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EL-19-763Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Issue Date: /17 Location Address Parcel Number 750 NE 97TH ST, Miami Shores, FL 33138 1132060142220 Contacts Permit NO.: EL -04-19-763 Permit Type: Electrical - Residential Work Classification: Al€eration Permit Status: Expiration: 10/14/2019 Description: NEW LIGHT FIXTURES Valuation: $ 5,000.00Inseectton Requests: 305-76,2 494, Total Sq Feet: 2,468.00 Fees INVESTINGHOUSE LLC Owner DARWIN TORREMIC 2061 NW 112 AVE 131, MIAMI, FL 33172 SAL ELECTRICAL CONTRACTORS CORP Contractor RAMON SALAZAR Business: 7863444762 $50.00 CCF Description: NEW LIGHT FIXTURES Valuation: $ 5,000.00Inseectton Requests: 305-76,2 494, Total Sq Feet: 2,468.00 Fees Amount Application Fee - Other $50.00 CCF $3.00 DBPR Fee $2.63 DCA Fee $2.00 Education Surcharge $1.00 Permit Fee $125.00 Scanning Fee $15.00 Technology Fee $4.38 Total: $203.01 Payments Date Paid Amt Paid Total Fees $203.01 Check # 1226 04/17/2019 $203.01 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 zoning. Futhermore, I authorize the above nam tra, or toNp thg work stated. , I Authorized Signature: Owner / Applicant / Contractor / Agent Date April 17, 2019 Page 2 of 2 BUILDING PERMIT APPLICATION IVIldifii .311Ureb viiidt;e 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 ❑BUILDING ELECTRIC ❑ ROOFING 4Ay 0 E� ?019 FBC 201i Master Permit No. c - of -n-.234 Sub Permit No. FL_c4'i9 " I'a_:> ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: '715 o N e� 1 ! ST City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Occupancy Type: Load the Building Historically Designated: Yes NO Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): 1�1� l > ��(_ Phone#:-] (33- 6 21 Z2� Address: ' �) \y E TI) S I City: wIRsm S 1�0mS State: l— Zip: Tenant/Lessee Name: Phone#: Email CONTRACTOR: Company Name:` �` �E,1( ('_ca.JT� c,��//� Phone#: 3Y T�JZ. Address: 288,3 /vu) leg 5z City: 01f%f�F 2,61 State: Zip:�f- Qualifier Name: 12-o A4' 0o,6 S� GY> Phone#: �-)-ow --_'�!�a'2 J State Certification or Registration #:� I %300 to �� Certificate of Competency #: dJ �CJOO �Z DESIGNER: Architect/Engineer: Add hone#: City: State: Zip: Value of Work for this Permit: $ Square/Linear Footage of Work: �5c�o --�v \ , Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: � � Specify color of color thru tile: Submittal Fee - Permit Fee $ Scanning Fee $ Technology Fee $, Structural Reviews $ Radon Fee $ Training/Education Fee $ CCF $. DBPR $ CO/CC $ Notary $ Double Fee $ Bond $ TOTAL FEE NOW DUE 9 Bonding Company's Name (if applicable) Bonding Company's Address City State Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State `l5n OE q'� ST- 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. Signature L,[WN6orAGENT The foregoing instrument was acknowledged before me this �dayoftN`�`(�\ 20 \,C-\, - by �vJW�n�`IVZU , who is iersanaIIy known to me or who has produced identification and who did take a oath. NOTA PUB C: .Sign: Print: o" •bbl, i MARIAR DRIGUEZ Seal: MY COMMISSION # GG 068353 EXPIRES: February 4, 2021 ;012„.• Bonded Thru Notary Public Undexwaters Signature. CONTRACTOR The foregoing instrument was acknowledged before me this day of �'��� 20 IQ by F64-(oA) 5 ,-J02G r who is personally known to as me or who has produced identification and who did take an oath. NOTARY PUBLIC: Print: L� Seal: M' WWRSSM • FF93180 EXPIRES Novwrnper /8.2019 as **s****ssss**********s******sss**q********************************sss**********s*s*****s**s****ss*******s APPROVED BY I Plans Examiner Zoning Structural Review Clerk ncoRn° CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YYYY) �–� 0410412019 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 Steve Clein we FAX .No Ext)" 954) 431.2008 (A1C Nc)_(954) 704.0507_ C & C Insurance, Inc. 1921 NW 150 Ave. E-MAIL— -ADDRESS. reception@candcinsurance.com_________ INSURER1S-LAFF089ING CQVERAGE --- — ---- _------- __ NAIC If Ste. 101 Pembroke Pines FL 33028 INSURER Guard Insurance Company DAMAGE TO RENTED INSURED INSURER 13; Technolo Insurance Company INSURER Y SAL ELECTRICAL CONTRACTING, CORP INsuRER o;__—__._.___ 1010312019 7803 NW 199TH STREET INSURER E _...----- 5.000 MIAMI FL 33015 PERSONAL & ADV INJURY INSURER F : COVERAGES CERTIFICATE NIIMRFR- aFVlslnM ILII IMRFR- 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 ITRPOLICY TYPE OF INSURANCE ADDLIUBR N MBE POLICY EFF POLICY EXP LIMITS A X i COMMERCIAL GENERAL LIABILITY— CLAIMS -MADE � OCCUR j EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED 50,000 Y Y SABP993191 10/0312018 1010312019 MED EXP (Any one erson 5.000 PERSONAL & ADV INJURY S Included AGGREGATE LIMIT APPLIES PER: l POLICY PRO - LOC GENERAL AGGREGATE $2,000,000 GEN'L .X,._ COMP/ COPAGG._ _§_ZfOOO OOO OTHER:$ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS ! BODILY INJURY Pident (Per acc ( ) S PROPERTY DAMAGE (Per accidents $ NON -OWNED HIRED AUTOS AUTOS $ UMBRELLA LIAB — OCCUR EACH OCCURRENCE AGGREGATE EXCESS LIAB CLAIMS -MADE DED T NTI N WORKERS COMPENSATIONX AND EMPLOYERS' LIABILITY Y N PER OTH- E.L. EACH ACCIDENT $ 500,000 B ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? MLA (Mandatory in NH) A AWC1120963 01/06/2019 01/06/2020 ._ E.L. DISEASE - EA E.MPLOYEEI_$500,000 ---- If yes, describe under PTI N OF OPERATIONS below -- E.L. DISEASE-- POLICY LIMIT 1 + _- ...... _ s500,OOO DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) SAL ELECTRICAL CONTRACTING, CORP License # CC03E000224 MIAMI SHORES VILLAGE 10050 NE 2ND AVE MIAMI SHORES, FL 33138 ELLATI 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 { `CL' ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD reyrodl267@yahoo.com - Yahoo Mail -1AA POP A mow a r io . '. 9��yJ ;,' , °•,yam^ r Y p�. � � � � � dRoJ is ti r^� -NQ4 t�rt'l+ -01. T► --k -r ' ISOSAO W1JPAWS �!41 2/14/19,12:58 PM ME = fief m \t ,ittps://maii.yahoo.com/d/search/referrer=photos&accountlds=l&listCon.-IQ:2.2?.intl=us&.tang=en-US&.partner=none&.src=finance&fuliscreen=l Page 1 of 1 Local Business Tax Receipt Miami—Dade County, State of Florida -THIS IS NOT A BILL -DO NOT PAY 5032610 BUSINESS NAME/LOCATION SAL ELECTRICAL RECEIPT NO. EXPIRES CONTRACTORS CORP RENEWAL SEPTEMBER 30, 2019 7803 NW 199TH ST 5255237 Must be displayed at place of business MIAMI, FL 33015 Pursuant to County Code Chapter 8A - Art. 9 & 10 OWNER SEC. TYPE OF BUSINESS SAL ELECTRICAL CONTRS CORP 196 ELECTRICAL PAYMENT RECEIVED C/O RAMON SALAZAR, PRESIDENT BY TAX COLLECTOR CONTRACTOR Worker(s) 75.00 08/23/2018 1 03E000224 FPPU06-18-016556 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 holders qualifications, 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 Ba -276. MIAMFDADE ° ' For more information, visit www.miamidade gov/taxcollector Municipal Contractor's Tax Receipt Miami—Dade County, State of Florida -THIS IS NOT A BILL -DO NOT PAY CC NO: 03E000224 MC BUSINESS NAME/LOCATION RECEIPT NO. EXPIRES SAL ELECTRICAL CONTRACTORS CORP 7803 NW 199TH ST 7548899 SEPTEMBER 309 2019 MIAMI, FL 33015 Pursuant to County Code See 10-24 OWNER TYPE OF BUSINESS SAL ELECTRICAL CONTRS CORP ELECTRICAL CONTRACTOR PAYMENT RECEIVED C/O RAMON SALAZAR, PRESIDENT BY TAX COLLECTOR 200.00 08/23/2018 FPPU06-18-016556 This receipt is not valid in the following Municipalities: Aventura, Doral, Hialeah, Key Biscayne, Miami Gardens, Miami Lakes, Palmetto Bay, Pinecrest, Sunny Isles Beach, Town of Cutler Bay. M�IAM ,I For more information, visit www.miamidade.00yhoxcollector I Miami shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CONTRACTORS' REGISTRATION IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: A. COPY OF QUALIFIER'S STATE LICENCES B. ✓ COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF LIABILITY INSURANCE* D. COPY OF WORKERS COMPENSATION INSURANCE* (Workers Compensation EXEMPTION must have NOTICE TO OWNER form and Contractor Affidavit) IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY: A. COPY OF CERTIFICATE OF COMPETENCY OF QUALIFIER B. COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF STATE REGISTERED CONTRACTOR LICENSE OR MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT. D. COPY OF LIABILITY INSURACE* E. COPY OF WORKERS COMPENSATION INSURANCE* (Workers Compensation EXEMPTION must have NOTICE TO OWNER form and Contractor Affidavit) *YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE AS FOLLOW: Certificate Holder: MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES, FL 33138 Certificate must specify the description of operations or contractor license number. .soon ..... among ...... owns ..■... map ..... .......... .■■....... .......... mammon .... mom c I � BUSINESS NAME: BUSINESS ADDRESS: 7803 IU() J.99 -A 6I, CITY 4/4041 STATE ZIP X016 BUSINESS PHONE: (�SG� ) 344-436,4 FAX NUMBER ( ) CELL PHONE (39G) 3444-362 QUALIFIER'S NAME: ZY04 v� ALdQ, QUALIFIER'S LIC NUMBER: C13006314 Miami shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Notice to Owner - Workers' Compensation Insurance txemption 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 CONTENTS. State of Florida County of Miami -Dade The foregoing was acknowledge before me this day of 120 By who is personally known to me or has produced as identification. Notary: SEAL: