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EL-16-2387Miami 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) 7624949 FBC 201 4E 2 BUILDING Master Permit No. R,(6-�' 3 PERMIT APPLICATION Sub Permit No. EL 1 G - 2 3 ❑BUILDING [� ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION E] RENEWAL PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR JOB ADDRESS: 7Z47 NE c12. t1r'► Ss( DRAWINGS City: Miami Shores • County: Miami Dade Zip: 333136 Foilo/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): %PC+ r (0pkee Phone#: 30c- 5-9,c-3- E 2-I 1 Address: .tIV € 619- '`T\-- 1 L City: IA. r Ck'Yn9 k(1- r`Q Q State: ---FL Zip: A3 ‘ 13 B Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: i e EteCA-r; calk CorRlCrorS in C Phone#: 305 - 525 - VAC k Address: 1,4202, S. (...). 1eoO441 -Ter-vac e City: CT iom i State: F L zip: 33 1-77 Qualifier Name: 0Gatr Do till n5ue Z Phone#: ?8G,- 2io2 - '7521 State Certification or Registration #: EC 1340074 -11 Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: $ ®ir%, v 0 Square/Unear Faota of Work: Type of Work: ❑ Addition ❑ . Alteration ❑ New Repair/Replace ❑ Demolition Description of Work:i C / . l 1(L/-/ ' Al 9 t 2 ar /7 N cc Specify color of color thru tile: Submittal Fee $ Permit Fee $ X Z 6-74:" CCF $ CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Notary $ Technology Fee $ TralninJEducation Fee $ Double Fee $ Structural Reviews $ Bond $ q TOTAL FEE NOW DUE $ L. D . (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 $2500, the applicant must: promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit Is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature OWNE The foregoing instrument was acknowledged before me this O (2 ,-//: , 20 / Cp , by C77/L?t . r'r�iha is personally kntlwn to ✓ AJ,f � Signat The foregoing instrument wasknowledged before me this 9 +dayo.. f u5 , 20 l c.• eft._ , who me or who has produced as me or who has produced identification and who did take an oath. NOTARY UBUC: Sign: Print: ta.;t:�`• Seal: STL A HORAN Notary Public - State of Florida6110-A- Dnunisslan / FF 197603 My Comm. Expires Feb 9, 2019. 'read e Identification and who did take an oath. NOTARY PUBLIC: ��Ntt111M1/1�11T% rrrii, a A• i . te a° 'i° » Sign: omn Print: Seal: by 0 as n• ,,e. : S AFF 9m27 = a :o elt „ t iii i►+��\``• ****** *tit*** til********************************•***************•**•*************************************** APPROVED BY (Revised02/24/2014) 62,440 fr /Plans Examiner Structural Review Zoning Clerk CK sayrr, STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD ADDITIONAL BUSINESS QUALIFICATION ne Llif OTRICAL CONTRACTOR - Named below IS CERTIRED Under the prevlsitate o,f Chapter 469 FS E.xpitation date P I 2018 61 Leen Bus ness Tax Receipt t.) aC ft.I£r,.r+ fFir.ad NAM ;LOCATiO NRIQLE: IE WL, 7482449 TYPE :'Ci EUaaf LC= ELECTRICA, 3007477 EXPIRES PIEMBER 30, 2017 cess Tai. Ilia ;der rtuaz e 64asiaess''' P V M ng T a EY TAX COLa.EC. 75 07/121 CED% R 7. .0$ oat sI€c E •.' CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 08/08/2016 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 certificate holder in lieu of such endorsement(s). PRODUCER American Trust Insurance 9360 Sunset Drive Suite 240 Miami, FL 33173 Phone (305) 270-2220 Fax (305) 270-2496 CONTACT Edna Sanchez NAME: (Arc. N . Esti: (305) 270-2220 INC. No): (305) 270-2496 ADDRESS: service@americantruslins.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Wesco Insurance Company INSURED H & E Electrical Contractors, Inc. 14202 SW 160 Terrace Miami FL 33177 INSURER B : 04/28/2016 INSURER C : EACH OCCURRENCE INSURER D : ❑ CLAIMS -MADE 0 OCCUR INSURER E : $ 100,000.00 INSURER F : MED EXP (Any one person) CERTIFICATE 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 LTR TYPE OF INSURANCE ADDLSUBR INSR WVD POLICY NUMBER POLICY EFF (MM/DD/YYYY) POUCY EXP (MM/DD/YYYY) LIMITS A 0 COMMERCIAL GENERAL LIABILITY WPP1456101-00 04/28/2016 04/28/2017 EACH OCCURRENCE $ 1,000,000.00 ❑ CLAIMS -MADE 0 OCCUR DAMAGE TO RENTED PREMISES (Ea occurrence) $ 100,000.00 MED EXP (Any one person) $ 5,000.00 • PERSONAL &ADV INJURY $ 1,000,000.00 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000.00 • POLICY • ',INF • LOC PRODUCTS - COMP/OP AGG $ 2,000,000.00 ❑ OTHER AUTOMOBILE UABIUTY • ANY AUTO COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ • ALL OWNED •SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ HIRED AUTOS •NON-ONED AUTOS PROPERTY DAMAGE (Per accident) $ ❑ In $ UMBRELLA UAB ❑ OCCUR ❑ • EXCESS UAB • CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ • DED 111 RETENTION $ $ WORKERS COMPENSATION EMPLOYERS' LIABIUTY Y / N ANY PROPRIETOR/PARTNER/EXECUTIV N / A ■ ;MUTE STATUTE • ER E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - EA EMPLOYE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, K more space Is required) Electrical Contractor EC - 13007477 CANCELLATION MIAMI SHORES VILLAGE 10050 NE 2ND AVENUE MIAMI SHORES, FL 33138 ATT: Building Dept. 'FAX 305-756-8972 ACORD 25 (2014/01) QF 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 ©1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD JEFF ATWATER CHIEF FINANCIAL OFFICER STATE OF FLORIDA DEPARTMENT F FINANCIAL SERVICES DIVISION OFWORKERS' COMPENSATION * * CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA ERS. COMPENSATION LAW * CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers' Compens EFFECTIVE DATE. 4/22/2016 EXPIRATION DATE: 4/22/2018 PERSON: HERNANDEZ ENRIQUE FEIN: 463065901 BUSINESS NAME AND ADDRESS. H & E ELECTRICAL CONTRACTORS INC 14202 SW 160TERR MIAMI FL 33177 SCOPES OF BUSINESS OR TRADE: LICENSED ELECTRICAL CONTRACTOR Pursuant to Chapter 440.0 may not recover bene within the scope of the n officer of a corporation who elects exemption from this chapter Pursuant to Chapter 440.05(14 F.S., Certificates of of election to be exempt. Pursuant io Chapter 440.05(13j, F S.,' xempt and certificates of electlan to be exempt shaft be subject to revocation if at any time after the filing of the notice or th rson named on the notice or certificate no longer meets the requirements f this section for issuance of a certificate. The DFS-F2-DWC CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 n under this section apply only to be oke QUESTIONS 850). JEFF ATWATER CHIEF FINANCIAL OFFICER * * CERTIFICATE OF ELECTION TO CONSTRUCTION INDUSTRY EXEI4 This certifies that the individua, EFFECTIVE DA1 PERSON: HER STATE OF FLORIDA PARTMENT OF FINANCIAL SERVICES ION OF WORKERS' COMPENSATION OM FLORIDA WORKERS' COMPENSATION W.* Florida Workers' Cornpensaii 4/22/2018 FEIN: 463065901 BUSINESS AND ADDRES H & E ELECTRICAL CONTRACT 14202 1N 160 TERR MIAMI SCOPES OF BUSINESS OR LICENSED ELECTRICAL CONTRACTOR Pursuant to Chapter 440.05(14), F.$ an officer of a c may not recover benefits or Compensation under this chapter within the scope of the business or trade listed onthe. exempt and certificates of election to be exempt shall bt the person named on Lite notice or certificate no longer rc DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE elacts axemptiwn fmm tnsa cdtspter by fling a certificate of electionunder this section nifo Cha pE r .0 12), F.S., CertLScates of election fo be e.en,t . apply only rt to be exemgt: Pursuant to Chapter 440:05(13). F.S.. Notices of election to be notation N, 01 arty time aha the lifng or the notice or Ore issuance of the ceratiaate: uiemuanls of 1150 section for issuance of a Certificate. The department shalt revoke a XEMPT RE 1SED 08-13 QUESTIONS? (1350 )4