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EL-15-16 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-226512 Permit Number: EL-1-15-16 Scheduled Inspection Date: January 15, 2015 Permit Type: Electrical - Residential Inspector: Devaney, Michael Inspection Type: Final Owner: MOWERS,JEFFREY Work Classification: Low Voltage Job Address: 1175 NE 101 Street Miami Shores, FL 33138- Phone Number Parcel Number 1132050190230 Project: <NONE> Contractor: CONNECTIVE ELECTRIC INC Phone: (954)782-7879 Building Department Comments LOW VOLTAGE WIRING PERMIT FOR LOW VOLTAGE Infractio Passed Comments WIRING INDICATED; TV, TELEPHONE, ETC. INSPECTOR COMMENTS False Inspector Comments Passed Failed ) Correction f Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. January 14, 2015 For Inspections please call: (305)762-4949 Page 32 of 37 ' 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 FBC 20C_ ) BUILDING Master Permit No. RC-6-13-1361 PERMIT APPLICATION Sub Permit No. B_ ❑BUILDING ❑■ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL F-1 PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 1175 NE 101 St. City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: _� I Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): � f/� �-��-, d L�I�I r��L+1'�//1 �� '7S- x'177 y Addresses:: 1175— C/ ��fi l0/ S City:/ �6 fuTwyh'W�'e-� State: Ft— Zip: 3��3 Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name: Connective Electric, Inc. Phone#: 954-782-7879�Q Address: 3907 N. Federal Hwy. #245 City. Pompano Beach State: FL Zip: 33064 Qualifier Name: Michael Caponera Phone#: 954-205-7501 State Certification or Registration#: EC13003789 Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$500 Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration 0 New ❑ Repair/Replace ❑ Demolition Description of work: Low voltage wiring permit for low voltage wiring indicated; TV, telephone, etc. Specify color o--f��color `tt hru tile: Submittal Fee$ ` 'J "Uy Permit Fee$ /OUB d U CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ (Revised02/24/2014) Bonding Company's Name(if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name(if applicable) Mortgage Lender's Address City State 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. i A� Signature Signature OWNER or AGENT CONTRACTOR / The foregoing instrument was acknowledged before me this The foregoing instrument was acknowle✓✓dged before me this 5 day of -V-o r 20 1 -5 by 5 day of January ,20 15 by J1tb Q.r:,c A<crwe-ri- I who isersp onally known to Michael Caponera 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 ovhs did take an ea-" NOTARY PUBLIC: ' ,,;�yj� TAYLOR J.SARIOL NOTARY PUBLIC: TAYLOR J.SARIOL# 904 �.'.{ My COMMISSION EE185 MY COMMISSION#EE165904 -j IRES February 02.2018 Sign: l EXPIRES February 02,2015 Sign: (� / •'", Fl0"08" rys" '00"' 1 PIoAU oom Print: Xd Print: Taylor Sariol Seal: Seal: APPROVED BY 7�/� ia r��Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) W ELECTRICAL CONTRACTORS LICENSING BOARD (850) 487-1395 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 CAPONERA, MICHAELA CONNECTIVE ELECTRIC INC 3907 N. FEDERAL HWY#245 POMPANO BEACH FL 33064 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 ::lw�: STATE OF FLORIDA Tom architects to yacht brokers,from boxers to barbeque restaurants, _ DEPARTMENT OF BUSINESS AND and they keep Florida's economy strong. ;' ` PROFESSIONAL REGULATION Every day we work to improve the way we do business in order to EC13003789 ISSUED: 07/31!2014 serve you better_ For information about our services, please log onto www.myfloridalicense.com. There you can find more information CERTIFIED ELECTRICAL CONTRACTOR about our divisions and the regulations that impact you,subscribe CAPONERA,MICHAEL A to department newsletters and learn more about the Department's CONNECTIVE ELECTRIC INC 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, Is CERTIFIED under the provisions of ch 439 =s. and congratulations on your new license! Expiration date AUG E. =015 .40731,06 Q3.5 DETACH HERE RICK SCOTT.GOVERNOR KEN LAWSON. SECRE TARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD 1 EC13003789 , The ELECTRICAL CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2016 CAPONERA, MICHAEL r CONNECTIVE ELECTRIC INC 3907 N. FEDERAL HWY.#245 ° POMPANO BEACH FL 33064 ' �: �ZZ � +,, I. REGISTRATION NO. a City of Pompano Beach pompano Business Tax Receipt + 024beach NEW RENEWAL Florida's Warn Welcome m ,;. OWNER DATE ISSUED ACCOUNT NO. REGISTRATION FEE BUSINESS NAME DELINQUENT CHG. I:. LOCATION TRANSFER FEE TOTAL AMOUNT PAID CLASSIFICATION EFFECTIVE BATE EXPIRATION DATE ,.s OCTOBER 'i SEPTEMBER 30 BUSINESSES MAST CONSPICUOUSLY DISPLAY THIS BUSINESS TAX RECEIPT TO PUBLIC VIEW AT BUSINESS I.0(:A'f10N CONTRACTOFIS MUST MAINTAIN ON FILE CURRENT LICENSING AND INSURANCE WAIVER OF ANY PROVISION OF THE CITY CODE NOR SHALL THE ISSUANCE OF A BUSINESS TAX RECEIPT RE CONSTRCIED'I O DF A JUDGEMENT OF'EHE CITY NOTICE:A CHANGED. ISSUANCE OFA BUSINESS TAX RECEIPT SHALT. NEW APPLICATION MUST BE FILED IF THE BUSINESS NAME.OWNERSHIP OR ADDRESS IS CHANGNOT BE DEEMED A WA i} AS TO THE COMPETENCE OF TIdE APPLICANT TO TRANSACT BUSINESS. T 2 From:Tasha Forbes FaxID:954-963-8519 Page 1 of 1 Date:1/14/2015 12:26 PM Page:1 of 1 I (el CONNELE OP ID: TF ACRO CERTIFICATE OF LIABILITY INSURANCE DATE 01/141201 YY) 01/14/2015 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. 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. A statement on this certificate does not confer rights to the certificate holder In Ileu of such endorsement(s). PRODUCER CONTACT Newman Insurance Agency, Inc. PHO FAX 5700 Stirling Road LAIC No Ext:954-963-9626NE (ACNo): Hollywood, FL 33021- -MADDRESS:11_ Jeffrey M. Newman INSURER(S)AFFORDING COVERAGE NAIC 8 INSURERA:Arch Speciality Insurance Co INSURED Connective Electric Inc INSURER B: 3907 N. Federal Hwy#245 Pompano Beach,FL 33064 INSURER C: INSURER D: INSURER E: 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 MAYHAVE BEEN REDUCED BY PAID CLAIMS. INSR CTEWO LTR TYPE OF INSURANCE POLICY NUMBER MMIDDIYYYY MMIDD YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE 11 OCCUR GL0008106-01 01/09/2015 01/09/2016 DAMAGE T7PrNT7T7— PREMISES(Ea occurrence) $ 100,000 MED EXP(Any one person) $ 10,00 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $ 2,000,000 POLICY ❑PRO- JECT LOC PRODUCTS-COMP/OP AGG $ 1,000,000 OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED PROPERTY DAMAGE AUTOS Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ WORKERS COMPENSATION $ AND EMPLOYERS'LIABILITYPER - ANY PROPRIETOR/PARTNER/EXECUTIVE YIN STATUTE ER OFFICER/MEMBER EXCLUDED? N/A E.L.EACH ACCIDENT $ (Mandatory In NH) If yes,describe under E.L.DISEASE-EA EMPLOYEE $ DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1$ DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space is required) Contract# EC13003789 CERTIFICATE HOLDER CANCELLATION MIAMISH SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Miami Shores Building Dept THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 10050 NE 2nd Ave ACCORDANCE WITH THE POLICY PROVISIONS. Miami Shores Village, FL 33138 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD