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EL-19-160Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Permit NO.: EL-01-19-160 - Permit Type: Electrical - Residential Work Classification: Addition/Alteration Permit Status: Approved Issue Date: 01/30/2019 Expiration: 06/10/2020 Location Address Parcel Number 940 NE 99 ST, Miami Shores, FL 33138 1132060143380 Contacts VICTOR MAYORGA Owner VICTOR MAYORGA Applicant 940 NE 99 ST, MIAMI SHORES, FL 33138 940 NE 99 ST, MIAMI SHORES, FL 33138 JARR PROFESIONAL ASSOCIATES Contractor JOSE BATISTA 7361 SW 16 TER, miami , FL 33155 Business: 7862088209 claudiacolom@gmail.com Description: ELECTRICAL AS PER PLANS Valuation: $ 1,500.00 Inspection Requests: TotalSq Feet: 240.00 Fees Amount Application Fee - Other $50.00 CCF $1.20 Change of Contractor $110.00 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: $221.10 Payments Date Paid Amt Paid Total Fees $221.10 Credit Card 01/23/2019 $50.00 Credit Card 01/30/2019 $61.10 Credit Card 12/13/2019 $110.00 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 construoQ and zoning. Futhermore, I authorize the above named contractor to do the work stated. Authorized Owner / Applicant / Contractor / Agent Date December 13, 2019 Page 2 of 2 N m Miami Shores Village ENTBRED Bui'-ding Department DEC 13 2019 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 BY. - Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 j BUILDING PERMIT APPLICATION ❑BUILDING ELECTRIC ❑ ROOFING ❑PLUMBING ❑ MECHANICAL ❑PUKIC WORKS FBC 20 I 'l Master Permit No. 1�c- ( 5` -Z Sub Permit No. C-L - 01-19 - 16® ❑ REVISION ❑ EXTENSION ❑ RENEWAL CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: i q D N 9 ,— ST- City: Miami Shores County: Miami Dade Zip: 3-31 3� Folio/Parcel#: 11 32 6 (o01 Zd 33'90 Is the Building Historically Designated: Yes NO tC Occupancy Type: �jl(- Lead: . Construction Type: Flood Zone: BFE: FIFE:_ OWNER: Name (Fee Simple Titleholder): &AAA M- (.OLoti A6R U I V4f& MA%QWhone#: Address: 6?40 m /91 5,-' City: Pf6m; SNP S State: F Zip: Tenant/Lessee Name: s-- - Phonell: Email: GtAVDrA,COLOM (& 6M/�Arc/--(&If CONTRACTPR* Company Narne: /Ll� 'Phone Address: Gam/ City: 4 State: Zip: Qualifier Name: S Phone#: State Certification or Registration #: Certificate of Competency 1.: DESIGNER: Architect/Engineer: FERAIAOD0 aD . P"IM Phonek: (61) 7z �- brf Address: 227K td �41�, SVi�# ZOo City: LAKE Lv0/Z7F1 State: �L Zip: Value of Work for this Permit: $ Square/Linear Footage of Work: _ Type of Work: ❑ Addition r❑ Alteration I --] New❑ Repair/Replace ❑ Demolition Descrintion of Work: X (e '—�- -td-',( 4,S r�l«Y`S Specify color of color thru tile: Submittal Fee $ Permit Fee $ Scanning Fee $ Radon Fee $ Technology Fee $ Training/Education Fee $ Structural Reviews CCF S DBPR $ CO/CC $ Notary $ Doable 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 ►F1 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 5nd 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 iall applicable laws regulating construction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCE^/IENT MAY RESULT IN YOUR PAYING TWICE Ff)R 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 The foregoing instrument was acknowledged before me this l d(a�/y�of �Q QQ--,y'��oa— c —, 20 11 by 1Q • �QM. is known syJIhho persona!ly to 1' ► duc 5— me or o has pr as identi icati and ho did ke an oath. ����\\111111111�N///// NOTA Y PU IC: \�\\�yPNADY/ 25 •,• Sign. g UGH ? i� K c � • r �' Print• A Seal: d"Oded O i'p1 ? 04, 6,460.•••0�O, /*V///�,". STATE�F w*********w**w**www*****ww*w*****wwww**w APPROVED BY CONTRACTOR The foregoing instrum nt was acknowledged before me this day of 20 /1' by ho is personally known to me or who has produced _ as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: <•. sawa -- ': Public - SZZ*, -id, Seal: h 551C r.• .C.' E� '—�ExPi•cs s_S: <. 2023 _ rcL:r Nadcrai VC.dry Assn. Plans Examiner Structural Review Zoning Clerk (Revised02/24/2014) ENTERED DEC 13 2019 sY Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CHANGE OF CONTRACTOR / ARCHITECT Permit N. t L " 0119 - 16o Owner's Name (Fee Simple Title Holder): ��p�D(p� M• GOLOtA h(4,4-V Phone #: Owner's Address: 140 N4—:- of) -"- city: m i pM i SHORk-S State : Zip Code: 331375� Job Address (Of where work is being done): ��+li 91°) S-r- City: Miami Shores State: —Florida Zip Code: Contractor's Company Name: MU, EICCT(;C,-M1 Address: ST. Phone#: (305}--n(o--�099 City: M i l M i State: � L- Zip Code: 33 Qualifier's Name: -tONV w-el,L-- Lic. Number: Architect/ Engineer of Record Name: 4r�lZ-NaNDO {Z - P2iFT0 Phone #: I (5/'11424,_ � Address: `li ZY- 0TI- AVIE� l SU i'fC- --#- Zoo City: L 4t4< WQ(urtf State: t-L, Zip Code: 33L((,ol Describe Work: �-c�STW%&P . W"Alk - As qP�- PV45S hereby certify that the work has been abandoned and/or the contractor/architect is unable or unwilling to complete the contract. I hold the Building Official and the Miami Shores harmless of all legal involvement. Signature i;l- �'� Owner or A nt Signature The foregoing instrument was aknowledged befo� thisree me � 7 day of —NC 2019 ,by 1.160diC1 11. (010M k&V Who is personally known to me or who has produced otary u lic: �Q;.,sN25s,.Wo . o �O .',� Sig Seal: * ; 2$ 63 4*' oa 0 i 2•?°�d Bonded��de�,� Z, /UBLIC, sj,�o��`\`` I111111111 Contractor or Architect The foregoing instrument was aknowledged before me this day of 20 by who is personally known to me or who has produced Notary Public: Sign: Seal: as indentification. r� r ^'A,N� r�• Change of Contractor/Architect or Engineer Miami Shores Village Building Department 10050 N.E. 2ND Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 A change of contractor, architect or engineer must be done under a permit number .There is a $1 10.00 charge for a change of contractor. The owner will submit a Change of Contractor Form completed with notarized signatures. If the signature of the previous contractor cannot be obtained the owner must send a certified letter/return receipt notifying the previous contractor, architect or engineer the reason for the change .The owner must allow 10 business days for the contractor, architect or engineer to respond. A permit application must accompany the change of contractor form, with the information and signature of the new contractor .The new contractor must be registered with the Village or must submit the required documents to register with the Village. 1. Change of Contractor form completed, signed and notarized. 2. Permit application by new contractor. 3. Required fees. 4. Copy of original letter sent via certified mail along with the returned receipt. In addition to the requirements above the architect or engineer of record must authorized the new architect or engineer to reproduce his documents. The authorization must be in writing and must be signed and sealed. ti m 0 m .A CEI 0 a l3 M M -o a 0 n- O N Certified Mail Fee %3 22 flfl FlVd ------------ r No. . cu Ul 1 Extra Services ffi Fees (check bar, add le Certified Mail service provides the following benefits: ■ A receipt (this portion of tta CertfW, Mail latch. for an electronic return receipt, see a retail ■ A unicr a identifier for your ma2piece. associate for assistance. To receive a dup:;a to ■ Electronic verification of delivery or attempted return receipt for no additional fee, precent this dctivery. r 1. USPS®-postmarked Certified Mail receipt to the ■ A record of de'lvery (including the recipients rctan associate. signature) that is retained by the Postal Service' Restricted de'Nery service, which provides for a specified period. delivery to the addressee specified by name, or to theedd; asae's authorized ag nt. Important Reminders: Adult signature service, which requires the ■ You mcy purchase Certified Mail service with signee to be at least 21 years of age (not Rrst-Class Mall', Rrst-Class Package Service°, available at retaill. or Pri" M^'y eervIO.. - Adult signature restricted de:;vmy service, which • CertlP:.d M tail€erv;cee isnoie Stable for requires the s:giee to be at least 21 years of age irdemati and provides dc:lvery to the addzssae specified ■ Insurenea. Vag Is not avai' a for purchase , by name, or to the addresee s authorized agent with C¢rtifl ,r(;ervice. However, the pu;,.hase (not available at retapq. of Certifud KkIlsorvIce does not &.ange the ' . insurancAchrerege a r<omaticch included with ■ To ensure that your Certified NO roccipt is certainNoli(y . items. accepted as ftJ print of mal:ing, R should bear a USPS postmark. If you would like a postmark on ■ For an adOon4fee, and with a proper eadorsemegt on i.Yrnailpieca, you may request tit, Certified WI receipt, pease present your Certfied Mail Item at a Post Office' for the following services:, postmarking. R you don't need a postmark on this - Return reccipt service, which provides a record Certified Mail reccppt, detach the barcoded portion of delivery (including the recipient's signature). of this Libel, affix it to the ma;:piece, apply You can request a hardccpy return receipt or an approprL:te postags, and deposit the mailpiece. electronic ver�—om. For a twdcopy return receipt, complets PS Fenn 3811, Domestic Refum Receipt; attach PS Form 3811 to your me::piece; 1MPORTANC Save this receipt for your records. Ps Porn 38f)O, April 2015 (Reverse) PSN 7530.02-000.9047 Victor A. Mayorga, Esq. Claudia M. Colom Abreu, Esq. 940 NE 99th Street Miami Shores, FL 33138 November 1 ", 2019 Well Electric Technology, Inc. c/o Mr. Tony Well 4310 NW 11 Street Miami, FL 33126 Dear Mr. Well, We are notifying you via this certified letter that a change of contractor has taken place, by which we are requesting the Building Department at the Village of Miami Shores to replace and delete your company's name from our property records, due to the fact that you have not been available to complete the work. Regards, Victor A. Mayorga, Esq. A" Claudia M. Colom Abreu, Esq. USPS.com® - USPS Tracking® Results Page 1 of 3 USPS Tracking® FAQs > Track Another Package + Tracking Number: 70190160000078630312 Remove X Your package is moving within the USPS network and is on track to be delivered to its final destination. It is currently in transit to the next facility. m m m CL In -Transit n December 9, 2019 'c In Transit to Next Facility Get Updates \/ Text & Email Updates Tracking History December 9, 2019 In Transit to Next Facility Your package is moving within the USPS network and is on track to be delivered to its final destination. It is currently in transit to the next facility. December 5, 2019, 10:00 am Departed USPS Regional Facility MIAMI FL DISTRIBUTION CENTER u n https://tools.usps. comlgolTrackConfirmAction?tRef=fullpage&tLc=2&text28777=&tLab... 12/ 12/2019 USPS.com® - USPS Tracking® Results Page 2 of 3 November 27, 2019, 1:55 pm Unclaimed/Being Returned to Sender MIAMI, FL 33126 November 9, 2019, 4:42 pm Notice Left (No Authorized Recipient Available) MIAMI, FL 33126 November 5, 2019, 4:30 pm Arrived at USPS Regional Facility MIAMI FL DISTRIBUTION CENTER November 4, 2019, 10:52 am Forwarded MIAMI, FL November 2, 2019, 5:16 pm Departed Post Office MIAMI, FL 33138 November 2, 2019, 12:47 pm USPS in possession of item MIAMI, FL 33138 Product Information u See Less /\ Can't find what you're looking for? Go to our FAQs section to find answers to your tracking questions. m m m 0- Cr v 0 https://tools.usps.com/golTrackConfirmAction?tRef=fullpage&tLc=2&text28777=&tLab... 12/12/2019 RICK SCOT , GOVERNOR JCJSvt;: � itas► 3tvCt 1iUr , � G'�L� t,�"� C. t STATE OF FLORIDA DEPARTMENT OF BUSINESS AND RROFESSIONAL REOULATIC." 11-31 f ELECTRICALCONT, R ►:CTOR.S LENSING BOAP.D THE ELECTRICAL ItONTRACTOR HEREIN-'FlAt REVY'E'RED UNDER 4 PROVISIONS�.OF CHAPTER 489, FLORIDASTAI UTES `? BATI TA, JOSE, LUIS JARr} fi'R.OFES'S106` Z ASS0-CIATES 'ELEC7RIC INC. 420 -FLAGAMI BLVD r MIA-Ml- FL 33144 LICENSE NUMSER:-ER 0147,28 EXPIRAT!0N,DATE:*AUGUS T 33, 2020 Always verily licenses online at M yFloriciaUcense.co n Do not alter this ,document in any form. This is your license. It is unlawful for anyone ether than Lhe licensee to�sa a5.1 M W 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: 9/8/2018 PERSON: RAUL A RODRIGUEZ FEIN: 204889865 BUSINESS NAME AND ADDRESS: EXPIRATION DATE: 9/7/2020 EMAIL: MINCLAN@EGUINO.COM JARR PROFESSIONAL & ASSOCIATES ELECTRIC INC 410 FLAGAMI BLVD MIAMI, FL 33144 SCOPE OF BUSINESS OR TRADE: Electrical Wiring Within Buildings and Drivers IMPORTANT: Pursuant to Chapter 440.05(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 benefits 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 440.05(13), F.S., Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation if, at any time after the filing of the notice or the issuance of the certificate, the person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate. The department shall revoke a certificate at any time for failure of the person named on the certificate to meet the requirements of this section. DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUESTIONS? (850)413-1609 �� a1 DATE (MMlDD/YYYY) '°�..., CERTIFICATE OF LIABILITY INSURANCE 12/11/2019 _ _ _ _ _ __ _ ..... 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(les) 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 � NAMEACT __ MARITZA INCLAN 'PHONE &AssociateslEMt(305) 267-1197 s 7229 Coral Way E-MAILs. Mindan(Meguino.com Miami, FL 33155 INSURERS) AFFORDING COVERAGE _ _ NAIC K Phone (305) 266-1700 Fax (305) 267-1197 INSURER A: Covington Specialty Insurance Company ... _............ __ ._ INSURED Inf:nommerciauto INSURER e : it y Commercial Ai Jarr Professional & Associate Electrical Inc INSURER C Lloyd's of Landon Insurance Company 7361 SW 16TH Terrace INSURER D INSURER E : l ................ Miami FL 33155 INSURER F _...... ......................----._.............._................__.._.. .._..._. .._..__._.....—_.—.......................... — I . ........... 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. TYPE OF INSURANCE I POLICY NUMBER, _ .................... IMMIDOJYYYI) .IMMIDOIYYY)-...__......._.................. LIMITS _ COMMERCIAL GENERAL LIABILITY 1 EACH OCCl/R_ RENCE S 1,000,000.00 ❑ CLAIMS MADE OCCUR i_..._ .__. DAMAGE TO RENTED PREMISES (Ea occurrenceZ_ i i $ 100,0{10.00 u_.__.........__...,.._.................... MED EXP (A ............... _...._..._ _. ❑ _ PERSONAL & ADV INJURY S 1,000,000.00 G��EN'L AGGREGATE LIMIT APPLIES PER: 'J POLICY ❑PRO ❑ LOC JECT j GENERAL AGGREGATE_ ( PRODUCTS - COMPlOP AGG $ 2,000,000.00 0 S 2,000,000.00 ❑ OTHER _--�` + �_....._.___—.__....._..__._ ) -- S AUTOMOBILE LIABILITY i ICEOMBINEE^SD tS INGLE LIMB arxxleI ` 5 1,000,000.00 — ❑ ANY AUTO I BODILY INJURY (Per person) $ OWNED �I-�� SCHEDULED L`l B ❑ AUTOS ONLY J AUTOS Y 509820034730001 07/17/2019 07/17/2020BODILY INJURY (Per accident) $ i ;...�........... .... _...._....._._.___... _........ _....... ,......... . . —_---. HIRED ❑ NON -OWNED ❑AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE I (Per ®cc%dentJ,,,,, —� $ 1 ._.. ��_ ..__ ......._ _... PIP $1000 Ded $ 10,000.00 .,.,,.,,............ .�� __. _ ❑ �� OCCUR .................. .................. — --- __.. _ �. EACH OCCURRENCE 5 1,000,000.00 EXCESS UABAB C © ❑ CLAIMS -MADE . ) Y Y GREXS001013-00 02/20/2019 `02/20/2020 AGGREGATE $ 1,000,000,00 l I I ❑ DEO ❑1RETENTIONs_. � Products Completed O 1,000,000.00 _ WORKERS COMPENSATION _._...._................._ _. L _---$ � -- PER OTH STATUTE ❑ AND EMPLOYERS' LIABILITY YIN ............. ANY PROPRIETORIPARTNERIEXECUT — OFFICERlMEMBEREXCLUDED? NIA' DWC-252-Exemption Form E.L. EACH ACCIDENT 09/08/2018 09/07/2020 ; $ __..._.__._..._.................— (Mandatory in NH) E.L. DISEASE - EA EMPLOYE $ If yes, describe tinder DESCRIPTION OF OPERATIONS below I j E.L. DISEASE -POLICY LIMIT I S �. DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) Electrical Work- installation, Servicing or repair. CERTIFICATE HOLDER Miami Shares Village Building Department 10050 N.E. 2nd Avenue Miami Shores, FI 33138 ACORD 25 (2016103) OF CANCELLATION 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 @31988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Local Business Tax Receipt Miami —Dade County, State of Florida —THIS IS NOT A BILL —DO NOT PAY 3954576 RECEIPT NO. RENEWAL BUSINESS NAME/LOCATION 4127023 JARR PROFESSIONAL & ASSOCIATES ELECTRIC INC. 7361 SW 16TH TER MIAMI, FL 33155 RI ''A0 OWNER SEC. TYPE OF BUSINESS JARR PROFESSIONAL & 196 ELECTRICAL ASSOCIATES ELECTRIC INC. CONTRACTOR rin RAI II RnnRint IF7 Worker(s) 1 14E000407 LBT EXPIRES SEPTEMBER 30, 2020 Must be displayed at place of business Pursuant to County Code Chapter BA — Art. 9 & 10 PAYMENT RECEIVED BY TAX COLLECTOR 82.50 10/04/2019 0229-20-000123 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 or nongovernmental regulatory laws and requirements which apply to the business. mcm The RECEIPT NO. above must be displayed on all commercial vehicles —Miami—Dade Code Sec Sa-276. M®DADE for more information, visit www.miamidade.gov/taxcollector Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Permit NO.: EL-01-19-160 br, Permit Type: Electrical - Residential P@ lil- oh �J work Classification: Addition/Alteration Permit status: Approved Issue Date: 01/30/2019 Expiration: 07/22/2019 Location Address Parcel Number 940 NE 99 ST, Miami Shores, FL 33138 1132060143380 Contacts VICTOR MAYORGA Owner VICTOR MAYORGA Applicant 940 NE 99 ST, MIAMI SHORES, FL 33138 940 NE 99 ST, MIAMI SHORES, FL 33138 WELL ELECTRIC TECHNOLOGY Contractor TONY WELL 4310 NW 11 ST, MIAMI, FL 33126 Business: 3057267098 Other:7864738455 Description: ELECTRICAL AS PER PLANS Valuation: $ 1,500.00 Inspection Requests: 305-762-4949 TotalSq Feet: 240.00 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 Credit Card 01/23/2019 $50.00 Credit Card 01/30/2019 $61.10 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 t above named contractor to do the work stated. 114 A ylp'Wr f�� Authorized Signature: dwner Applicant / Contractor / Agent Date January 30, 2019 Page 2 of 2 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 PgELECTRIC ❑ ROOFING RECEIVED JAN 2 3 2019 FBC 201-T Master Permit No. [zc}lr� - 1g�IZ Sub Permit No. fEl q ❑ REVISION ❑ EXTENSION RENEWAL PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: q yO Nl(�_ 19V-'- City: Miami Shores County: Miami Dade zip: 3 313 $ Folio/Parcel#: ii - 3206 - 01y - 33%0 Is the Building Historically Designated: Yes NO X Occupancy Type: Sfw Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): ViMyt- A • MA104- 0- Phone#:1 (91166)qq4 • 2,34t 1 Address: qyO NE Qql-- €T tr City: M(aNni ! �*s State: F L Zip: 3313 X Tenant/Lessee Name Nl6e Phone#: N/fP• Email: V;CfoQ •- / q CONTRACTOR: Company Name: W L ( ,f7/IG /t�-�1/Iy Phone#: 7�� Address City: /4 � A -Ma, State: L Zip / 7 Phone#: %sv I Qualifier Name: State Certification or Registration #: 4E C-/ `— 13 00 //gLLCertificate of Competency #: _ DESIGNER: Architect/Engineer: U1�Gl�E(G%/L�l�,�7"/�lhl I- • CC�Aj Phone#: Address: City: State: Zip: 2-- Value of Work for this Permit: $ ( > O O. OO Square/Linear Footage of Work: Type of Work: ❑ Addition Alteration ❑ New 1. ❑ Repair/Replace ❑ Demolition Description of Work: Specify color of colorlhru' tile: a Submittal Fee $ Permit Fee $ Scanning Fee $ Technology Fee $ Radon Fee $ Training/Education Fee $ e;Him i t'H4H9Z!C ♦Y n tag Y:. t • +,, CCF $ A--r a .rr-..,.�•r• +CO/GCS �+wwww� DBPR $ Notary $ Double Fee $ Structural Reviews $ (Revised02/24/2014) Bond $ TOTAL FEE NOW DUE $ 61 - I Q Bonding Company's Name (if applicable) A Bonding Company's Address City State Mortgage Lender's Name (if applicable) Mortgage Lender's Address Zip City State 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 fAwill be charged. Signature'/ _ Signature OWNER or AGENT NTRACTOR The foregoing instrument was acknowledged before me this day of J' 2019 by 00-on— A- MAyO A-0who is personally known to me or who has produced identification and who did take an oath. NOTARY PUBLIC: as The foregoing instrument was acknowledged before me this —2-1 day of f'✓ 20 I�, by LC ho is personally known Jo - me or who ha produced as identification and who did take an oath. NOTARY PUBLIC: Sign: �Y1,QvIYYr>' Sign: Print: Seal: `m% STEPHANIE POMARES 4E Notary Public - Slate'ot Florida Commission # FF 997687 My Comm. Expires Sep 26.2020 1114101 �Mi9egANIPIONa1N�#l9)a� 4)X W APPROVED BY / Print: Seal: ********************** Plans Examiner MAXIMO A. RODRIGUEZ Notary Public - State of Florida Commission # GG 005481 My Comm. Expires Jul 5, 2020 *********** Zoning (Revised02/24/2014) Structural Review Clerk 1/23/2019 Property Search Application - Miami -Dade County OFFICkE OF THE PROPERTY APPRAISER Summary Report Property Information Folio: 11-3206-014-3380 Property Address: 940 NE 99 ST Miami Shores, FL 33138-2567 Owner VICTOR A MAYORGA CLAUDIA M COLOM ABREU Mailing Address 940 NE 99 ST MIAMI SHORES, FL 33138 USA PA Primary Zone 1100 SGL FAMILY - 2301-2500 SQ Primary Land Use 0101 RESIDENTIAL -SINGLE FAMILY: 1 UNIT Beds/Baths/Half 3/2/0 Floors 1 Living Units 1 Actual Area 1,923 Sq.Ft Living Area 1,558 Sq.Ft Adjusted Area 1,721 Sq.Ft Lot Size 10,300 Sq.Ft Year Built 1941 Assessment Information Year 2018 2017 2016 Land Value $309,063 $309,063 $268,145 Building Value $119,782 $119,782 $119,782 XF Value $1,730 $1,743 $1,755 Market Value $430,575 $430,588 $389,682 Assessed Value $267,214 $261,718 $256,335 Benefits Information Benefit Type 2018 2017 2016 Save Our Homes Cap Assessment Reduction $163,361 $168,870 $133,347 Homestead Exemption $25,000 $25,000 $25,000 Second Homestead Exemption $25,0001 $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 3 LOTS 6 & 7 BLK 80 PB 10-37 LOT SIZE 100.000 X 103 COC 22300-3176 05 2004 1 Generated On : 1/23/2019 Taxable Value Information 2018 2017 2016 County Exemption Value $50,000 $50,000 $50,000 Taxable Value 1 $217,214 $211,718 $206,335 School Board Exemption Value $25,000 $25,000 $25,000 Taxable Value 1 $242,214 $236,718 $231,335 City Exemption Value 1 $50,000 $50,000 $50,000 Taxable Value 1 $217,214 $211,718 $206,335 Regional Exemption Value 1 $50,000 $50,000 $50,000 Taxable Value 1 $217,214 $211,718 $206,335 Sales Information OR Previous Price Book- Qualification Description Sale Page 01/30/2018 $520,000 30873- Qual by exam of deed 1741 05/01/2004 $355,000 22300- Sales which are qualified 3176 08/01/2001 $0 19902- Sales which are disqualified as a result of 4037 examination of the deed 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/disciaimer.asp Version WELL ELECTRIC TECHNOLOGY INC. 4312 NW 11T" ST., MIAMI, FL 33126 TEL. 754-245-1679 STATE LICENSE: EC-13001181 Permit: EL-19160 Date: 01/24/2019 State of Florida County of Miami Dade Before me this day personally appeared Mr. Tony Well who, being duly sworn, deposes and says: That he will be the only person working on the project located at: 940 ne 99th St, Miami Shores, FL 33138 Contractor Signature Sworn to (or affirmed) and subscribed before me this 24th day of January, 2019. By Tony Well. V Personally Know_ MAXIMO A. RODRIGUEZ Notary Public - State of Florida of r� Commission x GG 005481 My Comm. Expires Jul 5, 2020 Print, Type or Stamp Name of Notary Notice to Owner — Workers' Corn Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 nsation 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 OU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. Signature: loe Owner State of Florida County of Miami -Dade The foregoing was acknowledge before me this 2' day of �� , 20-. By I//[ Tj/L /4 • M/�YJ'L who is personally known to me or has produced as identification. Notary: mayi c> A — SEAL: _ •� '�1MO,p Notary Publi "Wig ak �cfi: C C •e o'}f statIF ommission # GG 0054A1 MY Comm. Expires Jul 5,10&