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EL-15-1528Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 �zcl5- I I S3 Inspection Number: INSP-269094 Permit Number: EL -6-15-1528 Scheduled Inspection Date: October 19, 2016 Inspector: Devaney, Michael Owner: Job Address: 1263 NE 94 Street Miami Shores, FL Project: <NONE> Contractor: PROSTAR ELECTRICAL CONTRACTOR INC Permit Type: Electrical - Residential Inspection Type: Final Work Classification: Addition/Alteration Phone Number (954)288-7886 Parcel Number 1132050100070 Phone: (786)307-4295 Building Department Comments NEW PANEL & NEW ELECTRIC UPDATE EXISTING Infractio Passed Comments INSPECTOR COMMENTS False Passed L Failed Correction Needed Re -Inspection Fee No Additional Inspections can be scheduled until re -inspection fee is paid. Inspector Comments CREATED AS REINSPECTION FOR INSP-268999. No access. At 3:20 P. M.. October 18, 2016 For Inspections please call: (305)762-4949 Page 18 of 26 Project Address Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 P mit Permit NO. EL -6-15-152$ Permit Type: Electrical - Residential Work Classification: Addition/Alteration Permit Status: APPROVED Issue Date: 8118/2015 Expiration: 02/14/2016 Parcel Number Applicant 1263 NE 94 Street Miami Shores, FL 1132050100070 Block: Lot: NUHOUSE INVESTMENTS INC Owner Information Address Phone Cell NUHOUSE INVESTMENTS INC 15751 SHERIDAN Street FORT LAUDERDALE FL 33331- (954)288-7886 Contractor(s) Phone PROSTAR ELECTRICAL CONTRACTC (786)307-4295 Cell Phone Valuation: Total Sq Feet: $ 11,050.00 0 Type of Work: NEW PANEL & NEW ELECTRIC UPDATE EXI Additional Info: Classification: Residential Scanning: 1 Fees Due CCF DBPR Fee DCA Fee Education Surcharge Permit Fee - Additions/Alterations Scanning Fee Technology Fee Total: Amount $7.20 $5.81 $5.81 $2.40 $387.00 $3.00 $9.60 $420.82 Pay Date Pay Type Invoice # EL -6-15-56048 08/18/2015 Credit Card 06/22/2015 Credit Card Amt Paid Amt Due $ 370.82 $ 50.00 $ 50.00 $ 0.00 Available Inspections: Inspection Type: Final Meter Box Alteration Relocation Fire Alarm Service Change Review Electrical Underground W. W. 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 AFFIDA construction a certify th Futhe Authorized Signature: Owner rregoing information is accurate and that all work will be done in compliance with all applicable laws regulating ofize the above-named contractor to do the work stated. / Applicant / Contractor / Agent Building Department Copy August 18, 2015 Date August 18, 2015 1 Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 iucErSTED JU g2 2015 BY FBC20(0 BUILDING Master Permit No. RC.. 5 • 15- 1 153 PERMIT APPLICATION Sub Permit No. n_ 15— ( 52.1 ❑BUILDING CAELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 1 Z6 ✓ 1v Lt S� City: Miami Shores County: Miami Dade Zip: 33138 Folio/Parcel#: 11 — 320S— • 0 10 • 00Z0 Is the Building Historically Designated: Yes NO A Occupancy Type: Load: Construction Type: C.42>C.42>Flood Zone: At BFE: 1.100 FFE: OWNER: Name (Fee Simple Titleholder): Ntto AE L -STi hAessi-5 Address: 1 gi S-1 51'tE•4zt.Dk r . (LiS Phone#: gt. Z -et /WAX City: 'Pr- WkO D A t: State: Zip: 3 3 3 3 Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: YA' OS/'.¢/z Z�Pc%; c i4 L a•OriizA c77Air k / nl ( Phone#:266-3) 7- VaeR.5-- Address: /6/V) ,41 i C) 26 0 67— City: City: Pa (1 L_ State: / Zip: 3.3 / 6 - Qualifier qualifier Name: 81/ 4,4 ¢ AJ f 6 .X Po ,) Phone#: _=. - 32j,2- 6<,,2's— State Certification or Registration #: 4=C D ,O, el: 66 S Certificatellof Competency #: DESIGNER: Architect/Engineer: GVIE Z hJJWLL )T E i• Difi'1&t Phone#: 1t6- Z55 - 2-110 Address: 1lo Address: 2160N MtiW ( Po'Wcs sbo o City: M �C hi E State: PL, Zip: 3'1' 12/.7 Value of Work for this Permit. $OG• //O 4-0' 0 Square/Linear Footage of Work: Zi N1 Type of Work: ❑ Addition E Alteration JNew 1j. Repair/Replace ❑ Demolition Description of Work: NOW Ph tSEU 4 f JtW .lX0Cl ,L C ' (! P P/1, .e)ot511 WI Specify colorof.color thru.tile: •s Submittal Fee' �� (•- .'.. ..,. Permit Fee >.. CCF $ CO/CC $ f a Scanning Fee Radon Fee $ DBPR $ Notary $ Technology Fee $ Training/Education Fee $ Double Fee $ Structural Reviews $ Bond $ TOTAL FEE NOW DUE $ 0 Ping •% 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 NOTICEOF 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. OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this 1\ day of J 01.3E , 20 lS , by / l day of c%% ai L- , 20 /S' , by t�fl�7L C, , who is personally known to efrIAOij b P i , who is personally known to me or who has produced A, -DL $k _ 1 identification and who did take an oath. NOTARY PUBLIC: Sign: Print: Seal: L LOZ 'Vg 100 :8381dy3 L989903I# NOISSMIN00 AW 09tH WOWS ***************** identification and who did take an oath. ASOd-1)06 NOTARY PUBLIC: Sign: n Print: ,'i L.4 2j ZZ (i Seal: ****************** APPROVED BY �u� Plans Examiner Notary Public State of Florida s Nils Rizzo M y Commission FF 081061 sfie rt9rb******** ************* Zoning Structural Review Clerk '` ::mi'l CERTIFICATE OF LIABILITY INSURANCE DATEIMWDO/YYYY) 06/10/2015 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. IMPORTANT: M the certificate holder is an ADDITIONAL INSURED, the poticylies) must be endorsed. 0 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). G -Mar insurance 8200 W 33 Ave #7 Hialeah, FL 33018 Phone (305) 287-4541 Fax (305) 287-4543 fart NAME t MARY URREGO PN ty,_), (305) 267-4541 rnrc, No (305) 267-4543 AnnirFas: quotes@gmarinsuranCe.cOm . INSURER(S) AFFORDING COVERAGE NAIC 5 INSURER A: FEDERATED NATIONAL GENERAL LIABIUTY GENERAL LABILITY ❑ ❑ CLAIMS -MADE W OCCUR ❑ INSURED Prostar Electrical Contractor, Inc 11569 S.W 5 STREET MIAMI FL 33174 INSURER a : NORMANDY HARBOR INSURANCE COMPANY GL0000027407-00 INSURER 0 : 00,000 00 OCOMMERCIAL INSURER 0: $ 1 x,000.00 NSURER E : $ 1,004,000.00 INSURER F; GENERAL AGGREGATE • a.vV cnrwacO ..........��....-,....—__ -- 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 BEiSSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN 13 SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. UMITS SHOWN MAY HAVE BEEN REDUCED BY PAID IL. R TYPE OF RISURANCE INSA SRWVWVD ,1"RIR'---, l POLICY NUMBER (M DNYYYYYt 03/29/2015 pppCLAIMS. fMMNOtYYYY1 03/29/2016 UMTS EACH OCCURRENCE $ 1,000,000.00 A GENERAL LIABIUTY GENERAL LABILITY ❑ ❑ CLAIMS -MADE W OCCUR ❑ N GL0000027407-00 DAMAGE TO RENTED PREMISES (Ea occurrence) 00,000 00 OCOMMERCIAL MED EXP (Any arta person) $ 1 x,000.00 PERSONAL &ADV INIURY $ 1,004,000.00 ❑ GENERAL AGGREGATE $ 2,000,000.00 GENE. AGGREGATE LIMIT APPLIES PER: PRODUCTS • COMP/OP AGG $ 2,000,000.00 r POLICY • PEEN • LOC$ B AUTOMOBILE LIABILITY 0 ANY AUTO ALL OWNED SCHEDULED ❑ AUTOS ❑ AUTOS NON•OWNEO ❑ HIRED AUTOS 0 AUTOS �I 0 CORacci idf'sntl NGLE LIMIT t50011Y 5 INJURY (Per person) $ BODILY INJURY (Per ecadent) $ ppMq g0° en1) GE $ $ ❑ UMBRELLA LAB ❑ OCCUR 0 EXCESS LAB C CLAIMS -MADE • EACH OCCURRENCE $ AGGREGATE $ ❑ DED 0 RETENTION$pp $ B WORKERS COMPENSATION AND EMPLOYERS' UABLITY Y / N OFFI OFFICER/MEMBER EXCLuOEO?? ECl1T1VEtN (Msndstory in NH) I1 yes, describe underE.l. DESCRIPTION OF OPERATIONS below N /A N NHFL142551 ' 07/17/2014 07/17/2015 ER ❑ STATUTE ❑ S E L EACH ACCIDENT $ 100.000.00 £.L DISEASE - EA EMPLOYEE $ 500,000.00 DISEASE -POLICY LIMIT $ 100,000.00 I DESCRIPTION OF OPERATIONS i LOCATIONS / VEHICLES (Attach ACORD 101, Adeltheet Remarks Schedule, 0 more spice le required) ELECTRICAL WORK LICENCE EC.0000405 CANCELLATION 1 MIAMI SHORES VILLAGE BUILDING DEPARMENT 10050 N.E 2 AVE MIAMI SHORES VILLAGE FL.33138V SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE MARY URREGO }(1` ,1"RIR'---, l ACORD 25 (2014/01) QF ®1988.20141 RD CORPORATION. AM rights reserved. The ACORD name and Togo are registered marks of ACORD • itI�ORb® CERTIFICATE OF LIABILITY INSURANCE �..�' DATE(MM/DD/YYVY) 07/16/2015 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 BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the poilcy9es) 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 G -Mar Insurance 8200 W 33 Ave #7 Hialeah, FL 33018 Phone (305) 267-4541 Fax (305) 267-4543 REACT GERMAN URREGO Welk;, (305) 267-4541 1 rttxc No): (305) 267-4543 ADDRESS: quotes@gmarinsurance.com INSURER(S) AFFORDING COVERAGE NAC If INSURER A: FEDERATED NATIONAL GL0000027407-00 INSURED Prostar Electrical Contractor, Inc 11569 S.W 5 STREET MIAMI FL 33174 INSURER 5: NORMANDY HARBOR INSURANCE COMPANY EACH OCCURRENCE INSURER C: DAMAGE TO RENTED PREMISES (Ea occurrence) INSURER D : ❑ CLAIMS -MADE OCCUR INSURER E : S 1,000,000.00 PISURER F PERSONAL 8 ADV INJURY • REVISION NUMBER: %eV V Gra"\it. vr......r...— ........... ... 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, EXCWSIONS AND CONDITIONS OF SUCH POUCIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IISR TYPE OF INSURANCE ADDLSUBR NSR WVD POUCY NUMBER , POLICY EFF (MM/DD/YYYY) POLICY EXP LIMBS (MMIDOIWYY)� LTR A ❑/ COMMERCIAL GENERAL UABIUTY N GL0000027407-00 03/29/2015 03/29/2016 _ EACH OCCURRENCE $ 1,000,000.00 DAMAGE TO RENTED PREMISES (Ea occurrence) $ 100,000 DD ❑ CLAIMS -MADE OCCUR MED EXP (Any one person) S 1,000,000.00 . PERSONAL 8 ADV INJURY $ 1,000,000.00 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000.00 In POUCY • FER& • LOC LI OTHER PRODUCTS - COMP/OP AGG $ 2,000,000.00 $ B AUTOMOBILE LIABILrTYE ❑ ANY AUTO ❑ Amu O NED D ASETHRULED NON -OWNED ❑ HIRED AUTOS ElAUTOS 0❑ r, Ca t81NGLE LIMIT $ BODILY INJURY (Per person) S BODILY INJURY (Par accident) $ PROPERTY DAMAGE $ (Per accident) $ EACH OCCURRENCE $ II UMBRELLALIAB OCCUR AGGREGATE $ NI EXCESS UAB • CLAIMS -MADE RETENTIONS1 DED 0 B WORKERS COMPENSATION AND EMPLOYERS' LIABIUTY Y f N ANY PROPRIETOR/PART OFFICER/MEMBER EXCLUDED? N 1 N /A N NHFL0025512015 07/17/2015 07/17/2016 0 STATUTE • r$ E.L EACH ACCIDENT $ 100,000.00 E.L.DISFJkSE- EA EMPLOYEE $ 500,000.00 (MYndatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY UMIT $ 100,000:00 DESCRIPTION OF OPERATIONS! LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space fs required) ELECTRICAL WORK UCENCE EC.0000405 • CERTIFICATE HOLDER MIAMI SHORES VILLAGE BUILDING DEPARMENT 10050 N.E 2 AVE MIAMI SHORES VILLAGE FL33138 ACORD 25 (2014/01) OF AN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PRO • AUTHORIZED REPRESENT GERMAN URRE 1101( • o4 ACOR • • ' ` • AT1ON. Ail rights reserved. ACORD name logo are registered marks of ACORD