EL-13-920Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP - 191790 Permit Number: EL -5 -13 -920
Scheduled Inspection Date: May 21, 2013
Inspector: Devaney, Michael
Owner: LEVASSER, PHILIP&DARLENE
Job Address: 9819 NE 4 Avenue Road
Miami Shores, FL 33138-
Project: <NONE>
Contractor: LONGMAN ELECTRIC INC
Permit Type: Electrical - Residential
Inspection Type: Final
Work Classification: Alteration
Phone Number (305)756 -6214
Parcel Number 1132060170210
Phone: (305)758 -1211
Building Department Comments
INSTALL SMOKE DETECTOR IN BATHROOM AS NEEDEC
(4)
Infractio 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
.2(16(49
0 /7
May 20, 2013
For Inspections please call: (305)762 -4949
Page 19 of 20
BUILDING
PERMIT APPLICATION Master Pit No.
Miami Shores Village
Building Department
t0050 N.E.2nd Avenue. Miami Shams, Florida 33138
Td (305) 795.2204 Fat: (305) 7564972
t ECITOWS PHONE WOOER: ) 762..4949
`Bc2O(D
Permit No. C..1
Permit Type: Electrical
JOB Awns& 9819 NE tOnAV RD
Ciw: _ 'a i tarc s n#y: ;arni Zip: 33138
Pntio/Parce1#: 11-32-06-017-0210
fs`the t3niteli ig Historically tom: Yes NO X
ne: NO
OWNER: Name Sir k Titlehotder): PHILIP AND DARLENE LEVASSER 1t1e* 305- 756 -6214
Addrem 1218 NE 95 ST
City: MIAMI SHORES : FL
Tcuant4 Na JOHN AND MELIDA MATOS phone* 305. 759 -8844
Emit: levasser@bellsouth.net
zap. 3313$
CONTRACTOR :: Company Naafi 4 �% t, ' ! CP.
1
Address-
3- 2514a//
City: 5 b, J,.. State: . Tap: 3
Qualifier Name: LoN 4,4 40f+/ > :
mpetency
State Certification or Registration
Contact t t: Email
DESIGNER: ArehitectiEn ineer-
Phone#:
Value of Work for this Peru $ _Stprairtainear Footage of Work
Type of Wort ClAlteration ?Mow LiRepairefItcp1 ace CIDennotition
Devription of W Xii..- iaph e- � ,
41 A-4,-.11-4-1
Submittal Fee
Seaming Fee $
Notary S
Double Fee $
Penult Fee L.104' G•°°' CCFS CO/CC$
Radon Fee $ [APR $ Boat $
Training/Education Fat $
Structural Review S
TOTAL FIE NOW IMJR_
Technology Fee S ,
%Mktg Company's Name (if applicable)
Bonding Company's Address
City1te
Mortgage Lender's Name (if applicable) NONE
Mortgage Lender's Address
City State
Zip
Zp
Application is hereby made to obtain a permit to do the work and installations as ink, 1 certify that
commenced prior to the issuance of a permit and that ail work will be performed to meet the of sill
constr106.0n in this jurisdiction. i understand that a separate permit rust be secured for ELECTRICAL WORK. PLLEA*
WELLS. POOLS, FURNACES, BOILERS, THEATERS, TANKS and AIR CONDITIONERS, .....
has
OWNER'S AFFIDAVIT: H certify that all the foregoing information is accurate and that all work, will be
applicable laws regulating construction and zoning.
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR
LMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN
FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
RECORDING YOUR NOTICE OF COMMENCEMENT'
e with all
Notice to Applicant As a condition to the issuance of a building permit with an estimated value swooning $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 natiee. the
inspection will not be approved and a rehwpectwn fee will be charged.
Owner or Agent
The foregoing instaument was acknowledged before me this 30
slay of , 201,x,, by J cwt' l+t
who is personally known to me or who has produced —t 1)
identification and who did take an oath.
NOTARY .' : LIC:
11111 ■
Sign:
Print: cA.ma, \-9
My Commission Expires:
Signature
Contract
mesons- instrument was acknowledged before me
2D .11. bys .SA`raeA
ttte or who has prcdua
as identification and who rid take a.n cwt,
)
9999.ti9..9s41,11.10
APPROVED BY
(Revised
*wised O7/ 47gRevited06/1
Sri
Clerk
A
CERTIFICATE OF LIABILITY INSURANCE
DATE(MM/DOmyv)
04 -17 -2013
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 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 ADDITIONALINSURED, the pofcyfes) must be endorsed. If SUBROGATIONIS 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
PAYCHEX INSURANCE AGENCY INC
210705 P: () - F:(888)443-6112
PO BOX 33015
`SAN ANTONIO TX 78265
CONTACT
NAME:
PHONE
(A/C No, Ext): l (FA/C, Nor. ( 8 8 8) 443 - 6112
ADC,No,E
INSURERIS) AFFORDING COVERAGE NAIC d
INSURER A: Twin City Fire Ins Co
INSURED
LONGMAN ELECTRIC INC
844 NE 9 8TH ST
MIAMI FL 33138
INSURER B :
u
INSURER C :
INSURER D :
INSURER E :
$
INSURER F :
DAMAGE FO REN TED
PREMISES (Ea occurrence)
REVISION NUMBER:
GOVtKAL t* '.cn t tna.ai t ivvrv.aacn.
THIS IS TO CERTIFY THAT THE POUCIES 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. OMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
TYPE OF INSURANCE
INSR
WVD
POLICY NUMBER
(MMIDD/YYYY)
IMMIDD/YYYY)
LIMITS
GENERAL
LIABRITY
COMMERCIAL GENERAL LIABIUTY
u
'
u
EACH OCCURRENCE
$
DAMAGE FO REN TED
PREMISES (Ea occurrence)
$
MED EXP (Any one perm)
9
CLAIMS -MADE I I OCCUR
PERSONAL & ADV INJURY
$
GENERAL AGGREGATE
$
PRODUCTS - COMP /OP AGG
$
GEN'L AGGREGATE LIMIT APPLIES PER:
$
POLICY I I JECT 1 I LOC
_
AUTOMOBILE
LIABILITY
ANY AUTO
ALL OWNED SCHEDULED
AUTOS u AUTOS
HIRED AUTOS ' INON -OWNED
1J AUTOS
I I
COMBINED SINGLE UMtT
IEa accident)
$
BODILY INJURY (Per person)
$
BODILY INJURY (Per accident) $
PROPERTY DAMAGE 9
(Per accident)
$
UMBRELLA UAB I I OCCUR
Li
I I
EACH OCCURRENCE $
AGGREGATE $
EXCESS UAB CLAIMS -MADE
$
DED I RETENTION 9
A
WORKERS
AND
ANY
OFFICER/MEMBER
If yea,
DESCRIPTION
COMPENSATION
EMPLOYERS• LIABILITY Y N
NIA
u
76 WEG IX1296
05/01/2013
05/01/2014
X1 TORY LIMIT I I
E.L. EACH ACCIDENT
$1,000,000
$ , 000, 000
PROPRIETOR /PARTNER/EXECUTIVE
CER/MyE�MB EXCLUDED? I I
E.L. DISEASE - EA EMPLOYEE
describe under
OF OPERATIONS below
E.L DISEASE -POLICY LIMIT 5 ] i 0 0 0 , i3 0%
11
11
DESCRIPTION
Those
OF OPERATIONS / LOCATIONS 1 VEHICLES (Attach ACORD 101, Additional Remarks Schedule. If more space is required)
usual to the Insured's Operations.
CERTIFICATE HOLDER
Miami Shores Village
10050 NE 2ND AVE
MIAMI SHORES, FL 33138
ACORD 25 (2010/05)
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED
BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE
DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS.
AUTOO
MAINE
7ettile"\--•'"
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The ACORD name and logo are registered marks of ACORD