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EL-15-1212Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-235915 Permit Number: EL -5-15-1212 Scheduled Inspection Date: June 03, 2015 Permit Type: Electrical - Residential Inspector: Devaney, Michael Owner: RACK, CHARLES Job Address: 439 NE 92 Street Miami Shores, FL 33138 - Project: <NONE> Inspection Type. Final Work Classification: Alteration Phone Number (305)762-1666 Parcel Number 1132060140250 Contractor: P&M ELECTRIC INC Phone: (305)949-6373 Building Department Comments HOOK UP AC UNIT WIRING INSPECTOR COMMENTS False Inspector Comments Passed y e� Failed Correction Needed Re -Inspection ❑ Fee No Additional Inspections can be scheduled until re -inspection fee is paid June 02, 2015 For Inspections please call: (305)7624949 Page 23 of 28 ems ryt Miami Shores Village 10050 N.E. 2nd Avenue NE CCF Miami Shores, FL 33138-0000 DBPR Fee Phone: (305)795-2204 Project Address Parcel Number Applicant 439 NE 92 Street 1132060140250 Miami Shores, FL 33138- Block: Lot: CHARLES RACK Owner Information Address Phone Cell CHARLES RACK 439 NE 92 Street (305)762-1666 MIAMI SHORES FL 33138- 439 NE 92 Street MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone P&M ELECTRIC INC (305)949-6373 (305)588-9724 of Work: HOOK UP AC UNIT WIRING onal Info: ification: Residential ling: 1 Fees Due Amount CCF $0.60 DBPR Fee $2.25 DCA Fee $2.25 Education Surcharge $0.20 Permit Fee - Additions/Alterations $150.00 Scanning Fee $3.00 Technology Fee $0.80 Total: $159.10 Valuation: $ 699.67 Total Sq Feet: 0 Pay Date Pay Type Amt Paid Amt Due I Invoice # EL -5-15.55653 06/02/2015 Check* 10681 05/21/2015 Check #: 10674 $ 109.10 $ 50.00 $ 50.00 $ 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 1 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: 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. Futhermore, I authorize the above-rxamed cgntractpr to do the work stated. June 02, 2015 Authorized Signature: Owner / Applicant Building Department CopjK June 02, 2015 1 Miami Shores Village - Building illage Buildin Department MAY 2qa' 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 FBC 200J BUILDING Master Permit No. PERMIT APPLICATION Sub Permit No.� i �o ❑BUILDING ® ELECTRIC ❑ ROOFING E] REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL [:]PUBLICWORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: City: Miami Shores County: Miami Dade Zip: (3 Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): V1Qr lP� a (_Qi c� Phone#: 3n5- -��z - 166 Address: (A &C1 N I_ Cj "Z. STS - City: V V� J e L4.• k Tenant/Lessee Name: State: V i_ a%- ne#: -'R --, I :P --,P Email: ► C"4;LC(C S r'C t� ®� CONTRACTOR: Company Name: /- r �i�� �'L�_ �� Phone#: 3n Address: Zjj� 4" City: Al. �"�Ce� ®� State: �/ Zip: Qualifier Name: ne#: State Certification or Registration #: Z6: �Gf-?d� f F 7- Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: // City: State: /nZip: Value of Work for this Permit: $ C� ��' Square/Linear Footage of Work: � A - Type of Work: ❑ Addition ❑ Alteration 19 New /❑ Repair/Replace ❑ Demolition Description of Work: Win a (` -L.,_rx /C- (J.,,+ -" 'el Specify color of color thru tile: Submittal Fee $ Scanning Fee $ Technology Fee $ Structural Reviews $ (Revised02/24/2014) Permit Fee $ /� ®re"' CCF $ CO/CC $ 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. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charge Signature OWNER or AGENT The foregoing instrument was acknowledged before me this day of L . 20 1 S , by C)nalz\ S - who ispersonally known to me or who has produced NOTARY Sign: Print: Seal: (RevisedO2/24/2014) as did take an oath. Joseph Ciure _ ir' ,tet CAMMISSIOWEE09M L � NoParyPubicl State PIRES: MAY 17 2015 Joanna of Joanna n°� n••••• www.AA o c o� My C M Feliciano 8 0111212ola BY %%j`�/1�°G�l Plans Examiner Zoning d. Signatur CONTRACTOR The foregoing instrument was acknowledged before me this day of (::�i'` o- e ^o , 20 , by AO-9��7 who is personally known to me or who has produced I D- (I —, as identification and who did take an oath. NnTARV PIIRI IC- NMI C- Structural Review Clerk STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD WE 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 THRASHER, SCOTT NORMAN P & M ELECTRIC INC 800 NW 98TH AVE PEMBROKE PINES FL 33024-6121 Congratulations! With this license you become one of the 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 Department's 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 RICK SCOTT, GOVERNOR (850) 487-1395 <: .y STATE OF FLORIDA il DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION EC13001875 ISSUED: 08/31/2014 CERTIFIED ELECTRICAL CONTRACTOR THRASHER, SCOTT NORMAN P & M ELECTRIC INC IS CERTIFIED under the provisions of Ch.489 FS. Expiration date : AUG 31, 2016 L1408310006814 KEN LAWSON, SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD LICENSE NUMBER 11 The ELECTRICAL CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2016 THRASHER, SCOTT NORMAN P & M ELECTRIC INC 1936 NE 148 ST NORTH MIAMI FL 33181 [ONZM ISSUED: 08/31/2014 DISPLAY AS REQUIRED BY LAW SEQ # L1408310006814 Local Business Tax Receipt Miami—Dade County, State of Florida -THIS IS NOT A BILL - DO NOT PAY 1502831 BUSINESS NAME/LOCATION P & M ELECTRIC INC 1936 NE 148 ST NORTH MIAMI, FL 33181 LBT RECEIPT NO. EXPIRES RENEWAL SEPTEMBER 30, 2015 1502831 Must be displayed at place of business Pursuant to County Code Chapter 8A - Art. 9 & 10 SEC. TYPE OF BUSINESS PAYMENT RECEIVED OWNER P & M ELECTRIC INC 196 ELECTRICAL BY TAX COLLECTOR CONTRACTOR 49.50 10/10/2014 Worker(s) 10 EC13001875 0221-15-000229 This Local Business Tax Receipt only confirm payment of the Local Business Tax. The Receipt is not a license, permit, or a certification of the holder's qualificntions, to do business. Holder must comply with any governmental or nongovernmental regulatory laws and requirements which apply to the business. momilk The RECEIPT N0. above must be displayed on all commercial vehicles- Miami -Dade Code Sec 6a-276. MIAMFWIDE For more information, visit www miamidade aov/taxcollector 5-01-2015 4:12PM FROM PREW SE INS CENTER 305 685 5000 P. 1 CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDONYM 105 01 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($), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder le an ADDITIONAL INSURED, the pollcy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and Conditions of the policy, certain policies may require an endo* monmit. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement($). PRoaucwt Southeast Insurance Center, Inc Charles R. Wirt _ --�J 6175 NW 987 5t 1335 PHONE 305 885-0000 FAX Not; 305 8854000 ADDAESS,. h .Br aol.c*m Miami FL 33015.4350 INSURERIS) AFFORDINd COVERAGE NAILA INSURER A: (3ranada Insurance CO. !- .._....-....p 8a - INSURED 1936 NE 148 St. North Miami FL 33181 INSURER 8: " - INSURER C :INSURER D: INSURER E: --- INSURER F: GUVERAGES 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, r^_+TYPE OF INSURANCEAOOL POLICY EFF POLICY P - ---- — _ LTR POLICY NUMBER mumpffyyy) LIMITS A ✓ COMMERCIAL GENERAL LIABILITY 0185FL00070136 05/01/2015 ONI 012016 EACH OCCURRENCE $ 1,000,000. CLAIMS -MADE ❑✓ OCCUR ES „ $ 100,000• MED EXP (Any onepermn,) $ 5,000. PERSONAL & ADV INJURY 31,000,000. GENERAL AGGREGATE- � $ 1,000,000• PRODUCTS - COMP/OP AGG $ - GEWL AGGREGATE LIMIT APPLIES PER: RPOLICY ❑ JE LOC I I - $ OTHER AUTOMOBILE LIABILITY F,.e a[:ddBR11��. LIMIT - BODILY INJURY (Per parson) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOg HIRED AUTOS AUTO$WNED�OR�OAMAG BODILY INJURY (Per accident) $ $ - UMBRELLA UAB OCCUR 1 EACH OCCURRENCE $ __.. ? EXCESS UAS-� CLAIMS -MADE - — AGGREGATE - - _ $_- - DED RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LU1a1LITY YIN AOFFNYICPEROPRIETOR/PRfME�gREXARTNCLUDERtE7(ED?ECUTNE 7 N f A E S7ATUT FR -• E.L. EACH ACCIDENT $ .-_- E.L. DISEASE - EA EMPLOYE $ (Mandatory In NH) If yea, dea0ri$e under DESCRIPTION OF OPERATIONS below I I — E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEIHCLEB (ACORD 101, Additional RenMUICiSchedW% may be adached If more apace to requbed) Electrical Instalation & repair. City of Miami Shores Building Dept. 10050 NE 2 Av. Miami Shores FL 33138 Fax 305 756-8972 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELNERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED ©1988.2014 ACORD 28 (2014101) The ACORD name and toga are registered marks of ACORD Produced using FOMM 8068 Web sofbvme. www.FormaBosexam; 0 imp,asslve Publishing 800-208-1977 All rights reserved. r� ACORDCERTIFICATE OF LIABILITY INSURANCE PRODUCER L 05/01L2016 The Conrad Agency Inc CFONE IS NEMPOF ICTO YADCFERS©RGHTS UPON THE INFORMATION 4690 N Powerline Rd HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR Deerfield Beach, FI 33073 ALTER THE COVEKAGI! AFFORDED BY THE POLICIES BELOW. INSURED P & M Electric, Inc. 9938 NE 148 St North Miami Beach FI 33181 INSURERS AFFORDING COVERAGE I NAIC # I 305 949-6373 i INSURER D` INSURER E: OVERAGES 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 RESpf;C7 TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HE IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. D R POUCYNUMank POLICYEFFECTIVE PC RxPUiATION GENERAL LU1p0.17Y LIMITS $ COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE P MI5ES E o ,yq� R CLAIMS MADE F7 occuR .._.._.._._ PER: DMOBILE UABRM ANYAUTO ALL OWNED AUTO$ SCHEOULEDAUTOS HIRROAUTOS NON-OWNROAUTO5 GARAGE uarstlLlrr --- ANY AUTO tlo MNMLLn LIADJUTY R CLAIM. MADECTIBLE NTION $ WORKERS COMPENSATION AND NHFi,939722 CMPLOYERW 1JAmuTy ' ANY PROPRIETOR/PARTNERIEXECUTIVE OyFFkERM1EhRSER EXCLUCED7 SpECWLP OVISIONSbgtgw OTHER , Electrical Contracting, EC13001875 Miami Shores Village Building Dept, 90050 NE 2nd Avenue Miami Shores, FL 33138 25 10/04/2014 11110/04/207 5 S COMBINEDSINGLEUMrr S (I.3Ctl6-M) BODILYINJURY $ (Peraeraon) IBODIL.aYI48 nRY S PROPERTY DAMAGE (Peraa;ident) 8 Al1T'OONLY-EAACMOENT S OTHERTHAN EAACC S AUTO ONLY: AGG $ EACH OCCURRPNrF e E.L SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLEb BEFORE THE wwATION *ATE THEREOF, }Hi RUING INSURCK WILL ENDEAVOR TV AWL DAYS WRITTEN NOnCE TO THE CERTwIDATE HOLDER NAMED TO THE LEFT, BUT FAILURE To DD SD SHALL IMPOSE NO OBLIGATION OR LIABILITY Op ANy KIND UPON yHE INSURER ITS AGENTS OR REPRESENTA71VG29. AUTNORDED REPRESENTATIVE ,w Brett C Miller �40PW..ROiq� ® ACORD CORPORATION 1988