Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
RC-17-1667 (2)
BUILDING PERMIT APPLICATION ❑BUILDING (ELECTRIC ❑PLUMBING %0 MECHANICAL JOB ADDRESS: 12 VC / VI 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 ❑ ROOFING ❑PUBLIC WORKS City: Miami Shores County: Folio/Parcel#: 11 2+0Co c)i 3— i 3 s0 Occupancy Type: Load: :RECE P APR 03 -znis FBC 201 Master Permit No. 1 5 —17 - / 2,Z '7 Sub Permit No. RC— —/7— g% 67 ❑ REVISION ❑ EXTENSION ❑RENEWAL 6 %> -g Ls ❑ CHANGE OF 0 CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS Miami Dade Zip: Is the Building Historically Designated: Yes NO Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): I'•LA ` J c'L J Phone#: C 2 3 S / 3d Address: C� lV 1 % (7 / City: /44:41 i 1,1(,-/cc, State: FL Tenant/Lessee Name: Phone#: Email: cif 4 vl aL.J Lvt I q.wi.i Q, 4)4t/tot: I . CC�Wi CONTRACTOR: Company Name: I. ES Phone#: Address:ei9 2/ ` bo *7ef44 LT-, y,n City: / v l -may oil( State: F _ Zip: 3 3 15 5 Qualifier Name: IFI' ti ✓t K Roko r « dop-e.Z, _ Phones: 77i,—,26 o •- 33 f e1 State Certification or Registration #: C_ I cCX.,Co 5 O/ 5 Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: $ c2 50.00R Square/Linear Footage of Work: Zip: 3 3/ g Type of Work: ❑ Addition((yz Alteration ❑ New ❑ Repair/Replace X'-1 Description of Work: . P /. 'c._/' Li c)), s . CDLJ4 ( e 4 -, 79PC0 --2a,0-- 33s zy ❑ Demolition Specify color of color thru tile: Submittal Fee $ Permit Fee $ - /� toe, _ CCF $ CO/CC $ Scanning Fee $ Radon Fee $ f-• DBPR $ Technology Fee $ Tralning/Education Fee $_ Double Fee $ Structural Reviews $ Bond $ TOTAL FEE NOW DUE $ ( V& , es (Revised02/24/2014) d" • Notary$ Bonding Company' Name (if applicable Bonding -Company's Address City 1 State Zip Mortgage Lender's Name (if applicable) 7- 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. 1 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. "WARNINGTO 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 $2504 the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure wilt be delivered to the person whose property Is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at'the job site for the first inspection. hi occurs seven (7) days after the building permit is issued. In the obsen of suc • •osted notice, the inspection will not be • • ro ed and a reinspection fee will be charged. OWNER or AGENT The foregoing instrument was acknowledged before me this a --)day of �L��L- , 20 C7 , by ` I -» : Sr1(�-� , who is personally known to me or who has produced _O 2-1 VI+t- as identification and who did take an oath: NOTARY PUBLIC: Sign: Print: Seal: 11NII11111/,% SP ppI� �q a*ss****s**sss*s*s*�::.*s***s**�'A►ff ink APPROVED BY IRevised02/24/2014) - Signature CONTRACTOR The foregoing instrument was acknowledged before me this r2 ddyof _V1f14.- ,20 1-1 ,by �►atr1 IC exia.ri (AVtZ , who is personally known to me or who has produced identification and who did take an oath. NOTARY PU1syrC: Sign: Print: Seal: as o.4y •.,,, CHENY SI' .' OILY iF `4•',' Notary Public - +te of Florida o1'r CommIssion • F 217742 �� y Comm. Exr Apr b. 2019 ''fl u t ° Bonded t,"m, ' : • • • d Notary Assn. • ?A ?7 l$Plans Examiner Structural Review Zoning Clerk Uc ii ,ri rit rCc RICK SCOTT, GOVERNOR KEN LAWSON, SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL • REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD LICENSE NUMBER EC13006595 The ELECTRICAL CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2018 .:4C4,...ti,::$7-'.. 4 ` ;�4 , RODRIGUEZ, FRANCISCO:MARfO INTEGRATED ELECTRICALSERVICES OF DADE INC.^, 8860 SW 43RD TER " ''.. ---.... `�� :'c.`3:. W `% - �,* MIAMI FL,38165;x`a,_ Y ISSUED: 08/25/2016 DISPLAY AS REQUIRED BY LAW SEQ # L1608250002734 016715 Local Business Tax Receipt Miami —Dade County, State of Florida -THIS IS NOT A BILL - 00 NOT PAY 183172 — ;a. BUSINESS NAME/LOCATION RECEIPT NO. F INTEGRATED ELECTRICAL SERVICES OF DADE INC RENEWAL 4540 SW 74 AVE 7463790 MIAMI FL 33155 LBT EXPIRES SEPTEMBER 30, 2018 Most be displayed at place of business Pursuant to County Code Chapter BA - Art. 9 & 10 OWNER \ SEC.'TYPEOP BUSINESS INTEGRATED ELECTRICAL SERVICES OF D'1N4EGIT T ICAL CONTRACTOR C/O FRANCISCO M RODRIGUEZ QUAUFIIK13006595 Worker(s) 1 PAYMENT RECEIVED BY. TAX COLLECTOR 3'75.00 07/17/2017 CREDRCARD1-17-o48287 This Local Rasbaulas Receipt o ty aatdams peyeset of the Lee* Business Tax. The Receipt is wet a li0000A - permitwoe ,1ISeodol elate beder'sav ificat.rs, to do busiest Helder west amply with astygentamental .ernongwmmessul replay/ laws sod requirements which apply b the anions. Us RECEIPT NO. above mail M &splayed es ill cess.relal vehicles -Miami -Bade Cede SecBa,Z1B For More information, visit www.miemidede aov/szceOe,lg ® i A� L7 CERTIFICATE-OFe LIABILITY/INSURANCE + DATE (MM/DD/YYYY) 04/06/2018 TAMS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVEL'StAMEND;.EXTEND OR ALTER -THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUtE" A CbRtFRACT ;BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: ff the certificate holder is an ADDITIONAL INSURED, the poiicy(ies) must have ADDITIONAL INSURED provisions or 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 Garcia Lorenzo & Associates 6527 Coral Way Miami FL 33155-1843 CONTACT NAME: Joanna Arias (aco. No, Ext : (305) 266-8195 FAX No): (305) 262-2050 ADDRESS: Joanna@garcialorenzo.com INSURER(S) AFFORDING COVERAGE NAIC # INSURERA: WESTERN WORLD INS CO 13196 INSURED INTEGRATED ELECTRICAL SERVICES OF DADE INC 4921 SW 74th Court Miami FL 33155 INSURER B: AMGUARD INSURANCE COMPANY 42390 INSURER c : ASSOCIATED INDUSTRIES INSURANCE COMPAt INSURER D : INSURER E : INSURER F : VERAGES 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 LTRINSD TYPE OF INSURANCE ADDL SUBR WVD POLICY NUMBER POLICY EFF (MM/IYYYYI POLICY EXPDD (MMIDD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY NPP8439918 06/09/2017 06/09/2018 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES Ea occurrence) $ 100,000 CLAIMS -MADE X OCCUR MED EXP (Any one person) $ 5,000 X Owner/Cont. Prot. PERSONAL s ADV INJURY $ 1,000,000 X PD Ded: $250 GENERAL AGGREGATE $ 2,000,000 GEN'L X AGGREGATE POLICY OTHER: LIMIT APPLIES O- JET PER: PRODUCTS - COMP/OP AGG $ 2,000,000 $ B AUTOMOBILE V XOWNED LIABILITY ANY AUTO AUTOS ONLY HIRED X SCHEDULED AUTOS NON -OWNED AUTOS ONLY CA02353757 07/20/2017 07/20/2018 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ UMBRELLA LIAB EXCESS LIAB O OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ $ DED RETENTION $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY OFFICER/MEM ERPEXCLUD DXECUTIVE (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below YNN NIA Y AWC1105080 03/25/2018 03/25/2019 PER STATUTE OTH- ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 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. Coverages are subject to the terms conditions and exclusions as shown in the policy. CANCELLATION Miami Shores Village Building Department 10050 NE 2nd Avenue Miami Shores Fl 33138 t 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 Jose M. Garcia ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD msvp L. c,ov SNAVI-C.S .