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WS-17-2164
Project Address Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 Permit NO. WS -8-17-2164 Permit Type: Windows/Shutters r pe int ork Classification.- WindowlDoor Replacem Permit Status: APPROVED Issue Date: 912112017 Expiration: 03/20/2018 Parcel Number Applicant 621 NE 92 Street Number: 2-A Miami Shores, FL 1132060430020 Block: Lot: ELSA BRUGUES Owner Information Address 621 NE 92 Street MIAMI SHORE FL 33138-2956 Phone Cell Contractor(s) Phone PROTECTIVE SHUTTERS & WINDOW; (954)987-1684 Cell Phone Valuation: Total Sq Feet: $ 6,100.00 10 Type of Work: REPLACING 6 OLD WINDOWS WITH NEW IM No of Openings: 6 Additional Info: Classification: Residential Scanning: 4 Fees Due CCF DBPR Fee DCA Fee Education Surcharge Permit Fee Scanning Fee Technology Fee Amount $4.20 $2.40 $2.40 $1.40 $160.00 $12.00 $5.60 Total: $188.00 Pay Date Pay Type Amt Paid Amt Due Invoice # WS -8-17-65000 09/21/2017 Check#: 5635 $ 138.00 $ 50.00 08/28/2017 Check #: 005604 $ 50.00 $ 0.00 Available Inspections: Inspection Type: Window Door Attachment Final Review Building 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 work will be done in compliance with all applicable laws regulating construction- . ning. Futhermore, I authorize the above-named contractor to do the work stated. i - Author?=.: iOW gnature:Owner / Applicant / Contractor / Agent .II September 21, 2017 Buildin epartment Copy Date September 21, 2017 1 Miami Shores Village RECEIVED t.- Building Department �z;441111/10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 Sr �u FBC 01L-1 BUILDING Master Permit No.09 -7-~ I ice- Zo 13 PERMIT APPLICATION Sub Permit No. \N 5 0 --e.1 W 0 I2(BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR JOB ADDRESS: ( n 9.) r I E (12_ Z - DRAWINGS City: Miami Shores County: Miami Dade Zip: 3-313 Folio/Parcel#: 113 a.0 tP 04 M)�(6 Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: OWNER: Name (Fee Simple Titleholder): Address: Loa i n E 92_ 61 - city: LA «wk i hb rps E Isa. 3,rue5 4- 2 A State: r �- Flood Zone: BFE: FFE: Phone#: 3CiS - 30)- 773) Zip: 53(36 Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name:�eek Ve s oireo 6 Kh(14(1)J5 C . Phone#: 1C-14- V d / 4e ti Address: -70 City: v\i �-PCx( rG •ate: it - Qualifier Name: GLNaa.) TOrre5 State Certification or Registration #: LC- 1311 5 )L1. 8 I Zip: -9_,A.) 23 Phone#: 9S4- 9S7-10 Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: $ tr 1C0 Type of Work: Description of Work: Ne� W t 1vC� T/15+1400)-0-1. Square/Linear Footage of Work: /66 ❑ Addition I vt Alteration ❑ New ❑ Repair/Replace ❑ Demolition -ro ��p ► G VS RD 2)13 Specify color of color thru tile: //�� ^� Submittal Fee $ Permit Fee $ I(::;0 � , W CCF $ CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Notary $ Technology Fee $ Training/Education Fee $ Double Fee $ Structural Reviews $ Bond $ (Revised02/24/2014) TOTAL FEE NOW DUE $ 13111 W 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 $1500, 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 X p e - OWNER or AGENT The foregoing instrument was acknowledged before me this i951‘A. day of AN) cj�� , 20 (-7 , by 5Dr 0,,J , who is personally known to me or who has produced( �-- identification and who did take an oath. NOTARY PUBLIC: Sign: Print: Seal: as Signatur CONTRACTOR The foregoing instrume t was acknowledged before me this 9/-'f� day of 7S UZ` b( i' l , who is personally known to me or who has produced P t- as , 20 f' , by identification and who did take an oath. NOTARY PUBLIC: Sign• Print Seal: O 0% 5750 Mme, iun EXPIRES* 17, 2021 ,t' ' Bonded Thru bllc UndervvAters ******************************* ************************************************************************* APPROVED BY (Revised02/24/2014) Plans Examiner Structural Review Zoning Clerk RICK SCOTT, GOVERNOR KttY LJAVVOU/N, OC.UMC ,Arc - - " - - 7 -• • - - - ,,-,.......-..........._ ,...— _S,...T„..A,T,..„Es...,..... .O........_F FLORIDA - DEPARTVNT,OBUSINESS:-AND PROFESSIONAL, REGULATIONCONSTRUCTION.16DUSTRY,LICENSING:BOARD- .(53115•148-, • - Ttie 51:1E-.CIALTY-.8-TRUCTORCONTRAC:TOR: Nemedelow..lS CERTIFIED -v • On`cie:rthp:_prcyi8to-6s-(if..Chaplei"--48-6--FS: — - - „. - - :TOkFtES,-,GUSTAVO_TR-'--- --15.ROTEcTIVE_SHILT-T - HOLLYWOOD_.` 3074— DISPLAY AS REQUIRED BY LAW SEQ # L1608280004339 004267 Local Business Tax Receipt Miami -Dade County, State -of Florida — -THIS ISNOT A BILL =DO NOf PAY 63,91501 BUSINESS NAMPI,OCATION PROTECTIVE SHOTIERS,81•WINDOWS INC DOING BUSINESS If\IDADE COUNTY RECEIPT,NO " RENO4i4L: .8EEPT,„..„ 6567524 Must be.clir,da'yeci` at {Jlate.of business Purs,U.O'nt3o,Cdunty Code Chabter E3A;— Aft. 9 & 10 .4, OWNER SEC. TYPE OF BUSINESS, PAYMENT RECEIVED PROTECTIVE SHUTTER & WINDOWS INC 196 SPECIALTY BUILDING CONTRACTOR By TAX COLLECT,OR _ , , L;USTAVO TORRES QUALIFIER SCC131151481 ., ., . . • ' 475.00 09/D02016 Worker(s) '4 . . „ . , :GfiEDITCAFD-1§7-062125 This Local Business Tax Receipt only confirms payment of the Local Business Tax. The Receipt is not a license, permit, br a certification of the holder's qualifications, to do business. Holder musrcompliwith any governmental _ or nongovernmental regulatory laws and requirements which apply to the business. The RECEIPT NO. above must be displayed on all commercial vehicles —11.6iami..4a4e Code Sec 8a-276. For more information, visit www.miamidade.gov.itaxcollectot elk al.,.. CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDMYY) 10/26/2016 THI$ 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 CONTACT A NAME: Freeway Insurance Services of FL #5 tA/cN o. Ext): (954) 358-2129 FAX No): (954) 358-2130 6129 Stirling Rd EMAIL _ADDRESS: @ Yfreewa bmoore insurancefl.com Davie, FL 33314 INSURER(S) AFFORDING COVERAGE NAIC # Phone (954) 358-2129 Fax (954) 358-2130 INSURER A : Federated National Insurance Company 10790 INSURED INSURER B: $ 1,000,000.00 Protective Shutters 8 Windows, Inc. INSURER C : $ 2,000,000.00 5780 SW 25th St Bay 4 INSURER D $ 2,000,000.00 INSURER E : West Park FL 33023 AUTOMOBILE LIABILITY II ANY AUTO INSURER F : 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. INSTR TYPE OF INSURANCE ADDLSUBR INSR WVD POLICY NUMBER POLICY EFF (MMIDD/YYYY) POLICY EXP (MMIDDIYYYYd 10/27/2017 LIMITS EACH OCCURRENCE $ 1,000,000.00 A V COMMERCIAL GENERAL LIABILITY N N GL050401390901 10/27/2016 ❑ CLAIMS -MADE V OCCUR DAMAGE TO RENTED PREMISES (Ea occurrence) $ 1 OO,000.00 ❑ MED EXP (Any one person $ 5,000.00 . PERSONAL s ADV INJURY $ 1,000,000.00 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000.00 ❑PRO ❑ LOC 0 POLICY JECT PRODUCTS - COMP/OP AGG $ 2,000,000.00 1.1 OTHER AUTOMOBILE LIABILITY II ANY AUTO COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ ❑ALL OWNED SCHEDULED AUTOS ❑ AUTOS ❑ HIRED AUTOS NON -OWNED AUTOS ❑ N BODILY INJURY Per accident ( ) $ PROPERTY DAMAGE (Per accident) $ $ ❑ UMBRELLA LIAB ❑ OCCUR ❑ EXCESS LIAB ❑ CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ ❑ DED ❑ RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y I N ANY PROPRIETOR/PARTNER/EXECUTIV N / A ❑PER ❑ OH STATUTE R 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, If more space Is required) License # SCC131151481 Job: Replacing 6 windows Job Address: 621 NE 92nd Street Apt.#2A Miami Shores, FL 33153 CANCELLATION Miami Shores Village Building Department 10050 N.E. 2nd Avenue Miami Shores, FI 33138 I 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 JIMMY PATRONIS CHIEF FINANICAL OFFICER STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION * * CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW * * CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law. EFFECTIVE DATE: 10/18/2017 EXPIRATION DATE: 10/18/2019 PERSON: TORRES FEIN: 474386109 BUSINESS NAME AND ADDRESS: PROTECTIVE SHUTTERS & WINDOWS INC 5780 SW 25TH STREET BAY # 4 WESTPARK FL SCOPE OF BUSINESS OR TRADE: Door and Window Installation ❑ All Types rl Residential and Commercial 33023 GUSTAVO IMPORTANT: Pursuant to Chapter 440.05(14), F.S., an officer of a corporation who elects exemption from this chapter by filing a certificate of election under this section may not recover benefits or compensation under this chapter. Pursuant to Chapter 440.05(12), F.S., Certificates of election to be exempt... apply only within the scope of the business or trade listed on the notice of election to be exempt. Pursuant to Chapter 440.05(13), F.S., Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation if, at any time after the filing of the notice or the issuance of the certificate, the person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate. The department shall revoke a certificate at any time for failure of the person named on the certificate to meet the requirements of this section. DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUESTIONS? (850)413-1609