RC-13-1531 (2)C
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Miami Shores Village CEIVIEDU
Building Department MAY 1 4
1005V,.E.2nd Avenue, Miami Shores, Florida 33138
: (305) 795.2204 ax: (305) 756.8972 "'-
INSPECTION'S PHONE NUMBER: (305) 762.4949
FBC 20
BUILDING Permit No. ��` ! - �� •�'�
PERMIT APPLICATION Master Permit No. c Ci YA
Permit Type: Electrical
JOB ADDRESS: ��/Aw
City: Miami Shores County: Miami Dade Zip: ���� tP
Folio/Parcel#:
Is the Building Historically Designated: Yes NO Flood Zone:
OWNER: Name (Fee Simple Titleholder):�� � tie's / Phone#: 3 � -
Address: �v2 & 2
City: '�/�[/ State• L Zio:
Tenant/Lessee Name: Phone#:
Email: 141_ ad /Cd>"
CONTRACTOR: Company Name: L ` P1 Ga 114 rI tCG-r t'c I C04- n - Phone#: 595-1665-1 j
Address: Q • t30'C 1011 Q O H
City: to M o0L 44 t State: 0 zip:..:k 3 Z tj
Qualifier Name:
State Certification or Registration #: .- L3cio (j, (t I Certificate of Competency #:
Contact Phone#: 78 moo- H (2 -26 3 8i Email Address: aheci I in(gyp r"tT='. - ' ein- o o eoyy
DESIGNER: Architect/Engineer: Phone#:
Value of Work for this Permit: $S Q O . 00 Square/Linear Footage of Work:
Type of Work: ❑Address ❑Alteration ❑New 93Repairr/Replace ❑Demolition
Description of Work: 2 t2 Pe_- 2 zF--,& 2-=-,- IA2�' �� i n
Submittal Fee $�� ° Permit Fee $ ®S !:' e,0 ,0 CCF $ CO/CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training(Education Fee $ Technology Fee $
Double Fee $ Structural Review $
TOTAL FEE NOW DUE $
* ! 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 commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. Int absen of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature Signature �` "��� 4 sw / /
Owner or Agent Contractor
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
day of20, by ���✓� day of 120 1, byZ�H'2 k► n1 I�Cz
who is personally known to me or who has produced f- 1 J::) who is personally known to me or who has produced �— 1
As identification and who did take an oath. as identification and who did take an oath.
�ti�uniirwri
NOTARY PUBLIC:
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NOTARY PUBLIC:
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Sign:
Print:
Print
My Commission Expires:
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My Commission Expires:
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cad.: c,•.�
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APPROVED BY.-,, " .li
%�ff�,Y Plans Examiner
Zoning
Structural Review Clerk
(Revised 3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09)
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Inspection Worksheet°
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-216355 Permit Number: EL -5-14-982
Scheduled Inspection Date: July 24, 2014 Permit Type: Electrical - Residential
Inspector: Devaney, Michael
Inspection Type: Final
Owner: ENCARNACION, SHIRLEY Work Classification: Alteration
Job Address: 1125 NE 92 Street
Miami Shores, FL 33138 -
Phone Number
Parcel Number 1132050270380
Project: <NONE>
Contractor: LINCOLN ELECTRICAL CONTRACTOR INC Phone: (305)694-1616
suiming ueparltment comments
2 GFCI OUTLET & 2 SWITCHES IN BATHROOM Infractlo Passed Comments
INSPECTOR COMMENTS False
Inspector Comments
Passed
Failed
Correction
Needed �" C
Re -Inspection ❑
Fee
No Additional Inspections can be scheduled until
re -inspection fee is paid.
July 23, 2014 For Inspections please call: (305)762.4949 Page 25 of 34
05/13/2014 7:34 AN FAX + IM 0001/_0001
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ACO
I)ATJY rJataraOJYYYYI
C> CERTIFICATE OF LIABILITY INSURANCE 04/02/2014
THIS CERTIFICATE IS ISSI ED INS -A MA *OF-y,�',�U,4FORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES l4gT.AFftit{�MAThEELY' Oft TYCGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW, THIS -EERTIFICATE••Or�,1 5URAN*F- DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND -11411 CERTIFICATE HOLDER, ----
IMPORTANT: If the certincate holder is an ADDITIONAL INSURED, the pollcypes) must be endorsed. It SUBROGATION IS WAIVED, subject to
the terms and conditions of the policy, certain pollcias may require an endorsement. A statement on this Ceriltic9te does not confer rights ca the
rnrtlflratf+ hnider In lieu of such endorsement(s).
PROWCEN
nsuranov marxet Place LLC
Z801 SW College Rd Suite 3
Ocala, FL 34474
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ap 352.237-2700 — T I 352.237.5884
SARTOW
INSUkERIS! AFFORDING COVERAGE
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INauaER A; Federated National Insurance-
INSUREU Lincoln Electrical Contractors
INIrur{LR u Florida Citrus Buslnoss & Ind
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PO Box 611004
I North Miami, FL 33261
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04SCRIPTiON OF OPERAMON5.1 LOCATIONS I VEHICLES (ACORD 101, Adahlonal Ramafka 50hodole, may be aaaahod If Moro SPOre In required)
E3>�rdha Niraroosi 'is axaluded from workers Compensation.
l,lacrisu B CIC -13001591 '
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C!LR'I•IFICAT.= HOLDER — ,,,, CANCELLATION
Miami Shores Village SHOULD ANY OF TME ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Building 0cpartment THE EXPIRATION DATC THERCOF, NOTICE WILL DE CELIVEREO IN
100SO N.E. 2°d Ave ACCORDANCE WITH THE POLICY PROVISIONS.
Miarni FI, 33138 `
Fax : 30S-756-8972 AUTHORMCD k8PRE5ENTATIVIC
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to 1983.2014 ACORD CORPORATION, All rights rescrvad.
(CORD 25 (2014101) The ACORD name and logo are registered Marks of ACORD