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EL-17-596Project Address Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 Parcel Number is gat+ 3/20/2017 al - Res entiai:: d�tion/AR Rratort Expiration: 09/16/2017 Applicant 173 NE 107 Street Miami Shores, FL 1121360070310 Block: Lot: Lauren Rangel Owner Information Address Phone Cell Lauren Rangel 173 NE 107 Street Miami Shores FL 33138- 173 NE 107 Street Miami Shores FL 33138- Contractor(s) Phone Cell Phone NOVOA ELECTRICAL CONTRACTOR (786)287-4220 (305)824-2858 Valuation: Total Sq Feet: $ 4,500.00 0 Type of Work: AS PER APPROVED PLANS Additional Info: AS PER APPROVED PLANS Classification: Residential Scanning: 1 Fees Due CCF DBPR Fee DCA Fee Education Surcharge Permit Fee - Additions/Alterations Scanning Fee Technology Fee Total: Amount $3.00 $3.38 $3.38 $1.00 $225.00 $3.00 $4.00 $242.76 Pay Date Pay Type Invoice # EL -3-17-63206 03/20/2017 Credit Card 03/07/2017 Credit Card Amt Paid Amt Due $ 192.76 $ 50.00 $ 50.00 $ 0.00 Available Inspections: Inspection Type: Final Meter Box Alteration Relocation Fire Alarm Service Change Review Electrical W. W. Underground 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, PLUMBI , MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS AFFID VIT: I .-•'��'' all the foregoing informationas,accurate and that all work will be done in compliance with all applicable laws regulating construction and - i Futhe or e a • ove-named contractor to do the work stated. Auth i • - u. • Applicant / Contractor / Agent Building Department Copy March 20, 2017 Date March 20, 2017 1 BUILDING PERMIT APPLICATION 0BUILDING 0 ELECTRIC ❑PLUMBING ❑ MECHANICAL JOB ADDRESS: 173 NE 107th Street City: Miami Shores Folio/Parcel#:11-2136-007-0310 Occupancy Type: R-3 Load: 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 El ROOFING FBC 20 Master Permit No. PNC 11 424 Sub Permit No.E L 1 ^ b REVISION 0 EXTENSION 0 RENEWAL El PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS County: Miami Dade Zia: Is the Building Historically Designated: Yes NO Construction Type: IIIB Flood Zone: X BFE: OWNER: Name (Fee Simple Titleholder): Jeffrey Hawn / C(gtu.,i( Address: 173 NE 107th Street FFE: (R_ Phone#: City: Miami Shores State: FL Zip: '"N o 1. Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name:®,l/LC W'� �j�,:\„../ Address: 8/ W(A) 6 7 -re 1i /A. U pi) 71 6 City: fl' L Cl 1S1 l 1 State: L Qualifier Name: Ja L . C0 R®T i 1 State Certification or Registration #: ec 1•30063'i 1 Certificate of Competency #:j. -21e01)0227 DESIGNER: Architect/Engineer: Mark A. Campbell Address: 373 NE 92nd Street Value of Work for this Permit: $ 11, -Ar Square/Unear Footage of Work: 7 c o Phone#: 30S -8421'18V0 Zip: 73i6 6 p Phone#:9'8 a-1 J -3s3a Phone#: 305.754.2318 City: Miami Shores State: FL. Zip: 33138 Type of Work: D Addition Description of Work: ❑■ Alteration ❑ New re, r p t• e -I* ❑ Repair/Replace ❑ Demolition Specify color of color thru tile: Submittal Fee $ 50 FQIt d Permit Fee $ Scanning Fee $ Radon Fee $ Technology Fee $ Structural Reviews $ (Revised02/24/2014) X. e'er' CCF $ !?� ' DBPR $ CO/CC $ • �S Notary $ Training/Education Fee $ Double Fee $ Bond $ TOTAL FEE NOW DUE $ ' 2 • 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 o 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 OWNER or A The foregoing instrument was ackn 10 day o -e / INL2 vN e Elf( Signature CONTRACTOR before me this The foregoing instrument was acknowledged before me this , 20 (/ , by day of aY a-' , 20 _ by , who is personally known to QSlire..a-tD allle-who is personally known to me or who has produced as me or who has produced as identification and who did take an oath. NOTARY P • LIC: identification and who did take an oath. NOTARY PUBLIC: Sign: � - r U T� Sign: � erLi Print: LR/M C' Print: Seal:"':*�:'°�% LAURAF Seal: MYC01AIISSION t FF 188027 EXPIRES: March 16, 2019 +rP 'n0S Bonded Thru Budget Notary Won ss t"- ' fir,DIANA M HERNADNEZ-PADRON MY COMMISSION # FF988058 EXPIRES May 28.2020 ie area FbrMarontarySeMee.c rn APPROVED BY A C%' ) /tI,&h. / Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) 002764 Local Business Tax Receipt Miami—Dade County, State of Florida -THIS IS NOT A BILL - DO NOT PAY 5999470 BUSINESS NAME/LOCATION NOVOA ELECTRICAL CONTRACTOR INC 8171 NW 91 TER #UNIT 4 MEDLEY FL 33166 RECEIPT NO. RENEWAL 6259691 EXPIRES SEPTEMBER 30, 2017 Must be displayed at place of business Pursuant to County Code Chapter 8A - Art. 9 & 10 OWNER SEC. TYPE OF BUSINESS NOVOA ELECTRICAL CONTRACTOR INC 196 ELECTRICAL CONTRACTOR C/O OSVALDO MONIER QUALIFIER EC13006771 Worker(s) 1 PAYMENT RECEIVED BY TAX COLLECTOR $45.00 09/01/2016 ECHECK-16-174653 This Local Business Tax Receipt only confirms payment of the Local Business Tax. The Receipt is not a license, permit, or a certification of the holder's qualifications, to do business. Holder must comply with any governmental or nongovernmental regulatory laws and requirements which apply to the business. The RECEIPT NO. above must he displayed on all commercial vehicles - Miami -Dade Cade Sec 8a-276. For more information, visit www miamidade aovttaxcolle + STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD (850) 487-1395 ' 2601 BLAIR STONE ROAD TALLAHASSEE FL 32399-0783 MONIER, OSVALDO S NOVOA ELECTRICAL CONTRACTORS, INC. 8171 NW 91 TERR MEDLEY FL 33166 Congratulations! With this license you become one of the nearly 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 SCOTT, GOVERNOR LICENSE NUMBER STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION EC13006771 ISSUED: 08/15/2016 CERTIFIED ELECTRICAL CONTRACTOR MONIER, OSVALDO S NOVOA ELECTRICAL CONTRACTORS, INC. IS CERTIFIED under the provisions of Ch.489 FS. Expiration date AUG 31, 2018 L1608150001883 DETACH HERE KEN LAWSON, SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD The ELECTRICAL CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2018 MONIER, OSVALDO S NOVOA ELECTRICAL CON 8171 NW 91 TERR UNIT #4 MEDLEY FL 33166 ISSUED: 08/15/2016 DISPLAY AS REQUIRED BY LAW SEQ # L1608150001883 A� o® CERTIFICATE OF LIABILITY INSURANCE DATE(MIWDD/YYY11) 03/07/2017 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(les) 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 such certificate holder In lieu of such endorsement(s). PRODUCER Power Insurancef 13911 SW 42 St #113E-MAIL Miami FL 33175 CONTACT NAME: Violeta Khouri Wm o. Eatl: (305) 261-2559 FAX No): (305) 261-6277 SS: infot powerinsurancefl.com INSURERS) AFFORDING COVERAGE NAIC B INSURER A: SCOTTSDALE INSURANCE CO UABILITY COMMERCIAL GENERAL UABILITY INSURED NOVOA ELECTRICAL CONTRACTORS 8171 NW 91 Terrace Unit 4 Medley FL 33166 INSURER B : PROGRESSIVE CPS2480569 INSURERC: EVANSTON INSURANCE CO 06/13/2017 INSURER D : CASTLEPOINT INSURANCE CO $ 1,000,000 INSURER E: SCOTTSDALE INSURANCE CO $ 100.E INSURER F : $ 5,000 GES 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. UMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS INSR TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER POUCY EFF (MM1DD/YYYYI POLICY EXP (MMIDDIYYYY) LIMITSLTR A GENERAL X UABILITY COMMERCIAL GENERAL UABILITY CPS2480569 06/13/2016 06/13/2017 EACH OCCURRENCE $ 1,000,000 GE TO RENTED Pp REM SES (Ea occurrence) $ 100.E MED EXP (My one person) $ 5,000 CLAIMS -MADE OCCUR PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 GEN'L AGGREGATE UMIT APPUES —1 POLICY n JECTT PER: LOC $ B AUTOMOBILE X UABIUTY ANY AUTO ALL OWNED AUTOS HIRED AUTOS �X/ X SCHEDULED AUTOS u-osNON-OWNED 02254982-3 06/13/2016 06/13/2017 COMBINEDSINGLE LIMIT 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ ((Per PROPERTY Daccident) $ C UMBRELLA UAB EXCESS UAB _ OCCUR CLAIMS -MADE XSMP1007616 06/13/2016 06/13/2017 EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5,000,000 $ DED RETENTION $ D WORKERS COMPENSATION AND EMPLOYERS' LUABIUTY ANY ANY PROPRI 9ER E)(AR NER/E ECUTNE (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below YIN N / A TWC3568711 08/21/2016 06/21 /2017 WC STATU- TORY LIMITS OTH- ER EL EACH ACCIDENT $ 1,000,000 EL DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POUCY UMIT $ 1,000,000 E Improvements & Betterments Property CPS2480569 06/13/2016 06/13/2017 $25,000 / 80 Co Insurance $1,000 / 5% W/H DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (Attach ACORD 101, Additional Remarks Schedule N more space Is required) EC13006771 CERTIFICATE HOLDER CANCELLATION Miami Shores Village BLDG DEPT 10050 NE 2 AVE MIAMI SHORES FL 33138 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Violeta Khouri ACORD 25 (2010/05) © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD