EL-19-2327Permit NO.: EL-10-19-2327
Miami Shores Village - ,- r
� Permit Type: Electrical -Residential
10050 NE 2 Ave
Miami Shores FL 33138 l Work Clossificotion: Alteration
V
305-795-2204 PermitStotus: Approved
Issue Date:10/15/2019 Expiration: 04/13/2020
Location Address Parcel Number
9701 N MIAMI AVE, Miami Shores, FL 33150 1132060130970
Contacts
STARFISH HOMES LLC Owner
3001 W HALLANDALE BEACH BLVD, PEMBROKE PARK, FL 33009
Business: 9549811154
FIVE STAR ELECTRIC SERVICE Contractor
JEAN YVON AURELIEN
Business: 7863560162 WIX1237@AOL.COM
Other:7863560162
Description: ELECTRICAL FOR KITCHEN, BATHROOM, LAUNDRY Valuation: $ 4,000.00 Inspection Requests:
AND PLAYROOM 35-762-4949
Total Sq Feet: 447.00
Fees
Amount
Application Fee - Other
$50.00
CCF
$2.40
DBPR Fee
$2.10
DCA Fee
$2.00
Education Surcharge
$0.80
Permit Fee
$90.00
Scanning Fee
$3.00
Technology Fee
$3.50
Total:
$153.80
Payments
Date Paid Amt Paid
Total Fees
$153.80
Check # 2242
10/02/2019 $50.00
Check # 2243
10/15/2019 $103.80
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 a he foregoing information is accurate and that all work will be done in compliance with all applicable laws
regulating constr cti n and zoning. Fuymo u on the above named contractor to do the work stated.
Authorized Signature,Owner /' Applicant / Contractor / Agent Date
October 15, 2019 Page 2 of 2
M
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 X ELECTRIC ❑ ROOFING
RECEIVED
jT 0 2 2015
BY:
FBC20(4
Master Permit No. —U f — 1-1 %flu
-b Sub Permit No.B-- — I �13z
❑ REVISION ❑ EXTENSION [:]RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS:
City: Miami Shores County: Miami Dade Zip: �3i5u
Folio/Parcel#: i0
Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): Phone#: !sy" % jam (I 3rlf
Address: 3cx,'% l,) 'Ace1rl4t 1�rs�. R1UIc ?30U
City: Fe, Pk < State: L Zip: 3JaG'�
Tenant/Lessee Name: Phone#:
Email: 7kz'r O'rC)0 5 .-I L-A kc% ilco�) r1, l
OIL?.CONTRACTOR: Company Name: ��"iWL'l`G�C. SP.•l't%1(A.�%/tc• Phone# f
Add
Qualifier Name:
State Certification or Registration #:-
Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City: State:
Value of Work for this Permit: $ Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace
/ • /1 L/ 1 . J _ a
Zip:
❑ Demolition
Description of Work: A .w/rl
Specify color of color thru tile:
Submittal Fee $ �>� • W Permit Fee $ CCF $ CO/CC $
Scanning Fee $
Radon Fee $
Technology Fee $ Training/Education Fee $
Structural Reviews $ _
DBPR $
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"raf 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 charged.
f µ
Signature
-d, al,��
OWNER or AGENT
The fore ping instrument wps acknowledged+before,lne this
day of 20 by
-Sa�►n •46' , who is personally known to
me or who has produced as
The foregoing instrum t was acknowledged before me this
11 LL dayof -tt:4 LA'-,t 20104 by
Ctr JC 12A-U1l' 1 who is personally known to
Me or who has produced as
ArmS i g � n a; u r 0 If —
identification and who did take an oath. identification and who did --take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
OC �ii
Sign: ��-++ aG is,��ll. ` ` Sign:
LSD Uke P `�'t� (� r .
Print: Print: •�s
Seal: r acr�o
i �G ••. rowed thru
BliC• :e'YServi's:••��
APPROVED BY
Seal: �o"'°" " FRITZ MATHURiN
MY COMMISSION # GG89280
QFndtFT EXPIRES: June 10, 2021
***********************************************************************
Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
ELECTRICAL CONTRACTORS LICENSING BOARD
2601 BLAIR STONE ROAD
TALLAHASSEE FL 32399-0783
(850) 487-1395
Congratulations! With this license you become one of the.nearly one million Floridians licensed by the
Department of Business and Professional Regulation. Our professionals and businesses range from 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.myfloridalicense.com. There you can find more information about our divisions
and the regulations that impact you, subscribe to department newsletters and learn more about the
Department's initiatives.
Our mission at the Department is: License Efficiently, Regulate Fairly. We constantly strive to serve you better
so that you can serve your customers. Thank you for doing business in Florida, and congratulations on your new
license!
STATE OF FLORIDA DEPARTMENT
dbpr REGULATION AND PROFESSIONAL
EC13002983 ISSUED:08/02/2018
ELECTRICAL CONTRACTOR
AURELIEN, JEAN YVON
FIVE STAR ELECTRIC SERVICE INC
("
��% .
Signature
LICE NS D UNpER CHAPTER 489, FLORIDA STATUTES
EXPIRATION DATE: AUGUST 31, 2020
AldlIbItIL
ANNE M. GANNON
,_.
UL� CONSTITUTIONAL TAX COLLECTOR
Serving Palm Beach Countq
Serving you.
P.O. Box 3353, West Palm Beach, FL 33402-3353
www.pbctax.com Tel: (561) 355-2264
**LOCATED AT**
8904 ROCKRIDGE GLEN COVE
BOYNTON BEACH, FL 33437
TYPE OF BUSINESS
OWNER
CERTIFICATION #
I RECEIPT #/DATE PAID
AMT PAID
IBILL #
23-0169 ELECTRICAL CONTRACTOR
AURELIEN JEAN YVON
EC13002983
I U20.2842-10/01/19
$30.50
1 840124957
This document is valid only when receipted by the Tax Collector's Office.
STATE OF FLORIDA
PALM BEACH COUNTY
2019/2020 LOCAL BUSINESS TAX RECEIPT
FIVE STAR ELECTRIC SERVICE INC
LBTR Number: 200802737
FIVE STAR ELECTRIC SERVICE INC
EXPIRES: SEPTEMBER 30, 2020
8904 ROCKRIDGE GLEN COVE ST
BOYNTON BEACH, FL 33473-4830
This receipt grants the privilege of engaging in or
managing any business profession or occupation
within its jurisdiction and MUST be conspicuously
displayed at the place of business and in such a
manner as to be open to the view of the public.
4'e - -%'J'
PLEASE CUT OUT CARD BELOW AND RETAIN FOR FUTURE REFERENCE
I ----------------------
STATE OF FLORIDA THE
DEPARTMENT OF FINANCIAL SERVICES
DIVISION OF WORKERS' COMPENSATION
I
CONSTRUCTION INDUSTRY EXEMPTION
r--
I F
—————————————— — — — — —
IMPORTANT I
CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA
WORKERS' COMPENSATION LAW •��on ve�
I EFFECTIVE GATE: 1/31/2019 EXPIRATION DATE: 1/30/2021
PERSON: JEAN Y AURELIEN EMAIL: wizinr�aoL.corn
FEIN: 562407715
I O
I L
D
I u
I
Pursuant to Chapter 440.05(14), F.S., an officer of a Corporation
who elects exemption from this chapter by filing a certificate of I
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.
BUSINESS NAME AND ADDRESS:
I E
Pursuant to Chapter 440.05(13), F.S., Notices of election to be I
FIVE STAR ELECTRIC SERVICE INC.
8904 ROCKRIDGE GLEN COVE
I BOYNTON BEACH, FL 33473
SCOPE OF BUSINESS OR TRADE:
I
R
E
I
I
I
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 I
notice or certificate no longer meets the requirements of this
section for issuance of a certificate. The department shall revoke I
a certificate at any time for failure of the person named on the
certificate to meet the requirements of this section.
Li—.d ElacU c.,_br
— — — — — — — — — — — — — — — — — — —
I —
— — — — — — — — — — — — — — — — — — — —
DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUESTIONS? (850)413-1609
Miami shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
Notice to Uwner — worKers' compensation Insurance txemption
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.
Signature:
caner
State of Florida
County of Miami -Dade
The foregoing was acknowledge before me this IS day of *^NCA1_ , 20 V_1
By NGivt,�, —so` who is personally known to me or has produced
WL as identification.
j`t^ PCB, ROSALIN ALZAMORA
Notary: Y State of Florida -Notary Public
; CoY mission #t GG 242544
SEAL: M Commission Expires
''°ii�`` August 25, 2022
ACORbr CERTIFICATE OF LIABILITY INSURANCE
DATE(MM/DD/YYYY)
10/10/2019
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 endorsement(s).
PRODUCER
CONTACT
NAME: Lissette Perez
L.P. Insurance Associates, Inc.
801 W. 48th Street Suite B
AICNo Ext • (305) 888-5747 aC No): (305) 888-8926
E-MAIL ssette Insure.com I
ADDRESS: LiCap P
INSURER(S) AFFORDING COVERAGE
NAIC #
Hialeah FL 33012
INSURERA: Granada Insurance Company
16870
INSURED
INSURER B :
Five Star Electric Service Inc
INSURER C :
8904 Rockridge Glen Cove
INSURER D :
INSURER E :
Boynton Beach FL 33437
INSURER F :
COVERAGES CERTIFICATE NUMBER: REVISION NUMRER-
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
I TYPE OF INSURANCE
AD L
INSD
SUBRI
WVD
POLICY NUMBER
POLICY EFF
MM/DD/YYYYl
POLICY EXP
(MMIDDIYYYYI
LIMITS
X
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE X OCCUR
EACH OCCURRENCE
$ 500,000
PREMISES Ea occurrence
$ 100,000
MED EXP (Any one person)
$ 50,000
PERSONAL& ADV INJURY
$ 500,000
A
0185FL00004923
12/07/2018
12/07/2019
GEN'L
X
AGGREGATE LIMIT APPLIES PER:
POLICY E � LOC
GENERAL AGGREGATE
$ 500,000
PRODUCTS -COMP/OP AGG
$ 500,000
$
OTHER:
AUTOMOBILE
LIABILITY
COMBINED SINGLE LIMIT
Ea accident
$
BODILY INJURY (Per person)
$
ANY AUTO
ALL OWNED SCHEDULED
AUTOS AUTOS
BODILY INJURY Per accident
( )
$
NON -OWNED
HIRED AUTOS AUTOS
PROPERTY t DAMAGE
Peracciden
$
$
UMBRELLA LIAB
OCCUR
EACH OCCURRENCE
$
AGGREGATE
$
EXCESS LIAB
CLAIMS -MADE
DED I I RETENTION $
$
WORKERS COMPENSATION
PER OTH-
I
AND EMPLOYERS' LIABILITY Y / N
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED? ❑
N / A
STATUTE ER
E.L. EACH ACCIDENT
$
E.L. DISEASE - EA EMPLOYE
$
(Mandatory in NH)
If yes, describe under
E.L. DISEASE - POLICY LIMIT
$
DESCRIPTION OF OPERATIONS below
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
License # EC13002983
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Miami Shores Village Buidling Department ACCORDANCE WITH THE POLICY PROVISIONS.
10050 NE 2nd Ave AUTHORIZED REPRESENTATIVE
Miami Shores FL 33138 6x
U 1933-2014 ACORD CORPORATION. All rights reserved.
ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD
Five Star Electric Service Inc
8904 Rockridge Glen Cove
Boynton Beach, FI. 33473
EC13002983
Date: 10-12-2019
State of 4� r 1 41;2�_
County of Ln�� I
Before me this day personally appeared 0 rd, ho, being duly sworn, deposes
and says:
That he or she will be the only person working,pn the pF*ect located at:
tractor Signature
Sworn to (or affirmed) and subscribed before nme this� day of
OG b� �. 20 , by J �I • �h� C41MPersonally know
Produced Identification !/ Type of Identification ProducedIL
Print, Type or Stamp Name of Notary
rK1TZ MATHIJIM
My COMMISSION #GGS=
EXPIRES: June 10 2021
✓ OR