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EL-17-1520Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 Project Address Permit NO. EL-6-17-1520 pe t Permit Type: Electrical - Residential IWork Classification: Addition/Alteration Permit Status: APPROVED Issue Da : 7/12/2017 Expiration: 01/08/2018 Parcel Number Applicant 101 NE 104 Street Miami Shores, FL 33138- 1121360130700 Block: Lot: RMGM PROPERTIES LLC Owner Information Address Phone Cell RMGM PROPERTIES LLC 4764 NW 120 Drive CORAL SPRINGS FL 33076- 4764 NW 120 Drive CORAL SPRINGS FL 33076- Contractor(s) CARIB ELECTRIC INC Phone (954)646-0365 Cell Phone Valuation: Total Sq Feet: $ 300.00 0 Type of Work: CHANGE EXISTING OUTLETS IN KITCHEN Additional Info: CHANGE EXISTING OUTLETS IN KITCHEN Classification: Residential Scanning: 3 Fees Due CCF DBPR Fee DCA Fee Education Surcharge Permit Fee - Additions/Alterations Scanning Fee Technology Fee Total: Amount $0.60 $3.38 $3.38 $0.20 $225.00 $9.00 $0.80 $242.36 Pay Date Pay Type Invoice # EL-6-17-64250 07/12/2017 Credit Card 06/08/2017 Check #: 105 Amt Paid Amt Due $ 192.36 $ 50.00 $ 50.00 $ 0.00 Available Inspections: Inspection Type: Final Meter Box Alteration Relocation Fire Alarm Service Change Review Electrical W. W. Underground 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 .. ning. Futhermore, I authorize the above -named contractor to do the work stated. July 12, 2017 ze Signature: Owner / Applicant / Contractor / Agent Date Building Department Copy July 12, 2017 1 BUILDING PERMIT APPLI ATION ITIBUILDING ELECTRIC ❑PLUMBING ❑ MECHANICAL JOB ADDRESS: Miami Shores Village 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 Master Permit No. Sub Permit No. RECEIVED N Ofi 2017 dkt FBC 20 IL't ,l ‘5Z0 ❑ ROOFING ❑ REVISION ❑ EXTENSION n RENEWAL ❑ PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS t-Q 1 J City: Miami Shores County: Miami Dade 01'5— 01-n Folio/Parcel#: ' ` " 2 t 7(-% Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: // FloodJZone: BFE: FFE:r� la OWNER: Name (Fee Simple Titleholder): G-VY c r pog-t IP S L jC Phone#: J c A Q) - 3 G a y Address: (, (( '1 W [ �,o t r rY ,1 1 City: C\ C�- �- 1 S iv i n55 State: T Zip: �3 (\ Tenant/Lessee Name: Phone#: Email: Cego(`\i m 1i a , C.fpr� CONTRACTOR: Company Name: e,91 ,a3 2 CiliC� //VJC____ Phone#: ye�"-#(900 Address: f 1 /� IA/ V 3I !!! 1 I' City: `Ad./A/,/ /10e State: { j4%1— Zip: 33c3 /, Qualifier Nam: �,0ibt)LS I W 4k1-'1� // ) Phone#: /f&_- State Certification or Registration #: L,' C— l S /P07, Pli Certificate of Competency #: / DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: $ WO Square/Linear Footage of Work: Type of Work: El Addition El Alteration Cl New ❑ Repair/Replace ❑ Demolition Description of Work: Specify color of color thru tile: Submittal Fee $ Permit Fee $ Z z$ 6 3/A-- CCF $ CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Notary $ Technology Fee $ Training/Education Fee $ Double Fee $ Structural Reviews $ Bond $ TOTAL FEE NOW DUE $ 19' 2- ' 3 i, (Revised02/24/2014) 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 OWNER or AGENT CONTR OR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of f\c..\ , 20 , by day of tko.\ , 20 1 , by Gftict�/ , who is personally known to l5 7'C , who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Seal: MONALISA GIPSON Notary Public - State of Florida Commission # FF 964211 **************** ee*101# Ckininik ii1s#4 4,i,,o2 41 F °F,,," Bonded through National Notary Assn. APPROVED BY me or who has produced identification and who did take an oath. NOTARY PUBLIC: Sign/ Print: Seal: *************** Plans Examiner Po' MONALISA GIPSON = Notary Public • State of Florida Commission # FF 964211 My Comm. Exit 9 Rational Notary Assn. as Zoning (Revised02/24/2014) Structural Review Clerk STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 TUCKER, DENNIS F CARIB ELECTRIC INC 4441 NW 5TH STREET PLANTATION FL 33317 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 from architects to yacht brokers, from boxers to barbeque restaurants, and they keep Florida's economy strong. Every day we work to improve the way we do business in order to serve you better. For information about our services, please log onto www:myfloridaiicense.com. There you can find more information about our divisions and the regulations that impact you, subscribe to department newsletters and learn more about 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 serve your customers. Thank you for doing business in Florida, and congratulations on your new license! (850) 487-1395 STATE OF FLORIDA DEPARTMENT OE BUSINESS AND PROFESSIONAL REGULATION EC13002662 ISSUED:. 06/23/2016 CERTIFIED ELECTRICAL CONTRACTOR TUCKER, DENNIS;F, `4;;�„' ,;� CARIB ELECTRIC INC. IS CERTIFIED under the provisions of Ch.489 FS. Expiration date : AUG 31, 2018 L1606230001169 DETACH HERE BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT 115 S. Andrews Ave., Rm. A-100, Ft. Lauderdale, FL 33301-1895 — 954-831-4000 VALID OCTOBER 1,2016 THROUGH SEPTEMBER 30, 2017 DBA: CARIB ELECTRIC INC Receipt #.ELECTR8IICAL/ALARMS/CONTRACTOR Business Name: Business Type: (ELECTRICAL CONTRACTOR) if Owner Name: DENNIS F TUCKER Business Opened:us/o1/1981 Business Location: 4441 NW 5 ST State/CountylCert/Reg:EC13002662 PLANTATION Exemption Code: Business Phone: 954-584-6546 Rooms Seats Employees Machines Professionals . 8 Tax Amount For Vending Business Only Number of Machines: Vending Type: Transfer Fee NSF Fee Penalty Prior Years Collection Cost Total Paid 27.00 0.00 0.00 0.00 0.00 0.00 27.00 THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS THIS BECOMES A TAX RECEIPT WHEN VALIDATED Mailing Address: DENNIS F TUCKER 4441 NW 5TH STREET PLANTATION, FL 33317 This tax is levied for the privilege of doing business within Broward County and is non -regulatory in nature. You must meet all County and/or Municipality planning and zoning requirements. This Business Tax Receipt must be transferred when the business is sold, business name has changed or you have moved the business location. This receipt does not indicate that the business is legal or that it is in compliance with State or local laws and regulations. Receipt #1CP-15-00014881 Paid 07/20/2016 27.00 2016 - 2017 ARh®, �. CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDIYYYY) 05/11/2017 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 Levi And Associates Ins. LLC 2790 N Federal Hwy Suite # 300 Boca Raton FL 33431 CONTACT NAME: Michele Vaillancourt (a/c No. EXt): (561) 353-1234 x-112 (Nc, No): (561) 241-2474 ADDARESS: michele@leviinsurance.com INSURER(S) AFFORDING COVERAGE NAIC # INSURERA: TRAVELERS INSURANCE COMPANY INSURED CARIB ELECTRIC, INC 4441 NW 5th Street Plantation FL 33314 INSURER B : INSURER C : 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. INSR LTR TYPE OF INSURANCE ADDL INSD SUER WVD POLICY NUMBER POLICY EFF (MM/DD/TYYY) POLICY EXP (MM/DD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY 660-0288P511 09/01/2016 09/01/2017 EACH OCCURRENCE $ 1 ,000,000 DAMAGE RENED PREMISESO(Ea occurrence) $ 100,000 CLAIMS -MADE X OCCUR MED EXP (Any one person) $ 5,000 PERSONAL 8 ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L X AGGREGATE POLICY OTHER: LIMIT APPLIES JECT PRO-LOC PER: PRODUCTS - COMP/OP AGG $ 2,000,000 $ AUTOMOBILE _ LIABILITY ANY AUTO ALL OWNED AUTOS � SCHEDULED AUTOS NON OWNED AUTOS COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ UMBRELLA LIAB EXCESS LIAB _ OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ $ DED RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y I N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A PER ERH E,L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT i $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached it more space is required) Electrical Contractor LDER CANCELLATION Miami Shores Village Building Dept 10050 NE 2nd Avenue i Miami Shores FL 33138 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE , ACORD 25 (2014/01) © 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD '4 D CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 5/11/2017 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 Work Comp Associates, Inc. P.O. Box 33297 Palm Beach Gardens, FL 33420-3297 CONTACT Michael D Holleman (A/c No, Ext): (561) 500-3592 FAX No): (561) 500-2329 ADMa@WorkCompAssociates.com ADDDRRLESS: il WkCAssociates.com � P INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Florida Citrus, Business & Ind. n/a INSURED Carib Electric, Inc. 4441 N.W. 5th Street Plantation, FL 33317-2131 INSURER B: INSURER C: 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. INSR LTR TYPE OF INSURANCE ADDLSUBR INSR WVD POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MWDDIYYYY) LIMITS GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED PREMISES (Ea occurrence) $ MED EXP (Any one person) $ CLAIMS -MADE OCCUR PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GEN'L 7 AGGREGATE POLICY LIMIT APPLIES PET PER: LOC PRODUCTS - COMP/OP AGG $ $ AUTOMOBILE LIABILITY _ SCHEDULED MBIND (Ea acciden) INGLE LIMIT $ BODILY INJURY (Per person) $ BODILY INJURY Per accident) $ PROPERTY DAMAGE (Per accident) $ U UMBRELLA LIAB EXCESS LIAB O OCCUR CLAIMS- Mq� EACH OCCURRENCE $ AGGREGATE $ $ DED RETENTION $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICE/MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below r/ N N n/a N 10633794 4/1/2017 4/1/2018 X TWC STTU- OTH- ORY LAIMITS ER E.L. EACH ACCIDENT $ 100000 E.L. DISEASE - EA EMPLOYEE $ 100000 E.L. DISEASE - POLICY LIMIT $ 500000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) According to DBPR, Dennis Tucker is the license holder for Carib Electric, license #EC-13002662 CERTIFICATE HOLDER CANCELLATION Miami Shores Village 10050 N E 2nd Avenue Miami Shores Village, FL 33138-2382 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE (BP) ACORD 25 (2010/05) © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD