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ELC-16-2555
Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Dn 1r, Inspection Number: INSP-267421 PermitNumber: ELC-9-16-2555 Scheduled Inspection Date: December 23,2016 Permit Type: Electrical- Commercial Inspector: Devaney, Michael Inspection Type: Final Owner: ,SHORES SQUARE INVESTMENTS Work Classification: Addition/Alteration Job Address:9025 BISCAYNE Boulevard Miami Shores, FL 33138-0000 Phone Number Parcel Number 1132060110051-25 Project: <NONE> Contractor: E&R ELECTRICAL INC Phone: (954)325-4702 Building Department Comments 2 OUTLETS AND 1 SIGN Infractio Passed Comments INSPECTOR COMMENTS False Inspector Comments Passed ,r Failed Correction ❑ � .��/� Needed Re-Inspection Fee No Additional Inspections can be scheduled until re-inspection fee is paid. December 22,2016 For Inspections please call: (305)762-4949 Page 12 of 32 Miami Shores Village Ftri11t 7yp )ttt) I:-Ctt@r1 ) 10050 N.E.2nd Avenue WcrkClaslfr�son:AdtNitlAn/Ailatit�t>i; _ '• "'""'' Miami Shores,FL 33138-0000 Aer> it 5tats�"AR1 - E `nrF° Phone: (305)795-2204 iss, sW1612016 Expiration: 03/15/2017 Project Address Parcel Number Applicant 9025 BISCAYNE Boulevard 1132060110051-25 SHORES SQUARE INVESTMENT Miami Shores, FL 33138-0000 Block: Lot: Owner Information Address Phone Cell SHORES SQUARE INVESTMENTS 3850 BIRD Road MIAMI FL 33146- Contractor(s) Phone Cell Phone Valuation: $ 600.00 E S R ELECTRICAL INC (954)325-4702 Total Sq Feet: 0 Type of Work:2 OUTLETS AND 1 SIGN Available Inspections: Additional Info: Inspection Type: Classification:Residential Final Scanning:1 Meter Box Alteration Relocation Fire Alarm Service Change Review Electrical W.W. Underground Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $0.60 Invoice# ELC-9-16-61357 DBPR Fee $2.00 09/15/2016 Check#:389 $50.00 $58.60 DCA Fee $2.00 Education Surcharge $0.20 09/16/2016 Credit Card $58.60 $0.00 Permit Fee $100.00 Scanning Fee $3.00 Technology Fee $0.80 Total: $108.60 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 Ak1d : I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction ore,I authorize the above-named contractor to do the work stated. September 16,2016 Authorized Signature:Owner / Applicant / Contractor / Agent Date Building Department Copy September 16,2016 1 Miami Shores Village Building Department € 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 P --- Tei:(305)795-2204 Fax:(305)756-8972 — INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 20 BUILDING M stenPermitNb- C,C PERMIT APPLICATION Sub Permit No.�w_t 6— 2ss5 ❑BUILDING �LECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL r-1 PLUMBING ❑MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BF((E: FFE: OWNER:Name(Fee Simple Titleholder): SRbf_C (SQVW 'PWaTtE'S4 Phone#:1'3�\1 n3- 115!; Address: 69& E 12,5--rH SSTAfe—i • City: Alar.•1H 6414:v11 State: TEWZiDA zip: ,31(0 I Tenant/Lessee Name: MODE" MAJE1 IAL A-aIS $ h"fPreI 5s ISI(- Phone#: Email: In 6A3 CONTRACTOR:Company Name: Z'S! A. �PAv IK L Phone* - Address: 9?o 014b/ANia .4-/� City: State: F�- zip: 33312 Qualifier Name: Toil mil ' a Phone#: �55._ 5S'7• '7� State Certification or Registration#: <E; L �.3�0 g"� Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ 16 OO • oo Square/Linear Footage of Work: Type of Work: F-1Addition El Alteration El New LJ Repair/Replace ❑ Demolition Description of Work: T t�u!/�t--�.P 11) SSA said Specify color of color thru tile: Submittal Fee$ IM, 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$ 7� (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 Signature / Ge J INNER or AGENT CONTRACTOR The foregoing instru ent was acknowledged before me this The foregoing instrument was acknowlgdged before me this 01, day of -5C-"1E M 9- .,20 It, by r6 day of ==- s �,J-MjL,20 1 A. by YOPAAA iZ�H+w who i ersonally know to CW<h'— Pf /&i<b t.�i;C ,who is personally known to me or who has produced as me or who has produced as identification and ho did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: Sign: rr Print: Print: 1 FLS" SYDIYi FF ROWWR Seal: s �� Notary PuWIC•State of Florida Seal: i 'ta(AES:February J3,018 Commission#FF 948519 tt"'Bud�tN S�y My Comm.Expires Apr 23.2020 Bonded through National Notary Assn. ***t* *a APPROVED BY /3'!`� /moo Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) STATEOF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD (850) 487-1395 2601 BLAIR STONE ROAD TALLAHASSEE FL 32399-0783 RUDDOCK, EVERTON D E& R ELECTRIC INC 920 INDIANA AVE. FT. LAUDERDALE FL 33312 Congratulations! With this license you become one of the nearly one million Floridians licensed by the Department of Business and �, Professional Regulation. Our professionals and businesses range may. STATE OF FLORIDA from architects to yacht brokers,from boxers to barbeque DEPARTMENT OF BUSINESS AND restaurants,and they keep Florida's economy strong. -' PROFESSIQNAL REGULATION Every day we work to improve the way we do business in order EC13001829 I$SUED: 07/24/2016 to serve you better. For Information about our services, please to onto www.myfloridalicense.com. There you can find more CERTIFIED ELEQ.TRICAL CONTRACTOR information about our divisions and the regulations that impact RUDDOCK,EVERTON D you,subscribe to department newsletters and learn more about E&R ELECTRIC INC the Department's initiatives. Our mission at the Department is: License Efficiently, Regulate Fairly.We constantly strive to serve you better so that you can serve your customers. Thank you for doing business in Florida, IS CERTIFIED under the provisions of Ch.489 qS. and congratulations on your new license! Expiration date,AUG 31,2018 tIG07240002526 DETACH HERE RICK SCOTT, GOVERNOR KEN LAWSON,SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD EC13001829 ADDITIONAL BUSINESS QUALIFICATION The ELECTRICAL CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 FS. ' � � Expiration date: AUG 31, 2018 U RUDDOCK, EVERTON D E& R ELECTRIC INCRPu 920 INDIANAAVE. �:� ,�� FT. LAUDERDALE �, 3312 ffla ISSUED: 07/24/2016 DISPLAY AS REQUIRED BY LAW SEQ# L1607240002526 R. ARD COUNW LOCAL BUSINESS TAX RECEIPT 115 S.AMrtm Ave.,Ism,A-100, Ft. Lauderdale, FL -1 1-40M VALID OCTOBER 1,2015 THROUGH SEPIEMBER30,2016 lsc�! / 1-2428 :E & R �RrCINC OMW NOtf60a MRTOW D RUDDMK SUOrmse OpWmd.*02/24/2004 Mahmn L e 90 INDIANA Statef =EC13001829 2 EkMhWM Phone'954-557-4070 ROOM Sam EMPWIBM Prefsedands 1 mumber of liendtrtg f Tax Fee I t+iSf'Fee 7 Pte/ Pftr Year$ conedwood Tom Paid 27.00 0.00 0.001 2.701 0.001 0.00 29.70 r THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS THIS BECOMES A TAX RECEIPT This Ucis bvied for Me W~of doing bAiness wMVn&wmd Cly and is non-re0uiakry in name.You must most aii County and/or MunkipaiHyy planning WHEN VALIDATED and zoning requiwwb.This Business Tax Reoeipt must be transferred when the business is sold, buskiess neons has urged or you have mowed the busiracss location.This rem does not'indwaft#wk the business is WgW or that 0 is in compliance with Sir or local lam and regulations. Mailing Address: EVERTON D RUDDOCK Receipt #108-15-00000215 920 INDIANA AVE Paid 10/09/2015 29.70 FORT LAUDERDALE, FL 33322 2015 - 2016 I A RO+C V CERTIFICATE OF LIABILITY INSURANCE DAT9/15/2016I� 09/15/2016 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 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(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 NCON AMTAE:CT Nikki Sciacca PHONE (954)792-3660 FVC No: (954)791-8019 Synergy Insurance Group Arc No 7771 W Oakland Park Blvd#122 EJDDRIESS: nsciacca@synergyins.net Sunrise,FL 33351 INSURERS AFFORDING COVERAGE NAIC# INSURERA: Lloyds of London Insurance Company INSURED INSURER B: E&R Electric,Inc. INSURERC: 3881 NW 4th Ct INSURER D: INSURER E: Ft Lauderdale FL 33311 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. INS, TYPE OF INSURANCE SUER POLICY NUMBER MM/DDLICY EFF MOMLDD EXP LIMITS LTR INSR R WVD GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000.00 D MAGE T RENTED 100,000.00 X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ CLAIMS-MADE X OCCUR MED EXP(Any one person) $ 5,000.00 A CIBFL0001992 10/14/2015 10/14/2016 PERSONAL&ADV INJURY $ 1,000,000.00 GENERALAGGREGATE $ 2,000,000.00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000.00 X POLICY PR0JECLOC $ AUTOMOBILE LIABILITY COa acc:clidentSINGLE LIMIT ANYAUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ WIRED AUTOS ATOS AUTOS UTOS PROPERTY DAMAGE $ Per accident UMBRELLA LIAR H OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION VUC STATU- OTHER - AND EMPLOYERS'LIABILITY YIN T ANY PROPRIETOR/PARTNER/EXECUTIVE F--1 E. E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space is required) License#13001829 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Miami Shores Village THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Building Department 10050 N.E.2nd Avenue AUTHORIZED REPRESENTATIVE Miami Shores FL 33138 ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION.All rights reserved. The ACORD name and logo are registered marks of ACORD TE A Rte® CERTIFICATE OF LIABILITY INSURANCE °A 9/8",o1s) 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 certlficate holder Is an ADDITIONAL INSURED,the pollcy(les)must have ADDITIONAL INSURED provisions or 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). ACT PRODUCER SUNZ Insurance Solutions, LLC. ID: (Ally) NAME: Melissa Ash c/o Allyy HR, Inc. PHONE 904739 2722 FAX No: 904 262-2760 9016 Phili s Highway E-MAIL Jacksonville, FL 32256 ADDRESS: mash matrixonesource.com INSURER(S)AFFORDING COVERAGE NAIC a# INSURERA: SUNZ Insurance Company 762 INSURED INsuRER B: Aspen Re-London-Best Rating"A+" Ally HR, Inc. 9016 Philips Hwy INsuRER c: Chaucer Syndicate-Lloyds-Best Ra' "A+ Jacksonville FL 32256 INSURER o: Faraday Syndicate-Lloyds-Bes ti +" INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER: 31684800 ER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE I_ D E OVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR O R C RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESC ED S SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLA INSR .SPE OF ULS Atm ADDL SUEFF CY BR POLICY NUMBER , LTR _ COMMERCIAL GENERAL LIABILITY - EACH OCCURRENCE $ UA ENTFLI CLAIMS-MADE 71 OCCUR C PREMISES a occurrence $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: 4fto GENERALAGGREGATE $ POLICY[::]JECT F—] LOC PRODUCTS-COMP/OPAGG $ OTHER: — $ COMBNED SINGLE LIMIT AUTOMOBILE LIABILITY - - Eaaccident) Iaccident $ ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per ecciderd $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ A WORKER,RCOMPENSATON W 032302 1/1/2016 1/1/20174. �/ STATUTE ERH AND EMPLOYERS'LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE YIN N I E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 It yea,describe under DESCRIPTION OF OPERATIONS below _ E L.DISEASE-POLICY LIMIT $ 1,000,000 B Workers Compensation This is for informational purposes C Excess Coverage and nothing shall create any right .,illIg D under such reinsurance. DESCRIPTION OF OPENS/ Voloyees HICLES (ACORD 101,Additional Remarks Schedule,mey be attached K more space Is required)Coveraw a but not subcontractors of:E&R Electric Inc 920 Indiana Ave. Effectiv Current oyees is One.Only Kenneth Griffith is covered. CERTIFICATE HOLDER CANCELLATION 7139 Miami Shores Village SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 9 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Building Department ACCORDANCE WITH THE POLICY PROVISIONS. 305-756-8972 10050 NE 2nd Ave Miami Shores FL 33138 AUTHORIZED REPRESENTATIVE � � w Glen J Distefano ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD 31684800 1 Master certificate I carine Arias 19/8/2016 11:57:38 AM (IDT) I Page 1 of 1