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EL-13-1503Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-212783 Permit Number: EL -7-13-1503 Scheduled Inspection Date: May 22, 2014 Permit Type: Electrical - Residential Inspector: Devaney, Michael Inspection Type: Final Owner: BARCHAN, NORTON & MARGARET Work Classification: Alteration Job Address: 1600 NE 103 Street Miami Shores, FL 33138 - Project: <NONE> Contractor: EVOLUTION ELECTRICAL CONTRACTORS comments Phone Number Parcel Number 1132050310120 Phone: (786)351-5784 ELECTRICAL WIRE BOATLIFT INSTALL 4 LIGTHS ' —_ ��""" INSPECTOR COMMENTS False Passed ET Inspector Comments Failed�� Correction Needed Re -Inspection ❑ Fee No Additional Inspections can be scheduled until re -inspection fee is paid. May 21, 2014 For Inspections please call: (305)762-4949 Page 23 of 37 Miami Shores Village Building Department artment Jug 111113 :a 90050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER- (305) 762.4949 FSC 20 BUILDING PERMIT APPLICATION Permit Type: Electrical JOB ADDRESS: j(000 _ t L 1 ®3 2' E5\ ., Permit No. CU 13 s I`Sn Master Permit No.QQl — I ` 9" City: Miami Shores County: _ Miami Dade Zip: Folio/Parcel#: i `r `3e�®!r- t)31 ~ ®1 Z-0 Is the Building Historically Designated: Yes NO Flood Zone: OWNER: Name (Fee Simple Titleholder): Uo2t erN QAf2_CAt1rf'J Phone#: �j®S • �ej �i �� j� Address: I b ®0 N G' 0 z"Z-0 S i City: KI flV%& oq2 - S State: Zip: 133 1 Tenant/Ussee Name: Email: CONTRACTOR: Address: 11? City: )�AtA� Qualifier Name: Name: k"I 0 1 aj&� f- k &AU Cla� 6 QA�VnAnKT hona.46 - 7-P -?a 1!? State Certification or Registration #: f(L J � �_ 4 3 t Certificate of Competency #: J 0 E 0 00 Contact Phone# : (0 - 1.4- -Z'J�� Email Address: �V O <~u t 1 � � 1((2[�'o DESIGNER: Architect/Engineer: Phone#: Value of Work for this Permit- $ (yE ® ® SquardLinear Footage of Work: Type of Work: ❑Address ❑Alteration ❑New Wepair/Replace ❑Demolition Description of Work: _ ERL C j Q -t "-L - Lo ( 2r e)&t4 t L 1'i r - t Nbi fl� L 1-i LZ'AYJT rj Submittal Fee $ Permit Fee $ 3 CCF $ CO/CC $ Scanning Fee $ Radon Fee $ Notary $ Tndning/Education Fee $ Double Fee $ Structural Review $ DBPR $ Bond $ Technology Fee $ 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 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 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. I _. N I W, _E I 1 0 Owner or Agent The foregoing instrument was ac7wledged before me this day of , 20 L5—, by IJ , who is personally known to me or who has produced As identification and who did take an oath. NOTARY PUBLIC: �r ...?.I De Sign:nise Mweemw l Print: C RES: FEB. 1.%2018 pN My Commission Expires: r� , k9J 201 Signature Contractor ,? The foregoing in t p acknowlledged before me this I0 day of / � 2013, by who is personally known to me or who has produced,. jam' Q 22� -f 1 *10identification and who did take an oath. NOTARYWRLI My Commission Expires: naiill's 1 j - APPROVED BY Plans Examiner Zoning Structural Review (Revised 3/12t2012)(Revised 07/10/o7)(Revised o&lo w)(Revised 3/15/09) Clerk 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. IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: A. COPY OF QUALIFIER'S STATE LIC CARD B. 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 SHORES, FL 33138 ■■rrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrr� COMPLETE CONTRACTOR'S INFORMATION BUSINESS NAME: jog 'E l f-04%tQa BUSINESS ADDRESS: llW31 to .)A '59'VL. CITY 1hl hla STATE-- L ZIP CODE 31011, BUSINESS PHONE:(3oy 1 1 - t (off FAX NUMBER CELL PHONE (aj�-) QUALIFIER'S NAME: N ak la i Q b-605-1- h QUALIFIER'S LIC NUMBER: i7 �J�/516:1 F h� E-MAIL ADDRESS OF APPLICABLE): �l .�T ®�C I tat IUk,'a0" 0)M L,9�� Created on 3M90 BY MLOV I RV 3!26!09 MLDV TE A D® CERTIFICATE OF LIAILITY INSURANCE DA 6/18/1 � FPRODUCER Southern Star Insurance Agency, Inc 8338 SW 8th Street _B_ THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR Miami, FL 33144 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Phone (305)496-0079 Fax (305)262-2647 INSURERS AFFORDING COVERAGE NAIC # INSURED EVOLUTION ELECTRICAL CONTRACTORS INC. INSURERA ASCENDANT COMMERCIAL INS 10050 N.E 2ND AVE 11631 NW 58TH PL MIAMI SHORES,FLORIDA 33138 INSURER B: INSURER C: HIALEAH,FL.33012 INSURER D: INSURER E: COVERAGES INSURER F: THE POLICIES OF INSURANCE LISTED 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR ADD L INS RD TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE MMIDD POLICY EXPIRATION DATE MM/DD LIMITS GENERAL LIABILITY EACH OCCURRENCE 1,000,000.00 COMMERCIAL GENERAL LIABILITY GL-36537-0 07/29/12 07/29/13 DAMAGE TO PREMISES EaENTED occurence 100,000.00 MED EXP (Any one person) 5,000.00 A ❑ 1:10 CLAIMS MADE FV OCCUR ❑ PERSONAL BADVINJURY 1,000,000.00 ❑ GENERAL AGGREGATE 1,000,000.00 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG 1,000,000.00 0 POLICY ❑ PROJECT ❑ LOC AUTOMOBILE LIABILITY j COMBINED SINGLE LIMIT ❑ ANY AUTO (Ea accident) BODILY INJURY (Per person) ❑ ❑ ALL OWNED AUTOS ❑ SCHEDULED AUTOS ❑ HIRED AUTOS ❑ NON OWNED AUTOS BODILY INJURY (Per accident) ❑ PROPERTY DAMAGE ❑ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT OTHER THAN EA ACC ❑ ❑ ANY AUTO ❑ AUTO ONLY: AGG EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE AGGREGATE ❑ OCCUR ❑ CLAIMS MADE ❑ ❑ DEDUCTIBLE ❑ RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY WC STATU- ❑ OTH- TORY LIMITS ER E.L. EACH ACCIDENT ANY PROPRIETOR / PARTNER / EXECUTIVE E.L. DISEASE - EA EMPLOYEE OFFICER / MEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE -POLICY LIMIT OTHER DESCRIPTION OF OPERATIONS / LOCATIONS i VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS r_GaTII:IreTF NnI nFR CANCELLATION ACORD 25 (2001/08) QF I �.—✓ `.' J%%."^" w., SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL MIAMI SHORES VILLAGE 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO BUILDING DEPARTMENT THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR UABIUTY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. 10050 N.E 2ND AVE AUTHORIZED REPRESENTA MIAMI SHORES,FLORIDA 33138 ROBERTO OJEDA ACORD 25 (2001/08) QF I �.—✓ `.' J%%."^" w., FIRST-CLASS UAL POSTAGE PMD MIAA% FL PER MT NO. ni THIS 18140T A BILL — DO NOT PAY 6738RENEWAL 2-9 eub�nlEsB /LocA'rtON RECEIPT NO. 701181-0... EVOLUfIOM ELECTRICAL CONTRACTORS CC 8 IOE000610 INC i 11631 NW 58 PL 33012 UNIN DADE COUNTY OR EVOLUTION ELECTRICAL CONTRACTORS WORKER/S CONTRACTOR 1 DO NOT FORWARD IMCBro�sa e�nrrax 10/01/2012 Q225'003Q001- 000815.00 SEE OTHER SIDE EVOLUTION ELECTRICAL CONTRACTORS INC ANTONIO ACOSTA PRES 11631 NW 58 PL MIAMI FL 33012 !F}f�4tli�t/i!!kllt�li/It�t{�Illi�iDt!!{t1�71Ftillil77 �17iiD7� � f ACOSTA, ANTONIO EVOLUTION ELECTRICAL CONTRACTORS, INC. 11631 NW 58TH PLACE HIALEAH FL 33012 (850) 487-1395 I staff of AG 6fl ? 0 Congratulations! With this license you become one of the nearly one million DEPAgp+; EtTgNBSS AND Floridians licensed by the Department of Business and Professional Regulation.p gyg II"T- 11 +7� Our professionals and businesses range from architects to yacht brokers, from boxers to barbeque restaurants, and they keep Florida's economy strong.'` ER1301453i;'i3 12T011519 Every day we work to improve the way we do business in order to serve you better. For information about our services, please log onto www.myfloridalloonse.com REG There you can find more information about our divisions and the regulations that . AC�QSTAr impact you, subscribe to department newsletters and learn more about the SVOLf7TIQ kONTRAC'ORS Department's initiatives. (TI+IDIYi9 Aix LOCFL LICENS131ta S PRIQR Our mission at the Department is: License Efficiently, Regulate Fairly. We TO CONTRACTNG.s ANY, AREA) constantly strive to serve you better so that you can sere your customers. _dew ti p{ovasigns _off ` , 48 Thank you for doing business in Florida, and congratulations on your new license! AQ' 31 2I4 is 2aB27a60 DETACH HERE 11-19-2012 JEFF ATWATER STATE OF FLORIDA CHIEF FINANCIAL OFFICER DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION * * CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS COWENSATION LAW * * CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers Compensation law. EFFECTIVE DATE: 11/19/2012 PERSON: ACOSTA FEIN: 273616053 BUSINESS NAME AND ADDRESS: EVOLUTION ELECTRICAL CONTRACTORS INC 11631 NW 58TH PL HIALEAH FL 33012. SCOPES OF BUSINESS OR TRADE: 1- ELECTRICAL MIRING WITHIN BUIL EXPIRATION DATE: 11/19/2014 ANTONIO IMPORTANT. Pursuant to Chapter 440 . 05114!, F.S., an officer of a corporation who elects exemption from this chapter by filing a certificate of election under this section may not recover benefits or compensation ander this chapter. Pursuant to Chapter "(1.0600, F.S.. Certificates of election to be exempt... apply only within the scope of the business or trade listed on the notice of election to be exempt. Pursuant to Chapter 440.05113), F.S., Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation if, at any time after the filing of the notice or the issuance of the certificate, the person earned on the notice or certificate no longer meets the requirements of this section for issuance of a certificate. The department shalt revoke a cenificate at any time for failure of the person named on the Certificate to meet fire requirements of this section. QUESTIONS? 0501 413-1609 OWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01-11 PLEASE CUT OUT THE CARD BELOW AiND RETAIN FOR FUTURE REFERENCE STATE OF FLORIDA - DEPARTMiENT OF FINANCIAL SERVICES DIVISION OF WORKERS! COMPENSATION CONSTRUCTION INDUSTRY CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS COMPENSATION LAW I&. EFFECTIVE: 11/19/2012 EXPIRATION DATE: 11/19/2014 PERSON: ANTONIO ACOSTA FEIN: 273616053 BUSINESS NAME AND ADDRESS: EVOLUTION ELECTRICAL CONTRACTORS INC 11831 NW BOTH PL HIALEAH, FL 33012 SCOPE OF BUSINESS OR TRADE:- I- RADE1- ELECTRICAL WIRING WITHIN BUIL IMPORTANT F Pursuant to Chapter 440.05114), F.S., an officer of a corporation who 0 elects exemption from this dhapter by filing a certificate of election L under this section may not recover benefits or compensation under this D chapter. Pursuant to Chapter 440.05!121, F.S., Certificates of election to be H exempt.. apply only within the scope of the business or trade listed on E the notice of election to be exempt R E Pursuant to Chapter 440.05(131, F.S., Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation if, at any time after the filing of the notice or the issuance of the certificate, the person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate The department shall revoke a certificate at airy time for failure of the person reamed on the certificate to meet the requirements of this Section. QUESTIONS? (850) 413-1609 CUT HERE w Carry bottom portion on the job, keep upper portion for your records. OWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01-11 CTQB { Construction Trades Qualifying Board 41 ` = BUSINESS CERTIFICATE OF COMPETENCY EVOLUTION ELECTRICAL CONTRACTORS INC D.B.A.: ACOSTA ANTONIO is certified under the provisions of Chapter 10 of Miami -Dade County i '23-000-58-,' jio CIO"-", .1 . not. To Miami Shores Village To whom it may concern. uary 13, 2014 In reference to the following permit numbers: DOCK-7-13-14G.and EL -7-13-1503 for Norton and Margaret Barchan, we would like to ask for an extension due to our barge undergoing repairs at a dry dock. This means we will have to wait for mobilization, and have had to put this project on hold until the repairs are completed. Thank you for your patience and understanding. Re a s Jam c zie Max a ne and Foundation, In. iamesjamesmjr aAaol.com 305.785.8682