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EL-16-1373 Permit No. E'L-5-16-1'373 'RES�It Miami Shores Village r Permit Type:Electrical -Residential 10050 N.E.2nd Avenue NE Peril I WorkCtassi€fcation:Alteration Miami Shores,FL 33138-0000 Permit Status:APPROVED Phone: (305)795-2204 j°LORiDp' Issue Date: 11/912016 Expiration: 05/08/2017 Project Address Parcel Number Applicant 475 NE 91 Street 1132060140142 Miami Shores, FL 33138-3150 Block: Lot: AVANT PLACE , LLC r Owner Information Address Phone Cell AVANT PLACE, LLC 7845 W 2 Court (786)566-2454 HIALEAH FL 33014- 7845 W 2 Court HIALEAH FL 33014- Contractor(s) Phone Cell Phone Valuation: _ $ 3,500.00 INDUSTRIAL ELECTRICAL SYSTEM C 305/228-1384 __._._. _ ._._._,. ..._ __.w_ ._...�,_... ................_._...__.._...,... ......,.-.... _ Total.Scl Feet: 0 Type of Work:MOVE OUTLETS&SWITCHES,UPGRADE OU Available Inspections: Additional Info: Inspection Type: Classification:Residential Review Electrical Scanning: 1 Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $2.40 DBPR Fee Invoice# EL-5-16-59846 $4.50 11/09/2016 Check#: 1478 $273.40 $50.00 DCA Fee $4.50 Education Surcharge $0.80 05/19/2016 Credit Card $50.00 $0.00 Notary Fee $5.00 Permit Fee-Additions/Alterations $300.00 Scanning Fee $3.00 Technology Fee $3.20 Total: $323.40 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 that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zon' F ore, I authorize the above-named contractor to do the work stated. November 09, 2016 Authorize igna :Owner / Applicant / Contractor / Agent Date Building Department Copy November 09,2016 1 Miami Shores Village Rpf x�rFt> Building p De �artment N v 02 2016 10050 N.E.2nd Avenue, Miami Shores,Florida 33138 B. Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 (�J FBC 20't`f' �•--� BUILDING Master Permit No.RC16-1208 PERMIT APPLICATION sub Permit No.1a AG `j 313 E BUILDING Q ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL [:]PUBLICWORKS EaCHANGE OF ❑CANCELLATION ❑ SHOP T—CONTRACTOR DRAWINGS JOB ADDRESS: 475 NE 91 STREET City: Miami Shores County: Miami Dade Zip: Folio/Parcel#:11-3206-014-0142 Is the Building Historically Designated:Yes NO X Occupancy Type: Load: Construction Type: Flood Zone: BFE: 'FFE: OWNER:Name(Fee Simple Titleholder):Java Holdings LLC, Avant Place LLC Phone#: Address:7845 W 2 CT BAY 3 City: Hialeah State: FL Zip: Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name: Industrial Electrical Systems, Corp Phone#: 305-388-4648 Address: 14050 SW 84 STREET SUITE 206 City: MIAMI State: FL Zip: 33183, Qualifier Name: Nestor I COrvea Phone#: State Certification or Registration#: EC13002182 Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$5,000.00 Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New ❑M Repair/Replace ❑ Demolition Description of Work: Replace panel 150 amps and meter can. Install 20 high hats & kitchen remodeling according to approved plans. Specify color of color thru tile: Submittal Fee$ Permit Fee$ �%fin _ CCF$ CO/CC$ Scanning Fee$ Radon fee$ DBPR$ Notary$ P, 5 Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ �� D (Revised02/24/2014) t 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." 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 oc en (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be oppr e a reinspection fee will be charged. Signature Signature OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this 02- day of NOV•�WT'—'-)E:P-- ,20 ( (oO ,by 31 st day of October 20 2016 by who is personally known to Nestor I COrvea ,who is personally known to me or who has produced L 17 � UQ. - a n or who has produced as identification and who did take an oath. identification and who did take an oath. t ' NOTARY PUBLIC: NOTARY PUBLIC: Sign: Sign: ( Print: Print.� , f Fran *E�-Y o' _r� Public-State of Florida 1 N��. �1(�P�� Commission#FF 39767 Seal: `y�r pr., Notary Public State of Florida al' "'Fos F�°P' My Comm.Exp.November 17,2017 i° �F Bonded Thru National Assocation.Florida Sindia Alvarez c p` My Commission FF 156750 9. Expires 0910312018 i APPROVED BY ,� 1 A10d/0lans Examiner Zoning i Structural Review r Clerk (Revised02/24/2014) r- STATE OF FLORIDA ' -.-_� • :°A�, DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD (850) 487-139541 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 i • i CORVEA, NESTOR I t INDUSTRIAL ELECTRICAL SYSTEMS CORP i 14050 SW 84 ST STE 206 MIAMI FL 33183-4440 t i t i. E t Congratulations! With this license you become one of the nearly one million Floridians licensed by the Department of Business and ( - F';-STATE OFLORIDA , Professional Regulation. Our professionals and businesses range E x ; from architects to yacht brokers,from boxers to barbeque DEPARTMENTS OF BUSINESSAND ,restaurants,and they keep Florida's economy strong. PROFESSIONAL4'REGOLATION w �. .J-. G t �,.., :. Every day we work to improve the way we do business in order " -`- C 130021 :'ISSUED 05/25/2016 a to serve you better. For information about our services,please _ _, -� �- • ��� � Y � to onto www.myfloridalleense.com. There you can find more CERTIFIED EL''ECTRICAL CONTRACTOR -- information about our divisions and the regulations that impact "CORVEA�NESTOR',I ' you,subscribe to department newsletters and learn more about E INDUSTRIAL'ELECTRICALSYSTEMS CORP the Department's initiatives. °' �" � Our mission at the Department is: License Efficiently, Regulate Fairly.We constantly strive to serve you better so that you can '" a•��^_.. •' serve your customers. Thank you for doing business in Florida, + = 60 069 Ll 5250001 and congratulations on your new license!, --m DETACH HERE ---RICK SCOTT,GOVERNOR�- KEN LAWSON SECRETARY N STATE OF_`FL'ORIDAx.,. 4 - - DEPARTMENT OF BUSINESS°ANDPROFESSIONAL-REGULATION' ELECTRICAL CONTRACTORS'LICENSING BOARD , u _ EC13002182 f "" w 3 ._ a '9f „TK6-EL-EC.T,RICALCONTRACT �. -OR }_ s �L "►Y. .- �."�`f '_° _ = �` Named;below IS.CERTIFIED�-- —:` Under the.provisions of,Chapter-489 FS ,`;� .,Expirationrdate:—AUG,31 2018. _CORVE NESTOR1� -• :^s� 4�, i INDUSTRIAL�ELECTRICALO.SYSTEMS"CORP: ; `" � '' 14050-SW'84,ST�STE-,206' FL 331'83;4440Uk 51""_ ..-�- , ✓ '. -17 ISSUED: 05/25/2016 DISPLAY AS REQUIRED BY LAW SEQ# L1605250001069 ACDTM CERTIFICATE OF LIABILITY INSURANCE °ATE(MMIDDrfY) O05/12/2016 PRODUCER Serial# B3192 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION OVERSEAS INSURANCE AGENCY ONLY AND CONFERS NO RIGHTS UPON THE;CERTIFICATE it HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR P.O.BOX 162936 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. MIAMI,FLORIDA 33116 INSURERS AFFORDING COVERAGE INSURED INDUSTRIAL ELECTRICAL SYSTEMS CORP INSURER A: ARCH SPECIALTY INSURANCE COMPANY _ a 14050 SW 84 STREET, SUITE#206 INSURER B: MIAMI, FL 33183INSURER C: r INSURER D: INSURER E: , COVERAGES 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IN 8R _ TYPE OF INSURANCE 1 POLICY NUMBER POLICY EFFECTIVE POUCY EXPIRATION I LIMITS GENERAL LIABILITY EACH OCCURRENCE S 1,0001000 A X COMMERCIAL GENERAL LIABILITY AGL002536201 05/12/16 05112/17 FIRE DAMAGE(Any one fire) S 100.000 � CLAMS D I MADE I X OCCUR MED EXP(Any one person) Is. 5.000.� { I i PERSONAL&ADV INJURY Is 1,000,000 GENERAL AGGREGATE $ 2,000,000 if G—EN�'L AGGREGATE LIMIT APPLIES PER:I i PRODUCTS-COMPIOP AGG S 2,000,000 R!POLICY JET LOC I 1) AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S ANY AUTO (Ea accident) fI ALL OWNED AUTOS BODILY INJURY I SCHEDULEDAUTOS (Per person) I S HIRED AUTOS 1 BODILY INJURY NON�OWNEOAUTOS (Per accident) S PROPERTY DAMAGE $ I (Par accident) I GARAGE LIABILITY AUTO ONLY-EA ACCIDENT S _ ANY AUTO I I OTHER THAN EA ACC $ _ 1 I i AUTO ONLY: AGG ,S EXCESS LLABIUTY EACH OCCURRENCE ($ OCCUR 17-1 CLAIMS MADE I AGGREGATE $ S DEDUCTIBLE S RETENTION S S IQTATI- H-' WORKERS COMPENSATION AND TORY.LIMITS ER_I 1 EMPLOYERS'LIABILITY E.L.EACH ACCIDENT S E.L.DISEASE-EA EMPLOYEEI$ E.L.DISEASE-POLICY LIMIT S OTHER DESCRIPTION OF OPERATIONSILOCATIONSIVEHK:LESIEXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS Description Of Operation Electrical Wiring: E C 13002182 Is Qualifier Nestor I Corvea CERTIFICATE HOLDER I I ADDITIONAL INSURED;INSURER LETTER: CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Miami Shores Village Building Dept DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN 10050 N E 2 Ave NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL Miami Shores, FI 33138 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. •IrrNnRI7Pr1 RFPRFSENTATIVE P ACORD 25-S(7197) a ACORD CORPORATION 1988 { f A d LMMF2;3/2'016 (MM/ D(YYYY) CERTIFICATE OF LIABILITY INSURANCE 8001 THIS CERTIFICATEIS 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 pollcy(ies)must be endorsed. If SUBROGATIONIS 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). CONTACT ' NAME: PAYCHEX INSURANCE AGENCY INC (AIHCNEo,Ext): FAX (888) 443-6112 210705 P: F: (888) 443-6112 CRESS: PO BOX 33015 INSURER(S)AFFORDING COVERAGE NAICN SAN ANTONIO TX 78265 • INSURER A: Twin City Fire Ins Co 29459 INSURED INSURERS: 1 INSURER C: I INDUSTRIAL ELECTRICAL SYSTEMS CORP INSURER D: 14050 SW 84TH ST STE 206 INSURERS: MIAMI FL 33183 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 TYPEOFINSURANCE ADDL SURR POLICYNUMBER POLICYEFF POLICYEXP LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE CLAIMS-MADE ❑OCCUR DAMAGE TO RENTED PREMISES(Ea occurrence) MED EXP(Any one person) PERSONAL&ADV INJURY GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE POLICYF]JECT PRO--F—]LOC PRODUCTS-COMP/OP AGG OTHER: AUTOMOBILE LIABILITY (Ea SINGLE LIMIT (Ea accident) ANY AUTO BODILY INJURY(Per person) ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE HIRED AUTO AUTOS (Per accident) $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ RIEXCESS LIAB CLAIMS-MADE AGGREGATE ED RETENTION S WORKERS COMPENSATIONX PER OTH- ANDEMPLOY£RS'LIABILITY STATUTE I I ER ANY PROPRIETOR/PARTNER/EXECUTIVE YIN E.L.EACH ACCIDENT $1, 000, 000 OFFICERIMEMBER EXCLUDED? A (Mandatory in NH) ❑ WA 76 WEG F06188 01/24/2016 01/24/2017 E.L.DISEASE-EA EMPLOYEE $1, 000r 000 H yes,describe under E.L.DISEASE-POLICY LIMIT 11, 000, 000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Those usual to the Insured's Operations. EC13002182 t i CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Miami Shores Village Building Dept AUTHORIZEDREPRESENTATIVE 10050 NE 2ND AVE �� ���,�/ MIAMI SHORES, FL 33138 ©1988-2014 ACORD CORPORATION.All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD r I `5gOREs G,l .... �....� Miami Shores Village Building Department OR1Dp' 10050 N.E.2nd Avenue 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 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: Owner State of Florida County of Miami-Dade The foregoing was acknowledge before me this 3 I S'1 day of A-()r . ,20 . Byrn QQA- D n e e who is personally known to me or has produced as identification. Notary: Ab �1w,f'.Pys� YANADY PRIETG SEAL: +: ':+= MY COMMISSION N FF 21402 1 :a EXPIRES:March 25,20 i 1 Bonded Thru Notar!Putk;;Und f 1 { k G r Wftt . c NEC ELECTRICAL CONTRACTOR INC 11720 SW 185 ST MIAMI, FL 33177 PH:786-389-8116 E-mail:necelectricl5@gmail.com r DATE:09/20/2016 Before me this day personally appeared Maikel Garcia Borne y who,being duly authorized and says: That he or she will be the only person working on the project located at: f 475 NE 91st St. Miami Shores, Florida Sworn to(or affi ) nd subscribed before me this P oqhn (Sign r (Da ) f j ) C 4tae) _ 4:1� l\.. �J v, (Corporate Sell) ILI_ L $TATE`QF`FLORIbA E - COUNTY OF MIAMI DADE /__' { The foregoing instrument was acknowledged before me this �� day of,5—AMA�_ _,20_L('0 by r on behalf of [ ]was is personally known to me or[ ] has produced as identification. Notary Signature: ,,,���������������� ' $ s •• Type or Print Name: . ••, t�; F