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EL-15-1745 (2) Per WO Miami Shores Village Pemmmil T 10050 N.E.2nd Avenue NE W"' ', .�. 1"" lift Miami Shores,FL 33138-0000 Phone: (305)795-2204 .�, 7/2112{}1; Expiration: 1U17/2016 Project Address Parcel Number Applicant L1225MNE 92 Street 1132050270300KAREN BLAIR PREDRAG START ai Shores, FL 33138-2936 Block: Lot: Owner Information Address Phone Cell KAREN BLAIR PREDRAG STARCEVIC 1225 NE 92 Street (305)751-9333 MIAMI SHORES FL 33138-2936 1225 NE 92 Street MIAMI SHORES FL 33138-2936 Contractor(s) Phone Cell Phone Valuation: $ 3,500.00 JAM ELECTRIC SERVICE INC (954)227-8944 Total Sq Feet: 0 Type of Work: INSTALL NEW LIGHT NICHE WITH 4 COLO Available Inspections: Additional Info: InSpeCtion Type: Classification:Residential Review Electrical Scanning: 1 Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $2.40 DBPR Fee Invoice# EL-7-15-56318 $4.50 07/13/2015 Cash $ 50.00 $268.40 DCA Fee $4.50 Education Surcharge $0.80 07/21/2015 Cash $268.40 $0.00 Permit Fii3e-Additions/Alterations $300.00 Scanninq.Fpe $3.00 Technology Fee $3.20 Total: $318.40 In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining 11jereto and in strict conformity with the plans,drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required fo7FELECTRICAL,PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work. OWNS,, .ed : I certify t all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating const g. Futhermore, uthorize the above-named contractor to do the work stated. July 21, 2015 ignature:Owner / Applicant / Contractor / Agent Date Building Department Copy July 21, 2015 1 Miami Shores Village Building Department i 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 —TtA FBC 20 (y '�:) BUILDING Master Permit No. ir-5- i244-,� PERMIT APPLICATION Sub Permit No.TL (5 - l-4 -T✓ ❑BUILDING 17 ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 12.25 MG 9Z 5T12EET City: Miami Shores County: Miami Dade Zip: 33133 Folio/Parcel#: Ill • 3 ZC),5 ' 02•'7.. 0300 Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name(Fee Simple Titleholder): I RE NZAEa 5-TAIRCE 121 0KA RE N a Phholne . Address: 12.2.E NE 9Z '-Ft2EET City: HIRM I Si-40RIE:S State: F=L Zip:33 13 Tenant/Lessee Name: Phone#: Email: e� CONTRACTOR:Company Name: c/ ) y"� C a V S`L^ Phone#: C15-4- 227• NO ` Address: 3 � 4 '� 4,,,, FE City: ( State: Zip: >D I-) Qualifier Name: �_ Phone#: State Certification or Registration#: �f L7 0/ Ca Certificate of Competency#: O5 —3 C� DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ -�;5C?I) Square/Linear Footage of Work: 317 X I�( Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: 10 I A LL NEW LIGHT NI(-HC WITH 4 LO L.o R LE 6 LI 6H I�� N t W F 'S i,,1,'I i C F1 POOL u IL1 p Specify color of color thru tile: e-'17 Submittal Fee$ Permit Fee$ .�C'�d��0__ CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ (Revised02/24/2014) Bonding Company's Name(if applicable) Bonding Company's Address _ City State 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 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 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 inspection will not be approved and a reinspection fee will be charged. Signature .�'V`` Signature OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing i trument was acknowledged before me this 2 2. day of JUI'le 120 It) by 22 day of JV n e 20 !S by �� .CARR C-TT MVND LE who is ersonall know to P..:ED '1�C7 IA12C:�21C ,who i ersonally kno to y me or who has produced as me or who has produced as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sig Print:S10i L. I VEIZA Print: ANb RA Seal: AY SANDRA L RIVERA Seal: =o? SANDRA L RI@!E`"A e MY COMMISSION#FF-1 ' I MY COMMISSION#F�o1� EXPIRES April 3, 20i? p ':., Pj t EXPIRES April 3, eo r ,41OF FloridallotarySery,ce.com 1" #***##**## *#'�k>fe�rk ##*1�HsNde►loY m *###*########*##****#* 0 53 **##*#**#********#**#*** (407)386t a APPROVED BY - � /y4L4Y/.j` Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) MIAMI-DARE COUNTY DEPARTMENT OF PERMITTING, ENVIRONMENT AND REGULATORY AFFAIRS 11805 SW 26TH ST. SUITE 207 MIAMI FL, 33175 (786) 315-2880 CONTRACTOR'S BUSINESS CERTIFICATE OF COMPETENCY ISSUED JULY 29, 2005 THIS IS TO CERTIFY THAT JAM ELECTRIC SERVICE INC. CONTRACTOR CERTIFICATE NO. : 05E000734 TRADE: ELECTRICAL CERTIFICATE EXPIRATION DATE: 09/30/2015 HAVING MET THE CODE REQUIREMENTS OF MIAMI-DADE COUNTY, AS AMENDED, IS CERTIFIED AS A CONTRACTOR IN THE FOLLOWING CATEGORY(S) : 0001 ELECTRICAL WITH ALL WORK TO BE DONE UNDER THE SUPERVISION, DIRECTION AND CONTROL OF QUALIFYING AGENT MUNDLE JARRETT S.S.N. - -4710 ALTERATION, REPRODUCTION OR TRANSFER OF THIS CERTIFICATE IS PROHIBITED. JULIANA H. SALAS, P.E. SECRETARY, CONSTRUCTION TRADES QUALIFYING BOARD JAM ELECTRIC SERVICE INC. 350 NW 46 AVE. PLANTATION FL 33317 FEE FOR THIS CERTIFICATE WAS PAID ON PROCESS NO. 72013132502 5KNC-1932 ORES G, 7� ' logo .....� Miami shores Village Building Department ��OR1Dp' 10050 N.E.2nd Avenue Miami Shores, 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 form and Contractor Affidavit) IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE 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 form and Contractor Affidavit) *YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE AS FOLLOW: Certificate Holder: MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES, FL 33138 Certificate must specify the description of operations or contractor license number. BUSINESS NAME: BUSINESS ADDRESS: 356 MCA) /Jtfi,-CITY �1�LI-STATEJ-e-- ZIP 3 BUSINESS PHONE: jjffl FAX NUMBER( 9X- ) 3Z I " T CELL PHONE&�—) QUALIFIER'S NAME: QUALIFIER'S LIC NUMBERJ,� << s CTQB Construction Trades Qualifying Board BUSINESS CERTIFICATE OF COMPETENCY 05EO00734 JAM ELECTRIC SERVICE INC. D.B.A.: UNDLE JARRETT Is certified under the provisions of Chapter 10 of Miami-Dade County i . L VALID FOR CONTRACTING UNTIL 08/30/2015 007055 LocalB'usiness Ta - Miami—Dade count X Receipt THIS IS NOTA BILL State PA Florida DO NQTPAY 5612024 BUt31NESO NAME/LOCATION - 103 jT AIM`ELECTRIC SERVICE INC RECEIPT NO. DOING BUS INDADE CO RENEWAL EXPIRES MII Al FL 33000,. 5853149 SEPTEMBER 30, 2015 s " Must be displayed at place of business Pursuant to County Code Chapter SA-Art.9&10 OWNER IAM ELECTRIC SERVICE INC SEC'TYPE OF BUSINESS 196 Worker(s) i 05E000734 ELECTRICAL CONTRACTOR PAYMENT RECEIVED 13Y TAX COLLECTOR $75.00 09/29/2014 This Local Business Tax Receipt only confirms a CREDITCARD-14-.042408 permit or a certification of the holder's qualifications,to do business. Holder must comply with any governmental or nongovernmental regulatory laws and requiremenft whi b apply ine s.the derbusmust a Ocal Business Tax. Receipt is not a license, The RECEIPTNO,above must be displayed on ail commercial vehicles-Wami—Dade Code Sec 6a476. For more information,visityp'ppl,�amidade 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 to improve the way we do business in order to serve you better. For information about our services, please log onto www.myfloridalicense.com. There you can find more information about our divisions and the regulations that impact you,subscribe to department newsletters and learn 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 'aanj aa/avurvPwo to fopuan//a it :1E customers. Thank you for doing business in Florida, S311TIu0 IUDW OA05 aleis puu s.zopuan uaanuaq and congratulations on your new license! loddns slooa epu0133o a1ris inoge;no pug o I ` DETACH HERE RICK SCOTT GOVERNOR _ ___- KEN LAWSON, SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD ER13012909 The ELECTRICAL CONTRACTOR Named below HAS REGISTERED Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2016 (INDIVIDUAL MUST MEET ALL LOCAL LICENSING REQUIREMENTS PRIOR TO CONTRACTING IN ANY AREA) MUNDLE, JARRETTA JAM ELECTRIC SERVICE-INC URI . 350 NW 46TH AVEPLANTATION FL-33317 ISSUED: 07/01/2014 DISPLAY AS REQUIRED BY LAW SEQ# L1407010002003 A R� HLM DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE R002 6/15/2015 THIS CERTIFICATEIS 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(ies)must be endorsed. If SUBROGATIONIS 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). PRODUCIR CONTACT NAME: NORTHEAST AGENCIES INC/PHS (HCG."No,E#): (866) 467-8730 is,No): (888) 443-6112 210619 P: (866) 467-8730 F: (888) 443-6112 ADDRESS: 301 WOODS PARK DRIVE INSURER(S)AFFORDING COVERAGE NAICR CLINTON NY 1.3323 INSURER A: Hartford Casualty Ins Co nvsuRED INSURER 8 INSURER C: JAM ELECTRIC SERVICE INC INSURER D: 350 NW 46TH AVE INSURER E: PLANTATION FL 33317 INSURERF: 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 TYPEOFINSURANCE ADDL SUBR POLICYNUMBER POLI EFF POLICYEXP LIMITS LTR INSR H" (A~D1YYYV COMMERCIAL GENERAL LIABILnY EACH OCCURRENCE $1, 000, 000 CLAIMS-MADEOCCUR DAMAGE TO RENTED 3 0 0 0 0 0 PREMISES(Ea occurrence) / A X General Liab 01 SBM AM6253 04/13/2015 04/13/2016 MED EXP(Any one person) $10, 000 PERSONAL&ADV INJURY $1, 000, 000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE s2, 000, 000 POLICY EO-❑LOC PRODUCTS-COMP/OP AGG s2, 000, 000 OTHER: AUTOMOBILE LUU31LrTY COMBINED SINGLE LIMIT (Ea accident) ANY AUTO BODILY INJURY(Per person) ALL OWNED SCHEDULED BODILY INJURY(Per accident) AUTOS AUTOS HIRED AUTO NON-OWNED PROPERTY DAMAGE AUTOS (Per accident) UMBRELLA LIABOCCUR EACH OCCURRENCE EXCESS UAB CLAIMS-MADE AGGREGATE DED RETENTION S WORKERS COMPENSATION PER OTI+ AND EMPLOYERS'LLIBILITY STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE YIN E.L.EACH ACCIDENT OFFICER/MEMBER EXCLUDED? MIA(Mandatory in NH) ❑ E.L.DISEASE-EA EMPLOYEE If yes,describe under $ DESCRIPTION OF OPERATIONS below F E.L.DISEASE-POLICY LIMIT DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space is required) Those usual to the Insured's Operations. Contractor License#05E000734 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED Miami Shores Village BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE g DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Building DEPT AUTHORrLED REPRESENTATIVE 10050 NE 2ND AVE 7A-z— @ �� MIAMI SHORES, FL 33138 ©1988-2014 ACORD CORPORATION.All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD HLM DATB(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE R002 16/15/2015_ THIS CERTIFICATEIS 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 SUBROGATIONIS 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). PRODWER CONTACT NAME: HOPAYCHEX INSURANCE AGENCY INC (A/CC.N.,E,R): (MC,No): (888) 443-6112 210705 P: F: (888) 443-6112 E-MAIL ADDRESS: PO BOX 33015 INSURER(S)AFFORDING COVERAGE NAICN SAN ANTONIO TX 78265 INSURERA: Hartford Casualty Ins Co MISURED INSURER B INSURER C JAM ELECTRIC SERVICE INC INSURER D: 350 NW 46TH AVE INSURER E: PLANTATION FL 33317 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 TYPEOFINSURANCE ADDL SUBR POLICYNUMBER M�EFF POLICYE" LIMITS YYV COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE CLAIMS-MADE ❑OCCUR DAMAGE TO RENTED PREMISES(Ea occurrence) MED EXP(Any one person) PERSONAL&ADV INJURY GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE POLICY JPERCOT-ElLOCPRODUCTS-COMP/OP AGG OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ ANY AUTO BODILY INJURY(Per person) ALL OWNED SCHEDULED BOOILY INJURY(Per accident) AUTOS AUTOS HIRED AUTO NON-OWNED PROPERTY DAMAGE AUTOS (Per accident) UMBRELLA LIABOCCUR EACH OCCURRENCE EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION f WORKERS COMPENSA TION X PER OTH- ANDEMPLOYERS'LIABILITY STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE WN E.L.EACH ACCIDENT $100, 000 OFFICERIMEMBER EXCLUDED? A (Mandatory in NH) ❑ wA 76 WEG DU5932 09/24/2014 09/24/2015 E.L.DISEASE-EA EMPLOYEE $100, 000 tf yes, be under DESCRIIPTTIION OF OPERATIONS belowE.L $500, 000 .DISEASE-POLICY LIMIT DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Those usual to the Insured's Operations. License # 05E000734 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED Miami Shores Village BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE g DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Building DEPT AUTHORMED REPRESENTATIVE 10050 NE 2ND AVE MIAMI SHORES, FL 33138 ©1988-2014 ACORD CORPORATION.All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD