EL-14-2665 R Miami Shores Village 4
Building Department r
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel:(305)795.2204 Fax:(305)756.8972 Ply
INSPECTION'S PHONE NUMBER:(305)762.4949
FBC 20 lj
BUILDING Permit No.T�: -
PERMIT APPLICATION Master Permit No:E_F—
Permit Type: Electrical
JOB ADDRESS: 164 NE 105 STREET
City: Miami Shores County: Miami Dade Zip: 33138
Folio/Parcel#: 11-2136-013-0660
Is the Building Historically Designated:Yes NO X Flood Zone:
OWNER:Name(Fee Simple Titleholder):GLEN FORD&CATHERINE H ANN phone#.305-505-7104
Address: 164 NE 105 STREET �'
City: MIAMI SHORES State: FL Zip: 33138
Tenant/Lessee Name: N/A Phone#:N/A
Email: N/A
AMILTON1AW
TRIG- ? < 561-210-5263
CONTRACTOR:Company Nam Phone#
Address: 2701 NE 27 CIRCLE )
City: BOCA RATON ,,"'-State: FL Zip: 33431
Qualifier Name: MARK HAMILTON Phone#: 561-210-5263
State Certification or Registration#: ER13013563 Certificate of Competency#: 08E000700
Contact Phone#: 561-210-5263 Email Address: HAMILTONELECTRIC@GMAIL.COM
DESIGNER:Architect/Engineer: DAVID FAERMAN Phone#: 561-445-1787
Value of Work for this Permit:$900.00 Square/Linear Footage of Work: 9
Type of Work: ❑Address ❑Alteration A4ew ❑Repair/Replace ❑Demolition
Description of Work: ELECTRIC WORK FOR NEW SWIMMING POOL
Submittal Fee$ Permit Fee$ CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Bond$
Notary$ Training/Education Fee$ Technology Fee$
Double Fee$ Structural Review$
TOTAL FEE NOW DUE$ �� �0
Bondktg Company's Name(if applicable) NA
Bonding Company's Address NA
City NA State NA Zip NA
Mortgage Lender's Name(if applicable) NA
Mortgage Lender's Address NA
City NA State NA Zip NA
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
EMPROVEMENTS 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 ( ) days after the building permit is issued In the absence of such posted notice, the
inspection will not be approv and a rei tion fee will be charged.
Signature Signature_
weer o gent Contractor
The fore oing instrument was ackno edged�before�. ^�me this The foregoing instrument was acknowledged beforeme this(
day of� ,20 a,by " t.J+ day of _ 20�,by M ��
who is personally known to me or who has produced �—' who is rsonally known to'm'e—)or who has produced.-
Qt—
roducedQ-- As identification and who did take an oath. as identification and who did take an oath.
NOTARY UBLIC: NOTARY Pff JBLIQ
Si A4E Sign:
Print: Print: DlQ_R- I D- �-
My Co n wPX1
My Commiss" b; fo/ lS
,,� 'S ;fR. Y DALEA.h4ASKER
Rl 9428 _. .7 < <_,,:ir,; I:,src,n EE0:99428
Q `_ �`xpires Jbne h,2015
APPROVED BY `e G Plans Examiner Zoning
Structural Review Clerk
(Revised 31 W012)(Revised 07/10W)(Revised 06110MM)(Revised 3/15/09)
Nov 2614 02:09p Hamilton Electric 561-392-3111 p.1
oSTATE OF FLORIDA
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
ELECTRICAL CONTRACTORS LICENSING BOARD (850)487-1395
1940 NORTH MONROE STREET
TALLAHASSEE FL 32399-0783
HAMILTON,MARK
HAMILTON ELECTRIC
2701 NE 27TH CIRCLE
BOCA RATON FL 33431
Congratulatiortsl With this license you become ori®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 boners to barbeque restaurants, DEPARTMENT OF BUSINESS AN D
and they keep Florida's economy strong PROFESSIONAL-REGULATION
Every day we work to improve the way we do business in order to ER13013563 ISSUED: - 09/01/2014
serve you better_ For information about our services,please log onto
www.myflorkkdicome.corn. There you can fmd more information REG ELECTRICAL CONTRACTOR
about our divisions and the regulations that impact you,subscribe HAMILTON,MARK
to department newsletters and team more about the Department's
initiatives. HAMILTON ELECTRIC
(INDIVIDUAL MUST MEET ALL LOCAL
Our mission at the Department is:License Efficiently,Regulate Fairly. LICENSING REQUIREMENTS PRIOR
We constantly strive to serve you better so that you can serve your TO CONTRACTING IN ANY AREA)
customers. Thank you for doing business in Florida, HAS REGISTERED under the provisions or Ch.488 FS.
and congratulations on your new licensel rte«,dam:AUG31.2016 L14MICNI080
DETACH HERE
RICK SCOTT,GOVERNOR KEN tAWSON,SECRETARY
STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
ELECTRICAL CONTRACTORS LICENSING BOARD 'S;,
• Cl .�_ =i1R''7.I4
! '
ER13013563
The ELECTRICAL CONTRACTOR
Named below HAS REGISTERED �•:� yt�'
Under the provisions of Chapter 489 FS.
Expiration date. AUG 31,2016
(INDIVIDUAL MUST MEETALL LOCAL LICENSING
REQUIREMENTS PRIOR TO CONTRACTING IN ANY AREA)
HAMILTON, MARK'
HAMILTON ELECTRIC
2741 NE 27TH CIRCLE
BOCA RATON FL 33431
■ o
ISSUED_ oer01r2014 DISPLAY AS REQUIRED BY LAW SEQ# L1409010001080
Nov 26 14 02:09p Hamilton Electric 561-392-3111 p.5
glossa
Local Business Tax Receipt
Miami—Dade County, State of Florida
THIS IS NOTA BILL — DO NOT PAY
6781323 �'LB_7j
BUSNEW NA ff1E1LC"TWN aficMPTtvo. EXPIRES
HAMILTON ELEMM RENF-wAL SEPTEMBER 30, 2015
DOING BUS IN DADE CO 70MO76 Must b--displayed at place of business
MIAMI FL 33000 Pursuant m Ccunty Code
Chapter 8A-AR.9&10
pppNER SEC.TYPE OF BUSHWESS .
MARK D HAMILTON 196 ELECTRICAL CONTRACTOR, BY TA teT RECEIVEDRCTOR
BY TAX COLLECTOR
wrorker(s) 1 08EMOW $75.00 09/26/2014
CHiECK21-14-082145
This Local Business TacRenipt=[I coidims payment dtbe local BasimssTat.Tile Readpis not a liceese.
perWtare ce attheholdefstpuli6ea8ons.todobusinw3.HoldermwcamovwIlbany gaveramulal
ornaogovermaestat rapatatury lnvs am regnaenegnwisieb applylb the badnew
dbe RECEIPT NIL abmre au0 be displayed am aU eamasmial vabiNes-WismtBade Code Sec e&-771
for rams iidarmaflan vgit wrww miam dade.aovhaawllector
CERTIFICATE OF LIABILITY INSURANCE2 E0%VDO�Y
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 13 WAIVED,subject to
the terms and conditions of the policy,certain policies may require an endorsement A statement an this certificate does not confer rights to the
certificate holder In lieu of such endorsement(s).
PIROOICER CONrAcT NOME Kerrie ]Kenna
LRA Insurance PHONE (407)838-3445 FAX N,:(407)838 3460
498 S Lake Destiny Rd kraines@lrainsurance.com
ADEIRESS
INSUREIM AFFOROWG COVERAGE NAIL s
Orlando FL 32810 INMAURA Travelers 10796
INSLQUD INSURERS:Star Insurance C 8023
Mark Ramilton, DBA: Hamilton Electric INsuReRC:
2701 NE 27th Circle INSURERO:
INSURERE:
Boca Raton TL 33431 INaLtRBtF:
COVERAGES CERTIFICATE NUMBER.-14/15 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.
D
LR TYPE OF 24SURANCE POLICY NUMBER ICY EFF POLICY ERP Imr78
GE IERAL LIABILITY EACH OCCURRENCE $ 1,000,000
DAMAX TO RENTED
COMMERCIAL GENERAL LIABILITY PREMISES IEa oaxnrence $ 100,000
A CLAIMS-MADE ®OCCUR -660-7A23092-2-TCT-13 /23/2014 /23/2015 MED EXP(Any one persoi) $ 5,000
PERSONAL 8 ADV IN,UP.Y $ 1,000,000
GENERAL AGGREGATE $ 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER PRODUC-S-COMP/OP AGG $ 2,000,000
- POLICY PRO- LOC JEr $
AUTOMOBILE LIABILITY COMBINED SINGLE L
Ea eocident
ANYAUTO BODILY INJURY(Per pemn) $
ALL OVVNFDSCttEDULED BODILY INJURY(Per accident) $
AUTOS AUTOS
NON-OVMIED PROPERTY DAMAG
HIRED AUTOS AUTOS Per ca $
UAM tE a LIASOCCUR EACH OCCURRENCE $
EXCESSLIAS HCLAIMS-MADE AGGREGATE $
DED RETENTION
$ rYOWfl3iSCOMPEJSATtON x WCSTATU- DTI+
AND EMPLOYERS'IABlLrrY Y I NLLMITS
ANY PROPRIETORIPARTNIB DECUTIVE El EACH ACCIDENT $ 1,000,000
OFnCER/NENIBEREXp.UDED7 ® NIA 0690933 /23/2014 /23/2015
pbruftaly In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000
if yes.describe Nader
DESCRIPTION OF OPERATIONS below EL.DISEASE-POLICY LIMIT $ 1,000,000
DESCWPTION OF OPERATIONS f LOCATIONS I VEHICLES iACaoh ACORD 101,Additiarrel Remarks Sdw"e,K more space is regtdred)
ER13013563
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED m BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Miami Shores Village Building Department ACCORDANCE WITH THE POLICY PROVISIONS.
10050 NE 2nd Avenue
Miami Shores, FL 33138 AUTHORIMREPIESEdrATPIE
J Lumbra, Jr./DCOGGO .�
ACORD 25(2010105) O 1OW2010 ACORD CORPORATION. All rights reserved.
INS025 potooe)of The ACORD name and logo are registered marks of ACORD