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ELC-18-1203Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 Project Address Permit PermitNO. ELC-5-18-1203 Permit Type: Electrical - Commercial Work Classification: Addition/Alteration PermitStatus: APPROVED e Date: 7/9/2018 Expiration: 01/05/2019 Parcel Number Applicant 1546 NE 105 Street Number: B9 Miami Shores, FL 33138- 1122300530210 Block: Lot: STEPHEN MENDELL Owner Information Address Phone Cell STEPHEN MENDELL 1546 NE 105 Miami Shores FL 33138-2114 1546 NE 105 Miami Shores FL 33138-2114 Contractor(s) XL ELECTRIC CORP Phone (786)282-4449 Cell Phone Valuation: Total Sq Feet: $ 5,000.00 0 Type of Work: LEGALIZE NEW WIRING DEVICES AND LIG Additional Info: LEGALIZE NEW WIRING DEVICES AND LIG Classification: Commercial Scanning: 1 Fees Due CCF DBPR Fee DCA Fee Education Surcharge Penalty Fee Permit Fee Scanning Fee Technology Fee Work without Permit Fee Amount $3.00 $2.63 $2.00 $1.00 $100.00 $175.00 $3.00 $4.00 $175.00 Total: $465.63 Pay Date Pay Type Invoice # ELC-5-18-67427 07/09/2018 Credit Card 05/04/2018 Credit Card Amt Paid Amt Due $ 415.63 $ 50.00 $ 50.00 $ 0.00 Available Inspections: Inspection Type: Final Meter Box Alteration Relocation Fire Alarm Service Change Review Electrical Underground W. W. 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/lujrize the abpup-npmgd contractor to do the work stated. Authorized Signature: Owner \CA -- V / Applicant / Contractor / Agent July 09, 2018 Date Building Department Copy July 09, 2018 1 BUILDING PERMIT APPLICATION BUILDING E1ELECTRIC ❑PLUMBING MECHANICAL JOB ADDRESS: 1st -lb j.)g City: tic Skgiami Shores 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 'tEC p7f [� AY . 208 BY: 1.0 CC,'2FBC 201 Master Permit No. - 1 Sub Permit No. gLc1 -5-16 -1ZQ3 E ROOFING ❑ REVISION EXTENSION ❑RENEWAL PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION CONTRACTOR County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated: Yes Occupancy Type: Load; Construction Type: OWNER: Name (Fee Simple Titleholder): Address: �e o� S 1 w. I o5 st 1 City: Lit.eC.nA". ShANP-ems Tenant/Lessee Name: Email: State: - Flood Zone: BFE: Phone#: Phone#: ❑ SHOP DRAWINGS NO FFE: Zip: CONTRACTOR: Company Name: Address: 15 b3 - SC,E,) , _ 5 g. St' City: Mom,. State: c• (r Qualifier Name: (P G Vcc1141 CI•ed State Certification or Registration #:)\ E.C. 1 3005379 DESIGNER: Architect/Engineer: Address: City: State: Zip: Value of Work for this Permit: $ X `,C, .0 0 4 Square/Linear Footage of Work: Phone#: Phone#: Certificate of Competency #: Phone#: Zip: 3.3lq Type of Work: ❑ Addition l �i Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: IL9lli,v �i r i1� ci-) Qnd ,Q,�C ], - 1 k -k t' k 4 tkrZ .A_ AAAba,-�hroow. J j' Specify color of color thru Submittal Fee $ Scanning Fee $ Technology Fee $ Structural Reviews $ la . tile: Permit Fee $ % )' oGy CCF $ CO/CC $ Radon Fee $ 2- ' DBPR $ Z - 6 3 Notary $ Training/Education Fee $ Double Fee $ l . �d Bond $ TOTAL FEE NOW DUE$ I 44C) • 6 3 (Revised02/24/2014) 4105.03 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 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 absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature Signature OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this 3i day of MA.H S.pl a.,. (p,.,JitJ ( , who is personally known to ,20 /0 ,by day of 1-1,20 19 ,by 1 , who is personally known to me or who has produced as me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: Seal: identification and who did take an oath. NOTARY PUBLIC: Sign: Print: Seal: I o✓gJ ' cJCiv:. LON *************************************************************************** APPROVED BY ; :S•g.; PATRICIA FEB; ES MY COMMISSION # 3G0C9157 ,aal EXPIRES July 06, 2020 ys, Plans Examiner Zoning (Revised02/24/2014) Structural Review Clerk ; STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD (850) 487-1395 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 VALMASEDA, JULIO ALBERTO XL ELECTRIC CORP 15632 SW 59TH STREET MIAMI FL 33193 Congratulations! 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 team more about the Departments initiatives. Our mission at the Department is: License Efficiently, Regulate Fairly. We constarrtly 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 s'adit—doTiektiak LICENSE NUMBEFL EC13005379-'-' 1— The ELECTRICAL CONTRACTOR-4- , rNerned below IS CERTIFIED-7' Under the provisions of Chapter_489 FS._ Expiration date AUG 312018"-----4*"" STATE,OF• FLORIDA DEPARTMENT ORBUSINESS AND ' PROFESSIONAL REGULATION EC 13005379 IOUgl5Z66/16/2016 CERTIFIED ELECTRICAL CONTRACTOR -VALMASEDA:IltJLIOAL.-BERTDTZ 4 XL -ELECTRIC CORP 1". • cERTfFIE0.undir.the,ptoilsions "of Chi'489 ES. 116,06160001138 DETACH HERE KEN LAWSON, SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD , -3-- ,,----,-- , , r „NALMASEDA,„JULlu ALETERTG.- / if „,,XL ELECTRIC CORP -1;ee - -::-. -'1-,1--.15632'SW59TH:STREET, 6 ISSUED: 06/16/2016 -Tr ikr. s; e• • „ "°‘ a A, DISPLAY AS REQUIRED BY LAW SEQ # L1606160001138 00.5169 Local Business Tax Receipt Miami -Dade County, State of Florida -THIS IS NOT A BILL -DO NOT PAY 7159607 BUSINESS NAME/LOCATON XL ELECTRIC CORP 15632 SW 59 ST MIAMI FL 33193 OWNER XL ELECTRIC CORP - C/O JULIO VALMASEDA PRES Worker(s) 1 RECEIPT NO. RENEWAL 7438927 EXPIRES SEPTEMBER 30, 2018 Must be displayed at place of business Purs0eM to County Code Chapter 8A - Art. 9 & 10 SEC. TYPE Of BUSINESS 196 ELECTRICAL CONTRACTOR EC13005379 PAYMENT RECEIVE° BY TAX COLLECTOR $75.00 08/06/2017,- ,,-- CREDITCARC)-17-052445 This Local Business Tax Receipt only confines payment of the Local Business Tax. The Receipt is not a license, permit, or a certification of the holders qualifications, to do business. Fielder must comply with any governmental Of nongovernmental regulatory laws and requirements which apply to the business. The RECEIPT NO. above must be displayed on all commercial vehicles - Miami -Dads Code Sec 8a-276. For more information, visit yffixatimeniatle,govitaxcgIlector ACORO CERTIFICATE OF LIABILITY INSURANCE `" '---- DATE(MM/DDmYY) 04/18/2018 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 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 Pandora Insurance, Inc. 3520 W 18th Avenue Suite 155 Hialeah, FL 33018 CONTACT NAME: Jacqueline Lamas (4/c. No. Est): (305) 231-9898 FAX No): (305) 675-8034 E-MAIL ADDRESS: info@pandorainsurance.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Covington Specialty Insurance Company INSURED XL Electric Corp, LIC # EC 13005379 15632 SW 59 ST MIAMI, FL 33193 (786) 282-44 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 INSR SUBR WVD POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MM/DD/YYYY) LIMITS A GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY N N VBA61222900 04/17/2018 04/17/2019 EACH OCCURRENCE $ 1,000,000.00 DAMAGE TO RENTED PREMISES (Ea occurrence) $ 100,000.00 CLAIMS -MADE X OCCUR MED EXP (Any one person) $ 5,000.00 X $ 500.00 BI/PD Ded. Per Claim. PERSONAL & ADV INJURY $ 1,000,000.00 GENERAL AGGREGATE $ 2,000,000.00 GEN'L AGGREGATE 51 POLICY LIMIT APPLIES JECT JECT PER: LOCPRO- PRODUCTS - COMP/OP AGG $ 2,000,000.00 $ AUTOMOBILE LIABILITY 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 UAB O OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENT ON $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y / N N /A WC STATU- TORY LIMITS OTH- ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule if more space is required) Electrical Contractor License # EC 13005379 Blanket Additional Insured- Owners, Lessees or Contractors; Primary and NonContributory; Blanket Waiver of Transfer of Rights of Recovery Against Others To Us. CERTIFICATE HOLDER CANCELLATION Miami Shores Village 10050 NE 2 Ave FL, 33138 305-795-2204 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 ACORD 25 (2010/05) © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ACORN►® CERTIFICATE OF LIABILITY INSURANCE `..� DATE(MM/DD/YYYY) 04/19/2018 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 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 - Automatic Data Processing Insurance Agency, Inc. 1 AdpBoulevard Roseland, NJ 07068 CONTACT NAME: PHONE FAX (NC, No, Ext): (NC, No): E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : NorGUARD Insurance Company 31470 INSURED XL ELECTRIC CORP 15632 SW 59 ST Miami, FL 33193 INSURER B : INSURER C INSURER D : INSURER E: INSURER F : CERTIFICATE NUMBER: 881842 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 INSD SUBR WVD POLICY NUMBER POLICY EFF POLICY EXP (MM/DD/YYYY) LIMITS COMMERCIAL GENERAL LIABILITY _(MM/DD/YYYY) EACH OCCURRENCE $ CLAIMS -MADE OCCUR DAMAGE TO REN rED PREMISES (Ea occurrence) $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PRO - JECT PER: LOC GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ $ AUTOMOBILE _ UABIUTY ANY AUTO ALL OWNED SCHEDULED AUTOS NON -OWNED AUTOS COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ UMBRELLA LIAR EXCESS LIAB O OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION$ $ A WORKERS COMPENSATION AND EMPLOYERS' UABIUTYER ANY PROPRIETORPARTNER/EX OFFICER/MEM ER/ EXCLUDED? ECUTIVE (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below YYN N / A N XLWC895648 10/18/2017 10/18/2018 Xy PER STATUTE OTH E.L. EACH ACCIDENT $ 100,000 E.L. DISEASE - EA EMPLOYEE $ 100,000 E.L. DISEASE - POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) Contractor License: EC13005379 CERTIFICATE HOLDER CANCELLATION Miami Shores Village 10050 NE 2 Ave Miami, 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 A© 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD