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ELC-11-2063
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 BUILDING PERMIT APPLICATION FBC 20 RECEIVED NOV 07 2011 BY- Permit No. rC1LC I I 2.C)3 Master Permit No. C' C-1 1 ., Permit Type: Electrical OWNER : Name (Fee imple Titleholder): e d M„c li•. -> LL. L Phone #:3as " %85• Q ro Address: �d / L U.i t 16 a f nn City:.410. k J5 eQ. G G L State: I 1-. Zip: 33/q / Tenant/Lessee Name: {� Phone#: Email: V b 1 Q- D u S g DG I j 5D t .-1. JOB ADDRESS: e i t 15- PeA.T R City: Miami Shores r1,+re-). County: Miami Dade Zip: 33 /3h-' Folio/Parcel #: Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name: 1 D II- 1e e' k Phone #: 3a I " oZ fo 0 " (m i Address: 11S6-6-- Ca- iD'0) fkl City: 1 �°` 1J1. cS V i 11"e' State: F c L Zip: 3 '�. 7 C� D rL Qualifier Name: 5`17 w„ct -t'I oak.. A3. G t Phone #:Ct�� 3 a $%3 R Sc) State Certification or Registration #: E ( D D t 9 P Certificate of Competency #: Contact Phone #: 32. j - 02 to $ - 112418 Email Address: C. 10 1. cis. b + -t c. t Vt G ,I DESIGNER: Architect/Engineer: �°t- t 1< A. &L..1.1, b G t ( , c i s . (f "Phone #: 3 0S. ' S i � a:31,3) w Value of Work for this Permit: $ �j Z OO() Square/Linear Footage of Work: a t 0 O ,i, Type of Work: DAddress ❑Alteration ❑New , epair/Replace ❑Demolitio AAA- Mlsw S M. S eh..- t / (I'7UF I L.,/ 4 i.kr / 4 67 Description of Work: ******************* ** **** ** **** *** *****Fees** ****m** 0000 ***** *** **** ****** * ** *** * *O* *** Submittal Fee $ ' Permit Fee $ u 44 " Scanning Fee $ Radon Fee $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ CCF $ CO /CC $ DBPR $ Bond $ Technology Fee $ TOTAL FEE NOW DUE $ r3' x.00 d 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 .sttendaids of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL F.CTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC OWNER'S AFFIIAVIT: 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 $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified coPy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued . In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. , Signature The fore day of h. 's J& f7Owner or Agent mg in.trumen vas a kntwlep :edpefo ' e this Alli' 20 9, by I Alt R . Ltif ownt�,nte or who has produced -1111itr Signature ntification and w o did take an oath. Contractor tent was acknoged be 1r 20!/ ,b perstznally.knovam tame or ho has produced de entification and who did take an oath. NOTAR Sign: Print: My Commission Expires: • My Co +k********* *** * ****Ns+ **** ****+# *Ns*W *sh*+ h+ p******+k******+k*** { r ,.•.. ,� ..r # t,*** APPROVED BY Plans Examiner • ning Structural Review Clerk (Revised 07 /IO/07)(Revised 06/10/2009)(Revised 3/15/09) BREVARD COUNTY BUSINESSTAX RECEIPT 2011 • 2012 SUBJECT TO COUNTY ZONING RESTRICTIONS TAX RECEIPT SHOULD BE DISPLAYED ON PREMISES BUSINESS PERIOD: OCTOBER 1, 2011 - SEPTEMBER 30.2012 EXPIRES: . SEPTEMBER 30, 2012 IssutU NuHSUANT AND SUBJECT TO FLORIDA STATUTES AND BREVARD COUNTY CODE ISSUANCE DOES NOT CERTIFY COMPLIANCE WITH ZONING OR OTHER LAWS. BUSINESS TAX RECEIPT IS SUBJECT TO REVOCATION FOR ZONING VIOLATIONS, AND! OR FAILURE TO MAINTAIN REGULWjHY PRE-REQUISITES AS REQUIRED FOR BUSINESS CI .A$SFICATION(S), OR SUBSEQUENT ACnVTTTES, NOTIFY TAX COLLECTOR UPON CLOSING OF BUSINESS. A PERMIT IS REQUIRED TO ADVERTISE (InctudMg wIth signage) 'GOING OUTOF BUSINESS". LISA CULLEN, CPC, Brevard County Tax Collector P 0 Box 2600, Titusville, Florida 32781-2500 (321) 264 -6910 UPON A CHANGE OF OWNERSHIP OR LOCATION, RUMNESS TAX RECEIPT SHOULD RE TRANSFERRED%%TI•IJN 30 DAYS. THE PERSONS). OR ENTITY BELOW; VOLT TECH 4555 CAPRON RD TITUSVILLE FE 32780 LOCATION: 4555 CAPRON Rn CITY OF TITUSVILLE, FL 32780 OWNED BY: JONATHAN S DEWITT BU$iNESS CLASSIFICATIONS, DISCLAIMERS, AND RELATED FEES: ACCOUNT NO. 9710732 EXEMPTIONS: NON EXEMPT PENALTY: 5.00 300240 ELECTRICAL CONTRACTOR 820005 2011 - 2012 RECEIPT AMT $37.00 • •.•RCT .1∎1, 11 • • •TILL::flAT•:••9gMT PAID • •••PAI1 '8361x019:00014001: HST04/271201137 ;00 • BRANCH OFFICES: Merritt island Office, 1450 N. Courtenay pkwy, Merritt Island, FL 32953 Melbourne Office, 1515 Sarno Road, Melbourne, FL 32935 Palm Bay Office, 450 Cogan Dr. SE, Palm Bay, FL 32909 MAIN OFFICE: 400 South St., 6th Floor, Titusville, FL 32780 (321) 264.6910, (321) 633 -2199, ext. 46910 STR- 7wkcPT -04 CITY OF TIrusVILLE BUSINESS TAX RECEIPT FOR FISCAL YEAR 2011 - 2012 EXPIRES: Sept mbar 3012012 ISSUED: September 23, 2011 ACCOUNT NO! 12- 00003942 • i....77,,• r KEEP CONSPICUOUSLY POSTE D At THE PLACE, USINESS SHOWN r• ti• . P & ,..D1 AL/BUSIN :SUMO AND 4 VOLT .TECH TECH ,; ' ',. 455S CAPRON RD wr. • "°�`f .� —t. TITIJSVILLE FL 32780 "' ikf OWNER NAME is DEWF T, JO 410 DEL -;; i s' AV 1.' i. THE PER$l1 ' OR 1 RM NAMED ABOVE IS HEREBY REIN IN THE BUS*, ESS,` OPESSION, OR TRADE LISTED BE TITUSVILLE 1I.oRID `y BUSINESS CLA ICA� s ' ' '' '; UTAH_ N FACTORS CON .: aRs ^.sate . • ....• Sv91db SPECIAL CONTINGENCIES •• . .l'r 'aa� 1 x SIG t r... : n 1C: `ti 'l fi. �' . NfiN 7 W3.g 'i ik AP4014 ZA 474' AUTHORIZING REPRESENTATIVE KJm1LL. TOTAL; THIS RECEIPT BECOMES OFFICIAL ONLY WHEN SIGNED BY AN AUTHORIZING REPRESENTATIVE OF THE CITY OF TITUSVILLE. PLEASE RETURN THIS RECEIPT SIGNED AND DATED IF YOU CO OUT OF BUSINESS. THE ENGINEERING SERVICES DEPARTMENT CANNOT TAKE YOU OUT OF BUSINESS WITHOUT THIS DOCUMENTATION! �-- CERTIFICATE OF LIABILITY INSURANCE VOLTOOI OP ID: MC DATE (MMIDD/YYYY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, R., 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(5), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.. „ �'PORTANT; If the certificate holder Is an ADDm0MAL INSURED, the policy(lea) must be endorsed. If SUBROGATION IS WAIVED, subject to �sfin forms and conditions of the policy, certain policies mey requins an andersemenn. A statement on this certificate goes not Confer rights to the certificate hbider in lieu of such endorsement(s). PRODUCER J.W. Edens & Compponyy , Commercial Ins of Breverd, Inc 326 Fifth Avenue, Suite 108 Indialantic, FL 32903 Phillip Lane INSURED Volt -Tech Jonathan B. Dewitt dba 4555 Capron Rd Titusville, FL 32780 321 -725 -4000 werx 321.725-7856 PHONp _LAIC, No. Eft COVERAGES E-MAIL IAA, No): INSURERisiAFI-OJIaING ▪ OOVCRAOE INSURER A I FCCI Insurance Company INSURER INSURER 0 NA{G 10178 INSURER D : INSURER E INSURER F : CERTIFICATE NUMBER: REVISION NUMBER: THIS is TO CERTIFY THAT THE POLIDIFS AF INRURANCE LISTED BELOW HAVE BEEN ISSUED TQ THE INCUItCD NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OP 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 SEEN REDUCED BY PAID CLAIMS, TYPE OF INSURANCE GENERAL UA L7 y ClllumPoIJAI r,.ENERAL LIABILrY CLAIMS -MADE © OCCUR GENtk PO GPJV'L AGGREGATE LIMIT APPLIES PER: PO ICY ,PjEC T El LOC AtiroltaILE L)ASIU1'Y ' X ANY AUTO AAlrtro5 ED HIRED AUTOS EMIG UmesteLLA LIAR EXCESS Las SC IAFn WNED AUTOS OCOUR CLAIMS -MADE 10.00 WORKERS COMPSNBATION AND EMPLOYERS' uAaILrr' A ANY PROPRiSTORIPARTNERIEISE:CUTIvE Y� fMaenadatary In NHI It y DESCRIIONN 0 O TIONS below POLICY NUMBER ma seems cA0012403 UMB00079T2 '{7{I.,.I'fl -'`'Ir ' P I seek 12/14111 EAcH OCCURRENCE 12/44/12 uSIT$ MED EXP {Any one , , roan) PERSONAL ADV INJURY GENERAL AGGREGATE PRODUCTS - COMP/OP AGO 12/14/11 12/14412 12/44111 12/14/12 NIA 001 WC11A -60B85 12/14(11 12/14/12 RIPT1ON OP OPERATIONS / LOCATIONS I WIGGLES /Amen Arxrrtu vac, Aaanlenar Remarks Smrefade If more space le regl,Und) CERTIFICATE HOLDER • Miami Shores Village Building Department 10050 N.E. 2nd Avenue Miami Shores, FL 33138 ACORD 25 (20010/06) MIAMSHO CANCELLATION COMBINED SINGLE LIMrr Ee eeaidQ•) • BODILY INJURY (Per person) a BODILY INJURY Mar Berdeers) S $ 1,000.00 $ 100,00 E S S PROPER Par ,.• .e10 EACH OCCURRENCE AGGREGATE X STATU- j arm. 5,00 1,000.00 2,000,00 2,000.00 1,000,00 1,000,0 s 1,000.00 S E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE EL DISEASE - POLICY LIMIT 1,000,00 1,000,00 s 1,000,00 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACcORPANOE WITH TI•IC PouCY PROVISIONS. AUTHORISED REPRESENTATIVE Philip Lane CP 1988 10 ACORD CORPORATION. The ACORD name and logo are registered marks of ACORD All rights reserved.