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EL-14-1647 /Z/ J Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-236970 Permit Number: EL-7-14-1647 Scheduled Inspection Date: June 17, 2015 Permit Type: Electrical - Residential Inspector: Devaney, Michael Inspection Type: Final Owner: WILLIAM J.JURBERG, R.ANDREW DE Work Classification: Low Voltage DACC Job Address:9350 NE 12 Avenue Miami Shores, FL 33138- Phone Number (305)609-3851 Parcel Number 1132050070150 Project: <NONE> Contractor: PALMER HOLDINGS, INC Phone: 305-310-4673 Building Department Comments INSTALLATION OF LOW VOLTAGE WIRING IINNSPECSPEC Passed Comments TOR COMMENTS False Inspector Comments PassedE� r Failed l Correction Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. June 16, 2015 For Inspections please call: (305)762-4949 Page 32 of 36 =REVMiami Shores VillageI 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 FBC20 BUILDING Master Permit No. RC7-13-1656 PERMIT APPLICATION Sub Permit No. EU '-1 -- 0(0`1-- 7BUILDING Q ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 9350 NE 12th Avenue City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: 11-3205-007-0150 Is the Building Historically Designated:Yes NO X Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name(Fee Simple Titleholder):Andrew de Pass/William Jurberg Phone#: Address.9350 NE 12th Avenue City: Miami Shores State: FL Zip: 33138 Tenant/Lessee Name: Phone#:305-502-6289 Email: CONTRACTOR:Company Name: Interseckt Corporation Phone#: - -7 9 Address: 2307 S. Douglas Road, Suite 101 City: Coral Gables State: FL Zip: 33145 Qualifier Name: Javier A. Lugo Phone#: 305-448-7899 State Certification or Registration#: ES12000842 Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ 10,000 Square/Linear Footage of Work: 3 Type of Work: ❑ Addition ❑ Alteration Q New ❑ Repair/Replace ❑ Demolition Description of work: Installation of low voltage wiring (phone/data). Specify color of color thru tile: Submittal Fee$w'C>3 Permit Fee$ 3.S l� X00 CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ c TOTAL FEE NOW DUE$ 33S ' ,'_T,)j f1i','!T)r:-'1,0111pavy -, Nan,�e Of applicable) nr Corrpany's Address State Ogage Lenders Name(if applicable) %!,3rtzaage Lender's Address ------ - state Zip_ is hereby made to obtain a permit to do the work and installations as indicated. I certify -,t no mt,nced Prior to the issuance of a permit and that all work will be Performed to meet The std carc!< �f i avv r in, this jurisdiction. I understand that a separate permit must be secured for ELECTRk P! U%ri r, I N', PNACLS, BOILERS, HEATERS, TANKS, AIR CONDITIONERS, ETC..... OWNER'S AFFIDAVIT- I certify that all the foregoing information is accurate and that all work will bt cry r p! a ; F. avvs 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." Applicant, As a condition to the issuance of a building permit with an estimated value exceed: 9 S25t-)i rr, eIrgood faith that a copy of the notice of commencement and construction lien low brochure v. ii of Drooerry is subject to attachment. Also, a certified copy of the recorded notice of commencement t v c r, iirli ,rispecriciri which occurs seven (7) days after the building permit is issued In the absent- of tJ( or:inn .viii not be approve d a reinspection fee will be charged. Signator N or GENT CONTRACTC,R rrr foregoing instru entwas ackno dged before me this Th foregoing instrument was ackno Jeagr,c 1) 4Q day of 20 • by 44,�day of w o Is pers nal y nown 0 p e r a1 no�yr e of who has wotiuced as me or who has produced w ation and whbdid takgan oath. identification and who did ta%orkp NOTARY PU IC: 6//v1' SANDRA LINN NOTARY PUBLIC: My COMMISSION#EE 837836 EXPIRES:September 23,20x3 AM, "OF F Thru Budget Notary Services EXPIR 0'. PIRES:Sept?f-,Of oil IW Sign: FF ------ Print: Seat- APPROVED BY Plans Examiner Structural Review AC# 6240941 : STATE OF FLORIDA DEPART MENTO BUSINESS AND PROFESSIONAL REGULATION ELECTR CALCONTRACTORS LICENSING BOARD SEQ#>L12080102789 go] Oki III IT,1.01 q LICENSE NBR z>r 1,0.0101/101, 2012 11.8215:758 E$120008v'L ,E. =f , c +t:;,� ',. The SPECIALTY ELECTRICAL CONTRPCTOR` Named beldw IS CERTIFIED Under the rovisions of Cha tek-:o.4 St ' P P � Expiration date: AUG 31, 20141, t AS A LIMITED ENERGY SYSTEMS.., SL�,�CII��,�'T�� r,�� Q 9 mss,°x tk 1s, ,x111 9 r y' I LUGO, ..'JAVIER A r y INTERSECKT CORP .- 2307 RP 2307 S DOUGLAS ROAD SUITE l0I CORAL GABLES FL 33145 RICK SCOTT KEN LAWSON GOVERNOR SECRETARY DISPLAY AS REQUIRED BY LAW 7 ® DATE(MM/DDNYYY) ACORO CERTIFICATE OF LIABILITY INSURANCE 7/22/2014 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 CONTAC NAME: CPC FINANCIAL SERVICES INCPHONE (305)774-9618 ac, No:(305)774-9620 A/C No Ext): 3835 SW 8 St E-MIEss:]mocha@cpc-insurance.com Coral Gables, FL 33134 INSURER(S) AFFORDING COVERAGE NAICf1 INSURER A: Lloyds of London INSURED Interseckt Corporation INSURER B: Technology Insurance co INSURER C: 2307 S Douglas Rd Ste 101 INSURER D: Coral Gables, FL 33145 INSURER E 305.448.7899 x201 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 AbOL 'SUR POLICY EF POLICY XP LIMITS LTR INSR WVO POLICY NUMBER MM/DD MM/DD GENERAL LIABILITY EACH OCCURRENCE $$1,000,000 DAMAGE TO RENTED__ X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ $300,000 CLAIMS-MADE CI OCCUR MED EXP(Any one person) $ $10,000 A ESC04075208 4/16/14 4/16/15 PERSONAL&ADV INJURY $$11000,000 GENERAL AGGREGATE s$2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $$1,000,000 POLICY PRO LOC $ PRO- JECT AUTOMOBILE LIABILITY COMBID(Ea aaccldent) L $$1, 000,000 BODILY INJURY(Per person) $ AESC04075208 4/16/14 4/16/15 ALLLL OWNED SCHEDULED BODILY INJURY(Per accident) $ A AUTOS AUTOS X HIRED AUTOS ]( NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION WCSTATU- OTH- AND EMPLOYERS'LIABILITY TORY LIMITS ER ANY PROPRIETOAFITNE B OFFICER/MEMBERI/EXCLUDEp XECUTIVE YN N/A E.L.EACH ACCIDENT $ 1,000,000 (Mandatory In NH) TWC3393557 2/5/14 2/5/15 E.L.DISEASE-EA EMPLOYEE $ 1,000,000 if yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 A Professional ESC04075208 4/16/14 4/16/15 $1,000,000 occurrence liability $1,000,000 aggregate DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Technology services. CERTIFICATE HOLDER CANCELLATION City of Miami Shores SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 10050 NE 2nd Avenue ACCORDANCE WITH THE POLICY PROVISIONS. Miami, FL 33138 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD25(2010/05) The ACORD name and logo are registered marks of ACORD 1 POST THIS 1010(" ENT INA CONSPICUOUS PLACE THIS IS NOT A BILL (�j TRITn NOT OR VALID AT ANOTHER ADDRESS 5 UNLESS APPROVED BY THE FINANCE DEPARTMENT. DO NOT PAY CITY OF MIAMI 444 S.W.2 AVE 6TH FLOOR.MWM, FL 33130. PHONE(305)118-1918. Effective Year OcL 12013 That Sep.30 2014 RECEIPT FOR INTERSECKT CORP Tlk WsUanm of a bu Wen f„r mcW d0n M peat the holder to violets any zm*V laws of d,s ISSUED Oct 15,3013 TOTAL`FEE PAID 116.00 City nor dm r Q1 " A0� 01"mWroar,a. o<tterrrti<a ara may be regprMed by taw. Tha domanent doss not oansU4do a oa0dwtlon the ft hsldar is auaUed b ewqne in d+a protsssion ar ooa4mbw aI ifad heraYr- The doaxnw t Yrrfoates psyrnom of dra drw wm tan recoo 0*1 ACCOUNT NUMBER 49248 RECEIPT NUMBER 30418 NAME OF BUSINESS INTERSECKT CORP DBA INTERSECKT CORP LOCATION 2307 SW 37 AV 101 IS HEREBY IN COMPLIANCE 01 TO ENGAGE IN OR MANAGE THE OPERATION OF: CONSULTANT:BUSINESS OR PROF. Jose M. Femande Finance Director