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EL-13-1296Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-220343 Scheduled Inspection Date: October 01, 2014 Inspector: Devaney, Michael Owner: PEARSON, LEONARD Job Address: 246 NE 103 Street Miami Shores, FL 33138-2431 Project: <NONE> Contractor: A CUSTOM ELECTRIC SOLUTION INC t3 comments REINSTALL VARIOUS OUTLET IN BEDROOM AND BATH Expiration date 1/5/2015 - based on last approved inspection Permit Number: EL -6-13-1296 Permit Type: Electrical - Residential Inspection Type: Final Work Classification: Alteration Phone Number Parcel Number 1132060134880 PLAN REVIEW COMMENTS False INSPECTOR COMMENTS False Phone: (954)868-6809 Inspector Comments Passed CREATED AS REINSPECTION FOR INSP-209452. CREATED AS 1Z REINSPECTION FOR INSP-209450. Electrical permit dated 9 march 1972 states that a 200 amp service was to be installed. At that time the electric meter was not replaced and it is only rated at a maximum of 100 amp. The Failed ❑ receptacle that is required between the closet and bathroom doors is not installed. 25 sep. 2014 No access to inside. Correction ❑ Needed Re -Inspection ❑ ���®/� Fee No Additional Inspections can be scheduled until re -inspection fee is paid. September 30, 2014 For Inspections please call: (305)762-4949 Page 25 of 41 Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 j u N 10 2013 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 FBC 201 Z) BUILDING PERMIT APPLICATION Permit Type: Electrical Permit No. F�l -3', Z�t� Master Permit No. f— C 1'* "� 12,1 JOB ADDRESS: 144, ° E_�_ ` D -b SIT2_ City: Miami Shores County: Miami Dade Zip: 33 1-3q Foho/Parcel#: Is the Building Historically Designated: Yes NO >--' Flood Zone: OWNER: Name (Fee Simple Titleholder): LQ>jAra) o e -S®l� Phone#: Address: 7--Lf� F -it 10 '�_' IST Vt__. City: At AtA 4 State: fi-1- Zip: Tenant/Lessee Name: tdlu Phone#:lea pss'5. Email: k -7-75:x-, S -`'- 6Lu.' l . 1 CONTRACTOR: Company Name: L �j%!tel � CT��CieL LZz e hone#: Ary F1119- 49b-� Address: 11C`1:96 A114d ; Ae City: C4eA.A jSe- State: 1�L zip: .333 S_/ Qualifier Name: be&_k C AGV ;4-/ N6_GL I Phone#: State Certification or Registration #: ZZ Certificate of Competency #: Contact Phone#: Email Address:. DESIGNER: Architect/Engineer: Phone#: Value of Work for this Permit: $ ®Z� Square/Linear Footage of Work.: Type of Work: ❑Addressalteration ONew ORepair/Replace =-UlDemolition ,n n Description of Work: Submittal Fee $ �� Permit Fee $ CCF $ CO/CC $ Scanning Fee $ Radon Fee $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ DBPR $ Bond $ Technology Fee $ TOTAL FEE NOW DUE $_j ' 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. .4 e IMP 41& `% 'IT' Signature •or Agent The foregoing instrument was acknowledged befe th�i�s day of = 20 f - by AA►� �G , y�bo is 12manally known to me or who has produced and who did take an oath. NOT. G MENZEL Sign: Print: My Commission Expires: The foregomp instrument was acknowledged before me this day of 2013 , by , who is personally known to me or w o rd10 �m i3 APPROVED BY Plans Examiner Structural Review (Revised 3/12/2012)(Revised 07/10/07)(Revised 06/10/2009XRevised 3/15/09) as identification and who did take an oath. My Cbibmission Expires: CARLOS G MENZEL i Public - State of Florida r)pr!Axpires Apr 5, 2014 Zoning Clerk DATE (MMIDDNYYY) CERTIFICATE OF LIABILITY INSURANCE 6/2412013 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), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy (les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: POLICY EXP (MM/DDIYYYY) PHONE 1-800-277-1620 x4800IFAX 727-797-0704 (AIC, No, EM): (A/C, No): E-MAIL ADDRESS: FRANKCRUM INSURANCE AGENCY, INC. 100 S. MISSOURI AVE. INSURERS AFFORDING COVERAGE NAIC# CLEARWATER FL 33756 INSURER A: FRANK WINSTON CRUM INSURANCE CO. 11600 INSURED INSURER B: INSURER C: COMMERCIAL GENERAL LIABILITY FrankCrum 1-800-277-1620 INSURER D: 100 S MISSOURI AVENUE INSURER E: CLEARWATER FL 33756 INSURER F: 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 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR LTR TYPE OF INSURANCE INSR SUBR WVp POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MM/DDIYYYY) LIMITS GENERAL DABILMY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Ea occurrence) $ MED EXP (Any oneperson) $ CLAIMS -MADE OCCUR PERSONAL B ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: n lav n�aa o0 PRODUCTS - COMP/OP AGG $ AUTOMOBILE LIABILITY COM INED SINGLELIMIT (Ea accident) $ BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Par accident $ NON -OWNED HIREDAUTOS AUTOS HCLAIMS-MADE $ UMBRELLA UAD OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS DAB OED RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERIETOR/UTY YIN ANYPROPRIETOREXCLUER/EXECUTIVE Irllut�l OFFICER/MEMBER EXCLUDED? N/A WC201300000 1/1/2013 1/1/2014 WO STR X TORY LIMITS EERMIT _ E.L. EACH ACCIDENT $1000,000 (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - EA EMPLOYEE $1,000,000 E.L. DISEASE - POLICY LIMIT $1000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) EFFECTIVE 08/15/2011, COVERAGE IS FOR 100% OF THE EMPLOYEES OF FRANKCRUM LEASED TO BUILDIN nNCPPrc nF s 1=1 ORI_.,DA CORP. (CLIENT) FOR WHOM THE CLIENT IS REPORTING HOURS TO FRANKCRUM. COVERAGE IS NOT EXTENDED TO STATUTORY EMPLOYEES. ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 26 (2010/05) The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. MIAMI SHORES VILLAGE 10050 N.E. 2ND AVENUE AUTHORIZED REPRESENTATIVE MIAMI SHORES, FL 33138 ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 26 (2010/05) The ACORD name and logo are registered marks of ACORD A`CORO w CERTIFICATE OF LIABILITY INSURANCE DATE /24/2013 6(2412013 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), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy (les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NA.E: PHONE 1-800-277-1620 x4800 727-797-0704 (A/C, No, Ent): I. No): E-MAIL ADDRESS: FRANKCRUM INSURANCE AGENCY, INC. INSURERS AFFORDING COVERAGE NAIC# 100 S. MISSOURI AVE. INSURER A. FRANK WINSTON CRUM INSURANCE CO. 11600 CLEARWATER FL 33756 INSURED INSURERS INSURER C: INSURER D: FrankCrum 1-800-277-1620 INSURER E: 100 S MISSOURI AVENUE INSURER F: CLEARWATER FL 33756 UUVEKAGES CERTIFICATE NUMBER: 226915 REVISION NUMBER: 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 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER (POLICY POLICY EFF POLICY EXP (MM/DD/YYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED COMMERCIAL GENERAL LIABILITY PREMEa ISES occurrence) $ MED EXP (Any one erson $ CLAIMS -MADE =OCCUR PERSONAL B ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: ov r wwr PRODUCTS - COMPIOP AGG $ COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY (Ea accident) BODILY INJURY (Per person) $ I—AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ NON -OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS (Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS DAB CLAIMS -MADE DED I RETENTION $ $ I A WORKERS COMPENSATION AND WC201300000 1/1/2013 1/1/2014 ER X TORY LIMITS T EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? NIA E.L. EACH ACCIDENT $1000,000 (Mandatory In NH) If yes, describe under E.L. DISEASE - EA EMPLOYEE $1,000,000 DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS /VEHICLES (Attach ACORD 101,AddHional Remarks Schedule, if more space is required) EFFECTIVE 08(15/2011, COVERAGE IS FOR 100% OF THE EMPLOYEES OF FRANKCRUM LEASED TOB ILDING CONCEPTS nF S Ej QaLDA TORP (CLIENT) FOR WHOM THE CLIENT IS REPORTING HOURS TO FRANKCRUM, COVERAGE IS NOT EXTENDED TO STATUTORY EMPLOYEES. UEKTIFICATE HOLDER CANCELLATION ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. MIAMI SHORES VILLAGE AUTHORIZED REPRESENTATIVE 10050 N.E. 2ND AVENUE MIAMI SHORES, FL 33138 ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD