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EL-15-153Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-230492 Permit Number: EL -1-15-153 Scheduled Inspection Date: March 18, 2015 Permit Type: Electrical - Residential Inspector: Devaney, Michael Inspection Type: Final Owner: ADSIT, DANIEL Job Address: 68 NW 93 Street Miami Shores, FL Project: <NONE> Contractor: PRACTICALITY INC comments Work Classification: Alteration Phone Number (646)709-2710 Parcel Number 1131010170030 INSTALL 6 RECEPTICAL AND 1 SWITCH AROUND THE I KITCHEN COUNTER TOP. INSPECTOR COMMENTS False Inspector Comments Passed E:!r Failed Correction ❑ PAIL Needed Re -Inspection ❑ Fee No Additional Inspections can be scheduled until re -inspection fee is paid. Phone: (954)628-4557 March 17, 2015 For Inspections please call: (305)762-4949 Page 34 of 34 V� 0A BUILDING Miami Shores 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 PERMIT APPLICATION ❑BUILDINGECTRIC ❑ ROOFING FBC 20[() Master Permit No.. ` 15- 1153 Sub Permit No. ❑ REVISION ❑ EXTENSION [:]RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP f CONTRACTOR DRAWINGS JOB ADDRESS: 6 N-ef ft s, City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: f/'_ 3101 - Ol 9 - c2o � o Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple tTitlehoder): o ltt1� Ads -I Phone#: Address: _"> i t? t _ 1" City State: Tenant/Lessee Nam/e: A, Phone#: � dT Email: C" `j .."'-' I , c.0 ("N_ p:i Sp CONTRACTOR: Company Name: /"R'9 C 11 C Phone#: ZA?e � �'V-z J�E Address: //?Z/ Iva //6 /� 0 City: COC -0 n ce'x C4 @/E ! State: � L Zip: " Qualifier Name: \/Q e S' / 6 % Phone#: State Certification or Registration #: gZLIU 3"1 Certificate of Competency M _ DESIGNER: Architect/Eneineer: P-/* Phone#: Address: KI 4- City: State: Value of Work for this Permit: $ Square/Linear Footage of Work: Type of Work: ❑ Addition [ Alteration Description of Work: l "1 S 1�� oc /i -e C Z A-&~ 14 e lc/'�C 4 La h CC ❑ New ❑ Repair/Replace M ❑ Demolition Specify color of color thru tile:,, Submittal Fee $ Permit Fee $ t�G� rav CCF $ CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Notary $ Technology Fee Structural Reviews $ (Revised02/24/2014) Training/Education Fee $ Double Fee $ Bond $ //�� ('`� TOTAL FEE NOW DUE $ V9 • y 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 inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be Ap roved 4reinspec*n fA will be charged. Signature NER or The foregoing i tr ent was acknowledged before me this 19 day of _—}vl ll��%�! 20� by �L- A kWt y who is personally known to me or who has produced-Nwo'-esi as i Signature TRACTOR The foregoing instrument was acknowledged before me this day of 20 �, by 1 n who is personally known to me or who has produced as identification and who did take an oath. identification and who did take an oath. NOTARY PUBL \ NOTARY PUBLIC: Sign: Sign: Print: �.� �' 1-�-ice Print: via Ti=i Lt::- Pe 22 A LT Seal: Seal: %y MYRTELLE PERRAULT M4"",ROSEMARY PLASENCIA '�' A �`�'_ C MY COMMISSION#FF13D778018"° MY COMMISSION #FF035074 EXPIRES: June 9, 2li" Bonded ThruNotary PubkUndemrtters EXPIRES July 10. 2017 ;8r *********** *************************,ta1�IS�.dkE93k***�aowi4ekkaMWr�Bs•�PdtR*** ******** txG/S APPROVED BYPlans Examiner Zoning Structural Review (Revised02/24/2014) Clerk STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 LUBIN, YVES PRACTICALITY INC 4921 NW 48TH AVE COCONUT CREEK FL 33073 -among ions. this ice you become one of�te nearly - one million Floridians licensed by the Department of Business and Professional Regulation. Our professionals and businesses range from architects to yacht brokers, from boxers to barbeque restaurants, and they keep Florida's economy strong. Every day we work to improve the way we do business in order to serve you better. For information about our services, please log onto www.myfloridalicense.com. There you can find more information about our divisions and the regulations that impact you, subscribe to department newsletters and learn more about the Departments initiatives. Our mission at the Department is: License Efficiently, Regulate Fairly. We constantly strive to serve you better so that you can serve your customers. Thank you for doing business in Florida, .and congratulations on your new license! DETACH HERE a (850) 487-1395 eFLORIDA..Lf My -w y e000 RICK SCOTT, GOVERNOR KEN LAWSON, SECRETARY ---.. _ $T1Tf OF f�"OR�DA DEPARTfi11EN Of �C1SiESS Alia eRFES iONA 12ECt1i_A�ION !. ._ �" ..w ..• w'wa.w... w`�www^u Twrl.iw�aw,ww.� ww AiCiIOROe CERTIFICATE OF LIABILITY INSURANCE112124/2014 DATE (MM/DD/YYYY) 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 REEL INSURANCE AGENCY DIBIAI COVER ALL INSURANCE 5800 W. ATLANTIC BLVD. MARGATE FL 33063 CONTACT PHONE(AIC No 954 956.0006 FAX 954 956-0555 E-MAIL . REELINSURANCE YAHOO.COM I RE 8 AFFORDING COVERAGE NAIL # INSURER . FEDERATED NATIONAL INSURANCE CO. 10790 114SURED PRACTICALITY, INC. 4921 NW 48TH AVENUE COCONUT CREEK FL 33073-4939 INSURER B: INSURER C: INSURER D: 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 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. IFISR TYPE OF INSURANCE DDL UBR LAAM POLICY NUMBER POLICY EFF MMID POLICY EXP LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE X� OCCUR GL -0504012681.00 1011912014 1OH912015 EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED $100,000 MED EXP (Any oneperson) $5,000 PERSONAL & ADV INJURY $1,000,0000 GENERAL AGGREGATE s2.000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY F PRO LOC PRODUCTS - COMP/OP AGG s2,000,000 $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIREDAUTOS NAUTOS COMBINED SINGLE LIMIT BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ UMBRELLA LIAR EXCESS LIAR HOCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ RETENT N WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVED OFFICERIMEMBER EXCLUDED? (Mandatory in NH) I es, describe under IPTI N 01 N / A WC STATU• 0FR E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE _ E.L. DISEASE - POLICY LIMIT I $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, K more space is required) REMODELING CERTIFICATE HOLDER CANCELLATION MIAMI SHORES VILLAGE BUILDING DEPT 10050 NE 2ND AVENUE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH T E POLICY PROVISIONS. MIAMI SHORES FL 33138 ON AUTHORIZED REPRESENTA FAX: 954-688-6646 01988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD CERTIFICATE OF LIABILITY INSURANCE Date 1/5/2015 Producer: Plymouth Insurance Agency This Certificate is issued as a matter of information only and confers no 2739 U.S. Highway 19 N. rights upon the Certificate Holder. This Certificate does not amend, extend Holiday, FL 34691 or atter the coverage afforded by the policies below. Insurers Affording Coverage NAIC # (727) 938-5562 insured: South East Personnel Leasing, Inc. & Subsidiaries 2739 U.S. Highway 19 N. Holiday, FL 34691 Insurer A: Lion Insurance Company 11075 Insurer B: Insurer C: Insurer D: Insurer E Coverages 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. Aggregate limits shown may have been reduced by paid claims. INSR LTR ADDL INSRD Type of Insurance Policy Number Policy Effective Date Policy Expiration Date Limits (MM/DD/YY) (MM/DD/YY) GENERAL LIABILITY Each Occurrence 8 Commercial General Liability Claims Made [] Occur Damage to rented premises (EA occurrence) Med Exp Personal Adv Injury General aggregate limit applies per: Policy11Project 11 General Aggregate Products Products - Comp/Op Agg AUTOMOBILE LIABILITY Combined Single Limit Any Auto (EA Accident) Bodily Injury All Owned Autos Scheduled Autos (Per Person) Bodily Injury Hired Autos Non -Owned Autos (Per Accident) Property Damage (Per Accident) ' EXCESS/UMBRELLA LIABILITY Each Occurrence Occur ❑ Claims Made Aggregate Deductible A Workers Compensation and WC 71949 01/01/2015 01/01/2016 x I WC Slatu- OTH- Employers' Liability to Limits ER E.L. Each Accident 81,000,000 Any proprietor/partner/executive officer/member E.L. Disease - Ea Employee 81,000,000 excluded? NO If Yes, describe under special provisions below. E.L. Disease - Policy Limits 81,000,000 Other Lion Insurance Company is A.M. Best Company rated A- (Excellent). AMB # 12616 Descriptions of Operations/Locations/Vehicles/Exclusions added by Endorsement/Special Provisions: Client ID: 92-68-943 Coverage only applies to active employee(s) of South East Personnel Leasing, Inc. & Subsidiaries that are leased to the following "Client Company": Practicality, Inc. Coverage only applies to injuries incurred by South East Personnel Leasing, Inc. & Subsidiaries active employee(s,, while working in: FL. Coverage does not apply to statutory employee(s) or independent contractor(s) of the Client Company or any other entity. A list of the active employee(s) leased to the Client Company can be obtained by faxing a request to (727) 937-2138 or by calling (727) 938-5562. Project Name: ISSUE 12-23-14 (TLD) 2014 Begin Date 11/3/2014 CERTIFICATE HOLDER CANCELLATION VILLAGE OF MIAMI SHORES Should any of the above described policies be cancelled before the expiration date thereof, the issuing BUILDING DEPARTMENT insurer will endeavor to mail 30 days written notice to the certificate holder named to the left,. but failure to do so shall impose no obligation or liability of any kind upon the insurer, its agents or representatives. 10050 NE 2ND AVE MIAMI SHORES, FL 33138 , Fad