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EL-17-1230Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138-0000 Phone: (305)795-2204 Project Address Parcel Number Permit No. EL-5-17-1230 Permit Type: Electrical - Residential Work Classification: Addition/Alteration Permit Status: APPROVED Issue Bete: 11/27/2017 1 Expiration: 05/26/2018 Applicant 10125 BISCAYNE Boulevard 1132050190190 Miami Shores, FL 33138-2647 Block: Lot: MDHI FOUR LLC Owner Information Address Phone Cell MDHI FOUR LLC 1680 MICHIGAN Avenue (786)703-7132 MIAMI FL 33139- 1680 MICHIGAN Avenue MIAMI FL 33139- Contractor(s) Phone Cell Phone SOUTH FLORIDA ELECTRICAL ENGD (786)523-8879 (Type of Work: UPGRADE ELECTRICAL SERIVCES TO 200 Additional Info: Classification: Residential Scanning: 3 Fees Due Amount CCF $10.80 DBPR Fee $9.45 DCA Fee $9.45 Education Surcharge $3.60 Permit Fee -Add itions/Alterations $630.00 Scanning Fee $9.00 Technology Fee $14.40 Total: $686.70 Valuation: $ 18,000.00 Total Sq Feet: 0 Pay Date Pay Type Amt Paid Amt Due Invoice # EL-5-17-63908 11/27/2017 Credit Card $ 636.70 $ 50.00 05/04/2017 Check #: 154 $ 50.00 $ 0.00 Avanaoie inspections: Inspection Type: Final Meter Box Relocation Fire Alarm Service Change Review Electrical W. W. Underground 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, PLUI)48r 4G, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS AFFIDAVITAcefify th t all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zonin ther re, I authorize the above -named contractor to do the work stated. November 27. 2017 Authoriziaepartment nature: Owner / Applicant / Contractor / Agent Building✓ Copy November 27, 2017 1 Miami Shores Village RECEIVED Building Department MAY 04N 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 O(L- Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 SA-- FBC 20\'-A BUILDING Master Permit No.vz_-, ttc '4ISy PERMIT APPLICATION Sub Permit No 'F--U'-I— � Z!;C--') ❑BUILDING Q ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL [:]PUBLICWORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS 10125 BISCAYNE BLVD JOB ADDRESS: City: Miami Shores County: Miami Dade Zip: 33138 11-3205-019-0190 Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): BISCAYNE 10125 LLC Phone#: 786 390 3177 Address: 1680 MICHIGAN AVE SUITE 910 City: MIAMI BEACH State: FL Zip: 33139 Tenant/Lessee Name: Phone#: Email: SOUTH FLORIDA ELECTRICAL ENGINEERING 786 523 8879 CONTRACTOR: Company Name: Phone#: Address: 979 NE 36 AVE MIAMI FL 330,13 City: State: RODRIGUEZ JORGE A Qualifier Name: Phone#: State Certification or Registration #: 14E000085 Certificate of Competency #: _ DESIGNER: Architect/Engineer: Phone#: Address: p: City: State: Zip: ,§t Value of Work for this Permit: $ / 00!G-0 Square/Linear Footage of Work: Type of Work: ❑ Addition %C Description of Work: - ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition ij (Y� qAar% l/ /vim r % Se,'-'dj ce c -1d 206' .gym Specify color of color thru tile: Submittal Fee $ So PP"D Permit Fee $ ' J i ©b CCF $ ` CO/CC $ --� Scanning Fee $ 6 rr '' Radon Fee $ 9 . Q S DBPR $ �(I, QS �, Notary $ Technology Fee $ Jul 4A0 Training/Education Fee $ �`� 1�1oV Double Fee $ Structural Reviews $ 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 4 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 OW R or NT The foregoing instrument was acknowledged before me this day of 1a! �R',l 20 11- by �I Doo a 1 c) ?w-n e c iz4+r . who is personally known to me or who has produced identification and who did take an oath. NOTARY PUBLIC: Sign:_ Print: as COMMISSION dFF922657 Seal: — c EXPIRES: September30.2019 www.AARoNNOTARY.COM Signature CONTRACTOR The foregoing instrument was acknowledged before me this Z� day of APt2i L 20 14 by 2�4)eZ, who is personally known to me or who has produced / as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: Li v ter Lk Lopez Pimelldl Seal: COMMISSION OFF922651 EXPIRES: Septembu 30, 201➢ wwwMONNOTARV AM APPROVED BY ��, /�' Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) Miami shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Notice to Uwner — worKers' Compensation Insurance Exemption 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 1.0 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. / 9 Signatui State of County of Miami -Dade The foregoing was acknowledge before me this Z 4 day of k r?-, (- , 20 (� . By CLA DX') ��CtfC©�� who is personally known to me or has produced as identification. Notary: ;26W_Wa4,� -��� Lisbeth Lope Pimentei Q SEAL: — COMMISSION iFF922657 � EXPIRES: September 30, 2019 WWW.AARONNOTARY.COM SOUTH FLORIDA ELECTRICAL ENGINEERING INC. 979 NE 36TH AVE MIAMI DATE: 04/21 /17 STATE OF FLORIDA COUNTY OF MIAMI DADE Before me this day personally appeared JORGE RODRIGUEZ who, being duly sworn, deposes and says: That he will be the only person working on the project located at 10125 Biscayne Boulevard - Miami FL. Sworn to and subscribed before me is 2-I day of 201 1 , by BUR V Personally known or produced identification Type of identification produced Lddh Lopez Rmenie, COMMISSION IFF92207 EXPIRES: September 30, 2011 WWW.AARONNOTARY.CO,* 7 /112 Print, Type or Stamp Name of Notary JEFF ATWATER 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: 3/5/2016 EXPIRATION DATE: 3/55=18 PERSON: RODRIGUEZ JORGE A FEIN: 464646197 BUSINESS NAME AND ADDRESS: SOUTH FLORIDA ELECTRICAL ENGINEERING INC 979 NE 36 AVE MIAMI FL 33033 SCOPES OF BUSINESS OR TRADE: ELECTRICAL WIRING ELECTRIC LIGHT OR WITHIN BUIL POWER LINE C Pursuant to Chapter 440 06(14), F S., w of xxv of a aorporekon who ektcts exernpban bom Oft ttstolw M ON a c arlik aloe of Me~ under Ids saalwn n" not meet or oompwumban undow Iris chapter Rxsurd to Ctmpter 440 05It2). F.a . c4nocarm d 41,4061ft b be esurasrri... OP* a+N wtuwf to wAve of me wwnese or trade WW on •se nonce of elaclion Io be an"wL Purewrn to Om ler 4400503). F.8., Ndiaea of elacbm to be exempt and of ekdm to be exw,# AM be sdbpd b revnaeWn d. M my Wne alter"ft" of Ow nobm or Ose d the owwkwe the person nernM on"nobw or oex wile no longer meas the requirernwft of Ohre sadion fm wamrtcn of a cvvWk ste The departn ent dwil revoke a OFS-F24)WC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED W13 OLIESTIONS? (850)4/3.1609 .;e CTQB Construction Trades Qualifying Board BUSINESS CERTIFICATE OF COMPETENCY 14EO00085 SOUTH FLORIDA ELECTRICAL ENGINEERING INC D.B.A.: RO RIGUEZ JORGE A. Is certified under the provisions of Chapter 10 of Miami -Dade County alhw � CERTIFICATE OF LIABILITY INSURANCE DATEIM20117YYY) 04j20117 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE 'D.OES'NOT.AFFIRMATIVELY ORNEGATIVELY.A"MEND,EXTEND OR;ALTER THE'COVERAGE.AFFORDEDBY THE'POL1CIES BELOW. 'THIS,CERTIFICATE OF INSURANCE DOESNOT CONSTITUTE A CONTRACT BETWEEN THE .ISSUING INSURER(nAUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is'an ADDITIONAL INSU ED,,the policy(ies) must be,endorsed. If SUBROGATION IS WAIVED, subject.to the be... and'conditions of the policy, certain policies mayrequire an endorsement. A statement on this certificate,does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Florida -Bankers Insurance CONTACT ARTJ4ALONSO -NAME: PHONE (305)266=64�33 a Na : (305)262 0679 'MAIL mana@floddabankersinsurance.com 6874 SW 8 ST INSURERS AFFORDING COVERAGE NAIC # Miami, FL 33144 INSURER A: FEDERATED NATIONAL INSURANCE COMPANY Phone (305) 266-6493 Fax (305) 262-0679 INSURED INSURER B : INSURER C : SOUTH FLORIDA ELECTRICAL ENGINEERING INC INSURER D : 979 NE 36 Ave INSURERE' HOMESTEAD; FL 33033- INSURER'F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 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 ADDL INA& UBR WVD POLICY NUMBER POLICY EFF MM/DD POLICY EXP MM/DD LIMITS A GENERAL LIABILITY ✓❑ COMUERCIAL GENERAL LIABILITY ❑ ❑-CLAIMS-MADE J�]OCCUR ❑ N N GL-()504011758-03 02t2012017 02/20I201'8 EACH OCCURRENCE $ 300,000.00 DAMAGE TO RENTED PB bIIS£S Ea $ 100,000.00 bAEDEXP.(Anyanepersron) :$ :5,000:00 PERSONAL & ADV INJURY $ 300,000.00 ❑ GENERAL AGGREGATE $ 300,000.00 GEN'L AGGREGATE LIMIT APPLIES PER: ❑ POLICY ❑ PRO ❑ JECT LOC PRODUCTS - COMP/OP AGG $ 300,000.00 $ AUTOMOBILE LIABILITY ❑ ANY AUTO ❑ALL OWNED SCHEDULED AUTOS ❑ AUTOS NON -OWNED, ❑ HIREDAUTOS ❑ AUTOS � � COMBINED SINGLE LIMIT Ea accident BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE dracaident $" a ❑ UMBRELLA LIAB ❑ OCCUR ❑ EXCESS LIAB ❑ CLAIMS -MADE EACH OCCURRENCE_ $ AGGREGATE $ ❑ DED ❑ RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? ❑ (Mandatory In NH) #.yyes�..descdbe under [7ESCRIPTION OF OPERATIONS beb N N / A ❑ T WC STATU- OTH- RY LIMRS ❑ ER -E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ E.L. DISEASE - POLICY LIMIT '$ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) ELECTRICAL CONTRACTORS LIC: 14E000085 CFRTIFICOTF HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES' BE CANCELLED BEFORE MIAMI SHORES VILLAGE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE 1NfTN THE, POLICY,P.ROVdSI M BUILDING DEPARTMENT 10050 NE 2nd AVE AUTHORIZED REPRESENTATIVE c MIAMI SHORES, FL 33138 v 01988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) QF The ACORD name and logo are registered marks of ACORD offm-lm OUGINGGS► i1 CILOQCA'nO ACCOPIT Vo. SOUTH FLORIDA ELE#:INQ'-MERING WC RENEWAL 979 rr 36 AVE 744GS311, F.XLPIRES SEPTEMBER *,i EX3 di-,r`j t tl 1 Cyr towlim=:$ Pur --n to Cou=y cotic Ch.iptcr SA - Am 9 & 10 5u fA: t"j t4 i Rl(,Nt LMT G INC, 100 EIECMCAL CONtRACIOR PAYMENT RECEtYED CJO xis A r2OORICUL4 PRESt1 Nt 4Et�.= tx�r V►�ncic � 3 $45= 07/ 1 f 201 CHECK21-1CY-09714 &mi"m Tax Pa _;# oriit wulimts pl t ' - A" ti floc tipi is a. t ttvsuo �t ► t:piii c ati of Ca Dalbt s iifi�s, # ir=u i Simi ccrlip a,� C;py uovg mlr,; l 0sit =e"wS re t: rr ire # to t : n=A ttl,o t_'z#;t.t#'t Nth s a + 41 c+ ciw - liac�-4- aA Sir its -a