EL-19-1368BUILDING
PERMIT APPLICATION
❑BUILDING 0 ELECTRIC
Miami Shores Village RECEIVED
Building Department JUN 13
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
FBC 201
Master Permit No. 'Rc'6 1 —
Sub Permit No. 'EL -/dp- �e
❑ ROOFING ❑ REVISION ❑ EXTENSION [—]RENEWAL
❑PLUMBING ❑ MECHANICAL E] PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION [:] SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 750 NE 97 St
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: Is the Building Historically Designated: Yes NO
Occupancy Type: _ Load: __- Construction Type:_Flood Zone
OWNER: Name (Fee Simple Titleholder): Inyestinghouse LLC
Address: 1835 NW 112th Ave Suite 174
BFE: FIFE:
hone#: 786-521-2276
City: Miami _ i -.-state: FL Zip: 33172
Tenant/Lessee Name: _
Finail: investinghouse20149gmail.com
one#:
CONTRACTOR: Company Name: �'VS tt�wA s — t F—CV_Z7C L LC Phone#: TOG 3)J71 61i
Address:_�l_� W I?�°C-------------_._.—.
City: f1LA�DCAA/►TLState: �L Zip:
Qualifier Name: Aa2 A_Ap-oo �V4� Phone#: +_2C' !3 it:;- Ol
State Certification or Registration #: EC -1200 '.COQ U l -q_ Certificate of Competency #
DESIGNER: Architect/Engineer: Phone#:
Address: City: _ State: Zip:
Value of Work for this Permit: $_ Igo. Square/Linear Footage of Work: ! _
Type of Work: ❑ Addition ❑ Alteration ❑ New EO/Repair/Replace ❑ Demolition
Description of Work: _0O,Vo
C�N.A�C_ PJG
Specify color of color thru tile:
Submittal Fee $ Permit Fee $
Scanning Fee $
Technology Fee
Structural Reviews S
(Revised02/2.4/2014)
Radon Fee $
Training/Education Fee $
CCF $.
DBPR $
CO/CC $
_.__ Notary $
Double Fee $
Bond $ (( —
TOTAL FEE NOW DUE $
r
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. /1 _
Signature_15
OWNER o AGEN
The foregoing instrument was acknowledged before me this
--f 101 day of _ Iy%Le .— , 20 __L t_ by
N*(wIna rregibo� who is personally known to
me or who has produced bL,16 4 ) ) 6 3 --1 Z,3-0 as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print: Tu" LOP 0 -
Signature,___
CINTRACTOR
The foregoing inst
1� day of
me or who has produced
,was
/acknowledged before me this
y 20 _ by
r&Z _ who is personally known to
as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:—
Print: lS /,�- Al
Seal:
Notary Pun Z
DNC State of Florida Seal: * � * MY COMMISSION / GG 011161
My Commission GG2120
BoMed 3726667 Foe F\oilru Budgel NotaEXPIRES: Novenil* ry Smites
a F Exoires 04/22/2023
ti
APPROVED BY b �4 / I _ Plans Examiner _ Zoning
(Revised02/24/2014)
Structural Review
Clerk
L—L WO-1?6B
Miami shores Village
Building Department
10060 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel (305) 795,2204
Fax: (305) 755.72
Notice to-OW'n'er Workers' Compehs.ation Insurance Exemption
Florida Law requires \Vorkcrs' Compensation insurance coverage under Chapter 440 of the Florida Statutes. Fla, Stat. 9 440.05
allows corporate officers in the construction ifidustry to exempt themselves from this requirement for any ,conwuetiom project imer to
zbtaining'abuiIdi,ng-pcmTit, Tursti'a-W-lo
An employer in the constructibn industry who ein_ploys one or more parl-time or fidl-flnie
employces, irchiding the owner, mustobtair, workas'cornpensation coverage. C'brporateofficcrs
or mernbers of a limited liability company (LLC) in the wnst=tiori industry may elect to be
exernpi if:
l-, The officer owns at least 10 percent (if the sleek of the corporation, or in the case of
art LLC, a statement attestin- to the mininumi 10 percent Ownership.
1 The officor is listed is an officer of the corporation in the, records of the Florida
Department of State, Division of Corporations; and
31 The corporation is registered and listed as active with the Florida Department of
State, Division of Corporal ions.
No more than three corporate officers pe'r corporation or limited liability company members are
allowed !o he, exempt. Coriqrucnon exempiions are valid for a period of two years or amil a
voluntary revocation is 6W or the exemption is revo I ked by the Division.
Your cotitractor is requesting a permit under chis wotkers' conitwnsadon exemption Arid liar acknowledge that Ise or she will not use
day labor. part-time employees or subcontractors for yoar project, The contractor has provided an affidavit stating that he or slit will
be the only person alloNved to work on your projcc,(, In these Shores Viliage dots not requite verification of
workers' comcensation insurance coveraiLte frOn the colliractor`s comany, for day Libor, part-time employees or subcontract ars.
p
BY SIGNiNG BELOW YM' A('kNO%V1J`.I)(,:F, THAT {"Olj HAV�,-, Ri;AD THIS NOTICE AND UNDERSTAND ITS
CONTENTS.
te
OW
State of Florida
County of klami-Dadc
The f0Tqoing was,acknowledge before tile this dZiY Of
By r\C\ who is personilly, known to me or has produced
.ISL, — C) L_ 4� V _
N _11ry Public State of Florida
Notxry: 111� ACNORES ARROUGA
My Commission GG 160879
Expires 11i1s/2021
SEAL: —1 '0. - - - - � . A&,Ohh /
Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Issue
Location Address Parcel Number
750 NE 97TH ST, Miami Shores, FL 33138 1132060142220
Contacts
Permit NO.: EL -06-19-1368
Pern*,,Type: Electrical - Residential
Work Ciassifrcation: Pool
PermitStotus Approved
Expiration: 12/10/2019
Description: POOL GROUNDING BOUNDING Valuation: $ 700.00 Inspection Requests:
305-762-494s
Total Sq Feet: 2,468.00
Fees
INVESTINGHOUSE LLC Owner
WIREWAYS ELECTRIC LLC Contractor
$50.00
DARWIN TORREMIC
ARMANDO ALVAREZ
DBPR Fee
2061 NW 112 AVE 131, MIAMI, FL 33172
DCA Fee
$2.00
Education Surcharge
Business: 7863150158
Permit Fee
Description: POOL GROUNDING BOUNDING Valuation: $ 700.00 Inspection Requests:
305-762-494s
Total Sq Feet: 2,468.00
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
06/19/2019 $116.30
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
regulatingonstru;rtion and abning. Futhermore, I authorize the above named contractor to do the work stated.
Authorized SignatW6: Owner / Applicant / Contractor / Agent Date
June 19, 2019 Page 2 of 2
RICK SCOTT, GOVERNOR JONATHAN ZACHEM, SECRETARY
FI dda
dopr
,
r
STATE OF FLORIDA
DEPARTMENT OF BUSINESS -.AND --PROFESSIONAL REGULATION
ELECTRICA,Ly,CUNTRA ;� �aRScLICE SING BOARD
THE ELECTRI L,CQ�VTRACTO,R REtN`I'CERTlD UNDER THE
PROVISION �IDA'SAS
UTES R-
AOFCiHA
Z; ) �-PuAdditnal RusriessiQAifieafion
7 7 �]
i 'R N, AN
G '119 , YS E!-ECTRIC, LLC -r
I` �46893N1N89,CT .-
I
L'AICSF�L3�3Q18►
LICE 5E'NIH�MBER EC3007b79
EXPIRATIONTd' T QdUST 31, 2020
Always verify licenses online at MyFloridaLicense.com
1
k Do not alter this document in any form.
This is your license. It is unlawful for anyone other than the licensee to use this document.
049918
Local Business Tax Receipt
Miami -Dade County, State of Florida
-THIS IS NOT A BILL - DO NOT PAY
7213735
WIREWAYS ELECTRIC LLC
8517 SW 166TH PL
MIAMI FL 33193
RECEIPT NO. EXPIRES
RENEWAL SEPTEMBER 30, 2019
7497546 Must be displayed at place of business
Pursuant to County Code
Chapter 8A - Art. 9 & 10
OWNER SEC. TYPE Of BUSINESS
YTAXCOLLECTOR
ELECTRIC LLC 198 ELECTRICAL CONTRACTOR BPAYMENT RECEIVED
C/0 CARl05 CAMACHO MGR EC13007879 Tax
$75.00 09/26/2018
Worker(s) I CREDITCARD-18-073828
This Local Business Tax Receipt only confirms payment of the Local Business Tax. The Receipt is not a license,
permit, or a certification of the holder"squalifications. to do business. Holder must comply with any governmental
or nongovernmental regulatory laws and requirements which apply to the business.
The RECEIPT N0. above must be displayed on all commercial vehicles - Miami -Dade Code Sec 8a-276.
For more information, visit wvw miamidade.govttaxcollector
Qn
4•
1S.l F�
JIMMY PATROMS O
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 bek)w has elected to be exempt from Florida Workers' Compensation law_
EFFECTIVE DATE: 1/4/2018
PERSON: ALVAREZ
FEIN: 812857014
BUSINESS NAME AND ADDRESS:
WIREWAYS ELECTRIC, LLC
8517 SW 166 PL
MIAMI FL 33193
SCOPE OF BUSINESS OR TRADE:
I icivsed HecWiciil ConlrAclor
EXPIRATION DATE: 1/4/2020
ARMANDO
IMPORT ANT. PursuaA to GtWter 440.05(14), F.S., an officer of a corporation who elects exemption from this chapter by ltfanq a certificate of election under
this section may no; recew bemhts or compenmbon under this ctwpter. Pursuant to Chapter 440.05(12), F.S , Certificates rA flection to be nxe:mpt apply
only within the scope rtf the business or trade ogled on the, nc6or of Mcbon to be exempt, Pu(Suant to Chapter 440.05(13), F.S., Notices of HlWion to bu
exempt and certificates of election to be exempt stall be Subject to revocation 4, at any time atter the tiling of Vv notice or the msuanco of the Certificate, ttv
person r)amexl on lho notice or certificate no longw merits the requiremetnts of this section for issuance of a certificate TM department shall revoke a
certnccate at any nine for fasure of the, pw ,on named on the cerrticate to meet thic require-menis of tFts swAiun.
DFS -F2 -DWG -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUESTIONS? (850413-1609
® DATE(MMIDDNYYY)
AC�
CERTIFICATE OF LIABILITY INSURANCE10/8/2018
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. 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 pollcy(les) 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 endorsements),
PRODUCER CONTACT
NAME:
NEW LAW INSURANCE PHONEND Ex: (305) 887-0711 FAX
INC.
No (305) 884-2411
1030 E 4th Ave AIOR1Ess:newlawinsurance@aol.com
Hialeah, FL 33010 INSURER(II) AFFORDING COVERAGE NAICI
INSURER A: ASCENDANT
INSURED WIREWAYS ELECTRIC LLC INSURER 8:
8517 SW 166 PL INSURER C:
MIAMI, FL 33193 INSURER 0:
INSURER E:
INSURER F:
rtnVFRAr:FS r'FRTIFIr:ATF NIIMRFR- 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
ADOL
INSD
USR
WVD
POLICY NUMBER
EFF
MWDDNYYY
LI P
MMIDD/YYYY
LIMITS
X COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE $ 1,000,000
CLAIMS -MADE a OCCUR
PREMISES Ea occurrence $ 100, 000
MED EXP (Any one person) $ 5, 000
GL 53936 0
10/04/2018
10/04/2019
PERSONAL 6 ADV INJURY $ 1,000,000
GEN L AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE $ 1,000,000
POLICY F-1 jECT FI LOC
PRODUCTS - COMP/OP AGG S 11000,000
$
OTHER:
AUTOMOBILE LIABILITY
Co Ea accident3INULF LIMIT $
BODILY INJURY (Per person) $
ANYAUTO
ALL OWNED SCHEDULED
AUTOS AUTOS
BODILY INJURY (Per accident) $
Per accident)E $
NON -OWNED
HIRED AUTOS
UMBRELLA LIAB
HOCCUR
EACH OCCURRENCE $
AGGREGATE $
EXCESS LIAB
CLAIMS -MADE
DEO I I RETENTION $
$
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY YIN
ANY PROPRIETOR/PARTNERIEXECUnVE
OFFICER/MEMBER EXCLUDED?
NIA
STATUTE ER
E.L. EACH ACCIDENT S
(Mandatory In NHL
E.L. DISEASE - EA EMPLO`. E $
If yes, describe under
DESCRIPTION OF OPERATIONS below
I
E.L. DISEASE - POLICY LIMIT $
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required)
Wireways Electric LLC
Contractor's License Number EC 13007679
Electrical contractor
Miami Shores Village ,10050 NE 2 AVE, Miami Shores FL
UADIUCLL.H 1 I VIV
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
Cc) 1989-2014 ACORD CORP09ATION. All riahls reserved
ACORD25(2014/01) The ACORD name and logo are registered marks of ACORD
COMPANY LETTER HEAD
Date: 06/15/2019
State of: Florida
County of
Before me this day personally appeared Armando Alvarez, who, being duly sworn ,deposes and
says
That he or she will be the only person working on the project located at:
750 NE 97 ST
Contractor Sign
Sworn (or affirmed) and subscribed before me this ! l day of
.2019, by
Personally know u
Or Produced Identification
Type of Identification
LUIS FERNANDEZ
* MY COMMISSION 0 GG 041161
o` EXPIRES: November 7, 2020
-1710F Ff BOnded ihru Budget Wary Set Am
Print, Type or Stamp Name of Notary