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EL-11-20-2534, 137 NW 106th StMiami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Location Address Parcel Number 137 NW 106TH ST, Miami Shores, FL 33150 1121360080290 Contacts ESTEBAN BETANCOURT Owner GR ELECTRICAL SERVICE INC Contractor 137 NW 106TH ST, Miami Shores, FL 33150 ALEJANDRO GOMEZ 5471 W 8 LN, HIALEAH, FL 33012 Business: 3058648885 alegomez2@outlook.com j Description: NEW UNDER GROUND SERVICE TO REPLACE Valuation: $ 2 850.00 Inspection Requests: %2' 949 EXISTING OVERHEAD SERVICE Total Sq Feet: 0.00 �/ y Fees Amount Application Fee - Other $50.00 CCF $1.80 DBPR Fee $2.00 DCA Fee $2.00 Education Surcharge $0.60 Permit Fee $50.00 Scanning Fee $9.00 Technology Fee $2.50 Total: $117.90 Payments Date Paid Amt Paid Total Fees $117.90 Credit Card 11/17/2020 $117.90 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 ,con§truction and zoning. Futhermore, I authorize the above named contractor to do the work stated. rized Signature: Owner / Applicant / Contractor / Agent d✓ / Date ?O � & November 17, 2020 Page 2 of 2 Miami Shores Village G jX'_VD BUILDING PERMIT APPLICATION Building Department O NV' 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 201_--� Master Permit No.EL- tl - ZQ" 153 -- Sub Permit No. ❑ BUILDING ❑■ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑ RENEWAL PLUMBING ❑ MECHANICAL PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 137 NW 106 ST City: Miami Shores County: Miami Dade Zip: 33150 Folio/Parcel#: 11 -2136-008-0290 Is the Building Historically Designated: Yes _ NO Occupancy Type: Load: Construction Type: Flood Zone: BFE:: FFE: OWNER: Name (Fee Simple Titleholder): Esteban Montes Betancourt Phone#: 347-580-2918 Address: 137 NW 106 ST City: Miami Shores State: Florida Zip: 33150 Tenant/Lessee Name: Email: Phone#: CONTRACTOR: Company Name: GR ELECTRICAL SERVICES INC. Phone#: 786-362-9679 Address: 14262 SW 140th Suite #118 City: Miami State: Florida Zip: 33186 Qualifier Name: Alejandro Gomez Phone#: 786-362-9679 State Certification or Registration #: EC-13007301 Certificate of Competency #: _ DESIGNER: Architect/Engineer: Phone#: _ Address: City: State: Zip: Value of Work for this Permit: $ 2850.00 Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New ■❑ Repair/Replace ❑ Demolition Description of work: New underground service to replace existing overhead service. Specify color of color thru tile: Submittal Fee $ Permit Fee $ Scanning Fee $ Radon Fee $ Technology Fee $ Training/Education Fee $ Structural Reviews $ CCF $ DBPR $ CO/CC $ Notary $ Double Fee $ Bond $ _ TOTAL FEE NOW DUE $ s C (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 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 instrument was acknowledged before me this � 18 day of Jc5\6?rv) be f- 20 '26 by ES'i'JC bc;ti 1o(I442,S who is p rsonally known to me or who has produced / ` fiver Tce/A,):e - as identification and who did take an oath. Signature CQ;XACTOR The foregoing instrument was acknowledged before me this 0'-) day of -1 ()Nff tt r , 20 Z-CD by Alaay)Ar0 ! evix K40o is personally known to me or who has produced 11 DL. as identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: Sign: Print: jetem4 1ZgkV1f rem Print: �f ba I -AM Seal: ZPAyPOe,, JEREMY ADAM RAMM Seal: o � Commission 4 GG 220563 l:* °. SELENA ARANDA �, ��or Expires July 28, 20�1' ;.. MY COMMISSION p GG 971705 ',;OF F��P\ BMW Tryu DAB" po; EXPIRES: March 22, 2024 APPROVED B �� C�l�� Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) ACOR" CERTIFICATE OF LIABILITY INSURANCE F DATE 10/28/2020 YYY) 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(les) 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 Kjv Insurance Agency CONTACT NAME: PHONE (305)227-8956 FAX (305)227-8961 (AIC. No. Fxt) A!C No 601 SW 57th Ave Suite "E" E-MAIL ADDRESS: )uanitaaau@yahoo.com _ INSURER AFFORDING COVERAGE NAIC# Miami, FL33144 INSURER A: Ascendant Commercial Insurance, Comp. Phone 305 227-8956 Fax 305 227-8961 INSURED INSURER B : Lloyd's of London INSURERC: Ascendant Commercial insurance, Comp. GR ELECTRICAL SERVICES, INC INSURERD: Gurad Insurance, Comp. 14262 SW 140 ST SUITE # 118 INSURERS___ MIAMI, FL33186 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. INSRLTR TR TYPE OF INSURANCE POLICY NUMBER MMIDD E MMIDD LIMITS A COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR Y Y NPP1432934 01/27/2020 01/27/2021 EACH OCCURRENCE $ 1,000,000.00 DAMAGE RENTE15— PREMISE Ea o urrence $ 100,000.00 MED EXP (Any one person) $ 5,000.00 PERSONAL & ADV INJURY $ 1,000,000.00 GEN'L AGGREGATE LIMIT APPLIES PER: ED JPRO- POLICY El LOC OTHER: GENERAL AGGREGATE $ 2,000,000.00 PRODUCTS - COMP/OP AGG $ 2,000,000.00 $ B AUTOMOBILE LIABILITY ANY AUTO OWNED I SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY Y CA-31291-1 12/26/2019 12/26/2020 COMBINED INGLELIMIT Ea accident $ 1,000,000.00 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per a end $ pip $ 10,000.00 UMBRELLA OCCUR EXCESS HCLAIMS-MADE Y TMAIWD 02/19/2020 02/19/2021 EACH OCCURRENCE $ 3,000,000.00 AGGREGATE $ 3,000,000.00 DED I I RETENTION $ $ p WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANYPROPRiETORIPARTNERIEXECUTIVE OFFICER/MEMBEREXCLUDEDI Y❑ (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA Y GRWC64774 I 03/03/2020 03/03/2021 OTH- STATUTE ER E.L. EACH ACCIDENT _ $ 500,000.00 E.L. DISEASE - EA EMPLOYEE $ 500,000.00 — E.L. DISEASE - POLICY LIMIT $ 500,000.00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) ELECTRICAL CONTRACTOR LICENSE EC 13007301 MIAMI SHORES VILLAGE BUILDING DEPARTMENT 10050 N.E. 2ND AVENUE MIAMI SHORES,FL 33138 SHOULD ANY OF THE ABOVE DE! THE EXPIRATION DATE THIEF ACCORDANCE WITH THE POLICY AUTHORIZED REPRESENTATIVE D POLICIES BE CANCELLED BEFORE NOTICE WILL BE DELIVERED IN @ 1988-2015 ACO D CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD 2601 BLAIR STONE ROAD TALLAHASSEE FL 32399-0783 Congratulations! With this license you become one of the nearly one million Floridians licensed by the Department of Business and Professional Regulation. Our professionals and businesses range from architects to yacht brokers, from boxers to barbeque restaurants, and they keep Florida's economy strong. Every day we work to improve the way we do business in order to serve you better. For information about our services, please log onto www.myfloridalicense.com. There you can find more information about our divisions and the regulations that impact you, subscribe to department newsletters and learn more about the Department's initiatives. Our mission at the Department is: License Efficiently, Regulate Fairly. We constantly strive to serve you better so that you can serve your customers. Thank you for doing business in Florida, and congratulations on your new license! (850) 487-1395 STATE OF FLORIDA DEPARTMENT dbpr REGULATION AND PROFESSIONAL EC13007301 ISSUED:08/05/2020 CERTIFIED ELECTRICAL CONTRACTOR GOMEZ, ALEJANDRO ALEXIS GR ELECTRICAL SERVICES, INC. 'v Signature LICENSED UNDER CHAP ER 489, FLORIDA STATUTES EXPIRATION DATE: AUGUST 31, 2022 Ron DeSantis, Governor Halsey Beshears, Secretary STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD LICENSE NUMBER: EC13007301 EXPIRATION DATE: AUGUST 31, 2022 THE ELECTRICAL CONTRACTOR HEREIN IS CERTIFIED UNDER THE PROVISIONS OF CHAPTER 489, FLORIDA STATUTES �r GOMEZ, ALEJANDRO ALEXIS GR ELECTRICAL SERVICES, INC. 14262 SW 140TH ST SUITE # 118 MIAMI FL 33186 ■ A ISSUED: 08/05/2020 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. Local Business Tax Receipt Miami -Dade County, State of Florida -THIS IS NOT A BILL - DO NOT PAY 6543475 BUSINESS NAME/LOCATION GR ELECTRICAL SERVICES INC 14262 SW 140TH ST 118 MIAMI, FL 33186 OWNER GR ELECTRICAL SERVICES INC RAMON RAMON PRES Worker(s) RECEIPT NO. RENEWAL 6814074 SEC. TYPE OF BUSINESS 196 ELECTRICAL CONTRACTOR EC13007301 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 75.00 08/25/2020 ECHECK-20-239481 This Local Business Tax Receipt only confirms payment of the Local Business Tax. The Receipt is note license, permit, or a certification of the holder's qualifications, to do business. Holder most 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. MIAM►DAD* For more information, visit www.miamidade.govftaxcollector