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EL-15-464 Inspection Worksheet Miami Shores Village u0 � 10050 N.E. 2nd Avenue Miami Shores, FIL �� f 1 Phone: (305)795-2204 Fax: (305)756-8972 oo Inspection Number: INSP-238807 Permit Number: EL-3-15-464 Scheduled Inspection Date: July 13, 2015 Permit Type: Electrical - Residential Inspector: Devaney, Michael Inspection Type: Final Owner: HURLEY,JAMES Work Classification: Addition Job Address:685 GRAND CONCOURSE Miami Shores, FL 33138- Phone Number Parcel Number 1132060172180 Project: <NONE> Contractor: ATLANTIS ELECTRICAL CORP Phone: (305) 551-4043 Building Department Comments ELECTRICAL WORK FOR GARAGE CONVERSION AND Infractio Passed Comments INTERIOR REMODEL INSPECTOR COMMENTS False Inspector Comments Passed El Failed / 3 Correction ❑ Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. July 10, 2015 For Inspections please call: (305)762-4949 Page 20 of 24 Iq ( ti; Miami Shores Village Cz>RNGe'ZN Building Department MAR 03 2015 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 20 BUILDING Master PermitNo.9 c_(0 - Iq- Z1�g PERMIT APPLICATION Sub Permit No. ❑BUILDING ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP (� CONTRACTOR DRAWINGS JOB ADDRESS: y�`�"r-r %U ix c City: Miami Shores U County: Miami Dade Zip: Z31Folio/Parcel#:�J OP- �1-- V O Is the Building Historically Designated:YesNO Occupancy Type: Load: Construction Type: Flood Zone: N() BFE: FFE: OWNER:Name(Fee Simple Titleholder): // Fs _ �1�1Phone y #: �� /�L) Address: -C ti City: �-k State: Zip: � Tenant/Lessee Name: &- Phone#: Email: CONTRACTOR:``Company Name: �� r, -�(�°�-( Phone#:--NCO- Address: 12 7 0j zo City: -lam i State: IZ Zip: Qualifier Name: 6zpucrs co Phone#: State Certification or Registration#: �G -1 1 C-f Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$' t Square/Linear Footage of Work: Type of Work: P Addition _C��`(4Alteration F-1New ❑ Repair/Replace E:1Demolition Description of Work: r-UVC 4z_ "a-c- Specify color of color thru tile: - Submittal Fee$ Permit Fee$ CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$. (Revised02/24/2014) TG Bonding Company's Name(if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name(if applicable) Mortgage Lender's Address City State 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 ELECTRICAL WORK, PLUMBING, SIGNS, WELLS,POOLS,FURNACES,BOILERS,HEATERS,TANKS and 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 hich occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not a roved and a rein pectinn fee will be charged. Sin re Signature Sign g Owner or Agent n Contractor The foregoing instrument was acknowledged bef re me this -3 The foregoing instrument was acknowledged before me this day of tnt(�a ,20 � by � �Z_T I t('ct 1 day of � 20 ,by 1 SCO who is personally known to me or who has produced who is ersona known e or who has produced r�N Lt, As identification and who did take an oath. as identification and who did take an oath. NO PL)BLIC• -- - -- NOTARY UBLIC: S' CZ Sign Print: Print: My Commission Expires: =�REBECANA My Commission Expires: �( ' RMBECA M.PASTRMAMY COMMISSION#EE8726242624 WIRES:February 07,201717 APPROVED BY —1�1 ?;/�—wl 3 Ll.��L Plans Examiner Zoning Structural Review Clerk (Revised 3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09) ATLEL-1 OP ID: MA TE(MM/DDNYYY) CERTIFICATE OF LIABILITY INSURANCE DA02/27/2015 02/27/2015 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 endorsement(s). PRODUCER CONTACT BUTLER,BUCKLEY,DEETS INC. NAME: MARIANA GONZALEZ 6161 BLUE LAGOON DR.,STE 420 (PA No. o Ell:786-216-1778 FAX A//C Nol:305-262-0187 MIAMI,FL 33126 E-MAIL MARIANA@BBDINS.COM Mariana Gonzalez ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC A INSURERA:WESCO INSURANCE COMPANY INSURED ATLANTIS ELECTRICAL CORP. INSURER B: 12803 SW 20TH TERRACE MIAMI, FL 33175 INSURER C: INSURER D: 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. INSR ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER MM DD MM DD LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY WPP1138623 01 02/10/2015 02/10/2016 PREMISES Ea occurrence $ 100,00 CLAIMS-MADE OCCUR MED EXP(Any one person) $ 5,00 PERSONAL&ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,00 X POLICY PRO- LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCTOS HEDULED AUTOS AUBODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS PER ACCIDEN H $ UMBRELLA LIABOCCUR EACH OCCURRENCE $ EXCESS LIAB RCLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N TORY LIMITSI ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? ❑ N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space is required) ELECTRICAL CONTRACTOR CERTIFICATE HOLDER CANCELLATION MIASHVI SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE VILLAGE OF MIAMI SHORES THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN BUILDING&ZONING ACCORDANCE WITH THE POLICY PROVISIONS. 10050 N E 2 AVE. MIAMI SHORES, FL 33138 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD