EL-16-419Project Address
1285 NE 95 Street
Miami Shores, FL
Miami Shores Village
10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138-0000
Phone: (305)795-2204
Owner Information
Permit Type: EIectrlca �S C3,ttti
Wo * Glas if ataon Low Ve It lg
Pemrit'Stattt VE
Address
Parcel Number
1132060144020
Block: Lot:
APPI'
Expiration: 0 1201201
Applicant
ROBERT AND NANCY FREHLINI
Phone
CeII
ROBERT AND NANCY FREHLING
421 E SAN MARINO Drive
MIAMI BEACH FL 33139-
421 E SAN MARINO Drive
MIAMI BEACH FL 33139-
Contractor(s)
HT -INSTALL, INC
Phone CeII Phone
(561)305-8141 (561)526-6421
Valuation:
Total Sq Feet:
Type of Work: LOW VOLTAGE WIRING FOR CABLE TV, TE
Additional Info:
Classification: Residential
Scanning: 2
Fees Due
CCF
DBPR Fee
DCA Fee
Education Surcharge
Permit Fee - Additions/Alterations
Scanning Fee
Technology Fee
Total:
Amount
$2.40
$2.25
$2.25
$0.80
$150.00
$6.00
$3.20
$166.90
Pay Date Pay Type
Invoice # EL -2-16-58698
02/16/2016 Cash
02/22/2016 Credit Card
Amt Paid Amt Due
$ 50.00 $ 116.90
$ 116.90 $ 0.00
$ 3,500.00
0
Available Inspections:
Inspection Type:
Review Electrical
1
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 c• r or + do the work stated.
February 22, 2016
Authorized Signature: Owner / Applicant / •ntrar / Agent
Building Department Copy
Date
February 22, 2016 1
orkv,
(-1\s‘
BUILDING
PERMIT APPLICATION
❑BUILDING 0 ELECTRIC
❑PLUMBING ❑ MECHANICAL
JOB ADDRESS: 1285 NE 95th St
City: Miami Shores
Folio/Parcel#:1132060144020
Occupancy Type: Residen Load:
Miami snores wage
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
TSI: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 7624949
FEB k 20%
. ": ®®r/1/7 •-`
FBC20n
Master Permit No. RC -3-14-564
Sub Permit No.
❑ ROOFING ❑ REVISION ❑ EXTENSION El RENEWAL
❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR
DRAWINGS
County:
Miami Dade
zip: 33i
Is the Building Historically Designated: Yes NO X
Construction Type: • Flood Zone:
OWNER: Name (Fee Simple Titleholder): Robert and Nancy Frehling
Address: 1292 NE 95th St
BFE: FFE:
Phone#: 305-742-3448
City: Miami Shores State: FL zip: 33138
lelldl I iilebbee rYdIIIe.
r'iwneii.
Email:
CONTRACTOR: Company Name: HT -Install, Inc
Address: 5272 Tennis Ln
Phone#: 561-305-8141
city: Delray Beach State: Florida
Qualifier Name: Carl Becker
zip: 33484
Phone#: 954-415-4215
State Certification or Registration #: ESI2000249 Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
35004006
Value of Work for this Permit: $ Square/Unear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration 0 New ❑ Repair/Replace ❑ Demolition
Description of Work: Low voltage wiring for Cable TV, Telephones, and Internet
Specify color of color thru tile:
.71,4IOIIId/ Fee $ c' , CV Per .•• t• fCC $ [r0/O® CCP i , €. cV/ woo CcI.c
Scanning Fee $ Radon Fee $ a...,...... DBPR $ . a J Notary $
----tTechnology Fee $ Training/Education Fee $ Double Fee $ 9
Structural Reviews $ Bond $ 1 Apd�®�
___w. _r_ .."u.... ./ .' 1 R G 0 �� Off'
. V.PU. rV'..IVI. 1.0/11..0BBB
(aevlsed02/24/2014)
isonaing company s ivame (if applicable)
Bonding Company's Address
City State Zip
Mortgage Lender's Name (if applicable)
iviortgage Lender's Address
City State Zip
Application is hereby made to obtain a permit to do the work and
commenced prior to the issuance of a permit and that all work
construction in this jurisdiction. , understand that a separate p
FURNACES, BOILERS, HEATERS, TANKS, AIR CONDITIONERS, ETC.....
Installations as indicated. I certify that no work or Installation has
will be performed to meet the standards of all laws regulating
ermit must be secured for tLtL rut.., rwnriiiiivti, Sit;i4S, POOLS,
OWNER'S AFFIDAVIT: I certify that all the foregoing information
applicable laws regulating construction and zoning.
is accurate and that all work will be done in compliance with all
"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."
Nonce to Applicant: Asa conwnon to the issuance of a building permit with an estimated value exceeding )LSU(1, 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 wijh of be approved and a reinspection fee will be charged.
Signature
OWNER or GENT
The foregoing instrument was acknowledged before me this
40_ day of f
enti ,wiwis
, 20 (�
Signature
CONTRACTOR
The foregoing instrument was acknowledged before me this
by �` day of � , 20 `D , by
uwn iu
me or who has produced
identification an who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal:
APPROVED BY
(Revisedo2/24/2014)
CARLOS SANABRIA
Commission # FF 37673
My Commission Expires
July 18, 2017
i
CARL. p c. et\ , wiiu is WI sui,i y itnuwit iu
as me or who has produced F L 0 L a )60 11G S l 0 I as
Identification and who did take an oath.
NOTARY PUBLIC:
Sign. . a_
Print:
Seal:
/I / '/sem Plans Examiner
Structural Review
Is'IYP°4b PHYLLIS A. BEDERKA
MY COMMISSION # FF204192
fie° ...EXPIRES: Feb3'ETYit.a�Ql9.
Zoning
Clerk
•
STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
ELECTRICAL CONTRACTORS LICENSING BOARD (850) 487-1395
1940 NORTH MONROE STREET
TALLAHASSEE FL 32399-0783
BECKER, CARL R
HI -INSTALL, INC.
1239 SE 13TH AVENUE
DEERFIELD BEACH FL 33441
Congratulations! With this license you become one of the nearly
one million Floridians licensed by the Department of Business and
Professional Regulation. Our professionals and businesses range
from architects to yacht brokers, from boxers to barbeque restaurants,
and they keep Florida's economy strong.
Every day we work to improve the way we do business in order to
serve you better. For information about our services, please log onto
www.myfloridalicense.com. There you can find more information
about our divisions and the regulations that impact you, subscribe
to department newsletters and learn more about the Departments
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,
and congratulations on your new license!
DETACH HERE
RICK SCOTT, GOVERNOR
STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND
PROFESSIONAL REGULATION
ES12000249 ISSUED: 09/25/2014
CERT. SPECIALTY ELECTRICAL CONTR
BECKER, CARL R
HI -INSTALL, INC.
CERTIFIED AS:
LIMITED ENERGY SYSTEMS SPEC.
IS CERTIFIED under the provlslons or Ch 489 FS.
Expvation date AUG 31. 2016 L1409250005495
KEN LAWSON, SECRETARY
STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
ELECTRICAL CONTRACTORS LICENSING BOARD
LICENSE NUMBER
ES12000249
The SPECIALTY ELECTRICAL CONTRACTOR
Named below IS CERTIFIED
Under the provisions of Chapter 489 FS.
Expiration date: AUG 31, 2016
AS A LIMITED ENERGY SYSTEMS SPECIALIST
BECKER, CARL R
HI -INSTALL, INC.
5272 TENNIS LN
DELRAY BEACH FL 33484
Alco/ AV AC t:mni IIPPrl RV 1 AW
SFO # L1409250005495
ANNE M. GANNON
CONSTITUTIONAL TAX COLLECTOR
Serving Paint Beach County
Serving you.
P.O. Box 3353. West Palm Beach, FL 33402-3353
www.pbctax.com Tel: (561) 355-2264
"LOCATED AT"
5272 TENNIS LN
DELRAY BEACH, FL 33484
TYPE OF BUSINESS
OWNER
CERTIFICATION #
RECEIPT #!DATE PAID
AMT PAID
BILL #
81-0379 ELECTRONICS INSTALLATION
HT INSTALL INC
B16 4697 - 10/21/15
$36.30
640187828
This document is valid only when receipted by the Tax Collector's Office.
B3-196
HT INSTALL INC
HT INSTALL INC
5272 TENNIS LN
DELRAY BEACH, FL 33484
IsIIIs,II''Iu,IIulI'uI,'I
STATE OF FLORIDA
PALM BEACH COUNTY
2015/2016 LOCAL BUSINESS TAX RECEIPT
LBTR Number: 201475936
EXPIRES: SEPTEMBER 30, 2016
This receipt grants the privilege of engaging in or
managing any business profession or occupation
within its jurisdiction and MUST be conspicuously
displayed at the place of business and in such a
manner as to be open to the view of the public.
HTINS-1
OP ID: AJC
ACORD
`� CERTIFICATE OF LIABILITY INSURANCE
DATE (MM/DD/YYYY)
0212/2016
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 thls certificate does not confer rights to the
certificate holder In lieu of such endorsement(s).
PRODUCER
Royal Palm Insurance Advisors
1515 S Federal Hwy, Suite 213
Boca Raton, FL 33432
Alyssa Carlin
CONTANAME: CT Alyssa Carlin
PHONE561 FAX
-935-9450
(A/C, No,_ EA): (A/c, No): 561-935-9451
E-MAIL ssa al ro al almins.com
ADDRESS: Y Y P
INSURER(S) AFFORDING COVERAGE
NAIC #
INSURER A:SCottSdale Insurance Co
41297
INSURED HT -Install, Inc.
License: ES12000249
5272 Tennis Lane
Delray Beach, FL 33484
INSURER B : Associated Industries Ins Comp
23140
INSURER C :
01/11/2017
INSURER D :
$ 1,000,000
INSURER E :
$ 100,000
INSURER F :
ER:
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.
ILICY
LjR
TYPE OF INSURANCE
ADDL
NSD
SWVD
POLICY NUMBER
EFF
(MUBR MIDD/YYYY)
POLICY EXP
(MMIDD/YYYY)
LIMITS
A
X
COMMERCIAL GENERAL LIABILITY
CPS2389285
01/11/2016
01/11/2017
EACH OCCURRENCE
$ 1,000,000
pREM SESO(EaEoccurrence)
$ 100,000
CLAIMS -MADE
X
OCCUR
MED EXP (Any one person)
$ 5,000
PERSONAL & ADV INJURY
$ 1,000,000
GENERAL AGGREGATE
$ 2,000,000
GE
X
'L AGGREGATE
POLICY
OTHER:
LIMIT APPLIES
JECT PRO -LOC
PER:
PRODUCTS - COMP/OP AGG
$ 2,000,000
E&O
$ Included
AUTOMOBILE
LIABILITY
ANY AUTO
ALL OWNED
AUTOS
HIRED AUTOS
SCHEDULED
AUTOS
AUTOS
COMBINED SINGLE LIMIT
(Ea accident)
$
BODILY INJURY (Per person)
$
BODILY INJURY (Per accident)
$
ROPERTY DAMAGE
(Peraccident
$
$
UMBRELLA UAB
EXCESS LIAB
OCCUR
CLAIMS -MADE
EACH OCCURRENCE
$
AGGREGATE
$
$
DED
RETENTION $
B
WORKERS COMPENSATION
EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
(Mandatory In NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
Y / N
-
N / A
AWC1051832
09/10/2015
09/10/2016
PER
STATUTE
OTH-
E.L. EACH ACCIDENT
$ 100,000
E.L. DISEASE - EA EMPLOYE
$ 100,000
E.L. DISEASE - POLICY LIMIT
$ 500,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required)
License: ES12000249. Installation of t.v's and security cameras.
MIAMISH
Miami Shores Village
Building
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 POLICY PROVISIONS.
AUTHORIZEDREPRESENTATIVE
6S7---1)7—
ACORD 25 (2014/01)
The ACORD name and logo are registered marks of ACORD
Miami Shores Village
Building Department
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 LIC 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 COMP INSURANCE (EITHER CERTIFICATE OR EXEMPTION)
YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE HOLDER AS FOLLOW:
MIAMI SHORES VILLAGE BLDG DEPT
10050 NE 2ND AVE
MIAMI SHORES, FL 33138
BUSINESS NAME: HT -Install, Inc
COMPLETE CONTRACTOR'S INFORMATION
BUSINESS ADDRESS: 5272 Tennis Ln
CITYDelray Beach
STATE FL ZIP CODE 33484
BUSINESS PHONE: (561) 3058141 FAX NUMBER (561 ) 4199023
CELL PHONE (561 ) 5266421 QUALIFIER'S NAME: Carl Becker
QUALIFIER'S LIC NUMBER: ES12000249
E-MAIL ADDRESS (IF APPLICABLE): david@ht-install.com
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