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EL-01-21-152 10666 NE 11 AveRECEIVED 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 ® ELECTRIC ❑ ROOFING FBC 20 Master Permit No. BPP-10-20-2378 Sub Permit No.I ❑ REVISION ❑ EXTENSION ❑RENEWAL PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS [-]CHANGE OF [—]CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: inRRR NF 11 AVE Miami Shores County- Miami Dade Zip; Folio/Parcel#:11-2232-02"690 Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: SFE: FFE: OWNER: Name (Fee Simple Titleholder): Laudy Luna Phone#: 1nRRR NE 11 AVE Cit., Miami Shores Tenant/Lessee Name: _ State: FL Email: CONTRACTOR: Company Name: Caraball0 Electrical Industries, Inc Phone#: Address: 5810 SW 113 CT tit,,: Miami _state: FL Qualifier Name: George Cancio Phone#: State Certification or Registration M EC13008168 Certificate of Competency #: DESIGNER: Architect/Engineer. 1p: 33138 7867156056 zip 33173 7867156056 Address: City: State:_Zip: Value of Work for this Permit- $ Z �) N) square/Linear Footage of Work: 0\0 Type of Work, ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of work: electrical for swimming pool Specify color of color thru Submittal Fee; Scanning Fee $ Technology Fee S Structural Reviews $ Permit Fee $ Radon Fee $ TrainhWEducation Fee S CCF $ CO/CC $ DBPR $ Notary $ Double Fee $ Bond $ TOTAL FEE NOW DUE $ I (3 U . C) (RoAwdOZ/24/20141 Bonding Company s Name (if applicable) Bonding Company's Address City State Mortgage Lender's Name (If applicable) Mortgage City state 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 low brochure will be delivered to the person whose property is subject to attachment. Also, o cerWkd 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 wr7f'n�t be approved and a reinspeFtion fee will be charged. � Jk !J OWNERdrAGENT The foregoing instrument was acknowledged before me this + day - KA4'`�l 20 by who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: I Signature ��� CONTRACTOR The foregoing instrument was acknowledged before me this 20th day of January, 20 21 by George Cancio who is personally known to me or who has produced identification and who did take an oath. NOTARY as V + Notary �� 1 nee Mirefs M z Print: N-A Print: My Commisswn G2 t9t Seal: +iare�' ex0irero2i2erzo2z Seal:...'(0kiP8kSL idlaTlIRBB COMMISSION IGG,66408 'i`: '� pc v+maE6 OpcETner • ION Rnorkv, 'hqv ,r, Y." 49ory ersr►►rrs►s►rrprrrrrrsrsss►s►rss►►►►s►rr►s►rrrrrrrrrrrrrrsrrrr►rrl'Yliarrrrrr►►rrprrprrrsr►sar►rrrssesr APPROVED BY _ Plans Examiner Zoning Structural Review _. _ Clerk (Revtse02/24/2014) �I p O 0 g v w o �D1���// N W// s fi Q Q w V m J mD Z O = Z U a Li z cN o O Z LL F- (/') to 00 N O 0 N E c N Z o° W E2 � T v L o Q W W O F c~n n O M c O OC J Z J LL O Q U C'') CV) N •L .� c ra O a cn 'w c7 w ~ MQ� LL u w� C7 -2 >. v LLJ O = co N au.-� Wd Q uE O Z O � w F O fR m LLJ c O co w w 0_ Z o n s c H N Q W f" Q Oa L Z N ° Zn NV O O U a LLI u wv OOZ° wo 3 � CMQ U �n Z a m � a _� o � O V Q u a W> 3 H w _� > Q v Z ~ u O v v W 0 ° LU J w a u_ L H W w 2 0 c F- in Q v •� � a � 0 W FL- � Q &OR .? L Local Business Tax Receipt Miami —Dade County, State of Florida -THIS IS NOT A BILL - DO NOT PAY 7235491 BUSINESS NAME/LOCATION CARABALLO ELECTRICAL INDUSTRIES INC - 5810 SW 113TH CT MIAMI, FL 33173 OWNER CARABALLO ELECTRICAL INDUSTRIES INC n/n rFnRrF r.ANrin Of JAI IFIFR Worker(s) 3 RECEIPT NO. RENEWAL 7521398 SEC. TYPE OF BUSINESS 196 ELECTRICAL CONTRACTOR EC13008168 LBT EXPIRES SEPTEMBER 30, 2021 Must be displayed at place of business Pursuant to County Code Chapter BA - Art. 9 & 10 PAYMENT RECEIVED BY TAX COLLECTOR 75.00 08/25/2020 CREDITCARD-20-069650 This Local Business Tax Receipt only confirms payment of the Local Business Tax, The Receipt is not a license. permit, or a certification or Me holders qualifications, to do business. Holder must comply with any governmental or nongovernmental regulatory laws and requirements which apply to the business. The RECEIPT NO. above must be displayed on all commercial vehicles- Miami -Dade Code Sec 83-276. IMAW NSIZI For more information, visit www miam'dade go0oxcollecmr .avi CERTIFICATE OF LIABILITY INSURANCE °"'11104 � _ „fognoz0 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: M this cMllkate hold" an ADDITIONAL INSURED, the polky(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 right. to the certificate holder In lieu of such sndo_nemem(s). PRODUCER C' xME Nin Matle Estrada Yes Insurance Agencies, Inc. Wc. n s,g. (305 22557571. (0 5) 2238158 Np. 30 9507 Bird Road ADD�. madeanaijItnalms.com Miami. FL 33165 utaunER)gj AFFo di COVERAM _ NAIL• Phone (305)225.5757 Fax (305)2238158 INSURER A: Grenade Insurance COMP. INSURM .INSURER B: Caraballo Electrical lndustnes.lnc INSURER C: _ ��- 5810 SW 113 LT INSURER D : _ INSURER E . NWrM FL 33173 MIl1M8RF: — — — 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.#deft _.I._ yy_ FF ❑ COMMEROAL GENERAL UASLITV — POLICY NUMBER 1MW C Y110aMN01YYYY1 _ MM1T8 AXIL TYPE OF INSURANCE BR _ _ FACN OCCURRENCE _ S 1000,000_00 CWM&MADE N OCCUR DAMAGE TO RENTED BLe AaUrnnQJ_ $ 100,000.00 MED ExP IMy cow Ia.wnl s 5,000.00 A --' _ _ N N 0185FL00103B11 1112212020 11/22/2021 PERBONALBgDV NJURY s 1,000,000.00 G�^E�NL AGGREGATE UNI T APPLIES PER: GENERALAOraiEGATE s 2,000,000.00 LI POLICY JEOCT LJ LOC PROOIICTS-COMPXIP AGO s 2,000,000.00 _ OTHER $ AUTOMOBILE LYI&LRYGEa 71NGLE LIMIT _a ~ — ANY AUTO _ 9CNEWLEO I (BODILY INJURV IPo.pereenl S DW NED ADS BODILY INJURY (Par attlOwe; S AUTOS ONLY _ L. HIRED AUTD LY �' AUTOSONLY ((Pn.P�nItWAAGE f T UMBRELLAl1AB ]OCCUR EACH OCCURRENCE L AGGREGATE y E%CESB LLAB �- CLNs16�M,A0E DED RETDJ110rJ s_ I` - s _ _.— VIAMERSCOMPENSATION — _ - -PER r ET4 . MID EMPLOYTORPAR IMTY Y!N ---STATUTE ANY PROPMRS-LIMINU RAJ(ECUTp/G1--I OFFICERIMEMBER EXCLUDED? IJ MIA EL EACH ACCIDENT s (WndOM In NH) EL DISEASE -EA EMPLOYE a Iryea, dwmtw urea - OEBCRIPTION OF OPERAT10N8 .slew r E.L. DISEASE • POLICY LIMIT 3 —_ OFBCIaIiION OF OPERATIONS 1 LOCATIONS / VEHICLES (AnaM ACOiO let, Aetlllbnal RamaAs eceeEule, It more apes If rtpulmC) Electrical Work -inside or outside building State LiC R 13OD8168 CERTIFICATE HOLDER - Miami Shores Village Building Department 10050 NF 2 Ave Miami Shores, A 33138 ACORD 25 (2016/03) CIF 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. reserved. of ACORD �Ro® CERTIFICATE OF LIABILITY INSURANCE DAT2YYY) 01108/20/OB/2021 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 pollcy(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 Automatic Data Processing Insurance Agency, Inc. 1 Adp Boulevard Roseland NJ 07068 CONTACT NAME: Automatic Data Processing Insurance Agency, Inc. uc°Na Exe: 1-800-524-7024 FAX No; EMAIL ADDRESS: INSURER($) AFFORDING COVERAGE MAN: It INSURER A: Travelers Indemnity Company of Amerce 25666 INSURED CARABALLO ELECTRICAL Industries Inc DBA: CARABALLO ELECTRICAL Industries Inc 5810 SW 1131h Cl Miami FL 33173 INSURER B: INSURERC: INSURER D: INSURER E : INSURERF: COVERAGES CERTIFICATE NUMBER: 1799307 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 ADDLSUBR POLICY NUMBER PO MMIDDY EFF I YYYI MOOD LIMITS COMMERCIAL GENERAL LIABILITY CLAIMS -MADE ❑ OCCUR EACH OCCURRENCE $ DAMAGE TO R PREMISES Ea occurrence S MED EXP (Any one person) $ PERSONAL S ADV INJURY S GEN'L AGGREGATE LIMIT APPLIES PER: POLICY ❑ JET E LOO OTHER, GENERAL AGGREGATE S PRODUCTS-COMP/OPAGG S $ AUTOMOBILE LIABILITY ANY AUTO OWNED LED AUTOS AUTOS ONLY AUTOS HIRED NON-OWNEDPR AUTOS ONLY AUTOS ONLY AUTOS$ COMBINED SINGLE LIMIT$ Ea accident BODILY INJURY (Per person) $ ent (1 BODILY INJURY Per accid $ P RTYDAMAGE Per accident UMBRELLA LUIB EXCESS LIAR CLAIMS -MADE EACH OCCURRENCE $ HOCCUR AGGREGATE $ DEO RETENTION$ $ A WORKERS COMPENSATION AND EMPLOYERS•LIABILITY YIN My OFFICER/MEMBER EXCLUDEO?ECUTIVE Q (Mandatory In Nil) Use, desadboundo, balm DESCRIPTION OF OPERATIONS ba MIA N UB-2L345266-20-42 12/13/2020 12/13/2021 STATUTE ER El EACH ACCIDENT $ SOO,000 El DISEASE - EA EMPLOYEE $ 500,000 El. DISEASE -POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) Contractor License: State Lic # EC13008168 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Miami Shores Village BLDG Department ACCORDANCE WITH THE POLICY PROVISIONS. 10050 Ne 2 Ave AUTHORIZED REPRESENTATIVE Miami FL 33138 © 1988-2015 ACORD CORPORATION. All rights reserved ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD