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EL-14-1762 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-237705 Permit Number: EL-8-14-1762 Scheduled Inspection Date: June 29, 2015 Permit Type: Electrical - Residential Inspector: Devaney, Michael Inspection Type: Final Owner: MILLION, CHARLES Work Classification: Alteration Job Address:485 NE 94 Street Miami Shores, FL 33138- Phone Number (917)887-5511 Parcel Number 1132060140540 Project: <NONE> Contractor: LS CURTIS INC Phone: 305-892-0115 Building Department Comments KITCHEN COUNTER TOP RECEPTACLES, LIGHTS, infractio Passed Comments SWITCHES AND APPLIANCE INSPECTOR COMMENTS False Inspector Comments Passed Failed .i Correction ❑ Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. June 26, 2015 For Inspections please call: (305)762-4949 Page 18 of 28 Miami Shores Village g- i Building Department 2 2014 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 p+U� Tel: (305)795.2204 Fax: (305)756.8972 INSPECTION'S PHONE NUMBER:(305)762.4949 1 BUILDING Permit No. "E' l — 1 CoZ PERMIT APPLICATION Master Permit No. rZG 1 ~'-i (Po FBC 20 Permit Type: Electrical OWNER:Name(Fee Simple Titleholder): Phone#: 305-933-0683 Address: 485 NE 94 Street City: Miami Shores State: F1 Zip: 33138 Tenant/Lessee Name: Phone#: Email: JOB ADDRESS: 485 NE 94 Street City: Miami Shores County: Miami Dade Zip: 33138 Folio/Parcel#: Is the Building Historically Designated: Yes NO X Flood Zone: CONTRACTOR:Company Name: L S Curtis i n c Phone#: 786-486-1961 Address: 20341 NE 30 Ave #108 City: Aventura State: FL Zip:- 33180 Qualifier Name: Lewis S Curtis Phone#: 786-486-1961 State Certification or Registration#: E C 0 0 0 317 5 Certificate of Competency#: Contact Phone#: 786-486-1961 Email Address: aasteve .aol com DESIGNER: Architect/Engineer: Phone#: Value of Work for this Permit:$_I 5 0 0 . 0 0 Square/Linear Footage of Work: Type of Work: ❑Address ❑Alteration ❑New )Utepair/Replace ❑Demolition Description of Work: Kitchen counter top receptacles; lights, switches and appliance ********* �* ***** *****************Fees*x�x***** Submittal Fee$ Permit Fee$ ??add CCF$ CO/CC$ Scanning Fee$ Radon Fee$ 7:3- S& DBPR$ _-:25 Bond$ _ Notary$ Training/Education Fee$ Technology Fee$ �1 Double Fee$� Structural Review$ TOTAL FEE NOW DUE$ 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 ELECTRICAL WORK,PLUMBING,SIGNS, WELLS,POOLS,FURNACES,BOILERS,HEATERS,TANKS and 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$2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such poste notice, the inspection will not be approved and a reinspection fee will be charged. Signature Signature Owner or Agent Contractor The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this2 7 da of b pt 01 t t ` 1 day of July 2014 ,by Lewis Curtis Y � Y is personally known to m r who has pilo uced who is ow me or who has produced identification and who did take an oath. as identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC Sign: n Sign: Print a n Print: Awl Y ■wp�n '*' ''=MY COMMISSION#EE219418 My Commission Expires: *"Irwe•Iw 0$Bob My Commis,i ft 6—1*0-aw is.MG �!o��,.� EXPIRES July 25,201() G�u1N I NOp (407)396 U1b3 Fb,d&Wt3ry3wvfa,=n APPROVED BY s/� �� O(Zee.-,Plans Examiner Zoning Structural Review Clerk (Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09) TV STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD (350) 437-1395 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 CURTIS, LEWIS STEVEN L.S. CURTIS INC 20341 NE 30TH AVE APT 108 AVENTURA FL 33180 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 ,.- STATE OF FLORIDA from 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 ECO003175 ISSUED: 05/29/2014 serve you better: For information about our services,please log onto www.myfloridaticense.com. There you can find more information CERTIFIED ELECTRICAL CONTRACTOR about our divisions and the regulations that impact you, subscribe CURTIS. LEWIS STEVEN to department newsletters and learn more about the Department's LS, CURTIS 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 CrRTIFIE D under the provisions or Cn 484 Fs and congratulations on your new license! Exp vatton wm AUG 31,,201,15 L t 106250;}0297 4 DETACH HERE RICK SCOTT,GOVERNOR KEN LAWSON, SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD d t ECO003175 The ELECTRICAL CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2016 D �l CURTIS, LEWIS STEVEN L.S. CURTIS INC 20341 NE 30TH AVE#108 Er AVENTURA FL 33180 ' ISSUED- 05r2912014 DISPLAY AS REQUIRED BY LAW SEct# L1405290002874 005419 Local Business Tax Receipt Miami—Dade County, Stateof Florida .-THIS IS NOTA BILL 00 NOT PAY 5108006 LBT Bt1StNESS NAMEILOCATION RECEIPT NO. EXPIRES L S CURTIS INC RENEWAL SEPTEMBER 30, 20115 20341 NE 30 AVE 108 2427060 Must lie displayed',at place of business AVENTURA FL 33180' Pursuant to County Coda Chapter BA;-Art.9&10 OWNER SEC.TYPE OF BUSINESS PAYMENT RECBIV9G L S CURTIS INC 196 ELECTRICAL CONTRACTOR BY TAX COLLECTOR Worker(s) 1 EC0003175 $45,00 07/17/2014 CREDITCARD-14-028306 This Local Business Tax Receipt only confirms payment of the Local Business Tax. Tho Receipt is not a license,, permit or a certification of tbo holder's qualifications,to do business. Holder must comply with any govetnmonlal or nongovernmental regulatory taws and requirements which apply to the business, The RECEIPT NO,above must he displayed an all commercial vehicles-Miami-Bade Code Sec 84-276. For roam information,visit YrYtkY iplamsdado y�gX g1106t4[ CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY) 11/20/13 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(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 lieu of such endorsement(s). PRODUCER CONTACT NAME: STACY PARKS Insurance IndustriesPHONE (AIC.No.Ext: (305)891-2808 a No: (305)891-6367 953 N.E.125th St. EMAIL stacy@insuranceindustriesinc.com N.Miami,FL 33161 INSURERS AFFORDING COVERAGE NAIC# Phone (305)891-2808 Fax (305)891-6367 INSURERA: SCOTTSDALE INSURANCE CO INSURED INSURER B: LS CURTIS INC. INSURER C: 20341 NE 30 Ave #108-6 INSURER D: AVENTURA,FL 33180- (305)892-0115 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 MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADD UBR POLICY EFF POLICY EXP LTR IN R WVD POLICY NUMBER MM/DD/YYYY MMIDD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000.00 COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED 1 PREMISES Ea occurrence $ 00,000.00 ❑ ❑ CLAIMS-MADE S?] 11/18/2013 11/18/2014 OCCUR CPS188037 MED EXP(Any one person _$ 5,000.00 A ❑ Y PERSONAL&ADV INJURY $ 1,000,000.00 ❑ GENERAL AGGREGATE $ 2,000,000.00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 1,000,000.00 ❑ POLICY ❑ JECTPRO ❑ LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident ❑ ANY AUTO BODILY INJURY(Per person) $ ALL AUTOS OWNED ❑ SCHEDULED AUTOS BODILY INJURY(Per accident $ ❑ HIRED AUTOS ElNON-OWNED PROPERTY DAMAGE AUTOS Per accident $ ❑ ❑ $ ❑ UMBRELLA LIAB ❑OCCUR EACH OCCURRENCE $ ❑ EXCESS LIAB ❑CLAIMS-MADE AGGREGATE $ ❑ DED ❑ RETENTION$ $ WORKERS COMPENSATION W C STATU- OTH- AND EMPLOYERS'LIABILITY Y/N ❑TORY IMIT 11R ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? ❑ N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT I $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) ELECTRICIAN CERTIFICATE HOLDER IS ALSO ADDITIONAL INSURED CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE MIAMI SHORES VILLAGE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN 10050 NE 2 AVE ACCORDANCE WITH THE POLICY PROVISIONS. MIAMI SHORES,FL.33138 AUTHORIZED REPRESENTATIVE A"l-Aw A47 ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05)OF The ACORD name and logo are registered marks of ACORD