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ELC-17-2066Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 Project Address Parcel Number Permit No. ELC-8-17-2066 Permit Type: Electrical - Commercial Work Classification: Addition/Alteration Permit Status: APPROVED Issue Date: 8/2412017 1 Expiration: 02/20/2018 Applicant 9501 NE 2 Avenue 1132060133920 Miami Shores, FL 33138- Block: Lot: DVS LLC Owner Information Address Phone Cell DVS LLC 9400 NE 2 Avenue (305)756-3711 MIAMI FL 33138- Contractor(s) Phone Cell Phone AAA ON TIME ELECTRIC INC (786)295-1748 e of Work: ELECTRICAL FEE FOR PUMP STATION itional Info: ELECTRICAL FEE FOR PUMP STATION >sification: Commercial nning: 1 Fees Due Amount CCF $2.40 DBPR Fee $2.25 DCA Fee $2.25 Education Surcharge $0.80 Permit Fee $150.00 Scanning Fee $3.00 Technology Fee $3.20 Total: $163.90 Valuation: $ 3,500.00 Total Sq Feet: 0 Pay Date Pay Type Amt Paid Amt Due Invoice # ELC-8-17-64885 08/16/2017 Cash $ 50.00 $ 113.90 08/24/2017 Credit Card $ 113.90 $ 0.00 Avanaoie inspections: Inspection Type: Final Meter Box Relocation Fire Alarm Service Change Review Electrical Underground 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. Futherrmo�re, I authorize the above -named contractor to do the work stated. _11en. _ I Auaust 24. 2017 Authoriz�Signature:Owner / Afplicant / Contractor / Agent Building Department Copy August 24, 2017 Miami Shores Village RED 'HIV Building Department a,!r 2 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 RECEIVED INSPECTION'S PHONE NUMBER: (305) 762.4949 AUG2 4 2011 3 FBC 201L(s BUILDING PERMIT APPLICATION omit Type: Electrical JOB ADDRESS: `bvs, L-Lc— Permit No. ,FL-r— l "-'�;w(t(a Master Permit N q!01- q� NV�_ 'ZOb N\L City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated: Yes NO OWNER: Name (Fee Simple Titleholder): LL—Ci-- Flood Zone: Address: 2_(::�) 1 t4t_ R5H L City: '' /�1l G H d Sl-ly�es State: Zip: J J 3 Tenant/Lessee,Name: lJ.--C, Phone#: Email: 4 / Z/ f. CONTRACTOR: Company Name: A AA 08 6 me- E l eckr i C` Phone#: 784 d 3 6 Address: 19110 N \^i 'b N qc e, City: i\A \ Ay'v\ State: EL Zip: 33 Qualifier Name: 9-o b Gd lC a L rn.A r Phone#: State Certification or Registration #: fZ 1300 a tj L Certificate jof Competency #: Contact Phone#: Cal r NV4 1 A rVd Email Address: M 11 I A A e �kso L) +fn • n e DESIGNER: Architect/Engineer: Phone#: Value of Work for this Permit: $_ 3,` coo Square/Linear Footage of Work: Type of Work: ❑Address may' ❑Alteration ❑New ❑Repair/Replace ❑Demolition Description of Work: 1C—�2� ```p``-—�-� c-M-Tt ***************************************Fees******************************************** Submittal Fee $ Permit Fee $ I -50' Jz> CCF $ CO/CC Scanning Fee $ Notary $ Radon Fee $ Training/Education Fee $ DBPR $ Bond $_ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ 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 ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and 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 w ' h-e n (7) days after the building permit is issued. In the absence of such posted notice, the inspection wil�nat" e_appr&ved and a reinsp tion fee will be charged. Signa re Signatur O er or Agent Contracto he foregoi g instrument was acknowledged before me this The foregoing instrument was acknowledged before me this ti ^Al day of a , 20L7,by day of A- , 20 J 2, by JQ a� (?✓�'� " who is personally known to me or who has produced As identification and who did take an oath. NOTARY PUBLIC: who is personally known to me or who has produced --- as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commission Expir s: My ELIZABETH ELORRWM 'c MY COMMISSION # FF9535W AO/1IgA-0'�1 Flon"Npte serv"ow APPROVED BY Plans Examiner Structural Review Notary Pubk State of Florida Jose Luis Saladin My Commission FF 914315 Zoning Clerk (Revised 3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09) nn.n aW I I, titivtttlVl !rt KEN UVVSON, SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD EC13002896 The ELECTRICAL CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Exp+ration date AUG 31, 2018 KATZMAN, ROBERT AAA - ON TIME ELECTRIC INC 651 N W 100 TERR. MIAMI FL 33150 ISSUED 06/1612016 DISPLAY AS REQUIRED BY LAW Local Business Tax Receipt �rf4it11=-C). ,it`CUU111j1�.�1at@ U: FIOIiU1F stel:6` 40 Ok "W EIECM C 14C RL NEVVAL oS4 \A 100TM 36297" ~ R 13150 SEQ 0 L160616OW1107 �"� LBT) EXPIRES SEPTEMBER 30.2017 1i..e5 INS 6/611M'rR iN at"* q .C.*, ar ..s ►anwel w Sawly' Cost �a�. ru► - ire s It �o Oft `9Af EtiCiRKINC Ili p[[ IL ':-w s A4±ct0 i.TAX r-okkmyw c fi.� :! 1S sAi+t�k !CI]0021N11 E"4Ou �, 01fW201 C'qF 'CAftD— "a.. lw.si ir7arr/<islr irsM awry caeb�r. Wr^*" d 64 IoWtiw.a,r s�w� v . rw"Iwirls slrr h►.Ir v wed::.- .ww a * erus p" 11w set w11n crr>MI w.1r rq 1!r 020410"t1— rd r4. 14. l.. "% tr �LkMI rr srwr rerrl ss O.sy.r.et or sr. rnrrr s"s: sr►. r'. - yrp..j�M Ca0 Sk M- #Wow. d.,n.a1�.o�%.ar!,r'w1+wlr1a11sNa>«lewriww ACORDe CERTIFICATE OF LIABILITY INSURANCE FATE (MMIDD/YYYY) Os/2s/2o,7 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 lies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WANED, subject to the terns 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 FrankCrum Insurance Agency, Inc. 100 South Missouri Avenue Clearwater, FL 33756 CONTACT NAME: PHONE A/C, No Exl : (800) 277-1620 X4800 FAX (A/C, No): 727 797-0704 E-MAIL ADDRESS: INSURERS AFFORDING COVERAGE NAICE INSURER A: Frank Winston Crum Insurance Company 11600 INSURED FrankCrum L/C/F A A A On Time Electric, Inc. 100 South Missouri Avenue Clearwater FL 33756 INSURER B: INSURER C: INSURER D: INSURER E: INSURER F CAVFRAP.FS CERTIFICATE NUMBER' 417577 KhVIbIUN NUMUMK: 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 TYPE OF INSURANCE ADOL INSRD SUER WVO POLICY NUMBER POLICY EFF (MMIDONYYY) POLICY EXP (MMfDDfYYri) LIMITS COABJERCIAL GENERAL LIABILITY EACH OCCURRENCE S DAMAGE TO RENTED PREMISES Ea ocnarence S CLAIMS�,IADE �� MED EXP (Any one person) S PERSONAL A ADV INJURY $ GEM AGGREGATE LIMIT APPLES PER: GENERAL AGGREGATE S PRODUCTS-COMPADP AGG s POLICY F--] PROJECT F—ILOC OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea aaiOerR $ BOOBY ala1RY (Per ersm) $ ANY AUTO OWNED AUTOS ONLY AUTOS BOOILY I AJRY (PeractlOervi) S Per aca0era� DAMAGE S ISCHEDULED HIRED AUTOS NON -OWNED ONLY AUTOS ONLY S LIAR OCCUR EACH OCURRENCE S AGGREGATE S EXCESS LIAB CLAIMS -MADE IJUMBRELLA OED I RETENTIONS S A WORKERS COMPENSATION AND EMPLOYERS LIABILITY Y/N WC201700000 01/012017 01/012018 X PERSTAT11rE oR El. EACH ACCIDENT S1000000 ANY PROPRIETORIPARTNERIEXECUTNE F—] OFFICER EMBER EXCLUDED? N/A El DISEASE -EA EMPLOYEE S1000000 (MMdMMY in NM Ryes, describe ,ate DESCRIPTION OF OPERATIONS bebw r I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Effective 09/07/2015, coverage is for 100% of the employees of FrankCrum leased to A A A On Time Electric, Inc. (Client) for whom the client is reporting hours to FrankCrum. Coverage is not extended to statutory employees. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE Miami Shores Village EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE 9 POLICY PROVISIONS. 10050 NE 2 Avenue Miami Shores, Florida 33138 AUTHORIZED REPRESENTATIVE a 1988-2016 ACORD CORPORATION. All tights reserved. ACORD 25 f2016/031 The ACORD name and loco are reoistered marks of ACORD CERTIFICATE OF INSURANCE JISSUE DATE 06/329017 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 CONRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUDER, 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 Investments Corporation 2503 2503 SW 8 St Miami, FL 33135 INSURER(S) AFFORDING COVERAGE suce F INSURER A: Western World Insurance Company Y INSURER B: N/A INSURED AAA On Time Electric Inc 651 NW 100th Terrace Miami, FL 33150 INSURER C: N/A INSURER D: N/A INSURER E: N/A COVERAGES 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 TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE POLICY EXPIRATION DATE LIMITS A General Liability NPP1448683 9/26/2016 9/26/2017 General Aggregate $2,000,000 Products-Com/Op Agg. $1,000,000 Personal & Adv. Injury $1,000,000 Each Occurrence $1,000,000 Damage Prem Rented To You $100,000 Med Expense (Any one person) $5,000 B Personal Liability Combined Single Limit Medical Payments To Others C Excess Liability Each Occurrence Aggregate D E Property Building Contents Loss Of Use HIS 14—SU—RA-RCE IS ISSUED PURSUANT TO THE FLORIDA SURPLUS LINES LAW. PERSONS INSURED BY SURPLUS LINES CARRIERS DO NOT HAVE THE PROTECTION OF THE FLORIDA GUARANTY ACT TO THE EXTENT OF ANY RIGHT OF RECOVERY FOR THE OBLIGATION OF AN INSOLVENT UNLICENSED INSURER. SURPLUS LINES INSURERS' POLICY RATES AND FORMS ARE NOT APPROVED BY ANY FLORIDA REGULATORY AGENCY. Description of Operations / Specialty Items Electrical Work within buildings Certificate Holder Miami Shores Village 10050 N.E.2nd Avenue Miami Shores, Florida 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 Signature /� y • - -