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EL-12-267Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 172847 Permit Number: EL -2 -12 -267 Scheduled Inspection Date: April 30, 2012 Inspector: Devaney, Michael Owner: o Job Address: 10150 NE 2 Avenue Miami Shores, FL Project <NONE> Contractor: CONCORD ELECTRIC INC Permit Type: Electrical - Residential Inspection Type: Final Work Classification: Alteration Phone Number Parcel Number 1132060131850 Phone: (305)981 -8664 Building Department Comments REPLACE OUTDOOR WEATHER HEAD SERVICE CONDUCTOR BACK TO FPL CAN. REMOVE & RELEASE 2 100 AMP PANELS INSIDE CHURCH INTALL 1 NEW 100 AMP PANEL IN ELECTRIC ROOM. Passed ffd Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments 70 -,P;x- c, / ,-..- April 27, 2012 For Inspections please call: (305)762 -4949 Page 29 of 38 Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 n [►,�/ INSPECTION'S PHONE NUMBER: (305) 762.4949 ILDING Permit No. EU2_ (01— PERMIT APPLICATION Master Permit No. RECEIVED FEB 15 2012 FBC 20 Permit Type: Electrical 6(1 OWNER: Name (Fee Simple Titleholder): ' �" ' °'-t �/2/577"12 �d�C�o >_ - `v I Address: /O#' O it/E Al ity: %ti9l1i ,j/-f 2+ State: ,1 Zip: 33/35 Tenant/Lessee Name: Phone #: Email: JOB ADDRESS: City: Folio/Parcel #: /0/5-o ,394-(16- it/ ' 4-(/ Miami Shores County: Miami Dade Zip: 33/3£ Is the Building Historically Designated: Yes NO n Flood Zone: CONTRACTOR: Company Name: •49e.-"-i) &Zc is L Phone #: 3 °' 576 /7/7 Address: D919 A/ City: .9749/ State: Zip: 23/3'7 Qualifier Name: r/ /c ; 7 Phone #: 30- 574 • /% /7 State Certification or Registration #: e.00D 43' V Certificate of Competency #: /1-1//9 Contact Phone#: �� $26 /7/7 Email Address: C— o✓I�OQG� �/ec 2�c c c.4s .ae/ Phone #: DESIGNER: Architect/Engineer: /V% Value of Work for this Permit: $ 5-#.00. no Square/Linear Footage of Work: Type of Work: ❑Address ❑Alteration ❑New XRepair/Replace ODemolition Description of Work: / G7249-ee 29e/7-book ee-417 -egi2 K .SE�vie Go7huc Z 4,9--/. 4 G . T d44-✓r 04 e` Re,0 e (2 /po 4 .t e-o fie/ , "sick 0.- eN r nsh, 1/ (" ) /IA.) /0o4,e420,#ie/ /•o eke -/k/e. ,44f2.44. ** ** * * ** * ***** **** C * ** ** * ** ****** ** * * ** Fees************* * ** *** * * *** * **** *** ** * * * * * *** ** Submittal Fee $_ Permit Fee $ G: ® CCF $ CO /CC $ DBPR $ Bond $ Technology Fee $ Scanning Fee $ Radon Fee $ Notary $ Training/Education Fee $ Double 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 approved and a reinspection fee will be charged. Signature (e), Owner or Agent The foregoing instrument was acknowledged before me this 5 day of ' ' , 20 by CA who is personally known to me or who has produced . As identification and who did take an oath. rDTARUBLIC: Sign: Print: My Commission Expires: </ ®� 0�.. * * * * *** * * ** * * * * * * * * * ** APPROVED BY Signature /4( Contractor The foregoing instrument was acknowledged before me this 1 day of , 20 by by %/ - (,0- L,6 t.;1 who is personally known to me or who has produced r t.-% as identification and who did take an oath. R_,'UBLIC: luu,,,,// Sign: Print: My Commission Expires : ��\b ® \s,0 : ]y ti\ a !!Blum !e/!l11111111 /? 8lPlans Examiner Structural Review (Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09) Zoning Clerk PROPOSAL CONCORD ELECTRIC, INC. 219 N.E. 35 ST Miami, Fl 33137 (305) 576 -1717 EC0001354 PROPOSAL SUBMITTED TO: O W / Miami Shores Christian Church PHONE: DATE: 12/1/2011 -`_ STREET: 10150 NE 2 AVE JOB NAME: FPL Overhead Service Drop CITY, STATE AND ZIP CODE: JOB. LOCATION: Wire Replacement to CT Cabinet ARCHITECT: DATE OF PLANS: NONE NONE and Repair/ Replace Electrical Panels We hereby submit specifications and estimates for: Remove & Replace Wiring from Weather head to FPL CT Cabinet and install (3) electric panels as per electrical inspector request. Scope of Work: We will pull permit at City of Miami Shores for FPL work and service repair to CT cabinet. We will have FPL disconnect their (5) wires at the outdoor weather head in the early morning. We will then remove the damaged aluminum wiring from the weather head back to the FPL CT cabinet located on the wall of the electric room. We will then furnish and install (5) aluminum #300 MCM cables from the existing weather head into the FPL CT cabinet approximately 15 feet away and reconnect wires. $1,900.00 After our meeting with the electrical inspector, we will replace the (2) FPE electric panels inside the church, install new fuses in the bathroom electric panel and install (1) new electric panel in the outside electric room to remove cluttered small panels on the wall. We will also repair the wires inside the top gutter panel as per the inspectors request. We will install (2) new ground rods and bond all equipment as needed to bring up to code. $3,500.00 Permit Fee not included and to be paid by owner. We Propose hereby to furnish material and labor - complete In accordance with above specifications, for the sum of: ** *FIVE THOUSAND FOUR HUNDRED DOLLARS * ** $5,400.00 Payment to be made as follows: UPON COMPLETION Authorized z manner according to standard practices. Any alteration or deviation from above specifi, Signature Topley tions involving extra costs will be executed only upon written orders, and will become an _Mark extra charge over the above the estimate. All agreements contingent upon strikes, accidents or delays beyond our control. Owner to carry fire, tomado and other necessary insurar NOTE: This proposal may be withdrawn by us if not Our workers are fully covered by Workmen's Compensation Insurance. accepted within 15 days. Acceptance of Proposal The above prices, specifications and conditions are satisfactory and are hereby accept( Signature: You are authorized to do the work as specified. Payment will be made as outlined above. Date of Acceptance: Signature: CONCELE -01 _ RGOMEZ CVR� . DATE (MM/DDNTTY) �... CERTIFICATE OF LIABILITY INSURANCE 2/10/2012 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 the certificate holder is an ADDITIONAL INSURED, the policy(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 this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Collinsworth, Alter, Fowler & French, LLC 8000 Governors Square Blvd Suite 301 Miami Lakes, FL 33016 ,INSURED Concord Electric Inc. 219 NE 35th Street Miami, FL 33137 CONTACT NAME: PHONE (305) 822 -7800 E -MAIL ADDRESS: • FAX (305) 362 -2443 I LAIC, No): INSURER(S) AFFORDING COVERAGE INSURER A : Amerisure Mutual Ins Co INSURER e : FCCI Insurance Company INSURER C : !_INSURER D : INSURER E : INSURER F : NAIC /I 23396 10178 COVERAGES CERTIFICATE NUMBER: 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 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. INSR ! TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMBS LTR INSR WVD POLICY NUMBER (IM/DD/YYYY) (MM/DD/YYYY) L GENERAL LIABILITY A X COMMERCIAL GENERAL LIABILITY � I CLAIMS -MADE LX� OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY I X : JECT LOC AUTOMOBILE LIASILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS SCHEDULED AUTOS NON -OWNED AUTOS UMBRELLA LIAB EXCESS UAB OCCUR CLAIMS -MADE CPP132165113 DED ' I RETENTION $ WORKERS COMPENSATION AND EMPLOYERS UABILnY y / N B ANY PROPRIETOR/PARTNER /EXECUTIVE - OFFICER/MEMBER EXCLUDED? N / A (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below 9/1/2011 ,9/1/2012 EACH OCCURRENCE $ -DAMAGE TO RENTED PREMISES (Ea occurrence) ' $ MED EXP (Any one person) I $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ 1,000,000 300,000 10,000 1,000,000 2,000,000 2,000,000 60313 COMBINED SINGLE LIMIT (Ea accident) __ $ BODILY INJURY (Per person) I $ BODILY INJURY (Per accident) PROPERTY DAMAGE _E'er accident) EACH OCCURRENCE AGGREGATE 9/1/2011 1g11/2012 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) Ops: Electrical Contractor - 30 day of cancellation is provided, except 10 days for non - payment. CERTIFICATE HOLDER Miami Shores Village Hall 10050 Northeast 2nd Avenue Miami Shores, FL 33138 ACORD 26 (2010/05) CANCELLATION X WC STATU- OTH- TORY LIMITS ! i ER EL EACH ACCIDENT $ E.L DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ 100,000 100,000 500,000 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 © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 1 CCu7AFTm u - -- Lac__ RCS °: !: f0 c 4 p3 ..T � JTreL,� C�� r� • 4 t� Bad ..,..• c; `"-I'' I_rr iir,: *=.6r�1G SJ ..off ice/ -o vas?: o \ to o Ica WI -d ",,..... . c: :x r ,, V •". Q p rt191 f Ttdeg xa m i n r ye 4.Zrj0wFff..`�JT�4 G' ..,0,+:,Cy ,�' 11 � $P: (1L„ (dal. rte)► rill {f)4. _9. 140 W. LAGLER ST. 1st FLOOR MIAMI, FL 33130 470778 -3 MrA EXPIRES SEPT. 30, 2012 MUST BE DISPLAYED AT PLACE OF BUSINESS PURSUANT TO COUNTY CODE CHAPTER 8A - ART. 9 & 10 THIS IS NOT A BILL — DO NOT PAY RENEWAL RECEIPT NO. 491638 -4 BUSINESS NAME / LOCATION CONCORD ELECTRICAL CONTRACTORS INC 33888 MUNICIPALITIES LOC FIRST- CLA4S • U.S. POSTAGE PAID MIAMI, FL PERMIT NO. 231 OWNER CONCORD ELECTRICAL CONTRACTORS A$GR.S@ FT Sec. T e of Business 19Z COMMERCE /INDUST /OFFICE SPACE 2440 THIS IS ONLY A LOCAL BUSINESS TAX RECEIPT. IT DOES NOT PERMIT THE HOLDER TO VIOLATE ANY EXISTING REGULATORY OR ZONIN LAWS OF THE 14 NOR AX t r �4 0 40112:., 0 SEE OTHER SIDE DO NOT FORWARD CONCORD ELECTRICAL CONTRACTORS INC 219 NE 35 ST MIAMI FL 33137 i SorJc .Q Sivr+kerle Lrle ,I'VER LICENSE - CLASt" MARK GREGORY TOPLEY' 860 NE 69 ST II1F MIAMI, F433138-0000 cos: 1123 -1964 sex: M HOT: 6 40:07 -2009 :ew