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EL-17-2791 Miami Shores Village N 2 y 26 y Building Department BY: 10050 N.E.2nd Avenue,Miami Shores, Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 "�} INSPECTION LINE PHONE NUMBER:(30S)762-4949 —� k FBC 20tq BUILDING Master Permit No -A r1 — PERMIT APP (CATION Sub Permit No. ,BUILDING ELECTRIC ROOFING ❑ REVISION ❑ EXTENSION ORENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS [:] CHANGE OF ❑ CANCELLATION ❑ SHOP 1 CONTRACTOR DRAWINGS• JOB ADDRESS: City: Miami Shores County: Miami Dade Zip 3313 Y Folio/Parcel#: (P" C] y— d O Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name(Fee Simple Titleholder): a Phone#: Wco zl�' Address: p �r Aja City: State: Zip: Tenant/Lessee Name: Phone#: Email: ,1 /J CONTRACTOR:Company Name: XAfD%26V /y_ sem, �-/�G� Phone#: Address:,7, Silnl /¢ r—f10'03-_ �D.tiA.��o Q � State: ��• 3.3wggy City: Zip:Q �y Qualifier Name: TD5•F• /T�1��/Z Phone#:�/ �,.�� //me State Certification or Registration#:_ C#®�Q/.2 tF7 Certificate of Competency#: T f, DESIGNER:-Architect/Engineer: -Phone#: Address: City: State: Zip: Value of Work for this Permit:$ too 00 Square/Linear Footage of Work: Type of Work: ❑ Addition Alteration ❑ New ❑ Repair/Replace ❑ DJemolition Description of Work: Nt LJ DkGyVd 7,00 a h SpedcIQL, r 'i" rilil, .E.., u +vrir#YHyry vp ,..3 Submittal Fee$ .�:. Permit Fee$A- CCF$ CCO'CC$ Scanning Fee$ Radon Fee$ 2DBPR$ Notary$�7 E " Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ 6• {(7� (Revised02/24/2014) Bonding Company's Name(if applicable) BondinglCompany'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 tht a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is sutij t to attachment. Also,a certified copy of the recorded notice of commencement must be posted at the job site for the first inspect' hich occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not proved and a reinspection fee will be charged. Signature Signature NER or AGENT CONTRACTOR The Rr of g i strum nt was acknowledged before me this The foregoing instrument was acknowledged before me this a of VL�De� 20 �� by day of �ToB�2 20 7 by r. 1 NW4��4 ,who is personally 4knogwn oo �49� /��d�� who is personally known to me or who has produced tL_ CA-(75C-0 a7 me or who has produced as identification and who did take an oath. identification and who did take an oath. NOTARY PU IC: NOTARY PUBLIC: Sign: Sign: C Print: Print: U.SILVEIRA r vie Notary Public State of Florida `'a� Notary Public 1a e o on a Seal: :' Seal: ��orgmis�iR�45,E 0;#fJJlda Sindia Alvarez 2a } o` My Commission FF 156750 •r Mgt t oFc�o� Expires 09/0312018, y _ a y4410` APPROVED BY lans Examiner Zoning Structural Review Clerk (Revised02/24/2014) Permit NO. EL-11-17-2791 Miami Shores Village Et Permit Type:Electrical -Residential s`* 10050 N.E.2nd Avenue NE er r... � Work Classification:Service Change Miami Shores,FL 33138-0000 Phone: (305)795-2204 Permit Status:APPROVED F�OR4DA issue oate.1/2212018 Expiration: 07/21/2018 Project Address Parcel Number Applicant 575 NE 95 Street 1132060140760 Miami Shores, FL Block: Lot: THOMAS N CONWAY Owner Information Address Phone Cell THOMAS N CONWAY 575 NE 95 Street (786)218-2757 MIAMI SHORES FL 33138- 575 NE 95 Street MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone Valuation: $ 4,500.00 ANDREU &ASSOCIATES INC (954)943-7032 (954)254-9918 �. n. Total Sq Feet: 0 Type of Work:NEW ELECTRICAL PANEL 200 AMP, 18 RE Available Inspections: Additional Info: Inspection Type: Classification:Residential Review Electrical Scanning: 1 Fees Due Amount Pay Date' Pay Type Amt Paid Amt Due CCF' $3.00 Invoice# EL-11-17-65739 DBPR Fee $3.38 01/22/2018 Credit Card $ 196.63 $50.00 DCA Fee $2.25 Education Surcharge $1.00 11/27/2017 Credit Card $50.00 $0.00 Notary Fee $5.00 Permit Fee-Additions/Alterations $225.00 Scanning Fee $3.00 TechAology Fee $4.00 Total: $246.63 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 i strict conformity with the plans,drawings,statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I sume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for EJFA TRI/ L,PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work. OWNERS-A� IT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construc``ion a z"ni . Futhermore,I authorize the above-named contractor to do the work stated. 6"1 / January 22, 2018 i A ho zed Si ature:Owner / Applicant / Contractor / Agent Date Buil i g Department Copy January 22, 2018 1 Kllit�Jt,V 1 1, UVVCKIVVK DCIV LNVVJVIV,JCI.KCl/iKT F`y STATE OF FLORIDA f DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ';• _ ELECTRICAL CONTRACTORS LICENSING BOARD �^ fi d E00001257• � ��., ... a .>x,,�• . � ,�. ` The ELECTRICAL CONTRACTOR Named below IS.CERTIFIED- VM - Under the provisions-of Chapter 489 FS. "• `~ "�' � :Expiration'date:,.AUG 31;2018,-- ;' w"' Y s+r„''�"+�`✓'..- r''{"�._. d"' v. ... "'..�� `7,,,,..., r"••y'w •'» ti :y -•,y, �\•'� ,`c�,5�' �'kt °' .,r"' �,,..M^.a.,�'-^ ,..r' .r' ..... .«- � ,� a`�+1� }�..`+� '.,.;�,y � ..,*, any ❑ ,� . �` -AREU;JOSE'---- �OE�r�s• '. '•s.. S 4r l ZNDANDREU-iASSO,CIATESdINC _n. w27,5 SW 14THAVENUE�- - POMPANO-BEACH', FL'33069 ', Ll ZL " ISSUED: 06/26/2016 DISPLAY AS REQUIRED BY LAW SEQ# L1606260001501 . t r __7 p m ano� k 9beaoh , Florida's Warmest Welcome CITY,OF POMPANO BEACH BUSINESSTAX.RECEIPT y_ _ FISCAL YEARS 2017- 2018 t THIS IS`NOTA BILL Business Tax Receipt Valid from. October 1, 2017, through September 30;2018 9/,19/2017 0027700 € ANDREU&ASSOCIATES INC 275,SW`14 AVENUE POMPANO BEACH FL 33069 THIS IS YOUR BUSINESS TAX RECEIPT. PLEASE POST INA CONSPICUOUS PLACE AT THE t7 _ BUSINESS LOCATION. .BUSINESS OWNER: ANDREU, JOSE QUAL BUSINESS LOCATION: 275 SW 14 AV 200 POMPANO.BEACH FL RECEIPT NO: CLASSIFICATION 4 18-00000550 CONTRACTOR ELECTRICAL. (CME) 18-00037367 s CONTRACTOR ELECTRICAL (CME) B i�_PM�� y..... .. r.Mr ..,.. .�.- . u ..r3. .0 .. E' ai - - ..t�--, �� Tp......• ^C54 r.� - I NOTICE: ANEW APP LICATON MUST BE FILED IF THE BUSINESS NAME;OWNERSHIP OR ADDRESS 19 CHANGED.-THE ISSUANCE OF A - BUSINESS TAX RECEIPT.SHALL NOT BE DEEMED A WAIVER OF ANY PROVISION OF THE CITY CODE NOR SHALL THE ISSUANCE OF A BUSINESS TAX.RECEIPT BE CONSTRUED'TO.BE A JUDGEMENT OF THE CITY AS TO THE COMPETENCE OF THE APPLICANT TO TRANSACT BUSINESS.,THIS DOCUMENT CANNOT BE ALTERED. BUSINESS TAX RECEIPTS EXPIRE SEPTEMBER 30TH OF EACH.YEAR co CERTIFICATE OF LIABILITY INSURANCE 10/3/22017017DATDMW) 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 CONTRACT BETWEEN THE ISSUING INSURER($), 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 NAME: Bateman Gordon and Sands Exum954-941-0900 w No 95�9�1�20.0.6 3050 North Federal Hwy E-MAIL Lighthouse Point FL 33064 A _______INSURERMAFF0RDING COVERAGE NAIC# INSURER A: at(O.I]aL[M$t(LLSULaaoe C_oMp 0 INSURED ANDAS INSURER 8'ECCLI.osUt_aIce_COL' pa Q'LZ8 Andreu&Associates, Inc. INSURER c s (Sto�e�latiOlaLins Corbpa 5496 275 S.W. 14th Avenue INSURER D: Pompano Beach FL 33069 INSURER E: I INSURER F COVERAGES CERTIFICATE NUMBER:1251835775 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 ADDL SUBR.. _ POLICY EFF POLICY EXP r LIMITS LTR TYPE OF INSURANCE N INVD POLICY NUMBER ! Ma910D MM I A GENERALLIABILITY Y Y GL00116917 13/31/2017 3/31=18 1 EACH OCCURRENCE 51,000.000 N COMMERCIALGENERALLIABILITY PREMISES�E�accunonce $100,000 CLAIMS-MADE 171 OCCUR MED EXP Any one porson $5,000 500 PERSONAL&ADV INJURY $1,000,000 _ GENERAL AGGREGATE $2.000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOPAGG $2,000,000 X POLICY PRO- 7 LOC $ B AUTOMOBILE LIABILITY Y y CA10001111801 3/31/2017 3/31/2018 Eaacddent 1$ 000.000 X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Par accident) S AUTOS AUTOS NO 4 PROPERTY DAMAGE HIREDAUTOS X AUTOS I Peracddont S B X UMBRELLA LWBOCCUR Y Y UMB00122087 3/31/2017 3/312018 EACH OCCURRENCE $2.000,000 EXCESS LJAB HCLAIMS-MADE t i AGGREGATE $2,000,000 X .NSO ' $ WORKERS COMPENSATION WC STABS OT_AND EMPLOYERS LIABILITY YIN ANY PROPRIETORIPARTNERIEXECUTIVE[—� N!A E.L.EACH ACCIDENT S OFFICERIMEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE S Ityes describe under !DESCRIPTION OF OPERATIONS below :E L.DISEASE-POLICY LIMIT S C Excess-Follow Form Y Y 758431173ALT ,3/312017 3/31/2018 Limit(xs$2,000,000) $3,000,000 B Rented/Leased Equipment CM00060127 31312017 3/312018 Limit:$5,000 Deductible$1,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICI ES(Attach ACORD 901,Additional Romarks Schodulo,N tnom sPaco Is roqulrod) General Liability: Blanket Additional Insured including for On-going and Completed Operations and Primary and Non-Contributory,as required by written contract,per FORM CGL084 1013;Blanket Waiver of Subrogation,as required by written contract,per FORM CGL0004 0510; Additional Insured Per Project Aggregate(Scheduled),as required by written contract,per FORM CGL005 0299. Automobile Liability: Blanket Additional Insured,as required by written contract,per FORM CA0003-FL 1208; Blanket Waiver of Subrogation, as required by written contract,per FORM CAU014 0404(Scheduled);Primary and Non-Contributory,as required by written contract,per FORM CAU082 0115. See Attached... CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Miami Shores Village Building Department THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 10050 NE 2ND AVE ACCORDANCE WITH THE POLICY PROVISIONS. Miami Shores FL 33138 AUTHORIZED REPRESENTATIVE I ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID:ANDAS _ LOC M A©® ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY NAMEDINSUREO Bateman Gordon and Sands Andreu&Associates, Inc. 275 S.W. 14th Avenue POLICY NUMBER Pompano Beach FL 33069 CARRIER NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE Umbrella Liability:Blanket Additional Insured,as required by written Contract per C00001 1207; Umbrella/Excess Liability policy extends coverage to General Liabil' Automobile Liability and Workers Compensation/Employers Liability. ALL COVERAGES SL -:E -T TO THE POLICY TERMS,CONDITIONS AND EXCLUSIONS Re: Electrical Contractors license number:#1257 i ACORD 101 (2008109) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ANDRE-2 OP 1 •N '4�oRD CERTIFICATE OF LIABILITY INSURANCE DATE 1010312017 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 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 have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WANED,subject to the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer ri hts to the certificate holder In lieu of such endorsemen s. PRODUCER 561-392-3300 c ACT Workers Compensation Group Workers Compensation Group PHONE561-392-3300 1 FAX 561-361-1132 P O Box 410 (Arc.No.Ext).. {AIC,No Boca Raton,FL 33429-0410E ss cer�@wor erscompgroup.com Workers Compensation Group 1NSU AFFORDING COVERAGE NAIC it INSURER A:Associated Industries Ins Co 123140 INSURED Andreu&Associates,Inc. B 275 S.W.14th Avenue INSURER Pompano Beach,FL 33069 INSURER C: INSURER D INSURER E INSURER F: COVERAGES 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. !NSR TYPE OF INSURANCE IODL Sl1BR POLICY NUMBER POLICY EFF POLICY EXP LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S CLAIMS-MADE [--]OCCUR DAMAGE TO RENTED SES iEa $ MED EXP one S PERSONAL&ADV INJURY S GEMLAGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE S AT� POLICY u JECT F-1LOCPRODUCTS-COMPIOPAGG S OTHER' S AUTOMOBILE LIABILITY I COMBINED tSINGLE LIMIT S ANY AUTO BODILY INJURY PerPerson) S _ OWNED SCHEDULED AUTOS ONLY AUOoTOS EEpp BODILY INJURY PeraCOdent S AUTOS ONLY AUTlJS ONLYOa E�Rdt MAGE S � is I UMBRELLA LIAB OCCUR EACH OCCURRENCE S EXCESS LWB CLAIMS-MADE !AGGREGATE S DEC) RETENTION S I A WORKERS COMPENSATION wPER OTH- AND EMPLOYERSLIABILITY ' ANY PROPRIETORJPARTNERIEXECUTIVE Y('""I' . �AWC1087522 08/05!2017 OE/05/2015 EL EACH ACCIDENT $ 1'000'000 FFICER/MEMBER EXCLUDED? �_ N I A �Manrlatory in NF1) 1,000,000 L.DISEASE-EA EMPLOYE S If yes,describe under E. DESCRIPTION OF OPERATIONS belowI EL.DISEASE-POLICY LIMIT S 1,000,000 I S DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Scbodule,may ba attacbad If mom spat*Is roqulrod) Electrical Contractors e CERTIFICATE HOLDER CANCELLATION MIAMIS3 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Village of Miami Shores THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN g ACCORDANCE WITH THE POLICY PROVISIONS. Fax:305-756-8972 10050 NE 2nd Ave. Miami Shores,FL 33138 AUTHORIZED REPRESENTATIVE ACORD 25(2016103) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD