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EL-15-1724 a,Qm� ,'r Miami Shores Village 10050 N.E.2nd Avenue NE \ ` Miami Shores,FL 33138-0000 R, k, t s, , ' nriny Phone: (305)795 2204 3A& jl xpir n. E at�o 02/13/2016 Project Address Parcel Number Applicant 9909 NE 4 Avenue Road 1132060171310 JOHN RUARK Miami Shores, FL Block: Lot: Owner Information Address Phone _ Cell JOHN RUARK 9909 NE 4 Avenue Road (410)610-2148 MIAMI SHORES FL 33138- 9909 NE 4 Avenue Road MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone Valuation: $ 6,000.00 AJL ELECTRIC INC 305-895-4971 Total Sq Feet: 0 Type of Work: INTERIOR HI HATS/SWITCHES/OUTLETS Available Inspections: Additional Info: Classification:Residential Inspection Type: Review Electrical Scanning: 1 Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $3.60 DBPR Fee Invoice# EL-7-15-56292 $3.38 07/10/2015 Credit Card $50.00 $ 194.36 DCA Fee $3.38 Education Surcharge $1.20 08/17/2015 Credit Card $ 194.36 $0.00 Permit Fee-Additions/Alterations $225.00 Scanning Fee $3.00 Technology Fee $4.80 Total: $244.36 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,PL ,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work. OWNERS AFIDAV T: I c rti t all the foregoing infor accurate and that all work will be done in compliance with all applicable laws regulating construction n o ng. F o authorize ve-named contractor to do the work stated. August 17, 2015 Aut zed Si Lure er / Applicant / Contractor / Agent Date Building Department Copy August 17,2015 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 00C Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-245558 Permit Number: EL-7-15-1724 Scheduled Inspection Date: October 14, 2015 Permit Type: Electrical - Residential Inspector: Devaney, Michael Inspection Type: Final Owner: RUARK,JOHN Work Classification: Alteration Job Address:9909 NE 4 Avenue Road Miami Shores, FL Phone Number (410)610-2148 Parcel Number 1132060171310 Project: <NONE> Contractor: AJL ELECTRIC INC Phone: 305-895-4971 Building Department Comments INTERIOR HI HATS/SWITCHES/OUTLETS AS PER Infractio Passed Comments ELECTRICAL PLANS INSPECTOR COMMENTS False Inspector Comments Passed-� Failed Correction ❑ Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. October 13,2015 For Inspections please call: (305)762-4949 Page 66 of 69 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-245558 Permit Number: EL-7-15-1724 Scheduled Inspection Date: October 14, 2015 Permit Type: Electrical - Residential Inspector: Devaney, Michael Inspection Type: Final Owner: RUARK, JOHN Work Classification: Alteration Job Address:9909 NE 4 Avenue Road Miami Shores, FL Phone Number (410)610-2148 Parcel Number 1132060171310 Project: <NONE> Contractor: AJL ELECTRIC INC Phone: 305-895-4971 Building Department Comments INTERIOR HI HATS/SWITCHES/OUTLETS AS PER Infractio Passed Comments ELECTRICAL PLANS INSPECTOR COMMENTS False Inspector Comments Passed Failed Correction Needed l Re-Inspection Fee No Additional Inspections can be scheduled until re-inspection fee is paid. October 13,2015 For Inspections please call: (305)762-4949 Page 66 of 69 Miami Shores Village Building Department J'U 10 2015 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 r Tel:(305)795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 200 BUILDING Master Permit No. 1 (C_;- [� l PERMIT APPL CATION sub Permit No.�L r-]BUILDING ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS [:] CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: ��bq jz' City: Miami Shores County: Miami Dade Zip: 05 Folio/Parcel#: Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: `'J ✓OWNER: Name(Fee Simple Titlehol er): p Phone#:_ �� 2--LT Address: ^-' 22 City: 1 State: Zip. 7�� Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name: Le L L Phone#: Address: 65 C t— p Lb City: � 4Xr19 LA1& State: �+ V ` Zip: 3� g Qualifier Name: 1.'^(�,�N y Uva Phone#: State Certification or Registration#: C+ 43 oto Z_10 C Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ 4 1 d"'�O� Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: G U +C Specify color of color thru tile: Submittal Fee$_❑ ,cj�) Permit Fee$ AA,f i4P,0 CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ 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$2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also,a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signatu Signature 7K OWNER or AGENT CONTRA OR The foregoing instrum nt was acknowledged before me this The foregoing instrument was nowledged before me this c _day of V 20,f 5 by / day of %J-t^c—"-( 20 15 by �H �cJrn who is personally known to AW-1-0-WI eJ kj,.L.10 ,who is personally known to me or who has produced as me or who has produced as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: Sign: Print: �- ky FVZ (,e`� Print: d KIM ECK__ My COMPriSSION Seal: Seal: �� EXPIRES:February 12,2019 LAURA FARLEY MY COMMISSION#FF 188027 * * EXPIRES:Mardi 16,2019 Bonded ThN 8ud9M Noarry Serrkea APPROVED BY T Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) 07/10/2015 10 : 15 #4311 P. 001/001 ACOlZ,O"' AJLEL-1 GIP ID: TR t. CERTIFICATE OF LIABILITY INSURANCE110 DATE(M�Vrfy.,.} THIS CERTIFICATE IS ISSUED A5 A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, OTHIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,. EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the can nate holder is an ADDITIONAL INS RED, tha poucAies) must be endorsed.this Certificate does not confer rights 1f SUBROGATION 15 WAIVED, Subject t0 the terms and conditions of the policy, certain policies mar require an endorsement certificate holder in lieu of such endorsement s)- - A statement On to the PRODUCER GCINTACT Roebuck Associates Insurance NAME: Exchange LLC PHONE 5599 S University Drive, #301 lap—E29` Je No J= Fax Davie, FL 33328 `fC No): Roebuck Associates ADDRESS: _ INSURERS AFFORDING COVERAGE misuRED AJL Elec INSUlReRA:WeSCO Insurance Company_ NMC* tric lnC. 12408 N.Bayshore Drive ,NsuRER13:RetailFirst Insurance Company N:Miami Beach,FL 33181 INSURSRe;Uniteq States LiabilityIns Co 1TISURERD: I MStI!'ER E. - COVERAGESHdSURER F CERTIFICATE NUMBER: THIS IS TO CERTIFY THAT THE POLICIEREVISS OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED FOR THE POLICY PERIOD INDICATED. NOTV41TH-STANDING 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. LTR TYPE OF INSURANCE B PbLI POLICY NLMIgERPO GENERAL LIABILITYLIMITS ... A X ,.^.i�MMF_RCiAL GENE" LIRE{LIY EACH OC (:URRENCE C s 1,000,00 PP114875701 )iOS15/2015 151201DAv01=. ( RhNTE"—' CLAIMS WT= LrXl PREMSE(♦ICO 100,000 M1 IJrl)EYP(kny oris Person) j S 5,0 ! F'LRSOW a Avv INJURY s 1,000,00 GEN'L AGGRFC7071 r LIMIT APPLIES PER: Cy 1V-RAL AGGRCGATE S 2,OOO,t)O X POLICY PRO- LOC i PponlJCTS-COMF'IOPAGO S 2,000,00 AUTOMOBILS LIABILITY S (:UMBiNCD AIN LE LIMIT ANY AUIU rn l. s ALL OVVNF[J SCI r-DULED BODILY INJURY(PFT PsrSolI} IT$— AUTOS ALTO IIIR9DAUr0; NON-(ATIED BODILY INJURY(Pe.xaG:A7}'S AUTOS f'ffOPEf^erY�isu GE r PERC aDENT } �— UMBF26LLA LIAS I X OCCUR Is C X 9XCESSLIAR XL1566070 EACHOCCLat„rr,CE _ 2,000,00 c.L�IMs-MAr�= 05/18/2015 05!18/2016 DED RFTEMION S A(A R'=CATS I S 2,000,00 WORKERS COMPENSATION ( s AND EMPLOYERS'LIABILRY Y I N X �C I RS LL O"H B ANY PROPRIcrORJPARTNER/E=XECUiiV.- 52I)Q7rJ411 RYLIMR;'; ER (MandaRXEMSERtory NH) X(:LUUED9 � NIA 05f1512015 05/15/2016 E.L.EACH AC CiLt:NT S 100, (Mandatory in NH} I.VES,deSCf'ibc undgr h1 NSEASE_CA E,+d'LOYEE S 100,00 UE.`:CRIr TION OF CIPFR iT,ONS below E.L.DIS ASE-POLICY LIMIT I S 500,00 f DESCRIPTION OF OPERATIONS I LOCATIONS VEHICLES CAttach ACORD 101,Additional Remarks Schedule,WMye space Is rl uircd) 013002089 CERTIFICATE HOLDER CANCELLATION Miami Shores Village SHOULD ANY OF BEFORE THE EXPIR&TION NDATEOvT E EO DESCRFENOT CE POLICIES VALSL B ECDEVERED IH Building Dept ACCORDANCE VWTH THE POLICY PROVISIONS. 10050 NE 2Avenue Miami Shores, FL 33138 AUTHORO-=DF�;;PRESENTATAM ACORD 25(2010!0$) Q 1888-2010 ACORD CORPORATION, All rights reserved, The ACORD name and logo are registered marks of ACORD