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EL-18-476 Permit NO. EL-2-18-476 �ewo'tEs L,� Miami Shores Village Permit Type:Electrical-Residential Fns't 10050 N.E.2nd AvenueNEil ! Work Classification:Alteration Miami Shores,FL 33138-0000 Per . yFN �,o Permit-Status:APPROVED Phone: (305)795-2204 COR'WA Issue Daw 3/112,018 Expiration: 08/28/2018 Project Address Parcel Number Applicant 10666 NE 10 Court 1122320280910 F-1 PERFORMANCE LLC Miami Shores, FL 33138- Block: Lot: Owner Information Address Phone Cell LF' -1 PERFORMANCE LLC 530 N SHORE Drive (786)302-8768 MIAMI BEACH FL 33141- 530 N SHORE Drive MIAMI BEACH FL 33141- Contractor(s) Phone Cell Phone Valuation: $ 100.00 A.T. ELECTRICAL CONTRACTORS IM (786)499-5249 w M.. Total Sq Feet: 0 Type of Work:ELECTRICAL FOR RENOVATION OF MASTER Available Inspections: Additional Info: Inspection Type: Classification:Residential Review Electrical Scanning: 1 k b t t Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $0.60 DBPR Fee Invoice# EL-2-18-66563 $2.25 03/01/2018 Credit Card $ 163.85 $0.00 DCA Fee $2.00 Education Surcharge $0.20 Not Fee $5.00 Permit Fee-Additions/Alterations $150.00 Scanning Fee $3.00 Technology Fee $0.80 Total: $163.85 r 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 ning. Futhermore, I authorize the above-named contractor to do the work stated. March 01, 2018 Athor' gnature:Owner / Applicant / Contractor / Agent Date Buildi g Department Copy March 01, 2018 1 r \� Miami Shores Village Building Department l � g p �L9 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 & FBC 26-1 -7 BUILDING Master Permit No. 9G1 1� 3 PERMIT APPLICATION Sub Permit No. � ❑BUILDING ",ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS CHANGE OF ❑CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS I � JOB ADDRESS: 10666 NE 10 COURT City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: 11-2232-028-0910 Is the Building Historically Designated:Yes NO X a Occupancy Type: SFR Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder):F-1 PERFORMANCE LLC (JOHN BOWES)phone#:786-302-8768 Address:530 N SHORE DR City: MIAMI BEACH State: FL Zip: 33141 i Tenant/Lessee Name: NA Phone#: Email: JBOWES.F1@GMAIL.COM A.T. Electrical Contractors, Inc. 786-499-5249 CONTRACTOR:Company Name: Phone#: Address: 16000 NW 45 Ave City: Miami Gardens � state: FL Zip: 33054, Qualifier Name: Mario J Daisson Phone#: 786-499-5249 State Certification or Registration#: EC 13005120 Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: i Value of Work for this Permit:$ 3� `C� Square/Linear Footage of Work: Type of Work: ❑ Addition ❑■ Alteration ❑ New Repair/Replace ❑ Demolition Description of Work: 1 !C C.Mt 4L_ JoO Specify color of color thru tile: Submittal Fee$ Permit Fee$ `11��r00 CCF$ CO/CC$ 1 Scanning Fee$ Radon Fee$ w 7,k-s DBPR$ Notary$ k Technology Fee$ Training/Education Fee$ Double Fee$ i Structural Reviews$ Bond$ - TOTAL FEE NOW DUE$ ITr�G (Revised02/24/2014) I 1 I 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. I I r "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$1500, 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 sted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absent of such posted notice, the 'inspection will not be approved and a reinspection fee will be charged. h��Signature Signature OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this Cday of r\ I��(`+� 20 by day of ✓RJ✓ 20 le by �OH ��1W'w ,who oiispepersonally ykknown to /L141.0 T '041 O�� who is personally known So me or who has produced y" as ane or who has produced as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: ��N►►111 tN� J �U►unitutb Sign: F2'% Sign: �` -TA- .'S' `a•• arc ��•• �' •.� ' Print: =`�• �`%: :_ Print: , r 54- fires g � ' m'm= — November 30,2021 Seal:- •• ? �� s o �e Seal: No.GG 1644B4 fIt1111 APPROVED BY p Plans Examiner Zoning I C Structural Review Clerk I '(Revised02/24/2014) F k SHORES k �1 ANG 1932 Sol J ..,..M Miami shores Village Building Department* r �IORiDP' 10050 N.E.2nd Avenue k Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax:'(305) 756.8972 CONTRACTORS' REGISTRATION IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: COPY OF QUALIFIER'S STATE LICENCES (B� COPY OF LOCAL BUSINESS TAX RECEIPT '(C COPY OF LIABILITY INSURANCE* 1COPY OF WORKERS COMPENSATION INSURANCE* (Workers Compensation EXEMPTION must have NOTICE TO OWNER form and Contractor Affidavit) i { IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY: A. COPY OF CERTIFICATE OF COMPETENCY OF QUALIFIER B. COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF STATE REGISTERED CONTRACTOR LICENSE OR MIAMI DADE COUNTY MUNICIPAL f CONTRACTOR'S TAX RECEIPT. D. COPY OF LIABILITY INSURACE* E. COPY OF WORKERS COMPENSATION INSURANCE* (Workers Compensation EXEMPTION must have NOTICE TO OWNER form and Contractor Affidavit) *YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE AS FOLLOW: Certificate Holder: MIAMI SHORES VILLAGE BLDG DEPT j 10050 NE 2ND AVE MIAMI SHORES,FL 33138 Certificate must specify the description of operations or contractor license number. 1 BUSINESS NAME: t � �T�G�-- ��jyp' i�QRS , - �✓ BUSINESS ADDRESS: J� �W 4S— MJ CITY -6A- --VSSTATE ZIP BUSINESS PHONE: ( �) ���� FAX NUMBER( ) CELLPHONE( QUALIFIER'S NAME: I� A'(�Lb �A��So�•1 QUALIFIER'S LIC NUMBER: 1 Ut IAL:I-I HtKt r RICK SCOTT, GOVERNOR -KEN LAWSON, SECRETARY_. �-.. `".. STATE OF EFLORID ` _.._ �'!•.. DEPARTMENT- _,..r._._ �- -.�._ _�. 4''`a. .. . LATI"``�., � _ ENT-OF,BUSINES SA,Q'PROFESSIONACREGUON —ELECTRICAL CONTR ,ACTORS�CICENSING.BOARD N�� —The°ELECTRICAL-CONTRACTOR---"`.-- `,„ ... .,�� =ter-,.. ,. o Named below IS CERTIFIED-,--- - ", -' Un eir.the prOVW6nsof ChaPter_489+S*'1- -, Ezpiration'date:,-AUG.31`2018 "Z" l �`'�_.t . "� �-• D'AISSON;.MARIO�,1 � i- ❑ ❑ A T.;ELECTRICAL.CONTRACTORS INC. ..� X16000 NW;45"AVE - Y MIAMI GARDENSF;L33054� orr ' ' ISSUED: 07/05/2016' DISPLAY AS REQUIRED BY LAW SEQ# L1607050002133 9 005031 Local Business Tax Receipt Miami-Dade County, State of Florida -THIS IS NOT A BILL-DO NOT PAY 7078090 BUSINESS NAME/LOCATION RECEIPT NO. EXPIRES AT ELECTRICAL CONTRACTORS INC RENEWAL SEPTEMBER 30, 2018 16000 NW 45 AVE s 7355928 Must be displayed at place of business MIAMI GARDENS FL 33054 :: Pursuant to County Code Chapter SA-Art.9&10 OWNEFt SEC'TYPE'OF'BUSINESS PAYMENT RECEIVED A T ELECTRICAL',CONTRACTORS INC, _196 ELECTRICAL CONTRACTOR av rax COLLECTOR - - 1 EC13005120 j •'" ' Worker(s) f i $45.00 07/26/201.7. CREDITCARD=17-050352 This Local Business Tax Receipt only confirms payment of the Local Business Tax.The Receipt is not a Ilcense, permit,or a certification of the holder's qualifications,to do 6usineas..Holder moat comply with any govermentel f or nongovernmental regulatory laws end requirements which apply to the business. f 1 i Z --The RECEIPT N0.above must be displayed on9all commercial vehicles-Miami-Dade Code Sec Ila-276. _ . ' �.. For more info,�rmation,visit � 1 I DATE(MM/DD/YYYY) ,aco CERTIFICATE OF LIABILITY INSURANCE 112/19/2017 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 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 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 - Madison Insurance Group NAME:PHONE FAX 800 Oak Ridge Tumpike, E-MAIL Suite&200 Oak Ridge TN 37830 INSURER(S) AFFORDING COVERAGE NAIC rl INSURER A:Technology Insurance Company 42376 INSURED 30346 INSURER B: INVO PEO, Inc.II/INVO PEO of Florida, Inc. INSURERC: /INVO PEO of Florida Inc. I/INVO PEO of Florida Inc. II/INVO PEO of Florida, Inc. III INSURER D 800 Oak Ridge Turnpike,Suite A-700 INSURER E: Oak Ridge TN 37830 INSURER F: COVERAGES CERTIFICATE NUMBER:2077811199 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 ADDLISUOR TYPE OF INSURANCE POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICYNUMBER MM/DD MM/DD COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ NTED CLAIMS-MADE FIOCCUR DAPREMMISES Ea A O E occurrence) rence $ MED EXP(Any one person) $ PERSONAL 8 ADV INJURY $ GEN L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 'R POLICY❑JET F—]LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT-17 Ea acddent $ ANY AUTO BODILY INJURY(Per person) $ I OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY AMAG $ AUTOS ONLY AUTOS ONLY Per accident S UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED RETENTION$ i $ A WORKERS COMPENSATION TWC3602748 1/1/2017 1/1/2018 X PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVEEL EACH ACCIDENT $1,000,000 OFFICERIMEMBER EXCLUDED? H N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYE 51,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached N more apace Is required) Coverage provided for all leased employees but not subcontractors of: A.T. Electrical Contractors Inc Coverage effective date: 11/26/2016 CERTIFICATE HOLDER CANCELLATION I' SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Miami Shores Village THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 10050 N E 2nd Avenue ACCORDANCE WITH THE POLICY PROVISIONS. Miami Shores FL 33138 i AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) rThe ACORD name and logo are registered marks of ACORD ,4co CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YlY1t7 E `.� 12/19/2017 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 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 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). f PRODUCER CONTACT Olga Valdes Lopez Insurance Agency Inc.d/b/a Statewide Ins PHON o . (305)2643636 ac No): 5755 W.Flagler St.#204 A DRESS : egglis.cepero@statewideins.net t INSURERS AFFORDING COVERAGE NAIC# Miami FL 33144 INSURERA: GRANADA INSURANCE COMPANY INSURED INSURER B A.T.ELECTRICAL CONTRACTOR INC INSURER C: 16000 NW 45 Ave INSURER 0: INSURER E: OPA LOCKA FL 33054 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 ADDL SUBR POLICY EFF POLICY EXP LTR POLICY NUMBER MM/DD MM/DD LIMIT'S X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAGE TO RENTED CLAIMS-MADE 191OCCUR PRREMISES Ea occurrence $ 100,000 MED EXP(Any one person) $ 5,000 A N Y 0185FL00041155-3 11/26/2017 11/26/2018 -PERSONAL&ADV INJURY $ 1,000,000 GEN'.AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY❑JE T F LOC PRODUCTS-COMP/OP AGG S 2,000,000 OTHER: 1 $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1 $ Ea accident ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED tid BODILY INJURY Per accident) $ AUTOS ONLY AUTOS ( ) HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY Per accident $ UMBRELLA LIAB * OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ S WORKERS COMPENSATION PER OTH- AND EMPLOYERSIAB 'LILITY Y/N STATUTE I I ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? ❑ N I A (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ Y k i .1 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) ELECTRICAL WORK WITHING BUILDINGS I i i b , I CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE MIAMI SHORES VILLAGE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN BLDG DEPT ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE 2ND AVE AUTHORIZED REPRESENTATIVE MIAMI SHORESFL 33138 M ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD t.