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EL-15-1489 �2C � , 1 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-253189 Permit Number: EL-6-15-1489 Scheduled Inspection Date: February 19, 2016 Permit Type: Electrical - Residential Inspector: Devaney, Michael Inspection Type: Final Owner: TAVARES,TIERES Work Classification: Service Change Job Address: 10050 NE 12 Avenue Miami Shores, FL Phone Number (305)244-2356 Parcel Number 1132050190370 Project: <NONE> Contractor: ALES GROUP ELECTRICAL CONTRACTORS Phone: (305)219-4806 Building Department Comments SERVICE CHANGE Infractio Passed Comments INSPECTOR COMMENTS False Inspector Comments Passed Eq_ Failed Correction Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid February 18,2016 For Inspections please call: (305)762-4949 Page 32 �I�IME 1• 3} Miami Shores Village N t�T?3li37 Eit'> i,C Resi+ enti� 10050 N.E.2nd Avenue NE •��j�{�� yB" k��W y� }{/) /til NIH # R..C9f �I�G {Fk4 [Y Miami Shores,FL 33138-0000 t € Phone: (305)795-2204 �31�7tP � ` •. FLORLOI+ is a Expiration: 15/2015A ( 0120 Project Address Parcel Number Applicant 10050 NE 12 Avenue 1132050190370 BEYOND ALL REVOCABLE TRU Miami Shores, FL Block: Lot: Owner Information Address Phone Cell BEYOND ALL REVOCABLE TRUST 10050 NE 12 Avenue (305)244-2356 (786)709-3909 - --- - --- MIAMI SHORES FL 33138- 10050 NE 12 Avenue MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone Valuation: $ 2,000.00 ALES GROUP ELECTRICAL CONTRAll (786)244-0004 Total Sq Feet: 00 Type of Work:SERVICE CHANGE Available Inspections: Additional Info: Inspection Type: Classification:Residential Review Electrical Scanning:3 Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $1.20 Invoice# EL-6-15-56005 DBPR Fee $2.25 06/18/2015 Credit Card $ 121.70 $50.00 DCA Fee $2.25 Education Surcharge $0.40 06/17/2015 Credit Card $50.00 $0.00 Notary Fee $5.00 Permit Fee-Additions/Alterations $150.00 Scanning Fee $9.00 Technology Fee $1.60 Total: $171.70 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 fore oing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zo ' g. Futhermore,I author' a th above-named contractor to do the work stated. c June 18, 2015 Autho ed natur caner Applicant / Contractor / Agent Date Building Department Copy June 18,2015 1 Miami Shores Village AN 1.7 2.015 Building Department s . 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 /p BUILDING Master Permit No&'/__/Z/� PERMIT APPLICATION Sub Permit ❑BUILDING ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS CHANGE OF ❑ CANCELLATION ❑ SHOP p CONTRACTOR DRAWINGS / JOB ADDRESS: D®7 City: Miami Shores County: Miami Dade Zia: Folio/Parcel#: Is the Building Historically Designated:Yes NO Occupancy Type: Load: .��Construction Type:/ / Flood Zone: ,t BFE: ` FFF,E: OWNER:Name(Fee Simple Titleholder): /jq,�f��j /'l f&ej8L Af— �Ph n��(� 7C —39170 Address: 00Jo xile 12X05 /� >2 City: �f l/�/ -S 0�L� State: FZ�t;7,-/a4 Zip: Tenant/Lessee Name: Phone#: Email: / / o CONTRACTOR:Company Name:A_6a CSCR coal Phone#: 7g6 -2-�SJ G 6 7f, Address: S 9G -Sit) Z O ALI(L- City: L4�f State: FZ_ Zip: Qualifier Name: Phone#: 7 S 7760 7 C �6 State Certification or Registration#: z 99 Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value oo#�iltorkQ�th)a Perts�t:$ Square/Linear Footage of Work:no yttork 7 ❑ Addition Alteration ❑ New ❑ Repair/Replace ❑ Demolition Specify color of color thru tile: Submittal Fee _ Permit Fee$ �'C®/0 CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ (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 certified copy of the recorded notice of commencement must be posted at the job site for the first inspectio hich occur seven (7), 7) days after the building permit is issued. In the absence of such posted notice, the inspection will not a approved a a reinspection fee will be charged. r 4 Signature t / Signature L s OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this . day of 20��by o day of '(fes-� 20 by /ere<- /bJQJ��Cwho is//personally known to &VwOV) bw-L—U .wh is persona known to me or who has produced C�- as me or who has produced as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: S' Sign Print: Print: �✓�' lr-(r�i r Sea Watery Public State of F1orlda Seal: IONJoanna M FeNdI10adzqADRUJVA aIRARDI My Commiatslan FF 082783 *__ MY COMMISSION#EE 867174 yT Erpina01N2P1018 ( ';. a` EXPIRES:January 22,2017 Borded Thru Notary Public..... riters f� j-2 - APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) ACORO® DATE(MMIDDNYYY) �_. CERTIFICATE OF LIABILITY INSURANCE 6/9/2015 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 policy(les)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 Ileu of such endorsement(s). CONTAPRODUCER SUNZ Insurance Solutions, LLC. ID: TLR NAME: Aimee Gra c/o TLR of Bonita, Inc PHONE : 727-520-7676 x 222 FAc No: 727-525-3862 700 Central Ave Suite 500 EMAIL St. Petersburg, �L 33701 ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC 2 INSURERA: SUNZ Insurance Company 34762 1NSURTLR of Bonita, Inc dba EnterpriseHR INsuRERB: Aspen Re-London-Best Rating"A" Encore Business Solutions, Inc INSURER : Catlin Syndicate-Lloyds-Best Rating"A" and its Subsidiaries INSURERD: Brit Syndicate-Lloyds-Best Rating"A" 700 Central Ave Suite 500 INSURERE: St. Petersburg�t 33701 INSURER F COVERAGES CERTIFICATE NUMBER: 25019616 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, EXCLUSIONSAND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAYHAVE BEEN REDUCED BY PAID CLAIMS. INSR 7ypE OF INSURANCE POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER MIDD MIDD COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE r-1OCCURAlN D PREMISES Ea occurrence $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ POLICY F—]jECT 1-1 LOC PRODUCTS-COMP/OP AGG $ OTHER. $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNEDSCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS HIRED AUTOS NON-OWNED PROPERTYDAMAGE $ AUTOS Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESSLIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ 1 $ A WORKERS COMPENSATION WCPE0000000111 6/1/2015 6/1/2016 �/ STATUTE �RH- AND EMPLOYERS'LIABILITY YIN WCPE00000001 10 6/12014 6/1/2015 ANY PROPRIETOR/PARTNER/EXECUTIVEE.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBEREXCLUDED? ❑N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 B Workers Compensation This is for informational purposes C Excess Coverage and nothing shall create any right D under such reinsurance. DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Coverage Provided for all leased employees but not subcontractors of.Ales Group, Inc. Client Effective:6202014 dba Ales Group Electrical Contractors CERTIFICATE HOLDER CANCELLATION 7790 Miami Shore Village Building Dept. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Miami h 2nd g p THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Miami Shores Ave.A 33138 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Glen J Distefano O 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD 25019616 1 Master Certificate I Airoee Cray 1 6/9/2015 2:C4:34 PM (CCT) I Page 1 of 1