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EL-15-2487 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL a Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-249279 Permit Number: EL-9-15-2487 Scheduled Inspection Date: December 15,2015 Permit Type: Electrical- Residential Inspector: Devaney, Michael Inspection Type: Final Owner: HERBITS, STEPHEN Work Classification: Alteration Job Address:246 NE 101 Street Miami Shores, FL Phone Number (305)962-5552 Project: <NONE> Parcel Number 1132060134630 Contractor: JESSEE ELECTRIC LIGHTING AND SUPPLY CO Phone: (305)970-8426 Building Department Comments REMODEL OF INTERIOR-KITCHEN-BATH-CLOSET 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 December 14,2015 For Inspections please call: (305)762-4949 Page 43 of 43 • Miami Shores Village Building Department SEP 3 o 2015 10050 N.E.2nd Avenue,Miami Shores, Florida 33138' Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 20(4 BUILDING Master Permit No. RC f5-4-8 PERMIT APPLICATION Sub Permit No. i�:I- (6-- 2CF83- ❑BUILDING ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: Z- q& N /01 S-�' City: Miami Shores Countv: Miami Dade zip: 3 3 1.3$ Folio/Parcel#: 3206 -0 ZO6 -0 1 3- q(0 3 O Is the Building Historically Designated:Yes NO�C Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): `� I Q �� 1 E Iy2/'�r'�S Phone#: �S / C110/ Address: I1 City: y 1 la Yvi i �t 0 r2 J -State:_ �-�- Zip: 3 �3 I :� 7 Tenant/Lessee Name: 11 Phone#: 3 oS- 9 7 8-9/d / Email: 9 ",f b;Ts � O PAa , r . Gd w� CONTRACTOR:Company Name:.ZGSS'C-e /- /� P�41'c- L �'S CO Phone#: 3c) -f 76--eq-Z6 Address: INS-0 /�� 3 ®L /, City: ,�[/wr�inJ-C- �jState: /: L Zip: 3 3?2 3 Qualifier Name: /"/J� Phone#: 70'[N2(6 rs : �° State Certification or Registration#:- ��,��/. .� Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ 3 S-00 .00 Square/Linear Footage of Work: O 0 Type of Work: ❑ Addition Alteration ❑ New ❑ Repair/Replace ❑ Demolift-ion Description of Work: ° I '� i n (�t1 r - k d c h Q n - L a�� - c A o S eT ' '°�+ e. , oma° • . . . s' -. Specify color of color thru tile: Submittal Fee$ Permit Fee$ CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ IGe.rieerl/1'f MA/1M Al � 4 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 b ap roved and a reinspection fee will be charged. Signature Signature WNER or AGENT 1 Y CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrump4 was acknowledged before me this day of wt 4xe A— ,20 /S ,by ��day of 61�" 20 /s by 4114 41 %.S ,who isersonal=known —;14,, AT—r who is p sonall know o 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 P LIC: NOTARY PUBLIC: Si Si Print: � �C� Print• 771 710tJs . Seal• P ' AYARI MARQUEZ S al;:�.a•P +, _�° A °��, SALLYANN K RITTENHOUSE MY COMMISSION N EE19l838 My COMMISSION#FF149916 EXPIRES:May 06,2016 ,,r EXPIRES August 22.2018 ******************************************************** 0a*� ***Tt�ffil1d�a'll✓yf`a* ervice.com*** ******************* APPROVED BY 7 Plans Examiner Zoning Structural Review Clerk Io....7�n.1I17/7d/7(11 dl STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ' ELECTRICAL CONTRACTORS LICENSING BOARD, EC0001585 The ELECTRICAL CONTRACTOR Named below IS CERTIFIED ..b> - . Under the provisions of Chapter 489 FS. D�` Expiration date: AUG 31, 2016 MALONE, MICHAEL BRETT JR JESSEE ELECTRIC LIGHTING AND SUPPLY CO. 11450 NW 38TH PLACE • SUNRISE FL 33323 ■ ISSUED: 09/01/2014 DISPLAYAS REQUIRED BY LAW SEQ# L1409010001028 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 77 DBA: Receipt#:ELECTRICAL/ALARMS/CONTRACTOR CAL/ ALARMS/CONTRACTOR Business Name:CEOSSEE ELECTRIC LIGHTING & SU Business Type: CERT ELECTRICAL CONTRACTOR) Owner Name:MICHAEL BRETT MALONE Business Opened:06/01/2006 Business Location:11450 NW 38 PL State/County/Cerf/Reg:EC0001585 SUNRISE Exemption Code: Business Phone:305-970-8426 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 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: MICHAEL BRETT MALONE Receipt #04C-14-00001594 11450 NW 38 PL Paid 07/14/2015 27.00 SUNRISE, FL 33323 2015 - 2016 r%mr%►s#A nk ^Aa i►t1'v i" -%^A1 QI Ic1A1CC,e TAY DC/`CIDT 09/2412015 13:38 9543409456 INNOVATIVE INSURANCE PAGE 01101 JESSE-1 OP ID:CT DATE(MMIDDII-M) ,oft o,,,.�' CERTIFICATE OF LIABILITY INSURANCE 09/24!2015 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 pollcy(les) must be endorsed. If SUBROGATION IS WANED,subject t0 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 Ileu of such endorsemen s. PRODUCER CONTACT NAME: INNOVATIVE INSURANCE PHONE - CONSULTANTS,INC. 5461 UNIVERSITY DRME #103 'MaIL CORAL SPRINGS,FL 33467 ADDR55s. BARRY S.GOLDSTEIN INSURER(s)AFFORDIN©COVRRAGE NAIC# _ INSURVR A:THE TRAVELERS INDEMNITY CO. 26658 INSURED JESSEE ELECTRIC LIGHTING& INSURER 8:ASSOCIATION INSURANCE co. 11240 SUPPLY CO INSURER C; 11450 NW 38TH PLACE -- - - SUNRISE,FL 33323 INSURER 0; INSURER E: _ INSUR R 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 H8REIN 18 SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,LIMITS SHOWN MAY HAVE BEEN REDUCER BY PAID CLAIMS, r TYPE OF INSURANCE VXP Y -- POUCY NUMBER •i MM/D POLICY LIMITS` GENERAL LIAMLnY EACH OCCURRENCE S _1,000,000 A X COMMERCIAL GENERAL LIABILITY 1-660-3GO26978-TIL-15 09/07/2015 09/07/2016 R4MISE5(E8 occurrence S 100,0_0_ _ CLAIMS-MADE LX]OCCUR MED EXP(Any one parson) _S•__ 6,00 _ PERSONAL 81 ADV INJURY 9 1,000,0 _ GENERAL AGGREGATE $ 2.000,00 GENS.AGGREGATE LIMIT APPLIES PER; PRODUCTS-COMPIOP AW S 2,000,00 POLICY PRO- LOC 8 AUTOMOSILE LIAMUTY iE„B�IN�EMSINGLF,LIAAIT $ ANY AUTO BODILY INJURY(Per person) S UTOS�"E° AOTOSHEDULED BODILY INJURY(Par acctlent) S, HIREtl AUTOS NON-OWNED PROPERT GE AUTOS PER ACCIDENT) S UMBRELLA LIAR OCCUR EACH OCCURRENCE S EXCESS LU►B CLAIMS-MADE AGGREGATE DED RETENTIONS S WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITYY/N X QIiL'UN]lIS_X. �. l� ANY PROPRIETORIPARTNERIEXECUTIVE CV0132866.03 09/07/2015 09/07/2016 E,L,EACH ACCIDENT S 1.000,000 OFFICERIMEMBER EXCLUDED? NIA _-•— tr yes,Baty in NH) if , E-EA EMPLOYEE S ea,d�aihe untlx ELDISEASE 1,000,000...• ._. DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT I S 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Aliaeh ACORD 401,Addlgo,mf Remarks schedule,it mare.—paw is raquIwq R8: MIACEL MALONE 9120001595 FAX: 305-756-9972 CERTIFICATE HOLDER CANCELLATION MIAMI-6 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, M0110E WILL ®G DELIVERED IN MIAMI SHORES VILLAGE ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE 2 AVENUE AUTWORLZGD REpREBENTATIVE MIAMI SHORES,FL 33132 41988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD l er t 46 L- -16-24W 3' sH°1iTVs yMiami Shores VillagePermit Type:E��I[�+I��iS�#litP, (' �. 10050 N.E.2nd Avenue NE Ar ttl pWlfl � M `. P *%.✓4 A�� Miami Shores,FL 33138-0000 tivg— Phone: (305)795 2204 permit�^t' APPROVED A�ORiD�' 1sd�DOW,'f0161201 , Expiration: 0 0312016 Project Address Parcel Number Applicant 246 NE 101 Street 1132060134630 Miami Shores, FL Block: Lot: STEPHEN HERBITS Owner Information Address Phone Cell STEPHEN HERBITS 246 NE 101 Street (305)962-5552 MIAMI SHORES FL 33139- 1000 VENETIAN Way MIAMI FL 33139- Contractor(s) Phone Cell Phone Valuation: $ 3,500.00 JESSEE ELECTRIC LIGHTING AND St (305)970-8426 Total Sq Feet: 200 Type of Work:REMODEL OF INTERIOR-KITCHEN-BATH Available Inspections: Additional Info: Inspection Type: Classification:Residential Review Electrical Scanning:3 Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $2.40 DBPR Fee Invoice# EL-9-15-57259 $3.38 09/30/2015 Check#: 1491 $50.00 $197.16 DCA Fee $3.38 Education Surcharge $0.80 10/06/2015 Check#:1502 $ 197.16 $0.00 Permit Fee-Additions/Alterations $225.00 Scanning Fee $9.00 Technology Fee $3.20 Total: $247.16 In consideration of the issuance to me o6his 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 assume respo4lbility, for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL,PLUMBINi�,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work. OWNERS 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 a�d zo in rmdre horize the above-named contractor to do the work stated. October 06,2015 Authorized gnatur�rment wne / Applicant / Contractor / Agent Date Building epa Copy October 06,2015 1