EL-16-1191 r �
` pG liij j.� Miami Shores Village
10050 N.E.2nd Avenue NE F
Miami Shores,FL 33138-0000
E,
Phone: (305)795-2204
} ;?
Expiration: 12104/2016
Project Address Parcel Number Applicant
689 NE 92 Street Number: 11-G 1132060430270
Miami Shores, FL Block: Lot: ALEJANDRA LIBONATTI
Owner Information Address Phone Cell
ALEJANDRA LIBONATTI 10401 NE 6 AVE
MIAMI SHORES FL 33138-2048
Contractor(s) Phone Cell Phone Valuation: $ 1,800.00
NEC ELECTRICAL CONTRACTOR INC (786)389-8116
Total Sq Feet: 0
Type of Work:CHANGE PANEL,INSTALL GROUND TO REC Available Inspections:
Additional Info: Inspection Type:
Classification:Residential Final
Scanning:1 Meter Box
Alteration
Relocation
Fire Alarm
Service Change
Review Electrical
Underground
W.W.
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $1.20
DBPR Fee Invoke# EL-5-16-59628
$2.25 06/07/2016 Credit Card $ 110.70 $50.00
DCA Fee $2.25
Education Surcharge $0.40 05/03/2016 Credit Card $50.00 $0.00
Permit Fee-Additions/Alterations $150.00
Scanning Fee $3.00
Technology Fee $1.60
Total: $160.70
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 andM
Futhermore,I authorize the above-named contractor to do the work stated.
�Q_ , June 07, 2016
Authorized Signature:Owner / Applicant / Contractor / Agent Date
Building Department Copy
June 07,2016 1
Miami Shores VillageEO
Building Department10050 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 No. 49--ZE?
PERMIT A=ON Sub Permit No. �L ((0- `C
❑BUILDING ELECTRIC ROOFING ❑ REVISION ❑ EXTENSION [j RENEWAL
❑PLUMBING ❑ MECHANICAL PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 9 /t.°,:� 92 n`i S�r��� 11-6
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: // - X206 Qq 3- 0270 Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder):TobCa �/ r i�m� of.>* Phone#: ?05-713 --C,595
Cee
Address: ��V"° kT+-- Q d ►J O - -p
8
City: �_ �,\CX9 FS hCAR_S State: Zip:
Tenant/Lessee Name: Phone#:
Email: C.I16() J D0 . t.0 M
CONTRACTOR:Company Name: F('- (f i C,a 1 U DJ KAa 6&= W C, Phone#:
Address:tl 3'U)
City: Ig-i A yyL State: �l, Zip:
Qualifier Name: % nA AL.&:& Phone#: =7 1 Ce--3 94 y( 11,
State Certification or Registration#: E4,13620 �t _Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State Zip:
Value of Work for this Permit:$ I O L9 Square/Linear Foo a of Work:
Type of Work: El Addition ❑ Alteration,,, n Repair/Replace rJ❑ Demolition
Description of Work: OW a & S_tw I01 '&hJ1 d _tD
Specify color of color thru tile:
Submittal Fee Permit Fee$ CCF$ i '2_® CO/CC$
Scanning Fee$ :E!>•- Radon Fee$ ' DBPR$ Notary$
Technology Fee$t Training/Education Fee$ ®` Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$ �
(Revised02/24/2014)
f
4
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,14'such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature / Signature 1
,---- eWN or AGENTC Ol CTOR
The fpyegoing instrument was acknowledged before metbis The foreng instrument as ackriwledged before me this
day of 20 by day of .20/ by
t ! e�` o is personally known to 1 o s personally known to
J me or who has produced �� as mfr who has produced as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLI
Sign: Sign:_'z
Print • O )Print: "jS ���%✓�B`'
Seal: 2Notary
CASANDRAHARRISOW Seal: ��a;.:i,'s4, LUIS FERNANDEZ
Public.State of Florida ;s c MY COMMISSION#EE 838180
Commission#EE 198163 * * EXPIRES:November 7,2016
comm.expires May 14,2016 \QeBonded Thru Budget Notary 5e 0"'
*e<e<****�*a��a**��*�s*s�roe�s�:say***�asesr*s•wew�*>ea�a�**r**a�e�xs��x**�s�am+r*�x��x*x�
APPROVED BY 3/tf�l��6 Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
STATE OF FLORIDA - --- -- - --
DEPARTMENT-Of BUSINESS AND - - -- ~ 3
PRCJA I REWLAVON ___—_�
Eco 3007087AC# 01256943
'lfl120=5
CERTIFIED EL '# d I,CON f' C"tt3R
GARCIA I3QRNE`l, ttC �>
NEC ELECTRte"A� �t i✓TOR;
s N Y
IS CERTIFIED under the provisions of Ch.489 FS.
Eq&Won4W&:AU031,2MG L151
�- - -- ATURE
01
Local Business Tax Receipt
Miami—Dade County,State of Florida a..3
-THIS IS NOTA BILL-DO NOT PAY
6677281
BUSINESS NAMEROCATHM RECEIPT NO. EXPIRESNEC ELECTRICAL RENEWAL SEPTEMBER 30, 2016
CONTRACTOR INC 6949532 L Must be displayed at place of business
11720 185Pursuant to County Code
MIAMI,FFL 331177 7 Chapter 8A-Art.s&10
OWNER SEC.TYPE OF BUSINESS
NEC ELECTRICAL CONTRACTORPAYMENT RECEIVED
196 ELECTRICAL BY TAX COLLECTOR
INC CONTRACTOR 75.00 09/09/2015
Worker(S) 1 EC13007087 0221-15-007718
This Local Business Tax Receipt only confirms payment of the local Buslassa Tax.The Receipt is act a license,
permit or a certification of tiro boldWs qualifications,to do business.Halder most comply with any governmental
or nongovernmental regulatory laws and requirements which apply to the business.
The RECBFr N0.above rpt be displayed on all commercial verifies-Miami-Dado Cods Sec 88-276.
at1AM tmntore imformaBoa,visEt
AC"REP m m"E t INIMM" '1
CERTIFICATE OF LIABILITY INSURANCE 04/14/2016
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 owe holder Is an ADDITIONAL INSURED,the pollcy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to
the terns and cond"I m 4 of the policy,certain policies may requite an endorsement A statement on this certificate does not confer rights to the
certificate holder in Neu of such endorsement(s).
PRODUCER NAME:cl Alina Jimenez
A&A Insurance Services,Inc PHONE 786-518-2989 FAX N,:305-233-4289
12918 SW 133 CT 106: jainsurariceservices@gmail.com
Ward,FL 33186 AFFORDING COVERAGE NAIL#
INSURER A.Granada Insurance Company 16870
INSURED
INSURER s
Nec Electrical CorMad r Inc INSURER C:
11720 SW 185 CT INSURER D:
INSURER E:
Miami FL 33177 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 PERF
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.
DILA T�OF INADDL KM SURANCE Y NUMBER POLICY EFF POLICY EXP LIMITS
A X CNnMERCIAL GENERAL Lt4BILrY 0185FL00061036-01 07/22/2015 07/22/2016 EACH OCCURRENCE $ 1,000,000
cLalrSMace ❑X OCCUR PREMAGE TO $ 100,000
MED EXP one $ 55,000
PERSONAL&ADV INJURY $ 1,000,000
GE NL AGGREGATE LBT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
POLICY❑&
PRO-
X ❑LOC PRODUCTS-COMP/OPAGG $ 2,000,000
OTHER: $
AUTOMOBILE LIABILITY COMBINED SING LIM $
aoddent
ANY AUTO BODILY INJURY(Per Person) $
ALL MOIE) SCHEDULED BODILY INJURY(Per accident) $
AUTOS AUTOS
HIRmAUiGS � PROPE2TYDAMAGE $
$
tom!A tJABOCCUR EACH OCCURRENCE $
EXCESSLIAS C A ADE AGGREGATE $
DED I RETENTIONS $
VIORI(ERSCOMPENSAUM I SPEEkTUTER OTH-
NO EMPLOYERS'LIABILITY YIN —"
ANY PROPRI6rORIPARTNERfDECUiNEE.L.EACH ACCIDENT $
OFFICERIMEMBEREXCLUDED? ®N/A
(Mandatory In N1Q E.L.DISEASE-EA EMPLOYEE $
I lesarbe under
DESCRIPTION OF OPERATIONS bow E.L.DISEASE-POLICY LIMIT $
DESCA�f[ONQ> RATT /LDCA71 /YE1tLES(AGGRO 701,Addidond Remarks 8o1aalule,may be alfached I more space Is requhad)
Electrical Work Within Building
CERTIFICATE HOLDER CANCELLATION
Miami Shores Village Building Department
10050 NE 2 nd Ave, THE�IIRRA ori D� THEREOF,VE ENOT�ICE SS BE WILL BE DELIVEREED BEFORE
N
Miami Shores, FL 33138 ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHOR®REPIOESENTATIVE Og
O 1988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25(2014101) The ACORD nerne and logo are registered marks of ACORD
'
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."ATWATER STATE OF FLORIDA
CHIEF FWANCIA1.OFFICER DEPARTMENT OF FINANCIAL SERVICES
DIVISION OF WORKERS COMPENSATION
..CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS'COMPENSATION LAW"
CONSTRUCTION INDUSTRY EXEUPTK IN
Thts ceMfm that the irKWK W listed below has elected to be exempt from Fbnds Workers'Cornpensabon taw
EFFECTIVE DATE: 7125M14 EXPIRATION DATE: 7,2412016
PERSON: GARCIA BORNEY MAIKEL
FEIN: 273276231
BUSINESS NAME AND ADDRESS:
NEC ELECTRICAL CONTRACTOR INC
11720 SW 185 ST
MIAMI FL 33177
SCOPES OF BUSINESS OR TRADE:
LICENSED ELECTRICAL
CONTRACTOR exq
P nwemCnepcc 440 py i4 FB maaaamc 4S CCdde�od M.-11•e.ow scow
not rww.r cvefb m ca,pru>b.^
oltn.Ous�w abs7.hM.nws.00rw ete,.cOmnme.m�iVwwNm�et����iHF� amv�^'�ae vm wee
a.ma.to m.�•^44 ttr�O.suole,.t to mam..d,m•"r m+.mzrar�y
� a�� mr�e�gy oea ca�IDcate nm a_aman+u a'v],�ea�¢4e��am�.,t.ta.3aa ire
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DFS-F2-0WC-252 GE
P ;CATE OF ELECTION Tr F,-YEWPT REVISED 07-12 OL,EST�ONS^85Ud13tfg0y
NEC ELECTRICAL CONTRACTORS, INC.
May 3, 2016
State of Florida
County of Miami-Dade
Before me this day personally appeared Maikel Garcia Borney who being sworn,
deposes and says:
That he/she will be the only person working at the project located at:
689 NE 92 St. 11-6.
Cx
Sworn to an=,;; ibed be re me this day of
20 , by `�'� C- c
Personally Known
Or Produced Identification
Type of Identification Produced
1
'nt., Type o Stamp of Naotary
+P Notary Pubic Siete of FWAs
Cediia Medina
%70161
My Commission FF 939711
`7 p E*m 11MMM9
SCORES G1t
s� �► Miami Shores Village
"" Building Department
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.
Signature: aY&&I�aA
O �
State of Floria
County of Miami-Dade
The foregoing was acknowledge before me this day of r/1�y ,20 16 .
By A L-C.JANI)ej�, M��i NN1�( I who is personally known to me or has produced
fL 1w VE a - i Q)�-7- S� as identification.
Notary:
SEAL: aIMEMO se,ldxa aeion
FePUOIJ
9L996��u01S91Wwoz)lyq b t �u .5
ZO�OAIV e�pui,
Jo aledS o!K1nc!tIelop� �n ffiati`
a