EL-14-1042 (2) L ( 1q _ 3 Ot
Inspection Worksheet
Miami Shores Village
10050 N.E.2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-212811 Permit Number: EL-5-14-1042
Scheduled Inspection Date: February 12,2015 Permit Type: Electrical- Residential
Inspector: Devaney, Michael
Inspection Type: Final
Owner: PALMISANO,INGRID&ERIC Work Classification: New
Job Address:1035 NE 96 Street
Miami Shores, FL Phone Number
Parcel Number 1132060143730
Project: <NONE>
Contractor: MIKES CUSTOM ELECTRIC SERVICE INC Phone: (305)969-5460
Building Department Comments
ELECTRICAL WORK AS PER PLANS Infractio Passed Comments
INSPECTOR COMMENTS False
Inspector Comments
Passed
Failed tog" 40
Correction ❑
Needed
Re-Inspection
Fee
No Additional Inspections can be scheduled until
re-inspection fee is paid
February 11,2015 For Inspections please call: (305)7624949 Page 3 of 22
1 Miami Shores Village REC P'TE
Building Department MAY 2.1 2014
10050 N.E.2nd Avenue,Miami Shores,Florida 33138 BY-
Tel:(305)795.2204 Fax:(305)756.8972
INSPECTION'S PHONE NUMBER:(305)762.4949
FBC 20
BUILDING Permit No.
PERMIT APPLICATION Master Permit No.92C j L/ —3 L/9'
Permit Type: Electrical
JOB ADDRESS: 10 ISS N L C-11 �o S
City: Miami Shores County: Miami Dade Zip: SS, Sl(
Folio/Parcel#:
Is the Building Historically Designated:Yes NO Flood Zone:
OWNER:Name(Fee Simple Titleholder): F_6 c t oQ YY\t S c,/1 v Phone#:
Address: I o 3 S N�_ C1 to S TF
City: �4 t^ VN f\ S 1-ZWr!en State: Zip: 13
Tenant/Lessee Name: 9 Phone#: 3 v5- 1 k-3
Email: PaAfr l S qnp \ °, (YllC7ly- ) cc \7 M J" 8a
CONTRACTOR: Company Name: /fe (,fJS�a►,�/1 /e�C'� L Phone# ®5' 7 ZA
Address: I o T"? /T_d /,r � �� ' (
City: LS Q State: ( &Dr" 3/ C'?
Qualifier Name: tM + o�� _17_t_4�,✓Ltd C Phone#:
State Certification or Registration#: LR- �l g-) A 3 Certificate of Competency#: 4
Contact Phone#: 3e 5°`2_67 ` U 9 Email Address: 44'14L 9) Al JUSCO�SZO*7- C0 04
DESIGNER:Architect/Engineer: Phone#:
Value of Work for this Permit:$ 3;7, 1 Z- d!T Square/Linear Footage of Work:
Type of Work: OAddress DAltes�raiition 2�ew ORepair/Replace ODemolition
Description of Work: 2t0, 14 C
Submittal Fee$ -TO 0 0 Permit Fee$ 0 + CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Bond$
Notary$ Training/Education Fee$ Technology Fee$
Double Fee$ Structural Review$
TOTAL FEE NOW DUE$ 365-.5-.
r 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
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 the abse e of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
SignatureP6Jrr,&S0r-G Signatur
Owner or Agent Contractor
The foregoing instrument was acknowledged before me this %'' The foregoing instrument was acknowledged before me this
day of WX&AfLY ,201h,by /Alb?—ID P&M l S ANO , day of��,20 I(J by i V A1.G�i ai f( aLWv t6✓
who is personally known to me or who has produced who is personally known to me or who has produced
As identification and who did take an oath. as identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: Sign:
Print: ?-0 2/� Print: AVS6 r– A4V
My Commission Exp' * PN
Notary Public Stave of Florida My Commis
Robert Murphy Notary Public State of Florida
My Canmiasion EE 201088 . Robert Murphy
q Expires 0512212018 My Commissiori EE 201088
E> Irea 08/2212018
APPROVED BY —T rJ'v v ke Plans Examiner Zoning
Structural Review Clerk
(Revised 3/1=012)(Revised 07/10/07XRevised 06/10/2009XRevised 3/15/09)
CERTIFICATE OF LIABILITY INSURANCE DAo5r,3rTE(MMi14DD"
r;RODUCElt Galloway Insurarice THIS ONLY ANCFICATE IS ONFERS IS uR D AS UPON MATTER OFTHEFIINnORMATION
FICATE
I 17354 South Diode HOLDER THIS CERTIFICATE DOES NOT AMEND,EXTEND OR
Muni,FL 3315/ ALTER THE COVERAGE AFFORDED BY THE OW.
_ Phone(305)255-1661 Fax(786)206.7068 INSURERS AFFORDING COVERAGE NAIC 9
fNst Mlke's Custom Electric Service,Inc INSURER A Federated Natlonai Insurance Co.
! 10871 SUN,88th Strout,#10 INSURER
Miami,Florida 33157 INSURER C:
C:
INSURER a
t� INSURER E
COVERAGES
THE POLICIES OF INSURANCE LISTED HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING --
ANY REMIR&MU,TERM OR CONDITION OF ANY CONTRACTOR OTHER ANT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR
MAY PERTAIN.THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN 13 SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES,AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAM CLAdIiE.
MR AWL TYPE INSURANCE POLICY NULMBER MEDMVE POUCIF E W RATM I
DATE DATE LiMnB.
G�ERAL L�ILI�1� EACH OCCURRENCE $1,000,000
®COMMEI'DAL GENERAL LIABILITY GL-0417436-0 06028/2013 08028/2014 PREMISES $100,000
D❑c1.Aw MADE 0 OCCUR MED EXP(Argramperem) $51000
;A ® PD:Ded:$5W PERSONAL&AIN INJURY. $1,000,000
❑ GENERALAGGREGATE $2,000,000
' GEML AGGREGATE LUT APPLES PER: PRODUCTS-COMPIOP AGO $2,000,000
`'0 POLICY ❑PROJECT ❑ LOC
i f AUTQNOBILE LIABILITY COMBINED SINGLE LIMIT
!�D ANYAUTO _
I❑ ALL OWNED AUTOS BODILY INJURY
❑ ❑ SCHEDUL.EDAUTOS p�gpo
❑❑ HIREDAUTOS
f _.NON OWNED AUTOS BODILY INJURY(Per> ►t)
- -F❑ _ PR PeT� AMA(3E
GARAGE LUIBLITY AUTO ONLY-EA ACCIDENT
❑ ❑ ANY AUTO OTHER THAN EA ACC --
❑ AUTO ONLY: AGG
�^ EXCESS I UMBRELLA LIABILITY EACH OCCURRENCE W_
El OCCUR ❑ CLAIMS MADE AGGREGATE
❑ DEDUCTIBLE
E 1 ❑ RETENTION $ -- `
WORKERS COWENSATION AND21111PLOYM LIABILITY ❑
I NY PROPRETOR I PARTNER I EXECUTNEYM L EACH F.NT
OFFICER/MEMBER EXCLUDED? E ACCIA
demy IE.L.DISEASE-EA EMPLOYEE
under
I $PECIAL PROVISIONS below E.L.DISEASE-`POL.ICY LIMIT
OTHER
DESCt#yPTIQN OF OPERATIONS I LOCATIONS I VEHICLES EXCLUSIONS ADDED BY WI SPECIAL PROVISIONS . .
Electrical Co*wbr/%Nork....: '
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE'DESCRIBED POLICIES
�I:W
LED THE .i
EXPIRATION DATE THEREOF.THE ISSUING YAVOR TO MAIL
I Miami Shores Village 30 DAYs wRrrm NoncE To THE C TR NAMED TO
10050 NE 2nd AVmtUe THE LEFT,BUT FAILURE TO DO SO SHALT.IMPOSE OR LIABILITY
Miami Shares,Florida 33138
OF ANY KIND UPON THE INSURER,ITS AGENTS OR ATIVES. --�--
Attn:Building Dept AUTHORIZED REPRESENTATNE
_
Fax#505-756-8972 Jose H Romero,Llcensed Agent-A225234 I/
ACORD 2!i(2009101 j pF — i ®1988.2009 ACORD GO TION.AD rights rsserv�ed.
The ACORD name and logo atreglebwed marks of ACORD