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ELC-14-2290Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-223158 Permit Number: ELC-10-14-2290 Scheduled Inspection Date: November 12, 2014 Permit Type: Plumbing - Commercial Inspector: Devaney, Michael Inspection Type: Final Owner: PROPERTIES LLC, SHORE SQUARE Work Classification: Addition/Alteration Job Address: 9007-9029 BISC"NE Boulevard 9007 Miami Shores, FL 33138 - Phone Number (305)779-8040 Parcel Number 1132060110070 Project: <NONE> Contractor: GLOBAL ELECTRIC & COMMUNICATION CORPORATION Phone: (954)868-0648 Building Department Comments NEW LIGHTING RECEPTACLES AND SWITCHES Infractio Passed Comments INSPECTOR COMMENTS False Inspector Comments Passed CREATED AS REINSPECTION FOR INSP-223040. CANCELLED BY G.0 KEN 954-471-1247 Failed Correction 7- Needed Re -Inspection ❑ Fee No Additional Inspections can be scheduled until re -inspection fee is paid. November 10, 2014 For Inspections please call: (305)762-4949 Page 41 of 49 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 BUILDING PERMIT APPLICATION ❑BUILDING [dELECTRIC ❑ ROOFING OCT 16 2014 FBCq 2,90 (G' D Master Permit NO . Sub Permit No.I . �p ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF [:]CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 00 7- h 1 S co y u POW Folio/Parcel#: 11-3a6&-6/1-0070 Is the Building Historically Designated: Yes NO Occupancy Type: Load: I Construction Type: Flood Zone: BFE: FFE:: OWNER: Name (Fee Simple Titleholder): hnne SIopre, &02 1 16S �ne#: WS 973 VES Address:tD I (P /V 6 131115- b City: r) - if Y I (Ad�m�/� �n(-�/1r�QC ,n State: Zip: Tenant/Lessee Name: i 1 1 y r1 11 l.-�S �� 4�.�v l Phone#: Email: CONTRACTOR: Company Name: Address: :j tzYU � A-flam a�-A J A City: 101-1 L/� .r .41 -State: C Zip:-? ,305 Qualifier Name: e�/� gug/C 9 oy Phone#: 75r-2�'//7® State Certification or Registration #: 45 � W�X f �G ® Certificate of Competency #: DESIGNER: Architect/Engineer: All C10A ...j ASso ct".- -) Phone#: '3 oS- Address: k 1v 14k City: Yjec.Lk —State:—F4 Zip: 3 t wLi 6 Value of Work for this Permit: $ Iloyoo Square/Linear Footage of Work: Type of Work: ❑ Addition Alteratlon ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: nl e.r re re4 .." . U S .ten a S "J.G S Specify color of'color thru tile: Submittal Fee $ s Permlt Fee $ fm 4' CCF $ CO/CC $ Scanning Fee $ Radon Fee $ Technology Fee $ Training/Education Fee $ Structural Reviews $ DBPR $ Notary $ Double Fee $ 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. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. oe Signature Signature BbJ�I OWNER or ACqE CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this j_7 day of S 20 1 L1 byday of��P� ��el 20 l by 4o. 'n'/& -r who is oersonaliv I nown to p/►�C ��ci,� C who is personally known to me or who has produced as me or who has produced as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign:++ Sig / .�+.. Print: k#L 97-., ioa Print: S ry t seal: KATALMI SZAKACi Seal: KATALMI WAKA" MY COMMISSION 0 EE�5815 MY COMMISSION 0 EE>15 ,a , • ' EXPIRES Jar�ry 17, 2017 EXPIRES January 17.2017 ,N***** , *** **** I M,F h k,fN„k&BUI, N, N9M,$4ffi+k Nfl, +f+6t8,�,k,kX„kiR$N, 1 P� APPROVED BY e9- Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (30.5) 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 EXCEMPTION) 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: 6-44-1 6 c h-, cg. J c o rxrn c. h• c _ #'Lr *N3 BUSINESS ADDRESS: ( PO N wy4 q CITY a STATE FL ZIP CODE 3 � 1>001 BUSINESS PHONE:( s 4 ) l c 8 -- 0 5 -Lf l FAX NUMBER ( j CELL PHONE ( ) QUALIFIER'S NAME: /` o r u by r Pc QUALIFIER'S LIC NUMBER: 1;e- 1 3 a o 3 a-) 0 E-MAIL ADDRESS OF APPLICABLE): Created on 31190 BY NXV 1 RV 312M MWV DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION .� ELECTRICAL CONTRACTORS LICENSING BOARD (850) 487-1395 .� . 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 BURKE, MARK GLOBAL ELECTRIC & COMMUNICATION CORPORATION 1806 NW 38TH STREET OAKLAND PARK FL 33309-4410 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! DETACH HERE RICK SCOTT, GOVERNOR STATE OF.F,LORIDA" STATE DEPAR �W PROFE EC 13003220 ... I,S CERTIFJ.ED ,under tl Expiratihn,aale.:-AUG 31;'2b16 QF BUSINESS AND "GULATION ,ft -!x08/31/2014 C•�N���R -tJN CO visions of Ch- .489 FS, L1408310006667 KEN LAWSON, SECRETARY ►V:arjied below 18 CERTI=FIED Under the provisions bf Cheater 489 FS Expiration date: AUG 31, 2016 n�. "1i.1A1.�r`nDD.nDAT111A1 "C, 1 B1L7-PARKL 3309-4410'x?" w���� «mss-., a x L -•'�"� a �" „ .'^�� �,'".`� ti4p `'� � \'' a• � - ___y an'Y,oaeu.' .�� ":`s.., "`'w� •�. `'< -_.._.�.�. .""?rte . _ i s, .�+��5. �. r ,. a ....>. ..� ',. _,_+ ISSUED: 08/31/2014 DISPLAY AS REQUIRED BY LAW SEC) # L1408310006667 IN i AeqtotrCERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 10/09/14 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 policy(les) must be endorsed. 9 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 Ileu of such endorsement(s). PRODUCER Pride Insurance 4261 North State Rd. 7 CONTACT Mike NAME: PHONE(g•`) 485-8333 FAX No): (954) 485-1894 -�L mtv@pddeinsurance.com NISI S AFFORDING COVERAGE NAIC # Lauderdale Lakes, FL 33319 INSURER A: Federated National Insurance company Phone (954) 485-8333 Fax (954) 485-1894 INSURED INSURER B: Progressive Express Insurance Company INSURER C: Global Electric and Communication Corp INSURER D: 1806 NW 38th St INSURER E: Oakland Park, FL 33309 (954) 270-1180 B AUTOMOBILE LIABILITY ❑ ANY AUTO ❑ AALOOWNED © SCHEDULED AUTOS F-]HIREDAUTOS ❑ AUTOS ❑ ❑ 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. INSR LTR TYPE OF INSURANCE ADD UBR POLICY NUMBER POLICY EFF MWD POLICY EXP MM/D MIAMI SHORES FL 33138 A GENERAL LIABILITY 0 COMMERCIAL GENERAL LIABILITY Q F-1CLAIMS-MADEQ OCCUR El N N GL -0504011680-00 02/03/2014 02/03!2015 EACH OCCURRENCE $ 1,000,000.00 PREMISES (EaE�rrrence) $ 100,000.00 MED EXP (Any one person $ 5,000.00 PERSONAL BADV INJURY $ 1,000,000.00 ❑ GENERAL AGGREGATE $ 2,000,000.00 GEN'LAGGREGATE LIMIT APPLIES PER: ® POLICY ❑ PRO- ❑ LOC PRODUCTS -COMP/OP AGG $ 2,000,000.00 $ B AUTOMOBILE LIABILITY ❑ ANY AUTO ❑ AALOOWNED © SCHEDULED AUTOS F-]HIREDAUTOS ❑ AUTOS ❑ ❑ N N 03050360-0 04/30/2014 04/30/2015 OMBINidentED SINGLE LIMIT Ea acc BODILY INJURY (Per person) $ 10,000.00 BODILY INJURY (Per accident) $ 20,000.00 AMAGE PpB�a cTerri $ 10,000.00 $ ❑ UMBRELLA LIAB ❑ OCCUR ❑ EXCESS LIAR ❑ CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ ❑ DED ❑ RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNERIEXECUTNE OFFICER(MEMBEREXCLUDED? (Mandatory In NH) if yes describe under DESCRIPTION OF OPERATIONS below N/A E] ToSLIMIT ❑ ETH - 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, N more apace Is required) Electrical Contractor Mark Burke Qualifier License # 13003220 CERTIFICATE HOLDER CANCELLATION ©1988-2010 ACORD CORPORATION. All rigmS resefta. 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 ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE 2 AVE MIAMI SHORES FL 33138 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rigmS resefta. ACORD 25 (2010/05) OF The ACORD name and logo are registered marks of ACORD DM CERTIFICATE OF LIABILITY INSURANCE R054 10/15/20 4 THIS CERTIFICATEIS 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 SUBROGATIONIS WAIVED, subject to the terns 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 CONTACT AUTOMATIC DATA PROCESSING INS AGCY PHONE FAX (AIC, No, Ext): C. No): 250717 P: F: E-MAIL ADDRESS: PO BOX 33015 INSURER(S) AFFORDING COVERAGE NAIC# SAN ANTONIO TX 78265 INSURERA: Hartford Casualty Ins Co INSURED INSURER B INSURER C: GLOBAL ELECTRIC AND COMMUNICATION CORP INSURER D: 1806 NW 38TH ST INSURER E: FORT LAUDERDALE FL 33309 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. INSR TYPE OF INSURANCE ADDL 1N.VR SUER MM POLICYNUMBER M�� EFF M POLICYEXP MIMMID/YVIMI LLUM COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS MADE ❑OCCUR DAMAGE TO RENTED $ PREMISES Ea occurrence MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GEML AGGREGATE LIMIT APPLIES PER: POLICY PRO-- ❑ LOC JECT PRODUCTS - COMP/OP AGG OTHER: $ AUTOMOBILELUU31LIlY 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 $ EXCESS UAB CLAIMS -MADE AGGREGATE $ DED RE'rEM10N $ $ WORKERS COMPENSATION ANDEmmorEwLL9amm X PER OTH- ISTATUTE ER E.L. EACH ACCIDENT 1100,000 ANY PROPRIETOR/PARTNER/EXECUTIVE YIN A OFFICER/MEMBER EXCLUDED? (MandatorylnNHI N/A 76 WEG DU7923 10/22/2014 10/22/2015 E.L.DISEASE- EAEMPLOYEE $100,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONS/ LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached K more space Is required) Those usual to the Insured's Operations. Electrical Contractors #EC13003220 CERTIFICATE HOLDER CANCELLATION ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED Miami Shores Village Building g g BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE - Department 10050 NE 2ND AVEQ.� MIAMI SHORES, FL 33138 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD