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EL-14-1559 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-226291 Permit Number: EL-7-14-1559 Scheduled Inspection Date: January 12, 2015 Permit Type: Electrical - Residential Inspector: Devaney, Michael Inspection Type: Final Owner: PATINO, BIBIANA Work Classification: Addition Job Address: 95 NW 95 Street Miami Shores, FL 33150- Phone Number (786)252-1343 Parcel Number 1131010330540 Project: <NONE> Contractor: HARMISON ELECTRIC GROUP INC Phone: (305)969-5682 Building Department Comments INSTALLATION OF 2 NEW CEILING FANS IN NEW infractio Passed Comments TERRACE INSPECTOR COMMENTS False Inspector Comments Passed Failed _ Correction Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. January 09, 2015 For Inspections please call: (305)762-4949 Page 23 of 26 Miami Shores Village CEIVED Building Department JUL l 2014 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 2 1 U BUILDING Master Permit No. 14- IybZ,� PERMIT APPLICATION Sub Permit No.T_L ( I 59 1 ❑BUILDING Q ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 95 NW 95 ST City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: 11-3101-033-0540 Is the Building Historically Designated:Yes NO no Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name(Fee Simple Titleholder): Bibiana Patino Phone#:786-252-5732 Address:95 NW 95 ST City: Miami Shores State: Florida Zip: 33150 Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name: Harmison Electric Group Inc Phone#: 305-969-5682 Address: 12255 SW 128 ST Bay 411 City: Miami state: Florida Zip: 33186 Qualifier Name: Steven C Harmison Phone#: 786-229-0276 State Certification or Registration#: EC0002144 Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$300 Square/Linear Footage of Work: Type of Work: 0 Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: Installation of(2) new ceiling fans in new terrace Specify color of color thru tile: Submittal Fee$ 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) 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 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 Signature OWN Ek or AGENT CONTRACTOR The foregonng instrument s acknowledged before me this The foregoing instrument was acknowledged before me this day of 20 1'1" by 18th day of June 20 14 by a G who is personally known to Stephen C. Harmison who i5 personally kaawiLto me or who has produced as me or who has produced as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: TARY PUBLIC: Sign: Si Print: P t , de Seal: Se I: ?� Notary Pdk-State of FlVW NOTARY PUBLIC STATE OF FLORIDA My Comm.ENO"Doc k2017 " •. MERCEDES B. ESPEROIV `;„;�. Commbaloa# 016791 MY COMMISSION#EE 1716 j—�'ULy APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) HARM101 OP ID: MA ,a►coRc� CERTIFICATE OF LIABILITY INSURANCE DATE 06/20/2014 Y) 06/2012014 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(ies) 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 Am Mencia FILER INSURANCE,INC. NAME: 9440 S.W.77 Avenue ac°Nly Ell:3O5-270-2100 /C No: 3O5-270-2195 Miami„FL 33156 E-MAIL Keith R.Miller ADDRESS:amencia@filerins.com INSURERS AFFORDING COVERAGE NAIC# INSURER A:Allied P&C Insurance Co 42579 INSURED Harmison Electric Group,Inc INSURER B:Associated Industries Ins Co 23140 12255 S.W.128 Street Bay 411 Miami, FL 33186 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 TYPE OF INSURANCE ADDL 5UBR POLICY EF POLICY EXP POLICY NUMBER MM DDtYYYY MM DDIVYYY LIMITS LTR GENERAL LIABILITY EAG o CH OCCURRENCE $ 1,000,00 A X COMMERCIAL GENERAL LIABILITY ACP3006631184 02/27/2014 02/27/2015 AMA100,00 PREMISES Ea occurrence $ CLAIMS-MADE I OCCUR MED EXP(Any one person) $ 5,00 PERSONAL&ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 PRO- POLICY X LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 Ea accident A X ANY AUTO ACP3006631184 02/27/2014 02/27/2015 BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE c HIRED AUTOS AUTOS PER ACCIDENT 1 $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 3,000,000 A EXCESS LIAB CLAIMS-MADE ACP3006631184 02/27/2014 02/27/2015 AGGREGATE $ 3,000,000 DED I X RETENTION$ 0 $ WORKERS COMPENSATION X T WC STATU- OTH- AND EMPLOYERS'LIABILITY RY LIMIT ER B ANY PROPRIETOR/PARTNER/EXECUTIVE YIN AWC1031134 02/27/2014 02/27/2015 E.L.EACH ACCIDENT $ 1,000,00 OFFICER/MEMBER EXCLUDED? ❑ N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,00 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,00 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space Is required) Blanket additional insured applies via form CG2033(07/04) and form CG7160 (08/04) . Blanket Waiver of Subrogation and Primary/Noncontributory coverage apply per form CG0001 (04/13) , when required in a written contract. CERTIFICATE HOLDER CANCELLATION MIAMISH SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Miami Shores Village THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN g ACCORDANCE WITH THE POLICY PROVISIONS. Building Department 10050 NE 2nd Avenue AUTHORIZED REPRESENTATIVE Miami Shores,FL 33138 :fc 0->� Marielle Beraza P184346 ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD