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EL-16-1031 Miami Shores village i e$1dVat 10050 N.E.2nd Avenue NE �t0 e@ �n s ... Miami Shores,FL 33138-0000 a„' ` Pettit ; t# d'' O'tC f � Phone: (305)795-2204 W Ex �ration: 11/05/2016 I bate:61912016 p. Project Address Parcel Number Applicant 42 NE 96 Street 1132060130640 Miami Shores, FL 33138- Block: Lot: LUNI USA LLC Owner Information Address Phone Cell LUNI USA LLC 235 LINCOLN Road MIAMI BEACH FL 33139- 235 LINCOLN Road MIAMI BEACH FL 33139- Contractor(s) Phone Cell Phone Valuation: $ 3,700.00 DOLCHE INC (786)399-1900 Total Sq Feet: 0 Type of Work:INSTALL 50 RECESSED LIGHTS,5 SWITC Available Inspections: Additional Info: Inspection Type: Classification:Residential Review Electrical Scanning:1 Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $2.40 Invoice# EL-4-16-59442 DBPR Fee $3.38 DCA Fee $3.38 04/18/2016 Credit Card $50.00 $416.16 Education Surcharge $0.80 05/09/2016 Credit Card $416.16 $0.00 Permit Fee-Additions/Alterations $225.00 Scanning Fee $3.00 Technology Fee $3.20 Work without Permit Fee $225.00 Total: $466.16 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 zoninFuth ore,I authorize the above-named contractor to do the work stated. �,,, May 09,2016 C , �Authorized Signature:Owner / Applicant / Contractor / Agent Date Building Department Copy May 09,2016 1 j Miami Shores Village , Building Department IRV: APR 18 2016 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 STS FBC 20p%j BUILDING Master Permit No.RC1 6-337 PERMIT APPLICATION Sub Permit No. E(-I(40 —1031 ❑BUILDING M ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 42 NE 96 Street City: Miami Shores County: Miami Dade Zip: Folio/Parcel#:11-3206-013-0640 Is the Building Historically Designated:Yes NO X Occupancy Type: R-3 Load: Construction Type: IIB Flood Zone: X BFE: N/A FFE: OWNER:Name(Fee Simple Titleholder):LUNI USA, LLC Phone#: Address:235 LINCOLN ROAD #310 City: Miami Beach State: FL Zip: 33139 Tenant/Lessee Name: N/A Phone#: Email: CONTRACTOR:Company Name: DOlche Inc Phone#: 786-399-1900 Address: 253 172 Street Ste:216 City: Sunny Isles Bch State: FL Zip: 33160 Qualifier Name: Hristo DOltchinkov Phone#: State Certification or Registration M EC 13004399 Certificate of Competency#: DESIGNER:Architect/Engineer: Robert Kirchgessner Phone#: 954-980-4430 Address:1835 E Hallandale Beach Blvd City. Hallandale Bch State: FL Zip: 33009 Value of Work for this Permit:$3,700.00 Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New M Repair/Replace ❑ Demolition Description of Work: Install 50 recessed lights, furnish & install 5 switches, install 15 gardens lights. Specify color of color thru tile: _ c Submittal Fee$�-� Permit Fee$ ���o®p �<�CCF$ CO/CC$ Scanning Fee$ 3 • Radon Fee$-3 -S8 DBPR$3 ` S L9 Notary$ Technology Fee$ --Rb - �� Training/Education Fee$C5 a Double Fee$ a—tgLs Structural Reviews$ Bond$ 9 TOTAL FEE NOW DUE$ 6 (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 � ' Signature OWNER or AGENT CONTRACTOR The foregoing Instruineunt was acknowledged before me this The foregoing instrument was acknowledged before me this 3 I day of G.� C.� 20 .by 1 day of L CA-v C,\,-., 20 t.L by t�C ` vf who is personally known to �-S� O Q() ia)s�ersonally known to L � 5 me or who has produced as me or who has produced L as identification and who did take an oath. identification nd who d' take an oath.. NOTARY PUB NOTARY P BLIC: Sign: Sign: C� Print: ;s" VICT®RIA ROSADO =•: :'= MY COMMISSION FF8T1492 Seal: �;K 'p kqY CAANMIBSI®lV d FF@?1g82 EXPIRES March 15.2020 . , ' EXPIRRS Matrt)h 16,20, ae's o+s3 407)39 '163 #####*#**# APPROVED BY / Plans Examiner, Zoning Structural Review Clerk (Revised02/24/2014) CERTIFICATE OF LIABILITY INSURANCE DATE04/06/16 rn 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 WANED,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: Leonardo Cicarelli Alltrust Insurance Group Pa/cNno,F�dt: (305)944-0002 N (305)949-1010 17038 Collins Ave. '^ LIS; leo@alltrustfl.com Sunny Isles Beach,FL 33160 INSURER(S) AFFORDING COVERAGE NAIC# Phone (305)944-0002 Fax (305)949-1010 INSURERA: Scottsdale Insurance Company INSURED INSURER B: Florida Citrus Business&Industries Fund Dolche Inc INSURER C: 243 172 St #216 INSURER D: North Miami Beach,FL 33160 INSURER 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 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. INSR TYPE OF INSURANCE ADDL UBR POLICY EFF POLICY EXP LIMITS LTR INR WVD POLICY NUMBER MMIDD (MMIDDNYYYI GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000.00 0 COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED 100,000.00 PREMISES Ea occurrence) $ A [ I ❑ Y Y 01!27/2016 01/27/2017 CLAIMS-MADE Q OCCUR CPS2347265 MED EXP(Any one person) $ 5,000.00 ❑ PERSONAL&ADV INJURY $ 1,000,000.00 ❑ GENERAL AGGREGATE $ 2,000,000.00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 1,000,000.00 ❑ POLICY ❑ PRO ❑ LOC $ JECT AUTOMOBILE LIABILITY EGa,:ddEntSINGLE LIMIT $ ❑ ANY AUTO BODILY INJURY(Per person) $ B ❑ AALL UTOS OWNED ❑ SCHEDULED BODILY INJURY(Per accident) $ AUTOS NON-OWNED PROPERTY DAMAGE $ ❑ HIRED AUTOS ❑ AUTOS Per accident ❑ ❑ $ ❑ UMBRELLA LIAB ❑OCCUR EACH OCCURRENCE $ ❑ EXCESS LIAB ❑CLAIMS-MADE AGGREGATE $ ❑ DED ❑ RETENTION$ $ WORKERS COMPENSATION ❑ ❑ER WC STATU- OTH- _ AND EMPLOYERS'LIABILITY YIN TORY LIMITS_ _— B ANFICER/MEMBERIEXCLUER/E ECUTIVE N/A 10644955 04/05/2016 04/05/2017 E.L.EACH ACCIDENT $ 100,000.00 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEI[_$ 100,000.00 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1 $ 500,000.00 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,K more space is required) Electrician CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Miami Shores THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN 10050 Northwest 2nd Avenue ACCORDANCE WITH THE POLICY PROVISIONS. Miami Shores,FL 33138 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05)QF The ACORD name and logo are registered marks of ACORD RICK SCOTT,GOVERNOR _ KEN LAWSON,SECRETARY STATE OF FLORIDA DEPARTMENT A TRICBL �710N CONTRACTORS LICENSING BOARD E01300a399 The ELECTRICAL CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2016 LN DOLTCHINKOV, HRiSTO a- L7D DOLCHE INC 253 17210 STJ4E�', 'J 3 _ SUNNY ISLESFt 33160 r ♦• ,. ISSUED: 07/17/2014 DISPLAY AS REQUIRED BY LAW SEQ# L1407170000485 002129 an "i $57311 0,4 AVIS N+I t>l 'A`i 'lbt .-iFt�88C't0 8EC.TYPE OF OWNBR PAYMENTFECE11f�CD gQLChtE K 196 EMRICALCO?�`CT TAX t: tieera#1 r(s) 1 EC130043.99WbAe $75,00 07/02/20#5 OtEDITCARD-15-032128 _. .> Thislo�Busiaeei;T#it ilacelPt t�fi^tta p . X10;. 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