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EL-10-138113 101 Street Miami Shores, FL 33138- 1132060131910 Block: Lot: GIL & DEANNA GREEN Owner Information GIL & DEANNA GREEN Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Contractor(s) TIRONE ELECTRIC, INC. Phone 954-989 -7162 Cell Phone Type of Work: ELECTRICAL Additional Info: HOOK UP FOR WATER HEATER Classification: Residential Fees Due CCF Education Surcharge Permit Fee - Additions/Alterations Scanning Fee Technology Fee Total: Amount $0.80 $0.20 $100.00 $3.00 $0.80 $104.60 Address 113 101 Street MIAMI SHORES FL 33138 -2320 In consideration of the issuance to me of this permit, l 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 February 04, 2010 Expiration: 08/03/2010 Phone Valuation: Total Sq Feet: Invoice # EL -1 -10 -36920 $ 104.60 $ 104.60 $ 0.00 Check #: 91259 Total Amt Paid Amt Due Cell $ 1,000.00 0 February 04, 2010 Date For Inspections please call: (305)762 -4949 Available Inspections: Inspection Type: Final Meter Box Alteration Relocation Fire Alarm Service Change Underground W. W. 1 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 Job Address (where the work is being done) I 13 iV 10 1 S K-'V . City Miami Shores Village County Miami -Dade FOLIO / PARCEL # 3 2 4 C — 01' — / 9/ 1 5 Is Building Historically Designated � YES k NO Contractor's Company Name 1 i nl( au/hi 1 ' L • Phone . Contractor's Address is 1 Ptiusb Vb eit 124, Zip 333 is lipEOMEWSD JAN2 $2019 BUILDING Permit No. El Off ° 5K PERMIT APPLICATION Master Permit No pL° "I - I O ° 11 FBC 2001 Permit Type: ELECTRICAL ' (Fee Simple Titleholder) 412I A Phone # 1G6 - 365 Owner's Name Fee Sim le Titleholder [ L 4 �.Z,� Owner's Address 1 ('3 /J C, J 1) ( 4 3—p , 2614 - 7 — I ,2 (' '1 City H lk' 1 SlAZ(1rr - S State ` Zip 3 - S/3 $ Tenant/Lessee Name Phone # Email Flood Zone 9'5t1- 991- ' 1i)-• City d 401 W ,.State Zip 3 3 t Qualifier Name -rittchAiAD ro y1/4-e Phone # State Certificate or Registration No. cocoa Ns- Cer ifcate of Competency No. Contact Phone E -mail t r k- F , }.1,;- weer s ame (if a licab � � L (j n . Phone # g� � - �� . pp_ ��) 13 _ p •4 -lam • • S it J ,. ^ 1 451) , ['Alteration Value of Work For this Permit $ Type of Work: ❑Addition Describe Work: llfri S' , . .) dJ 1Y1 Square / Linear Footage Of Work: ❑New ❑ Repair/Repla'ce ik Ia0V ► ( -}e @ oit thin ******** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** F * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Submittal Fee $�� Permit Fee $ / ® CCF $ 0.60 CO /CC $ Notary $ Training/Education Fee $ 0"9.0 Technology Fee $ ® c:) Scanning $ O' Radon $ DPBR $ Bond $ Double Fee $ _ Violation date: Structural Review. $ Total Fee Now Due $ I W(/l_/ See Reverse side 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 ot 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 posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. , the absenc such poste; f stice, the inspection will not be approved and a re- inspection fee will be charged. Signature Owner or :ent The for oing instrument was ac owledged before • ' e this day of�, 20 .LPL, by ho is . rsonally known to NOT Sign: Print: My Commission Expires: * * * * * * * * * * * * * * * * * * * * * APPROVED BY (Revised 07 /10 /07)(Revised 06/10/2009) lACt e or who has produced tification and who did take an oath. Engineer Sign: Print: Contractor The foregoing instrument was acknowledged before me this day of Ct ((ua.�"� , 20 !SC, by CarT l , who is ersonally known to m�r who has produced as identification and who did take an oath. NOTARY PUBLIC: My Commission Expires: /® 2, Plans Examiner Zoning Clerk checked 07; T031204)8 .e$0'Q; 018182%_ e ELECTRICAL �Cth RA rN be]:oIS , ° $IF Uiider the proVistons o Cha ExRiration date: AUG 31, . 2010 ;: 61= ' = t'PE12ROR HOLLYWOOD •QUIRE© ' LA Tax Amount Transfer Fee NSF Fee Penalty Prior Years Collection Cost Total Paid $ 27.00 $ 27.00 BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT 115 S. Andrews Ave., Rm. A -100, Ft. Lauderdale, FL 33301 -1895 - 954 - 831 -4000 VALID OCTOBER 1, 2009 THROUGH SEPTEMBER 30, 2010 DBA: Business Name: Owner Name: Business Location: Business Phone: Rooms Mailing Address: TIRONE ELECTRIC INC CARMELO TIRONE 6151 PEMBROKE RD HOLLYWOOD 33023 (000)989 -7162 • TIRONE ELECTRIC INC CARMELO TIRONE 6151 PEMBROKE ROAD HOLLYWOOD FL 33023 Seats Employees 2 UNITS For Vending Business Only Receipt # Business Type: ELECTRICAL CONTR Business Opened: State/County /Cert/Reg: EC0000345 Exemption Code: NON EXEMPT 2009 - 2010 Machines Vending Type: 181- 0088517 Professionals 0000000000 0000002700 0000001810088517 1001 5 THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS THIS BECOMES A TAX RECEIPT WHEN VALIDATED This tax Is levied for the privilege of doing business within Broward County and is non - regulatory in nature. You must meet all County and/or municipality Li' planning and zoning requirements. This Business Tax Receipt mudRim transferred when the business is sold, business name has changed ogydg. m . have moved the business location. This receipt does not indicate th t1i business is legal or that it is in compliance with State or local law nd regulations. 4 ACORD CERTIFICATE OF LIABILITY INSURANCE I ii2e%2o 0 PRODUCER (954) 724 -7000 FAX: (954) 724 -7024 Keyes Coverage, Inc . 5900 Hiatus Road Tamarac FL 33321 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 Tirone Electric, Inc. 6151 Pembroke Road Hollywood FL 33023 INSURER A: Hanover American Ins Co 36064 INSURERB:Hanover Insurance Co 22292 INsuRERc:Bridgefield Employers Ins 10701 INSURER D: 1/15/2011 INSURER E: $ 1,000,000 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 I LTR INSRD TYPE OF INSURANCE POLICY NUMBER POLICY (MMIDD POLICY EXPIRATION DATE (MMPND LIMITS A GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY RZJ 6992155 -00 1/15/2010 1/15/2011 EACH OCCURRENCE $ 1,000,000 X PREMISES (Ea E r r ence) $ 100,000 CLAIMS MADE I X OCCUR MEDEXP(Anvoneaerson) $ 5,000 PERSONAL &ADVINJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 G AGGREGATE LIMIT APPLIES PER: II POLICY f JEC fl LOC PRODUCTS - COMP /OP AGG $ 2,000,000 GE EN'L B AUTOMOBILE LIABILITY ANY AUTO ALLOWNED SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS AHJ 6992286 - 00 1/15/2010 1/15/2011 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 BODILY INJURY (Per person) X BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY ANY AUTO AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ AUTO ONLY: AGG $ B EXCESS/UMBRELLALIABILITY UHJ 6991944 - 00 1/15/2010 1/15/2011 EACH OCCURRENCE $ 1,000,000 X OCCUR CLAIMS MADE AGGREGATE $ 1,000,000 DEDUCTIBLE RETENTION $ $ $ $ c WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER /EXECUTIVE OFFICER/MEMBEREXCLUDED? If yes, describe under SPECIAL PROVISIONS below 830 - 33270 1/15/2010 1/15/2011 77U(� 41- X I TORYT.IMITS I O E E.L. EACH ACCIDENT $ 1,000,000 E L . DISEASE - EA EMPLOYEE $ 1,000,000 EL DISEASE - POLICY LIMIT $ 1,000,000 OTHER DESCRIPTION OF OPERATIONS /LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT /SPECIAL PROVISIONS (954)449-0799 Miami Shores Village Building Dept 10050 NE 2nd Ave Miami Shores, FL 33138 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. AUTHORIZED REPRESENTATIVE Carey Keyes /AR .. CATS HOLDE ACORD 25 (2001/08) IAICl9R ,nano, no.. CANCELLATION © ACORD CORPORATION 1988 Pon. 1 of