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EL-16-598 Miami Shores Village8#xC )A,aaientiai 10050 N.E.2nd Avenue NE ... �� +ork Ojai#6604 Sari ce Chang , Miami Shores,FL 33138-0000 erm,tt armlt Statt;�s.',�!`t vE!?`.I Phone: (305)795-2204 issue gate.W14(201161 Expiration: 10/112016 Project Address Parcel Number Applicant 1086 NE 96 Street 1132060143480 ANA ROJAS Miami Shores, FL Block: Lot: Owner Information Address Phone Cell ANA ROJAS 1086 NE 96 Street MIAMI SHORES FL 33138-2552 Contractor(s) Phone Cell Phone Valuation: $ 1,500.00 RING ELECTRIC INC (754)610-4534 Total Sq Feet: 00 Type of Work:RELOCATE OVERHEAD ELECTRICAL SERVIC Available Inspections: Additional Info: Inspection Type: Classification:Residential Review Electrical Scanning:1 Fees Due Am]50.00 Pay Date Pay Type Amt Paid Amt Due CCF Invoice# EL-3-16-58926 DBPR Fee 04/14/2016 Credit Card $ 160.70 $0.00 DCA Fee Education Surcharge Permit Fee-Additions/Alterations $ Scanning Fee Technology Fee Total: $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 i accur and that all work will be done in compliance with all applicable laws regulating construction and zoning. Futhermore,I authorize the above- n ctor to do the work stated. April 14,2016 Authorized Signature:Owner / Applicant / Contractor / Agent Date Building Department Copy April 14,2016 1 To: Page 4 of 4 2016-04-13 18:02:05(GMT) 305-270-0765 From: . . cp RINGE-1 OP ID:MARZ CERTIFICATE OF LIABILITY INSURANCE DATE04/1312016Y, � 04/13/2016 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 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 .Javier A.Fernandez iSure insurance Brokers 8700 W.Flagler St.,Suite 270 PHONE 305-223-2533 ac Ne,305-220-0765 Miami,A. ernin ADO :Certificates iSureBrokers.com Javier A.Fernandez INSURE 5 AFFORDING COVERAGE NAIL 0 INSURER A:WeStern World Insurance Co. 13196 INSURED Ring Electric,Inc. INSURER s:Florida Citrus,Business FUB SW 63 St Miami,FL 33193 INSURER C:Pr09 ressive Ins.Co. Miami INSURER 0:Scottsdale Ins. 41297 INSURERE: 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. INSRLTR D SR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MMIDDIYYYY MMIDofYYYY LIMITS A X COMMERCIAL GENERAL LIABILITY _ EACH OCCURRENCE S 1,000,000 CLAIMS-MADE FRI OCCUR NPPS269437 08/19/2015 08/19/2016 PREMISES Ea occurrence S 100, MED EXP(Any one person) $ 5,00 PERSONAL&ADV INJURY 5 1,000,00 GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 2,0001 POLICY❑PRO. F-]LOC JECTPRODUCTS-COMPIOP AGG S 2,000,0 OTHER: S AUTOMOBILE LIABILITY Ea accident) U $ 500,00 C H ANY AUTO 08215968-4 09/23/2015 09/23/2016 BODILY INJURY(Per person) S ALL OWNED X SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) S HIRED AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ Pet accident UMBRELLA LIAR X OCCUR EACH AGGREGATE D X EXCESS UAB CLAIMS-MADE XBS0054436 08/19/2015 08/19/2016 AuRRENGE a 1,000,00 AGGREGATE S 1,000,000 DED RETENTION I S WORKERS COMPENSATION AND EMPLOYERS'LIABILITY STATUTE 'ER B ANY OFFICER/MEMBER EXCLUDED?EGUTIVE yIN�NIA 10640008 0410112016 0410112017 E.L.EACH ACCIDENT S 1,000,000 (Mandatory In NH)and E.L.DISEASE-EA EMPLOYE S 1,000,000 tt yes.describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD N1,Additional Remarks Schedule,may be attached if more space Is required) ELECTRICAL WORK-WITHIN BUILDINGS CERTIFICATE HOLDER CANCELLATION CITYMII SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Miami Shores ACCORDANCE WITH THE POLICY PROVISIONS. Fax:305-756-8972 10050 NE 2 Ave AUTHORIZED REPRESENTATIVE Miami,FL 33138 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD y33 EL Ib - S1v Miami Shores Village °p � � r ' Building Department GNpR 0h1 �'� 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 d G Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 20 BUILDING Master Permit No. 2r— b " L13 PERMIT APPLICATION Sub Permit No. ❑BUILDING [91fLECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL PLUMBING F--I MECHANICAL PUBLIC WORKS CHANGE OF ❑ CANCELLATION ❑ SHOP / CONTRACTOR DRAWINGS 6 JOB ADDRESS: [ d F Al� F 6 jre I f City: Miami Shores County: Miami Dade zip:/ 3�l3 Folio/Parcel#: [ / —.3�06' QY'Y- 3 Y S-0 Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): AVS �� O/� f Phone#: al !S --2 ey Address: t 61?6 A,�F 96- City: P 1 ghi 'Parer State: Zip: Tenant/Lessee Name: Phone#: Email: n CONTRACTOR:Company Name:�4/CLQ ��G �Zr� , t'�j JG— Phone# S & �%�� Address: City: ,lar'fylf'! State: Zip: Qualifier Name: Phone#: 3 State Certification or Registra ion#: ertificate of Competency#: DESIGNER:Architect/Engineer: MAPIW LA .44*2 &L Phone#: Address: City: State: Zip: Value of Work for this Permit:$ / S O D C!, Square/Linear Footage of Work: Type of Work: ❑ Addition CK Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: Specify color of color thru tiler Submittal Fee$ Permit Fee$ CCF$ 1 CO/CC$ Scanning Fee$ Radon Fee$ �� DBPR$ 2-S Notary$ Technology Fee$ Training/Education Fee$ 0 --�jo Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ (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. t G�� Signature �- Signature 9f OWNER or AGENT C NTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this I®OL day of �—e b-oa r l) 20 Re by c:7'?,5f day of 20 by Ana KAQ a'P61aS who is personally known to —G'� dJa�2a� V ,who is 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 v Sign Angela Ospina � Print: ina Print- L 2— IR:��°s Pe6ida Gutierrez Seal: _�: . Seal: tA�1' 9' "�EXPIRES: FE9.03,2017 l: NOTARY PUBLIC ��wuvev.AaRorallore,Rvcrom STATE OF FLORIDA Commit FF931890 APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014)