EL-10-10671
Project Address
Miami Shores Village
10050 N.E. 2nd Avenue
Miami Shores, FL 33138 -0000
Phone: (305)795 -2204
Parcel Number
Applicant
547 NE 94 Street
Miami Shores, FL 33138-
1132060140880
Block: Lot:
DEAN MADIGAN
1
Owner Information
Address
Phone
CeII
DEAN MADIGAN
547 NE 94 Street
MIAMI SHORES FL 33138 -2847
Contractor(s)
Phone Cell Phone
0 AND J ELECTRICAL CORP (305)326 -8892
Valuation:
Total Sq Feet:
$ 2,200.00
400
1
Type of Work: 18 HIGH HATS REPLACE RECEPTACELS
Additional Info: ELECTRICAL
Classification: Residential
Scanning: 1
Fees Due
CCF
Education Surcharge
Permit Fee - Additions/Alterations
Scanning Fee
Technology Fee
Total:
Amount
$1.80
$0.60
$150.00
$3.00
$2.40
$157.80
Pay Date Pay Type
Invoice # EL -6 -10 -38168
06/11/2010 Credit Card
06/21/2010 Credit Card
Amt Paid Amt Due
$ 50.00 $ 107.80
$ 107.80 $ 0.00
Available Inspections:
Inspection Type:
In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In
accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are
required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work.
OWNERS 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. Futhermore, I authorize the above -named contractor to do the work stated.
June 21, 2010
Authorized Signature: Owner / Applicant / Contractor / Agent
Building Department Copy
Date
June 21, 2010 1
Miami Shores Village
Building D:epartm.ent
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305). 762.4949
Permit No. E L 1O 1 -
Master Permit No.
BUILDING
PERMIT APPLICATION
i+BC 20
BY:
Permit Type: ELECTRICAL I� r
fro i 10
Owner's Nance (Fee Simple Titleholder) O ,fir -flies lL�- (Pfi S one t ~ H ,
Owner's Address
€ 3°
City t" )O 'pry t State l,-
Zip 1;3°
Tenant/Lessee Name Phone #
Email
Job Address (where the work is being done)
City Miami Shores Village County Miami -Dade Zip
FOLIO /PARCEL #
tv
s't
I B I lin liist 'ical yDesignated - *- -E5 NO i
Flood Zone
Contractor's Company Name Q ccr � / c- , l G ��p cphng - . '9-1G 54 - lI C?
Contractor's Address ; t % y' % Pi/ 1'1
IAA i a r State
City
ii Zip 33/ "t/
Qualifier Name f e m r /44.6nd, e / Phone # 'O $"S 9 ?4 ^ &'.'
State Certificate or Registration No. C 0 CO e.2 / Certificate of Competency No:
Contact Phone C300 3 415' Email ®c� c/ . € ((��yrcr��/ -�s )14*o
V
Ti:
Describe Work: f e —
ewe
ame (iffplioab
4'
ork For lhis Permft $
Addition
Tpe
r
Alteration
�.:.. one
Ar"+ ZLinearoatagse-if Wor]: '/ ®0
[-] t Rep ir/Replace ❑ Demolition
4 2C--4
:e
1.4
D
Horis
flet i"i
Face
*, ** * *** * * *, ** * ** ** *, * *,r, , **** *** Fees************* * * ** ** ** * * * ** * ** * ** ***** * **** **
Submittal Fee $ L . Op Permit Fee $ 2 c ev® ,0 IA, 57 CCF $ 1 CO /CC $
sr. '10
Notary $ Training/Education Fee $ ; 0 • t } Technology Fee $ 2
Scanning $ 3 Radon $ DPBR $ Bond $
Double Fee $ Violation date:
Structural Review. $ Total Fee Now Due $ 1. 01
See Reverse side -4
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
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
COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE
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 n be apjroved and a re- inspection fee will be charged.
Owner or Agent Contractor
The foregoing instrument was acknowledged b/eforeee me this 1/ The foregoing instrument was acknowledged before me this /1
day of 4 , 20 c�B c� i Q' /al it " day of LI
who is personally known t• K' ti',;r has p • who is person
- coy" u"• - *,ties °Irior .W8
8o'w ton * OD Pr 23, im.. 2(013.
—Ng Nallom "w77
Assk
NOTARY PUBLIC:
Sign:
Print: trK. (14 d v
My Commission' Expires:
NOT
* ** * * ** **
Sign:
r
Print: a c1.4 �P r b P<
My Commission Expires:
****,******************************** * ** * ** ** * * * * * * * *** * * * * ** + * * * **, **
Plans Examiner Zo
Engineer Clerk checked
(Revised 07 {10 /07)(Revised 06/10/2009)
10:04 JUN 11, 2010
ACQ l7®
RECEIVED 06/11/2010 09:05
FR: AMANDA #70207 PAGE: 1/1
CERTIFICATE OF LIABILITY INSURANCE
DATE (MMIDDIYYYY)
6/11/2010
PRODUCER (305) 595 -3323 FAX: (305) 595 -7135
Eastern Insurance Group, Inc.
9570 SW 107 Avenue
Suite 104
Miami FL 33176
THIS CERTIFICATE 1S ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
INSURERS AFFORDING COVERAGE
NAIC #
INSURED
2164 NW 19 Avenue
Miami
FL 33142
INSURER AMid- Continent Casualty
INSURER a Praetorian Insurance Company
INSURER c Bridgef ield Employers
INSURER a
INSURER E:
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTAN DING
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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
LTR
ADD'L
INSRD
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
DATE (MMIDD/YYYYt
POLICY EXPIRATION
DATE (MMID0WYYYI
LIMITS
A
GENERAL
X
LIABILITY
COMMERCIAL GENERAL LIABILITY
04– GL- 000799058
5/1/2010
EACH OCCURRENCE
$ 1, 000 , 000
PREMISES (Ea occurrence) once)
$ 100,000
CLAIMS MADE X OCCUR
MED EXP (Any one person)
$ Excluded
GENII
PERSONAL & ADV INJURY
$ 1,000,000
GENERAL AGGREGATE
$ 2,000,000
AGGREGATE OMIT APPLIES PER:
POLICY PRO-
IFCT LOC
PRODUCTS - COMP /OP AGG
$ 2,000,000
B
AUTOMOBU
X
E LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON -OWNED AUTOS
PICFL0001100
5/1/2010
5/1/2011
COMBINED SINGLE OMIT
(Ea accident)
$ 1,000,000
BODILY INJURY
(Per person)
BODILY INJURY
(Per accident)
$
PROPERTY DAMAGE
(Per accident)
$
GARAGE
LIABILITY
ANY AUTO
AUTO ONLY - EA ACCIDENT
$
OTHER THAN EA ACC
$
AUTO ONLY: AGG
$
A
EXCESS/UMBRELLA
X
LIABILITY
OCCUR CLAIMS MADE
DEDUCTIBLE
RETENTION $
04–X8-168058
5/1/2010
5/1/2011
EACH OCCURRENCE
$ 1,000,000
AGGREGATE
$ 1,000,000
$
$
$
C
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNERIEXECUTIVE
OFFICER/MEMBER EXCLUDED?
(MandatorylnNH)
If Yes, describe under
SPECIAL PROVISIONS below
46800 00
5/19/2010
X TWC SMIU- S O-
E.L. EACH ACCIDENT
$ 100 , 000
E.L. DISEASE EA EMPLOYEE
$ 100,000
:57-19721Y1111
E.L. DISEASE - POLICY LIMIT
$ 500,000
OTHER
DESCRIPTION OF OPERATIONS 1 LOCATIONS! VEHICLES 1 EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS
Electrical contractor
CERTIFICATE HOLDER
CANCELLATION
ACORD 25 (2009101)
I NS025 (200901)
0 1988 2009 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN
ky —5140ren 1
10050 NE 2nd Avenue
Miami Shores, FL 33138
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO 80 SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
David Lopez /AMANDA -�-
ACORD 25 (2009101)
I NS025 (200901)
0 1988 2009 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
AC# 399,478.Q_
T ATE SSE FLORID;
} =<x ;�, a ±;gym;
gi
The E
Named
Upder the proiriS,. onss
Expiration date:
gatatirENT7 ]
DO NOT FORWARD
SEE OTHER SIDE
JOSE A RODRIGUEZ PRES
2164 NW 19 AVE
MIAMI F1.33142
111111)11111111i11111111111111*11,11111111$111.11111.111h$4141$1