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EL-11-2310Miami 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. Permit Type: Electrical �) OWNER: Name (Fee Simple Titleholder) G/ �� Igfito71, Address: -77t 70 c 13 2 City: /1114-714-A. 7' State: F/ Tenant/Lesspe Name: JAN JArli 0 Phone #: g - 7,Y)/2 �% )/2 Email: ej-, " I /. e of-"- JOB ADDRESS: City: Folio/Parcel #: 16.5 Al° Miami Shores zip: 23/E- 3 Phone #: t -79.92 ?/ Miami Dade Zip3S /3 r County: Is the Building Historically Designated: Yes NO d Flood Zone: Phone #: s ©S/56 276-6. CONTRACTOR: Company Name:. If 7 .) (4 (e- t" Address: (®— AT& G, C City: Qualifier Name: State Certification or Registration #: Contact Phone #: fi A State: FA-, 96?i42 00/9-106 3 0 e1J Email Ad DESIGNER: Architect/Engineer: Zip:. 3 / 6c)- Phone#: .RpoS g'5 vc P y �(O L-' X15 , Certificate of Competency #: Phone #: /LA Value of Work for this Permit: $ �� ° ®� ¶ �� Square/Linear Footage of Work: Type of Work: ❑Address ❑Alteration DNew Description of Work: /a1L C-35-01C Gig (epair/Replace ❑Demolition DES *** ******** *****+ x*x: *********a: ********** *+ x*** ***** ***: u*****: x********+x+x+x*********u *** Submittal Fee $ Permit Fee $ 2 CCF $ CO /CC $ Radon Fee $ DBPR $ Bond $ Training/Education Fee $ Technology Fee $ Structural Review $ Scanning Fee $ Notary $ Double Fee $ TOTAL FEE NOW DUE $ I _ `•L' / r Bonding Company's Name (if applicable) Bonding Company's Address City State p Zip 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 FT.RCTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC OWNER'S AFFIIDAVIT: 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 ce 'nt must be posted at the job site for the first ins' 'cti, n which occurs seven (7) days after the building permit is issue , absence of such posted notice, the inspection wil of b approved and a reinspection fee will be charged. use K z1(6n rs ; Signature Owner or Agent The fore ng instrument was ackn wledged before e this day �S& . 20 0e%, by N Q. 14 P L� 0 I who is personal kn� 1 •- ���or who ha' produced ' As identification and who did take an oath. Sign: Print: My Commission Expires: JOSEPH R. COLLETTI * MY COMMISSION # DD 988187 EXPIRES: September 4, 2014 -S Bonded Thru Budget Notary Se Fop pt0 Mces Signat70 Contr. or The foregoing instrument was ac 7 ,wledged before me this 3 day of eijkl, 20 Irby £ (D2 IC. 2 1,J`,1z,2 who is personally known to me or who has produced as identification t 1,ykied take an oath. NOTARY PUBLIC:..`` Sign: Print: My Commission Expir :i 0 + kiksk +i<�ksN=kHkN=�kH�H�N�N��k*** +k�kHsN�+kN �kN�shikq q�ik�kN��kNsN= H= sk�kN�H��kNij N�kiN�kN��NN= �hq+ 9ksHH�N��kN�N�nkN =H+N=H=NiikH+�k+kN�H�N�*** NON= �k�kN�q��kH�N�q= q�N�N�ihskskq�N�H�sN�kNaepNagi *** APPROVED B l/� ,1-'7e'/� Plans Examiner Structural Review (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) Zoning Clerk SOUTH07 OP ID: MI CERTIFICATE OF LIABILITY INSURANCE 1 DATE 110 ,° 2'Y' 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 certlflcete holder Is an ADDITIONAL INSURED, the policy(les) 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 Behnke & Associates, Inc. 6565 Taft SL, Ste. 104 Hollywood, FL 33024 Carmen D Orsini INSURED Southern Tropical Electric, In Cedric D.vw 262 N 163 street N. Miami Beach, FL 33162 COVERAGES 954-982 -8014 �'� Cedric Dwyer 9549843422 P Fmk,. Cie:305-986 -3955 FAX (AC. No): ADDRESS: INSURERS) AFFORDING COVERAGE INSURER : Castlepoint Florida Ins Co INSUREtB: NAIC INSURER C: INSURER D: INSURER E: INSURER F : • THIS INDICATED. CERTIFICATE EXCLUSIONS Revlsiun NUM tli: IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, AND CONDmONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TYPE OF IN SURANCE AWL .0J Z. SUBR : i rr POLICY NUMBER i POLICY EFF POLICY aE GENERAL LIABILITY COMMERCIAL GENERAL UADIUTY wins EACH OCCURRENCE $ DAMAGE TO RENTED PREMISES (Ea occurrence) $ 1 CLAIMS -MADE OCCUR MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GENT AGGREGATE OMIT APPLIES PER: (POLICY n & n LOC PRODUCTS- COMP/OP AGG $ $ AUTOMOBILE LIABILITY cOM NNED SINGLE LIMP/ 8 ANY AUTO ALL OWNED AUTOS HIRED AUTOS — _ _ SCHEDULED AUTOS NED AUTO BODILY INJURY (Per person) $ BODILY INJURY (Per accident) 8 PROPERTY DAMAGE • (Per accident) $ $ — UMBRELLA LUIS EXCESS LIAB — OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED 1 I RETENTION $ $ A WOE COMPENSATION APO EMPLOYERS' IABILIIY ANY I R EXCLUDED? � Y� (Mandatory In NH) If yam, tlenGlbs under DESCRIPTION OF OPERATIONS below NIA WEB0194333 10/21111 10/21/12 I WC STATU- 10TH- x TORY OMITS I ER EL. EACH ACC1Da4T $ 500,000 E.L. DISEASE- EA EMPLOYEE $ 500,000 E.L. DISEASE- POLICY UNIT $ 500,000 DESCRIPTION OF OPERATIONS f LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule If more space Is regWrod) &ownat1Are Lint nrn ELLATION MIAMISH Miami Shores Village Building Department 10050 NE 2nd Ave Miami Shores, FL 33138 MOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE TFIIREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 4 AUTFORIZEa REPRESENTATIVE ACORD 25 (2010105) ® 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD iRO ARD GQU Ft 40 - �`tc�1P1e MASTER ELECTRICIAN CONTRACTOR Cod ` 97- 0ME- 16824 iWYER. CEDRIC QUALIFYING SOUTHERN.TROPIC ,L ELEC INC 26Z NE163 ST .. . NORTH MIAMI; BEACH FL 33162 Construction nrodeo Quaffing Board BUSINESS CERTIFICATE OF COMPETENCY 96E000015 SOUTHERN TROPICAL ELECTRIC INC D.B.A.: RC DRICO EXPIRES 08/3112012 Is certified under the provisions of Chapter 10 of Miami -Dade County a- d� -M-- -. --' VALID FOR CONTRACTING UNTIL 09/30/2013' • MIAMI -DADE COUNTY TAX COLLECTOR 140 W. FLAGLER ST. 1st FLOOR MIAMI, FL 33130 RECEIPT NO. BUSINESS NAME / LOCATION SOUTHERN TROPICAL ELECTRICAL INC 262 NE 163 ST OWNER :SOUTHERN TROPICAL ELECTRICAL INC 2011 MUNICIPAL CONTRACTOR'S 2012 TAX RECEIPT MIAMI -DADE COUNTY - STATE OF FLORIDA PURSUANT TO COUNTY CODE SEC. 10-24 EXPIRES SEPT. 30, 2012 30- 3700318 GEC lJOI N0: -96 Ouu015" SEE BACK OF Rtt.EtrT JOw A LIST OF NON- PARTICIPATING MUNICIPALITIES Receipt holder must register in the city where work is to be done. PAYMENT RECEIVED =111121172b11 02270011001 000200.00 1 LY--- __T_ --- - TAX COLLECTOR 140 W. FLAGLER ST. et FLOOR MIAMI, FL 33130 .! FIRST-CLASS U.S. POSTAGE PAID MIAMI, FL PERMIT NO. 231 RECEIPT HOLDER MAY DO BUSINESS AS AkCONTRACTOR AS SPECIFIED HEREON. ELECTRICAL CONTRACTOR DO NOT FORWARD SOUTHERN TROPICAL ELECTRICAL INC CEDRIC DWYER PRES 262 NE 163 ST NORTH MIAMI BEACH FL 33162 11111111 1111 111111111,111 1111)1 1111111Ief111111I1111111111t,t1 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 - ANT. 9 & 10 354100 -1 'VENN/ IMAM � Af. ELECTRICAL INC 262 NE 163 ST 33162 UNIN DADE COUNTY 0 SOUTHERN TROPICAL ELECTRICAL Sec1T +e`tfereICAL CONTRACTOR THIS IS ONLY A LOCAL BU515555 TAB . RECEIPT. IT DOES NOT PERMIT THE HOLDER TO VIOLATE:. ANY EXISTING REGULATORY OR 205150 LAWS - OF THE COUNTY on 0055. ;NOR DOES IT -EXEDXPE THE HPEERMIT 05 OR REQUIRED BY LAW. THIS IS NOT A CERTIFICATION OF THE LDER'S OUALIFICA- PAYMENT RECEIVED MIAMI-OADE COUNTY TAX COLLECTDID 07/20/2011 60010000567 000075.00 INC err - FIRST -CLASS U.S. POSTAGE PAID MIAMI, FL PERMIT NO. 231 RENEWAL CC iEO 6E %0015 370031 -8 WORKER /S 1 DO NOT FORWARD SOUTHERN TROPICAL ELECTRICAL INC CEDRIC DWYER PRES 262 NE 163 ST NORTH MIAMI BEACH FL 33162 1 153 11111, 1111,11, 111111,111,111111,1,1,,,1,111,1 }11111„ 1111,11,1 SEE OTHER SIDE SOUT -13 OP ID: 1Z '4� °RO® CERTIFICATE OF LIABILITY INSURANCE DATE 0103/12YY) 01!03/12 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: H the cortlftcate holder Is an ADDITIONAL INSURED, the policypes) must be endorsed. 11 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 endonhmontis). PRODUCER 305- 6704111 InSource, Inc. 9 South Dadeland BIvd.,#400 305470-9695 P.O. Box 681667 Miami, FL 33286 -1667 Philp C. Lyons V I PHONE FAX INC. Ehd): I INC. Not a ADDRESS: WHITS A NAM s INSURER (S) AFFORDING COVERAGE INSURER A : Travelers P & C of America 25674 INSURES Southem Tropical Electric 273 NE 163 Street North Miami Beach, FL 33162 -3523 INSURERB: 02118/12 c . $ 1,000,000 INSURER D : $ 300,000 INSURER E : CLAIMS -MADE 1 X 1 OCCUR INSURER F: $ 5,000 COVERAGES C REVISION NUMBER: THIS IS TO CERTIFY THAT THE POUCIES 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 POUCIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR 1; TYPE OF INSURANCE AD - : --.rat i�• POLICY NUMBER POUCY EFF '!ikk ii POLICY MCP l: a.1• •Juu, WHITS A GENERAL X LIABILITY COMMERCIAL GENERAL UAS1UTY 11113091187C412TIL11 02115111 02118/12 EACH OCCURRENCE $ 1,000,000 PREMISES (Ea aaareacel $ 300,000 CLAIMS -MADE 1 X 1 OCCUR MED EXP (Any one ) $ 5,000 PERSONAL &ADVINJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER 0 POLICY f JEL`i n LOC $ AUTOMOBILE — — LIABILITY ANY AUTO AUTOS HIRED AUTOS — SCHEDULED NON-OWNED AUTN � SLR LSAT ( ) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY )DAMAGE $ $ UMBRELLA LIAB EXCESS LIAB _ OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ $ DED 1 1 RETEST ON $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPR�7ORIP,� Y / N OFFICER/MEMBER EXCLUDED? (Mandatory In NH) DESCRIPTION OF OPERATIONS below NIA .1 I o us I A TORY I ER E.L EACH ACCIDENT $ E.L DISEASE - EA EMPLOYEE $ E.L DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS 1 LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If mom space la required) • Miami Shores Village g Building Department 10050 NE Second Avenue Miami Shores, FL 33138 MIAM054 SHOULD ANY OF THE ABOVE DESCRIBED POLICES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. @ AUTHORIZED REPRESENTATIVE eALI cll./ ACORD 25 (2010105) ©1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Permit No. 6.7/ 0.2 e Job Name /604-er CRITIQUE SHEET (,4/ 7d ewe 5- 7- 5,4,071/ �°1 -P /G O if , ,, % /rye' G /rT 062-14°641 W_ _9 re /7»':Z/ ) ey''.tc /4s'