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EL-16-3224Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 Project Address Parcel Number Permit No. EL-11-16-3224 Permit Type: Electrical - Residential ' Work Classification: Addition/Alteration Permit Status: APPROVED Issue Date: 12/8/2016 1 Expiration: 06/06/2017 Annlinant 1037 NE 91 Terrace 1132050010050 Miami Shores, FL Block: Lot: ALISON HARKE Owner Information Address Phone Cell ALISON HARKE 1037 NE 91 TERR MIAMI SHORES FL 33138-3401 Contractor(s) Phone Cell Phone SAME & Q ELECTRIC INC (305)219-0427 Type of Work: FIRST FLOOR NEW ELECTRICAL PANEL NE Additional Info: FIRST FLOOR NEW ELECTRICAL PANEL NE Classification: Residential Scanning: 1 Fees Due Amount CCF $16.20 DBPR Fee $14.18 DCA Fee $14.18 Education Surcharge $5.40 Permit Fee - Additions/Alterations $945.00 Scanning Fee $3.00 Technology Fee $21.60 Total: $1,019.56 Valuation: $ 27,000.00 Total Sq Feet: 0 Pay Date Pay Type Amt Paid Amt Due Invoice # EL-11-16-62185 12/08/2016 Check #: 1605 $ 969.56 $ 50.00 11/28/2016 Credit Card $ 50.00 $ 0.00 Avauaole Inspection Type: I Alteration Relocation Fire Alarm Service Change Review Electrical W. W. 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 authorize the above -named contractor to do the work stated. December 08, 2016 Authorized Signature: Owner / Applicant / Contractor / Agent Date Building Department Copy December 08, 2016 Miami Shores Village g Nov 2 8 2016 Building Department; _ 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 ~ ~--r— Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 aC_ FBC 20 BUILDING Master Permit No. (0 " I PERMIT APPLICATION Sub Permit No. 6 1 3 L?N ❑BUILDING ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION []RENEWAL ❑PLUMBING ❑ MECHANICAL PUBLIC WORKS ❑ CHANGE OF [:]CANCELLATION ❑ SHOP (, ss ,, CONTRACTOR DRAWINGS JOB ADDRESS: 1 3 �} N� City: Miami Shores County: Miami Dade Zip: l �8 Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FIFE:OWNER: Name (Fee Simple Titleholder)--: A ��S� � ✓ �� Phone#: Address: Gl ( -A CQ-, City: �a�', State: f -- Zip: 3� I Tenant/Lessee Name: Phone#: Email: _ CONTRACTOR: Company Name:��-C "� C� �� l L Phone#: �1) 2 i 1) Z*) Address: s3 1 0 S i%.-,3 >4 -c-, Jlc- City: I-10 (L- ` &6 lU Ck7)9 State: EL ip: .3 ::� f Qualifier Name: JA A tJy C L E ayC-8 Phone 3czo z Q l 2)- State Certification or Registration #: 1=" \ 3 d G ':A 1 2--9 Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: Value of Work for this Permit: $ �o©o.00 City: State: Zip: Square/Linear Footage of Work: Type of Work: ❑ Addition ,, ❑ Alteration / ❑ New ❑ Repair/Replace El Demolition Desc iption of Work: lb4 ��1 �j�l i�1� �%GGJ G11 lC'� 41 6,� HG� Specify color of color thru tile: Submittal Fee $ Permit Fee $ �H1/ GY7 CCF $ COAC $ Scanning Fee $ Radon Fee $ Technology Fee $ Training/Education Fee $ Structural Reviews $ DBPR $ 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 $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature N Signature OWNER r GENT CONTRACTOR The foregoing instrument was ackn wI dged before me this The fo�iegoing instru;01RA"bel-, was acknowledged before/me this 2 / day of �v I%ih r 20 , by / day of 20 �(!i by 061 M ge 4 kc ho is persona known to Q •eec,. who is personally known to ,Qor who has produced as me or who has produced as identification and who did take an oath. NOTARY PUBLIC: identification and who did take an oath. NOTARY PUBLIC: Sign: Sign: ANAY BAZAIN Print: Print: " b ' to of Florida Seal: ;s�41021 P1, k; SAN�I PENA Seal: '_• ; : My Comm. Expires May 1, 2017 ,o. MY COMMISSION #FF163783 =;9, Commission # FF 013542 _• OF Bonded Through National Notary Assn. EXPIRES September 28, 25018 •w, FbridallotmService.com APPROVED BY., �041 %Z Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) 11/28/2018 1:OOPM FAX 305263485E EXCLUSIVE 00001/0001 i64hr CERTIFICATE OF LIABILITY INSURANCE FDATE(MMIDDmY1r) THIS CERTIFICATE IS, ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the pollCy(ies) must be endomed. 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 endomement(s). PRODUCER c0 Reina Seade EXCLUSIVE INSURANCE AGENCY NAME: PNONL+ 305.263�t855 a 7175 SW 8 ST #204 A a 305-263-4856 eon IL EXClusiveins@comeast,net MIAMI INSUREM )AFFORDINOCOVER- F NAIC INSURED FL 33144 INSURSR A: GRANADA INSURANCE COMPANY ' SAME 5 0 ELECTRIC INC INSURERe: NORMAN15Y INSURANCE COMPANY 950 SW 104 CT wsuRER C : APT 301 C INSURER D : INSURER E : Miami FL 33174 ,,,.,,,._.. - _ MB THIS IS TO CERTIFY THAT THE POLICIES OF INSURgNCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABpFOR INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION THE POLICY PERIOD OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. HEREIN IS SUBJECT TO WHICH THIS LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAiD uLISRR CLAIM$, TO ALL THE TERMS, TYPE OF INSURANCE oL UUOR P pD POLICY E POLICY NUMBER P DMW LIMITS COMMERCIAL GENERAL LIABILITY CLAIMS -MACE X OCCUR EACH OCCURRENCE S 1,000,000 PREMISE6T(OFer y 100,000 A - 0185FL00087723 MED EXP (Any one person) 09/29/2016 09/29/2017 g 5.000 $ 1,000,000 PERSONAL LADVINJURY GENT- AGGREGATE LIMIT APPLIES PER: POLICY a GENERAL AGGREGATE CT PECT LOG _ y 1,000,000 OTHER: PRODUCTS-COMP/OPAGG S 1,000,000 AUTOMOBILE I_Uai lTY S ANYAUTO Eo I ED SINGLE L I i' S AALL O UT0OS ED SCHEDULED 130DILY INJURY (Per person) S AUTOS HIREDAUTOS NON -OWNED BODILY INJURY (Par aw(Jent) AUTOS s PROPER AGE Per acci S uMeReu q LIAe OCCUR $ EXCESS LIA9 CLAIMS -MADE EACH OCCURRENCE i DEC) RMNTIONS AGGREGATE $ WORKERS COMPENSATION S AND EMPLOYERS' LIABRM O B ANY PRQFR1ET0R/PARTNER/EXECUTIVI: Y / ❑Y NIA WC-189960-00 y 100,000 (M al ryInNEREXCLUDED9 (Mandatory in Nt♦y 11/28/2016 11/28/2017 .E.L.EACH ACCIDENT eactibe�Luxor DLRiPTION OF OPERATIONS Delow E.L. DISEASE - EA EMPLOYE S 500,000 E.LCISEASE- POLICY LIMIT S 100.000 DESCRIPTION OF OPERATIONS T LOCATION51 VEHICLES (ACORD 101. Add1t10nel Rem aks 9chedmElectricalSeServices , Rors 90s0e Ie MgUlred) License Contractor Number 13007128 CANCELLATION ;ACCORDANCE ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Miami Shores Village PIRATION DATE TNEREO C+Tt�E WILL 13E • DELIVERED IN 8. WITH THE POLI OVISIONSBuilding Department10050 NE 2nd Ave. SENT vE Miaml Shores FL 33138 ACORD 26 (2014/01) The ACORD name and logo are registere, marks of ACORD RD CORPORATION. All rights reserved. Local Business Tax Fbcei pt M iam i-Dade County, State of Florida -THIS (SNOT ABILL -- DO NOT PAY LR 6607734 BUSINESS NAME/LOCATION RECEIPT NO. EXPIRES SAME & Q ELECTRIC INC RENEWAL SEPTEMBER 30, 2017 950 SW 104TH CT APT 301 C 6878350 MustMIAMI, FL 33174 Must be displayed at place of business Pursuant to County Code Chapter 8A - Art. 9 & 10 OWNER SEC. TYPE OF BUSINESS PAYM ENT RECEIVED SAME & Q ELECTRIC INC 196 ELECTRICAL BY TAX COLLECTOR C/O MANUEL E QUESADA PRES CONTRACTOR 75.00 09/15/2016 Worker(s) 1 EC13007128 0224-16-005818 This Local Business Tax fbcelpt only con"mis payment of the local Business Tax. The Ibceipt is not a license, permit, or a certi "cation of the holder's qua] i "cations, to do business. Folder mud corm y with any govermmnted or nongovernmental regulatory laws and requirements which apply to the business. The FSMPT NQ above must be di splayed on all co(rrrte dd vehicles- Miami -Dade Code Sec ea-278. Fm For more IMormation,visit www.miamidadeQ0 taxcdlector Scanned by CamScanner L JEFFATWATER CHIEF FINANCIAL OFFICER STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW CONSTRUCTION INDUSTRY EXEMPTION This Certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law. EFFECTIVE DATE: 4/18/2016 EXPIRATION DATE: 4/18/2018 PERSON: OUESADA MANUEL E SR FEIN: 271614399 BUSINESS NAME AND ADDRESS: SAME 6 O ELECTRIC INC 950 SW 104 CT # C301 MIAMI FL 33174 SCOPES OF BUSINESS OR TRADE: LICENSED ELECTRICAL ELECTRICAL WIRING ELECTRIC LIGHT OR CONTRACTOR WITHIN BUIL POWER LINE C Pursuant to Chapter 440.05(t4), F.S.. an cificer or s corpol ion wW ek u exemption rrom this chapter by r*V a certificate detection under Iles section may not recover benefits or compensation under Ode chaplet. Pursuant to Chapter 440.05(12), F.S.. Ce"cues of election to be exartpt._"o* wphin tie scope of the business or trade hued an the notice of election to be exempt. Pursuant to Chapter 440.05(13)• F.S., Notices of election 10 be exempt and certdKates of eiaction to be exempt steal be subject to revocation d at any time atler the fdnp of the notice or the issuance of Vie cer sate, the person maned on the notice or cerutcate no longer meets the requirements of On section for Issuance of a caAtkste. The department alad revoke a OFS-F2-DWC•252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 0843 _ .,. DRIVER LICENSE C E t .. „��►► 0230-145-56-068-0 ' lFtO 7piiM 1t341'H tT AtsT 11i1+C o+FL WTAUU r ir�,�*0101 S wit-"1t1t' Est 11� • IItM/,+��lSZ+Ol+I�.�.. � , S. t�}r+tiM d � ..ww .ri�kfiY •w+��lwfwr xsWpM M err vi�wKf. lead erg Hr Yn QUESTIONS? (850)413.1609 STATE OF FLORIDA DEPARTMENTOFBUSINESS AND PROFESSIONAL REGULATION EC13007128 x l8SUE1� 08/30/2016 t4, CERTIFIED EELE ICAL CONTRACTOR OUESADA, 1.4ADIO° - SAME & 0 ELEC'i IC.INC., IS CERTIFIED under the provisions of Ch.489 FS Exprstondale AUG31,2014 L160E3000C11s1 3 Scanned by CamScanner