EL-14-2426 (2) Miami Shores Village CET
BuildingDepartment
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10050 N.E.2nd Avenue,Miami Shores,Florida 33138 BY:_D�_A__
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949
FBC 20 110
BUILDING Master Permit No. R C.I'{-- 2-03 1
PERMIT A=ON sub Permit No.F-Q Lq --2-;-t Z�
❑BUILDING ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
F-1 PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: N
City: ff Miami Shores County: Miami Dade Zip:
Folio/Parcel#: p32,Q w O I CJ Is the Building Historically Designated:Yes NO
Occupancy Type: 3CL FtALoad: Construction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder): TQN M 0q Cv C° ®� Phone#: 'c,zz-
Address:
City: State: F Zip: 3 i 5�
Tenant/Lessee Name: Phone#:
Email:
T
CONTRACTOR:Company Name: A LLl c-D e Lt&1`'4 c'giL SVy I., S� Ph°one#:
Address: I o 2ty- �✓ g f d '�
City: State: EU Zip: 33139
Qualifier Name: S M I`' Phone#:QQ
State Certification or Registration#: I� Certificate of Competency#: �—
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ Square/Linear Footage of Work:
Type of Work: ❑ Addition 6Alteration ❑ NewjJ I] Repair/Replace El Demolition
,,Description of Work: l _®� QDa, ��➢ Ntw / � cN 6 0 0
Specify color of color thru tile: °w
Submittal Fee$ Permit Fee$ CCF$ zCQ/�C$
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 ab nce of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
e
Signature Signature
OW ER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
kW11 day of!]Pi� ,20 , by kc>k day of'Pf— 20 (� , by
-3h 'Wk&�anno
a ,who i personally kw to S Z- who is personally known to
me or who has produced as me or who has produced f"(, V--X �4FZSZ — as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Si Sign:
Print: -& Print:
Seal: TARELIAINRYANOKONiYAN Seal:
NOTARY PUBLIC
STATE OF FLORIDA % ' ° • ........
Cam*1-F09W
APPROVED B ; � 20;' Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
vY 'T STATE OF=.FLORIDP` - - Construe Trades Qualifying Board
PA
DERTMI�ENT OF BUSINESS AND BUSINESS CERTIFICATE OF COMPETENCY
PROFE",ONAI.
REGULATION
R�3o a7az< iSSu D. o8/03/2014 `�2 D0 0 ��
x REG ELECTRIGQ( TRAC �R LIE®ELECT�ICAL` ER@llCE�i INC
PIERRE,STEVE A
I' P,LLFED Ei_ECTRIGRM NC _.�'_ ! D.B.A.:
LpCAL
(INONI..UAL-fVILls�11�EET -I-
`LICENSING REt�IREIE $pRyOR
TO CONTRA(�TIN(a ININYAF-A) I RRE STEVE=
HA3 R'E6ISTERED under the provision L1oho� 29 FS is cenhfied under the provisions of Chapter 10 of Mlaml Dade County
.r Exphatlort�:AUG 31,2016 I � .
.tos 3:a 13 t �� •��%}� �'"
unioi pal Contractor's Tax Pecei pt
Miami-Dade County, State of Florida
-THIS IS NOTA BILL DO NOT PAY
CC N0: 12ED00012
BUSINESS NAME/LOCATION RECEIPT NO. EXPIRES
AWED pFCTRIMSMACESINC NEW BUSINESS SEPTEMBER 30, 2015
10 NE64 ST 7455631 Must be displayed at place of business
MIAMI,FL 33138 Pursuant to County Code
Chapter 8A-Art.9&10
OWNER TYPE OF BUSINESS PAYMENT RECEIVED
AWED ELECTRICAL SERVICES INC ELECTIRICAL CONTRACTOR BY TAX COLLECTOR
200.00 09/30/2014
0225-14-005817
MIAMI. Forn-oreinfaTndon,visit •wid deaov/tmrcdlector ,.
r
Vi
mosommoserm
i
Local Business Tax Receipt
Miami—Dade County, State of Florida
-THIS IS NOT A BILL-DO NOT PAY
r T
6964333
BUSINESS NAME/LOCATION RECEIPT NO. EXPIRES
ALLIED ELECTRICAL SERVICES RENEWAL SEPTEMBER 30, 2015
INC 7239890 Must be displayed at place of business
10 NE 64 ST Pursuant to County Code
MIAMI, FL 33138 Chapter 8A-Art.9&10
OWNER SEC.TYPE OF BUSINESS PAYMENT RECEIVED
ALLIED ELECTRICAL SERVICES INC 196 ELECTRICAL BY TAX COLLECTOR
CONTRACTOR 45.00 09/30/2014
Worker(s) 1 12E000012 0225-14-005817
This Local Business Tax Receipt only confirms payment of the Local Business Tax.The Receipt is nota license,
permit,or a certification of the holders qualifications,to do business.Holder must comply with any governmental
or nongovernmental regulatory laws and requirements which apply to the business.
The RECEIPT N0.above must be displayed on all commercial vehicles-Miami-Dade Code Sec fla-276.
MIAMI•
Farmers information,visit www miamidade.aov/taxcollector
DEC-19-2014(FRI) 15: 01 P. 001/001
A Rn' CERTIFICATE OF LIABILITY INSURANCE DATEiMYYI
121,191,9/1 Y4
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$Y 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.
IIV1POftTANT: If tho wAlflcato holder is an ADDITIONAL INSURED,tlto ptilicy(Ios)must be endorsed. If SUBROGATION IS WAIVED,subjoet 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 Ileu of such endomement(s).
PRODUCER CONTACT
.NAME.
Accredliod Insurance PHONEFAX
_a1c..NQ.r:Rf)- 54)964-.- . I IA/C,No}: (954)964-0772
6099 Hollywood$IvdADDRESS.---• insureyourhome@aol.com
Hollywood,FL 33024 INSURERS APPORDING COVpaApE NAIL 0
Phone (954)964.5444 Fax (954)964.0772 INSURERA: GRANADA INSURANCE 524210
INSURED - ...__—...._....._.. ._—..—..._...... ..— ..
INSURER B: --- —
Allied Electrical Services.Inc INSURER C:
10 NE 64 St SURER D:
Miami,FL 33138- (786)566-0863 II tNsuREa E: _
__• f 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 TI•IE POLICIES DESCRIBED Mr=RE1N IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS,
INSR '
LY_R TYPE OF INSURANCE ADRR D U POLICY NUMBER MM�n'�yE�FyF� IMPOL01 E%P IJMRs
GENERAL LIABILITY I I EACH OCCURRENCE s 1.000.000,00
❑/ COMMERCIAL GENERAL LIABILITY DAMR_bi,�."E Td RENTE[) , $
U U CLAW"ADE d OCCUR PREMISES(Ea c=rrencel 100,000.00
,
A ❑ n OI BSFLOOD132164 1210912014 12/09/2015 MGD CxP(Any one PUP-an) $ 5,000.00
PERSONAL&AOV INJURY $ 1,000,000.00
AGGREGATE $ 2,000,000.00
GEML AGGREGATEI 0.1T APPLIES PER: PRODUC YS_comp/OF ACC S 2.0-00,000.00
I�/_I POLICY .TTI.P2er. $ --
AUTOMOBILE LIABILITYi C�OMNIPttO SINOLt LIMIT
❑ ANY AUTO I�1BODILY IINJURY(Par pensan) $-- --,
❑
AUTOS OMM ❑ AUTOS BODILY
BODILY INJURY(Per ecclden( S
HIRED AUTOS ❑ AUTO�t0 PROPERTY DAMAGE g
I •1per aerJdent)
_._.- ............
$
UMBRELLA LLAB ❑OCCUR EACH OCCURRENCE $
1 1 EXCESS LIAR n G AIM'S MADG ACCRtOATE $
U-DED�_RETENTIONS $
' WORKERS COMPENSATION OFFICERIMUMER EXCLUDED? INIA
_....._._._.....
AN
AND F,MPLOYCFZ LIABILITY Y f N 1-1TORWCY STLIMITS ❑EROTH-
ANY PROPRIROR/PARTN6R/CXCCUTIVC C.L.CACHACCIDCNT S
Wandatory in NH) 1 E.L.DISEASE-EA EMPLOYE a
nyas descibL urcLv
DFRCRIPTION OF OPCRATIONS below E.L.DISEASE-POLICY LIMIT $
DE$CRIPTION•OF OPERATIONS!LOCATIONS 1 VEHICLES(Attach ACORD 707,Agctlticeml Ramarks•Schedrde,If mora space is required)
ELECTRICAL WORK
CERTIFICATE HOLDER _.... _. ...
_--CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCE"ED BEFORE
VILLAGE OF MIAMI SHORES THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN
BUILDING DEPARTMENT ACCORDANCE WITH THE POLICY PROVISIONS.
10050 NE 2ND AVENUE AUTHORIZED REPRESENTATIVE
MIAMI SHORES,FL 33138
®1988-2010 ACORD CORPORATION. All rights reserved.
ACORD 25(2010/05)QF The ACORD name and logo are registered marks of ACORD
804/ V14 t ab v t ba
r/ 1 WA 1
i•
JEFFATWATER
CHIEF FINANCIAL OFFICER STATE OF FLORIDA
DEPARTMENT OF FINANCIAL SERVICES 'f 1
DIVISION OF WORKER&COMPENSATION i
CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS'COMPENSATION LAW
CONSTRUCTION INDUSTRY EXEMPTION
This certifies that the Individual1isted below has elected to be exempt from Florida Workers'Compensation law.
EFFECTIVE DATE: 3/23/2014 EXPIRATION DATE: 3/22/2016
•?'`% PERSON: PIERRE STEVE
:>
FEIN: 800770364
BUSINESS NAME AND ADDRESS:
ALLIED ELECTRICAL SERVICES INC f
' 10 NE 64 ST
MIAMI FL 33138
SCOPES OF BUSINESS OR TRADE:
LICENSED ELECTRICAL
CONTRACTOR
Pursuant to Chaptar440.GX14),F.S.,an officer of a corporation who elects exemption from this dmpter by fmn?o cem0oate of election under this section may
not recover benefits or compensation under this chapter.Pursuentto Chapler 440.05(12),F.S., cetss of a edion to be exempL..apply onlywtihin the scope
ofthe business ortrade listed on the notice of election to bo exempt Purmotto Chapter440.0,%13).F.S.,Notices of election to be exempt and cer00cetes of
ih lea
election to be exempt ansa be subject a revocation It,at time ance of flpng ofthe notice p a ush ll ofthe e oaoerifiica the person named on the notice or
certigaate no longer meets the requirements otthia section for Issuance of a outs.The department shall revoke a oertitloate at errytlme for fe0ure of the
} person named on the oetilcate to meetthe requlrementsof this sermon.
' DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 07-12 QUESTIONS?(850)413-1609
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2/29/2014
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„ Miami shores Village
,.r,0 oJII Building Department
OR1Dp' 10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
Notice to Owner — Workers' Compensation Insurance Exemption
Florida Law requires Workers' Compensation insurance coverage under Chapter 440 of the Florida Statutes. Fla. Stat. § 440.05
allows corporate officers in the construction industry to exempt themselves from this requirement for any construction project prior to
obtaining a building permit. Pursuant to the Florida Division of Workers'Compensation Employer Facts Brochure:
An employer in the construction industry who employs one or more part-time or full-time
employees,including the owner,must obtain workers' compensation coverage. Corporate officers
or members of a limited liability company (LLC) in the construction industry may elect to be
exempt if:
1. The officer owns at least 10 percent of the stock of the corporation, or in the case of
an LLC,a statement attesting to the minimum 10 percent ownership;
2. The officer is listed as an officer of the corporation in the records of the Florida
Department of State,Division of Corporations;and
3. The corporation is registered and listed as active with the Florida Department of
State,Division of Corporations.
No more than three corporate officers per corporation or limited liability company members are
allowed to be exempt. Construction exemptions are valid for a period of two years or until a
voluntary revocation is filed or the exemption is revoked by the Division.
Your contractor is requesting a permit under this workers'compensation exemption.In these circumstances,Miami Shores Village
does not require verification of workers'compensation insurance coverage from the contractor's company. Therefore, o��be
personally liable for the worker compensation injuries of any person allowed to work under this permit. Please check with your
insurance carrier since most property insurance policies DO NOT cover this type of liability.
BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS
CONTENTS.
Owner Contra
r
Print Nameft44 9414K Print Name: V e_ v-e_
Signature: Signature:
State of Florida) State of Florida)
County of Miami-Dade) County of Miami-Dade)
Sworn to and subscribed before me this Sworn to and subscribed before me this\ hIl 1 1'I ,,d
day of �c��w.Me,r ,201`1, day of �`L.. ,20 �`\ A�/��ss,�'�.
By �ni�� BY
• �!� c4:G
CD
(SEAL) TAREUABRYAN OK0�11fAN (SEAL) m �F� .a�a�6'
Type of I 0 '. •�J�•® Type of Identification produced
CommO FF0M367 �` .........
°
E 2112/2018
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Miami Shores Village
o
Building Department
V
a R 10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
CHANGE OF CONTRACTOR / ARCHITECT
Permit N. � �° -ZO�I � � �—' �y —��4��
Owner's Name(Fee Simple Title Holder): I V N M` i 1'� f'�3v C, 'V' e#: � " ®� 2--L
Owner's Address: ?59 ; E o 'dGe'r
City: m,A w sj4oazs State : L Zip Code:
Job Address (Of where work is being done): 3T9 NIS , "I qL J I &t� t—
City: Miami Shores State:—Florida Zip Code: 2313,R
Contractor's Company Name: 4 v`�i Phone#: (3 c5) 3 3,S' 6f
Address:
5560 N,v\/, NZIN12
City: MiA-91 StateZip Code: ®►�
Qualifier's Name: SUS C M � Lic. Number 1)0 SE 1
Architect/ Engineer of Record Name: Phone#:
Address:
City: State: Zip Code:
Describe Work: or~ 0 �(, Nla W HT�(�UUP K4TCP"P � 1 j
O r)DAA /2-Mc-ilq(- , i� 1,� LAleNPrZY fuc)m
1 hereby certify that the work has been abandoned and/or the contractor/architect
is unable or unwilling to complete the contract. I hold the Building Official and the
Miami Shores harmless of all le I involvement.
Signature Signature
*erAge t Contractor or Architect
The foregoing instrument was knowledged before m'e'1 The for ing instrument was aknowledged before me
this rrday of ,20�,by a gS�►Ma this day of Dtai ,20kA by -Isc a �
Who i ersonally known o me or who has produced who is per�snonally known
1 to me or who has produced
as indentification. !L .. l"\�,C ' .`I'�1' �as indentification.
Notary Publi Notary Public:
Sign: AN Sign:
-::�����..
Seal: NOTARY PUSUC Seal: NOTARY PU M
STATE OF FLCIDA STATE OF FLORIDA
Cow*FF0KW 0i&Ex*a2M2=1l*
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