EL-17-2888 Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972 '
Inspection Number: INSP-306918 Permit Number: EL-12-17-2888
Scheduled Inspection.Date: June 22, 2018 Permit Type: Electrical - Residential
Inspector: Devaney, Michael
Inspection Type: Final
Owner: LESTRADE SFARA,VERONIQUE Work Classification: Low Voltage
Job Address: 1080 NE 105 Street
Miami Shores, FL 33138- Phone Number (305)799-2006
Project: <NONE> Parcel Number 1122320280090
Contractor: A&M CONTROL SYSTEM LLC Phone: (786)237-6677
Building Department Comments
REPAIR/UPGRADE CCTV OUTDOOR. Infractio_ Passed Comments
INSPECTOR COMMENTS False
i
Inspector Comments
PassedEHII
Failed
2z r U 9 l�
Correction ❑
Needed
Re-Inspection ❑
Fee
{
No Additional Inspections can be scheduled until
re-inspection fee is paid.
p
{
'une 21, 2018 For Inspections please call: (305)762-4949
Page 19 of 29
I
r
43
Permit,No. EL-12-17-2888
`SNoREs Miami Shores Village Permit Type;,Electlrical Residential
10050 N.E.2nd Avenue NE Work Classification:Low Volta e
Per Miami Shores,FL 33138 0000 it
Permit Status:APPROVED
Phone: (305)795-2204
CORLOp`
Issue Date: 1/18120it Expiration: 07/17/2018
Project Address Parcel Number Applicant
1080 NE 105 Street 1122320280090
VERONIQUE LESTRADE SFARA
Miami Shores, FL 33138- Block: Lot:
Owner Information Address Phone Cell
LVE.R.ONIQUE LESTRADE SFARA 1080 NE 105 Street (305)799-2006
MIAMI SHORES FL 33138-2106
Contractor(s) Phone Cell Phone Valuation: $ 1,468.02
A&M CONTROL SYSTEM LLC (786)237-6677 Total Sq Feet: p
Type of Work:REPAIR/UPGRADE CCN OUTDOOR. Available Inspections:
Additional Info: Inspection Type:
Classification:Residential
eview Electrical
Scanning:3
f
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $1.20
Invoice# EL-12-17-65844
DBPR Fee $2.00 12/07/2017 Check#: 1228 $50.00 $66.20
DCA Fee $2.00
Education Surcharge $0.40 01/18/2018 Check#: 1237 $66.20 $0.00
Permit Fee-Additions/Alterations $100.00
Scanning Fee $9.00
r
Technology Fee $1.60
Total: $116.20
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 zonin . Fu er ore, I authorize the above-named contractor to do the work stated.
L=n January 18, 2018 1
Aud ignature:Owner / Applicant / Contractor / Agent Date
Building Department Copy
January 18, 2018 1
�ir1oN �C'�Ak
/K Miami Shores Village
D C 07 2017
Building .. partment
BY:
i 10051 N.E.2r.-'' ":1 i Shores,Florida 33138
V ?I:(305)795-2204 Fax.(305)756-8972 j
INSPECTION LINE PHONE NUMBER:(305)762-4949 5 l
FBC 201�/QQ,��
BUILDING Master Permit No.7T�:
PERMIT APPLICATION Sub Permit No.
❑BUILDING ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
�
CONTRACTOR DRAWINGS
JOB ADDRESS: 1 'k 3 C) 10! 5-1 P- e-r
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: Q.2 3a— fl,2'9 " O 09 O Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
}J r
OWNER:Name(Fee Simple Titleholder): '6- lt4l'QoE /ARA Phone#:
Address: y o Os-
City: t�)/7 H I S*:s125 State: �lel t/A Zip: 3 Q)
Tenant/Lessee Name: •U► /� Phone#: apo(o
i
Email: ,1 /1 ,��
CONTRACTOR:Company Name: / +, � 1.��1Y 1 1/�l. �`��JT S LLC Phone#: ��0 0?31 �D�O 1
Address:_
City: �Er LIW00'� state: --V'L021DA Zip: -!�30a
Qualifier Name: Jc1 OI,4 �ZlZT1 k Phone#: 7 Sc 02 3-� G4;33
State Certification or Registration#: 1 I 1000'76 3 Certificate of Competency#:_ �J
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ �� �� Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New N Repair/Replace ❑ Demolition
Description of Work: CeXLA T-A--, r V U--f-D 00--Q-
Specify color of color thru tile:
Submittal Fee$ `�C'-' , o� Permit Fee$ CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$-
Structural Reviews$ Bond$ Z
TOTAL FEE NOW DUE$
(Revised02/24/2014)
Bonding'Compahy's Name(if applicable)
Bonding Company's Address1
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
OWNER or AGE_T CONTRACTOR
The/foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
dayCoff,„%N f*A, Li .20 11 by -k day of WmAy ,20 1'' by
�tiW QV? who is personally known to SmA l6ww R:mL who is personally known to
me or who has produced qOIIG<( VIIA'S I'LL'AY as me or who has produced kial )IMUS A1(1*y as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUB;*: NOTARY PUBLIC:
Sign: Sign: Qe p� t
Print: M411A CIY�h`�R 1,ak\'. Print: uAwl,
,,1�a- buril,Vlq nV�
Seal: MARIA CAROLINA GOMEZ Seal:
, y �� Notary Public,State of Florida MARIA CAROLINA GOMEZ
$ Commisslon#FF 209431 ��� p�we Notary Public,State of Florida
Expires Mar.12,2019 $ " Commission#FF 209431
APPROVED BY ,Y y J2L Zt Plans Examiner Zoning
' Structural Review Clerk
(Revised02/24/2014)
Construction lq
§ua ifying Board
BUSINESS CERTIFICATE OF COMP
ETENCY
13EO00161
A&M CONTROL SYSTEMS LLC
D.BA:
A;RA SIMON G
Is certified under the provisions of Chapter 10 of Miami-
Local Business Tax Fbcei pt
Miami-Dade County, State of Florida
-THIS IS NOT ABILL-DO NOT PAY __ BT
7162449 !_j
BUSINESS NAM E/LOCATION RECEIPT NO. EXPIRES
A&M CONTROL SYSTEMS LLC RENEWAL SEPTEMBER 30, 2018
1555 N TREASURE DR#408 7440463
Must b
NORTH BAY VILLAGE, FL e displayed at place of business
33141 Pursuant to County Code
Chapter 8A-Art.9& 10
OWNER SEC.TYPE OF BUSINESS
PAYM ENT RECEIVED
A&M CONTROL SYSTEMS LLC
196 SPEC ELECTRICAL BY TAX COLLECTOR
C/O SIMON G AZRAK,MANAGER CONTRACTOR 49.50 10/19/2017
Worker(s) 1 13E000161 0229-18-000254
This Local Business Tax Receipt only con^rms payment of the Local Business Tax.The Receipt is not a I i cense,
perm t,or a cart"cation of the holder's quell"cations,to do business.Holder must comply with any governmental
or nongovernmental regulatory laws and requirements w hich apply to the business.
The RE)3 PT NO.above must be displayed on all commercial vehicles-Miami-Dade Code Sec 8a-276.
M IM I®D For more information,visit www.m arrdade.gov/taxcol I ector
STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
x-
ELECTRICAL CONTRACTORS LICENSING BOARD (850) 487-1395
" 2601 BLAIR STONE ROAD I QUALIFYING
TALLAHASSEE FL 32399-0783 0037 LOW VOLTAGE SPECIALTY
I
i
1
Jaime D.Gascon,P.E_
AZ RAK, S I M O N G Secretary of the Board
A&M CONTROL SYSTEMS, LLC
Miami-DadeCouMyretainsaYproperty ghtsheen. W��miamidade.gov/economy
i 1555 NORTH TREASURE DR
AP 408
NORTH BAY VILLAGE FL 33141
--------------- i
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 - STATE�OF FLORIDAr�=_.' -
from architects to yacht brokers,from boxers to barbeque - ff DEPARTME( a'C EzBUSINESS- AND---
restaurants,and they keep Florida's economy strong. �•4�. �-- PROF °SSI DNA
--�— _ -..
Every day we work to improve the way we do business in order t 1 11000963 1S�7E-Q: >8/04/2016
to serve you better. For information about our services, please . ,}f �
log onto www.myfloridalicense.com. There you can find more REG..SP.ECt.' TAY` L•EGTR 1
information about our divisions and the regulations that impact AZRAKSMOG -----
you,subscribe to department newsletters and learn more aboutA&M.CONTRO� YST C' ---
the Department's initiatives. REG`I8TERED:AYS �--�
Our mission at the Department is: License Efficiently, Regulate IleL'1MtT[=DrENERG�°Y�
Fairly.We constantly strive to serve you better so that you can .-----,r,{. -
serve your customers. Thank you for doing business in Florida, i IS]ERE.D`6-h-def- e.pr�isions-of:G-h 4'89�F•S-:...,
and congratulations on your new license! xpirationdate .AU31,r206►" -~" 1606040004913
DETACH HERE i
'RICK SCOTT, GOVERNOR T KEN LAWSON, SECRETARY
$TATE O.F FLORIDA` --
'%r` `DEPARTMENT OF-BUSINESS!'AND:,PROEESSIONAL REGULATIONS
- ELECTRICAL CONTRACTORS•LICENSING BOARD,,`
I _ - -
`j`�r
77ThIAP- ELECTRIGACCEW CTOR- ,
Named.below HAS REGISTERED �`- `�1�� ion WE
lJnder the provisions of-Chapter-489•FS�
-�Ezpiratibn date: AUG_31„201.8
/� AS"A•LIMI•TED_ENERGY-SYSTEM ECI ILIS�� `�
AZRAK;SIMO.Nr G,..------
" A&11II-COIVTROL`SYST
f555,N_0R H~TI_- ,URE'QR
r
,,,(_5RTH'BAY- -Vl1:LeAGE—Fl_?33;14. ❑�
ISSUED: 08/04/2016 DISPLAY AS REQUIRED BY LAW Z SEQ# L1608040001913
a
ACO CERTIFICATE OF LIABILITY INSURANCE DATE 2/01/1IYYYY)
1
�- 12/01/17
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 lieu of such endomement(s).
PRODUCER CONTACT
NAME:
Alistair Insurance Services PHI N; Et): (305)865-7777 No): (305)865-9693
740 71 st Street E-MAIL chooseallstar@aol.com
Miami Beach,FL 33141 INSURERS AFFORDING COVERAGE NAIC#
Phone (305)865-7777 Fax (305)865-9693 INSURER A: GRANADA
INSURED INSURER B:
A&M CONTROL SYSTEMS,LLC INSURER C:
1555 North Treasure Dr#408 INSURER 0:
North Bay Village,FL 33141 (786)237-6677 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 RES^LCT I T.
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.
1L7R TYPE OF INSURANCE ADR WVD UB POLICY NUMBER MM/DDY/YEYYY MM/DD/YriY LIMITS
GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000.00
F O F F pr r nPn rr DAMAGE TO RENTED n nnn nn
COMMERCIA L G_N_R_-I._!U PRFr $ 10-
❑ ❑ CLAIMS-MADE ❑ OCCUR 0185fl00043793 MED EXP(Any one person $ 5,000.00
A ❑ n n 03/07/2017 03/07/2018
PERSONAL 8 ADV INJURY $ 1,000,000.00
❑ GENERAL AGGREGATE r $ 2,000,000.00
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $
❑ POLICY ❑ PRO ❑ LOC BI/PD DED $ 500.00
Ea accident- -
❑ ANY AUTO BODILY INJURY(Per person) $
ALL❑ AUTOS OWNED ❑ SCHEDULED AUTOS BODILY INJURY(Per accident) $
❑ HIRED AUTOS NON-OWNED PROPERTY DAMAGE $
❑ AUTOS Per accident
❑ ❑ $
❑ UMBRELLA LIAR ❑OC^,LIR EACH 0^.^LI`ICF $
❑ EXCESS LIAR• ❑CLAIMS-MADE AGGREGATE $
❑ DED ❑ RETENTION$ $
WORKERS COMPENSATION ❑WC S TU- El ETH-
AND EMPLOYERS'LIABILITY Y/N
ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $
OFFICER/MEMBER EXCLUDED? ❑ N/A
(Mandatory in NH) E.L.DISEASE-EA EMPLOYE $
H
D�5GKII IIVIY VI�VYCNi11VRvLS'!v:: E.I_.(7ioi.._a:.-- -:i
DESCRiP-1,0% .. A,=.
CCN/AI ARM IRSTA.I I ATiC,sc
LOW V0L*i'A E 6Y;' 10A -01 1`1-1 i=Lsi C I V 6'T'.
F`I'•�'Tt i"a'�''Tt�f t+17 TG Y+>afl+C 1 A 1 _. --•
„� r . .. . z .....-
SHOULD ANY OF THEA_'r:��_�:::::_�_:�•-_:_:__�:_____:��_:_.-_-�•:--�--.;
Miami Shores Village Bldg Dept THE EXPIRATION DATE THEREOF,NOTICE
10050 N.E.2nd Ave ACCORDANCE WITH THE POLICY PROVIS!L-i"_:
Miami Shores FL 33138 AUTHORIZED PEPRESE ITAITto
13E00016 1 LIUDI; I_A
ACORD 25(2010/05)QF The ACORD.n._—c.nn�
JIMMY PATRONIS
CHIEF FINANICAL OFFICER STATE OF FLORIDA
DEPARTMENT OF FINANCIAL SERVICES
DIVISION OF WORKERS'"COMPENSATION
**CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS'COMPENSATION LAW
NON-CONSTRUCTION INDUSTRY EXEMPTION
This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law.
r
EFFECTIVE DATE: 9/18/2017 EXPIRATION DATE: 9/18/2019
PERSON: AZRAK SIMON G
FEIN: 454913418
BUSINESS NAME AND ADDRESS:
A&M CONTROL SYSTEMS, LLC
2100 N 32ND CT ,
HOLLYWOOD FL 33021
SCOPE OF BUSINESS OR TRADE:
Electronic
Equipmento Installation,Service
or RepairoShop and Outside&
Drivers
IMPORTANT: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
certificate at any time for failure of the person named on the certificate to meet the requirements of this section.
DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUESTIONS?(850)413-1609
k
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�t►OREs Gil
'ate
..,, ,,,,,1" Miami shores Village
- —��� Building Department
oRmA
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
Notice to Owner — Workers' Compensation Insurance Exemption
Florida Law requires Workers' Compensation insurance coverage under Chapter 440 of the Florida Statutes. Fla. Stat. § 440.05
allows corporate officers in the construction industry to exempt themselves from this requirement for any construction project prior to
obtaining a building permit. Pursuant to the Florida Division of Workers' Compensation Employer Facts Brochure:
An employer in the construction industry who employs one or more part-time or full-time
employees,including the owner,must obtain workers' compensation coverage. Corporate officers
or members of a limited liability company (LLC) in the construction industry may elect to be
exempt if:
I. The officer owns at least 10 percent of the stock of the corporation, or in the case of
an LLC,a statement attesting to the minimum 10 percent ownership;
2. The officer is listed as an officer of the corporation in the records of the Florida
Department of State,Division of Corporations;and t
3. The corporation is registered and listed as active with the Florida Department of
State,Division of Corporations.
No more than three corporate officers per corporation or limited liability company members are
allowed to be exempt. Construction exemptions are valid for a period of two years or until a
voluntary revocation is filed or the exemption is revoked by the Division.
Your contractor is requesting a permit under this workers'compensation exemption and has acknowledge that he or she will not use
day labor,part-time employees or subcontractors for your project.The contractor has provided an affidavit stating that he or she will
be the only person allowed to work on your project.In these circumstances,Miami Shores Village does not require verification of
workers' compensation insurance coverage from the contractor's company for day labor,part-time employees or subcontractors.
BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS
CONTENTS.
Signature:
Owner
State of Florida
County of Miami-Dade
h l
The foregoing was acknowledge before me this day of VftW Q t ,20
'�
By Wi qVk S"Qf G who is personally known to me or has produced
_ 'Nadi t',\pS �wm as ideptification.
Notary:
SEAL: MARIA CAROLINA GOMEZ
c~�+ p6wo Notary Public,State of Florida
commission#FF 209431
rly mrr,,n.expires mar.12,
A&M Control Systems, LLC
2100 N 32nd Ct
Hollywood, FI 33021
Date: December 08th,2017
State of Florida
County of Miami-Dade
Before me,this day personally appeared Simon Azrak who, being duly sworn deposes and says:
That he or she will be the only person working on the project located at:
1080 NE 105th Street
Miami,FL 33138
Sworn to(or affirmed)and subscribed before me this day of -nE7CJ /T&VJ�.20LI by
Personally Know
OR Produced Identification F/,
Type of identification Produced r1 F)
Print,Ty ;- %f Notary
wpb M`I Nyy 16I
A. �D
_�« F�tyo•G