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EL-19-1511Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Location Address Issue Date: 07/17/2019 Parcel Number 535 NE 95TH ST, Miami Shores, FL 33138 1132060140730 Contacts Permit NO.: EL-07-19-1511 Permit Type: Electrical - Residential Work Classification: Pool Permit Status: Approved Expiration: 01/13/2020 GARRETT & NAYLA MOFFETT Owner MAXIMO ELECTRIC Contractor 535 NE 95 ST, MIAMI SHORES, FL 33138 MAXIMO ERNESTO MARTIN Mobile: 3054092770 16931 SW 141 CT, MIAMI, FL 33177 Business: 3052832418 Other:3052383755 Description: NEW POOL ELECTRIC Valuation: $ 1,200.0j Inspection Requests: 305-762-4949 Total Scl Feet: 0.00 Fees Amount Application Fee - Other $50.00 CCF $1.20 DBPR Fee $2.00 DCA Fee $2.00 Education Surcharge $0.40 Permit Fee $50.00 Scanning Fee $3.00 Technology Fee $2.50 Total: $111.10 Building Department Copy Payments Date Paid Amt Paid Total Fees $111.10 Check # 37701 07/17/2019 $111.10 Amount Due: $0.00 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 narped-crniff—a—Tto-clpthe work stated. I I —? I)`7It Authorized Signature: Owner / Applicant / Contractor / Date July 17, 2019 Page 2 of 2 Miami Shores Village Building Department ✓U�°� �+ 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 1 INSPECTION LINE PHONE NUMBER: (305) 762-4949 BUILDING PERMIT APPLICATION ❑BUILDING EQ/ELECTRIC ❑ ROOFING ❑PLUMBING ❑ MECHANICAL [:]PUBLICWORKS FBC 20 ['' Master Permit No. lam[ -� h59 Sub Permit No. -a --En - -( I S i I ❑ REVISION ❑ EXTENSION ❑ RENEWAL ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 5-3 5- x%E& S r n ee r City: Miami Shores County: Miami Dade zip: ?J3 13 p Folio/Parcel#: I I `3Zo6~ oy-4-- 0`73a Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FIFE: OWNER: Name (Fee Simple Titleholder): N R 1-A K,J FFP_ r Phone#: Address:IU �1 Q 6-SjLLe_r �. City: A G*M i✓ S tA-� n e N State: 7j:�(y R C; U IA- zip: Tenant/Lessee Name: Email one#: CONTRACTOR: Company Name: M if Y/YYl v Cc le (In M -by C Phone#: Address: 1691 S LA-) 14f 3 City: �� �m C State: FL 0 0-03 1`-7 o�- Zip: 7 Qualifier Name: State Certification or Registration #: 1;G I hone#: Certificate of Competency #: DESIGNER: Architect/Engineer: A, I C:S&no,,Lo TH ft Lmr Phone#: 7l b `597 — 3 n3 3Z v1� Address: � 3`tz SLAJ N SST_ City: Ivy _04Y-ft- State: PZ. Zip: 3 3 1-7 Value of Work for this Permit: $ \2-(DC).___ Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: 't- Specify color offccolor thru tile: Submittal Fee $ Permit Fee $ Scanning Fee $ Technology Fee $ Structural Reviews $ (Revised02/24/2014) Radon Fee $ Training/Education Fee $ CCF $ DBPR $ CO/CC $ Notary $ Double Fee $ Bond $ x TOTAL FEE NOW DUE $ I 1 V 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 Signaturebl �~���/G'r�%`�� OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this Q Z day of r t 4LZ- , 20 11 by �_ day of M 20 n by A&yLr4 who is personal_known to who is aam naUy known to me or who has produced as me or who has produced as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: •,atilw, RICHARD P SUMMER .a,.,,. RICHARD P SUMMER Sign: .``��ar nee.,, rida Sign:. .`•,rr •o ••. Print: j' ' -` Commission N GG 046773 print: i • ` Commission #� GG 046773 y o , My Comm. Expires Nov 14, 2020 Seal: '•�,°; ,`„�•` Bonded throMffugh National Notary Assn. Seal:-%��F•`, gyp•,,,,•••` Bonded through National Notary Assn. IF :*r:***•*r*s*t***rssr**r*srsr*ssr***r•**********r*******rs***rss**rsrrssr*ss:wesasssssr*ssr*ss*s****�arwss** l APPROVED BY/4 �IV Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) Property Information Folio: 11-3206-014-0730 Property Address: 535 NE 95 ST Miami Shores, FL 33138-2731 Owner GARRETT C MOFFETT NAYLA MOFFETT - Mailing Address --..._..._......... __ 535 NE 95 ST MIAMI SHORES, FL 33138 USA PA Primary Zone ... ........ _..................... ..__......... ......._. Primary Land Use 1000 SGL FAMILY - 2101-2300 SQ ._.... _........................ _....... _..... __ ... __...._.............._ 0101 RESIDENTIAL -SINGLE FAMILY: 1 UNIT Beds / Baths / Half 3/2/0 Floors 1 Living Units 1 Actual Area 2,152 Sq.Ft Living Area 1,786 Sq.Ft Adjusted Area 1,956 Sq.Ft Lot Size 10,725 Sq.Ft Year Built 1950 Assessment Information Year 201!7$3,672 2017 Land Value $321,85 $321,854 Building Value $163,36 $167,903 XF Value $3,627 -- $3,717 -.._._.......... _ Market Value __._..._... $488,846 ._._.__.... _.......... $491,160 $493,474 Assessed Value $488,846 $491,160 $493,474 Benefits Information Benefit Type 2019 2018 2017 Homestead Exemption $25,000 $25,000 $25,000 Second Homestead Exemption $25,000 $25,000 $25,000 Note: Not all benefits are applicable to all Taxable Values (i.e. County, School Board, City, Regional). Short Legal Description MIAMI SHORES SEC 2 PB 10-37 LOT 17 & E1/2 LOT 16 BLK 54 LOT SIZE 75.000 X 143 OR 14535-1914 0590 1 Generated On : 7/17/2019 Taxable Value Information 2019 2018 2017 County Exemption Value $50,000 $50,000 $50,000 Taxable Value $438,846 $441,160 $443,474 School Board Exemption Value $25,000 $25,000 $25,000 Taxable Value $463,846 $466,160 $468,474 City Exemption Value $50,000 $50,000 $50,000 Taxable Value $438,846 $441,160 $443,474 Regional Exemption Value $50,0001 $50,000 $50,000 Taxable Value $438,846 $441,160 $443,474 Sales Information Previous Sale Price OR Book -Page Qualification Description 10/24/2016 $635,000 30287-3108 Qual by exam of deed 08/06/2013 $533,300 28763-3650 Qual by exam of deed 05/01/1990 $115,000 14535-1914 Sales which are qualified The Office of the Property Appraiser is continually editing and updating the tax roll. This website may not reflect the most current information on record. The Property Appraiser and Miami -Dade County assumes no liability, see full disclaimer and User Agreement at http://www.miamidade.gov/info/disclaimer. asp Version https://www8.miamidade.gov/Apps/PA/propertysearch/ 7/17/2019 A� � CERTIFICATE OF LIABILITY INSURANCE I DATE o (MMtDD 8 ) 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()es) 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: David Gil, Sr. _ Gil & Associates Insurance PHONE FAX (AIC, Ny,_EX , (305 ) 279-7665 AICtiNo)p (305) 279-9705 9485 S.w 72 St Suite A-120 E-MAIL ADDRESS: dQ9 it Ilinsurance.com 9 Miami INSURED Maximo Electric, Inc 16931 SW 141 Ct INSURER(S) AFFORDING COVERAGE _ NAIC 11 FL_33173 _ INSURER A:_WE_SCO INS CO25011 INSURERB: PROGRESSIVEEXPRESS 10193 INSURER C : INSURER D : I Miami FL 33177- I INSURER F : COVFRAAFR CFRTIFICATF NIIMRFR• RF\/I¢IAu w1KRUCD• 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 ADO ,9UBR; POLICY EF POLICY EXP LTR TYPE OF INSURANCE INSO WVDI POLICY NUMBER MMIDDIYYYY MMID LIMITS X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE 2 OCCUR EACH OCCURRENCE -DwETiSIiENTED PREMISES (Ea eccurten�. S 1,000.000 $ 100,000 MED EXP (Any ono person) S 5,000 A WPP1389385 03 07/29/2018 07/29/2019 PERSONAL & ADV INJURY I s 1,000,000 AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE IS 2,000,000 ,-GEN'L X I POLICY L l JET J LOC '--� PRODUCTS -COMP/OP AGG I S 2,000,000 I S OTHER. i AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ee accident $ 1 OO,000 ANY AUTO I BODILY INJURY (Per person) I S B �~ ALL OWNED SCHEDULED AUTOS %� AUTOS NON -OWNED HIRED AUTOS AUTOS ( 02406982-0 09/23/2017 09/2312018 BODILY INJURY (Per accident) 1 PROPEGE Wor accident) — S $ -� S UMBRELLA LIAR OCCUR HI EACH OCCURRENCE _$ S EXCESS Lp1B CLAIMS -MADE AGGREGATE DEO I RETENTIONS _ $ I WORKERS COMPENSATION AND EMPLOYERS' LUIBILITY YIN ANY PROPRIETOR/PARTNERIEXECUTIVE ❑ OFFICERIMEMBER EXCLUDED? NIA A PER OTH- STATUTE ER E.L EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE (Mandatory In NH) S It yyebe s, desce Under DCSCRIPTION OF OPERATIONS bekar E.L. DISEASE - POLICY LIMIT S DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached R more space Is requirod) LICENSE #EC13005618 CERTIFICATE HOLDER CANCFI 1 ATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Miami Shores Villas Building Department AUTHORIZED REPRESENTATIVE 10050 NE 2nd Avenue Miami Shores FL 33138 ©1988-2014 ACORD CORPORATION. All rights reserved, ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD JIMMY PATRONiS CHIEF FINANICAL OFFICER STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION • • CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW • " CONSTRUCTION INDUSTRY EXEMPTION This ceftifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law. EFFECTIVE DATE: 6/31/2019 PERSON: MAXIMO MARTIN FEIN: 201480521 BUSINESS NAME AND ADDRESS: MAXIMO ELECTRIC INC 16931SW141CT MIAMI, FL 33177 SCOPE OF BUSINESS OR TRADE: EXPIRATION DATE: 5/30/2021 EMAIL: MAXIMOMARTIN@BELLSOUTH.NET IMPORTANT: Pursuant to Chapter 440.05(14). F.S., an officer of a corporation who elects exemption from this chapter by fierng a cardficete of election under this section may not recover benefit or compensation under thIs chapter. Puasuant to Chapter 440.05(12), F.S.. Certificates of election to be exempt... apply only wtfti the atxtpe ofthe business or trade dsfed on the tno11 s of election to be exempt. Pursuant to Chapter 440.06(13). F.S., Nofces of election b be exempt and certificates of election to be exempt shall be subject to revocation if, at any time after the Ong of the notice or the Issuance of the oertlllcate, the person named on the notice or cerlikata no longer..the re0 aments of Oft *action for Issuance of a certificate. The deperimmA shall revoke a oartificate at any time for fsikne of the person named on the certificate to most the nxp* merft of leis section. DFS-F2.0WC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUESTIONS? (850)413-1609 AL4XLKO ELECTRIC INC. MAXIMO MARTIN 16931 SW 141 CT M)AMI FL 33177 LIC#EC13005618 State of Florida County of Miami Dade Date: 7/8/19 Before me this day personally appeared Maximo Martin who, being duly sworn, deposes and says: That he or she will be the only person working on the project located at: 535NE 95 T1 I ST. MIAMI SHORES FL. 33138 Contractor Signature Sworn to (or affirmed) and subscribed before me this 8'11 day of July. 2019. by Maximo Martin who is Personally know, OR Produced Identification Type of Identification Produced ,1-%PAY Pug, ' ' �' MAYELIN QUESADA 0 SI state of Florida =Public- COMMI$610n GO 060410 C $$ion 410 Ga 060 fl 11, e` BNotary M M Comm. y M . Explr�s Jan 5 , 2021 Y Comm. Explies Jan 5, 2021 onaed Mug National Bonded thfoUgh National Notary ASSn, 'o nal Nola Print, Type or Stamp Name of Notary Miami shores Village Building DepDartme' 10050 N, E, 2nd Ave Miami Shores, Florida 331 Tol: (306) 7961 ' : Fax 6at751-1 Notice to Owner - Workers' Compensation Insurance Exem Florida Law requires Workers' Compensation insurance coverage under Chapter 440 of the Florida Statutes, Flaw 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 (I.LC) in the construction industry may elect to be exempt if. 1. The officer owns at Ic"t 10 percent of the stock of the corporation, or in the caw of an LLC, a statement attesting to the minimurn 10 percent ownership; Z. 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 slating 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 YOLT ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND !ITS CONTENTS. Signature: iOi �IWA, n. r State of Florida County of Miami -Dade The foregoing was acknowledge before me this,,_.g _ day .f 20, 1 J By_ who is PC C gaWJXJn9wn to me or has produced is identification. 117, 11tL_TJ7tff_1 ..,TAX r I C