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ELC-18-3633Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Issue Date: Location Address Parcel Number 9710 NE 2 AVE, Miami Shores, FL 33138 1132060132350 Contacts Permit NO.: ELC-12-18-33 Permit Type: Electrical - Coromercial Work Closs#katwn: Alteration Permit status: Approved Expiration: 06/05/2019 SHORES LANDING LLC Owner SHORES LANDING LLC Applicant GLADYS MATZ GLADYS MATZ Other:3055258816 GLADYSMATZ@AOL.COM Other:3055258816 GLADYSMATZ@AOL.COM JES ELECTRIC, INC Contractor JULIO SOTO 12490 NW 123 ST, MEDLEY, FL 33178 Business: 3052189492 Other:7862512207 Description: MAINTENANCE ON BREAKERS AND CHECK FOR Valuation: $ 500.00 Inspection Requests: MALFUNCTIONING 305-762-4949 "AFTER THE FACT" Total Sq Feet: 2,193.00 UNIT 9730 Fees Amount Application Fee - Other $50.00 CCF $0.60 DBPR Fee $2.00 DCA Fee $2.00 Education Surcharge $0.20 Permit Fee $50.00 Scanning Fee $3.00 Technology Fee $2.50 Work Without Permit 1st Offense $100.00 Work Without Permit 1st Offense $100.00 Total: $310.30 Building Department Copy Payments Date Paid Amt Paid Total Fees $310.30 Credit Card 01/29/2019 $260.30 Credit Card 12/07/2018 $50.00 Amount Due: $0.00 In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: I gertify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating con truction a d oning. Futhermorree', II authorize the above name contractor to do the work stated. Author})J; Wgnature:ibwner / Applicant / Contractor / Agent Date January 29, 2019 Page 2 of 2 Miami Shores Village v Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 BUILDING PERMIT APPLICATION BUILDING g ELECTRIC ❑ ROOFING DEC 0 7 2 18 9Y: A�1 FBC 20 Master Permit No. j,C 11 (—�a_3I ? Sub Permit No. r_ \ � 1 U - ❑ REVISION ❑ EXTENSION EJRENEWAL PLUMBING ❑ MECHANICAL PUBLIC WORKS ❑ CHANGE OF CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: DqG " I,4--20 k_)F1 land City: Miami Shores County: Miami Dade Zip: 3317-5R' Folio/Parcel#: 11 - 3'_-47(o " 00— Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): C-A"Cc LAS Ma-Z Phone#: 0], 9L� " Ooill. Address: -41`A ue, 59 5-T ^�-- City: tlnrNl11 State: "r L Zip: 33V!5 Tenant/Lessee Name: PIA\b(o C_a.y; N10 Phone#: a �.R &-S - 388$ Email: oIN_jACO catA ogu..)- I) qayo . coin CONTRACTOR: Company Name: J • E.`J �lee___ylr6_ Phone#:��" � 5 ^ ate} Address:_ I (-p%o n)u) 123 ST ► I.nd City: 1 State: -F- Zip: Qualifier Name: i i o Phone#: State Certification or Registration #: Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: fValue. of.Work.for•this Permit:$ -Ste• ' Square/Linear Footage of Work: T,ype,of Work g ,Addition "❑ `Alteration ❑ New Repair/Replace ' Demolition iDescriptioh of Wo mrk: (`nGt�� C71! 1LG CYi Pam. S i G~RP CK- �.. fir- a) f Lair Dkq1] u Specify color of color th u tile: Submittal Fee $ 01 Permit Fee $ % CCF $ CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Notary $ Technology Fee $ Training/Education Fee $ Double Fee $ jCb - CA Structural Reviews $ Bond $ (00, TOTAL FEE NOW DUE $ �� O .30 (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 AG T The /foregoing instrument was acknowledged before me this t0 1 day of 1�k--� CeT 20 19 by l�C 1 �K.L:EZ who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: ;;�" KATIA J CASTILLO MY COMMISSION # GG009999 Sig a,,•' EXPIRES July 10, 2020 Prin . rn CLAhlto Seal: Signature ONTRACTOR The foregoing instrument was acknowledged before me this C day of T)CCexC\ Pr , 20 k D reby J U- I1 D It. ,5OT- who is personally known to me or who has produced T�:f ► jer L► as identification and who did take an oath. NOTARY PUBLIC: -c4s KATIA J CASTILLO MY COMMISSION # GG009999 EXPIRES July 10, 2020 Sign: 30.0153 F Print: --,y l^nsi;l b Seal: .*::::*::s:::**:s::::*s*******s*ss*:«**«****sss*s****r�ssss:*sss::ssss:*s*sss::::*:::::*:::�::■**:ssssss**ss APPROVED BY rG/� Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) dblar,STATE�bF FLORiDA.DEPARTMENT REGULAT ESS ON AND PROFESSIONAL EC13002612 .� , ISSUED: 06/26/2018 , ELECTRICAL,c647 ACTOR s . SOTO, JUL(O:E J.E.S. ELECTRIC LICENSED UNDER CHA 9, EXPIRATION DATE: AUGUST , I >RI STATUTES Local. Business Tax Receipt Miami -Dade County, State of Florida -THIS.IS NOT A BILL -DO NOT PAY 4117586 BUSINESS NAME/LOCATION J E S ELECTRIC INC 12490 NW 124TH ST 5 MIAMI, FL 33178 OWNER J E S ELECTRIC INC Worker(s) RECEIPT NO. EXPIRES RENEWAL SEPTEMBER 30, 2019 4299889 Must be displayed at place of business Pursuant to County Code Chapter 8A - Art. 9 & 10 SEC. TYPE OF BUSINESS 196 ELECTRICAL CONTRACTOR EC13002612 PAYMENT RECEIVED BY TAX COLLECTOR 75.00 07/10/2018 CHECK21-18-063999 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 holder's qualifications, to do business. Holder must comply with any governmental or nongovernmental regulatory laws and requirements which apply to the business. Thu RECEIPT NO. above must be displayed un all cunnnurcial vehicles- Miami-Oade Code Sec 6a-276. Mi®DADE For more information, visit www.miamidede ggyAexcollRRSyr A� o® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 12/06/2018 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 The Insurance Doctor, Inc. 15280 NW 79TH CT NAME:cT RAIZA CHACON PE - (305) 822-0042 FAx Ne : (305) 826-0911 E-MAIL rchacon@tidfl.com INSURER(S) AFFORDING COVERAGE NAIC 0 INSURERA: OMEGA INSURANCE SOLUTIONS INC MIAMI LAKES, FL 33016 INSURED INSURER B : INSURER C : Jes Electric Inc INSURER D : 12490 NW 124 St Bay 5 INSURER E : INSURER F Medley FL 33178 rnVFRARFS CFRTIFICATF NLIMRFR- 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 LTRWVD TYPE OF INSURANCE ADDL POLICY NUMBER MPAA�IDCY EFF MPMOID�DY� 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 PRO LOC JECT OTHER: GENERAL AGGREGATE S PRODUCTS - COMP/OP AGG $ $ AUTOMOBILE LIABILITY$ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HIREDAUTOS AUTOS Ea aBINED BODILY INJURY (Per person) S BODILY INJURY (Per accident) $ PP OPERTY DAMAGE $ $ UMBRELLA LIAR EXCESS LIAR HCLAIMS-MADE OCCUR EACH OCCURRENCE $ AGGREGATE $ DED I I RETENTIONS $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNERIEXECTIVE YIN U OFFICER/MEMBER EXCLUDED? YI (Mandatory in NH) "yes, describe under DESCRIPTION OF OPERATIONS below NIA N 10649306 03/27/2018 03/27/2019 �/ X STATUTE ERA 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 Remark* Schedule, may be attached ff more space is required) ELECTRIC WIRING -WITHIN BUILDING Contractor License EC13002612 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Miami Shores Village 10050 Northeast 2nd Avenue AUTHORIZED REPRESENTATIVE / / Miami Shores, Florida 33138 //J� / // V IU53-ZU14 A(:UKU GUKI'UKA I IUN. All rlgnts reserveo. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD 1 ® A� o CERTIFICATE OF LIABILITY INSURANCE DATE (MMDDIYYYY) 12/06/2018 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 Emmanuel Insurance & Associates, Inc. 2370 E 8TH AVE HIALEAH FL 33013-4236 CONTACT Sarai Medina NAME: PNCTN Ext). (305) 693-0003 AIC No : (305) 691-4381 EMAIL ADDRESS: sarai@emmanuelinsurance.com INSURE S AFFORDING COVERAGE NAIC p INSURER A: U.S. Specialty Insurance Company 29599 INSURED J.E.S. ELECTRIC, INC. Julio E. Soto 10690 NW 123rd St Bay 105 Hialeah FL 33178 INSURER B : INSURER C : INSURER D : INSURER E: INSURER F : rnVFRA(:FC rFRTIFIrATF NIIMRFR• 001 REVISION NUMBER-001 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 OF INSURANCE ADDLTYPE INSD SUER POLICY NUMBER POLICY EFF MM DDIIYYYY MMI D NYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE Fx] OCCUR U18AC101530-01 11/13/2018 11/13/2019 EACH OCCURRENCE $ 1,000,000.00 DAMAGE TO RENTED PREMISES Ea occurrence $ 100,000.00 MED EXP (Any one person) $ 5,000.00 PERSONAL&ADVINJURY $ 1,000,000.00 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY JECOT PR ❑ LOC OTHER: GENERAL AGGREGATE $ 2,000,000.00 PRODUCTS - COMP/OP AGG $ 2,000,000.00 $ AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY r COBINED SINGLE LIMIT Ea Maccident $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE Par accident $ $ A UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE U18AC101530-01 11/13/2018 11/13/2019 EACH OCCURRENCE $ 1,000,000.00 X AGGREGATE $ 1,000,000.00 DED I I RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICERMIEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA PER OTH- STATUTE ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ 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 rFRTIFIrATF HAI nFR CANCELLATION Miami Shores Village SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 10050 Northeast 2nd Avenue ACCORDANCE WITH THE POLICY PROVISIONS. Miami Shores, Florida 33138 AUTHORIZED REPRESENTATIVE 01888-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD