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EL-10-676Project Address Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Expiration: 11/14/2010 Parcel Number Applicant 10255 BISCAYNE Boulevard Miami Shores, FL 33138- 1132050190070 Block: Lot: FRANZ AND JASMIN RIVERA Owner Information FRANZ AND JASMIN RIVERA 10255 BISCAYNE BLVD. MIAMI SHORES FL (786)200 -6605 Valuation: Total Sq Feet: $ 19,478.00 Type of Work: ELECTRICAL Additional Info: GENERATOR Classification: Residential Fees Due CCF Education Surcharge Permit Fee - Additions/Alterations Scanning Fee Technology Fee Total: Amount $12.00 $4.00 $681.73 $6.00 $16.00 $719.73 Address Authorized Signature: Owner / Applicant / Contractor / Agent Building Department Copy May 21, 2010 Phone Pay Date Pay Type Amt Paid Amt Due Invoice # EL-4-10 -37645 05/21/2010 Check #: 1552 $ 719.73 $ 0.00 CeII Available Inspections: Inspection Type: Final 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 contractor to do the work stated. May 21, 2010 Date 1 Inspection Number: INSP - 149384 Scheduled Inspection Date: July 28, 2010 Inspector: Devaney, Michael Owner: RIVERA, FRANZ AND JASMIN Job Address: 10255 BISCAYNE Boulevard Miami Shores, FL 33138- Project: <NONE> Contractor: WEST KENDALL ELECTRIC Building Department Comments Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 INSTALLATION OF 30KW GENERATOR OVER PRE -FAB SLAB Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments PROPERTY ALREADY VISITED AS PER CONTRACTOR. PLEASE SIGN IT July 27, 2010 For Inspections please call: (305)762 -4949 Permit Number: EL -4 -10 -676 Permit Type: Electrical - Residential Inspection Type: Final Work Classification: Generator Phone Number (786)200 -6605 Parcel Number 1132050190070 Phone: 305 - 596 -6240 Page 23 of 31 Scheduled Inspection Date: July 20, 2010 Inspector: Devaney, Michael Owner: RIVERA, FRANZ AND JASMIN Job Address: 10255 BISCAYNE Boulevard Miami Shores, FL 33138- Project: <NONE> Contractor: WEST KENDALL ELECTRIC Building Department Comments July 19, 2010 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 148821 Permit Number: EL -4 -10 -676 For Inspections please call: (305)762 -4949 Permit Type: Electrical - Residential Inspection Type: Rough Work Classification: Generator Phone Number (786)200 -6605 :Parcel Number 1132050190070 Phone: 305 -596 -6240 INSTALLATION OF 30KW GENERATOR OVER PRE -FAB SLAB Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments f/L Page 20 of 25 BUILDING PERMIT APPLICATION FBC 20 Permit Type: Electrical JOB ADDRESS: 10 2.55 Is the Building Historically Designated: Yes Submittal Fee $ Permit Fee $ 1 J • cO Scanning Fee $ Radon Fee $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ Miami 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 3Nr7, 6- f C.,TEWISO BY: Permit No. E. L e 10— 6 Master Permit No. 4.1 z 1 d6e* Phone#: OWNER: Name (Fee Simple Titleholder): Address: 00L.55 F 3 cAy " City: &tom 514 e.lcs State: rL O gT ■-• Zip: Tenant/Lessee Name: Phone#: Email: City: Miami Shores County: Miami Dade Zip: Folio/Parcel #: NO ✓ Flood Zone. CONTRACTOR: Company Name: V ( Venda! 6 Ele C- Address: q L �` S Cit M an1L — S Qualifier Name: �,��� fi State Certification or Registration #: ,� I OD Contact Phone #: 3/5 6 6 DESIGNER: Architect/Engineer: Phone#: Certifi Ateof Fomge #: Email Address: e( mo . Value of Work for this Permit: $ Square/Linear Footage of Work:: - Type of Work: °Address °Alteration ONew ORepair/Replace?` Description of Work: ,r /i3 `rAO /k-rf, Al d . 6 K G re Phone#: U5 :Ray • 62 Zip: b Phone#: 11064- ne °Demolition **** * *** * * *** ********+x***** **** x***x *** F ees ***** ***** *********** * * * * ****** * ************ CCF $ CO /CC $ DBPR $ Bond $ Technology Fee $ TOTAL FEE NOW DUE $ 15 • D 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 FI,FCTRICAL 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 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. Signature Owner or Agent The foregoing instrument was acknowledged before me this 2 0 day of ,,4 ,201 , by who is personally known to me or who has produced As identification and who did take an oath. NOTARY PUBLIC: * * * * * * * * * * * * * * * * * * * * ** APPROVED BY ✓ � ` „ , / , '; . " - 4 , 4 1 " Examiner Structural Review (Revised 07 /10 /07)(Revised 06/10/2009)(Revised 3/15/09) on, '.. a The foregoing instrument was ackno edged before me this day of 0...ne , 20 !, by