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EL-17-1511 t Permit No. EL-6-17-1511 Miami Shores Village t Permit Type:Electrical -Residential tom ' I 10050 N.E.2nd Avenue NE Miami Shores,FL 33138-0000 Work Classification:Alteration Permit Status:APPROVED Phone: (305)795-2204 CORIOp Issue nate:7i512017 Expiration: 01/01/2018 Project Address Parcel Number Applicant 1135 NE 100 Street 1132050340050 Miami Shores, FL 33138- Block: Lot: THOMAS WENSJOE Owner Information Address Phone Cell THOMAS WENSJOE 1135 NE 100 Street MIAMI SHORES FL 33138 Contractor(s) Phone Cell Phone Valuation: $ 2,000.00 LS CURTIS INC (305)892-6501 - - Total Sq Feet: 0 N Type of Work:3 SWITCHES 8 HI HATS RELOCATE LIGHT Available Inspections: Additional Info: Inspection Type: Classification:Residential Scanning: 1 Review Electrical Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $1.20 DBPR Fee Invoice# REV-6-17-64240 $2.25 07/05/2017 Credit Card $ 160.70 $0.00 DCA Fee $2.25 Education Surcharge $0.40 Permit Fee-Additions/Alterations $150.00 Scanning Fee $0.00 Scanning Fee $3.00 „ Technology Fee $1.60 Total: $160.70 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 a t foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction a oni thermore a above-named contractor to do the work stated. July 05, 2017 Authorize gn ure: / Applicant / Contractor / Agent Date Building epa ment Copy July 05,2017 I 1 C ` Miami Shores Village RECEIVED Building Department JUN 071017 10050 N.E.2nd Avenue,Miami Shores, Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 S '� FFBC 20 t BUILDING Master Permit No. PC 1(a `" PERMIT APPLICATION Sub Permit No. . BUILDING ❑X ELECTRIC ❑ ROOFING REVISION ❑ EXTENSION RENEWAL PLUMBING ❑ MECHANICAL PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS 106 ADDRESS: 1135 NE 100 Street City: Miami Shores' County: Miami Dade Zip: 33138 Folio/Parcel#: 11-3205-034-0050 Is the Building Historically Designated:Yes NO Occupancy 4ype: Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): Monica Kulsich &Thomas WeniQe _ Phone#: 786-478-1989 Address: 1135 NE 100 Street City: Miami Shore State: FI Zip: 33138 Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name: L S Curtis Phone#: 305-933-0683 Address: 20341 NE 30 Ave 108 City. Aventura State: FI Zip: 33180 Qualifier Name: Lewis Curtis Phone#: 305-933-0683 State Certification or Registration#: EC0003175 Certificate of Competency#: DESIGNER:Architect/Engineer:' Phone#: Address: City: State: Zip: Value of Work for this Permit:$ 2000. Square/Linear Footage of Work: Type of Work: ❑ Addition( ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of work: 3 switches, 8 Hi Hats, Relocate lights, Install GFCI by vanity as per code Specify color of color tI ru tile: Submittal Fee 1 Permit Fee$ Y0,00 CCF$ CO/CC$ Scanning Fee$ Radon Fee$ 2- a-S DBPR$ L Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ f TOTAL FEE NOW DUE$ (Revised02/24/2014) 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, HEATERSJANKS,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. Si ture Signature Y-OWNkor ENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this 6 ppday of ��ti' E 20 �� by 05 day of June 120 17 by TkoNA-S GOrNSJOV who is personally known to _�_�i�/.v�/S who is own to ,me or who has produced as me or who has produced as identification and who did take an oath. identification and who did take an oath. I NOTARY PUBLIC: NOTARY PUBLIC: i Sign: Sign' VADOANDRA NE881A Print: Print: �'s Notary Public- ° tdotary PuMk gtate o4 Florida Commission 9 FF 979238 Seal: Seal: My Comm.Expires Jul 25,2020 Comnd�ttion* ���� � Bonded through National Notary Assn. ' My COOT.Ettphat 1,.2020 APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revisedo2/24/2014) STATE OF FLORIDA ,,F01i �r➢", W �G DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION . ` ELECTRICAL CONTRACTORS LICENSING BOARD (850) 487-1395 { x ✓J 1940 NORTH MON ROE STREET. TALLAHASSEE FL 32399-0783 CURTIS, LEWIS STEVEN L.S. CURTIS INC 20341 NE 30TH AVE APT 108 AVENTURA FL 33180 r. '..,g-+e+,r.aiw-_-e•'a�*+ ._.«R '-'==-a, ^raw,d'.e^'1+'+wi t. Cor3gratulati6nsl With this license you become one of.the neatly one million Floridians licensed b the De artment of Business:and Professional Regulation. Our professionals and businesses range STATE-OF,FLORIDA from architects to yacht brokers,from boxers to barbeque, i s ," F, DEPARTMENTOFx.BUSINESS AND restaurants;and they keep Florida'seconomy strong: # r :: ;'', PRbF,ESSIONAL"REGULATION Every day we work to improve'the'way we do business in order t't •,•EC0003175 '`SSUED06123/2016 ; to serve you better. For information about our services, please log onto www.myfloridalicense.com. There you can find more CERTIFIED ELECTRICAL=CONTRA,TOR information about our divisions and the regulations that impact r CURTIS, LEWIS STEVEN' S. you;subscribe to department newsletters and learn'more about t' L:S-CURTIS INCA 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 x IS CERTIFIED under the p ov sions of Ch:AB$ FS.-. ' serve your customers. Thank you fordoing business in Florida, t _ , E310' tin date:'AUG 37,2098 Uo[ 39vt)9113-• and congratulations on your new license! .�.._ .• - DETACH HERE. RICK SCOTT, GOVERNOR KEN LAWSON, SECRETARY STATE 0'F FLORIDA DEPARTMENT OF:BUSINESS AND PROFESSIONAL REGULATION ,. ELECTRICAL CONTRACTORS LICENSING BOARD ' i f, (:C0003175 "' S " The ELECTRICAL CONTRACTOR k ` -Named below IS CERTIFIED Under the proVisions of.Chapter-489•FS, n Ex piration-date::AUG 31;,2018k _ q ft. x CURTIS;,LEWIS STEVENL:S."CURTIS INC 20341-'NE 30TH AVE#108a . L `� A` AVENTURA, FL 33180 b �J.,•".•�,F� r ...w „.��'yp,:.� � ,��' 'eye•ea•..,. ^�C -�„ vyny w� '��9.. °�, � ll�i 4 � W,1, �..,_m g, ISSUED: 06/23/2016 DISPLAY AS REQUIRED BY LAIN SE # L1606230001113 001467 Local Business Tax Receipt Miami.-Dade County, State of Florida -THIS IS NOTA'BILL—DO NOT PAYTj 5108006 LB . , BUSINESS NAME11.06ATION RECEIPT NO. y E?(PIRES L S CURTIS,INC RENEWAL SEPTEMBER,30, 2017 20341 NE 30 AVE 10$ 2427060 Must lm fisplayed'at place of business AVENTURAIL133180 Pursuant.to County Code Chapter 8,A-Art.9&10 OWNER SEC:TYPE OF BUSINESS PAYMENT RECEIVED L S CURTIS INC 136 ELECTRICAL CONTRACTOR BY TAX coi.t.ECToR ECO003175 Worker{s} 1 $45.00 07/1,2/2016: 'CREDITCARD-16-035366 This Lucal Business Tax Receipt only confirms payment of ilia Local Business Tax.The Receipt is not a license, panttit,oris cortificationof the Folder siluulilications,to do business. Holder must comply with any governmental, or nongovertunwital regulatory lows and requirements which apply to,,the business. ' The RECEIPT NQ above must be displayed on all commercial vehiclas-Miand-Dano Code See 8a-276. For mereinformation,visit www.miamidade.uov�IoA-�-ojlt)stQr " ACO I DATE(MM/DD/YYYY) - CERTIFICATE OF LIABILITY INSURANCE 12/27/16 THIS CERTIFICATE IS ISSUED ASA 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(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 STACY PARKS NAME: Insurance Industries a ANL Ext• (305)891-2808 FAX No): (305)891-6367 953,N.E.125th St. stacy@insuranceindustriesinc.com N.Miami,FL 33161 INSURERS AFFORDING COVERAGE NAIC# Phone (305)891-2808 1 Fax (305)891-6367 INSURERA: ARCHsSPECIALTY INSURANCE COMPANY INSURED f INSURER B: MERCURY INSURANCE COMPANY L S CURTIS INC. INSURER C: UNITED STATES LIABILITY INSURANCE COMPANY 20341 NE 30 Ave #108-6 INSURER D: AVENTURA,FL 33180- (305)892-0115 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. INSR TYPE OF INSURANCE ADD UB POLICY NUMBER MM/DD/Y7EYYY MM/DDS LIMITS LTRIN R GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000.00 DAMAGE TO RENTED 1 00,000.00 COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ F—] ❑ CLAIMS-MADE YJ OCCUR AGL0043614-001778310 MED EXP(Any one person $ 5,000.00 A Y Y 12/09/2016 12/09/2017 PERSONAL&ADV INJURY $ 1,000,000.00 e ❑ I GENERAL AGGREGATE $ 2,000,000.00 GEN'L AGGREGATE LIMIT APPLIES PER:I PRODUCTS-COMP/OP AGG $ 2,000,000.00 ❑ POLICY W PRO- ❑ LOC $ IN AUTOMOBILE LIABILITY Ea accciidentSINGLE LIMIT $ 1,000,000.00 ❑ ANY AUTO BODILY INJURY(Per person) $ B w ALL AUTOS OWNED ❑ SCHE ULED Y Y BA090000008429 04/20/2016 04/20/2017 BODILY INJURY(Per accident, $ UTOHIRED AUTOS yj NON-OWNEDAUTPROPERTY DAMAGE $ Per accident ❑ ❑ $ ❑� UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 2,000,000.00 EXCESS LIAB XL1574975 C ❑ ❑CLAIMS-MADE Y Y 10/26/2016 10/26/2017 AGGREGATE $ 2,000,000.00 ❑ DED ❑ RETENTION$ $ WORKERS COMPENSATION ❑WCRSTATULIM - ❑OTRH- AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIV❑ E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below 1 E.L.DISEASE-POLICY LIMIT $ l DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space is required) ELECTRICIAN:scheduled auto:2008 lexL es350.blanket additional insured.waiver of subrogation.Additional Insured/Certificate Holder: CERTIFICATE'HOLDER IS LISTED AS ADDITIONAL INSURED CERTIFICATE HOLDER CANCELLATION 4 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE MIAMI SHORES VILLAGE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN I ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE 2 AVE MIAMI SHORES,FL.33138 AUTHORIZED REPRESENTATIVE , ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105)QF + The ACORD name and logo are registered marks of ACORD MEN DATE(MNVDD/YYYY) CERTIFICATE OF LIABILITY INSURANCE R022 3/31/2017 THIS CERTIFICATEIS 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(ies)must have ADDITIONAL INSURED provisions or 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: AUTOMATIC DATA PROCESSING INS AGCY PHONE FAX AJL 250717 P: F: ADDRESS: PO BOX 33015 INSURER(S)AFFORDING COVERAGE NAIL# SAN ANTONIO TX 78265 INSURER A: Twin City Fire Ins Co 29459 INSURED INSURER B: INSURER C: L. S. CURTIS INC. INSURER D: 20341 NE 30TH AVE APT 108 INSURER E: AVENTURA FL 33180 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. IN.SR TYPEOFINSURANCE ADDL SUBR POLICYNUMBER POLICYEFF POLICYEXP LIMITS MM/DD/Y COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE ❑ PREMI OCCUR DAMAGE TORENTED PREMISES(Ea occurrence) $ MED FRCP(Any one person) $ PERSONAL 8 ADV INJURY g GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY PRO LOC PRODUCTS-COMP/OP AGG $ JECT OTHER: COMBINED $ AUTOMOBILE LIABILITY (Ea accident)NGLE LIMIT $ ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) S AUTOS ONLY AUTOS I HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY I (Per accident) $ S UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMS-MADE AGGREGATE $ $ DED RETENTION$ WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE YIN E.L.EACH ACCIDENT $1, 000, 000 OFFICERIMEMBER EXCLUDED? N/A A (Mandatory in NH) ❑ 76 WEG TR4954 05/01/2017 05/01/2018 E.L.DISEASE-EA EMPLOYEE $1, 000, 000 If yes,describe under E.L.DISEASE-POLICY LIMIT $1, 000, 000 DESCRIPTION OF OPERATIONS below I DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Those usual to the Insured' s Operations. License #EC0003175 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE Miami Shores Village DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Building Department AUTHORIZED REPRESENTATIVE 10050 NE 2ND AVE MIAMI SHORES, FL 33138 ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD