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EL-16-2328 (2) Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-265812 Permit Number: EL-8-16-2328 Scheduled Inspection Date: August 22,2016 Permit Type: Electrical - Residential Inspector: Devaney, Michael Inspection Type: R Owner: Del Mar,Village Work Classification: Repair Job Address:1200 NE 105 Street Miami Shores, FL 33138- Phone Number Parcel Number 1122320910001 Project: <NONE> Contractor: CUSI ELECTRICAL SOLUTIONS INC Phone: (786)390-4962 Building Department Comments SAFETY INSPECTION FOR FPL RECONECTION Infractio Passed comments INSPECTOR COMMENTS False � L Inspector Comments Passed Failed Correction Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. August 19,2016 For Inspections please call: (305)762-4949 Page 30 of 42 Miami Shores VillagePB �T"', a ed -Fiesid,00 10050 N.E.2nd Avenue NE �0� ' Gavotl Miami Shores,FL 33138-0000amb";� k s: Phone: (305)795-2204 �`...,:fir I fir 'APPAT Expiration: 1512017 Project Address Parcel Number Applicant 1200 NE 105 Street � 1122320910001 Village Del Mar a/o Regatt Manal Miami Shores, FL 33138- Block: Lot: Owner Information Address Phone Celt Village Del Mar c/o Regatt Management 1200 NE 105 Street MIAMI SHORES FL 33138 Contractor(s) Phone Cell Phone Valuation: $ 727.09 CUSI ELECTRICAL SOLUTIONS INC (786)390-4962 Total Sq Feet: p Type of Work:SAFETY INSPECTION FOR FPL RECONECTI Available Inspections: Additional Info:SAFETY INSPECTION FOR FPL RECONECTI Inspection Type: Classifioatinr.:Commercial Final Scanning:2 Review Electrical Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $0.60 Invoice# EL-8-16-61034 DBPR Fee $2'25 08/18/2016 Credit Card $50.00 $117.10 DCA Fee $2.25 Education Surcharge $0.20 08/19/2016 Credit Card $ 117.10 $0.00 Notary Fee $5.00 Permit Fee-Additions/Alterations $150.00 Scanning Fee $6.00 Technology Fee $0.80 Total: $167.10 In consir!erst;n of the issuance to me of this perm t, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plat s,drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting to s permit I assume responsiblliry for au �fork done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL,PLUMBING,MECHANICA_,WINDOWS,DOORS,ROOFING and S MMING POOL work. OWNERS AFFIDAVIT: I certify that all the foregoinc information is accurate and that a k will be done in compliance with all applicable laws regulating construction and zoning. Futhermore,I authorize the bove-named contractor to do the o stated. August 19, 2016 Authorized Signature:Owner / Applica It / C Date Building Department Cop I August 19, 2016 1 Miami Shores Village AUG A� ��16 Building Department 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 20i 4 BUILDING Master Permit No. ,L i6- 9-528 PERMIT APPLICATION Sub Permit No. ❑BUILDING Gg ELECTRIC ❑ ROOFING F-� REVISION ❑ EXTENSION RENEWAL PLUMBING F-J MECHANICAL PUBLIC WORKS F� CHANGE OF CANCELLATION 0 SHOP CONTRACTOR DRAWINGS JOB ADDRESS: I ZCI'o 1-3 rc City: Miami Shores County: Miami Dade F Zip° 3�l3 Folio/Parcel#: Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder)&-AkS-QL#§e- c�a� Phone#: Address: 11,1017� 1-p IL I=75 `3;�q CityState: zip: Tenant/Lessee Name: Phone#: Email: \3k-,60 CONTRACTOR::/Company Name: C✓) a6creLot-jrizws i/vi: Phonne#: � GT�® Address: b 5 •� l yll A. cr• -78E� `At-17D bbl --' City: ��LI 1! State: F4- Zip: 3 3 t'' t)7b. Qualifier Name: Zt S US' AlS -l CaI,® Phone#: n State Certification or Registration#: 62, 13 C(26 // Certificate of Competency#: 220 DESIGNER:Architect/Engineer: Phone#: 0/ L Address: / City: State Zip: bpd Value of Work for this Permit:$ 3( T 2-1 Square/Linear Footage of Work: Type of Work: ❑ Addition /�❑ Alteration ❑ New Repair/Replace ❑ Demolition Description of Work: SQ Oil u 11/1 C OQ`OU F;2t 60/_ /`eC�O fl eU iQ(j Specify color of color thru tile: ".J� A`c` �t7 �/ Submittal Fee$ Permit Fee$�, /® CCF$ ID ° EDO CO/CC$ Scanning Fee$ Radon Fee$ • �C-- DBPR$ - Notary$ Technolo gy Fee$ Training/Education Fee$_�" �® Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ I (Revised02/24/2014) 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. q / f Signature Signature PC�O Q y4--�!' OWNER o ENT CONT CTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of AVG V's-T 20 I So by 3rC� day ofC C i`�� 20 by ho is personally known to' i 'Sts S M `,C�lC�2�d,who is personally known to me or who has produced as me or who has produced ► L as identification and who did take an oath. identification and who did to an oath. NOTARY PUB NOTARY P ELIC: Sign: Sign: v Print: fI► �9�.� A ° �` Print: Seal: Seal: ���, ; ► " RAFAEL P AQUINO. � YiWADY PRILiO MY COMMISSION 0 FF991091 'f't MY COMMISSION#FF 2140.31 EXPIRES JuV OS,2020 0= EXPIRES:Match 25,2019 r*aara* � �rx+�st ► s�* s rs��ar** ****+rarsr�aa+r*rrsrwrr 3Y» ��� s**•*r*s►t�sr .can APPROVED BY -/ Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) gHoREs Gil l... ....� Miami shores Village Building Department �LORIDp' 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. _COPY 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: CU 51 &fc f C/i-4, Sot, 710AJS &C BUSINESS ADDRESS: ,j 5bj j qq A C7� CITY R lazwli STATES ZIPS BUSINESS PHONE: 3 l 0— �V Z FAX NUMBER�) CELL PHONE ( ) QUALIFIER'S NAME: QUALIFIER'S LIC NUMBER: K-C'1300 6 9 9 l 009892 Local Business Tax Receipt Miami-Dade County, State of Florida —THIS IS NOT ABILL—00 NOT PAY LBT 6637731 BUSINESS NAMEILOCATION RECEIPT NO. EXPIRE CUSI ELECTRICAL SOLUTIONSS INC RENEWAL SEPTEMBER30, 2017889 SW 149 CT 6908462 MIAMI FL 33194 Must be displayed at place of business Pursuant to County Code Chapter 8A—Art.9&10 OWNER SEC.TYPE OF BUSINESS CUSI ELECTRICAL SOLUTIONS INC 196 ELECTRICAL CONTRACTOR PAYMENT RECEIVED C/O JESUS SALCEDO l OE000122 BY TAX COLLECTOR Worker(s) 1 $75.00 07/19/2016 CHECK21-16-093289 This Local Business Tax Receipt only confirms payment of the Local Business Tax.The Receipt is not a license, permit,or a certification of the holder's qualifications,to do business. Holder must comply with any governmental or nongovernmental regulatory laws and requirements which apply to the business. The RECEIPT N0.above must be displayed on all commercial vehicles—Miami—Dade Code Sec Ba-276. For more information,visit www.miamidade aovRaxcollector MAIM P opon,st�muax top�a #y - AC40 O® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) ll..� 08/06/2016 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 endorsement(s). PRODUCER CONTACT NAME: Sonia TOrunO Florida City Insurance DBA Inter continental insur PHONE Ext: (786)601-2654 FAX.No): (786)601-2998 1485 NE 1st AVE Suite 103 D LESS: floddacityins@gmail.com INSURERS AFFORDING COVERAGE NAIL# Miami FL 33034 INSURER A: WESCO INSURANCE COMPANY INSURED INSURER B: NORMANDY INSURANCE COMPANY 29803 CUSI Electrical Solutions Inc INSURER C: 889 SW 149th Ct. INSURER D: INSURER E: Miami FL 33194 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 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. INSR ADDL SUBRI LTR TYPE OF INSURANCE D D POLICY NUMBER MM/DD EFF MM/LIDD EXP LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS MADE X OCCUR REMIGE RENTED PSES Ea occurrence $ 100,000 MED EXP(Any one person) $ 5,000 A WPP1055044 03 03/16/2016 03/16/2017 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY JECT F—]LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY Per accident $ AUTOS AUTOS ( ) HIRED AUTOS NON-OWNED PROPERTY DAMAGE AUTOS Per accident $ $ UMBRELLA LIAB OCCUR H OCCURRENCE $ EXCESS UA13 HCLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY Y/N STATUTE ER B ANY PROMEMBERIEXCLUERIE ECUTIVE a NIA NHFL0051532016 04/09/2016 04/09/2017 E.L.EACH ACCIDENT $ 100,000 (Mandatory In NH)If E.L.DISEASE-EA EMPLOYE $ 100,000 DESCRIPTION OF OPERATIONS below yes,describe under E.L.DISEASE-POLICY LIMB $ 500,000 D DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached H more space is required) ELECTRICAL WORK CONTRACTORS CUSI ELECTRICAL SOLUTIONS INC. LICENSE NUMBER EC13006891 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 ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE 2nd Avenue AUTHORIZED REPRESENTATIVE Miami Shores FL 33138 ©1988-2014 ACORD CORPORATION.All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD (850) 487-1395 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 SALCEDO,JESUS MISAEL CUSI ELECTRICAL SOLUTIONS INC. 889 SW 149TH CT MIAMI FL 33194 Congratulations! With this license you become one of the nearly one million Fborid!ans licensed by the Department of Business and Professional Regulation. Our professionals and businesses range STATE OF FLORIDA from architects to yacht brokers,from boxers to barbeque DEPARTMENT OF BUSINESS AND restaurants,and they keep Florida's economy strong. '` PROFESSIONAL EGULATION Every day we work to improve the way we do business in order EC13006891 IS SU D: 06/19/2016 to serve you better. For information about our services,please log onto www.myfloridallcense.com. There you can find more CERTIFIED ELECTRICAL CONTRACTOR information about our divisions and the regulations that impact SALCEDO,JESUS MtSAEL you,subscribe to department newsletters and learn more about CUSI ELECTRICAL SOLUTION;S INC. the Departments initiatives. I' ' Our mission at the Department is:License Efficiently,Regulate Fairly.We constantly strive to serve you better so that you can IS CERTIFIED under the provisions of Ch.489 FS. serve your customers. Thank you for doing business in Florida, Ex&ao1,date:AUG 31,2018 t16081=16V and congratulations on your new license! DETACH HERE RICK SCOTT,GOVERNOR KEN LAWSON,SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION o. ELECTRICAL CONTRACTORS LICENSING BOARD f, EC13006891 The ELECTRICAL CONTRACTOR ` Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31,2018 SALCEDO,JESUS MISAEL CUSI ELECTRICAL SOLUTIONS INC. 889 SW 149TH CT - MIAMI FL 33194 ❑ ■ __..__ nlnnl A%/ An MC/1I 11"1--r% nv 1 A%A+ cgnu 1 4GfKAAAM4CA7