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EL-13-1721Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 200333 Permit.Number: EL -7 -13 -1721 Scheduled Inspection Date: October 03, 2013 Permit Type: Electrical - Residential Inspector: Devaney, Michael Inspection Type: Final Owner: BAKER, GOLDIE Job Address: 9510 NW 1 Avenue Miami Shores, FL 33138- Project: <NONE> Work Classification: Alteration Phone Number Parcel Number 1131010240260 Contractor: EVOLUTION ELECTRICAL CONTRACTORS Phone: (786)351 -5784 Isuna comments REPALCE METER FOR 200 AMP INSPECTOR COMMENTS False Inspector Comments Passed / Failed Correction ❑ Needed Re- Inspection ❑ Fee No Additional Inspections can be scheduled until re- inspection fee is paid. October 02, 2013 For Inspections please call: (305)762 -4949 Page 24 of 27 NO' ' Permit Type: Electrical Miami Shores Village = __ Building Department - 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 20'3 JOB ADDRESS: �I (� ,� .► Permit No. l-' 112-1 Master Permit No. City: Miami Shores County: Miami Dade Zip: Foho/Parcel #: Is the Building Historically Designated: Yes NO Flood Zone: OWNER: Name (Fee Simple Titleholder): e° 0" a(2 0 �� s� � c Phone #: V6 U; City: 46 I e n State: TenantlLessee Ime. Phone#: —?6E2 %4 P t 19 Email: C4 a S ® ✓' � � • C.®�h CONTRACTOR: Company Name: `�- "� �-'�T� �'� Phone#: Address: \\C^ 2A N,-' Sis City: Qualifier Name: zip: 2. State Certification or Registration #: VZ Certificate of Competency #: W d03 61 Contact Phone #: MY&- - 5kR6 2S c.5l Email Address: 'S dAt S i c_raL& e , C DESIGNER: Architect/Engineer: Phone#: Value of Work for this Permit: $ 112,00, Square/Linear Footage of Work: Type of Work: ClAddress DAlteration ONew taRepair/lkeplace Description of Work: Submittal Fee $ 0 L Permit`Fee $ tS ®P1 6�� CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ Technology Fee $ TOTAL FEE NOW DUE $ ODemolition OkN,� Bonding Company's Name (if applicable) Bonding Company's Address City State Mortgage Lender's Name (if applicable) Mortgage Lender's Address zip 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 be approved and a reinspecuon f will be charged. Signature Signature Ovifer or Agent Contractor The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this a' day of , 20 , by ��fN �XyrI o day of 20 f�3, by r1 +� l9eafJT.— who is personally known to me or who has produced )rlleS who is person y known to me or who has produced R'sM�-J ill 4-0- i✓ 1C4111st . As identification and who did take an oa& as identification and who did take an oath. NOTARY PUBLIC: NOTARY PUB C: Sign: Sign. o� ^ Print: YIA LIESY ARIAS Print ;P,, Se m et'f�4 Get e� ?* *a omission 065 My Commission xpires. _. My Commission Expires My Commission November 14, 2015 '., ROSE MARIE LOPEZ C `fir. = MY WMM1=0N # EE871061 APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised 3 /1=012)(Revised 07 /10/07)(Revised 06/1=009)(tevised 3/15/09) CERTIFICATE OF LIABILITY INSURANCE ' DATE(MM/DD/YY) rrttJIPuUtR southern Star Insurance Agency, Inc THIS CERTIFICATE is ISSUED AS A MATTER OF INFORMATION 8338 $W 8th Street ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Miami, FL 33144 1 HOLDER THIS CERTIFICATE D_0_E_S_ NOT AMEND, EXTEND OR AI Tee rum n�i.- ....... .___ Phone (305)44 -0079 FaX , INSURED EVOLUTION ELECTRICAL CONTRACTORS INC. 11631 NW 58TH PL HIALEAH,FL.33012 INSURERS AFFORDING COVERAGE NAIC # INSURERA: ASCENDANT COMMERCIAL INS I INSURER - - -- COVERAGES INSURER R F: THE POLICIES OF INSURANCE LISTED 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. BR. ADD'L L INSRQ I TYPE OF INSURANCE POLICY NUMBER j GENERAL LIABILITY © COMMERCIAL GENERAL LIABILITY I � I A ❑ ❑ ❑ CLAIMS MADE W-1 OCCUR GL- 36537 -1 II GARAGE LIABILITY ❑ ❑ ANY AUTO EXCESS/UMBRELLA LIABILITY ❑ ❑ OCCUR L CLAIMS MADE ❑ DEDUCTIBLE ❑ RETENTION $ EMPLOYERS LIABILITY ~�y ANY PROPRIETOR/ PARTNER/ EXECUTIVE OFFICER / MEMBER EXCLUDED? If yes, describe under L SPECIAL PROVISIONS below OTHER �- I � DESCRIPTION OF OPERATIONS / LOCATIONS / ELECTRICAL CONTRACTOR PERMIT #EL13 -1721 CERTIFICATE HOLDER CITY OF MIAMI SHORES BUILDING DEPARTMENT 10050 NE2ND AVE MIAMI SHORES VILLAGE,FL33138 XICY ATEiMMND/YY1 DAOTE MEN DIp m NI LIMITS IGENT AGGREGATE LIMIT APPLIES PER: © POLICY ❑ PROJECT ❑ LOC 07/29/13 07/29/14 AUTOMOBILE LIABILITY 100,000 ❑ ANY AUTO 5,000.00 ❑ ALL OWNED AUTOS I ❑ LJ SCHEDULEDAUTOS ❑ HIRED AUTOS Ij NON OWNED AUTOS PRODUCTS - COMP /OP AGG 1,000,000.00 GARAGE LIABILITY ❑ ❑ ANY AUTO EXCESS/UMBRELLA LIABILITY ❑ ❑ OCCUR L CLAIMS MADE ❑ DEDUCTIBLE ❑ RETENTION $ EMPLOYERS LIABILITY ~�y ANY PROPRIETOR/ PARTNER/ EXECUTIVE OFFICER / MEMBER EXCLUDED? If yes, describe under L SPECIAL PROVISIONS below OTHER �- I � DESCRIPTION OF OPERATIONS / LOCATIONS / ELECTRICAL CONTRACTOR PERMIT #EL13 -1721 CERTIFICATE HOLDER CITY OF MIAMI SHORES BUILDING DEPARTMENT 10050 NE2ND AVE MIAMI SHORES VILLAGE,FL33138 XICY ATEiMMND/YY1 DAOTE MEN DIp m NI LIMITS EACH OCCURRENCE 1,000,000.00 07/29/13 07/29/14 rEMICETOREr nce 100,000 MED EXP (Any one person) 5,000.00 — PERSONAL &ADV INJURY 1,000,000.00 GENERAL AGGREGATE 1,000,000.00 Ij — — PRODUCTS - COMP /OP AGG 1,000,000.00 COMBINED SINGLE LIMIT j Ea accdent) BODILY INJURY II ' (Per person) BODILY INJURY —) (Per accident) PROPERTY DAMAGE --_IJ —. Per accident) AUTO ONLY - EA ACCIDENT OTHER THAN EAACC — AUTO ONLY: AGG EACH OCCURRENCE AGGREGATE E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE E.L. DISEASE - POLICY LIMIT I EXCLUSIONS ADDED SY / SPECIAL CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTA ROBERTO OJEDA U Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 August 5, 2013 Permit No: EL13 -1721 ELECTRICAL REVIEWER COMMENTS 1. Need riser diagram, panel schedule and load calculation, N. E. C. 220.56. Plan review is not complete, when all items above are corrected, we will do a complete plan review. 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