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EL-16-292 Z (- 16 . - Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores,FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-253882 Permit Number: EL-2-16-292 Scheduled Inspection Date: March 03,2016 Permit Type: Electrical- Residen 'al Inspector: Devaney,Michael Inspection Type: ugh Owner: HARKRADER,EDWARD Work Classification: AI tion Job Address:806 NE 97 Street Miami Shores, FL Phone Number Parcel Number 1132060142760 Project: <NONE> Contractor: GR ELECTRICAL SERVICE INC Phone: (305)864-8885 Building Department Comments KITCHEN OUTLETS AND LIGHTING Infractio Passed Comments INSPECTOR COMMENTS False Inspector Comments Passed G � Failed Correction Needed Re-Inspection Fee No Additional Inspections can be scheduled until re-inspection fee is paid March 02,2016 For Inspections please call: (305)762-4949 Page 44 of 44 I 4 Miami Shores Village 10050 N.E.2nd Avenue NE Miami Shores,FL 33138-0000 Phone: (305)795-2204711 ` y �ttm ll'I i Expiration: 07/2016 Pro ect Address Parcel Number 1 be Applicant Cant 806 NE 97 Street 11320601427 60 EDWARD HARKRADER Miami Shores, FL Block: Lot: Owner Information Address Phone Cell EDWARD HARKRADER 806 NE 97 ST MIAMI SHORES FL 33138-2628 Contractor(s) Phone Cell Phone Valuation: $ 1,500.00 GR ELECTRICAL SERVICE INC (305)864-8885 Total Sq Feet: 0 Type of Work:KITCHEN OUTLETS AND LIGHTING Available Inspections: Additional Info: Inspection Type: Classification:Residential Review Electrical Scanning:1 Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $1.20 Invoice# EL-2-16-58541 DBPR Fee $2.25 DCA Fee $2.25 02/09/2016 Credit Card $165.70 $0.00 Education Surcharge $0.40 Notary Fee $5.00 Permit Fee-Additions/Alterations $150.00 Scanning Fee $3.00 Technology Fee $1.60 Total: $165.70 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,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 andzonF herho' e the above-named contractor to do the work stated. more� February 09,2016 Authorized Signature:Owner / Applicant / Contractor / Agent Date Building Department Copy February 09,2016 1 Miami Shores Village Building Department FEB 2 20 s 10050 N.E.2nd Avenue,Miami Shores,Florida 3313846 Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 20 (1 -t� - T, .. BUILDING Master Permit No. 2L Jho- :�Ij3 PERMIT APPLICATION Sub Permit No. t-7.L i(-O/--q ❑BUILDING 0K ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION W RENEWAL ❑PLUMBING ❑ MECHANICAL [:]PUBLICWORKS CHANGE OF ❑CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS Ab JOB ADDRESS: Tf°V 6 City: Miami Shores County: Miami Dade Zip: 3313 Folio/Parcel#: /—d� f �1—� ®14 a V Is the Building Historically Designated:Yes NO Occupancy Type: _Load: Construction Type: _Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): E M Ul A4'IZ.) C 8A)Z P_A SUR Phone#: -; 1?6'- -;2,4 6`aid 0 Address: s046 /9 E q4 5,f - city: AA i& til,i 15'� ILP State: E L Zip: -33 1315 Tenant/Lessee Name: Phone#: Email: //�� CONTRACTOR:CompanyName: 9 A t Q EeaAj � 1 �iS5 Phone#: -4 04 -3 6a -S� Address: ,..4',�f LZ) City: /I✓ AA State: Zip: 3 3 e/ �L qualifier Name: i5kTMi u 66MX-1Z Phone#: �' -30!�a 967 State Certification or Registration#:FL 1300),ac I Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ ( Square/Linear Footage of Work: tU Type of Work: ❑ Addition ❑ Alteration ❑ New _ ® Repair/Replace ❑ Demolition Description of Work: 1 ' x)/J- p CSC C� Q c Specify color of color thru tile: /gyp Submittal Fee$ 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$ t_(OS•90 (Rev1sed02/24/2014) r, 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$2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also,a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. B Signature Signature OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged befor me this 02, day of 20 ,by �—day of �Z 20 �� .by AS2� I o is personally known to I"�udho is 1perrsonal(ly known too me or who has produced T--k- Wl� �s me or who has produced U` — LyEIa�' identification and who did take an oath. identification and who did take an oath. NOTARY PULI : NOTARY PUBLIC: Sign: Sign: Print: ' h`--v��"` Print: Seal: , Seal:M* s. ary Public Stats of Florida coo os Notary Public State of Florida`�' Sindia Alvarez dia Alvarez Commission FF 156750 c� My Commission FF 156750 ires 09/0312018 . Expires 09/03/2018 ###****i I * # # # # * **#*##****######## APPROVED BY86k `�j� fpm/1® Plans Examiner Zoning Structural Review Clerk (RevisedOZ/24/2014) •t *a STATE 'OF FLORIDA: DEPARTMIUSINESS AND M PROFE aULATION t .. ;PrP EC 13007301. - a2L07/ 015 CERTIFIED E ' Y` � Y�( " OR �a „a, A G 011�EZ, ALEJ�$ f�� -GR ELECTRICS •• r^ _ ..•. ��3,.I,y"p�yv Ar'L"Re.^y3 f - y moi. GfRTIFI,E❑ untler the.. ro,its.iorr9 of Cfi,.4`&9.FS. Ex >t�n datq AUS 31,20 6L1512070000498 pa AC# 01327118 s SIGNATURE __--- ------ ---------------------- ----------------_ _ ----------- M:�Imi f ad$Co .104 of;Pionda TMI$i&ItdTAt3ki::`6 NQ7,'PAY: 8543475:= ;BU SIME33 NAta ESI OC ' 'EX,RSC€1r�r tao. E�C AI R ES C3R QEC`I'RICALRiICES ING RENEWAL ��waw 8a 14Q74 SEP7EIWB€k 30; MALF.1�t i,F°L 1 +��+at t�afs ayea at 00*01 oust► ,as <` Puraulant't¢tountY i;:dde Ch ,Ba Art 8 >�0 OWNER SEC.TYPE OF BUSINESS GREpAYM EN7 RECEIVED, W, TRICALSEI�VICES INC 198 ;'! ELECTRiCi t. BY TAX COLLECTOR* CONTRACTOR " 45.0007/061201.5" Work@r(s) 1 09EOW03 D235-15- 279 ThislaceFSuainesaTBc♦ IPt0dycc4.i"spWMtdthmLw Bfl rmsTwL-ftF xdptisnotalioenspe Pmtoraae tl"caticnW ie#idders il' �sdotl�it�esaHaldermat cmvoywithW* a reiY(aasand regldtrovjjl>ch applymthet�neas n>Bt�er�Naagmust a®diapla�ed�i�I oodai wr,tees-ae�nl�de a�aeseas�ua Fct7morei►�Iblraiatlan.visit ' ' M,Onicipain# #or's Tex Receipt :":Mraml�Dade Crunt�r�Sfate df.Florida TFItS;iS A107 Jk;131li, 0t2;NOT PAY' . CC"N.O 09EM703 t�MAI�L�CATIQM :: R�EIPT Mo. �R�Ct'h1CAl.:SERStIEkS IAK � �P�`E.� s�7i wsw, ` Taeaaia�7 SEFTEAABE11t 30, X16 ftfmant to county Sea 10—M OWNER TYPE OF BUSIME" GR ELECTRICAL SERVICES INC ELECTRICAL CONTRACTOR PAYME10T RECEIVED BY TAX COLLECTOR 200.00 07/06/2015 0235-15-005279 lRlFsmDdPis aeat"M is bre LoIbNing tl>UIpalitM kmWxe,UomL WAnk Key Bim. WNW AWdeM**lakm Patau Bay,Pft8=mW6 SWW bbs Beack Tom of Cater Bay. Frlrmmewomilmvm CERTIFICATE OF LIABILITY INSURANCE DA7E( D/YYYY) 011/25/25/16 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: K the certificate holder Is an ADDITIONAL INSURED,the policypes)must be endorsed. If SUBROGATION IS WANED,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 endorsement(s). PRODUCER CONTACT N Kjv Insurance Agency Po e 2652 SW 87th Ave L (305)227-8956 Fnrc No): (305)227$961 juanitaaau@yahoo.com Miami,FL 33165 INSURERS)AFFORDING COVERAGE NAIC e Phone (305)227-8956 Fax (305)227-8961 INSURER A: ASCENDANT COMMERCIAL INSURANCE INSURED INSURER B: Lloyd's OF LONDON GR ELECTRICAL SERVICES,INC INSURER C: ASCENDANT COMMERCIAL INSURANCE 14819 SW 176 St INSURER D: GUARD Miami,FL 33187- (786)447.4318 INSURER E: INSURER C. 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. INSR LTR TYPE OF INSURANCE ADD BR POLICY NUMBER M EFF N�EXP LIMITS GENERAL LIABILITY -- EACH OCCURRENCE $ 1,000,000.00 COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Ea occurrence $ 100,000.00 01/27!2016 01/27/2017 A El El cLAIMsaAt/►DE © occuR y y ESINHI MED EXP(Ary one person) $ 5,000.00 ❑ PERSONAL&ADV INJURY $ 1,000,000.00 ❑ GENERAL AGGREGATE $ 2,000,000.00 GEN L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG $ 2,000,000.00 ©POLICY SECT ❑ LOC $ AUTOMOBILE LIABILITY �MBINED SINGLE LIMB 1,000,000.00 Q ANY AUTO BODILY INJURY(Per person) $ B ❑ ALL OWNED O AUTOS SUTOSCHEDULED y CA-31291-1 12/26/2015 12/26/2016 BODILY INJURY PeraccideMl $ Q HIRED AUTOS ❑ AUTOS ED FRO, �nt AMAGE $ COM 1000 Q COLL 1000FVJ PIP $ 10,000.00 UMBRELLA LIAR ❑OCCUR TMAPJVD EACH OCCURRENCE $ 3,000,ODO.00 C ❑ EXCESS uAe ❑CLAIMS-MADE Y 02/19/2016 02/19/2017 AGGREGATE $ 3,000,000.00 ❑ DED ® RETENTIONS 10,000.00 $ WORKERS COMPENSATION Y/N WC STATU ❑OTH- ER EMPLOYERV LIABILITY IVE D OFFICERIMEMBER PEXC EXCLUDED?ECS NIA A y GRWC64774 E.L.EACH ACCIDENT $ 500,000.00 I,N a 03/03/2016 03/03/2017 yyeess E.L.DISEASE-EA EMPLOYEE$ 500,000.00 DESdRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S 500,000.00 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,H more space is required) Electrical Services(Commercial,Residential&Industrial Works) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED LICI BE CANCELLED BEFORE Additional Insured: THE EXPIRATION DATE THEREOF,NOTICE LL DELIVERED IN Miami Shores Village ACCORDANCE WITH THE POLICY PROVISI N Building Departement AUTHORIZED REPRESENTATIVE 10050 NE 2nd Ave Miami Shores,Fl.33128 ©1988-2010 ACORD C RATION. All rights reserved. ACORD 25(2010/OS)QF The ACORD name and logo are registered marks of ACORD