EL-12-0660Inspection Worksheet n 144— ��
Miami Shores Village � �
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number -INSP- 205050 Permit Number: EL -4 -12 -660
Scheduled Inspection Date: December 30, 2013 Permit Type: Electrical - Residential
Inspector: Devaney, Michael
Inspection Type: Final
Owner: DEVINE, MICHAEL & CLAUDIA
Job Address: 54 NE 102 Street
Miami Shores, FL 33138-
Project: <NONE>
Contractor: MESA BROTHERS INC
LKe1 it] uL�h l�-J
ELECTRICAL WORK GARAGE CONVERSION
as per approval, ok to eaten permit 6 months.
Work Classification: Addition /Alteration
Phone Number 305 - 759 -4883
Parcel Number 1132060131470
INSPECTOR COMMENTS False
Phone: (305)345 -1974
Inspector Comments
Passed CREATED AS REINSPECTION FOR INSP- 172393. Add 2 small appliance
receptacles to kitchen counter, and arc fault breakers.
Failed
Correction ❑
Needed
Re- Inspection ❑
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
December 27, 2013 For Inspections please call: (305)762 -4949 Page 18 of 28
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
BUILDING
PERMIT APPLICATION
FBC 2010
Permit True: Electrical
�gC�gII�%l�rI��I
APR 13 2011 �U
B Y:.aeee____._
Permit No. t
Master Permit No. EA 1z I L!("
OWNER: Name (Fee imp e i eholder): Phone#:i� -C3'�
Address: Y C--) e� � e
City: �ACXA:�1!5�nn ftf� State: �l Zip:
d'
Tenant/Lessee Name: Phone#:
Email:
JOB ADDRESS:�1�
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel #:
Is the Building Historically Designated: Yes
CONTRACTOR: Company Name:
Address:
City:
i -e� -- /0 0 L"� ,
NO 1,/ Flood Zone:
w
tv e. ,
f
/� ;,--d- *-4, ;
Qualifier Name: 1/ C 2 C4— Phone #: ��� /��' /;0'
75�
State Certification or Registration Certificate of Competency #: --fT— f AO,- 1 .970
Contact Phone #:.3 0 !�° � 1 Email Address:
DESIGNER: Architect/Engineer: Phone#:
Value of Work for this Permit: $ t ®00 a Square/Linear Footage of Work:
ss Alteration New ORepair/Replace ODemolition
I?e iptcawof.. k• �t C i ✓e Ba
Submittal Fee $ Permit Fee $ CCF $
Scanning Fee $ Radon Fee $
Notary $ Training/Education Fee $
CO /CC $
DBPR $ Bond $
Technology Fee $
Double Fee $ Structural Review $
TOTAL FEE NOW DUE $ •
Bonding Company's Name (if applicable)
Bonding Company's Address
City
State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
city
State
Zip
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 t ns� ce of such posted notice, the
inspection wN kt be approved and a reinspection fee will be charged. --, ` •�
Signature,- K �, � �), i Signature ��� ;
Owner or Agent Contractor
The for --Instrument was a Me his 0 The foregoing instrument was acknowledged before me thiS� //��
day of , 20 Jby e i day of Wt , 20� —by ,
is p4rsonally �nowp to me or who has produced who is per nall known me or who has produced
'entification and who did take an oath. as identification and who did take an oath.
NOT
Sign:
Print:
My
APPROVED BY
_V0
otiacy ��
Expires: PJei
pn w
(Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09)
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Plans Examiner
NOTARY PUBLIC:
Sign:
Print:
My
Nd" �eva rbav 9, 2014
..
m7 w,,,....-- DD 9511
commission Nst
gsnded through Nazi W
Zoning
Structural Review Clerk
DATE BATCH NUPJi6ER
--7-8
CERTIFICATE OF LIABILITY INSURANCE oPID arc I "°D^'''''"'
12/19/11
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, N e holder Is an the po es must en o
the terms and conditions of the policy, csrtaln policies may require an endorsement. A statement on this ceRtNcate does
not confer rights to the
certificate holder in lieu of such endorsement(s).
PRODUCER
UMITS
BROWN 61 BROWN OS FLORIDA INC
Arc No arc No
14900 NW 79th Court Suite #200
aD ss:
Miami Lakes FL 33016 -5869
CUSTOMERIDB MESAS -1
Phone:305- 364 -7800 Pax:305- 714 -4401
� �� COVERAGE
NAILS
INSURED
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10178
INSURERS:
$10000,000
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INSURER C:
cENEMAOGREGATE
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OEN9. AGGREGATE LIMIT APPLIES PER:
$ POLICY JECT LOO
INSURER 0:
$2,000,000
INSURER 6:
COVERAdE3 f'CDT7CIf►wTe w Illaerr�.
INSURER F :
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THIS ( ( U i N PO LICY INDICATED. NOTWITHSTANDING ANY REt�UiREMFJNT, 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.
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TYPE OF INSURANCE
KSR
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POUCY NUMBER
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GENERAL LIABILITY
$ coMCLAIMS -MADS RaLLUaSiCU
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GL00031918
12/18/1112/19/12
EACH OCCURRENCE
&1,0 0 000
PREMISES Me
$100F000
MED EXP (My one perwn)
s3,000
PERSONAL &AOVINJURY
$10000,000
cENEMAOGREGATE
$2,000,000
OEN9. AGGREGATE LIMIT APPLIES PER:
$ POLICY JECT LOO
PRODUCT$ - COMP/OP AGO
$2,000,000
$
ALIT )UMLE LIABILITY
ANY AUrO
ALL OWNED AUTOS
SCHEDULED AUTOS
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COMBINED SINGLE LIMIT
(Fe aeddard)
$
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(PersoddeM)
$
$
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DESCRUMON OF OPERATIONS f LocATIONS I VBHICLBS (Attach ACORD tot, Additional Remarks schedule, It more space is reftM
CERTIFICATE HOLDER ....._....._._.-
City Of Miami Shores
10050 N.E. 2Nd Ave
Miami. Shores FL 33138
Vr11wGL6Fi 1 IVIY
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
ACORD 25 (2009109) The ACORD name and logo are registered marks of
r EO TI BATE OF LIABILITY INSURA CE �A�tM Y>m
THIS GERTIFICATE IS ISSUED AB A MATTER OP INFORMATION ONLY AND CONFERS NO RCGHTS t PON THE CERTIFICATE HQLOEIL THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE 004EIiAGE 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. _
IMPQRTANT. It the cerltltaale holder is an ADPIT10NAL tNSURED,'thO Pallcy(lee) must is endorsed. l ` SUBROG4ATION i WAIVED, subject to
ow teems and oonditlane of the Polley, Certain Policies may require an endorsement. A statement . an this eeRihcate does not oonter rights to the
cerURCate holder In Ileu of such endorsement(s),
PROMIR $unz Insurance Company CONYACT NAMR, ' ---
PO Box 1777 MoNe W,*RJ4
St Petersburg, FL 33731 "AIL ADDREM
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=CRIPTION OF CPE"7(oNs r LOCATMS IYEMOLE'S tAeeeh ACORD tM,Addldonel Remem wodete, R Moro space 19 rag0iredl '—
Coverege__pprroovided for all teased employees but not subcontractors of. Mesa Brolhels Inc
Location ElTeoliv8:11112011
Miami shores Mime
1060 NE 2nd Ave V456
Miami FL 33136
SHOULD MY OF THdABOVat 098C'IIBt:D POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE I HEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLCY PROVISIONS.
RUTHOR"D It Itsserrrnrtvs
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t) 1088.2010 AC." RD CORPORATION. All rights reserved.
ACORD B8 j2010105) The ACORD name and logo are registered marks of ACORLI
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