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EL-16-3479 Permit No. EL-12-16-3479 °aEs Miami Shores Village Permit Type:Electrical -Residential 10050 N.E.2nd Avenue NE ' Work Classification:Alteration Miami Shores,FL 33138-0000 Perl" 11 "tPermit Status:APPROVED rye` Phone: (305)795-2204 f�ORtDp Issue Date: 115)2017 Expiration: 07/04/2017 Project Address Parcel Number Applicant 85 NE 97 Street 1132060131020 Miami Shores, FL Block: Lot: SANDRA AND RIQUET MORRIS[ Owner Information Address Phone Cell SANDRA AND RIQUET MORRISEAU 85 NE 97 Street (305)759-2365 MIAMI SHORES FL 33138-2330 Contractor(s) Phone Cell Phone Valuation: $ 500.00 HOPE ELECTRICAL CONTRACTOR LI (305)962-0305 �..._.........___ ..,. ......_...._... .._ Total Sq Feet: 0 Type of Work: Available Inspections: Additional Info: 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-12-16-62483 $2.25 DCA Fee $2.25 01/05/2017 Credit Card $ 109.10 $50.00 Education Surcharge $0.20 12/28/2016 Credit Card $50.00 $0.00 Permit Fee-Additions/Alterations $150.00 Scanning Fee $3.00 Technology Fee $0.80 Total: $159.10 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 05, 2017 Authorized Signature:Owner / Applicant / Contractor / Agent Date Building Department Copy January 05, 2017 1 Miami Shores Village Building Department aEc Ze Bois 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 BY: INSPECTION LINE PHONE NUMBER:(305)762-4949 -_ FBC 20 HS BUILDING Master Permit No. C� �� —3 PERMIT APPLICATION Sub Permit No.:EU —:34-n ❑BUILDING ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP �/{ \r C CONTRACTOR DRAWINGS JOB ADDRESS: O J Pe, L� 's&- City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: -01:3 - l6ao Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFEE: F 6 FIFE: q + I OWNER:Name(Fee Simple Titleholder): Y, Q 1 ucronU-'\a Phone#: 't� a cam.3" Address: <i�s 01E C-3 1 S-�-- City: "1Q-QMk S1n6'Y,-S State: Zip: '5i�r,� d Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name: t•-t�1�Qa-QCA'41 C 01 C(}Y1��C�(P`h e#: Address: 'AD I AJk) 1 y-�r->� 9�1r�Q City: I State:6:4n' ?_21za" Zip: ,'33/raK Qualifier Name: f Phone#: State Certification or Registration#: 4E 12 (-30 14 Certificate of Competency#: ©G Cj,97 DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ ' Square/Linear Footage of Work: D"-�3 Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace - El �Deem�olition Description of Work: Specify color of color thru tile: ,I _ Submittal Fee$ - Permit Fee$ f,41111OZ-w CCF$ -.� -CO/CC$ nw�./.. Scanning Fee$ Radon Fee$ 2. 25 DBPR$ Notary$ �- Technology Fee$ • C)U Training/Education Fee$ JLC Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ j�J (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_(�4 4 Signature &&AALS,.�---- OWNER 9 " - — or AGENT CONTRACTOR The for oing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of �or2i�?,t6A 20 /4 by S� ay of d .Q 20l!'v by LO U S who is ersonall �knowntoSO O who is a sonall known to P Yr PJ Y e r who has produced as me or who has produced l as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign. Sign,• Print: Print: Seal ��,'tJ►%. t_ MY COM lON ,r,-.05368 NADINE GREENE Seal: :;r EXPIRES:March > 23,4^ €* : MY COMMISSION i FF 105368 '•.t�r��4�'� Bonded Tiuu Notary Putlie Under.:;:&- a �£ EXPIRES:March 23,2018 4f, BOOded Thru Notary Public Underwriters ***•*s***** sr*******•*******r****r**r*****s*****ss******s********s********** APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) +j v Hope Electrical Contractor LLC Serving Miami Dade/ Broward Counties 401 NW 148 STREET MIAMI FLORIDA 33168 (305)962-0305 Date: State of Roy- County of 1 u tA� 02�AL Before me personally this day appeared , o CA Ma Mw i who, being dully sworn, deposes and says: r MSS Sole qualifier Tar NoJA- Thal( Clea 14 CWVO.C,OY LLC. Tha he r she will be the only person working on the project at: 6'2s4" lilla,ml '51fdA & "34f Sworn t I subscribed before me this Zeay ofAY.l! . 20Z6-1 by Personally Know •n"� - Ar NADINE GREEN OR Produced Identification !" MY OWMISSION 0FF 105368 •c de EXP'HES March 23,2016 I F;F•; Bolded """°`a"P0�1Cu"a°� Identif ation Produced . C/ rint, Type or Stamp Name of Notary ♦S ORE,V INC.193, Miami shores Village soon - _� '" - Building Department 10050 N.E.2nd Avenue �LoRtiDp' Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Notice to Owner - Workers' Compensation Insurance Exemption Florida Law requires Workers' Compensation insurance coverage under Chapter 440 of the Florida Statutes. Fla. Stat. § 440.05 allows corporate officers in the construction industry to exempt themselves from this requirement for any construction project prior to obtaining a building permit. Pursuant to the Florida Division of Workers' Compensation Employer Facts Brochure: An employer in the construction industry who employs one or more part-time or full-time employees,including the owner,must obtain workers' compensation coverage. Corporate officers or members of a limited liability company (LLC) in the construction industry may elect to be exempt if: 1. The officer owns at least 10 percent of the stock of the corporation, or in the case of an LLC,a statement attesting to the minimum 10 percent ownership; 2. The officer is listed as an officer of the corporation in the records of the Florida Department of State,Division of Corporations;and 3. The corporation is registered and listed as active with the Florida Department of State,Division of Corporations. No more than three corporate officers per corporation or limited liability company members are allowed to be exempt. Construction exemptions are valid for a period of two years or until a voluntary revocation is filed or the exemption is revoked by the Division. Your contractor is requesting a permit under this workers' compensation exemption and has acknowledge that he or she will not use day labor,part-time employees or subcontractors for your project.The contractor has provided an affidavit stating that he or she will be the only person allowed to work on your project.In these circumstances,Miami Shores Village does not require verification of workers' compensation insurance coverage from the contractor's company for day labor,part-time employees or subcontractors. BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. i Signature: Owner State of Florida County of Miami-Dade The foregoing was acknowledge before me this p day of a�,e% 20�. BY--/- y C���S who is personally known to produced as identification. Notary• NADINE GREENE SEAL: = : -.4 MY COMMISSION#FF 1Q5368 .o EXPIRES:March 23,M8 A P`' Bonded Thru Notary Puhlz UndervrAers ♦ 1 - RICK SCOTT,GOVERNOR KEN LAWSON,SECRETARY STATE OF FLORIDA DEPARTMENT OF,BUSINESS PROFESSIONAL-REGULATION', ELECTRICAL CONTRACTORS LICENSING BOARD �...` ,� •" � .10_ 986R34 . �" �—�� -�_, ..; i •'ti -'�: .<`` - •'."'°��'4wa *e h . " The'ELECTRICALCONTRACTOR :'. - ` , '-...": - ~ '4 . -;` �� " •' -Named`below,HAS-REGISTERED„---: •'-` `~w �- � a 'y ` �` =Unde'rr the,provisions'of,Chapter.,489�FS._. ;E_xpifatibn'dMe:-AUG.31;`2018--= - `'°� '� °°,, j *' �~R_EQUIREMEN SNDIVIDUALMISPR OR TO CONTRACTING-INMEET ALL LOCAL LICENSING ANW'AREA, w �` �M° ATHURINSOREL- �� ,��HOPE ELECTRICAL-CONTRACTOR L•LC�� A01'.NW148 STREETIL ;--- ,-�,,,`" MIAMI _ ,,FL"r33168s4245 - t`� '' 1`` .N -� ISSUED: 07/31/2016 DISPLAY AS REQUIRED BY LAW SEQ# L1607310004386 f CTQB Construction Trades Qualifying Board '0t6BUSINESS CERTIFICATE OF COMPETENCY 14E000278 HOPE ELECTRICAL CONTRACTOR LLC D.B.A.: ATHURIN SOREL Is certified under the provisions of Chapter 10 of Miami-Dade County QUALIFYING TRADES) 0001 ELECTRICAL Se- iy Sawa P.E m- *(U*B.rd 7MamFOade C robins awww.�riami0atle.poNe°p�pay r Local Business Tax Receipt Miami—Dade County, State of Florida -THIS IS NOT A BILL-DO NOT PAY 7L B T ' 7172621 BUSINESS NAME/LOCATION RECEIPT NO. EXPIRES HOPE ELECTRICAL RENEWAL SEPTEMBER 30, 2017 CONTRACTOR LLC 7451604 Must be displayed at place of business 401 NW 148 ST Pursuant to County Code MIAMI,FL 33168 Chapter SA-Art.9&10 SEC.TYPE OF BUSINESS PAYMENT RECEIVED OWNER BY TAX COLLECTOR HOPE ELECTRICAL CONTRACTOR 196 CO CNTFt ICAL LLC 75.00 08/302016 r./rl SORFI MATHI IRIN1 14EO06278 0230-16-005242 Worker(s) This Local Besiness Tax Receipt only confirm payment of the Local Business Tax.The Receipt is not a liceasa, permit or a ceroke ien of the holder's qualifications,to do business Holder must comply with any governmentei or nongorermaeatal regulatory laws and requirements which apply to the basiness. The RECEIPT N0.above must be displayed on all commercial vehicles-Miami-Dede Coda Sec ge-276. MAN ® For more inMrrrrelioa visit NOMMIAMideftAffallauffillm CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 09/20/16 THIS CERTIFICATE IS ISSUED ASA 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: (f 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 I certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Allstar Direct Insurance ; PHONE ROland BaisiS FAX - (fuc-too,ExtL: (305)754-7414 (g/c.No): (305)754-7416 16123 Biscayne Boulevard f--E-MAIL --"-' -— - - I AopRESS;. roland@allstardirect.com Aventura,FL 33160 INSURER(S(AFFOROING COVERAGE NAIL# Phone (305)754-7414 Fax (305)754-7416 C r - __-�NsuRER A. YP ess Propert&Casualty Insuarance Company 012247 INSURED � -- ._ _- _-_-. . INSURERS: _ HOPE ELECTRICAL CONTRACTOR LLC INSURERC: - I 401 NW 148TH ST ,INSURER D MIAMI,FL 331684245 f INSURER E 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 INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT POLICY PERIOD WITH RESPECT CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BTO WHICH THIS Y THE POLICIES DESCRIBED HEREIN IS _EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, SUBJECT TO ALL THE TERMS, INSR ADDLSUBR LTR. TYPE OF INSURANCE POLICY EFF POLICY EXP /YYYY;,(MMfDD/YYYY). _ _.. LIMITS _. INSRiwvp_ - POLICYNUMBER __.fMM/DD GENERAL LIABILITY � -- _. _ �� EACH OCCURRENCE s 2,000,000.00 irJ COMMERCIAL GENERAL LIABILITY I DAMAGE TO RENTED - -- 1 PREMISES rEa occurrence $ 100.000.00 CLAIMS-MADE U OCCUR E A Y Y SGL 0051986 00 81❑ 04/30/2016 04/30/2017 MED EXP(Anyone person) ' S 5,000.00` PERSONAL&ADV INJURY s 2,000,000.00 � GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 2,000,000.00 PRO- i POLICY LOC PRODUCTS-COMP/OP AGG s 2,000,000.00 I L-i_JECT � _ I ., � AUTOMOBILE LIABILITY DED $ 250.00 COMBINED SINGLE LIMIT — Ea accident) S ❑ ANY AUTO F- SCHEDULED t ALL OWNED BODILY INJURY(Per person) $ F- Li AUTOS I ! AUTOS I BODILY INJURY(Per accident) $ HIRED AUTOS ❑ AUTOSWNEO PROPERTY DAMAGE —'❑ ❑ i j (Per accident) $ .... ._ UMBRELLA LIAR I OCCUR -i $ EACH OCCURRENCE EXCESS LIAR $ I - _ ❑CLAIMS-MADE , � �- Lj DED L� RETENTIONS j AGGREGATE $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY y/N I ❑T CORY LIMITS I-J EORH' ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? - ,;N/A, • E.L EACH ACCIDENT $ (Mandatory In NH) - - ._ - U yes,describe under I E.L.DISEASE-EA EMPLOYEE$ • DESCRIPTION OF OPERATIONS below I EMPLOYEE - --- - E1,DISEASE-POLICY LIMIT' $ ` - i DESCRIPTION OF OPERATIONS/LOCATIONS 1 VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) — ELECTRICAL CONTRACTOR CERTIFICATE HOLDER CANCELLATION "— SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE MIAMI SHORES VILLAGE i THE EXPIRATION DATE THEREOF,NOTICE WILL BF–DELIVERED IN BUILDING DEPARTEMENT ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE 2ND AVE AUTHORIZED REPRESENTATIVE — MIAMI SHORES I FLORIDA 33138 f ACORD 25(2010/05)QF 0190 0 ACORD CORPORATION. All rights reserved, The ACORD name and logo are registered marks of ACORD JEFF ATWATER CHIEF FINANCIAL OFFICER STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS'COMPENSATION **CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS'COMPENSATION LAW CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers'Compensation law. EFFECTIVE DATE: 6/11/2016 EXPIRATION DATE: 6/11/2018 PERSON: MATHURIN SOREL FEIN: 465321050 BUSINESS NAME AND ADDRESS: HOPE ELECTRICAL CONTRACTOR LLC 401 NW 148 ST MIAMI FL 33168 SCOPES OF BUSINESS OR TRADE: LICENSED ELECTRICAL CONTRACTOR Pursuant to Chapter 440.05(14).F.S.,an officer of a corporation who elects exemption from this chapter by filing a certificate of eladron under this section may not recover benefits or compensa on under this chapter.Pursuant to Chapter 440.05(12).F.S.,Certificates of election to be exempt...apply only within the scope of the business or trade listed on the notice of election to be exempt.Pursuant to Chapter 440.05(13),F.S.,Notices of election to be exempt and certificates of election to be exempt shat be subject to revocation if,at any time after the filing of the notice or the issuance of the cerrficate, the person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate.The department shall revoke a DFS-F2-DM-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUESTIONS?(850)413-1609