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ELC-14-941Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-217299 Permit Number: ELC-5-14-941 Scheduled Inspection Date: August 08, 2014 Permit Type: Electrical - Commercial Inspector: Devanev. Michael Owner: MIAMI, ARCHDIOCESE OF Job Address: 9401 BISCAYNE Boulevard Miami Shores, FL Project: <NONE> Contractor: CARLY ELECTRICAL SERVICE ulna a Department comments RELOCATE EXISTING GENERATOR 06/12/2014 - PENDING PAYMENT OF $72.00 BEFORE INSPECTIONS OR REVIEWS. 06/13/2014 - Paid. Inspection Type: Final Work Classification: Generator Phone Number (305)762-1033 Parcel Number 1132060490010 INSPECTOR COMMENTS False Phone: 305-970-6345 Inspector Comments Passed CREATED AS REINSPECTION FOR INSP-212118. NEED TO PASS BLDG 12 FIRST JF Failed Correction �� 7Are Needed Re -Inspection ❑ Fee No Additional Inspections can be scheduled until re -inspection fee is paid. August 07, 2014 For Inspections please call: (305)762-4949 Page 21 of 31 Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 BUILDING PERMIT APPLICATION Permit Type: Electrical JOB ADDRESS: 9401 Biscayne Blvd MAY Q 9 2014 Permit No. _ Master Permit No. Ll City: Miami Shores County: Miami Dade 33138 Folio/Parcel#: 11-3206-049-0010 Is the Building Historically Designated: Yes NO X Flood Zone: OWNER: Name (Fee simple Titleholder): Archdiocese of Miami phow*: 305-762-1032 Address: 9401 Biscayne Blvd. City: Miami Shores State: FI. Zip: 33138 TenandLessee Name: N/A Phone#: Email: CONTRACTOR: Company Name: Carly Electrical Services, Inc Phone#: 305-261-8077 Address: 680 Flagaml Blv. City: Miami See. FI. Qualifier Name: Carlos A. Hernandez 33144 State Certification or Registration #: Certificate of Competency #: 99E000310 Contact Phone#: Email Address: DESIGNER: Architect/Engineer: HNGS Engineers Phone#: 305-270-9935 Value of Work for this Permit: $ 3900.00 SquareUnear Footage of Work: Type of Work: ❑Address ❑Alteration ❑New ❑Repair/Replace ❑Demolition Description of Work: Relocate existing Generator Submittal Fee $ Permit Fee $ -;Z CCF $ CO/CC $ Scanning Fee $ Radon Fee $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ DBPR $ Bond $ Technology Fee $ TOTAL FEE NOW DUE $ lb r' Bonding Company's Name (if applicable) N/A Bonding Company's Address City State Mortgage Lender's Name (if applicable) N/A 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 a absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature _ Signafore Ownid or Agent Contractor The foregoing instrument was acknowledged before me thi The foregoin strttment was�a/�knowled d befo a mem day of , 20 , by��SLlYCo/! 1710��, day of , 6�w--4L 20,&Y, I Crfl � who is personally known to me or who has produced who i(personally know)to me or who has produced As identification and who did take an oath. as identification and who did take an oath. NOTARY PUBLIC: NOTARY an th McPherson -Arguello Sig Sign: OF FLORIDA Print: � � oa, O®rnea��" EI :09 x931 My ommission Expires: c i a Expires 5/2812015 My Commission $sskilaKNeskakXask aKak�k�k�kskA�A'ssk�H�sk NsH�%�X�N�%�xaikAa�N�%��akHs�Niks#��sKals�ksk�#3��aXa%skN�N�mH�sk AwK�ksk�Isak�ksKA`�akak�kikq�alsH�skak� APPROVED BY G Plans Examiner Structural Review (Revised 3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09) 000 P%, Notary Public State of Florida Liliana Aivarez if My Commission EE026160 =>�cY�aOA�'k�xgraa<R��fleE�S�l9�A�*��k�k j� Zoning Clerk POWER OF ATTORNEY KNOW ALL MEN BY THESE PRESENTS: That the most Reverend Thomas Wenski, as Archbishop of the Archdiocese of Miami, his successors in office, a corporation sole, has made, constituted and appointed, and by these presents does hereby make, constitute and appoint Sister Elizabeth A. Worley, C.O.O., his true and -lawful attorney for him and in his name, place; and stead. Giving and granting unto Sister Elizabeth A. Worley, C.O.O., his said attorney full power and authority to do and perform all and every act and thing whatsoever requisite and necessary to be done in and about the premises as fully, to all intents and purposes, as he might or could do if personally present, with full power of substitution and revocation, hereby ratifying and confirming all that Sister Elizabeth A. Worley, C.O.O., his said attorney or his substitute shall lawfully do or cause to be done by virtue hereof. In Witness Whereof, I have hereunto set my hand and seal this 15 day of August, A.D., 2013. Signed, sealed and delivered in the presence of: Wi s: W ess Signature Printed Name —/. "-,O�x�zak Witness Signature at& & g q Print Name STATE OF FLORIDA SS: COUNTY OF DADE B The Most Reverend ThomasWenski As Archbishop of the Archdiocese of Miami his successors in office, a corporation sole I hereby certify that on this day, before me, an officer duly authorized to administer oaths and take acknowledgements, personally appeared The Most Reverend Thomas Wenski, as Archbishop of the Archdiocese of Miami, his successors in office, a corporation sole, known to me to be the person described in and who executed the forgoing instrument, who acknowledged before me that he executed the forgoing instrument, who acknowledged before me that he executed the same, and an oath was not taken. Said person is personally known to me Said person provided the following type of identification: Witness my hand and official seal in the County and State last aforesaid this 15 day of August, A.D., 2013. My Commission Expires: MAYRA N 10;SSEL Notary Public, Steffe o1 Roma yl.,sEu,;=oma commissioner My Commftto Ezpka Jan. 27. 2015 mac ® CERTIFICATE OF LIABILITY INSURANCE nNYM 10DATE"013 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 WANED, sublet 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 MAIRO INSURANCE INC 2138 SW 67 Avenue Miami., FL 33155 CONTACT NAMON (305)2670565ev. 305)266-3515 C o AIC ADDRESs:MAIROINSORANCE@ATT .NET MuleERs) aFFOlmmro covEaasE NAIC9 INSURER A : ATLANTIC CASUALTY INS CO INSURED CARLY ELECTRICAL SERVICES INC 680 FLAGAMi BLVD MIAMI, FL 33144 INSURER B-: FLORIDA WORiMRS COMPENSATIO INSURER C: INSURER 0: INSURER E: INSURER F: r.nVFRAr,FS CERTIFICATE NUMBFR- 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. RR TYPE OF INSURANCE THE EXPIRATION DATE THEREOF, NdTICE WILL BE DELIVERED IN 10050 ME 2ND AVE POLICY NUMBERMAX MIAMI SHORES FL 33138 D LIM A GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS -MADE rx-� OCCUR /*/ L017000892-1 9/27/13 9/27/14 EACH OCCURRENCE. S 1,000,000 PREMISES Me Ij ens $ 50,000 MED EXP (Arty one person) $ 1,000 PERSONAL&ADVINJURY S 1,000,000 AGGREGATE $ 1,000,000 GEN•L AGGREGATE LIMIT APPLIES PER: POLICY PRO- LOC -mom PRODUCTS - COMPIOP AM $ 110001000 $ AUTOMOBILE LIABILITY ANYAUTO ALL AUTOS ASCHEDU� T HIRED AUTOS TS A TOASTED GO Ea a ciderrt BODILY INJURY (Per person) S BODILY INJURY (Per aaad�t) $ AMAGE Per accident $ $ UMBRELLA LIAR EXCESS LIAR OCCUR CLAIMS -MADE EACH OCCURRENCE S AGGREGATE $ DED RETENTION $ $ B WORKERS COMPENSATION AND EMPLOYERS LIABILITY ANY �OPRIETORlPAniNERfD�g1TNE Y❑ OFFIc EXCIAMED7 @&Adam In NIq D"y� describe under "r describe OF OPERATIONS Blow N7A 57428048 10/10/13 10/10114 $ ATU- 100,000 EL EACH ACCIDENT $ + E.L. DISEASE - EA EMPLOYE: $ 100,000 E.L. DISEASE - POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD iO1, Additforrel Remarks SrJwWo, K mom space Is required) ELECTRICAL SERVICES rCc MIr%ATC unr n=0 CotUr`FI I ATInN MIAMI SHORES VILLAGE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE BLDG DEBT THE EXPIRATION DATE THEREOF, NdTICE WILL BE DELIVERED IN 10050 ME 2ND AVE ACCORDANCE WITH THE POLICY PROVISIONS. MIAMI SHORES FL 33138 AUTHORIZED REPRESENTATNE' I ----.J— /*/ ( 019W201FACORD CORPORATION. All rigtttS 1`8158WOO. ACORD25(2010/05) The ACORD name and logo are registered marks of ACORD HERNANDEZ, CARLOS ALBERTO CARLY ELECTRICAL SERVICE, INC. 680 FLAGAMI BOULEVARD MIAMI FL 33144 I i Congratulations! With this license you become one of the nearly one miillon Floridians licensed by the Department of Business and Professional Regul tion. Our professionals and businesses range from architects to yacht brokers, tom 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.myfloridalicenso.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 jicensel kC# 6256056 DF1?,i Ther` ELEC Named- .be Under th Exoirati DETACH HERE STATE OF r'TdTd1�TT: nW . R:TTQTWR1Q1q A ICNENBR i" - ER301512 date: AUG .. 31, 20 XMV-T MW.VT. &T.t. T. (850) 487-1395 cA L i CA P_ RVIc�, INC . (ItDIVIDU�P�Lz:�+lITSTt_NEET AL,L LOCAL LICENSING' 'REQTJ1R TS PRIOR TO CONTF.ACTZNC3:TN ANY AREA) W :.REGISTERED;: anAer the provisions- of Ch. 4 B 9 r =8tsoa aaoa. W4 l .*- 20.14 L12'0808 -620e1 :RNAND><sZ_: QS ALSERO ,' d ,RLY. FLET ...: CAL. Sidi tn.CE , INC 0 FLAGAMI 9OULEVARD' , ;AMI FL .33144 , RICK SCOTT GOVERNOR. SEW L12080802081 KEN LAWSON SECRETARY Oct 0413 08:20a CTOR QUALIFYING TRADE(S) Cas Bowd 0001 ELECTRICAL BUSINESS CERTIFICATE OF COMPETENCY 99EO00310 CARLY ELECTRICAL. SERVICES INC D.B.A.: HEPAANDF-Z'CARLOS Is cerbTisd tailor the provbsms at chopw to of Mbmwade courdy VALID FOR CONTRACTING UNTIL 09/30120/5 p.2 ctmilen P.E. t X41 & 9badaan ert>ie ttoxd exwrt�sotdaoeee�amavmoamsa Municipal Contractoes Tax Receipt Miami --Dade County, State of Florida -THIS I SNOTA BILL -DO NOT PAY CC IVO: 99EO00310 SUSIXESS aA En.ocazaoK CARLY ELECTRICAL SERVK1 INC 680 FLAGAMI BLVD MIAMI, FL 33144 OWNER CARLY ELECTRICAL SERVICE INC Local Business Tax Receipt Miami—Dade County, State of Florida THISIS NOTA BILL -DI) NOT PAY 5040761 BUSINESS NAMBILOCATION CARLY ELECTRICAL SERVICE IRC 680 RLAGAMi BLVD MIAMI, FL 33144 MC RECUIPT Na. EXPIRES ww suaurass SEPTEMBER 30, 2014 743!64'17 Must be disployed at Pleas of business Purmentto Ctutrity Code Chapter 9A - ArL 9 & 10 TYPE or BUSINESS PAYMENT RECER= ELECTRICAL CONTRACTOR Lev TAX COLLECTOR 200.00 07/3112013 0221-13.000652 Far mom 1rdWM Qion.+rlsR Iva RECOPT no. EXPIRES RMEWAL 30, 2044 Must be t6sployed of place of business Pursuarit to County Cade Chapter SA-ArL 9 & 10 OWNER SEC. TYPE OR BUSINESS PAYMSNi'RECEIVED CARLY ELECTRICAL SERVICE INC 198 ELEC'MCAAL CONTRACTOR aY TAx COLLECTOR 45.00 07/31/2013 Worker(s) 2 99£000310 0221-13-000651 This Local Susto oss. Taal Receipt only eonfems psymest of the Lard Business lm7ft RecoW !91101 a lioeem permit. era aertillsadse si tits hsldm's qu05cadoomb do 5osinnL Holder mad emi A udtb NoY 11GYMMMU1 or oaagoum—ml ragulatoryisw3 andmorsioents whm appty to Me Inwiasss. [itis RECRI TNR. akm slant bre dlap "oe ail commerstaiVeVAas -INierrd-UmIs Coda Ses 8a -Ell}. for more lnisrmalloe, visit