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EL-17-2333Miami Shores Village 10050 N.E. 2nd Avenue NW Miami Shores, FL 33138-0000 Phone: (305)795-2204 Project Address Permit Parcel Number ISsu Permit NO. EL-9-17-2333 Permit Type: Electrical - Residential Ciassiication: Temp for Construction Permit Status: APPROVED Date:10/24/2017 Expiration: 04/22/2018 Applicant 5 NW 105 Street Miami Shores, FL 1121360050320 Block: Lot: DEBORAH LEONE Owner Information Address Phone Cell Contractor(s) Phone ALES GROUP GENERAL CONTRACT( (786)223-6096 Cell Phone Valuation: Total Sq Feet: $ 3,700.00 0 Type of Work: TEMP ELECTRIC SERVICE TO PROVIDE PO Additional Info: Classification: Residential Scanning: 3 Fees Due CCF DBPR Fee DCA Fee Education Surcharge Permit Fee - Additions/Alterations Scanning Fee Technology Fee Amount $2.40 $2.25 $2.00 $0.80 $150.00 $9.00 $3.20 Total: $169.65 Pay Date Invoice # 10/24/2017 09/28/2017 Pay Type EL-9-17-65188 Check #: 1504 $ 119.65 $ 50.00 Check #: 1392 $ 50.00 $ 0.00 Amt Paid Amt Due Available Inspections: Inspection Type: Final 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. Fu e . uthorize the above -named contractor to do the work stated. uthor ed Signature: Own pplicant / Contractor / Agent October 24, 2017 Date Building Department Copy October 24, 2017 1 3os��l� 4 0-7c Local Busi ness Tax Race' pt Miami -Dade County, Staterof Florida -THIS ISNOTABILL- DONOTPAY s' 6950886 BUSINESS NA M'E/LOCATION ALES GROUP ELECTRICAL CONTRACTORS 896 SW 70 AVE MIAMI, FL 33144 S OWNER ALES GROUP INC gg 'f Worker(s) I 1 t / MIAMI OADE i"t;Tjj I F RECEIPT NO `RENEWAL 7226574 EXPIRES SEPTEMBER '30, 2018 Must be displayed at place of business Pursuant to County Code Chapter 8A Art. 9 & 10 ,SEC TYPE OE BUSINESS �-PAYM ENT RECEIVED 196 ELECTRICAL ... By TAX COLEECTOP( ' CONTRACTOR t�,75'.00 09�/21/2017 EC0001288 / 0208-17-004849 This Local Business Tax Receipt only con^rms payment of the Local Business Tax' The Receipt is not a I ieense. Permit, or a certi "cation of the holder's qua!1" cations, to do business.: Holder mist comply with any governmental -- Or nongovernmental regtietorylawsand rreguirementswhichapplytothe business! fl The FZBD3PT NO above must be displayed on allrconmercial veFxdes -- Miter i- Dede code Sec Ba-276 For more inforrretion. Vi sit WIYYLmanidillie.94vLaxS' lector f *--,,......----,STATE OFFLORIDA--,.�,\ � t4 '- . \' DEPARTMENT,OF•BUSINESS.AND PROFESSIONAL REGULATION' .'.,,,, ELECTRICAL-CONTRACTORS,LICENSING,.BOARD e,N ,*,\\� f E00001286 "" The°ELECTRICAL CONTRACTOR- Nm'ed'bel6 v'1S CE tTiFIED' :068et th6:0.9 1§ions•6EChapte ` $9'FS:^- Ezp raati6nntlaate_;AUG.31--2018 ,,,LOR_ENTE�R � MO � � '~ AL-ES•GROUP_'EL'ECTRIGAL'FCONTRACTORS 896:SW:70,THt VENUE rIVIIAMI= -�' ISSUED: 08/10/2016 DISPLAY AS REQUIRED BY LAW SEQ # L1608100001993 GROUP 896 SW 70TH AVE, ALCS MIAMI, FL 33144 "r ^TRm AL C t:INTRACTOF S PHONE 786-223-6096 FAX 305.262-1389 LICENSE #EC0001288 alesgroupec@gmail.com October 17, 2017 State of Florida County of Miami Dade Before me this day personally appeared Ramon Lorente who, being duly sworn, deposes and says: That he will be the only person working on the project located at: 5 NW,105 St, Miami Shores, FL 33150 Ra on Lorente Qualifier SWORN AND SUBSCRIBED before me by , being personally known to me, and who being fully sworn and cautioned, states that the foregoing is true and correct to the best of his knowledge and belief. Signature of Notary Date IIyoh Puctode) Print Name t: a ..... �uer.y AALIYAH MERCEDES ALVARADO • •; MY COMMISSION ##FF075,110 • PA` EXPIRES December 10. 2017 (407) 3'98.0153 Florid314ot rYSCrviCe.Com JEFF ATWATER CHIEF FINANCIAL OFFICER STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION * * CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law. EFFECTIVE DATE: 1/3/2016 EXPIRATION DATE: 1/2/2018 PERSON: LORENTE RAMON FEIN: 592157712 BUSINESS NAME AND ADDRESS: ALES GROUP INC 896 SW 70 AVENUE MIAMI FL 33144 SCOPES OF BUSINESS OR TRADE: LICENSED GENERAL LICENSED ELECTRICAL DOOR AND WINDOW CONTRACTOR CONTRACTOR INSTALLATION Pursuant to Chapter 440.05(14), F.S., an officer of a corporation who elects exemption from this chapter by filing a certificate of election under this section may not recover benefits or compensation under this chapter. Pursuant to Chapter 440.05(12), F.S., Certificates of election to be exempt... apply only within the scope of the business or trade listed on the notice of election to be exempt. Pursuant to Chapter 440.05(13), F.S., Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation if, at any time after the filing of the notice or the issuance of the certificate, the person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate. The department shall revoke a DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUESTIONS? (850)413-1609 A` C)RL® CERTIFICATE OF LIABILITY INSURANCE 4/3/(2017 WI 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 ANDYS ASSURANCE AGENCIES 1441 W Flagler St Miami, FL 33135 License#:A223890 CONTACI PHONE ANDY RODRIGUEZ JR EwC,Nd.E4) (305) 642-8407 F ND) (3O5) 643-5969 ADDRIEss:andyjr@andysassurance. com INSURER(S) AFFORDING COVERAGE NAICY INSURER A.CATLIN SPECIALTY INS CO INSURED ALES GROUP INC 896 SW 70th AVE MIAMI , FL 33144 INSURER B INSURER C' INSURER D INSURER E INSURER F : 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 AODL INSO SUER wvo POLICY NUMBER POLICY EFF 4MM/DO/YYYY) POLICY EXP (MMIDD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY 1000113070 01/03/17 01/03/18 EACH OCCURRENCE $ 1,000,000 $ 100,000 $ 5,000 CLAIMS -MADE X I OCCUR PREMISESO(EaEoccurrrrence) MED EXP (Any one person) PERSONAL&ADVINJURY $ 1, 000, 000 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY I PRO- JECT I LOC OTHER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 $ I AUTOMOBILE , LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS SCHEDULED COMBINED SINGLE LIMIT (Ea accident) $ 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 $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE r— OFFICER/MEMBER EXCLUDED, i—I iMYndatory in NM If yes, describe under DESCRIPTION OF OPERATIONS below N/A i PER I STATUTE I ERH E L. EACH ACCIDENT $ El. DISEASE - EA EMPLOYEE $ Et DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Concrete Construction (91560), Electrical Work (92478), General Contractor (91580) & Subcontracted Work (91585), Plumbing (98482), Tile/Stone/Marble Work (99746) IFICATE HOLDER CANCELLATION Miami Shores Village Building Department 10050 NE 2 Avenue Miami Shores, F1 33138 ACORD25(2013/04) SHOULD ANY OF THE ABOVE DESC :ED POLICIES BE CANCELLED BEFORE THE E PIRATION DATE THER . NOTICE WILL BE DELIVERED IN ACCO',YANCE WITH THE POLIC - OVISIONS. 1988-2013 ACORD The ACORD name and logo are registered ma s of ACORD PORATION. All rights reserved.