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EL-11-1928Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 165663 Permit Number: EL -10 -11 -1928 Scheduled Inspection Date: October 24, 2011 Inspector: Devaney, Michael Owner: LEE, PATRICK Job Address: 1122 NE 97 Street Miami Shores, FL 33138- Project: <NONE> Contractor: HI TECH ELECTRICAL INC Permit Type: Electrical - Residential Inspection Type: Final Work Classification: Temp for Test Phone Number Parcel Number 1132050170170 Building Department Comments 30 DAY TEMP FOR TEST Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Com /7 October 21, 2011 For Inspections please call: (305)762 -4949 Page 13 of 22 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 PERMIT APPLICATION FBC 20 a -iI .I0)W Permit No. U. rig,), I s l b Master Permit No. RC b r f all Permit Type: Electrical OWNER: Name (Fee Simple Titleholder): 1.--e5 `ltck Let_ Phone#: 121b -0-'titl Address: �,,( 3 �'� �i qu+'b c"�f,@..p City: 1 �gr"N:544'j State: C Zip: 3 3 L353 53 Tenant/Lessee Name: Phone #: Email: �e•S1v1�-1�e�ss_ <p� JOB ADDRESS: 2 2 f 93 s i City: Miami Shores County: Miami Dade Zip: 33161 Folio/Parcel #: Is the Building Historically Designated: Yes (NO� Flood Zone: CONTRACTOR: Company Name: H 1 '� ,'ems i J,Y�,C. • Phone #: (' )� c\ 5— 5 7.1).• Address: ®1.) c5C) AL L.. 2 t �' ST 1, I City: Geve�� State: .t_ Zip: 3197-- Qualifier Name: Co Y b 4Y kl bLY 1-C.k. Phone #: State Certification or Registration #: I (--k2C) ? Certificate of Competency #: Contact Phone #: n Email Address: DESIGNER: Architect/Engineer: a DP Phone #: Value of Work for this Permit: $ Square/Linear Footage of Work: Type of Work: ❑Address ❑Alteration DNew ORepair/Replace ❑Demolition Description of Work: 3'0 c& c Ve-m e I' t,St **** ***** **** ** * *** * *** * * * ** * ****** *** Fees * * * **** x********* ******* * * * * *********** *wax ** Submittal Fee $ . Permit Fee $ /0 , e 0 CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ ' U • 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 AI'F'IDAVIT: 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 absence of such posted notice, the inspection will no e approved a;, ;1 a reinspection fee will be charged. Signature Owner or Agent The foregoing instrument was acknowledged before me this day of , 20 i 1 , by if Q41 l who is personally known to me or who ) s produced As identification and who did take an oath. NOTARY P Sign: Print: LIC•. ° 3 �.c _..- My Co s ;' ssion Expires: * * * * * * * * * * * * * * * * * * * * * ** APPROVED BY R .11,E 19GQGC4:i,,, a., Goi R /9 Plans Examiner Zoning Signature Contractor The foregoing i'.' ment was acknowledged before me this ick wl day of J.. ,20 It , by l :S "1 G'i'lii., who is personally known to me or who has produced as identification and who did take an oath. NOTARY : L. print , r Sign: � .J v, /1 � 4.41111171# Luis C. Guerra at ° :4 '- 7 EXPIRES: FEB.15, 2015 ;�ott,::'a yrWW.AAR0NN0tARYcom nrsn My Co' u 'ssion Expires: Structural Review (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) Clerk MIAMNC�4DE COUNTY Building 11805 SW 26th Street Miami, Florida 33175 -2474 786 - 315 -2100 miamidade.gov AFFIDAVIT FOR 30 DAY TEMPORARY ELECTRIC SERVICE ELECTRICAL CATEGORY 26 ELECTRIC SERVICE WILL BE DISCONNECTED "WITHOUT NOTICE" UPON 30 DAY TERMINATION UNLESS APPLICATION IS RENEWED OR CERTIFICATE OF OCCUPANCY OBTAINED. It is understood that the temporary electrical approval by the Miami -Dade Buil • in with the building bein constructed under the Building Permit # Permit# �6c� 9 at address 14 for owner: ket. �. i Les L-ee- and is being given only for construction purposes or for testing the following equipment Fahaid structure: The owner does hereby agree to assume the responsibility of maintaining the installation in such manner that there is no hazard to life or property. Such approval is in no event to be considered a RELEASE of said structure for the purposes of use and occupancy, and no occupancy shall be granted or permitted until final inspections have been called for and approved by the inspection divisions concerned, and/or a Certificate of Occupancy or Completion is obtained. Department is given in connection and Electrical TPA 1315 The undersigned also understands that the temporary electric approval is subject to rescission and cancellation and electric power can be cut off at the discretion of the Building Official and will be disconnected if the building concerned is occupied before final inspections are approved and /or a Certificate of Occupancy or Completion is obtained. I, /�,r1 , being first duly sworn, depose and say that I am the owner of the above describedoperty, and that I agree that the structure covered in this agreement shall not be occupied until the building contractor has obtained approval of final inspections and/or obtained a Certificate of Occupancy or Completion. Note: Failure to comply with the provisions of this affi it will result in you g unable to obtain futur e r • ry for Test permits. i di Sign. ure of Owner Sign\�:ture of Notary VIQ fig MyCommission Expires • _• � . , being duly sworn, depose and say that I am th ' Electrica Contractor for the above - described property and that the electrical installations as no a ?' noty� a safety hazard if to mpe <- ervice is connected. „„ / err � e7 Sig 1rur of Electrical Contractor „ ure of Notary ' f Commission Expires: %:L' Luis G. Guerra ta _COMMISSION #EE058383 : . 15i 2015 r:n∎VA WWW.AARONNOTARYmni , being first duly sworn, .,-pose and say that I am the Building Contractor of the above described property and that I will not permit occupancy of this building until final inspections have been called for by th ;tractors a .,sub- contractors concerned and final approval by the inspection division obtained and th av e aut 1i nsofar as the owner of said prop s concerned to pr. ' • it occupancy until such final in ice, e obt., -d and /or a Certificate of Occ an (. ompletion 's issu Sig"'u of Building Contractor Signature of Electrical Inspector 123_01 -124 6/06 igna ure of Notary My C.mmission Expires: , 'Ed 11 Date: Date released to FPL: MIAMI-DADE COUNTY TAX COLLECTOR 140 W. FLAGLER ST. 1st FLOOR MIAMI, FL 33130 664290-5 -~'�^~ � RENEWAL BUSINESS NAME /LOCATION HI TECH E INC STATns«s��w^~ E^^"" uO428869l35G-7 10850 NW 21 ST 190 33172 SWEETWATER STATE OF FLORIDA AC# 5138.4114 ^ ^� � ' `• `�"� �/ :��>��'^�` _- ' *- —� 4' 1080300t3 IS CERTIFIED under the pz *visions of ch.489 Ps Sxpiratiort date. AUG 33., 20;.2 L10081001732 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 BA - ART. 9 & 10 11:7, A 8Uj—��:JTFAY U.S. POSTAG PAID MIAMI, FL PERMIT NO. 2. OWNER HI TECH E INC Sec. Type of Business 196 ELECTRICAL nos 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 NOT DOES IT EXEMPT THE HOLDER FROM ANY OTHER PERMIT OR LICENSE REQUIRED BY LAW. THIS IS NOT A CERTIFICATION OF THE HOLDER'S OUALIFICA. DONS PAYMENT RECEIVED MIAMI.DADE COUNTY TAX COLLECTOR. 07/06/2011 09010137001 000045.00 SEE OTHER SIDE CONTRACTOR WORKER/S 2 00 NOT FOI1WARD HI TECH E INC ERICKA PEREZ GARCIA PRES 10850 NW 21 ST 190 MIAMI FL 33172 [./[nU"/j/["[`/,[jj1[o./lnv/[jo//1/11015// '.1 ACORL ' CERTIFICATE OF LIABILITY INSURANCE HITEC -7 OP ID: J3 DATE (MM /DD/YYYY) 10/03/11 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 ^GLOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED PRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) 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 Brown & Brown of Florida, Inc. 1201 W Cypress Creek Rd # 130 P.O. Box 5727 Ft. Lauderdale, FL 33310 -5727 Shawn A. Burton, CIC 954- 776 -2222 954 - 776 -4446 CONTACT NAME: PHONE (A/C No EM): EMAIL ADDRESS: FAX (A/C, No): INSURER(S) AFFORDING COVERAGE NAIC # INSURED Hi -Tech E, Inc. Attn: Mr. Garcia 11003 NW 33 Street Miami, FL 33172 INSURER A : Bridgefield Employers Ins. Co+ INSURER B : Starr Indemnity & LiabilityCo+ 10701 38318 INSURER C:Commerce & Industry Ins Co+ 19410 INSURER D : First Nat "I Ins Co of America+ 24724 INSURER E : *AGCS Marine Insurance Co + 22837 INSURER F : COVERAGES • ___ - - "" -- RCVIOIVry NUIVItbtt: 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. INSR LTR TYPE OF INSURANCE ADDL INSR SUBR WVD POUCY NUMBER POLICY EFF (MM/DDYYY) POLICY (MM/DDIYYT YYY) UMITS B GENERAL X UABIUTY COMMERCIAL GENERAL LIABILITY SIPGGL0000100 10/01/11 10/01/12 EACH OCCURRENCE $ 1,000,000 pREM SES EaEoNccu ence) $ 50,000 CLAIMS -MADE X OCCUR MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE POLICY LIMIT APPLIES PRO- JECT PER: LOC PRODUCTS - COMP /OP AGG $ 2,000,000 Emp Ben. $ 1,000,000 LUTOMOBILE UABIUTY 25CC3295681 10/01/11 10/01/12 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 D X ANY AUTO ALL OWNED AUTOS HIRED AUTOS SCHEDULED AUTOS NON -OWNED AUTOS BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ C X UMBRELLA UAB EXCESS UAB X OCCUR CLAIMS -MADE BE025036229 10/01/11 10/01/12 EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5,000,000 DED X RETENT ON $ 0 $ A WORKERS COMPENSATION AND EMPLOYERS' UABILITY Y / N 083046115 10/01/11 10/01/12 X WC STATU- TORY LIMITS OTH- ER ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? N / A E.L. EACH ACCIDENT $ 1 000 , ,000 (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 E Contractors Equip MXI93024511 10/01/11 10/01/12 Leased & Rented 22,500 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule if more space is required) nrnTlrl"••■ 1 IA, e,••• CANCELLATION MIAMISH Miami Shores Village Attn: Building Dept. 10050 NE 2nd Avenue Miami Shores, FL 33138 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25 (2010/05) © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD