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EL-12-148Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 172863 Permit Number: EL -1 -12 -148 Scheduled Inspection Date: May 31, 2012 Inspector: Devaney, Michael Owner: SUTTON, CHERYL Job Address: 290 NE 101 Street Miami Shores, FL 33138 -2423 Project: <NONE> Contractor: LIVE WIRE ELECTRIC INC Permit Type: Electrical - Residential Inspection Type: Final Work Classification: Alteration Phone Number Parcel Number 1132060134590 Phone: (954)563 -9959 Building Department Comments REPLACE ELECTRICAL PANEL Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments CREATED AS REINSPECTION FOR INSP - 172855. cancelled byjudy via vmail. ./7((16/?/20/ May 30, 2012 For Inspections please call: (305)762 -4949 Page 7 of 26 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 RECEIVED JAN 2 6 2012 BY: Permit No. v 2_ ' 9C6 Master Permit No. Permit Type: Electrical OWNER: Name (Fee Simple Titleholder) :CLL (11 7��j,n ci e' 'a5QYo a a phonetASA akArnuto Address: City: State: Zip: Tenant/Lessee Name: Phone #: Email: JOB ADDRESS: 0196 NE /61 Jt r e f City: Miami Shores Folio/Parcel #: Is the Building Historically Designated: Yes NO Flood Zone: County: Miami Dade Zip: JJ / 3? CONTRACTOR: Company Name: II) 1() a c k E Cie IYCj _Ph C Address0 . 9 E J- ,U e %% �e C i ty: f ( State: FL Qualifier Name: L".. To rn Phone #: N %j •I-63 —9V? Zip: \33 3 Phone #: 9try _a ` State Certification or Registration #: E(.... -- ®d&0'0 VG) Certificate of Competency #• Contact Phone #: Email Address: L /V E �1 El e C7' l/ C OJ ad/ o C® DESIGNER: Architect/Engineer: Phone #: Value of Work for this Permit: $ /j go . ® ® Square/Linear Footage of Work: Type of Work: Address DAlteration New l pair/Replace DDemo1ition Description of Work: KC kat !4_ 2 i /7 dle o % 11-4g/ p * * * * * * * * * * * ** * * * * * * ***** ** **+x** **** *** Fees***************** * ** * * *******+x***** *** * ***** Submittal Fee $ ` ,. Permit Fee $ /'ee e CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ `1 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 FT FCTRICAL 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 wner or Agent The foregoing instrument was acknowledged bbenefor this day of ' , 20 11_4, by Ckrr% X92./ 7APa.r a who i ' • ersonally know to me or who has produced As identification and who take an oath. NOT ' Y PUBLIC: Sign: Print: My Commission p SMF JUDYT tom, Y 14• t-U1/501 M COMMISSION # DD82o 2 My Commission E EXPIRES September 12, APPROVED BY '' F A 1- > V.4771"/Plans/Examiner or The foregoing instrument was ac ow_led ed before me this day of ThiiJ • , 20 hi., by 't >A 7.2117)\P , who is o rsonally known'o me or who has produced as identification and whotake an oath. NOTARY PUBLIC: Sign: Print: ires:,� °ucz JU JY H. HUDSOONI 1ViY COMMISSION # DDS01283 EXP'P.E:S: Sertembe' 12, 2012 c, Zoning Structural Review Clerk (Revised 07 /10 /07)(Revised 06/10/2009)(Revised 3/15/09) From: Gulfshore Insurance, Inc. To: Judy Page: 2/2 Date: 1/12/2012 2:27:38 PM ACCORDTM CERTIFICATE OF LIABILITY INSURANCE DATE (MM!DDM'YY) 1/12/2012 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 Gulfshore Insurance, Inc. 4100 Goodlette Road North Naples, FL 34103 -3303 239 261 -3646 NCAONNTACT Elia R. Labra, ACSR PHONE 239 430 -7546 FAX 239 213 -2830 °' Eye)` (ac, No >: E MAID ADDRESS: elabra @gulfshoreinsurance.com INSURER(S) AFFORDING COVERAGE NAIC # INSURERA: Amerisure Insurance Company LIABILITY COMMERCIAL GENERAL LIABILITY INSURED Live Wire Electric, Inc. 4024 NE 5th Ave Oakland Park, FL 33334 INSURER B : GL2072481000000 INSURER 0: 10/08/2012 INSURER D $1,000,000 INSURER E : $300,000 $10 000 INSURER F : CLAIMS -MADE X OCCUR 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. L R TYPE OF INSURANCE NI gR Sy VO POLICY NUMBER (PMMOIUDDIYYYY) (I'APMMJDDD�YY) LIMITS A GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY GL2072481000000 10/08/2011 10/08/2012 EACH OCCURRENCE $1,000,000 PREMI E SE RENTED PREMISES R NTED cal $300,000 $10 000 CLAIMS -MADE X OCCUR MED EXP (Any one person) PERSONAL & ADV INJURY $1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: POLICY n JEGO'T- —I LOC PRODUCTS - COMP /OP AGG $ 2,000,000 $ A AUTOMOBILE X X X L.UABLL.ITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS Drive Oth Car )( SCHEDULED AUTOS NON -OWNED AUTOS CA2072478001 10/08/2011 10/08/2012 COMBINED SINGLE LIMIT (Ea accident) $1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ UMBRELLA LIAR EXCESS LIAR OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N OFFICER/MEMBER EXCLUDED? Y (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below N /A WC207248300 10/08/2011 10/08/2012 X ITWORYrLIMITS I OTH- ER E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE - EA EMPLOYEE $1,000,000 $1,000,000 E.L. DISEASE - POLICY LIMIT A Inland Marine iM2072482000000 10/08/2011 10/08/2012 Leased /Rented Equipment $50,000 Limit $500 Deductible DESCRIPTION OF OPERATIONS / LOCATIONS !VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more apace is required) CERTIFICATE HOLDER CANCELLATION Miami Shores Villas Building Department 10050 N.E 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 c144 sly . e� ACORD 25 (2010/05) 1 of 1 #S528486/M509585 © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ERL 115 S. Andrews Ave., Rm. A -100, Ft. Lauderdale, FL 33301 -1895 — 954 - 831 -4000 VALID OCTOBER 1, 2011 THROUGH SEPTEMBER 30, 2012 DBA: Receipt #:181 -4 84 Business Name: LIVE WIRE ELECTRIC INC JOSEPH TOMS Business Type :ELECTRICAL /ALARMS /CONTRA (ELECTRICAL CONTR) Owner Name: LIVE WIRE ELECTRIC INC Business Location: 4024 NE 5 AVE OAKLAND PARK Business Phone: 563 -9959 Rooms Seats Employees 10 Business Opened:09 /19/1994 State /County /Cert/Reg:EC - 0002240 Exemption Code:NONEXEMPT Machines Professionals For Vending Business Only Number of Machines: Vending Type: Tax Amount Transfer Fee NSF Fee Penalty Prior Years Collection Cost Total Paid 27.00 0.00 o.00 0.00 0.00 0.00 27.00 THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS THIS BECOMES A TAX RECEIPT WHEN VALIDATED Mailing Address: LIVE WIRE ELECTRIC INC 4024 NE 5 AVE OAKLAND PK, FL 33334 This tax is levied for the privilege of doing business within Broward County and is non - regulatory in nature. You must meet all County and /or Municipality planning and zoning requirements. This Business Tax Receipt must be transferred when the business is sold, business name has changed or you have moved the business location. This receipt does not indicate that the business is legal or that it is in compliance with State or local laws and regulations. 2011 - 2012 Receipt 4k15B -10- 00002796 Paid 07/18/2011 27.00 a.. __o, motor vehicle , constitutes-consent to any sobrattylostoctisired # t BATCH NUMBER