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EL-14-1052Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-224026 Scheduled Inspection Date: November 26, 2014 Inspector: Devaney, Michael Owner: SEGAL, ILAN Job Address: 500 NE 96 Street Miami Shores, FL 33138 Project: <NONE> Contractor: METRO ELECTRIC SERVICE, INC Building Department Comments Permit Number: EL -5-14-1052 Permit Type: Electrical - Residential Inspection Type: Final Work Classification: Alteration Phone Number Parcel Number 1132060140700 NEW ELECTRICAL FOR LIGHTING & REPLACEMENT AT Infractio Passed Comments KTICHEN, BATH LIVING ADN DINING. ELECTRIC FOR AC INSPECTOR COMMENTS False Inspector Comments Passed 12 Failed Correction Needed Re -Inspection ❑ Fee No Additional Inspections can be scheduled until re -inspection fee is paid. November 25, 2014 For Inspections please call: (305)762-4949 Page 48 of 48 Miami Shores Village-pEcEjvjp— p Building Department MAY -1 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 _ Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 FBC 2010 BUILDING Master Permit No. 1�I __Ozy PERMIT A=ON Sub Permit No. F'lA q _lost ❑ BUILDING ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑ RENEWAL ❑PLUMBING ❑ MECHANICAL E] PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: '5® ® �t 16A A 5To City: Miami Shores County: Miami Dade Zip: 53 i3 b Folio/Parcel#: 1 ! P '77 '2® fi5' ' ®i ® 7 ® ® -Is the Building Historically Designated: Yes NO OccupancyType: Load: VeifW Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): �"'�"' Phone#: 3'u S® - 6 aat Address: 5�10 ® gA 1611 5T, City: I Awl' 15 t% State: 1. Zip: 53136 Tenant/Lessee Name: _ Email: 15� CONTRACTOR: Company Name: _ Address: City: c -n Qualifier Name: State Certification or Registration #: .Jolt, wy' r ® 2 r®e'f;8 . ne#: 30 �- , %. 2. V 1AQ Phone#: (Mis2 f)- G -Certificate of Competency #: _ DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: $ (V ® .9001' Square/Linear Footage of Work: Type of Work: ❑ Addition EIrAlteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: W r -w -r- XA a4 -%—'n" Q 7e Ai Specify color of color thru tile: t, Submittal Fee $'"' Permit Fee $ U CCF $ CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Notary $ Technology Fee $ Training/Education Fee $ Structural Reviews (RevisedO2/24/2014) i� Double Fee $ Bond $ TOTAL FEE NOW DUE $ 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 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 inspectionwhich occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved andn reinspection fee will be charged. Signature Sigmaue CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day �of �by day of ADU I ( �w Inn Q2 wo oesoally known to me or who has produced as me or who has produced as identification and who did take an oath. NOTARY PU LIC: Sign: Print: identification and who did take an oath. NOTARY PABLIC: Sign: =FM ?_C.. o- Notary Public - State of Florida Seal: RHAPEF11112 Se I: \, My Comm. Expires Apr 30, 2016 FF0691$4 h7,2018Commission # EE 194096 aD43&SdQ� %�` ° Po^ded Through h' fiord NGtafy Assn. jr APPROVED BY i Plans Examiner _ Zoning Structural Review Clerk (Revised02/24/2014) AcoRQ� CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 5/14/2014 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 CT PAft Carlton Ext 306 NAME: BB Insurance Marketing Inc PO Box 551267 Ft. Lauderdale FL 33355-1267 PHONE4900 FAX AIC NO - 0450 ADL •P INSU S AFFORDING COVERAGE NAIL # V912014 INSURER A :FAO DAMAGE TO E NT Es $100,000 INSURED METRO -2 INSURER B:Essex Insurance Company INSURER C: Metro Electric Service, Inc. 21407 NE 38th Avenue Aventura FL 33180 INSURER D: PRODUCTS - COMP/OP AGG $2,000,000 $ INSURER E INSURER F LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON-OWNEDPROPERTY HIRED AUTOS AUTOS COVERAGES CERTIFICATE NUMBER: sm9Ag9fid 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 R POLICY NUMBER POLICY EFF IMmpnnnn9 POLICY EXP LIMITS B GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS -MADE � OCCUR 34528 /2013 V912014 EACH OCCURRENCE $11000,000 DAMAGE TO E NT Es $100,000 MED EXP (Any one n $5,000 PERSONAL &ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 rGEN'L AGGREGATE LIMIT APPLIES PER: X POLICY PRO- LOC PRODUCTS - COMP/OP AGG $2,000,000 $ AUTOMOBILEEIMT— LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON-OWNEDPROPERTY HIRED AUTOS AUTOS ED SINGLE Ea atrJdard BODILY INJURY (Per parson) $ BODILY INJURY (Peracdclard) $ DAMAGE Per aoddant $ UMBRELLA LIAB EXCESS LIAB HCLAIMS-MADE OCCUR EACH OCCURRENCE $ AGGREGATE $ DED I I RETENTION $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIEfORIPARTNERIEXECUTIVE OFFICERIMEMBER EXCLUDED? ❑ (Mandatory M NII) Myer d'O'Fer DESCRescrIPTIONOPERATIONS below N / A 10651441 2=014 015 X I WC S ATU OTH- TORY LIMITS ER. E.L. EACH ACCIDENT $1,0001000 E.L. DISEASE - EA EMPLOYEE $1,000,000 E.LDISEASE-POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (At wh ACORD 109, AddiHanal Remarks Scfwdule, If more space Is required) Electrical Contractor located at 15050 NE 20 Avenue, North Miami, FL 33181. Re: License # EC13005326 Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores FL 33138 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Rr. T.l-1 " j!] ©1900-2010 ACORD CORPORATION. All dahts reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD