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EL-16-2479Miami Shores Village RECE, 4EL Building Department MAR 0 S 1018 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 S� FBC 20JU BUILDING Master Permit No. PERMIT APPLICATION Sub Permit No. �_� l �r�—ZQ�'� ❑BUILDING X ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS © CHANGE OF [:]CANCELLATION [—]SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 17 N;% 105 S"Y - City: Miami Shores County: Miami Dade Zip: 3 139 Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): QL_Iv1E7Z 5CEa/1xT Phone#: 305.810.R1S1 Address: 17 ME 105 SriYlCE City: ! 5 lfoy-o' State: T-L_- zip: 33/ 3k Tenant/Lessee Name: Email: ne#: CONTRACTOR: Company Name: Xl/ak"i Re7-/ TtiG• Phone#• 309= 439- $s71 Address City 7O0 L!--) Z —O'GT ?qf/ 1l.eAk 7-7- State: Zip: 33b�7 Qualifier Name: _V__ Phone#: State Certification or Registration #: // Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: $ $i oGiJ • eo Square/Linear Footage of Work: Type of Work: ❑ Addition ® Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: Ar Specify color of color thru tile:, Submittal Fee $ Scanning Fee $ Permit Fee $ �� G� CCF $ CO/CC $ Radon Fee $ Technology Fee $ Training/Education Fee $ Structural Reviews $ DBPR $ Notary $ Double Fee $ Bond $ TOTAL FEE NOW DUE $ (Revised02/24/2014) Bonding Company's Name (if applicable) Bonding Company's Address City State Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip Zip W 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 appreved a reinspection fee will be charged. NT The foregoing instrument was acknowledged before me this day of ( 20 ( � by who is personally known to me or who has produced .as Signature _ 6*�? CONTRACTOR The foregoing instrument was acknowledged before me this CO day of A 20 AF by O v1'� who is personally known to me or who has produced as identificati and who did take an oath. identification and who did take an oath. NOTARY B IC: NOTARY PUBLIC: Sign: Sign: d� Print: Print: Seal: . ro1YA�s�� Notary?ub'cStateofFlorida5ea COltl" W130110 o Alvarez My C4 E*rn IN VM18 � ua My oTm�cs,on FF 156750 �(` V�ro°F Expires 09113/2018 • i a a .a ,r, m d4 R.;A ,Re .iS,.A..J.....d APPROVED BY �7�%Z i8 Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CHANGE OF CONTRACTOR / ARCHITECT Permit N. JE)_a(-16-2419 Owner's Name (Fee Simple Title Holder): N J VEEL SMVA-r Phone #: � g1�.�1 �✓ l Owner's Address: 17 149 )Q5 SUIECT City: M [AM 1 5 ROCEF-5 State : El Zip Code: 33l 38 job Address (Of where work is being done): 17 MF- 105 STRFOr City: Miami Shores State: —Florida Zip Code: 33l38 Contractor's Company Name: Address: 1 (1Z' Phone #: 3OS _al62 32-2-4 City: %iI/-.9-7-, --- —�_ State: �L Zip Code: 33/14Sz Qualifier's Name: &L3ECTA P&7V[.00 L.A Lic. Number: EC /30043-57-- Architect/ Engineer of Record Name: Address: City: State: Describe Work: 15 OUDZ-1 2S 20LACE ` AA) . Phone Zip Code: 1 hereby certify that the work has been abandoned and/or the contractor/architect is unabl nwilling to complete the contract. i hold the Building Official and the - ,.. 4iami Shores harmless of all legal involvement. Sig Signature �L n r or Contractor or Architect The foregoing instrument was aknowledged before me The foregoing instrument was aknowledged before me this __S_ day of 2019,byle-ijjE:L SG"AT- this _/ day of 414Cr 20 ley � � L 1+ Who is personally known to me or who has produced who is personally known to me or who has produced as indentification. Nota 'c: Notary Sign: Sign:_ Seal: C.�I (�� \�L�� Seal: 4 cep Jotary blic State of Florida {1' I S-nd.a .AxareZ f, �c kAy commission FF 156750 o� Expires 09!03/2018 indentification. 101 MWTA ACOSTA *. W COMMISSION 8 FF 971450 .*. o, EXPIRES: May 1. 2020 .�Eaf �, op; BoM Thru Notary Public UndaMrtbm 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 W 07 role a� FBC 20 )q S4 Master Permit No. IE!� f (0 — *� 1 Sub Permit No. E(—,k ('0 — p?415 ❑ REVISION ❑ EXTENSION ❑ RENEWAL ❑PLUMBING ❑ MECHANICAL [--]PUBLICWORKS CHANGE OF [:]CANCELLATION [:]SHOP CONTRACTOR DRAWINGS JOB ADDRESS: I-7 W E PS' 'S I City: Miami Shores County: Miami Dade Zip: 33 13'7 folio/Parcel#: n Is the Building Historically Designated: Yes NO - Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): ,tDL[ !%`.� s���T Phone#: Address: / q /`� s- / V (5- /- City: 1W'i -r 7 S-A�5 State: L Zip: -3 �✓ 3� Tenant/Lessee Name: Email: CONTRACTOR: Company Name: ,,,4L .S G �� GJ1721 L. / AJ C Phone#: � C�( C C? Address: City: State: FL Zip: 33 1 3W Qualifier Name: e-12-T,�, /�-,-J I�L�S)Li I CC L4 Phone#: State Certification or Registration #: L.C, 13 dO V-3 32. Certificate of Competency #: _ DESIGNER: Architect/Engineer: Phone#: Address: value of Work -fox this Permit;, Type of Work: M Addition ❑ Alteration Specify color of color thru tile: Square/Linear Footage of Work: ❑•New ❑ Repair/Repl State: Zip: ❑ Demolition Submittal Fee $ Jy vy Permit Fee $ ' a 0 CCF $ 1 - 2- lCO/CC $ Scanning Fee $ 3 Radon Fee $ 4• D B P R $ -/ • SO Notary $ 0 Technology Fee $ 1 Training/Education Fee $ 0, 40 Double Fee $ 0 Structural Reviews $ Bond $ TOTAL FEE NOW DUE $ 2 6 - 20 (Revised02/24/2014) Bonding Company's Name (if applicable) Bonding Company's Address City State Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip 41 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 whickr occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be app=Aed.attd i�,reinspection fee will be charged. OWNERorAGENT The foregoing instrument was acknowledged before me this i day of ,t 20 '�io by t v who personally known to me or who has produced c%k`04A,-, as identification and who did take an oath. NOTARY PUBLIC: Signature CONTRACTOR The foregoing instrument was acknowledged before me this 2.9- day of a -1�-1 A . 120 1 � by Dts'IV/CoLAvho is personally known to me or who has produced �Y-T M as identification and who did take an oath. NOTARY PUBLIC: Sign: Sign: Z4�1 Print: Print: MARIIA ACOSTA Seal: :_:"'�fi= MW2TAACo3t: ~7 Seal: I. MYCOMMI9BIONiFF0714i0 v� MIYCOMM64.WA y ' P"�.c `� EMI ft MNp 1, 2020 . o,r EMRF:c +styi,'ai'xi y %"oFi;R"••'• B=WThruNo" P1iiA Wdwwd '•p,;;�.. BaidedThF'r•t�f:'v;'ra;.'C:�'rS^�:e�'i�q •, APPROVED BY S�P�C Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) �sµ°S Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 �"CORiD4` Phone: (305)795-2204 Permit NO. EL-9-16-2479 Per Permit Type: Electrical - Residential ' Work Classification: Alteration Permit Status: APPROVED Issue Date: 9/1212016 I Expiration: 03/11/2017 Project Address Parcel Number Applicant 17 NE 105 Street 1121360060100 Miami Shores, FL 33138- Block: Lot: OLIVER & ANDREE STEPHANIE Owner Information Address Phone Cell OLIVER & ANDREE STEPHANIE 17 NE 105 Street --- - - -- MIAMI SHORES FL 33138- 17 NE 105 Street MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone AL'S ELECTRIC (305)446-6149 (305)962-3224 Type of Work: AS PER PLANS 15 OUTLETS REPLACE PAN Additional Info: Classification: Residential Scanning: 1 Fees Due Amount CCF $1.20 DBPR Fee $4.50 DCA Fee $4.50 Education Surcharge $0.40 Permit Fee - Additions/Alterations $300.00 Scanning Fee $3.00 Technology Fee $1.60 Total: $315.20 Valuation: $ 2,000.00 Total Sq Feet: p Pay Date Pay Type Amt Paid Amt Due Invoice # EL-9-16-61254 09/12/2016 Check #: 647 $ 265.20 $ 50.00 09/07/2016 Credit Card $ 50.00 $ 0.00 Available Inspections: Inspection Type: 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 or all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL, PLUMBING, HANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: I certify thff all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction arrAzoning. FuthermgVe, I authorize the above -named contractor to do the work stated. September 12, 2016 / Applicant / Contractor / Agent Building Department Copy September 12, 2016 1 ica! Business Tax Receipt Miami —Dade County, State of Florida THIS IS NOT A SILL-00 NOT PAY 54143 LBT' SINESS f4lAMMOCATION RR!CSnPr NO. EXPIRES ; ELECTRIC INC Rmr-Wa- SEPTEMBER 30, 2017 13 SIN 45 AVS 1254M Must be displayed at places of business W FL 33134 Pursuant to County Code Chapter 8A - ArL S & 1 D MER SF-C. TYPE OF BUSINESS PAYMENT RECEIVED i EL�crw ING 196 ELECTRICAL CONTRACTOR BY TAX C.OUXCTOR ECI3002332 $75.00 07/18/2016 ►rker(s) 1 CREDITCA[iD-] 6r041952 Tlds taoml Easiness Tax Receipl ally MGM pgmga at"M:oeal Baslaess Tax Tks ReaNpt Is sat a Iicswe, pausk or a naHl9radon of dm boldoes nealtri�� �hHdoo s. Holder mnet c .9ph, any 6ovenwaa l or aoopaverrineanl reaulatary low am apply to the baiaess. The BECE K NO- above mast ha displaysd on all ooa maul vahides- i ami-Dada Code Sao 80-M For awe IMfarmabah visit 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 mytloridalicetwe.com. There you can 9d more Information about our divisions and the regulations that impact you, subscribe to department newsletters and loam more about the Departmeriys initiatives. Our mission at the Department is: License Efficiently, Regulate Fairly. We constantly strive to serve you better so that you can serve your customers. Thank you for doing business in Florida, and congratulations on your new dcensel RICK SCOTT. GOVERNOR rATION (850) 487-1395 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIOMkL REGULATION EC13002332 'ISSUED' - 07/06/2016 CERTIFIED ELECTRICAI-001FTRACTOR AVS ELECTRIC'INC' IS CERTIFIED under the provisions of Ch.489 FS. Explradmdate : AVGai. axle L%0708ao0l337 DETACH HERE M w KEN LAWSON, SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING SOAR13 EC13002332 i The ELECTRICAL CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2018 DENICOIL , ALBERT J AUS ELECTRIC INC 1423 SW 45TH AVE MIAMI FL 33134 ar-n 4+ t 4rn7rv2mnq A*+7 P�P, A&CMH CERTIFICATE OF LIABILITY INSURANCE �� FDATE(MMIDD/YYYY) 08/29/2016 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 CONTACT NAME: Pablo M Conde P"ENEO. >n : (305) 220-7447 A/c No): (305) 220-4821 A&A Underwriters Inc. 8778 SW 8st E-MAILADDRESS: pmc@aaunderwdters.com INSURER(S) AFFORDING COVERAGE NAIC III INSURERA: WESCO INSURANCE COMPANY Miami FL 33174 INSURED INSURERS: BUSINESSFIRSTINSURANCE COMPANY INSURER C : AL'S ELECTRIC INC INSURER D : 1423 SW 45th Ave INSURER E : INSURER F : Coral Gables FL 33134 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. ILTR TYPE OF INSURANCE A UBR POLICYNUMBER MMIDDIIYEYW MMILDID/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS MADE a OCCUR WPP1173597 02 07/20/2016 07/20/2017 EACH OCCURRENCE $ 1,000,000 PREMISES Ea occurrence $ 100,000 GEN'L X MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY s Excluded AGGREGATE LIMIT APPLIES PER: POLICY E ECT LOC OTHER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS COMBINED SINGLE LIMI Ea accident $ BODILY INJURY (Per person) $ BODILY INJURY Per accident ( ) $ PROPERTY DAMAGE Per accident $ UMBRELLA LIAB EXCESS LIAR HCLAIMS-MADE OCCUR EACH OCCURRENCE $ AGGREGATE $ DEC) I I RETENTION $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY y / N OFFICER/MEMBER EXCLUDED? PROPRIETOR/PARTNER/EXECUTIVEANY 7 (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A 0521-08333 03/15/2016 03/15/2017 OTH- X STATUTE ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYE $ 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) "----""""'Electrical Contractor**-* vcM r rrn.r% r V_ nvwcrc 1L AN6tLLA I IUN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Miami Shores Village ACCORDANCE WITH THE POLICY PROVISIONS. Building Department. AUTHORIZED REPRESENTATIVE 10050 NE 2nd Ave Miami Shores FL 33138 f, ------ @ 1988-2014 ACORD CORPORATION. All rights reserved ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD