EL-13-32 9� 7 T
Miami Shores Village
Building Department `'
90050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel:(305)795.2204 Fax:(305)756.8972
INSPECTION'S PHONE NUMBER: (305)762.4949
FBC 20
�
Bi IL ING Permit No.
PERMIT APPLICATION faster Permit No.
Permit Type: Electrical / l
JOB ADDRESS: .7 ky ef /D I f� 5��`.—e-io 7
Z ty: Miami Shores County: Miami Dade Zip: -3 7S 1 3 E// �
s the Building Historically Designated:Yes NO �_ Flood Zone:
OWNER:Name(Fee Simple Titleholder):✓l d"C.1 �Dn c lC Q✓i D , Phone#: 286 FCl*S9 V O
Address: 3-' AJ,E /01-574 .S';_---_eq�
City: m G e--d r Ap—ar State:
Tenant&,cssee Name: Phone#:
Email: of A-1 on Ca��- ;!60.4 a g2 30:5790-3.CONTRACTOR:Com. nyName: RFABRAMS, INC. Phone#: " 7 �/
Address: 3-1 - C j.J Vt+ r+
City: S u'a,+4 rA t EeAA, State. E°�_ Zip: f
Qualifier Name: ORDON C. SIMS VP Phone#: -7 � q23 ° �-?7
State Certification or Registration#:: EC13001212 Cert' `e.Of Competency#:
Contact Phone#: 3®5103 S"1°t r, Email Address: O��� �"^"�a'�'J 10 at W,, G t-o
DESIGNER:Architect/Engineer.. 1`� /'t Phone#:
('�
Value of Work for this Permit:$ J C Squarell inear Footage of Work:
Type of Work.: DAddress I DAlt ation .j ew ORe lace( 1 (�OMin o
Description of Work: C `o e 4 C 1+�S�� �"'�i'l I�l� 0!, l P�
Submittal Fee$ Permit Fee$ -��� CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Bond$
Notary$ Training/Education Fee$ Technology Fee$
Double Fee$ Structural Review$
TOTAL FEE NOW DUE$ a� '�
s
Bon ' g Company's Name(if applicable)
diCompany's Address
Fy t'
r State Zip
M rt age Lnder's Name(if applicable) A"d C.—r a a-,% 3 G."C 5-A4.•-CJ /" e, Lt- IC T
Mo age Lender's Address &2 / �'a�.•.-ie ele Cie �Y � 1[5 f3
C i /"•.ti wyA i Ca 1LC S State_ to r t< a� Zip 3 tea
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 roust
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 certiCed copy o(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
Anspection will not be approved and a reinspection fee will be charged.
" � W NJ
Signature +� Signature
Owner or Agent Contractor
The foregoing instrument was acknowledged before me this (_ The foregoing instrument was acknowledged before me this 30
day of 20Q ,by s �7U�t� day of NOVEMBER 20_ by GORDON C SIMS VP
who is personally known to me or who has produced 61 ID who is rsoy known me Ced ll
As identification and whiz did take an oath. as ide�tion and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
d I t1 urtft,��
t�®qt1 S1Il��,'�i, �tPHV RIB W
Sign: ®` Sio
Print: _� '
By d? F:p &Sep il,2014
Commission# 24
M Commission Expires:Y p NOTARY PUBLIC - � `1i0tBiigh National Notary Assn.
b Commission # '
CP •.,EE113059:
ahH<d<<kM?k8aq<6a<I<<He<+kwI«<2<Xakska++HWd<M<e.&+ks#x<+k@ ask�fi��yt '' •dam �S+d<a<�<u<a<a�R&x<R«<8aK<a<&&mK<d<i<ffia+�<s.dam.us<&�<I<R<&a�I<s<s<&�Hsd<&NakH<8<Se H<�<sk&#H<3«x&
•,y�/ Fit
APPROVED BY /t-.ZF an Examiner Zoning
Structural Review Clerk
(Revised 3/12/2012)(Revised 07/10/07)(Revised 06/lOr-009)(Revised 3/15/09)
01/08/2013 14:18 3055985157 BRIARBAY PAGE 01
riC7ITG1� DATE(MMIDDIYY)
CERTIFICATE OF LIABILITY IN_SUR_ANCE _ �__o1�os/tea _
PRODUCER Briar Bay Insurance Agency THIS CERTIFICATE IS lgiUED AS A MATTER OF RF&AMAT10N
14229 S Dixie Hwy ONLY AN13 CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR
Miami,FL 33176 ALTER THE COVERAGE AFFORDEb BY THE.P-Q.0 IE3,jELOW,__
Phone (305)251.5548 Fax (911)111-1111 .� INSURERS AFFORDING COVERAGE__ , NAIC# _
INSURERA: GRANADA INDURANCE COMPANY '
INSURED RFABRAMS INC _—_..._.
312 POINCIANA DR INSURER B: _ ---
_--;
SUNNY ISLES BEACH FL 33160 INSU••••RER C:
(305) •-••:- -••• ••••_.. .. . ._—.-_-._.,_ ,,, ,
I
INSURER D•
803.5441 _ ..... _,. ----..—
I �_._ INSURER E;
COVERAGES JI INSURER F: i
^THE POLICIES OF INSURANCE LISTED HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDI64YED. NOTWITHSTANDING
ANY R6OUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH R6SPE0T TO WHICH THIS CERTIFICATE MAYBE 158UED OR j
MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN 15 SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR ADD
'L �YpE OF INSURANCE j POLICY NUM9ER •POLICY EFFECTIVE POLICY EXPIRATION
I TR,INSRD_-_ _,--„_•,,, DATE„(M(u(/DDIYY) DATE(MtdMWp Y)I LIMITS_
I i ; GENERAL LIABILn7 I j EACH OCCURRENCE 1,000,000,00
I5AM4GE TO R ENTED**"-*( COMMERCIAL GENERAL LIABILTY 0185FL00012952.2
02/18!12 02/1$/13 ;PREMISEg1Ea occurence 50,000.00
CLAIMS MADE R OCCUR I MED EXP(Any one person) 1,000/10,000
f -- _ I PERSONAL&ADV INJURY 1,000,000,00
E. GENERAL AGGREGATE _2,000,000.00
I QEN'L AGGREGATE LIMIT APPLIIS PER; PRODUCTS~ _C_OMP/OP AGG 1,000,000.001
j - [ POLICY ❑PROJECT _] LOG
�__ I.. __._. ... . i.. .. ....... J
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
C_. ANY AUTO j (!a accident) _ .; —--
ALL OWNED AUTOS I BODILY INJURY
[ ,LJ SCHEDULED AUTOS J jPer person)
HIRED AUTOS
j BODILY INJURY
[] NON OWNED AUTOS i(Per afxadent)
n -•- PROPERTY DAMAGE I
(Per accident
! GARAGE LIABILITY AUTO ONLY-EA ACCIDENT
--•
I ANY AUTO
L. ! -----., _-----.
I :( i ;
OTHER THAN RA ACC
,AUTO ONLY: AGG•
j EXCESSIUMBRELLA LIABILITY I - -- EACH OCCURRENCE -- ��----
ED OCCUR n CLAIMS MADE ! I I AGGREGATE
LJ DEDUCTIBLE
I
RETENTION $ I - -•-•• -_._--••---�.._-_?
. . _ .W('}I�Kf=RS CaMPE1�iSA`T10N A IF d--''."--..'-- ---•F-..__. ..._--_._.�.._. -�.. . . - ---_... _..i
EMPLOYERS'LIABILITY I ❑ WC ST2A��HT���LI; i j OTH•'
I ---
TORY
1169iTaS,...
ANY PROPRIETOR I PARTNER/EXECUTIVE E.L.EACH ACCIDENT
OFFICER/MEMBER EXCLUDED? - -••••••If yes,describe under I E.L.DISEASE-EA EMPLOYEE I
_ SPECIAL PROVISIONS below-. 'E.L.DISEASE-POLICY LIMIT
.OTHER --• ,-- ---...._—..
I I .
-• __-_.._.L__.._-. ....
DIE;SCRIPTION OR OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES 6E CANCELLED BEFORE THE
EXPIRATION 0AT9 THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL
MIAMI SHORES VILLAGE DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO
10050 NE 2nd AVENUE THE LEFT,BUT FAILURE TO DO SO St1ALL POSE NO OBLIGATION Oil LIABILITY
MIAMI SHORES FL 3313$
OF ANY KIND UPON THE INSURER,ITS EN S OR RESENTATIVES.
FAX 0: 305-756-8972 AUTHORIZED REPRESENTATIVE -
IPPOLITO ROMAN
ACOFtD 25(2001108)QF -•• -••-•�•••--__.._.-.. .. ....._-. .. ..
0 ACORD CORPORATION 1988
Vami snores Village
DATE
AppROVED BY
6
7_0NING DEPT
BLDG DEPTk A
SUBJECT i0 CGP�1°I If`MCE\m fH •AI_L FEUER,tiL ��
e �,I�I�� , �
F
PTE AP:I�l: r 1 _ � r
t;,a.0140 Od"d},{.drGm� �!"'l�f
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RFAbrams,Inc.
312 Poinclana Drive
+^cd, Sunny Isles Beach,FL 33160 "V
t 305-603-5441
Gordon Q Sims
�n EC13001212
1—IMF-t 3
ADD SMOKMARBON MONOXIDE DETECTORS. pt9e. 2—,P,
ANY AND ALL CLOTH AND RUBBER Q,
INSUIT1 CONDUCTORS TO BE REPLACED. J�1MRY Ave�i TERRI B POWELL
.`�. Notary Public-State of Fto""
My Comm.Expires Sep 8,2014
",",�,F ��;� Commission#EE 24432
"���`►"�� Bonded Through National Notary Assn.
7
RFAbrarns,Inc.
312 Poindana Drive
Sunny Isles Beach,FL 33160
i4w II
305-803-M41
Gordon C.SIrns 1_1J
EC13001212
TERRI B.POWELL
z Notary Public-State of Florida
I My Comm.Expires Sep 6,2014
Commission#EE 24432
Bonded Th"h National Notary Assn.
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