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EL-13-1219 V ; Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores,FL Phone: (305)795.2204 Fax: (305)756-8972 Inspection Number: INSP-256960 Permit Number: EL-6-13-1219 Scheduled Inspection Date:April 15,2016 Permit Type: Electrical- Residential Inspector: Devaney,Michael Inspection Type: Final Owner. BUTLER,JACQUELINE Work Classification: Low Voltage Job Address:1461 NE 102 Street Miami Shores, FL 33138-2621 Phone Number Parcel Number 1132050240140 Project: <NONE> Contractor. FLORIDA CABLE NETWORK INC Phone: (305)274-3662 Building Department Comments LOW VOLTAGE WIRING FOR VOICE, DATA,AUDIO, Infractio Passed Comments CABLE AND CAMERAS INSPECTOR COMMENTS False Inspector Comments PassedEe --� Failed Correction ! i� Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid April 14,2016 For Inspections please call: (305)762-4949 Page 26 of 31 t t Miami Shores Village BuildingDepartment p JUN 0 3.2013 10050 N.E,2nd Avenue,Miami Shores,Florida 33138 • Tel. (305)795.2204 Fax:(305)756.8972 INSPECTION'S PHONE NUMBER:(303)762.4949 F13C 20 .. BUILDING Permit No. >✓I 10, PERMIT APPLICATION Master Permit No. -- 2-06P Permit Type: Electrical � O a � ^ JOB ADDRESS: /7� Oy City: Miami Shores County. Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated:Yes NO Flood Zone: OWNER:Name(Fee Simple TitleholderjaCk1 f (3 u fiL e- Phone#: Address: I Y�t Q G 102 ',A— SI City: KI awL "s ky&JF State: 4�,L— Zip: Tenant/Lessee Name: II__ Phone#: Email: vr_bV k 42 len Ca- CONTRACTOR:Company Name: RoguDAA Cps$( �Cl�d�� -°�L Phone#: 332S W 36��— Address: S CA) /'L)5; !�_ ^ 33 I City, Q to'I State: I"L Zip Qualifier Name: Q cJ l Q vl 2 it e Phonb#: cell State Certification or Registration#: e7S/ZO00 71 Certificate of Competency#: Contact Phone#: Email Address: Sew L (2 C u L,h 2—�- DESIGNER:Architect/Engineer. Phone#; Value-of Work for4his Permit: Square/Liner Footge of Wolk Type of Work: OAddress DAlteration Oew ORepair/Replace ),Demolition Description of Work: )__1 W 1jQ1tA_-_4,e W/462t, iir iJ,'d Submittal Fee$ Permit Fee CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Bond$ Notary$ Training/Education Fee$ Technology Fee$ Double Fee$ Structural Review$ TOTAL FEE NOW DUE$ 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 ELECTRICAL WORK,PLUMBING,SIGNS, WELLS,POOLS,FURNACES,BOILERS,HEATERS,TANKS and 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 t be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In a abs ce o h posted notice, the inspection will not be approved and a reinspection fee will be charged. k Signature Signature Owner or Agent Ar Contractor The foregoing instrument was owledged before me tbik The foregoing' ent was acka be rem this✓ day of ,20 (3 ,b day of��^� '3 ,20E3 ,by who is p nally kn wn to me or who9 It produced ho is onally known to me or who has produced ga. As identification and who did take identification and who did take oath. NOT P LIC: , . c,��``��F\��2o�5 NO ARY UBLIG 12%16' so Sign: oP & c %-% '•:�.i Mm r ' _ Ga+nm Csona Print: '% �° r�oo9 Print: tnsoQ'INa :, • .� ,cern L , My Co - sion Expires: :S;q,E My Co--- APPROVED o APPROVED BY � �/�l/ Plans Examiner Zoning Structural Review Clerk (Revised 3/12/2012)(ReWsed 07/10/07)(Revised 06/102009)(Revised 3/15/09) wwww Miami shores Village Building Department 'tOR> 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel:(305) 795.2204 Fax:(305)756.8972 CONTRACTORS' REGISTRATION FORM ALL CONTRACTORS MUST PROVIDE COPIES OF LICENCES AND INSURANCES EACH TIME A PERMIT IS SUBMITTED OR THE VILLAGE MAY MAINTAIN A FILE WITH YOUR INFORMATION FOR A$30.00 FEE PER YEAR. IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: A COPY OF QUALIFIER'S STATE UC CARD B. COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF LIABILITY INSURANCE(CERTIFICATE HOLDER TO BE MIAMI SHORES VILLAGE BLDG DEPT) D. COPY OF WORKERS COMPENSATION(EITHER CERTIFICATE OR EXCEMPTION) IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY: A COPY OF CERTIFICE OF COMPETENCY OF QUALIFIER B. COPY OF MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT C. COPY OF LIABILITY INSURACE(CERTIFICATE HOLDER MUST BE MIAMI SHORES VILLAGE BLDG DEPT) D. COPY OF WORKER COMA'INSURANCE(EITHER CERTIFICATE OR EXEMPTION) YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE HOLDER AS FOLLOW: MIAMI SHORES VILLAGE BLDG DEPT 90050 NE 2ND AVE MIAMI SHORES,FL 33938 ■■rrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrr COMPLETE CONTRACTOR'S INFORMATION BUSINESS NAME: �`L�O 2Ll� L-� 0-eTw 0 2 V4'( �U BUSINESS ADDRESS: 6�gS CITY (a STATE FL- ZIP CODE t �� BUSINESS PHONE: 3(0} 21 4`3(o ( -FAX NUMBER(305; } CELL PHONE Sai � 4nelll-dPZ QUALIFIER'S LIC NUMBER: S 1 Z 0 OO J E-MAIL ADDRESS(IF APPLICABLE): -5 Q j L q L UL`e Creed on MOM BY MLDV/RV 3&$M KDV JANIL STATE OF FLORIDA AC# 6 O S O%6 O j DEPARTMENT OF BUSINESS AND pRNER LICENSE CLASS E i PROFESSIONAL REGULATION ( a M553-782-65-342-0 ES 12 0 0 0717 06/26/12 118211560 I SAIL BEN[TO MENENDEZ 8785 SW"6TH CT LItAtlYM FL 33173-1388 CERT. SPECIALTY ELECTRICAL CONTR fl9-2� -1965 S":M MGT:6-01 MENENDEZ, SAUL BENITO 7 FLORIDA CABLE NETWORK INC 2-2013 CERTIFIED AS E LIMITED ENERGY SYSTEMS SPEC. � j I5 CERTIFIED under the provisions of ch.489 Fs i .Expiration date: AUG 31, 2014 L12062600994 opt aoa CCR Yo—V 5bbney t*V,.QL—d by law t' r AL BUSINESS TAX RECEIPT 2013 FIRST-CLASS Tp11- € `* RADE COU,M, Flf-STATE OF FLORIDA U.S.POSTAGE 140 W.FLAGLER ST. EXPIRES SEPT.30,2013 PAID 1st FLOOR IYf1�S7 NE`D1.SPLAyaD'A'FPLACE OF BUSINESS MIAMI,FL MIAMI w.,,;. CHAPTER 8A-ART.9&10 PERMIT NO.231 77, .z �r THIS IS NOT A BILL-DO NOT "' RENEWAL BUSINESS NAMMEE LOCATION 647089RECEIPT NO. 674003-0 / FLORIDA CABLE NETWORK INC STATE# ES12000717 6785 SW 105 CT 33173 UNIN DADE COUNTY OWNER FLORIDA CABLE NETWORK INC WORKER/S Sec.Type of Business 1 196 ELECTRICAL CONTRACTOR THIS IS ONLY A LOCAL BUSINESS TAX RECEIPT.IT DOES NOT PERMIT THE HOLDER TO VIOLATE ANY EXISTING REGULATORY OR pp NOT FORWARD ZONING LAWS OF THE COUNTY OR CITIES. NOR DOES IT EXEMPT THE HOLDER FROM ANY OTHER PERMIT OR LICENSE REQUIRED BY LAW.THIS IS FLORIDA CABLE NETWORK INC NOT A HOLDER'S UALlF OF SAUL B MENENDEZ PRES THE MOLDER'S QUAON OF nONS. 6785 SW 105 CT PAYMENT RECEIVED MIAMI FL 33173 MIAMI-DADE COUNTY TAX COLLECTOR: 10/01/2012 09010p324001 t( t t( !( 1 + ( t j { �z1 000082.50 i111it111it11Im...illliltllfil llil it lilillit It 1j"i''1�11 III SEE OTHER SIDE 06-21-2011 p8 JEFF ATWATER STATE OF FLORIDA CHIEF FINANCIAL OFFICER 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: 06/21/2011 EXPIRATION DATE: 06/20/2013 PERSON: MENENDEZ SAUL B FEIN: 650690583 BUSINESS NAME AND ADDRESS: FLORIDA CABLE NETWORK INC 6785 SW 105TH COURT MIAMI FL 33173 SCOPES OF BUSINESS OR TRADE: 1— LOW VOLTAGE 2— CERTIFIED SPECIALTY CONTRACTOR IMPORTANT. Pursuant to Chapter 440 . 051141, 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 ander this chapter. Pursuant to Chapter 440.06(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 440.051131, F.S., Notices of election to be exempt and certificates of election to be exempt shell be subject to revocation If, at any time after the filing of the notice or the issuance of the certificate, the person named an the notice or certificate no longer meets the requirements of this section for issuance of a certificate. The department shell revoke a certificate at any time for failure of the person named on the certificate to meet the requirements of this section. O.UESTIONS? (850) 413-160: DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01-11 CERTIFICATE OF LIABILITY INSURANCE 6I3d2013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AHO CONFERS NO MOM UPON THE CERTIFICATE 701 ER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THUS CEIMFX:ATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE !MING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT. N Ow certiflCate hoWer is an ADDITIONAL INSURED,the )nnlst be endorsmi V SUBROGATION IS WAIVED,subod to the tarns and condiUous of His poky,carlain policies my requirs an arderseinert A steleineat an this cerliftate does not confer rtgMs to tha csrtifk¢ala hokler In Hou of such eralorssment(sy PRAOUCERCONTACT MULTI LINES RISK UNDERWRITERS INC (305)598-1 11 rte.(305)598-7851 10250 SW 56th St #0202 Affinmlineaftellsouth. Miami., FL 33165 INUMINIM A"0010010 001KAM A;The Travelers Insuance Co. INSURED Florida Cable Network Inc. DaUlm B INSURER C: 6765 SN 105 Ct INSURER 0: Miami., FL 38173 INSURER E. F,- COVERAGES :COVERAGE, GEi' nFICATE NUMBER: REVISION NU ER, THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED WMED 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 INSCIRANCE 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 MW LTR TYPE OF INSURANCE POLICY L GENEM LIABILITY F OCCURRENCE S 14000,000 x C LIOLffY MEMISSS EA 100,000 X CLAM MADE Q OCCUR c+F.xP ft S10.000 A 519OLS160 11-9-1 ll-9-13.mRsDN&&AOvWuRY s 1 000 000 GENERAL AGGREGATE $ 1 000 000 GEWL AGGREGATE LIMIT APRs PER PRODUCTS.COMPIOP AGO $ 1,000,000 POLICY LOC $ AUTOMOBILE UASIL1TY 0007= a ANYAUTO BOMY ODURY(ft ) S ALL OWNED SCHEDULEDNOILY MIRY(Per ffi AUTos AUT HIO AUTOS AOD ffi s UMBRELLA Lw9 OCCUR EACH OCCURRENCE S EXCESS I" CTA! GATE ffi t O RETENTIONS S WORKERS COMPENSATION i AND ERS'LIABILITY via AWPUSAMIMOM W FROPRIISORWARTNEIVISSOWM kv on EL E EACH ACCIDENT ffi E-EAELOM ffi f 0 'OF OPERATIONS EL DAME-POLICY LUNT ffi DESCRIPTION OF OPERATION$d LOCATIONS 1 VEHICLES ACORO 101, #was is i t CERTIFICATE HOLDER CANCELLATION MIAMI SORES VILLAGE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE BUILDING DEFARTidB ' THE EXPIRATION DATE THEREOF. NOTICE WALL BE DELIVERED IN 10050 NL 2ND AVENUEACCORDANCE WITH THE POLICY OViSIONS. MIAMI SHORES, FL 33138 AUTHORIZED 0*1'RESENTATNE 0 ISM2010ACORD CORPORATION. ARVIIsmserved. ACORD25(2010M) The ACORO rairm and logo am mgbftmd nmft of ACORD FIRST-CLASS U.S.POSTAGE PAID MIAMI,FL PERMIT NO.231 ESS THIS IS NOT A BILL—DO NOT PAY RENEWAL BUSINNAME 64MNME/LOCATION RECEIPT NO. 674003-0 FLORIDA CABLE NETWORK INC STATE# ES12000717 6785 SW 105 CT 33173 UNIN DADE COUNTY OWNER FLORIDA CABLE NETWORK INC WORKER/S Sec.Type of BueGleea 1 196 ELECTRICAL CONTRACTOR THS Hi ONLY A LOCAL TAX RECEIPT.R DDEe NOT PERADT THE 0 =LATCCRY On zor'lm wws OF THE DO NOT FORWARD COUNTY OR CMUL MR DOM IT MMUPT THE HoLmm P@I9DT ANY OTHEROR M=MW.YLAw.T1USEi FLORIDA CABLE NETWORK INC OF THE a SAUL B MENENDEZ PRES TOM 6785 SW 105 CT pAVIIENTRECENED CWINTYTAX MIAMI FL 33173 jgjj� 10/01/2012 09010324001 � 000082.50 Isdl,„IIt„sIII*tel IIII&Is11i,tII>:I„11111IfIsII/,I,I�TI"eteI , SEE OTHER SIDE