ELC-12-206Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP - 169675
Permit Number: ELC -2 -12 -206
Scheduled Inspection Date: March 20, 2012
Inspector: Devaney, Michael
Owner: SKLAR, ARI & OSCAR
Job Address: 9400 NE 2 Avenue 9400
Miami Shores, FL 33138 -0000
Project: <NONE>
Contractor: ATLANTIC ELECTRIC AND ALARM, INC
Permit Type: Electrical - Commercial
Inspection Type: Final
Work Classification: Addition /Alteration
Phone Number (786)326 -2747
Parcel Number 1132060132780 -00
Phone: 561- 798 -1914
Building Department Comments
ELECTRICAL WORK FOR TENANT IMPROVEMENT. NEW
SPRINT RETAIL STORE
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
/ /C
March 19, 2012
For Inspections please call: (305)762 -4949
Page 5 of 15
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
BUILDING
PE 'LL IT APPLICATION
FBC 20
Permit No.
Master Permit No
FEB a ►�
BYe
Permit Type: Electrical
O :Name (Fee Simple Titleholder): c)� L. t_C Phone#: g 54 - 4
Address: a D 1-1-0
-O
City: i4OLt L (G.a O b
Tcnant/lcsscc Name: 'S ( 1 N fi
Email:
State: ( L_
3?, a O
Phone#: 3 1 i.9 L1 S - S->-00
JP% ADDRESS: -a1^., ? / l� O i'Vg 2. five . Sv-ilk 14 417-
City: Miami Shores
Folio/Parcel #:
County:
Miami Dade Zip:
Is the Building l istorieally Designated: Yes
NO Flood Zone:
CONTRACTOR: Company Name (iAtkA IC t tee_ �E t Phone#: -GS -2 _ 17
Qualifier Name:
State Certification s Registration #:
6
ec&c 3oos
zziip` 3c (70
Phone��F cK -Zc o '..S*-7
ertificate of Com • tcncy #:
men
Contact Phone#: Email Address:
DESIGNER: Architect/Engineer: Phone #:
49
Value of Work for this Permit: $ /2" CC) Square/Linear Footage of Work:
Type of Work: ❑Address
,elWvikut °IWO
teration ❑New , URepair/Replace
e. (e� 1 l.- c.tit -L v3(V2 -e>
❑Demolition
Submittal Fee $
.5,'P?rreew Fee $
Permit Fee $ 3i�'�'�j CCF $ CO /CC $
Radon Fee $ DBPR $ Bond $
17. F $ Teehnolog Fee $
acase$s. arses $
o`^+scta�rset evie W $
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 wi ' ° - . ccurs seven (7) days after the building permit is issued. In t • . ce of suc posted notice, the
inspection will not b p roved <d a reinspection fee will be charged,
!j
Sign:acure MU ! Siigna,
WI RN
�J�/ Y r Agent Contractor
The fore ,gojpng instrument was acknowledged before me this 3 The foregoing instrument was acknowledged before me this I 0
day of , 20 by 00,1%A , day of
who is personally known to me or who has produced
As identification and who did take an oath.
NOTARY PUBLI
Sign:
Prins.:
9107.10 ewpdXSI
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VOIHOOd tiO 3,Ltl1S
My Commission Expires:
APPROVED B
2011, by m I et.dn ,
to is personally known to memor who has produced
as identification and who did take an oath.
NOTARY PUBLIC:
Sign: T T
Prins: _ 1YVA.46 Le. i
1'
ILEI S.ROMERO SSSS'SS�'
DD08711.
My Commission Expires
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Plans Examiner Zoning
Structural Review
(Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09)
Clerk
Jan. 6. 2012— 8:53AM
Auutw CERTIFICATE OF LIABILI
PRODUCER
C & C Insurance
1921 NW 150 Ave
Suite 101
Pembroke PI FL 33028
INSURED
ATLANTIC ELECTRIC & ALARRSII, INC
17072 91ST PLACE NORTH
LOXAHATCHEE FL 33470
COVERAGES
No. 9666
iY INSURANCE
DATE MM100IYYYt')
0110812012
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
NAIL #
INBURERPr BANKERS INSURANCE COMPANY
$ 5.000
s 1,000 000
INSURER B: Bridgefletd
ENERML AGGREOA
( NSURER C:
mRODUCT$ - COMPIOP Ace
INSURER D:
INSURER E
COMBINED SINOLE LIMIT
(Es accident)
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE P
ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO W
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TE
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY pAID CLAIMS.
114 1 POL tY EEF�FF� WAY Po L� �'Y EXPI�pVN
TYPE Dr mows POLICY NUMBER aA_ r111Mmn, h m„F (WIMrDb1YY1
GENERAL LIABILITY
A X cOMMERc,a, GENE LIABILITY 09 0004547712 512 0310612011 0310812012
1 mum= I X I OCCUR
GEN'L AGO TE UI UT APpLIE$ FER:
P ICY PR LOC
AUTOMOBILE LIABILITY
ANY AUTO
_ Au, OWNED AUTOS
_ SCHEDULED AUTOS
HIRED AUTOS
NON-OWNED AUTOS
B
GARAGE IJABIUr r
ANY AUTO
CES$!UMBRELLA u ILITY
OCCUR [CLAMMS MADE
1 DEDUCTIBLE
RETENTION
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
ANY PROPRIETOpR PARTNE JEJ ECUTNE
OFFICER/MEMBER EXCLUDED'?
11 dea Abb under
__SPECIAL PROVIt31Or ba4ew
OTHER
19505444
0410112011 0410112012
DE$CRX'TIQN OP OPERATIONS I LOCATIONS) VEHICLES!EXCLUSIONS ADDED BY ENDORSEMENT ! SPECIAI. PROVISIONS
ELECTRICAL CONTRACTOR
CERTIFICATE HOLDER
CITY OF MIAMI SHORES
10050 NE SECOND AYE
MIAMI SHORES, FL 33138
ACORD 25 (2001108)
DLICY PERIOD INDICATED. NOTWITHSTANDING
HIGH THIS CERTIFICATE MAY BE ISSUED OR
MS, EXCLUSIONS AND CONDITIONS OP SUCH
waifs
EACH OCCURRENCE
s 1,000,000
$ 50,000
DAMAGE TO RENTED
PREMISES (Fe)
MED EXP (ADY tee pwapn)
$ 5.000
s 1,000 000
PERs011AL & ADV INJURY
ENERML AGGREOA
1 000 000
mRODUCT$ - COMPIOP Ace
$1,000,000
COMBINED SINOLE LIMIT
(Es accident)
$
BODILY INJURY
(Per perean)
$
BODILY INJURY
(pet ardent)
$
PROPERTY DAMAGE
(Per accMent)
AUTO ONLY - EA ACCIDENT
$
PA ACC
AUTT
A YY
ONNL AGO
EACH OCCURRENCE
AGGREGATE
$
$
s
X I WO STATU- I IOTH-
TORY I IMrri FR
$ 500,000
s 500,000
.
E.L. EACH ACCIDENT
El, DISEASE - EEEMPLQYEE
EL DISEASE - POLICY LNE T
$ 500,000
CANCELLATION•
SHOULD ANY OPTHE ABOVE DESCRIBED POLIiXES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN
NOTICE TO THE CERTIFXJITE HOLDER NAMED TO THE LEFT, HUT FAILURE TO DO SO SNALL
IMPOSE NO OEL1 AT10N DIL LIABILITY OF ANY RIND UPON THE INSURER. ITS AGENTS OR
REPRESENTATIVES. . �r
AUTHORIZED
@ ACORD CORPORATION 4988
STATE OF FLORIDA
7.'D OF BUSINESS AND PROFESSIONAL REGULATION
DEPAR
ELECTRICAL CONTRACTORS LICENSING BOARD
1940 NORTH MONROE STREET
TALLAHASSEE FL 32399 -0783
()REAR, BRUCE E
ATLANTIC ELECTRIC & ALARM INC
17072 91 PLACE N
LOXAHATCHEE FL 33470
angratulationsl With this license you become one of the nearly one million
oridians licensed by the Department of Business and Professional Regulation.
ur professionals and businesses range from architects to yacht brokers, from
nxers to barbeque restaurants, and they keep Florida's economy strong.
eery day we work to improve the way we do business in order to serve you better
r information about our services, please log onto www.myfloridaticense.com.
sere you can find more information about our divisions and the regulations that
pact you, subscribe to department newsletters and team more about the
apartment's initiatives.
ur mission at the Department is: License Efficiently, Regulate Fairly. We
instantly strive to serve you better so that you can serve your customers.
lank you for doing business in Florida, and congratulations on your new license!
DETACH HERE
(850) 487 -1395
BUSIES;
REG y
07/21/10 3,00039:
BATCHNUMBE_R,i<
x/21/2010
Le ELECTRI
.med below
.der the p
-pirat ion da:
OREAR, -
A°TLANTIC
17072 9X
:o TCHEE
ANNE 144 .PAN N ON P.O. Box 3353, West Palm Beach, FL 33402 -3353
CONSTITUTIONAL TAIL COLLECTOR www.taxcollectorpbc.com Tel: (581) 355 -2272
Servtigg Paha Reatt Coon ty
**LOCATED AT**
17072 91ST PLACE NORTH
LOXAHATCHEE, FL 33470
TYPE OF BUSINESS 1 OWNER
CERTIFICATION H
23 -0169 ELECTRICAL CONTRACTOR
O'REAR BRUCE E
500003005
RECEIPT #/DATE PAID + AMT PAID
B11.145866 - 08/18/11 1 $27.50
BILL 8
840072927
This document is valid only when receipted by the Tax Collector's Office.
ATLANTIC ELECTRIC & ALARM INC
ATLANTIC ELECTRIC & ALARM INC
17072 91ST PL N
LOXAHATCHEE, FL 33470 -2787
111111111 11111iim111nn111llu11111k1.111
STATE OF FLORIDA
PALM BEACH COUNTY
2011/2012 LOCAL BUSINESS TAX RECEIPT
LBTR Number: 200005828
EXPIRES: SEPTEMBER 30, 2012
This receipt does not constitute a franchise,
agreement, permission of authority to perform the
services or operate the business described herein
when a franchise, agreement or other county
commission, state or federal permission of authority
is required by county, state of federal law.
AO.
1