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DEMO-12-21Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL ll -214Z Phone: (305)795 -2204 Fax: (305)756 -8972 OE wNo r 11- 214, Inspection Number: INSP- 168484 Permit Number: DEMO- 1 -12 -21 Scheduled Inspection Date: July 16, 2012 Permit Type: Demolition Inspector: Devaney, Michael Inspection Type: Final Owner: SFARA, VERONIQUE Work Classification: Electric Job Address: 1080 NE 105 Street Miami Shores, FL 33138- Phone Number (305)799 -2006 Parcel Number 1122320280090 Project: <NONE> Contractor: MR1 CORPORATION Phone: 305 - 261 -6000 comments DEMOLITION OF SOME ELECTRICAL TO RECEIVE NEW REMODEL & ADDITION Inspector Comme Passed Failed Correction ❑ Needed Re- Inspection ❑ Fee No Additional Inspections can be scheduled until re- inspection fee is paid. July 16, 2012 For Inspections please call: (305)762 -4949 Page 2 of 35 01 17 12 02:24p MR1 Corporation 3052614048 P.1 -A CERTIFICATE OF LIABILITY INSURANCE DATE (MMDD�) 01/0612012 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), AUT}10RIZED REPRESENTATIVE OR PRODUCER AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(es) must be endorsed. W SUBROGATION IS WANED. subject to the terms and conditions of the policy, Certain policies may requre an endorsement. A statement on this certfficate does not confer rkj is to the certificate holder in lieu of such endorsement(s). PRODUCER WELLS FARGO INS. SERY. USA-CH, 14C 6100 FAIRVIEW ROAD, SUPTE 800 PO BOX 220748 CHARLOTTE, NC 2=2 co Ct PHDNE e imss INSURERS) AFFORDING COVERAGE Nato P iNsuRERA: HARTFORD FIRE INSURANCE COMPA 0=RM 3348 STRATEGIC OUTSOURCING, INC. PO BOX 241448 CHARLOTTE, NC 28224 INSURER B: INSURER C: FAC H OCCURRENCE INSLIREit o: AAIG NrED INSURER E: MED EUCP (Anyone peman) INSURER F• PERSONA!. B ADV INJURY COVERAGES 11E12711FiCATE NUMRFR^ A9 ARA REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSL)D TO THE INSURED NAMED AsUVE FOR THE POLICY FERiop INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED SY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERNS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIAdTS SHOWN MAY HAVE BEEN REDUCED BY PAD CLAIMS, MR TYPE OF INSURANCE I D' POLICY NUMBER PO PO EXP Loam GENERAL LIAMLITY COMMERCIALGENERALLIABILITY CLAINIS MADB [:] O=LJR FAC H OCCURRENCE S AAIG NrED g MED EUCP (Anyone peman) $ PERSONA!. B ADV INJURY S GENERAL AGGREGATE $ GERLAGGREGAU LIMIT APPLIE$ Ilk POLICY LOC PRODUCTS- COMFJOPAGG S $ AUTOMOBR.E LIASILITY ANY AUTO ALL ULED HIREDAUTCS NA�� D 1342841 hPR - SINGLE LIMIT 8 BOMY INJURY (Per person) S BODILY INJURY (Per aaidwt) $ PROPERTVDAMAGE $ S UMBRELLA LIAR EXCESS LUM OCCUR CLAIMS MADE EACH OCCURRENCE S AGGREGATE S OED I I RETENTION S $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY WN ANY PROPRIETI OMPARTHERUEXECUTIVE 0 QFFI E MEQ EXCLUDED? g Ye9 a ,,.or DESCRIPTION OF OPERATIONS beko f1UA 22WBRJ79226 03/01/2011 03101 /2012 X wD TL- OTH E.L. EACH ACCIDENT S 1,000,000 E L. DISEASE - EA EMPLOYEES 1,000,000 E.L. DISEASE - POLICY LIMIT S 1,000,100 DESCRIPTION OF OPERATiONSILOCATIONSArSIMLES (Attach ACORD 101, Additional Remarks Schedule. If mare space Is required) LIMITED TO EMPLOYEES LEASED TO MR1 CORPORATION BY STRATEGIC OUTSOURCING, INC. FAX 3DS- 261 -6674 CFRT1FICATE 44nLINPR r:AMr:Ft t ATInM rwtifirata In 42.939 CITY OF MIAMI SHORES VILLAGE 10050 NE 2ND AVENUE woULD ARY OF THa ABOVE ItIESCR76E0 POLICIES HE CANCELLED BEFME THE OWumnom DATE THEIMCF, NOTICE anLL BE DELIVENO tN MIAM I SHORES, FL 33138 AC COFMANC E W"H THE POLICY Wig ISIGII . AUTHORIZED REPRESENTATIVE �+ rd 1OW2010 ACORD CORPORATION. AB rights reserved, ACORD 25 (x010105) The ACORD name and logo are registered marks of ACORD 01 17 12 02:24p MR1 Corporation 3052614048 p.2 DarEL/06/12 ,V�-+_ CERTIFICATE OF LUd1BELITY INSURANCE �o YC oijos 1a THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE KOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATMELY AMEND, EX I ND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CON5111 Ul A CONTRACT BETWEEN THE ISSUING INSURMSj. AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. olden IS at AUMNAL WSURED, the Aoncy m be en e the terms and condiffma of the poltCy. eeEtela polleBos may requim an endomenunt. A sidemlt on Ods cer6dieato does not confer ligW to 91e cent Nome holder In lieu of such ntm=!M—) PROnUCER BROWN 6 wwWX OF YLORIDA INC 14900 = 79th Cowrt Suite #200 Miem3 Lakes FL 33016 -5869 Phone:305- 364 -7800 Fax:305 -714 -4401 MAIM: fAWL Nk Vxg; lvo ADnRESo: �me 14Zi3.CO -1 UMPERMAFF0Ra1Q aAICa °N 12CS1K- 71tti giaaeet, Suit" 201 Miami FL 3314 INSI/RFBLA: r=x insurance 10178 IN:NIRExe: 09101/121 : LNSURM C : 61 000 1000 INSURER D S 100 000 MUSM E : $5,000 W9UMM F : 81,000 000 LA"tmaUts GERTIFICATE NUMBER: REVISION NUMBER: TDcmTIFYTHA FOL OFI LISTED BMW HAVE IIEE14 ISSUED VO THE REMKAMED OMW FOR TH POLICY INDICATM. NOTWIiHSTANDIW 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 SIIBJECr TO ALLTHE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POIJCIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAMS. L Two OF OISUR41=6 #WJM OLSR WOK ywy POLICY NUMBER Lam A GFaItS uALNLCEY R COMIiIIERCLOIL GENERAL &JA51UTY ]OCCR GAMS MAM FX C3?P0005309 09/01/11 09101/121 : EACH OCCIiRRENCE 61 000 1000 PREMSM ooumne S 100 000 $5,000 PUISO"&ADVINJURY 81,000 000 GENERAL.AGGREGATE S2 000,000 GERLAGGREGATEiIWrAMUESPER x PM= I LOC PRODUCTS -comp DPAGG s2,000,000 $ �► AUTOMOBILE LJgaIEJTY ANYAU ALLOWNEDAUTOS $ SCHED _, LIIJ =D AU705 X HIREDAUrC3 $ I CILD006320 09/01/2 CQI"4E0 M%E Dtdlr tEea -Went SODLYINJUITYIPerpemnj s 300,000 S BCOAY tK TRY (Pw ddent) $ (tPP - S Is $ Ummu" LIA9 EXCESSLIM OCCUR HCLAIMS4&VXE; EACH OC NCE i $ AGGREGATE: Is raerr CT n, e RETENTION S S S we "win SA= ANO91MOYGRS'LIJUMMY YIN ANY PRO hN3M X eXC L ANY PRO RbrCLUDW? (�yea, In IPTIDNOFOPERATIONSbelpw IA TOI�If EL. EAt lAGO10ENT S F..l_ 01SEASE- EA EMPLO 5 EL BISEASE- POLICYI.WT $ D®CR>f Tt�l OF OPINIATIM I WCJITR> I VEMCLES p4tadr ACOIM 11" Adelitf l Rwurl®SWeduW g more space le CERTIFICATE HOLDER Miami Shores Village Building Department 10050 HE 211d, Ave Miami Shores FL 33138 SUCK"AWOFTHEABOW DIESCRISED POLICIES BE CANCELLED BEFORE THE E KPIRATION DATE TIMREOF, HOTICS WILL. BE DELIVERED IN ACCOFMANCEWIM T1A: POLICY PROVISIONS ACORD 25 (2009109} The ACORD name and logo are registered marks of 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 20 Permit Type: Electrical OWNER: Name (Fee Simple Tid Address: 10 9 Cl W F- a JAN D 5 iU sL t -------------- Permit P Master Permit I L)6 `1� 9 City: A 1 State: P Le 9� \ a Zip: Tenant/lessee Name: Phone#:_ Email: V, 1 P_ S t'1r,0L ci C,_ eo I ncl-L . 60 fry JOB ADDRESS :Q City: M 19S M iami Shores County: Miami Dade Zip: Folio/Parcelt Is the Building Historically Designated: Yes CONTRACTOR: Company Name: Address: � Gr ) City: Qualifier Name: NO Flood Zone: '? ?6- d'YZ - V ?aZ i State Certification or egistration ` Certificate of Competency #: Contact Phone#: Email Address: rnx* 6' /7,41 a. Z-4 DESIGNER: Architect/Engineer: Phone#: Value of Work for this Permit: $ Square/Linear Footage of Work: Type of Work: ❑Address ❑Alteration ❑New ❑Repair/Replace ❑Demolition Description of Work: Submittal Fee $ Permit Fee $ /& � ,e5Re,> CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ d 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 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 RECORDINGNOUR NOTICE OF COMMENCEMENT:''' Notice to Applicant. As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not b� approved and a reinspection fee will be charged Signature Signature Owner-or Agent - Contractor ' The foregoing instrument was acknowledged before me this The foregoing instrument was acknowled ed before me this day of J otn , 20 l2 , by �'Q/�N , (7uQ~ S . day of , �Q 62LbY. , who is personally known to me or who has produced 1 who is personal] own to me or who has produced As identification and who did take an oath. as identification and who did take an oath. NOTARY •PUBLIC: NOTARY PUBLIC: Sign: �^ EMWSAWHEZ Print: U A.S sk 'g " Notary Public State of Florida t: f- My Commission Expires: 1111(Qf 0 My Commies DD940681 Expires 11 /1812013 Expires, QZ� /3 %2lYcS^ APPROVED BY Plans Examiner Zoning Structural Review (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) Clerk f ,QQ � ',s��' @ #�.�$..� §fi,��* -`�. �: ��G„ T�'tat�5�&�ts ^.fl�;NYeaca.��i7.. �,�a 1 l .� a