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EL-14-1989Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-219801 Permit Number: EL -9-14-1989 Scheduled Inspection Date: September 17, 2014 Permit Type: Electrical - Residential Inspector: Devaney, Michael Inspection Type: Final Owner: EMERSON, EDITH TYLER Work Classification: Alteration Job Address: 284 NE 102 Street Miami Shores, FL 33138- Phone Number (305)310-9607 Parcel Number 1132060134710 Project: <NONE> Contractor: LONGMAN ELECTRIC INC Phone: (305)758-1211 isunaing loepartment comments ADD 30 AMP OUTLET FOR ELECTRIC CAR CHARGER Infractio Passed Comments 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 16, 2014 For Inspections please call: (305)762-4949 Page 40 of 45 Miami Shores Village IR - Building Building Department SEP 112014 90050 N.E.2nd Avenue, Miami Shores, Florida 33138 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: Permit No. � ® I � � �. Master Permit No. City: Miami Shores County: Miami Dade Zip: Folio/ParceW1,4 1- � _ h%OL� 3i Is the Building Historically Designated: Yes NO Flood Zone: State: L1 Zip: 33 B a 9 Email: :W&'(60 ew e� Acys r1. Lx)" AS <.L;�e� CONTRACTOR: Company Name: � `�' Phone#: �65 -591 V I Address: t4L4 q Ne CT - City: M i 1JVaB State: � Zip: 3;5 Qualifier Name: Ml e_ qe-ig Lo ),,21cjel-I0rye Phone#: 305'? -I -g State Certification or Registration #: ) j 4P0 a /1,T_ertificate of Competency #: Contact Phone#: Email Address: (�N'1L1 V✓ILWi��2 t' Irl L (l I �ou� �1P DESIGNER: Architect/Engineen Phone#: Value of Work for this Permit: $ �!0 Oc ()Q Square/Linear Footage of Work: Type of Work: ❑Address ❑Alteration PNew ❑Demolition Descriptionof Work: � � �4�J j� ®�T� °�/' i�3L it e �z Submittal Fee $� Permit Fee $ 400, ° OP CCF $ 0 CO/CC $ Scanning Fee $ Radon Fee $ - • ® DBPR $ ` 2-5 Bond $ Notary $_ �j Training/Education Fee $ 0 'ZJO Technology Fee $ 0 S(3 Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ 0®q' 10 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 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 approv and a reinspection fee will be charged. i"•1 Signa Signaturef�, Owner or Agent Contractor The foregoing instrument was acknowledged before me this day of —(��, 20 J4, by QJA 11eLkL , who is personally known to me or who has produced_ As identification and who did take an oath. NOTARY PUB1JC: n Sign: CA—J vv Print: My Commission Ex ro PuW Stgw d Florida +I nemne FF X0341 t� § An49 APPROVED BY The foregoing instrument was acknowledged before me this h day of , 20.i�, byf,Aiie% .,.-- who isdgjjjall know o me or who has produced as identification and who did take an oath. Plans Examiner My Commission Ex fres: Notary Public State oFlarida Michelle PerYz Structural Review Clerk (Revised 3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09) AC ORD, CERTIFICATE OF LIABILITY INSURANCE°"TE@wMDI"M 0911112014 PRODUCER Phone: 407-86.1333 Pontell Insurance and Financial Group, Inc. THIS CERTIFICATE IS ISSUED AS, MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 1484 Tuskawilla Road Oviedo, FL 32765 HOLDER, THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. License #: P085436 INSURERS AFFORDING COVERAGE MAIC 8 INSURE) INSURER A Natimwide hwurw C8 compaw of Ameden 25M Longman Electric Inc INSURER B rasa I comomw 25682 844 NE 98th St INSURERC: Miami Shores, FL 33138-2533 INSURER D: INSURER I- 9- a THE 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDI POLICY EFFECTIVE POLICY EXPIRATION POLICY NUMBER EMITS A GENERAL LlaetuTY ACPS905107300 09/07/2014 09/07/2015 EACH o=RRENCE $ 2,000,000 X C�M1AMERCIAL GENERAL LIABILITY $ 100,000 CLAIMS MADE FXI OCCUR MED EXP (Airy one ) $ 5,000 PERSONAL & ADV INJURY $ 2 000 000 GENERAL AGGREGATE $ 2,000,000 GFN L AGGREGATE LIWT APPLIES PEI- PRODUCTS - Comm AGG $ 2,000,000 POLICY PRS LOC B AUTODMOsILE LIABILITY 03264540.0 09/07/2014 09/07/2015 COMBINED SINGLE LIMIT $ 1,000,000 ANY AUTO (Ea mxldmu) ALL OWNED AUTOS BODILY INJURY X SCHEDULED AUTOS (Per Ike) $ HIRED AUTOS BODILY INJURY $ NON40WNED AUTOS (Pm a-wmrt) PROPERTY )AMAGE(Peraodderd$ GARAGE LIABILRY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTOONLY: AGG $ EXIEBSARABRELLA LIABILITY EACH OCCURRENCE $ OCCUR F1 CLAIMS MADE AGGREGATE $ S DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION ANDWC sTATU- OTH- EMPLOYERS' LIABILITY ANYPROPRI£TORfPARTNEWEXECUTNE E.L. EACH ACCIDENT $ OFFICEWAIEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYE $ H d d S E.L. DISEASE - POLICY LIMIT OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS EC 13003713 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Miami Shores Village DATETHEREOF,TMEISSWNGINSURMWILLBmEAVORTOMAI- 30 DAYSWRITTEN P-305-795-2207 NOTICE TO THE CERTWICATE HOLDER RANTED TO THE LEFT, BUT FAILURE TO DOSO O SHALL 10050 NE 2 Ave DIPOSE NO OBLIGATION OR LIABILITY OF ANY KILT) UPON THE INSURER, ITS AGENTS OR Miami Shores, FL 33138 REPR` AT1 /` S. 25 (2001108) - — ©ACORD CORPORATION 1988 Pdnted by EMC on September 11, 2014 at 12:00PM SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Miami Shores Village DATETHEREOF,TMEISSWNGINSURMWILLBmEAVORTOMAI- 30 DAYSWRITTEN P-305-795-2207 NOTICE TO THE CERTWICATE HOLDER RANTED TO THE LEFT, BUT FAILURE TO DOSO O SHALL 10050 NE 2 Ave DIPOSE NO OBLIGATION OR LIABILITY OF ANY KILT) UPON THE INSURER, ITS AGENTS OR Miami Shores, FL 33138 REPR` AT1 /` S. 25 (2001108) - — ©ACORD CORPORATION 1988 Pdnted by EMC on September 11, 2014 at 12:00PM