EL-15-2377 Inspection Worksheet
Miami Shores Village
10050 N.E.2nd Avenue Miami Shores,FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-257114 PermitNumber: EL-9-15-2377
Scheduled Inspection Date:April 20,2016 Permit Type: Electrical- Residential
Inspector: Devaney, Michael Inspection Type: Final
Owner: BREEN,JAMES&MAR Work Classification: Alteration
Job Address:1481 NE 104 Street
Miami Shores,FL 33138-2663
Phone Number (786)617-3500
Parcel Number 1122320320090
Project: <NONE>
Contractor: DAW ELECTRIC, INC Phone: (786)877-3500
Building Department Comments
ELECTRICAL HOOK UP FOR POOL lnfractio Passed Comments
INSPECTOR COMMENTS False
Inspector Comment
Passed Zr.
Failed
Correction ❑
Needed
Re-Inspection ❑
Fee
No Additional Inspections can be scheduled until
re-inspection fee is paid
Apra 19,2016 For Inspections please call: (305)762-4949 Page 37 of 46
Miami Shores Village R r
10050 N.E.2nd Avenue NE
Miami Shores,FL 33138-0000 My
Phone: (305)795-2204
Expiration: 03820/2016
.; „F
Project Address Parcel Number Applicant
1481 NE 104 Street 1122320320090
JAMES Sz MAR BREEN
Miami Shores, FL 33138-2663 Block: Lot:
Owner Information Address Phone Cell
JAMES&MAR BREEN 1481 NE 104 Street (786)617-3500
MIAMI SHORES FL 33138-
1481 NE 104 Street
MIAMI SHORES FL 33138-
Contractor(s) Phone Cell Phone Valuation: $ 1,000.00
DAW ELECTRIC,INC (786)877-3500
. Total Sq Feet: 0
Type of Work:ELECTRICAL HOOK UP FOR POOL 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 Invoice# EL-9-15-57131
DBPR Fee $4.50 09/22/2015 Check#:40023 $319.60 $0.00
DCA Fee $4.50
Education Surcharge $0.20
Permit Fee-Additions/Aiterations $300.00
Scanning Fee $9.00
Technology Fee $0.80
Total: $319.60
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 responsibil' all work done by either myself, my agent, servants, or employes. I understand that separate permits are
required for ELECTRICAL,PLUMBING, 1CAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work.
OWNERS AFFIDAVI certify th all th foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
construction and z in Futherm e,Is orize the above-named contractor to do the work stated.
September 22,2016
Auth ign Owner / plicant / Contractor / Agent ate
Buil ng Department Copy
September 22,2015 1
Miami Shorey Village FSEP
-17
Building Department
$ 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
FC 2® 10
BUILDING Master Permit No. (3,010- lS l5`�O
PERMIT APPLICATION Sub Permit No. L IS
❑BUILDING 0 ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF CANCELLATION ❑ SHOP
U7j.
CONTRACTOR DRAWINGS
JOB ADDRESS: I-AN IV 1 l,,.
City Miami Shores rr�� �Coouunty Miami Dade Zip:
Folio/Parcel#:� �" �� �— is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder): Phone#:
12�—
Address::1 `►V /'_•�
City:► OM- 4"'SJ &e2 State: Zip:
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name: D.A.W. Electric Inc. Phone#: 786-877-3500
Address: 20421 NW 22th Ave.
City. Miami State: Florida Zip: 33056
Qualifier Name'•Derrick Williams Phone#: 786-877-3500
State Certification or Registration,#: EC-13005443 Certifi f Competency#:
DESIGNER:Architect/Engineer . Phone#:
Address: . ' CityState: Zip:
Value of Work for this Permit:$ C&U + Square/Linear Footpige of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑-Repair/Replate ❑,Demolition
Description of Work:- - "
Specify color of color thru tile.
Submittal Fee$ Permit Fee ®!U CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE i - G 0
(Revised02/24/2014)
Bonding Company's Name(if applicable) N/A
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-T® YOUtt'`PROPERTY. IF Xj INTEND
TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING
YOUR NOTICE OF COMMENCEMENTS„
Notice to Applicant: As a condition to the issuance of a building permit wlth'an estirnat�+ Value exceeding, 2500, the applicant must
promise in good faith arca copy of the notice of commencement a►Id construction lien law brochure yvii be denvered to the person
whose property is s ect to attachment. Also,a certfled copy of the recorded notice of commencement must be posted at the,jab site
for the first insp cti n which occurs s en (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will t b approved and a r inspection fee will be charged.
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OWNER or AGENT CONTRACTOR
The fore in instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
d y of 20 ,by _O` day of 20 by
ho personally known w p ,who! personallyk
me anrh his produced as me or who fias pro + as
identi kation and h ". Ike aYAe,N J IBES identification and d tj �n�p
C S1'AL N•JONES
• S${ON#FF1287l38 w MY OMMISSION#FF128798
NOTA PUBLIC: t COMMI NOTARY PUBUC:, ••..„ a� RES May 28,2018
; ... ..' IBES May 28,2018 (407)ase-o1
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Sign. Sign:
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Seal: Seal:
APPROVED BY f�/�tO�l� Plans Examiner Zoning
Structural Review Clerk
(Rev1sed02/24/2014)
Congratulations! Vl�th 6aense you t1eo0�ne ori
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CERTIFICATE OF LIABILITY INSURANCETHIS
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14900 NW 7Mh Court SuiteM
Miami Lakes,FL 830164889
Ryon Heimbold INEIIIIIEMAffORDINGCOVERME NAIC 0
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INSURED Van Kirk&Sorel,Inc. INSURERS*FOCI Ifeurance Com 10178
Ati n:Janet Van Kirk c:
3144 SW 13th Drive
Deerfield Beach,FL 33442 "ago`
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COVERAGES CERTIF-ICATE NUMBER;- REVSION
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTW(THSTANIMG 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 PND CLAIMS.
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DESCRIPTION OF OPERATIONS I LOCATIONS i VEHICLES(ACORD 904,AddMos'ReMdW Sohod^may be qoffisd 0 mos space is requtrM)
svn fmming Pool
License#:CPCt1am
CERTIFICATE HOLDER CANCELLATON
MIAMISFI SHOULD ANY OF THEABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DSUVSRED IN
Miami Shores Village Ac coRDANcE WITH THE POLICY PROVISIONS.
Building D epartment
10060 Northeast 2nd Avenue AUTHOMWRWPMM'rA7M
Miami Shores,FL 33138 Brown and Broom of Florida.Inc.
®19882014 ACORD CORPORATION. All righlS raser"d.
ACORD 26{2014101) TM ACORD name and logo are registered marks of ACORD