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PL-11-23-2979Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Permit NO.: PL-11-23-2979 Permit Type: Plumbing - Residential Work Classification: Alteration. Permit Status: Approved issue Date:12/08/2023 Expiration: 06/10/2024 Location Address Parcel Number 60 NE 102ND ST, Miami Shores, FL 33138 1132060131461 —� Contacts ROBERT SIMMONS Owner ACE QUALITY PLUMBING LLC Contractor 60 NE 102ND ST, Miami Shores, FL 33138 JAMES NYCUM Business: 7863806277 rsimmons016@yahoo.com 7041 NW 24 ST, SUNRISE, FL 33313 aceq ua lityplumb i ngl Ic@gma il. com Description: REPLACE TANK WATER HEATER WITH A NEW Valuation: $ 800.00 TANKLESS TITAN N-210IN LAUDRY ROOM Total Sq Feet: 0.00 ®vow Fees Amount Application Fee - Other $50.00 CCF $0.60 DBPR Fee $2.00 DCA Fee $2.00 Education Surcharge $0.30 Permit Fee $50.00 Scanning Fee $9.00 Technology Fee 510.00 Total: $223.90 Ins ectfon Requests: i Payments Date Paid Amt Paid Total Fees $123.90 Credit Card 12/08/2023 $73.90 Credit Card 11/29/2023 $50.00 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 rtify that Illthe0oregoing information is accurate and that all work will be done in compliance with all applicable laws regulatingponstrt2R�on and oning. F he re, I authorize the above named contractor to do the work stated. Authoriz ignature: Own r I Applicant / Contractor / Agent Date December 08, 2023 Page 2 of 2 RECEIVE Miami Shores Village NOV 2 9 2023 Building Department BY: 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-9972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 20Z0 BUILDING �F'�BC Master Permit No. -;-II-Z3�Z416i .. PERMIT APPLICATION Sub Permit No. ®BUILDING [j ELECTRIC ® ROOFING ® REVISION ® EXTENSION RENEWAL [2(PLUMBING ® MECHANICAL CHANGE OF ® CANCELLATION ® SHOP CONTRACTOR DRAWINGS JOB ADDRESS: & O 2- City: Miami Shores County: Miami Dade Zip: .33/ 3fl Folio/Parcel#: I , �ZD D �� ` , I y 6 Is the Building Historically Designated: Yes NO Occupancy Type: Load: Flood Zone: BFE: FFE: �consttruction-Ty"pe: / / - I'W ' Z OWNER: Name (Fee Simple Titleholder): /�-"'T�� ` I WL wi o k .S Phone#:19 b b � T Address: h0./✓ �L 7�'Z� City: lM i IA iM I.fU / N. State: �� Zip: 33 Tenant/Lessee Name: Phone#: Email: 1 SlwIVIILD4s 16 YA�on, e0W�- CONTRACTOR: Company Name:/4-C-C- a4�=GTS, 4-L-e- Phone#: Address: 70W /d In/- 2 if Email: Qer�Js.s-�rrv.��c�.yrs.:dvc>�.tC_ �yMaeL� eDM —T Qualifier Name:6✓ Alyce,, / Phone#: SL/- 9� 7-SS3 6 State Certification or Registration #: G'i-'G' OS-69 2 C6 Certificate of Competency If: DESIGNER: Architect/Engineer: Phone#: Zip: Value of Work forthis Permit: $ L� O U Square/Linear Footage of Work: Type of Work: 0 Addition ® Alteration ® New 01 Repair/Replace [[3 Demolition Description of Work: /Z 7 74-1k a- ,tl6i/ Specify color of color thru tile: Submittal Fee Permit Fee $ CCF Scanning Fee $ DCA Fee $ DBPR $ Technology Fee $ Training/Education Fee $ Structural Reviews $ P&Z Review $ CO/CC $ Notary $ Double Fee $ Bond $ TOTAL FEE NOW DUE $ (Revised04/05/2022) Banding 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 subjectto 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 inspecti>willn,,rovedaot be appareinspecti will be charged.T/ISignature / Signature! i._..,r_ez Lc/ .tlydsc� OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this c2GGday of NOV94 belt . 20 2.3 by TtVb p ✓T r w.n7l o 1, $' , who is personally known to me or wh as pradu Pl. bjZ; VfiiS Li C as identification and who did take an oath. NOTARY PUBLIC: Print: rLIZ1 It__ Seal: "Notary Public -State of Florida Commission a HH 452227 My Comm. Expires Oct 8, 2027 rec through National Notary Assn. APPROVED BY The foregoing instrument was acknowledged before me this day of NO20 4;2 3 • by �T/1m v S /'/ .t*4ri_ ho is ersonally known to me or who has produced identification and who did take an oath. NOTARY PUBLIC: i Seal: I ESTHER WILLIAMS GORDON MY COMMISSION #HH169880 IXPIRES: AUG 08, 2026 Bonded through let State Insurance Plans Examiner as ############# Zoning (Revised04/05/2022) Structural Review Clerk ReportOFFICE OF THE PROPERTY APPRAISER Summary Generated On: 11/29/2023 Folio 11-3206-013-1461 Property Address 60 NE 102 ST MIAMI SHORES,. FL 33138-2323 Owner ROBERT SIMMONS Mailing Address 60 NE 102 ST - MIAMI SHORES, FL 33138 Primary Zone 1000 SGL FAMILY- 2101-2300 SO ad 0101 RESIDENTIAL- SINGLE FAMILY: 1 Primary Land Use UNIT Beds / Baths /Half 2/2/0 Floors 1 Living Units 1 Actual Area 2,290 Sq.Ft Living Area 1,767 Sq.Ft Adjusted Area 2,099 Sq.Ft Lot Size 5,750 Sq.Ft --- - -- - - - --- Year Built 1961 Year 2023 2022 2021 YRY1�!?,s"1'�.,�,: COUNTY Year 2023 2022 2021 Exemption Value $0 $0 $50,000 Land Value $327,692 S247,066 $172,569'. Taxable Value $665 966 $605,424 $161,991 Building Value $351,918-$356,158 S113,346. SCHOOL BOARD - Extra Feature Value $2 200 $2,200 __.- _:-.._-_ $2,200 -... Exemption Value $0 $0 $25,000 Market Value $681,810 S605,424 S288,115 Taxable Value $681,810 $605,424 $186,991. Assessed Value $665,966 $605,424 S211,991I CITY -, Exemption Value $0 $0 $50,000 Benefit Type 2023 2022 2021 Taxable Value $665,966 $605,424 $161,991 Save Our Homes Assessment 576,124 REGIONAL Cap Reduction Non -Homestead Assessment S15 844 Exemption Value $0 $0 $50,000 Cap Reduction Taxable Value $665,966 $605,424 $161,991 Homestead Exemption S25,00C Second Homestead 'Exemption $25,000 Note: Not all benefits are applicable to all Taxable Values (i.e. Previous Price 0R Book - Qualification Description County, School Board, City, Regional). ;. Sale Page 04/26/2021 $655,000 32491-1183 Qual by exam of deed 1 5341 6 53 42 06/25/2019 $100 31612-0434 Corrective, tax or QCD; min consideration MIAMI SHORES SEC 1 AMD PB 10-70 : Corrective, tax or QCD; min LOT 4 BLK 11 - 04/28/2015 $100 29719-4122 consideration LOT SIZE 50.000 X 115 -- 02M4/2012 $215,000 28004-1778 Qual by exam of deed CDC 26123-1895 11 2007 5 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 County assumes no liability, see full disclaimer and User Agreement at http://www. mia m idade.govfiinfo/disclaim er.asp PAOde f Tl icin ti,-Lly 50160 kw I 2 )oublt W (e S`b qoK� 3necIleers 2 6/7- wire 1wt° F am 0 9 � r �fo-vj�T RECEIVED Nov 2 9 2023 5y: F3 `4 Tkv'OPS'S w/ IO 11CIt' ,1C q Ron DeSantis, Governor Melanie S. Griffin, Secretary bpr h STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD THE PLUMBING CONTRACTORHEREIN IS CERTIFIED UNDER THE PROVISIONS OF CHAPTER 489, FLORIDA STATUTES 4 NYCUM, JAMES W ACE QUALITY PLUMBING L.L.0 7041 NW 24TH STREET SUNRISE FL 33313 LICENSE NUMBER: CFC056920 EXPIRATION DATE: AUGUST 31, 2024 Always verify licenses online at MyFloridal-icense.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. IL L -:--TAX '4;-L-0 BU* INI�SS E C. E VWX-C9XPIWE5EIFT 9 3 -0 2 0 2 Z • BUSINESS PMM: ACE QUMMY PLUMING L.L.0 7.041 NW 24 ST :SUNRISE, FL 33313-2819 October 01, 2023 EXPIRATION DATE: September 30, 2024 TAX - NUMBER: IHMOCC-MSW2023 BUSINESS CLASS: 89.1 - Home occupations TOTAL AMOUNT PAID: S134a1. Home 0 focplumbing SiNmtem' LicenselMMM Aft -74 LOCAMM. U T M 0KAMMMISCHAPMD. NOTICE:xC�WFBzC0NW.S NULL &VOID IFOVVNERSFOPI, WR MUMSS"TT. APPLY" BUSBUM Z 4:U 4. A. Co. MM -- ------ --- -- -- /,,- *See Reverse Side For Easy Opening lndmchons* Cfty of Sunrise Local Duane= Tax Receipt DMsion 10770 West Oaldand Pa* BoukrAud SLqw!M FL 33361 MY OF SUNRISE BUSINESS TAX RECEIPT DO NOT DISCARD ACE QUALITY rl, UMBIKG L.L.0 7041 NW 24 ST ' SUNRISE, FL 33313-2919 ACORa CERTIFICATE OF LIABILITY INSURANCE "TEPIMDD"/-M 11/02/2023 CERTIFICATETHIS L 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 WANED, subject to the terns 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 endorsements). PRODUCER Hiscox Inc. 5 Concourse Parkway Suite 2150 "CONTACT PHONE (888) 202-3007 FAX . E41AIL ADDRESS: contact@hiscox.com INSURER(S) AFFORDING COVERAGE NAIC # Atlanta GA, 30328 INSURERA: Hiscox Insurance Company Inc 10200 INSURED INSURER B INSURERC : Ace Quality Plumbing LLC 7041 NW 24th St Fort Lauderdale, FL 33313 INSURER D ` INSURER E : INSURER F CAVERAGES 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. LTR TYPE OF INSURANCE am R im POLICY NUMBER [POLICY EFF POLICY ExP LIMITS A X COMAIERCIAL GENERAL LIABILITY CLAIMS -MADE D OCCUR P100.099.328.7 02/13/2024 02/13/2025 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RERMD PREMISES Ea occurrence $ 100,E MED EXP one person $ 5,000 PERSONAL BADVINJURY $ 1,000,000 GEML AGGREGATE LIMIT APPLIES PER: X J� ❑ LOC POLICY ❑ OTHER: GENERAL AGGREGATE S 2,000,000 PRODUCTS - COMP/OP AGG $2,000,000 $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS OS NON --OWNED HIRED AUTOS AUTOS COMBINED SINGLE LIMIT QEA accident) $ BODILY INJURY (Per person) S BODILY INJURY (Per accident) S PRROae�DAMAGE $ a UMBRELLA LIAR EXCESS LIAR OCCUR CLAIMS4AADE EACH OCCURRENCE $ AGGREGATE $ DED I I RETENTION $ $ WORKERS COMPENSATION AND EMMOYEW LIABILITY ANYPROPRIETORIPARTNEWEXECUTNE YIN OFRCER/MEMBEREXCLUDED? (Mandatory In NH) If yyeess.� describe under DESCRIPTION OF OPERATIONS below N / A STATUTE. ER E.L. EACH ACCIDENT S E.L. DISEASE - EA EMPLOYEE S E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) Plumbing Contractor CFC 056920 GEKTIFIGA It: MULULK VP*NU=LLA I [LON Village of Miami Shores Village NE is Shores SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Miami Shores, FL 33138 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORPED REPRESENTATWE 01988 2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD A� o® CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY) 12/06/2023 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 BIBERK P.O. Box 113247 Stamford, CT 06911 CO CT NAME: PHONE 844-472-0967 FAxAA, A/C No 203-654-3613 E-MAIL customerservice@biBERK.com ADDRESS: INSURERS AFFORDING COVERAGE NAIC # INSURER A: Berkshire Hathaway Direct Insurance Company 10391 INSURED Ace Quality Plumbing LLC INSURER B : INSURER C INSURER D : 7041 NW 24 St. INSURERE: Sunrise, FL 33313 rINSURER F I f% C0ArrGc f'_I:QTIFI(_ATF NIIMRFR- 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 I LTR TYPE OF INSURANCE ADDL Aok SUER WVD POLICY NUMBER POLICY EFF MMIDD(MMIDDIYYYYI POLICY EXP LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 0 CLAIMS -MADE OCCUR PREMI S Roccur ence $ 0 MED EXP (Any one person) $ 0 PERSONAL & ADV INJURY $ 0 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 0 PRO POLICY❑JECTaLOC - 0 $ OTHER: A AUTOMOBILE LIABILITYaccident) COMBINED SINGLE LIMIT acci ent $ BODILY INJURY (Per person) $ ANY AUTO BODILY INJURY (Per accident) $ OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE Per accident $ $ UMBRELLA UAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAR CLAIMS -MADE DED I I RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY TIVE Y� ANYPROPRIETOR/PARTNER/DCECRIMU OFFICEEMBEREXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A N9WC938053 12/19/2022 12/19/202-3 %� STATUTE ER E.L. EACH ACCIDENT $ 500,000 E.L. DISEASE- EA EMPLOYEE $500,000 E.L. DISEASE -POLICY LIMIT $ 500000 Professional Liability (Errors & Per Occurrence/ Omissions): Claims -Made Aggregate DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Plumbing Contractor License CFC#056920 Commercial & Residential Projects E.L. 100,000/100,000/500,000 effective 12/19/2022; 100,000/100,000/500,000 effective 12/19/2022; 500,000/500,000/500,000 effective 03/22/2023; 500,000/500,000/500,000 effective 03/22/2023; CERTIFICATE HOLDER LAIVVCLLAIIVIV Village of Miami Shores Building Department 10050 NE 2nd Avenue 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 eA�e� 9)1988 2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Permit NO.: EL-11-23-2980 Permit Type: Electrical - Residential Work Classification: Alteration Permitstatus: Approved" Issue Date: 1210812023 Expiration:06/10/2024 Location Address Parcel Number 60 NE 102ND ST, Miami Shores, FL 33138 1132060131461 Contacts ROBERT SIMMONS Owner AAA ON TIME ELECTRIC INC Contractor 60 NE 102ND ST, Miami Shores, FL 33138 ROBERT KATZMAN Business: 7863806277 rsimmons016@yahoo.com 651 NW 100 TER, MIAMI, FL 33150 Business: 7862951748 pmyland@bellsouth.net ACE QUALITY PLUMBING LLC JAMES NYCUM 7041 NW 24 ST, SUNRISE, FL 33313 acequalityplumbingllc@gmaii.com Description: REPLACE TANK WATER HEATER WITH A NEW Valuation: $ 900.00 Ins ection Requests: TANKLESS TITAN N -2101N LAUDRY ROOM �' 305-%G2-4949 AMPS 88HZ 50/60 KW21240 VOLTS, 2 DOUBLE POLE 50 AMP Total Sq Feet: 0.00 BREAKERS 2 6 2 WIRE LINE Fees Amount Application Fee - Other $50.00 CCF $0.60 DBPR Fee $2.00 DCA Fee $2.00 Education Surcharge $0.30 Permit Fee $50.00 Scanning Fee $9.00 Technology Fee $20.00 Total: $123.90 Payments Date Paid Amt Paid Total Fees $123.90 Credit Card 12/08/2023 $123.90 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 that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating. construc' 7ano g.Fut/hey���/,, I authorize the above named contractor to do the work stated. ,Ke l lZgZa Authorized Signature: Owner / Applicant / Contractor / Agent D to December 08, 2023 Page 2 of 2 Miami Shores Village RECEIVED NOV 2 9 2023 BUILDING 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 BY:�k FBC 20Zo - -" Master Permit No. PL-11-23--2-gl`I PERMIT APPLICATION Sub Permit No. 8-L- ( I - 2!9 - ZgSv BUILDING LECTRIC t3ROOFING ® REVISION 13EXTENSION ©RENEWAL ®PLUMBING I3 MECHANICAL CHANGE OF ® CANCELLATION ® SHOP CONTRACTOR DRAWINGS JOB ADDRESS: City' Miami Shores County: Miami Dade Zip: Folio/Parcel#: 6 Is the Building Historically Designated: Yes NO Occupancy Type: Load: !Construction Type: Flood Zone: BFE: FFE: OWNER:Na�rme(Fee Simple Titleholder): /� zrT I V%"weehS Phone#: 126-�Z� Address: (nn� Aj li %t)ti .S City: Nn t A hAN- State: Zip: % U Tenant/Lessee Name: Email: 11�I m im wj CONTRACTOR: Company Name Address: Email: {(+ Qualifier Name: �= DESIGNER: Architect/Engineer: State Certification or Registration #: C J Ob2�q certificate of Competency #: _Zip: �Z Value of Work for this Permit: $ `1 0 6 Square/Linear Footage of Work: Type of Work: I3 Addition E3 Alteration 13 New ® Repair/Replace ® Demolition I ' lryvrtdry Descri{{''tion of Work: ��{Lt'' T:♦syl)L (�✓Iqn+ f _NtCq i Cr lt/ ii� a y4tL/ j pILIeSS)n rnyd-0 �� it Tan IV-21 a Avg e0�- �PJ/. & ,�I / --1 240yoI tS 2 [�cxb(f ?olre S��,vtt� �,r1ciLtrc—Tdl2 4y"( Specify color of color thru tile: Submittal Fee Scanning Fee $ Technology Fee Structural Reviews $ Permit Fee $ DCA Fee $ Training/Education Fee $ __ CCF DBPR $ P&Z Review $ CO/Cc S Notary: Double Fee $ Bond $ _ TOTAL FEE NOW DUE $ (Revised04/05/2022) 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 rei ct' n fee will be charged. Signatur� Signature OWNER or AGENT Theforegoinginstrument was acknowledged before me this �d q day of M �,` bgd. 20 3 —, by 4 oT T- � 1 I'm wcot S , who is personally known to me or who sptoduc _ha YruS Lf C as identification and who did take an oath. NOTARY PUBLIC: CONTRACTOR The foregoing instrumennt(ack was owledged before me this day of l V v 20 D-3 , by q PA..d personally known to me or who has produced as identification and who did take an oath. NOTARY OUBLIC: Sign: Print: s of Florid+ 1452227 Seal: Notary Public State of Florlde Dct s, 2027 Jose Lure Seladln Notary Assn. R My Commission HH 457676 Expires 10/24/2027 APPROVED BY 3o,v'c'��z� Plans Examiner Zoning Structural Review (Revised04/05/2022) Clerk Ron DeSantis, Governor STATE OF FLORIDA Melanie S. Griffin, Secretary d Fonda p DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS' LICENSING BOARD THE ELECTRICAL CONTRACTOR HEREIN IS CERTIFIED UNDER THE PROVISIONS OF CHAA ,TE_48.9jFL0RIDA STATUTES KATZMAN, ROBERT AAA - ON TIME ELECTRIC INC 651 N W 100 TERR. MIAMI FL 33150 LICENSE NUMBER: EC13002896 EXPIRATION DATE: AUGUST 31, 2024 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 —00 NOT PAY 5188263 BUSINESS NAME/LOCATION AAA ON TIME ELECTRIC INC 651 NW 100TH TER MIAMI, FL 33150 OWNER AAA ON TIME ELECTRIC INC C/O JOSE LUIS SALADIN Worker(s) 1 RECEIPT NO. RENEWAL 3629756 SEC. TYPE OF BUSINESS 196 ELECTRICAL CONTRACTOR EC13002896 LBT EXPIRES SEPTEMBER 30, 2024 Must be displayed at place of business Pursuant to County Code Chapter SA — Art. 9 & 10 PAYMENT RECEIVED BY TAX COLLECTOR 82.50 10/02/2023 INT-24-001475 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 holders qualifications, to do business. Holder must comply with any governmental or nongovemmental regulatory laws and requirements which apply to the business. The RECEIPT N0. above must he displayed on all commercial vehicles —Miami —Dade Code Sec 6a-276. MIA ao For more information, visit www.miamldade.nov/laxeolleetor 4e0 M 10231 ACORN® CERTIFICATE OF LIABILITY INSURANCE �4.� DATE 2/04/2023 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 endorsemen s . PRODUCER Maned Assurance Agency CONTACT Victor M Camacho NAM : PHONE 305 541-8456 A/C No): (305) 643-1188 EMAIL , saint747@aol.com 6488 SW 24th Street INSURERS AFFORDING COVERAGE NAIC # INSURER A: State National Insurance Company, Inc. Miami FL 33155 INSURED INSURER B : Progressive Express Insurance Company INSURER C : Technology Insurance Company, Inc. AAA ON TIME ELECTRIC, INC. INSURER D : INSURER E : 651 NW 100th Terrace INSURER F : MIAMI FL 33150- OVERAGES 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 I= SUBR IBM POLICY NUMBER POLICY EFF POLICY EXP LIMITS A rX COMMERCIAL GENERAL LIABILITY CLAIMS -MADE � OCCUR $0.00 Deductible N N NXT39J7PLR-00-GL 02/03/2023 02/03/2024 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTE PREMISES a occu D $ 100.000 MED EXP (Any oneperson) $ 15,000 I PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY JECT LOC OTHER: GENERAL AGGREGATE S 2,000,000 PRODUCTS - COMP/OP AGG S 2,000.000 $ B AUTOMOBILE LIABILITY A ANY AUTO OWNED X SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY N N 00268467 01/04/2023 01/04/2024 COMBINED SINGLE LIMIT Ea a de $ 50,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ S UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE s DED RETENTION $ C WORKERS COMPENSATIONPER AND EMPLOYERS' LIABILITY ANY PROPRIETOWPARTNER/EXECUTIVE Y � N OFFICER/MEMBER EXCLUDED? a (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA N TWC4238708 04/28/2023 04/28/2024 X STATUT ERH- E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT S 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, nay be attached If more apace to required) License Number: EC13002896 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Miami Shores Village -Building Department. ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 10050 NE 2nd Ave � jam,` Miami Shores FL 33138 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 26 (2016103) The ACORD name and logo are registered marks of ACORD