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ELC-12-1389
Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 177873 Permit Number: ELC -7 -12 -1389 Scheduled Inspection Date: August 28, 2012 Inspector: Devaney, Michael Owner: Job Address: 10500 BISCAYNE Boulevard Miami Shores, FL 33138- Project <NONE> Contractor: ADAN ELECTRICAL SERVICES LLC Permit Type: Electrical - Commercial Inspection Type: Final Work Classification: Repair Phone Number Parcel Number 1122300010500 Phone: (786)2854847 Building Department Comments REPAIR MAIN DISCONNECT AS PER INSPECTOR REQUEST Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments August 27, 2012 For Inspections please call: (305)762 -4949 Page 17 of 17 , Miami Shores Village '` ECEOVE Building Department JUL 2412 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 -7BI4j, DING PERMIT ,APpLICATIQN Permit Type: Electrical JOB ADDRESS: FBC 20 Permit No. Master Permit No. City: Miami Shores County: Miami Dade Zip: Folio/Parcel# ra Is the Building Historlcaliq Designated: Yes NO Flood Zone: OWNER: Name (Fee Simple Titleholder): S. C., tot C_ 1aOt...&1s k Phone#: 30S.-- VII -S i Z.Lit Address: iOSCStS ta'a44.4krd llts'.. 6w.4 City: MIAMI (1\0424,5 State: jrL Zip: 3'513 Tenant/Lessee Name: Phone#: Email: �4 S-2 CONTRACTOR: Company Name: 4-4244A r ,mil , Sc r �� c 5 X c Phone# 86 °l S 2 Q 0T Address: 3CC 1 cSL.t/ City: Air . State: Zip:. Qualifier N. ie: State Certification or Registration #: (/3 O 0 £/T! //�� Certificate of Competency #: Contact Phone#: Email Address:Q�i4° e c./r1e 3 G 0.-/ r r /`/ CO-v✓+ DESIGNER: Architect/Engineer: Phone#: Phone#: Value of Work for this Permit: $ 0 e.7 CG 0 Square/Linear Footage of Work: Type of Work: DAddress DAlteration ONew DRepair/Replace ODemolition Description of Work: leiee9.0L °'--- `�� -°----) 3 p°4 e4.-7,=-7,e e-' T s '`°-- ,•7 5./02 &L + x****+ x***** ********* * * * * * * * * * * * * **x:a *** Fees****** ****+ x***** ****** *******+x************** Submittal Fee $ Permit Fee $ `3,C AeP CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ 1 1 J l -Bon Cdil sany's Name (if applicable) Bonding Coainpany'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. t understand that - sejsarate permit-mustbe secured for ELECTRICAL WOM WORK PLUMBING,- SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC OWNER'S A} 14 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 $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the abse of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature Signature wner or Agent ( Contractor The foregoing instrument was acknowledged before me this t� The foregoing instrument was acknowledged before me this day of �L'( , 20 (2 by i t 4 \ , day of So L� , 20 to ; by e ��'�`� who is personally known to me or who has produced 4 who is personally known to me or witicias pro c ('ih As identification and who did take an oath. as identification and who did take an oath. NOTARY PUBLIC: t e►r16w0, //� Sign: Sign: � , � = ••,... b �'t Print: Print: My Commission Expires: o .yam ti __ My Commission Expires: yr.•. O V �J.. Q`.`. ***m * + * * * * * *+x**a:+x.x ,.., . _ * * * * *' , * * * * * ** P$************ * * * * * * * * * * * * * * * * * * * *** * * * ** * * ** Ni►►►mtiM"I`‘ 260/7 APPROVED BY 'l,� CA- G /c%22'I,V Plans Examiner NOTARY PUBLIC: 7U4l 6 1 .67' Ff ass /04`/d * loss III otitis imv\`' Structural Review (Revised 3 /12/2012)(Revised 07110 /07)(Revised 06 /10/2009)(Revised 3/15/09) Zoning Clerk Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number. INSP - 174184 Scheduled Inspection Date: June 28, 2012 Inspector. Devaney, Michael Owner: Job Address: 10500 BISCAYNE Boulevard Miami Shores, FL 33138- Project: <NONE> Contractor: L&J CONSTRUCTION LLC, Permit Number: DEMO -5 -12 -976 Permit Type: Demolition Inspection Type: Final Work Classification: Electric Phone Number Parcel Number 1122300010500 Phone: (786)255 -1980 Building Department Comments ELECTRICAL DISCONNECTION FOR TOTAL DEMOLITION AND REMOVAL OF COMMERCIAL SWIMMING POOL .0L%/#9!/ Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments �/4 G �. re) /e2 ' 1 pG G 49/x.', k c ,1 °"°/('Vel' MAC irG geepAg.41(-.0--' 6"7/5 `I/ fll-55 01- (?&/914 61/AJ p ikNeep,14-4-40,— &•410.- cP4,947L/>-.46-- peA)400/ .lung 97 9A19 For Inspections please call: (305)762.4949 n.. _ •• _s n• 06 -01 -2012 JEFF ATWATER 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: PERSON: ADAN FEIN: 272398773 BUSINESS NAME AND ADDRESS: ADAN ELECTRICAL SERVICES LLC 3001 SW 37 AVE HOLLYWOOD FL 33023 06/01/2012 EXPIRATION DATE 06/01/2014 ROLANDO SCOPES OF BUSINESS OR TRADE: 1- ELECTRIC LMT OR POWER LINE C * IMPORTANT: " Pursuant to Chapter 440. 05114!, 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 revoatian if, at any time after the filing of the notice or the issuance of the certificate, the person named an the notice or certificate so 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 meat the requirements of this section. QUESTIONS? (850) 413 -1E OWC -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 06/01/2012 PERSON: ROLANDO ADAN FEU* 272398773 BUSINESS NAME AND ADDRESS: ADAN ELECTRICAL SERVICES LLC 3001 SW 37 AVE HOLLYWOOD, FL 33023 EXPIRATION DATE: 06/01/2014 SCOPE OF BUSINESS OR TRADE 1- ELECTRIC LIGHT OR POWER LINE C 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 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 Rthe notice of election to he exempt • E Pursuant to Chapter 440_051131, 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 manned on the notice or certificate no longer meet the requirements of this section for issuance of a certificate. The department shall revoke a certificate at anytime for failure of the person loaned on the certificate to meet the requirements of this section. QUESTIONS? (850) 413 -1809 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 • . -..•• .....yy,o „o, V atm rax. (ovn/ .14U -1:C4b To: +13067668972 ACCOli Fax: +13067668972 Page 2 of 2 7/19/2012 10:08 CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 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(ies) roust 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 Qbik Insurance, Inc 5701 Sunset Drive Ste. 256 South Miami, FL 33143 Phone (866) 320-7245 INSURED Fax (305) 9647715 CONTACT NAME: Alexis Del voile rAilCOIio ' E ): (866) 320 -7245 VAIL ADDRESS: adelvall A e(tgbildnsurance.com (A/c. Not (305) 964 -7715 INSURER(S) AFFORDING COVERAGE Man Electrical Service 3001 SW 37 Avenue Hollywood, FL 33023 COVERAGES CERTIFICATE NUMBER: INSURER A : Accidental Insurance Company INSURER B : NAIC • INSURER C : INSURER D : INSURER E : INSURER F : THIS 15 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 POUCIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR A TYPE OF INSURANCE GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY ❑ ❑ CLAIMS -MADE 0 OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: ❑ POLICY ❑ Wf ❑ LOC AUTOMOBILE LIABILITY ❑ ANY AUTO ❑ SOS NEO ❑ HIRED AUTOS ❑ UMBRELLA LAB ❑ EXCESS LIAR ADDL INSR SUER VVD POLICY NUMBER CPP0002917 (MMO/DDD ) 05212012 POLICY EXP (MM/DDKYYY) 05212013 EACH OCCURRENCE LIMITS PRREMISESO(Ea occccurrrence) $ 1,000,000.00 $ 100,000.00 MED EXP (Any one person $ 5,000.00 PERSONAL & ADV INJURY $ 1,000,000.00 GENERAL AGGREGATE PRODUCTS - COMP /OP AGG $ 1,000,000.00 $ 1,000,000.00 1_1 AUTOSULED ❑ AnSVVNED ❑ ❑ DED ❑ RETENTION $ ❑ OCCUR ❑ CLAIMS -MADE 'Ea eBIINEDtSINGLE LIMIT $ BODILY INJURY (Per person) $ BODILY INJURY (Perecddent) PROPERTY DAMAGE (Per accident) $ YORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFRCERIMEMBER EXCLUDED? (Mandatory in NH) DESG`RI TION OF OPERATIONS below EACH OCCURRENCE $ AGGREGATE NIA ❑ ORY LIIMIITTS ❑ ERH E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYE DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) CERTIFICATE HOLDER EL. DISEASE - POLICY LIMIT CANCELLATION Qty of Miami Shores 11050 NE 2nd Avenue Miami Shores, F1.33138 Fax 305 - 756-8972 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE %MTH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25 (2010/05) QF ©1988 -2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD BROWARD COUNTY LOC vd# 115 S. Andrews Ave., Rm. A -100. Ft. Lauderdale. FL , 33301 -1895 — 954-831 -4000 VALID OCTOBER 1, 2011 THROUGH SEPTEMBER 30, 2012 Receipt #:181- 236204 Business Type: cic L/ s /CONTRACTO (ELECTRICAL CONTRACTOR) Owner Name: ROLANDO ADAM Business Opened:06 /01/2010 Business Location: 3001 SW 37 AVENUE State/County/CeriIReg:EC13004 53 HOLLYWOOD Exemption Code: Business Phone: 786 -285 -3847 Vendlna Type: nwauw ,l inaww.vo. - - - - Tax Mount Transfer Fee NSF Fee Penalty Prior Years Coled on Cost Total Paid 27.00 0.00 0.00 0.00 0.00 0.00 27.00 THIS RECEIPT MUST BE THIS BECOMES A TAX RECEIPT WHEN VAUDATED POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS This tax is levied for the privies of doing business within Broward County and is non- regulatory in nature. You must meet all County and/or Municipality planning 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: ROLANDO ADAN 3001 SW 37 AVENUE HOLLYWOOD, FL 33023 Receipt #132 -10- 00008048 Paid 09/30/2011 27.00 2011 - 2012