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EL-14-121Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 206876 Scheduled Inspection Date: February 10, 2014 Inspector: Devaney, Michael Owner: BALZANO, JAMES Job Address: 9043 PARK Drive Miami Shores, FL Project: <NONE> Contractor: MOODY ELECTRIC INC DUIIUI11 LJUPOF 1MML %,UFF1111G11LS Permit Number: EL -1 -14 -121 Permit Type: Electrical - Residential Inspection Type: Final Work Classification: Alteration Phone Number Parcel Number 305/757 -9781 1132060460220 Phone: (305)758 -2000 CHANGE OUT BURNT UP 200 AMP SINGLE PHASE Infractio Passed Comments PANEL REUSE EXISTING METER & GROUNDING I INSPECTOR COMMENTS False Inspector Comments Passed e; �r K Failed Correction ❑ Needed Re- Inspection ❑ Fee No Additional Inspections can be scheduled until re- inspection fee is paid. February 07, 2014 For Inspections please call: (305)762 -4949 Page 39 of 44 Miami Shores Village IBuilding 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 FB C 20 SAN 2 Permit No. CL i — � 21 Master Permit No. Permit Type: Electrical OWNER: Name (Fee Simple Titleholder): \c�`�/ (/` �� (044hone#: 5105 � Q Address: 446_�q DD Q City: State: L CnC Oe..% 9 Zip: �U Tenant/Lessee Name: - , "�' Phone #: Email: Value of Work for this Permit: $ c ;�0, ©© Square/Linear Footage of Work: Type of Work: ❑Address ❑Alteration ❑New pair/Replace ❑Demolition Description of Work: Submittal Fee $ Permit Fee $ /S . eU CCF $ Scanning Fee $ Radon Fee $ DBPR $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ Technology Fee $ CO /CC $ Bond $ TOTAL FEE NOW DUE $ JOB ADDRESS: �� / 4,,-: �aL� ,�) P City: Miami Shores County: Miami Dade Zip: Folio/Parcel #: Is the Building Historically Designated: Yes NO �� Flood Zone: CONTRACTOR: Cpmpsny Name: /,/uG Phone #: 5e !!5� aO00 Address: City: � /S State: /—Z14 Zip: % SO Qualifier Name: 7o `/ p A-A) �— X+Jp�/t/% Phone #: 50 5 7f 579 90�90 State Certification or Registration #: �CeJOO Certificate of Competency #: Contact Phone #: Email A dress: V / o A A) 69 �f�l's�1 ��G� 1 d14 DESIGNER: Architect/Engineer: Phone #: Value of Work for this Permit: $ c ;�0, ©© Square/Linear Footage of Work: Type of Work: ❑Address ❑Alteration ❑New pair/Replace ❑Demolition Description of Work: Submittal Fee $ Permit Fee $ /S . eU CCF $ Scanning Fee $ Radon Fee $ DBPR $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ Technology Fee $ CO /CC $ Bond $ 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 the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature Owner or Agent The forcloing strument was acknowledged before me this day of 20 L L, by 6h h r Il lm who is rsonally known to me or who has produced Co actor The foregoiog instrument was acknowledged before m t is� day of 20by o% who is pereally kn own 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: M Print: NOTARY PUBLIC: Sign: Print: ? °. eL +: fv1Y COMMISSION # DD 979267 MY COMMISSION # DD 979267 My Commission Expires: _ d "= 1. :a EXPIRES: May 11, 2014 My Commission Ex i's.4- EXPIRES: May 11, 2014 ! Bonded Th. Notary Public Underwriters �o Bonded Thru Notary Public Underwriters APPROVED B � �%/f Plans Examiner Zoning Structural Review (Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09) Clerk Jan, 7. 2014 11.56AM No.5905DY -1 P' 1 OP ID:TH CERTIFICATE OF LIABILITY INSURANCE 12/30//2013 2013Y) 1 D 12(MM THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 1401 -DER, 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 policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain pollcles may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsements). PRODUCER Workers Compensation Group P O Box 410 Boca Raton, FL 33429 -0410 ureGrowth CO TACT NAME: PNONE .561 - 3923300 FAX No): 561 -361 -1132 E-MAIL Ass s6: cents workersconT u ro .com INSURERS AFFORDING COVERAGE NAIC B LIMITS INSURrRA:l3rid afield Employers Ins 10709 LIABILITY INSURED Moody Electric, Inc 669 Northwest 90th Street INSURER B; Miami, FL 33150 INSURER C: INSURER D : INBURER E INBURER F EACH OCCURRENCE $ 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 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. INSR LTR TYRE OF INSURANCE AD13L SU13 WVrJ POLICY NUMBER POLICY EFF M DDlYYYY POLICY EXP MM /DD/YVl'Y LIMITS AUTHORIZED REPRESENTATIVE GENERAL LIABILITY EACH OCCURRENCE $ $ COMMERCIAL GENERAL LIABILITY MEDEXP Anyone person)ffi CLAIMS -MAnE a OCCUR PERSONAL 8 ADV INJURY $ GENERAL AGGREGATE $ GENT. AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMNOP AGG $ POLICY PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT BODILY INJURY (Per person) $ SCHEDULED AUTOS BODILY INJURY (Per accfcent) $ ANOT -OWNED PROPER DAMAGE $ $ MENTION$ B OCCUR EACH OCCURRENCE AGG REGATE CLAIMS -MADE TENTION $ $ WORKERS COMPENSATION AND X WC STATU- OTH- EMPLOYERS' LIABILITY Y!" E_L. EACH ACCIDENT $ 1,000,00 A ANY PROPRIETOR/PARTNERlEXECUTIVE OFFICERIMEMBEREXCLUDED? MIA 830 -28873 0110112014 01/01/2015 E.L. DISEA8E - EA EMPLOYEE $ 1,000 000 (Mandatory in NH) I(yea desoribeunder U9.3 DESL�RIPTION OF OFERATION8 below E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS ! LOCATIONS! VEHICLES (Attach ACORD 101, Additional Remarke Schedule, if more space is required) 8/27/07- increase EL Limits to $500,000/$500,000 /$500,000 WJ laua -LU'IU AGUKU GUKI'UKAI ION. All rights reserved. ACORD 26 (2010105) The ACORD name and logo are registered marks of ACORD MIAMIS3 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES HE CANCELLED BEFORE Village of Miami Shores THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 10050 NE 2nd Ave. ACCORDANCE WITH THE POLICY PROVISIONS. Miami Shores, FL 33138 AUTHORIZED REPRESENTATIVE WJ laua -LU'IU AGUKU GUKI'UKAI ION. All rights reserved. ACORD 26 (2010105) The ACORD name and logo are registered marks of ACORD Jan 02 14 11:21a Moody Electric Inc 305- 754 -1333 P.1 AC 0" MOODELE -01 CLAUDIA CERTIFICATE OF LIABILITY INSURANCE DATE(MM /DD/YYYY) _ q /2013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER, IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT InSOurce, Inc, NAME: 9500 South Dadeland Boulevard PHONE 4th Floor Arc No, Ext : ( 305 ) 670-61115353 A Nb : 305) 670 -9699 Miami, FL 33156 -2867 E-MAIL ADDRESS: INSURED Moody Electric, Inc. Mr. John Moody 669 NW 90 street Miami, FL 33150 rnJUKthyS) AFFORDING COVERAGE A: FCCI Insurance Company B :FCCI Commercial Ins. Co. C: D: E: 10178 COVERAGE$ rw�ncrc r CERTIFICATE NUMBER: REVISION NUMBER: 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 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. V YPE OF INSURANCE POLICY EFF POLICY EXP BILITY POLICY NUMBER MM /DD/YYYY M /DDlYYYY LIMITS CIAL GENERAL LIABFLII Y CPP00056949 EACH OCCURRENCE $ 1,000,01 � 12/31/2093 12/31/2014 PREMISES Ea occurrence $ 100,01 MS MADE I ' 1 OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY X PRO- n LOC GT AUTOMOBILr LIABILITY B X ANY AUTO ALL OWNED AUTOS X HIRED AUTOS X UMBRELLA UAB $ EXCESS LIAR MED EXP (Any one person) $ 5, PERSONAL & q IV INJURY $ 1,000, GENERAL AGGREGATE $ 2,000, PRODUCTS - COMP /OP AGO $ 2,000, COMBINED S (Ea acciderAl NGLE LIM a 1.000.1 v 11 yy 12/31/2013112/31/2014 *PROPE INJURY (Per person) $ SCHEDULED AUTOS NON-OWNED INJURY (Per accident) $ AUTOS TY AMAGE dentl ( I OCCUR I $ DrD I Jl I RETENTION $ 10,000 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN OFFICER /MEMBER EXCLUDED? ❑ N/A (Mal tdatory in NH) If Yes, describe Under EACH OCCURRENCE I $ 1213112013 12131/2014 gGGREGATE $ DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORO 101, Additional Remarks Schedule, if more space Is required) TE E.L. EACH ACCIDENT $ EL DISEASE -EA EMPLOYE $ E.L. DISEASE - POLICY LIMIT $ SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Village of Miami Shores THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 10050 NE 2nd. Avenue ACCORDANCE WITH THE POLICY PROVISIONS. Miami Shores, FL 33138 AUTHORIZED REPRESENTATIVE ACORD 26 (2010/06) © 1988 -2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD