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EL-17-23235goRES Y,! Miami Shores Village 10050 N.E. 2nd Avenue NW Miami Shores, FL 33138-0000 Phone: (305)795-2204 Project Address 196 NW 95 Street Miami Shores, FL 33150 - Owner ANATASE CINEUS ALEX VITAL Permit No. EL -9-17-2323 Permit Type: Electrical - Residential Work Classification: Alteration Permit Status: APPROVED Issue Date: 10/1612017 1 Expiration: 0411412018 Parcel Number 1131010330660 Block: Lot: Address 196 NW 95 Street MIAMI SHORES FL 33150-1712 196 NW 95 Street MIAMI SHORES FL 33150-1712 Contractor(s) Phone Cell Phone TOWER ELECTRIC OF PALM BEACH (561)718-1816 ape of Work: TIE IN FROM INVERTER TO BREAKER BOX dditional Info: lassification: Residential canning: 1 Fees Due Amount CCF 0.60 DBPR Fee 2.00 DCA Fee 2.00 Education Surcharge 0.20 Permit Fee - Additions/Alterations 100.00 Scanning Fee 3.00 Technology Fee 0.80 Total: 108.60 Applicant ANATASE CINEUS ALEX VITAL Phone Cell Valuation: $ 250.00 Total Scl Feet: 0 Pay Date Pay Type Amt Paid Amt Due Invoice # EL -9-17-65177 10/16/2017 Credit Card $ 108.60 $ 0.00 Available Inspections: Inspection Type: 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 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. Fu!ofrmore, I authprizjf the above-named contractor to do the work stated. October 16, 2017 Signature: Owner / Applicant / Contractor / Agent Building Department Copy October 16, 2017 1 RECEIVED Miami Shores Village c OCT 16 1017 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 FBC 20H BUILDING Master Permit No. F01 _ 23 Z l PERMIT APPLICATION Sub Permit No._ R - 2:3=5 BUILDING ELECTRIC ROOFING REVISION EXTENSION RENEWAL PLUMBING MECHANICAL PUBLIC WORKS CHANGE OF CANCELLATION SHOP CONTRACTOR DRAWINGS JOB ADDRESS:/ 4, A,l li-f ZS` -57— City: Cit : Miami Shores County: Miami Dade Zi : .3 d Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): A l_i. x/ y / % t Phone#: SOS- ALI?- Address: '4'/ W 9 T" City: M M 1—!'i D 4 State: i Zip: Tenant/Lessee Name: Email CONTRACTOR: Company Name: '7_6 WIEA E_L.. IA %G e> 1--5- /V. 46 Phone#: Address: City: W LI 9-G r42 State: ,~ L Zip: r% f Qualifier Name: eiq ;fes a - Phone#: State Certification or Registration #: O a Y a Certificate of Competency #: DESIGNER: Architect/Engineer: Address: hone#: City: State Zip: Value of Work for this Permit: $fin Square/Linear Footage of Work: Type of Work: Addition Alteration New Repair/Replace Demolition Description of Work: 'M E: (il (T 020 AT/ 1 1 JEATZE91 a laa_ M o -G Specify color of color thru tile: Submittal Fee $- • Permit Fee $ s Scanning Fee $ Radon Fee $ Technology Fee Structural Reviews $ Revised02/24/2014) b O 'pp CCF $_ DBPR $ Training/Education Fee $ CO/CC $ Notary $ Double Fee $ Bond $ / TOTAL FEE NOW DUE $ i - 6 0 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. Signature (, OWNER or AGENT The foregoing instrument was acknowledged before me this day of A(sC9 20 /`7, by EAL who is personally known to me or whoas produce ,']21, as identification and who did take an oath. NOTARY PUBLIC: Signature CONTRACTOR The foregoin instrument was acknowledged before me this 7 day of A U G U S 1 , 20 1:7 by cnf= ic_ cti(A{=2( L, who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: j:::J JSign: Sign: n ` Print: Print: TT/a-"iZk L Y Seal: $`,AyA Notary Public State of Florida Seal: rP Notary Public State of Florida Alexander Pavlinek' Alexander Pavlinek c My Commission GG 035271 c a` My Commission GG 035271 or n°" Expires 12/19/2020 Ci _c Expires 12/19/2020 APPROVED BY AK &?Plans Examiner Zoning Structural Review Clerk Revised02/24/2014) STATE OF FLORIDA 4.. DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD {850} 487-1395 VX 1940 NORTH MONR OE STREET TALLAHASSEE FL 32399-0783 CHAPEL, JOEL TOWER ELECTRIC OF PALM BEACH, INC 12912 BUCKLAND STREET WELLINGTON FL 33414 Congratulations! With this license you become one of the nearlyonemillionFloridianslicensedbytheDepartmentofBusinessand Professional Regulation. Our professionals and businesses range from architects to yacht brokers, from boxers to barbeque restaurants, and they keep Florida's economy strong. Every day we work to improve the way we do business in order to serve you better. For information about our services, please log onto wwwmyfloridalicense.com. There you can find more information about our divisions and the regulations that impact you, subscribe to department newsletters and learn more about the Department's initiatives. Our mission at the Department is: License Efficiently, Regulate Fairly. We constantly strive to serve you better so that you can serve your customers. Thank you for doing business in Florida, and congratulations on your new license! RICK SCOTT, GOVERNOR -- STATE OF FLORIDA DEPARTMENT OF BUSINESS AND w PROFESSIONALREGULATION 11 EC13005580 _ x1SSUE . ' 05/26/2016 CERTIFIED ELECTFt1CAL CONTRACTOR r. CHAPEL, JOEL ,•- TOWER ELECT911(5-OF PALtvI EACH- , INC IS CERTIFIED under the provisions of Ch.489 FS_ Exp MWn dale : AUG 31, 2010 LIGUSSMW0106f DETACH HERE KEN LAWSON, SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS 1_lr.FM 1Mr: Onaon EC13005580 he ELECTRICAL CONTRACTOR reamed below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 21718 CHAPEL, JOEL ° yN TOWER ELECTRIC OF PALM GH,.,INC 12912 BUCKLAND STREETS '?' . _ WELLINGTON ,FL°33414 Il ' Lcaiir=n• DISPLAYAS.REOUIRED BY LAW VM ". SEQ # 1-1605260001061 0 04a''4 ANNE M. GANNON CONSTITUTIONAL TAX COLLECTOR Serving Palm Bench county Serving you. P.O. Box 3353, West Palm Beach, FL 33402-3353 PbClax.com Tel: (581) 355-2264 "LOCATED AT" 12912 BUCKLAND ST WELLINGTON, FL 33414 TYPE OF BUSINESs 2UI69 ELECTRICAL CONTRACTOR OWNER CHAPELJOEL This document is valid only when receipted by the Tax Collector s Office. TOWER ELECTRIC OF PALM BEACH INCTOWERELECTRICOFPALMBEACHINC12912BUCKLANDST WELLINGTON, FL 33414 CERTIFICATION— RECEIPT#fDATEPgFO AMT PAID BILL kEC1300g5g0017.707401-OW14l17 $27.50840162499 STATE OF FLORIDA PALM BEACH COUNTY 2017/2018 LOCAL BUSINESS TAX RECEIPT LBTR Number: 201467848 EXPIRES: SEPTEMBER 30, 2018 This receipt grants the Privilege of engaging in or managing any business profession or occupation within its jurisdiction and MUST be conspicuouslydisplayedattheplaceofbusinessandinsucha manner as to be open to the view of the public. A'? CERTIFICATE OF LIABILITY INSURANCE DATE /YYYY) 099/25/1/25/17 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: acNNo Ext): (305)275-0810 FAX, No): (305)275-0890AmtrustInsuranceGroup 8100 SW 81 Drive, Ste 280 EAMIL info@amtrustinsurance.net INSURERS AFFORDING COVERAGE NAIC # Miami, FL 33143 INSURER A : Western World Insurance CompanyPhone (305)275-0810 Fax (305)275-0890 INSURED INSURER B : INSURER C: Tower Electric Of Palm Beach, Inc. INSURER D: 6846 High Ridg Road INSURER E : Lantana, FL 33462- 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. INSRLTR TYPE OF INSURANCE ADD UBR POLICY NUMBER POLICY EFFMM/DD/YYYY) POLICY EXPMM/DDIYYYYl LIMITS A GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY F-1 F]CLAIMS-MADE OCCUR F-1 Y NPP 8452117 07/30/2017 07/30/2018 EACH OCCURRENCE $ 1,000,000.00 DAMAGE TOPREMISES (Ea oNccuRENTED 100,000.00 MED EXP (Any one person $ 5,000.00 PERSONAL PERSONAL a ADV INJURY $ 1,000,000.00 GENERAL AGGREGATE $ 2,000,000.00 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY / PRO LOC PRODUCTS - COMP/OP AGG $ 2,000,000.00 AUTOMOBILE LIABILITY ANY AUTO ALL AUTOS OWNED AUTOSULED NON -OWNED HIRED AUTOS AUTOS EOMaBINdEDtSINGLE LIMIT $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ UMBRELLA LIAB OCCUR EXCESS LIAB CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION $ WORKERS COMPENSATIONWC AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? Mandatory in NH) If as, describe under DESCRIPTION OF OPERATIONS below N / A STATU- OTH- T RY LIMITS 1:1 FR E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Eletrical work CEKTIPICATE HOLDER CANCELLATION Miami Shores Village Building Department 10050 NE 2nd Avenue Miami Shores, FI 33138 ACORD 25 (2010/05) 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 -" 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD JEFF AMMER CHIEF FINANCIAL OFFICER DEPARTMENT OF FINANCIAL. SERVICES' DIVISION OF WORKER$• COMPENSATM CERTIFICATE OF ELECTION TO BE EXEWT FROM FLORIDA WORKERS' COMPENSATION LAWCONSTRUCTIONINDUSTRYEXEWMN This certifies that the indvidual filed belowhas +eleded to be a mnpt frmn Florida Wwlmlw C©mpensatian law. EFFECTIVE DATE: 12/16f2015 EXPIRATION DATE: 12/1512,017 PERSON: CHAPEL JOEL FEIN: 480600545 BUSINESS NAME AND ADDRESS: TOWER ELECTRIC OF PALM BEACH INC 12912 BUCKLAND ST. WELLINGTON FL 33414 SCOPES OF BUSINESS OR TRADE: LICENSED ELECTRICAL CONTRACTOR PwtWld to FRe S tbn tNto thcempbpn frau tkis dtapbrsby f, a eaYB&fe t#ek t n rMbn vr9ltin the tuft to 440-0X121, F.$„ Certrkates of obcom to bescoprxofthehmkm" ortrme Feted on the rwftofetedion to be ° Dt . apply ontY the pammexaMm rmmed on ttta+wetice ori tto to Mocabon ff. at my ft- after the ofve ntokv n foewbnreUtert>AviMxft of sem fort of a Vilna d dM mw*,, DFS F2-DUItl4 CERTIFICATE OF ELECTION T8 Be EXBAPT REVISED 4813 4UES'rIONS? (850)418-9809