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DEMO-11-20-2552, 9701 N Miami AveLocation Address Parcel Number 9701 N MIAMI AVE, Miami Shores, FL 33150 1132060130970 Contacts STARFISH HOMES LLC Owner FIVE STAR ELECTRIC SERVICE Contractor 3001 W HALLANDALE BEACH BLVD 300, PEMBROKE PARK, FL 33009 JEAN YVON AURELIEN Business: 9549811154 Business: 7863560162 WIX1237@AOL.COM Other:7863560162 .............. Description: WELL PUMP DISCONNECT Valuation: $ 10.00 Inspection Requests: 305-762-4949 Total Sq Feet: 0.00 , Fees Amount Application Fee - Other $50.00 CCF $0.60 DBPR Fee $2.00 DCA Fee $2.00 Education Surcharge $0.20 Electric, Plumbing, Mech, Gas Demolition $50.00 Fee Scanning Fee $3.00 Technology Fee $2.50 Tota I : $110.30 Payments Date Paid Amt Paid Total Fees $110.30 Credit Card 11/12/2020 $110.30 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 c struction and zoning. Futhermore, I authorize the above named contractor to do the work stated. e i I 1 1- Authorized tihnature:(0)gner "' / Applicant / Contractor / Agent November 12, 2020 Date Page 2 of 2 Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Location Address Parcel Number 9701 N MIAMI AVE, Miami Shores, FL 331SO 1132060130970 Contacts STARFISH HOMES LLC Owner FIVE STAR ELECTRIC SERVICE Contractor 3001 W HALLANDALE BEACH BLVD 300, PEMBROKE PARK, FL 33009 JEAN YVON AURELIEN Business: 9549811154 Business: 7863560162 WIX1237@AOL.COM Other:7863560162 $ 10.00 Inspection Requests: Description: WELL PUMP DISCONNECT Valuation: 305 762-49A9 Total Sq Feet: 0.00 Fees Amount Application Fee - Other $50.00 CCF $0.60 DBPR Fee $2.00 DCA Fee $2.00 Education Surcharge $0.20 Electric, Plumbing, Mech, Gas Demolition $50.00 Fee Scanning Fee $3.00 Technology Fee $2.50 Total: $110.30 Payments Date Paid Amt Paid Total Fees $110.30 Credit Card 11/12/2020 $110.30 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. November 12, 2020 ' Page 1 of 2 (5 � -,AD 1-3�" BUILDING 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 �ECEIVEV> NO`J 0 5 ZION BY: FBC 20 n �01A,' Master Permit No.12CM0 - 11-20 - 2552 PERMIT APPLI ATION Sub Permit No. [:]BUILDING ELECTRIC ❑ ROOFING ❑ REVISION EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL [—]PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 9 7 0) N - ✓� 4 r� , City: Miami Shores County: Miami Dade Zip: Q 31 Sy Folio/Parcel#: 11-3 20 (--d) — o cN1 0 Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): ST0oZV\ S" ®`MSS LL C Phone#: 9-SC9 zO 2 �0 �7- Address: 3 ��� \4. 0.� e'�.0 J�y 34- City: o_ nn�ti�t a r �,� State: t Zip: ;7 d n 1 Tenant/Lessee Name: Phone#: Email: a/!/I A CONTRACTOR: Company Name: \)`-e— ��v`/ IG[J1`i i�, to Phone#: �i 0y ° l 6 Z Address: in c) V.4- City: ��� +'� State: Zip: 33�'i "3— Qualifier Name: -?_ -"-- Phone#: '7S�1; —` Sy Z State Certification or Registration #: `\C Certificate of Competency #: DESIGNER: Architect/Engineer: Phone Address: City: State: Zip: Value of Work for this Permit: $ p Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑New ❑ Repair/Replace Demolition Description of Work: W OJ: !e'-,, 0 \,�s G,irtl_� Specify color of color thru tile: Submittal Fee $ Scanning Fee $ Technology Fee $ Structural Reviews $ Permit Fee $ Radon Fee $ Training/Education Fee $ CCF $ DBPR $ CO/CC $ Notary $ Double Fee $ Bond $ /� 2 TOTAL FEE NOW DUE $ � V • 36 (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 Zi 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 NER or AGENT The foregoing instrument was,, acknowledged before me this dayof `y1Qye'1QC"r 20 by SaZ 66 �61inaH TWMwfio't� personally known to _ me or who has produced L as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: SelchG ATOY&I Seal: :* .,c APPROVED (Revised02/24/2014) Signatur C NTRACTOR The foregoing instrument was acknowledged before me this 3 iCk day of " 0 Q 0-/-'^\04ef 20 ZO by 'S eae) A(0(-eAk2n _,who is personally known to me or who has produced P/L as identification and who did take an oath. NOTARY PUBLIC: Sign: CA— `IN Print: Rc6avn Al LAmorz;-, SELENA ARANDA Seal: MY COMMISSION # GG 971705 ���� ���� ROSALIN ALZAMORA ♦�Y pV i EXPIRES: March 22, 2024 ;_� �� =State of Florida -Notary Public Bond edThruNotaryp�,blicUndervrrlten =* Commission N GG 242544 iIS4�7�i��lR�* August 25 2022 Plans Examiner Zoning Structural Review Clerk Notice to Owner - Workers' Com Miami shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 nsation 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: I . 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: caner State of Florida County of Miami -Dade The foregoing was acknowledgebeforeme this - day of �3I N4eVhbe r , 20 ZO . By'`�pl�ji� ('I �Q�►��1 77QsW) ►►�Q, who is personally known to me or has produced L Q L.L. as identification. Notary: SEAL: ti SELENA ARANDA MY COMMISSION # GG 971705 :•;E°R F:°�? Bonded Thor Notary Public Under*r tens ELECTRICAL • • ' • 'D THE ELECTRICAL CONTRACTOR CERTIFIED UNDER THI PROVISIONS OF CHAPTER 489, FLORIDA STATUTES AURELIEN,,JEAN YVON FIVE STAR ELECTRIC SERVICE INC 8904 ROCKRIDGE GLEN COVE BO'YNTON FL 334 7 LICENSE NUMBER: EC13002983 EXPIRATION DATE: AUGUST 31, 2022 Always verify licenses online at MyFloridaLicense.com i] A FEI .. Do not alter this document in any form. .7*U ' +. � ° This is your license. It is unlawful for anyone other than the licensee to use this document. COUNTY OF PALM BEACH: NOTICE OF LOCAL BUSINESS TAX LBTR NUMBER I BILL NUMBER I CERTIFICATION NO. I NUMBER I LOCATION I 1 200802737 1 B40122100 I EC13002983 1 1 1 8904 ROCKRIDGE GLEN COVE I OWNER AURELIEN JEAN YVON 1 TYPE OF BUSINESS I 1 23-0169 ELECTRICAL CONTRACTOR I FIVE STAR ELECTRIC SERVICE INC A N N E M. G A N N O N T FIVE STAR ELECTRIC SERVICE INC CONSTITUTIONAL TAX COLLECTOR FrS c 8904 ROCKRIDGE GLEN CV Serving Palm Beach County BOYNTON BEACH FL 33473-4830 �Il,ll�lllll,�IIII�IIIIII�LIIIII�I1111111111�1��I�11111�11111111 Serving you. www.pbctax.com I (M0 @TAXPBC 2021 LOCAL BUSINESS TAX NOTICE Attention Business Owners & State Licensed Professionals: All businesses, professionals and businesses that employ professionals providing services and/or merchandise to the public are required to pay Local Business Tax (LBT) for the privilege of operating a business in Palm Beach County. Professionals licensed by the Florida Department of Business and Professional Regulation and/or the State of Florida must also provide a current copy of their license at the time of renewal. Change of ownership, business name or address must be reported to our office and requires an application and additional fees. If this entity is no longer in business, under penalty of perjury sign, date and return the bottom stub. Delinquent Local Business Taxes are also subject to a $10 collection fee, delinquency penalty of 10% for the month of October, plus an additional 5% penalty for each month of delinquency thereafter. Failure to pay the required business tax and obtain the required receipt within 150 days after the initial notice of tax due may lead to civil actions and penalties. These include court costs, reasonable attorney's fees and additional administrative costs incurred as a result of collection efforts. Pursuant to Florida Statute 205.053(3), a penalty of up to $250.00 may be incurred pre -lawsuit and up to $500.00 once a lawsuit has been filed. AMOUNT DUE WHEN RECEIVED BY FEBRUARY 1, 2021 INCLUDES $250 PENALTY SEPTEMBER 30, 2020 OCTOBER 31, 2020 NOVEMBER 30, 2020 DECEMBER 31, 2020 JANUARY31, 2021 $27.50 $30.50 $31.63 $43.01 $44.39 $294.39 CURRENT DELINQUENT DELINQUENT DELINQUENT DELINQUENT DELINQUENT � ® �!`'D' CERTIFICATE OF LIABILITY INSURANCEF11 DATE (M MIDD/YYYY) /02/2020 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 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: Lissette Perez HONE FAX Ell: (305) 888-5747 (A/C, No): (305) 888-8926 L.P. Insurance Associates, Inc. E-MAIL ADDRESS: C Psse Litte I Insure.com 801 W. 48th Street Suite B EI INSURER(S) AFFORDING COVERAGE Hialeah FL 33012 INsuRERA: Granada Insurance Company 16870 I INSURED INSURER B : INSURER C :___- Five Star Electric Service Inc 8904 Rockridge Glen Cove INSURER D : ? INSURER E__----------- _ INSURER F : Boynton Beach FL 33437 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. r INSR - t L.TR_ TYPE OF INSURANCE ADDL I INSD SUBR WVD POLICY NUMBER POLICY EFF MM/DDM'YY POLICY EXP MM/DD/YYYY - LIMITS I X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 500,000 i 1 CLAIMS -MADE OCCUR DAMAGE TO RENTED PREMISES occurrence) $ 100,000 ME D EXP (Anyone person) �$ 50,000 . -J, A 0185FL00004923-12 12/07/2019 12/07/2020 PERSONAL & ADV INJURY 1 $ 500,000_______ GENERAL AGGREGATE j $ 500,000 _ GEN'L AGGREGATE LIMIT APPLIES PER: r� PRO- POLICY L JECT LOC PRODUCTS - COMP/OP AGO �--------------- $ 500,000 _ _ . . OTHER: I AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accidence. $ BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) -- $ PROPERTY DAMAGE Per accident $ NON -OWNED HIRED AUTOS AUTOS '�UMBRELLA LIAR OCCUR EACH OCCURRENCE $ $ — -- EXCESS LIAR CLAIMS-MADEAGGREGATE RETENTO— WORKERS COMPENSATION E AND EMPLOYERS' LIABILITY YIN PER OTH- STATUTE I I ER E.L. EACH ACCIDENT $ ANV PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? ❑ N / A l E.L. DISEASE - EA EMPLOYEE' $ i (Mandatory in NH) If ves, describe under DESCRIPTION OF OPERATIONS below ( E-L. DISEASE - POLICY LIMIT $ f DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) ! Irense # EC13002983 s f CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Miami Shores Village Buidling Department 10050 NE 2nd Ave AUTHORIZED R`E)PRESENTATIVE � Miami Shores FL 33138 ` ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD JIMMY PATRONIS CHIEF FINANICAL OFFICER STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION `CERTIFICATE 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: 1/31/2019 PERSON: JEAN Y AURELIEN FEIN: 562407715 BUSINESS NAME AND ADDRESS: FIVE STAR ELECTRIC SERVICE INC. 8904 ROCKRIDGE GLEN COVE BOYNTON BEACH, FL 33473 SCOPE OF BUSINESS OR TRADE: Licensed Electrical Contractor EXPIRATION DATE: 1/30/2021 EMAIL: WIZ1237@AOL.COM IMPORTANT: Pursuant to Chapter 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 Chapter440.05(12), F.S., Certificates of election to be exempt... apply only within the scope of the business or trade listed on the notice of election to be exempt. Pursuant to Chapter 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. i:aFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUESTIONS? (850)413-1609 FIVE STAR ELECTRIC SERVICE INC Main Address: 8904'ROCKRIDGE GLEN COVE BOYNTON Florida 33437 Date: j % 0 — o oa.. - State of: �71_0 C� L a— Countyof: ?q( r^ c Before me this day personally appeared �c� n0"(A yf& who, being duly sworn, deposes and says: That he or she will be the only person working on the project located at: 9701 N. Miami Ave, Miami Shores, FI. 33150 - AA,4 / Z�;' OZ qontractor ignature Sworn to (or affirmed) and subscribed before me this J day of MOIJ . 20 LD by Seams lUfei�Qt� Personally known or produced identification Type of identification D IL _" 2"'� q"' �' Print, Type or Stamp Name of Notary E ROSALIN ALZAMORA State of Florida -Notary Public Commission # GG 242544 o�:;. My Commission Expires ` August 25, 2022