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EL-17-961 Perm#NO,EL-4-17-961 ytia W iMiami Shores Village Permit Type 10050 N.E.2nd Avenue NE I W Gftssifii=Cattott:Aitclitlfratio"' .:. Mi�rni Shores,FL 33138-0000 -e r - `�ffN a Phone: (305)795 2204 Per7i it Status APPROVED 0R Isaue at 41241201 Expiration: 10/21/2017 Project Address Parcel Number Applicant 10550 NE 2 Place 1122310130550 Miami Shores FL 33138- Block: Lot: VULCAN DYNAMIC REALTY FUP I Owner Information Address Phone Cell VULCAN DYNAMIC REALTY FUND L 175 SW 7 Street MIAMI FL 33130- 175 SW 7 Street MIAMI FL 33130- Contractor(s) Phone Cell Phone Valuation $ 550.00 SUNSHINE ELECTRICAL CONTRACT( (305)268-4958 Total Sq Feet: 0 Type of Work:INTERIOR REMODELING OF KITCHEN AND Available Inspections: Additional Info:INTERIOR REMODELING OF KITCHEN AND Inspection Type: Classification:Residential Final Scanning:1 Meter Box Alteration Relocation Fire Alarm Service Change Review Electrical W.W. Underground Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $0.60 Invoice# EL-4-17-63606 DBPR Fee $3.38 DCA Fee $3.38 04/24/2017 Credit Card $ 186.36 $50.00 Education Surcharge $0.20 04/06/2017 Credit Card $50.00 $0.00 Permit Fee-Additions/Alterations $225.00 Scanning Fee $3.00 Technology Fee $0.80 Total: $236.36 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 fogingDep L,PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work. OWNERSI ce ify that the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construct** t ,I authorize the above-named contractor to do the work stated. April 24, 2017 nature:O her / Applicant / Contractor / Agent Date Bui ment Copy April 24,2017 1 ` RECEIVEL l Miami Shore�''Viflagea�� f AF3 0 6 7017 Building Department= 10050 N.E,2nd Avenue,Miami Shores,Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBED:;(305)762-49f4i' s� :. FBC 20 `--I BUILDING Master P9rrMtt.No. Q• C I PERMIT APPLICATION sub P.errnit.No. ❑BUILDING ELECTRIC ❑ ROOFING ❑ REVISION ❑.EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF [ CANCELLATION SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 0 6 5 02 ri i'` ��?t de '. i i Shores Zip, Folio/Parcel#: ZZ 3�'" 3"0�6 95 -Is the Sul.4Ir1g Hlstorlca)ii De�ignated:Yes NO X Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: va 1; . OWNER:Name(Fee Simple Titleholder): G401 'Phone#:. /1912— Address:�''� yyS�J City: }A,I A.wl.i State: r /s qZip: 3«d tr s Tenant/Lessee Name: Phone#: Email: 7� CONTRACTOR:Company Name: Phone#: Address:)c t r Y Pfr"fr s City-.3(X M- i!C2=L state: j Zip: y Qualifier Name Phone "1.0 r State Certification or Registration#: itte of Ci�Cetgncy#: i r+_ DESIGNER:Architect/Engineer: P " F.-h o h e M c, Address: City: State: Zip: Value of Work for this Permit:5 Square//pear Footage of Work: nM ❑ Type of Work: ❑ Addition [:1 Alteration ❑ New ❑] Repair/Replace Demolition �le til S Description of Work: `� ��°' ��'�� Specify color of color thru tile: ;4 i Submittal Fee$ Permit Fee$ � `CCF$ 1 CO/CC$ Notary$ Scanning Fee$ Radon Fee$ Technology Fee$�° �� _Training/Education Fee$ :Double Fee$ Structural Reviews$ Bond$ TOT�'& :NOW DUE$ (Revised02/24/2014) 77 e"ii i WC ; Bonding Company's Name(if applicable) Bonding Company's Address 4 City State Mortgage Lender's Name(if applicable) Mortgage Lender's Address ` " " City State ,t :Zip Application is hereby made to obtain a permit to do the work and installations as indicated;::)',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`fbr 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 estimatedyglue exceeding$2500,the applicant must promise in good faith that a copy of the notice of commencement and comtruetion lien A7W 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 S cif l• • !'i .,' 1�'.... Signature Signature ?, �w'l1✓1 O ER o ---CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of 20.i Z by Q`I' day of tnr 20,1? by kg (f�re Er who is personally known to g , fit• illfwho is personally known to me or who has produced as rn "o has prod i7F d as identificatio and who d take an oath. idehtificbtion and wffbldl&ke an oath. NOTAR UBUC: NOTARY PUBLIC: tr: vE Sig 7777 4r P • t Prigte Se 1 r COMMISSION#FF8Z6OQ0 Seal-, MY COMMISSION#FF972714 EXPIRES:MAR 20,2020 EXPIRES Oobo1w 23.20119 -.,=OF�Bonded through 1st State insu!ance (<07 38847 FbWaftrarySera=cm t 0 W►YiitYii•ikWF•At�k�Y ♦�►+M1� ai;it�hM�6WOi�iy�ii �R>• i�Y♦M4YkiflWM�Y��w117F•4+MfFWi+Ml�tF�#�4SF4tW iY itt��ttt4ftiR w+MMitt iRii itS+k+YiY#4 .� �. APPROVED By Plans Examiner,, - Zoning Structural Review; ,_ Clerk (Revised02/24/2014) SUNSHINE ELECTRICAL CONTRACTOR CORP. LICENSE NUMBER: CFC1428288 PHONE#786 443 9590 786-2736194 Date: 03/28/2017 County of: Miami Shores Village Building Department Before me this day personally appeared Mariano Santiesteban who, been duly sworn, deposes and says: That he will be the only person working on the property located at 10550 NE 2 PL Miami Shore. Coordially: MARIANO SANTIESTEBAN Sworn to and subscribed before me thisday oU4 20 1� By Personally know Or produced Identification Type of identification Print Type or stamp of Notary .4PaYPa,, RAULNAVARRO MY COMMISSION#FF972714 EXPIRES:MAR 20,2020 Bonded through 1st State Insurance M : Miami shores Village Building Department 10050 N.E.2nd Avenue MORrpA Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Notice to Owner — Workers' Compensation Insurance Exemption Florida Law requires Workers' Compensation'insurance coverage under Chapter 440 of the Florida Statutes. Fla. Stat. § 440.05 allows corporate officers in the construction Yndustry'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 labor,part-time employees or subcontractors for your project.The contractor has provided an affidavit stating that he or she will 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. G Signature: er ji J A(4 A MpeT6 State of Florida County of Miami-Dade !L ff The foregoing was acknowledge before me this day of 1 ,20AT—. By elq who is personally known to me or has produced as identification. Notary: SEAL: C�MM�ss�a _a3��9 �� •_�aA1St3 14p1 3�" ACC>R0® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY) 03/23/2017 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 CONTACT NAME: Flor Molina Ample Insurance Company PHONE Ftl: 305-264-9900 ac No): 786-401-6493 PO Box 929 ADDRESS: fmolina@ampleins.com INSURER(S)AFFORDING COVERAGE NAIC# Oakland FL 34760 INSURERA: GRANADA INSURANCE COMPANY INSURED INSURER B: Sunshine Electrical Contractor Corp INSURER C: 1300 SW 85 Court INSURER D: INSURER E: Miami FL 33144 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 SUER POLICY NUMBER MMIDDYrYY POLICY EXP LIMITS LTR X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMA CLAIMS-MADE X OCCUR PREM SES EaENcTurrence $ 100,000 MED EXP(Any one person) $ 5,000 A 0185FL00094091 04/07/2017 04/07/2018 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY E PRO- JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea acddent ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident UMBRELLA UA13 OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION PER AND EMPLOYERS'LIABILITY Y/N STATUTE I I ER ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ N A E.L.EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Electrical work inside outside building**** License No.EC13005807 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN VILLAGE OF MIAMI SHORES ACCORDANCE WITH THE POLICY PROVISIONS. BUILDING DEPARTMENT AUTHORIZED REPRESENTATIVE 10050 NE 2ND AVE MIAMI SHORES VILLAGE,FL 33138 J ©1988-2014 ACORD CORPORATION.All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD