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EC-04-20-815, 9353 NE 9th Ave�, ► r v ,--L . RECFJVF,D Miami Shores Village AP 2 33 2020 Building Department B: 10050 N.E.2nd Avenue, Miami Shores, Florida 33138� Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 FBC 20 BUILDING Master Permit No. RC�(1 9 2 /1- 12 -7 PERMIT APPLICATION Sub Permit No.� ( t — 2-6 ❑BUILDING 2- LECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: q.1 ID 3 1 -/ aV City-_ Miami Shores County: Miami Dade Zip / 3O Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: Load: _ Construction Type: / Flood Zone: BFE: FFE: / OWNER: Name (Fee Simple Titleholder): �/ 3 � /by 1Cct l ,_Phone#(1' U� 6 3 % to Address:(3e,-j- w � / 1/ City: ��tato I eezet,_ Stater Zip: 3e� / �� Tenant/Lessee Name: Phone#: Email CONTRACTOR: Company Name: 06 6AL t22 OA r ��J�/n� / � Phone#: Address: / -' s70 f i / fib` & T' City:lf'��,4 41 State: Zip: Qualifier Name: 600 � �'y-4 Phone#: State Certification or Registration #: C: 2. 120 /1SVy Certificate of Competency #:2- DESIGNER: Architect/Engineer: Add Phone#: City: State: Value of Work for this Permit: $ 1 62 49 Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New IR Repair/Replace Description of Work: .Specify color of color thru tile: � i 03 ❑ Demolition Submittal Fee'$ Permit Fee .$ CCF $CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Notary $ Technology Fee $ Training/Education Fee $ Double Fee $ Structural Reviews $ Bond $ TOTAL FEE NOW DUE $ (Revlsed02/24/2014} ;. Bonding Company's Name (if applicable) Bonding Company's Address City State Mortgage Lender's Name (if applicable) _ Mortgage Lender's Address City State E. WE 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, 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 •t�t day of �� — —J 20 q by y Q _ ho is personally known o n Signature CONTRACTOR The foregoing b instrum�eyntt wyas acknowledged before me this 121 day /,of�,-� I l�rO- 1 20 iq by "� (O 20k2 who is ersonaily know 'to me or who has produced as me or who has produced as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: Sign:tia i Print: Print: 2�'Z Seal: `�t t•- MY COMMISSION # GG075248 Seal: ;FY► MFVISGONZALEZ Notary Public -State ofFlonda EXPIRES March O6, 2021 Commission # GG 159892 My Comm Expires Nov 13, 2021 1JTJJJrogNWj n iN o Ass *********** Zoning APPROVED BY 1 Mans Examiner .t Structural Review Clerk (Revised02124/2014) AC"R" CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDlYYYY) 04121 /2020 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 CONTACT Maday Corona PnNic°No Ext : (305) 300-6187 FAAic No : EME Insurance Group E-MAIL ADDRESS: aazcorona1 sler hotmail.com Y P C 1600 Pomce De Leon INSURERS AFFORDING COVERAGE NAIC # INSURER A: Westchester Surplus Line Insurance Coral Gambles FL 33134 INSURED INSURER B : Ascendant Insurance Company INSURER C Global Electric Services LLC INSURER D : 15905 SW 105TH Court INSURER E : Miami, FI 33157 INSURER F : 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. INSR LTR LTR TYPE OF INSURANCE JUM WVD SUER POLICY NUMBER MM DD/YYYY MM DD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1 000 000.00 %/ CLAIMS -MADE OCCUR S DAMAGETO RENTED PREMISES Ea occurrence $ 100 000.00 1 MED EXP (Any one person) $ 5000.00 PERSONAL & ADV INJURY S 1000000.00 GLWF15298145001 12/21/2019 12/21/2020 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2 000 000.00 POLICY �� jECT L LOC PRODUCTS - COMP/OP AGG $ 2 000 000.00 is OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N OFFICER/MEMBEREXCLUDED' rN (Mandatory in Ni N/A; N GLWC094171-13 12/21/2019 12/21/2020 1 STATUTE ERPER H- E.L. EACH ACCIDENT S 500 000.00 i E.L. DISEASE - EA EMPLOYE $ 500 000.00 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT - $ 500OOO.00 i DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101. Additional Remarks Schedule, may be attached if more space is required) Electrical Wiring Lic Number: EC13009200 CERTIFICATE HOLDER CANCELLATION Miami Shores Village SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE 2nd Avenue Miami, FL 33138 AUTHORIZED REPRESENTATIVE © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 26 (2016/03) The ACORD name and logo are registered marks of ACORD