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ELC-11-319Project Address Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Pe l rt Tv Elect ical - Cofrtrttercla pan. Temp for Tee t tus: APPR Parcel Number Expiration: 08/28/2011 Applicant 9100 NE 2 Avenue Miami Shores, FL 33138- 1132060133200 Block: Lot: MIAMI SHORES CONGREGATIOI Owner Information Address Phone Cell MIAMI SHORES CONGREGATION OF & , 9100 NE 2 Avenue MIAMI SHORES FL 33138- (305)759 -6235 (786)493 -2556 206 NW 97 Street MIAMI SHORES FL 33150- Contractor(s) Phone RYAC ELECTRIC COMPANY CORP (305)308 -5061 CeII Phone Valuation: Total Sq Feet: $ 1,000.00 0 1 Type of Work: ELECTRICAL Additional Info: 30 DAYS TEMP FOR TEST Classification: Residential Scanning: 1 Fees Due CCF DBPR Fee DCA Fee Education Surcharge Permit Fee Scanning Fee Technology Fee Amount $0.60 $2.00 $2.00 $0.20 $100.00 $3.00 $0.80 Total: $108.60 Pay Date Pay Type Amt Paid Amt Due Invoice # ELC -2 -11 -40159 03/01/2011 Credit Card $ 108.60 $ 0.00 In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in complia pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the props accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. 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 compl construction and zoning. Futhermore, I authorize the above -named contractor to do the work stated. Available Inspections: Inspection Type: Final MIAMI SHORES VILLAGE HALL 10050 NE 2ND AVE MIAMI SHORES, FL 33138 305 -795 -2207 Phone/Web ID: 74847283 Ref 0: 0005 0301/11 13:27:39 Batch A: 159 AVS: ZIP MATCH Z P/0 N: 0 Cust ti: 0 I TERCARD PPr Code: 914913 Invoice: CVV2 Code: MATCH M Trans ID: 0391MCPU6IU5,, Amount: $ 108.60 Tax: $ 0.00 Total: $ 108,60 March 01, 2011 Customer Coy Authorized Signature: Owner / Applicant / Contractor / Agent Building Department Copy Date March 01, 2011 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 o Inspection Number: INSP- 156538 Permit Number: ELC -2 -11 -319 Scheduled Inspection Date: March 02, 2011 Inspector: Devaney, Michael Owner: SYLVAIN, FRED Job Address: 9100 NE 2 Avenue Miami Shores, FL 33138- Project: <NONE> Contractor: RYAC ELECTRIC COMPANY CORP Permit Type: Electrical - Commercial Inspection Type: Final Work Classification: Temp for Test Phone Number (305)759 -6235 Parcel Number 1132060133200 Phone: (305)308 -5061 Building Department Comments 30 DAY TEMP SERVICE Passed Failed Correction Needed Re- Inspection. Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments March 01, 2011 For Inspections please call: (305)762 -4949 Page 40 of 44 AQ-.% ‘1/4 $i Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 Permit No. E f 1) ti Master Permit No. CC _ f —1 a -1/) BUILDING PERMIT APPLICATION FBC 20 Permit Type: Electrical OWNER: Nan}e� ee imple Titleholder): �` , /� ��0 ' �I // Phone#: Address: (d� - R77,1ZWIni A, FEB 2 4 2011 v f City: / / : h state: Zip: 30 Tenant/Lessee Name: Phone#: Email: JOB ADDRESS: CI I ©" kE E 2 &Le- City: Miami Shores ��nn ��CCo�ounty: Miami Dade Zip: 35 130e / Folio/Parcel #: / 9O <O®f 3 G« Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name: % C ??e$ fc Phone#: 6" -32/8 Address: 2 erY3 -S tv. _3 y r9 City: ,-1-1/4 State: ea Zip: Qualifier Name: ,4i cry. Acas'i ,. /"te A ocer7ta Phone#: State Certification or Registration #: Certificate of Competency #: ®Y3e4= ®D 78 Contact Phone#: 37/e Email Address: DESIGNER: Architect/Engineer: Phone#: Value of Work for this Permit: $ 1/1�y Square/Linear Footage of Work: Type of Work: ❑Address ❑ . ration ❑New URepair/Replace Description of Work: _Q ��' ' [ 5Cr4) ODemolition Submittal Fee $ Permit Fee $ /,‘:3'e CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ Bonding Company's Name (if applicable) r Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip 46z- 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 AF1'LDAVIT: 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 - 'elivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencemen must b posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In tI so a o. uch posted notice, the inspection will not be approved nd a eeinspection fee will be charged. � _ ) Signature alt Signature '0 ; r or Agent The foregoin instrument was acknowledged before me this 32I day of i, ,20 'I,by who is personally known to me or who has produced A 'dentification and who did take an oath. NOTARY P t CI • V Sign: Print: My Commission Expir APPROVED BY 1.194 COLOMA ati A Notary Public' State o _T o; Commission # EE 3074 ' , °per` Bonded Through National Notary Assn. a 14 * ** Contractor The forego estrument was acknowledged before me this rr ' day of WO- , 20 , by who is personally known to me or who has produced as ',/":-&--457 Plans Examiner Structural Review (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) NOTARY P Sign: Print: My Commis dentific . tion and who did take an oath. C: 1 40/4to- .11 (lB'- FERNANDO COLOMA s aR1G - +: e0 f a a. My Comm. Expires Jul 19, 2014 ; Commission # EE 3074 � ''''r Bonded Through National Notary Assn. Zoning Clerk MIAMI COUNTY Building 11805 SW 26th Street Miami, Florida 33175 -2474 786 - 315 -2100 AFFIDAVIT FOR 30 DAY TEMPORARY ELECTRIC SERVICE ELECTRICAL CATEGORY 26 miamidade.gov ELECTRIC SERVICE WILL BE DISCONNECTED "WITHOUT NOTICE" UPON 30 DAY TERMINATION UNLESS APPLICATION IS RENEWED OR CERTIFICATE OF OCCUPANCY OBTAINED. It is understood that the temporary electrical approval by the Miami- D ui[din: Departm- t is given in connection with the building being constructed under the Building Permi # an E� is l Permit # at a dress (-1(61:7 �. / /d'' M/ l�rmo for owner: / /. _'" 12-2115111PA i t /and is being given only for construction purposes or for testing the following equipmen in said structure: The owner does hereby agree to assume the responsibility of maintaining the installation in such manner that there is no hazard to life or property. Such approval is in no event to be considered a RELEASE of said structure for the purposes of use and occupancy, and no occupancy shall be granted or permitted until final inspections have been called for and approved by the inspection divisions concerned, and/or a Certificate of Occupancy or Completion is obtained. The undersigned also understands that the temporary electric approval is subject to rescission and cancellation and electric power can be cut off at the discretion of the Building Official and will be disconnected if the building concerned is occupied before final inspections are approved and /or a Certificate of Occupancy or Completion is obtained. , being first duly sworn, depose and say that I am the owner of the above described property, and that I agree that the structure covered in this agreement shall not be occupied until the building contractor has obtained approval of final inspections and/or obta. Completion. Note: Failure to comply with the provisions of this affidavit will future Terpora for Test permits. /✓ Signature of Own •, ii Signature of ot-ry MyCommission Expires: I, , being duly sworn, depose and say tha r4.-°tri- c am,* —, the above - descri • -. property a . iihat the electrical installations as now e istin temporaryye is c nne . ed. � 6 I. �' ���x•�reate tilltlatifd if s -*-bt -*-b Notary Public - State of Florlda Co m. pI 19, 2014 Signature of Electrical Co actor Signature o 1, 1IZ °r1 ,� - My Commission Expires: �` f , being first duly sworn, depose and say that I am the Building Contractor of the above described property and that I will not permit occupancy of this building until final inspections have been called for by the contractors and sub - contractors concerned and fina approval by the inspection division obtained and that I have the authority insofar as the owner of said property is i onc:1/ such final inspections are obtained and/or a Certificate of Occupancy or Co 1 • - 3074 Signature of Building Contractor Signature of Electrical Inspector 123_01 -124 6/06 O milk Signature o My Commission E p 01 q„ �_ 4 • Vie, FERNANDO COLOMA bile Florida I r . u119, 2014 Bonded Through National Notary Asan. Date: Date released to FPL: 03- 01- 11;11:58AM; �frbe CERTIFICATE OF LIABILITY INSURANCE 3O(MMEIDnmr) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POUCIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER, IMPORTANT) 11 the cBRincate holder ban ADDITIONAL INSURED. the po11cy(lee) must he endorsed, If SUBROGATION 13 WAIVED, subject to the terms and conditions of the policy. certain policies may require an endorsement A statement on thla certificate does not confer rights to the Certificate holder in Ireu of such endorsement a PRODUCER Government Insurance Corp. 18501 Pines Blvd., Suite #205 Pembroke PInes, FL 33029 Phone (054)727 -2999 Fax (954)727 -2888 CONTACT _NAMEI PHONE FAX (A/C No Pitt M. Nek JAMS, PRODUCER CUSTOMER to re_ INSURER SU AFFORDING COVERAGE A NAIL If INSURED Ryac Electric Company Corp 2843 SW 34 Ave Miami, FL 33133- (305) 4488881 wnve•t APOM. - �,......�_._ _.� INSURER A I National Insruance CO. INSURER 0 t 5 5100,000 INSURER C I $ $5,000 INSURER 0 PERSONAL &ADV INJURY INSURER E: • INSURERPO _ $ 52,000,000 • THIS INDICATED. CERTIFICATE EXCLUSIONS 1NSR LTR IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE NOTWITHSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR MAY BE ISSUED OR MAY PERTAIN THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID INSURED NAMED OTHER DOCUMENT HEREIN CLAIMS, P000Y'EXP- WINNOW, 1 09/17/2011 ABOVE FOR THE POLICY WITH RESPECT TO IS SUBJECT TO ALL THE LIMITS EACH OCCURRENCE PERIOD WHICH THIS TERMS, 5 $1.000,000 TYPE OF INSURANCE ADDL INSR smile WVD POLICY UMBER 02L 0000288 09 AOACiYEFF (MM(DDIYYYYI 69/17/2010 A GENERAL LIABILITY 0 COMMERCIAL GENERAL LIABILITY N PAMAGE TO RELAYED PREMISES taaoccuaeuw MED EXP (Any one percent 5 5100,000 MI 0 CLAIMS -MADE OCCUR $ $5,000 L0 J PERSONAL &ADV INJURY $ $1,000.000 • GENERAL AGGREGATE $ 52,000,000 GEN%AGGREGATE LIMITAPPLIEB PER PRODUCTS • COMP /OP AGG 5 $1 000,000 II POLICY II JFCOT • LOC $ AUTOMOBILE LIABILITY COMBINED StNGLE LIMIT (Ea aeddani) S ■ ANY AUTO Q ALL OWNED AUTOS • SCHEDULED AUTOS HIRED AUTOS El NON.OWNED AUTOS BODILY INJURY (Per person) 9 BODILY INJURY(Per /neatem) 9 PROPERTY DAMAGE (Par accident) $ S $ ■ ■ UMBRBUA LIAO 0 OCCUR EACH OCCURRENCE $ Q EXCESS!- 0 CLAIMS -MADE AGOREGAIE $ • DEDUCTIBLE $ ❑ RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' UASIUTY ANY PROPRETOR/PARINER/EXECUTIVE ' OFFICER/MEMBER EXCLUDED? u NI A I--1 WC BTATU- r�I 01)1. I 1 TORY LIMrI9 I 1 6R E.L EACH ACCIDENT $ (Mandatory In NH) n desenbe under 0E9bRIPT10N OF OPERATIONS below E.L. DISEASE -GA EMPLOYE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS ( LOCATIONS f VEHICLES etwermCtl•are uetr ne-n (Attach ACORD ACORD Addhtonat Renate Schedule, if more apnea is required) ION Miami Shores Building Department 10050 NE 2nd Avenue MIamI Shores, FL 33138 Fax: 305- 755.8972 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25 (2009109) QF ®1988 -2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD