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EL-13-116Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 202103 Scheduled Inspection Date: November 05, 2013 Inspector: Devaney, Michael Owner: PETERSON, DIRK & ELIZABETH Job Address: 1350 NE 101 Street Miami Shores, FL Project: <NONE> Permit Number: EL -1 -13 -116 Permit Type: Electrical - Residential Inspection Type: Final Work Classification: Addition /Alteration Phone Number Parcel Number 1132050230020 Contractor: SOUTH DOM ELECTRIC INC Phone: (305)626 -5904 Building Department Comments ELECTRICAL WORK FOR ADDITION AND INTERIOR Infractio Passed comments REMODEL I INSPECTOR COMMENTS False Passed Failed Correction Needed Re- Inspection Fee nE Inspector Comments CREATED AS REINSPECTION FOR INSP - 184526. Not ready � c D r` No Additional Inspections can be scheduled until re- inspection fee is paid. 7f November 04, 2013 For Inspections please call: (305)762 -4949 Page 21 of 40 BUILDING PERMIT APPLICATION Permit Type: Electrical JOB ADDRESS: 1350 N. E. 101 STREET Permit No. E 1 ✓ + 11 Master Permit No. 12 -1984 City: Miami Shores County: Miami Dade gip. 33138 Folio/Parcelk 11- 3205 - 023 -0020 Is the Building Historically Designated: Yes NO X Flood Zone: VE11 & AE9 OWNER: Name (Fee Simple Titleholder): DIRK PETERSON & ELIZABETH PETERSON phone#: e,4A —.. -1350 N.E. 101 STREET City: MIAMI SHORES State: FLORIDA gip: 33138 Tenant/Lessee Name: Phone #: Email: CONTRACTOR: Company Name: SOUTH DOM ELECTRIC, INC. Phone#: 305 - 335 -9124 Address: 5860 N.W. 192 STREET City: MIAMI State: FLORIDA Zip: 33015 Qualifier Name: Jose Del Carmen Matos Phone#: 305- 335 -9124 State Certification or Registration #: Certificate of Competency #: Contact Phone#: 305 - 335 -9124 Email Address: DESIGNER: Architect/Engineer: A &I Associates Phone Value of Work for this Permit: $ Square/Linear Footage of Work: Type of Work: ❑Address OAlteration ONew ORepair/Replace Description of Work: Relocating existing fixtures 04E000560 305 - 310 -5030 ODemolition Submittal Fee $ Permit Fee $ �°` �'P�� CCF $ CO /CC $ Scanning Fee $ Radon Fee $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ DBPR $ Bond $ Technology Fee $ TOTAL FEE NOW DUE $ ;S I - 00 Bonding Company's Name (if applicable) N/A Bonding Company's Address City State Mortgage Lender's Name (if applicable) N/A 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 be approved and a reinspection fee will be charged. Signatur Owner or Agent The foregoing instrument was acknowledged before me this 5th day of August , 20 L, by Elizabeth Peterson Signature Contractor The foregoing instrument was acknowledged before me this 5th day of August , 2013 , by Jose Del Carmen Matos , 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. NOTARY PUBLIC: Sign. Print: O ga L. Cruz My Commission Expires: APPROVED BY OLOA L CRUZ MY COMMISSION # FF 028437 EXPIRES: September, 2017 BondW Tfw try Pub1b Umlewftm Plans Examiner Structural Review (Revised 3 /12/2012)(Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) as identification and who did take an oath. NOTARY PUBLIC: Sign: g. x ! � �� Print: ga L. Cruz OLOA L CRUZ My Commission Expires: pqy COIUIMISSION NIXON*` PIRES: September 23,2D1 7 '�;g ;y Bonded Thru NWmy Pubb Urdenwtm OR Zoning Clerk 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 Permit Type: Electrical JOB ADDRESS: 1350 N.E. 101 STREET FBC 20 c d - AN 2 Permit No. l Master permit No. 12 -1984 City: Miami Shores County: Miami Dade Zip: 33138 Folio/Parcel#. 11- 3205 -023 -0020 Is the Building Historically Designated: Yes NO X Flood Zone: VE11 & AE9 OWNER: Name (Fee Simple Titleholder): DIRK PETERSON & ELIZABETH PETERSON phone#. AAA, .- 1350 N.E. 101 STREET City: MIAMI SHORES State: FLORIDA Zip: 33138 Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: SOUTH DOM ELECTRIC, INC. Phone#: 305 - 335 -9124 Address: 5860 N.W. 192 STREET City: MIAMI State: FLORIDA Zip: 33015 Qualifier Name: Jose Del Carmen Matos Phone#: 305 -335 -9124 State Certification or Registration #: Certificate of Competency #: 04E000560 Contact Phone#: 305 - 335 -9124 Email Address: DESIGNER: Architect/Engineer: A &I Associates Phone#: Value of Work for this Permit: $ l �/ als• 1 A 1 Square/Linear Footage of Work: Type of Work: OAddress OAlteration ONew ORepair/Replace Description of Work: 305 -310 -5030 Submittal Fee $ Permit Fee $ �ed' oOra? CCF $ CO /CC $ Scanning Fee $ Radon Fee $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ DBPR $ Bond $ Technology Fee $ TOTAL FEE NOW DUE $ 1 ODemolition Bonding Company's Name (if applicable) N/A Bonding Company's Address City State Mortgage Lender's Name (if applicable) N/A 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 $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature � G Signature Owner or Agent \ J Contractor The foregoing instrument was acknowledged before me this 18th The foregoing instrument was acknowledged before me this " day of January , 20 by Elizabeth Peterson day of January , 20 by Jose Del Carmen Matos , who is personally known to me or who has produced who is personally known to me or who has produced As identification and who did take an oath. as identification and who did take an oath. NOTARY PUBLIC: Sign: OX-A- Print: ga L. Cruz My Commission Expires: APPROVED BY NOTARY PUBLIC: OLGA L. CRUZ Sign: u c- Sta to of or a 1._Exuires Set) 23.2013 Print: Commission # DO 894805 My Commission Bonded Through National Notary Assn. Structural Review (Revised 3 /12/2012)(Revised 07 /10/07)(Revised 06(10/2009)(Revised 3/15/09) Notary Public - State of Florida My Comm. Expires Sep 23, 2013 Commission # DO 894805 Bonded Through National Notary Assn. Clerk Apr 091311:22a Capital General Cont 305- 827 -6411 p.1 A CERTIFICATE OF LBABILITY INSURANCE TUF THIS CE4TIRCATE IS 1S&M ASA MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTWICATE HOLML THIS CERTIFICATE DOES NOTAFFIRMATIYE.Y OR NEGATWELYAMEND, E=XTEND OR ALTERTHE COVERAOEAFFOMXD 13Y7MPOLIMES = BELOW. Tit$ GERTH40AI MOFHOURANCEDOES Nor CONSiiTUTEAOMTRACT BETWEEN THE JWWNOIIVSUROgS).AtU7HORMED REPRESENTATIVE OR PRODUCER, AND THE CEIt I CATEHOLDER NPORTANT: lf% ecettlttcalzhiddertsamADDRIONALI = MW, the policy(Fes)mmst0eesdarsrd. d'w8R0QATICI1i91wVED.sUbjedt0 the t1el7R6 a tt� candtUoas 0f the purity, senaln Aonges may > im an �ldorssment A st Miment on Oft comeaw does =confer rights to the coMiloate holder In Beu or sue* eadcpgmMt4W. World Inswance ftency tw doseAlFanso Ulu iSOOD MIN 87Ave Unit 113 s nt MM Miami Lakes FL33MS 6SWRALUAINLPY COMUMMMOSMERALUAbluTy C C Olt rrt;t5 aeaDE �/ OLCUR ❑ WW1. 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E. 2nd Avenue Miami Shores, Florida 33138 ACGRID 2s immaso Cam' SHOULDARYOFT:i£MOVE DESCRIED POUGM BE CANCELLED BEFORE T}IQ EXPI"TtON OATH THEREO F, NOTtCL WILL HE DEUVMtW W ACCORDANCE WIF H 17HE POLICY PROV[SIOt1,'L AuntOMM aGPl rrA'nW8 Jose Alfonso 0INS -2009 ACORD CORPQRATION All rigbbs nesenraL Tha ACORD manta and Ingomw tegisbmd marks OPACORD