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REV-16-2666 Miami Shores Village7SEP'2 X�, i ; Building Department � 2o�s 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 .'. Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 15 C FBC 20(4J BUILDING Master Permit No.X- 3- IS- SOL PERMIT APPLICATION Sub Permit No. � yF-]BUILDING ❑ ELECTRIC ❑ ROOFING REVISION ❑ EXTENSION ❑RENEWAL PLUMBING ❑ MECHANICAL Ej PUBLIC WORKS ❑ CHANGE OF CANCELLATION SHOP CONTRACTOR DRAWINGS JOB ADDRESS: ��� /" y.3 0,77- City: Miami Shores County: Miami Dade Zip: 33 '3 Folio/Parcel#: Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name(Fee Simple Titleholder): YA2 C-/ Phone#: Address: City: 011 ArYr► / State: - Zip: Tenant/Lessee Name: Phone#: Email: ' f CONTRACTOR:Company Name: �'f"� %�,EG Phone#: Address: f ��� -Cm S 17' City: lic-�i/�/14'�(� i State: '�h Zip: , '" Qualifier Name: ��'`� /�� �.i'a Phone#:�}6� Q,}�j�j'9C''3 State Certification or Registration#: '0� L��� Z ,�' �j Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ �_/ Square/Linear Footage of Work: .(%Y Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: 4)a e_AaL4//a yN.mTir.t:MAYf!Ak?,0.: !!!#49 Specify colo ;c' u tile' I " Submittal Fee$ Permit Fee$ �� °�d CCF$ ___ CO/CC$ Q o0 Scanning Fee$ 3 r Radon Fee$ - • DBPR$ 7_ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ (Revised02/24/2014) A 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. "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." t r 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 inspection fee will be charged. ignature ' Signature WNER o ENT CONTRACTOR s The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this , �& "day of 20 J (D by ��� day of 20 1( by yrl+ry� V� v .K—Q, • w personally know 'y+�Wwho isto 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. NOTARY PUBLIC: NOTARY PUBLIC: r Sig o. Sign~ Q JL"_ Print: 0 Print: +fr r _ RAOUQ A SCARBOROUGH ;: ; MY COMMISSION M FF 242181 Seal: _*: .`__ MY COMMISSIONAFF242181 Seal: . :� EXPIRES:October 18,2019 EXPIRES:October 18 2019 8 ug. Bonded ThN Notary Public Underwriters 4J1,'',l c• Banded Thru Notary Pu*Underw bm APPROVED BY �1,0� Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) Oct 0416 04:07p EJD Construction 305-981-6715 p.6 DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD (850) 487=1395 •�t�`` 2601 GLAIR STONE ROAD TALLAHASSEE FL 32399-0783 i 1 ' MENDEZ, JUAN M QUINTANA ELECTRIC BROTHER'S INC 660 E 60 ST a HIALEAH FL 33013 1 t Congratulations! With this license you become one of the nearly one million Floridians licensed by the Department of Business and Professional Regulation. Our professionals and businesses rangeqa6), �% STATE OF FLORIDA , from architects to yacht brokers,from boxers to barbeque DEPARTMENT OF BUSINESS AND restaurants,and they keep Florida's economy strong. PROFESSIONAL REGULATION Every day we work to improve the way we do business in order EC0002546 ISSUED: 08109/2016 to serve you better. For information about our services, please lop onto www.myfloridalice6se.com. There you can find more CERTIFIED ELECTRICAL CONTRACTOR information about our divisions and the regulations that impact MENDEZ,JUAN M Nu,subscribe to department:newsletters and team more about e Department's initiatives. QUINTANA ELECTRIC BROTHER'S INC Our mission at the Department is:license Efficiently,Regulate Fairly.We constantly strive to;serve you better so that you can serve your customers. Thank you for doing business in Florida, IS CERTIFIED under 1he provisions Of Ch.489 FS. and congratulations on your new licensel Exp�mbon date : AUG 31.2018 X16080 oo022e7 f DETACH HERE RICK SCOTT, GOVERNOR KEN LAWSON, SECRETAR STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD EC0002546 The ELECTRICAL CONTRACTOR II 9r Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2018 ) " . 1 MENDEZ, JUAN M © " QUINTANA ELECTRIC BROTHER'S INC • 765 SW 101 CT CIRCLE MIAMI FL 33174 IssuEtr 0e1092016 DISPLAYAS REQUIRED BY LAW • SEQ# L1608090002287 i " t a , C } .% o 2 ^ ;oom � ] /§ .§§ �2 ` w C14 Kcc 2. 0LU08 �� � / \k § X I 0 §2 § § k(' k W 3§ i !tea§ 'e LU a c . d § CL.° LU k§: $ § �§ _■� . � / � ■�� ; 2§ CL.& z « m ZI f ■ 2 a3 . a -& @ . �. cLLI to /0 Wga � lu� 2V _ � � ( IL to df a Lu/ � � \ ■)O I. k I-MMM, Cl) ' . 0 ( § � Uz 0 3 moo@ kSc oc )}ƒ § 2 0 0 o\ 00 2\f CO § G 2 E z � ƒ / LU \\� � • LU co ~ g 7 2 � k(� V ` \ 2 « f � lu/ � $ a k ) U» 3 k\ / k . : } , : . i ` � ! »d 9[L9-M-900 u@pn ;lsuo0 OR] dg$to 9L#0 loo i ACORECERTIFICATE OF LIABILITY INSURANCE DATE 1 11/30/201166 2/ 11/30/ 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 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: Amtrust Insurance Group PHONE . (305)275-0810 ac No): (305)275-0890 8100 SW 81 Drive,Ste 280 E-MAILADDRESsa info@amtrustinsurance.net Miami,FL 33143 INSURER(SIAFFORDING COVERAGE NAIC i1 Phone (305)275-0810 Fax (305)275-0890 INSURER A: Normandy Insurance Company INSURED INSURER B: Quintana Electric Brother's,inc. INSURER C: 4801 SW 6th St INSURER D: INSURER E: Miami FL 33134 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. lLTR TYPE OF INSURANCE ND R WVD POLICY NUMBER MMIDDY EFF MMIDD EXP LIMITS ❑ COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ F—] CLAIMS-MADE F-] OCCUR DAAGE (RENTED _PREMMSESS Ea occurrence) $ ❑ MED EXP(Any one person $ ❑ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ ❑ POLICY ❑ 'ECT ❑ LOC PRODUCTS-COMPIOP AGG $ ❑ OTHER $ AUTOMOBILE LIABILITY EOMaBIINdEDtSINGLE LIMIT ' $ ❑ ANY AUTO BODILY INJURY(Per person) $ ❑ ❑ALL OWNED SCHEDULED AUTOS AUTOS ( )BODILY INJURY Per accident $ F—] HIRED AUTOS E:] NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident ❑ ❑ 1 $ ❑ UMBRELLA L1AB ❑OCCUR EACH OCCURRENCE $ ❑ EXCESS LIAB ❑CLAIMS-MADE AGGREGATE $ ❑ DED ❑ RETENTION$ $ WORKERS COMPENSATION ❑� PTAT T ❑ EORH AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIV NHFL0054772016 07/07/2016 07/07/2017 E.L.EACH ACCIDENT $ 100,000.00 A OFFICER/MEMBER EXCLUDED? N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ 100,000.00 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000.00 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space is required) Electrical contractor CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Village of Miami Shores THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN 10050 NE 2nd Ave ACCORDANCE WITH THE POLICY PROVISIONS. Miami Shores,FL 33138 AUTHORIZED REPRESENTATIVE I ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101)QF The ACORD name and logo are registered marks of ACORD