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EL-17-55Project Address Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 Permit Permit NO. EL -1-17-55 Permit Type: Electrical - Residential Work Classification: Addition/Alteration Permit Status: APPROVED Issue Date: 1/10/2017 Expiration: 07/09/2017 Parcel Number Applicant 340 NE 94 Street Miami Shores, FL 1132060136160 Block: Lot: WILLIAM PERRY Owner Information Address Phone Cell WILLIAM PERRY 340 NE 94 ST MIAMI SHORES FL 33138-2832 Contractor(s) Phone BATES ELECTRIC SERVICE & TECHN (786)602-3939 Cell Phone Valuation: Total Sq Feet: $ 4,680.00 0 Type of Work: COMPLETE SERVICE REPLACEMENT 400 -AM Additional Info: COMPLETE SERVICE REPLACEMENT 400 -AM 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 $3.00 $2.41 $2.41 $1.00 $5.00 $161.00 $9.00 $4.00 $187.82 Pay Date Pay Type Invoice # EL -1-17-62564 01/10/2017 Credit Card 01/10/2017 Credit Card Amt Paid Amt Due $ 50.00 $ 137.82 $ 137.82 $ 0.00 Available Inspections: Inspection Type: Final Meter Box Alteration Relocation Fire Alarm Service Change Review Electrical W. W. Underground 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 constructioore, I authorize the above-named contractor to do the work stated. January 10, 2017 Aui!iio`rized Sign. ture: Owner / Applicant / Contractor / Agent Bui • ' g Dep . rtment Copy ate January 10, 20 1 BUILDING PERMIT APPLICATION 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 FBC2d'(4 Master Permit No. E' (4 ^ 5 --) Sub Permit No. ❑ BUILDING Q ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL PLUMBING ❑ MECHANICAL (PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 340 NE 94 ST City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: 1 1-3206-013-6160 Is the Building Historically Designated: Yes NO X Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): WILLIAM R PERRY III & W DYNISE Phone • 786-290-9810 Address: 340 NE 94 ST City: MIAMI SHORESState: FL Zip: 33138 Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: BATES ELECTRIC SERVICE & TECHNOLOGY, INC. phon 636-464-3939 Address: PO BOX 100 city. IMPERIAL State: MO Zip: 63052 Qualifier Name: BLAINE FRINK phone#: 636-464-3939 State Certification or Registration #: EC13005952 Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: $ 4,680 Square/Linear Footage of Work: Type of Work: ❑ Addition El Alteration ❑ New Repair/Replace D Demolition Description of Work: COMPLETE SERVICE REPLACEMENT 400 -AMP METER ENCLOSURE WITH DISCONNECT, 400 -AMP RATED RISER ASSEMBLY, (2) 200 -AMP 120/240 MLO PANELS, NEW COPPER FEEDERS, GROUND PER NEC Specify color of color thru tile: Submittal Fee $ 5Dffit VD Permit Fee $ / A/ ' 90 CCF $ 3 CO/CC $ Scanning Fee $ `` � Radon Fee $ 2 ' (_4 DBPR $ a . L-1 1 Notary $ S— Technology Fee $ (-11Training/Education Fee $ 1 Double Fee $ Structural Reviews $ (Revised02/24/2014) Bond $ TOTAL FEE NOW DUE $ I . ' f � 1 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 ,�+k% Signature OWNER AGENT The foregoing instrument was acknowledged before me this 4TH day of JAN UARY , 20 17 , by FELICIA JUAREZ , who is personally known to me or who has produced PERSONALLY KNOWN as identification and who did take an oath. NOTARY PUBLIC: Signe ,Q Print: Seal: a LLk-t) heryl A Mueller Notary Public Notary Seal State of Missouri County of Jefferson My Commission Expires 02/23/2019 Commission #15406215 CONTRACTOR The foregoing instrument was acknowledged before me this 4TH day of JANUARY , 20 17 , by , who is personally known to me or who has produced PERSONALLY KNOWN as identification and who did take an oath. NOTARY PUBLIC: BLAINE FRINK Sign( l Print: CHE Seal: Q()11dA,j; ) UELLER Cheryl A Mueller NotaSeal Stale of Misso�ouPublic nty of Jefferson My Commission Expires 02/23/2019 Commission # 15406215 *********************** *****************************. ***************************** * * *********** APPROVED BY �'D c) Al"' Flans Examiner Zoning Structural Review Clerk (Revised02/24/2014) Local Business Tax Receipt Miami—Dade County, State of Florida -THIS IS NOT A BILL - DO NOT PAY 7168897 BUSINESS NAME/LOCATION BATES ELECTRIC SERVICE & TECHNOLOGY INC DOING BUSINESS IN DADE COUNTY OWNER BATES ELECTRIC SVC & TECHNOLOGY INC ("Al C.1-IRISTOPHFR .1 RATFit PRF Worker(s) 60 mule RECEIPT NO. RENEWAL 7447567 SEC. TYPE OF BUSINESS 196 ELECTRICAL CONTRACTOR EC13005952 LBT EXPIRES SEPTEMBER 30, 2017 Must be displayed at place of business Pursuant to County Code Chapter 8A - Art. 9 & 10 PAYMENT RECEIVED BY TAX COLLECTOR 325.00 07/11/2016 CREDITCARD-16-038404 This Local Business Tax Receipt only confirms payment of the Local Business Tax. The Receipt is not a license, permit, or a certification of 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 So -276. For more information, visit vwvw.miamidade.gov/texcollector 1 RICK SCOTT, GOVERNOR STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD KEN LAWSON, SECRETARY LICENSE NUMBER ECt3005952 ,. The', ELECTRICAL CONTRACTOR Named below IS CERTIFIED Under, the provisions of Chapter 489 FS. Expiration.date:`.AUG 31, 2018 - J"� ..a FRINK, ,�r BLAINE"L -BATES ELECTRICr SERVICE.' I ECHIVOLOGY•INC • r '/2006"SIERRA PARKWAY-- __ '`` ' -- R • ' ,. `i - j, ARNOLD% MQ -63010-.-. _ .... . .-�.. - -- .':,,,.-,a. ,,y% /.ter R t ..--i. /J i f- _ -1 y,-",' - �," lL , ...., `� 4 - . ISS ED r`0829/20"T6 .� ``DISPL`AY"AS REOUIR D -BY -L -AW'' ` - SEQ # ACCORD CERTIFICATE CERTIFICATE OF LIABILITY INSURANCE `../..- DATE(MM/DDIYYYY) 1/9/2017 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 POUCIES 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 Lakenan 890 Rozier Street Ste. Genevieve MO 63670 CONTACT NAME: PHONE573-883-7446 FAX 573-883-3981 WC. NQ Ext (A/C. No): ADD AIL ss: info@lakenan.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A:Allied Insurance 25114 INSURED BATES -1 Bates Electric Inc PO Box 100 Imperial MO 63052 INSURER a :MISSOURI EMPLOYERS MUTUAL 10191 INSURER c :ARGONAUT INSURANCE 2056 INSURERD: $1,000,000 INSURER E : $100,000 INSURER F : COVERAGES CERTIFICATE NUMBER: 289735808 REVISION 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 ADDL INSD SUBR D POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MI(MIA/DO/TM)/DO/Y1 UMITS A X COMMERCIAL GENERAL LIABILITY ACP 3007546736 3/9/2016 3/9/2017 EACH OCCURRENCE $1,000,000 GE TO PREMISES (EaENTED occurrence) $100,000 CLAIMS -MADE X OCCUR MED EXP (Any one person) $10,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $2,000,000 GE 'L AGGREGATE POLICY OTHER: X UMIT APPLIES 1218r PER: LOC PRODUCTS - COMP/OP AGG $2,000,000 $ A AUTOMOBILE X %( LIABILITY ANY AUTO AUTOWNED HIRED AUTOS X SCHEDULED NON -OWNED AUTOS ACP 3007546736 3/9/2016 3/9/2017 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ s A X UMBRELLA UAB EXCESS LIAB X OCCUR CLAIMS -MADE ACP 3007546736 3/9/2016 3/9/2017 EACH OCCURRENCE $5,000,000 AGGREGATE $5,000,000 $ DED RETENTION $ B C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVEN OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y / N N / A MEG 2019819 WC 928128445204 3/9/2016 3/9/2016 3/9/2017 3/9/2017 X PER STATUTE OTH- ER E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE- EA EMPLOYEE $1,000,000 E.L. DISEASE - POLICY LIMIT $1,000,000 A Inland Marine ACP 3007546736 3/9/2016 3/9/2017 Borrowed/Leased 40,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) Electrical Contracting License # EC13005952 CERTIFICATE HOLDER CANCELLATION I Miami Shores Village Building Department 10050 NE 2nd Ave. Miami Shores FL 33138-2304 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 ) <?11474112...fe ACORD 25 (2014/01) ©1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD EC13005952 January 9, 2017 Sate of Florida County of Miami -Dade ELECTRIC SERVICE & TECHNOLOGY, INC. ;Nit110I4nR PCYYr ,,1 Before me this day personally appeared who, being duly sworn, deposes and says: I, William Perry, as the owner of property located at 340 NE 94th Street, Miami Shores, FL 33138, give permission to Felicia Juarez to sign on my behalf for the building permit application and/or permits. Sworn to (or affirmed) and subscribed before me this 621 day of Jon . 201 by 1" Uv am p�-nr`t til Personally Know PR Produced Indentification Type of Identification Produced f 1 proV CT S P Cv00 -G 3io -Sqi - I9 -G rint, Type or Stamp Name of Notary MAHARAI K. GONZALEZ MY COMMISSION # GG 044602 EXPIRES: November 2, 2020 Bonded Thro Notary Public Underwriters