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ELC-13-2351
Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 206719 Permit Number: ELC -10 -13 -2351 Scheduled Inspection Date: February 26, 2014 Inspector: Devaney, Michael Owner: EDELMAN, ALEX Job Address: 9999 NE 2 Avenue f i%71 Miami Shores, FL 33138- Project <NONE> Contractor: TRI- SYSTEMS GROUP INC Permit Type: Electrical - Commercial Inspection Type: Final Work Classification: Addition /Alteration Phone Number ()_ Parcel Number 1132060134490 Phone: (305)591 -4266 Building Department Comments NEW OUTLETS AS PER PLANS AND LIGHTING REARRANGEMENT Infractio Passed Comments INSPECTOR COMMENTS False Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments CREATED AS REINSPECTION FOR INSP - 201355. Exit and emergency fixtures missing and fluorescent fixtures not working. Need miami dade county fire inspection first. ;w/-0/0/ February 25, 2014 For Inspections please call: (305)762 -4949 Page 18 of 28 4 .. 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 RECEIVED JAN 142013 FBC 20 t� Permit No. 1-1'3 D2 S1 Master Permit No. 56, f d /e�M /3 - 3 3V JOB ADDRESS: qqq 66 Rove =l fir City: Miami Shires Folio&Parcel#: Is the Building Historically Designated: Yes NO Flood Zone: County: Miami Dade Zip: .0 .5p. OWNER: Nat ► (Fee Simple Titleholder): ,�, ��'G ° At/ >'4' Phone#: Address: P. 0 • 2d , City: aCO 4.544e State: Zip: // 9, 0 Tenant/Lessee Name: Phone#: Email: �y- CONTRACTOR: Company Name:17! 0 ,/)7 A PO e%p Phone#:./` ! 59j 9e2 'b Address: 7 OO#h J 5✓- S ," )O7 City: ,144-"1/ State: FL— Zip: 33 /'22 -- Qualifier Name: ( 6641te./%, //,�C�G , `.% 00 Phune#:,3O5 / cf074f j State Certification or Registration #: (� Certificate of Competency #: Contact Phone##: r /__Ye , (fEmaiil Address: /OP p 7?'/ /7 ems . ,Dc2/). DESIGNER: Architect/Engineer: Pho ne#: Value of Work for this Permit: $ P % Od, 4 12 Square/Linear Footage of Work: Type of Work: °Address °Alteration °New ®step /air /lReplace Description of Work: 9, atp// $ der �� `f �j' �f�' 4 "$, ODetnolititm * egett* * * * ** *** *** * * * * * *** * *eye ********* * * * **aa * *e *** ** *** * * * *** **m * * * * *** **** ***** Submittal Fee $ Permit Fee $ CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ Bonding Company's Name (if applicable) '`' Bonding Company's Address City State Zip 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, HEA'L'ERS, TANKS and AIR CONDITIONERS, EIt 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 c unstnaction 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 const .,.� '< j r: - e will be delivered to the person whose property is subject to attachment. Alan, a certified copy of the > nrded notice of commencement »ruche posted at the job site for the first inspection which occurs seven (7) days after the b ' g pernut ,. « �r` " " %% sense of such posted notice, the inspection will not be approved and a reinspection fee will be chu ed. Signature Sign Owner or Agent Contractor The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this I 4411 day of , 20 _, by , day of 5 Pvty , 20 A, by 0?.4.4ver4,k, who is personally known to me or who has produced why is personally ° wn to me or who has produced As identification and who did take an oath. as identification and who did take an oath. NOTARY P LIC: NOTARY PUBLIC: Sign: Sign: _ _ • -- Print: Print: a trail %:.r My Commission Exp My Commission Expires: APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised 3/I2/2012)(Revised 07 /Ill fllXRevised(WIU/2009XRevised 3/15A19) THIS DOCUMENT HAS A COLORED BACKGROUND MICROPRINTING • LINEMARK"' PATENTED PAPER .,,,:,... STATE .53!..F, FLORIDA siiRTO ...tP*1743....'alaRPROFESSIONAL . .8 . .:.:::::,:. • :.::: , , .:,-,., •.::,,-.::: ::. • if, ,i, _,___,,,,,:::---:-.;.: :...,,...,:: .:,.::•-,-,.?;:;.: :.,. LICENSE NBR M,,ls. .. ......, ---,:• . ,..."-A,' .100',4- ....05/2312032 .:::' 11,8180451 ,BC130.0472i. The ELECTRICAL CONTRACTOR Named below IS CERTIFIED # Under the provisions of Chapte Expiration date: AUG 31, 2014 OMINGUEZ TRI20800 'SW 10 RD SYSTB041914 . -- MIAMI 1 FL 331 . •,• ,. ',::.: Y..i1:. 0: .,..•• . .. ,..... ...4.. .A:,:,.. :.:..:: !...,. "..i'i ' • ''•'• .:':4 .=,:T.,..z1/ .1*. i'.;::.'4.,;` I.:••.... ,:,.... DISPLAY AS REQUIRED BY LAW KEN LAWSON SECRETARY 4 PAYME;`, , +- EIVED $YTAX`u;s ;'ECTQR 5.00 + e 9/2013 S1 =10 -016418 4 The RECE114446. above I Business Tex. The pt is not ; Manse, ess. Holt* any g mmental or whnc to the but all corcial vela ttwww miami arkrapvhallealTeettra A`EO CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 01/14/14 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 pollcy(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 American Trust Insurance 9360 Sunset Drive Suite 240 Miami, FL 33173 Phone (305) 270 -2220 Fax (305) 270 -2496 CONTACT Edna Sanchez NAME: lac°. No. Ext): (305) 270 -2220 FAX No): (305) 270 -2496 A ednasiamericantrustins.com ADD RE SS• INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Penn America Insurance Company y INSURED Tri- Systems Group, Inc. 7500 NW 25 Street, #207 Miami, FL 33122 (786) 262 -7521 INSURER B: Bridgefleld Employers Insurance Company 06/01/2013 INSURER C : Progressive Express Insurance company EACH OCCURRENCE INSURER D : V COMMERCIAL GENERAL LIABILITY ❑ ❑ CLAIMS -MADE V OCCUR ❑ INSURER E : $ 100,000.00 INSURER F : $ 5,000.00 COVERAGES 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. INSR LTR TYPE OF INSURANCE ADD INSR SUBR WVD POUCY NUMBER POLICY EFF (MM/DD/YYYY}(MM/DD/YYYYU POUCY EXP LIMITS A GENERAL LIABILITY y BDG0075407 -01 06/01/2013 06/01 /2014 EACH OCCURRENCE $ 1,000,000.00 V COMMERCIAL GENERAL LIABILITY ❑ ❑ CLAIMS -MADE V OCCUR ❑ DAMAGE TO RENTED PREMISES (Ea occurrence) $ 100,000.00 MED EXP (Any one person $ 5,000.00 PERSONAL &ADVINJURY $ 1,000,000.00 ❑ GENERAL AGGREGATE $ 2,000,000.00 GEN'L AGGREGATE LIMIT APPLIES PER: n POLICY ❑JET ❑ LOC PRODUCTS - COMP /OP AGG $ 2,000,000.00 $ C AUTOMOBILE LIABILITY V ANY AUTO ALL OWNED ►'7 At1TOS SCHEDULED ❑ AUTOS NON -OWNED V HIRED AUTOS CA AUTOS ❑ ❑ 01668261 -1 06/16/2013 06/16/2014 COMBINED SINGLE LIMIT (Ea accident) $ 1 00,000.00 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ . $ C ❑ UMBRELLA LIAR ❑ OCCUR ❑ EXCESS UAB ❑ CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ ❑ DED ❑ RETENTION $ $ B WORKERS COMPENSATION AND EMPLOYERS' UABIUTY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE N / A 830-48243 06/01/2013 06/01/2014 _, TORY L TU- ❑ ET EL EACH ACCIDENT $ 100,000.00 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L. DISEASE - EA EMPLOYE $ 100,000.00 B describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 500,000.00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, H more space Is required) Electrical Contractor CERTIFICATE HOLDER CANCELLATION MIAMI SHORES VILLAGE 10050 NE 2ND AVENUE MIAMI SHORES, FL 33138 i FAX 305 -756 -8972 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 REPRESENTATIVE ACORD 25 (2010 /05) QF © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Miami Shores Village Building Department 10050 N.E2nd 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: City: Miami Shores Folio/Parcel#: /1/ ° 2A (' Oir County. FBC 20 Permit No. / 13 ' 073S1 Master Permit NoQ 13 ,23 y 3 Miami Dade Zip: Is the Building Historically Designated: Yes NO Flood Zone: OWNER: Name (Fee Simple Titleholder): ( 771 )4.317-042 Phone#: 7 7 `f ') Address: 91, er City: ote-4 I Di4rn61 state: Tenant/Lessee Name: ,r f Phone#: 7P6 - 22 Zip: .7 2 Email: 74,07gb CONTRACTOR: Company Name: %''/ - Phone#: 7.:PW - ®ger, Address: OIO" t / City:. /'7.4i State: �^ r Zip: - d t4° Qualifier Name: ( ,,i State Certification or Registration #: ( &I i 7f3 g- Certifies of Competency #: Contact Phone* 74. sol $ ''® 13f" Email Address: Jr c A Ji G11;A-. ,->r DESIGNER: Architect/Engineer: )'hone#: Phone#: Tre ° /3 Value of Work for this Permit: $ /Sri '4' Square/Linear Footage of Work: Type of Work: °Address FDdteration Description of Work: c�% t ivn-kri c °New ORepair/Replace ODemolition +r*,; ***** + **** **** ;*****,ir****** *F ******* ***** ire ************,r ** **** *** Submittal Fee $ Permit Fee $ i'P e ",d /� CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ 1/9' Bonding Company's Name (if applicable) Bonding Company's Address City State Zip 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 RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500 applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be live to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement m v , "be po; ted at the job site for the first inspection -which' occurs seven (7) days after the building permit is issued. In the abs of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature Signature Owner or Agent The foregoing instrument was acknowledged before me this day of , 20 __, by who is personally known to me or who has produced As identification and who did take an oath. NOTARY PUBLIC: Sign: Print My Commission Expires: The foregoing day of tractor ent was acknowledged before me this 16 20 /;,by , 7r C7 raid who iss�personaally known to me or who;has identification and who did take an oath. NOTARY PUBLIC: Sign: Print NOTARY PUBLIC . `00111. 1 I I I, My Commission Expires: cp\ Commiss /on # ",••.EE1730g9 OF. F oP�\\`. * * *** **** * * **** * * *** *** ** : _+ *�rrr**** * ***** * ***** r ** r ye***** *irk** *,ie r,�****,r+k*****arir�rar, ,r�r,�a�r�,�,f4 1~r* *, ws s��r r t APPROVED BY i0 2 /G an / i2 /7 / ,�✓G�l� Plans Zoning Structural Review Clerk (Revised 3/122012)(Revised 07n0/07)(Revised 06/10/2009)(Revised 3/15/09)