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EL-15-92Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-226794 Scheduled Inspection Date: January 21, 2015 Inspector: Devaney, Michael Owner: WICHMANN, LEE AND ANGELA Job Address: 1399 NE 104 Street Miami Shores, FL Project: <NONE> Permit Number: EL -1-15-92 Permit Type: Electrical - Residential Inspection Type: Final Work Classification: Alteration Phone Number Parcel Number 305/758-0566 1122320320040 Contractor: MOODY ELECTRIC INC Phone: (305)758-2000 duuamg uepartment comments INSTALL A BMW ELECTRIC CAR CHARGER, 40 A- 250V Infract INSPECTOR Passed Comments TOR COMMENTS False Inspector Comments Passed Failed Correction�j Needed Re -Inspection ❑ Fee No Additional Inspections can be scheduled until re -inspection fee is paid. January20, 2015 For Inspections please call: (305)762-4949 Page 34 of 37 Miami Shores Village Building Department artment JAN 15 2015 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Q.S.. Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 FBC 20 �C) BUILDING Permit No. E: 2 - PERMIT APPLICATION Master Permit No. Permit Type: Electrical JOB ADDRESS: 13 QI (O¢ Sz'R6�-7- City: Miami Shores County: Miami Dade zip: 3 3t 3 S Folio/Parcel#: Is the Building Historically Designated: Yes NO ✓ Flood Zone: OWNER: Name (Fee Simple Titleholder): M t CUM(- Phone#: 154-15(7-361( Address: l 2�)99 0 E 10 + 5t'p_Ejr- T— City: to 11AlAl S1-0-eres State: 4::;�(Zx bA, Zip: 331 a $ Tenant/Lessee Name: Phone#: Email: m 14W It* -I-- W 2 • 66-m- 1 CONTRACTOR: Company Name: M 0' Address: (o 6 9 !j - Cts -94� City: 10 t A -mi State: Zip: 331 -to Qualifier Name: . 6 h4i �./� A *-4 _ Phone#: 3ar'`7J'8 ' Zlba State Certification or Registration #: �G O "/ 49 Contact Phone#: %L(,9 ' 2-210 - 66 S3 Email Address: DESIGNER: Architect/Engineer: /lJl,- _Certificate of Competency #: Value of Work for this Permit: $ < /'?.-5- Square/Linear Footage of Work: Type of Work: ❑Address ❑Alteration Mfl4ew ❑Repair/Replace Description of Work: �AAr Submittal Fee $ Permit Fee $ �. 5J�'4'�� CCF $ CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ ❑Demolition 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 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. Signature t.A-(.trV 4UL Owner or Agent The foregoig uistrument was acknowledged before me this day of �—�Q n , 20 L6, by M r 4aOl who is personally known to me or who has produced As identification and who did take an oath. NOTARY PUBLIC: Sign: phjw & Al Print: My Commission Expires: — ,`:�"Y "�e'•. MARY PAT BRIGGS Notary Public - State of Florida My Comm. Expires May 11, 2018 APPROVED BY ContractoV The foregoing instrument was acknowledged before me this /6 day of -�/Qi1 , 201�7, by who is personally known to me or who has produced ,l'•D7�1�`' 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. NOTARY PUBLIC: L/OT-FAPARRAP MARY PAT -BRIGGS Notary Public • State of Florida Commission #r FF 120746 Clerk +...hn 12 21 08:35a Moody Electric Inc 305-754-1333 p.2 Ate- R MOODELE-01 MELBA CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) THIS CERTIFICATE is ISSUED AS —F 16 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(ies) 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 ON CT Acrisure, LLC d/b/a InSource NAME: 9500 South Dadeland Boulevard PHONE 305) 670-6'111 4th Floor E ac Na Ext): FAX NI: (305) 670-9699 AIL Miami, FL 33156^2$67 ADDRESS: INSURER(S) AFFORDING COVERAGE NAIL # INSURED INSURER A: Monroe Guaran Ins. Co. INSURER B: FCCI Insurance Compny 10178 Moody Electric, Inc. r INSURERC: 669 NW 90 Street INSURER D Miami, FL 33150 INSURER F: INSURER F: NUMt3ER: 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 fS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, Q TYPE OF INSURANCE POLICY NUMBER PO ICY EFF POLICY E X COMMERCIAL GENERAL LIABILITY IMM /YYYY MM1DD/YYYY LIMITS CLAIMS -MADE a EACH OCCURRENCE $ 1,000,01 OCCUR CPP000569410 12/31/2014 12/3l/2015 PREMISES (ea occurrence S 100,0 I- J MED EXP (Any one person) - $ _ GEN'L AGGREGATE OMIT APPLIES PER: PERSONAL & ADV INJURY S 1,00PRO-GENERAL POLICY ECT LOC I" I J ECT � AGGREGATE $ 2,00 OTHER: PRODUCTS - COMPIOP AGG $ 2,00 AUTOMOUILE UABILITY $ g X ANY AUTO CA000&77910 EsacWQent L $ 1,00 ALL OWNED SCHEDULED 12/31/2014 12/31/2015 BODILY INJURY (per person) s AUTOS UT X NON-0VVNED HIRED AUTOS X BODILY INJURY (Per accident) S AUTOS PROP Y DAM Per accident $ X UMBRELLA LIAR XS OCCUR R ExcEss L1AB CLAIM$ -MADE UMB0004787 9 EACH OCCURRENCE $ 2,001 OED X RETENTION $ 10,000 12/31/2014 12/31/2015 AGGREGATE $ 2,001 WORKERS COMPENSATION $ AND EMPLOYERS' LIABILITY PER OTH- ANY PROPRIETORIPARTNER/EXECUT. YJ N OFFICER/MEMBER EXCLUDED? ❑ NIA STATUTE ER (Mandatory In NH) E_L EACH ACCIDENT $ If Dyes, describe Under DESCRIPTION OF OPERATIONS below E.L. DISEASE - EA EMPLOYE $ E.L DISEASE - POLICY LIMIT S DESCRIPTION OF OPERATION `lectrical Contractors S ! LOCATIONS f VEHICLES (ACORD 101, Additional RamaNcs Sehsdule, may he attached iI mare space is required) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Miami Shores Village - Building Department THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 10050 N.E. 2nd Avenue ACCORDANCE WITH THE POLICY PROVISIONS. Miami Shores, FL 33138 AUTHORIZED REPRESENTATIVE Pa'4.-14� ACORD 25 (2014/01)©1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD . ,_'%an 12 21 08:35a Moody Electric Inc 305-754-1333 P.3 MOODY -1 OP ID: TH A�O�RO CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDlYYYY) 01 /09/2015 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(ies) 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 endorsomanrrsi PRODUCER Workers Compensation Group P O Box 410 Boca Raton, FL 33429-0410 INSURED 669 Northwest 90th Street Miami, FL 33150 Workers' Coml n. 561-392-3300 !NSURER A : INSURER B: INSURER C: INSURER D : INSURER E: INSURER F: Ins 561-361-1132 -- - 10701 vrcrwisw CERTIFICATE NUMBER: 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. F15R — TYPEOFINSURANCE COMMERCIAL GENERAL LIABILITY POLICY NUMBER _ CYEFF POI EXP-"` MMIODIYY MMIDDI LIMITS EACH OCCURRENCE CLAIMS-MADE OCCUR I I 1 DAMAGETO RENTED - $ �GEN'L AGGREGATE LIMIT APPLIES PER' JPPOLICY - ECOT LOC OTHER: AUTOMOBILE LIABILr Y ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOSNON-OWNED AUTOS UMBRELLA LIAR OCCUR EXCESS LIAS CLAIMS�ADE — T. , AND EMPLOYERS' LiAsiLITY A ANY Y' IG PR EMISES(Eaoccurreme) IS MED EXP (Any one petsmn _$ PERSONAL a ADV INJURY $ GENL-RALAGGREGATE $ PRODUCTS :COMPIOPAGG 5 COMBINED SINGLE LIMITEa $ nt BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ (Per aaident) EACH OCCURRENCE $ AGGREGATE $ 1A asu-�6/3 01/01/2015 01/01/2016LE L.EACHACCIDENT $ -1 L. DISEASE -EAEMPLOYE $ i . DISEASE - POLICY LIMIT $ 1 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarlos Schedule, may be attached If more space is required) Clectr1cal Contractors TION MIAMIS3 L HOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Village of Miami Shores HE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 10050 NE 2nd Ave. CCORDANCE WITH THE POLICY PROVISIONS, Miami Shores, FL 33138 AUTHORIZED REPRESENTATIVE ACORD 25 (2014101)©1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD MoaD4 6L*e--rv-�, t#JC (042CA tiUP eja�'- �1 0 4-AkI t 33 1.56 r,t.IS aw Iff L I IMiAlYA -0- hores vi'llaqc 1 ZONING DEPT DATE SUBJECT TO COMPLIANCE - WITH ALL FEDERAL A -T F AND COUNTY FlUff') AND fWGUI ATIONS MARY PAT BRIGGS • S Notary Public - State of FI MY Comm. Expires May 11, Commission # FF 1207, W -- JAN 115 66 BMW ter 1fl, 32. 139 V044 srcaer- <964t:61 V4-- 5a.IZS f 4"-"1 *1