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EL-15-1507 (2) f S 6 TY Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-237174 Permit Number: EL-6-15-1507 Scheduled Inspection Date: May 24,2016 Permit Type: Electrical- Residential Inspector: Devaney,Michael Inspection Type: Final Owner: GREENBERG, DAVID Work Classification: Addition/Alteration Job Address:534 NE 95 Street Miami Shores, FL Phone Number (786)333-8567 Parcel Number 1132060140820 Project: <NONE> Contractor: ACE ELECTRIC OF SOUTH FLORIDA INC Phone: (954)261-2885 Building Department Comments ADD/RELOCATE OUTLETS AND LIGHTS. REMOVE Infractio Passed Comments KITCHEN INSPECTOR COMMENTS False Inspector Comments Passed Failed Correction ❑ Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid May 23,2016 For Inspections please call: (305)762-4949 Page 6 of 42 Miami Shores Village P�tyrlll�'T) 8�.� 10050 N.E.2nd Avenue NEVlrt�llit Gla�siaJ/?r 't1t�ieAt+e#'atlrli'� Miami Shores,FL 331380000 ..... "' 'er ' ` -PROWPhone: (305)795-2204PeiatAPPfl /ED,, ae��Date:7115t q15 Expiration: 0111112016 s. s, Project Address Parcel Number Applicant 534 NE 95 Street 1132060140820 1031 FUNDING&REVERSE COR Miami Shores, FL Block: Lot: Owner Information Address Phone Cell 1031 FUNDING&REVERSE CORP. 681 ENCINITAS Boulevard (786)333-8567 ENCINITAS CA 92024- 681 ENCINITAS Boulevard ENCINITAS CA 92024- Contractor(s) Phone Cell Phone Valuation: $ 3,000.00 ACE ELECTRIC OF SOUTH FLORIDA 1 (954)261-2885 Total Sq Feet: 1600 Type of Work:ADD/RELOCATE OUTLETS AND LIGHTS.RE Available Inspections: Additional Info: Inspection Type: Classification:Residential Final Scanning:1 Meter Box Alteration Relocation Fire Alarm Service Change Review Electrical Underground W,W. Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $1.80 Invoice# EL-6-15-56027 DBPR Fee $2.25 06/18/2015 Check#:185 $50.00 $112.30 DCA Fee $2.25 Education Surcharge $0,80 07/15/2015 Check#:192 $112.30 $0.00 Permit Fee-Additions/Alterations $150.00 Scanning Fee $3.00 Technology Fee $2.40 Total: $162.30 In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans,drawings,statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL,PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work. OWNERS AFF T: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating constructio nd ning. Futhermore,i authori a above-named contractor to do the work stated. 22�n� July 15,2015 utho g tures / Applicant / Contractor / Agent ate Building Department Copy July 15,2015 1 4 Miami Shores Village W Jl1N 18 2015 Building Department 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(30S)762-4949 FBC 20 BUILDING Master Permit No.�..�� (O�� PERMIT APPLICATION Sub Permit No. v5- j�.. ❑BUILDING 'ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING [] MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: S3� �� J J �` 5TQ ff City: Miami Shores County: Miami Dade Zip 313<9 Folio/Parcel#: 1 t — 12 o G "4/Y — ®Rc�-C)• Is the Building Historically Designated:Yes NO Occupancy Type: S,4:- Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder):/V-3 A"D/Ala j r2 c4 Ph$°e#: e Address:.�3a''�'� ��i da- City:84-e LS.Wb Stated: ' Zip: q g D a 00 A Tenant/Lessee Name: i (R V A a R DIA S Phoned a��o� Email: i f-4 I ( aCO3 co ttCft-C L •C-0-A, CONTRACTOR:Company Name: Ad C d a:(,��-�� OF &YL q# &,-:Zn4 Z'��C phone#:-` Y1 .22W 210.- Address: 101'Y'K cSf"' LlG1 f,, 104,V02 City: , COPIX- C-L TY State: FL Zip: 333 Ig Qualifier Name: Ki:,yvC*;#- cL Phone#: C)Sy 2&1 Z13!6 State Certification or Registration#:_G—x-i3PQA lS- Certificate of Competency#: DESIGNE(t:Architect/Engineer: Phone#: Address: City: State Zip: value of Work for this Permit:$ ?00C Square/Unear Footage of Work: tC" Type of Work: ❑ Addition 5ff Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: 40L11.rC" JTK- Ovd,TL.iQ h-i0 4ZGo e AfAtq(4- i4 .i�r,� Specify color of color thru tile: Submittal Fee$5U Q Permit Fee$' CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$_ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ • f O-4—An9 MA MM A% 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 which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be a proved and a reinspection fee will be charged. Signature Signature NJ OW ER r AGENT CONTRACTOR T foregoing alrument wa acknowledged before me this The foregoing instrument was acknowledged before me this day of��- -- .20 k� ,by (M day of 13M �p .20 G by X1'1 x+21 A-r i 'I ZV p' ,who is onall n to OF-w m Te'�9P&I personally known to me or who has produced as me or who has produced v4— To\&— LD \&s identification and who did take a�d��► ►►►ill►I111,.111111111,1k," identification and who did take an oath. , NOTARY PUBLIC: `�� ; �dp� NOTARY PUBLIC: Sign: Sign: Print: '�. ✓,t; ....... .. ' S~fi��` Print: Seal: ��plu l l U q+�� N Seal: Notary Public Stets of Florida Sindia Alvarez (Q4 c MY Cornmfssfon FF 168750 � Expires 09!03/2018 a APPROVED BY �/� ! �U��Plans Examiner Zoning Structural Review Clerk I,.-_ --JR•11'A/YIN A% 06/0812015 14:02 Mendez&Associates (FAX) P.0011001 CERTIFICATE OF LIABILITY INSURANCE DAT 01 061608/081201155 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 UTAPORTANT: Ifthe certificate holder is an ADDITIONAL INSURED,the potloy(les)must be endorsed. If SUBROGATION 18 WAIVED,subject to the temts and conditions of the policy,certain policies may require an andoreernent Astete hent on this certificate does not confer rights to the certificate holder In Hau of such endorsement(s). PRODUCER CNTACT AIben Mendez Mendez&Associates �u E,�; (954)436 3778 Fac No (886)461-0503 9953 Pines Blvd. HOMEGMENDEZINSURANCE.COM Pembroke Pines,FL 33024 INSURER(S)AFFORDING COVERAGE NAIC 9 Phone (954)436-3776 Fax (866)461-0503 INSURERA: WESTER WORLD INS.CO INSURED INSURER B: PROGRESSIVE Ace Electric Of South Florida,Inc. INSURERC: NAUTILUS INSURANCE 10148 SW 49th Manor INSURER D: Ascendant Cooper City FL 33328- 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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. TV TYPE OF INSURANCE ADM SUBF POLICY NUMBER OW&M AMfZ EX LIMITS GENERAL LIABILITY EACH OCCURRENCE S 1,000,000.00 IdI COMMERCIAL GENERAL LIABILITY PREMISES RENTED ene s 100,000.00 A ❑ ❑ CLAIMS-MADE 0 OCCUR MED EXP(Any one on S 5,000.00 ❑ Y NPP8269185 06/0512015 06105/2016 PERSONAL a ADV INJURY S 1,000,000.00 ❑ GENERAL AGGREGATE S 2,000,000.00 GE 'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG S 1,000,000.00 J POLICY _ LOC S alrroMONLB LIABILITY COAdBINEDI INGLE LIMIT 5 500,000.00 ❑ ANY AUTO rINIURY(Per person) S ALL OWNED SCHEDULED (Peracdderrt SBAUTOS `� AUTOS 01304466-1 0111012015 01/10/201HREDAUTOS ❑ AUTOS NEDM 5s 100,OOOAO U UMBRELLA UAB 11 J OCCURENCE S 3 000 OOO.00 C n EXCESS LIAB 7 CLAIMS-MADE N AN020784 0610512015 06/0512016 g El DED 0 RETENTIONS WORKERS COMPENSATION Y/N —I PER 0TH- S AND EMPLOYERS'LIABILITY —J STATUTE L- D OFFFICEERRNEMBEEXCLUDED?A �XECUTIV�NIA E.L.EACH ACCIDENT $ 1,000,000.00 (Mandatory In NH) WG62512 4 09115!2014 09/15!2015 If yea.desoibe under E.L.DISEASE-EA EMPLOYE S 1,000,000.00 OESCRFMON OF CPERATIONS below E.L.DISEASE-POLICY LIMIT S 1,000,000.00 DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES(Attach ACORD 101,Additional Remadm Schedule,if more space is required) State of Florida Eectrical Contractor License Number.EC13004315 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Miami Shares Village Bldg Dept. THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN 10050 NW 2nd Avenue ACCORDANCE WITH THE POLICY PROVISIONS. Miami Shores.FL 33138 AUTHOPoZED RB+RESENTATIVE ^? r Fax#305-756-8972 ell ACORD 25(2014101)QF ©19a8.2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo aro registered marks of ACORD