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EL-13-1528 Miami Shores Village Building Department o F 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel:(305)795.2204 Fax:(305)756.8972 INSPECTION'S PHONE NUMBER:(305)762.4949 FBC 20 13 I BUILDING Permit No. PERMIT APPLICATION Master Permit No RC-4-13-895 Permit Type:Electrical JOB ADDRESS: 467 NE 100th Street City: Miami Shores County: Miami Dade Zip. 33138 Folio/Parcel#: Parcel# 1132060170530 Is the Building Historically Designated:Yes NO X Flood Zone: OWNER:Name(Fee Simple Titleholder):Eugene L. Daley phone#.305-758-8118 Address;467 NE 100th Street City: Miami Shores State. FL yip. 33138 Tenant/Lessee Name: phone#:305-758-8118 Email: gene_daley@hgtmail.com CONTRACTOR:Company Name: 6"q Vk,q[, Phone#: D 5 ° b, Address V - // City: State: `�1. Zip: Qualifier Name Phone#• State Certification or Registration#: Certificate of Competency#: Ct 00 Contact Phone#:-�E)Y - 9� k 9 Email Address: DESIGNER:Architect/Engineer: Robert Gallagher phone#.: 305-987-3300 Value of Work for this Permit:$300.00 Square/Linear Footage of Work: Type of Work: OAddress Alteration ❑New ❑Repair/Replace ODemolition Description of Work.. Add four(4)electrical outlets-two inside"AN Storage Room"and two outside of"AN Storage Room" all within six(6)feet of newly created doorway(per Miami Shores Electrical Inspector)of two 24"pocket doors(see drawings) Submittal Fee$ Permit Fee$ CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Bond$ Notary$ Training/Education Fee$ TechnoIogy Fee$ Double Fee$ Structural Review$ TOTAL FEE NOW DUE$ BeAding 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 which occurs seven (7) days after the building permit is issued In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged Signature Signature Sk 4t-or-� m Agent i Contractor oc,, The foregoing instrument was acknowledged before me this The fore ,goingAnstrument was acknowledg befor me this day of `SV14 ,20 13,by&Q6,n.ra Lbu S -J a1�¢T_ day of 20 ,by 5, � who is personally known tome or who has produced X. Rc„cb- who is known me or who has produced D4 0o,1,2-6 K-1 U-OAs identification and who did take an oath. as identification and who did take an oath. NOTARY PUBLIC: NOT RY PUB C: WENDY SANDOVAL Commission#EE 68802 zt e My Commission Expires Si NANCYMEi�AlAtli>£Z Sip: Sip:gn: .� Print - Ndwy Puff-6tata of fiorlda UW COMM-Expim Noy IS 9014 Print: ' Commission#EE 42670 My Commission Expires: ,Za1S My Commission ,M •'` Bonded Through National Notary Assn. APPROVED BY J`G/�Y Plans Examiner Zoning Structural Review Clerk (Revised 3/12/2012)(Revised(Y7/10/07)(Revised 06110=M)(Revised 3115/09) Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-194873 Permit Number: EL-7-13-1528 Scheduled Inspection Date: October 11, 2013 Permit Type: Electrical - Residential Inspector: Devaney, Michael Inspection Type: Final Owner: DALEY, EUGENE Work Classification: Addition/Alteration Job Address:467 NE 100 Street Miami Shores, FL 33138-2446 Phone Number Parcel Number 1132060170530 Project: <NONE> Contractor: CARLY ELECTRICAL SERVICE Phone: 305-970-6345 Building Department Comments ADD 4 ELECTRICAL OUTLETS, TWO SIDE A/V STORAGE Infractio Passed Comments ROOM ALL WITHIN 6' NEWLY CREATED DOOR WAY INSPECTOR COMMENTS False AND TWO 24" POCKET DOORS Inspector Comments Passed I I AFTERNOON N Failed Correction Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. October 11,2013 For Inspections please call: (305)762-4949 Page 5 of 26 .'- on Traces ,CTQB BUSINESS CERTIFICATE OF COMPETENCY }{=I: CAMY ELECTRICAL SERVIM W D.i7A.. HER ARLOS 0001 ELECTRICAL Cl�ute9 P.E. ( dx J - Y ofMe Bond -" WaM1` cwudy t a+aAmtfl 1 TfW commm-m is ISSUED AS A MATMR OF INFORNIATION ONLY AND CONFERS NO ROM UPON THE CERTWATE HOLDER.THIS ClOtTMATE DOES NOT .,--cr+.- EL. OR NEGATIVELY A,,;N...D EXTEND OR ALTER THE COVERAGE, r •'"(DW BY THE POLICIES t-a REPREWMATIVE OR PRODUCER,AND THE CERTMATE HOLDER. ,^ 1 A. .,,.. , .. •.. , a. a .. Is .i. AM INSURANCE :R 4l t i SW Ave 680 ITAGma BLVD m M • FL 33144 # i ,.•. ;;�^ itli#,l,Mlltf Lc',.:i�.ra r•i ®® Al ti:E - -nc:^. t.� i..a' '�a' ■'..i4 r:z•fE •.•;.=a'1•::7,`c.'rl�.i 1 1 R t t. , - • af no l7l r ryraM[liija•. •� s'.-: • �. t-..�.-.,,. l��#lr.:w- :• ;.•;t'si'�/ / i t t 1 C MlMa 813ORW VILLA= SHOULD ANY OF .. 1.t 1.v 10050 10 2ND AVE ACCORDANCE WITH THE POLICY PROVISIONS. .M M SHOMS 1 • IA p0/y ADE L6/UN ■ 2 LOCAL BUSINESS TAX p RECEIPT FLORIDA 2013 FIRST-CLASS A / TAX CO ADE -STATE OF F U.S.POSTAGE AGE 1 140 W.FLAGiLER ST. EKPIRES SEPT.30,2013 PAID 1st FLOOR MW BE DELAYED AT PLACE OF BUSINESS MIM,FL ,FL 33130 PURSUANT TO COUNTY CODE CHAPTER$A-ART.9&10 PERMIT NO,231 THIS IS NOT A SILL—DO NOT PAY 7 -1 RENEWAL BUSINESS AJLOCATION RECEIPT 436679-5 , CARLY ELECTRICAL SERVICE INC CC # 99ED00310 680 FLAGAMI BLVD 33144 MIAMI OWNER CARLY ELECTRICAL SERVICE INC Sec.Type of aw WORKER/S IHIS I MAA F, ,CTRICAL CONTRACTOR 2 MISINESS TAX Of f;IT DOES NOT Pmuff THE HOLDER TO VIOLATE ANY OUSTIM XD ELAN OTP THE DO NOT FORWARD COUNTY OR CITIES. NOTE DOES ET APT TEES AM OTHER HOUM pum "FOR LUMNSE CARLY ELECTRICAL SERVICE INC E�A CSW ca a CARLOS A HERNANDEZ PRES M HOLDS"OUALAWA• 680 FLAGAMI BLVD MIAMI FL 33144 PAYMM RECEIVED 1RANWMDSCOW=TAX COLLECTOM 07/13/2012 02210013002 t 1111 ill,lW iE j u n 11111 000045.00 46 E SEE OTHER SIDE E LVANI-DADIECOUNTY 2012 MUNICIIIAL CONTRACTCWS 2013 FIRST-CLASS, TALC COLLECTOR 'SAX RECEIPT U.S.POSTAGE ' 1440 W.FLA ST. AOE °ST�iTE UP l�l. A PAID FLOOR FLii�. PUF[Bt1ANI'T4COUN l't_'•ODESEC 1Q-24 :' FL R4UWA E#PIRE3 SEPT.3D.2D13 P N®.231 T HI6Z IS'NOT F.BILL--D13 I!:i F.`.`t RECEIPTNO. * 30°4366795 CC NO: 99E000310 — BUSINESS NAME/LOCKnON RECEIPT HOLDER MAY DO BUSINESS AS A CONTRACTOR CARLY ELECTRICAL SERVICE INC AS SPECIFIED HEREON. 680 FLAGAMI BLVD OWNER :CARLY ELECTRICAL SERVICE INC SEE BACK OF RECEIPT FOR ELECTRICAL CONTRACTOR A LIST OF NON-PARTICIPATING MUNICIPALITIES Receipt hoiden must DO NOT FORWARD register tn itiedw CARLY ELECTRICAL SERVICE INC w"m�"'k�to� CARLOS A HERNANDEZ PRES °'° 680 FLAGAMI BLVD MIAMI FL 33144 PAYMEW RMSVE D M AIAaAOE CDC TAX C°1gM13/2012 02210013001 ppj ?? ytyy tt !Ill £{ } {{ yp j{ { i 000200.00 ilJhf1$11iflihil I!Illlh Ill 111111fill ifliffEEE�ffh;,11al S 2i 3 'ami Shores Village �� C.;FE, vtz< � Building Department 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 ®-m____.e_ Tel:(305)795.2204 Fax:(305)756.8972 INSPECTION'S PHONE NUMBER:(305)762.4949 FBC BUILDING Permit No. CI 0 I PERMIT APPLICATION Master Permit No. Permit Type. BUILDIN ROOFING JOB ADDRESS: 4q � �� /00 77-"' S.71��7— City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated:Yes NO Flood Zone: OWNER:Name(Fee Simple Titleholder): E U 60V 97 L Phone#: Address: q(0 N C 1 06 " 57,-Fg-� ' City: State: 1:l Zip: Tenant/Lessee Name: Phone#: 3 oC, 7.ST 9 S 1117 Email: !21 e-f) A®"f L 1601-1 l , Cd)q ' CONTRACTOR:Company Name:.. T � [-F Phone#: ��21&m�� Address: 9 7 � -1 ° City: w State: E� Zip: n , Qualifier Name: 1 lam°1/ Ci D Phone#: -7 q q Sd State Certification or Registration ®�J J ' Certificate of ompetency#: r Contact Phone#: g ��®� Email Address: ('a Q' A �C C J-7 CA v DESIGNER:Architect/Engineer: '96 I 6AU-N Phone#: -3®,5-9 g / - -33W Value of Work for this Permit:$ 1.000_00 Sgnare/Linear Footage of Work: 19 Udghe Type of Work: DAddition Iteration ONew ORepair/Replace ODemolition Description of Work: 'V/L C-4 M V EQvIem k> u c . 'D06 AS Color thru tile: Submittal Fee$ Permit Fee$ CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Bond$ Notary$ Training/Education Fee$ Technology Fee$ Double Fee$ Structural Review$ TOTAL FEE NOW DUE$ Bonding Company's Name(if applicable) f Bonding Company's Address City State Zip Mortgage Lender's Name(if applicable) L 1 't7�I�i - .�AA)I`'� Mortgage Lender's Address City � State 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 which occurs seven (7) days after the building permit is iAuAl. IA the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged Signa Signature Owner or Agent U Contractor The foregoing instrument was acknowledged before me this I q The foregoing instrument was acknowledged before me this day of At&L ,20 jam,by &JG&NL L.ou is LA LEY day of ,20-L�by_ �r l�n. Aowll e , who is personally known tome or who has,produced laRivE'ti's who is personally known to me or who has produced Ll CXA)SS As identification and wh as identification and who did take an oath. NOTARY PUBLIC: �Stsy°°B�, JOSEPH L ANDRE NOTARY PUBLIC: MY COMMISSION#DD910s24 �ra EXPIRES:sept6,2013 c 1' � & AUCIADOMINGUEZ Sign (4M 39 153 Florida Notary Sery--M Sign. �; MY ON#FF 006818 gn: XPIRE ne 8 20 7 ,.• n ubpcUnderadters Print: --roSEPi4f L b Print: c My Commission Expires: My Commission Expires: &W-)017 -)017 APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised 3/12/2012)(Revised 07/10/07)(Revised 06110n")(Revised 3/15/09) Ac&V CERTIFICATE OF LIABILITY INSURANCE DATE(MM/)DNYYY) 4/18/2013 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 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 CONTACT NAME: Jon Rock The Contractors Choice Agency PHONE (800)918-3584 FAX A/C N :(877)684-9951 PO Box 13645 AQ RE, Jon @nginsuranceonline.com INSURERS AFFORDING COVERAGE NAIC# Chandler AZ 85248 INSURERA:Nat'l Contractors Insurance 12293 INSURED INSURER B H&H International Development Group Inc. INSURER C: 9747 SW 92nd Terrace INSURER D: INSURER E: Miami FL 33176 INSURER F: COVERAGES CERTIFICATE NUMBER:CL113911427 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 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LTR POLICY NUMBER M MM1DD LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Ea occurrence $ 50,000 A CLAIMS-MADE OCCUR LF000013346-03 /9/2013 /9/2014 MEDEXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 1,000,000 X POLICY PRO LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED F 1 SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE HIRED AUTOS H AUTOS Per accident $$ _ - UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMS-MADE AGGREGATE $ - DED I I RETENTIONS $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N T I IT 1 FIR ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? ❑ N/A E.L.EACH ACCIDENT $ (Mandatory in NH) If yes,describe under E.L.DISEASE-EA EMPLOYE $ DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Building Department of ACCORDANCE WITH THE POLICY PROVISIONS. Miami Shores Village 10050 NE Second Ave. AUTHORIZED REPRESENTATIVE Miami, FL 33138 Robert Rock/JDA - ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025(201005).01 The ACORD name and logo are registered marks of ACORD P STATE OF FLORIDA A DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD 1940 NORTH MONROE STREET (850) 487-1395 TALLAHASSEE FL 32399-0783 HE& H RCIWERNATIONAL DEV GROUP INC 2100 SW 22 ST STE 403 MIAMI FL 33145 STATE jF FLORIDA AC# ? 'DEPARENT OF BUSINESS AND PROFSIONAL REGULATION CG C055834 08/OS/Q6 06803810 CERTIFIED GENERAL CONTRACTOR HENRIC:, .GILBERT H' & H `INTERNATIONAL DEV GROUP INC IS CERTIFIED under the Provisioae of Ch.489 FS. �miration date: AUG 31, 200$ aosasasosizs DETACH HERE STATE OF-FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION; CONSTRUCTION INDUSTRY LICENSING BOARD ` EtQ#r<0fi.080801126 LICENSE NBR 08� 08 -20.06 Q68023210 CGGCO55834 The GENERAL.-CONTRACTOR Named 'belOw IS CERTIFIED Under the provisions Of Chapter 489 FS. Expiration dates AUG 31,. 2008 HENRIC, GILBERT H & H INTERNATIONAL DEV GROUP INC 2100 SW 22 ST STE 403 2+IIAASI FL 33145 JEB` BUSH GOVERNOR SIMONE MARSTILLER LAW SECRETARY ♦5�OREs y ' ••• n...� Miami shores Village JZ W-IM Building Department LpRjpp► 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 RECEIPT /� 132q,PERMIT#• l.� DATE: ✓ / 3, (NAME) o Contractor XOwner o Architect Picked up 2 sets of plans and (other) a Address: 7 r From the building department on this date in order to have corrections done to plans And/or get County stamps. I understand that the plans need to be brought back to Miami Shores Village Building Department to continue permitting process. Acknowledged by: (Signature) PERMIT CLERK INITI RESUBMITTED DATE PERMIT CLERK INITIAL: Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-190229 Permit Number: RC-4-13-895 Scheduled Inspection Date: October 17, 2013 Permit Type: Residential Construction Inspector: Rodriguez,Jorge Inspection Type: Final Owner: DALEY, EUGENE Work Classification: Addition/Alteration Job Address:467 NE 100 Street Miami Shores, FL 33138-2446 Phone Number Parcel Number 1132060170530 Project: <NONE> Contractor: . H&H INTERNATIONAL DEVELOPMENT GROUP Phone: (786)229-9800 Building Department Comments BUILD TWO WALLS TO CREATE A 56"X 112"SPACE FOF Infractio Passed Comments COMPUTER, A/V EQUIPMENT WITH TWO 24" POCKET INSPECTOR COMMENTS False DOORS Inspector Comments Passed Failed Correction ❑ Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. October 16,2013 For Inspections please call: (305)762-4949 Page 4 of 27 S�. ES G Miami shores Village ` oR Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 xORIUp' Fax: (305) 756.8972 May 2, 2013 Permit No: RC13-895 Building Critique 1. Provide electrical and mechanical permits. Norman Bruhn CBO 305-762-4859 i I I Norman Bruhn CBO 305-762-4859 Plan review is not complete, when all items above are corrected, we will do a complete plan review. If any sheets are voided, remove them from the plans and replace with new revised sheets and include one set of voided sheets in the re-submittal drawings.