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EL-15-75 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-232008 Permit Number: EL-1-15-75 Scheduled Inspection Date: April 13, 2015 Permit Type: Electrical - Residential Inspector: Devaney, Michael Inspection Type: Final Owner: ROSS, COLLIN AND TRACY Work Classification: Alteration Job Address: 134 NE 100 Street Miami Shores, FL 33138- Phone Number (305)494-3557 Parcel Number 1132060132150 Project: <NONE> � Contractor: ASSOCIATE ELECTRIC, INC. Phone: (305)898-7853 Building Department Comments NEW GROUNDING. Infractio Passed Comments INSPECTOR COMMENTS False Inspector Comments Passed © CREATED AS REINSPECTION FOR INSP-231858. Grounding electrode conductor to be#4 cu.. Failed Correction Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. April 10,2015 For Inspections please call: (305)762-4949 Page 16 of 25 Miami Shores Village �En Building Department JAN 20,5 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 BY: Tel:(305)795-2204 Fax:133D5]„75 8972 J INSPECTION LINE PHONE IN IdIBER (305')762-4949 FBC 20 BUILDING Master Permit NO.KF — 12 D-,-S�Y” PERMIT APPLICATION Sub Permit No. ❑BUILDING ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL [::]PUBLICWORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP B, CONTRACTOR DRAWINGS JOB ADDRESS: City: Miami Shores County: Miami Dade Zip: 3 3 l 3g Folio/Parcel#: Is the Building Historically Designated:Yes NO Occupancy Type: Load: /Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): W I1k� ��"`fir Phone#: Address: kc L� Y1 e- �(30 S'CY City: 1-..Arl O'M-k S1/l��/� State: lam-. Zip: 33 1 3p Tenant/Lessee Name: Phone#: Email: 2 CONTRACTOR:Company Name: r 1 JS�G' � Phone#: 30 S- E16_'__79S 3 Address: �LO) S VW4 2 City: o � State: C - Zip: 3 3 Qualifier Name: �O ��`� O Phone#: State Certification or Registration#: y 0 Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ _ /CC�O ' o © Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: � � c CO IL-1, Specify color of color thru tile: Submittal Fee$lq-)' w Permit Fee:$ 'O CCF$ CO/CC$ Scanning Fees$ Radon Fee$ DBPR$ NotarV$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ p TOTAL FEE NOW DUE$ l I O (Revised02/24/2014) s r 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 on 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 a a reinspection fee will be charged. Signature Signature OWNER or AGENT CONTRACTOR The foregoing instrument lwas acknowledged before me this Theforegoing instrument was acknowledged before me this dairy of 'k-41 ( 20 IS by I day ofyAVIV10t 20 ( S by S who is personally known to U who is personally known to me or who has produced dly�V-r �Z as me or who has produced iqlG'vas identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: MA&t-5 Sign: Sign: Print: r � U �' Print: liltCM. U �,ne�l Seal: E4, PisMICHELLE MOLINA Sea : ,,:r�'P�o a� MICHELLE MOLINA Notary Public -State of Florida �: .°= Notary Public -State of Florida My Comm. Expires Sep 19,2017Pc My Coma. Expires Sep 19,2017 oW �k**** �k *E* ** *********************** *b,(riMbl APPROVED BY /`� 119Y� Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD (850)487-1395 a n 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 MORENO, ROBERTO ASSOCIATE ELECTRIC,INC. 7220 NW 5 STREET MIAMI FL 33126 Congratulationsl 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 rangeSTATE OF FLORIDA from architects to yacht brokers,from boxers to barbeque restaurants, DEPARTMENT OF BUSINESS AND and they keep Florida's economy strong. 066 PROFESSIONAL REGULATION Every day we work to Improve the way we do business in order to EC0000838 ISSUED: 07/30/2014 serve you better. For information about our services.please log onto www.myflortdalicww com. There you can farad more information CERTIFIED ELECTRICAL CONTRACTOR about our divisions and theregulebons that Impart you,subscribe MORENO,ROBERTO to newsletters=learn more about the Department's initiatives. ASSOCIATE ELECTRIC.INC. 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.489 FS. and congratulations on your new license! moria,date:AU1331.2016 L140730DOM12 DETACH HERE RICK SCOTT,GOVERNOR KEN LAWSON,SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION + ELECTRICAL CONTRACTORS LICENSING BOARD —11111*0 EC0000838 The ELECTRICAL CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31,2016 MORENO, ROBERTO ASSOCIATE ELECTRIC, INC. 7220 NW 5 STREET MIAMI FL 33126 ISSUED: 07rXM14 DISPLAY AS REQUIRED BY LAW SE-0# L1407300002312 Scanned by CamScanner Local Busi' ness Tax Receipt Miami-Dade County, State of Florida THIS IS NOTA BILL - DQ NOT PAY 6732268 BUSINESS NAME/LOCATION RECEIPT NO. EXPIRES ASSOCIATE ELECTRIC INC RENEWAL SEPTEMBER 30, 2015 7220 Nth 5 ST 7005721 Must be displayed at place of business MIAMI FL 33126 Pursuant to County Code Chapter 8A - Art. 8 & "I OWNER, SEC. Tlt PE +I is BUSINESS 196 ELECTRICAL CONTRACTOR PAYnnEN ECEIV ASSOCIATE ELECTRIC INC BY TAX = I.LECTC1r Caooa83 75.00 Q7/27/2014 ECHECK--14-14031j., This Local Business Tax receipt on cofi�rms payment of the Local Business Tax, The Re6elpt is not a lGena , .y On of do qua • �tr�rnrn ntal tato a law t� re l uirem�is w ch apply business. to thelbur mu�vot� oy�i� any gov#M� tl Y Y R rY IIinit The RECEIPAO' '. above most as displayed ow"commercial vehi(4' ON mlow-hide Cade Sec 80-b& y� Scanned by CamScanner To: Page 2 of 2 2015-01-12 20:02:16(GMT) 18773330274 From: Frank H. Furman, Inc. .aco CERTIFICATE OF LIABILITY INSURANCE 1/12/22015015DATE(MW) 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 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). PRODUCER NTACT NAME: Christine Auman, CISR Frank H. Furman, Inc. HONE Xt: (954)943-5050 FAAX No: (954)942JA&N -6310 1314 East Atlantic Blvd. ADt-MAIL ss:christine@furmaninsurance.com P. O. BOX 1927 INSURER(S)AFFORDING COVERAGE NAICN Poagpano Beach FL 33061 INSURERA:Ohio Security Insurance Co 24082 INSURED INSURER B:Florida Citrus Bus & Ind Fund Associate Electric LLC; Associate Electric Inc INSURERC: 314 North Iowa Avenue, Suite D INSURER D: INSURER E: Lakeland FL 33801 INSURERF: COVERAGES CERTIFICATE NUMBER:14/15 AU GL UMB WC 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 INSURANCEWUVOnj CY EFF POLICY EXP INSR POLICYNUMBER MMIDDIYW MMIDDIYW LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ 300,000 A CLAIMS-MADE FZ OCCUR BKS55528297 /29/2014 /29/2015 MED EXP(Any one person) $ 15,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 X POLICY PRO LOC AUTOMOBILE LIABILITY COMBINED Ea accident $ 11000,000 A JX ANY AUTO BODILYINJURY(Perperson) $ ALL OWNED SCHEDULED AS55528297 /29/2014 /29/2015AUTOS AUTOS BODILYINJURY(Peraccident) $ HIRED AUTOS X AUTOS NON-OWNED PROPERTY DAMAGE AUTOS $ P racci n X UMBRELLALIAB PIP-Basic $ OCCUR EACH OCCURRENCE $ 1,000,000 A EXCESS LIAB CLAIMS-MADE AGGREGATE $ 1,000,000 DED RETENTION$ UM055528297 /29/2014 /29/2015 $ B WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY YIN X ANY PROPRIETOR/PARTNER/EXECUTfVE OFFICER/MEMBER EXCLUDED? NIA E.L.EACH ACCIDENT $ 1,000,000 (Mandatory in NH) 10651949 /3/2014 /3/2015 E.L.DISEASE-EA EMPLOYE $ 11000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 11000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space Is required) Roberto Moreno's License #EC 0000838 CERTIFICATE HOLDER CANCELLATION 13057568972@efaxsend.com SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Miand Shores ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE 2nd Avenue Miami Shores, FL 33138 AUTHORIZED REPRESENTATIVE � ) Dirk Dejong KS ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INS17175on1nnr)M Tho A r1Rn name anrt Innn aro ronlctororlmarirc of Cr oRn