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EL-15-2550 Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores,FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-247992 PermitNumber: EL-10-15-2550 Scheduled Inspection Date: December 15,2015 Permit Type: Electrical - Residential Inspector: Devaney, Michael Inspection Type: R�h Owner: SCORNAVACCA, MICHAEL Work Classification: Pool - Private Job Address:999 NE 94 Street Miami Shores, FL Phone Phone Number Parcel Number 1132060350010 Project: <NONE> Contractor: ADVANCE SOLAR&SPA INC Phone: (954)938-8507 Building Department Comments ELECTRICAL FOR POOL HEATER INSTALLATION Infractio Passed Comments INSPECTOR COMMENTS False Inspector Comments Passed CREATED AS REINSPECTION FOR INSP-247647. Not ready. Failed Correction /&/5) Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid December 14,2015 For Inspections please call: (305)762-4949 Page 21 of 43 FT so Miami Shores Village PelMit?y 8 " iS + ai a ntiall - . a 10050 N.E.2nd Avenue NE Miami Shores,FL 33138-0000 ;, Work GiSAt1Qfsi-Pr`nralt� Phone: (305)795-2204Ex 'AP ell piration: 05/0492016 Issue Ip�t�.11l51201��; p� Project Address Parcel Number Applicant 999 NE 94 Street 1132060350010 Miami Shores, FL Block: Lot: MICHAEL SCORNAVACCA Owner Information Address Phone Cell MICHAEL SCORNAVACCA 999 NE 94 Street MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone ADVANCE SOLAR&SPA INC Valuation: $ 420.00 v (954)938-8507 :__ - , , I -__ Total Sq Feet: 00 Type of Work:ELECTRICAL FOR POOL HEATER INSTALLA Available Inspections: Additional Info: Inspection Type: Classification:Residential Final Scanning:3 Light Niche Bonding Review Electrical Alarms Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $0.60 DBPR Fee Invoke# EL-10-15-57349 $4.50 11/06/2015 Credit Card $319.60 $0.00 DCA Fee $4.50 Education Surcharge $0.20 Permit Fee-Additions/Alterations $300.00 Scanning Fee $9.00 Technology Fee $0.80 Total: $319.60 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 conformity with the plans,drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I me responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRI , LUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work. OWNERS AFFIDA IT I, i that all the for information is accurate and that all work will be done in compliance with all applicable laws regulating construction and ni he ore,I authorize the above-named contractor to do the work stated. November 06, 2015 Ath ' ed g tures er / / Contractor / Agent Date Buildi g partment Copy Novembe 0 ,2015 1 Miami Shores Village Building Department OCT ®'� 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305)795-2204 Fax: (305)756-8972 7y"- INSPECTION LINE PHONE NUMBER: (305)762-4949 FBC 20/�� —Lk, BUILDING Master Permit No.,%/.' ` � PERMIT APPLICATION Sub Permit No.-// ZO ❑BUILDING IPLECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: qqq KE�I-I SL-� City' Miami Shores County' Miami Dade Zi P: Folio/Parcel#: I t-':�ad(o- b3 1)1® Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone:.___BFE: FFE: OWNER: Name(Fee Simple Titleholder):_.A I Ghoud Scorna.VC,= Phone#:-30SW 0o Address:qqq ME qq- -h ('Z Y � _ City: L/I 1 C' ( l S VlOrf 5 State: Zip: 33\31K Tenant/Lessee Name: Phone#: Email: /� CONTRACTOR:Company Name: ��Ylf Sn\a -- � �� Phone#: 0iSL4 QJR-R so Address: qqC) N3Uj CJ3eA S hree� City: �� . L-�1 lX�PXd C7��P. _ State: —Zip: 33309 Qualifier Name: (.Cl k)1re_h r . Q)11\ Phone#: State Certification or Registration#:EC,,t�W LOy 5L4 Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: _State: Zip: Value of Work for this Permit:$ qntQ• Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ew ❑ Repair/Replace ❑ Demolition Description of Work: ��J� ^02,1 Lk )6I� /�QCz±::�r?C"Ilb Specify color of color thru tile: Submittal Fee$ Permit Fee$14f CCF$ _ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$— Double Fee$ Structural Reviews$ _ Bond$ TOTAL FEE NOW DUE$ 60 (Revised02/24/2014) w � p 1 , 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 Signature OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this 7:—day of 5YMCm V- ,20 is by _day of V-1 V-6 20�S by ®fOLGtA�Y29 GC'G� ,wh ersonally kn- �_ wh ersona y know to me or who has produced as me or who has produced_ as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: Sign: eG Pring n Print: 14 Seal: LFke Notary public State of Florida Seal: NO�rYPublic State of Florida Kristen Brown Q Kristen Brown My commission EE 828145 ,EOFMY commission EE 828145 xpires 08/19/2016 Expires 08/19/2p1B APPROVED BY �'®c� /s Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) ♦S�OREs tI ' ... - ..,..M Miami Shores Village - �� Building Department �ZOR1UP' 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CONTRACTORS' REGISTRATION IF CONT CTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: A. OPY OF QUALIFIER'S STATE LICENCES B. COPY OF LOCAL BUSINESS TAX RECEIPT C. PY 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. ■■��a�ot��a��r��r��a�n�o��ra■■so�m��o��rn��au��u��■ BUSINESS NAME: � n __ ►�nC� __ ._ _ _ BUSINESS ADDRESS: b N UU 53o 5 + CITY . IWATEP_ZIP 33�Url BUSINESS PHONE: (a5� ) Q 3R-250 - FAX NUMBER (gSL4)�--O— aSg3 CELL PHONE ( ) QUALIFIER'S NAME:_L0.u]Y-cna. 6M QUALIFIER'S LIC NUMBER: EU5c)C )&-ASH _._ r STATE OF FLORIDA DEOARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD (850) 487-1395 1940,t4ORTH MONROE STREET TALLAHASSEE FL 32399-0733 BILL, LAWRENCE J ADVANCE SOLAR &SPA, INC. 1635 JEFFERSON AVE. FORT MYERS FL 33901 Congratulations! 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 range 'x►•• STATE OF FLORIDA From architects to yacht brokers,from boxers to barbeque restaurants, DEPARTMENT OF BUSINESS AND and they keep Florida's economy strong. PROFESSIONAL REGULATION Every day we work to improve the way we do business in order to EC13006454 ISSUED: 11/25/2014 serve you better. For Information about our services, please log onto www.myfloOdalicense.com. There you can find more information CERTIFIED ELECTRICAL CONTRACTOR about our divisions and the regulations that impact you,subscribe BILL,LAWRENCE J to department newsletters and learn more about the Department's ADVANCE SOLAR&SPA, INC. initiatives. 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 udder the provisions of Ch 489 FS and congratulations on your new license! Expiratwn date AUG 31.2016 1.1012500c;223 DETACH HERE RICK SCOTT,GOVERNOR KEN LAWSON, SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION t � ELECTRICAL CONTRACTORS LICENSING BOARD .•�\• '`R��: .ate. .. EC13006454 t' •�' + '7:i'' The ELECTRICAL CONTRACTOR Named below IS CERTIFIED i Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2016 BILL, LAWRENCE J ADVANCE SOLAR&SPA, INC. 2431 CRYSTAL DR ° FORT MYERS FL'33907 ISSUED: 11125/2014 DISPLAY AS REQUIRED BY LAW SEQ# L1411250001223 1r- Lee County Tax Collector Tax %tor 2480 Thompson Street Fort Myers, Florida 33901 of Ode www.lootc.com Tel:239.533.6000 Local Business Tax Account" 1601721 Dear Business Owner. Your 2015-2016 Lee County Local Business Tax Receipt is attached below. The receipt is non- regulatory and is issued using the Information currently on file with our office. It does not signify compliance with zoning, health or other regulatory requirements nor is it an endorsement of work quality. Annual account renewal notices are mailed in August to the address of record at that time;to ensure delivery of your annual notice, mailing addresses may be updated online at www Ieetc.com. If there is a change in the business name, ownership, physical location or If the business is being dosed, please follow the instructions on the back of this letter to transfer or to close the account. I hope you have a successful year. 4 Lee County Tax Collector Dench and display bottom portion and keep upper potion for your records LEE COUNTY LOCAL BUSINESS TAX RECEIPT 2015 -2016 Tax Co for ACCOUNT NUMBER: 1501721 ACCOUNT EXPIRES SEPTEMBER 30, 2016 If me may engage s ss-of CERTIFIED ELECTRICAL CONTRACTOR Location 2431 CRYSTAL DR FT MYERS FL 33907 THIS LOCAL BUSINESS TAX RECEIPT IS NON REGULATORY ADVANCE SOLAR AND SPA INC BILL LAWRENCE J THIS IS NOT ABILL-00 NOT PAY 2431 CRYSTAL DR FT MYERS FL 33807 PAID 3BB086-39-1 07/31/201510:05 MX01 $50.00 Client#:51405 1ADVSOLA ACORDr. CERTIFICATE OF LIABILITY INSURANCE =10/07/2015 YYYY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(les)must be endorsed.If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Baldwin Krystyn Sherman a/CC No, Edt:813 984-3200 A/C,No): 813 984-3201 4010 W Boy Scout Blvd E-MAIL certificates@bks-partners.com caes bks- Suite 200 ADDRESS: @ p Tampa,FL 33607 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Bridgefield Employers Insurance 10701 INSURED INSURER B: Advance Solar$Spa,Inc. INSURER C 2431 Crystal Drive Fort Myers,FL 33907 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 CONTRACTOR 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. LTR TYPE OF INSURANCE ADDLSUBR POLICY EFF POLICY EXP LIMBS INSR WVD POLICY NUMBER MM/DD M/ MDD GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY GE ENTER ISE a occurrence $ CLAIMS-MADE E]OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ POLICY jE OT LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ A WORKERS COMPENSATION 83054321 2/06/2015 02/06/201 X TORY I IMIT FIR AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/" E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? � N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE es Gribe under $1 000 000 If DESCRIPdesTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space Is required) Brian Goldberg-CVC 056664 James Fields CWC043077 Daniel Goldberg CAC1817663 Lawrence Bill EC13006454 CERTIFICATE HOLDER CANCELLATION Miami Shores Village Building SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE g g THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Department ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE 2 Avenue Miami Shores,FL 33138 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD #531653/M15018 HAWI A`C CERTIFICATE OF LIABILITY INSURANCE �0/7`;oi5' 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: 9 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 Diana Ross Herndon Carr & Company PHONE (239)939-1996 F .(239)274-0277 10501 Six Mile Cypress Pkwy. .di.ana@herndoncarr.com Suite 101 AFFORDING COVERAGE MAIC 0 Fort Myers FL 33966-6400 INSURERA:James River Insurance Company 12203 INSURED Advance Solar & Spa, Inc. =wERBAhio Security Insurance Co. 24082 DSA: 5 County Wholesale Distr.Lbutors INSURER C: & Heat Pump Services INSURER D: 2431 Crystal Dr. INSURER E: Fort M ers FL 33907 1 INSURER F: COVERAGES CERTIFICATE NUMBER9'Iaster 2014-2015 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. VUL BUM INSR TYPE OF INSURANCE unn, POLICY NU LIAOTS GENERAL UABILITY EACH OCCURRENCE S 1,000,000 X COMMERCIAL GENERAL LIABILITY p $ S0,000 A CLAIMS MADE ®OCCUR 0064523-0 1/8/2014 1/8/2015 �EXp one 12/8/2014 $ Excluded PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GENS.AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG S 2,000,000 T POLICY PR4 7 LOC $ AUTOMOBILE LIABILITY w2w a 11000,000 X ANY ALTO BODILY INJURY(Per person) $ B ALLOWWNEDSCHEDULED 56212042 1/8/2014 1/8/2015 BODILY INJURY(Per ac*hwt) S AUTOS AUTOS TY DAMK NON-OWNED GE X HIAUTOS X RES unfired aI 131-shile $ 100,000 UMBRELLALIAR OCCUR EACH OCCURRENCE $ EXCESS LI AB CLAIMS-MADE AGGREGATE $ Eo I I RETENTIONA $ WORKERS COMPENSATION i INYSM O AND EMPLOYERS'LIABILITY ANY PROPRIETORIPARTNERIEXECUTIYE N/A E.L.EACH ACCIDENT $ OFFICERIMEyy wtddM In� � E.L.DISEASE-EA EMPLO $ DE8�RIPTI1-owerOF ATI INS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD I OI.Addtdorret Remarks Sehedula,R come space le regWroM Brian Goldberg - CVC 056664 James Fields CNC043077 Daniel Goldberg CACIS17663 Lawrence J Bill BC13006454 CERTIFICATE HOLDER CANCELLATION (305)756-8972 geliciano j @miamishoresvial 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 Building Department 10050 HB 2 Ave. AUTHORIZED REPRESENTATIVE Miami Shores, FL 33138 Reed Herndon/JULIE o�C?Q.�/1 u.% ACORD 25(20'10!06) @ 1986-2010 ACORD CORPORATION. All rights reser INSn2. ("Immnq Tho Arrion mato and IMn sra renlatarad mar4o rd Armin