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EL-16-1696Project Address Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 Parcel Number 20' Expiration: 01/17/2017 Applicant 10565 NE 2 Court Miami Shores, FL 1122310130590 Block: Lot: YORNET AND SAMUEL COMERI Owner Information Address Phone Cele YORNET AND SAMUEL COMERFORD 10565 NE 2 Court MIAMI SHORES FL 33138- (305)751-7467 10565 NE 2 Court MIAMI SHORES FL 33138- Contractor(s) LONGMAN ELECTRIC INC Phone (305)758-1211 Cell Phone Valuation: Total Sq Feet: $ 21,565.00 400 Type of Work: ELECTRICAL WORK FOR HOUSE REMODELIN Additional Info: Classification: Residential Scanning: 1 Fees Due CCF DBPR Fee DCA Fee Education Surcharge Permit Fee - Additions/Alterations Scanning Fee Technology Fee Total: Amount $13.20 $11.33 $11.33 $4.40 $754.78 $3.00 $17.60 $815.64 Pay Date Invoice # 06/17/2016 07/21/2016 Pay Type EL -6-16-60244 Check #: 4079 Credit Card Amt Paid Amt Due $ 50.00 $ 765.64 $ 765.64 $ 0.00 Available Inspections: Inspection Type: Review Electrical 1 In consideration of the issuance to me pertaining thereto and in strict conform accepting this permit I assume resp •:' si required for ELECT CAL, PLUMBIN M -tris permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In bili for all work done by either myself, my agent, servants, or employes. I understand that separate permits are HANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. ation is accurate and that all work will be done in compliance with all applicable laws regulating ove-named contractor to do the work stated. OWNERS AFFIDAV construction and zon plicant / Contractor / Agent Building Depment Copy July 21, 2016 Date July 21, 2016 1 Miami Shores Villag Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 3313 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 :JI\1 1OW' . BUILDING PERMIT APPLICATION Permit Type: Electrical City: Miami Shores County: Miami Dade Zip: 3 3iar Folio/Parcel#: Is the Building Historically Designated: Yes NO Flood Zone: OWNER: Name (Fee Simple itleholder) ( D VAP ° Phone#: S�Z �'Z5 75 Address: ( S L5 1---‘,E- 2 (1---( City: V kiN () State: l t Zip I� Tenant/Lessee Name: Phone#: Email: JOB ADDRESS: ET- FBC20I� cft "FLA iGqG Permit No. p, lI, Master Permit No:12L (G - 8 TZ - CONTRACTOR: Company Name: L ®m i Th rt ,i g l Yl G Phone#: 3 05=75 } — is ll Address: q 5 Ar12- I W ( 5 City: ,M-/ 4/4.1 i - /Statte: fl--- Qualifier Name: / " 1 / Gl q/ A y lJ 9 /I State Certification or Registration #: h C 13 C') 3 7 / 3 f Certificate of Competency<_&11-h #: > ,c/ Contact Phone#: 3C3 S— 5 .$s ill l Email Address: L. ori .M 4'-! e1 `GG/rh L 13 e / / %fir �J • /Le--, Zip: 331 % g, Phone#: 75,E — 1 't' C DESIGNER: Architect/Engineer: Phone#: io Value of Work for this Permit: $t_ bt3fi Square/Linear Footage of Work: ( C)-0 Type of Work: ❑Address Az ew URepair/Replace ODemolition Description of Work: / � / 7 0 ci C / ()/t�-- Submittal Fee $ 50 " Scanning Fee $ 3 - Notary $ Double Fee $ 4 A Permit Fee $ •9erreret CCF $ 2-0 CO/CC $ Radon Fee $ ( 33 DBPR $ 1 1 3 3 Bond $ Training/Education Fee $ '4" '40 Technology Fee $ j ! ` 6 C) Structural Review $ TOTAL FEE NOW DUE $ 65 - 6 `4 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 ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and 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. Signature The foregoin instrument was acknowledged before me this day of3vltire_ 14c-,20 (G , by N.oci✓h 4 C.,C7ftt'' , who is personally known to me o who has produced As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commission Expires: rafts' .;ul40 ************* APPROVED BY 40f / Plans Examiner Zoning FAf�LEY LAURA MY COMMISSION it FF 188027 EXPIRES, Mardi 18, 2019 4119e4 iMag:************************************************** * ** Signature ---)1114--A--C140-e_....--••-401---fr Contractor The foregoing instrument was acknowledged before me this 9- day of 'i),*'t- , 20 /62_, by / C.h4e I , i s., whop sonally kno me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commissio Notary Public State of Florida Michelle Perez My Commission FF 000321 Expires 04/08/2017 Structural Review Clerk (Revised 3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09) CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY, 4/23/2016 S CERTIFICATEIS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS ERTIFICATE 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 poliryQes) must have ADDITIONAL INSURED provisions or 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 PAYCHEX INSURANCE AGENCY INC 210705 P: F: (888) 443-6112 PO BOX 33015 SAN ANTONIO TX 78265 CONTACT NAME: PHON(NC,No.Ed): FAX WC. Not (888) 443-6112 E-MAIL ADDRESS: INSURERS) AFFORDING COVERAGE MICA INSURER A: Twin City Fire Ins Co LBWS INSURED LONGMAN ELECTRIC INC 844 NE 98TH ST MIAMI FL 33138 INSURER B : COMMERCIAL INSURER C: LIABILITY INSURER D: INSURER E: INSURERF: EACH OCCURRENCE 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. DISR LTR TYPE OFJNSURANCE ADDL 1NNR SUBR WPD POLICY NUMBER POLICY EFF (MMJDD/rrIY) POLICY EYP II9f.7/DD/MYI LBWS f __, `` �-"' COMMERCIAL GENERAL -MADE LIABILITY EACH OCCURRENCE CLAIMS OCCUR DAMAGE TO RENTED PREMISES (Ea occurrence) S MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT PRO ,(ECT APPLIES PER GENERAL AGGREGATE $ POLICY - LOC PRODUCTS - COMP/OP AGG $ OTHER s AUTOMOBILE LIABILITY ANY AUTO OWNED AUTOS ONLY HIRED AUTOS ONLY SCHEDULED AUTOS NON -OWNED AUTOS ONLY COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ _ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per dent) $ _ $ UMBREIL►LIAO EXCESS LIAR OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DEC RETENTIONS $ A wommmaMpEYSAIIOn `aI✓D ea>PZOTFasLtmIIdrr ANY OFFlPCER/MEMBER EXCLUDED? (Mandatory inNH) If yea, descrtbe under DESCRIPTION OF OPERATIONS CUTIV�/N AB - 76 NEC IX1296 05/01/2016 05/01/2017 PER OTH- X STATUTE ER E.L EACH ACCIDENT '1,000,000 E.LDISEASE-EAEMPLOYEE S1, 000, 000 below E.L DISEASE - POLICY UNIT S1,000,000 lr000,000 DESCR1P770N OF OPERATIONS /LOCA77ONSIVEH/C(>ECEDRD 101 Additional Remarks Schedule, may be attached If more space is required) Those usual to the Insured's Operations. LIC# EC13003713 f•COTir•In A TLS LIA111en - ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Miami Shores Village AUTHORIZEDREPRESBVTATIVE 10050 NE 2ND AVE MIAMI SHORES, FL 33138 —7•a,� / -'7 / f __, `` �-"' ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD