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ELC-10-1012BUILDING PERMIT APPLICATION FBC 20 City a I x res State r - 0 r t GL. Tenant/Lessee Name Email Job Address (where the work is being done) ILC re 5 0.0 r.i m Contractor's Company Name Al Contractor's Address 1sfJ CCIJ City i / i Qualifier Name / V el<'6N ame City Miami Shores Village County Miami -Dade Zip FOLIO / PARCEL # r 7 Z_ ( 0 -05 -0 0 , Is Building Historically Designated YES NO G •rn £ler - ricer! , tee /?M' Kj State Fe.— State Ce rtificate or Registration No. e ® p 2 Contact Phone 3e' 7 76 7 a Value of Work For this Permit $ /0 Qe Type of Work: ['Addition ['Alteration Describe Work: c%Govl arr r ‘4.7 Submittal Fee $ Notary $ Scanning $ *31*' Ot ift****tY1ti** * ** ( f* * Miami Shores Village Buildin g Department artment 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 Fee $ Zip 33f Phone # 3 0 -5 — .5'S7L// Z Square / Linear Footage Of Work: [New a Repair/Replace r ipz@NEvsim AliN is B: Permit No. C,/1 O -101 P Master Permit No. Permit Type: ELECTRICAL Owner's Name (Fee Simple Titleholder) h0 re $ Owner's Address / D O . is N-S Zip :j Phone # I°l? af1 /`Pho # � 57 -- (P 7 4 1 ! Flood Zone' / es Phone # dS 37 674 8' Architect/Engineer's Name (if applicable) Phone # 0 Demolition AGri `ri'tQG° ///?� ,�/ / J /qi /6/ � + cJc,,7 l� , � J , ' � P3 � e -T C-' / Kam-- `� V / 4� {..� � C �' 4 be . * *E *,ter *** ** * * *** ***,+ ** **** *** ** *** **** ** * ** *** CCF $(x-00 CO /CC $ Training/Education ' cation Fee $ gJE � Technology Fee $ K-00 Radon $ DPBR $ Bond $ Double Fee $ Violation date: Structural Review. $ Total Fee Now Due $ e3aa 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 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 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 not be appro ed and a re- inspection ee will be charged. * ** ►a► 5ignatur• ,1� Ll Owner The foregoing instrument was acknowledged before me this day a ,20, 4 who • ersonally known to me or who has produced As identification and who did take an oath. NOTARY PUBLIC: Si Print: Lca c l7i+ �17o� My Commission E * * ** 6 ,0;00 4 ,_ _ Notary Public State of Florida : Lucretia S Payton ��. My Commission D13 896711 * *Riek* * * * * * * * * * * * * ** * * * ,* APPROVED BY (Revised 07 /10 /07XRevised 06 /10/2009) * * * ** 3 --nefr re Plans Examiner Engineer Contract The foregoing instrument was acknowledged before me this of V Uk , 20 by N 6,C.5 0 p-, 14 ,4 er onally known to me •r who has produced N A as identification and who did take an oath: NOTARY PUBLIC: * * * ** ,lip VICTOR AMES n) 14 MY COMMISSION # D O912091 off•' Bonded Mrs NotsifPi Sign: Prin IOW My ommission Expires: * * * * * * * * * * * ** Zoning Clerk checked AC# BOSQUE, NELSON PLUG IN ELECTRICAL INC 8002 S.W. 9TH TERRACE MIAMI FL 33144 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.myfloridalicense.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! DATE BATCH NUMBER STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD (850) 1940 NORTH MONROE STREET TALLAHASSEE FL 32399 -0783 CHARLIE CRIST GOVERNOR LICENSE NBR 07/22/2008 080051596 EC0002943 The ELECTRICAL CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2010 BOSQUE, NELSON PLUG IN ELECTRICAL INC 15480 SW 19 WAY MIAMI FL 33185 DETACH HERE DISPLAY AS REQUIRED BY LAW 487 -1395 STATE OF FLORIDA AC a DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CHUCK DRAGO INTERIM SECRETARY EC0002943 07/22/08 08005155 CERTIFIED ELECTRICAL CONTRACTOF BOSQUE, NELSON PLUG IN ELECTRICAL INC IS CERTIFIED ender the provioiors of ch.489 Expiration date, AUG 31, 2010 L0807220143C STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD SEQ# L0807220143 SEC TYPE 196 EiEC JM CLASS: DATE: 10/07/2000 TIME: i0:3i:29 LOCAL BUSINESS TAY ACCOUNT: 623699-6 PLUG IN E|FCTRECEIpT INQUIRY . , , R|CAL INC RECEIPT: 650166-3 R ^ ^ ^ ~ ~ ^ ^ ^ ^ ^ ^ STATUS: LAST-TRANS-DATE: 09/19/P0OP EmtWAL COMM-DATE: 05/20 ITEMS DESCRIPTION 5 E|-FCTRICA/ CONTRACTOR STATE' EC0002943 [C: EXi.:MPT-CD VrT-I�' CI[; RFCEIPT/ZCNTNC,i PERMIT:: H0'/-upn/ ,r. L� -' ^ '^^` ' ` F Y **HOLD*i. p c�^ - ; NARNIN� #� 00009Y991 INS RCT# «�v YEAR 2009 .00 YFAp: TR4 lRAkSF-l NA�C9, CAT/kM7CS: 238P1 : wHAMUDADE DATE 10/07/2{8 TI : 10:32:59 WHAMI-DADE COUNTY, FLORIDA hYN• ONT MIAMI-DADE COUNTY, FLORIDA LOCAL BUSINESS TAX ACCOUNT INMIRY ACCOUNT : 623699-6 NAME: PLUG IN ELECTRICAL INC"=`-c/c-S/: 15480 SW 19 WAY . . .. . . ^ . ENTRY �« IN8P -ID -Dl BID |K]LD: ; (|K/G-RFC: FINANCE DEPARTMENT TAX COLLECTION omsior 140 W. FLAGLER STREET MIAMI, FLORIDA 33130 LBTR YE .00 O-E��REV SCR B=FMHlST F3=PYMlS F4 / �� MEMINO F6=MK1NlN0 F12=PRNT F13=HELp �1�=pI=MORE REC rz5CONTR ��m�xo�� -----~ DOES NOT �a��Y CONTAIN A��s��z��s AND OTHER SIMILAuAC7WmTIES. ENTRY W JNSP ' _ ZIP: '32105 MUN SUITE: / NAME: PLUG IN ELECTRICAL ` '' " � � � m � ) : -`��' /CHL INC ADDR: 15480 SW 19 WAY C/O: ENRIQUF ZIP: 33185 '' CITY: MIAMI HOW. OFFICE: OTHER INFORM TION: PP xo o^^"^^ SSN/EIw '' R2 �O-'^ � "`'"vvv , E 06 2f9i81� �A�CF' -r cT"; 20 4909 004 2450 FICTNM: ' : ** Y ** /- •• to , , ' , et , to , AST-lRANS-DTE: 05/08/2009 LQT RCPT SEC TYPE AMOUNT �b ^ ' ^ ~ ^ ^ ^ ^ ^ ^ ^ ^ ^ ~ ~ ^ 650166-71 196 E|EC - E D/R PD L� '= GAL I�xSp�ID lNSP-DATE L - .00 P BI0 08/21/2008 u ' SANCH[7 FRFS F1=NENU CLEAR=PREVSCR F4=11DREREC ENTER=REC F12=PRT APP L F13=P El 4 F l IMPORTANT: THE INFORMATION HEREIN NECESSARILY CONTAIN PERTINENT FACTS oOwEA~mS«��;��m��m�� mGARDS 05 /0R/200 08 /21/p00 - PG FINANCE DEPARTMiNT TAX COLLECTION DIViS101 MIAMI, FLORIDA 33130 LBTR YEAR: 2009 O[1-MOO 05/08/20` Inc ANY MAY POLICIES. INBR rl1LIl.It REQUIREMENT, PERTAIN, ul• INSLJKANGE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING TERM OR CONDITION 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 SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR ADM. NERD TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MM/DD/YYYY) POLICY EXPIRATION DATE (MM/DD/YYYY) LIMITS A GENERAL LIABILITY 10 -9487 01/30/10 01/30/11 EACH OCCURRENCE $ 1 000,000 $ 100, 000 X COMMERCIAL GENERAL LIABILITY P (Ea occurence) CLAIMS MADE I x I OCCUR MED EXP (Any one person) $ 5,000 $ 1,000,000 $ 2,000,000 $ 1,000,000 PERSONAL &ADV INJURY GENERAL AGGREGATE GENL AGGREGATE LIMIT APPLIES PER: I POLICY 1 jEa I1 LOC