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EL-04-21-1087Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Location Address Parcel Number 190 NW 100TH ST, Miami Shores, FL 33150 1131010230330 Contacts BRITTANY RETKOFSKY Owner ELECTRICAL SERVICE IN MIAMI CORP Contractor 190 NW 100, MIAMI SHORES, FL 33150 IHOSVANY MORALES Mobile: 2154591002 birxl6@comcast.net 21152 SW 128 CT, MIAMI, FL 33177 Business: 3059728461 Description: LEGALIZE HOME REMODEL & ELECTRICAL PANEL Valuation: �$ 500.00 Inspection Requests 305-�iFr2-499 411 T 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 Permit Fee $50.00 Scanning Fee $15.00 Technology Fee $2.50 Total: $122.30 Building Department Copy Payments Date Paid Amt Paid Total Fees $122.30 Credit Card 04/28/2021 $122.30 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 and that all work will be done in compliance with all applicable laws reWlatirtg construction and zoning. Futhermore, I authorize the above named contractor to do the work stated. Owner / Applicant / Contractor / Agent Date April 28, 2021 Page 2 of 2 Miami Shores Village c�IvED B 'Id' D UI Ing epartment , 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 _ _ INSPECTION LINE PHONE NUMBER: (305) 762-4949 FBC2((��02� ,1 BUILDING Master Permit NO.Rr; PERMIT APPLICATION Sub Permit No. [—]BUILDING LECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: Iy N1�10&f-± City: Miami Shores 2� County: Miami Dade Zip: Folio/Parcel#: 1l 3, 0 1 (Z3 yo 3 �l 1 Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): � Phone#: Address: i Ao N 11� It City: State: Zip:-60 Tenant/Lessee Name: Phone#: �� Lo�X a CONTRACTOR: Company Name:t Address: City:. 1 mubs Qualifier Name: rc) State Certification or Registration #: DESIGNER: Architect/Engineer: Certificate of Competency #: one#: • �� ! Address: City: State: Zip: Value of Work for this Permit: $ Square/Linear Footage of Work: ,A Type of Work: ❑ Addition ❑ Alteration 11 ❑ New epair/Replace ❑ Demolition Description of Work: Specify color of color thru the: Submittal Fee $ Scanning Fee $ Technology Fee $_ Structural Reviews $ Permit Fee $ Radon Fee $ Training/Education Fee $ CCF CO/CC $ DBPR $ 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 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. Signatu OWNER or AGENT The foregoing instrument was acknowledged before me this day of M,r20 z i by who is personally known to me or who has produced f �n� s L«---� as identification and who did take an oath. NOTARY PUBLIC: Sign Signature , CONTRACTOR The foregoing instrument was acknowledged before me this �� day of + T Ytr &l 20 2-1 by --J.kJC75N r`'�C)ICctGS who is personally known to me or who has produced identification an wh ' id take an oath. NOTARY P BLI o,J'ri* Pry Notary Public State of Florida t Martha Gonzalez K = • My Commission HH 051134 '?oV-/ Expires 10/06/2024 Sisn: Print: ,'.; Print: P Notary ublic, - ;Slate. of Florida Seal: •v Seal: Commission N GG 165091 ! My Comm. Expires Mar 28, 2022 as ************************************************************************************************************ APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) 0 01 Ron DeSantis, Governor a Floridiar STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION Halsey Beshears, Secretary ELECTRICAL CONTRAS r S LICENSING BOARD THE ELECTRICAL CONTRACTOR HEREIN ISCERTIFIEDUNDER THE PROVISIONS OF GRAPTER 489, FLORIDA STATUTES Additional Business Qualification MORALES, IHOSVA`NY ELECTRICAL SERVICE IN MIAMI CORP /► 21152 SW 128TH CT MIAMI FL 33177 LICE 909 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. fl� OWNIER BJ5CTPJCAL $FRYICE IN VAAAM CORP w !C) 3 i R.0 M ra} ..$. lEi � li�OIl�1�►�1�ir0.f►MI�N�t0yl1*�'Mn�i� wiaormommmd,41ws aM w4�il t� IM ice. MORML is 1 to*swft A� " CERTIFICATE OF LIABILITY INSURANCE DATE3/19/2021 Y) 03/19/2021 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(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 Service Team NAME: Insurance Guy, Inc. ONEThe No : (305) 668-7722 IC.Ext : (305) 668-7100 FA E-MAIL Commercial@lnsGuy.com ADDRESS: 4928 S. Le Jeune Road INSURER(S) AFFORDING COVERAGE NAIC # INSURERA: Evanston Insurance Company 35378 Coral Gables FL 33146 INSURED INSURERB: Wesoo Insurance CO 25011 INSURER C : Electrical Service in Miami, Corp. INSURERD: 14760 SW 176th St INSURER E : INSURER F: Miami FL 33187 COVERAGES CERTIFICATE NUMBER: CL2112000139 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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. ILTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MMIDDfYYYY MM/DD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE X OCCUR DAMAGE TO RENTED PREMISES Ea occurrence $ 100,000 MED EXP (Any one person) $ 5,000 PERSONAL BADVINJURY $ 1,000,000 A 3AA448751 01/20/2021 01/20/2022 GEN'LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY PRO LOC JECT PRODUCTS - COMP/OPAGG $ 2,000,000 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ ANYAUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 X AGGREGATE $ 1,000,000 A EXCESS LIAB CLAIMS -MADE EZXS3041714 01/20/2021 01/20/2022 DED I I RETENTION $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y I N ANY PRO PRI ETOR/PARTN ER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) NIA WWC3496660 11/30/2020 11/30/2021 PER X STATUTE EORH E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) License Number EC13008909 - New Construction, remodeling and additions :ya:\II7PL'\I�:CtlR�133 Miami Shores Village BLDG DEPT 10050 NE 2ND AVE Miami Shores FL 33138 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 @ 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD