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EL-15-972/acJ-- 96y Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 nspection Number: INSP-251430 Permit Number: EL -4-15-972 Inspection Date: January 22, 2016 Inspector: Devaney, Michael Owner: Job Address: 5 NE 107 Street Miami Shores, FL 33161-7029 Project: <NONE> Contractor: HIGHGRADE ELECTRIC CONTRACTORS CORP Permit Type: Electrical - Residential Inspection Type: Final Work Classification: Addition/Alteration Phone Number Parcel Number 1121360070330 Phone: (305)576-8807 Building Department Comments REPLACE 28 HI HATS REPLACE GFI'S IN KITCHEN AND BATHS Infractio Passed Comments INSPECTOR COMMENTS False Passed Inspector Comments CREATED AS REINSPECTION FOR INSP-233209. Arc fault breakers. G. F. I. breaker for pool pump. Breaker locks in the off position. Remove broken fixture from east side of pool. /,. - iam' \r/1/6' Failed Correction Needed Re -Inspection Fee No Additional Inspections can be scheduled re -inspection fee is paid. until For Inspections please call: (305)762-4949 January 22, 2016 Page 1 of 1 • Project Address Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 5 NE 107 Street Miami Shores, FL 33161-7029 Owner Information Permit Permit NO. EL -4-155-972 Permit Type: Electrical - Residential Work Classification: Addition/Alteration Permit Status: APPROVED Issue Date: 9/15/2015 Expiration: 03/13/2016 Address Parcel Number 1121360070330 Block: Lot: EAST WEST PROPERTIES HOLDINGS 3900 NW 2 Avenue - - MIAMI FL 33127- 3900 NW 2 Avenue MIAMI FL 33127- Applicant EAST WEST PROPERTIES HOLE Phone Cell Contractor(s) Phone HIGHGRADE ELECTRIC CONTRACTO (305)576-8807 CeII Phone Valuation: Total Sq Feet: $ 4,500.00 00 Type of Work: REPLACE 28 HI HATS REPLACE GFI'S IN Additional Info: Classification: Residential Scanning: 3 Fees Due CCF DBPR Fee DCA Fee Education Surcharge Permit Fee - Additions/Alterations Scanning Fee Technology Fee Total: Amount $3.00 $3.38 $3.38 $1.00 $225.00 $9.00 $4.00 $248.76 Pay Date Pay Type Invoice # EL -4-15-55308 09/15/2015 Credit Card 04/23/2015 Credit Card Amt Paid Amt Due $ 198.76 $ 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 AFF constr ction a AVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating tiorize the above-named contractor to do the work stated. Authorized Signature: Owner / Applicant / Contractor Building Department Copy / Agent September 15, 2015 Date September 15, 2015 1 P R� BUILDING PERMIT APPLICATION BUILDING ECTRIC 0PLUMBING 0 MECHANICAL 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 KECEIVED APR 23 2015 BY: FBC201O Master Permit No2C q y Sub Permit No. Z7 /� " 9-72_ 0 ROOFING El REVISION ❑ EXTENSION ❑RENEWAL 0 PUBLIC WORKS 0 CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 5 N../E. 1 o -14-- . City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Buildingil^Historically Designated: Yes Occupancy Type: ie, r��� i.� . Load: Construction Type: Flood Zone: BFE: OWNER: Name (Fee Simple Titleholder): Address: 2 cDcD tv City: t NO tri FFE: t_,-LC- PFione#: 3O5 - S lc;. CI (4,S w �—_� fes. State: �L - Tenant/Lessee Name: / Phone#: Email: Zip: -3 1 --�, Cvi-CD S' CONTRACTOR: Company Name:,-jg Cs ( Phone#: -�S — q "B6 Address: 3(0 13 S-/"/ (o% /.e . City: 'T ( C ' C / State: Til Zip: 3 L�a'� -� Qualifier Name: {G O^ (^r�G Phone#:2(j'S - CI86'a-4 . State Certification or Registration #: Ci CI E_. .0 c)C13 e g DESIGNER: Architect/Engineer: Address: Value of Work for this Permit: $ Certificate of Competency #: Phone#: City: State: Zip: Square/Linear Footage of Work: 1 Zoo El Demolition Type of Work: Description of Work: 5c) z) ❑ Addition ❑ Alteration n New 0"1tepair/Replace iG C e z8 1---)% 9 ►-ter �-s', r -r- Icy cc C>:, F K.% -��. c.-- ►-�c.-was Specify color of color thru tile: Submittal Fee $ Permit Fee $ 726 , 4742 Scanning Fee $ Radon Fee $ Technology Fee $ Structural Reviews $ (Revised02/24/2014) CCF $ CO/CC $ DBPR $ Notary $ Training/Education Fee $ Double Fee $ Bond $ TOTAL FEE NOW DUE $ 1-1 6) • -9 v 1P 1 • 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 OWNER or AGENT The foregoing{ instrument was acknowledged before me this �4l'ay of Ap•f t , 20 I `'5. ���Y`r-?'�C� (-2► d-elc:19Gi1 is p sonally kno me or who has produced identification and who did take an oath. NOTARY PUBLIC: Signature���C Ley- />,e,N.) CONTRACTOR The foregoing instrument was acknowledged before me this by day of AJY t t . , 20 I '� by i to N- -LCCYm ` t (rYYa, who is ersonally kno n to as me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign:J Sign: � NNI ANN BLANK Print: �.� 1 :,14 Print: Seal: Seal: EXPIRES EXPIRES October 1, 2018 (407) 3&34153 F oridallota Service.com MY COMMISSION #FF1580 EXPIRES October 1, 2n-; F oridallotaryService.com ************************************************************************************************************ ,,i'%- /- APPROVED BY •��ii�4-f"// g'e" 7, Plans Examiner (Revised02/24/2014) Zoning Structural Review Clerk ".1)4/2'2/2015 18:36 3058200670 ACCPROrCERTIFICATE OF LIABILITY INSURANCEr=' 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 INSURE -R(3), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. — IMPORTANT; Vibe certilkate holder is an ADDITIONAL INSURED, the policy¢esj must be endorsed_ if SUBROGATION Is WAIVED, subs to the terms and rand ar:1ns of the policy, cerin pollcles may require an endorsement A statement on ttNs certificate does not confer rights to the oertUHcate holder In lieu crf stuck endorsement(s). MutuallnsuranceGroup #4286 P.001/001 PRODUCER Mutual Insurance Group Of Florida 5580 W. 16th Avenue, Suite #105 Hialeah, FL 33012 Phone (305) 820-0600 INSURED HIGHGRADE ELECTRICAL 3613 SW 167 AVE HOLLYWOOD, FL 33027 Fax (305) 820-0670 COVERAGES (786) 357-8728 MITeAcr GLADYS DELGADO PHONEwatxm (305) 820-0600 SliadY4IMULBalinsurancelLoorn I lac, No) (305) 820-0670 INSURERS) ADDING COVERAGE 1 NAHC t INSURER A : ASCENDANT COMMERCIAL INSURER 8 : ENSURER D ENSURER E INSURER F 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. INSR LIR TYPE OF INSURANCE GEtAERAL LiABEI Y • COWAERCIAL GENERAL LIABILITY ❑ 0 CLAIMS MAOE OCCUR GEN'L AGGREGATE LINT APPLIES PER ❑ POLICY ❑ jR ❑ LDC BRI POLICY EFF POUCY EXP POLICY NUMBER (MMIDD/Y'YYY) (YWDDWYYYY) ALITONOBI E LIAERLITY ❑ ANY AUTO n ALL OWNED SCHEDULED AUTO ❑ ► OIC O VINO ❑ HIRED AUTOS ❑ AlJros O ❑. GL -46864-0 ❑ MEBRELLA LAB ❑ OCCUR ❑ MESS UAB 0 CLARISHdADE O DED 0 RETENTIONS WORKERS CONPerISATWN ANP EmPLOYERS L.IAluftY Y / N ANY PROPRErORIPARTNER/ExECUTNE OFFICER/MEMBER EXCLUDED? (MandinorY in NH) OFSCAP1IONembe OPERATIONS below NIA 01/08/2015 LAMS EACH OCCURRENCE $ 1,000,000.00 DAMAGE TO RENTED 10q,000.00 __MENSES (Ea oo urree) $ MED EXP (Any one person} S 5,000.00 01/08/2016 -- PERSONAL & Acv INJURY $ 1,000,000-00 GENERAL AGGREGATE $ 2,000,000.00 PRODUCTS - COMPiOP ACC3 $ $ C SINGLE LMT $ODILY INJURY (Per p6raon) BODILY INJURY (Per sodden PROLeer �R�'E EACH OCCURRENCE AGGREGATE $ $ $ $ $ $ $ n WG STATU- OTH- „j TQIZY. LILA T$ ER El.. EACH ACCIDENT $ EL DISEASE - EA EMPLOY ES $ EL. DISEASE - POLICY LAW I $ DESORPTION OF OPERATIONS/ LOCATIONS I VEHICLES (Altar ACORD 101, Miasma Reirdifie6 Schedule, it afore roam in required) NELSON PALMA STATE CERTIFICATION -99E000388 ITRADE-CERTIFIED ELECTRICAL CONTRACTOR CERTIFICATE HOLDER CANCELLATION VILLAGE OF MIAMI SHORES BUILDING DEPARTMENT 10050 NE 2ND AVE MIAMI SHORES, FL 33138 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE %NTH THE POLICY AUTHORIZED REPRESENTATIVE ACORD 25 (2010105) QF The ACORD name a CO - • RATION. All rights reserved. logo are registered marks of ACORD • i -0 61W-- (S—(`6cf S-612 ACORD CERTIFICATE OF LIABILITY INSURANCE DATE (MMroD/YYYY) 01/19/2016 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 policypes) must be endorsed. If SUBROGATION I5 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 Mutual Insurance Group Of Florida 5580 W. 16th Avenue, Suite #105 Hialeah. FL 33012 Phone (305) 820-0600 INSURED HIGHGRADE ELECTRICAL Of Florida LLC Fax (305) 820-0670 3613 SW 167 AVE HOLLYWOOD FL 33027 CONTACT _.. NAME'............ PHONE (AIC, No, Ext): EMAIL ADDRESS: GLADYS DELGADO (305) 820-0600 gladys@mutualinsurancefl com INSURERS) AFFORDING COVERAGE INSURER A : ASCENDANT COMMERCIAL INSURER 8 : INSURER C INSURER D : INSURER E : INSURER F : FAX...............�_.._... _,. 4AIc, No (305) 820-0670 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. INSR ADDLSUR B LTR ,INSR WVD. POLICY NUMBER A TYPE OF INSURANCE Nej COMMERCIAL GENERAL LIABILITY L.; CLAIMS.MADE Vi OCCUR GENE. AGGREGATE LIMIT APPLIES PER POLICY PRO- r—' JECT LOC OTHER AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS H� fl SCHEDULED AUTOS NON -OWNED AUTOS UMBRELLA LIAB ' OCCUR EXCESS LIAB 2. CLAIMS -MADE DEO ......; RETENTIONS WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPR!ETOR/PARTNER/EXECUTNE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes: descnbe under DESCRIPTION OF OPERATIONS below N/A GL -46664-1 POLICY EFF POLICY EXP 4MMIOD/YYYY) (MMIDDIYYYY) LIMITS EACH OCCURRENCE 5 DAMAGE TO RENTED PREMISES (Ea occurrence) 5 MED EXP (Any one Person) 5 01/08/2016 01/08/2017 PFRSONAI. 8 ADV INJURY $ GENERAL AGGREGATE. $ PRODUCTS-COMP/OPAGG S COMDINED SINGLE. LIMIT tEn.acc/den12...._.. BODILY INJURY (Per person) $ BODILY INJURY (Per accident} 5 PROPERTY DAMAGE 5 (Pe, acc,dent) EACH OCCURRENCE AGGREGATE PER STATUTE C'..L EACH ACCIDENT $ 5 OTH- ER E DISEASEEA EMPLOYEE E . DISEASE. - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Nelson Palma Electrical Contractor License number: EC13006296 CERTIFICATE HOLDER Miami Shores Village Building Department 10050 NE 2nd AVENUE, Miami Shores, Florida 33138 fax 305-756-8972 CANCELLATION NAIC # 1:000.000.00 100,000.00 5,000.00 1.000.000 00 2,000.000.00 1.000..000.00 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 © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) QF The ACORD name and logo are registered marks of ACORD BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT 115 S. Andrews Ave., Rrn A-100, Ft Lauderdale FL 33301-1805- 954.83,-1C00 VALID OCTOBER 1,2015 THROUGH SEPTEMBER 30, 2016 DBA; Business Name: HlG*GP DE r1.4CI'RICAL (F r,^ Owner Name: MEI SCI; y nota Business Location: 11+13 sk :( 0 Ala tiTRAGIAN. Business Phone:35-0_5,28 Room Tax Amount Seats Number of Machines; Employees RssTI e: ECTn1U3tlAtOlt MS!r:OiRCtA:1° BusinesaTypet,�cT-.-cal cos�rx:-�c;-.� Business Openedzil/08. 21S StatefCounty/Ce,L Reg:,:C130:,h29b Exemption Code: Machines Professionals For Vending BTmeseCrl, --- - Vending Type: _., Penalty Prior "foals TbC Ct);) THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS THIS BECOMES A TAX RECEIPT WHEN VALIDATED Mailing Address: t4E L:itiiN A I'AJ P. 3513 Shl 167 AVE MIRAMAR, FL +t77 This tax is le'.ted for the privilege of doing business Who Brow-urd County and non-roculaxry in nature. Y7u must meet ad County andror Muniapelity planning and zon ng requirements. 'his Business Tan Receipt meet be iransferrec when Irte busiress is sold. business name nes changed or ycu have moved the business Iocztion. This recept noes not inyicate that the business is *gel or the: t is in COT pkence with State x local lams and regulations. 2015 - 2016 Receipt .01A -44-3C610462 Paid 09/30/2C15 27.00 JEFF ATWATER CHIEF FINANCIAL OFFICER STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION * * CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW * * CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law. EFFECTIVE DATE: 10/10/2014 EXPIRATION DATE: 10/9/2016 PERSON: PALMA NELSON A FEIN: 471870302 BUSINESS NAME AND ADDRESS: HIGHGRADE ELECTRICAL OF FLORIDA LLC 3613 SW 167TH AVENUE M I RAMAR FL 33027 SCOPES OF BUSINESS OR TRADE: LICENSED ELECTRICAL CONTRACTOR Pursuant to Chapter 440.05(14), F.S., an officer of a corporation who elects exemption from this chapter by filing a certificate of election under this section may not recover benefits or compensation under this chapter. Pursuant to Chapter 440.05(12), F.S., Certificates of election to be exempt... apply only within the scope of the business or trade listed on the notice of election to be exempt. Pursuant to Chapter 440.05(13), F.S., Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation if, at any time after the filing of the notice or the issuance of the certificate, the person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate. The department shall revoke a DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 07-12 QUESTIONS? (850)413-1609