EL-17-2123Miami Shores Village
10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138-0000
Phone: (305)795-2204
Project Address
Permit No. EL-8-17-2123
Permit Type: Electrical - Residential
Pen m Work Classification: Low Voltage
Permit Status: APPROVED
Parcel Number
Issue Date: 812812017 1 Expiration: 02/24/2018
Applicant
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
50 STATE TECHNOLOGY INC (305)899-2500 (305)525-5955
e of Work: RE -WIRING OF ALARM SYSTEM + INSTALL
itional Info: RE -WIRING OF ALARM SYSTEM + INSTALL
>sification: Residential
nning: 1
Fees Due
Amount
CCF
$5.40
DBPR Fee
$4.31
DCA Fee
$4.31
Education Surcharge
$1.80
Permit Fee - Additions/Alterations
$287.00
Scanning Fee
$3.00
Technology Fee
$7.20
Total:
$313.02
Valuation: $ 8,200.00
Total Sq Feet: 0
Pay Date Pay Type Amt Paid Amt Due
Invoice # EL-8-17-64959
08/22/2017 Credit Card $ 50.00 $ 263.02
08/28/2017 Credit Card $ 263.02 $ 0.00
Available Inspections:
Inspection Type:
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 ano[6nNg. Futhermore, I authorize the above -named contractor to do the work stated.
Auaust 28. 2017
AuthWFZ igrl'atyfre: Owner U / Applicant / Contractor / Agent
Buildin Department Copy
7 1
Miami Shores Village
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 KELECTRIC ❑ ROOFING
AUG 22 2017
. i
BY: _ -- --
FBC 201 J
Master Permit No. fi -6-11 — 177 O
Sub Permit No. EL (A
Z 1 Z3
❑ REVISION ❑ EXTENSION ❑RENEWAL
F-IPLUMBING ❑ MECHANICAL Ej PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
9 % S"r
JOB ADDRESS: 103 7 Ali- L / '
City: Miami Shores County: Miami Dade Zip: 33 131?
Folio/Parcel#: Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FIFE:
OWNER: Name (Fee Simple Titleholder)f•6: a%kAl A49� Phone#:
Address: 403 ? Nf-- / cf 'fir -
City: GLC (A� 1511G'� State: f L-044 i4 Zip:
Tenant/Lessee Name:
Email:
CONTRACTOR: Company Name: 92> S750rL iEzLa�CC[�'� 1X)6• Phone#:
Address: //
City: / 47y'l State: �l Zip:
Qualifier Name: STc.,ow / ��/} Phone#: dos��-
State Certification or Registration #: Certificate of Competency #:
DESIGNER: Architect/Engineer:
hone#:
Address: City: State
00
Value of Work for this Permit: $Square/Linear Footage of Work:
Type of Work: ❑ Addition 0 Alteration ® New ❑ Repair/Replace ❑ Demolition
Description of Work: _ L) ( f—LA.;r, df— �' y .S i>.� .L/i'iS % 44,-( Arlen V
Specify color of color thru tile:
Submittal Fee $ `�' Permit Fee $
Scanning Fee $
Technology Fee $
Structural Reviews $
Radon Fee $
Z8/,e"en' CCF$
Training/Education Fee $
DBPR $
CO/CC $
Notary
Double Fee $
Zip:
Bond $
TOTAL FEE NOW DUE $ -G3, 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
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 AMA 1d-,Q I
OWNS r VENT
The foregoing instrument was acknowledged before me this
—2/ day of 20 17 , by
who is personally known to
me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
Sig
%-o��2,
Pr• t:
Signatu
CONTRACTOR
The foregoing instrument was acknowledged before me this
day of — 4&a� 1 20 / 7 , by
15MP11>`•XI who is personally known to
as me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
Sign: ' A
Print: Oww
Seal: °O Seal:
�►:. SANDI PENA
±� My COMMISSION #FF163783
EXPIRES September 28.2018
APPROVED BY
Plans Examiner
Structural Review
'01
KEVIN MICM.EL Ll
MY ComMISSION 0 FF23:9/43
as
Zoning
Clerk
(Revised02/24/2014)
RICK SC OTT, GOVEKNUR
LICENSE4NUMBER:
KEN LAWSON, SECRETARY
STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
ELECTRICAL CONTRACTORS LICENSING BOARD
The ALARM SYSTEM CONTRACTOR I
Named below IS CERTIFIED
Under the provisions of Chapter 489 FS.
Expiratiori date: AUG 31, 2018
RENTERIA, STEPHEN J
50 STATE TECHNOLOGY, INC.
915 NE 125TH STREET
NORTH MIAMI FL 33161
ISSUED: 10/26/2016 DISPLAYAS REQUIRED BY LAW
SEQ # L1610260002876
:^ DRIVER LICENSE CLASS E�
_ R536- 90-55-413_0
' 'm
;RENTERLA
6
I
S NJGSEP,
3T92 NE 1,.,Ci�iai-I0,�4t �S7y kliAMl , FL 33160-3H5.3nm i I 1--u4gsr sing h1, ,
r. ISSL t Y,N � 3--2U1I Hk j
�XrG+e's 3-019
' I�s�A .
r� '
SAFE W.WeY R MIDTORMLE AL0
:?u�.:n,�n .:, n.,m;� .,�t+.cx.'ran.. ,�nac•n ,r �Rr .•.:,—•.:n: ..oun.a n, ,a. '
000827 ,
Local Business Tax Receipt
Miami —Dade County, State of Florida
—THIS IS NOT A BILL — DO NOT PAY
7214646
BUSINESS NAME/LOCATION
50 STATE TECHNOLOGY INC
915 NE 125 ST 105
NORTH MIAMI FL 33161
OWNER
50 STATE TECHNOLOGY INC
C/O JAYSON YAO PRES
Worker(s) 10
RECEIPT NO.
EXPIRES
RENEWAL
SEPTEMBER 30, 2017
7498516
Must be displayed at place of business
Pursuant to County Code
Chapter 8A — Art. 9 & 10
SEC. TYPE OF BUSINESS
196 SPEC ELECTRICAL CONTRACTOR PAYMENT RECEIVED
EF0000818
BY TAX COLLECTOR _
$45.00 11/15/2016
CREDITCARD-17-007366
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 holders qualifications, to do business. Holder must comply with any governmental
or nongovernmental regulatory laws and requirements which apply to the business.
The RECEIPT NO. above must be displayed on all commercial vehicles — Miami —Dade Code Sec 88-276.
For more information, visit www.miamidade.govftax� for
50STA-1 OP ID: PR
'4� Ro. CERTIFICATE OF LIABILITY INSURANCE
DATE 08122/2017
08122/2017
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 endorsements .
PRODUCER
Tanenbaum Harber of Florida
2900 SW 149th Avenue
CONTACT Alina Larraz, CPCU, AAI, CRIS
NAME'
PHONE 954-883-2900 ac No ; 954-517-7400
Miramar, FL 33027-6605
Alina Larraz, CPCU, AAI, CRIS
.
DORIEss: alarraz@thfloridacom
----- --
INSURER(S) AFFORDING COVERAGE
NAIC #
INSURER A: Everest Indemnity Ins. Co
INSURED 50 State Technology Inc
Jayson Yao
915 NE 125th Street, #105
INSURER B : Everest National Insurance Co.
10120
—__....___...__
INSURER C : RetailFirsl Insurance Company
10700
INSURER D ; Hartford Fire Insurance Co.
19682
North Miami, FL 33161
INSURER E :
INSURER F :
GUVhKAGES CFRTIFIrATF NIJMRFR- RPVICInfd NI I6ARFR•
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.
LTR
TYPE OF INSURANCE
L
IN
___
POLICY NUMBER
POLICY EFF
MM/ODIYYYYI
POLICY EXP
(MMIDDNYYYI
LIMITS
A
X
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE n OCCUR
SIGLO12634161
08/2912016
08/29/2017
EACH OCCURRENCE
$ 1,000,000
DAM�GEt
PREMISES Ea occurrence
50,000
$ ,
GEN'L
MED EXP (Anyone person)
__--„--_
$ 5,000
PERSONAL & ADV INJURY
$ 1,000,000
AGGREGATE LIMIT APPLIES PER:
POLICY PRO- ❑
JECT LOC
OTHER:
GENERAL AGGREGATE
$ 2,000,000
PRODUCTS -COMPIOPAGG
— `—
$ 1,000,00
----....-._.—
$
AUTOMOBILE
X
X
LIABILITY
ANY AUTO _
ALLOWNED SCHEDULED
AUTOS AUTOS NON -OWNED
HIRED AUTOS LAUTOS
51 CA001207161
09/1612016
09116/2017
COMBINED SINGLE LIMIT
(Ea accident)$
1,000,000
BODILY INJURY (Per person)
$
BODILY INJURY (Per aaident)
$
PROPERTY DAMAGE
Per accident
$
_
$
A
UMBRELLA LIAR
EXCESS LIAR
X
OCCUR
CLAIMS -MADE
SIE0003553171
01/1012017
08/2912017
EACH OCCURRENCE
$ 1,000,000
X
AGGREGATE
$ 1,000,000
DED I I RETENTION $
$
C
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY N
ANY PROPRIETORlPARTNERIEXECUTIVE YIN
OFFICERIMEMBER EXCLUDED? N
(Myyandatory esin NH)
be under
DESCRIPTION OF OPERATIONS below
N / A
052054915
09/26/2016
09/2612017
X R
STATUTE ER
E.L. EACH ACCIDENT
$ 1,000,000
E.L. DISEASE - EA EMPLOYE
$ 1,000,000
E.L. DISEASE - POLICY LIMIT
$ 1,000,000
D
Crime
21BDDHO7580
12105/2016
1210512017
Limit 250,000
Ded 2,500
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
Sales, Installation of Security, Fire Alarm Systems, Access Control and
Cameras.
MIAM138
Miami Shores Village
Building Department
10050 N.E. 2nd Avenue
Miami Shores, 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
@ 1988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD