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EL-15-2554 -/Z1_3 Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-253187 Permit Number: EL-10-15-2554 Scheduled Inspection Date: February 19,2016 Permit Type: Electrical - Residential Inspector: Devaney, Michael Inspection Type: Final Owner: TAVARES,TIERES Work Classification: Low Voltage Job Address: 10050 NE 12 Avenue Miami Shores, FL Phone Number (305)244-2356 Parcel Number 1132050190370 Project: <NONE> Contractor: WATTS ELECTRIC INC Phone: 305-824-3722 Building Department Comments LOW VOLTAGE LIGHTING CONTROLS,2 TVS,4 Infractio Passed Comments CAMERAS AND WIRELESS INTERNET. INSPECTOR COMMENTS False Inspector Comments Passed Ef_ 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 30 of 35 k 'k Miami Shores Village Ptt E)BrIGr't) *� i6tn�i1 n 10050 N.E.2nd Avenue NE Miami Shores,FL 33138-0000 - te: �t71iJt�filu"=�1��E� Phone: (305)795-2204 '' Expiration: 04/06/2016 Project Address Parcel Number Applicant 10050 NE 12 Avenue 1132050190370 Miami Shores, FL Block: Lot: BEYOND ALL REVOCABLE TRU 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: $ 1,500.00 WATTS ELECTRIC INC 305-824-3722 Total Sq Feet: 0 Type of Work:LOW VOLTAGE LIGHTING CONTROLS,2 TV 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-10-15-57357 DBPR Fee $2.25 DCA Fee $2.25 10/09/2015 Credit Card $ 110.70 $50.00 Education Surcharge $0.40 10/08/2015 Credit Card $50.00 $0.00 Permit Fee-Additions/Alterations $150.00 Scanning Fee $3.00 Technology Fee $1.60 Total: $160.70 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 conform' 'th the plans,drawings,statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this perm i ume re onsibili for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for 1CFID,,AVIT- 'CAL, LLI ING,MEC ANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work. OWNERS Ice ify that II the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating constructionon' g. Futhermor ,I authorize the above-named contractor to do the work stated. October 09, 2015 Authori ed Signature: ner / Applicant / Contractor / Agent Date Building Department Copy October 09,2015 1 Miami Shores Village Building Department OCT 2015 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 2019 BUILDING Master Permit No. KC- 5-l5 1,213 PERMIT APPLICATION Sub Permit No.F_IS-- 2S S `j ❑BUILDING ® ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL [:]PUBLICWORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP .. II CO/N�TRACTOR DRAWINGS JOBADDRESS: /��o fl6 �- �. r'II 1 ivecs rL 3313;3 City: Miami Shores County: Miami Dade Zio: Folio/Parcel#: Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: —Flood Zone: BFE::/ FFE: OWNER:Name(Fee Simple Titleholder) 7aa� 4 OZ(a� 4Ye, 0/x'4, ( Phone#: - V& � 07 Address: 3'13 s &A- _ 7T p a'✓(- 9#2- City: & Iff t))'11,46,6 State: �- Zip: 3,51c, l -7 Tenant/Lessee Name: Phone#: Email: 1e-0 s C M4,<, C.-04,1 CONTRACTOR::Company Name: (.,l-A I IS /Ue✓W Phone#: `�/� �� 3 1r7 Address: S"_ 41UJ SI*--(d2, city: �.'�� State: Zip: 3 6 Qualifier Name: 61W V)L<1rCA Phone#: State Certification or Registration#: 6C-OC -0 b Certificate of Competency M DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: oP Value of Work for this Permit:$ Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: towi/O Zfi%��„ �/,� COAA 7ZOZ-5 _rVS r q G ,�S r+/ZRo'cc-65 ia./l�jJcr Specify color of color thru tile: Submittal Fee$ Permit Fee$ e/,�®a�� CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ ` (� TOTAL FEE NOW DUE$ 1`J (Revised02/24/2014) F� 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 chrand eve (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not b approveinspection fee will be charged. 1 Signature Z Signature L,, OWNER or AGENT 0 CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of DupBIEZ .20—)-5----,by day of / / .20 by who is personally � UZ known to �r>'�l /P�')�-E I'' _who is personally known to me or who has produced �L -DOT2 LI IM me or who has produced as identification and who di ake an oath. identification and who did take an oath. NOTARY PUBLIC: 1 NOTARY PUBLIC: Sign: Sign: 6 �� Print: Print: :off°s� Notary Public State of Florida mmuft pow Seal: Sindia Alvarez Seal: My 04� Commission FF 156750 Ex�'boP wpm Expires 09/03/2018 .� ************************************************************************************************************ APPROVED BY �8�� /s Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT 115 S.Mdrem Ave.,Rm. � Ft. Luderdsle, FL 33301-IM 4000 ,�i VAUD R 1.2"5 5 i NAT" NM sucmlc mc mald; tsl n ftshms Typw-isilicnica Comm Owner .Mmunma FAMML ® � A" d BtMrtM on:541S ► . q - Reame , T TMBWFM NWFGC ftftawl wtv Yom coeowcam T tl MOM t, THIS RECO"WAT 09 MSTM CON LY CIE OF WSINMa 1S SWOMS AT 1 0"46amwy in nam.y l all t ., v' wt ISK Reovo MUM to vaswnd when 19 r= indMaW OM ft WIRMa. it Is In comoarm Wth We or Ec Gt ` 5415 'NW 15 STRECT 412 Paid 09/06/2015 27..00 YARGATE, M 33 D63 5 . 2016 RIM SCOTT,GOVMNOR KEN SUTE OF FLORIDA DWYMMM FU E L di:A LIC NG'BOARD .. ELECTRICAL NwnW IS CEFMRED Under a pwsmm of ch 489 FS. a GREENB VMTTS�,g R 0!! ricmajiieY 1kCH ROYNMN d F, rr a p a sMAM AV r RFCA HR Fn RV I AW L14WIMM2§7 .•-"'^� WATNE01 OP ID:ACE CERTIFICATE OF LIABILITY INSURANCE °ATE1 1 108/2015 �--'-•'" 1 ato8i2o15 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 lieu of such endorsement(s), PRODUCER CONTACT NAME; Evergreen Insurance Agency Evergreen Insurance Agency " 561-966-8883 N,;561-964-8885 583105th Avenue N Ste 2 No Royal Palm Beach,FAL 33411 ADDRESS:ESS: tNSURER(S AFFORDING COVERAGE NAIC 0 INSURER A:Fla.Citrus,Bus.&Industries INSURED Watts New Electric, Inc. INSURER B:First National Insurance Co. 24724 5415 N.W. 15 St., Bay 12 INSURER c:Mercury Indemnity Co.of Americ Margate, FL 33063 INSURER 0: INSURER E INSURER F: 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. LTRR TYPE OF INSURANCE POLICY NUMBER M MMIDDIYYYY ADDL SUBN POLICY EFF POLICY EXP LIMITS B X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE__ $ 1,000,00 CLAIMS-MADE ®OCCUR 01C14867055 07/01/2015 07/01/2016rO RENTEr5 PREMISES Eaoccurrence $ 200,000 MED EXP(Any one person) $ 10,00 PERSONAL&ADV INJURY $ 1,000'Wo GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,OW,OW X POLICY ❑JECT F]LOC PRODUCTS-COMPIOP AGG $ 2,000,00 OTHER $ AUTOMOBILE LIABILITY Ee acBINEDtSINGL LIMIT $ 300,00 C X ANY AUTO BA090000008913 07/01/2015 07/01/2016 BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident PIP $ 10,00 UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION X STATUTE EOTH- R AND EMPLOYERS'LIABILITY A ANY PROPRIETOR/PARTNER/EXECUTIVE Y 7 N 0647496 07/01/2015 07101/2016 E.L.EACH ACCIDENT $ 1,000,00 OFFICER/MEMBER EXCLUDE D9 D N I A (Mandatory in NH) E L.DISEASE-EA EMPLOYEE $ 1,000,00 If yes.describe under DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT $ 1,000,00 DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached K more space is required) License#: EC0002705 CERTIFICATE HOLDER CANCELLATION Miami Shores Villa a MIASH01 Village SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 10050 NE 2nd Avenue THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Miami,FL 33138 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE O 1888-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD