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EL-18-2236Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 `�z. Phone: (305)795-2204 lkr= Permit vo. EL-8-18-2236 Pe Permit Type: Electrical - Residential rt[ 1 ' work Classification: Alteration Permit Status: APPROVED Issue Date: 8/27/2018 1 Expiration: 02/23/2019 Project Address Parcel Number Applicant 289 NE 104 Street 1121360130610 GOODNIGHT MIAMI LLC Miami Shores, FL 33138- Block: Lot: Owner Information Address Phone Cell GOODNIGHT MIAMI LLC 289 NE 104 Street (305)898-9085 MIAMI SHORES FL 33138-2015 289 NE 104 Street MIAMI SHORES FL 33138-2015 Contractor(s) Phone Cell Phone SYNERGY ELECTRICAL INC (239)574-0430 /pe of Work: INTERIOR REMODEL ELECTRICAL dditional Info: INTERIOR REMODEL ELECTRICAL lassification: Residential canning: 1 Fees Due Amount CCF $3.60 DBPR Fee $6.30 DCA Fee $4.20 Education Surcharge $1.20 Permit Fee - Additions/Alterations $420.00 Scanning Fee $3.00 Technology Fee $4.80 Total: $443.10 Valuation: $ 6,000.00 Total Sq Feet: 0 Pay Date Pay Type Amt Paid Amt Due Invoice # EL-8-18-68631 08/27/2018 Credit Card $ 393.10 $ 50.00 08/21/2018 Credit Card $ 50.00 $ 0.00 Available Inspections: F spection Type: view 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 AFFIDAVI I certify that I the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and ni g. Futherm I authorize the above -named contractor to do the work stated. r A\ . T— /a, August 27, 2018 Authc�rizei'fSignaiure: Mner / Applicant' / Contractor / Agent uate Building Department Copy August 27, 2018 1 Miami Shores Village qA1g�1 nv-pj-) 20 Building Department ;. 18 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 - -- .__ Tel: (305) 795-2204 Fax: (305) 756-8972 --Fj L INSPECTION LINE PHONE NUMBER: (305) 762-4949 W 1''i FBC 20, � BUILDING - Master Permit No. C C 652,� a6C' PERMIT APPLICATION Sub Permit No. ICU _ 223� ❑BUILDING ,ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑ PLUMBING ❑ MECHANICAL [:]PUBLIC WORKS ❑ .CHANGE OF ❑ CANCELLATION ❑ SHOP n CONTRACTOR DRAWINGS JOB ADDRESS: S4 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): T cT r i C"d G 11� IOVI Ic�j Phone#: Address: City: /)2/`e4 j-" - 4 ®/`CS State: L Zip: Tenant/Lessee Name: Phone#: Email CONTRACTOR: Company Name: �� !ir, G Phone#: Address: 11-21. 3 Ve!—f— City: , e- State: G Zip: Qualifier Name: S ��CL�G��6 ��dPi/ Phone#: State Certification or Registration #: CC 13009W2 -5' Certificate of Competency M DESIGNER: Architect/Engineer: hone#: Address: f City: State: Zip: Value of Work for this Permit: Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration j❑ New ❑ Repair/Replace ❑ Demolition Description of Work: �-.� 7Z�''ed/ 14e01 ad C-' I Specify color of color thru tile: Submittal Fee $ I O 1 C Permit Fee $ "t2 >, 0 49 CCF $ CO/CC $ Scanning Fee $ Radon Fee $ 4' • ZC7 DBPR $ Notary $ Technology Fee Structural Reviews $ Training/Education Fee $ Double Fee $ Bond $ TOTAL FEE NOW DUE $3 ' v (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 Cqn� OWNER or AGENT Signature CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this , Q� day of IV741- 120 L Y by I Jf day of f Q ,. a c<s 20 g by who is personally known to Qac de' CC. S41`6 f r' pD who is personally known to_-� me or who has produced identification and who did take an oath. NOTARY PUBLIC: #14 A404-1 Sign: �],, Print: �-I�r 1 kcv'2 �'/ Seal: �4"' U9AiAaiW YY CCN4tMM # FF 9049{ EWRES: Jwtwy 15, 2M as Jae or who has produced identification and who did take an oath. NOTARY PUBLIC: ,l Sign: e Pri �ITOMMA b� „l/ of Flon a' GG 203229 Seal "-Brace iss n s _'? �._ Coma' rmission ExP ire MY Co 3 2022 a�APro 11111110 APPROVED BY ��f�:l'r ialans Examiner as ############################################# Zoning Structural Review (Revised02/24/2014) Clerk d" .N RICK SCOTT, GOVERNOR JONATHAN ZACHEM, SECRETARY FI dda STATE OF FLORIDA DEPARTMENT OF BUSINESSiA Z FESSIONAL REGULATION ELECTRICA NG BOARD - � � `�� d THE ELECTRIC i' r. . a�. , E �N* CER I UNDER THE � lyr.. w �: PROVIs S : 48 UTES r' �r �39 A. L ,, I a- -7- EXPIRAI;I-*O**"N 1, 2Q24 Always verify licenses online at MyFloridaLicense.com 00 Do not alter this document in any form. I a� . • This is your license. It is unlawful for anyone other than the licensee to use this document. CITY OF t� .PC �Q I� 1 THIS RECEIPT IS FUI M C The law requires this receipt and available for inspection. 1 err a. City of Cape Coral Business Tax Receipt 0 BT19-78438 Issue Date: 07/20/2018 CONTRACTOR/SPECIALTY CONTRACTOR/1-6 EMPI DBA: SYNERGY ELECTRICAL INC Owner Name: CASTRO PUPO, RAUDEL Expiration Date: 09/30/2019 ISHED PURSUANT TO FLORIDA STATE STATUTES, CHAPTER 205 AND Y OF CAPE CORAL ORDINANCE 9-72 AS AMENDED be displayed conspicuously at the place of business so that it is open to the view of the public Payment is due each year by eptember 30th. Payment after September 30th is delinquent and subject to a penalty of 10% for the month of October, plus w additional 5% for each month thereafter. The total delinquency penalty shall not exceed 25% of the tax. A 25% penalty is posed on any person engaged in any new business, occupation or profession without first paying a Cape Coral Businesi Tax. This receipt is for a business only. It does not permit the person/business to violate any existing regulatory or zoning laws of the state, county, or cities, or does it exempt the business from licenses or permits that may be required by law. This receipt does not assure quali of work. Business Tax Receipts are change of business name, i the proper information. Detach and post CITY OF CAPE ( City of This - THIS TAX IS NON Location: 1013 NE 7TH ST Business Phone: (239) 699 SYNERGY ELECI CASTRO-PUPO F 1013 NE 7TH ST, CAPE CORAL, FL for purchase on July 1 st. If you need to transfer your Business Tax Receipt due to a , location or closing your business, please contact our office at 239-574-0430 to obtain portion ►L BUSINESS TAX RECEIPT RECEIPT M BT19-78438 Coral --1015 Cultural Park Blvd — Cape Coral Florida 33990 — (239) 574-0430 pt expires September 30, 2019 Visit our website at: www.capecoral.net DISPLAY AT PLACE OF BUSINESS FOR PUBLIC INSPECTION FAILURE TO DO SO IS CONTRARY TO LOCAL LAWS. 14 CITY OF 4 V* 9A � o� ICAL INC UDEL Number of Employees: 5 Classification CONTRACTORISPECIALTY CONTRACTOR/ Classification Code: 140A Issued Date: 07/20/2018 Amount $88.00 This document is a business tax . This is not certification that licensee is qualified. It does not permit the licensee to violate any existing regulatory zoning laws of the star county or cities nor does it exempt the licensee from other taxes or permits that may be required by lair. ACCO U CERTIFICATE OF LIABILITY INSURANCE DATE`'°"DOMM 08/20/2018 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(les) must have ADDITIONAL INSURED provisions or be endorsed. R 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 endo s PRODUCER ProAcbve Insurance Management 5633 Strand Blvd. Suite 318 Naples FL 34110- CONTACT Thelma Villa PHONE (239)514-1141 F� (888)822-0197 E-MAILs. Thelma.Villa@ProAcfiveIns.00m INSURE AFFORDING COVERAGE NAIC# INSURER .Auto Owners Insurance Co 18988 INSURED SYNERGY ELECTRICAL INC 1013 NE 7TH ST STE 2 Cape Coral FL 33909- INSURERS: INSURER C : INSURER D . INSURERE. INSURER F t nvFRArFC r`FRTIMIATF NIIMRFR- REVISION NIIMRER- 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 CONTRACTOR 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. MR AXILA TYPE OF INSURANCE ADM R POLICY NUMBER POLICY EFF POLICY EXP LIMITS X COMMERCIAL GENERAL LIABILrrY CLAIMS -MADE a OCCUR X X 20825526 20/2018 /20/2019 EACH OCCURRENCE 1,000,000 DAMAGE TO RENTEDRMB) 3001000 MED EXP (Any one on 10,000 PERSONAL & ADV INJURY 1,000,000 GENL AGGREGATE LIMIT APPLIES PER: POUCY [�] j�7 M LOC GENERAL AGGREGATE 2,00Q000 PRODUCTS-COMP/OPAGG 2,000,WO A AUTOMOBILE LIABILITY X ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS X HIRED X NON -OWNED AUTOS ONLY AUTOS ONLY 5182552600 6/20/2018 019 COMBINED SINGLE LIMIT $ 1 000 O0G BODILY INJURY (Per person) $ BODILY INJURY (Per aoddent) $ PROPERTY DAMAGE $ UMBRELLA LIAB EXCESS LL&B CLAIMS -MADE EACH OCCURRENCE HOCCUR AGGREGATE WORKERSCOYPENSATION AND EMPLOYERS LIABILITY Y / N ANY PROPRIETORMARTNER/EXECUTPIE OFFICER/MEMBER EXCLUDED? ❑ (MMwx%M V Ma NH) If es, descr be MERATIONS blow NIA A PER OTH- E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT DE906PnoN OF OPERATIONS / LOCATIONS / VEHICLES (ACORD IM AddMoral Remarks Sehedula, mafr be aNadnd N mom space Is required) ELECTRICAL CONTRACTOR: INSTALLATION AND SERVICE REPAIR INCLUDED ON POLICY: BLANKET ADDITIONAL INSURED - LESSOR OF LEASED EQUIPMENT BLANKET ADDITIONAL INSURED - MANAGERS OR LESSORS OF PREMISES BLANKET WAIVER OF SUBROGATION Miami Shores Village Building Dept 10050 NE 2nd Ave Miami Shores Al UU!,)Mb SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. FL 33138- FAUiHORQ D REPRESENTATIVE 01988-2015 ACORD 25 (2016103) The ACORD name and logo are registered marks of CORPORATION. AII)ights reserved. RES T. -Fn. 17�4'KAMD, DPW~ 0' - wpow --w— —Y -3brw.."-*mot,,