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EL-10-20-2301Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Location Address Parcel Number 45 NE 93RD 5T, Miami Shores, FL 33138 1132060133660 Contacts I �ction nests: Re I Description: REPLACE ELECTRICAL METER AS PER FPL REQUEST Valuation: $ 1 Insecti 500.00 Ins 49Re 3 �Total S Feet: 0.00 I q Fees Amount Application Fee - Other $50.00 CCF $1.20 DBPR Fee $2.00 DCA Fee $2.00 Education Surcharge $0.40 Permit Fee $50.00 Scanning Fee $9.00 Technology Fee $2.50 Total: $117.10 Payments Date Paid Amt Paid Total Fees $117.10 Credit Card 10/08/2020 $50.00 Credit Card 10/27/2020 $67.10 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 [,assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are quired for ELECT/T6ICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS F ID VIT: I c@rti that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws fY 9 regulating c n ru�on and Futhermore, I authorize the above named contractor to do the work stated. Authoriz "ture:-Dw}lj ' / applicant / Contractor / Agent Date October 27, 2020 1 Page 2 of 2 Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Location Address Parcel Number 245 NE 93RD ST, Miami Shores, FL 33138 � 1132060133660 Contacts Gary Green Owner SUCCESS ELECTRICAL CONTRACTOR INC Contractor 245 NE 93 Street, Miami Shores, FL 33138 VICTOR ROBELTO Business: 786-370-0840 jamnical@bellsouth.net Mobile: same as above Business: 7862961404 Home: same as above Other: same as above Inspection Requests: Description: REPLACE ELECTRICAL METER AS PER FPL REQUEST Valuation: $ 1,500.00 F 3{l5 7 i-4949" Total Sq Feet: 0.00 Fees Amount Application Fee - Other $50.00 CCF $1.20 DBPR Fee $2.00 DCA Fee $2.00 Education Surcharge $0.40 Permit Fee $50.00 Scanning Fee $9.00 Technology Fee $2.50 Total: $117.10 Payments Date Paid Amt Paid Total Fees $117.10 Credit Card 10/08/2020 $50.00 Credit Card 10/27/2020 $67.10 Amount Due: $0.00 4 ATa�m�40 4 r 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 maybe found in the GOVERNMENTAL ENTITIES SUCH AS WATER MANAGEMENT DISTRICTS, public records of this county. STATE AGENCIES, OR FEDERAL AGENCIES. October 27, 2020 Page 1 of 2 IVlldl I II JI IUI CJ V IIId8C �. �- 13 jsL�:) 'UEI Building Department 1 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 BYE INSPECTION LINE PHONE NUMBER: (305) 762-4949 r FBC 20 Q A BUILDING Master Permit No. PERMIT APPLICATION ❑BUILDING Q ELECTRIC ❑ ROOFING ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS 245 NE 93th ST JOB ADDRESS: City: Miami Shores Folio/Parcel#: 11-3206-013-3660 n Occupancy Type: _ Load: Construction Type Sub Permit No. ❑ REVISION ❑ EXTENSION ❑ RENEWAL ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS Miami Dade Zio: Is the Building Historically Designated: Yes NO GARY MARK GREEN OWNER: Name (Fee Simple Titleholder): 245 NE 93th ST Address: Flood Zone: BFE: FFE: 786-370-0840 Phone#: Miami Shores FL 33138 City: State: Zip: Tenant/Lessee Name: Phone#: Email CONTRACTOR: Company Name: SUCCESS ELECTRICAL CONTRACTOR, INC Phone#: 786-816-1622 15440 SW 148 ST Address: MIAMI FL 33196 City: State: Zip: Qualifier Name: VICTOR ROBLETO Phone#: 786-816-1622 ER-13014649 l l E000547 State Certification or Registration #: Certificate of Competency #: DESIGNER: Architect/Engineer: Address Phone#: State: Zip: Value of Work for this Permit: $ 1,500.00 Square/Linear Footage of Work: _ Type of Work: ❑ Addition ❑ Alteration ❑ New ■❑ Repair/Replace Description of Work: REPLACE ELECTRICAL METER, AS PER FPL REQUEST. Specify color of color thru tile: Submittal Fee $��` Permit Fee $ Scanning Fee $ Radon Fee $ Technology Fee $ Structural Reviews $ Training/Education Fee $ CCF $ DBPR $ ❑ Demolition CO/CC $ Notary $ Double Fee $ Bond $ TOTAL FEE NOW DUE S�p ^� . to 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 $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurlr�T ven (7) days after the building permit is issued. In the absence of such posted notice, the inspection wi not a approved an anspection fee will be charged. Signature ER or AGENT The foregoing instrument Was acknowledged before me this L$ day of J ep�t 2�� e C 20 Ly by LOI�C�I 00ot & (Jr l2Zdl , who is personally known to me or who has produced Ft_ IL�. G CoS0 identification and who did take an oath. NOTARY PUBLIC: Sign: Print:L,f— :f \n Seal: EXPIRES: MAR 20, 2022 'gO Bonded through 1st State Insurance Signature ` CONTRACTOR The foregoing instrument was acknowledged before me this LB dayof epke he: 20 2-3 by who is personally known to me or who has produced FL_7c� �ty3 - ,b\'�13-L�3-a as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: _eS0 Seal: tiParr& LESLIE RUBLETO NARANJU �MY COMMISSION #GG198322 �***t�P`Ii4LrS*it�PE'LCf,*��** ************** „ Bonded through 1st State Insurance APPROVED BY j%ZZ��� �^6> Plans Examiner Zoning Structural Review Clerk Property Information Folio: 11-3206-013-3660 Property Address: 245 NE 93 ST Miami Shores, FL 33138-2826 Owner GARY M GREEN CHRISTINA PERALTA GREEN Mailing Address 245 NE 93 ST MIAMI SHORES, FL 33138-2826 PA Primary Zone 1300 SGL FAMILY - 2801-3000 SQ Primary Land Use 0101 RESIDENTIAL -SINGLE FAMILY: 1 UNIT Beds / Baths / Half 3/2/0 Floors 2 Living Units 1 Actual Area 2,899 Sq.Ft Living Area 2,004 Sq.Ft Adjusted Area 2,231 Sq.Ft Lot Size 12,042.24 Sq.Ft Year Built 1961 Assessment Information Year 2020 2019 2018 Land Value $386,610 $361,026 $361,026 Building Value $155,278 $155,278 $155,278 XF Value $10,844 $10,937 $11,030 Market Value $552,732 $527,241 $527,334 Assessed Value $221,637 $216,654 $212,615 Benefits Information Benefit Type 2020 2019 2018 Save Our Homes Assessment $331,095 $310,587 $314,719 Cap Reduction Homestead Exemption $25,000 $25,000 $25,000 Second Exemption $25,000 $25,000 $25,000 Homestead Note: Not all benefits are applicable to all Taxable Values (i.e. County, School Board, City, Regional). Short Legal Description 1 5341 6 53 42 MIAMI SHORES SEC 1 AMD PB 10-70 LOT 12 & BEG AT SW COR LOT 13 N 127.52FT E4.52FT SE140.69FT W 63.56FT TO POB BLK 27 Generated On : 9/30/2020 Taxable Value Information 2020 2019 2018 County Exemption Value $50,000 $50,000 $50,000 Taxable Value 1 $171,637 $166,654 $162,615 School Board Exemption Value $25,000 $25,000 $25,000 Taxable Value 1 $196,637 $191,654 $187,615 City Exemption Value $50,000 $50,000 $50,000 Taxable Value $171,637 $166,654 $162,615 Regional Exemption Value $50,000 $50,000 $50,000 Taxable Value 541 $162,615 Sales Information Previous OR Book- Price Qualification Description Sale Page 21737- Sales which are disqualified as a result 09/01/2003 $0 1208 of examination of the deed 18864 08/01/1999 $165,000 Sales which are qualified 2364 18663- 05/01/1999 $124,500 Other disqualified 1282 18663- 04/01/1999 $103,000 Other disqualified 1277 The Office of the Property Appraiser is continually editing and updating the tax roll. This website may not reflect the most current information on record. The Property Appraiser and Miami -Dade Countv assumes no liability. see full disclaimer and User Agreement at hfr)://www.miamidade.gov/info/disclaimer.asD https://www.miamidade.gov/Apps/PA/propertysearch/ 9/30/2020 Property Search Application - Miami -Dade County Page 2 of 2 https://www.miamidade.gov/Apps/PA/propertysearch/ 9/30/2020 CT B Construction Trades ualifying Board USINESS CERTIFICATE OF COMPETENCY s • B ■ • • Is certified under the provisions of Cha 111.011.1of Miami- " County Local Business Tax Receipt Miami —Dade County, State of Florida -THIS IS NOT A BILL - DO NOT PAY 6954490 BUSINESS NAME/LOCATION SUCCESS ELECTRICAL CONTRACTORINC 14321 SW 147TH CT MIAMI, FL 33196 OWNER SUCCESS ELECTRICAL CONTRACTORINC Worker(s) RECEIPT NO. RENEWAL 7230253 3Syi��Sy: SEC. TYPE OF BUSINESS 196 ELECTRICAL CONTRACTOR 11E000547 01 LBT EXPIRES SEPTEMBER 30, 2021 Must be displayed at place of business Pursuant to County Code Chapter 8A - Art. 9 & 10 PAYMENT RECEIVED BY TAX COLLECTOR 82.50 10/02/2020 C R E D ITCAR D-21-000901 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 Ba-276, MIAMI.04DE For more information, visit www.miamidede.gov/taxcollector ACORl7® CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 10/06/2020 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 endorsement(s). PRODUCER CONTACT NAME: Anabey Rufin HON IPA , o Xt : (305) 233-9223 FANo): (305) 233-9239 At Tamiami Insurance Corp E-MAIL-ADDRESS: b anae anabey@attamiamicorp.com YC .com P 11362 SW 184 St. INSURERS AFFORDING COVERAGE NAIC # INSURERA: GRANADA Miami FL 33157 INSURED INSURER B : INSURER C : SUCCESS ELECTRICAL CONTRACTOR, INC INSURER D : 14321 SW 147TH CT INSURER E INSURERF: MIAMI FL 33196 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 MMIDDPOLICY /YYYY MMIDD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR � ` 0185FL00030691-4 10/24/2019 10/24/2020 EACH OCCURRENCE $ 1,000,000 DAMAGE TO (E.cu ocr e nce $ 100,000 —PREMISES MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L X AGGREGATE LIMIT APPLIES PER: POLICY PRO ❑ LOC JECT OTHER: GENERAL AGGREGATE $ 1,000,000 PRODUCTS - COMP/OP AGG $ 1,000,000 $ AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY COEa aMccBINidentSED INGLE LIMIT $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A PER OTH- STATUTE ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ E.L. DISEASE - POLICY LIMIT $ 7, DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) Electrical installations 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 10050 NE 2ND AVE AUTHORIZED REPRESENTATIVE MIAMI SHORES FL 33138 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD ..MMY PATRONIS CHIEF FINANICAL 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: 11/10/2018 PERSON: VICTOR A ROBLETO FEIN: 452753359 BUSINESS NAME AND ADDRESS: SUCCESS ELECTRICAL CONTRACTOR, INC 14321 SW 147 CT MIAMI, FL 33196 SCOPE OF BUSINESS OR TRADE: Licensed Electrical Contractor Electrical Wring Within Buildings and Drivers EXPIRATION DATE. 11/9/2020 EMAIL: ALFREDARU@HOTMAIL.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 Chapter 440.05(12), F.S., Certificates of election to be exempt... appty 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 ellection to be exempt shall be subject to revocation it, 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 shah m-.K*e a certificate at any time for failure of the person named on the certificate to meet the requirements of this section, DFS-F2-DWG-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUESTIONS? (850)413-1609 Success Electrical Contractor,lne. Phone: (786) 816-1622 Office: (786) 296-1404 License #:EC 13009892 Address: 15440 SW 148th St Miami, FL 33196 DATE:10/20/2020 COUNTY OF: MIAMI DADE, Before me this day personally appeared VICTOR ROBLETO who, being duly sworn, deposes and says: That he will be the only person working on the project located at: 245 NE 93 street Miami Shores. FL33138 Contractor Si�,nature. Sworn to ( or affirmed) and subscribed before me this 20 days of October, 2020 by: th't car 9,r�A3kt> Personally know: Q AQyx7�l+ Produced identification: 143-861-73-283-0 Notary: Date:Iz921ry Stamp. ,r n,. LESLIE ROBLM N*AW \ W COMMISSION *GG'19W E)TIRES: MAR 20, 2022 Bonded ft%O 1st O Wince Thank you for businesses and preference with Success Electrical, Inc. 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 Exemation 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 vei' ge from the contractor's company for day labor, part-time employees or subcontractors. BY SIGNING BELOW YO ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. , Signature: --- State of Florida County of Miami -Dade The foregoing was acknowledge before me this ()b day of �9C.TO--W;Z7, , 20 16 . By nAMN? �I�.lt CP�"C.F3 who is personally known to me or has produced �TL44 WkUJOE7 c as identification. Notary: SEAL: IF: A E+ i SINDIA ALVAREZ MY COMMISSION # GG 238273 a EXPIRES: September 3, 2022 Bonded Thru Notary Pubric Underwriters s • x ••er• s • t•s•as • • • f • r r ► tfa•a. • r • a • • • • f • • • i ! • 3 • r • • lrMtsii 2 rt•`M fl/Ol.nd 5!0' 1 OOf ADORES& 2•3 W 43 STREET M AM SNORES, FL 3YM