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EL-17-794 (2) Miami Shores Village �� Building Department MAR, 2 Z 2011 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 ' f Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 20 iq BUILDING Master Permit No. PERMIT APPLICATION sub Permit No.Q R ❑BUILDING ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION []RENEWAL ❑PLUMBING [:] MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP `� G�`� CONTRACTOR DRAWINGS JOB ADDRESS: 6-5y / ( S�" City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction�ype: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): " 1 ' ` �' r4 5' Phone#: Address: b 50 /V 97 F-7- Ci TCity: CA M l A'D/l11 S State: �- Zip: f Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name: �UC Phone#: Address: i�w 3 0 4L)Y- City: n 1 Stater Zip: '3 Qualifier Name: � �w but PL),69 Phone#: State Certification or Registration#: "E�2 1-300-71e2 Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ /!©O6 Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration 1:1New ❑ Repair/Replace ❑ Demolition Description of Work: (f f L -✓)'kC6 Q Y46 DLC V 4'b n r 1 w Specify color of color thru tile: Submittal Fee$ Permit Fee$ 67cV" CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ r Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE S 2� o (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 i City State Zip e Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installationhas commenced prior to the issuance of a permit and that all work will be performed to meet the standards of ail 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..... f j 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. 1 Signature Signature 4 OWNER or AGENT CO�7 A R The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this 1 /�3YI L day of d`C �/2� '20 l by ` 7 day of Ac) %r 20 �� by Z{MsjrRE who is personally known to Na who i nall known me or who has produced ft—ul as me or who has produced as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: Sign: Print: 0/yes Print: ( nh Seal: ' Seal: ,p Nary Public State of FWU _ Zettie Jones Alayan AcDstaission 3305 =,c �_ �CyOpM'�pppMrCISSION 1�F1fd2090�8Q1 OF N9' Expires 0812U2018 ########### ###XPIR AARONNOTARY,GAM �' APPROVED BY - �®/40/&ans Examiner Zoning Structural'Review Clerk tRevised02/24/2014) SPIKEBU OP ID:YG CERTIFICATE OF LIABILITY INSURANCE DATE 03/22/2017 Y) 03/22/2017 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(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 SLATON INSURANCE NAME: Yvonne Goode P.O.Box 220537 A/CONN Ext:561-683-8383 Fp No):561-684-5995 West Palm Beach,FL 33422 n DRe J.Cal Boynton,CIC,President ss:ygoode@slatonriskservices.com INSURERS AFFORDING COVERAGE NAIC# INSURER A:Scottsdale Ins CO 41297 INSURED Spikebusters,Inc. INSURER B:AmTrust North America %Matthew Nieves r 30 NW 130th Avenue INSURER C: Miami,FL 33182 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. ILTR TYPE OF INSURANCE lNqR ADD SUB POLICY NUMBER MM/DDYmrrY MMLDDY/Y VY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 A X COMMERCIAL GENERAL LIABILITY CPS2605821 12/12/2016 12/12/2017 PREMISES Ea occurrence $ 100,00 CLAIMS-MADE 1XI OCCUR MED EXP(Any one person) $ 5,00 PERSONAL&ADV INJURY $ 1,000,00 X GENERAL AGGREGATE $ 2,000,00 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,00 POLICY PRO LOC $ET F AUTOMOBILE LIABILITYEa BIKED SINGLE LIMIT $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY Per accident $ AUTOS AUTOS ( ) HIRED AUTOS L $ NON-OWNED PROPERTY DAMAGE AUTOS PER ACCIDENT $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ I EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY TORY LIMITSER B ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N AWC1055773 12/10/2016 12/10/2017 E.L.EACH ACCIDENT $ 500,00 OFFICER/MEMBER EXCLUDEN/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 500,00 If yes,describe under DESCRIPTION OF OPERATIONS bet I E.L.DISEASE-POLICY LIMIT $ 500,00 3 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space Is required) License Number: EC 13007187 CERTIFICATE HOLDER CANCELLATION MIAMISP SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Miami Shores Village ACCORDANCE WITH THE POLICY PROVISIONS. Bldg Department AUTHORIZED REPRESENTATIVE 10050 N.E.2nd Avenue Miami Shores,FL 33138 ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD RICK SCOTT,GOVERNOR KEN L ARAGON,SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD _ EC13007187 ` 'y s The ELECTRICAL CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31,2018 NIEVES, MATTHEW JOSEPH t SPIKEBUSTERS INC. •y 30 NW 130TH AVENUE. MIAMI FL 33182 I ISSUED: 08101/2016 DISPLAY AS REQUIRED BY LAW SEQ# L1608010001694 0001913 Local Business Tax Receipt Miami—Dade County, State of Florida —THIS IS NOTA BILL—DO NOT PAY r 3753671 jBUSINESS NAME/LOCAncm RECEIPT NO. EXPIRES SPIKEBUSTM INC RENEWAL SEPTEMBER 3B, 2017 30 NW 130 AVE 3998969 MIAMI FL 33182 Must be displayed at place of business Pursuant to County Code E i Chapter 8A—Art 9&10 OWNER SEC.TYPE OF BUSINESS SPIKERUSTERS INC 196 ELECTRICAL CONTRACTOR PAYMENT RECEIVED C/O MATTHEW 1 NIEVES QUALIFIER EC13007187 BY TAX COLLECTOR Worker(s) 2 $82.50 10/19/2016 1 CREDITCARD—1 7-001622 This Local Business Tax Receipt only conrjnns payment of the Local Business Tax.The Receipt is not a license, permit or a certification of the holders qualification%to do business Holdermust comply with any govemmemei Of eengovernmental regulatory IBM and raquiremems which apply to the business. The RECEIPT N0.above most be displayed on all commelciai vehicles—Miami-Dade Code Sec Be-276. For them Information,visit wwwMiamwade.gov texcollaetor I I � . i i i I I i ,