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ELC-17-1863
Miami Shores Village �c 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 y a` Phone: (305)795-2204 �LORIDA Permit No. ELC-7-17-1-863 Permit Type: Electrical - Commercial Perlillot Work Classification: Addition/Alteration Permit Status: APPROVED Issue Date: 7/2812017 1 Expiration: 01/24/2018 vroiect Address Parcel Number Applicant 1700 NE 105 Street 1122300500001 Miami Shores, FL Block: Lot: SHORES CONDOMINIUM Owner Information Address Phone Cell SHORES CONDOMINIUM 1700 NE 105 ST MIAMI SHORES FL 33138 Contractor(s) Phone Cell Phone YORK ELECTRICAL CONTRACTOR C, (305)962-0759 1pe of Work: TEMPORARY PANE FOR 3 AMP DOUBLE POL dditional Info: TEMPORARY PANE FOR 3 AMP DOUBLE POL lassification: Commercial canning: 1 Fees Due Amount CCF $1.20 DBPR Fee $2.25 DCA Fee $2.25 Education Surcharge $0.40 Permit Fee $150.00 Scanning Fee $3.00 Technology Fee $1.60 Total: $160.70 Valuation: $ 1,400.00 Total Sq Feet: 0 Pay Date Pay Type Amt Paid Amt Due Invoice # ELC-7-17-64639 07/20/2017 Check #: 2651 $ 50.00 $ 110.70 07/28/2017 Check #: 2652 $ 110.70 $ 0.00 Available I Inspection Type: Final Relocation Fire Alarm Service Change Review Electrical W. W. Underground 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 AFFIDKojj�,Vin I certi that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and Futhe ore, I authorize the above -named contractor to do the work stated. ork <_'%z July 28, 2017 Authorize ' n re Owner / Applicant / Contractor / Agent Date Building Department Copy July 28, 2017 1 t Miami Shores Village RECEIVED Building Department JUL z 2017 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 F BC 20AU BUILDING Master Permit No.C1—'l -(e—/4 PERMIT APP ICATION Sub PermitNo.0-AC I� �Sco ❑BUILDING ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: /BOO xy�r-'- Z05 s1- City: Miami Shores County: Miami Dade Zip: 1U3 Folio/Parcel#: 11115065D©00is Is the Building Historically Designated: Yes NO Occupancy Type: Load: ) Construction Type: -o Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): M 154eAS LU�1lJrllymUYA Phone#: Address: %100 MC-- - 1,V5 5 r ` City: N I'A Pal ir, Sr 'Vs State: ! (.r Zip: 331 38 Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: G4 �r7b 'J Phone#: Addres��s:// SW l S l �c f �/ City: 141(1�i" 1 /f State: Fz— Zip: �3�5 Qualifier Name: LO rQVX -.O 10 1,C4Z.S Phone#: 3o5 ^ IDSa •2a� State Certification or Registration #: EC 1300 5 (4 S tQ Certificate of Competency #: DESIGNER: Architect/Engineer: Address: City: State Value of Work for this Permit: $ /; yea, fed Square/Linear Footage of Work: Type of Work: M Addition ❑ Alteration ❑ New ❑ Repair/Replace Description of Work: .N kV% G 20 A" J%\Aivsg wv%cceAe_ r2 Specify color of color thru tile: Submittal Fee $ Permit Fee $ CCF $ CO/CC $ Scanning Fee $ Radon Fee $ Technology Fee $ Training/Education Fee $ Structural Reviews $ DBPR $ Notary $ Double Fee $ Zip: Bond $ ` TOTAL FEE NOW DUE $ l I c) •� orn (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 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 approved and a reinspection fee will be charged. Signature Gto OWNER or AGENT Signature CO RACTOR r�� The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this L8 d`aycof c, U 20 �� , by 2'y day of--n4�'/ 20 1 by �C.l� ho ' ersonally kno o r who is pe sonally own to me or who has produced as me or who has produced identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: as Sign: Sign: (( /J Print: -Lv� vPrint:ail I �a Notary Public State of FMOa ,, Yesenia Mora +� Luia E Ibarra Seal: �,, Seal: Commission # GG105827 Mr Commission Gc 043500 �► Exou 02W MI Expires: August 19, 2021 ON IN ON APPROVED BY i� :Z © �V Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) 7/20/2017 Detail by Entity Name 1I'IUIUt' f1,j P( r, r ,�°A"7� i1z� r�rtrt! .:trtls srj P'L• ru/st l.eLsbx Department of State / Division of Corporations / Search Records / Detail By Document Number / Detail by Entity Name Florida Not For Profit Corporation THE SHORES CONDOMINIUM, INC. Filing Information Document Number 707621 FEI/EIN Number 59-1095398 Date Filed 07/21/1964 State FL Status ACTIVE Last Event AMENDMENT Event Date Filed 06/27/2012 Event Effective Date NONE Principal Address 1700 NORTHEAST 105TH STREET MIAMI, FL 33138 Changed: 04/22/2000 Mailing Address 1700 NORTHEAST 105TH STREET MIAMI, FL 33138 Changed: 04/22/2000 Registered Aaent Name & Address Jara & Associates, PA 19 West Flagler Street Suite 504 Miami, FL 33130 Name Changed: 01/24/2017 Address Changed: 01/24/2017 Officer/Director Detail Name & Address Title Treasurer STUBBS, PATRICIA 1700 NE 105 ST #211 http://search.sunbiz.org/Inquiry/CorporationSearetVSearchResultDetail?inqui rytype=EntityName&di rectionType= Initial&searchNameOrder=SH OR ESCON DO. 1/3 7/20/2017 Detail by Entity Name MIAMI SHORES, FL 33138 Title P SAMMONS, CHARLES 1700 NORTHEAST 105TH STREET #301 MIAMI, FL 33138 Title Secretary Grable, Jane 1700 NE 105 ST #117 MIAMI, FL 33138 Title VP RAJO, PEDRO 1700 NE 105 ST #111 MIAMI, FL 33138 Title VP Benavides, Jorge 1700 N.E.105 St #409 Miami Shores, FL 33138 Annual Reports Report Year Filed Date 2016 03/18/2016 2016 12/14/2016 2017 01 /24/2017 Document Images 01/24/2017 -- ANNUAL REPORT 12/14/2016 — AMENDED ANNUAL REPORT 03/18/2016 --ANNUAL REPORT 01/25/2015 -- ANNUAL REPORT 04/02/2014 -- ANNUAL REPORT 03/3V2013 -- ANNUAL REPORT 06/27/2012 — Amendment 02109/2012 -- ANNUAL REPORT 01/27/2012 -- Req. Agent Change 01/19/2011 — ANNUAL REPORT 09/27/2010 — Reg. Agent Chanqe 05/04212010 -- ANNUAL REPORT 10/14/2009 -- Reg . Agent Chan e 06/15/2009 -- Reg Agent Chanqe 04/30/2QQ9 — ANNUAL REPORT View image in PDF format 2/3 )7/20/17 01:39PM Leticia Insurance Agency 7867036435 Page 2 CERTIFICATE OF LIABILITY INSURANCE DAT@(MMfDD/YYYY) _ 07/20/2017 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 13ETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the POlicy(1e8) must be endorsed. If SUBROGATION 13 WAIVED, subject to the terms and conditions of the policy, certain Policies may require an Indorsement A statemont on this certificate does not confer rights to the certificate holder in lieu of such ondorsement(s). PRODUCER AC LETICIA RODRK3UE2 Leticia Insurance Agency P 5538 SW Est L — (30bL31-2094 A/ N.� (766) 703-643; angram leticiainsurenocagency®hotmea.00m Coral Gables, FL 33134 IN RE S AFF DING COVERAGE NAIC e Phone (305) 631-20N Fax 305 631-2184 INauRERA: GRANADA INSURANCE COMPANY INSURED INSURER • PROGRESSIVE EXPRESS INS COMPANY YORK ELECTRICAL CONTRACTORS CORP INSURER C., NORMANDY INSURANCE COMPANY 18071 SW 188 ST #25 ANSURER 0 : MIAMI FL 33157 INSURER I : COVERAGES 1 F: 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. uen rl TYPE OF INSURANCE _ COMMERCIAL GENERAL LIABILITY r , [:1 CLAIMS -MADE rV]' OCCUR U 0 I I 10185FL00084712 GEN'L AGGREGATE LIMIT APPLIES PER: LyI POLICY ❑ jECT ❑ LOC OTHER AUTOMOBILE LIABILITY ❑ ANY AUTO ("'1 �O�SWNED �OESOULEO HfREDAUTOS NON -OWNED AUTOS UMBRELLA LIAO ❑ OCCUR EXCESS W B n n, —.- WORKERS COMPENSATION AND EMPLOYERS• LIAMUTY Y / N C OFFFICR,'MEMBEREXCL�DpECUTN�— (Mandalory In NH) L If Yea, deacriba under — - DESCRIPTION OF OPERATIONS below N/A 07/1&2017 107/16/2018 LIMITS NCE 0 wpron'e tone person)0 INJURY1GATE P2OOO,00( 1PIOP AG( 8001LY INJURY (Par pmon) $ 1 01723018-5 07110/2017 07/10/2018 BOD" INJURY (Par "c6denf) S 1, Y MAG SY MAG S w PIP S 1 s NHFL0015442017 07/22/2017 �77 E.L EACHACCIDENT s 1,000,000,00 1LE.L DISEASEEEEAEMPLOYE s 1,000,000.00 -- _ EL DISEASE -POLICY LIMIT I S 1,000,000.00 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Rem&dm Schedule, N more spaee Is raqukw) ELECTRICAL CONTRACTORS UC# EC13005656 CERTIFICATE HOLDER MIAMI SHORES VILLAGES BUILDING DEPARTMENT 10050 NE 2 AVE MIAMI SHORES FL 33138 ACORD 25 (2014/01) OF 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 REPVSENTAIW.E LETICIA RODRIGUEZ LIC*0067160 m 188&2014 ACORD CORPORATION. AA rights re$ervBd. The ACORD name and logo are neg)utersd marks of ACORD