EL-17-285Project Address
Miami Shores Village
10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138-0000
Phone: (305)795-2204
Permit
Permit NO. EL -2-17-285
Permit Type: Electrical - Residential
Work Classification: Alteration
Pennit status: APPROVED
Issue Date: 2/21/2017
Expiration: 08/20/2017
Parcel Number
Applicant
75 NE 92 Street
Miami Shores, FL 33138-
1132060130270
Block: Lot:
JARED ZECH
Owner Information
Address
Phone
CeII
JARED ZECH
75 NE 92 Street
MIAMI FL 33138-
(347)899-6579
Contractor(s) Phone CeII Phone
RENE ELECTRICA CORPORATION (954)766-4685
Valuation:
Total Sq Feet:
$ 8,290.00
0
Type of Work: AS PER PLANS ADDITION
Additional Info:
Classification: Residential
Scanning: 1
Fees Due
CCF
DBPR Fee
DCA Fee
Education Surcharge
Notary Fee
Permit Fee - Additions/Alterations
Scanning Fee
Technology Fee
Total:
Amount
$5.40
$4 35
$4.35
$1.80
$5.00
$290.15
$3.00
$7.20
$321.25
Pay Date Pay Type Amt Paid Amt Due
Invoice # EL -2-17-62817
02/21/2017 Credit Card $ 321.25 $ 0.00
Available Inspections:
Inspection Type:
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 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 and zoning. Futhermore, I authorize the above-named contractor to do the work stated.
February 21, 2017
Authorized Signature: Owner / Applicant / Contractor / Agent
Building Department Copy
Date
February 21, 2017 1
June 7 ,2017
RENE ELECTRIC CORP.
5220 SW 5th STREET Plantation FL
License # EC13004709
Phone# 954 931 4735
To the Building Department of Miami Shores
This e-mail is to request that only Rene and Alexander Suarez be allowed to request inspections
for the property :
75 NE 92ND Street Miami Shores, FL 33138
Permit# EL 217285
Respectfully Rene Suarez
Rc 16-332b
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fail: (305) 756-8972
' INSPECTION LINE PHONE NUMBER: (305) 762-4949
BUILDING
PERMIT APPLICATION
❑ BUILDING Z ELECTRIC
❑PLUMBING ❑ MECHANICAL
Master Permit No.
Sub Permit No.
❑ ROOFING ❑ REVISION
❑ PUBLIC WORKS ❑ CHANGE OF
CONTRACTOR
JOB ADDRESS: /'JCI 92"'"
City: Miami Shores
RECEIVED
FEV
1017
FBC 20IL
33'2
ELt1-2SS
❑ EXTENSION ❑ RENEWAL
❑ CANCELLATION
❑ SHOP
DRAWINGS
County: Miami Dade
Zip:
Folio/Parcel#: Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
O.WNER'Name (Fee Simple Titleholder): M,Q,Itazz cJi
Address�: �� 9 C r e ' 2 ST
yv W
City: '-t• posy'a-V
\(---
Tenant/Lessee Name:
Phone#: 3cir .53 h
State:
Email: VIA h V 6( G O VVLQLk '. C CfY',
CONTRACTOR: Company Name:
Phone#:
Zip: ;3(.6
Address: 4"Z2 2 Sw 5� '57/
City: /9-2/7(744.?,,-) State: /,/0.<("6,
Qualifier Name:
Phone#:
TV93/ ��Jf
Zip:
Phone#:
State Certification or Registration #: FC /J 10 5 ? 7' ' Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
f410•060
Value of Work for this Permit: $ j Square/Linear Footage of Work:
Type of Work: rg Addition n Alteration ❑ New ❑ pair/Re lace
p ❑Demolition
Description of Work: ,15" /6" /0/ /%- ,0/e/i: ter•
v.
•
Specify color of color thru tile:
•
Submittal Fee $ £ Permit Fee $ CCF $ '''`ts,,,.,,rs,0" CO/CC $
Scanning Fee $ Radon Fee $ DBPR $
Technology Fee $ Training/Education Fee $
Structural Reviews $
(Revised02/24/2014)
Notary $
Double Fee $
Bond $
TOTAL FEE NOW DUE $ 32,1 .
2 5
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
OWN • AGENT
The foregoing instrument was acknowledged before me this
a day of r=rejJ , 20 `t1 , by
l"t , who is personally known to
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
.C�
a . Maw,' `nen' N
_�: T .. zzs=
Seal: s tit o a ?b°
iy' 0..
/, LORl0P 1:%0•``��•
Signat
CONTRA TOR
The foregoin: instrument was acknowledged before me this
day of -C-e- b , 20 �� , by
Keri,(} <303 red , who is personally known to
me or who has produced .-S(!)-1" 20 - p20 °
C� d q
as
identification and who did take an oath.
r I I1��"1
NOTARY PUBLIC:
**************************************************************
APPROVED B �j%�J' �S u°Oi/f Plans Examiner
(Revised02/24/2014)
Zoning
Structural Review Clerk
RICK SCOTT, GOVERNOR
KEN LAWSON, SECRETARY
STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
ELECTRICAL CONTRACTORS LICENSING BOARD
LICENSE NUMBER
EC13004709
The ELECTRICAL CONTRACTOR
Named below IS CERTIFIED
Under the provisions of Chapter 489 FS.
Expiration date: AUG 31, 2018
SUAREZ, RENE
RENE ELECTRIC CORPORATION
5220 SW 5TH STREET
PLANTATION FL 33317
ISSUED: 07/17/2016 DISPLAY AS REQUIRED BY LAW
SEQ # L1607170002112
RICK SCOTT, GOVERNOR
KEN LAWSON, SECRETARY
STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
ELECTRICAL CONTRACTORS LICENSING BOARD
LICENSE NUMBER
EC13004709
The ELECTRICAL CONTRACTOR
Named below IS CERTIFIED
Under the provisions of Chapter 489 FS.
Expiration date: AUG 31, 2016
SUAREZ, RENE
RENE ELECTRIC CORPORATION
5220 SW 5TH STREET
PLANTATION FL 33317
ISSUED: 07/15/2014 DISPLAY AS REQUIRED BY LAW
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i.4
BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT
115 S. Andrews Ave., Rm. A-100, Ft. Lauderdale, FL 33301-1895 — 954-831-4000
VALID OCTOBER 1, 2016 THROUGH SEPTEMBER 30, 2017
DBA:
Business Name: RENE ELECTRIC CORPORATION
Owner Name: RENE SUAREZ
Business Location: 5220 SW 5 STREET
PLANTATION
Business Phone: 954-931-4735
Rooms
Seats
Employees
1
Receipt #:
ELBECTR OCAL/ALARMS/CONTRACTOR
Business Type: (ELECTRICAL CONTRACTOR)
Business Opened:04 / o4 / 2 011
State!County/Cert/Reg:Ec13 0047 0 9 r
Exemption Code:
Machines Professionals
For Vending Business Only
Number of Machines:
Vending TVDe:
Tax Amount
Transfer Fee
NSF Fee
Penalty I Prior Years
I Collection Cost
Total Paid
27.00
0.00
0.00
0.00 1 0.00
1
Ii 0.00
27.00
THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS
I ( THIS BECOMES A TAX RECEIPT This tax is levied for the privilege of doing business within Broward County and is
non -regulatory in nature. You must meet all County and/or Municipality planning
I I WHEN VALIDATED and zoning requirements. This Business Tax Receipt must be transferred when
the business is sold, business name has changed or you have moved the
business location. This receipt does not indicate that the business is legal or that
it is in compliance with State or local laws and regulations.
Mailing Address:
RENE ELECTRIC CORPORATION
5220 SW 5 STREET
PLANTATION, FL 33317
2016 - 2017
Receipt #02C-16700000153
Paid 10/10/2016 27.00
09/30/2016 Effective Date
CERTIFICATE OF INSURANCE ISSUE DATE 2/1/2017
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 CONRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUDER, 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
Accu -Rate Assurance
2619 Davie Blvd.
Ft Lauderdale, FL 33312
INSURER(S) AFFORDING COVERAGE
INSURER A: Penn America Insurance Company
INSURER B: N/A
INSURED
Rene Electric Corporation
5220 SW 5th Street
Plantation, FL 33317
INSURER C: N/A
INSURER D: N/A
INSURER E: N/A
COVERAGES
THIS IS
POLICY
WITH
DESCRIBED
BEEN
TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE
PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT
RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES
HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE
REDUCED BY PAID CLAIMS.
INSR
LTR
TYPE OF
INSURANCE
POLICY
NUMBER
POLICY
EFFECTIVE DATE
POLICY
EXPIRATION DATE
LIMITS
A
General Liability
PAC7122676
8/24/2016
8/24/2017
General Aggregate
$2,000,000
Products-Com/Op Agg.
$1,000,000
Personal & Adv. Injury
$1,000,000
Each Occurrence
$1,000,000
Damage Prem Rented To You
$100,000
Med Expense (Any one person)
$5,000
B
Personal Liability
Combined Single Limit
Medical Payments To Others
C
Excess Liability
Each Occurrence
Aggregate
D
E
Property
Building
Contents
Loss Of Use
THIS INSURANCE IS ISSUED PURSUANT TO THE FLORIDA SURPLUS L NES LAW. PERSONS INSURED BY SURPLUS LINES CARRIERS DO
NOT HAVE THE PROTECTION OF THE FLORIDA GUARANTY ACT TO THE EXTENT OF ANY RIGHT OF RECOVERY FOR THE OBLIGATION OF
AN INSOLVENT UNLICENSED INSURER.
SURPLUS LINES INSURERS' POLICY RATES AND FORMS ARE NOT APPROVED BY ANY FLORIDA REGULATORY AGENCY.
Description of Operations / Specialty Items
Electrical Work within buildings
Certificate Holder
MIAMI SHORES VILLAGE BUILDING DEPARTMENT
10050 NE 2 AVE
MIAMI SHORES, FL 33138
56K'1--1'99
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 Signature/
l
JEFF ATWATER
CHIEF FINANCIAL 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: 2/28/2017 EXPIRATION DATE: 2/28/2019
PERSON: SUAREZ
FEIN: 274436582
BUSINESS NAME AND ADDRESS:
RENE ELECTRIC CORPORATION
RENE
5220 SW 5TH ST
PLANTATION FL 33317
SCOPES OF BUSINESS OR TRADE:
LICENSED ELECTRICAL
CONTRACTOR
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
DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUESTIONS? (850)413-1609
JEFF ATWATER
CHIEF FINANCIAL 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: 3/1/2015 EXPIRATION DATE: 2/28/2017
PERSON: SUAREZ
FEIN: 274436582
BUSINESS NAME AND ADDRESS:
RENE ELECTRIC CORPORATION
5220 SW 5TH ST
PLANTATION FL 33317
SCOPES OF BUSINESS OR TRADE:
LICENSED ELECTRICAL
CONTRACTOR
RENE
Pursuant to Chapter 440.05(14), F.S., an officer of a corporation who elects exemption from this chapter by fling 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 fisted 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
DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUESTIONS? (850)413-1609
Rene Electric Corp.
Lic # EC 13004709
5220 SW 5th St, Plantation
Fort Lauderdale
02/01/2017
State of Florida
County of Miami Dade
Before me this day personally appeared Rene Suarez who, being duly sworn,
deposes and says:
That he will be the only person working on the project located at 75 NE 92" St,
Miami Shores, FL 33138.
Sworn to (orAffirmed) and subscribed before me this -day of -r—e-
2017, by eh.Q. SOO
Printed Name
Personally know
OR Produced Identification S%0 ZO ' Z0 -G'3 - ce01J
Type of Identification Produced nor ick)
Print, Type or Stamp of Notary
s M�RAI K GONZALEZ
MY COMMISSION # GG 044602
,-.��.. '. EXPIRES: November 2, 2020
'• 6g;; „°••- Bonded Thru Notary Public Underwriters
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 Insurance Exemption
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 and has acknowledge that he or she will not use
ay labor ai t-liure employees-orsubcontractors foryourproject. The contractor -has -provided -an -affidavit -stating that he or -she -will
be the only person allowed to work on your project. In these circumstances, Miami Shores Village does not require verification of
workers' compensation insurance coverage from the contractor's company for day labor, part-time employees or subcontractors.
BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS
CONTENT
Signature:
State of Florida
County of Miami -Dade
The foregoing was acknowledge before me this 0 day of 53 , 20 17
By 0117.(.0513 4 21--61-/
Notary:
SEAL:
D2/l�t',2.
who is personally known to me or has produced