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EL-15-3133 Miami Shores Village EEC EIVED T �\� It 0'2 2016 Building Department Y: 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 B Tel: (305)795-2204 Fax: (305)756-8972 _ INSPECTION LINE PHONE NUMBER:(30S)762-4949 �( FBC 20 iq BUILDING Master Permit No. G 9- /,57- �7-fib& PERMIT APPLICATION Sub Permit No. F-1 BUILDING 10 ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION [—]RENEWAL PLUMBING ❑ MECHANICAL PUBLIC WORKS CHANGE OF CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 3 I I S T N - 9( City: Miami Shores County: Miami Dade Zip: :3 / Folio/Parcel#: Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: �I -�; Flood Zone: BFE: FFE: C OWNER: Name(Fee Simple Titleholder): �E ��/ OAF721 TE fMaGT Phone#: �/��6 7— % �Y Address: -3 5 — q 7 S T City:/42AUQ 61AQai5 State: �L Zip: Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: 4ZE�S OUR �L�G, GOa/T -7, Phone#: / 96-22 0174 Address: ;?c/� J� YN 70 A0i=- City: /`` / State: 3 Zip: Qualifier Name: 17_.414c>1,1L 1t/ 01- 1-17-C- Phone#: 7266- State Certification or Registration#:EC Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: .r 64 Value of Work for this Permit:$ S06 �� Square/Linear Footage of Work: Type of Work: ❑ Addition , Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: t<!E� WllZ/L1LC, �LG. .5�72 i0l c� OL/,'FT 7-0 Specify color of color thru tile: Submittal Fee$ Permit Fee$ ✓�7APe9 CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ 4 8 ' 00 (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. ignatureJ Signature WOR or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before/me this day of �p" 20 by day of`-\Qr 1 20 C7 by �t G✓�— R--.4 il—Sk fte-C 1,who is personally known to �� 'V—who.is personally known to (me or who has produced 1L l l'C.t-,.�� - as _rae 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: Print: �c�vtGr� Print :1t.� AUHIANA RDI Y GOMM1 Seal: MY COMMISSION#EE 867174 o`' r 10.2017 Seal:' `:;� . �(pIRESDecernbe �= EXPIRES:January 22,2017 '�a'`•• �rvice,com w' 4 Bonded Thru Notary Public Unde writers 140o 399 015.9 FioridallotBry APPROVED BY �1*11*VlAlans Examiner Zoning Structural Review Clerk (Revised02/24/2014) T ORES GIS M 1 - 1 iami shores Village Big - Binet" Building Department �LE8I 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CHANGE OF CONTRACTOR / ARCHITECT Permit N. Owner's Name (Fee Simple Title Holder): 9dphone#: Owner's Address: City: State Zip Code: 3 3 Job Address (Of where work is being done): 35 NE City: Miami Shores State:—Florida Zip Code: 33` 8 Contractor's Company Name: 7C P L2 M. /=s.�1, Phone#: D,�! 2�c� 00 Address: q33 AJ IY5 City: I 6All State: Zip Code:d15 f Y9 Qualifier's Name: _ otJ Lic. Number:EL9 Opo Z.7_7— Architect/ Architect/ Engineer of Record Name: Phone#: Address: City: State: Zip Code: Describe Work: %OZ/� hereby certify that the work has been abandoned and/or the contractor/architect is unable or unwilling to complete the contract. I hold the Building Official and the 4p, i Shores harmless of all legal involvement. Signature Signature r-_I�rz neo ontract r Architect The foregoing instrumerWwas aknowledged before me The foregoing instrument was aknowledged before me this qday of ,20M,by this 9--+ day of 0'(/ , 207dby Who is personally known to me or who has produced who is Derspnally known to me or who.has produced as indentification. JL s indentification. Notary P lic: Notary P lic: / Sign: /Yt/ Sign: �� Seal: Seal: ;: LILtANA S MORENO LILIANA S MORENO MY I-OMMISSION N FF232151 ~ MY- 4;'QMMIS6- #FF23M • EXPIRES my 17.2019 ,• EXPIRES July 17,2018 �"— STATE DFFLORIDA DEPARTMENT 0FBUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD 10 818 The ELECTRICAL CONTRACTOR Named below |SCERTIFIED Under the provisions ufChapter489FS. Exp/rahondate AUG 31. 201G LDRENTE RAK8ON ALES GROUP ELECTRICAL CONTRACTORS S99SVV7OTHAVENUE M|AN1! FL33144 /sauso oo'zo/2014 DISPLAY ABREQUIRED BYLAW SEO# 1-14082u00020e9 Local Business Tax Receipt Miami-Dade County, State of Florida -THIS IS NOTA BILL - DO NOT PAY LBT 6950886 -L BUSINESS NAME/LOCATION RECEIPT NO' EXPIRES ALES GROUP ELECTRICAL CONTRACTORS RENEWAL SEPTEMBER 30, 2016 896 SW 70 AVE 7226574 Must be displayed at place of business MIAMI FL 33144 Pursuant to County Co<ie Ctapier 8A-Art.9&10 OWNER SEC.TYPE OF BUSINESS PAYMENT RECEIVEO A.-:-:S GROUP %`1 196 ELECT�*;CAL CONTRACTOR BY TAX COLLECTOR E COOK,12 8 8 575-00 09/30/2015 ECHECK-15.-167400 This Local Business Tax Receipt only confirms payment of the Local Business Tax. The Receipt is not a license, permit,or a certification of the holder's qualifications,to do business. Holder most comply with any governmental or nongovernmental regulatory laws and requirements which apply to tile business. The RECEIPT NO.above must be displayed on all commercial vehicles-Miami-Dade Code Sec 8a-276, For more informimoo,visit WAw_MJ.f.Vjjtdad-gqyftax;_Qjjjctor .A j1?")r CERTIFICATE OF LIABILITY INSURANCE3/DATE(mM/016Y) 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)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!leu of such endorsement(s). ;PRODUCER CONT ANDYS ASSURANCE AGENCIES PHONE ANDY RODRIGUEZ JR _.... No,Ext) (305) 642-8407 {aC N_. 1441 ).(305)643-5969 W Flagler St AfL . Miami, FL 33135ADDRESSandyjr@andysassurance.com INSURER(S) AFFORDING COVERAGE NAtCa INSURER A SCOTTSDALE INSURANCE CO I ,INSURED ALES GROUP INC IINSURER e: _._. ........._......_... d/b/a PROLOCK & SAFE/ALES GROUP INSURER C, ELECTRICAL CONT/ALES GROUP GC INSURER D 896 SW 70 AVENUE INSURER E MIAMI, FL 33144 i 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. •NSFt^.. ......._............_�—_ ...._..... _..-iA001"'SUER i,TR TYPE.OF INSURANCE 11NSD:wvD POLICY NUMBER M DDNCY_WY MODIYYYYT LIMITS .I /� X I COMMERCIAL GENERAL LIABILITY ( j 'EACH OCCURRENCE $ 1 000 000 D71GfAGE"TtsRENTFD _............... !___. _I CLAR.IS Mi�DE X OCCUR LREMISES{Ea occunence) s lOO 000 ` _.. ..... . . ! MED EXP(Any one person) $ 5 6661 I _ r A I CPS2381008 !01/03/16 01/03/17 PERSONAL&ADV INJURY is 1,000, 000 GENA..AGGRF,GATE LIMIT APPLIES PER POLICY I 'PRO _ GENERAL AGGREGATE i$ 2,OOO,OOO r.............._ __..._.... _........._ ......._... ..__ JECT LOC1,000,006 _._........., I PRODUCTS-COMP/OP AGG S 1,0 0 0,0 0 6 OTHER AUTOMOBILE LIABILITY _ ' $ 1 ANYAUTO BODILY INJURY(Per person) $ —_...............—_ ALL OWNED `:'__ SCHEDULED ! —.. .........-_ __.......... _. AUTOS _ ;AUTOS I BODILY INJURY(Per accident)!S I ! "!NON.OWNED E " i. .I HIRED AUTOS AUTOS � ; � (Per accident) ? UMBRELLA LIAR ( ( OCCUR TEACH CURRENCE s EXCESS LIAR F--•-----OC _ CLAIMS-MADE I ; I AGGREGATE _.._ I s_.............. ......___... DED RETENTIONS ? $ VVORKERS COMPENSATION {{ f AND EMPLOYERS'L.IARILITY ! = 1 i STATUTE__..:._ !ER _ YrN ,4^:Y PRCpRI-TOR,PAR.TNE2FkECU'iJE E.L.EACH $ OFFCERry PSER LY.C_UCED; NIA '_. j {re,;,,u n m NM7 ° ;E.L.DISEASE-EA EMPLOYE$ I!y es d c eiind=t ._. UESC,F{II TION OF OPERATIONS below I E.L.DISEASE-POLICY LIMIT;$ f i T11ES('.RfI1"r10N OF OPERATIONS;LOCA"r IONS 1 VEHICLES iACORD 101,Additional Remarks Schedule,may be attached if more space is required) Locksmith (14913) , Door & Window Installation (91746) , Alarm Installation (91127) , Electrical Work (92478) , General Contractor (91580) & Subcontracted Work (91585) i I CERTIFICATE HOLDER CANCELLATION City of Miami Shores SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE j 10050 NE 2 Avenue THE EXPIRATION DATE THEREOF, NOTL� E WILL BE DELIVERED IN Miami Shores, Fl 33138 ACCORDA CE WITH THE POLICY PROVISION$/ AUTHORIZE REPRESENTATIVE f f «-T( ©1 8-2013 ACO D CORPO TIO 11 rights reserved. ACORD25(2013/04) The ACORD name and logo are registered marks ACORD V A��® 74/25/2016 TE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 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)must have ADDITIONAL INSURED provisions or 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 SUNZ Insurance Solutions, LLC. ID: (TLR) NAME:CONTACT Workers'Comp Department c/o TLR of Bonita, IncPHONE FAX 700 Central Ave, Suite 500 a MAIL° Ext: 727-520-7676 x 3 AIc No): 727-525-3862 St. Petersburg, FL 33701 ADDRESS: INSURERS AFFORDING COVERAGE NAIC# INSURERA: SUNZ Insurance Company 34762 INSURED INSURER B: Aspen Re-London-Best Rating"A+" TLR of Bonita, Inc INSURER C: Chaucer Syndicate-Lloyds-Best Rating"A+" EnterpriseHR 700 Central Avenue Suite 500 INSURER D: Faraday Syndicate-Lloyds-Best Rating"A+" St. Petersburg FL 33701 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 29587341 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. INSR1 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LTR INSD WVD POLICYNUMBER MMIDD/YYYY) fMM/DD1YYYY1 LIMITS COMMERCIALGENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE OCCUR DAMAGE TO PREMISES Ea oNTED urrence $ MED EXP(Any one person) $ PERSONAL 8 ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY❑ PRO- JECT 1:1LOC PRODUCTS-COMPIOP AGG $ OTHER. $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident $ UMBRELLA LIAR HOCCUR EACH OCCURRENCE $ EXCESS LIAR — CLAIMS-MADEi AGGREGATE $ DED I I RETENTION$ 1 $ A WORKERS COM PEN SATIONWCPE00000001 11 6/1/2015 6/1/2016 jSPERTATUTE OERH AND EMPLOYERS'LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE YIN E.L.EACH ACCIDENT $ 1,000,000.00 OFFICER/MEMBER EXCLUDED? ❑ N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000.00 If yes,describe under DESCRIPTION OF OPERATIONS below I E.L.DISEASE-POLICY LIMIT 1$ 1,000,000.00 B Workers Compensation This is for informational purposes C Excess Coverage and nothing shall create any right D under such reinsurance. DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Coverage Provided for all leased employees but not subcontractors of:Ales Group,Inc.dba Prolock and Safe Client Effective:6/20/2014 dba Ales Group Electrical Contractor CERTIFICATE HOLDER CANCELLATION 7790 Miami Shores Village Building Department SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 9 9 P THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 10050 NE 2nd Ave. ACCORDANCE WITH THE POLICY PROVISIONS. Miami Shores FL 33138 AUTHORIZED REPRESENTATIVE Glen J Distefano ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD 1 Master Certificate I Aimee Gray 1 4/25/2016 3:52:54 PM (CDT) I Page 1 of 1