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EL-17-927 Permit No. EL-4-17-927 �et`O1s y,� Miami Shores Village Permit Type:Electrical -residential 10050 N.E.2nd Avenue NE i Work Classification:Alteration Miami Shores,FL 33138-0000 Permit Status:APPROVED Phone: (305)795-2204 FLORIDA Issue Date:4/19/2017 Expiration: 10/1612017 Project Address Parcel Number Applicant 349 NE 99 Street 1132060135510 Miami Shores, FL 33138- Block: Lot: J HENRY VIDAL Owner Information Address Phone Cell J HENRY VIDAL 349 NE 99 Street MIAMI SHORES FL 33138-2436 Contractor(s) Phone Cell Phone Valuation: $ 550.00 AJL ELECTRIC INC 305-895-4971 Total Sq Feet: 0 _]_ Type of Work:ELECTRICAL DEMOLITION Available Inspections: Additional Info:ELECTRICAL DEMOLITION Inspection Type: Classification:Residential Review Electrical Scanning: 1 Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $0.60 Invoice# EL-4-17-63570 DBPR Fee $2.00 DCA Fee $2.00 04/05/2017 Credit Card $50.00 $58.60 Education Surcharge $0.20 04/19/2017 Credit Card $58.60 $0.00 Permit Fee-Additions/Alterations $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 AFF VI I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction an z ng. FutIf r re>luthorize the above-named contractor to do the work stated. April 19, 2017 ori ed Sig ture:Owner / Applicant / Contractor / Agent Date Builring Department Copy April 19, 2017 1 Miami Shores Village Building Department PR 05201 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 20 19 BUILDING Master Permit No. P_G I L'p — 3 U-o PERMIT APPLICATION Sub Permit No. EL 1-1 — q2_1 ❑BUILDING ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP � �( C� G� n CONTRACTOR DRAWINGS rr�f JOB ADDRESS: ` +`� `` ` S �k L I City: Miami ShoresCounty: Miami Dade Zip: 3 ( 3� Folio/Parcel#: I_�- .30_o(-, -o(3 — Sf Is the Building Historically Designated:Yes NO Occupancy Type: Load: '( fConstruction Type: Flood Zone: BFE: FFE: OWNER: Name(Fee Simple Titleholdceer):�-1 • e A a.N4 V L 0 AL_ Phone#: Address: �/ }� City: 1` 1 A rnLy0(_Lc S State: �L Zip: s� Tenant/Lessee Name: Phone#: Email: G CONTRACTOR:Company Name: TL L L(E C eLC_ �T_u)G Phone#: Address: 'B lSapt 4,0 e- City: tj - 1Ml.,lnA State: r L_ Zip: S3 1-91 Qualifier Name: L^-LA'-y 0 �2- Phone#: State Certification or Registration#: 13 V Oa-C) Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ Square/Linear Footage of Work: Type of Work: ❑ Addition Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: L—L=-C-�C(Z ( e.t4 c, Q M O t--+ z+ y Specify color of color thru tile: Submittal Fee$ rJO POt Permit Fee$ CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ 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. 1 Signature Signature OWN or AGENT CO A OR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of ftY t % 20 1--J by _/n► I day of % L 20 1- by who is personally known to kd-rr-1c9..N T LSV Jw4j1 ,personally known to me or who has produced as me or who has produced as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: P"" a Sign: Print: ►'J✓C P si ` I Print: KIM ES ONNFFF11999222s Seal: ANA PARRILLA Seal: OFF EXPIRES:February 12,2019 t q'. z.. `.`".' Notary Public-State o1 Florida My Comm.Expires Apr 21,2017 ,. Commission#EE 867787 APPROVED BY/,qfi I/ -R" rY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) STATE-OF FLORIDA DEPARTMENT OF-BUSt ESS,AND-PROFE,5SIONAL:RE!PULATION ELECTRICAL C _ TRACTORS LICENSING BOARD EC'13002089' ' r•_ The ELECTRICAL CONTRACTOR Named.belo+u IS CERTIFJEII. ;. Underµtho'"provisions o_fChapter 4.89 FS. Expiration date: AUG 31;2018 LUPO,ANTHQNY-,J-..J-R- A J L ELECTRIC ING 1.2bBL�55-BISCAY�E _ ` �,� `0' NORTH MIAMI �V10 all ISSUED: 07/26/2016 DISPLAY AS REQUIRED BY LAW sEQ# L1607260001567 �.. ..i City of North Miami DRT H M I A M 1 776 N.E.125 Street • North Miami, FL 33161 • 305-893-6511 liwlillii N Business Tax/Certificate of Use Receipt Issued Date: 10/1/2016 ELECTRICAL CONTRACTOR Expiration Date: 9/30/2017 Business Tax Receipt#: BT-002364 Business Name 1 Address: A J L ELECTRIC, INC. 12555 BISCAYNE BLVD, BOX 826 >. A J L ELECTRIC, INC. NORTH MIAMI, FL 33181 12555 BISCAYNE BLVD 4• f' BOX 826 Michael A.Etienne,Esquire,City Clerk NORTH MIAMI, FL 33181 • •", OR SOLD. NON-TRANSFERABLE POST INA CONSPICUOUS PLACE NON-TRANSFERABLE 001304 Local Business Tax Receipt Miami—Dade County, State of Florida -THIS ISNOT ABILL-DO NOT PAY , 1929745 � LBTI BUSINESS NAME/LOCATION RECEIPT NO. EXPIRES AIL ELECTRIC INC RENEWAL SEPTEMBER 30, 2017 12408 N BAYSHORE DR 2037000 Must be displayed at place of business NORTH MIAMI FL 33181 Pursuant to County Code �. Chapter BA-Art.9&10 OWNER SEC.TYPE OF BUSINESS PAYMENT RECEIVED AIL ELECTRIC INC 196 ELECTRICAL CONTRACTOR BY TAX COLLECTOR EC13002089 $45.00 09/13/2016 Worker(s) 1 encnrro-AMM Ie ne71 1n A&EL-1 OP ID:TR ACOR©' DATE iNm CERTIFICATE OF LIABUTY INSURANCE os1031201 THIS CERTIFICATE IS ISSUED AS A/MATTER OF INFORMAZION 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 qONS1TIVTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE BOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the poll (les)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may re,4uire an endorsement. A statement on this certificate does not confer rights to the certificate holder In Ileu of such endorsemen a. PRODUCER T Roebuck Associates Insurance NAME Exchange LLC 0&VOL PHONE 5599 S University Drive,0 301 Davie,FL 33328 i4DDR6° Roebuck Associates INSU AFFORDING COVERAGE MAIC 0 INSURER A:We Insurance Company INSURED AJL Electric Inc. INSURER B:RetailFirst Insurance Company N.Miami Beach, FL 33181 R 12408 N.BeNwER c:United States LiabilityIns Co FDrive t INSURER D: t RMSURER E: e. INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES'OF INSURANCE LISTED ggELOW'HAVE BETA ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR gONDITION 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 SHOWWMAY HAVE BEENfREDUCED BY PAID CLAIMS. -POtJCY EFF POLICY EXP NSR TYPE OF INSURANCE POLJCI NUMBER MID M LIMITS LTR GENERAL LIABILITY EACH OCCURRENCE f 1,000,00 A X COMMERCIAL GENERAL LIABILITY P1148757.0; 05/1512016 0511512017PREMISES(Es , s 100,00 CLAIMS-MADE X❑OCCUR MED EXP Wy one parson) $ 5,00 PERSONAL i ADV INJURY 11 1+000,00 GENERAL AGGREGATE 3 2,000,00 GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG t 2,000,00 xi POLICY PRO LOC s AUTOMOBILE LIABILITY COMBINED LIMIT 6cdd ANY AUTO BODILY INJURY(Per person) >j ALL OVIMED SCHEDULED BODILY INJURY(Per aeddenq t AUTOS AUTOSNON-OVWMO PROPERTY Wazze : HIRED AUTOS AUTACCT i UMBRELLA LIAB )( occult EACH OCCURRENCE $ 2,000,00 C FX EXCESS LIAB CLAIMS-MADE XL1566070A 05/18/2016 05/18/2017 AGGREGATE $ 2,000,00 L�JDED RETENTION $ WORKERS COMPENSATION X LIABILITYvuC sTATu OTH AND EMPLOYERS'LIABILITYB ANY PROPRIETORIPARTNERIEXECUTIVE Y� N/A 52047540 05/15/2016 05/15/2017 EL EACH ACCIDENT $ 11000100 OFFICERIMEMBER EXCLUDED? (Maendalgy In 11" E.L.DISEASE-EA EMPLOY $ 1,000j00 DESCdescribe urder RIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT i 1,000;00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attack ACORD 101.Addit+@1 Rwnwft 3e w&^I was spec Is n4*) EC13002089 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THS EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Miami Shores Village ACCORDANCE WITH THE POLICY PROVISIONS. Building Dept. 10050 NE 2 Avenue AUTHORIZED REPRESENTATIVE Miami Shores,FL 33138 ®198$-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD