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DEMO-14-444Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756.8972 Inspection Number: INSP- 208571 Scheduled Inspection Date: April 16, 2014 Inspector: Devaney, Michael Owner: FREDERIC PUREN, FREDERIC PUREN Job Address: 9179 N BAYSHORE Drive Miami Shores, FL 33138- Project: <NONE> Contractor: METRO ELECTRIC SERVICE, INC tiunaing vepartment comments DEMOLITION FOR ELECTRICAL Permit Number: DEMO -3- 14-444 Permit Type: Demolition Inspection Type: Final Work Classification: Electric Phone Number Parcel Number INSPECTOR COMMENTS False Inspector Comments Passed EJ_ Failed Correction pA, Needed ❑ Re- Inspection ❑ Fee No Additional Inspections can be scheduled until re- inspection fee is paid. 1132050270600 April 15, 2014 For Inspections please call: (305)762.4949 Page 13 of 32 Q 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: �- I I I',j 1'I ° City: Miami Shores Folio/Parcel #: Is the Building Historically Designated: Yes OWNER: Name (Fee Simple City: Tenant/Ussee Name: Email: CONTRACTOR: Company Name: Address: J Ak City: %V " A ICJ i"'O N Qualifier Name: 1_jM%1i` M VVkA State Certification or Registratign #: E Contact Phone#: 3 0 q Lt T�q_ 0 FBC 20 Permit No. ) e.mr1 1, Master Permit NoQe_.( � County: Miami Dade Zip: 30 NO Y_ Flood Zone: ;it' I- ' Address: ' ,iu 1r, C, �� ( Phone� L Phones Certificate of Competency #: �jOr0- .9,krZ_ DESIGNER: Architect/Engineer: Phonek .WA�W of Work for this Fe Square/Linear Footage of Work: Type of Work: OAddress DAlteration C` ONew. . O.Repair/Replace D�%,j..f;..., of Work' � �-'il°J� '�'' d'� � \`� �-- 4•' Submittal Fee $ °� Permit Fee $_ P®4"10 U CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ '0 Tykic, (Ia C i"� ODemolition 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 AFFIDAVTT: 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. <—! -OWneLor- argent Contractor The fore oing instrument was acknow edge day of 20 , by i 4 who i rson kn me or who has NOTARY Sign: Print: me thi4 ZU As identification and who did take My Commission Expires: per) I U APPROVED BY The fore oing instrument was acknowled ed before me this y of ' 20 a, by tea" h lwh � n6'(- o is ersonally cno n to me or has produced as identification and who did take an oath. 0M 0 M to �a C) A Z® at g 11 Plans Examiner Structural Review (Revised 3 /12/2012)(Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) Clerk 4 ACOIRV® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDNYYY) 3/18/2014 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 endorsemen s . PRODUCER BB Insurance Marketing Inc PO Box 551267 Ft. Lauderdale FL 33355 -1267 NAME: Pattv Carlton Ext 306 PHONE FAX AIC NO AD Rm 34528 IN S AFFORDING COVERAGE NAIC 9 INSURER A EACH OCCURRENCE $1,000,000 INSURED METRO -2 INSURERS:ESS8X Insurance INSURERS: Company MED EXP (Any one person) INSURER C : PERSONAL BADVINJURY Metro Electric Service, Inc. 21407 NE 38th Avenue Aventura FL 33180 INSURERD : GENERAL AGGREGATE $2,000,000 GEITL AGGREGATE LIMIT APPLIES PER X7 PRO LOC INSURER E: $2,000,000 INSURER F: $ COVERAGES CERTIFICATE NUMBER:1 g2sowm3 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. INSR LTR TYPE OF INSURANCE IN POLICY NUMBER POLICY EPF MIDD POLICY EXP (MM/DDlYYYY1 LIMITS B GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE a OCCUR 34528 /9/2013 /9/2014 EACH OCCURRENCE $1,000,000 DAMA T RENTED PREMISES Ea occurrence $100.000 MED EXP (Any one person) $5,000 PERSONAL BADVINJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEITL AGGREGATE LIMIT APPLIES PER X7 PRO LOC PRODUCTS - COMP /OP AGG $2,000,000 $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS NON -OWNED HIRED AUTOS AUTOS Ea accident BODILY INJURY (Per person) $ BODILY INJURY (Per accdwd) $ PROPERTY DAMAGE Per accident $ UMBRELLA LIAR EXCESS LUIB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) H describe under DESCRIPTION OF OPERATIONS below NIA 10651441 014 2=015 X WC STATU OTH- E.L EACH ACCIDENT $110001000 E.L. DISEASE - EA EMPLOYEE $1,000,000 ELL DISEASE - POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, H more space is required) Electrical Contractor located at 15050 NE 20 Avenue, North Miami, FL 33181. Certificate Holder is included as an Additional Insured on the policy with respect to General Liability, only as required by written contract. Re: License # EC13006326 Miami Shores Village Building Department 10050 N E.2nd Avenue Miami Shores FL 33138 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD