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
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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
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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.