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DEMO-13-2194 Inspection Worksheet Miami Shores Village '� �`" 10050 N.E.2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-200002 Permit Number: DEMO-9-13-2194 Scheduled Inspection Date: November 20, 2013 Permit Type: Demolition Inspector: Devaney, Michael Inspection Type: Final Owner: CACCAMISE, RICHARD Work Classification: Electric Job Address: 1490 NE 101 Street Miami Shores, FL 33138- Phone Number Parcel Number 1132050350030 Project: <NONE> Contractor: METRO ELECTRIC SERVICE INC Phone: 305-945-1991 Building Department Comments ELECTRTICAL CAPPING Infractio Passed Comments INSPECTOR COMMENTS False Inspector Comments Passed EE Failed Correction Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. November 19,2013 For Inspections please call: (305)762.4949 Page 16 of 40 LO CO a m o B L d [O O c'7 N T T C-4 m � N - U O 41 O� d pN O T N x O A in N in IA O Ih V H o W a J W �p ac 1-- W E M ■r P Feb O 1 A Ih O N WaBI Bi1fS1niSS Tu-Receipt Mi TJ smI4)sd9 QDU Y;ate of Florida- • ��NdfABYl—ppNQTPAY` _ - AA��ualnan�oatmn mombrim.- S RE,e ppcsNC 30,2074 Np�IF�13�11-•N.X181 a - - - ��t�o Caur�y Cadwa - • _ pi�ar8�1—IU�9m1D _ WC.T1lE Cpli RAC*�� 91RMIQp1C �9B Ei.EgAECAL@OAl11WdCIC� BnrTAxa3tt�Dmow • tp E1�40 -3+16 pD t /ZD13 - - � �IBi=13-Q1021i6 1 � i�I iKgr� pis*Ha�laraelMr.7�NN�1�� auMellor :s - fbrAllil110�111�'rW - :.•-•r Car of Now uwm Nflp TIC N E I23 8i�et •KOM IlQle a FL 33169 • X91 Business Tax Recei pVCefdftete of use eAH iwvn HAMMALCONTRACTOR lum WE wmk sms"I i�T iO 6i I:CIRBC IpIC WORM UVft FL=ffl �MHdJIf<4A FL ®0Mti��aP 11011-1RA RI1812: F06 NA(CIUSPtCM=PLWE •Nth!-'fyGiN3FMME N J � rom: jcantrell FaxID: Date: 10/4/2013 03 :44 PM Page: 2 of 2 .4co a►® CERTIFICATE OF LIABILITY INSURANCE F 1 10/4/2013 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 endorsements. PRODUCER NAME: Patty Carlton Ext 306 BB Insurance Marketing Inc PHONE FAx 11870 W.State Road 84,C-15 ac No: Ft. Lauderdale FL 33324 E-MAIL SS: INSURER(S)AFFORDING COVERAGE NAIC S INSURERA:Florida Cltrus&lndustries Fund INSURED METRO-2 INSURER B Metro Electric Service, Inc. INSURER C: 21407 NE 38th Avenue Aventure FL 33180 INSURER D: INSURER E: INSURER F' COVERAGES CERTIFICATE NUMBER:6302336 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. INSR ADOL SUER POLICDV� POLICY EXP u�� LTR TYPE OF INSURANCE POLICY NUMBER WVD B GENERAL LIABILITY 34528 812013 18/2014 EACH OCCURRENCE S1.00 '000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED CLAIMS-MADE n OCCUR MISS Ea occu S100,D00 MED EXP(Anyone person) 55,000 PERSONAL&ADV INJURY $1.000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY PRO- PRODUCTS-COMP/0P AGG $2.000,000 LOC $ AUTOMOBILE LIABILITY Cum Ea..ciderrl S ANY AUTO BODILY INJURY(Per Person) S ALL AUTOS OWNED AUTOS BODILY BODILY INJURY(Per accident) S HIREDAUTOS AAUTOS-0V1MED PROPERTY er DAMAGE S (P accident} $ UMBRELLA B OCCUR EACH OCCURRENCE $ EXCESS LIAR H.LAIMS-MADE AGGREGATE $ DIED I I RETENTIONS $ A WORKERS COMPENSATION 106-47548 2/212013 014 X WC STATU OTH- AND EMPLOYERS'LIABILITY YIN ANY PROPRIETOWPARTNERIEXECIITIVE OFFICER/MEMBEREXCLUDED? F-1 NIA E.L.EACH ACCIDENT $1,000,ODO (Mandatory in "yes describe under and er E.L.DISEASE-EA EMPLOYE $1,000,000 , DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,001),000 DESCRIPTION OF OPERATIONS 1 LOCAMOPIS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space ht required) Electrical contractor located at 15050 NE 20 Ave., N Miami, FL 33181. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Miami Shores Village ACCORDANCE WITH THE POLICY PROVISIONS. Building Department 10050 N.E.2nd Avenue Miami Shores FL 33138 AUTHORIZED RESENrATnrE 14�� I ©1888-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD Miami Shores Village Building Department �,��5 ., 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 $EP ! i Tel: (305)795.2204 Fax: (305)756.8972 U 1� `; INSPECTION'S PHONE NUMBER:(305)762.4949 °1( Goo Q o0 0 o meV f FBC 20 ko L BUILDING Permit No. mo) � V9 y PERMIT APPLICATION Master Permit No.QF.MQ-q-13-21 Permit Type: Electrical JOB ADDRESS: I q CIO NE�_ 1 C,I ST City: Miami Shores County: Miami Dade Zip: ) Folio/Parcel#: ) 1 -32-05 -®435 -'00-_SC) Is the Building Historically Designated:Yes NO Flood Zone: OWNER:Name(Fee Simple Titleholder): 1 PhoneO 123_S Address: 199 U N x. 141 G 1 City: MIAMI F --� State: FL_ Zip: 5B 13 Tenant/Lessee Name: �`► Phone#: Email: r A ird o Co o C.C,(6°1'l 1��, �Yy1L� I�l1'1��_ corn CONTRACTOR:Company Name: Phone#: �S Address: 1=9 '1k E City: Aj Ak4 VA State: f L Zip: 331)?r P Qualifier Name: ��-rr rf uu _ Phone#: State Certification or Registration#: QZ Q® � Certificate of Competency#: Contact Phone#: JJ'a� �`_l-W Email Address: DESIGNER:Architect/Engineer: I Phone#: Value of Work for this Permit: $ >� Square/Linear Footage of Work. �3,G'ry SH &-D- Type of Work: ❑Address DAlteration ONew ORepair/Replace 26molition Description of Work: - ,CAL-- CAP P 11--11C� Submittal Fee$ ° Permit Fee$ f®0i.m® CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Bond$ Notary$ Training/Education Fee$ Technology Fee$ Double Fee$ Structural Review$ r TOTAL FEE NOW DUE$ Bonding Co 's Na�(if ppl icable) Bonding Company's Ad 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 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$2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to at h certified copy of the recorded notice of commencement must be posted at the job site for the first inspection a occurs seven (7) d after the building permit is issued. In the absence of such posted notice, the inspection will not b rov einspection fee ill be charged. , Signature Signature Ull �f�j, er or Ag t �y j,, Contractor The foregoing i'�strument was acknowledged before me this_g/' -�'he fore oin trument was acknowledged before me this day of CJ� 20 J>by S Mtc�� day of ® who is personally known to me or who has produced w is perso own to me or o has produced As identification and who did take an oath. as identification and o oath: N NOTARY UBLIC: NOT Y PUBLIC: Er o 0 UJ C, <Y m � O 2 d « y W C Sign: Sign: - Print: Print- My Commission Expir'S _ JESSICA t�ONZALEZ My o ssion Expires: a 4. O U MY COMMISSION#EES43682 z e EXPIRES October 2o,2016 7Y7ti�7YiY�C7Y3t3t�t�'7Y7Y�G�C3C7ti� �'.Y� Sti�C�C3C7ki�Sti��3.'i�G�TC7Y7ti�7tiiti'7�'lY7♦CAS'A'2Y�i"x"x"�C'�CSti�C��t��2Y � .,,�3G�i�3C� y 6� APPROVED BY ' 2}- '$°W'.17 Plans Examiner Structural Review Clerk (Revised 3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09)