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EL-15-1484 (2) Fenftit No. L -15-148.4 Miami Shores Village Putts Type. ElOGtri4s).-R+"tht'll's _� �e+ 10050 N.E.2nd Avenue NE Work ork Owafteon.4 fternatJOA Miami Shores,FL 33138-0000 Phone: (305)795-2204 ' `OR1D� Expiration: 12/19/2015 dt11�12ti<1� Project Address Parcel Number Applicant 485 NE 92 Street 1132060140280 Jordana Hart Miami Shores, FL 33138-3154 Block: Lot: Owner Information Address Phone Cell Jordana Hart 485 NE 92 Street 305 577-9977 Miami shores FL 33138 Contractor(s) Phone Cell Phone Valuation: $ 800.00 MARCELO SOLUTIONS, INC. (786)838-6104 Total Sq Feet: 0 Type of Work:REMOVE SOME LIGHT FIXTURES AND RECE Available Inspections: Additional Info: Inspection Type: Classification:Residential Review Electrical Scanning: 1 Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $0.60 Invoice# EL-6-15-55999 DBPR Fee $2.00 06/22/2015 Check#: 1295 $58.60 $50.00 DCA Fee $2.00 Education Surcharge $0.20 06/17/2015 Credit Card $50.00 $0.00 Permit Fee-Additions/Alterations $100.00 Scanning Fee $3.00 Technology Fee $0.80 Total: $108.60 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 thereto 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 for ELECTRICAL,PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: I ce et all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zo r1�e ,I authorize the above-named contractor to do the work stated. June 22, 2015 Authorized Signature:Owner / Applicant / Contractor / Agent Date Building Department Copy June 22,2015 1 Miami Shores Village REc-1-11 , Building Department 0417 2015 10050 N.E.2nd Avenue,Miami Shores, Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(30S)762-4949 FBC 20 � BUILDING Master Permit No. /C C�/i''1/` /S- 1-33 PERMIT APPLICATION Sub Permit No. ��' l 4 V 1' ❑BUILDINGELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL [:]PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: /� 2 Cl City: Miami Shores Countv: Miami Dade zip: :V l) Folio/Parcel#: Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: ) OWNER: Name(Fee Simple Titleholder): °x-19 Y Phone#: 6'l �-7 Address: City: State: Y Zip: Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name: ./��GG� J��41 Ili Phone#: ° ;7&G Address: 2 7,i�d 4u) ?8 4k City: State: f'"� Zip: 3 3 / p Qualifier Name: //��'c`l�Jry Phone#: State Certification or Registration#:_ZC ��U cls �? Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: D.a Value of Work for this Permit:$ Se D Square/Linear Footage of Work: Type of Work: ❑ Additio ❑ Alteration ❑ New ❑ Repair/Replace Demolition L Description of Work: G -4.9 -'X-e'!57 specify color of color thru tile: Submittal Fee$ � ,CO Permit Fee$ CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ Y 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 Signature )WVIRorAGENT CONTRACTOR The foregoing ins ent was acknowledged before me this The foregoing instrument was acknowledged before me this day of ;• d 20 by J \ � day 01 20 �� by ho is personally c n to �T lT3 1 who is personally known to me or who has produced as me or who has produced -'�'n�l identification and who did take an path. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: �� Sign: Sign: Print: Print: P. da ° ..... � Sindia AlvarWY ez Seal: ?orN EXPIRES January 21.2018 Seal: Myd aAgtai17 FF 156750 (407)398-0153 FloridallotaryService.com J�%jj Expired 09!03!201 B APPROVED BY Plans Examiner , Zoning Structural Review Clerk (Revised02/24/2014) 004630 Local Business Tax Receipt Miami—Dade County, State of Florida -THIS IS NOT A BILL - DO NOT PAY 7169195 �/ RECEIPT NO. EXPIRES BUSINESS NAME/LOCATION RENEWAL MARCELO SOLUTIONS INC 7447891 SEPTEMBER 30, 2015 2740 SW 28 TERR 803 Must be displayed at place of business Pursuant to County Code MIAMI FL 33133 Chapter 8A-Art.9&10 .TYPE OF BUSINESS NT RECEIVED SEC PAYMENT OWNER 196 ELECTRICAL CONTRACTOR BY TAX COLLECTOR MARCELO SOLUTIONS INC EC13005947 $45.00 07/11/2014 Worker(s) CREDITCARD-14-026335 This Local Business Tax Receipt only confirms payment of the Local Business Tax.The Receipt is not a 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 8a-276. For more information,visit miamidade aoyAAXc II c or ---- - - --:-- IMPORTANT STATE OF FLORIDA �4 c ei' ,`°Rcn f s 3° c a c.' DEPARTMENT OF FINANCIAL SERVICES r Ff fn � a j DIVISION OF WORKERS'COMPENSATION 3 = F CONSTRUCTION INDUSTRY EXEMPTION O not. pp•onlym n n p15 17 S e L -on.n ot„-of elect nto°Fcs m, CERTIFICATE OF ELECTION TO BE EXEMPT FROM=LOR".DA D !°Ch'[: '.140 Ott F :.I<5 - - WORHERS'COMPENSATION LAW a^b t m ( f.0 t be F s r y fi r i f v ttc n:- EFFECTIoEDATE. -• EXPIRATION DATE'. -'''F' �H 'he ° t' o rce f °rg me s s PERSON. MARTIN' YA RCE_0 Er 5 fd t(C ETh, d e°on e R r° r f,. FEIN- _e_3n5YG E .c to mlll..Ie 11q_--,, -�.. BUSINESS NAME AND ADDRESS: MARCELO SOLUTIONS INC 2740 SW 28TH TER#803 MIAMI FL 33133 SCOPES OF BUSINESS OR TRA LICENSED ELECTRICAL CONTRACTOR 4i �f STATE OF FLORIDA 'z= DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION EC13005947 ISSUED: 06/04/2014 CERTIFIED ELECTRICAL CONTRACTOR MARTIN, MARCELO GUSTAVO MARCELO SOLUTIONS, INC. IS CERTIFIED under the provisions of Ch.489 FS. Expiration date AUG 31,2016 L1406040001874 illy Rn DATE(MMDIY DYYY) CERTIFICATE OF LIABILITY INSURANCE 06/05/2015 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(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terns 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). PRODUCER CONTACT ANA E DON NAME: Palm Beach Insurance Consultants PHONE 305)860-1052 tae, PHONE, Ezt): ( FA lac,No): (305)643-3229 1901 SW 27 Avenue EADDRE -MAIL SS: pbinsure@bellsouth net Miami,FL 33145 INSURER(S)AFFORDING COVERAGE NAIC M Phone (305)860-1052 Fax (305)643-3229 INSURER A: GRANADA INSURANCE COMPANY INSURED INSURER 8: MARCELO SOLUTIONS INC INSURER C: 2740 SW 28 TERR 1803 INSURER D: ENSURER E: MIAMI,FLORIDA 33133 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 CONTRACTOR 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 ADDTYPE OF INSURANCE INSR W D POLICY NUMBER MM DD/YYYY MY EFF MDD/YYYY LIMITS LICY EXP LTR INSR WVD t ).( ) GENERAL LIABILITY EACH OCCURRENCE. S 1,000,000-00 DAMAGE TO RENTED 100,000.00 COMMERCIAL GENERAL.LIABILITY PRFMISFS!Ea ccc�,rence) S CLAIMS-MADE I/ OCCUR MED EXP,Ary one persc $ 5.000.00 A 0185FL00058454 04/10/2015 04/10/2016 PERSONAL a ADV INJURY S 1.000,000.00 GENERAL AGGREGATE S 2.000.000.00 GENL AGGREGATE LIMIT APPLIES PER PRODUCTS-COMPIOP AGG $ 2.000,000.00 POLICY PRO- LOC $ JECT ACOMBINED SINGLE LIMIT AUTOMOBILE LIABILITY (Ea accident) S ANY AUTO BODILY INJURY(Per person) S ALL OWNED — SCHEDULED BODILY INJURY iPer acc.dert) S AUTOS AUTOS -- - NON-OWNED PROPERTY DAMAGE S HIRED AUTOS AUTOS (Pe acadent) — S UMBRELLA UAB OCCUR EACH OCCURRENCE S EXCESS LIAB _ .CLAIMS-MADE AGGREGATE $ DED RETENTIONS S WORKERS COMPENSATION PER OTH- AND EMPLOYERS LIABILITY YIN STATUTE ER ANY PROPRIETOR/PARTNER/EXECU IIVE L L. EACH ACCIDENT S OFFICER/MEMBER EXCLUDED-> NIA (Mandatory in NH) E L DISEASE-EA EMPLOYEE S If yes,describe under L t DISEASE-POLICY LIMIT S DESCRIPION OF OPERATIONS below T DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) """ELETRICAL WORK-WITHIN BUILDINGS ""' THIS CERTIFICATE IS SUBJECT TO ALL POLICY TERMS,EXCLUSIONS AND CONDITIONS •`•` MARACELO SOLUTIONS INC LICENSE#EC 13005947 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE MIAMI SHORES VILLAGE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE 2 AVE MIAMI,FLORIDA 33138 AUTHORIZED REPRESENTATIVE, �7 ANA E DON ©1 14 ACORO CORPORATION. All rights reserved. ACORD 25(2014101)QF The ACORD name and logo are registered marks of ACORD Marcelo Solutions Inc.. 2740 SW 28th ter#803Miami FI 33133 Ph 786 838 6104 Lic#EC 13005947 Dateb.�Zks State of Florida County of Miami Dade Before me this day personally appeared Marcelo G Martin who, being duly sworn,deposes and say. That he will be the only person working on the project at 485 Ne 92th St Miami Shore FI 33138 Sworn to and subscribed before me this 10_day of A )1 2015 by. Produce Identification(YC35-S"Il' 3Z-1— Type of Identification ProducelFL 'DWT�U N Z 4p►„° � Notary Public State of Florida Sindia Alvarez My Commission FF 156750 OF FV Expires 0910312018 Print,Type or WP Name of Notary SNIVC'1932 oREs ��' Miami Vhores Villa e ... .....� 9 o Building Department �l~ORlpp► 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Notice to Owner — Workers' Compensation Insurance Exemption , "{2 .'+ '�[ X<,:x- ;s % r-e.;.„o. :,_: : res t.;; ^'s 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 and has acknowledge that he or she will not use day labor,part-time employees or subcontractors for your project.The contractor has provided an affidavit stating that he or she will be the only person allowed to work on your project.In these circumstances,Miami Shores Village does not require verification of workers' compensation insurance coverage from the contractor's company for day labor,part-time employees or subcontractors. BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. Signature: er State of Florida County of Miami-Dade The foregoing was acknowledge before me this day of V J J 20 By �s�(_ ��a /--U is personally known t or has produced as identification. Notary: Al........ ': MAR SEAL: MY COMMISSION#FF084828 EXPIRES January 21.2018 (407)3913-0153 FloridallotaryService.com