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EL-17-2965Miami Shores Village 10050 N.E. 2nd Avenue NW Miami Shores, FL 33138-0000 Phone: (305)795-2204 Project Address P mit Parcel Number Issue Permit NO. EL-12-17-2965 Permit Type: Electrical - Residential Worts Classification: Addition/Alteration Pennit Status: APPROVED te;..51112018 Expiration: 11/03/2018 Applicant 158 NW 94 Street Miami Shores, FL 1131010330790 Block: Lot: GUILUZ LLC Owner Information Address Phone Cell GUILUZ LLC 158 NW 94 Street MIAMI SHORES FL 33150- (305)926-9129 158 NW 94 Street MIAMI SHORES FL 33150- Contractor(s) MESA BROTHERS INC Phone (305)345-1974 CeII Phone Valuation: Total Sq Feet: $ 2,650.00 0 Type of Work: NEW SMOKE DETECTOR GFI IN BATHS AND Additional Info: NEW SMOKE DETECTOR GFI IN BATHS AND Classification: Residential Scanning: 1 Fees Due CCF DBPR Fee DCA Fee Education Surcharge Notary Fee Penalty Fee Permit Fee - Additions/Alterations Scanning Fee Technology Fee Amount $1.80 $3.38 $2.25 $0.60 $5.00 $225.00 $225.00 $3.00 $2.40 Total: $468.43 Pay Date Pay Type Invoice # EL-12-17-65935 05/07/2018 Check #: 1055 $ 418.43 $ 50.00 12/18/2017 Check #: 1029 $ 50.00 $ 0.00 Amt Paid Amt Due 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:, rtify at all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zonin rlgy)dj ore, I authorize the above -named contractor to do the work stated. Authorized Sig :Owner / Applicant / Contractor / Agent Building Department Copy May 07, 2018 Date May 07, 2018 1 BUILDING PERMIT. APPLICATION ❑BUILDING -ELECTRIC Miami- Shores Village_ Building Department 10050 N.E.2nd Avenue, Miami: Shores, Florida 33138 Tel: (305) 79'512204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 ❑ ROOFING D REVISION RECEIVED Dg 18 2017 FBC. 20. -2Q Master,Perinit No. Sub; Permit No. ITR -2G1(05 D°EXTENSION DRENEWAL, ❑ PLUMBING ❑ MECHANICAL D PUBLIC WORKSO CHANGE: OF y CONTRACTOR JOB ADDRESS: 'c e. wilt g4 ST City: Miami Shores . ..County: ..'Miami Dade. v ,f Zip:.S3rt Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: R. Load:-Construction.Type: .Flood Zone: BFE: FFE: OWNER: Name (Fee SimpleTitleholders)::. C- si iv2 Address: 18151 tek 3t C,$" City: kiel41.1= State: Zip: j'�f,^rb Tenant/Lessee Name: ! . Phone#: Email:' CONTRACTOR:' CompanyAlame: Mesa /8,2) Address: SDI S SQ./ /03 4ji, City: Ilia /77/ State: Qualifier, Name: PoLvil State Certification' or Registration #: / 30O18v DESIGNER: Architect/Engineer: Address: Phone#: 305— b.30' aS'g9 Zip: 33/L -Phone#c 30s_34{,S J% 77 Certificate of. Competency #: - Phone#k.__ - City: State: Zip: Value: of Work for this Permit: $ 2 Ile Square/Linear Footageof Work: • Type of Work: ❑ Addition ❑ Alteration ❑. New ❑Repair/Replace ❑Demolition Description of Work: Rag) SO:�. GR. 1 - •xt• % Specify color of color thru tile: I ""' `�� J-r-re'/QC,` 775 Submittal Fee $ So pat U . Permit Fee;$X O ! CCF $. :I i 0 CANCELLATION' SHOP ., DRAWINGSt, CO/CC $ '� Scanning Fee $ Radon Fee $ 2 • Z. S DBPR'S 3 -•3 S " } - : Notary,$ S' Technolo` Fee'$ 2 -• 4"0 ' ^^ gY Training/Education,Fee $ 0 • VQ '° t ' Doutile�Fee $; "2:25 .a" Structural Reviews $ Bond $-.• '-- TOTAL FEE NOW,DUE$ • (Revised02/24/2014) 7.9P�': rA-4 Bonding Company's Name (if applicable) Bonding Cor,,,;,iny'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 asindicated:I certify that no work or installation has commenced prior to the issuance of a permit -and that all work will be'performedto 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,JANKS, AIR CONDITIONERS, ETC OWNER'S AFFIDAVIT: I certify that all the foregoing Information is accurate and that all work will be donein compliance with all applicable laws regulating construction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR, PAYINGTWICE' FOR IMPROVEMENTS. TO' YOUR. PROPERTY., IF YOU INTEND TO OBTAIN FINANCING, CONSULTxWITH 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, fhe'applicant must promise in good faith that a copy of thenotice of commencement and construction lien law. brochure "will :be.delivered to the person whoseproperty 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 obsenrnf.such !posted notice; the inspection will not be appro ed • d a reinspection fee will be charged. Signature CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged' before me this , 20:. by �- day of pea 2 , 20 / 7 by o personal! nown to _120o4,4,d( € . who is';pers"onaliy known to me or o has'prodUced -0 1 1 as Me or has produced _ .... identification and who did take an oath. f NOTARY PUBLIC: Sign Print: Seal: APPROVED BY (Revised02/24/2014) identificati'on`and who did take 'an'oath. NOTARY PUBLIC: Sign: Print Seal: Plans Examiner NANCITUMA Iff:3011PAISSON EXPIRES JAN 21, 111113 toad troop lg Warn as Zoning Structural Review Clerk ram Notice of Preventative Treatments for Termites (As required by Florida Building Code (FBC) 104.2.6) 8310 SW 43rd Street • Miami, FL 33155 Phone: 305-221-3149 158 NN 94 ST Miami Shores,F1 5/18/18 Date Premise 75 Product Used Address of Treatment or Lot/Block of Treatment 9:30 am Time Alfonso Soriano Applicator Imidacloprid 4 Gallons Chemical used (active ingredient) Number of gallons applied .05a 13 SF Percent Concentration Area trreated (square feet) Linear feet treated Horizontal: & Adjoining Slab Stage of treatment (Horizontal, Vertical, Adjoining Slab, retreat of disturbed area) As per 104.2.6- If soil chemical barrier method for termite prevention is used, final exterior treatment shall be completed prior to final building approval. If this notice is for the final exterior treatment, initial and date this line 5/18/18 w TADEOS ENGINEERING June 1,2018 Attention to: Building Official Miami Shores Village Building Department Re: 158 NW 94th St., Miami Shores, FL 33150 Building Permit: RC-12-17-2890 Tadeos Engineering LLC 14750 NW 77th Ct., Suite 205, Miami Lakes, FI. 33016 Email: Iu isatadeosengineering.com Phone: 305 903-8816 SOIL LETTER I hereby attest after inspecting the foundation at the property referred before, that to the best of my knowledge and professional judgment, the soil encountered at the foundation deep is suitable for supporting foundation for a maximum allowable bearing capacity of 2000 psf corroborating our initial assessment. If you have any question or need additional information regarding the statement above, please do not hesitate �• U Respectfully, / e R',. 0f \ o,. Luis Oscar de la Hoz Oli era, F y: License No. 73932 E112 NGINEERING June 1, 2018 Attention to: Building Official Miami Shores Village Building Department Re: 158 NW 94th St., Miami Shores, FL 33150 Building Permit: RC-12-17-2890 Tadeos Engineering LLC 14750 NW 77t Ct., Suite 205, Miami Lakes, FI. 33016 Email: Iuisetadeosengineerino.com Phone: 305 903-8816 hereby attest after inspecting the foundation reinforcement at the property referred before, that to the best of my knowledge and professional judgment, the work is in compliance with the actual Florida Building Code and approved set of drawings. If you have any question or need additional information regarding the statement above, please do not hesitate to,contact us. Respectfully 139 ✓` • , Luis Oscar de la Hoz Olivera, P.E. License No. 73932 ACORO CERTIFICATE OF LIABILITY INSURANCE `' DATE(MM/DD/YYYY) 5/7/2018 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 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 SUNZ Insurance Solutions, LLC. ID: (Kymberly) c/o Kymberly Group Payroll Solutions, Inc. 3218 E. Colonial Drive, Ste F Orlando , FL 32803 NAME CT Phil Martina PHONE FAX .(A/C. No. ExtL 407-228-6428 (NC, No): ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURERA: SUNZ Insurance Company 34762 INSURED Kymberly Group Payroll Solutions, Inc. 3218 E Colonial Drive Suite F Orlando FL 32803 INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : CERTIFICATE 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 Jean SUBR wvn POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MM/DD/YYW) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS -MADE OCCUR DAMAGE TO RENTED PREMISES (Ea occurrence) $ MED EXP (Any one person) $ PERSONAL 8 ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PRO- JECT PER: LOC GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ $ AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS NON -OWNED AUTOS ONLY 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 $ $ A WORKERS SATION AND EMPLOYERSELCOMPIABILIITY ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBEREXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y/N N / A WC010-00001-018 3/1/2018 3/1/2019 /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) Coverage provided for all leased employees but not subcontractors of: Jager International, Inc. Client Effective: 7/22/2015 CERTIFICATE HOLDER CANCELLATION 1215 Miami Shores Village 10050 NE 2 Avenue Miami Shores Village 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 Glen J Distefano ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 41749797 I Kymberly Group Payroll PEO 010 MASTER CERT I Phil Martina 5/7/2018 1:06:11 PM (CDT) I Page 1 of 1