ELC-12-2278 Inspection Worksheet
Miami Shores Village
10050 N.E.2nd Avenue Miami Shores, FL °" (� L
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-199015 Permit Number: ELC-12-12-2278
Scheduled Inspection Date: September 16,2013 Permit Type: Electrical -Commercial
Inspector: Devaney, Michael
Inspection Type: Final
Owner: , Work Classification: Addition/Alteration
Job Address:160 NE 99 Street
Miami Shores, FL 33138- Phone Number (305)864-8885
Parcel Number 1132060132250
Project: <NONE>
Contractor: SOS ELECTRICAL CONTRACTOR INC Phone: (305)226-8400
Building Department Comments
INSTALL 2 POLES IN.PARKING SITE AND FREE Infractio Passed Comments
STANDING SERVICE INSPECTOR COMMENTS False
Inspector Comments
Passed [Er
Failed E:1
Correction /'' ✓�
Needed
Re-Inspection ❑
Fee
No Additional Inspections can be scheduled until
re-inspection fee is paid.
September 13,2013 For Inspections please call: (305)762-4949 Page 28 of 38
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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
FBC 20
BUILDING Permit No.vkcI &_,�
PERMIT APPLICATION Master Permit No. 19-- 2®q'-
Permit Type:Electrical
JOB ADDRESS: 1 Loo N E 99 +[-1 st r C`ee4
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: l ! - 3a®(0 - Ps C--)
Is the Building Historically Designated:Yes NO Flood Zone:
OWNER:Name(Fee Simple Titleholder): Miami Shores 0-en i-er, L L-C Phone#(305) '86 L4 2 9 S
Address: P)Q 71 S' e4 SS U'4(' 309
City: M i A ni i g eos G h State: E l p r e)Q. Zip: 3
Tenant/Lessee Name: Phone#:
Email: ``
CONTRACTOR:Company Name: �l CA • Q4 'i S Phone#:
Address: AA6Q D S S lJd.� �� CA
1`�'`
City: tCx (V_ l State: L Zip: a b S
Qualifier Name Q-a c k S GflS C^ Phone#•
State Certification or Registration#: > ?2®® 3®2 0 Certificate of Competency#.
Contact Phone#: 1 &r 3bl''114 3 Email Address: S6
DESIGNER:Architect/Engineer: Phone#:
Value of Work for this Permit:$ C s D D• D D Square/Linear Footage of Work:
Type of Work: ❑Address DA`lteration '$NNew ORepair/Replace ❑Demolition
Description of Work: 19 0..e S y'ice U W 15%
Submittal Fee Permit Fee$ -j0L4__1 CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Bond$
Notary$ Training/Education Fee$ Technology Fee$
Double Fee$ Structural Review$
TOTAL FEE NOW DUE$_W •
Na
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$2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days er the building permit is issued. In th of such posted notice, the
inspection will not be approved and a reinspection fee ill be charged.
Signature Signature VV X0
Owner or Agent ontracto
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
day of V ,20 Z,by , e� CZ day of N NOV ,20 t 2,by
who is personally known to me or who has p oduced who i ersonally kno o me or who has produced
As identification and who did take an oath. as identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: f Sign:
I Z,Print: �/ 144z® ®l4 in Print: 0r(ec,
My Commission Expires:' My s• n Ex
DITH TORRES
,.�,K�►„o•, ORIT MIMOUN �...
Commission#DD 946825 '� Mg(6;OMMISSION#DD983139
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APPROVED BY ' %Zs2kxaminer Zoning
Structural Review Clerk
(Revised 3/12/2012)(Revised 07/10/07)(Revised 06110/2009)(Revised 3/15/09)
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THIS IS NOT A-84 DO idQT PAY
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SOS ELEC - 3 2 BUSINESS NAME TLOCATON REcilin 43663
0 RICAL. STAT :EC130-.0302
3005 SW 99 CT'
33165 UNIN DADS,C(IUN�If
OWNER. I
SOS ELECTRICAL CONTRACTOR INC
Sec.T of Business. WORKER/$;
19 ELECTRICAL NTRACTOR 20
8 IS ONLY A LOCAL.
NNESS TAX RECEIPT.IT
!a r NOT'PERM T THE
XER TO RPM REQULA�TORY OR
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LAWS' OF'THE DO IYO`r FORWARD ..
Im OR CITIES: NOR
IS IT EXEMPT THE €
.DER FROAA ANY OTHER .
RdIT OR LICENSg
CW„ .TM OF SOS .ELECTRICAL CONTRACTOR INC
as.°LDom CARLOS.A SOSA QUALIFIER
3005' SW 99 CT
m�la�1r�pRHECEIY m, MIAMI FL 33165
1WECTOR:OTYTAx
09/04/2012 �� it ll 1 X11 111 ! 1i l I ! }
09010057001 �I. Itt :rat E >>I thli f }I'll sa s rtlr I raI
000125.00 107
SEE OTHER SIDE
.a
CERTIFICATE OF LIABILITY INSURANCE DATE, -
a
I 17112
THMs4 CERTIFICATE IS ISSUED As A MATTER OF(#iFdttlliAnot ONL*Ad CONFERS No RIGMTE!IRON TIME CERT{FICKT— N6L EP-THFS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND.EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLIM
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT WTVIIEEN THEt9SUING INSURER(S),AUMORMED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER,
NPORTANT: Ft the? holder Ii an ADDITIONAL INSURED.tha __ _ ____ _._
�ttcy{teal matat��ru�nnsee. sr StIBROQA'17CIH IS wtA#ttdbD,subject bo
the temis and ear ditlm of tho poky,eertw polies MY require an erdoraement. A sUlarrmn on this wmkaw dM rW comer Vft tD#w -
cexfofltatr holder in Ileti of such ano). _.-- Ai;T
---
- _
10260 S Quality Assura+tce ►� 1306)273.3377 13051273-7339
10250 S,W.56 Street Ste D-102 e�S�gtsku'!n
Miami,FL 33185 61 COVERASFE NIA a
Phone {305}273-3377 Fax (306)273.7339 wawa. G _ Co
GMURED
S.O.SEtEelrisai Contractors Inc C„
3005 SW 99th Court p
Miami,FL 3310 305
COVERAGES CERTIFICATE NUbtSER. p�
REVISION til,tl�IIBER.
TH 1"it CEix*y TH T THE P66CIES AF WSWRAN&LISTED iELOW HAVE BEEN ISSUED T6 THE OJCPjRED NAME6ASOVE pjR THE PL1 'Ir pf*lpb
INDICAT€D. NOfiV1RTHSTANDING ANY REQ TERM OR CONDITION OF ANY CONTRI C OR OTHER t?OCUIy9ENT LV11Ii R SRECT TO H TNiS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,TIME INSURANCE Af:FORQED BY THE POLICIES QESCRIBEO HEREIN IS SUBJEG°TP!ALL THE fE[tl+hT
EXCLUSIONS AND C.QNDITIONS OF SUCH POLICIES LIMITS_SNMVN VAY HAVE SEEN REDUCED BY PAIO CL41 .
_, r ;: .. PaI 1�t NIILtBER Ultri`+3
TYPE CIF CE
Cf€1!IEWW.ttA�ldtY d _ .„
EAC�4 C CUR EIS S._1(=OW 00
-:
!✓ GRbW.lER&tsUl GENERAL LIABILITY
1/' dECCUR
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A 0185FL /110113012 11/0112013 � FJ�1 .rRn I �$,tI40�
I oE"A s s-3V INJURY 5 1,000.000.00
—_
0600M AGE gEGATE 3 2,000,000.00
GEML AGGREGATE LWpA APPLIES PER f; +acs Ar a__Z000.000.00
POLICY� -'lOC
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- -
`AtTtORtCBI.E LIABILITY a>�O�thE 1>�AYT
AAI1f AL9TO 8�3DILY U�tlUfi'^' ). ffi '
t
2MDNR�A SCHED4ULED
AL6 O ii BODILY IN1UR�(PW S=AwdI E..
WRED AUTOS AUTOS M�D
YIMBRELLALIAB OCCUR
9ACH OCCUIV EME 3
EI GE$S LUlB TENtIDH_CLAVASMAM AGGREGATE 5
v
AND U4eA9tY YIN
ANY PAT BOR EXCL �Mr GIRNE NIA' —EL EACH ACC[IM 5
r DES!<"iBUPTI ,OF OPEPAT -
�- . _ -�---- ' DISEASE-'tILICYLUtIT. 8
D OF C3pERA1"[DfJ816CCATICtli9p P VE :LES(AdWh 0=110 90, Ram .its eEpaee is_ �
P
6
CERTIFICATE HOLDER
— J CANCt1LATI6N
SHOULD ANY OF THE ABO"DESCFUM POLICIES1 BE CANCELI"SEFORE #
Miami Shores Yftp THE tDt MTION DATE THEREOF,NOTICE Val.BE DELPIERM IH
Sul Department ACCORDAWR WITH THE POLICY PROVISIONS.
10050 NE 2nd Avenue ---. _. -- -- _ i
— -
Au $UWFMWffATM
Miami Short FL 33138
YLLS_. _. I 2010 ACORD CORPORATION. All dghts
ACORD 26(20101"QF The ACORD nww and logo ate reghdmvd marks of ACORD
A CERTIFICATE OF LIABILITY INSURANCE DA7(MWDDNYM
11/OS/201201
2
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:
AMERICAN QUALITY ASSURAN PHONE FAX
10250 SW 56TH ST D-102 AIC,No,Ext: [AIC,No):
E-MAIL
ADDRESS:
MIAMI FL 33165
INSURER(S)AFFORDING COVERAGE NAIC#
76FNR
INSURER A:FLORIDA W.C. JUA
INSURED INSURER B:
S.O.S. ELECTRICAL CONTRACTORS INSURERC:
INC
INSURER D:
3005 SW 99TH COURT
MIAMI FL 33165 INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER: 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 ADDL SUBR POLICY EFF POLICY EXP
LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER MM/DONYYY MMIDD/YYYY LIMITS
GENERAL LIABILITY EACH OCCURRENCE $
DAMAGE TO RENTED
COMMERCIAL GENERAL LIABILITY PREMISES occurrence $
CLAIMS-MADE 1:1 OCCUR MED EXP An one person) $
PERSONAL&ADV INJURY $
GENERAL AGGREGATE $
MPOLICYr L AGGREGATE LIMIT APPLIES PER: PRODUCTS—COMP/OP AGG
PROJECT LOC $
COMBINED SINGLE LIMIT
AUTOMOBILE LIABILITY
accident) $
ANY AUTO J&6RULED
BODILY INJURY(Per rson $
ALL OWNED NON-OWNED BODILY INJURY(Per accident) $
AUTOS AUTOS PROPERTY DAMAGE
HIRED AUTOS (Per acciden $
UMBRELLA LIAB OCCUR EACH OCCURRENCE $
EXCESS LIAB CLAIMS-MADE AGGREGATE $
IDEDI IRETENTION $ WC A WORKERS COMPENSATION TO RY LIMIT Y LIMIT S OTH-
AND EMPLOYERS'LIABILITY (6FR 13UB-2845C 1 1-9-12) 10-29-12 10-29-13 X TO ER
ANY PROPRIETOR/PARTNER/EXECUTIVE 100,000
OFFICERIMEMBER EXCLUDED? Y/N EL EACH EACH ACCIDENT $
(Mandatory In NH) Y WA E.L.DISEASE—EA EMPLOYEE$ 100+000
If yes,describe under
DESCRIPTION OF OPERATIONS below E.L.DISEASE—POLICY LIMIT $ 500,000
DESCRIPTION OF OPERATIONSILOCATIONSVEHICLES(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 THEREFO,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE
MIAMI SHORES VILLAGE POLICY PROVISIONS.
BUILDING DEPARTMENT AUTHORIZED REPRESENTATIVE
10050 NE 2ND AVE 6LA�
MIAMI SHORES FL 33138
01988-2010 ACORD CORPORATION.All rights reserved.
ACORD 26(2010/05) The ACORD name and logo are registered marks of ACORD
q FLORNWORKERS'CWFF MON
JOWF LRmERBMOMC ASSOCIATION,WC.
FWCJUA
P.O. BOX 3556
ORLANDO FL 32802-3556
MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
10050 NE 2ND AVE
MIAMI SHORES FL 33138
m—
o�
o�
oC'
ACORD
CERTIFICATE
OF
INSURANCE
(On Reverse)
009855
Electrical Contractors, Inc.
State Certified Electrical Contractors - EC 13003020
3005 SW 99 Ct Miami, FL 33165
Tel: (305)226-8400 Fax: (305)226-0040
Soselectricl aOaol.com
Estimate
Date Estimate# Plan Page Dated
Oct-23-2012 20121030 E-1,A-SP202 7/24/12
A-SP202 1 8/28/2012
Contractor/ Owner Project Name/Address
Elysee Investments
Attn: Orit Mimoun Miami Shore Parking
210 71th Street, Suite 309 160 NE 99 St
Miami Beach, FL 33141 Miami, FI 33138
O: 305.864.8885
Email:oritO-elyseeinc.com
Item # Description Amount
1 All electrical installation shown in plans in pages shown above
2 Install Two lights Fixtures. Two concrete Poles 32'
3 Electrical Service, 14' Concrete Pale and up to 50' to FPL
4 Permit
5
6
7 Total Labor $ 2,416.18
8 Total Electrical Materials $ 1,967.88
9 Gear( Meter, Dist. Panel, Timer, Photocell, etc) $ 216.52
10 Two Lights Fixtures, 2 Concrete Poles 32' and one 14', delivery: $ 3,309.08
11 Direct Job expenses ( Backhoe, Permit, Crane ) $ 2,120.00
12 Total Bid Price $ 10,029.66
Not Cut, Patch concrete and/or asphalt
Included Garbage removal, Patch and Paint
This Estimate can be change after plans approval by the City
Accepted by: A, Date: '' °) TOTAL $ 10
Estimate valid for 90 dayff 7f _j
F �ees.E'Y` i '�s fit' Vi,rri r SPs °i}a Cornfirac r.