ELC-14-437 Inspection Worksheet
Miami Shores Village
10050 N.E.2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-208545 Permit Number: ELC-3-14-437
Scheduled Inspection Date: March 19,2014 Permit Type: Electrical-Commercial
Inspector: Devaney, Michael
Inspection Type: Final
Owner: CHURCH, Work Classification: Addition/Alteration
Job Address:602 NE 96 Street
Miami Shores, FL
Phone Number (305)754-9541
Parcel Number 1132060141410
Project: CHURCH
Contractor: G&R.ELECTRIC CORP Phone: (305)688-5025
Building Department Comments
ELECTRICAL FOR CHILLER REPLACEMENT Infractio Passed Comments
INSPECTOR COMMENTS False
Inspector Comments
Passed ai/
Failed
Correction ❑
Needed
Re-Inspection ❑
Fee
No Additional Inspections can be scheduled until
re-inspection fee is paid
March 18,2014 For Inspections please call: (305)762.4949 Page 28 of 51
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Miami Shores Village `
Ip I Building Department �a� 20
90050 N.E.2nd Avenue,Miami Shores,Florida 33138 BY:
Tel:(305)795.2204 Fax:(305)756.8972
INSPECTION'S PHONE NUMBER:(305)762.4949
I/ FBC 20
BUILDING Permit No. g-`C /ty
PERMIT APPLICATION Master Permit No. YC O /�
Permit Type: Electrical Q
JOB ADDRESS: 64� /1/67,
//
City: Miami Shores County: Miami Dade Zip: t�
Folio/Parcel#:
Is the Building Historically Designated:Yes NO Flood Zone:
OWNER:Name(Fee Simple Titleholder):1A I tm SE�012--5 '� 6�04Phone#:
Address: Lag 7— N5 9(.o GT
City: VA0.j^k SAQAA.S State: _ Zip:
Tenant/leMWCAA_1___f11
ame: Phone#:
Email: C
CONTRACTOR:Company Name: C � � � � C`� `/ Phone#:
Address: f/?C-50
City: A410If—'W I-7 State:
Qualifier Name: 4 o-'O Phone#: ' IV6 /40l46�p
State Certification or Registration#: ` G'7G7 S Certificate of Competency#:
Contact Phone#: fg�/�1�0-11 Email Address.
DESIGNER:Architect/Engineer: Phone#:
Value of Work for this Permit:$ SquareAAnear Footage of Work:
Type of Work: DAddress DAlteration ONew >kepair/Rieplace ODemolition
Description of Work: E 1'rG��'I Cwt oy- Ci� I -e r f 4ePl Q&eM 1ei`1.1 ,
ae.w.xsx�.�+�*�.ax��.�.x*.xa�w�.x:�+xx.wx.aex�xama•.�Feesa�e.a,.e.e.w.xxxaa.xs..x.n*a�a�xaxwa.�.x.x�aw.xaa*�.xws.,�x
Submittal Fee$ Permit Fee$^/A-Q'of Of'— CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Bond$
Notary$ Training/Education Fee$ Technology Fee$
Double Fee$ Structural Review$
TOTAL FEE NOW DUE$
4
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
EMPROVEMENTS 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.
Signature Signa
Owner or Agent Contractor
The foregoing instrument was acknowledged before me this The fore oin instrument was acknowl ed before thi
day of%zka0�,by it� ItC lZC� day of ,20�-by2�4a &
who is rsonall known tom or who has produced who is personally known to me orwho produced
As identification and who did take an oath. entific 'o and ho e an oath.
NOTARY PUBLIC: NOTARY
r
Sign: / 'a� Sign:
Print: SAX�X=Auv XMJ rr STATr of FrpRMA Print: t
0.00%,�
S lvia Halter MY 00 ION I EE
My Commission Expires: s Commission#EE098053 My Commission Expires:* * EX A 5:April 1, 5
3 `Expires: JUNE 08,2015 �q �o tom
BONDED THRU ATLANTIC BONDING CO.,INC.
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised 3/122012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09)
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Mar 05 2014 8: 16HM RVG INSURAnCE GROUP 3053856133 P. 1
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PORGY Number. Dale Entered: 03/05/2014
ACo CERTIFICATE OF LIABILITY INSURANCE �"�'o
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Omy pa CONIF ER THE COVERAGE AFFORDED BY THERB NO RIGHTS UPON THE CMRTWICATE E L POLH�i 8
CERTIFICATE DOES NOT AFF�►TRIELY OR NEGATIVELY ADDEND,
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT COI+ISTITUTE A CONTRACT BETWEEN THE ISSUING iNSURIt:R{S�, AUTHORED
REPRESENTATIVE OR pRWUCER,ANOTHE CERTIFICATE HOLDER
IMPORTANT: If the Cat 0118 tlokW le an ADDITIONAL INSURED,Rhe Polk:yt�esl mUnt be erutoreed. j SUMMATION iS WAIVED,subject to
the Terme and condMone Of the POIW,Owbdn po"Clam may MgUlre an endomemenL A statement on thtg csffl trate does not confer rIgtft to the
CoMflo to holder In IMU of SUCh snd0tSON WTKBI,
PRODUCER AV(a Iasvran4e Group, Ittto. PNga, (SOS)388-6133
(305)385-6693
13701 ON 88 St L an"avwin9 ra;nc"vO .mat
Suite 222C . t
Miami, rlosida 33166 . A,Saottadale Insusaaae ala. (South. Cross)
_ s C>aati t FiOX26. no. Co.
IN7iVp� O 612 8leotrio, COrp.
CONZALO PIRMS
4450 E. 10 COt1AT
HIS, 8L 33013
COVERAGES CERTIFICATE NUMBER: RE't►I O NUMBER:
THIS L3 TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVt:FOR THE POLICY PERIOD
tN0{CATED• NOTWITHSTANDING ANY REQUIREMENT.TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO wKICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN 13 SUBJECT TO ALL THE TERMS.
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LISATS SHOWN INKY HAVE BEEN REDUCED BAY PAID CLAIMS. ut11 r8
� �-— --TYPE 0P 1RAND6 R
EACH oxuRr *1,000,000
I GENERAL UADLITY S0,000
A •.��//�co scw GEr�I.U WLaY CPS1639664 /19/2023 /18/2014 IEJt aIxU mmm 1
.^!._. NIED EXP ane 1 5,000
CLANSW E �OCCUR PRBONAL _41,000,000
CONTRACTUAL 7iAD1riNJ7IRY
_ TE $2,000,000
GENERAL DED 81,000 1,000,000
.• - PRQDI/CT$•ICOMPA7P At)Q 1
Gott.AGGRWA'M UWAPPLIES P $
POUCT I G Loc
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ANY AUTO �rA
A o p swab .EO SLY"ATRY(PW ao U7 $
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HMI AUTOS AUTOS 8
Ep:HOCCURRENCE S
UMBRILLALIAS OCCUR s
6X07439LIAR CLAWSMADE I AG0RE4ATE
A
+WORNMOCOMPOWAT40r1
ANDOWLOYOWLIAMTY !N NCP760723003 /30t2ttia /3o/iols E.L.EACHACC rr s1,000,000
B =orf PPEROMErORMtCARTN n� CU"VE R!a EL.p18EABE +toYFE $1,000,000
(uten�tsrrtnNHl EL,Dt E-POLICYLUIfir s1,000,000
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D68CRIPSIOR OP CPERATICKW�Looco��•IIONa r IAftM A00RD 187.A l Ratan$dWU IF Inonapam•b N4�
Insured is Bleotri72al Coatcaa7:or and (eetu3ttal Ca7al;raator LIA$ILITY
CERTIFICATE SOLDER IS blAi= AS ADDYTIO=L INSURED ON 09216RAX,
CERTIFICATE HOLDER CAN
tatai 8ho7res Village SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED N
9uilding vepaztmant ACCORDANCE WITH TOR POLICY PRON191ONS.
14090 vs 2 Ave
Miami Shores, IL 33138 AUTHOVU110 REPRESSN
60NSALT7 '
IV 1ON-7010 ACORD CORPORATION. All tighlo reserved.
ACORD 25(20101051 The ACORD name and logo are registered marks of ACORD
pm*t*W UWV FOM Sass P[us satlwwa wwr.Fina9S0$0=:kogWml,e Ptd9W"=4W1877
PYKE MECHANICAL, INC. Purchase Order
9401 N.W.106th St
Suite 109 Order: 28274
Medley FL 33178
305-8845600 Date: 02/25/2014
License: CAC 008897
Ordered By: 33-Gilbert Rodriguez
To: G&R Electric Corp Project: Miami Shores
4450 East 10 Court 602 N.E. 96th Street
Hialeah FL 33013 Miami Shores FL 33138
You are hereby requested to provide the following materials/services to the above named project for the price listed below.
Part# Description Unit Quantity Price Amount
Electric Work associated with Chiller Replacement 1 1.00 2,850.00 2,850.00
CO#1 Nema 3R Electrical Disconnect 400A 1 1.00 600.00 600.00
Subtotal: 3,450.00
Notes
Accepted By: Date A 0Sales Tax: 0.00
Total Amount of Order 3,450.00
Terms: All changes to quantity,specification or price must be approved in writing. All materials✓services must be delivered to job site unless
otherwise instructed in writing.Failure to deliver materials or services in a timely fashion will release contractor from any obligation to purchase
implied by this order.
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Own-itC COIF 1 8Y T
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2 EC1 � $45. 3
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Miami shores Village
Building Department 'eggs a
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204 �ORIDA
Fax: (305) 756.8972
FEBUARY 7, 2014
Permit No: ELC14-437
ELECTRICAL REVIEWER COMMENTS
Need a copy of contract.
Plan review Is not complete,when all Items above are corrected, we will do a complete
plan review.
If any sheets are voided, replace them with new revised sheets and place behind the most
current page.
♦5�os
Miami shores Village /9'a
Building Department logo
10050 N.E.2nd Avenue
Miami Shores, Florida 33138 , ��
Tel: (305) 795.2204 ZORIDA
Fax: (305) 756.8972
FEBUARY 7, 2014_
Per No: ELC14-437
ELECTRICAL REVIEWER COMMENTS
Need a copy of contract.
'1J1k_4SS -'(ASC
s
Plan review is not complete,when all items above are corrected,we will do a complete
plan review.
If any sheets are voided, replace them with new revised sheets and place behind the most
current page.