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EL-14-1478Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-215926 Permit Number: EL -7-14-1478 Scheduled Inspection Date: July 16, 2014 Permit Type: Electrical - Residential Inspector: Devaney, Michael Inspection Type: Final Owner: CARROLL, JAMES Work Classification: Service Change Job Address: 1269 NE 98 Street Miami Shores, FL Phone Number Parcel Number 1132050090260 Project: <NONE> Contractor: MISTER SPARKY Phone: (305)251-3440 Isuuamg uepartment comments SERVICE UPGRADE INSPECTOR COMMENTS False Inspector Comments Passed Failed Correction ❑ Needed Re -Inspection ❑ Fee No Additional Inspections can be scheduled until re -inspection fee is paid. July 15, 2014 For Inspections please call: (305)762-4949 Page 18 of 21 M Miami Shores Village 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 BUILDING PERMIT APPLICATION ❑ BUILDING XELECTRIC ❑ ROOFING ze dr JUL 11 201 FBC 20 L0 Master Permit No. �z-�-�� " I L4 - Sub Permit No. ❑ REVISION ❑ EXTENSION ❑ RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: % A 6 9 A,/ F_ 9 k*, - .S _r City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): cif Me 5 CIO I'G o �l Phone#: 30.E 979'- 975 7 Address: City: n -z dJ�6-re State: � Zip: Tenant/Lessee Name: v/IiD Phone#: Email: G A It- /,5`r ` —7 -1d0 G./ . G v/m TG�' /a0/4K"/ Cvedei� P,o'Iry Q e/ai og0_r CONTRACTOR: Company Name: Al /.S tier �fSi✓2/d _Phone#: S'1 -7 Address: City: 'eotl 1 1"Z �' nn State: /-/ � Zip: 3' Qualifier Name: 3rC. IG d of> e- ? A �_`7 Phone#:'71C V1 7 q_7 d q State Certification or Registration #: Z --C 7 S do Vj�_ Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State: Value of Work for this Permit: $ �� Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New Repair//Replace / Description of Work: /2 P -/-?/OL c -f- (2L. f- ��ra Zip: ❑ Demolition Specify color of color thru tile: Submittal Fee $' Permit Fee $ 44 d(/ CCF $ CO/CC $ Scanning Fee $ Radon Fee $ Technology Fee $ Training/Education Fee $ Structural Reviews (Revisedo2/24/2014) DBPR $ Notary $ Double Fee $ Bond $ gg TOTAL FEE NOW DUE $ 6 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 Zi 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, FURNACES, BOILERS, HEATERS, TANKS, 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 OWNER or AGENT The foregoing instrument was acknowledged before me this t day of�.�� , 2014 , by who is personally known to me or who has produced i' r'D as `��\\10III identification and who did take an oato� \ .,,4 v n NOTARY PUBLIC: FS(. •� '� Print: Seal: Signature CONTRACTOR The foregoing instrument was acknowledged before me this l day of SU U- 20 , by t-1�1r NZ who is personally known to me or wh has as ois 1 �d identification ai tlj�0 r �k"6� -Dath. :t/a= NOTARYjMt#!I�/9?7, yam• d x�'' Sign: Print: Seal: � eq1`/ APPROVED BY Y Plans Examiner Structural Review (Revised02/24/2014) Zoning Clerk Luca! Busainesr Tax Recti pt Miami—Dade County, State of Florida -THIS IS NOTA BiLt-OO NOT PAY 6690888 BUSINESS NAMIS&OCATION RECEIPT NO.MISTER EXPIRES 14260 W 136 RENEWAL SEPTEMBER 30 14260 SW 136 ST 3 8983814 30, 2014 MLWI, FL 33186 Must be displayed at place of business Pursuant to County Code Chapter 8A - Art. 9 & 10 OWNER SEC. TYPE OF BUSINESS PAYMENT RECEIVED JCR HOLDINGS OF FLORIDA LLC 196 ELECTRICAL CONTRACTOR BY TAX COLLECTOR Worker(s) 2 EC13004551 75.00 09/04/2013FPPU09-13-001853 This Local Business Tax Recut only eoafbms payment of the Local Business Tax. The Receipt is not a license, permit, or a corti6catios of the bolder's qualilicadons,to do business. Holder most compy with any governmental er 00090vemmental regulatorylaws and requirementswbicb apply to the bmdaess. The RECEIPT N0. above muatbe displayed on ag commercial vebiclen—Miami4ade Code Seces 278. On For more Information, visit w Malamidade,gWitaxoollector 346296958 STATE OF FLORIDA DEPARTMENT OF BUSINESg AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD SEi# L12082302714 ACORV CERTIFICATE OF LIABILITY INSURANCE10/14/2013 I�� 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 Gil, Garden, Avetrani Insurance Group N. Kendall Drive Suite 208 Miami FL 33176 =ACT Vanessa Davila PHONE . (305) 630-4777 FAX (305)279-3022 MIC No r-Kh10689 E vanessa$ggaig.com INSU S AFFORDING COVERAGE MAIC# INSURERA:Travelers Indemnity Company 5658 INSURED JCR Holding Group of Florida, LLC dba Mister Sparky 14260 SW 136 Street Bay 3 Miami FL 33186 uNsuRms.-Travelers Prop Cas Cc of Ameri 25674 INSURER C: INSURER D INSURER E: INSURER F : flAVCOARCC Pr-0TICIr`ATC 6II IAAQC0-rT.1 -AQQna-iQFi RFVI-CInN NI IMRFR- 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. TYPE OF INSURANCE Ary DDL BR POLICY NUMBER POLICY Elf POLICY EXP LIMITS rA GENERALLIAS1IM X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE FZ OCCUR 6609413R989 /9/2013 /9/2014 EACH OCCURRENCE $ 1,000,000 PR SES Ea $ 100,000 MED EXP (Any one person) $ 5,000 PERSONAL 8 ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEML AGGREGATE LIMIT APPLIES PER: X POLICY PRO LOC PRODUCTS- COMPIOP AGG $ 2,000,000 $ $ AUTOMOBILE X UABILITY ANY AUTO ALLY ED SCHEDULED2217.019 AOS NON -OWNED HIRED AUTOS AUTOS 0/11/2013 0/11/2014 COMBINe SINGLE LIMITIF 11000,00 BODILY INJURY (Per person) $ BODILY INJURY (PeracddsM) $ PROPERTY DAMAGE $ er urdrMfWMotodatcrombined $ 11000,000 UMBRELLA LWB EXCESS LIAS OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y I N ANY PROPRIETORMARTNERIEXECUTIVE 7 OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, tleactibe under DESCRIPTION OF OPERATIONS below NIA WC STATU- 11 OTH- TORY LIMITS ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Addltlonal Remarks Schedule, If more space Is required) Village of Miami Shores 10050 NE 2 Ave Miami Shores, FL 33138 ACORD 25 (2010105) 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 Rodriguez/vD -x- 0) x" ©1988-2010 ACORD CORPORATION. All rights reserved. INI%025 onirmi m Tho ArnRn name and Innn aro raniotorad marina of Arnon OPEN INVOICES AS OF 08:35:43am 14 May 2014 K ACCT.. CUSTOMER JOB -NAME TR -DATE. INV#.. AMT....... BAL ......... A OUST—POO..... 1.5263 MISTER S --SHOP A 03/1-7/14 273108 46.66ef"'*46 6 2 BRIGHT STAR 2 SOUTH DADE ELECTRIC & SOUTH DADE LIGHTING FAX 305-251-5254 - PHONE 238-7131 MISTER S --SHOP A 03/25/14 274431 ,4 44.154WrV 'V" V 4 15 4.15 2 2 008 PHIFER MISTER S --SHOP A 03/31/14 274418'- 1 8.38e 8 38 1 LEFLY 15263 MISTER S --SHOP A 03/31/14 274420 56.$0., 56*80 1 VALDIN 15263 15263 MISTER MISTER S S --SHOP A 04/01/14 274722 33.75- - 33.75 1 RICHARD SMITH 15263 MISTER S --SHOP --SHOP A A 04/02/14 04/02/14 274992< 274995 3.50'' 3.50 1 TOBAR-2008 15263 __T3763 MISTER —MISTER S -- ;HOP A 04/01/14--274997 9.39r - 9 103:4 - 9 9 3 .9 9.39 03.49 1 1 1 BAEZ-2008 PFEIFER-2008 S --SHOP A 6�2.30; ___�5��62.30 2. _ 0 SPLINTER STOC K 15263 15263 MISTER MISTER S S --SHOP --SHOP A A 05/09/14 05/12/14 279192 279274 20. 6-,*' 20.16 0 TANA LLINAs 15263 MISTER S --SHOP A 05/12/14 279276 276 18— 9 276.18 0 TANA .16-l' 90.16 0 RIVIERA 2, 30/99 2,130.99 SOUTH DADE ELECTRIC & SOUTH DADE LIGHTING FAX 305-251-5254 - PHONE 238-7131 �' ©® CERTIFICATE OF LIABILITY INSURANCE �`�M/°°"Y"f' °"'04/0812014 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 WANED, 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). PRODUCER Alliance Insurance Solutions LLC 7406N Tamiami Trail Sarasota, FL 34243-30&3W7 CONTACT NAME - A .7405 PHONE 1- 7 GENERAL LIABILITY E-MAIL ADDRESS: WSU S AFFORDING COVERAGE NAIC 9 INSURERA: —�_— -- ilus RED ntial HR, Inc. dba First Star HR INSURER 13: Aspen Re - London - Beat Rating n a INSURER C: - Uads - Best Rating 251 O'Connor Ridge Blvd INSURER D INSURER E Suite 370 Irving TX 75038 INSURER F: COVERAGES CERTIFICATE NUMBER: 18284529 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 REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADOL POLICY NUMBER POLICY EFF M POLICY EXP M LIMITS GENERAL LIABILITY EEpAAp�CCpHHp $ COMMERCIAL GENERAL LIABILITY CLAIMS -MADE 7 OCCUR GOEECCTURRRENCE PREMISES EaEnce $ MED EXP (Any ere person) $ PERSONAL & ADV INJURY $ GENERALAGGREGATE $ GEML AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPlOP AGG $ POLICY JECT PRO LOC $ AUTOMOBILE LIABILITY EeINN D INGLE UMrr $ BODILY INJURY (Per person) $ ANY AUTO AUTOSACU,HrOESDULED F BODILY INJURY (Per accident) $ HIRED AUTO AUTOSED P er TYAMAGE $ $ $ UMBRELLA LIAB HCLAIMS-MADE OCCUR EACH OCCURRENCE $ EXCESS LIAR AGGREGATE $ DED RETENTION $ $ $ A j WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETORIPARTNEWEXECUTIVE OFFICERIMEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA WCPE0000018401 10/1/2013 10/1/2014 LIMITS OR f LI TTS EA. EACH ACCIDENT $ 1,()0010(10 E.L. DISEASE - EA EMPLOYE: $ 1 0 0 E.L. DISEASE - POLICY LIMIT $ 11000,000 B I C D Workers Compensation Excess Coverage This Is for informational purposes and nothing shall create any right I undersuch reinsuirence. DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, N more space Is required) Coverage provided for all leased employees but not subcontractors of JCR HOLDINGS GROUP OF FLORIDA, LLC dba MISTER SPARKY Effective date: 10/1/2013 CERTIFICATE H LD R CANCELLATION 62600001 Village of Miami Shores 10050 NE 2 Ave SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WALL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Miami Shores, FL 33138 AUTHORIZED REPRESENTATIVE Glen J Distefano ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD ._KT NO- 18284529 Todd Trowbridge 11/6/2013 12:35:28 PM Page 1 o1: 1 OPEN INVOICES AS OF 08:35:43am 14 May 2014 ACCT_ CUSTOMER JOB -NAME TR -DATE. .' 15263 MISTER S --SHOP A 01/28/14 267735 15263 MISTER S --SHOP A 01/28/14 267743 15263 MISTER S --SHOP A 01/28/14 267746 15263 MISTER S --SHOP A 01/28/14 267747 15263 MISTER S --SHOP A 01/28/14 267748 1.5263 MISTER S --SHOP A 01/28/14 267749 -� 6: 15263 15263 15263 1526) 15263 15263 15263 5263 --:G3 .:2H3 15263 15263 15263 15263 15263 15263 15263 15263 15263 15263 15263 15263 15263 5263 15263 15263 15263 15263 15263 15263 MISTER S --SHOP A 01/28/14 267750 MISTER S --SHOP A 01/28/14 267751 MISTER S --SHOP A 01/31/14 268073 MISTER S --SHOP A 01/31/14 268076 MISTER S --SHOP A 01/31/14 268077 ART ill -Y LOS11ER S --SHOP A 01/31/14 268078 MISTER S --SHOP A 01/31/14 268079 MISTER S --SHOP A 01/31/14 268080 MISTER S --SHOP A 01/31/14 268122 MISTER S --SHOP A 01/31/14 268247 MISTER S --SHOP A 02/03/14 C35775 MISTER S --SHOP A 02/05/14 268718 MISTER S --SHOP A 02/06/14 268719 MISTER S --SHOP A 02/06/14 26872 MISTER S --SHOP A 02/07/14 268861 MISTER S --SHOP A 02/07/14 268J70 MISTER S --SHOP A 02/07/14 2872 MISTER S --SHOP A 02/07/14 28873 MISTER S --SHOP A 02/07/1V268876 68875 MISTER S --SHOP A 02/07/1 MISTER S --SHOP A /3/17/14 4 268877 MISTER s --SHOP A 4 268878 MISTER S --SHOP A 4 269600 MISTER S --SHOP A 4 272056 MISTER S --SHOP A 4 272098 MISTER S --SHOP A 4 272099 MISTER S --SHOP A 4 272100 MISTER S --SHOP A 4 273088 MISTER S --SHOP A 273091 MISTER S --SHOP P1 03/17/14 273093 MISTER S --SHOPA 03/17/14 273096 MISTER S --SHOP 03/17/14 273105 MISTER S --SHO A 03/17/14 273107 1 59.394 59. 39 3. C RLOS RAUREL 24.911 0.91 3 ANNA PAPUTANS 0.80 /0 .80 3 GREG EBLING 4.15-' 4.15 3 JOHATHAN BENN ETT 6.30'x" / 6.30 3 MEARS CONSTRU / CTION 9.30r// 9.39 3 PATRICK KARAK AZE 5.90 3 FERMIN ORDAZ 9.81 3 MARY RENOLDS 101.68 3 18 177.34 3 19 /2.51' 26.51 3 14 54.63 3 15 4.82 3 16 61.66 3 17 69.35 3 SEIDNER 57.784' 57.78 3 SEIDNER -37.32- -37.32 3 120.98-I 120.98 3 GEORGE GREY" 46.524 46.52 3 BLISS 167.62-4' 167.62 3 SEIDNER 7.30-)r 7.30 3 ONE SOURVC ST UDIO 49.37 49.37 3 TAP TAP RESTA 9.24_'1` 9.24 3 URANT RON STAMEY 36.42 36.42 3 JOSLYN WHIPPL E 2.03 2.03 3 MARIA MURICIA 40.95' 40.95 3 TIMOTHY COUNC IL 17.44,1' 17.44 3 LISETTE SMYTH o711��9 0. 54 10 FISSHMAN 31.2 31.22 2 BRIGHTSTAR 17.744 17.74 2 1463 12.714- 12.71 2 1459 2.34' 2.34 2 1414 57.87 57.87 2 MARSHALL 2011 62.91 62.91 2 NANCLARES 201 1-2008 3.50-x" 3.50 2 WRIGHT 2008 44.29 44.29 2 PFANZ 2008 6.15. 6.15 2 SILVER 2008 0.76-r 0.76 2 PALIN 2008 SOUTH DADE ELECTRIC & SOUTH DADE LIGHTING FAX 305-251-5254 - PHONE 238-7131 d