS::;
U.S. POSTAGE I
• PAID •,•
..•• ..•
MIAMI, FL •••
PERMIT..NO; 231
. RECEIPT HOLDER MAY 'DO
BUSINESS AS A CONTRACTOR _'
AS SPECIFIED HEREON.: • :. :
SEE BACK OF RECEIPT•FOR
A LIST OF NON - PARTICIPATING
MUNICIPALITIES
• Receipt holder must'
register in the ay; ' :
where work is to be ::
. done. ' • ;
PAYMENT RECEIVED •
MA1M•OAce cO itITY TAX
• •CO uri701 /201.0
02220037001
:000200.00••;
ELECTRICAL,. CONTRACTOR"
DO NOT FORWARD
D A W ELECTRIC INC
DERRICK WILLIAMS PRES
20200 NW 2 AVE 301
MIAMI GARDENS FL 33169
7
11 ,II1u1I,u,I11 11111111, 1114 I,I11nf1111,I,I111111111,I1111f
G� Trades'Quallfyinp Board
BUSINESS CERTIFICATE OF COMPETENC
f. WILLIAMS DERRICK A
is certified under the provisions of Chapter iD of Miami -Dade Coun
, OLIO FOR CONTRACTING UNTJL 09/30X201.
Atc ®Rb CERTIFICATE OF LIABILITY INSURANCE
DATE(M41/DD/YYYY)
02/15/2011
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE GOES 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 1s an ADDITIONAL INSURED, the policy(les) 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
AUTOMATIC DATA PROC INS AGCY INC
71 HANOVER RD
FLORHAM PARK, NJ 07932
(877) 677 -0428
XV770 70A
CONTACT •
(��1� o, eat): (saa) e17-0428 I (AA/c, No): (817)07?-04W
@•MAIL
ADDRESS: spcblcadu@travetere.com
PRODUCER
CUSTOMER ID 0: 3220X3128
INSURER(S) AFFORDING COVERAGE
NAIC 0
INSURED
D.A.W. ELECTRIC INC
20200 N.W. 2ND AVENUE
MIAMI GARDENS, FL 33169
INSURER A:TRAVELERS CASUALTY ANO SURETY COMPANY
UABIUTY
OCCUR
INSURER B:
INSURER C:
INSURER 0: .
EACH OCCURRENCE
INSURER E:
INSURER F:
DAMAGE TO RENTED
PREMISES (Fe nrrrmanre l
CERTIFICATE NUMBER: 871057749411640
REVISION NUMBER:
•
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 REOUIREMENT, TERM OR CONDrON 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 SUBJECTTO ALL THE TERMS, EXCLUSIONS
AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
NSR
LTR
TYPE OP
ADDL
INSR
SUER
WUD
pOUCYNUMBER
POLICY EFF
(MM/DO/YYYY)
POUCY EXP
(MMIODFYYYYt
LIMITS
GENERAL
LIABITY
CONIMERCIAL GENERAL
ICLAIMS -MADE
UABIUTY
OCCUR
EACH OCCURRENCE
$
DAMAGE TO RENTED
PREMISES (Fe nrrrmanre l
$
XP e
$
GEN
L AGGREGATE UNIT
POLICY 1-1_,M
•
APPUES PER: p
PRODUCTS - COMP/OP AGG
$
—I
-
I ILOC
$
AUTOMOBILE
_
UABIUTY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON -OWNED AUTOS
COMBINED SINGLE UMR
(Ea accident)
$
.
BODILY INJURY (Per person)
$
BODILY INJURY (Per esddenl)
$
--
..(Par
$
-_
_
$
—..
$
UMBRELLALIAB
EXCESSLIAB
_
OCCUR
CLAIMS -MADE
EACH OCCURRENCE
$
AGGREGATE.
$
DEDUCTIBLE I
RETENTION $
$
'
—
$
A
=02 RRSCOMPENSATION
PLOYERS' LIABILITY YM
ANYPROPRIETOR/PARTNER/EXECUTNE [J
OFFICER/MEMBER EXCLUDED?
(Mandatory In NH)
11 s. describe under
SPECIAL PROVISIONS below
N/A
UB- 1485L867 -11
03/07/2011
•
03/07/2012
X I TOW NN 1 1°EN
E.L. EACH ACCIDENT
$1,000,000
$ 1,000,000
E.L DISEASE - EA EMPLOYEE
E.L. DISEASE - POLICY LIMIT
$1,000,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, 11 more space is required)
Electric
•
•
CERTIFICATE HOLDER
CANCELLATION
City of Miami Shores
Building Dept
10050 NE 2nd Avenue
Miami Shores, FL 33138
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
®1988 -2009 ACORD CORPORATION. All rights reserved.
ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD
TEN DATE
07 -01 -2010
ACORDL, CERTIFICATE.OF LIABILITY INSURANCE . 1
RODr
NORTHEAST AGENCIES II�iC %PBS THIS CERTIFICATE 15 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 POUCIES BELOW. •
210204 P: (866)467 -8730 F: (800)308-5459
301 WOODS PARK DRIVE
CLINTON NY 13323
1sPAASED •
D.A.W. ELECTRIC INC., DERRICK A
WILLIAMS
20200 N.W. 2ND AVE. STE 301
MIAMI FL 33169
COVERAGES ,, �r, �� • + + I . NM 'T �. • T'L 0
H PO CIE 0 1`7 "T1 �T11 B •Ti HA INI 1 tT 1 M A; • 1
ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY P= RTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
OA AD m
0022
INSURERS AFFORDING COVERAGE
NsuRIERA:Bartford Casualty Ins Co
INSURER 8
INSURER C:
INSUBLR O:
INSURER E
svSR
tTR
TYRE OFtrisa ANL:E
RoLICYMOWE
GENERAL HABO.RY
A COMMEP.CIAL GENERAL LIABILITY
1 CLAIMS MADE ® OCCUR
General Liab
GEM. AGGREGATE LIMIT APPLIES PER:
PODGY I� IECT ! 1 Loc
AIfTOMQBILEIMAARRY
ANY AUTO ..
AIL OINDED AUTOS
SGHEOULEO ALROS
HLRED AUTOS
NON•OWNED AUTOS
■
a
■
01 SBM AM8606
06/01/10
Ia4rfS
06/01/11
EACH OCCURRENCE $1,000,000
FIRE DAMAGE One •, Tiro) $300,040
MEO EXP !Pew are omen) 810,000
PERSONAL s AOV INJURY $1,000,000
GENERAL AGGREGATE *2,000,000
PIOUCTS•COMPOPAGG $2,000,000
COMBINED SINGLE LIMIT
Ma nekton:/
$
BODILY INJURY
IPer perm
8
BODILY INJURY
IPer acddae)
S
PROPERTY DAMAGE
(Per actidemf
ceRAGE1/ABAJTIr
ANY AUTO
AUTO ONLY -EA ACODENT
8
OTHERTHAN
AUTO ONLY:
EA ACC
AGG
8
S
EXCESS STA81UTY
■ OCCUR El CLAIMS MADE
DEDUCTIBLE
RETENTION
S
EACH OCCURRENCE
8
AGGREGATE
8
8
WORKERS COMPENSATION AND
EMPLOYERS- UAOPUTY
WC STATU- I 10T11-
TORY LIMITS ER
8
E.l.. EACH ACCIDENT r
EL. DISEASE -EA EMPLOYEE $
E1. DISEASE • POLICY UMIT 9
OTHER
DE SCRE PWAWOFOfERAi1oM5 I. OCRT( OAwu EIYaESExcsus /ONSADDEDBYUVOuRSEPAEM/S EO4t RFOW O'VS
Those usual to the Insuredls Operations.
CERTIFICATCHOLDER I I ADWITONALausUREO
City of Miami Shores
Building Dept
10050 NE 2nd Avenue
Miami Shores, FL 33138
cowrietETrm CANCELLATION
SSII0UL0 ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF. THE ISSUING INSURER WILL ENDEAVOR TO MAIL
30 DAYS WRITTEN NOTICE (10 DAYS FOR NON - PAYMENT, TO THE CERTIFICATE
HOLDER NAMED TO THE LEFT. BUT FAILURE TO DO SO SHALL IMPOSE NO
OBUGATION OR UABIUTY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
REPRESENTATIVES.
AU
ACORD 25 -S (71971
0 ACORD CORPORATION 1989