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EL-17-725Miami Shores Village 10050 N.E. 2nd Avenue NW Miami Shores, FL 33138-0000 Phone: (305)795-2204 Project Address Permit NO. EL-3-17-725 Permit 7 Electrical - Residential r l� it Type: Work Classification: Addition/Alteration Permit Status: APPROVED Parcel Number issue Date: 4124/2017 1 Expiration: 10/21/2017 Applicant 43 NW 110 Street 1121360030610 Miami Shores, FL 33168-4318 Block: Lot: INTER MALL INC Owner Information INTER MALL INC Address 8260 SW 2 Street MIAMI FL 33144- 8260 SW 2 Street MIAMI FL 33144- Contractor(s) Phone Cell Phone CPS ELECTRIC, INC. 305-607-8221 of Work: NEW 150 A SERVICE. REWIRE (PARTIAL onal Info: NEW 150 A SERVICE. REWIRE (PARTIAL ,ification: Residential Scanning: 1 Fees Due Amount CCF $5.40 DBPR Fee $4.73 DCA Fee $4.73 Education Surcharge $1.80 Notary Fee $5.00 Permit Fee - Additions/Alterations $315.00 Scanning Fee $3.00 Technology Fee $7.20 Total: $346.86 Phone Cell (786)231-7789 Valuation: $ 9,000.00 Total Sq Feet: p IAvailahlP InsnPrtinns: Pay Date Pay Type Amt Paid Amt Due Invoice # EL-3-17-63348 04/24/2017 Credit Card $ 346.86 $ 0.00 Inspection Type: Final Meter Box Alteration 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 per it I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELEC ICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS FFID T: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction ng. Futhermore, I authorize the above -named contractor to do the work stated. April 24. 2017 A Tat er / Applicant / Contractor / Agent Build' g D rtment Copy 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: (30S) 762-4949 BUILDING PERMIT APPLICATION ❑BUILDING ELECTRIC ❑ ROOFING ❑PLUMBING ❑ MECHANICAL ❑PUBLICWORKS ' 7EDTED MAR 16 2017 BY: FBC 2014r Master Permit No. &C -- 5 = /6 — /11,0 Sub Permit No T-.L I— f ZS ❑ REVISION ❑ EXTENSION [:]RENEWAL ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 43 mw Iko 61 City: Miami Shores County: Miami Dade Zip: 33/,6 3 Folio/Parcel#: / ) - 2 / 36 014 / 6 Is the Building Historically Designated: Yes NO Occupancy Type: Z_r2— Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): _-x-n4eI(- Mf1 t� �L• Phone#: 3 so6 2 3 i q q g 1 Address: 8 -7- G.+ O 15u) � I 5 City: ti_&\ Gi► ^L t, State: �L Zip: 33 /y 14 Tenant/Lessee Name: Email: e#: CONTRACTOR: Company Name: l_.. P S ��e_C_fy- ►1 L Phone#: W5 4 6 L 6 Address: I %OC7 QW Z- AV E City: M i Q� � State: F L Zip: Qualifier Name: AM Cz, LL ef) t-KC Q. C> Phone#: 305 State Certification or Registration #: G C 13005-40 ( Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: p City: State Value of Work for this Permit: $ f� op. Square/Linear Footage of Work: Type of Work: ❑ Addition El Alteration El New ElRepair/Re Description of Work: ,�/@ �' iGt% l �� Lea V I ' . //� _ W / Specify color of color thru tile: Submittal Fee $ Permit Fee $ CCF $ Scanning Fee $ Technology Fee $ Radon Fee $ Training/Education Fee $ DBPR $ Zip: ❑ Demolition �i a•e 1. �4 CO/CC $ Notary $ 5 • CIZ� Double Fee $ Structural Reviews $ (Revised02/24/2014) Bond $ TOTAL FEE NOW DUE $ 34 6 - aro 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 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 $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is s bject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspec on which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will n t approved and a reinspection fee will be charged. Signatur Signature _15�/'� CONTRACTOR The foregoing inst ment was acknowledged before me this day of I -W-1b 20 i "T' by -� ,ISSZ .-Zt0- S 8 -gOo, who is personally known to me or who has produ� 1jCs �S2 identification and who did take an oath. NOTARY PUBLIC: Sig ,,"Y fr *_ MY COMMISSION # GG 044602 Print: Seal: Bonded Thru Notary Publlc Undsrwrlters The foregoing instrument was acknowledged before me this day of — 20/ � by � •-' �jf7 .� � �� , Oho is personally known to .J me or who has produced ��C, as identification and who did take an oath. NOTARY PUBLIC: Sign: �—, MY COMMIStION M FFpB1g23 Print: . _ cvn.e,.... . Seal: APPROVED A/A-A ii Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) ' '� � 4 3�Ihf+tiUUYYYY} CERTIFICATE OF LIABILITY INSURANCE DATE 4/20J20(17 THIS CERTIFICATE IS MSUIED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE, HOLDER, THIS CERTIFICATE DOE$ NOT AFFIRMATIVELY OR NEGATNELY AMEN@,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT COWTTTUTE A CONTRACT BETWEEN THE ISSUIM� INSURERS), AUTHORaD REPRESENTATIVE OR PRODUCER,.AND THE CERTIFICATE HOLDER, WORTANT. if the OWACats holder Is an ADDITIONAL INSUREO, the pOHOY{lesl rrrust be endorsed. It SUBROGA17ON 13 WAIVED, subject to terms and condbions of Um polky,cefuln poNcies msy rmgWre an endomernent A statement on this certificate does riot confer rights to the CertifiCaft holder In lieu of such .endm ms s , PRODUCER KMEZ INSURANCE%FIN SVCS MW _ 508 E 49th St (305) 769-4936 r�, C305} 769-1844 Hialeah, FL 33013 ADoREs&mehdezlil C+hotmail , com WOUREM&I COVER:k6E. y INSURER A . SCOTTSDALE INSURANCE COMPAN'S". INSURED C . P . S . . ELECTRIC , INC . INSURER B : 1600 Nw 28 AVE INSURER C MIAMI, FL 33125 INSURER LIC#EC130OS401 INSURER E ANGEL ROMU' R0 J;NSURER f CC3Vr-RAr,i=..v i1ro"rrcirlAre ire cane rs _ _.. _ _ _ _ __. mr-W lum Mumtrtm THIS IS TO CERTIFY THAT THE POLICIES t0F INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOT WTMSTANDtNG 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 TEAMS, EXCLUSIONSAND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTT* TYPE OF KSURANC6 POLICY NtihIBER MMW LIMITS A '� CRC1M;' b�RAL uilasrrY R C`us `c"'rc 500 DED' CPS2608148 04/02/17 04/02/18 EACH OCCURRENCE _ s1,000,000 U70V=PREMISESEn s 00,000 X ' b1ET3IxP'IA?tytxtew�9rlr;: _ s 5 000 PERSONAL&ADVINJURY T 1,000 000 GENL AGGREGATE LIMIT APPLIES PM PQILICY R4 Q LOC GENERAL AOGREOA'rE _S 2,000,000 :.PRO TS • CVMpmp AGO s 2 , 000, 000 OTHER:. CLIOCTAICA,L WORK ONLY S AUTOMOBN E LIABILITY ANYAUTO ALL ONMEO SCHEDULED .AUTO?$ AUTOS NON OWNE© HMO AUTOS. AUTOS e amdem f BODILY IN JILORY IPer po'"n) $ BODILY INJURY (Per iseddent) S Par ac>cideni S UMBRELLA LIAR EXCESS LN18 OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE DEO RETENTIONS WORKERS OOMPE14SATION AND EMPLOYERS' LIA91LrTY CFIN FIC A �A LOEM Y� Iu+irWwztytaNMI tyy� DE&CR1 OF OPERATIONS Wow � STATUTE ER , E NIA A�ITC104957$ S/il2/16` 06/02/17 _ EL, EACH ACCIDENT s 000- 000 E'.L.DISEASE .•EAEMPT,OYE t 1.4000 000 E,L.DISEASE -POLICY LIMIT S 1,000,000 CtESI RIPTION OF OPERATIONS! LOCATIONS t VEHICLES tACORD 101, IW nsi Remok - ELECTRICAL �f Ue 8ltedi6d f enara zpmos iz retryuiggi ELECTRICAL 'WORK Orns LIC#EC13005401 MIAMI SHORES VILLAGE GALL SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 10050 NE '2ft AVE THE EXPIRATION DA E THEREOF, NOTICE WILL 8E DELIVERED IN MIAMI 3>gORE$ , FL 33138 ACCORDANCE WITH Tiff POLICY PROVISIONS. , 305-756-8972 AUTHORIZED REPRES jA 01 ORATION. All rights mserved, ACORD25(2014101) The ACORD name and logo are registered marks o A ORD