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EL-08-20-1862, 9999 NE 13th Ave` 3 'per I Sle��� �� RECE1VE 1E) Miami Shores Village A11, 2 4 1020 Building Department 100SO N.E.2nd Avenue, Miami Shores, Florida 33138 BY' _. Tel: (30S) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 6T4 P FBC 20 I:� BUILDING Master Permit No. PERMIT APPLICATION sub Permit No. �t__L -08-,?6 1862- F_�BUILDING FM-� ELECTRIC ❑ ROOFING ❑ REVISION EXTENSION ❑RENEWAL PLUMBING MECHANICAL PUBLIC WORKS F] CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 9999 NE 13 AVE City: Miami Shores County: Miami Dade Zip: t Folio/Parcel#: 11-3205-009-0460 Is the Building Historically Designated: Yes NO on Occupancy Type: Load: Construction Type: Flood Zone: BFE: FIFE: OWNER: Name (Fee Simple Titleholder); MICHELLE CHERIE PAPPAS Phone#: 305-244-0595 Address: 9999 NE 13 AVE r, City: State: Zip: MIAMI SHORES FL. 33138 3L ii, Tenant/Lessee Name: Phone#: If Email; CONTRACTOR: Company Name: PINAR ELECTRIC MD INC Phone#: 786-256-0812 Address: 8285 NW 64 ST. SUITE 8 City: MIAMI State: FL Zip: 33166 Qualifier Name: ANDRES ORTA Phone#: 786-256-0812 State Certification or Registration #: EC13-005412 Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: $ t Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New ElRepair/Replace ❑Demolition Description of Work: r-o Specify color of color thru tile: Submittal Fee $ Permit Fee $ Scanning Fee $ Radon Fee $ Technology Fee $ Training/Education Fee $ Structural Reviews $ — CCF $ CO/CC $ DBPR $ Notary $ Double Fee $ Bond $ TOTAL FEE NOW DUE $ (Revised02/24/2014) 1 Miami anu,.. tsoncling 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 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`// OWNER or AGENT The foregoing instrument was acknowledged before me this 22- dayof A(ARUS-t 2020 by i iCIII' G - P?pGL) who is personally known to me or who has produced fL—IX Q 12 O-S�i3`I 3 identification and who did take an oath. NOTARY PUBLIC: Sign:5-�t'=! Print: Seal: xn CRKTIANYTORIES Notary Public - State of flori44 Commission �# GG 927216 Or . My ; Comm. Expires Nov 42023 Signature C�—/" CONTRACTOR The foregoing instrument was acknowledged before me this 29 day of JULY 20 20 by ANDRES ORTA who i personally known o me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: W LIAM Ril V ry Pubtic - State of Florida Seal: mmission # GG 973700 omm. Expires May 7, 2023 Sonded through National Notary Assn, Zoning Clerk AC6J?& CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY) 7/28/2020 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 endorsements . PRODUCER CPC FINANCIAL SERVICES INC 3835 SW 8 St ONTACT NAME: PHONE 305 774-9618 AIC N 305 774-9620 AD AILSS COI c c-insurance.com INSURERS AFFORDING COVERAGE NAIC M Coral Gables, FL 33134 INSURER A: Technology Insurance Co 42376 INSURED Pinar Electric MD Inc INSURER B INSURER C : INSURER D : _ 13930 SW 30 St INSURER E: MIAM1, FL 33175 INSURER F : 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 POt ICIFS I RAITR RHOWN MAY HAVI= RFGN Rent Irrn QV DAM rt Au.c INSR TYPE OF INSURANCE LTR ADDL SUER POLICY NUMBER POLICY EFF MM DONYYYI POLICY EXP IMMfDDM= T T LIMITS COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR GENT- AGGREGATE LIMIT APPLIES PER: PRO POLICY ❑ JECT LOC EACH OCCURRENCE $ D M 0 NTED PREMISES IEa_occurrencel $ MED EXP (Any one person) _ $ PERSONAL & ADV INJURY $ GENERAL AGGRUGATE PRODUCTS-COOTHER:AUTOMOBILE LIABILITY ANYAUTOBODILY OWNED SCHEDULED AUTOS ONLY AUTOSBODILY HIRED NON -OWNED AUTOS ONLY AUTOS ONLY COMBINED SINGEaaccident INJURY INJURY PROPERTY DAMAGE Per accid nt $ $ 1 Li UMBRELLA LIAB EXCESS LIAB CLAIMS -MADE EACH OCCURRENCE $ HOCCUR AGGREGATE $ DED RETENTION $ I $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN A OFFICERIMEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N J A TWC3859838 211812020 2118/2021 PER OTH- STATUTE ER E.L. EACH ACCIDENT $ 1,000 0OO E.L. DISEASE - EA EMPLOYE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 _ E I I 7 k I ) k DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLE5 fAUUKU 1U1, Aamnona� rcc,,,mm •..aa " •••"•- .-r..-` - CERTIFICATE HOLDER Miami Shores Village Building Department 10050 NE 2nd Ave Miami Shores, FL 33138 ACORD.?5 (2016/03) 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 O 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD was°Rs yet Miami Shores Village saq�c 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 FLOlR1Dp' Project Address 9999 NE 13 Avenue Miami Shores, FL 33138- Parcel Number Applicant 1132050090460 MICHELLE CHERIE PAPPAS Block: Lot: Owner Information Address Phone Cell MICHELLE CHERIE PAPPAS 9999 NE 13 Avenue (305)807-2987 MIAMI SHORES FL 33138- .... 9999 NE 13 Avenue MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone PINAR ELECTRIC MD INC (786)256-0812 of Work: CONNECTION OF BOATLIFT onal Info: ification: Residential Scanning: 3 Fees Due Amount CCF $1.80 DBPR Fee $2.25 DCA Fee $2.00 Education Surcharge $0.60 Permit Fee - Additions/Alterations $150.00 Scanning Fee $9.00 Technology Fee $2.40 Total: $168.05 Valuation: $ 2,500.00 Total Sq Feet: 0 Pay Date Pay Type Amt Paid Amt Due Invoice # EL-12-17-66827 12/14/2017 Credit Card $ 118.05 $ 50.00 12/05/2017 Check #: 4507 $ 50.00 $ 0.00 Available Inspections: Inspection Type: Review Electrical 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 SWNG POOL work. OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and that alIXA will be construction and zoning. Futhermore, I authorize the above -named contractor to do the Authorized Signature: Owner / Applicant / Contractor / Building Department Copy in compliance with all applicable laws regulating December 14, 2017 December 14, 2017 1 It 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 BUILDING PERMIT APPLICATION ❑ BUILDING ELECTRIC ❑ ROOFING RECEIVED DEC 0 5 X-17 (OL S-}" FBC 20H Master Permit NoDu*x) _Z,SG(o Sub Permit No. IZ7`" 11 —7-8 11 ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL [:]PUBLICWORKS ❑ CHANGE OF [:]CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: E 13 lv-e City: Miami Shores �/ Countyy:r/ Miami Dade Zip: Folio/Parcel#:/f - '4`; - e2a / in Is the Building Historically Designated: Yes NO Occupancy Type: Load: OWNER: Name ((Fee Simple Titleholder Address: c(l T q X) (�. Construction Type: Flood Zone: City: 41 &A 61,e% 5 State: Tenant/Lessee Name: Email: BFE: FFE: one#:b ^ SJU0/' Phone#: CONTRACTOR: Company Name: ! liUAre- e<SC1721C �"�� IYOC­• Phone#: / O6 c � -Oy/ Address: (,D901 /L/� � S / / City: / `7// 0,9n / Stater Zip: Qualifier Name: 0'Q Phone#: o1s4 o p/.'?- State Certification or Registration #: �cC Certificat/e� Competency #: DESIGNER: Architect/Engineer: � 5, .c X0.4! Phone#: Address: Lj City: _/(j ®('" �-►4 State: Zip: Value of Work for this Permit: $Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: o -F f �� Specify color of color thru tile: Submittal Fee $50o `co Permit Fee $ %S-941-Vi CCF $ CO/CC $ Scanning Fee $ Radon Fee $ 2 - � DBPR $ ZS Notary Technology Fee $ Structural Reviews $ Training/Education Fee $ Double Fee $ Bond $ (Revised02/24/2014) TOTAL FEE NOW DUE $ ( 1 & • CD 4 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 OWNER or AGENT The foregoing instrumen was acknowledged before me this 10 day of 20 7 by who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Signature (::�L CONTRACTOR The foregoing instrument was acknowledged before me this 13 day of / A0 r 20 by who is ersonally kno to me or who has produced as :ao c'� COp. MORALES • .os identification and who did to Notary Public - State of Florida �; P; My Comm. Expires Nov 17, 2017 NOTARY PUBLIC: '' ,0F Commission # FF 039767 Seal: 11W '"` J31VMfirV0109 Seal: EXPIRES: Nmernber 92,209 8w*d ihru NW" Pv* Undenfen ************************************************************************************************************ APPROVED Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) Local Busi ne s Tax Pecei pt Miami -Dade County, State of Florida " --THIS IS NOT A BILL � DO N07 PAY LBT 5125802 BUSINESS NAME/LOCATION RECEIPT NO, EXPIRES PINAR ELECTRIC MD INC RENEWAL SEPTEMBER 30, 2018 6901 NW 50 ST 5354774 MIAMI, FL 33166 Must be displayed at place of business Pursuant