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EL-14-1657Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-230813 Permit Number: EL -7-14-1657 Scheduled Inspection Date: March 24, 2015 Permit Type: Electrical - Residential Inspector: Devaney, Michael Inspection Type: Final Owner: BRUZZI, MARCO Work Classification: Alteration Job Address: 10433 NE 6 Avenue Miami Shores, FL Phone Number (786)691-0933 Parcel Number 1122310120180 Project: <NONE> Contractor: CASSIA ELECTRICAL CONTRACTORS INC Phone: (954)650-5840 6unaing uepanment comments INSTALL KITCHEN OUTLETS AND SWITCH FOR DISHWASHER IN KITCHEN INSPECTOR COMMENTS False Inspector Comments Passed 4f;W'a_ Failed Correction ❑ Needed Re -Inspection ❑ Fee No Additional Inspections can be scheduled until re -inspection fee is paid March 23, 2015 For Inspections please call: (305)762-4949 Page 43 of 52 t 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 * � C ❑BUILDING ® ELECTRIC ❑ ROOFING ❑PLUMBING ❑ MECHANICAL MPUBLICWORKS .LOB ADDRESS: 10433 NE 6 Ave Master Permit r 1; r Z/ -7S --X / . Sub Permit NoZI Al— 1Z 15— 57-1 ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑ CHANGE OF CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS MT. Miami Shores County: Miami Dade Zip: 33138 Folio/Parcel#: 11-2231-012-0180 is the Building Historically Designated: Yes NO X Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): Kiluan Inc Phone#: Address: 10433 NE 6 Ave. City: Miami Shores State: Florida zip: 33138 Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: Cassia Electrical Contractors, Inc Phone#:.(954) 650-5840 Address: 8261 NW 48 St. city: Lauderhill State: Florida zip: 33351 Qualifier Name: Glenworth Walker Phone#: (954) 650-5840 State Certification or Registration #: ER 1301303 Certificate of Competency #: 05E000248 DESIGNER: Architect/Engineer: Joseph S. Dobos Phone#: (954) 380-3616 Address: 3550 Powerline Rd. city: Oakland Park State: FI. zip: 33309 Value of Work for this Permit: $ 520.00 Square/Linear Footage of Work: 250 Sq, Ft. Type of Work: ❑ Addition ❑ Alteration ❑ New Q Repair/Replace ❑ Demolition Description of Work: Install Kitchen GFI outlets outlet and switch for dishwasher in kitchen �aecify color of color thru tile: Submittal Fee $ S®. 6 jb Permit Fee $ Id`;691.049 CCF $ CO/CC $ Scanning fee $ Technology Fee $ Structural Reviews $ (Revised0212412014) 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 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. /n the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. 7 Signature OWNER or AGENT The foregoing instrument was acknowledged before me this ,ge— day of ��Jl , 20 IV , by J'MA4 7-9 who ' rsonally know o me or who has produced identification and NOTARY PUBLIC: Print: Seal: as ALDO'PUSCHENDORF MY COMMAS M 0 SE185149 . EXPtREB April 01. 2016 MARTHA HERNANDEZ MY COMMISSION # FF035456 EXPIRES: July 11, 2017 Signature CiGtl CONTRACTOR The foregoing instrument was acknowledged before me this day of , 20 , by 6:ie icJdvla AJALI�E/� , who is personally known to me or who has produced as identification and w7��ke an oath. NOTARY PUBLIO: Sign:_ Print: Seal: MARTHA HERNANDEZ MY COMMISSION # FF035456 EXPIRES: July 11, 2017 &+k�kak�k�kaRsksksk+k#*,kak�k&d�sk��kPskik#�R�k+kik&�ksksk&�k4*sk+R�kA�+k�k�k�k+kAcakskak�ksk*isx�k�k�k��c*�k�kffisk�kMs&�ksk+ksk+�*��R�k�R*�k�kok4�k�h�k�k+k*�ksk�*�4*+kak�ksk�k�k�kffi�He�ka��k /el APPROVED BY°g / 3l`rG°G y Plans Examiner Zoning Structural Review Clerk (RevisedO2/24/2014) Fax: (305)756-8972 ACOR©® CERTIFICATE OF LIABILITY INSURANCEDATE(MMIDD)YYYY) INSR LTR TYPE OF INSURANCE 07/30/2014 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 CONTACT NAME: Lisa Tulloch LaPlante AgencyPHONE FAX "• (727)796-8566 ,� Ne: (727)7x1 -1x12 2715 State Rd 580 E-MAIL, ADDRESS: lisa@)aplanteagency.com Clearwater, FL 33761 MED EXP (Any one person) $ 5 000 License #: A149680 INSURERS AFFORDING COVERAGE NAIC 0 INSURER A: North Pointe Insurance Company GEML AGGREGATE LIMIT APPLIES PER X POLICYF-1 jEcT PRO LOC INSURED Cassia Electrical Contractors Inc INSURER B: Normandy Harbor Insurance Company 8261 NW 48th St INSURER C: and Glen Walker INSURER D: Lauderhill, FL 33351 INSURER E: BODILY INJURY (Per parson) $ BODILY INJURY (Per acdderd) $ INSURER F: COVERAGES CERTIFICATE NUMBER: 00000697-1341728 REVISION NUMBER: 24R 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 ADD BR POLICY NUMBER POLICY EFF M1DC POLICY EXP MIDD LIMITS A GOAL LIABILITY CMERCIAL GENERAL LIABILITY 1:01M CLAIMSMADE�OCCUR 3094110169 07129/2014 07129/2015 EACH OCCURRENCE $ 1,000.000 D GE O RENTED PREMISES ce $100 000 MED EXP (Any one person) $ 5 000 PERSONAL $ ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEML AGGREGATE LIMIT APPLIES PER X POLICYF-1 jEcT PRO LOC PRODUCTS - COMP/OP AGO $ 2,000,000 $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNEDSCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS COMBINED SINGLE LIMIT O, ecddent BODILY INJURY (Per parson) $ BODILY INJURY (Per acdderd) $ PROPERTY DAMAGE eraccl $ UMBRELLALIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED I I RETENTION $ $ B WORMERS COMPENSATION YIN ANDEMPLOYEWLIABILITY ANYPOFFlCERROPRIETOR/PARTNERIIMEMBEREXCLUDED7EXECUWE® (Mandatory N NH) I'M f yes, describe under DESCRIPTION OF OPERATIONS Below NIAE.L. NHFL142190 03126/2014 03126/2015 WC STATU- OTH- X T .EACHACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, M more space Is rpulred) Electrical Contractor #ER13013013 Miami Shores Village 10050 NE 2nd Ave Miami Shores, FL 33138 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD Printed by LMT on July 30, 2014 at 08:57AM