EL-12-159410/22/2012 11 :56 FAX 1 800 665 7530
DATA SCAN FIELD SERVICES 141003 /003
inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
riNSP - 177757
Scheduled inspection Date: October 22, 2012
Inspector: Devaney, Michael
Owner: HYNES, KIMBERLY
Job &e as` 302.NEt00 St .
Miami Shores, FL
Project: <NONE>
Contractor.
AABAA ELECTRICAL SERVICES CORP
pecrfa .Number EL-41-124594
Permit Type: Electrical - Residential
Inspection Type: F i l:
Work Classification: Addition /Alteration
Phone Number
Parrs 4 Number 1132060135470
Building Department Comments
REPLACE CFI AND f_XIIAUS I FAN
Phone: 305-620-7664
Passed
Fad
Correction
Needed
Re-inspection
Fee
Nc' Attu!inn ai tnspoeh nx Can ba Saleduked until
te- tg3peettOn tee paid
Inspector Comments
/97'
For Incriaittinns _pease calk (305)7624949
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
Permit Type: Electrical
JOB ADDRESS: 302 11)C-- /065/
City: Miami Shores
Folio/Parcel #:
County:
AUG
B° -------- e,aomeam
FBC 20
Permit No. 4P.- I 14
Master Permit No. (9.-- 159 2-
Miami Dade
Zip:
Is the Building Historically Designated: Yes
NO
e
Flood Zone:
OWNER: Na e (Fee Simple Titleholder): Cc'v14/4r �� ' Phone #:
Address: -JO e- ea ®�
City: / fr rat • , -(76 A_ / State: Zip:
Tenant/Lessee Name: Phone #:
Email:
CONTRACTOR: Company Name: 1161/9 ,gG Phone #: 3Gdr %BJf.%_9 Z
Address: 5-9t.47 ova/ t e/4/4)
City: ..Gi /AGry /' State: AL Zip: 03 4//m
Qualifier Name: V :040ijeli /, 7 'i./zri2 Phone #: 3.0S-706.939.1.-
State Certification or Registration #: z? /34)J23 2_4 Certificate of Competency #:l%Z" ewe" ZO21"/'
Contact Phone#: 3#6'7 66.93 .92. Email Address:
DESIGNER: Architect/Engineer: Phone #:
Value of Work for this Permit: $ 100 *a_ Square/Linear Footage of Work:
Type of Work: ❑Address OAlteration ONew epair/Replace ODemolition
Description of Work i� S �j C -plfG/ 6-/c-z.
******** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Fees************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
Submittal Fee $ Permit Fee $ /S e›'' d# CCF $
Scanning Fee $ Radon Fee $ DBPR $
Notary $ Training/Education Fee $ Technology Fee $
Double Fee $ Structural Review $
CO /CC $
Bond $
TOTAL FEE NOW DUE $ /09 • /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 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 . e approved and a reinspection fee will be charged.
/ t Signature
The f e oin
day o
who is pe
AV
wne
or Agent
trument was a
_, 20 27`by
al,
owle • ed ' - fore tl
J
sonally known to me or who has produ
•
1r, 01
NOTAR
Sign:
Print:
PUBLIC:
tification and who did take an oath.
My Commission Expires.
**** M+6*N * ***Bib***
Signature
V:/g
ontractor
The foregoing instrument was acknowledged before me s
day of NO , 20 12 by 10 fi t) J ` (4
o is personally kno o me or who has pro used
as identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
My Commission Expires:
* + N*k**** *********+k**+N*****B+ ****M**+M******************B ***********B*********4****
APPROVED BY 4'1: , Plans Examiner Zoning
Structural Review
(Revised 3 /12/2012)(Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09)
Clerk
AABAA-1
OP ID:LR
' #�0, szcz° CERTIFICATE OF LIABILITY INSURANCE
1 D 3/1 ` YI
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 AM END, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER {Sj, AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: if the certificate holder Is an ADDITIONAL INSURED, the poHcy(tes) must be endorsed. If SUBROGATION IS WANED, subject to
the terns 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 305-262-0086
Eliot McKlever, & Stowe 3!}5 -26�- 0187
6181 Blue Lagoon Dr#420
Laeni, 33 126
Larry B S
Ac�r
1f s . 1 FAX
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INSURERS' AFFORDING COVERAGE
NATO 8
INSURER A: GRANADA INSURANCE COMPANY
INSURED Aabaa Electrical Service, Inc.
5951 NW 209 Lane
Miami, FL 33015
INSUREtli:
INSURER
IN$IRtERD:
INSURER E:
INSURER pi
COVERAGES
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 CONDIT/ON OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
ChitlIHCATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TUBAS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
CERTIFICATE NUMBER:
REVISION NUMBER:
TYPO OF INSURANCE
A
GENERAL UAnUIY
X COMMERCIAL GENERAL UABY
UT
cLAt SSW■On ill 3 OCCt t
GEM. AGGREG�ATEUNIT AP�P-7UES PER
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ALL OVASED
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0185FL00007241
03114I12
EACHOCCdEIRENCE
03144113y
MEO EXP (Any one person)
PERSONAL & AM/ INJURY
$ 1,000,000
$ 100,000
s 6,000
s 1,000,000
GENERAL AGGREGATE
$ 2,000,000
PRODUCTS - COMP10PAGO
s 2,000,000
SCIEDULED
AUTOS
HIREDAUTOS u AUTOS
COMEDIED SINGLE UNIT
BODILY INJURY (Per wan)
$
S
BODILY INJURY (Per atideny S
S
MORELLA LIAR
EXCESS LIAR
CLAIMS -MADE
DEO 1 I RETEiNTON S
EACH OCCURRENCE
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WORKERS COMPENSAIXIN
AND EMPLOYERS' LIARIUTY Y U
ANY PR
OFFICERSTEMDER EXCLUDED?
(Mandatory In NN)
recibe War Op OPERATIONS below
UA
LAAITUTS 1 Mr
E.L. EACH ACCIDENT
EL DISEASE -EA EMPLOYEE
EL DISEASE -POUcY UNIT
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fectrica Work thin El
OCAT[ONSUMECUM {ASach ACORD 101,AdoaonaI
Sehodtda, R mew apace Is
CERTIFICATE HOLDER
CANCELLATION
Miami Shores Village
Building Dept.
10050 NE 2nd Ave.
Miami Shores, FL 33138
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE.
THE EXPIRATION DATE THesEOI, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
Aumcgozeo REPRESENTATIVE /
Larry B
ACORD 25 (2010105)
01988 - t t ACORD CORPORATION. All rights reserved.
are reg . red marks f ACORD
The ACORD name and logo eg