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ELC-16-1229 Perm NO. E CS-' 6 223 . Miami Shores VillagePeirnitP Pe E16��11Commercial 10050 N.E.2nd Avenue NE .• aa.�+ 'E�� lNO CPass�awn New Miami Shores,FL 33138-0000 Permit Statu$.APPROVED hv—y � Phone: (305)795-2204 FtARtDp' � � Issue - X19*46 Expiration: 11/1512016 E Project Address Parcel Number Applicant 699 NE 92 Street 1132060141560 CATA LIGHTS CORP. Miami Shores, FL Block: Lot: Owner Information Address Phone Cell CATA LIGHTS CORP. FL (786)712-9510 l Contractor(s) Phone Cell Phone Valuation: $ 2,200.00 WORLD ELECTRICAL CONSTRUCTIO (954)213-5663 Total Sq Feet: 0 Type of Work:NEW ELECTRICAL METER FOR HOUR PANEL Available Inspections: Additional Info: Inspection Type: Classification:Commercial Final Scanning:3 Meter Box Alteration Relocation Fire Alarm Service Change Review Electrical W.W. Underground Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $1.80 Invoice# ELC-5-16-59688 DBPR Fee $2.25 05/19/2016 Credit Card $ 168.30 $0.00 DCA Fee $2.25 Education Surcharge $0.60 Permit Fee $150.00 Scanning Fee $9.00 Technology Fee $2.40 Total: $168.30 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 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. Futhermore,I authorize the above-named contrac or to do the work stated. � rs May 19, 2016 Authorized Signature:Owner / Applicant / Contractor / Agent Date Building Department Copy May 19,2016 1 v Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-258350 PermitNumber: ELC-5-16-1229 Scheduled Inspection Date: June 22, 2016 Permit Type: Electrical - Commercial Inspector: Devaney, Michael Inspection Type: Final Owner: LIGHTS, CATH Work Classification: New Job Address:699 NE 92 Street Miami Shores, FL Phone Number (786)712-9510 Parcel Number 1132060141560 Project: <NONE> Contractor: WORLD ELECTRICAL CONSTRUCTION SERVICE CORP. Phone: (954)213-5663 Building Department Comments NEW ELECTRICAL METER FOR HOUR PANEL Infractio Passed Comments EXTERIOR LIGHTS. INSPECTOR COMMENTS False TO CANCEL PERMIT#ELC15-2216 Inspector Comments Passed Failed Correction Needed ❑ �i J Lid Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. June 21,2016 For Inspections please call: (305)762-4949 Page 15 of 36 7'T Miami Shores Village M �� Building Department . : 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 20LL4 J BUILDING Master Permit No � i PERMIT APPLICATION Sub Permit No. ❑BUILDING )s ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANIC4L ❑PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP / q CONTRACTOR DRAWINGS JOB ADDRESS: _(� J Q 2, S City: Miami Shores m County: Miami Dade Zip: 41 Folio/Parcel#: 11.3 Zo,6-O 1 5�—13'4 d Is the Building Historically Designated:Yes NO ).e Occupancy Type: Load: Construction Type: Flood Zone: BFE: TF]FE: OWNER:Name(Fee Simple Titleholder): Ga jg U 4' S Corp Phone#: `� V ►ee Address: -7-�® Glay!6A�yl 1-y pt y& City: /'/l l State: Zip: -313/ 3/ Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name: k4. Q .(0 ELEC-ZW641C CO(J$r. S4V Phone#�-3-.q_c® 13-5663 Address: '2_ 50L.) '3(a Az45 City: /`7� del/ State: OCL Zip: 3 3/3 3 Qualifier Name: Phone#:QS-q- 0 73- 656-3 State Certification or Registration#: jr;CQQQ Certificate of Competency M DESIGNER:Architect/Engineer: Phone#: Address: City: State Zip: Value of Work for this Permit:$ t� Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration 1:1 New ElRepair/Replace F-1DemoIitio/ Description of Work: AN Pi /'f Cg GY rir �1C�% y/j f c l/ �j Specify color of color thru tile: Submittal Fee$ Permit Fee$ 1J_i91&46' CCF$ CO/CC$ Scanning Fee$ Radon Fee$ ° X� 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) LA 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 inspectio 7 end and a reinspection fee will be charged. 11-1 Signature OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this Z7_day of � ,' 20 ((by 2-7 day of f}R n% 20. 1(e ,by Jet- 6nj4 c odea e ,who is personally known to C4 ean'Ic� e 14ca/,-a i-, ,who is personally known 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: f� ���— Sign:a, Z• Print: - i Print rel .S a-3 Seal �? l !COMMISSIONFF225614 Seal: v,. ANGELA V.BASSAS �1y r EXPIRES APR 29 2019 'F"= My COMOISSION#FF225614 an' + Bonded through 1st State Insurance BYPIRES APR 29,2019 Oanded ,n 1st Stale Insurance APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) Property Search Application - Miami-Dade County Page 1 of 1 OFFICE OF THE PROPERTY, APPRAISER Summary Report Generated On:5/6/2016 Property Information Folio: 11-3206-0144560 Property Address: 699 NE 9?_ST- Miami Shores,FL 33138-2961 Owner LATA LIGHTS COR 770 CLAUGHTON ISLAND DR APT - Mailing Address #1914 MIAMI,FL 33131 USA Zone 5000 HOTELS&MOTELS- Prima ry GENERAL ? Primary Land Use 0803 MULTIFAMILY 2-9 UNITS: • MULTIFAMILY 3 OR MORE UNITS Beds/Baths/Half 4/4/0 Floors 1 z Living Units 4 Actual Area Sq.Ft Living Area Sq.Ft Taxable Value Information Adjusted Area 2,565 Sq.Ft 2015 2014 2013 Lot Size 8,580 Sq.Ft County Year Built 1955 Exemption Value $0 $0 $0 Taxable Value $257,283 $236,315 $221,264 Assessment Information School Board Year 2015 2014 2013 Exemption Value $0 $0 $0 Land Value $154,440 $137,280 $122,229 Taxable Value 1 $257,283 $236,315 $221,264 Building Value $102,843 $99,035 $99,035 City XF Value $0 $0 $0 Exemption Value $0 $0 $0 Market Value $257,283 $236,315 $221,264 Taxable Value 1 $257,283 $236,315 $221,264 Assessed Value $257,283 $236,315 $221,264 Regional Benefits Information Exemption Value $0 $0 $0 Taxable Value $257,283 $236,315 $221,264 Benefit Type 2015 2014 2013 Note:Not all benefits are applicable to all Taxable Values(i.e.County, Sales Information School Board,City,Regional). Previous OR Book- Sale Price Pae Qualification Description 9 Short Legal Description 9 MIAMI SHORES SEC 3 PB 10-37 10/24/2014 $590,000 2938938Qual by exam of deed 4076 LOT 21 &BEG SW COR LOT 22 E25FT 28321- NW131.23FT W7FT S129.99FT TO POB 09/04/2012 $270,000 0438 Qua]by exam of deed BLK 63 05/01/2001 $0 19721- Sales which are disqualified as a result LOT SIZE 75 X 130 2814 of examination of the deed 06/01/1999 $180,000 18701- Sales which are qualified 2617 The Office of the Property Appraiser is continually editing and updating the tax roll.This website may not reflect the most current information on record.The Property Appraiser and Miami-Dade County assumes no liability,see full disclaimer and User Agreement at hfp://www.miamidade.gov/info/disclaimer.asp Version: http://www.miamidade.gov/propertysearch/ 5/6/2016 Detail by Entity Name Page 1 of 2 W k Detail by Entity Name Florida Profit Corporation QTS Q= Filing Information Document Number P14000079242 FEI/EIN Number 30-0844168 Date Filed 09/24/2014 Effective Date 09/24/2014 State FL Status ACTIVE Principal Address 770 CLAUGHTON ISLAND DRIVE SUITE 1914 MIAMI, FL 33131 Mailing Address 770 CLAUGHTON ISLAND DRIVE SUITE 1914 MIAMI, FL 33131 Registered Agent Name &Address F Qlini Manuel 770 CLAUGHTON ISLAND DRIVE SUITE 1914 MIAMI, FL 33131 SUITE 1914 MIAMI, FL 33131 Name Changed: 01/04/2016 Address Changed: 01/04/2016 Officer/Director Detail Name &Address Title DPST MONTERO MUNOZ, CATALINA ' 770 CLAUGHTON ISLAND DRIVE#1914 MIAMI, FL 33131 Annual Reports http://search.sunbiz.org/Inquiry/CorporationSearch/SearchResultDetail?inquirytype=Entity... 5/6/2016 LIMITED POWER OF ATTORNEY KNOW ALL MEN BY THESE PRESENTS: That CATA LIGHTS CORP.,a Florida corporation (herein the "Company"), has made, constituted and appointed, and by these presents does make,constitute and appoint VICTOR GRUNBAUK as true and lawful attorney for them and in their name, place and stead to do the following: (1) To ask,demand,sue for,collect,receive and deposit in the Company's bank account all sums of money,rents,payments,late charges,penalties or other consideration now due or which may hereafter become due and owing to the Company; and give good and valid receipts and discharges for such payments. (2) To manage all of the Company's properly, real or personal, wherever located;to foreclose mortgages and to take title to property in the name of the Company if he thinks proper;and to insure any of our properties in such amount,against such risks and on such terms as our agent may deem proper. (3) To rent and lease as the Company's agent any and all property now or hereafter owned by the Company for such prices and on such terms, as the agent shall deem proper, and to sign and deliver leases, contracts and other instruments and make whatever payments may be appropriate or incidental to any such rental or leasing as our agent shall determine in his sole discretion. (4) To open and close utility accounts for utility services to the Company's properties and to engage the services of any and all contractors, subcontractors, repairmen, laborers, and other persons as necessary or required to repair and/or maintain all of the Company's properties in good working order and condition. (5) To retain counsel and attorneys on our behalf; to appear for the Company in all actions and proceedings to which the Company may be parry in the courts of Florida or any other state in the United States, or in the United States courts;to commence actions and proceedings in our name, if necessary;to sign and verify in my name all complaints,petitions, answers and other pleadings of every description. HEREBY GIVING AND GRANTING to our said attorney full power and authority to do and perform all and every act and thing whatsoever necessary to be done in the premises,as fully to all intents and purposes as the Company might or could do by and through its directors and officers, with full power of substitution and revocation,hereby ratifying and confirming all that said attorney may do pursuant to this Power. An executed duplicate of this Power,or a photostatic copy thereof, delivered by me or by my agent to any third party will be conclusive proof that this power has not been terminated and will continue in effect until the third party is advised by written notice from me or from my agent of the termination of the power. This Power shall become effective immediately. This Power shall be governed by the laws of the State of Florida. IN WITNESS WHEREOF, we have hereunto set our hands and seals the Z,�) day of February,2015. Signed, sealed and delivered in the presence of CATA LIGHTS CORP., a Florida corporation By. Name: Catalina M utero 001� P 9yorez -- Title: Director/President Printed e of Witness Apf'�O. 4.(q Printed Name of Witness STATE OF FLORIDA ) )SS: COUNTY OF MIAMI-DADE ) The foregoing instrument was sworn to,subscribed and acknowledged before me by Catalina Montero,as Director and President of CATA LIGHTS CORP.,a Florida corporation,on behalf of the company. She is personally known to me_or has produced as identification and she (x)did( )did not take an oath. IN WITNESS WHEREOF,I have hereunto set my hand and official seal in the State and County aforesaid this 2 ay of February,2015. NO =PUB tate 1 'da F7y� ARBARA D DELGAD®my con�MISSlor3#FF103244 ted Name of Notary EXPIRES March 17.2018 My Commission Expires: 9a ,, ice.ccmq p FlorldeN Commission No.: TT-10 2 2 q`'8 2 - STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD (850}487-1395 " a8 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 ;t a ARCHER,GEORGE T WORLD ELECTRICAL CONSTRUCTION SERVICE,CORP. 2744 SW 36TH AVE. MIAMI FL 33133 Congratulations! With this license you become one of the nearly one million Floridians licensed by the Department of Business and Professional Regulation. Our professionals and businesses range "&, STATE OF FLORIDA from architects to yacht brokers,from boxers to barbeque restaurants, DEPARTMENT OF BUSINESS AND and they keep Florida's economy strong. 1;.<' PROFESSIONAL REGULATION Every day we work to improve the way we do business in order to EC0002995 `ISSUED:•. 08/21/2014 serve you better. For information about our services,please log onto www.myfloridalicense.com. There you can find more information CERTIFIED ELECTRICAL CONTRACTOR about our divisions and the regulations that impact you,subscribe ARCHER,GEORGET, to department newsletters and learn more about the Departments WORLD EIECTRiCAL'CONSTRUCTION SERV initiatives. Our mission at the Department is:License Efficientty,Regulate Fairly. We constantly strive to serve you better so that you can serve your p' customers. Thank you for doing business in Florida, IS CERTIFIED under the provlslons of Ch.488 FS. and congratulations on your new Gcenset ExpMiion date:AUG 31.2016 1.14d6210MIGM DETACH HERE ",sa RICK SCOTT,GOVERNOR KEN L.AWSON,SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD ECOOD2995 The ELECTRICAL CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31,2016 ARCHER, GEORGE T V WORLD ELECTRICAL CONSTRUCTION SERVICE,CORP. 2744 SW 36TH AVE. MIAMI FL 33133.° ran ia. . ISSUED: 0821/2014 4 DISPLAY AS REQUIRED BY LAW Seth L1408210001893 Scanned by CamScanner ON 132 Local Business Tax Receipt Miami-Dade County, State of Florida -THIS IS NOTA SILL - DO NOT PAY 6128391 y�y�+�+ BUSINESS NAME1t OCATtptV RECEIPT mm XP��Ca7 WORLD ELECTRICAL CONSTRUCTION SERVICE.CORMNt f�AL SEPTEMBER � � 2,016 2744 SW 3*3 AVE 6391361 Must be displayed at place of business MIAMI FL 33133 Pursuant to,County Cade Chapter SA-Are.0&10 OWNER SEC.TYPE OF BUSINESS WORLD ELECTRICAL CONSTR SVC CORP. 196 ELECTRICAL CONTRACTOR PAYMENT RECEIVED ECO002995 Worker(s) 4 BY TAX COLLECTOR$45.00 09/30/2015 CREDITCARD—I6-0,00136 This Local Business Tax Receipt nail,confirms paymentof the Local Business Tax.The Receiptis nota license, perit or a certificaon of the hoidet" Holder must comply with any governmemalornaggovemmentairogwatorylawsa requirements which appiy.to the business. The RECEIPT NO.above must be disp►ayed on all cotrmtercial vehicles-Miami-Dade Code See Ba-278. For more ixfor nation,visit ZW miamidodo.eg_vPta=liector OF �' C,,...• CERTIFICATE OF LIABILITY INSURANCE DAT 05/0516YYY) _ 05.105116 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 CONTACT Sonia Alvarez MSN Insurance Brokers PHONE (305)266-4776 FA No): (305)266-4071 8150 SW 8 street Ste 224 AAAIL msninsurance(�igmail.com Miami,FL 33144 INSURERS AFFORDING COVERAGE NAIC# Phone (305)266-4776 Fax (305)266-4071 _ INSURER A: Granada insurance Company INSURED INSURER B: World Electrical Construction Service Corp INSURER C: 2744 SW 36 Ave INSURER D: Miami,FL 33133 INSURER E: INSURER r: 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. _ ILTR TYPE OF INSURANCE ADD SUBR POLICY EFF POLICY EXP INSR MD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000.00 COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED _PREMISES Ea occurrence $ 100,0w.00 F-1 F] 05/22/2015 05/22/2016 CLAIMS-MADE 0 OCCUR 0185FL00059671 MED EXP(Any one person $ 5,000.00 A ❑ PERSONAL&ADV INJURY $ 1,000,000.00 ❑ GENERAL AGGREGATE $ 2,000,000.00 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG $ 2,000,000.00 ❑ POLICY ❑ PRO- ❑ LOC $ AUTOMOBILE LIABILITYCOMBINED SINGLE LIMIT Ea accident ❑ ANY AUTO BODILY INJURY(Per person) $ ❑ ALL OWNED ❑ SCHEDULED AUTOS BODILY INJURY(Per accident) $ ❑ HIRED AUTOS ❑ AUTOS NED P OPERTY DAMAGE g er accident - - - - ❑_ $ ❑ UMBRELLA LIAB ❑OCCUR EACH OCCURRENCE i $ EXCESS LIAB ❑CLAIMS-MADE AGGREGATE $ DED ❑ RETENTIONS S WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY y/N ❑ ❑ R ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDEDIF7N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ If yes describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ i DESCRIPTION OF OPERATIONS t LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) License#EC0002995 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 10050 Northeast 2nd Avenue ACCORDANCE WITH THE POLICY PROVISIONS. Miami Shores,Florida 33138 AUTHORIZED REPRESENTATIVE ©1988-2010 AC ORPORATION. All rights reserved. ACORD 25(2010/05)CIF The ACORD name and logo are registered marks of ACORD 4W=16 7 ReportViewer t3 t tl i JEFF gTWATER C.IEF FINANCIAL OFFICER STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS'COMPENSATION I' 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'ComP ensation taw. 15s EFFECTIVE DATE: 4130/2016 EXPIRATION DATE: 4130/2016 fj d PERSON: ARCHER GEORGE ` t' FEIN: 463529854 BUSINESS NAME AND ADDRESS: ,I WORLD ELECTRICAL CONSTRUCTION SERVICE,CORP Ii 2744 SW 36TH AVE < MIAMI FL 33133 SCOPES OF BUSINESS OR TRADE: e` i ELECTRICAL WIRING WITHIN BUIL Rrwr+a Clapp a40.05{ta),Fy,.ma9cr aecapvWonwbaecU waneay+ew t»yame Dy forge Cer6fxematicBonwW ply yacum ' ." mar.u«weep.AaaeoeFpweemvaa ae a+�.waeaocnepp tgmllz).F.s,Cero daaemaeam.mp...avr app k?• ..a:nu,pecgmeaproi,Neuupomms+ypmu4+aocpaao�romaa�ma.Fwem.roclmo�aa�tI3LF.8..Naa,aa�nomEp � � plBparoceaawoyaaactlmblae.wap!amu.amis.+ro.apwda,E,a.yumea�s,o aw4aar:nrcevpotaeuaceamecauRmw FaymNYMCmUv/tALpp OlO4fb�eebfpBf mesa u+ereoaamsw amyummra uswspaemcacee.TnoaeF�e..asem,,.elea �*. �h 1" OFS.F2-0WC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 0&13 ' .y,•; QUESTIONS?IBSO)4131609 ? Z� I , C ` ca U 19 co U I � G r I U � � �� cn Ac moo® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY) .__ 05/17/2016 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 CON ACT NAME: PHONE FAX Automatic Data Processing Insurance Agency,Inc. ac No Ext): A/C,No): 1 Adp Boulevard ADDRIESS: _ Roseland,NJ 07068 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: NorGUARD Insurance Company 31470 INSURED INSURER B: WORLD ELECTRICAL CONSTRUCTION SERVICE CORP 2744 SW 36 AVE INSURER C: Miami,FL 33133 INSURER D INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 493280 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 I TYPE OF INSURANCE POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER MM/DDIYYYY MM/DDIYYYY COMMERCIAL GENERAL LIABILITY � EACH OCCURRENCE � $ CLAIMS-MADE u OCCUR j PREMISES(EO a occurrence) $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ — POLICY❑ PE 7 LOC PRODUCTS-COMP/OP AGG $ ' OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ — ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED 1 � RETENTION$ $ WORKERS COMPENSATION X STATUTE EORH AND EMPLOYERS'LIABILITY A OFFICERIMEMBER EXCLUDED?ANY N/A Y� NIA N WOWC700144 04/09/2016 04/09/201] E.L.EACH ACCIDENT $ 100+000 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under 500+000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS 1 VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Contractor License:EC0002995 CERTIFICATE HOLDER CANCELLATION 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 Northeast 2nd Avenue Miami Shores,FL 33138 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION.All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD ♦5B�'�S D *"' opA F4 Miami shores Village � wd Building Department �oR 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 RECEIPT PERMIT#: -FL-C- Is-- 2zr6 DATE: ❑Contractor (NAME) • Owner rchitect Picked up 2 sets plans and (other) Address: ' From the building department on this date in order to have corrections done to plans And/or get County stamps I understand that the plans need to be brought back to Miami Shores Village ing Department to tinue permitting process, Acknowledged by 1 ignature) PERMIT CLERK I ITIAL: �_ RESUBMITTED DATE: PERMIT CLERK INITIAL: ' Miami October 16, 2015 i � 1� 15 '22.1 Miami Shores Village OCT 2 ® 2015 Building Department 10050 NE 2nd Ave Miami Shores FI 33138 REFERENCE : Process No. ELC-8-15-2216 This letter is to notify that we have decide not to proceed with the proposed electrical work submitted under process number ELC-8-15-2216 at the property located at 699 NE 92 St.As consequence, please void that process number ay Victor Grunbau 6G V 2 ��l Property Ma er STATE OF FLORIDA COUNTY OF MIAMI DADE The foregoing document was acknowledged before me this L� day of /U ,2015, by Victor Grunbaum (Signature of Notary Public-State of Florida) (NOTARY SEAL) 1/ y p� ANGELA V.BASSAS g V ` MY COMMISSION#FF225614 (Name allotary Typed, Printed, or Stamped) BondEXPIRES:APR 29,ed through 1st 2019 Insurance -Personal m �L� OR Produced Identification Type of Identification oduced DATE(MMIDDfYYYY) CERTIFICATE OF LIABILITY INSURANCE 05123116 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 pollcy(l*s)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 CONTACT Sonia Alvarez NA A I MSN Insurance Brokers PHONE (305)266-4776 U)l (305)266 4071 8150 SW 8 street Ste 224 IRImsninsurance@gmail.corn Miami,FL 33144 INSURER($)AFFORDING COVERAGE NAIC Phone OW Granada Insurance Company 266-4776 Fax (305)266AO71 INSURER A: .......... INSURED INSURER 8, World Electrical Construction Service Corp INSURER C: .......................... 2744 SW 36 Ave INSURER D. .................... .................. Miami,FL 33133 INSURER E i .......................... ..................... .................. .................... COVERAGES CERTIFICATE NUMBER* REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN),SSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOT 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 1ADDLISUBN 1 POLICY EFF i POLICY EXP LTR TYPE OF INSURANCE !114SRIWVD Y NUMBER LIMITS POLICY (IMM1001'YYYY);IMMIDDIYYYYI ....... . ........ ............ GENERAL LIABILITY EACH OCCURRENCE s I,OW,000,00 ...................... DAMAGE TO RENTED fV COMMERCIAL GENERAL LIABILITY PRE S 100,000.00-1.1 CLAIMS-MADE OCCUR A ' MED EXP(Any one person $ 0.00185FLOD05961+ 05=(2016 EPERSONAL&ADV INJURY S 1,OW,000 , 0....0 _J ❑ .................... GENERAL AGGREGATE 2,000,000,00 GSN'L AGGREGATE LIMIT APPLIES PER. PRODUCTS-COMP/OP AG s 2,000,000.00 Rl� LOC ❑ POLICY El 'I'E AUTOMOBILE LIABILITY COMBINED SINGLE LIM IT ANY AUTO Ry(Per person} $ ALL OWNED SCHEDULED ❑ AUTOS ❑ AUTOS BODILY INJURY(Per accidents S .............. NON-OWNED 11-PR-�+--�++RTY AMAGE HIRED AUTOS ❑ AUTOS UMBRELLA LIAB ❑OCCUR EACH OCCURRENCE S ............. ❑ EXCESS LIAR ❑ CLAIMS-MADE AGGREGATE El DED [I RETENTION 11+111................... ................. .....................-++- WORKERS COMPENSATION TORY TATU OTH ER AND EMPLOYERS*LIABILITY YIN E.L.EACH ACCIDENT $ANY PROPRIETOR/PARTNERIEXECUTIVE NIA OFFICERIMEMBER EXCLUDED? (Mandatory in N14) F- �fj.21SEASfj-F�EMPLOYE. if tes,describe under POLICY LIMIT 1 DESCRIPTION OF OPERATIONS below E L DISEASE ......... ..................................... .................... DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(AUach ACORD 101,Add)13oiwil Remarks Schedule,it more space is requirea) License#ECO002995 ......................... ...................... 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 10050 Northeast 2nd Avenue ACCORDANCE WITH THE POLICY PROVISIONS. 4 Miami Shores,Florida 33138 AUTHORIZED REPRESENTATIVE 6 0 1988-2010 AC— D/�P�ORA N. All rights reserved. ACORD 26(2010J05)OF The ACORD name and logo are registered marks of ACORD