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ELC-12-636Inspection Worksheet - IXMiami Shores Village 12, 10050 N.E. 2nd Avenue Miami Shores, FL C Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-191295 Scheduled Inspection Date: May 15, 2013 Inspector: Devaney, Michael Owner: , LEOCAVA LLC Job Address: 9534 NE 2 Avenue Miami Shores, FL 33138 - Project: <NONE> Contractor: STANLEY SUMMER LLC Building Department Comments ELECTRICAL WORK FOR TENANT SPACE Permit Number: ELC-4-12-636 Permit Type: Electrical - Commercial Inspection Type: Final Work Classification: Addition/Alteration Phone Number Parcel Number INSPECTOR COMMENTS False 1132060132630 Phone: (305)776-2443 Inspector Comments Passed CREATED AS REINSPECTION FOR INSP-172261. by JUAN JOSE Failed Correction ❑ Needed Re -Inspection ❑ Fee No Additional Inspections can be scheduled until re -inspection fee is paid. May 14, 2013 For Inspections please call: (305)762-4949 Page 29 of 45 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 FBC 26 APR 11 2.511 L�!1 BY:mm-_.__ee` e Permit No. lr, / Master Permit No. Permit Type: Electrical _ OWNER: Namep ) [ e c ccrty `` �Y (Fee Simple Titleholder): �- �'� Phone#: Address: City: —State: 1" Zip: 3>2-. 7;9 Tenant/Lessee Name: 0 G °" 4 Email: T® ->,-> C LC-- ,ti ( C_u , �,.._ S C S P C_qz> — JOB ADDRESS: r '!�- 312 �1 ; -� v r City: Miami Shores County: Miami Dade Zip: i c '3 2 Folio/Parcel#: Is the Building Historically Designated: Yes NO X Flood Zone: ,j CONTRACTOR: Company Name: b n / t -i J t ec sd i Address (� City: G� e 1. State: z Zip: Qualifier Name: Phone#. State Certification or Registration #: o D 1 Z 56-�; Certificate of Competency #: Q 0o y (x 7 ci C7 Contact Phone#: 21'3 6_ 3 2 6 -- I C-,-,4 i Email Address: DESIGNER: Architect/Engineer: Value of Work for this Permit: Type of Work: ❑Address Description of Work: ❑Alteration Csj- Footage of Work: ❑Repair/Replace ❑Demolition Submittal Fee $ Permit Fee $ �.®r Q' p CCF $ - - Scanning Fee $ Radon Fee $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ DBPR $ Technology Fee $ TOTAL FEE NOW DUE $ I W Y—) 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 iss bject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspecn which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not b approved god a reinspection fee will be charged. Signature_ Signature % r te 6 Z, -- Owner or Agent ThAforom 'nstrume was ackn wl g bef re meitthi� day , 20t1whly known to a or who has produced As identification and who did take an oath. Contractor The foregoing instrument was acknowledged before me this day of �� r5 , 20 9, by ff/'w"/y who is personally known to me or who has produced :2�C identification and who did take an oath. Structural Review (Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09) Clerk '1c'o'ri'®CERTIFICATE OF LIABILITY INSURANCE 5/24/2012 °"YYY' 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(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terns 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 endorseme s . PRODUCER Bateman Gordon and Sands 3050 North Federal Hwy Lighthouse Point FL 33064 NT CT NAME: F PHONE _954-941-2006 _0900 No E-MAIL ADDREss:cedaQbQswencyxom INSURER(S) AFFORDING COVERAGE NAIL S /28/2012 INSURER A:Landmark American Insurance Company EACH OCCURRENCE $1000000 INSURED EM IEL INSURER B: INSURER C: Emilio Electric Service Corporation INSURER D: 3596 Cocoplum Circle Coconut Creek FL 33063 PRODUCTS - COMP/OP AGG $1000000 BUPD Deductible $500 INSURER E: INSURER F LIABILITY ANY AUTO ALLOWNED SCHEDULED AUTOS HIRED AUTOS OS SOS COVERAGES CERTIFICATE NUMBER:17A3500A 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 DL ISR R POLICY NUMBER POLICY EFF M1DD POLICY EXP MMIDD LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE a OCCUR LBA16844200 /28/2012 /28/2013 EACH OCCURRENCE $1000000 DAMAGTo R2ff0 PREMISES Ea $100000 MED EXP (Arty one peen) $5000 PERSONAL 6 ADV INJURY $1000000 GENERAL AGGREGATE $2000000 GEML AGGREGATE LIMIT APPLIES PER X I POLICY PRO LOC PRODUCTS - COMP/OP AGG $1000000 BUPD Deductible $500 AUTOMOBILE LIABILITY ANY AUTO ALLOWNED SCHEDULED AUTOS HIRED AUTOS OS SOS Ea accident BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PRO DAMAGE $ UMBRELLA UAB EXCESS LIAR HCLAIMS-MADE OCCUR EACH OCCURRENCE $ AGGREGATE $ DED I I RETENTION s $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETORIPARTNERIEXECUTIVEEl OFFICER/MEMBER EXCLUDED? (Mandatory In NH) Ryes describe under DES6RIPIION OF OPERATI NS below NIA WC ST OTH- I EL EACH ACCIDENT $ EL DISEASE - EA EMPLOYEE $ EL DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, H more space Is required) City of Miami Shores Villas 10050 NE 2nd Ave Miami Shores FL 33138 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTH RDD REPRESENTATIVE A ©198&2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD