EL-14-727Miami Shores Village
Building Department APR 10 2014
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 —�
Tel: (305) 795.2204 Fax: (305) 756.8972 - -
INSPECTION'S PHONE NUMBER: (305) 762.4949
FBC 2013
BUILDING
PERMIT APPLICATION
Permit Type: Electrical
Permit No.
Master Permit No. ` c -1'A I a(e-�
JOB ADDRESS: %oct w'� O -r- 1RnCLCh
City: Miami Shores County: Miami Dade Zip: 3 1
Folio/Parcel#: 11 32J�Lp 61-- 110
Is the Building Historically Designated: Yes NO Flood Zone:
OWNER: Name (Fee Simple Titleholder):Sb%ph I Jul i -e 6War17cylet2 Phone#:
Address: NIS A -U f n L)Q �ao0.d
city:, MI(xrnt Shoaes State: TL Zip:
Tenant/Lessee Name:
Email:
CONTRACTOR: Company Name: &*-)A E i'lt'CIZ06SCS Phone#: 9l 4' 42-4
Address: U)Os64
City: State: 'F -L- Zip: 133928
Qualifier Name: -&AUn kibL .�- 1�i Phone#:
State Certification or Registration #: EGA2-50C� 12AD 1 Certificate of Competency #:
Contact Phone#: Email Address: b6aen+e�oe11sou4�-
DESIGNER: Architect/Engineer: Phone#:
Value of Work for this Permit: $ 16 00 4 Square/Linear Footage of Work: 1,51
Type of Work: ❑Address Alteration ❑New ❑Repair/Replace ❑Demolition
Description of Work: 19MOCUA I Q,1Pp P,ce sifYl - ae rrtn v1
.\ A_
hJn��` 0.� ex1'tc�5i' 4an a3WAo;rLg1k-izn ont+r, )urribivri-AiC4-4=,—or�l
-N.Rae5 Cornee-K-A -it, E'415q" i?io lino► A , 4-A e1SAetca% NrtUrO
Submittal Fee $ WPermit Fee $
Scanning Fee $ Radon Fee $
Notary $ Training/Education Fee $
Double Fee $ Structural Review $
CCF $ CO/CC $
DBPR $ Bond $
Technology Fee $
TOTAL FEE NOW DUE $\ i k. a
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-219374 Permit Number: EL -4-14-727
Scheduled Inspection Date: September 11, 2014 Permit Type: Electrical - Residential
Inspector: Devaney, Michael Inspection Type: Final
Owner: OBERMEYER, JOSEPH & JULIE Work Classification: Alteration
Job Address: 9909 NE 4 Avenue Road
Miami Shores, FL
Phone Number
Parcel Number 1132060171310
Project: <NONE>
Contractor: B.S.A ENTERPRISES INC Phone: (954)424-0998
dunaing uepartment comments
REMODEL MASTER BATHROOM
INSPECTOR COMMENTS False
Inspector Comments
Passed ® a e
Failed
Correction ❑
Needed
Re -Inspection ❑
Fee
No Additional Inspections can be scheduled until
re -inspection fee is paid.
September 10, 2014 For Inspections please call: (305)762-4949 Page 26 of 31
R
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 nt must be po t the job site
for the first inspection which occurs seven (7) days after the d. In absence uch posted n ' e, the
inspection will not be approved and a reinspection fee will be rged.
Signature
Owner or
The foregoing instrument was acknowledged before me this
day of NAPQW* 1 , 20 &, by
who is person ly know to me or who has produced
As identification and who did take an oath.
The foregoing instrument was acknowledged before me this
day of 41 fitLj6 20 &, by�f(+ l L&a( 41 �.
who is personally known to me or who has produced
identification and who did take an oath.
NOTARY P NOTARY PUBLIC:
i
Sign:F Sign: ` kL�l
Print: ROBERT FEINBERG Print:
e .° = Notary Public - State of Florida
My Commission Exp' •)' My Comm. Expires Apr 8, 2016 My Commission Expire►; auB LOISTEPPER
», 4b
'%' ����� ..•` Commission # EE 158541 * MY COMMISSION # FF 0044
EXPIRES: September 9, 2017
� BondedThNBudgolNobrYeerolwc
APPROVED BY *K064:—/�40ans Examiner Zoning
Structural Review
(Revised 3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(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.. Z 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
COMPLETE CONTRACTOR'S INFORMATION
BUSINESS NAME: En -el S
BUSINESS ADDRESS: Z _ :�U) &CITY i e
STATE 4--L ZIP CODE
BUSINESS PHONE: R5-4-).4 FAX NUMBER ( ) !V+ 0_9(p
CELL PHONE ( )
QUALIFIER'S LIC NUMBER: t 30-0121b 1
E-MAIL ADDRESS (IF APPLICABLE): 106a lfr--rt G be 1w --LA -I, . (1C+
Created on 3119109 BY MLDV I RV 3126109 MLDV
04-10-'14 12;46 FROM -Allied Kitchen
CERTIFICATE OF
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND
NOT AFFIRMATIVCLY 09 NEGATIVELY AMEND, EXTEND 018 AL. raft THE CI
INSURANCE 0063 NOT CONSTITUTE A CONTRACT VETWEI:N THE ISSUINI
CERTIFICATE HOLOER,
IMPORTANT, If the certificate holder Is an ADDITIONAL INSURED, the policy
.onditione of the Do11CV. certain nallelm eAnu va....i.A m,. e. +..�e.�e.. • .....
,NKCRUM INSURANCEAGENI;Y, INC,
S. MISSOURI AVE,
ARWATER FL 33755
■
954-564-2676 T-547 P001/001 F-919
_IAISIL.ITY INSURANCE --we(U JOUM-'
41412014
%0NR@RS NO RIOHTS UPON TME CERTIFICATE HOLDER. THIO CERTIFICATE; ODES
IVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE= OF
i INSURERIS), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE
ROB) must'lIC 0401`60. Of allBROGATION IS WAIVED, subjeeg to the teTrA* end
Ihcnl on thls Certiflege daea not confer rights to the e##tlfit Ste holder in lieu aFsuch
60NTA01
RANG:
IA¢.N.6411;• 1-Ba0-2Ty 1620 x4890 wa} 727-797.0704
RW
AAOnCEn
INSURER 5 AFFORDINGCOVPI?AGE N toe
INOV4LK A FRANK Wlg8Y 7N CRUM INSURANCE CO 11609
IHAURFN a
N6URER G
FrenkCrum 1.099.277-1820 I SURERO �~ � �-
ICOS MISSOURI AVENUE INSURER E ~�
CLEARWATER FL 33759 INSURER I•
VSRAGES DL�WY ICATENUMBER: THIS is TO CERTIFY Ta"HE P 2 t152 NISsugg AEVISiONN BER:
ND7VATHSTRN91NG ANY REOUIREMENT, TERM OR CCONaTH9 11116111(til) NAMED ABOVE FOR THEP LICY
fr ¢N pF ANYONTRACT OR OTHE14 OCCUMENT WITH RESPECT 0 WHICH THIS CERTIFICATE MAY BE SUED OR MAY
PERTAIN. THE INSURANCE AFFDRbBb aY THE 03CLICIEP 000J9ED HEREIN IS SUBJECT TO ALL PQ TERMS, EXCLUSIONS AND CON01710N3 OF SUCH 0OLICiES. LIMITS OHOWN
MAY HAVE OWN REOV690 BY PAID CtAIMs,
INCA Tod of k5�4met
A
LTR OOL sumPOL1r:YNUIdOlR POLFOYEFF POLICY EYP
Wit NN9 Y IMAVOO.rr�Yl IMN10OrYYYY1 L.R1TS
• ■mains
oENERALLiAOILIyr I F
iFir Omni
13
Lft Dill"' 1AL11 I I I I I 60DILYtµA1RPY v t rteAlj , ••
A W96114tA$ COUPENOATON MND
EIAPLOWAMLIAINUTY
ANY 000A19YOWPARTNEPMECUDYE
0PAW;AtN umaF)IL;)u19.OP It14
(t•�AlMnlorr N NM
bErCRIRTIOM OF OPEtyMT10N5 Ott
WC2014t1 O 1 1/112014 1 1/112095
OTR.
ER
uwl:mrnvn yr PriFN nCnlil LODPr1gn15/YCNICLCS IAImcM MOORD 1Di,AdltiDdulrGNwrru dchuqurP, bfilr/0 roaroaf09YIN191
EFFECTIVE 04123!3012, COVERAGE IS FOR 109% OF THE EMPLOYEES OF FRANKCRUM LEASCO TO 9.S A. ENTERPRISES, INC. (CLIENT) FOR WHOM THE
CLIENT 15 REPORTING HOURS TO FRANKCRUM. COVERAGE IS NOT EXTE3NOW TO STATUTORY EMPLOYEES
HOLDER
SHOULD ANY OF THE A90VE 00CRIEEO POLICIES OF CANCELLED BEFORE
THE EXPIRATION DATE THER60, NOTICE YIIILL 99 9196PAREO IN
AGGOROAKE WITH THE POLICY PROVISIONS.
CITY OF MIAMI SHORES
10050 N E 2ND AVENUE AurwoagEO aEPRE6ENTPTNE
MIAMI SHORES, FL 3373&
'I'' rte- 4188&.291 b ACORq fipRP¢RATiON. All rghl4 ro6pryeu,
ACORD 26120901051 Th@ ACORD AIM$ AAO 1400 Ott 0414itOrerl fn#Ms Of ACORO
0-
-----^^~~
0-
Rpr 310141?:Upm P00J/001
-- - - -- --- -- — — — �r�r.■ ■
PaoDucERTHIS
ROADWAY INSURANCE SERVICES, INC,
1200 South Federal Highway
Fort Lauderdale, FL 33316
(954)527.2886 I. Fred Anderson
Annmoiinq
■�'�VV��/1��V` V�ilV�71LY'1%F
CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
COMPANIES AFFORDING COVERAGE
COMPANY PENN AMERICA INSURANCE COMPANY
A
INSURED
COMPANY
B.S.A. ENTERPRISES, INC.
B
6830 NW 20 AVE.
COMPANY
C
FORT LAUDERDALE, FL, 33309
COMPANY
D
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.
CO
LTR
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
DATE (MMINIVY)
POLICY EXPIRATION
DATE (MMMDIYY)
LIMITS
A
GENERAL LIABILITY
X COMMERCIALGENERAL LIABILITY
CLAIMS MADE FX� OCCUR
PAC7023735
05/17/2013
05/17/2014
GENERAL AGGREGATa S 2,000,000
PRODucm-coMPiOPAG� s 1,000,000
PERSONAL & AOV INJURY $ 1,000,000
OWNER'S B CONTRACTOR'S PROT
EACH OCCURRENCE 5 11000,000
FIRE DAMAGE (Ahyww(Iro) S 100,000
MED Exp (Any aria P=0^) $ 5.000
AUTOMOBILE
LLABIUTY
ANYAUTO
COMBINED SINGLE LIMIT S
ALL OWNED AUTOS
SCHEDULED AUTOS
BODILY IN.111RY
(Per person) S
a
HIRED AUTOS
NON -OWNED AUTOS
BODILYINJURY
(Por accident) S
DEDUCTIBLE COMP & COLL 500
GARAGE LIABILITY
AUTO ONLY - EA $
ANY AUTO
OTI'ICR THAN AUTO ONLY: 5
EACHACCIDENT S
AGGREGATE $
EXCESS
LIABILITY
EACH OCCURRENCE II
UMBRELLA FORM
AGGREGATE 5
OTHER THAN UMBRELLA FORM
$
WORKER'S COMPENSATION AND
EMPLOYERS' LIABILITY
I W!C sR-Y LL $
EACH OCCURRENCE 5
EL DISEASE - POLICY LIMIT S
Tf.E PROPRETOFJP INCL
EXECUTIVE OFFICERS ARC; EXCL
EL DISEASE - EA EMPLOYEE $
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONSMEHICLES/SPECIAL ITEMS
ELECTRICAL CONTRACTOR
CERTIFICATE HOLDER
CITY OF MIAMI SHORES
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
10050 NE 2ND AVENUE
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
MIAMI SHORES, FL 33138
30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMRO TO THE
LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR
LABILITY OF AN ND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES.
'FAX: (954)564-1664
AUTNORIZI:O REPR V
ATT: ALLIED
ACORD 25-S 1/95
(RIACORD CORPORATION 1988
-11 6145326 STATE OF FLORIDA
iv
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
ELECTRICAL CONTRACTORS LICENSING BOARD
SEML12053001473
' LICENSE NBR
105/30/20121118188874
EC13001261
The ELECMICAL CONTRACTOR
Named below IS CERTIFIED
Under the provisions of Chapter 489 FS.
Expiration. date; AUG 31, 2014
t
ASHWORTH, BRIAN SCOTT
B.S.A. ENTERPRISES INC
2750 SW 86 WAY
DAME FL 33328
RICK SCOTT KEN LAWSON
GOVERNOR SECRETARY
DISPLAY AS REQUIRED BY LAW
AW
G�.adaC.�ra?sCt�' _ .e4 �tC&t`�aat{!aa y escamr„�ar- u, sa.—