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EL-09-22-2225• li!!3E i:�i w Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Location Address 9301 NW 2ND CT, Miami Shores, FL 33150 Contacts Permit NO.: EL-09-22-2225 Permit Type: Electrical - Residential Work Classification: Alteration Permit status: Approved Issue Date: 09/01/2022 Expiration: 03/01/2023 Parcel Number 1131010150400 Pierre Leroy Owner DIRECT BUILDERS Applicant 9301 NW 2 CT, MIAMI SHORES, FL 33150-2212 MIGUEL AMADOR pleroy1956@yahoo.com Mobile: 3052322329 MIKE@DIRECTBUILDERS.NET SAIBA LEROY Applicant ELECTRICAL SERVICES JC INC Contractor JUAN PORTILLO sleroy09@gmaii.com 4401 SW 102 AVE, MIAMI, FL 33165 Business: 3052448628 Description: ELECTRICAL DEMOLITION AS PER APPROVED PLANS RC-04-22-1053 Fees Amount Application Fee - Other $50.00 CCF $0.60 DBPR Fee $2.00 DCA Fee $2.00 Education Surcharge $0.30 Permit Fee $50.00 Scanning Fee $9.00 Scanning Fee (Manual) $3.00 Technology Fee $10.00 Total: $126.90 Building Department Copy Valuation: j � $ 800.00 Inspection Requests: 305-762-4949 Total Sq Feet- 1,200.00 Payments Date Paid Amt Paid Total Fees $126.90 Credit Card 09/01/2022 $126.90 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. certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws zonin Futhermore, I authorize the above named contractor to do the work stated. Authorized SignWure: Owner Applicant / Contractor / Agent Date September 01, 2022 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 XELECTRIC ❑ ROOFING �l SEP 01 2022 IU A FBC 20 Master Permit NoDG:M0 -01'22- 009 Sub Permit No. ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑ CHANGE OF CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS Q JOB ADDRESS: -1 5o I N II I 2—Ra C-T - City: Miami Shores County: Miami Dade Zip: :S 3_1_50 Folio/Parcel#: 1 I'50 CAI 0 k 50 L00 Is the Building Historically Designated: Yes NO Y_ Occupancy Type: Load: Construction Type: Flood Zone: ` BFE: FFE: OWNER: Name (Fee Simple Titleholder): R e-'ct- Phone#:.1 gb -1 %1 2 5 6 2 3 Address: O� 50 1 N N Z 4-1 Cl ' City: K i A.V-V. S S&43qj w-a State: o V" n-d zip: _13 l S'O Tenant/Lessee Name: I\/ d W is Phone#: Email: e CONTRACTOR: Company Name: Address: y4 U 1 I--102, Email: r C^---I � < < ':�z I U Cc4 J u ct N O 0, CxN`V)- Qualifier Name: VC�n T O'� State Certification or Registration #: �L ( 30 0 971� 1 DESIGNER: Architect/Engineer: Phone#: V 65 Phone#: Certificate of Competency #: ne#: 30 s .2yC1 &-29 Address. City: State:i Zip: Value of Work for this Permit: Square/Linear Footage of Work: 0 I ZOO •0 0 Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace [Demolition Description of Work: GG 1Q t- j'" aez ❑k= AA ei- CCU' c&'- A s ots� 4-0 s arpto vcn M. $ . 13 Specify color of color thru tile: Submittal Fee $ , o� Permit Fee $ CCF $ V, k7O CO/CC $ Scanning Fee $ DCA Fee $ 4'-• DBPR $ 2- CO Notary $ Technology Fee $ -off Training/Education Fee $ ©,-' Double Fee $ Structural Reviews $ 0 P&Z Review $ Bond $ TOTAL FEE NOW DUE $ S r k. (Revised04/05/2022) 12.140. 9 o Bonding Company's Name (if applicable) N A Bonding Company's Address— Q A City State Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State 1J 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 t a ted notice, the inspection will not be approved and a rein,�pection fee will be charged. Signature 1,41 A;' _^ Signature 1�7w- NER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this dayof 31 , 20 Z , by who is pers_ o_ nally known to i - ..Me or who has produced iV%S-,,c as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: Y•q °f1wda •,, aF rti: ` My Comm. Expires Jul 1,1025 Seal: Bonded through National Notary Assn. APPROVED BY The foregoing instrument was acknowledged before me this day of {0 , 20 2 1- by V GJl 0 i l who