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EL-15-2097 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-241679 Permit Number: EL-8-15-2097 Scheduled Inspection Date: October 27,2015 Permit Type: Electrical - Residential Inspector: Devaney, Michael Inspection Type: Final Owner: CARRON,JEFF& MALACHY Work Classification: Addition/Alteration Job Address:94 NE 99 Street Miami Shores, FL 33138- Phone Number (917)655-5400 Parcel Number 1132060131040 Project: <NONE> Contractor: CUSI ELECTRICAL SOLUTIONS INC Phone: (786)390-4962 Building Department Comments REPLACE 3 SWITCHES,4 OUTLETS AND REWIRE 2 Infractio Passed Comments OUTLETS INSPECTOR COMMENTS False Inspector Co n s Passed Z' Failed Correction ❑ Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. October 27,2016 For Inspections please call: (305)762-4949 Page 11 of 43 permit No, EL-8-1 O-A Miami Shores Village P it. )0e EleCt1riW-Residential 10050 N.E.2nd Avenue NE x x� Miami Shores,FL 33138-0000 Phone: (305)795-2204 'ei n+l S a e APPROVED FGORIDp` � Issue Date:8120/2 r Expiration: 02/24/2016 Project Address Parcel Number Applicant 94 NE 99 Street 1132060131040 Miami Shores, FL 33138- Block: Lot: JEFF 8 MALACHY CARRON j Owner Information Address Phone Cell JEFF&MALACHY CARRON 94 NE 99 Street (917)655-5400 (917)749-0242 MIAMI SHORES FL 33138- 94 NE 99 Street MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone Valuation: $ 1,200.00 CUSI ELECTRICAL SOLUTIONS INC (786)390-4962 Total Sq Feet: 0 Type of Work:REPLACE 3 SWITCHES,4 OUTLETS AND R Available Inspections: Additional Info: Inspection Type: Classification:Residential Final Scanning: 1 Meter Box Alteration Relocation Fire Alarm Service Change Review Electrical W.W. Underground Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $1.20 DBPR Fee Invoice# EL-8-15-56762 $2'25 08/19/2015 Credit Card $50.00 $ 110.70 DCA Fee $2.25 Education Surcharge $0.40 08/28/2015 Credit Card $ 110.70 $0.00 Permit Fee-Additions/Alterations $150.00 Scanning Fee $3.00 Technology Fee $1.60 Total: $160.70 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 self, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL,PLUMBING,MECHANICAL,WINDOWSa- ING and SWIMMING POOL work. OWNERS AFFIDAVIT: I certify that all the foregoing informati t all work will be done in compliance with all applicable laws regulating construction and zoning. Futhermore,I authorize the above-n work stated. August 28, 2015 Authorized Signature:Owner / Applicant / Date Building Department Copy August 28,2015 1 --"N CUSIE-1 OP ID:KD 'mkt � CERTIFICATE OF LIABILITY INSURANCE DATE 08/27/2015 08/27/2015 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(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 endorsement(s). PRODUCER CONTACT W.F.Roemer Insurance Agency NAME: Jonathan F. Remes FAX 3775 NW 124 Avenue C No •95NE 4731-5566 A/C No):954731-8438 Coral Springs,FL 33065 E-MAIL Jonathan F.Remes ADDRESS: jremes@roomer-ins.com INSURERS AFFORDING COVERAGE NAIC# INSURER A:Association Insurance Co. 11240 INSURED Cusi Electrical Solutions,lnc. INSURER B: 889 SW 149th Court Miami,FL 33194 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 BR POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER M D M D COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE FlOCCUR PREMISES Ea occurrence $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY PRO LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident UMBRELLALIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR Ed CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITYSTATUTE I I ER A ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N WCV016955401 04/09/2015 04/09/2016 E.L.EACH ACCIDENT $ 1,000,00 OFFICER/MEMBER EXCLUDED? N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,00 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached It more space Is required) Cusi Electrical Solutions, Inc. Liscense#:EC 13006891 Electrical Contractor CERTIFICATE HOLDER CANCELLATION MIAMASH SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Miami Shores Village ACCORDANCE WITH THE POLICY PROVISIONS. Building Dept 10050 NE 2 Ave AUTHORED REPRESENTATIVE Miami Shores, FL 33138 @ 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD Miami Shores Village _� ie_ . Building Department AUG 9 2015 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 BYX: _ f INSPECTION LINE PHONE NUMBER:(305)762-4949 �hA FBC 2014 BUILDING Master Permit No. — :7 —I,5—176�— PERMIT AP=ON Sub Permit No. - IS- 20(1-4 ❑BUILDING LECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL F-1 PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP Q qCONTRACTOR DRAWINGS JOB ADDRESS: q+d" t a ) E — [ 1 � ` �f'CO City: Miami Shores County: Miami Dade Zia: Folio/Parcel#: _J � d(� 0 Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): Phone#: j T ® �-- Address: City: A1 m i [6caState: �-- Zip: 1 a� Tenant/Lessee Name: Phone#: Email: (, b CONTRACTOR::/,�lCompany Name: CUSl W Cf I2((Ac S®L{177 Cl,(/i� �(l�C Phone#: Q & '7® —`I Address: b q �� �� M el City: f a K4( State: IF-66 zip: 33,61 Qualifier Name: P sus / sei / e'4i //,,�� Phone#: tP wo ` 2 State Certification or Registration#: �f =; j q q lT_Certificate of Competency M 10GO®0 I -22 DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ 1 Za() Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition Descripti of Work: 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$ 1 I 0 (Revisedo2/24/2014) s 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. SignatureSignature �4e Z OWNER or AGENT CONtMCTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this ''r9 day of R,y� 20 7 A-7 ,by day of ®e V3 o S4 ,20 f by who is personally known to �P`s.�S �� � ,who is personally known 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:a Print: Print• Seal �,. ,oQ MY COMMISSn1,2018 Seal MABELIS E FERNANDEZ EXPIRES JMY COMMISSION#FF127992 s-ot53 Floridallot EXPIRES June 1, 2018 A�of A..,.>. i53 Floridallot Service --- - ******** APPROVED BY e4* *"& ��Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014)