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EL-10-401Scheduled Inspection Date: April 27, 2010 Inspector: Devaney, Michael Owner: ROSE, JOHNATHAN Job Address: 1259 NE 98 Street Miami Shores, FL Project: <NONE> Contractor: DAY STAR ELECTRIC INC Building Department Comments April 26, 2010 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 141623 Permit Number: EL- 3- 10-401 For Inspections please call: (305)762 -4949 Permit Type: Electrical - Residential Inspection Type: Final Work Classification: Alteration Phone Number Parcel Number 1132050090250 Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments Page 24 of 29 Project Address Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Expiration: 09/11/2010 Parcel Number Applicant 1259 98 Street Miami Shores, FL 1132050090250 Block: Lot: JOHNATHAN ROSE Owner Information JOHNATHAN ROSE 1259 NE 98 ST MIAMI SHORES FL 33138 -2562 Ms le Valuation: Total Sq Feet: $ 700.00 0 Contractor(s) DAY STAR ELECTRIC INC Phone Cell Phone Type of Work: Additional Info: ELECTRICAL Classification: Residential Fees Due CCF Education Surcharge Permit Fee - Additions/Alterations Scanning Fee Submittal Fee Submittal Reversal Fee Technology Fee Total: Amount $0.60 $0.20 $150.00 $3.00 $50.00 ($50.00) $0.80 $154.60 Authorized Signature: Owner / Applicant / Contractor / Agent Building Department Copy Address Phone Pay Date Pay Type Invoice # EL -3-10 -37272 03/11/2010 Check #: 4302 $ 50.00 $ 104.60 03/17/2010 Check #: 4304 $ 104.60 $ 0.00 Amt Paid Amt Due Cell Available Inspections: Inspection Type: 1 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. March 17, 2010 Date March 17, 2010 1 BUILDING PERMIT APPLICATION FBC 20 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. ELI - 40 Master Permit No. n to ---, Permit Type: ELECTRICAL f�pp p Owner's Name (Fee Simple Titleholder) iallo (,(� d-. Te f r i gore ' Phone # 3o 17S q , a7 7 a Owner's Address j 2.5 q i q g J 1 City I'kQ,WU, e.5 State R. Tenant/Lessee Name 1\J 0 vi P Email rose (2s4 @ bellsoctitA met- Job Address (where the work is being done) Value of Work For this Permit $ 700, e c7 Type of Work: ['Addition ❑Alteration [New Describe Work: /R., g Lo c/•! T E' A Le e 7 /e F o X11 Ham /E 1259 Ai eig &t-. zip 33138 Phone # BY: City Miami Shores Village County Miami -Dade Zip 3'N " FOLIO / PARCEL # Is Building Historically Designated YES NO V Flood Zone Contractor's Company Name ed °r' S �°`2Vt. E L 6 C TR 1 6 JAR, Phone # 3 0 `5 / 6 - 3 r7 3 Contractor's Address /V E., / J. a, k u p S City /(JOEL TK /) / A iv/ l State /Z L- Zip - ' � 3 / 6 / Qualifier Name c i 6 ( 6—E P, CA L b e © Phone # X03 = a. /6 -3 / 7 g State Certificate or Registration No. EA' as 1 '4 i 4 S ) Certificate of Competency No. Q00® Contact Phone 3 O 5 - - a, 1 f,, - 3 % 73 E -mail D A Y 57 /L /-/ 6r-. Co en c Z r, A/ E — Architect/Engineer's Name (if applicable) Phone # Square / Linear Footage Of Work: 4 Repair/Replace ❑ Demolition RO® Yo S IbE oF ******** , * * * * * * * * * * * * * * * * * * * * * * *** * * * ** F ees * * * * * ** **** * * * * * * * * ,** * * * * **** * * * * * * * * * * * ** Submittal Fee $ - Permit Fee $ CCF $ I (/ CO /CC $ Notary $ Training/Education Fee $ 0 • Q Technology Fee $ ©'C Scanning $ Radon $ DPBR $ Bond $ Double Fee $ Violation date: ,n Structural Review. $ Total Fee Now Due $ l 04• ,, �D See Reverse side -+ mAR 2010 big 14-e Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for 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 COM ENCEMENT." 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 - occurs seven days after the building permit is issued. In the absence of such posted notice, the inspection wi . e approved and inspection fee will be charged. The foregoing instrument was acknowledged before me this ! 1 day of _, 20 ID , by 'Jo h nai-han Rote— , who is personally known to me or who has produced FL 4 G As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commission Expires: Ili3b \ o APPROVED BY Owner or Agent F (Revised 07 /10 /07)(Revised 06/10/2009) Engineer Signature A A A .A AM. M A Contractor The foregoing V instrument was acknowledged before me this // day o , 20 La, by 'So t 1 he rot) who is personally known to me or who has produced p L as identification and who did take an oath. i •Iyu • NOTARY P LIC: �� ,,,,1111,, SHUMINTRATA D. BUZZANELLSf .4iY PV / , bs o •ry •u• is - e of Florida r • _M Commission Ex . ires Apr 26, 2Olt Commission # DD 529448 � JF IIIt\ F� Bonded By National Notary AssriY4 Commission Expires: TARY PUBLIC -STATE OF FLORIDA 1" Andrea P hili ou DD560143 010 ED THRU ATLANTIC BONDING CO., EN C. f[$$ i' *i$ SF****** *** iY*****X 3l*:Y****'X!•C*.'t*** *** * ** CSC****$ *] t[ ******** 1C] 1 C9C**YC* Ini**** *I[*•ICBC*****A'SQL***fit.' FAY * *****aL'***tY*]Y***** J / / Plans Examiner Zoning Clerk checked WO TYPE OF INSURANCE POW( NUMBER PA 1' PA P 6444gOttervi Lfd1IT8 GE ML LNWBITY I:UNMLI/I:IAL URINAL LIALIJLI IY EACH OCCUR ENCE 6 1 UVL UAMAGL (A, al /a ltwI 6 1 CLAIMS MADE OCCUR MED EXP Mpg ern mach, 6 1 A MTV KIM 6 GENERAL AGGREGATE 6 GENT. AGGREGATE MST APPLIES PER: POLICY Ti n LOC PRODUCTS • COM'IOP AN 6 — I AM °M OM UAD1111 v ANY AUTO ALL OWNED AUTOS IRA 1LUULLU AU I US HIRED AUTOS NnN4ANNFII Mow; co (E ngc COMBINED L6 UNIT 6 _ BODILY INJURY 414 oaraad 6 _ BODILY (NJLIRY OW .acldantl 6 -.— PROBITY DAMAGE (Par eaclda,,1 6 &IMAf•.F IlAMRITV R ANY AUTO AUTO ONLY. EA ACCID�T 6 � p TH(� EA ACC $ AUTO ONLY= ACC 6 &XGtssLIAlrMJ!V UL:t:Uli 7 L6,AIMS MAUL nrn% ICTIPI r MENTION 6 EACH OCCURRENCE 4 AC HR{LIiAI L 6 6 6 A WafEns calGOLLPENsATA7NAND EMPLOYERS" 1Ji1 76 WEG E28317 07/27/09 ti 07/27/10 I TnRYSi INiTR V EL. EACH AAGIENT 400,000 E.L. astas - EA EMM.OYEE 610 0 , 0 0 0 E.L, DIsiABE.IawcV LjWIT 65 0 0, COO u!!A~t, DESCRIPTION DROPERAT 40DATLOI VENDLENEXOLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROW:DOW ELECTRICAL WIRING (COMMERCIAL) RE; 520 N.E. 92ND STREET, MIAMI SHORES, FL. Mar 11 2818 11:23:33 ACORQTh, CERTIFICATE OF LIABILITY INSURANCE PROANa&R PAYCHEX INSURANCE AGENCY INC /PHS 210703 P:(877)287 -1312 F :(888)443 -6112 PO BOX 33015 SAN ANTONIO TX 78265 INsUkt6 DAY STAR ELECTRIC 830 N.E. 122ND ST. NORTH MIAMI FL 33161 COVERAGES CEATIFICATEHOLD6R MIAMI SHORES VILLAGE 10050 NE 2ND AVE MIAMI SHORES, FL 33138 ACORD 26-S17/971 ADDIPMIAL RJSUkt& lA4UAtR stk.: 2002 -06 -01 13 :15 1115 LEGAL SERV 660 -547 -5000 -> DAY STAR ELECTRIC IN The Hartford Fax Page 883 THIS CERTIFICATE 15 ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 1 IOLCICfi. TI 115 cCfM - MATE OOCS NOT AMCND, EXTEND OR AL I EH 1 Ht CUVtHA(iE AFtUHUEU BY 1 HE POLICIES BELOW. INSURER A: Hartford Underwriters Inca Co INSURER BI ININIIS 14 C: INSURER 0: INSURER E: THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REOUIREMENT. 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 POUGIES DESCRIBED HEREIN I5 SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AOOREOATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CANCELLATION INSURERS AFFORDING COVERAGE Aumolugp7ZTATX GMH DAM' R022 03 -11 -2010 SHOULD ANY 01- I HE ABOVE UESCHILIEU POLICIES GE CANCELLED IEWHE I HE FXPIRATInN nATF TNFRF(F, TI -IF ISSUIN/ INSURER WI11 FNI1FAVCR To MAII 30 DAYS WRITTEN NOTICE 110 DAYS FOR NON - PAYMENT) TO THE CERTIFICATE HOLDER NAMED TO THE LEFT. BUT FAILURE To DO 50 SHALL IMPOSE NO nRI IL:ATInN nR I IARII ITY OF ANY KINN UPON THE INiSURFR, ITS Ac,FNTS nR RCT+RCSCNTATIVCC. ACUHU CUHI I ION *Isms Page 3 THE ANY MAY POUCIES. 111667(W 1. POLICIES REQUIREMENT. PERTAIN, .:5.l.. OE INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POUCY PERIOD INDICATED, NOTWITHSTANDING TERM OR CONOITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUE,IECT TO AU. THE TERMS. EXCLUSIONS AND CONDITIONS OP SUCH AGGREGATE LIMITS SHOWN MAY HAVE SEEN REDUCED BY PAID CLAIMS. , ..,- �, �- ,, 1 , : ::1 ti.' • i. .... PC .L 1 0- 2 41. 1 k • :.�I/ I :� *I neA Al ' . ;Itii ''' , 1 I ..1 •: NANO 4 A INspREBA NOVA CASUALTY CO GENERAL X LIABILITY COMMERCIAL GENERA, LIABUrV 09AL065513 07/31/2009 07/3112010 CH accU,1A.1 - s 500,000 !' tt a;' -,�c; -4- : , „ M EC OP (Any one perRol 100,000 1 CLAIMS MADE [ OCCUR SA . I PERSONALS ADV INJURY B, 000 OENERA4 ACeATE $ 1,000 000 Lu+R GENE AGSM T AIYP PER: PRODUCTS • COMFtof' AGO $ 1 , 0 00,0 0 0 POLICY LOC . LIABB'RV ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS COMBINED SINGLE LUN[T I an) $ H Boo INJURY I mmo) eopity INJURY (Per =Vent) .I __J PROPERTY DAMADE (Per =Mem . GARAGE UAMU Y ANY AUTO AUTO ONLY EA ACCIDENT 8 OTHER THAN EA ACC 8 AUTO ONLY: AGE $ 6$S R€1,40. LIABILITY OCCUR CLAIMS MAOE EACH OCCURRENCE $ — DEDUCTIBLE -MOM— J S PORKERS COMPENSATION AND EMPLOYERS' LIABLITY ANY pIIQpR1E1'ORJPARTIVMEXECUTNE OFFICER/NEWER EXCLUDED? Iy�, Scribe and ? SPECIAL_pROVISIONS below 04471g.1 T G E L EACH ACCIDENT S E L _D) E • Eft EMILOYEE B.L. DISEASE - POLICY LIMIT $ ,.,,,� OTHER DESCRIPTION OF OPERATIONS 1 LOCATIONS / VE¢9CLE81 E1CCLUS1ONS MbDED 9Y ENDORSEMENT / $PEDAL PROYl81CN8 ELECTRICIAN ACORD CERTIFICATE OF LIABILITY INSURANCE DATE 43 E 2 0 1 ` � M OF INFORMATION CERTIFICATE BELL mat= API Group P.O. Box 934125 BROOKSIE PEEPLES #A203142 Margate FL 33093 THIS CERTIFICATE IS ISSUED AS A MATTER ONLY AND CONFERS NO RIGH'T'S UPON THE HOLDER. L E COVERAGE O �O ED N BY�ThE EP POLICIE ES S INSURERS AFFORDING COVERAGE NANO 4 IMSURSD DAY STAR ELECTRIC INC 830 NE 122ND ST HENRY GOCKENBACH N MIAMI FL 33161 INspREBA NOVA CASUALTY CO INSURERS: INSURER C; p . INSURER El - 03/11/2010 19:14 9549688307 API GROUP RAGES PAGE 01/01 CERTIFICATE HOLDER CITY OF MIAMI SHORES 10050 NE 2ND AVENUE MIAMI SHORES, FL 33138 ACORD 25 (2001108) 2002 -06 -01 14:04 9549688307 CANCELLATION SHOW.. ANY OPTHE ABOVEOEOCRIBEIPPOLENES BEOANOELLEO BEFORE THE EXPIRATION OATS THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WINI TBN NOTICE TO THE CERtIFICATB HOLDER NAMED TOME LEVI. RUT FAILURE TO DO SO SHALL IMIPCGM NO OSUGA1ION OR LIABILITY OP : KIND UPON THE Imo, ITS AGENTS ON TIV ACORD CORPORATION 1808 Page 1 BATCH NT 'DER t QUALIFYING TRADE(S) 0001 ELECTRICAL HermWo Gonn(ez P.E. Secretary at the Board Mtarrd-Dade Board BUSINESS.CCERTIF YE OF COMPETENCY 0000 mfuG pt®r T; ofi ` e „ , Vt ID FOR CONTRACTING UNTIL 09130120 1 1 wYw.odamidade. 1 _ *FIROF0..V4 ' 7.t • - „ - 4r. " SEE OTHER SIDE DO NOT FORWARD DAY STAR ELECTRIC INC HENRY E GOCKENBACK PRES 830 NE 122 ST NORTH MIAMI FL 33161 WhAmildhunBAJLJAhlhadh T 1? DO NOT FORWARD DAY STAR ELECTRIC INC HENRY E GOCKENBACK PRES 830 NE 122 ST NORTH MIAMI FL 33161 1111111111 I _ _ - _ _