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EL-10-19-2546, 335 NE 101st StMiami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Location Address Parcel Number 335 NE 101ST ST, Miami Shores, FL 33138 1132060135211 Contacts FEDERICO ROJAS AYALA Owner Fuenmayor & Salgueiro LLC Contractor 335 NE 101 ST, MIAMI SHORES, FL 33138 Gabriel Lander Home: 3054847714 FEDERICO.ROJAS@YAHOO.COM 1532 NW SW 147th Ave, Pembroke Pines, FL 33027 Business: 3059044884 GABRIEL.LANDER@GMAIL.COM Ins ection Re uests: Description: SWITCH OUTLETS, LIGHTS MODIFICATION FOR Valuation: $ 6,500.00 0, KITCHEN &BATHROOM REONOVATIONS AND NEW BATHROOM NII7 Total Sq Feet: 0.00 , Fees Amount Application Fee - Other $50.00 CCF $4.20 DBPR Fee $3.41 DCA Fee $2.28 Education Surcharge $1.40 Permit Fee $177.50 Scanning Fee $3.00 Technology Fee $5.69 Total: $247.48 Building Department Copy Payments Date Paid Amt Paid Total Fees $247.48 Credit Card 10/25/2019 $50.00 Credit Card 11/25/2019 $197.48 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 contracjo to do th ;Yvork.stated. Authorized Signature: Owner / Applicant / Contractor / Agent / Date November 25, 2019 Page 2 of 2 ENTERED 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 OCT 25 2019 1 ±' FBC 20iff- BUILDING Master Permit No. V d)6 1 C> PERMIT APPL ATION Sub Permit No. F L.-1 D ' ICI- a'5 4 Lp ❑BUILDING ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS [:]CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: �jf_ Vj I ST City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): T_y-M_2V__C1 V--(3Ah,5:_ Phone#: 6j,- *8-A 7� �4 Address: Uf- \a 1 S_ City: rS})G9�K State: mil` Zip: Tenant/Lessee Name: Phone#: Email:�R;C CONTRACTOR: Company Name:�1.`� Phone#: Address: —I fk,l NW M, cl— City: tN ("k, Qualifier Name: _Zip: 331 9Z ne#: 3c35-- zn -al 02 State Certification or Registration #: G— I✓ 13oo G q (� Certificate of Competency #: DESIGNER: Architect/Engineer: n e#: Address: City: State: Value of Work for this Permit: $ �, �� C�) v Square/Linear Footage of Work: Type of Work: [2- Addition Alteration ❑ New ❑ Repair/Replace Zip: ❑ Demolition Description of Work: S_kjMN oc��� ,,NZS hOl1\f'IC l�Tio� S TC-2. 07C11TLU Specify color of color th{'u tile: Submittal Fee $ Permit Fee $ Scanning Fee $ Technology Fee $ Structural Reviews $ 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 whic;2ajn� r seven days after the building permit is issued. In the absence of such posted notice, the inspection will not be approvy6einsec on fee will be charged. Signature OWNER 6r AGENT The foregoing instrument was acknowledged before me this day of JA C 1� 20 ' -� by -(� who is personally known to me or who has produced identification and who did take an oath. NOTARY PUBLIC: Sign: Print Seal: t4a APPROVED BY Signature CONTRACTOR The foregoing instrument -fwas lacknowledged before me this " day of 20 i by C L�Gh 2/�i who is personally known to as me or who has produced identification and who did take an oath. NOTARY PUBLIC: as I�QC`(.fL%l✓l(n ►l'4 Print: I J Ibm�� M eonor i M Dares Commission ;rE GG099300 �. �= Seal: : � _ x Maria Leo r Mgares Commission # 0%300 GG Ices: A ril EXP p 30, 2021 ,�= Expires: April 30, 2021 �,� �1�� Bonded thru Aaron Notary Bonded thru Aaron Notary Z e� err/f' Plans Examiner Zoning (Revised02/24/2014) Structural Review Clerk Local Business Tax Receipt Miami —Dade Ccunty, State of Florida -THIS IS Nfl7 A BILL — DO NOT PAY 7179790 BUSINESS NAME/LOCATION DENIS BROTHERS ELECTRIC LLC 16652 SW 71ST TER MIAMI, FL 33193 OWNER DENIS BROTHERS ELECTRIC LLC C/O MICHAF_ DENIS MGR Workerts; 1 RECEIPT NO. RENEWAL. 7460094 EXPIRES SEPTEMBER 30, 2020 Must be displayed at place of business Pu,suant io County Code Chapter 8A — Art. 9 & 10 SEC_ TYPE OF BUSINESS 196 ELECTRICAL CONTRACTOR EC 13006416 PAYMENT RECEIVED BY TAX COLLECTOR 75.00 09/ 13/2019 CREDITCARD-19-074547 This Local Business Tax Receipt only confirms payment (it the Local Business Tax, The Receipt is not a license, permit, or a certification of the holder's qualifications, to do business. Holdo r must comply with any governmental or nongovernmental regulatory laws and requirements which apply to the business. The RFCFIPT NO. above must be displayed on all commercial vehicles — Miami —Dade Cade Sec f a-276. MIAMf For more information, visit www.rniemidade.griv/taxerdlector usi )Ok^T"*,% 1,W-#4tA 1W -*tIAAV db la rak.40 fqw", DEPARTMENT OF BUSINESS AND PROFESSIONAL RFC Ut-ATiON, t#4 EtICYRKAL WN TRACTOR 040*1 PR(>VISON'tt Of C-HAPTf4f 481� i I A DENIS. MICHAEL Atw#y-* *vJ " lowvseA #1 %ipf , - Tl,ft it ~' at~, It ift U"imw4w ttv orvv*w *#%or ttw t1w to mr th#% —•�"1 D EN I S-1 OP ID'SB ACORCa► CERTIFICATE OF LIABILITY INSURANCE DATE(MMiDD/YYYY) �•••--� " 10/1712019 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 772-223-0400 1 CONTACT Thomas N.Tardonia Atlantic Pacific - Stuart PHONE 772-223-0400 FAX 772-223-1919 620 SE Central Parkway (AIC, No, Ext): (AIC, No): Stuart, FL 34994 E-MAIL Thomas N.Tardonia ADDRESS:' White Pine Insurance Com thers Electric, LLC. INSURERB: 71 Terr INSURER C 33193 INSURER E : INSURER F : COVFRAGFS CERTIEICATF NIIMRPR• REVISION NLIMRFR- 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 MAYHAVE BEEN REDUCED BY PAID CLAIMS. S ILTR LTR TYPE OF INSURANCE ADDL IN — SUB D --- POLICY NUMBER --- POLICY EFF MIDDIYYYY POLICY EXP MMfDOlYYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE � OCCUR WPCP005690 12/04/2018 12/04/2019 EACH OCCURRENCE $ 1,000,000 DAMAGEPREMISES ( occurrence)RENTEDEa $ 500,000 MEDEXP (Any one erson 5,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY jE � LOC OTHER GENERAL AGGREGATE $ 2,000,000 PRODUCTS- COMP/OP AGG 2,000,000 $ AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUUTOpSt� p OONLY AUTOS ON Y 01 COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY Perperson) BODILY INJURY Per accident $ PROPERTY DAMAGE Per accident $ UMBRELLA LIAB EXCESS LIAR OCCUR EACH OCCURRENCE $ HCLAIMS-MADE AGGREGATE $ DED RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y I NSTATUTE ANY PROPRIETORIPARTNERIEXECUTIVE OFFICERIM M EXCLUDED? ( endato If yes, describe under DESCRIPTION OF OPERATIONS below NJA PER OTH- E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E L DISEASE - POLICY LIMIT _ $ i DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) License #EC13006416 rCDTICIrATC LVII r1CD rAMrCI 1 ATIrNKI MIAMIS2 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Miami Shores Village ACCORDANCE WITH THE POLICY PROVISIONS. Building Department 10050 NE 2nd Avenue Miami Shores, FL 33138 AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD A o® CERTIFICATE OF LIABILITY INSURANCE DATE(MWDD/YYYY) 10/22/2019 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 NAME: Automatic Data Processing Insurance Agency, Inc. PHONE FAX A/C No Ext : A/C No): E-MAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIC # 1 Adp Boulevard INSURER A : NorGUARD Insurance Company 31470 Roseland NJ 07068 INSURED INSURER B : INSURERC: DENIS BROTHERS ELECTRIC LLC INSURER D : 16652 SW 71 ST TER INSURER E : INSURERF: MIAMI FL 33193 COVERAGES CERTIFICATE NUMBER: 1290801 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 ADDL UBR POLICY NUMBER POLICY MOWLDIt�� LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS -MADE 17 OCCUR N PREMISES Ea occurrence $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY PRO ❑ LOG JECT PRODUCTS - COMP/OP AGG $ $ 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 $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED I I RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? � (Mandatory in NH) N/A N DEWC098539 05/22/2019 05/22/2020 PER OTH- STATUTE ER 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) License #EC13006416 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Miami Shores Village ACCORDANCE WITH THE POLICY PROVISIONS. Attn: Building Department AUTHORIZED REPRESENTATIVE 10050 NE 2nd Avenue Miami Shores FL 33138 © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016tO3) The ACORD name and logo are registered marks of ACORD