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EL-19-334Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 PD t- _- �1�jRp Issue Data:.05103/2019 Location Address Parcel Number 29 NE 109TH ST, Miami Shores, FL 33161 1121360040600 Contacts Peru Afo.: L-02-19-334 Permit Type: Electrical. - Residential Work Ctassifrcation. Alteration Permit Status: Approved Expiration: 10/30/2019 Description: INTERIOR ALTERATION (RECONFIGURATION OF Valuation: $ 3,200.00 Ins ection Requests: SPACE) REMOVE AND RELOCATE KITCHEN, MASTER BATH AND 305 762-4949 MASTER CLOSET AS PER PLANS. INSTALL NEW AC SYSTEM AS Total Sq Feet: 593.50 PER PLANS REPATCH AND PAIN RESIDENCE Fees JACQUELINE GONZALEZ Owner 29 NE 109TH ST, Miami Shores, FL 33161 Mobile: 3052818409 ODETTE ELECTRIC CO Contractor LUIS M AGUILA 300 W 30 ST, HIALEAH, FL 33012 Business: 7868534177 $50.00 CCF $2.40 Description: INTERIOR ALTERATION (RECONFIGURATION OF Valuation: $ 3,200.00 Ins ection Requests: SPACE) REMOVE AND RELOCATE KITCHEN, MASTER BATH AND 305 762-4949 MASTER CLOSET AS PER PLANS. INSTALL NEW AC SYSTEM AS Total Sq Feet: 593.50 PER PLANS REPATCH AND PAIN RESIDENCE Fees Amount Application Fee - Other $50.00 CCF $2.40 DBPR Fee $2.00 DCA Fee $2.00 Education Surcharge $0.80 Permit Fee $62.00 Scanning Fee $30.00 Technology Fee $2.80 Total: $152.00 Building Department Copy Payments Date Paid Amt Paid Total Fees $152.00 Credit Card 05/03/2019 $152.00 Amount Due: $0.00 In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulafiVg construction and zoning. Futhermore, I authorize the above named contractor to do the work stated. Signature: Owner / Applicant / Contractor / Agent Date ay 03, 2019 Page 2 of 2 BUILDING PERMIT APPLICATION Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 F—] BUILDING dELECTRIC ❑ ROOFING Fkd 13 281 BY: FBC 2011 A Master Permit No. KC.I$ — 3(Akf 2 Sub Permit No. EL oZ-1 J3u `— 1 ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑ PLUMBING ❑ MECHANICAL [:]PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP -} CONTRACTOR DRAWINGS JOB ADDRESS: "1 �E l o q -51 r ej City: Miami Shores County: ) Miami Dade Zip: 33� Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: \ FIFE: OWNER: Name (Fee Simple Titleholder): i Clcq u l-1 v�Q--LoryZ �x IX Z- Phone#: (3(' J J •� $ l ' $' { O� Address: o Lct\J E log 5l mP_ 1 City: +CLw+-c State: '� �0+-x4Ck Zip: Tenant/Lessee Name: + Phone#: Email: i/1CLvYXCL to • Gt2v%7_-e2— 6? a,a',► .cc3vr1 V v �(?v3 CONTRACTOR: Company Name: ©�C� f%�C� C �e�2 G� • c� Phone#: ? s 6 ?5-3 - © Address: 7 06 32 S City: g d" / k State: Zip: 3 /� Qualifier Name: L Oe:6 .45 y C Phone#: State Certification or Registration #: GG'f ��/ Certificate of Competency #: DESIGNER: Architect/Engineer: Address: City: Value of Work for this Permit: $ 3, �� Square/Linear Footage of Work: one#: _ C. a State Type of Work: ❑ Description of Work: Zip: Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition Scanning Fee.$ p _ ,, ,-Radon.Fee.$,.- 10 DBPR $ Notary $ Technology Fee $ Structural Reviews $ (Revised02/24/2014) Training/Education Fee $ Double Fee $ Bond $ TOTAL FEE NOW DUE $ k52 • CA 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 al proved a reinspection fee will be charged. ,� Signature � Signature OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this day of T ��UC1 r•� 20 147 by_ who is personally known to me or who has produced tr13o 4 u -) as identification and who did to a an oath. The foregoing instrumentwas acknow_ ledged before me this g .� day of 0IrGLU ✓ �20 by S lt' �Ct who is personally known to me or who has prod ced GP_V--?0tAX q VL W meas identification and who did take an oath. NOTARY P IC: NOTARY PUBLIC: Sign: �� , ` Z(% wc�D ?Sign: Q,} �� e.\' Print: �.k Y s J'Print: r` Seal: — —7 Seal: • " JARDIEL ABREU ROMERO ?'i ••c W COMMMION # GG06494 EXPIRES January 23, 2021 APPROVED BY ZI tS (Revised02/24/2014) Plans Examiner Structural Review JARDIEL ABREU ROMERO :'� ••: MY COMM=l1ON # GG084945 Zoning Clerk I. RICK SCOTT, GOVERNOR JONATHAN ZACHEM, SECRETARY r P fNg ,, I y P STATE OF FLORIDA I DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD THE ELECTRICAL CONTRACTOR HEREIN IS CERTIFIED UNDER THE PROVISIONS OF CHAPTER 489, FLORIDA STATUTES A I— I I I I A 1 1 I I C KA 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. 4' Dov WXT ,mom s RICK SCOTT, GOVERNOR JONATHAN ZACHEM, SECRETARY r P fNg ,, I y P STATE OF FLORIDA I DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD THE ELECTRICAL CONTRACTOR HEREIN IS CERTIFIED UNDER THE PROVISIONS OF CHAPTER 489, FLORIDA STATUTES A I— I I I I A 1 1 I I C KA 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. (+11753 Local Business Tax lceip Miami -Dade County, State, af "Florida —THIS I$ NOTA BILL -D0 NOT PAY 1421007 BUSINESS NAME/LOCATION RECRIAT NO. EXPIRES ODETTE ELECIRIC.CDMPANY WC RENEWAL SEPTEMBER 30, 2019 726 E 32ND ST 1421007 Must be displayed at place of business HiALEAH FL 33013 Pursuant to County Code Chapter 8A— Art. 9 & 10 OWNER SEC. TYPE OF oi1siNe3'S ODETTE ELECTRIC COMPANY INC 196 ELECTRICAL CONTRACTOR PAYMENT RECEIVED LUIS M AGUILA PRES EC13002055 BY TAX COLLECTOR Warker(s) 10 s45.00 07/06/201 s CH ECK21-18-056573 This Local 8asigM TaX RBvW 0*caalb= peymtapt at dm Lead Buskess Tax. The Refs is na a Ikwm, pelt,'ora caniboaden of the hold et's, q'ualificatiankto do budness. Holder most ceiaPl► wkb anygovemmente er ncadoreraamalel regalalmy laws sad regglremaats width applyto the business. T6 ItECEIPT110.abevenuWbed'vkpdasall comnereWvehicles=Misr -Dade Cada SecgaM For am* lnfmwGdgkvisit wymmimaidsde.un mallectm CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 02/12/19 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 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 CONTACT NAME: TERE PHONE (305) 267-2231- ac No): (305) 267-2453 De Zayas Insurance Corp. E-MAIADDRESS: TEREADEZAYASINSURANCE.COM 10110 SW 107 AVE. Miami, FL 33176 PRODUCER ID -CUSTOMER INSURER(S) AFFORDING COVERAGE NAIC # Phone (305)274-1234 Fax (305)274-1238 INSURED INSURER A: ASCENDANT COMMERCIAL INSURANCE, INC INSURER B: AmTrust ODETTE ELECTRIC COMPANY INC INSURERC: DAMAGE TO RENTED 100,000 PREMISES Ea occurrence $ 300 W EST 30 ST INSURER D: F-] F1CLAIMS-MADE[,-/]OCCUR ❑ HIALEAH, FL 33012 INSURER E: GL -35178-8 (786) 853-2803 12/13/2019 PERSONAL & ADV INJURY $ 1,000,000 ❑ 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 INSRYAM-L-POLICY SUB NUMBER POLICY EFF MM/DD/YYYY POS EXP MM/DD/YYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED 100,000 PREMISES Ea occurrence $ MED EXP (Any one person) $ 5,000 A F-] F1CLAIMS-MADE[,-/]OCCUR ❑ N N GL -35178-8 12;13/2018 12/13/2019 PERSONAL & ADV INJURY $ 1,000,000 ❑ GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 1,000,000 ❑ POLICY ❑ JE ❑ LOC $ AUTOMOBILE LIABILITY ❑ ANY AUTO ALL OWNED AUTOS ❑ SCHEDULED AUTOS ❑_ HIRED AUTOS N/A COMBINED SINGLE LIMIT $ (Ea accident) BODILY INJURY (Per person) $ BODILY INJURY (Per acadent) $ PROPERTY DAMAGE (Per accident) $ NON -OWNED AUTOS $ ❑ $ ❑ UMBRELLALIAB ❑ OCCUR EACH OCCURRENCE $ ❑ EXCESS LIAB ❑ CLAIMS -MADE N/A AGGREGATE $ ❑ DEDUCTIBLE $ $ ❑ RETENTION $ WORKERS COMPENSATION WC STATU- ❑ OTH- B AND EMPLOYERS' LIABILITYER ANY PROPRIETOR/PARTNER/EXECUTIVEY � N OFFICER/MEMBEREXCLUDED? NIA N AWC1075739 01/01/2019 01/01/2020 E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYE $ 1,000,000 (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMITT $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required) ELECTRICAL WORK WITHIN BUILDINGS. CERTIFICATE HOLDER CANCELLATION Miami Shores Village 10050 Northeast 2nd Ave Miami Shores, FL 33138 ACORD 25 (2009/09) QF 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 Cecilia T Alvarez PDF created with pdfFactory trial version www.pdffactory.com ©1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD