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EL-12-2231Project Address Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 ei mit Parcel Number Permit NO. EL -9-17-2231 Permit Type: Electrical - Residential Work Classification: Repair Permit Status: APPROVED Issue Date: 9114/2017 Expiration: 03/13/2018 Applicant 335 NE 93 Street Miami Shores, FL 33138- 1132060136260 Block: Lot: DEBORAH MADSEN Owner Information Address Phone Cell PAUL MADSEN 335 NE 93 Street MIAMI SHORES FL 33138-2854 Contractor(s) Phone BREIG ELECTRIC AND CONSULTANT (305)885-0667 Cell Phone Valuation: Total Sq Feet: $ 750.00 0 Type of Work: REPAIR SERVICE Additional Info: REPAIR SERVICE 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 Amt Paid Amt Due Invoice # EL -9-17-65077 09/14/2017 Credit Card $ 69.60 $ 50.00 09/13/2017 Credit Card $ 50.00 $ 0.00 Available Inspections: Inspection Type: Final Review Electrical 1 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 1 assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNER FFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construcrt nd-icnmg. huthermor: authorize the above-named contractor to do the work stated. uthorized`f gnatur> Owne'-+1—plicnffr--'•/---Contractor / Agent Buil 2ting-Department Copy September 14, 2017 Date September 14, 2017 1 BUILDING PERMIT APPLICATION ❑ BUILDING 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 - • ▪ (T1 ETVED SEP 1'3 2017 FBC 2014s+h Master Permit No: EL 11— Z23 Sub Permit No. ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS JOB ADDRESS: YV 673 6,1 -(0 - City: Miami Shores Folio/Parcel#: Occupancy Type: County: CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS Miami Dade Zip: / Load: OWNER: Name (Fee Simple Titleholder): Address�:g35c A.) q 5�r r City: r ' `-AO YYt;\ 'hiiS Tenant/Lessee Name: Is the Building Historically Designated: Yes Construction Type: Flood Zone: BFE: NO FFE: CA / • f U j ` Phone#: J ACS;—)41c- State: ) c State:Zip: 3'5) 32 Email: Ce 1 �, on( . an\ Phone#: CONTRACTOR: Company Narne:16v-c. C.iQc LezooNSg-Alt-w•-vck-S Phone#: Sca. 'azZ.S' • �iceka4 Address: 1- \S5 City: ,(\/\eA\t State: 1 Zip: Qualifier Name: � e S ,pct Phone#: State Certification or Registration #: FC.c 5C. 55i-‘271 Certificate of Competency #: DESIGNER: Architect/Engineer: Address: City: State: Value of Work for this Permit: $ % 't) Phone#: Zip: Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New Description of Work: X 2EP ii R �21L.i� c Repair/Replace n Demolition Specify color of color thru Submittal Fee $ ► d Scanning Fee $ Technology Fee $ tile: Permit Fee $ /OPI m CCF $ CO/CC $ Radon Fee $ DBPR $ Notary $ Training/Education Fee $ Double Fee $ Structural Reviews $ (Revised02/24/2014) Bond $ TOTAL FEE NOW DUE $ 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 ing4A4,4 4119 OWNER or AGENT The foregoing instrument was acknowledged before me this 5 day of ST.:Pt , 20 . R , by ho is personally known to me or who has produced identification and who did take an oath. NOTARY PUBLIC: Si Pri S as • .,�• MYCoMMISSION#GG044602 .,��. 0(PIRES:TIovember2, 2020 Bonded Thru Notary Public Underwriters (Revised02/24/2014) CONTRACTOR The foregoing instrument was acknowledged before me this \� day of S .---)411\e.S 1E). 1Pjt-e%q3 , who is personally known to me or who has produced as identification and who did take an oath. , 20 \ 1 , by NOTARY PUBLIC: Sign: Print: Seal: **************************************************************************** 'Or/" Plans Examiner Structural Review Zoning Clerk BREIG-5 OP ID: OJ A`C.--- CERTIFICATE OF LIABILITY INSURANCE DATE 13/2017 09/13/2017 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(ies) 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 Brown & Brown of Florida, Inc. 1201 W Cypress Creek Rd # 130 P.O. Box 5727 Ft. Lauderdale, FL 33310-5727 James F. Murphy CONTACT NAME: PHOE (A/C,NNo, Ext): 954-776-2222 FAX No): 954-776-4446 E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Hanover Insurance Co. 22292 INSURED Breig Electric & Consultants, Inc., Designed Electrical Solutions, Inc. 71555NW 74 Street Medley, FL 33166 INSURER e: Hanover American Insurance Co 36064 INSURERC: Bridgefield Employers Ins. Co 10701 INSURER D : AGCS Marine Insurance Co 22837 INSURER E : INSURER F : X COVERAGES 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 LTRINSD TYPE OF INSURANCE ADDL SUBR WVD POLICY NUMBER POLICY EFF (MM/DO/YYYY) POLICY EXP (MM/DD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY ZHJ910435606 04/15/2017 04/15/2018 EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE X OCCUR DAMAGE TO RENTED PREMISES (Ea occurrence) 300 000 $ s MED EXP (Any one person) $ 10,000 PERSONAL 8 ADV INJURY $ 1,000,000 GEN'L AGGREGATE POLICY OTHER: X LIMIT APPLIES JECT PER: LOC GENERAL AGGREGATE $ 2,000,000 PRODUCTS -COMP/OP AGG $ 2,000,000 Emp Ben. $ 1,000,000 B AUTOMOBILE X X LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS X SCHEDULED AUTOS AUTOS NON -OWNED AZJ910444006 04/15/2017 04/15/2018 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ A X UMBRELLA UAB EXCESS UAB X OCCUR CLAIMS -MADE UHJ910435706 04/15/2017 04/15/2018 EACH OCCURRENCE $ 3,000,000 AGGREGATE $ 3,000,000 DED X RETENTION$ $0 $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y N OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A 83047807 04/15/2017 04/15/2018 X STATUTE OTH- �R E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 D Installation Float SML93036502 04/15/2017 04/15/2018 Job Site 150,000 Storage 150,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) Electrical Contracting CERTIFICATE HOLDER CANCELLATION MIAMISH Miami Shores Village Building Department 10050 NE 2nd Avenue 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 ACORD 25 (2014/01) © 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD RICK SCOTT, GOVERNOR KEN LAWSON, SECRETARY Baa.,.." +n`•''..,. 4 µ' ,,,y ` •.,^ .,,r.�, �'"- .�,, \1 _ti,� ",�41. • • +°a _ ,y y'�r'i. .. STATE, OF` FLORIDA,,,, `"_�h"",� r ,. DEPARTMENT OF`BUSII ESSwAND'PROFESSIONAL REGULATION ;" � ELECTRICAL CONTRACTORS"LICNSING`BOARp' LICENSE NUMBER h , _` y.r�- -••••••m---••••- , "41;4' r .,, 7-,..."'",,,N...\'''''''',...\„ „°, ','' "r -EC0000567 -rd.t=i a'a ,,,., ``. \,"*N.*". .. , ""-..-' .............??•t44.2.....,........, `,�``\'� .0,�' _, `a ''4sW,..',+,`'” . a-,»-..ar ?--..7c.........-....,._ ECTRICALCONTRACTOR: , .Na►ned belowlS CERTIFIED�.w �._..,,, -•Under-th`eprovisions of Chapt& 489 FS"w .Expiration date. AUG 31, 2018 ':' -=.- �, BREIGrJAMES.BRYAN-- - -,--:: " , , "~«--.. _y _::../BREIG;ELECTRICAND,Ce.NSULANTSti';. INC" '-`' :. �^fi, :7155 NW74TH.STREE.T'�,.-�.��.' `:MEDLE33d`"•,-`,``"=..,\tY 16 , DISPLAY AS REQUIRED BY LAW ISSUED: 07/06/2016 SEQ # L1607060001327 004878 Local Business Tax Receipt Miami—Dade County, State of Florida —THIS IS NOT A BILL — DO NOT PAY 7201275 BUSINESS NAMEiLOCATIO11F'''" " M BREIG ELECTRIC AND CONSULTANTS INC 7155NW74ST MEDLEY FL 33166 RECEIPT LBT EXPIRES RENEWAL SEPTEMBER 30, 2018 7483966 OWNER SEC. TYPE OF BUSINESS BREIG ELECTRIC AND CONSULTANTS INC196 ELECTRICAL CONTRACTOR C/O LAURA BREIG EC0000567 Worker(s) 6 Must be displayed at place of business Pursuant to County Code Chapter 8A — Art. 9 & 10 PAYMENT RECEIVED BY TAX COLLECTOR ..t45.00,07/27/20.17_: CREDITCARD-1 7-050582 This Local Business Tax Receipt only confirms payment of the Local Business Tax. The Receipt is not a license, permit, or a,certificationof 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 be displayed on all commercial vehicles — Miami—Dade Code Sec 8a-276. For more information, visit www.miamidade.gov/taxcollector neMR Sec✓r'ce ee ,3.32�� co �CL.00Do -scp 535 ME . � st p1(,041 •5hoRes.) FL, 33138 2" (Ai 63) / (6-a-) �s.ii* 3 os - ,g o: :','Py; A M. GONZALEZ Purl 'MMISSION#FF170109 •o IRE .ctober 25 2018 u Notary Public Underwriters EI-11-Z.Z31 r a . . • • • .••• •• .... OOOOOO .• •• •• • • • . • •••• • • • . • •• ••..•....• • . . .• •..• . . ••.j. • • W CC 0 z 0) w -J 0 CC 0 0 0 7 LL rr • • • • • • •• •• • L((21 9JP RECD SEP I1 2017 BY: (2)5/6" (01 Goppe thcd geouaD Rods. Fuytge b RCou b FPL' •• ••..•. • • • • •