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EL-12-595Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 171991 Permit Number: EL -4 -12 -595 J Inspection Date: May 10, 2012 Inspector: Devaney, Michael Owner: MILLER, EDDIE Job Address: 2 NE 108 Street Miami Shores, FL 33161 -7036 Project: <NONE> Contractor: INDUSTRIAL ELECTRICAL SYSTEM CORP Permit Type: Electrical - Residential Inspection Type: Final Work Classification: Repair Phone Number (305)807 -4045 Parcel Number 1121360110080 Phone: 3051228 -1384 Building Department Comments CHANGE MAST HEAD Passed Inspector Comments /c /tar Y zc' /1 r- Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled re- inspection fee is paid. until For Inspections please call: (305)762 -4949 May 10, 2012 Page 1 of 1 11 p'1 �r BUlLD�V VP..( PERMIT APPLICATION FBC 20 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 Type: Electrical &Ord/ S / '/C OWNER: Name (Fee Simple Titleholder): wi - 1 " 0 ` U �' OII5Phone#: 30s-- 8.D ' �� rJ Address: City: nit An, j 5 Abe e, State: c L.. Zip: 33 /6 / Tenant/Lessee Name: _ n Phone #: Email: ac0c1J rre x/1144 /c/NVeS�Ifs. co 0..- JOB ADDRESS: .2 N C / 0 r 5iee of County: ,mgr. APR 0 a012 13Y: Permit No. � L J 2 SetS Master Permit No. 190 fvf // I S7 (ee f City: Miami Shores Miami Dade Zip: .37/6 / Folio/Parcel #: Is the Building Historically Designated: Yes NO ✓ Flood �Zo�ne: CONTRACTOR: Company Name: p�(� f �Q� �`+ 1l eC $/ �� Phoney' ;3o s -a^2S —/3 Address: City: / o; 5 7 N 9 ti Sf (; i 2c5 i )4'w► ∎ State: F L Qualifier Name: /V e 5 T b g C©t V e/i **�� '/ Certificate of Competency #: Contact Phone #: 30 -c2 c0 '/J 7 Email Address: / e 5--P la R. cil o" Co/e4 (-4 S/ i /Ne l— DESIGNER: Architect/Engineer: Phone #: Zip: 3 3./ 7 2 Phone #: State Certification or Registration #: r l 31,621 8 °Z C 45-6 Value of Work for this Permit: $ Square/Linear Footage of Work: LttRepair/Replace UDemolition Type of Work: DAddress DAlteration DNew eeei tt Woe( t); h" Description of Work: o �1 A i /1# 740 ffJv� 57L •� "#r G17,1 -c ; tole, SeeeR, /iCfifT I'D N * ***+ x******* **+ x** ************** *+ x*x:**** Fees*** ***+ x***** *+ x******* *********+x*******x+***** Submittal Fee $ Scanning Fee $ Notary $ Double Fee $ Permit Fee $ ' U CCF $ CO /CC $ Radon Fee $ DBPR $ Bond $ Training/Education Fee $ Technology Fee $ Structural Review $ TOTAL FEE NOW DUE $ 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 ap;` ved and a reinspects, ee will be charged. Signet . Owner or Agen The foregoing instrument was acknowledged before me this �ry�� day of ` CO2 , 20 /a, by Ala x e. SLtb ( 4 o , who is personally known to me or who has produced As identification and who did take an oath. t Signature Contractor The foregoing instrument was acknowledged before me this 05711 day of F} P e1 L , 2012_ , by Ala7o2 . Ct> Atei1, who is ersona plly known to me or who has produced NOTARY P Sign: Print: My Commission Expires: jp4 n% DahNotaryit Duenas Public State of Florida 4e My Commission 00971539 '1`bF ao0 Expires 04/22/2014 APPROVED BY as identificatin.qold pi( Notary Public - State of Florida mmission # DD 913453 ion Expires 11 -17 -2013 Atlantic Bonding Co. Inc. es NOTARY PUBLIC: Sign: Li-1-001,0 on Print: n M G/ $ (.o .(1), My Commission Expires: L(-- /'1-.2_t/3 Plans Examiner Zoning Structural Review (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) Clerk °s° CERTIFICATE OF LIABILITY INSURANCE DATEIMM/OD/YYYY► 04 -05 -2012 1 THIS CERTIFICATEIS 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 POUCIES BELOW. THIS CERTIRCATEOF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER'S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. • IMPORTANT: If the -certificate holder is an ADDITIONALINSURED, the polcy(�) must be . H SUBROGATION'S WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statementan this certificate does not confer rights to the certificate holder in lieu of such endorsement(sl. PRODUCER PAYCHEX INSURANCE AGENCY INC 210705 P:()- F:(888)443-6112 P O BOX 33015 SAN ANTONIO TX 78265 CONTACT +N FAX. (Al L,Ext) 1tA/C,ARo): 1888)443 -6112 A °d °'E.ss: CUSTOMER ID INSUS) AFFORDING COVERAGE NA►C0 ASSURED INDUSTRIAL ELECTRICAL SYSTEMS CORP 10257 N. W. 9TH STREET C IR . APT. 205 MIAMI FL 33172 misureRA: Twif City Fire Ins Co (ASSURER B : INSUR R C: EACH OCC NCE INSURER D: INSURER E : $ INSURER F . - I CLAIMS -MADE U OCCUR COVERAGES CERTIACATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAI 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 Oft MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. AND CONDITIONS OF SUCH POLICES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. USSR INSR LTA TYPE OF ASSURANCE I FNSR YV POLICY Nib IeLICY EFP IMMIDDITYYYI POLICY WP DISSALIWYINYI !ors GENERAL LIAEEJ Y COMMERCIAL ORAL UABILITY 1 EACH OCC NCE $ MIMESSEES (Ea occurrence) $ I CLAIMS -MADE U OCCUR MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ ,,,J POLICY I 1 Ni- L-.._-) LOC $ AUTOMOSEE UANUrY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS H IREB AUTOS NON-OWNED AUTOS COMBINED SINGLE LIMIT Ilia accident) -- BODILY INJURY (Per person) $ BODILY INJURY per arse) 8 — IR3OPERTY DAMAGE $ (Par accident) $ $ UCLA use I I OCCUR EACH OCCURRENCE $ EXCESS MAO I 1 CLAIMS MADE AGGREGATE $ $ IBLE RETENTION $ $ A vmRlESS AND ANY lotfetya�,>�.vC�ED7 If yes, COMPHQSATIOI EMPLOYERS' MAMMY Y /N- NjA 76 WEG F06188 01/24/12 01/24/13 &_. xIAR4741Mil rat- EL EACH ACCIDENT $ 11000,000 $ 1, 000, 000 PROPROETORIPARTNERIEXECUTI , u OF OPERATIONS below E.I.. DISEASE' -EA EMPLOYEE E.L. DISEASE - POUCY LIMIT s 1 , 0 0 0 , 0 0 0 DESCRIFRON OP OPERATIDNS 1 LOCATIONS /mucus (Attach ACORD 401. Add Remarks Schedule. If more space Is required) . Those usual to the Insured's Operations. Village of Miami Shores 10050 NE 2ndAVe Miami Shores, FL. 33138 Fax: 305 756 -8972 I SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POUCY PROVISIONS. ACORD 25 (2009/09) ® -988 -2009 ACORD CoRPVRATION. A® r�hts removed. The ACORD name andloqo are registered marks of ACORD (