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EL-14-142Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-208851 Scheduled Inspection Date: March 26, 2014 Inspector: Devaney, Michael Owner: , Job Address: 131 NW 110 Street Miami Shores, FL 33168 - Project: <NONE> Permit Number: EL -1-14-142 Permit Type: Electrical - Residential Inspection Type: Final Work Classification: Alteration Phone Number (305)219-8267 Parcel Number 1121360030540 Contractor: RAY WILLIAM ELECTRIC, INC Phone: (305)582-6142 i3 comments KITCHEN AND 1 BATH RENOVATION INSPECTOR COMMENTS False Inspector Comments PassedIE CREATED AS REINSPECTION FOR INSP-207048. Add smoke detector to 3rd bedroom. Microwave receptacle needs a goof ring and plate. Label panel. Failed Correction Needed ❑ �� Re -Inspection ❑ Fee No Additional Inspections can be scheduled until re -inspection fee is paid. March 25, 2014 For Inspections please call: (305)762-4949 Page 18 of 40 Miami Shores Village EID Building Department FZEID SAN; r 201V 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 4 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 FBC 20 BUILDING PERMIT APPLICATION Permit Type: Electrical JOB ADDRESS: 13 I N -W - I (0 44k f F Permit No. C -L --i y — 111 z Master Permit No. L -t" I y 1 City: Miami Shores County: Miami Dade Zip: Folio/Parcelk Is the Building Historically Designated: Yes NO )_Flood Zone: OWNER: Name (Fee Simple Titleholder):��4ityY— LTl1we,- •d-frl oyfmem 6- Phone#:.305-2/ Address: 21 SO UJ . t(Yk i -I • avf - City: V+t Q:"h State: PLI , Zip: .130t D Tenant/Lessee Name: Email: CONTRACTOR: Company Name: 1j?04 (n1 • 0, Wks i �• �.�'�f I't c.. Phone#: 3 bs"' Address�:q j 8't do N • � . Rq a� city:g-41 eA &I State: f -C- Zip:3.?0 4r Qualifier Name: I Ct,y W1 tLt & r_ C .f CL . Phone#: State Certification or Registration #: 1� e 1 304 Z g1 9 Certificate of Competency #: Contact Phone#: Email Address: DESIGNER: Architect/Engineer: Value of Work for this Permit: $ 5 -CO. 01' Square/Linear Footage of Work: Type of Work: ❑Address., ❑Alteration - ❑New ElfEepair/Replace < „ _ ❑Demolition Description of Work: a j c & to a. -► aE ba -64Caa r 9-.4M►O Q ( ( �(eG%r� c v� i tZ�e v+n a i •, i t'ln,e_ S� w►�e. L ac, -E-c 4 u f- `s- loc &C tl Gh 'a -w oJt (0 At � � rO Cr &,AA Ni Submittal Fee $ <570:;1 A Permit Fee $ CCF $ CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ Technology Fee $ TOTAL FEE NOW DUE $ 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 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. 4Z SignatSignature W __—tj Owner or Agent Contractor The foregoing instrument was acknowledged beforeAme this day of �20 l �t-, by Zchaeo 14 who ' ersona a or who has produced As identification and who did take an oath. NOTARY PUBLIC: My UmInissfon # ffE 116040 My Commiss* Expires July 26, 2016 The foregoing instrument was acknowledged before me, this day of 7q, 201 t , by PP (Ji l (' who is �rsonaHyknto me or who hag produced as identification and who did take an oath. l� aep/I,( C ��p Plans Examiner Structural Review (Revised 3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09) NOTARY PUBLIC: I DY ROMERO My S n 1 %Ion # EE 116040 of My Commission Expires July 26, 2015 Zoning Clerk A400NCERTIFICATE OF LIABILITY INSURANCE DATE(MYY) �"'°� 01/223!143/14Y 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 WANED, 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 Get Smart Insurance Inc. 20286 NW 2 Ave NCAOMNEACT Gregg Diwan IKPHONE , (305)653-7977 A No): (305)654-0293 ADDRESS E-MAIL-smart.com INSURER(S) AFFORDING COVERAGE NAIC a Miami, FL 33169 INSURER A: Accident Insurance Company Phone (305)653-7977 Fax (305)654-0293 INSURED INSURERS: INSURER C : Ray E Williams Inc INSURER D : 4820 SW 134 Ave INSURER E : Davie, FL 33330 (305) 582-6142 INSURER F: k;UVr-KAGtS GERTIFIGATE 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. LTR TYPE OF INSURANCE ADD B11 R POLICY NUMBER POLICY EFF MMID POLICY EXP MM/D Lwrrs A GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY F1 F1CLAIMS-MADEQ OCCUR F]PERSONAL N N CPP0009523 00 08/08/2013 08/08/2014 EACH OCCURRENCE $ 1,000,000.00 PGE TO RENTED REM SES El IC1111111 $ 100,000.00 MED EXP (Any one person $ 5,000.00 &ADV INJURY $ 1,000,000.00 ❑ GENERAL AGGREGATE $ 2,000,000.00 GEN'L AGGREGATE LIMIT APPLIES PER: 0 POLICY ❑JECTPRO- ❑LOC PRODUCTS - COMP/OP AGG $ 2,000,000.00 BUPD Deductible $ 500.00 AUTOMOBILE LIABILITYBINED ❑ ANY AUTO ALL O ❑ AUTOS ❑ NON -OWNED ❑ HIREDAUTOS ❑ ❑ ❑1 1 SINGLE LIMIT a acddent BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ Per accident $ ❑ UMBRELLA LIAR ❑ OCCUR ❑ EXCESS UAB ❑ CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ ❑ DED ❑ RETENTION $ $ WORKERS COMPENSATION❑WRY AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatary in NH) El Ii Yyes describe under DESG�RIPTION OF OPERATIONS below N / A IJMIT ❑ OTH- E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, N more space Is required) 92478 ELECTRICAL WORK - WITHIN BUILDINGS CERTIFICATE HOLDER CANCELLATION CITY OF MIAMI SHORES 10050 NE 2ND AVE. MIAMI SHORES, FL 33138 954-438-4737 FAX# ACORD 25 (2010/05) QF SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORED REPRESENTATIVE T &Qanl 236 ©1888-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD