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EL-15-1270 ones ' Miami Shores Village f�f lTTlit a El of �i= 4116 ft �S. 10050 N.E.2nd Avenue NE r I to c r iWeaticrt lQit dilonl, 0otion Miami Shores,FL 33138-0000 �,� � � Phone: (305)795 2204 'BrmJtStat P oRr >• ., Is>u _iate.6I61�I95 Expiration: 12/23/2015 Project Address Parcel Number Applicant [L640N�E 101 Street 1132060172090 Shores, FL 33138-2468 Block: Lot: LOIS WEISMANTLE Owner Information Address Phone Cell LOIS WEISMANTLE 640 NE 101 Street (305)467-5342 MIAMI SHORES FL 33138- 640 NE 101 Street MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone D&E ELECTRIC INC (954)345-9040 Valuation: $ 2,500.00 _.., Total Sq Feet: 0 Type of Work:REPLACE ALL EXISTING RECEPTACLES& Available Inspections: Additional Info: Inspection Type: Classification:Residential Final Scanning: 1 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 $1.80 Invoice# EL-5-15-55729 DBPR Fee $3.38 DCA Fee $3.38 05!27/2015 Check#:1983 $50.00 $189.56 Education Surcharge $0.60 06/26/2015 Check#:1989 $ 189.56 $0.00 Permit Fee-Additions/Alterations $225.00 Scanning Fee $3.00 Technology Fee $2.40 Total: $239.56 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 donek either myself, my ent, servants, or employes. I understand that separate permits are required for ELECTRICAL,PLUMBING,MECHANICAL,WIND D RS,ROOFI G nd SWIMMING POOL work. OWNERS AFFIDAVIT: I certify that all he oregoing inform tion is accur to and th t all ork will be done in compliance with all applicable laws regulating construction and zoning. Futhermore,I uth ize the above- med ntra or to do work stated. June 26, 2015 Authorized Signature:Owne / Applicant / Contr ctor / AgenV Date Building Department Copy June 26,2015 1 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-244030 Permit Number: EL-5-15-1270 Scheduled Inspection Date: October 05, 2015 Permit Type: Electrical - Residential Inspector: Devaney, Michael Inspection Type: Final Owner: WEISMANTLE, LOIS Work Classification: Addition/Alteration Job Address:640 NE 101 Street Miami Shores, FL 33138-2468 Phone Number (305)467-5342 Parcel Number 1132060172090 Project: <NONE> Contractor: D& E ELECTRIC INC Phone: (954)345-9040 Building Department Comments REPLACE ALL EXISTING RECEPTACLES &SWITCHES Infractio Passed Comments ON KITCHEN, BATHROOM, BEDROOM AT POOL HOUSE INSPECTOR COMMENTS False Inspector Comments Passed CREATED AS REINSPECTION FOR INSP-235517. Add arc fault breakers. Repair connection to sprinkler pump and panel. Failed Correction ' Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. October 02,2015 For Inspections please call: (305)762-4949 Page 11 of 31 �A Miami Shores Village MAY r Building Department 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 L y Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 FB C 20 [b BUILDING Master Permit No. Vo— PERMIT APPLICATION Sub Permit No.-.«- Z- ❑BUILDING ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: _(2�-o /0-0 . lot St - City: Miami Shores County: Miami Dade Zip: 3 Folio/Parcel#: Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder):S1�,(�r u'a d hC4uS�re��t)i S�f i%VW Q Kn k Phone#: 3y�-1 S1 Address: lQq-o tV•6 . to/ -s4 City: /I'I i 4 say . cSG,o r 5 State: Zip: 33 13 r Tenant/Lessee Name: Phone#: Email: may, ��9� CONTRACTOR:Company Name: E GY�g�I rue �1 vim, Phonel X7`7�YY_� 9V"10 Address: Arw o C-4,.;J&) Z�eeoj'4'- City: CoRALState: Zip: SA®-7/0 Qualifier Name: W e "P'noz�APhone#: !p'2y.ej-' State Certification or Registration#: Certificate of Competency#: __511(04 j-42'0 DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: ®® Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New epair/Replace ❑ Demolition Description of Work: 'PL6 Com. VALL G F'S'T)A)& 3ZZ a'hA(' lzS .SG ta' ,®•'1� Specify color of color thru tile: Submittal Fee$ Permit Fee$ �2 o� ~ r CCF CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ a (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. Signature2� � ic 2_ Signature >i� OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of �I'►�y�^`% ,20 Ir ,by l/—i day of/��' /, ,by personally known who' ��l Oe5 TC�� who is personw ally known-t6--, n-t6--, 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 PUBLI NOTARY PUBLIC: Sign: Sign: Print Print: KoSCUd1 ✓Ylca? ovP"� DOUGLAS MARIANOSea• Seal: ,=� ? Notary Public-State of Florida ROSALYN WALDMAN a e, My Comm.Expires Aug 27,2017 _' =.r . Commission#FF 079712 %; ��o?.• Commission#FF 046776 -� Expires February 4,2018 ,� R•` Bended Ther Troy Fain Insurer"800.388.7019 rk+krkrkrk rk�k rkrk�k�R+k+k+R�k rR+RrR rk#rkrk+k rkrk rk�R rkrk _.. rk rRrk�Rrk rkrk#rk�Ir*# APPROVED BY "h ?�- /t1&Y Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) 4 r _�A,Ftt 1 U�N�('�(°'LOCAL BUSIN" S T�► u -- _. .. - 115 S. Andrews Ave., Rm. A-100, Ft. Lauderdale, FL 33301-1895—954-831-4000 VALID OCTOBER 1,2014 THROUGH SEPTEMBER 30,2015 DBA:D & E ELECTRIC INC Receipt :ELECTRIR9CAL/ALARMS/CONTRA O Business Name: Business Type:(ELECTRICAL CONTRACTOR) i Owner Name:DONALD R WESTERDALE Business Opened:10/31/1994 Business Location:5221 KENSINGTON CIRC State/County/CerUReg:EC13001260 CORAL SPRINGS Exemption Code: w Business Phone:954-345-9040 Rooms Seats Employees Machines Professionals 2 For Vending Business Only Number of Machines: Vending Type: Tax Amount Transfer Fee NSF Fee, Penalty Prior Years Collection Cost Total Paid 27.00 0.00 0.00 0.00 0.00 0.00 27.00 THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS THIS BECOMES A TAX RECEIPT This tax is levied for the privilege of doing business within Broward County and is non-regulatory in nature.You must meet all County and/or Municipality planning ? WHEN VALIDATED and zoning requirements. This Business Tax-Receipt must be transferred when the business is sold, business name has changed or you have moved the business location.This receipt does not indicate that the business is legal or that X it is in compliance with State or local laws and regulations. Mailing Address: DONALD R WESTERDALE Receipt #OIA-13-00005401 5221 KENSINGTON CIRC Paid 07/16/2014 27.00 CORAL SPRINGS, FL 33076 2014 - 2015 ......... _ - _ ._......... .. . _._ .: ..__ .. ...- RICK SCOTT, GOVERNOR KEN LAWSON, SECRETARY STATE OF FLORIDA - y „EPARTMENT OF`BUSINESS AND PROFESSIONAL RLQULATIO,N -� ELECTRICAL C.QNTRACTORS;'LICEN.SING BOARQ"° •�` w w Thejr_-;L CTRtCA -Qj§N-T "�brJowI�;FaR'�4FIED 1J�11e,`„�tipavltlsfet9 F�. `,a' +A tix tlaAU� 20"I y �`�- 'S�"�'f. ° Ey DIPA-06NN, _tbasRs� 77 7 �w � N 'N' �'. .. �,'La�* '. y�w ��aMq '�• W��fr?'ty� �r, .,.,., ms'sc. 078 h r d .4ii 47 ;,r' °r'.?�,� .. .y'•�t'�c•,.Y 4.7 �'Vy.x � A' �.S 'i t'a '416- � CERTIFICATE OF LIABILITY INSURANCE 5/2 i 015 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 Stephanie Perez NAMEMack, Mack & Waltz Insurance Group, Inc. PHONE . (954)640-6225 FAX No):(954)640-6226 1211 S Military Trail E-��:sperez@mackinsurance.com Suite 100 INSURERIBI AFFORDING COVERAGE NAIC# Deerfield Beach FL 33442 INSURERA4)hiO Casualty INSURED INSURER B:The Charter Oak Fire Ins. CO. 25615 D 6 E Electric, Inc. iNsuRERc.Normandy Harbor Insurance 5221 Kensington Circle INSURER D: INSURER E Coral Springs FL 33076 INSURER F COVERAGES CERTIFICATE NUMBER;CL1511732226 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 BR POLICY EFF POLICY EXP LTR POLICY NUMBER MID MID LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 REM X COMMERCIAL GENERAL LIABILITY PREMDAMAGE TO RENTED 300,000 PREMomurence $ A CLAIMS-MADE ®OCCUR RS(15)55961388 /12/2015 1/23/2015 MEDEXP(Any ortepersm) $ 15,000 PERSONAL&ADV INJURY $ 1,000,000 S contractual Liability* GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 x POLICY PRO- LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT(Ea 1,000,000 B B ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BA1B199763 1/23/2014 1/23/2015 BODILY INJURY(Per acdderd) $ AUTOS AUTOS x HIRED AUTOS g NON-OWNED PROPERTY DAMAGE $ AUTOS er acddent UMBRELLA UAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS MADE AGGREGATE $ DED I I RETENTION s $ C WORKERS COMPENSATION g I WC STATU- OTH- AND EMPLOYERS'LIABILITY Y I N TORY LIMITS ANY PROPRIETORIPARTNEIVEIECUTiVE E L EACH ACCIDENT $ 1,000,000 OFFICERIMEMBER EXCLUDED? NSA Phmdatmy In NH) 030522014 1/23/2014 1/23/2015 EL DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedulejt more space Is required) *Contractual Liability included for damages assumed in an insured contract or agreement. License #EC13001260 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Miami Shores ACCORDANCE WITH THE POLICY PROVISIONS. 10050 RE 2nd Avenue Miami, FL 33138 AUTHORED REPRESENTATIVE Paul Mack/MARYRA — ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INS(195 rminnri m The A(f113n name and Inn^are renicfarari marlrc of A9_r%I2n