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EL-11-2023Permit Number: EL -11 -11 -2023 1 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 ---ii(S2e )nspection Number: INSP - 166114 Inspection Date: February 15, 2012 Inspector: Devaney, Michael Owner: DAVIES, JOHN Job Address: 1041 NE 94 Street Miami Shores, FL Project: <NONE> Contractor: AGC ELECTRIC, INC Permit Type: Electrical - Residential Inspection Type: Final Work Classification: Alteration Phone Number Parcel Number 1132050120080 Building Department Comments INTERIOR RENO OF KTICHEN AND BATHROOM REPLACEMENT FLOORING CABINETS AND FIXTURES Passed Inspector Comments ,1 vie" ill 2c.. /2- Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled re- inspection fee is paid. until February 15, 2012 For Inspections please call: (305)762 -4949 Page 1 of 1 Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 BUILDING PERMIT APPLICATION FBC 20 OE': 0 8 2011 BY: Permit No. e -71/V/ 074 • Master Permit No. CC -9-11 -1738 Permit Type: Electrical OWNER: Name (Fee Simple Titleholder): Miami Country Day School, Inc. Phone#: (305) 206 -1716 Address: 601 NE 107th Street City: Miami State: Florida zip: 33238 Tenant/Lessee Name: Miami Country Day School Head Master Residence Phone#: (305) 206 -1761 Finail cabanm @miamicountryday.org JOB ADDRESS: 1041 NE 94th Street City: Miami Shores Folio/Parcel#: 11- 3205-012 -0080 Is the Building Historically Designated: Yes County: Miami Dade zip: 33138 NO X Flood Zone: CONTRACTOR: Company Name: AGC Electric, Inc. Phone#: (305) 823 -2280 Address: 2660 West 79th Street City: Hialeah Qualifier Name: Enrique I. Guzman phone#: (305) 823 -2280 State Certification or Registration #: EC0000764 Certificate of Competency #: Contact Phone: (305) 823 -2280 l?matl Address: tomas @agcelectric.com state: Florida Zip: 33016 DESIGNER: Architect/Engineev'4 c• Phone#: (305) 285-4343 Value of Work for this Square/Linear Footage of Work: 500 SF 1 f • Type of Work: UAddr Alteration ONew ORepair/Replace ODemolition Description of work. Revision of drawings to reflect addition of ceiling Tight fixtures, additional receptacles, additional electrical 01'0'0 ` ndyater valve box. Original drawings consisted of Interior renovation of kitchen & bathroom replacement flooring, cat i ets,and-fxtures. ** * * * *44* *0440 * * * * * * * * * * *** * * * * * * * * * * * * ** Fees************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Submittal Fee $ Permit Fee $ -..f2 "!a CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ Bonding Company's Name (if applicable) N/A Bonding Company's Address N/A City State Zip Mortgage Lender's Name (if applicable) N/A Mortgage Lender's Address N/A 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 ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, BEATERS, TANKS and 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 promise in good faith that a copy of the notice of commencement and construction lien law brochure w whose property is subject to attachment. Also, a certified copy of the recorded notice of for the first inspection which occurs seven (7) days after the building permit is iss inspection will not be approved and a reinspection fee will be charged Signature Gary T. Butts Owner or Agent The foregoing instrument was acknowledged before me this 7" day of %/e` -ea °R , 20 ✓/, by �, 7 who is personally known to me or who has produced As identification and who did take an oath. NOTARY PUBLIC: Sign: 1 My Commission Expires:September 22, APPROVED BY $$ $$a „u'n ,.,. # co mgagn 4:Nitp EE028432 ' EXPIRES t Sep. 22.2014 .�� bOA.. of . % %% %rim %%%% Signature 00, the applicant must livered to the person e posted at the job site f such posted notice, the The foregoin s ,1- day of who is personall e I. Guzman ontractor nt was acknowledged before me this 20)I ,by i/ Plans Examiner >, • known to me or who has produced as identification Structural Review (Revised 07 /10/07)(Revised 06/10/2009)(Revised 3/15/09) NOT Si LIC: N did take an oath. raoh Beldelomar Bemardin Commis xplra8 01/15/2014 Zoning Clerk Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 BUILDING PERMIT APPLICATION FBC 20 Permit No. Master Permit No. CC -9-11 -1738 2 Permit Type: Electrical OWNER: Name (Fee Simple Titleholder): Miami Country Day School, Inc. Phone#: (305) 206 -1716 Address: 601 NE 107th Street City: Miami Tenant/Lessee Name: Miami Country Day School Head Master Residence Phone#: (305) 206 -1761 Finail cabanm@miamicountryday.org State: Florida zip: 33238 JOB ADDRESS: 1041 NE 94th Street City: Miami Shores Folio/Parcel#: 11- 3205 - 012 -0080 County: Miami Dade zip: 33138 Is the Building Historically Designated: Yes NO X Flood Zone: CONTRACTOR: Company Name: AGC Electric, Inc. Phone#: (305) 823 -2280 Address: 2660 West 79th Street City: Hialeah State: Florida Qualifier Name: Enrique I. Guzman Zip: 33016 Phone#: (305) 823 -2280 State Certification or Registration #: EC0000764 Certificate of Competency #: Contact Phone#: (305) 823 -2280 Email Address: tomas @agcelectric.com DESIGNER: Architect/Engineer. JDC Architect, Inc. Phone#: (305) 285 -4343 Value of Work for this Permit: $ 2500.00 Square/Linear Footage of Work: 500 SF Type of Work: UAddress ®Alteration ONew ORepair/Replace ODemolition Description of Work: Interior renovation of kitchen & bathroom replacement flooring, cabinets and fixtures. aae****** *** ******** * * *w► * *t* *e****** ** Fees'* ` ** * ** * * * *********** **** ** ******* ******** Submittal Fee $ Permit Fee $ /4—.0' i'eet, '' CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ I la. Bonding Company's Name (if applicable) N/A Bonding Company's Address N/A City State Zip Mortgage Lender's Name (if applicable) N/A Mortgage Lender's Address N/A 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 ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and 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 must b at the job site sted notice, the whose property is subject to attachment. Also, a certified copy of the recorded notice of comme for the first inspection which occurs seven (7) days after the building permit is issued 1 inspection will not be approved and a reinspection fee will be charged T. B Owner or Agent The foregoing instrument was acknowledged before me day of I /D9*,20 ,,by 97db , who is personally known to me or who has produced As identification and who did take an oath. •,,,, ,L ,PO6 �osi �. ;49.'Midi §s o''' ' a �: Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 7952204 Fax: (305) 756.8972 CONTRACTORS' REGISTRATION FORM ALL CONTRACTORS MUST PROVIDE COPIES OF LICENCES AND INSURANCES EACH TIME A PERMIT IS SUBMITTED OR THE VILLAGE MAY MAINTAIN A FILE WITH YOUR INFORMATION FOR A $30.00 FEE PER YEAR IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: A. x COPY OF QUALIFIER'S STATE LIC CARD B. x COPY OF LOCAL BUSINESS TAX RECEIPT C. x COPY OF LIABILITY INSURANCE (CERTIFICATE HOLDER TO BE MIAMI SHORES VILLAGE BLDG DEPT1 D. x COPY OF WORKERS COMPENSATION (EITHER CERTIFICATE OR EXCEMPTIONI IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY: A. COPY OF CERTIFICE OF COMPETENCY OF QUALIFIER B. COPY OF MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT C. COPY OF LIABILITY INSURACE (CERTIFICATE HOLDER MUST BE MIAMI SHORES VILLAGE BLDG DEPT1 D. COPY OF WORKER COMP INSURANCE (EITHER CERTIFICATE OR EXEMPTIONI YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE HOLDER AS FOLLOW: MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES, FL 33138 COMPLETE CONTRACTOR'S INFORMATION BUSINESS NAME: IT &C- rt. ,tc ilv' -( BUSINESS ADDRESS: 2669 w S CITY STATE - ZIP CODE 110 k 6 BUSINESS PHONE: ( 3 01 ) p„) tL iv FAX NUMBER( 3°) Z' ktri �^ CELL PHONE (3 °f ) Yo 3 -to (f QUALIFIER'S NAME: QUALIFIER'S LIC NUMBER: glA 6t—"e , E-MAIL ADDRESS (IF APPLICABLE): 'IC G C e1. � `' ` -' ` °'.`" Created on 3119109 BY MLDV 1 RV 3126109 MLDV ACORO" CERTIFICATE OF LIABILITY INSURANCE OP ID: J3 DATE (MM/DD/YYYY) 09/16/11 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 =LOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED PRESENTATIVE 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 Brown & Brown of Florida, Inc. 1201 W Cypress Creek Rd # 130 P.O. Box 5727 Ft. Lauderdale, FL 33310 -5727 Christopher M. Moore, CPCU INSURED A G C Electric Inc. Attn: Farach Bernardin 2660 West 79th Street Hialeah, FL 33016 954 - 776 -2222 954 - 776 -4446 CONTACT NAME: PHONE (A/C. No, Est): E -MAIL ADDRESS: PRODUCER CUSTOMER ID #:AGCEL-2 FAX (A/C, No): INSURER(S) AFFORDING COVERAGE INSURER A :Amerisure Mutual Ins. Co.+ NAIC # 23396 INSURER 8: *Amerisure Insurance Company+ 19488 INSURER C : *FFVA Mutual Insurance Co.+ 10385 INSURER D : INSURER E : 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 8 B TYPE OF INSURANCE GENERAL LIABILITY X X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE X OCCUR xcU X Contractual Liab GEN'L AGGREGATE LIMIT APPLIES PER: POLICY X PRO- JECT I r LOC 1 AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS X Comp Ded: $500 A C A X X X X ADDL SUBR POLICY EFF POLICY EXP INSR WVD POLICY NUMBER (MM/DD/YYYY) (MMIDD/YYYY) GL205729800 10/01/11 10/01/12 OMITS EACH OCCURRENCE DAMAGE TO RENTED PREMISES (Ea occurrence) $ 1,000,000 $ 300,000 MED EXP (Any one person) $ 10,000 PERSONAL 8 AbV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP /OP AGG $ 2,000,000 CA205729600 10/01/11 10/01/12 Emp Ben. COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 $ 1,000,000 BODILY INJURY (Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE (Per accident) UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE X DEDUCTIBLE RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below Equipment Floater CU2072438 10/01/11 10/01/12 EACH OCCURRENCE $ $ 4,000,000 AGGREGATE $ 4,000,000 Y/N NIA WC84000249842011A 10/01/11 10/01/12 X WC STATU- TORY LIMITS OTH- ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 CPP2057297 10/01/11 10/01/12 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule If more space Is required) E.L. DISEASE - POLICY LIMIT Scheduled Leased/Re $ 1,000,000 CERTIFICATE HOLDER CANCELLATION 69,000 50,000 MIAM Miami Shores Village 10050 N.E. 2 Avenue Miami Shores, FL 33132 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 CORD 25 (2009/09) © 1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD City of Hialeah Business Tax Receipt Mayor Carlos Hernandez 2011-12 o* MIAMI-DADE COUNTY TAX COLLECTOR 140 W. FLAGLER ST, 1st FLOOR MIAMI. FL 33130 2011 LOCAL BUSINESS TAX RECEIPT 2012 MIAMI-DADE COUNTY - STATE OF FLORIDA EXPIRES SEPT. 30, 2012 MUST BE DISPLAYED AT PLACE OF BUSINESS PURSUANT TO COUNTY CODE CHAPTER SA - ART. 452878-3 BUSINESS Nate LutcATIoN AGC ELECTRIC INC 2660 W 79 ST 33016 HIALEAH OWNER AGC ELECTRIC INC 1 FIRST-CLASS U.S. POSTAGE PAID MIAMI, FL I PERMIT NO. 231 THIS IS NOT A BILL — DO NOT PAY * RENEWAL 472774-0 STATErEETo Oh 764 swiTige rEetTRICAL CONTRACTOR 18 WORiCER/S THIS IS ONLY A LOCAL BUSINESS TAN RECEIPT. IT 1 DOES NOT mum THE HOLDER TO VIOLATE ANY EXISTING REGULATORY OR 1 I. ZONING LW COUNTY OR LAWS TPE CITIES. NOR *DOES IT EXEMPT THE HOLDER FROM ANY OTHER t PERMIT OR LICENSE RECITED BY LAW THIS01: It THE HOLDER'S IMIALLFICA- TIONS. PAYMENT Femme) SIUMMDADE COUNTY TAX P COLLECTOR: 07/13/2011 6nO7tnnagnc DO NOT FORWARD AGC ELECTRIC INC TOMAS CURBELO PRES 2660 W 79 ST HIALEAH FL 33016 • STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD 1940 NORTH MONROE STREET TALLAHASSEE FL 32399 -0783 GUZMAN, ENRIQUE I AGC ELECTRIC, INC. 2660 W 75 STREET HIALEAH FL 33016 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 leam 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! DETACH HERE (850) 487 -1395