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EL-15-3169 C )CH Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-251599 Permit Number: EL-12-15-3169 Inspection Date: January 26, 2016 Permit Type: Electrical - Residential Inspector: Devaney, Michael Inspection Type: Final Owner: FRAME, ROSALINE Work Classification: Service Change Job Address:680 NE 97 Street Miami Shores, FL Phone Number (305)302-1784 Parcel Number 1132060171610 Project: <NONE> Contractor: ALES GROUP ELECTRICAL CONTRACTORS Phone: (305)219-4806 Building Department Comments CHANGE OF SERVICE Infractio Passed Comments INSPECTOR COMMENTS False Inspector Comments Passed Ed/ Failed Correction Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. For Inspections please call: (305)762-4949 January 26,2016 Page 1 of 1 Permit Iva LA ­ -3169 ,.'qMiami Shores Village P T Et0 call-.Residential 10050 N.E.2nd Avenue NE WnrtClassiiicatic aR Serviice.Change Miami Shores,FL 33138-0000 � �� Permit Status:APPROVED Phone: (305)795 2204 fitOR'LD4' issue Date: 12128/2015 Expiration: 06/25/2016 Project Address Parcel Number Applicant 680 NE 97 Street 1132060171610 Miami Shores, FL Block: Lot: ROSALINE FRAME Owner Information Address Phone Cell �OSALINE FRAME 680 NE 97 ST (305)302-1784 MIAMI SHORES FL 33138 Contractor(s) Phone Cell Phone Valuation: $ 500.00 ALES GROUP ELECTRICAL CONTRAI (786)244-0004 Total Sq Feet: 00 t is Type of Work:CHANGE OF SERVICE Available Inspections: Additional Info: Inspection Type: Classification:Residential Review Electrical Scanning:3 Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $0.60 DBPR Fee Invoice# EL-12-15-58144 $2.25 12/23/2015 Credit Card $50.00 $ 115.10 DCA Fee $2.25 Education Surcharge $0.20 12/28/2015 Credit Card $ 115.10 $0.00 Permit Fee-Additions/Alterations $150.00 Scanning Fee $9.00 Technology Fee $0.80 Total: $165.10 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 by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL,PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work. OWNERS AFFIDAVI I e ify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating constructs a zoni g. u emtore,I authorize the above-named contractor to do the work stated. ;76 December 28, 2015 Authorized Sign re:Owner / Applicant / Contractor / Agent Date Building Department Copy December 28,2015 1 ACC►Ra DATE(MMDOMYY) .. CERTIFICATE OF LIABILITY INSURANCE 11/26/2016 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 NAME: ANDY RODRIGUEZ JR ANDYS ASSURANCE AGENCIES PSE- -- — --_ _................_..._.._i N E t: (305) 642-8407 Alc,No (305)693-59(19 1441 W Flagler St _mac__ )__._._.._....._... ..___._............ Miami, FL 33135 AOORsa,andyjr@andrsassurance.com _... ��................. INSURERtS)AFFORDING COVERAGE NA1CC INSURER A:SCOTTSDALE INSURANCE CO INSURED ALES GROUP INC INSURER B d/b/a PROLOCK & SAFE/ALES GROUP INSURER C � ELECTRICAL CONT/ALES GROUP GC INSURER D: 896 SW 70 AVENUE INSURER E MIAMI, FL 33144 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 CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS j CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, 3 EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITSSHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. lNSR ICY EXP _ I LTR TYPE OF INSURANCE Net, g YIYo POLICY NUMBER DtYYYY MM/DO LIMITS X i-O COMMERCIAL GENERALLIABILlTY I -EACH E C��Tq�ENCE $ 1,000,0 I,W ,00 _._._..._.I CLAIMS-MADE LX OCCUR I PREMISES(Ea occurrence) $ 100 1,000 ..._.....................�..............p MED EXP(Any one person) $ --�-„ ,-n O 0 ._ I A i ; �__ -- CPS2381008 101/03/16 01/03/17 PERSONAL&ADV INJURY $ 11000,000i ri! 'L AGGREGATE LIMIT APPLIES PER: i GENERAL AGGREGATE t$ 2 OOO,OOO �._......�PRO- -_ ......� r POLICY! JECT _ _;LOC i PRODUCTS-COMPlOP AGG $ 1,000,006 i OTHER, AUTOMOBILE LIABILITYCOMBINED SINGLE LIMIT— f i Ea acciden! $ i ANYAUTO BODILY INJURY(Per person) i$ ALL OWNED SCHEDULED __ _ ...._._._............ AUTOSAUTOS BODILY INJURY(Pet accident) $ NON-OWNED PROf�E`itFY OR1vfAGE ............................_ — ................i HIRED AUTOS - AUTOS Pera�cdent} S $ UMBRELLA LIAB i gCCUR EXCESS LIAB _._ EACH OCCURRENCE $ GLA(PAS MADE AGGREGATE _.__.._. _.. $ -- DEDJ RETENTION$ - WORKERS COMPENSATION $ 'AND EMPLOYERS'LIABILITY YIN STATUTE .._ ER ... _...... MANY PROPMETORMARTNE"XEGUTIVE E.L.EACH ACCIDENT �— OFFICERMEM13ER EXCLUDED? 7-11 NIA IMandatory in NM L—J E.L DISEASE-EA EMPLOYE$ Is,,describe wider ...__. . ...................._.__.�._...................._.; DESCRIPTION OF OPERATIONS below E,L.DISEASE-POLICY LIMIT 1$ 1 s i i i 1 DESCRIPTION OF OPERATIONS/.LOCATIONS I VEHICLES (ACORD 101.Additional Remarks Schedule,may be attached N more space is required) i 'Locksmith (1,4913) , Door & Window Installation (91746) , Alarm Installation (91127) , Electrical Work (92478) , General Contractor (91580) & Subcontracted Work (91585) i CERTIFICATE HOLDER CANCELLATION City Of Miami Shores SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 10050 NE 2 Avenue THE EXPIRATION DATE THEREOF, NOW WILL BE DELIVERED IN Miami, Shores, F1 33138 ACCOR0 CE WITH THE POLICY PROVISIPNW i i I AUTHORIZ REPRESENTATIVE � + L. 4W I j 1948-2013 AC(*D CORPO TIO 1I rights reserved. ACORD25(2013/04) The ACORD name and logo are registered marks ACORD i JEFF ATWATER CHIEF FINANCIAL OFFICER STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS'COMPENSATION CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS'COMPENSATION LAW CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers'Compensation law, EFFECTIVE DATE: 1/3/2016 EXPIRATION DATE: 112/2018 PERSON: LORENTE RAMON FEIN: 592157712 BUSINESS NAME AND ADDRESS: ALES GROUP INC 896 SW 70 AVENUE MIAMI FL 33144 SCOPES OF BUSINESS OR TRADE: LICENSED GENERAL LICENSED ELECTRICAL DOOR AND WINDOW CONTRACTOR CONTRACTOR INSTALLATION Pursuant to chapter 440,05(14),RS.,an officer of a corporation who elects exemption from this chapter by filing a cartificate,of election under this section may not recover benefits or compensation under this chapter.Pursuant to Chapter 440,05(12),F.S,Certificates of election to be exempt...apply only within the scope of the business or trade listed on the notice of election to be exempt.Pursuant to Chapter 440,06(l 3),FS.,Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation it,at any time after the filing of the notice or the issuance of the certificate, the person named on the notice Or certificate no longer meets the requirements of this section for issuance of a certificate.The department shall revoke a DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 OLIESTIONS?(850)413-1609 JEFF ATWATER CHIEF FINANCIAL OFFICER STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS'COMPENSATION * CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS'COMIPENSATION LAW CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers'Compensation law. EFFECTIVE DATE: 1/3/2016 EXPIRATION DATE: 1/2/2018 PERSON: GONZALEZ DAVID FEIN: 592157712 BUSINESS NAME AND ADDRESS: ALES GROUP INC ALES GROUP GENERAL CONTRACTORS/ALES GROUP ELECTRICAL CONTRACTORS 1 PROLOCK AND SAFE 896 SW 70 AVENUE MIAMI FL 33144 SCOPES OF BUSINESS OR TRADE: LICENSED GENERAL LICENSED ELECTRICAL DOOR AND WINDOW CONTRACTOR CONTRACTOR INSTALLATION Pursuant to Chapter 440.{}5(14),F.S.,an officer of a corporation who elects exemption from this chapter by filing a certificate of election under this section may not recover benefits or compensation under this chapter.Pursuant to Chapter 440.05(12),IF.S,.Certificates of election to be exempt...apply only within the scope of the business at trade listed on the notice of election to be exempt.Pursuant to Chapter 440.05(13),F.S.,Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation if.at any time after the filing of the notice or the issuance of the certificate, the person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate.The department shall revoke a DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUESTIONS?(850')413-1809 DEC 2'3 2015 Miami Shores Village Building Department 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 BUILDING Master Permit No. RC-6-14-1383 PERMIT AQPL�C ION Sub Permit No-4V /Is--- 3)19 ❑BUILDING ® ELECTRIC ❑ ROOFING F-� REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ,&OF ❑CANCELLATION ❑ SHOP DRAWINGS JOB ADDRESS: 680 NE 97th Street Ci Miami Shores County- Miami Dade Zip' Folio/Parcel#: 11-3206-017-1610 Is the Building Historically Designated:Yes NO X Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): Robert Frame _Phone#: 305 302 1784 Address: 680 NE 97th Street city: Miami Shores State: FL Zip: 33138 Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name: Ales Group,Inc Phone#: 305-219-4806 Address: 896 SW 70th Ave city: Miami State: FL Zip: 33144" Qualifier Name 61UY\0 o v-e✓L-�e Phone#: State Certification or Registration#: r ()(30 1 L& Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ 500 - 0-0 Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New M Repair/Replace ❑ Demolition Description of Work: Change of Service per apnro�ed plans Specify color of color thru tile: Permit Fee$ � ®r®a CCF$ CO/CC$ Submittal Fee$ .� Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ c r� TOTAL FEE NOW DUE (Revised02/24/2014) 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. ('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 7i Signature � � )\ +N'tRor AGENT CONTRACTOR The foregoing in! umme�nt ws acknowledged before me this The foregoing instrument was acknowledged before me this day of !/�� ,20�✓tby day of d .20 A � .by 5a I e:n ZZ e618/ who is personally known to VQV NQv-1 LOI'Q-e . whopersonally 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: Pri Print: Gf i-I 0✓fit r YM✓t, „y t,,,, 1 ?r :c MY COMMISSION 1i EE 867174 S I�pc►s+► iVote P Seal: H: ,•� EXPIRES:January 22,2017 • Notary ��+�State of Florida StAded Thru Notary Pubfic Underwriters Joanna M F no MY commisslon'FF 082753 Expires 01/12/2018 APPROVED BY ,6 Plans Examiner Zoning Structural Review Clerk (RevisecIO2/24/2014)