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EL-15-169Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-227103 Permit Number: EL -1-15-169 Scheduled Inspection Date: January 29, 2015 Permit Type: Electrical - Residential Inspector: Devaney, Michael Inspection Type: Final Owner: PUMO, JERRY AND SALLY Work Classification: Repair Job Address: 1500 NE 101 Street Miami Shores, FL Project: <NONE> Contractor: I E I ELECTRICAL CONTRACTORS INC tsuuaing uepartment comments SERVICE REPAIRS (EMERGENCY) Phone Number Parcel Number 1132050350020 INSPECTOR COMMENTS False Inspector Comments Passed F71 Failed Correction Needed Re -Inspection ❑ Fee No Additional Inspections can be scheduled until re -inspection fee is paid. Phone: (786)621-5215 January 28, 2015 For Inspections please call: (305)762-4949 Page 26 of 39 t BUILDING PERMIT APPLICATION Miami Shares 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 ❑BUILDING tKELECTRIC ❑ ROOFING JAN 1 8„2015 FBC 20( 0 Master Permit No 7B— 157- t (O-,�- Sub Permit No. REVISION ❑ EXTENSION ❑ RENEWAL PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: City: Miami Shores County Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: OWNER: Name (Fee Simple Load: Construction Type: Flood Zone: 0�1- _ n /Auurebs: I c City:/ Cit a "cam State: Tenant/Lessee Name: Phone#: Email: FFE: /- A2 -7 CONTRACTOR: Company Name: � �` L AZ C O:A,- /p- e9C 7-(),e 5/L1Z: Phone#: Address: / .�� (� : ST.1.�- Arl>PF l .D k' , �— City: Al lA- M t State: t'Z ' Zip: 310/ 5 Qualifier Name: M,' f�k l j 6 61 N S Phone#: G� a % - 1 State Certification or Registration #: no r. 9 / `r Certificate of Competency M 0000/ DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: $ �{ ; % / D Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New � Repair/Replace ❑ Demolition Description of Work: :5EW V 1,L C r 'S Specify color of color thru tile: Submittal Fee Permit Fee $ �d.<� �3 CCF $� Scanning Fee $ Radon Fee $ DBPR $ Technology Fee $ Training/Education Fee $ Structural Reviews $ (Revised02/24/2014) CO/CC $ Notary 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 $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien low brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature �'`—� Signatu Ce /� OWNERorAGENT CONTRACTOR The fo egoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this _day of o " e ✓j 20 C by ` day of J!$!2d , 20 1S by � � J who is personally known to % � �l 1KCZjQ, ) ,, who is personally known to me or who has 6duced as me or who has produced as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: Sign^....,. ,, � �bl� • e q40 PriSe 1: %"�' Cortanisa N FF �.,�,51 NOTARY PUBLIC: Sign: ************************************************************************************************************ APPROVED BY Ay_ Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) 3 {s§� 49CMIII Const -uctf( dais Qualifying Sowd F. orni Tra rl -8U INESS CERTIFICATE OF bCiMPETft"[4 'R I NC .1 E I ELEMICALCO NxT,. ACTO 'FZOBBINS-MA ' RK NORMAN is d tlhdr the 'slons of ChaDterl 0 of VlnmLrl=Ao t-,%w-,Fr%hjr' leiaProw QUAILWYINOIPADE(S), �Lg-CTR ICA FIRE.' 10"S' EC �Jvp i Chatsb*qAer PF - . x . . Secratary ri Emw -4 r - q El F STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD s_ _ _..,_ . cojr& CERT191CATE OF LIABILITY INSURANCE M/23/2014 Safeguard Casually Insurance THtaCERTIFICATE is ISSUED AS A MATTroATION 9996 tines Blvd ONLY AND CONFEM NO RIGHTS UPON 7HE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AIi�1D, €'embroke Pines, FL 33024 EXTEND �R ALTER THE COVERAGE AFFORDED 8Y THE POLtCEX SI D OR ►NSUstsG INSURERS AFFOROINC COVERAGE MAIC # I E I 'F, IeCVIC2f Contractors INSURER A rens P & G�Sltli IrISGf3n0e 1915© S SI Andrews Ddve INSURER 8, fn;3n1 Miami, FL 33415 INSU tER C: INsuftER Cr COVERAGES INSURER E: THE POLICM$ or- INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PER l0I3 INDICATE], ANY.REQUIREMEN7 'n M OR CONtIMON OF ANY CONTRACT OR OTHER DOCUMENT MTN RESPECT TO WHfCli T1iIS NOTWITHSTANDfP1G MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HERRN IS SUBJECT TO ALL THE TERMS, I:XCLUStC ONS CpmAy BE lsmjm OR POLICIES. AGGi GATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID p ONS O SUCH CLAIMS_ Mff isOLICY NUprBoR Pam 7f EFFECTIMiYILElaNy RAiiD[i GERM 11BILnY LRORs X COM MEI 0KLc R(�ALUAe1LITY 20POO56685 07/18/2014 07/18/2015 EAM OR s 1.000.000 A CLOMS UAOE u OCCUR s 100000 M s 5.0ao a ADV I NJURY s 1.mo,oOo GENLAGGRE"T9LLyrrAPP=PER: GEtNERALAeGREGATE 5 2. ,000 7F POLICYEl PRO- LdC uals-camptoPAGG s Z.00O,ODO AU'ralEO81LE LU!>!Il" MYAuro 50�-SOil00ti5108-001 07/06/2014 07/06/2015 (s OLE LIM 5 ALL OWNED AUTO$ �/ B X S048DULEDAUTM YR4dt}RY (Pe. PC—) s 25,000 kIREU RUT03 NON•OMQD AUTOS BODILY INJURY IPer ammem & 50,000 PROPERTY DAInE (Pot Bent) s 25,000 GARAGE LIABILITY ANY AUr0 ATO ONLY . EA ACCIDENT s _ OTHERT14AN E-4ACG 5 ExcEss/uxsREUA LlAlaltrlY AUTO ONLY: AGO s OCCURFACN CLAIMS MADE OCCURRENCE S AGGREGATE S DEDUCMaLE 5 REYEhMON $ WCAkERS COl4tP8NSATlON 8 AND EMPLOYERS, UABILr1Y Y 1 N ANY PROPM12TOR1PARTfE:R�OUTIVE WC 3TIAMTU O OPFICEWMEMBER EXCLUDED? (Malpdatmy 1tt NH) 6 L EACH RG: IDENT g tfyes. aeec'he yndst SPECIAL PROVISIONS below RL DISEASE-! q pypLov s "— I orI;ER I + E.L nlstvasf - PDLIcv Lt�Ir s _ OSSCRIIntoROFOPFP.ATtt7A16liAGAhOtasJVEHICUM( EXCIAISIOMSADDEI)RYMOORS&NIMIlSPEGIAt PRaY13tONS Elecir i COntram g• - Village of Miami Shores 1050 NE 2 Avenue Miathi Shares, FL 33138 ACORD 25 (2003/04) 0 SHOULDAWOPTHEABOVQDESCRIB>:GpOLl MUMCANCE6LE0SEFORETMEXPIRe(TION DATE TRMMOF. THE ISSU'Na INSURER WALL EHDEAVOR TO KNI. 30 AAPS yuMTM NOTICE TO THE CERTIFICATE NA4pER NAKED TO THE LEFT, HUT PAILURBTO ooSO MMLL. IMPOSE NO O$LIgATMN OR LIAHtt W OF ANY KIND UPON THE INSu rte, rM AGENTS Old RePRESENTA11VE3. UTHOREM jtE +RES041 ATPIE -- — ec^ � The ACORD name and 1090 are registered marks or ACORD reserved. lF1F«L,ECi9 PIiSI: �..- CERTIFICATE OF LIABILITY INSURANCE THIS CERTIFICATE IS ISSUED AS A MATTER OF INFY3RMATTON ONLY AND CONFERS NO MGtI:1'S UPON 'TME CERTIFICATE KOL>Q e1`R. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, MMND OR ALTER THE COVERAGE AFFORD® BY T"E PORINS BELOW- THIS CERTIFICATE OF INSURANCE bOn NOT CONSTITUTE A CONTRACT BETWeEN THE ISSUING INSURER(8L AUTHORtZEd REPRESEAFrAIWER OR PRODUCE. AND THE CERTIFICATE HOLDER - IMPORTANT. N the oertifiCOW holder is an ADDITIONAL INSURED, the policy(ice) ivasr he endorsed. If SUBROGATION 18 WANED. sot3ei t. In Uis terms and cond'Itions of the policy, certain P01101g mvy requke an andomamenL A Statement on this eerMcau does not confer d" to the certificate holder In lieu of such andonminantint PxODUC�t Automatic Data Processing insurance Agaixy, Inc I ADP Boulevard Roseland, NJ 07W S INSURED li=e Electrical CoLnractCr m Inc. ;NSURFR ii _ 19150 S. St Agdreurs skive LNsulasac Hialeah, FL.33015- INSUReRD- INSURER E : INSUR5R r- CnVFRAGFS enzw ph -a im IJI iMaLg. n�no,e�w, ru t.m�w._ THIS IS TO CERTtf1! THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN (SSUED T'O TME INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REOUIREMMT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMOW WITH RESPECT TO WHICH THIS CERTWICATE MAY 8E IS up OR MAY PERT'AK THE INSURANCE AFFORDED BY THE POLICIES iiESCRIRED HEREIN IS SUBJECT TO ALL THE TERMS, DCCLUSIONS AND COMMONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIM& ILSIi TYPO OFINSURANCS SU PDuLC'YNUMBI:R P D EXP LIhm 024E RAL LIAML.1rY COMMERCLAL GENERAL LIAMUTY (:IAma—wm F-1 OCCUR EACH OCCURRENCE 5 PREMISES Ma tmcurrenpe S MED ESOP (MAY m�e Pmmn S � __.._ P[ MNAL& ADV INJURY S GENERALAE)GRE0ATS s G2N•LAWRpGAT6LUATAPPU06PM pouCY LCC PRODUCTS-COMPlOPAGG S L: AUTUi1 OMA LiARRHY ANYAUTO ALL AUTOS NLS AUTOSCI-IESULED HiR£DAUrO3 O W1,150 COMBINED R S 8O01LY1d1URY(PerpM0q S BDDILYINJUIRY(f'6reDddCttsj S PROP 1e`Y�OA S — _— S UMOROLLA UAB EXCESS [JAR OCCUR CLAIM94AAM TACH OCCURRENCE 5 AGGREGATE s DED 17> 7EM70N 5 S A AND LUPLOYERS' LIASKM WORKERSW-MPEN9AW11 NY APROPRIETOR�P� YIN F7�: Ul DT (M n0 In NH) P�WWN OF OPERATIONS belowT NIA IEWC616325 912512AZ4 01=018 X WCSTBTU• O E.L. EACHACMDENT S 100,00 _ E.L =EASE -EA EMPLOYEE S - 100,00 E L OrSFASE-PQL1frY UNIT 5 800, DESCRIPTION OP OPMtATiONS I WrATMS I VgWDLES (AMC[, ACORD IM. Additional ne na ft fthed(de, 7 mnm r4— is regtkU*O) 171eadcat cantracung CERTIFICATE MULULK L:AINoCL LA I LUN r. SHOULD ANY OF THE A@OVE DESCRIBEn POLICIES BE CANCWAD BEFORE 1/iliage of Miami Shores THE EXPIRATION DATE 'THEREOF, NOTICE WILL EM DEUVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Wilding Dept 1050 INE 2 Rive AUYHOWED R I7AYNF- Miami Shores, FL 33138-"` ®1988-20'10 ACORD CORPORATION- All rights reserved. ACORD 26 (2010105) The ACORD name and logo are mgfsWred marks of ACORD „