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EL-02-21-293, 9333 N Miami AveMiami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Location Address Parcel Number 9333 N MIAMI AVE, Miami Shores, FL 33150 1132060130350 Contacts PATRICIA N PENICHEIRO Owner Lemon City Applicant 9333 N MIAMI AVE, Miami Shores, FL 33150 KamaLrPowell Other: 9167965773 tpenicheiro@yahoo.com 3634 Grand AVE, Miami, FL 33133 kpowell@lemoncity.com UNITED ELECTRICAL SERVICES INC. Contractor MANUEL GARCIA 26453 SW 135 CT, HOMESTEAD, FL 33032 Business: 7867972188 Inspection, Requests: Description: ALL ELECTRIC WORK NECESSARY FOR PERMITTED Valuation: $ 6,500. PLANS.E Total S Feet: 1,110.0j q Fees Amount CCF $4.20 DBPR Fee $3.41 DCA Fee $2.28 Education Surcharge $1.40 Permit Fee $227.50 Scanning Fee $3.00 Technology Fee $5.69 Total: $247.48 Payments Date Paid Amt Paid Total Fees $247.48 Credit Card 02/03/2021 $247.48 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 hat all work will be done in compliance with all applicable laws regulating construction and zoning. Futhermore, I authorize the alive nameSkimtrActor to do the work stated. Authorized Signature: Owner / Agent Date February 03, 2021 Page 2 of 2 Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Location Address Parcel Number 9333 N MIAMI AVE, Miami Shores, FL 33150 1132060130350 Contacts PATRICIA N PENICHEIRO Owner Lemon City Applicant 9333 N MIAMI AVE, Miami Shores, FL 33150 Kamau Powell Other: 9167965773 tpenicheiro@yahoo.com 3634 Grand AVE, Miami, FL 33133 kpowell@lemoncity.com UNITED ELECTRICAL SERVICES INC. Contractor MANUEL GARCIA 26453 SW 135 CT, HOMESTEAD, FL 33032 Business: 7867972188 Description: ALL ELECTRIC WORK NECESSARY FOR PERMITTED Valuation: $ 6 500.00 Insecron Reuests PLANS. r`a sr Total Sq Feet: 1,110.00 Fees Amount CCF $4.20 DBPR Fee $3.41 DCA Fee $2.28 Education Surcharge $1.40 Permit Fee $227.50 Scanning Fee $3.00 Technology Fee $5.69 Total: $247.48 Payments Date Paid Amt Paid Total Fees $247.48 Credit Card 02/03/2021 $247.48 Amount Due: $0.00 Applicant Copy For Inspections, Call (305) 762-4949 or Log on at https://bidg.miamishoresvillage.com/cap/. Requests must be received by 3pm for following day inspections. NOTICE: In addition to the requirements of this permit, there may be AND THERE MAY BE ADDITIONAL PERMITS REQUIRED FROM OTHER additional restrictions applicable to this property that may be found in the GOVERNMENTAL ENTITIES SUCH AS WATER MANAGEMENT DISTRICTS, public records of this county. STATE AGENCIES, OR FEDERAL AGENCIES. February 03, 2021 Page 1 of 2 Miami Shores Village PILECr D 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 �T FBC 201-1 BUILDING Master Permit No. -7 - Zy -1103 PERMIT APPLICATION Sub Permit No. 2 - 2a - 2-9 3 ❑BUILDING [(ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION [-]RENEWAL ❑PLUMBING ❑ MECHANICAL E PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION SHOP CONTRACTOR DRAWINGS JOB ADDRESS: �13 33 N IM awe► Ave City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated: Yes NO ,-V Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: / OWNER: Name (Fee Simple Titleholder): T0. \ (* � C. -. ?e-r%i C-.'" RT" Phone#: 10- Address: 3 N r—ki e.-� Ov--X City: %-�` Gvw: 1^�sf'�S State: 2— Zip: Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: l/iVi /� �I�7�1ZiCAC �f.✓ Phone#: e� SS DS a g Address: c)(o `(5-13 S&&P /,�✓� C.,% City: WQ^-0e-*lt-W 0 State: /C-G Zip::�- Qualifier Name: 1-7,0^1yEL� 4�"y'2Cr,00 Phone#: State Certification or Registration #: L�l- C -o o 9a y / Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: $ �,.0 , 5 0 Square/Linear Footage of Work: Type of Work: Rl Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: i4t ul u k$ C- WirX. rLGc-Ssedm k-*-r ?uw; 44d Qfp^5 Specify color of color thru tile: Submittal Fee $ Permit Fee $ CCF $ CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Notary $ Technology Fee $ Training/Education Fee $ Double Fee $ Structural Reviews $ Bond $ TOTAL FEE NOW DUE $ '2-4 3 ' 49 (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 t uilding permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspectionfee_wffrbe charged. OWNER o The f(o�regoing instrument was acknowledged before me this day of �� n c n� _ 20 2- by �r U ?t"-k ho is ersonally mown o me or who has produced identification and who did take an oath. NOTARY PUBLIC: r Sig Print: Faked e e-:� f,� Signature CONTRACTOR The foregoing instrument was acknowledged before me this day of r 20 02 \ by IAA---Ck &_� , who i�ersona y mown o as me or who has produced identification and who did take an oath. NOTARY PUBLIC: r Sign: p Print: Seal: Ncfr.9 NATEIFaE i' 0±'I P(-,ELL " Seal: 1"MMdMION" 11IMP10a rr k, ' NY CC ' . 58� IIZOZ'LZ99&5 S3il1dX3 EXP : S E £mS 00 # NbI8 rifloJ AN -n3MOd I)(VftlN 3J31aLVN APPROVED BY Plans Examiner Structural Review as ********* Zoning Clerk (Revised02/24/2014) 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. OPY OF QUALIFIER'S STATE LICENCES B. v� OPY 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. ■■rrrrrrrraraaaarraaraaaaraarrararrrrrrararrraaaaaaarrrrrrrrrrrrrrrrrrarrrrrrarrrrrrrrrrrrr• BUSINESS NAME: BUSINESS ADDRESS: 0 (o 4 S 3 '�w 13 5 CA -CITY q a\,�, s %--� STATE E L ZIP 3 3 0 3-:�, BUSINESS PHONE: ( FAX NUMBER ( CELL PHONE -12i-0 5),Oi QUALIFIER'S NAME: MAkny d (-n t,- E* QUALIFIER'S LIC NUMBER: Ron DeSants> Governor Halsey Beshears, Secretary DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD THE ELECTRICAL CONTRACTOR HEREIN IS CERTIFIED UNDER THE PROVISIONS CHAPTER489, FLORIDA STATUTES ."y'. .. W- GARCIA, MANUEL 0 UNITED ELECTRICAL SERVICES INC. 26453 SW 135TH COURT �r HOMESTEAD FL 33032 LICENSE NUMBER: EC13009241 EXPIRATION DATE: AUGUST 31, 2022 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. Local Business Tax Receipt Miami -Dade County, State of Florida -THIS IS NOT A BILL - DO NOT PAY 6983507 BUSINESS NAME/LOCATION UNITED ELECTRICAL SERVICES INC 26453 SW 135TH CT MIAMI, FL 33032 RECEIPT NO. RENEWAL 7162894 n EXPIRES SEPTEMBER 30, 2021 Must be displayed at place of business Pursuant to County Code Chapter 8A - Art. 9 & 10 OWNER SEC. TYPE OF BUSINESS PAYMENT RECEIVED UNITED ELECTRICAL SERVICES INC 196 ELECTRICAL BY TAX COLLECTOR CONTRACTOR 75.00 09/02/2020 Worker(s) 1 EC13009241 CREDITCARD-20-072195 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, MtAMFor more information, visit �,miatt� idade,goyj1axcollector TE (MM/DDIYYVY) Ac"R" CERTIFICATE OF LIABILITY INSURANCE E01/25/2021 '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(les) must 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($). CONTACT PRODUCER NAME; MARTA ALONSO Florida Bankers Insurance PHONE C.,o t5693 c:(305)262-0679 6$74 SW 8 St E-MAILaoDREss; magt�( ankersinsurance.co_m i Miami, FL 33144 INSURERIS) AFFORDING COVERAGE a NIUC N INSURER A; AIX SPECIALTY INSURANCE COMPANY INSURED INSURERS TECHNOLOGY INSURANCE COMPANY United Electrical Services Inc INSURERC 26453 SW 135 COURT INSURERD I HOMESTEAD, FL. 33032 (786) 797-21 I INSURER F ; I i 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, ADDLSUBR POLICY EFF POLICY EXP ILTR TYPE OF INSURANCE POLICY NUMBER M/ MD IYYYY MI MDDIYYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000.00 X COMMERCIAL GENERAL LIABILITY $ES�Ea occttLr�cs1- S-- 50,000.00 _,. CLAIMS MADE [X] OCCUR $�_ 5 000.00 MED EXP An one parson)_ A N N SIZGL1017B241570 10/06/2020 10/06/2021 PERSONAL& ADV INJURY $ 1,000,000,00 GENERAL AGGREGATE $ 2,000,000.00 PRODUCTS COMP/OP AGG GEN'L AGGREGATE LIMIT APPLIES PER: $ 2,000,000,00 X POLICY PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLELIMIT dent) - BODILY INJURY (Per person) ANY AUTO $ - ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per ecoident) $ NON -OWNED PROPERTY DAMAGE _ HIRED AUTOS AUTOS Per poeldent - --- • $ UMBRELLA LIAR �11.11OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS -MADE AGGREGATE $ J DED RETENTION $ $ WORKERS COMPENSATION �( WC STATU OTH- AND EMPLOYERS' LIABILITY YIN � ` TOR`LLIMITS L__.. ANY PROPRIETOR/PARTNER/EXECUTIVE ! E L• EACH ACCIDENT $_ 1,000,000.00 B OFFICERIMEMSEREXCLUDED? �INIA N TWC3913717 11/19/2020 11/19/2021 ---- _ _-- _"- (Mandatory in NH) E L DISEASE EA EMPLOYE $ 1,000 000.00 Ues, dascribe under SCRiPT,ON OF OPERATIONS below ---..-- __._.--- - _- E L DISEASE POLICY LIMIT -__-... _...___ _._ _..__-•. $ 1,000 000,00 j DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (Attach ACORD 1e1, Additional Remarks Schedule, If more space is required) License number EC13009241 CFRTIFICATF HOLnFR CANCFI_LATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. VILLAGE MIAMI SHORES 10050 NE 2 AVE AUTHORIZED REPRESENTATIVE MIAMI SHORES, FL 33138 FAX: 305-795-7884 ACORD 25 (2010/05) U 1988-2010 ACORD CORPORATION, All rights reserved. The ACORD name and logo are registered marks of ACORD