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EL-12-691Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 12 -S Z., Inspection Number: INSP- 172752 Permit Number: EL -4 -12 -691 Scheduled Inspection Date: April 26, 2012 Inspector: Devaney, Michael Owner: HURTAK, JEROME Job Address: 533 GRAND CONCOURSE Miami Shores, FL 33138 -2464 Project <NONE> Contractor: SUN POWER & LIGTH INC Permit Type: Electrical - Residential Inspection Type: Final Work Classification: Alteration Phone Number Parcel Number 1132060171350 Phone: (786)286 -4391 Building Department Comments INSTALL ONE AC MINISPLIT UNIT 20AMP /220 VOLT IN EXISTING 20 AMP SERIVCE Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments April 25, 2012 For Inspections please call: (305)762 -4949 Page 20 of 27 BYJIL ING PE FBC 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 PLICATION Permit No. 0-• 1 2- 4)9 Master Permit No. 1/1C-A t'Z. Permit Type: Electrical (�/�� / OWNER: Name (Fee Simpletuvi Titleholder): 6iOIlµo ft. Phone#: 5 (.o6 6623 Address: �� 533 C n (,3'Jv' �.1- City: M11 t (es State: _ rr 1011 del Zip: 33 v38 Tenant/Lessee Name: Phone#: Email: JOB ADDRESS: 53 e O. Q City: Miami Shores County: Miami Dade Zip: Folio/Parcel #: Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name: 6 PO W 4- (ILO —D IC. Phone #: GO Gi4 3'I 1 Address: 641(O paW 3S1 City: 14A akti► State: IfOltkdA Zip: t)1 33%! Qualifier Name: : A 'till Phone #: 2%4M 1 State Certification or Registration #: EC, MO Al l Co, Certificate of Competency #: Contact Phone #: 18‘# t VI 'k 9 1 Email Address: �i h O.('I Etvirnail. DESIGNER: Architect/Engineer: Phone#: 00 Value of Work for this Permit: $ 3O Square/Linear Footage of Work: Type of Work: ❑Address DAlteration Description of Work: el ‘w ❑Repair/Replace Demolition i r 4 onE tIc Miwi sO;C uY \•r 20 Al/ 22o%ts I•cisdl (1 2i7 bam P 6eP4ce ** * * ** aa******************************* Fees**** ********** ****** *********** ************* Submittal Fee $ •�At 0 Permit Fee $ / '4' CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ 1109' 1,0 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 ANNIDAVIT: 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 ab � e of suc l; osted notice, the inspection - no a ,. , s : and a j�,y ec % on fee will be charged Owner or Agent The foregoing instrument was acknowledged before ��me��this day of ,20 «by 6OM ►l/! ) to me or who has produced As identification and who did take an oath. NOTARY PUB ' C: Sign: Print: Public State of Florida r A Titian � ,1 �L bilk y Commission EE029739 My Commission Expires: APPROVED BY The foregoing instrument was acknowl ged before me this day of ARV L , 20 1 ts-by 5o3 re— TOM 0,M LL, who is personally known to me or who has produced , 17 as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: ``� otit11d /j,,,, . . , as, My Commission Expires: ' 4 t .% ?' . c ■ 4:e illw ,',,,lir ►N! Ht 11111N ° / I fPA Plans Examiner Zoning Structural Review Clerk (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CONTRACTORS' REGISTRATION FORM ALL CONTRACTORS MUST PROVIDE COPIES OF LICENCES AND INSURANCES EACH TIME A PERMIT'IS SUBMITTED OR THE VILLAGE MAY MAINTAIN A FILE WITH YOUR INFORMATION FOR A $30.00 FEE PER YEAR. IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: A. 11 /COPY OF QUALIFIER'S STATE LIC CARD B. COPY OF LOCAL BUSINESS TAX RECEIPT C. OPY OF LIABILITY INSURANCE (CERTIFICATE HOLDER TO BE MIAMI SHORES VILLAGE BLDG DEPT) D. COPY OF WORKERS COMPENSATION (EITHER CERTIFICATE OR EXCEMPTION) IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY: A. COPY OF CERTIFICE OF COMPETENCY OF QUALIFIER B. COPY OF MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT C. COPY OF LIABILITY INSURACE (CERTIFICATE HOLDER MUST BE MIAMI SHORES VILLAGE BLDG DEPTI D. COPY OF WORKER COMP INSURANCE (EITHER CERTIFICATE OR EXEMPTION) YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE HOLDER AS FOLLOW: MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES, FL 33138 BUSINESS NAME: COMPLETE CONTRACTOR'S INFORMATION 12— (1T BUSINESS ADDRESS: l' 57r CITY P 1 A n STATE ZIP CODE ( 55 BUSINESS PHONE: (7%) Co 151 ( FAX NUMBER 2 ' 7 14,4 9 CELL PHONE (76) 2 4541 ( QUALIFIER'S NAME: Ce QUALIFIER'S LIC NUMBER: ec- t3OO4) 1 E -MAIL ADDRESS (IF APPLICABLE): -ron 1 ' 1 e hDT(r'c{ a . con,. Created on 3119109 BY MLDV 1 RV 3126109 MLDV STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD (850) 487 -1395 1940 NORTH MONROE STREET TALLAHASSEE FL 32399 -0783 TILLAN, JOSE A SUN POWER & LIGHT, INC. 6400 SW 37 ST MIAMI FL 33155 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.myfloridallcense.com. There you can find more information about our divisions and the regulations that impact you, subscribe to department newsletters and team more about the Departments 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 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. 10 -08 -2010 EFFECTIVE DATE: PERSON: FEIN: 10/08/2010 TILLAN 271228764 BUSINESS NAME AND ADDRESS: SUN POWER & LIGHT INC 6400 SW 37TH STREET MIAMI FL 33155 EXPIRATION DATE: 10/07/2012 JOSE A SCOPES OF BUSINESS OR TRADE: 1- ELECTRICAL/ ELECTRICIAN 2- CERTIFIED ELECTRICAL CONTRACTO 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 under this section may not recover benefits or compensation under 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. DWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 09-06 QUESTIONS? (850) 413 -1609 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: 10/08/2010 EXPIRATION DATE: PERSON: JOSE A TILLAN FEIN: 271228764 BUSINESS NAME AND ADDRESS: SUN POWER & LIGHT INC 6400 SW 37TH STREET MIAMI, FL 33155 10/07/2012 SCOPE OF BUSINESS OR TRADE 1- ELECTRICAL/ ELECTRICIAN 2- CERTIFIED ELECTRICAL CONTRACTO IMPORTANT F 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. H E R E 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 -1609 CUT HERE 41 Carry bottom portion on the job, keep upper portion for your records. r MIAMI -DADE COUNTY TAX COLLECTOR 140 W. FLAGLER ST. 1st FLOOR MIAMI, FL 33130 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 FIRST -CLASS U.S. POSTAGE PAID MIAMI, FL PERMIT NO. 231 THIS IS NOT A BILL - DO NOT PAY 669824 -6 RENEWAL BUSINESS NAME / LOCATION RECEIPT NO. 697133-8 SUN POWER & LIGTH INC STATE# EC13004559 6400 SW 37 ST 33155 UNIN DADE COUNTY OWNER SUN POWER & LIGTH INC Sec. Type of Business 196 ELECTRICAL CONTRACTOR THIS IS ONLY A LOCAL BUSINESS TAX RECEIPT. IT DOES NOT PERMIT THE HOLDER TO VIOLATE ANY EXISTING REGULATORY OR ZONING LAWS OF THE COUNTY OR CITIES. 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 COLLECTOR: 07/13/2011 60020000467 000075.00 SEE OTHER SIDE WORKER /S 1 DO NOT FORWARD SUN POWER & LIGTH INC JOSE A TILLAN 6400 SW 37 ST MIAMI FL 33155 11, 111, 111111111111 ,� }I,IllItIJ11111111111►i 1111Ileh Fm:Fortun Insurance To:SUN POWER AND LIGHT,, 660- 6120R573 (13052691649) 12:08 04/02/12 EST Pg 3 -3 A CERTIFICATE OF LIABILITY INSURANCE D`�"�°�""' THIS CER1IFICA1E IS ISSUED AS A MATTER OF INFORMATION ONLY AND NO �e UPON TIE CERTI AYE �0.OER. THM CER1WICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEIID OR ALTER THE COVERAGE AFFORDED BY THE POUCIES BELOW. THIS C RTIMCATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETNEEN THE ISSUING INSURER(S), AUTHCMIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE E HOLDER. IMPORTANT: It the certificate holder is an ADDITIONAL INSURED, the poHLy(Ies) must be enthused. N SUBROGATION NI WAIVED, suitedto the terms and 10idltons of the poftcy, certain policies may requhe an endorserneta A statement on fhls certificate does not confer rights to the certificate hailer In Ibis of such mss). PRODUCER Forton Insurance, Inc. 365 Palermo Ave. Coral Gables INSURED SUR POKER AND LIGHT. 6400 SW 37TH STREET FL 33134 -6607 c°a'• Mezay P0006 (305)445 -3533 111 aey (Wpu5 -ea25 icy • caapaaano9fer+.+..+., uranae. caa 81 AFFORDING COMA= Miami FL 33155 r a :Travelers Insurance Co. (CL) INSURERS: MAC INIURSRC: INSURER IL IN5UaER E: COVERAGES INSURER e: CERTIFICATE NUMBEECL1172203330 THIS IS TO CERTIFY THAT THE POU IES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTAAIDING ANY REOUIRBBENT TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO 00CH THIS CERTFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POUCES DESCRIBED HEREIN IS SIS,IECT TO ALL THE TERM, Tx TYPE CONDITIONS OF SUCH POUCIES. LIMITS SHOW MAY HAVE BEEN REDUCED BY PAIDCLABIS. �tR TtPE (P INSURANCE AIM MR" NMI Ism POLICY RUMEN &BM RAN NUMBER: GENERAL LIABILITY A CAL GENERAL U LM ITV CLADASIMDE El OCCUR GENLAGGRE(G�ATE MOT AP(P�UESPER X POUCYI I I ILOC AUTOMOBILE UNDULY ANY AUTO ALL OWNED AUTOS HOEDAUTOS UMBRELLA UAa EXCESS LIAR 660- 61208573 7/21(2011 7/21/2012 EACH OCCURRENCE DMIAGE TO REINED $ MEDEXP (ARVADA perm,) PERSONAL B ADY EMMY GENERAL AGGREGATE I S 1,000,000 PRODUCTS. COMPEMAGG 1 50,000 5.000 1,000,000 2,000,000 2,000,000 1 �A+(�C�rd(�(iiE��042.fi0 1r AUTOS pfliNalifiGiE LIMY 1 HOMY INJURY (Prpe 1 BODILY p1 (ParsoMeN ) e =TIME S OCCUR CLANS A N—G TI_RETEN TI iONS WORMS COMPENSATION AND EMIRJ3YERr/IMAM ANY PROPRIETOR/PARTNER/MECUM Y EXCUSED? Sy�� deOe trO U 7a11 lFOPERATWNSpeipw EACH OCCURRENCE 1 AGGREGATE 0IA IMTA.M. 1FR 1 El EACH ACCIDENT 1 EL DISEASE- Ell EMPLOYEE 1 o uCRIPTIBR OF OPERATiOR* /LOCA7101IS MM US (ASagI MGM 1D1. AGeHARA Amato SGMMpr,Nmara gem Ai requhsto E Era RZ AL COMPACTOR ERTIFICATE HOI DER El DISEASE- POLICY L00T 1 City of Miami Shore Village Building Department. 1005 N:E. 2nd Avenue Miami Shores,: Florida 33138 ACORD 25 (2010105) INSB?S*WARS ni CANCELLATION SHOULD ANY OF THE ABOVE 00Sclusim POLICIES BE CANCEL= BWFORE THE EXPIRATION DATE THEREOF, NOTICE WILL SE DELIVERED IN ACCORDANCE WITH MB POLICY PROVISIONS. AUTHORIZED REPREE NTNIN E tutor Fortin/HE 61988.2010 ACORD CORPORATION. A9 rights resented. 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