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EL-16-2160 Miami Shores Village M P6E 10050 N.E.2nd Avenue NE -14 /l 405}«�I1� ration Miami Shores,FL 33138-0000 PeItStatus,APPRO 4 h Phone: (305)795-220 ' ls> uepa 1i/11�1 °3 Expiration: 07/2017 3 � Project Address Parcel Number Applicant 1199 NE 92 Street 1132050270330 Miami Shores, FL Block: Lot: REY WHITEHORN Owner Information Address Phone Cell REY WHITEHORN 1199 NE 92 Street (954)612-8850 MIAMI SHORES FL 33138- 1199 NE 92 Street MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone Valuation: $ 900.00 SASSON ELECTRIC INC (305)933-4442 w. _. _...... Total Sq Feet: 0 Type of Work:REMODEL BATHROOM,INSTALL SMOKE DET Available Inspections: Additional Info: Inspection Type: Classification:Residential Review Electrical Scanning:1 Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $0.60 Invoice# EL-8-16-60826 DBPR Fee $2'25 08/11/2016 Check#:136 $ 114.10 $50.00 DCA Fee $2.25 Education Surcharge $0.20 08/01/2016 Check#: 133 $50.00 $0.00 Notary Fee $5.00 Permit Fee-Additions/Alterations $150.00 Scanning Fee $3.00 Technology Fee $0.80 Total: $164.10 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 all t�foregoinginformations accurate and that allwork will be done in compliance with all applicable laws regulating construction zoning Futh or_ I acontractor to do the work stated. 94 August 11, 2016 u rize Signature:Owner nt / Contractor / Agent Date Building Department Copy August 11,2016 1 Miami Shores Village Building Department UG o 201 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 - INSPECTION LINE PHONE NUMBER:(305)762-4949 ': FBC 20 'AS1 Q BUILDING Master Permit NoQ - PERMIT APPLICATION sub Permit No. EL 1 ZI W ❑BUILDING EfELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL F-]PLUMBING ❑ MECHANICAL [:]PUBLICWORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: I c(n( F C(� Sk`�'A City: Miami Shores County: Miami Dade Zip: 37, \3`d Folio/Parcel#: Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): LA� ,��0 0 -4 Phone#: Address: City:M1a.n..1 State: Zip: 3';\-3 j Tenant/Lessee Name: Phone#: Email: (Ze.,��, Ve�na t _j Ccs ry\ CONTRACTOR:Company Name: / ;I-- Phone#: 303' 93.3 V40(2_ Address: Z.5S0 f dY/ 193- city: 9SCity: Al la- g"le State: F L Zip: 3 -7 / ,?a Qualifier Name: fS&Ge SSS 5-u Phone#: rQ.oi &-- State Certification ori#: G Cao® 25,-2-7 Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: -Value of Work for this Permit:$ %0a0c) Square/Linear Footage of Work: Type of Work: ❑ Addition _J;� Alteration ❑ New ❑ Repair/Replace ❑ Demolition =. ,Description of Work: Ok V QrA Specify color of color thru tile: Submittal Fee$ EO Permit Fee$ CCF$ (90 CO/CC$ Scanning Fee$ GQ) Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ c', 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. �;r Signature V Signature OWNER or AGENT CONTRACTOR G.. The foregoing instrument was acknowledged before me this The foregoing instr ment was acknowledged beforer me this 1 day of Q��w ,20 fO by day of v�� 20 �b , by Y ( ( U( ,w1ho its personally known to �a r� who is personally known to me or who has producedVL DUTR- uc-�g-as me or who has produced � U( as identification and who did take an oath. identifcaItia, who did take an oath. NOTARY PUBLIC: NOTARY Sign: '' ff Sign: I Print: �1 � T'�W Print: v� Seal: n aey NO N 3 y ,;ate of Florida Seal: F gs , ba a Pi!Gorr s_.ion FF 156750 n a-17 o n'> 0'lc Siat7ofFlorida ExpireFO '0 '018F04** 'rx APPROVED BYPlans Examiner Zoning Structural Review Clerk (Revised02/24/2014) STATE OF FLORIDA . @'� DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD (850) 487-1395 " 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 SASSON, ISAAC SASSON ELECTRIC INC 2501 NE 195TH STREET MIAMI FL 33180 Congratulations! With this license you become one of the nearly one million Floridians licensed by the Department of Business and Q,744i) Professional Regulation. Our professionals and businesses range STATE OF FLORIDA from architects to yacht brokers,from boxers to barbeque DEPARTMENT OF BUSINESS AND restaurants,and they keep Florida's economy strong. �..� PROFESSIONAL REGULATION Every day we work to improve the way we do business in order EC0002527 ISSUED: 06/08/2016 to serve you better. For information about our services, please to onto www.myfloridalicense.com. There you can find more CERTIFIED ELECTRICAL CONTRACTOR information about our divisions and the regulations that impact SASSON, ISAAC you, subscribe to department newsletters and learn more about SASSON ELECTRIC INC the Department's initiatives. Our mission at the Department is: License Efficiently, Regulate Fairly.We constantly strive to serve you better so that you can IS CERTIFIED under the provisions of Ch.489 FS. serve your customers. Thank you for doing business in Florida, Expiration date: AUG 31.2018 L16060800D1056 and congratulations on your new license! DETACH HERE RICK SCOTT, GOVERNOR KEN LAWSON,SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD A EC0002527 The ELECTRICAL CONTRACTOR ' Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2018 SASSON, ISAAC •� SASSON ELECTRIC INC 2501 NE 195TH STREET MIAMI FL 33180 ■ IRRI IFn• 1718r08i2016 DISPLAY AS REQUIRED BY LAW SEG/# L1606080001056 UU42:3 Local' Business Tax Receipt Miami—Dade County, State of Florida —THIS IS NOTA BILL — DO NOT PAY \ILBT-I/ 2625920 BUSINESS NAME/LOCATION RECEIPT NO. EXPIRES SASSON ELECTRIC INC RENEWAL SEPTEMBER 30, 2016 2501 NE 195 ST 2754225 Must be displayed at place of business MIAMI FL 33180 Pursuant to County Code Chapter 8A—Art.9&10 OWNER SEC.TYPE OF BUSINESS SASSON ELECTRIC INC 196 ELECTRICAL CONTRACTOR PAYMENT RECEIVED EC0002527 BY TAX COLLECTOR Worker(s) t $75.00 07/02/2015 CREDITCARD-15-032317 This Local Business Tax Receipt only confirms payment of the Local Business Tax.The Receipt is not a license, permit,or a certification of the holder's qualifications,to do business. Holder must comply with any governmental or nongovernmental regulatory laws and requirements which apply to the business. The RECEIPT N0.above must be displayed on all commercial vehicles—Miaml—Dade Coda Sec Ba-276. For more information,visit www.miamidade.aov/toxcollector J Aug 81 2816 15:81:28 EDT FROM: F2M/98355561269 MSG# 1614998871-896-1 PAGE 882 OF 992 JRV nAxs;x�smnn�YY) CERTIFICATE OF LIABILITY INSURANCE RU01 8/1/2016 THIS CERTiFICATEIS ISSUED ASA 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 pollcy(les)trust have ADDITIONAL INSURED provisions or 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 flights to the certificate holder In Ileu of such endorsement(S� NAME: NORTHEAST AGENCIES INC/PHS (acNN,E:): (866) 467-8730 FAX (868) 443-6112 210204 P: (866) 467-8730 F: (888) 443-6112 A13OREBB: 301 WOODS PARK DRIVE INSURERS)AFFORDING COVERAGE NAI'--C CLINTON NY 13323 INBURER A: Hartford Casualty ins ca 29424 INSURED INBURER 3: INSURER'3: 5A55ON ELECTRIC INC. INSURER D: 2501 NE 195TH ST INBURER E: MIAMI FL 33180 INBURER F: COVERAQES 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 MAYHAVE BEEN REDUCED BY PAID CLAIMS. mm 7WE a,MWEM471= -41=3LBR FaLx7Jv ..9zA F Cr EFF FOLR:9xxr r J78 LYN NW COMMERCIAL GENERAL LIABILITY EA(:$-I a=JRRENCE t500,000 DAi•AAGE TO RENTED C O O _7 7CL41Iv1S-Id.40E OCCUR FIREMISES(E©acounenoeI '-300' A X General Liab 01 SSM AX8052 10/01/2015 10/01/201E MED EA* Any anaperean) $10, 000 PEREaNAL a ADV INJURY CE-00,000 GEN-L AGGREGATE LIMIT APPLIES PER: aENERALAGGREaATE El,000, 000 POLICY JECT ❑LOC PRODUCTS-COMPIOP AOO $1,COO,000 OTHER: comWNED EINuLE LIMIT AUTOMOBILE LIABILITY (Ea acsidehq p ANY iUTO BODILY INJURY(Per per^.em) a OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Par etcldent) g HIRED NONaMNNED PRaPERTYDAMAoE AUTUS ONLY AUTOS ONLY (Per aeeide n) G UMBRELLA LIAR OCCUR. EACH OCCURRENCE E EXCESS UAB CLAIMS-MADE A,saREaATE OED kETENTIoN t W0R88R?)V&VP A6 ff&V PER ..L�AI�l.OT88128�7JA8JLllT STATUTE ER ANY PROPP.IETaR/PARTNEA/EXEcLMVE YIN EL.EACH ACCIDENT OFFICERINIEI-ASER E<CLUDED? fMandaealy In NN) ❑ NIA E.L.DISEASE,EA EMPLOYEE If yes,describe under s DESCRIPTION OF OPERATIDNs below EL.DISEASE-POLICY LIMIT 0ESCRIPr10NOF OPERATIONS/LOCATIONS/VEHICLEN(ACORO 101,Addlelahal Ramatka Sahadula,may ba anae:had If Inch 0aaa la taqulhd) Tliose usual to the Insured' s Operatioris. RE: LICENSE #EC00021.27. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE VMLL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. MIAMI SHORES VILLAGE AUTHORIZED REPRESENTATIVE 100-50 NE 2ND AVE MIAMI SHORES, FL 33138 e' f 151 1988-2015 ACORD CORPORATION.All r reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD JEFF ATWATER CHIEF FIKANCIAL OFFICER STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS'COMPENSATION **CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS'COMPENSATION LAW CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers'Compensation law. EFFECTOVE DATE: 9/27/2014 EXPIRATION DATE: 9/26/2016 PERSON: SASSON ISAAC FEIN: 650323151 BUSINESS NAME AND ADDRESS: SASSON ELECTRIC INC 2501 NE 195 ST MIAMI FL 33180 SCOPES OF BUSINESS OR TRADE: LICENSED ELECTRICAL CONTRACTOR Pursuant to Chapter 440.05(14),F.S.,an officer of a corporation who elects exemption from this chapter by filing a certificate of election under this section may not recover benefits or compensation under this chapter.Pursuant to Chapter 440.05(12),F.S.,Certificates of election to be exempt..apply only within the scrape of the business or trade listed on the notice of election to be exempt Pursuant to Chapter 440.05(13),F.S.,Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation if,at any time atter the filing of the notice or the issuance of the certificate, the person named on the notice or certificate no longer meets the requirements of this section for Issuance of a certificate.The department shall revoke a DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 07-12 QUESTIONS?(850)413-1609 SASSON ELECTRIC INC e Date(--o C �2-0 Ki State of �L.�T2-1'.D 1"t County of �.F'� K k - Before me this day personally appeared ��e�� —�9( who,being duly sworn, deposes and says: That he or she will be the only person working on the project located at:V-79 NE 92 E[ 0I'A'M( SfMc-s , F�- Sworn to(or affirmed)and subscribed before me this day of U ' S( 20 (C_,by Personally know OR Produced IdentificatioTL Type of Identification Produced l -M V—ULC'VIAJ'�-- 01�Y�Vd. �I otary F'!3G!C Jt2tP.Ot`FIOfIC�B ' e m .Sindid a.Ir13i My Commission FF 156750 toFa�° Eypires09/031?019 Print,TV r Stamp Name of Notary ♦SHORES yi l s� Miami shores Village logo Building Department artment 10050 N.E.2nd Avenue �IORIDA 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 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 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 CKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. Signature: Owner State of Florid 3 " County of Miami-Dade The foregoing was acknowledge before me this 1 day of til GUST ,20_(�. By +i rtc 44U7� who is personally known to me or has produced LA CJEN<i;_:- as identification. Notary: ' O4�Y PU@r �144c�P�P,15 lv Jr n i(C�Fa AIU'XOz SEAL: „ Ak,Con+,n;c;lon FF 155T50 �a.��'pe Expires Otl';13f2�48