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DEMO-05-19-985, 1041 NE 94th StMiami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Location Address Parcel Number 1041 NE 94TH ST, Miami Shores, FL 33138 1132050120080 Contacts MIAMI COUNTRY DAY SCHOOL INC Owner CONTRACTORS ELECTRICAL SERVICES Contractor MIAMI COUNTRY DAY SCHOOL INC LEONARDO RODRIGUEZ 601 NE 107 ST, MIAMI, FL 331617165 Other: 3057592843 Business: 7862521284 _. ... _.... ........ .._......_............_.... Description: CAP ELECTRICAL LINES � Valuation: $ 500.00 Insection Requests: 305762-4949 - 'x Total 5q Feet: 0.00 ,� Fees Amount Application Fee - Other $50.00 Building Demoloition Fee $50.00 CCF $0.60 DBPR Fee $3.75 DCA Fee $2.50 Education Surcharge $0.20 Scanning Fee $3.00 Technology Fee $6.25 Total: $116.30 Payments Date Paid Amt Paid Total Fees $116.30 Credit Card 05/02/2019 $50.00 Check# 1060 05/09/2019 $66.30 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 const ction and zoning Futhermore, I authorize the above named contractor to do the work stated. Authorized Signature: Owner / Applicant / Contractor / Agent Date May 09, 2019 Page 2 of 2 Miami Shores Village ,1Av 02019 Building Department ' 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 BY: Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 FBC 20 BUILDING Master Permit No.DEMO-12-18-3750 PERMIT APPLICATION Sub Permit No.b`TVIIV� �'I ❑BUILDING ® ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL [:]PUBLICWORKS [:]CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 1041 NE 94th St Citv: Miami Shores Countv: Miami Dade ZiD: 33138 Folio/Parcel#: 11-3205-012-0080 Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): MIAMI CTRY DAY SCHOOL INC Phone#: 305-613-6451 Address: 601 NE 107 St city: Miami State: FL zip:33238 Tenant/Lessee Name: Phone#: 305-613-6451 Email: buttsg@miamicount/ryday.orrg, martellc(a)_miamicountryday.org CONTRACTOR: Company Name: (.bn�1G%14rSFII.C4fl(6d �"QrVJCU Phone#: 01S233-33W Address: (n2 2A =1�) L-1-7 4 City:M-m-t State: FL Zip: 3"N97 Qualifier Name:J�OIt(�IC �� Phone#: State Certification or Registration #: Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: $ S ©D Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of work: Cap electrical lines Specify color of color thru tile: Submittal Fee $ -05' Permit Fee $ Scanning Fee $ Technology Fee $ Structural Reviews $ Radon Fee $ Training/Education Fee $ CCF $ DBPR $ CO/CC $ _ 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 Zip 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 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. a Signature Signature OWNER or AGENT CONTRACTOR Theforegoinginstrument w s acknowledged before me this The foregoing instrument was acknowledged before me this G ''d��a��y��of 1i 20 (� by � day/of ��� � 20 �by �C ,who is personally known to �CO 'rt° ,�,11P?�? , who is personally known to me or VAO has r�"s�uced �ri Y (I t` � � S as me or who has produced �J'( I/ers ('d 6671"(tr as identif ation a d w BIOTA Y PUBLI Sign. Print: Seal: did take an oath.`�,Nl j ppjer /i identification and who did take an oath. NOTARY PUBLIC: e _ Sign: Print: ;..: Seal: l,iy cOMMISS101,41 # GG 126487 EXPIRES: July 20, 2021 Bonded Thru Notary Public Underwriters ********************************************************************************************************** APPROVED BY S (� Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) LIMITED POWER OF ATTORNEY KNOW ALL MEN BY THESE PRESENTS THAT, I, zs��R"!, 7, (Owner), do by these presents hereby make, constitute and appoint for the period of twelve (12) months from execution herein, Christopher Block, General Manager of Habify, a/k/a Florida Building Performance, LLC, Miami, Florida, my true and lawful attorney -in -fact for me and in my name, place and stead, to sign permit applications on my behalf with Miami -Dade County Building Department and with all municipalities located therein, regarding the property located at /V W4 2b Z ,e , NIA ii i PhaW, Florida, Folio No. t` " aJ X Z -0090 I give and grant unto said attorney -in -fact, limited power and authority to do and perform the specific acts necessary or incident to the performance and execution of permit applications with Miami - Dade County Building Department and with all municipalities located therein, with power to do and perform the limited acts authorized hereby, as fully to all intents and purposes as I might or could do if personally present, with full power of substitution and revocation, hereby ratifying and confirming all that said attorney -in -fact or his substitute shall lawfully do or cause to be done by virtue hereof. IN WITNESS WHEREOF, 1 (Owner), have hereunto set my hand and seal this (} day of 'Da, / ea , 20 IL. Sealed and delivered in the presence of ignature Dwner) WiTt'less Signature Print Witness Name:t�rl(p STATE OF FLORIDA ) COUNTY OF MIAMI-DADE ) The foregoing instrument was acknowledged b e me this /V day of Defe®t'» ,,el 20A by (Owner). (Check one) [ ] He/She is personally 7kwn to me or N He/She has produced /Ps 4keffiffition. NOTARY,PUBLIC-STA 5 OF FL kIDA DESSALINES FRANCOIS At Large ?;MY COMMISSION # GG027034 Print, type or slam �ionedame of Notary Public: s EXPIRES September 06, 2020 ACCJRDF CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 11 /14/2018 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 pollcy(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: Alina Jimenez Pn"/c°NI o Ext : 786-518-2989 No, 305-233-4289 J&A Insurance Services, Inc ADo ESS: iainsuranceservices@gmail.com 12918 SW 133 CT INSURERS AFFORDING COVERAGE NAICx Miami, FL 33186 INSURER A: Infinity Auto Insurance Company 11738 INSURED INSURER B : Colony Insurance Company 39993 Contractors Electrical Services, Inc INSURER C : 6821 SW 147th Ave, Suite 3E INSURER D: INSURER E : Kendall FL 33193 INSURERF: _ 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 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 OF INSURANCE ADDLTYPE INSD SUER WVD POLICY NUMBER MOM/LDICY EFF POLICY EXP LIMITS B X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE �X OCCUR Blanket Additional Insured I 101 GLO107593-00 09/08/2018 09/08/2019 EACH OCCURRENCE $ 1,000,000 DAMAGES ( RENTED PREMISES Ea occurrence) $ 100000 X MED EXP (Any one person) $ 5,000 X Blanket Waiver of Subrogatioi PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY PRO JECT ❑ LOC OTHER GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 $ A AUTOMOBILE LIABILITY ANY AUTO OWNED X SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY X AUTOS ONLY Comp -Coll X PIP-PD 509800030484001 11 /16/201811 /16/2019 COMBINED SINGLE LIMIT Ea accident $ 300,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ X PROPERTY DAMAGE (Per accident) $ X $ UMBRELLA LIAB EXCESS LIAR OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY Y/N ANYPROPRIETOR/PARTNER/EXECUTIVE ❑ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A PER OTH- STATUTE ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT -- $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached it more space Is required) Electrical work Within building CERTIFICATE HOLDER CANCELLATION Miami Shores Village 10050 NE 2 Ave SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Miami Shores Village FL 33138 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE j)(),+ ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD 01)1369 Local Buamiss Tax Receipt Miami -Dade County, State of Florida7r -THIS 1S NOT A BILL DO NOT PAY 6517248 BUSINESS NAME/LOCATION RECEIPT NO- EXPIRES CONTRACTORS ELECTRICAL SERVICES INC RENEWAL E BER 30,2019 6821 SW 147TH AVE 3E 6787685 Must be displayed at place of business MIAtiM EL 33193 Pursuant to County Code Chapter 8A - dirt. 9 & 10 OWNER SEC. "TYPE OF BUSINESS PAYMENT RECEIVED CONTRACTORS ELECTRICAL SERVICES INC96 ELECTRICAL CONTRACTOR BY TAX COLLECTOR C/O RODRIGUEZ L ONARDO SIR EC1 006559 5.CICf 07J�}2j2t}IR Worker(s) t CREDITC RD-18-046364 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 qualification% to do business. fielder 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-Oado Code Sec 8a-276.. For more information, visit ww.miamidade.govftaxcollector