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EL-17-23341 Project Address Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 Parcel Number - Rrl sideral ivn> L oW Volt l Expiration: 05/16/2018 Applicant 1226 NE 100 Street Miami Shores, FL 33138-2604 Owner Information Address 1132050090060 Block: Lot: VALDIVIA HOLDINGS LLC c!o MELLAW 2601 S BAYHORE Drive --- - -- -- - COCONUT GROVE FL 33133- 2601 S BAYHORE Drive COCONUT GROVE FL 33133- Contractor(s) SOUTH DOM ELECTRIC INC Phone (305)626-5904 CeII Phone 1 Phone VALDIVIA HOLDINGS LLC c/o M CeII Valuation: $ 100.00 Total Sq Feet: 0 Type of Work: LOW VOLTAGE PERMIT AND TV CABLE Additional Info: Classification: Residential Scanning: 3 Fees Due CCF DBPR Fee DCA Fee Education Surcharge Notary Fee Permit Fee - Additions/Alterations Scanning Fee Technology Fee Total: Amount $0.60 $2.00 $2.00 $0.20 $5.00 $100.00 $9.00 $0.80 $119.60 Pay Date Pay Type Invoice # EL -9-17-65189 11/17/2017 Credit Card 09/28/2017 Credit Card Amt Paid Amt Due $ 69.60 $ 50.00 $ 50.00 $ 0.00 Available Inspections: [sPection Type: eview Electrical In consideration of the issuance to me of this perm t, I agree to perform the work covered hereunder in compli ince with all ordinances and regulations pertaining thereto and in strict conformity with the plays, drawings, statements or specifications submitted to the prof ar authorities of Miami Shores Village. In accepting t ' •ermit I assume responsibility for all v✓ork done by eithe- myelf, my ay,.r:`, ser,/a7.3, or a•,p'oyes I understand that separate permits are required f. ELECTRICAL, PLUMBING, M€CHANICA'r1p(INDOWS, DOORS, ROOFING and SWIMMING POOL wor<. OWNER . - DAVIT: I certify tnat ation is accurate and that all work will be done in com )fiance with all applicable laws regulating constru on an. oning. Futhermor I a thori a the ab ve named contractor to do the work stated. Nover iber 17, 2017 uthorized Sign - ure: Ovbner / Applicant / Contractor / Agent Building Department Copy )ate November 17, 2017 1 Questions/Comments/Concerns ? Miami Shores Village Monique Smith, 786-253-2869 Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION UNE PHONE NUMBER: (305) 762-4949 RECETA7r4.0 S P 2 8 ni7 BY: ,SEN I� FBC 20).-1 BUILDING Master Permit No. ize. ( /1 T PERMIT APPLICATION Sub Permit No. 11-1-1- 2-339 ❑BUILDING IA ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL D PLUMBING MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 1/224 Arli /00 sr. City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): VAT a/' v 1/ ,► / J" 1--b i A[ a J Phone#: 7 k �3 2 621 Address: `2/24 iV 1 /Q0 J City: (41st t <f HO i3 State: F (— Tenant/Lessee Name: Phone#: -L Email: 'ONi Qc0Ce..-. 0/V i atiC fiP r',c1 iG f • y• -.Y2 -- Zip: 33 3 0 CONTRACTOR: Company Name: „,( f/,M/t4 Z ;7-602-/ C Address: 5-060 M'v', / C1 Z 5T Phone#: ?C7 30'5.g /74z City: V/A1`,/ State: Zip: 330/c5 Qualifier Name: J 2 6 M/ -'Z(7 S Phone#: z State Certification or Registration #:--C,, / 3 00 552/ Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: r� City: State: Zip: Value of Work for this Permit $ $ 0 0O Square/Linear Footage of Work: Type of Work: ❑ Addition RI Alteration_❑ New ❑ Repair/Replace Description of Work: w VD L -T-66 C Pere -11-47--- rV ❑ Demolition CMSL�� Specify color of color thru tile: Submittal Fee $ Permit Fee $ iCCF $ CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Notary $ Technology Fee $ Training/Education Fee $ Double Fee $ Structural Reviews $ Bond $ TOTAL FEE NOW DUE $ R. A (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. 1 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 pr erty is subject to attachment Also, a certified copy of the recorded notice of commencement must be posted at the job site for the fi ' inspection which occurs sevep (7) days after the building permit is issued. In the absence of such posted notice, the inspection 1 n• be approved and a rpin9pection f wi be charged. Signa re Signature OWNER or AGENT CONTRACTOR Thep foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this Otn day of AucD)S , 20 I- , by n day of A alas V , 20 17 , by MY) ¶M SYf+-#11 , who is personally known to 10e- del e • U iet (65, who is personally known to me or who has produced I) f V''f identification and who did th NOTARY P Sign: Print: Seal: as me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Y PRIETO _YCOMM 'ON#FF214031 EXPIRES: March 25, 2019 Bonded Thru Notary Public Underwriters Sign: Print: j'--1 Seal: 10, 01 I 'NYT•T'[.r CRY GONZALEZ mis ion 3 r My Commission Expires June 30, 2014 ******S****S********************************i******t**************ate*******fir** *************************** APPROVED BY (Revised02/24/2014) Z 75.'&/7/ e° Plans Examiner Zoning Structural Review Clerk A� Ro® CERTIFICATE OF LIABILITY INSURANCE DATE(RIWDIYYYY) 8/28/2017 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 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 SUNZ Insurance Solutions, LLC. ID: (Comerstone)r. c/o Comerstone Capital Group, Inc. 10 VVillow Road, Budding 3, Suite 151 Maple Shade, NJ 08052 Zachary King PHONE 972-885-5089 FAX ,Nor O E E-MAIL ADDREss: coi.requests@comerstonepeo.com LIMITS DISURER(S) AFFORDING COVERAGE NAIC # INSURERA: SUNZ Insurance Company 34762 ComerstoneINSURED Capital Group, Inc. 10 WuIlow Road, Building 3 Suite 151 Maple Shade NJ 08052 msuRERe. INSURERC: EACH OCCURRENCE INSURERD: DAMAGE TO RENTED PREMISES (Ea occurrence) INSURERE: INSURER F : CLAIMS -MADE MBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POUCY 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 LTR TYPE OF INSURANCE ADM INSD SUBR WVD POLICY NUMBER POLICY EFF (M IDDIYYYY) POLICY EXP HO DWYYYY) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED PREMISES (Ea occurrence) $ CLAIMS -MADE OCCUR MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GEM_ AGGREGATE POLICY OTHER LIMITAPPLIES .ECT PER: LOC PRODUCTS - COMP/OP AGG $ $ AUTOMOBILELIABdT/ 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 acdderd) $ PROPERTY DAMAGE (Per acddent) $ $ UMBRELLA UAB EXCESS LIAR OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ $ DED RETENTION $ A WORT COMPENSATION AND EMPLERS' LIABILITY O�CROPRIEBEREJRTNERIXEC�E (Mandatory In NH) If yes, descnbe under DESCRIPTION OF OPERATIONS below YIN N N /A WCPE0000036202 WCPE0000036201 1/1/2017 1/1/2016 1/1/2018 1/1/2017 .1 laliZ TE EORTH- EL EACH ACCIDENT $ 1,000,000 EL DISEASE - EA EMPLOYEE $ 1,000,000 El DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS 1 LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached it more space Is required) Coverage provided for all leased employees but not subcontractors of: SOUTH DOM ELECTRIC, INC. Client Effective: 1/11/2017 CERTIFICATE HOLDER CANCELLATION 1120 MIAMI SHORES VILLAGE BUILDING DEPARTMENT 10050 N E 2 AV MIAMI SHORES, FLORIDA 33138. MIAMI 1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE WILL BE DEL RE IN CCORRDDAN E WITH THE POLIDATE CY PROVISIONS. AUTHOREED REPRESENTATIVE 4;047(.. Glen J Distefano ACORD 25 (2016103) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 37442014 I Cornerstone Capital Group PEO 362 MASTER CERT 1 Jessi Crumb 1 8/28/2017 2:38:31 PM (EDT) 1 Page 1 of 1 003796 Local Business Tax Receipt Miami—Dade County, State of Florida -THIS IS NOTA BILL - DO NOT PAY 5355755 BUSINESS NAME/LOCATION SOUTH DOM ELETRIC INC 5860 NW 192 ST MIAMI FL 33015 OWNER SOUTH DOM ELECTRIC INC Worker(s) RECEIPT -NO: RENEWAL 4732062 � 1 _.. EXPIRES.., .- .. SEPTEMBER 30, 2018 Must be displayed at place of business Pursuant to County Code Chapter 8A - Art. 9 & 10 SEC. TYPE OF BUSINESS 196 ELECTRICAL CONTRACTOR 04E000560 PAYMENT RECEIVED BY TAX COLLECTOR $75.00 07/24/2017 CHECK21-17-071178 This Local permit, or a ce iness n fication Receipt f the holdei