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EL-15-2448 12L A�F4 Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-253910 Permit Number: EL-9-15-2448 Scheduled Inspection Date: March 04,2016 Permit Type: Electrical- Residential Inspector: Devaney, Michael Inspection Type: Final Owner: HAYDEN, DONALD J Work Classification: Low Voltage Job Address:310 NE 99 Street Miami Shores,FL 33138- Phone Number (305)799-5198 Parcel Number 1132060135580 Project <NONE> Contractor. CONTROL YOUR LIFE,INC Phone: (954)366-1181 Building Department Comments AN LOW VOLTAGE Infractio Passed Comments INSPECTOR COMMENTS False Inspector Comments Passed Failed Correction A/1 Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid March 03,2016 For Inspections please call: (305)762-4949 Page 28 of 36 X a Miami Shores Village p 10050 N.E.2nd Avenue NE Miami Shores,FL 33138-0000 , Phone: (305)795-2204 ' 21 ' � `� zi`iV Expiration: 0312612016 Project Address Parcel Number Applicant 310 NE 99 Street 1132060135580 DONALD J HAYDEN Miami Shores, FL 33138- Block: Lot: Owner Information Address Phone Cell DONALD J HAYDEN 310 NE 99 Street (305)799-5198 MIAMI SHORES FL 33138- 310 NE 99 Street MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone Valuation: $ 8,095.00 CONTROL YOUR LIFE,INC (954)366-1181 Total Sq Feet: 0 Type of Work:AN LOW VOLTAGE Available inspections: Additional Info: Inspection Type: Classification:Residential Review Electrical Scanning:1 i Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $5.40 Invoice# EL-9-15-57213 DBPR Fee $4.25 09/25/2015 Check#:7081 $50.00 $259.23 DCA Fee $4.25 Education Surcharge $1.80 09/28/2015 Check#:7124 $259.23 $0.00 Permit Fee-Additions✓Alterations $283.33 Scanning Fee $3.00 Technology Fee $7.20 Total: $309.23 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: certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zorthfgAuthormore,I authVP the above-named contractor to do the work stated. September 28,2015 Authorize Signature:Owner / Applicant / Contractor / Agent Date Building Department Copy September 28,2015 1 Miami Shores Village R:1E Building DepartmentsE s 2015 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 B :___ __ - i Tel:(305)795-2204 Fax:(305)756-8972 T INSPECTION LINE PHONE NUMBER:(305)762-4949 yFBC 20 BUILDING Master Permit No. ,-C J 15 1 to i 4- PERMIT APPLICATION TTI ON Sub Permit No. ❑BUILDING LECTRIkaNC ] ROOFING E] REVISION ❑ EXTENSION [:]RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS a JOB ADDRESS: . City: Miami Shores County: Miami Dade Zio: 531319 Folio/Parcel#: 1 l 1'3Zn l/1— 0 15 — SSW Is the Building Historically Designated:Yes NO Occupancy Type:kuw4d: Construction Type:lel 75 Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): ty-iflaid ]LAUdw Phone#: SQS_-702—4 to_73 Address: n NE qG City: State: Zip: 3-5138 Tenant Lessee Name: Phone#: Email: CONTRACTOR:Company Name: PhoneM P Y I�� Ugi�I�I (�rv��vni �n� �� Address: Z (n ki, 1h C, h1S W Ci State: Zip: 335 rr�� Qualifier Name: v Vt, Phone#: Q&4.3tDt0_l 19, State Certification or Re istration#: Certificate of Com eten #: g P cY DESIGNER:Architect/Engineer: Phone#: Address: Ci State: Zip: p: Value of Work for this Permit:$8��5.�D Square/Linear Footage of Work: II Type of Work: ❑ Addition Alteration ❑ New ❑ Repair/Replace ❑ Demolition I Description of Work: low yol+a .2 I Specify color of��color ��thru tile: Submittal Fee$ Sy •1J" Permit Fee$ .2 AXI 040 CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ — s (Revised02/24/2014) r 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 eertify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulatin4 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. a Signature Signaturei4AMA d4u& OWNER or AG T CONTRACTOR The foregoing instrument was ackno I ged before me this The foregoing instrument was acknowledged before me this 1154h day of 20 1 5 .by _daffy of �5' �2 t` -,bf C ,20 by LCJ1Xc�d 40\J dere ,who is personally known to ��r��y�JIAA��"�,who is personally known to me or who has produced as me as Identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: Sign:,, Print: NA VPrint '!-hA Seal: �iyy� Seal: Notary Public State ofFbrida MY0016NlS�ON iff 162M Jason DeBaugh t��8MY Commission FF 030570 (� qw Expires 0=412017 IV, *********************** * ************ APPROVED BY tPlans Examiner Zoning Structural Review Clerk (Revised02/24/2014) .7��FC.1.V,ol .... p�.� Miami Shores Village Building Department lOR1Up 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. V COPY OF QUALIFIER'S STATE LICENCES B. V1 COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF LIABILITY INSURANCE* D. ✓ COPY OF WORKERS COMPENSATIO INSURANCE* (Workers Compensation EXEMPTION must have NOTICE TO OWNER form and Contractor 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 form and Contractor 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: Control Your Life BUSINESS ADDRESS: 5062 N. Hiatus Rd CITY Sunrise STATE FL. Zip 33351 BUSINESS PHONE: 9( 54 ) 366-1181 FAX NUMBER(9 1 745-8764 CELL PHONE( QUALIFIER'S NAME: Frankie Blankenship QUALIFIER'S LIC NUMBER: ES12001063 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD (850)487-1395 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 BLANKENSHIP, FRANCES CONTROL YOUR LIFE, INC 5062 N. HIATUS ROAD SUNRISE FL 33351 Congratulations! With this license you become one of the nearly one million Floridians licensed by the Department of Business and ki 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. PROFESS! #1GULATION Every day we work to improve the way we do business in order to ES12001063 1108/2412014 x s serve you better. For information about our services,Please log onto - wrwv.myfloridelicome.com. There you can find more information CERT SPECT I A t3�Ts1'TR Y BLANKENSHI about our divisions and the regulations that impact you,subscribe 1 r to department newsletters and learn more about the Department's CONTROL YO B' initiatives. s CERTIFIED AS-.C _ x d Our mission at the Department is:License Efficiently,Regulate Fairly. LIMITED ENERGY? We constaniLy 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[ Expka+ia-dam AUG 31.2016 L140824 DETACH HERE RICK SCOTT,GOVERNOR KEN LAWSON,SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD ES12001063 The SPECIALTYELECTRICAL CONTRACTOR., Named below IS CERTIFIED w ` Under the provisions of Chapter 489 FS. Expiration date: AUG 31,2016x ASA LIMITED ENERGY SYSTEIS. CU�itST k BLANKENSHIP,FRANCES K� CONTROL YOUR`LIFEIN { 5062 N,-HIATUS O# r+ SUNRISE FL3m1 ' " ISSUED: 0624!2014 DISPLAY AS REQUIRED BY LAW SEQ# L1408240004600 Loc L BUSIN RE RECE' 'T' T PIKES : SeptemUv,r 3'Q 2016 BUSINESS NAI46: CONTROL YOUR LIFE LOCATION ADDRXSS5062 N HIATUS RD SU ISSUE DA'Z'E: A%yst 03,2015 EXPIRATION DATE. Stptambar 30,2016 : tAX'RECEI&T NUMZIto..w02 I I o I BUSINESS CLASS BUSINESS OFFICE CONTROL NUMIIEI�:. 0022380 BUSINESS TAS IAC 6a9,. PENAt;TY 360.15 o ao AIDITIONAI.CHARGES TOTAL 4%. rldttlonul Charges Breakdown............ ANNUAL FIRE kVSP'ECTION 21846000 X 1.00 218.46 00 TECHNOL6j sdy'F;L'E 5.00000 X 5.00 STORAGE WAREHOUSE<5000 .; :. 136.69000 X fXo 13,6.69 i CoCETORAGE WAREINQUSt OOR HOME THEA., ;Sc A iDY(i 'RECEIPT ,JBE CONSPICUbUgLY DISPLAYED TO I41BLIIr V EW. AT BUSINM LOCA IOM. NOTICE.;LCIS RECEIPT:SELO N[IL3 Sc VOID IF OWNERSIiIP,1�tI;.S 1VAtE,OR ADDRESS CHANGED. TAXPA"i;"API' 'Y TO BUSINF,SS x DTVIS OA1=alt TRANSFER.- ---------------- ------------ RANSFER. 3: Client#:24860 CONTRYOU ACORD,>, CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYl� 9/10/2015 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 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 endomement(s). PRODUCER REACT Carla Cypress Insurance Group PJR16EF,954 771-0300 ac N.): 954 772-9424 PO Box 9328 ADDRESS: carlaw@cypressinsumnce.com Fort Lauderdale,FL 33310-9328 INSURER(S)AFFORDING COVERAGE MAIC# 954 771-0300 INSURER A:Old Dominion Insurance Company 40231 INSURED INSURER B:Bridgefleld Employers Ins.Co. Control Your Life INSURERC: Custom Home Audio, Inc.dba INSURER D 5062 N Hiatus Road INSURER E Sunrise,FL 33351 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 CONTRACTOR 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. LTT Po TYPE OF INSURANCE INS SWU�B POLICY NUMBER M UMrrS A GENERAL LIABILITY MPG1204D 6/08/201505/08/201 -EACHOCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES EaEMaxur ernes $500 000 CLAIMS-MADE FXOCCUR MED EXP(Airy one person) $10 000 PERSONAL&ADV INJURY $1,000 000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $2,000,000 POLICY PCT LOC $ A AUTOMOBILE LIABILITY BI G1204D /08/2015 05/08/201 (Ea god ED entSINGLE LIMIT $I, AN ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS X NON-OWNED PROPERTY DAMAGE $ X HIRED AUTOS X AUTOS Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESSLI►B CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ B WORKERS COMPENSATION 83047750 D312512015 owistioia X I v611STATU- OTH- AND EMPLOYERS'LIABILITY OOFFICRO MEMBEREEXRCLUDERD?ECUTIVE� NIA E.L.EACH ACCIDENT $1,0w,000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1 000 000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Addhionai Remarks Schedule,H more space M requhed) License Number-ES12001063 Certificate Holder Is an additional Insured as respects to general liability when required by written contract subject to policy terms,conditions,and exclusions on work being performed on the above project. CERTIFICATE HOLDER CANCELLATION ANY OF THE ABOVE DESCRIBEDBEFORE Village of Miami Shores THEULD EXPIRATION DATE THEREOF, NO CEIEELLED WILL BE CDELIVERED N Bldg Dept. ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE 2nd Avenue Miami,FL 33138 AUTHORIZED R��EPR,,ESSENTATIVE 1�_. ©1908-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010105) 1 of 1 The ACORD name and logo are registered marks of ACORD #S209791/M205758 CAT