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EL-15-885Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 F Phone: (305)795-2204 Project Address Parcel Number Applicant 320 NE 100 Street 1132060135460 LEAH GROSSMAN Miami Shores, FL 33138-2421 Block: Lot: Owner Information Address Phone Cell LEAH GROSSMAN 320 NE 100 Street (786)342-8921 MIAMI SHORES FL 33138- 320 NE 100 Street MIAMI SHORES FL 33138 - Contractors) Phone Cell Phone ALL PHASE ELECTRIC CORP 305-345-6480 of Work: REPLACE LIGHT FIXTURE itional Info: �sification: Residential nnina: 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: $ 400.00 Total Sq Feet: 0 Pay Date Pay Type Amt Paid Amt Due I Invoice # EL4-15-55208 04/22/2015 Credit Card 04/15/2015 Cash $ 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 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: 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-named contractor to do the work stated. 22, 2015 Signature: Owner / Applicant / Contractor / Agent Building Department Copy April 22, 2015 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-235268 Permit Number: EL -4-15-885 Scheduled Inspection Date: May 26, 2015 Permit Type: Electrical - Residential Inspector: Devaney, Michael Inspection Type: Final Owner: GROSSMAN, LEAH Work Classification: Alteration Job Address: 320 NE 100 Street Miami Shores, FL 33138-2421 Phone Number (786)342-8921 Parcel Number 1132060135460 Project: <NONE> Contractor: ALL PHASE ELECTRIC CORP Phone: 305-345-6480 Building Department Comments REPLACE LIGHT FIXTURE INSPECTOR COMMENTS False Inspector Comments Passed Failed Correction ❑ ,4 Needed Re -Inspection ❑ Fee No Additional Inspections can be scheduled until re -inspection fee is paid. May 22, 2015 For Inspections please call: (305)762-4949 Page 40 of 42 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 PERMIT APPLICATION ❑ BUILDING [VI ELECTRIC ❑ ROOFING APR 15 2015 FB 2C 0 J�) Master Permit No?0__ S— 2 Sub Permit No. -' �S-Pin ❑ REVISION ❑ EXTENSION ❑ RENEWAL F-1 PLUMBING ❑ MECHANICAL PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: '3 ao ,yamF_ loo '51 City: Miami Shores County: Miami Dade Zip: (_9309 Folio/Parcel#: %V • ,?oAD 0 %42 ° 57° 6C) Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): �A �aIA i LAY g ro.SS fta4. Phone#: Address: t3 2 0 AIF— 160 Sp City: zqiiiw, i, State: 5L Zip: c?3 .3 Tenant/Lessee Name: Allffi Phone#: ear Email: bbl 1A CONTRACTOR: Company Name: A 00 r R Phone#: 7dplb 4 /w/oW, Address: 2'04p/ .4 ,442 AWS City: State: �� Zip:— Qualifier Name: ?c4ro � tkl Phone#: State Certification or Registration #: �' L, i3 Z< 0.3 Certificate of Competency #: dal At DESIGNER: Architect/Engineer: AIZA Phone#: N,/4 Address: tq/A City: &(IA State: Zip: Value of Work for this Permit: $ t4 Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New Repair/Replace ❑ Demolition Description of Work: 'Re-�:)Za cp _ 0 Ex re AZP 6&1' awx Specify color of color thru tile: Submittal Fee $• Permit Fee S. 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 $ 108 - I�� 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 d a 0 % 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. Signaturep OWNER or AGENT The foregoing instrument was acknowledged before me this 1 day of� � i 20 S by ra55P9a 4who is personally known to me or who has produced F161.* G&25'5,3Q -7,39 &&0 as identification and who did take an oath. NOTARY PUBLIC: Print: „ X Seal: .t;A,. Z m $ g cad ' "°,LO u' Cc o A <. 8903 z -__---------� a !`" co APPROVED BY - dans (Revised02/24/2014) Signature CONTRACTOR The foregoing instrument was acknowledged before me this day of Nr 20 J� by who is personally known to me or who has produced G _ as identification and who did take an oath. NOTARY PUBLIC: Print: „I M < �} g � Seal: :,I,- P` r ( � s 1( Ai � C0f� Ei" ' g im r:> N m (407, 3 00 miner Structural Review Zoning Clerk ACCA % '' CERTIFICATE OF LIABILITY INSURANCE DAT04/15/DI 04/15/201155 ' THIS ERTIFICATE 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 WANED, 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 endomement(s). PRODUCER Southwestern Insurance 4375 Palm Ave. Hialeah, FL 33012 Phone 305) 556-7399 Fax (305) 555-5469 CONTACT BAEATRIZ RODRIGUEZ PHONE( 556-7399 FAX No): (305) 556-5469 MAIL ronin826Qgmail.cwm INSURER AFFORDING COVERAGE NAIC S INSURER A: PROGRESSIVE EXPRESS INSURANCE 10193 INSURED All Phase Electric Corp 11899 NW 91st Ave Bay E Hialeah Gardens FL 33018- INSURER E: ASCENDANT INSURANCE COMP INSURER c: NORMANDY HARVOR INS COMP INSURER 0: INSURER E: 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. ILTR TYPE OF INSURANCE ADD UBR POLICY NUMBER POLICY EFF MMw POLICY EXP MM/D LIMITS A GENERAL LIABILITY 0 COMMERCIAL GENERAL LIABILITY ❑ ❑ CLaMS-MADE FV -1 OCCUR ElPERSONAL ❑ GL411401-2 011=015 01113/2016 EACH OCCURRENCE $ 1,000,000.00 DAMAGE(RENTED 100,000.00 PREMISESS occurrence $ MED EXP (Any one person $ 5,000.00 & ADV INJURY $ 1,000,000.00 GENERAL AGGREGATE $ 2,000,000.00 GEN'L AGGREGATE LIMIT APPLIES PER: ❑ POLICY ❑ PRO- ❑ LOC PRODUCTS - COMPIOP AGG $ 1,000,000.00 $ B AUTOMOBILE LIABILITY ❑ ANY AUTO LED ❑ AUTOS ALL AUTOS ❑ HIRED AUTOS ❑ AUTO ED ❑d PIP $10,000 ❑ 08314488-3 11/19/2014 11/19/2015 COME,NGLE LIMB 50 ,000.00 BODILY INJURY (Par person) $ BODILY INJURY (Peracclderd) $ PROPERTY DAMAGE r accida $ $ C ❑ UMBRELLA LIAR ❑ OCCUR ❑ EXCESS LIAR ❑ CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ ❑ DED ❑ RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS LIABILITY YINLIM ANY PROMEMBE EXCLUDED? (Mandatory In NH) If yea, descObs under DESCRIPTION OF OPERATIONS below NIA NHFL0034242015 03/03/2015 03!03!2016 ❑ PER ❑ W- E.L. EACH ACCIDENT $ 500,000.00 E.L. DISEASE -EA EMPLOYE $ 500,000.00 E.L. DISEASE- POLICY LIMB $ 500,000,00 DESCRIPTION OF OPERATIONS 1 LOCATIONS f VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is raqu(red) ELECTRICAL WORK CERTIFICATE HOLDER CANCELLATION SHOULD ANYOF THE ABO SCRIBED POLICIES BE CELLED BEFORE mlami shores village building THE EXPIRATION DATE F, NOTICE WILL BE DIN 10050 N E 2 AVE ACCORDANCE WITH T OLICY PROVISIONS. MIAMI SHORES FL 33138 AUTHOR D REP EAT.. �j �-L�'@Iirg-hl4ACOk6C6RP6RATION. All rlahts reserved. ACORD 25 (2014/01) QF The ACORD name and logo are registered marks of ACORD