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EL-13-28Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 186176 Permit Number: EL- 1 -13 -28 Scheduled Inspection Date: February 21, 2013 Inspector: Devaney, Michael Owner: LAMB, PAUL Job Address: 374 NE 92 Street Miami Shores, FL 33138- Project: <NONE> Contractor: MOODY ELECTRIC INC Permit Type: Electrical - Residential Inspection Type: Final Work Classification: Alteration Phone Number (786)252-4455 Parcel Number 1132060136430 Phone: (305)758 -2000 Building Department Comments REPAIR RISER, GROUNDING SYSTEM INSTALLED Infractio Passed Comments INSPECTOR COMMENTS False Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments 2< February 20, 2013 For Inspections please call: (305)762 -4949 Page 22 of 23 11143 Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 BUILDING PERMIT APPLICATION FBC 20 Permit Type: Electrical Pt) j,� OWNER: Name (Fee SimplepTitleholder): ( L I l Address: 314 P E "1 Z 5T City: T i ki-m) 514C*65 State: F JAN (4 7 L Ng Permit No. 12" Master Permit No. Phone #: Zip: 33/3 e Tenant/Lessee Name: Phone #: Email: JOB ADDRESS: 5 e City: Miami Shores County: Miami Dade Zip: Folio/Parcel #: Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name: Th Lg 6/C /Af. Phone #: �/O, 7 &" Address: 7 2 q ,ow 41D57- City: //1/Y/ State: FL, Qualifier Name: -.I 014 1)9 CO Zip: 33 /CO Phone #: State Certification or Registration #: �� // 9 y Certificate of Competency #: Contact Phone #: Email Address: DESIGNER: Architect/Engineer: Phone #: Value of Work for this Permit: $ 6)50 .00 Square/Linear Footage of Work: Type of Work: ❑Address ❑Altersttion ONew Repair/Replace ❑Demolition Description of Work: �P» gisait j V &) 11J c rte/ O ec ********* *** ** * * ** *** ****** ** * *** ** ****F ************* * * ** ** * * ** *** *** ******** ** ***** Submittal Fee ."-V %� Permit Fee $ / ®!®o 6' ' CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ JX 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 absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature Owner or Agent The fore g . ing instrument was acknowledged before me this 1 day of '. -;' , 2013 , by -PdL.L1 who is personally known to me or who has produced As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: Pm- My Commission Expires: * * * * * * * ** * * * * * * * * * * ** APPROVED BY MARY PAT BRIGGS MY COMMISSION 9 DD 979267 EXPIRES: May 11, 2014 Bonded Thru Notary Pe* Underwriters The fore day of who is per5.nally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: g instrument was acknowledged before me this 7 , 2013 , by (fa b Sign: Print: My Co *************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** .�rvl2. /8--- / `��"'v Plans Examiner Structural Review (Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09) r Zoning Clerk Jan 07 13 03:07p Moody Electric Inc 305- 754 -1333 p.l MOODELE -01 JULIE ACO►RD" CERTIFICATE OF LIABILITY INSURANCE 1 °"'`17/20 12/17/20 2 12 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 POUCIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BE1WELN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(les) must be endorsed If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER InSource, Inc. P P.O. Box 561567 PWHC� Na Ea); (305j 670-6111 Nol: (305 670 -9699 Miami, FL 33256 -1567 MAIL CONTACT INSURED Moody Electric, inc. Mr. John Moody 669 NW 90 Street Miami, FL 33150 ADDRESS: INSURER'S) AFFORDING COVERAGE NAIC It A_ SURERA: FCCI Insurance Company ----40i78 INSuRERB:FCC1 Commercial Ins. Co. 33472 INSURER C INSURER D INSURER E INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS 15 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 POLIO ES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TYPE OF INSURANCE II POLICY NUMBER POLICY EFF M DY E P LI,(9____ EACH OCCURRENCE $ 1,000,000 LIABILITY 11CPP00056947 12/31!2012 12/31/2013 PREMISESSE�a�t�rattoaj__$ 100,000 OCCUR MED EXP Any one parson) 6,000 ... PERSONAL8ADVINJURY E _ 1,000,000 - GENERALAGGREGATE S 2,000,000 SPER. PRODUCTS - COMP/OP AC3G $ 2,000,000 LOO $ COMBINED SINGLE OMIT (Eaacc(dmit) $ 1,000,000 CA00067797 12/31/2012 12/31/2013 BODILY INJURY (Per person) $ DuLED S BODILY INJURY (Par accident) $ )VdNED GENERAL UABLLITY COMMERCIAL GENERAL L .] CLAIMS -MADE f _X GEM_ AGGREGATE UMIT APPLIES POLICY 1..X } Ea . f-I AUTOMOBILE LIABILITY ANY AUTO ALL OWNED 1C AUTOS i rau u PROPERWbAMAGE (PER ACCIDENT) UMBRELLA LIAB occur EACH OCCURRENCE $ 2,000,000 EXCESS LIAR � CLAIMS-MADE UMI300047878 12/31/2012 12/31/2013 AGGREGATE $ 2,000,000 RETENTION 10,000 s AND EMPLOYERS' LIABILfY r WC STATU_ IOTF!- ANY PROPRIETOR/PARTNER/EXECUTIVE v J N OFFICER/MEMBER EXCLUDED? (Mandatory In NH) dying, describe under E.L. DISEASE - EA EMPLOYEE $ E.L. EACH ACCIDENT S DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS l LOCATIONS l VEHICLES (Attach ACORD let, Additional Remarks So todute, if more apace la required) CERTIFICATE HOLDER Village of Miami Shores 10050 NE 2nd. Avenue Miami Shores, FL 33138 CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Phi r2vc.,..- ®19882010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD