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EL-15-942Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-233987 Permit Number: EL -4-15-942 Scheduled Inspection Date: May 14, 2015 Permit Type: Electrical - Residential Inspector: Devaney, Michael Inspection Type: Final Owner: HASSAD, SHAVANA DAVI Work Classification: Service Change Job Address: 35 NE 91 Street Miami Shores, FL 33138- Phone Number (305)331-6605 Parcel Number 1132060130100 Project: <NONE> Contractor: HI -TECH ELECTRIC & FIRE CORP Phone: (786)326-0931 duuamg uepartment comments REPLACE EXISTING PANEL AND METER WITH OVER Infractio Passed Comments HEAD SERVICE I INSPECTOR COMMENTS False Inspector Comments Passed CREATED AS REINSPECTION FOR INSP-233753.4 \4 may 2015 1E Bond water line. F P L service drop to cross the roof no more than 3 feet. f Failed Correction Needed Re -Inspection Fee No Additional Inspections can be scheduled until re -inspection fee is paid. May 13, 2015 For Inspections please call: (305)762-4949 Page 18 of 30 Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 �A o Phone: (305)795-2204 Project Address Parcel Number Applicant 35 NE 91 Street 1132060130100 SHAVANA DAVI HASSAD Miami Shores, FL 33138- Block: Lot: Owner Information Address Phone Cell SHAVANA DAVI HASSAD 35 NE 91 Street (305)331-6605 MIAMI SHORES FL 33138- 35 NE 91 Street MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone HI -TECH ELECTRIC & FIRE CORP (786)326-0931 of Work: REPLACE EXISTING PANEL AND METER WI onal Info: kation: Residential ling: 3 Fees Due Amount CCF $1,60 DBPR Fee $2.25 DCA Fee $2.25 Education Surcharge $0.60 Notary Fee $5.00 Permit Fee - Additions/Alterations $150.00 Scanning Fee $9.00 Technology Fee $2.40 Total: $173.30 Valuation: $ 2,800.00 Total Sq Feet: 00 Pay Date Pay Type Amt Paid Amt Due Invoice # EL -4-15-55273 04/30/2015 Check #: 5065 $ 123.30 $ 50.00 04/21/2015 Check #: 5050 $ 50.00 $ 0.00 Available Inspections: Inspection Type: Review Electrical In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL. PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS 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 zon u rmore, I authorize the above-named contractor to do the work stated. April 30, 2015 Authorized / Agent Building Department Copy April 30, 2015 1 BUILDING PERMIT APPLICATION 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 `ELECTRIC ❑ ROOFING APR 21.2015 FBC 2016 Master Permit No.Z77 k " ?%2 Sub Permit No ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL E] PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: City: Miami Shores County: Miami Dade Zip: % is Folio/Parcel#: 32®-060_ ® /3 00 Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: il OWNER: Name (Fee Simple Titleholde4M64&l✓imf� SS' ® Phone#: Address:" �� 5,,4 City: ; State:lf� Zip: �/.3 F Tenant/Lessee Name: �� Phone#: Email: v/! a CONTRACTOR: Company Name: f � �C �� Address: fJ ®e)7 4Qf� City: 7n 3a -e-09_31 p:33/°i14L Qualifier Name: ZW� ;vW C,J�E UeAO ' Phone#: State Certification or Registration #: Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: $ 2,I 0a. 04 Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New Repair/Replace ❑ Demolition Description of Work: l2k,,,iA e� � f S f, Aj &�etQ /��/ �'�-- �c✓dt �� Specify color of color thru tile: Submittal Fee $ r Permit Fee $ Scanning Fee $ Technology Fee $ Structural Reviews (Revisedo2/24/2014) Radon Fee $ 1i"69 a 'W® CCF Training/Education Fee $ CO/CC $ DBPR $ Notary $ C Double Fee $ Bond $ TOTAL FEE NOW DUE $ 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. Signaturey g"ct-J 0'—" 4c�-S-a OWNER or AGENT The foregoing instrument was acknowledged before me this day ,of/46M 1 , 20 � � by Fhi 04. L. A j7WrS,00 . who is personally known to me or who has produced ?/) i! < as Signature CONTRACTOR The foregoing instrument was acknowledged before me this 1 day of �P2 % C-- , 20 ('5- by SPA—"C'X-X "'J , who is personally known to me or who has produced +,-q_ r -.J ir'& as identification and who did take an oath. ��"'°'°"'r�fr, identification and who did take an oath. %%� O ALTA 49, 4; \� •••........• G � NOTARY PUBLIC: ` G��MISS/py ..:y :;� NOTARY PUBLIC: 23 uniui► `\��'►► '�b��i •� arch \ •fit �D �� • SO cn • � Sign:® o • ,Sign: QJ`: CG o = may•. •oma % ':;'ey°m�+' _ sn : �� — Print:,�- 19l •;' ��b� Print Seal: �rirodtls�A►►ti�Seal: APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) Miami Shores Village Building Department CONTRACTORS' REGISTRATION 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: A. 1/ COPY OF QUALIFIER'S STATE LICENCES B. L11 COPY OF LOCAL BUSINESS TAX RECEIPT C. -COPY OF LIABILITY INSURANCE* D. COPY OF WORKERS INSURANCE COMPENSATION * (Workers Compensation EXEMPTION must have NOTICE TO OWNER form and Contractor Affidavit) IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY: A. COPY OF CERTIFICATE OF COMPETENCY OF QUALIFIER B. COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF STATE REGISTERED CONTRACTOR LICENSE OR MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT. D. COPY OF LIABILITY INSURACE* E. COPY OF WORKERS COMPENSATION INSURANCE* (Workers Compensation EXEMPTION must have NOTICE TO OWNER form and Contractor Affidavit) *YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE AS FOLLOW: Certificate Holder: MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES, FL 33138 Certificate must specify the description of operations or contractor license number. BUSINESS NAME: ®��j��i`� e BUSINESS ADDRESS: Ingo =5aj c` ®/� CITYLSTATE ® ZIP 33 1'% BUSINESS PHONE:( 2h� ) ,!2� /6 FAX NUMBER )3 149� CELL PHONE C7tfG QUALIFIER'S NAME: QUALIFIER'S LIC NUMBER: EDS BROWARD-COUNTY LOCAL BUSINESS TAX RECEIPT 115 S. Andrews Ave., Rm. A-100, Ft. Lauderdale, FL 33301-1895 — 954-831-4000 VALID OCTOBER 1, 2014 THROUGH SEPTEMBER 30, 2015 DBA: Receipt #:181-2913 Business Name: HI TECH ELECTRIC &FIRE CORP ELECTRICAL/ALARMS/CONTRACTOR Business Type: (ELECTRICAL CONTRACTOR) Owner Name: EDMONDO I JARQUIN Business Opened:12/20/2004 Business Location: 1500 Sw 101 AVE State/County/Cert/Reg:Ecl3002608 MIAMI DADE COUNTY Exemption Code: Business Phone: 786-543-5216 Rooms Seats Employees Machines Professionals 3 For Vending Business only Number of Machines: Vending Type: = Tax Amount Transfer Fee NSF Fee Penalty Prior Years Collection Cost Total Paid 27.00 0.00 0.00 0.00 0.00 0.00 27.00 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 it is in compliance with State or local laws zind r ;ulations. Mailing Address: EDMUNDO I JARQUIN 1500 SW 101 AVE Receipt #30A-13-00012781 MIAMI, FL 33174 Paid 04/15/2014 27.00 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD, 5� LICENSE NUMBER I ne tLtU I KIUAL UUN 1 KAU 1 UK Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2016 CERTIFICATE OF LIABILITY INSURANCE GATE (dnWD041 D)YYYr) THIS CERTIFICATE 1S ISSUED ASA M FI=R OF INFORMATION ONLY AND CONFERS NO FLIGHTS UPON TILE CERTIFICATE HOLDER. THIS 04/21/2016 CERTIFICATE DO NOT AF'FIRMATIV cLY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED EY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($), AUTHORIZED REPRESENTATIVE OR PRODUCER, ANI THE CERTIPICATE HOLDER. IMPORTANT; If the certificate holder 16 an ADDITIONAL INSURl:p, the Policy(le>s) muse be endorsed. If SUBROGATION IS WAIVED the terms and conditions of the oil main :rtaln policies may require an endorsement. A statement on this cortlflaxate does not confer right to the certilicato holder In Ileu of such endorse Trent(s). PRODUCER, MUTUAL INTEREST ASSURANCE co ACT �: LSTH VIpAI. 1295 CORAL WAY PHONE — — -- #h/c=r1; 305-860-2003 SUITE 3 ' SIL -- i , �la►:305-860 0907 �DOROSS;l_UT ALgs((�AOL,COM MIAMI, FL 33145 INSUPaRtS1AFFORWNpCOVSRAOE — INSURED - iNsuRERA: SECURITY NAiIdNALUIS. —CO _N HI-TECH ELECTRIC & FIRE CORP INauRrRe: NORMANDY HARBORS INS, C 1500 SW 101 AVE INsuRlaRc: _ ---- --•- INSURER D:-- MIAMI, FL 33174 INSURER E: COVERAGES CERTI 'ICATP NUMBER:— THIS IS TO CERTIFY Th1AT SION NU THE_ POLICIES O INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURE NAMREVASABOVEB OR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REOI IREMENH TERM A CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WMICH THIS CERTIFICATE MAY O ISSUED OR MAY PE tTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH PC .1CIES, LIMITS SHOWN MAY HAVE BEEN REDUCED SY PAID CLAIMS. INSR "•—". TR YYaEOFINSURANCE AO IL ,flFtk _ Y0MD0YSFFNllDCY'�TFP -- .. GEN9RAL LIABILITY POLICY A NUMBER SES1919418 10/10/201410/10/2015 EACH OCCURRENCE $ X COMMERCIAL GENERALLIABIUTY PORAI(9XGE'I'ORFs'1�T5L _ .— 1,000000 CLAIMS-MADE C7 OCCUR Ep W1am—I' Bal S _. 100,000 MED EXP (Any ona por3ptl) $ nn A 0 PERSONAL A ADV INJURY $ - 1,0000,.00000-- GEN'L A'G WAYE LIMIT APPLIES PER: GENERAL A00113 SATE $ 2,000yQOO X POLICY I PELT I— LOC PRODUCTS - COMP/OPAGG $ 2,000,000 AUTOmOBILEL1AsILITY $ ` ANY AUTO M. a= ontt EI ALL OWNED SCHEDULED BODILY INJURY (porporwn) S AUTOS AUTOS - MIRED AUTOS NON-0WNED BOU1LY INJURY (Par accident) $ -- AUTOS PQOPSRTMAGE UM&RP1LA LIAB S occuR — EXCUM LIAR _ CLAIMS-MADE EACH OCCURRENCE $ _ DED RETENTIONS AGGROGATE -$ B WORKERS OOMPENSATIOItl $ - -- AND EMPLOyewuAMIUTy NHIC08124 09/23/201409/23/2015 WCsrAT . H_ ANY PROPFt1E1OR/PARTNER/EXCOUTiVE YIN - OP! ICER/MCMUER EXCLUnew I -E NI) 6.1,. EACH ACCIDENT S 500,000 (Mandatory III NN) U aa, dascnhe under DESCRIPTION OF OE.L. DISSASS - LA E S EMPLOYE5OO OO PERATIONS ao1VW t.L. DISEASE, POLICY LIMIT S 9";nf) f• Ili• DESCRIPTION OF OPERATIONS / LOCATION,O I VEHICLES 1 Ittaoh ACORD •109, Addltlooal Romarka Salwdyla, It mora n 1 ELECTRICAL. CONTRACTOR Pie is required) JOB SITE: SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CITY OF MIAMI SHORES VILI AGE THE EXPIRATION DATE THEREOF, NOTICE WILL E DELIVERED IN BUILDING DEPARTMENT ACCOR13ANCE WfrH THE POLICY PROVISIONS. 10050 NE 2ND AVE MIAMI SHORES, FL, 33138 "uTMOR1xCbREPRESENraTIVE �- -� ACORD 25 12010/051 d 1988.2010 ACORD C PORATION. All rights reserved. TI 0 ACORD name and loac are realstered marks of ACORD 10/T0 39dd 1S3Z31NIidf11f1W L060098906 60:01 5TOZ/TZ/170