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EL-15-264 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-234303 Permit Number: EL-2-15-264 Scheduled Inspection Date: June 04,2015 Permit Type: Electrical - Residential Inspector: Devaney, Michael Inspection Type: Final Owner: TOMMIE, QUENTIN Work Classification: Alteration Job Address:124 NEI 11 Street Miami Shores, FL Phone Number (772)237-9346 Parcel Number 1121360040101 Project: <NONE> Contractor: R& R ELECTRIC OF BROWARD INC Phone: (954)319-5630 Building Department Comments REPLACE 200 AMP SERVICE INSTALL SMOKE Infractio Passed Comments DETECTORS INSTALL TANKLESS WATER HEATER AND INSPECTOR COMMENTS False OUTLETS IN KITCHEN Inspector Comments Passed CREATED AS REINSPECTION FOR INSP-234202. need low voltage first. O. K. to release work with to F P L. Failed Correction ❑ _ Needed Re-Inspection Fee No Additional Inspections can be scheduled until re-inspection fee is paid. June 03,2015 For Inspections please call: (305)762-4949 Page 5 of 28 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 FBC 20 t0 BUILDING Master Permit No. l.G S — 119 PERMIT APPLICATION Sub Permit No. ❑BUILDING, + MELECTRIC ❑ ROOFING ❑ REVISION ❑EXTENSION ❑RENEWAL__.. ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION E] SHOP AA CONTRACTOR DRAWINGS JOB ADDRESS://A// -1/� // A. City: Miami Shores Co Miami Dade zip: Folio/Parcel#: /' i�G� Is the Building Historically Designated:Yes NO Occupancy Type: f d Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): ����/� /�/Yl iM �C Phone#: /� '� `� �V7-W, Address: ,_R�! W✓5 1114 City: State: ��' Zip: Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name: E. L - 8.2r Phone#: L 5 Address: e�> l City: �Y r //2' State Zip: Qualifier Name: r� Lf'('k-I-Pck C�0�1 Phone#: (4_31 q257,30 State Certification or Registration#:4- L3,/)4Y,3/�'f Certificate of Competency M DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ Square/Linear Footage of Work: Type of Work: ❑ AdditionAlteration ❑ New ❑ Repair/Replace ® Demolition Description of Work: 411j2 2 Specify color of color thru tile: Submittal Permit Fee$ .AW CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$_ Double Fee$ Structural Reviews$ Bond$ t c TOTAL FEE NOW DUE$�`l (RevisedO2/24/2014) III 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 inspectionwill t be approved and a ' spection fee will be charged. SignatureSignature OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of_'ya .20 �� .by day o v Iil 20 A ,by w personally k oc ho' personally nk owner 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. Si Print ;lyP�e. Print '= MY COMMISSION#EE082191 =;�'.�PJ*.0 Seal: �9, ��= Seal: _: *: My COMMISSION#EE082191 soFa? EXPIRES April 10,2015 �,a, r- (407)30"'0153 FlovidaMotaryServim.com � Oitv�PR, EXPIRES April 10,2015 (407),39"0153 FlorldaPwaryService.-M ww*wwwwwww*ww*wwwwwwww**www***www*w****w*wwww**w*ww*w*w******www**www*w*wwww*ww**w*www**w*wwww*www***�ww**** APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) r g ORsale �s n Miami Shores Village Building Department RNA 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305)795.2204 CONTRACTORS' REGISTRATION Fax: (305)756.8972 IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: A COPY OF QUALIFIER'S STATE LICENCES B. COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF LIABILITY INSURANCE* D. COPY OF WORKERS COMPENSATION INSURANCE* (Workers Compensation EXEMPTION must have NOTICE TO OWNER 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 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 ertificate must specify the description of operations or contractor license nuWnr, BUSINESS NAME: R & R Electric of Broward, Inc. BUSINESS ADDRESS: 7958 Pines Blvd, Suite 238 CiTyPembroke Pines STATE ZIP33024 BUSINESS PHONE; 9( ) 319-5630 FAX NUMBER9( 54 1983-8851 CELL PHONE(954 )1319-5630 QUALIFIER'S NAME: Erin Richardson QUALIFIER'S LIC NUMBER: EC13006319 RICK SCOTT,GOVERNOR KEN LAWSON,SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD EC13006319 The ELECTRICAL CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31,2016 RICHARDSON, ERIN ° R& R ELECTRIC OF BROWARD, INC. 7958 PINES BLVD., SUITE-1238-- = PEMBROKE PINES ,FL 33024 ,a. t ISSUED: 0923/2014 DISPLAYAS REQUIRED BY LAW SEQ# L1409230000350 SRC WAR® COUNTY LOCAL BUSINESS TAX -RE11 CEIPT 115 S. Andrews Ave., Rm.A-100, Ft. Lauderdale, FL 33301-1895—954-831-4000 VALID OCTOBER 1,2014 THROUGH SEPTEMBER 30,2015 DSA: & R ELECTRIC OF BROWARD INC Receipt#:ELECTP-181 Business Mame: Business Type:(MASTER ELECTRICIAN) Owner Name:ERIN RICHARDSON Business Opened:02/27/2008 Business Location:7958 PINES BLVD 238 State/County]Cett/Reg:EC13006319 PEMBROKE PINES Exemption Cade: Business Phone:9543195630 Rooms Seats Employees Machines Professionals 3 - For Vending Business Only _ ._ .. .. . . Number of.Machines;.. .Vendin T Tax Amount Transfer Fee NSF Fee Penalty Prior Years Collection Cost E!3!0 27.00 3.00 0.00 0.00 0.00 0.0000 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 and regulations. Mailing Address: R & R ELECTRIC OF BROWARD INC Receipt #308-13-00003813 7958 PINES BLVD 238 Paid 09/25/2014 30.00 PEMBROKE PINES, FL 33024 2014 - 2015 , I f 'a Ekt11+i__RSCSARDSON , .. R & R'ELECTRIC OF'BROWARD, INC 7958 PINES BLVD, #'238 PEMBROKE PMES FL 33024 CITY OF PEMBROKE PINESLOCAL ' �® ® 10100 PINESBOVLEVARD;PEMBROKE PINES,FL 33026 BUf lel �� ���rT ACCOVNT-NO: 20070919/01 RECEIPT-YEARS CCTOBIM 1, 2014 thru SEPTEP9BRR 30, 20x3 RECEIPT-NO: 144112 p� j. NOTICE stm-NAME R,& R ELECTRIC OF "BROWARDi INC. In the eveAt the businese' to'whicY% this $IIS-ADDR 9958 PINES BLVD, #;238 receipt oras issued cbi ges"3iSR8�i,' the teCeipt' PEMBROKE PINES FL 33024 . will become:tu7l.and void.'An! application for a new receipt must be made. BIIS-DESCR ELECTRICAL CONTRACTOR/QUALIFIER RECEIPT-TYPE: RESTRICTED LICENSE: SUSINSSS-CLASSIPICATION INV/MMS SPPECTIVE PE$MIT-NOI�ERr(COM B RCT TYPE' CEL CONTRACTOR - ELECTRICAL 0 z0101/2�14" PJPines 6 1' I. J1 , -------------- ADVAN-8 OP ID:KW i4e�,.:RoF CERTIFICATE OF LIABILITY INSURANCE 1 °02/041°"Y"Y' 02/04/2015 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 pollcy(ies) 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 Omega Insurance Solutions Inc PHONE FAX 1933 E.Edgewood Dr Suite 102 �aL Lakeland, L 33803 M 8 AFFORDING COVERAGE NAIC S INSURERA:AmTrust North America of FL INSURED Advanced PEO Solutions II,LLC INSURER B: LIC/F R&R Electric of INSURER C Broward,Inc. 1933 E Edgewood Dr,STE 102 INSURER D: Lakeland,FL 33803 INSURER E: 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. � AM SUN R TYPE OF WSURANCE CYN MBER POLICY EFF POLICY EXP LIMITS GENERAL LIABILITY EACH OCCURRENCE _ $ DAMATO COMMERCIAL GENERAL LIABILrfY PREMISES Me o=mmce) $ CLAIMS41ADE 0 OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GENT_AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGO $ POLICY PR4 Loc $ AUTOMOBILE LIABILITY SIN Ea accidEenrtS $ ANY AUTO BODILY INJURY(Per person) $ OALLOS HIRED AUTOS WNED SAUTOS CHEDULED BODILY INJURY(Per acddent) $ NON-OWNED ROPERTRTY $ AUTOS P UMBRELLA LIABOCCUR EACH OCCURRENCE $ EXCESS LIMffCLAIMS-MADE AGGREGATE $ DED RETENTION $ WORKERSCOMPENSATIONX WCSTATU O1H AND EMPLOYERS'LIABILIY YIN Y6MIIi A ONFFlCRamIXr ® NIATWC3414927 05/20/2014 05/20/2015 E.L.EACH ACCIDENT $ 1,000, (Mary In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,00( H describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000, DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(AM*h ACORD 101,AddiBon al Remarks SchedWe,it mm spate Is requlred) Coverage is extended to the leased employees of alternate employer"R & R Electic of Broward" (Eff 05/20/14)This certificate doesn't constitute a contract between the insurer, authorized rep or producer and the certificate older nor does it amend, extend or alter coverage listed on the policies listed thereon. CERTIFICATE HOLDER CANCELLATION MIAMI-9 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE MIamlShoresVllla a THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Village ACCORDANCE WITH THE POLICY PROVISIONS. Building Department 10050 NE 2 Avenue AUTHORMEDREPRESENTATI VE Miami,FL 33338 ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 26(2010105) The ACORD name and logo are registered marks of ACORD R&REL-1 OP ID: KW Aa a✓RQ� DATE(MWDDNYM CERTIFICATE OF LIABILITY INSURANCE 1 02/05/2015 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 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). PRODUCER CONTACT Omega Insurance Solutions Inc pN pNE FAX 1933 E.EdgeWood Dr Suite 102 c No): Lakeland,FL 33803 E-MAIL ADDRES INSURERS AFFORDING COVERAGE NAIC d INSURERA:Accldent Insurance Company 11573 INSURED R&R Electric of Broward,Inc INSURER B: 7958 Pines Blvd,STE 238 INSURER C: Pembroke Pines,FL 33024 INSURER D INSURER E., INSURER 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. ILTR TYPE OF INSURANCE ADD SUBR POLICY EFF POLICY EXP LIMITS POLICY NUMBER GENERAL LIABILITY EACH OCCURRENCE $ 1,000,0001 DAMAGE TO RENTEU A X COMMERCIAL GENERAL LIABILITY CPPOO1022001 10/01/2014 10/01/2015 PREMISES Ea occurrence $ 100, nnd CLAIMS-MADE OCCUR MED EXP(Anyone person) $ 5, PERSONAL&ADV INJURY $ 1,000, GENERAL AGGREGATE $ 2,000, GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000, POLICY PROJEC- LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT a accident $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ NUTOS PER ACCIDE HIRED AUTOS AUTOS UMBRELLA LIM OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION WSTATU- OTH- AND EMPLOYERS'LIABILITY TORC Y LIMTB ER ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? F] N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEd$ If ,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1$ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,H more space Is required) Commercial and Residential Electrical Contractor License # EC13006319 CERTIFICATE HOLDER CANCELLATION MIAMI-9 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE MtamiShoresVilla a THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Village ACCORDANCE WITH THE POLICY PROVISIONS. Building Department 10050 NE 2 Avenue AUTHORIZED REPRESENTATIVE Miami,FL33138 ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD