Loading...
EL-17-2752Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 Project Address Permit Issue D Permit NO. EL-11-17-2752 Permit Type! Electrical -Residential Work Classification: Alteration Permit Status: APPROVED .12/13/2017 Expiration: 06/11/2018 Parcel Number Applicant 89 NE 109 Street Miami Shores, FL 33161-7039 1121360040550 Block: Lot: JAGRUTI & HEMENDRA PATEL Owner Information Address Phone Cell JAGRUTI & HEMENDRA PATEL 89 NE 109 Street MIAMI SHORES FL 33161-7039 89 NE 109 Street MIAMI SHORES FL 33161-7039 Contractor(s) Phone F&A ELECTRIC CONTRACTORS LLC (305)788-8165 Cell Phone Valuation: Total Sq Feet: $ 5,000.00 0 Type of Work: REPLACE EXISTING ELECTRICAL OUTLETS Additional Info: REPLACE EXISTING ELECTRICAL OUTLETS Classification: Residential Scanning: 1 Fees Due CCF DBPR Fee DCA Fee Education Surcharge Permit Fee - Additions/Alterations Scanning Fee Technology Fee Total: Amount $3.00 $2.63 $2.00 $1.00 $175.00 $3.00 $4.00 $190.63 Pay Date Pay Type Invoice # EL-11-17-65700 12/13/2017 Cash 11/17/2017 Credit Card Amt Paid Amt Due $ 140.63 $ 50.00 $ 50.00 $ 0.00 Available Inspections: Inspection Type: Review Electrical i 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. Authoriz ure:-Owner / Applicant / Contractor / Agent December 13, 2017 Date Building Department Copy December 13, 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 zis ELECTRIC ❑ ROOFING ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS 4. ' ,71vED 7 2017 �. FBC 201 QC, Master Permit No. 2-C 1O lU Sub Permit No. ��, 1� ❑ REVISION EXTENSION RENEWAL ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 89 NE 109 St Zip: 33161 City: Occupancy Type: Miami Shores ounty: Miami Dade Folio/Parcel#: 11-2136-004-0550 Is the Building Historically Designated: Yes NO X Resident Load: - Construction Type: Flood Zone: BFE: - FFE: OWNER: Name (Fee Simple Titleholder): HEMENDRA PATEL & JAGRUTI PATEL Phone#: 305-281-6559 Address: 89 NE 109 St City: Miami Shores State: Florida Zip: 33161 Tenant/Lessee Name: N/A Phone#: 305-281-6559 Email: dpate029@gmail.com -t- 4 Eledyil Co L i onS: 3Ds _ 138 --816 5 CONTRACTOR:6.3 •t Company Name: Address: LO J' City:H i (e�� State: Qualifier Name:. ((n l)/r T ► *In Phone#: r State Certification or Registration #: lQL d -( fah �`r °Certificate of Competency #: � G bvd.� � •\DESIGNER: Architect/Engineer: Phone#: zip: 3 3 a 6 Address: City: State: Zip: Value of Work for this Permit: $ Type of Work: ❑ Addition Alteration ❑ New Description of Work: Cep\el Le. Os k •QI Pc,,6 cuk 0 uk.---\e'S/ S : ,) Specify color of color thru tile: , Submittal Fee $ >U1,1' I Permit Fee'$ l if /PP Scanning Fee $ Radon Fee $ ? , O Technology Fee $ Structural Reviews $ Bond $ TOTAL FEE NOW DUE$ I90 • Co3 CCF $ - 6 Square/Linear Footage of Work: ) I (9° S1 ❑ Repair/Replace n Demolition CO/CC $ DBPR $ 2 ' '3 Notary $ Training/Education Fee $ Double Fee $ • y 1 (Revised02/24/2014) Bonding Company's Name (if applicable) N/A Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) Mortgage Lender's Address { City - State Zip N/A 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 a•sence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature r" ff / Signature OWNER or AGENT ONTRACTOR The foregoing instrument w s acknowledged before me this �The^f-o�regoing instrument/w' s acknowledged before me this day of 0 0 L e r , 20 i / , by 1 day of 0 l O tr , 20 i by trerch ri - f , who is personally known to y (1 j4 D>yro o is personally known to �� J Yl s- 07 - 2 �f'p — ias�51'l me or who has produced as me or who has produced identification and who did take an oath. NOTARY PUBC: identification and who did take an oath. NOTARY PUBLIC: Sign: Sign: Print:,� V� Print: �� 1 Le •t ' ' 4 ' ' ` " ' -I' • on Dawn rie Leighton Seal:e O NOTA PUBLIC Seal: 4 ���t NOTARY PUBLIC STATE OF FLORIDA - F I' o STATE OF FLORIDA t Comrn#GG110341 y ��'. ? Domm#GG110341 NCE 10 Expires 5/31/2021 ' 's 0 APPROVED BY 69Vh ns Examiner Structural Review Zoning Clerk (Revised02/24/2014) DRIVER LIC D552-256 :LtX R ,ZOMINGUE2 631 E 35TH ST t+HIALEAH. FL 33013-3139 Goititt DOB.14-14-0165 2E 1SSUEt tE51 SAFE DRIVEROpeCallo...:.t . ,� 1 of• motor vatic*CfifStfUt<5 :; �1tt ri CTgB Construction Trades ualifying Board BUSINESS CERTIFICATE OF COMPETENCY 12E000533 F&A ELECTRIC CONTRACTORS LLC D.B.A.: DOMIN ' EZ FELIX Is certified under the provisions of Chapter 10 of Miami -Dade County yo5-- 76-49' 30S - 75 - g'70. STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD (850) 487-1395 / 2601 BLAIR STONE ROAD TALLAHASSEE FL 32399-0783 DOMINGUEZ, FELIX F&A ELECTRIC CONTRACTORS LLC 631 E 35TH ST HIALEAH FL 33013 C"ngratulations! 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,myfloridalicense.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! RICK SCOTT, GOVERNOR LICENSE NUMBER STATE OF FLORIDA DEPARTMENT'OR BUSINESS AND " PROFESSIONAL -REGULATION ER13014849.10ISSUED508/14/2016 REG ELECTRIC L G)NTRACTOR DOMINGUEZ FELIX e '' " t-' F&A ELECTRIC CONTI AC1 ORS :LC' • (INDIVIDUAL MUST TEE 1.1.11». OCAL 'LICENSING REQUIREMETSL.PRIOR 1, TO...CONTRACTING IN ANY AREA) rt • HAS REGISLERED:under-ihe provisions of Ch.489 FS ,Expebuon Hale AUG 31 '2018 L1608140004773 DETACH HERE KEN LAWSON, SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD 6t The ELECTRICAL CONTRACTOR Named below HAS REGISTERED Under the provisions of Chapter'489 FS. Elpiration date: AUG 31, 2018 , r "'r...;~ (INDIVIDUAL MUST MEETALL LOCAL LICENSING REQUIREMENTS"PRIOR TOr.CONRACI,ING IN ANY AREA) DOMINGUEZ FELIX• ',FAA ELECTRIC CONTRAC 631.E 35TH ST ISSUED: 08/14/2016 DISPLAY AS REQUIRED BY LAW SEC) if L1608140004773 Municipal Contractor's Tax Receipt M iami-Dade County, State of Florida -THIS IS NOT A BILL - DO NOT PAY CC NO:, 128)00533 BUSINESS NAM EILOCATION F & A BBC CONTRACTORS LLC 631 E35 ST HIALEAH, R_ 33013 OWNER F & A B_ELIRIC CONTRACTORS LLC C✓ O FBJX R DOMINGUR MANAGER miAmma RECEIPT NO. 7519751 TYPE OF BUSINESS ELECTRICAL CONTRACTOR C EXPIRES SEPTEMBER 30, 2018 Pursuant to County Code Sec 10-24 PAYM ENT RECEIVED BY TAX COLLECTOR 200.00 10/20/2017 0224-18-000301 This receipt is not valid in the fallowing Municipalities: Avendura, Dora], Efaleah, Key Biscayne, Miani Clirdens, Miani Lakes, Palmetto Bay, Flnecrest, Sunny Isles Beach, Town of Cutler Bay. For more information, visit www.rrianidade.goy/taxcdlector 0134a6 Local Business Tax Receipt - Miami -Dade County, State of,Florida -THIS IS NOT A BILL - DO NOT PAY 7138076 BUSINESS NAME/LOCATION F & A ELECTRIC CONTRACTORS LLC 631 E 35 ST HIALEAH FL 33013 OWNER F & A ELECTRIC CONTRACTORS LLC C/O FELIX R DOMINGUEZ, MANAGER Worker(s) 1 RECEIPT NO. RENEWAL 7415060 EXPIRES SEPTEMBER 30, 2018 Must be displayed at place of business Pursuant to County Code Chapter 8A - Art. 9 & 10 SEC. TYPE OF BUSINESS 196 ELECTRICAL CONTRACTOR 12E000533 PAYMENT RECEIVED BY TAX COLLECTOR $45.00 07/12/2017 ECHECK-17-186351 This Local Business Tax Receipt only confirms payment of the Local Business Tax. The Receipt is not a license, permit, or a certification of the holders qualifications, to do business. Holder must comply with any governmental or nongovernmental regulatory laws and requirements which apply to the business. The RECEIPT NO. above must be displayed on all commercial vehicles - Miami -Dade Code Sec Ba-276. For more information, visit www.miamidade.gov/taxcollector 03-10-2017 JEFF ATWATER STATE OF FLORIDA CHIEF FINANCIAL OFFICER 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: 03/14/2017 EXPIRATION DATE: 03/14/2019 PERSON: DOMINGUEZ FELIX FEIN: 461199189 BUSINESS NAME AND ADDRESS: F&A ELECTRIC CONTRACTORS LLC 831 E 35 ST HIALEAH FL 33013 SCOPES OF BUSINESS OR TRADE: 1- Electrical Wiring Within Buil IMPORTANT: Pursuant 10 Chapter 440 . 05114), F.S., an officer of a corporation who elects exemption from this chapter by tiling a certificate of election under this section may not recover benefits or compensation under this chapter. Pursuant to Chapter 440.051121, 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 440.05113), 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 certificate at any time for failure of the person named on the certificate to meet the requirements of this section. QUESTIONS? (850) 413-16( OWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01-11 PLEASE CUT OUT THE CARD BELOW AND RETAIN FOR FUTURE REFERENCE STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION CONSTRUCTION INDUSTRY CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW EFFECTIVE: 03/14/2017 EXPIRATION DATE: PERSON: FELIX DOMINGUEZ FEIN: 481199189 BUSINESS NAME AND ADDRESS: F&A ELECTRIC CONTRACTORS LLC 631 E 35 ST HIALEAH, FL 33013 SCOPE OF BUSINESS OR TRADE: 1- Electrical Wiring Within Buil 03/14/2019 IMPORTANT OPursuant to Chapter 440.05(14), F.S., an officer of a corporation who elects exemption from this chapter by filing a certificate of election L under this section may not recover benefits or compensation under this D chapter. Pursuant to Chapter 440.05(12), F.S., Certificates of election to be H exempt... apply only within the scope of the business or trade listed on E the notice of election to be exempt. E 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 certificate at any time for failure of the person named on the certificate to meet the requirements of this section. QUESTIONS? (850) 413-1609 CUT HERE * Carry bottom portion on the job, keep upper portion for your records. OWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01-11 To: Page 2 of 2 2017-11-17 19:07:03 (GMT) 18888300846 From: Lizette Arguello ACORO CERTIFICATE OF LIABILITY INSURANCE ""--- DATE(MM/DD/YYYY) 11 /17/2017 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 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 Lizette Arguello Insurance DBA Estrella Insurance # 169 18355 NW 57 Ave, Suite#1036 Miami FL 33055 CONTACT NAME; Yassini Michel FAX INC, No. Ex : (305) 830-1477 No): (888) 830-0846 ADDRESS: agency169@estrellainsurance.com INSURER(S) AFFORDING COVERAGE NAIC 0 INSURERA: ASCENDANT COMMERCIAL INSURANCE INSURED F & A Electric Contractor 631 E 35 St Hialeah FL 33013 rAIr=oA- ------_._-_---------- INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : THIS INDICATED. CERTIFICATE EXCLUSIONS INSR -- ---- - .__ lCCV1J1UIY IVUIJ t'(: IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS LTR TYPE OF INSURANCE ADOLSUBR INSD WVD POLICY NUMBER POLICY EFF IMMMD/YYYY) POLICY EXP IMM/DDNYYY) LIMITS X COMMERCIAL GENERAL LIABILITY JCLAIMS EACH OCCURRENCE S 1,000,000 -MADE l ,OCCUR DAMAGE TO PREMISES Ea RENTED $ 100,000 A MED EXP (Any one person) $ 5,000 GL-54145-1 10/25/2017 10/25/2018 PERSONAL 8 ADV INJURY $ 1,000,000 GEN'L X AGGREGATE LIMIT APPLIES PER: n PRO- 71 GENERAL AGGREGATE $ 2,000,000 — POLICY __.__ JECT LOC PRODUCTS - COMP/OP AGO $ 1,000,000 OTHER: S AUTOMOBILE UABILITY ANY AUTO COMBINED SINGLE LIMIT (Ea accident) $ —^ OWNED SCHEDULED BODILY INJURY (Per person) S AUTOS ONLY HIRED AUTOS NON -OWNED BODILY INJURY (Per accident) $ A AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE (Per accident) $ $ UMBRELLA LIAB EXCESS LIAR —^ OCCUR EACH OCCURRENCE S CLAIMS -MADE AGGREGATE $ DED RETENT ON S S WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE PER OTH- STATUTE ER OFFICER/MEMBER EXCLUDED? N / A E.L. EACH ACCIDENT $ (Mandatory In NH) If yes, describe under E.L. DISEASE - EA EMPLOYEE S D DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMB S DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) CERTIFICATE HOLDER MIAMI SHORES VILLAGE BUILDING DEPARTMENT 10050 NE 2ND AVE MIAMI SHORES, FL 33138 FAX# 305-762-4949 CANCELLATION 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 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD 4 Notice to Owner — Workers' Com p Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 ensation 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 ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. State of Florida County of Miami -Dade The foregoing was acknowledge before me this By Tp,60 rr l rAM- Notary: SEAL: 1Z— day of Dk.OZ N-R,-20 fl� who is personally known to me or has produced as identification. �4,Ser Ns. Notary Public State of Florida a x ; Sindia Alvarez { c a;My Commission FF 158750 p�OF F��P Expires09/03/2018 i .;.A.+k.R.,�.,,a...s4,..+t.e4..-... ..e. X x. n a..+,.. F & A Eectricat Contractor LLC. 631 E 35th Street Hialeah, Ft 33013 305-788-8168 Date: December 11, 2017 State of Florida County of Dade County Before me this day personally appeared Felix Dominguez who, being duly sworn, deposes and says: That he or she wm be the only person working on the project located at: 89 NE 109 St Miami, FI 33138. Sworn to (or affirmed)and subscribed before me this 11th day of December, 2017,. by Felix Dominguez. Personally Know Produced Identification Type of Identification Produced: Florida Driver License # D552-256-65-374-1 Notary Name: Dawn Marie Leigh a Dawn Mane Leighton NOTARY PUBLIC STATE OF FLORIDA Comm# GG I 10341 Expires 5/31/2021