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EL-15-2182Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 Project Address ■ Permit NO. EL-8-15-2182 Permit Type: Electrical - Residential Work Classification: Pool - Private Permit Status: APPROVED Issue Date: 9/18/2015 Expiration: 03/16/2016 Parcel Number Applicant 1050 NE 107 Street Miami Shores, FL 33161-7374 1122320280520 Block: Lot: GABRIEL MARTIN KUSKUNOV Owner Information Address Phone Cell GABRIEL MARTIN KUSKUNOV 1050 NE 107 Street MIAMI SHORES FL 1050 NE 107 Street3 3 161-7 74 MIAMI SHORES FL 3 PILE, Contractor(s) Phone XTREME POWER ELECTRICAL INC (786)255-1182 Cell Phone Valuation: Total Sq Feet: $ 1,800.00 0 Type of Work: Additional Info: Classification: Residential Scanning: 3 CAU C ELLED Available Inspections: Inspection Type: Fence Final Pool Deck Wall Steel Review Planning Review Plumbing Review Electrical Review Building CANg1 Fees Due CCF CCF DBPR Fee DBPR Fee DCA Fee DCA Fee Education Surcharge Education Surcharge Permit Fee Permit Fee - Additions/Alterations Scanning Fee Scanning Fee Technology Fee Technology Fee Total: Amount $1.20 $0.00 $4.50 $0.00 $4.50 $0.00 $0.00 $0.40 $300.00 $0.00 $0.00 $9.00 $1.60 $0.00 $321.20 Pay Date Pay Type Invoice # BPP-8-15-56861 09/18/2015 Check #: 2839 $ 271.20 $ 50.00 08/25/2015 Check #: 2787 $ 50.00 $ 0.00 Amt Paid Amt Due fD 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 a urate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Futhermore, I authorize the above -named cq ractor to do the work stated. Authorized Signature: Owner / Applicant / Contractor / Agent September 18, 2015 ate September 18, 2015 1 Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 Project Address Pe •m it Permit NO. EL-8-15-2182 Permit Type: Electrical - Residential Work Classification: Pool - Private Permit Status: APPROVED Issue Date: 9/18/2016 Expiration: 03/16/2016 Parcel Number Applicant 1050 NE 107 Street Miami Shores, FL 33161-7374 1122320280520 Block: Lot: GABRIEL MARTIN KUSKUNOV Owner Information Address Phone Cell GABRIEL MARTIN KUSKUNOV 1050 NE 107 Street MIAMI SHORES FL 33161-7374 1050 NE 107 Street MIAMI SHORES FL 33161-7374 Contractor(s) Phone XTREME POWER ELECTRICAL INC (786)255-1182 CeII Phone Valuation: Total Sq Feet: $ 1,800.00 0 Type of Work: Additional Info: Classification: Residential Scanning: 3 Fees Due CCF CCF DBPR Fee DBPR Fee DCA Fee DCA Fee Education Surcharge Education Surcharge Permit Fee Permit Fee - Additions/Alterations Scanning Fee Scanning Fee Technology Fee Technology Fee Total: Amount $1.20 $0.00 $4.50 $0.00 $4.50 $0.00 $0.00 $0.40 $300.00 $0.00 $0.00 $9.00 $1.60 $0.00 $321.20 Pay Date Pay Type Invoice # BPP-8-15-56861 09/18/2015 Check* 2839 $ 271.20 $ 50.00 08/25/2015 Check #: 2787 $ 50.00 $ 0.00 Amt Paid Amt Due Building Department Copy Available Inspections: Inspection Type: Fence Final Pool Deck Wall Steel Review Planning Review Plumbing Review Electrical Review Building September 18, 2015 2 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 ❑ PUBLIC WORKS JOB ADDRESS: 10 SO N E 101 S� WED AUG 23 2013 FBC 20 Master Permit No. C. 7 " (g" 2 q I Sub Permit NoLt 5 — 2 1 � ❑ REVISION ❑ EXTENSION ERENEWAL ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS City: Miami Shores County: Miami Dade Folio/Parcel#: IF" ` ZZ: ` 62.6 OS 2..0 Is the Building Historically Designated: Yes Occupancy Type: SC: R. Load: ' Construe ? • t .. y P'' _ Fjood Zone: Zip: 33I 4,01 NO N BFE: FFE: OWNER: Name (Fee Simple Titleholder): C► c L t e` A ' ►J K l) NOW Phone#: Address: I oSo k) E. I D1 s�-- City: :v\ i CA`M. • %- G c.5 Tenant/Lessee Name: Email: State: �llor; cic eocyo,(Q 0, @ ho+ meld t, cots Phone#: Zip: SS)1pI CONTRACTOR: Company Name: Xl—Y2.tN42 -Pow-et elet: era . Phone#:7%a Address: Ce 1 N 11.i Sq Cfi City: A:\ G\' ',: State: 101 Qualifier Name: •_-- DSO cvo m V 6,Y e.-/- State Certification or Registration #: ' R 1301 49 41 Certificate of Competency #: DESIGNER: Architect/Engineer: Sl 'L U T CA Address: l ISCG SUi • e • Sate. i I S Value of Work `Per ra t $ � f i • 00 Square/Linear Footage of Work: " e i \_1 L. e„ W Type of Work: Addition ❑ Alteration FN. New ❑ Repair/Replace -a *G\\ Pc I ;vhe.r) Pump NA Description of Work: Zip: 17.4 Phone#: IOE. 000seri oA;c1Phone#: ao5-�)-032. City: t \ Q T i State: ti . Zip: 3S I S Cp ❑ Demolition , Specify color of color thru tile: Submittal Fee $ Scanning Fee $ Technology Fee $ Training/Education Fee $ Structural Reviews $ wtet Permit Fee $ lve.,e7li CCF $ CO/CC $ Radon Fee $ DBPR $ Notary $ Double Fee $ Bond $ TOTAL FEE NOW DUE $ QTR ( • 2.0 (Revised02/24/2014) Bonding Company's Name (if applicable) 0 -A Bonding Company's Address 1 t 10,. , ,f t • 5 u City State • n,. Zip Mortgage Lender's Name (if applicable) r Mortgage Lender's Address �` r City { ' 1 r-' t State+. Zip ▪ t1 t t tljt lytf Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installa▪ tion has commenced' prior to the issuance of a permit and that all work will be performed 'to meet the.standards-of all lawsrregulating 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...... t•. _ rL.P.,`0 tl 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. • 1, .1 t "WARNING TO OWNER:- YOUR FAILURE 'TO-RECORDi A -'NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. ' IF YOUINTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant: Asa condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment; Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not • - approved and a reinspection fee will be charged. , Signature WNER`or AGENT ,T The foregoing instrument was acknowledged before me this /A day of more , 20 t' , by 67411oriQI Kcskut e? , who is personally known to me or who has produced dr r l t ceps-v, as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: Seal: APPROVED BY Signature % /) CONTRACT The foregoing instrument was acknowledged before me this /91 day of -S , 20 1 ' 0 ,W.j S x -e—L , who is personally known to ;;ite or who has -produced r as identification and who did take an oath. • f 'i' .. NOTARY PUBLIC: . _ _ - Sign: CARY M. RODRIGUEZ • Print: pY n�•4 =. ,�, �=; Notary Public - State of Florida • My Comm. Expires Aug'18, 2015 Seal: o-; Commission # EE 106632 OF ,,, ,, t,'�- Bonded Through National Notary Assn. _ — -- • 1L. ZS i-!!t-/J' Plans Examiner • • Structural Review a ion!;,,,, CARY M. RODRIGUEZ ,P�e , .rida :r n� .f. My Comm. Expires Aug 18, 2015 N',4, ,. Commission # EE 106632 8 i$• Bonded'Through Natioial Notary Assn. Zoning 1.11 $ii 1 i Clerk (Revised02/24/2014) STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD The ELECTRICAL CONTRACTOR Named below HAS REGISTERED Under the provisions of Chapter 489 FS. Expiration date: AUG 31,2016 (INDMDUAL MUST MEETALL LOCAL LICENSING REQUIREMENTS PRIOR TO_CONTRACTING IN ANY AREA) SUAREZ, IHOSVANY XTREME POWER ELECTRICAL, INC. 611NW59CT4 MIAMI - FL 33126; ISSUED: 08/282014 DISPLAY AS REQUIRED BY LAW Local Business Tax Feces p Mlaml DadeCounty State of Horid p` THIS IS NOT A BILL':p0 NOT PAY 6721907 BUSINESS -NAM EILOCATION_ XTREME POWER ELECTRICAL INC 611 NW59CT :MIAMI, Ft_ 33126" ;:.RECEIPT NOa RENEWAL • 6995253 OWNER SEC. TYPE OF BUSINESS XTREME POWER ELECTRICAL INC 1g6 ELECTRICAL CONTRACTOR 10E000547. Workers) 1 0225-15.000069 ?his Local BuciirasTaxiboeiptaiyarrayspayment dthe Load BugsessTalcThetbceiptien:Calicers% pemit,gracard "e/gmdtheteldersquafi we,todotwines&Fdderramc npyvrithanygomnrnental .; ornongoarm entel regtlataytaxsandreq ireme eswNehgplyiothebusiness, The MaiIPrNQabaemet bea*playadci icpmuaslvehides-Miad-Dade Code Sac tia-281 Far nixeintantiati. vi.41 wwwiriatidadegowlaccetlector EXPIRES SEPTEIVMBER 30, 2015 Must be displayedat place of business . Pursuant to County Code ;Chapter 8A - Art. 9 & 10 PA vat ENT RECEIVED BY TAX COLLECTOR 49.50 10/07/2014. CTQB Board BUSINESS CERTIFICATE OF COMPETENCY 1 0E000547 ME POWER ELECTRICAL INC SUAREZ II:IOSVANY Is certified under the provisions of Chapter 10 of AlGami-Dade County SEQ # L1408280003492 ACG CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY) 08/10/2015 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 ADDmONAL 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 A&A Underwriters, Inc. 8778 SW 8 St Miami, FI 33174 NC AM: PABLO M CONDE PHONE jA/C No. Extl: 305-220-7447 Ne); 305-220-4821 E-MAIL pmc@aaunderwriters.com INSURERS) AFFORDING COVERAGE NAIL! INSURER A: GRANADA INSURANCE COMPANY 000334 INSURED Xtreme Power Electrical 611 NW 59 CT Miami FI 33126 INSURER B: BUSINESSFIRST INSURANCE COMPANY 012629 INSURER C : INSURER D : INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 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 VNTH 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. UMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS INSR LTR TYPE OF INSURANCE ADOL INRD SUER WVn POLICY NUMBER POLICY EFF (MMIDLWYYYI POLICY EXP (MMIDDIYYYY) LIMITS A X COMMERCIAL GENERAL LIABIJrY 0185FL00040143-2 10-19-14 10-19-15 EACH OCCURRENCE ; 1,000,000 DAMAGETO occurrence) $ 100,000 CLAIMS -MADE X OCCUR MED EXP (My are Peron) ; 5,000 PERSONAL A ADV INJURY ; 1,000,000 GENERAL AGGREGATE $ 2,000,000 GENE X AGGREGATE UMIT APPUES PER: POUCYI PMLOC OTHER: PRODUCTS- COMP/OP AGG $ 2,000,000 ; AUTOMOBILE — UA81LTTY ANY AUTO AU. OWNED HIREDAUTOS AUTOS SCHEDULED fCO BI SINGLE UMIT $ BODILY INJURY (Per perm) $ BODILY INJURY (Per accident) $ DAMAGE PR(Pero accident) (Per $ ; UMBRELLA UAB EXCESS UAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ 3 DED I I RETENTION; B WORKERS COMPENSATION AND EMPLOYERS' UABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERIM MBER EXCLUDED? In (MievlatoryEL dyes, describe under DESCRIPTION OF OPERATIONS below Y/N N NIA 521-10985 01-10-15 01-10-16 X STATUTE ER EL EACH ACCIDENT $ 1,000,000 D FecF - EA EMPLOYEE ; 1,000,000 E.L DISEASE - POLICY UMIT $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Addhbnal Remarks Schedule, may be attached 11 more space Is required) Contractor's License Number: 10E000547 CERTIFICATE HOLDER CANCELLATION Miami Shores Village 10050 NE 2nd Ave Miami Shores, FL 33138 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DEUVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE /`��_- I r_' ACORD 25 (2013/04) ®1988-2013 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 10/19/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. EXTEND OR ALTER THE COVERAGE AFFORDED BY THE THIS POLICIES A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED 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 A&A Underwriters Inc. SW 8st Miami FL 33174 CONTACT NAME: Pablo M Conde PHONEFAX (IVC. No. ExU: (305) 220-7447 (A/C, Not: (305) 220-4821 m aaunderwriters.com ADDRESS: Pmc@aaunderwriters.com ADDR INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: GRANADA INSURANCE COMPANY 000334 INSURED XTREME POWER ELECTRICAL 611 NW 59th CT Miami FI 33126 INSURER B : BUSINESSFIRST INSURANCE COMPANY 012629 INSURER C : INSURER D : INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 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 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 (MMIDDIYYYY) POLICY EXP (MMIDD/YYYY) UNITS A X COMMERCIAL GENERAL LIABILITY 0185FL00040143 10/19/2015 10/19/2016 EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE X OCCUR DAGE TO RENTED PREMISES SES (Ea occurrence) $ 100,000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'LAGGREGATE X POLICY OTHER: LIMIT APPLIES JECOT- PER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 $ AUTOMOBILE _ LIABIUTY SCHEDULED AUTOS NON -OWNED AUTOS COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ UMBRELLA UAB EXCESS UAB O OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBEREXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y / N N NIA 521-10985 01/10/2016 01/10/2017 X P ATUTE 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) Lic. 10E000547 Electric contractors CERTIFICATE HOLDER CANCELLATION Miami Shores Villages 10050 NE 2nd Avenue Miami Shores, FI. 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 (8111RR.2014 ACARf CARPARATIAN_ All rinhtt rasearvarl_ Local Business Tax Receipt Miami —Dade County, State of Florida -THIS IS NOT A BILL - DO NOT PAY 6721907 BUSINESS NAME/LOCATION XTREME POWER ELECTRICAL INC 611 NW 59 CT MIAMI, FL 33126 OWNER XTREME POWER ELECTRICAL INC Worker(s) 1 RECEIPT NO. RENEWAL 6995253 SEC. TYPE OF BUSINESS 196 ELECTRICAL CONTRACTOR 10E000547 LBT, EXPIRES SEPTEMBER 30, 2017 Must be displayed at place of business Pursuant to County Code Chapter 8A - Art. 9 & 10 PAYMENT RECEIVED BY TAX COLLECTOR 49.50 10/31/2016 0222-17-000289 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 holder's 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 8a-276. MIAMI-DAD For more information, visit www.miamidade.gov/taxcollector RICK SCOTT, GOVERNOR LICENSE NUMBER KEN LAWSON. SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD "he ELECTRICAL CONTRACTOR lamed below HAS REGISTERED nder the provisions of Chapter 489 FS. Kpiratson date AUG 31. 2018 (INDIVIDUAL MUST MEET ALL LOCAL LICENSING REQUIREMENTS PRIOR TO CONTRACTING IN ANY AREA) SUAREZ. IHOSVANY XTREME POWER ELECTRICAL INC. 611 NW59CT MIAMI FL 33126 ISSUED 09/13/2016 DISPLAY AS REQUIRED BY LAW SEQ tt 1.1609130003631