EL-15-2172 Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-247002 Permit Number: EL-8-15-2172
Scheduled Inspection Date: November 24, 2015 Permit Type: Electrical - Residential
Inspector: Devaney, Michael Inspection Type: Final
Owner: SWICK, KATHY ANN & BOB Work Classification: Addition/Alteration
Job Address: 138 NE 92 Street
Miami Shores, FL 33138- Phone Number
Parcel Number 1132060133270
Project: <NONE>
Contractor: RAYS ELECTRICAL SUPPLY INC Phone: (786)236-2777
Building Department Comments
INSTALL 2 120 OUTLETS FOR HOT TUB Infractio Passed Comments
INSPECTOR COMMENTS False
Inspector Comments
Passed CREATED AS REINSPECTION FOR INSP-242194. Not ready.
Failed
i
Correction ❑
5
Needed
Re-Inspection ❑
Fee
No Additional Inspections can be scheduled until
re-inspection fee is paid.
November 23,2015 For Inspections please call: (305)762-4949 Page 12 of 25
CC�RI� CIFICATE OF LIABILITY INSURANCE DATE E T
19/17/2015
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
i REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the pollcy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to
i 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).
I.
PRODUCER CO E Carmen J.Rivera
Koski and Co.Inc PHO E
305 695-2927 ac No: 305)596-9780
i 9875 Sunset Drive M"u188; carmen@mykoski.com
INSUREn AFFORDING COVERAGE MAIC P
Miami FL 33173 INSURERA: HUDSON SPECIALTY INS CO 37079
INSURED INSURER B:
RAY'S ELECTRICAL SUPPLIES INC INSURER C:
I 2015 Opa Locka Blvd INSURER D
INSURER E
___Qpa Locke FL 33054 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,
j EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
i
IN
R TYPE OF INSURANCEPOLICY NUMBER POLICY FF POLICY P LIMITS
X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
'
CLAIMS-MADE Ln r OCCUR PREMIE T_q ocntrrence) $ 100,000
MED EXP Any one person S 5,000
A HBD90013018 10/19/2015 10/19/2016 PERSONAL&ADV INJURY $ 1,000,WO
vGEEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
PRO
POLICY F]JECT LOC
PRODUCTS-COMPtOP AGG S EXCLUDED
OTHER:
$
AUTOMOBILE LIABILITY MRIINGLLMI $
ANY AUTO BOOiLY INJURY(Pat person) $ ��
ALL OWNED SCHEDULED
AUTOS AUTOS NO COVERAGE
BODILY INJURY(Per accident) $
HIRED AUTOS AUTOS
NON-OWNED PROPERTY DAMAGE u'
AUTOS $
accident)
UMBRELLA LIAB OCCUR EACH OCCURRENCE $
EXCESS LJAa CLAIMS-MADE NO COVERAGE AGGREGATE $
DED RETEN ON S $
VPOFMRS COMPENSATION PER OTH.
AND EMPLOYERS'LIABILITY
Y STATUTE I LER
ANY ERUDECUTNE
OFFICERNEMBEXCLUDED? ]NIA E.L.EACH ACCIDENT S
IMandatoryin NH) NO _
Nyes,describe under E.L.DISEASE-EA EMPLOYE $
DESCRIPTION OF OPERA ONS below E.L,DISEASE-POLICY LIMIT $
NO COVERAGE
DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES(ACORD 104,AddEHonal Remarks Schedule,may be attached It more apace Is required)
ELECTRICAL WORK-THEY SELL ELECTRICAL EQUIPMENT SUCH AS COPPER WIRE,CIRCUIT BREAKERS,ETC,
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY&CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.
THIS CERTIFICATE DOESN'T AMEND,EXTEND OR ALTER COVERAGE AFFORDED BY THE POLICY.ALL TERMS CONDITIONS
LIMITATIONS&EXCLUSIONS OF THE POLICY&THE INSUREDS WARRANTIES TO THE COMPANY APPLY.(10)DAY NOTICE OF
CANCELLATION IS APPLICABLE TO NONPAYMENT.
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 NE 2ND AVENUE
MIAMI SHORES,FL 33138 AUTIIORaW REPRESENTATIVE
�.�C�`t.i"Iirf v►tiL '` r Lr�Jj.ya'
0 1988-2014 ACORD CORPORATION.All rights reserved.
ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD
_ I
Local Business Tax Receipt
Miami—Dade County, State of Florida
-THIS IS NOT A SILL - DO NOT PAY LBT
6636303 y r
BUSINESS NAMEILOCATION RECEIPT NO. EXPIRES
RAYS ELECTRICAL SUPPLIES INC RENEWAL- SEPTEMBER 30, 2016
2015 OPA LOCKA BLVD 2400679 Must be displayed at place of business
OPA LOCKA FL 33054 Pursuant to County Code
Chapter BA-Art.9&10
OWNER SEC.TYPE OF BUSINESS PAYMENT RECEIVED
RAYS ELECTRICAL SUPPLIES INC 196 ELECTRICAL CONTRACTOR BY TAX COLLECTOR
Worker(s) 10 EC13002844 $45.00 09/16/2015
CHECK21-15-130201
This Local Business Tax Receipt only confirms payment of the Local Business Tax.The Receipt is not a license,
permit,or a certification of the holder's qualifications,to do business. Holder must comply with any governmental
or nongovernmental regulatory taws and requirements which apply to the business.
The RECEIPT N0.above must be displayed on all commercial vehicles-Miami-Dade Code Sec 6a-276.
For more information,visit www miamidade.govitexcollectgr
O
\ \ a \
*sN:17M, Miami Shores Village
•` 10050 N.E.2nd Avenue NE
Miami Shores,FL 33138-0000
Phone: (305)795-2204
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,a, � mnn
"A" 115 Expiration: 02/24/2016
Project Address Parcel Number Applicant
138 NE 92 Street 1132060133270
Miami Shores, FL 33138- Block: Lot: KATHY ANN&BOB SWICK
Owner Information Address Phone Cell
KATHY ANN&BOB SWICK 138 NE 92 Street
MIAMI SHORES FL 33138-2814
Contractor(s) Phone Cell Phone Valuation: $ 800.00
RAYS ELECTRICAL SUPPLY INC (786)236-2777 Total Sq Feet: 0
Type of Work: INSTALL 2 120 OUTLETS FOR HOT TUB 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 $0.60 Invoice# EL-8-15-56851
DBPR Fee $2.25 08/28/2015 Check#:802 $ 109.10 $50.00
DCA Fee $2.25
Education Surcharge $0.20 08/25/2015 Check#:801 $50.00 $0.00
Permit Fee-Additions/Alterations $150.00
Scanning Fee $3.00
Technology Fee $0.80
Total: $159.10
In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans,drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In
accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are
required for ELECTRICAL,PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work.
OWNERS AFFID VIT: I certify that all a foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
constructio d on' ermore, I thorize tye above-named contractor to do the work stated.
August 28, 2015
Authorized Signat :Owner / Applicant / Contractor / Agent ate
Building Department Copy
August 28,2015 1
_f t
i
Male Shares Village
Building Department AUG 2015
10050 N.E.2nd Avenue, Miami Shores,Florida 33138
Tel:(305)755-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4149
FBC ZB(U
BUILDING Master Permit No.P—O— ` \ G
PERMIT APPLI ON Sub Permit No. L `�--t 79BUILDING ELECTRIC 0 ROOFING REVISION 0 EXTENSION RENEWAL
[PLUMBING Q MECHANICAL DPUBLIC WORKS [ CHANGE OF El CANCELLATION D SHOP
ty CONTRACTOR DRAWINGS
JOB ADDRESS: f u % �
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: Is the
Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: - Ci Hood Zone: 8FE: FFE:
OWNER:Name(Fee Simple Titleholder): A t w 1 C- Phone#:-�e -::k�` ��{S
Address:
C�
City: � � State: / Zip: saw
Tenant/Lessee Name: Phone#-.
Email:
CONTRACTOR:Company Name: / Phone#: ZT4 X777
Address: ?
City: i'! ' State: Zip:
Qualifier Name: pc?�+,�} L� I Phone#: fir
State Certification or Registration �3or Z 444 Certificate of Competency#:�"+<11207.-VWC-d
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ Square/Linear Fot ge of Work:
Type of Work: 0 Addition Alterations QFl-;NewRepair/Replace Q Demolition
Description of Work:
Specijf�r color of color than tile:
Submittal Fee$ Permit Fee$ l J mrd f 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 taws 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 rein;pection fee will be charged.
(/s l� 7 //'G�
Signature Slgnature �,/
CGIK
NER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
day of � U� 20 ,by
day of -� %'! 20_/, ,by
o is known to who is personally known to
me or who has produced UC ss 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: Print:
Seal: Public state of Fioriaa Seal: ) ' `"'i��`� VALTY RAYMORE
�o�:MF
y =}`' 4 `�+;
=o a Alvarez 56750
commission FF r, ,` MY COMMISSSON#FF0202"es0910312018 "'tyk �P EXPIRES June 19,20'.........+t ' �I:
AOf
APPROVED BY Z✓� ��r' Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)