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EL-18-1584`yNOREy 9" Miami Shores Village 10050 N.E. 2nd Avenue NE " Miami Shores, FL 33138-0000 Phone: (305)795-2204 Ft0IOA Permit NO. EL-6-18-1584 Permit Type: Electrical - Residential Work Classification: Pool - Private Permit Status: APPROVED Issue Date: 6/18/2018 I Expiration: 12/15/2018 Project Address Parcel Number Applicant 526 NE 97 Street 1132060171530 ROBERT & ALLISON LUDICKE Miami Shores, FL 33138- Block: Lot: Owner Information Address ROBERT & ALLISON LUDICKE 9999 NE 13 AVE MIAMI SHORES FL 33138 Contractor(s) Phone Cell Phone DAVE VANZWIETEN INC DBA HIGHV( (954)309-7607 Type of Work: ELECTRIC HOOK UP POOL Additional Info: ELECTRIC HOOK UP POOL Classification: Residential Scanning: 1 Fees Due CCF DBPR Fee DCA Fee Education Surcharge Permit Fee - Additions/Alterations Scanning Fee Technology Fee Total: Amount $1.20 $4.50 $3.00 $0.40 $300.00 $3.00 $7.50 $319.60 Phone Cell (305)754-2903 Valuation: $ 1,500.00 Total Sq Feet: p Pay Date Pay Type Amt Paid Amt Due Invoice # EL-6-18-67871 06/18/2018 Check #: 42662 $ 269.60 $ 50.00 06/08/2018 Check #: 42633 $ 50.00 $ 0.00 Available Inspections: Inspection Type: Final Light Niche Bonding Review Electrical Alarms 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 AFFIDAVyT: I certify tot -)all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and z g. Futher ore, I authorize the above -named contractor to do the work stated. June 18, 2018 Auth rized Sigdatt5re: Owner) / Applicant / Contractor / Agent Building Department Copy June 18, 2018 1 Miami Shores Village Building Department } t'' UN S 18 I 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 ELECTRIC ❑ ROOFING FBC 20 'y Master Permit No. ppI S— 1�J0 Sub Permit No. EL i ij --i Sa 4 ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOBADDRESS: 5Q_(4 A F_ 97 57" City: Miami Shores County: Miami Dade Zip: 3313 8' Folio/Parcel#: //- 3, C6- O/7 1530 Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): / -III SOY) -oi 1&6,e-4 UJd icke Phone#: 30_(;--7(o- '51,7 o Address: &E q-7 ST City: M is m i Shams State: Zip: 3 313 g Tenant/Lessee Name: /n� � / Phone#: Email: �kdi-ckPQ land sa-erye Inc,, GO►m CONTRACTOR: Company Name::/ h 116 l4.ge ffetrjG Phone#: 957'30 - 7&6-7 Address:�, _p0 0X q /"7� � ram, City: el--� f) 8-eA ' 1 State: T' LI Zip: 33 V I/9 Qualifier Name: I)Lyt [An zw i-eT4rh Phone#: 4W,309'-7(P0_7 State Certification or Registration #: & G- l -3 06 9,89S Certificate of Competency #: DESIGNER:gqArchitect/Engineer: V file.✓kha n n Phone#: q-818-3 6 Address: a bS S, i e►`"ql 4vw 4/0 City:_/6rj4_ttd State: Fl- Zip: 33(/(I1 Value of Work for this Permit: $ Type of Work: ❑ Addiction Description of Work: 1E%Ccj Square/Linear Footage of Work: ❑ Alteration New ❑ Repair/Replace ❑ Demolition , , .4 Ann / c:r is I Lj A." ✓J .M Specify color of color thru tile: Submittal Fee $ S 0 P(I � Permit Fee $ 3'C>0 "OD CCF $ CO/CC $ Scanning Fee $ Radon Fee $ -3- Q DBPR $ Y, Notary $ Technology Fee $ Training/Education Fee $ Structural Reviews $ Double Fee $ Bond $ Q TOTAL FEE NOW DUE $ Qf--1 • EQ (Revised02/24/2014) Bonding Company's Name (if applicable) Bonding Company's Address City State Mortgage Lender's Name (if applicable) Al /- Mortgage Lender's Address _ Ai bi 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. ig— V Signature Z^ Signature OWNER or AGENT CON CTOR The foregoing instrument was acknowledged before me this —� day of PebV-L A!4 20 IS by AdI1'SOt'> LI.IdLI'l' lt`e who is personally known to me or who has produced identification and who did take an oath. NOTARY PUBLIC: Sign: Print: —KA4-h hEti?_Nl 6614e- Seal: � KATHLEEN A KRAUS ? : "'•. ° * * MY COMMISSION # FF 239683 EXPIRES: June 11, 2019 -14110,0, �' Bonded Thru Budget Notary Senim The foregoing instrument was acknowledged before me this 5 day of Thel ? CII 20 / 5 by 06wt Van 'Zwf-o� , who is personally known to as me or who has produced identification and who did take an oath. NOTARY PUBLIC: Sign: Print: Ittr) Kra., a° ••.��o KATHLEEN A KRAUS Seal: * * MY COMMISSION A FF 2396M EXPIRES: June 11, 2019 af140F r6 �~ Bonded Thru Budget Notary Seryka as ************************************************************************************************************ APPROVED BY C/ J'U.� !8 Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) To: Building Dept. Page 7 of 8 2018-06-01 18:16:53 (GMT) 19542522299 From: Ike's Carter Pools Ike's Carter Pools HIGH VOLTAGE ELECTRIC P.O. Box 4514 Deerfield Beach, FL 33442 954-309-7607 561-892-7600 fax Ccxl-IZO-9 �Idqqrn Date l % R State of FLORIDA County of PALM BEACH Before me this day personally appeared DAVE VAN ZWIETEN who, being duly sworn, deposes and says: That he will be the only person working on the projectt located at: Contractor Signature Sworn to (or affirmed) and subscribed before me this day of F"I 20 IS byy e, Peronally know or Produced Identication i T TT T" of Identidication Produced Notary Public State 14 FkMs Annammi sio qF�My Commission FF 90A661 ExpiresOW22/201B Print, Type or Stamp Name of Noi' To: Building Dept. Page 6 of 8 2018-06-01 18:16:53 (GMT) 19542522299 From: Ike's Carter Pools Ike's Carter Pools Miami shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 IV%JLI ,c w vwnrr — VVUUKeF5 c.►ompensaTlon insurance txernwjon Florida Law requires Workers' Compensation insurance coverage under Chapter 440 of the Florida Statutes, Fla. Stat. § 440.05 allows corporate officers in the construction industry to exempt themselves from this requirement for any construction project prior to obtaining a building permit. Pursuant to the Florida Division of Workers' Compensation Employer Facts Brochure: An employer in the construction industry who employs one or more part-time or full-time employees, including the owner, must obtain workers' compensation coverage. Corporate officers or members of a limited liability company (LLC) in the construction industry may elect to be exempt if: I . The officer owns at least 10 percent of the stock of the corporation, or in the case of an LLC, a statement attesting to the minimum 10 percent ownership; 2. The officer is listed as an officer of the corporation in the records of the Florida Department of State, Division of Corporations; and 3. 'The corporation is registered and listed as active with the Florida Department of State, Division of Corporations. No more than three corporate officers per corporation or limited liability company members are allowed to be exempt. Construction exemptions are valid for a period of two years or until a voluntary revocation is filed or the exemption is revoked by the Division. Your contractor is requesting a permit under this workers' compensation exemption and has acknowledge that he or she will not use day labor, part-time employees or subcontractors for your project. The contractor has provided an affidavit stating that he or she will be the only person allowed to work on your project. In these circumstances, Miami Shores Village does not require verification of workers' compensation insurance coverage from the contractor's company for day labor, part-time employees or subcontractors, BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. Signature: c Ow State of Florida County of Miami -Dade The foregoing was acknowledge before me this day of Ap t` t ` 20 13, (� '. --�� BY—hQ1 e> `S t a+ �1� `� L'� who is per Molly kn� to me or has produced "-� as identification. Notary: r ryes Ploiary Public State of Florida QQQ Anna Chrlsto SEAL: My comrsission FF 906651 ors�o EKplres 08/2212019 To: Building Dept. Page 1 of 8 2018-06-01 18:16:53 (GMT) 19542522299 From: Ike's Carter Pools Ike's Carter Pools Miami shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CONTRACTORS' REGISTRATION IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: A. `-� COPY OF QUALIFIER'S STATE LICENCES B. v COPY OF LOCAL BUSINESS TAX RECEIPT C. ✓ COPY OF LIABILITY INSURANCE* D. COPY OF WORKERS COMPENSATION INSURANCE* (Workers Compensation EXEMPTION must have NOTICE TO OWNER form and Contractor Affidavit) IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY: A. COPY OF CERTIFICATE OF COMPETENCY OF QUALIFIER B. COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF STATE REGISTERED CONTRACTOR LICENSE OR MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT. D. COPY OF LIABILITY INSURACE* E. COPY OF WORKERS COMPENSATION INSURANCE* (Workers Compensation EXEMPTION must have NOTICE TO OWNER form and Contractor Affidavit) *YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE AS FOLLOW: Certificate Holder: MIAMI SHORES VILLAGE BLDG DEPT" 10050 NE 2ND AVE MIAMI SHORES, FL 33138 Certificate must specify the description of operations or contractor license number. r���rrrrrrrr�rrrrr�r�ra■■rrr�rrrrrr�rrr�rs�rrrrrrrrr�rr��rrrrr�rrr�rrrrrrrrrrrr�rr�r�rrrrr■ BUSINESS NAME: Cave i%l v 2 &v/C f FN I W C /99/(� Vc, j �aq p. E/ec I c BUSINESS ADDRESS: 4b6 NW a 2 AUK CITY IJ U r a STATE E C ZIP 3 3 `/ 6'6 BUSINESS PHONE: �`i S 4 1 ?y q - 7 C d 7 FAX NUMBER { ) _ 9 1 ,-4 — 7-600 CELL PHONE (� 5 (4 3 e 9 - - . Q .7 QUALIFIER'S NAME: 6a vp a j QUALIFIER'S LIC NUMBER: _fC - 1 ? 0 6�` To: Building Dept. Page 5 of 8 2018-06-01 18:16:53 (GMT) 19542522299 From: Ike's Carter Pools Ike's Carter Pools JIMMY PATRONIS CHIEF FINANICAL OFFICER 0 d •�'cOD WdS* 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: 7/7/2017 EXPIRATION DATE: 7/7/2019 PERSON: VANZWIETEN DAVE FEIN: 651125361 BUSINESS NAME AND ADDRESS: DAVE VANZWIETEN INC HIGH VOLTAGE ELECTRIC 401 NW 22 AVE BOCA RATON FL 33486 SCOPE OF BUSINESS OR TRADE: Electrical Wring Within Buildings and Drivers IMPORTANT: Pursuant to Chapter 440.05(14), F.S., an officer of a corporation who elects exemption from this chapter by filing a certificate of election under this section may not recover benefits or compensation under this chapter. Pursuant to Chapter 440.05(12), F.S., Certificates of election to be exempt,., apply only within the scope of the business or trade listed on the notice of electon to be exempt. Pursuant to Chapter 440.05(13), F.S„ Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation if, at any time after the filing of the notice or the Issuance of the certificate, the person named on the notice or certificate no longer meets the requirements of this section for Issuance of a certificate. The department shall revoke a certificate at any time for failure of the person named on the certificate to meet the requirements of this section. DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO 13E EXEMPT REVISED 08-13 QUESTIONS? (850)413-1609 To: Building Dept. Page 8 of 8 2018-06-01 18:16:53 (GMT) 19542522299 From: Ike's Carter Pools Ike's Carter Pools " 1 O CERTIFICATE OF LIABILITY INSURANCE �'� D4/10ATE l2018Y) -14 4i10/2018 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. I'HIS 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 CONTACT NAME: Tracy Brehm Setnor Byer Insurance & Risk PHONE (954)382-4350 FAX (954)382-2810 _(AlG._Na.Ext)' 900 3, Pine Island Road #300 ---..__...._.............._lA<S,.No);.._._....--- — ADDRE— SS:certificates®setnorbyer.com --............_._........... -----.._............... _......... - rNSURER(S) AFFORDING COVERAGE -- _.—_. ---- NAIC 0 P Plantation FL 33324 _-..-..-_..............._................._.....-...__..-_............__ INSURERA:Travelers Indemnity Co of Conn ...-------- 25682 _ — INSURED ........... . Dave Van Zwieten, Inc, DBA: High Voltage Electric INSURER B ; PO Box 4514 INSURERC: INSURER D Deerfield Beach FL 33442-4514 rMMER E__ INSURERF: --- -- - - rteYr�77V1Y IYUMCCR: 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 INSR �----- � ..... _ LTR TYPE OF INSURANCE POLICY NUMBER POLICY OLI D/YY1 V CLAIMS. POLICYYVYY LIMITS X COMMERCIAL GENERAL LIABILITY A CLAIMS -MADE IOCCUR EACH OCCURRENCE DAMACGE'TO RENTED S 500,000 — —'---- I -PREMISE$__(Eaoccurrenc�) S- 00 - - -- — 66060277865 i 1/1/2018 1/1/2019 � � MED EXP (Any one person) ------_..— S 5,000 PERSONAL B ADV INJURY S 500,000 GEN'L X AGGREGATE LIMIT APPLIES PER: PRO- POLICY n GENERAL AGGREGATE S 11000,000 S 1, 000, 000 J JECT LOC PRODUCTS - COMP/OP AGO OTHER- .__..-_._..._._.......-...__........._..............................._.. S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (Ea.._acrioer— -......._._...........................__........`------- $ - - — --- ALLOWNEDI SCHEDULED I BODILY INJURY (Per person) __-__..__.__._....................__.._..........._._._........._...._....__..-....-___.._....-_.--... S AUTOS j AUTOS NON -OWNED BODILY INJURY (Per accident) _ ......._-... _.. S -- HIRED AUTOS I AUTOS , .... ...................._._._._ Per accident UMBRELLA LIAR OCCUR 1 _ EXCESS LIAB I ( EACH OCCURRENCE t------....._-.._..--- ..............-- $ �— �—"- I LAIMS-MADE � i - I DED RETENTION$ { ;AGGREGATE S WORKERS COMPENSATION S AND EMPLOYERS' LIABILITY YIN PER STATUTE._j....._.__.j._ER....,,"......,..._ ANY PROPRIETOWPARTNER'EXECUTIVE OFFICERtMEMBER EXCLUDE69 N!A I E.L. EACH ACCIDENT -------------------- S (Mandatory In NH) -----' S It es, describe under I I E.L. DISEASE - EA EMPLOYE 1==--- - _-.... ..._..........-.._...._. D SCRIPTON OF OPERATIONS below I I E.L. DISEASE - POLICY LIMB _......__._ _.._-..._...---------- S I i I I i I i � I � I DESCRIPTION OF OPERATIONS ! LOCATIONS ! VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is requlred) Electrical Contractor - License #EC-13002855 As per Florida Statute 45 day Notice Of Cancellation except in the event of nonpayment of premium, then 10 day notice. All of the above are subject to policy terms, limitations, exclusions and conditions. (305)756-8972 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE MIAMI SHORES VILLAGE Building Department THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 10050 NE 2nd Ave ACCORDANCE WITH THE POLICY PROVISIONS. Miami Shores, FL 33138 AUTHORIZED REPRESENTATIVE Tracy Brahm/DAWNC!' ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD INS026 (201401) -----•.,.,� �..��.� � w�.H�-.aualtvt�5 IAX=R-E��E1PTw"��"`;;,,�;,._. 115 S. Andrews Ave., Rm. A-100, Ft. Lauderdale, FL 33301-1895 — 954-831-4000 VALID OCTOBER .1, 2017 THROUGH SEPTEMBER 30, 2018 DBA: Receipt #:181- 2 9 3 9 Business Name HIGH VOLTAGE ELECTRIC DAVE p ELECTRICAL/ALARMS/CON VANZWIETEN INC Business Type: (ELECTRICAL CONTRACTOR); Owner Name: DAVE VAN ZWIETEN Business Opened:02 /21/1996 Business Location: 401 NW 22 AVE State/CountylCert/Reg:EC 13002855 PALM BEACH COUNTY Exemption Code: Business Phone:954-309-7607 Rooms seats Employees Machines Professionals 1 x. i For Vending Business Only Number of Machines: Vending Type; Tax Amount Transfer Fee NSF Fee Penalty Prior Years Collection Cost Total Paid 27.00 0.00 0.00 0.00 0.00 0,00 27.00 a� THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS THIS BECOMES A TAT( RECEIPT This tax is levied for the privilege of doing business within Broward County and is non -regulatory in nature. You rnust meet all County and/or Munidpaiity planning WHEN VALIDATED and zoning requirements. This Business Tax Receipt must be transferred when the business is sold, business name has changed or you have moved the business location. This receipt does not indicate that the business is legal or that it is in Compliance with Slate or local laws and regulations. Mailing Address: DAVE VAN ZWIETEN PO BOX 4514 DEERFIELD BEACH, FL Receipt #01A-16-00006976 33442 Paid 06/03/2017 27.00 2017 .2018 To: Building Dept. Page 2 of 8 2018-06-01 18:16:53 (GMT) 19542522299 From: Ike's Carter Pools Ike's Carter Pools vc i^%,n ricna RICK SCOTT, GOVERNOR KEN LAWSON, SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD 410ENSE NUM$ER` The ELECTRICAL CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2018 VANZWIETEN, DAVE BRIAN DAVE VANZWIETEN INC. DBA HIGH VOLTAGE ELECTRIC 401 NW 22ND AVE BOCA RATON FL 33486 ISSUED: 08/14/2016 DISPLAY AS REQUIRED BY LAW SER# L1608140004661