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EL-10-1187Inspection Type: Final Meter Box Alteration Relocation Fire Alarm Service Change Underground W. W. Project Address Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Parcel Number Applicant 95 NE 98 Street Miami Shores, FL 33138- 1132060131170 Block: Lot: LIZIANNY FRANCZAK Owner Information Fees Due CCF Education Surcharge Permit Fee - Additions/Alterations Scanning Fee Technology Fee Total: Amount $1.80 $0.60 $225.00 $3.00 $2.40 $232.80 Building Department Copy July 06, 2010 Address Contractor(s) G &T ELECTRIC COMPANY Phone Cell Phone Authorized Signature: Owner / Applicant / Contractor / Agent Phone Type of Work: ELECTRICAL Additional Info: GATE MOTOR Classification: Residential Scanning: 1 Pay Date Pay Type Amt Paid Amt Due Invoice # EL -6 -10 -38297 07/06/2010 Check #: 8080 $ 232.80 $ 0.00 July 06, 2010 Date Cell LIZIANNY FRANCZAK 95 NE 98 ST MIAMI SHORES FL 33138 -2334 i Available Inspections: 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. 1 BUILDING PERMIT APPLICATION FBC 20 Permit Type: ELECTRICAL rc.Ne,2, TA Owner's Name (Fee Simple Titleholder) CAA, r a ° S A-o is, Le 4- Liz j Phone # Q 3- 7 57- ?Z,11..? Owner's Address 6 (fl T City VM.I A% 5V, a s. State P` Zip 3 3 VS 8 A S* Tenant/Lessee Name Phone # Email Job Address (where the work is being done) 9 5 - p 78 ST City Miami Shores Village County Miami -Dade Zip 4 334 FOLIO / PARCEL # Is Building Historically Designated YES NO Flood Zone Contractor's Company Name - (% I 9', CJs(` Phone # 3O S • 053 Contractor's Address 44 i City State Zi p �- a Qualifier Name t Phone # �? - S I g � ° C' 3 3. 4, Miami Shores Village Building Department 1 0050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 State Certificate or Registration No. EC, / % Do l $ 3 ertifcate of Competency No. Contact Phone S - ° E -mail n� Architect/Engineer's Name (if applicable) Phone # Value of Work For this Permit $ ®® ��" Square / Linear Footage Of Work: Type of Work: DAddition Alteration ONew ❑ Repair/Replace ❑Demolition Describe Work: la b r ar 0_0 v.s ►� � j � 14,t e» Submittal Fee $ Permit Fee $ e CCF $ i ' CO /CC $ Training/Education Fee $ 0' (CA Rmazgys5 JUN `L 2010 ILY BY: Permit No.. JO I 1 Master Permit No. Technology Fee $ sa tC Notary $ Scanning $ / ( 2 )' 00 Radon $ DPBR $ Bond $ Double Fee $ Violation date: n;�c� Structural Review. $ Total Fee Now Due $ a 2 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 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 A}FIDAVIT: 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 insp ction which occurs seven (7) days after the building permit is issued the of such posted notice, the inspection will be approved and a re- inspection fee will be charged Signature Sign: Print: A.L. - Owner or 4gent Q The fo 'oing instrumen was ac owledged before e + 's t day oJYuCJ , 201 by 3 3 y/y) j , who is 'ersonall:Y known to me or who has pro • who is P - - '0 'I 1 \ ce identification and who did take an oath. � My Commission Expires : APPROVED BY (Revised 07/10/07X Revised 06/10/2009) State Zip ek C. Le vprA ****************: ***st Jt,t**,tr* k4t,t*at** *Ytic9nirs'rdt*,kat,t9t,Y,tai **le*** 5.1 j `''a Plans Examiner Engineer Contractor The foreg ing instrument wassackn• ledged day of , 2010, by ersonally known to me or who has produced -o-/ identification and who did take an oath. OTARY PUBLIC: Sign: Print: de*3t*****9e*4tat * My Commission Expires: �1. 73, tS► * * *** ant * *** * ** * * Zoning Clerk checked 2009 LOCAL BUSINESS MIAMI DE' COUNTY L$5 EXPIRES S S EPT. MUST BE'DISPLAYED.; 1T P PURSUANT TO COUNTY CODE'C THIS IS NOT A BILL = DO DO G & T ELECTR GERALD MAJ 9550 NW MIAMI STAGE I MIAMI -DADE COUNTY TAX COLLECTOR 140 W..FLAGLER ST 1st FLOOR MIAMI, FL 33130 b wALD .MAJEWS SeDTxpe r 1'ftca THIS IS :ONLY' A ..L BUSINESS =TAX,RECEIPT IT , NOT PERMIT _:THE - HOWE,R - TO VIOLATE ANY - EXI STING REGULATORY OR ZONING - LAWS'- OF THE COUNTY OR CITIES. NOR DOES if EXEMPT THE _HOLDER;FROM ANY OTHER PERMIT '.:OR. LICENSE REOUIRED'SY - LAW. THIS IS NOT A-CERTIFICATION- OF THE HOLDER'S QUALIFICA- TIONS. PAYMENTERECEIYED :.:. f IAMlD O COUNTY =T 10109/200 =6000t aaln 0000 00 SEE OTHER SIDE FORWARD COMPANY KI ST #15 33172 4t t��ut��ntt���tstlstitlult��uStn��tntiittt� ls� tOta4+Y1 � NO. 231 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD 1940 NORTH MONROE STREET TALLAHASSEE FL 32399 -0783 MAJEWSKI, GERALD G & T ELECTRIC COMPANY 9550 NW 12 ST UNIT MIAMI FL 33172 Congratulations! With this license you become one of the nearly one million Floridians licensed by the Department of Business and Professional Regulation. Our professionals and businesses range from architects to yacht brokers, from boxers to barbeque restaurants, and they keep Florida's economy strong. Every day we work to improve the way we do business in order to serve you better. For information about our services, please log onto www.myflorldalicense.com. There you can find more information about our divisions and the regulations that impact you, subscribe to department newsletters and learn more about the Department's initiatives. Our mission at the Department is: License Efficiently, Regulate Fairly. We constantly strive to serve you better so that you can serve your customers. Thank you for doing business in Florida, and congratulations on your new license! DETACH HERE (850) 487 -1395 DATE BATCH NUMBER The Sunshine State = UCENSE KMSER M220 -281 -60 -427-0 GERALD ANTHONY MAJEWSFQ 7001 SW 126 ST PINECREST, FL 331664247 eiRM DIRE SEX MT. REST. ENDORSE 1127$0 M 647 A ISSUED EXPIRES DUPLICATE 11-2443 11-27-09 004000 L���ceeo • SAFE DRNER Operation of a motor vehicle constitutes consecdt► any sow test required by law. BATCH NUMBER rigtff E� ritat.mck,A 1 t. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR ADD1 INSRD TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MM/DDIYY) POUCY EXPIRATION DATE (MMIDD/YY) LIMITS A GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY CPS1099418 11/1/2009 11/1/2010 CH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES (Ea occurrence) $ 50,000 CLAIMS MADE X OCCUR MED EXP (Any one person) $ 5,000 PERSONAL BADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 G 1L L AGGREGATE LIMIT APPLIES PER: I POUCY f JEC f LOC PRODUCTS - COMP /OP AGG $ 1,000,000 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 UABILITY ANY AUTO AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA OCCUR DEDUCTIBLE RETENTION LIABILITY $ CLAIMS MADE EACH OCCURRENCE $ AGGREGATE $ $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below TWC3212518 10/31/2009 X I T WC ST ORY LIMIT TS OTH- ER 0 E.L. EACH ACCIDENT $ A00,000 DISEASE - EA EMPLOYEE $ 100,000 E.L. DISEASE - POUCY LIMIT $ 500,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES /EXCLUSIONS ADDED BY ENDORSEMENT /SPECIAL PROVISIONS 0 11n.1 m1 -1-. TY INSURANCE INSURERS AFFORDING COVERAGE INSURER A: Scottsdale Insurance Co INSURER B: Technology Ins. Co. INSURER C: INSURER D: INSURER E: I DATE (MMIDDIYYYY) 10/5/2009 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 POUCIES BELOW. NAIC # 41297 42376 ACORDTh, CERTIFICATE OF LIABILI PRODUCER (954) 724 -7000 FAX: (954) 724 -7024 Keyes Coverage, Inc. 5900 Hiatus Road Tamarac INSURED FL 33321 G & T Electric Co, Inc Attn: Mary Kilpatrick 9550 NW 12 St., Bay 15 Miami FL 33172 COVERAGES 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 CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POUCIES 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. (305)882 -0810 City of Miami Shores Department of Building and Zoning 171 Westward Drive Miami Springs, FL 33166 ACORD 25 (2001/08) AUTHORIZED REPRESENTATIVE Carey Keyes /KB © ACORD CORPORATION 1988 ELECTRICAL CONTRACTORS Post Office Box 226317 - Miami. FL 33122 6317 Post Office Box 226317 • Miami, FL 33122 -6317 Tel: (305) 592 -0534 • (305) 274 -1606 Fax: (305) 592 -9462 4411TH` ° ^ c .TRLi - T!!T} C'i'I A 6:. • •o E c "' 15 tD719923 3., d .° iNID L,EF. 23, 2011 BONDED MAU MANTIC BONDII GCO.,INC. Es's - r --4 C(J C G Wets TL u C,ACAs w)a - * 1a e• i, id lD ) f DRAWING PAPER b 04 e- �- L;z,a.�►N� JOB: C -t.1 c 4Lk \ °AA1. DATE: (p 1 t P.O. IS t.iL g rni Aw�i skcpc -r- ( 31i 3`!{ "J 00v 1 0A G e I pAz a. la i 1 3 la. sTE, tom. e,o iAl cleN I anc- eCt- e4d Ste. C .5 p c 13 " u44ce - 0-rx) S) • 1,3) -411 TMv J cL) tj STL, 14056 IVLarni Shores Village SUBJECT i0 CCMPIJANCE WITH ALL FEDERAL STATE AND CLUN 1 HUL ES AND PPG _,IL,L fig ylze.