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DEMO-14-25005 L `t ' /�z_x Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-223817 Permit Number: DEMO -11-14-2500 Scheduled Inspection Date: November 25, 2014 Permit Type: Demolition Inspector: Devaney, Michael Inspection Type: Final Owner: WEBER, STEVEN & VIRGINIA Work Classification: Electric Job Address: 1214 NE 92 Street Miami Shores, FL 33138 - Phone Number (631)379-8547 Parcel Number 1132050270480 Project: <NONE> Contractor: GODLY ELECTRICAL SERVICES Phone: (957)560-4234 comments DEMO 2 OUTLETS FROM BACK WALL INSPECTOR COMMENTS False Inspector Comments Passed CREATED AS REINSPECTION FOR INSP-223369. Need G F I protected Izf receptacle for personal. What was demoed? Add receptacle to area between doors after drywall is removed. Failed � � Correction J �q � 7- l Needed ❑ /�(y Re -Inspection Fee No Additional Inspections can be scheduled until re -inspection fee is paid. November 24, 2014 For Inspections please call: (305)762-4949 Page 33 of 42 Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 REC VED Nov I 81� FBC 201 0 BUILDING Master Permit No. l-,'�J �s H " Is •. PERMIT APPLICATION Sub Permit No. Dlem ®l4 —,'-2s Oto ❑BUILDING M4fECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION []RENEWAL ❑PLUMBING [:]MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: I�2 / rr `- 172 Y�elew 33%3 Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee(VSiimple Titleholder): / 6"(/el IA C ►J � + ti Phone#: Address: 'a L T Al 0 92- 5��e -70 City:_i(_�9fvLr YIY24-0—State•-s'' Zip: 33 Tenant/Lessee Name: Phone#: Email: e r/ CONTRACTOR: Company Name: . L-� Phone#: I q% 7'— 9 / �.- ((-02-Z Address _ �� dl Ie✓ • ^4 C (� City: te: Zip; 7 % f Qualifier Name: �/ a ( til k . V1 7 r Phone#: State Certification or Registration #: 4-79 120.13 5' 49 Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Value of Work for this Permit: Type of Work: ❑ Addition Description of Work: ❑ Alteration ❑ State Zip: Square/Unear Footage of Work: w ❑ Repair/Replace Demolition fire.9 /,I Specify color of co`lor�thru tile: Submittal Fee' 1°� Permit Fee $ _� �'®� CCF $ CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Notary .$_ Technology Fee $ Training/Education Fee $ Structural Reviews $ Double Fee $ Bond $ ! , G 0 LL w 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 ELECTRIC, PLUMBING, SIGNS, POOLS, FURNACES, BOILERS, HEATERS, TANKS, 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. Signature g Signature INNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The for going strument was acknowledged before a his - i�----day of 20 day of -0200 20 by /06 ho is personalI kno 7(.- fit '�+ � ho is perso �1.nally known to ,-'m—"r who has produced as (�r who has produced as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: Sign: Print:' TifE111>Ni RICIIiyIM WAIAW Mort Puelk • SMS of FWft Mp Comm. Expi "A" 10, 2011 APPROVED BY NOTARY PUBLIC: Sit Prl Se .P �Vd-' Plans Examiner Zoning QUALIFYING TRADE(S) 0001 ELECTRICAL CnaMs Danger P t. Secretary aFMe Cmrtl rw.mramidsde.gov/CerNeprcrt CT'QB Consmacn BUSINESS CERTIFIC ATE OFA COMPETENCY ,> 07EM 245 )- GODLY ELECTRICAL SERVICES INC D.BA v-� va V IE JOHN K Is certif+ed under the Provisions of C - 10 of Iur,NEW QUALIFYING TRADE(S) 0001 ELECTRICAL CnaMs Danger P t. Secretary aFMe Cmrtl rw.mramidsde.gov/CerNeprcrt J I ami ISSUED: 06108=4 DISPLAY AS REQUIRED BY LAW SEG# L140808MIS32 1<curDate><curTime>Work Comp Associates Inc.Elissa A Lucchese CERTIFICATE OF LIABILITY INSURANCE DATE (MWDD/YYYY) Tvor OF INSURANCE 11/12/2014 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), 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 N "ter Michael D. Holleman Work Comp Associates, Inc. P.O. Box 33297RM: Palm Beach Gardens, FL 33420-3297 NN., r.);(561) 863-9581 FAX N.): (561) 881-9745 mail@WorkCompAssoc.com INSURER(S) AFFORDING COVERAGE NAIC9 INSURED Godly Electrical Services, Inc. 4712 N.W. 2nd Place INSURER A` BusinessFirst Insurance Company INSURER E: INSURER C: Plantation, FL 33317-3144 INSURER D: GENERAL AGGREGATE $ INSURER E: PRODUCTS -COMP/OPi4GG $ INSURER F: COVERAGES / OTICIA �T�... u.e��w AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS NON -OWNED AUTOS H ..Ivn nvrvlvcn. 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 SUBJECTTO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. 1M Tvor OF INSURANCE POL1CYNUMRrR POLICY FF POLICY GENERAL LIABILITYHIVIII COMMERCIAL GENERAL LIABILITY CLAIMS -MADE []OCCUR EACH OCCURRENCE $ $ MED EXP (Any one person) $ PERSONAL& ADV INJURY $ GENERAL AGGREGATE $ GEN'LAGGREGATE LIMIT APPLIES PER: POLICY PRO- LOC .ECT PRODUCTS -COMP/OPi4GG $ $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS NON -OWNED AUTOS H ❑ a accid $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ 'P., .1.1,1111 $ A UMBRELLALIAB EXCESS LIAB OCCUR CLAIMS -MADE N/A© ❑ 0521067940000 3/9/2014 3/9/2015 EACH OCCURRENCE $ AGGREGATE $ DEC) RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTTVE OFFICEIMEMBEREXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below $ X 1W LIMITS I J ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) According to DBPR, John K Vittie holds license #ER -13013956 for Godly Electrical Services, Inc. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, Miami Shores Village Building Dept. ACCORDANCE WITH THE POLICY PROVISIONS. WILL BE DELIVERED IN 10050 N E 2nd Avenue Miami Shores Village, FL 33138-2382 AUTHORIZED REPRESENTATIVE L X 441 'r ®1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD NOV/12/2014/WED 12:15 PM FAX No, P,001/001 GODLY -1 OP ID: WC CERTIFICATE OF LIABILITY INSURANCE DATE; MWOOYM 1212lY 11/12/2x14 4 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 lS WANED, 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 andersmmantlat PRODUCERdleyI Rijn Commercial Dept FAX -ake S. Insurance Agency, SF. 1644 S. PHONE Florida Ave 863 701-7411 (AM, Ne ; 863-701 -akeland. FL 33803 E.MA1 .. _ ..... -- - - _ INSURED Godly Electrical Services Inc _... 4712 NW 2nd Place INSURER Plantation, FL 33317 INSURER e0. - THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSUREDGNAMED ABOIVE 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, UNATS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TYPE OF INSURANCE L EFF �MlLDI G E)tP GEN&RAL LIARIL IWMRID POLICY NUMBER LOUIITS X COMMERCIAL GENERAL LIABILITY CLAIMS MADE a OCCUR 7X poUcy FjPRG>:N`L At4BREGATE LIMITAPPUES PER: LOC CPP 5000823 01 1210712013 12107M14 wwterNvb u,:t I vu:ri vwRPNTED­ PREMISES E ' e nce 3MED W CAny one on I PERSONAL & ADV INJURY $ GENERALAGGREGATE $ PRODUCTS - COMPIOP AGG $ AUTOMOBILE UAsWTy ANY AUTO AUTO FD SCHEDULED AUTOS HIRED AUTOS NON-OAUTOSWNED s OMBINED SINGLE LIMIT somamIt,$ BODILY INJURY (Per person) .5 BODILY INJURY (Per awdem S PR R ACCIDE $ $ UIIIiIaRELLA LIAR EXCEW LIAR OCCUR CLAIMS-0+1ADE EACH OCCURRENCE $ DED RETENTION$ AGGREGATE $ WORKERS COMPEta$AT10N AND OMPLOYERW LIABILnYY! N ANY PROPRIETO"ARTNERAD=UTIVEFR OFF�,6WM5pgSuREXCLUDED? (ma.tQaWry In NHl NIA S 7 RYSTATU- OTH - EL EACH S P -L. DESCRIPTION OF OI'ERATIONB /LOCATIONS I VEHICLES (Attach ACORD 101, AddIVOM1 Remarks Schedule, It morn space Is regplro* ±:lectrlcal `Pork W/ixl Btii.lding 'ONTRACTORS LICEL3SE # 07HOO1245 E-305-759-8972 1 SHOULD ANY OF THE ABOVE DESCRIaEb POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Miami Shores Village Building ACCORDANCE WITH THE POLICY PROViglogS, Department 10050 NE 2nd Ave AUTHORaso PAPRi�S ATNe Miami Shore, FL 33138 Scott Headley ®190--2010 ACOltb CORPORAT ON. A his reserved. ACORD 25 (2040/05) The ACORD name and 1090 are registered marks of ACORD g - 0661 Business Tax Receb R/:--- - , "Co BtJSINB AL SERVICES MC 196 ELECTRICAL CONTRACTOR PAYMENT HBCEn" 4 07E001245 By rAx C UEMOR 875.00 07/11/2014