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EL-13-1385Miami Shores Village Building Department 40050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762A949 BUILDING PERMIT APPLICATION Permit Type: ElectricW ` / JOB ADDRESS: C �� /_ N �V 1� 22 � CcUP.-r FBC 20 L® Permit No. f i�L 1 -3 Master Permit No. T -C-1 3 ._ City: Miami SWOs County:Matey Dade _ _Zip: (�� Folio/Parcel#: Is the Building Historically Designated: Yes NO X Flood Zone: OWNER: Name (Fee Simple Titleholder):~L r ' al el (4- AM..- C:Tv me )-_ / 'KAA) % City: M i a on 15-Fh0rf- e,-7 State: Tenant/I.essee Name: Phnne#* 9 &L4 - Z -L- & - ZO Z9 Email: CONTRACTOR: Address: City: V PA — L O C- ICA State: � _ .. Zip: Qualifier Name: �U� /� /iJ�'e= Phone#:? 4 -%Q State Certification or Registration #: -00 ��Certificate of Competency #: CX300 i� Contact Phone# , `�a:�'� 9-7 q � Email Address: A P qS PrL (s)y4 map - 5. � r DESIGNER: Architect/Engineer: Phone#: Value of Work for this Permit: $ i� ®°� a Square/Linear Footage of Work: Type of Work: QAddress UAlteration f ONew DRepair/Replace ODemolition Description of Work: , ioy I �c 6, Submittal Fee $ C� Permit Fee $ �J~G'� �`� CCF $ CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Educatiou Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL: FEE NOW DUE $ 1Aj ,V ,.:,. ( ',�, a ;,•,'?•::'+{4••-.J• �'�'" i".d*•j •[/�� +rr [/�] r 1 'rv•Yrn,..;: 6�;:: �:,'.r;.:'<:::,•S,:{•.,. 1a,.7. • THIS CERTIFICATE IS ISSUEp AS A MATTER OF INFORMATION ONl Y AND PRODUCER CONFERS NO RIGHT UPON TWE CERTIFICATE WOLpER. TWIS CERTIFICATE NORTHEAST AGENCIES, INC DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED SY 6950 CYPRESS ROAD, SUITE 105 THE POLICIES eElow, PLANTATION, FL 33317 COMPANIES AFFOR12ING COVERAGE COMPANY Phone No. 866-290^8680 Fax NO.954-584-0995 A WESTERN WORLD INSURANCE COMPANY INSURED COMPANY PRECISION TECH INC B ELECTRICAL CONSTRUCTION COMPANY $S00 NW 23RD STREET C ' PEMBROKE PINES, FI.. 33024 COMPANY Off# 954704-$006 cell#305-303.9747 .•CC1VEiZA6f:S • .. ,;:•:..,.-•:.• •. .:. „ ,'•.�'��•;:::.,•.,.,.�`:;�.'x�'''.��:":�r.•r.•r. 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 RY PAID CLAIMS. POLICY POLICY CO TYPE:OF INSURANCE POLICY NUMBER EFFECTIVH EXPIRATION LIMITS LTR DATE (MMIDD/YY) DATE (MMIDpiYY) GENERAL LIABILITY GENERAL AGGREGATE $2.000,000 A ❑ COMMECIAI. GENERAL LIA90.m/ PRODUCTS-COMP/OP AW $1,000,000 [3[] CLAIMS MADE ❑OCCUR PERSONAL &ADV INJURY $140001000 [] OWNER'S & CONTRACTORS PROT NPP7247319 02/28/2073 02/2$iZ014 EACH OCCURRENCE $1,000,000 d FIRE DAMAGE (Any one flro) $50.000 © MED EXP (Any o m person) $ 5000 AUTOMOTIVE LIABILITY COMBINED SINGLE LIMIT $ ❑ ANY AUTO ❑ ALL OWNED AUTOS ❑ SCHEDULED AUTOS BODILY INJURY (Per parson) $ ❑ HIRED AUTOS ❑ NON -OWNED AV= BODILY INJURY (Per madden) $ El PROPERTYDAMAGE $ GARAGED LIABILITY AUTO ONLY -EA ACCIDENT S ❑ ANY AUTO OTHER THAN AUTO ONLY: r' ` ` : ":'*.�'i'' ''"•'t wti. ;: ❑ EACH ACCIDENT $ AGGREGATE S EXCESS LIABILITY EACH OCCURRENCE $ ❑ UMBRELLA FORM AGGREGATE $ $ ❑OTHER THAN UMBRELLA FORM F WORKERS COMPENSATION AND x RtC SiA OTW y. ; •.•: N,Y :::; r:{•'% j:nr:1;•,' TaRYu a .Ea ,:'•.L'"-::^�,:.:f•.•�•;',:: EMPLOYERS' LIABILITY RL FACH ACOMENT $1,000,000 THE PROPRIETORIPARTERS/ INCL 01WECK04690 10/01/2012 10/09/2013 EL DISEASE - POLICY LIMIT $1,000,OaO El. DISEASE - EA EMPLOYEE $1,000,000 NE EXECUTOFFICERS ARE: ENCL OTHER DESCRIPTION OF OPERATIONSILOCATIONS/VEHICLES/SPECIAL -Electrical Contractor- Precision Tech. CERTI cmill'WOLDER . :.:. .....,+ : ':.'; s '"•': :• '. ; :CANCEL"LAT*I0N'.•..: '!•. "•I•: :i', :•:r:tY r:a:'!'.<r.%: MIAMI SIiO)I S Vi�,LAGES SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL V DAYS WRITEN NOTICE TO 10050 NW 2 AVENUE THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL 1Vt)<A Mi SHORES, FL 33139 IMREPRESENTATIVES. SENO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR AUTPl6RIYEb ftM`IWWffATM L�aa IFa(na 14. 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