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EL-18-762Miami Shores Village 10050 N.E. 2nd Avenue NE r " Miami Shores, FL 33138-0000 yam` Phone: (305)795-2204 FLORIOp' Permit NO. EL--18-762 —00 Permit Type: Electrical - Residential erl' Work Classification: Temp for Construction Permit Status: APPROVED Issue Date: 3/27/2018 1 Expiration: 09/23/2018 Project Address Parcel Number 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 ADVANCED SECURITY INNOVATION: (786)302-1175 ,e of Work: TEMPORARY POLE FOR CONSTRUCTION. iitional Info: TEMPORARY POLE FOR CONSTRUCTION. ssification: Residential inning: 1 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 $3.00 Technology Fee $0.80 Total: $108.60 Valuation: $ 500.00 Total Scl Feet: 0 Pay Date Pay Type Amt Paid Amt Due Invoice # EL-3-18-66904 03/27/2018 Credit Card $ 58.60 $ 50.00 03/23/2018 Credit Card $ 50.00 $ 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 zing. Futhermore, I authorize the above -named contractor to do the work stated. March 27, 2018 Signature: Owner / Applicant / Contractor / Agent Building Department Copy March 27, 2018 1 Miami Shores Village \I�° 3 C, 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 20 149 BUILDING Master Permit No.C) — Cc= PERMIT APPLIC ON Sub Permit NoT ❑BUILDING LECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL [—]PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOBADDRESS: 'S I0`r I ST City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: Load: Constructions Type: Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): /.Flood �t� i l � j,��ty�i7 Phone#: Address:S (� ( �� IUA S T ,,,,I City:�T�, A'iac1 t AN&S, State: Zip: Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: 00 6 Y.4Ncev Phone#: Address: 33 IVY✓ S b f J City: Dt,44 & State: �' Zip: Qualifier Name: cJO.T� � �j,a/L.20� Phone#: State Certification or Registration M. �G - 34 Sy7 Certificate of Competency M DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: $ i O U� Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑/ New ❑ Repair/Replace ❑ Demolition Description of Work: Specify color of color thru file. - Submittal Fee $ \r sW.rr:L PermitYFee $ f �O, cot> CCF $_ Scanning Fee $ Radon Fee $ 6Z DBPR $ Technology Fee $ Training/Education Fee $ Structural Reviews $ �.N Notary '$ Double Fee $ Bond $ TOTAL FEE NOW DUE $ S G6 (Revised02/24/2014) Bonding Company's Name (if applicable) Bonding Company's Address i _ City State Mortgage tender'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 OWNER or AGENT The foregoing instrument was acknowledged before me this day of 20 1,6 by cbc�j j,� who is ersonally Hawn me or who has produced identification and who did take an oath. NOTARY PUBLIC: C Sign: Print: S Seal: APPROVED BY (Revisedo2/24/2014) CONTRACTOR The foregoing instrument was acknowledged before me this day of /��k 20 /,4 by TOSIy I?S.Ik J,00 who is ersonally known o as me or who has produced identification and who did take an oath. NOTARY PUBLIC: as Sign: v $ Print:Q— Sussy AWm Seal: suseY AJVM NOTARY FUBLJC NOTARY PLMM WSTATE OF FLORIDA STATE OF FLORIDA Srm M;., 8IZ2MM art2/ZOZO /M_,1t 2,,�r/V/%};2 /;i Plans Examiner Zoning Structural Review Clerk ° --'--- --' - '-- JDN/glH ANZACHBN.SECRETARY RICK SCOTTGOVERNOR ~ ` - — STATE OF FLORIDA ` DEPARTMENT OF BUSINESS AND PROFESSIONAL REGUL-A 11014 ' ELECTRICAL - ' "�C /, - The ELECTRICAL CONTRACTOR Named below IS CERTIFIED ' v/we"the Chapter 489 FS. E -nabondato:-AUG31,3O1B - ~ ADVANCED - . - ' -'--`— - ~r � ISSUED: —'DkSPLAYASREQU| Local Business Tax F;bcei pt M iami-Dade County, State of Florida -THIS IS NOT A BILL -DO NOT PAY 7241059 BUSINESS NAM E/LOCATION ADVANCED SECURITY INNOVATIONS LLC 8334 NW 56 ST DORAL, FL 33166 OWNER ADVANCED SECURITY INNOVATIONS LLC r1n .InRF RARR(1Rn Ot IAI IFIFR Worker(s) 1 RECEIPT NO. EXPIRES NEW BUSINESS SEPTEMBER 30, 2018 7527216 Must be displayed at place of business Pursuant to County Code Chapter 8A - Art. 9 & 10 SEC. TYPE OF BUSINESS 196 ELECTRICAL CONTRACTOR EC 13006547 PAYM ENT RECEIVED BY TAX COLLECTOR 45.00 02/06/2018 0208-18-003469 This Local Business Tax Peceipt only con"ms payrnerd of the Local Business Tax. The Pecei pt is riot a license, pemit, or a c;erti "cation of the hcIdefs qual i "cations, to do twsi ness Folder mist comply with any grnernnental or nongovernrrental regulatory laws and requirements which apply to the business. The F EM PT NQ abo%e mist be displayed on all cormercial vehicl es - Miarni-Dade Code Sec 8a-276. MLAM ®mm For more infomgtion,visit www.rrianidade.aw/taxcdlector J T ® AC40ROF CERTIFICATE OF LIABILITY INSURANCE . DATE (MM/DD/YYYY) 1 03/22/2018 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 AAIC P"N No (305) 888-0524 ac No): (786) 272-0044 Blanco Insurance Assoc., Inc. E-MAIL ADDRESS: maria@blancoinsurance.com 1462 E 4 Ave INSURER 5 AFFORDING COVERAGE NAIC # INSURERA: MAXUM INDEMNITY COMPANY 26743 Hialeah FL 33010 INSURED INSURER B : INSURER C : Advanced Security Innovations Llc INSURER D : 350 Navarre Dr INSURER E : INSURER F : Miami Springs FL 33166 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 X OCCUR DAMAGE TO RENTED PREMISES Ea occurrence $ 100,000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 A BDG-0114734-01 02/22/2018 02/22/2019 GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY PRO- JECT ❑ LOC PRODUCTS - COMP/OP AGG $ 2,000,000 $ OTHER I 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 LIAB CLAIMS -MADE DED RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE PER OTH- STATUTE ER E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? ❑ N/A E.L. DISEASE - EA EMPLOYE $ (Mandatory in NH) If yes, 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 Contractor License EC13006547 Lha:IllaLh_lia SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Miami Shores Village THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Building Department ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE 2da Ave AUTHORIZED REPRESENTATIVE Miami Shores FL 33138 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD ACORN® CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 03/21/2018 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 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 CO TA T NAME: Automatic Data Processing Insurance Agency, Inc. PHONE FAX vc No Ext : a✓c, No 1 Adp Boulevard ADDRIESS: INSURER(S) AFFORDING COVERAGE NAIC # Roseland, NJ 07068 INSURER A: NorGUARD Insurance Company 31470 INSURED INSURER B : ADVANCED SECURITY INNOVATIONS LLC 350 NAVARRE DR INSURER C Miami Springs, FL 33166 INSURER D : INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 861336 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 ADDLSUBR INSD WVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR EACH OCCURRENCE $ PREMISES Ea occurrence $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: POLICY ❑ JECT PRO ❑ LOC OTHER. GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ UMBRELLA LIAB EXCESS LIAB HCLAIMS-MADE OCCUR EACH OCCURRENCE $ AGGREGATE $ DED RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A N ADWC917475 02/07/2018 02/07/2019 X PER OTH- STATUTE ER E.L. EACH ACCIDENT $ 100,000 E.L. DISEASE - EA EMPLOYEE $ 100,000 E.L. DISEASE - POLICY LIMIT $ 500r00o DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) Job Reference: 1569 NE 104 street Miami Shores Contractor License: Electrical -- EC 13006547 CERTIFICATE HOLDER CANCELLATION Miami Shores Village Building Department 10050 NE 2 Avenue Miami, FL 33138 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 988-2014 ACORD CORPORATION. All riahts reserved ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD