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DS-17-1437 rug0 _647 1437 Miami Shores Village Type-0e'fN'a*s/Siabs 10050 N.E.2nd Avenue NE liyorkchtuawaNow Miami Shores,FL 33138-0000 M,I,t. h � Permit Status:APPA EW Phone: (305)795-2204 01Expiration: 01/24/ 1 Project Address Parcel Number Applicant 1301 NE 104 Street 1122320300040 DION SENA Miami Shores, FL 33138- Block: Lot: Owner Information Address Phone Cell DION SENA 1301 NE 104 ST MIAMI SHORES FL 33138-2661 Contractor(s) Phone Cell Phone Valuation: $ 470.00 EMPOWER GENERATORS INC (954)922-3800 Total Sq Feet: 0 Approved:In Review Available Inspections: Comments: Inspection Type: Date Approved::In Review Final Date Denied: Foundation Type of Work:NEW PREFAB PAD Additional Info: Review Planning Bond Return: Classification:Residential Review Building Scanning:3 Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $0.60 Invoice# DS-5-17-64145 DBPR Fee $2.00 07/28/2017 Check#:2500 $ 114.60 $0.00 DCA Fee $2.00 Education Surcharge $0.20 Permit Fee $100.00 Scanning Fee $9.00 Technology Fee $0.80 Total: $114.60 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 that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Futhermore,I authorize the above-named contractor to do the work stated. ADL (A 11("j__ July 28,2017 Authorized Signature:Owner / Applicant / Contractor / Agent Date Building Department Copy July 28,2017 1 w• Miami Shores Village RECEIVED Building Department MAY 30 2017 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 20H BUILDING Master Permit No. �—�� PERMIT APPLICATION Sub Permit No.)J r?—6 L13 -- BUILDING ❑ ELECTRIC ROOFING ❑ REVISION ❑ EXTENSION [—]RENEWAL ❑PLUMBING ❑ MECHANICAL [:]PUBLICWORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 1301 NE 104 St. City: Miami Shores County: Miami Dade Zip: .33138 Folio/Parcel#: 11 2232 030 0040 Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: AE BFE: 8 FFE: OWNER:Name(Fee Simple Titleholder): Dion Sena Phone#:305-986-8772 Address: 1301 NE 104 St. City: Miami Shores State: FL Zip: 33138 Tenant/Lessee Name: N/A Phone#: Email: Itcowner@aol.com CONTRACTOR:Company Name: Empower Generators, Inc. Phone#: 954-922-3800 Address: 364 SW 4 Ct. City: Dania Beach State: FL Zip: 33004 Qualifier Name: Robert Slowinski Phone#: 954-922-3800 State Certification or Registration#: CGC 1520012 Certificate of Competency#: DESIGNER:Architect/Engineer: MAG Engineering Inc. Phone#: 561-771-1010 Address: 4611 Lotus Way, suite 202 v/ City: Boynton Beach State: FL Zip: 33436 Value of Work for this Permit: !i)- 00 Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration R New ❑ Repair/Replace ❑ Demolition Description of Work: Install new 22KW Standby Generator on new prefab pad,Install 1-200amp ATS, 1-150amp ATS& and all electrical connections. Install aboveground 2-120gal. LP tanks and gas piping connections to generator. Specify color of c for thru tile: /\(� Submittal Fee$ Permit Fee$ 0 v - M5 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) Bonding Company's Name(if applicable) N/A Bonding Company's Address City State Zip Mortgage Lender's Name(if applicable) N/A 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 app5wqd and a rein. ectio will be charged. e //tkj,14 Signatur Signature OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this ,0 day of M a q 20 11 by 23rd day of May 20 17 by IJ Ion 6 cn Q who is personally known to Robert Slowinski who is personally known to me or who has produced as me or who has produced Pktm as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: AJ0144�J AA, L Sign: WMA Print: DL b bra h S H Net Print: Deborah S Hodge Seal: Seal•`9 `ao 'R`� ` asa`� z J c HODGE = DEBORAH S.HODGE c DEBORAH MY COMMISSION#FF176428 MY COMMISSION#FF176428 o,aop EXPIRES:November 16,2018 q 9�o,_'Fl-oP° EXPIRES:November 16,2018 ******* APPROVED BY I f Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) RICK SCOTT, GOVERNOR KEN LAWSON, SECRETARY STATE OF FLORIDA DEPARTMENTOFSCISINESS AND PROFESSIONAL REGULATION C-ONSTRUS_fl .INDUSTRY LICENSING BOARD =1520012 w,,. The GENERAL CONTRACTOR Named below 1S CERT- Under-the RTUnderthe provisions f Chapter 489 FS'. � Expiration date: AUG 31-12018 0-O- A �.? ❑� SLOWINSIEI,ROBERT--GL EMPOWER GENERATQ T_ —gal .790 790 WEST-PIA14T,T1 =.yk .■ t PLANTATIQN ISSUED: 07/17/2016 DISPLAY AS REQUIRED BY LAW SEQ# L1607170001741 BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT 115 S. Andrews Ave., Rm. A-100, Ft. Lauderdale, FL 33301-1895—954-831-4000 g VALID OCTOBER 1,2016 THROUGH SEPTEMBER 30,2017 Receipt#:180-245639 DBA: Receipt GE GENERAL CONTRACTOR Business Name: Business Type: Owner Name:ROBERT GLENN SLOWINSKI (QUALIFIER) Business Opened:12/12/2011 Business Location:364 SW 4 CTt. State/COunty/CerUReg:CGC1520012 DANIA BEACH Exemption Code: w Business Phone:954 922-3800 Rooms seats Employees Machines Professionals 5 For Vending Business Only Number of Machines: Vending Type: Tax Amount Transfer Fee NSFdee Penalty Prior Years Collection Cost Total Paid 27.00 0.00 0.00 0.00 0.00 0.00 27.00 i I I THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS T This tax is levied for the privilege of doing business within Broward County and is A TAX RECEIPT 9 THIS BECOMES P e9 non-regulatory in nature. You must meet all County and/or Municipality planning must be transferred when and zoningrequirements, This Business Tax Receipt WHEN VALIDATED �1 the business is sold, business name has changed or you have moved the business location.This receipt does not Indicate that the business is legal or that it is in compliance with State or local laws and regulations. Mailing Address: EMPOWER GENERATORS Receipt #ICP-15-00020109 364 SW 4 CT Paid 08/18/2016 27.00 DANIA BEACH, FL 33004 is 22016 17 0 AC 40RV0 CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 5/23/2017 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(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). PRODUCER CONTACT Judy Pinkney Corporate Insurance Advisors PHONE (954)315-5000 FAX No:(954)315-5050 1401 E Broward Blvd ADDRESS:Ijpinkney@ciafl.net Suite 103 INSURERS)AFFORDING COVERAGE NAIC# Ft. Lauderdale FL 33301 INSURERANationwide Insurance Company 25453 INSURED INSURER BDe sitors Insurance Company 00035 Empower Generators Inc INSURERC Allied Property 6 Casualty Ins. Co. 29262 364 SW 4th Court INSURER DBri efield Employers Ins. Co. INSURER E: Dania FL 33004 INSURER F: COVERAGES CERTIFICATE NUMBER:17-18 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 ADDLTYPE OF INSURANCE IMP-SUER POLICY NUMBER POLICY EFF MMIDD EXP LIMITS LTR WVD X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS-MADE FZ OCCUR PREM SESOEaEoccurrence $ 100,000 GLZ03036643607 4/22/2017 4/22/2018 MED EXP(Any one person) $ 5,000 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 $ 1,000,000 Ea accident B Ix ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS HAPD3036643607 4/22/2017 4/22/2018BODILY INJURY(Per accident) $ AUTOSNON-OWNED PROPERTY DAMAGE $ HIRED AUTOS X AUTOS Per accident Medical payments $ 5,000 X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 5,000,000 C EXCESS LIAB CLAIMS-MADE AGGREGATE $ 5,000,000 DED RETENTION$ CAP3036643607 4/22/2017 4/22/2018 $ WORKERS COMPENSATION X STATUTE EERH AND EMPLOYERS' IABWTY ANY CFFICEOPRIETEREXCLUDR/PROPRIETOR/PARTNER/EXECUTIVE YIN N/A E.L.EACH ACCIDENT $ 1,000,000 D (Mandatory In NH) 0830-47938 4/22/2017 4/22/2018 E.L.DISEASE-EA EMPLOYE $ 1 000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1$ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101.Additional Remarks Schedule,may be attached H more space Is required) I LL CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Miami. Shores Village THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Building Dept. ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE 2 Ave. Miami Shores, FL 33138 AUTHORIZED REPRESENTATIVE Mark Schwartz/ANGELA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025 onunii