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EL-14-42Inspection Worksheet ILI—Z Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 nspection Number: INSP-208569 Permit Number: EL -1-14-42 Inspection Date: March 11, 2014 Permit Type: Electrical - Residential Inspector: Devaney, Michael Inspection Type: Final Owner: MALUL, OFIR Work Classification: Alteration Job Address: 1700 NE 105 Street 110 Miami Shores, FL 33138- Phone Number Parcel Number Project: <NONE> Contractor: VALDEN SERVICE SYSTEMS LLC Buildina Deoartment Comments 1122300500100 Phone: (786)253-7700 REMOVE AND INSTALL GFI OUTLETS REMODEL infractio Passed Comments INSPECTOR COMMENTS False KITCHEN Inspector Comments Passed CREATED AS REINSPECTION FOR INSP-208462. Install all receptacles and label the panel. Failed Correction Needed Re -Inspection ❑ Fee No Additional Inspections can be scheduled until re -inspection fee is paid. For Inspections please call: (305)762,4949 March 11, 2014 Page 1 of 1 Miami Shores Villa e U ��/' I Building Department N4 o 9 tor; 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 ayo..___®_mdmom INSPECTION'S PHONE NUMBER: (305) 762.4949 FBC 20 l') BUILDING Permit No. Ck,IL4—A-4 PERMIT APPLICATION Master Permit No. 2jzA 4'_" iC::) Permit Type: Electrical xrIAa ,a"nnIVee. b Irk IAa<` , 5-� _-q- I.,n City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated: Yes NO Flood Zone: OWNER: Name (Fee Simple Titleholder): C>"-,1Y'L Phone#: O IX�%'�3 Address: Aa-'f- city: s City: o State: e -A Zip: a Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: \%lde,s f Phone# Address: I', O . r9S 4.'a�'s �3 City: W, State:� L Zip: Qualifier Name: Phone#: State Certification or Registration #: 'E % r%° Certificate of Competency #: 068 ®�® Contact Phone#: S,_� 72t2 Email Address4QhA e/ VA e c®oz.�- DESIGNER: Architect/Engineer: Value of Work for this Permit: $ 3 Cx--0 Square/Linear Footage of Work: Type of Work: DAddress DAlteration ❑New Description of Work:_`' ❑Demolition Submittal Fee $50 Permit Fee $ /t✓��''�'� CCF $ CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ Technology Fee $ TOTAL FEE NOW DUE $ l 6) 67. 1 a r Bonding Company's Name (if applicable) Bonding Company's Address City State Mortgage Lender's Name (if applicable) Mortgage Lender's Address City LAS State Tap 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 U"ROVEMENTS 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 properly 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 �� of such posted notice, the inspection will not be approved and a reinspection fee will be charged, —i_ _ ,aUP -ft i M-- E Owner or Agent Contractor The f going i Mrment was ac ledged be ore The foregoing was acknowledged before me this -� day of , 20 by Fl �- day of go .4 20 by"Wcl. Zoning Structural Review Clerk (Revised 3/1212012)(Revised 07n0W)Otevised 0&10 WXRevised 3n5M) • , g e , e . 2 2 STATE aF FLORIDA DEPARTMENT OF BUSINESS AND PRFNSSTONAL,REGULATION ELECTRICAL CONTRACTORS EXCES11: . HOARD T T SEW L1208200239: 001892 Local Business TaxReceipt Miami -Dade County, State of Florida THIS IS NOT A BILL — DO NOT ?A" ' 6422497 REN LAWSON SECRETARY LBT BUSINESS NAME/LOCATION RECEIPT NO. EXPIRES VALDEN SERVICE SYSTEMS LLC RENEWAL SEPTEMBER 30, 2014 650 NW 100 TERR 6690672 Must be displayed at place of business MIAMI FL 33150 Pursuant to County Code Chapter 8A - Art. 9 & 10 OVMNER SEC. TYPE OF BUSINESS PAYMENT RECEIVED VALDEN SERVICE SYSTEMS LLC 196 ELECTRICAL CONTRACTOR BY TAX COLLECTOR 06E000462 $75.00 09/01/2013 Worker(s)CREDITCARD-13-006870 This Local Business Tax Receipt only confirms payment of the Local Business Tax. The Receipt is not a license, permit or a certification of the holders qualifications, to do business. Holder must comply with any governments[ or nongovernmental regulatory laws and requirements which apply to the business. fThe RECEIPT N0. above must be displayed on all commercial vehicles — Miami—Dade Code Sec Be -276. For more information, visit www mismidade govltaxcelleclor -.: Rionlra9desBConstruQualifying Board _ BUSINESS CERTIFICATE OF COMPETENCY l 06E000462 VALDEN SERVICE SYSTEMS LLC i D.B.A.: FG SON DENHAM G Is certified under the provisions of Chapter 10 of Miami -Dade County 4 11115/2013 16:41 9543409456 INNOVATIVE INSURANCE PAGE 01/01 ..-�� OP ID: TO '41��aT CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDlYYYY) 11/15/73 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 cortifiioate holder Is an ADDITIONAL INSURED, the pol(cy(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(sl. PRODUCIM 954-M-9561 4-,M-9561 INNOVATIVE INSURANCE oONSUL,TANTS, INC. 954-340-9456 5481 UNIVERSITY DRIVE, 0103 :ORAL SPRINGS, FL 33067 BRIAN J. MAMO INSURED , VALDEN SERVICE SYSTEMS, LLC. - P.O. BOX 693513 MIAMI, FL 33269 _ 1NSUIMR(S) AFFORDING COVERAGE A. FUSA WORKERS' COMP D! COVFRACFS V_R0TIC1[_ATF Mt IRMIMMD- a WS1101nM Mt IRRMIND, - - ----- -- -- - -- - - - -- 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. _ PO L TYPE OF INSURANCE Amm POLICY NUMBER ro Y EFP LIMITS l GENERAL LIABILITY EACH OCCURRENCE COMMERCIAL GENERAL LIABILITY7 PFIE TSE$ f Ea $ CLAIMS-MAbe F7 OCCURMED - � (Any one person) $ _ ...- PERSONAL A ADV INJURY $ GENERAL AGGREGATE $ - GEWL AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP AGO S POUCY PRD- LOC S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Es accident) ANY AUTO BODILY INJURY (Per parson) S ALL OWNED AUTOS BODILY INJURY (Per awment) S SCHEDULED AUTOS PROPERTY DAMAGE R HIREDAUTDS (Perseddent) - NON-OWNEDAUTOS S Zs ... .. UMORWA A L IAO • - OCCUR EACH OCCURRENCE S EXCESS LIAR CLAIM$.MADE AtSQREGATE ._. 9 DEDUCTIBLE $. -- RETENTION WORKERS COMPENSATION X WC STATU- X 0 A AND EMPLOYERS• LIABILITY IN Yj _ ANYNGRRIDFXECUTIVE PROIP EMt OR 10641247 04/01/13 04101114 E.L. EACH ACCIDENT EXCL (Mandddatory In NH) LJ DESG�(31PTION N 1 A $ - 500,00 LL. DISEASs . EA EMPLOYEE $ 500,0 OF OP RAT/ NS Ifelow E.L. DISEASE -POLICY LIMIT I DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach AOORD 101, Aft0unal RaMnMa SchetltUa, R mom npncn to rogalr*M 305-7568872 MIAMI SHORES VILLAGE BUILDING DEPARTMENT 10050 NE 2 AVENUE MIAMI SHORES, Fl, 33132 ACORD 25 (2009109) MIAMI -6 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELWWRID IN ACCORDANCE WITH THE POLICY PROVISIONS, AUTHOFWM REPRESEWATNE ©1988.2009 ACORD CORPORATION, All rights reserved. The ACORD name and logo are registered marks of ACORD A� V CERTIFICATE OF LIABILITY INSURANCE F 71/9812(!13 THIS CERTIFICATE 18 ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLUM THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTIME A CONTRACT BETWEEN THE ISSUING INSURER(Sh AUTHORIZED REPRESENTATM OR P'ROtiUCER AND THE CERTIFICATE HOLDER. IMPORTANT. If the certificate ihoN1ler is an ADDITIONAL INSURED, the policy(tes) must the endorsed_ If SUBROGATION IS WAWD, subject to the tomes and emdltions of the policy, certain policies may require an endorsement. A StdtEmerd on this eehtificato does riot confer rights to the oarY,fcarte IhWder in lieu of such endorseme s)_ PRODUUM E,- Daniel RWnson Sihr>plified Morl8ga9a And tnSUranCe Services Inc °"C"'E 15M. 954-5837500 - _ Ne : 954 583-6987 E ns . ,_. 666 SW 27 Ave Suite #5 DOURERls)AweCovRaao9 NaeP Ft Laudstdole, A 33311 wsureERa, Accident Insurance Company INSURER a INSURED Valden Services Systems, LLC FWURINC, Y P O Brno 693513 orano i n s POURER E ..._ Miami. Fl. 33269 ri Dx�rrRERF; COVERAGES CUMFICATE NUMBER. REVISION NUMBER THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ASOVE' FOR THE POLICY PERIOD INDICATED. NOTWRHSTANDWG 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 DESCRISED HEREIN IS SUBJECT TO ALL THE TERM% EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IN= Type OF DOURANCE _ADS POLICY NUMM EFF Lam A GENERALLIASLLrrY X 00MhM VL c�AL LIAsa rtv CCA.A54 ADE r-1 OCCUR _ _ GENLAGGREGATE LWr APPLIES PGk POLICY LOC CCPSOM53 12t211Z013 1221/2014 6aGFIOGCURRENce a 1,000,000.00 PREMISES ra G=wvnrmo a x,000.00 NED race cele person) 9 5.000.00 P &ADVO a 1,000,000.00 GENERa6AAqGGiRTe a 2.000,000.00 PRO DU -M-COMPOPAGG $ 1,0WA00,00 i a/TQRrOea.E LRA�LRY ANY AUTO OWNED SOS n rn MRFD AUTOS AUTOS aneder# UIIRIT 8 BODILY INJURY ft pwzCM) S 90DlLY lN3URY per veeidart) $ QTY DAMAGE S ri _ UMBRELLA LWB EXCESSLIAe OCCUR CLA#&Q MA0E FSI OCCURRENCE S aE,4^aRErtaTe [ OED RETEIITION$ $ INORIUM COMPENSATION ANb gNPLOT W LIASLI Y V i N aNYPkWfflE70MFAMNEReM=IVEELEACHAflgDW OPF10ER&WAm3ER Exo M=7 � IryIry�. io CE FRON OF OPERATIONS below N f A 140MAR>OTI1 $ 9:1 DI$1_AM - EA EMPLOM S EL DISEASE - POLICY UhUr S DESCRI>FPTWN OF OPERATIONS I LOGTI4uta J VC ICIAS iatedl ACORD 101, Addidanal Renrvro Sanodute, limprp epee, Is avuuedl Electrical Sefvipess D� ZLa11 � W1,11 4. [oiIoil ia SHOULD ANY OF THE ABOVE DESCNiB® POUCWS BE CANCELUM IEFOW THE EXPIRATION DATE THWOF, NOTICE WILL BE DELIVERM BI Waild Shotes V171age Building DeparUnent ACCORDANCE WITH E PO.fY PROVISIQN$. 10050 N E 2 Ave J Miami Stloras, Fl 33138 hlvE i +' 1 0 ACORD CORPORATION. All rights reserved - The 25 {2090/05) The ACORD nanhe and logo are registered of ACORD