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REV-16-1474 4 Miami Shores Village LBY: q 26 2016 Building Department " 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 T" INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 20 t q c� BUILDING Master Permit No. – Oe PERMIT APPLICATION Sub Permit No. 01.11 141 • ❑BUILDING 0 ELECTRIC ❑ ROOFING RrEVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING [:]MECHANICAL PUBLIC WORKS E] CHANGE OF [:] CANCELLATION [:] SHOP �7 C1� x + CONTRACTOR DRAWINGS 1 JOB ADDRESS: gl / ' E j 0 City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Of�6s&Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: n Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): ��r1 f�(A-Q- 19-1 J O V274 Phone#: tPT(o'" "l20"��71 Address: � `7 7 A) 67 102— City: l� -q%ea�� State: Zip: Tenant/Lessee Name: Phone#: l Email:CONTRACTOR:Company Name: 0- /ij 6'—Phone#: Address:_ __q-700 &Sg::�et L Nod 5-dl City: Xd� G0.hKJ State: Zip: Qualifier Name: A- -ft 4Z TQ I Ad- Phone#: State Certification or Registration#: O d f! / 7 Z Certificate of Competency#• ll if-00 0 3 DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ -360 Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ Newir/Replace ❑ Demolition Description of Work: 44-14: QY'L (31C 49/�C/1, Ala4 �Lt Specify color of color thru tile: Submittal Fee$ 0 Permit Fee$ CCF$ '2—Q CO/CC$ Scanning Fee$ ' Co Radon Fee$ -Q . `;S DBPR$ vl. Notary$ rs� Technology Fee$ ( - 6 G Training/Education Fee$. /'1 . q0 Double Fee$ X� Structural Reviews$ 0 Bond$ TOTAL FEE NOW DUE$ ' r0 • '- (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. 4ZTt %Signature Signature OWNER o AGENT CONT OR The foregying instrument was acknowledged before me this The foregoing instrument was acknowledged re me this daY of 20 by �ay of20 �by d `�` l �personall���y kCCno���n to •�'/GLI / r.tho is �ersonawn to me or who has produced as me or who has produced as identification and whoRzt] identification and who did take an oath. NOTARY PUBLIC: NOTARY PURI IQ Sign: Sign:_ Print: Print: Seal: clot`b1 vs3xlaxs Seal: nU SS10A1#FF43855 "REbrl.4#Nols& WO3 AW MY COMNu Aum 14 2017 Sa03dfdallna APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) From:Nelly Nisbett Fax:(306)672-9556 To: Fax: +1(306)7668972 Page 4 of 7 0612612016 2:26 PM 77 ? ir•{•, :t ,,;fit„•AT? Awe NMI 'W a. 1'f.t:t��:yw•: %.i.. •z� _ i� 3. •..'w. .fat:<., >TZ• Y :;'�;+f•'::4tiA ai, "3`n ;.�Z •.Yip ..A. •:.`.3•�: ,rj:iy .Lit `.yi:fa ••:••'fi•ti .t„�`��yt;v'4 :�:” +Sig•� .a•:.a:: ;y's}t• at=� •�t� i•a s: }� •t. r C'i�ecy•.a�" fi,' it• 3?;y .ate h� h lw:iit+ �3: ° < s:�.r .,rtt t: c t S a JoF,lyi'':9^ "^r*r Z,.. %};Yy,•.n ,..,.. .• +w: �jt3 .ti ;'i•.•,;$2:r �l4' `q.'yii• ":fi:::.,.', `'si' \.�...Ar;;p j• :>.. ..r:: •r�.t �'L�. 7>%ii.-r..`"�4,q+,. .x tfl� :? y�,Tiv •,:.> ,;1 .? �y,: .+a:}w•,'•`.�.'t ., :a}�t.,. ,'fir .w` . v,` '::i+:' i?iLn; .;nt. ,;.yz�>_..+ :..1..;.trt:••:.:x::.�. p:T.;<' Tx^:'•:. T•�w 1. `.3• 'Ctt.1, •.t" n...` .jR711c.FJ9� .•i: 'f :x.�i Awe,^`J�::'•:?'�S:i�: . ma 7 .ay ,,:.: :.,fir::{f52': J-: "•OY4 :;i+•,:;'i;:c;}' ';ii' S4r ' X011976 From:kely Nisbett Fax:(306)57Z9666 To: Fax: +1(305)7568872 Page 4 of 7 051281201810:39 AM Gem w, i lt.ti.. ki} n Y} — 5 Y}Y.. 4tv f"a (t4 { L:• 1� :.1 v' r1� yp r. .A y�•t:` .•y. RN �t�-r�.' ... syn. .. ��':� >;`.�'•':::'•'::'''. yy}�. " ax rAft ::. pi h T .... .... iasaa . - into _ ' =i - - f• t.. - f f f •,?i •- f r}I. 24 l,-'. ' 1 l,.. ::f1 t4• �... fTj f,,'. .•.'.. f. V^,I..'� F. t. aa.Sv} .:l;, f t,-.^ t ... i a f•",,,.i. I: qq t 4:fb a•, i�Y - x n-"1'4 ,mss 7-•,•s �t yr .r, i • !'��` � .{ i� •,i ;�; +i�. .�� *.�,. � tis;':: :'t. is r a From:Nelly Nisbett Fax:(305)572-9555 To: Fax: +1 (305)7568872 Page 5 of 7 05/2612016 2:26 PM . .L. ICTOB �`e3css 7Mar 11M.Gum a Bu FwtSS CERTi�K i4T E71F r' TED l is� � loaf 3atx� 1<taefe . From:NeAy Nisbett Fax:(305)572-9555 To: Fax: +1(306)7668972 Page 6 of 7 05/26/201610:39 AM QUALOFY S) owl ELEGMICAL 0004 RM ALAFM SPECLT a� v, From:Ney Nisbett Fax:(306)672-9666 To: Fax: +1(306)7668972 Page 2 of 7 •0612612016 2:26 PM AcoR[y® CERTIFICATE OF LIABILITY INSURANCE DATEIMM,oD,rYYY,. O5/2Q/2016 Tl;IIS 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), AUTHOR.IZEA 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 endomement.A statement on this certificate does not confer rights to.the certificate holder in Reu of such endorsements). PRODUCER S _NA_ u nem Herrera IwE: Advanced Professional Insurance.Ser ��, (95NE 46112 FAc No(954)725-6115 240 Lock Road "' A g. Sunem@epISUS-CQM _ INSURER(S)AFFORDING COVERAGE NAtC 3 Deerfield Beach FL 33442.. INSURER A: WESTERN WORLD INSURANCE COMPANY 13196 INSURED INSURER B: BJ BURNS,INC.DBA Outlook International Electrlp+ INSURER C: 1411.Sawgrass Corporate Parkway Suite B40 : INSURER D: :.. HYSURER E: Sunrise FL 33323 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. 1W +iTR TYPE OF INSURANCE v PDLICY'NUMBER t LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE FX-I OCCURS100,000 PREMISES Ea ce • ' $ �. LIED ExP(gr�one nl $ 50,000 A. NRR8353527. 05(14/2016. 05/14/,2017' !M.3ONAl.$ADV.rNJURY $ 1,000,000 GEWL AGGREGATE LIMITAPPLIES PER: ••• , �. ...., ' ' GENERAL AGGREGATE ' $ 2,000,000 X POLICY E)JE " Loc. PRODUCTS-COMPIOPAGG $ 2,000,000 OTHER: $ .. AUTO.MOBIEE LIABILITY. ' .. . .... ANY AUTO ..... .... Ea acdtlentZ_-._ --� BODILY INJURY $ ALL OWNED 'SCHEDULED ''. AUTOS AUTOS BODILY INJURY For accident) $ ti1REO.AUTOS UTOg PROPS WNEO . A $ $ UMBRELLA LIAB. ' OCCUR EACH OCCURRENCE $ EXCESS LIAR -CLAIMS-MADE .a. .r..,_„,_.. AGGREGATE $ 4 DED RETENTION$ $ WORKERS COMPENSATION AND EMPLOYERS,LIABILITY Y/N STATUTE ER ANY PROPRIETOWARTNERMXEC4[IVE. OFFICERPAEMBER EXCLUDED? N/A E L.EACH ACCIDENT $ - [Mandatory M NH) if yes,describe wider E.L.DISEASE.-EA EMPLOYE DESCRIPTION OF OPERATIONS betow E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,AddNl-.al Ramatks Sd�adu►e,. 6e al .,. !rlgY., t@Ched.Pr;morea0.agelBrequtred) . ertlfigats F)older,i�.addltiollel irlgyrad. Electrical Contractor .CERTIFICATE HOLDER ' CANCELLATION Miami Shores Village SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, • •• '• NOTICE -WILL BE •DELIVERED IN Building Department : -ACC QRDANCE WITH THE POLICY PROVISIONS, 10050-NE 2 Ave AUTHORIZED REPRESE TIVE ..' Miami Shores Village FL 33138 1 Sunem•Herter N . &A L uu_— ©1 8-2014 ACO RP0—RAT ISN.All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD From:Nefly Nisbett Fax:(306)672-9666 To: Fax: +1(306)7668972 Page 3 of 7 0612612016 2:26 PM OUTLO-1 OP ID: MKM ACORO" CERTIFICATE OF LIABILITY INSURANCE OATD o51201i2oi201 16 s 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 CONTA WEINSTEIN INSURANCE SERVICES NAME:CT Mary Muxo 5915 PONCE DE LEON BLVD.,#29 �N •305-665-2622 C No:3O5-665-3236 CORAL GABLES FL 33146 Aft-MAIL DDRESS: JAY A.WEINSTE N INSURERS)AFFORDING COVERAGE MAIC 0 INSURERA:ZENITH INSURANCE COMPANY INSURED OUTLOOK INTERNATIONAL ELECTRIC INSURERB: BJ BURNS INC.DBA 1411 SAWGRASS CORP. PKW#8-40 INSURERC: SUNRISE,FL 33323 INSURER D: 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,TERRA 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 MAYHAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCE POLICY NUMBER IMAJ159AI (AgMar%; LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE OCCUR PREMISES Eeoccurrence $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY F—]JPERC F-1 LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBIN Ea accdVt)S'NGLE LIMIT $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNEDSCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNEDPRO AMAGE H AUTOS Per accident $ UMBRELLA B OCCUR EACH OCCURRENCE $ EXCESS LU►B CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY X STATUTE ER A ANY PROPRIETORIPARTNERIEXECUTI VE YIN 126621303 05/14/2016 05/14/2017 E.L.EACH ACCIDENT $ 1,000,00( OFRCERIMEMBER EXCLUDED? � /A (Mandatory in NH) Il yes.describe under E.L.DISEASE.EA EMPLOYEE $ 1,000,00 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached K more space is requtred) Electrical Contractor CERTIFICATE HOLDER CANCELLATION Mlam i Shores Village SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Building Department THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 10060 NE 2 Ave Miami Shores Village FL 33138 AUTHORIZED REPRESENTATIVE 4,4 1)&__� O 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD