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EL-13-2466Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 206621 Scheduled Inspection Date: February 05, 2014 Inspector: Devaney, Michael Owner: PENDLETON, CAMILA & RYAN Job Address: 166 NE 93 Street Miami Shores, FL 33138- Project: <NONE> Contractor: ALL -STATE DATA & ELECTRICAL SERVICES comments INTERIOR REMODEL Permit Number: EL -10 -13 -2466 Permit Type: Electrical - Residential Inspection Type: Final Work Classification: Alteration Phone Number Parcel Number INSPECTOR COMMENTS False Inspector Comment Passed Failed L� < Correction ❑ Needed Re- Inspection ❑ Fee No Additional Inspections can be scheduled until re- inspection fee is paid 1132060133090 Phone: (954)804 -8054 February 04, 2014 For Inspections please call: (305)762 -4949 Page 46 of 47 Miami Shores Village Building Department 10050 NY-2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 7952204 Fay (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 BUILDING PERMIT APPLICATION Permit Type: Electrical "C 20 OCT 0 1 2013 Permit No. 6 1 { N 66 Master Permit RIL 2 Lql A 2qA. L JOB ADDRESS: 16 6 0 E q5 5�-r e C-� City: Miami Shores - county: Miami Dade Zip: Folio/Parcel#: 6 -013- Is the Iluilding Historically Designated: Yes NO �C Flood Zone: OWNER: Name (Fee Simple Titleholder): i? V A- N P -6 w D L x-70 pJ Phone*. j d Y- :'- � 7 City: Mom Tenant/Lessee Name. Email: ?-(-P EN D I, Gi i State: E L, Zip: 3311 b CONTRACTOR: Company Name: All -State Data & ElecMcal Services Phone#: 954- 8048054 Address: 5185 Rosen Blvd City: Boyton Beach State. fl Zip. 33472 Qualifier,Nam&. A.J. Randazzo 6 Phone#: State Certification or Registration t ECO002816 Certificate of Competency # Contact Phone#: Email Address: tony @myesde.com DESIGNER: Architect/Engineel: L /kmP O E GA-, Phone#: Value of Work for this Permit: Squarer Footage of Work: Type of Work UAd" � ; %Alietation ONew ORepair/Replace ODemolition Description of Work: ��eev�+a a�ee�s�ee�+ �g�ee�eweeeeaee *+a�seeeesse�saee�sa�aeee� SubmUW Fee $ M110 Permit Fee $ CCF $ CO /CC $ Scanaing Fee $ Radon Fee $ DBPR $ _Bond $ Notary $, TrainingWAwation Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ A I • L 0 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 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�L Signature Owner or Agent � W L Contractor The foregoing instrument was acknowledged before me this day of , 20 i3 by , who is personally known to me or who has produced As identification `wo m1h,14d take an oath. NOTARYPUBLIC: .......... , Sign: 'rW"M My Commission Expires: S T PZ���` /f►ni1fillO� The foregoing instrument was acknowledged before me this day of 2. OC L,by RTR,*► d4st v who is personall Anown to me or who has produced NOTARY Sign: Print: r My Commission Expires: APPROVED BY Plans Examiner Structural Review (Revised 3 /12/2012)(Revised 07 /10 /07)(Rgvised 06110/2009)(Revised 3/15/09) Zoning Clerk Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax:.(305) 756.8972 CONTRACTORS' REGISTRATION FORM ALL CONTRACTORS MUST PROVIDE COPIES OF LICENCES AND INSURANCES EACH TIME A PERMIT IS SUBMITTED OR THE VILLAGE MAY MAINTAIN A FILE WITH YOUR INFORMATION FOR A $30.00 FEE PER YEAR. IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: A. COPY OF QUALIFIER'S STATE LIC CARD B. COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF LIABILITY INSURANCE (CERTIFICATE HOLDER TO BE MIAMI SHORES VILLAGE BLDG DEPT) D. COPY OF WORKERS COMPENSATION (EITHER CERTIFICATE OR EXCEMPTION) IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY: A. COPY OF CERTIFICE OF COMPETENCY OF QUALIFIER B. COPY OF MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT C. COPY OF LIABILITY INSURACE (CERTIFICATE HOLDER MUST BE MIAMI SHORES VILLAGE BLDG DEPT) D. COPY OF WORKER COMP INSURANCE YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE HOLDER AS FOLLOW: MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES, FL 33138 COMPLETE CONTRACTOR'S INFORMATION BUSINESS NAME: All -State Data & Electrical Service BUSINESS ADDRESS: 5185 Rosen Blvd. CITY Boyton Beach STATE FI ZIP CODE 33472 BUSINESS PHONE: 9( 54 1 8048054 CELL PHONE ( FAX NUMBER 5( 61 14312277 QUALIFIER'S NAME: A.J. Randazzo QUALIFIER'S LIC NUMBER: EC0002816 E -MAIL ADDRESS (IF APPLICABLE): tony @myasde.com Created on 3119109 BY MLDV I RV 3!26109 MLDV STATE OF FLORIDA DEPARTMENT OF BUSINESS ANA PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD (850) 487 -1395 eta TALLAHASSEEMONROE STRFLT32399 -0783 RANDAZZO, ANTHONY J ALL -STATE DATA & ELECTRICAL SERVICES 7503 SW 28 ST. DAVIS FL 33314 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. For inform ton about our services please ss og onto ewww.myflor dalicenseU om. There you can find more information about our divisions and the regulations that impact you. subscribe to department newsletters and Team 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! DETACH HERE STATE OF FLORIDA AC# 6 23061— 1 DEPARTMENT OF BUSZNESS AND ,;' PROFESSIONAL REGULATION EC0002816 WT/27/1.2 128019333 CERTIFIED ELECTRICAL OON'TRACTCR RANDAZZO, ANTOW ..!I P;L ALL -STATE DATA & EC`f'RICAL SERV IS CERTIFIED under the provisions of Ch.48`." FS exp:Tation date- AVG 31, 2014 L120727012f,v � r s- a •s e AC # 6230646 STATE OF FLORIDA DEPART LECTRICALSCOONN 'TTR.ACTORSRLICENSINGLBREGULATION ARD TIO SEW L12072701280 The ELECTRICAL CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 FS- Expiration date: AUG 31, 2014 RANDAZZO, ANTHONY J ALL -STATE DATA & ELECTRICAL SERVICES 6111 NW BROKEN SOUND PARKWAY #360 BOCA RATON FL RICK OVERNOR DISPLAY AS REQUIRED BY LAW KEN LAWSON SECRETARY �`� V CERTIFICATE OF LIABILITY INSURANCE F10/21/2013 DATE ( dAMlDD /YYYIO 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(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 endomement(s). PRODUCER Frank H. Furman, Inc. 1314 East Atlantic Blvd. P. 0. Box 1927 Pompano Beach FL 33061 CNAOMTE�CT Melba Loveless PHONE (854)943 -5050 o (954)942 -6310 L ESSAialba0furmaninsuraince. com INSURER(S) AFFORDING COVERAGE NAIC 0 INSURERA:Old Dominion Insurance Company 40231 INSURED Randazzo Consulting Group Inc, DBA: All State Data & Electrical Service 5185 Rosen Boulevard Boynton Beach FL 33314 INSURER B.Florida Citrus Bus & Ind Fund /6/2013 INSURER C: EACH OCCURRENCE INSURER D: AGE To RENTED REMI E a Ce INSURERE: MEDEXP(Any one person) 1 INSURER F: PERSONAL & ADV INJURY COVERAGES CERTIFICATE NUMBER:13 /14 GL WC 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 REDU CED BY PAID CLAIMS. LTRR TYPE OF INSURANCE POLICY NUMBER MMIDD EFF POLICY EXP LIMITS A GENERAL LIABILITY PCOM MERCIALGENERALLIABILITY CLAIMS -MADE OCCUR 1249H /6/2013 /6/2014 EACH OCCURRENCE $ 1,000,000 AGE To RENTED REMI E a Ce $ 100,000 MEDEXP(Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEML AGGREGATE LIMIT APPLIES PER X POLICY PRO LOC PRODUCTS- COMPIOPAGG $ 2,000,000 $ A AUTOMOBILE LIABILITY ANY AUTO SCHEDULED AUTOS AUTOS HIRED AUTOS X NON -OMED AUTOS G1249H /6/2013 /6/2014 Ea aoWd BINED SINGLE LIMIT 11000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per acddent) $ PROPERTY $ $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION$ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANFlCEOPPJETERREXCLUDE DSCUTNE (Mandatory In NH) If yes describe under DESNIPTION OF OPERATIONS below N/A 10651473 /31/2013 /31/2014 X 7 � STATU- OTH- E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EAEMPLOYE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional RemarkeSched de, If more space Is required) (305)756 -8972 Miami Shores Village Building Department 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 DeJong /KS r .- ACORD 25 (2010105) ©1988 -2010 ACORD CORPORATION. All rights reserved. IN9025 rgntnnsi ni Tha ACr1Rr1 name anri Inn^ an+ raninfarad marka of ARARr1 , ANNE M . % A N N O N P.O. Box 3353, West Palm Beach, FL 33402 -3353 "LOCATED AT" t. www.pbctax.com Tel: 561 355 -2264 �,� CONSTITUTIONAL TAX COLLECTOR � � 0 5185 ROSEN BLVD Serving Palm Reach County BOYNTON BEACH, FL 33472 -1275 Serving you. TYPE OF BUSINESS OWNER CERTIFICATION # I RECEIPT #/DATE PAID AMT PAID BILL # 23 -0169 ELECTRICAL CONTRACTOR RANDAZZO ANTHONY J EC 0002818 1 U13.689893-08/13113 $27.50 I 840210880 This document is valid only when receipted by the Tax Collector's Office. STATE OF FLORIDA PALM BEACH COUNTY 2013/2014 LOCAL BUSINESS TAX RECEIPT ALL STATE DATA & ELECTRICAL SERVICES LBTR Number: 201248634 RANDAZZO CONSULTING GROUP INC EXPIRES: SEPTEMBER 30, 2014 7503 SW 28TH ST DAVIE, FL 33314 This receipt grants the privilege of engaging in or managing any business profession or occupation within its jurisdiction and MUST be conspicuously displayed at the place of business and in such a manner as to be open to the view of the public.