is personally known to me or who has produced TO)- P63`I `1 13-81-M4s-0 identification and who did take an oath. NOTARY PUBLIC: b<+T F -.. ELIZABETH VASQUEZ Sign: ?. �a`� ; Notary Public - State of Florida pr ,••' My Comm, Expires Aug 5, 2025 Print: � ssn. SnOlepq Seal: Plans Examiner Structural Review Zoning Clerk (Revised04/05/2022) ELECSER-01 YSARDINA TY INSURANCE DATE CERT14 ATE ULTAQ 8/29/2022 ( THIS CERTIFICATE IS ISSUED AS A MATTER INF M N 1614LY CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY O NEGATIVE Y AMEND, E D OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE OES N T NSTITUTE A ONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE C YW4 R. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the po Icy 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 endorsements . PRODUCER CONTACT Niurka Garcia Pandora Insurance, Inc. 14578 SW 8th Street IAH/CC."No. Ext): (305) 603-7301 JC. Nol:(305) 675-8034 Miami, FL 33184 E w niurka@pandorainsurance.com INSURERISI AFFORDING COVERAGE NAIC # INSURED ELECTRICAL SERVICES JC INC 4401 SW 102 AVE MIAMI, FL 33165 INSURER C : INSURER E INSURER F : Industries In r-nV1170AMPA rFRTIFIrATF NIIMRr-R- RFVISICIN NIIMRFR- 23140 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. NSI TELA TYPE OF INSURANCE ADDL SINSD VUIBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 1 CLAIMS -MADE 7V7 OCCUR GL-48549-7 7/1/2022 7I112023 nAMAGETREMISESORENTED 100,000 MED EXP (Any oneperson) 5,000 PERSONAL BADV INJURY 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 2,000,000 PRODUCTS-COMP/OPAGG $ 2,000,000 X POLICY ❑ PRO ❑ LOC JECT OTWF.R, AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ BODILY INJURY fPerperson) $ ANY AUTO BODILY INJURY Per accident $ OWNED SCHEDULED AUTOS ONLY AUTOS PROPER t AMAGE per $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED I ' RETENTION $ $ AWC1172658 B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARXECUTIVE 10/30/2021 10/30/2022 X PER OTH- T 7 E.L. EACH ACCIDENT 1,000,000 $ ' OFFICER/MEMBER EXCLUDED? ❑ (Mandatory in NH) N / A E.J_ DISEASE - FA EMPLOYEE $ 1,000,000 E.L. DISEASE -POLICY LIMIT $ 1,000,000 IF yes, describe under DESCRIPTION OF OPERATIONS beIDW DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Electrician ,License #EC13005560 MIAMI SHORES VILLAGE BUILDING DEPARMENT 10050 NE .2nd AVENUE 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 j ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD L■7 Cl li;.,,. B� -� m Ln ou cc m m c) r o m M + '• 0 n -4 Z ° fD D < ;U f c �. m "' n C1 C _ — m z �_n � p C } � 0.. -� a 0 CA } :v Z TI ICD (D < C rn -n C : k� i� , � m' r ? r o C1 n m m - ,.i 0 C w w z Lr) � i �� Z r 0 70 cn -n fD o CD N o (I n � �� D � � tin � v.:. D G) Z _ c Z r N m p 0 cn m > m = 70 C) = D C ,1 o m U71 7U. CL f � i 023692 �p T g 10 T � SEP 01 2022 Local Business Tax Receipt Miami —Dade County, State of Florida -THIS IS NOT A BILL - DO NOT PAY 7049547 LBT BUSINESS NAAIF/ "TION K1EIPTPoo. EXPIRES ELECTRICAL SERVICES JC INC RENEWAL SEPTEM BER 30, 2023 4401 SW 102ND AVE 7326051 Must be displayed at place of business MIAMI FL 33165-5022 Pursuant to County Code Chapter SA - Art 9 & 10 OWNER SEC TYPE OF BUSINESS ELECTRICAL SERVICES JC INC 196 ELECTRICAL CONTRACTOR PAYYENTBECENED EC13005560 BYTAR COLLECTOR $75.00 07/12/2022 Worker(s) 1 INT-22-358763 This La cal Business Tax Recaiptonly confirms payment of tho Local Business Tax. The Receipt is not ficsoss. permit, o r a ceOil icadon of tho holder"squa lificatians, to do husiness. Hold or must comply with any governmemal a nongavarnmeMal regulatory laws and requirements which apply to the Itusinssa. The RECEIPT NO. above must be displayed on all commercial vehicles — Miami —Dade Coda Sec Ile—M For more information, visit www.mirrmidade.0yAgXroflector