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EL-15-1822 (2) Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-239530 Permit Number: EL-7-15-1822 Scheduled Inspection Date: November 18, 2015 Permit Type: Electrical - Residential Inspector: Devaney, Michael Inspection Type: Final Owner: MCFADDEN,MILLICENT Work Classification: Pool - Private Job Address:5 NW 107 Street Miami Shores, FL 33138- Phone Number Parcel Number 1121360070480 Project: <NONE> Contractor: YORK ELECTRICAL CONTRACTOR CORP. Phone: (305)962-0759 Building Department Comments ELECTRICAL ROUGH FOR NEW POOL Infractio Passed Comments INSPECTOR COMMENTS False Inspector Comments Passed Failed Correction ❑ Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. November 17, 2015 For Inspections please call: (305)762-4949 Page 6 of 33 Miami Shores Village g �.�CFTvF_jD Building Department JUL 21 2015 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 20_N � BUILDING Master Permit No ��IJ— &220 PERMIT APPLICATION Sub Permit NoZ-/ 102 21.e_ ❑BUILDING (ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL PLUMBING F-1 MECHANICAL PUBLIC WORKS F__] CHANGE OF F-1 CANCELLATION SHOP CONTRACTOR DRAWINGS JOB ADDRESS: U Sig City: Miami Shores County: Miami Dade Zip: 3 Folio/Parcel#: I I •2 i 001 CL4 `HCl Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: `Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): �.(r �1 ce-ri '- mc FC Ac:" -1 Phone#: Address: S tJw + [�`l Si . City: " +arv+► s lnr 3 State: 4:--L Zip: Tenant/Lessee Name: N ) A Phone#: Email: r( f r_ CONTRACTOR:Company Name: 0 f `C��C� %-CaZ_( ,^`t i"I( Phone#: 30 — 9 Ce 2-D 50\ Address �� s I �i't6 2 V!A:c Z S O 6 City: Ccr wc�t: State: ( L: S-r, Zip: 3 3 ( 15-1 Qualifier Name: L-,o f.Q_ -N :L--O l O if 2 S Phone#:30 S- `I,S 5-4 - 14 9�o State Certification or Registration#:EC 13 Dy 5(.e S ce Certificate of Competency#: DESIGNER:Architect/Engineer: -J([�.z'i t . }��nc i��9�.7�1�C- "1I�cY 3Phone#: Address: 130y V City: State:R_Zip:_3L--�)_-1y� Value of Work for this Permit:$ IA._0-cy 1 aQ Square/linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: t' E +ccy fc��Cnl� Specify color of color thru tile: Submittal Fee$ Permit Fee$ CCF$ LLJ CO/CC$ Scanning Fee$` .CRadon Fee$ t .Sf� DBPR$��Notary$ Technology Fee$ 1 . 60 Training/Education Fee$ i) A-1 to Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ (Revised02/24/2014) Bonding Company's Name(if applicable) Bonding Company's Address 0 ! P City State Zip Mortgage Lender's Name(if applicable) 0 I 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 reinspection fee will be charged. 7 Signature ) Signature OWNER or AGENT COTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this 30 day of 20 yU1 S ' by Z`�( day of �y �`-R 20 I 1 by ` #-{��;c�►4 -(�Tc;,e�� ,who is ersonally know 'to `'�'b- a- ,who is personally known to me or who has produced as me or who has produced �ZG Zc)5�. Z as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: r Sign: Sign: Print: �--v Z N P I tea' Print: Seal: _,=o` ` u` ��%WMtnISSICY#FF01905'° Seal: .�``"rp''% LuzilelemAe in 2017 `'M',§EXPIRES: F EKPIRES: MAY 19, ::o :WMialSSIC`I#FF01905: p•' WWW.AARONNOTARY.con PdAY 19,2017 �9 OF 15 ,MWW.AARONNOTARY.soM APPROVED BY _ ✓UGY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) h Local Business Tak Receipt Miami—Dade County, State of Florida -TM t5 NGTA BILL DO NOT PAY 5118542 IL B T BtRSHESS fAANr_&0C.A1V M Rr WX EXPIRES yow aEcrwCAi_CON IU CIM COMP RMEWAL SEPTEMBER 30, 2015 10871 SW 188 Sr 25 5346825 rpt be displayed at place of business LOW FL 33165 Pursuant to County Code Chapter 8A-Art 9&10 OAR SEC,TYPc OF Btu PAYMENT RECEMM YORK aECTRICAL CONTRAC(OR CORP 196 ELEC,31(:AL CONTRACTOR BY TAX t.Cu.P.CTOR Worker(s) EC13005655 $75.00 08/03/2014 1 CREDITCARD-14-031146 76'a lseat Tax Receipt oaf a uams papno of d*Local Tax.Tie is wa a Gcaese. as radabMumm 9 rolmninea d r ill lara vAkb apply a ir�ess. oav VWKCB f RQ.aiwe slat be&pk rW"aM emnowtW veiieles-i6aoi-Dale We Sec la-M- for once ioiar�atiortxisiR RICK SCOTT,GOVERNOR KEN LMNSON_SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARDRk �C1so0ssss x �� The ELECTRICAL CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2016 07 Ful TORRES, LORENZO ` ' YORK ELECTRICAL CONTRACTOR CORP 14255 SW 183RD TERRACE MIAMI FL 33177 ■ ISSUED- 06112/2fT14 DISPLAY AS REQUIRED BY LAW SEQ a L140612OWi558 AIM- !c=,sv CLASS we ..w Frow Bentrust 305 444 6501 07/21/2015 11:06 #408 P.002/002 A. . YORKELE-01 BGONZALEZ .4�v CERTIFICATE OF LIABILITY INSURANCE DATE(MOVDD 7/21/201515 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: H the certificate holder is an ADDITIONAL INSURED,the policy(les)must be endorsed. H 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 In lieu of such endorsemen s. BonAIB LLC CONTACT Chrystal Martinez PHONE —�— Suit 30abe0rf Way _ff3051444-8350 - - 30S)4.44-Ml--,— ( ... Miami,FL 331263682 INSURER(S)AFFORDING COVERAGE NMC e IN A:The Travelers IndemnityCompany 25658 INSURED INSURER 13:Proressive American Insurance Co. 24252 York Electrical Contractor Corp s;uRmC-Normandy Insurance Company 13012 10871 SW 188 Street — _ Unit 25 WSURER D ------------._...----...--`-------'---------------------------'—'----- ----------'--------- Miami,FL 33157 INSURER E: 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. LTk TYPE OF INSURANCE2= WVD POLICY NUMBER MMIDDIYYYY MM/DD LIMITS RIENCA X COMMERCIAL GENERAL LIABILITY cLA1Ms-MADE a OCCUR 604D446488 EACH OCTORENTE "$ 1 07/16/2015 07H8/2016 PREMISES Ms occwww) $ MED EXP(An — -- PERSONALBADVINJUGEN'L AGGREGATE LIMIT APPLIES PryX POLICY .O- LICGENERALAGOREGATE orHElt PRODUCTS.COMPIOP AGG $ 2,000,00 AUTOMOBILE LIABILITYCOMBIN LIMIT $ S B ■ �eM AN AUTO _ 017230183 07/10/2015 07/10/2016 BODILY INJURY(Par person) $ 10,00 �0�E X BEDULED ----"INED BODILY INJURY(Per aoddent) S 20, HEED S 8 PROPE odderu $ 10, UMBRELLA LIAR R $ OCCU EXCESS LL4WEl CLAIMBalADE EACH OCCURRENCE 5 AGGREGATE 5 DED RETENTION= - WORKERS COMPENSATION i AND EMPLOYERS'LIABLnY PER C ANY PROPRIETORMARTNERIEXECUTWE YIN NHFLOO1544201507/Z2/2015 07/22/2016TUTE ER OFF HtDCCLUDEO? F-1MIAE.L.EEACHACCIDENT i 1,000,00 (Yrd■rery h NH) N EL DISEASE-EA EMPLOYE $ 1,000,00 CRPTIONde■albe OF orderOPERATIONS below E.L.o13EASE-POLK:Y u mn-:$ 1,000,00 DE8CRIPTION OF OPERAMW I LOCATIONS I VEMSIXES(ACOM)101,AddBlon■I ft—k■Schedule,may Ma 812whed N mon■Pam kr nquhw) RE:F-DC13005656 CERTIFICATE BOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICES BE CANCELLED BEFORE Miami Shores Village THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELlvERED IN Attn:Building Department ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE 2nd Avenue Miami Shores,FL 33138 AUTHORIZED REPRESENTATIVE ®1988,2014 ACORD CORPORATION. All rights reserved. ACORD 2S(2014/01) The ACORD name and logo are registered marks of ACORD