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REV-02-23-268, 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 Description: AS PER PLAN (EL-04-21-924) EVERYTHING Valuation: $ 4,000.00 Inspection Requests: REMAINS THE SAME, DIFFRENT LAYOUTS Total Sq Feet: 0.00 Fees Amount Payments Date Paid Amt Paid Revision: Major Change of Plans $90.00 Total Fees $93.00 Scanning Fee (Manual) $3.00 Credit Card 02/03/2023 $93.00 Total: $93.00 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 thispermit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELF,CTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: I rtify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating �strri a oning. Futhermore, I authorize the above named contractor to do the work stated. 1 Authorized Signature: O%kner / Applicant / Contractor / Agent Date February 03, 2023 Page 2 of 2 ENTERED Miami Shores Village FEB 01 2023 Building Department BY; -- filL WOW 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 F C 20 BUILDING air �' f Master Permit No. 32L PERMIT APPLICATION Sub Permit No. EL-04-21-924 ❑BUILDING En ELECTRIC ❑ ROOFING f4 REVISION ❑ EXTENSION ❑RENEWAL PLUMBING MECHANICAL ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 29 NE 102ND ST , MIAMI SHORES, FL 33138 City: Miami Shores County: Miami Dade Zia: Folio/Parcel#:1132060131650 Is the Building Historically Designated: Yes NO Occupancy Type: S/F Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): CARLOS ANDRADE phone#:3053363631 Address: 29 NE 102ND ST City: MIAMI SHORES State: FL Zip; 33138 Tenant/Lessee Name: Phone#: Email: christian.ulvert@gmaii.com CONTRACTOR: Company Name: WELL ELECTRIC Phone#: 305-986-3884 Address: 4312 NW 11 ST , MIAMI ,FL ,33126 Email: omarbaylighting@gmail.com 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: $ 4.000 Square/Linear Footage of Work: Type of Work: ❑ Addition Alt ration O Ne Repair/Replace ❑ Demo 'tion Description of Work: 00/ =QAU<_�:VY — 2 MM Specify color of color thru tile: ` 0 Submittal Fee $ Permit Fee $ _ CCF $ CO/CC $ Scanning Fee $ DCA Fee $ DBPR $ Notary $ Technology Fee $ Training/Education Fee $ Double Fee $ Structural Reviews $ P&Z Review $ Bond $ TOTAL FEE NOW DUE $ • ao (Revised04/05/2022) Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State 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 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 inspe.C.t1on which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection wi of be aproved andInspection fee will be charged. , ER or AGENT The foregoing instrument was acknowledged before me this 1 day of 20J by 70 -(1 lA = who is personally known to me or who has produced �&��aqAsf as identification and who did take an oath. NOTARY PUBLIC: The foregoing instrument was acknowledged before me this az day of .71 .20 Z by who is er5 yckaswn to me or0eho has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: fflp��/VVLSign: Print: 1 Print: u Seal: Seal: _ W EXPIRES: Jum28.2026 ''�' z MERLIAiECHERYYRbictNbe� w '•� *' MY COMMISSION # HH 252206 **sssssss at��',' ii*ssssi"*sli�iYrk�RMe���ytss* *s***ss********s**s*s**s#s**sssssss*ssssss*sssss*ss**ssssssssss APPROVED B ��Plans Examiner Zoning Structural Review Clerk (Revised04/05/2022) Ron DeSantis. Governor STATE OF FLORIDA Melanie S. Griffin, 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 x ,MIAMI FL 33126 LICENSE NUMBER: EC13001181 EXPIRATION DATE: AUGUST 31, 2024 Always verify licenses online at MyFloridaLicense.com F 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. b"pr ,acoR" CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/WYY) llla.� 7/29/2022 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 CONTNAME: PAULETTE BROWN IMPACT INSURANCE SERVICES LLC PHONE 954 885-3884 FNC No: 954 885-3885 18064 SW 33 Court ADDRESS: Im actsery msn.com Miramar, FL 33029 INSURER(S) AFFORDING COVERAGE NAIC# INSURED WELL ELECTRIC TECHNOLOGY, INC. 4312 NW 11 STREET MIAMI, FL 33126 INSURERA: UNITED STATES LIABILITY INS INSURER B : INSURER C : INSURER D : INSURER E : COVFRAGFS CFRTIFICATF NIIMRFR- RFVIRION NIIMRFR- 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 TYPE OF INSURANCE ADDL SUBR POLICY NUMBER MM POLICY EFF POLICY EXP LTR MMIDD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE 191 OCCUR DAMAGE TO EaENTED occurrence $ 100,000 —PREMISES MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 A CL 1799478E 3/16/2022 3/16/2023 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY EJECT � LOC PRODUCTS -COMP/OP AGG $ 2,000,000 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY r PROPERTY DAMAGE Per accident $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ HCLAIMS-MADE AGGREGATE $ EXCESS LIAR DED I I RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE PER OTH- STATUTE I ER E.L. EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? ❑ i N I A E.L. DISEASE - EA EMPLOYEE $ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) ELECTRICAL WORK k,r-m 1 Ir II.A 1 C rIULL r-M I.AIVI.tLLA I IUN MIAMI SHORES VILLAGE BUILDING DEPARTMENT 10050 NE 2ND AVE MIAMI SHORES, FL 33138 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 (2016103) The ACORD name and logo are registered marks of ACORD WE JIMMY PATRONIS CHIEF FINANCIAL OFFICER STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION * * CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW * * CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law. EFFECTIVE DATE: 11/1/2021 PERSON: TONY WELL FEIN: 352252781 BUSINESS NAME AND ADDRESS: WELL ELECTRIC TECHNOLOGY, INC. 4312 NW. 11 ST. MIAMI, FL 33126 SCOPE OF BUSINESS OR TRADE: Electrical Wiring Within Buildings and Drivers EXPIRATION DATE: 11/1/2023 EMAIL: WELLTECHNOLOGY@HOTMAIL.COM IMPORTANT: Pursuant to subsection 440.05(14), F.S., an officer of a corporation who elects exemption from this chapter by filing a certificate of election under this section may not recover benefits or compensation under this chapter. Pursuant to subsection 440.05(12), F.S., Certificates of election to be exempt issued under subsection (3) shall apply only to the corporate officer named on the notice of election to be exempt and apply only within the scope of the business or trade listed on the notice of election to be exempt. Pursuant to subsection 440.05(13), F.S., notices of election to be exempt and certificates of election to be exempt shall be subject to revocation if, at any time after the filing of the notice or the issuance of the certificate, the person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate. The department shall revoke a certificate at any time for failure of the person named on the certificate to meet the requirements of this section. DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 E01436982 QUESTIONS? (850) 413-1609 004292 Local Business Tax Receipt Miami -Dade County, State of Florida -THIS IS NOT A BILL - DO NOT PAY 5567087 BUSINESS NAMFJLOCATim RECEIPT NO. EXPIRES WELL ELECTRIC TECHNOLOGY INC RENEWAL SEPTEMBER 30, 2023 4312 NW 1 1 TH ST 5807087 Must be displayed at place of business MIAMI FL 33126-2504 Pursuant to County Code Chapter 8A - Art. 9 & 10 OWNER SEC. TYPE OF BUSINESS PAYMENT RECEIVED WELL ELECTRIC TECHNOLOGY INC 196 ELECTRICAL CONTRACTOR BY TAX COLLECTOR EC13001181 $45.00 08/05/2022 Worker(s) 1 CHECK21-22-060141 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 holders 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.aovAax"ll�or