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EL-13-2097 Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-199884 Permit Number: EL-9-13-2097 Scheduled Inspection Date: September 30,2013 Permit Type: Electrical - Residential Inspector: Devaney, Michael Inspection Type: Final Owner: LUCIO,ASHLEY Work Classification: Alarm Job Address: 10651 NE 10 Court Miami Shores, FL 33138- Phone Number Parcel Number 1122320280740 Project: <NONE> Contractor: MASTEC NORTH AMERICA, INC Phone: 305-257-3095 Building Department Comments Infractio Passed Comments INSTALL BURGLAR ALARM INSPECTOR COMMENTS False Inspector Comments Passed Failed ZZ2 Correction ❑ Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. September 27,2013 For Inspections please call: (305)762-4949 Page 13 of 30 S Miami Shores Village err` Building Department �� L g p , CEP 1 s 2013 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel: (305)795.2204 Fax:(305)756.8972 INSPECTION'S PHONE NUMBER:(305)762.4949 FBC 20t z) BUILDING Permit No. PERMIT APPLICATION Master Permit No(LLA 3'CPjCD 11) Permit Type: Electrical JOB ADDRESS: 10651 NE 10 CT City: Miami Shores County: Miami Dade zip: 33138 Folio/Parcel#: 11-2232-028-0740 Is the Building Historically Designated:Yes NO Flood Zone: OWNER:Name(Fee Simple Titleholder): Ashley D LIICIo Phone#: 30.5-747-4874 Address: 10651 NE 10 CT city: Miami Shores State: FL zip: 33138 Tenant/Lessee Name: Phone#: Email: ashlucio@yahoo.com CONTRACTOR:Company Name: MasTec North America Phone#: 786-573-7355 Address: 12400 SW 134 CT Bldg 3 Unit 10 City: Miami State: FL zip: 33186 Qualifier Name: Robert Hernandez Phone#: State Certification or Registration#: EC0002759 Certificate of Competency#: Contact Phone#: Email Address: DESIGNER:Architect/Engineer: Phone#: Value of Work for this Permit:$ 249.00 Square/Linear Footage of Work: Type of Work: DAddress O Alteration ONew ORepair/Replace ODemolition Description of Work: Install Burglar Alarm Submittal Fee$ Permit Fee$ �� °� CCF$ CO/CC$ Scanning Fee$ Radon Fee$ 2. •00 DBPR$ Bond$ Notary$ Training/Education Fee$ 2f Technology Fee$ Double Fee$ Structural Review$ TOTAL FEE NOW DUE$ 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 ap roved a a reinspection fee will be charged. Signature Signature Owner r ent Contractor The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged efore me this 13 day of ,201.3,by 1Q.�1G!6 day of September,20 n,by Robert Hemandez who is personally known to me or who has produced who is personally known to me or who has produced As identification and who did take an oath. as identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: ASi AL=1'htu t:/WNYI M.RAAdIREZ My Commission Expires: My Commission Expire �ZCOMMISSION#EE 091724 _*:'' = MY COMMISSIONN##EE 091724 J'A.� XPIRES,M9 9,2015 Thal No Public Underwriters ',•` EXPIRES;May 9,20 I5 e Oonded Thru NotQry public Underwriters sk �ksksk�ksk�kaksk �k�k �Issk�k�k��k�kak�ak��kakaksksksksIs�ksk�k�lssk�kakaksksk�k�k�k aR APPROVED BY Plans Examiner Zoning II Structural Review Clerk (Revised 3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09) ACOR � DATMDnYYY)TFIATE O F LIABILITY INS U R A N C E o9.u/zo33 THIN CERTIFICATE IS ISSUED AS A MATTER OF NFORMATDN ONLY AND CONFERS NO RTHTS UPON THE CERTIFICATE HOLDER.THIS CERT]FIvATE 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),AUTHORPLED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: Ifthe certificate holderies an ADDITIONAL INSURED,the polby(ies)m ustbe endorsed. I£SUBROGATDN IS W ABED,subjacttD the tams s and condkbns ofthe policy,certain policies m ay require an endorsem ent. A statem enton this certificate does not confer rights tD the certificate hollerin lieu ofsuch endonsem ent(s). PRODUCER CONTACT 'ry!IaidiUSA,lm. NAME: TWOAlkim Ceritm PHONE FAX NQ f 3560LmrxRcad,Suie2400 E-MAm Atlmta,GA 30326 ADDRESS: AW:AtlmtaCe3iRequ9sm ma>stlrsm/Fax:212-90-4321 INSURER C.)AFFO RD NG COVERAGE NA E# 6051 Cae 1314 USG NsuRER A:ACE Amedmn b%= p Candy 22667 INSURED INSURER B :Y m rAylm COOtNadhAmeia 43575 MASTEC NORTH AMERSA,NC ATM:MAUREEN POPOVCH INSURER C :NA N/A d 7221DR.MARTN WTHER KING JR BLVD E NSURER D TAMPA,FL 33619 INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: ATL-00294666906 REVISDN NUMBER:l THE B TO CERTIFY THAT THE POLr-]SS OF NSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD ' INDICATED. NOTW 3THSTANDNG ANY REQUIREMENT,TERM OR CONDlr3)N OF ANY CONTRACT OR OTHER DOCUMENT W ITH RESPECT TO W RICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, 4 EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LMITS SHOW N MAY HAVE BEEN REDUCED BY PAID CLAMS. NSR ADDL SUER PO LEY EFF POLMY EXP LTR TYPE OF INSURANCE PO LEY NUMBER M D YYY M D YYY LN 7rS A GENERAL LIAR ZITY HDOG27022790 09/154013 09/154014 EACH OCCURRENCE $ 2PGOAM X COMM ERCALGENERALLAB]L= DAANAGE TOREN n� $ 500pw CLANS-MADE rl OCCUR MED EXP one mon) $ 25,000 PERSONAL&ADV NJURY $ 2,000,000 i GRNERALAGGREGATE $ 20XOp00 GEN LAGGREGATE LN IT APPLES PER: PRODUCTS-CON P,OP AGG $ 6A�A00 X POLIDY PRO- LO $ A AUTO M0SME LIRE]Ln'Y BAH08721348 09/1.5/9013 09/15AO14 CON BNEDSINGLEL14 IV 3000,000 aac3• X ANY AUTO BODILY INJURY (Perpemn) $ ALLOWNED SCHEDULED AUTOS AUTOS BODILY INJURY t�erac¢ilent) $ X HRED AUTOS � X SC ICED PROPERTY DAMAGE $ AUTOS eracanen a $ IUMBRELLA LAB OCCUR EACH OCCURRENCE $ f EXCESS LRE CLANS-MADE AGGREGATE $ r DED I I RETENTION $ B WORKERS COMPENSATION WIR C47325213 WS) 09/15/9013 09/154014 X W C STATII- oTH- AND EMPLOYERS'LAB ILICY To RY LI. A Y/N]E WIR C47325250(1Z,CA,MA) 09.15.9013 09.15.1014 2,000,0 ANY PRO PRTOR/PARTNER,E%ECIITlVE SL.EACH ACCIDENT $ A OFFrERARMBER EXCLUDED? N/A WCUC4732533A M GA,NC,TX) 09/15.9033 09/15.9014 2,000,OOC N andatory ai NH) 9L.D ERASE-EA EM PIA YEE $ ryes,desccbeunder SR:$15M f�rFLj�IC�7C/$IM f>rGA 2,000p00 D RECR IPTE N O F O PERATD NS bebw EL.DEEASE-POLEYLNH' $ I j A WcuhwCanpmimttn SCFC47325298 W7) 09.15.1013 09/15.9014 DESCRI PTIDNOFOPERATDNS/LOCATDNS/VEHrLES pltlachACORD 101,AdditbnalRem mica Schedub,ifmom space ismqused) CERTHOIDER E ADDITIONAL INSURED AS RESPECTS LABIIM COVERAGES VXCWDNG EMPIDYERS LABIM)AS REQURED BY W RITM CONTRACT. I I CERTIFICATE HOLDER CANCELLATION MirniSkx>1asVmw SHOULD ANY OF THE ABOVE DESCRIBED POL:CIRS BE CANCELLED BEFORE 1005ONE.adAZErm THE EXPRATDN DATE THEREOF, NOTICE WILL BE DELIVERED N Ml%niSboffis,FL 33138 ACCORDANCE W I['H THE POLICY PROVISIONS. I a AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Manashi Mukhegee .ar ac 0 1988 2010ACORD CORPORATION. Al1rightsreserved. ACORD 25 (2010/05) The ACORD name and logo are registered m arks ofACORD C ' C 0299-01-000008001-M-=0055 r p r,, rt 3 3 a + tlr� ae or rF �kClCf OdaMF 4 �HIU W . FL ORM-1- +path Trau s ,y SEWM20708=4I x z a S 4 �At�t3kt E !N$RGAX ASQtft6tE©61i LAW