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DEMO-18-287Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 Project Address Permit Issue Date.' 2/28/2018 o. DEMO-2-18-87 Permit Type: Demolition Work Ciassitcation: Electric Permit Status. APPROVED Expiration: 08/27/2018 Parcel Number Applicant 1420 NE 101 Street Miami Shores, FL 1132050230050 Block: Lot: MATTHEW ALLEN Owner Information Address Phone Cell MATTHEW ALLEN 1420 NE 101 Street MIAMI SHORES FL 33138- (305)673-2847 Contractor(s) Phone UNLIMITED ELECTRICAL SOLUTION (786)554-3269 CeII Phone Type of Demo: Electric Additional Info: DEMO FPL TO REMOVE METER ELECTRICIA Classification: Residential Scanning: 1 Fees Due CCF DBPR Fee DCA Fee Education Surcharge Permit Fee Scanning Fee Technology Fee Total: Amount $0.60 $2.00 $2.00 $0.20 $100.00 $3.00 $0.80 $108.60 Pay Date Pay Type Amt Paid Amt Due Invoice # DEMO-2-18-66344 02/05/2018 Check #: 10873 $ 50.00 $ 58.60 02/28/2018 Check #: 10870 $ 58.60 $ 0.00 Available Inspections: Inspection Type: Final Review Electrical 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-n-. -d contfec Authorized Signature: Owner / Ap. scant / ontrac or / Agent February 28, 2018 Date Building Department Copy February 28, 2018 1 Address: City: Address: 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: Master Permit No. Sub Permit No. RECEIVED FEB 0 5 2018 ❑ REVISION ❑ EXTENSION Li RENEWAL ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS H2O 14- `p2►.Np S 'ce-- City: Miami Shores County: Folio/Parcel#: ) I- g 2 05 - 02 3 0050 Occupancy Type: Load: OWNER: Name (Fee Simple Titleholder): ►ii2O .ut ioksr City: }(n M l S\U r - Tenant/Lessee Name: Email: Skeer Construction Type: Miami Dade Zip: Is the Building Historically Designated: Yes NO BFE: FFE: Flood Zone: }414A I (e y' Phone#: State: �(— Phone#: Zip: 33 (34 305. 2°) • CONTRACTOR: Company Name: (.AS f 1Ia71. f Phone#: ?F6 S�'f! 3 Z moo/ Nw 4-0/ Qualifier Name: State Certification or Registration #: DESIGNER: Architect/Engineer: Address: City: State: Zip: State: (.S/).1cc .2. Sr.,a_ - Fc /Joo V/fr/ Value of Work for this Permit: $ 3 00. 00 Type of Work: ❑ Addition I l Alteration Description of Work: oleMV - F L lv Square/Linear Footage of Work: Zip: 33d /S" Phone#: 9i -12 / 3? ‘ f Certificate of.,Competency #: s Phone#: ❑ New n Repair/Replace Demolition cr—triOL) WLtt�r / irNB1,42c `(CC -i Col %r/Y1 Specify color of color thru tile: Submittal Fee $ Permit Fee $ / V 0 . O Q CCF $ CO/CC $ scanning Fee $ Radon Fee $ DBPR $ Notary $ Technology Fee $ Training/Education Fee $ Double Fee $ Structural Reviews $ Bond $ TOTAL FEE NOW DUE $ 56' • 60 (Revised02/24/2014) Bonding Company's Name (if applicable) 3-=c--.r'21%J Bonding Company's Address City /411-2.1-77' /3/3/iw' 0*,1 ST State Mortgage Lender's Name (if applicable) Mortgage Lender's Address City Zip _3 3 / 6 S` 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 condition to the issuance of o 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 low 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 e apprloved and a reinspection fee will be charged. Signature OWNER .r ' GENT The foregoing instrument was acknowledged before me this 01) day of kJ Ovary)%Y , 20 / , by A-Ilt n who is personally kno me or who has produced as identification and who did take an oath. NOTARY PURL -� Sig.: Print fal u (C/ca's Sea . .a.. —..-in_ -an An. TAUA RICKARDS Notary Public - State of Frorlda #*0900llllt(1994fEJ$9,514## My Comm. Expires Jan 19, 2019 Aoltasdthrough6gtiona Notary Assn. I ll00,141. _ l Ai_ Plans Examiner Signature CONTRACTOR The foregoing instrument was acknowledged before me this 4,10 day of ��.�v�.t vj , 20 /,Y , by r who s produced who is personally known to 1 as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: Seal: Structural Review (Revised02/24/2014) Zoning Clerk .A C"CJ • PRODUCER Amtrust Insurance Group 8100 SW 81 Drive, Ste 280 Miami, FL 33143 Phone (305)275-0810 CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YY) 01/25/18 Fax (305)275-0890 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC # INSURED Unlimited Electrical Solution, Llc. 7601 NW 182 Terrace Hialeah, FL 33015- Fax: 305-698-6877 INSURER A: Granada Insurance Company B+4 INSURER B: Progressive Insurance Company INSURER C: INSURER D: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR ADD'L INSRD TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MMIDDIYYYY POLICY EXPIRATION DATE (MMIDDIYYYY) LIMITS A II GENERAL UABILITY 0185FL00012219 12/06/2017 12/06/2018 EACH OCCURRENCE 1,000,000 Eg COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES (Ea occurrence) 100,000 MED EXP (Any one person) 5,000 II ❑ CLAIMS MADE In OCCUR PERSONAL & ADV INJURY 1,000,000 V Contractual Liability GENERAL AGGREGATE 2,000,000 v Broad Form PD GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS -COMP/OP AGG 2 QQQ QQQ 0 POLICY ❑ PROJECT ❑ LOC B ❑V AUTOMOBILE LIABILITY 03888057-0 08/16/2017 08/16/2018 COMBINED SINGLE LIMIT (Ea accident) 50,000 ANY AUTO II ALL OWNED AUTOS BODILY INJURY (Per person) SCHEDULED AUTOS Il HIRED AUTOS BODILY INJURY (Per accident) NON OWNED AUTOS a PROPERTY DAMAGE (Per accident) ❑ ❑ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT II ANY AUTO OTHER THAN EA ACC . AUTO ONLY: AGG EXCESS / UMBRELLA LIABILITY EACH OCCURRENCE AGGREGATE II OCCUR ❑ CLAIMS MADE DEDUCTIBLE NI RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY y/N ANY PROPRIETOR / PARTNER / EXECUTIVE OFFICER / MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under SPECIAL PROVISIONS below ❑ WC STATU- ❑ OTH- TORY LIMITS ER E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE E.L. DISEASE - POLICY LIMIT A OTHER Hired / Non -Owned Auto 0185FL00012219 12/06/2017 12/06/2018 $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS 1 VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS Electrical work License No.: EC13004141 CERTIFICATE HOLDER CANCELLATION Miami Shores Village Building Department 10050 NE 2nd Ave Miami Shores, FL 33138 1 Fax 305-756-8972 ACORD 25 (2009/01) QF SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE © 1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Unlimited Electrical Solutions, LLC EC13004141 February 20, 2018 State of Florida County of Miami -Dade Before me this day personally appeared Osmany Suarez, who, being duly sworn, deposes and says: That he will be the only person working on the project located at: 1420 NE 101m Street Miami Shores, FL 33138 Contractor Signature Date Swom to (or affirmed) and subscribed before me this — / day of er?_ T , 2018, by (S�� irt� / errsonally known_ Or produced identification Type of identification produced 7601 N.W. 182'd Terrace, Hialeah, FL 33015 Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Notice to Owner — Workers' Com ensation Insurance Exemption p 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 contractorr 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: Owner State of Florida County of Miami -Dade The foregoing was"acknowledge before me this -al day of hyUA p , 20 1 Fj . '` By t G:i'I V�Y_t,t) j Q Yl is personally known to m as identification. Notary: SEAL: or has produced TALIA RICKARDS AY PUe(t+'-. Notary Public - State of Florida • Commission a FF 189581 My Comm. Expires Jan ,13, 2019 Bonded -through National Notary Assn.