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EL-03-19-675, 1275 NE 103rd StMiami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Location Address Parcel Number 1275 NE 103RD ST, Miami Shores, FL 33138 1132050200080 .ontacts Jacques Nijankin Owner ELECTRICAL MASTERS INC Contractor 1275 103 OSVALDO RODRIGUEZ 8400 SW 14 ST, MIAMI, FL 33144 Business:3052657996 ELECTRICAL. MASTERS@HOTMAIL.COM Mobile: 3058797029 Description: POOL REMODELING POOL PUMP, BONDING AND Valuation: $ 950.00 Inspection Requests: LIGHTS 762 4949 (�1(" Total Sq Feet: 1,450.00 Fees Amount Application Fee - Other $50.00 CCF $0.60 DBPR Fee $2.00 DCA Fee $2.00 Education Surcharge $0.20 Permit Fee $50.00 Scanning Fee $12.00 Technology Fee $2.50 Total: $119.30 Payments Date Paid Amt Paid Total Fees $119.30 Check # 4678 06/05/2019 $69.30 Check # 4540 03/29/2019 $50.00 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. Authorized Signature: Owner / Applicant / Contractor / Agent Date June 05, 2019 V `j 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 P< ELECTRIC ❑ ROOFING FBC 20 1 - Master Permit No.: 6�3 19 -0 Sub Permit No.-L-D3 Jcl -(c Ts ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 1 275 N v C- 105 S"r. City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: 49ff— Load: Construction Type: Flood Zone: BFE: FIFE: Of OWNER: Name (Fee Simple Titleholder): O AG 6 0 G 7 1 �1INJ frill 1-1 ILL Phone#:3 Q Address: 1,216 6 N E 16 3 5T MAN 58 d 1ZE s City: State: T v F Zip: Tenant/Lessee Name: l) Allelee Ph Email: CONTRACTOR: Company Name: �_ �� �//� r / ��`/S.C�j -f ��O . Phone#: -3o 977-70Z`1 Address: �/ `�/l2-1 5t-I-) Z l City: 9/ rri/ State: �'� Zip: 33195 Qualifier Name: � /1 0e-11-1 I LeGZ Phone#: �C3-5) 972-10, State Certification or Registration #: C= b- 1 L,1 . ) J 7 C L` G 0 0 3 g �? � Certificate of Competency #: / 7 DESIGNER: Architect/Engineer: 7C. EuQ/%%-eQ%il2a Phone#: JOG- 2 (0/' d 32/ .Pe 157 Address: 7805 5W �57, City:/�//%9/ State-) Zip: �J % $ % Value of Work for this Permit: $ 5il). 40Square/Linear Footage of Work: Type of Work: ❑ Addition X Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: �GtJ//%��7i//7l-� ©('(,G IpCJ/IiD _/UD��%g/Glhl S Specify color of color thru tile: Submittal Fee S4J • V Permit Fee $ Scanning Fee $ Radon Fee $ Technology Fee $ Structural Reviews $ Training/Education Fee $ CCF $ CO/CC $ DBPR $ Notary $ Double Fee $ Bond $ TOTAL FEE NOW DUE $ 0 y _ (Revised02/24/2014) Bonding Company's Name (if applicable) Bonding Company's Address City Mortgage Lender's Name (if applicabl Mortgage Lender's Address City State 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 su,Aiqt to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first insperfion 1which occurs/seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will t be approved and 0 reypspection fee will be charged. Signature or AGENT The /foregoing instrument was ijwas acknowledged before me this KJ �-�- day of -CA. , 20 ( 1 by Tit U P� `� f1J who is personally known to me or who has produced identification and who did take an oath. NOTARY PUBLIC: Sign:_ Print: Signature CONTRACTOR The foregoing instrument was acknowledged before me this Z� day of 0 Gt-�"e� 20 l c by Q%V P1\W'Vbri qua who is personally known to as me or who has produced identification and who did take an oath. NOTARY PUBLIC: Sign:_ Print: ": •= Commission # FF 924095 = `t V* .= Seal: "olF My Comm. Expires Dec 13, 2019 Seal: • + Commission # FF 924095 o, oFp� ,• My Comm. Expires Dec 13, 2019 Bonded through National Notary Assn. Bonded through National Notary Assn. as ********************************************************************************************************* APPROVED BY (� Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) ,Irk :. '+` • �s � � t' t y� „,' r , T FA9Mvv0003 ELECTRIC.. -AL MASTERS INC D.B.A.: RODRIGUEZ OSVALDO Is certified under the provisions of Chapter 10 of Miami -Dade County �,l 1�,: f � !A .'I'' �'��� r 4 1 ° , r `. i•!�,,+�, �'. ~ y ��" ,� � �.ij\i�� „�. � • � Y: } y Air {+a�ri�J � �, ray%...1` r' t r . �� �•m'� « �./ ��.,�rja � e r � �,..#'. :. .,#,.. ! 1` • :\ ^+. l � M'iry r` t d"e..+,syl '7 :. r r y 1 , ro �,. � vim,: � � ,. , f , r : 1 � , ? ' I '+ i' ` .