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ELC-17-862 Permit NO. ELC-3-17-862 sH°RE,S o,� Miami Shores Village Permit Type:Electrical-Commercial 10050 N.E.2nd Avenue NEPer s � ' Work Classification: Low Voltage Miami Shores,FL 33138-0000 Pen-nit Status:APPROVED Phone: (305)795-2204 F10RiDp` Issue Date: 3/31/2017 Fxpiration: 09/27/2017 Project Address Parcel Number Applicant 9501 NE 2 Avenue 1132060133920 Miami Shores, FL 33138- Block: Lot: DVS LLC Owner Information Address Phone Cell DVS LLC 9400 NE 2 Avenue (305)756-3711 MIAMI FL 33138- Contractor(s) Phone Cell Phone Valuation: $ 100.00 DOSOLES ELECTRICAL CORP. (954)793-2414 Total Sq Feet: 0 Type of Work:LOW VOLTAGE COST INCLUDED IN THE MA Available Inspections: Additional Info:LOW VOLTAGE COST INCLUDED IN THE MA Inspection Type: Classification:Commercial Review Electrical Scanning:1 Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $0.60 Invoice# ELC-3-17-63495 DBPR Fee $2.00 DCA Fee $2.00 03/29/2017 Check#:853 $50.00 $58.60 Education Surcharge $0.20 03/31/2017 Check#:858 $58.60 $0.00 Permit Fee $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 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. Futhermore,I aut i tae-aboue-nai d contra k stated. March 31, 2017 Author' Applicant / Contractor / Agent Date Building Department Copy March 31, 2017 1 � � ��r�- �� `� � 3 °�q CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 03129/2017 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 CONT NAMEacT Eric Anderson Anderson Insurance Solutions PHONE(Ala Nft 954 565-4321 FAX(AM 954 7040507 1921 NW 150th Ave Suite 101 EMAIL er) andersoninsurance rou .com Pembroke Pines FL 33028 INSURERS AFFORDING COVERAGE NAIL INSURER A: Travelers Indemnity Company of Connecticut INSURED INSURER B: Associated Industries Insurance Company Dosoles Electric Corp INSURER C: ,4061 Northeast 14 Avenue INSURERD: Oakland Park,FL 33334 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS 1S 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. INS R TYPE OF INSURANCE AODL SUBR POLICY EFF POLICY EXP LTR POLICY NUMBER IM LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1,000,000 A CLAIMS-MADE FXI OCCUR DAMAGE TO RENTED 100,000 Y 66068638197 03/2212017 0312212018 MED EXP(Any oneperson) $5,000 PERSONAL B ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 X [:]PRO- POLICY JECT r LOC PRODUCTS-COMPIOP AGG $2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ e ANY AUTO BODILY INJURY(Per person) $ ALL OWNEDSCHEDULED AUTOS BODILY INJURY(Per accident) $ AUTOS NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE DED RETENTION $ WORKERS COMPENSATION X PER X OTH- AND EMPLOYERS'LIABILITY ANY B o FF ICERIMEMBER EXCLUDED?ECUTIVE YIN NIA 4437602 0312312017 03/23/2018 E.L.EACH ACCIDENT $1,000,000 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE S 1,0009000 tf yes,describe under DE CRIPTIO F OPERATIONS below E.L.DISEASE-POLICY LIMIT I s 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached H more space is required) Electrical Contractor-License#EC13004985-Walter Perrone Fax#305-756-8972 CERTIFICATE HOLDER CANCELLATION Miami Shores Building Department SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 90050 Northeast 2nd Avenue ACCORDANCE WITH THE POLICY PROVISIONS. Miami Shores„FL 33138 AUTHORIZED REPRESENTATIVE W ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2094101) The ACORD name and logo are registered marks of ACORD Miami Shores Village -_ -, Building Department 4AR 2 Q 207 BY: \ 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 - �� • � Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 S `� `tel FBC 20 1`-1 BUILDING Master Permit No. PERMIT APPLICATION Sub Permit No.F i c2- F-11BUILDING © ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL F-IPLUMBING ❑ MECHANICAL OPUBLICWORKS ❑ CHANGE OF CANCELLATION ❑ SHOP ,,1 /� CONTRACTOR DRAWINGS JOB ADDRESS: �(6,,3J t V l', � NL 0 1 - City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): 00,' L` /, Phone#: Address: `d° _>C'r"_- , � r N° City: (I(ACK State: Zip: 3 3 13,S) Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name: Jb5oLE5 E LT 1'L I L C (L.ap Phone#: ' �1S f1 �q 3 241 Address: `(y I �6 1f1T"_ AVE City: _>,ACLV- State: E r_o2 pra zip: 3333 �1 Qualifier Name: (JA-LTE►Z 3)z rt Ot_l E Phone#: Sy 7 X13 2tI State Certification or Registration#: C C-) 3 vo y H{a 5 Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: p� City: State: Zip: Value of Work for this Permit:$ 5--Alteration ,/ Square/Linear Footage of Work: Type of Work: ❑ Addition [5 Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: Ld(� 1�0 / �� lC c ati: 1 �(�CO 0 1 N &aay,,� l�cL�l�vt7- Specify color of color thru tile: / ��//�� Submittal Fee$ Permit Fee$ �a �� CCF$ LII G CO/CC$ -- Scanning Fee$ Radon Fee$ DBPg$ ?_ Notary$ �— Technology Fee$ 'UC Training/Education Fee$ 'L O Double Fee$ �— Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ 53 -cea (Revised02/24/2014) Bondi ng'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. 1 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 inspect4no.tpro and-a-reins ection fee will be charged. SignaSignatureNERor4AGENT CONTRACTOR Theforre ng nstrument was acknowledged before me this The foregoing instrument was acknowledged before me a this O�O �dav of J —�L.l� 20 ,by 093 day of r/ 7�' { ,20 / ,by YP�¢ ( ad&Anywwho is personally known to WA LT;f,,I; 1P-f-x'vA1£ ,who is personally known to i r�or who has produced as me or who has produced as identification and who did take an oath. identification and who did take an oa1hl irP aria G. 4yysocki \, NOTARY PUBLIC: NOTARY PUBLIC: COMMi SoIOPd#Ff2339$1 EXPIRES. May 25, 2019 t^IWw.AA1Ro00TARY.00M Sign: Qi Sign: Q Lw Print: r Print: ..14 Seal: ,F10*"' ELIZABETH ELORRIAGA Seal: MY COMMISSION#FF9536M '•,,a EXPIRES January 25,2020 aor� 'e.o• ************ ***** ************************************************************** APPROVED BY I - /Z �'[>S' Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014)