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EL-14-694Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-214776 Scheduled Inspection Date: June 25, 2014 Inspector: Devaney, Michael Owner: GLINN, MacDAM & DENISE Job Address: 1201 NE 102 Street Miami Shores, FL 33138 - Project: <NONE> Contractor: ENERGIZER ELECTRIC LLC Permit Number: EL -4-14-694 Permit Type: Electrical - Residential Inspection Type: Final Work Classification: Alteration WIT7MLI I -117—T, Parcel Number 1132050250160 Phone: (305)308-5061 5ulilding Uepanment comments replace all electrical in kitchen and addition of new lights and Infractio Passed Comments outlets I INSPECTOR COMMENTS False Inspector Comments Passed EJ_ Failed Correction ❑ Needed Re -Inspection ❑ Fee No Additional Inspections can be scheduled until re -inspection fee is paid. June 24, 2014 For Inspections please call: (305)762-4949 Page 27 of 35 % *` '` Miami Shores pillage cEI N7,: Building Department MAR 201 tf 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 i Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (3057 762.4949 ... FBC 20 t BUILDING PERMIT APPLICATION Permit Type: Electrical Permit No. Master Permit No. eu 14 a G!�141 JOB ADDRESS: 1 C)-© � iU C 0 1 �-\ - City: Miami Shores County- Miami Dade Zip: Folio/Parcel#: l k ---� 0 S - 0a. - 0 k 4. D Is the Building Historically Designated: Yes NO ✓ Flood Zone: � -3\x rya �c;C�U OWNER: Name (Fee Simple Titleholder): Mot r- Aj c� a IJC - " C e- c, 1, c Phone#: Address: \ )= 0 1 6-) 1-. � ( 6 -�. S'r City: V\ -,La- ��..�,�,o State: (`— _ zip: 3 �, 13 Tenant/Lessee Name: A Phone#: ul A Email: G� ' �,., (9 V\ -.\C v.c, CONTRACTOR: Company Name: p1 " 1_ e Phone#: U 30 s-0 6 Address: City: / r� �- c� ` State: Zip: n Qualifier Name:Phone#: State Certification or Registration #: Certificate of Competency #: ® 2.,g DS O G 6 Contact Phone#: 3Dd0'v''0t!;/ Email. Address: er / e0-7 DESIGNER: Architect/Engineer: CAJ kJ u c cj and ; © mz o L Phone#: -S 0 ( 0 S-03' (� Value of Work for this Permit: $ 'Z000 Square/Linear Footage of Work: ct 0 0 �t a Type of Work: ❑Address Alteration ONew Okepair/Replace- ODemolition Description of Work: n�a 'i Q- k'Q CA- • c Ci , + r C-0 I z .. -.. `� l S 'a- -w, `fL-v 41-4, ����•��r�u����r�r�r��,�ar����..r�:��.���u:��:r��r��: ��r:��Fees����r��r��•���:��:�����r:�:��:����u�:����:���:��r�������:�� Submittal Fee $ S 0 ` Permit Fee $ % ®sib 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) AJ - Bonding Company's Address City State zip Mortgage Lender's Name (if applicable) (UA Mortgage Lender's Address 0 :D c%& v ud City V " ` : c., State r _ zip �; l 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 Signature Owner or Agent Contractor The foregoing instrument was acknowledged before me this V The foregoing instrument was acknowledged before me this day of , 20 �, by �,(�, day of 1^ , 20 tt by ($11Qp , who is personally known to me or who has produced who is personally known to me or who has produced F i V Q Ir As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commission Expires: MY COMMISSION a uu uoa EXPIRES: April 11, 2014 Bonded Thru Notary Public Usderorriters 11, au 4e- as identification and who did take an oath. e., 141 APPROVED BY /d Plans Examiner Structural Review (Revised 3/12[2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09) NOTARY Sign: Print: 1 My Commission Notary Public State of Florida Elizabeth Yelin MY Commission FF 063868 Expires 10/16/2017 Zoning Clerk f 6 �- ConstructionCTrades TQB Qualifying Board BUSINESS CERTIFICATE OF COMPETENCY 09E000661 ENERGIZER ELECTRIC LLC D.B.A.: BEDASIE DEOCHAN Is certified under the provisions of Chapter 10 of Miami -Dade County VALID FOR CONTRACTING UNTIL09/30/2015 D ,V> iL 'NSE CLASS E �� - -68-430-0 DEOC.- ,. SEDAS1; ?808 INDIGO ST MBiAIRAW PL 330234M 00811-30-1868 sEx tit POM: 1 dV20 oparuwn ct a minor w1y¢M MOTORCYCLE ALSODont alwts oonNfK to any sot—ty test r gw6d by law. �- ConstructionCTrades TQB Qualifying Board BUSINESS CERTIFICATE OF COMPETENCY 09E000661 ENERGIZER ELECTRIC LLC D.B.A.: BEDASIE DEOCHAN Is certified under the provisions of Chapter 10 of Miami -Dade County VALID FOR CONTRACTING UNTIL09/30/2015 '' � CERTIFICATE OF LIABILITY INSURANCE °"��/114 '"' 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), AUTHOR® REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certifies holder is an ADDITIONAL INSURED, the Policy(les) must be endorsed. If SUBROGATION IS WAWED, 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 endomement(s). PRODUCER Government Insurance Corp. 18501 Pines Blvd Suite 205 Pembroke Pines, FL 33029 Picone (305) 883.9398 Fax 305 885-1936 CONTACT PHONE Extk 305) 883-9398 FAX Ne (305)88&1936 L (nsuranceineed@yahoo.com s AFFORDING COVERAGE NAIL s INsuRER A: Travelers Indemnity Company of America 114SURED Energizer Electric, LLC 7W8 lndigo Street Miramar, FL 33023 305 INSURER 0: INSURER C: INSURER 0: INSURER E: INSURER F : 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. I SR OF INSURANCE ADDLSTYPE UB wwD POLICY NUMBER OCY EFFWYVM POLICY EXP UAtiTS A GENERAL LIABILITY 0 COMMERCIAL GENERAL LIABILrfY ❑ ❑ CLAIMS -MADE 0 OCCUR ❑ 660-613476609 09/16/2013 09/16/2014 EACH OCCURRENCE $ 1, 000.00 DAMATO RENTED PREMISES Eaa a=rrrence $ 100,000.00 MED EXP (Any mre perew $ 5,000:00 PERSONAL & ADV INJURY $ 1,000,000.00 ❑ GENERAL AGGREGATE $ 2,000 000.00 GEN'L AGGREGATE LIMIT APPLIES PER: R] POLICY ❑ PRO- ❑ LOC PRODUCTS - COMPIOP AGG $ 2,000,000.00 $ AUTOMOBILE LIABILITY ❑ ANY AUTO ❑ ALLWNED ❑ PULED ❑ HIRED AUTOS ❑ N'O O WNED ❑ E en SINGLE LIM IWd D BODILY INJURY (Per pm w) $ BODILY 0WRY(Peracdderd) $ pR�OPERTy�pAMAGE $ d $ UMBRELLA LIAS ❑ OCCUR ❑ ❑ EXCESS LIAR ❑ CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ ❑ DED El RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y I N ANY PROPRIETORIPARTNERIEXECUTIVE OFFICEWMEMBER EXCLUDED?N El In NH) B describe under DESCRIPTION OF OPERATIONS below I A 11 YDC STATLL 1:1 OTH E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ EL DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS f LOCATIONS / VEHICLES (Attach ACORD 101, AddHlonal Remarks Soule, H more spaw to required) Contractor License Number. 095000661 CERTIFICATE HOLDER CANCELLATION Miami Shores Village Building Department 10050 NE 2nd Avenue Miami Shores, FL 33138 ACORD 2S (2010/05) OF 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 ®1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD °' CERTIFICATE OF LIABILITY INSURANCE F3731/2014 THIS CERTIFICATEIS 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. R SUBROGATIONIS 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 certlficate holder In lieu of such endorsement(s). PRODUCER PAYCHEX INSURANCE AGENCY INC 210705 P: F:(888) 443-6112 PO BOX 33015 SAN ANTONIO TX 78265 COKFACT °"K%FJo wic ft): (888) 443-6112 AW INSURER(S)AFFORMOCovomoE NAICA wsURERA: Twin City Fire Ins Co 29459 awrm ENERGIZER ELECTRIC LLC 7808 INDIGO ST HOLLYWOOD FL 33023 INSURER e INSURER C: WSURERD: E-:—: E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER.- THIS UMBER: 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. RM T9P&OFINSORANCR ADDL SODR POL/CVNOMB&R POMCYJW POLWYM7 ,,,um C/O Building COMMERCIAL GENERAL LIABILITY CLAIMS -MADE -� OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY � M LOC OTHER: AUTHORIZEDREPRESENTAnK ` 10050 NE 2ND AVE MIAMI SHORES, EACH OCCURRENCE DAMAGE TO RENTED PREMISES (Ea occurrence) MED EXP (Any are person) PERSONAL & ADV INJURY GENERAL AGGREGATE PRODUCTS -COMPIOPAGO AUTOMOBILE LIABILITY ANYAUTO ALL OWNEDSCHEDULED AUTOS AUTOS HIRED AUTOS NON -OWNED AUTOS COMBINED SWGLE LIMIT $ aadde�d) BODILY INJURY (Per person) $ BODILY INJURY (Peracciderd) PROPERTY DAMAGE $ (Per accident) UMBRELLA LIAROCCUR EXCESS LIAR CLAIMS -MADE EACH OCCURRENCE AGGREGATE . I... A wOR WC01tpRNSM" AND&NS' %07E LIAR/UTY ANY PROPRIETOMPARTNERIEXECUTIVE YIN OFFICERNEMBER EXCLUDED? (MwtdgwYIni DESSCRIPTTION under FOPERATIONS below MIAfn 76 WEG NG1286 01/05/2014 01/05/2015 X O.C.nt• TAtai E.L. EACH ACCIDENT 10 0 , 000 E.L DISEASE -EA EMPLOYEE 5100, 000 E L DISEASE - POLICY LIMIT '500, 000 DFSCR"ON OF OPERATIONS /LOCAT)OHS/VEHICLES (ACORD 101, Addt lanal Remarirs Schedule, may be attached H more Spam to required) Those usual to the Insured's Operations. Re: Contractors Licensing #09E000661 CERTIFICATE HOLDER CANCELLATION 0 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED MIAMI SHORES VILLAGE BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IACCORDANCE WITH THE POLICY PROVISIONS. C/O Building Department AUTHORIZEDREPRESENTAnK ` 10050 NE 2ND AVE MIAMI SHORES, FL 33138 0 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD