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EL-17-356 Ib Perm �C - - ? � 3 x �gt� s 0 Miami Shores Village 10050 N.E.2nd Avenue NEP lull � Miami Shores,FL 33138-0000 Phone: (305)795-2204 Rr ,.. ,.. ... ,._., a.. .. . Issae •'t15/ t!'t7 Expiration: 08/14/2017 Project Address Parcel Number Applicant 390 NE 91 Street 1132060190190 Miami Shores, FL 33138- Block: Lot: KENNETH WILKINSON Owner information Address Phone Celt KENNETH WILKINSONFL (973)632-2529 Contractor(s) Phone Cell Phone Valuation: $ 400.00 ELECTRICAL SOLUTIONS FOR ALL L (786)663-0025 __....._ ,,,..._.. - _.......... Total Sq Feet: 0 Type of Work:low voltage>tv cables Available Inspections: Additional Info:low voltage>tv cables Inspection Type: Classification:Residential Review Electrical Scanning:1 Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $0.60 DBPR Fee Invoice# EL-2-17-62911 $2.00 02/15/2017 Credit Card $58.60 $50.00 DCA Fee $2.00 Education Surcharge $0.20 02/13/2017 Credit Card $50.00 $0.00 Permit Fee-Additions/Alterations $100.00 Scanning Fee $3.00 Technology Fee $0.80 Total: $108.60 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 AFFIDAVI IWrliathe foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction andzo in 1 uthorize the above-named contractor to do the work stated. February 15,2017 Authorized Signature: ner / Applicant / Contractor / Agent Date Building Dep ment Copy February 15,2017 1 Miami Shores Village ------ Building __Building Department FEB 13 2011 10050 N.E.2nd Avenue,Miami Shores, Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 F B C 20 BUILDING Master Permit No. R - (,- 44 - 170 PERMIT APPLICATION Sub Permit No. EL tl 35(n ❑BUILDING RELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL PUBLIC WORKS ❑ CHANGE OF CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: _�'90 /Ue- 9/ � '$7 City: Miami Shores County: Miami Dade ZiP:,52 Folio/Parcel#: Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): //�<An/ jGA U_hZ iR'9rk1 Phone#:(qY/?) r.R) 2 Address: ® )J g City: 1�7i/s2�!/jJl/ �'` � State: Zip: 1_3 Tenant/Lessee Name: Phone#: Email: p /� CONTRACTOR:Company Name: L&(Or A: 1j gZ)1 �� Phone#: L7ig� (c�4 � 01)Z-� Address: 1.(S Z /� �l'S City: /X'12412 11 State: 1=�rr•� a�� Zip: /D Qualifier Name: 90 )r w Q�y a3 o�y Phone#: (`,e.6 6 1y 2-3;; State Certification or Registration#: (!5P— 13 0/4 !79 A Certificate of Competency#: /2E P?nn :�t � DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work:_�o u J 4w/ !z,j2 gina /, TV CA big s Specify color of color thru-tile: � 4 O CCF$Permit Fee$ � CO/CC$ Submittal Fee$ V � q �, Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ X3 (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 0 ER or AGENT C NTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this 31_day/of ,rn JNJC4 4•y ,20 1- by 01 day of/J� 4t t\ )/CL r"y ,20 11 ,by A� - nn6(h ull- tns o ,who is personally known to 4y'('4 /(& ("'C u X7 3 ,who is personally known to me or who has produced as me or who has produced as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: �' Sign: lJ�� Print: N Print: I LAWAJ r+a Seal: MY COMMISSION p FF964W5 Seal: MY COMM1881gN#FF984005 EXPIRES Fabnjwy 23.2020 EXPIRES February 23,2020 �P^.J,3�-C•7:f rlurUxNoW8ewr;�wm 1407�� APPROVED BY J.5' Plans Examiner Zoning Structural Review Clerk (Re.vised02/24/2014) �. CERTIFICATE OF LIABILITY INSURANCE DAT 022/11//11/2001717 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 WANED,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 AMELIA REINOSO NAME: Estrella Insurance#115 PHON o . (305)887-8696 FAX No): (305)887-7869 (AIC1041 East 8th Avenue -p AIL Manager115@estrellainsurance.com Hialeah,FL 33010 INSURER(S) AFFORDING COVERAGE NAIC d Phone (305)887-8696 Fax (305)887-7869 INSURERA: ASCENDANT COMMERCIAL INSURANCE INSURED INSURER B: Electrical Solutions For All INSURER C: 2070 Bright Dr Apt 7 INSURER D: INSURER E: Hialeah FL 33010- 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 INSUF$ANCE 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. ILTR TYPE OF INSURANCE ADD UBR POLICY NUMBER MMND EFF MPOLICYI� EXP LIMITS 0 COMMERCIAL GENERAL LMILITY EACH OCCURRENCE $ 1,000,000.00 F-1CLAIMS MADE Q OCCUR DAMAGE TO RENTED PREMISES Ea occurrence $ F-1A GL 47001-1 02/04/2017 02/04/2018 MED EXP(Any one person) $ 5,000.00 ❑ PERSONAL&ADV INJURY $ 1,000,000.00 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000.00 ❑ POLICY ❑ PECROT ❑ LOC PRODUCTS-COMP/OP AGG $ 1,000,000.00 J ❑ OTHER FIRE DAMAGE LIABILITY $ 100,000.00 AUTOMOBILE LIABILITY RETTdIN�DtSINGLE LIMB ❑ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident $ ❑ AUTOS ❑ AUTOS NON-OWNED PROPERTY DAMAGE $ E] HIRED AUTOS ❑ nt AUTOS (pr accide ❑ ❑ $ ❑ UMBRELLA LIAB ❑OCCUR EACH OCCURRENCE $ ❑ EXCESS LIAR ❑CLAIMS-MADE AGGREGATE $ ❑ DED ❑ RETENTION$ $ WORKERS COMPENSATION ❑ PER ❑OTH- AND EMPLOYERS LIABILITY Y/N A TEER ANY PROPRIETOR/PARTNER/EXECUTIVT E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? u N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1 $ DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,H more space Is required) ELECTRICAL SERVICE(COMMERCIAL AND RESIDENTIAL) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE OVE DESCRIBED POLICIES BE CANCELLED BEFORE MIAMI SHORES VILLAGE THE EXPIRATION DA THEREOF,NOTICE WILL BE DELIVERED IN BUILDING DEPARTMENT ACCORDANCE WI THE POLICY PROVISIONS. 10050 NE 2 AVE AUTHO ED RE E ENTATIVE MIAMI SHORES FL 33138 AME IA INO A217750 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01)QF he ACORD name and logo are registered marks of ACORD