EL-18-1829`y�aOREs L,`
Miami Shores Village
10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138-0000
Phone: (305)795-2204
FxOR1DP'
Permit No. EL-7-18-1829
Permit Type: Electrical - Residential
Pen
Work Classification: Alteration
Permit Status: APPROVED
Issue Date: 8/9/2018 1 Expiration: 02/05/2019
Project Address Parcel Number Applicant
68 NE 91 Street 1131010200020
Miami Shores, FL 33138- Block: Lot: ROBERT IRWIN FLOYD GONZAL
Owner Information
Address
Phone
ROBERT IRWIN FLOYD GONZALES 68 NE 91 Street (305)492-9763
MIAMI SHORES FL 33138-2808
68 NE 91 Street
MIAMI SHORES FL 33138-2808
Contractor(s) Phone Cell Phone
REGENCY MAINTENANCE & ELECTRI (305)728-9171
of Work: ELECTRICAL AS PER PLANS
onal Info:
ification: Residential
Scanning: 1
Fees Due
CCF
DBPR Fee
DCA Fee
Education Surcharge
Permit Fee - Additions/Alterations
Scanning Fee
Technology Fee
Total:
Amount
$1.80
$2.25
$2.00
$0.60
$150.00
$3.00
$2.40
$162.05
Cell
Valuation: $ 2,500.00
Total Scl Feet: p
Pay Date Pay Type Amt Paid Amt Due
Invoice # EL-7-18-68147
08/09/2018 Credit Card $ 162.05 $ 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 zXing. Ohermore, I authorize the above -named contractor to do the work stated.
August 09, 2018
Authorized Signature: OlfD / Applicant / Contractor / Agent
Building Department Copy
August 09, 2018
1
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel• (305) 795-2204 Fax• (305) 7[Zr-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949 '
BUILDING
PERMIT APPLICATION
❑BUILDING '�6 ELECTRIC ❑ ROOFING
FBC20(-'�
Master Permit No. !�(4 `Ae - 3--2)"'
Sub Permit No._F�-Qj " 1 (-) Z-n
❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR
DRAWINGS
!^ C `
R t) 6 9 (s+
JOB ADDRESS:
V 7 T-
City:
Miami Shores County:
Miami Dade Zip: 3
?J' (3p
Folio/Parcel#:
1 to - O20 - b02-0
Is the Building Historically Designated: Yes
NO
Occupancy Type:
Load: Construction Type:
Flood Zone: BFE:
FFE:
OWNER: Name (Fee Simple Titleholders ot'tze'u S Phone#: ?Os t' 776
Address: tf
C r' ..
City: fq.� L J✓` O Ve5 State: 11 Zip: p
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: / Lim i(/" Phone#: b
Address: 2
City: State: Zip: r331033
JQualifier Name: Phone#:
State Certification or Registration #:. Certificate of Competency #:
" ' •. DESIGNER: Architect/Engineer: Phone#: _
Address: City: State:
Value of,.Work,for this Permit:.$ 21� 00 0-0 Square/Linear Footage of Work:
Type.of Work: Addition 'oAlteration ❑ New ❑ Repair/Replace
r �
t" ' »Description of Work: iE Uv c/" 1�l L?5
Zip:
❑ Demolition
Specify color of color thru tile; i T
Submittal Fee $ Permit Fee $ 1Jr®t CCF $ CO/CC $
Scanning Fee $ Radon Fee $ DBPR $ Notary $
Technology Fee $ Training/Education Fee $ Double Fee $
Structural Reviews $ Bond $
TOTAL FEE NOW DUE $ 167Z - 0
(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 reinspection fee will be char ed
Signature
OWNER or AG
The foregoing instrument was acknowledged before me this
day of b .p 20J by
lwLs personally known to
me or who has produced (� _ v , as
identification and who did take an oath.
NOTARY PUBLIC:
Print:
Seal:
MAHARAIK.GONZALEZ
9
-, FXSignature
CO TRACTOR
The for going instrume t as ac owledged beJh
(o day of 20who is personme or who has producedidentification a who did ak an oath.NOTARY PU Q„c, :
C OrtirSign:
.^
Print: •c
EXPIRES:Novembar2,2020
rwters Seal:
Bonded Thru Notary Pu*Unded
-3>47
or r . • : ;
'�if�.r 1�f`'11r"1N"�. y.aV,I�lf•
############################################################################################################
APPROVED BY Y /.P Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
STATE OF FLORIDA
M, DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
ipAl
ELECTRICAL CONTRACTORS LICENSING BOARD
1940 NORTH MONROE STREET
TALLAHASSEE FL 32399-0783
NEGRIN, FELIX A
REGENCY MAINTENANCE & ELLCTRIC INC
504 S.Nl 1201 H AVENUE
MIAMI FL 33184
ongratulations? With this license you become one of the nearly
We rrlimon Floridians licensed by the Department at Business and
Professional Regulation. Our professionals and businesses range
`rom 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 www.myfloridaliconse.com. There you can find morn
information about out divisions and Hie regulations chat impact
you, subscribe to department newsletters and learn more about
the Department's initiatives.
Our mission at the Department is. License Efticicntl�, Regulate
Fairly. We constantly strive to serve you butler so that you can
serve your customers. I'hank you for doing business in Horida,
and wii9ratulations urI your new license?
RICK SCOTT. GOVERNOR.
(850j 487-1395
STATE OF FLORIDA
t: 4DEPARTMENT OF BUSINESS AND
PROFESSIONAL REGULATION
EC 1300588.4 ISSUED: 06/19/2016
CERTIFIED ELECTRICAL CONTRACTOR
NEGRIN, FELIX A
RE'GENCY MAINTENANCE & ELECTRIC INC
IS Ctx f 1't it=n under Ito provisions Of Ch aa, i•,;
i �pniss^n ti�te AU 3:.'A75 ;,t �CiC�19ik:;Ft(1.;':
DETACH HERE
KEN LAWSON. SECRI-fARY
STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
ELECTRICAL CONTRACTORS LICENSING BOARD
EC13Q05Rt3a ADDITIONAL BUSINESS QUALTFIGITION
I m Gt_C l.. r rNm--ki- —U IN I MARE— i UK
Named below IS CERTIFIED
Under the provisions of Chapter 489 FS.
Expiration date. AUG 31, 2018
NEGRIN, FELIXA
REGENCY MAINTENANCE & ELECTRIO INC
3701 NE 170TI•I STREET, APT 3
NORIH MIAMI BEACH FL 33160
ISSUED: osr10r2ot0 DISPLAY AS REQUIRED BY LAW SE0.4 1-1606190001635
UIW0.f
Local Business Tax Receipt
Miami -Dade County, State of Florida
-THIS IS NOT A BILL -DO NOT PAY
7166581
LBT
EMSINESS'NAME/LOCATION
RECEIPT NO.
EXPIRES
REGENCY MAINTENANCE & ELECTRIC
INC RENEWAL
SEPTEMBER 30, 2018
3701 NE 170 ST APT 3
7445063
Must be displayed at place of business
N MIAMI-BCH FL 33160
Pursuant to County Code
Chapter BA - Art. 9 & 10
OWNER
SEC. TYPE OF BUSINESS
REGENCY MNTNtE & ELECTRIC INC
196 EiECTRICAL CONTRACTOR PAYMENT RECEIVED
C/O ANAYS ALVAREZ PRES
EC13085884
BY TAX COLLECTOR
Worker(s) T '
"
$45.00 09/26/.2017
CREDITCARD-17=06344T
This Local Business Tax Receipt only confirms payment of the Local Business Tax. The Receipt is not a license,
permit, or a certification of the holders qualifications, to do business. Holder must comply with any governmental
at nongovernmental regulatory laws and requirements which apply to the business.
The RECEIPT NO. above must be displayed on all commercial vehicles - Miami -Dade Code Sec Ba-276.
For more information, visit www.miamidade gpv t caltacirir ,
w
ACOR I
�� CERTIFICATE OF LIABILITY INSURANCE
DATE(MMIDD/YYYY)
06ro52018
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 pollcy((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 endorsements .
PRODUCER
Ample Insurance Company
PO Box 929
Oakland FL 34760
E Flor Molina
PHONE 305-264-9900 FAx N
ocgE • fmolina@amploins.com
INSURER AFFORDING COVERAGE
NAIC
INSURER A: GRANADA INS CO.
INSURED
REGENCY MAINTENANCE & ELECTRIC INC
655 S.E. 37 TERR
HOMESTEAD FL 33033
INSURER B : ASSOCIATED INDUSTRIES INS. CO
INSURER C :
INSURER D :
INSURER E
INSURERF:
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
TYPE OF INSURANCE
ADO
UK
POLICY NUMBER
POLICY EFF
CY EOIP
LIMITS
A
X
COMMEiCNALOEtERALLYIBIUTY
CLAIMS -MADE a OCCUR
0185FL00063928
10/212017
10/21/2018
EACH OCCURRENCE
S 1,000.000
DAMAGE TO RENTFU
S 100,000
NED EXP VM one ereon
S 5,000
PERSONAL A ADV INJURY
S 1,000,000
GENLAGGREGATE UMITAPPLIES PER:
POLICY ❑ J�LOC
MKOTHER:
GENERAL AGGREGATE
S 2,000,000
PRODUCr9-COMPIOPAGG
S 2,000,000
S
AUTOMOBILE LIABILITY
ANY AUTO
NED AUTOSSCHEDULEDHEDU
ALL OWNED
NON -OWNED
HIRED AUTOS AUTOS
INED LEUMfr
S
BODILY INJURY (Per parson)
S
BODILY INJURY (Per acddem)
S
S
S
UMBRELLA UAB
EXCESS LIAO
OCCUR
CLAIMS -MADE
EACH OCCURRENCE
S
AGGREGATE
S
DED I I RETENTIONSS
B
WORKERS COMPENSATKON
AND EMPLOYERS LIABILITY
ANY PROPRIETORIPARTNERIEKECUTIVE YIN
OFRCERMEMBERE%CLUDED9
(W ndetory M N")
Udes' be under
DESCRIPTION OF OPERATIONS below
MIA
AWC 1086643
07/312017
07/312018
X R E
E.L. EACH ACCIDENT
S 1001000
E.L. DISEASE - EA EMPLOYEE
S 10D.000
E.L. DISEASE - POLICY LIMIT
S 500,000
DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Addhional Remark, Schedule, may be eeeohed N more space Is required)
ELECTRICAL WORK""'
ncenelnATe unr nco CAhICF1 I ATIAN
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
VILLAGE OF MIAMI SHORES
10050 NE 2ND AVE
AUTHORIZED REPRESENTATIVE
MIAMI SHORES VILLAGE FL 33138
W 1UNS-ZU14 AWNU UVhVUKA1 wN. wi ngnm roservea.
ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD