The URL can be used to link to this page

EL-18-375 Permit No..10-1--1 35-375 Miami Shores VillagePermit 7Residentialyp@:SIB tr10aResidential N.E.2nd Avenue NW Werk Classification-Alteration Miami Shores,FL 33138-0000 Perl" 11 ,1' _ Permit S#a#cts:APPROVED Phone: (305)795-2204 "lint Expiration: 7J2018 issue.Date:31612018 p Project Address Parcel Number Applicant 107 NW 96 Street 1131010250090 Miami Shores, FL Block: Lot: ELLA ALLEN Owner Information Address Phone Cell { 107 NW 96 ST ELLA ALLEN , MIAMI SHORES FL 33150-1714 Contractor(s) Phone Cell Phone Valuation: $ 2,825.00 EMPIRE ELECTRIC MAINTENANCE& 305-264-9982 Total Sq Feet: i 0 c Type of Work:KITCHEN ELECTRICAL AS PER PLANS Available Inspections: Additional Info: Inspection Type: Classification:Residential Review Electrical Scanning: 1 Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $1.80 Invoice# EL-2-18-66441 DBPR Fee $2.25 DCA Fee $2.00 03/06/2018 Check#: 1738 $ 162.05 $0.00 Education Surcharge $0.60 Permit Fee-Additions/Alterations $150.00 Scanning Fee $3.00 Technology Fee $2.40 Total: ` $162.05 i In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans,drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL,PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work. OWNERS AFFIDA IT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construc' z in . F rmore,I authorize the above-named contractor to do the work stated. March 06, 2018 i Alkhohred Signature:Owner / Applicant / Contractor / Agent Date Building Department Copy i March 06, 2018 1 Miami Shores Village RRICENVOT3 Building p De artment EB 18 sY ol$ 10050 N.E.2nd Avenue, Miami Shores,Florida 33138 Tel:(30S)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 �^ ly FBC 20 1 `�Ir, . BUILDING l master Permit Ivo. � �'` PERMIT APPLICATION Sub Permit No. � BUILDING YELECTRICa ROOFING ❑ REVISION Ej EXTENSION RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS [:] CHANGE OF ❑ CANCELLATION [n SHOP CONTRACTOR DRAWINGS JOB ADDRESS: W[ /V W I(O City: Miami Shores County: Miami Dade Zip: 33150 Folio/Parcel#: I It•"31 D J-D Z-5-.0-0 CT V Is the Building Historically Designated:Yes NO Occupancy.Type: Load: Construction Type: Flood Zone: BFE: FFE: ,,//�� ( Phone#: 30�' �+✓ OWNER:Name(Fee Simple Titleholder): 4=-1,j-j+ ..fT�'G]r V Address:: , ,,d/� / N 71 ca 2 City: I v1 t'1�1f V 4` � State: zip: Tenant/Lessee Name: Phone#: i Email: CONTRACTOR:Company Name: y Phone#:;.3B5:2h.4f-�� , Address: City: 4V State: Zip: Qualifier Name: *P,/-,*0L//� u / � — Phone#.366:7 G State Certification or Registration#:y, Certificate of Competency#:' l k DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip:' Value of Work for this Permit:$_74(43 Square/Linear Footage of Work: Type of Work: ❑ 1Addition )❑ Alteration c .❑1 New nC ❑�Rnepaaiir/Replace ❑ Demolition Description of Work: ; "`' l+�c�...)•,_s ,a,4.,Yit f'"�En ` ^�N.-:. a`.�y✓r Specify coloi of colorthru tiler :`' °' t, D1re., xlss„a3 q}.4 '*r , ;'•: ,�',yam_ 4'+r-, � ,•} .1;,_ , ” Submittal Fee$ .4oft*-**-w--ft .rPermit Fee$-t CCF$ CO/CC$ Scanning Fee$ Radon Fee$ �• DBPR$cif '�-� Notary$ t Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ 1 TOTAL FEE NOW DUE$ (Revised02/24/2014) S 1 ' Bonding Company's Name(if applicable) Bonding Company's Address I 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..... a 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.I IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." • A 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 m ncement mu st b p ted at the ' site for the first inspection which occurs seven (7) days after the building;permit is issued. h absence a su osted n e, t inspection will not be approved and a reinspection fee will be charged. Signature G� / y T� "Signature. J* , . C7,OWNER or AGENT t 0 A y The foregoing instrument was acknowledged before me this The'foregoing instrument was acknowledged before me this roti` day of 20 by 4day of 20 by ALL f1-� w o is personally known to O ��personally known to me or who has produced as me or who has produced as identification and who did take an oath. identification-arid who did-take an oath. NOTARY PUBLIC: NOTARY PUBLIC: y Sign: Sign: ,.•`:�a �� ,,SIXTO FERNANDO ESCOBAR Print, Print: rionrypoonc siaveomonaa ;�y PVe�, SIXTO FERNANDO ESCOBAR Seal: Commission#GG 094108 f Seal: =r°. .`�: ' e.•' Notary Public-State of Flori ,,'„o��¢;.•` My Comm.Expires Apr 13,2021, - • Commission #GG 09410 My Comm.Expires Apr 13, 021 llillll�� APPROVED BY Z ly l4ePlans Examiner ' Zoning "�_�,• Structural Review Clerk (Revised02/24/2014) a u,I I RICK SCOTT,GOVERNOR KEN LAWSON, SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD EC13003428 I ADDITIONAL BUSINESS QUAaFICATION The ELECTRICAL CONTRACTOR __ Named below IS CERTIFIED Under the provisions of Chapter 489 FS. - ' Expiration date: AUG 31, 2018 HERNANDEZ,ANTONIO E--"* EMPIRE FIRE SAFETY-L'LC __. • 2200 SW 67TH'_VENl1E55= r MIAMI -` L 3311 ` Y y a a 021 ISSUED: 05/15/2016 DISPLAY AS REQUIRED BY LAW SEQ# L1605150001327 007985 Local Business Tax Receipt Miami—Dade County,State of Florida LBT—THIS IS NOT A BILk;-DONOT PAY 6668157 - BUSINESS NAME/LOCATION RECEIPT NO. EXPIRES EMPIRE FIRE SAFETY LLC RENEWAL SEPTEMBER 30, 2018 2200 SW 67 AVE 6940200 Must be displayed at place of business MIAMI FL 33155 Pursuant to County Code Chapter 8A—Art.9&10 OWNER SEC.TYPE OF BUSINESS EMPIRE FIRE SAFETY LLC _ 196 ELECTRICAL CONTRACTOR PAYMENT RECEIVED C/O ANTONIO HERNANDEZ MGR-y EC13003428: BY TAX COLLECTOR Worker(s) 8 $45.00 07/07/2017 CREDITCARD-17-045079 This Local Business Tax Receipt only confirms payment of the Local Business Tax.The Receipt Is not a license, panalk or a certification of the holdet:s qualifications,to do business.Holder must comply with any governmental or nongovernmental regulatory laws and requirements which apply to the business. The RECEIPT N0.above must be displayed on all commercial vehicles—Miami—Dade Code Sac 8e-276. For more information,visit www.miamidede.govltaxcollector EMPIR-8 OP ID:MLI ACORO" CERTIFICATE OF LIABILITY INSURANCE DATE 03/31/201 Yv) 03/31!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 ACT NAME: Matthew Seese BROWN&BROWN OF FLORIDA INC 14900 NW 79th Court Suite#200 -(A/C,N.No,.Ext):305-364-7800 �A c Noll: 305-714-4401 Miami Lakes, FL 33016-5869 E-MAIL Matthew Seese ADDRESS: INSURER(S)AFFORDING COVERAGE I NAIC# INSURER A:AmerisureInsurance Company 119488 INSURED Empire Electric Maintenance INSURER B:Amerisure Partners Ins.Co. 111050 and Service Inc. INSURER C:Amerisure Mutual Insurance Co 123396 Empire Fire Safety,LLC* -- 2200 SW 67th Avenue INSURER D:Philadelphia Indemnity Ins Co 118058 Miami,FL 33155 INSURER E: INSURER F: I 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. 1�TR ADDL POLICY EXP TYPE OF INSURANCE IVSD SUER POLICYNUMBER MM/DD/YYYY MM/DDYLIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 CLAIMS-MADE oOCCUR CPP21006690001 03/31/2017 03/31/2018 DA PREM SES EaoETOffENTED ren $ 100,00 MED EXP(Any one person) $ 10,00 PERSONAL 8 ADV INJURY $ 1,000,00 GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,00 POLICY FX]JE F—]LOC PRODUCTS-COMP/OP AGG $ 2,000,00 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident B X ANY AUTO CA21006680006 03/31/2017 03/31/2018 BODILY INJURY(Per person) $ ALLOWNED Fy SCHEDULED BODILY INJURY(Per accident) $ AUTOS I AUTOS NON-OWNEDPROPERTY DAMAGE X ac_cident HIRED AUTOS X AUTOS Per $ $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,00 C EXCESS LIAB CLAIMS-MADE CU21006700002 03/31/2017 03/31/2018 AGGREGATE $ 5,000,00 DED I X I RETENTION$ 0 $ WORKERS COMPENSATION ( I X T ti STATUTE X O _ AND EMPLOYERS'LIABILITY A ANY PROPRIETOR/PARTNER/EXECUTIVE YIN N WC21006710001 03/31/2017� 03/31/2018 E.L.EACH ACCIDENT $ 1,000,00 OFFICEWMEMBER EXCLUDED? N❑ N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ 1,000,00 if yes,describe under 1,000,00 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ D General Liability* PHPK1474996 03/31/2017 03/31/2018 Occ/Agg $1M/$2 D" UmbrellaLiability* PHUB535665 03/31/2017 03/31/2018 Occ/Agg $5 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,maybe attached If more space is required) Electrical Contractor-State License EC#0001274 CERTIFICATE HOLDER CANCELLATION 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. 10050 N.E.2nd Avenue Miami Shores,FL 33138 AUTHORIZED REPRESENTATIVE Brown and Brown of Florida,Inc. ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD