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EL-13-1228'*� C-10)�l�1L18 3,51T- obO 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: (3057 762.4949 BUILDING PERMIT APPLICATION Permit Type: Electrical JOB ADDRESS: FBC 20 REC MAY 3 12013 BY: _— - - Permit No. td ) �77 u Master Permit No. City: Miami Shores County. Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated: Yes OWNER: Name (Fee Simple Titleholder):_ Address: q /L) ,E:7 r9 NO Flood Zone: City: /-6k4--11A 51V0RQ) State: 14�—c Zip: Tenant/Ussee Name: Phone#: Email: CONTRACTOR,:` Company Name: Lyygr w-�/ W,, Address: 3240 A)&) �®� ��- r City: '64"? Ac, t State: Zip: Qualifier Name: 6?Z>-/ ng c,10 ` Phone#:,?0.� ( 5& C% State Certification or Registration #:�®� Certificate of Competency #: Contact Phone#: Email Address: o to '94®® -1 DESIGNER: Architect/Engineer: Vain. e,of Work for this Permit: $ h�� ` ^—Square/Linear Foo of Work: ^T Type of Work: ❑Ad Description of Work: Submittal Fee $ ' Permit Fee $ 40�-�,,,01 CCF $ CO/CC $ Scanning Fee $ Radon Fee $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ DBPR $ Bond $ Technology Fee $ TOTAL FEE NOW DUE $ c 1 Bonding Company's Name (if applicable) Bonding Company's Address City State Mortgage Lender's Name (if applicable) Mortgage Lender's Address zip City State zip Application is hereby Inde 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 whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the j b site for the first inspection which occurs seven (7) days after the building permit is issued. In the s ce such posted n e, the inspection will not be appy and a reinspection fee will be charged. Signature / Signature r Owner or Agent ontractor The foregoing instrument was acknowledged before me this day of ^-{y, 20 / , by who is personally known to me or who has produced � As identification and who did take an oath. NOTARY PUBLIC: Sign: The foregoing instrument was ackno e ed 44e this/ day of -5— , 20 , byoV identification and who did take an oath. N TARY PUBLIC: APPROVED BY /� // ,yLr/IiE /P Plans Examiner Structural Review (Revised 3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09) Sign: Print: My zoning Clerk A� " CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD,YYYY) 5/29/2013 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 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 ,alliance Insurance Solutions, LLC ID: (PEMCO) c/o Progressive Employer Management Company, Inc. 6407 Parkland Dr CONTACT NAME: Joe Ott PHONE FAX (A/C.No): 866-377-3044 Sarasota, FL 34243 E-MAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIC # INSURER A : SUNZ Insurance Company 34762 INSURED Progressive Employer Management Company II, Inc. 29 N Pinellas Ave INSURER B : - Be ° INSURER C : Catlin Syndicate - ods - Best RatingW INSURER D: Brit Syndicate - Rating Tarpon Springs FL 34689 INSURER E : INSURER F: PREMISES (EaEoccur encs) $ COVERAGES CERTIFICATE NUMBER: 1Fasagnna 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 SUBR POLICY NUMBER POLICY EFF MM/DD POLICY EXP MM@D LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY PREMISES (EaEoccur encs) $ CLAIMS -MADE F� OCCUR MED EXP (Any one person) $ PERSONAL 6 ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ $ POLICY PRO- LOC AUTOMOBILE LIABILITY (IPM Bt:ptl®D SINGLE LIMIT $ BODILY INJURY (Per person) $ ANY AUTO ALL ED SACOEDDULED BODILY INJURY (Per accident) $ P OPPEERdT AMAGE $ ent NON -OWNED HIREDAUTOS AUTOS $ UMBRELLA LIAR HOCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS -MADE AGGREGATE $ DED RETENTION $ $ A WORKERS COMPENSATIONY YIN AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVEE.L. OFFICER/MEMBER EXCLUDED? (Mandatory In NH) N / A WCPE00000153 01 3/6/2013 3/6/2014 TOWC STLIMATU ITS OEV- RY EACH ACCIDENT $ 1,000,00 E.L. DISEASE - EA EMPLOYEE $ 1,000.00 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 B Workers Compensation This is for informational purposes C Excess Coverage and nothing shall create any right Dunder such reinsurance. DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more apace Is required) Coverage Provided for all teased employees but not subcontractors of: General Construction Master Corp Client Effective: 3/14/2013 CERTIFICATE HOLDER CANCELLATION 364500 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Miami Shores Villages THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Building Department ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE 2nd Ave AUTHORIZED REPRESENTATIVE Miami Shores Village FL 33138 Glen J Distefano ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD CERT NO.: 16492008 Monica Conrad 5/29/2013 5.:53:06 AM Page 1 of 1 OP ID: ARBR A.. R CERTIFICATE OF LIABILITY INSURANCE DATE(M� 05/228/18/1YYY) 3 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 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 Phone: 305-648-7070 Avante Insurance Agency, lnc.Fax' 305-648-7090 7490 West Flagler Street Miami FL 33144 Libla iIlvera NAME:ACT PHONE FAX A/c No A/c No): E-MAIL ADDRESS: PRODUCERGENER-7 CUSTOMER IDS: INSURER(S) AFFORDING COVERAGE NAIC it INSURED General Construction Master 334Corp. NW 102 Street Miami, FL 33147 INSURER A: Mid -Continent Casualty Company INSURER a INSURER C : 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 TYPE OF DL R POLICY NUMBER POUCY.EFF MM/DD POLICY EXP MM/DD LIMBS Miami Shores, FL 33138 GENERAL LIABILITY f EACH OCCURRENCE $ 1,000,00 A X COMMERCIAL GENERAL LIABILITY 04 -GL -000861400 07/17/12 07/17/13 DAMAGE To RENTED PREMISES Ea occurrence $ 100,00 CLAIMS MADE OCCUR MED EXP (Any one person) $ EXCLUDE PERSONAL & ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 GEML AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 $ POLICY PRO LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY (Per person) $ ALL OWNED AUTOS BODILY INJURY (Per accident) $ SCHEDULED AUTOS HIRED AUTOS PROPERTY DAMAGE $ (Per accident) $ NON -OWNED AUTOS $ UMBRELLA UAB HCLAIMS-MADE OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESSLIAB DEDUCTIBLE $ $ RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIEfOR/PARTNER/EXECUTIVEEl WC STATU- OTH- ITORY LIMITS E.L. EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? N / A (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ If yes, describe under DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS/ LOCATIONS /VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more ce Ia required General Contractor with Trade Contractor business (Electrical Miring wining building, Air Conditioning, Alarm Installation) CFRTuzunATF Mnl nFR CANCFI I ATIAN MIAMISV SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Miami Shores Village THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN g ACCORDANCE WITH THE POLICY PROVISIONS. Building Dept 10050 N.E. 2nd Avenue AUTHORIZED REPRESENTATIVE Miami Shores, FL 33138 f ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD STM OF FLORIDA � rDEPARTMENT OF � BUSIMSS A= PROVESSIONAL� REGULATION. ELECTRICAL CONTRACTORS LICENSING BOARD 487-1395 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 GRANADO, GENERAL! itCORP 3340 NW 102ND MIAMI PL 33147 s+aa3a-a 1734 -u 1! 33147 URN 09liDl20i2 0901:02'07001 000075.00 araca� i ft,ffIIIfit uer�r as#fste trs tIII $ IIf-11111ItMt.1r0'y t. i The Shores Nam East condom%timn .associatiot4 Inc. 745 North East 91" Street Miami Shores, FL 33138 305-759-9069 / FAX 305-759-2101 E-MAIL soe123@att.net June 4, 2013 Miami Shores Village Building Dept. 10050 NE 2nd Avenue Miami Shores, FL 33138 Dear Sir / Madam: This letter will serve as your confirmation that "General Construction Master, Corp" has been contracted by the owner of Unit 3G, 9120 NE 8' Ave., Miami Shores, Fla., and is authorized by the Board of Directors of the Shores Plaza East Condominium Association to perform alterations to said Unit. Should you have any questions regarding the enclosed, please feel free to contact the condominium office. Sincerely yours, rI f 1/' ertGonzalez President cc: file 'i3 8 a • � 4 7AW1 &a,6o'We44 �� 156C d s"'�i3RE/CARB®N f�®NOXIDE DETECTORS. ANY AND ALL CLOTH -AND RUBBER MA LATER CONDUCTORS TQ BE REPLACED, r--- elL P Oi a -0110 V tad/ -o o Ale llorU �e SD d 39"tl o o c) tare N WA-5AM &I;c i� 2(� � 2� Wt 6� )4 '2Cqo — Rti®®LFO CRUZ MY COLiti,$18StON #EEOg717Q EXPIIES M" 25.2015 C0 N m -n-� r N a m L1 �p n o; v �-�{ . & � Ps Ccj Di D