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EL-13-2873Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-205107 Permit Number: EL -12-13-2873 Scheduled Inspection Date: March 13, 2015 Permit Type: Electrical - Residential Inspector: Devaney, Michael Inspection Type: Final Owner: PATRICK DESBIOLLES & LING Work Classification: Addition/Alteration t`ADA\/A IAI DAYOU'`1! r%CQ01A1 1 CQ 9_ Job Address: 390 NE 98 Street Miami Shores, FL 33138-2410 Phone Number (305)527-4748 Parcel Number 1132060135670 Project: <NONE> Contractor: CPS ELECTRIC, INC. Phone: 305-607-8221 Building Department Comments ELECTRIC WORK DONE FOR 2 BATHROOMS I Intractio Passed comments INSPECTOR COMMENTS False Inspector Comments Passed 1Z Failed Correction ❑ Needed Re -Inspection ❑ Fee No Additional Inspections can be scheduled until re -inspection fee is paid. March 12, 2015 For Inspections please call: (305)762-4949 Page 3 of 38 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 JOB ADDRESS: -3010 Pj C -1�3 Sr FBC 20 tO Permit No` 'E-_ L 13 06 Master Permit No. PL LS - c) ) City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated: Yes NO Zone: OWNER: Name (Fee Simple Titleholder): 1.1 A � Phone#: q Address t® KtF 11? Sr City: oAt Vel( 'itlow. State: - Zip: ,33160 Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: S � 4 �- --DIC Phone#: 0� 633 SS' / 0 Address: 000 KILO N City: NAL ,y�� l State: Zip: 3312,r Qualifier Name: W7 Phone#: State Certification or Registration #: �� 1 � Q Certificate of Competency #: �1'�C:VriGJ, 0J @`�tMCu,� jco w Contact Phone#: Email Address: DESIGNER: Architect/Engineer: Phone#: Value of Work for this Permit: $ 90 Square/Linear Footage of Work: Type of Work: ❑Address ❑Alteration ❑New epair/Replace ❑Demolition Description of Work: 3 164TP A00M el Ec-04CAL 'b4TVIZODAn Submittal Fee $ Permit Fee $ /�U' 'd/� CCF $ CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ 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 e appr d and a reinspection fee will be charged. Signature � Signator O r or AgInt Contractor The foregoing inns ment was acknowledged before me this The foregoing instrument was acknowledged b fore me this day of I,p �(.¢ -, by day of ' - , 20 , by - - who ,is'personally known to me or who has produced .14 Ll who is personally known to me or who has produced SFU As identification and who did take an oath. as identification and who did take an oath. NOT ITRUrce NOTARY PUBLIC: ARIO O OTALORA K 10 O 0 ALORA " O I ION #FF056301 p FF056301 Sign: Si r Print: IDS r P tlr p'' �dallo ry My Commission Expires: My Commission Expires: 2a �y APPROVED BYPlans Examiner Zoning Structural Review (Revised 3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09) Clerk 03/12/2014 8:54 AM FAX 3057691844 CERTIFICATE OF PNFE; CEH NENDU INSUR,imCE & FINANCIAT, SVC 508 E 49 ST HIALEAH FL 33013 305 769 4936 45URED C. P, S , ELECTRYC, xNC. 1600 NDP 28 AVE MIAMI,FL 33125 MENDEZ INSURANCE U0001/0001 INSURANCE UA,, IMnYwl THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE CC1Vraer_r INSURERS AFFORDING COVERAGE I NAIC# INSURER 0; INSURER C; INSUkeR D: — THEPOLICIES 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 MAY PERTAIN, THE INSURANCE AFFORDED RESPECT TO WHICH THIS CERTIFICATE MAY BE 15SUE0 OR SY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSION$ AND CONDITIONS OF SUCH POLICIES, ArrQR[GATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, .tri. N POLIO a NUMOER GCmeRAL LIABILITY I Y' IVEI,ICYZR�IkATi N X COMMERCIAL GENERAL LIABILITY LIMITS F14CH OCCURRENCE S��Q_Yr 01 CLAIIM$MApE LX I OCCUR P MI$ RERTCD' iO pS fGoaC011l7hOol S -x,190.001 A X 50 0 DEA _ C,x,-84425-4 MED EXP on. pe�aon) $ $ 5 � O ( 09/23/13 09/23/14PERsaNAL&ADVINJURY �----- — � '`1 090 0 ( GEML AGGREGATE LIMIT APPLIES Pw GENERAL AGGREGATE S Z O o , o Q-( POLICY PR LOC _O PI�dDUCTS _COMP/OI'AGG S ,� 1.0OO�QOC AUTOMOBILG LIABILITY _ ANYAUTO COMBINEDSINGLE ALL OWNED AUTOS NE ) S X SCHEDULED AUTOS A HIRED AUTOS CA, -33303-1 i0 rDILYYIINJURY S 10,000 Q 0 Q 0 NON-OWNEDAUTpg 09/23/13 09/23/14 fPOoDicmidenryRY 2 20,000 OARAGt. LlAbiuTY (Pe°: DAMAGE s 10 000 , ANYAUTO AUTO ONLY, CA ACCIDENT y OTHER THAN eAACC S GXCE88JUMORELLA LIABILITY AUTOONLY; ACS y OCCUR CLAIMSMADC EACH OCCURRENGe S AGGRF,GATC y DGDUCYI81.E — RETENTION a WORKCRSCOMPENSATIONAND i CMPLOYt:KS LIAI211,ItY l'RG�nlarowr,�IstNervezatvrlva ANrwanNY WC -62117-2 wew+w mwwlxo? O s / O 2 / 13 0 6 / O 2 / 14 k. L EACH aCCIDCNT Ifyyooaa Q��aibot<W/! SPFF,IALPROVISIONS belay S '0 400' 000 OTHER C.L. DISEASE _ EA EMPLOYE S 1•, 000 1000 91, DISCASF_POLICY LIMIT $ 1 O00 OOO DESCRIPTION OFOPERATIONS /LOCATIONS VEHICLES IEXCLUSIONS ADDEDBYGNDORSEMENTl5PCClALPROVISIONS ELECTRICAL WORK 'ERTIMPATE HOLDER CANCELLATION CITY' OF NMAMT SHORES 100SO NE 2nd, AVE SHOULD ANY OF THk oVE DES ED POLICIES BE CANCELLED 9t:FOR THE EXPIRATION DATE MIAMI SHORES FL 33168 THEREOF, TI4F I U1NG INSURER WILL ENDEAVOR TO MAIL lO' AY5 WRITTEN NOTICE 70 THE TIP , 3QS-756-8972 T6 HOLDER NAMED TO THE LEFT, BUT FA11U T DO SO SHALL IMP08e Nd OBL Tip OR LIABILITY OF ANY KIND UPON THE INSUR , 1 S ACGNTS OR RGPRESCNTAT AUTHORWED RGPR 8[NT CORD25(2001/08) ®ACOROCOR RAT19NI988