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EL-19-1873Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Issue Date: 08/16/2019 Location Address Parcel Number 601 GRAND CONC, Miami Shores, FL 33138 1132060172140 Permit No.: EL-08-19-1873 Permit Type: Electrical - Residential Work Classification: Pool Permit Status: Approved Expiration: 02/12/2020 Contacts CARLOS FELIPE LEMOS Owner FLORIDA ELECTRIC SOLUTIONS INC Contractor 601 GRAND CONC, MIAMI SHORES, FL 33138 YOISLANDY MARRERO 9115 BROAD MANOR RD, MIAMI, FL 33147 Description: NEW SWIMMING POOL WITH SPA Valuation: $ 1,850.00 Inspection Requests: 49 TotalSq Feet: 611.00 �j Fees Amount Application Fee - Other $50.00 CCF $1.20 DBPR Fee $2.00 pCA 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 # 4780 08/16/2019 $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 namgd cRntractor tRdo the work stated. Authorized Signature: Owner / Applicant / Contractor / I Agent Date August 16, 2019 Page 2 of 2 r Miami Shores Village 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 BUILDING PERMIT APPLICATION ❑BUILDING g ELECTRIC ❑ ROOFING 4ECEIVEC AUG 14 fq UZ-1 FBC 20 Master Permit No. TO -64p- C1 1 " 114 5 9 Sub Permit No. �- 1 ^� �rl 3 ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 6 D 1 ARAO ( lW( 6V G VQ . City: Miami Shores County: Miami Dade Zip: -7'5 1 39 Folio/Parcel#: I q2 9 3 ^ l o a 0 1- -zoo I Is the Building Historically Designated: Yes NO Occupancy Type:01"Load: Construction Type: Flood Zone: BFE: FFE: OWNER: 7 Address: (_ DU'l (-'> Kra l iV� JQ/ L.(J/V �.y� I �7G / L�-- City: _ ,�,Rb/- e IG nn State: eL . Zip:: Tenant/Lessee Name: n\>W K1 e V- �G Vi�/ 17 Phone#: 305- 71O4i- 70 yJ % Email: a � -moi ; 6 q mcA J - C.o lmIle V CONTRACTOR: Company Name: tj)(Z)C>A G�"I r1C. g0L0b6ti S Phone#: 796-24910' 1610 Address: !q I ! J 066AD MA MiA '9D. 2 City: M1AM II+ �( `/ �,�/� pState: ,/���i• Zip: 15 /)�q C, o Qualifier Name: /65LANQ 7 ►r A1Zke ,6 Phone#: 7�(O - 2 !0 " ( a,40 State Certification or Registration #: IF -RI' �cJO ('� �J g Certificate of Competency #: I E dy d g DESIGNER: Architect/UL---.:�neerVgtcen7 c RAMC-0 �/� Phone#: 365"-465-543jp Address: jD YV I 01 t+ WirAIL- r L• City: II1)t71I ! Stater Zip: :! 3 (% O Value of Work for this Permit: $ I 1,50. Ov Square/Linear Footage of Work: Type of Work: E� Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: Specify color of color thru tile: Submittal Fee $ Permit Fee $ Scanning Fee $ Technology Fee Structural Reviews $ Radon Fee $ Training/Education Fee $ CCF DBPR $ CO/CC $ Notary $ Double Fee $ Bond $ ]� TOTAL FEE NOW DUE $ (Revised02/24/2014) 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 $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a rein�qction fee will be charged. Signature \—/ • NER ottAGENT The foregoing instru en t was a knowledged before me this day of V J S 20, by COX i O S FO I voe, Ll',fYlQ&ho is personally known to me or who has produced as Signatu Tl �Yegoing 'nstru day of voi s Lam DV or who has produced identification an ho did take an oath. identificatiorLICC NOTAM( PUB NOTARY)�{1 Sign: Sign:_ Print:�u15 n117�SL------_-_-- Print: ;:� c1, lAIIS ESPINOSA Seal: ;;�• Seal: Commission p GG 290679 'd Expires January 13. 2023 Bondod Thru Troy rein Insurance 800.385-7019 �******�****************** APPROVED B U� lJ /f T.r�Z /Plans Examiner Structural Review CONTRACTOR i-s ackngwledged before me this ys 7 , 20 /f , by is personally known to as did take an oath. LIJI1S ESPINOSA Commission # GG 290679 Expires January 13, 2023 Bnndod Thru Troy Fein Insurance 800*5-7010 *************** Zoning Clerk (Revised02/24/2014) 8/14/2019 IMG_0488.jpg ' .JL 1. d.11 ;: 1., Rn ca+ N,.�..1•���.F. 'k: Nr'1 - 'of U'v db v STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD HE I. It TRICAL C ONTRAC rr rR •aF Zr1N HAS rL(.,I`r 1E11El.) UNDER THE 11 PROVISION!' OF CHAP ER 189 FLORIDA STATUTES MARRERO, YOISLANDY FLORIDA LLLC i RIC SOW I ON$. INC. 91-15 BROAD MANOR RD MIAMI FL 33147 LICENSE NUMDER. F-1113014501 EXPIRATION DATE; AUGUST 31, 2020 AIways vc'nfy liconses vnli,;e at MyFloridal-mvnw,com ' Do not alter that document in any foam. This is your liccose It It unlawful for anyone other than the linen, Pc to uae this document. https://mail.google.com/mail/u/1Ninbox/FMfcgxwDgfMNbSNCSMHNDdphtfsNVzlf?projector=l 1/1 FLORIDA ELECTRIC SOLUTIONS INC CC# 12-CME-11900-R EXPIRES 08/31/2019 ACORD Page 2 of 2 GATE IMMAD/y1'YVI A��® � CERTIFICATE OF LIABILITY INSURANCE D6nanDls COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: CERTIFICATE HOLDER CANCELLATION i�Y, 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE GOES 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. g 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 endarsement(sj. PRooucea ry�E. Marian He 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 VMTH 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. EXLLJSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. Ns LTR TYPE OF INSURANCE Iry3p YVVD POLICY NUMBER POLICY IMMUl]DIVWY) (MMODNVYY) UNITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 3 1000000 100000 CLAIMS -MADE DX OCCUR PREMISES (Ea accym rce) E MEG E%P lAny one peerwnl 3 5,000 CL 1683110 12/22/2018 12/22/2019 PEasoNAL s Aw INJURY a 1000000 GEN'L AGGREGATE LIMR APPLIES PER GENERAL AGGREGATE S 2000000 PRODUCTS-CAMPIOP AGO S 200D000 POLICY OJEG OLOC E OTHER LOMU M1EJ SINGLE LIMIT (Ea ocademl E AUTOMOBILE DABIDTY BODILY IM1..RV IPer peraonl E ANY AUTO BOOILV INJURY IPer accdenll E OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NONd'WNED PROPER'V DAMAGE (PerawMeMl E AUTOS ONLY AUTOS ONLY E UMBRELLA DAB OCCUR EACH OCCURRENCE 3 AGGREGATE E E %GEES DAB CLAIMS -MADE OED RETENTION E E WORKERS COMPENSATION PER OTH- 6'ATUTE ER AND EMPLOYERS' DABILITy y / ry ANY PROPRIETOPIPARTNERrE%ECUTIVE ACCIDENT E OFFICER:MEMBER E%CLUDEOT O N/AEACH (Mandatory InUISEAEE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT 11 yea, tlewMa agar SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE E%PIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. MIAMI SHORES VILLAGE AUTHORIZED REPRESENTATIVE 10050 NE 2 AVE n / MIAMI SHORES FL 33138 a https://api.accuagency.com/api/2.0/AcordForms/Reprint?printed[temld=Sd5463df22235b0... 8/14/2019 JIMMY PATRONIS CHIEF FINAWCAt. 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 certifies that the lndNWual listed below has elected to be exempt from Florida Workers' Compensation law. EFFECTIVE PATE., 4/21/2019 PERSON: YOISLANDit MARRERO FEIN.- 274625762 BUSINESS NAIVE AND ADDRESS: ELECTRIC SOLUTIONS, INC. 9115 BROAD MANOR RD MIAMI, FL 33147 SCOPE OF BUSINESS OR TRADE: t raeansad ewtrtcai ContracOr EXPIRATION DATE: 4/2012021 EMAIL: FLORiDAELECTRICSOLUTION CaGMAILCOM DRTANT- Pt:rWarrt is t teptea 440.05114j, F.S , an officer of a CDMordiOn who aWcts ctXOMPhOn tram Ust!s duVerby "no a caMcase of eteet'on tasdsr section may not recow�' bonei`ts or oompensation und*r this char. Pursuant to Chaipter 440i 05(12t, F.S„ Certlii 40S Ot election to tso e)dimt.. beP�r wuhin tho swpo of the business or trade Wed an the not." of.ohx%on to be e�tcnipt Purtuasst to C haler 440 t?5(13), F.S., Nolkes of eJeWan t©ba tpi ar r1 o4ttifieatr s of !!1@Gti01! to b6 exe�mpi a*" ba -$u*ct to revacatuas it, at any tine titter the LaM of the notwo or The issu2tow of stye certfta*, tFte an a used ors the mica ec rondo be M longue gets the regtiirsrments of this secOnn for issuanco al a cerii'lcato. Thp &,p* tmisni ,shaft rwalta a bate at any I," i it faltu►o of Ine pawn named on "cedftatv try MW t1tQ recjtftmvnt3 of Uiis saWcxs, CERTIFICATE OF ELECTION TO BE (XEMPT DEVISE[? 08.13 QUESPONS? ( U}413.160S 8/14/2019 (16 unread) - aquadesignl@bellsouth.net -AT&T Yahoo Mail - ' I . E'ER FIrICC TE OF `_IARiii € '1 F 1-1 ES t7IC SQt s i file:///C:/Users/Lu is/Desktop/cert. html 4/5 FLORIDA ELECTRIC SOLUTIONS 9115 BROAD MANOR RD. MIAM1, FL. 33147 DATE: AUGUST 15, 2019 STATE OF FLORIDA COUNTY OF DADE Before me this day personally appeared Yoislandy Marrero who being duly sworn, Deposes and says: That he or she will be the only person working on the project located at: 601 Grand Concourse Rd. Miami Shores, Fl. Sworn to ( Or Affirmed) and subscribed before me this 1-�,24day of (J LIs 2019 By �15�1�ti(�122 Personally known Or Pr u e entification Ty p of ification produced -- LUIS ESPINOSA Notary Commission # OG 290679 Seal: - ,'� Expires January 13, 2023 •�!:�,!.`,`' Bonded Thm Troy Fein Insurance 000.3857019 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: l . 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/`') � f Signature: L er State of Florida I County of Miami -Dade The going was acknowledge before me this day of 20. By e )—e",f7 who is personally known to me or has produced as identification. Notary: SEAL: LUIS ESPINOSA Commisslon # GO 290679 BnWed lhru Troy feln Meuranee 800.9W1019