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EL-14-2121Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-220542 Scheduled Inspection Date: October 08, 2014 Inspector: Devaney, Michael Owner: HOLT, JAMES Job Address: 361 NE 97 Street Miami Shores, FL 33138-0000 Project: Contractor: <NONE> ANAMIK ELECTRIC CORP Building Department Comments DISCONNECT - RECONNECT OF A/C UNITS AHVS /_ Z-1i ,, Permit Number: EL -9-14-2121 Permit Type: Electrical - Residential Inspection Type: Final Work Classification: Repair Phone Number Parcel Number INSPECTOR COMMENTS False Inspector Comments Passed Failed C �7, Correction ❑ Needed Re -Inspection ❑ Fee No Additional Inspections can be scheduled until re -inspection fee is paid. 1132060135760 Phone: (786)395-6931 October 07, 2014 For Inspections please call: (305)762-4949 Page 12 of 25 Miami Shores Village Building Department 90050 NY -2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 IAWECTION'S PHONE NUMBEB: (305) 762.4949 BUILDING PERMIT APPLICATION :.Permit Type.- ect icW FBC 20 (0 Permit No. Il 21 Master Permit No. MC - 4.14 - $ Z JOB ADDMM.- 361 N Qistvr �- City: County; ZIP; Fglio/ParcxhY: l- �6- 0 1 S7 ko - Is the Bugg Mdortaffly Designate& Yes NOPlood Zone: OWNERS Name (Fee Simple Titleholder):_ B I QGIe we d . S"hG-i'PS LLC Phanet Addr=: 2425S"direc+ :34S ►: Fk,Gko Stn: N C zp; z$6D Tensat2essee Name: Pte . Entail - iib 3°�5 b9a1 CONTRACTOR: Company Name: A morn i iG �Ic I-*- 60ap Phonefk:305 -Z$2- 31 b$ .:Address: 48 ► t11 Tbs_t city: "%4leA%% State: FLzip:14 Qualift Name. - - I_Ac'g uCj Metn d CMPhone#: 30S - Zig 2- 316$ State. C.e dncatkm or ltegist don#: EC Certificate of Competency#: Contact Phonal►: Email Address: DFSIGNM ArchitecWn&eea: Phoaei6: Value of Work for this Permit: $yrOO. e v ..nre/Linear Footage of Work: Type of Work; OAddress OAlteration CINew UltepaWRplace CaDemolitton Damon of Work Die corwecooll - Mc c 0 ec.0 Off' i4 .4f{GIs �_�2� G�G!• eeee�e eee F� e Submittal I{`+da $ Permit Fee $ . dl 99 >P��r'' CCF $ � (00 CO/CC $ Senning Fee $ � •� Radon Fee DBPR $ � ($, Notary $ TrniningfEducation Fee $ ® Te1no1W Fee $ C '� Double Fee $ Stradaral Review $ 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 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 goad 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 ncc such posted notice, the inspection will not be ap rov and a reinspection fee will be charged. Signature Signature ' Owner or Agent Contractor The foregoing ' nt was acknowledged before this AF The foregoing instrument was knowledged before Inc this day of ' 20, by day of , 20 by who is personally known to me or who has produced who is personally known to ark" or who has produced As identification and who did take an oath. as identification and who did take an oath NOTARY PUBLIC: NOTARY LIC: Sign: Sign: Print: " •MEAGM RICE print MY C0WISSt0N # EE 81f3345 .. My Commission ' EXPIRES: Match 13, 2017 My Commicci r CHRISTOPHER d POMPIt10 BMW Ttn Public Unbemfts � �~ MY COMMISSION # EE X15 EXPIRES: July 2,017 Fb APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revisal 311212012)(Revised 07/1W7XRevisBd 06/1=009)(Revised 31[5/09) 41940 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD �� NORTH MONROE STREET TALLAHASSEE FL 32399-0783 MENDEZ, MIGUEL ANAMIK ELECTRIC CORP 481 WEST 76 STREET HIALEAH FL 33014 Congratulations! With this license you become one of the nearly ^ one million Floridians licensed by the Department of Business and Professional Regulation. Our professionals and businesses range from architects to yacht brokers, from boxers to barbeque restaurants, and they keep Florida's economy strong. 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.myfloridalicense.com. There you can find more information about our divisions and the regulations that impact you, subscribe to department newsletters and learn more about the Department's initiatives. Our mission at the Department is: License Efficiently, Regulate Fairly. We constantly strive to serve you better so that you can serve your customers. Thank you for doing business in Florida, and congratulations on your new license! v ISSUED: 08/25/2014 DETACH HERE (850) 487-1395 I a a XM LY CERTIFICATE OF LIABILITY INSURANCE DATE05/27DMlY1r) 05/27/14 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. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the poticy(ies) 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 Government Insurance Corp. 18501 Pines Blvd., Suite #205E-MAILADDRE Pembroke Pines, FL 33029 Phone (954) 727-2999 Fax (954) 727-2888 COME:NTACT JESUS ARBOLEYA NA PHONE (954) 727-2999 FAX No): (954) 727-2888 anna@ginscorp.com INSURERS AFFORDING COVERAGE NAIC d INSURER A: The Travelers Property Casualty Ins Co of America 25674 INSURED Anamik Electric Corp. 2900 Glades Circle, Suite 200 Weston, FL 33327 (305) 282-3168 INSURER B INSURER C: INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 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 CONTRACTOR 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. ILTR TYPE OF INSURANCE ADD UBR POLICY NUMBER MUDY EFF POLICY Y LIMITS A GENERAL LIABILITY ® COMMERCIAL GENERAL LIABILITY F-17 CLAIMS -MADE ® OCCUR ❑ 660-8928X005 11/01)2013 11/01/2014 EACH OCCURRENCE $ 1,000,000.00 PREMISES Ee occ rrence $ 100,000.00 MED EXP (Anyone person $ 5,000.00 PERSONAL &ADV INJURY $ 1,000,000.00 ❑ GENERAL AGGREGATE $ 2,000,000.00 GEN'LAGGREGATE LIMITAPPLIES PER: © POLICY ❑ PlFrTRO ❑ LOC PRODUCTS - COMP/OP AGG $ 2,000,000.00 $ AUTOMOBILE LIABILITY ❑ ANY AUTO ALL ❑ AUTOS NED ❑ SACOEDULED NON -OWNED HIRED AUTOS ❑ ❑ AUTOS ❑ ❑ OMBINED INGLE LIMIT accident TM BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ Per accident $ ❑ UMBRELLA LLAB ❑ OCCUR ❑ EXCESS UAB ❑ CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ ❑ DED ❑ RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTNE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) rN Ues describe under RRIPTION OF OPERATIONS below N /A Rj WC STATU- ❑ OTH- DRYLIMS ER E.L. EACH ACCIDENT $ E.L DISEASE - EA EMPLOYE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, H more space is required) ANAMIK LICENSE NUMBER # EC130059DO CERTIFICATE HOLDER CANCELLATION @ 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) OF The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE MIAMI SHORES VILLAGE BLDG DEPT THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 10050 NE 2 AVE ACCORDANCE WITH THE POLICY PROVISIONS. MIAMI SHORES, FL 33138 AUTHOR® REPRESENTATIVE @ 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) OF The ACORD name and logo are registered marks of ACORD ANAMIA OP ID: HH ,d►►�coRcr CERTIFICATE OF LIABILIW INSUMNCE D0512712014Y) 05127/2014 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 endorsement(s). PRODUCER Ryan Insurance & Financial Svc 302 W Now►York Ave Deland, FL 32720 Silver NME: Insurance Department OUCEN E :386-738-2000 FAX No: 386-738-2053 a DRE SS: Certificates@seanryaninsurance.com Rodney GENERAL LIABILITY INSURERS) AFFORDING COVERAGE NAIC @ INSURERA:Star Insurance Company 24562 INSURED Anamik Electric Corp 2900 Glades Circle Ste 200 Weston, FL 33327-2214 INSURER B: INSURER C: INSURER D: INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: 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. LTRR TYPE OF INSURANCELIMITS AIJUL UU15H POLICY NUMBER POLICY EFF MM@ PO MM@DrYYW 10050 NE 2nd Avenue GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY CLAIMS -MADE F—I OCCUR DAMAGE TO RENTE PREMISES Ea occurrence $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS- COMPIOP AGG $ POLICY jRa LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ PER ACCIDENT HIRED AUTOS NON -OWNED AUTOS UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED I I RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITYER ANY PROPRIETOR/PARTNERIEXECUTIVE YIN OFFICER/MEMBER EXCLUDED? (Mandatory In NH) N f A C0780856 0 02/13/2014 0211312015 ST MITS OTH- X TORY E.L. EACH ACCIDENT $ 10% wo E.L. DISEASE - EA EMPLOYEE $ 100,00 Ifyes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE- POLICY LIMIT $ 500,00 DESCRIPTION OF OPERATIONS I LOCATIONS f VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Ia required) ArLamik Electric Corp EC13005900 CERTIFICATE HOLDER CANCELLATION MIAMISH SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Miami Shores Village ACCORDANCE WITH THE POLICY PROVISIONS. Building Department AUTHORIZED REPRESENTATIVE plasencia.javier@g m ail.com 10050 NE 2nd Avenue Miami Shores FL 33138 O 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 26 (2010105) The ACORD name and logo are registered marks of ACORD