EL-16-1494 I'VE�� r `� �•,� h y
Miami Shores Village � ° =
10050 N.E.2nd Avenue NE E" • `€ �;
Miami Shores,FL 33138-0000
Phone: (305)796-2204 =1=
�£ �€ Expiration: 11/30/2016
Project Address Parcel Number Applicant
464 NE 92 Street 1132060140030
Miami Shores, FL Block: Lot: JONATHAN&ANDREA TOVAR
Owner Information Address Phone Cell
JONATHAN&ANDREA TOVAR 464 NE 92 Street (786)375-5533 (305)610-0914
Miami Shores FL 33138-
464 NE 92 Street
Miami Shores FL 33138-
Contractor(s) Phone Cell Phone
Valuation: $ 300.00
AD ELECTRIC SERVICES INC (786)344-0211 Total Sq Feet: 00
Type of Work: Available Inspections:
Additional Info: Inspection Type:
Classification:Residential Review Electrical
Scanning:3
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $0.80
DBPR Fee Invoice# EL-5-16-58881
$2.25 05/31/2016 Credit Card $50.00 $120.10
DCA Fee $2.25
Education Surcharge $0,20 06/03/2016 Credit Card $120.10 $0.00
Notary Fee $5.00
Permit Fee-Additions/Alterations $150.00
Scanning Fee $9.00
Technology Fee $0.80
Total: $170.10
In consideration of the issuance a of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict co o ity with the plans,drawings,statements or specifications submitted to the proper authorities of Miami Shores Village. In
accepting this permit I assume r s .. for all work done by either myself, my agent, servants, or employes. I understand that separate permits are
required for ELECTRICAL,PLU N ,MEC NICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work.
OWNERS AFFIDAVIT: I certify ha all the regoing ' formation is accurate and that all work will be done in compliance with all applicable laws regulating
construction and zoning. Futhe o ,I th ove-named contractor to do the work stated.
June 03,2016
Authorized SignatuZent
er / Applicant / Contractor / Agent Date
Building I Copy
June 03,2016 1
R
ri
Y 11f'1 0 Miami Shores Village MAY 31 zois
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 20
BUILDING Master Permit NO15 jQ19A
PERMIT APPLICATION Sub Permit No
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION RENEWAL
❑PLUMBING ❑ MECHANICAL [:]PUBLICWORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 9,Q 4
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood
Flood Zone: BFEt FFE:
OWNER:Name(Fee Simple Titlgholder): AnJ rM 25. 1►:lV)'1 O V Phone#: 266 3575,533,
Address:
` E G
464 U
Ma b-
City: )OM> 'bV10roS State: F= , Zip: )3X
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name: �J C �l ld1C 5 0-KWO) -LY-C Phone#: :?-r(4"a.J' y.'C»1l
Address: /,QC/ (/Z 5W
City:-Ail°IA41 State: Zip: 3 !�
Qualifier Name: 'r t Phone#:
State Certification or Registration#: 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 ❑ Alteration ❑ New E21 Repair/Replace ❑ Demolition
Description of Work-
Specify color of color ihru iff►e:
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$
(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$2500,the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whoseprnperEy issrsrl6jeet to attachment 7#Isa;a certified capgaftheTecordettrrotfceaf commencememu3ted�i
for the first inspection wh" occurs seven (7) days after the building permit is issued in the absence of such posted notice, the
inspection will not be appr on einspection fee will be charged. d4
Signature Signature
INNER or GENT CONTRA OR
The foregoing instrume t was acknowledged before me this The foregoing instrument was acknowledged before me this
31 day of 20 by Z6 day of fu 11.S j P20-016 .by
--, who is personally known to % �f I q,,�,, f�.�/�(�/ �� who is personally known to
( r Lr�..l�—S�: p Y
me or who has produced as me or who has produced as
identification and who did take an oath. Identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Si Sign:
P Printil. C �,
Seal. Seal: F tNt01a0t
�~dn 10& Notary Public State of Florida
7� Joanna M Feliciano
My Commission FF 082153
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(ReWsed02/24/2014)
Jun. 1. 2016 4:22PM Emmanuel Insurance No. 8372 P. 1
A'►`Rd CERTIFICATE OF LIABILITY INSURANCE F°"06/01/MI/20011316
THIS CERTIFICATE 13 ISSUED A$A!BATTER 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
REPRIESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT:If the certificate holder Is an ADDITIONAL INSURED,the poi oy(les)must be endorsed.If SUBROQA-T10N $WAIVED,subject to
the terms and condlfions 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 endorsemeht(a).
PRODUCER a, Sere)Medina
Emmanuel Insurance&Associates.Inc. . (305)893-0009 o, (305)8014381
2370 E 8TH AVE: S. joele8mmanueMsunance.com
INBURERtSI AFFORDING COVERAGE NAIO 0
HIALEAH FL 33013.4236 INSMRA: Associated Industries Insurance Company,Inc.
INSURED INSURSR e: TRAVELERS PROPERTY CASUALTY COMPANY
AD ELECTRICAL SERVICES,INC. INIVAIM C�
Willem M.Dominguez INSRaffl D s
10442 SW 129TH PL INSURERt
MIAMI FL 33188-3848 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 TtiE 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.
A0VLTYPE OF INSURANCE POLICY NUMBER UMNS
COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE s 1.000,000.00
LAM,-.ADE �OCCUR S 100,000.00
MGD Exp M ons exon s 5.000.00
B 1.660.182M4921-TIL.-15 OMW2015 00/20016 p�ONAL A ACV INJURY g 1,000,000.00
_._._.. .... ....�._.. _.._... ....._._.........__... .. .._.. ..._ _...__.�...
GEN'LAOMOATEL@aTAPPLIESPER GENERALAGGREGATE g 2,000,000.00
POUCtf'L-j jt& ❑LOC PRODUCTS.COMPIOPAGG g 2,000,000.00
OTHER: 8
AUTOMOB8.8 LIABILITY E
ANY AUTOSSSCCCN BODILY INJURY(W Pers" S
AllULED
ALL OYVNED AUTOS D BODILY INJURY(Per acrid" S M—
MREOAUTOS
S
UMBRELLA LIAR OCCUR EACH OOCURWX09 8
EXCB8eUAB CWMS-MAOE AGGREGATE S
CEO I I RETENTION S Ig
WORKERS oolaP�Nsa
AND EMPLOYER&LIABILITY YIN X1 SPARTUTEE
A ANY FROPAIBTOR18ART'NGROMCUTNE E.L.EACH ACCIDENT S 1,000.000.00
=019.m 1,119 UDEDr Y�MIA AWC1062442 03/08/2018 03/06/2017 E.L DISEABE-EA EMPLOYE 'S 1,000,000.00
DEBCOON1 OPERATIC blow E.LDISEASE.POLICYLIMIT s 1,000.000.00
DE8CRftON OF OPERATIONS/LOCA7I0118l VBRICLEB IACORD 16f.Addldanal Ramaft iM6dule6 my be etInhad Iimore span Is reautre4
Electrical Contraoior,,
CERTIFICATE HOLDER CANCELLATION
Miami Shores Vitlage
Building Department SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
10050 NE 2 Avenue THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
Miami Shores Village FL 33138
auTHORI>�o RSPReaeNTaTIYe
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