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EL-18-509 Permit NO. EL-2-18-509 Miami Shores Village Permit Type: Electrical-Residential' 10050 N.E.2nd Avenue NE i Wo 10050 Alteration Miami Shores,FL 33138-0000 Per Permit status:APPROVED Phone: (305)795-2204 FtoRrvP i Issue Dat®:3/121201Expiration:P� Project Address Parcel Number Applicant 1250 NE 95 Street 1132060144070 DIANNE FISCHER Miami Shores, FL Block: Lot: Owner Information Address Phone Cell DIANNE FISCHER 1250 NE 95 Street MIAMI FL 33138-2550 Contractor(s) Phone Cell Phone Valuation: $ 770.00 ROSS ELECTRIC SOLUTIONS, INC (954)214-5476 (954)572-7626 Total Sq Feet: 0 Type of Work:REPLACE GFI AND INSTALL 4 RECESSED Available Inspections: Additional Info: Inspection Type: Classification:Residential Review Electrical Scanning: 1 I f i Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $0.60 Invoice# EL-2-18-66601 DBPR Fee $2.25 DCA Fee $2.00 02/27/2018 Cash $50.00 $ 108.85 Education Surcharge $0.20 03/12/2018 Check#: 1606 $ 108.85 $0.00 Permit Fee-Additions/Alterations $150.00 Scanning Fee $3.00 Technology Fee $0.80 Total: $158.85 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 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. Futhermore, I authorize the above-named contractor to do the work stated. le' March 12, 2018 Authorized Signature:Owner / Applicant / Contractor / Agent Date Building Department Copy March 12, 2018 1 j Miami Shores VillagecEi f Building Department 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(30S)762-4949 FBC 201 (� BUILDING Master Permit No. k- t� PERMIT APPLICATION Sub Permit No ✓ QBUILDING ® ELECTRIC ❑ ROOFING ❑ REVISION ❑EXTENSION ❑RENEWAL QPLUMBING ❑ MECHANICAL PUBLICWORKS CHANGE OF CANCELLATION SHOP 11 f i CONTRACTOR DRAWINGS JOB ADDRESS: (2 r-- fi 5O cry f City: Miami Shores County: Miami Dade Zig): 33 1.3 0 32�06 �'i,'t��! Folio/Pan:el#: � j - - - � Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: 41 r(��v OWNER:Name(Fee Simple Titleholder)t'G N+z SG tie✓ Phone#: 3 cr — 6 3 ' 47 53 Addre�ssss: �2 3_0 Q i= 95_4a 54,City 11 ak-.'X z 5�0'yeS State: TL Zip: Tenant/Lessee Name: (t II Phone#: Email: Cf4feC��G • +cSC_`lei CIL 4? Q_ CONTRACTOR:Company Name: R6-;75 EleJt�L SO -kc.)L' hone#: ps Zf-21�f Address: c>�. 3 S {city:ig CR k S� —State: �—Z Zip: 33 I 'Qualifier Name _ rl l L f V1 •-�, LC g L a In C � r Phone#: 26 State Certification or Registration#:Er— 15006-6,76 Certificate of Competency M DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ �7.70� '—'�""'9 Square/Linear Footage of Work: }Type of Work: ❑ Addition ❑ Alteration ❑ New Repair/Replace ❑ Demolition Description of Work: '.'• G Specify'color of color thru tile: Submittal Fee$ Permit Fee$ `, �1 A d CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ (RevisedO2/24/2014) a s ,,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$2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also,a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. h Signature_ Signature OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this Z(s'� day of Pb20 1,$ by �� ar v a day of Y 20 J!& by :a�nree ��c�-p✓ who i e kn ovally to nhit_ ip Ltbb IC_ ,who is sonally know o me or who has produced as me or who has produced as identification and who did take an oath. identification and who did talo,N,oath. `.•••;'4• STARFOUfCH•LILLY NOTARY PUBLIC: NOTARY PUBLIC: * * MY COMMISSION t FF 106154 EXPIRES:Maith 25,2018 ftdedThroaudpetNoWy$e"l= i Sig Sign: Print: Print: ir 1 " Seal: w�a JEANE MARTINEZ ` Notary Public—State o`Florida Sea I: STAR FOUTCH•LILLY 'JY:: My Comm.Ex7 r�Dec 4.202 t ; MY COMMISSION i FF 106154 t •aF Q"r. germed:tnrgr Na'jcaa Notary Assn. *\� F EXPIRES:MeaaO 25,2018 APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) GOVERNOR. ; -� _ KEN LAWSON, SECRETARY "'' , _. r�,•,,. STATE OF FLORIDA -„ DEPARTMENT OF=BU—S—lk S`S-AND;PROFESSIONAL.REGULATION� •:�"` ELECTRICi4L.00'NTRACT RS LICENSING':B i O O R - .. _ _ . - - � '•* '�..,.«.�M`°' "--i..ti�'--"fes ,, �"�`"^�'�!w.+'�``""�+:'- 'i.�a "w'*.4.�«.�`��."`'�i'+h. ''hy,' M�,.'\��* - Y` ;� EC13006896e � "`: ." _. The;EtECTRICAL4C ""ONTRACTOR"""' "`�- Named below IS10ERTIFIED.•, -�.. `' �.. � �Un'dertlieprovislonsofChapter�489FS. R r • Expiration date AUG•31,-2018 --- - �f' IN p . [EQ L'ANC;rPHILfP,.JJR. OSS:EL-ECTRICfSOLU1IINC." '�_ 10004,NV9y46TH:STRE '°" i - r SUNRlSE� _ jISS ED: 08/24 20 6 P- AS' t71REu r1th, s tZ `�°sos aaoos2s2 t BROWARD COUNTY LOCAL. BUSINESS TAX RECEIPT 115 S. Andrews Ave., Rm. A-100, Ft. Lauderdale, FL 33301-1895=954831-4000 VALVdiCTOBER'1,2017 THROUG-H SEPTEMBER 30,2018 DBA: tti Receipt#:181-25566 Business Name:ROSS ELECTRIC SOLUTIONS INC BUSIne$S Type: ELECTRICAL/ALARMS/CONTRAC yp (MASTER ELECTRICIAN CONT OR) �ff Owner Name:PHILIP J LEBLANC Business Opened:o5/21/2013 I Business Location:10004 NW 46 ST State/County/Cert/Reg:EC13o06696 I I SUNRISE Exemption Code: Business Phone:954-572-7626 Rooms Seats Employees Machines Professionals 2 For Vending Business Only Number of Machines: Vending Type: Tax Amount Transfer Fee NSF Fee Penalty Prior Years Collection Cost Total Paid I I 27.00 0.00 0.00 0.00 -01'bo 1 0.00 27.00 r ti THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS • Fi } THIS BECOMES A TAX RECEIPT This tax is levied for the privilege of doing business within Broward County and is non-regulatory in nature.You must meet all County,and/or Municipality planning WHEN VALIDATED and zoning requirements. This Business Tax Receipt must,be transferred when the business is sold, business name has changed or you have moved the business location.This receipt does not indicate that the business is legal or that it is in compliance with State or local laws and regulations. Mailing Address: ROSS ELECTRIC SOLUTIONS INC Receipt #ICP-16-00014328 10004 NW 46 ST Paid 07/19/2017 27.00 SUNRISE, FL 33351 07/17/2017 Effective Date i I I 015077 Local Business Tax Receipt Miami—Dad.e County, State of Florida -THIS IS NOT A BILL-DO NOT PAY 7.190749 LBT BUSINESS NAME/LOCATION . RECEIPT NO. EXPIRES ROSS ELECTRICSOINLTIONS INC RENEWAL SEPTEMBER 3O, 2018 DOING BUSINESS DADE COUNTY , ;� 7472260 Must be displayed at place of business Pursuant to County Code. ate" Chapter 8A-Art.9&10 OWNER SEC.TYPE OF BUSINESS ROSS ELECTRIC SOLUTIONS INC 196 ELECTRICAL CONTRACTOR PAYMENT RECEIVED C/O PHILIP J LEBLANC PRIES EC13006696 BY TAX COLLECTOR, Worker(s) -- 5 $75.00 07/12/2017 I CREDITCARD-17-046883 This Local Business Tax Receipt only confirms payment of the Local Business Tax.The Receipt is not a license, permit,or a certification of the holders qualifications,to do business.Holder must comply with any governmental or nongovernmental regulatory laws and requirements which apply to the business. The RECEIPT N0.above must be displayed on all commercial vehicles-Miami-Dade Code Sepea76. 1 For more information,visit www miamidade gov/taxcolle!oi'- - ` 4 i ---""1 ROSSE-1 OP ID- QJ ACORO' DATE(MMIDDrYYYY) CERTIFICATE OF LIABILITY INSURANCE 02126/2018 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 ADD111ONAL INSURED,the policy(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). PRODUCER 813-963-1669 cNRWCT DEBBIE JOHNSON CIC Morrow Insurance Group PHONE 813-963-1669FAX 813-830-7873 18936 North Dale Mabry Highway (A1C,No,Ext): (AIC,No): Lutz,FL 33548 :CERTIFICATES@MORROWINSURANCE.NET Steven Mitzel INSURERIS)AFFORDING COVERAGE NAIC 0 INSURER A:AMERICAN STATES INS CO 19704 INSURED ROSS ELECTRIC SOLUTIONS INC INSURERS:NATIONAL BUILDERS INSURANCE 16632 10004 NW 46TH ST SUNRISE, FL 33351 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. INSR TYPE OF INSURANCE ADDL SUB POLICY NUMBER POLICY EFF POLICMMIDlDIY)nMDY EXP LIMITS LTRA X COMMERCIAL GENERAL LIABILITY1,000,000 EACH OCCURRENCE $ CLAIMS-MADE OCCUR 01CIS7395510 03/1912017. 03/19/2018 DAMAGETO RISES(EaENToccED ren ce) $ 200,000 MED EXP(Any oneperson) 10'000 PERSONAL&ADV INJURY $ 1'00000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2'000'000 X POLICY F_x1 jpeT F]LOC PRODUCTS-COMPIOP AGG 2'000'000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ ANY AUTO BODILY INJURY Perperson) $ OWNED SCHEDULED AUTOS ONLY AUTOS yy Ep BODILY INJURY Per accident $ AUTO ONLY AUTOSONLY PROaERd�t AMAGE $ F $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ B WORKERS COMPENSATION PERTUTE X OR H- AND EMPLOYERS'LIABILITY ANY PROPRIETORIPARTNEWEXECUTIVE YIN WCV 0070820 08 09/09/2017 09!0912018 E.L.EACH ACCIDENT $ 1'000'000 OFFICERIMEM%R EXCLUDED' N 1 A 1,000 000 (Mandatory in H) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under 1,000,000 I DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) PHILIP J LEBLAC JR ROSS ELECTRIC SOLUTIONS INC. CERTIFIED ELECTRICAL CONTRACTOR LIC#EC13006696 1 CERTIFICATE HOLDER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN MIAMI SHORES VILLAGE ACCORDANCE WITH THE POLICY PROVISIONS. BUILDING DEPARTMENT 100:50 N.E.2ND AVE' AUTHORIZED REPRESENTATIVE MIAMI SHORES, FL 331338 ACORD 25(2016103) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD t I I.