EL-14-2539 C N - 2
P Inspection Worksheet
Miami Shores Village
10050 N.E.2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-234191 Permit Number: EL-11-14-2539
Scheduled Inspection Date: May 07,2015 Permit Type: Electrical - Residential
Inspector: Devaney, Michael
P y�
Inspection Type: Final
Owner: , Work Classification: Alteration
Job Address:33 NE 93 Street
Miami Shores, FL 33138- Phone Number
Parcel Number 1132060130380
Project: <NONE>
Contractor: FUSE ELECTRICAL INC Phone: (305)970-4379
Building Department Comments
REPLACE ALL EXISTING 15A AND 20A, 125V OUTLETS Infractio Passed Comments
WITH NEW TAMPER RESISTANT TYPE. REPLACE INSPECTOR COMMENTS False
EXISTING ELECTRICAL PANEL WITH NEW. RELOCATE
ELECTRICAL METER.
Inspector Comments
Passed
Failed
Correction ❑
Needed
Re-Inspection
Fee
No Additional Inspections can be scheduled until
re-inspection fee is paid.
May 06,2015 For Inspections please call: (305)762-4949 Page 39 of 42
Miami Shores Village
Building Department ®v 8 2514
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel:(305)795.2204 Fax:(305)756.8972
INSPECTION'S PHONE NUMBER:(305)762.4949 Y
FBC 20
BUILDING Permit No. 0-4
PERMIT APPLICATION Master Permit No.,RO— 1 r
Permit Type: Electrical
JOB ADDRESS: 5S N b q 3 St(�Q-&
City: Miami Shores County: Miami Dade Zip: '-I 515S
Folio/Parcel#: 11 - 3'2i0&—Q 0'39�0
Is the Building Historically Designated:Yes NO Flood Zone:
OWNER:Name(Fee Simple Titleholder): AjA V -c— Phone#:
Address:3 �� N Fi �010 SA- -W(010
City: PN- �LAAV-rol State: rL Zip: d551
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name: -Fo e- (iG' Phone#: &
Address:
City: ea State: 1=c-r Zip: o;?-
a
Qualifier Name: i-on (�( Phone#: 32K117:>012 7-:2
State Certification or Registration#:6-C Z 9 67'.-'5-5"-0 2Q Certificate of Competency#:
Contact Phone#: SO59'—�PLss X 3 2 Email Address: -Ce�C C
DESIGNER:Architect/Engineer. Phone#:
Value of Work for this Permit:$ '"� Square/Linear Footage of Work: S
Type of Work: ❑Address Alteration ❑New ORepair/Replace ODemolition
Description of Work: QU IUC OM .Q„ (Q n A 125 O&kQ-+�
,CLS
Submittal Fee$� `a �T Permit Fee$ a ( � CCF$ e CO/CC$
Scanning Fee$ C f75- Radon Fee$ a a DBPR` '3 Bond$ J
Notary$ Training/Education Fee Techn,opW Flee$
Double Fee$ Structural Review$
TpF`AL FEE NOW DUE$_ ��
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
CORDING YOUR NOTICE OF COMMENCEMENT." ,
Notice t pplicant: Asa condition to the issuance of a building permit with an estimated value exceeding$2500, the applicant must
Promise i ood faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose prop is subject to attachment Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first ection which occurs seven (7).days after the building permit is issued In the ab ence of such posted notice, the
inspection will' t e approved and a reinspe n fee will be charged
Signature Signature
Owner or Agent tractor ;
The foregoing instrument was acknowledged before me this The foregoing instrument was-acknowledged before me this,
day of 20 ,by U kw day of 20 f 4-.by L�Ply C ,
who is personally known tome or who has produced_ who is personally known to me or who has produced
As identification and who did take an oath. as identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: Sign:
Print: + Print:
YER" Ing.
My Commission Expires: ' 'iit y My Commission Expir ;.
iyr MY COMI4BS$I�V OFF 103292, •': MY COMMISSION II EE210275
EXPIRES:Marro 18,2018 LXPIREB Jima 21;201®
r, Bum nw try Pubic Umdane�ten ,�� 1� �.aan
APPROVED BY IrWe-10' Plans Examiner Zoning
Structural Review Clerk
(Revised 3/12/2012)(Revised 07/10AM(Revised 06/10/20 XRevised 3/15/09)
STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
ELECTRICAL CONTRACTORS LICENSING BOARD (850) 487-1395
1940 NORTH MONROE STREET
TALLAHASSEE FL 32399-0783
GOZLAN, LIRON
FUSE ELECTRIC INC.
4950 SARAZEN DR
HOLLYWOOD FL 33021
Congratulations! With this license you become one of the nearly
one million Floridians licensed by the Department of Business and r
Professional Regulation. Our professionals and businesses range STATE OF FLORIDA.
from architects to yacht brokers,from boxers to barbeque restaurants, DEPARTNiENOF BUSINESS AND
and they keep Florida's economy strong. PROFF,"I� E ULATION
Every day we work to improve the way we do business in order to EC13005070 f 06/22/2014
serve you better. For information about our services,please log onto � = f
www:myfloridalicense.com. There you can find more information
CERTIFIED E kEAkCQ3T+ OR
about our divisions and the regulations that impact you,subscribe GOZLAN ;L!R" 3
to department newsletters and learn more about the Department's t r
FUSE ELECTI
Initiatives.
IN
��d <;
�¢
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, t I-S CERTMED:under,the provisions of Gh.48.9..FS.
and congratulations on your new license! ,ary, ry Aug s��o °`. LIAW=W1689
_
1
1
DETACH HERE
RICK SCOTT,GOVERNOR KEN LAWSON,SECRETARY
STATE OF FLORIDA
DEPARTMENT OF BUS114ESS AND PROFESSIONAL REGULATION
ELECTRICAL CONTRACTORS LICENSING BOARD
E013005070
The ELECTRICAL CONTRACTOR . .-
Named Below IS CERTIFIED
Under the provisions of Chapter 489 FS. � �
Expiration,date: AUG 31,201;6
All
GOZLAN,LIRON 4y
FUSE E*LEGTRI k�IC
4960 S,ARAZE�I Df `�
4OL WOCtD FL 33021
Ic
ISSUED: 06!22!2014 DISPLAY AS REQUIRED BY LAW SEQ# L1406220001589
II
r
,----, B90W 0 BOUNTY LOCAL BUSINESS TAX"1�ECEIPT _,,,.. � .. Im
115 S.Andrews Ave., Rm.A-100, Ft. Lauderdale, FL 33301-1895—954831-4000
VALID OCTOBER 1,2014 THROUGH SEPTEMBER 30,2015 MAP
DBA: Receipt#:181-250155
Business Name`FUSE ELECTRIC INC Business Type:EL��CAAz S/C�RRAc oR
Owner Name:LIRON GOZLAN Business Opened:o8/01/2012
Business Location:4950 SARAZEN DR State/COUnty/Cert/Reg:EC13005070
HOLLYWOOD Exemption Code:
Business Phone:305-970-4379
Rooms Seats Employees IUlachines Professionats
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 0.00 0.00 0.00 0.00 0.00 27.00
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:
FUSE ELECTRIC INC Receipt: #OSA-13-00010789
4950 EARA.ZEN DR Paid 09/04/2014 27.00
HOLLYWOOD, FL . 33021
r
2014 - 2015
i
� � DATE(MMJDDNYYYI
CERTIFICATE OF LIABILITY INSURANCE 11/7/2014
THIS CERTIFICATEIS ISSUED ASA MATTER OF IJFORMATIONONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATEHOLDER.THW
CERTIFICATE DOES NOT AFFOZMATIVELYOR NEGATNELYAMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING UJSURER(S),AUTHORED
REPRESENTATN®R PRODUCER,AND THE CERTIFICATEHOLOER.
IMPORTANT:It the certlflcateholderht an AODITIONALDISURED,the poday(iealInust be endorsed.If SUBROGATIONIS WANED,sub)eotto
the termsandcomtlflonsafthe polleyFertaln pollciesmayrequheanendorsemerrLA atatametdon U1lsceraflcatedoesnot conferrightsto the
cerflficatsholder In Rau of such endorsement(s).
PRODUCER CONTACT
NAME:
SOUTH FLORIDA CASUALTY PH°'N E A, (561)533-6144 1;x,10 (561)533-6170
415 North 4th Street �, Elaine@southfloridacasualty.com
Lantana, 1% 33462
INSURER(8)AFT'ORDIN6 COVERAGE Neu
INSURERA: W@SCO Insurance Companv 25011
INSURED Fuse Electric Inc. INSURER B: Madison Insurance Company
4950 Sarazen Dr. INSURERC:
Hollywood, FL 33021 INSURERD:
305-970-4379 INSURER E
INSURERF:
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 DESCRBED HEREIN B SUBJECT TO ALL THE TERMS.
EXCLUSIONSANDCONDITIONS OF SUCH POUCIES.LOvM SHOWNMAY HAVEBEENREDUCED BYPAID CLANS.
TYPE OFPI3URANCE POLICY EFF POLICY EXP
POLICY NUMBER OMITS
GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
]C COMMERCIAL G17TOAL LIABILITY PREMISES =ggr e $ 100,000
CLANSINADE ED OCCUR MED EXPWy—permn) $ 5 000
A WPP106700102 /2/14 8/2/15 P—NAL&Aov 1NjuRY $ 1,000,000
GENERAL AGGREGATE $ 1,000,000
XM
LIMIT APPLIES PER: PRODUCTS-COMPIDPAGG $ 1,000,000
X POLICY F1
�. LOC $
AUTOMOBILE LIABdITY COMWED SWGLELOdR
accident $
ANYAUTO
BODILYINJURYOWp—) $
ALL OWNED El SCHEDULED
AUTOS AUTOS BODILY INJURY(Per actldant) $
NON-OWNED PROPERTY DAMAGE $
HIRED AUTOS AUTOS accMard
UMBRELLA LAB OCCUR EACH OCCURRENCE $
EXCESS LIAR CLAIMSMADE AGGREGATE $
DED I I RETENTION $ $
IWO.COMPENSATION X `NC 9TATU- On+
AND EMPLOYEPZLUABIUTY YIN
WCV0010878 00 /8/14 /8/15 E.LEAGHACCIDENT $ 100,000
B exclwwF 1:1NIA
(IBandedo o Nlq EL DISEASE-EA EMPLOYEE $ 100,000
Byes,descrbe under
DESCRIPTION OFOPERATIONS below EL DISEASE-POLICY LIMIT $ 500,000
DESCRIPTION OFOPERATIONS I LOCATIONS/VEHICLES(Atsch ACORD 101,AdA0ma1 Remarks Schedule,0mme spars la mquhed)
Electrical Contractor
CERTIFICATE HOLDER CANCELLATION
Miami Shores Village
SHOULD ANY OF THE ABOVE DESCRIBED PoucEs BE CANCELLED BEFORE
Building Department THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
10050 NE 2nd Ave ACCORDANCE WITH THE POLICY PROVISIONS.
Miami Shores, FL 33138
AUTHORIZED REPRESENTATNE
Hdiw I
®1988-2010 ACORD CORPORATION. All rights reserved.
ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD