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EL-14-0254Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 207447 Scheduled Inspection Date: February 21, 2014 Inspector: Devaney, Michael Owner: MATEO, RAYMOND AND DAMARIS Job Address: 900 NE 100 Street Miami Shores, FL 33138- Project: <NONE> Permit Number: EL -2 -14 -254 Permit Type: Electrical - Residential Inspection Type: Final Work Classification: Alteration Phone Number Parcel Number 1132060340220 Contractor: WEST KENDALL ELECTRIC Phone: 305 - 596 -6240 sunaing uepartment comments 100 AMP TEMPORARY POLE INSPECTOR COMMENTS False Inspector Comments Passed CREATED AS REINSPECTION FOR INSP- 207379. Add main breaker, 2 w.p. g.f.i. protected receptacles on dedicated circuits and hook for FPL to connect to. Failed �� `j 7o Correction Needed ❑ �� Re-inspection Fee No Additional Inspections can be scheduled untile re- inspection fee is paid. KM- February 20, 2014 For Inspections please call: (305)762.4949 Page 22 of 34 Miami Shores Village Building Department 10050 N.E.2nd Aveme, Miami Shores, Florida 33138 Teb (305) 7952204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 BUILDING PERMIT APPLICATION Perm* : EimtricM JOB ADDRESS. 100 me 10d,* ••mil Gm' i RE CEjV7-EM FEB 11 2014 BY'. CJL F-BC 20 LO remit No. liter Permit No k—L i % :: %A City: Miami Shnzes Cowtty: Miami Dads Zip: FoOeParMit. Is Me Building Histartadly Designate& Yes NO Flood Zone: OWNER: Name (Fee Simple Titleholder): s"1 I f7 ' Q p� Address: City: State Zip: Tee aK.essee Nam: Phone# Email: l ftaaw ? 4L 6pm CONTRACTOR Company Name: K F.lG iG Phonet 3—"'�iw_ "` Adams: � -,�W ate''"'tt.M - city: Em State contact Phona Email Address: DESIGNER: Archiwaffingineer. Phone#: 3 V" d' Wo* 6 WS Parma± `$ • c es SgwuWL1uear Footage of Work: Type of Work: QlAddres OAtteration ONew ORepair/Replace UDemolition Desa4donofWork Iwo eagrses�r sswl sss +MS?a�ssssss+rslwssss$*sssgrsr rsa ass *a+wssssss:s MSSarsweeea�sss Submittal Fee $ Pent IFee $ / &P ° ®O CCF $ CO /cc $ Smaning Fee$ Ram Fee $ DBPR $ Bond $ Note• $ TrabdoWTducaBon Fee $ Technology Fee $ Denbie Fee $ Stracttuai 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 Zap 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 data separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS. TANKS and AIR CONDITIONERS. ETC..... MMERIS AFMAVPT: I certify that all the fig information is accurate and that all work will be done in compliance with all applicable laws regulating cation and zoning. `WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COAMENCUMNT MAY RESULT IN YOUR PAYING TWICE FOR EffROVEMENTS 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 goad 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 cer ifted copy of the recorded notice of commencement mast be posted of 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 itrspeettonc will not be approved and a reutspection fee will be charged Sigma Signature Owner or Agent Contractor The foregoing itstrumenj jvas acknowledged me day of J�—,20 .bp, who is personally known to me or who has produced- Df i Ler— r [ C.& _ As identification and who did take an oath. NOTARY PUBLIC: n L _ 7°r'O Sign: Prime _ N atftj l My Commission Ex E r Cremes arr -'� a APPROVED BY Me of Fbf da EE 870877 117 Mt'1+r�1 ss+twt+bab�s The foregoing instrument was acknowledged before me this day of 20 —(q4 7T/ ,by V IQ who is personally known to me or who has p=iucedf&:j!& UCPir= as identification and who did take an oath. NOTARY PUBLIC: ALIVAiER Sign: - staid+ of Florida Prints Y EE 1 t6219 My •° Ttoaugll National Notary As Plans Examiner Structural Review (Rcvlsed 3ti2/l0l2xRevised 07/i1U07KRevised 0fitltb�09)(ftevisesi 3/15109) Zoning Clerk t %ING 01 y4 1� • ! w :w 1B REGULATION DEP. ME WINE. AM PROFESSIONAL • r k- a. ! r 0=20 Local Business Tax Receipt Miami -Dade County, State of Florida TMIS NOTA BILL —DO NOT PAY 1643954 BUSUdEW KANUMACATION WBT c(NDALL BEC.MC INC 9305 SW 94 ST WNW R 33176 . OWNER WEST Ii1;PIQfl I ELB MC INC Wodmr(s) 10 LBT EXPIRES Mau- SEPTEMBER 30, 2014 1 Mud be displayer at place of bodness Pwww t m CaruaY Code Chapter SA— ArL M 10 V;Er_ Tvm OF BLUMIESS PAYNIEVU RECEWED 198 ELECTRICAL CONTRACTOR BY TAX COLLECTOR EC130M1BSO $75.00 08/08/2013 TXHSI- 13-044139 7M3 Laaal Tax �t>� Lasal the Tae. T� is E98 9088M sera oaf aatl to�Qaaass ltatdrl� anY or q*tafthwinen Ift FWW I & dMe M90 he dkpbpd an 8H cmwnMZW WONdft— C06SOCBE -M 7 ff faraeit . Date: 2/11/2014 Time: 11:25 AN To: 1 800 665 7530 Client#: 7899 WESTICEND i Page: 03 ACORD. CERTIFICATE OF LIABILITY INSURANCE F DATE(M,;DNYYY) 2/07/2014 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 pol(cy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terns 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 endorsem ent(s). PRODUCER Cypress Insurance Group PO Box 9328 Lauderdale, FL 33310 -9328 954 771 -0300 NAME, Carissa LaFreniere PHONE 954 771 -0300 FAX a!C No Ext : A/C, No): 954 772 9424 Eno Tess: CarissaL@Cypressinsumnes.com INSURER(S) AFFORDING COVERAGE NAIC N INBURERA :Charter Oak Fire Insurance GENERAL LIABILITY INSURED West Kendall Electric Inc. INSURER 0: Normandy Harbor Insurance Co 16601055X579TCT14 INSURER C 02/281201 9305 SW 94th Street INSURER D : Miami, FL 33176 -2013 INSURER E INSURER F : $100,000 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 CONTRACTOR 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 LTR TYPE OF INSURANCE ADDLSUIBR SR POLICY NUMBER POLICY EFF MPS RpV EXP LIMBS A GENERAL LIABILITY 16601055X579TCT14 D212812014 02/281201 EACH OCCURRENCE $1.000.000 X COMMERCIAL GENERAL LIABILITY PDMMA9E& Ee TErrDenoe $100,000 CLAIMS -MADE 5XI OCCUR MED EXP (Anyone Person) $5,000 PERSONAL &ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS- COMPIOPAGG $2,000,000 POLICY PO- JERCT LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE _LIMIT Ea aoddent g BODILY INJURY (Per parson) $ ANY AUTO ALL OWNED SCHEDULED BODILY INJURY (Per axident) $ AUTOS AUTOS HIRED AUTOS NON-OWNED AUTOS AUTOS $ Per accident UMBRELLA LUU3 OCCUR EACH OCCURRENCE $ HCLAIMS-MADE EXCEBBLIAB AGGREGATE $ DED RETENTION $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY NGFL130916 3/ZO/2013 03/20/201 X WCSTATU- OTH- $ YIN ANY GERIMEMB RIPXCLUDED? CUTIVE OFFICERfAAEMBERIXCLUDED7 ❑ NIA EL. EACHACCIDENT $1 000000 (Mandatory in NH) Kyes, daeortba under E.L. DISEASE - EA EMPLOYEE $1,000,000 DESCRIPTION OF OPERATIONSWeli EL. DISEASE - POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS! VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required) Workers Compensation applies to Florida operations and employees only. CERTIFICATE HOLDER CANCELLATION Miami Shores Village SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Building Dept. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE 2nd Avenue Miami Shores, FL 33138 AUTHORIZED REPRESENTATIVES ACORD 25 (2010105) 1 of 1 #S167561/M167412 O 1988 -2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD C«141M Date: 2/7/2011 Time: 2:32 PH To: 1 800 685 7530 Page: 02 Client#: 7899 WFSTKFNn ACORDTa CERTIFICATE OF LIABILITY INSURANCE F DATE(MMIDDIYYYY) 2/07/2014 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 pollcypes) must be endorsed. If SUBROGATION IS WAIVED, subject to the terns 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 endorsem ent(s). PRODUCER Cypress Insurance Group 130 Fo Box 9328 Fort Lauderdale, FL 33310 -9328 NAME: Carissa LaFreniere �, 0 "N Ext:954 771 -0300 ac, Nc : 954 772 9424 E, MAIL DR' S: CarissaL @Cypresslnsurence.com GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE � OCCUR 954 771 -0300 INSURER(S) AFFORDING COVERAGE NAIC 0 INSURER A : Charter Oak Fire Insurance OCCURRENCE INSURED. West Kendall Electric Inc. INSURER B: Normandy Harbor Insurance Co $100,000 INSURER C $5,000 9305 SW 94th Street INSURER D : Miami, FL 33176 -2013 INSURER E : INSURER F: TH IS 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 CONTRACTOR 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. tNSR LTR TYPE OF INSURANCE ADDL NS UBR D POLICY NUMBER POOLDCYEFF MP�DYP.XP LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE � OCCUR 16601OM579TCT14 2/28/2014 0212812015 OCCURRENCE $1.000.000 DpEAApCCHHq R&A11SE6 EaoNoTarrEDrenoe $100,000 MED OCP (Anyone person) $5,000 PERSONAL & ADV INJURY $1.000.000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER., POLICY JERCT LOC PRODUCTS - COMP/OPAGG $2,000,000 AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HIRED UT03 NON -OWNED AUTOS COMBINED SINGLE LIMIT Ea acadent $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTYDAMAGE Per accident $ $ B UMBRELLA LIAB EXCESSUA13 OCCUR N/A NOFL130916 3/2012013 03120/201 EACH OCCURRENCE $ HCLANS-MADE AGGREGATE DED RETENTION $ ANDEMPLOYER COMPENSATION AND EMPLOYERS' LIABILITY ANY PROP RIEfOR1PARTNEWEXECUTIVEYIN OFFICERNEMBEROCCLUDED? (Man yeaadaso Ibe Iun� X wcsTATU- OTH- $ E.L. FACHACCIDENT $1 000000 E.L. DISEASE - FA EMPLOYEE $1,000,000 DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS/ LOCATIONS I VEHICLES (Attach ACORD 101, Additlonal Remarks Schedule, Ir more space Is requ" Workers Compensation applies to Florida operations and employees only. CERTIFICATE Hnt nFO Miami Shores Village SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Building De THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN g pt• ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE 2nd Avenue Miami Shores, FL 33138 AUTHORIZED REPRESENTATIVE y ®1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) 1 of 1 The ACORD name and logo are registered marks of ACORD #S 167561/M 167412 CC