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EL-15-747Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-231467 Permit Number: EL -4-15-747 Scheduled Inspection Date: April 08, 2015 Permit Type: Electrical - Residential Inspector: Devaney, Michael Inspection Type: Final Owner: BOURNE, ROBERT Work Classification: New Job Address: 490 NE 101 Street Miami Shores, FL 33138-2449 Phone Number Parcel Number 1132060170430 Project: <NONE> Contractor: ALES GROUP ELECTRICAL CONTRACTORS Phone: (786)244-0004 Building Department Comments UP LIGHTS ON THE TREES IN SWALE & ELECTRIC. mtractio vassea ttomments INSPECTOR COMMENTS False Inspector Comments Passed E?f Failed Correction ❑ Needed Re -Inspection ❑ Fee No Additional Inspections can be scheduled until re -inspection fee is paid. April 07, 2016 For Inspections please call: (305)762-4949 Page 24 of 41 Project Address Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 Parcel Number Applicant 490 N E 101 Street 1132060170430 ROBERT BOURNE Miami Shores, FL 33138-2449 Block: Lot: Owner Information Address Phone Cell ROBERT BOURNE 490 NE 101 MIAMI SHORES FL 33138-2734 490 NE 101 MIAMI SHORES FL 33138-2734 Contractor(s) Phone Cell Phone ALES GROUP ELECTRICAL CONTRAi (786)244-0004 of Work: UP LIGHTS ON THE TREES IN SWALE & E onal Info: ification: Residential 1inp: 3 Fees Due Amount CCF $1.20 DBPR Fee $2.25 DCA Fee $2.25 Education Surcharge $0.40 Permit Fee - Additions/Alterations $150.00 Scanning Fee $9.00 Technology Fee $1.60 Total: $166.70 Valuation: $ 1,200.00 Total Sq Feet: 0 Pay Date Pay Type Amt Paid Amt Due Invoice # EL -4-15-55029 04/02/2015 Credit Card $ 50.00 $ 116.70 04/07/2015 Cash $ 116.70 $ 0.00 AvauaDle Inspection Type: Final Meter Box I Fire 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,;WIMMING POOL work. OWNERS AFFIDAVIT: I certify that all the foregoing informati ,ef is accurate construction and zoning. Futhermore, I authorize the abov71 �y Authorized Signature: Owner / / Contracf6r / ork will be done in compliance with all applicable laws regulating stated. April 07, 2015 Building Department Copy April 07, 2015 1 BUILDING PERMIT APPLICATION 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 ❑BUILDING ELECTRIC ❑ ROOFING C20j() c L'] Master Permit No. �!L- '�" � "i T Sub Permit No. ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP Folio/Parcel#: " 3Z ©tV 6M 04-30 Is the Building Historically Designated: Yes Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: �.w ��! `t I --) 4D 1 -(g -"L OWNER: Name (Fee Simple Titleholder): (' Phone#: Address: 490 13 R5—LCA S City: State: Zip: Tenant/Lessee Name: Phone#:_ z f! S Email: (�e�j =\=6 us `�J � S0U--)0/l •'( eA— CONTRACTOR: Company Name: � ee• ; �.-+.A�4wE46z;• COiclrl. 7bi2 Phone#: 784' Address: 84f46500 %O doe City: 7io"" State: N -0&10Q Zip: :R4/ d Qualifier Name: P,4H64 L PAC— -176 Phone#: 7 e, • G O174 State Certification or Registration #: 46C. 000 ZZ&B Certificate of Competency #: DESIGNER: Architect/Engineer: one#: Address: City: State: Zip: Value of Work for this Permit: $ �� Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration New ❑ Repair/Replace ❑ Demolition Description of Work:�� `� Y CA'�i �� S: CJUQ \ l- P Specify color of color thru file: _ Submittal Fee Permit Fee $ Z o ®41 CCF $ CO/CC $ Scanning Fee $ Technology Fee $ Structural Reviews $ (Revised02/24/2014) Radon Fee $ Training/Education Fee $ DBPR $ Notary $ Double Fee $ Bond $ TOTAL FEE NOW DUE $ ST � .CONTRACT R DRAWINGS JOB ADDRESS: � '' Citv: Miami Shores County Miami Dade Zin: 32 t3N Folio/Parcel#: " 3Z ©tV 6M 04-30 Is the Building Historically Designated: Yes Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: �.w ��! `t I --) 4D 1 -(g -"L OWNER: Name (Fee Simple Titleholder): (' Phone#: Address: 490 13 R5—LCA S City: State: Zip: Tenant/Lessee Name: Phone#:_ z f! S Email: (�e�j =\=6 us `�J � S0U--)0/l •'( eA— CONTRACTOR: Company Name: � ee• ; �.-+.A�4wE46z;• COiclrl. 7bi2 Phone#: 784' Address: 84f46500 %O doe City: 7io"" State: N -0&10Q Zip: :R4/ d Qualifier Name: P,4H64 L PAC— -176 Phone#: 7 e, • G O174 State Certification or Registration #: 46C. 000 ZZ&B Certificate of Competency #: DESIGNER: Architect/Engineer: one#: Address: City: State: Zip: Value of Work for this Permit: $ �� Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration New ❑ Repair/Replace ❑ Demolition Description of Work:�� `� Y CA'�i �� S: CJUQ \ l- P Specify color of color thru file: _ Submittal Fee Permit Fee $ Z o ®41 CCF $ CO/CC $ Scanning Fee $ Technology Fee $ Structural Reviews $ (Revised02/24/2014) Radon Fee $ Training/Education Fee $ DBPR $ Notary $ Double Fee $ Bond $ 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 Zi d , . ; 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 approved and a reinspection fee will be charged. Signature OWNER or AGENT The foregoing instrument was acknowledged before me this day of V Q� C� _ 20 S ._... by wh is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Signature CONTRACTOR The foregoing,instrument was acknowledged before me this ��. day of , 20, by who is personally known to me or who has produced identification and who did take an oath. NOTARY PUBLIC: as Print: Print: ��► °� �v''• BARBARAA Seal: W COWSSION # FF 073975 Seal: ,�qt°�Y°�2: ADRI MGIRARDI "sem•, EXPIRES' Maroh 29, 2018 =�: ?il Ml° COMMISSION # EE 867174 7t§, �r :•'�� Bondw 7WU Nowy Pawk Uwamftts ,.••:�4 EXPIRES: January 22, 2017 pf��,.• &ended Thru Notary Pabfic Underwriters ye*,k,Kik,kBcffi*Makakak�Ie�k�k***�k*�k�k�k#*�k�k�k�kak�Is�1,y,�k�k�t,�k�kffi�k&�k*ffi***�k�kN�Nuk�k&�k�k�k&ffi&&�k*�k�k+k�kffi�k&�kffi�k�k*N�*�k*�k�k&** �kaksk�k�k�k�k�k*�kffi�k�k�k�k�k�K APPROVED BY Plans Examiner Zoning Structural Review Clerk (RevisedO2/24/2014) w . . i A� Rai' CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDIYYYY) 3/27/2015 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 endorsemant(s). PRODUCER SUNZ Insurance Solutions, LLC. ID: TLR c/o TLR of Bonita, Inc 700 Central Ave, Suite 500 St. Petersburg, FL 33701 NAME OT Aimee Gra acN� 727-520-7676 x 222 nIC Nol: 727-525-3862 E-MAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIC # INSURERA: SUNZ Insurance Company 34762 INSURED TLR of Bonita, Inc dba EnterpriseHR Encore Business Solutions, Inc and its Subsidiaries INSURER B: Aspen Re - London - Best Rating "A" INsuRER c : Catlin Syndicate - Lloyds -Best Rating "A" INSURER D: Brit Syndicate - Lloyds - Best Rating "A" INSURER E: 700 Central Ave, Suite 500 St. Petersburg FL 33701 INSURER F COVERAGES CERTIFICATE NUMBER: 23981261 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. INSR LTR TYPE OF INSURANCE ADDL S SUBR - POLICY NUMBER POLICY EFF. MM/DD POLICY EXP MM/DD LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS -MADE � OCCUR E TO RE 11 ccurrence $ SES Ea M.".) PREMISES MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ POLICY a PECO?- E] LOC $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea acadent BODILY INJURY (Per person) $ ANY AUTO BODILY INJURY (Per accident) $ ALLOWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS PROPERTY DAMAGE $ Per accident UMBRELLA LIAR [7OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS UAB CLAIMS -MADE DED I I RETENTION $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN WCPE0000000110 6/1/2014 6/1/2015f STATUTE OT ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYE $ 1,000,000 OFFICERIMEMBER EXCLUDED? ❑ (Mandatory In NH) N / A E.L. DISEASE - POLICY LIMIT I $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below B Workers Compensation This is for informational purposes C Excess Coverage and nothing shall create any right D under such reinsurance. DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached If more space is required) Coverage Provided for all leased employees but not subcontractors of: Ales Group, Inc. Client Effective: 6/20/2014 dba Ales Group Electrical Contractors CERTIFICATE HOLDER CANCELLATION 7790 Miami Shore Village Building Dept. 9 9 P 10050 NE 2nd Ave. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Miami Shores FL 33138 AUTHORIZED REPRESENTATIVE Glen J Distefano ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD CERT NO.: 23981261 Aimee Gray 3/27/2015 11:06:42 AM (CDT) Page 1 of 1