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ELC-15-1862 f, �eO1�s ry{ Miami Shores Village 10050 N.E.2nd Avenue NE �f - - Miami Shores,FL 33138-0000 Phone: (305)795-2204 �tonivA :� h 'M Expiration: 01127/2016 Project Address Parcel Number Applicant 415 NE 105 Street 1122310430010 Miami Shores, FL Block: Lot: ST ROSE OF LIMA CATHOLIC C' Owner Information Address Phone Cell ST ROSE OF LIMA CATHOLIC CHURCH 9401 BISC BLVD (305)758-0539 MIAMI FL 33138-2970 Contractor(s) Phone Cell PhoneValuation: $ 500.00 STREAMLINE ELECTRIC INC (954)830-0637 Total Sq Feet: 0 Type of Work:REPLACE EXISTING RECEPTACLES IN 11 Available Inspections: Additional Info: Inspection Type: Classification:Residential Final Scanning:3 Meter Box Alteration Relocation Fire Alarm Service Change Review Electrical Underground W.W. Fees Due Amount Pay Date Pay Type Amt Paid Amt Due � CCF $0.60 DBPR Fee Invoice# ELC-7-15-56459 $2.25 07/23/2015 Credit Card $50.00 $ 109.10 DCA Fee $2.25 Education Surcharge $0.20 07/31/2015 Check#:2676 $ 109.10 $0.00 Permit Fee $150.00 Scanning Fee $3.00 Technology Fee $0.80 Total: $159.10 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 withthe-p ,drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume respon ' i for all wo k don by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL,PLUMBIN ,MEgHANICAL, IN S,DOORS,ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: I rti ha th goi i rm ion is accurate and that all work will be done in compliance with all applicable laws regulating construction 77= re, I au o' e ov amed contractor to do the work stated. July 31, 2015 Authorize ignature: licant / Contractor / Agent Date Build' g Department Copy July 31, 2015 1 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-240724 Permit Number: ELC-7-15-1862 Scheduled Inspection Date: August 06, 2015 Permit Type: Electrical - Comm rcial Inspector: Devaney, Michael Inspection Type: Ro` h Owner: CHURCH, ST ROSE OF LIMA CATHOLIC Work Classification: Addition/Alteration Job Address:415 NE 105 Street Miami Shores, FL Phone Number (305)758-0539 Parcel Number 1122310430010 Project: <NONE> Contractor: STREAMLINE ELECTRIC INC Phone: (954)830-0637 Building Department Comments REPLACE EXISTING RECEPTACLES IN 11 LOCATIONS Infractio Passed Comments WITH NEW TGFCI. INSPECTOR COMMENTS False Inspector Comments Passed Failed Correction Needed ❑ �j Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. August 05,2015 For Inspections please call: (305)762-4949 Page 27 of 33 Miami Shores Village JUL 23 015 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 20 BUILDING Master Permit No. CC1 S 1 (o-4- PERMIT APPLICATION Sub Permit No. k-L_Z'-I — I R�o'Z ❑BUILDING Z ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP f� (CONTRACTOR DRAWINGS JOB ADDRESS:-T gra _..... i T City: Miami County: Miami Dade Zip: Folio/Parcel# /i` -U_-'( Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder):- i .' ", A C .;t C r £p` Phone = i €' Address: City: ,.'' , I'V,kLt �' , C 'a State: Zip: � NfLr , Tenant/Lessee Name: Phone#: Email: t�1"ya YIf'1C;G' CONTRACTOR:Company Name: t i :(;: T= C s + '' Phone# Es`i> --" Address a t city:�­ \V c.~L - �c o'\ State: �.� zip: : Qualifier Name: \A t C`' t a " z Phone# 3,3 ` State Certification or Registration#:_ Certificate of Competenc}' DESIGNER:Architect/Engineer: �`�a #:, 1�C - '� .�.-� t I`��C�-�-1�.'i` ,� � `�Phone#: Address: -�` `j t 3 t City 140Jj(, er_d State: C .Zip: oc Value of Work for this Permit:$ Soca Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: �C •' "C + < `$'�i %"_' l 'S Specify color of color thru tile: Is-P l Agf Submittal Fee$ �Sc_ oa _Permit Fee$ 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. 1 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: 1 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 ATTORNEYBEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding$2500, the applicant must promise in good foith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also,a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issaed. in the abserAce of such pasted notice, the 1charged. �n cfion fee will be inspection will not be approved and a rei spe f Signatur Signature OWNER or AGENT CONTRAC$OR The foregoing instrument was acknowledged before me this The foregoing instn nt w s acknowledged before me this 2 Z day of_ 20 I� by �� �a day 20 j5 by -- ?rc rp Ccu✓ta.-% who is personally known to / ! Q who is personally known to me or who has produced 4A rso, as me or who has produced _ as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: \`0%%%11111111/ If NOTARY PUBLIC: NDO���i�i� Sign: _ •aV�� 1p FCo•: Sign: Print: CIVV4 r..olo ••� 'm"S�Ir= Print: i :• OF 05594® :Q� CORAM EDWARDS-KERR Seal: 9;• ._, _�•�a Sea{: NOTARY PUEILIC / Ak U ••.••��F` ��� STA OF FLORIDA STAT � C=" r1 •K#YskK#K########iK•###K##KK##K##KKi�t#i#`#K##K####KKKKKiKKK###KiKKKK##K, •K #• f1l%WiYKKssKKK#KKK#KK �1�2018 APPROVED BY /�� 2 3Tu4 V Plans Examiner Zoning Structural Review Clerk (Re%Ased02/24/2014) ♦ RFs y am sell amt" Miami Shores Village ' Building Department 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. V COPY OF LIABILITY INSURANCE* D. COPY OF WORKERS COMPENSATION INSURANCE* (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 Compensatior orAP must have10Tft"'MOMM form and *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: BUSINESS ADDRESS: bbl, K), FPde�c �� CITY IIC(Y`CYU�k. 1STATE J'L- ZIP J BUSINESS PHONE: c )_ ��O �(�(�3�- FAX NUMBER Lq5 ) — CELL PHONE �_) QUALIFIER'S NAME: wsw'6 QUALIFIER'S LIC NUMBER: C X100 -39-44 STREA-2 01P ID:CC A►��lz®= CERTIFICATE OF LIABILITY INSURANCE °A 'MwDOvyyw' 07/17/2015 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 lieu of such endorsement(s). PRODUCER Clawson&Company,Inc NSE Chi Clawson Iawson PAX _ 2731 Executive Park Drive,#8 N. Eti-954-389-6930 Weston,FL 33331 �►rL - 954-389-0452 LAS No�:� _ ADDREE:Chip@Ciawsonlnsurance.com INSUREly8)APPORDING COVERAGE r NAlC S --� -- INSURER A:W@SCO Insurance Company INSURED Streamline Electric Inc. INSURER B: 1830 Dixianna St.#104 Hollywood, FL 33020 INSURER C: INSURER 0: L 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 _-. ... _ ; LTR TYPE OF INSURANCE --�� LYE E%P POLICY NUMBER ummo YYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRFNCF 1.1 1,000,0001 X :CO PREMISES Es occ5 TED CLAIMS-MADE ! X OCCUR WWP105125704 111071201411110712015! x,rrenrai - -- --- -- MED EXP(Any one Person) S 5,00 PERSONAL 6 ADV INJURY !$ 1,000,00 ------ --------------_. GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE - $-- ----2,000 X POLICY I PRO- LOC PRODUCTS-C(MPi) Ai=JECT 2,000,,0000 0f OTHER. $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT a ANY AUTO j BODILY INJURY(Per Person) $ ALL OWNED SCHEDULED AUTOS :AUTOS BODILY INJURY(Per&cadent) $ --.----_,--,-NON-OWNED PROPERTY PRCPERTY DAMAGEHIRED AUTOS �l?ereadern - r AUTOS $ _ � a I LLA EX ERSS LIAR ® OCCUR MADE AGGREGATEEACH RRENCE E ' DED RETENTION$ S ' WORKERS COMPENSATIONH- - - ^ AND EMPLOYERS'LIABILITY Y f N ( r- STATUTE ER ❑ -� ANY PROPRlETOR/PARTNER/EXECUTNE E L.EACH ACCIDENT � i '' 'OFFICE EMBER EXCLUDED? N I A � h-- -+s --- ----------- i (Mandatory In NMI If vas-describe under E L.DISEASE-EA EMPL..Y`L S - - --—.. DE'SCRIPTiG_N OF OPERATIONS beiow E.L.LlSEPwE-POLICY LIMIT c DESCRIPTION OF OPERATIONS.r LOCATIONS I VEHICLES (ACORD 101,AdMonal Remarks SdWAA&.may be attached K nava&Pans Is required) Electrical Contractor iI CERTIFICATE HOLDER CANCELLATION i SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE: THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Miami Shores Village ACCORDANCE WITH THE POLICY PROVISIONS. BLDG DEPT 10050 N.E.2nd Ave. Miami Shores, FL 33138 I AUTyer+�D REPTATt�rE: C ' f ®1988-2014 ACORD CORPORATION. All rights reserved. ACORD 26(2014/01) The ACORD name and logo are register-ad marks of ACORD AC d► PPR DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 8001 17/20/2015 THIS CERTIFICATEIS 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 SUBROGATIONIS WANED,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). PRODWER CONTACT HARTFORD FIRE INSURANCE COMPANY PHONE FAx (AIC,No,EIA): (ArC,No): 250878 P: F: E-MAJ, ELSS: PO BOX 33015 INSURER(S)AFFORDING COVERAGE NAIC$ SAN ANTONIO TX 78265 INSURER A: Hartford Underwriters Ins Co 30104 /NSURED INSURERS: INSURER C: STREAMLINE ELECTRIC, INC INSURER D: 1830 DIXIANNA ST APT 104 INSURLR E: HOLLYWOOD FL 33020 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 TYPEOFINSURANCE ADDL SUER POLICYNUMRER OU ITS YEFF POLICYEXP LIM COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE❑OCCUR DAMAGE TO RENTED $ PREMISES Ea occurrence MED EXP(Any one person) $ PERSONAL&ADV INJURY GENII.AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY�JE O-F—]LOCPRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Es acddeM) ANY AUTO BODILY INJURY(Per person) $ ALL OWNEDSCHEDULED BODILY INJURY(Per acckW) $ AUTOS AUTOS HIRED AUT NON-OWNED PROPERTY DAMAGE $ AUTOS (Per soddeM) UMBRELLA L OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION S $ MOREERSCOMPENSA TION X PER OTl1_ AND EMPLOrERS'LLI6ILITT STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE YM E.L.EACH ACCIDENT $100, 000 OFFICER/MEMBER EXCLUDED? WA A wWatmYInW7 ❑ ( 76 WEG DR9630 05/24/2015 05/24/2016 E.LDISEASE-EAEMPLOYEE $1001000 If DESCRIPTION Odescibe U OPERATIONS below E.L.DISEASE-POLICY LIMIT $500, 000 DESCRIPTION OF OPERATIONS I LOCATR>f1IS I VEHICLES(ACORD 101,Additional Rsmsrkn Schedule,In"be attached H more specs Is"Imd) Those usual to the Insured' s Operations. Electrical Contractor CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED Miami Shores Village BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE g DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Building Department AUTMORIZEDREPRESENTATIVE 10050 NE 2nd Ave. Miami Shores, FL 33138 / ©1888-2014 ACORD CORPORATION.All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD 0STATE OF FLORIDA - DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD (850) 487-1395 •`��n� ` 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 PRIZANT, MICHAEL J STREAMLINE ELECTRIC INC 1830 DIXIANA ST APT 104 HOLLYWOOD FL 33020 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, DEPARTIVIE T OF BUSINESS AND and they keep Florida's economy strong. PROFES ULA TION Every day we work to improve the way we do business in order to ;, EC13003874 u7/24/2014 serve you better. For information about our services, please log onto www.myfloridalieense.com. There you can find more information CERTIFIED E £ OR about our divisions and the regulations that impact you,subscribe PRIZANT,MI to department newsletters and learn more about the Department's x 1w" initiatives. STREAMLINE' U' 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 CERTII tED under the provisions of Ch.489 FS. , and congratulations on your new license! Expirn6ndais:'Auc31,sols L,1407z40001864 i DETACH HERE RICK SCOTT, GOVERNOR KEN LAWSON,SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD -EC13003874 .;� The ELECTRICAL CONTRACTOR Named below IS CERTIFIED "° ' Igo Under the provisions of Chapter 489 FS:- Expiration'date: AUG 31, 2016 PRIZANT,MICHAEL J �4 •� STREAMLINE E- LECTI .� =1$30 D IA jS-T A= = 1X NpC _ _ ;HC�LL1CW00[ -� 020 tia N - � - 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#:181-3441 STREAMLINE ELECTRIC INC EELECTRICALACONTRACTORRACT Business Name: Business Type: Owner Name:MICHAEL J PRIZANT Business Opened:10/30/2008 Business Location:1830 DIXIANA ST 104 State/County/Cert/Reg:EC1 3 0 0 3 8 7 4 HOLLYWOOD Exemption Code: a Business Phone: Rooms Seats EmployeesMachines Professionals ' 1 For Vending Business Only Number of Machines: Vending Type: Tax Amount Transfer Fee NSF Fee Penalty Prior Years Collection Cost Total Paid 27.00 1 0.00 0.00 0.00 0.00 0.00 27.00 r 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 a it is in compliance with State or local laws and regulations. tw Mailing Address: MICHAEL J PRIZANT Receipt #ICP-13-00010532 1830 DIXIANA ST # 104 Paid 08/05/3014 27.00 HOLLYWOOD, FL 33020 08/04/2014 Effective Date 2014 . 2015 .e „� �?� s� ��, it l��� � , I it ii ��j�,�i I'Ih I �, �I 'h,�� '": . . .�-