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EL-17-2132Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 Project Address Pe ■ Permit NO. EL-8-17-2132 Permit Type: Electrical - Residential' Work Classification: Addition/Alteration Permit Status: APPROVED Issue Date: 10/31/2017 Expiration: 04/29/2018 Parcel Number Applicant 731 NE 95 Street Miami Shores, FL 1132060142130 Block: Lot: FENTON FIVE GROUP, INC Owner Information Address Phone Cell FENTON FIVE GROUP, INC 731 NE 95 Street MIAMI SHORES FL 33138- (305)796-5460 731 NE 95 Street MIAMI SHORES FL 33138- Contractor(s) HEFFERNAN ELECTRIC INC Phone 305-757-8380 CeII Phone Valuation: Total Sq Feet: $ 500.00 0 Type of Work: REPAIR / REPLACE RECEPTACLES AND SW Additional Info: REPAIR / REPLACE RECEPTACLES AND SW Classification: Residential Scanning: 1 Fees Due CCF DBPR Fee DCA Fee Education Surcharge Permit Fee - Additions/Alterations Scanning Fee Technology Fee Total: Amount $0.60 $3.38 $2.25 $0.20 $225.00 $3.00 $0.80 $235.23 Pay Date Pay Type Amt Paid Amt Due Invoice # EL-8-17-64968 08/23/2017 Check #: 1099 $ 50.00 $ 185.23 10/31/2017 Check #: 1084 $ 185.23 $ 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 :FFIVIT: I certi that . the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construe/zoning. Fut. -rmor- auth.;.ze the above -named contractor to do the work stated. A horized nure: Owner Applicant / Contractor / Agent October 31, 2017 Date Buil • ing m epartment Copy October 31, 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 El BUILDING ELECTRIC ROOFING El PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR RECEIVED AUG 2 32pp Sh FBC 201q JOB ADDRESS: 7 J 1 /V-' sr. City: Miami Shores County: Master Permit No. 2 Sub Permit No.6,1 i� - 2132 ❑ REVISION ❑ EXTENSION ❑ RENEWAL Miami Dade Zip: DRAWINGS Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): 1U1d t1/4J • l 11 G r� vP Phone#: 36S ' 7 /=6 -s Y.( 7-b ($ Address: / N l 1 `Q4T N 5 r > City: j4 t / Hi✓(,/ State: T " Zip:33/.6 / Tenant/Lessee Name: Phone#: Email: i}LF6—"S'J a�/�%�` ''JA.(4J:tivi3-4 i),C> . Co ✓►i CONTRACTOR: Company Name: ` ` �!t R)\mot t\ Address: 5S I AS E 2 8'30 City: !- (A 1 i S©(& (-S � State: 1— .,� ,� J Zip: ( 3Q'q Qualifier Name: ) 7'-1�\ 1 ' \ \1 RI J J� v Phone#: C� o) 3 U 1 - F3 vQ' 0 State Certification or Registration #: -5e-f3OO/'/O2- Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: $ 50.0o °C) Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ Description of Work: F cA I R % f-Z PL,4 C-,F (q--.EGE if (A-C-LE S • - .S L) rYC44- S New I Repair/Replace n Demolition Specify color of color tl ru.the: .0101 Submittal Fee $ "' Permit Fee $ -. Z,.$ , 4047 CCF $ Scanning Fee $ Radon Fee $ DBPR $ Technology Fee $ Training/Education Fee $ Structural Reviews $ (Revised02/24/2014) CO/CC $ Notary $ Double Fee $ Bond $ TOTAL FEE NOW DU _. Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage Lender's,Narrie (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. —T: Z'.D 1C" "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." S , L�£C • Notice to Applicant: As a condition to the issuance of a building permit with dJ, n?sti a ed va'luexceeding$2500,Ltheplicant must promise in good faith that a copy of the notice of commencement and' construction lien law brochure will befdelivered to the person �'�ti whose property is subject to attachment. Also, a certified copy of the rec"orded 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 willb hard. ' «, ., a'v 44V*1 _ }S +/ /l Signature Signature OW or AGENT CONTRAL i The foregoing instrument was acknowledged before me this l The foregoing instrument was acknowledged before me this SAM t � ab day of � , 20 �� , by day of Au 6 c's , , by o is personally known to mocartievu 7 I'fte-4, Cnrlio`Is personally known to me or who has produced as me or who has produced ?L`1'117q. P L._ as identification and who did take an oath. NOTARY PUBLIC: Sign: Prin Seal: t! Jeanne R per My CommIr aion FF 978905 tior Expires 05/17/2020 identification and who did take an oath. NOTARY PUBLIC: Sign: Print: a-ikizcp Seal: ***************************�****************************************** APPROVED BY Te �9L? /9 ) Plans Examiner CAROUNA RIVERA RUIZ MY COMMISSION #GG070660 WIRES: FEB 07, 2021 Bonded through 1st nsura* e State Inc ****** ********** Zoning Structural Review Clerk (Revised02/24/2014) Miami Shores Viiiage Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Notice to Owner — Workers' Compensation 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. Signature: State of Florida County of Miami -Dade )( ST- The foregoing was acknowledge before me this ° . \ day of By Notary: .. daci_ SEAL: ,20fl. who is personally known to me or has produced as identification. CARIDAD VILA NOTARY PUBLIC STATE OF FLORIDA Catxrdt FF223862 Expires 6/22/2019 Heffernan Electric, LIc Matthew T. Heffernan, President 10551 Northeast 2nd Place Miami Shores, FL 33138-2004 Office: 305. 757. 8380 Cell: 305. 389. 8380 Fax: 305. 757. 8380 Email: mheffernan680522@aol.com CC#: 13001402 August/ 7, 2017 State of Florida County of Dade Before me this day personally appeared Matthew T. Heffernan who, being duly sworn, deposes and says: That he or she will be the only person working on the project at: 731 Northeast 95 Street Miami Shores, Florida 33138 7 Contractor Signatur Sworn to (or affirmed) and subscribed before me this / day of . 2017 By `AtAeiA Yhoi Personally know Or Produced Identification 64,!) Type of Identification Produced II 165--Ssq -6 / ZI Print, Type or Stamp of Notary NATACHA A. ALEXANDRE MY COMMISSION 441'781994 EXPIRES: APR 22, 2018 0 RICK SCOTT, GOVERNOR AO STATE:OF FLORIDA `* `4y �. ..e.... > wY"i.vw+Ma.w a.tiM6 ,«;. N^`+ h r+. � buy ^++ DEPARTMENT OF BUSINESS NOT ROFES'NS. LREGUL"ATION'TM ELECTRICAL"CONTRACTORS LICENSINGGBOAR ,,,,,Nb.:,,, MATILDE MILLER, INTERIM SECRETARY 1 ter, ,.,,,„, ,�,�.:',• ,EC he'ELECTRICAL.CONTRACTOR Jamed below IS.CERTIFIEDa--- Under.the.provlsions°"ofChapte 489 FS „�Expiration,date AUG 31:„2018 .- i°` „/HEFFERNAN, MATTHEW-4-Q.MAS.. HEFFERNAN ELECTRI0,-XiE�- ,,. ' 4 4055.1 NE'2ND PLACE ` •' - - -NUAIVII SHQRES3 I:C AGE FL33138 2QQ4 ISSUED: 01/15/2017 0.� DISPLAY AS REQUIRED BY LAW SEQ # L1701150001249 JIMMY PATRONIS CHIEF FINANICAL 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: 9/27/2015 EXPIRATION DATE: 9/26/2017 PERSON: HEFFERNAN MATTHEW T FEIN: 650603416 BUSINESS NAME AND ADDRESS: HEFFERNAN ELECTRIC LLC 10551 NE 2ND PLACE MIAMI SHORES FL 33138 SCOPE OF BUSINESS OR TRADE: Licensed Electrical Contractor IMPORTANT: 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 certificate at any time for failure of the person named on the certificate to meet the requirements of this section. DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUESTIONS? (850)413-1609 Client#: 1448996 132HEFFEELE ACORDr. CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 08/04/2017 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 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 BB&T-Oswald Trippe and Company 9200 S. Dadeland Blvd, Ste 314 Miami, FL 33156 305 670-0083 CONTACT PHONE Fax Ext): 305 670-0083 (A/C, No): 8668028668 E-MAILe, ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Wesco Insurance Company 25011 INSURED Heffernan Electric Inc. Matthew Heffernan 10551 NE 2nd Place Miami Shores, FL 33138 INSURER B : 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 ADDLSUBR INSR WVD POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MM/DD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY WPP120793102 10/20/2016 10/20/2017 EACH ! $500,000 CLAIMS -MADE X OCCUR �ES (EOCCURRENCE E PREMISaEoNauErrrence) $100,000 X BI/PD Ded:250 MED EXP (Any one person) $5,000 PERSONAL A. ADV INJURY $500,000 GEN'L AGGREGATE LIMIT APPLIES JECOT PER: LOC GENERAL AGGREGATE $1,000,000 PRODUCTS - COMP/OP AGG $1,000,000 $ AUTOMOBILE _ _ _ LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS _ 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 LIAB _ OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION $ $ 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 PER STATUTE OTH- FR E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS 1 LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) License: EC13001402 CERTIFICATE HOLDER CANCELLATION Village of Miami Shores 10050 NE 2nd Avenue Miami, FL 33138 ACORD 25 (2014/01) 1 of 1 #S18584838/M18584809 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 @ 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SHDE ' 4. 165-558-61-219-0 MATT HE V. f HONAS H E F FE RNA 10551 NE 2 PLACE WAIN SHORES FL 33138 2004 DCIEI 06 19.1961 SEx M ISSUED 11-12-201$14G/ IC EXPIRES 04-19-2024 ASSY 2A - MOORS E SAFE DRIVEN 3111333 ..3 .*h.tk. en.erktnArm,