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EL-17-2392Project Address 325 NE 104 Street Miami Shores, FL 33138 - LUIS & CARRIE REYNOSO Permit No. EL -10-17-2392 Permit Type: Electrical - Residential ' Work Classification: Addition/Alteration Permit Status: APPROVED Issue Date: 10/10/2017 1 Expiration: 04108/2018 Parcel Number 1121360130100 Block: Lot: 325 NE 104 Street MIAMI SHORES FL 33138-2017 Contractor(s) Phone Cell Phone JAR COMMUNICATIONS INC (305)316-6907 ,e of Work: ADDITION/REMODELING SOME MORE OUTLE iitional Info: ADDITION/REMODELING SOME MORE OUTLE ssification: Residential inning: 1 Fees Due Miami Shores Village CCF 10050 N.E. 2nd Avenue NE — ... Miami Shores, FL 33138-0000 �-�-s Phone: (305)795-2204 FLORLDp' $1.20 Project Address 325 NE 104 Street Miami Shores, FL 33138 - LUIS & CARRIE REYNOSO Permit No. EL -10-17-2392 Permit Type: Electrical - Residential ' Work Classification: Addition/Alteration Permit Status: APPROVED Issue Date: 10/10/2017 1 Expiration: 04108/2018 Parcel Number 1121360130100 Block: Lot: 325 NE 104 Street MIAMI SHORES FL 33138-2017 Contractor(s) Phone Cell Phone JAR COMMUNICATIONS INC (305)316-6907 ,e of Work: ADDITION/REMODELING SOME MORE OUTLE iitional Info: ADDITION/REMODELING SOME MORE OUTLE ssification: Residential inning: 1 Fees Due Amount CCF $3.60 DBPR Fee $3.38 DCA Fee $2.25 Education Surcharge $1.20 Notary Fee $5.00 Permit Fee - Additions/Alterations $225.00 Scanning Fee $3.00 Technology Fee $4.80 Total: $248.23 Applicant LUIS & CARRIE REYNOSO Valuation: $ 5,400.00 Total Scl Feet: 0 Pay Date Pay Type Amt Paid Amt Due Invoice # EL -10-17-65272 10/10/2017 Check #: 389 $ 198.23 $ 50.00 10/06/2017 Check #: 2794 $ 50.00 $ 0.00 Available Inspections: Inspection Type: Final Meter Box Alteration Relocation Fire Alarm Service Change Review Electrical W. W. Underground 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. Eljthermyye, I authorize the above-named contractor to do the work stated. October 10, 2017 Authorized Veature: Owner / Applicant / Contractor / Agent Building Department Copy October 10, 2017 Miami Shores Village RECEIVED Building Department OCT 06 0» 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 �3 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 BUILDING PERMIT APPLI ATION ❑BUILDING ELECTRIC ❑ ROOFING FBC 20 (� Master Permit No. ,tC._ _ C Sub Permit No.� 1 G 2? C1 ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: S City' Miami Shores County: Miami Dade zip: 93/2CP Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): Address: City: Tenant/Lessee Name: Email: State: ne#: _Zip: Jai 3 ne#: ,305-612 CONTRACTOR: Company Na/me� /(. V U Y(/ i l vnone#: Address: _J City: ��%/ �%�'YJ/ State: zip: / Qualifier. Name: ���� l �� �� Phone#: &6<5 - 3)G- 690 7 F State Certification or Registration #: ` ��D U�5 Certificate of Competency #: r DESIGNER: Architect/Engineer: Phone#: Address: 1;7 / �' �Iil % City: State: f/ Zip k4 Uv Value of Work for this Permit: $�'��''-- Square/Linear Footage of Work: Type of Work: Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: J 033 OOO K ,. 0 01- es 4 ri AIN Spefy�toSrds+7of rLigutlr. d pe.ahr Submittal Fee $ Permit Fee $ 'g2j-"De CCF $ 10'A` Scanning Fee $ Radon Fee $ DBPR $ Notary Technology Fee $ Training/Education Fee $ Double Fee ~$ Structural Reviews $ Bond $ I �� (Revised02/24/2014) TOTAL FEE NOW DUE .$ ;` D r 3i 3.W 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 will be charged. Signatur Signature 0 E or AGENT CONTRACTOR The foregoi g instru w s ackn wledged before me this The foregoing instrument was acknowledged before me this tiµ day of �.� '20 by �� day of Sim, '� 20� by who ' personMtrnr who is personally known to m,,- or who has produced as me or who has produced CWS2 2 �r •as r n and who did take an oath. NOTAWY PUBLIC: I Sign:__ r L Print: 1, Seal: FMM R. f8 y MM1SS10N OM1 103 • lXPI & Juy 19, 2019 identification and who did take an oath. NOTARY PUBLIC: Sig Print: s�"�'0B'• MAHARAI K :�� .••u,: Seal: EXPIRES: Novetabe t2 d20 Bonded Thru Notary Public lh&e•}y nn APPROVE: +E, Plans Examiner Zoning r' ' Structural Review Clerk F TF (Revised02/24/2014) A a i 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 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 CONTENTS. signator�1Y:iY�'�,, Frank R. Camara Or �= COMMISPW 0Mt tO3 .. �� O MMES: Joy 19, 2019 State of Florida %,;� pcp WWW MRONNOiAR�,COM 'n��nna � County of Miami -Dade The foregoing was acknowledge before me this l day of By. �u i S c l V who i personally know to me or has produced as identification. Notary:_L A oXWM& SEAL: P\%% N R,' \,C\ TJ)qq\ . Jar Communications Ins. Date: 09/25/2017 State of Florida. Country of Dade Country Before me this day personally appeared ��''�S A�71who, being duly sworn deposes and says: That he or she vyll be the only person working on the project located at: Contractor Signature SFSworn to (or affirmed) and subscribed before me this day of (��:P7 20 by Personally know, Or Produced Identification Type of identification Produced AA A A%0 31d1Sfii�a •.ys�uMWylp %moi ? * 09" yss� %'�y�,ssiriw At, pe or Stamp Name of Notary Sep 06 2017 10:58AM HP LRSERJET FAX p.1 �coR� CERTIFICATE OF LIABILITY INSURANCE 9%6%2017 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, $Meet to the terms end 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 andorse s). PRODUCER CONTACT NAME: MENDEZ INSURANCE/FIN SVCS 305) 769-4936. FAX tAc N,:(305) 769-1844 508 E 49th St ADDRESS: monde zlil @hotmai1. com Hialeah, FL 33013 INeeRERpI AFFORDING COVERAGE NAICR INSURER A: GRANADA INSURANCE COMPANY INSURED JAR COMMUNICATIONS , INC.. INSURER B: 8831. NW 153 TERR. INSURER C: MIAMI, FL 33018 INSURER D: INSURER E : INSURER F: COVERAGES CERTIFICATE NUMBER- RFVISION NIIMRFR 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, EXCLUSIONSAND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INTSRR TYPE OF INSURANCE POLICY NUMBER M p LIMITS A R OOMMEPA2AL GENERAL LIABILITY CLAIMS -MADE 7xOCCURED A 500 DED 0185FL00015529 09/16/16 09/16/.7. EACH OCCURRENCE $ 1,000,000 PREMISES Es occurrence) S 50,000 MED EXP Any one person) 3 1,000 PERSONAL ti.ADVINJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO- JECTLOC OTHER: GENERAL AGGREGATE S 1,000,000 PRODUCTS - COMPIOP AGG S 1,000,000 $ AUTOMOBILE LIABILITY ANYAUTO ALLOWNEDAUTOS HIRED AUTOS NON-OWNEDAUTOS QLMWINF=U a ¢dml S BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ Per a9d0entl S 8 UMBRELLA LIAR EXCESS LIAR HOCCUR CLAJM34VADE EACH OCCURRENCE S AGGREGATE i DED I I RETENTIONIIII i WORKERS COMPENSATK)N ER AND EMPLOYS' I.MBIUTY YIN ANY PROPRIE:TMPARTN FUEXECUTVE OFRCERMEMBER EMUDEO7 ❑ (ftwd toy In NN) Kr descrlbe under DESCRIPTION OF OPERATIONS below NIA STATUTE I I R E.L. EACH ACCIDENT S E.L. DISEASE - EA EMPLOYEE S EL DISEASE. POLICY LIMIT II .11 . ' 11111 luno i L X11.11110 r ♦Cnn:LcO L;IJ Tui, Addtoona. ItenlBnte ORIIOLIM may be attached d mon space Is required) ELECTRICAL WORK LIC(. EC13001536 CITY OF MIAMI SHORES 10050 NE 2ND AVE MIAMI SHORES,FL 33138 305-756-8972 ATTN: ARLENIS SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITHA}IE POLICY PROVISIONS. AUTHORIZED reserved. ACORD25(2014101) The ACORD name and logo are registered marks -