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EL-15-2741 2SH9 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-246941 Permit Number: EL-10-15-2741 Scheduled Inspection Date: November 02, 2015 Permit Type: Electrical - Residential Inspector: Devaney, Michael Inspection Type: Final Owner: LAURORE,JEAN & BERTHA Work Classification: Alteration Job Address: 11110 NW 6 Avenue Miami Shores, FL 33168-3312 Phone Number Parcel Number 3021360210500 Project: <NONE> Contractor: A CUSTOM ELECTRIC SOLUTION, INC Phone: (305)519-2043 Building Department Comments RELOCATE CONDUIT ON ROOFTOP Infractio Passed Comments INSPECTOR COMMENTS False Inspector Comments Passed Failed Correction Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. November 02, 2015 For Inspections please call: (305)762-4949 Page 30 of 44 i Miami Shores Village \\� t�7 tIC � Ttfd� 10050 N.E.2nd Avenue NWS Miami Shores,FL 33138-0000 s �Fkrm Phone: (305)795-2204 M•. SONY" ... Expiration: 04/27/201 Project Address Parcel Number Applicant 11110 NW 6 Avenue 3021360210500 Miami Shores, FL 33168-3312 Block: Lot: JEAN&BERTHA LAURORE Owner Information Address Phone Cell JEAN&BERTHA LAURORE 11110 NW 6 Avenue MIAMI SHORES FL 33168-3312 Contractor(s) Phone Cell Phone Valuation: $ 1,000.00 A CUSTOM ELECTRIC SOLUTION, IN( (305)519-2043 Total Sq Feet: 0 Type of Work:RELOCATE CONDUIT ON ROOFTOP Available Inspections: Additional Info: Inspection Type: Classification:Residential Review Electrical Scanning:3 Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $0.60 Invoice# EL-10-15-57576 DBPR Fee $2.25 DCA Fee $2.25 10/28/2015 Credit Card $50.00 $ 115.10 Education Surcharge $0.20 10/30/2015 Cash $ 115.10 $0.00 Permit Fee-Additions/Alterations $150.00 Scanning Fee $9.00 Technology Fee $0.80 Total: $165.10 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 conformit plans,drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume re risibility fora work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL, PLU ING, MECHANIC L,WINDOWS, DOORS,ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: I c that all the for ing information is accurate and that all work will be done in compliance with all applicable laws regulating construction a zoning. hermore, I au rize the above-named contractor to do the work stated. October 30, 2015 thorize i natu :Owner / Applicant / Contractor / Agent Date Buil g Department Copy October 30,2015 1 r Miami Shores Village OCT 2s± zoo Building Department 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 -; Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-494941 FBC 20H s BUILDING Master Permit No.RF 10-15-2549 PERMIT APPLICATION Sub Permit No. I✓L IS-- 2 7-q ❑BUILDING 0 ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL [:]PUBLICWORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 11110 NW 6th Ave. City: Miami Shores County: Miami Dade Zip: 33168 Folio/Parcel#: 11-2136-021-0500 Is the Building Historically Designated:Yes NO NO Occupancy Type: Res- Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder):Jean O Laurore & W Bertha Phone#: Address: 11110 NW 6th Ave City: Miami Shores State: FL Zip: 33168 Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name: A Custom Electrical Solution, Inc. Phone#: 305 519 2043 Address: 8362 Pines Blvd City: Pembroke Pines State: FLZ;p: 33024 Qualifier Name: Joshua Agriesti Phone#: 954-921-6360 State Certification or Registration#: EC13006960 Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$$1000.00 Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New ❑■ Repair/Replace ❑ Demolition Description of Work: Relocate Conduit on rooftop Specify color of color thru tile: Submittal Fee$ Permit Fee$ 1-4-4?14PG' 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. 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 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 posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature 5, Signature OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrum nt was acknowledged before me this day of 20 by day of X61 C✓ 2-0��,by who is t Z wh ' personally known to me or who has produced as me or who has produce _ —as_ identification and who did take an oath. identification and who d tai th. JANET ROBERTS-KRIEGER Notary Public-State of Florida NOTARY PUBLIC: NOT PUBLIC: s m :Pc My Comm.Expires Mar 20,2018 P° Commission # FF 104313 ' ,OFF",�� n Sign: ` Sig Print. Pri t: L Wb Seal: ' ' KELLELJACKSON Seal: * * MY COMMISSION ii FF 901375 EXPIRES:July 20,2019 11t loft Thru 04d d Novy Sv*u APPROVED BYPlans Examiner Zoning Structural Review Clerk (Revised02/24/2014) SHS, wr*� Miami Shores Village moo` 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. 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 Compensation EXEMPTION must have NOTICE TO OWNER form and Contractor Affidavit) *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. •rrra■■■r�rrrrrrrrrrrrrrrrrrrrarrrrrrr a■r.•rrrrar a arrr a rrarr uaaarrraaaarrrrraaurrrrra• BUSINESS NAME: A Custom Electric Solution, Inc. BUSINESS ADDRESS: 8362 Pines Blvd #450 CITY Pembroke Pines STATE FL ZIP 33024 BUSINESS PHONE: 3( 05 ) 519-2043 FAX NUMBER8t 88 1 3641905 CELL PHONE3( 05j 519-2043 QUALIFIER'S NAME: Joshua Agriesti QUALIFIER'S LIC NUMBER: EC13006960 40STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD (860)487-1395 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-07$3 AGRIESTI,JOSHUA LEONARD , A CUSTOM ELECTRIC SOLUTION,INC. 2830 N 28TH TERRACE HOLLYVWOOD FL 33020 CorWatuhtonst V th this loons you become one of the nesciy one million Floes licensed by the pepaubnerd of Bushviss and Praftssional Reguls*h. our professionals and busWasses fromro yscra brokers.from boxers to l ue ` ° t STATE OF FLORIDAAND and they keep Fbricta's saonorryr sttorhg. TI ►1 r,: Every day we work to improve the way we do busirms in order to ECT ° 2112018 serve you better. For miamufi m about our services,please log onto =nfff . There you can flrhd more irdommMon abs our CERTIFIED ciMsiorm and the that inipect you.subscribe GRIESYi to mmietters mW Imern more about the Department's A CUSTOM E Our hission at the is:License Eftienly.'Reg to Fairy rr ft con8 h"you to� better so that you c m serve your ., CUMtomers. ' yoU for doing business in Florida, is CERTIptEO under r+.o prahrtr+oni or Ch 46e a:e. <4 and corcratuiefts on your now loensel O0 0, dru.AUG 31.2M t,36012figxmy DETACH HERE . Jl K SCOTT.GOVERNOR KEN LAWSON.SECRETARY STATE OF FLORIDA DMRTMENT OF BUM10M AND 11001LAT1001 ELECTRICAL COWRACTORS LICENSWO BOARD "C M13 0 mmm The ELECTRICAL CONTRACTOR Named below IS CERTIFIED Under ttm pmvidorn of Chapter 489 F& ti° dna: AUG 31, '16 ;g , k✓ r4f. A tIESTI, LE v 4100 NY119 ,^ I a SUNRfSE t .,r .PAW. MUM11- Awilg hiR i1mpi AV AS Ri=x]t iiRFr't RY 1 AW SFAM tIRAMoo=17 BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT 115 S. Andrews Ave., Rm. A-100, Ft. Lauderdale, FL 33301-1895—954-831-4000 VALID OCTOBER 1,2015 THROUGH SEPTEMBER 30,2016 DBA:A CUSTOM ELECTRIC SOLUTION INC Receipt#:Ee ELECTRICAL/ALARMS/CONTRACTOR Business Name: Business Type:(ELECTRICAL CONTRACTOR) Owner Name:JOSHUA LEONARD AGRIESTI /QUAL Business Opened:03/21/2003 Business Location: 8362 PINES BLVD #450 State/County]CerdReg:EC13006960 PEMBROKE PINES Exemption Code: Business Phone:305-519-2043 Rooms seats Employees Machines Professionals 2 For Vending Business Only Number of Machines: Vending Type: Tax Amount Transfer Fee NSF Fee Penalty Prior Years Collection Cost Total Paid 27.00 3.00 0.00 2.70 0.00 0.00 32.70 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 it is in compliance with State or local laws and regulations. Mailing Address: JASON MCDONALD /OWNER Receipt #03A-15-00000367 8362 PINES BLVD #450 Paid 10/23/2015 32.70 PEMBROKE PINES, FL 33024 2015 - 2016 ACDRD CERTIFICATE OF LIABILITY INSURANCE 17-0/27/2015 O0"0P" THIS CERTIFICATEIS ISSUEDASA MATTEROF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Dixie Specialty Rask HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 4290 10th Avenue N..Ste 102 ALTER THE COVERAGEAFFORDED BY THE POLICIES BELOW. Lake Worth, FL 33461 561/968-6026 INSURERSAFFORDSNGCOVERAGE NATO — A Custom Electric Solution, Inc. Western World 8362 Pines Blvd. Suite 450 s Normandy Harbor Pembroke Pines, FL 33024 COVERAGES THE POLICIESOF INSURANCE LISTEOBELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FORTHE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED Oi MAYPERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLL 40NS AND CONDITION OFSUCH POLICIES.AGGREGATE LIMITSSHOWN MAYHAVEBEEN REDUCED BY PAIDCLNMS. .Nrt Pq,CV F.%v:1NE E°4LY0tPMTq, 1,000,000 L 100 0°""rt �AE�� 1 5 000 A PP8269119 05/15/15 05/15/16 Ee� ..°Iww. 1 000 000 re 2,000.000 2,000,000 CpN!M m„wTww curt Lwazar �axenxae "°raEc"TERfl = . a cewcrs�x rtErexrw„ rtscaoeanTmew„° - °r„- Ese�mms•�ua=„r 100,000 NHFL143131 12/16/14 12/16/15 oNaaE.EE„amma 100.000 500,000 OESCnvA°x°E roPMTgNS,LaGTrWS/vHlfiEdiE%CLVNpnS,tU°MMEW,ORSBIE„I�SEEgN.m0.bo,6 Electrical Contractor CERTIFICATE HOLDER CANCELLATION =„wln.m°E T�.amc°Eeaa�E°vole�Eec,wceus°e�oaeTreE.aeairo„ Miami Shores Village Bldg. Dept. 10050 NE 2nd Ave. Miami Shores, FL 33138 ACOROM2001M) w CACOROCORPORATIOMMIS