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EL-16-2622Project Address Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 Parcel Number Expiration: 05/03/2017 Applicant Owner Information EQUITY TRUST CO C/O RONALD A Address FL Phone CeII 10274 Sandy Cay Lane West Palm Beach FL 33412- Contractor(s) Phone Cell Phone B.J. BURNS INCORPORATED DBA 01 (786)286-3584 Valuation: Total Sq Feet: $ 1,700.00 250 Type of Work: ELECTRICAL OUTLETS, SWITCHES, LIGHT Additional Info: ELECTRICAL OUTLETS, SWITCHES, LIGHT Classification: Residential Scanning: 1 Fees Due CCF DBPR Fee DCA Fee Education Surcharge Permit Fee - Additions/Alterations Scanning Fee Technology Fee Total: Amount $1.20 $2.25 $2.25 $0.40 $150.00 $3.00 $1.60 $160.70 Pay Date Pay Type Invoice # EL -9-16-61440 11/04/2016 Check #: 3328 09/22/2016 Check #: 3313 Amt Paid Amt Due $ 110.70 $ 50.00 $ 50.00 $ 0.00 Available Inspections: Inspection Type: Final Meter Box Alteration Relocation Fire Alarm Service Change Review Electrical W. W. Underground 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 construction and zo • that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating , I authorize . above-named contractor to do the work stated. Authorized Signature: 0 / • nt / Contractor / Agent Building Department Copy November 04, 2016 Date November 04, 2016 1 Iz)i ( Miami Shores Village pmvs, Bui l d i ng Department 10050 N.E2nd Avenue, Miami Stores; Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION UNERIONENUMBEt (305) 762-4949 Stf- FBC2O BUILDING Master Permit No. f2C 8 - i ' 2.311 PHFM IT APPLICATION SAD Permit No. f 0 1 (.0- Z(.0 2 L ❑BUILDING El ELECTRIC ❑ FCORNG 0 REASON ❑ DCfBVSON FB' /VAL f'EPgt2016, A IPA ❑ PLUMBING ❑ MECHANICAL ❑ PUEUC WOFIKS ❑ CHANGE OF 0 G NCII ANON ❑ 9-I0P CONTRACTOR DRAWINGS ,CB ADDRESS q0 IV G it F -.F-- City: Miami 9iores County: Miami Dade Ap: Folio/ Parcel#. 1 1 " 316 >t - 02- ® -- (D® 1 I2he Building listorically Designated: Yes NO Qxiipanoi Type: Load: Construction Type: Rood pone: BFE FSE: OWNER Name (Fee ample Titleholder): O Wald `Jaid �` S Rione#: ctd' ^ 7 _ (4 32 C) Address: ,y10 2- 714. Sc,;,d� Ccs L aty: \.J U' p ct-e.1,1Sate: zip: 33 4 1 2 Tenant/Lessee Name: Phone#: Frail: �uf n1e#,t6e- CONTRACTR Company Name: J "- B vryiStomc. (d_ipc,, : i8 2-66- sa g Address: -7O G 13f5ca-c/ el.Q,)+ucf * so / aty: lq r a Sate: L Zip: 3 3 f 3 Qualifier Narrie: 7--a ki ict / Q 14 rt Phone#: 76 6 " Zi p 55 c) :tate Certification or Registration #: PER` 0 P/'1 / Z Certificate of Oampetency #: 1/E O Do 3Z. 9 DES OVER Architect/Engineer: Rione#: Address: City: Sate: Op: Square/ Linear Footage of Work: a c C Value of Work for this !limit: $ Q 1 OD Type of Work: ❑ Addition I► Alteration 0 New ❑p Rapair/F%plaoe Description of Work: E col I /Jacfr( S SIR.e�i'cl'llS/ 0 Demolition qaesify color of color thru tile: 0 aibmittal Fee $ I n �J F�irmit Foe $ ' / U CL's$ caws P S&anning Fee $ 3- ) Radon Fee $ � - 2TJ DBPR$ 2 ' 25 Notary $ Technology Fee $ l ` 60 Training/ Education Fee $ 0 - "10 Double Fee $ Sructural Reviews$ Bond $ 9 TOTAL FEE NOW DUES 11(5:0 (Ftsvised02/24/2014) • 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. OWNER or AGENT The foregoing instrument was acknowledged before me this 13 day of en6c101 G o i S ,whams personally kin to , 20 / L , by me or who has produced as identification and who did take an oath. NOTARY PUBUC: Sign: Print: Seal: QUIDA JACOBS MY COMtvlISS!ON N FF43855 `�,!!►Sif EXPIRES: August 14, 2017 APPROVED BY 7, i 427i C. (Revised02/24/2014)' Signature CONTRAR The foregoing instrument was acknowledged before me this day of . F , 20 (» , by •rr�.n-�. me or who has . ro sonally known to identification and who did take an oath. NOTARY PUBLIC: Sign: Print: Seal: w as QUIDA MY COMMISSIONJACOBS 1/ 55 0EXPIRES: August 14, 2017 ****************iii************* .q))-^ Plans Examiner Structural Review *********** Zoning Clerk Fax: (305) 572-8555 To: Fax: +1 (305) 7568972 Page 5 of 7 05/2612016 2:26 PM Fax: (305) 572-9565 To: Fax: +1 (306) 7688972 Page 6 of 7 06126/2018 2:28 PM QUALEYING TRADE(S) 0001 ELECTRICAL 0004 FIRE ALARM SPECLT AS:ma Wafts RE anzardory aetaaxed From: Nosily Nisbett Fax: (305) 572-9555 To: Fax: +1 (305) 7588972 Page 3 of 7 0512612016 2:26 PM OUTLO-1 OP ID: MKM ACURO" �, - CERTIFICATE OF LIABILITY INSURANCE DATE (MM+DD n 78 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: 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 Ileu of such endorsement(s). ERNAM 5915 INCINSURANCE DE LEON BSERVICES CORAL GABLES FL 33146 JAY A. WEINSTEIN CONTACT E Mary Muxo Ext):3 -2 Fax 305-6654236 WG �) L ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC INSURER A :ZENITH INSURANCE COMPANY COMMERCIAL GENERAL LIABILITY INSURED OUTLOOK INTERNATIONAL. ELECTRIC BJ BURNS INC. DBA 1411 SAWGRASS CORP. PKW #13-40 SUNRISE, FL 33323 ENSURER B: LNSURERC: INSURERD: $ 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 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 MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCE AD POUCY NUMBER POLICY IFF (MM/DD1YYYY) POLICY EXP �) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ AMAGE it) HEN i ED PREMISES (Ea occurrence) $ CLAIMS -MADE OCCUR MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GENt AGGREGATE POLICY OTHER: LIMIT APPUES PRO - JE PER: LOC PRODUCTS - COMP/OP AGG $ $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS — SCHEDULED AUT— NON OWNED AUTOS COMBINED SINGLE OMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) 8 PROPERTY DAMAGE (Per accident) $ $ UMBRELLA LIAB EXCESS UAB _ OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ $ DED RETENTION $ A WORKERS COMPENSATION AND EMPLOYERS, LIABILITY ANY PROPRIETOR/PARTNBUEXECUTIVE YIN OFRCERIMEMBER EXCLUDED? (Mandatory In NH) If yes, descrbe under DESCRIPTION OF OPERATIONS below NIA 2128621303 05/14/2016 05/14/2017 XOTH- STATUTE ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POUCY OMIT $ 1,000,000 DESCRIPTION OF OPERATIONS 1 LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached K more space Is required) Electrical Contractor Miam I Shores VIIIage Building Department 10050 NE 2 Ave Miami Shores Village FL 33138 THE SHOULD ANYTHEATTE TTHEREOOFOVE ,NNTICE POLICIES WILL BECELLED DELIVERED INS ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZEDREPRESEMIATNE qp-44 I 1 1-^""...--- ACORD 25 (2014/01) O 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD From: Nein Nisbett Fax: (305) 572-9555 To: Fax: +1 (305) 7668972 Pace 2 of 7 05726/2016 2:26 PM ACOJI'0� �, : CERTIFICATE OF LIABILITY INSURANCE DATE (t > '!) 05/20/2016 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 pollcy(ies) 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 Advanced Professional Insurance Ser 240 Lock Road Deerfield Beach FL 33442.. .. C0AI:r- nem Herrera I(954) rem µ, 725-6112F Nop (954)725-6115 moms: surtern@episus.com INSURERS) AFFORDING COVERAGE NAIC # INSURER A: WESTERN WORLD INSURANCE COMPANY 13196 INSURED BJ BURNS, INC.DBA Outlook International Electric 1411. Sawgrass Corporate Parkway Suite B40 .... .. .. .. Sunrise FL 33323 INSURER B : iii INSURER C : INSURER D : ___ . , . 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 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 MAY HAVE BEEN REDUCED BY PAID CLAIMS. 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 REPRESE Sunem.Herrera TWE all iui LTR TYPE OF NISURANCE - ;_ ; i ::, i, POLICY NUMBER Akita1, iii . _.. . COMMERCIAL GENERAL LIABILITY•11rOrrAMITIMIll s 1.,000,000 ■ CAIASb0.DE X OCCUR E= r ..« $100.000r MED E 0 (Niy one ) $ 50.000 I. NPP8353527 .. 05/14/2016. 05/14/2017 PERSONAL. & ADv.INJURY $ 1,000,000 ' • GEN'/ AGGREGATE LIMIT APPLIES PER . GENERAL AGGREGATE $ 2,000,000 X POLICY ElJPE8r. - - 1 1 LOC. PRODUCTS. COMPIOP AGG $ 2,000,000 OTHER _ $: AUTOfMORa F UABILrnf. ;.iw «• !: i ' $ ANY AUTO BODILY INJURY.(Psr. wenn) BODILY 5 ALL OWNED SCHEC I.ED AUTOS INJURY (Per accident) 5 HIRED HIRED AUTOS �_ A -0wP1Ep•a OAMAe%" IIIEXCESS UMBRELLA UAB. UAB ■ occuR CLAIMS MADE 1111111111111ni EACH OCCURRENCE AGGREGATE .. n1 �_• RETENTION$ WORKERS AND ANY COMPENSATION EMPLOYERS' LIABILITY Y I N PROPREETORT,ARTNERIEXECUTI E n IIEMIHIIIEEVIOIIIIIIIIIIIMII E.L. EACH ACCIDENT $. OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E.L. DISEASE - EA EMPLO -- $ IIIIIIIIIIIIIIIIIIIIIIIIIIMIIIIIIIIIIIIIIMIIIIIIIN pESCI6PT10N Certificate If )es: descnbe under DESCRIPTION OF OPERATIONS below OF OPERATIONS /LOCATIONS 1 VEHICLES Holder is additional insured. Electrical (ACORD Contractor 101. AddOlanal Remarks SWtedub,may, 6e attached U,mare slime IB.!4g}dred) EL. DISEASE -POLICY LIMIT i $ .. CERTIFICATE HOLDER CANCELLATION Miami Shores Village . 9 Building Department wow .N E 2 Ave Miami Shores Village FL 33138 - - • 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 REPRESE Sunem.Herrera TWE ACORD 25 (2014101) 6 18$8.2014 ACO RIfitORPORAT1ON. Ali rights reserved The ACORD name and logo are registered marks of ACORD From: Nay Nisbett 1 Fax: (305) 572-9555 To: Fax: +1 (305) 76688972 Page 4 of 7 05/26/2016 226 PAA !Q,Qualifying Board 'S'NEd S CERTIFICATE OF COMPETENCY 11 E000329 BURNS INCORPORATED D.BA_=err-C€ r ialTERNATIONALELECTRIC airr csrlil unitstejd1jj Casty a QUALIFYING TRADER 0001 ELECTRICAL 0004 FIRE ALARM SPECLT Xis, Nit Sams PE. Seeda)dtetkse iLai taSeCa tsedaiaslpia a rVisOeeia. Municipal Contractor's Tax Receipt Miami -Dade County, State of Florida -THIS IS NOTA BILL -DO NOT PAY CC NO: 11®00329 BUSINESS NAM E/LOCATION OUTLOOK INTERN/410NAL B.ECIRIC 4700 B19CAYNE BLVD 501 MIAMI, FL 33137 OWNER B J BUR'S BURN INOCIRFORAIED BEC7RICAL CONTRACTOR RECEIPT NO. 7497674 • TYPE OF BUSINESS MC EXPIRES SEPTEMBER 30, 2017 Pursuant to County Code Sec 10-24 PAYM ENT RECEIVED BY TAX COLLECTOR 200.00 11/04/2016 0223-17-000656 ibis receipt is not valid inthetdlowing MuredpalitlesAventura, Doral, Kaleah, Kay Biscayne, Miami Gardens, Muni lakes, Pal netto Bay, Pineorest, Sunny Isles Beach, Town d Culler Bay. For more information, visit www.niamidade govftaxcdiector Local Business Tax Faecei pt Miami -Dade County, State of Florida -THIS IS NOTA BILL - DO NOT PAY 5653713 BUSINESS NAM E/LOCATION OUTLOOK INTERNATIONAL ELECTRIC 4700 BISCAYNE BLVD 501 MIAMI, FL 33137 RECEIPT NO. RENEWAL 5897385 OWNER SEC. TYPE OF BUSINESS B J BURNS BURNS INCORPORATED 196 ELECTRICAL CONTRACTOR Worker(s) 1 11E000329 LD EXPIRES SEPTEMBER 30, 2017 Must be displayed at place of business Pursuant to County Code Chapter BA - Art. 9 & 10 PA YM ENT RECEIVED BY TAX COLLECTOR 45.00 09/28/2016 CREDITCARD-18-059070 ibis Local Business Tax Receipt oNyoon"rnspayment dthe Local Business Tax. The I ptisnot aticense, pernit, or a cerircation of the holder's quell 'cations, to do business. Holder must or nongweer regulatory taws and requir which apply to the ywitharrygouenarerdsf lhe RECEIPT NOabove rrtlatbedispiayedonall coAmercialvehiSes-Miami-Dade Code SECBa-T)Q For more irdarnetion, visit