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RC-16-756 Miami Shores Village SCF, Building Department LIAR Z4 2096 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 ]BY: *SSW INSPECTION LINE PHONE NUMBER:(305)?b2-4949 FBC 2014 BUILDING Master Permit No. 9'C'IU Is b PERMIT APPLICATION Sub Permit No. ELIAki =�� ❑BUILDING EIIELECTRIC ❑ ROOFING ❑ REVISION EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP // / �^,� CONTRACTOR DRAWINGS ? JOB ADDRESS: J. L /�a AJE c.7%�lA� City: Miami Shores County: Miami Dade Zip: 3313 T Folio/Parcel#: I1DD'.21 U - Dl3 ow Is the Building Historically Designated:Yes NO ^ Occupancy Type:Fesieen�,a/ Load: Construction Type: &mak Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder):✓ n&A Mj AjrJC L ALr' Phone#: - �(S-2 .. Address: 30 IVEF /01-0 ��qq /I �L City: /I/lia.w: gAorej State: Zip: 33/3' Tenant/Lessee Name: 11& Pho e#: Email: 'Ona a LD M CONTRACTOR:Company Name: Pv*�C Side Phone#: i�t��s2»�7'S5 Address�Ooy G✓ S S`3 City: State: Zip: ?r 340I Qualifier Name: r/1MA✓!e-S Phone#: State Certification or Registration#: f'�O� / �/ Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ '210049 Square/UnearrFIF,000ttage of Work: c2t0 Type of Work: El Addition [ Alteration New L_ Repair/Replace ❑ Demolition Description of Work: 'TA SAX11416 ot, new Il4 k./f Y Specify color of color thru tile: Submittal Fee$ Permit Fee$ CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ (ReWsed02/24/2014) Bonding Company's Name(if applicable) s .1 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. 1 Signature Signilture OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this �—day of M A.arm 20 `( ,by 2 Z day of AlAct 4 020 l to ,by ,10 ,—(u A61^ ersonally known to O7;o"er =CVi ,who is personally known to me or who has produced a UW,*Az�as me or who has produced as identification and who did take an oath. identification and who did take an oath. NOTARY P LIC: NOTARY PUBLIC: ,. �: Andres Sanchez COMMISSION#FF206242 EXPIRES: MvO 4, 2019 Sign: Sign:' . °''h n l,��a WWw.AARONNOTARY.COw Print: �� V►/F� Print: 4V3 d Z Seal: Seal: v m Notary Public State of Florida Sindia Alvarez My Commission FF 156750 APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD (850) 487-1395 ° 1940 NORTH MONROE STREET 1TALLAHASSEE FL 32399-0783 IRVIN, JAMES RICHARD RIVERSIDE ELECTRIC AND CONTRACTING SERVICES LLC 8091 TENNYSON DRIVE TALLAHASSEE FL 32309 � million ddians Nosed by the Department of Business and - _ Professional Reguiation. Our professionals and businesses range STATE OF FLORIDA from archito yacht brokers,from boxers to barbeque restaurants, DEPARTMENT OF BUSINESS AND and they keep Fkuida's ecxmongr strong. _ PROFESSIONK-T EGULATION Every day we work to improve the way we do business in order to EC13004114 j4SUED: _07/24/2014 serve you better. For Information about our services,please log onto wlaww.myflorldellcense.com. Thema you can find more information CERTIFIED ELECTRICAL CONTRACTOR about our divisions and the regulations that impact you,subscribe CERTIFIED IRVIN, IED E ECTRI AL to department newsletters and lea m more about the Department's Initiatives. RIVERSIDE ELECTRIC AND CANTRACTING Our mission at the Department Is:License Effklently,Regulate Fairly. We constarmtiy stove to serve you better so that you can serve your Customers. ank you for doing business in Florida, IS CERTIFIED under the provisions of Ch.488 FS. and congratulations on your new license! Ejorm m,dit ALIG 31 2016 0407240001818 DETACH HERE RICK SCOTT,GOVERNOR KEN LAWSON,SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD EC1 4114 ADDITIONAL BUSINESS QUALIF1 ATION The ELECTRICAL CONTRACTOR NaMed below IS CERTIFIED Under the provisions Of Chapter 489 FS. Expiration date: AUG 31,2016 IRV"'JAMES.RICHARD Al D D RIVERSIDE ELECTRIC AND'CONTRACTING.SERVICES LLC 8091 TENNYSON DR _ TALLAHASSEE FL-32309 isms rn• n7immIA numi AY AC RFOI IIRFn RY I AW SEO# L1407240001818 A X 002426 Local Business Tax Receipt Miami-Dade County, State of Rome -THIS IS NOTA BILL - Do NOTPAYLBT 7180272 _ eus>wlesa NaNtenocATt�t atr►r eta. EXPIRES �F ELECTRIC 8 CONTRACTING SERVEC 10NO NW 138 ST#1 Ug&MAL SEPTEMBER 7426 30r2016 HW.EAH GARDENS FL 33018 Must be dbOfted at*of buskress PatauBot to CO,my CnaptereA-Arts&to ;litV€Ii.SIIDDE EHEC&CONTMaWG SVCS 196 ELECTRICAL CONTRACTOR PAYME gtr IMMMOD OC130C4114 BY TAX C1>"CT08 Worker(i) 75 '$00.00 08/03/2015 1� 0ECK21-15-110413 PaT POUEBat m �mLad'B Tax.Tre PWWpt lB na 1 . =rd s MC860W to dobmilwalL No to the toadoap.ll yry—e�8Wetahreartal ry latira vrl�happtp TlwXCWtN0.ab6wiinWb9 an all ceain craw raWales-Miaow Coda Seo ft-M For�alo�doa,felt --VION RIVEELE-01 WENDY 14CORU® DATE cM"uDD"mm �, CERTIFICATE OF LIABILITY INSURANCE 3/23/2016 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 CONTACT NAME: Acrisure,LLC d/b/a InSource PHONE FAX 9500 South Dadeland Boulevard N ;(305)670-6111 - lac.Not:(305)670-9699 4th Floor ADS:small@lnsoume4nc.com Miami,FL 33156-2867 ------- - --- INSURERS)AFFORDING COVERAGE +_NAIC S INSURER A:Colony Insurance Compal _ 39993 INSURED INSURER B:Wesco Insurance Co. 25011 Riverside Electric&Contracting Services,LLC INSURERC_Associated Industries Insurance Company Inc '23140 8004 NW 154 Street,#591 INSURER D. Miami Lakes,FL 33016 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 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 A POLICY EFF POLICY EXP LTR TYPE OF INSURANCE IND yryp POLICY NUMBER M1DD D LIMITS A X COMMERCIAL GENERAL LIABILITY 103GL000148602 12/01/2015 12/01/2016 EACH OCCURRENCE $ 1,000,00 j - CLAIMS-MADE �OCCUR 1 PREIDAMAGE TO RENTED $_-- — 100,000 -- _ MED EXP(Any one person) $ 5,00 -- — --- J _ PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,00 POLICY ""JECTPRO- [:]LOC l PRODUCTS-COMP/OPAGG $ 2,000,00 MBIde°,SINGLE LIMIT $ OTHER: acc �AUTOMOBILE LIABILITY � COMBINED -- $ 1,000,00 B X ANY AUTO WPP142256700 12/01/2015 12/0112016 BODILY INJURY(Per person) $ r ALL OWNED SCHEDULED BODILY INJURY(Per accident)j$ XAUTOS X NON-OWNED PROPERTY DAMAGE - $ HIRED AUTOS AUTOS (Per accident) _ $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ -- - -- -- EXCESS UAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY YINN STATUTE _ ER 12101/2016! E.L.EACH ACCIDENT $ 1,000,00 (Mandatory in NH) --- ---- C ANYPROPRIMB R/PXCLUD/EXECUTIVE AWC105W75 12/01/2015 OFFICER/MEMBER EXCLUDED? N N/A (yas describe tinder E.L.DISEASE-EA EMPLOYE $ 1,000,00 y ---— DESdRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,maybe attached C more apace Is required) Electrical Work license number EC 13004114 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Miami Shores Village Building Department THE EXPIRATION DATE THEREOF, NOTICE WALL BE DELIVERED IN g g p ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE 2nd Ave Miami Shores,FL 33138 AUTHORIZED /REPRE�SENNTTATNE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD