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EL-16-3198 h T-77777�:77, %77Y77 Miami Shores Village _ etElOdd� 0 Bt �. Q 10050 N.E.2nd Avenue NE "F Miami Shores,FL 33138-0000 M, Phone: (305)795-2204 fi... uQl A � I u j ;1 j2gj 8 Expiration: 05/28/2017 Project Address Parcel Number Applicant 889 NE 97 Street 1132060142650 Miami Shores, FL 33138- Block: Lot: EDORADO&CATHERINE RIBET Owner Information Address Phone Cell EDORADO&CATHERINE RIBETTI 888 NE 97 Street (305)609-7323 (786)612-9664 MIAMI SHORES FL 33138- 889 NE 97 Street MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone Valuation: $ 1,000.00 YORK ELECTRIC CORP (786)287-7380 Total Sq Feet: p Type of Work:POOL ELECTRIC Available Inspections: Additional Info:POOL ELECTRIC Inspection Type: Classification:Residential Final Scanning:1 Light Niche Bonding Review Electrical Alarms Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $0.60 CCF Fee Invoice# EL-11-16-62155 DBP $4.50 11/29/2016 Credit Card $313.60 $0.00 DCA Fee $4.50 Education Surcharge $0.20 Permit Fee-Additions/Alterations $300.00 Scanning Fee $3.00 Technology Fee $0.80 Total: $313.60 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 e' er myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL,PLUMBING,MECHANICAL,WINDO D ORS,ROOFING an IIOMING POOL work. OWNERS AFFIDAVIT: I certify that all the foregoing i rmation is ccurate at all work will be done in compliance with all applicable laws regulating construction and zoning. Futhermore,I authorize the ove-named ntra o do the work stated. November 29,2016 Authorized Signature:Owner / Ap icant tractor Agent ate Building Department C p November 29,2016 1 Miami Shores Village RFIECEIVUD Building Department Nov 22 2016 10050 N.E.2nd Avenue,Miami Shores, Florida 33138 BY: l Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 G-M FBC 20 14 BUILDING Master Permit No. 90 16 -ZS*7-7 PERMIT APPLICATION Sub Permit No.4E L I --3196 ❑BUILDINGLECTRIC ❑ ROOFING r--] REVISION E] EXTENSION [:]RENEWAL F-]PLUMBING ❑ MECHANICAL [—]PUBLICWORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP 1 CONTRACTOR DRAWINGS JOB ADDRESS: F� City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): Phone#: Address:MaAM P,i P-) City: I l �hDte1 Staters Zip: m Tenant/Lessee Name: Phone#: Email: ysg�r & cm- �'1'�il I L ° ccj� l CONTRACTOR:Company Name: Y®r v-- 1ecr i c - Phone#: ' Address: 000 ':Da Q—A10 - City: ( State: ELI Zip:-3,3� Qualifier Name: tDer 1 Phone#: State Certification or Registration#: E .i I 15737 Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: 0 0 Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration New ❑ Repair/Replace ❑ Demolition Description of Work: r� C-J r � Specify color of color thru tile: Submittal Fee$ Permit Fee$ CCF$ (0 •G(D CO/CC$ Scanning Fee$ Radon Fee$ _ o ,+�DBPR$ Lt. � Notary$� Technology Fee$ 0 CEJ Training/Education Fee$ 11 2-0 Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ 3 ° 0 (Revised02/24/2014) r , Bonding Company's Name(if applicable) Bonding Company's Address _ City State ip Mortgage Lender's Name(if applicable) Mortgage Lender's Address City Sta Zip Application is hereby made/on. a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the iof a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdi 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 notbe approve nd a reinspection fee will be charged. Signature Signature OWNER or AGENT CONTRACTOR T e foregoing instr e/n't was acl nowledged before me this The foregoing instrument was a knowledged before me this day of l� 20 by day of 20 � by e o ally known to 11( � is person kms` o me or who has produced as me or who has produced as identification and who di take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: IS SANCHEZ Sign: F 5s 2 Sign: t b r Ne 8. -4— Iftoftc , Print: Print Seal: Seal iaorZ sas�i5� Foridallot Service.com APPROVED BY �'jt v�7it�4iP`4G Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) a n0 CERTIFICATE OF LIABILITY D�ATEiMMiDD TY INSURANCE l THIS CERTIFICATE i5 ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CER1IFfCATE HO ER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGA2016 TIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE GOES NOT AUTHORIZED N THE ISSUING INSURE CONSTITUTE A CONTRACT BETWEER(S), REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER, REPRESENTATIVE IMPORTANT: c the ionscertificate h holder is an ADDITIONAL INSURED,the pollcy(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 W certificate holder in lieu of such endorsement(s). PRODUCER NTACT I Continental III NAM£: Maria Reyes _. PHONE 5200 SW 8st Ste 250 AIC Ns Etcsi: (305)207-7886 (�*� - :D;MAIL _ _.,,,_L,{NCRNo): (305)207-0565 Coral Gables,FL 33134 ooRas ^n�reYes(�continetalpac com _ Phone (305)207-7886 Fax (305)207-0565 1NsuRER(JAFFORDiNG COVERAGE INSURED INSURERA: Nautilus insurance Company I` _ - INSURER B. ; York Electric Corp. — INSURER C• 45 NW 27tH Ave INSURER Ill i Miami FL 33125 INsuRER E: IN COVERAGES CERTIFICATE NUMBER: SURER F REVISION NUMBER: - THiS iS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED SELQW HAVE BEEN ISSUED TO REDNAMED THE INSUABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDMON OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE fSSUED OR MAY PERTAfN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS ANb CONDITIONS Of SUGH POLICIES.LIMIT S SHOWN MAY HAVE BEEN REDUCED BY PAiD CLAIMS. 1NSRI iA00 B LTR_i TYPE OF INSURANCE POLICY MAC, EXP 1COMMERCIAL GENERAL LIABILITY1ItIS POLICY UMBER y(MM/pDJYYYY��(, M/D-DlYYY1]•� LIMITS I© jI 3 EACH OCCURRENCE S_1,000,000.00_ ❑ CLAIMS-MADE Q OCCUR (— DAMAGE TO RENTED " A ❑ I � PR9M1SE„§(,Eaooanrerroel s 100,000.00 i ? NN622923 MED EXP(Anyone person) $ $,000.00 ❑ 06/05/2016 06/05/2017 _ GEII AGGREGATE LIMIT APPLIES PER: PERSONAL 8 ApV INJURY SM 1,000,000AO ❑ � GENERAL AGGREGATE © POLICY ❑ JPR1 LOC I s 2,000,000.00OO P/OP AGG; S 2,000,OAO__ ❑ OTHER PRODUCTS-COM I .._.. _..._.....__._ I AUTOMOBRE LU46iLITY l ' COMBINED SINGLE Il j ❑ ANY AUTO BODILY INJURY(Pet person) _s - -•-----i ❑ AU�•osS ❑ aUTOSDULEo I ; INJURY ( -_._-- III•••�� BODILY tNJURY(Pet accident s HIRED AUTOS AUOi�OSWNED 3 ❑ UMBRELLA LIAR ❑OCCUR t! ( s — - D EXCESS LIAR ❑CLAIMS-MADE I ! EACH OCCURRENCE -.._._.d $ AGGREGATE $ DED RETENTIONS WORKERS COMPENSATION ---- s __4 AND EMPLOYERS LIABILITY Y/N I ❑ PER E( I EWED?ECS I �ICMHMMBR EXCLUDED? NIA { E.L.EACH ACCIDENT $ (Mandatory in E.L.DISEASE-EA EMPLOYE$ un Ityes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMITJ $ DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(Atte h ACORD 101,Additional Remarks Schedule,if More space Is required) Electrical work within buildings. Licence#ECI3004 87 i i i r I �Policy subject to policy terns and conditions. i ._......_.._.__._... CERTIFICATE HOLDER CANCELLATION I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Miami Shores Village THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELiVERED IN •: ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE 2ND Ave l Miami Shores,Fl 33139 AUTHORIZED REPRESENTATIVE U^ �- Fax(305)756-8972 TM ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01)QF The ACORD name and logo are registered marks of ACORD T00/T0010 XV9 81 ITT MIX 9TOZ/5T/11