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DEMO-13-2877aJU Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 BUILDING PERMIT APPLICATION Permit Type: Electrical FBC 20 Permit No. D_8= L3 -' .?_�-� Master Permit Nonc `3 - 62 JOB ADDRESS: r "& C-' "_`, � � o� City: Miami Shores County: Miami Dade Zip: 3 `3 113 Folio/Parcel#: Is the Building Historically Designated: Yes NO Flood Zone: OWNER: Name (Fee Simple Titleholder): 0Q?k c_n.',. Phone#: Address: & 1 I� :.S`�-,`,\v City: V y_'M , Y`� s State: Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name:. F 'C•wE a i W�w Phone#: �30-T) 7,32- 1fl D Address: t2:1511- Sw City: . ^-w-%: State: Zip: 3 3 1 8 6 Qualifier Nam : y ^ At Phone#: State CertificatioiY+ot-R istration 0 3 S % S Certificate of Competency #: Contact Phone#. x 3 4 2yz q 50 p- 4 4n Address: R • ti( G DESIGNER: Architect/Engineer: Phone#: oe�y. Value of Work for this Permit: $/xy Square/Linear Footage of Work: Type of Work: ❑Address ❑Alteration ONew O-ftair/Repl a ❑Demolition Description of Work: ck-ct �(ZtiiP►s ��•¢ L�ILCc Submittal Fee $ Permit Fee $ 27,6 ,0,0 - CCF $ CO/CC $ Scanning Fee $ Radon Fee $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ DBPR $ Bond Technology Fee $ TOTAL FEE NOW DUE $,g=? Vs. J - Bonding Company's Name (if applicable) Bonding Company's Address City State Mortgage Lerider's Name (if applicable) Mortgage Lender's Address City State Zip Zip I a er 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 absenpf such posted notice, the inspection will not be approved and a reinspection fee will be charged. /s Signature Owner or Agent The foregoing instrument was acknowledged before me this w ' day of , 20 jt�, by �G�(`Ietiar who is ersonally kno to me or who has produced As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commission Expires: Signature. -in The foregoing instrument wa`s acknowledged before me this day of 3aikoeti, 20 _L5, by rz &A_c e.," , who is BARBARA A. ES TE? MY COMMISSION # DD 9o53W EXPIRES: March 29, 2014 Bonded Thru Notary Public Underwriters Sign: �., uced�V _ 1JaAdX0WW96WA1WkJ,hid take an oath. �VUW 8 Aam e_2, 20i yn„r u Z ommission Expires: -*-(1 201 APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised 3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09) Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-205151 Permit Number: DEMO -12-13-2877 Scheduled Inspection Date: February 03, 2015 Permit Type: Demolition Inspector: Devaney, Michael Inspection Type: final Owner: , TROPICAL CHEVROLET Work Classification: Electric Job Address: 8880 BISCAYNE Boulevard Miami Shores, FL Phone Number (305)754-7551 Parcel Number 1132060200880 Project: <NONE> Contractor: KEYLITE POWER AND LIGHTING CORP Phone: (305)232-9910 Guild comments DEMO SELECTED AREAS ELECTRICAL WORKINSPECTOR COMMENTS . ---- _ False Inspector Comments Passed Failed Correction ❑ Needed Re -Inspection ❑ Fee No Additional Inspections can be scheduled until re -inspection fee is paid. February 02, 2015 For Inspections please call: (305)7624949 Page 3 of 41 KEYLI-1 OP 1D: SD ACI R L7►� OF LIABILITY INSURANCE12/30/13 E (MM/DDNYYY) ATCERTIFICATE r THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPONTHE 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 305-446-2271 Kahn -Carlin & Company, Inc. 3350 S. Dixie Highway 305-448-3127 Miami, FL 33133-9984 CONTACT NAME: PHCNNEo, Ext :305-446-2271 FFAxc. No : 305-448-3127 E-MAIL rocessn k ADDRESS: h ig@ ahn-carlin.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: FCCI Insurance Company 10178 INSURED Keylite Power & Lighting Corp. Miami, FL S L 331186 11Court Miami INSURER B: National Trust Insurance Co 20141 INSURER C: FCCI Commercial Insurance Co 33472 INSURER D: Federal Insurance Company 20281 INSURER E: INSURER F: COVERAGES 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 CONTRACTOR 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 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Miami Shores Village POLICY NUMBER POLICY EFF M DD POLICY EXP LIMITS A GENERAL LIABILITY1 X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE 7 OCCUR Miami Shores Village, FL 33138 GLOO139162 07/17/13 07/17/14 EACH OCCURRENCE $ , 000,Q PREMISES Ea occurrence $ 300, MED EXP (Any one person) $ 10,00 PERSONAL & ADV INJURY $ 1,000,0014 X PER PROJECT/PER L GENERAL AGGREGATE $ 2,000,0 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY JECT PRO- LOC PRODUCTS - COMP/OP AGG $ 2,000, Emp Ben. $ 1,000,00 B AUTOMOBILE LIABILITY X ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS NON -OWNED AUTOS CA00214872 07/17/13 07/17/14 COMBINED SINGLE LIMIT 1,000,00( Ea accident BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ Per accident C X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE UMB00146432 07/17/13 07/17/14 EACH OCCURRENCE $ 2,000,00 AGGREGATE $ 2,000,00 DED I X I RETENTION$ 10,000 $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N OFFICER/MEMBER EXCLUDED? �N (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below / A 001 WC13A68847 07/17/13 07/17/14 X I WC STATU-TH- TORY LI _ E.L. EACH ACCIDENT $ 1,000,00 _ E.L. DISEASE - EA EMPLOYEE $ 1,000,E E.L. DISEASE -POLICY LIMIT $ 1,000,00C D Equipment Floater 45465858 07/17/13 07/17/14 Lease/ 100,00 Rent, DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) CERTIFICATE HOLDER CANCELLATION MIAM-04 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Miami Shores Village THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN g ACCORDANCE WITH THE POLICY PROVISIONS. Building and Zoning 10050 NE 2nd Avenue Miami Shores Village, FL 33138 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD