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ELC-16-3395 e�;O1t t� Miami Shores Village l„ Commercial, 10050 N.E.2nd Avenue NEWaik Cla � �ddltion/AIW�*A" ior Miami Shores,FL 33138-0000 Permit Stahi&Al�PR"EQ Phone: (305)795-2204 A 12(29/2016 Expiration: 06/2712017 Project Address Parcel Number Applicant 9450 NE 2 Avenue 1132060132780 MSVC LLC Miami Shores, FL Block: Lot: Owner Information Address Phone Cell MSVC LLC 2310 HOLLYWOOD Boulevard ()__ HOLLYWOOD FL 33020- Contractor(s) Phone Cell Phone Valuation: $ 920.00 YBM ELECTRIC INC (786)458-3839 (786)307-6383 Total Sq Feet: 0 Type of Work:ELECTRICAL SERVICE FOR NEW LIFT STA Available Inspections: Additional Info:ELECTRICAL SERVICE FOR NEW LIFT STA Inspection Type: Classification:Commercial Final Scanning:2 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# ELC-12-16-62387 DBPR Fee $2.25 12/29/2016 Credit Card $ 114.10 $50.00 DCA Fee $2.25 Education Surcharge $0.20 12/16/2016 Credit Card $50.00 $0.00 Notary Fee $5.00 Permit Fee $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 AFFI VIT. I rtify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and z i g. F hermore,I authorize the above-named contractor to do the work stated. December 29,2016 Authorizedi ture.Owner / Applicant / Contractor / Agent Date Building Depart ent Copy December 29,2016 1 -VSTAII�Vi Ar -o Miami Shores VillageCr" Nam , i Building Department 6 2016 �1 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 7DEC ( � INSPECTION UNE PHONE NUMBER:(WS)762-4949 FBC 2014 BUILDING Master Permit No. ELC Uo -,339- 5- PERMIT APPLICATION Sub Permit No. ❑BUILDING 0 ELECTRIC ROOFING ❑ REVISION ❑EXTENSION ❑RENEWAL PLUMBING f-1 MECHANICAL PUBLIC WORKS CHANGE OF CANCELLATION SHOP CONTRACTOR DRAWINGS JOB ADDRESS: ��k 'Gly Jl� �. J&0 y e, . Mt A M` 0 Q es t '� 1p Q NDA 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 Sim I Titleholder);.Hlp Tr,` Phone#:-94—M,Y� c( Addre City /® State: Zip: at>b®*h� Tenant/Lessee Name: I Phone#: Email: 2- Cq N'A t L_ t C fi�k!A CONTRACTOR:Company Name: Tw �-_1Q C"jI R--'c ^i�G Phone#: -4 S-2 3 8 3 g Address:_��� %Z �`� 5� k P \2-s City: \� Cil 12/S,k� State: ` Zip: X30 t 2 Qualifier Name � �IL >GR/S.S�'�� v` l Phone#•_4t( 381 (0383 State Certification or Registration#: �� 6r ®�O 3 Certificate of Competency#: �-- DESIGNER:Architect/Engineer: .YO Le, �L6 Phone#: 305 S43 la Lt,' Address: k O 0 \O Sk3 3Y City: a� A-wt t State:.F L- Zip: -38143 Value of Work for this Permit:$ Z Square/linear Footage of Work: Type of Work: R] Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑Demolition Description of Work:F,1 e, Lf 11:1 r-A L S ra V_IJ I CC y3 U Specify color of color thru tile: / y� Submittal Fee$ ® i d Permit Fee$ .�/��'`� CCF$ V ' (Q Q CO/CC$_ Scanning Fee$ 3 'W Radon Fee$ o°� DBBPRR�$ C)1 5 Notary$ Technology Fee$ 'W Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ �T (Revised02/24/2014) a 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 a a reinspection fee will be charged. c Signature Signature R or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this 1 day of 53M 20 /G by �1o4 day of 09 n L �y -.20 / by 0.5QA9.�LM- who is personally known to ye ll ��� S= Efda:�� /Y,N+ffi� personally known to me or who has produced �'�' T)�( Q- �--� me or who has produced r'L qb!' as identification and who did take an oath. identification and who did take an oath. NOTARY PU I NOTARY PUBLIC: Sign: Sign: Print: Print: Seal: ,oW No,, Notary Public State of Florida Seal: Sindia Alvarez My Commission FF 156750 , � 01 RWWI OF F� Expires 0910312018 C006111W E*=I W APPROVED BY /k Zaj�C/oCPlans Examiner Zoning Structural Review Clerk (Revised02/24/2014) Detail by Entity Name Page 1 of 2 E ` r � � w Detailt1 Florida Limited Liability Company MSVC, LLC Filing Information Document Number L04000045828 FEI/EIN Number 20-1311464 Date Filed 06/17/2004 State FL Status ACTIVE Principal Address 2310 HOLLYWOOD BLVD HOLLYWOOD, FL 33020 Mailing Address 2310 HOLLYWOOD BLVD HOLLYWOOD, FL 33020 Registered Agent Name &Address SKLAR, NEAL IESQ 2310 HOLLYWOOD BLVD HOLLYWOOD, FL 33020 Authorized Person(s) Detail Name &Address Title MGR MSVC MANAGEMENT LLC 2310 HOLLYWOOD BLVD HOLLYWOOD, FL 33020 Annual Reports Report Year Filed Date 2014 01/10/2014 2015 01/06/2015 2016 01/22/2016 Document Images 01/22/2016 --ANNUAL REPORT http://search.sunbiz.org/Inquiry/CorporationSearch/SearchResultDetail?inquirytype=Entit... 10/11/2016 Detail by Entity Name Page 2 of 2 F77�View image in PDF format-7 01/06/2015 ANNUAL REPORT View image in PDF format 01/10/2014 ANNUAL REPORT View image in PDF format 01/1 01201 3 ANNUAL REPORT View image in PDF format 01/04/2012 ANNUAL REPORT View image in PDF format 01/06/2011 ANNUAL REPORT View image in PDF format---] 01/06/2010 --ANNUAL REPORT View image in PDF format 01/06/2009 ANNUAL REPORT View image in PDF format 01/18/2008 ANNUAL REPORT View image in PDF format 01/29/2007 ANNUAL REPORT —View image in PDF forma-t7] 01/31/2006 ANNUAL REPORT —View image in PDF format 05/19/2005 ANNUAL REPORT F—View image in PDF format 06/17/2004 Florida Limited Liabilites View image in PDF format Cooyngh and Privacy Policies State of Florida,Department of State http://search.sunbiz.org/Inquiry/CorporationSearch/SearchResultDetail?inqui"pe=Entit... 10/11/2016 Detail by Entity Name Page 1 of 2 4- Detail by Entity Florida Limited Liability Company MSVC MANAGEMENT, LLC ng Information Document Number L04000045826 FEI/EIN Number 20-1011414 Date Filed 06/17/2004 State FL Status ACTIVE Principal Address 2310 HOLLYWOOD BLVD. HOLLYWOOD, FL 33020 Mailing Address 2310 HOLLYWOOD BLVD. HOLLYWOOD, FL 33020 Registered Agent Name &Address SKLAR, NEAL IESQ 2310 HOLLYWOOD BLVD. HOLLYWOOD, FL 33020 Authorized Person(s) Detail Name &Address Title MGRM SKLAR, OSCAR 2310 HOLLYWOOD BLVD HOLLYWOOD, FL 33020 Title MGRM SKLAR, ARI L 2310 HOLLYWOOD BLVD HOLLYWOOD, FL 33020 Title MGRM SKLAR, NEAL I 2310 HOLLYWOOD BLVD HOLLYWOOD, FL 33020 http://search.sunbiz.org/Inquiry/CorporationSearch/SearchResultDetail?inquirytype=Entit... 10/11/2016 Detail by Entity Name Page 2 of 2 Annual Reports Report Year Filed Date 2014 01/10/2014 2015 01/06/2015 2016 01/22/2016 Document Images 01/22/2016 ANNUAL REPORT View image in PDF format 01/0612015 ANNUAL REPORT View image in PDF format--7 01/10/2014 ANNUAL REPORT View image in PDF format 01/10/2013 ANNUAL REPORT View image in PDF format 01/04/2012 ANNUAL REPORT View image in PDF format 01/06/2011 --ANNUAL REPORT View image in PDF format 01/06/2010 ANNUAL REPORT View image in PDF format 01/06/2009 ANNUAL REPORT View image in PDF format 01/18/2008 ANNUAL REPORT View image in PDF format 01129/2007 ANNUAL REPORT View image in PDF format 01/31/2006 ANNUAL REPORT View image in PDF format 05/09/2005 ANNUAL REPORT View image in PDF format 06/17/2004 Florida Limited Liabilites View image in PDF format Copyright 4,K)and Privacy Policies State of Florida,Department of State http://search.sunbiz.org/Inquiry/CorporationSearch/SearchResultDetail?inquirytype=Entit... 10/11/2016 CTqB Gvstr-Vio� 9 T•aLa fv;n Hoard BLSINFSS CFRT =IC.ATE OF CCWPETENCY 16E000453 YBM ELECTRIC INC D.B.A.: BERAW!Y �1 EGUWARTINEZ YASSER Is certified under the proviswrs of Chapter 10 of Miami-Dade County yes STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ER13015258 ISSUED: 09/19/2016 REG ELECTRICAL CONTRACTOR BERASATEGUI-MARTINEZ,YASSER YBM ELECTRIC INC (INDIVIDUAL MUST MEETAL1 LOCAL LICENSING REQUIREMENTS PRIOR TO CONTRACTING IN ANY AREA) HAS REGISTERED under the provisions of Ch.489 FS. Expaffion tate:AUG 31,2018 L1609190000489 AC# 01514547 _ ._ _ sidiiATiTRE I B -1 Local Business Tax Receipt Miami--Dade County, State of Florid -UIS IS NOT A Ste, 00 W pAY 72M76 L T BURIN€GS NAME .01MATIO REM" EXPIRES YBM ELECTRIC INC RENMAL SEPTEMBER 30,,"2017 1871 W 62 ST APT 128 _ 7493277 Mum be displayed at puce of buaiem" HIALEAH.FL 330'12 ftmant to Courdy Code Chapter 8A-Art.4&10 OWNER GEC.Typo OF BUSHY OGS PAVMSICr II10EM9 YSb1 ELECTRIC INC 195 SPEC ELECTRICAL 6Y TAX COLLEMR CIO PASSER S'SRAS,ATEGUI CONTRACTOR 45.OD 022=16 Worker(S) 1 18E0004$3 47113-1B-0D8431 Thla Iaral B�tacas Tec tAeaelpl rr1►+aaninaa pagNacl o3tbe local Brsinraa Trac.The Rroelpt tr rM r ik pemc9l,ara oaetl3aat6nrolduo ha1doPa gsallHset7ara.tn d.hvafroaa.Hat/arm®toom�l�+r��n'19rMernmrrW artwrgaaermrtamlc!roga6atory laaysead tagnirercarm vrbfch rpplytstlnM�taats. Tt�RlCEFT P1;0.r9aa+r atrat Cm dpod rr r1!acaarerclattcaAiolet-Mle�l-Dada CSIs$vr l�-rni 9. n farrtcaa laaa�atlaaxhrH t'k ACo O® CERTIFICATE OF LIABILITY INSURANCE DATE(AANfDD/YYY1� 10/14/2016 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(Ies)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. PRODUCERT Sandy Aldana Q INSURANCE LLC. PNONE 305-9949981 FAX a: 1800-775-0576 2531 NW 72 Ave Suite A E ,,: saldana@q-insurance.com UNSURE AFFORDING COVERAGE NAIC# MIAMI FL 33122 INSURER A: Covington Specialty Insurance Company 3314 INSURED INSURER B YBM ELECTRIC INC INSORERC: 1871 W 62 ST#128 INSURER 0: INSURER E: Hialeah FL 33012 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. UNSR TYPE OF INSURANCE ADDL R POLICY NUIdBER POLICY EFF POLICY EXP UNITS TR COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 DAMAGE TO RERTE15— CLAIMS-MADE FlOCCUR PREMISE occurrence) $ 100,000 MFD EXP(Any one person) $ 5,000 A ASL00032779 09/12/2016 09/12/2017 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY❑jE 6 Owe PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ a accident) ANY AUTO BODILY INJURY(Per parson) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS eraxident UMBRELLALIAB OCCUR EACH OCCURRENCE $ EXCESS LU1B CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKIERS COMPENSATION AND EMPLOYERS'UABUM YIN STATUTEER . ANY PROPRIETORIPARTNERIDIECUTIVEEl N/A EL EACH ACCIDENT $ OFFICF_R/MEMSER IXCLUDED? (Mandatory in NHi E.L.DISEASE-EA EMPLOYEE $ Idescribe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEFItx.ES(ACORD 181,Additloral Remarks Schedule,maybe attaclmd U more apace Ia required) ELECTRICAL WORK WITHIN BUILDING LICENSE NUMBER: 16E000453 CERTIFICATE HOLDER CANCELLATION Miami Shores Village SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Building Department THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 10050 NE 2nd Ave ACCORDANCE WITH THE POLICY PROVISIONS. Miami Shores FL,33138 AUTHORIZED REPRESENTATIVE 9 / / ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD JEFF ATWATER •��wa CHIEF FINANCIAL 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'Compersaton EFFECTIVE DATE: 9/20/2016 EXPIRATION DATE: 9120/2018 PERSON: BERASATEGUI YASSER FEIN: 813218146 BUSINESS NAME AND ADDRESS: YBM ELECTRIC INC 1871 W 62 ST APT 128 HIALEAH FL 33012 SCOPES OF BUSINESS OR TRADE: ELECTRICAL WIRING WITHIN BUIL Pursuant to Chapter 440.05(14),F.S.,an officer of a corporation who elects exemption from this chapter by filing a certificate of eledicn u^zterM:s saw c^ may not recover benefits or compensation under this chapter.Pursuant to Chapter 440.05(12),F.S.,Certificates of election to be exempt..e;,,,;:-,, within the scope of the business or trade listed on the notice or election to be exempL Pursuant to Chapter 440.05(13),F.S..Notices of e,ectcr.`e ce 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_-e the penton named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate.The der_artment s'a.re:_�r_a DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 CLESTICNS'�1850;413-1609 ♦Sgo 193 Gi s� Miami shores Village "" Building Department 10050 N.E.2nd Avenue LOR1Dp' 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' compensatio sura coverage from the contractor's company for day labor,part-time employees or subcontractors. BY SIGNING BE OW 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 day of 0 CrQ Q e D, ,20 f�p By o EC4t, rK L,ARR who is personally known to me or has produced Ft..W 14.60 640 �0 [L5 -� ,,.,�►��wu as identification. \`�o���P�pp G•���''� Notary: l � or O ��TAAY My Comm.Expires SEAL: Apr.6,2018 m No.FF 109890 5"*',; OF COMPANY LETTER HEAD i Date: State of F�o/"A.- County of / 67i Before me this day personally appeared�ct �a &An030i who, being duly sworn, deposes and That he or she will be the only person working on the project located at: °#60 NE ZAVE.^lt"i r0� Sworn to (or affirmed) and subscribed before me this�day of �t �_.20i , by Bow lowill C*VMM NIL FF 17M Personally Know OR Produced Identification Type of Identification Produced Print,Type or St mp Name of Notary CDL CLASS B B623-960-79-218-0 YASSER BERASATEGUI MARTINEZ '. 'E71 W fi2S"APT 12E HIALEAH. FL 33 mm 06-18-1079 012-6096SEXU t553SE0 �3 d# -2fl1c i int 5-ft kms& 06-19-2024 REST SAFL DWVt;k ow a`m of•nM-.:e Vow*%fiMMAYN c a aMlM M wy�rinlMy MM i4 Irr