ELC-11-1241Miami Shores Village
Building Department
10050 N.E.2nd Avenue. Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949
BUILDING Permit No. +C/ i2-4)
PERMIT APPLICATION Master Permit No.
FBC 20
Permit Type: Electrical 11
OWNER: Name (Fee Simple Titleholder): ' U VQ4.vy\ y Phone#: 30S-0— 305D
Address: ti? G ���p� : 1
City: M -..,m :fvw t+S State: 9., Zip: S°16(
Tenant/Lessee Name: g, IZIY-T" Phone#: 30'15tlri' D
Email: 10 eAultAS G \- \OAxc .
JOB ADDRESS:
City:
Folio/Parcel #:
Miami Shores
V \ 56cbb'O
County: Miami Dade
Zip: 33' /
Is the Building Historically Designated: Yes NO
Flood Zone:
� r
CONTRACTOR: Company Name: . 517,7/2 4'24 if, °,44,4 e'.� ,fit i Phone #:
Address: ///'02 ivc 7',: de
City: /.' 41%1- t %C State: ,/ -e /e. p: .333'
Phone #: 3
Certificate of Competency #:
Qualifier Name: 4_1/ vi;4/7.'
State Certification or Registration #: C-4°. /34'4' '11 i
Contact Phone#: �� / "9 ` :5- Email Address:
DESIGNER: Architect/Engineer: Phone#:
Value of Work for this Permit: $ xi 300,-00 Square/Linear Footage of Work:
Type of Work: CI Address UAlteration iew Z1Repair/Replace Demolition
Description of Work: 4r:.l
»* n**** * * *e * * *** * ****** *** ***,r *ro **0,0 +ea Fees**** ** ** *********** *** * **e ** * *** **** * ** ****
Submittal Fee $ Permit Fee $ /1-1;14' CCF $ CO /CC $
Scanning Fee $ Radon Fee $ DB1'R $ Bond $
Notary $ Training/Education Fee $ Technology Fee $
Double Fee $ Structural Review 5
TOTAL FEE NOW DUE $11(075V
Bonding Company's Name of 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: l 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 he approved and a reinspection fee will be charged.
Signature
Owner or Agent
The f. _o'' g instrument was ac owl ged be re this ` The foregoing instrument was acknowledged bef me thisS
day o r 1 , 20 11 . by i �� 1. �, day of '� 201 1 , by ' & `1 1 r—,
who is personal : known to r who has produced who is nall own to me or who has produced
Contractor
As identification and who did take an oath.
NOTA ' PUBLIC: •
Sign:
Print:
My Commission Expires:
wF 'ti. r ='.,
mss'
Revised (37,10,1)7Hkevised 06/111/2009A Revised 3115/19)
as identificatildtthw
NOTARY PUBLI
Plans Examiner
Structural Review
1 ,
111
�
y,ry� - r `bi oluDA
,
• Brooke Turpin
Commission # DD795528
JUNE 08, 2012
ATLANTIC BONDING CO., INC.
%woo
BONDED
Sign:
Print:,` �rp`Il� 1 d ar-p 'Th
My Commission Expires: g t 2 412,
Zoning
Clerk
Mr U 1 T LWMI_ nC -K - Iarek1
115 S. Andrews Ave.. Rm. A•100. Ft. Lauderdale, FL 33301-1895 — 954-831-4000
VALID OCTOBER 1, 2010 THROUGH SEPTEMBER 30, 2011
DOA:
Business SH.;vts 9 CATE ELECTRIC OF
Owner WORM .34LVA R ErAUSER
Business Location: 1112 N FLEER DR
ST LAUDERDALE
Business Phone: 954-565-1:53
Rooms
Seats
Resew # :1s: -zbELI fra
toatDA Business Type: �17 C /cotaT
dET�[RICk7NT7
stye
Business Opened:09 / 02 / 2 0 o s
StatelCountyiCertlReg:EC13 0012 01
Exemption Code:NONEXEMPT
tblactdnes Prefessionats
For Ven4fig Etuetness Cady
Vendinu 7ttue:
Tax Armed
Transfer Fee
- NSF Fes
Penny
Frier Yeas 1 won Cast
Total Paid
37.00
n.Cn
it. 00 .
0.30
2. U C.00
27.C3
THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS
THIS BECOMES A TAX RECEIPT This tax is levied for trig prietege of cluing business vitierdn Browmrd County and is
non - regulatory in nature. You must meet ail County andax Municipality planning
WHEN VALIDATED and zoning requirements. This mss Tax Receipt must be transferred when
Ma business is sold, business name has charged or you have moved the
business location. Tais receipt does not 'Wheats that the business is legal or that
it is in consonance with State or local laws and regulations.
Mailing :
&r._Ve TORE HAUSER
1112 N ='LAGLER DR
?OW? LAUDERDALE, FL 33304
2010 - 2011
Receipt #03A- 09.00020495
Paid 08/19/2010 27.00
STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
ELECTRICAL CONTRACTORS LICENSING BOARD (850) 487-1395
1940 NORTE MONROE STREET
TALLAHASSEE FL 32399 -0783
HAUSER, SALVATORE ANTHONY
SUNSHINE STATE ELECTRIC OF FLORIDA INC
1112 N FLAMER DRIVE
FORT LAUDERDALE FL 33304
Commits latimmi With this license you become one of the nearly ate million
Flak d by the Department of Business and Professional Regulation.
Our professionals and businesses range from architects to yacht brokers, from
bas to barbecue restaurants, and they keep Florida's economy strong.
Every day we work to improve the way wa do business in order to serve you batter.
For infcanstecn about our seavlase. please lag onto wwrar ense.cam.
Them you can find mane irdcrtrattion about our crwislons and the ovulations shad
impact you s subscribe to d ust newsletters and l Hoare about the
Our mission at the Depaartrnent le; Licensee Efficiently, Regulate Fairly. We
constantly skive to ewre you hatter so that you can sea your custanwes.
Thank you for doing bualness in Florida, and congrabastions on your new lame!
DETACH HERE
ACORD.
Client#: 20109 SUNSHSTA
CERTIFICATE OF LIABILITY INSURANCE
DATE
6/15/2011
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 poltcy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to
the terms and conditions of the policy, certain policies may rewire an endorsement. A statement on this certificate does not confer rights Witte
certificate holder in lieu of such endorsement(s).
PRODUCER
Cypress Insurance Group BO-CL
P.O. Drawer 9328
Fort Lauderdale, FL 33310-9328
954 771-0300
miSURED
Sunshine State Electric of Fl. Inc.
1112 N. Flagler Drive
Fort Lauderdale, FL 33304 -2130
COVERAGES
•
ACT Joyce Simpson
mg,L Eur 954 771 -0300 1 f , 954 772 9424
targas_JoYceS@CypressInsumrice.com
INSURER(S) AFFORDING COVERAGE
NSURER A : FCCI Insurance Group Inc.
mum a : Associated Industries Ins.Compa
INSURER C
INSURER 0:
DORMER E
INSURER F :
r11., r,.ww IYYNWpGrl.
THIS IS TO CERTIFY THAT THE POUCIES OF INSURANCE USTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDrrIONOF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POUCIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS.
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
LTR INSR
TYPE OF INSURANCE
DLSUBA
POLICY NWSER
(M65tJ)
LIMITS
A
GEVERALLIABIUTY
GL00096182
12115(2010.12(1 011
EACH OCCURRENCE
$1,�,_
X COMMERCIAL GENERAL LIABILITY
PFIEMISES (E aocya rrence)
$10Da000
�� CLAIMS -MADE 1 XI OCCUR
MMEDEXP(My ono person) S5
XI PD Ded: 500
PERSONAL 8 ADV INJURY
$1,000,000
--
GENERAL AGGREGATE
$ 000,000
_OEM- AGGREGATE LIMIT APPUES PER:
PRODUCTS - COMP/OP AGG
$2,000,000
oLICY : JERCTT
I L:.00
$
'-
A AUTOMOBILE LIABILITY
CA00149472
12!15/2010
12/15/2011
COMBINED SINGLE NGLE LIMIT 51Amino
A' ANY TO
BODILY INJIdtY (Per person)
$
ALL OWNED SCHEDULED
BODILY INJURY (Per =Melt
$
AUTOS AJTIGS
' H$iEDAUTOS * AUTOS ED
P DAMAGE
$
X Drive Oth Cur
$
A x. UM+SEU a LUAB
OCCUR
UM60�9312
12!15(2010,12/15 /2011
EACH OCCURRENCE
51,000,000
1 EXCESS LAB
, CLAIMS -MADE
AGGREGATE
$1 000,000
DEO X RETENTION $10 000
$
8 I
WORKERS 'SATIN
AND EMPLOYERS' LIABILITY Y! N
AWC1006293
01 /05/2011
01/05/201
X Trn_avTL Rc 1 ' �f
_
E.L. EACH ACCIDENT
$1,000,
ANY PROPRIETOR/PARTNER/EXECUTIVE—
OFHCEP/MEMBER EXCLUDED? N N /A
dirtory IbeIn N
1 yes
E.L DISEASE - EA EMPLOYEE
51,0,000
i DESCRiPTtON OF OPERATIONS noror.
E.L DISEASE - POLICY LIMIT j
$1,000,000
1
I
DESCRIPTION OF OPERATIONS / LA:warmS / venom (Attach ACCORD 101. Additional Remarks Schedule. I more apace Is required)
Workers Compensation applies to Florida operations and employees only.
CANCELLATION
Miami Shores Village Building
Department
10050 NE 2nd Ave.
Miami Shores, FL 33138
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POUCV PROVISIONS.
AUTHORIZED REPRESENTATIVE
arise-
Si) 1988 -2010 ACORD CORPORATION. All rights reserved.
ACORD 25 (2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD
#S116591/M116307 JS
moo -I
91 I 1--2-450
STATE OF � PERMIT 6' 9 3-SG1 298993 D AR �� D�M Mlsml -Dade County Health Dereftillitm FI826645
OM= SEWAGE TP.EATMLIM m aESI AIMMI Pr gare
LL
CONSTRUCTION 113SPIRC1e2ON AND PickTAL OVAL DATE pASD:02/02/2011
CO��►''AF&7.xCATrpN .:A P992376
APPLIOANT: Magile BaroU4t
200.00
- -}- -1T 11=13 -PID- 1680034
=TM A rtcan PlUtrtbiro
non= =MS: 50 NW 108 St Miami, FL 33188
LOT: f
SUBDIVISION:
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3141: _ 1•x738-011 -0139
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DEP= DP COVKR
ELEVATION [ A50v1 /
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(293 PRIVATE DELL0
[303 3144C 'SLLS
1313 IRRIGATION WELLS
[323 POTABLE WATER
(333 BUILDING FOONDATIt7NS
(34] 9itasffi S% =NES
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(413 STOR m ATNA MOST
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(433 DANCE AGREEMENT
144 ] »UXIMIKG AREA
[45] LOCATIDN coNaDAME WITS gx2$ PLAN'
1463 rum MR GRADENO
[471 CONTRACTOR A Aaron S.Roo1 (A Aaron S
(493 mniat _ ADS ARC 24
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CONSTROCITON (11=G1 / DIBAPP OTED 1: Dada TED
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ran: 02/10/2011
TED DATE: 02/10/2011
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