Loading...
EL-15-536Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-230363 Permit Number: EL -3-15-536 Scheduled Inspection Date: March 17, 2015 Permit Type: Electrical - Residential Inspector: Devaney, Michael Inspection Type: Final Owner: JACKSON, JAMES Work Classification: Alteration Job Address: 1240 NE 91 Terrace Miami Shores, FL 33138- Phone Number Parcel Number 1132050010540 Project: <NONE> Contractor: MOODY ELECTRIC INC Phone: (305)758-2000 7u11u111y IJUIJOIL111C11L VV111111C11Lb MICROWAVE CIRCUIT INSPECTOR COMMENTS False Inspector Comment Passed E Failed Iz�l,S� Correction ❑ Needed Re -Inspection ❑ Fee No Additional Inspections can be scheduled until re -inspection fee is paid. March 16, 2015 For Inspections please call: (305)762-4949 Page 33 of 38 Q Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 MAR 12, 20155 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 FBC 20 K3 BUILDING Permit No. PERMIT APPLICATION Master Permit No. Permit Type: Electrical JOB ADDRESS: Aa J� A14 �/ City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated: Yes NO Flood Zone: OWNER: Name (Fee Simple Titleholder): j �/_t�S cx_� Phone#: Address:. City: State: Zip: 6� Tenant/Lessee Name: Phone#: __�?D 5 7.5G 596/ Email: CONTRACTOR: Address City: Name: /��L����"/ C/L �c'� `'' Phone#: �07 %j 0 oIJOC� Qualifier Name: v /�- Phone#: 04f State Certification or Registration #: G j2z ^ Certificate of Competency #: Contact Phone#:S 7s p v-;7-0 Email A dress: �^ CX_ DESIGNER: Architect/Engineer: 1,4 Phone#: Value of Work for this Permit: $ _i�� Square/Linear Footage of Work: Type of Work: ❑Address ❑Alteration ONew epair/Replace Description of Work: _ ❑Demolition Submittal Fee i Permit Fee $ /&01 oOep CCF $ CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ `( TOTAL FEE NOW DUE $ 11q7- ,60 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 Owner or Agent j The foregoing instrument was acknowledged beforery:e this day of 2016, _ by 14 2 e 4(���, who is personally known to me or who has produced As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commission Expires Signa r Contrac r The foregoing instrument was acknowledged before me this day of 0 , by ',601117 CI, who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: MARY PAT BRIGGS My .Notary Public - State of Florida My Comm. Expires May 11, 2018 Commission # FF 120746 APPROVED BY / 2/1+ A-/ - /-4irlans Examiner Structural Review (Revised 3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09) MARY PAT BRIGGS 3 _ Notary Public - State of Florida My Comm. Expires May 11, 2018 �9l F F «�",•° Commission # FF 120746 Zoning Clerk MOODELE-01 MELBA .*CORD" CERTIFICATE OF LIABILITY INSURANCE �-� FDAT 3//11/11/2015D°1 YM 5 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 Acrisure, LLC d/b/a InSource 9500 South Dadeland Boulevard(AIC.No 4th Floor Miami, FL 33156-2067 CONTACT NAME: PHONE FAX (305) 670-9699 Ext : (305 ) 670-6711 A/C No E-MAIL ADDRESS: INSURERS AFFORDING COVERAGE NAK: ti INSURER A: Monroe Guaranty Ins. Co. 12131/2015 INSURED INSURER B; FCCI Insurance Company 10178 Moody Electric, Inc. Mr. John Moody 669 NW 90 Street INSURER C; INSURER D INSURER E : Miami, FL 33150 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. INSRL LTR TYPE OF INSURANCE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. R POLICY NUMBER POLICY EFF M/DD POLICY EXP M/DD� A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE X OCCUR CPP000569410 12131/2014 12131/2015 EACH OCCURRENCE $ 1,000,00 DAMAGE TO REN 10 - PREMISES F occurrence 100,00 _$ MED EXP (Any one person) $ 5,00 PERSONAL R ADV INJURY $ 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY a jE a X LOC OTHER: GENERAL AGGREGATE $ 2,000,00 PRODUCTS - COMP/OP AGG $ 2,000,00 $ B AUTOMOBILE X X LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS X NON -OWNED AUTOS CA00288881 12/3112014 12/31/2015 Ea exideD SINGLE LIMIT $ 1,000,00 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPER7YDAMAGE $ Per accident B X UMBRELLA LIAB EXCESS LIAR X OCCUR CLAIMS -MADE UMB0004787 9 12131/2014 12/3112015 EACH OCCURRENCE $ 2,000,E AGGREGATE $ 2,000,00 DED I X I RETENTION $ 10,000 $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y I N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below N /A PER OTH- STATUTE I I ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Electrical Contractor CERTIFICATE HOLDER CANCELLATION ACORD 25 (2014/01) ©1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Village of Miami Shores 10050 NE 2nd. Avenue THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Miami Shores, FL 33138 AUTHORIZED REPRESENTATIVE eA-4 aZF.,4-- ACORD 25 (2014/01) ©1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD MOODY -1 OP ID: TH /A! C.- "ML> DATE (MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 01/09i2015 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 endorsement(s). PRODUCER CCOONT CT Workers' Compensation Group Workers Compensation Group P O Box 410 AJC, NHONE Ext : 561-392-3300 A No): 561-361-1132 Boca Raton, FL 33429-0410 1 E-MAIL INSURED Moody Electric, Inc 669 Northwest 90th Street Miami, FL 33150 INSURER C : INSURER E : COVERAGE NAIC # .Ins 10701 UUVEKAGES 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 D UBR POLICY NUMBER POLICY EFF MWD POLICY EXP MIWD LIMITS COMMERCIAL GENERAL LIABILITY CLAIMS -MADE F]OCCUREF1 EACH OCCURRENCE $ PREMISES Ea occurrence) $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: POLICY ❑PRO ❑LOC JECT OTHER: GENERAL AGGREGATE $ PRODUCTS-COMP/OPAGG $ $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS COMBINED SINGLE LIMIT $ Ea accident BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ Per accident UMBRELLA LIAB EXCESS LIAB HCLAIMS-MADE OCCUR EACH OCCURRENCE $ AGGREGATE $ DED RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N OFFICER/MEMBER EXCLUDED? � (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A 830-29673 01/01/2015 01/01/2016 X PER OTH- STATUTE ER E.L. EACH ACCIDENT $ 1,000,00 E.L. DISEASE - EA EMPLOYE $ 1,000,00 E.L. DISEASE - POLICY LIMIT I $ 1,000,00 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Electrical Contractors CERTIFICATE HOLDER MIAMIS3 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Village of Miami Shores THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN g ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE 2nd Ave. Miami Shores, FL 33138 AUTHORIZED REPRESENTATIVE I I I k�� ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD RICK SCOTT, GOVERNOR KEN LAWSON, SECRETARY } STATE OF FLORIDA_ DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD . The ELECTRCCAL CONTRACTOR :.:;.Narled below IS.CERTIFIED; Unde.rt a pcovisrons of chapter 489 FS. - P E�rpi.catlon dafe AU,G 31,; 2016... 75 MOODYK.JGHN Jy MO©DY E1;>rCFRiQ' IN sh 13�OU ROANCI<E TR 14 .14 DAME u Al 'A Xt- 1.2 ISSUED: 08/10/2014 DISPLAY AS REQUIRED BY LAW SEQ # 1-1408100003121 I Project Address Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 Parcel Number Applicant 1240 NE 91 Terrace 1132050010540 JAMES JACKSON Miami Shores, FL 33138- Block: Lot: JAMES JACKSON 1240 NE 91 Terrace MIAMI SHORES FL 33138-3406 Contractor(s) Phone Cell Phone MOODY ELECTRIC INC (305)758-2000 of Work: MICROWAVE CIRCUIT onal Info: ification: Residential ling: 3 Fees Due Amount CCF $0.60 DBPR Fee $2.00 DCA Fee $2.00 Education Surcharge $0.20 Permit Fee - Additions/Alterations $100.00 Scanning Fee $9.00 Technology Fee $0.80 Total: $114.60 Cell LValuation: $ 350.00 eet: 0 Pav Date Pav TvDe Amt Paid Amt Due I Invoice # EL -3-15-54761 03/16/2015 Credit Card $ 114.60 $ 0.00 Available Inspections: Inspection Type: Review Electrical In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT:if thf at all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning,, Futt)e5rmore I a4horize the above amed contractor to do the work stated. March 16, 2015 Authorized Signature: Owner / Applicant /Q6ntractor / Agent Date Building Department Copy March 16, 2015 1