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EL-12-233Inspection Number: I NSP- 169849 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Permit Number: EL -2 -12 -233 Scheduled Inspection Date: April 12, 2012 Inspector: Devaney, Michael Owner: LEGO, JAMES REGIS Job Address: 163 NW 100 Street Miami Shores, FL Project: <NONE> Contractor: DEVELOPMENT ELECTRICAL CONTRACTORS INC Permit Type: Electrical - Residential Inspection Type: Final Work Classification: Addition /Alteration Phone Number Parcel Number 1131010230310 Phone: (786)273 -0025 Building Department Comments REPLACE KITCHEN CABINETS 3 UNDER COUNTER LIGHTS/ 5 HIGH HATS Passed �I Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments /1 AP, 67 April 12, 2012 For Inspections please call: (305)762 -4949 Page 3 of 15 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 Not-1 1/2.70A5 PERMIT APPLICATION Master Permit No. VO 2. 'JZ. FBC 2001 Permit Type: Electrical OWNER: Name (Fee Simple Titleholder): 14,' 4 5-5 1 EI C) Phone#: --/N0 223- e&7, Address: t LC) 1,00 61- City: M1 IW41 S t--6 e'er State: Zip: 3J .3 1 SO Tenant/Lessee Name: Phone#: Email: ��- ®$:5 . Cowl JOB ADDRESS: City: Miami Shores County: Miami Dade Zip: Folio/Parcel #: Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name: OEVEtoPi4E4JTEEEcT2/C&€ C TOC704,JXC. Phone #: 7e6 Las 00e Address: .1S 1.IJ s w 5e3 lee City: /`'%/1.04/ State: 'C• Qualifier Name: .46i 5 A. • .1 v i/ o Z Phone #: 786 ?q3 00 Zr. State Certification or Registration #: ht 130 i`7 58,.3 _ /Certificate of Competency #: e� d0 00 Contact Phone #: 7 B G Z 13 D O Z j Email Address: .l e //c»/ro trx-c7 ' 7 a) 4 DESIGNER: Architect/Engineer: Phone #: Zip: 3 34 9 3 Value of Work for this Permit: $ .9 Square/Linear Footage of Work: Type of Work: ❑Address QAlteration Description of Work:- 3 - co viA ~ PR l ❑New I epait,/Replace ODemolition die 2 p /w re ' e ► 04,s *+ x***** ****a: ****• x********* ***********Feesx++x******** ****• x*+ x+ x***• x*+x**m*****+x** ********* Submittal Fee $ Permit Fee $ /0'd7 r CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ 1 0 :1,0 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 Al'FIDAVIT: 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. Owner or Agent The foregoing instrument was acknowle day of Js4-4,/ ,20 .,by who is personally known to me or L2.®®"', (9-40C- 31gA?- o s identification and who did take an oath. NOTARY PUBLIC: roduced L,► cS r Sign: Print: My Co * * * * * * * * * * * * * * * * * * ** APPROVED B gam- / P lans Examiner Zoning Signature Contractor The foregoing instrument was acknowledg- . be /r e 4 day of .Jn-k/ ,20/9. ,by Alf.,--41°' %/ who is personally known to me or o : 'p� .duced as identificati and who did take an oath. NOTARY PUBLIC: Structural Review (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) Clerk Jan. 30. 2012 4:04PM No. 3567 P. 1 �QRO1 CERTIFICATE OF LIABILITY INSURANCE DATE D THIS CERTIFICATE 1S ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE GERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OP INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: 1f the certificate holder to an ADDITIONAL INSURED, the polley(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the pollcy, certain policies may require an endorsement. A statement on This certificate doss not confer rights to the certlFcate holder In lieu of such endoreemenl(s). PRODUCER Roxana Solo Insurance Agency, Inc 6230 Coral Way Miami, PL 33155 CDMTL,ACT PHONE FAX (WC E" 0' 1("C' Ha): AanRE55: INURER(E) AFFORDING COVERAGE HAWN INSURER A: Western World Insurance Company LIABILITY COMMERCIAL GENERAL LIABILITY INSURED DEVELOPMENT ELECTRICAL CONTRACTOR 5250 SW 40 STREET #B9 Miami, FI 33155 INSURER e: NPP1325321 INSURER C: 12/23 /2012 INSURER O: S 300 000 INSURER E s $ 300,000 INSURER F • COVERAGES CERTIFICATE NUMBER: REVISION NUMBER; THIS IS TO CERTIFY THAT THE POLICIES 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 CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN 1S SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. UMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE of INSURANCE +� = i POUCY HUMBER p • LICY EPF ,:, . iii1 POLICY EXP Map , LIMITS GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY ■ NPP1325321 12/23/2011 12/23 /2012 EACH OCCURRENCE S 300 000 ' . ,,,,� $ 300,000 CLAJMS MADE ✓ OCCUR MED EXP one • - $ 5,000 PER$ONAL &ADVINJURY s 300,000 GENERAL AGGREGATE $ 600,000 GENT. AGGREGATE . POUCY LIMIT AP : : ■ PRO ■ ' PER: LOC PRODUCTS - COMP/OP AGO $ 300,000 $ AUTOMOBIELUAUIU'(Y ANY AUTO AUTOS OWNED HIRED AUTOS • ■ AUTOS SCHEDULED ANON ED cesig 1, ahi.luiii BODILY INJURY (Par Paw) $ e001LY INJURY (Per aCC1de!U) $ PROP R Y .AM4GE $ S . . UMBRELLA LIAR EXCESS LIAR • . OCCUR CLAIMS -MADE EACH OCCURRENCE S AGGREGATE $ OED ill RETENTIONS $ WORKERS COMPENSATION AND EMPLOYERS' LLANIUTY O FICERAYIENiEER EK PROPRIETOWPARTNEMXECUTIVE C a (Mandatory In tat If yeA describe under DESCRIPTION OF OPERATIONS beIoW N/ A ,., 1A E. EACH ACCIDENT s B.L DISEASE • EA EMPLOYE- 5 E.L DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS /VEHICLES (Attach ACORD 191, Adrlidenal Remarks $ haduie, If more apace Is reeulre4) ELECTRICIAN CERTIFICATE HOLDER CANCELLATION MIAMI SHORES VILLAGE 10050 NE 2ND AVENUE MIAMI SHORES, FL 33138 ACORD 25 (2010/05) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION�,,..--DATE — tRER OP, NOTICE WILL BE . IVERED IN W ACCORDANCE iTN THE POLICY IEOVISIONS. AUTHORI7$D REPRESENTATIVE • otO 1888 -2010 ACORITterPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Produced uetny Forms Bodo Web software. www Fem+eBeae.ewm; Se DoprestWe PubESbfne 8119 - 206.1917