MC-10-19-2419, 1453 NE 104th St (2)Miami Shores Village ENTERED
Building Department 2020
By;
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 20ri
BUILDING Master Permit No. C-- 10" R-- 1
PERMIT APPLICATION Sub Permit No.
❑BUILDING L] ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL PUBLIC WORKS ❑ CHANGE OF [:]CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: ' 5�3 G,sfiree 1
City: Miami Shores County: Miami Dade Zip: 31 3
Folio/Parcel#: 1 i . 7J`�3 ' O3a'' UCH W Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BEE: FFE:
OWNER: Name (Fee Simple Titleholder): Latv.L% KL,t e ( VI W0 VI Phone#: �=Q►G� a— %5�
Address: t LS 3 L 6- l Q Li ins i
City: i'VA IaHYlI f State: FL Zip: 341
Tenant/Lessee Name: ll�lj Phone#:�GICI -
Email: Cx+,e I n man 1 � , VG i.� o0
CONTRACTOR: Company Name: �Lckz k vt' (st,2 Phone#: 3dS 3(70 74.2 4
Address: �' �507q w s� 4 'z'
City: AtAylr - ' ` T�
State: T �— Zip: -33 1 � 2' (
Qualifier Name: K/"t'0 �) � Phone#: 30S300 Tf -2-
State Certification or Registration #: EAZ 13 0 13 q f Certificate of Competency #: e)!YE 000 N 3
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $ 4. 3 oz. ab Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace
Description of Work:
Specify color of color thru tile:
Submittal Fee $
Scanning Fee $
Technology Fee $_
Structural Reviews $
Permit Fee $
Radon Fee $
Training/Education Fee $
❑ Demolition
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
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 Signature
OWNER or AGENT CONTRACTOR
Theforegoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
%lure( 4 Ian A , who is personally known to
me or who has produced
as
who is personally known to
me or who has produced fit-
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC: l `iaco�a�y�!(lCgr
as
Sig
Sign:
Sign:
Print:
QJANAA1
Print:
Seal:
Seal:
• mow:
'"• .ROSADO
DTAMM
'
• .: MY COMMISSION S GG 911807
• EXPIRES: Doom" 11, 2023
l
APPROVED BY
Plans Examiner
Zoning
Structural Review Clerk
(Revised02/24/2014)
coaAcJ: 02101L020
PERMIT ADDRESS: 1453 NE 104TH ST PARCEL: 1122320320080
Miami Shores, FL 33138
APPLICATION DATE: 02/18/2020 SQUARE FEET: 0.00 DESCRIPTION: AC CHANGE OUT, CONDENSER AND AIR HANDLER
EXPIRATION DATE: 08/16/2020 VALUATION: $1,300.00 RELOCATION. ADD A MINI SLIPT TO SECOND FLOO
AND KTICHEN (DUAL ZONE) NEW DUCT SYSTEM.
CONTACTS NAME COMPANY ADDRESS
Contractor MARIO PINO GMP ELECTRIC CORP 8250 NW 25 ST
MIAMI 33122
Owner LAUREL INMAN 1453 104 ST
MIAMI SHORES, FL 33138
REVIEW ITEM
Electrical v.1
STATUS REVIEWER
Requires Re -submit CARLOS SOSA email: EL@MSVFL.GOV
Comments: NEED AN ELECTRICAL PLAN WITH LOAD CALCULATION, PANEL SCHEDULE AND CIRCUIT NUMBERS.
MAD SR 19 FEB 20
February 19, 2020 10050 NE 2 Ave Miami Shores FL 33138 Page 1 of 1
Ron DeSantis, Governor Haisey Beshears, Secretary
Florida
pr
STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
ELECTRICAL CONTRACTORS LICENSING BOARD
THE ELECTRICAL CONTRACTOR HEREIN HAS REGISTERED UNDER THE
PROVlSl0;1APTER 4$9, FLORIDA STATUTES
Always verify licenses online at MyFloridaLicense.com
Do not alter this document in any form.
This is your license. It is unlawful for anyone other than the licensee to use this document.
0
PLEASE CUT OUT CARD BELOW AND RETAIN FOR FUTURE REFERENCE
STATEOF FLORIDA — — — — — — — — — — — — — — — — 1 _ _ _ — — — — — — — — — — — — — — — — _ _ I
I DNIS ONMOF WORKERS' COMPENSATION I I
C IMPORTANT
CONSTRUCTION INDUSTRY EXEMPTION I IF PUrSUant t0 Chapter 440.05(14), F.$., an officer of a corporation I
CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA 0.. O who elects exemption from this chapter by filing a certificate of
I WORKERS' COMPENSATION LAW ''ao w.�• I election under this section may not recover benefits or I
L compensation under this chapter.
I EFFECTIVE DATE: 72/132018 EXPIRATION DATE: 72/12/2020 I pursuant to Chapter 440.05(12), F.S., Certificates Of election to I
PERSON: MARIO E FIND EMAIL: OMVFIEGTRIC�RPGvM100.4VN be exempt.. apply only within the scope of the business or trade
FEIN: 010718422
I I L,� listed on the notice of election to be
I
I I h'I
BUSINESS NAME AND ADDRESS: E Pursuant to Chapter 440.05(13), F.S., Notices of election to be I
I I exempt and certificates of election to be exempt shall be I
GMP ELECTRIC CORP R subject to revocation if, at any time after the filing of the notice
I I E or the issuance of the certificate, the person named on the I
notice or certificate no longer meets the requirements of this
I e250 NW 25sr I section for issuance of a certificate. The department shall revoke I
I MIAMi, FL 33122 I a certificate at any time for failure of the person named on the I
I certificate to meet the requirements of this section. I
I SCOPE OF BUSINESS OR TRADE:
ILiwnwl EMctriul Conbacbr I I
DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUESTIONS? (850�-.13-1609
OF FINANCIAL SERVICES
exempt
Local Business Tax Receipt
Miami —Dade County, State of Florida
—THIS IS NOT A BILL — DO NOT PAY
5341771
BUSINESS NAME/LOCATION
G M P ELECTRIC CORP
1438 E MOWRY DR 202
HOMESTEAD, FL 33033
OWNER
G M P ELECTRIC CORP
Worker(s)
RECEIPT NO.
RENEWAL
5076229
SEC. TYPE OF BUSINESS
196 ELECTRICAL
CONTRACTOR
04E000343
EXPIRES
SEPTEMBER 30, 2020
Must be displayed at place of business
Pursuant to County Code
Chapter 8A — Art. 9 & 10
PAYMENT RECEIVED
BY TAX COLLECTOR
51.75 11 /04/2019
0204-20-000571
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-275.
For more information. visit www.miamidade govhaxcollector
TMRI
CTQB
Construction Trades Qualifying Board
ISINESS CERTIFICATE OF COMPETENCY
04E000343
.M.P. ELECTRIC CORP.
B.A.:
PINO MARIO E
Is died under the provisions of Chapter 10 of Miami -Dade Couriiy ,
DATE (MMIDDIYY)
CERTIFICATE OF LIABILITY INSURANCE 02/18/20
— — — — ----- - --- -- . .. . ....... ......... --- - — — ----- - ------------ . ...... --- . . . ...... . ........
PRODUCER WAM Insurance Agency
. .. ....
MATTER
THIS CERTIFICATE IS ISSUED AS MATT OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
10637 SW 88th St. Ste 7-i
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
Miami, FL 33176
. . .. .... K 0 1 ............. OW.
__AjgRTHE !qQVgfA ,E AFFORDED,�BY T PCI L ES BEJ,
Phone (305)274-4353 Fax (305)274-9994
INSURERS AFFORDING COVERAGE NAIC N
1INSURERA: GRANADA INSURANCE COMPANY
INSURED G. M. P. ELECTRIC, CORP
11INSURER
6: - - ------ ---- ...................... ....................... .................. . .. . .......... .. ..
8250 NW 25 Street #2
IINSURER 9.:
MIAMI, FL 33122
.............................................................................. 11 .................. ................
ER . . . ..... . ..... . . . .. . ......... ............. ... . ... ....... . ..... . . .. .................. . . — — ------- - . ................
INSURINSURER D:
INSURER E:
COVERAGES
INSURER F:
THE POLICIES OF INSURANCE LISTED 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS... ..... ..
...........................
.................... ................... ............................. ---1 ........................
NSR, ADD`L
TYPE OF INSURANCE POLICY NUMBER
............ ....... ....... . .. ..... ........................
i POLICY EFFECTIVE POLICY EXPIRATION'
I DATE (MMIDOM) DATE (MWDOfYY) LIMITS
1,000,000
GENERAL LIABILITY
EACH OCCURRENCE _
COMMERCIAL GENERAL LIABILITY 10185FL00063237-5
. ..........
DAMAGElb Att%itED 100,000
09/30/19 09/30/20 iPRE ISE _S(Eaocc4rence) . .......... . ..... .............. . ................ ..
DO CLAIMS MADE Fie, OCCUR
person)
1 MED EXP (Any one 5,000
........... . .
A
D
PERSONAL ADV INJURY 1,000,000
GENERAL AGGREGATE 2,000,000
.............. .. ....................
GEN'L AGGREGATE LIMIT APPLIES PER:
. ........ . ..........
PRODUCTS - COMPIOP AGG 2,000,000
POLICY PROJECT ❑ LOG
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT
ANY AUTO
accident)
...(Ea ............ . . . . . .......................
ALL OWNED AUTOS
BODILY INJURY
SCHEDULED AUTOS
HIRED AUTOS
. . ........ . ............. . ........... . .... .....
BODILY INJURY
NON OWNED AUTOS
(Per accident)
.................. -
PROPERTY DAMAGE
.. . ............... ................. ..... . ..... .. . .. - - - — -------------- --- --- - -- ................... . ... .
..................... . .............................. .. .... . . .......................... .....
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
ANY AUTO
OTHER THAN EA ACC
. . ... ..........
................... . ............................ ............. ....... ...... ................... ....................................... ... ....................
AUTO ONLY: AGG
................. .............. ............ . ................... ... ... ... ..
EXCESSIUMBRELLA LIABILITY
EACH OCCURRENCE ............
OCCUR ❑ CLAIMS MADE
AGGREGATE ........ ............
❑ DEDUCTIBLE
RETENTION $
. .. . . ...
.......
WC STATU- n OTH-
EMPLOYERS' LIABILITY
TORYMER
-LTS - — - -----
!'
I ANY PROPRIETOR/ PARTNER I EXECUTIVE
E,LEACH ACCIDENT
,
OFFICER I MEMBER EXCLUDED?
.................................. ................
E.L. DISEASE - EA EMPLOYEE
1 If yes, describe under
... . .... . ........
SPECIAL PROVISIONS below .............. . ............ .....................
E.L. DISEASE - POLICY LIMIT
...................... . ... . ..................... . ... ...................... .... . .....................................
OTHER
.......... . .. ........ . . . .. . ....... .
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS i666
BY 9 NOORSEMENT 1 SPECIAL PROVISIONS
Mario Pino License # 04EO00343
11-1-1111-1 ...... . ..... .
CERTIFICATE HOLDER .............
... .................
CANCELLATION
. ..... . ... . ........ . .... ...... . ......... ............. . ........... . ........................................................ ............... . .
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
Miami Shores Village Building Department
EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAL
10050 Northeast 2nd Avenue
30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO
..... . .... ..
THE LEFT, BUT FAILURE TO 00 SO SHALL IMPOSE NO OBLIGATION OR LIABILITY
Miami Shores, Florida 33138
OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES.
................... -- ...... ...... -
AUTHORIZED REPRESENTATIVE A
Fax 305-756-8972 E: amipndas@ TSVfL OV
WIENER ALMARALES
....... . ....... .... . . . ........... . . . ........
ACORD 25 (2001108) QF
T ACORD CORPORATION 1988
... . . ....... . . ..........
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 aru 20.
By k_Ct(1_�j1014,q who is personally known to me or has produced
as identification.
SEAL: "" "' MMAM.ROSADO
t W COMMISSION # GO 911607
;� EXPIRES: Dawmbw 11, 2W
Miami shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
CONTRACTORS' REGISTRATION
IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR:
A. COPY OF QUALIFIER'S STATE LICENCES
B. COPY OF LOCAL BUSINESS TAX RECEIPT
C. COPY OF LIABILITY INSURANCE*
D. COPY OF WORKERS COMPENSATION INSURANCE*
(Workers Compensation EXEMPTION must have NOTICE TO OWNER form and Contractor Affidavit)
IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY:
A. COPY OF CERTIFICATE OF COMPETENCY OF QUALIFIER
B. COPY OF LOCAL BUSINESS TAX RECEIPT
C. COPY OF STATE REGISTERED CONTRACTOR LICENSE OR MIAMI DADE COUNTY MUNICIPAL
CONTRACTOR'S TAX RECEIPT.
D. COPY OF LIABILITY INSURACE*
E. COPY OF WORKERS COMPENSATION INSURANCE*
(Workers Compensation EXEMPTION must have NOTICE TO OWNER form and Contractor Affidavit)
*YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE AS FOLLOW:
Certificate Holder:
MIAMI SHORES VILLAGE BLDG DEPT
10050 NE 2ND AVE
MIAMI SHORES, FL 33138
Certificate must specify the description of operations or contractor license number.
...........................................................................................
BUSINESS NAME:
BUSINESS ADDRESS:
CITY
STATE ZIP
BUSINESS PHONE: ( ) FAX NUMBER
CELL PHONE O QUALIFIER'S NAME: b
<.
QUALIFIER'S LIC NUMBER: v
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