EL-17-2088Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Permit NO.: EL-8-17-2088
��j j` Permit Type: Electrical -Residential
nj)j I Work Classification: Addition/Alteration
Permit Status: Approved
issue Date: 08/17/2017 1 Expiration: 12/03/2018
Location Address _ Parcel Number
1569 NE 104 ST, Miami Shores, FL 1122320320160
Contacts
ALAIN & CARLY GONZALEZ Owner ALAIN & CARLY GONZALEZ Applicant
1S69 NE 104 ST, MIAMI SHORES, FL 33138 1569 NE 104 ST, MIAMI SHORES, FL 33138
Mobile: 7862779756 Mobile: 7862779756
ADVANCED ELECTRICAL INNOVATIONS Contractor
10SEBARROSO
8334 NW 56 ST, DORAL, 33138
Business: 7863021175
Description: PROVIDE NEW PANELS, NEW CIRCUITS FOR ALL Valuation: $ 19,500.00 Inspection Requests:
762-4949
LIGHTING, RECEPTACLES AND SWITCHES AND OTHER ITEMS
AS PER PLANS LISTED ON THE BLUE PRINT. Total Scl Feet: 0.00
Fees
Amount
CC F
$12.00
Change of Contractor
$110.00
Change of Contractor Fee
$75.00
DBPR Fee
$10.24
DCA Fee
$10.24
Education Surcharge
$4.00
Notary Fee
$5.00
Permit Fee - Additions/Alterations
$682.50
Scanning Fee
$3.00
Technology Fee
$16.00
Total:
$927.98
Building Department Copy
Payments
Date Paid
Amt Paid
Total Fees
$927.98
Credit Card
01/26/2018
$75.00
Credit Card
12/19/2018
$110.00
Credit Card
08/17/2017
$742.98
Amount Due:
$0.00
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 auihori th above named contractor to do the work stated.
Authorized Signature: Owner / Applicant / Contractor / Agent Date
December 19, 2018 Page 2 of 2
Miami Shores Village
RECEIVED Building Department
DEC 1 9 10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
CHANGE OF CONTRACTOR / ARCHITECT
Permit N. -1�(-A --2
Owner's Name (Fee Simple Title Holder): 41-4/ V104Z,6 Z. Phone #: 7Y6 -- ,-77- 17S�
Owner's Address: / 5-6 7 Al L5 /D V d
City: State : nt Zip Code:
Job Address (Of where work is being done): %�� IV L 104 J `�
City: Miami Shores State: —Florida Zip Code: 3'3)-79
Contractor's Company Name: �GZ Phone #: 7 916 -- 8'* - 09S�
Address: *3 $ 9 a ,V / tkm
City: / , / & 14 State: Zip Code: Z t 0
Qualifier's Name : A aJO 57 /h ZOJ'O Lic. Number: 3D )"
Architect/ Engineer of Record Name: Phone #:
Address:
City: State: Zip Code:
Describe Work: F— L--\-1 -MYY
hereby certify that the work has been abandoned and/or the contractor/architect
is unable or unwilling to complete the contract. 1 hold the Building Official and the
Miami Shores harmless of all leg in Iv ent.
Signature f Signature
Owner or Agent Contractor or Architect
The foregoing instrument was aknowledged before me The foregoing instrument was aknowledged before me
this n day of ��C--,201 this da of bUC— 20 by 9 Sa
���N�
Wh Wally k wn to rrtp � i�ia� pdr�s d wh personally known o me or who has produced
Notary Public: _ • 5,1� : Notary �l
IZZ
Sign: soo;: o`
g Sign: `.
Seal: ro�l4E'"PU Seal: -
�Q
•' r.ut ublic - State ot'Florida
� 8
� Bonded lhrougi1 National Notary Assn.
T��C�
45',.L5-119
Miami Shores Village RECEIVED
Building Department DEC 19 20195L,
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949 5-1-11
FBC 20 N
BUILDING Master Permit No.
PERMIT APPLICATION Sub Permit No.
❑ BUILDING G26ECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑ RENEWAL
❑PLUMBING ❑ MECHANICAL [:]PUBLICWORKS [:]CHANGE OF ❑ CANCELLATION [:]SHOP
/ CONTRACTOR DRAWINGS
JOB ADDRESS: 114)
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): L A) bN ZA-L, 62- Phone#: 7
Address: 13-6 i ICJ/�
City: X119 ►'✓) ,.S`DState: � Zip:
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: /� >/���'�CsG%��ilG.�L %U.V�9U�17/Pr1 Phone#:
Address: �j 3.3U 'elzo '�' i6n—
City: UUX--A'Y'(-
Qualifier Name: j QS
,/rz�-- zip: 33%/ �
Phone#:
State Certification or Registration #: LC� `� �n % Certificate of Competency #:
DESIGNER: Architect/Engineer:
Add
fD
one#:
State
Value of Work for this Permit: $ oZ�i Ddy Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace
Dpscrintinn of Wnrk2 r2. ! trz/t+^ ✓LI�C�c% O/�'`> i ri 0� D �. /n ///i/(�
Cy i�1'I; c c.►2�
Zip:
❑ Demolition
—14 A
Specify color o for thru tile:
Submittal Fee $ Permit Fee $y ' CCF $ CO/CC $
Scanning Fee $
Technology Fee $,
Structural Reviews $
Radon Fee $
Training/Education Fee $
DBPR $
Notary $
Double Fee $
Bond $
TOTAL FEE NOW DUE $ 1l o 't)._7
(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
OWNER or AGENT
The foregoing instrument was acknowledged before me this
day/oaf Q-, 20 , by
t ty �i-���� , who is p ovally wn to
me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
\l\lxo
sz-
Sign:
Print:
Seal:
APPROVED BY
r•�1
Signature
CONTRACTOR
The foregoing instrument was acknowledged before me this
day of ��� a , 20 ' by
who is personally known to
me or who has produced \x-Z i�l 2 as
identification and who did take an oath.
NOTARY PUBLIC:
Print:
Seal:
Plans Examiner
Structural Review
Y�ePun . • _ tii �i_
r:• yr
• Ogg at:.
yy ` =
Zoning
Clerk
(Revised02/24/2014)
Miami Shores Village'""'
Building Department AN 6 2016
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 BY
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
FBC 20 1,4
BUILDING
PERMIT APPLICATION
❑BUILDING �ECTRIC ❑ ROOFING
❑PLUMBING ❑ MECHANICAL [:]PUBLICWORKS
JOB ADDRESS: / /1,5 /P Z/
Master Permit No. %Z C,— �'1%' /S& S
Sub Permit No. @_ " Zo
❑ REVISION ❑ EXTENSION ❑RENEWAL
CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
City: Miami Shores County: Miami Dade Zia: 3313,8
Folio/Parcel#: Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): t41_A% °U (jtN 0Z,4Z i5Z Phone#: 7 $t'— .,-Z774
7S6
Address: IS6 9 00� / 0 yfT
City: /n /fA'MI s op&"Cf State: L �i/�! l�' Zip: 33/38
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: '4 C4q[. -Sd;W1G4'9 OF r��QOPhone#:
Address: 5990 GJ 1/ / i16
City: /a/A,State: r---LZip: 339/2---
Qualifier Name: Phone#: '79& — 9,9V_ 'q�%S(o
State Certification or Registration #: e2t l 3o 15 ! 15 Certificate of Competency #:
DESIGNER: Architect/Engineer:
one#:
Address: City: State
Value of Work for this Permit: $ 49 090 , (OV Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration New ❑ Repair/Replace
i
Description of Work: _2;�7 7L� /!lx 0' �P�N ���-, ��f�'�f12
Specify color of color thru tile:
Submittal Fee $
Scanning Fee $
Technology Fee $
Structural Reviews $
Zip:
❑ Demolition
Permit Fee $ 7 (dd CCF $ CO/CC $
Radon Fee $
Training/Education Fee $
DBPR $
Notary $
Double Fee $
Bond $
(Revised02/24/2014)
TOTAL FEE NOW DUE $ -Z� OO
II
M iy
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.
i
Signature =---) Signatur
OWNER or AGENT
CONTRACTOR
The foregoing instrument was acknowledged before me this
The foregoing instrument was acknowledged before me this
day of DMLAOkWjC 20 by
day of / I 20 by
6 DN 2_44-L Z , whoispersonal known to
ho is personally known to
Or
me or who has produced as
7
me or who has produced t% .r'Pix�2 as
identification and who did take an oath.
identification and who did take an oath.
NOTARY PUBLIC:
NOTARY PUBLIC:
Sign:
Anp"
Sign:
Print: \�
Print:STP;!e: OFAXNWA
?' JENNIFER FADUL
Seal: "
;. l :-` _ Notary Public - State of FloridaPir
Seal: ' { C%..,fn# 170
8/22 ►20
+�
Commission # GG 171862
My Comm. Expires Jan 2. 2022
bonded through Namnai NOtary Assn.
*********** * *******************************************************************
APPROVED BY 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. �L - 8 "`M
Owner's Name (Fee Simple Title Holder):I•AI'U Phone #: Y S
Owner's Address: AS % X145 -Id eld
City: S4 0AC-s State DA/ 0A Zip Code: 331.38
Job Address (Of where work is being done): X/9- /d c�
City: Miami Shores State: —Florida Zip Code: 33/3S
Contractor's Company Name: C flei (5�CJI ICAI- Phone #: 30 S- SAS/70�
Address: / 5�3 f 8 5 6 J I q 7'&-&P-AC,4T-
City:
Qualifier's Name:. J OS
Architect/ Engineer of Record Name:
Address:
City:
0
State: /%4-• Zip Code: 33/8S"
Lic. Number: LAG 13,040 (o
State:
Phone #:
Zip Code:
Describe Work.?OC z A4X,01 GAL (,J17yL4::�- 4-C
I hereby certify that the work has been abandoned and/or the contractor/architect
is unable or unwilling to complete the contract. I hold the Building Official and the
Miami Shores harmless of all legal involvement.
Signature . C— 0 Signature atU= AZ;jj�Oi4-0
Owner or Agent Contractor or Architect
The foregoing instrument was aknowledged before me
thi$,.��5 y of ✓ J 0 ,byAl-,& �! �y� ;;�lL
Who i p rsonally n�me or who has produced
as indentification.
Notary Public:
Sign:
Seal: TAlt RAVAA
Catn� G00�
The foregoing instrument was aknowledged before me.
this `2 J day of um , 20 by' s- �404oD
who i persona y nown to me or who has produced
j KsE� as indentification.
Notary Pubffq
Miami Shores Village
Building Department
10050 N.E. 2No Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
Change of Contractor/Architect or Engineer
A change of contractor, architect or engineer must be done under a permit number. There is a $75.00 charge
for a change of contractor. The owner will submit a Change of Contractor Form completed with notarized
signatures. If the signature of the previous contractor cannot be obtained the owner must send a certified
letter/return receipt notifying the previous contractor, architect or engineer the reason for the change. The
owner must allow 10 business days for the contractor, architect or engineer to respond. A permit application
must accompany the change of contractor form, with the information and signature of the new
contractor. The new contractor must be registered with the Village or must submit the required documents
to register with the Village.
1. Change of Contractor form completed, signed and notarized.
2. Permit application by new contractor.
3. Required fees.
4. Copy of original letter sent via certified mail along with the returned receipt.
In addition to the requirements above the architect or engineer of record must authorized the new architect
or engineer to reproduce his documents. The authorization must be in writing and must be signed and sealed.
Construction T RAH Ing Board
IINESS CERTIFICATE OF COMPETENCY
a
BARROSO ANDRES
Ia cartltled under the provisk
QUALIFYING TRADE(S)
0001 ELECTRICAL
0002 BURGLAR ALARM
0004 FIRE ALARM SPECLT
Jaime 0. Oeecon, P.E.
Secretary of the Board
M &*Dade CoWV raielne el nraoedv dnrd. r....i. Mv-mlemidn".9wlecawmy
UE000518
rRICAL SERVICH OF FLORIDA INC
i- U.,}
of Chapter 10 of
Local Busi ness Tax: Fbcei pt
M iami -Dade . County,. State of Florida
-THIS IS NOT A BILL -DO NOT PAY
7239556
BUSINESS NAM E/LOCA-TION'
A & 9 ELECTRICAL SERVICES
OF F,LOMDA INC
8334.NW 56 ST
DORAL, FL 33166
OWNER
A &.B ELECTRICAL SERVICES OF
FLORIDA INC
f./n ANr1RFR RARRnRn nl IAI IFIFR
Workers) 5
RECEIPT NO.
,EOIRES
NEW BUSINESS
SEPTEMBER.30, 2018
7525674
Must be displayed at place of business
Puisuant to County Code
Chapter 6A _ Art. 9 & 10
SEC. TYPE OF BUSINESS
196 SPEC ELECTRICAL
PAYMENT RECEIVED
BY TAX COLLECTOR
CONTRACTOR
45.00 01/25/2018
14E000518
0224-18-002422
Mus Local Business Tax Rxmptonly con"n spayna tof the Local BusiressTax_ fie Fbceipt is not alicense,
pemit, or a cerb "cation of the holder's quali "cations, to do business Holder must car ply with any go verrlrnental
or norgouamsrrtal regulatory taws and requinsim is wNch apply to the business.
The FEMPTNQ above mist be dispiayedon all carmerdal veNcles-Miani-Dade Wde Sac 83-27E
MIAMFDM=AM I Fbr more i nform4lion, visit www.R1an7dade.CQVNO(CdlaCmr
Mun''idpal Contractor's Tax Fbcei pt
iam i-Dade County, .;State. of Florida
=TI,lit is NOT A BILL - bo NOT PAY
CC NOr-1 4ED00518
BUSINESS NAM EMOCA TION RECEIPT NO.
A & B ELMIMAL 33UM OF
ROMAWC 7525675
6U NW56 ST
DORN, R- 33166
MC
EXPIRES
SEPTEMBER 30, 2018
Pursuant to County Code
Sec 10 -24
it
OWNER TYPE OF BUSINESS PAYM ENT RECEIVED
A & B aECMCA- S19MCES OF SmMIXTY ELBOMICAL CONTIR4MOR BY TAX COLLECTOR
FLORDA INC 200.00 01/25/2018
CJOANDFESBAW40M QUALJRER- 0224-I8-002422
THs receipt is not valid in the following Municipalities Aventura, Doral, Malath, Key Biscayne,
Miami Grdens, Nam Lakes, Pal nietto Bay, Pirwxest, Sunnry Wes Beack Town of Cutler Bay.
Emm-mMIAM'Fbrinm informadoM visit wccdlectar
RICK GOOTTGOVERNOR JON/THANZACHBN.SECRETARY
_ -
`
ISSUED: 11/07/201
'
ACOR" CERTIFICATE OF LIABILITY INSURANCE
DATE (MM/DD/YYYY)
01 /24/2018
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: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or 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: Maria Vila Almolda
acN o ,d : (305) 888-0524 ac No): (786) 272-0044
Blanco Insurance Assoc., Inc.
E-MAIL ADDRESS: maria@blancoinsurance.com
1462 E 4 Ave
INSURERS AFFORDING COVERAGE
NAIC #
INSURER A: SCOTTSDALE INSURANCE COMPANY
41297
Hialeah FL 33010
INSURED
INSURER B :
INSURER C :
A & B Electrical Service of Florida, Inc.
INSURER D :
3890 W 4 AVENUE
INSURER E :
HIALEAH FL 33012
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
ADDL
SUBR
POLICY NUMBER
POLICY EFF
MM/DD/YYYY
POLICY EXP
MM/DD/YYYY
LIMITS
X
COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE
$ 1,000,000
CLAIMS MADE I OCCUR
NTED
REM SES ( aDAMAGE TO Eoccurrence)
$ 100,000
—PREMISES
MED EXP (Any one person)
$ 5,000
PERSONAL & ADV INJURY
$ 1,000,000
A
TBA1792979A
10/19/2017
10/19/2018
GEN'L AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE
$ 2,000,000
X POLICY PRO LOC
JECT
PRODUCTS - COMP/OP AGG
$ 2,000,000
$
OTHER:
AUTOMOBILE
LIABILITY
COMBINED SINGLE LIMIT
Ea accident
$
BODILY INJURY (Per person)
$
ANY AUTO
OWNED SCHEDULED
AUTOS ONLY AUTOS
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
Per accident
$
HIRED NON -OWNED
AUTOS ONLY AUTOS ONLY
UMBRELLA LIAB
OCCUR
EACH OCCURRENCE
$
AGGREGATE
$
EXCESS LIAR
CLAIMS -MADE
DED I I RETENTION $
$
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y / N
PER OTH-
STATUTE ER
ANY PROPRIETOR/PARTNER/EXECUTIVE
E.L. EACH ACCIDENT
$
OFFICER/MEMBER EXCLUDED' ❑
N / A
(Mandatoryin NH)
E.L. DISEASE - EA EMPLOYE
$
Ifyes, describe under
DESCRIPTION OF OPERATIONS below
E.L. DISEASE - POLICY LIMIT
$
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
Electrical work within buildings. ER-13015115
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
MIAMI SHORES VILLAGE BUILDING DEPT ACCORDANCE WITH THE POLICY PROVISIONS.
10050 NE 2ND AVE AUTHORIZED REPRESENTATIVE
MIAMI SHORES FL 33138
01988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
CERTIFICATE OF LIABILITY INSURANCE FDATE(MM/DD/YYYY)
�'"""✓ 01 /2612018
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
Automatic Data Processing insurance Agency, Inc.
1 Adp Boulevard
Roseland, NJ 01068
INSURED
ABB ELECTRICAL SERVICE OF FLORIDA INC IIN
3890 W dTH AVE
Hialeah, FL 33012 N
tN3URER(S) AFFORDING COVERAGE ? NAIC t/
A: NorGUARD Insurance Company 31$70
B:
COVERAGFS t Gct7 C rnrc ►tt taaacrs. 20'Inan _.,._._.. ,....__
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 REOUIREMENT, 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.
................
LTR TYPE OF INSURANCE I , �- POLICY NUMBER ! MM/DDlYYYY MM/DD/YYYY LIMITS
COMMERCIAL GENERAL LIABILITY
,„. CLAIMS -MADE OCCUR
-«-
g1
1
EACH OCCURRENCE
$
PREMISES Ea orenco
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j ANY PROPRIETORIPARTNERIEXECUTIVE
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it yaa, describe under
DESCRIPTION OF OPERATIONS below
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DESCRIPTION OF OPERATIONS t LOCATIONS 1 VEHICLES (ACORO 101, Additional Remarks Schedule, may be attached if more specs is required)
Contractor License: ER 13015115
CERTIFICATE HOLDER re�Ir_aI I ATlnht
Miami Shores Village Bldg Dept
10050 NE 2 AVE
Miami Shores, FL 33138
ACORD 25 (2014/01)
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
1
The ACORD name and logo are registered marks of ACORD
All rights
Miami Shores Village
10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138-0000
Phone: (305)795-2204
Project Address
Parcel Number
Permit No. EL-$-17-2088
Permit Type: Electrical - Residential
Work Classification: Addition/Alteration
ot Permit Status: APPROVED
Issue Date: 8/1712017 1 Expiration: 02/13/2018
Applicant
1569 NE 104 Street 1122320320160
Miami Shores, FL Block: Lot: ALAIN & CARLY GONZALEZ
Owner Information Address Phone Cell
ALAIN & CARLY GONZALEZ 1569 NE 104 Street (786)277-9756
MIAMI SHORES FL 33138-
1569 NE 104 Street
MIAMI SHORES FL 33138-
Contractor(s) Phone Cell Phone
E & C ELECTRICAL SERVICE INC. (305)525-1701 (786)302-1175
/pe of Work: PROVIDE NEW PANELS, NEW CIRCUITS FO
dditional Info:
lassification: Residential
canning: 1
Fees Due
Amount
CCF
$12.00
DBPR Fee
$10.24
DCA Fee
$10.24
Education Surcharge
$4.00
Notary Fee
$5.00
Permit Fee - Additions/Alterations
$682.50
Scanning Fee
$3.00
Technology Fee
$16.00
Total:
$742.98
Valuation: $ 19,500.00
Total Sq Feet: 0
Pay Date Pay Type Amt Paid Amt Due
Invoice # EL-8-17-64916
08/17/2017 Credit Card $ 742.98 $ 0.00
,vvauame, inspections:
Inspection Type:
Final
Meter Box
Alteration
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 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 authori ed contractor to rlo the work stated.
August 17. 2017
Authorized Signature: Owner / Applicant / Contractor / Agent
Building Department Copy
August 17, 2017
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
FBC 20 1 q _
BUILDING master Permit No ZO- i-4' 156b
PERMIT APPLICATION Sub Permit No.ELl4` 209g
❑BUILDING [V/ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑ PLUMBING ❑ MECHANICAL PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR
DRAWINGS
JOB ADDRESS:
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder):`j'/,k,;tj Phone#: 7 ?Q 2?7 - I TS
Address:
City: (�/j� t1� iD�, State: Zip: 3�
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: 5 t i2WI CLC__ /A.4�- Phone#: �] �� ?0,2 —11;�r
Address: 8 33 Y
City: DO/2„ L--� State: Zip: 33/66
Qualifier Name: :J n sc Zki2 "ro Phone#:
State Certification or Registration #: (300 65gl Certificate of Competency #:
DESIGNER: Architect/Engineer: V, M, 13. 'V41J K 4:'7—E S,+AJ n_ 4:1'03/0 7 Phone#: 3Or-
Address: la/Is- /� 167 S�} SlJ%?t Gi — 210 City:'&Z411"� State: % Zip: 3301
Value of Work for this Pe�mit'$1 �G) / �� ' S ure/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration F�Nw ❑ Repair/Replace
Description of Work:
Specify color of color thru tile; ;&
Submittal Fee $ Permit Fee $ i yU CCF $,
Scanning Fee $
Radon Fee $
Technology Fee $ Training/Education Fee $
Structural Reviews $
❑ Demolition
CO/CC $
DBPR $ Notary $ • M
Double Fee $
Bond $
aa
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
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 Signature A�1✓�
OWNER or AGENT
The foregoing instrument was acknowledged before me this
day of Ak-kSU S I 20 R by
&-Ldm N who is personally known to
me or who has produced
identification and who did take an oath.
as
CONTRACTOR
The foregoing instrument was acknowledged before me this
day of zekz 20 i �Z by
i
who is personally known to
me or who has produced + P-/;, Cis" as
identification and who did take an oath.
NOTARY PUBLI
NOTARY PUBLIC:
Sign:
Sign -
Print: S-Irgr-
Printsy ��
Seal:
aNOTARY
e00No.i+
.
Notary Public State of Florida
Sindia Alvarez
PtWJC
Seal: IWA P���
A `� �,�
My Commission FF 156750
C I M1M 00172361D8
} f or no
Expires 09/0312018
E7
a
M� .l,�i�
***********************************************************************************************************
APPROVED BY
Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
mr-14 Ll1VVOUI'4, or-Lmr- 1 mr-% T
E-OF .-LORIDA,,
AW PROFF-99V.N t-WL4-TlOk-
?ACTORS LlCENSlMG-8OkR6-," 1190ME&A,
ISSUED: 06/22/2016
SEQ # L1606220001238
004550
Local Business Tax Receipt
Miami —Dade County, State of Florida
-THIS IS NOT A Rlll - DO NOT PAY
5240627
BUSINESS NAME/LOCATION RECEIPT NO. EXPIRES
E & C ELECTRICAL SERVICE INC RENEWAL SEPTEMBER 30, 2017
15398 SW 19 TERR 5476940 Must be displayed at place of business
MIAMI R 33185 Pursuant to County Code
Chapter BA - An. 9 & 10
OWNER SEC. TYPE OF BUSINESS PAYMENT RECEIVED
E & C ELECTRICAL SERVICE INC 196 ELECTRICAL CONTRACTOR BY TAX COLLECTOR
Worker(s) 20 04E000109 $125.00 09/15/2016
CHECK21-16-124794
This local Business Tax Receipt only confirms payment of the local Business Tax. The Receipt is not a license,
permit, or a certification of the holders qualifications, to do business. Holder must comply with any governmental
or nongovernmental regulatory laws and requirements which apply to the business.
The RECEIPT NO. above must be displayed on all commercial vehicles - Miami -Dade Code Sec fia-276.
For more information, visit www.miamidade.govAaxcollector