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EL-14-2442 IT) • Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-222937 Permit Number: EL-11-14-2442 Scheduled Inspection Date:April 29, 2015 Permit Type: Electrical - Residential Inspector: Devaney, Michael Inspection Type: Final Owner: MATEO, RAYMOND AND DAMARIS Work Classification: Generator Job Address:900 NE 100 Street Miami Shores, FL 33138- Phone Number Parcel Number 1132060340220 Project: <NONE> Contractor: BATES ELECTRIC SERVICE&TECHNOLOGY INC Phone: (786)602-3939 Building Department Comments WIRE, SUPPLY+ INSTALL 27 INV NATURAL GAS Infractio Passed Comments GENERATOR, INCLUDING TRANSFER SWITCH. INSPECTOR COMMENTS False Inspector C ents Passed 2 Failed Correction ❑ Needed Re-Inspection Fee No Additional Inspections can be scheduled until re-inspection fee is paid. i April 28,2015 For Inspections please call: (305)762-4949 Page 4 of 33 Miami Shores Villages' 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 FFBC 20 LO BUILDING Master Permit No. Rc_—1:3- I PERMIT APPLICATION Sub Permit Nom= ISI - 29 (BUILDING qMELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP q0c) CONTRACTOR DRAWINGS JOB ADDRESS: /0U� City: Miami hores ��// oun : Miami Dade ZiK): Folio/Parcel#: - 3 � `t 2()(0` _ oa a Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: a -LFlood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder f��(�C� !" '�;)+P � Phone#: Address: ©® k)e loo to city: -. State: 4�A zip: 3313 Tenant/Lessee Name: Phone#: Email: r CONTRACTOR:Company Name:�� '� I JF: fC Phone#: to`U _2- 319 3� Address: V 00 City: S State• 1 Zip: cJ��I LF_ Qualifier Name: Phone#•` -1'?l®"l0 a a. State Certification or Registration#: Gl., I �3a �)q n Certificate of Competency#: DESIGNER:Architect/Engineer: _j7_ l l/1 �'''L o- -- ----- --_ Phone#: D Address:- — - - - -- - --- _- City: �`� 1 { State: Zip: 53/257 Value of Work for this Permit:$ I `tel J Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration J-New ❑ Repair//Reep�lace.KLA) ❑ Demolition /I Description of Work: .� S of j w O� r r�y' �S L/j 4 WKh Specify color of color thru tile: Submittal Fee$ Permit Fee$ P/ CCF$ r�� `P� CO/CC$ Scanning Fee$ :2>- � Radon Fee$ �e DBPR$ '-1 . Notary$ Technology Fee$ °� d Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ (RevisedO2/24/2014) 4 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 jab 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 f/ Signature OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before a this t 7l day of 20 by day of 0QAQ r .20 by Alm'wu t—aTE�p ,who is personally known to 1(al f)I-_ �I� ,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: Fy Public 312ty—r Print Seal: Sindia Alvarez Seal: Brenda Lea Tyler +� My Commission FF 159750 o, Expires 09/03/2019 Notary Public Notary Seal State of Missouri County of Jefferson My Commission Expires 04/29/2017 �xss*ae+►.*wx. * **.a*a� w * **w��e+e*w �s �r** + �s*.six*esax*r� �**ox* * a�* �r* CoAP mm i 1 7 or * +e �ea►x.+� a�+�** APPROVED BY ®�,';Cr j� �S 1-'40l.V Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) RICK SCOTT,GOVERNOR KEN LAWSON,SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ( ELECTRICAL CONTRACTORS LICENSING BOARD g _ 1 EC13005952 The ELECTRICAL CONTRACTOR Named below IS CERTIFIED , Under the provisions of Chapter 489 FS. w i Expiration_date: AUG 31,2016 u LiFRINK, BLAINE L � "" • BATES,ELECTRIC SERViCl✓ TCHNOLQGY,JINC.. • :2006 SIERRA PARKV�IAX - . ..` "� `° x:s ,� • ARNQLD D `° I ISSUED: 06/19/2014 DISPLAYAS REQUIRED BY LAW SEQ# L1406190001112 II i T15 _ =s x 14 `l ,. �`n) 15ns tt'.,. fir;41 r s' �. 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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: I the certificate holder Is an ADDITIONAL INSURED,the policy(ies)must be endorsed.I SUBROGATION IS WAIVED.subject to the tw ss and con tions at the policy,certain policies may require an endorsement A statement on this Certificate does not confer rights to the Certificate bolder In Neu of such s. PRODUCER CONTACT FEDERATED MUTUAL INSURANCE COMPANY A , CLIENT CONTACT CENTER HOME OFFICE: 'P.O.BOX 328 PHONE FAX 507-446-4664 OWATONNA,MN 55050 E-MAIL .CNT ENT S.COM INSURERS AFFORDINO COVERAGE NAIL P INSURER A:FEDERATED MUTUAL INSURANCE COMPANY 13935 INSURED 225-216-1 INSURER B:FEDERATED SERVICE INSURANCE COMPANY 28304 BATES ELECTRIC INC INSURER C. PO BOX 100 IMPERIAL,MO 63052 INSURER D: INSURER I» INSURER F: COVERAGES CERTIFICATE NUMBER:301 REVISION NUMBER:I 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. TERAS 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 mm SUER POLICY NUMBER POLICY EFF POLICY EXP O GENERAL LULBILITY EACH OCCURRENCE $1.0w.000 X COMMERCIAL OENERAL LIABILITY DAMAGE RENTED $10.000 dA M34mm ❑X OCCUR MED EXP(Amr we penO EXCLUDED B N N 9430249 03/0.9/2014 =942015 PERsoRAL a ADvmJURY $1,000,000 GENERAL AGGREGATE $2.000.000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTe-COMPADP AM $2AW.OW X PoucY LOC AUTOMOBILE Li"Lrnr COMBINED SINGLE LIMIT $1,000,000 X ANY AUTO BODILY mm"(Por pante ALL ULED B AAMOOS D AUTOS N N 9430249 03/0.9/2014 03/09W5 BODILY INJURY(Par aed HIRED AUTOSEDAUTOS �JhMDAMAGE X UMBRELLA LLAB X OCCUR EACH OCCURRENCE $5,000,M B ExcEss Lure cLaMsanADE N N 9430250 03109/2014 03/W12015 AGGREGATE $5.000,w Dm I Immm gTp7 WORIUM COMPENSATION AM TORY LIANTSU. ESR ARD EMPLOYERS•LIABILITY A ANY PROPRIET*"A"NERWMCUT1VE E.L.EACH ACCIDENT $1,000,ow A AMBER EXCLUDEDr N+A N 9430251 03/09/2014 03/09/2015 (mmum ry In NH) E.L.DISEASE-EA EMPLOYEE $1=000 tea, a $1.000,000 DESCRIPTION OF OPERATIONS Aabw LL DISEASE-POLICY LIMIT DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEIUCLEG(AEth ACORD IM.AdM mmt Remarks ScIm6de,H mere spam b modrad) ELECTRICAL CONTRACTING LICENSE i EC13005952 CERTIFICATE HOLDER CANCELLATION 225.218-1 3011 CITY OF MIAMI SHORES SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 10050 HE 2ND AVE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN MIAMI SHORES,FL 33138-2304 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORD�D REPRESENTATIVE F r 9 1988-2010 ACORD CORPORATION.All riffs reserved ACORD 26(20101'051 The ACORD new and logo are registered marks of ACORD