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EL-15-983 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-245095 Permit Number: EL-4-15-983 Scheduled Inspection Date: October 07,2015 Permit Type: Electrical - Residential Inspector: Devaney, Michael Inspection Type: Final Owner: , Work Classification: Alteration Job Address:652 NE 105 Street Miami Shores, FL Phone Number Parcel Number 1122310120140 Project: <NONE> Contractor: CASSIA ELECTRICAL CONTRACTORS INC Phone: (954)650-5840 Building Department Comments INSTALL NEW PANEL RELOCATE PANEL AND INSTALL Infractio Passed Comments SWITCHES LIGHTING AND OUTLETS AS PER PLANS INSPECTOR COMMENTS False r Inspector Comments Passed Failed Correction ❑ Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. October 06,2015 For Inspections please call: (305)762-4949 Page 47 of 60 Miami Shores Village P+ - � C tial 10050 N.E.2nd Avenue NES Miami Shores,FL 33138-0000 � � Phone: (305)795-2204F Expiration: 10/25/2015 Project Address Parcel Number Applicant 652 NE 105 Street 1122310120140 Miami Shores, FL Block: Lot: KILUAN, INC Owner Information Address Phone Ceti KILUAN,INC 652 NE 105 Street MIAMI SHORES FL 33138- 150 SE 2 Avenue MIAMI FL 33131- Contractor(s) Phone Cell Phone Valuation: $ 25,000.00 CASSIA ELECTRICAL CONTRACTOR' (954)650-5840 (954)274-6277 Total Sq Feet: 00 Type of Work:INSTALL NEW PANEL RELOCATE PANEL AN Available Inspections: Additional Info: Inspection Type: Classification:Residential Review Electrical Scanning:3 Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $15.00 Invoice# EL-4-15-55320 DBPR Fee $13.13 04/24/2015 Credit Card $50.00 $900.26 DCA Fee $13.13 Education Surcharge $5.00 04/28/2015 Credit Card $900.26 $0.00 Permit Fee-Additions/Alterations $875.00 Scanning Fee $9.00 Technology Fee $20.00 Total: $950.26 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 1 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,DOORS,ROOFING and SWIMMING POOL work. OWNERS 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. Futhermore,I author bove-named contractor to do the work stated. .. April 28,2015 Authorize ' nature:Owner / Applicant / Contractor / Agent Date Buildinii6lepartment Copy April 28,2015 1 Miami Shores Village �D Building e art ent APR 24 2015 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 BY: INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 2® 10 BUILDING Master Permit No. /2C- Al- /S- 933 PERMIT APPLICATION Sub Permit No.E/ / P ❑BUILDING ® ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS [:] CHANGE OF ❑CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 652 N. E. 105 St. City: Miami Shores County: Miami Dade Zip: 33138 Folio/Parcel#: 11-2231-012-0140 Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): Kiluan, Inc. Phone#: Address: 652 N.E. 105 St. City: Miami Shores state: Florida Zip: 33138 Tenant/Lessee Name: N/A Phone#: Email: CONTRACTOR:Company Name: Cassia Electric Phone#: (954)650-5840 Address: 8261 N.W.48 St. city: Lauderhill State: Florida Zip: 33351 Qualifier Name: Glenworth Walker Phone#: (954)650-5840 State Certification or Registration#: EC 13005907 Certificate of Competency#: DESIGNER:Architect/Engineer: A$ I Associates Phone#:(305)310-5030 Address: 370 N.E. 101 St. city:Miami Shores State:Fl. Zip: 33138 Value of Work for this Permit:$�{'i �er0 Square/Linear Footage of Work: Type of work: ❑ Addition ❑X Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: Install new panel, relocate panel and install switches, lighting and outlets as per plan Specify color of color threw tile: Submittal Fee$ Permit Fee$ rte CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ 03 !do (Revised02/24/2014) Bonding Company's Name(if applicable) N/A Bonding Company's Address City State Zip Mortgage Lender's Name(if applicable) N/A 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. Marco Bru i ( Director Kiluan, Inc) Glen Walker(Qualifier) Signature Signature OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of nQri l 20 15 by e) day of •20 IS- by who is personally known to G4fflUJ0y-411 L Maley, 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. �'" "`° LUCIA G ISASI •�' ft NOTARY PUBLIC: /'°s:-""`•.�� NOTARY PUBLIC: ��. ",t, LUCIA G ISAS1 ;� MY COMMISSION#FF182628 '• •£ MY COMMISSION#FF182626 1n9•.. ;fid O` EXPIRES December 10,2018 'i°� ' OP ?a„he '' EXPIRES December 10,2018 Sign: wir9e ots3 Florldallotaryservtce.com Sign: (40 39"163 FlortdallotaryService.com Print: LOG Print: Seal: Seal: �x�x�xrn��s+��a�sxxsa��ssaau»��,�eaex+��+as��+c�+ux.�a�x�a�a��a�ffi�xx�xcsuas.wrasw�a+aas�a�st�xa��stae,�aama�sr.�.��xa++�sx+�&n� APPROVED BY .1/407? ' Plans Examiner Zoning Structural Review Clerk (Revisedo2/24/2014) Fax:(305)756-8872 Aco 'TE 110111IMN" CERTIFICATE OF LIABILITY INSURANCE °0312S/20i6 �,• THIS CERTIFICATE le ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CEiRTIFICATE HOLOER.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 certficate holder Is an ADDITIONAL INSURED,the poliey(iss)must he endorsed. n SURR CATION 18 WAIVED,subject to the terms and conditions of the policy,canain policies may require an endorsement. A statement on this sertiftcate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER CONTACT Lisa TuUxh LaPlante Agency PHONE (r27)79s-e60e u N •f127 791-td/z 2715 State Rd 580 ADOLEIIS, lisa®laplantetttgencxcom Clearwater,FL 33761 iNeuRERe AFFORDINSCOVERAOE N e License#:A149680 019URERA: North Pointe Coinpany INWRm Cassia Electrical Contractors Inc INSYMA: Normandy Har4giLI fsurance Company INSU 8261 NW 48th St R and Glen Walker INSURER 0:0 D --- Lauderhill,FL 33351 INEURERE; INSURER F: COVERAGES CERTIFICATE NUMBER: 00000697-2714256 REVISION NUMBER: 294 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANOINO ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUME:NY WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCES 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. 0L4SR TYPE OF INSURANCE A POLICY NUMBER PSUML! LIMITS TR A GENERAL LIABILITY 3094110169 07PM014 07129/2015 EACH OCCURKNCG a 11000,000 X COMMEACLALGENERALLIABILSY E s 100.000 gAIRAg NAGE QOCCUR MEDNnyo x oermn) s 5,000 PERSOo L A AOV WJURY S 1,000,000 GENERAL AGGREGATE s 2,000,000 GEN1Ac,GREGATELAUTAPPLIES PER: PRODUCTS-COMPIOPAGO S 2,000,000 X POLICY f — LOC I S COMSINFOMOLE W AUTOMOBILE UAHUM I „ _ ANY AUTO BODILY INJURY(Pet Pelson) s ALL OWNEDeCHEOULED I MMY INJURY(Per arddael) S AUTOS NON-pVNJEO I PRDPE. D S HIRED AUTOS AUTO$ 6 UMBREL.IALMOCCUR I EACH OCCURRENCE S EXCESS IJAII CLAIM :—EI AGaREGATE 5 Om R NS �-11 S WORKERS COMPENSATION B ,NHFI.0021902015 03125/2ots 03/28rzo1B X AND EAIPLDYEWLLAeILm YIN ANY PROPRIETORIPARTNERfMCImVE EACH ACCIDENT s 1,000,000 FFICEI RIM FM13 M EXCLUIUM ® NIA E.L.(MmIDISEASE-EA EMPLOYEE S 1,000 OOO IfYe'd06P'* 0H6CRIPTI OF OPE IONS betty DESCRIPTION OF OPERATIONS/LOrAMONS I V9111 ¢S IAttaoh ACORD SOL Addlea.u1 Raaars Schedule.If •P•d Is FAWM01 Electrical Contractor#ER13013013 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WALL BE DEUVERED IN Miami Shores Village ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE 2nd Ave Miami Shores,FL 33138 AUMMIEDREPRUU AnVE L 0 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 26(2010105) The ACORD name and logo are registered marks of ACORD Printed by LMT on March 25,2015 at 11:04AM