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EL-13-393 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-212649 Permit Number: EL-2-13-393 Scheduled Inspection Date: June 03, 2014 Permit Type: Electrical - Residential Inspector: Devaney, Michael Inspection Type: Rough Owner: HOLT,JAMES Work Classification: Addition/Alteration Job Address:361 NE 97 Street Miami Shores, FL 33138-0000 Phone Number Parcel Number 1132060135760 Project: <NONE> Contractor: OHMS ELECTRICAL CONTRACTOR Phone: (954)974-3840 Building Department Comments ELECTRICAL WORK FOR INTERIOR REMODEL AND Infractio Passed comments ADDITION INSPECTOR COMMENTS False All Inspector Comments Passed CREATED AS REINSPECTION FOR INSP-210586. CREATED AS E�r REINSPECTION FOR INSP-205923. CREATED AS REINSPECTION FOR INSP-201968. CREATED AS REINSPECTION FOR INSP-201736. ROUGH INSPECTION FOR THE WALL AND CEILING Failed ❑ 22 oct. 2013. Partial 2nd. floor . 21 Jan. 2014 Partial rough 1st floor see yellow hi lighted area. 8 apr. 2014 Correction ❑ Cabana bath rough o. k.. Needed Need G.F.I. protected receptacles for personal protection. Re-Inspection ❑ Fee ,%�'� �° G'/�✓ No Additional Inspections can be scheduled until re-inspection fee is paid. June 02,2014 For Inspections please call: (305)762-4949 Page 21 of 41 f - Miami Shores Village Building Department 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel:(305)795.2204 Fax:(305)756.8972 INSPECTION'S PHONE NUMBER: (305)762.4949 FBC 20 lC' BUILDING Permit No. L 1 ,3 ` 1 PERMIT APPLICATION Master Permit No. RC1 3-391 Permit Type: Electrical JOB ADDRESS: 361 NE 97th Street City: Miami Shores County: Miami Dade zip; 33138 Folio/Parcel#: Is the Building Historically Designated:Yes ✓ NO Flood Zone: OWNER:Name(Fee Simple Titleholder):Jim Holt Phone#:828-781-0563 Address:361 NE 97th Street City: Miami Shores State: FL Zip: 33138 Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name: OHMS Electrical Corp. Phone#: (954) 974-3840 Address: 1761 Banks Rd City. Margate State: FL Zip: 33063 Qualifier Name: Jose Espaillat Phone#: (9`- 4) 520-9466 State Certification or Registration#: Certificate of Competency#: Contact Phone#: (954) 520-9466 Email Address: Jespaillat@ohmselec.net DESIGNER:Architect/Engineer: Ruben Travieso Phone#: 786-250-7522 Value of Work for this Permit:$12,748.00 Square/Linear Footage of Work: 4,300 Type of Work: ✓Addition LIAlteration ONew ORepair/Replace ❑Demolition Description of Work: New pipes, additional bedroom, relocate pipe in existing bathroom. Addition roof terrace over new veranda. Submittal Fee$ Permit Fee$ CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Bond$ Notary$ Training/Education Fee$ Technology Fee$ Double Fee$ Structural Review$ TOTAL FEE NOW DUE$ t 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 withan estimcued value exceeding$2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to achment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection wh' occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be app d a einspection fee will be changed Signature Signature OC st er A eg\nt Contractor The foregoing instrument acknowiedged,before me this The foregoing instr meat was acknowledged before me this r day of y s ,20 ,by Y �, -, day of ,20�,by :1017F E$PA%L who is personally known to me or who has produced is personally known me or who has produced As i ;7".. p an�() d �iQRI as identification and who did take an oath. ryi Y PUB MY COMMISSION#FF001475 NOTARY t VULIC:/ tip, °e NO'T'ARY PUBLIC: •', ; o?Af EXPIRES March 25,2017 „�Y P�,• R.A.FREDERICK (407)398.0153 Florldallole servlcexom 1aa e 'e,-; Notary Public-State of Florida Sign: Sign: - = e p 22,2015 E :,+ EE 132722 Print: 9 - Print: /�� ;," otary Assn. a My Commission Expires: My Commission Expire APPROVED 8 � ��; ?�/ � Pglrans/Exaininer Zoning— Structural oningStructural Review Clerk (Revised 3/12t2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09) L all A #.61365 rar�� , migi OF FLORIDA DEPRT -OF,, F-BgSIESS;ELEC AND PROFESSIONALArCONTRiCTORS LICER'F.GUFATION B. CENSE`NBs g SEQ#Ll R 2012 1• j.`"YHE .. 20543 2200,7 OS/2z. . 1601s,s .,. ECTRI The •EL CAI, CONTRACT-0 ,� Named below IS CERTIFIBL? �0}' ' -- Under the >� a p.rovi s i ons o Cha Expiration date: AUG 31, 201 ESPAIT,T,Ai' " i70SE RAFAEL OBMS ELECTRICAL CORPORRTION` ' _ 1 1761 BANKS RD MARGATE FL 31D63 RICK SCOTT ; I GOVERNOR " DISPLy�Y IGEN LAWSON AS REQUIRED BY°LAW SECRETARY I OHMSE-1 OP ID:SISI CERTIFICATE OF LIABILITY INSURANCE °A0812312013 08123!2013 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 poUcy(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 Phone:305-223-2533 NAAMMEACT iSure Insurance Brokers -- 2700 SW 137 AVE Fax:305-220-0765 LAICNo.6rq _ __ (ac,No):_ -- Miami,FL 33175 E-MAIL Javier A.Fernandez ADDRESS. INSURERIS)AFFORDING COVERAGE NAIL 9 INSURER A:Houston Specialty Ins Co 12936 INSURED OHMS Electrical Corp. INSURER B:Progressive Ins.Co. 1761 Banks Rd - Margate,FL 33063 INSURER C.Mt.Hawley INSURER D: 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 --� - AbDL SUBR-_--_ - - --- ----__-- ---POLICY EFF POLICY -_---- LTR TYPE OF INSURANCE POLICY NUMBER fMMiDDfYYYYI Iw_MlDOIYYVY ( LIMITS GENERAL LIABILITY EACH OCIC.URRENCE $ 1,000,00 A i X COMMERCIAL GENERAL LIABILITY TEN11801 11106/2012 1110612013 DA_RREA SET Ee oc�curt6 ) ce $ - 100,00 -�— - ` CLAIMS•MADEF OCCUR MED EKF';.Anyone persrhn) $ 5,00 PERSONAL&ADV INJURY S 1,000,00 GENERAL 4GUREGAIE L$ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP(OP AGO $ 2,000,000 POLICY I X I (�T LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000 00 __.__ LE5 h B ANY AUTO 01895473-0 10101/2012 10/01/2013 BODILY INJURY(Per person) S ALL OWNED X :SCHEDULED _._-- AUTOS N j AUTOS BODILY INJURY(Per accident) 5 NON-J'NNEC PROPER'y OAAUIGE X HIRED AUTOS [X I AUTOS .Far accident)_-- $ -- - $ UMBRELLA LIAR X EACH OCCURRENCE $ 2,000,00 C X EXCESS LIAR CLAY.IS.MADE ;EMX0317132 10101120121,10/01/2013 AGGREGATE $ 2,000,00 DED PFIrWiCINS -- --- -~ WORKERS COMPENSATION WC STATU- TH. AND EMPLOYERS'LIABILITY YIN _.. TORY LIMITS ER_ ANY PROPRIETORIPARTNERIEXECUTIVE OFFICERWEMBER EXCLUDED? ❑ N'A E.L.EACH ACCIDENT $ (Mandatory In NH) E L DISEASE-EA EMPLOYEE S 11 yyees,desrnhe tmdnr DESGRIPTIONOF OPERATIONS tratcw E.L DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Addltbnal Remarks Schedule,If more apace is required) ELECTRICAL WORK WITHIN BUILDINGS. CERTIFICATE HOLDER CANCELLATION Mims 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. 10050 NE 2 Ave. Miami Shores,FL 33138-23AUTHORIZED REPRESENTATIVE 33138-23" ©1988.2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD OHMSE-1 OP ID:SISI '4`oRa. CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 08/23/2013 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 Phone:305-223-2533 NAMN CT iSure insurance Brokers Fax:305-220-0765 H Fafc No): 2700 SW 137 AVE Miami,FL 33175 ADDRESS: Javier A.Fernandez INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Houston Specialty Ins Co 12936 INSURED OHMS Electrical Corp. INSURER B:Progressive Ins.Co. 1761 Banks Rd INSURER C:Mt Hawley Margate,FL 33063 INSURER D 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. rA TYPE OF INSURANCEru"R POLICYNUMBER M WDL 11 YE M Y LIMITSGENERAL LIABILITY EACH OCCURRENCE $ 1,000,0/)X COMMERCIAL GENERAL LIABILITY TEN11801 11/06/2012 11/08/2013 PREMISES Ea occurrence $DAMAGETORENTEU- 1�,� CLAIMS-MADE FX_] OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ 1,000,40 GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,0 POLICYFX_]PRO LOC $ AUTOMOBILE LIABILITY Ea acciden) NGLE LIMIT 1,000,00 B ANY AUTO 01895473-0 10/01/2012 10/01/2013 BODILY INJURY(Per person) $ ALL OWNED F,7 SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident UMBRELLA LIAR Xd OCCUR EACH OCCURRENCE $ 2,000,00 C X EXCESS LIAB CLAIMS-MADE EMX0317132 10/01/2012 10/01/2013 AGGREGATE $ 2,000, DED RETENTION$ _ $ WORKERS COMPENSATION TOR SLIMIT O R AND EMPLOYERS'LIABILITY Y I N ANY PROPRIETORIPARTNERIEXECUTIVE❑ NIA EL EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $ (Mandatory in NH) If yyes describe under E.L.DISEASE-POLICY LIMIT $ DESG�RIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Sdhedule,H more space Is require/) ELECTRICAL WORK WITHIN BUILDINGS. CERTIFICATE HOLDER CANCELLATION MIAMI S SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Miami Shores Village 10050 NE 2 Ave. Miami Shores,FL 33138-2304 AUTHORIZED REPRESENTATIVE � 7 ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD i BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT 115 S. Andrews Ave., Rm. A-100, Ft. Lauderdale, FL 33301-1895—954-831-4000 VALID OCTOBER 1,2013 THROUGH SEPTEMBER 30,2014 DBA:OHMS ELECTRICAL CORP Receipt#:ELECf3RICAL/ALARMS/CONTRACT Business Name: Business Type:(ELECTRICAL CONTRACTOR) Owner Name:JOSE R ESPAILLAT Business Opened:il/18/1997 Business Location:1761 BANKS RD State/County/Cert/Reg:EC 0001899 i MARGATE Exemption Code: Business Phone:954-974-3840 Rooms 8ea#s Eltyeas Machines Professional -- - For VwWli.19 Business Only Number of Machhres: Veiwirg Type: Taff Ar1muM Transfer Fee NSF Fee Penalty.' PnoryOars Collection Cost Total Paid 27.00 0.00 �_ 0.06 0.00 6.00 0.00 27.00 i -- 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 P 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: JOSE R ESPAILLAT Receipt >)t01C-12-00011162 1761 BANKS RD Paid 07/03/2013 27.00 MARGATE, FL 33063 07/01/2013 Effective Date 2013 • 2014 Date CERTIFICATE OF LIABILITY INSURANCE 8/26/2013 producer. Lion Insurance Company This Certifies Is Issued as a matter of infor n-tion only and confers no 2739 U.S. Highway 19 N. rights upon the Certificate Holder. This Certificate does not amend,extend Holiday, FL 34691 or alter the coverage afforded by the policies below. (727)938-5562 Insurers Affording Coverage NAIC# Insured: South East Personnel Leasing, Inc. &Subsidiaries Insurer A-. Lion Insurance company 11075 2739 U.S. Highway 19 N. Insurer 8: Holiday, FL 34691 Insurer C: Insurer D: Insurer E: Coverages The policies of Insurance listed below have been issued to the insured named above for the policy period indicated. Notwithstanding any requirement,tern 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. Aggregate h ats shown may have been reduced by paid c1mms. INSR ADDL Policy Effective Policy Expiration Date Limits LTR INSRD Type of Insurance Policy Number Date (MM/DD/YY) (MM/DD/YY) GENERAL UABIUTY Each Occurrence S Commercial General Liability Damage to rented premises(EA Claims Made 11 Occur occurrence) Mad Exp Personal Adv Injury neral aggregate limit applies per. General Aggregate Policy ❑Project ❑ LOC Products-Comp/Op Agg UTOMOBILE LIABILITY Combined Single List Any Auto (EA Accident) 9 All Owned Autos Bodily Injury (Per Person) Scheduled Autos Hired Autos Bodily Injury Non-Owned Autos (Per Accident) Property Damage (Per Accident) EXCESSIUMBRELLA LIABILITY Each Occurrence Occur ❑Claims Made Aggregate Deductible A Workers Compensation and WC 71949 01/01/2013 01/01/2014 X I wC Statu- OTH- Employers'Liability tory Limits ER Any proprietor/part—lexecutive officer/member E.L.Each Accident 31,0M.000 excluded? NO E.L.Disease-Ea Employee $1,000,000 If Yes,describe under special provisions below. E.L.Disease-Policy Limits $1,000,000 Other Lion IMMrance Company Is A.M.Best CoMpany Companyrated A- (Excellent). AM8#12616 Descriptions of Operations/Locations/Vehicles/Exclusions added by Endorsement/Special Provisions: Client ID: 81-65-049 Coverage only applies to active employee(s)of South East Employee Leasing Services,Inc.that are leased to the following"Client Company": OHMS Electrical Corp. Coverage only applies to injuries incurred by South East Personnel Leasing,Inc.&Subsidiaries active employee(s),while working in:FL. Coverage does not apply to statutory employee(s)or independent contractor(s)of the client Company or any other entity. A list of the active employee(s)leased to the Client Company can be obtained by faxing a request to(727)937-2138 or by calling(727)938-5562. Project Name: ISSUE 08-26-13(TD) Bealn Date:9/712012 CIERTfFlCATE HOLDER CANCELLATION MIAMI SHORES VILLAGE Should any of the above described policies be cancelled before the expiration date thereof,the Issuing Insurer will endeavor to mail 30 days written notice to the certificate holder named to the left,but failure to do so shall impose no obligation or liability of any kind upon the insurer,its agents or representatives. 100500 NE 2ND AVENUE MIAMI SHORES, FL 33138 ��