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ELC-17-88 Permit No. ELC-1-17-$8 `Sones q Miami Shores Village Permit Type:Electrical-Commercial 10050 N.E.2nd Avenue NE Work Classification:Addition/Alteration Miami Shores,FL 33138-0000 Per ItPermit Status:APPROVED Phone: (305)795-2204 �LORiDA Issue Date: 1/24/2017 Expiration: 07/23/2017 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: $ 28,900.00 DOSOLES ELECTRICAL CORP. (954)793-2414 Total Sq Feet: 0 Type of Work:DENTAL OFFICE A/C UNITS ELECTRIC • 4, Available Inspections: Additional Info:DENTAL OFFICE A/C UNITS ELECTRIC Inspection Type: Classification:Commercial NO ST BE ON Final Scanning: 1 Meter Box Alteration J03 ATIME OF Relocation Fire Alarm #' Service Change Review Electrical W.W. Underground Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $17.40 DBPR Fee Invoice# ELC-1-17-62599 $12.83 01/12/2017 Credit Card $50.00 $ 1,840.06 DCA Fee $12.83 Education Surcharge $5.80 01/23/2017 Credit Card $ 1,840.06 $0.00 Notary Fee $5.00 Permit Fee $855.00 Scanning Fee $3.00 Technology Fee $23.20 Work without Permit Fee $855.00 Work without Permit Fee $100.00 Total: $1,890.06 Applicant Copy For Inspections, Call (305) 762-4949 or Log on at https://bldg.miamishoresvillage.com/cap/. Requests must be received by 3 pm for following day inspections. NOTICE: In addition to the requirements of this permit, there may be AND THERE MAY BE ADDITIONAL PERMITS REQUIRED FROM OTHER additional restrictions applicable to this property that may be found in GOVERNMENTAL ENTITIES SUCH AS WATER MANAGEMENT the public records of this county. DISTRICTS,STATE AGENCIES,OR FEDERAL AGENCIES. January 23,2017 2 Permit nlo. ELC-1-17-88 `SHORES Miami Shores Village Permit Type:Electrical -Commercial 10050 N.E.2nd Avenue NE Pen 'i Work Classification:Addition/Alteration Miami Shores, FL 33138-0000 Permit status:APPROVED Phone: (305)795-2204 -��0 11D Issue Date: 112W2017 F Expiration: 07/23/2017 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: $ 28,900.00 DOSOLES ELECTRICAL CORP. (954)793-2414 ......... Total Sq Feet: 0 Type of Work:DENTAL OFFICE A/C UNITS ELECTRICAL Available Inspections: Additional Info:DENTAL OFFICE A/C UNITS ELECTRICAL Inspection Type: Classification:Commercial Final Scanning: 1 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 $17.40 DBPR Fee Invoke# ELC-1-17-62599 $12.13 01/12/2017 Credit Card $50.00 $1,840.06 DCA Fee $12.83 Education Surcharge $5.80 01/23/2017 Credit Card $ 1,840.06 $0.00 Notary Fee $5.00 Permit Fee $855.00 Scanning Fee $3.00 Technology Fee $23.20 Work without Permit Fee $855.00 Work without Permit Fee $100.00 Total: $1,890.06 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 authorize the above-named contractor to do the work stated. January 23, 2017 Authorized Signature:Owner / Applicant / Contractor / Agent Date Building Department Copy January 23, 2017 1 `f Miami Shores Village C— FBY: 211 Building Department AN 1 2 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 201q BUILDING Master Permit No.16-860 PERMIT APPLICATION sub Permit No.C.I C r-1 - 488 ❑BUILDING 0 ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 9503 NE 2nd ave City: Miami Shores County: Miami Dade Zip: Folio/Parcel#:11-3206-013-3920 Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FIFE: OWNER:Name(Fee Simple Titleholder): D Phone#: Address: a-(7 t tj�,- I� ST_ City: M ( b (S 1 State: — Zip: 330C Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name: DOSoleS Electric Crop Phone#: 9547932414 Address: 4061 NE 14th ave City: Oakland Park State: FL Zip: 33334 Qualifier Name: Walter Perrone Phone#: 9547932414 State Certification or Registration#: EC13004985 Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ jLU14X06 Square/Linear Footage of Work: Type of Work: ❑ Addition Alteration ❑ New ❑ Repair/Replaceel ❑ Demolition Description of Work: n o"\,*L cn� -i4i,'m Specify color of color thru tile: q /ep'00 Submittal Fee$ Permit Fee$ 3-5-,g� CCF$ CO/CC$ �— Scanning Fee$ Radon Fee$ DBPR$ Notary$ IC5 Ica Technology Fee$ Training/Education Fee$ Double Fee$ S Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ (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 no pprovedZA tion fee will be charged. zig:: Signatur Signature OWNE CONTRACTOR The foregoing i rument was acknowledged before me this The foregoing instrument was acknowledged before me this i Z day of �t3t_{� Q/ 20 1 by _�I day of �r 20 � + by Q Ldon1,•,who is personally known to Yf who is personally known tom^ me or who has produced as me or who has produced ,60—90 1 `8 5 �s'"2 identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: Sign: Print: Print: Seal ;; ELIZABETH ELORRIA A Seal: � MY COMMISSION#GG 2,20202 4� ' EXPIRES:November 2,2020 MY COMMISSION 0 FF953536 a o Bonded Thru Notary Public Underwriters EXPIRES January T5.Z020 r�0��•�"+ fbrtleNan enc.00ir ***ss*s***t**s*s s*ts#*r*ssss***s*sss**sssr***s*s*s*******ss*s***r*rssss***r*s*s APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) r . BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT 115 S. Andrews Ave., Rm. A-100, Ft. Lauderdale, FL 33301-1895—954-831-4000 VALID OCTOBER 1,2016 THROUGH SEPTEMBER 30,2017 DBA: Receipt ELECTRIC CORP Receipt#:EL CTRICAL/ALARMS/CONTRACTC Business Name: Business Type: (ELECTRIC CONTRACTOR) Owner Name:WALTER PERRONE Business Opened:03/21/2012 Business Location:4061 NE 14 AVE State/County/Cert/Reg:EC13004985 OAKLAND PARK Exemption Code: Business Phone:954-793-2414 Rooms Seats Employees Machines Professionals 1 For Vending Business Only Number of Machines: Vending Type: Tax Amount Transfer Fee NSF Fee Penalty Prior Years Collection Cost Total Paid 27.00 0.00 0.00 0.00 0.00 1 0.00 27.00 THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS THIS BECOMES A TAX RECEIPT This tax is levied for the privilege of doing business within Broward County and is non-regulatory in nature.You must meet all County and/or Municipality planning WHEN VALIDATED and zoning requirements. This Business Tax Receipt must be transferred when the business is sold, business name has changed or you have moved the business location.This receipt does not indicate that the business is legal or that it is in compliance with State or local laws and regulations. Mailing Address: DOSOLES ELECTRIC CORP Receipt #03C-15-00003539 4061 NE 14 AVE Paid 08/31/2016 27.00 OAKLAND PARK, FL 33334 2016 - 2017 RICK SCOTT,GOVERNOR _ — KEN LAWSON,SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD EC13004985 r•� The ELECTRICAL CONTRACTOR .. Named below IS CERTIFIED `Ojx Under the provisions of Chapter 489 FS. t; Expiration date: AUG 31, 2018Ail PERRONE,WALTER ALEJ/4NDR0 Emil� DOSOLES ELECTRIC WRA, — 4061 NE 14TH AVENUE L& OAKLAND PARK`_-FL•133334 —' ( 1 CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDITYYY) Fol/11/2017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE BOLDER.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 Eric Anderson Anderson Insurance Solutions PHONE9S4 S6r.7-4$21 FAX 954 7040507 1921 NW 150th Ave Suite 101 FAMMAL erlc@andersoninsurancegroup.com Pembroke Pines FL 33028 INSURERS AFFORDING COVERAGE NAIC x INSURER A:Travelers Indemnity Company of Connecticut INSURED INSURERS: Brid efield Employers Insurance Company Dosoles Electric Corp INSURER C: 4061 Northeast 14 Avenue INSURER D Oakland Park,FL 33334INSURER 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 FORTHE 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. rA TYPE OF INSURANCE D UBR POLICY EFF POLICY EXP POLICY NUMBER M LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S1,000,000 DAMAGE TO RENTED CLAIMS-MADE a OCCUR 1001000 Y 6606B638115 0312212016 03/2212017 MED EXP(Anyone $6,000 PERSONAL&ADV INJURY $1,000,000 t AGGR E LIMIT APA S PER: GENERAL AGGREGATE %2.000,001) X POLICY JECT "LOC PRODUCTS-COMPIOPAGG $2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANYAUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS HIRED AUTOS NONAUT-OWNED PROPERTY DAMAGE $ S UMBRELLA UABOCCUR EACH OCCURRENCE $ EXCESS LIAR HCLAIMS-MADE AGGREGATE RETE ION$ $ WORKERS COMPENSATIONX PER X OTH- AND EMPLOYERS'LIABILITY YIN ER B �ICERMP EMBERRE)((C UDED7 ECS ❑ N I A 83050579 03123/2016 03/23/2017 E.L.EACH ACCIDENT 500,000 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEd S 500,000 yer d Mescribe under DESCRI N O OPERATIONS below E.L DISEASE-POLICY LIMIT I s50D,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101.Addllonal Remarks Schedule.may be attached If more space Is reeulred) EC13004985 CERTIFICATE HOLDER CANCELLATION Miami Shores building department SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 9 P THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 10050 NE 2nd Ave, Miami Shores, FL ACCORDANCE WITHTHE POLICY PROVISIONS. 33138 AUTHORIZED REPRESENTATIVE O V~ ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD