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DEMO-14-1018Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-212637 Scheduled Inspection Date: July 31, 2014 Inspector: Devaney, Michael Owner: ESCALONA, CRISTINA CRUZ Job Address: 10616 NW 2 Avenue Miami Shores, FL 33150 - Project: <NONE> Permit Number: DEMO -5-14-1018 Permit Type: Demolition Inspection Type: Final Work Classification: Electric Phone Number Parcel Number 1121360020060 Contractor: DANCE ELECTRIC INC Phone: (954)236-8824 tsuuamg uepartment comments DEMO INTERIOR ELECTRIC INSPECTOR COMMENTS False Inspect C mmenl Passed EEJ/_ Failed Correction ❑ Needed Re -Inspection a Fee No Additional Inspections can be scheduled until re -inspection fee is paid. July 30, 2014 For Inspections please call: (305)762-4949 Page 5 of 26 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 02 LECTRIC ❑ ROOFING MAY 18 2014 FBC 20 l c:�' Master Permit No.) 0h Sub Permit No.^yb q t CA � ❑ REVISION ❑ EXTENSION VRENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS [:]CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: /00v/ /V A/ l -Ph . e City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: l I / J d�020060 Is the Building Historically Designated: Yes NOS" Occupancy Type .f� Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): 46ii�yi,7s Crvz L �[���, s U rain Phone#: Address: _ Cr49 City: L f' State: %^� Zip: -? 97 I " Tenant/Lessee Name: Phone#: Email: G CONTRACTOR: Company Name: r2al.ccC-4de; Phone#: / ��/�2,701– ffl.? I-/ Address: o9 40 C, i plc City: i v r P State: rL Zip: Qualifier Name: MAJ / 6IP,)Ce Phone#: State Certification or Registration #:�: �f'.7i.��9 Certificate of Competency #: DESIGNER: Architect/Engineer: /V/ Phone#: Address: City: State: Zip: Value of Wor for this Permit:. $; 770 0 Square/Linear Footage of Work: Re air/Replace ❑ Demolition Type of Work: ❑ Addition ❑ Alteration El New Descri tion of Work:Cell, i ✓wept + 4 tz/: //,;" i Specify Submittal Submittal F Scanning Fee $ _ Technology Fee $ Training/Education Fee $ Double Fee $ Structural Reviews (Revised02/24/2014) Bond $ TOTAL FEE NOW DUE $ 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 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 day of 20 /V , by 4. who is personally known to Signature e — CONTRACTOR The foregoing instrument was acknowledged before me this ay of �y , 20 / V , by G+�I who is.pswQ &Hyicnawn to me or who has produced 1 as me or who has produced as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: N �} 4 Sign: &L�- Print: U,'O Print: '° i t &r:1 Seal:Seal: DEBBIE AF0LftVW G. 4 DEBBIE APOLINAIN Notary PUDIiC - She #I • , Notary P ,. • StMe of FlorMa •a My Comm. Expires May ��S My Comm. Expires May 27.20 ° ,„',;:��`' �t • ZOIi mo�oo.. Comma N FF APPROVED BY`'� ff,tP�o 2eajlz/ Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) 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. IT A. V/ -,COPY OF QUALIFIER'S STATE LIC CARD B. i/ o COPY OF LOCAL BUSINESS TAX RECEIPT C. ✓ COPY OF LIABILITY INSURANCE (CERTIFICATE HOLDER TO BE MIAMI SHORES VILLAGE BLDG DEPT) D. 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 SHORED, FL33138ONE COMPLETE CONTRACTOR'S INFORMATION 1 BUSINESS NAME: OCA>1Cf. 674fAr',c ,. -Tty< BUSINESS ADDRESS: f4�14(tiC -1 fele CITY Owe, STATE fr�L ZIP CODE BUSINESS PHONE: ( 7 `i ) Z6- FAX NUMBER �) CELL PHONE L) QUALIFIER'S NAME: P%I 04ncC QUALIFIER'S LIC NUMBER: L L 0c)005'0 EMAIL ADDRESS (IF APPLICABLE): '��: L'�*�-�r' r� �'a'"��� /fie 7 - Created Created on 3119109 BY MLDV I RV 3126109 MLDV Y ® .414. © CERTIFICATE OF LIABILITY INSURANCE 5�6i20M�14 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. a IMPORTANT: If the Certificate holder la an ADDITIONAL INSURED, the pollcy(lies) 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). PRODUCER Bruening Insurance CO NA AE r Commercial Lines PHONE (954)473-1406 FAX (554)659-2338 2700 S. Commerce Parkway L Suite 309 INSU S AFFORDING COVERAGE NAICP Weston FL 33331 INSURER A -Travelers INSURED misula;ER B INSURER C: Dance Electric, Inc. INSURER D: 2663 E Abiaca Circle INSURER E: 60-1C852844 INSURER F: Davie FL 33328 GOVERAGES CERTIFICATE NUMRFR-CL1382003782 REVISION NIIMRFR- 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. L TYPE OF INSURANCE LICY NUMBER M U EFF POLICY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 -DAMAGE TO RPRIta PREMISES $ 100,000 A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OX OCCUR 60-1C852844 /1/2013 /1/2014 MED EXP (Any one perm) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/0P AGG $ 2,000,000 X POLICY M PRO LOC $ AUTOMOBILE LIABILITY Ea COMBINED I IT BODILY INJURY (Per Person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per aodderd) $ HIRED AUTOSNON-OWNEDPROPERTY AUTOS DAMAGE_ $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS UAB Lwl CLAIMS MADE DED I I RETENTION $ WORKERS COMPENSATION WC S A - OTH- AND EMPLOYERS LIABILITY Y / N ANY PROPRIETOR/PARTNERIEXECUTNE OFRCER/MEMBER EXCLUDED? N/A TORY LIMITS ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ (Mandatory In NH) describe under EL DISEASE - POLICY LIMIT $ g;6If DRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS / LOCATIONS 1 VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) Please refer to Policy for terms, Conditions and exclusions. Electrical Contractor -Unlimited State Certification EC0000569 Miami Shores Village Building Department 10050 N.E. 2nd Avenue Miami Shores, FL 33138 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCE1.ED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORED REPRESENTATIVE i Bradley Bruening/IP ©1988-2010 ACORD CORPORATION. All rights reserved. IN9025 r?nim5i n1 Tho A(`.nRn norma and Innn urn raniataraaA madre of Ar'.ARn CERTIFICATE OF LIABILITY INSURANCE I °BMW 1 1a Richard M. Galt Insurance Agency Inc 9367 WEST SAMPLE ROAD CORAL SPRINGS, FL 33065 019WAD UI'NYVG CL -%OI IMV 1119V. 2663 EAST ABIACA CIRCLE, FT LAUDERDALE, FL 33328 COVERAOE8 CER I FWATE NURIBM REVISION NUS THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTIMTHSTANINNGI 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 13 SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POUC1ES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAN& MPOLMTEFF JA TMOFINSURANCE LINII'S A GENERALUASHM COMMERMALGENEMLIASUff WIMIRAAM ❑ OOM EACHOOCUlutEMMS M Eaoo keno s MEDEXPWWawpw=0 s PERSONAL&AWINAW S GENERALAGGRWATE s GEWLAGGREGATEUNITAPPLIESPER POLm Loc PRODUCTS - S s A AUTOMOW a MY X aNrauro ALLX AUTOS HORWAUTOS XAUTOS 9�es s 4 10 14 s 0 eoorLrtPe►Pe") $ 250= 500000 �nYDLamriPe. SNONOMaW S loom a t J I1 EXU$LIAB Ho=m p EAW OCCUR $ AtGA7E $ lD RETENTION $ A NORKERSOOMPENSATMLIAI L"Y ANYPROPRFETOWP� YIN uraaae�mme�ILI NIA 98 -BH -K7463 F 01@013 0 111Dt4 STATU E.L.EIIGUAOCO]HIT i 900000 EL. -EA s 100000 E L. aSEASE-POLICY Lolly $ s PH C IIO11 0 1 IMTOWILOCA7RMIVEMIXES IAft0bACORDW%Ad R�uul® gBmasapmeise CbnftatkM 51M BeCbicWffln"" bWMkW Florida Siete Warm Miami shores village Building Department 10050 N.E. 2nd Avenue Miami Shores, Fi 33138 SHOULD ANY OF THE ABOW DESCRIBED POLICIES BE CANCEIMM BEFORE THE EKPFRATIOM DATE THERSOF. NOTICE llLL BE DEIJVERED IN ACOORDANCEVOTHTHEPOLICYPROVNIOUL L r_a r1 AQ AW 0 (MMM TW ACORD naM and k>go are regkftred marks of ACORD 1001486 132849.6 0123.2013 DETACH HERE 3 _ SfikT Off: fLO IDA .. _. :. 4Y x,' i1RPART T ' I� Pxt FE9SX01" REGU Ecs ea�oRsEs�vG $aRn p8 :2 :.2C1 0+41381.. cooao569�� � F � }.,�• The : ELEC`�>I�I� Nam,&& below .I'9 C> ;itTIFIEI):. y Mader the oviaioa� of Chapt ` $xpiration .ate: AtT.q,:; 31, .2014> �,f� ffl s J DANART CE :ELEf c ; M 2663 2 ASIla CIR s DIL :t ISL 33325 r 2r I" ECOT RA st OR h DISPLAY AS REQUIRED BY LAW SEQ#L12082202976 KEN LAWS.ON SECRETARY. I0r1AJWVJ'►R{J VVLOM 1 i LVL/1L` 12LOON gV-00 I P%^ RGLGir" 1 115 S. Andrews Ave., Rm. A-100, Ft. Lauderdale, FL 33301-1895 — 954-831-4000 VALID OCTOBER 1, 2013 THROUGH SEPTEMBER 30, 2014 DBA: Receipt x:;181-16363 DANCE ELECTRIC INC ELECTRICAL ALARMS/ Business Name: Business Type: (=CTRICAL CpNTR) Owner Name: PAUL A DANCE Business Opened:03/01/1986 Business Location: 830 NE 58 CT State/COunty/Cert%Reg:EC0000569 OAKLAND PARK Exemption Code: Business Phone: 771-0707 Rooms Seats Employees Machines Professionals 10 For Vending Blwineas Only Number of Machines: F" Tvoe: Tax Amount Transfer Fee NSF Fee Penaay Prior Years Collection Cost Total Paid 27.00 0.00 0.00 0.00 0.00 0.00 27.00 I i THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS i 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 and/or Municdpality planning i WHEN VAUDATED and zoning requirements. This Business Tax Receipt must be transferred when ' the business Is sold, business name has changed or you have moved the i business location. This receipt does not indicate that the business Is legal or that i It Is in compliance with State or local laws and regulations. i Mailing Address: PAUL A DANCE 2663 E ABIAGA CIR DAVIE, FL 33328