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EL-16-3042 Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 20 BUILDING Master Permit No.IDQCY-� 11—(E,—Ic63G PERMIT APPLICATION Sub Permit No.F-,,,, L ❑BUILDING E&ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL F—IPLUMBING F__j MECHANICAL PUBLIC WORKS Ej CHANGE OF CANCELLATION SHOP //�� CONTRACTOR DRAWINGS 10B ADDRESS: `©o' jk'6 ( 0 4 S f City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated:Yes NO iZ Occupancy Type: Load: Construction Tpe: Flood Zone: BFE: FFE: OWNER: Name(Fee Simple Titleholder): f 5 l 2 Phone#: G 2 2 3 3 Address: 1 O b 4 WL ( �`1 f? City: L41 1 Ay4t ';Pct/ State: Zip: Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name: pk 0/ N ��t 6C4%,J 7 C Phone#: IT'S N — y f 9 Address: FE)& —4o• 1>/xe_ �y City: RAU ~orrla State: Zip: 3-3007 Qualifier Name: e c4o"( G",r.. Phone#: State Certification or Registration#:jr—e— 2)-_"z2-3 Certificate of Competency#: DESIGNER:Architect/Engineer: Pr Phone#: Address: // City: State: Zip: Value of Work for this Permit:$ 1 $O Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ihew ❑ Repair/Replace ❑ Demolition p� Description of Work: I r-S?.n I I A � — 3�y � P 'Z Ljo V , r-t b t�.�.1Z1 �fi� Ciel Specify colortof color thru tile: Submittal Fee$ Permit Fee$ j—m !ya CCF$ ( CO/CC$ Scanning Fee$ in Radon Fee$ 2 - 7-5 DBPR$ Z' Z-5 Notary$ 5 Technology Fee$ Z_• U Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ I � , 30 (Revised02/24/2014) 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 ELECTRIC, PLUMBING, SIGNS, POOLS, FURNACES, BOILERS, HEATERS,TANKS,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 OWNER or AGENT CONTRACTOR The fol;--66-ng instrument was acknowledged before me this Theforegoing instrumen was acknowledged before me this _ff+day of kUV1Qm5Xy- 20 i� by `71/ daJy of OV1---L -c/ 20 by `ekCiti�lr`C 6 C, M • �C�iv2r who is personally known to j�44-C 4 1 who i personally known t me or who has produced D r SY0c y U CQ as me or who has prod ced as identification and who did take an oat identification and who did take an oath. NOTARY PU NOTARY LIC: Sign: Sian Print: Print: Seal: Seal: �Jayr ��'^v''• YANADY PRIETO Notary f Florida _ fMY COMMISSION#FF 214031 Com85470 EXPIRES:March 25,2019 My Commission Expires Apr.20,2018 Bonded Thru Notary Public Underwriters ******* ********************************************************************* APPROVED BY ! /Zz�iyt/!/l` Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) Permit iv©. EL-11-16-3042 ,SBORES�� Miami Shores Village Permit Type: Electrical -Residential 10050 N.E.2nd Avenue NE ''t Work Classification:Addition/Alteration Miami Shores,FL 3313&0000 Per Permit Status:APPROVED Phone: (305)795-2204 LORIDp` 05/28/2017 Issue Date: 11/29/2016 Expiration: Project Address Parcel Number Applicant 1009 NE 104 Street 1122320290140 Miami Shores, FL 33138-2655 Block: Lot: ALEXANDRE&EMILIE RODIER Owner Information Address Phone Cell ALEXANDRE&EMILIE RODIER 2325 MAGNOLIA Drive MIAMI FL 33181- 2325 MAGNOLIA Drive MIAMI FL 33181- Contractor(s) Phone Cell Phone Valuation: $ 2,485.00 LAPIN ELECTRICAL CONSTRUCTION (305)935-4526 Total Sq Feet: 0 Type of Work:INSTALL WIRING FOR 2-3(4HP 2 240 Available Inspections: Additional Info: INSTALL WIRING FOR 2-3(4HP 2 240 Inspection Type: Classification:Residential Final Scanning:2 Meter Box Alteration Relocation Fire Alarm Service Change Review Electrical W.W. Underground Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $1.80 DBPR Fee Invoice# EL-11-16-61973 $2.25 11/29/2016 Credit Card $ 170.30 $0.00 DCA Fee $2.25 Education Surcharge $0.60 Notary Fee $5.00 Permit Fee-Additions/Alterations $150.00 Scanning Fee $6.00 Technology Fee $2.40 Total: $170.30 h . S 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 zonin Futhermo r I aut ize the ab -named contractor to do the work stated. November 29, 2016 Aut riz Signature:Owner / Applicant / Contractor / Agent Date Building Department Copy November 29,2016 1 From: GFI FaxMaker To:9544581030 Page: 2/2 Date 10/24/2016 9:42:35 AM Client#:77448 LAPEL ACORD_ CERTIFICATE OF LIABILITY INSURANCE DATE 24/20lY 10124!206 16 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 COATRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(,.:s)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 Certificate Department NAME:Advanced Insurance Underwriters, LLC PHONE SAX (Arc,No,Ext):954-4_16-9780 — �(A/c,No): 954-963-9776 3250 N.29th Ave ADDRIESS, Certificateofinsurance@advancedins.com Hollywood, FL 33020 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Wesco Insurance Company 25011 INSURED INSURERB:Associated Industries Ins.Co., 23140 Lapin Electrical Construction Inc INSURER C 806 S Dixie Highway INSURER D Hallandale, FL 33009 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 CONTRACTOR 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. INSR TYPE OF INSURANCE ADDL UBR POLICY EFF POLICY EXP LIMITS LTR INSR D POLICY NUMBER MMIDD/YYYY) (MMIDDIYYYY) A GENERAL LIABILITY WPP115581301 5/04/2016 05/04/2017 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES(Ea RENTED rr rce) $100,000 CLAIMS-MADE EX]OCCUR MED EXP(Any one person) $5,000 X PD Ded:500 PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'I_AGGREGATELIMIT APPLIES PER. PRODUCTS-COMP,'OPAGG $2,000,000 POLICY PECT LCC $ AUTOMOBILE LIABILITY COMRINED S,NGI E I IM:T Ea acciden! Is ANY AUTO BODILY INJURY(Per person) $ ALL OWNFD SCHFDUI FD AUTOS AUTOS BCOILY INJURY(Pe,accident) $ NCN-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS fPer accidenll $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MACE AGGREGATE $ DEC) I I RETENTION$ $ B WORKERS COMPENSATION AWC1065031 6/27/2016 06/27/2017 X WC STATIT OTH- AND EMPLOYERS'LIABILITY TORY LIMITS ER Y/N ANY PROPR!ETCRiPARTNER)EXECUTiVE� E.L.EACH ACCIDENT $1,000,000 OFFICERIMEMBER EXCLUDED? I � ; N/A (Mandatory in NH) F.DISEASE-EA EMPLOYEE $1,000,000 Ifyes.describe under DESCRIPTION OF OPERATIONS below I F.DISEASE-POLICY[IMIT $1,0010,000 I I DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) Lic#EC13003523 CERTIFICATE HOLDER CANCELLATION Miami Shores Village SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE g THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 10050 N.E.2nd ACCORDANCE WITH THE POLICY PROVISIONS. Mlami, FL 33138 AUTHORIZED REPRESENTATIVE ©1588-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010105) 1 of 1 The ACORD name and logo are registeree;narks of ACORD #..,1d99d31/M11Ag7x;n Rf,M This fax was sent with GFI FaxMaker fax server. For more information,visit: http://www.gfi.com I��I l.�l�ll�l�l�11111�1�1 VIII 11111 VIII 1111111111111 Partlotl Payroll Experts PO Box 5629 Scottsdale,AZ 85261-5629 CONFIDENTIAL 111111 VIII VIII VIII VIII VIII VIII VIII VIII VIII IIII IIII (Code 3976780101)(Box (50441) EE Checks/Returns)(Client 50441 Lapin Electric MAIL MAIL MAIL Lapin Electrical Construction Inc 806 South Dixie Highway Hallendale FL 33009 DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICc—LASING BOAR[ (850) 487-1395 uwW, fi' 2601 BLAIR STONE ROAD TALLaHASSEC F"L 32339-078., LAPIN, MICHAEL L LAPIN ELECTRICAL CONSTRUCTION (NG 2041 NE 2.08 ST MIAMI FL 33119 t onyssitulatiarls? With this license you tr.=.coral&aIle of the nearly one rnililon Floridians licensed by the fJepw'irr,ent of ussness rind ,,. STATE OF FLORIDA P'rof'essional Regulation. our professionaIs arid businesses range r DEPARTMENT GF z3USIPLES:;A.Pd1 from architects to yacht brokers,from boxers to barbeque " p Pp{�FESgiGrt AL F l*GULAj NON estaurants, and they keap Florida's ecuvomy strong. EC13CI03523 1:;I5'SUEI3: 08116/2016Every day v e work to;reprove the way we do business In order i.o serve you better. For information about our services, please CERTIFIED Et E'"TR1Q L CONTRACTOR log onto www.myfloridalicense.com. There you can Lind more A information about our divisions and the regulations that irnpac:t LAPIN, N11C HAEi I you, subscribe to deltartnrerlt newsletters and learn more abcut LAPIN ELECTIRIC L;C{jN§Ty�, TION INC the iiepartment's initiatives. Our mission at the Department is: License Efficiently. yegL1iutU Iu cer~TINtEf� under tha provi<<ons of ch.ae9 VS. Fairly.V�je constantly strive to serve you better so iF;at ou call ,.1s�eteocv-- , S?rve your customers. thank you for doing t}Li51neSS In Florida. Lx watam date : AUG 31,1018 and congratulations on your new license! DETACH HERE KEN LAWSON, SECRETARY RICK SCOTT, GOVERNOR J-fA..rl"OF FLORIDA f�EF'AR' '�IFNTT OF RPCpaL tCSINESS AND ONTR.AC TO LICE '.NSING BOARC3L�1'�ICii�4 ELEC 7,,,, LECTFZICAL CONTRACTOR Named. below IS CEKFlFIEJ Udder the provisions of Chapter 489 FS. Expiration date. AUG 31, 2018 � 0 LAPIN, MICHAEL L IN{, LAPIN ELECTRICAL CONSTRUCT 806 S DIXIE HWY FL 33009 ~' aMile� �= HALLANDALE K aV Rte. LAW SF t1st18'16t3()0Zr7J >wn osriDISPLAY AS REQUIRED BY ISbU s�2ots _ ilk lm P4 V V7-4�' :9*99: rA 00004. 000 :•00:0, 00 0 • 0 90 '00060 RFCEJ�VED NOV .7 2016 Op BY: IT #: m ,,nj Shores Village AP-90tiED BY DATE ZCNI','G DEPT BI DO DEPT �,_dJFCT 10 C(,,NIPI.V NCE W FH ALL FEUERAL -TA'E ANL)�,UjN i ( 4,LL--S AND REGtiLATIO':S ------------ Dor ,A,, t5 - 7-!?13