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RC-16-1256 (3)Project Address Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795=2204 Permit Permit NO. RC -6-16-1266 Permit Type: Residential Construction Work Classification: Alteration Permit Status: APPROVED Issue Date: 7121/2016 Expiration: 01/17/2017 Parcel Number Applicant 5 NE 105 Street Miami Shores, FL 33138-2030 1121360060090 Block: Lot: GROUP 10 CAPITAL MANAGEMI Owner Information Address Phone Cell GROUP 10 CAPITAL MANAGEMENT, 1680 MICHIGAN AVE Avenue MIAMI BEACH FL 33139- Contractor(s) AJ FULTON CONTRACTORS Phone 6 Cell Phone (305)970-8802 Valuation: $ 76,717.73 Total Sq Feet: 1200 Approved: In Review Comments: Date Approved: : In Review Date Denied: Type of Construction: FULL HOME REMODEL Stories: Front Setback: Left Setback: Bedrooms: Plans Submitted: Yes Certificate Date: Bond Return : Occupancy: Exterior: Rear Setback: Right Setback: Bathrooms: Certificate Status: Additional Info: Classification: Residential Fees Due CCF CO/CC Fee DBPR Fee DCA Fee Education Surcharge Permit Fee Plan Review Fee (Engineer) Plan Review Fee (Engineer) Scanning Fee Technology Fee Total: Amount $46.20 $50.00 $34.53 $34.53 $15.40 $2,301.53 $160.00 $120.00 $39.00 $61.60 $2,862.79 Pay Date Invoice # 07/21/2016 07/06/2016 05/10/2016 Pay Type RC -5-16-59722 Credit Card Credit Card Credit Card Amt Paid Amt Due $ 2,612.79 $ 250.00 $ 50.00 $ 200.00 $ 200.00 $ 0.00 Available Inspections: Inspection Type: Fill Cells Columns Final PE Certification Window Door Attachment Framing Insulation Drywall Screw Window and Door Buck Review Planning Review Structural Review Structural Review Structural Review Electrical Review Electrical Review Building Review Building Review Building Review Mechanical Review Mechanical Review Plumbing Review Plumbing t t Review Plumbing In consideration of the issuance to me of this permit, 1 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. Futhe 4010V1 horize the above-named contractor to do the work stated. Authorized Signatur , •wner / Applicant / Contractor / Agent Building De • artment Copy July 21, 2016 Date July 21, 2016 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 CEIVED FBC 2014° Master Permit No. RC 16- ItS76' Sub Permit No. a. f & f S 3-3 ❑BUILDING ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF CONTRACTOR JOB ADDRESS: 5 21.4 1 05 s [] CANCELLATION ❑ SHOP DRAWINGS City: Miami Shores County: Miami Dade Folio/Parcel#: Is the,B�Historicaily-Designated:,yes Occupancy Type: Load: Construction Type: Flood Zone: BFE: OWNER: Name (Fee Simple Titleholder): cAy.,S e.J o Address: l Q +� 33)3$ NO FFE: Phtiff011 SOS- GI'7a— ggo z City: v��' %in State:7, Zip: Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: B 6 1(kS G C. Address: 1 Q-1 /lJ(- %% COUi�'1` City: a State: eu u4 -U O ? ea d/a s Qualifier Name: State Certification or Registration #: CROW Phone#:30, SOS d 7 Zip: ,�`3S 3 0/ Phone#:,3W 9-20 a/ 73 g 7 7 D Certificate of Competency #: 0000 / tJ 203. DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: $ 'S %/ O 0 Square/Linear Footage of Work: • Type of Work: El Additiot71n Alteration 0 New a �1❑ Repair/Replace 0 Demolition (' Description of Work: �nO\% 6'-` re d( �� +Cc: - 1 Y1S�Cv� ice . bl-- 0-F- 30 f OQ51,w1nn1 ) 1 ft- IC, ;- Y► i is- 113L4 Specify color of color thru tile: ,42" 26 Submittal Fee $ Permit Fee $ _ CCF $ -f"' Scanning Fee $ 3 - A• Radon Fee $ S G DBPR $ 3 2 -- Technology Fee $ e - G 0 Training/Education Fee $ 1 9-0 Structural Reviews $ co/as 9) Notary $ 0 Double Fee $ P Bond $ XJ TOTAL FEE NOW DUE $ 05G "4 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; ha: 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 al applicable laws regulating construction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAl RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTENE 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 mus promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the perso► whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job sits for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice,thl inspection will not be approved and a reinspection fee will be charged. Signature WNER or AGENT Signature The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this S day of 3�, ly , 20 , by day of J._L , by $ -' �a�l�o • is personally know o � �./') &eu s(�� who is personally kno n to me or who has produced identification and who did take an oath. NOTARY PUBLIC: Sign: Print: Seal: M PELEGRIN OMMISSION #FF,1:78894 es EXPIRES November 23, 201 b :407) 385-0153 FloridallotaryService.com as me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: Seal: M PELEGRIN COMMISSION #FF1TERIN ry`Js EXPIRES Nnvwmher 23.2018 1:s98•0I53 FloridallotaryService.com a •#*********************************************************************************R******************ski*## APPROVED BY r s ans Examiner Zoning Structural Review Clerk STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 BERUVIDES, EULALIO I B AND B ELEC., CO 18021 NORTH WEST 77TH COURT HIALEAH FL 33015 Congratulations! With this license you become one of the nearly one million Floridians licensed by the Department of Business and Professional Regulation. Our professionals and businesses range from architects to yacht brokers, from boxers to barbeque restaurants, and they keep Florida's economy strong. Every day we work to improve the way we do business in order to serve you better. For information about our services, please log onto www.myfloridalicense.com. There you can find more information about our divisions and the regulations that impact you, subscribe to department newsletters and learn more about the Department's initiatives. Our mission at the Department is: License Efficiently, Regulate Fairly. We constantly strive to serve you better so that you can serve your customers. Thank you for doing business in Florida, and congratulations on your new license! DETACH HERE RICK SCOTT, GOVERNOR (850) 487-1395 �► STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ER0008778 ISSUED: 09/10/2014 REG ELECTRICAL CONTRACTOR BERUVIDES, EULALIO 1 B AND B ELEC., CO (INDIVIDUAL MUST MEET-ALL;LOCAL LICENSING REQUIREMENTS PRIOR TO CONTRACTING IN ANY AREA) HAS REGISTERED under the provisions of Ch.489 FS. Expiration date AUG 31. 2015 - 11409100002402 , KEN LAWSON. SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD LICENSE NUMBER ER0008778 The ELECTRICAL CONTRACTOR Named below HAS REGISTERED Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2016 (INDIVIDUAL MUST MEET ALL LOCAL LICENSING REQUIREMENTS PRIOR TO CONTRACTING IN ANY AREA) BERUVIDES, EULALIO I B AND B ELEC., CO 18021 NW 77 COURT HIALEAH FL 33015 ISSUED: 09/10/2014 DISPLAY AS REQUIRED BY LAW SEQ # L1409100002402 CTQB Construction Trades Qualifying Board BUSINESS CERTIFICATE OF COMPETENCI 000014282 B AND B ELEC CO D.B.A.: eaoza),67-/tezer BERUVIDES EULALIO 1 Is certified under the provisions of Chapter 10 of Miami -Dade County LUL,LH li bb 1 UA neww pt Miami -Bade County, State of Florida THIS IS NOTA BILL - DO NOT PAY 987488 BUSINESS NAME/LOCATION B AND B ELEC CO 18021 NW 77 CT MIAMI, FL 33015 OWNER B AND:B ELEC CO C/O BERUVIDES EULALi0 Worker(s) r 10 RECEIPT NO. RENEWAL 7488 T' EXPIRES SEPTEMBER 30, 201 Must be displayed at place of busin Pursuant to County Code Chapter SA - Art, 9 & 10 SEC. TYPE OF BUSINESS 196 ELECTRICAL CONTRACTOR 000014282 PAYMENT RECEIVED BY TAX COLLECTOR. 75.00 09/29/2015 0226-15-005888 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 nongcve °amental =egutatory laws and requirements which apply to the business. The RECEIPT NO, above must be displayed on alt commercial vehicles- Miami -Dade Code Se 8a-216. For more information, visit www miamidade.guv/iaxcottector i -Dade County, S A L -DO BUSINESS NAMEtt:OC.fi T :A_D PCom} 18021 'J\ 77 CT OWNER B AND B ELEC CO C/0 BERUVIDES EULALUO RECEIPT NO. 7472954 TYPE OF BUSINESS ELECTRICAL CONTRACTOR EXPIRES METER 30, 2016 Minty Code 10-24 PAYMENT RECEIVED BY TAX COLLECTOR 200.00 09/29/2015 0226-15-005888 This receipt is not valid in the following Muai<cipaf ties; Aventure, Doral, Hialeah, Key Biscayne, Miami Gardens, Miami Lakes, Palmetto Bay, Pinecrest, Sunny isles Beach, Town of Cutler Bay. For more information, visit www.miamidade,govftaxcollector JUL/06/2016/WED 12:03 PM FAX No, P. 001/001 ilk--"TICS-P CERTIFICATE OF LIABILITY ``I-. INSURANCE DATE(MM/DD/YYYY) 07/06/2016 TYPE OF INSURANCE 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 13Y 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. .,. WVD IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the po11Cy(Ics) 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). yy EEFpFF PRODUCER Global Insurance 6175 NW 153st street Suite 100E-MAILoss; Miami Lakes, FL 33014 Phone (305) 512-9721 Fax (305) 512-9889 CONTACT Jessica Menendez NAME: A iPAHrc° No Fxt)' (305) 512-9721 FAX c, No): (305) 512-9980 jessica®glabalinsuranceffa.com GL-76520-1-3 INSURER AFFORDING COVERAGE NAIC it EACH OCCURRENCE INSURER A: Ascendant In CLAIMS -MADE O OCCUR DAMAGE TO RENTED PREMISES (Ee occurrence) INSURED IB and B 810c. Co 18021 NW 77th Court CC#: 000014282 Miami, FL 33015 License#:ER0008778 rnvcoar_,c INSURER B : Ascendant MED EXP (Any one parson) $ 5,000,00 INSURER C: PERSONAL & ADV INJURY $ 1,000,000,00 INSURER D: GENERAL AGGREGATE $ 2,000,000.00 INSURERS: $ 1,000,000.00 MI OTHER INSURER F: _ _J CERTIFICATE NUMBER: 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. R ILTR TYPE OF INSURANCE ADDLSUBR ,1C15R .,. WVD POLICY NUMBER yy EEFpFF POLICYM//YVYy1 LIMITS A M COMMERCIAL GENERAL LIABILITY GL-76520-1-3 _MM/oo/Yyyy 02/1912016 02/19/2017 EACH OCCURRENCE $ 1,000,000.00 In CLAIMS -MADE O OCCUR DAMAGE TO RENTED PREMISES (Ee occurrence) $ 100,000.00 MI MED EXP (Any one parson) $ 5,000,00 mi PERSONAL & ADV INJURY $ 1,000,000,00 GENII_ AGGREGATE LIMIT APPLIES PER: LJ POLICY ❑ PRO-JECT ❑ LOC GENERAL AGGREGATE $ 2,000,000.00 PRODUCTS - COMP/OP AGG $ 1,000,000.00 MI OTHER $ B • AUTOMOBILE LIABILITY • ANY AUTO QOM I3INED SINGLE LIMIT WI aceidant) $ BODILY INJURY (Per person) 5 • AUTOS NED SCHEDULED E AUTOS NON-OWNEb BODILY INJURY (Per accident) $ HIRED AUTOS ■ AUTO$ PROPERTY DAMAGE (Per accident) 5 ❑' fl • UMBRELLA LIAR OCCUR EACH OCCURRENCE • EXCESS LIAB • CLAIMS -MADE AGGREGATE $ $ nSL DED I RETENTION $ $ VVUKnt'(a UUIVIYCIVU auIIIV AND EMPLOYERS' LIABILITY y / N ANY PROPRIETOR/PARTNER/EXECUTN OFFICER/MEMBEREXCLUD(=D? (Mandatory In NH) f yes, describe under DESCRIPTION OF OPERATIONS below N/A WC -125862 01/23/2016 01/23/2017 rC V STATUTE 1 I ER ' E.L. EACH ACCIDENT $ 1,000,000.00 E.L. DISEASE - EA EMPLOYEE $ 1,000,000.00 E.L. DISEASE - POLICY LIMIT $ 1,000,000.00 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Electrical Contractor Licensis# ER0008778 CERTIFICATE HOLDER ,..-..,._.. __._-. Miami Shores V(Ilaga Building Department 10050 NE 2nd Ave Miami Shores, FL 33138 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 Deeiger-r-f 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD