Loading...
EL-14-1561BUILDING PERMIT APPLICATION Miami Shores Village ED Building Department JUL 212014 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 BY: FBC 20)02 Master Permit No. � /7/, " /9096 Sub Permit No. 67 /g -" /.5-6/ ❑BUILDING ❑CTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL PLUMBING ❑ MECHANICAL ❑PUBLICWORKS ❑ CHANGE CONTRACTOR ❑ CANCELLATION ❑ SHOP DRAWINGS JOB ADDRESS: ,li City: Miami Shores County: • Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): P_.'1r1, �c.0 , i .eC�y,✓f Phone#:3 6 cis601-490- `l.V ity;)- /V'I� 9/ref - / - City: //�/ ©fef State: P/0//0/4 ---Zip: � 1, 3 Tenant/Lessee Name: A � / /� Phone#: Email: Address: CONTRACTOR: Company Name: Address: City: 9 Qualifier Name: eta e. Phone#: Phone#: Zip: 3 3' /6(z7 State Certification oatioti"�n #:ane /,?00 74 -7 _ Certificate of Competency #: DESIGNER: Architect/Engineer: M / Phdne#: Address: v ty: State: Zip: Value of Work for this Permit: $ P-(.9-0 Type of Work: ❑ Addition ❑ Pperation ❑ New [SZRepair/Replace ❑ Demolition �' Description of Work: �� /c./ -44 rr.,-7O0,._74/ /r Square/Linear Footage of Work: Specify color of color thru tile: Submittal Fee $ Permit Fee $ /5-0/4W /4W CCF $ CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ . Structural Review $ TOTAL FEE NOW DUE$ G• l�J 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. 1 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 $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs s • . days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved an.. reinspectio fee will be charged. Signatu The foregoing instrument was acknowledged before a this tsi- day of U: , 20 1 , by Yif(Tl.r .YUQy\ , who is personally known to me or who has produced identification and who did take an oath. NOTARY PUBLIC: Sign: Print: Seal: Signature CONTRACTOR The foregoing instrument was acknowledged before me this day of 117 , 20 /Y, by ,•c /q -, 'Z- %444 , who is personally known to as me r who has produced as identification and who did take an oath. NOTARY PUBLIC: Notary Public State of Florida Barbara Losada g q • My Commission EE087575 e0,, O Expires 04/25/2015 Sign: Print: Seal: 4,4 ��IARMON$ EE :17 :°� EXP�r• =g: July 14, 2016 .:.'3411 Pathe ***********************************************************************************.**** APPROVED BY (Revised02/24/2014) 24P/y _ Plans Examiner. Structural Review **,w**************** Zoning Clerk TATE OF FL.ORLDA ►EPARTMMNT OF BUSINESS AND PROFESSIONAL REGULATION 3LECTRICAL CONTRACTORS LICENSING BOARD p940NORTH AHAS EE CNROE STREET 32399-0783 WAY, RICHARD JR SKY ELECTRIC INC MIAMIGARDETNS NW FL 33169 Floridians licensed by the Department of from Business tects toyacht broand Prossional kersavm Our professionals and businesses rangekeep Florida's economy strong• boxers to barbeque restaurants. and they better Every day we work to improve the way we do business in order to serve you i- For information about our services, please log onto www•myforidaticense.com. , impact you can more information ep rtment newslettersut our andand leam more abouvisionS and the t that impact you,111 Departments initiatives. :.:.:.. pi. pt 89 F. IS: CERTIFIED +u! .? . Our mission at the Department is: License Efficiently, Regulate Fairly. We (850) 487-1395 STATE of FL0R DA ... AND, DRPARTil1BNT OF BUSINESS PROFES S IONLa,REGIILAT_I ON:.: ; 127009751 Congratulations! With this license you become one of the nearly one milliontion. • ou can serve your customers. 31 2014 ;1,1208.2102607 constantly strive to business you better SO that y ^ : ir,U,a date AUG,` Thank you for doing business in Florida, and congratulations on your new Hoene AC#6 8: DATE DTACH.HERE,= ' j .6tTHIS DOCUMENT,HAS`A COLORED 8ACKG9OUND„rhR 1COPRINTINC; .LINEr9ARK"`.PATENTED PAPER 9 e : STATE OF FLORIDA ; pp:AR +TENT OF :B INESS AND PROFESSION .$LECTRICAL CONTRACTORS LICENSIN LICENSE NBR2E; BATCH NUMBER 127 1300.27:62 ne:'. ELECTRICAL CONTRACTOR :NamedJ--belavo-;:IS CERtTIFIED - 'LTaider the provisions of Chapt ' Expiration date: AUG,31, 2014:- 41AY, =:'RICHARD: JR =: 9d riELECW ST: INC. MIAMI, .GARDENS RICR ,`SCOTT: ..-.._-__-__D_PBW S2 L1 RED BY LAWY___-- GOVERNOR J FL 33169 :REGULATION BOARD SEQ#L1208210260 KEN LAWSON SECRETARY. 07/21/2014 10:51 9549560555 COVER ALL INSURANCE PAGE 01/01 ACORD CERTIFICATE OF LIABILITY INSURANCE PRODUCER COVER ALL INSURANCE 5800 W. ATLANTIC BLVD, MARGATE, FL. 33063 PHONE # (95) 956-0006 FAX # (954) 956-0555 INSURED SKY ELECTRIC, INC. 90 NW 156TH STREET MIAMI, FL, 33169 FAX# 305.949.3838 COVERAGES • GATE (MM/DD/YYYY) 01/21/2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE INSURER k FEDERATED NATIONAL INSURANCE NAIC # INSURER B; INSURER C; INSURER D: INSURER E: 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 WF'H 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN RFnI Irr n BY pAlp CLAIMS IN3R I TR ADD'L NRRD -au OF IhrUIRANCE POLICY NUMBER POLICY EFFECTM' (mix IMMlnnml POLICY EXPIRATION nATP A GENERAL LIABILITY GL -0504010969-00 07-28-2013 (MMIRMYY) 07-26-2014 LIMITS EACH OCCURRENCE $ 500,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED CLAIMS MADE X OCCUR �MISES (Q accuLa tle) :100,000 MED EXP Any one parson) 5 5,000 PERSONAL a ADV INJURY 1 500,000 GENERAL AGGREGATE $ 1,000,000 'G`ENt AGGREGATE LIMITRo_APPUEs PER: PRODUCTS - COMP/OP AGO 5 1,000,000 I POLICY I I FCC f LOC AUTOMOBR.E LABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS COM9INEO SINGLE LIMIT (Ea accident) -, BODILY INJURY (Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE (Per accident) GARAGE LIABILITY ANY AUTO AUTO ONLY Y•EA ACCIDENT OTHER THAN EA ACC f -M `m" $ H AUTO ONLY; AGO S ExCESS/UMBRELLA LIABILITY EACH OCCURRENCE 5 OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE RETENTION 5 $ $ $ WORKERS EMPLOYERS' ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER Kyes, tleec $PE JAL PROVISION$ COMPENSATION AND UABILITY EXCLUDED? Ibe Intler below � 7OS AM - FR EL EACH ACCIDENT 5 E.L. DISEASE -EA EMPLOYEE 8 E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OTHER OF OPERATIONS/ LOP-6Tlnue 1 vete.. ee I eve.. i.ei.../.• .................. .,_...... ____ _ ELECTRICAL WORK CERTIFICATE HOLDER Rr7VISION CANCELLATION MIAMI SHORES BUILDING DEPT 150 NE 2ND AVE MIAMI SHORES FL 33138 FAX: 305-756-8972 ACORD 26 (2001!08) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THERECF, THE G INSURER WILL ENDEA • ' TO MAIL 10 DAYS WRITTEN NOTICE TO The CERTIFl . LDER NAMED TO TM , OUT FAILURE TO DO SO SHALL IMPOSE NO OI�LIGATION - OF ANY 10 . - • N THE INSURE /L ITS AGENTS OR RBPRE$ENTA`IVES AUTHORIZED REM£NTATIV ACORD CORPORATION 1958 Local Business Tax Receipt Miami—Dade County, State of Florida -THIS IS NOT A BILL - DO NOT PAY 5568721 BUSINESS NAME/LOCATION SKY ELECTRIC INC 90 NW 156 ST MIAMI, FL 33169 OWNER SKY ELECTRIC INC Worker(s) ( I• RECEIPT NO. RENEWAL. 5808671 EXPIRES SEPTEMBER 30, 2014 Must be displayed at place of business Pursuant to County Code Chapter 8A - Att. 9 & 10 SEC. TYPE OF BUSINESS PAYMENT RECEIVED 196 ELECTRICAL CONTRACTOR BY TAX COLLECTOR 75.00 09/24/2013 2 EC13002762 0223-13-001545 This Local Business Tax Receipt only Confirms payment of the Loco' Business Tax. The Receipt is not a license. permit. or a certification of the holders qualifications. to do business. Holder must comply with any governmental or nongovernmental regulatory taws and requirements which apply to the business. The RECEIPT NO. above must be displayed on all commercial vehicles- Miami -Dade Code Sec as 276. For more information, visit www.miamidadegov/taxcallectot Report Viewer 1 /1 100% Page 1 of 1 JEFF ATWATER CHIEF FRIANCIAr. 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: 6/16/2014 EXPIRATION DATE: 6/15/2016 PERSON: WAY RICHARD JR FEIN: 650759183 BUSINESS NAME AND ADDRESS: SKY ELECTRIC INC 90 NW 156 STREET MIAMI FL 33169 SCOPES OF BUSINESS OR TRADE: LICENSED ELECTRICAL CONTRACTOR Pursuant lo Chapter 440.05(14), F.S., an officer 01 a corporation wile elects exemption from this chapter by flaw a cenYKate of election under anti *adient may not recover bendb or compensation under ties chapter. Pursuant to Chapter 440 05(12). F.S.. Certificates at election to be exempt... appy only within the scope of the business or bade oiled on are notice of &neon lobe exempt. Pursuant to Chapter 440 a(13). F.S., Notices of dation to be exempt and certificates a election to be exempt shalt be subject b revoaGm I[ el any time after the Ming of the notice or Me issuance of the certificate, the person named on the nadce or cartiicale no longer meets the requirements of this section kr nsuance of a certificate. The department shaft revoke a certificate e1 any time for failure of the person named en the certificate to meet the ...monuments of this secdan. DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 07-12 QUESTIONS? (650)413-1609 https://apps8.fldfs.com/crreportviewer/reportViewer.aspx?data=kdvosinc9D7n3gH6TFR 6 6117/x(114 Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Notice to Owner — Workers' Compensation InsuranceE�! xem tion` Florida Law requires Workers' Compensation insurance coverage under Chapter 440 of the Florida Statutes. Fla. Stat. § 440.05 allows corporate officers in the construction industry to exempt themselves from this requirement for any construction project prior to obtaining a building permit. Pursuant to the Florida Division of Workers' Compensation Employer Facts Brochure: An employer in the construction industry who employs one or more part-time or full-time employees, including the owner, must obtain workers' compensation coverage. Corporate officers or members of a limited liability company (LLC) in the construction industry may elect to be exempt if: 1. The officer owns at least 10 percent of the stock of the corporation, or in the case of an LLC, a statement attesting to the minimum 10 percent ownership; 2. The officer is listed as an officer of the corporation in the records of the Florida Department of State, Division of Corporations; and 3. The corporation is registered and listed as active with the Florida Department of State, Division of Corporations. No more than three corporate officers per corporation or limited liability company members are allowed to be exempt. Construction exemptions are valid for a period of two years or until a voluntary revocation is filed or the exemption is revoked by the Division. Your contractor is requesting a permit under this workers' compensation exemption. In these circumstances, Miami Shores Village does not require verification of workers' compensation insurance coverage from the contractor's company. Therefore, you may be personally liable for the worker compensation injuries of any person allowed to work under this permit. Please check with your insurance carrier since most property insurance policies DO NOT cover this type of liability. BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. Owner State of Florida ) County of Miami -Dade ) Sworn to aad subsc 'bed before me this day of Print Name: Signature: Contractor State of Florida ) County of Miami -Dade ) Sworn to an si bscribed before me tis day of , 20/ tion produced = '''.