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ELC-15-88Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-226538 Permit Number: ELC-1-15-88 Scheduled Inspection Date: February 18, 2015 Permit Type: Electrical - Commercial Inspector: Devaney, Michael Inspection Type: Final Owner: PROPERTIES LLC, SHORE SQUARE Work Classification: Addition/Alteration Job Address: 9007-9029 BISCAYNE Boulevard 9007 Miami Shores, FL 33138- Phone Number (305)779-8040 Parcel Number 1132060110070 Project: <NONE> Contractor: CERRITO ENTERPRISE INC Phone: (561)790-0775 iiuiming uepartment comments ELECTRICAL WORK AS PER PLANS INSPECTOR COMMENTS False Inspector Comments Passed Eff Failed A / P Correction Needed Re -Inspection ❑ Fee No Additional Inspections can be scheduled until re -inspection fee is paid February 18, 2015 For Inspections please call: (305)762-4949 Page 19 of 52 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: (305) 762-4949 BUILDING PERMIT APPLICATION ❑ BUILDING 0 ELECTRIC ❑ ROOFING jAN 1 a 2014 FBC 20 16 Master Permit No& .11-11-211Z Sub Permit No. 6-1(-1/S-- ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑ PLUMBING ❑ MECHANICAL [:]PUBLIC WORKS [:]CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: � 00-7 � �)� � �� � S c� � City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: -' 3 - ® ( 4 — CO-? Q Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): [Yoe `c sr, P Ak`t-AVt L_L.- Phone#: Address: Cr->gG tjE s -r - City: o State: Zip: ((�'p Tenant/Lessee Name: Phone#: 3 cis ?b2- 6724' Ema(I:'Duj c- '-fbe.) CONTRACTOR: Company Name: Cerrito Enterprise Inc. Phone#: 561-790-0775 Address: 2765 Vista Parkway Ste. 1 City. West Palm Beach State: FL Zip: 33411 Qualifier Name: Thomas Cerrito Phone#: 561-790-0775 State Certification or Registration #. EC13005640 Certificate of Competency #: DESIGNER: Architect/Engineer: ®cl Uel- r 14tt.c-A P e�.� Phone#7z,7 I&) 7� u - Address: 32-707 W f-ft5AW?f VF City: Re -M ®t'stateFF— Zip:�`E� Value of Work for this Permit: $ 3,500.00 Square/Linear Footage of Work: 'r'0 *a Type of Work: ❑ Addition Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work:���.���2 Specify color of color thru tile: Submittal Fee $ Permit Fee $ %0 O /40&9 CCF Scanning Fee $ Technology Fee Structural Reviews $ (Revised02/24/2014) Radon Fee $ Training/Education Fee $ DBPR $ CO/CC $ Notary $ Double Fee $ Bond $ TOTAL FEE NOW DUE $ (I _;a , : Bonding Company's Name (if applicable) Bonding Company's Address City State Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State 2M 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. 0 I or AGENT The foregoing instru t was acknowledged before me this I— day of AN v4p 20 Q �_J by /,#'Arlt :2Ait� , j who is ers Wally kn n to me or who has produced as Identification and who did take an oath. NOTARY PUB0C: Sign: V Print• Plofery Pub C State o! Florida Seal: Jorg9 De La RCBS (I P,,,jo�� =E8 191707 The foregoinginstru nt was acknowledged before me is 11 day of 20 /J . by M4- o is personally kno n to --------------- me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Si / Print: ��he Gccc� SRE MAL Seal: * MY COIIRlI ON # FF 081221 EXPIRES: Jet uaty 29, 2018 ������yOF Boml@d1lwtto(aySaVi� APPROVED BY ViVOW751ANL 46 S== -v /)-Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 CERRITO, THOMAS J CERRITO ENTERPRISE INC. DBA CERRITO ELECTRIC 14751 HORSESHOE TRACE WELLINGTON FL 33414 Congratulationsl 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.rnyfloridalicanse.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 (850) 487-1395 STATE OF FLORIDA DEPARTMENT -OF BUSINESS AND PROFE91 NAL REGULATION EC13005640 :U.0 07/30/2014 CERTIFIED EUEQTI L C 4�,Nl�W, - TOR CERRITO, THWA $ ` s CERRITO ENTE[RPItiSl3fl DSQy�C�RRIT y{ IS CERTIFIED under tile. provisions of Ch.489 FS. Expiration date : AUG 31, 2016 L1407300000WS KEN LAWSON, SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD EC13005640 IN ANNE M. G AN N O N P.O. Box 3353, West Palm Beach, FL 33402-3353 "LOCATED AT** CONSMUTIONAL TAX COLLECTOR www.pbctax.com Tel: (561) 355-2264 2765 VISTA PKWY Ste H1 Serving Palm Beach County WEST PALM BEACH, FL 33411 Serving you. TYPE OF BUSINESS OWNER CERTIFICATION # RECEIPT #!DATE PAID AMT PAID I BILL # 23-0189 ELECTRICAL CONTRACTOR I CERRITO THOMAS J U-17478 B14.1413500 - 08/15114 1 $27.50 1 B40185826 This document is valid only when receipted by the Tax Collector's Office. CERRITO ENTERPRISE INC CERRITO ENTERPRISE INC 14751 HORSESHOE TRCE WELLINGTON, FL 33414-7840 ul�n��lulnlu�l��l����n�llu�nlullln� STATE OF FLORIDA PALM BEACH COUNTY B3 - 322 2014/2015 LOCAL BUSINESS TAX RECEIP' LBTR Number: 201005668 EXPIRES: SEPTEMBER 30, 2015 This receipt grants the privilege of engaging In or managing any business profession or occupation within its jurisdiction and MUST be. conspicuously displayed at the place of business and in such a manner as to be open to the view of the public. s>: ANNE M. G A N N O NP.O. Box 3353, West Palm Beach, FL 33402-3353 ""LOCATED AT** h` CONSTITUTIONAL TAX COLLECTOR www.pbctax.com Tel: (561) 355-2264 2765 VISTA PKWY Ste H1 Serving Palm Beach County WEST PALM BEACH, FL 33411 Serving you. TYPE OF BUSINESS OWNER CERTIFICATION # RECEIPT #/DATE PAID AMT PAID BILL # 23-0108 CW ELECTRICAL CONTRACTOR I CERRITO THOMAS J U-17478 U114.697640 -08/27J14 $284.80 84015582: This document is valid only when receipted by the Tax Collector's Office. B1 - 323 CERRITO ENTERPRISE INC CERRITO ENTERPRISE INC 14751 HORSESHOE TRCE WELLINGTON, FL 33414-7840 nllu�llnluln�l��lnlln�l�nlnlnllln� STATE OF FLORIDA PALM BEACH COUNTY 2014/2015 LOCAL BUSINESS TAX RECEIP LBTR Number: 201005670 EXPIRES: SEPTEMBER 30, 2015 This receipt grants the privilege of engaging in or managing any business profession or occupation within its jurisdiction and MUST be conspicuously displayed at the place of business and in such a manner as to be open to the view of the public. CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYM 11/8/2015 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 POLICY NUMBER 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 Astatement on this certificate does not confer rights to the certificate holder In lieu of such .endorsement(s). GENERAL LIABILITY PRODUCER Samuel W. Irvine Associates 1920 Palm Beach Lakes. Blvd. #101 West Palm Beach, F1. 33409 A128169 NAME A/C, N : 561 684-0222 FAX No):561-684-0225 ADDRESS: swlrvin@@bellsouth.n@t INSURER(S) AFFORDING COVERAGE NAICM INSURER A: Arch gy!qcialty Ins Co. INSURED Cerrito Enterprise Inc INSURER B: 2765 Vista Parkway #H1 INSURER C: 14751 Horseshoe Trace INSURER D: INSURER E: West Palm Beach, FL 33411 561-790-0775 IINSURER 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 LTR,TYPE OF INSURANCE "M WADDL W POLICY NUMBER (MM/DD/YYYY) h" (MM/DD/YYM LIMFuut;y BS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISESMe omwerrc®) $ 100,000 CLPJMS-MADEOCCUR MED EXP (AM onepenw) $ 5,000 PERSONAL BADVINJURY s 1,000,000 A g primary non contrib AGL004209-01 9/22/149/22/15 GENERAL AGGREGATE $ 2,000,000 X waiver Of subro GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OPAGG $ 2 000 OOO X POLICY PRa LOC $ AUTOMOBILE LIABILITY acdderd$ BODILY INJURY (Per Parson) $ ANYAUTO ALLOWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ NON -OWNED HIRED AUTOS AUTOS PROPERTY DAMAGE $ (Per accident) UMBRELLA LIAR OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LAS CLAIMS -MADE DED I I RETENTION $ $ WORKERS COMPENSATIONWC AND EMPLOYERS LIABILITY YIN A - TOR LIMITS ER ANY PROPRIETOR/PARrNEROMCUTIVE ❑ OFFICERIMEMBER EXCLUDED? (Mandatory In NH) NIA EL EACH ACCIDENT $ EL DISEASE- EA EMPLOYEE $ Ifyes, desalba under DESCRIPTION OF OPERATIONS below E.L. DISEASE- POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS /VEHICLES (AttachACORD 101,AddrdonalRem ftS&mdule,B morespawIs required) Electrical contractor CERTIFICATE HOLDER CANCELLATION Miami 10050 Shores Village Building Dept N.E. 2nd Ave SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Miami Shores, FL 33138 ACCORDANCE WITH THE POLICY PROVISIONS. fax - 305-756-8972 AUTHORIZED REPRESENTATIVE © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD25 (2010105) The ACORD name and logo are registered marks of ACORD c-- CERTIFICATE OF LIABILITY INSURANCE 0A�/1201D°""""' 15 THIS CERTIFIrnTE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATEbOES 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 pollcy(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). )DUCER CONTACT PAYCHEX INSURANCE AGENCY, INC. 150 SAWGRASS DRIVE PHONE FAX (A/C, NO. EXT): 877-266-6850 (A/C, No): 585-389-7426 ROCHESTER, NY 14620 E-MAIL ADDRESSM INSURER(S) AFFORDING COVERAGE NAIC i URED INSURER A: ILLINOIS NATIONAL INSURANCE COMPANY 23817 Paychex Business Solutions LLC Cerrito Enterprises Inc INSURER B: INSURER C: CERRITO ELECTRIC INC 911 PANORAMA TRAIL SOUTH INSURER D: ROCHESTER, NY 14625-0397 INSURER E: INSURER F: IVERAGES 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. TYPE OF INSURANCEDL NSR UBR POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MWDD/YYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY CLAIMS-MADE=OCCUR DAMAGE TO RENTEDmncw $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ EN'L AGGREGATE LIMIT APPLIES PER: POLICY =PROJECT= LOC PRODUCTS - COMP/OP AGG $ $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNEDSCHEDULED AUTOS = AUTOS HIRED AUTOS = aug-ED _ COMBINED SINGLE LIMIT $ (Ea accident) BODILY INJURY $ (Per person) BODILY INJURY $ (Per accident) PROPERTY DAMAGE $ (Per accident) UMBRELLA LI/1B = OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB = CLAIMS-MADE DED RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY 011732318 06/01/2014 06/01/2015 X WC STATU- OR E.L. EACH ACCIDENT $ 1,000,000.00 ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $ 1,000,000.00 E.L. DISEASE - POLICY LIMIT $ 1,000,000.00 (Mandatory In N)) FN N/A If yes, desctme under CRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Rented® Schedule, if more space Is required) Worker's Compensation coverage is provided to only those employees leased to, but not subcontractors of the named insured. Electrical Contractor .RTIFICATE HOLDER CANCELLATION Miami Shores Village Building Dept. 10050 N.E. 2nd Ave SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS, BUT FAILURE TO MAIL SUCH NOTICE SHALL NPOSE NO OBLIGATION OR Miami Shores, FL 33138 LIABILITY OF ANY IGND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ORD 25 (2010/05) @1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD