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EL-14-1679Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-218863 Scheduled Inspection Date: September 03, 2014 Inspector: Devaney, Michael Owner: TANONA, ANTHONY Job Address: 253 NE 94 Street Miami Shores, FL 33138 - Project: <NONE> Permit Number: EL -8-14-1679 Permit Type: Electrical - Residential Inspection Type: Final Work Classification: Service Change Phone Number (954)593-3229 Parcel Number 1132060133820 Contractor: C.W. FISCHER ELECTRIC INC Phone: (954)566-5689 Building Department Comments - CORRECTIONS TO EXISTING SERVICE INSPECTOR COMMENTS False Inspector Comments Passed Failed Correction ❑ Needed Re -Inspection ❑ Fee No Additional Inspections can be scheduled until re -inspection fee is paid. September 02, 2014 For Inspections please call: (305)762-4949 Page 27 of 30 C_. Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 BUILDING PERMIT APPLICATION ❑BUILDING 0 ELECTRIC ❑ ROOFING FBC 2046 Master Permit No 2 G� c' 1,6-7 Sub Permit No. ❑ REVISION ❑ EXTENSION [-]RENEWAL r-1 PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 253 NE 94 Street City: Miami Shores County: Miami Dade Zia: Folio/Parcel#:11-3206-013-3820 Is the Building Historically Designated: Yes NO X Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): ANTHONY & LINSEY TANONA Phone#: 305 710-9152 Address: 253 NE 94 STREET City. MIAMI SHORES State: FLORIDA Zip: 33138 Tenant/Lessee Name: NONE Phone#: Email: CONTRACTOR: Company Name: CW FISCHER ELECTRIC, INC. Phone#: 954 566-5689 Address: 4057 NE 5 TERRACE City: OAKLAND PARK State: FLORIDA Zip: 33334 Qualifier Name: CHARLES W FISCHER Phone#: 954 565-8007 State Certification or Registration #: EC0001578 Certificate of Competency #: 3866694 DESIGNER: Architect/Engineer: NA Phone#: Address: City: State: Zip: Value of Work for this Permit: $ Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New Repair/Replace ❑ Demolition Description of Work: CORRECTIONS TO EXISTING SERVICE Specify color of color thru tile: Submittal Fee $-,5L- 06 Permit Fee $ 1AAW /-S 2�p® CCF $ CO/CC $ Scanning Fee $ Radon Fee $ Technology Fee $ Training/Education Fee $ Structural Reviews $ _ (Revised02/24/2014) DBPR $ Notary $ Double Fee $ Bond $ TOTAL FEE NOW DUE $ A a- Bonding Company's Name (if applicable) NA Bonding Company's Address City State Mortgage Lender's Name (if applicable) NA Mortgage Lender's Address City Zip State Zip or 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 ELECTRIC, PLUMBING, SIGNS, POOLS, FURNACES, BOILERS, HEATERS, TANKS, 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. n Signature � Signature O ER or AGENT CONTRACTOR The foregoing instrumen was acknowledged before me this The foregoing instrument was acknowledged before me this day of 20 ` by ay of �� 20 by who is personally known to who is personally known to me or who has produced as me or who has produced as identification and who did take an oath. identification and who did take an oath. � y e� �,< �.[�ON ANN BONCZ NOTARY P •' , t, 6M i ARY PUBLIC NOTARY PUBLIC: tik Vie. STS,: -OF FLORI Cc m EP922 Sign: Sign• Q�2_N Print: Print: _10011% NOTARY PUBLIC OP FWRIGA Seal: Seal: ® Co "m4 EE122MIS E4 ptrea 9/4/20116 '>e-0fy APPROVED BY jL ALC" Plans Examiner 4r - Structural Review (Revised02/24/2014) Zoning Clerk 1w CIIanMl- R7AR1 CVIIFIS ACORD. CERTIFICATE OF LIABILITY INSURANCE ATE (IrMNDIYYY1r) D 5/12/2014 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(les) 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 Ileu of such endorsement(s). PRODUCER Michelle A. Kallcharan Gulfshore Insurance - Naples P,NVCONr o, 239 435-7143 FAXac No): 239 213-2852 4100 Goodlette Road North ADDS, mkaiicharan@guifshoreinsurance.com Naples, FL 34103 -3303 239 261-3646 INSURER($) AFFORDING COVERAGE NAIC # INSURER A: National Trust Insurance Compan 20141 INSURED C.W. Fischer Electric, Inc. 4057 NE 5th Terrace Oakland Park, FL 33334 INSURER 13: FCCI Insurance Company 10178 INSURERC: INSURER D INSURER E INSURER F: DEAACCHH PREMISES Ea oxu� nce $300,000. 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 CONTRACTOR 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. MTRTYPE OF INSURANCE ASR 8UBR POLICY NUMBER MP�pY EFF Y EXP LIMITS POLTR LIOrr" A GENERAL LIABILITY GLOO154102 05f2212014 05122/2015 OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY DEAACCHH PREMISES Ea oxu� nce $300,000. CLAIMS -MADE a OCCUR MED EXP (Any are person) $10,000 X PD Ded:500 PERSONAL & ADV INJURY $1,000 000 GENERAL AGGREGATE $2,000,000 GEN'LAGGREGATE LIMITAPPLIES PER. PRODUCTS-COMP/OPAGG $2,000,000 POLICY X ECT LOC $ A AUTOMOBILE LIABILITY CA00242592 D512212014 05/22/201 a tgMBBIINdani)ED SINGLE LIMIT 1,000,000 AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED JY NON BODILY INJURY (Per accident) $ -OWNED X PROPERTY DAMAGE$ ED AUTOS AUTOS Peraccidente Oth Car $ A X UMBRELLA LIAR X OCCUR UMBOD167602 5/22/2014 05=2015 EACH OCCURRENCE $1,000,000 EXCESS LIAB CLAIMS -MADE AGGREGATE $1,000,000 DED I X RETENTION $1 O 000 $ B WORKERS COMPENSATION 001 WC14A706435/2.1/2014 051=015 X TW STATU- OTH- AND EMPLOYERS' LIABILITY ANY PROppRIETORIPARTNERIEXECUTIVEa OFFICE ER EXCLUDED? Y NIA E.L. EACH ACCIDENT $1,M0,000 (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $1,000,000 Kdescribe radar DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $1,000,000 B Leased/Rented CM00075802 OW2212014 05122/2015 $50,000 Limit Equipment $500 Deductible DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (AQaah ACORD 101, Additional Remarks Schedule, N more space is mquiroM Re: Electrical Contractor - #EC0001578 Miami Shores Village SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE g THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Building Department ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE 2nd Avenue Miami Shores, FL 33138 AUTHORRED REPRESENTATIVE -Zza 04e i ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/03) 1 of 1 The ACORD name and logo are registered marks of ACORD #S753147/M753051 MAK Telephone (954) 566-5689 (954) 565-8007 glacher ELECTRIC, INC. Z,,,VO,5 '01W0/V,* SlJo4eS, Ft AUG 01 2014 4057 Northeast 5th Terrace Oakland Park, Florida 33334 rmITY