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EL-18-2419Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 Project Address Permit Parcel Number Permit NO. EL 9-18-2419 Permit Type: Electrical - Residentia Work Classification: Service Change Permit Status: APPROVED Issue Date: 9/11/2018 Expiration: 03/10/2019 Applicant 410 NE 105 Street Miami Shores, FL 33138-2043 1122310150080 Block: Lot: JOSEPH HAYLES Owner Information Address Phone Cell JOSEPH HAYLES 410 NE 105 Street MIAMI SHORES FL 33138- Contractor(s) WEST KENDALL ELECTRIC Phone 305-596-6240 Cell Phone Valuation: Total Sq Feet: $ 1,500.00 0 Type of Work: SERVICE REPAIR NUMBER GIVE TO MIKE Additional Info: Classification: Residential Scanning: 3 Fees Due CCF DBPR Fee DCA Fee Education Surcharge Permit Fee - Additions/Alterations Scanning Fee Technology Fee Amount $1.20 $2.25 $2.00 $0.40 $150.00 $9.00 $1.60 Total: $166.45 Pay Date Pay Type Amt Paid Amt Due Invoice # EL-9-18-68844 09/11/2018 Cash $ 166.45 $ 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 fore construction and zoning. Futheu»ore, I aut -named contractor to do the work stated. uthohzed Signature: Owner / Applicant / Contractor / Agent ion is accurate and that all work will be done in compliance with all applicable laws regulating September 11, 2018 Date Building Department Copy September 11, 2018 1 RICK SCOTT, GOVERNOR JONATHAN ZACHEM, SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD THE ELECTRICAL CONTRACTOR HEREIN IS CERTIFIED UNDER THE PROVISIO S OF CHAPTER 489, FLORIDA STATUTES WEST KENDALL ELECTRIC INC 9305 SW 94TH ST FL33176 L ` SE MBER: E 13001890 EXPIRATION DATE: AUGUST31, 2020 Always verify licenses online at MyFloridaLicense.com Do not alter this document in any form. This is your license. It is unlawful for anyone other than the licensee to use this document. BUILDING PERMIT APPLICATION ❑ BUILDING ,ELECTRIC 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 ❑ ROOFING Master Permit No. Sub Permit No. rb GD 64'1-` FBC 20 n Fri -2.41631 ❑ REVISION ❑ EXTENSION, 0RENEWAL PLUMBING ❑ MECHANICAL PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP { CONTRACTOR DRAWINGS JOB ADDRESS: 4 to 1 e to 5 T 11 5.-ACv. City: Miami Shores County: Miami Dade Folio/Parcel#: f' I ' 2-23 (' t� 5— On CB 0 Is the Building Historically Designated: Yes Zip: NO Occupancy Type: S Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): C-. 1�Y ies Phone#: �� _ Z� r Address: L/' ids 1 5 Tv\ 1��- T I City: ��i a AA ' State: r t C•\ 1/ 1- Zip: i � I 6 Tenant/Lessee Name: Cep C� '� aS(---SV% % �i Phone#: p 'Z(2 — 2 �,, t Email: 'Pt-Vt� Li, ��1� 1 '\_. 'C.O Vt." CONTRACTOR: Company Name: (4 )e5�{ 7?G jeg ��CK/C Phone#:5 �7U y C7 Address: Sv V q C/ S City: V St te� Qualifier Name: G'1 (Y'(c (-j(/ e State Certification or Registration #: ( > C3 t p •(i0 DESIGNER: Architect/Engineer: -Address: • Value of Work for this Permit: $ 1 % ca° Type of Work: -❑ Addition ❑ Alteration Description ofWork: t':"•`" City: Zip: /2 Phone#: S ? 7 Certificate of Competency #: Phone#: State: Zip: Square/Linear Footage of Work: ❑ New Repair/Replace IT Demolition Y f. Specify color of color thru Submittal Fee $ Scanning Fee $ Technology Fee $ Structural Reviews $ tile: w Permit Fee $ 1 ,, and CCF $ CO/CC $ Radon Fee $ DBPR $ Training/Education Fee $ Notary $ Double Fee $ Bond $ c TOTAL FEE NOW DUE $ ( '�7- `1�J (Revised02/24/2014) Bonding Company's Name (if applicable) Bonding Company's Address City Mortgage Lender's Name (if applicable) State Zip i2e� F 111,G v� e �`c� 1 Mortgage Lender's Address ?� (S (0 U D NE 1 - 1' City 1 Q, O. 1 t State �i�i l6u Zip 33L(0( Application is hereby made to obtain a permit todo 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 infotrmation is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. k ` 1 ' ' "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS'TO YOURIPROPERTY. 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 $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of.such posted notice, the inspection will not be approved and a reins : ection fee will be charged. Signature Th- foregoing'instrum- . wa acknowledged before e this Thefq{`�going instr -nt as acknowledged before a this day of _,� "/'J , 20' by it ring of , 20 by OWNER or AGENT Signature CONTRACTOR who is personally known to me or who has produced as identification and who did take an oath. NOTARY .PUBL• vie,,, who is personally known,,to d , me or who has produced 1 ' J as identification and., o did to NOTARY PUB Sign: Print: Seal: *******sss*****sss***s****************s**ss***********sss*********************s****************************s APPROVED BY ,-CE'77./fJ Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) 2 Client#: 7899 CYPRESS WESTKEND ACO$DTMCERTIFICATE OF LIABILITY INSURANCE !WAR LTR DATE (MM/DD/YYYY) 9/11 /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: It 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 COM-Cypress Insurance Group PO Box 9328 Fort Lauderdale, FL 33310-9328 954 771-0300 INSURED West Kendall Electric Inc. 9305 SW 94th Street Miami, FL 33176-2013 COVERAGES ntIPCT Carissa LaFreniere PHONE No, Ex: 954 771-0300 FAX 954 772 9424 L 2� � (aC, No A t SS: Certs@Cypresslnsurance.com tNSURER(S) AFFORDING COVERAGE INSURER A : Travellers Indemnity Co of America INSURER B : NOrmwdY INSURER C INSURER D INSURER E : NAIC ► INSURER F : 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 POL CIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, ADDLT$UBR IN&R. WYD TYPE OF INSURANCE CERTIFICATE NUMBER: A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE I XI OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: I I PRO- 1 POLICY JECT II LOC OTHER: POLICY EFF POLICY EXP PORGY NUMBER(MM/DD/YVYY), (MM/DD/YYYY)_ 16601055X579TCT18 02/28/2018 02/28/2019 EACH OCCURRENCE LIMITS p�,1q�ET $1,000,000 Ft[MI a &,,a, occu ence, $100,000 MEDEXP (Any one Person) PERSONAL & ADV INJURY $ 5,000................. $1,000,000 GENERAL AGGREGATE $2,000,000 ............. PRODUCTS • COMP/OP AGG $2,000,000 R AUTOMOBILE LIABILITY ISCHEDULED AUTOS i NON -OWNED i AUTOS UMBRELLA LIAR OCCUR EXCESS LIAB CLAIMS -MADE )tD RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROoPRIETOpR/PARTNER/EXECUTSVE V_(N OFFICER/MEMBER EXCLUDED? I._ (Mendntory to NN) n ea, describe under DESCRIPTION OF OPERATIONS below ANY AUTO ALL OWNED AUTOS HIRED AUTOS N/A [COMBINED SINGLE LIMIT igs accident)._ BODILY INJURY (Par parSOn) $ BODILY INJURY (Per accident) $ EROPERTV"LUMAi.E ............................... (Orr OPII4rnU........ _.......__------ EACH OCCURRENCE $ AGGREGATE NHFL0009162017 NHFL0009162018 03/20/2017 03/20/2018 03/20/2018. X...I. $T1/Tu1k....................�.E EH * 3//20/2019 EL, EACH ACCIDENT ................................................................................. E.L DISEASE - EA EMPLOYEE EL. DISEASE - POLICY LIMIT DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached If more apace Is required) Workers Compensation applies to Florida operations and employees only. West Kendall Electric (Electrical Contractor) - State License #EC13001890. $1,000,000 $1,000,000 $1,000,000 CERTIFICATE HOLDER Village of Miami Shores Bldg Dept. 10050 NE 2nd Avenue Miami, FL 33138 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 ifergfit .f , eiD., © 1988-2014 ACORD CORPORATION. Ali rights reserved. ACORD 25 (2014/01) 1 of 1 The ACORD name and logo are registered marks of ACORD #8272539/M261545 CAT • Local Business Tax Receipt Miami —Dade COunty, State of Florida -11HtStS4101' A EMI. - DO NOT PAV I 0,0144 INPS/NISIGS itAlltraUPLATION WEST KENDAU_ ELECTRIC INC 51305 SW134TH ST WAIL FL 33176 OWSNA 1417V1 Kr NOM i C t1 CI CITC i Cult: t (XIINT/TA,.=,L . WarkerN 10 EcaM101410 RIKAWT NQ, KEN:041AL 1949954 ow. vpie IIIVIMMICNII LBT EXPIRES SEPTEMBER 30, 2019 Nuatbe displayed pi= of iminims Pursuant to Courtly cede Chapter 8A —Aft 981.)0 OP,M1tOolaff IRICCINVID SIT TAX COILLSCTON 75.00 07.1110.2'• ECRECK•18.201040 Pa WWI &Awn TIIIR1144**916 suPrxxx pereeete4 de Lead OteehieceTex. The themeee ee agog Seeseek pomil, era cdeftrikidlos qualMozBoto. to Os beim Maar most acouplyedb Erg goomarmotzl inimpannoludai Npikant Nies sad Nepikmielta Wadi Emil Is es • The leCENT II0,1691Pli wart lip r5svolwrod commvid Arin Cada 2mc forum, ihrawrierioink wwitainsidedasolkinomilscsor