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1215 NE 97 St (10)Date Type Insp'n Name Address l 215 tl " cp c� Company ) NJ Lt nia. Phone # q5(4 443 -4 I a I Inspection Date "7 I(` aq 6 ,, t MIAMI SHORES VILLAGE fia BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Request Permit No. I ( -0 Approved Correction Re- Insp'n Fee Date Type lnsp'n t I C' C — ef�cm Permit No. Name 1� L t " ` ' . �.�' Address ( IS � i Compan 0 NJ Ld C J Phone # q Sqt 443-41 Inspection Date �( tU Approved Correction Re- Insp'n Fee MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Request ❑ //7-2,/ y��� MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Bui sing Inspection Request Date Type Insp'n Permit No. Nam@ Address Company Phone # Inspection Date Approved Correction Re-Insp'n Fee MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Request Date — ±7 /- 1A) CILL- Type Insp'n ! ` P No, Nam Address Company / Phone # g / q V .,ga 4L Inspection Date Approved ❑� — "' Correction � / // < -- Re- Insp'n Fee ❑ '`, MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Request 4 Date' / 403 Type Insp' — _ - Permit No. Name Address Company ©/ Phone # Inspection Date Approved Correction Re- Insp'n Fee MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Request \\ Dated -8 /41 "- Type Insp'n Permit No.� Name J C/ Address Company ®/t/ j/ /i- e Phone # J Inspection Date Approved - Correction' Re- Insp'n Fee _ v ^ Permit No...!.. Owner's Name and Address Registered Architect and /or Engineer Employing Electrician's Name...,/ MIAMI SHORES VILLAGE ELECTRICAL INSPECTION DEPARTMENT APPLICATION FOR ELECTRICAL PERMIT Date Street Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules ancl regulations of the Building Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at building during progress of work. No Street • No. Street Location and Legal Description Lot Block Subdivision Street and Number where work is to be performed— No....... _ - ' State work to be performed and purpose of building (By Floors) New Building Remodeling • Addition Repairs No. of Stories Service Overhead Size Feeders Conduit Main Sw Amps Main Fuses Amps Underground Type of Installation — Conduit Tubing B.X.L Metal Moulding Amount of Permit $ The undersigned applicant for this building permit does hereby certify that he understands and a labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws has complied with the provisions thereof, and will require similar compliance from all contractors or work to be performed under this permit; and will post or cause to be posted for inspection on the site as are required by the Act. The undersigned agrees to employ only such subcontractors, on work to licensed by Miami Shores Village. STATE OF FLORIDA, COUNTY OF DADE. ss. (Signed) Electrical Inspector. ccepts his obligations as an employer of of Florida Permanent Supplement, and subcontractors employed by him in the of the work such public notice or notices be performed under this permit, as are (Signed Master Electrician. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the of the above described construction, and he has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated are true. My Commission Expires Notary Public, State of Florida NOTE: A re•inspection fee of $1.00 will be made when such re'inspection is made necessary by improper notice for inspection, or faulty materials and /or workmanship. SWITCH OUTLETS LIGHT OUTLETS PLUG RECE'P'T'S FIXTURES NO. LAMPS REFRIG. OUTLET IRON OUTLET RANGE OUTLET RANGE CONN. WATER HEATER W. HEAT. CONN. SPACE HEATER STRIP HEATER TOTAL CONTR. LIST CHECK ENT. SW. DIST. CAB. SERVICE SERVICE TEMP. J PERM. / / �/ MOTORS 0.1 HP MOTORS 1.5 HP NEON TRANS. RADIO TOTAL CL LIST ' CHECK "7 6 �'`t. - ' Permit No...!.. Owner's Name and Address Registered Architect and /or Engineer Employing Electrician's Name...,/ MIAMI SHORES VILLAGE ELECTRICAL INSPECTION DEPARTMENT APPLICATION FOR ELECTRICAL PERMIT Date Street Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules ancl regulations of the Building Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at building during progress of work. No Street • No. Street Location and Legal Description Lot Block Subdivision Street and Number where work is to be performed— No....... _ - ' State work to be performed and purpose of building (By Floors) New Building Remodeling • Addition Repairs No. of Stories Service Overhead Size Feeders Conduit Main Sw Amps Main Fuses Amps Underground Type of Installation — Conduit Tubing B.X.L Metal Moulding Amount of Permit $ The undersigned applicant for this building permit does hereby certify that he understands and a labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws has complied with the provisions thereof, and will require similar compliance from all contractors or work to be performed under this permit; and will post or cause to be posted for inspection on the site as are required by the Act. The undersigned agrees to employ only such subcontractors, on work to licensed by Miami Shores Village. STATE OF FLORIDA, COUNTY OF DADE. ss. (Signed) Electrical Inspector. ccepts his obligations as an employer of of Florida Permanent Supplement, and subcontractors employed by him in the of the work such public notice or notices be performed under this permit, as are (Signed Master Electrician. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the of the above described construction, and he has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated are true. My Commission Expires Notary Public, State of Florida NOTE: A re•inspection fee of $1.00 will be made when such re'inspection is made necessary by improper notice for inspection, or faulty materials and /or workmanship. Permit No Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at building during progress of work. Owner's Name and Address O Ai? A o L I . No / N Street 9 > S �' Registered Architect and /or Engineer Employing Electrician's Name._. Location and Legal Description Lot Block Subdivision Street and Number where work is to be performed —No Street State work to be performed and purpose of building (By Floors) New Building Remodeling Addition Service Overhead Size Feeders Conduit Main Sw Amps Main Fuses Amps Underground Type of Installation — Conduit Tubing B.X.L Metal Moulding 1 ✓ Amount of Permit $ ` 3 (Signed) The undersigned applicant for this building permit does hereby certify that he understands and a labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws has complied with the provisions thereof, and will require similar compliance from all contractors or work to be performed under this permit; and will post or cause to be posted for inspection on the site as are required by the Act. The undersigned agrees to employ only such sub-contractors, on work to licensed by Miami Shores Village. STATE OF FLORIDA, 1 COUNTY OF DADE. I ELECTRICAL INSPECTION DEPARTMENT ,IL APPLICATION FOR ELECTRICAL PERMIT Date S - s s. MIAMI SHORES VILLAGE Repairs No. of Stories (Signed)... No 0 4 a /Y e Street o1n/Zr Electrical Inspector. ccepts is obligations as an employer of of F orida Permanent Supplement, and subcontractors employed by him in the of the work such public notice or notices be perforned under this permit, as are )64 Master Electrician. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the of the above described construction, and he has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated are true. My Commission Expires Notary Public, State of Florida NOTE: A re-inspection fee of $1.00 will be made when such re-inspection is made necessary by improper notice for inspection, or faulty materials and /or workmanship. SWITCH OUTLETS LIGHT OUTLETS PLUG RECE'P'T'S FIXTURES NO. LAMPS REFRIG. OUTLET IRON OUTLET RANGE OUTLET RANGE CONN. WATER HEATER W. HEAT. CONN. SPACE HEATER \ STRIP HEATER TOTAL CONTR. LIST —� CHECK ENT. SW. DIST. CAS. SERVICE TEMP. SERVICE PERM. MOTORS 0.1 HP M OTORS 1.3 HP N EON TRANS. RADIO TOTAL CONTR. LIST r0.11___±/62.______ �y 3.(0 f ' YW ie P CHECK .1' • s li 7 Permit No Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at building during progress of work. Owner's Name and Address O Ai? A o L I . No / N Street 9 > S �' Registered Architect and /or Engineer Employing Electrician's Name._. Location and Legal Description Lot Block Subdivision Street and Number where work is to be performed —No Street State work to be performed and purpose of building (By Floors) New Building Remodeling Addition Service Overhead Size Feeders Conduit Main Sw Amps Main Fuses Amps Underground Type of Installation — Conduit Tubing B.X.L Metal Moulding 1 ✓ Amount of Permit $ ` 3 (Signed) The undersigned applicant for this building permit does hereby certify that he understands and a labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws has complied with the provisions thereof, and will require similar compliance from all contractors or work to be performed under this permit; and will post or cause to be posted for inspection on the site as are required by the Act. The undersigned agrees to employ only such sub-contractors, on work to licensed by Miami Shores Village. STATE OF FLORIDA, 1 COUNTY OF DADE. I ELECTRICAL INSPECTION DEPARTMENT ,IL APPLICATION FOR ELECTRICAL PERMIT Date S - s s. MIAMI SHORES VILLAGE Repairs No. of Stories (Signed)... No 0 4 a /Y e Street o1n/Zr Electrical Inspector. ccepts is obligations as an employer of of F orida Permanent Supplement, and subcontractors employed by him in the of the work such public notice or notices be perforned under this permit, as are )64 Master Electrician. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the of the above described construction, and he has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated are true. My Commission Expires Notary Public, State of Florida NOTE: A re-inspection fee of $1.00 will be made when such re-inspection is made necessary by improper notice for inspection, or faulty materials and /or workmanship. Amount of Permit $ STATE OF FLORIDA, 1 COUNTY OF DADE. I Street and Number where work is to be performed— No.. ..%. 58. MIAMI SHORES VILLAGE ELECTRICAL INSPECTION DEPARTMENT APPLICATION FOR ELECTRICAL PERMIT Permit No /11.1.. ,C� Date. ...::.... Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other A ` structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division of Miami Shores Village shall be complied with, whether erein specified or not. A copy of approved plans and specifications must be kept at building during progress of work.�w_ ..�J Owner's Name and Address . No Street Registered Architect and /or Engineer .�, . o e� Employing Electrician's Name � � , No 'Street...., Location and Legal Description Lot Block Subdivision Street State work to be perfor ed and purpose of building (By Floors) New Building Remodeling Addition Repairs No. of Stories Ov Service erhead ce Underground Size Feeders.r -fr Conduit O %- Main Sw Type of Installation — Conduit Tubing Cf " B X L Metal Moulding Electrical The undersigned applicant for this building permit does hereby certify that he twlelerstands and accepts his obligations - . s an emyer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supplem t, and has complied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by hi in the work to be performed under this permit; and will post or cause to be posted for inspection on the site of the work such public notice or notices as are required by the Act. The undersigned agrees to employ only such sub - contractors, on work to be performed under this permit, as are licensed by Miami Shores Village. (Signed) Amps Main Fuses l' Amps 52 5 5 Master Electrician. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the of the above described construction, and he has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated are true. My Commission Expires Notary Public, State of Florida NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made necessary by improper notice forllnspection, or faulty materials and /or workmanship. SWITCH OUTLETS LIGHT OUTLETS PLUG RECE'P'T'S FIXTURES NO. LAMPS REFRIO. OUTLET IRON OUTLET RANGE OUTLET RANGE CONN. WATER HEATER W. HEA'r. CONN. SPACE HEATER STRIP HEATER TOTAL C ,� eA AA a- o / 5 -/- o -- , (!v .s e CHECK _ 5e ENT. SW. DIST. CAB. SERVICE TEMP. SERVICE PERM. MOTORS 0.1 HP MOTORS 1.5 HP NEON TRANS. RADIO TOTAL / CHECK ,c /et 6 " e - i b Amount of Permit $ STATE OF FLORIDA, 1 COUNTY OF DADE. I Street and Number where work is to be performed— No.. ..%. 58. MIAMI SHORES VILLAGE ELECTRICAL INSPECTION DEPARTMENT APPLICATION FOR ELECTRICAL PERMIT Permit No /11.1.. ,C� Date. ...::.... Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other A ` structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division of Miami Shores Village shall be complied with, whether erein specified or not. A copy of approved plans and specifications must be kept at building during progress of work.�w_ ..�J Owner's Name and Address . No Street Registered Architect and /or Engineer .�, . o e� Employing Electrician's Name � � , No 'Street...., Location and Legal Description Lot Block Subdivision Street State work to be perfor ed and purpose of building (By Floors) New Building Remodeling Addition Repairs No. of Stories Ov Service erhead ce Underground Size Feeders.r -fr Conduit O %- Main Sw Type of Installation — Conduit Tubing Cf " B X L Metal Moulding Electrical The undersigned applicant for this building permit does hereby certify that he twlelerstands and accepts his obligations - . s an emyer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supplem t, and has complied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by hi in the work to be performed under this permit; and will post or cause to be posted for inspection on the site of the work such public notice or notices as are required by the Act. The undersigned agrees to employ only such sub - contractors, on work to be performed under this permit, as are licensed by Miami Shores Village. (Signed) Amps Main Fuses l' Amps 52 5 5 Master Electrician. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the of the above described construction, and he has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated are true. My Commission Expires Notary Public, State of Florida NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made necessary by improper notice forllnspection, or faulty materials and /or workmanship. FBC 2001 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 TeI:,(3(15) .295...2204 Fax: (345) '756.8972 BUILDING r Permit No. I os - PERMIT APPLICATION il Master Permit: No SPO5 AIM o?® e Owner's Name (Fee Simple Titleholder) Owner's Address 15 ` City/ / ' d S A Ihi / State Tenant/Lessee Name Is Building Historically Designated YES Contractor's Company Name 0,44016 Ala / Contractor's Address 3,2/9( gdo, pi 6 ,/ , `b, City R4 /�/ /S 1e Qualifier P . � / i f` , 7,,t./ /e ( /r Architect/Engineer's Name (if applicable) $ Value of Work For this Permit � goo ' 0 Total Fee Now Due $ (Continued on opposite side) Miami Shores Village Building Department NO Permit Type (circle): Building Electrical Plumbing Mechanical Roofing Zip Job Address (where the work is being done) City Miami Shores Village County _ Miami-Dade 1 Phone # 917# zip ,_$5,(2. State Certificate or Registration No. , &)L/13 Certificate of Competency No. q9 5 Odaa 15 Phone # Zip Square Footage Of Work: oZ / Type of Work: ❑Addition ❑ teration ❑New X Repair/Replace Describe Work: ife 1746/. ? D* J /N /S4 1 1ri £ g/ f A mP i g /J , e ii 52 7' , q' - q%31 co 14 A , / % • r / t . ❑ Demolition e ✓+/ 1,04`111,C * * * * * * * * * * * * * * * * * * * * * * * * * * ** F ees * * * * * * * * * * * * * * * * * * * * * * * * * *k * ** Submittal Fee/ Permit Fee $ ' �� CCF $ l CO /CC Notary $ Training/Education Fee $ 0 t Lt 0 Technology Fee $ 6,( Scanning $ Radon $ Zoning Bond $ Code Enforcement $ Structural Plan Review. $ Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) Mortgage Jnds 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 ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC OWNER'S AFFIDAVIT: I certify that t all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and z . n g w ,. "WARNING TO OWNER: YOUR FAIL TO RECORD'SA $dOTICo COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY.`1'*)U 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 #osted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of • /ch posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature Signatur Owner or Agent The foregoing instrument was acknowledged before me this The forego ! instrument was acknowledges efore me this 1 1 Cr , 20 C by c Vd ' 0_, yaw 1 day of , 20 , by , day of who is personally known to me or who has produced who is personally know / p.to me or who has produced As identification and who did take an oath. h identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: Sign: Print: Print: My Commission Expires: My Commission Expires: *********************************************************************** * * * * * * * * * * * * * * * * * * ,C* * ** * v� t, rga5 ommission 231984 .)•* Expires: hi' '3,2007 9' •..• P; ;oni *********************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** ` p° * * *A* :IIS Co.,lnc APPLICATION APPROVED BY: Chc 05/13/03 e— 9lj -i7t�! Plans Examiner Engineer Zoning BUILDING ELECTRICAL PLUMBNG ROOFING Owner of Building • • n S 195 Contractor's License No Architect . Contractor or Builder ` Legal Description Address of Building Lot n ❑ Work to be performed under 1 ° t ' l CONTRACTOR OR BUILDER MIAMI SHO ES VILLAGE, FLORIDA DATE__ =RMIT N° 11880 Bl. 4 Subdi- vision herefor p p g drawings, statements or specifications that may have been submitted to a time if the work is not done in compliance with such ordinances or if the granted is the understanding that the contractor or builder named above pertaining to the work covered hereby whether shown on the plans or drii done by his agents, servants or employees. ° Permit Value of Project $ This permit is granted to the contractor or lfilder named abovto�it understan h in strict com with all ordinances estainin thereto an W d ,Approved tetie t pr umes the) es lens are cha? ed wi BY Amt. of Permit 1'4* 011. construct the building or to install the equipment or device described in the applica onn at t e work will be performed in compliance with any plans, er municipal authoritief. This Permit may be revoked at any ut authorization. A further condition upon which this permit is p for a thorough knowledge of the ordinances and regulations s,c,F,i+the statements.Qr. specific ncl.th • B4 A ■ Signed: — , INSPECTOR In consideration of the issuance to me of p this perm, agree to , orm the e covered hereunder in compliance ordinances regulations nts or specifications submitted to the a r Miami Village. myself, pertaining thereto and in strict conformity with the plans, drams stater,_ p agent, servant or employee. In accepting this permit I assume responsibility for all work done by dill f AUTHOR= BUILDING ❑ ELECTRICAL PLUMBING ROOFING Owner of Building Architect Contractor or Builder Legal s Lot Description. Address of Building II E MIAMI SHORE PERMIT X? Work to be performed under tl r CONTRACTOR OR BUILDER Bl. This permit is granted to the contractor or builder named above to herefor in strict compliance with all ordinances pertaining thereto and wit drawings, statements or specifications that may have been submitted to and time if the work is not done in compliance with such ordinances or if the plar granted is the understanding that the contractor or builder named above ass pertaining to the work covered hereby whether shown on the plans or draw done by his agents, servants or employees. tr VILLAGE, FLORIDA 11799 Subdi- vision Value of Project $ BY DAT 195 Contractor's License No Permit to Amt. of Permit $ a onstruct the building or to install the equipment or device described in the application the understanding that the work will be performed in compliance with any plans, approved by the proper municipal authorities. This Permit may be revoked at any s are changed without authorization. A further condition upon which this permit is mes the responsibility for a thorough knowledge of the ordinances and regulations rigs pr i the st Rtements or specifications and that he assumes responsibility for work BY J � • Signed INSPECTOR In consideration of the issuance to me of this permit I agree to parfo} =m the work covered hereunder in compliance with tll4rdinances and regulations pertaining thereto and in strict conformity with the plans, drawings, statement'ts 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, servant or employee. AUTHORITY 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. MI SR S I LTR AUD'L INSRE TYPE OF INSURANCE PRODUCER Gateway Insurance Agency 2430 W. Oakland Park Blvd. Fort Lauderdale FL 33311 Phone: 954- 735 -5500 Fax: 954- 735 -2852 POLICY NUMBER DATE POLICY EFFECTIVE POLICY (MMPDDION IY LIMITS A 01130 GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY SCP37264075 12/07/04 12/07/05 EACH OCCURRENCE $ 1000000 X PREMISES (Ea occurence) $ 300000 1 CLAIMS MADE (X OCCUR MED EXP (Any one person) $ 10000 PERSONAL BADVINJURY $ 1000000 X Aggr limit per Pr GENERAL AGGREGATE $ 2000000 GE 'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ 2000000 POLICY' PRO- JECT LOC AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY ANY AUTO AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE RETENTION $ $ $ $ B WORKERS COMPENSATION AND EMPLOYERS'LU►BILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? If Yes, describe under SPECIAL PROVISIONS below 2003325369 12/16/04 12/16/05 X ITO Y I ER E.L. EACH ACCIDENT $ 100000 E.L. DISEASE - EA EMPLOYEE $ 100000 E.L. DISEASE - POLICY LIMIT $ 500 000 A OTHER Inland marine SCP37264075 12/07/04 12/07/05 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS Electrical Work Within Buildings. Owned Tools /Equipment $2500; Rented /Leased $5000. $250 Deductible ACORD CERTIFICATE OF LIABILITY INSURANCE ON OPID MB DATE (MWDD/YYYY) NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. PRODUCER Gateway Insurance Agency 2430 W. Oakland Park Blvd. Fort Lauderdale FL 33311 Phone: 954- 735 -5500 Fax: 954- 735 -2852 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC # INSURED Online Electrical Services Inc Attn: Mr. Sean Crowley 8201 N.W. 15 Street Pembroke Pines FL 33024 INSURER A: Assurance Co. of America 01130 INSURER B: Business First Ins. Co. INSURER C: INSURER D: INSURER E: VILLAGE OF MIAMI SHORES 10050 NE 2ND AVE MIAMI SHORES FL 33138 VILMI 02 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZI D P- •1•l9V f COVERAGES CERTIFICATE HOLDER CANCELLATION ACORD 25 (2001/08) ©ACORD CORPORATION 1988 Miami Shores Village 10050 NE 2nd Avenue Phone: 305- 795 -2204 Permit Number: EL2005 -60 Printed: 3/10/2005 Applicant: FERNANDO GODINEZ Owner: GODINEZ FERNANDO JOB ADDRESS: 1215 NE 97 ST Contractor ONLINE ELECTRICAL SERVICES INC Local Phone: (954) 443 -4131 Parcel # 1132050090380 Legal Description: 5 53 42 EARLETON SHORES Fees: FEE2005 -3152 FEE2005 -3153 FEE2005 -3154 FEE2005 -3155 FEE2005 -3156 Description Building Fee CCF Notary Fee Training and Education Fee Technology Fee Total Fees: Amount $225.00 $1.80 $5.00 $0.60 $5.63 $238.03 Total Fees: $238.03 Total Receipts: $0.00 Permit Status: APPROVED Permit Expiration: 8/10/2005 Construction Value: $2,500.00 Work: REPLACE EXISTING SERVICE- MASTER PERMIT BP2005 -202 Signed: (INSPECTOR) Electrical Permit Contractor's Address: 1401 NW 84 TERRACE Page 1 of 1 PB 43 -80 LOT 12 BLK 3 LOT SIZE NPR 1 1 PAID 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 responisibility for all work done by either myself, my agent, servants or employes. Signed: (Contractor or Builder) BY: ITEM BATH TUB UNIT FEE ITEM SWITCH OUTLETS UNIT FEE ITEM SPACE HEATERS UNIT FEE BIDET LIGHT OUTLETS CENTRAL HEATING DISHWASHER RECEPTACLES A/C (WIND) DISPOSAL SERVICE TEMPORARY A/C (CENTRAL) DRINKING FOUNTAIN SERVICE SIZE IN AMPS (i' j) / DUCT WORK FLOOR DRAIN SERVICE REPAIR/METER CHANGE / REFRIGERATION GREASE TRAP APPLIANCE OUTLETS PROCESS AND PRESS PIPING INTERCEPTOR RANGE TOP UNDERGROUND TANKS LAVATORY OVEN ABOVE GROUND TANKS LAUNDRY TRAY WATER HEATER U.F. PRESSURE VESSELS CLOTHES WASHER MOTORS 0- 1 HP STEAM BOILERS SHOWER MOTORS OVER 1- 3 HP HOT WATER BOILERS SINK, POT /3 COMP. MOTORS OVER 3- 5 HP MECHANICAL VENTILATION SINK, RESIDENCE MOTORS OVER 5- 8 HP TRANSPORTING ASSEMBLIES SINK, SLOP MOTORS OVER 8- 10 HP ELEVATORS/ESCALATORS TEMPORARY WATER CLOSET MOTORS OVER 10- 25 HP FIRE SPRINKLER SYSTEMS URINAL MOTORS OVER 25-100 HP COOLING TOWERS WATER CLOSET MOTORS OVER 100 HP VIOLATION INDIRECT WASTES- A/C WINDOW REINSPECTION WATER SUPPLY TO: AIR CONDITIONERS A/C UNIT STRIP HEATER FIRE SPRINKLER GENERATORS TRANSFORMERS HEATER -NEW INST. GENERATORS TRANSFORMERS HEATER - REPLACE GENERATORS TRANSFORMERS LAWN SPRINKLER -WELL SPECIAL PURPOSE SWIMWING POOL OUTLETS COMERCIAL WATER SERVICE SIGN TUBES r SEWER CONNECTIONS SIGN TRANSFORMERS UTILITY -SEWER SIGN TIME CLOCK UTILITY -WATER FIXTLRES SEPTIC TANK ANTENNA RELAY TELEVISION OUTLETS DRAINFIELD, 4' TILE/RES. VIOLATION PUMP 8 ABANDON SEPTIC TANK REINSPECTION SOAKAGE PIT CU. FT. CATCH BASIN DISCHARGE WELL DOMESTIC WELL AREA DRAIN ROOF INLET SOLAR WATER HEATER . FIRE STANDPIPE POOL PIPING LAWN SPRINKLER SYSTEM GAS RANGE METER SET (GAS) GAS PIPING (AN APPLI%ATION FOR BUILDING PERMIT MUST ACCOMPANY THIS ADDENDUM. IF A MASTER PERMIT HAS B. OBTAINED, THE OWNER'S NOTARIZED SIGNATURE NEED NOT BE PRESENT ON SUBSEQUENT APPLICATIONS.) PLUMBING ADDENDUM TO BUILDING PERMIT APPLICATION ELECTRICAL MECHANICAL 4 MIAMI SHORE VILLAGE BUILDING DEPARTMENT 305- 795 -22 Building Inspection Request Date Type Insp' n 5 202 Permit No. Name LG Address Company Phone # Inspection Date - 7 Approved Correction Re- Insp'n Fee Approved Correction Re -Insp' n Fee MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -220 Building Inspection Request Q DateZ — Type lnsp'n " ZO Permit No. Name. me Address 1 Company 1 ( Phone # Inspection Date fur C0? "/"T "Et 4,14 S