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EL-14-871 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-219458 Permit Number: EL-4-14-871 Scheduled Inspection Date: September 12,2014 Permit Type: Electrical - Residential Inspector: Devaney, Michael Inspection Type: Final Owner: GREEN, MATTHEW&AMANDA Work Classification: Alteration Job Address:930 NE 95 Street Miami Shores, FL Phone Number Parcel Number 1132050070070 Project: <NONE> Contractor: KEVIN WALTON Phone: (954)802-6214 Building Department Comments LOW VOLTAGE WIRING INCLUDING TELEPHONE, TV Infractio Passed Comments AND STEREO INSPECTOR COMMENTS False Inspector Comments Passed Failed / '�q 0/"", xav Correction ❑ Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. For Inspections please call: (305)762-4949 September 11,2014 Page 30 of 35 Y� Miami Shores Village [P*—*-FCE1VED Building Department APR a 0 .014 10050 N.B.2nd Avenue,Miami Shores,Florida 33138 Tel:(305)795.2204 Fax:(305)756.8972 INSPECTION'S PHONE NUMBER:(305)762.4949 FBC 20 BUILDING Permit No. PERMIT APPLICATION Master Permit No. I C-13 -.,23-LJ ` Permit Type:Electrical I l JOB ADDRESS- q V 3_® I C 95-111 s T r-e+L City: Miami Shores County: Miami Dade Zip: , 3 313 Folio/P'arcel#: I 1 �R0 ()n 2[-) Is the Building Historically Deftmted:Yes NO Flood Zone: OWNER:Name(Fee Simple Phone#: Address: I✓ ' City: cA I � state: Tenant/Lessee Name:-.� t�Yl Phone#• Email: 9 C a ro k"Yl CONTRACTOR:Company Name: IV i/I' 1+0n- Phone#: R 5q-802-- C.,2 l Address: 3_ )o-Q c2Gi`t- CC11-),r-+ C9`�L W-'C City: o l l e rrT A�t�n + Stater Z p: CD ` Qualifier Name:_fy VV n Lk)b- 1+001 Phone#: ��/ State Certification or Registration#: f-�-4 rj Certificate of Competency#: Contact Phone#: q 5A- 61=(4-Zi Email Address: '51ereokev ,r) ayabt2n x DESIGNER:Architect/Engineer Phone#: Value of Work for this Permit: 3®®— S uar&TAuear Footage of Work: Type of Work: UAddress- OAlterarion- ew ORepair/Replace ODemolition Description of Work.- 1--ow V a �.T f�C°'P LoY r i n� -�yn Submittal Fee$ Permit Fee$ CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Bond$ Notary$ Training/Education Fee$ Technology Fee$ Double Fee$ Structural Review$ ` TOTAL FEE NOW DUE$ l J Bonding Company's Name(if applicable) i_onding Company's Address City ~� State Z9 Mortgage Lender's Name(if applicable) 1 Mortgage Lender's Address CityState Zir , - , t P pblication 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 ELECTRICAL WORK,PLUMBING,SIGN. WELLS,POOLS,FURNACES,BOILERS,HEATERS,TANKS and 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 ►RECORDiN6 V&R.NOTICE OF COM MNCEMENT.'' 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 Signature—U��&Ic\ � i ' Owner or kSent Contractor The foregoing instrument was awledged before me this The foregoing instrument was acknowledged before me this o�9 day of ,20 ,by f' 'Q day of 20&- by &Vi l) Wa/�O-1.1 who' erso o me or who has produced'` own to who is personally or who has produced As identification and who did as identification and who did take an oath. NOTARY PUBLIC: NO P PAILioi141t61i18BPi// \\�� ;�: ...•��� ° �/oma C �Nj� •F��///// Sign: rac��FS \ �, /_ Sign: Print: My Commission Expires: o,, y P • � b �'� M Commission Expires: "o� �1oai21 �Q a «xxx �wae= * e � e .xs *xxae �saxxsa xse� xes x�ax� Ql # 3#Wr � ,x APPROVED BY46j�� ��i��� Plans Examiner - Zoning Structural Review Clerk (Revised 3/12=12)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09) ♦SNO iQc''�a .... o,..� Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CONTRACTORS' REGISTRATION FORM ALL CONTRACTORS MUST PROVIDE COPIES OF LICENCES AND INSURANCES EACH TIME A PERMIT IS SUBMITTED OR THE VILLAGE MAY MAINTAIN A FILE WITH YOUR INFORMATION FOR A$30.00 FEE PER YEAR. IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: A. ✓ COPY OF QUALIFIER'S STATE LIC CARD B.�COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF LIABILITY INSURANCE(CERTIFICATE HOLDER TO BE MIAMI SHORES VILLAGE BLDG DEP D. ✓ COPY OF WORKERS COMPENSATION(EITHER CERTIFICATE OR EXCEMPTION) IF CONTRACTOR HAS A MIAMI BADE COUNTY CERTIFICATE OF COMPETENCY: A. COPY OF CERTIFICE OF COMPETENCY OF QUALIFIER B. COPY OF MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT C. COPY OF LIABILITY INSURACE(CERTIFICATE HOLDER MUST BE MIAMI SHORES VILLAGE BLDG DEPT) D. COPY OF WORKER COMP INSURANCE(EITHER CERTIFICATE OR EXEMPTION) YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE HOLDER AS FOLLOW: MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES,FL 33138 etw COMPLETE CONTRACTOR'S INFORMATION BUSINESS NAME: fn LL)a n BUSINESS ADDRESS: 31 o o N ; 4e C cert crrY N o 14wan t STATE P L ZIP CODE 3 3 ma BUSINESS PHONE:(q;ff ) 9ZZ 4e21!4 FAX NUMBER�a CELL PHONE 0$02-1!0214 QUALIFIER'S NAME:gL'1lm WCL. Hon QUALIFIER'S LIC NUMBER: E G I s O oo a.4S E-MAIL ADDRESS OF APPLICABLE): S4-e rro k eyl n j0D yGt.bCg2•GoM Created on 3H910 BY MWV 1 RV 3126109 MWV YM CERTIFICATE OF LIABILITY INSURANCE DATE`MIOD 01 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION A.M.C. INSURANCE ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AMEND, EXTEND OR P.O. HOA 15880 w ALTER THE COVERAGE AFFORDED BY THE POLIOS BELOW. PLANTATION, FL. 33318 954 581-5800 INSURERS AFFORDING COVERAGE NAIC# INSURED KEVIN VALTON INSURER A, CAPACITY INSURANCE CO. INSURER S' NOS P.O. Boz 292751 INSURER V DAVIE, FL 33329 INSURER D: INSURER E COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERRA 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 16 SUBJECT TO ALL THE TERMS.EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PND CLA61A5. aMR pp POLICY NUMBER EF_WNFE IgAT[ON LIUtlI S GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 A COMMERCIAL GENERAL LIABILITY PREMISES Ea o�m- s 100,000 CLAIMSMADE ®OCCUR MEDi7WWWompm m) s 5 000 A CIM 01001995B 5/13/13 5/13/14 PMUMALBAAVWURY s .11 00,000 GENERAL AGGREGATE s 2.000,000 GEN'LAGGREMTELIMIT APPLIESPER PRODUCTS-COMPIOPAGG S 1 000 000 POLICY PRO- LOC AUTONIOWLE LIABUTY �f�SINGLE LM s excluded ANYAUTa ALLOWNEDAUTOS BODILR )RY s excludedSCHEDULED AUTOS HIRED AUTOS BO s excluded NON-0WNEDAUTOS PROPERTY DAMAGE s excluded GARAGE LIABILITY AUTO ONLY-EAACCIDENT $ exclude ANYAUTO OTHERTHAN EAACC S exOl AUTOONLY: AcG s excluded EXCESSNMBRELLA LIABILITY EACH OCCURRe4M s excluded OCCUR FIGIANSMADE AGGREGATE s excluded s excluded DEDUCTIBLE s excluded RETENTION S s excl WORKERSCOMPENSATIONAND A T A EA9PLaYERSLIABNIm PFUffrOWAMNIMMUnVE IMUM26488 4/2/14 4/2/15 F-LEACHACCIDEtNT $ .100 000 B, Oy�yeess E.L.DISEASE-EA EAn2 s 100 000 SPEL�IALP VMIONSbalow EL DISEASE-POLICY LOMT -S 500,000 OTHER excluded DESCRIPTION OF OPERATIONSILOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENTISPECIALPROVISIDNS INSTALLATION O.F LM VOLTAGE ELECTRONIC SYSTE[4S CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION MIAMI SHORES VILLAGE DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAD-1_0 DAYS WRITTEN BUILDING DEPART 10050 N.E. 2 AVENQE NOTICE To THE CI�TTFtCaTE HOLDER NAMED TO TO THE LETT,BUT FAILURE TO DO SO 3HA WPM NO OBLIGATION OR LIABILITY OF ANY IONO UPON THE INSURER.ITS AGENTS OR MIAMI SHORES, FL 33138 F305-756-8972 REPRESF�NrATnrss AUTHDRGMD REFRES�FTATIVE . AC.ORD25000IM 0,9CORD CORPORATION 1968 1; STATE OF FLORIDA DSPARTXM ,Or8 IS' S AAfD CTRIC 4L PROFkSS7 `:.R. SGM ATION MORS BOARDT � fI S E Lz2os3oo384: .. L SN8 NSR, !Co tkaCTAR II 1�Tam�rd; be ..caar 1S CE.RT.lF., SD "ceder t grovi a ois® off 'Chapt"bt So _FS . epiration date o Ate. 31 e 203.*, , 0�1' =IGEN S»[ nMI OAL . .. . 3100 IIORTH .29TH COURT-SUITS 130 HOLLYWOOD FL 33020 VIM r.bWMM f HOLLYWOOD, FL 3302U WALTON, KEVIN 3100 N 29 CT HOLLYWOOD FL 33020 223 42784 °•`'"mak CITY OF HOLLYWOOD LOCAL BUSINESS TAX RECEIPT PRINT DATE: 1/17/14 THIS IS YOUR LOCAL BUSINESS TAX RECEIPT. PLEASE DETACH AND POST IN A CONSPICUOUS PLACE AT THE BUSINESS LOCATION. PLEASE DO NOT REMIT ANY PAYMENT. THIS IS NOTA BILL. BU iness Name: WALTON, KEVIN Business Locations 3100 N 29 CT Business Class: CONTRACTOR/ELECTRICAL Tax Basis: 2 - 4 WORKERS Receipt Number: 14 00051671 Receipt Year: 10/01/13 Expiration Date: 09/30/14 NEW CHARGES: (Itemized Below) 251.00 Comments: Base Fee - 251.00 Additional Charges: TOTAL. NEW CHARGES: 251.00 Penalty Amount: 25.10 Previous Balance Due: .00 TOIAL AMOUNT PAID: 276.10 PURSUANT TO STATE LAW, THE LOCAL BUSINESS TAX IS LEVIED ON THE PRIVILEGE OF DOING BUSINESS WITHIN A CITY'S LIMITS, AND IS NON-REGULATORY IN NATURE. ISSUANCE OF A LOCAL BUSINESS TAX RECEIPT BY THE CITY OF HOLLYWOOD DOES NOT MEAN THAT THE CITY HAS DETERMINED THAT THE EXISTING OR PROPOSED USE OF A LOCATION IS LAWFUL. ISSUANCE OF A LOCAL BUSINESS TAX RECEIPT DOES NOT LEGALIZE OR CONDONE THE NATURE OF THE BUSINESS BEING CONDUCTED IF CONTRARY TO ANY LOCAL, STATE OR FEDERAL LAWS OR REGULATIONS.