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EL-14-1430 Inspection Worksheet Shores 10050 N.E.'2 d' Village Avenue Miami Shores, FL l LI — Phone: (305)795-2204 Fax: (305)756.8972 Inspection Number: INSP-255829 Permit Number: EL-7-14-1430 Scheduled Inspection Date: March 30,2016 Permit Type: Electrical- Residential Inspector: Devaney, Michael Inspection Type: Final Owner: COHEN, DEDE Work Classification: Alteration Job Address:571 NW 112 Street Miami Shores,FL 33138- Phone Number (305)510-4646 Parcel Number 3021360210940 Project <NONE> Contractor: ALL PHASE ELECTRIC CORP Phone: 305-345-6480 Building Department Comments CHANGE OF ELECTRICAL PANEL NEW WATER HEATER Infractio Passed Comments NEW KITCHEN UPGRADE ALL SWITCHES AND OUTLET INSPECTOR COMMENTS False Inspector Comments Passed E/ Failed Correction Needed / T Re-Inspection Fee No Additional Inspections can be scheduled until re-Inspection fee is paid March 29,2016 For Inspections please call: (305)762.4949 Page 36 of 39 i • C EIVF:I� Miami Shores Village JUL 0 2 2014 Building DepartmentBY: 90050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel:(305)795.2204 Faz:(305)756.8972 INSPECTION'S PHONE NUMBER:(305)762.4949 FBC 20 BUILDING Permit No. 17 DY-- IY30 PERMIT APPLICATION Master Permit NO.&, I!YOF Permit Type:Electrical JOB ADDRESS: 5 9 1 N W 117 ti77 City: Miami Shores County: - Miami Dade Zip: Folio/ParceW. Is the Building Historically Designated:Yes NO �� Flood Zone: OWNER:Name(Fee Simple Titleholder): �,C r)h 10- Address:!), t 1F CnIlCi P 2 �, City: qq 3 2Jv 1 tW bd State:EL- Zip:__1N sy Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name: &1( p tf.h5-f C+1L i C �OR FPhone#: —7Y6 Address: q 9 a/w Cf I A-V '� City: k t D L-Q, Q/I CAI V&-q-n/ State: Zip: ' O / Y Qualifier Name: f 0 o L, to!"7- (06 5 2_ State Certification or Registration# C C 13 0 0 11 5 Certificate of Competency#.- Contact :Contact Phone# Email Address: DESIGNER:AmItitect/Engineer Phone#: Value of Work for this Permit:$ SquardLinear Footage of Work: Type of Work: DAddress OAlteration l]New ORepair/Replace ODemolition mon of Work:Chcrx_�p o L v 2G "c-o i p©r n n Q k .n P x.l) cpc4ei �1-Pa(t✓ r �P Submittal Fee$ ..JS' Q•M Permit Fee$ A CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ jftnd$ Notary$. Training/F.dacathm Fee$ Technology Fee$ Double Fee$ Stractural Review$ l G C�a . 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 ELECTRICAL WORK,PLUMBING,SIGNS, 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 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 frost inspection which occurs seven (7) days after the building permit is issued In the absence of such posted notice, the inspection will not be approv,od 7and a reinspection fee will be charged Signature l/`� Sigriamria $1 Owner or Agent Contractor The foregoing instrument was acknowledged before me this The foregoing instrument was ac wledged before me this 1� day of Me 201 L4 ,by CO 40/- day of,LJ rNe ,20 h-A- by 'K--�Am who is personally known to me or who has produced who is personally known to me or who has produced As identification and who did take an oath as identification and who did take an oath. NOTARY LIC: NOTARY PUBLIC: CERTAIN H Sign: .-'o` Florida gn; 'a' State 91 Fletid Print a--��'� o Erpn�s Oct 3.20th Print. 'Nl '� M Co 9�6Commiss1 MY Commissio Exfiras" My ************************************************************************************************************ APPROVED BY �'�L>��/ �1/Examiner Zoning Structural Review Clerk rn....:..ea anorm�ouoe..:,.�mnnuruvea..�r�nnnrowuue.,:..ea xncmn� 1 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION 'a ELECTRICAL CONTRACTORS LICENSING BOARD (850)487-1395 1940 NORTHN O ROE STREET TALLAHASSEE FL 32399-0783 LOPEZ, PEDRO LUIS ALL PHASE ELECTRIC CORP 1861 SW 4TH AVE MIAMI FL 33129 ........ Congratulationsi With this license you become one of the nearly y� ..... one million Floridians licensed by the Department of Business and Professional Regulation. Our professionals and businesses range STATE OF FLORIDA from architects to yacht brokers,from boxers to barbeque restaurants, DEPARTMIinNT OF BUSINESS AND and they keep Florida's economy strong. z PROFESSIq�ULATION I'' Every day we work to improve the way we do business in order to E 1.3003152 ,�. �: C �U�.`,,-,-08/06/2014 serve you better. For irtfomtation about our services,please log onto ` www.myfforidalicense.com. There you can find more information t CERTIFIED ELE�#tICACO1�ITk�AC�OR about our divisions and the regulations that impact you,subscribe l t}I'EZ,PEDRY initiatives. tIIS , to department newsletters and learn more about the Department's ALL ERASE ELRC; 51 .° Our mission at the Department is:License Efficiently,Regulate Fairly. We constantly strive to serve you better so that you can serve your customers. Thank you for doing business in Florida, CS,CERTIFIED under the.provisions of Ch.489 FS, and congratulations on your new license! '` Exp�atipn'ilske':,AUG3f;P0i8 u40805 ossa DETACH HERE RICK SCOTT,GOVERNOR KEN LAWSON,SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD EC134U3152 The ELECTRICAL CONTRACTOR ` Named below IS CERTIFIED Under the provisions of Chapter 489 FS: Expiration date: AUG 31,2016. M.. . o LOPEZ, PEDRO LUIS ALL PHASE ELECTRIC 4:fl� 1189,9 NW,91 AVE r BAYS � HIALEAH GARDENS FL 3311t3 V R • 3 �. ,PPE II M. MCI^&11%^4: MOM AV AGS OCni noon OV i MAI colt at E-1 ARQRAAtMA7l.`� 1 �.i5.iT'y»�i ,. d VPV F ? F N' K fQ' tier = i9 OVU�R S€C Bt�SNNE$$ IaVMENT R •EKED A! ASE ELECTR ,,gQRP 996 �� •C ELC-CI Rti; RY Tau COLaOTOR DRO LOPEZ NTR TOR 7a X1(1 0 8,"2014 x EC13t} �2 9rts} s- -14-007 i2 J6islsesilesaTaxMEM 9eiroipti000krieeess f 68beadal qaa catie�ddbowrHoaeppiy ttiima bd.. The i RO 68 ftod on an temmereial Ste6i Code Sec -vow Sam W ,A�l2t1 CERTIFICATE OF LIABILITY INSURANCED06,'MMMD 4 PRODUCER 305-556-7399 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION SOUTHWESTERN INSURANCE SERVICES, INC ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 4375 PALM AVE ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. HIALEAH,FL 33012 FAX:305-556-5469 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURERA:ASCENDANT COMMERCIAL INSURANCE 10233 ALL PHASE ELECTRIC CORP INSURERS: PROGRESSIVE EXPRESS INSURANCE 10193 11899 NW 91 AVE BAY E INSURER c:ASCENDANT COMMERCIAL INSURANCE 10233 HIALEAH GARDENS FL 33018 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,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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR D POLICY EFFECTIVE POLICY EXPIRATION TYPE OF INSURANCE POLICY NUMBER LIMITS A GENERAL LIABILITY GL-41401-0 01/22/14 01/22/15 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTE11— X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ 100,000 CLAIMS MADE Fx-1 OCCUR MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 500 DED GENERAL AGGREGATE $ 2,000,000 GEWL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 1,000,000 POUCY PRO LOC B AUTOMOBILE LIABILITY 08314488-1 11/09/13 11/09/14 COMBINED SINGLE LIMIT $ 50,000 ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY X SCHEDULED AUTOS (Per Pe—) $ HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) X PIP 10,000 PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS I UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR F1 CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ C WORKERS COMPENSATION WC STATY_LIMLU- OTH- ANDEMPLOYERSIPART ER/ITY YIN WC-606872-0 02/27/14 02/27/15 ER ANY PROPRIETOR/PARTNERIEXECUTIVE E.L.EACH ACCIDENT $ 500,000 OFFICERIMEMBER EXCLUDED? Y-1 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEd$ 500,000 If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT 1$ 500,000 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS LIC #EC13003152 CERTIFICATE HOLDER CANCELLATION CITY OF MIAMI SHORES SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORETHE EXPIRATION 10050 NORTHEAST 2 AVE DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN MIAMI SHO RES, FL 33138 NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBUGAT10N OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25(2009/01) ©1988 2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD A� CERTIFICATE OF LIABILITY INSURANCE °01/29/2015 PRODYCER 305-556-7399 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION SOUTHWESTERN INSURANCE SERVICES, INC ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 4375 PALM AVE ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. HIALEAH, FL 33012 FAX:305-556-5469 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURERA. ASCENDANT COMMERCIAL INSURANCE 10233 ALL PHASE ELECTRIC CORP INSURER B: ASCENDANT COMMERCIAL INSURANCE 10233 11899 NW 91 AVE BAY E INSURER C: HIALEAH'GARDENS FL 33018 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,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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSRD POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION TYPE OF INSURANCEA GENERAL LIABILITY GL-41401-2 01/22/15 01/22/16 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ 100,000 CLAIMS MADE OCCUR MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 500 DED GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 1,000,000 POLICY PRO LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) $ HIRED AUTOS BODILY INJURY NON-OWNED AUTOS (Per accident) $ PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS I UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ B WORKERS COMPENSATION WC STATU OTH- ORY AND EMPLOYERS'LIABILITY Y/N WC-606872-0 02/27/14 02/27/15 _LM �ICERMIEMBERPAR EXCNERIEDED?ECUTIVE E.L.EACH ACCIDENT $ 500,000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION CITY OF MIAMI SHORES SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION 10050 NORTHEAST 2 AVE DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN MIAMI SHORES, FL 33138 NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25(2009/01) ©1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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 in lieu of such endorsement(s). DISCLAIMER This Certificate of Insurance does not constitute a contract between the issuing insurer(s),authorized representative or producer,and the certificate holder,nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25(2009101)