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EL-12-1486Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 180945 Permit Number: EL -8 -12 -1486 Scheduled Inspection Date: October 30, 2012 Inspector: Devaney, Michael Owner: TEIGLAND, MELBOURNE Job Address: 9780 NE 5 Avenue Road Miami Shores, FL Project: <NONE> Contractor: KILOWATT ELECTRIC COMPANY Permit Type: Electrical - Residential Inspection Type: Final Work Classification: Addition /Alteration Phone Number (305)751 -3981 Parcel Number 1132060171490 Phone: (954)975 -8200 Building Department Comments REPLACE DAMAGED CT METER CAN UNDER FPL AMI METER DESIGN Infractlo Passed Comments INSPECTOR COMMENTS False 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- 179660. CREATED AS REINSPECTION FOR INSP- 179461. Electrician on the job didn't know if inside problems were corrected. yo) 6E)-,7 0 October 29, 2012 For Inspections please call: (305)762 -4949 Page 14 of 16 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 ILDING PERMIT APPLICATION Permit Type: Electrical JOB ADDRESS: 9780 N.E. 5th AVE RD FBC 20 BY: AUG 0 6? i Permit No. -I I 9\--1469 Master Permit No. City: Miami Shores Folio/Parcel #: 11 32060171490 County: Miami Dade Zip: 33138 Is the Building Historically Designated: Yes NO Flood Zone: OWNER: Name (Fee Simple Titleholder): MELBOURNE TEIGLAND TR Address: 9780 NE 5 AVE RD City: MIAMI SHORES State: FL Tenant/Lessee Name: Email: Phone#: 305 - 751 -3981 Zip :33138 -2445 Phone#: CONTRACTOR: Company Name: KILOWATT ELECTRIC COMPANY Phone#: 954- 975 -8200 Address: 1700 N.W. 22nd AVE City: POMPANO BEACH State: FL Zip: 33069 Qualifier Name: EDWARD D. FLACK Phone#: 954 -520 -9312 State Certification or Registration #: EC- 13001961 Certificate of Competency #: Contact Phone#: 954- 975 -8200 Email Address: eddie_flack @kilowatt- electric.net DESIGNER: Architect/Engineer: N/A Phone#: Value of Work for this Permit: $ 1,215.83 Square/Linear Footage of Work: Type of Work: DAddress ❑Alteration ONew EIRepair/Replace ❑Demolition Description of Work: &' Oct ea- pN"41 lo 4 IN C i 4--re. h. 64. U v�• FP Pr) * * * * * * * * * * * * * *****+ *** * ****** * * * * * * * * ** Fees********** ******** *+x ****** * ******* ********** Submittal Fee $ Permit Fee $ /001/6110) CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ (lQ ' i Bonding Company's Name (if applicable) N/A Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip N/A 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 broch ill be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of comme t be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued In lace of such posted notice, the inspection will not be approved and a reinspection fee will be charged. I r Owner or Agent The fore oing instrument was acknowledged before me this 40 ' The foregoing instrument was acknowledged before me this (a IA day of ®G , 20l , by IkA& ' t 4t' 7e5l•.4r4 0 , day o 20 1 by EDWARD D. FLACK who is personally known to me or who has produced D 1t4 g-.4 P e4v who is ersonally known to me or who has produced 3 (ef BAs identification and who did take an oath. as identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Signature Contractor Sign: .+ : / _iA L 1) t JP__ LL-P‹, Print: "44 6- 0 40 My Commi (407) APPROVED BY j NJ. GERALD 0 MILLER MY COMMISSION # EE209381 *Aa§Saal9.18 3004153 FbriesNomrySeMae.aom z��� Plans Examiner Structural Review (Revised 3 /12/2012)(Revised 07 /10 /07)(Revised 06/10/2009)(Revised 3/15/09) Sign: Print: My 93.9E 1 ATS. GERALD 0 MILLER ~i MY COMMISSION # EE209381 * *** es •41 **. (407) 340153 rwneaP4om+rserwce aom Zoning Clerk KILOELE -01 TGARRIDO '4`._°R °� CERTIFICATE OF LIABILITY INSURANCE DATE(MM2012YY) 5/25/2012 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 POUCIES ` 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 certfficate holder Is an ADDITIONAL INSURED, the policy(les) 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 certlflcate holder in lieu of such endorsement(s). PRODUCER Collinsworth, Alter, Fowler & French, LLC 8000 Governors Square Blvd Suite 301 Miami Lakes, FL 33016 NAME Teresa Garrido (ac°NN Ext): (305) 822 -7800 A/ No); (305) 362 -2443 E-MAIL ADDRESS: tgarrldo @caffllc.com INSURER(S) AFFORDING COVERAGE NAIC # INSURERA:Amerisure Insurance Co 19488 INSURED Kilowatt Electric Company 1700 Northwest 22nd Avenue Pompano Beach, FL 33069 INSURER B : INSURER C : X INSURER D : MED EXP (Any one person) INSURER E: X INSURER F : PERSONAL & ADV INJURY 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 POLIC ES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS; EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR A GENERAL X TYPE OF INSURANCE UABIUTY COMMERCIAL GENERAL LIABILITY ADDL INSR X SUER WVD X POUCY NUMBER GL2010669080012 POUCY EFF (MMIDD/YYY1� 6/2/2012 POLICY EXP (MM/DDIYYYI� 6/2/2013 LIMA EACH OCCURRENCE $ 1,000,000 DAMAGE TORENTED PREMISES (Ea occurrence) 300,000 $ � CLAIMS -MADE X OCCUR MED EXP (Any one person) $ 10,000 X BIt A/I PERSONAL & ADV INJURY $ 1,000,000 X Blkt Waiver GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: 7 POLICY n 78: n LOC PRODUCTS - COMP /OP AGG $ 2,000,000 $ A AUTOMOBILE X X LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS X SCHEDULED AUTOS NON OWNED AUTOS CA20106660702 6/2/2012 6/2/2013 C OMBBIINED SINGLE LIMIT $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ A X UMBRELLA LIAB EXCESS UAB X — OCCUR CLAIMS -MADE CU20300960502 6/2/2012 6/2/2013 EACH OCCURRENCE $ 1,000,000 AGGREGATE $ 1,000,000 DED RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y / N N N / A X WC202577806 12/1/2011 12/1/2012 X TORY LIMITS ER EL EACH ACCIDENT $ 500,000 E.L DISEASE - EA EMPLOYEE $ 500,000 E.L DISEASE - POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS / LOCATIONS 1 VEHICLES (Attach ACORD 101, Additional Remarks Schedule, H more space Is required) CERTIFICATE HOLDER CANCELLATION Miami Shores Village Building Department 10050 NE 2nd Ave 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 © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD THIS DOCUMENT HAS A COLORED; BACKGROUND •MICROPRINTING • LINEMARKT"; PATENTED, PAPER: AC# 6136586 STATE OF FLORIDA DEPARTMENT OF 'BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING.. BOARD DATE BATCH NUMBER SEQ# L12052200744 LICENSE NBR 05/22/2012 118188455 EC13001961 The ELECTRICAL CONTRACTOR Named below 'IS CERTIFIED: Under the provisions of Chapter Expiration date: AUG 31, 2014 FLACK, EDWARD. DEAN KILOWATT ELECTRIC.. COMPANY 1700 NW 22 AVE POMPANO BEACH FL 33069 RICK :SCOTT: GOVERNOR DISPLAY AS REQUIRED BY LAW KEN LAWSON SECRETARY 115 S. Andrews Ave., Rm. A -100, Ft. Lauderdale, FL 33301 -1895 — 954 - 831 -4000 VALID OCTOBER 1, 2012 THROUGH SEPTEMBER 30, 2013 DBA: Business Name: KILOWATT ELECTRIC COMPANY Owner Name: EDWARD D FLACK /QUAL Business Location: 1700 NW 22 AVE POMPANO BEACH Business Phone: 954- 975 -8200 Rooms Seats Employees 1 Receipt #:ELE4I4ch /ALARMS /CONTRA Business Type: (ELEC:nkIcAL CONTRACTOR) Business Opened:04/28/1994 State /County /Cert/Reg:EC13 0 019 61 Exemption Code: Machines , Professionals Number of Machines: For Vending Business Only Tax Amount Transfer Fee NSF Fee Penalty _ . Prior Years Collection Cost Total Paid 27.00 0.00 0.0 -0.. 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: EDWARD D FLACK /QUAL 1700 NW 22ND AVE POMPANO BEACH, FL 33069 -1560 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. 2012 - 2013 Receipt #032 -11- 00003233 Paid 07/12/2012 27.00 8 7 6 5 4 3 2 1 D C D JOB INFO: 9780 NE 5TH AVENUE RD, MIAMI SHORES, FL. 33138 SCOPE OF WORK: REPLACE DAMAGED EXISTING FPL METERING ENCLOSURE FOR CURRENT TRANSFORMERS CLOUDED AREA IS EXISTING TO REMAIN C 4- B EXISTING SERVICE EQUIPMENT TO REMAIN REPLACE EXISTING DAMAGED FPL CURRENT TRANSFORMER METERING ENCLOSURE EXISTING CT CABINET TO REMAIN FPL CURRENT TRANSFORMERS LOCATION EXISTING 1" GRC CONDUIT TO FPL • CURRENT TRANSFORMERS LOCATED IN ELECTRIC ROOM INSIDE OF BUILDING '2-.....1 z& Shores Village 4. Miami ALL WIRING DONE BY FPL FROM CT TRANSFORMERS TO FPL APPROVED BY DATE METER ENCLOSURE :ate ZONING DEPT 0 0�2 BLDG DEPT ;��'f,e,_ SUBJECT TO CCMPUANCE %MTh ALL FEDERAL STATE AND CGUN i { rat LES AND REGULATIONS �, X � Y , -_ - • KILOWATT ELEC OMPANY 1700 NW 22 AVEN POMPANO BEACH, 33009 EC 13001961 !Off � r$01 4 I NUNt OR 16 IBS 1!r 8 8 7 6 5 4- 3 2 1 p D JOB INFO: 9780 NE 5TH AVENUE RD, MIAMI SHORES, FL. 33138 SCOPE OF WORK: REPLACE DAMAGED EXISTING FPL METERING ENCLOSURE FOR CURRENT TRANSFORMERS CLOUDED AREA IS EXISTING TO REMAIN _ C B 0 ,- B EXISTING SERVICE EQUIPMENT TO REMAIN I �� REPLACE EXISTING DAMAGED FPL CURRENT TRANSFORMER METERING ENCLOSURE EXISTING CT CABINET TO REMAIN FPL CURRENT TRANSFORMERS LOCATION EXISTING 1" GRC CONDUIT TO FPL CURRENT TRANSFORMERS LOCATED IN ELECTRIC ROOM INSIDE OF BUILDING 1 12--- ILERIV:Fr ALL WIRING DONE BY FPL FROM #: Miami Shores Village CT TRANSFORMERS TO FPL METER ENCLOSURE ��, �'�j�� APPROVED BY DATE AUG 0 62012 ZONING DEPT BY _ f BLDG DEPT 0 ' / SUBJECT (0 CC(VIPUANCE WTT'ri ALL 4 � /7!- FEDERAL A STATE ANL) CGUN-i f ALLES AND REGULATIONS A 1. KILOWATT ELECTRIC 0 ANY 1700 NW 22 AVENUE POMPANO BEACH, FL, ,3[ •9 EC 13001961 SU Reid nalI& I NUN ION NO. > 8 1 7 1 6 1 5 t 4 1 3 I 2 1 1