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EL-19-1245Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 CX�Jc�� Issue Date: 06/11/2019 Location Address Parcel Number 175 NW 98TH ST, Miami Shores, FL 33150 1131010240120 Contacts Permit'NO.: EL4WI9-1246 Permit7ype: Electrical- Residential Work Clossi�on:.Service Change Permit Status: Approved Expiration: 12/09/2019 INDIRA RAD GUTIERREZ Owner ALL SERVICE ELECTRIC OF FT. MEYERS Contractor INC Home: 3056080714 JAMES WRIGHT Business:2396036967 JORDANO@ALLSERVICEELECTRICFM.CO Mobile: 3059513776 M Inspection Requests Description: METER CHANGE UPGRADE FROM OVERHEAD TO Valuation: $ 1,500.00 Inspecion Re UNDERGOUND Total Sq 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 Payments Date Paid Amt Paid Total Fees $111.10 Credit Card 06/11/2019 $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 construct' zoning. Futhermore, I authorize the above named contractor to do the work stated. Authorized Si4nature: Owner / Applicant / Contractor / Agent Date June 11, 2019 Page 2 of 2 Miami Shores Village p� Building Department W 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 MAY 3r I0A 2019 V Tel: (305) 795-2204 Fax: (305) 756-8972 +�v 1 S INSPECTION LINE PHONE NUMBER: (305) 762-4949 L- ,1 FBC 201^1 BUILDING Master Permit No.1245 PERMIT AP P ICATION Sub Permit No. ❑ BUILDING , ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION [:]RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF [:]CANCELLATION ❑ SHOP ` ,uCONTRACTOR DRAWINGS JOB ADDRESS: 1 i 5 Wj W q 6 4 City: Miami Shores County: Miami Dade Zip:�� SQ Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: (Flood Zone: BFE:: �^� FFE: OWNER: Name (Fee Simple Titleholder): I J Phone#: 7? ✓- &o(So�Ljy Address:2030 5 t 2 City: (� V,(�. ��1 7 C� Stater Zip: Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: Address: E i• 1. QrS Phne#: Z�)C) �a0�(�'i (, % City: State: Zip: 2' l !:2 Qualifier Name: LQWIPS kict (A-, Phone#: State Certification or Registration #: E_Ci 3CDSco1 �0 Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: I c City: State: Zip: Value of Work for this Permit: $ t 500 Y�q Square/Linear Footage of Work: Type of Work: ❑,Addition '❑' 'Alteration ❑ New Repair/Replace ❑'Demolition L, ,. Description of Work. 0 LOV]CG a CM'► k)nC��.:ni ts4�di S Specify color of color thru tile: Submittal Fee $ Permit Fee $ CCF $ CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Notary $ Technology Fee $ Training/Education Fee $ Double Fee $ Structural Reviews $ Bond $ j (\ 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 reinfection fee will be charged. Q A Signature_ ER or AGENT The foregoing instrument was acknowledged before me this day of %J� 20 by (L J who is personally known to me or who has produced �l !/` as identification and who did take an oath. NOTARY PUBLIC: - Exphrs� �ry 14, 2023 Sign, -= ,> r J ,,��// Bu Print: �� 41, !/' t <<_f 9f Seal: Signatu NTRACTOR The foregoing instrument was acknowledged before me this day of /"1 20 by iQ6MS L Wf who is personally known to me or who has produced Ft /9 y as identification and who did take an oath. NOTARY PUBLIC: ?r Sign: 3, • : Print: I+'?� �� lot,�i, t," � Seal: *****�**********r***ss ss*******s*******r********s*r*********s*****s***ss***•**sr**::**********..**r�***r APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) RICK SCOTT,,GOVERNOR JONATHAN ZACHEM, SECRETARY FI rich Y c t 5' MN M 'STATE -OF FLORIDA i w DEPARTMENT'OF BUStN FESSIONAL REGULATION ELE&RICA NG BOARD lf THE ELECTRIC a E5 C ,UNDER TIJE PROVISzFATJ g F ,�- T UTES Va "Mite n EXPIRATI 31, 2020 r Always verify licenses online�atMyFloridaLicense:com ; ❑� �❑� Do not alter,this document in any form. This is your license. lt,is unlawful for anyoneother than the licensee to use this document. 3 CoUp,y 'k- Dear 'k- Business Owner: Your 2018-201.9 Lee County Lo If the a is a change in one of the • Business name • Ownership • Physical location • Business closed This it not a bill. Detach the bott' l.hope you have a successful year Sincerely, kJ • r Lee County Tax Collector Local Business Tax Receipt I Business Tax Receipt is attached below for account number 1900227. (lowing, refer to the instructions on the back of this receipt. � portion and display in a public location. 2018 - 2019 LEE CO TY LOCAL BUSINESS TAX RECEIPT Accouni Number: 1900227 Account Expires: September 30, 2019 State License Number: EC1300 16 If state Ito' wnw has cluenged, contact our ace, 239.533.6000 Location: 17460 EAST ST N FT MY RS FL 33917 ALL SERVICE ELECTRIC OF FT. MYER WRIGHT J�MES D 17460 EA T' ST N FT MY FL 33917 May engage in The business of. ELECTRICAL CONTRACTOR -CERTIFIED THIS LOCAL BUSINESS TAX RECEIPTIS NON REGULATORY Payment Information: PAID 494446-6-I 10lOS/18 11:54:58 AM } $50.00 Local Business Tax Receipt I Business Tax Receipt is attached below for account number 1900227. (lowing, refer to the instructions on the back of this receipt. � portion and display in a public location. 2018 - 2019 LEE CO TY LOCAL BUSINESS TAX RECEIPT Accouni Number: 1900227 Account Expires: September 30, 2019 State License Number: EC1300 16 If state Ito' wnw has cluenged, contact our ace, 239.533.6000 Location: 17460 EAST ST N FT MY RS FL 33917 ALL SERVICE ELECTRIC OF FT. MYER WRIGHT J�MES D 17460 EA T' ST N FT MY FL 33917 May engage in The business of. ELECTRICAL CONTRACTOR -CERTIFIED THIS LOCAL BUSINESS TAX RECEIPTIS NON REGULATORY Payment Information: PAID 494446-6-I 10lOS/18 11:54:58 AM } $50.00 A� RE11i CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 5/29/2019 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 lieu of such endomement(s). PRODUCER LRA Insurance CONT CT NAME: Nikki Alexander PHC NN , (407) 838-3445 AIC N0: (607)938-3460 E-MAILs:NAlexander@LRAinsurance.com ADDRES 498 S Lake Destiny Drive INSURERS AFFORDING COVERAGE NAIC N INSURER A: Westfield Insurance Company 24112 Orlando FL 32810 INSURED INSURER B : INSURER C: All Service Electric of Ft. Meyers, Inc. INSURER D: 17460 East St INSURER E : INSURERF: North Fort Myers FL 33917 COVERAGES CERTIFICATE NUMBER:19/20 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 CONTRACTOR 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 LTR OF INSURANCE ADDLTYPE imgn SUER POLICY NUMBER MM/DDPOLICYEFF /YYYY POLICY P MMIDD/YY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS -MADE 50 OCCUR PREM SEO SEa occurrence $ 150,000 MED EXP (Any one person) $ 1,000 CWP8939817 1/15/2019 1/15/2020 PERSONAL & ADV INJURY $ 1,000,000 GEN'LAGGREGATEUMITAPPUESPER: GENERALAGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 POLICY FE JE - LOC $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,000. BODILY INJURY (Per person) $ A X ANYAUTO ALL OWNED SCHEDULED AUTOS AUTOS NON OWNED X HIREDAUTOS X AUTOS CWP8939817 1/15/2019 1/15/202o BODILY INJURY (Per accident) $ PROPERTY DAMAGE Paccident) $ pip $ 10,000 X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 AGGREGATE $ 1,000,000 A EXCESS LIAB CLAIMS -MADE DEC) I X I RETENTION $ 0 $ CWPO939817 1/15/2019 1/15/2020 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE PER OTH- STATUTE ER E.L. EACH ACCIDENT $ E.L.DISEASE- EAEMPLOYEE $ OFFICER/MEMBER EXCLUDED? El (Mandatory in NH) N /A E.L. DISEASE - POLICY LIMIT $ If yes, describe under DESCRIPTION OF OPERATIONS below A Inland Marine CWP8939817 1/15/2019 1/15/2020 Rented/Leased Equipment Limit $ 50,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Re: Miami Shores Village EC13008616 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE MIAMI SHORES VILLAGE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. BLDG DEPT 10050 NE 2ND AVE AUTHORIZED REPRESENTATIVE MIAMI SHORES, FL 33138 Brian Tomlinson/NIKKI- (o 198a-2014 AGORU GURPURAI ION. All rights reserved. ACORD 25 (2014/01) INS025 (201401) The ACORD name and logo are registered marks of ACORD ACORV CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) P5/29/2019 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 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 SUNZ Insurance Solutions, LLC. ID: (PME) C/O Payroll Made Easy, Inc. 11691 Gateway Blvd., Suite 104 Fort Myers, FL 33913 CONTACT NAME: Eliese Goldenbloome PHONE 239 415 1110 AX No : 239-415-1114 E-MAIL ADDRESS: eliese continuumhr.com INSURER(S) AFFORDING COVERAGE NAIC # INSURERA: SUNZ Insurance Company 34762 INSURED Payroll Made Easy, Inc; Payroll Made Easy II, Inc dba Continuum HR; Continuum HR of Texas, LLC INSURER B : INSURERC: INSURERD: 11691 Gateway Blvd, Suite 104 Fort Myers FL 33913 INSURER E : INSURER F COVERAGES CERTIFICATE NUMBER: 48974506 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 LTR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF MWDD/YYYY POLICY EXP MM/DD LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS -MADE OCCUR DAMAGE T RENTED ccurrence PREMISES Ea occurrence) $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY JECT LOC PRODUCTS - COMP/OP AGG $ $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident ) $ PROPERTY DAMAGE Per accident $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY UMBRELLALIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DIED I $ A WORKERS COMPENSATION AND EMPLOYERS'LIABILITY Y / N ANYPROPRIETOR/PARTNER/EXECUTIVE WC017-00001-019 WC017-00001-018 6/1/2019 6/1/2018 6/1/2020 6/1/2019 STATUTE OERH E.L. EACH ACCIDENT $ 1,000 000 OFFICER/MEMBEREXCLUDED? ❑ N / A E.L. DISEASE - EA EMPLOYEE $ 1 ,000,000 (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1 000 000 IL DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Coverage Provided for all leased employees but not subcontractors of: All Service Electric Of Ft Myers, Inc. Client Effective: 6/1/2013 ELECTRICAL CONTRACTORS LICENSE #EC13008616 GtK 111'IGA I t HVLL1t11 I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE MIAMI SHORES VILLAGE BUILDING DEPARTMENT MIAM NE RE AVENUE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN MIAMI SHORES FL AVENUE ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Rick Leonard ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD 48974506 1 Payroll Made Easy, Inc PEO 017 MASTER CERT I Eliese Goldenbloome 15/29/2019 1:40:53 PM (CDT) I Page 1 of 1