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EL-13-1717I� Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-196209 Permit Number: EL -7-13-1717 Scheduled Inspection Date: October 29, 2013 Permit Type• Electrical - Residential Inspector: Devaney, Michael Owner: MERRILL, MARGUERITE Job Address: 141 NE 102 Street Miami Shores, FL 33138 - Project: <NONE> Contractor: ATLANTIC COASTAL ELECTRIC INC comments ADD RECEPTACLE FOR ENCLOSED AREA Inspection Type: Final Work Classification: Addition/Alteration Phone Number Parcel Number 1132060131830 INSPECTOR COMMENTS False Inspector Comments Passed Ea Failed Correction �G Needed Re -Inspection ❑ Fee No Additional Inspections can be scheduled until re -inspection fee is paid. Phone: (305)253-6425 October 28, 2013 For Inspections please call: (305)762-4949 Page 10 of 46 Miami Shores Village Building Department 10050 N.Elnd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 BUILDING PERMIT APPLICATION Permit Type: Electrical JOB ADDRESS: I L /C� FBC 20 JUL 3 1 2e!3 F;X3— .............�eoo Permit No. r I ) 5— ) -I I -I Master Permit No. e-" - el - 13 - 222 City: Miami Shores County: Miami Dade Zip: -5 3 Folio/Parcel#: Is the Building Historically Designated: Yes NO Flood Zone: OWNER: Name/(Fee Simple Titleholder): ��(/(-� 17C- l� �-��I Phone#: Address: -6 N� �� -ST- city: U14L AGC ®F NiAmt Sh t,126 ' State: L Zip: 3313 Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: 9?LAt±� /C 60'KT&C_�C % I Phone#: ,�05 3-4�az Address: �� `� --IzIke /01 C7 City: M [ A!"\ I- State: EL Zip: .3 3/v Qualifier Name: n State Certification or Registration #:C- C /�I "0- 2 3 Certificate of Competency #: Contact Phone#:'�0S 9 9 �/ 14Q ? Email Address: DESIGNER: Architect/Engineer- Value rchitect/Engineer Value of Work for this Permit: $ 02 3 oo Square/Linear Footage of Work: Type of Work: DAddress SAlteration ONew ORepair/Replace ODemolition Description of Work: Q D b 2!ec ac Fe'* OL.A h% � Submittal Fee $ Permit Fee $ 2 ®p CCF $ CO/CC $ Scanning Fee $ Radon Fee $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ DBPR $ Bond $ Technology Fee $ TOTAL FEE NOW DUE $ A3 % 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. Signaturex6la Signature Owner or Agent Contrac The foregoing instrument was acknowledged before me this ® The for oin instrument ym ackngledged be re m day of 0� 20 Gam, by pa i� day of 2 , by l► �I l -- d�4tG�, 1, L fr l I S who is personally known to me or who has produced_ who is p Hall known to me or who has produ �- • As identification and who did take an oath f� sdentification and who did take an oath. NOTARY PUBLIC: NO AR PUBLIC: c la B LLos t of Florida Sign: Sign "^ ' +�'' p 23.2015 Print - t Print: i;onun�ss,on EE Diary Assn. UV My Commission Expires: �SrVALVN � M Co io'!i "�°�,`` Bonded ro $� Notary Public, State of Florida y Commhaiorl# EE 167448 My comm. expires Feb. 7, 2016 zee /$ APPROVED BY ��e/�y Plans Examiner zoning Structural Review Clerk (Revised 3/12/2012)(Revised 07/10/07)(Revised 06/1012009XRevised 3/15/09) JAN. 2013 12:01PM Gulfstream Insurance No. 8324 P. 1 AGORD,. CERTIFICATE OF LIA13ILITY INSURANCE°ATE 07/30/2013 PROdUCER Gulfstream Insurance Agency, Inc. 5833 Johnson Street Hollywood FL 33021- THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE INSURED Atlantic Coastal x1ectric Inc. dba A-1 Atlantic Coastal Electric 17305 SW 109th Court Miami EL 33157-404 ►NSURmA:North Pointe Casualty Insurance INSUHIKEI: _ INSURER C. INSURER Q. • ..T. �� INSURER E. TI19 POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REOUIREMLNT, 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. I SR TYPE Or -INSURANCE POLICY NIJ&U ER POLICY EFFECTIVE POLIOY EXPIRATIONLTR LUdITS A r3FNER LUABILITY 3094117945 10/12/2012 10/12/2013 EAcaIOCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY ('MINI``; MADE FRO OCCUR I I I I FIRE DAMAGF (Any ww tire) $ 100,000 MED EXP (Any cu* i 51000 ro FU<X)NAL8AUvN,A— $ 1,000,000 GENERAL AGGREGATE S 2,000,000 GFM AGGHFFGATF I UT APPF IES PFR- X PODGY JEGT I.00 PRODUCTS rOMPIOP AGOG $ 2,000,000 Al ITOM*MLe 11ALITY ANY AUTO / / / / COMINNW SINGLE LIMIT (Ea aoddwm — ALL OV44M AUTOS SCHEDULED AUTOR / / / / OWLYINJURY HIKWAUIOS / / / I NON -OWNED AUTOS BOOILYINJURY (Pct xddeno $ MiOPERTYLAMAGE (Per =Wash S %RAGE LIABILITY _AUTO ONLY-EAACCIDENT S 4 ANY AUTO I I / / OTHER THAN EA ACC $ AU 10 OMY: AGO $ 9MCEBS LIADIM OCCUR ❑ CLAIMSMADERECIATC•�- / / / IH c,1MA fflRMj $ $ $ RETENTION 8 EVA!FM C�P�WTWN AND TyOY MI t P-.L.EACH ACCIDENI' $ C.L DISEASE - EA EMPLO $ E.L.OISEASE-POLICY LIMIT Is OTHER I / L -/ DESORPTION OF OPERATIOWLOCATIONSAM- IICL MEXCLUSIONS ADDED IiY ENDORSEMI N USPECIAL PROVISIONS fax#305-756-8972 12 - Miami Shores Village 10050 ATE 2nd Avenue Miami shores ACORD 26-S (7187) TN INS0253w.)m SHOULD ANY Of THE ABOVE 068001680 POLICIES BE CANCELLED BEFORE TM EXPIRATION OATS THEW", THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS wRnTEN NOTICE To THE OERTFFIOATE HOLDER NAMED TO no Uwr, BUT FAILURE TO DO 30 SHALL IMPOSE NO OPLIGAYION OR LIAIIILITY OF ANY IOND UPON THE ELECI'R6MC 1 A-XA FOI'.AAS. INC. (800)327 -MS CORPORA Page I o12 08/07/2013 11:56 3052359095 MANNY MIRANDA INS PAGE 02/02 CERTIFICATE OR INSURANCE Thi a titiles<tbra ❑ 8MATE FARM FIRE AND CASUALTY COMPANY, Bloomington, Illinois ' ❑ ;TATE FARM GENERAL INSURANCE COMPANY, Bloomington, Illinois ❑ STATE FARM FIRE AND CASUALTY COMPANY, Scarborough, Ontario �ttsukamc� ® $TATE FARM FLORIDA INSURANCE COMPANY, Winter Haven, Florida ❑ $;TATE FARM LLOYDS, Dallas, Texas insures the fbilovAnc polloyholderfor the coverages indicated below: Name of poliq lder A-1 ATLANTIC COASTAL ELECTRIC INC. J i Address of pollIcyholder 17305 SW 109TH CT Location ofoplorations MIAMI, FL 33157-4045 Description of operations 8usinesa Office The policies listed slow have ;been Issued to the policyholder for the policy periods shown. The Insurance described in these policies Is subject to all the tonins exciusiohs, and conditions of those policies. The limits of liability shown may have been reduced by any paid claims. POLICY PERIOD LIMITS OF LIABILITY POLICY NUM131R T1 PE OF INSURANCE Effective Data Expkean Dabs (at beginning of poll period) CoMprehensive BODILY INJURY AND _ -----• ------------ ------ Business Liabil ---- ---------------------- ------------------------------------- PROPERTY DAMAGE This insurance inolu es: Q roduots Completed Operations ❑ ibontractuai Liability ❑ lnderground Hazard Coverage Each Occurrence $ ❑ Nrsonal Injury ❑ Advertising Injury General Aggregate $ ❑ explosion Hazard Coverage ❑ Collapse Hazard Coverage Products - Completed E ❑ ' Operations Aggregate Q POLICY PERIOD BODILY INJURY AND PROPERTY DAMAGE $XCESS LIABILITY Effective Data ; MR*1ition oa6e (Combined Single Limit) Cj Umbrella Each Occurrence $ ❑ Other Aggregate $ Part 9 STATUTORY Part 2 BODILY INJURY 98 -BFI -14964-6 F WdrkeW Compensation 01/15/13 01/15/14 ardd Employers Liability Each Accident $100,000 Disease Each Employee $100,000 Disease - Policy Limit $500,000 POLICY PERIOD LIMITS OF LIABILITY POLICY NUMBER 7YIPE OF INSURANCE EtfBve Data expiiiation 17a* (at beginning of pollcy period) THE CERTIFICATE bF INSURANCE is NOT A CONTRACT OF INSURANCE AND NEITHER AFFIRMATIVELY N R NEGATIVELY AMENDS, EXTENDS OR ALTERS THE COVERAGE APPROVED BY ANY POLICY DESCRIBED HEREIN. If any of the described policies are canceled before Its expiration date, State Farm Will try to mail a written notice to the certificate holder 30 days before Name anti! Address of Certificate Halder cancellation. If hoWver, we fall to. mail such notice, no obligation or . rability will be im osed on State MIAMI SHORES VILLAGE Farm 0 pre tatives. 10050 NE 2n" AVE 142ANlI SHORES, ?L 33138 S' n9ft a of uthofted Representative AGENT 08/07/2013 FAX: 305-756-89 2 Title Data Agent's Code Stamp AFO Code F600 658-894 0 04.1999 Print Id in U.S.A, AC# .6 2 7 5 5 0$ STATS OF FLORIDA DBPARTI�EXT ppg BIISINESS AND PROFESSIONA% REG EL;C�FLIGAL CONTRACTORS LICENSING BOAR DATE BATCH NUMBER -.. SEM L1208160232 GOVERNOR REN LAWSON DISPLAY AS REQUIRED BY LAW SECRETARY THIS IS NOT A BILL — DO NOT PAY FIRST-CLASS U.S. POSTAGE I PAID MIAMI, FL PERMIT NO. 231 206889-8 RENEWAL BUSINESS NAME / LOCATION RECEIPT NO. 217646-9 A 1 ATLANTIC COASTAL ELECTRIC INC STATE# EC13002593 17305 SW 109 CT **** 33157 UNIN DADE COUNTY OWNER A 1 ATLANTIC COASTAL ELECTRIC IN Sec. Type of Business WORKER/S THIS IS WA&CTRICAL CONTRACTOR 2 BUSINESS TAX RECEIPT. IT DOES NOT PERMIT THE HOLDER TO VIOLATE ANY NN6RREGULATORY OR nWSOTHDO NOT FORWARD COUNTY OR CITIES. NOR DOES IT EXEMPT THE HOLDER FROM ANY OTHER PERMIT OR LICENSE REQUIRED CATIOW. N of NOTA CERTIFICATION A 1 ATLANTIC COASTAL ELECTRIC INC TIOOLDER'8 DuauwcA• NS.RIMANTAS A PAUZUOLIS PRES PAYMENT RECEIVED 17305 SW 109 CT M IAMI•DADE COUNTY TAX MIAMI FL 33157 COLLECTOR: 60130000224 iM.IIMMMIt:I,M11M1�1,iMM,i�i>>11i�IMJ,Mi�i,lMt1M,MM1�1�MM1L! 000075:00 75 SEE OTHER SIDE