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EL-13-2789Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 209689 Permit Number: EL -12 -13 -2789 Scheduled Inspection Date: March 26, 2014 Inspector: Devaney, Michael Owner: HERNANDEZ, ROLANDO Job Address: 95 NW 95 Street Miami Shores, FL 33150- Project: Contractor: <NONE> HARMISON ELECTRIC GROUP INC Building Department Comments Permit Type: Electrical - Residential Inspection Type: Final Work Classification: Alteration Phone Number Parcel Number REPLACE OVERHEAD FPL SERVICE UNDERGROUND Infractio Pass INSPECTOR COMMENTS False Inspector Comments Passed Failed Correction Needed ❑ Re- Inspection ❑ Fee No Additional Inspections can be scheduled until re- inspection fee is paid. 1131010330540 Phone: (305)969 -5682 March 25, 2014 For Inspections please call: (305)762 -4949 Page 38 of 40 Y 1 Miami Shores village �b Building Department 90050 N.E.2nd Avenue, Miami Shores, Florida 33138 V Tel: (305) 795.2204 Fag: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 BUMDING PERMIT APPLICATION Permit Type: Electrical � AV DEC 1 2013 8Y 0000�` ®000 ®om FBC 20 tO Permit No. Master Permit No.� 3 b 1 JOB ADDRESS: 95 N.W. 95 St City: Miami Shores County: Miami Dade gip: 33150 Folio/Parcel#.. 11- 3101- 033-0540 Is the Building Historically Designated: Yes NO X Flood Zone: 7-64 OWNER: Name (Fee Simple Titleholder): Rolando Hernandez Phone#: 0&252 -5732 Address: 16765 N.W. 86 Ct. City: Miami Lakes State. FL Zip. 33016 Tenantft essee Name: Phone#: Email: aperez @perpat.com CONTRACTOR: Company Name,' ame Harmison Electric Group, Inc Phone# 305- 969 -5682 Address: 12255 SW 128 St. Suite#411 City: Miami State. FL zip: 33186 Qualifier Name: Stephen C. Harmison Phone#: 305-969 -5682 State Certification or Registration #: EC0002144 Certificate of Competency #: Contact Phone#: 305 -969 -5682 Emil Address: steve @harmisongroup.com DESIGNER: Architect/Engineer: Phone#. Value of Work for this Permit: $1,000 Square/Linear Footage of Work: Type of Work: LlAAddress OAlteration CINew ORepair/Replace ODemolition Description of Work: Replace overhead FPL service to underground service Submittal Fee $ 5,0-o"D Permit Fee $ / 3 ° ®® CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ Technology Fee $ TOTAL FEE NOW DUE $ I J 7 • La, Bonding Company's Name (if applicable) Bonding Company's Address City State Mortgage Lender's Name (if applicable) Mortgage Lender's Address Zip 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 estunated 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 gpproved and aAreinspection fee will be charged a Signature er or Agent The to o' trument was 1ged befo me this day of _�, 20 l3 bya� %� /�/���Pl%Y.1/7 �? Signature Contractor The foregoing instrument was acknowledged before me this 17th day of October . 20/3 by Stephen C. Harmison who is personally known to me or who has produced who is personally known to me or who has produced A&*Ientific ation and who did take an oath. as identification and who did take an oath. NOTARY PUBLI h'lw Sign: o i Print: My Commission Expires: APPROVED BY RIDA I UuMmISSION #EE 1716 ' MY June 16, 2014 Plans Examiner Structural. Review (Revised 3 /12/2012)(Revised 07 /10/07)(Revind 06110/2009)(Revised 3/15/09) L� de Orozco 'FAIMM41ssol w co 5"e"41i EXPIRES: Dccemh2r 8,203 Eunded 7!ru NIC arM Pu6!ic Undcrwdter� U Zoning Clerk , ' Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CONTRACTORS' REGISTRATION FORM ALL CONTRACTORS MUST PROVIDE COPIES OF LICENCES AND INSURANCES EACH TIME A PERMIT IS SUBMITTED OR THE VILLAGE MAY MAINTAIN A FILE WITH YOUR INFORMATION FOR A $30.00 FEE PER YEAR IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: A. X COPY OF QUALIFIER'S STATE LIC CARD B. X COPY OF LOCAL BUSINESS TAX RECEIPT C. X COPY OF LIABILITY INSURANCE (CERTIFICATE HOLDER TO BE MIAMI SHORES VILLAGE BLDG DEPT) D. X COPY OF WORKERS COMPENSATION (EITHER CERTIFICATE OR EXEMPTION) IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY: A. COPY OF CERTIFICE OF COMPETENCY OF QUALIFIER B. COPY OF MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT C. COPY OF LIABILITY INSURACE (CERTIFICATE HOLDER MUST BE MIAMI SHORES VILLAGE BLDG DEPT) D. COPY OF WORKER COMP INSURANCE (EITHER CERTIFICATE OR EXEMPTION) YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE HOLDER AS FOLLOW: MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES, FL 33138 COMPLETE CONTRACTOR'S INFORMATION BUSINESS NAME: Harmison Electric Group, Inc BUSINESS ADDRESS: 12255 SW 128 St. #411 CITY Miami STATE Fl- ZIP CODE 33186 BUSINESS PHONE: 3( 05 969 -5682 FAX NUMBER 7( 86 ) 571 -9337 CELL PHONE 7( 86 1229 -0276 QUALIFIER'S NAME: Stephen C. Harmison QUALIFIER'S LIC NUMBER: EC0002144 E -MAIL ADDRESS OF APPLICABLE): steve @harmisongroup.com Created on 3H90 BY MUN 1 RV 312610.9 MWV HARMI -1 OP ID' RG '4f*. R CERTIFICATE OF LIABILITY INSURANCE D 1011 1120131 10/17/2013 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(les) must be endorsed. 6 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 Oeu of such enda Us. PRODUCE Phone: 305. 3647800 BROWN & BROWN OF FLORIDA INC Fax: 305 - 7141401 14800 NW 79th Court Suite#200 cmT FAx Miami Lakes, FL 330165869 axAtL Ramon A Rodriguez GL600994I04 02127@013 INSURER(S) AFFORDING COVERAGE NAIC @ INSURERA:'*FCCI Insurance Com an ' 10178 $ 100,00 INSURED Harmison Electric Inc. Harmison Electric Group Inc. 12255 SW 128th Street, Ste 411 INSURER B :'*FCCI Commercial Insurance Co 33472 INSURER C: GENERAL AGGREGATE Miami, FL 33186 INSURERD: PRODUCTS - COMPIOP AGG INSURERE: $ INSURER F : AUTOMOBILE LIABILITY ANY AUTO A O SCHEDULED AUTOS AUTOS NON-OWNED HIRED AUTOS AUTOS GUVERAGES CFRT[Rr -ATE MIIMRPR- DCUICInM MlnunCD- 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 TYPE OF INSURANCE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Miami Shores Village g PO C NU POLICY EFF POLICY EXP LIMITS B GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE F OCCUR GL600994I04 02127@013 02/27/2014 EACH OCCURRENCE $ 1'0w' PREMISES Ea occurrence $ 100,00 MED EXP (Any one person) $ 5, PERSONAL & ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ �r00r GENT_ AGGREGATE LIMIT APPLIES PER: POLICY PRO LOC PRODUCTS - COMPIOP AGG $ 2r�r1 $ B AUTOMOBILE LIABILITY ANY AUTO A O SCHEDULED AUTOS AUTOS NON-OWNED HIRED AUTOS AUTOS CA00234MI 02127=3 02127/2014 COMBINED SINGLE LIMIT 1.�. X BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROP AMAGE $ B X UMBRELLA LIAB EXCESSLIAB X OCCUR CLAIMS MADE UMB001361402 02/27/2013 02127/2014 EACH OCCURRENCE $ 3,000,0 AGGREGATE $ 3,000,0 DED I X I RETENTION 10,000 $ A WORKERSCOMPENSATM AND EMPLOYERS' LIABILITY ANY PROPWETORIP� Y / N OFFICERIMEMBEREXCLUDED? ® y(� in" DESCRIPTION OF OPERATIONS below MIA 001WC13A70179 02127/2013 02 211114 X WC STATU E.L. EACH ACCIDENT $ 1,00010 E.L. DISEASE- EA EMPLOYEE $ 1,000,0 E.L. DISEASE - POLICY LIMIT $ 1,00,0 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remadcs Schedule, I more space is required) CERTIFICATE imi nFR f- AkIt%= * A74nM MIAMISH SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Miami Shores Village g THE EUM71ON DATE THEREOF, NOTICE WILL BE DELIVERED IN Building Department ACCORDANCE WITH THE POLICY PROVISIONS. 10050 N.E. 2nd Avenue AUTHORIZEDREPRESMTATIVE Miami Shores, FL 33138 ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD 4 1 ZOAIN ti W ry U) Q D Z Z) O m LL 0 SH 1—f r RAL ELE✓ WCAL B SU STA ING i 60' T IBLIC R/W 30.00' :I: .. :.. W •:Asph • :at •.. Z........ ::� W E Q •a° 3 •t +•+ co 0- r � a io F.I.P. 15' A L L E Y ilro o cap) EAST —WEST 81 4' C.B.S. wolf in Una / 3' C.B.S. wall 2 oft \ 2� 1.2' 7 :54Ass l3 Utility vow C4 \ h. \ \ / Car Port cc b ;.��� i dam- 13.20" `- - F i• 1� no ATE a'I Plani er F P. 9� (no pop) � e M (M o xIx mim co I r" 0 I J ONE STY CBS RESIDENCE No. 95 I HI.F.F. Elev. 13.13 1 Low F.F. Elev. 12.65 1 14.00' I 18.60' � I 1 ' :• :Drivewa ...... 20 ' —WEST 81.30' M &R ......... .......... F.I.P. 11ro (no cap) On li 5' C.B.S. wan ir c it 0 U) dN' V) M � x d ml ^O �m (n 30- 0 z JOn line oeF (no �llh��ap___) ___��' K0 Q;A— ..tl. 15' Parkw 15. .:.. :3 , .. &2�..Guff ... 48' Asphalt Pavement' : �'4 . ) :;: '::: 80 TOTAL t: ...... . ......... t• PUBLIC R . :: :. . .. . .................................. ........ : :�: :.................. .:: 'N.W. 95th .STREET 16 AND THE WEST 1/2 6 F LOT 17, KM 131, OF MIAMI SHORES PION N0.6 ACCORDING TO THE PLAT THEREOF AS RECORDED IN PLAT K 10 AT PAGE 39, OF TIE PUBLIC RECORDS OF MIAMI -DADE COUNTY, TO C0 LlAII; E ',�i ,! -LL i t - -L ;, ± SITE ADDREM&. 95 N.W. 95th AVENUE, MIAMI SHORES, FL 33150 JOB NUMBER: 13 -1205 DATE OF SURVEY JUNE 12, 2013 REVISED DATE DECEMBER 5. 2013 FOLIO NUMBER: 11- 3101 - 033 -0540 RE AND RAISED SEAL OF A FLORIDA LICENSED SURVEYOR AND MAPPER FPL POLE Lemr depth 0 botaM W=2-M- twooto pad (121n.) Concrpad Le e j 18 In. rrdn. (d md burial) L PVC conckift and NOW Oredy burled in earth at a depth not low Khan 18 in.