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ELC-15-1406 Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-236395 PermitNumber: ELC-6-15-1406 Scheduled Inspection Date: December 24,2015 Permit Type: Electrical-Commercial Inspector: Devaney, Michael Inspection Type: Final Owner: SLMB LLC, UNG LLC CIO CJ LAW Work Classification: Addition/Alteration Job Address:651 NE 88 Terrace Miami Shores, FL 33138- Phone Number (305)200-8696 Parcel Number 1132060120020-651 Project: <NONE> Contractor: HENRY RODRIGUEZ ELECTRICAL CONTRACTOR,INC Phone: (305)218-7878 Building Department Comments INSTALL NEW ELECTRIC IN PARTITION WALLS& Infractio Passed comments RELOCATE LIGHTS 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 23,2015 For Inspections please call: (305)762-4949 Page 3 of 21 Permit No. ELC- 4 - 0 esn°Rs�, Miami Shores Village817?7lt r ( 14tt91I ) 10050 N.E.2nd Avenue NE WorkOlasgiffoation Addition/Alteration '• "'"�'' Miami Shores,FL 33138-0000 Permit Status.APPROVECJ ab Phone: (305)795-2204 OR Expiration: 01/18/2016 Issue tate:712�t t 6 P Project Address Parcel Number Applicant 651 NE 88 Terrace 1132060120020-651 Miami Shores, FL 33138- Block: Lot: LFNG LLC C/O CJ LAW SLMB Ll Owner Information Address Phone Cell LFNG LLC C/O CJ LAW SLMB LLC 651 NE 88 Terrace (305)200-8696 MIAMI SHORES FL 33138- 651 NE 88 Terrace MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone Valuation: $ 8,400.00 HENRY RODRIGUEZ ELECTRICAL CC (305)554-5711 Total Sq Feet: 0 Type of Work:INSTALL NEW ELECTRIC IN PARTITION W Available Inspections: Additional Info: Inspection Type: Classification:Commercial Final Scanning:1 Meter Box Alteration Relocation Fire Alarm Service Change Review Electrical Underground W.W. Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $5.40 DBPR Fee Invoice# ELC-6-15-55911 $3.78 06/09/2015 Credit Card $50.00 $226.96 DCA Fee $3.78 Education Surcharge $1.80 07/22/2015 Credit Card $226.96 $0.00 Permit Fee $252.00 Scanning Fee $3.00 Technology Fee $7.20 Total: $276.96 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 assume responsibility for all work done bye' r myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL,PLUMBING,MECHANICAL,WINDOWS ORS,ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: I certify that all the foregoing informati is cc ate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Futhermore,I authorize the above-na o actor to do the work stated. July 22, 2015 Authorized Signature:Owner / Applicant / C ntr r / Agent Date Building Department Copy July 22,2015 1 Miami Shores Village CFIVED Building Department JUN 092015 10050 N.E.2nd Avenue,Miami Shores, Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 BY: INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 20 �0 BUILDINGti Master Permit No.-y'— �— PERMIT APJEILCE ATION Sub Permit No.�-�n. Ito -140(o F1 BUILDING CTRIC ❑ ROOFING REVISION ❑ EXTENSION ❑RENEWAL PLUMBING ❑ MECHANICAL PUBLIC WORKS CHANGE OF ❑CANCELLATION ❑ SHOP (9!s` I^ n CONTRACTOR DRAWINGS JOB ADDRESS: V�` �� �� �dAU City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name(Fee Simple Titleholder). 1 tt��+,tis� 5`t- ®.�6u�,_,� Phone#: _�� 2-04—y Lf` Address I ( f0-1-L" *ve- c 4f— • n City:_ ►� ' State: -� Zip: t Tenant/Lessee Name: A'r 4..MQ 'PA -ECAW�-A Phone#: �yz.���'��• Email: CONTRACTOR:Company Name: hone#: Address: City:- � ( _ State: Zip: Qualifier Name: Phone#: State Certification or Registration •#: �%CgJ�� `-C l 1 Certificate of Competency#: _ DESIGNER:Architect/Engineers L jW —y, :S . Phone#: �� � Address 1 �L �k) NU—t� US.r City:. W State:,�Zip: Value of Work for this Permit:$ t-j i]O Square/Linear Footage of Work: Type of Work: ❑ Addition )(Alteration ❑ New ❑ lace/Re Re air p ' ❑ Demolition Description of Work: \�`4. LO (,a c lC ­j Oyu lZQA K d l LGSAA 3 Specify color of color thru tile: Submittal Fee$ jMS.d.. 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$ Mn..i.wAn-W he Yuw Al 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 approved and a reinspection fee will be charged. Signature Signature OWNER or AGENT CONTRACTOR The foregoing i s ument was acknowledged bef`ore rye this The foregoing instrument was acknowledged before me this day of ,20 l `/ ,by %,' I— /qday of -to11ll� 120 l by IVLA � �1l�r (s,t� � ,who is personally known to t'IClV1�1 -lam G� ,who is personally known to Mme or who has Aiu ed /q as me or who has produced�L�O V�.� m�-as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: cc tt�� Sign Print J rl Ca.IU C�� Print: Seal: SHARON ANN COX Seal: ,,:,P)1q:Notary Public State of Florida MY COMMISSION#FF124989 i' dia AlvarezEXPIRES:MAY 20,2018 Commission FF 156750Bonded through 1 st State insurance � ires 09/03/201 B ***************************** ************** ***************** APPROVED By,2 Plans Examiner Zoning Structural Review Clerk /7A/9/14 n\ .... NUNN Miami shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CONTRACTORS' REGISTRATION IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: A. r/ OPY 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 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 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. BUSINESS NAME: i BUSINESS ADDRESS: � -tSD2 �(_-O-CITY Il l STATE S ZIPS c� BUSINESS PHONE: ( 3v�) Z66 FAX NUMBER�) CELL PHONE ( ) �—r6 QUALIFIER'S NAME: QUALIFIER'S LIC NUMBER: _EC6L_-09.l t STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD (850) 487-1395 " 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 RODRIGUEZ, HENRY ANTHONY HENRY RODRIGUEZ ELECTRICAL CONTRACTOR INC. 14522 SW 142ND PLACE CIRCLE MIAMI FL 33186 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 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 EC0002411 ISSUED: 04/14/2015 serve you better. For information about our services, please log onto www.myfloridalicense.com. There you can find more information CERTIFIED ELECTRICAL CONTRACTOR about our divisions and the regulations that impact you, subscribe RODRIGUEZ, HENRY ANTHONY to department newsletters and learn more about the Department's HENRY RODRIGUEZ ELECTRICAL CONTRAC 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 under the provisions of Ch.489 FS. and congratulations on your new license! Expiration date AUG 31,2016 L1504140001119 DETACH HERE RICK SCOTT, GOVERNOR KEN LAWSON, SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD �EC0002411 The ELECTRICAL CONTRACTOR y Named below IS CERTIFIED n WS Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2016 RODRIGUEZ, HENRY ANTHONY L � a HENRY RODRIGUEZ ELECTRICAL CONTRACTOR INC. 14522 S W 142 PLACE CIRCLE MIAMI FL 33186 ISSUED: 04/14/2015 DISPLAY AS REQUIRED BY LAW SEQ# L1504140001119 002970 Local Business Tax Receipt Miami—Dade County, State of Florida ' —THIS IS NOTA BILL — DONOT PAY �LBTJ 5116330 BUSINESS NAME/LOCATION RECEIPT NO. EXPIRES RODRIGUEZ HENRY ELECTRICAL CONTRACTOR RENEWAL SEPTEMBER 30, 2015 14522 SW 142 PL CIR 5344379 Must be displayed at place of business MIAMI FL 33186 Pursuant to County Code Chapter 8A—Art.9&10 OWNER SEC.TYPE OF BUSINESS PAYMENT RECEIVED RODRIGUEZ HENRY 196 ELF' TRICAL CONTRACTOR BY TAX COLLECTOR Worker(s) EC0002411 $75.00 09/08/2014 CREDITCARD-14-035821 This Local Business Tax Receipt only confirms payment of the Local Business Tax. The Receipt is not a license, permit,or a certification of the holders qualifications,to do business. Holder must comply with any governmental or nongovernmental regulatory laws and requirements which apply to the business. The RECEIPT N0.above must be displayed on all commercial vehicles—Miami—Dade Code Sec Ba-276. For more information,visit www miamidade aovAoxcollector 06/02/2015 14:29 FAX 3052071343 RANALLO ASSURANCE INC 01001 CERTIFICATE OF LIABILITY INSURANCE - DA06102/15 066/02/15102/15 PRODUCER Ramallo Assurance:nc. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION 12955 S,W,42nd Street ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR Miami,FL 33175 ALTER THE COVERAGE AFFORDED BY THE PpkICIES BELOW. Phone (305)207-1332 Fax (305)207-1343 INSURERS AFFORDING COVERAGE _ NAIC INSURED Henry Rodriguez Electrical Contractor Inc INSURER A: Granada Ins Co — ^- INSURER B: Progressive 14522 SW 142 Pi.Circ, INSURER C: Normandy Harbor _ Miami FL 33186 INSURSR D: — __—...__...___......_ .._. INSURER E: COVERAGES INSURER F: THE POLICES OF INSURANCE LIS7 ED HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN.THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE SEEN REDUCSD BY PAID CLAIMS, INS ADWL .LT,.R, INSRD , „, ,TYPE OF INSURANCE POLICY NUMBER pow'EFFECTW POUCY EXPIRAMN SBT_mpp.1m , D4TE,(MMIDDfYY) LIMITS GEN,ERAL LIABILITY EACH OCCURRENCE 1�000,006 COMMERCIAL GENERAL LIABILITY DAMAGE f0 RENTED 0185FL00062736-1 09/12/14 09/12/1$ PREMISES(Ee Ccxx tlrenCe} 100,000 CLAIMS MADE [ OCCUR MED EXP(Any one person) ------ 5,000 ❑ __.._ ... .._.___ !PERSONAL 9 ADV INJURY 11000,000 LJ GENERAL AGGREGATE - 2',000,000 GEN'LAGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG 1.000,000 -_POLICY �,_!PROJECT !�j LOC AUTOMOBILE LIABIUTY -- --'--'---° - ❑ ANY AUTO 75715618-7 08/23/14 08/23/15 COMBINED SINGLE LIMIT 500,000 ❑ ALL OWNED AUTOS (Ee eocldent) B L! © SCHEDULED AUTON BODILY INJURY ❑ HIREDAUTOS (Per person) — ❑ NONOWNEDAUTO:3 BODILY INJURY ❑ (Per acddent) — PROPERTY DAMAGE ..........._— ----—-- -—�—— . .. (Per aackient) GARAGE LIABILITY — AUTO ONLY-EA ACCIDENT - ❑ ❑ ANY AUTO PAREa❑ THAN EAACCNLY: G E7CCESS/UMBRELLA LI,461LITY CCURRENCEOCCUR I-I CLAIMS MADEATE - !-! DEDUCTIBLE _ .._._._..---_-- -•_— LI RETENTION $ WORKERS COMPENSATION AICD ---... ._ ...__.. ..._... .-•_-- -._., EMPLOYERS'LIABILITY NHFL131704 09/26/14 09/26/15 !•-j W� T_L s ❑ 0TH' C ANY PROPRIETOR I PARTNER f E:XECUTIPVE OFFICER/MEMBER EXCLUDED? E,L,EACH ACCIDENT 100000 IF yAs,deSCIFbB under E.L.DISEASE-EA EMPLOYEE 100000 SPECIAL P_ ROVISIONp 0q:w,,,, •, -• , OTHER ___._— E,L.DISEASE•POLICY LIMIT 500000 DESCRIPTION OF OPERATK)NS/LOCATIONS ff #fC0002411 VEEFIICLES I EXCLUSIONS ADDED BY ENDORSEMENT!SPECIAL PROVISIONS CERTIFICATE HOLDER - CANCELLATION "—"--' SHOULD ANY OF THE ABOVE DES IS D POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ING INSURER WILL ENDEAVOR TO MAIL Village of Miami Shores EXPIRATION WRITTEN NOTICE HE;CE"pICATE HOLDER NAMED TO 10050 NE 2 Ave THE LEFT,BUT FAILURE TO DO S IMPOSE NO OBLIGATION OR UABIUTY Miami Shores Ft 33138 of ANY KIND UPON THE INSURE S AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORID 28(2001108)QF --- 6ACIORD CORP0RWn__0f7j 1988