EL-15-2695I Predawn CERTIFICATE OF LTABILIfiY•INSlRA1NCE 1 mime
Piyr aufh Ireurar4 Agency 1180 Ce els od 4 or
• 2739 U.S. Highway 19 N. galas aim UsoCiolfficatellotdaL lido CeseXcate dors inotonsuut attend
• holiday, FL 34699 orammo Fowlsdea byeepandits
.e......wrri 27) 938.5562 Insurers Affording � ..
Insureds South East Personnel Leasing, Inc. & Subsideries
A; Um ,
2739 U.S. Highway 19 N. '"
Holiday, FL 34691
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NAIC# .
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Coverage only ogres to • hilftrdes !named bysouth East PosormetLeasllo,Inr &Subatiartei Joao araptayee(s),e=Mil in: FL
mama dons wet epplyto wry employags) oT Independent Forts:WO cline Gott Company or ony othor may.
Alistofthe active er gn) Inatodtothea ttCompanyranbechainedbytatdn a tette (727)937.23or byogre (727)938 .
State of Florida #ER 0012819
Miami Dade C.C. #000018971
E.L.Meow- Paltry Limas 3!,11111140011
Village of Miami Shores
1050 N.E. 2 Ave.
Miami Shores, FL. 33138
st d soy ot the eCurro duseibed Weissruer dM rtises. euphathowlete Moot dmte
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A Iltt alba active apPlulAWAlea toi eeMed Ottretany can be dittoed by keg e retookes 01937-213B orfry r+ '1S (? 93B-5542.
State of Florida #ER 0012819
Miami Dade C.C. #000018971
Village of Miami Shores
1050 N.E. 2 Ave. •
Miami Shores, FL 33138
Project Address
Miami Shores Village
10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138-0000
Phone: (305)795-2204
r:-
86 NE 106 Street
iami Shores, FL 33138-
Owne:
LCK PROPERTY SOLUTIONS, LLC
Address
t NO. EL -10-15-26'
Typa:`EI:ectrical-Residential
Work C;iassii7cation: Aiteration.
Parcel Number
1121360050010
Block: Lot:
M _
209 NE 95 Street
MIAMI SHORES FL 33138-
209 NE 95 Street
MIAMI SHORES FL 33138-
Contractor(s) Phone CeII Phone
I E I ELECTRICAL CONTRACTORS INC (786)621-521:
1
Permit Status: APPROVEr
2015 Expiration: 0 08/201
Applicant
CK PROPE=RTY SOLUTIONS, LLt
Phone
(305)758-3133
Valuat§on:
Total Sq Feet.:
Type of Work:
Additional Info:
Classification: Residential
Scanning: 3
Fees Due
CCF
DBPR Fee
DCA Fee
Education Surcharge
Permit Fee - Additions/Alterations
Scanning Fee
Technology Fee
Total:
Amount
$5.40
$4.73
$4.73
$1.80
$315.00
$9.00
$7.20
$347.86
4111=111!Elf11=111129MMENINIMOSIKIIRT T.
Pay Date Pay Typ
Invoices EL -10-15-57521
10/22/2( 5 Credit Car
12/11/2C ,5 Credit Caru
1111371,
Amt Paid Amt Due
3.0C $ 297.86
$ 237.L6 $ 0.00
In consideration of the issuance to me of this perry
pertaining thereto and in strict conformity with the plai
accepting this permit I assume responsibility for all
require^ For i F('T?ICA L. PLUMBING. MECHANICA
OWNERS AFFIDAVIT: I certify that all the foregoinc
construction and mg. Futhermole, I authorize he r
t. I agree to perform the work covered hereunder in compl,
s, drawings, statements or specifications submitted to the pro!
pork dor._ :_
, WINDOWS, DOC S FIC°F,Nr_, -,nd SWIMMING POOL v'or
information is accurate: and that 2l! work will be done in corn
bove-named contractor to do the work stated.
Cell
$ 9,000.00
00
Availahle Irsnections:
Incnertion Tvr
'Review Electrical
ince with ail ordinances and regulations
3r authorities of Miami Shores Village. In
I understand that separate permits are
t.
rliance with all applicab:e laws regulating
Decer tber 11, 2015
Autho d Signe re: Owner / Applica It /
Building Department Copy'
Decemlher• 11, 2015
Cc .tractor / PJen:
)ate
1
1
BUILDING
PERMIT APPLICATION
❑BUILDINGELECTRIC ❑ ROOFING ❑ REVISION
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
Master Permit No.
Sub Permit No
❑ EXTENSION ❑ RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF
CONTRACTOR
JOB ADDRESS: / 4 ive' /'' 7
1VkCRIVED
OCT 2015
BY: /e2---
FBC 20/444:
Z
❑ CANCELLATION
❑ SHOP
DRAWINGS
City: Miami Shores County:
Miami Dade
Zip:
Folio/Parcel#: // Z / 3 6 C9 0 cc, v / 0 Is the Building Historically Designated: Yes NO
Occupancy Type: Load:
Construction Type: G S Flood Zone: "4".-C1 BFE: FFE:
OWNER: Name (Fee Simple Titleholder): /,4O/t?7 y 5c24- 7€oy4 Phone#:
Address: 2 &' 9 A// 95 S r' 4' 7
City: ///,11! �7 ✓%�!i ' i
State: ` L
3 7 5 3/
Zip: ? /
Tenant/Lessee Name: /� Phone#:
k7
Email: (7 �® _ /� eii /�U!'- �_ �L� •�
CONTRACTOR: Company Name: G'__ � 6 'i�Z✓!�, i a�_ f ,`� ��. Phone#: //, � P', 47.
Address: 9 9 I
,
City: 7r+�ld'(A6
Qualifier Name: //(1,&-1'
State Certification or Registration #:2 F
p:
State: Zi
Phone#:
°
(i /� % 9 Certificate of Competency #: (-°�-= ,3";/
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $ %' ° [d()
Type of Work: ❑ Addition ❑ Alteration
Description of Work: t� 9 (4c C-
Square/Linear Footage of Work:
❑ New
coo (..i
Repair/Replace ❑ Demolition
Specify color of color thru tile:
Submittal Fee $ S o(00
Scanning Fee $ i.00
Permit Fee $ 1/1 • ®d
Radon Fee $ o
CCF $CO/CC $
DBPR $ `� P'7 3 Notary $
Technology Fee $ u 7-0 Training/Education Fee $ Q ° i Double Fee $
Structural Reviews $ Bond $
TOTAL FEE NOW DUE $ g"/ G
(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: 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 approved and a reinspection fee will be charged.
Signature0/°//`�
Signat f
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The forsing instrument was acknowledged before me ti,
/0 day of41/11„,62----�<t�, 20 by - 110' day of f ( , 20 /KA , by
$/r J ii Io jft,yrf, z ( , who is personally known to � �'�� � � /�`� J , who is personally known to
me or who has produced L—. as me or who has produced e'
identification and who did take an oath.
identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign:
Print:
Seal:
V2 ell Pk, p
JIM D. PAMPLIN
Notary Public - State of Florida
My Comm. Expires Jan 13, 2017
ti***Cestui*sie*#*6 i39 E**'
APPROVED BY
(Revised02/24/2014)
7/04W✓3 Plans Examiner
Sign:
Print:.
Seal:
as
SANDRA E PENNY
Nary Public • State of Florida a
t. C051106o11 # FF 116240
*********************************************************
Zoning
Structural Review Clerk
Congratulations! With this license you
one million Floridians licensed by the Department of Business and
Professional Regulation. Our professionals and businesses range
from architects to yacht brokers, from boxers to barbeque restaurants,
and they keep Florida's economy strong.
Every day we work to improve the way we do business in order to
serve you better. For information about our services, please log onto
www.myfloridalIcense.com. There you can find more information
about our divisions and the regulations that impact you, subscribe
to department newsletters and learn more about the Department's
initiatives.
Our mission at the Department is: License Efficiently, Regulate Fairly.
We constantly strive to serve you better so that you can serve your
customers. Thank you for doing business in Florida,
and congratulations on your new license!
RICK SCO17, GOVERNOR
moo -1281s
DETACH HERE
STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND
PR
izREE 1:1CPCr1C)114
EG ELECTRICAL
OI3BINS, MARX
(INDIVIDUAL MUS
11 LICENSING-Re:10
TOCONTRACTING'IS'. r too
13AS flESiStERES'411efitio'PfoOisloott -of Chr489- CS.
Expltutiall. date AhJL 1 204 j_14ogo3cp46
STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULAT
ELECTRICAL CMITRACTORS LICENSING BOARD
The ELECTRICAL CONTRACTOR
Named below HAS REGISTERED
Under the provisions of Chapter 489 FS.
Expiration date: AUG 31, 2016
(INDIVIDUAL MUST MEETALL LOCAL LICENSING
REQUIREMENTS PRIOR TO CONTRACTING IN ANY
li:AvE #i0.5
m.,21622ihNIT5R9S. mAlig(1.NcOR()Nlltlf ;ANT:,ORS INC
"
ISSUED: 09/03/2014
KEN LAWSON, SECRETARY
DISPLAY AS REQUIRED BY LAW SEO #
L1409030002425
Local Business Tax Receipt
Miami—Dade County, State of Florida
-THIS 15 NOT A SILL -DO NOT PAY
6470355
BUSINESS NAME/LOCATION
MI ELECTRICAL
CONTRACTORS INC
19150 S ST ANDREWS DR
MIAMI, FL 330.95
RECEIPT NO,
RENEWAL
8739495
OWNER SEC. TYPE OF BUSINESS
1E1 ELECTRICAL CONTRACTORS INC 198
Worker(s)
LBT
EXPIRES
SEPTEMBER 30, 2016
Must be displayed at place of business
Pursuant to County Code
Chapter 8A - Art. 9 & 10
•
ELECTRICAL PAYmENT RECEIVED
By TALC COLLE=CTOR
CONTRACTOR 75.00 08/25/2015
7 000018971 CREDITCAR1D-15-042330
This local Business Tax Receipt only confirms payment Gift Local Business Tax. The Receipt is oat a license,
petit, ora cerlifcation of the holder's qualifications, to do business. Holder num gamely with any gcvernmeetal
w nongovernmental regulatory laws and requirements which apply to Ibe business.
The RECEIPT NO. nave mast be displayed co MI commercial vehicles- Mmol -Dade Cads Sec 8a-2 S.
Tor mere information, viaitmmpyirriandiadc gavltaxcellectot
Municipal Contractor's Tax Receipt.
Miami -Dade County, State of Florida
-THIS IS NOT A BILL DO NOT PAY
CC NO: 000013971
BUSINESS NAME/LOCATION
1E1 ELECTRICAL CONTRACTORS INC
19150 S ST ANDREWS DR
MIAMI, FL 33015
OWNER
IEI ELECTRI
RECEIPT NO.
7473159
TYPE OP BUSINESS
CONTRACTORS INC ELECTRICAL CONTRACTOR
MC
EXPIRES
SEPTEMBER 3012016
Pursuant to County Code
Sec 10-24
PAYMENT RECEIVED
BY TAX COLLECTOR
200.00 10/13/2015
ECHECK-1 6-000925
This receipt Is net valid In the Mewing Municipal Avanture, Dore1. Hialeah. Key Biscayne,
Wand Gardens, Mit ! Lakes, Palmetto Bay. Piaec,sst, Sunny ivies Beath. Taws of Outer Bay.
For ware inkalien, visite miaeridadecevrrctttr
A witzca-
CERTIFICATE OF LIABILITY INSURANCE
PROOUCER
SAFEGUARD CASUALTY INSURANCE
9996 PINES BLVD
PEMBROKE PINES, FL 33024
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
INSURERS AFFORDING COVERAGE
NAM #
INSURED
1E I ELECTRICAL CONTRACTORS
19150 S ST. ANDREWS DR.
MIAMI. FL 33015
R A: CYPRESS
ReSURER 5: INFINITY
COVERAGES
THE POLICIES OF INSURANCE LI TED BELOW
ANY REQUIREMENT. TERM OR CONDITION
MAY PERTA/N, THE INSURANCE AFFORDED
POUCIES. AGGREGATE UMITS SHOWN MAY
HAVE BEEN ISSUED TO THE INSURED
OF ANY CONTRACT OR OTHER
BY THE POLICIES DESCRIBE -0 HEREIN
HAVE BEEN REDUCED BY PAID
NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
IS SUBJECT TO ALL 7"}4E TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
CLAIMS.
EFFECTIVE POLICY EXPIRATION
DATE IMMIDDITYVY1 DATE RdWOOPerrY1UIMTS
NSR
LiR
ADDJ 1POLICY
TYPE OF tNSURM4C
GENERAL
g
L
GERI
UABIUTY
commeRcva. Ge.,ERAL LIABrun,
/ CLAIMS MADE OCCUR_
GFL1025463-02
07/18/2015 07/18/2016
I. EACH OCCURRENCE
s 1,000,000
' ppgDAt4N3E1°RF-Pfrcp )
MED EXP (Any ane amen)
$ 100,0 1m,
S 5,000
i PERSONAL s ACV INJURY$ 1,000,000
t GENERAL AGGREGATE 2,000,000
AGGREGATE LIMIT APPUES PER:
LICY 7 rge-/- 1-1 LOC
PRODUCTS - COMP/OP AGG $ 2,000,000
X
ANY AUTO
ALL OWNED AUTOS
AUTOS
HIRED AUTOS
n0l4.0W1.ED AUTOS
509-80000-5108-001
07/06/2015
07/06/2016
COMSNED SINGLE LIMIT
1 te6fiamw")
BODILY INJURY
, (Pei person) S 25,000
I
BODILY INJURY
(Pe/ accident)
s 50,000
s 25,000
i PROPERTY oamAse
, iper accident)
GAEUABUTY
TJANY AUTO
AUTO ONLY - EA ACCIDENT
OTHER THAN EA ACC
AUTO ONLY: A GG
S
'1
LILXCESS /UMBRELLA UAMTY
OCCUR Ell ae
i DEDUCTIBLE
. ,
/ RETENTION
i
;
EACH GGCURRENOE
AGGREGA
5
WORKERS c.oMPENBATiON
AND EMPLOYERSUABILITY y
ANY PROPRIETOMPARTNEINEXE E /
OFNCER'EN2ER EXCLUDED?
(Mandy n NH)
d yes.dcribe under
SK-CIALesPROVISIONSw
,,
.WSTATU. 0 -
ILIM
$ .._ ,
-
E.L. EACH ACCIDENT, „
, -
DISEASE - EA EMPLOYEd
S
Ei. DISEASE • POLICY UMIT 5
OTHER
OESCRWTION OP OlE AT1DW, C.'.:ATi•,-m vEHICL Es C, uStei:/5 eCOTT ..'17 U/T-c,i,,,,, •^L,i: ISECIALPROVIS1DNS
State License #ER0012819
Miami -Dade CC #000018971
CERTIFICATE HOLDER
CANCELLATION
VILLAGE OF MIAMI SHORES
1050 NE 2ND AVENUE
MIAMI SHORES, FL 33138
SHOULD ANY OF114E ABOVE DESCRIBED POLICIESBE CANCELLED BEFORE THE TION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN
mance TOME CERTIFICATE HOLDER NAMED TO THE LEFT. BUT FAILURE TO 00 50 SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
REPRESENTAITVES.
AUTHORIZED REPRESENTAT
ACORD 25(2009101)
01988-2009 ACOR CORPORATION. AU rights reserved.
The ACORD name and logo are registered marks of ACORD
prod ten Plymouth Insurance Agency
2739 U.S. Highway 19 N.
Holiday, FL 34691
(727) 938-5562
9/24/201/
Is Issued as a matter oY Information only and ones no
Cen4iificate Holder. This certificate does not amend, extend
rage armed by the polities below.
Insurers Affording Coverage
Insured: South East Personnel Leasing, Inc. & Subsidiaries
2739 U.S. Highway 19 N.
Holiday, FL 34691
Coverag
respetds7tTGt
:harm rosy Mese
{Fel$ tti9 dmuted
r mSy perm. d'!a ErFsurarace �ftrrrdex4 ttp t e �ilc
nLt tmcdCtrm3ttOrioranytraMhatr7
exdt$ians< and taondatiarce of such
Type of Insurance
ENERAL LIABILITY
Commercial General Liability
Claims Made Occur
Policy Effective
Date
(MM/DD/YY)
Poli y Expiration
Date
(MM/DO/re
eneral aggnate limit applies per.
Panty 0 Proieci 0 LDC
UTOMOB1LE LIABIt
Any Auto
AU (Donee Autos
Scheduled Autos
Mired AWN
Non -Owned Autos
Damage to rented premises (EA
occurrence)
Combined Single Lunt
(EA ACCidsrnt)
Bodily [t{teiay
(Per Achdent)
Workers Compensation and
Employers' Liability
Any proxietm/partnedacecutive officer/mer
WC 71949
1/2015
E.L. Each Accident
E L Dias- Ea Employee
Lion Insurance Com. t is A M. t Corn • n = rated A- fent . A
Descriptions of Opeerations/Locatione/'ehicles/Exciusions added by Endorsement/Special Provisions: ChM 19 92-69-681
Coverage only applies to active employee(s) of South East Personnel Leasing, Inc. & Subsidiaries that are leased to the following `Client Company":
E I Electrical Contractors Inc
Coverage only apples to injuries: incurred by South East Personnel Leasing, Inc. & Subsidiaries active emptoyee(s;, w)ele working in. EL.
Coverage does not apply to statutory employee(s) or independent contractors) or the Client Company or any other entity.
A list or use active employees) leassed to the Client Company can be obtained by faxing a request to (727) 937-2138 or by calling (727) 938-5562_
Project Name:
ISSUE 09-24-15 (TLD)
VILLAGE OF MIAIvMI SHORES
1050 NE 2 AVE.
MIAMI SHORES, Fl
n D
0
Ca$ the at9 ted crt'bae p tt tie -c37 tad tre`oa a e:�aarealara isle -.' _ and a.
en deevorta i(a dayswnttedt na ce to the c'Enirscat but
t»rtvsd rue dolidat3o#t c raebiliiy t# kind ueon Lite &'!.surer. Sts wards sir rasprauente