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El-17-1083
Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138-0000 Phone: (305)795-2204 Project Address 9300 BISCAYNE Boulevard Miami Shores, FL 33138- Owner Information Address Permit Permit°NO. EL-4-17-1083 Permit Type: Electrical - Residential Work Classification: Alteration Permit Status: APPROVED Issue Date: 4/1812017 Expiration: 1011512017 Parcel Number 1132060141640 Block: Lot: Phone Applicant GABRIEL COSENTINO Cell GABRIEL COSENTINO 9300 BISCAYNE Boulevard MAIMI SHORES FL 33138- (305)962-1893 9300 BISCAYNE Boulevard MAIMI SHORES FL 33138- Contractor(s) Phone NODAL CONSTRUCTION & ELECTRIC (786)586-3020 Cell Phone Type of Work: INSTALLATION OF HIGH HATS, OUTLETS, Additional Info: Classification: Residential Scanning: 1 Fees Due CCF DBPR Fee DCA Fee Education Surcharge Permit Fee - Additions/Alterations Scanning Fee Technology Fee Total: Amount $2.40 $3.38 $3.38 $0.80 $225.00 $3.00 $3.20 $241.16 Pay Date Pay Type Invoice # EL-4-17-63742 04/18/2017 Credit Card Amt Paid Amt Due $ 241.16 $ 0.00 Available Inspections: Inspection Type: Review Electrical 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 zoning. Futhermore, I authorize the above -named contractor to do the work stated. April 18, 2017 Date Authorized Signature: Owner / Applicant / Contractor / Agent Building Department Copy April 18, 2017 1 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 BUILDING PERMIT APPLICATION (BUILDING (ELECTRIC ❑ ROOFING ['PLUMBING ❑ MECHANICAL El PUBLIC WORKS JOB ADDRESS: q 3OL 0/.SCtN6-- WQ Master Permit No. RC ((, 2Sc$ Sub Permit No. ( (b e ❑ REVISION El EXTENSION ❑ RENEWAL ❑ CHANGE OF Ei CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS City: Miami Shores � County: Miami Dade Folio/Parcel#: 1 I J2cQ— bI`'f "(, J Occupancy Type: Load: Construction Type: Flood Zone: Zip: Is the Building Historically Designated: Yes NO BFE: FFE: OWNER: Name (Fee Simple Titfehorder): 5/2 t Z� GO'&r•T7Na Phone#: Address: City: l300 (S«}-yAi F 6fr✓ij - r A -A.{ ( f 1 J /a-5 State: Ft- Tenant/Lessee Name: Email: /Zip: -5�L1�i`� Phone#: CONTRACTOR: Company Name: NODAL CONSTRUCTION & ELECTRIC ASSOCIATES INC Address: 9053 NW 189 TERRACE Phone#: 786-586-3020 City: HIALEAH State: FL Qualifier Name: JOSE A NODAL Zip: 33018 Phone#: State Certification or Registration #: CEC#13004085 Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: Value of Work for thi Permit: $4,000 Type of Work: Addition El Alteration City: State: Zip: Square/Linear Footage of Work: %DO �. ❑ New El Repair/Replace ❑ Demolition Description of Work: 1-In344 01 (A fsf Uu4I11 j £.40I1 d(ir,Eus, M<'vr. lag. v S+6✓r'rP No,./ 0(0, bf'1 S Specify color of color thru tile: Submittal Fee $ Permit Fee $ Scanning Fee $ Radon Fee $ Technology Fee $ Training/Education Fee $ 2.7 da CCF $ CO/CC $ Structural Reviews $ DBPR $ Notary $ Double Fee $ q Bond $ `'� TOTAL. FEE NOW DUE $ Z +1 1 v (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 Jaw 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 OWNER or A ENT The foregoin:' strument was acknowledged before me this The foring instrument was acknowledged before me this 51' day of 9 el( , 20 I 1 by ?,1 day of Au t,, ; t , 20 I C. by k It e ( C � , who is personally known to ,Iit A /V 0 J.i , who is personally known to me or who has produced hL 'C . (/ olt50.2. as me or who has produced 0e t r« S I((al s < identification and who did take an oath. NOTARY PUBLIC - Sign: QQ ,, Print: ele. i4 Seal: / MEDELIN SUAREZ 4 MY COMMISSION # G02961 Ep, �y0 O EXPIRES: June 15, 2020 identification and who did take an oath. 'NOTARY PUBLI Sign: Print: Seal: as ******************** i**********************************************ski********************************* APPROVED BY ��� /(���� l f 1', y}Plans Examiner Zoning (Revised02/24/2014) Structural Review Clerk Miami -Dade County, State of. Florida -THE ISNOT A aim -DO NOT PAY 6121834 BUSNESSNAMIE/10CAT10N NODAL CONSTRUCTION A ELECTRIC ASSOCIATES INC 4165 NW 132.ST BAY 2 OPA LOCK& FL 33054 OW HER crioN & ELECTRIC ASSOC cq actin ingr tenAt PR .1 ECI30040 Woke* 135 NODAL CON tArEs INC SEC. "MPS 0 U SEEDS lgt WECELEMICAI- CONTRAciorz E PIPES SEPTEM.BER 30, .201;7 Must be displayed at piece of business Purulent to county Code Chapter 8A Art- DA 19 PA YM ENT RECEIVED BY TA x-901:LEOTOR 46.00 0912012016 02041-002494 Via toad BusinessTcat 11,ceiptcdyccalsospaymeatcliheiccal Business Tax: llieflacelpfis not ailicarOle, peorttor a cacti -cation iheholder'squalPtatisok to &hoboes. Mader nut comply wilt arsolchiceibesibil dr nangavanirenial maltaorylostsandiequliamsaswhieb apcly tolhe,busineas, The Bal3PINC1 ohms soothe dig:doodahs', dearnocial %glades - Miarel-OadeOxleS*88-281. Far recrelitotation. sewarataniclede,gatbeatdiester Local snesS.. Tax Receipt Miami —Dade County, State of Florida -TtitstS NOT A Ell -DO NOT PAY 6121834 BUSINESS NAME/LOCATION NODAL CONSTRUCTION & ELECTRIC ASSOCIATES INC 4165 NW 132 BTBAY 2 OPA LOCKA. FL 33054 NOC TRIC ASSOCIATES VIC8 ELECTRIC TION JastF NMAI PPM Walia9441. COMMIX FlEctitPT NO. RENEWAL 6313039 SEC. TYPE OP stumps; 196 GENERAL CONTRACT CGC1508213 EXPIRES SEPTEMBER 30, 2011 Must be displayed at place ol business Pursuant tc! Code Chapter 8A - POt. 9'& 10 Ibis local Business Tax Receipt ooly axioms pystele flee local 0011111C410 Tax, Ilse Recelptb mei* lemems. permit. orteettifcereme ef the bade* issaleidees. to de Itesleess. Rehler, most testi*, with awf wee‚-Is or seegovereotteld regulateqhmsend 'squinting*" voltieb eirplf to Rekbesineme. The RECEIPT' NO. Ibsen ascot he displayed vet edl eemetesditlirekieks -111holATTatle tide Setle-ITS. Per mew identatise..tisitenetemouspaltlede4evitextolkelef A� o® CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YVYY) 03/10/2017 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 DOpazo & Associates Inc 8725 NW 18th Terr Ste 300 Miami FL 33172 CONTACT Alexander Dopazo NAME: p PHONE (866)647-9673 (A/C. No.Ext): (305)470-8500 FAX (A/C No): E-MAIL alex@dopazo.com ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC R INSURERA:Western World Insurance Co 13196 INSURED Nodal Construction & Electric Associates Inc 9053 NW 189 Terr Hialeah FL 33018 INSURER B : INSURER C: INSURERD: INSURER E : INSURERF: COVERAGES CERTIFICATE NUMBER:CL1731016305 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 ALLTHE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL INEn SUBR wvn POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MM/DD/YYYY) J LIMITS A X COMMERCIAL GENERAL LIABILITY NPP8397890 03/11/2017 03/11/2018 EACH OCCURRENCE $ 1,000,000 DAMAGE PREMISESO(Ea o currrrence) $ 100,000 X CLAIMS -MADE OCCUR MED EXP (Any one person) $ 5,000 PERSONAL 8 ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L X XPOLICY AGGREGATE OTHER: LIMIT APPLIES PRO JECT PER: LOC PRODUCTS - COMP/OPAGG $ 1,000,000 $ AUTOMOBILE _ LIABILITY ANY AUTO ALL OWNED AUTOS HIRED 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 ANY PROPRIETOR/PARTNER/EXECUTIVE Y� OFFICER/MEMBER EXCLUDED? I I (Mandatory in NH) If yes, describe under ' DESCRIPTION OF OPERATIONS below N /A PER OTH- STATUTE ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) General Contractor and Electrical Contractor. General Contractor License CGC1505213 Electrical Contractor License CEC13004085 CERTIFICATE HOLDER CANCELLATION ( ) Miami Shores 10052 NE 2 Avenue 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 Alexander Dopazo/AD ACORD 25 (2014/01) INS025 (201401) © 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD JEFF ATWATER ci,IEF FINANCIAL OFRCER STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION * * CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW * :ONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law. EFFECTIVE DATE: 3/29/2016 EXPIRATION DATE: 3/29/2018 PERSON: NODAL JOSE A JR FEIN: 711026080 BUSINESS NAME AND ADDRESS: NODAL CONSTRUCTION & ELECTRIC ASSOCIATES INC 6460 MAIN STREET UNIT 5-207 MIAMI LAKES FL 33014 SCOPES OF BUSINESS OR TRADE: LICENSED GENERAL LICENSED ELECTRICAL CONTRACTOR .CONTRACTOR Pursuant to Chapter 440.05(14), F.S., an officer of a co noration who elects exemption from this Cher by fikng a certificate of election under this section may not recover benefits or compensation under this dyer. Pursuant to Chapter 440.05(12), F.S., Certificates of election to be exempt.- apply only wdhin the scope of the business or trade fisted on the notice of election to be exempt. Pursuers to Chapter 440.05(13), F.S., Notices of election to be exempt and certificates of election to be exempt shall be subject is revocation if at any tine after the firing of the notice or the issuance rile certificate, the person named on the notice or certifies* no longer meets the requiremerts of this section for issuance of a certificate. The department anal revoke a DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE E)OMPT REVISED 08-13 QUESTIONS? (850)413-1809 Miami Shores Viiiage Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Notice to Owner — Workers' Compensation Insurance Exemption Florida Law requires Workers' Compensation insurance coverage under Chapter 440 of the Florida Statutes. Fla. Stat. § 440.05 allows corporate officers in the construction industry to exempt themselves from this requirement for any construction project prior to obtaining a building permit. Pursuant to the Florida Division of Workers' Compensation Employer Facts Brochure: An employer in the construction industry who employs one or more part-time or full-time employees, including the owner, must obtain workers' compensation coverage. Corporate officers or members of a limited liability company (LLC) in the construction industry may elect to be exempt if: 1. The officer owns at least 10 percent of the stock of the corporation, or in the case of an LLC, a statement attesting to the minimum 10 percent ownership; 2. The officer is listed as an officer of the corporation in the records of the Florida Department of State, Division of Corporations; and 3. The corporation is registered and listed as active with the Florida Department of State, Division of Corporations. No more than three corporate officers per corporation or limited liability company members are allowed to be exempt. Construction exemptions are valid for a period of two years or until a voluntary revocation is filed or the exemption is revoked by the Division. Your contractor is requesting a permit under this workers' compensation exemption and has acknowledge that he or she will not use day labor, part-time employees or subcontractors for your project. The contractor has provided an affidavit stating that he or she will be the only person allowed to work on your project. In these circumstances, Miami Shores Village does not require verification of workers' compensation insurance coverage from the contractor's company for day labor, part-time employees or subcontractors. BY SIGNING BELOW YOU v' KNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. Signature: Owner State of Flo • a County of Miami -Dade The foregoing was acknowledge before me this day of ,20/,. By 6A/32/ E—t— CoSEou77, / o who is personally known to me or has produced Notary: SEAL: as identification. ww \4EDELUN SUAREZ t'i)MMISS (ON 1 GG2961 or�� EXPIRES- T5, 2020 13004085 1505213 RESIDENTIAL - COMMERCIAL - INDUSTRIAL - CIVIL 0 NI TRUCTION CT RI CRL STATE CERTIFIED CONTRACTORS LICENSED - INSURED - BONDED (786) 586-3020 In^r A N!r- (786) 355-1892 Fax: (305) 825-3411 4165 W 132nd St. Bay 26 Miami, Fl 33054 JOSE NODAL 9053 NW 189 TERR HIALEAH FL 33018 8/29/2016 PRESIDENT NODAL CONSTRUCTION & ELECTRIC ASSOCIATES INC STATE OF FLORIDA COUNTY OF MIAMI DADE BEFORE ME THIS DAY PERSONALLY APPEARED JOSE A NODAL WHO, • BEING DULY SWORN, DEPOSES AND SAYS: THAT HE WILL BE THE ONLY PERSON WORKING ON THE PROJECT LOCATED AT: 9300 BISCAYNE BLVD SWORN TO(AFFIRMED) AND SUBSCRIBED BEFORE ME THIS.29" 1 DAY OF' AUGUST 2016 BY: b5E A . A(v°A-L PERSONALL KNOWN: OR PRODUCED ID: N3CID ^y2(- 3(--0¢ TYPE OF ID PRODUCED: c.E eats e MEDEL SU c'fa MY COMMISSION I! r. ollet ' SIRES: June 15, 2020 Z