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EL-15-2989 rz, C"' I 5 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-251026 Permit Number: EL-12-15-2989 Scheduled Inspection Date: January 15,2016 Permit Type: Electrical- Residential Inspector: Devaney, Michael Inspection Type: Final Owner: LAFRENIERE, KATHY Work Classification: Alteration Job Address:1100 NE 91 Terrace Miami Shores, FL 33138- Phone Number Parcel Number 1132050010390 Project: <NONE> Contractor: CAP ELECTRIC INC Phone: (954)818-2374 Building Department Comments RELOCATE LIGHT FIXTURES AND OUTLETS IN MASTER Infractio Passed Comments BATH CLOSET INSPECTOR COMMENTS False Inspector Comments Passed Failed Correction ❑ Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. January 14,2016 For Inspections please call: (305)762-4949 Page 23 of 23 nrv. EL-12-15-2989 E � � Miami Shores Village Perm#Type. Eloct) � `<y 10050 N.E.2nd Avenue NE , Miami Shores,FL 3313&0000 l+ tffk to Stat tlCtlt �lltet i k Phone: (305)795-2204 1�l�l�ROVED Expiration: 05/30/2016 Project Address Parcel Number Applicant 1100 NE 91 Terrace 1132050010390 Miami Shores, FL 33138- Block: Lot: KATHY LAFRENIERE r Owner Information Address Phone Cell KATHY LAFRENIERE 1100 NE 91 Terrace MIAMI SHORES FL 33138-3404 1100 NE 91 Terrace MIAMI SHORES 33138- Contractor(s) Phone Cell Phone Valuation: $ 1,200.00 CAP ELECTRIC INC (954)818-2374 , .... ... _.. _... .. . ......... _,_. Total Sq Feet: 200 Type of Work:RELOCATE LIGHT FIXTURES AND OUTLETS Available Inspections: Additional Info: Inspection Type: Classification:Residential H _ Review Electrical Scanning: 1 S M., 03 LL P JOB AT � IMF 07, s 01 000 10, N Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $1.20 Invoice# EL-12-15-57902 DBPR Fee $2'25 12/02/2015 Credit Card $ 110.70 $50.00 DCA Fee $2.25 Education Surcharge $0.40 12/01/2015 Check#:627 $50.00 $0.00 Permit Fee-Additions/Alterations $150.00 Scanning Fee $3.00 Technology Fee $1.60 Total: $160.70 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, DORS,ROO ING and SWIMMING POOL work. OWNERS AFFIDAVIT: I certify that all the foregoing information is ccu t d that all work will be done in compliance with all applicable laws regulating construction and zoning. Futhermore,I authorize the above-named ontra o o the work stated. December 02, 2015 Authorized Signature:Owner / Applicant / Co act / gent Date Building Department Copy December 02,2015 1 Miami Shores Village - Building Department Nov �o�§ 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 _ INSPECTION LINE PHONE NUMBER:(305)762-4949 �= ' FBC 201y BUILDING Master Permit No.RC-10-15 5(p PERMIT APPLICATION Sub Permit No. ELOS-- 2-'q AGO []BUILDING M ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑MECHANICAL F-1 PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 1100 NE 91 st Terrace City: Miami Shores County: Miami Dade Zip: Folio/Parcel#:11-3205-001-0390 Is the Building Historically Designated:Yes NO Occupancy Type: R Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder):Kathy Lafreniere Phone#:508-259-9793 Address:1100 NE 91 st Terrace City: Miami Shores State: FL Zip: 33138 Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name: CAP ELECTRIC INC. Phone#: 954-818-2374 Address: 5234 NW 15th Street City: Margate State: FL Zip. 33063 Qualifier Name: Clive Pickersgill Phone#: 954-818-2374 State Certification or Registration#: ER13012569 Certificate of Competency#: E DESIGNER:Architect/Engineer: JCD Architect Phone#: 305-2h54343 Address:1385 Coral Way Suite 207 Cit,: Miami State: FL Zip: 33145 Value of Work for this Permit:$11,200 Square/Linear Footage of Work: 200 sq.ft. Type of Work: ❑ Addition M Alteration ❑ New 0 Repair/Replace ❑ Demolition Description of Work: Relocate light fixtures and outlets in master bath and master closet. Specify color of color thru tile: Submittal Fee$ LO° L'o Permit Fee$ CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ (RevisedOZ/24/2014) M 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�'nspection fee will be charged. Signature �! ��� Signature OWNER or AGENT CO TRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this V�) 9 day of KL UC r-, l? .20 1- .by � (I/ _day of 0)ties 6C 0- .20 9 � by i� l y L9 LAS e?c g,)yr-ef°,who is personally known to C 1f o lo-t2 C-i P d .who is ersonally know to me or who has produced z S �:��, �' as me or who has produced as identification and who did take an oath. identification anal who did take an oath. NOTARY PUBLIC: NOTARY PU LIC: s_�1_ /1 F Sign: A ��� �--Sign: / ', �' Print: Print: 4 OR 04 Notary c tateFlorida %Alejandro R Andino +° Ale andro R Andino Seal: My Commission FF 829919 Sea I: ) �or�� Expires 10/22/2018 My Commission FF 929919 �ifq 4 Expires 10/2212019 APPROVED BY l r�40 Plans Examiner Zoning Structural Review Clerk (Rewsed02/24/2014) �•� �a� Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CONTRACTORS' REGISTRATION IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: A. _COPY OF QUALIFIER'S STATE LICENCES B. COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF LIABILITY INSURANCE* D. x_COPY OF WORKERS COMPENSATION INSURANCE* (Workers Compensation EXEMPTION must have NOTICE TO OWNER form and Contractor Affidavit) IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY: A. �OFLO� NCY OB. COPY CAL BUSINESS TAX RECEIPT C. COPY OF STATE REGISTERED CONTRACTOR LICENSE OR MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT. D. COPY OF LIABILITY INSURACE* E. COPY OF WORKERS COMPENSATION INSURANCE* (Workers Compensation EXEMPTION must have NOTICE TO OWNER form and Contractor Affidavit) *YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE AS FOLLOW Certificate Holder: MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE S FL 33138 Certificate must specify the description of operations or contractor license num or. ■���a��o■■say•■ ■����������ao�r�toasea������• ����������a��� BUSINESS NAME: E �� ( ) tj C BUSINESS ADDRESS: 52�� f� ��� r���l' CITYI�(� STATE R ZIP BUSINESS PHONE: It c`� ) It 1'� - Z—` FAX NUMBER(____� CELL PHONE(_ S/--'jQUALIFIER'S NAME: t-'J1' P) QUALIFIER'S LIC NUMBER: 2 13 0 ) Z S�-7 tk anti :": i S f5 CT Construction Trades Qualifying Board BUSINESS CERTIFICATE OF COMPETENCY 07EO00374 CAP EL INC D. B.A. : PICKERS ILL CLIVE A Is certified under the provisions of Chapter 10 of Miami-Dade County r 6 3o11 x RICK SCOTT. GOVERNOR KEN LAWSON. SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD ER13012569e The ELECTRICAL CONTRACTOR ` S Named below HAS REGISTERED_ -' Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2016 . (INDIVIDUAL MUST MEETALL LOCAL LICENSING REQUIREMENTS PRIOR TO CONTRACTING IN ANY AREA PICKERSGILL, CLIVE ANTHONY ; • CAP ELECTRIC INC • 3660 NW 126 AVENUE SUITE 5 . .r s- CORAL SPRINGS FL 36065, ISSUED: 08/26/2014 DISPLAY AS REQUIRED BY LAW SEQ# L1408260002336 Local Business Tax Fbcei pt Miami-Dade County, State of Florida THIS IS NOTA 81E.t Od NOT PAY �_ LJ[3 6113526 BUSINESS NAME/LOCATION RECEIPT NO EXPIRES CAP ELECTRIC INC RENEWAL SEPTEMBER 30, 2016 DOING BUSINESS IN DADE 6376404 COUNTY Must be displayed at peace of business Pursuant to County Code Chapter 8A - Art 9& 10 OWNER SEC TYPE OF BUSINESS PAYMENT RECEIVED CAP ELECTRIC INC 196 ELECTRICAL BY TAX COLLECTOR CIO CLIVE PICKERSGILL, PRES. CONTRACTOR 82.54 10/23/2015 Worker(s) 1 07EOD0374 0224.16-000268 This Loud"rM3 Tax toi pt orty con'm pa,�d the Local Business Tax The Pecs pt is not a l iceetw. permt or a cert"canon d the hddWs gLWi"cab**b do businea kidder mei comp y with any g0o6rrrnMW or nongovernmental reef*Wy laws and requt mmwUwNch apply to"Ouonw& The FiB,1` P r NO above mat be displayed ort all C0111119rGal vdWas-Mia*d-Dade Oode See Ile-276 "IAMIj ICrmote iMOrnMVon,Vtsit CERTIFICATE OF LIABILITY INSURANCE DATE0WIDDIYYYY) F1111912015 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 REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the policy(-res)must be endorsed. If SUBROGATION IS WAIVED,subject to 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 M lieu of such endorsement(s). PRODUCER CONTACT Ralph Russo RUSSO INSURANCE GROUP PHONE(AIC No 964-345-1904 FaxNk 1700 N.UNIVERSITY ADDRESS. 964-345-1954 SUITE 215 NG COVERAGE NAIC A CORAL SPRINGS FL 33071 • GRANADA INSURANCE COMPANY INSURED NSU B: CAP ELECTRIC INC 5234 NW 15 ST. IN D: MARGATE,FL 33063 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 CONTRACTOR 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 R POLICY EFF POLICY EXP LIMITS X COMMERCIALGENERALLIABILITY EACH OCCURRENCE $1,000,000 A CLAM S-MADE ®OCCUR namw DAMAGE TO RENTED 100,000 0185FL00067096 0210912015 02/09/2016 MEDExP M w one pwspnl $6,000 PERSONAL.&ADV INJURY $1,000,000 GEMLAGd TE LIMIT APPLIES PER: GENERAL AGGREGATE111,000,000 POLICY JECT PRO- ❑Loc PRODUCTS-COMP/OP AGO 1 A90,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ AP1Y AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NOM-MIMED PROPERTY DAMAGE $ HIREDAUTOS AUTOS UNBRB.LA LIABOCCUR EACH OCCURRENCE EXCESS LIAB HCLAIMS-MADE AGGREGATE WOF I FEROTH- AND EMPLOYERS'LIABILITY ANY PROPRIETOR(PARTNERIEXECUM2 N/A E.L.EACH ACCIDENT OFFICERIMEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ If descrThe under IP E.L.DISEASE-POLICY LIMIT DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,AddMonal Remarks Schedule,may be attached if more space Is required) ELECTRICAL WORK Miami-Dade Certificate of Competency#07E000374 CERTIFICATE HOLDER CANCELLATION MIAMI SHORES VILLAGE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Building Department ACCORDANCE WITH THE POLICY PROVISIONS. 10050 N.E.2nd Avenue Miami Shores,FL 33138 AUTHORIZED REPRESENTATIVE <DA> O 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD CORM' CMS DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE Root 111/19/2015 THIS CERTIFICATEIS 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 REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(les)must be endorsed. If SUBROGATIONIS WAIVED,subject to 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 andorsement(s). PRODUM WNTACT E: PAYCHEX INSURANCE AGENCY INC/PAC (AIC No,EMY. lwc.Nor. (888) 443-6112 210764 P: F: (888) 443-6112 AD�, PO BOX 33015 INSURER(S)AFFORDING COVERAGE NA= SAN ANTONIO TX 78265 INSURERA: Hartford Casualty Ins Co 29424 fxBufrm INSURER B INSURER C: CAP ELECTRIC INC INSURER D: 5234 NW 15TH ST INSURER E: MARGATE FL 33063 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,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. JNSR IIME OFINSVRANC6 ADDL SY/BR POLICYNUAMR POLICrEFF POLICYEXP UMM COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE El DAMAGE TO RENTED CLAIMS MADE OCCUR PREMISES omffence) MED EXP(Any one pereon) PERSONAL&ADV INJURY GEML AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE POLICY a PRO ❑LOC PRODUCTS-COMPIOP AGG OTHER: JECT AUTOMOBILE LL469JW COMBINED SINGLE LIMIT (Ea Hent) S ANY AUTO BODILY INJURY(Per person) ALL OWNED SCHEDULED BODILY INJURY(Peraccidem) AUTOS AUTOS HIRED AUTOS NON-OWNED PROPERTY DAMAGE AUTOS (Per acowerd) UMBRELLA LIAR OCCUR EACH OCCURRENCE EXCESS LIAB CLAIMS-MADE AGGREGATE D RETENTION' W0RXMC0MPE=4TT0N X PER on-1. A"E?"LOYMWLUBDPfY STATUTE I ER ANY PROPRIETORIPARTNEWEXECUTIVE YIN E.L.EACH ACCIDENT $100, 000 OFFICER/MEMBER EXCLUDED? A ffibndet hi NH) El7676 WEG VK7577 02/11/2015 02/11/2016 EL DISEASE-EA EMPLOYEE loo, 000 If yes,describe Under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1'500, 000 D DWCR97M OFOPERATIOMS/LOCAL ONS/VEMCLES(ACORD 101.AddWarad Remarks Schedule,may be aftoMW M mom space Is regWrad) Those usual to the Insured's Operations. Miami-Dade Certificate of Competency # 07E000374 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. MIAMI SHORES VILLAGE BLDG. DEPT. AUTHORrMREPRESENTATIVE 1OD50 NE 2ND AVE MIAMI SHORES, FL 33138a2 � 01988-2014 ACORD CORPORATION.All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD