EL-17-1057 i
Permit ivo. EL-4-17-1"067
y�� Miami Shores Village w Parm#t Ty ",Eli ctrical Residential
�• 10050 N.E.2nd Avenue NE
.... a...� Work Clas cakon:Service Change
Miami Shores,FL 33138-0000
111 Phone: (305)795-2204
Permit Status,€APPROVED
fitORl �
issue Date:4tf912 7 : Expiration: 10/16/2017
Project Address Parcel Number Applicant
9022 NES8 Avenue Number: 3R 1132060420580
Miami hores, FL Block: Lot: MERCEDES CORTAZAR
Owner Information Address Phone Cell
9010 NESBIT FERRY RD#207
MERCEDES CORTAZAR
ALPHARETTA GA 30022
Contractor(s) Phone Cell Phone Valuation: $ 900.00
MAX ELECTRIC CORPORATION (305)498-5422 (786)277-6278
Total Scl Feet 0
Type of Work:CHANGE PANEL 100AMP Available Inspections:
Additional Info: Inspection Type:
Classification:Residential Review Electrical
Scanning:3
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $0.60
Invoice# EL-4-17-63715
DBPR Fee $2.25 04/19/2017 Credit Card $ 115.10 $50.00
DCA Fee $2.25
Education Surcharge $0.20 04/17/2017 Credit Card $50.00 $0.00
Permit Fee-Additions/Alterations $150.00
Scanning Fee $9.00
Technology Fee $0.80
Total: $165.10
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,MECL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work.
OWNERS AFFIDAVIT: I certify that all the for n information is accurate and that all work will be done in compliance with all applicable laws regulating
construction and zoning. Futhermore, I authorize ve-named contractor to do the work stated.
April 19, 2017
Authorized Signature:Owner / / Contractor / Agent Date
Building Department Copy
April 19,2017 1
3t)5 �,C�B C5 4 Z Z
18 Miami Shores Village
a ' a1AA
�-� Building Department j
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949 5-TV
FBC 201
BUILDING Master Permit No c�
PERMIT APPLICATION Sub Permit No.
❑BUILDING 2rELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
PLUMBING MECHANICAL Ej PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: ® Z,7— V.-D /o & `61z
City: Miami Shores County: Miami Dade Zia: 3 3 1-6-5
Folio/Parcel#: Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder): n W C6A K 7_Ne Phone#: C1 A k- -+-4
Address: IM
ZZ t-3F- s A vE Ak 3 Q
City: jg%a d3 Ska[Lt. State: Zip: 3-513
Tenant/Lessee Name: Phone#:
Email: n 11
CONTRACTOR:Company Name: �"�� ���e II�.Je `��M�- Phone#:
Address:
City: State: 13Zip: 330`9`
Qualifier Name: Phone#: 49$154 Z2
State Certification or Registration#: 1,300-40(l(p. Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
�O
Value of Work for this Permit:$ Square/Linear Foot a of Work:
Type of Work: ❑ Addition Alteration New Repair/Replace ❑ Demolition
Description of Work: NF1. ��� %a0 to
Specify color of color thru tile:
Submittal Fee$ V Permit Fee$ CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$ • I
(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 ab ence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature �AA h 4 M,)-L- C &� Signature
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
kA da of h 20 ,by ( � day of �D c-A .20 by
A p,. ,who is personally known to leeal who is personally known to
t
me or who has produced C.(0 ,Z -5`l0- 40 -W-'Oas me or who has produced as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
`a,1 "Adia Munn.,
Sign: Olga Lidia Munoz Sign:
:COMI,IIS510N#FF037831 "'� �: i? JULY 21;? �
Print: �-' 4 n 17 Print:
Seal ounee�� 4YWw.AAR0NN0TARY.aom per'°! ✓y A 0lpa, Udia ffly
Seal: C-0MfiSISS; '` m��Iili7ifl
y•- ON§Fi=u3ySm
JULY 21,2017
IWww.AARONNOTARV:wm
s**s*ss*s***ss*ass*sass****as***asses*****s***s*ssssssssss*s******s*ss*sass*s***sass*ssssssss**s*sssssssssss
APPROVED BY � lZ /tl"HPC l 1" Plans Examiner Zoning
Structural Review Clerk
(RevisedO2/24/2014)
STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
ELECTRICAL CONTRACTORS LICENSING BOARD (850) 487-1395
1940 NORTH MONROE STREET
TALLAHASSEE FL 32399-0783
FERNANDEZ, MARCELINO
MAX ELECTRIC CORPORATION
P O BOX 442184
MIAMI FL 33144
Con ns! With this license you become one of the nearly
one million Floridians licensed by the Department of Business and STATE OF FLORIDA
Professional Regulation. Our professionals and businesses range
from architects to yacht brokers,from boxers to barbeque DEPARTMENT OF BUSINESS AND
restaurants,and they keep Florida's economy strong. PROFESSIC,QM. L REGULATION
Every day we work to improve the way we do business in order
EC13007046 ISSUED 06/29/2016
to serve you better. For Information about our services,please
log onto www.myfloridaiieense.com. There you can find more CERTIFIED ELECTRICAL,CONTRACTOR
information about our divisions and the regulations that impact FERNANDEZ,MARCELINO
you,subscribe to department newsletters and learn more about MAX ELECTRIC CORP:O' 104
the Departments initiatives.
Our mission at the Department is:License Efficiently,Regulate
Fairly.We constantly strive to serve you better so that you can
serve your customers. Thank you for doing business in Florida, IS CERTIFIED under the provisions of Ch.488 FS.
and congratulations on your new license! >xpiretindate.AU031.2010 L160629CODD987
DETACH HERE
RICK SCOTT,GOVERNOR KEN LAWSON,SECRETARY
STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
ELECTRICAL CONTRACTORS LICENSING BOARD
EC130D7046
The ELECTRICAL CONTRACTOR
Named below IS CERTIFIED •�c,>o VWME c `•
Under the provisions of Chapter 489 FS.
Expiration date: AUG 31,2018
I # m
FERNANDEZ, MARCELINO T
MAX ELECTRIC CORPORATION
P O BOX 442184
MIAMI FL 331.44
■
Fi
i
ISSUED: Oraf2912016 DISPLAY AS REQUIRED BY LAW SEQ# L1606290000967
i
:a
•
Local Business Tax fecei pt
Miami-Dade Cout�ty, State of Florida
-THISIS NOTA 13U1-DO NOT PAY
6815984 LBT
BUSINESS N-AM EFLOCATt0# RECEIPT NO. EXPIRES
MAX ELECTRIC CORPORATION RENEWAL SEPTEMBER S 2017
3625 S LAKE DR 6886488 Must be dktplayed at place of business
MIAMI,FL 33155 Pursuant to County Code
Chapter BA-Art.8 8 10
OWNER SEC.TYPE OF BUSINESS
PArle ENT RECEIVED
MAX ELECTRIC CORPORATION 196 ELECTRICAL
BY TAX COLLECTOR
CONTRACTOR 75.00 07!2812016
WOrker(s) 1 EC13007046 CHmm-18-100$92
Tits tocal&WrmTaXFbOelpt-0Npeowmspaynim o/#OtMdBusln=Taxthel?acdplisnotall-; s;,
pemil,�aamti"catlmoethehdaW'squali"catlons.todo6udness,Holderm�oo�t�piywlthargrllo�rnn>srdal
Orn(Sngafkribdl reveftytawsandregWrwerfswFMdtapgtlytothebusiresa.
VelEMPrNQabom uatbodsptMWmallcoirrrmdalvehides-Nlleml-Dxb0w9gaeW2M
Far rrore infarmef ion,visa
_. _..... _.__. ........ . ... .. ... _.
co CERTIFICATE OF LIABILITY INSURANCE DATE teruDm►+YYn)
04/052017
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 OWING INSURER(S), AUTHOR®
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT:U the certificate holder Is an ADDITIONAL INSURED,the poRoyges)must be endorsed. If SUBROGATION IS WAIVED,subject to
the terms end moons of the pollcy,certain policies nay require an andon me tL A statement an this certificate does not confer rlgm to the
certificate holder in Ileu of such endorsem s.
Pfd WWACT FLOR MOLINA
Ample U:swam Company 305-2844900 766-401-6493
PO Box 929
AMROM COVOLM 11=
Oakland FL 34780 BSA: COLONY INSURANCE COMPANY
aaalm e: PROGRESSIVE EXPRESS INS CO
MAX ELECTRIC CORP C:
P.O Box 442184 o:
E:
Mian/ FL 33144 1 01011111IR 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. N0TWITHSTANDING ANY REOUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO VMCH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED MEREN IS SUBJECT TO ALL THE TERMS.
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAM CLAIMS.
TMOP RJSUAANCH Unum
X COURIMMUGOMMUAMUFT EACH OCCUR IENM s 1 0130.000
cwwmlrowmwfgu—
CxAM Q OCCUR a 100000
Mw EXP one s 5.000
A 101GL0040327-01 11PA20/8 11/22017 t aADvmw s 1.000.E
GMAGGI EGATEppU��I>tppIT..APPLESPR GENERALAGGREeATE $ 2,000,0w
X PO im I JECT ❑LOC JOTS-COMPIOPAW s 1.0000�
OTHER s
AUTOMOBRB UABUM a w—mum — s
ANYAUTO BODILY 4VJIIRY(Per Pwsm) $ 100,000
B AUTO X 01591746.4 06/102018 03/102017 BODILY MAIRY ft e $ 300,E
KFM AUTOS AUTOS s 50,000
PIP s 10,000
UUMU LLALIARHCOL=Am
EACH RICHs
.M.UABIMS.MADE AQtaREeATE $
OED s
WORl�AB COI�aSAT[ON
AND BriLOYBRB UAMM
ANYrmirmcIORPARTNENEXECUTIVE NIA ELEJ4U.'faALxJT s
W t" E.L.DISEASE-EA EMPLOYEE s
9110M9110MMN�OPERATHDIS b WON E.L.DISEASE-POLICY LIMIT i S
DESCRPTION OF OPERATUM I LOCATIONS V81==(ACORD 101,AddWwW Remeft Sdwftt%emyr be aftdmd I1 awe apses Is
"Elecbk:al Contractor
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Mland Shores VlUage ACCORDANCE WITH THE POLY PROVIStON8.
BUIkbg departinent AUTHORISED REPRESMATIVII
I0DW NE 2nd AVE J-
MWW Shores,FL 33138
019BB-2014 ACORD CORPORATION.All N9ft reserved.
ACORD 25(2014/01) The ACORD name end logo we regi marks of ACORD
MWMI' hors CondomlBlum Association, [Be w
i ,
CAM
June 16, 20,17
JU 92017
Ref App-rival fbi-work
To whm a way,wncern
This Lener ill sae as cftkW notfication th-A tto 9aard of dmw1m 01 Nam-
Shonn _arxio Asswatan appmwd Max EkzhisCwp to do alectiW wark In
9022' NE 8 Ave 0 3 R Mian4,shmvs iFL 3138.
Please fw fre U- to 00mad M 0 yw have any qwoftfm ao 3-05,61 4�' r
Sirmerely,
nreli Fckem
We lir TT
Lfiiami SftrL,-!% CorkkoWnium
��•�•�°a9�SFR��a �;��, �.a.-q��r�. ':c_.,,�- ��.�z_r, ��� � ��,��.�
t fps
1,N-1516e 3-194 Fria i�T'A—A 673-8M-9
,.ef tL,M1�P-�T�,iT�-�, "r '_,�' b�'-,I'fi' d.c u a `�' 5-.. •:e'8-.,,i- -'��`�
r--
c Rn CERTIFICATE OF LIABILITY UR 111
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: H the certificate holder is an ADDITIONAL INSURED,the policy(fes)must be endorsed. If SUBROGATION IS WAIVED,subject to
the term and conditions of the policy,certain policies may require an endorsement. A statenumt on this certificate does not confer rights to the
certificate holder In lieu of such endorsement
PRODUCER NA ustomer--service epartmen
PioiuE._ 941-927 9500 941 927-9551
Cennairus, LLC ._�..... _. __ _.....__._..... ._ _ JA/c Net, . .............___. .. __-
c e n n a l r u S 711 South Osprey, Suite 2 ADDRESS certlficates�Cennairtls.com
Sarasota, FL 34236 IN&Ia t8R[SlAFFORDWG_COVERAGE NAICs
_....... .._.. _
INSURERA: Technology Insurance Company
INSURED
INSURER 0:
Max Electric Corporation INI�c,
.... ..........
3625 S Lake Dr nusuIM0:
Miami, FL 33155 INSURER E:
_............... .. ._..... . _.............._..........._..........._........ _.............._........_.....
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. NOTWTHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT VNTH 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.
._........_.... ....TYPE OF INSURANCE ...... ...... .""ADOLh{U ._. .v..._ .... ........_....._- __.___.._ __..__.
POLICY NUINBER .,_..._ �€ POL 'Y1E5iP LIMITS
GENERAL LIABILITY $ `EACH OCCURRENCE $
DAMAGETO RENTED
f
..._......C�f7MMERCIAL GENERAL LIABILITY ' .PIREMI9ES,*a occhrertce} ..._$
CLAIN&MADE i_.. 1 OCCUR ' }
HIED EXP(Any ora Person) $
PERSONAL 8 ADV INJURY S
GENERALAGGREGATE $ ___...
GEN'L AGGREGATE LIMIT APPLIES PER. PRODUCTS-COMPIDP AGG $
POLICY :PRO. LOC
AU70MOBILE LIABILnY __. __
ANY AUTO BODILY INJURY(Per Person) ...S
...�ALLMM® 'SCHEDULED
OS
..._.. AUTOS ! : BODILY INJURY(Per aomderrQ $
NON-0VAJED j j COPED?1MllGI_ $
_........ ..._.
HIRED AUTOS AUTOS
5
UM SRELLA LM `
OCCUR EACH OCCURRENCE S
!EXCESS LIAR
OLAIMSAIADE i AGGREGATE $
OED RETENTION S $
WORKERS TION , __ AC STATU
AND EMPLOYERS•LIAMUTY YIN' x !L1 d X t
A ANY PROFRfE CRIPARTNERIEXECUTNE TWC3606138 E.L.EACH ACCIDENT
$ 1.0m,000
OFFICERMESERECCLUDErn"FIN] NIA x/13/2017 2/13/2018 _
Mandatory In NH) � EL DISEASE-EA EMPLOYEE.$ 1,000,000
IyDNaFTION OF OPERATIONS below
�... El.O1S£ASE-POLICY LIMIT $ 1.000.000
DESCRIPTION OF OPEPtATXMS I LOCATIONS I VEHICLES(ACaeb ACORD 101.Addlffionai Reme"m Schedule,If more apace Is reaulred)
Electrical Contractor
EC 13007046
CERTIFICATE HOLDER CANCELLATION
Miami Shores Village BLDG DEPT SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
10060 NE 2nd Ave. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Miami Shores, FL 33138 ACCORDANCE WITH THE POLICY PROVIEMS.
AUTHORIZED REPRESENTATIVE ���
Forrest J.Harris President
®1988-2010 ACORD CORPORATION. All rights reserved.
ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD