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EL-14-2408Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-223220 Permit Number: EL -10-14-2408 Scheduled Inspection Date: November 19, 2014 Inspector: Devaney, Michael Owner: FISCHER, LUCIANA Job Address: 1237 NE 93 Street Miami Shores, FL 33138 - Project: <NONE> Permit Type: Electrical - Residential Inspection Type: Final Work Classification: Pool - Private Phone Number (954)734-3411 Parcel Number 1132050270060 Contractor: R & R ELECTRIC COMPANY INC Phone: (954)968-5907 Building Department Comments ADD NEW POOL BOND REPLACE POOL TIMER AND inrractio Passed comments INSTALL NEW DISCONNECT AT POOL REMOVE OLD INSPECTOR COMMENTS False POOL LT. Inspector Comments Passed CREATED AS REINSPECTION FOR INSP-222702. Failed Correction Needed ❑ (� Re -Inspection ❑ Fee No Additional Inspections can be scheduled until re -inspection fee is paid. November 18, 2014 For Inspections please call: (305)762-4949 Page 19 of 41 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: (30S) 762-4949 CIV OCT 3 2014 Y: FBC 201'0 BUILDING Master Permit Not4_`27-!�S� PERMIT APPLICATION Sub Permit No. 1, 1�-4-? 10 ❑BUILDING FO -1 ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: s r\ N ot'a V., 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): /-�� o /�/�ZPhone#: Address: City: M '-\. State: 'f\ca Zip: Tenant/Lessee Name: Phone#: 7t,", M. CONTRACTOR: Company Name:a' ®� G �Y\ kc- G ® Phone#: Address: V100 N W %T akk 01s4-016%-SR011 City: DGr1Q nn® State: ;®4 Zip: S10 6!3 Qualifier Name 9.4,a X , F� X (Arn - ` }D f► Phone#• State Certification or Registration. #: V-C-AC10 - % 6 -S Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: _ City: State:_Zip: _ Value of Work for this Permit: Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New Repair/Replace ❑ Demolitiorr Description of Work: 60k Specify color of ct ;lgr`t�h �p gtil •= Submittal Fee $ Permit Fee $®� ®® CCF $ d (00 CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ cQ Notary $ Technology Fee $��^�1 Training/Education Fee $ ° �O Double Fee $ Structural Reviews $ Bond $ TOTAL FEE NOW DUE $ (Revised02/24/2014) 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. the absence of such posted notice, the inspection will not be approved an a reinspection fee will be charged. SignatOre, Signature OWNER or AGENT The f r ing instrument was acknowledged before me this day of ��. 20 by �.riiierwho is personally know® me or who has produce as der►tifmation and M+ o ;d a a oath. N!Q3`AV PUBLIE:, The foregoing instrument was acknowledged before me this �►� day of Of. -V& a 44- , 20 14 . by A— q :` oe , who is personally known to me or who has produced UL as identification and who did take an oath. NOTARY PUBLIC: Prin, q $MR Print EXPIRES Fell 23, 2018 m0. Seal: .•• 9odThruNotery Mode Seal: �Meloy t�*11 l)a • Stye of FMrlds `My Comm. Expires Dec fl, 2016 Comn asiom • EE tyl�92,ftla BOIIAtli I NatOfY Atstl. +k+Btk+kBt�ktki�%At9t IItiln[ttltelttlt tkffi+B+kNtKt�BtgttY tktktktk$tk+k 9t tltNtAttlttk�Ittktk$tk$�N+k&�N+b tktkYtRMtltMt�It A� $� 6� At Att&tk�lt�k tkffi9At+R+k Nt+M APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revisedo2/24/2014) 6 ` STATE OF FLOW DEPARTMENT OF BUSINESS AND PROFESSIONAL hEGULATION ELECTRICAL CONTRACTORS LICENSING BOARD 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 HAMILTON, REXA R & R ELECTRIC COMPANY INC 1700 NW 15 AVE SUITE 345 POMPANO BEACH FL 33069 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 seam more about the Departments 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! RICK SCOTT, GOVERNOR DEPA DETACH HERE STATE 'OF FLORIDA WENT OF BUSINESS AND PROFE The..;ELECTRI.CAL- CONTRACTOR =Named below IS.C_ERTIF-IED _ - l7Tid&, lthe=provisions .of-ehapter 4897S. E pirafwn.,date: AVO 31 201& HAI IET-OAI -REX A a., R &-R ELF-CTRICCMP#fiNC 17Q0�I�IWT1.5AMESU1Tfw3? 33.Q69 ISSUED: 07/30/2014 DISPLAY AS REQUIRED BY LAW SEQ # L1407300002283 (850) 487-1395 STATE OF FLORIDA DEPARTMENT�F BUSINESS AND PROFEB�SI yO I�E•CULATION EC13001865773012014 R- & R •ELECTR'IJ011,001".0W11" ?ANh' I �,- sr "W IS GER-TiF1ED..under the p'roGisions of Ch.489 FS. Expiration date .-AUO'31.W6 L14073000=83 KEN LAWSON, SECRETARY BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT 115 S. Andrews Ave. Rm. A-100, Ft. Lauderdale FL 33301-1895 — 954-831-4000 f� VALID OCTOBER 1, 2014 THROUGH SEPTEMBER 30, 2015 DBA: ReCel t#-181-2277 Business Name: R & R ELECTRIC CO INC Owner Name: REX A HAMILTON Business Location: 1700 NW 15 AVE STE 345 POMPANO BEACH Business Phone: 954-968-5907 p 'ELECTRICAL/ALARMS/CONTRACTOR" Business Type: (ELECTRICAL CONTRACTOR) Business Opened: o 9 / o 1 / 19 8 9 State/County/Cert/Reg:EC13 0 018 6 5 { Exemption Code: Rooms Seats Employees Machines Professionals 14 For Vending Business Only Number of Machines: Vending Type: Tax Amount Transfer Fee NSF Fee Penalty- Prior Years_ Collection Cost Total Paid 54.00 0.00 0.00 0.00 0.00 0.00 54.00 THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS 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 Municipality planning WHEN VALIDATED and zoning requirements. This Business Tax Receipt must be transferred when the business is sold, business name has changed or you have moved the business location. This receipt does not indicate that the business is legal or that M :- .- ...ab. 04-4— -1 Innnl I�AAIO onA mmnt flafi nc OP ID: CT CERTIFICATE OF LIABILITY INSURANCE �'�`°°°"'"�' 10/30/2014 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, EXTENDOR. 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. it 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 corifer rights to the certificate holder In lieu of such endorsement(s). PRODUCER INNOVATIVE INSURANCE CONSULTANTS, INC. CONTACT NAME: PHONE a No: N Ext: ap—LEW, 6461 UNIVERSITY DRIVE, #103 CORAL SPRINGS, FL 33067 BRIAN J. MAMO PRODUCER 81REL-1 INSURER(S) AFFORDING COVERAGE NAIC 10050 NE 2 AVENUE INSURED R & R ELECTRIC COMPANY, INC. INSURERA: FCCI COMMERCIAL INSURANCE CO.. 33472. INSURER B: 1700 NW 15TH AVE SUITE 345 POMPANO BEACH, FL 33069 INSUIERc INSURER 0: EACH OCCURRENCE $ 1,000,00 ItEURER E : A INSURER F: i►ce.r+�+i. err +++"MITI c_ VVYCIVIVG�1 vO-+vu +ve.+:.. __—____ _ 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. ISR TR TYPE OF INSURANCE DL SUBN POLICY NUMBER POLICY MIAMI SHORES VILLAGE �� 10050 NE 2 AVENUE GENERAL LIABILITY MIAMI SHORES, FL 331'32 EACH OCCURRENCE $ 1,000,00 300,0 A X COMMERCIAL GENERAL LIABILITY GLOO11387 4 02!0112014$ 7021(OM1IM2016Rw1F1=(Eq0=UrrQn09) MED EXP (Arty one ) $ 10,00 CLAIMS -MADE FKOCCUR PERSONAL &ADV INJURY $ 1+00010 GENERAL AGGREGATE. $ 2;000,00 GEN'L AGGREGATE LIMIT APPLIES PER:PRODUCTS - COMPIOP AGG $ 2+00+ $ POLICY X PRO- JECT El LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,00 (Ea -d) A X ANY AUTO CA00177004 02!0112014 02/01/2015 BODILY INJURY (Per person) $ BODILY INJURY (Per accident).: $ ALL OWNED AUTOS PROPERTY DAMAGE $ SCHEDULED AUTOS X HIRED AUTOS (PER ACCIDENT) , $ X NON-OWNEDAUTOS $ X- $500 DED COMP UMBRGLLA UA13 XJ OCCUR EACH OCCURRENCE ffi . 1,000',00 AGGREGATE $ 1'000+. A EXCESS LIAB CLAIMS -MADE UMB0016468 2 02101/2014 02/01/2015 DEDUCTIBLE $ $ WC STATU- DTH = RETENTION $ WORKERS COMPENSATION 1. ER AND.EMPLOYERB' LIABILITY ANY PROPRIETORIPARTNER/EJ�CUTNE Y E.L. EACH ACCIDENT $ E.L DISEASE - EA EMPLOYEE $ OFFICERIMEMBER EXCLUDED? El (Mandatory in NH) N / A E.L. DISEASE -POLICY LIMIT . ffi if y� describe under OESGIRIPTION OF OPERATIONS lova APROPERTY CP.0009286 2 02/01/2014 02/01/2016 PERS.-PROP 85+ 1000 $1,000 DED AOP RCV 58/6 DED WIND & HAIL BUS INCOAA 192; DESCIBPTION OF OPERATIONS/ LOCATIONS /VEHICLES (Atfaah ACORD 101 Ad"Cnal Remarios Schedule,.R more.space wrequiroco LECTRICAL CONTRACTOR LICSNSB #EC -1300-1805 liCRllrri.AlCr7VWCR MIAMI -6 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION LL DATE THEREOF,. NOTICE WILL BE DELIVERED IN ACCORDANCE WITH..THE'POLICY PROVISIONS. MIAMI SHORES VILLAGE 10050 NE 2 AVENUE AUTxoRI�D REPRESENTATIVE MIAMI SHORES, FL 331'32 Cid 7VWw4UUV A%iVKN \►VK1-U1%A-J JIJ nl+ rum nU+iw ACORD 26 (2009/09) The ACORD name and logo. are registered marks. of ACORD' A� ® CERTIFICATE OF LIABILITY INSURANCE DA11/05/2014Yn 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 ALTERTHE COVERAGE AFFORDED BYTHE 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(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies mayrequire an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such andorsement(s). PRODUCER - Risk Transfer Programs, LLC 219 East Livingston Street Orlando, FL 32801 CONTACT NAME: PHONE 866-481-9363 FAX C o Ext : A/c No): E-MAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIC # SURER A:Technology Insurance Company, Inc. 42376 INSURED Engage PEO Labor Contractor for leased workers to: INSURER B: EACH OCCURRENCE $ R&R Electric Company, Inc. INSURER C: 3001 Executive Drive Suite 340 INSURER D: INSURER E: St. Petersburg, FL 33762 INSURER F: DAMAGE PREMISES Ea occurrence $ COVERAGES CERTIFICATE NUMBER:6KJ8G58R REVISION NUMBER: THIS ISM CERTIFY THATTHE 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. IR LTR LTWVD TYPE OF INSURANCE DL POLICY NUMBER POLICYEFF MPOMILDD YY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE PREMISES Ea occurrence $ CLAIMS -MADE � OCCUR MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP/OP AGG $ 17 POLICY E 0. LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea acddeM BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ (Par accident HIRED AUTOS NON -OWNED AUTOS $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAR CLAIMS -MADE DED I I RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNERIEXECUTNEN TWC3442418 11/01/2014 12/31/2014 O R X WC STAMTUIT-S E.L. EACH ACCIDENT $ 1,000,000 OFFICERIMEMBER EXCLUDED? (Mandatory In NH) / A E.L. DISEASE - EA EMPLOYEE $ 1,000,000 If yes describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, N more space is required) Coverage is extended to the leased employees of alternate employer in all states except in monopolistic states (ND, OH, WA, WY): R&R Electric Company, Inc. #131026 (Effective 02/01/13) This certificate only applies to Electrical Contractor License #EC 1300-1865. CERTIFICATE HOLDER CANCELLATION Page 1 of 1 ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATETHEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Miami Shores Village AUTHORIZED REPRESENTATIVE 10050 NE 2ND AVE Miami Shores, FL 33138 Page 1 of 1 ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD r"\, r r" ��S CA\ J -, rn 1 %, M i S\ -,Qv, e L®1 `MS 3t A\\ V,hQ Y%%)M ra.w s1� "oma V vrftv 't® 0.0\ xrn P�G� OCT 2014 BY: ROGER w WORTUM - ft of Reft [d1)P coffin. E%pm on 17, 2016 bmMTknp i U, v 7700 NW T AUE'• SUITE 345 • POMPANLO BE CHS FL 33069.O.FFIICE: (954)968-5907 • FAX: (754) 222-8642 " ka zc39_ 7700 NW T AUE'• SUITE 345 • POMPANLO BE CHS FL 33069.O.FFIICE: (954)968-5907 • FAX: (754) 222-8642 "