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EL-17-2476 � I Permit N©. EL-1 0-17-2476 �e�jO1S y,� Miami Shores Village Permit Type:Electrical-Residential 10050 N.E.2nd Avenue NE work clessirication:AdditionlAlteratton Miami Shores,FL 33138-0000 Per i - Permit Status:APPROVED a,�— �s Phone: (305)795-2204 .64.-,.op Iss o te: 10/1812817 Expiration: 04/16/2018 Project Address Parcel Number Applicant 746 NE 94 Street 1132060141660 WILLIAM ARNOLD' Miami Shores, FL 33138- Block: Lot: ' � 4 Owner Information Address Phone Cell WILLIAM ARNOLD 746 NE 94 Street MIAMI SHORES FL 33138-2915 Contractor(s) Phone Cell Phone Valuation: $4,600.00 DADE COUNTY ELECTRICAL CONTRA "..._ Total Sq Feet: 0,1 Type of Work:NEW ADDITION BATHROOM Available Inspections: Additional Info: Inspection Type: Classification:Residential Final Scanning: 1 Meter Box ; Alteration Relocation Fire Alarm Service Change ° Review Electrical i W.W. Underground 4 , Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $3.00 DBPR Fee Invoice# EL-10-17=65380 $3 38 , DCA Fee 10/18/2017 Credit Card $ 191.63 $50.00 ° $2.25 Education Surcharge $1.00 10/17/2017 Check#:274 $50.00 $0.00 Permit Fee-Additions/Alterations $225.00 Scanning Fee $3.00 Technology Fee $4.00 Total: $241.63 I In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans,drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECT CAL,PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work. OWNERS AFFIDAVI ce that all t oregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction an' oni ut rmor authorize the above-named contractor to do the work stated. October 18, 2017 Autho ' Sig r / Applicant / Contractor / Agent Date Building Department Copy October 18,2017 1 v It Miami Shores Village 7BY:= Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 f INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC20 � BUILDING Master Permit No.-21T-- 1 PERMIT A=ON Sub Permit No. ❑BUILDING ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB,ADDRESS* City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: l��J�G ��y`� Is the Building Historically Designated:Yes NO t Occupancy Type: Load: Construction Type: ViFlood Zone: /' BFE: FFE: /. OWNER: Name(Fee Simple Titleholder): ?'!u'1 -j4- � e �; vi ij 6 hone#: Address: City: /�ih "'/ �(''�0` f State: Zip: �� 1 Tenant/Lessee Name: Phone#: Email: # v CONTRACTOR:Company Name: Phone#: 7 Address: City: State: �� Zip: CA ' r , Qualifier Name: IR—) �Ij Phone#: State Certification or Registration#: EC'no t, 7 1G Certificate of Competency#: I DESIGNER:Architect/Engineer! ! Phone#: CAJ Address:/�v� City: State: Zip: Value of Work for this Permit:$�i J Square/Linear Footage of Work: Type of Work: KAddition ❑ 'Alteration ❑ New ❑ Repair/Replace ❑ Demolition t Description of Work: 0, �. .. -iA+ut Specify color of color thru tele : • Submittal Fee$ j"�- �j•O 0�y' �Pe"rrriit Fee$ ' ©� �`r CCF$ :3• dZ) CO/CC$ ' 1-. Scanning Fee$ � Radon Fee$ 2, 2� DBPR$-:3 • 39 Notary$ Technology Fee$ t?" dU Training/Education Fee$ Double Fee$ Structural Reviews Bond$ TOTAL FEE NOW DUE$ KJ (Revised02/24/2014) Bonding Company's Name(if applicable) y � Bonding Company's'Acl&essLT :t 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$2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also,a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature Signature :OW'NER'or AGENT CONTRACTOR The foregoing instrument was a knowledged befor/e me this The foregging instrument was ackn_owwlledged before me this 16 day of 0(� ��r 20 / � by I V d y of �G .0 '20�, by l�fGvr► r Y! who is personally known to Slid V& 44 r tlf who is personally knownto me or who has produced F UL r as me or who has produced fl o1'L � �✓G q L (050"- identification and who did take an oath. identification and who did take an oath. NOTARY'PUBLIC: NOTARY PUBLIC: Sign: Sign: Print: I Print: Seal: � '� y COMMISSION F FF914NO Se LEEANATHOMPSON ` EXPIRES Scow ibmQ/,401st '~�J MYCOMMISSION#GGOTSM N07��96-0'S7 Fbr QaNupr pNn ;:: ' EXPIRES:February 26,2021 ted:;o'tB_e, Thru Na Public Underwriters APPROVED B Plans Examiner r Zoning Structural Review Clerk i (Revised02/24/2014) c f A 1 { 003M Business Tax Receipt Miami--Dade County, State of Florida THIS 15 NOT A BILL—DO NOT PAY 6463772, '8136111ESS NAME/LOCATION RECEIPT N.O. EXPIRES MAA*C01Ji-' ELECTRICAL.CONTRACTORS LLC RENEWAL. SEPTEMBER 30, 201$ 7 '' 'L=4 - 41732524 Must be displayed at place of business HIALTAIJQ*330*,,`,' Pursuant to County Code Chapter 8A—Art.9&10 Ar ! OYYINqR' i:;. *�K .; SEC.TYP)ff OF=SUSINESS +:. DADS COUNTY ELECTRICAL'CRONTRACTOCLECTAICAL;CONTRACTOR SY Ta R��N �° COLLECTOR E /t A,'MILKA LSIERRA PRES= EC1300516 �� I4rlcet{s) FPPU11—' 17-013391 This'Local Business Tax Receipt only confirms payment of the Local Business Tax. The Receipt is not a)Lgwse,° pelrnit,<or:a certification of the holder's qualifications,to do business. Holder must comply wig: ✓` or non evetnmen;al.regulptory lavers anUsquirements which apply to the business. :The RECEIPT NO.above must be`displayed on all commercial p ! For more infatmation,vim , ! S J ! ! r ! Scanned by CamScanner AC`R bf CERTIFICATE OF LIABILITY INSURANCEDATE,MM�DDIY : � F1044/2017 I THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS j CERTIFICATE bOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES° i BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICAiiE 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: RIVERS INSURANCE AGENCY INCE (3175) 888-3627 AVC No:(305)888-3647 2879 West 2nd Ave No Ext: y ADDRESS:ri.v'ersino@bellsouth.net Hialeah, FL 33010 INSURER(8) AFFORDING COVERAGE NAICK INSURER A:COVINGTON SPECIALTY INSURANCE INSURED DADE COUNTY ELECTRICAL CONTRACTORS LLC INSURER B 775 W 70TH PL INSURER C: PROGRESSIVE EXPRESS INSURANCE COMPANY ! HIALEAH, FL 330014 INSURER D:ROCKHILL INSURANCE COMPANY 786 586 2242 INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: i 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. /NSR POLICY EFF POLICY EXP IF TYPE OF INSURANCE POLICY NUMBER MMlDD/YYW MMIDDIYYYY LIMITS LTR GENERAL LIABILITY EACH OCCURRENCE s 1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES Ea accurrenca $ , 100,000 CLAIMS-MADE OCCUR MED EXP(Any one person) $ u 5,000 A X $500 DED Y Y VBA344259-00 11/20/1611/20/17 PERSONAL&ADV INJURY $ 97,123 GENERAL AGGREGATE s$2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ 1,000,00 POLICY PRO- LOC i $ INED SINGLE LIMIT AUTOMOBILE LIABILITY Ea acxident $ 1,000,000 ANYAUTO11/16/16 11/16/17 BODILY INJURY(Per person) $ ALL OWNED SCHEDULED 01944543-4 BODILY INJURY(Per accident) $ C AUTOS X AUTOS PROPERTY UAMAU _ ....._..._.,. .. _._ HIRED AUTOS AUTOSWNED Par accident) $ UMBRELLA LIA8 X OCCUR RXSLWGROC1768-00 11/20/16 11/20/17 EACH OCCURRENCE s 2,000,000 O EXCESS LIAB CLAIMS-MADE AGGREGATE s 2,000, DED RETENTION$ $ " i WORKERS COMPENSATION TRY L!M) E AND EMPLOYERS'LIABILITY YIN09/27/17 09/27/18 ANY PROPRiETO"ARTNERtEXECUnVE DAWC669177 E.L.EACH ACCIDENT $ 1,000,000 B OFFICEP MEMBER EXCLUDED? NIA Y i E.L.DISEASE-EA EMPLOYE $ .1,0001000 /Mandatory in NH) l` s,describeunder E.L.DISEASE-POLICY LIMIT $ 1 000 000 DESCRIPTION OF OPERATIONS below 3 1 DESCRIPTION OF OPERATIONS/LOCATIONS 1 VEHICLES (Attach ACORD 101,Additional Remarks Schedule,0 mors space is required) SCHEDULED VEHICLE: 2005 CHEVY EXPRESS G1500 VINMSGCFG15X751236437 Dade Electrical Contractor. EC13005164. I CERTIFICATE HOLDER CANCELLATION MIAMI SHORES VILLAGE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 't t 10050 NE 2ND AVE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN MIAMI SHORES, FL 33138 ACCORDANCE WITH THE POLICY PROVISIONS. 4 AUTHORIZED REPRESE A E 4 3 019 2010 ACORD CORPORATION. All rights reserved. ACORD25(2010105) The ACORD name and logo are registered marks of ACORD I i AOR� DATE(MWODNYW) iJA CERTIFICATE OF LIABILITY INSURANCE10/4/2017 j THIS CERTIFICATE IS ISSUED AS-A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CEi2TIFICATI: bOES 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 i 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: RIVERS INSURANCE AGENCY INC PHONE Ext. (305 888-3627 FAX AvC No):(305)888-3647 2879 West 2nd Ave t-MAIL Hialeah, FL 33010 ADDRESS: , INSURER(8) AFFORDING COVERAGE MAIC# ' INSURER A:COVINGTON SPECIALTY INSURANCE INSURED DADE COUNTY ELECTRICAL CONTRACTORS LLC INSURER 8 : AWAY GUAIM INSURANCE CMCrMff— ` 775 W 70TH PL INSURER C:PROGRESSIVE EXPRESS IN'SURAN'CE COMPANY I HIALEAH, FL 330014 INSURER O':ROCKHILL INSURANCE COMPANY 785 586 2242 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 a INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS I 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. IN�R TYPE OF INSURANCE INSR POLICY NUMBER MMroDrvvW MMIDADDL 3USR POLICY EFF Drmrr LIMITS GENERAL LIABILITY' EACH OCCURRENCE s$1,0001000 X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ 100,000 I CLAIMS-MADE OCCUR MED EXP(Any one person) $ 5,000 A X $500 DED VBA344259-00 11/20/1611/20/17 PERSONAL&ADV INJURY $ 97,123 I Y Y GENERAL AGGREGATE s$2,000,01711711 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG S 1,000,000 1 POLICY PRO- LOC $COMBINED SINGLE LIMI AUTOMOBILE LIABILITY/ Ea accident $.1-n0 r 000, i ANYAUTO11/16/16 11/16/17 BODILY INJURY(Par parson) $ ALL OWNED SCHEDULED 01944543-4 BODILY INJURY(Per accident) $._ 'C AUTOS X AUTOS HIRED AUTOS AUTOS Par accident ROPERTY DAMAGE $ $ UMBRELLA LIAR OCCUR RXSLWGR001768--00 11/20/16 11/20/17 EACH OCCURRENCE $ 2,000,000 FD EXCESS LIAR CLAIMS-MADE AGGREGATE s 2,000,000 .OED RETENTIONS $ WORKERSIOTH- COMPENSATION T RY LIMI S ER AND EMPLOYERS'LIABILITY- g y J / ` ANY PROPRIETORIPARTNEWEXECUME YIN DAWC669177 �9J 27/17 0�/27/1g E.L EACH ACCIDENT $' 1,000,000 B OFFICIMMEMSER EXCLUDED? N/A Y FT (Mandatory in NHS E.L.DISEASE-EA EMPLOYElf$ 1,000,000 , 3` s,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 I I 3 i DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,it more space is required) SCHEDULED VEHICLE: 2005 CHEVY EXPRESS 61500 VIN#IGCFG15X751236437 Dade Electrical Contractor. EC13005164. I t jI I I CERTIFICATE HOLDER CANCELLATION I MIAMI SHORES VILLAGE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 10050 NE 2ND AVE, THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED, IN MIAMI SHORES, FL 33135 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESS AT E I a 19W201 0 ACORD CORPORATION. All rights reserved. ACORD25(2010/05) The ACORD name and logo are registered marks of XCORD