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EL-15-3098 t Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores,FL /' Phone: (305)795-2204 Fax: (305)756.8972 Inspection Number: INSP-255426 Permit Number: EL-12-15-3098 Scheduled Inspection Date: March 24,2016 Permit Type: Electrical- Residential Inspector. Devaney, Michael Inspection Type: Final Owner. PERAGALLO, DINO S IRENE Work Classification: Alteration Job Address:55 NE 97 Street Miami Shores,FL 33138- Phone Number (305)995-5224 Parcel Number 1132060130990 Project: <NONE> Contractor: FUSE ELECTRICAL INC Phone: (305)970.4379 Building Department Comments KITCHEN RENOVATION Infractlo Passed Comments INSPECTOR COMMENTS False Inspector Comments Passed Eyf Failed 44 Correction Needed Re-Inspection Fee No Additional Inspections can be scheduled until re-Inspection fee is paid March 23,2016 For Inspections please call: (305)762-4949 Page 36 of 36 tg� Miami Shores Village GE l 10050 N.E.2nd Avenue NE �'z laa Miami Shores,FL 33138-0000 t Phone: (305)795-2204 Expiration: 06/2612016 Project Address Parcel Number Applicant 66 NE 97 Street 1132060130990 DINO&IRENE PERAGALLO Miami Shores, FL 33138- Block: Lot: Owner Information Address Phone Cell DINO&IRENE PERAGALLO 55 NE 97 Street (305)995-5224 MIAMI SHORES FL 33138- 55 NE 97 Street MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone $ 2,500.00 Valuation: FUSE ELECTRICAL INC (305)970-4379Total Sq Feet: 00 Type of Work:KITCHEN RENOVATION Available Inspections: Additional Info: Inspection Type: Classification:Residential Review Electrical Scanning:3 Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $1.80 Invoice# EL-12-15-58051 DBPR Fee $2.25 12/15/2015 Credit Card $50.00 $118.30 DCA Fee $2.25 Education Surcharge $0.60 12/29/2015 Credit Card $118.30 $0.00 Permit Fee-Additions/Alterations $150.00 Scanning Fee $9.00 Technology Fee $2.40 Total: $168.30 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. �-- ,,-- December 29,2015 Authorized Signature:Owner / Applica / Contractor / Agent Date Building Department Copy December 29,2015 1 Miami Shores Village C�ri 1��D Building Department DEC 2015 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 BY: Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION UNE PHONE NUMBER:(305)762-4949 FBC 20 BUILDING Master Permit No. PERMIT APPLICATION Sub Permit No4" AC-- [:]BUILDING —❑BUILDING �LECTRIC ❑ ROOFING REVISION ❑EXTENSION RENEWAL r-jPLUMBING E] MECHANICAL MPUBLIC WORKS M CHANGE OF []CANCELLATION SHOP CONTRACTOR DRAWINGS JOB ADDRESS. City Miami Shores County: Miami Dade Zio: 331 Folio/Parcel#: 3 13 q d Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): j A k 'ICGlo NC (_6"6&UPhone#: 7v(- .23q— ;Y92- Address: S 5 q I- S 7 City:_M m IS Otto State: � Zip: 3 Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name: Fuse Electric, Inc. Phone#: 305-970-4379 Address: 4950 Sarazen Dr. City. Hollywood State: FL Zip: 33021 Qualifier Name: Laron Gozlan Phone#: 305-970-4379 State Certification or Registration#: EC 13005070 Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit$ _Q�S 0 0 Square/Linear Footage of Work: Type of Work: ❑ Addition [1] Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of work: (-r `2�N6w", Specify color of color thru tile: Submittal Fee$ S�60 Permit Fee$ is m�®� CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ zo (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 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$2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment Also,a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. �( Signature Signature J� O R or AGENT O CTO The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of 20 by a( day of 4e c- 20 15 ,by v 11, w� � �,1-ko Liron GOzlan ,who is personally known to me or who has produced as me or who has produced as identification and who did take an oath. identification and �• YERRr NOTARY P UC: ��+� NOTARY PUBLIC: .; '.1 KO�/ ��i g: ;.�, MY COMM275 �.•`.�P��...«.�kOA�� EXiM S16 Si :, '••�'0- 5-� D'• i Sign daN Print: -+ m P nt• Seal: 7 '•su' `e<�� • Z� Sea APPROVED BY1.-�Vc 4$—Plans Examiner Zoning Structural Review Clerk (Rev1sed02/24/2014) ever 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. COPY OF QUALIFIER'S STATE LICENCES B. V'COPY OF LOCAL BUSINESS TAX RECEIPT C. ��Y OF LIABILITY INSURANCE* D. COPY OF WORKERS COMPENSATION 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. ■rrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrr BUSINESS NAME: cJS-t' Gt/ec lr l t ., BUSINESS ADDRESS: Sow-ki-ewi U" CITY ��TATE Fi-- ZIP 3 BUSINESS PHONE: f 3,5- ) Q'7 p Lf 1-�j FAX NUMBER( T9q *A 3�--,?-4 2 9 CELL PHONE(�- 0-?v13-71 QUALIFIER'S NAME: Like-4 6;z/&,n QUALIFIER'S LIC NUMBER: 5C-" ( 3 O-C� -'>o 310 ' STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD (850)487-1395 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 GOZLAN, LIRON FUSE ELECTRIC INC. 4950 SARAZEN DR HOLLYWOOD FL 33021 Congratulations! With this license you become one of the nary 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,frau boxers to berbeque restaurants. DEPARTM OE:BUSINESS AND and they keep Florida's economy strong. PROFE . �x �,I�L�f ULATION Every day we worts to improve the way we do business in order to EC13005070^? � , j*Upl, g6/22/2014 serve you better. For information about our services,please log onto w .my0oridalic�nsecrom. There you can fab more information CERTIFIED EL F��CR ww about our divisions and the regulations that impact you,subscribe ; GOZLAN,LIR to department newsletters and team more about the Departrnenrs y FUSE EL.E 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 Gh.469 FS. and congratulations on your new license! t E ► i►iaai note rises 1 DETACH HERE RICK SCOTT,GOVERNOR KEN LAWSON,SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD EC13005070 The ELECTRICAL CONTRACTOR { Narned below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31,2016 m GO LIRON ., .,�.. .r =, • FUS ECTRIC.A4C ''`" q 4950 SARAZI DI'; HOLLYAWJO.-.d' wwwaw. t - ISSUED: 05=014 DISPLAY AS REQUIRED BY LAW SEQ# u40=00015N BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT 115 S.Andrews Ave., Rm.A-100. Ft. Lauderdale, FL 33301-1895—954831-4000 VAUD OCTOBER 1,2015 THROUGH SEPTEMBER 30,2016 DBA: Receipt#;181-250155 Business Name'FUSE ELECTRIC INC Business Type:(ELECTRICALL COACTORRACT NTR Owner Name:LIRON GOZLAN Business Opened:08/01/2012 Business Location:4950 SARAZEN DR State/County/Cert/Reg•EC13005070 HOLLYWOOD - Exemption Code: Business Pirrone:305-970-4379 Rooms Seats Employees OaChines Professionals ! i 1 I Only For Ve�►g B�b�eeB Number of Machines: Vending Type: Tax Amm" Transfer Fee NSF Fee Pana(ty Prior Years Calm Cost Tommi Pao 27.00 0.00 0.00 1 0.00 1 0.00 1 0.00 27.00 II,� ,i 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 andfor Municipality planning VWiEN VALIDATED and zoning requirements.This Business Tax Receipt must be transferred when the business is sold, business name has did 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 taws and regulations. Mailing Address: FUSE ELECTRIC INC Receipt l#OSA--14-00009467 4950 SARAZEN DR Paid 09/29/2015 27.00 HOLLYWOOD, FL 33021 2015 - 2016 7 DATE(MMIDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 8/3/2015 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* B the certlHcate holder is an ADDITIONAL INSURED, the pollcp(les) must be endorsed. B SUBROGATION IS WAIVED, subject to the terms and conditions of the polity,certain policies map mgWm an endorsement A statement on this certificate does not confer rights to the certificate holler in Neu of such en s. PRODUCER JONA SOUTH FLORIDA CASUALTY PHONEjoig p2 E4 561 533-6144 (561)533-6170 415 North 4th Street W,&SB.z1a1.neLdsZc1ns.net Lantana, FL 33462 aro eOVEeae;<E Naea WeSCO Insurance Company 25011 INSURED FuSe Electric Inc. INSURER B:Technology Insurance Company 4 4950 Sarazen Dr. jNSURFRC- Hollywood, FL 33021 INSURER : 305-970-4379 COVERAGF,S CERTIFICATE NUMBER REVIS NUMBER THIS IS TO CERTIFY THAT THE PEES OF INSURANCE LISTED BELAY 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 SY THE POLICIES DESCRIBED HEREIN 6 SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITION OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCE LIMITS GENERAL LIABILITY EACH OCCURREN E $ 1 OOO 000 COMMERCIALGENERALLIABILITY 100,000 CLAIMS-MADE E)OCCUR MED EV 5,000 A WPP1067001-03 8/2/15 /2/16 PERSONAL&ADV INJURY 1,000,000 GENERAL AGGREGATE 2,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: PRODUCTS-COMAPPAGG 2 000 000 X PWCYPRO- M LOCIWIT $ AUTOMOBILE LIABILITY drlerd) NGLELIMIT ANYAUTO BODILY INJURY(Per parem) $ �� ED SCHEDULED BODILY INJURY(Peracddent) $ HIRED AUTOS AUTOS NON-OWNED $ AUTOS UMBRELLA L.IABOCCUR EACH OCCURRENCE $ EXCESS LIAB HCLAIMS-MADE AGGREGATE $ WORKERS COMPENSATIONAND EMPLOYERS'LIABILITY ANY PROPRIEToRlPARTNER&xEcunvE � MC3492334 7/8/15 /8/16 E.LEACH ACCIDENT '000,000 B OFFICERtAAE1MBER EXCLUDED? NIA in NIq EL DISEASE-EA EMPLOYEE Ir "" 1,000,00 DESCRIPTION OF OPERATIO NS ILOCATIONSS/VEHICLES~ACMD 1(",AdftMW Renes Sdmdle.H awe apace is re Electrical Contractor Miami Shores Village Building De arttaant SHOULD ANY OF THE ABOVE DESCRIBED FOLIAGA ES BE CANCELLED FORE g P THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 10050 NE 2nd Ave ACCORDANCE WITH THE POLICY PROVISIONS. Miami Shores, FL 33138 AUTHORIZED REPRESENTA ®1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010105) The ACORD narne and logo are registered marks of ACORD