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EL-20-671Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Issue Date: 04/09/2020 Location Address Parcel Number 258 NE 100TH ST, Miami Shores, FL 33138 1132060134460 Contacts Permit NO.: EL-03-20-671 Permit Type: Electrical - Residential Work Classification: Alteration Permit Status: Approved Expiration: 09/23/2020 ANNE MENNES Owner LEC ELECTRIC INC Contractor 258 NE 100 ST, MIAMI SHORES, FL 33138 LEONARDO RODRIGUEZ Mobile: 3054581190 17130 NW 82 AVE, MIAMI, FL 33015 Business: 7862296157 LECELECTRICINC@YAHOO.COM Requests: Reo Inspection Description: ELECTRICAL FOR REMODEL KITCHEN REMODEL valuation: $1,800.00 Ins 305-eti Re BACK PORCH 49 Total Sq Feet: 225.00 —j Fees Amount CCF $1.20 DBPR Fee $2.00 DCA Fee $2.00 Education Surcharge $0.40 Permit Fee $100.00 Scanning Fee $3.00 Technology Fee $2.50 Total: $111.10 Payments Date Paid Amt Paid Total Fees $111.10 Credit Card 04/09/2020 $111.10 Amount Due: $0.00 Building Department Copy 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 named contractor to do the work stated. COVID-19 Authorized Signature: Owner ! Applicant / Contractor / Agent Date April 09, 2020 Page 2 of 2 BUILDING PERMIT APPLICATION ❑ BUILDING [S ELECTRIC Miami Shores Village RECEIVED Building Department MAR 2 7 2020 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 BY: INSPECTION LINE PHONE NUMBER: (305) 762-4949 410--141JA FBC 20(� Master Permit No. &C r g- l g- 2l IY8 Sub Permit No-,L a3y 20 -6-:): ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Ty OWNER: Name (Fee Simple Titlehold Address: Tena Email Flood Zone: BFE: FFE: S State: Zip: Zip: �c3/ FAM-l."A ne#: c � T CONTRACTOR: Company Name: L E—c n �\C " '00'U Phone#: Address: / �_/ '7A2(.) -Va_j P)? 4 l/ City: I-�- I'� %- e rd L"- I Qualifier Name: �-eO JA I-, _Zip: -75 . /c State Certification or Registration #: C P ?,e2D S4l Zi Certificate of Competency #: DESIGNER: Architect/Engineer: Ad City: ne#: State: Zip: Value of Work for this Permit: $l%'� r� Square/Linear Footage of Work: Type of Work: ❑ Addition Alteration ❑ New �i ❑ Repair/Replace ❑ Demolition Description of Work: 24/U Specify color of color.thru tile: ,. Submittal Fee $ V Permit Fee $ CCF $ CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Notary $ Technology Fee $ Structural Reviews $ Training/Education Fee $ Double Fee $ Bond $ (Revised02/24/2014) TOTAL FEE NOW DUE $ 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 appro ed and a reinspection fee will be charged. Signature Signature OWNER rAGENT CONTRACTOR The foregoing instrument was acknowledged before me this day of IZ-( 20 by At-i N rL- rl-N N r`-), who is personally known to me or who has produced 'P-1- l -IV as identification and who did take an oath. The foregoing instrument was acknowledged before me this 'd of �Al/� C'� \ 20 Zd , by -is-personally known to me r who has produced as identification and who did take an oath. NOTARY PUBLIC: !!4 111IOi// /�/ NOTARY PUBLIC:/ Sign: 1EXPIRF '> Sign: --� ° Print: ��r q Print:cli Seal: ` 4f Q4 0:, � 0� . Seal: = °' `" Commission # GG056725 Expires: April 11, 2021 y �,,� • , • - . �� Bonded thru Aaron Notary APPROVED BYVlt��2 Ma/% . Plans Examiner Structural Review Zoning Clerk (Revised02/24/2014) Property Search Application - Miami -Dade County Page 1 of 1 U U r y "HWE "I' THE 0"'Ru"PER'l " N APPRAISER t, Summary Report Property Information Folio: 11-3206-013-4460 Property Address: 258 NE 100 ST Miami Shores, FL 33138-2419 Owner ANNE M MENNES Mailing Address 258 NE 100 ST MIAMI SHORES, FL 33138-2419 PA Primary Zone 1000 SGL FAMILY - 2101-2300 SQ Primary Land Use 0101 RESIDENTIAL -SINGLE FAMILY: 1 UNIT Beds / Baths / Half 3/2/0 Floors 1 Living Units 1 Actual Area 2,197 Sq.Ft Living Area 1,601 Sq.Ft _ __.--.._.- ........ ............._.......- Adjusted Area _.. 1,922 Sq.Ft Lot Size 8,625 Sq.Ft Year Built 1950 Assessment Information Year 2019 2018 2017 ................. Land Value $258,854 $258,854 $258,854 Building Value $133,771 $133,771 $133,771 XF Value $495 $495 $495 Market Value $393,120 $393,120 $393,120 Assessed Value 1 $188,8121 $185,2921 $181,481 Benefits Information Benefit Type 2019 2018 2017 Save Our Homes Assessment $204,308 $207,828 $211,639 Cap Reduction Homestead Exemption $25,000 $25,000 $25,000 Second Exemption $25,000 $25,000 $25,000 Homestead Note: Not all benefits are applicable to all Taxable Values (i.e. County, School Board, City, Regional). Short Legal Description MIAMI SHORES SEC 1 AMD PB 10-70 LOT 5 & E1/2 LOT 6 BILK 33 LOT SIZE 75.000 X 115 OR 18087-0343 0498 1 Generated On : 3/27/2020 Taxable Value Information 2019 2018 2017 _ ------__.._ .._.........._ ............._...._----- County Exemption Value $50,000 $50,000 $50,000 Taxable Value I $138,812 $135,292 $131,481 School Board Exemption Value $25,000 $25,000 $25,000 Taxable Value $163,812 $160,292 $156,481 City ---- Exemption Value $50,000 $50,000 $50,000 Taxable Value $138,812 $135,292 $131,481 Regional Exemption Value 1 $50,000 $50,000 $50,000 Taxable Value $138,812 $135,292 $131,481 Sales Information Previous OR Book - Price Qualification Description Sale Page 26818- Sales which are disqualified as a result 04/15/2008 $10 3031 of examination of the deed 18087 04/01/1998 $151,400 Sales which are qualified 0343 17051- 12/01/1995 $135,300 Sales which are qualified 4169 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://www.miamidade.gov/Apps/PA/propertysearchJ 3/27/2020 R. n 0 RICK SCOTT, GOVERNOR JONATHAN ZACHEM, SECRETARY Florida EA1 1,0-0w& 1W STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL,CONTRACTORS-LICENSING BOARD THE ELECTRICAL CONTRACTOR HEREIN -IS CERTIFIED UNDER THE PROVISIOt`4S►OF CHAPTER 48?,;FL0RIDA STATUTES RODRIGUEZ; -L-EONARDO LEC ELECTRIC INC, 17130 NW 82ND.AVENUE MIAMI FL 33015, T 1 L �hnrr+F, fir.: LICENSE NUMBER:,EC13004121 EXPIRATION DATE: i. AUGUST 31, 2020 Always verify licenses online at MyFloridaLicense.com Do not alter this document in any form. This is your license. It is unlawful for anyone other than the licensee to use this document. 002-2a .Local Business Tax Receipt Miami -Dade County, State of Florida -TH S IS NOT A Bill - DO NOT PAY 4898749 BUSINESS NAME,10CATION RECEIPT NO LEC ELECTRIC INC RENEWAL 17130 NW 82ND AVE 5113378 MIAMI FL 33015 v r. G:. OWNER SEC.WPE OF BUSINESS LEC ELECTRX 11IC 196 ELECTRICAL CONTRACTOR EC13004121 Worker(s) EXPIRES SEPTEMBER 30, 2020 %'ust be d :played at plow of b�slness Pursuant tO County Code Chapter 8A - An. 9 & 10 PAYMENT RECEIVED BY TAX COLLECTOR 575.00 07/15/2019 CREDITCARD-19-056643 This local Business Tex Receipt only confirms payment of the local Business Tax. The Receipt Is not a license, permit, or a certification of the holder's quaMicat:ors, to do business. Holder most comply wi:h any governmental or nongovernmental regulatory laws and requirements which apply to the business. The RECEIPT NO. above must be displayed on all commercial vehicles - Wami-Dade Code Sec Sa-276. For more Information, visit y�ypK,M,ipiQp gg�gyEQllSI)91 ACORa CERTIFICATE OF LIABILITY INSURANCE [—DATE (MMIDONYYY) 11 /20/2019 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 Iieu of such endorsement(s). PRODUCER CON AC NAME: Brenda Global Insurance and Financial Services, Inc. H Np I at): (305) 512-9721 f INC�No): (305) 512-9889 ADDRESS: info@gbbalinsurancefla.com 6175 NW 153rd Street Suite 100E-MAIL INSURERS AFFORDING COVERAGE NAIL 0 INSURER A: Hiscox Insurance Company Miami Lakes, FL 33014 INSURED INSURER B : INSURER C : LEC Electric Inc INSURER D : 17130 NW 82nd Ave INSURER E : INSURER F : Hialeah. FL 33015 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 REOUIREMENT, 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 TR TYPEOF INSURANCE ADDL B 1 POLICY NUMBER PMOLICY F MI D POLICY EXP M ID LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE FRI OCCUR UDC-4315890-CGL-19 10/31/2019 10/31/2020 EACH OCCURRENCE $ 1,000,000.00 PREM E3 ER rrence $ 300.000.00 MED EXP (Any one person) $ 5,000.00 PERSONAL BADVINJURY $ 1,000,000.00 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY ❑ PRO• ❑ JECT LOC OTHER. GENERAL AGGREGATE $ 2,000,000.00 PRODUCTS - COMP/OP AGG I $ 2,000,000.00 is AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NO OWNED HIRED AUTOS AUTOS COMBINED SINGLE LIMIT $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTYDAMAGE$ Per accident UMBRELLA LIAR EXCESS LIAR OCCUR CLAIMS-NIADE EACH OCCURRENCE $ AGGREGATE $ DED I I RETENTIONS $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPMETORPARTNEREXECUTIVE OFFICERWEMBER EXCLUDED? (Mandatory In NH) If Yes, describe under DESCRIPTION OF OPERATIONS below NIA R O H• PERT STUTg ER E.L EACH ACCIDENT $ E.L. DISEASE • EA EMPLOYE $ E.L. DISEASE •POLICY LIMIT 1 $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101. Additional Remarks Schedule, may be attached if more space is required) Electrical Work. Miami Shores Village Building Department 10050 NE 2nd Ave, Miami Shores, FL 33138 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 Qr-fs— -%—, 01988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD i. V 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 certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law. EFFECTIVE DATE: &712018 PERSON: LEONARDO RODRIGUEZ FEIN: 611424213 BUSINESS NAME AND ADDRESS: LEC ELECTRIC, INC. 17130 NW 82 AVE HIALEAH, FL 33015 SCOPE OF BUSINESS OR TRADE: Electrical Nuking wthln Buildings and Drivers EXPIRATION DATE: 8/6/2020 EMAIL: LECELECTRICINC@YAHOO.COM IMPORTANT: Pursuant to Chapter 440.0fx.14). F.S., an officer of a corporation who elects exemption from this chapter by filing a certificate of election under this section may not recover banal is or compensation under this chapter. Pursuant to Chapter 440.05(12), F.S., Certificates of election to be exempt... apply only within the scope of the business or trade listed on the notice of election to be exempt. Pursuant to Chapter 440.055(13), F.S , Notices of election to be exempt and certificates of election to be exempt shall be subleot to rovocation if, at any the after the filing of the notice or the issuance of the certificate, the person named on the notice or csrtiticate no longer meets the requirements cf this section for Issuance of a certificate. The department shall revoke a cerlificale al any time for failure orthe person named on thn certificate to meet the requiremerts of this section. DFS-172-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUESTIONS? (850)413-1609 4� 1_:i J j J "Giving 09N5 is Families Since 2002' Monday, March 30, 2020 State of Florida. LEC ELECTRIC INC ELECTRICA. CONTRACTOR EC-13004121 17130 NW 82 AVE MIAMI FL 33015 CELL# 786-2296157 FAxa305.sl corn 381 lecelectricinc@Y County of Dade ersonally appeared Leonardo Rodriguez President of LEC ELECTRIC INC who, duly Before me this p sworn, deposes and says: other That he will be the only person working Exempt of Workers' Compensation Law and never use any employee on the project located at: t O cam. Sincerely, 1 V President of LEC E �RICINC�� "170day 0 Zj 20�_ Sworn to (or affirmed) and subscribed before me this — BY` Personally know____ _ Or Produced ID__ CrlStina E. Leon nt, Type or Stamp Name of Notary Miami Ohares Village Building Department 10050 N.E,2nd Avenue Miami Shores, Florida 33138 Tel: (305) 796.2204 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. Flit. Stat. � 440.05 C, allows corporate officers in ,he construction industry to exempt themselves front this re#r-.trient for any CollSti-I.,Ction project Irio- i r , Ito obtaining a building permit. Pursuant to the Florida Division of Workers' Compensation Employer Facts Brochure: An employer in the construction industry who employs ond or more part-tiroc or full-time employees, incliuding the owner, ritust obtain workers' compensation coverage. Corporate officers or menibers of a limited liability company (LLQ in the construction industny may elect to be exempt if: I . The officer ovois at least 10 percent of the stock- of the corporation. or in the case of an LLC, a statement attesting to the niinimuni 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 w%ith the Florida Department of State. Division of Corporattons. No more than three corporate officers per corporation or limited liability company -merribers are allowed to be exempt. Construction exemptions are valid foi- a period of two vears or until a voluntary revocation is filed or the exemption is revoked by e 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 employee, or subcontractors for your project. The contractor has provided an affidavit stating that he or she be the only person allowed to work on your project. In these circumstances. Miami Shores Village does not require verification of workers' compermation 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 CONTENITTS. Signature: :i,-64tAf-1z1 f --- State of Florida County of Miami-Dadc The f acki By tre this J�, L .20 1-0 I., s (fl� day of 11 p ...so --who is personally known to itte or has produced 5710— OS� - W —0a's identification. Cristina. E. Leon SEAL: J*T Expires: April 11, 2021 , . W-10 Bonded thru Aaron Notary