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ELC-12-482Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 cc- ti- th95 Inspection Number: INSP - 171293 Permit Number: ELC- 3- 12-482 Scheduled Inspection Date: July 02, 2012 Inspector: Devaney, Michael Owner: , SHORES SQUARE INVESTMENTS Job Address: 9025 BISCAYNE Boulevard Miami Shores, FL 33138 -0000 Project: <NONE> Contractor: WILLIAM P DONELLY INC Permit Type: Electrical - Commercial Inspection Type: Final Work Classification: Addition /Alteration Phone Number Parcel Number 1132060110051 -25 Phone: (954)653 -4173 Building Department Comments 16 DOUBLE DROPS 16 VOICE AND 16 DATA 16 OUTLETS Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments June 29, 2012 For Inspections please call: (305)762 -4949 Page 5 of 38 2-111 14-1- Miami Shores Village � Po Building Department i4AR 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 .�,,���""''�/] Permit No. -'LA L: 0- Master Permit Noce 1 ` (d33 BUILDING PERMIT APPLICATION FBC20 Permit Type: Electrical OWNER: N (Fee Simple Titleholder) Address: 5 city: ," A441 H-rae Tenant/Lessee Name: Phone#: Email: JOB ADDRESS: q. 'c::. d 6 is C_ANI �� ✓4 City: Miami Shores County: Miami Dade Folio/Parcel#: 11 3 4) o 4 on l o os I a' i Is the Building Historically Designated: Yes NO Flood Zone: lt� ' \` �'ptM L 0lU N �, ` ,1 N & Phone#: '1' -7 q3"- ae CONTRACTOR: Company Name: AllF : LvL State: r(- Phony# 305 Y35 103:4q zip: 33 I3; Zip: 3�!3 Address: (4 453 A) ` W - "i l .A) S tate: City: P' i Qualifier Name: (-1—$ • i l A --"` State Certification or Registration #: L a Contact Phone# DESIGNER: Architect/Engineer: ` Zip: 3 33 ' Phone#: 9314:7 / oc.oa Certificate of Competency #: — �� 1A- �-1 Email Address: (=Ia .t1AS i Q_ Y tT-Z eSo to It° Phone#: Value of Work for this Permit: ) 52(-) b Type of Work: °Address kiAlteration;� Description of Work: 16 °'u � 21) $ . Square/Linear Footage of Work: ❑New °Repair/Replace 2-a- 14. 1 A- -4 °Demolition Submittal Fee $ Permit Fee $ 4-43 '47e) CCF $ CO /CC $ Scam ng Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ t (.00 -T) u 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 must be posted at the job site for the fi Y insp Lion which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspe . n will . t be appri' i and a reinspection fee will be charged. Signature • - or Agent Contractor The foregoing day +f .• 20a, by k- vtdv � �Q/o��f •�?. , day of , 20 byk-I-1 �•.,�.� -e -,�� , who is personally known to me or who has produced who is Wally knowi�to me or who has produced As identification and who did take an oath. as identification and who did take an oath. NOTARY PUBLIC: NO ARY PUBLIC: ' -I II was acknowledged before me this The foregoing instrument was acknowledged before me this3' Sign: t 4222 L KI,i-xtAp-Lc&J print: i- W uric her- Si ytrs. , Print Myco,,.�f__s�r.�!�, . 5/s12o16 2'C /1-44 Plans Examiner Zoning Structural Review Clerk (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) Miami Shores Viiiage 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. B. C. D. COPY OF CERTIFICE OF COMPETENCY OF QUALIFIER COPY OF MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT COPY OF LIABILITY INSURACE (CERTIFICATE HOLDER MUST BE MIAMI SHORES VILLAGE BLDG DEPT) 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: JV BUSINESS ADDRESS: STATE r L MPLETE CONTRA TOR'S INFORMAT \I I Am oaU (. �-- jU C . 9453 it) w Marry ZIP CODE 33 .35 I BUSINESS PHONE: ('ice `f) —7(A2 • /2� n FAX NUMBER ) 45-3- ! ..3 CELL PHONE 5 i ' t. 6 ° t3 QUALIFIER'S NAME: A \ , t\--ix- 4)- A 0 furl \ QUALIFIER'S LIC NUMBER: ES I c O Co C� E-MAIL ADDRESS (IF APPLICABLE): O xiu E41 Q (--M4 • .J L T Created on 3119109 BY MLDV t RV 3126109 M DY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD 1940 NORTH MONROE STREET TALLAHASSEE FL 32399 -0783 DONNELLY, WILLIAM P WILLIAM P DONNELLY INC 4453 NW 99 WAY FORT LAUDERDALE FL 33351 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 Department's 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! (850) 487 -1395 DETACH HERE ISPLAYA RE QUIRED BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT 115 S. Andrews Ave., Rm. A -100, Ft. Lauderdale, FL 33301 -1895 — 954 - 831 -4000 VALID OCTOBER 1, 2011 THROUGH SEPTEMBER 30, 2012 DBA: Receipt #:181 -2617 Business Name: WILLIAM P DONNELLY INC Business Type :ELECTRICAL /ALARMS /CONTRALTO (SPEC ELEC CONT /LTD ENGY SY, Owner Name: WILLIAM P DONNELLY Business Opened:01 /01/2005 Business Location: 4453 NW 99 WAY State /County /Cert/Reg:Esl2000089 SUNRISE Exemption Code :NONEXEMPT Business Phone: 954-771-0377 Rooms Seats Number of Machines: Employees 1 Machines Professionals For Vending Business Only • Tax Amount Transfer Fee . NSF Fee Penalty . - .. -....� . ,,- -. Prior Years Collection Cost Total Paid 27.00 0.00 0.00 0.00 0.00 0.00 27.00 THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS THIS BECOMES A TAX RECEIPT This tax is levied for the privilege of doing business within Broward County and is non - regulatory in nature. You must meet all County and /or Municipality planning WHEN VALIDATED and zoning requirements. This Business Tax Receipt must be transferred when the business is sold, business name has changed or you have moved the business location. This receipt does not indicate that the business is legal or that it is in compliance with State or local laws and regulations. Mailing Address: WILLIAM P DONNELLY 4453 NW 99 WAY SUNRISE, FL 33351 Receipt #035 -10- 00001849 Paid 07/15/2011 27.00 2011 - 2012 03 -17 -2010 ALEX SINK 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: 05/06/2010 EXPIRATION DATE: 05/05/2012 PERSON: DONNELLY FEIN: 113710070 BUSINESS NAME AND ADDRESS: WILLIAM P DONNELLY INC 4453 NW 99 WAY SUNRISE FL 33351 SCOPES OF BUSINESS OR TRADE: 1- WIRING WILLIAM P 2- TELECOMMUNICATIONS ( 6325 ) * IMPORTANT: Pursuant to Chapter 440 . 05(14), 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 under this chapter. Pursuant to Chapter 440.05{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 440.05(13), F.S., Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation if, at any time after the filing elf the notice or the issuance of the certificate, the person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate. The department shall revoke a certificate at any time for failure of the person named on the certificate to meet the requirements of this section. QUESTIONS? (850) 413 -1609 DWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 09 -06 PLEASE CUT OUT THE CARD BELOW AND RETAIN FOR FUTURE REFERENCE STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION CONSTRUCTION INDUSTRY CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW EFFECTIVE 05/06/2010 EXPIRATION DATE: 05/05/2012 PERSON: WILLIAM P DONNELLY FEIN: 113710070 BUSINESS NAME AND ADDRESS: WILLIAM P DONNELLY INC 4453 NW 99 WAY SUNRISE, FL 33351 IMPORTANT OPursuant to Chapter 440.05(14), F.S., an officer of a corporation who elects exemption from this chapter by filing a certificate of election 1- under this section may not recover benefits or compensation under this D chapter. H Pursuant to Chapter 440.05(12), F.S., Certificates of election to be exempt.. apply only within the scope of the business or trade listed on Rthe notice of election to be exempt E Pursuant to Chapter 440.05(13), F.S., Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation if, at any time after the filing of the notice or the issuance of the certificate, the person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate. The JEFF ATWATER CHIEF FINANCIAL OFFICER STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION 02 -14 -2012 * * 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: PERSON: 05/05/2012 EXPIRATION DATE: 05/05/2014 DONNELLY FEIN: 113710070 BUSINESS NAME AND ADDRESS: WILLIAM P DONNELLY INC 4453 NW 99 WAY FT LAUDERDALE FL 33351 WILLIAM P SCOPES OF BUSINESS OR TRADE: 1- WIRING 2- TELECOMMUNICATIONS (6325) * IMPORTANT: Pursuant to Chapter 440 . 05(14), 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 under 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 440.06(13), F.S., Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation if, at any time after the filing of the notice or the issuance of the certificate, the person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate. The department shall revoke a certificate at any time for failure of the person named on the certificate to meet the requirements of this section. QUESTIONS? (850) 413 -1609 DWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01 -11 PLEASE CUT OUT THE CARD BELOW AND RETAIN FOR FUTURE REFERENCE STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION CONSTRUCTION INDUSTRY CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW EFFECTIVE: 05/05/2012 EXPIRATION DATE: 05/05/2014 PERSON: WILLIAM P DONNELLY FEIN: 113710070 BUSINESS NAME AND ADDRESS: WILLIAM P DONNELLY INC 4453 NW 99 WAY FT LAUDERDALE, FL 33351 SCOPE OF BUSINESS OR TRADE: 1- WIRING 2- TELECOMMUNICATIONS (6325) IMPORTANT F Pursuant to Chapter 440.05(14), F.S., an officer of a corporation who O elects exemption from this chapter by filing a certificate of election I. under this section may not recover benefits or compensation under this D chapter. Pursuant to Chapter 440.05(12), F.S., Certificates of election to be H exempt.. apply only within the scope of the business or trade listed on E the notice of election to be exempt R E Pursuant to Chapter 440.05(13), F.S., Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation if, at any time after the filing of the notice or the issuance of the certificate, the person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate. The department shall revoke a certificate at any time for failure of the person named on the certificate to meet the requirements of this section. QUESTIONS? (850) 413-1609 CUT HERE * Carry bottom portion on the job, keep upper portion for your records. DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01 -11 CERTIFICATE OF LIABILITY INSURANCE DATE 012 THIS CEETTB1CATE IS ISSUED AS A MATTER OF 111WORNIATKIN ONLY AND CONFERS NO RIGHTS UPON 'THE CERTIFICATE FOLDER. TM CERTIFICATE DOES NOT AFFMIMATNELY CR MATEtiELY MOW ECPN OR ALTER THE COVERAGE AFFORDED BY THE POLICIES MOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN ME MOM • S), AUTHORIZED REEPRESENTANE OR PRODUCER, N T E OERTWMATE HOLDER. NVORTANII w the eertMotte holder Is an AVOWAL Ithe ate} tit be etatareed, If SUBROCRWRIVAIVB0, subject to the terms a wl contaltatts of the pansy, comb wades may make on ellimmant. Atonement on this mattlteltedoes not mho motto bathe oertaktate holder In Hal E such si- PROEU llkirikts kmtre SSD S.W. 40 Ave. Madden. FL 33317 Phone M54)587-7850 OISURIED WORM P may, ins 4453 NW Nth Way Sunrtsa, FL WW1- COI/MAWS (954)807 -7 aom SMORMIN4AFTGRallas maim= tra (954 /-7rt8 A. Crams& (9 54) 743 -61320 tea: WIG INSURERD: RJR E; INNO/10i F • cERTEICATE RUMBE RR: REVISIM NUMBER: THIS IS TO CERTIFY THAT d5$ OF INSURAIVE > asLCW wws BEEN THE tusuRED NAMED ABOVE FOR THE ROLIGY MOD MATED. NOTWIMSTAteele ANY Rectummarr, TERM OR COMMTICW CF ANY CONTRACT OR OTIER =wen WITH RESPECT TO WHICH THE CERTIFICATE NAY RE InSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BYTHS TOWER DESCRIBED HEREIN IS BIBLIECT TO ALL THE TEBES, EIGEGLUIRONG AND OF SUCH FOUCIEs. WETS SHDINN MAT HAVE BEEN =UMW/ PAdD 7YR60R Rd9I PiflfDYttJllABw1(I MENAL MORAY • OGIBMOVIAL GRIM& UARLnV A 0 Cl aAmmAcE 6/ CCmis uses O186FL4N31160 Mt AGGREGATE MIT APPI.EE S PER T_ I ❑ LOC Aumom LIAaiU ❑ Win ❑ tD ❑ MEG Awes 0 Attics D L A U A S ❑ OZOVR LI EWERS mAn ❑ NORMS =IRRIGATION AND ERAFLIAM IJTY Y/N "ANINMETEW*AwEr- ganeftenvy N rA 1N ham' PERSONAL R ADD Ate' . AGGREGATE maim • COMPIOP AGO DERGERTANI # OMAN= ILaeAT WERIGLEs (iamb AGM 101.Ad naIRsaaits8aha ute,if more s fe COMMUMEM TE H Muni Shares Valve t Cknortinent 10050 NE 2nd Avenue liNarld Shares, FL 33138 1954-633-4173 CANCELLATION ACORD 26 (2010/66) IGF Nts.O ANY OF THE Ate. DESORISED POLWES Se CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE! WILL BE DELWEED IN ACcoNoANcat WITH THE MIST 19$16.2019 ACORD CORPORATION. All rights rte. The Ate name and logo are registered marks of ACORD Mar. 19. 2012 3 :U /PM the Phone Doctor No. 101/ P. 1 "For All Your Communication Needs" Gr�ceps ?3dr d axsd'froareet crkh40ei1yy4t 4453 AMT 99 Way Sumrties FV 33352 StiteeLiowt4teES 12000089 * REQX71RED *DATE X t t L COP Liti *REQUEST EIThY X r 0 M �i � * TEL x = O ftrg 954.748.6600 Fag/ 954.653.4173 Annellaktligathall 3/14/32 PAX 7iv5757 - E-MAR. _ �1 tti e CPYI C?P'1// *MASTER PERMIT # X YI [ P O L I O # 1 N. l C2 b -$ 611- L& (RCEL # 1 )-P46 (l t yt r ?..J *JOB NAME X ' 1 9 lit F �' *CUSTOMERNAME X 0- C MAX PRUNE X I ®5 1 )5'b.3 7 *YOB ADDRESS X q N? frile L CITY v i 1044 ► Wit' 3 / *PROPOSED PROPERTY USE f � 15 l! IG& *GENERAL CONTRACTOR X Tt ?6 3 C "td *PHONE i Oa ** 65542— *G C'S. ADDRESS X L( l /do 56 it. CITY POOL ZIP I i 4 "NEW ALTERATION ADDITION J)EMO' -MON X *# OF CAT 3'S (VOICE) X COST X 0 # OF FIBER Cti COST }# OF CAT 5'S (DATA) X Y COST # OF CATV'S ID COST DI' 4tO COST (IF ANY) # OF SPEAKERS t) COST TOTAL# OF OIYrLETS X 1 - TOTAL COST X EQUIPMENT 111 PLEASE ER ADVISED: All info is re qufed Tryon pick up the permit, I need a copy of the lo voltage permit with the permit number. I also need to know when you call hi for the rough and the final. The Master Permit Number (Vail) needs to be exact, wtwo dashes and zeros. Please lit me know when the permit is tinny! and num( YOU g C TS- ,g;Pa5=-- a-c/Q-/"Zr b t6 Ca,47 L -8i 1q5 G A 3 313 Pavel' ,)--Lf59 •