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EL-16-2911 �qn—i, Miami Shores Village Perm#t 7�s E��al ��C�e�a) 10050 N.E.2nd Avenue NE > #a sr t€n A1*rat16 Miami Shores,FL 3313&0000 Parr ° fie=, i?"Pt �!E e— s Phone: (305)795-2204 FLon Isst� 3er 11111121 Expiration: 30/2017 Project Address Parcel Number Applicant 45 NE 103 Street 1121360130950 Miami Shores, FL 33138-2126 Block: Lot: 45 NE 103RD STREET LLC Owner Information Address Phone Cell 45 NE 103RD STREET LLC 1801 S FEDERAL Highway BOCA RATON FL 33432- 1801 S FEDERAL Highway BOCA RATON FL 33432- Contractor(s) Phone Cell Phone Valuation: $ 1,000.00 FARADAY ELECTRICAL CONTRACTC (954)980-6128 ......... _ ..... . ,_. _ Total Sq Feet: 0 Type of Work:REMOVE AND REINSTALL VANITY AND WAT Available Inspections: Additional Info: Inspection Type: Classification:Residential Review Electrical Scanning:1 Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $0.60 Invoice# EL-10.16-61790 DBPR Fee $2'25 10/26/2016 Check#:2195 $50.00 $109.10 DCA Fee $2.25 Education Surcharge $0.20 11/01/2016 Check#:2217 $ 109.10 $0.00 Permit Fee-Additions/Alterations $150.00 Scanning Fee $3.00 Technology Fee $0.60 Total: $159.10 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 AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating constru ion and zo ' g. Futhermore,I author/ a ab ve-named contractor to do the work stated. November 01, 2016 Authorized Signature:OwnerAp icant / Contractor / Agent Date Building Department Copy November 01,2016 1 RECEIVED Miami Shores Village j Z9 31 Building Department ti 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 q BUILDING Master Permit No.?0-1 PERMIT APPLICATION Sub Permit No. � ❑BUILDING .ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL F-1 PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: /r�I.f ' �� City: Miami Shores County: Miami Dade Zip: Folio/Parcel#:II"02/✓�4P -bl /��� Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFFE: FFE: OWNER:Name(Fee Simple Titleholder): 97IV s &t o ei—�e, Phone#(2E6,2/�,-D 5�` Address: ay4 '5 f-60 ='g-(- City: zye"e `�s^� State: Zip:I Tenant/Lessee Name: &Z±: Phone#: Email: CONTRACTOR:Company Name: Ali"� rcj Phone#:krv/,�m Yo Address: 06 � Ali City: \ State: �(. Z-p: Qualifier Name: c� Phone#: State Certification or Registration#: 6 ®��� Certificate of Competency#: / /v` DESIGNER:Architect/Engineer: oye Phone#: Address: �� S l (���`e City: /?2i��e.� State: Zip: 33r7C- Value of Work for this Permit:$ ,lX03 Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑/ New // EJRepair/Replace ❑ Demolition Description of Work: -e �� owe ,e,� A ,4&— te— gm cc Specify color of Folor thru tile: Submittal Fee$ w CQ) Permit Fee$ CCF$ a ® CO/CC$ 2 Scanning Fee$ Radon Fee$ 2 . DBPR$ 2 • 2 Notary$ Technology Fee$ 18® Training/Education Fee$ ZO Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ L —1 • 1O (Revised02/24/2014) J V 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 absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. SignatureF �) t s ��t'`�' i� Signature OWNER or AGENT TRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this —2:2 day of :OC% 20 by :2 day of / C 20 ,by L'Lcta-j D't'm rnl. / .who is personally known to I [ h/F who is personally known to me or who has produced Dr""'-Y- L'(L as me or who has produced�1;`�d ��'C� as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign• Sign• __ZLZ� Lz� Print:_.( O_Ltcic � ���� Print: WLES Seal: �`1�;�.e T�4H>JAKNOIM Seal: 4* 0.. V MYCOWON 0FF0052 .1':SSION#FF 068152 * * S:January 31,2018 va oP :11t&January 31.2018 " B�dedtlmBudgetNa�rY�tes �cpnoP` BmtdadThruBud�etNr� �l°c>:Fs APPROVED BY�/� Z���r/moi Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD (850) 487-1395 2601 BLAIR STONE ROAD TALLAHASSEE FL 32399-0783 JEAN-CHARLES, FRITZ MYTHO FARADAY ELECTRICAL CONTRACTOR, INC. 10640 LAGO WELLEBY DRIVE SUNRISE FL 33351 Congratulations! 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 { - "dtr; rc!�itr�i is t�. cttt:i�tt�ker�; Atli boxers tc� a li cjue - - DEPAR TIMEN -OF l~3`Sii ESS'AND` _. restaurants,and they keep Florida's economy strong. �`2 - PROFESI REGULATION Every day we work to improve the way we do business in order EC13007114 �SI ''08/07/2016 to serve you better. For information about our services,please - Ina onto www.myfloridalicense.com. There you can find more CERTIFIED ELECT C �QIgR GTOR Wor matiory abcwttour divisions and the regulations that impact JEAN-CaiARLES, t� "" you,subscribe to department newsletters and learn more about FARADAY ELEC"fllC trlA£TOR, INC the Departments initiatives. Our mission at the Department is: License Efficiently, Regulate Fairly.We constantly strive to serve you better so that you can IS CERTIFIED under the provisions of Ch.489 FS. serve your customers. Thank you for doing business in Florida, Expiration date:AUG 31,2018 L1608070003108 and congratulations on your new license! DETACH HERE RICK SCOTT, GOVERNOR KEN LAWSON, SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD - aq EC13007114 ` The ELECTRICAL CONTRACTOR = Named below IS CERTIFIED ,� b Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2018 ., LE• L JEAN-CHARLES, FRITZ MY HO_ = FARADAY ELECTRI•CAI,,C0W.- T4R,-•INC- 4952 NW 7TH AVENUE MIAMI FL b)474708 ❑ • > We, 5 . ISSUED: 08/07/2016 DISPLAY AS REQUIRED BY LAW SEQ# L1608070003188 Local Business Tax Receipt Miami—Dade County,State of Florida THIS I5 NOT A BILL-DO NOT PAY BUSINESS NAME/LOCATION RECEIPT NO. EXPIRES FARADAY ELECTRICAL RENEWAL SEPTEMBER 30, 2017 CONTRACTOR INC 6724570 'MusYbe displayed at piece of busimiess 4952 NW 7 AVE 18 MIAMI, FL 331.27 PursuaAt to County Code Chapter BA-Art.9&10 OWNER SEC_TYPE OF BUSINESS RECEIVED FARADAY ELECTRICAL 196 ELECTRICAL BY TAXE COLLECTOR CONTRACTORINC CONTRACTOR r/O FRIT7 MYTHn.IFAN RAHRI FS 45.00 08/29/2016 Worker(s) 2 EC13007114 0229-16-008595 This Local Business Tax Receipt only confirms payment of the Local Easiness Taal The Receipt is not a license, permit,or a certification of the holdoes qualifications,to do buslness.Holder mem comply with any governmental or nongovernmental regulatory laws and requirements which apply to the business. The RECEIPT N0.above malar be displayed on all commercial vehicles-Milani-Dade Code Sec 8e-M MIAM for more information,visit www.miemidade.amlomilectar A Lr CERTIFICATE 4F LIABILITY INSURANCE DATE o; ,�D;Y') 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 have ADDITIONAL INSURED provisions or be endorsed if SUBROGATION IS WAIVED,subject to the terns 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 ,JEAN R MESADIEU NAME: All Universe Insurance PHONE (�)6553-7359 C No): (3W 653-7343 20328 N.W.2nd Ave. ADDRESS: Jrmesadieu@)gmail.com Miami Gardens,FL 33169 INSURERS AFFORDING COVERAGE MAIC# Phone (305)653-7359 Fax (305)653-7343 INSURER A: WESTERN WORLD INSURANCE CO. 1217069 INSURED INSURER B: FARADAY ELECTRICAL CONTRACTORS INC INSURER C: 4952 NW 7TH AVE#8 INSURER D: INSURER E MIAMI,FL FL 33127 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. INSR TYPE OF INSURANCE ADDL UBR POLICY EFF POLICY EXP LIMITS LTR I POLICY NUMBER MMfD MMID e COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 300,000 ❑ CLAIMS-MADE W OCCUR DAMAGEPREMISESS(RENTED 50 000 a occurrence $ A a NPP1409764 04/13/2016 04/13/2017 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY s 300,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 600,000 ❑ POLICY [:] JECTT [3 LOC PRODUCTS-COMP/OP AGG $ 300,000 ❑ OTHER $ AUTOMOBILE LIABILITY VBIINdED SINGLE LIMIT $ ❑ ANY AUTO BODILY INJURY(Per person) $ ❑ OWNED ❑ AAUUTOS LEDAUTOS BODILY INJURY(Per accident) $ HIRED ONLY ❑ NON-OWNED P OPFJ? AMAGE $ ❑AUTOS ONLY AUTOS ONLY er acci�n ❑ ❑ $ ❑ UMBRELLA LIAR ❑OCCUR EACH OCCURRENCE $ ❑ EXCESS LIAB ❑CLAIMS-MADE AGGREGATE $ ❑ DED ❑ RETENTION$ $ WORKERS COMPENSATION ❑PPTERI�E ❑OTH- AND EMPLOYERS'LIABILITY Y i N ER ANY PROPRIETOR/PARTNER/EXEC E.L.EACH ACCIDENT $ OFRCER/MEMBER EXCLUDED? UTIV� N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) .....ELECTRIC CONTRACTOR..... 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 10050 NE 2ND AVENUE ACCORDANCE WITH THE POLICY PROVISIONS. MIAMI SHORES,FL 33138 AUTHORIZED REPRESENTATIVE Jean R Mesadieu ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 26(2016/03)QF The ACORD name and logo are registered marks of ACORD Faraday Electrical Contractor Inc. 10640 Lago Welleby Drive Sunrise, Florida 33351 02/24/2016 State of Florida County of Miami-Dade Before me this Day personally appeared Fritz M Jean-Charles who, being dult sworn, deposes and says: That he or she will be the only person working on the project located at 45 NE 103rd Street. Sworn to and subscribed before me this _24—day of Feb--2016 by Fritz M Jean-Charles. Personally Know Or Produced Identification Type of Identification Produced ti Print, Type cep Name of Notary Q e ♦51 REs Miami shores Village Building Department fiC0iUA 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305)795.2204 Fax: (305)756.8972 Notice to Owner — Workers' Compensation Insurance Exemption A 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' compensation insurance coverage from the contractor's company for day labor,part-time employees or subcontractors. BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. ol Signature: Owner State of Florida County of Miami-Dade The foregoing was acknowledge before me this day of ��r' ,20!6. By L DU M who is personally known to me or has produced T t'z<�zz � . as identification. Notary: SEAL: 4ogl!&k, TARSHALA KNOWLES MY COMMISSJOIJ#FF X9152 EXPIRES:January 31,2018 solo ora Permit No. RC40� 6 Miami Shores Village - TPS FLeslentlal Constrialcton 10050 N.E.2nd Avenue NE Wo OWSifrcatiatt Alt ratloft Miami Shores,FL 33138-0000 s Ap Phone: (305)795-2204 wA5tattts: sue at 11112016 Expiration: 04/3012017 Project Address Parcel Number Applicant 45 NE 103 Street 1121360130950 45 NE 103RD STREET LLC Miami Shores, FL 33138-2126 Block: Lot: Owner Information Address Phone Cell 45 NE 103RD STREET LLC 1801 S FEDERAL Highway BOCA RATON FL 33432- 1801 S FEDERAL Highway BOCA RATON FL 33432- Contractor(s) Phone Cell Phone Valuation: $ 6,000.00 CAIBAI CONSTRUCTION LLC (786)229-2770 (786)470-4207 ....:._ _.. .., Total Sq Feet: 1769 Approved:In Review Available Inspections: Comments: Inspection Type: Date Approved::In Review Final PE Certification Date Denied: Window Door Attachment Type of Construction:REPLACE KITCHEN CABINETS,IN Occupancy:Single Family Framing Stories: Exterior: Insulation Front Setback: Rear Setback: Drywall Screw Left Setback: Right Setback: Window and Door Buck Bedrooms: Bathrooms: Fill Cells Columns Plans Submitted:Yes Certificate Status: Review Planning Certificate Date: Additional Info: Review Building Review Plumbing Bond Return: Classification:Residential Review Electrical Fees Due Amount Pay Date Pay Type Amt Paid Amt Due Review structural Review Mechanical CCF $3.60 Invoice# RC-10-16-61788 DBPR Fee $2.70 10/26/2016 Check#:2195 $50.00 $167.00 DCA Fee $2.70 Education Surcharge $1.20 11/01/2016 Check#:2217 $ 157.00 $0.00 Permit Fee $180.00 Scanning Fee $12.00 Technology Fee $4.80 Total: $207.00 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 construotion and zopirf Futhermore,I authorize the .i;e-n ed contractor to do the work stated. November 01, 2016 Authorized Signature:Owner / p icant Contractor / Agent Date Building Department Copy November 01,2016 1