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EL-16-1710 OL is. 'k, 1ss y Miami Shores Village ��T� ` 10050 N.E.2nd Avenue NW ' Miami Shores,FL 33138-0000 3 �' Phone: (305)795-2204 2, Expiration: 01/1812017 Project Address Parcel Number Applicant 165 NW 92 Street 1131010331000 Miami Shores, FL 33150- Block: Lot: WE BUY MIAMI LLC Owner Information Address Phone Cell WE BUY MIAMI LLC 18800 NE 29 Avenue (432)349-4620 AVENTURA FL 33180- Contractor(s) Phone Cell Phone Valuation: $ 800.00 MICHAUD ELECTRICAL SERVICES IN (786)273-1270 Total Sq Feet: 500 Type of Work:TO BRING EXISTING ELECTRIC UP TO CO Available Inspections: Additional Info: Inspection Type: Classification:Residential Review Electrical Scanning:1 Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $0.60 DBPR Fee Invoice# EL-6-16-60266 $3.38 07/22/2016 Credit Card $ 191.36 $50.00 DCA Fee $3.38 Education Surcharge $0.20 06/20/2016 Credit Card $50.00 $0.00 Notary Fee $5.00 Permit Fee-AdditionstAiterations $225.00 Scanning Fee $3.00 Technology Fee $0.80 Total: $241.36 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 zoni Fut ore,I authorize the above-named contractor to do the work stated. �� o July 22,2016 A horized Si a ure: ner / Applicant / Contractor / Agent Date Building Depa ment Copy July 22,2016 1 Miami Shores Village7JUN ` 016 Building Department 744�2' 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 209 BUILDING Master Permit No.T-01 (�— 0161 PERMIT APPLICATION Sub Permit No. V--" b — t-1 ❑BUILDING ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL F-IPLUMBING ❑ MECHANICAL PUBLIC WORKS ❑ CHANGE OF CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: � 6s- Sao 1z' City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: i 1 3 1 i " Vi I®04Z� Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titlp-holder): Wc- Phone#: `4 Address: City: ea� ��:_<' '� State: a Zip: Tenant/Lessee Name: Phone#: Email: J) Q CONTRACTOR:Company Name: E'@ t(�� L�� L W Phone#: ,>0 y' Address: S jL4(I,u 9-1)' :q?rLr'- ,bQ I!2 City: State: j -p Zip: ?3®s!�' Qualifier Name: 1 V-4! M1.e..�1-4AAL Phone#: 5V5 State Certification or Registration#: Certificate of Competency#: 02,E 40 li, DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ 8O Square/Linear Footage of Work: U® �6.f='T- Type of Work: ❑ Addition ❑ Alteration 9 New Repair/Replace ❑ Demolition Description of Work: a 3 -i 9-f(4 44 C':1-)Tl (1 C t-C- -M C p tic- Specify ic-Specify color of color thru tile: Submittal Fee$ Permit Fee$ ZZ eO CCF$ Q - CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ G U Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ I �� (Revised02/24/2014) Y 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 pasted at the JobFsite 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. ' Signat Signature C kZW--A �(,� OWNER or GENT / CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this �—day of Wy— 20 by day of 20 by N7FDbkQGR 3?\ � t r�Q&eersonally known to ho is personally known_to me or who has produced W- —k-N Was 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: nn Sign: Print: T� Print: p �t Seal: or�o�da Seal: W.n �us. BEl11 g00 Py" Notary��si�staceSandia Alvarez SSION#FF 1500o� My(;ora�m;slop FF 156750 EX�IRES-September 25,2018 p6cFi f20o9.031at �•3` Bm , ilrro' Y Setsices APPROVED BY WAN /W Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) DATE(MM/DD/YYYY) AC40R© CERTIFICATE OF LIABILITY INSURANCE 05/18/2016 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 pollcy(ies)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 NAME: T CMccullom Cloverleaf Insurance Brokers PHONE .No. 305-655-1006 FAA/c No):305-655-0730 18314 NW 7th Avenue E-MAIL Miami,Florida 33169 ADDRESS: cand r cloverleafinsurance.com CUSTUCE PRODR R Ip 0.18 INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURMA:GRANADA INSURANCE COMPANY MICHAUD ELECTRICAL SERVICES,INC INSURERB: 3882 NW 207 STREET ROAD INSURER C: OPA LOCKA, FL 33055 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,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 AD L SUBR POLICY NUMBER POU EFF MMIDD/YYYY LIMITS GENERAL UABIUTY 2M WVD EACH OCCURRENCE $ 500,000. DAMAGE TO RENTED ✓ COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ 50'000' A CLAIMS-MADE Z✓ OCCUR 0185FL0008734 4/21/16 04/21/17 MED EXP(Any one person) $ 1,000. PERSONAL&ADV INJURY $ 500,000. GENERAL AGGREGATE $ 1,000.000. GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 500,000. ✓ POLICY 71 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 DAMAGE HIRED AUTOS (Per accident) $ NON-OWNED AUTOS $ UMBRELLA LIAR HOCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION WC STALIMTU- I OTH- AND EMPLOYERS'LIABILITY ER ANY PROPRIETOR/PARTNER/EXECUTIVE� N/A E.L.EACH ACCIDENT $ OFFICERlMEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA MPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space Is required) Electrical Work in Buildings Is certified under the provisions of Chapter 10 of Miami-Dade County Lic# 03E000904 CERTIFICATE HOLDER CANCELLATION City of Miami Shores SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 10050 NE 2 Ave THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Miami Shores, FL 33161 ACCORDANCE WITH THE POLICY PROVISIONS. AU RIZE 7:0a"'F ©1988-2009 ACO D CORPORATION. All rights reserved. ACORD 25(2009109) The ACORD name and logo are registered marks of ACO 5�ORINC 1.93E,s Gr s� Irl iami shores Village Building Department r �`� 10050 N.E.2nd Avenue �LORIDp' Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Notice to Owner — Workers' Compensation Insurance Exemption Florida Law requires Workers' Compensation insurance coverage under Chapter 440 of the Florida Statutes. Fla. Stat. § 440.05 allows corporate officers in the construction industry to exempt themselves from this requirement for any construction project prior to obtaining a building permit. Pursuant to the Florida Division of Workers' Compensation Employer Facts Brochure: An employer in the construction industry who employs one or more part-time or full-time employees, including the owner,must obtain workers' compensation coverage. Corporate officers or members of a limited liability company (LLC) in the construction industry may elect to be exempt if: 1. The officer owns at least 10 percent of the stock of the corporation, or in the case of an LLC,a statement attesting to the minimum 10 percent ownership; 2. The officer is listed as an officer of the corporation in the records of the Florida Department of State,Division of Corporations;and 3. The corporation is registered and listed as active with the Florida Department of State,Division of Corporations. No more than three corporate officers per corporation or limited liability company members are allowed to be exempt. Construction exemptions are valid for a period of two years or until a voluntary revocation is filed or the exemption is revoked by the Division. Your contractor is requesting a permit under this workers'compensation exemption and has acknowledge that he or she will not use day labor,part-time employees or subcontractors for your project.The contractor has provided an affidavit stating that he or she will be the only person allowed to work on your project.In these circumstances,Miami Shores Village does not require verification of workers' compensation insurance coverage from the contractor's company for day labor,part-time employees or subcontractors. BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. Signa Own State of Florida County of Miami-Dade The AAforegoing was acknowledge before me this day of ( �( ,20 (y BylkV Ill (vltT?tata L1 GH JR 9EY M OVQ ho is personally known tome or has produced R_ -Do viDz C-IGENEC as identification. Notary: ,_JQ SEAL: �, oY ocB4 Notary Pubic State of r lorida Sindia Alvafaz Z DAy Commiss fr!cr 156750 x A OF aso�Q EXPires 091012^16 4y t �Gf�R��GGtf°/GQ��e�uices 3882 NW 207`h street road Opalocka,FL 33055 305-318-5150 Date:5/24/2016 State of Florida County of Miami-Dade County Before me this day personally appeared F&7who,being duly sworn,disposes and says: That he or she will be the only person located on this project located in: to S H \,,I 9 Z, .'T Sworn to(or affirmed)and subscribed before me this_,(Z day of 2016,by � G��c" Personally know._V OR introduced Identification: Type of Identification Produced: o'��;°°� BETTY HOLDER MY COMMISSION#FF 159690 EXPIRES:September 25,2016 iP�q oF�oP°e BandWThruBudge mury$eH" Print,Type or Stamp of Notary