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EL-17-2460 i e Permit O. EL40-17-2460' `st!°REs yMiami Shores Village Permit Type:Electrical -Residential 10050 N.E.2nd ANE venue "" �� ' tNorkCiassification:Pool -Private 't Miami Shores,FL 3313&0000 Phone: (305)795-2204 Permit Status:APPROVED FLORIDA Issue Date: 11/2112017 Expiration: 05/20/2018 Project Address Parcel Number Applicant 78 NE 101 Street 1132060131330- Miami Shores, FL Block: Lot: GLENN E BOARDMAN Owner Information Address Phone Cell GLENN E BOARDMAN 78 NE 101 Street (303)437-1529 MIAMI SHORES FL 33138- 78 N E 101 Street MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone Valuation: $ 1,000.00 R GOOD ELECTRIC INC (954)432-2232 ..... . w ,_...,, . .. ,..,.� Total Sq Feet: p Type of Work:POOL ELECTRIC Available Inspections: Additional Info: Inspection Type: Classification:Residential Final Scanning: 1 Light Niche Bonding Review Electrical Alarms J Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF� $0.60 DBPR Fee Invoice# EL-10-17-65359 $4.50 11/21/2017 Check#:3615 $262.10 $50.00 DCA Fee $3.00 Education Surcharge $0.20 10/13/2017 Check#:3535 $50.00 $0.00 Permit Fee-Additions/Alterations $300.00 Scanning Fee $3:00 Technology Fee $0.80 Total: $312.10 In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans,drawings,statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL,PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work. i OWNERS AFFIDAVIT: I certify that all the foregoing informatio)f is accurate and that all work will be done in compliance with all applicable laws regulating construction and Toning. Futhermore, I authorize the above-naxx orto do the work stated. - November 21, 2017 Authorized Signature:Owner / Applicant / tractor / Agent Date Building Department Copy November 21, 2017 1 r Miami Shores Village 7BY IVEID 2017 Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 20 iy S-- BUILDING Master Permit No. y PERMIT APPLICATION Sub Permit No--Os-1 -4-- 7�n F-IBUILDING ELECTRIC ROOFING REVISION EXTENSION RENEWAL F-IPLUMBING ❑ MECHANICAL PUBLIC WORKS CHANGE OF O CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS:_ 78 NC l01 S•(Ya,:t City: Miami Shores County: Miami Dade Zip: 3313 Folio/Parcel#: I(- 3206- 013- 1330 Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): QeAn BoAr zlNan Phone#: 303• y37- 1525 Address: to, &h(&& City: mla&i �hn!¢b State: �L. Zip: 3313$ r Tenant/Lessee Name: Phone#: Email: C"aLaunia.rnushorpA C QrxaG Q.tym CONTRACTOR:Company Name: : L7Daa�' (er;c. Phone#: 454- 4.32¢29 23A Address: � City: irn ro(v PinLA State: Zip: 33024- Qualifier Name: USSQ.(( �poa( Phone#: State Certification or Registration#: , ECS.Q3-70 Certificate of Competency#: DESIGNER:Architect/Engineer: N�A .Phone#: Address: City: •State: Zip: Value of Workfoithis Permit:$ l000'. — Square/Linear,Footage ofWoik......---.....I Type of Work: ❑ Addition, ` Alteration © N"11 + s -�• Q Reparr/Replace +,� ,, ❑ Demolition Description of Work: "4>01 1C leE k =•• "' �I Specify color of color thru tile: Submittal Fee$ )• (� Permit Fee$ CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ *4• So Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ Z 6 2 • J D (Revised02/24/2014) t 1 Bonding Company's Name(if applicable) _LAA Bonding Company's AddressIl City State Zip Mortgage Lender's Name(if applicable) PIA 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. g "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 r i.. +. kr whose property is'subject to attachment. Also,a certified copy of the recorded notice of commencement must be poste ":, ,i ste'd'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 _ ^ter -�--�Signature4 �� OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this _ day of I I A., 20 1" by 3_day of �hT ' .120 (: by 116/1 d who is personally known to who is personally known to me or who has produced 'ArlyefS (i c.dxAA-, as me or who has produced as identification and who did take an oath. identification andTZ7 , a a—n- --------------- CHERYL MORGAN �� CHERYL MORGAN.NOTARY PUBLIC: ;?A ' °4; NOTARY PUBLIC: MY'COMMISSION#GG082765 MY COMMISSION#GG082765 EXPIRES June 28,2021 � EXPIRES June 28,2021 Sign: Sign: Print: Print: Seal: Seal: APPROVED BY Plans Examiner Zoning Structural Review Clerk (116ised02/24/2014) 09/14/2016 02:03PM 9544322232 R GOOD ELCT PAGE 02/05 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND'PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD {850}487-1395 Wa 2601 BLAIR STONE ROAD TALLAHASSEE FL 32399-0783 GOOD, RUSSELL R GOOD ELECTRIC INC 1730.N W 88TH WAY PEMBROKE PINES FL 33024 Congratulations! With this license yyoou become one of tate nearly r; r;'; one million Floridians licensed by uD1e`partmermt of Business and Professional Regulation. Our professionals and businesses range :'. :STA TE'OF,1=tORiDA: ;:: +; from architects to yacht bmkara,from boxers to barbeque DEPARTMENT OF:Bl{S1NE5S:AND ' ::. restaurants,and they keep Florida's economy strong. :PROFI 1$$3'*).: REGS An01N ''• <; -• • ::, Every day we work to Improve thew we do business in order ..EC'f 3002270.: ; `;'t5$`UEt :;;07111'212016;• ; :. ;.;,. W serve you better. For information about our services,please ":• '! log onto www myflo'ridalicanw com. There you can find more 6�RTIFIEA E��'�i~21CAr COtU'�FtAG1;OR , information about our'divrsions and the regulations that impact 0000;RU.SSE :.'`:' :"`;:. ":>:,•i,.'. " '.. you,subscribe to department newsletters and learn more about R'GOOD,�ELECTl 1 :'1►�! the Departmenfs initiatives. Our mission at the Department is:License Efficiently,Regulate <` Fairly.We constantly strive to serve you batter so that you can serve your customers. Thank you for doing business in Florida, '-16 GER TtF1ED undeuine;proviaions"df.:. li.409.FS. ..I and congratulations on your new iioeneel -:t n:'gt>Gb�::znie,'':. uavr,zoom,sr ' DETACH HERE RICK SCOl7 GOVERNOR KEN LAWSON,SECRETARY. ::S.TA7E;0FJ FLORIDA' DEPARTWIEN T .4U IN S5'AND PROFESSIOl�!#1.:REGt7taAT1ON ' .. by :fL;EGTR[C'At4•;CONTR.AC S:.UOENSIiVG''BOAfM EC 13002270. :. The ELECTRICAL: :CQNTRACTOR,'._ .. :, .•, ••K• � •�; Name 'below CERTIFIED`: Under the. rovisi6�i &!"a ter489 P. .P. .. i•' E . :.Expiration'date::.AUG:'31';'.20 :", •...:.:...: ■ ••S5E�•L': 1:.. GOOD:R U !. :H:W. 7 A `-x. • P•IVIB Of�E�F�INES��: ,'L 33024.33'!9, 's�•�,, .•; ■ r 1• 001197 iccrrc�• n�,• ns�•:• :...,;.... .. !'a` ^ fieri�t i�srjj717n •,••- ••,.,. ��r, !\I,w11 nrwrltT �r 1,A1Af,• 19/13/2017 06:41 9544322232 R GOOD ELCT PAGE 02/03 k BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT _ i 115 S. Andrews Ave., Rm.A-100, Ft. Lauderdale, FL 33301-1895--954-831-4000 VALID OCTOBER 1,2017 THROUGH SEPTEMBER 3o,2018 DBA:R GOOD ELECTRIC INC Receipt#:XLEcTRiCAi/ALARMS/CONTRACT' Business Name: Business Type:(gLECpgZ , corrrR) Owner Name:RUSSELL GOOD Business Opened:07/16/1993 Business Location:3-730 NW 88 WAX State/County/Cert/Reg:EC13002270 PEMBROKE PI•NES Exemption Code: Business Phone:954-432-2232 ; tI Rooms beats! Employees Machinos Professionals i .2 I For Vending HuWnoss only • Number of Machines: Vending T Py j Tax Amount Transfer Fee NSF Fee• Penalty or Years' Collection Cost Total Paid 27.00 0.00' 0.00 0.00 0,00 0.00 27.00 I ! THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS f 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 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 Indlcate that the business Is legal or that it is in compliance with Slate or tical laws and regulations. Mailing Address: RUSSELL GOOD Receipt VICP-16-00021654 1730 NW 88 WAX Paid 08/29/2017 27.00 PEMBROKE PINES, FL 33024 i I i io17 - zais 10/12/2017 14:52 9544322232 R GOOD ELCT PAGE 02/09 10/12/2017 02:18PM 9549605093 CIAG PAGE 08/09 CERTIFICATE OF LIABILITY INSURANCE 2_12012017ATUMN110or""I THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIQK76 UPON THE CI;RTIF7CATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVt:RAGE AFF01WED VY THE POLICIES 99WW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTnUM A CONYRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRI18reNTATIVE OR PRODUCER,AND THE C9ATIFICATE HOWWL IMPORTANT`. It the aertillwate holder It an ADDITIONAL INSURED,the polloyriss)must hero ADDITIONAL INSURED provialons or be ondomod, It SUBROGATION IS WANED,tuDJoct to the tennis and conditions of the polley,oodoln Qolicles may mquim an endoraWht. A statement on this Cw0cat6 door not confer r1 hto to the cerufi holder in lieu of such endorsement(s). PROOUCBR CONTACT LoM Keravasllls Complete Insurance AvlhonV Group,Inc. PHONS (954)857-8987 F (9§4j 9SM093 128 E McNab Road ' : sales as ino.00m eteufv s AFFORD YEw1Cfi NN Pompano Beads FL 33060 MURFRA: LLOYD'S OF LONDON 04swmv WAIUMR O: R.Goad Electric,IAC, etsUr:ERc: 1730 NW 65M Way u Pembroke Phos FL 33024 esu COVERAGES CERTIFICATE NUMBER: $EON NUMBER., THIS IS TO CIIRMY THAT THE POLICIES OF INSURANCE;LISTED BELOW KAVE BEEN ISSUED TO THR INSURED NAMPO ABOVE FOR THE POLICY PERIOD INDICATED, NOrMTHSTANDINO ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIPICATS MAY PE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREN SS SUBJECT TO At t,THE TERMS, EXCLUSIONS ANO CONDITIONS OF SUCH POLICIES.OMITS SHOWN MAY KAVE BEEN REDUCED BY PAID CLAIMS. TYPEOFeISURAN01 GP WOR OYNUMGCIk r CV LiYffO X CIOM ER'MALGENERALLLRBILm _EIMAEACHCOOUR _ s 4�ODOdOO CINIrf-MAOE Q QCCUR P I LS CBaaxrence 100,000 MEDEXP i>As non S 5,000 A N N CIBFLOW0777 0411412017 014/2016 PIMAQtIAL&ADV INJURY s 1.000.000 42WLA001E 3AATE LIMrTAPPUES PER A3ENERAL rai6AT¢ S 2,000.000 X POLICY Ej MOT ❑Las PROOUCrs.00MPtOPAGG s 2.000,000 _ OTHER: $ _ AUTOM08Q.R WWLlTYBINED UQUE 3 B aedae� ANY AUTO 8601LV INJURY(Pw pw"A) $ o1WVEA SCHEDULED BODILY INJURY(hrao dwe) S AUR"TFOpS ONLY �UT05 AUTp80KY AUTOo SONLY 4 UMOMJJ1 UAPOpowl EACH CCCURRENCH S 1 ' EXCFSSLtAa H-CLAIMSIMM AGGREQATf i 0 oNe WMIMS 001APIWAT10I1OTI Arm ENPLOYM LUM" JN ANY PROPME70"ARTNEF4EXECUf1VE B.L.BACHACCIDENT Z (WnSC 6ER>0(CWF[ o » (� N)A N E.L.0152A9c-CA MPLOYE S OMR �V E.L.DISEASE-P01IOY WAIT i aBSCMFMN OF OPEItAT104s f LOCATIONS I VEHKXF.S V40RD 101,AEOraontl RWMr n 5rn9w^nwy Au xMchad C mom spm is regtrbad) Eec"an p CERTIFICATE HOLDER NCELLATI 5HOUW ANY OF THA ASOW DESCRIBED POLICIES BE OANOSLLED BEFORb TNG FXPJRAT1oN DATE YnZar.Qt, NOME WILL ILII VISUVERED IN Miami Shores Vllidyg ACCORDANOE WRH THE POLICY PKOYIBIOK5. 10050 NE 2nd Avonua AUTHORM RtPRESENTATM MamSshores FL 331U ®19(182015 ACORD CORPORATION. All Aghts reservod. ACORD 25(2016/03) The ACORD flame and logo are registered maria of ACORD f 07/14/2017 09:25 9544322232 R GOOD ELCT PAGE 03/03 i .i :i JIMMY PAI RONIS .1 CHIEF FIN NICAL OFFICER STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS'COMPENSATION ;I *=CERT FICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS'COMPENSATION LAW CONSTRUCTION INDUSTRY EXEMPTION This certi Ies that the individual listed below has elected to be exempt from Florida Workers'Compensation law. EFFECTI E DATE: 8/30/2017 EXPIRATION DATE: 8/30/2019 PERSON GOOD RUSSELL j FEIN: 591965734 `I BUSINESS NAME AND ADDRESS: .( R GOOD ELECTRIC INC a 1730 N 88TH WAY PEMBRO<E PINES FL 33024 t ,E SCOPE OF BUSINESS OR TRADE: , Electrical Wrir g Within ,l Buildings and rlvers ':III IMPORTANT:Pu uant to Chapter 440.05(14),F,S„an officer of a corporation who elects exemption from this chapter by filing a certificate of d�ection under this section may t recover benefits or compensation under this chapter.Pursuant to Chapter 440.05(12),F.S..Certificates of election to be a' mpt...apply only within the sa pe 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 certifi tes of election to be exempt shell be subject to revocation if,at any time after the Sting of the notice or the issuance of the certificate,Mho person named on he notice or certificate no longer meets the requirements of this section for issuance of a certi8cete.The department shall reVPks a certificate at any t no for failure of the person named on the certificate to meet the requirements of this section. 'I 'i :I DFS-F2-DWC-2 52 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUESTIONS?(850)413-1609 { ;I 'I ;i °i I� a I :I `i i i �i R. GOOD ELECTRIC INC . 1730 NW 88th Way Pembroke Pines, FL 33024 September 9, 2017 Before me this day personally appeared Russell Good,who being duly sworn,deposes and says: i That she will be the only person working on the project located at 78 NE 101 Street Miami Shores, FL 33138. i RUSELL GOOD EC13002270 t Sworn to and su ub,ed lar. me this 9 day,of September,2017 by,Russell Good,who is personally known to be or _:.p �adenGWRIcyAN "= My COMMISSION if FF245967 EXPIRES July 20,20 0 398-0153 FtoridallotaryService cow NOT STATE OF FLORIDA AT LARGE 1730 NW 88th Way Pembroke Pines,FL 33024 Phone:954-214-5899 v g1�ORFs itac.t�si L� s ` Miami shores'Village s"' nail Building Department artment rag IN 10050 N.E.2nd Avenue �LORNA 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 t 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 day labor,part-time employees or subcontractors for your project.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 CONTENTS. Signature: nr-- Owner State of Florida County of Miami-Dade The foregoing was acknowledge before me this 100 day of Q ,20 By dicer who is personally known to me or has produced IW I HYA COPLIN p My COMMISSION FF?_45967 Notary: .,ray EXPIRES July 20,2019 (407)39 8.0153 FtorWallotarySerWceccm SEAL: >