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EL-17-633 3� frraatr -'I?4433 Miami Shores Village ■ PI O' Electl�i+r�l'�`#�esi�rltial,: 10050 N.E.2nd Avenue NE .�� kad 1 rtfditiOWA a Miami Shores,FL 33138-0000 � ►ett it Status:AFPIR Phone: (305)795-2204 �ORtD�' 3r \ g, tea 17: Expiration: 09/10/2017 Project Address Parcel Number Applicant 270 N E 100 Street 1132060134450 HEIKO&ELENICE DOBRIKOW Miami Shores, FL 33138- Block: Lot: Owner Information Address Phone Cell HEIKO&ELENICE DOBRIKOW 270 NE 100 Street MIAMI SHORES FL 33138-2419 Contractor(s) Phone Cell Phone Valuation: $ 1,200.00 DEPOT ELECTRIC CORP (305)992-4202 Total Sq Feet: 0 Type of Work:REPLACE ALL GFCI OUTLETS IN KITCHEN Available Inspections: Additional Info:REPLACE ALL GFCI OUTLETS IN KITCHEN Inspection Type: Classification:Residential Final Scanning:3 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 $1.20 Invoice# EL-3-17-63244 DBPR Fee $2.00 03/14/2017 Credit Card $66.20 $60.00 DCA Fee $2.00 Education Surcharge $0.40 03/09/2017 Check#:8037 $50.00 $0.00 Permit Fee-Additions/Alterations $100.00 Scanning Fee $9.00 Technology Fee $1.60 Total: $116.20 In consideration of the issuance to me of this pe i agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with t ings,statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume respo r done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL,PLU G, I L,WINDOWS,DOORS,ROOFING and SWIMMING POOL work. OWNERS AFFIDAV fo going information is accurate and that all work will be done in compliance with all applicable laws regulating constru zon r ize t e above-named contractor to do the work stated. March 14, 2017 Authorized Signatur . w er plicant / / Agent Date Building Department Copy March 14,2017 1 Miami Shores Village ` Building Department 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 - � INSPECTION LINE PHONE NUMBER:(30S)762-4949 FBC 20 BUILDING Master Permit No. ly-Zs 4 3 00 PERMIT APPLICATION sub Permit No. b Iq — (033 ❑BUILDING YELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION [-]RENEWAL r-1 PLUMBING ❑ MECHANICAL 0PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: ARC t e 10 0 5"r City: Miami Shores County Miami Dade Zip: Folio/Parcel#:_ Is the Building Historically Designated:Yes Occupancy Type: (ZB!; Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder):W K6,& RbVia b0612)C kl Phone#: ao5 o"Rl '3 2( Address:- W4 0.G City: State: Zip: Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name: k eP ar , k c--n21 L D (ice Phone#: -:5bS - 919 Z -y Zoo Address: liu) / 4l ' City: t`t l 4-x'1 I State: 1-0 R-i 9 q Zip: Z3 Qualifier Name: T-72P-rAL is c-,3 z® cz 2_ Phone#: -5®S= '%Z 4 z Z State Certification or Registration#: �` �'cm/SZ/ Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address• ll City: State: Zip: Value of Work for this Permit:$_h 20c Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New /Re lace EN Re air p p ❑ Demolition Description of Work: IREl914- dim 40&7tA9K VjV J<o`TZpqa A%%* AWI..I°Av67--5 Specify color of color thru tile: Submittal Fee$ 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$ (Revised02/24/2014) Boling 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 commencsqTt and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also,a certified f the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven a building permit is issued. In the absence of such posted notice, the inspection will not be approved and a charged. r—- Signature Itiq Signature OWNER or AGENT fir TRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of AW-W20 11 by day of_ IAK%a, .20 tJ-=by 'Adir .� rZ ��who i r on o m is/5 CO Q .tt4�who i ersonall kn o me or who has produced as me or who has produc d as identification and who did tak o th. identification and w did take an oath. NOTARY PUB C• RTINEZ NOTARY PUBLIC: 01 Horidn MARTINEZ C Apr 90. MARTI 2016 � 01 paiea Apr 90.2018 g Com Sion#EE 189180 Sign: Sig a aam. ' 2 I Boom It" I NOW am COMMMSMn Print: Prin Nowl Seal: Seal: ��*+says*�ra��ra�*��a**�+r�**s**a��ra�w+r*w�e�*�*+��*r�*�xa�es�s�sx��e+�+�*sa*a�**a�ea�s�►***a��s�r�r�+r*�xwa�*��xr�e��**��*��*��x APPROVED BY .� Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) ' nn.n��.0 l t, uvvcrctvurt KtN L OII,Jtt;Kt lAKY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD r EC0001544 The ELECTRICAL CONTRACTOR Named below IS CERTIFIED - , Under the provisions of Chapter 489 FS. -=_ Expiration date: AUG 31, 2018 GONZALEZ, FRANCISCO JAVIER .0 0 DEPOT ELECTRIC CORP. 11500 SIN 143 CT MIAMI FL 33186 ■ ISSUED., 06/26/2016 DISPLAY AS REQUIRED BY LAW SEQ# L160626MO1519 002646 Local Business Tax Receipt Miami—Dade County, State of Florida THIS IS NOT A BILL-DO NOT PAY 3265337 _[( B: BUSINESS NAMEILOCATION RECEIPT NO. EXPIRES DEPOT ELECTRIC CORP RENEWAL SEPTEMBER 30, 2017 11500 SW 143 CT 34016814 MIAMI FL 33186 Must be displayed at place of business Pursuant to County Code Chapter BA-Art.9&10 OWNER SEC.TYPE OF BUSINESS DEPOT ELECTRIC CORP 196 ELECTRICAL CONTRACTOR PAYMENT RECEIVED C/O FRANCISCO GONZALEZ QUALIFIER EC0001644 BY TAX COLLECTOR Worker(s) 1 $75.00 08/01/2016 CREDITCARD-16-045131 This local Business Tax Receipt only confirms payment of the Local Businass Tax.The Receipt is aot a license, permit or a certification of the holder s queRftcadons,to do business.Holder must comply with any governments, Or mmilavernmem 0l regulatory laws and requirements which apply to the business. The RECEIPT N0.above must be displayed on aH commercial vehicles-Mand-Dade Code Sec 8a-276. For more information.visit www.miamidade gov/temilector ATE �`� CERTIFICATE OF LIABILITY INSURANCE D/28/tDDtY7 2i28i2o17 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 term 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 NAMECr Juan Hernandez Casualty systems,Ina. PHONE , (305)551-0590 AIC e:(305)551-0857 3331 SW 107 Ave DDRE .Admi.n@casualtysystems.com INSURER(S) AFFORDING COVERAGE NAIC# Miami FL 33165 INSURERA:SCottsdale Insurance Co. INSURED NSURERB Retail First Insurance Cc Depot Electric Corp INSURERC: 11500 SW 143 Ct INSURER D: INSURER E: Miami. FL 33186 INSURERF: COVERAGES CERTIFICATE NUMBER-.CL132502892 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. MSR TYPE OF INSURANCE Y NUMBER POLICY EFF L POLICY EXP LIMIT'S GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES s rre ce $ 100,000 A CLAIMS-MADE a OCCUR CPS2508718 /26/2016 /26/2017 MED EXP(Any oneperson) $ 5,000 PERSONAL 8 ADV INJURY $ 1,000,000 GENE RAL AGGREGATE $ 2,000,000 GEML AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 1,000,000 X POLICY PRO LOC $ AUTOMOBILE LIABILITY a od COMBINEDSINGLE LIMIT ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PPROaPE T DAMAG $ HIRED AUTOS AUTOS UMBRELLA UAB HOCCUR EACH OCCURRENCE $ EXCESS LUAS CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ LIM$ WORKERS COMPENSATION WC STATI- 0 H- EEL AND EMPLOYERS'UA81UTY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN N E.L.EACH ACCIDENT $ 1,000,000 OFFICERIMEMBER EXCLUDED? FE NIA 20-93869 /20/2017 /20/2018 (Mandatory In NH) E.L.DISEASE-EA EMPLOYE4$ 1.000,000 If es,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1$ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Addrdonal Remarks Schedule,If more space Is required) License# EC 0001544 CERTIFICATE HOLDER CANCELLATION (305)756-8972 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Miami Shores Village ACCORDANCE WITH THE POLICY PROVISIONS. Building Dept 10050 NE 2nd Ave. AUTHORIZED REPRESENTATIVE Miami Shore, FL 33138 Juan Hernandez/YOYI - ACORD 25(2010105) ©1988-201 O ACORD CORPORATION. All rights reserved. IN9025 mnirnsi m Tha OCnR11 narna and Innn ara ranicia"A marlin ni ACr1Rr1