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EL-15-1975 EL 8 � °1Qhs y Miami Shores Village Pew � �tCllt3Sld8nt11i 10050 N.E.2nd Avenue NE � � �t `•" p Miami Shores,FL 33138-0000 UVt�lk Phone: (305)795-2204 `' ROOE0 r nam;gE01 Expiration: 02/20/2016 Project Address Parcel Number Applicant 1285 NE 95 Street 1132060144020 ROBERT AND NANCY FREHLINI Miami Shores, FL Block: Lot: Owner Information Address Phone Cell ROBERT AND NANCY FREHLING 421 E SAN MARINO Drive MIAMI BEACH FL 33139- 421 E SAN MARINO Drive MIAMI BEACH FL 33139- Contractor(s) Phone Cell Phone Valuation: $ 1,500.00 ELECTRICAL MASTERS INC 305-265-7996 _.......... Total Sq Feet 0 _...::. . ........_ _ ._....__. _.,,....._..._.. ,_ ...x.. Type of Work:POOL ELECTRICAL Available Inspections: Additional Info: Inspection Type: Classification:Residential Final Scanning: 1 Light Niche Bonding Review Electrical Alarms Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $1.20 Invoice# EL-8-15-56611 DBPR Fee $4.50 08/06/2015 Credit Card $50.00 $265.20 DCA Fee $4.50 Education Surcharge $0.40 08/24/2015 Credit Card $265.20 $0.00 Permit Fee-Additions/Alterations $300.00 Scanning Fee $3.00 Technology Fee $1.60 Total: $315.20 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: IN that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zonin a ore,I authorize the above-named contractor to do the work stated. August 24, 2015 Authorized S' na re: ner / Applicant / Contractor / Agent Date Building ep ment Copy August 24,2015 1 won R 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:(305)762-4949 FBC 20 _ BUILDING Master Permit No. I J !D5 PERMIT APPLICATION sub Permit No.�- c ❑BUILDING ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP g� CONTRACTOR DRAWINGS JOB ADDRESS: > �� City: Miami Shores County Miami Dade zip: l Folio/Parcel#: �k— 32,w ®k�-A �\ Is the Building Historically Designated:Yes NO Occupancy Type: Load: "Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder):�t� Q� � hk' Phone#: Address: \,<21^4��V2— 'SS —';,X City: tot �C�� State: � � Zip: Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name: �n(a_Phone#: Address: gkAr-sC) t� +�— city: State: �� Zip: r Qualifier Name: J►C,� ,��1P V P�lAf1 _ Phone#: State Certification or Registration#: Certificate of Competency M. DESIGNER:Architect/Engineer:c�''C?i X1�i1�114 �4��elal d k--, !_�7J_- ne#: Address: r City: ��1 19Aa A 1 State: �I-- Zip: Value of Work for this Permit:$ i �JSquare/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: �2-Apk - r C Specify color of color thru tile: Submittal Fee$ ��o 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$ 015 ' (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: 1 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 p pRr�ii�is 1ssMe'. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be chdgeds Signature Signature OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this 4—day of "609- 20 ,by ;�O day of nA 20 by AZO who is pets y now to who is personally known to me or who has produced as me or who has produced as identification and who did take an oath. identification and who did take an oath. d NOTARY PUBLIC: NOT*PUBUC Sign:— Sign: Print: Print CARL Seal: `'"r Commission a FF 37673 I. ;+ R° MY Commission Expires e 1� ,�a LE?SG46 N'� %•;'eo,a�o``r July 18. 2017 APPROVED BY Plans Examiner Zoning a, Structural Review Clerk (Revised02/24/2014) ELECT-1 OP ID:TC ACORU CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDNYYY) `.� 0511512015 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. y IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the policy(les)must be endorsed. H 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 endorseme s. PRODUCER NAS Teresa R.Carmona, Agent (Sure Insurance Brokers PHONE 305_223-2533 _ FAX — 8700 W.Fla9ler St,Suite 270 c r o (ArC,No):305-220-0765_ Miami,FL 33174 AoO .tearmona@lsurebrokers.com Teresa R.Carmona. Agent ---- INSURER(S)AFFORDING COVERAGE_—____ _ NAIC a INSURER A:Ataln Insurance 17159 INSURED Electrical MaBters Inc. -- — INSURERS: - - --- -- 8400 SW 14TH Strut Miami,FL 33144 INsuRER c: INSURER D: INSURER E: J — - 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. TYPE OF INSURANCE 9MLPOLICY NUMBER EFF IMMIDDrYffn POLICY EXP LIMITS A X I COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,0001 CLAIMS-MADE El OCCUR CIP24408 12/17/2014 12/17/2015 DAMAGE TO RENTED PREMISES Ea ooaarence $ _ 100,E I�---- MED EXP(Any one person) $ 5,0 �� -- PERSONAL B ADV INJURY $ 1,000+00 J— GEML AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE _$ 2,000,00 POLICY a PE O- D LOC PRODUCTS-COMPI_OP AGG $ _-_ 2,G0,00 CT OTHER. I $ AUTOMOBILE LIABILITY, COMBINED i L LIMIT $ � Es acatlent _-- _ BODILY INJURY(Per person) S ANY AUTO ALL OWNED SCHEDULED AUTOS BODILY INJURY(Per accident) $ AUTOS NON-OWNED PR�OPEERa tDAMAGE $ HIREDAUTOSAUTOS — ------ UMBRELLA LAB OCCUR EACH OCCURRENCE $ EXCESSLIAB CLAIMS-MADE AGGREGATE $ ---- DED RETENTION $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY STATUTE ER ANY PROPRIETORIPARTNERIEXECUTIVE YIN❑N NIA A E.L.EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYES _ If yes,descrWe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMITL$ i I DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES(ACORD 101,Additional Remarks Schedule,may be aftached I mora she is required) License 0 ER0013057 CERTIFICATE HOLDER CANCELLATION CITYMI7 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Miami Shores ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE 2 Ave Miami,FL 33138 AUTHORDEDREPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD 6/5/2015 7:17 AM FROM: 7276667636 TO: +13052341822 P. 2 Date CERTIFICATE OF LIABILITY INSURANCE T 6/5/2015 - producer. Plymouth Insurance Agency Tittle CehWimte Is ttsued as a matmr of Information only and eordors no 2739 U.S. Highway 19 N. `iglus upon the Cariffidate Holder. This Cerbt6tate does not amend,tnt�hd Holiday, FL 34691 m altar the CO1ierage afforded by tilts policies below. - (727)938-5562 Insurers Affording Coverage MAIC# Insured: South East Personnel Leasing,Inc.&Subsidiaries insurer Lion Insurance Company 11075 2739 U.S. Highway 19 N. Insurer B: Holiday, FL 34691 Insurer C' Insurer D: indust E: Coverages The policies of insurance listed n issued In the mmrred named above for the Policy=== Notwithstandaig any requirement.term or condition of any contract or other docurriert with respect to watch this ceraflcete may be issued or may penam.cite Insurance alrorded by the po5Ges described herein is subject to an the tarts,exclus�ans.and conditions of such hCh- A99rle limits shor<tt may have linen reduced by paid Gams. INSR ADDL T of Insurance Poi' Number Policy Effective Policy Expiration Limits LTR INSRO Type icy Date Date (MM/DD/YY) (MM/DD/YY) GENERAL LIABILITY Each Occurrence rC,:aims mercial General Liability Damage to rented premises(FA Made 13 Occur ownrence) $ Med Exp aggregate limit applies per. Personal Adv Irtprry General Aggregate ❑Project ❑ LOC Products-ComP10P A99 AUTOMOBILE LIABILITY Combined single Urnit Any auto (EA Acddent) All owned Autos Bodily InM Scheduled Aulos (Per Person) Hued Autos Bodily Inmy Not-Owned Athos (Per Accident) Property Carnage (Per Accident) EXCESS/UMBRELLA LIABILITY Each Occurrence Occur ❑Claims Made Aggregate Deductible A Workers Compensation and WC 71949 01/01/2015 01/01/2016 X I WC Statu- OTH- Employers'Liability tory Limits ER Ary propnetorlpartnedexecutive officer/member E.L Each Accident St,oRl.goO excluded? NO E.L.Disease-Ea Employee $1.000,000 If yes,describe under special provisions below. E.L.QI5ea99-Potla:y Urns $1,lHri1.000 Other Lion Insurance Company is A.M.Best Corn rated A- (Excellent. AMB!1 12616 Descriptions of Operations/LoeMons/Vehicles/Exdusions added by EndorsomentfSpecial Provisions: client ID: 91-68-228 Coverage only applies to active empioyee(s)of South East Personnel Leasing,Inc.&Subsidiaries that are leased to the followim"Client Company": Electrical Masters,Int. Coverage only applies to injuries incurred by South East Personnel Leasing,Inc.&Subsidiaries active emloyee(s),while wort dng Ir:Fl- Coverage LCoverage does not apply to statutory employees)or independent contractor(s)of the Client Company or ani`outer entity. A list of the active empioyee(s)leased to the Client Company can be obtained by faxing a request to(727)937-2138 or by Calling(727)938-5562. Project Name: OSVALDO RODRIGUE2;LICENSE NUMBER ER0013057 AS QUALIFIER. ISSUE 08-0315(AF)I REISSUE 05-05-15(TLD) I M Date 2 15 CR1iTFtGATE HOLDER CANCELLATION CITY OF MIAMI SHORES Shard any of the above demnbed Policies be rarrcelled before the exprabon date thereof,the Issuing insurer vnp endeavor to mail 39 days written notice to the cert&cale holder named to the left,but failure to do so span Itrilloss no obligation or liability of any kind upon the insurer,as ageras or tepresentathres 10050 NE 2N0 AVE. MIAMI SHORES, FL 33138