PRODUCTS - COMP /OP AGG 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 (Per accident) PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY ANY AUTO AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS / UMBRELLA LIABILITY f I CLAIMS MADE DEDUCTIBLE RETENTION $ EACH OCCURRENCE $ I OCCUR AGGREGATE $ $ $ $ B WORKERS AND EMPLOYERS' ANY OFFICER/MEMBER E/MEMB (Mandatory If yes, d If yes,describe SPECIAL PROVISIONS COMPENSATION LIABILITY Y/ N WSAUIEC12000101 08/06/09 08/06/10 !TORY C LIMITS 1 I ER R/ EXCLUDED? R/EXCUTNE EXCLUDED? E.L. EACH ACCIDENT $ 100,000 $ 500,000 $ 100,000 under below E.L. DISEASE - EA EMPLOYEE E.L. DISEASE - POLICY LIMIT OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS ELECTRICAL - COMMERCIAL, RESIDENTIAL 06/01/2010 TUE 14: 28 FAX ACCPRIEY CERTIFICATE OF LIABILITY INSURANCE PRODUCER PROMINENT SERVICES & INSURANCE 9668 N.W. 25th Street Doral, FL 33172 (305)207 -8585 INSURED PLUG -IN ELECTRICAL, INC 15480 SW 19 WAY MIAMI, FL 33185 1305- 776 -2708 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 INSURER A: LLOYDS OF LONDON INSURER B: APPALACHIAN UNDERWRITER INSURER C. INSURER D. INSURER E: DATE (MM/pp/1' Y 6/1/2010 NAIC# COVERAGES CERTIFICATE HOLDER ACORD 25 (2009/01) CANCELLATION @198.£62n9 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 2001/001 MIAMI SHORES VILLAGE 10050 NORTH EAST 2 AVE MIAMI SHORES FL 33138 ATTENTION VIVIAN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL N/A DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR UABILrrY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Inspection Number: INSP- 149851 Permit Number: ELC -6 -10 -1012 Scheduled Inspection Date: August 10, 2010 Inspector: Devaney, Michael Owner: CONDOMINIUM, SHORES Job Address: 1700 NE 105 Street Miami Shores, FL Project: <NONE> Contractor: PLUG IN ELECTRICAL CONTRACOTRS Building Department Comments Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 EPLACE OLD SECURIY CAMERAS THROUGHOUT THE CONDOMINUM INCLUDES RUN CONDUITS FOR CCTV CABLES AND TAKE OLD CABLES AND CAMERAS DOWN Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments >72-, (/".;‘- August 09, 2010 For Inspections please call: (305)762 -4949 Permit Type: Electrical - Commercial Inspection Type: Final Work Classification: Addition /Alteration Phone Number Parcel Number 1122300500010 Phone: (786)4864893 Page 19 of 21 Inspection Number: INSP - 149346 Scheduled Inspection Date: July 27, 2010 Inspector: Devaney, Michael Owner: CONDOMINIUM, SHORES Job Address: 1700 NE 105 Street Project: <NONE> Contractor: PLUG IN ELECTRICAL CONTRACOTRS Building Department Comments July 26, 2010 Miami Shores, FL 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: ELC -6 -10 -1012 Permit Type: Electrical - Commercial Inspection Type: Final Work Classification: Addition /Alteration Phone Number Parcel Number 1122300500010 Phone: (786)486 -3893 EPLACE OLD SECURIY CAMERAS THROUGHOUT THE CONDOMINUM INCLUDES RUN CONDUITS FOR CCTV CABLES AND TAKE OLD CABLES AND CAMERAS DOWN Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments e t ort l A Ge--/ e "6 ,P71/77-V 1917/1 �a ,� '/r Page 17 of 25