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EL-11-1349 6 T*ri23 Fie L f � s�O y Miami Shores Village low, illi � # i 10050 N.E.2nd Avenue NE i 'Vol 3 Miami Shores,FL 33138 0000NMI 1 Phone: (305)795-2204 �� E;. 0 0_ Ex iratlon: 07/19/2015 jssu .711 p Project Address Parcel Number Applicant 123 NE 97 Street 1132060132440 ROBERT BUTLER Miami Shores, FL 33138- Block: Lot: Owner Information Address Phone Cell ROBERT BUTLER 10932 NE 6 Avenue (786)556-2919 MIAMI FI-3 31 61- Contractor(s) L33161- Contractor(s) Phone Cell Phone $ 200.00 Valuation: F LS CURTIS INC 305-892-0115 Total Sq Feet: 0 Type of Work:ELECTRICAL Available Inspections: Additional Info:LOW VOLTAGE Inspection Type: Classification:Residential Scanning:1 Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $0.60 Invoice# EL-7-11.41566 DBPR Fee $2'25 05/08/2015 Check#:151 $ 159.10 $0.00 DCA Fee $2.25 Education Surcharge $0.20 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 certify that all the foregoininformation is accurate and that all work will be done in compliance with all applicable laws regulating construction and z n F rrl�Iautho �beZ-7 contractor to do the work stated. May 08, 2015 Aufhorized Signature:Owner / Applicant / Contractor / Agent Date Building Department Copy May 08,2015 1 05/07/2015 03:41 3059402138 #7383 P.002 /002 ACS RR® KLW DATE(.MaroDrwYY) CERTIFICATE 4F LIABILITY INSURANCE R001 5/6/2015 THIS CERTIFICATEIS 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:If the certificate holder is an ADDITIONAL INSURED,the pollcy(les)must be endorsed. If SUBROGATIONIS 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 NAME: AUTOMATIC DATA PROCESSING INS AGCY PHONE FAx (AIC,No,ed), (AIC,No): 250717 P: F: ADDRI ESS: PO BOX 33015 INSURERS)AFFORDING COVERAGE NAIC# SAN ANTONIO TX 78265 INSURER A: Twin City Fire Ins Co 29459 MSUREO INSURER B: INSURER C: L. S. CURTIS INC. INSURER D: 20341 NE 30TH AVE APT 108 INSURER E: AVENTURA FL 33180 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 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. I11VSR TYPE OF1NSL+R4NCE ADDL tiL+BR POLICYA`L+AIRER POLICY EFF POLICVEXP UA9lTS AfAMD/YYTY) COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE CLAIMS MADE❑OCCUR DAMAGE TO RENTED S PREMISES(Ea occurrence) MED EXP(Any one person) PERSONAL&ADV INJURY GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL.AGGREGATE POLICY PRO-[7 RO-❑LOC PRODUCTS-COMPIOP AGG OTHER: JECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S (Es accident) ANY AUTO BODILY INJURY(Per person) ALL OWNED SCHEDULF� BODILY INJURY(Per accident) AUTOS AUTOS HIRED AUTOS AUTOS (Per accident) NON-OWNED PROPERTY DAMAGE UMBRELLA LIAR OCCUR EACH OCCURRENCE 5 EXCESS LIAR CLAIMS-MADE AGGREGATE S DE RETENTIONS WORKERS COS/PEK,rION X PER OTH- ANDER'LOyER.S•LLTI.ITr STATUTE ER ANY PROPRIETORIPARTNERIEXECUTIVE YIN E.L.EACH ACCIDENT $1,000, 000 OFFICERIMEMBER EXCLUDED? A (Mandatory in NM MIA 76 ;1EG TR4954 05/01/2015 05/01/2016 E.LDISEASE-EAEMPLOYEE 11,000, 000 If yes,describe under E.L.DISEASE-POLICY LIMIT 11,000, 000 DESCRIPTION OF OPERATIONS below DESCRIPTION OFOPERATIONS/LOCATIONS/VENICLES(ACORD 101,Additional Remarks Sctredule,may be attached H more space Is required) Those usual to the Insured's Operations . License #EC0003175 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED Miami Shores Village BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Building Department AUTHORIZED REPRESENTA TPIE r 10050 NE 2ND AVEC,, MIAMI SHORES, FL 33138 ©1988 2014 ACORD CORPORATION.All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD Miami Shores Village Building Department MAR ® 1 20 5 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel:(305)795.2204 Fax:(305)756.8972 INSPECTION'S PHONE NUMBER:(305)762.4949 BUILDING Permit No. EL-7-11-1349 PERMIT APPLICATION Master Permit No. 13 FBC 20 Permit Type: Electricalbs OWNER:Name(Fee Simple Titleholder): Robert Butler Phone#: 305-933-0683 Address: 123 NE 97 Street -_. F1. _?"� 33138. City- _Mia;,1 S' oxer —Stst :_.— _ __..._. ---- _. �_ Teriant/Lessee Name: Phone#: Email: JOB ADDRESS: 123 97 Street City: Miami Shores County: Miami Dade Zip: 33138 Folio/Parcel#: 1132060132440 Is the Building Historically Designated:Yes NO Flood Zone: CONTRACTOR:Company Name: L S Curtis inc Phone#: 786-486-1961 Address: 20341 NE 30 Ave #108 City: Ayentura State: FL Zip: 33180 QualifrerName: Lewis S Curtis Phone#: 786-486-1961 State Certification or Registration#: E C 0 0 0 317 5 Certificate of Competency#: Contact Phone#: 786-486-1961 Email Address: Gast eve Qa o 1 C otn DESIGNER:Architect/Engineer: Phone#: Value of Work for this Permit:$ 10 0.0 . 0 0 Square/Linear Footage of Work: Type of Work: ❑Address OAlteration ONew QRxpair,R2eplace ❑Demolition Description of Work: Low Voltage renew Submittal Fee;Z77 Permit Fee$ P CCF$ CO/CC$ Scanning Fee$ Radon Fee$ _ DBPR$ Bond$ Notary$ Training/Education Fee$ Technology Fee$ Double Fee$ Structural Review$ TOTAL FEE NOW DUE$ ��'� 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 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 ice, the inspection will not be approved and a reinspec .on fee will be charged. SignatureSignature"00a r Owner or Agent Contractor The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this 08 day of_�WI-1,20/�by �, y� t� day of february ,20 15,by Lewis Curtis , who is personally known to me or who has produced w is person to me or who has produced As identification and who did take an oath. as identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBIJC: Sig / Sign: E)WIRM A*25,2016 •rWWN#ME 21941 Print Print: No7 398.0,83 .aom My Commission Expires: My Commission xpires: - �� LOtSWELLS �� •„,”o* MY COMISSION#FF U610 TMVftWNWy6 ��x�xx��x�x�x��x��:��x��xx�x��x�x��:��x��x��x�x�x��x��x��x��x��x�� Sam APPROVED BY /yl� Plans Examiner Zoning Structural Review Clerk (Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09) -7/2q j tl NAC5sag0- ©ffie-L JJ Miami Shores Village � . Building Department n t 101 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel: (305)795.2204 Fax:(305)756.8972 ; INSPECTION'S PHONE NUMBER:(305)762.4949 .. ........ BUILDING Permit No. L I J X _ PERMIT APPLICATION Master Permit No. 2C _17" FBC 20 Permit Type: Electrical OWNER:Name(Fee Simple Titleholder): /eC7 k4, Phone#: Address: 4? :3 Al, . 'F_2 _1�_ City: MI/AM/ S'Wel-44S State: f-1-A zip: Tenant/Lessee Name: Phone#: Email: r Gf JOB ADDRESS: /2-3//_4 , 22 City: Miami Shores County: Miami Dade Zip: 33/3 A' Folio/Parcel#: Is the Building Historically Designated:Yes NO�,( Flood Zone: /a/11 CONTRACTOR:Company Name: oy,y4 ' Phone#: 746 S_S 6 97 Address: 5A avKI City.. State: Zip: Qualifier Name: Phone#: State Certification or Registration#: Certificate of Competency#: Contact Phone#: Email Address: DESIGNER:Architect/Engineer: w Phone#: Value of Work for this Permit:$ Square/Linear Footage of Work: Type of Work: ❑Address DAlteration ONew ❑Repair/Replace ODemolition Description of Work: /-uS7n co lbG C16 A�G,ot'," d'- / rA?3 44S V- ca-" e, UC As �rrt /,yY��/,rte�- rA►�!� C V /'��yy�� d S GCid-✓ZV CaP'Z-42A.5 Submittal Fee$ Permit Fee$ 4-19 CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Bond$ Notary$ Training/Education Fee$ Technology Fee$ Double Fee$ Structural Review$ TOTAL FEE NOW DUE$ 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 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 a a reinspection fee will be charged. Signature Signature Owner or Agent , Contractor The f e o' instrument was ac o ]edged of e s� The foregoing instrument was acknowledged before me this day ,20 11,by day of 20_by who is personal] known to me or who has produced who is personally known to me or who has produced As identification and w o did take an oath. as identification and who did take an oath. NOTA Y PUBLIC: � �4 NOTARY PUBLIC: Sign: �. y� Sign: n, Print: °tip '•ssGG� `p ;3 Print: My Commission Expires: ' (.IIIOp1�jY ••..uJ•� V M Commission Expires:ires:` :x�:x:x>k�:x:x:x�:�:�::x�:xxx�:��:x: ...:::xa• :x:��:x:x:xx�x:x�:x:x�:��:x�xx��:x�=x:xxx:xx::x��x�x�x:��:x�:x>tix�x�:x:x:x��:x��x�::x:x:x:x:x�:x��x� NMI 2� APPROVED BY '�2�r&-/yPlans Examiner Zoning Structural Review Clerk (Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09) Ilk R BY t'6`1 \