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ELC-15-1921 Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-241761 Permit Number: ELC-7-15-1921 Scheduled Inspection Date: September 18,2015 Permit Type: Electrical -Commercial Inspector: Devaney, Michael Inspection Type: Final Owner: WARD, DAVID Work Classification: Addition/Alteration Job Address:755 NE 91 Street 1F Miami Shores, FL Phone Number (305)903-4927 Parcel Number 1132090440210 Project: <NONE> Contractor: APL ELECTRICAL CONTRACTOR INC. Phone: 305-331-9876 Building Department Comments WIRING 2 TON AC UNIT Infractio Passed Comments INSPECTOR COMMENTS False Inspector Comments Passed CREATED AS REINSPECTION FOR INSP-241555. CREATED AS EI/ REINSPECTION FOR INSP-240269. Add smoke detectors. Wire T stat.. 20 amp fuses for ACCU disconnect Failed ❑ 19 aug. 15 Add smoke detectors. Correction ❑ Needed Re-Inspection ❑ �� Fee No Additional Inspections can be scheduled until re-inspection fee is paid. September 17,2015 For Inspections please call: (305)762-4949 Page 26 of 37 i ty Miami Shores Village 10050 N.E.2nd Avenue NE l� j8 Miami Shores,FL 33138-0000 e Phone: (305)795-2204 y Expiration: 02JO8/2016 a �QzlteI ,Ir.....v ....,3... ..,ig ,.• '� .... Project Address Parcel Number Applicant 755 NE 91 Street Number: 1F 1132060440210 DAVID WARD Miami Shores, FL Block: Lot: Owner Information Address Phone Cell DAVID WARD 755 NE 91 Street (305)903-4927 MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone Valuation: $ 800.00 APL ELECTRICAL CONTRACTOR INC 305-331-9876 Total Sq Feet: p Type of Work:WIRING 2 TON AC UNIT Available Inspections: Additional Info: Inspection Type: Classification:Residential Final Scanning:2 Meter Box Alteration Relocation Fire Alarm Service Change Review Electrical Underground W.W. Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $o.s0 DBPR Fee Invoice# ELC-7-15-56531 $225 07/30/2015 Check#:2772 $50.00 $109.10 DCA Fee $2.25 Education Surcharge $0.20 08/12/2015 Check#:2818 $ 109.10 $0.00 Permit Fee $150.00 Scanning Fee $3.00 Technology Fee $0.80 Total: $159.10 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-named contractor to do the work stated. -- �� August 12,2015 Authorized Signature:Owner / Applicant / Contractor / Agent Date Building Department Copy August 12,2015 1 s Miami Shores Village Building Department JUL 30 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 1 q ray BUILDING Master Permit No. M,1 C' r� PERMIT APPLICATION Sub Permit No. EL Ig21 ❑BUILDING TELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL [-]PUBLICWORKS CHANGE OF [:] CANCELLATION [:] SHOP CONTRACTOR DRAWINGS JOB ADDRESS: J -✓ Q 13 147 City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: I I/-�(51C40—04��11 " 02 c Is the Building Historically Designated:Yes NO Occupancy Type: to-fld Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): DALAI D W-A�O Phone#: `-'Iq2_'? Address:_'-ft KtEl .fit (�-�(y-�— .--_ City: 1.,�- I"11t�-'1 m yState: Zip: vtJl Tenant/Lessee Name: Phone#:Ib-at I 3qs-1 Email: //�� CONTRACTOR:Company Name: AVL `-► �l� Phone#: (OXPM Address`:.'"fl" f P� j r)® �t 2 ST City: °" l W14?` 1� State '1 _ Zip: ��y Qualifier Name: 1�"�j�(_ P?"C U bkL Phone#: (00.2 l State Certification or Registration#: �0014q b � Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ Square/Linear Footage of Work: Type of Work: ❑ Addition ll❑ Alteration �Nyew1 JRepair/Replace El Demolition Description of Work: 61 J P L� T (SL' S r E� L_ e Specify color of color thru tile: Submittal Fee$ Permit Fee$ A CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ C� (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$2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also,a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occursven (7) days after the building permit is issu . In the absen of such posted notice, the inspection will not be approved an a reinspection fee will be charged. Signature Signature OWNER or AGENT CrONTRACTOR The for going instru ent was acknowledged before his The foregoing instrument as acknowledged before me this F day of 20 bym day f 20 �� ,by who is personally known to 6 4v o s personally known to p who has produced _ as me or who has produced a® identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: ( � Sign: \ Print: Print: ug ot• 't';',, DASSILLE N.DURAN ••��,•• DA Seal: o: Notary Public-State of Florida Seal: dao Notary Public-State of Florida Commission FF 193182 a• Commission#FF 193162 %,2 ,�• fJly Comm.Expires Jan 28 2019 My Comm.Expires Jan 28,2019 ,�.. `•�� 6arded-through ,�� UndedWouglt Ntd"N�yAsE National APPROVED BY r �� Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) O CERTIFICATE OF LIABILITY' INSURANCE DAT �;7 ,,,. __ t THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLD CERTIFICATE DOES NOTAFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES 1 BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($),AUTHORIZED 1 REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT. if the cerd8c*bolder is an ADDITIONAL INSURED,the pollcy(tss)must be endorsed. If SUBROGATION lS WANED,subject to the terms.and conditions of the poilcy,certain policies may require an endorsement. A statement on this certi#icata does not confer rights to the certilloata holder in.iieu of such endorsement(s). PRODUCER CONTACT El DANIEL WILLIS Annette WIUIs IRSUTaItCe HONE (305' 625-8131 � Faax 305 625 3ta9�F s 4759 N.W.183rd St. fi-MAIL ;_.. DANIEL WILLI ANNETTEWILUSINSURANGE COM ......... _.....,. _........ I Miami,FL 33055 INSUIRM41.017PIRDINGCOVERAGE N ca Phone (3135)625-8131 Fax (3L5)625-5694 INSURER A: GRANADA INSURED _INSURER B: APL ELECTRICAL CONTRACTOR,INC INSURER C: ' 4850 NW 170$T INSURER D: Miami FL 33055 (305)520-2098 i INSURER E { INSURER F. w 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 y 1 INDICATED. NOTWITHSTANDING ANY REQUIREMENT',TERM OR CONDITION OF ANY CONTRACT OR OTI4ER DOCUMENT WITH RESPECT TO WHICH THIS i CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIf3NSAND CONDITIONS Of SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSA — ADD UbR POUCyy EFF POLICY EXP i LIMITS LTR _ TYPE'OFINSURANCE (tpgR POLICY NUMBER _ MMtDOhYYY D GENERAL L4413ILIlY' ( EAGFI CCURRENCE�. $ 1 DDC 0 3 I ¢OMMERCIAL GENEIIAL LIABILITY I ; I .90— DAMAGE TO♦QENTE�D CC D00 60 I I P MI$��Ea accwrence).._ $_< _ —_., I 'D I CLAIMS-MADE ©OCCUR i. F p1$5FL00027876 ' MSO EXP An one person) $ 5,000 OA { 08/06/2015 08106/2016 k A s I PERSONAL a ADv INJURY $y 1,0D0 000:0'0 { GENERAL AGGREGATE is 2,000,004:00 GEN L AGGREGATE LIR11T APPLIES PER PRODUCTS-COMP/OP AGG $ 2,000,000.00_...__•i --.. I..,POLICY 10 ❑ LOC I $ Al1TOMOBILE LU1& COMBINED 8WGLE LIMB ev�idenl)__ j ! _ ANY AUTO I BODILY INJURY(Per person) $ _y .__.. ._.--._.. ALL 01NIVED DULED 4 BODILY INJURY(Per accidentl, AUTOS AUTOS, :.:., �-•� PR ERTY ggAMAGE j HIRED AUTOS L J AUTOS FPR l FP._ E UIdIeRELLA 1 IAB 0 OCCUR EACH OCOURRENCE S.. it1 EXCESS UAB Il CLAIMS-MADE RRGREGATE $ _...... RETENTI :NS — .,__ _---...._ —_........_— ._. WCSTATU OTIi 9 $ WO.IiKERS COMPENSATIbN ANO EMPLOYERS LIABILITY Y/N I TORY..LIMITS...._ E __ _.. .... _... $ ...._, i ANY PROPRIETO. ARTNER/EXECUTiVE I + E.l EACH ACCIDENT OFFICERtMEMBf32 E!(CLUDED7 N 1 A i (Mandatory in NH), E.L DISEASE-EA EMPLOYEE$ I Nyyeeas descdoeunder E.L.DISEASE-POLICY LIMIT $ 1 IIESdRIPTION OF OPERATIONS Mow I _ � 1 1 DESCRIPTION OF OPERATIONS(LOCATIONS 1 VEHICLES(Attach ACORD 101,Addittonal Remarks Schedule,If more space is required) ELECTRICAL CONTRACTOR ELECTRICAL WORK CERTIFICATE fiOLDER, CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Village of Miami Shores THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. i Building Depatment 10050 NE 2 AVE AUTHORIZED REP AT 1 MIAMI SHORES,FI 33138 ©1988-20 A CORPORATI .-M rights reserved. ACORD 25(2010105)QF The ACORD and logo are registered(narks of ACORD