ELC-14-21691
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 206668
Scheduled Inspection Date: February 11, 2014
Inspector: Devaney, Michael
Owner: EDELMAN, ALEX
Job Address: 9999 NE 2 Avenue
Miami Shores, FL 33138-
Project: <NONE>
Contractor:
B&I ELECTRICAL CONSTRACTORS
Buuamg Department comments
LOW VOLTAGE SUITE #119
Permit Number: ELC -2 -14 -216
Permit Type: Electrical - Commercial
Inspection Type: Final
Work Classification: Addition /Alteration
Phone Number O_-
Parcel Number 1132060134490
INSPECTOR COMMENTS False
Inspector Comments
Passed UNIT 119
Failed
Correction ❑
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Phone: (305)266 -5686
February 10, 2014 For Inspections please call: (305)762-0949 Page 18 of 37
C�
Brat AM Miami Shores Village
« Z-6 A Building Department
90050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fag: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949
BUILDING
PERMIT APPLICATION
Permit Type: Electrical
JOB ADDRESS: 9999 NE 2nd Avenue Suite 119
FBC 20
Permit No.
FE13 0 5 201
Master Permit No.. e!
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#:
Is the Building Historically Designated: Yes i NO Flood Zone:
OWNER: Name (Fee Simple Titleholder): 6 0 r�f� Li ce Y-O� Phone#: ��S �� D ^
Address: '"19 ! 9 ICS l.. Z. �_ 4&u; -f-e (((R G�
City: Lk t a- 0. I�T`�y ne s - IState: _ L Zip: 3 3 l �1
Tenant/L.essee Name: F LD � c r 41x.1 C1 S Phone#:
Email: :1"(0 C0 P 4
CONTRACTOR: Company Name: B. & 1. Electrical Contractors, Inc. phone#. 305 266 5686
Address: 9222 SW 136 Terrace
city: Miami
Florida
33176
Qualifier Name: Brian A. Marshall Phone#: 305 607 2419
State Certification or Registration #: ECO000926 Certificate of Competency #:
Contact Phone#: 305 206 5686 Email Address: info@globalgreensavings.com
DESIGNER: Architect/Engineer: Phone#:
Value of Work for this Permit: $ e_-o 6 C-�, 0 Square/Linear Footage of Work:
Type of Work: DAddress DAlteration DNew DRepair/Replace ®� OLIDemolirion
Description of Work: ON4 ° 0 -T Q
Submittal Fee
Scanning Fee $
Permit Fee $� _ CCF $ CO /CC $
Radon Fee $
DBPR $ Bond $
Notary $ Training/Education Fee $ Technology Fee $
Double Fee $ Structural Review $
TOTAL FEE NOW DUE $ . y
Bonding Company's Name (if applicable)
Bonding Company's Address
City
State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City
State
zip
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 t copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose properly is s ect to 11, hment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspecti n whit occurs seven (7) days after the building permit is issued In the absence of such posted notice, the
inspection will not b ov 'and a reinspection fee will be charged. Q
caner or Agent
The foregoing ins nt was acknowledged before me this Y
day of -e % , 2 1 , by �U t D 1- kax'ki y`I2rL
�vho is onally known to or who has produced
As identification and who did take an oath.
NOTARY PUBLIC:
Sign: r
Print: �
My Commission Expires: Nowy Pubft 3e of fwwa
DMy EE057531
ri Expkes 0403=16
gn
d Contractor
The foregoing instrument was acknowledged before me this
day of 20 f t{, by—t73?114V\ f- 6r'44C
who is personally known to me or who has produced
APPROVED BY If Plans Examiner
Structural Review
(Revised 3 /12/2012)(Revised 07 /10/07)(Revised 06/10/l009)(Revised 3/15/09)
identification and who did take an oath.
NOTARY PUBLIC:
Sign: C
Print- Se
My Commission 1.0 " Nory Pub Stab of Florida
Be1sI► D Peres
My Canmi W= EE057531
m add' Exphes X015
zoning
Clerk
t
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. X COPY OF QUALIFIER'S STATE LIC CARD
B. X COPY OF LOCAL BUSINESS TAX RECEIPT
C. _COPY OF LIABILITY INSURANCE (CERTIFICATE HOLDER TO BE MIAMI SHORES VILLAGE BLDG DEPT)
D. X COPY OF WORKERS COMPENSATION (EITHER CERTIFICATE OR EXEMPTION)
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 (EITHER CERTIFICATE OR EXEMPTION)
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: B. $ 1. Electrical Contractors, Inc.
BUSINESS ADDRESS: 9222 SW 136 Terrace CITY Miami
STATE Florida ZIP CODE 33176
BUSINESS PHONE: (-LO—S) 266 -5686 FAX NUMBER 3( O5 1 251 -3690
CELL PHONE ( 3Q5) 607,2419 QUALIFIER'S NAME:
QUALIFIER'S LIC NUMBER:
EC0000926
Brian A. Marshall
E -MAIL ADDRESS (IF APPLICABLE): Info"lobalgreensavings.com
Created on 3h9109 BY MLOV 1 RV 326/09 MLOV
receipt
Florida
[LBT-0
K
JEFF ATWATER
CHIEF FINANCIAL OFFICER STATE OF FLORIDA
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: 4/14/2013 EXPIRATION DATE: 4/14/2015
PERSON: MARSHALL BRIAN A
FEIN: 591797033
BUSINESS NAME AND ADDRESS:
B & 1 ELECTRICAL CONTRACT
4250 SW 73RD AVENUE
MIAMI FL 33155
q-i- *I�7�1 «3I�1 3�I 1;7_lT
ELECTRICAL WIRING
WITHIN BUIL
Pursuant to Chapter 440.05(14), F.S., an offloar of a corporation who elects exemption from this chapter by Mg 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 Punuad to Chapter 440.05(13), F.S., Notices of election to be exempt and certtticstes of
election to be exempt shall be subjeot to revocation If, at any time after the filing of the notice or the issuance of the cm0fa te, the person named on the notice or
certificate no longer meats the requtremenis of this section for Issuance of a certithWe. The department shall revoke a certificate at any time for fallure of the
person named on the certificate to meet the requirements of this section.
DFS- F2- DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 07 -12 QUESTIONS? (850)4131809
CERTIFICATE OF LIABILITY INSURANCE
04119!13
THIS CERTIFICATE 18 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.
111W TANT: lithe cor ilicets holler ban ADDITIONAL INSURED, #w IofYSes) must be andomed. 8 SUBROGATION IS WAIVED, subject to
the term and condltlm of the poky, cefte polictes may reyuke an andommeft A abatement on this cm6licats does not confer rights to the
amMoaa holder In 8su of such sndoraemerd(s).
PRODUCER Meet L Diaz
D4cwmy Fn6: InsuTa m Agency Mr E Ea 305 718.8919 (306) 718 -3584
10733 N.W. 58th SVeet
Apmemp
nwam9ftcoft ins com
M19M. FL 33178 MUMM)AFFORMIGCOVEItAft wAscs
Phi 718.8919 Fax 305 718 -3584 WIRI RA: NOVA CASUALTY COMPANY
RLBURED
B. & I. ELECTRICAL CONTRACTOR, INC. c
9222 S.W. 138 TERRACE INSURERD:
MIAMI, FL 33176 305
P:
COVERAM CERTIFICATE KINSER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLIES OF INSURANCE LISTED BELOW HAVE SEEN 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 MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN 5 SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LUTS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS,
TYPE OF 91SURANCE
Ilm AM
POUCV LIt11TS
GENERAL LABILITY EACH OCCURMCE s 500.000.00
® COMMERCIAL GPf RAL LIABB PTY Eg s 100,000.G1
❑ ❑ CW M A WE ® OCCUR mw mw � 5,000.E
A I.00 P.D. DEDUCTIBLE N 013 05/06/8014
PERSONAL & AnV euURY a 500,000.00
❑ GENERALAC+GREGATE a 1000,000.00
GENLAGGREGATE LIMMAPPLES PER; PRODUC111- 00100PAGO a 1,000,000.00
❑ POLGCY ❑ JFM ❑ LOC a
AUTOMOBILE UABLLCTY QdED
DESMPTM OF OPM7TONB I LOCATTONB i VE *MM (AI{eah ACORD 401, AdaHBortal R9marks Sa►ladute, B came to requ6ed)
ELECTRICAL CONTRACTORS
CERTIFICATE HOLDER
MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
10050 NE 2ND AVENUE
MIAMI SHORES, FL 33138
FAX IN: 303-768 -8972
ACORD 20 (201008) OF
of
01OW2010 ACORD CORPORATION. AN rIghbs reserved.
The ACORD name and RW are nqosbmW meet of ACORD