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EL-13-2170 �� Miami Shores Village RECEMOD Building Department FE-B 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 BYE Tel: (305)795.2204 Fax: (305)756.8972 INSPECTION'S PHONE NUMBER:(305)762.4949 FBC 20 BUILDING Permit No.E6 /3 PERMIT APPLICATION Master Permit NoRC—1 13 — 2l(b.? Permit Type: Electrical JOB ADDRESS: /15PI11 f4) I 9 q4 City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated:Yes / � NO A Flood Zone: OWNER:Name(Fee Simple Titleholder): 26Z0 20 �'VC�Jtjls l� ;o JUC- Phone#: ♦0 6 7, �(`�/ 304'0") Address: ��,.. _sal ;.-7 "- City: I State:-91 Zip: Ir -Tenant/Lessee Name: nn Phone#: Email: �Y` -& CONTRACTOR:Company Name: AMO% �C/W,�E Phone#: -,796 Address: s:p / 3 157 C/2 City: eq State: -if'L Zip: 3 30 3 Qualifier Name: ® & "q/,7C/,�q Phone#: State Certification or Registration#: 6.9 36)1tz A�; 6T Certificate of Competency#:^12eODZ 0/f Contact Phone#: �Ovi o�� O S i�9 Email Address: (//V lT4a�Q� 1iR� _ ♦f/ )O&OW1 G'drif. DESIGNER:Architect/Engineer: Phone#: Value of Work for this Permit:$ ®' O Square/Linear Footage of Work: Type of Work: ❑Address ❑Alteratiion ❑New ❑Repair/Replace ❑Demolition Description of Work: J2{11f E Pi�+%� �. r, Submittal Fee$ Permit Fee$ CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Bond$ Notary$ Training/Education Fee$ Technology Fee$ Double Fee$ Structural Review$ TOTAL FEE NOW DUE$ Kbo N • t Bodding Cofnpany'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 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 he issuance(i�yec ilding permit with an estimated value exceeding$2500, the applicant must promise in good faith th a copy of e notice of cement and construction lien law brochure will be delivered to the person whose property is subj t 0 attach nt. Also, a ceopy of the recorded notice of commencement must be posted at the job site for the first inspectio hich oc s seven (7) da the building permit is issued. In the absence of such posted notice, the inspection will not b ap roved n a reinsp n ' e charged. Signature Signature Owner o A Contractor The foregoing ins a cknowledged before me this ` The foregoing instrument was acknoNylidged before me this day of 0 by , day of J1/ 20 /,by Ni J01, ho ersonall _ 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•!O�L ckl vg Print: � My Commission ExpireL06D, ,�-w JAGI]l1EtINE.tAOE-kAATAI ON COMMISSION i1 EE877112 My ComNotary Public-,State of FloridaEXPIRES F®4lu8fy 21,2017 y Comm.Expires Jul 10 2017 +oi"3"1s3Commission#f FF 34236 APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised 3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09) r 8 s G 19 l� 3a 1 j? .... .....� Miami shores Village .�„ � res Building Department LORIDA 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CONTRACTORS' REGISTRATION FORM ALL CONTRACTORS MUST PROVIDE COPIES OF LICENCES AND INSURANCES EACH TIME A PERMIT IS SUBMITTED OR THE VILLAGE MAY MAINTAIN A FILE WITH YOUR INFORMATION FOR A$30.00 FEE PER YEAR. IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: A. COPY OF QUALIFIER'S STATE LIC CARD B. COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF LIABILITY INSURANCE(CERTIFICATE HOLDER TO BE MIAMI SHORES VILLAGE BLDG DEPT) D. COPY OF WORKERS COMPENSATION (EITHER CERTIFICATE OR EXCEMPTION) IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY: A. COPY OF CERTIFICE OF COMPETENCY OF QUALIFIER B. COPY OF MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT C. COPY OF LIABILITY INSURACE(CERTIFICATE HOLDER MUST BE MIAMI SHORES VILLAGE BLDG DEPT) D. COPY OF WORKER COMP INSURANCE(EITHER CERTIFICATE OR EXEMPTION) YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE HOLDER AS FOLLOW: MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES,FL 33138 ........................................................................................... COMPLETE CONTRACTOR'S INFORMATION BUSINESS NAME: &-�i BUSINESS ADDRESS: 074#$3 94J /3��c�' CITY '0 �J e STATE !'/ ZIP CODE 33 0.3 2- BUSINESS BUSINESS PHONE: ( 771 ) �! 93 — Z/q 9 FAX NUMBER( ) CELL PHONE (, )_ 7!1?— Pi,?� QUALIFIER'S NAME: QUALIFIER'S LIC NUMBER: A'?d!!FD®0 /0:a E-MAIL ADDRESS (IF APPLICABLE): //Az /y �Gr� Loe Created on 3119109 BY MLDV I RV 3126109 MLDV II srnre OF Fi oRmA AC# 6 3 2 2 6 3 0 Congratulations! With this license you become one of the nearly one million DEgARTMENT OF ]F3'USINESS AND Floridians licensed by the Department of Business and Professional Regulation. PROFES0.I9 W,.M-, REGULATION'- Our professionals and businesses range from architects to yacht brokers,from boxers to barbeque restaurants,and they keep Florida's economy strong. gR1301466 p; /3 /12 120099072 Every day we work to improve the way we do business in order to serve you better. r J For information about our services,please log onto www.myfloridalicense.com. .REG 13LEOR There you can find more information about our divisions and the regulations that GARCIA, ..,�1 e impact you,subscribe to department newsletters and learn more about the UNITED vol itf I-CAS, u`LRwICES INC. Department's initiatives. (I1SIDIVID17Ai+ 1 MSFT ALL LOCAL LICENSING''RE +1TS PRIOR Our mission at the Department is:License Efficiently,Regulate Fairly.We TO CONTRACTIN'Gp`. X—ANY AREA) constantly strive to serve you better so that you can serve your customers. SAS .REGISTSRED,V#d— elle„provi'sions of. cn.489 Thank you for doing business in Florida,and congratulations on your new license! sagiraeion aaae� A>1ti 1 2Q14 . 12083Q63901 DETACH HERE Ap226 Q. STATE OF FLORIDA DEPARTMENT O BUSINESS AND PROFESSIONAL REGULATION ELECTR CAL CONTRACTORS LICENSING BOARD SEQ#L12083003901 . •.- _ _ LICENSE NBR. 013` 3f). ,2012 : 12009907:2 ER-30�.4fr�6�_:; The ELECTRICAL CONTRACTOR . .Nan►ed below: HAS REGISTERED Under the provisions of 'Chapter` 9 F3. Expiration date: AUG 31, 2014,,E (INDIVIDUAL MUST MEET ALL LOC2 L`t L •CEN I TG ” ' >rrzR �R-02, co�CTINc�: GARCIA, 'MANTJRL O - n UNITED. ELECTRICAL SER'V'ICES INC 26453 SW 135TH COURT; HOMESTEAD FL;33032 RICR SCOTT . REN LAWSON GOVERNOR SECRETARY DISPLAY AS REQUIRED BY LAW f CTQB Construction Trades Qualiifyin9 Board BUSINESS CERTIFICATE OF COMPETENCY 12E000192 UNITED ELECTRICAL SERVICES INC dACIA MANUEL O Is certified under the provisions of Chapter 10 of Miami-Dade County ALID FOR CONTRACTING UNTIL09/30/201_5' CERTIFICATE OF COMPETENCY SR,, ,WARD MANUEL GARCIA MASTER ELECTRICIAN UNITED ELECTRICAL SERVICES, INC. CC#13-CME48404-R Ref. 28213415 Expires 8/31/14 Ctrl#14-22709 00499 Local Business Tax Receipt Miami—Dade County, State of Florida —THIS IS NOTA BILL—DO NOT PAY LBT 6983507 BUSINESS NAMMOCAMON RECEIPT NO. EXPIRES UNITED ELECTRICAL SERVICES INC RBIJEuuAL SEPTEMBER 30, 2014 26453 SW 135 CT 7162894 Must be displayed at place of business MIAMI FL 33032 Pursuant to County Code Chapter 8A—Art.8&10 SEC.TYPE OF BUSINESS OWNER PAYMENT RECEIVED UNITED ELECTRICAL SERVICES INC 196 ELECTRICAL CONTRACTOR BY TAX COLLECTOR Worker(s) T 12E000192 $75.00 07/19/2013 CREDITCARD-13-003462 This Local BusinessTax Receipt only confirms payment of the Local Business Tex.The Receipt is not a license, pemsf4 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 NO.above must be;displayed on all commercial vehicles-Miami—Dade Code Sec Ha.276. For more information,visit www.mismideftilovkexcollector Municipal Contractor's Tdx Receipt Miami—DadeCiy County, State of Florida o THISIS NOT A&LL—DO NOT PAY MC CC NO: 12E000192 BUSINESS NAME/LOCATION RECEIPT NO. EXPIRES UNITED ELECfRICALSF"CESINC NEW BUSINESS SEPTEMBER 30, 2014 26453 SW 135 Cf 7438398 MIAMI,FL 33032 Must be displayed at place ofbusineas Pursuant to County Code Chapter 8A—Art.9&10 OWNER TYPE OF BUSINESS PAYMENT RECEIVED UNITED EIECTRICAL SERVICES INC ELECMI ALCCNTRACTOR BY TAX COLLECTOR 200.00 0900/2013 0226-13-001269 MA"H For more information,asit www miamidade G*y1 xcolloat®r WE 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: 10/17/2013 EXPIRATION DATE: 10/17/2015 PERSON: GARCIA MANUEL FEIN: 452648508 BUSINESS NAME AND ADDRESS: UNITED ELECTRICAL SERVICI 26453 SW 135 COURT HOMESTEAD FL 33032 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.,Notice 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 certificate at any time for failure of the person named on the certificate to meet the requirements of this section. DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 07-12 QUESTIONS?(850)113-1609 I ACC ' CERTIFICATE OF LIABILITY INSURANCE DATE02/114/144/14(Ml) 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 endorsement(a). PRODUCER CONAMNEACT MARTAALONSO Florida Bankers Insurance PHONE FAX (305)266-6493 C No: (305)262-0679 E- 7278 SW 8 Street L marta@floridabankersinsurance.com Miami,FL 33144 INSURERS AFFORDING COVERAGE NAIC @ Phone (305)266-6493 Fax (305)262-0679 INSURERA: FEDERATED NATIONAL INSURANCE CO. INSURED INSURER 13: SOUTHERN INSURANCE CO United Electrical Services Inc INSURER C: 26453 SW 135 COURT INSURER D: HOMESTEAD,FL.33032 (305)262-6743 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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 ADD UBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER M D M D LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000.00 © COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED 100,000.00 PREMISES Ea occurrence $ A ❑ CLAIMS-MADE Q OCCUR GL-0504008126-02 MED EXP(Any one person) $ 5,000.00 ❑ N N 10/06/2013 10/06/2014 PERSONAL&ADV INJURY $ 1,000,000.00 E GENERAL AGGREGATE $ 2,000,000.00 GEN'LAGGREGATE LIMITAPPLIESPER: PRODUCTS-COMP/OP AGG $ 2,000,000.00 © POLICY ElSRO- ECT ❑ LOC $ AUTOMOBILE LIABILITY OMBINED ccident SINGLE LIMIT Ea a ❑ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED B ❑ AUTOS ❑ AUTOS BODILY INJURY(Per accident) $ ❑ HIRED AUTOS ❑ AUTOSNED PROPERTY DAMAGE $ Per acc(dant ❑ ❑ $ ❑ UMBRELLA LIAB ❑OCCUR EACH OCCURRENCE $ [jEXCESS LIAB ❑CLAIMS-MADE AGGREGATE $ ❑ DED ElRETENTION$ $ WORKERS COMPENSATIONY/N ©W C STATU- ❑OTH- AND EMPLOYERS'LIABILITYORY_LIMER ANY PROPRIETOR/PARTNER(EXECUTIVE PW C008467-13 E.L.EACH ACCIDENT $ 100,000.00 B OFFICER/MEMBEREXCLUDED? ❑ N/A 11/19/2013 11/19/2014 (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ 100,000.00 If yes,describe under DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT $ 500,000.00 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space Is required) ELECTRICAL CONTRACTORS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CITY OF MIAMI SHORES BUILDING DEPARTMENT THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN 10050 NE 2 AVE ACCORDANCE WITH THE POLICY PROVISIONS., MIAMI SHORES,FL 33138 AUTHORIZED REPRESENTATIVE 305)756-8972 @ 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05)OF The ACORD name and logo are registered marks of ACORD r � " ♦g WonesM shores iamiVillage Building Department �ep& 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CHANGE OF CONTRACTOR/ARCHITECT Permit N.gr 1 —,21697 O1mef s Name (Fee Simple Title Holder): 2(pZ® A ;�;� }hone#: Owner's Address:_(00 . o'7 City: , State Zip Code: v-5 13 0 Job Address(Of where work is being done):_ 11661IL20 City: Miami Shores State:—Florida Zip Code: 33 &9 Contractor's Company Name: l��s -,��,-�G,G;® �v�, Phone#:-7Y&-6'7 -5 7,s2) Address: qqJ0 szo City: State:_ rC Zip Code: 33 Qualifier's Name : Lic. Number: C-6, 111Sg,C3 Architect/Engineerof Record Name: Phone#: Address: `� City: State: Zip Code: Describe Work: I hereby certify t the work h s be n abandoned and/or the contractor/architect is unable n it ing to c p ete t contract. I hold the Building Official and the nam! S r ha less for all legal involve en Signature "7 Signature gent r or Architect The for ' Ins ment was akno ledged before me The foregoing instrum nt was aknowledged before me this day of &k 20 I4,by T this 12— day of20�y u personally known a aLwho has produced rsonall known to me o has produced as indentification. as indentJfication. \Notary Pu i' • Notary Pu I Sign: Sign: ,•"Y',.,, MYI.AI H JWWEZ MYtAI NERNWEz U�M =: 49 Seal: W COMMISSION r EE 221249 Seal: a EXPIRES:December 1,2016 EXPIRES:December 1,2016 Bonded Tt Bonded Thru Notary Pubflc Undersdew " i�P � w Notary Pubtic enmiters IIL d CONSTRUCTIONS KISSERVICIES ) LLC Ref Miami Shore project To whom it may concern: Please accept this letter as the formal information for the change of contractor for the above mentioned property. We are changing from the current electrical contractor on record Compuvid effective immediately. Please update your records accordingly. I will be available at your convenience if you need to discuss or have any questions regarding the proposal. Sincerely, i Juan A. Sen CGC 151141 (305) 216 0118 0980 SSV 64 Street,Miami F1,33173 Phonc. 305-595 3504 • F.u: 305 412 2058 • ('ell: 305318 111 l0 cntail: kisccrostruitionti�%icmtc.tst.nrt USPS.com® -USPS TrackingTM Page 1 of 1 English Customer service USPS Mobile Register/Sign In AMUSPICO1I1• Search USPS.00m or Track Packages Quick Tools Track Ship a Paamp Sw IlAw Manage YtBN Mal sm Business Soles Enter up to 10 Tracking A Find Find USPS Locations Buy Stamps Schedule a Pickup Customer Service)caltISyc TrackingM Have questions?We're here to help. I. Holo Mail _. Change of Address _ .... .... Tracking Number.9505600017214042000159 Expected Delivery Day:Wednesday,February 12,2014 Product & Tracking Information Available Actions Postal Product: Features: Priority Mail 1-Day' $50 insurance included USPS Tracking" Email Updates DATE&TIME STATUS OF ITEM LOCATION February 13,2014,12:33 Delivered MIAMI,FL 33178 pm February 13,2014,9:26 am Out for Delivery MIAMI,FL 33122 February 13,2014,9:16 am Sorting Complete MIAMI,FL 33122 February 13,2014,7:24 am Arrival at Post Office MIAMI,FL 33122 February 13,2014 Depart USPS Sort Facility OPA LOCKA FL 33054 February 12,2014,7:34 am Processed at USPS OPA LOCKA FL 33054 Origin Sort Facility February 11,2014,9:39 am Acceptance(SSK) MIAMI,FL 33183 Track Another Package Whars your tracking(or receipt)number? Track It LEGAL ON USPS.COM ON ABOUT.USPS.COM OTHER USPS SITES Privacy Policy> Government Services> About USPS Home) Business Customer Gateway) Terms of Use> Buy Stamps&Shop) Newsroom> Postel Inspectors> FOIA) Print a Label with Postage> USPS Service Alerts) Inspector General) No FEAR Act EEO Data) Customer Service> Forms&Publications> Postal Explorer) Delivering Solutions to the Last Mile) Careers> Site Index, Copynght0 2014 USPS.All Rights Reserved. https://tools.usps.com/gO/TrackConfinnAction!input.action?tRef'--gt&tLc=1&tLabels=950... 2/14/2014 Miami Shores Village Building Department Pe� 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel: (305)795.2204 Fax:(305)756.8972 ' `; INSPECTION'S PHONE NUMBER: (305)762.4949 FBC 20k'D BUILDING � "' Permit No. '`� " '9 PERMIT APPLICATION ''' er Permit No. �l`��' t� Permit Type: Electrical JOB ADDRESS: /141 /Va City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: 67 Is the Building Historically Designated:Yes NO Flood Zone: OW„NER:Name(Fee Simple Titleholder): �� G /s/ 1 � Phone#: �,? `? 30 Y/ Address: ® �' l '� 760 City: /'em State: F1 Zip:," &, I Tenant/Lessee Name: ®V Phone#: Email: LAR .1' CONTRACTOR:Company Name: CO 0-i&I//'./J l A.)C° Phone#: 0 05 1 1 117_ '9 k' '&ess: 10b )0 A/W 12Z" ST&ECT 40,#D U�/�% /D 6 State: Fe zip: 3 3 ( 19 60alifier Name:19 e'&06 100 Phone# :�) 9 43J4 Mate Certification or Registration#: FC- J 3D D 't 6 N Certificate of Competency#: Contact Phone#: �,y 9 45 l D 69 Email Address: e�J:9 11 e,,e,40'lAj n/' V Y/,O I C tM . DESIGNER:Architect/Engineer: Phone#: r;. s. _ Value of Work for this Permit:$ S ©O Square/Linear Footage of Work: l bO TT,pe of Work: ❑Address ❑Alteration ❑New MRta�epair/R_eplace ❑Demolition De&cription of Work: �xx�xx��x��x��x��mxx�x�xx�x�xx��x�Fees��xxx�x�xxxxxxx�xxx�xxx��xxx�xxxx�xxx��x ubmittal Fee$ Permit Fee$ CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Bond$ �btary$ Training/Education Fee$ Technology Fee$ Double Fee$ Structural Review$ TOTAL FEE NOW DUE$ 1UL1 ID Bonding Company's Name(if applicable) Bo iding Company's Address pity' State zip �4I rtgage 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 ELECTRICAL WORK,PLUMBING,SIGNS, r:IS;POOLS,FURNACES,BOILERS,HEATERS,TANKS and AIR CONDITIONERS,ETC..... WNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all a plicable 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 CORDING YOUR NOTICE OF COMMENCEMENT." 4� jcie:16" licant. As a condition to the issuance f a bu' ing permit with an estimated value exceeding$2500, the applicant must prbintse in good faith that a copy of a notice of omme ment and construction lien law brochure will be delivered to the person ivligse property is subject anac t. Also, a rtified c py of the recorded notice of commencement must be posted at the job site �. .:�. .. fist.tlie first inspection ich oc r seven O s after the building permit is issued In the absence of such posted notice, the Inspection will not be oved d a reins ti fee wi le charged. P,�6 Signature Signature er o Agen Contractor hp foregoing instru ent was ackinowL(ngPblefore'lme this ® The foregoing instrument was acknowledged before me this. a4 .' -h X5.4 0 !3,by J d` 4CA&J day of t ,20-a,b 6 AWe- G%6 f'�2 Q� �vho'i9 personally known to me or who has produced who is personally known to me or who has produced--V A d d f Afi L4jgdg0 As identification and who did take an oath. O/1)v L Lf G as identification and who did take an oath. r t TAR LIC: NOTARY PUBLIC: t r: 3 1 may. Sip: SPrint: �' l(J`^ Print: My.Commission p '�sy Pub 'Stats of Florida My Commission Ex :`� ply ANDEL Maria C Castelis � MyCommissionEE191533 A•: ag MY COMMISSION$EE22t248 Expires O&/08/,018 ' EXPIRES:December 1,2018 10-: eased Ttw Nary Pule UWffWdW a 44A 19 ?PROVED BY P 61,eP Plans Examiner Zoning Structural Review Clerk Oteyised 3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09) to} n AC# 6184676 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PREFESSIONAL REGULATION ELECTRICAL CONTRACTORS ICENSING BOARD SEQ#L12070400460 - LICENSE NBR 107/04/20121118206164 JEC13004601 The ELECTRICAL CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2014 FIGUEREDO, ERIK COMPUVID, INC. 10670 NW 123RD STREET ROAD UNIT 106 MEDLEY FL 33178 RICK SCOTT KEN LAWSON GOVERNOR SECRETARY DISPLAY AS REQUIRED BY LAW OP ID:LIPS ,d►`oR® CERTIFICATE OF LIABILITY INSURANCE 09f19113 3rn 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 endorsement(s). PRODUCER Phone:305-648-7070 NAME AcT Avante Insurance Agency,Inc. Fax•305-648-7090 PHONE F 7490 West Flagler Street ac No Col.- Miami, o:Miami,FL 33144 Gabriela F.Dominguez ADDRESS: CUSTOMERPRODUCER ID a:COMPO-1 INSURER(S)AFFORDING COVERAGE MAIC 0 INSURED Compuvldd Inc. INSURER A:Granada Insurance Company 10670 NW 123 ST RD Unit 106 INSURM 13:Technology Insurance Company 42376 Medley,FL 33178 INSURER C: INSURER D: INSURERE: 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. LTINSA Ow SUOR -POCY EXP TYPE OF INSURANCE POLICY NUMBER Y F MM p LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,0001 ff— A X COMMERCIAL GENERAL LIABILITY 018SFL00001619 W07113 08/07114 PREMISES Ea occurrencel $ 100,00 CLAIMS-MADE a OCCUR MED EXP(Any one person) $ 5,00 PERSONAL&ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 1,OWA GEWL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 1,000, 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 err deent)DAMAGE $ HIRED AUTOS NON-OWNED AUTOS $ $ UMBRELLA UAB OCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMS-MADE AGGREGATE $ _ DEDUCTIBLE $ RETENTION $ WORKERS COMPENSATION X WC STAT TORY T- OTH- AND EMPLOYERS'LIABILITY B ANY PROPRIETORIPARTNERIEXECUTIVE Y/N TWCi3335170 12/02/12 12102113 E.L.EACH ACCIDENT $ 100, OFFICERIMEMBER EXCLUDED? F N I A (Mandatory In NH) EL.DISEASE-EA EMPLO $ 100,00 K yes,describe wider DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,N mons space is required) Machinery equipment installation a repair CERTIFICATE HOLDER CANCELLATION MIAMSH1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Miami Shores Village Building THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN g g ACCORDANCE WITH THE POLICY PROVISIONS. Department 10050 NE 2nd Ave AUTHORIZED REPRESENTATIVE Miami Shores,FL 33138 ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 26(2009109) The ACORD name and logo are registered marks of ACORD ddtAMt-MADE COUI�iTY 2012 I.OGAL BUSINESS TAX RECEIPT 2013 FIRST-CLASS TAS CALLECTOR MIANq-t?ADE COUNTY-STATE OF FLORIDA U.S.POSTAGE 9 140 W:FWta1LER ST. EXPIRES SEPT,30e 2013 PAID 98t FLOOR 'MUST BE DISPLAYED AT PLACE OF BUSINESS MIAMI,FL Id1G114RQ,FL 33130 PURSUANT TO CdUNTY CODE CHAPTER Oka ART.9&lo' PERMIT NO.231 6051s9N1-6 �p THIS IS NOT A SILL-00'NOT PAY RENEWAL Btleg&PUV /jj C SON STATEWE EUM4601631310-0 10670 NW 123 ST RD 106 33178 MEDLEY OWNER se� �fC,OMPUVID INC "IWI ECTRICAL CONTRACTOR WORKE2/S THIS IS ONLY A LOCAL. BUSINESS TAX RECEIPT.IT ODES NOT PERMIT THE HOLDER TO VIOLATE ANY acs°LAWS OFR THE DO NOT FORWARD COUNTY OR CITIES. NOR DOES IT EXEMPT THE HOLDER FROM ANY OTNER COMPUVID INC RIREOBYLAW.TH E RUBEN FIGUEREDO FRES THE HOICOERRTSiQUALMCA- 10670 NW 123 ST RD 106 TIONS' MEDLEY FL 33178 PAYMENT RECEIVEO MIAMI-DAME COUNTY TAX COLLECTOR: 07/16/2012 60010000309 000045.00 irr�'ere�leeeel��ue�ler�er+�jenr��r��n��errer��eroe�52rt� SEE OTHER SIDE I I � b T 002613 Local Business Tax Receipt Miami—Dade County, State of Florida —THIS IS NOT ABILL—DO NOT PAY "% LBT/ 6051916 BUSUNESS NAMEILOCATION RECEIPT NO. EXPIRES COMPLNID INC RENEWAI. SEPTEMBER 30, 2014 10670 NW 123 ST RD 106 6313100 Must be displayed at place of business MEDLEY FL 33178 Pursuant to County Code Chapter BA-Art.9&10 OWNER SEC.TYPE OF BUSINESS PAYMENT RECEIVED COMPUIflD INC 196 SPEC ELECTRICAL CONTRACTOR BY TAX COLLECTOR Worker(s) 2 EC130M1 $45.00 07/10/2013 TXHS1-13-020740 This local Business Tax Receipt only confirms payment of the local Business Tex.The Receipt is not a license, permit,or a certification of the holder's 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 iia 276. For more information,visit www.miamidnde AovRaxcollector