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EL-17-2750Project Address 10007 NE 4 Avenue Miami Shores, FL JOHN & CRISTINA BUTLER Permit NO. EL -1 1-17-2750 Permit Type: Electrical - Residential Work Classification: Temp for Construction Permit Status: APPROVED issue Date: 1112112017 l Expiration: 0512012018 Parcel Number 1132060170490 Block: Lot: Address 10007 NE 4 Avenue MIAMI SHORES FL 33138- 500 NE 102 Street MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone KELLY BENSON ELECTRIC INC (954)921-5400 of Work: PROVIDE TEMPORARY POWER POLE FOR HO onal Info: PROVIDE TEMPORARY POWER POLE FOR HO ification: Residential Scanning: 1 Fees Due Miami Shores Village CCF 10050 N.E. 2nd Avenue NE DBPR Fee 2.00 Miami Shores, FL 33138-0000 2.00 Phone: (305)795-2204 FLORIDA Permit Fee - Additions/Alterations Project Address 10007 NE 4 Avenue Miami Shores, FL JOHN & CRISTINA BUTLER Permit NO. EL -1 1-17-2750 Permit Type: Electrical - Residential Work Classification: Temp for Construction Permit Status: APPROVED issue Date: 1112112017 l Expiration: 0512012018 Parcel Number 1132060170490 Block: Lot: Address 10007 NE 4 Avenue MIAMI SHORES FL 33138- 500 NE 102 Street MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone KELLY BENSON ELECTRIC INC (954)921-5400 of Work: PROVIDE TEMPORARY POWER POLE FOR HO onal Info: PROVIDE TEMPORARY POWER POLE FOR HO ification: Residential Scanning: 1 Fees Due Amount.. CCF 1.80 DBPR Fee 2.00 DCA Fee 2.00 Education Surcharge 0.60 Permit Fee - Additions/Alterations 100.00 Scanning Fee 3.00 Technology Fee 2.40 Total: 111.80 JOHN & CRISTINA BUTLER Valuation: $ 2,500.00 Total Sq Feet: 0 Pay Date Pay Type Amt Paid Amt Due Invoice # EL -11-17-65698 11/17/2017 Check #: 21194 $ 50.00 $ 61.80 11/21/2017 Check #: 21195 $ 61.80 $ 0.00 Available Inspections: Inspection Type: Final Review Electrical 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 ELECTRQAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS AFFI A l Grertify lat all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction a g u4ery(ore, I authorize the above-named contractor to do the work stated. November 21, 2017 WinghorizeWeepartmentgrfiture: Owner / Applicant / Contractor / Agent Buil Copy November 21, 2017 1 9 r U -y r9y Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138- Tel: 3138Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 f S 1-11 FBC 20 I BUILDING Master Permit No. C tY92 - PERMIT APPLICATION Sub Permit No. Lr Z1EX) BUILDING o ELECTRIC ROOFING REVISION EXTENSION [:]RENEWAL PLUMBING MECHANICAL 0PUBLIC WORKS CHANGE OF CANCELLATION SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 10001 , `f E ! `t V L City: Miami Shores ` l V County: Miami Dade Zi : 1 Folio/Parcel#: U Vl — Is the Building Historically Designated: Yes NO Occupancy TypeMom: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): Q 1 lIV 1. S V (r1 l.l Phone#: Address: r r! Ay -e City: I Vl l l% VVl l Tenant/Lessee Name: Email: n hu" CONTRACTOR: Company Name: Address: City: / K State: p:3J/ Phone#:----.N, ne#:,' r q -21'J YyU Qualifier Name: UffA,l.S Z4&Z Phone#: _ State Certification or Registration #: I J Certificate of Competency #: _ DESIGNER: Architect/Engineer: Phone#: Address: n City: State: Value of Work for this Permit: $ 2 Square/Linear Footage of Work: Type of Work: Additio n lCJAAlterationn New ElRepair/Re e Description of Work:N V /(T1tP6i i1 rQ"' Ism 15AR106(r- 170 Ho P Zip: Demolition Specify color ofcolor thru tile: SOSubmittalFee $ AD04 Permit Fee $ /®U CCF,$. __ _ CO/CC $ ? Scanning Fee $ Radon Fee $ DBPR $ Notary $ Technology Fee $ Training/Education Fee $ Double Fee $ Structural Reviews $ Bond $ TOTAL FEE NOW DUE $ Lie M Revised02/24/2014) f 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 • ection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection ill n e approve direipection fee will be charged. Signatur Signature t OWNER or AGENT ONTRACTOR,. The foregoing ristrume I'was acknowledged before me this The fo oing instrument was acknowledged before and this day of 'fJ 2011 by day,of , -evu 0" 20 '-1 by who is personally known to ` who is personally known to me or who has produced l as me or who has produced I1a 0• _.as identification and who did take an oath. NOTARY PUBLIC: NSign:6( 010 Print: Seal: ", u. " MADELEINE TIRADOi, a,: MY COMMISSION #FF172460 EXPIRES December 21, 2018 identification •and who dill take an oath. NOTARY PUBLIC: C.0Pj-int: s i + Seal: MADELEINE TIRADO MY COMMISSION #FF172460 t d`or e k.8h3 FloridallotaryService.com APPROVED BY Plans Examiner Zoning Structural Review Revised02/24/2014) Clerk KELLY BENSON ELECTRIC, INC. 8XCTRICAL CONTRAMR EC0001385 www.kd&bwwndecdicwm P.O. BOX 223425, HOLLYWOOD, FLORIDA 33022 Email: kjteincrqbcINgt th.rwt TELEPHONE & FAX (954) 921-5400 Butler Residence Temporary Power 10007 N.E. 4th Avenue Miami Shores, Florida 33138 11-07-2017 10' MIN HIEGHT TO ' WEATHERNEAD NOV 17 2017 20 AMP QUAD GFI W.P. RECEPTACLES 4''X.4"XI2'WOOD POST Y INTO GROUND WITH 2 X 4 BRACING 90* TO FPL DROP NEwICOAMP— Mce L l- All IT #-: F, L i-.2 a LOAD CENTER M'a-ni Shrrl-s V l'? e N3R 24 CKT 120/240VbL `'`-o\1FD_. BY DATE 1 PHASi7CV'NG DEPT T LIg#8 THHN CU JI tL,T iyxilu ir,':.w ''in ^- .ri± .C. .3 1 5/8" X 8' GRNW ROD --- - – — MADELEINE TIRADO MY COMMISSION #FF172460 EXPIRES December 21, 2018 l 407) 398.0153 Floridallotarvservice.com 1%" CONDUIT 30 #3 THHN CU NEW 200 AMP IPHASE METER SOCKET NEwICOAMP— Mce L l- All IT #-: F, L i-.2 a LOAD CENTER M'a-ni Shrrl-s V l'? e N3R 24 CKT 120/240VbL `'`-o\1FD_. BY DATE 1 PHASi7CV'NG DEPT T LIg#8 THHN CU JI tL,T iyxilu ir,':.w ''in ^- .ri± .C. .3 1 5/8" X 8' GRNW ROD --- - – — MADELEINE TIRADO MY COMMISSION #FF172460 EXPIRES December 21, 2018 l 407) 398.0153 Floridallotarvservice.com A 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) BUSINESS NAME: 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. V -j BUSINESS ADDRESS:P ' I b 15viK 223y2,5" CITY CUk STATE ZIP "O;L;L BUSINESS PHONE: () 9ZI ;S'oi% FAX NUMBER ( ) CELL PHONE (Y;Y) QUALIFIER'S NAME: A?5 VJPX/ QUALIFIER'S LIC NUMBER: jZbp 0 -1 s RICK SCOTT, GOVERNOR KEN LAWSON, SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS' LICENSING BOARD EC0001385 - ._ • 4 , The ELECTRICAL CONTRACTOR Named'tielowlS CERTIFIED Under the provisions of;Chapter 489 FS. Expiration date: AUG31-,2018 V "` BENSON"KELLY PATRICK-" KELLY, BENSONELECTRICy1NC POST -OFFICE -BOX -222_3425 ` ' ` ` _`,,'.."`'-" 'tib, -, •'• ., ` HOLLYWOOD"' L 33022 r. r ,.. r .[ tl ii^ a« 1 . -. ` ' I 5. i i ae • ' % \ ISSUED: 08/07/2016 DISPLAY AS REQUIRED BY LAW SEQ # L1608070003129 BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT 115 S. Andrews Aver, Rm. A-100, Ft. Lauderdale, FL 33301-1895 — 954-831-4000 VALID OCTOBER 1, 2017 THROUGH SEPTEMBER 30, 2018 DBA: Business Name: KELLY BENSON ELECTRIC INC Owner Name: BENSON KELLY Business Location: 611 N 21 AVE HOLLYWOOD Business Phone: 9 5 4 - 9 2 1 - 54 0 0 11- ReC@Ipt#: ELECTRICAL/ALARMS/CONTR Business Type: (ELECTRICAL CONTRACTOR) Business Opened:07/01/1992 State/County/Cert/Reg:EC 0001385 Exemption Code: Rooms Seats Employees Machines Professionals 5 For Vending Business Only Number of Machines: Vendino Tvne: Tax Amount Transfer Fee NSF Fee Penalty Prior Years Collection Cost Total Paid 27.00 0.00 0.00 0.00 0.00 0.00 27.00 THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS THIS BECOMES A TAX RECEIPT This tax is levied for the privilege of doing business within Broward County and is non -regulatory in nature. You must meet all County and/or Municipality planning WHEN VALIDATED and zoning requirements. This Business Tax Receipt must be transferred when the business is sold, business name has changed or you have moved the business location. This receipt does not indicate that the business is legal or that it is in compliance with State or local laws and regulations. Mailing Address: BENSON KELLY PO BOX 223425 HOLLYWOOD, FL 33022 2017 -2018 Receipt 802C-16-00006619 Paid 09/28/2017 27.00 AC4RU0 CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 11/10/2017 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 WANED, 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 Corporate Insurance Advisors 1401 E Broward Blvd Suite 103 Ft. Lauderdale FL 33301 CONTA.NAME. Jaclyn Stamper PNONE (954)315-5000 No: (954)315-5050 EADoESS:JStamper@ciafl.net INSURER(S) AFFORDING COVERAGE NAIC 9 INSURER A.Monroe Guaranty Insurance Co. INSURED Kelly Benson Electric, Inc. PO Box 223425 Hollywood FL 33022 INSURER BBrierfield Insurance CO 012306 INSURERC:FCCI Insurance Group INSURERD:FCCI Insurance Company 10178 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:17-18 Master Cert 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. ILTR TYPE OF INSURANCE A L POLICY NUMBER MWDDSUBR O EFF MMIUDDI EXP LIMITS ATff- X COMMERCIAL GENERAL LIABILITY CLAIMS-MADE X OCCUR EACH OCCURRENCE $ 1,000,000 DAMAGE TO REN PREMISES Ea occurrence $ 100,000 MED EXP (Any one person) $ 5,000CPP0006552127/26/2017 7/26/2018 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY 0 RQ LOC GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 Employee Benefits $ 1,000,000OTHER: AUTOMOBILE LIABILITY COMBINEDSINGLE LIMIT Ea accident $ 1,000,000 BODILY INJURY (Per person) $ B X ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS CA100003111-01 7/26/2017 7/26/2018 BODILY INJURY (Per accident) $ HIRED AUTOSNON- OWNED AUTOS PROPERTY DAMAGE $ Per accident PIP -Basic $ 10,000 X UMBRELLA UAB X OCCUR EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5,000,000 CEXCESS4DED UAB CLAIMS -MADE I I RETENTION$ UMB100014962-01 7/26/2017 7/26/2018 D ERS COMPENSATION ANDREMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? Mandatory in NH) It Yes, describe under DESCRIPTION OF OPERATIONS below N / A 001WC16A50543 1/1/2017 1/1/2018 TH- X STATUTE ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEd $ 1,000,000 E.L. DISEASE - POLICY LIMIT 1 $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) Except 10 Day Notice of Cancellation for Non Payment of Premium EC0001385/Electrical Contractor Miami Shores Village 10050 NE 2nd Ave Miami Shores, FL 33138 ACORD 25 (2014/01) INS025 (201401) 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 rk Schwartz/JACLYN i V 1985-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD