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EL-14-1232Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 214797 Permit Number: EL -6 -14 -1232 cheduled Inspection Date: June 25, 2014 I spector: Devaney, Michael er: Job Address: 1550 NE 104 Street Miami Shores, FL 33138- Project: <NONE> Permit Type: Electrical - Residential Inspection Type: Final Work Classification: Service Change Phone Number (305)905 -6800 Parcel Number 1122320320380 Contractor: DELTA TECH ELECTRIC LLC Phone: (954)665 -9775 Building Department Comments ELECTRICAL SERVICE CHANGE Infractlo Passed Comments INSPECTOR COMMENTS False Passed Q Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments ,460 une 24, 2014 For Inspections please call: (305)762 -4949 Page 32 of 35 IVIIdl I it JI IUI C5 V IIId�C Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795 -2204 Fax: (305) 756 -8972 INSPECTION LINE PHONE NUMBER: (305) 762 -4949 j FBC 20/0 UILDING Master Permit No. EY /6/1/ -. ERMIT APPLICATION Sub Permit No. .1 BUILDING 0. ELECTRIC (l ROOFING ❑ REVISION ❑ EXTENSION 0RENEWAL PLUMBING ❑ MECHANICAL ID PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ICI SHOP CONTRACTOR I DRAWINGS B ADDRESS: 15<7 Al 10V si M' m" h.re Coun Miami Dade lio /Parcel #: 1 l " c9e9 3 ? C .r.9 A 0 3,O Is the Building Historically Designated: Yes _ _ NO 1.,--- ccupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: /� c� WNER: Name (Fee Simple Titleholder): " J 105 2- CL e, Phone#: 30) `30,7 !V goo o Address: is ?R I. ?� A-U P. NII! AL Sicre State: F-6. zip: Phone#: T nant/Lessee Name: E ail: 70 NTRACTOR: Company Name: 'i 6'1 v� l Phone#:2 -Gc& ddress: 8S3Cza /0/f1e09 /e- ;,efit.c,L 4 : ,g//'-'9i State: f Zip: 3- C)e) ? ualifler Name: ( 4 ► V I P � i / t Phone#: 2 0 C'1 7 4' t 2 ate Certification or Registration #: C 130 0'6' 2, t- Certificate of Competency #: ESIGNER: Architect /Engineer: CPg "di /.t /(' ' =- Phone#: / 5 Z 2 V-/ ddress: /6Y31 AI a 2 P 001" City: CV64 ' 4/- . State: / - Zip: alue of Work for this Permit: $ -2L' ®0 Square /Linear Footage of Work: ype of Work: ❑ Addition ❑ Alteration E3 New Q Repair /Replace ❑ Demolition ption of Work: t rlelA C!/ 5o"Z i 'de pecify color of color thru tile: bmittal Fee $ Permit Fee $ rJ ® iorze9 '' CCF $ CO /CC $ ning Fee $ Radon Fee $ DBPR $ Notary $ echnoiogy Fee $ Training/Education Fee $ Double Fee $ tructural Reviews $ Bond $ I I ct1) TOTAL FEE NOW DUE S nding Company's Name (if applicable) nding Company's Address C State Zip ortgage Lender's Name (if applicable) ortgage Lender's Address C 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 ELECTRIC, PLUMBING, SIGNS, POOLS, F RNACES, BOILERS, HEATERS, TANKS, AIR CONDITIONERS, ETC OER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all a placable laws regulating construction and zoning. " ARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY ESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING OUR NOTICE OF COMMENCEMENT." tice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must p omise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person hose property is subje to attachment Also, a certified copy of the recorded notice of commencement must be posted at the Job site r the first inspect n which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the i spection will no be appr ved and a reinspection fee will be charged. Signature Signature NER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this 1 12 day of 1 vov� , 20 /V , by ` I /1-- day of �° �� , 20 / , by V IAlf(3 C% A. (3 \ G \1�,MS , who i rs�nally kjn to V3,,t. ��f1o. ��((G ,vAclAe , who i ersonall n to me or who has produced as me or w�o has pfoClUceed as identification and who did take an oath. NOTARY PUBLIC: identification and who did take an oath. NOTARY PUBLIC: Sign: Print: TE OF FLORIDA Seal: ' " "a'•• Tatiana Elkayam Commission # EE088240 'aspires: APR. 26, 2015 :HR': .\TLANTIC BONDING CO, INC. Sign: Print: JOTARVPUBLIC-STATE OF FLORIDA Seal: o•`" Tatiana Elkayam - Commission # EE088240 r; Expires: APR. 26, 2015 BONDED THRU ATLANTIC BONDING CO., INC. * * * * •* * * •* * * * * * * * * * * • * ********************* s********** t************* s****** *** ** * *** ** *** ** ****** *** * ***** 140 /1/ 2 Plans Examiner APPROVED BY Zoning Structural Review Clerk Miami Shores Vitiage Building Department 100510 N.E.2nd Avenue Miami Shores, Florida 33138 T I: (305) 795.2204 Fax: (305) 756.8972 CONTRACTORS' REGISTRATION ALL CONTRACTORS MUST PROVIDE COPIES OF LICENCES AND INSURANCES EACH TIME A PERMIT IS SUBMITTED. IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: A. V COPY OF QUALIFIER'S STATE LICENCES B. V COPY OF LOCAL BUSINESS TAX RECEIPT C. frir COPY OF LIABILITY INSURANCE* D. COPY OF WORKERS COMPENSATION INSURANCE* IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY: A. COPY OF CERTIFICE OF COMPETENCY OF QUALIFIER B. COPY OF LOCAL BUSINESS TAX RECEIPT B. COPY OF STATE REGISTERED CONTRACTOR LICENSE OR MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT. C. COPY OF LIABILITY INSURACE* D. COPY OF WORKERS COMPENSATION INSURANCE* *YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE AS FOLLOW: Certificate Holder: MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES, FL 33138 Certificate must specify the description of operations or contractor license number. BUSINESS NAME: A C F) % L! e/e,�-r BUSINESS ADDRESS: 16 ,; ', /P°0 'e 11,;;;-,4-4-- - CITY /VO4 r20/c STATE II'- ZIP CODE 3 2 6)° BUSINESS PHONE: (30 i) -C?2 --&? 2 FAX NUMBER ( ) derrPfe-06lecil'i..6 •'Cal CELL PHONE ( .30f) QUALIFIER'S NAME: #6, M 4 r - /3 0 QUALIFIER'S LIC NUMBER: ill 4114, rie ON I 4 w w 115 S. Andrews Ave., Rrn. A -100, Ft. Lauderdale, FL 33301 -1895 — 954 -831 -4000 VALID OCTOBER 1, 2013 THROUGH SEPTEMBER 30, 2014 Business Name: DELTA TECH ELECTRIC LLC Reipt#Etic- T I ALAnts /c0 D: Business Type: Owner Name: KEXTIt PEGLER, QUALIFIER Business Opened :11/23/2010 Business Location: 1835 E HALLANDALE BEACH BLVD, State/County{Cert!Reg MC13004622 HALLANDALE Exemption Code: Business Phone: 954.665- 9775 Rooms Professionals Tax Amount Transfer Fee NSF Fee . , Penalty Prior Years T Collection Cost Total Paid 27.00 0,00 .b.0 "- 2.'T0 0.00 ; 0.00 29.70 THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS THIS BECOMES A TAX RECEIPT This tax is levied for the privilege of doing business within Broward County and is non- regulatory in nature. You must meet all County andlor Municipality planning WHEN VALIDATED and zoning requirements This Business Tax Receipt must be transferred when . the business is sold, business name has changed or you have mowed the business location. This receipt does not indicate that the business is legal or that it is in compliance pli h State or local laws and regulations. Mailing Address: DELTA TECH ELECTRIC, LLC. 1935 . E HALLANDALE BEACH BLVD, STE 470 HALLANDALE, FL 33009 2013 • 2014 Receipt #05A - 13- 00000492 Paid 10/18/2013 29.70 7 DEPARTMENT T _i "wT��`3,TE OF FLORIDA � 'SS AND . .OEESS ZONAL REGULATION w " .'s 7 LICENSING BOARD ..s' EQ# L12062500702 06/25/2012 _1182_, .`x ^ The ELECTRICAL CON °i ,. Named below IS Under the provi Expiration date PEGLER, KEITH DELTA TECHst €' 3801 NW 122 TE : SUNRISE RICK SCOTT GOVERNOR 17, jness Qualification DISPLAY AS REQUIRED BY LAW KEN LAWSON SECRETARY s ACORL DELTTEC -01 MATERAT CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 6/12/2014 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 endorsement(s). oRODUCER CONTACT Dawn Silver Insurance Office of America -LNG PHONE 855 West State Road 434 (NC No Extt: (407) 788 4000 ongwood, FL 32750 ADDRESS: Dawn.Silver @loausa.com INSURER(S) AFFORDING COVERAGE I FAX No): (407) 788 -7933 INSURER A :Old Dominion Insurance Company NAIL # 40231 NSURED Delta Tech Electric LLC 1835 E. Hallandale Beach Blvd. Suite 470 Hallandale, FL 33009 INSURER B: Twin City Fire insurance Company 29459 INSURER C : INSURER D : INSURER E : INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUM ER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POUCY 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 POLIC ES 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 INSR SUBR YND POLICY NUMBER MPG2406C POLICY EFF (MM/DD/YYYY) 11/24/2013 POUCY EXP (MM/DD/YYYY) 11/24/2014 UMITS EACH OCCURRENCE $ 1,000,000 A GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY PREMGESoRENTED! PREMISES (Ea occurrence) $ 500,000 CLAIMS -MADE X OCCUR MED EXP (My one person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GE 'L AGGREGATE X POLICY I LIMIT APPLIES PER: JCTT FLOC PRODUCTS - COMP/OP AGG $ 2,000,000 $ AUTOMOBILE — LUU31LnY ANY AUTO ALL OWNED HIRED SAUTOS SCHEDULED NON -OWNED AUTOS COMBBIINdED SINGLE LIMIT $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (PER ACCIDENT) $ $ A X UMBRELLA UAB EXCESS UAB X OCCUR CLAIMS-MADE CUG2406C 02/03/2014 02/03/2015 EACH OCCURRENCE $ 2,000,000 AGGREGATE $ 2,000,000 DED RETENTON$ $ B WORKERS COMPENSATION AND EMPLOYERS LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) It yes, describe under DESCRIPTION OF OPERATIONS below N /A 21 WBCAG0192 11/24/2013 11/24/2014 X -WFLU 0T- E.L. EACH ACCIDENT $ 100,000 E.L. DISEASE - EA EMpLOYEE $ 100,000 $ 500,000 E.L. DISEASE - POLICY LIMIT DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, H more space Is required) REF Delta Tech Electric EC13004622 CERTIFICATE HOLDER ELLATION Miami Shores Village Building Department 10050 NE 2nd Ave , !Miami shores Florida 33138 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POUCY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25 (2010/05) © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD • Raymond L. Robinson, Esq. Robinson & Associates, P.A. 1501 Venera Avenue, Suite 300 Coral Gables, Florida 33146 305 -662 -7618 File Number: CagnasnUJohnsan Bitzln Sumberg Baena Price & Axelrod, LLP 1450 Brleken Ave23id FL Miami, FL 33131 CFN 41040396304 BOOK 29176 PAGE 1452 DATE:06/0312014 02:59:07 PM DEED DOC 3,549.00 HARVEY RUVIN, CLERK OF COURT, MIA -DADE CTY [ Space Above This Line For Recording Data] WARRANTY DEED This Warranty Deed Made the all day of June, 2014, by Stephen V. Cagnazzi, a married man, under the laws of Massachusetts, joined by his spouse, Thomas Johnson, a married man, under the laws of Massachusetts, as joint tenants with right of survivorship, whose post office address is PO Box 530337, Miami Shores, Florida 33153, hereinafter called the grantors, And D LAS 2 LLC, a Florida limited liability company, whose post office address is 9839 NE 13t Avenue, Miami Shores, FL 33138, hereinafter called the grantee, W1TNESSETH: That said grantors, for and in consideration of the sum of 810.00 Dollars and other valuable considerations, receipt whereof is hereby acknowledged, hereby grants, bargains, sells, aliens, remises, releases, conveys and confirms unto the grantee, all that certain land situate in Miami -Dade County, Florida, to wit Lot 17, Block 4, RIVER BAY PARK ADDITION, a subdivision according to the plat thereof, as recorded at Plat Book 40, Page 72,1n the Public Records of Miami -Dade County, Florida. Parcel Identification Number: 11-2232432-0380. TOGETHER with all the tenements, hereditaments and appurtenances thereto belonging or in anywise appertaining. To Have and to Hold, the same in fee simple forever. And the grantors hereby covenants with said grantees that the grantors are lawfully seized of said land in fee simple; that the grantors have good right and lawful authority to sell and convey said land; that the grantors hereby fully warrants the title to said land and will defend the same against the lawful claims of all persons whomsoever; and that said land is free of all encumbrances, except taxes accruing subsequent to December 31, 2013. In Witness Whereof: Grantors has hereunto set grantor's hand and seal the day and year first above written. Signed, sealed and delivered in our presume n (sue) • • Raymond L. Robinson, Esq. Robinson & Associates, P.A. 1501 Venera Avenue, Suite 300 Coral Gables, Florida 33146 305-662-7618 File Number: Cagnazzi/Johnson Return to: Bilain Sumberg Baena Price & Axelrod, LLP 1450 Brickell Ave 23'" FL Miami, FL 33131 j Space Above This Line For Recording Data] WARRANTY DEED This Warranty Deed Made the day of June, 2014, by Stephen V. Cagnazzi, a married man, under the laws of Massachusetts, joined by his spouse, Thomas Johnson, a married man, under the laws of Massachusetts, as joint tenants with right of survivorship, whose post office address is PO Box 530337, Miami Shores, Florida 33153, hereinafter called the grantors, And D LAS 2 LLC, a Florida limited liability company, whose post office address is 9839 NE 13th Avenue, Miami Shores, FL 33138, hereinafter called the grantee, WITNESSETH: That said grantors, for and in consideration of the sum of $10.00 Dollars and other valuable considerations, receipt whereof is hereby acknowledged, hereby grants, bargains, sells, aliens, remises, releases, conveys and confirms unto the grantee, all that certain land situate in 1VIiami -Dade County, Florida, to wit Lot 17, Block 4, RIVER BAY PARK ADDITION, a subdivision according to the plat thereof, as recorded at Plat Book 40, Page 72, in the Public Records of Miami -Dade County, Florida. Parcel Identification Number: 11- 2232-032 -0380. TOGETHER with all the tenements, hereditaments and appurtenances thereto belonging or in anywise appertaining. To Have and to Hold, the same in fee simple forever. And the grantors hereby covenants with said grantees that the grantors are lawfully seized of said land in fee simple; that the grantors have good right and lawful authority to sell and convey said land; that the grantors hereby fully warrants the title to said land and will defend the same against the lawful claims of all persons whomsoever; and that I said land is free of all encumbrances, except taxes accruing subsequent to December 31, 2013. In Witness Whereof, Grantors has hereunto set grantor's hand and seal the day and year first above written. Signed, sealed and delivered in our presence: Witness Signature: Printed name: Witness Signatur Printed Name: Witness Signatar Printed name: Witness Signatu Printed Name: 17_ (Seal) • • STATE OF FLORIDA COUNTY OF MIAMI -DADE The foregoing instrument was acknowledged before me this 1_ ordi day of June, 2014 by Stephen V. Cagnazzi, a married man, under the laws of Massachusetts, joined by his 'spouse, Thomas Johnson, a married man, under the laws of Massachusetts, as joint tenants 'with right of survivorship. They are personally known to me, or have produced their Drivers U cerist as identification. My Commission Expires: 1111 -Q11S NOTARY PUBLICSTATEUF FLORIDA Print Name:,, 1(A TU C lowtreL