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EL-04-21-924, 29 NE 102nd StMiami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Location Address Parcel Number 29 NE 102ND ST, Miami Shores, FL 33138 � 1132060131650 Contacts Christian Ulvert & Carlos Andrade Owner WELL ELECTRIC TECHNOLOGY Contractor 29 NE 102ND ST, Miami Shores, FL 33138 TONY WELL Mobile: 3053363631 christian.ulvert@gmail.com 4310 NW 11 ST, MIAMI, FL 33126 Business:3057267098 wellelectrictech@gmail.com Other:7864738455 NNUMEMKOMMENUMMMEd Inspection Requests: Description: INSTALLATION OF INTERUPTORS, OUTLETS AND gI Valuation: $ 4,000.00 LIGHTS � Total Sq Feet: 2,000.00 � 305-762 4949 Fees Amount Application Fee - Other $50.00 CCF $2.40 DBPR Fee $2.10 DCA Fee $2.00 Education Surcharge $0.80 Permit Fee $90.00 Scanning Fee $120.00 Technology Fee $3.50 Total: $270.80 Building Department Copy Payments Date Paid Amt Paid Total Fees $270.80 Credit Card 04/12/2021 $270.80 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 authorizek"ove named contractor to do the work stated. Authorized Signature: Owner / Applicant / r /v Agent Date April 12, 2021 Page 2 of 2 engineering Inc LETTER TRANSMITTAL DATE: INCLUDES: 7/12/2022 AS TO COMPANY: ARPE PROJECT NUMBER Camilo Rosales 19-0816 ATTENTION: CLIENT PROJECT NUMBER: Mercedes RE: Ulvert-Andrade Residence Attached www.arpe-eng.com ❑ HAND DELIVERED ❑ COURIER ® PICKED UP [:]OTHERS _--- USPS_________ ❑ Shop Drawings Copies Description: ® Signed & Sealed 2 Sets Copies Description: ES-1,E-1, E-2, E-3, ❑ Originals Copies Description: ® Calculations Copies Description: ® Specifications 2 Sets Copies Description: Narrative ❑ Invoice included REMARKS: Signed and Sealed — Revision #4 Owner Changes Q:\19-0816 ULVERT-ANDRADE RESIDENCE 21 NE 102 ST MIAMI SHORES (CAMILO ROSALES)\DOCS\T-07-12-2022 REV 4.doc 2020 Ponce DeLeon Boulevard Suite 1002, Coral Gables, Florida 33134 Ph 305.444.9809 Fax >Mechanical >Electrical >Plumbing > Fire Protection >C.A. >LEED Certification Miami Shores Village REC. rVzD, Building Department APR 12 2021 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 .BY: SF Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 BUILDING PERMIT APPLICATION ❑BUILDING 0 ELECTRIC ❑ ROOFING FBC 20� 0 Master Permit No. RC-10-19-2368 Sub Permit No. (�_ L- (_� 4 — 21— 92+ ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS 29 NE 102ND ST JOB ADDRESS: City: Miami Shores County: Miami Dade Zip: 33138 Folio/Parcel#k' (' Z ��o ' lL}< Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: CHRISTIAN ULVERT & CARLOS ANDRADE 786-351-1699 OWNER: Name (Fee Simple Titleholder): phone#: Address: 29 NE 102ND ST MIAMI SHORES FL 33138 City: State: Zip: Tenant/Lessee Name: {{ y �' Email: C AIIS-h � �JIya 1 C t + (u)'m CONTRACTOR: Company Name: Well Electric Technology Inc _Phone#: 305-986-3884 Address: 4312 Nw 11 St City: Miami State: FI Zip: 33126 Qualifier Name: Tony Well Phone#: 305-986-3884 State Certification or Registration #: EC 13001181 Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: $ 4000 Square/Linear Footage of Work: Type of Work: ❑ Addition E Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: INSTALLATION OF INTERUCTORS, OUTLETS AND LIGHTS Specify color of color thru tile: Submittal Fee $ Scanning Fee $ Technology Fee $_ Structural Reviews $ Permit Fee $ Radon Fee $ Training/Education Fee $ CCF $_ DBPR $ CO/CC $ Notary $ Double Fee $ _ Bond $ TOTAL FEE NOW DUE $ _ (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 approveci ana,-reir}s'pection fee will be charged. Sign OWNER or AGENT The foregoing instrument was acknowledged before me this day of a-7 20 ?J by `0291 CAC who is personally known to me or who has produced identification and who did take an oath. NOTARY PUBLIC: Sign: Print: Seal: APPROVED BY MY COMMISSION # GG 117058 EXPIRES: June 26, 2021 Bonded Thru Notary Public Underwriters as Signature CONTRACTOR The foregoing in sKument was acknowledged before me this day of 4�, 20 Z-1 by low i 6;E; who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign:4i1*------,-,,�;�1, Print: Seal Plans Examiner Structural Review Zoning Clerk (Revised02/24/2014) 02026 Local Business Tax Receipt Miami —Dade County, State of Florida —THIS IS NOT A BILL — DO NOT PAY 5567087 BUSINESS NAME/LOCATION WELL ELECTRIC TECHNOLOGY INC 4312 NW 11TH ST MIAMI FL 33126 OWNER WELL ELECTRIC TECHNOLOGY INC Worker(s) RECEIPT NO. RENEWAL 5807087 SEC. TYPE OF BUSINESS 196 ELECTRICAL CONTRACTOR EC13001181 EXPIRES SEPTEMBER 30, 2021 Must be displayed at place of business Pursuant to County Code Chapter 8A — Art. 9 & 10 PAYMENT RECEIVED BY TAX COLLECTOR $45.00 08/07/2020 CHECK21-20-074941 This local Business Tax Receipt only confirms payment of the Local Business Tax. The Receipt is not a license, permit, or a certification of the holder's 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 8a-276. For more information, visit www.miamidade gov/laxcollector A� �® CERTIFICATE OF LIABILITY INSURANCE DATE /YYYY) 04/06/206/2021 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 0 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 Amanda Nogues NAME: Eastern Insurance Group, Inc. AICNr o Ext : (305) 595-3323 FAX No : (305) 595 7135 E-MAIL amanda@easterninsurance.net ADDRESS: 9570 SW 107 Avenue INSURER(S) AFFORDING COVERAGE NAIC # Suite 104 INSURERA: RetailFirst Insurance Company 10700 Miami FL 33176 INSURED INSURER B INSURER C Well Electric Technology, Inc. INSURER D : 4312 NW 11 th St INSURER E : INSURERF: Miami FL 33126 COVERAGES CERTIFICATE NUMBER: Master 20-21 REVISION NUMBER: THIS IS TO CERTIFY THATTHE 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. IICY LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/ D/YYYY EXP MMLDD/Y YY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE: 10 HEN 1177— CLAIMS-MADE F1 OCCUR PREMISES Ea occurrence $ IVIED EXP (Any one person) $ PERSONAL& ADV INJURY $ GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY ❑ PRO ❑ LOC JECT PRODUCTS -COMP/OP AGG $ $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ ANYAUTO 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 I I RETENTION $ $ WORKERS COMPENSATION X1 A AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? � (Mandatory in NH) N / A 12361 07/29/2020 07/29/2021 STATUTE EORH 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) General contr*tor EC 13001181 Gth1 111-iGA I t MULULK GANGtLLA I IUN Miami Shores Village Building Department 10050 NE Avenue, Mlami Shores, FLorida 33138 Tel:(305) 795-2204 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 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD 6 L CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 4/06/2021 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(ies) must be endorsed. If SUBROGATION IS WAIVED, subjectto 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 NAME: PAULETTE BROWN IMPACT INSURANCE SERVICES LLC 18064 SW 33 Court (954) 885-3884 (954) 885-3885 A/C No Ext : A/ No t-MAIL S3.mpacrservLdmsn.Com ADDRES Miramar, FL 33029 INSURERS AFFORDING COVERAGE NAIC# A032618 INSURER A: UNITED STATES LIABILITY INS INSURED WELL ELECTRIC TECHNOLOGY, INC. INSURER B : INSURER C: 4312 NW 11 STREET INSURER D MIAMI, FL 33126 INSURER E: (786) 399-9180 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 CONTRACTOR 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. LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE I X I OCCUR CL 1799478 3/16/2021 3/16/2022 EACH OCCURRENCE $ 1,000,000 PREMISES (Ea occurrence) $ 100,000 MED EXP (Any one person) $ 5,000 PERSONAL B ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. X POLICY000 PRO- LOC JECT PRODUCTS - COMP/OP AGG $ i $ AUTOMOBILE LIABILITY ANYAUTO ALLOWNED SCHEDULED AUTOS AUTOS NON -OWNED HIREDAUTOS AUTOS ( a acci Tent) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ Per accident $ UMBRELLA LAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes describe under DESCRIPTION OF OPERATIONS below N / A C g U 7H TRY LIMITS OER E. L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) ELECTRICAL CONTRACTOR Lic # EC13001181 r`FRTIFIr`ATF HOI nF:P rANr`FI I ATIOKI Miami Shores Village BUILDING DEPARTMENT SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 10050 NW tad Avenue ACCORDANCE WITH THE POLICY PROVISIONS. Miami Shores FL 33138 AUTHORIZED REPRESENTATIVE © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD25(2010/05) The ACORD name and logo are registered marks of ACORD Ron DeSantis, Governor STATE OF FLORIDA Halsey Beshears, Secretary DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD THE ELECTRICAL CONTRACTOR HEREIN IS CERTIFIED UNDER THE PROVISIONS OF CHAPTER 489, FLORIDA STATUTES WELL, TONY WELL ELECTRIC TECHNOLOGY INC 4310 NW 11 STREET MIAMI FL 33126 LICENSE NUMBER: EC13001181 EXPIRATION DATE: AUGUST 31, 2022 Always verify licenses online at MyFloridaLicense.com I,MZ-1000 Do not alter this document in any form. ' ram.This is your license. It is unlawful for anyone other than the licensee to use this document.