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EL-02-20-325, 100 NE 101st StMiami Shores VillageI Building Department SFr r Z. 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 BY: INSPECTION LINE PHONE NUMBER: (305) 762-4949 FBC 20001M BUILDING Master Permit No. it L 02 ','2o ' 3Z 5 PERMIT APPLICATION Sub Permit No. ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑ PLUMBING ❑ MECHANICAL [I -CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: O` cf— City: Miami Shores County: Miami Dade Zip: 3313R.) Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FIFE: OWNER: Name (Fee Simple Titleholder): Address: City: _ (�,n� State: Tenant/Lessee Name: Email: CONTRACTOR: Company Name: lr—t®v d Address: 2-4 &T k Email: � n Qualifier Name: i'o /�A�cr State Certification or Registration #: 22 DESIGNER: Architect/Engineer: Address: Value of Work for this Permit: $ Type of Work: ❑ Addition ❑ Alteration Description of Work: wvwm�-1111 one#: k t� Az" Phone#: 7S7 ^ 3Co7 S'?6? Certificate of Competency #: Phone#: City: State: Zip: Square/Linear Footage of Work: ❑ New ❑ Repair/Replace ❑ Demolition ``k' _iff A - r Specify color of color thru tile: Submittal Fee $ Permit Fee $ CCF $_ Scanning Fee $ DCA Fee $ DBPR $ Technology Fee $ Training/Education Fee $ Structural Reviews $ P&Z Review $ CO/CC $ _ Notary $_ Double Fee $ _ Bond $ _ TOTAL FEE NOW DUE $ (Revised04/05/2022) Bonding Company's Name (if applicable) Bonding Company's Address City State Mortgage Lender's Name (if applicable) I 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 aaaroved and a reinsaection fee will be charaed. Signature OWNER or AGEN The foregoing instrument was acknowledged before me this p day of 20 �o by V r� �� who is personally known to me or who has produced D{1 1'/► as identification and who did take an oath. NOTARY PUBLIC: Signature CONTRACTOR The foregoing instrument instrumentwas acknowledged before me this (John hw day � of q j t20 a , by 1 Y tq whois personally known to me or who has produced � )nw�h as identification and who did take an oath. NOTARY PUBLIC: Sign: Sign: Print:-44 Print: Mc t l m l 1 l yr 1.f Seal: MY COMMISSION SHH252206 Seal: t EXPIRES: Apr012, 2028 MERLINS CHERY ' MY COMMISSION 0 NH 25M #nMW#�K##'ikTP1i### ############# APPROVED BY a,'7— Plans Examiner Zoning Structural Review Clerk (Revised04/05/2022) 10/20/22, 8:52 AM Miami -Dade County - Building and neighborhood Compliance Office Contractor License Information Contractor Number: 22E000393 Contractor name: MOODY ELECTRIC INC Address: 603 N 21 ANE City, % Zip: HOLLYWOOD FL 33020 Phone: (305) 8774891 Other Phone: Fax: Email: BARNEY@MOODYELECTRIC.COM DB/A: Contractor Status: ACTIVE Class Cate o C2!Egog Descri tion Expiration Date ELEC 1 ELECTRICAL 09/30/2023 I I F C 2 BURGLAR ALARM 09/30/2023 EEC J 4 FIRE ALARM SPECLT 09/30/2023 __...... BCCO Contractor CONTRACTOR INQUIRY COMPLETE ........... .............................. ................... Inn�ry and Q2Mpjaint Search I BCCO Home Page I State License n •I About I Phone Directory P va y l Disclaimer © 2001 Miami -Dade County. All rights reserved. ........... Search Menu e .:gvsys.miamidade.gov:1608/WWWSERV/ggvt/BNZAW941.DIA?CNTR=22E000393 1/1 Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Permit NO.: EL-02-20-325 Permit Type: Electrical - Residential Work classification: Alteration Permit Status: Approved Issue Date:02/13/2020 Expiration: 02/20/2023 .ocation Address Parcel Number 100 NE 101ST ST, Miami Shores, FL 33138 1132060132020 Contacts BRYON THOMAS Owner MOODY ELECTRIC INC Contractor 136 NE 101 ST, MIAMI SHORES, FL 331382321 JOHN MOODY bryon.thomas@gmail.com 3812A N 29 AVE, hollywood, FL 33020 Business: 3057582000 barney@moodyelectric.com Ins ection Requests: Description: CHANGE OUT THREE BATHROOM VENT FAN IN Valuation: $ 4,500.00 305 762 4949 JPSTATIS MASTER AND GUEST BATHROOM . GUEST BAI HROOM THREE HIGH HATS, TWO GFI OUTLET AND ONE Total Sq Feet 150.00 MIRROR LIGHT RUN NEW LINE FOR WASHER AND DRYER ` Fees Amount Application Fee - Other $50.00 CCF $3.00 Change of Contractor $145.00 Change of Contractor $110.00 DBPR Fee $2.36 DCA Fee $2.00 Education Surcharge $1.00 Permit Fee $107.50 Scanning Fee $3.00 Technology Fee $3.94 Total: $427.80 Building Department Copy Payments Date Paid Amt Paid Total Fees $427.80 Credit Card 05/08/2020 $110.00 Credit Card 09/23/2022 $145.00 Check # 3085 02/13/2020 $172.80 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 the above named contractor to do the work stated. Signature:OwrWr / icant / Contractor / Agent Date Septembe�23, 2022 /— " Page 2 of 2 Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Location Address Permit NO.: EL-02-20-325 -7 Permit Type: Electrical - Residential Work Classification: Alteration Permit Status: Approved Issue Date.,02/13/2020 Expiration:08/11/2020 Parcel Number 100 NE 101ST ST, Miami Shores, FL 33138 1132060132020 Contacts BRYON THOMAS Owner SUNSHINE ELECTRICAL CONTRACTORS Contractor 136 NE 101 ST, MIAMI SHORES, FL 331382321 CORP MARIANO SANTIESTEBAN 1300 SW 85 CT, MIAMI , FL 33144 Business: 3052654958 Home: 7864439590 Other:7862736194 Description: CHANGE OUT THREE BATHROOM VELFANIN Valuation: $ 4,500.00 Inspection Re uests: UPSTATIS MASTER AND GUEST BATHROOM . GUE305-762-4949 BATHROOM THREE HIGH HATS, TWO GFI OUTLET Total Sq Feet: 150.00 MIRROR LIGHT RUN NEW LINE FOR WASHER AND Fees Application Fee - Other CCF DBPR Fee DCA Fee Education Surcharge Permit Fee Scanning Fee Technology Fee Total Amount $50.00 $3.00 $2.36 $2.00 $1.00 $107.50 $3.00 $3.94 $172.80 Payments Date Paid Amt Paid Total Fees $172.80 Check # 3085 02/13/2020 $172.80 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 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 the above named contractor to do the work stated. Owner / Applicant / Contractor / Agent February 13, 2020 Page 2 of 2 Permit Number: Owner's Name (Fee Simple Title Holder): Owner's Address: City: State : Job Address (where work is being done): City: Miami Shores, Conti Addr City: Quali Architect/ Engineer of Record Name: Address: City: Describe Work: Phone: Zip Code: State: —Florida Zip Code: State: Phone: Zip Code: I 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. Signatur wner / Agen The foregoing instrument cnowledged Signature Contractor / Architect / Engineer The foregoing instrument was aknowledged y before me this :�3 day of 02-z by before me this day of ,20 , by 'IULCQho is personally known to me or who has produced V ✓et ,� I WSC as indentification. Notary Public: �Owl '••RLINECHERY 0i MY COMMMSION 0 HN 262206 Sign and Seal: °. � �' 'ADr0122M Who is personally known to me or who has produced Notary Public: Sign and Seal: as indentification. 11062020 - Change of Contractor Form Page 2 of 2 Miami Shores Village Building Department 10050 NE 2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795-2204 www.msvfl.gov Change of Contractor/Architect or Engineer A change of contractor, architect or engineer must be done under a permit revision .There is a $110.00 charge for a change of contractor. The owner will submit a Change of Contractor Form completed with notarized signatures of both, owner and current contractor. If the signature of the current contractor cannot be obtained the owner must send a certified letter return receipt notifying the current contractor, architect or engineer the reason for the change .The owner must allow 10 business days for the contractor, architect or engineer notification before action is taken as required under section 8-13(4) of the Miami Dade County Code. A permit application must accompany the change of contractor form, with the information and signature of the new contractor and owner or owner agent as required under FS 713.135 (6)(a) .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 current 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, and shall comply with Florida administrative code 61G1-18.002 11062020 - Change of Contractor Form Page 1 of 2 CO Ln Er r- rLi M EM C3 M ru r%- ni r:I nj M r- ❑ — Receipt ftrd-py) $ ;p M•V U ❑ Return Receipt (electronic) $ tri 111'1 ❑ CoMed Mail Restricted Delivery $ $U UU ❑ Adult Signature Required $ ❑Adult SlWMbure Restricted Delivery $ .111w9e $0.60 RM Postmark Here 09/12/2022 3.---?02-rl Certified Mail service provides the following benefits: ■ A receipt (this portion of the Cergfled Mail label). for an electronic retuaVecelpt retail ■ A unique Identifier for your meilpiece. associate for assistance. To receive a duplicate ■ Electronic verHication of delivery or attempted return receipt for no additional fee, present this delivery. USPS®-postmarked Certified Mail receipt to the ■ A record of delivery prmludkng the reelpWs reel associate. signature) that Is retained by the Postal Service- Restricted delivery service, which provides for a specified period. del(very to the addressee specified by name, or te the addressee's authorized agent import int Reminders. Adult signature service, which requires the ■ You may purchase Certified Mall service with signee to be at least 21 years of age (not Rrst-Class Mall°, Rrst-Gass Package Service®, available at retalq. or Priority Maly service. Adult signature restricted delivery service, which ■ CertiNed Mall service Is not available for requires the signse to be at least 21 years of age International mall. and pmvldes delivery to the addressee specified ■ Insurance coverage Is notavallable for purchase by name, or to the addressee's authorized agent with Certified Mail service. However, the purchase (not available at retell). of Certified Mall service does not change the ■ To ensure that your Certified Mail receipt Is Insurance coverage automatically included with accepted as legal proof of mailing, R should bear a certain Priority Mall Items. USPS postmark. It you would like a postmark on ■ For an additional fee, and with a proper this Certified Mall receipt, please present your endorsement an the maliplece, you may request Certified Mail Item at a Post Office- for the following services. postmarking. H you don't need a postmark on this - Return receipt service, which provides a record Certified Mall receipt, detach the bercoded portion of delivery (Including the recipients signature). of this label, affix it to the maliplece, apply You can request a hardcopy return receipt or an appropriate postage, and deposit the mailplece. electronic version. For a hardcopy return receipt, complete PS Form 3811. Domuestfe Rearm Receipt attach PS Form 3811 to your makiplece; WOROW. Save this receipt for ymv records. PS Farm 39OOr Apra 2016 (Ravo=) PSN 7Ma0 M-OM9047 I t /UyNI+TED STATES f OJ TAL SE ICE. MTAMI SHORES 9825 NE 2ND AVE MIAMI, FI_. 33153-9998 (800)275-8777 09/12/2022 03:50 PM Pruduct Otv Unit Price Price First -Class Mail® 1 $0.60 Letter Hollywood, FL 33027 Weight: 0 lb 0.30 oz Estimated Delivery Data Wed 09/14/2022 Certified Mail® $4.00 Tracking #: 70212720000279582743 Total $4.60 Grand Total- $4.60 Credit Card Remit $4.60 Card Name: AMEX Account #: XXXXXXXXXXX5004 Approval #: 846944 Transaction #: 973 AID: A000000025010801 Chip AL: AMERICAN EXPRESS PIN: Not Required x AiC X7C Ycx HitXxxwx]CY[xx'x xxxkx'K :t x rcxxxXiCxxx Y. ]K x':Cxx Every Household in the U.S. is now eligible to receive a third set of 8 free test kits. Go to www.covidtests.gov xxx��Cx x'x*Y!*Yc1C�7txY(7Ckxx,tx �txxxx'ic lF 7t Kltxxxxtxxxx Text ;rout tracking number to 28777 (2USPS) to yet the latest status. Standard Message and Data rates may apply. You may also visit www.usps.com USPS Tracking or call 1-800-222-1811. Preview your Mail Track your Packages Sign up for FREE https://informeddelivery.usps.curn All sales final on Stamps and pu-.ta9e. Refunds for guaranteed services only. Thank you for vour business. Tell us about your experience. Gu to: hops:/!postalenparience.com/Pos or scan this code with !,our mobile device, or call 1-800-410-7420. UFN: 115885-0118 Receipt #: 840-53300063-1-5641868-3 Clerk: 03 September 12, 2022 Orlando Padin Green Planet Electric, Inc. 4320SW 148 Terrace Miramar, FI 33027 Dear Mr. Palin, We are writing you regarding the electrical job, permit EL-02-20-325, at the following address- 100 NE 1015t Street, Miami Shores, FL 33138. Due to our impending need to finish the job and close all permits, which currently conflicts with your prior commitments and work schedule. We would like to inform you that we will be submitting for a change of contractor. Thank you in advance for your work and professionalism. Sincerely, Bryon Thomas Property Owner 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 LECTR ❑ ROOFING F:1VElr� 111202n (0 1FBC 20 +--� l Master Permit No. Sub Permit No. L--G Z- L -�!bs� ❑ REVISION ❑ EXTENSION ❑ RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: ) 00 NE ( O 1 gt — rAm ns l 5 V O to S � 1 e�3 , 3 City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: OWNER: Name (Fee Simple Titleholder Flood Zone: BFE: FFE: City: f" \\ 53CA 5 State: -1� Zip: ?=3 1 Tenant/Lessee Name: Email: CONTRACTOR: Company Name: CiD""rU kiz EU.C)6 Cj • (or p • Phone#: T-�."13�1 �►—�g6�1`1?igl qo Address: 11700 4.5,W $'t c—+ City: Pwr' State: f) Zip: 331 `I Qualifier Name: �C�(Lr. � 5,�k.6 " Phone#:7-41` bcV� '`L v State Certification or Registration #: [: C. I -.JobO S� R q1 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 Description of Work: Specify color of color thru tile: Submittal Fee $ r Permit Fee $ Scanning Fee $ Technology Fee $ Structural Reviews $ Radon Fee $ re e- lJ Y1 e1� ILl h e Training/Education Fee $ CCF $ DBPR $ Zip: ❑ Demolition De ' 6 CR () 4•� CO/CC $ . Notary $ Double Fee $ _ Bond $ TOTAL FEE NOW DUE $ I '42 90 (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 reinspection fee will be charged. Signature OWNER or AGENT The foregoing instrument was acknowledged before me this 0--A- Sig Signature CONTRACTOR The foregoing instrument was acknowledged before me this day of 20 2� byi _day of � 20 ZO by k4o �',Wo is personally known toAQn1►cno5 igtih2-r, who is personally known to me or who has produced as me or who has produced as identification and who did take an oath. NOTARY Print: I Nbl Seal: F-t&vr-� SINDIA ALVAREZMY COMMISSION# GG 238273EXPIRES: September 3,2922 gonM TAN Notary Public. Urlds fttfe identification and who dio n oaJA. UL NAVARRO Commission #FF972714 NOTARY PUBLIC: ayyT My Commission Expires F�a March 20 2020 Sign: \L� �— Print: Ii 1QA Seal: *********************************************************************************************** APPROVED �Z �� Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) Sunshine Electrical Contractors Corp LICENSE # EC13005807 PHONE NUMBER 7862736194 Date; 7/26/ 2017 COUNTY OF MIAMI SHORES VILLAGE Building Department Before me this day personally appeared John A David, who been duty sworn deposes and says: That he will the only person working on the property located at Cordially: w Mariano Santies eban Sworn to and subscribed before me this a t Personally Know Or produced Identification Type of identification 1 Print, Type or stamp seal of Notary I O® tIL to I -t;\ - rk%ct 5 S+1 -�31j1 day of — 20&Q by IAQyU,awo `�)� 6co, y VARROFF972714L=O- on Expires 2020 Miami shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Notice to Owner — Workers' Compensation 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: 1. 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: Owner State of Florida County of Miami -Dade The foregoing was acknowledge before me this _ day of C.E►B�AJP2-`J , 20 20 By 1-71> Lb-h�i 7who is personally known to me or has produced —2- as identification. Notary: SEAL: SINDIA ALVAREZ MY COMMISSION # GG 238273 Bonded Thru Notes Public Undewriters BUILDING PERMIT APPLICATION ❑BUILDING 0� ELECTRIC PLUMBING ❑ MECHANICAL 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 RE'CEIVED A J 0 !4 o FBC 20 Master Permit No.C'�' Sub Permit No. ❑ ROOFING ❑ REVISION ❑PUBLIC WORK(:[)HANGE OF ONTRACTOR ❑ EXTENSION ❑RENEWAL ❑ CANCELLATION ❑ SHOP DRAWINGS JOB ADDRESS: / 0 0 Al r✓ l 01 S f Sk'CQt City Miami Shores County: Miami Dade Zia: ,3*3f 3b Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): City: W� rL. q 2LJIS, State: Zip: �;315b Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Address4 `F J aL City: Qualifier Name: k it l'& 147� State Certification or Registration #: -� I "-I' ul-'-" )u& Certificate of Competency #: Zip: L� DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: $ Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: Specify color of color thru tile: Submittal Fee $ Permit Fee $ Scanning Fee $ Radon Fee $ Technology Fee $ Training/Education Fee $ Structural Reviews S CCF $ CO/CC $ DBPR $ Notary $ Double Fee $ Bond $ (Revised02/24/2014) TOTAL FEE NOW DUE $ Bonding Company's Name (if applicable) Bonding Company's Address City State Mortgage Lender's Name (if applicable) Mortgage Lender's Address City 22 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 on estimated vale exceeding $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien low b chure will be delivered to the person whose property is subject to attachment Also, a certified copy of the recorded notice of comm ncement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In he absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature Signatu OWNER or AGE CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of t . 2020 by 0 day of 1� p�Y) . 20 2 O by P h who is ersonall kno to �L�-•-� i1'i�[u-^-� e y ,who is personally known to me or who has produced / i as me or who has produced 1i C-C as identification and who did take an oath. identification a an oath. NOTARY PUBLIC: NOTARY UBLIC: Sign: _ - Sign: Print OV`C . o wMa, Print: C r Seal: 'Sy Puae MARCILOWMM Seal: k Commission # GG 121481 Expires July 9, 2021 wf9j O+��;P Bv4WTluu6u tNM— rsrrsrrrrrtrrssS��bsssssssrsrr�i°irssrrssrrrsssrrerrrrrrssssrrrrrrrrrsrsrrrsrrrrrrrrrrsrssssrrrssrrrrrrsrrrrrrs fS"yi= APPROVED BY/V12—,210Plans Examiner Structural Review Zoning Clerk (Revised02/24/2014) March 14th, 2020 Sunshine Electrical Contractors, Corp. Mariano Santiesteban 1300 SW 85th CT, Miami, FL 33144 Dear Mr. Santiesteban, We are writing you regarding the electrical job, permit EL-02-20-325, commenced the week of Monday, January 13th under contract with Dilbert Enterprise, Inc., at the following address- 100 NE 1015t Street, Miami Shores, FL 33138. This letter hereby certifies, that as of Monday, March 2ntl, 2020 per your office's request, Mariano Santiesteban/Sunshine Electrical Contractors, Corp. is NO longer the qualifier nor contractor on this project. Sincerely, Bryon Thomas Property Owner Registered No. Postage $ Extra Services & Fees r ❑signature Conwmatlon Extra Services & Fees ❑ Registered Mau 9l'=�' ❑tmr RetReceipt (hardeopy) 9 ❑Return Receipt (etecnoWo $ ❑RRestr � " s Total Postage & Fees is to- ❑Restricted DGIVMIS- . • _ ; DC isi do Customer Must Declare Full Value, Received by PS Form 35101t L April 2015, PSN For dome: i Complete items 1, 2, and 3. ■ Print your name and address on the reverse so that we can return the card to you. ■ Attach this card to the back of the mallplece, or on the front if space permits. 1. Article Addressed to: m:,o 5f �: �-��+ Date Stamp hcwrenrs up to SKODO f based upon the vaWe. Irdematbnal is radted. (See Reverse). Receipt Copy 1- Customer (See information on Reverse) visit our website at www.usps.com ° _ B. F16ceived by Putted j�delivery address dUterertt from Item 1?' tJ Yes H YES, enter delivery address below: O No IIIIIIiII IIII IIIIII IIIIIIIII III iIIIIIII IIII III O MWtttSWaWr Re*WW DOIVe►y 0 �MMarm aDResbtated 9590 9402 4729 8344 6882 54 0 Cettgad linen Restricted DeIIYruy 0 ptfa Membuldise e e.w.,a A'"I'ar m»rwfwr -Lvlceg. (aben_ O CcAect an DBUvenyr 0 Collect on DWWW ResVitrted De1Wery0 SW Me mdrizattonWA 0 on _ Mall RE 6 7 3 615 593 US ,i au Restricted DelWary BUY DBPR - MOODY, JOHN BERNARD; Doing Business As: MOODY ELECTRIC, INC.,— Page 1 of 2 THE OFFICIAL SITE OF' T'HE F'LORIDA DEPARTMENT OF BUSINESS S PROFESSIONAL, REGULATION db'�'d ' I HOME CONTACT US MY ACCOUNT ONLINE SERVICES LICENSEE DETAILS 9:05:03AM 1012012022 Licensee Information Apply for a License Name: MOODY, JOHN BERNARD (Primary Name) , 4 i_;c;e1''i,,'. MOODY ELECTRIC, INC. (DBA Name) View Food & Lodging Inspections Main Address: 603 NORTH 21ST AVENUE HOLLYWOOD Florida 33020 File a Complaint County: BROWARD Continuing Education Course Search License Information View Application Status License Type: Registered Electrical Contractor Find Exam Information Rank: Reg Electrical License Number: ER13016067 Unlicensed Activity Search Status: Current,Active AB&T Delinquent Invoice & Activity Licensure Date: 10/06/2022 List Search Expires: 08/31/2024 Special Qualification Effective Qualifications Dade 10/06/2022 Alternate Names View Related License Information View License Complaint 2601 Blair Stone Road, Tallahassee FL 32399 :: Email: Customer Contact Center:: Customer Contact Center: 850.487.1395 The State of Florida is an AA/EEO employer. Copyright 2007-2010 State of Florida. Privacy Statement Under Florida law, email addresses are public records. If you do not want your email address released in response to a public - records request, do not send electronic mail to this entity. Instead, contact the office by phone or by traditional mail. If you have any questions, please contact 850.487,1395. *Pursuant to Section 455.275(1), Florida Statutes, effective October 1, 2012. licensees licensed under Chapter 455, F.S. must provide the Department with an email address if they have one. The emails provided may be used for official communication with the licensee. However email addresses are public record. If you do not wish https://www.myfloridalicense.com/LicenseDetail.asp?SID=&id=70D 11263D8F9FOB712... 10/20/2022 lE CITY OF HOLLYWOOD 0IAM0. TREASURY SERVICES DIVISION LOCAL BUSINESS TAX •GR�'ORA'f�,i MOODY ELECTRIC, INC 603N21AVE HOLLYWOOD, FL 33020 Please contact us with any changes or corrections to your information. CUSTOMER SERVICE: Should you have any questions regarding Local Business Tax or need to update / correct any Information related to your Business Tax Account, please contact us by phone at 954-921-3225, by email at businesstax@hollywoodfl.org or in person at City Hall, Room 103, 2600 Hollywood Blvd. Please send all written correspondence to: City of Hollywood, Treasury Services Division, Attn: Business Tax, Room 103, PO Box 229045, Hollywood, FL 33022-9045. PURSUANT TO STATE LAW, LOCAL BUSINESS TAX 15 LEVIED FOR THE PRIVILEGE OF DOING BUSINESS WITHIN A CITY'S LIMITS, AND IS NON -REGULATORY IN NATURE, ISSUANCE OF A LOCAL BUSINESS TAX RECEIPT BY THE CITY OF HOLLYWOOD DOES NOT MEAN THAT THE CITY HAS DETERMINED THAT THE EXISTING OR PROPOSED USE OF A LOCATION IS LAWFUL. ISSUANCE OF A LOCAL BUSINESS TAX RECEIPT DOES NOT LEGALIZE OR CONDONE THE NATURE OF THE BUSINESS BEING CONDUCTED IF CONTRARY TO ANY LOCAL, STATE OR FEDERAL LAW OR REGULATION. THIS IS NOT A BILL. DO NOT PAY. BFLO4V IS YOUR LOCAL BUSINESS TAX RECEIPT. PLEASE DETACH AND POST THIS LOCAL BUSINESS TAX RECEIPT IN A CONSPICUOUS PLACE AT YOUR PLACE OF BUSINESS. L CITY OF anin co �! FLORIDA 2022/2023 LOCAL BUSINESS TAX RECEIPT Business Name: MOODY ELECTRIC, INC DBA: Business Location: 603 N 21 AVE es; Category: SERVICE/LICENSED BUSINESS f,cation Contractor/Electrical 5 - 25 WORKERS Account Registration #: 89069056-2023 Expiration Date: 9/30/2023 Tax Rate: $316.00 �c o� CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) I Z129/2021 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. IMP the certificate holder is an ADDITIONAL INSURED, the po icy ies must be endorsed. , su ect 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). �I.UDUCERGUNTACT NAME: Andrew Stenberg .. _ .......... Partners PHONE FAX Ext):....813 -400 2720 (Aj -MAIL C, NO): 813-440-2747 - , ADDRESS: andrewiwcmhriskpartners.COm .......... _ INSURERS) AFFORDING COVERAGE NAIC 0 FL 33688 INSURER A : FCCI INSURANCE COMPANY 10178 f €" INSURER e ! FCC[ Insurance Company 10178 Moody Electric, Inc. INSURER C : 603 N 21 st Ave INSURER D : .......... INSURER E: Hollywood FL 33020 INSURER F : COVERAGES CFRTIFICATF N1IMR5:9- 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 AODL SUBR POLTCY EFF pODCY EXP INSD WVD POLICY NUMBER MM/OD MMIDD LIMITS X ;COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE X OCCUR Df' VV*E TO RENTED - PREMISES (Ea occurrence) $ 100,000 MED EXP (Any one person) S 5,000 A Y Y CM100064955 01 12/31 /2021 12/31/2022 PERSONAL & ADV INJURY $ 11000,000 GEN L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000 X POLICY PRO JECT 10C _. _,_ _ PRODUCTS - COMP/OP AGG $ 2,000,000 0TNFR.._. _...._.._ .._....._..__. _. . AUTOMOBILE LIABILITY tEa acadent> I'OW'000 X ANY A,JTO BODILY INJURY (PerpeBon) $ III JVJNFr SCHEDULED .. _._.._. _....-_— ._.._. _. r4s AUTUS CA100064957 01 1213IJ2021 12/31/2022 BODILY INJURY (Per a=Centi $ NCN-OWNED X F!!Tr c PROPERTY DAMAGE$ (Per accident) a( bMBRELLA LIAB X OCCUR EACH OCCURRENCE S 3,000,000 'EXCESS LIAB CLAIMS -MADE CP100064960-01 12/31/2021 12/31/2022 AGGREGATE S 3,000,000 DED X RETENTION $ 10,000 $ WORKERS COMPENSATION _ AND EMPLOYERS' UABIUTY Y / N STATUTE ER _.... _ . ANY PROPRIETOR PARTNER)EkECUTIVE OFFICER"MEMBER EXCLUDED ❑ N ! A E L EACH ACCIDENT $ (Mandatory in NH) I IC yy8Ss , describe under E L DISEASE EA EMPLOYEE $ .... __._. ......__._.... I OESCRIPTION OF OPERATIONS below E.L, DISEASE POLICY UMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 104, Additional Remarks Schsdute, may be attached if more spate is required) Miami Shores Village is listed as an additional insured. -- ICATE HOLDER Hii1YVGLI.MI IVry SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Mi,iml Shores Village ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE 2nd Avenue AUTHORIZED REPRESENTATIVE Miami Shores FL 33138 ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD MOODY-1 OP ID: CERTIFICATE OF LIABILITY INSURANCE DATE(M i+••+'`12/27120YYY) /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 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 Workers Compensation Group P0Box 410 Boca Raton, FL 33429-0410 I ED t/oo y Electric, Inc N. 21st Avenue -Iivwood, FL 33020 rrnvccarrcc 1'C0TICIrATC ►II,aAOCO. PHONE IAIC.,�No, Ext) 561-392-3300 ADDpR�SS cert @Workerscompgroup com INSURERS) AFFORDING COVERASE INSURER A Bridgefield Employers Ins INSURER 8 : .....__.__ _..._._. INSURER C INSURER 0 INSURER E INSURER F FAX. No).561-361-1132 OC\pC1A11L1 All 11NI000. NAIC 0 10701 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 SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. 'POLICIES. _LIMITS INSR TYPE OF INSURANCE_ A06L SUER POLICY NUMBER _ POLICY EFF POLICY EXP - -- LIMITS COMMERCIAL GENERAL LIABILITY , EACH OCCURRENCE $ CLAIMS -MADE OCCUR , DAMAGE TO RENTED ,.PREMISE6.LE3_QECaDLBnLel MED EXP (Any pne person}. _ ,.......... _...._. ___.__.. _--... _._ PERSONAL 8 ADV INJURY,_. GENY AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ _ POLICY '.,-....,., �PERa .. LOC PRODUCTS.•COMP;OP AGG $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT _ _ ..... ANY AUTO BODILY INJURY (Per.p_erav^) µA OWNED SCHEDULED -- AUTO$ ONLY AUTOS BODILY INJURY (Per accident)_ . $ HIR D NOVJWNED AU�tJS ONLY All O ONLY P�tQPERTY GE L Br 8cs;ttlent . ,. _ UMBRELLA LIAR OCCUR EACH OCCURRENCE__.. EXCESS LIAS CLAIMS -MADE AGGREGATE DED RETENTION 2" WORKERS COMPENSATION NC Fh1PLOYERS LIABILITY PER OTH- _X-.3I8SSIIli ___ER ._._ YIN X 830-29673 01/01/2022 01/01/2023 11000,000 - Eti:LtE!.1PERECCLUDED" N NIA EL EACH ACCIDENT $,__ (Mandatory In NH) ,. EL _DISEASE EA EMPLOYEE $.._-.1,000,000 $1 vtS' aescrlDe Under 1,000,000 DESCRIPTION OF OPERATIONS E.L E - MIT i DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be ahtached H more space Is required) Electrical Contractors •A blanket Waiver of subr ation is provided under Workers' compensation in favor of Village of Miami Shores. MIAMIS3 I Village of Miami Shores Fax:305-756-8972 10050 NE 2nd Ave. 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 k--/ ACORD 25 (2016103) ©1088-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD lm=� P V ".11 ", W, W. T M. N vV 77 : faces 1 acc—s ualifying Board 3NESS CERTIFICATE OF COMPETENCY 22E000393 )ODY ELECTRIC INC RD of Chapter 10 of Miami -Daft