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ELC-12-51Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 168703 Permit Number: ELC- 1 -12 -51 Scheduled Inspection Date: January 27, 2012 Inspector: Devaney, Michael Owner: CHURCH, ST ROSE OF LIMA CATHOLIC Job Address: 418 NE 105 Street Miami Shores, FL Project: <NONE> Contractor: SUN POWER ELECTRIC CO Permit Type: Electrical - Commercial Inspection Type: Final Work Classification: Addition /Alteration Phone Number (305)758 -0539 Parcel Number 1122310150060 Phone: (305)297 -6678 Building Department Comments TEMPORARY CHURCH CARNIVAL JAN 27- 29/2012 Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments JIL,/,- a-(2_, January 26, 2012 For Inspections please call: (305)762 -4949 Page 9 of 17 -4"/Pij ING PERMIT APPLICATION Miami Shores Village Building Department 10050 N.E2nd Avenue, Afiami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 '� Permit Na 12 l Master Permit No. FBC 2004 Permit Type: Electrical Owner's Name (Fee Shnple Titlleholder)Archd i ire e cif Miami Phone # (305 ) 72 7- 62 41 Owner's Address 9401 Biscayne Blvd. City Miami Shores State FL NEMO E -MAIL: Zip 33138 hone it (305) 758 -0539 Job Address (where the work is being done) 418 NE 105th Street City NrmmiSlumsViilmm Comzty Miami- Dade Zip FOLIO / PARCEL It Is Building Historically Designated YES NO Contractor's Company Name Sun Power Electric Co., Incphate# Contractor's Addre s 1363 NE 182 Street City N. Miami Beach State FL Qualifier Name Si lvi n Mc?c1 i n a State Certificate or Ramon No. EC13 0 02 897 E- MAIL: ai l vi nmedI na@aol _ com (305)297 -6678 Tap 13162 Phone# (305) 297 -6678 Certificate of Competency No. Architect/Engineer's Name (if applicable) Phone # Value of Work For this Permit $ 400 . Square / Linear Footage Of Work: Type of Work: ['Addition DAlteration ❑New D Repair/Replace DescribeWork: Temporary Church Carnival Jan_ 27 ?9,, 201.2 D Demolition Submittal Fee $ Notary $ Scanning $ Bond $ Permit Fee$ Training/Education Fee $ Technology Fee $ Radon $ DPBR $ Zoning $ Code Enforcement $ Double Fee $ �a, !- Total Fee Now Duo i 1, VS� • (r) See Reverse side -+ CCF$ CO /CC Structural Review. $ 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 OOVNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE F6R 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) dray after the building permit is issued In the absence of such posted notice, the inspection will a nd dJ d„ ysiir will be charged The foregoing instrument was acknowledged before me this r' T day of cc ,xcrc,20 II by R ° '- who is NOTARY PUBLIC: Sign: Print: „ro I ,i « , SOS– -- •+= 'AY COMMISSION # DD 920508 EXPIRES: December 27, 2013 8r' sinwoiThru Notary Public Undervo .r rt ETA M bn a4ssri IZ�zy�t3 My Commission Expires: UI Signature a Contractor The foregoing instrument was acknowledged before me this l day of , 20 f-by ✓ib %2) /;?°dt who >s,onalty known to meo>' who has produced as identification and who did take an oath. NOTARY PUBLIC: alrArfrIninhlrslsirkirJnitintslrinhb**************************************** APPLICATION APPROVED BY: (Revised Plans Examiner Engineer Zoning ": = DRIVER LICENSE CLASS E M350- 790 -72 -050 - SILVIO JOSE MEDINA 1383 NE 182 STREET NORTH MIAMI BEACH; FL 33162 am: 02 -10 -1972 sex. Myra: S -2008 -03 S030802080250 SAFE DR Operanon of f, motor velncI• cnn, . R con sobriety iast re STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD (850) 487-1395 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 MEDINA, SILVIO J SUN POWER ELECTRIC CO INC 1363 NE 182ND ST NORTH MIAMI BEACH FL 33162 Congratulation& 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 vAvw.myfloridalicense.com. There you can find more information about our divisions and the-regulations that impact you, subscribe to department newsletters and leam 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 AC,0784. ND - ,•• 00 1f4CT9L. - • .• ,=4 ' uproviflicB . 4,a0841.692 - . - 11 41:47A, 07 -29 -2011 JEFF ATWATER STATE OF FLORIDA CHIEF FINANCIAL OFFICER DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION * * CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law. EFFECTIVE DATE: PERSON: FEIN: 10/15/2011 EXPIRATION DATE: 10/14/2013 MEDINA SILVIO J 943472315 BUSINESS NAME AND ADDRESS: SUN POWER ELECTRIC CO INC 1363 NE 182ND STREET N MIAMI BEACH ' FL 33162 SCOPES OF BUSINESS OR TRADE: 1- FIRE ALARM CONTRACTOR 3- CERTIFIED ELECTRICAL CONTRACT° 2- SOLAR ENERGY SERVICE 4- TELEPHONE INSTALLATION IMPORTANT: Pursuant to Chapter 440 . 05(14), F.S., an officer of a corporation who elects exemption from this chapter by filing a certificate of election ander this section may not recover benefits or compensation ender this chapter. Pursuant to Chapter 440.05(12), F.S., Certificates of election to be exempt... apply only within the scope of the business or trade listed on the notice of election to be exempt. Pursuant to Chapter 440.05(13), F.S., Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation if, at any time after the filing of the notice or the Issuance of the certificate, the person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate. The department shall revoke a certificate at any time for failure of the person named on the certificate to meet the requirements of this section. QUESTIONS? (850) 413 -16 DWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01 -11 PLEASE CUT OUT THE CARD BELOW AND RETAIN FOR FUTURE REFERENCE STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION CONSTRUCTION INDUSTRY CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW EFFECTIVE 10/ 15/2011 EXPIRATION DATE : 10/14/2013 PERSON: SILVIO J MEDINA FEIN: 943472315 BUSINESS NAME AND ADDRESS: SUN POWER ELECTRIC CO INC 1363 NE 162ND STREET N MIAMI BEACH, FL 33162 SCOPE OF BUSINESS OR TRADE 1- FIRE ALARM CONTRACTOR 2- SOLAR ENERGY SERVICE 3- CERTIFIED ELECTRICAL CONTRACTO 4- TELEPHONE INSTALLATION IMPORTANT O Pursuant to Chapter 440.05(14), F.S., an officer of a corporation who elects exemption from this chapter by filing a certificate of election L under this section may not recover benefits or compensation under this D chapter. Pursuant to Chapter 440.05(12), F.S., Certificates of election to be H exempt.. apply only within the scope of the business or trade listed on E the notice of election to be exempt R E Pursuant to Chapter 440.05(13). F.S., Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation if, at any time after the filing of the notice or the issuance of the certificate, the person named on the notice or certificate no longer meet: the requirements of this section for issuance of a certificate. The department shall revoke a certificate at any time for failure of the person named on the certificate to meet the requirements of this section. QUESTIONS? (850) 413 -1609 CUT HERE * Carry bottom portion on the job, keep upper portion for your records. DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01 -11 aa, 0 2001 hnt fl6& nn SEE OTHER SIDE DO NOT FORWARD SUN POWER ELECTRIC CO INC SILVIO J MEDINA PRES . 1363 NE 182 ST N MIAMI BCH FL 33162 156 ` 'U CERTIFICATE OF LIABILITY INSURANCE °A'� 9/281""`"" 09/28/71 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 POLICIES BELOW. THIS CERTIFICATE OF WSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: lithe certificate holder is an ADDITIONAL INSURED, the poticy(tes) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER AHstar Direct Insurance 16123 Biscayne Boulevard Aventura, FL 33160 Phone (305) 754 -7414 Fax 5305) 764-7416 CONTACT JOE MIER PHONE 30 754.7414 FAX 754-7416 Extg ( tA�. xol: _ua1NQ ( aIi6RL & jcetaat aterdirectcom INSURER(S) AFFORDING COVERAGE NM O INSURERA: Natonwide ins Co Of Amer 25453 INSURED Sun Power Electric Co Inc 1363 NE 182nd St North Miami Beach, FL 33162 -1333 (305) 297 -6678 INSURER 0: $ 1,000,000.00 INSURER : • 6 INSURERD: $ 5,000.00 INSURER E : $ 1,000,000.00 INSURER F • GENERAL AGGREGATE CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT 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 INSURANCEAFFORDED BY THE POLICIES DESCRIBED HEREIN 15 SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR UM TYPE OF INSURANCE ADDIJsLIBr� INSR wvoI POLICY NUMBER P C tMMID 09/26/2011 POLICY EXP ((NMIDDNYYYH 09/25/2012 LIMITS A GENERAL UAB1LITY © COMMERCIAL GENERAL LIABLITY Y • II CLAIMS-MADE ' OCCUR ❑ ACPGLZ05904853454 EACH OCCURRENCE $ 1,000,000.00 RMIS T( RENTED P REMISES(Eeoccurrent* 6 MED EXP (Any one person $ 5,000.00 PERSONAL & ADV INJURY $ 1,000,000.00 1 GENERAL AGGREGATE $ 2,000,000.00 GENT. AGGREGATE LEdrEAPPLIES PER ❑ POLICY • YEer ❑ LOC PRODUCTS - COMPIGP AGG $ 2,000,000.00 $ AUTOMOBILE LIABILITY MI ANY AUTO ❑ ALL O NED ❑ SCHSE ULED ❑ HIRED • AUTOS • AUTO ED ■ ■ F Oa BN D 8NVGLE LIMIT $ BODILY INJURY(Perpeson) $ BODLY INJURY (Per accident) $ YAMAGE $ $ ❑ UMBRELLA LIAR ❑ OCCUR • EXCESS LIAR 1 CLAIMS-MADE EACH OCCURRENCE 8 AGGREGATE $ 1 DED ■ RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOWPARTNERIEXECUTNE N /A r � ❑ WC STATU- ER EL EACH ACCHENT $ OFFICER/MEMBER EXCLUDED? (Mandatory In NH) EL DISEASE - EA EMPLOYE $ If yyeess desrnbe under DESCRIPTION OF OPERATIONS blow EL DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS! LOCATIONS 1 VEHICLES (Attach ACORD 101, Addlloaa! Remarks Schedule, U more space Is required) CERTIFICATE HOLDER CANCELLATION MIAMI SHORES VILLAGE HALL BUILDING DPET 10050 NE 2ND AVE MIAMI SHORES, FL 33138- 1 ACORD 25 (2010105) QF SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLL ROVISIONS. 88 -2010 AOORD CORPORATION. All rights reserved. ACORD name and logo are registered marks of ACORD