REV-17-139 Av
IVSD
Miami Shores Villa e T
g J 8 2017
Building Department
10050 N.E.2nd Avenue, Miami Shores,Florida 33138
Tel:(305)795-2204'Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949 t—�
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BUILDING Master Permit No.—W16 1268
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PERMIT APPLICATION Sub Permit No.
a❑BUILDING 0 ELECTRIC F-1ROOFING ❑ REVISION ❑ EXTENSION r1RENEWAL
F-IPLUMBING MECHANICAL PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION SHOP
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 Cc;ryea Phone#:
State Certification or Registration#: EC13002182 Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$5,000.00 Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New Q Repair/Replace ❑ Demolition
Description of Work: Replace panel 150 amps and meter can. Install 20 high hats & kitchen remodeling
according to approved plans.
Specify color of color thru tile:
Submittal Fee$ Permit Fee$ 2Z2f%m'0 -rSCF$ 2 CO/CC$ �—
Scanning Fee$ Radon Fee$ J • DBPA$ J g Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$
(Revised02/24/2014)
f
,y
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.
r
r "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 oppro a reinspection fee will be charged.
Signature _ Signature
cif - C �
OWNER or AGENT CONTRACTOR
F - t
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
day of 7Aril a r 20 ( 7 , by 31 st day of October 20 2016 by
�^ f S Iwho is personallyknownto Nestor I Corvea ,who is personally known to
me or who has produced t)i'tv Q Y h c`�r UIQ as me or who has produced as
I identification and who did take a oath. identification and who did take an oath.
NOTARY BLI NOTARY PUBLIC• U
01,
FRANCISCO P. MORALES
. ��: Notary Public-State of Florida
_e *�
Commission#FF 39767
Sign: 0 Sign:!� ..`aa°f My Comm.Exp.November 17,2017
-Florida
Print: m Print: Francisco Mora
les
Seal: Seal:
YANADY PRIETO
MY COMMISSION#FF 214031 '
:,_" EXPIRES:March 25,2019
•;j_Z-, Bonded Thru tJotaryPublic Undenwbrs
APPROVED BY /" 1`(��`���' Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
CERTIFICATE OF LIABILITY INSURANCE 112/31/21016
THIS CERTIFICATEIS ISSUED AS A MATTED OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND ORALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. T1416 C5117nFICATS OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSUMR(S),AUTHORIZED
REPRESENTATIVE OR PRODUCER.AND THE CERTIFICATE HOLDER
IMPORTANT_If the certificate holder is an ADDITIONAL INSPIRED,the policy(ios)must have ADDITIONAL.INSURED provisions or be endorsed.
If SUBROGATION IS WAIVED,subject to the toretits 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 endomemen s.
v,rvawcfr Comf
NA
HON
PAYCHEX INSURANCE AGENCY INC (A//C..No.uiu: wc.Nor. (688) 443-6112
210705 P: F. (888) 443-61x,2 A0�;
PO BOX 33015 IHSURER(S)AFFORDING COVERArt NAIC0
SAN ANTONIO TX 78265 iNsuRERA: Twin City F'i>re ins Co
19SURED INSVRER A:
INSURER C:
INDUSTRIAL ELECTRICAL SYSTEMS CORP INSURER O:
14050 SW 84TH ST STE 206 I�Vxek:
MIAMI FL 33183 INeunEnF:
COVERAGES CERTIFICATE NUMBER= REVISION NUMBER.,
TH15 IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWIiHUTANDING ANY REQUIREMENT, TERM OR CONOIYION OF ANY CONTRACT OR OTHER DOCUMENT Wrni 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 G0140ITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
.(VAR NS(lRANCE aDDL S(JBR POLICTNUASU= POUCT OF POLICI Exp IIMIf4
DD!rYYY)
C014MERCW..0ENI5R^)- IABILtrY EACH OCCURRENCE g
CLAIM54AAOE I I OCCUR DAMAGE YO RENTED
PREMISES(Ea omun'anco) S
MED EXP(Arty one person) s
PERSONAL&ADV INJURY
GEN'LAGGR�EGA-T^-E� LIMIYAPPUESPER Gi:NEi:ALAGGREGATE e
POLICYU�E T❑LOC PAMUCTS-COMP/OPAGG g
OTHER:
AUYDM0131LF LIABILITY COMBINED SINGLE LIMIT �
Ea aocide
ANY AUTO BODILY INJURY(Per Person) $
OWNED SC1FDULF-D
AUTOS ONLY AUTOS BODILY INJURY(Paraocident)
HIRED NON-OWNED NKU�rKTYDAMAGE
AUTOS ONLY AUTOS ONLY (Peraedaent) s
S
UMBRELLALIABOCCUR EACH OCCURRENCE c
EXCU3 L UW CLAIMS-M&DE A(=RJ GATE
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NfJRA.c�S CY17�6fW770K X PERC7rH-
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ANY PROPRIETOR/PARTNER/EXEcu nvLY1N S L EACH ACCIDENT -1 Q00, 000
OGPICEWMEMBERFXCLVD�D7 r
.A. (Mandatory InNH) � nA •76 VEC F06186 01/24/7.07.7 01/24/7.016 E.L-DISEASE-FA EMPLOYEE s] OQQ 500
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yes•describe udder
D
ESCRIP7)ON OF OPERATIONS trslpw E,L.DISEASE.POLICY LIMIT
0ESCR/PT10N OF OPFRATIONS/LOCATiONS/VAR-901AWRD 101,Additional Remarks Schodule,may be attachwd it more apo is requirod)
Th6se usual to the Insured's Operation$. EC13002182
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBE()POLICIES BE CANCELLED
BEFORE THE pCPIRATION DATE THEREOF.NOTICE WILL BE
DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS.
M'ami ShOzes Village Building Dept AT)TNORlZEDREPRESENTAnVE
10050 NE 2ND AVE `
M7 AMI SHORES, FL 33138
ACORD 25 201 fi/03 V IBBB-2015 ACORD CORPORATION-All rights resery
) The ACORD name and logo are registered marks of ACORD