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EL-14-1769Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-217838 Scheduled Inspection Date: March 25, 2015 Inspector: Devaney, Michael Owner: COY, J FRANK MC Job Address: 85 NE 94 Street Miami Shores, FL 33138 - Project: <NONE> Contractor: ALL QUALITY ELECTRICAL SERVICES, INC dunamg ueparltment comments Permit Number: EL -8-14-1769 Permit Type: Electrical - Residential Inspection Type: Final Work Classification: Generator Phone Number Parcel Number 1132060130580 Phone: (305)968-7832 INSTALLATION OF NEW NATURAL GAS FIRED 22 INV Infractio Passed Comments GENERATOR AND AUTOMATIC TRANFER SWITCH. I INSPECTOR COMMENTS False NEW SERVICES ENTRANCE VIA OVERHEAD MAST. (REPLACE OLD) Inspector Comments Passed Failed Correction ❑ Needed Re -Inspection Fee No Additional Inspections can be scheduled until re -inspection fee is paid. March 24, 2015 For Inspections please call: (305)762-4949 Page 4 of 28 h 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 ❑BUILDING ELECTRIC ❑ ROOFING Master Permit Noz. I st F�69 Sub Permit No.r ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑ PLUMBING ❑ MECHANICAL PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP JOB ADDRESS: CONTRACTOR DRAWINGS 35 A) S q� f ON: Miami Shores Cnunty- Miami Dade lin: 33/39 Folio/Parcel#: It — 3 ZO b — 013 - 05 TO Is the Building Historically Designated: Yes NO r'L_ Occupancy Type: S&L oad: Construction Type: C[3 S Flood Zone: NO BFE: FFE: OWNER: Name (Fee Simple Titleholder): Fi`Q,Y1 K /& G to Phone#: -?Or 7 S- 7 Address: 9-S• mc— 9q St 9 • City: l�/ C�/'h ! D r cS state: /t:-" L zip: 33/ Tenant/Lessee Name: /y.4 1+ Phone#: /v/ At Email: N /A" CONTRACTOR: Company Name: Azz Address: /4/7.500 5b �A City: M t t 424 / Qualifier Name: SCa.mylll State Certification or Registration M. 6qe DESIGNER: Architect/Engineer: ;e 30Z' 96 8' 7932. —State: '1 • Zip: 3 3% 6'7 k 60 - g e— Phone#: 70 5— 910 7 ft 2_ g /3536 6rJ� �00 �}% O ertificate of Competency #: one#: Address: City: State: Zip: Value of Work for this Permit: $ 2. 210 Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration New ❑ Repair/Replace ❑ Demolition Specify color of color thru tile: Submittal Fee Permit Fee $ �/ Z 9 e Xf_� CCF $ CO/CC $ Scanning Fee $ ' �(� Radon Fee $ e 4 DBPR $ Notary $ Technology Fee $ Training/Education Fee $ . 6;0 Double Fee $ Structural Reviews $ Bond $ rA TOTAL FEE NOW DUE $ ��® ° (Revised02/24/2014) 2 - 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 ANOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS` Tb YOUR PKGPERTY:. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUit LENDER OR AN ATTORNEY I6E'FORE RECORDING YQUR NOTICE.OF. COMMENCEMENT." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exckeding $25QQ'th,'r 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 Suhje°ct to attachment. Also, a certified copy of the recorded notice of commencement must be hosted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. an. the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. / ° = .,OWNER or AG (ENT Th ,, oregging instrument was acknowledged before me this day of K . 20 ��L . by �A . who is personally known to me or who has dp'rrooduced &L®0�6 6O�Z •000s identification and wha diq take an oath. NOTARY P LI Sig Print: Seal: - �'"�' Comr►Usslon # FF 065936 .Sprn , py I T�Finw 18 10u aoo.�esao�e . ° Signature CONTRACTOR, The foregoing instrument was acknowledged before me this clay of. -,—ru w , 201(-/ ' by who' rsonally known to me or who has produced as identification apd,&ho did take an oath. NOTA RYPUBLI Sign: Print: Seal: * :. Cbmmission# FF 065936 .o Expires January 23, 2018 utP4P'. 8ondW Thru troy Fan bar =e 019 71AI APPROVED BY Plans Examiner ( ` Zoning Structural Review Clerk (Revised02/24/2014) Report Viewer •�•�/�g C��E�Y TIWATE OFElLECTION TO BE E71EWT FROM FLORIDA Yom' UM LAW PIDWTRY /iONS��� �/� TIft cm"n UPI Yt Mi Vick fil Wed tebwtmdecWdto beexmWkm FW WaWakW I. x EFFECTIVE DAM' 612V2013 EXPIRATION DATE: a&1=6 PERSON: LIGHTBOURNE SAMUEL FEDI: 542171753 BIAS NAME AND ADDRESS: ALL QUALITY ELECTRICAL SERVICES INC 14750 S. RIVER DRIVE UL4M1 FL 33187 SCOPES OF SWINESS OR TRADE: ELECTRICAL WIRING BURGLAR AND FIRE WITHIN BUIL ALARM INSTALL W OPS+2-®Ar,252 CZ:MV=TE OF 8 20TON TO BE EXEMFT REVWW 07-12 CUEmam 1850X413-0808 Page 1 of 1 https://apps8.fldfs.com/crreportviewer/reportViewer.aspx?data. kdvpginc9D7Q3gH6TER6... 4/17/2014 Y d CERTIFICATE OF LIABILITY INSURANCE DA07/30/14 /30 4 ' PRpDUCER MX to Wiffs hmmQe MIAMI SHORES VILLAGE THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION 18401 N.W. 27 Ave Miarrd, FL 33056 THE LEFT, BUT FAILURE TO DO SO SHALL MWOSE NO OBLIGATION OR LIABILITY ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC P Phone (305) 625-2403 Fax (305) 625-6472 MIAMI SHORES, FL 33138 INSURED ALL QUALITY ELECTRICAL SERVICES, INC INSURER A: GRANADA INSURANCE COMPANY INSURER B' AND SAMUEL LIGHTBOURNE 14750 SOUTH RIVERS DRIVE MIAMI, FL 33167 INSURER C'INSURER D: INSURER E: COVERAGES INSURER F: THE POLICIES OF INSURANCE LISTED HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERRA 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 ADD'L IN TYPE POLICY NUMBER POLICY EFFECTIVE DATE WDIUM POLICY EXPUMIGr DATE 6111INDOM L®BTS GENERAL LL48UM EACH OCCURRENCE 1,000,000 ®coNIUIERCIALGENERAL LIABILITY 0185fl00058653 04/17/14 04/17/15 PRREMISEsoaoc u� 100,000 ❑ ❑ CLAIMS MADE ® OCCUR MED EXP (Any one person) 5,000 A ❑ ❑ PERSONAL &ADV INJURY 1,000,000 ❑ GENERALAGGREGATE 2,000,000 GENT- AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG 2,000,000 © POLICY ❑ PROJECT ❑ LOC AUTOMOBLE LIABILITY ❑ ANY AUTO COMBINED SINGLE LIMIT (Ea ecdderd) ❑ ❑ ALL OWNED AUTOS ❑ SCHEDULED AUTOS ❑ HIRED AUTOS El NON OWNED AUTOS BODILY INJURY (Per ) BODILY INJURY (Peraccident) ❑ PROPERTY DAMAGE (Pet acddent) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT ❑ ❑ ANY AUTO ❑ OTHER THAN EA A C AUTO ONLY: AGG EXCESSMMBRE r A LIABILITY EACH OCCURRENCE AGGREGATE ❑ OCCUR ❑ CLAIMS MADE ❑ ❑ DEDUCTIBLE ❑ RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ©WC ATU- ❑ OTH- LEEt— C ANY PROPRIETOR / PARTNER / EXECUTIVE EL EACH ACCIDENT OFFICER / MEMBER EXCLUDED? If yea, describe under EL DISEASE - EA EMPLOYEE EL DISEASE - POLICY LIMIT SPECIAL PROVISIONS below OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS ELECTRICAL WORK CERTIFICATE HOUR CANCELLATION AGORID 25 (2001108) QF © ACORD CORPORATION 1988 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THERE, THE ISSUING INSURER WILL ENDEAVOR TO MNL MIAMI SHORES VILLAGE 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO BUILDING DEPARTMENT THE LEFT, BUT FAILURE TO DO SO SHALL MWOSE NO OBLIGATION OR LIABILITY 10050 NE 2ND AVENUE OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE MIAMI SHORES, FL 33138 AGORID 25 (2001108) QF © ACORD CORPORATION 1988 OR �'✓� C_ n sell oma Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Notice to Owner - Workers' Compensation Insurance Exemption Florida Law requires Workers' Compensation insurance coverage under Chapter 440 of the Florida Statutes. Fla. Stat. § 440.05 allows corporate officers in the construction industry to exempt themselves from this requirement for any construction project prior to obtaining a building permit. Pursuant to the Florida Division of Workers' Compensation Employer Facts Brochure: An employer in the construction industry who employs one or more part-time or full-time employees, including the owner, must obtain workers' compensation coverage. Corporate officers or members of a limited liability company (LLC) in the construction industry may elect to be exempt if: 1. The officer owns at least 10 percent of the stock of the corporation, or in the case of an LLC, a statement attesting to the minimum 10 percent ownership; 2. The officer is listed as an officer of the corporation in the records of the Florida Department of State, Division of Corporations; and 3. The corporation is registered and listed as active with the Florida Department of State, Division of Corporations. No more than three corporate officers per corporation or limited liability company members are allowed to be exempt. Construction exemptions are valid for a period of two years or until a voluntary revocation is filed or the exemption is revoked by the Division. Your contractor is requesting a permit under this workers' compensation exemption. In these circumstances, Miami Shores Village does not require verification of workers' compensation insurance coverage from the contractor's company. Therefore, you may be personally liable for the worker compensation injuries of any person allowed to work under this permit Please check with your insurance carrier since most property insurance policies DO NOT cover this type of liability. BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. Owner �y Print Name:.�►�OAa L � Signature:.. ' State of Florida) County of Miami -Dade ) Sworn to bscribed before me day of , 20/ Z By (SEAL) # FF 065936 E.xpiros January 23, 2018 Contractor �/ Print Name: " 0,1MV'Pi � L,A A &VrI Signature: el State of Florida) County of Miami -Dade) Sworn to and bscri!��- CommIssion s day of � , L-13 01— 7D Tvpe of Expires January 23,