EL-16-848 Q
Inspection Worksheet 22 a
Miami Shores Village
10050 N.E.2nd Avenue Miami Shores,FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-268236 PermitNumber: EL-3-16-848
Scheduled Inspection Date: October 03,2016 Permit Type: Electrical- Residential
Inspector: Devaney, Michael Inspection Type: Final
Owner: LAMB, PAUL Work Classification: Alteration
Job Address:161 NE 108 Street
Miami Shores, FL 33161-7037 Phone Number (786)252-4455
Parcel Number 1121360090220
Project: <NONE>
Contractor: LS CURTIS INC Phone: (305)892-6501
Building Department Comments
TRIM OUT RECEPTACLES,A/C AND WASHER. Infractio Passed Comments
INSPECTOR COMMENTS False
Inspector Comments
Passed 1211
Failed
Correction
Needed
Re-Inspection ❑
Fee
No Additional Inspections can be scheduled until
re-inspection fee is paid.
September 30,2016 For Inspections please call: (305)762-4949 Page 26 of 31
� k
Permit ttfC3 �V� 6448,
Miami Shores Village Pemtlt 7 ype Er{�t Iesilenti
10050 N.E.2nd Avenue NE
�� l! A1tritio
°•'° Miami Shores,FL 33138-0000
Phone: (305)795-2204
�sselCi1
Expiration:E at on• 10/ t2016
Project Address Parcel Number Applicant
161 NE 108 Street 1121360090220 PAUL LAMB
Miami Shores, FL 33161-7037 Block: Lot:
Owner Information Address Phone Cell
PAUL LAMB 374 NE 92 Street (786)252-4455
MIAMI SHORES FL 33138-
374 NE 92 Street
MIAMI SHORES FL 33138-
Contractor(s) Phone Cell Phone Valuation: $ 1,000.00
LS CURTIS INC (305)892-6501
_ ,, __. ...:.. _...._._ __. Total Sq Feet: 0
Type of Work:TRIM OUT RECEPTACLES,A/C AND WASHE Available Inspections:
Additional Info: Inspection Type:
Classification:Residential Review Electrical
Scanning: 1
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $0.60
DBPR Fee Invoice# EL-3-16-59209
$2.25 04/07/2016 Credit Card $ 109.10 $50.00
DCA Fee $2,25
Education Surcharge $0.20 03/30/2016 Credit Card $50.00 $0.00
Permit Fee-Additions/Alterations $150.00
Scanning Fee $3.00
Technology Fee $0.80
Total: $159.10
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 AFFIDAVIT: I certify that all the foregoi g information ' a curate d th II rk will be done in compliance with all applicable laws regulating
construction and zoning. Futhermore,I authorize th above-named nt actor to t q rl
�J April 07, 2016
Authorized Signature:Owner / Applicant / Con Factor / Agent Date
Building Department Copy
April 07,2016 1
Miami Shores VillageRECE
Building DepartmentM R002016
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel:(305)795-2204 Fax:(305)756-8972 BY:
INSPECTION LINE PHONE NUMBER:(305)762-0949 r—c
FBC 20 04
BUILDING Master Permit No.Zo—l J�D--�3
PERMIT APPLICATION Sub Permit No. t 1, 16 f`i 4 8
❑BUILDING ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION []RENEWAL
❑PLUMBING MECHANICAL PUBLIC WORKS [:] CHANGE OF ❑CANCELLATION [:] SHOP
A/ ,(/ CONTRACTOR DRAWINGS
/
JOB ADDRESS: �� // E /b " � S
City: Miami Shores County: Miami Dade Zip: -3/Cv
Folio/Parcel#: 7/ 210- -0 Of - D Z 7.0 Is the Building Historically Designated:Yes NO�
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder): pA d t L gfnA5 Phone#: 2-Y(7 4`/3,s�?fSy
Address: .3-] y N li. q2, 51`
City: iGf 44 ��_/�5 State: rL zip: .331 3 4:�
Tenant/Lessee Name: Phone#:
Email: 11 - W�
CONTRACTOR:Company Name: L i��I Phone#: ,JAG✓-�� -0 6
Address:
�2 o,
City: I e/7 ifv^14
/ State: Zip:
Qualifier Name: �� �f f Phone#: '7)'e Y&Z
State Certification or Registration#: 0<:� ,?Z 7.�Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ o D® Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New Repair/Replace ❑ Demolition
Description of Work:. ��j �,�, PL ezu � All-
Specify color of color thru tile:
Submittal Fee$ Permit Fee$ ���d�P�O CCF$ d 60 CO/CC$
Scanning Fee$ W Radon Fee$ 2 �� DBPR$ * Notary$
Technology Fee$�' �� Training/Education Fee$Q Double Fee$ ,,pp--��
Structural Reviews$ Bond$ $0
TOTAL FEE NOW DUE$ J Q C t e (0
(Revised02/24/2014)
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 approved and a reinspection fee will be charged.
Signature UG' /�' �G� Signature
OWNER or AGENT CONTRACTOR
The foregoing instrument was/acknowledged before me this The foregoing instrument was acknowledged before me this
U day of 4)'41n ! 20 ,by `)day of 20 by
who is persnraally k n / ��i 6 ' '•�2� .who is a y mown to
me or who has produced as me or who has produced as
Identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
CASSANORA rd iMES11IA
sa�o-e�ttoo� •°°My
Sign Sign 'Rr1ja�IDN#EE 21941a
MY 25.201
Print: 1+alt BB NOI>35ti�I+NOJ 1�W:.; ;_= Print raaTi 3sea,� Frormetvorey�, 6
IT
Seal: Seal:
****************** ******** ******************************************************************************
APPROVED BY >��/�Ads Plans Examiner Zoning
Structural Review Clerk
(RevlsedOZ/24/2014)
May 18 2816 88:53:32 EDT FROM: FZM/38774885254 MSG# 1684132224-886-1 PAGE 884 OF 884
13ATEVMMbAYY17
"�--- CERTIFICATE OF LIABILITY INSURANCE 5/10/2016
THIS CERTIFICATEIS 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 pollcy(les)roust have ADDITIONAL INSURED provisions or be endorsed.
If SUBROGATION IS WANED,subject to the terms and conditions of the policy,certain policies may require an endorsement A statement on this
certificate dons not confer rights to the certificate holder In lieu of such andorsament(4
PRODUCE" VONTAW
NAME:
AUTOMATIC DATA PROCESSING INS AGCY PHONE FA<
(AC,N:,,Ext): (AY.',Nal:
250717 P: F: ---VL--
PO
-"" LPO BOX 33015 INSURERS)AFFORDING CCVERAOE NAI60
SAN ANTONIO TX 78265 INBURERA: Twin City Fir+~ Ins Co 29459
INHUREO INSURER M:
INSURER.•J:
L. S. CURTIS INC. INSURER D:
24341 NE 30TH AVE APT 108 INSURER E:
AVENTURA FL 33180 INSURER F:
COVERA(+JES 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 MAYHAVE BEEN REDUCED SY PAID CLAIMS.
J?=R TYPE CV.MWZIIPAWCE' JIMMrSF
.LaDL BZtsli PQf iY.T7VlAlBER J+ POLTOPP.?'A
y I.W]78
COMMERCIAL GENERAL LIABILITY EACH a JRRENcE t
CLAIId6-MADE ❑OCCUR DAr•�AGETORENTED
PREMISES(E0 amurrante)
MED EC°(Anv ane peraan) E
PERE]NALa.ADV INJURY G
GEN'L AGGREGATE LIMIT APPLIES PER: OENERAL AwBREGATE S
POLICYJECT PRG-❑
LOC PRODUCTS-COMPIOP A00 6
OTHER:
AUTOMOBILE UABIL17Y CDM9l ED EINcErm LINQT ANY AUTO (Enatddrmp d
OVYNED SCHEDULED BODILY INJURY(Pr person) d
AUTOS ONLY AUTOS BODILY INJURY(Par at0dent) G
HIRED NaN-a\YNED PROPERTYDAMAOE
AUTOS ONLY AUTOS ONLY (Pr accidart) C
UMBRELLA LIAROCCUR. EACH OCCURRENCEE
EXCESS LIAR CLAIM&MADE AasREGATE
0® NETENTIoNt S
W0JI88R8CW1�BAE9AIN
.iAO.®{�S098IaB�IJA8rZIll PER DTH-
STATUTE ER
ANY PROPRIETCR/PARTNER1EXECLMVE yN 1
OFRCERIMEI•ASM E<CLUDED? ❑ Nie EL.EACH ACCIDENT ,404,444
A fata^damrY+nNN) 76 WEG TR4-054 05/0.1/201E 05/01 2017 EL.DISEASE-EA EMPLOYEE `1,000,000
If yes,describe under
DESCRIPTION OF OPERATIONS below EL.dlEASE-POLI•OY LIMIT 11,000, 000
OFSCRIRMNOF00911ATIONS/LOCATIONS/MICL99(ACORD 101,AddlGohal Ratnatka Sahadula,may ba anaehad hmora r&aaa is raiNitadl
Tliose usual to the Irisured's Ope.ratioris. LiceYise #EC0003175
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED
Miami Shores Village BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE
DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS.
Building Department AUTHORIZED REPRESENTATIVE
10050 NE 2ND AVE
MIAMI SHORES, FL 331:36
ACORD 25 2018/03 191888-2015 ACORD CORPORATIO .All rights reserved.
l ) The ACORD name and logo are registered marks of ACORD