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DEMO-15-2950 ZZ�7 Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-248303 PermitNumber: DEMO-11-15-2950 Scheduled Inspection Date: December 04,2015 Permit Type: Demolition Inspector. Devaney, Michael Inspection Type: Final Owner: GOSLIN,SIMON JAMES Work Classification: Electric Job Address:1155 NE 100 Street Miami Shores,FL Phone Number (305)766-9635 Parcel Number 1132050190331 Project <NONE> Contractor METRO ELECTRIC SERVICE,INC Phone: (305)945-1991 Building Department Comments ELECTRICAL DEMO Infractio Passed Comments INSPECTOR COMMENTS False Inspector Comments Passed Failed Correction Needed Re-Inspection Fee No Additional Inspections can be scheduled until re-Inspection fee is paid December 03,2015 For Inspections please call: (305)762.4949 Page 20 of 39 r Miami Shores Village Building Department NOV 2 3 2015 r 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 r <r Tel:(305)795-2204 Fax:(305)756-8972 b_a INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 20 Vi4 BUILDING Master Permit No.l�ho Is � PERMIT APPLICATION Sub Permit No. MID4 O I,!:-Qc ' ❑BUILDING (ELECTRIC ❑ ROOFING ❑ REVISION [ EXTENSION ❑RENEWAL PLUMBING [MECHANICAL [:]PUBLIC WORKS [ CHANGE OF CANCELLATION ❑ SHOP y �_. ,e�.�{�, CONTRACTOR DRAWINGS JOB ADDRESS:- I S Ibt� �O V 1�` 6pe-" City: Miami Shores County Miami Dade Zi o: I � rcet : Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type:` Flood Zone: BFE: FFE: OWE:Name(Fee Simple Titleholder): t-C `7G�`� Phony: g 9,cu A Tdress:_ WS5 Oa 100 v 4riv 1 S�nc�res state: Flo (I, QA ��,- � 331� Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name: LC C Phone#: .3d&CICT, l qcl t Address: City: 1 State (m Zip: 3 t Qualifier Name: TL Phone#:_� 7 /• �l State Certification or Registration#: 315 r-W3"Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: _State: Zip: Value oif Work fcr fiJ1fs-Pi $ 'fc"® Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace Q-15emolition Description of Work: Specify color of color thru tile: Submittal Fee$ Permit Fee$ /®'010 0 CCF$ CO/CC$ Scanning Fee$—!Q- Radon Fee$—2-rn '� DBPR$ 7P ` Notary$ Technology Fee$� _Training/Education Fee$ ?� Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$-G4 (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. 1 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$250,the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also,a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In thea:of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature Si OWNER or AGENT CONTRACTOR The fore oing instrument was acknowledged before m this The foregoing instrument was ac nowledged before me this da of y l y 6 Yt 61 .20� —.by day of 20 by 9 who is personally known to wh pe onally known to me or who has produced as me or who has produced as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY P BLI . c Sign: Sign, Print: jut Print: — �� Seal: �• ,�� r9,t,ryP�rh r SY-ier< MAY DRIGU Z Seal o, •,�� 2016 Commission B FF 211233 My Commission Expires fd r h 2 9 ############ APPROVED BY 2P !o "'Plans Examiner Zoning Structural Review Clerk iaevisedO2/24/20141 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL-CONTRACTORS LICENSING BOARD (850)487-1 395 1940 NORTH MONROE STREET TALLAHASSEE. •, 'FL 323WO783 HERNANDEZ,OMAR R METRO ELM TRIC SERVICE,INC. 3314 SW 123 AVE MIAMI FL 33175 Congrawledonst Wlth'tft cense you becom one of the noatly p rem R�IIrm oFbrkso ur by the DoWunem of Bu ss and fss in end from arc h teat to yacht bmkm,fmm boxers to bs �''' ".STATE OF FLORIDA and•they keep FlmWs etxercmy ' ' � 'DEP 01=BUSINESS AND Every day vie wo�c PROF taULATION sem You beer: For in R about ow ,ai r [; EC13005326. :t '�$ ' tog $42512014 wvwnr-n"Oridalicens8.cM. There you cm*W more ini on about our dhrisions and theregulailonth e at impact You, cast CERTIFIED AOR to departrnent newsletters end learn more about the Depart •$ • HEL�NAIYI� ,. . igitar4ves. ' �t >. .ME�•OE ELE' Our mission at the DOMMM t is:Uc wm Eifimntly,Reguh to Fairlyr We mmsw ly ShWe to smrvedug - Tt�nk �mer so Ya�can sen►e customers. you for doino business In Fkurds, YO1f j. °• _..• � ��;F' and congrWAOons on your now license[ ,l'�•CERTIFIED unifier th �ior(ejof Ch,4t#9 FS.- : I en&ft:ALK;al.2Mo - L1.9 2rq DETACH HERE RIC STATE OI?�L:QIIDA DEPARTMENT:OF RU.SI ESSAND PROFESSIONAL REGULATION : - LLECTIOCAL,Co. CTORS.LICENSING BO . ARG' , EC1 300b32r3 F WIT-TONAL_BUSINESS QUAL , . ON0 -TRICAL.0 i F) rittioe :. :et -IEAR60RNM Nq SE :MIAMI ' .. +:, ''�- ' '`;>• :A EN .; . City of North Miami 305-893-6511 Business Tax Receipt/Certificate of Use IF- Et ECIRICAL CONTRACTOR Issued Date: 10/01/15 Expiration Data: 09/30/16 Business Tax Receipt#: BT 001900 Business Name I Address; METRO ELECTRIC SERVICE INC 15050 NE 20 AVE.SUITE 111 METRO FI.FCTRIC SFRVICF INC NORTH MIAMI.FL 33181 21407 NE 18 AVE --AjC_hW A.Etienne.Esquire,City Clerk AVENTURA,I'l 33180 NON-TRANSFERABLE POST INA CONSPICUOUS PLACE NON-TRANSFERABLE ........... 000027 J Local, Buins Ta X R� + t Miami-Dade County, State of , Florida —THIS IS NOTA BILL bO NOT.PAY 173963 BUSINESS NAJMEjLOCAnON METRO ELECTRIC SERVICE INC RIN 0 11306r4 Moot bord go ayd"f" bu I 15050 NE 20 AVE Furg"rk to'County Cot1t NORTH MIAMI FL 33181 &'10 • SEC.TYPE OF E PAYMENT cit OWNER TolIV. METRO ELECTRIC SERVICE INC 196 ELECTRICAL CONTAAUO AY - 4 EC13005326 445.00 09/18/2015 Worker(s) 10 tCHECK=-15-163558 w0firms p",WA0f"LQ6I,Ba8Ia8Sj',FaL The ReceiOillsact il 1100ase jiguental This Local 8usiaess Triytt Receipt only 4CO ® CERTIFICATE OF LIABILITY INSURANCE %ftww-� g/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, 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 endomemen s. PRODUCER NCo' Patty Carlton Ext 306 BB Insurance Marketing Inc PHONE 954-452-4900 FAX 954-452-0450 10167 W Sunrise Blvd,3rd Floor IC N bbimi.com Plantation FL 33322 Patty@bbimi.com INSURE S AFFORDING COVERAGE MAIC# INSURERA:Florida Citrus&lndustries Fund INSURED METRO-2 INSURER B:Nautilus Insurance Company 17370 Metro Electric Service, Inc. INSURER C: 15050 NE 20TH Ave North Miami FL 33181 INSURER D: INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER:174313728 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. tR TYPE OF INSURANCE INS WVD POLICY NUMBER MMIDDI EFF POLICY EXP LTRLIMITS B X COMMERCIAL GENERAL LIABIL17Y NNS81981 9/7/2015 9!7/2018 EACH OCCURRENCE $1,000,000 CLAIMS-MADE 7X OCCUR DAMAGE T EN D PREMISES Eaoccunencs $100,000 MED EXP(Arty are person) $5,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 x POLICY❑JEa LOC PRODUCTS-COMP/OPAGG $2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED S1FZTffTTMT-- Ea accident $ ANY AUTO BODILY INJURY(Per person) $ AAL &NED AUTCHOESDULED UTBODILY INJURY(Per accident) $ J I — $ OOSS NON-OWNED PROPERTY 510VUE— HIREDAUTOS AUTOS Per accident $ UMBRELLA UAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ A WORKERS COMPENSATION 10851441 2/2/2015 2/2/2018 PER H- AND EMPLOYERS'LIABILITY Y/N X STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE NIA E.L.EACH ACCIDENT $1,000,000 OFFICERNEMBER EXCLUDED? (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/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,my be attached M more apace Is required) Electrical Contractor located at 15050 NE 20 Avenue,North Miami,FL 33181. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Miami Shores Village Hall ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE 2nd Avenue Miami Shores FL 33138 AUTHOR&MDREPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD e Ross 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. COPY OF LOCAL BUSINESS TAX RECEIPT C.�/ PY 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. BUSINESS NAME: Mt:V ib C �� c BUSINESS ADDRESS: (SbSD �4CITY-A&3—M4 STATE—F IP � BUSINESS PHONE: ; FAX NUMBER GST " CELL PHONE QUALIFIER'S NAME: VA� QUALIFIER'S LIC NUMBER: