EL-15-2152 Inspection Worksheet
Miami Shores Village
10050 N.E.2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-242688 Permit Number: EL-8-15-2152
Scheduled Inspection Date: September 02,2015 Permit Type: Electrical - Residential
Inspector: Devaney, Michael
Inspection Type: Final
Owner: PECK,STEPHEN Work Classification: Alteration
Job Address:760 NE 97 Street
Miami Shores, FL 33138- Phone Number (305)801-0427
Parcel Number 1132060142210
Project: <NONE>
Contractor: C.ALBERT ELECTRICAL CORP Phone: (786)417-4096
Building Department Comments
INSTALL ONE 3.5 TON UNIT Infractio Passed Comments
INSPECTOR COMMENTS False
Inspector Ccimments
Passed
Failed9
��5
Correction ❑
Needed
Re-Inspection ❑
Fee
No Additional Inspections can be scheduled until
re-inspection fee is paid.
September 01,2015 For Inspections please call: (305)762-4949 Page 42 of 47
K
'8r /# % JLMa
Miami Shores Village w
10050 N.E.2nd Avenue NE
M fir' x.. e � .�'j
Miami Shores,FL 33138-0000 < ,
Phone: (305)795-2204 ;
CORit
L"t
Iss us p 01� Expiration: 02128/2016
� ,
Project Address Parcel Number Applicant
760 NE 97 Street 1132060142210 STEPHEN PECK
Miami Shores, FL 33138- Block: Lot:
Owner Information Address Phone Cell
STEPHEN PECK 760 NE 97 Street (305)801-4427
MIAMI SHORES FL 33138-
760 NE 97 Street
MIAMI SHORES FL 33138-
Contractor(s) Phone Cell Phone Valuation: $ 1,200.00
C.ALBERT ELECTRICAL CORP (786)417-4096
__.m_.. ,�.... ,_..._.. ......._ .__ _ _ .... Total Sq Feet: 00
Type of Work:INSTALL ONE 3.5 TON UNIT Available Inspections:
Additional Info: Inspection Type:
Classification:Residential Review Electrical
Scanning:3
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $1,20
DBPR Fee Invoice# EL-8-15-56823
$2.25 08/24/2015 Check#:4788 $50.00 $116.70
DCA Fee $2,25
Education Surcharge $0.40 09/01/2015 Check#:4787 $ 116.70 $0.00
Permit Fee-Additions/Alterations $150.00
Scanning Fee $9.00
Technology Fee $1.60
Total: $166.70
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. Futhe ore,I aut o' e above-named contractor to do the work stated.
September 01,2015
Authorized Signature:Owner / -Applicant / Contractor / Agent Date
Building Department Copy
September 01,2015 1
Miami Shores Village
�
Building Department AUG 2 X815
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 Permit No. 4L'"70
PERMIT APPLICATION Sub Permit No
❑BUILDING ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
?-74
,J i CONTRACTOR DRAWINGS
-7
JOB ADDRESS: T�O /05' / 4 s[iek
City: Miami Shores County: Miami Dade Zip: 331,76
Folio/Parcel#: 3,2®.O,()( —,2216 Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder): "4e" CC. Pelt Phone#:
Address:_ low qu'ekc" (n0 _�r13aV
City: M icum j State: FL_ Zip: 33122
Tenant/Lessee Name: Phone#:
Email: Sb?_CKW\D 6 �in•�ct��.eaw,
CONTRACTOR:Company Name: ��64,c-/z-Y ° 46c'Ylyey jn i!/e _ Phone#:
Address: �`fvs-
City:—��/f®:�.vr i State: Zip: 33 l h�
Qualifier Name: oeo 4X Phone#: 3�5
State Certification or Registration M ke/a®® /.3 Y/ Certificate of Competency M
DESIGNER:Architect/Engineer: C\ Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ 00 Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New
® Repair/Replace ❑ Demolition
Description of Work: INSXA//` 9,t,0 '3'-s r/0� f�• C.
Specify color of color thru tile.
Submittal Fee$ ,�1�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$ • �j
'� (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 on 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 t 911'
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
0 day of A V6 , ,20by ® day of 4(le- ,20 IS ,by
Q`=A1� ,who is personally known to e::NI>.� ,who is personally I own to
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: NOTARY PUBLIC:
Sign: Sign:
Pr! . Print:
9
Seal: APP&q- Notary Public stats of Florida Seal:
Carlos A Russo " Notary Public 9tatm of Florida
My Commission EE123743 Carlos A Russo
Fp,pd" Expkes 09/0212015 MY Commission EE123743
J
APPROVED BY P o 4 ns Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
�-1 OP ID:PEC
CERTIFICATE OF LIABILITY INSURANCE 88M elm
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, N the certificate holder Is an ADDITIONAL INSURED,the les)must be endorsed. if SUBROGATION IS WAIVED,subject to
the terms and conditions of the policy,certain policy may require an endorsement. A statement on this certificate does not confer rights to the
certificate holder In lieu of such s
PRODUCER Wr Patricia Clawson
Clawson A Company,Inc PAX Na 9�r4-389,0952
2731 Executive P'aric DHve,08
Weston,FL 33331itW Eft 954-3894=
pawcia@dawsoninsumnce.com
Clawson&Canparry Inc CAL.BE-1
AFFORDING COVERAGE NAICNI
INSURED C.Afti t Electrical Corp INSURERA:S Y
Albert Russo
9995 SW 910 Tenreee Insu R B.
Miami,FL 33176 INSURER C:
INSunER D:
INSURER E
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.
TYPE OF INSURANCE NUMBER MP�f POLICY EXP UMTS
GENERAL LUIMLRY EACH OCCURRENCE $ 1,M1
rA X COMMERCIAL GENERAL LIABILITY CPS224SUl 07/30/2015 07130=16 PREMI o $ 160,004
CLAIMS-MADE FRI OCCUR MED EXP(Any are person) $ 510
PERSONAL&ADV INJURY $ 1,000,
GENERAL AGGREGATE $ 2,01110,4111114
GIRA AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ 1,000,
00(
X1 POLICY PRO LOC $
AUTONIOBI E LIABILITY Y COMBINED SINGLE LIMIT $
(Ea acdderd)
ANY AUTO BODILY INJURY(Per pew) $
ALL OWNED AUTOS BODILY INJURY(Per acciderd) $
SCHEDULED AUTOS PROPERTY DAMAGE
HIRED AUTOS (PER ACCIDENT) $
NON-OWNED AUTOS $
$
UNM§tBAA
Lu►S OCCUR EACH BICE $
EXCESSLWB CLAIMS•MADE AGGREGATE $
DEDUCTIBLE $
$
AND EMPLOYS LIABI ffY
TWRA ER
ANY PROPRIETORIPARTNER/EJECUTWE Y 1 N E.L EACH ACCIDENT $
OFFICERIMEMSEREXCLUDEDT FINIA
(Mandal y In Mq EL DISEASE-EA EMPLOYEE $
ff y�desct�under
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POUCY LUT $
DESCRIPTION OF OPERATIONS r LOCATIONS r VEFICLES(IUtech ACOAD 101,Addildoaal Remarks Schedule,If more space Is required)
Electrical Contractor
CERTIFICATE HOLDER CANCELLATION
N AMISH
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Mlaml Shares Village THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
Building Dept.
10050 NE 2nd.Avenue AM TATE
Miami,FL 33138
C 1988-2009 ACORD CORPORATION. All rights reserved.
ACORD 25(2009109) The ACORD name and logo are registered marks of ACORD