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EL-18-48`StyORFs L't Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 ` Phone: (305)795-2204 ��ORiDp' Project Address 420 NE 91 Street Miami Shores, FL 33138- Permit NO. E L-1-18-48 Permit Type: Electrical - Residential er It Work Classification: Temp for Construction Permit Status: APPROVED issue Date: 1/1,9/2018 Parcel Number 1132060190070 Block: Lot: Expiration: 07/18/2018 Applicant PROPERTY HOUNDS LLC Owner Information Address Phone Cell PROPERTY HOUNDS LLC 420 NE 91 Street (954)520-2268 MIAMI SHORES FL 33138- 7021 NW 67 Court PARKLAND FL 33067- Contractor(s) Phone Cell Phone ROSEMBERG ELECTRICAL SERVICE (954)501-9267 (954)415-4667 of Work: TEMP FOR CONSTRUCTION onal Info: ification: Residential ling: 3 Fees Due Amount CCF $0.60 DBPR Fee $2.00 DCA Fee $2.00 Education Surcharge $0.20 Permit Fee - Additions/Alterations $100.00 Scanning Fee $9.00 Technology Fee $0.80 Total: $114.60 Valuation: $ 250.00 Total Sq Feet: 0 Pay Date Pay Type Amt Paid Amt Due Invoice # EL-1-18-66069 01/08/2018 Check* 1231 $ 50.00 $ 64.60 01/19/2018 Check #: 1089 $ 64.60 $ 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. ther ore 1 authorize the above -named contractor to do the work stated. i� January 19, 2018 Authorized Signature: Owner / Applicant / Contractor / Agent Building Department Copy January 19, 2018 1 DATE (MMIDDIYYYY) Ao!z© CERTIFICATE OF LIABILITY INSURANCE 01 /17/2018 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 CONTANAME: Paulo Lopes Express Service Insurance Agency PHONE No, Ext): (954) 943-7900 I lac, yo); (954) 943-1810 E-MAIL 900 E. Atlantic Blvd. #10 ADDRESS: pauto@Press4u.net ex __._.________.______._____._._._...__...____,__...__._._.____.___ Pompano Beach FL 33060 INSURED ROSEMBERG ELECTRICAL SERVICES, INC PO BOX 501 DEERFIELD BEACH FL 33443 rnVFRAr_FC rFRTIFIrATF NIIMRFR- - INSURER(S) AFFORDING COVERAGE NAIC # INsuRER A : LLOYD'S OF LONDON 78444 INSURER B : FUBA INSURER C INSURER D INSURER E 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. EXP INSR': TYPE OF INSURANCE ''.ADDU,SUBRI POLICY NUMBER MMlDDYIYYYY MMf DIYYYY LIMITS LTR X COMMERCIAL GENERAL LIABILITY''' ;EACH OCCURRENCE $ 1,000,000.00 � :. CLAIMS -MADE " OCCUR ! ':, DAMAGE TO RENTED _PREMISES_(Ea occurrenc-e)_ 100,000.00 _$ $ 5,000.00 MED EXP (Any one person)_ - A N N ! CIBFL0005182 02/28/2017 02/28/2018PERSONAL tc_A_D_V_INJURY $ 1,000,000.00 _ GEN'L AGGREGATE LIMIT APPLIES PER'.'�: GENERAL AGGRCGATE �— -- — --- $ 1,000,000.00 - --- - PRO- ! XI POLICY [ JECT ) LOC ---' PRODUCTS - COMP/OPAGG -------- --- $ 1,000,000.00 - -- OTHER. :, AUTOMOBILE LIABILITY ! ! COMBINED SINGLE LIMIT _(Ea accident) $ $ ! ANY AUTO '', BODILY INJURY (Per person) OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS ONLY AUTOS - - HIRED NON -OWNED : ! PROPERTY DAMAGE $ --{� AUTOS ONLY__.. AUTOS ONLY LPer accident)----- $ '', UMBRELLALIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB _ _- CLAIMSMADEI AGGREGATE -- - $ DED I RETENTION $ $ WORKERS COMPENSATION PER OTH- STATUTE. ER__ AND EMPLOYERS' LIABILITY Y t N _; ANY PROPRIETOR/PARTNER/EXECUTIVE ! B N I A N 10654960 06/16/2017 L. EACH ACCIDENT 06/16/2018 -- -""" -- $ 100,000 -- :, OFFICER/MEMBER EXCLUDED? :. !, (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ 100,000 If yes: describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 500,000 I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) LICENSE # ER13014723 r`CDTICIr`ATC UnI r1CD rANrFI I ATIOM SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE MIAMI SHORES VILLAGE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. BUILDING DEPARTMENT 10050 NE 2ND AVE AUTHORIZED REPRESENTATIVE MIAMI SHORES. FL 33138'— (9) 1988-2015 ACUKU CUKNUKA I IUN. All rlgnts reservea. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD BUILDING PERMIT APPLICATION Miami Shores Village RECEIVED Building Department fAlY082017 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 6L INSPECTION LINE PHONE NUMBER: (305) 762-4949 4'x FBC 201yV Master Permit No. Q C ` u— Sub Permit No.EL-_,I ❑BUILDING ELECTRIC ❑ ROOFING PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ REVISION ❑ EXTENSION ❑ RENEWAL CHANGE OF CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 420 NG ` ST City: Miami Shores ^County: Miami Dade Zip: Folio/Parcel#: 1 32DU—ON (A PC V Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): Pl'7�Grr1A 44y.AyNck% L LC Phone#: qS4 "52D'ZZC� Address: 11 (� �41 I City: � l ct(-id State: 471— Zip: -7 Tenant/Lessee Name: Email Phone#: CONTRACTOR: Company Name: 9r05 ( JF) CC-fC (C �N Vs�hone#: "1 /'4 Address: City: A Gh State: r p� L�7i _Zip: 3 3T � � r, Qualifier Name: ,fYl �D f 0 J Alf I 1 (s/ Phone#: GIA -,S%Y`-/�Q -(0 State Certification or Registration #: -EV Q 1 4�1 Z _Certificate of Competency #: r_� D4 6 U DESIGNER: Architect/Engineer: Add e#: City: State: Zip: Value of Work for this Permit: $ L �/-� Oi) � V Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace Description of Work: Specify color of color thru tile: Submittal Fee $ 4D Permit Fee $ Scanning Fee $ Radon Fee $ Technology Fee $ Structural Reviews $ 40igF Oz:o CCF 2 • CZ Training/Education Fee $ DBPR $ 2• CZ ❑ Demolition CO/CC $ _ 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 Zi 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 Sign ur OWNER or A NT "CONTRACTOR The foregoing instrument was acknowledged before me this day of 20 by who is p ally know to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: 1 " 1611 rMal The foregoing instrument was acknowledged before me this W day of ont inr by owe �(/ is personally known to me or who has produced s identification and who did take an oath. NOTARY PUBLIC: A".4�� Sign: Print: Print: NATASHAB00KE Seal: �/'+' Seal: NTASAOOKE ;.: •,z MY COMMISSION # GG 154422 e4R-Oftl*27=1 N _. MY COMMISSION GG 154422 EXPIRES: OcWw 27, 2021 EXPIES •'' . Bor" ThN Pift Undwwfts **************************************************************** APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014)