� ' « ,; '�• r�,�t�,r4�r ',ar�tA �'y � .«n'�j�l"'" • J�� e• e', � ij� 4,� +���i sti .o-,t :ram ,s► „ y ��r"' s 4i ��a '.�w �'t .� t.e. • L`►r r ;•`r�+e ;e+."�'i-.� :r•• 1►"a; � r ,y� �. _•. � ,.,. _. ! .. ;• �� '" c rF�; . t'•-e4:`. w, a�„`'• t -"n `� e'er .,, � ;,"..� .} - RICK SCOTT, GOVERNOR JONATHAN ZACHEM, SECRETARY db' p3d DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD THE ELECTRICAL CONTRACTOR HEREIN HAS REGISTERED UNDER THE PROVISIONS OF CHAPTER 489, FLORIDA STATUTES RODRIGUEZ, O VALDO ELECTRICALMASTERS INC 8445 NE 2 AVE MIAMI FL 33138 LICENSE NUMBER: ER001 3057 EXPIRATION DATE: AUGUST 31, 2020 Always verify licenses online at MyFloridaLicense.com �AyFE I Do not alter this document in any form. &A. ®� •; This is your license. It is unlawful for anyone other than the licensee to use this document. Municipal Contractor's Tax Ieceipt Miami -Dade County, State of Florida -THIS IS NOT A BILL - 00 NOT PAY m C CC NO: 97ED00003 BUSINESS NAM EILOCATION RECEIPT NO EXPIRES aBaTRIut4��l8400 SEPTEMBER 30, 201 S MIAMI, R1. 33144 7550285 Pursuant to County Code Sec 10-24 OWNER TYPE OF BUSINESS 81MRICALmASIERS INC ELF�1EaCPL �JTRAMOR PA THENT RECEIVED BY TAX COLLECTOR 200.00 09/12/2018 0233.18-004609 This receipt is riot Ytlid in the fdlowirq Muriapii4Ps: Awnture. 0". H•tart. Key &S-jlfe, Miam Gwdens, Miam lakes. Palmetto Bay. Pn t w, Scary Isles Beack Town d Outlier Bay. T• Fornoreillorrnwm.r,stwww rriamdacie, (g;jg Local Business Tax fbcei pt Miami -Dade County, State of Florida - THIS IS NOT A BILL - 00 NOT PAY 3693075 BUSINESS NAM EILOCA TION RECEIPT NO ELECTRICAL MASTERS INC RENEWAL 8400 SW 14TH ST 3857902 MIAMI, FL 33144 L13..T EXPIRES SEPTEMBER 30, 2019 Must be displayed at place of business Pursuant to County Code Chapter BA, - Art. 9 6 10 OWNER SEC. TYPE OF BUSINESS ELECTRICAL MASTERS INC 196 ELECTRICAL PAY M ENT RECEIVED BY TAX COLLECTOR CONTRACTOR 75.00 09/12/2018 Worker(s) 3 97E000003 0233-18-004609 INS LmW Were" TaX POMP) Orly 00n^ms pwymxx d the local Business TaX. The Receipt is ndt a license. parrrit, or a ceB `Cagan d tre hadWs"i ^emions, lodD business. Hddsr n W oo npty with" ymwn ren, or norpowmsrrtal regal" laws and reW Mrentswh& apply to V* business The RBHPT NO above mat be displayed anal comwcisl vehides - M,"-Dods Dodo Sec as-278 luumt T�011For nwa informstion, Malt A ^ Q® CERTIFICATE OF LIABILITY INSURANCE DATE (MM/Y) l(V(J/A 2019 03/28/2019 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 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 Teresita Carmona NAME: iSure Insurance Brokers, Inc. A//C No Ext : (305) 223-2533 ac No : (305) 220-0765 gDORIEss: Teresita@iSureBrokers.com 8700 W. Flagler St INSURER(S) AFFORDING COVERAGE NAIL 8 Ste 270 INSURER A: BURWII- AlainSpecialtyInsuranceCompany Miami FL 33174 INSURED INSURER B : AmTruSt Insurance Co 15954 INSURER C : Electrical Masters Inc. dba electrical Master Group INSURER D : 9223 SW 4th Terr INSURER E : INSURER F : Miami FL 33174 COVERAGES CERTIFICATE NUMBER: CL182600141 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 ADDLISUBRI INSD WVD POLICY NUMBER POLICY EFF MM/DDh POUCY EXP M/DDIYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2000000 CLAIMS -MADE � OCCUR _7100,000 DAMAGE TO RENTED PREMISES (Ea occurrrence $ MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 2000000 A CIP359418 12/17/2018 12/17/2019 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2000000 X POLICY ❑ PECT RO- JLOC PRODUCTS - COMP/OPAGG 2000000 $ Employee Benefits $ OTHER' AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ ANY AUTO 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 $ HCLAIMS-MADE AGGREGATE $ EXCESS LIAB DED I I RETENTION $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y I N ANY PROPRIETOR/PARTNERIEXECUTIVE OFFICER/MEMBER EXCLUDED? _ (Mandatory in NH) NIA AWC1122580 02/01/2019 02/01/2020 /� STATUTE ORH E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Electrical Contractor CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Miami Shores Building Dept ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE 2nd Ave AUTHORIZED REPRESENTATIVE Miami Shores FL 33138 © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD