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EL-14-1702Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-220345 Scheduled Inspection Date: September 29, 2014 Inspector: Devaney, Michael Owner: CARR, JOHN Job Address: 246 NE 101 Street Miami Shores, FL Project: <NONE> Contractor: PENCE HEATON ELECTRICAL CONTRACTING INC tfui comments Permit Number: EL -8-14-1702 Permit Type: Electrical - Residential Inspection Type: Final Work Classification: Alteration Phone Number Parcel Number 1132060134630 Phone: (954)961-8005 SERVICE UPGRADE EXTERIOR METER CHANGE OUT I ""'"""" r000ou v"111111 ILM INSPECTOR COMMENTS False Inspector Comments Passed CREATED AS REINSPECTION FOR INSP-220205. Need inter system 1Z bonding termonal.AC Failed 912, Correction ❑ �� ® Needed Re -Inspection ❑ Fee No Additional Inspections can be scheduled until re -inspection fee is paid. September 26, 2014 For Inspections please call: (305)7624949 Page 22 of 29 BUILDING 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 PERMIT APPLICATION Permit Type: Electrical Mg,o 6 Z FBC 20 �0 Permit No. f'u -` — )-702- Master -702` Master Permit No. JOB ADDRESS: 2_+ 6 N C 1 ®k S'� S -rC2CC T City: Miami Shores County: Miami Dade Zip: :3 l Folio/Parcel#: 1 - 3 2 DC - ©1 34-6 Is the Building Historically Designated: Yes NO ✓ Flood Zone: OWNER: Name (Fee Simple Titleholder):® H. IU 'P &QJ_ /G h(tSLR Phone#:�"J®S� Address:_ 2 q- 6 N C 1 o I S k STP -4--6-7 C Pt city: Nt l F- M ( !S H n 2'C S' State: Fl- zip: 3 3 13 Tenant/Lessee Name: IV ZA; Phone#: Email: Address: City: 9 /A(q� State: Zit): D Qualifier Name: &14,1 Z i Phone#: i 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 commenceinent must be posted at the job site for the first inspection which occurs seven (7) days a er the building permit is issued. In the absence of such posted notice, the inspection will not be 4rove a reinspe ' n fee will be charged. Owner or Agent Contractor The foregoing ' trumentVwas acknowledged before me this The foregoing instrument was acknowledged before me this, AJ day of �( CJ ; 20' -I , by 5 day of U.S � , 20LY; by Q A,t S • 0�'i , who is personally known to me or who has produced_ _h �sersonall kn ' me or who has produced As identification- and who -did take an oath.. as identification and whq did take an oath. NOTARY PUBLIC: Sign: Print: My Commission Expires: o • _ iii/`s '' ° ..... • •'�� M1` APPROVED BY Plans Examiner Structural Review (Revised 3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09) NOTARY PUBLIC: Sign: G d+o/I 4 a//((' Print:. J; Z &Ika My Commission E - * ELIZABETH A. FOX Notary Public - State of Florida MY Comm. Expires Apr 20, 2016 Bonded Through National Notary Assn. Clerk STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD (850) 487-1395 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 HEATON, PAUL S JR PENCE & HEATON ELECTRICAL CONTRACTING, INC. 5715 TAFT ST HOLLYWOOD FL 33021-4528 Congratulationsl With this license you become one of the nearly one million Floridians licensed by the Department of Business and Professional Regulation. Our professionals and businesses range from architects to yacht brokers, from boxers to barbeque restaurants, and they keep Florida°s economy strong. Every day we work to improve the way we do busI66ss in order to serve you better. For infomration about our services, please log onto www. myllorldalicense.com. There you can find more information about our divisions and the regulations that impact you, subscribe to department newsletters and loam more about the Departments Initiatives. Our mission at the Department is: License Efficiently, Regulate Fairly. We constantly strive to serve you better so that you can serve your customers. Thank you for doing business in Florida, and congratulations on your new license! DETACH HERE RICK SCOTT, GOVERNOR _ KEN LAWSON, SECRETARY 1Qm Icn- n7MMIe MAN "AM RF®UfRED BY LAW SEA # L140722DOD1532 1 4 08/06/2014 10:18 9549890038 PENCEANDHEATON PAGE 02/02 producer; Lion Insurance Company 2739 U.S. Highway 19 N, Holiday, FL 34691 (727) 938-5562 Irreur+ed: South East Personnel Leasing, Inc. & 2739 U.S. Highway 19 N. Holiday, FL 34591 4Nih re&pect Ou vdtitl! Otis �4Cate nW be haled or no`w= soave tae the I li l shwm �y neve been raduWd M Pidd del= r Psrtain the Naurance effnrdcW hr IN$IZ AWL LTR INBRo Type of Insurance COmmerc)A,I eSnSral Liability 3 Claims Made 13 O=ur eras aggregate limit applies W. P'Qq' ❑ Pmjmr a LOC LlasiuTy Ally Auld All Owned AWN Scheduled Aut= Hued Atttoa MOr-Owned Autos EXCESS/UMBRELLA LiAB1t, W Odour 1:1 +28tnrs Made Deductible This Cede is h=aul as a maw of InforrrMum only and colift no e abw"WCefWCatB Holder: TMs C�ftrabe does notamer4 extend ao,wrage allordled bythepalidles hetow. Insurer Policy Number Poticy�Etiaaive insurers Affiording Coverage, A Workers Compensation and W071049 01/01/2014 01/01/2016 Employers' Liability Any y p -p7 �/ /ext=V" WON/member No li Yes, d"ofbe under special prao-torts below. ate terms, eakdwom, Urnits Earn Ocornenae ftme oocw )en►�p�"�(s c nrs4 Pereenal Adv Injury Genevan Aggregate Products. Camp/op Ago C-Vned SirVe Lim;= (EAAodderd) (per Person) Bodily I*ry (PerAcdderd) pa"dy Ogmage Each Camnorm A89fep(q WC stag. I I OTH- Aggregate EL EachAccideni S1,000ttoo E.L. DPseaw - Eel Employee $1.000,000 Ogler E.L. Dlve,m - Policy mnitg $4 an ru Linn iflSuranCe Compimy IS A.M. Basi gqTppy labed A- (EjcceRent. AMB # ] Desorrptions of aparationslLocatlonsNehicfewExclusions added by Endorsemant/Spoe;al Provisions: CovSrdge only appge9 to active eMplayee(s) of South East Personnel Leamg, Irtc. S. Subslttartes tial ate I OtWt 1D: 91.67.169 eased to IM roltowhV "Client �npaw: Pena® And Heatpn EWarfew hm Covera9e only applies to injudes incurred by South EaA PErsannel Leasing, ire. a subodtaries active empioyg#(s., while warieing In:FI,. �m9e does not apply m stausoty employees) or Indepenant comb adur(s) of tNe Uietrt Company or any outer hlie A list Of: NC acIlme; employees) leased m the Brent Company can be obtau►ed by ftdng a request tip (727) 937.2138 or by calling (7M 938-5562. 1projed ltilAlrre: ISSUE 10-08.13 (MT) / Raismed 12WIS (SH) BUILDING DEPARTMENT 1005 NE 2ND AVE MIAMI SHORES, FL 33138 o... W aurora are tagnreaan cele VMMf, the I=gng do so,a , endeavor ro mail so ri8ys writer nogaa fo=rte oertdiagte hander narnea fo fie Ie$, bun f$tlwe to Beam ti ll impose no obligation or IIaD)Rry 0r any tams upon ft inetasr. Its agents or WP»ssrrtatiVW. » .r.te--7 3+ vII=Mr. A-nwm ACORD. CERTIFICATE OF LIABILITY INSURANCE BATH( 6127/2014 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). AUTHORED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the carMete holder Is an ADDITIONAL INSURED, the pollcy(les) must be endorsed. K SUBROGATION IS WANED, subject to the terms and conditions of the policy, certain Policies may require an endorsement. A statenrent on this certificate does net confer rights to the certificate holder In Mur of such endorsement(s). PRODUCER Cypress Insurance Group Joyce Simpson 954 771-0300 R„ . 954 77Z 9424 PO Box 9328 E S&Cypressindwrance.Corn Fort Lauderdale, FL 33310-9326 INSUREM AFFOADtNeGOYERAGE NAIL# 954 771-0300 INSURERA: Travelers Insurance Co INSURED Pence & Heaton Electrical Contracting, Inc. 5715 Taft Stmt Hollywood, FL 33021 INSURER B : INSUIsERC: o: INSURERS. INSURER F n/MMnAkfIC0 eca"MPATM MIIYRRR• R1--VM1UN NIJNnew. 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 CONTRACTOR 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. ,SHOULD 0�TM DA DESTHEREOF ED � �y CANCELLED DELIVERED BEFORE TYPE OF INSURANCE ACCORDANCE WITH THE POLICY PROVISIONS. 10850 WE 2nd Avenue POLICY NUMBER AUTH09MM REPRESENTATIVE OEM LEM A GENERAL unsuff X COMMERCIAL GENERAL LIABILITY a"SMNW a OCCUR + 16NIIA962877TCT14 07IM2014 0710812015 EACH occuRRENcE $1,000,000 oaxtmaroe $1 ,000 MED EXP (Any ori pw=) $5 660 PERSONAL & ADV INJURY $1,09,000 GENSML AGGREGATE s2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER POLICY M LOC PRODUCTS - COMP/OP AGG s2,000000 $ AI JTOMpRA G DpgRy ANYAUTO ALL OWNED SCHEDULED AUTOS NON -O NED HIRED AUTOS AUTOS COMBINED SINGLE LFMIT BODILYRUJRY(Perperson) $ BODILY INJURY (Per edit) $ ==DAMAGE $ a USA LIAS EXCESS LIAR OCCUR CLAIMSMADE EACH OCCURRENCE $ AGGREGATE $ DED I I RETENTION $ WO 7ION AND EMPLOYERS' LIABILITY AINY P QRIPAt LMUMDE "? YIN CIi�FtCERfAAEMBER EXCLUDED? � ( fiff"Ory to NH) OE3C� RIPT OF OPERATIONS bel. N / A %STATU OTH EL EACH ACCIDENT a EL DISEASE - EA EMPLOYEE $ EL DISEASE - POLICY LIMIT $ DE8CRiPTiON OF OPERATIONS T LOCATIONS! VEHICLES (Aflaah ACORD 707, AddWarad Remeft Schad l% If more spa= is n Electrical Contractor wre'r&M^Ax ueu nCe f-Ahle=1 I A'PInM Village of Miami Shores Bldg ,SHOULD 0�TM DA DESTHEREOF ED � �y CANCELLED DELIVERED BEFORE DepL ACCORDANCE WITH THE POLICY PROVISIONS. 10850 WE 2nd Avenue AUTH09MM REPRESENTATIVE Miami, FL 33138 ©19N8.2010 ACORD CORPORATION. All rights reserved ACORD 25 (2010f0M 1 of 1 The ACORD name and logo are registered marks of ACORD OSIS152WM181431 CAT