The URL can be used to link to this page

EL-15-2243 Permit NO. EL-9-15-2243 Miami Shores Village Permit Type:Electrical -Residential 10050 N.E.2nd Avenue NPenlimtWork ClasSfCation:Repair Miami Shores,FL 33138-0000 Permit Status:APPROVED Phone: (305)795-2204 FLORIDA Issue Date:9/8/2015 Expiration: 03106/2016 Project Address Parcel Number Applicant 10001 N MIAMI Avenue 1132060131400 RICARDO RODRIGUEZ-ROA Miami Shores, FL 33150- Block: Lot: Owner Information Address Phone Cell RICARDO RODRIGUEZ-ROA 10001 N MIAMI Avenue (415)370-6964 MIAMI SHORES FL 33150- Contractor(s) Phone Cell Phone Valuation: $ 600.00 LONGMAN ELECTRIC INC (305)758-1211 .rc ,... .._. _,...._. .... Total Sq Feet: 00 Type of Work:REPAIR RISER TO F.P.L Available Inspections: Additional Info: Inspection Type: Classification:Residential Final Scanning:3 Review Electrical Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $0.60 Invoice# EL-9-15-56932 DBPR Fee $2.00 09/02/2015 Credit Card $50.00 $64.60 DCA Fee $2.00 Education Surcharge $0.20 09/08/2015 Credit Card $64.60 $0.00 Permit Fee-Additions/Alterations $100.00 Scanning Fee $9.00 Technology Fee $0.80 Total: $114.60 In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans,drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL,PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Futhermore I authorize the above-named contractor to do the work stated. j�� / September 08, 2015 Authorized Signat re:Owner / Applicant / ntractor Agent Date Building Department Copy September 08,2015 1 Building De artment " 'D Miami Shores,Florida 33138 SPLO 2 015 10050 N.E.2nd Avenue, Tel: (305)795.2204 Fax: (305)756.8972 BY: INSPECTION'S PHONE NUMBER: (305)762.4949 FBC 20/L� BUILDING Permit No.,—"--/ I. "' ZZ ZI- 3 PERMIT APPLICATION Master Permit No. Permit Type: Electrical JOB ADDRESS: 10001 N Miami Ave City: Miami Shores County: Miami Dade zip: 33150 Folio/Parcel#: Is the Building Historically Designated:Yes NO Flood Zone: OWNER:Name(Fee Simple Titleholder): Ricardo Rodriguez Roa Phone#: 415)370-6964 Address: 10001 N Miami Ave Miami Shores FL 33150 City: State: Zip: Tenant/Lessee Name: Phone#: Email: colorroy@gmail.com CONTRACTOR:Company Name: /L�/�y/�/�/y �`&fxxG 6 !6 Phone#: 30-5` l �l Address: g�NG I66y s City: /'1/�1,4 / State: /�L Zip: .�raj4� :21L Qualifier Name: Phone#: State Certification or Registration#: /-�O43`7j 3 Certificate of Competency#: Contact Phone#: .See Abase Email Address: DESIGNER:Architect/Engineer: Phone#: Value of Work for this Permit:$ y OP OO Square/Linear Footage of Work: Type of Work: ❑Address ❑Alterattiion Newer ,Wepair/Replace ❑Demolition Description of Work: ***************************************Fees******************************************** Submittal Fee$ Permit Fee$ CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Bond$ Notary$ Training/Education Fee$ Technology Fee$ Double Fee$ Structural Review$ f ,1 t Bonding Company's Address City State Zip Mortgage Lender's Name(if applicable) Plaza Home Mortgage Mortgage Lender's Address PU Box 660592 cit Dallas State Texas 75266-0592 Y 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 ELECTRICAL WORK,PLUMBING,SIGNS, WELLS,POOLS,FURNACES,BOILERS,HEATERS,TANKS and 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 foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of DJO(5 20 19 ,by RtU�ODD �C�2lGU€5� day of et,,20 L�5,by �<r�/ ��s.•i1Z�— who is personally known to me or who has produced Fl.tO VZl2—who i ersonally known t0 a or who has produced �N S As identification and who did take an oath. as identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: Sign: Print: Print: ' My Commission Expires: =° o,� Notary Public State of Florida My COmmi OIreNgtary Public State of Florida Sindia Alv2rez � Mchelle Perez My commission FF 186750My Commission FF 000321 or r�° Expires 09/03/2016of�, Expires 04/08/2017 APPROVED BY /4 �S�l'/ Plans Examiner Zoning Structural Review Clerk (Revised 3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09) A!"�® DATE(MM/DD/NYYY) l-• CERTIFICATE OF LIABILITY INSURANCE 08/24/2015 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 endomement(s). PRODUCER CONTACT NAME: Erin COndlin Pontell Insurance and Financial Group,Inc. PHONE FAX 1484 Tuskawiila Road E-MAIL C. 407-696-1333 aC No:407-696-1380 Oviedo,FL 32765 ADDREss: erin@pontellinsurance.com License#: D051265 INSURERS AFFORDING COVERAGE NAIC N INSURER A: Nationwide Insurance Company of America 25453 INSURED INSURER B: Pmgressive American Insurance Company 25682 Longman Electric Inc INSURER C: 844 NE 98th St INSURER D: Miami Shores,FL 33138 INSURERE: INSURER F: COVERAGES CERTIFICATE NUMBER: 00000000-1461506 REVISION NUMBER: 18 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. LTR TYPE OF INSURANCE SR ADDL S D POLICY NUMBER MMUCY EFF MPMI MY EXP YM LIMITS A X COMMERCIAL GENERAL LIABILITY ACP5905107300 09/07/2015 09/07/2016 EACH OCCURRENCE $ 2.000,000 CLAIMS-MADE I OCCUR PREMISE-1 DAMAGE ToEa occurrence $ 100,000 MED EXP(Any one person) $ 5 000 PERSONAL&ADV INJURY $ 2,000,000 GEN'LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY El JECLOC 7 PRODUCTS-COMP/OPAGG $ 2 000 000 OTHER: $ B AUTOMOBILE LIABILITY03264540-0 09/07/2015 09/07/2016 EeM� BIGdeenntSINGLE LIMIT $ 1,000,000 ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accideM) $ X NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS Paracddent $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR HCLAIMS-MADE AGGREGATE $ DED I i RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE I I ER ANY PROPRIETOR/PARTNERIEXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? ❑N I A (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ If yes,SCdescribe under DERIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached H more space is required) EC 13003713 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Miami Shores Village THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN P-305-795-2207 ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE 2 Ave Miami Shores, FL 33138 AUTHORIZED REPRESENT EMC ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD Printed by EMC on August 24,2015 at 09:23AM