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EL-17-2259Project Address Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 Permit Permit NO. EL -9-17-2259 Permit Type: Electrical - Residential Work Classification: Repair Permit Status: APPROVED Issue Date: 9/19/2017 Expiration: 03/18/2018 Parcel Number Applicant 24 NE 111 Street Miami Shores, FL 33161-7047 1121360040030 Block: Lot: PARMER HEACOX Owner Information Address Phone Cell PARMER HEACOX 24 NE 111 Street MIAMI SHORES FL 33161-7047 Contractor(s) SOLID POWER INC Phone Cell Phone Valuation: Total Sq Feet: $ 2,500.00 0 Type of Work: Additional Info: Classification: Residential Scanning: 3 Fees Due CCF DBPR Fee DCA Fee Education Surcharge Permit Fee - Additions/Alterations Scanning Fee Technology Fee Total: Amount $1.80 $2.00 $2.00 $0.60 $100.00 $9.00 $2.40 $117.80 Pay Date Pay Type Invoice # EL -9-17-65107 09/20/2017 Credit Card Amt Paid Amt Due $ 117.80 $ 0.00 Available Inspections: 126. Inspection Type: Final Review Electrical 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, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and that all ork will be done in compliance with all applicable laws regulating construction and zoning. Futhermore, I authorize the,above-named contraco the w., stated. September 20, 2017 Authorized Signature: Owner / Applica / Contractor / Age Date Building Department Copy September 20, 2017 1 S LIVri.(7_1\ I f_v EM4 BUILDING PERMIT APPLICATION BUILDING mvL. 0 v 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 ELECTRIC El ROOFING RECEIVED SEP f 9 2017 4-4 FBC 201'1 Master Permit No. EL ti- 22$1 Sub Permit No. [111 REVISION ri EXTENSION Li RENEWAL 0 PLUMBING LJ MECHANICAL LIPUBLIC WORKS 0 CHANGE OF flCANOELLATION Li SHOP CONTRACTOR JOB ADDRESS: 24 NE 111 st DRAWINGS City: Miami Shores Folio/Parcel#: 11-2136-004-0030 County: residential Occupancy Type: Load: Construction Type: Miami Dade Zp Is the Building Historically Designated: Yes NO Flood Zone: I3FE: FFE: OWNER: Name (Fee Simple Titleholder): Parmer Heacox Address: 24 NE 111 st City, Miami Shore state, florida Tenant/Lessee Name: PhoneI: Email: Zip: 33161-7047 CONTRACTOR: Company Name: SOLID POWER INC Address 581 E 36 ST Phone: City: HIALEAH Qualifier Name: Jorge F Bemiudez State: FL Zip: 33013 Phone#: State Certification or Registration t: E C 13006147 Certificate of Competenc-y DESIGNER: Architect/Engineer: Phone#: 3053053619 Address: City: Value of Work for this Permit: $ 2,500 Square/Linear Footage of Work: State: Zip: Type of Work: Li Addition I 1 Alteration El New 1151 Repair/Replace Li Demolition Description of Work: Repair of electrical meter combo Specify color of color thru tile: Submittal Fee $ Permit Fee $ CCF $ CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Notary $ Technology Fee $ Training/Education Fee $ Double Fee $ Structural Reviews $ Bond $ TOTAL FEE NOW DUE $ evtm,,,i0 2 / 24 /2014) Bonding Company's Name (if applicable) Bonding Company's Address Cil; State Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip Application is hereby made to obtain a permit to db 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 ail 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 wr.I 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 52500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien taw 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 srte 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 o reinspection ciarWill be charger!. Signature R or AGENT The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged be Signature CONTRACTOR _1_2_ day of _;'j,als}h'411 ;20 i by i E .~ MEP, E e who is personally known to c me or who has produced i ),2 i I/ d-12 L) cep F s y`'�' identification and who did tak ©A o ro Y s, = N NOTARY PUB C: a, o` E _ teCt. w= Seal. U.S. Embassy Lima, Peru MV Commission expirAs: f OG{ 1:161..V. APr R0VED 3' a i Rr'.wecO2/24J2O- 4 j 18 day of september Jorge f bermudez e rrr this me or who has produced identification and who did take an oath. NOTARY PUBLIC: Sign; Print: Seal: 7i%_% Plans Examiner al Reviev' tweue46.; fron HE 't.aiPsat- tr°Fbr Corrnssv Y Gt3 S ''r,. ,,,, itiCorElwhity 21,20 21 .3r4at3 y vra a a as Zoning City of ALEAH No: 238210-403 City of Hialeah Business Tax Receipt Mayor Carlos Hernandez 2017-18 Amount: $ 150.00 The person, firm or corp. listed here has paid the business tax required to engage in or operate the business specified subject to the regulations and restrictions of the City of Hialeah, Florida Owner: ARIEL RODRIGUEZ Type ofBusiness: Electrical Contractors and Other Wiring Installation Contractors SOLID POWER INC 581 E. 36 ST. HIALEAH, FL 33013 Validating No.: 415617 RICK SCOTT, GOVERNOR EC13006147 THIS IS NOT A BILL ,_vt= IAL,I-r 11crrG. Business Location: 581 E 36 ST Expires September 30, 2018 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 BERMUDEZ, JORGE F SOLID POWER INC 1265 W 41 ST UNIT# 1,_ HIALEAH FL..33012 • c il,. #. ... w . 'r,,. .. ..._. *. "...1.:. ISSUED: 10/05/2016 DISPLAY AS REQUIRED BY LAW SEC) # L1610050000501 010e06 Local Business Tax Receipt Miami -Dade County, State of Florida -THIS IS NOT A BILL - DO NOT PAY 7114473 BUSINESS NANIEfLOCATION SOUD POWER INC 1100 W 46 Si HIALEAH FL 33012 OWNER SOLID POWER INC C/0 ARIEL RODRIGUEZ PRES Worker(s) 1 RECEIPT NO. RENEWAL 6717970 LBT EXPIRES SEPTEMBER 30, 2017 SEC. TYPE OF BUSINESS 198 ELECTRICAL CONTRACTOR EC13006147 Must be displayed at place of business Pursuant to County Code Chapter 8A - Art. 9 & 10 PAYMENT RECEIVED SY TAX COLLECTOR 845.00 07/08/2016 CREDITCARD-16-036944 This Local Business Tax Receipi only confirms payment of the Leeal Bnsoncss Tax. Tba Receipt is nota license. permit. or a certification of the holder's qualifications, to do bushrssa. (folder most coat* with any governmental or nongovernmental regulatory taws sad requirantnts which apply. Lisa business. Tie RECEIPT NO. above muss be displayed on all commercial vehicles - Miani-4ade Coda Sec Be -216. For man i#omution visit www,miamidado.aovAax tgt From: Ariel Rodriguez Fax: (888) 233-4645 To: Fax: (305) 756-8972 Page 2 of 2 09/19/2017 4:44 PM 3 CERTIFICATE O LIABILITY IN'URANCE r DATE (MM/DD/YYYY) f 09/1'9/2017 IT THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND :CONF I j Q RI AHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OIC ALTER THE. COVERAGE AFFORDED BY THE POLICIES BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONStTfTUTEA CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER: i IMPORTANT: tf the 5ertIt►cate holder Is an ADDITIONAL INSURED, the pelicyties) must be darseff If.SU R©GATION IS WAIVED, subJectto the terms and conditions of the policy, certain policies may require an endorsement: A atatemalit:onthis certificate does not confer rights to the certificate holder In lieu of such endorsement(s). fp PRODUCER cOkrAtt ii ' _NAVY(:;,__-- i .. RMENRO.ORIGUEZ Unlnation Insurance Corp PNQNE:. p�( 1A/c 4_E- l xt) ,s41,6851 ,1'taA1/CyN0); (786) 272-7024 4888 NW 7 st E;M. .AIA!UAEss:— : ct ig; ;eunlnakinirrsivence.c4m Miami, FL 33126 eau at5}AFFORDrNGOOVERAGE. NAICe Phone (7866416851 FaxA7861272-7924 !imam IJ TED STATES LIABILITY INSURANCE COMP INSURED ..-�.......,.�—. __......,:_•---- —._.. 'NSURER.e: RR OR a�S.IVEINSl1RANCE IN URER j.; ......j.........:IL :• t INSURER 0 :, ._ANMSTRUST NORTH AMERICA SOLID POWER, INC 1265 W 41 ST UNIT 1 INSU I , HIALEAH FL 3304 �tFR e . i i. INSURER F7 f COVERAGES CERTIFICATE NUMBER: q ER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELO HAVE BEEN FSSU i0.TIIE:INSi)RED NA ED ABOVE FORnTBHE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDI ION OF ANY CONTRACTOR,OTHER.DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFO DED BY THE POLIO 4St? $CRI.ED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REf?U.CEQBY'PAID JLAIMS: INSR AD • UHR LLTR --_ TYPE OF INSURANCE I PDLICY' EF .: :POLICYEXP — ---.: —. —,Ills; IWO _ POLICY NUMBER hI Q COMMERCIAL GENERAL LIABILITY �M ME/p! - tIN-I(�."WYi Y} LIMITS [1 CLAIMS -MADE ❑/ OCCUR A ❑ a °ENL AGGREGATE LIMIT APPLIES PER; Li POLICY ❑ JRRO- ECI:`I ❑ OTHER AUTOMOBILE LIABIUTY ❑ ANY AUTO ALL OWNED SCHEDULED Ell �.._! AUTOS �� AUTOS HIRED AUTOS ❑ AUTOS ❑ . UM8RELLALIA3 / .1.4CCUR. ❑ EXCEBSi:r4B _❑.C.IAIMS•htADE ❑ DED N..J RT,OTIOidt 'WORKERS COMPENSATION. AND EMPLOYERS' LIABILITY Y/ N ANY PROPRIETOR/PARTNER/EXECUTIV OFFICER/MEMBER EXCLUDED? -1 (Mandatory In NH) If yes, d®scriDa.undei DESCRIPTION OF OPERATIONS below LOC Y Y 1 CL 1690712 02398074-2 AWC1058497 031. 05`I2017.; 03 15/2,018 EAIN-I DC URREI eE s 1,000,000:00 •I PREMISES i 1OP,000,00 MED EXP (Any ono.patso4i) $ 5,01:to,00. 2.015: 09 1 21201 7 } PERSONAL 8 ADV INJURY s 1,0.00,000.Q0 GENERAL AGGREGATE_ S 24000400.00 PRODUCTS.- 6.OMP/6PAGG: t: 2,000,0011:00 GMK wNEtj$INCiLE I.IIe _LEA 'aec.14 AI BODILY INJURY (Per person) BODILY INJURY (Per accident P OPERJX: AMAGE. ( S,r accident $ 02/€ $ s '25,000:00 s 50000.,00 $ 25;000:00. EACH OCCURRENCE AGGREGATE 812018 EL EACH ACCIDENT'.' ' E.L, DISEASE:.- EA EMPLOYE E.L. DISEASE - POLICY LIMIT S s s. $ 100,000.00 4 .500,000.0Q s 100,000.00 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, AddItloirI Remarks Schedule, Ifre.s1�ce Ie ELECTRICAL CONTRACTOR 1 _CERTIFICATE HOLDER' Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 ACORD 25 (2014/01) QF CANCELLATION: ` SHOULD. TOME tBOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EWER *IODATE 7 - -.; r NOTICE WILL BE DELIVERED IN ACCORDANCE T PROVISIONS. rerf. 014 ACORD CORPORATION. All rights reserved. D name and logo are registered marks of ACORD From: Ariel Rodriguez Fax: (888) 233-4646 To: Fax: (305) 766-8972 r �: A C. Rlt1 Page 2 of 2 09/19/2017 4:40 PM THIS CERTIFICATE IS ISSUED CERTIFICATE 00 LIABILI Y al URANCE AS A R OF INFORMATION ONLY AND CONFER0 RI HTS UPON THE CERTIFICATE HOLDER. THIS DATE (MM1DD/YYYY) I I 09/19/2017 CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND 'EXTEND ORAL. R 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: I IMPORTANT: tf the veal -he -ate holder Is an ADDITIONAL INSURED, the po icyQess must be endoraOd fIf SUBROGATION 1S WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement: A5tatemai t on this celtficatedoes not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER G�AC1 NApME. CARNIROORIGUEZ Unlnation Insurance Corp PHONE, I� _ p�e��tE(76(i)1i 1-6851 �Nol: (786) 272-7924 4888 NW 7 st 1a1Ai .. ADDRESS._ _l-; gigue vuninaBm Miami, FL 33126 oninsurance.co— _.... — —..__ 1 INSU I! RNSI AFFORDING COVERAGE /INC it Phone (786).5416851 Fax (786)272-7924A___:_.:€ INSURED INSURERU�NITED.STATES LIABILITY INSURANCE COMP 1. 1M5URER I PRrOOR SSIVE INSURANCE SOLID POWER, INC , 1265 W 41 ST UNIT 1 INSURER D j . 'AMSTRUST NORTH AMERICA HIALEAH INSURER E: Pi FL 3301? INSURER F • i; COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE:INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDI ION OF ANY CONTRA1; TOROTH . R DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLIO:4 D��'SCRIE ED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVEBEEN CLAIMS: INS It •AD UBR LTR _ TYPE INSURANCE —1>YS.RMD _ POUCYNI%I1SER P LiG'YER .:MPD1YrjY —' . — -- Q COMMERCIAL GENERAL LIABILITY (M�IDIN' —War; I�I � # L 1 CLAIMS -MADE LI OCCUR DAMAGE TO RENT Li A. �1_i THIS IS TO CERTIFY THAT THE POLICIES OF OEM_ AGGREGATE LIMIT APPLIES PER; zQ )`! LOC L—� POLICY ❑ OTHER AUTOMOBILE LIABILITY ANY AUTO r. AUTOS NED • AU OSULED HIRED AUTOS ❑ AUTOS WNED ❑ sly' •Ut:1BRELLALIAB r_ �:O'CCUR. ❑ EXCESSLIAB ❑.CLAIMS•.MVADE -DED C.m, l 'RETEN1'ION6 'WORKERS COMPENSATION. AND EMPLOYERS' LIABIUTY Y/ N ANY PROPRIETOR/PARTNER/EXECUTIVEn OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, deecnbe.under DESCRIPTION OF OPERATIONS below N A Y 1 CL 1690712 02898:0744 03/05401T EACH OCCUR .REH/CE 9 1,000,000:00 PFd�MISES.LE:45&ilE[F,) ; 100,00.0,00 MED EXP (Any one,EersoeI i $ 5,000.00 512018 PERSONAL & ADV INJURY $ 1,000,000:0.0 � 1I 09/124010:-10942/20/ 7 AWC 1058497 02/1B7201 GENERAL AGGREGATE_ P:RODUC:TS.-COMP/0 AGO COMBINED SINGLE LIMIT _LEA'accide tl BODILY INJURY (Per person) BODILY INJURY (Per accident' P, r)PERTY.p.AMAGE. L� eacidenlM EACH OCCURRENCE AGGREGATE s 2,000000.00 2,000,000:00 $ 25;000:00 $ 50.000,60i $ 25;000.00. S S $ 'Nov._TH. C. 'N . �.- I_FFt._.� 02/8/2018 E.L. EACH ACCIOErrr g 100,000.00 E -L, DISEASE - EA. EMPLOYE.500,000.00. w — E,L.DISEASE - POLICY LIMIT �.. 5 100,000.00 _ — tl Remarks Schedule, If irlai,{! I': DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES (Attach ACORD 101, Additle,- ELECTRICAL CONTRACTOR j f CERTIFICATE HOLDE.RI tormarII I I 1 CANCELLAil N SHOULD0 THE EXPI44''O1HE tATjc+N DA- ACCORDA11+tCCi- Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 ACORD 25 (2014/01) QF OVE DESCRIBED POLICIES BE CANCELLED BEFORE - - " NOTICE WILL BE DELIVERED IN PROVISIONS. 1988 2014 ACORD CORPORATION. All rights reserved. The: AC+(RD name and logo are registered marks of ACORD 11i