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RC-11-20-2631, 735 NE 94th StMiami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Location Address sue Date. 12/31/: Parcel Number 35 NE 94TH ST, Miami Shores, FL 33138 1132060141990 Contacts i Permit Expiration: 07/01/2021 II F Inspection Requests: Description. ROOF TOP SOLAR Valuation: $ 2,600.00 3057fi2 4949 Total Sq Feet: 0.00 a Fees Amount CCF $1.80 DBPR Fee $2.00 DCA Fee $2.00 Total: $5.80 Applicant Copy Payments Date Paid Amt Paid Total Fees $5.80 Credit Card 12/31/2020 $5.80 Amount Due: $0.00 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. December 31, 2020 Page 1 of 2 Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Location Address Parcel Number 735 NE 94TH ST, Miami Shores, FL 33138 1132060141990 Contacts I STEPHEN ICHNIOWSKI Owner ENGIPARTNERS LLC Contractor RAFAEL GONZALEZ SOTO Mobile: 4436324934 Business: 8338883644 .._......_......_.._.........._.._........_..�.__.._ .............m.._............., __...... � ..._ .._.-_...--.n..._�_...w € Inspection Requests f Description: ROOFTOP SOLAR Valuation: $ 2,600.00 TotalSq Feet: 0.00� 'EM Fees Amount CCF $1.80 DBPR Fee $2.00 DCA Fee $2.00 Total: $5.80 Building Department Copy Payments Date Paid Amt Paid Total Fees $5.80 Credit Card 12/31/2020 $5.80 Amount Due: $0.00 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 that all work will be done in compliance with all applicable laws regulating construction and zoning. Futhermore, I authorize the above named 96n�tor to do the work stated. Authorized Signature: Owner / Applicant / Contractor / Agent Date December 31, 2020 Page 2 of 2 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 FBC 20 BUILDING Master Permit No. -F_(_—t 1---.0-" 2A PERMIT APPLICATION Sub Permit No. VC-1 I - 1,0 -'Z.�O BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP 2 /� /IJ _ CONTRACTOR / DRAWINGS JOB ADDRESS: —73c�� �+ �4+ �� OIYI(\� r� L L 33 City: Miami Shores __ County: Miami Dade Zip: Folio/Parcel#: I - �jZ. ©�U-10(� I -! - [,p �?rp -Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: /FFEE:( 2, P Wien 1, OWNER: Name (Fee Simple Titleholder): •Phone#:�� Address: q j� City: State: I- Zip:4�1 Tenant/Less.�IeenfN,►amme. Phone#: Email: r[_/ V �,• �� ('� CONTRACTOR: Company Name: CVIClIOCI(104S Phone#: Address: ?--SS a'Cakm "P 51'^ JF)OOY- City: Q�oYoL� GA6\to State: F L Zip: �aT& 4 A. tom p, e 2 sdi-o Phone#: P �'.. '4C�'i� Qualifier Name: \ 0�,,� State Certification or Registration #: CV[ Svi ob^ Certificate of Competency #: O� • 83104 O DESIGNER: Architect/Engineer: Phone#: V 7i Address: City: State 70 Zip: Value of Work for this Permit: $ f-- , f�CJSquare/Linear Footage of Work: STATE OF, Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace 'litipn G �� Description of Work: I on�� l 0 IQ S CCU' Cb A. I I I Specify color of color thru tile: Submittal Fee $ Permit Fee $ CCF $ CO/CC $ Scanning Fee $ Technology Fee $ Radon Fee $ Training/Education Fee $ DBPR $ Notary'$ . Double Fee $ Structural Reviews $ (Revised02/24/2014) Bond $ TOTAL FEE NOW DUE $ '-:; - P_l�) 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. SignatureA4LL.j OWNER or AGENT The foregoing instrume was acknowledged before me this day of 20 �by 411PI Yl rk)Mj0kJS who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: \ Print: l ` ti'i C Signature CONTRACTOR The foregoing instrument was acknowledged before me this dayrof NoyeMbA✓ 120 20 by �N 1� Ip0/l2,Pil2 who is personally known to me or who has produced identification and who did take an oath. NOTARY PUBLIC: Sign: Print: U1l0ra Gontl>k Seal: Seal: ALIARA GONZALEZ SOTO " DAPNNEY CIVIL-JEUNE Notary Public -State of Florida i Notary Public - State of Florida Commission N HH 4l3�5 +► e * Commission # GG 913906 ``•� M Com r My Commission Expires *fie t rough on a frou;h National Notary Assn. 5�±,•,* APPROVED BY Plans Examiner as Zoning Structural Review (Revised02/24/2014) 1' Z _� 10 6 - 0 q q ,O Clerk RE 0 2 Ron DeSantis, Governor Halsey Beshears, Secretary ravnUa STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD THE SOLAR CONTRACTOR HEREIN IS CERTIFIED UNDER THE PROVISIONS OF CHAPTER 489, FLORIDA STATUTES GONZALEZ SOTO, RAFAEL ANGEL ENGIPARTNERS, LLC 255 GIRALDA AVE 5TH FLOOR CORAL GABLES FL 33134 LICENSE NUMBER: CVC57081 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. 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: 2/20/2020 PERSON: RAFAEL A GONZALEZ SOTO FEIN: 823702145 BUSINESS NAME AND ADDRESS: ENGIPARTNERS, LLC 255 GIRALDA AVE 5TH FLOOR MIAMI, FL 33134 SCOPE OF BUSINESS OR TRADE: Plumbing NOC and Drivers Electrical Wiring Within Buildings and Drivers EXPIRATION DATE: 2/19/2022 EMAIL: RGONZALEZ@ENGIPARTNERS.COM Heating, Ventilation, Air- Roofing - All Kinds and Conditioning and Drivers Refrigeration Systems Installation, Service and Repair, Shop, Yard & Drivers 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 E01124165 QUESTIONS? (850) 413-1609 Local Business Tax Receipt Miami -Dade County, State of Florida —THIS IS NOT A BILL — DO NOT PAY 7293795 BUSINESS NAME/LOCATION ENGIPARTNERS LLC 255 GIRALDA AVE 5TH FI R CORAL GABELS, FL 33134 OWNER ENGIPARTNERS LLC C/O RAFAEL GONZALEZ SOTO A MCIR Worker(s) 1 RECEIPT NO. RENEWAL 7583286 r i SEC. TYPE OF BUSINESS LBT EXPIRES SEPTEMBER 30, 2021 Must be displayed at place of bu ; w,,; Pursuant to County Code Chan,:' `iA . A, t 9 & 10 PAYMENT RECEIVED 196 SPECIALTY PLUMBING BY IAx COLLECTOR CONTRACTOR 45-00 07/28/2020 GVC57081 CREDITCARD-20-060872 This Local Business Tax Receipt only confirms payment ofthe Local Business Tax. The Receipt is not a license, permit, or a certification of the holder's qualifications, to do business. Holdermust 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 8,t-276. ht® )AOE ._ For more information, visit www.miamidade,povftaxcollector 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. COPY OF QUALIFIER'S STATE LICENCES B. COPY 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. ........................................................................................... BUSINESS NAME: Engipartners BUSINESS ADDRESS: 255 Giralda Ave 5th floor CITY Coral Gables BUSINESS PHONE: (833 ) 888-3644 FAX NUMBER ( ) STATE FL ZIP 33134 CELL PHONE ( 786 ) 393-4740 QUALIFIER'S NAME: Rafael A. Gonzalez Soto QUALIFIER'S LIC NUMBER: CVC57081 0 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: 1. 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: Af," avi, Owner State of Florida County of Miami -Dade The foregoing was acknowledge before me this day of �' 20�. By�J_ __ _fAJ�J �(,(�(,� �_ who is personally known to me or has produced as identification. Notary:_,rl'46 l/ SEAL: DAPHNEY CIVIL•JEUNE Notary Public • State of Florida H-;9315 ' Ay Comm. Expires Oct 1, 2024 Bonded through Nations! Notary Assn. Date:12/10/2020 State of Florida County of Miami Dade Engipartners Before me this day personally appeared Rafael A. Gonzalez Soto who, being duly sworn, deposes and says: That he or she will be the only person working on the project located at: 735 NE 94th St Miami Shores FL 33138 s� Contractor i nature Sworn to (or affirmed) and subscribed before me this 10 day of December . 20 20 by Aliara Gonzalez Soto Personally know OR Produced Identification X Type of Identification Produced DL G52-721-86-457-0 Z��GO SOTO �5 Notary Public -State of Florida a* Commission # GG 913906 My Commission Expires September 17, 2023 Print, Type or Stamp Name of Notary A� o® CERTIFICATE OF LIABILITY INSURANCE TE DA09-23-2020 Y) 09-23-2020 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 LIGIA M ESPINOSA NAME: A/ NN Ext : 407.797.8076 A/XC No Le Small Business Services, LLC 330 SW 27 Ave Suite 508 E-MAIL ADDRESS: LeSmal[BusinessServices@gmail.com INSURER(S) AFFORDING COVERAGE NAIC # Miami, FL 33135 INSURER A: Berkshire Hathaway Guard INSURED INSURER B : Lloyd's America, Inc INSURERC: ENGIPARTNERS LLC INSURER D : 255 Giralda Avenue, 5th Floor INSURER E : Coral Gables, FL 33134 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 POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL SUER POLICY NUMBER MM/DD/VYFF MM/POLDD/YY P LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1.000.000 COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Ea occurrence $ 50.000 CLAIMS -MADE OCCUR MED EXP (Any one person) $ 5.000 PERSONAL 8, ADV INJURY $ Included A ENBP112079 01/21/20 01/21/21 GENERAL AGGREGATE $ 2.000.000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2.000.000 POLICY PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ r PROPER eOa R DAMAGE $ NON -OWNED HIREDAUTOS AUTOS $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED I I RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/ N WC STATU- OTH- T Y I TER E.L. EACH ACCIDENT $ ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? ❑ N /A E.L. DISEASE - EA EMPLOYE $ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ B Professional Liabilty PS10011853572 02/15/20 02/15/21 Aggregate limit of liability: $ 1.000.000 ERRORS AND OMISSIONS:$ 1.000.000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Additional Insured : City of Miamii - Miami Riverside Center (MRC) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIE CANCELLED BEFORE Village of Miami Shores THE EXPIRATION DATE THEREOF, NOTIC WILL BE DELIVERED IN 10050 NE 2ND AVE, ACCORDANCE WITH THE POLICY PR VISION . Miami Shores. FL 33138 AUTHORIZED REPRESENTATIVE LIGIA M ESPINOSA ACORD 25 (2010/05) C) 19RR-2010 ACORO CORPORATION- All rinhts rPCPrvPd_ The ACORD name and logo are registered marks of ACORD