DEMO-11-959 (2)Miami Shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
Permit No. 17 Wr t
Job Name Pi/ 2-
CRITIQUE SHEET
wI 57 A./.6 pry c-LI 7 e if
�� 7/
May 1711 02,3'2p BBF Construction
305 - 234 -4515
p.2
Miami Shores Village t,
Building Department
10050 N.E.2nd Avenue, Miami Shores. Florida 33138
Ted: (305) 795,2204 Fax: 13051756.8972
INSPECTION'S PHONE NUMBER: 1305) 762.4949
BUILDING
PERMIT APPLICATION
FRC2O
MAY 24Nit
ym m uyZa -S6 -0.M
Ct59
Permit No
Master Permit No.--*- • e� �l'a �r°.;h
(4Gd
Permit Type: Electrical
OWNER: Name (Fee Simple Titleholder):,,, \L1 Phone#: ? ' 1 �ii� °S1 1 1
"1
Address: o . c • '�
City: E' e ktet \ tb 0,ce Sae: L Zip:
Tenant/Lessee Name: Phone-#:
Email:
JOB ADDRESS: 6" 0 ° 6164-t6
City: Miami Shore
County:
Mnti Dade Zip: 3 3
Folio/Parcel#:
Is the Building Historically Designated: Yes NO Flood zone:
CONTRACTOR: Company Name: VZ Phone#:
Address: A, a O 5 iy e d vtc.
City: ? :v , ,/ & "4,t`r i4 State:
Qunli$ierName:
&ate Certification of Re•nisirntic n #: a � C 0 ZO`/ Certificate of competency � #:
Contact Phone#: e &w i' -5 647 Email Address: . E t+ e € ,t t'- :� B C.. ,A a:6 C.60 ' L y
DESIGNER: Arthitecr/Eigineer: Phone#:
/ 4/3 7 1 o
Zip: -'731t) '71
Phone#: 5":45.1 44 )';et,' N
Value of Work for this Permit: $ CC) Square/Linear Footage of Work:
Type of Work: OAddres. QAlteration New 13RepairfReplace °Demolition
Description of Work: i --i i cod &, 1ii` t°i e'
� _ ***-f ,eaeexnd mcmae:x . *+s. a. 0* ******00Feessiw**svo.i ape***** *ss4iud+&se.5.4x$ **** **iut.-J+t**
Submittal Fee 5 3 - L Pertnt Fee $ l®® f O CCF $ CO/CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $ Technology Fee $
Double Fee $ Structural Review $ <6" TOTALF7 ENOWDUE$ /I
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,
WFI .i S, 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 properly 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 t absence of such posted notice, the
inspection will not be approved and a- reinspection fee will be charged
Si._ Signature /a C-
� er or Agent ,contractor
The irego' instrument was acknowledged before me this / ?C�`' The for going ins rnent was acknowledged before me this G/ Y
dajof 20 L.L, by 1. €(eSA- C Cdl -wei 0 , day of ' • , 2011— by )i >UV 'u A''`
who is personally known to me or who has produced who is personally known to me or who has produced
As identification and who did take an oath. as idhtification and who did take an oath.
/
NOTARY P ' IC,?
NOTARY PUBLIC:
Sign:
Print:
My Commission Expires:
• r" ‘4" A VY IsUBLIC4TATE OFFLORIPA
/"',,, Yaniv Di�ir
Commission #DD795680
-, • Expires: AUG. 22, 2012
BONDED TRW MANIC BONDING CD;IIfC
DANAC
Sign: Y '� NANO
MY COMMISSION IDOaura
0. Print: " EXPIRES: Mart.h 8, 2013
My Comlm°1is°�ion p
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised 07 /10/07)(Revised 06/10/2009)(Revised 3/15/09)
.1
a
r
-
■ IP • r • v
dV -i 1rlo
115 S. Andrews Ave., Rm. A -100, Ft. Lauderdale, FL 33301 -1895 — 954 - 831 -4000
VALID OCTOBER 1, 2010 THROUGH SEPTEMBER 30, 2011
DBA: Receipt #:181-2294
Business Name: RAC ELECTRIC INC Business Type :ELECTRICAL /ALARMS /CONT'
(MASTER ELECTN /BURG /FIR
Business Opened:o1 /01/1999
State /County /Cert/Reg:EC13 0 02 042
Exemption Code:NONEXEMPT
Owner Name: ROBERT A ROMANO
Business Location: no o SW 189 AVE
PEMBROKE PINES
Business Phone: 954 -443 -7561
Rooms
Seats
Employees
2
Machines Professionals
For Vending Business Only
Vending Type:
Tax Amount
Transfer Fee
NSF Fee
Penalty
Prior Years
Collection Cost
Total Paid
27.00
0.00
0.00
0.00
0.00
0.00
27.00
THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS
THIS BECOMES A TAX RECEIPT 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
WHEN VALIDATED 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.
Mailing Address:
ROBERT A ROMANO
1100 SW 189 AVE
PEMBROKE PINES, FL 33024
2010 - 2011
Receipt #05A- 09- 00024496
Paid 07/15/2010 27.00
TOR
STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
ELECTRICAL CONTRACTORS LICENSING BOARD
1940 NORTH MONROE STREET
TALLAHASSEE FL 32399 -0783
ROMANO, ROBERT ANTHONY
RAC ELECTRIC INC
1100 SW 189 AVENUE
PEMBROKE PINES FL 33029
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.myflorldalicense.com.
There you can find more information about our divisions and the regulations that
impact you, subscribe to department newsletters and learn 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!
(850) 487 -1395
DETACH HERE
DATE BA:TCHNIA4BE ^'5.4 "17
01 -27 -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:
01/27/2011 EXPIRATION DATE: 01/26/2013
ROMANO ROBERT A
650882878
BUSINESS NAME AND ADDRESS:
R AC ELECTRIC INC
1100 SW 189TH AVE
HOLLYWOOD FL 33029
SCOPES OF BUSINESS OR TRADE:
1- ELECTRICAL WORK
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 00 the certificate to meet the requirements of this section. QUESTIONS? (850) 413-1609
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: 01/27/2011 EXPIRATION DATE:
PERSON: ROBERT A ROMANO
FEIN: 650882878
BUSINESS NAME AND ADDRESS:
R A C ELECTRIC INC
1100 SW 189TH AVE
HOLLYWOOD. FL 33029
SCOPE OF BUSINESS OR TRADE:
1- ELECTRICAL WORK
01/26/2013
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.
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.
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.
IMPORTANT
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
OP ID: BS
'4 ` °- CERTIFICATE OF LIABILITY INSURANCE
°�'�`�17/11 '
05/17/11
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 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: If the certificate holder is an 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 lieu of such endorsement(s).
PRODUCER 954- 580 -2378
Best Insurance
8050 N. University � �1Dr Ste #205 954- 580 -0655
Barry Sokoloff
NEACT
((/CSC. Lo, Ezt): FAX , No):
ADDRESS:
PRODUCER RACEL -1
CUSTOMER ID #:
INSURER(S) AFFORDING COVERAGE
NAIC #
INSURED Rac Electric Inc.
1100 SW 189 Avenue
Pembroke Pines, FL 33029
INSURER A :Travelers Insurance Co.
OCCUR
INSURER B, Travelers Insurance Co.
INSURER C :
05/10/11
INSURER D :
EACH OCCURRENCE
INSURER E :
1,000,000
INSURER F :
RAmA SEs (Ea ce)
E
CERTIFICATE 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 INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
ILLTTRR
TYPE OF INSURANCE
NSR
VINO
POUCY NUMBER
(POUF
PMIDD EXP
UMIIS
A
GENERAL.
LIABILITY
COMMERCIAL GENERAL LABILITY
OCCUR
16600279R699TIA
05/10/11
05/10/12
EACH OCCURRENCE
$
1,000,000
X
RAmA SEs (Ea ce)
$
100,000
CLAIMS -MADE
X
MED EXP (Any one person)
$
5,000
PERSONAL & ADV INJURY
$
1,000,000
GENERAL AGGREGATE
$
2,000,000
GENII AGGREGATE LIMIT APPLIES PER
PRODUCTS - COMP /OP AGG
$
2,000,000
7 POUCY jE LOC
$
AUTOMOBILE
LABIIJTY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON -OWNED AUTOS
COMBINED SINGLE UMIT
(Ea accident)
$
BODILY INJURY (Per person)
$
BODILY INJURY (Per acdderd)
$
_
(Per accident)
$
$
B
X
UMBRELLA LAB
EXCESS UAB
X
OCCUR
CLAIMS -MADE
05/10/11
05/10/12
EACH OCCURRENCE
$
1,000,000
AGGREGATE
$
1,000,000
DEDUCTIBLE
RETENTION $
Retention
Retention
$
5,000
$
WORKERS COMPENSATION
AND EMPLOYERS' LABILITY
ANY PROPRIETOR/PARTNER/DQ
OFFICER/MEMBER EXCLUDED?
(Mandatory In NH)
fl yes describe under
DESCRIPTION tall
RIPTION OF OPERATIONS
Y! N
N / A
WC STATU- OTH-
TORY LIMITS ER
E.L. EACH ACCIDENT
$
CUTNE
E.L. DISEASE - EA EMPLOYEE
$
below
E.L. DISEASE - POLICY OMIT
$
DESCRIPTION OF OPERATIONS 1 LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, H more space Is required)
Electrical work within buildings
CERTIFICATE HOLDER
CANCELLATION
MIAMISH
Miami Shores Village
10050 NE 2nd Avenue
Miami Shores, FL 33138
SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POUCY PROVISIONS.
AUTHORIZED REPRESENTATIVE
Barry Sokoloff
ACORD 25 (2009/09)
01988-2009 ACORD CORPORATION. AU rights reserved.
The ACORD name and logo are registered marks of ACORD