EL-13-1769 I
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-196680 Permit Number: EL-8-13-1769
Scheduled Inspection Date: August 14,2013 Permit Type: Electrical - Residential
Inspector: Devaney, Michael
Inspection Type: Final
Owner: IRWANTO, RUDY&RIKA Work Classification: Addition/Alteration
Job Address:9302 NW 2 Place
Miami Shores, FL 33150-
Phone Number
Parcel Number 1131010150010
Project: <NONE>
Contractor: BAILEY ELECTRICAL CONSTRUCTION LLC Phone: (954)981-6770
Building Department Comments
REPAIR METER CAN WITH FP&L Infractio Passed Comments
INSPECTOR COMMENTS False
i
Inspector Comments
Passed E�
Failed
Correction ❑
Needed
Re-Inspection ❑
Fee
No Additional Inspections can be scheduled until
re-inspection fee is paid.
August 13,2013 For Inspections please call: (305)762-4949 Page 16 of 36
Miami Shores village ;
Building Department AU6 0.6 20J3
90050 N.E.2nd Avenue,Miami Shores,Florida 33138 ;;_ Y;
Tel:(305)795.2204 Fax:(305)756.8972
INSPECTION'S PHONE NUMBER:(305)762.4949
FBC 20
BUILDING PermitNo.E I3_11(1?C'1
PERMIT APPLICATION Master Permit No
Permit Type:Elech ical
JOB ADDRESS: 9 3®A N W 2 ia e
City: Miami Shores County: Miami Dade Zip: � 3JSQ_
Folio/Parcel#: ..�/'.3'®/—�1,;C- Q® /
Is the Building Historically Designated.:Yes NO Flood Zone:
OWNER:Name(Fee Simple Titleholder): i IL Phone#: 30S'
Address• 2-30 I&Z Plum --
city: _0 i(x yr % ®d,e 5 State: Zip: 331 S-®-a266
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name: Bailey Electrical Construction LLC Phone#: 954-981-6770
Address: 3521 SW 35th Street
City: West Park State: FL zip: 33023
Qualifier Name: Robert Scott Phone#: 964-981-6770
State Certification or Registration#: ER13014660 Certificate of Competency#: 000017022
Contact Phone#: 954-981-6770 Email Address: bobscottlighting @gmail.com
DESIGNER:ArchitecUEngineer. Phone#:
Value of Work for this Permit:$ "� ®C� Square/Linear Footage of Work:
Type of Work: DAddress DAlteration ONew *Cpair/Replace ❑Demolition
Description of Work: -1 / �J/R .�
Submittal Fee$ Permit Fee$ /�^®°®�' CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Bond$
Notary$ Training/Education Fee$ Technology Fee$
Double Fee$ Structural Review$
TOTAL FEE NOW DUE$ 16 0
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$2500, the applicant mast
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued In the absence of such posted notice, the
inspection will not be approved aqd a reinspection fee will be charged.
Signature Signature `
+Vt Contra
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
day of ,20 ,by 1QIr��o°i°�� day of, 20 ,by dN�lDa°
who is psrsmVffl1y1ffi5wMn or who has produced who is personally known to me
As identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: Sign: �L
Print & i' Print. A.
up My Commission Expir *: •'' MY COMMISSION#EE005497 My Commissi ; MY OOMMISSION#EE006497
EXPIRES June 30,2014 ? EXPIRES June 30,2014
( 398-0183 Florida com (407 Ill 153 FWN mm
skbF9�r9��W,[��#4:#��&eb�b �R�4fl9ffi�k+iNsBffi �lek#to$�#ffiB�koR�R������lroi�Ma6� �OnPA ���Y�a9dehtlQ�Q�R �4d:o6�
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised 3/12/2012XRevised 07/10/07)(Revised 0611012009)(Revised 3/15/09)
aaTE(�uvL�aorr�:m•j..
.acv n� CERTIFICATE OF UAEILITY INSURANCE ' 3!7/2013
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS
CERTIFICATE DOES NOT AF RRIATIVELY OR NEGAMMY AMEND, EXTEND OR ALTER THE COVERAGE. AFFORDED BY THE POLICIES
_-VEI.OW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE 1l WINGs 10MRER(S), AUTHORIZED
"EPRESENTATIVE OR PRODIJ DER,AND THE CERTIFICATE HOLDER.
,MPORTANT: if the cerMlimW wider Is an ADDITIONAL INSURED,the poHcy(ies)must be endorsed, S SU13ROGATWX IS WAIVED, to
the terms and condMons of flu ponq,certain poWwo may require an endomenwat. A atatemeM on of certlicate does not confer rids to Idle
rertiftate holder It Neu of sw I endorsemw4s).
PRODUCER VAME. -•-- --
lmzp wiw imsu tANcE ntC NoE E95!�j583-7100 Af'.val_(95411584-5100:
6827 Sunset Str3 ai_ss indinsl @�oI .t�O3fI
Sunrise, FL 33313 , ,AFFt FMW COVOIA" ¢ --
INSUPERA-MOUNT VERNON FIRE INS CO
ll SRWED HAILEY CTRIC CONSTRUCTION LLC INSUP[R s �� VERNON FIRE INS CO
DBA BOB S OTT LIGHT,PONER & Slut INSJI:ER C
3521 SE' 3 ST INSUI;ER D
HOLLYNOOD FL 33023 INSUFER E
959-981-6 70 INSJt ER 1
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT POLICIES OF INSURAVCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE =CSR THE POLICY PERIOC
NDICA ED. NOTWITHSTANDI G ANY REQiiIREMENIT TERRA OR CONDITION Of ANY CONTRACT OR OTHER DOCUMENT V%QTPI RESPECT TO WHICH THIS
^.ERTIFtCATE MAY BE ISSUE OR MAY PERTAIN,THE INSURANCE•AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AI4D CONDITION CIF SUCH POLICIES.L6ttIfS S_HOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
Mgt i TYPE OF Qd d POLICY NUMBER MkAr Y FFF PQL11�1'iCXPW l.lAtrf8
L"M GENERAL LIABILITY +�'�+ EACH OCCURRENCE S 1,000,000
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$. s�°
cO aRO1AL GENE"L H T1Y NR , 0.33
(cJ AIYIS MADE ! X CUR ' (Mw EXW(Any am ce-") a 43,068 '
CL2345070D o�/�6/ao13 oa/o6/?D14
� 1PERSONAL&AINJnIJUR� s 1,000,000
CENIRAI AcCREGAIE s 2,000,000
GEN9 AGGREGATE LIW AM S PER. PKAW-M 3-COW10�AG G S 2,'600,000
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i UMBREI LA LIAR `X CUR ! �1�+2550Q178 03/06/2013 03/06/2034.FACII (WURREMI:E s 2,000,000
X EXCESS LIAH AIM.R•MADx- ( ,
AGGiiE^sArE S 2,000,00b
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WORKERS CCMPENSATION ! TORYLBlTTS :OER
AND EMPLOYERS'UAWL" YIN I
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•.DESCRIPTION OF OPERA Ild.
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DT:SCTIB'TION O=bPt?RaTIDNS!l OC TIONS T vEMIC1.ES iAtteleh ACORD 109.AdQitiMel RemnlNS SGse�.la,it I71pTe apmem s requiredl
ELECTRICAL CONTPJCTOR
,
I CERTIFICATE HOLDER CANCELLATION
MIAMI S$O S VILLAGE BLDG DE'P'T ' SFOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE.
10050 NE AVEHM THE EXPIRATION DATE THEREOF NOTICE WILL BE JELNtRED IN
i� MIAMI SHO S, FL 33138 ACCORDANCE IAITH THE PO_tCY PROVISIONS.
Y AUThORIZED REPRESENTATNE
01 -2010 ACORD CORPORA-10N. AM Tights reserved
ACORD25(2010/05) The ACORD name and logo are registered marks of ACORD
Date
CERTIFICATE OF LIABILITY INSURANCE IJ31/2013
producer. Lion Insurance Company This certificate Is Issued as a of hilillonnotlon only and cow no
2739 U.S. Highway 19 N. rights upon the certificate Holdw. This cerclsCam does not amend,attend
Holiday, FL 34691 or alter the coverage afforded by the polices below.
(727)938-6562 Insurers Affording Coverage NAIC#
-gyred: South East Personnel Leasing, Inc. &Subsidiaries Insurer A: Lion Inm ante Company 11075
2739 U.S. Highway 19 N. Insurer B.
Holiday, FL 34691 Insurer C:
Insurer D:
Insurer E:
COY @rdg@S
The of have been issued to the insured ebohre i�Ode poNq any rid tom or of my madraot or other
with resped to which this carliflcate mey be Issued or noy pertah the Irmovince afforded by Ore policies described term to swot to all Ode term,owkniore,and candifiona of such pots.Aggregate
limb aihown may rove beer reduced by paid daims.
Policy Effective Policy E)pitatieon Date
�L R IINRO Type of Insurance Policy Number Date umb
(MM KID/YY) (MM/DD/YY)
GENERAL LIABILITY Each Occurrence b
Commercial General Liability Darr"e r (EA
Claims Made ® occur 8
Vied Exp
Personal Adv Injury
neral aggregate limit applies per
General Aggreg�
--lay a Pr*d ® LOC
Pwduce.rPare
UTOMOBILE LIABILITY ' s�eie uma
(EAAmderd)
Any Auto Boft
Ad Owned Autos
(Per Perm)
Scheduled Autos
Hired Autos fly irdoY
Non-Owned Autos (Per Aoddent)
Properly Damap
(Per Aid)
EXCESSIUMBRELLA LIABILITY Each Oarurance _
Occur ®CIS Idle AMegate
DeducMe
A Workers Compensation and WC 71349 01/01/2013 01/0112014 X wC Statu- OTH-
Employers'Liability tory Limes
Any PrWoRetor/Parttterle)(eoutive offiaerfinember E.L.Each Accident $1.O o coo
excluded? No E.L.D -Ea Employee $1.00D.000
9 Yes,describe under special proyloons below. E.L.Die-Poky Limes $1.0001ow
Other Lion Insurance CornMny Is A.M.Best EMM rated A- 4LWWrrt. ANS#12616
Descriptions of Operations/LocaUonsNehicles/ExciLmlons added by Endorsement/Spectal Provisions: Client ID: 83.55.022
Coverage only applies to adtive employees)of South Fast Employee Leasing Servi=,Inc.that are leased to the following°C'MM ComPany°:
Florida Tradespeople,LLC
Coverage only applies to k*fftes Incurred by South East Personnel Leasing,Inc.&Subsidiaries active employees),while working in Fria.
Coverage does not apply to statutory employee(s)or independent contractor(s)of the Client Company or any other entity.
A list of the active employes)leased to the Cilent Company can be obtained by faxing a request to(727)937-2138 or by calling(727)938-5562.
Project Nara:
Coverage only applies to active employeWs)of South East Personnel Leasing,Inc and We Subsidiaries that are leased to the tailowing°ClIent Company"Florida Tradespeople,
LLC for Temporary Assignment To BAILEY ELECTRIC BOB SCOTT LIGHT POWER&SIGN. FAX:661-870-2774&864-985-2678/ISSUE 07-30-12(JG)ReWsue!12/10/12
(SH)f REISSUE 01.31-13(TD)
I Redo Dow 312912010
�_—CERTIIFIQATEWLDER CANCELLATION
VILLAGE OF MIAMI SHORES BUILDING DEPT Shedd wW of 111m aNwe desmilmd pollcies ie oarmeited bets to apfration date itdersW,fie its
InshuerwN endcevmto rralI30 days written notice to Oe oertif a%holder rafted to Oe kA but teilhee to
ATTN:VALLIE do so shag impose no atiIigation or Iab0lq+of any Wnd won Ore hum.Its agenda or
10050 NE 2ND AVE
MIAMI SHORES, FL 33138 ,�
0
FFIL®
July 22, 2013
Rika Irwanto
9302 NW 2nd PI
Miami Shores, FL 33150
FINAL NOTICE
Re: 9302 NW 2nd PI
Dear Rika Irwanto:
A notice was sent to you earlier regarding the need for permanent repairs for the meter
enclosure at the above address. Permanent repairs to this enclosure should be made by
August 12, 2013 to enable continuation of your electric service. As a customer, you own the
meter enclosure and are responsible for its repairs.
As stated in our earlier notice, we suggest that you contact a licensed electrical contractor to be
utilized to perform these repairs as soon as possible and obtain the appropriate permits and
electrical Inspections required by local authority. You or your contractor are encouraged to call
FPL at(305) 770-7902 to schedule an appointment for the disconnect/reconnect of the electric
service so that the necessary repairs can be made.
We take our commitment to serve you in a safe and reliable manner very seriously. The Florida
Administrative Code, specifically No. 25-6.105 (b), states service may be disconnected °for
failure or refusal of the customer to correct any deficiencies or defects in his wiring or equipment
which are reported to him by the utility." Your prompt attention to this matter is appreciated so
we may continue your electric service.The Florida Public Service Commission phone number
(1-800-342-3552) is provided in accordance with the Florida Administrative Code.
If you have already made the necessary repairs or arranged an appointment, please notify FPL
by calling Angela Jamison at (305) 770-7902 as soon as possible to discuss this situation.
Florida Power& Light Company
Florida Power&Light Company
700 Universe Boulevard,Juno Beach,FL 33408
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