The URL can be used to link to this page

EL-15-485 Miami Shores Village _ uilding Department artment 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 JUN 2015 Tel: (305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 - -- "- FBC 20(() BUILDING Master Permit No. Vjp—,S PERMIT APPLICATION Sub Permit No. —j5 gkgG a ❑BUILDING ❑ ELECTRIC ❑ ROOFING REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: SOLI L-(�: / City: Miami Shores (� County: Miami Dade Zip: 3313% Folio/Parcel#:_I 13 2-0(e ()I / 1 �� Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: ?,FIFE: OWNER: Name(Fee Simple Titleholder): SMP F--C"1 �� iV� O Phone#: 3Gs (/33 T T Address: S SS N L-' ! S7� *. 210 City: r `1 G 'Y IiI State: C' Zip: /� / _p Tenant/Lessee Name: Phone#:_.y1e? -ac ISO Email: F r t CONTRACTOR: Company Name: �r �` Phone#:--pS I �� Address: Z- 5 )-7 S W 13S?— City: 1S/t'ate: ' Zip: 331 Qualifier Name: 'eY / '-�), v [� Phone#: State Certification or Registration#: L C l 3 0 d a�Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ 1)bno Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: ��e C \ l$('c7h $ CT-O Specify color of color thru+tife: Submittal Fee$ ,a.. .Permittee$ CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ y . CC (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 curs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approv and a reinspection fee will be charged. Signature Signature WNER or A ENT CONTRACTOR The foregoing instrunient was acknowledged before me this The foregoing instrument was acknowledged before me this S day of �J1�O, 120 IS V by day of V 20 ) S by %s C ��1( who is»er o to —, n_wn to 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: Sign: Sign: , ` Print: Print: G•—�' �'`� '•ii MV COM ION u Ff 2wr 3 I Seal: , , Seal: '— EXPIRES July 28.20 n I �� SANDRA J LEUTENS un+sisc'os FlaruNwsySo.�wo.u.� I •= MY COMMISSION#FF226953 ' EXPIRES July 28.2019 *********************************************************************** act* ***** APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) A�O CERTIFICATE OF LIABILITY INSURANCE DATE(M MW6/2015 2>�15 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 endomement(s). PRODUCER NAME MARIA REYES QUINTANA&ASSOCIATES OF MIAMI INC. PHONE 305-446-5063FAX W; 305-445-8153 fAIC,No. Ho: 5200 S W 8 ST SUITE 250 E4RAL MIAMI FLA 33134 INSUM(n AFFORDING COVERAGE NAS IR INSURER A:NAUTILUS INSURANCE:COMPANY INSURED INSURER 8. YORK ELECTRIC CORP INSURER C 2517 S W 13 STREET INSURERD: MIAMI, FL 33145 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. TYPE OF INSURANCE ADDwyn POLICY NUMBER MMIDOIY POLICY EFF MM O YP LIMITS LTR GENERALLIABLITY NN532628 6105/2015 6105!2016 EACH OCCURRENCE s1,000,000 COMMERCIAL GENERAL LIABILITY PREMISES(Ea o ce S 100,000 CLAIMS-MADE a OCCUR MED EXP An one person $ 5,000 PERSONAL&ADV INJURY $ 1.000.000 t GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG S UDL= POLICY PRO- LOC $ Jr AUTOMOBILE LIABILITY (EapCOMBINED SIN LIMIT ac ANYAVTO BODILY INJURY(Per pessm) S ALLAUTOWNED SCHEDULED BODILY INJURY(Per acddenq $ OS AUTOS PROPERTY DAMAGE HIRED AUTOS AUTOS (per $ S UMBRELLALIAS _ OCCUR EACH OCCURRENCE S EXCESS UAB CLAIMS-MADE AGGREGATE S DED RETENTION S S WORKERS COMPENSATION WC STATU OT AND EMPLOYERS'LIABILITYRYLIMITStYIN "—" H+ ANY PROPRIETOR/PARTNERIEXECUTIVEN A E.L.EACH ACCIDENT S OFFICER/NIEMBER EXCLUOED7 (Mandatory In NN) EL DISEASE-EA EMPLOYE S H yes desetoe under DESCRIPTION Of OPERATIONS below E.L.DISEASE-POLICY LIMIT S DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Adacb ACORD 101,Addldonai Rsmarke Sctwduie.K mora qmc*Is required) ELECTRICAL WORK WITHIN BUILDING POLICY SUBJECT TO POLICY TERMS AND CONDITIONS CERTIFICATE HOLDER CANCELLATION CITY OF MIAMI SHORES SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 10050 NE 2 AVENUE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. MIAMI,FL 33138 AUTHORI7uz TAVV EMAIL:consultantsolubon@me.com -�-- m 1988-201-6 ACORD CORPORATION. All rights reserved. ACORD 26(2010105) The ACORD name and logo are registered marks of ACORD JEFF ATWATER CHIEF FINANCIAL OFFICER STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS'COMPENSATION **CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS'COMPENSATION LAW CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers'Compensation law. EFFECTIVE DATE: 5/11/2015 EXPIRATION DATE: 5/10/2017 PERSON: MORENO ROBERTO FEIN: 223918884 BUSINESS NAME AND ADDRESS: YORK ELECTRIC CORP I 2517 SW 13 STREET MIAMI FL 33145 SCOPES OF BUSINESS OR TRADE: LICENSED ELECTRICAL CONTRACTOR Pursuant to Chapter 440.05(14),F.S.,an officer of a corporation who elects exemption from this chapter by filing a certificate of election under this section may not recover benefits or compensation under this chapter.Pursuant to Chapter 440.05(12),F.S.,Certificates of election to be exempt...apply only within the scope of the business or trade listed on the notice of election to be exempt.Pursuant to Chapter 440.05(13),F.S.,Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation if,at any time after the filing of the notice or the issuance of the certificate, the person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate.The department shall revoke a DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUESTIONS?(850)413-1609