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REV-17-2429 XN ro\ Miami Shores Village CT 11 017 V Building Department B 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 I` INSPECTION LINE PHONE NUMBER:(305)762-4949 F--BC 201 BUILDING Master Permit No. PERMIT APPLICATION Sub Permit N 1Li:_) Zy'a ❑BUILDING ; ❑ ELECTRIC ❑ ROOFING REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP ((�� CONTRACTOR DRAWINGS JOB ADDRESS: `13 R� Q1 Sk r..0 City: Miami Shores -County: Miami Dade zip: 331.,E Folio/Parcel#: Is the Building Historically Designated:Yes NO f Occupancy Type: -Load: Construction Type: Flood Zone: FSE: 1 _V�•S� t� OWNER: Name(Fee Simple Titleholder): &V� Q` ct l)Q.\,YA1Cj Pho I15_ tciZZ- Address: q3 tV R1 SV. City: M 1CvAi 'Acre's State: FL- Zip: -53t,56 Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name: FOslief�f SOS) /:��Cf/'fir I (,O Phone#: Address: 1r�Q8 IJI�I 3 S� City: IQMI State: 801/`C& Zip: Qualifier Name: J O* to " Phone#: State Certification or Registration#: `"f M 0449 25f Certificate of Competency#: DESIGNER:Architect/Engineer: Q_,,WQ_fA �r r{'1eL Phone#: 38S".31A_ '5db(. Address: 32,Q1 S..,3 `14 C1• City: \" kwy4, State: Zip: 3SiS5 Value of Work for this Permit:$ Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: Qy� r('CO do-J ., r ,..• •,Y J"p.u 't, 't t ' Specify color of color thru tile: Submittal Fee$ Permit Fee$ O CCF$ 1 LP CO/CC$ .� Scanning Fee$ �QRadon Fee$ Z. DBPR$ � Notary$ Technology Fee$ U Training/Education Fee$ �{_! Double Fee$ Structural Reviews$ Bond$ —" TOTAL FEE NOW DUE$ U� , � 0 (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$2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also,a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence,of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature Signature f OWNER or AGENTr: The foregoing instrument was acknowledged before me this The foregoing instrument -was acknowledged before me this day of �G cab ?� 20 11 by �"7yyday of '06. "��[� ~.20 1 by who ispersonally known to A�s/�:i3,who is persona nown to me or who has produced as me or who has prodGced as identification an who did take an oath. i enti ication and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: i�.--- Sign: Sig .e�:'�° "� .,�• ata lic S a a°.�.--•., � ' _ANION 11 Print Print: iCOMMM N# fi N» t°; M n EXPIRES:January 30,2019 y Comm.Expires Nov 18.2020 Seal: � Seal: ;�F OF r�o' BondM Thry 94dp�f NgMry A�IVhe1 Bonded through National Notary Assn. APPROVED BY.,, yPlans Examiner Zoning a r Structural Review Clerk (Revised02/24/2014) mo�N- CTB Ccrostruction Trades Qualifying Scar . . BUSINESS CERTIFICATE OF COMPETENCY 99EO00259 '$ ',V FOSTER&SON ELECTRICAL CONTRACTORS INC hTRFO JORGE L Is cefrted under the Pr°visions of Chapter 10 of MiamhDade County VALID FOR CONTRACTING UNTIL 0913012019 Muni ci pa! Contractor's, Tax cei pt Miami-DaaeCounty, State of Florida -THIS IS NOT A BILL-DO NOT PAY .M_ CC NO: 99E000259 g� BUSINESS NAM EILOCATION RECEIPT NO. L)�(`FIRES FosnER&9DPf B.ECTPoCAL SEPTEMBER 30, 2 018 C NTRACTMINC 7513184 2498 NW 3 ST Pursuant to County Code MIAMI,FL. 33125 Sec 10-24 OWtaER TYPE OF BUSINESS PAYMENT RECEIVED FOSTER&SDN 8.E,OONTFSINC ELECTRIC.-ALCONTRACTOR BY TAY. COLLECTOR ;O JDFGE L FOSTER PFESiDENT 200.00 07/19/2017 0210-17-004362 Ttlis receipt is not valid in thefolloving Municipalities:Aventura,Coral,Hialeah,Key Biscayne, Miarrti C3rdens,Miarti Lakes.PNrna to Bay,Piriecrest,Sunny Isles Beach,Torun of 0Aer Bay. MIAMI.!]L1DE,- For More Irrforrrrddon,visit y_WW_.rriarrgdadggPA4%cAlt_e,= u li 9i d it e s I Us x r—cm Miami—Clade Counter, State of Florida -THIS!S NO TA BILL-DONOT PAY 4149977 .. BUSINESS NANFJL:CATION RECEIPT NO. EXPIRES FOSTER&SON ELECTRICAL CONTRAK'TOPS INC RENEWAL SEPTEMBER 30, 2018 2498 NW 3 ST 4333777 Must be disp!ayed at Dlace o-bus:r ess MIAMI FL 331215 Pursuant to Co.=^tv Csda r Cha Drer i4.- OWNER SEC.TYPE OF BUSINESS PAYMENT RECEIVED FOSTER.&SON ELEC CONTRS INC 796 ELECTRIC;-.;_CCN TFACTCR 3Y TAX COLLECTOR C/O JORCE L POSTER,PRESIDENT 99E000259 _Y TA rJ?,'LECT0. O i Worker(s) 1 Ck=D;TCARD-17045069 This Local Businass Tax Receipt only confirms payment 3s the Loca'Business-,?x.T^e Receipt is pct a kenss, permit,or a certiticatian of the holder's qualifications,to do business.iiofder mast ccmaiy w1', any governme al or nongovernmental regulatory laws and requirements which apply to the Business. The RECEIPT N0,above must be displayed on alI commercial vehicles-Miami-Dada Coca Sec Ea-216. For more information,visit www.miam1dad9.g9yA@xra flactor STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL_ REGULATION T .s ELECTRICAL CONTRACTORS LICENSING BOARD (850) 487-1395 `n,.��AµP��;• 2601 BLAIR STONE ROAD TALLAHASSEE FL 32399-0783 FOSTER. JORGE L FOSTER & SON ELECTRICAL CONTRACTORS INC 2498 NW 3RD STREET MIAMI FL 33125 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 range �= 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 orderER0015146 ISSUED: 08/11/2016 to serve you better. For information about our services, please log onto www.myfloridalicense.com, There you can find more REG ELECTRICAL CONTRACTOR information about our divisions and the regulations that impact FOSTER,JORGE L y. you, subscribe to department newsletters and learn more about FOSTER & SON ELECTRICAL CONTRACTOR � the Department's initiatives. (INDIVIDUAL MUST MEET ALL LOCAL Our mission at the Department is: License Efficiently, Regulate LICENSING REQUIREMENTS PRIOR Fairly. We constantly strive to serve you better so that you can TO CONTRACTING IN ANYAREA) serve your customers. Thank you for doing business in Florida, HAS REGISTERED under the provisions of Ch 489 F.S '! and congratulations on your new license! Expiration date AUG 31,2018 L1608110003274 ,r DETACH HERE ' RICK SCOTT, GOVERNOR KEN LAWSON, SECRETARY" STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD �v0�i ' to EROC15146 The ELECTRICAL CONTRACTOR j Named below HAS REGISTERED Under the provisions of Chapter 489 FS xpiration date: AUG 31, 2018 (INDIVIDUAL MUST MEET ALL LOCAL LICENSING REQUIREMENTS PRIOR TO CONTRACTING IN ANY AREA) FOSTER, JORGE L 0 � FOSTER & SON ELECTRICAL CONTRACTORS INC 2.498 NVJ 3RD STREET , Y ,v MIAMI FL 33125 t 3 0&11f1016DISPLAY AS REQUIRED BY LAW SEQ# Lt608t101 07 .,t ACo® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) �....� 08/31/2017 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 CONTACT NAME: Camafreita Jenca Insurance Consulting Corp. PN0 N : (786)227-6935 ac No): (786)250-5465 12150 SW 128 Court Ste. 132 ADDRESS: info@jencainsurance.com INSURER(S)AFFORDING COVERAGE NAIC# Miami FL 33186 INSURER A: Scottsdale Insurance Company INSURED INSURER a: Associated Industries Insurance Company Foster&Son Electrical Contractor,Inc. INSURER C: Progressive Express Ins Company INSURER D: 2498 NW 3rd Street INSURER E: Miami FL 33125 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 TYPE OF INSURANCE POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER MMtDDNYYY MWDDNYYY X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 CLAIMS-MADE OCCUR PREMI EOE Eacc rr n e S 100,000 MED EXP(Any one person) S 5,000 A Y Y CPS2725924 8/25/2017 8/25/2018 PERSONAL&ADV INJURY S 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 2,000,000 X POLICY XI PRO-JECT ❑ LOC PRODUCTS-COMP/OP AGG s 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S 1,000,000 _(Ea accident _ ANY AUTO BODILY INJURY(Per person) S C ALL OWNED �/ SCHEDULED 03785578-1 05/29/2017 05/29/2018 BODILY INJURY(Per accident) S AUTOS X AUTOS X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE S AUTOS Per accident S UMBRELLA LIAB OCCUR EACH OCCURRENCE S EXCESS LIAB HCLAIMS-MADE AGGREGATE S DED RETENTION S �/ S WORKERS COMPENSATION X STATUTE X ER" AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNERJEXECUTIVE Y!N E.L.EACH ACCIDENT $ 1,000,000 B OFFICER/MEMBEREXCLUDED? FN NIA AWC1082612 5/1/2017 5/1/2018 -----____ ..___.-___........_-..-.._._.._._. (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE S 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE•POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) Electrical Contractor 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. Village of Miami Shores Building&Zonning AUTHORIZED REPRESENTATIVE 10050 NE 2nd Ave Miami Shores FL 33138 'x`,%` ©1988-2014 ACORD CORPORATION.All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD