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EL-18-1921`yµortEs L�� Miami Shores Village 10050 N.E. 2nd Avenue NE - Miami Shores, FL 33138-0000 Phone: (305)795-2204 �ORIDA Permit No. EL-7-18-1921 Permit Type: Electrical - Residential Per ' Work Classification: Solar Permit Status: APPROVED Issue Date: 8/2/2018 1 Expiration: 01/29/2019 Project Address Parcel Number Applicant 1080 NE 105 Street 1122320280090 VERONIQUE LESTRADE SFARA Miami Shores, FL 33138- Block: Lot: Owner Information Address Phone Cell VERONIQUE LESTRADE SFARA 1080 NE 105 Street (305)799-2006 MIAMI SHORES FL 33138-2106 Contractor(s) Phone Cell Phone ASSURANCE SERVICES INC (786)413-8364 of Work: ELECTRICAL PORTION OF PV SOLAR SYST onal Info: ification: Residential ning: 3 Fees Due Amo]$2.00 CCF DBPR Fee DCA Fee Education Surcharge Permit Fee - Additions/Alterations Scanning Fee Technology Fee Total: $ Valuation: $ 500.00 Total Sq Feet: 0 Pay Date Pay Type Amt Paid Amt Due Invoice # EL-7-18-68252 08/02/2018 Credit Card $ 4.60 $ 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 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 one in compliance with all applicable laws regulating o� construction and zoning. Futhermore, I authorize the above -named contractor to de�ork ust 02, 2018 Authorized Signature: Owner / Applicant / Contractor Building Department Copy August 02, 2018 1 F Miami Shores Village FCL'EI'/CU JUL 17 7N 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 + L BUILDING PERMIT APPLICATION ❑BUILDING ELECTRIC ❑ ROOFING FBC 2011`� Master Permit No. ?" C Sub Permit No. FL-1 Z — ❑ REVISION ❑ EXTENSION [:]RENEWAL ❑PLUMBING [:]MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP p CONTRACTOR DRAWINGS Q JOB ADDRESS: I O 0 N C / d� S City: Miami Shores County: Miami Dade Zip: 3 3 8 Folio/Parcel#: I i' 2 23 Z 028 O 09 d Is the Building Historically Designated: Yes NO P Occupancy Type: ("e S Load: Construction Type: Pit Sp l qrFlood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): V e.ror1 i y ve. � e 5i-rad e 5 fckrc-, Phone#: 3 d-5 - -7 9 9 -2.00 Address: f' O 80 /U City: M I G&N I s�\ O T)e—S State: Zip: 3 3 13 g Tenant/Lessee Name: Phone#: Email: V. L E 5- - RA D E P. MAC. , C 0M CONTRACTOR: Company Name: %ASS urayi CQ SR (Vices S y)C Phone#: 7$ 6 'L11 3- a 3 6 q Address: 7 0 3 9 S :tfI? City: 'M 1 cl A I 4,� n State: EL- Zip: 3 3! 73 Qualifier Name: R, J 1'J 121/1 1� I mil/ A Phone#: 7 SG - L'I 13 - Y 3 6 Y State Certification or Registration #: 5 C-/ 3 0 0 6 6 3 7 Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: $ S' 00 , 0 0 Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration 1 ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: �-1 e 1 C-� n o r+,-.po o 1F I f% S-f' c< 1 c- Y 0 n O-(-' I S- Ll k'w grid. +ieA f000jr Specify color of color thru tile: Submittal Fee $ Permit Fee $ d 1 dd CCF $ CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Notary $ Technology Fee $ Training/Education Fee $ Double Fee $ Structural Reviews $ Bond $ C� TOTAL FEE NOW DUE $ (Revised02/24/2014) y 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 Signature OWNER or AGENT NTRACTOR The foregoing instrument was acknowledged before me this day of V 20 is by c5 o s sonally kno n to me or who has produced identification and who did take an oath. NOTARY PUBLIC: 1 Sign: Print: Seal: ` APPROVED BY The foregoing instrument was acknowledged before me this pp 16 dayof S-JIH 20 t? by who is personally known to as me or who has produced identification and who did take an oath. NOTARY P BLIC: Sign: Print: J�"V� a a - - - - - -- Seal: ************ Examiner �* Notary Public State of Florida Steven Howard Goldman +�� s My Commission GG 226355 ''yaa Expires06/0712022 111 7/-1-0/ ` t Zoning (Revised02/24/2014) Structural Review Clerk STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD 2601 BLAIR STONE ROAD TALLAHASSEE FL 32399-0783 BLAYA, RUBEN A ASSURANCE SERVICES, INC. 5810 SW 112TH AVE MIAMI FL 33173 Congratulations! With this license you become one of the nearly one million Floridians licensed by the Department of Business and 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 vvww.myfloridalicense.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. (850) 487-1395 :�,w, STATE OF FLORIDA DEPARTMENT•OF BUSINESS AND PROFESSIONAL' REGULATION ,ft .li+. EC13006637 �-; :;--� ISSU9 -�.--08/21/2016 CERTIFIED ELECTRICAL CONTRACTOR BLAYA, RUBEN-X-, ASSURANCE SERVICES iINC: , tv Our mission at the Department is: License Efficiently, Regulate Fairly. We constantly strive to serve you better so that•you can IS CERTIFIED under the provisions of ch.ass Fs. serve your customers. Thank you for doing business in Florida, Expiration date : AUG 31, 2018 L1608210003975 and congratulations on your new license! DETACH HERE RICK SCOTT, GOVERNOR KEN. LAWSON, SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD EC13006637 CL ti The ELECTRICAL GUN I KAc I UK ,�.• Named below IS CERTIFIED Under the provisions of Chapter 489 FS., Expiration date: AUG 31, 2018 E ., BLAYA,,RUBEN A ASSURANCE SERVICES,. INC. 5810 SW 112TH AVE ""'"~' MIAMI FL 3317"`""'"'" ISSUED: 08%z1%2016 DISPLAY AS REQUIRED BY LAW SEQ 4 L1608210003975 Local Business Tax Receipt Miami=Da-de County, $tate.of Florida -THIS IS NOT A BILL -DO NOT PAY 7183694 BUSINESSWAME/EOCATION " RECEIPT NO. - ASSURANCE SERVICES INC RENEWAL 7039 SW i 15 PL STE B 7464360 MIAMI F 33173 .EXPIRES sEPTEMBER 30, 2018 Must be displayed at place of business Pursuant to County Code Chapter SA — Art. 9 & 10 OWNER. SEC. TYPE OF B,USI,NESS ASSURANCE SERVICES INC 196 ELECTRICAL CONTRACTOR PAYMENT RECEIVED C/o RUBEN A BLAYA, PRES EC13006637 gY TAX COLLECTOR .. Workers) 1 --$.75.00 08/24/2011-7: CREDITCARD-17-055634 This Local Business Tax Receipt only confirms payment of the Local Business Tax. The Receipt is not a license, permi4orscertification ofthe helder'sijualification§,Wdobusiness. Holder must comply, with any govei mental Whoagovernmental regulatory laws and requirements which apply to the business:.. - The RECEIPT NO, above must be displayed on all commercial vehicles — Miami -Dade Code Sec 8a—V6. For more information, visit www.miamidade.gov/taxcallector Yry Vb ONO* p"AWXW 60 Od OP0404 NWMVJO WWY71i» iII 1 -r t 4: ray- OdAK GO'ZL+800 ' O�Tflff:C1:1'IWVfifd ' V�4Vi8 Y:` + m3apifX M N 8i1a ct I� �p snWin;iswann a3n�aa AC0 CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY) 07/06/2018 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 have ADDITIONAL INSURED provisions or 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 FrankCrum Insurance Agency, Inc. 100 South Missouri Avenue Clearwater, FL 33756 CONTACTNAME: PHONE A/C, No, Ext : 800 277-1620 X 4800 FAX A/C, No : 727 797-0704 E-MAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIC# INSURER A: Frank Winston Crum Insurance Company 11600 INSURED FrankCrum L/C/F Assurance Services, Inc. 100 South Missouri Avenue Clearwater FL 33756 INSURER B: INSURER C: INSURER D: INSURER E: INSURER F: CnVFRen FC CFRTIFICATF NUMBER: 490457 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 INSRD SUBR WVD POLICY NUMBER POLICY EFF (MMIDDNYYY) POLICY EXP (MMIDDIYYYY) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS -MADE OCCUR TO PREMISES DAMAGES( RENTED Ea occurrence $ MED EXP (Any one person) $ PERSONAL d ADV INJURY $ AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ GEN'L PRODUCTS-COMP/OP AGG $ POLICY a PROJECT [7LOC $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Es arxJdent $ BODILY INJURY Perperson) E ANY AUTO OWNED AUTOS SCHEDULED ONLY AUTOS BODILY INJURY (Per accident) $ HIRED AUTOS NON -OWNED ONLY AUTOS ONLY PROPERTY DAMAGE Per accident $ S UMBRELLA LIAB HCLAIMS-MADE OCCUR EACH OCURRENCE $ AGGREGATE $ EXCESS LIAB DED I I RETENTION E $ A WORKERS COMPENSATION AND EMPLOYERS'LIABILITY Y/N WC201800000 01/01/2018 01/01/2019 X PER STATUTE OTH- ER E.L. EACH ACCIDENT $1 000000 ANY PROPRIETORMARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) If yes, describe under E.L. DISEASE -EA EMPLOYEE $1 000 000 DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $1000000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Effective 06/01/2015, coverage is for 100% of the employees of FrankCrum leased to Assurance Services, Inc. (Client) for whom the client is reporting hours to FrankCrum. Coverage is not extended to statutory employees. CERTIFICATE HOLDER k;AN(;tLLAI IUN 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 Miami Shores Village Bldg. Dept. 10050 NE 2nd Avenue Miami Shores, FL 33138 01988-2016 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD ACC>R&CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 07/06/2018 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 have ADDITIONAL INSURED provisions or 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 EDUARDO MARTIN NAME: All Motors Insurance PHONMo.E WC.X : (305)559-8818 A/C No): (305)227-0977 11934 S.W. 8th Street EAI -ML allmotors7@att.net Miami, FL 33184 INSURERS AFFORDING COVERAGE NAIC # Phone (305)559-8818 Fax (305)227-0977 INSURERA: SCOTTSDALE INSURANCE COMPANY INSURED INSURER B : ASSURANCE SERVICES INC INSURER C: 7039 SW 115 Place # B INSURER E : MIAMI FL 33173- 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 S UBR WVD POLICY NUMBER POLICY EFF MM/DD/Y POLICY EXP MM/DD/Y LIMITS A COMMERCIAL GENERAL LIABILITY CLAIMS -MADE ❑ a OCCUR N N CPS2912939 10/24/2017 10/24/2018 EACH OCCURRENCE $ 1,000,000.00 DAMAGE TO RENTED PREMISES Ea occurrence $ 100,000.00 MED EXP (Any one person) $ 5,000.00 PERSONAL & ADV INJURY $ 1,000,000.00 GEN'L AGGREGATE LIMIT APPLIES PER: ❑� POLICY ❑ PRO JECT ❑ LOC ❑ OTHER GENERAL AGGREGATE $ 2,000,000.00 PRODUCTS - COMPIOP AGG $ 1,000,000.00 $ AUTOMOBILE LIABILITY ❑ ANY AUTO ❑ OWNED AUTOS NLY ❑ AUTOS SCHEDULED ❑HIRED ❑ NON -OWNED AUTOS ONLY AUTOS ONLY ❑ ❑ COMBINED SINGLE LIMIT Ea accident $ 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 COMPENSATION AND EMPLOYERS' LIABILITY Y I N ANY PROPRIETOR/PARTNER/EXECUTIV OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A I ❑ PERTUTE ❑ OTH- E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) ELECTRICAL CONTRACTOR--#EC13006637 CERTIFICATE HOLDER GANGtLLAIIUN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE MIAMI SHORES VILLAGE BLDG. DEPT. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 10050 NE 2 AVE ACCORDANCE WITH THE POLICY PROVISIONS. MIAMI SHORES, FL 33138 AUTHORIZED REPRESENTATIVE @ 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) QF The ACORD name and logo are registered marks of ACORD