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EL-15-2366Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FIL 6 S7-13 q3 Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-243656 Scheduled Inspection Date: March 30, 2016 Inspector: Devaney, Michael Owner: PERIKLES, JOHN & MARIE Job Address: 9730 NE 5 Avenue Road Miami Shores, FL Project: <NONE> Contractor: BULLARD ELECTRICAL INC Building Department Comments Permit Number: EL-9-15-2366 Permit Type: Electrical - Residential Inspection Type: Final Work Classification: Addition/Alteration Phone Number (786)236-0254 Parcel Number 1132060171470 REPLACE LIGHTS, ADD NEW OUTLETS, ELECTRICAL Infractio Pass, WORK FOR KITCHEN. I INSPECTOR COMMENTS False Inspector Comments Passed Ef Faded Correction ❑ Needed Re -Inspection ❑ Fee No Additional Inspections can be scheduled until re -inspection fee is paid. -7a%�iz /,6 Phone: (786)487-9505 March 29, 2016 For Inspections please call: (305)762-4949 Page 6 of 39 `SNoaEs Miami Shores Village r 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 ` Phone: (305)795-2204 LWAIDA Permit NO. EL-9-15-2366 Permit Type: Electrical - Residential t r �' Work Classification: Addition/Alteration Permit Status: APPROVED issue Date: 912212015 1 Expiration: 03/20/2016 Project Address Parcel Number Applicant 9730 NE 5 Avenue Road 1132060171470 Miami Shores, FL Block: Lot: JOHN & MARIE PERIKLES Owner Information Address Phone Cell JOHN & MARIE PERIKLES 9730 NE 5 Avenue Road (786)236-0254 MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone BULLARD ELECTRICAL INC (786)487-9505 of Work: REPLACE LIGHTS, ADD NEW OUTLETS, EL onal Info: ification: Residential ling: 1 Fees Due Amount CCF $17.40 DBPR Fee $15.12 DCA Fee $15.12 Education Surcharge $5.80 Permit Fee - Additions/Alterations $1,008.00 Scanning Fee $3.00 Technology Fee $23.20 Total: $1,087.64 Valuation: $ 28,800.00 Total Sq Feet: 0 Pay Date Pay Type Amt Paid Amt Due Invoice # EL-9-15-57117 09/17/2015 Credit Card $ 50.00 $ 1,037.64 09/22/2015 Credit Card $ 1,037.64 $ 0.00 Available Ins Inspection Type: Final Meter Box Alteration IFire Alarm Review Electrical 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 certify th all th foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating cons ' n Wing. Futhermore-, 1 thorize the above -named contractor to do the work stated. September 22, 2015 Auth9fized Signature: Owner / Applicant / Contractor / Agent Date Building Department Copy September 22, 2015 1 Miami Shores Village Building Department SEP 1 q 2015 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 BY: _ INSPECTION LINE PHONE NUMBER: (305) 762-4949 FBC 20 P BUILDING PERMIT APPLICATION ❑BUILDING Q ELECTRIC ❑ ROOFING ❑PLUMBING ❑ MECHANICAL ❑PUBLICWORKS JOB ADDRESS: l V 3 0 v_" f-pi Master Permit No. K�— `ice t yl*"> Sub Permit No. 1L1 5-Z3 ❑ REVISION ❑ CHANGE OF CONTRACTOR fLr'' ❑ EXTENSION ❑RENEWAL ❑ CANCELLATION ❑ SHOP DRAWINGS Folio/Parcel#: 2or0 0�-i HN Is the Building Historically Designated: Yes Occupancy Type: Load: Construction Type: C Q& Flood Zone: BFE: _ NO FFE: OWNER: Name (Fee Simple Titleholder): QLA V" 'rI K 1, c � � Phone#: Jc>4s 0 -S,47y Address: u�W Tenant/Lessee Name: Email: State: CONTRACTOR: Company Name: Bullard Electrical, Inc. Address: 14724 SW 177 Terrace City: Miami Qualifier Name: Weddell Bullard —Lip: Phone#: Phone#: 786 487 9505 FL Zip: 33187 Phone#. 786 487 9505 State Certification or Registration #: ER0014906 Certificate of Competency #: 99E000O13 DESIGNER: Architect/Engineer: Phone#: Address: City: State Value of Work for this Permit:: ,—�,�- Pz �t�9,�Square/Linear Footage of Work: [ Type of Work: ❑ Addition �/ Alteration ❑ New ❑ Repair/Replace Description of Work: pv I-Xcr% Zip: ❑ Demolition Specify color of color thru tile: Submittal Fee $ '� Permit Fee $ r �,� CCF $ CO/CC $ Scanning Fee $ Q0 Radon Fee $ DBPPR $ LT. 1Notary $ Technology Fee $ �� kV Training/Education Fee $ �7�� Double Fee $ Structural Reviews $, (Revised02/24/2014) Bond $ TOTAL FEE NOW DUE $ V Bonding Company's Name (if applicable) Bonding Company's Address City State Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip 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. Signa4= Signature / OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this day of 20 CSC , by who is sonally know to me or who has produced The foregoing instrument was acknowledged before me this 15 day of $ "t'e b-elr 20 t5 by \tv-je (fit �a , who i ersonally know to as me or who has produced identification and who did take an oath. NOTARY Sign: Print: as Commission # EE 221023 Seal: Seal: a7 Expires November 28, 2016 ,,,* LORETiACOMES PF,aa,' BandedThruTroy Fan M www8MM-7a1s �o MY COMMISSION #EE181658 APPROVED BY/Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) BULLA-1 OP ID: TC ,a►`CORO• CERTIFICATE OF LIABILITY INSURANCE 09/14/2014/201DATE DD/YYYI� 5 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 iSure Insurance Brokers 8700 W. Flagler St., Suite 270 Miami, FL 33174 Teresa R. Carmona, Agent CONTACT NAME: a/CN o Ext : ac No): E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Travelers Ins.co. 25658 INSURED Bullard Electrical Inc. INSURER B: Florida Citrus, Business (FUB) Wendell Bullard 14724 SW 177th Terr INSURER C : INSURERD: Miami, FL 33187 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 LTR TYPE OF INSURANCE POLICY NUMBER MMIDD EFFPOLICY MMID LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY X I CLAIMS -MADE ElOCCUR I-660-8B67411A BLANKET ADD'L INSURED 05111/2015 05/1112016 EACH OCCURRENCE $ 1,000,00 DAMAGE TO RENTED PREMISES Ea occurrence $ 100,00 MED EXP (Any one person) $ 5,00 PERSONAL 8 ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO LOC PRODUCTS - COMP/OP AGG $ 2,000•,00 $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS COMBINED SINGLE LIMIT Ea accident BODILY INJURY (Per person) _ $ BODILY INJURY (Per accident) $ PROPERTY AGE ERTY DAM $ $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED I RETENTION $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N OFFICER/MEMBER EXCLUDED? ❑ (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A 106-49842 06/05/2015 06/05/2016 WC STATU- X OTH- T RY LIMITS MIT ER E.L. EACH ACCIDENT $ 1,000,00 E.L. DISEASE - EA EMPLOYE $ 1,000,00 E.L. DISEASE - POLICY LIMIT I $ 1,000,00 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) ELECTRICAL CONTRACTOR CERTIFICATE HOLDER CANCELLATION Miami Shores Village 10050 NE 2 Avenue Miami Shores Village, FL33138 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 1l4' , �V� ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD CTQB Construction Trades Qualifying Board BUSINESS CERTIFICATE OF COMPETENCY 99E000013 BULLARD ELECTRIC INC D.B.A.: BULLARD WENDELL Is certified under the provisions of Chapter 10 of Miami -Dade County NTRAUNTIL '3 12 CTQB Construction Trades Qualifying Board �1 BUSINESS CERTIFICATE OF COMPETENCY 99E000013 BULLARD ELECTRIC INC BULLARD WENDELL Is certified under the provisions of Chapter 10 of Miami -Dade County ;.+., UNTIL t STATE OF FLUKIUA DEPARTMENT OF B ELECTRICAL CONTRAC 1940 NORTH MONROE TALLAHASSEE FL BULLARD, WENDELL WALTER BULLARD ELECTRICAL INC 14724 SOUTHWEST 177 TERR MIAMI FL 33187 Congratulations! With this license you become on one million Floridians licensed by the Department Professional Regulation. Our professionals and b from architects to yacht brokers, from boxers to bE and they keep Florida's economy strong. AND PROFESSIONAL REGULATION tS LICENSING BOARD EET a9-0783 of the nearly I' Business and sinesses range beque restaurants, Every day we work to improve the way we do busiess in order to serve you better. For information about our servi s, please log onto www.myflor'idalicense.com. There you can find ore information about our divisions and the regulations that impact you, subscribe to department newsletters and learn more about tt a Department's initiatives. Our mission at the Department is: License Effic We constantly strive to serve you better so that customers. Thank you for doing business in Fli and congratulations on your new license! RICK SCOTT, GOVERNOR r, Regulate Fairly. can serve your DETACH HERE (850) 487-1395 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND =;•.� PROFESSfONAPREGULATION i ER0014906 -- IStUED!:*�.98/17/2014 REG ELE 'TR C4CO�NTRA''CTO,R BULL'ARD, WENDELL WAL•T. —W. BULLARD ELEC, RICAL-ING (INDIVIDUAL'fVIUSA M `TAL'L LOCAL LICENSING'REGiUI.ENTS PRIOR ,TO,CONTRACTINC�:INf ,k YiAREA) r',HAS'REGISTERED under the provisions of Ch.489 FS. Expirat wdete - UG 31, 2016 L1408170003939 KEN LAWSON, SECRETARY STATE OF FLORIDA DEPARTMENT_ F BUSINESS AND PROFESSIONAL REGULATION ELECTRI11CAL-CONTRACTORS LICENSING BOARD ER0014906 ti The ELECTRICAL- CONTRACTOR Named below HAS -REGISTERED- � 4 Uriderthe provisions. of-Cliapter 4897S. Expiration".date:_ AUG-31, 2016 .� ,. .(INDIVIDUAL. MUST MEETALL LOCAL.I,ICENSING'•"` --�,REQUIREMENTS`PRIOR T...CONTR� C. ING-IN'ANYAREA)•. i r � - iT- ��. -- �- . �! � �%'• III - ,�� y�^��y�`4 �\ ���'",. �� 1� � �',,��;o ,rBULIjARD=WENDELL WALT A � BULL:ARD'.EL-ECTRICAL-I-1NQ.- ;1472,(SOUTHWEST-177 TERRACE_ �`-_ ,.�� ��.i + ` �. ♦, �� f 1U11AMl.,F[.33187 4—S .- . 'S . "---.� `\ � `�L .."�._� ", .`�•. �" fit., a � 'tip•, •j 1 Municipal Contractor's Tax Receipt Miami —Dade County, State of Florida -THIS IS NOT A BILL - DO NOT PAY CC NO: 99E000013 MC BUSINESS NAME/LOCATION RECEIPT NO. EXPIRES BULLARD ELECTRICAL INC 14724 SW 177 TERR 7471804 SEPTEMBER 30, 2016 MIAMI, FL 33187 Pursuant to County Code Sac 1D-24 OWNER TYPE OF BUSINESS BULLARD ELECTRICAL INC ELECTRICAL CONTRACTOR PAYMENT RECEIVED C/O WENDELL BULLARD, PRES. BY TAX COLLECTOR 200.00 09/ 15/2015 0235-15-006248 This receipt is not valid in the following Municipalities: Aventurs, Doral, Hialeah, Key Biscayne, Miami Gardens, Miami Lakes, Palmetto Bay, Pinecrest, Sunny Isles Beach, Town of Cutler Bay. M® For more information, visit www.miamidade gov/taxcollector F� Municipal Contractors Tax Receipt ami Dade County, State of Florida -THIS IS NOT A BILL - DO NOT PAY CC NO: 99E000O13 BUSINESS NAME/LOCATION RECEIPT NO. EXPIRES BULLARD ELECTRICAL INC 14724 SW 177 TERR 7471804 SEPTEMBER 30, 2016 MIAMI, FL 33187 Pursuant to County Code Sec 10-24 OWNER TYPE OF BUSINESS BULLARD ELECTRICAL INC ELECTRICAL CONTRACTOR PAYMENT RECEIVED C/O WENDELL BULLARD, PRES. BY TAX COLLECTOR 200.00 09/15/2015 0235-15-006248 This receipt is not valid in the following Municipalities: Avenhtre, Doral, Hialeah, Key Biscayne, Miami Gardens, Miami Lakes, Palmetto Bay, Pinecrest, Sunny isles Beach, Town of Cutler Bay. M®AInw, for more information, visit www,miamidade gov/taYcollector Local Business Tax Fbcei pt Miami -Dade County, State of Florida -THIS IS NOT BILL -DO NOT PAY 4102067 BUSINESS NAM E/LOCATION BULLARD ELECTRICAL INC 14724 SW 177 TERR MIAMI, FL 33187 OWNER BULLARD ELECTRICAL INC C/O WENDELL BULLARD, PRES. Worker(s) RECEIPT NO. EXPIRES RENEWAL SEPTEMBER 30, 2016 4321139 Must be displayed at place of business Pursuant to County Code Chapter BA - Art. 9 & 10 SEC. TYPE OF BUSINESS 196 ELECTRICAL CONTRACTOR 99E000013 PAYM ENT RECEIVED BY TAX COLLECTOR 75.00 09/15/2015 0235-15-006248 This local Business Tax Rxei pt only con"ma payment of the Local Business Tax. The Receipt is not a license, permit, or a card i "cation of the hd der's qual i "cations, to do business. Holder rmust cor pl y with any governmental or raVovern ental regulatory laws and requirements which apply to the business. The RHM Pr NO. above mat be displayed on al I cony ercial vehicles - Miami -Dade Code Sec Ba-276. M® For more information, visit www.miamdade.ggmUucdlcctcr Local Business Tax Fbcei pt Miami -Dade County, State of Florida -THIS IS NOT BILL -DO NOT PAY 4102067 BUSINESS NAM E/LOCATION BULLARD ELECTRICAL INC 14724 SW 177 TERR MIAMI, FL 33187 OWNER BULLARD ELECTRICAL INC C/O WENDELL BULLARD, PRES. Worker(s) RECEIPT NO. EXPIRES RENEWAL SEPTEMBER 30, 2016 4321139 Must be displayed at pace of business Pursuant to County Code Chapter 8A Art. 9 6 10 SEC TYPE OF BUSINESS 196 ELECTRICAL CONTRACTOR 99E000013 PAYM ENT RECEIVED BY TAX COLLECTOR 75.00 09/15/2015 0235-15-006248 This Local Business Tax RBeei pt only con"rrns payment of the Local Business Tax. The Receipt is not a I icense, permit, or a certi "cation of the holder's qual i "cations, to do business. Holder must cortply with any governmental or nongovernmental regulatory laws and requirementswhich apply to the business. The REIM PT NQ above must be displ eyed on al I cormercial vehicles - Miami -Dade Code Sac 8a-278. MI®��✓// Rbr more irdornation, visit www.miamidade.g2gMcdlector