DEMO-13-1768Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-196659 Permit Number: DEMO -8-13-1768
Scheduled Inspection Date: July 25, 2014 Permit Type: Demolition
Inspector: Devaney, Michael Inspection Type: Final
Owner: WILLIAM J. JURBERG, R. ANDREW DE Work Classification: Electric
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Job Address: 9350 NE 12 Avenue
Miami Shores, FL 33138 -
Phone Number (305)609-3851
Parcel Number 1132050070150
Project: <NONE>
Contractor: HIGHGRADE ELECTRIC CONTRACTORS CORP Phone: (305)576-8807
comments
DISCONNECT UTILITY POWER TO MAIN HOUSE PANEL -
INSPECTOR COMMENTS False
Passed
Failed
Correction a
Needed
Re -Inspection ❑
Fee
No Additional Inspections can be scheduled until
re -inspection fee is paid.
Comments
40 "�L
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July 24, 2014 For Inspections please call: (305)762.4949 Page 2 of 31
Miami Shores Village D
� di3 rl���
Building Dep AUG 0 5 tDepartment �.
10050 N.E.2nd Avenue, Miami Shores, Florida 33438 �� oov000a000
Tel: (305) 7952204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 7Q4949
BUILDING
PERMIT APPLICATION
Permit Types Electrical
FBC 20
Permita ? I 1
Master Permit No.L� ------
JOB ADDRESS:
City: Miami Sl es County. Miami Dade
Folio/Parcel#• i - S20 S'. o v ro l s7o
Is the Building Historically Designated: Yes
N
OWNER: Name (Fee Simple Titleholder): P, ° AAS~` -�-,• 4 s Phi:�-
Address• � � � � � � .. �� �;
City 1 t -� State: _ l ,, i Zip:
Tenant/i esu Dame:
Email:'``
CONTRACTOR: Company Nam:f� , 7 e
Address: r°
City ./ ' State: Zip:
Qualifier Name: i � ,� phone#:4,,5 , 2 .
State Certification or Regisftfion #: Certificate of Competency #: e'
Cor�taet Phone#: � , s ` , `) Email Address: ` 01ZA 4 0 A U , , ,
DESIGNER: Architect/Enomr. Phsaae�#:
I I>
Velma of Work !or thfs Per-':•. " • '...
Type of Work: ®Address
Description of Work:
��w,r*,r,���w+t,oe��,s,irw,x+r,k,�sa*�.air«�►F�*,Hr.���ark�rw�r,r�srarw+�wa��r��x.hair*abeaar,Yar,�aa,►t�r�
Submittal Fee $---- Permit Fee $ ,� ��® CCF $. COICC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $
Double Fee $ Structural Review $
Technology Fee $
TOTAL FEE NOW DUE $ 114. CaU
Bonding Company's Name (if applicable)
Bondifig: t';otitpany's Address
City
State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
Zip
City State Zip
Application is hereby trade to obtain a permit to do the work and installations as indicated. I certify that no work or installation has
commenced prior to tate issuance of a permit and that all work will be performed to meet the smudards 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.
"WARMING 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 certiled copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (i) days after the building permit is issued. In the absence of suc posted notice, the
inspection will not be approved and a ret pection fee will be charged.
Signature Nom` Signature
Owner or Agent
The foregoing ' was acknowledged before
day , 2oL1,by 9
is personally 1 to me or who has produced.
As klentification and who did take an oath.
Sign:
Print:
My !Commission Expires:
APPROVED BY
MARTIN J. PALMER
Notary Public - State of Florida
My Comm. Expires May 23, 2016
National Notary Assn.
The foregoing instrument was acknowledged before me this,L
^
day of n/ 20 8,. by
who is personally known to the or who has produced
as identification and who did take an oath.
,7,gP/. X
Plans Examiner
NO
Sig,
Prin
My
Zoning
Structural Review Clerk
(Rv*W 3172t2t112XRevised 071io/07pevised 0600/2M9)(Revised 3115109)
07/03/2013 13:40 3058200670 MutualInsuranceQroup #3247 P.002/005
•I DATE (NIlRIE
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_CERTIFICATE..! F LIABILITY INSURANCE l o7i—W
PRODUCER Mutual Insuranoe Group of Florida THIS comFiCATE IS ISSUED AS A MATTER OF INFORMATION
5580 W.16th Avenue, Suite #105 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE �
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
Hiialeah, FL 33012 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW -
Phone (3055) 820.0600 _ - Fax (306)82 0-070 INSURERS AFFORDING COVERAGE NAIC N
INSURED Hlghgrade Electric Contractors Corp INsuRERA.-. ASCENDENT COMMERCIAL INS
3613 Southwest 167 Ave INSURER B: —
Miramar, FL 33027- 'esu'—.��_____ _....._
(786) 357-8728 It SURM D
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COVERAGES .... —_. _.--•—•-•---.__ _._.. _._ _
THE POLICIES OF INSURANCE LISTED NAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INpICATF6. • NOTWnItSTANDING
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 DESCRBBED HEREIN I$ SUBJECT TO ALL THE TERMS, EXCLUSION$ AND CONDITIONS OF SUCH
POLICIES AGGREGATE LWO SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
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EACH OCCURRENCE $5001000.00,
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❑ GENEtrALAGGREGAiE _1,000,000.00
GEWL AGGREGATE LIST APPLIES PER: PRODUCTS - COMPIOP AGG 1,�O�Ot30.Of
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-----.-. _
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS—ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS
CERT RCATE HOLIJE
City of Miami Shores
I OM North East 2nd Avenue
Miami Shores Village, FL 33138
FaxlrM&t55. =
- _J
CANCELLATION
SHOULD ANY OF THC ABOVE DESCRIBED POLUCES SE CANCELLED MMORe THE
EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO W&
DAYS WRITTEN NOTICE TO THE CEIRrIFICATE HOLDER NAMED TO
jTHE LEFT. Ma FAILURE TO DO SO SHALL MOOSE NO OBLIGATION OR LWIRCrY
I OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATNES.
AUTHORIZEDFEFACOZn
Brien McLa
- TION. All rigt'its reserved.
The ACORD naMS and 1090 SM regl3tered mares of ACORD
07/03/2013 13:41 3058200670 MutualInsuranceGroup
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PLEASE CUT OUT THE CARD;,SELOW AND RETAIN FOR FUTURE REFERENCE
STATE OF
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IMPORTANT
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Pursuant to Chapter 440Oii{14). f.S., an officer of a corporation who
CW&j tI ION INDLW RY
efeots exemption from this chapter by filing a certificate of election
CotnFICATE OF ELEMM TO BE iEXBOPT PROM FLOC
I- wader this section may not recover benefits or compensation under this
YYOfUcEW COMPMMTION LAW
0 chapter.
�FECT Ve 08/02/2414 EXPIRATION DATE:
O8/01/2O13
' Purviant to Chapter 440.05 12}, F.S.. Certificates of election to be
pERSM t4ELSQ1'i A PALMA
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H exempt. apply only within the $Cope of the business or trade listed on
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R the notice of election to be exempt
BUSNNESS NALIE AND ADDRESS:
Pursuam to Cit wr 440.05(13), F4, Notices of election to be exempt
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and certificates of election to be exempt shall be subject to revocation
3613 W 157 AVE
if, st any time after the filing of the notice or the 1ssumCe of the
MRAMAK FL 33027
certificate, the person named on the notice or certificate no longer meets
SCOL OF BUS EM OR TRADE
the requirements of this section for issuance of a certificate. The
deparmietit shall revoke a certificate at shy time for failure of the
person named on thtD certificate to most the requirements of this
section.