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RC-10-864Project Address 11028 NW 2 Avenue Miami Shores, FL 33168 -4304 1121360020260 Block: Lot: BENCHY PHILIPPEAUX Owner Information Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 BENCHY PHILIPPEAUX 11028 NW 2 Avenue MIAMI SHORES FL 33168 -4304 Valuation: Total Sq Feet: $ 900.00 40 Contractor(s) Phone Cell Phone SRJ CONSTRUCTION CORPORATION (954)578 -8117 (954)703 -8355 Approved: In Review Comments: Date Approved: : In Review Date Denied: Type of Construction: DRYWALL REPAIR Stories: Front Setback: Left Setback: Bedrooms: Plans Submitted: Certificate Date: Bond Retum : Occupancy: Exterior: Rear Setback: Right Setback: Bathrooms: Certificate Status: Additional Info: Classification: Residential Fees Due CCF Education Surcharge Permit Fee Scanning Fee Submittal Fee Submittal Reversal Fee Technology Fee Work without Permit Fee Total: Amount $0.60 $0.20 $150.00 $3.00 $50.00 ($50.00) $0.80 $150.00 $304.60 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 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. Authorized Signature: Owner / Applicant / Contractor / Agent Building Department Copy Address Parcel Number Phone Pay Date Pay Type Invoice # RC -5-10 -37905 05/14/2010 Credit Card 06/15/2010 Credit Card Amt Paid Amt Due $ 50.00 $ 254.60 $ 254.60 $ 0.00 Applicant Available Inspections: Inspection Type: Final June 15, 2010 Date Cell June 15, 2010 1 Inspection Number: INSP - 144207 Scheduled Inspection Date: July 07, 2010 Inspector: Devaney, Michael Owner: PHILIPPEAUX, BENCHY Job Address: 11028 NW 2 Avenue Miami Shores, FL 33168 -4304 Project: <NONE> Contractor: Building Department Comments July 06, 2010 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 For Inspections please call: (305)762 -4949 Permit Number: EL -5 -10 -930 Permit Type: Electrical - Residential Inspection Type: Rou h Work Classification: Repair Phone Number Parcel Number 1121360020260 ELECTRICAL REPAIR FOR POOL PUMP REPLACEMENT Passed v Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments rI1 Page 9 of 26 Inspection Number: INSP - 142510 Scheduled Inspection Date: July 09, 2010 Inspector: Hernandez, Rafael Owner: PHILIPPEAUX, BENCHY Job Address: 11028 NW 2 Avenue Miami Shores, FL 33168 -4304 Project: <NONE> Contractor: SRJ CONSTRUCTION CORPORATION Building Department Comments REPAIR REPLACE POOL PUMP Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments July 08, 2010 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 For Inspections please call: (305)762 -4949 Permit Number: PL -5 -10 -788 Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Repair Phone Number Parcel Number 1121360020260 Phone: (954)578 -8117 Page 3 of 11 Inspection Number: INSP- 148160 Permit Number: RC -5 -10 -864 Scheduled Inspection Date: July 12, 2010 Inspector: Bruhn, Norman Owner: PHILIPPEAUX, BENCHY Job Address: 11028 NW 2 Avenue Miami Shores, FL 33168 -4304 Project: <NONE> Contractor: SRJ CONSTRUCTION CORPORATION Building Department Comments Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 DRYWALL REPAIR THROUGHT OUT THE HOUSE Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments July 09, 2010 For Inspections please call: (305)762 -4949 Permit Type: Residential Construction Inspection Type: Final Work Classification: Repair Phone Number Parcel Number 1121360020260 Phone: (954)578 -8117 Page 14 of 15 b pi- r\kc>5,`t' 1,2.' 4 ,,„.,0 Miami Shores Village 13© Egvng CC_OS 9-1 `` Building Department MAY 1 4 201[ IV s� g p 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Q Tel: (305) 795.2204 Fax: (305) 756.8972 �' ' 1- "-- k A er e_ rats INSPECTION'S PHONE NUMBER: (305) 762.4949 BUILDING PERMIT APPLICATION FBC 20 Permit Type: BUILDING ROOFING Owner's Name (Fee Simple Titleholder) ��Px Owner's Address 44 ®2r$ N iaf 2," City P11 Aims 7415183 State ft Tenant/Lessee Name 14IA Email NOTRCI.1- G kAI lgo!)nt. mar Job Address (where the work is being done) 4,10248 N t4" 2 City V Miami Shores Village County Miami- Dade Zip FOLIO / PARCEL # Is Building Historically Designated YES NO Y Flood Zone Contractor's Company Name fiP�"Gsn sale a Phone # 55N-5 Contractor's Address 8358 74; OIA }e-@,q -n4- $-vh Zaaff State FL Zip 33351. City 5th.rWa Qualifier Name SirnIlity 1 y .7/ • State Certificate or Registration No. c iC 05$536 Contact Phone 55g- 5x$9119 E -mail S 2 b G9.ioTmAIL COW) Architect/Engineer's Name (if applicable) Notary $ Scanning $ 'o Radon $ { e" % Permit No. l CJO Master Permit No. Phone # S5/ ° ']Q9 -89S5 Zip 3ia Phone # Certificate of Competency No. Phone # 5.6 2516 Phone # ii J r Value of Work For this Permit $ 900 Square / Linear Footage Of Work: 40 Type of Work: DAddition ❑Alteration :New [( Repair/Replace ❑ Demolition Describe Work: 'gart'o.. thipAm ,� k Yl ll tAr AiIS rov oti& #C1�. ( ATf y1 0.4■11) . %Tci+ 4411'1 Mehra:I 4iniTk ****** ** * * * * * * * * * ** * * * * * * ** * ** * * * * * *** F * * * * * * * * * * * * * ** * * * * * * * * * * * * * * ** Submittal Fee $ - C Permit Fee $ /16 CCF $ O GO/rr $ Training/Education Fee $ 0•■0 Technology Fee $ 0'60 DPBR $ Bond $ Violation date: (m� Structural Review. $ Total Fee Now Due $ Z • / See Reverse side -> Bonding Company's Name (if applicable) Bonding Company's Address City State Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State 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 ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and 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 po ted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the Ci'sence of suc osted notice, the inspection will not b ' .proved and a reinspection fee will be charged. ;/ice/ - weer or Agent The foregoing instrument was acknowledged before me this 7 The foregoing instrument w s acknowledged before me this day of , 20 la by ( 6 4) y iI Reau)t , who is erson ^_ i -tQ- a or who has produced As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: NIPr ■1r gl A- My Commission Expires: (Revised 07 /10 /07)(Revised 06/10/2009) a 17 -k/Si SERGE - RICHARD SAINT ELOI MY COMMISSION #DD649901 EXPIRES: MAR 12, 2011 Bonded through 1st State Insurance NiPt Plans Examiner Signature Zip PI Zip NOTARY PUBLIC: Sign: Print: My Commission Expires: Contractor • day of 1101 , 20 UL, by who is personally known to me or who has produced as identification and who did take an oath. SERGE - RICHARD SAINT ELOI MY COMMISSION #DD649901 EXPIRES: MAR 12, 2011 Bonded through 1st State Insurance APPROVED BY ,./P O C) Zoning Engineer Clerk checked (.;copiL of Ihro F-13pch 1e4 plorkFt TM-16P.M. &Judd) 1/4.Honip,out *rig, 1 okr va0.0 6v)806A • • • • • (06A oF WRIL 2i ,2 ie./M/1.e ek-a Krai. 5fr 0 6-1.-krcZ eit L Pew( 44_02,S NIA' VI' g(1101 A I MAY 1 4 2010 17# :- Shores ViIiege APPROVED BY DATE ZONING DEPT BLDG DEPT SUBJECT 10 CCMPIJANCE STATE AND CCUN r -A ll°11°7 A 7 WITH ALL FEDERAL ise RULES AND REGULATIONS (.;copiL of Ihro F-13pch 1e4 plorkFt TM-16P.M. &Judd) 1/4.Honip,out *rig, 1 okr va0.0 6v)806A • • • • • (06A oF WRIL 2i ,2 ie./M/1.e ek-a Krai. 5fr 0 6-1.-krcZ eit L Pew( 44_02,S NIA' VI' g(1101 A I MAY 1 4 2010 17# • • . • . •• .... • • • • • '.. t CQG i fi6k' e p vf` ‘7 'Ac '14 A -,-/ // v c ; o/c-- ed 1 i hr 011/7 4',./ a 69 c 25 7 2 ,a , Q 'G, c /7 /z / eek-7 z Pee re inb>"0/>-- °I2- m') w //i rS eArg Project Address Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138-0000 Phone: (305)795 -2204 11028 NW 2 Avenue Miami Shores, FL 33168 -4304 1121360020260 Block: Lot: BENCHY PHILIPPEAUX 1 Owner Information Fees Due CCF Education Surcharge Permit Fee - Additions/Alterations Scanning Fee Technology Fee Total: Amount $0.60 $0.20 $100.00 $3.00 $0.80 $104.60 Building Department Copy Address Parcel Number Contractor(s) BL WILLIAMS ELECTRICAL INC (954)868 -9893 Phone Cell Phone Authorized Signature: Owner / Applicant / Contractor / Agent Phone Type of Work: ELECTRICAL Additional Info: POOL PUMP REPLACEMENT Classification: Residential Scanning: 1 Pay Date Pay Type Amt Paid Amt Due Invoice # EL -5-10 -37981 06/15/2010 Credit Card $ 104.60 $ 0.00 Applicant Cell BENCHY PHILIPPEAUX 11028 NW 2 Avenue MIAMI SHORES FL 33168-4304 1 Valuation: Total Sq Feet: $ 100.00 0 1 Date Available Inspections: Inspection Type: Final 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. June 15, 2010 June 15, 2010 1 t0 g•eit pp.D Owner's Address 1 , c_A.7 City City_Vieuzu L State Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 Permit No. . 10 61 60 Master Permit No. BUILDING PERMIT APPLICATION FBC 2001 Permit Type: ELECTRICAL Owner's Name (Fee Simple Titleholder) fl C=VO Pi ! � P/-one # 3 - S - (� 9 �/ 2' <4/ Tenant/Lessee Name Vv Email - p In C� L � P @ � 07Y1 Job Address (where the work is being done) 0 2 N City Miami Shores Village FOLIO / PARCEL # Contractor's Company Name Contractor's Addres Architect/Engineer's Name (if applicable) Submittal Fee S Is Building Historically Designated YES Zip County Miami -Dade Phone # NO State Certificate or Registration No. E Gl O (a O . 7 i T Certificate of Competency No. Contact Phone J -qgq3 E -mail hIrs ft7c E101- (p131 Phone # Zip — 5 3 / 6 9 m- ISIS City , 1 alla State FL- Zip Qualifier Name ( _ • a! // /�f�-f Phone # 9� �O - �� Flood Zone Value of Work For this Permit $ ' Square / Linear Footap Of Work: Type of Work: DAddition DAlteration [New P air/R lace ep ' ep ❑Demolition Describe Work: ►.i i + P 00 d Yn r r r te-t, r IA s R 0, de t . r (4) ..Pc.i 1.70*‘;- .r. . Ctr(AAA J. Polack . Reel( rx (teed& £M i n , d It&Te2 c c "„ko .. A- fkL Fault exr uk- 'taLejs c Pt'C,ofr,nced do efivki l- RC.. 1O — S6 4 ******* * * * * * * * * **** * * ** * * * ** * * * ** * ** ** *F ** * * * * * ** * * ** * ** * ** * * * ** ** * * * * * * ** Permit Fee $ ! d / TCCF $ 0 • CQ 0 CO /CC $ pA►n Notary $ Training/Education Fee $ 0 a., 0 Scanning 0'00 Radon $ DPBR $ Bond $ Double Fee $ Violation date: Structural Review. $ Total Fee Now Due $ 1041( On Technology Fee $ 4 X0 See Reverse side —> Bonding Company's Name (if applicable) C i// . Bonding Company's Address 0/(14 , City State �/ " Mortgage Lender's Name (if applicable) All Mortgage Lender's Address City State DOCE 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 ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC OWNER'S Aleti liDAVIT: 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 ' ccurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be i' ed and a re- inspection fee will be charged. Signature e or Agent The foregoing instrument was acknowledged before me this ig day of S NOTARY PUBLIC: Print: f i My Commission Expires: * * * * * * * * * * * * * * * * * * * * * * ** APPROVED BY 2010, by (Revised 07 /10 /07)(Revised 06/10/2009) who is pers onally known to me or who has oduced As identification and who did take an oath. ECl OI 1�1 SERGE - RICHARD SAINT EL01 MY COMMISSION #00649901 EXPIRES: MAR 12, 2011 * *21 ° * 1 5 anini * * * ** * * * * * * *x Plans Examiner Engineer Contractor The foregoing strument was acknowledged before me this ie' day of who i NOTARY PUBLIC: ,20L o me or who has produced as identification and who did take an oath. Sign: Print: 44dlge 4 r f Zoning Clerk checked May 2710 01:57p � BROWARDCOUNTY LOCAL BUSINESS TAX RECEIPT 115 S. Andrews Ave., Rm. A -100, Ft. Lauderdale, FL 33301-1 895 - 954 -831 -4000 VALID OCTOBER 1, 2009 THROUGH SEPTEMBER 30, 2 010 Receipt # 181 - 0001911 Business Type: ELECTRICAL CONTRACTOR DBA: Business Name: Owner Name: Business Location: Business Phone: Tax Amount $ 27. BL.Williams Rooms Mailing Address: B L WILLIAMS ELECTRICAL INC BARRINGTON L WILLIAMS 2252 NW 29 ST OAKLAND PARK 33311 (954)486 -3473 Number of Machin Transfer Fee B L WILLIAMS ELECTRICAL INC BARRINGTON L WILLIAMS 4400 NW 16 ST LAUDERHILL FL 33313 Seats Employees 1 UNIT Business Opened: StatelCounty1Cee tlReg: Exemption Code: 2009 - 2010 Machines 9545323151 For Vending Business Only Vending Type: NSF Fee Penalty Prior Years Collection Cost 01/22/92 EC0002487 NON EXEMPT Professionals Total Paid 0000000000 0000002700 0000001810001911 1001 p.1 $ 27.00 THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS THIS BECOMES A TAX RECEIPT This tax is lever for the privilege of doing business within mud County and Is non - regulatory in nature. You must meet all County must be VALIDATED planning and zoning requirements. This Business Tax Receipt transferred when the business is sold. business name has changed or you have moved the business that it Is in compliance alwith not lawstand business Is legal regulations. May27 10 02:11p A :77 BL.Williams CHARLIE CRIST GOVERNOR 9545323151 ••• p.1 May 2710 01:57p BL.Wiliiams STA'PEOFFLOR1OA + 34512062 DEPARTMENT OF EUSXNEEN .ARC PROFESSIONAL REGCLATIOU W0002487 . 08 /28/ou 08800110 CMT:FZEO ELECTRICAL CONTRACT= WILLIAM , EARAi Tc w L B . L . wzrzzB,iis AI L INC - • Z5 MCier: = - !Pm vesoessismos 2.1 OL.4 V 9 sS asszsear. iacs. AOC 31, 3C19 '4$l.i5$I:c7'!7 9545323151 STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSI4TION CONSTRUCTION INDUSTRY ,4u4% CERTIFiCAfE OF ELECTION TO 8E WORMERS' C OMPENSATION LAW EXEII+IPT FLORIDA EFFECTIVE 04/29/2010 EXPIRATION DATE: 04/28/2012 PERSON BARRINGTON L wrus J FEIN: 650922517 BUSINESS NAME AND ADDRESS: 81. WL.umes ELECTRICAL MC 4400 NW I6TH STREET FORT LAUDERDALE FL 33310 SCOPE OF BUSINESS OR 1- ELECTRICAL CONTRACTOR TRADE p.2 May 27 10 12:04p BL.Williams May. 18. 2010 1 I :38AM The company indicated below certifies that the insurance afforded by the policy or policies numbered and described below is in force as of the effective date of this certificate. This Certificate of Insurance does not amend. extend, or otherwise alter the Terms and Conditions of Insurance coverage contained in any policy numbered and described below. CERTIFICATE HOLDER: MIAMI SHORES VILLAGE BUILDING DEPARTMENT 10050 N E 2ND AVENUE MIAMI SHORES, FL 33138 TYPE OF INSURANCE LIABILITY [X] Liability and Medical Expense [X] Personal and Advertising Injury al Medical Expenses [X] Fire Legal Liability [ ] Other Liability AUTOMOBILE LIABILITY C J BUSINESS AUTO [ ] Owned [ ] Hired [ ] Non -Owned EXCESS LIABILITY : Umbrella Form C J Workers' Compensation and C ] Employers' Liability POLICY NUMBER & ISSUING CO. 77- AC- 479172 -3001 NATIONWIDE MUTUAL FIRE INSURANCE CO. Effective Date of Certificate: 09 -18 -2009 Date Certificate Issued: 05-18-2010 CERTIFICATE OF INSURANCE POLICY I POLICY EFF. DATE 'EXP. DATE 09 -1B -09 1 09-18-10 INSURED: BL WILLIAMS ELECTRICAL INC PO BOX 9891 OAKLAND PARK, FL 33310 9545323151 p.1 No. 2112 P. 1 96; — ais^ / LIMITS OF LIABILITY (*LIMITS AT INCEPTION) Any One Occurrence 5 1.000,000 Any One Person /0rg 3 1,000.000 ANY ONE PERSON S 5.000 Any One Fire or Explosion $ 100,000 General Aggregate* .. $ 2.000.000 Prod /Comp Ops Aggregate* S 1,000.000 Bodily Injury (Each Person) .... S (Each Accident) S Property Damage (Each Accident) 5 Combined Single Limit . - -- $ Each Occurrence S Prod /Comp Ops /Disease Aggregate* s STATUTORY LIMITS BODILY INJURY /ACCIDENT $ Bodily Injury by Disease EACH EMPLOYEE S Bodily Injury by Disease POLICY LIMIT S DESCRIPTION OF OPERATIONS /LOCATIONS venreLrs!l ,S TRWIWNSlorcwAL i, rig Aut prized Representative: DAY'S A FLECHSIG Countersigned at: 27 AMIAMI TRAIL #111 PU 'A GOROA, FL 33950 ZrATEOF A 395bfl6� DEI I OF BUSt ESS .AMID PROFESSXONAL REGOLATION X0002487 . 00 /28/08 0880Q1510 WL, _14e xILL:MIS ICXCTRICitaa =RC . =S M"a:TMCD' waft: ;.w yies.3a}aa vie 34.413 73 s.LKxscss saris ADD 3L, 2820 C*s tis=1 3 STATE OF FLORIDA DIVI O F T OF FINANCIAL CONSTRUCTION INDUSTRY ENSATION CERTIFICATE OF WORKERS' C OMPENSATION LAW FROM FLORIDA EFFECTIVE 04/29 /2010 EXPIRATION DATE: 04/28/2012 PERSON: BARRINGTON L WILLIAMS FEI N' 55 09225!1 BUSINESS NAME AND ADDRESS: OL wawa ELECTRICAL BttC 4400 NW Ism STREET FORT LAUDERDALE, FL 333m SCOPE OF BUSINESS OR TRADE 1- ELECTRICAL CONTRACTOR May 27 10 BL.WUhIarns STATEOFFLORIDA ACf 3956062 DF:PARTKERT OF BUSINESS .11RI! PROFESSIONAL REGULATION SC0002487 - 08/28/08 088002S30 C :IVIED ELECTRICAL CONTRACTOR 1IfrL.LI Ig Z, 8 _ L . WIL.LIANS WANCTRICAL INC "ZS imam u. seceprz.3s333i 3t ?a.413 rs s,gsrire is "*s 3+, 2010 Z.-M ..8M?a6) 9545323151 STATE OF FLORIDA DEPARTIMENT OF FINANCIAL SERIACES D CON T �j RKERS° COMPENSATION CERTI TI INDUSTRY WORKERS' COMPENSATION LAW EXEMPT FROM FLORIDA FFECTIVE: 04/29/2010 EXPIRATION DATE: PERSON: BARRTNGTON L WILLIAMS FEW: 85092251 BUSINESS NAME AND ADDRESS: BL WRLIAN1S ELECTRICAL INC 4400 NW 1STR STREET FORT LA $t ENDALE, FL 33970 SCOPE OF BUSINESS OR TRADE. r ELECTR cAl CONTRACTOR 04 /28/2012 p.2 May 271012:02p BL.Williams 9545323151 p.1 May. 18. MG 11: 38AM No. 2112 P. 1 9 ..f;/ ° 5rS / The company indicated below certifies that the insurance afforded by the policy or policies numbered and described below is in force as of the effective date of this certificate. This Certificate of insurance does not amend. extend, or otherwise alter the Terms and Conditions of Insurance coverage contained in any policy numbered and described below. CERTIFICATE HOLDER: MIAMI SHORES VILLAGE BUILDING DEPARTMENT 10050 N E 2NC AVENUE MLAM: SHORES. FL 3313E TYPE OF INSURANCE LIABILITY [X] Liability and Medical Expense [X] Personal and Advertising Injury CX] Medical Expenses [X] Fire Legal Liability [ 3 Other Liability AUTOMOBILE LIABILITY C J BUSINESS AUTO [ Owned [) H rreu ( ) Non-Owned EXCESS LIABILITY (] Umbrella Form [ ] Workers' Compensation and [ ] Employers' Liability POLICY NUMBER & 1SSUING CO. 77 -AC- 479172 -3001 NATIONWIDE MUTUAL FIRE INSURANCE CO. Effective Date of Certificate: 09 -18 -2009 Date Certificate Issued: 05 -16 -2010 CERTIFICATE OF INSURANCE POLICY EFF. DATE 09 -18 -09 INSURED: BL WILLIAMS ELECTRICAL INC PD BOX 9891 OAKLAND PARK. FL 33310 POLICY EXP. GATE 09 - 1B -10 LIMITS OF LIABILITY (*'LIMITS AT INCEPTION) Any One Occurrence $ 1.000.000 Any One Person /0rg $ 1.000.000 ANY ONE PERSON a 5,000 Any One Fire or Explosion S 100,000 General Aggregate* $ 2.000.000 Prod /Comp Cps Aggregate* S 1,000.000 Bodily Injury (Each Person) S (Each Accident) .... S Prupar Ly Damage (Each Accident) $ Cambined Single Limit - - - S Each Occurrence .. $ Prod /Comp Ops /Disease Aggregate* f STATUTORY LIMITS BODILY INJURY /ACCrDEMF ... S Bodily Injury by Disease EACH EMPLOYEE S Bodily Injury by Disease POLICY LIMIT S DESCRIPTION or OPERATIONS /LOCATION VEMLGSJiSQy TRICTCONSiortwAL z' ozo Aut prized Representative: DAVy7 A FLECHSIG Countersigned at: 27 AM;AMI TRAIL #111 PU ' A GORDA, FL 33950 514 - 51i-111 Permit No: Job Name 1 0 - Oj , 2010 Norman Bruhn CBO 305 - 795 -2204 Building Critique Sheet /G Ato.,FiL M iami Shores Viiiage Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 FAX Page 1 of 1 (9)5 - )8 "X111 ec>n m acrw 512111 Plan review is not complete, when all items above are corrected, we will do a complete plan review. If any sheets are voided, remove them from the plans and replace with new revised sheets and include one set of voided sheets in the re- submittal drawings. Permit No: e9=` / - `F�' Job Name: / /i77MaX 7° ka y i0 ;2009 ELECTRIC Critique Sheet fr _P 40,1 e TL / A 49 e7Ide - P, fz oc_ P% G l , 'S re l) _i� - M iami Shores Viiiage Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Page 1 of 1 Plan review is not complete, when all items above are corrected, we will do a complete plan review. If any sheets are voided, remove them from the plans and replace with new revised sheets and include one set of voided sheets in the re- submittal drawings. Mike Devaney 305 - 795 -2204 Project Address Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Permit Issue Date: 5/10/2010 Permit NO. PL- 5 -10 -788 Permit Type: Plumbing - Residential Work Classification: Repair Permit Status: APPROVED Expiration: 11/06/2010 Parcel Number Applicant 11028 NW 2 Avenue Miami Shores, FL 33168 -4304 1121360020260 Block: Lot: BENCHY PHILIPPEAUX 1 Owner Information Address Contractor(s) Phone CeII Phone SRJ CONSTRUCTION CORPORATION (954)578 -8117 (954)703 -8355 Fees Due CCF Education Surcharge Permit Fee - Additions/Alterations Scanning Fee Technology Fee Total: Amount $0.60 $0.20 $100.00 $3.00 $0.80 $104.60 Authorized Signature: Owner / Applicant / Contractor / Agent Building Department Copy Phone Type of Work: PLUMBING Type of Piping: POOL PUMP REPLACEMENT Additional Info: Bond Return : Classification: Residential Pay Date Pay Type Amt Paid Amt Due Invoice # PL -5-10 -37785 05/14/2010 Credit Card $ 104.60 $ 0.00 May 14, 2010 Date CeII 11028 NW 2 Avenue MIAMI SHORES FL 33168 -4304 Available Inspections: Inspection Type: Final 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. May 14, 2010 1 GI k Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 BUILDING PERMIT APPLICATION FBC 20 Permit Type: PLUMBING Owner's Name (Fee Simple Titleholder) (d� C= ! N't ?? grrtPG Phone # Owner's Address 7.1046 )'i1�f U City till titrgeSS State Ft- Zip 33168 Tenant/Lessee Name /410 Phone # Email N61 GH € av 1sotin4. mer Job Address (where the work is being done) 11O?1S NW R VB • DY ierMi City Nt Miami Shores Village County Miami - Dade Zip 33J.6B FOLIO / PARCEL # Is Building Historically Designated YES NO I Contractor's Company Name Par3tinrth m Contractor's Address $358 lFri OAtifiY)0 Perm B 'S, surfs 2033 City . 2roulti'$3 Qualifier Name 34ernlei Phone # 954.- 1 105. 8955 State Certificate or Registration No. Cf Gtt 413a. 85 Certificate of Competency No. Contact Phone 954 - 5'1 $ - l) r Architect/Engineer's Name (if applicable) NIA Phone # JA1fl Value of Work For this Permit $ ?GiO Type of Work: ['Addition ❑Alteration Describe Work: 7pPril2i1 febtlika j oo(, ?MT Miami Shores Village ,Stat FL. Zip 33351., E -mail &KATCOG#lohn ra • earn Square / Linear Footage Of Work: ❑New Permit No. P\ \ O 6 Master Permit No. [' Repair/Replace 95 519 -151.4 Phone # 9Sy • 5g) 1 Is) Submittal Fee $ Permit Fee $ / - h7 / . CCF $ 0.(00 Notary $ Training/Education Fee $ 0'c J Technology Fee $ Scanning $ ' Radon $ DPBR $ Double Fee $ Violation date: Structural Review. $ Total Fee Now Due $ 1 040 IPEOZEW3111 MAY 0 5 2010 gill HY: 1( Flood Zone ❑ Demolition CO /CC $ Bond $ See Reverse side --> Bonding Company's Name (if applicable) Bonding Company's Address City Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State State 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 ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and 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 COMNIENCEMENT 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 no .p oved and a reinspection fee will be charged. er or Agent The foregoing instrument was acknowledged before me this day of ,20, %Mti j ))ipQPG1vNit who is_ossonally known to me or who has produced As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commission Expires: �t" tNo SGiP) - ,E)r' SERGE - RICHARD SAINT ELOI MY COMMISSION #DD649901 EXPIRES: MAR 12, 2011 Bonded through 1st State Insurance APPROVED BY (Revised 07 /I0 /07)(Revised 06/10/2009) 1 Plans Examiner Engineer Nl � Signature Sign: P Zip My Commission Exp Zip Contractor The foregoing instrument s acknowledge • before me this day of VI to , 20 j , by S -dnl i at,,. 7 3o a ti) who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: SERGE - RICHARD SAINT-Ed MY COMMISSION #DD649901 EXPIRES: MAR 12, 2011 Zoning Clerk checked Licensing Portal - License Search Page 1 of 1 Data Contained In Search Results Is Current As Of 05/06/2010 03:45 PM. Search Results Please see our Wassail/ of terms for an explanation of the license status shown in these search results. For additional Information, including any complaints or discipline, click on the name. License License Type Name Number/ Status /Expires Rank Certified Roofing SRJ CONSTRUCTION CCC1327690 Current, Active Contractor CORPORATION DBA Cert Roofing 08/31/2010 License Location Address *: 8358 W OAKLAND PARK BLVD SUITE 203E SUNRISE, FL 33351 Main Address *: 11520 NW 23RD STREET PLANTATION, FL 33323 Certified Plumbing SRJ CONSTRUCTION CFC1428185 Current, Active Contractor CORPORATION DBA Cert Plumbing 08/31/2010 License Location Address *: 8358 W OAKLAND BLVD SUITE 203 E SUNRISE, FL 33351 Main Address *: 11520 NW 23RD STREET PLANTATION, FL 33323 Certified General SRJ CONSTRUCTION Contractor CORPORATION Construction Business Information Name Type DBA License Location Address *: 8358 WEST OAKLAND PARK BLVD SUNRISE, FL 33351 Main Address *: 11520 NW 23RD STREET PLANTATION, FL 33323 SRJ CONSTRUCTION Primary QB0011177 Null and Void CORPORATION Business Info 08/31/1999 License Location Address *: 6190 WOODLANDS BLVD #115 TAMARAC, FL 33319 Main Address *: 6190 WOODLANDS BLVD #115 TAMARAC, FL 33319 Main Address *: 8358 W OAKLAND PARK BLVD SUNRISE, FL 33351 3:41:11 PM 5/6/2010 CGCO58938 Current, Active Cert General 08/31/2010 Construction SRJ CONSTRUCTION QB51029 Current Business CORPORATION Primary Business Info 08/31/2011 Information Civiwth * denotes Main Address - This address is the Primary Address on file. Mailing Address - This is the address where the mail associated with a particular license will be sent (if different from the Main or Ucense Location addresses). Ucense Location Address - This is the address where the place of business is physically located. ( Terms of Use 1 1 Privacy Statement 1 https : / /www.myfloridalicense.com/w111. asp ?mode =2 &search =Name &SID= &brd = &typ= 5/6/2010