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EL-15-2941 Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores,FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-255989 Permit Number: EL-11-15-2941 Scheduled Inspection Date:April 04,2016 Permit Type: Electrical- Residential Inspector. Devaney,Michael Inspection Type: Final Owner. , Work Classification: Alteration Job Address:137 NW 107 Street Miami Shores,FL 33168- Phone Number (786)444-2945 Parcel Number 1121360100130 Project <NONE> Contractor ALL PHASE ELECTRIC CORP Phone:306445-6480 Building Department Comments INTERIOR REMODEL REPLACING SWITCHES FROM infractlo Passed Comments THE KITCHEN BATHROOM AND THE ENTIRE HOUSE INSPECTOR COMMENTS False Inspector Comments Passed CREATED AS REINSPECTION FOR INSP 255838. CREATED AS E�r REINSPECTION FOR INSP 255698.Add arc fault protection and disconnect for A C C U. Failed Correction Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid April 01,2016 For Inspections please call: (305)762.4949 Page 23 of 36 Mar 2816 04:00p E&C Luxury Homes,LLC t s-- ns (// 7867012759 p.1 .a►co�ry CERTIFICATE OF LIABILITY INSURANCE °A °e' THIS COMFICATE.IS ISSUED AS A mATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NL43ATPJELY 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: II the certificate holder Is on ADDITIONAL.INSURED,the policy(fes)must be endorsed. ff SUBROGATION IS WAIVED,subject to the terms and eondwOns Of the POLICY,certain PcllcfBs may require an endorsement. A statement on this cerElflcate does not confer ruts to the 00ftMicate holder in lieu of such andonsenuwagq Orlando Danes SOUTHWESTERN INSURANCE SERVICES,INC PHONE 305-556-7399 305-556-5468 4375 PALM AVE cel Ifficates(ftouthwestemins com HIAL>=AH,FL 33012 Bi$URER AFFORDM COVERAGE NAI* INSURED -INSURERA:ASCENDANT INSURANCE COMP URERB:PROGRESSIVE EXPRESS INSURANCE 10193 ALL PHASE ELECTRIC CORP 11899 NW 91 AVE BAY E mWotc:NORMANDY HARVOR INS CO WSII D: BiBt/R E HIALEAH GARDENS FL 33018 role g COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE SEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REOUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY SE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POUCIES DESCWBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POUCIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. 71-EXCLUSIONS , TR• TYPIEOFgdSIIRANCE ; LM" X I COMERCIAL GENERA.LIABILITY 1 EACH OCCURRENCE s 1.000,000 EIAS CLA •MADE �X oCcwi GL41401-3 01/23/16 01/23117 A s s 100,000 $500 DED MED EXP An one ereon S 51000 PERSONAL&ADVMURY $ 1,000,000 OENL!UGGRE(3ATEL9�AITA uESPER GENERAL AGGREGATE $ 2,000000 POLCY PRo- , OTHER- AUTOMOBILE ❑'� ❑LOc PrzoDucTs-COMPJOPIK3O s 1,000,000 AUTOMOBILE UAMUTY $ C ALrr1O accdan31C3L LIMIT s 1,0w,000 B A�OVd@ED qX HEDIA Ep 08314488-4 11/09/15 04�8/i 6 BODILY 1WURY(Per pesen) ,$ AUTOS EtOOILY INJURY(Per eoci-eng s HIREDAUT08NASO. II D PIP$10.000 WORE"LAe 'OCCUR ' $ EXCESS LIAR CLA004EAppEACH OCCURRENCE $ AGGSREOATE $ D 10 :WORKERS CONPENBATION S `. 1ANDENIPLOYMIUANUTY Y/NT ANY 5ROPR*ETOFW- ARTNeRrexECurn,e NHFL00342,42016 03103/16 03/03!17 5 OFFICERA4EMBEREXCLUOFX)? N/A E.LEACNACCIDENT $ 500,000 (Y� NH} E L D18EASE-Fn ENAPLOYE $ 500,000 DES dwadbe ndm N I E L DISEASE-POUCY LIMIT s 500.000 DESCRIPTION OF OPERATORS/LOCATIONS/VEHICLES(ACORD 1=.AddW..W Remaoim 8obed,de,rimy be eriaelsed Uaoore Nt apace requ6red) EC13003152 CERTIFICATE HOLDER CANCELLATION Miami Shores Village Building Department SHOULD ANY OF THE ABOVE DESCRIBED POLICIES 1312 CANCO"' BEFORE THE EXPIRATION DATE THEREOF, NOTICE: WILL 10 DELIVERED IN 10050 NE 2nd Avenue ACCORDANCE WITH THE POLICY PROVISIONS. Miami Shores, FL 33138 AUTHOR=ED REPRESENTATIVE ACORD 25 ®1888-2013 ACORD CORPORATWN. All rights regw ed. "4) The ACORD name and 1090 etre registered ftlarks of ACORD DATE(MWDDIYYYY) .4coira� CERTIFICATE OF LIABILITY INSURANCE 01/28/2016 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 pol(cy(ies)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 in lieu of such endorsement(s). ODUCERT Orlando Llanes NAME SOUTHWESTERN INSURANCE SERVICES, INC PHONE 305-556-7399 No:305-556-5469 4375 PALM AVE ��: certificates@>southwestemins.com HIALEAH,FL 33012 INSURER(S)AFFORDING COVERAGE MAIC# INSUItERA:ASCENDANT INSURANCE COMP INSURED INsuRERB:PROGRESSIVE EXPRESS INSURANCE 10193 ALL PHASE ELECTRIC CORP INsuPmc:NORMANDY HARVOR INS CO 11899 NW 91 AVE BAY E INSURER D: HIALEAH GARDENS FL 33018 INSURER EINSURER F: I J 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 ADDL SU13R POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER fMMIDDFYYYYI (MM0OfYYYYILIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1+0Wr0W CLAIMS-MADE FX OCCUR GL41401-3 01/23/16 01/23/17 DAMAGE TRE 100,000 A PREMISES Ea occurrence $ MED EXP(Any one person) $ 5,000 $500 DED PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY E JEa LOC PRODUCTS-COMPIOP AGG $ 1'wo'wo OTHER: $ AUTOMOBILE LIABILITY (CEO, ddentMBINED SINGLE LIMIT $ 1,000,000 ac ANY AUTO BODILY INJURY(Per person) $ B ALL AUTOS ED X SCHEDULED 08314488-4 11/09/15 11/09/16 BODILY INJURY(Per acddent) $ NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per ec dent X PIP$10,000 $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYELIABILITY STATUTE ER C RS'ANY PROPRIETORIPARTNERIEXECUTIVE YIN NHFL0034242015 03/03/15 03/03/16 E.L.EACH ACCIDENT $ 500,000 OFFICERIMEMBER EXCLUDED? ❑Y N I A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yyeess describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Addiflanal Remarks Schedule,may be attached H more space is required) EC13003152 CERTIFICATE HOLDER CANCELLATION Miami Shores Village SHO Building Department THE EXPIRATION LD ANYEXPIRATION DATE THEREOF,OF THE ABOVE NOTICE POLICIES WILL CBECDELIVEED ELLED RN 10050 NE 2nd Avenue ACCORDANCE WITH THE POLICY PROVISIONS. Miami Shores, FL 33138 AUTHORIZED REPRESENTATIVE ©1988-2013 ACORD CORPORATION. All rights reserved. ACORD 25(2013/04) The ACORD name and logo are registered marks of ACORD \ ,. a/�-\ �1 � f ,�-- Miami Shores Village ., 10050 N.E.2nd Avenue NW «� Miami Shores FL 33138-0000 Phone: (305)795-2204 expiration:- 0512121 � Pro ject Address Parcel Number Applicant 137 NW 107 Street 1121360100130 JCAS FUND CORP Miami Shores, FL 33168- Block: Lot: Owner Information Address Phone Cell JCAS FUND CORP 5600 SW 135 Street (786)444-2945 FL Contractor(s) Phone Cell Phone Valuation: $ 680.00 ALL PHASE ELECTRIC CORP 305-345-6480 Total Sq Feet: 00 Type of Work:INTERIOR REMODEL REPLACING SWITCHES Available Inspections: Additional Info: Inspection�� Type: Classification:Residential Review Electrical Scanning:3 Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $0.60 DBPR Fee InVOice# EL-1415.57843 x'38 12/01/2015 Check#:1018 $242.36 $0.00 DCA Fee $3.38 Education Surcharge $0.20 Permit Fee-Additions/Alterations $225.00 Scanning Fee $9.00 Technology Fee $0.80 Total: $242.36 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,R and SWIMMING POOL work. OWNERS AFFIDAVIT: I certify that all the foregoing information is rate a all work will be done in compliance with all applicable laws regulating construction and zoning. Futhemtore,I authorize the above-nam ntractor :?work stated. ecember 01,2016 Authorized Signature:Owner / Applicant / Contra Date Building Department Copy December 01,2015 1 Miami Shores Village RECEMED Building Department NOVI0 2015 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 BY: Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(30S)762-4949 FBC 201 7 BUILDING Master Permit No %�� PERMIT APPLICATION Sub Permit No. �-/ ❑BUILDINGECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP {{ii ,,.. �tt !!�� CONTRACTOR DRAWINGS JOB ADDRESS: 13#1 ivw V S7 - City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: � /F(FjE: OWNER: ame(Fee Simple T eholder): Phone#:I Da (�-t �t'"► 2ci!�� Address: y City: SD J4ate: Zip: C t� �-- Tenanessee Name: Phone#: Email 'C CD k-cMk' it �^-%. CONTRACTOR:Company Name: D'Acts0S f ftll tt'C -�Q-7!t Phone#:010- c.1 CFS?.A KSr— Address• City: t�1 1' (� State: Zip: 3 71 [,tt Qualifier'Name: - Phone#: `t 7_5 Y•h"— State Certification or Registration �32 Q Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for-this Perrnk $ Square/Linear Footage of Work: Type of Work: ElAddition Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: �....E o ; Specify color of color thru tile: Submittal Fee$ Permit Fee$ ZZS,®d > S C$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ c -�� ^ .fie (Revised02/24/2014) 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 theabsence of ch posted notice, the inspection will not b approved and a reinspection fee will be charged., Signature u• Signatur • OWNER or AGENT • CO RA OR The foregoing instrument was acknowledged before me this The f regoing instrument was acknowledged before me this day Woo • of by 1® ✓day of V' ,20 by a� �• Q.4*ciro ,who i ersonally known t ry who' personally kno n to me or who has produced as me or who has produced as identification and who did take an oath. identificatio dtake an oath. `•C�� NOTARY P NOTARY HEIDY CERTAIN • ° r Notary Public_State of Florida 's My Sign: �° HEI N Sign: 00i mmission#EE 84 • - Priv o a e of Florida C =040Print: �;;.�° Commissi #on EE 1 10251 Seal: Seal: APPROVED BY Ai—NvL7J`—PIans Examiner Zoning Structural Review Clerk (Revised02/24/2014)