ELC-15-361V. M Fob -
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Building Department FEB 18 2015
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
FBC 20 l, -o
BUILDING Master Permit No.ec 91q- z 119
PERMIT APPLI TION Sub Permit No. c- 1 5-3
❑BUILDING ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF [:]CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: / "' o � C4 `114 aal l) -
City: Miami Shores County: Miami Dade Zip: 33/ 3 e
Folio/Parcel#:-- d 3Z 00 0) 10 0 Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Na(ac
(Fee Simple
AddrPq,z- & ! � c 1
City: mzolr :Ft
Tenant/Lessee Name: H#
Email:
'iii=S y t'C/r rIi� P Phon
S tkv FF '117 Z,
State: Zip:
A/ C - Phone#:
CONTRACTOR: Company Name: )rjeMM15 / 6(-&-o l C0�V Phone#:
Address: 13 � � T 4 VT
City: 0zA6" State:
Qualifier Name: /° Phone#:
State Certification or Registration #: 6- e % 300 4�-30 I Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#: _
Address: City: State:
Value of Work for this Permit: $�/ ®®®° Square/Unear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration❑ New ElRepair/Replace
Description of Work: ffhou 9` T 04-� St' D ft ��-
Specify color of color thru tile;
Submittal Fee
Scanning Fee $
Permit Fee $
Radon Fee $
Technology Fee $ Training/Education Fee $
Structural Reviews $ _
(Revised02/24/2014)
30S- 3 31 b36 )
p. 3:30-12---
DESIGNER:
:30-1Z.
Zip:
❑ Demolition
CCF $ CO/CC $
DBPR $ Notary $
Double Fee $
Bond $ P
TOTAL FEE NOW DUE $ ISO 2 . 20
Bonding Company's Name (if applicable) _
Bonding Company's Address
City State
Mortgage Lender's Name (if applicable) _
Mortgage Lender's Address
City
State
Zip
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 ELECTRIC, PLUMBING, SIGNS, POOLS,
FURNACES, BOILERS, HEATERS, TANKS, 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 at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the abse a such p ed notice, the
inspection will not be approve and reinspection fee will be charged.
or AGENT
The foregoing instrurfient was acknowledged before me this
19 day ofbruar 201 5 , by
Y(IM 1 ��9k , who is personally know to
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
Print: 11'COWl as
Seal: ,.,�".p••, OadbWh
MICHAEL COSTA
3 `��= Rdwy PUNIC - State 01 Florida
My
''•.,�e►.��'�
Comm. E Oat 8.2018
_ Commiselo�r #► FF iNt87
(Revised02/24/2014)
The foregoing instrument was acknowledged befort rthis
— day of -C. 'r tt4 20 by
—AAi C Inc fJ P:!LIr-.eZwho is personally known to
me or who has produced
identification and who did take an oath.
as
NOTARY PUBLIC:
Sign:
Print:
Seal:
•'' ' XENIA O. SANCHEZ
a•: •'E MY COMMISSION At EE201443
• EXPIRES May 23, 2016
--- - - - - -i +ewws.�MM•
Examiner
Structural Review
Zoning
Clerk
Feb 121510:18a
p.2
Miami shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shares, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
CONTRACTORS' REGISTRATION
IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR:
A. !! COPY OF QUALIFIER'S STATE LICENCES
B. -.+ COPY OF LOCAL BUSINESS TAX RECEIPT
C. COPY OF LIABILITY INSURANCE`
D. _ COPY OF WORKERS COMPENSATION INSURANCE*
(Workers Compensation EXEMPTION must have NOTICE TO OWNER Affidavit)
IF CONTRACTOR HAS A MIAMI DADE COUN- CI_RTIFICATE OF COMPETENCY:
A. COPY OF CERTIFICATE OF COMPETENCY OF QUALIFIER
B. COPY OF LOCAL BUSINESS TAX RECEIPT
C. COPY OF STATE REGISTERED CONTRACTOR LICENSE OR MIAMI DADE COUNTY MUNICIPAL
CONTRACTOR'S TAX RECEIPT.
D, COPY OF LIABILITY INSURACE*
E. COPY OF WORKERS COMPENSATION INSURANCE'
(Workers Compensation EXEMPTION must have NOTICE TO OWNER Affidavit)
"YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE AS FOLLOW:
Certificate Holder.
MIAMI SHORES VILLAGE BLDG DEPT
90050 NE 2ND AVE
MIAMI SHORES, FL 33138
Certificate must specify the description of operations or contractor license number,
BUSINESS NAME: FFkY ��a i itlt ^ n4,tRO N
BUSINESS ADDRESS: I��Z l si }h Siler CrlYYAiJ.l114 STATE " ZIP ✓-2>0k'L
BUSINESS PHONE: i =� ) -`7�U " 21i'FAX NUMBER( 3L),L.) i 5� 5 L'_Ui
CELL PHONE (? _� I `, �v�;- QUALIFIER'S NAME: 1 I l� MSL- ��
QUALIFIER'S LIC NUMBER:i�
Feb 121610:10a
STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
ELECTRICAL CONTRACTORS LICENSING BOARD
1940 NORTH MONROE STREET
TALLAHASSEE FL 32399-0783
PEREZ, MICHAEL LENIN
FERREY ELECTRIC CORP
1372 W 44TH STREET
HIALEAH FL 33012
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 toimprove the way we do business in order to
serve you better, For information about our services, please log onto
www.mytioridalicerme.com. Thero you can find more Information
about our divisions and the regulations that Impact you, subscribe
to department newsletters and team 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
P. 3
(850) 487-1396
�" 3cSTATE OF FLORIDA
DEPARTMENT OF BUSINESS AND
PROFESSIONAL REGULATION
EC13004301 ISSUED: 08127/2014
CERTIFIED ELECTRICAL CONTRACTOR
PERF -Z, MICHAEL LENIN
FERREY ELECTRIC CORP
IS CERTIFIED under -he -provisions of Cri.480 FS.
E.*adW CkAm : AUC! 01, 2016 L140827OM303
RICK SCOTT, GOVERNOR KEN LAWSON, SECRETARY
STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION Biu sr�
ELECTRICAL CONTRACTORS LICENSING 130ARD
S
EC113004301
The ELECTRICAL CONTRACTOR
.
Named below IS CERT151ED xIY .
Under the provisions of Chapter 489 FS.
Expiration date: AUG 31. 2416
PEREZ MICHAEL LENIN
FERREY ELECTRIC CORP.. '..
1372 W 44TH STREET
HIALEAH FL 33012
ISSUED: 0MV2014 DISPLAY AS REQUIRED BY LAW SEG # L140827bt3043t13
:•13904
Local Business
Miami --Dade County,
-THS IS NOTA BILL
6579800
BUSINESS NAME&OCATION
FERREY ELECTRIC CORP
1372 W 44 ST
HIALEAH FL 33012
Tax Receipt
State of Florida
- DO fJOTPAY
B T
RECEIPT NO. EXPIRES
KNEWAL SEPTEMBER 30, 2095
6850425 Must be displayed at place of bustness
Pursuant to Carinty Code
Chapter SA - Art. 9 & 10
OWMER SEC. TYPE OF BUSINESS PAYMENT RECEIVED
FEW ELECTRIC CORP 190" ELECTRICAL CONTRACTOR BY TAX COLLECTOR
Warker(s) 1 ECI3WJ01 $45fl0 07/15/2014
CREDITCARD-14-027225
this Local Susiayss Tax Receipt only wolims payarent of the Local Bweiness Tax_ The Receipt is nal a Ham,
permit, or a cer10scadea of Ida hairier"s QuaLHI cadess, le da hvsicess. Halder must campiv wim any governmental
at ronaIloverrrmental repulatory lam mod regairemem whlch apply to the hasbus.
The RECEIPT No. aLove must he displayed on ell cormnerei el vetucins-miamt-Dade Cade Seeu-M.
For mom lidannatian,visit
yywwmjpatedade. voa Raxcglleetor
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Feb 12 15 10:19a
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CERTIFICATE OF LIABILITY INSURANCE 07112/15�
II. --
I
THIS CERTIFICATE IS ISSUED AS A MA i' OF INFORMATION ONLY AND CONFERS NO RIGHTS ij0W 1 THE d1 RYIFICATE 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 SETWEEN THE ISSUING 1NSURERM. AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE BOLDER.
11NPORTANT: if tho certlficeso notas� la an ADDITIONAL 1NSURfO, Me pollmylles}must be endorsed. tf 5116FtOtsATLON IS WAIVED, tuAj�Ct to
the terms and eonallons of the pollcy, certain golicles may require an andarsement. A statement on this certlflcale does not confer right* to the
certlMats holder In lion r1/ such endorsemeal(s). • • • _, ,,,
PRODUGEI+ 6N9•ACT MARLENL' Nl-h1F7 __
N!►NI�
FAX
Ocdtlental Risks Serviee�, Inc
PHONE : -�§§y 873 �1'�3-
.�A�c_N f t .._
11890 SW 85t Suite 500 AUp IRpgs_ r+mriener@arclrlentc. akscam - _ —
Miami, FL 33184 RISURER aEFOEiDIN_(S C4trERaGS _.. � NAIC a ._
PhonC (305)4.334068 Fax (& S} 678.2045 IN8UR6RA: INTERNATIONAL INSURANCE COOF HANNOVER
INSUR60 INSURER 6,: ZENI'T'H INSURANCE COMPANY —
FERREY ELECTRIC CORP -- �I
1372 W A4 ST
HIALEAH, 33012 (305) 331.8367 InSURER E t,,,
WM REk F, •„ ...
COVERAGES ' CERTIFICATE NUMBER: — REVISION NUMBER:
j--• TH18 iS TO CERTIFY THATTHB POLICIES OF WSUitANCE Lit3Tif6 ist-_LOW HAVE 139EN ISSUED TO THE INSURED NAMEL) ABOVE FOR THE POLICY Fi FMOD
j INDICATGO, NOTWITHSTANDING ANY RCOVIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHCR 00CUMENT 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. LIMP -5. SHOWN MAY HAVE! SEEN REDUCED BY PAID CLAIMS,
___._.. _. ,._ _ ...... _ —
INBR ADD U R��( _' POLICY PTP POLtcY EXP
LTR _ TYPEOFINGURANCE 1YiiDl•.__... M'OLIF37fq# BER A .. 6 k[IIYYYY! tM�OfYYYY) .. _.._ 4erY1S
r GENERAL U4AWW _ SACH OCCURRENCE. ti 1 _QOO,QOO.OQ
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`. J ❑ CUUhts MADE J OCCUR I MED hX? !Ary a» t:nrrum . S $.000.flQ
A I 1 N N• IG06A007697 02103=15 102103/Z016 l
L.1 . _ I I I FER.ow1L a MV 1NJ+JRr s 1,000�000.QO
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ELECTRICAL CONTRACTOR
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CERTIFICATE HOLDER
VILLAGE OF MIAMI SHORES
BUILDING DEPT.
10050 N6 2 AVENUE
MIAMI SHORES, FL. 33138
ACORD 25 (2010/05) QIF
GCNEIiALAG .KEOATE 1 2:000,000;00
ERODLICTS-COMWOPAGO $
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Z126500801 05/0312014 05/03/2015 F.L. EACH ACCIDENT _ i 100.0w.00
V-1.. 015hmE - EA CM10 0YE: ° i 100,000 00
X00,000.00 _
LA uh ACORD 109, AddklwuA %sawlri Sdteatga, a Ams apaca ta require*
CANCELLATION _
SHOULD- ANY OF 7ttE ABOVE OESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVER•E0 IN
ACCORDANCE WTrH THE POLICY PROVISIONa.
AUTHORIZED REPREg4d7ATIVE _ ..... . _ .�_—__. . • r' - � i --•
®1988-2010 ACORD CORPORATION. All rights reserved.
The ACORD nants and logo aro Iegistared marks of ACORD