EL-14-2595 A
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-223971 Permit Number: EL-11-14-2595
Scheduled Inspection Date: August 015 Permit Type: Electrical - Residential
InspectorAjedrig►fe -,deme X14. Inspection Type: Final
Owner: BOEHNE, PATRICIA Work Classification: Addition/Alteration
Job Address:55 NE 94 Street
Miami Shores, FL 33138- Phone Number (202)262-2500
Parcel Number 1132060130560
Project: <NONE>
Contractor: PENCE HEATON ELECTRICAL CONTRACTING INC Phone: (954)961-8005
Building Department Comments
REPLACE WIRING FROM SWITCHES TO LIGHT Infractio Passed Comments
FIXTURES &ADDING RECESSED LIGHTS. INSPECTOR COMMENTS False
TO CLOSE PERMIT# EL-14-578
Inspector Comments
Passed
Failed
Correction ❑
Needed
Re-Inspection ❑
Fee
No Additional Inspections can be scheduled until
re-inspection fee is paid.
August 26, 2015 For Inspections please call: (305)762-4949 Page 3 of 44
• Miami Shores Village a .
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
FBC 201( _
BUILDING Master Permit No.-C` ! )S JI
PERMIT APPLICATION Sub Permit No.
❑BUILDING ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION %RENEWAL
F-IPLUMBING ❑ MECHANICAL ❑PUBLIC WORKS CHANGE OF ❑CANCELLATION SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: cSs �C GI�th S-t
City: Miami Shores County: Miami Dade Zip: :3 D
01
Folio/Parcel#: Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type:¢ Flood Zone: BFE: FFE:
OWNER: Name(Fee Simple Titleholder): P Tr,- C i !31 (.Joe-4 YL a Phone#: 20 ZZ(`Z 2-
Address: -S S LE c 7 1 K -4 p�
City:. L J a tw i J l�o✓e,5 State: rL Zip: �� ✓�(1
Tenant/Lessee Name: Phone#:
Email: P0� � ^-� p�,, �d _ !.,_ G
CONTRACTOR:Company Name:&Ce d nO ja &/e • WJte, Phone#:� �/�A
Address:
City: {0 y ko"40 state: zip33D&I
Qualifier Name: &u •S 1k4,-4a4%- Phone#:
State Certification or Registration#: E e--I3 005Y�f Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State:�9 Zip:
Value of Work for this Permit:$_�_r - ' �� Square/Linear Footage of Work: ` '
Type of Work: ❑ Addition 0 Alteration ❑ New ❑ Repair/Replace
❑ Demolition
Description of Work: C��- (-d W
—TO L-2-
- — (
Specify color of color thru tile:
Submittal Fee$ Permit Fee$ /3?',eU CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$ r
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 SignaQMLdI
OWNER or AGENT CONTRACTOR
The foregoing instrum nt was acknowledged before a this The foregoing instrument was acknowledged before me this
day of 20 by day of G 201 y by
1� jCl& � �who is personally known to�o(/((_� m t S h ,who is so LLy- e�
me or who has produced 7 3�s'l me or who has produced as
identificati nd who did to an oath. identification and who did take an oath.
NOTARY UB IC: NOTARY PUBLIC:
47
Sign: Sign: •��—Al
Print: lMEE Print: 16 bfij,
�.,.....P•,,, ELIZABETH A.FOX
Seal: 'ussy ARION leuopeN g6noigl popuog Seal: ,,�''` e Notary Public-State of Florida
UMI 1. 33#uolsslwwoo °;" O'%;
,>', „-,,; •. ,• My Comm.Expires Apr 20,2018
S 1.OZ'L 6n sandx wwo0�W = - y gar,
b 3 Commission# EE 155587
ePPOIJ►o alels-oilgnd Al2ION ''%•°i"°P`, TNational Notary Assn.
o ehrou h *********
z v t/
APPROVED BYPlans Examiner Zoning
Structural Review Clerk
(RevisedO2/24/2014)
009661
SEC. BU PAYM
TON ELEC C G IN 966 1EL L
rwx
5.00 24/2
ECK2 4-0
�• � Tax.TM isnot�
iMa iRlnttl b da Ynsinsss.� �
PT
trove Soc
Client#:24832 PENCEHEA
ACORD. CERTIFICATE OF LIABILITY INSURANCE DATE
6/2712014
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 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 endomement(s).
PRODUCER Joyce Simpson
Cypress Insurance Group N, .954 771-0300 954_772 9424
PO Box 9328 AE4p&6. JoyceS@i Cypresslnsurance.Com
Fort Lauderdale,FL 33310-9328 INSURER(S)AFFORDING COVERAGE NAIC#
954 771-0300 INSURERA:Travelers Insurance Co
INSURED INSURER 6:
Pence&Heaton Electrical
INSURER c
Contracting,Inc.
INSU R D
5715 Taft Street
INSURER E
Hollywood,FL 33021
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 CONTRACTOR 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.
L RR TYPE OF INSURANCE _ IAD RL yyyp POLICY NUMBERY EFF POLICY EXP
LWITS
A GENERAL LIABILITY 16603A962877TCT14 7/08/2014 07/M2011 EACH OCCURRENCE $1,000,000
X COMMERCIAL GENERAL LIABILITY PREMISES Ea oa�xnrDence $_100,000 _
CLAIMS-MADE EX—J OCCUR MED EXP(Arty one person) $5,000
• PERSONAL&ADV INJURY $1,000,000
GENERAL AGGREGATE 52,000,000
GENT AGGREGATE LIMIT APPLIES PER PRODUCTS-COMPIOP AGG s 2 000 000
POLICY PRO-JECT F-1 LOC $
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
ANY AUTO BODILY INJURY(Per person) $
AUTALL
OWNED SCHEDULED BODILY INJURY(Per socident) $
HIRED AUTOS AUOS
TOS PROPERTY DAMAGE $
Per
a
UMBRELLA I" OCCUR EACH OCCURRENCE $ _
EXCESS LAB CLAIMS-MADE AGGREGATE $
DED I I RETENTION s $
WORK COMPENSATION WC STATU- O_TH-
AND EMPLOYERS'LIABILITY
ANY PROPRIETOR/PARTNERIEXECUTIVE Y/N E.L.EACH ACCIDENT $
OFFICERIMEMBER EXCLUDED? F7 N I A
Myyes0gy In NFT) E.L.DISEASE-EA EMPLOYEE $
desaft under
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Auhob ACORD 101,Additional Reawrks Schedule,N mac specs is required)
Electrical Contractor
CERTIFICATE HOLDER CANCELLATION
Village of Miami Shores Bldg �����N DA� ����p CEIEWILL CANCELLED
BE DELIVERED N
Dept ACCORDANCE WITH THE POLICY PROVISIONS.
10050 NE 2nd Avenue
Miami,FL 33138 AUTHORIZED REPRESENTATIVE
.�b I�lacc+�
®1988-2010 ACORD CORPORATION.All rights reserved.
ACORD 25(2010105) 1 of 1 The ACORD name and logo are registered marks of ACORD
#S181528/M181431 CAT
Data
CERTIFICATE 4F LIABILITY INSURANCE 1/6/2014
producer: Lion Insurance Company This Certykabe is ImLied as a matter of idornnation only and confers no
2739 U.S. Highway 19 N. r4oft upon dw Cef dfi`a°e H ' TW does not ani'
extend
or alter the coverage afforded by the policies tallow.
Holiday, FL 34691
(727)938-5562 Insurers Affording Coverage /AIC#
insured: South East Personnel Leasing, Inc. &Subsidiaries Insurer ion Insurance Company 11075
Insure`e.
2739 U.S. Highway 19 N.
Insurer C.
Holiday, FL 34691
Insurer D:
Insurer E:
COvemges
-The policies of Insurance named abovepolicy period indicated. Notwithstenifing any requirement, orcoriftwof arty contractorotherdocument
with respect to which this coffn ale may be issued or may pertain,the insurance afforded by the policies described herein is subject to all the terns,exclusions,arta conditions of such policies.Aggrega%.
limits shown may have been reduced by paid claims.
INSR ADDLPolicy Effective Policy ExpirHbOrh Limits
LTR INSRD Type of insurance Policy Number Date Date
(MM/DD/YY) (MM/DD/YY)
ENERAL LIABILITY Each Occurrence
Commercial General Liability Damage to rented premises(EA
Claims Made 11 Occur occurrence)
Med Exp
Personal Adv Injury
nal aggregate limit applies per:
General Aggregate
Policy ❑Project ❑ LOC Products-Comp/Op Agg
UTOMOBILE LIABILITY Combined single Limit
(EA Accident)
Any Auto Bodily Injury
All Owned Autos
(Per Person)
scheduled Autos
Bodily Injury
Hired Autos
Non-Owned Autos (Per Accident)
Property Damage
(Per Accident)
EXCESS/UMBRELLA LIABILITY Each Occurrence
Occur ❑Claims Made Aggregate
Deductible
A Workers Compensation and WC 71949 01/01/2014 01/01/2015 X WC Stabr OH_
Employers'Liability for Limits �R
Any proprietor/padnedexecubve affioadmember E.L.Each Accident S1,00o.oao
excluded? NO E.L.Disease-Ea Employee $1,000,000
If Yes,describe under special provisions below.
E.L.Disease-Policy Limits 51,000,000
other Lion Insurance Company is A.M.Best Cornpany rated A- (Excellent). AMB#12616
Descriptions of Operations/LocafiorWVOhiclOS/Exclusions added by Endorsement/Special Provisions: Client ID: 91-67-169
Coverage only applies to active employees)of South East Personnel Leasing,Inc.&Subsidiaries that are leased to the following"alent Company":
Pence And Heaton Electrical Contracting,Inc.
Coverage only applies to injuries Incurred by South East Personnel Leasing,Inc.&Subsidiaries active employee(s;,while woridng in:FL.
Coverage does not apply to statutory employees)or independent contractor(s)of the Client Company or any other entity.
A list of the active employee(s)leased to the Client Company can be obtained by faxing a request to(727)937-2138 or by calling(727)938-5562.
Project Mame:
ISSUE 10-09.13(MT)/Reissued 12/9/13(SH)
Begin Data 313112013
CERTIflCATE HOLDER CANCELLATION
MIAMI SHORES VILLAGE Should any of the above described policies be cancelled before the expiration date thereat,the issuing
insurer will endeavor to mail 30 days written notice to the certificate holder named to the$at but failure to
BUILDING DEPARTMENT do so Shan impose no obligation or liability of any kind upon the insurer,its agents or representatives.
1005 NE 2ND AVE
MIAMI SHORES, FL 33138 � �
I�
jBedroom
MA fmnc4Garage KitchenMBMaster j
I 1 Bath
I 1 �
I 1
� f 1
IMB Closet.
I AREAS WORK WILL BE PERFORMED IN:
1 1 ,•
Foyer
1 1 Great Room
f i
SCOPE OF WORK
ItDemolition:
Great Room 7'.3,sm&
Remove existing drywall ceilings.
Installation:
rra,,a� Install R-30 Batt insulation.
yg Install 5/8"Fire Rated Gypsum Drywall.
Outside Courtyard Living Room
Dining Room Miscellaneous work:
" In order to facilitate electrical repairs to the system,
y r it will require wall and ceilings to be opened.Therefore,
A minor ceiling and wall patching will be necessary
throughout.
Skim coat ceilings in:
y�g
W-1 I Ur Foyer
Entryway Foyer Living Room
" Great Room
6 Closet. Closet
Bdr 3 Kitchen
Master Bedroom
Hallway Dining Room
or, Paint,r•z, r
Paintimpactcd areas
,r-e,rte
Bedroom 2 Bedroom 3
Bathroom rT e
�+
'`• Bdr j Sir
X _
sa,v, n� r_�� BY DATE
CITY
01py 71.
1, — .qd F',-� %I.1. FFI '?A