who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Si d ",/' „.q �;'' o Print My Co yfa tga Public State F Florida i9 Rodriguez My Commission DD874683 Expires 04/22/2013 • * * *** * * * * * * * * * * ** f * * * * * * * ** Zoning Clerk PRODUCER Cypress Insurance Group BO-CL P.O. Drawer 9328 Fort Lauderdale, FL 33310-9328 954 771-0300 INSURED West Kendall Electric Inc. 9305 SW 94th Street Miami, FL 33176 -2013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOL DER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE INSURER A: Landmark American Insurance Co. INSURE2 B CastlePoirrt Florida Ins Co Ira INSURER D: INSURER E NAIC 0 33138 13599 ACORDTM CERTIFICATE OF LIABILITY INSURANCE COVERAGES 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 POUCHES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INLSR LTR A B Ao0T. AVM TYPE OF INSURANCE GENERAL MOWN X COMMERCIAL GENERAL LIABILITY I CLAIMS MADE © OCCUR X BIIPD Ded: 500 GENT. AGGREGATE LIMIT APPLIES PER — 1 POLICY ri rtrey n LOC AUTOMOBILE ME M/ ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS GARAGE LULEXLRY R ANY AUTO MICESSEMBRELLA LIABILITY OCCUR El CLAIMS MADE DEDUCTIBLE RE1ENTION $ WORKERS COMPENSATION AIM EMPLOYERS LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFRCERIMEMBER OCCLUDED? Iyes, desxleunder SpECLAI PROVISIONS below OTHER POLICY EMBER LBA068651-00 WCP760129000 POLICY DATE IM IMONYI 02128/10 01/01/10 POLICY EXPIRATION DATE IIMIGO YY1 02/28111 01/01/11 Imns EACH OCCURRENCE DAMAGE TO PREMISES (Ea occurrence) noel HED EXP (Any one person) PERSONAL MI ADV INJURY GENERAL AGGREGATE PRODUCTS - COMPA7PAGO COMBINED SINGLE UAUT (Ea accident) BODILY INJURY (Per pew) BODILY INJURY (Pen accident) PROPERTY DAMAGE (Per accident) AUTO ONLY - EAACCIDENT OTHER THAN AUTO ONLY FAACC AGG EACH OCCURRENCE E AGGREGATE X I TORY I I 1% EL EACH ACCIDENT El. DISEASE - EA EMPLOYEE EL DISEASE- POLICY UNIT $1,000.000 $100,000 . $5.000 $1,000.000 $2.000.000 $1.000.000 $ $ $ $ $ $ $ $ $ $ $ $ s500000 $500,000 $500,000 DESCRIPTION OFOPHRATIOIISI LOCATIONS / VEHICLES I EXCLUSIONS ADDED BYEIEORSE1ENT / SPECIAL PROVISIONS Workers Compensation applies to Florida operations and employees only. CERTIFICATE HOLDER Village of Miami Shores 10050 NE 2nd Avenue Miami Shores. FL 33138 SHOULD ANYOFTHE ABOVE DMA POLICES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, M E ISSRCGB WILL ENDEAVOR TOMA5 in Dan WIITION NOTICE TO THE CERTRCATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBL GATION OR LIAMU YOFANYEIHDUPONTHE INSURER, ITS AGENTS OR REPRESENTATIVES. REPRESENTATIVE ACORD 25 (2001101 of 2 #S935381M86260 CANCELLATION CL DATE (WINlDDYYYY) 6/10/2010 0 ACORD CORPORATION 1988 Miami Shores Village Building Department Change of Contractor Permit No. EL /fJ —C16 BY: Owner's Name (Fee Simple Titleholder) P12.. re., a., dE-12,9 Phone # Owner's Address 102 s cqi m, ti t. City nAlq441 S -14 State fZcizl Zip 231.3 Tenant/Lessee Name Phone # Job Address (of where the work is being done) I OZ SS Q ,s c 1 pE g.,- v r) City MIm' s tkgzc County WDE., Zip 3 3 • i 2' Legal Description Contractor's Company Name A 1. Fi E G..DS t t ,E c,-r(e I C Contractor's Address 5150 SW 163 Ave City *Tao 1ifse P,IJel 4 State ri.c-2i PA Qualifier KE,iari 0 iftt Describe Work: Tevs-t41)»-t,0 s 1 I hereby certify that the work has been abandoned and /or the contractor is unable or unwilling to complete the contract. I hold the Building Official and the Village of Miami Shores harmless from all legal involvement. Rev. 09/19/03) Owner or Agent The foregoing instrument was acknowledged before me this this 5 day of J., 11 , 20 Id , by who is personally known to me or who ha As identificatio and who-did take an oath. NOTARY PUBLIC:. GIDEC. ; Sign: ov": Print: My Commission E 1313. jl NotenyAssn., Inc The foregoing instrument was acknowledged before me day of / who is personall Phone # (7 S4\ Zip 3333 ) 20 10 by own to me or who has produced nn- :th,��Y�i.•. L. 1 NOTARY P113 Sign: Print: My Commission =xpires: aulisitificajo . •'d take an oath. cc 3rri:: 2010 -07 -14 11:23 EMPOWER GENERATORS 07/14/2010 14:20 FAX 1 800 685 7530 RIEMEnn3111 JUL 1 6 2010 BY: DATA SCAN FIELD SERVICES CHANGE OF CONTRACTOR / ARCHITECT Perim N.pL /o 6= Owner's Name (Fee Simple Title Holder): Ri Ve .e4 1 i�AaJ z ill i j Phone #: Owners Address: pgs se.z.elb City: AV M State : i=ce Zip Code: 3 Job Address (Of where work is being done): City: Miami Shores State: Florida Zip Code:__ Contractor's Company Name: iie4,` "iCe ,j %// e/ec, , c Phone #:3 96-caf Address: City: A4 Af State: A- Zip Code: 39/76 Qualifiers Name : PAY,/ 41; 4 Lic. Number. LFe- gee, S Architect/ Engineer of Record Name: Address: City: State: zip Code: Describe Work: I hereby certify that the work has been abandoned andlor the contractorlarchitect is unable or unwilling to complete the contract. I hold the Building Official and the Miami Shores harmless for all legal invotveme Signature owner or Agent The foregoing instrument was atmoiedged before me this _ day of .20 ,by Who is personally known to me or who has produced as indentification. Notary Public: Sign: Seal: ca wactoror The foregoing instrument was aknowledged before me this I 5 dayof J LAy 20 by c O I D who is personally known to me or who has produced d (' v- pys L4 C ep as indentitcation_ 7862288449 » Pion #: 305 596 5176 P 1/1 M iami Shores Village Building. Department 10050 N.E.2nd Avenue Miami Shores, Florida 33T38- Tel: (305) 795.2204 Fax: (305) 756.8972 MARIA A. LOP Notary Public - State of Florida My Corm tssion Expires Jul 11, 2011 Commission # DD 694457 Bonded Through Nations Notary Assn. • r - M 311) Village of Miami Shores BY: RE: Change of Contractor 7/12/2010 To Whom it may concern: Please use this letter as the official notice for an immediate change of contractor. I Kevin Chatfield qualifier for ALL FIELDS ELECTRIC agree to release myself from the Electrical permit EL1O -676 held with the village of Miami Shores. I acknowledge the fact that there is to be a change of contractor at the location of: 10255 Biscayne Blvd. Kevin Chatfield r nGIDEON DJERASSI IS A CommE DD0888440 Expires 1128/2011 Flodde Notary Assn, (nc.. ➢anYimamma._ BUILDING PERMIT APPLICATION FBC 2004 Miami Shores Village Building Department >0050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Permit Type: Electrical - Owner's Name (Fee Simple Titleholder) F(1wZ / TAs. ROCA.9 Phone # Owner's Address to 255 &SCA 646.4 -p City A t air t 4 4 e(tc,c. State Firctstiner Zip 3,3173' Tenant/Lessee Name E -MAIL: Job Address (where the work is being done) City Miami Shores Village County Miami -Dade Zip FOLIO / PARCEL # Is Building Historically Designated YES NO Contractor's Company Name 4t- �IIF��S �I�C�Zt ►L c- . Phone # 9/ b O bog-7 Contractor's Address SI J D 1 19,3 A.)F_ City .suew;Ct1 Qualifier Name V4.,it to CO 1Ft e State FL. Type of Work: ❑Addition [!Alteration New Permit No. t i iO(dlCQ Master Permit No. Phone # State Certificate or Registration No. E 1,3001 1.k 3 Certificate of Competency No. E -MAIL: Cvtarr ec-) PS 0 0 1 -1.4 " , fJQ7r Architect/Engineer's Name (if applicable) Phone # Value of Work For this Permit $ Square / Linear Footage Of Work: Describe Work: a us-14 (AvvetI•-row- • Zip 33..31 Phone # '1S9 6J 03 X . paMY3111 APR � 1 201 BY: ❑ Repair /Replace ❑ Demolition Submittal Fee $ b Permit Fee $ ' CCF $ Ji l� CO /CC Notary $ 6 Training/Education Fee $ g Technology Fee $ /6 Scanning $ 6 °_ Radon $ DPBR $ V Zoning $ Q Bond $ 0 Code Enforcement $ (, Double Fee $ Structural Review. $ ® Total Fee Now Due $ 7/7 See Reverse side —* 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: 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 $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature Contracto The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of , 20 , by , day of , 20 _, by who is personally known to me or who has produced who is personally known to me or who has produced as identification and who did take an oath. Sign: Print: (Revised 02/08/06) My Commission Expir Owner or Agent APPLICATION APPROVED B r As identification and who did take an oath. nsS IDEON D.tc Cane5D . E:4.: ^ r ail Pier ,oterynsSf.. Inc 000�o Signature_c�,._ Print: My Commission Exp ** ** *** * * ***** * * * * **** * *********** * ************ ****** ************ * ******* * * ** * ***— * * * * *** ** ** * * ** * *** * ** 4,/ Are, V / Plans Examiner Engineer Zoning Hallandale Branch River Insurance Group Po Box 250 Hallandale FL 33008 -0250 Phone :800 -742 -1691 Fax:954- 454 -9552 mums COVERAGE$ THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN 1S8UED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REOUIREMENT, TERM OR CONDITION OF ANY CONTRACT DR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE BE MAY PERTAIN, THE INSURANCE AFFORDED BY THE DESCRIBED ISSUED _ POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY pAto cLAIMS, LTR OTHER p co CERTIFICATE OF LIABILITY INSURANCE P�WCER 8R TYPE OF INSURANCE °L564 163rd A�ac South Ranchos FL 33331 GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS MADE fl OCCUR OEN'L AGGREGATE LIMIT APPLIES PER 11 POLICY n PRO- n LOC A GILE LIABA_flY ANY AUTO ALL OWNED AUTOS —_ SCHEDULED AUTOS HIRED AUTOS NON-OWNED AuToS GARAGE LIABILITY ANY AUTO DEDUCTIBLE RETENTION $ TAIMBRELLA LIABRTIY OCCUR n CLAIMS MADE WORKERS COMPENSATION AND EMPLOYERS' WORMY ANY PROPRIETOR/PARTNER XECLITME OFFICER/ MEMBER EXCLUDED" N SPECIAL Ois� S Wow MPG03245 POLICY NUMBER INSURER C: INSURER 0: INSURER E; 05/11/10 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUB1oNS ADDED BY ENDORSEMENT / SPECIAL, PROVISIONS ELECTRICAL mom WITHIN BLOCS CERTIFICATE HOLDER ACORD 25 (2001108) Village of Miami Shores 10050 NE 2nd Avenue Miami Shores FL 33138 Z0 . 3EIVd -.. VILLAGE THIS CERTIFICATE 1S ISSUED AS A MATTER OF INFORMA 3/10 ONLY AND CONFERS C HOLDER. THIS DOES NOT AMEND. EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE INSURER a Old Dominioia InSTUTOOce Co . INSURER B: CANCELLATION 05/11/11 EACH OCCURRENCE PREMISES f oe rufoeL MW EXP (Any one Benson) PERSONAL 8 ADV INJURY GENERAL AGGREGATE PRODUCTS - COMP/OP AGO COMBINED SINGLE LIMIT ((P p ) RY BODILY INJURY (Per aeeaere) ( PROPERTY DAMAGE ) AUTO ONLY - EA ACCIDENT OTHER THAN AUTO ONLY: EACH OCCURRENCE AGGREGATE E,L. EACH ACCIDENT OP ID ALLFEL1 EA ACC AGO ITORYL AMTS I E,LL DISEASE • EA EMPLOYEE E.L. DISEASE . POLICY LIMIT LIMITS $ 5 8 $ $ 8 S $ $ DATE (MM/DD/YYyy) NAIC # 5 1000000 5500000 810000 /1000000 82000000 82000000 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFOR# THE EXPRAT1ON DATE THEREOF. THE ISSUING (INSURER WILL ENDEAVOR TO MAIL 3 0 BAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT. BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OP ANY KIND UPON THE INSURER ITS AGENTS OR REPRESENTATIVES. AUTHORIZED ,,; ES p �� ® ACORD CORPORATION 1588 0600000909 ZO :ZZ 1700Z /50/90 Names Nltsurad(s) ThNat HR Corporation and all its *Was I subaidtaCee° AlifleIda Metric inn (Endorsed as alternate employer) 9000 Town Ca',tor Patiavay Brada:'ttcn, FL 34202 Ca M: 10060 NE 2ND AVE Miami Shores, FL 33138 TO 3Jdd -' �• •••••�.. •.,.v rams tnjs: 4.1 VVL r rx Darvur Certificate of Insurance This oortroer.Ir seeped as a matter ofIn!ormetlo l only and confers no retches upon the Collikete Holder. Thus await does oat amend. hence et OW Or W. coverage afforded by the policies amoebae nsraln• Inturnr Affording Covsrage `COMMERCE AND INDUSTRY !NetIRANQE COMPANY' w The pollees eliminate. Wad below tease been leiued to the flashed named above for the policy prod Inelated. Nattelh hafting any reatdlement, 'term or =elm deny contr.d all attw Cowmant Oh reapeal to which to Delicate may be esued a may parkin, the Instance idford.d by the pdk ss described strain la subject to all the term', sxduelona stn =Wane Or suds poles*. Aggregate limb shown may n see been maned by paid dale Ms of Insurance lee Workers' Cainpanaation Insurer A Others: Client Number 46662 Effective Polloyr Number Mats Data 023269191 FL 07_01 -2009 Expiration Data 07- 01.2010 Limit. ■ we atahrtry Lied* Employers Liability Body inky 0YAQdddartt 62,04000 Each Accident B odily Ifl ury By Disease $2,000,000 Pella Litt B odily inky By Maass 62,000,000 Each Person The shots referenced workers' ea npanssbon Older provioe statutory benefits only to toe smpioyees d the Named Insured(*) as wet pollees. not tot* employees of t**uremployer. • TrlN.t NR V, no TNat MR a par el:vs Csnoollatbn: Shedd any of * 9 eve described parlors be a artcel:ed before the expiration data thereof, ma Inferrer sirvding coverage wl!1 endeavor to mai n days wrttten nodes to ti. certificate h0.oer named h'train, but route to mall such notice Mail impose no obligation or Itablilt'vamy kind upon tie Maurer offering coverage, Its spits orrepressi anvee. Certifioete Hoiden VILLAGE OF MIAMI SHORE Sri rut ' atatLr tc+rl. ?.tr6. Adel Risk itervIceeNauthsssk lna Authorised R prsatntstIva of AON Risk U viatt (sae) 443-840 04 /0$/2 Old oboes sills Issued 9900000000 ZO:ZZ 1700Z/90/50 Miami Shores Village Re: Comments Permit# EL10 -676 Inspector/ Plan reviewer: Mike Devaney Dear Mike, As per our earlier conversation about the job value for the generator, The Generator was purchased along with the tank and transfer switch. I will give you the breakdown of the costs for the equipment and labor. 36KW Guardian QT36- $10,100 Automatic Transfer Switch (ATS) - $1600 Concrete pad -$528 500 Gallon Underground tank and plumbing work- $3500 Electric wires and labor- $3500 Electrical engineering (riser diagram) -$250 Total Valuation of the work to be performed: $19,478 o Minna n �{IJ MAY 0 3 2010 13Y: V For any questions or concerns please contact me directly. My name is Itay Djerassi and you can reach me on my cell: (954 261 -5747) or by email: Itay @EmPowerGenerators.com 1111111 11111 11111 11111 11111 111111111111111111 NOTICE OF COMMENCEMENT C N ` +346887 OR I?I•; 27294 Ps 32321' tlas) A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION ' .EOORGECI 05/24/2010 11 :300 :49 ARVEY RUV'Ihlr CLERK OF COURT IAI1I -DACE O'OUN'NTY, FLORIDA PERMIT NO. TAX FOLIO NO. AST PAGE STATE OF FLORIDA. COUNTY OF MIAMI -DADE: THE UNDERSIGNED hereby gives notice that improvements will be made to certain real property, and in accordance with Chapter 713, Florida Statutes, the following information is provided in this Notice of Commencement. E - la - 646 156.1° 1. Legal description of property and street / address: 10 255 ehsc14-1.) , $$d.v Ama Al s t 33I ?V 2. Description of improvement: qvuegivrot 3. Owner(s) name and address: FitANT it Tits AA I t4 1 Name and address of fee simple title older: Grem evor -fc 4. Contractor'dname and address: 3 6 c/ �w 5. Surety: (Payment bond required by owner from contractor, if any) Name and Address: Amount of bond $ 6. Lender's name and address: 7. Persons within the state of Florida designated by Owner upon whom notices or other documents may be provided by Section 713.13(1)(a)7., Florida Statutes. Name and Address: IJJ 8. In addition to himself, Owners designates the following person(s) to receive a copy of the Lienor's Notice rid = a in Section 713.13(1)(b), Florida Statutes. — 8 m` Name and Address: 9. Expiration date of this Notice of Commencement (the expiration date is 1 year from the date of recording unless a different date is specified) SIgnaturc'of Owner Print Owner's Name Pg. FP- 162 d � Sworn to and subscribed before me this rw■■n■ r:n■uumuu GIDEON DJ I Notary Public: dram #DD068844o Print Notary's Name: 4129/2011 My commission expires:: p.. a rs4 d f& 3 3° € Prepared by y't�1 V bre- -N , 20 c3 /!2.&t) jTAY Is Building Historically Designated YES NO Miami Shores Village Building Department /0050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 BUILDING Permit No. PL ' 4 10 14 PERMIT APPLICATION Master Permit No. EL - "IC e 6 3- 6 FBC 2004 E s /o Permit Type (circle): Building Roofing Owner's Name (Fee Simple Titleholder) Fizoz. 5 . 44i.J /Zwevei . Phone # Owner's Address 1®15.5 ats cA146 4L-N) p City NktA"'1 - ¢, State FLoal r3A Zip 3 1 Tenant/Lessee Name Phone # Job Address (where the work is being done) Siie Q, City Miami Shores Village County Miami -Dade Zip FOLIO / PARCEL # Contractor's Company Name Po++#at d°o.le E Contractor's Address 'MOO NAI I Gcli4 A v Q City C ha t. Qualifier Name Structural Review. $ S p e.;a(.45. s1EpHEA State Certificate or Registration No. ? ZI OS Architect/Engineer's Name (if applicable) State SubmFee $ Notary $ Scanning $ Radon $ Permit Fee $ Training/Education Fee $ ft wz; t7 35 DPBR $ Phone # 650 5b - et t3 Zip Phone # Certificate of Competency No. Phone # Value of Work For this Pig yX.._ Type of Work � d' : ; DAlteration ❑New ❑ Repair/Replace ❑ Demolition Describe Work' 574Il v d '?C 4Me 4 e 4 A (JP 500 G U 6. Square / Linear Footage Of Work: * ****** **** ** * * *** ** **** * * * ** ***** F * * * * ** **** * * *** * * * * * ** * *** CCF $ CO /CC Technology Fee $ Zoning $ Bond $ Code Enforcement $ Double Fee $ Total Fee Now Due $ SOO See Reverse side -) JUN 2 2JI() Protect Address Owner Information Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 10255 BISCAYNE Boulevard Miami Shores, FL 33138- 1132050190070 Block: Lot: FRANZ AND JASMIN RIVERA FRANZ AND JASMIN RIVERA 10255 BISCAYNE BLVD. MIAMI SHORES FL (786)200 -6605 1 Contractor(s) Phone CeII Phone POWERHOUSE EQUIPMENT SALES 8 (954)658 -4454 Type of Work: PLUMBING Type of Piping: UNDERGROUND GAS TANK Additional Info: Bond Retum : Classification: Residential Fees Due CCF Education Surcharge Permit Fee - Additions/Alterations Scanning Fee Technology Fee Total: Amount $1.20 $0.40 $150.00 $3.00 $1.60 $156.20 May 26, 2010 Address Building Department Copy Expiration: 11114/2010 Parcel Number Phone Amt Paid Amt Due Pay Date Pay Type Invoice # PL-4-10 -37646 05/26/2010 Check #: 1553 $ 156.20 $ 0.00 Authorized Signature: Owner / Applicant / Contractor / Agent Applicant Cell Valuation: Total Sq Feet: $ 2,000.00 100 Available Inspections: Inspection Type: Final Press Test ROW 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: 1 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 contractor to do the work stated. May 26, 2010 Date BUILDING PERMIT APPLICATION FBC 2004 Tenant/Lessee Name E -MAIL: Job Address (where the work is being done) 5AA. Architect /Engineer's Name (if applicable) Value of Work For this Permit $ 2) 00 Type of Work: ['Addition Describe Work: Ns - r411 Submittal Fee $ 0 Permit Fee $ Notary $ Scanning $ Bond $ ® Code Enforcement $ CD Structural Review. $ Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 d Alteration Radon $ ❑New DPBR $ Permit No. PI lO (6fl Master Permit No. Permit Type: Plumbing Owner's Name (Fee Simple Titleholder) FiUI 'JZ Tiould ittsiesa Phone # Owner's Address Iot 55 ckfut 6%- p City mooki SUc es State Ft-c1Llr) A Zip 2313V Phone # City Miami Shores Village County Miami -Dade Zip FOLIO / PARCEL # Is Building Historically Designated YES NO Contractor's Company Name t » c41 1.1. use 6,5444 w► Phone # Contractor's Address City caKkc S'Pr2tvC . State FL. W - 112 Jr Zip Qualifier Name STevf $- Phone # (ti S yi 65 Sr - `lyS State Certificate or Registration No. Certificate of Competency No. E -MAIL: Phone # Square / Linear Footage Of Work: ❑ Repair /Replace Training/Education Fee $ `.. °— Technology Fee $ 1 la Double Fee $ CCF $ I a CO /CC Total Fee Now Due $ Zoning $ See Reverse side -4 ['Demolition Alt TAN ** * *, * ** * ** **************** a *a*** ** * * *F *a * *a * * * *aa * * *, * ** * ** ** **** *** *,tit******* ** 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 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 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. Signature ' Signature wner or Agent Contractor The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of , 20 , by , day of , 20 , by who is personally known to me or who has produced who is personally known to me or who has produced As identification and who did take an oath. as identification and who did take an oath. NOTARY PUBLIC: MMUS GIDEON DJ Sign: I - Print: aesaaeeeaeaaammaca..a My Commission Expires: APPLICATION APPROVED BY: (Revised 07/10/07) NOTARY PUBLIC: Sign: Print: My Commi 6�hr r {I trfatrn nunenae aeaeaeaeroo ; aaaeccaeazccao GIDE ®id DI: S I stioitaara ` ** sir******************* a ******************** * ** * *,t * *** *it * * * * * ** * ** * ** * ** *,briar * ** - k*** * *kir**** * *** ** *,t * *A* Notarynssn„ Inc Plans Examiner Engineer Zoning y ►At zz., t 1, r,r 1 r..'. ' i 1'' f .� : .4 rot .. , � r 0 4 •; i '''K u /.111 44.6.0 • oo C ZF 0. ewe / ►l .1. C. � r • 4 . fyr, • g. fin pn LOT DETAILS SCALE: 1" = 15' 4°4 16;0 tv 3.5'7 49.05 -- - :NrA /n ',Mfg powarg ROL 0 /3 o . FP '/z C1R0.46 e1 1 Q " Q I c0- it, ' k k % N j N) . N7 r 13.4e / e fLe/ v/ el N0 PERM' #: J 10 cJ Miami Shores Village APPROVED BY DAIS ZONING DEPT BLDG DEPT SUBJECT ID CCMPLIANCE WITH ALL FEDERAL STATE AND C UN 1Y rUJLES AND REGULATIONS go k -le G / a3/e 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. 1 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: 1 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 $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature (Revised 02/08/06) "•• " ••• GIDEOIDJERA►. Sign: o.,.,N „rye Print: My Commission Expires.°mu''''•” "' APPLICATION APPROVED BY: A ssn., Signature er or Agent Contractor The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of , 20 , by day of , 20 , by who is personally known to me or who has produced who is personally known to me or who has produced As identification and who did take an oath. as identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: r ....... "d'T 7 cc p Sign: i ; r— A • Print: - ; . „�a - My Commission Ex � - _ ."n .......o.¢a...caa ®s+. * * * * * * * * * * * * * * * * * * * * * * ** :c 4z*** *3ea'r*4ru4r4ede*3rdr**** Ar* 4t$ r3rdr3t& da ia****** ** *dtae $sba4 ,' k* , t , ti , t , ti4 *** * 4 - g. 3 467 Plans Examiner Engineer Zoning POST LICENSE CONSPICUOUSLY State of Florida Department of Agriculture and Consumer Services Division of Standards Bureau of Liquefied Petroleum Gas Inspection (850) 921 -8001 Tallahassee, Florida MASTER QUALIFIER CERTIFICATE This Certificate is issued under authority of Section 527.02, Florida Statutes, to: STEPHEN STAFFORD Valid For License Number: 22305 POWERHOUSE EQUIPMENT SALES & SERVICE, INC 4900 NW 104TH AVE CORAL SPRINGS, FL 33076 -1750 State of Florida Department of Agriculture and Consumer Services Bureau of Z' d 996g Division of Standards Liquefied Petroleum Gas Inspection (850) 921-8001 Tallahassee, Florida Liquefied Petroleum Gas License CATEGORY I LP GAS DEALER GOOD FOR ONE LOCATION ONLY ANY CHANGE OF OWNERSHIP OR SALE OF THIS BUSINESS RENDERS THIS LICENSE INVALID This license is issued under authority of Section 527.02, Florida Statutes, to POWERHOUSE EQUIPMENT SALES & SERVICE, IN 4900 NW 104TH AVE CORAL SPRINGS, FL 33076 -1750 Certificate No: 21877 Exam Date: July 10, 200E issue Date: July 10, 2009 Expiration Date: July 9, 2012 Exam: 0601 HARLES H. BRONS COMMISSIONER OF AGRICULTURE License Number: Expiration Date: Date of Issue: License Fee: Type and Class: }uewdlnb3 esnowennod 22305 August31, 2010 Seatember 1, 2009 $425.00 0601 RLES H. BRONS COMMISSIONER OF AGRICULTURE sZZ :01. O l 6Z'sW 2006 -26697 SEE OTHER SIDE POWER HOUSE EQUIPMENT SALES & SERVICES INC STAFFORD STEVEN 1 This receipt is hereby valid for the above address for the period beginning on the first day of October and ending on the thirtieth day of September to engage in the business, profession or occupation or LIQUID PETROLEUM INSTALL c' d 8865 DO NOT FORWARD POWER HOUSE EQUIPMENT SALES & SERVICE INC STEVE STAFFORD PRES 4900 NW 104 AVE .; CORAL SPRINGS FL 33076 • ir�l�Yrr�lrl�rrrirtsis�irttrtlYi► rflt�tltl�rssi�rrs�lp STATE OF FLORIDA PALM BEACH COUNTY LOCAL BUSINESS TAX RECEIPT EXPIRES: SEPTEMBER - 30 - 2010 LOCATED AT 4900 NW 104TH AVE CORAL SPRINGS FL 33076 -0000 CNTY TOTAL 08 -041 THIS IS NOT A BILL - DO NOT PAY PAID. PBC TAX COLLECTOR 55.00 BTR 049 01878602 09/11/2009 }uetudlnb3 esnoy.ieMOd CLASSIFICATION 55.00 55.00 ANNE M. GANNON THIS DOCUMENT IS VALID ONLY WHEN RECEIPTED TAX COLLECTOR, PALM BEACH COUNTY BY TAX COLLECTOR EZZ:O t. 01 6Z'eW 1N9R7[OD'C LTR $RC — ' • — - TYPE OF INSURANCE PO P OI-My NUMBER POLICY DATE ( MJ DATl (PAMtp� L DATE (MMiD4 ) — LIMITS EACH OCCURRENCE $1,000,000 �! GENERAL X -- LIABILITY COMMERCtA1, GENERAL LIABILITY I CLAIMS MADE I X I OCCUR EN ®84833 NO JIDDITIONAL INEUAEDS UNLESS ENDORSED 07/25/09 07/25/10 DANE)0 iau PREMISES (Erimann* $50,000 MED ExP (Any enn parman) 5 5 , 000 PERSONAL $ ADV INJURY 31 000 000 _ GENERAL AGGREGATE $2,000,000 _ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP AGO 5 2,000,000 7 POLICY _ !Ng LOC AUTOMOBILE _ '— LIABILITY i ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTO NON - OWNS D AUTOS COMBINED SINGLE UMYf (Ea aacklent) $ BODILY INJURY (Per person) $ — — BODILY INJURY Tar Attldant) $ — PRQPERTY DAMAGE (Per Rldent) $ GARAGE LIABILI I Y ANY AUTO AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC AUTO ONLY: AGG $ _ $ B EXCESS/UMBRELLA J LIABILITY OCCUR [ j CLAIMS MADE XOVA316309 11/03/09 07/25/10 EACH OCCURRENCE $3,000,000 AGGREOAT$ 53,000,000 OEDhJCTIBLI! RETENTION $ 3 — $ 5 WORKERS COMPENSA'i70N ANIS EMPLOYERS LIABILITY ANY PROPRIETOR/PARTNERtEXECUTIVE OFFICERfiXEMBER EXCLUDED? ff n' d I3CTt U r�dar 5 EG PROVISIONS below " 1 • • . TO LIMITS ER EL EACH ACCIDENT $ E.L. DISEASE. EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ C OTHER EQUII ;NT FLOATER EC68919986 07/25/09 07/25/7.0 10 DAYS NOTICE IP cANC k'OR NON -PMT DESCRIPTION OF OPERATIONS t L N$ VEHICLES 1 EXCLUSIONS ADDED BY ENDORSEMENT 1 SPECIAL PROVISIONS ,CORD. CERTIFICATE OF LIABILITY INSURANCE Po'» 4 PRODUCER INNOVATIVE IN:3TJR14NCE CONSULTANTS, INC. 5461 LTNIVERSI9''I DRIVE, #103 CORAL SPRINGS FL 33067 Phone :954 -340 -9551 Fax:954- 340 -9456 INSURED bb/ 1J12blb 10:4b "9b4;�4U 4bb COVERAGES ACORD 25 (2001108) POEERHovsE EQQUIPMENT SALES & SERVICE INC. CORAL NsmiNGGS AVE 33076 cop 305- 756 - $972/954- 796 - 5988/786 - 228 -8449 CERTIFICATE HOLDER VILLAGE OE' MIAMI SHORES 10050 NE 2 AVENUE MIAMI SHORES FL 33138 MIAL C- 1NNUVAI1V. INSURANCE HAUL. 01101 DATE (NMIDDIYYYY) 05 /03/10 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE INSURER A; P UM WS INBAR711¢I E co • .. NDIX INSURERS: EVANSEON INSURA>CTCE Co. INSURER C: mama= =limy or ArcoE CA INSURER 0; INSURER E: THE POUCIES OF INSURANCE LISTED BELOW HAVE SEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFQRIXD BY THE POLICIES DESCNIEEb HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDmONS OF SUCH POLICIES, AGGREGATE UMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CANCELLATION NAIC # 17370 19305 SHOULD ANY OF THE ABOV$ DESCRIBED POLIcIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL. ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE DERT1FICATE HOLDER NAMED TO THE LEFT, OUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. C� ACORD CORPORATION 1988 CERTIFICATE OF LIABILITY INSURANCE 1 s/3f2010 Producer: Lion Insurance Company 2739 U.S. Highway 19 N. Holiday, FL 34691 This certrrtcate is Issued as a matter of information only and confers u Poe the Certificate Bolder. This Certificate does not amend, extend the coverage afforded by the polides below. no rights or after Insurers Afi'ordng Coverage NAIL Insured: South East Personnel Leasing, Inc. 2739 U.S. Highway 19 N. Holiday, FL 34691 insurer A: Uon Insurance Companr 11075 Insurer 8: insurer C: Insurer 0: Insurer E: Coverages Then Il Ilicertificate acres of tnsunince tre hated below nave been issuedto the insured rented above for ale poky perfect itukareci. t tw! Ustendhtgivy teyutremen( ieim orcomaceof anycomRO 01alhar doaUnamw ithraspIlowhicit ba issuad al mev certain. the insurance ridded byte policies described rms escribed herein is Subledt to el the te. exo dons, and conditions ant potties. Aggregate Ultras shorn row have beenradnced by z 1 ADM Type of insurance Polity Number Poky Effective Date (MM/DDMr) Policy Expiration Date (MM/DDMr) Limits GENERAL LIABILITY Commercial General Liability Each Occurrence Claims Made • Occur Damage errenc orerdadprernises(EA oawrence) Mal Ew S General aggregate limt applies per: j Policy ❑ Aajed ® LOC P$lscrrelAdvinjtay s General Aggregate S Products- CcrnpiCpAgg $ AUTOMOBILE UABIUTY Arri A uto Al Owned Autos Scheduled Autos Hired knos Nor.Ormed Autos cometnausitrpro jEA Accident) $ ecdNbinAr ( Parson) $ eodli hltaY (per Aodden) s Property Carnage frar Acddan9 .S ... �� EXCESS/UMBRELLA LIABIUTY Occu ❑ Claims Mode DedipdWe Each Occurrence Aggegata A • Workers ComperlsatJon and Employers' Liability Any proprietor /partner/executive officer/member excluded? If Yes, describe under special provisions below. WC WC 71949 01/01/2010 01/01/2011 x WC Stauu Limits 14 1 0T ER I EL Each Accident S1.O D,au0 E.L Disease - Ea Employee 51,030,000 E.L. Disease - Policy Limits 51,00.000 Other Lion Insurance Company is A.M. Best Company rated A- (Excellent). AMB # 112616 Descriptions of 0perations/Locations V3hicteslExcluslons added by EndorsementfSpeclal Provisions; Client m: 41 e3 Coverage only applies to active erployee(s) of South East Personnel Leasing, Inc. that are leased to the following *Client Company: Powerhouse Equipment Sales &Service, Inc. Coverage only applies to injuries incurred by South East Personnel Leasing, Inc, active ernpioyee(s) , while working In Fronde. Coverage does not apply to statutory employee(s) or independent contractors) of the Client Company or any other entity. A list of the active employee(s) leased to the Client Company can be obtained by faxing a request to (727) 937 -2138 or by calling (727) 938 -5562. Project Name: FAX: 954 - 796 -5988 & 305-756 -6972 & 786-228 -6449 / ISSUE 05 -03-10 (TD) Benin Date: 11/6 /2005 CERTIFICATE HOLDER CANCELLATION VILLAGE OF MIAMI SHORES 10050 NE 2ND AVENUE MIAMI St4ORES, FL 33136 Show any d fire aoova desaibedpaades be canceled before the expraUOOdais ibereoL the Issuing Insurer nen endeetar to mail 30 days wiser' notice to fie cartlncala hnider named to nee 1111 tag felbre to do so shall impose no obligation or liability of err/ land upon the insurer, is agents or cepresenmIyes. 1 - .41102.A..40-. L id 9969 }uewdinb3 esnotve/wod eZZ 06 oi. 6ZRaW Scheduled Inspection Date: July 23, 2010 Inspector: Hernandez, Rafael Owner: RIVERA, FRANZ AND JASMIN Job Address: 10255 BISCAYNE Boulevard Project: <NONE> July 22, 2010 Miami Shores, FL 33138- Building Department Comments Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 10-47 Inspection Number: INSP - 141117 Permit Number: PL -4 -10 -677 Contractor: POWERHOUSE EQUIPMENT SALES & SERVICE INC For Inspections please call: (305)762 -4949 Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Gas Phone Number (786)200 -6605 Parcel Number 1132050190070 Phone: (954)658 -4454 INSTALLATION OF AN UNDERGROUND GAS TANK Passed JZ Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments please check permit paper work is on the generator. Page 2 of 4