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EL-17-222 x , IM Al 3 Permitwb mss Miami Shores Village F&M t Type.e 10050 N.E.2nd Avenue NE ; Vort ClassiCattc�n G�h� ; Miami Shores,FL 33138-0000 `F Phone: (305)795-2204 OV, ioxu�' !~tate 1114Expiration: 07/31/2017 77 Project Address Parcel Number Applicant 50 NE 91 Street 1131010200030 ROBERTO CEPERO Miami Shores, FL 33138- Block: Lot: Owner Information Address Phone Cell ROBERTO CEPERO 50 NE 91 Street MIAMI SHORES FL 33138-2808 Contractor(s) Phone Cell Phone Valuation: $ 1,890.00 FLORIDA ELECTRIE SOLUTIONS INC ._....._ _ ..._..:._._..._...,.., ., ... - Total Sq Feet: 0 Type of Work:REPLACE ELECTRICAL SERVICES(METER Available Inspections: Additional Info:REPLACE ELECTRICAL SERVICES(METER Inspection Type: Classification:Residential Review Electrical Scanning:3 Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $1.20 Invoice# EL-1-17-62750 DBPR Fee $2.25 01/27/2017 Credit Card $50.00 $116.70 DCA Fee $2.25 Education Surcharge $0.40 02/01/2017 Credit Card $ 116.70 $0.00 Permit Fee-Additions/Alterations $150.00 Scanning Fee $9.00 Technology Fee $1.60 Total: $166.70 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 zoning. Futhermore,I authorize the above-named contractor to do the work stated. 3o—pl& A , --Av.A-30l t- February 01, 2017 Authorized Signature:Owner / Applicant / Contractor / Agent Date Building Department Copy February 01,2017 1 Miami Shores Village \\ ,cdA Bb• ding Department 10050 N.E.2n venue,Miami Shores,Florida 33138 ,yam �`� -- -- 1 v Tel:(305)7 5-2204 Fax:(305)756-8972 — INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 20 BUILDING Master Permit No.RG q— 1SjS PERMIT APPLICATION Sub Permit No e,� r-1 m zzz ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 5-0 pk q 1 5 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): F-oh`C-0 C!(--P(--" Phone#: Address: City: ill roM1 S�bYLC—S State: �� Zip: Tenant/Lessee Name: Phone#: Email: �G-I� Lo• �ab�-�� Q Irl/� l C , �. s CONTRACTOR:Company Name: a ��v,Do- Phone#: 1s `v Address: 1 S 616 '2 City: I #>ui,,1 State: CL Zip: 3!1 Qualifier Name: 1 \ a Phone#: e 1 0 L State Certification or Registration#: Certificate of Competency#: l l DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: C Square/Linea7Repai ge of Work: Type of Work: F-1Addition ❑ Alteration ❑ New r/Replace ❑ Demolition Description of Work: a-61266,-G , I; �� �, t2V�`CSS CtXir---r--d C p�2 •y: anr.s ar. Specify c ki 4f..color thru tile: a w� •� ii, 6 illrt+ryil, .,�.i.p''.. . •' oo _ U �', t9`ii;9j , r `g;'Ly�y:'.s ' Submittal F 6� ®/�® CCF$ F ��C® CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ 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. Signature.QQ, Signatur OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day o A>v 20 4> by �day of� _ &i� 20 /'- ,by who is personally known to is personally known to me or who has pro uced lyl�>,� as me or who hproduced wy���o ��o a5 s identification and who did take an oath. identification and who did talfe an oath. NOTARY PUBLIC: NOTARY PUBLIC: S' ign: Print: Print: • P 1 'q 44 .+'y"��.,, DAYSI R0011N!!Et °. ,�•; Notary Public•State of Floft Seal: �.�'j �s .,w Seal: • .�, Notary Pubk•State of FIwIft .•5 Commission#GG 032324 • •s Commission i GG 032324 ";, Bpd My Comm.Expires Sep 21,2020 My Comm.Explres Sep 21,2020 8 All t% Bonded through National Notary Assn. ** �4RkIfali�tkli x�* a*** ******* * All APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) 4 gBoR;�s �4 I� VillageMiami a7�hores Building Department . � 9 p 10050 N.E.2nd Avenue `FNrts►r�s �tpRXpA Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Notice to Owner ® Workers' Compensation Insurance Exemption Al.,z Florida Law requires Workers' Compensation insurance coverage under Chapter 440 of the Florida Statutes. Fla. Stat. § 440.05 allows corporate officers in the construction industry to exempt themselves from this requirement for any construction project prior to obtaining a building permit. Pursuant to the Florida Division of Workers' Compensation Employer Facts Brochure: An employer in the construction industry who employs one or more part-time or full-time employees,including the owner,must obtain workers' compensation coverage. Corporate officers or members of a limited liability company (LLC) in the construction industry may elect to be exempt if 1. The officer owns at least 10 percent of the stock of the corporation,or in the case of an LLC,a statement attesting to the minimum 10 percent ownership; 2. The officer is listed as an officer of the corporation in the records of the Florida Department of State,Division of Corporations;and 3. The corporation is registered and listed as active with the Florida Department of State,Division of Corporations. No more than three corporate officers per corporation or limited liability company members are allowed to be exempt. Construction exemptions are valid for a period of two years or until a voluntary revocation is filed or the exemption is revoked by the Division. Your contractor is requesting a permit under this workers' compensation exemption and has acknowledge that he or she will not use day - foryour-proj�ec-T e-eontractor�as provided a affit avit stating khat heir she'Nil� - be the only person allowed to work on your project.In these circumstances,Miami Shores Village does not require verification of workers' compensation insurance coverage from the contractor's company for day labor,part-time employees or subcontractors. BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. Signature: (. Owner State of Florida County of Miami-Dade The foregoing was acknowledge before me this a4/ day of­_7�/L, 20//-) Bwho is personally known to me or has produced I ntification. DAYSI t GUEZ eats Notary: r � to of Fl _ • _ SEAL: �`�; My Comm.Expires Sep 2t.+ t�� Bonded through National Nola,y Florida Electric Solutions 9115 Broad Manor Road Miami Florida 33147 Phone#786-290-9840 E-mail:floridaelectricsolutions@gmail.com Date State of ,ibrc,�c�p„ County of lµL la"t �yC� Before me this da Personallya eared ( a who being duly sworn deposes and says that the only person workine on thg proiect to ated at SO Sworn to(or affirmed)and subscribed before me this 29 day of9v"'-e-ii20av %��s�� (21V t14nZ Personally know Or produced identification a &/O c)6b—,9S dO3-P Type of identification 6'zp-� Print type or stamp name of notary Y p.. DAYS,RODRIGu" •'�'� "B`l% No Public State of Florida Commission#GG 032324 Sll ^, pw•' nay Gomm Fzpires Sep 21,2020 ''''%�°i i�� Bonaea iniuuyn Nxionai Notary Assn. CTQB Construction Trades Qualifying Board BUSINESS CERTIFICATE OF COMPETENCY 1IE000018 z� ;FLORIDA ELECTRIC SOLUTIONS INC D.B.A.: N � MAO YOISLANDY Ile carolled under the provisions of Chapter 10 of Miami-Dade Coun ly STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COM''ENSATIOt� '"�•�.�� r CONSTRUCTION INDUSTRY EXEMPTION CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS'COMPENSATION LAW 516f20v TE: EFFECTIVE DATE: 517/2015 EXpIRA�ON DA ;. PERSON: MARRERO YOISLANDY FEIN: 274625762 e � e e e BUSINESS NAME AND ADDRESS'- FLORIDA DDRESS:FLORIDA ELECTRIC SOLUTIONS INC e � � e 9115 BROAD MANOR RD � FL 33147 e MIAMI e SCOPES OF BUSINESS OR TRA I LICEN ' SED ELECTRICAL IZONTRACTOR l ,4c R CERTIFICATE OF LIABILITY INSURANCE01/23/2017 ' �"""�� 01!23/2017 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 NAME CT ANA.. SAMY INSURANCE PHONE Fax - 3855 SOUTHWEST 137 AVE SUITE 2B EEWMAILq eKgL 305!559_M55 ........ (A/C,No): 305-559 6856 ADORESS;.Sal'11y1(1&UranCe4Dpr0digy net,,. MIAMI,FL 33175 INSURER(SI AFFORDING COVERAGE MAIC q ..._.___ INSURERA_UNITED STATES LIABILITYGROUP INSURED INSURERS.. ASCENDANT INSURANCE FLORIDA ELECTRIC SOLUTION 9115 BROAD MANOR ROAD INsURER c ...... MIAMI,FL 33147 ANAP 4._.- -INSURERE:1 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. INSR7 _ .. ..........._ .. ......_ LTR TYPE OF INSURANCE ...........POLICY EFF POLICY EXP....`._. _____ _........ _,. POLICY NUMBER MM/DDIYYYY + MMtDD/YYYY ' LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1 000,000_ X,COMMERCIAL GENERAL LIABILITY ?DAMAGE=TO RENTED - ' 3 , DAMAGE occurrence) .$ 1QQ,Qg _ CLAIMS-MADE X 1 OCCUR MED EXP(Any one person) 5 5.000,. A I CL 1683110-B 12/22/2016 12/22/2017'PERSONAL a ADV INJURY $ 1,000.000 ............. GE NERAL AGGREGATE a$2,000 000 GENT AGGREGATE LIMIT APPLIES PERWOPA PRODUCTS•COMP! GG $2.QQQ.QpQ POLICY PROT LOC ?g 1 AUTOMOBILE LIABILITY C MBIN D SINGLE LIMIT ! ;ANY AUTO ; BODILY INJURY(Per person) $ 10.000 r ALL OWNED ..__.3 SCHEDULED t..._. _... ..... ; _..__•.-- --_..... B 1 AUTOS . AUTOS 'BODILY INJURY(Per accident)'$20,000 NON-OWNED CA-39981-00 01127/2016:01/27/2017 PROPERTY DAMAGE ;HIRED AUTOS AUTOS ! ecudenj) ................. {$ 10.000 .. iS UMBRELLA UAB OCCUR !F_ EACH OCCURRENCE EXCESS LIAR ! T CLAIMS-MADE .AGGREGATE $ DED RETENTION$ l WORKERS COMPENSATION WC STATU- I ,OTH AND EMPLOYERS'UABILrrV 1 ANY PROPRIETORtPARTNERIFXECUTIVE YIN -- I E L EACH ACCIDENT $ j OFFICEIMEMBER EXCLUDED? 1 N I A ,-.- --- ...- f ... ._ (Mandatory in NH) ; E L DISEASE EA EMPLOYEE,$ If ....... ... ..._ ........................ .... DES describe under E.l.DISEASE POLICY LIMIT!. $ if 3 DESCRIPTION OF OPERATIONS r LOCATIONS f VEHICLES(Attach ACORD 101,Additional Remarks Sehedute,it more space is required$ ELECTRICAL CONTRACTOR CERTIFICATE HOLDER CANCELLATION Miami Shores Village Building Department SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 10050 NE 2ND AVE ACCORDANCE WITH THE POLICY PROVISIONS. ALITHORO TA E...,. Miami Shores FL 33138 _ ©1988-,0 ACORD° ORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks ota"ACORD 0120be Local Business Tax Receipt Miami—Dade County, State of Florida —THIS IS NOT A BILL—DO NOT PAY LBT� 6807292 BUSINESS NAME/LOCATION RECEIPT NO. EXPIRES FLORIDA ELECTRIC SOLUTIONS INC RENEWAL SEPTEMBER 30, 2017 9115 BROAD MANOR RD 7080807 Must be displayed at place of business MIAMI FL 33147 Pursuant to County Code Chapter BA—Art.9&10 OWNER SEC.TYPE OF BUSINESS PAYMENT RECEINEO FLORIDA ELECTRIC SOLUTIONS INC 196 ELECTRICAL CONTRACTOR BY TAx COLLECTOR IlE000018 $75.00 07/11/2016 Worker(s) 1 CREDffCARD-16-038998 This Local Business Tex Receipt only confirms payment of the Local Business Tax.The Receipt is not a license, permit.or a certification of the holders pualdfcatroas,to do business.Holder must comply with any governmental or nongovernmental regulatory taws and requirements which apply to the business. The RECEIPT N0.above must be displayed as all commercial vehicles—Miami—!lade Code Sec tie-276. For more information,visit miamidade^ovhaxcollector n �. STATE OF FLORIDA DEPARENT OF BUSINESS A `�_„•; PROFESS ONAL REGULATION ND ER13Oi458i jr,SUED: 09/01/2016 REG ELECTRICAL,CONTRACTOR MARRERO,YOIS�ANDY FLORIDA ELECTRIC S�LUTIQ LS CAL (INDIVIDUAL MUST MEET A 11 Q LICENSING REQUIRENIS.�'RIOR TO CONTRACTING IN AN EA) HAS REGISTERED under the provision L11000 easFS. Expiration date:AUG 31,2018 ;H HERE KEN LAWSON,SECRETARY f i0��c�.g� lals IN 1 6 � �� • A tom• ► 1 g8 rT� f4 3v iz G � 94 (S GPj N a s�aLl a o ga S� 1S C-. l5 ' O 1c p 3-1 3 to �� �1� b, Mv( 6 A � is >�' ►s � � � qr ,,,E e-, 1� L ,,E - - to. R3 3 swkAltj BUS.. A l ®P t ,'4 k JAN 27 17 ...see NES � ►� ..... 6 . �.�. c 4 ..... .. . .. . / ...... so iss es 0 16 • • ...... • . Do A i{2 ...... .... • • mICillE IIOC@ Village • A,P .RO ED BY PATE I� EPT 7*r ' e y gn BLE GD PT N SUB ECT 7 0 CO PLIA CE WI FED RAL STA AN COU TY R LES A DRE, ULA IONS �. ICA, 9x 1 C �1 C. too