EL-17-870 Permit nrO. EL-3-17-870
Asn°REs L,� j Miami Shores Village ot Permit Type:Electrical-Residential
10050 N.E.2nd Avenue NW �' Work Classification:Addition/Alteration
Miami Shores,FL 33138-0000
._... - Permit Status:APPROVED
Phone: (305)795-2204
tonYVA
Issue Date:5/30/2017 Expiration: 11/26/2017
Project Address Parcel Number Applicant i
10804 NW 2 Avenue 1121360020140
Miami Shores, FL 33168- Block: Lot: ANGELA M HENAO
Owner Information Address Phone Cell
ANGELA M HENAO 10804 NW 2 Avenue (305)793-2495
MIAMI SHORES FL 33168-
10804 NW 2 Avenue
MIAMI SHORES FL 33168-
Contractor(s) Phone Cell Phone Valuation: $6,000.00
MITCH JOSEPH INC (954)655-7911
Total Sq Feet: 0
Type of Work:NEW ELECTRICAL FOR MASTER BATHROOM Available Inspections:
Additional Info:NEW ELECTRICAL FOR MASTER BATHROOM Inspection Type:
Classification:Residential Final
Scanning:3 Meter Box
Alteration
Relocation
Fire Alarm
Service Change
Review Electrical
W.W.
Underground
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $3.60
Invoice# EL-3-17-63503
DBPR Fee $3.38
DCA Fee $3.38 03/30/2017 Check#: 129 $50.00 $200.36
Education Surcharge $1.P0 05/30/2017 Check#: 1719 $200.36 $0.00
Permit Fee-Additions/Alterations $225.00
Scanning Fee $9.00
Technology Fee $4.80
Total: $250.36
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: 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 zon u efmur , -above-named contractor to do the work stated.
May 30, 2017
Authorized Signature:Owner / Applicant / Contractor / Agent Date
Building Department Copy
May 30,2017 1
Miami Shores Village RECEIVED
Building Department APR
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 I
BUILDING Master Permit No.
PERMIT APPLICATION Sub Permit No. 76 40
❑BUILDING (ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
A CONTRACTOR DRAWINGS
JOB ADDRESS: I RC7 W 2 �
City: Miami Shores County: Miami Dade. Zip:,
Folio/Parcel#: - 2130-OOZ-014n Is the Building Historically Designated:Yes NO
Occupancy Type: Load:x Construction Type: Flood Zone: BFE FFE:
OWNER: Name(Fee Simple Titleholder): �NE�'LA C) Phone#: 30S=" lf 1 s
Address: /y 1 q GJc�S J• �� �{ Z� r G,
City: fA lAM l Too-C-:4 State: Zip: 2✓31 l
Tenant/Lessee Name: Phone#:
Email:
P
CONTRACTOR:Company Name: ��1 t �DsuPH I�2_ Phone#: � { " �SS 37511
Address: 110 1 yj qV�
City: State: FL- Zip:: 3332--Z
Qualifier Name: R X�tr' el 0 Phone#:
State Certification or Registration#: E- 1300/25
59 Certificate of Competency#:
K)
.i2� (�
DESIGNER:Architect/Engineer: I' )1 .J (�3A� -f• G, Phone#:
Address:- 1?o2- NE 17,5- �)1 City: N- MlAr11 State: Zip: -2 I
Value of Work for this Permit:$ 6 °1)00 •o<D Square/Linear Footage
yoffWyorki:w .�
' �3 �'�diX f'>tion /•�[N�S�
Type of Work: X' AddiAlteration El New ).Y❑3Repair/Replaced ,yea ❑!Demolition
V`` '.•.i I sx i. 1
E
D e s c r i pt i o n of W o r k: ,�cJ �,(i�.L2?AIGAt_ fizl� M1��ll,+L g�fihCt �(° ' �A,i•� �'1zrllti►�!
Specify color of color thru tile:
Submittal Fee$ Permit Fee$ CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Notary$ +
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$
(Revised02/24/2014)
o r
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 FAILURE40 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 o the notice q,Lcommencet� c�colast[uttioa_Iiealaw— cocburewilLbedeliveredtoAe_perssn
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.
Signature Signature `
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
_day of ty 20 by t
0 day o' tirvU 2074 by
w is personal y wn to who ispersonally own 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 ( CHRISTOPHER COX NOTARY PUBLIC: 'rCHRISTOPHER COX
�i�•` •(ice , YP I•r
`= MY COMMISSION#GG011522
EXPIRES July.13,2020, MY COMMISSION#GG011522
s EXPIRES July 13,2020
Sign: 153 FlaidaN.WrySe-! .corn ' Sign: °` '`• oom
Print: Print: P
Seal: Seal:
APPROVED BY/ � 30 /X2 l Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
U AtV
STATE OF FLORIDA
} DEPARTMENT OF BUSINESSAND
PROFESSIONAL REGULATION
EC! , 02559 ISSUED: 07/31/2016
GERM D ELECTRICAL CONTRACTOR
JOSE[- MITCHELL MARK
MITCt ,3SEPH INC
IS CERTIFIED under the provisions of Ch . 489 FS.
Expiration date AUG 31, 2018 L16073110004241
BROWARD COUNTY LOCA'-. BUSINESS TALC REetlpT
andrews Ave . Rr� A-100, uderdale. FL 33301-1895 -9 83'_4000 }
VALID OCTOBER 1. 201.x{ THROUGH SEPTEMBER 30 2017
DBA: Receipt# lel-2511, SF
Business Name: HITCH JOSEPH INC Business Type'pL��i1vG,
'IELECTEICAL
CON
Owner Name: '-II C14. JOSEPH Business Opened:o3/lo;1994
Business Location: 1101 NW 95 AVE State/County/CertlReg:SC13002559
SUNRISE Exemption Code:
Business Phone: 954-345-8372
Rooms Seats Employees Machines Professions
For Vending Business Only
Numbar of Machines: Vending Type:
Amount Transfer Fee NSF Fee Penalty Prior Years C011dction Cost Tot:
27.00 0.00 0.00 Q.00 0.00 0.001
THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINE!
BECOMES A TAX RECEIPT This tax is levied for the privilege of doing business within Broward Cour
non-regulatory in nature.You must meet all County and/or Municipality
4 WHEN VALIDATED and zoning requirements. This Business Tax Receipt must be transferr
the business is sold, business name has changed or you have m,
business location.This receipt does not indicate that the business is leg
it is in compliance with State or local laws and regulations.
Mailing Address:
MITCH JOSEPH INC Receipt
° 1101 NW 95 AVE X348-15-00008862
pLAIVTATION, FL 33322 Paid 08/12/2016 27.00
w .
2016 • 2017
MITCH-4 OP ID: DP
CERTIFICATE OF LIABILITY INSURANCE1104120
/ 6
1110412016
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).
Atlantic Pacific Insurance-PBG NAM
ME: atthew A.Peace
FAX
11382 Prosperity Farms Rd#123 aHc Esc:800-538-0487
P Y Alc NO:
Palm Beach Gardens,FL 33410 [:-MAIL
MatthewA.PeaceADDRESS:dhamby@apins.com
INSURER(S)AFFORDING COVERAGE NAIC I
INSURER A:Brldgefleld Employers Ins.Co. 10701
INSURED Mitch Joseph Inc INSURER B:Old Dominion Insurance Co. 40231
1101 NW 95th Ave INSURER C
Plantation,FL 333224822
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 LI
S POLICY NUMBER MMIDD MMIDDIWW LIMITS
B X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
CLAIMS-MADE OCCUR MPG8575D 08/11/2016 08!11/2017 PREMISES Ea occurrence $ 500,00
MED EXP(Any one person) $ 5,00
PERSONAL&ADV INJURY $ 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,00
ECTPRO-ECT LOC
POLICY
1JECT COMP/OP AGG $ 2,000,00
OTHER: $
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $
Ea accident
ANY AUTO BODILY INJURY(Per person) $
ALL OWNED SCHEDULED BODILY INJURY Per accident) $
AUTOS AUTOS ( I
NON-OWNED PROPERTY DAMAGE
HIRED AUTOS AUTOS Per accident $
$
UMBRELLA LIAB OCCUR EACH OCCURRENCE $
EXCESS LIAR HCLAIMS-MADE AGGREGATE $
DED I I RETENTION$ $
WORKERS COMPENSATION _
AND EMPLOYERS'LIABILITY STATUTE ER
A ANY PROPRIETORIPARTNERIEXECUTIVE YIN
N 0196-39395 08/05/2016 08/05/2017 E.L.EACH ACCIDENT $ 1,000 00
OFFICERIMEMBER EXCLUDED? 0 N 1 A
(Mandatory in
If yes,describe under E.L.DISEASE-EA EMPLOYEE $ 1,000,000
DESCRIPTION OP OPERATIONS below E .DISEASE-POLICY LIMIT $ 1,000,00
DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space is required)
Ec13002559
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 NW 2nd Ave
Miami Shore, FL 33138 AUrHHHOORI�ZEDREPPRESENTA�TIVE y�
O 1988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD