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EL-11-2244Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 nspection Number: INSP - 168469 Permit Number: EL -12 -11 -2244 Inspection Date: January 12, 2012 Inspector: Devaney, Michael Owner: CAUZA TRS, WILLIAM Job Address: 723 NE 91 Street 3 -C Miami Shores, FL Project: <NONE> Contractor: UNITED ELECTRIC CONTRACTOR Permit Type: Electrical - Residential Inspection Type: R gh Work Classification: Addition /AI eration Phone Number Parcel Number 1132060440150 Phone: (305)731 -1241 Building Department Comments SEE IF EVERYTHING IS BY CODE ADD TWO GFCI IN THE KITCHEN AND ONE IN THE BATH. Fi k V Passe d Inspector Comments CREATED AS REINSPECTION FOR INSP- 168415. CREATED AS REINSPECTION FOR INSP- 167354. No access at 3:22 pm. Panel not to code. Nutral conductors to be in the same conduit with it's associated hot conductors. Add receptacles to kitchen and bathroom. j ,..„ p /' 1,�7i 4 - _ 2 1� /p�yy / 2- . Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled re- inspection fee is paid. until For Inspections please call: (305)762 -4949 January 12, 2012 Page 1 of 1 fl • oh B PE APPLICATION 7=1 Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel; (305) 795.2294 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.2.949 FBC,20 rermit Type: Electrical OWNER: Name (Fee Simple Titleholde0: CLAII/ 4 nr3 C42" Fhone#: 9f6e' 265 6 Z Address: 323 NE 91 7, Aff 3C City: f'7 k/'21 11/0 071-7,5 State: e•-/C)) f27' C /4- _3a1.3 Permit No. , 1 Master Permit No. Tenant/Lessee Name: Email: Phone#: JOB ADDRESS: 7-Z 1 E / City: Miami Shores County: Miami Dade Zip: 31 / 3trt Folio/Parcel#: Is the Building Histodesny Dignated: Yes CONTRACTOR: Company Name: Address: 32 Z 00 3 r City: 1.2...dairerkZ.2_ Zip: g33,,,s 1 Phone. f7,$) 73/ Certificate of Competency #: / V/ lo E000 NO Flood Zone: .4 2: 4 Phone#: 6W1) 7 z Qualifier Name: R 4/4 12f) 0j22_eb_s4._ State Certification or Registration #: Contact phone0o 5) 7 ‘? I - 1 2 4/ Email Address: DESIGNER: Architect/Engineer: Phone#: Value of Work for this Permit: $ di20e-61"—Stptareilinear Fo3tage of Work: i 0 00 Type of Work: DAddress C3Alteration 121Ne kpair/Replace CIDerolition Descripdon of Work: see IF eveic‘f 74. ,Alp a 85 /1 c A"7, T -7 - 4 1_7 n) e A mr 4eX ,471°Z' *******0 ******************************Fees************ ****** * ******************** COICC $ Bond $ Submittal Fee /t411 IP Permit Fee $ /10:2( c'.' CCF $ Seining Fee $ Radon Fee $ DBPR $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL !'EE NOW DUE 10140 Bo T ' Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) Mortgage Lendear'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 rregt lating construction in this jurisdiction. I understand that a 4separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOU'.ERS, filiATERS , TANKS ap AIRCONDITIONERS, ETC..... OWNER'S AFFIDAVIT: I certify that all the foregoing infor applicable laws regulating construction and zoning. "W A r ' G TO OWNER: YOUR FAILURE TO RECORD A NOTICE F CO 1.1 NCE1VIENT MAY RESULT IN YOUR PAYING FOR ROVEMENTS TO YOUR P PE .° p YOU INTEND TO OBTAIN IF AWING, CONSULT WITII YOUR LENDER OR AN , ATTORNEY Y 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 promisein ;good faith that a copy of the notice of and construction lien law brochure will be delivered to the person whose property is subiztet 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 Ater the building pernaii is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. •on; is accurate; and that all work will be done ftii...ir or Agent f The foregoing instrument was acknowledged before me this 1 f' The foregoing in ent was acknowl ged before me this 05.7 f / rr/ -elr, day of �rJ�o�� 20 �, by W t I 1i Dj"M 6/�(.� '" day of , � �—' by Wally known a or who , produced who is personally known tom ; . ,: • has produced n and who did take an oath. as • ' tiff :' and ri • did t° NOTARY P c ,r 11m4 Sergio R. Persil* Cctmmissina • EE086731 „,/ Expires: AT'R. 21, 2015 Wow Mc Amer= urama MAIM (Revised 0711 t?7)(Revised 06/10/2t019)(Revised 3/15/09) Si Print My C a 7 e an oath. 1 R. Peralta Ca ;:. scion # EE086731 n..,s Expres: APR. 21 2015 BONDED THRU ATLANTIC AONDIINGCO,i S Zoning Clerk 4941 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING EOARD- $EQ#L10060400501' LICENSE NBR DATE BATCH NUMBER 06/04/2010 000000000. ER13014443 The ELECTRICAL CONTRACTOR Named below HAS REGISTERED Under the provisions of Chapte 4.8 Expiration date: AUG 31, 2012.` (INDIVIDUAL MUST MEET ALL LOCAL LIC REQUIREMENTS PRIOR TO CONTRACTING_ DORELIEN, BERNARD UNITED ELECTRIC CONTRACTORS.INC 3292 NW 43RD ST LAUDERDALE. LAKES FL 3,3309 CTQB Construction Trades Qualifying Board • BUSINESS CERTIFICATE OF COMPETENCY 10E000315 UNITED ELECTRIC CONTRACTORS !NC D B A • 1 DOR LIEN BERNARD Is certified under the provisions of Chapter 10 of Miami - Dade' aunty CHARLIE;CRIST GOVERNOR DISPLAY' AS REQUIRED BY LAW CHARLIE LIEM� INTERIM SECRETARY BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT 115 S. Andrews Ave., Rm. A -100, Ft. Lauderdale, FL 33301 -1895 — 954 - 831 -4000 VALID OCTOBER 1, 2011 THROUGH SEPTEMBER 30, 2012 DBA: ; Receipt #:181- 233097 Business Name: UNITED ELECTRIC CONTRACTORS INC Business Type: ELECTRI AL /ACONTRACTOR MS/ RACT Owner Name: BERNARD DORELIEN Business Location: 3292 NW 43RD STREET LAUDERDALE LAKES Business Phone: 305 - 731 -1241 Rooms Seats Number of Machines: Business Opened:o2 /22/2010 State /County /Cert/Reg : CC# 10 - CME -16271 - X Exemption Code:NONEXEMPT Employees 1 For Vending Business Only Machines Professionals Vending Type: Tax Amount Transfer Fee NSF Fee Penalty Prior Years Collection Cost Total Paid 27.00 0.00 0.00 2.70 0.00 0.00 29.70 THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS THIS BECOMES A TAX RECEIPT WHEN VALIDATED Mailing Address: BERNARD DORELIEN 3292 NW 43RD STREET LAUDERDALE LAKES, FL 33309 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 planning and zoning requirements. This Business Tax Receipt must be transferred when the business is sold, business name has changed or you have moved the business location. This receipt does not indicate that the business is legal or that it is in compliance with State or local laws and regulations. Receipt #01A -11- 00000530 Paid 10/26/2011 29.70 06 -22 -2010 ALEX SINK 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: 06/22/2010 EXPIRATION DATE: 06/21/2012 PERSON: DORELIEN FEIN: 364666806 BUSINESS NAME AND ADDRESS: UNITED ELECTRIC CONTRACTORS INC 3292 NW 43RD STREET FT LAUDERDALE FL 33309 SCOPES OF BUSINESS OR TRADE: 1- ELECTRICAL BERNARD IMPORTANT: Pursuant to Chapter 440 . 05114), F.S., an officer of a corporation who elects exemption from this chapter by filing a certificate of election under this section may not recover benefits or compensation under this chapter.' Pursuant to Chapter 440.05112), 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 -160! DWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 09-06 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: 06/22/2010 EXPIRATION DATE: 06/21/2012 PERSON: BERNARD DORELIEN FEIN: 364666806 BUSINESS NAME AND ADDRESS: UNITED ELECTRIC CONTRACTORS INC 3292 NW 43RD STREET FT LAUDERDALE, FL 33309 SCOPE OF BUSINESS OR TRADE: 1- ELECTRICAL IMPORTANT OPursuant 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. H Pursuant to Chapter 440.05412), F.S., Certificates of election to be exempt.. apply only within the scope of the business or trade listed on Rthe notice of election to be exempt 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 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 -1609 CUT HERE * Carry bottom portion on the job, keep upper portion for your records. DWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 09 -06 1 8910016517 ©2010. RR Donnelley. All rights reserved. - 0667 FORM 7161 REVISED 05/10 * * * * *>r * * * *>r >r >r>r rr * * * * * MIAMI -DADE COUNTY TAX COLLECTOR 140 W. Flagler Street Miami, Florida 33130 Please keep your receipt for future reference. Thank you and have a nice day. 12/6/2011 1300 /227 /001CLAA 0047 -0001 Last Seq. #:0001 WI LBT #:30 716902 -2 Local Business Tax $200.00 CA $200.00 CHANGE $0.00 MIAMI -DADE COUNTY TAX COLLECTOR LOCAL BUSINESS TAX SECTION 140 W. Flagler St. - 1st Floor Miami, Florida 33130 TEMPORARY RECEIPT 2011 -2012 MUNICIPAL CONTRACT Local Business Ta State /CC #:10E0003 Issued to: UNITED ELCTRIC CONTRACTORS INC Type of Business: ELECTRICAL CONTRACTOR SEE BACK OF OFFICIAL RECEIPT FOR NONPARTICIPATING MUNICIPALITIES THIS RECEIPT IS ISSUED AS EVIDENCE OF PAYMENT FOR YOUR LOCAL BUSINESS TAX OR PERMIT. YOUR OFFICIAL RECEIPT WILL BE MAILED TO YOU WITHIN 10 DAYS FROM THE VALIDATION DATE ON THIS RECEIPT. Payment Received as Certified Above Miami -Dade County Tax Collector L • i J 4 CO x 0 F- 9W 0U 13 aa—I I- - UZ )U0 an -IUN XE L.) IV Z u - O U Ili co J co ,cr 0z0 m1 w "- O Iz wai j • :V o Cr' 3Q co CO IN ice+ -I0 :3N z0 0 N BUSINESS LOCATION: s z 1-1 • r co 00) LA ¢ W ct cat 1— Z p LE UH U-r Z to Z 0 t-CCWCE I— ¢ J to U °prow n Wl1 U J • J • ¢ I--I W A C3 _WI F AQZ..� I-I • 0- J I-XCU I - I 1 W 20601 1000 307169022 00020000 329E NW 43 ST LA 'E•'•LE LAMES NAICS: % -• APPLICATION IS HEREBY MADE FO • L" Al. BUSINESS TAX RECI PERMIT FOR THE BUSINESS, P. • ON OR OCCUPATION DEf HEREON. 1 HAVE BEEN INFO' DDJ • ZONING RESTRICTIONS II ON THIS RECEIPT. 1 °., >>c = -. .A: :-�`)� E AND Cf paib S N TURE REQUI ' 1 SEE INSTRUCTION ON REVERSE SIDE A * Zi N¢ o c O:.POJ * z Z O Z Z O w o CC o U.1 f ~ • co Z w v7 0) J MIAMI -DADE COUNTY TAX COLLECTOR 140 W. FLAGLER ST. 1st FLOOR MIAMI, FL 33130 2011 MUNICIPAL CONTRACTOR'S 2012 TAX RECEIPT MIAMI -DADE COUNTY - STATE OF FLORIDA PURSUANT TO COUNTY CODE SEC. 10 -24 EXPIRES SEPT. 30, 2012 THIS IS NOT A BILL — DO NOT PAY RECEIPT Na 06-7169022 CC NO: 10E000315 BUSINESS NAME / LOCATION UNITED ELCTRIC CONTRACTORS INC DOING BUS IN DADE CO OWNER :UNITED ELCTRIC CONTRACTORS INC RESTRICTED TO THE CITY OF: NORTH MIAMI Receipt holder must register in the city where work is to be done. PAYMENT RECEIVED MIAMI -DADE COUNTY TAX COLT8727 /2011 02210020001 000050.00 MIAMI -DADE COUNTY TAX COLLECTOR 140 W. FLAGLER ST. 1st FLOOR MIAMI, FL 33130 FIRST -CLASS U.S. POSTAGE PAID MIAMI, FL PERMIT NO. 231 RECEIPT HOLDER MAY DO BUSINESS AS A CONTRACTOR AS SPECIFIED HEREON. ELECTRICAL CONTRACTOR DO NOT FORWARD UNITED ELCTRIC CONTRACTORS INC BERNARD DORELIEN PRES 3292 NW 43 ST LAUDERDALE LAKES FL 33309 lillliillilillilillliill III litillAli 1111ililii11i11455111 2011 LOCAL BUSINESS TAX RECEIPT 2012 MIAMI -DADE COUNTY - STATE OF FLORIDA • EXPIRES SEPT. 30, 2012 MUST BE DISPLAYED AT PLACE OF BUSINESS PURSUANT TO COUNTY CODE CHAPTER 8A - ART. 9 & 10 NEW 716902 -2 CC PR18315 689340 -9 THIS IS NOT A BILL-DO NOT PAY BWOWMPIEVOlgie r@NCONTRACTORS INC DOING BUS IN DADE CO MUWITED ELCTRIC CONTRACTORS INC SeDil'BeffIE PRICAL CONTRACTOR THIS 1S ONLY A LOCAL BUSINESS TAX RECEIPT. IT DOES NOT PERMIT THE HOLDER TO VIOLATE ANY EXISTING REGULATORY OR ZONING LAWS OF THE COUNTY OR CmES. NOR DOES IT EXEMPT THE HOLDER FROM ANY OTHER PERMIT OR LICENSE REQUIRED BY LAW. THIS IS NOT A CERTIFICATION OF THE HOLDER'S QUALIFICA- TIONS. PAYMENT RECEIVED MIAMI -DADE COUNTY TAX COLLECTORI 0 /2 7 / 2 01 1 02210020002 000075.00 SEE OTHER SIDE FIRST -CLASS U.S. POSTAGE PAID MIAMI, FL PERMIT NO. 231 WORKER /S 1 DO NOT FORWARD UNITED ELCTRIC CONTRACTORS INC BERNARD DORELIEN PRES 3292 NW 43 ST LAUDERDALE LAKES FL 33309 1111111111111 111111111f 1111111 11111111111111111111111 i °i 111 Dec 0511 09:27a Insure Smart 954 - 783 -2425 p.1 ACORJI3)� CERTIFICATE OF LIABILITY INSURANCE DATE (M MIDDIYYYY) —� 12/05/11 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 INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder isan ADDITIONAL INSURED, the pollcy(les) 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 Ileu of such endorsement(s). PRODUCER Insure Smart III 2667 E. Atlantic Blvd, Pompano Beach, FL 33062 Phone (954)783 -8400 INSURED UNITED ELECTRIC CONTRACTORS INC 3292 NW 43 St LAUDERDALE LAKES, FL 33309- Fax (954)783 -2425 COVERAGES (305) 731 -1241 NAME: GREGG DI CONTACT NAME: TZfAN N L.WC. J• Eo,-E,G) (954)783 -8400 ^gpD• RESS: info @insure- smarl.com IAIC. Nnf: (954)783- 242525 INSURER(S) AFFORDING COVERAGE INSURERA: WESTERN WORLD INSURANCE COMPANY INSURER B : INSURER C: INSURER D ; INSURER E INSURER F : NAIL ti 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 TI-115 CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN rS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR 'TYPE OF INSURANCE ADOL UBR POLICY EFF POLICY EXP R wvo POLICY NUMBER (MMIDINYYYY) (MMIDD/YYYY) A GENERAL UABIUTY ® COMMERCIAL GENERALLUABILnY E] ❑ cLAIMS -MADE Eel OCCUR GEV'L AGGREGATE LMIT APPLIES PER: © POUCY ❑ Pqy ❑ LOC AUTOMOBILE LIABILITY ❑ ANY AUTO ❑ AUTOS NED Cl HIRED AUTOS ❑ CI UMBRELLA LIAB EXOESS LIAR L SCHEDULED AUTOS NON -OWNED AUTOS OCCUR CLAIMS -MADE DED E RETENTION S GBBLJJ-0 04(0712011 LIMITS EACH OCCURRENCE DAMAGE TO RENTED PREMISES fEa occurrence) 1 s 300,000.00 s 50,000.00 MED EXP (Any one person 04/07/2012 1 PERSONAL 8 ADV INJURY $ 5,000.00 $ 300,000.00 GENERAL AGGREGATE $ 600,000.00 PRODUCTS - COMP /OP AGG $ 300,000.00 DED $ 500.00 COMBINED SINGLE UMFT IEa acddeng BODILY INJURY (Per person) £ $ BODILY INJURY (Per accident) (Per PPEE 1Y DAMAGE WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N • ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER /MEMBER EXCLUDEED? _ , (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA EACH OCCURRENCE AGGREGATE I-I 5 �I J TTORYLI L� Ml S ER E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYE E.L. DISEASE - FCLICYUMIT S $ $ DESCRIPTION OF OPERATIONS/ LOCATIONS 1 VEHICLES (Attach ACORD 101, Additional Remark. Schedule, II more space is required) CERTIFICATE HOLDER CANCELLATION City of Miami Shores 10050 Ne 2nd Ave Miami shores, FL 33138 1305 -756 -8972 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DEUVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE (Ai r .i'bi(x :-iia r'l.069236 ACORD 25 (2010105) CIF © 1988 2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD