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EL-15-2827 (2) LZ -� - Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-253669 Permit Number: EL-11-15-2827 Scheduled Inspection Date: March 03,2016 Permit Type: Electrical- Residential Inspector: Devaney,Michael Inspection Type: Final Owner: , Work Classification: Alteration Job Address:9959 BISCAYNE Boulevard Miami Shores, FL 33138-2644 Phone Number (305)979-1781 Parcel Number 1132050190470 Project <NONE> Contractor. MESA BROTHERS INC Phone: (305)345-1974 Building Department Comments INSTALL HIGH HATS AND NEW ELECTRICAL PANEL 200 Infractio Passed Comments AMP WITH DISCONNECT INSPECTOR COMMENTS False i Inspector Comments PassedEH CREATED AS REINSPECTION FOR INSP-253558. CREATED AS REINSPECTION FOR INSP-253457. No rough inspection or arc fault breakers. Failed Correction Needed Re-Inspection Fee No Additional Inspections can be scheduled until re-inspection fee is paid March 02,2016 For Inspections please call: (305)762-4949 Page 21 of 44 Dec. 23. 2015 1 :55PM j I '�- 2U� /,S-2`b No. 1681 P. 1/1 MLSAB-1 OP lb:GM ACORD' DATEtMWOWYYYYl CERTIFICATE OF LIABILITY INSURANCE 12122/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NFIGATIVELY AMEND, EXTEM3 OR ALTER THE COVERAGE Al'PORMb 13Y THE POLICIES BELOW. THIS C91TT1FICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT HETWEEN 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. N 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 endomemen a). PRODUCER rCIRNTACT Yolanda Mendez Globe[Risk LLC AMM 306 455-7250 Ma;305.455-7251 8989 Blue Lagoon Dr Suite 101 Miami FL 3326 EDRAO R PORTAS ;mall globalriskllacom INSURE AFFORDING COVERAGE NRC d INURERA I WOSCO Insurance Company INSURED Mesa Brothers Inc. 52.16 SW 103 Ave aasuREac Miami,FL 33165 MURER IMSURRIe li IMAURBR F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE USTED 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 13Y THE POUCIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POUCIFS.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TYPE Ole INSURANCE RWL BR POUCYNUMBERD� POMIUCY LWTS A X COMMMCIAL"NOtAL WIBRM mom OOCURRENCR a 1,000.00 CLVMB-WE 0 OCCUR VWPI22167401 0/10112018 01/01/2017 Pig Ea oo I i 100,00 eMED EXP An one =o S 8 00 PEMOX4L&ADVINJURY »' 1.000,00 GEWLAGGREOATN°UMITAPPLIESPER: GFNERALAGGREGATE S 2,000,00 PR X POLICY Q Jr LOC PRODUCTS-COW10P AGO 8 2,000,00 OTHER: d AUTOM091LE LIABILITY COMB Nenf[NGLE UL41TAomw 1,000,0 A ANYAUTO Vi/PP122167401 01/01/2016 01101/2017 BODILY INJURY(per pw&m) NI ALLLED AUTOS® AUTOS BODILY INAW(Per swMeno S X HIREDAUTO6 X AUTOS P Ni r S UNDIM"UAM OCCUR EACHoacURRENCE $ 10MESS UAB CLAIMS-MADE AGGREGATE NI DED I I RETEM7ONS E WORKERS COMPENSATION AM kNft0Y6Ra'LMBHJWY L N E ANYOFPIICBV MLMBER W(CWROPRISTOR1PAR rt ED?EOurlve N/A EL EACH ACCIDENT $ (Ma�ndelmyInHH E.L.DISEASE-EABMPLOY s If do P OPL�RATI NS below EL.DISEASE-POLICY umrr a DE801&nDN oR OPBRAMUS 1 LOCATIONS!VEHIQLE9(AaORb ib1,AddiSonal Rom Schedule,ropy l+e Ogohed U mora epom is raquVed) Electrical Work within Bid s-Blanket Additional Insured 02033&Blanket Waiver of Subrogation C2404 are made part of the policy CERTIFICATE HOLDER CANCELLATION MIAM111 SHOULD ANY Olt THE ABOVE DESCRIBED POLICIES BE CANCEL=BEFORE Mlaml Shores Village THE W(PIRATION DATE THERI=OI-, NOTICR WILL BE DELIVERED IN 10050 Northeast 2nd Avenue ACCORDANCE WITH THE POLICY PROVISIONS, Nam)Shores,FL 33138 AUTHORIZED RErR roYA'nV9 ®1988.2014 ACORD CORPORATION. All rights reserved. ACORb 26(2014101) The ACORD name and logo are reglsfered marks of ACORD t Miami Shores Village Building Department NOV ® i nt5 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 By. Tel:(305)795.2204 Fax:(305)756.8972 INSPECTION'S PHONE NUMBER:(305)762.4949 FBC 20 BUILDING Permit No. PERMIT APPLICATION Master Permit NPermit Type:Type: Electrical JOB ADDRESS: 9959 Biscayne Blvd City: Miami Shores County: Miami Dade Zip: 33138 Folio/Parcel#: 11-3205-019-0470 Is the Building Historically Designated:Yes NO X Flood Zone: OWNER:Name(Fee Simple Titleholder):Global Real Estate Acquire Phone#:305-979-1781 Address:20817 SW 92nd Ave court City: Cutler Bay State: FL Zip: 33189 Tenant/Lessee Name: C/O Samantha Gardner Phone#:305-979-1781 Email. samantha8873@hotmail.com CONTRACTOR:Company Name: Mesa Brothers, Inc Phone#: 305-630-2549 Address: 5215 SW 103 Ave City: Miami State: FL Zip: 33165 Qualifier Name: Raul Mesa Phone#: 305-630-2549 State Certification or Registration#: Ec13001870 Certificate of Competency#: Contact Phone#: 310--Z�4��i' Email Address: mesabrothers@att.net DESIGNER:Architect/Engineer: Phone#: Value of Work for this Permit:$8,000.00 Square/Linear Footage of Work: Type of Work: ❑Address OAlteration ❑New ORepair/Replace ODemolition Description of Work, aiL 0 �x�xx��xx��xxx�xx��xxxx�xxx��x�+x�x�x��Feesxxx��n��xxxx�x��xx��xxxxxx�x�x��x��xxx�x Submittal Fee$ Permit Fee$ _,� i��r�� CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Bond$ Notary$ Training/Education Fee$ Technology Fee$ Double Fee$ Structural Review$ TOTAL FEE NOW DUE$ .(C) �® t 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$2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issue n t e a e of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature Signature Owner or Agent Contractor The foregoing instrument was acknowledged before me thisVV--0-L/' The foregoing inst ment was acknowledged before me this .J da of 13 y _,20_,by day of ,20 iS,by , who is personally known to me or who has produced who is personally known to me or who has produced 4�As identification and who did take an oath. as identificat A rHtc.a th. NOTARY PUBLIC: NOTARY PUBLIC: NANt:1'TEMA MY COMMISSION FR)84758 EXPIRES:JAN 21,2018 Bonded through let State Insurance Sign: Sign: Print• Print: My Co Notes Pubft StOW of Florida My Commission Expires: (A a(1 0201 J081Ni8 M Feliciano 082753 UU EYXpftss0112018 kkkdikk RB�Sr � k � kkkkrt�9k8k�&k+kkkkk��e�kkk8s��ekdats�&kk�dkkdk�k&kkkkkkkk�kkkkkkkkkkkkkk�akkk APPROVED BY "�v/ �irylO/� Plans Examiner Zoning Structural Review Clerk (Revised 3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09) ICK SCOTT, GOVERNOR .._. _ ....... KEN LAWSON, SECRETARY DEPARTT OF"SU �Kt�U'1'ROFE$S14Nk�.REGULATION CTORS fr{CfsN5T1VG�BflA6 !l5e1r C1 G' 7 RED v �pFe�.oi'G#a�pter9 F.S. 9 Ha'� ..�..t.•!1 ,_.:_lam' ....,•-��r., o -,�, ,, �`'.'.., /:.J. s ISSUED: 06/10/2014 DISPLAY AS REQUIRED BY LAW SEQ# L1406100001578 Local Ban ca Tax Receipt Miami—Dade County, State of Florida -THIS IS NOT A BILL - 00 NOT PAY -LBT 405779 BUSINESS NAME&OCATION MESA BROTHERS INC RECEIPT NO. EXPIRES 5215 SW 103 AVE RCENEWAL SEPTE MSE R 30, 3016 MIAMI FL 33165 4013779 Must be displayed at place Of business Pursuant to County Code Chapter BA •An.9&10 OWNER SEC.TYPE OF BUSINESS MESA BROTHERS INC 196 ELECTRICAL CONTRACTOR PAYMENT RECEIVED C/O RAUL MESA,QUALIFIER EC13001870 BY TAX COLLECTOR Worker(s) 10 875.00 07/15/2015 CHECK21-15-095549 This Local Business Tax Receipt only confirm$payment of the Local Business Tax. The Receipt is not a license, parmtl or a cerdHoetion of the holder's qualifications,to do business. Holder must oomply with any governmental or nonoovernmen1411 Mouletory laws ead repuiremems whichepplY to the buamast The RECEIPT NO,sbcve must be displayed on all commercial vehicles.Mltunl-Dede Code Sec sa-276. For more Information,visit MESAB-1 OP ID:YM CERTIFICATE OF LIABILITY INSURANCE I DATE(MMIDDIYYYY) 0611612016 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 this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER NAME: Yolanda Mendez Global Risk LLC 5858 Blue Lagoon Dr Suite 101 PHONE 305-455.7250 (FAX AIC.No):305.455-7251 Miami FL 33T26 ADDRESS:mall@globairlskllc—.com _ EDUA)2D0 R PORTAE _ INSURERS)AFFORDING COVERAGE NAIC p ---INSURER A:WOSCO Insurance Company INSURED Mesa Brothers—Inc. — INSURER B: 6215 SW 103 Ave Miami,FL 33165 INSURER C: INSURER 0: INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER: 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. L TYPE OF INSURANCE wvoPOLICY NUMBER IMMIODIYYYYI I(MMILIOD LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,0 CLAIMS-MADE T OCCUR WPP122167400 01/01/2015 01/01/2015 DAMAGE TO RENTEIT_ PREMISES Ea oecurrenco $ 100,00 MED EXP(Any one person) $� _ 5,00 PERSONAL&ADV INJURY $ 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ _ 2,000,00 X POLICY EC� LOC OTHER: PRODUCTS•COMP/OP AGG $ 2,000,00 � $ AUTOMOBILE LIABILITY COMBINE Me accident $_ ANY AUTO ! BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED UTOS $ r nt $ UMBRELLA UAB OCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMS-MADE AGGREGATE $ DED I RETENTION$ $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY TAT TE tER ANY PROPRIETORIPARTNERIEXECUTIVE Y 1 N OFFICER/MEMBER EXCLUDED? NIA4. L EACH ACCIDENT $ (Mandatory in NH) – — II es,deaptbe under E.L.DISEASE•EA EMPLOYE $ D SCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more apace Is required) Electrical work within buildings-CG2033&CG2404-Blanket Addl Ins and Waiver of Subrogation,when required by written contract/agreement CERTIFICATE HOLDER CANCELLATION MIAM111 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Miami Shores Village THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 10050 Northeast 2nd Avenue ACCORDANCE WITH THE POLICY PROVISIONS. Miami Shores,FL 33138 AUTHORIZED REPRESENTATIVE ®1888-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD A CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYY1� ,W01/20,5 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 this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT "ME: Risk Manacement Department Stonehenge Insurance Solutions,Inc. PHONE FAX 300 Avenue of the Champions,Suite 222 ac No Ext): ass 925.2990%20834 ac No): s 637.8949 Palm Beach Gardens,FL 33418 ADDRESS: certsor ressiveem to er.com INSURERS AFFORDING COVERAGE NAIC 8 INSURED INSURER A:Technology Insurance Company,Inc. 42376 Progressive Employer Management Co.,Inc.and all its affiliates and subsidiaries INSURER B: For co-employees of Mesa Brothers Inc INSURER C: INSURER D: 6407 Parkland Drive INSURER E: Sarasota,FL 34243 INSURER R COVERAGES CERTIFICATE NUMBER: 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. Limits shown areas requested IN SR TYPE OF INSURANCE INSR gWVDR POLICY NUMBER POLICY EFF POLICY EXP LIMITS TR (MM/DD/YYYlr) (MMIDD/YYY1) GENERAL LIABILITY iACH OCCURRENCE AMAGE TO RENTED ERCIAL GENER MILI Y REMISES(Es ocmffwxe) CLAIMS MADE L_IOCCUR AED EXP(Anyone person) ERSONAL&ADV INJURY ENERALAGGREGATE GEN'L AGGREGATE LIMIT APPLIES PER: RODUCTS-COMP/OP AGG POLICY[ PROJECT=LOC AUTOMOBILE LIABILITY j OMBINED SINGLE LIMIT Each accident ANY AUTO DILY INJURY(Per person) ALL OWNEDSCHEDULED ODILY INJURY(Per $ AUTOS ALTOS xident HIRED AUTOS NON•OWNED ROPERTY DAMAGE(Per AUTOS cddent) UMBRELLA LIAB r7 OCCUR ACH OCCURRENCE EXCESS UAB CLAIMS-MADE j GGREGATE DED I RETENTION$ WORKERS COMPENSATION WC STATU- OTH- A AND EMPLOYERS'LIABILITY Y/N TORY LIMITS ER TWC3498277 10/01/2015 10/01/2016 $1,000,000 ANY PFRiMEMTOWPAR LUDED?%ECUTIVE L. EACH ACCIDENT OFFICERMIEMBER EXCLUDED? N/A (Mandatory In NH) L.DISEASE-EA EMPLOYEE $1,000,000 If yes, ribe DESCRIPTION OF OrPERATIONS beknv $1,000,000 .L.DISEASE-POLICY LIMIT I i DESCRIPTION OF OPERATIONS!LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space is required): Coverage is extended to oo-employees but not subcontractors of Mesa Brothers Inc ID:416802 CERTIFICATE HOLDER CANCELLATION Miami Shores Village SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WALL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE 2nd Ave AUTHORIZED REPRESENTATIVE Miami Shores, FL 33138-2304 qw�w 0 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD � m Miami Shores Village 10050 N.E.2nd Avenue Miami Shores,FL 33138-0000 Phone: (305)795-2204 Expiration: 0611212016 Project Address Parcel Number Applicant 9959 BISCAYNE Boulevard 1132050190470 GLOBAL REAL ESTATE ACQUI: Miami Shores, Fl- 33138-2644 Block: Lot: Owner Information Address Phone Cell GLOBAL REAL ESTATE ACQUISITIONS 9959 BISCAYNE Boulevard (305)979-1781 - ------ -- - MIAMI SHORES FL 33138- 995920817 SW 92 Court CUTLER BAY FL 33189- Contractor(s) Phone Cell Phone Valuation: $ 8,000.00 MESA BROTHERS INC (305)345-1974 ..�.,. ��._.......�..,...,,.�...�...�. _ Total Sq Feet: 00 T of Work:INSTALL HIGH HATS AND NEW ELECTRICA Available Inspections: Type pe Additional Info: Inspection Type: Classification:Residential Review Electrical Scanning:3 Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $4.80 Invoice# EL-11-15-57699 DBPR Fee $4.20 12/15/2015 Credit Card $310.20 $0.00 DCA Fee $4.20 Education Surcharge $1.80 Permit Fee-Additions/Aiterations $280.00 Scanning Fee $9.00 Technology Fee $8.40 Total: $310.20 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 AFFI A certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction a ore,I authorize the above-named contractor to do the work stated. December 15,2015 Authorized Signet r / Applicant / o / Agent Date Building Department Copy December 15,2015 1