MC-11-1247 Miami Shores Village
Building Department Isj
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305)795.2204 Fax: (305)756.8972 -------
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BUILDING Permit No. )241
PERMIT APPLICATION Master Permit No. 1
FBC 2004
Permit Type: Mechanical
Owner's Name(Fee Simple Titleholder)�''l'Q7ydf/''VAF I�L/TG Phone# 786'-
Owner's Address /V6/ /Li_. /0�2 ST
City ^47"?1 S/eifD.��s State Zip 33 3 'k
Tenant/Lessee Name Phone#
E-MAIL:
Job Address(where the work is being done) /fle(s/ 4/-1 /Oa 57--
City
TCity Miami Shores Village County Miami-Dade Zip 3 31 a 8
FOLIO/PARCEL# //- ,3-:20.5 - Ov? V - O/VD
Is Building Historically Designated YES NO
Contractor's Company Name Aver 4/.g7'n 40-ts oc- 5�t YXe- Phone#
Contractor's Address V fffi 3.S Ai e.
City /V/~/ 7 State �L Zip 3-:3/ 'Iq
Qualifier Name Phone# 30-5--4 3 V 095,6
State Certificate or Registration No.CPe-14e56`/S/ Certificate of Competency No.
E-MAIL:
Architect/Engineer's Name(if applicable)kE'6'A*445�1� Phone#
Value of Work For this Permit$ Is-2460 Square/Linear Footage Of Work:
Type of Work: ❑Addition ❑Alteration ®New ❑ Repair/Replace ❑ Demolition
Describe Work: �iVSTA>t` /�i,4Tvts4L G.4sATE,e
Submittal Fee$ Permit Fee$ F✓vD CCF$ CO/CC
Notary$ Training/Education Fee$ Technology Fee$
Scanning$ Radon$ DPBR$ Zoning$
Bond$ Code Enforcement$ Double Fee$
Structural Review.$ Total Fee Now Due$
See Reversse-�
V
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. 1 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 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 Signature
Owner or Agent Contractor
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
day of TULY 20 i/ ,by.T�'tPG�1/���c�TLCG, day of �GLy ,20// ,byi4.�4- /ECt +yL�,
who is personally known to me or who has produced who is personally known to me or who has produced
As identification and who did take an oath. as identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: Sign:.
Print.
6--" Print:
Print:
My Commission Expires: GLORK P.ALFONSO My Commission Expires:
*********************** ' ,r• *•jE��A,t1�fl>3h'INMSJI�# 4 ************* ************* � k . �** .tALFONSC
EXPIRES December 06,2014 l MY COMMISSION#EE046674
{407)3913-0153 Floridallolaryservice.wm Y �, ,•` EXPIRES December 06,2014
APPLICATION APPROVED BY: v 1407)398-0153 ryi�•�m
Engineer
7,oning
(Revised 02/08/06)
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11/08/2010 15:09 3058250277 F JIMENEZ ELECT CONT PAGE 02/02
STATE OF FLORIDA
DEPARTMENT OF BUSINESS AMD PROFESSIONAL REGULATION
ELECTRICAL CONTRACTORS LICENSING BOARD (850) 487-1395
1940 NORTR MONROE STREET
TALLAHASSEE FL 33399=0783
JIMENEZ, FRANCISCO
F TTMENEZ ELECTRICAL CONTRACTOR INC
12407. WEST OSERCHOHES ROAD #41.9
HIAL EAH GARDENS FL 33018
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'AC . 4!98�e°f�i.
Congretulabonsl With this license you become one of the nearly one million
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Floridians licensed by the Department of Business and Professional Regulation. ?` �Ht39 >lCSS '
. Our professionals and businesses range from architects to ht brokers from 1+1t? hlS ''
boxers to ba
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rbeque restaurants,and they keep 1`lai0a'a ecano
my strong. _
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Every day we work to improve the way we do business in order to serve you ba ;: _,;
For rnformedw about our servicesplease log onto www. �cense corn. CBBTYIiRI lG --.Q41 R�i1t '4R.:..:
There you can find more information about our divisions enxthe ulations that
impact you,subscribe to department newsletters and lawn more about thet"nT
Department's initiatives.
Our mission at the Department is:License Efficiently,ieently, Regulate Fairly.We
contently shrive to serve you better so that you can serve your customers.
Thank you for doing business in Florida,and congratulations on your new iicenset Ss;;G�lltTtr'IIi3. uear.:di moo,;, or ek,489.aaa
el&—Aa6k.y►M' 8'l 'tkiL'�. 'r•�c060"1Q1189.. ..
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ridge• eld Employers
Insurance Company®
Mrmbcr of Libcrn Mutual Group
Rind A(Exccilent'1 by A.M.Lint Con;panY
sutlmti?holdin,gs.r on?
CERTIFICATE OF INSURANCE
RE : 0830-26529 Producer: Maximo A. Dopazo
ISSUED TO : Blue Water Pools of South FI. Company: Dopazo&Associates
4811 NW 35th Avenue Address : 3900 NW 79th Avenue
Miami, FL 33142 Suite 700
Miami, FL 33166
Phone : (305) 470-8500
This is to certify that F Jimenez Electrical Contractors, Inc., 12401 W.Okeechobee Rd,, Lot#419
Hialeah, FL 33018, being sut�ect to the provisions oT tile ori aor ers ompensa Ion aw, as
secure a payment of any workers'compensation benefits due by insuring their risk with the Bridgefield
Employers Insurance Company.
POLICY NUMBER: 0830-26529 Statutory Limits—State of Florida
Employers Liability
EFFECTIVE DATE: January 02, 2011 1,000,000 (Each Accident)
1,000,000 (Disease--Each Employee)
EXPIRATION DATE: January 02, 2012 1,000,000 (Disease--Policy Limit)
This certificate is not a policy and of itself does not afford any insurance. Nothing contained in this
certificate shall be construed as amending, extending, or altering coverage not afforded by the policy
shown above or affording insurance to any insured not named above.
The policy of insurance listed above has been issued to the named insured for the policy period
indicated. Notwithstanding any requirement, term or condition of any contract or other document to which
this certificate may pertain, the insurance made available by the described policy in this certificate is
subject to only the terms, exclusions and conditions of such policy.Paid claims may have reduced the
shown limits.
If the policy described above is cancelled before the expiration date indicated, the issuing company
will endeavor to mail 30 days'written notice to the certificate holder named above, although if cancellation
is for nonpayment of premium,then the issuing company will endeavor to mail 30 days'written notice to
the certificate holder. In any event, the issuing company, its agents, and representatives accept no
obligation or liability of any kind for failure to mail such notice.
Date: February 23, 2011
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Fm:MyFax-Dopazo&Associates InsuraTo:F Jimenez Electrical Contractor-Miami Shores 11:14 OSAW11GMT-05 Pg 03-03
AC�® DATE(MM/DDNYYY)
CERTIFICATE OF LIABILITY INSURANCE 6/6/2011
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 andorsement(s).
PRODUCER CONTACT NAME: Alexander Dopazo CIC
Dopazo and Associates PHONE (305)470-8500 F4% Nol.(305)470-0111
3900 NW 79th Ave nDORIEss:info@dopazo.com
Suite 700 PRODUCER 00000972
Miami FL 33166 INSURER S)AFFORDING COVERAGE NAIL 0
INSURED INSURERA:Charter Oak Fire Insurance Co 25615
INSURERB:Brid efield Employers Ins Co 10701
F Jimenez Electrical Contractor Inc INSURER C:
12401 W Okeechobee RD Lot 419 INSURER D:
INSURER E:
Hialeah FL 33018 INSURER F
COVERAGES CERTIFICATE NUMBER:CL1142602300 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 TYPE OF INSURANCEADULSUBK POLICY EFF POLICY EXP LIMITS
LTR POLICY NUMBER MM/DD/YYYY MMlDDIYYYY
GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
DAMAGE ToRFWI!0__
X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $)
100,000
A CLAIMS-MADE Fx_]OCCUR 60-4318N411 /10/2010 /10/2011 MED EXP(Any one $ 5,000
PERSONAL 8 ADV INJURY $ 1,000,000
GENERAL AGGREGATE $ 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000
X I 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
PROPERTY DAMAGE $
HIRED AUTOS (Per accident)
NON-OWNED AUTOS $
$
UMBRELLA LIAR HOCCUR EACH OCCURRENCE _ $_
EXCESS LIAR CLAIMS-MADE AGGREGATE $
DEDUCTIBLE $
1 RETENTION $ $
B WORKERS COMPENSATION X WC STATU- OTH-
AND EMPLOYERS'LIABILITY Y/N
TORY LIMITS ER
ANY PROPRIETORIPARTNERIEXECUTIVEE.L.EACH ACCIDENT $ 1,000,000
OFRCERIMEMBER EXCLUDED? � NIA
(Mandatory In NH) 83026529 /2/2011 /2/2012 E.L.DISEASE-EA EMPLOYE $ 1 000 000
II Aa<nihr.Irxkr
DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT $ 1,000,000
DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,N more apace is required)
Electrical contractor
CERTIFICATE HOLDER CANCELLATION
(305)634-0957 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Miami Shores Village ACCORDANCE WITH THE POLICY PROVISIONS.
10050 NE 2nd Avenue
Miami Shores, FL 33138 AUTHORIZED REPRESENTATIVE
.
M Dopazo CPIA/MAD
ACORD 25(2009109) O 1988-2009 ACORD CORPORATION. All rights reserved.
INS025(Wwq) The ACORD name and logo are registered marks of ACORD