to County Code Chapter BA - Art. 9 & 10 OWNER SEC. TYPE Of BUSINESS PAYMENT RECEIVED PINAR ELECTRIC MID INC 196 ELECTRICAL BY TAX COLLECTOR CONTRACTOR 45.00 08/21/2017 Worker(s) 2 EC13005412 0224-17-004475 This local Business Tax Racei pt only con"rn s payment of the Loaf Business Tax. The ibcei pt is not a license, permit, or a cart "cation of the holder's qual i "cations, to do business. Holder must comply with any govarnrnental or nongovernmental regulatory laws and requireffents which apply to the business. The FEB PT NO ab" must be displ ayed on al i conTrercial vehidas - Mlani- Dade Code Sec 8a-276, M® For more i nforrr"on, visit www.Haddadeoay/t9xcdIec III" Proposal: T9999 10/28/17 3319 W. 90 Terr. Hialeah FI. 33018 Miami, Florida 33177 EC#13005412 Phone: 305-218-3255 Fax: 305-638-0293 e-mail: pinarelectric(a)-gmail.com TO: Michelle Pappas Attn: Mr. Carballo Site: 9999 N.E. 13 Ave. Miami Shores FI. 33138 Quantity Description Unit Price Total Demolition of existing electrical damaged by Hurricane. All new installations will be in schedule 80 rigid PVC conduit, and junction boxes ran below the dock and with existing circuits to remain. New electrical connection for 6 dock lift motors. Hurricane Irma Damage. Notes: Lift heights controls to be programmed by other. Permit fees to be reimbursed to Pinar Electric. $2,500.00 RICK SCOTT GOVERNOR KEN LAWSON, SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD EC 13005412 The ELECTRICAL CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date. AUG 31, 2018 ORTA, ANDRES LAZARO, PINAR ELECTRIC MD ING 4910'NW 102 AVENUE., .. .,,...� . nr MIAMI ,FL ;, ISSUED: 08/04/2016 DISPLAY AS REQUIRED BY LAW ,gcoRv CERTIFICATE OF DATE (MM/DD/YY) I LIABILITY INSURANCE 12/01/17 PRODUCER Excellence Insurance Agency _ THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 3801 SW 107 Avenue HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR Miami, FL 33165 ALTER THE COVERAGE AFFORDED BY,THE POLICIES BELOW. _._. Phone (305)226-3900 Fax (305)226-3997 INSURERS AFFORDING COVERAGE NAIC # INSURED Pinar Electric, MD INC INSURER A Nationwide Insurance Company 19100 i INSURERS Normandy Insurance Company 13870 13930 SW 30 Street Miami Florida 33175 — INSURER C: INSURER D_ COVERAGES _ INSURER E: 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. INSR ADD'L jPOLICY EFFECTIVE POLICY EXPIRATION DATE MMIDD/YY DATE fMM/DD/YY) 6TR W.0p TYPE OF INSURANCE POLICY NUMBER LIMITS _ ��. -_ GENERAL LIABILITY EACH OCCURRENCE 1,000,000 M COMMERCIAL GENERAL LIABILITY ACP3007866080 08/09/17 08/09/18 DAMAGE TO RENTED PREMISES Ea occurence — 1 OO,000 MED EXP (Any one person) ❑❑ CLAIMS MADE❑ OCCUR 5,000 PERSONAL 8 ADV INJURY 1,000,000 A ❑ GENERAL AGGREGATE — 2,000,000 PRODUCTS - COMP/OP AGG 2,000,000— GEN'L AGGREGATE LIMIT APPLIES PER: 1$500 Ded Prop.Dama e O] POLICY ❑ PROJECT ❑ LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ❑ ANY AUTO (Ea accident) ❑ ALL OWNED AUTOS BODILY INJURY B ❑ ❑ SCHEDULEDAUTOS (Per person) ❑ HIRED AUTOS BODILY INJURY ❑ NON OWNED AUTOS (Per accident) F1— PROPERTY DAMAGE (Per accident) -- _ _ -- __.--- GARAGE LIABILITY --- '— — -- -- AUTO ONLY - EA ACCIDENT ❑ ❑ ANY AUTO OTHER THAN EA ACC [� AUTO ONLY: AGG EXCESSfUMBRELLA LIABILITY — EACH OCCURRENCE AGGREGATE ---------------- ❑ OCCUR ❑ CLAIMS MADE S— ❑ ❑ DEDUCTIBLE i ❑ RETENTION $ WORKERS COMPENSATION WhD NHFL0044242017 11/15/17 — 11/15/18 WC STATU- ❑ OTH- --- B EMPLOYERS'LIABILITY PROPRIETOR / PARTNER / EXECUTIVE _ T R2Y1itiLT$-- ER E.L. EACH ACCIDENT 1,000,000, ANY OFFICER / MEMBER EXCLUDED? E.L. DISEASE EA EMPLOYEE 1;000,000� if yes, describe under -- SPECIAL PROVISIONS below - E.L. DISEASE - POLICY LIMIT 1,000,000 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS License # EC13005412 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL Miami Shores Village 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO 10050 NE 2nd Avenue THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY Miami Shores, FL 33138 OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES__` AUTHORIZED REPRESENTATIVE ACORD 25 (2001108) QF © ACORD CORPORATION 1988