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PL-19-32 (2)Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 IDuUTNI''R Issue Date: Location Address Parcel Number 10585 NE 6TH AVE, Miami Shores, FL 33138 1122310120030 .ontacts Permit NO.: PL-01-19-32 Permit Type: Plumbing - Residential Work Classification: Alteration Permit Status: Applied Expiration: 07/06/2019 Daniela Apelliccotti Owner SPECTRUM RENOVATIONS, LLC Contractor 10585 NE 6 AVE, MIAMI SHORES, FL 33138 EZZARD MATUTE 12985 TANGERINE BLVD, WEST PALM BEACH, FL 334122085 Business: 7864457072 Description: REPLACE EXISTING SEWER PIPE FROM SEPTIC Valuation: $ 500.00 Inspection Requests: TANK WITH NEW LONGER SEWER PIPE 305-762-4949 TotalSq Feet: 0.00 Fees Amount Application Fee - Other $50.00 CCF $0.60 DBPR Fee $2.00 DCA Fee $2.00 Education Surcharge $0.20 Permit Fee $50.00 Scanning Fee $9.00 Technology Fee $2.50 Total: $116.30 Payments Date Paid Amt Paid Total Fees $116.30 Credit Card 01/10/2019 $66.30 Credit Card 01/07/2019 $50.00 Amount Due: $0.00 Building Department Copy 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 zoo g EO'ermore, I authorize the above named contractor to do the work stated. Owner / Applicant / Contractor / Agent Date January 10, 2019 Page 2 of 2 0+ spectrum Renovations, LLC CGC1513036 CCC1327978 CFC1427616 CMC1249932 Date: January 8th, 2019 State of Florida County of Palm Beach Before me this day personally appeared Ezzard C Matute who, being duly sworn, deposes and says: That he or she will be the only person working on the project located at: 10585 NW 6th Ave. Contractor Signature Sworn to (or affirmed) and subscribed before me this iZ) day of .20 by-Z�?1 cam-- 1`111 Personally know OR Produced Identification Print, Type or Stamp Name of Notary .............. MAI RAPHAEL i�OS' ►.. : Notary PGblic —State of Florida DOS' Corrrrissior=GG17�CC5 ^' ' ` My Corrrr.. Expires Dec 26 2021 ••••6CnOec:hrodCn Nmna Notary Assn. 12985 Tangerine Blvd West Palm Beach, FL 33412 T:561-291-8350 F:561-370-7019 chris@spectrum-renovations.com www.spectrum-renovations.com BUILDING PERMIT APPLICATION Miami Shores Village RECEIVED Building Department BAN o 7 zoos 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 BY: Tel: (305) 795-2204 Fax: (305) 756-8972 -{ f INSPECTION LINE PHONE NUMBER: (305) 762-4949 l' ` FBC 20 i"t Master Permit NoTNA q — 3 Sub Permit No. ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP VU CONTRACTOR DRAWINGS JOB ADDRESS: 16�— City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: Load OWNER: Name (Fee Simple Titleholder): Construction Type: Flood Zone: BFE: FFE: CLL Address: l `JJ 1) \ City: State: (_ Zip: Tenant/Lessee Name: Phone#: 3->5-4ez5i Email CONTRACTOR: Company Name: !!Z &e Ct ✓U On tl K D V 4 v �(�Phone#: %T �i � / �� 76 �1 Address: GI i) /Q,H Q WA 1.— A Q L I11AZ 26-' V-aj I& Ig eg ► z w . rL— City: * ka / State: Zip: Qualifier Name: f �,Z a. Yd�-C Phone#: AIIA- State Certification or Registration #: C�G[ 7(s/Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: $ �QL� a Square/Linear Footage of Work: 30 Type of Work: ❑ Addition ❑ Alteration // ❑ New Repair/Replace ❑ Demolition Description of Work: 0 La r- o e X57' 10Gu'p, 4y6 1t, ✓�ieV dL 5`G; vt % i,.�i �h yl Pam✓ /ate G.nr S� �sil ill l �1Jc Specify color of color thru tile: Submittal Fee $ '�I QQ) Permit Fee $ CCF $ CO/CC $ Scanning Fee $ Technology Fee Structural Reviews $ Radon Fee $ Training/Education Fee $ DBPR $ Notary $ Double Fee $ Bond $ TOTAL FEE NOW DUE $ U9,30 (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 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. Signatu Signature Ng�� OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this i(D day of Dece i1DPyy1% 20 Nb by J (3-day of 1-')0(QM0W 20 by PV/ oy -ij U ) /LIXcl7!%'� who is personally known to I V�� tAN�T� , who i personally known o me or who has produced as me or who has produced as identification and who did take an oath. NOTUUBLIC:Sign:Print Seal: MAI RAPHAEL _. `" Notary Public -State of Florida Corrmissior M GG 171005 • f. Comm. Expires Dec 26.2021 ** *** * * #!' s *ss****sss APPROVED BY identification and who did take an oath. NOTARY PUBLIC: Print: I �� a r t-- Seal: ;^1;1 _� •. �- MAI RAPHAEL Notary Public - State of Florida Commissior It GG 171005 Atv Comm. Expires Dec 26.2021 `,.;, 8onaed hro�gh Na was Naary Asap 1/1/10 Plans Examiner Zoning (Revised02/24/2014) Structural Review Clerk RICK SCOTT,,GOVERNOR J - 4 :� r ,'f '• JONATHA;� ` - w +. ry `N,ZACHEM,�SECRET-ARY «• ♦L�[�y -__ _ _ a , . - . . 1 ; .. K F FIOCTCat , •ice I a\` ~r *-`- .pr .� } '.+. ' � r ` `>•� > t,1 ``� � .• , � Wit-. � � l� .l � '. •Yak •..i)) ' r 1 • r �4 • 1 � i � I, 1 ♦ •� ZS ,r♦! = t R'r�` i! •- °, ♦y •' �_ ♦ ti a« ' .�4, , �. •� v ♦ ef� -�, a jf"4 �� ''M S�;' �'�. t ' . -� +b.a I K-.' , 1 . t* ,,` , 1 . if y�'.'� f� r yF t _wI •`�`- L • T ;} ' _ STATEOF FLORIDA � . • `�� -. "' . �� r DEPARTM�EN�T.OF BUSING 5= OFESSIONAL REGULATION r- Y + `r. '• �. h .-1 \!� ,� � » .S'� a S y . ! a «• ♦ `' �.- 4 y� y, ~ a' �� a; a { � a f g t _ I •,CONSTRU-C t NO - G BOARD,,, •"f� r- - Y �. ♦ ti ^6Y t . 41 \ �+._.�� 4*•,•�w• ir. `a1 {3 _ f y � � ,•� Fr t, 'THE PLUMBI'.=1S'CER F UNDER THE, `' ';•`,_ ' r ; , r a }' •" Q. R t PROVIS�RUTES , ^^ I'ar � •y �, � tip, *4r � �tia� - �' '~� +�,ti� 1♦� f ' �. ° � ,. ► p r • * �'.�� «� ♦� Y'r +' - r r _ iill.: S• '". ".++� •i ,.,t * J .I . -1 t, . i } •�,� •'! �.. a4�qx _ �Y• i • ti 1 � , I � .C7C+N : j�, �+��- a, �. � ,.� ,t � f% '�' � i / -Y'' • � ' rw r * li :, -P BImo— F 34�2 � .� —. � « •;;� PI tA ti sy :, '` ;' EXPhR20' ,' ` ' - ,�Y�, + .+ , , , �''• ,♦ ��'- ` • ' �"� Always ve?if' licenses``onli eat MyFloridaL• icense tom ', `r, •' `� .F' -;,�" _� ` - ,', •• ` i T t ' ,� ` y.� t ,ri' � e` ' .a , � - ) 4 y,4'�.r ♦ R � �� r. v fil. } � �� 4 s . �'l . t +,r} / -+ 11'�.' �,. � r ,:� • \ G- . '. # J- • f �f ' t h� � t •_ _ i ' • t' •� ♦ r VS Do,not Ater' his,document-in-any ,form. . This is yourllicense. it,is`unlawful for,anyone�other than the -licensee to:use,.this document. +`� f� <g"a7En'Yg_r'4: S�..L ♦ Ir .f t -• •- i f4 `.•� �" � ♦ � •. i._.r .-1r+� ,. .�_; .. .�. �_ ,..F. �, .,L '� •t ANNE M. . _CANNON i CONSTITUTIONAL TAX COLLECTOR Serving Palm Beach County Serving you. P.O. Box 3353, West Palm Beach, FL 33402-3353 "LOCATED AT" www.pbctax.com Tel: (561) 355-2264 12985 TANGERINE BLVD WEST PALM BEACH, FL 33412 TYPE OF BUSINESS OWNER CERTIFICATION # RECEIPT #/DATE PAID AMT PAID BILL # 23.0069 PLUMBING CONTRACTOR MATUTE EZZARD CHRISTOPHER CFC1427616 B18.503436 •08l04f18 $27.50 B40162964 This document is valid only when receipted by the Tax Collector's Office. STATE OF FLORIDA PALM BEACH COUNTY B3 - 1117 2018/2019 LOCAL BUSINESS TAX RECEIPT SPECTRUM RENOVATIONS LLC LBTR Number: 201476031 SPECTRUM RENOVATIONS LLC EXPIRES: SEPTEMBER 30, 2019 12985 TANGERINE BLVD WEST PALM BEACH, FL 33412 This receipt grants the privilege of engaging in or managing any business profession or occupation within its jurisdiction and MUST be conspicuously displayed at the place of business and in such a manner as to be open to the view of the public. ACORO® CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YYYY) 1/2/2019 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 have ADDITIONAL INSURED provisions or 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 1 st Street Agency 1300 Sawgrass Corporate Parkway Suite 300 Sunrise FL 33323 NAME: Melissa Matute A/c No, Ext : 954-331-4791 (AIC, No): ADDRESS: dots@lststreetagency.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : Catlin Insurance Company INSURED Spectrum Renovations, LLC 12985 Tangerine Blvd West Palm Beach FL 33412 INSURER B : INSURER C : INSURER D : INSURER E 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. LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MWDD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE ❑ OCCUR Y Y 0900106176A 12/30/2018 12/30/2019 EACH OCCURRENCE $ 1000000 PREMISES (Ea occurrence) $ 100000 MED EXP (Any one person) $ 5000 PERSONAL 8 ADV INJURY $ 1000000 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY JE � 7 LOC OTHER: GENERAL AGGREGATE $ 2000000 PRODUCTS - COMP/OP AGG $ 2000000 BIOP $ 500 AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ FIRUFLN$ (Per accident) UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED I I RETENTION $ $ ORKERS COMPENSATION kND EMPLOYERS' LIABILITY YIN NY PROPRIETORMARTNER/EXECUTIVE ❑ FFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under ESCRIPTION OF OPERATIONS below N / A LK OTH- STATUTE I ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) EZZARD C MATUTE CGC1513036 CCC1327978 CFC1427616 CMC1249932 MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE 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 @ 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD VWME. JIMMY PATRONIS CHIEF FINANICAL 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: 10/19/2018 PERSON: EZZARD C MATUTE FEIN: 371803732 BUSINESS NAME AND ADDRESS: SPECTRUM RENOVATIONS, LLC 12985 TANGERINE BLVD WEST PALM BEACH, FL 33412 SCOPE OF BUSINESS OR TRADE: EXPIRATION DATE: 10/18/2020 EMAIL: CHRIS@SPECTRUM-RENOVATIONS.COM Licensed General Contractor Licensed Plumbing Contractor Licensed Roofing Contractor Heating, Ventilation, Air - Conditioning and Refrigeration Systems Installation, Service and Repair, Shop, Yard & 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 election 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 BE EXEMPT REVISED 08-13 QUESTIONS? (850)413-1609 10' Spectrum Renovations, LLC CGC1513036 CCC1327978 CFC1427616 CMC1249932 PERMITAUTHORIZATION 1/3/2019 To Whom It May Concern, The purpose of this Letter is to authorize Kel Payne to register, pick up permits and drop-off permit applications on behalf of Spectrum Renovations, LLC for the job located at 10585 NW Ave in Miami Shores Village. BY Signature of Qualifier STATE OF FLORIDA COUNTY OF PALM BEACH The foregoing instrument was acknowledged before me this 3rd day of January, 2019, by Ezzard C Matute. (Seal) SHARISKA MONRQY ' MY COMMISSION M GG006827 , a EXPIRES June 211, 2020 (407) 398-0153 Nor4o4owyServimew sLt�� Sig` of Notary Pu — Print, Type/ Stamp Name of Notary 0 12985 Tangerine Blvd West Palm Beach, FL 33412 T:561-291-83SO F:561-370-7019 chris@spectrum-renovations.com www.spectrum-renovations.com Notice to Owner - Workers' Corn Miami shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 tion 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. 1. 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 CONTE Signature. ZVX_,'� Owner State of Florida County of Miami -Dade The foregoing was acknowledge before mmee this l>� day of n Q 120 �q so ,By `oaw e t l a A //! C - r7711 who is personally known to me or has produced as identification. ,;;; MAI RAPHAEL Notary:. „� `•: (rotary Public — State of Florida ` '� Corrrrissior s GG 171005 SEAL: kly Comm Expires Dec 26. 2021 Bonded :hroagh Nmna Nowy Assn.