EL-16-260 Inspection Worksheet
Miami Shores Village
10050 N.E.2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-253414 Permit Number: EL-2-16-260
Scheduled Inspection Date: February 26,2016 Permit Type: Electrical - Residential
Inspector: Devaney, Michael Inspection Type: Final
Owner: BURCH,ALICE Work Classification: Low Voltage
Job Address: 1440 NE 101 Street
Miami Shores, FL 33138- Phone Number (305)318-9578
Parcel Number 1132050240030
Project: <NONE>
Contractor: ELITE INTEGRATION SOLUTIONS Phone: (954)789-3274
Building Department Comments
CCN-SECURITY CAMERA INSTALLATION infractio Passed Comments
INSPECTOR COMMENTS False
Inspector C e
Passed
Failed
Correction
Needed
Re-Inspection ❑
Fee
No Additional Inspections can be scheduled until
re-inspection fee is paid
February 25,2016 For Inspections please call: (305)762-4949 Page 19 of 33
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s ° Miami Shores Village ParYnr ; i �ca �esiolnti�l ,
10050 N.E.2nd Avenue NE �rji,:
Miami Shores,FL 33138 0000 l
�c A � Phone: (305)795-2204 p Ait8.
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Project Address Parcel Number Applicant
1440 NE 101 Street 1132050240030
Miami Shores, FL 33138- Block: Lot: ALICE BURCH
Owner Information Address Phone Cell
ALICE BURCH 1440 NE 101 ST (305)318-9578
MIAMI SHORES FL 33138-2613
Contractor(s) Phone Cell Phone Valuation: $ 3,550.86
ELITE INTEGRATION SOLUTIONS (954)789-3274 (954)789 3274
Total Sq Feet: 0
Type of Work:CCTV-SECURITY CAMERA INSTALLATION 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-2-16-58508
$225 02/01/2016 Credit Card $50.00 $124.90
DCA Fee $2.25
Education Surcharge $0.80 02/03/2016 Credit Card $ 124.90 $0.00
Notary Fee $5.00
Permit Fee-Additions/Alterations $150.00
Scanning Fee $9.00
Technology Fee $3.20
Total: $174.90
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 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. Futhermore,I authorize the above-named contractor to do the work stated.
February 03, 2016
gnature:Owner / Applicant / Contractor / Agent Date
Building Department Copy
February 03,2016 1
Miami Shores Village
Building Department FEB U 1 2016
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949 S
FBC 201 �[
BUILDING Master Permit No. -EL 16 m 7-60
PERMIT APPLICATION Sub Permit No.
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP
P' \ CONTRACTOR DRAWINGS
JOB ADDRESS: IV ' C) k 5-C ST �i
City: Miami Shores County: Miami Dade Zip: 33 U S d
Folio/Parcel#: Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: ^ Flood Zone: BFE: FFE: rD
OWNER:Name(Fee Simple Titleholder): A l l ce tou,(c Vi Phone#:
Address:_ , ALAD OE l o % si- sr
city: M I A'M j syin<&, State: CL®c � 6- Zip: X313
Tenant/Lessee Name: Phone#:
Email: --1
CONTRACTOR:Company Name: ,I Ve_ Sl J�1CAPS Phone#: _54
Address: ® y-6 r ko C_
City: e ^ State: 1>f a G Zip:
Qualifier Name: W�n r oasn l'C�rrO _ �Vre f G" Phone#: ���— J&JZ q L/
State Certification or Registration#: (, D KM �001 Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ S5 b o® � Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteratiiosn- [g'tgew IDRepair/Replace ❑ Demolition
Description of Work: CCIV e r rf,-A-T ca V1ne ca \18_a-yA x\L-T i®k!2k.
Specify color of color thru tile:
Submittal Fee$ Permit Fee$ CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Notary$
"echnology Fee$ Training/Education Fee$ Double Fee$
ictural Reviews$ Bond$
TOTAL FEE NOW DUE$ ' /-70
-1124/2014)
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. 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 Signatur
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
2 day of �A�+�I�CL`(' ,20_1-,U by `�/f�day of �//�v. 20 G 6 ,by
who is ersonally known o /�y�oilo Th�'r/i'��i ,who is personally known to
me or who has produced f as me or who has produced f-L '6 Li as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: , \PCIIS �jf'',, Sign,
Print: �,i/llr1 Print: e7'
Seal: _ WG19KN��l�l��; = Seal:
_ '%X""Zp
ot., JESSE WADta
e!T!P cam m s5ipp ��,• Notary Public-Sy comm.Expire;Rrmission#�* � a+resa
APPROVED BY Plans Examiner Zoning
f A 1
Structural Review Clerk
(Revised02/24/2014)
Miura 31.V 1 1, l3VV:KIVUI'R DCIV LHVVJUIV, Or-LMC IAMT
STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
ELECTRICAL CONTRACTORS LICENSING BOARD -
EG13000529 � >:-
The ALARM SYSTEM CONTRACTOR II
Named below IS CERTIFIED
Under the provisions of Chapter 489 FS.
Expiration date: AUG 31, 2016
HERRERA, NORMANDO MAURICIO �•
ELITE INTEGRATION SOLUTIONS, LLC
12850 SW 33RD DRIVE_
DAVIE FL 33.330
a.
ISSUED: 03/18/2015 DISPLAY AS REQUIRED BY LAW SEQ# L1503180000501
--BROWAIM COUNTYLOC-AL BUSINESS TALC-RECENT
115 S. Andrews Ave., Rm. A-100, Ft. Lauderdale, FL 33301-1895—954-831-4000
VALID OCTOBER 1,2015 THROUGH SEPTEMBER 30,2016
DBA.ELITE INTEGRATION SOLUTIONS LLC Receipt#:ATTOR75NEY (ALARM SYSTEM
Business Name: Business Type:
coNTRACTOR)
Owner Name:NORMANDO MAURICIO HERRERA Business Opened:l0/01/2014
Business Location:12850 SW 33 DR State/County/CerNReg:EG13000529
DAVIE Exemption Code:
Business Phone:954 789 3274
Rooms Seats Employees Machines Professionals
1
For Vending Business Only
Number of Machines: Vending Type:
Tax Amount Transfer Fee NSF Fee Penalty Prior Years Collection Cost Total Paid
30.00 0.00 0.00 7.50 0.00 25.00 62.50
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:
NORMANDO MAURICIO HERRERA Receipt #WWW-15-00089799
8225 NW 8 PL Paid 01/21/2016 62.50
PLANTATION, FL 33324
2015 - 2016
CERTIFICATE OF LIABILITY INSURANCE DA 01/14)2016m
THIS CERTIFICATE 15 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 certlRcate holder Is an ADDITIONAL INSURED,the poilcy(les)must be endorsed. B SUBROGATION IS WANED,subject to
the terms and conditions of the policy,certaln policies may require an endorsement. A statement on this cerdfieate does not confer rights to to
certificate holder in lieu of such endorseamigs).
PRODUCER =ACT JESSICA TEJEDA
West Holiday Insurances 305 828-5655 305 826-9283
6905 W.4th Ave. JESSICA@ONLINEWN.COM
Hialeah,FL 33014 INs S AFFORDING COVERAGE
Phone 305)828-5655 Fax 305)828-9283 I1SURERA: WESTURN UNION INSURANCE GROUP
INSURED INSURERS:
ELITE INTEGRATION SOLUTIONS LICENSE#EG13OW529 mum c:
12850 SW 33 DRIVE RER D
DAME FL 33330 tUSURME:
INSUMF:
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 HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
11LINm TYPE OF INSURANCE ADD POLICY NUMBER POLICY EFF WLICY ETP Lam
❑ COMMERCIAL GENERAL LIABILITY EACHOCCURRENCE 1,000 000.00
❑ cLauRs MADE ❑ OCCUR DAMAG $ 100,000.00
A ❑ NPP1415151 07/02/2015 07/02/2016 MED EXP(kW orm pemon $ 5,000.00
PERSONAL&ADVINJURY $ 1,000,000.00
GENLAGGREGATELIMIT APPLIES PER: GENERAL AGGREGATE $ 1,000000.00
❑Poucy ❑ JECOT ❑ LOC PRODUCTS-COMPIOPAGG $ 1,000,000.00
❑ OTHER $
AUTOMOBILE LIABIUiY INED=INGLE LIMIT
❑ ANY AUTO BODILY W JURY(Per person) $
❑ ALL AUTOS OWNED ❑ AUTOS BODILY INJURY(PeratxJdmd) $
F-1HIRED AUTOS ❑ AAUUTOS NED P DAMAGE $
❑ UMBRELLA LIAR ❑OCCUR EACH OCCURRENCE $
❑ EXCESS LIAR CLAIMS-MADE AGGREGATE $
El DED ❑ RETeam s $
WORKERS COMPENSATION PER ❑OTH
AND EMPLOYERS'LIABILITY Y/N
ANY PROMETORIPARTNER/E)(E E.L.EACH ACCIDENT $
OFFICE
I WER EXCLUDED/ N/A
= In%. E.L.DISEASE-EA EMPLOYE $
DESCR�TION OF OPERATIONS below E.N.DISEASE-POLICY LIMIT $
DESCRIPTION OF OPERATIONS l LOCATIONS/VEHICLES(Attach ACORD 161.Additional Remarks Sdmdule,I amm space is m**oQ
LICENSE#EG130OD529
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
MIAMI SHORES VILLAGE BLDG DEPT THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN
10050 NE 2ND AVENUE ACCORDANCE WITH THE POLICY PROVISIONS.
MIAMI SHORES,FL 33138 auTNORNrJ:D REPReSENTarnE
C�5w-
0 ACORD CORPORATION. ACI rights reserved.
ACORD 25(2014101)QF The ACORD name and logo are registered merits of ACORD.
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: 3/25/2015 EXPIRATION DATE: 3/24/2017
PERSON: HERRERA NORMANDO M
FEIN: 471969502
BUSINESS NAME AND ADDRESS:
ELITE INTEGRATION SOLUTIONS LLC
12850 SW 33RD.DRIVE
DAME FL 33330
SCOPES OF BUSINESS OR TRADE:
BURGLAR AND FIRE
ALARM INSTALL
Pursuant to Chapter 440.05(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 rawer benefits or compensation under this chapter.!hours to Chapter 440.05(12).F.S.,Certificates of election to be exempt..,apply only within
the scope of the business or trade fisted 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 shalt be subject to revocation ff,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 or a certificate.The department shelf revoke a certificate at
DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUESTIONS?(850)413-1609
Miami shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305)756.8972
Notice to, Owner - Workers' Compensation Insurance Exemption
r ,,4
Florida Law requires Workers' Compensation insurance coverage under Chapter 440 of the Florida Statutes. Fla. Stat. § 440.05
allows corporate officers in the construction industry to exempt themselves from this requirement for any construction project prior to
obtaining a building permit. Pursuant to the Florida Division of Workers'Compensation Employer Facts Brochure:
An employer in the construction industry who employs one or more part-time or full-time
employees,including the owner,must obtain workers'compensation coverage. Corporate officers
or members of a limited liability company (LLC) in the construction industry may elect to be
exempt if
1. The officer owns at least 10 percent of the stock of the corporation,or in the case of
an LLC,a statement attesting to the minimum 10 percent ownership;
2. The officer is listed as an officer of the corporation in the records of the Florida
Department of State,Division of Corporations;and
3. The corporation is registered and listed as active with the Florida Department of
State,Division of Corporations.
No more than three corporate officers per corporation or limited liability company members are
allowed to be exempt. Construction exemptions are valid for a period of two years or until a
voluntary revocation is filed or the exemption is revoked by the Division.
Your contractor is requesting a permit under this workers'compensation exemption and has acknowledge that he or she will not use
day labor,part-time employees or subcontractors for your project.The contractor has provided an affidavit stating that he or she will
be the only person allowed to work on your project.In these circumstances,Miami Shores Village does not require verification of
workers' compensation insurance coverage from the contractor's company for day labor,part-time employees or subcontractors.
BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS
CONTENTS.
Signature:
Owner
State of Florida
County of Miami-Dade
The foregoing was acknowledge before me this day of S-A 2 20
By kA whois-Ve—rs6nally known me me or has produced
'0 q@A,0#fication.
Notary:
SEAL: NOTARY PuatIc
P #.
........ S1,
OF F
"himim'O"
Elite Integration Solutions, LLC
12850 SW 33rd Drive Davie, Florida 33330
State of Florida
County of Broward
Before me this day personally appeared Normando M.
Herrera who, being duly sworn, deposes and says:
That he will be the only person working on the project
located at 1440 NE 101 A St Miami Shores, Florida 33138
Sworn to (or affirmed) and subscribed before me this 21 st
day of January. 2016 by
Personally Know _______________ _
Or Produced Identification --------
Type of identification Produced
RAMAN MEJ1A
'E MY COMMISSION#FF206429
°!.
EXPIRES March 05,2019
J10.
J FkMw1&N0ta'8ery B(.'(�,'
Print, Type or Stamp Name of Notary