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DEMO-12-2383 (2)1V1141111 011V1 GJ V 111d Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 BUILDING PERMIT APPLICATION Permit Type: Electrical G JOB ADDRESS: 5-7 (2 Sifeeill City: Miami Shores County: Folio/Parcel #: // ° 24 -0 7 ' 3116 JAL'te L' DEC 1 8 2.012 FBC 20 Permit No. Master Permit No o i 2333 Miami Dade Zip: 3 r3e° Is the Building Historically Designated: Yes NO Flood Zone: 4� I ;41 t�- Phone#: 444a`IC I 'L�tek �1+t1141 l/it� OWNER: Name (Fee Simple Titleholder): �( �(� � � Address: 1'5-7 �� q2e 5T 1 City: /'li44o Eh State: "1'; 3t 3 i Tenant/Lessee Name: Phone#: Email: 4tf11UA 4 -.LeW( e /4iigi SAO .eda( CONTRACTOR: Company Name: ` Re Address: l Y337 5th / 3 4rdf City: t 4 /1/1/ State: ft° �4 Qualifier Name: /1414,/a6 6 ` 54. J et' State Certification or Registration #: Contact Phone#: 7149 - 3T O -003c DESIGNER: Architect/Engineer: ��i 4t %t hone#: 78‘ - g% © 3( Zip: 31 Phone#: 7a7ro 66' 3f Certificate of Competency #: 00r. eve lS'� Email Address: Phone#: Value of Work for this Permit: $ 40° Square/Linear Footage of Work: Type of Work: ❑Address ❑Alteration Description of Work: ❑New ORepair/Replace emolition Ke 4t or i c7s ca4& r p h 3 1 j kii J �c.�G cm) `3 Ib �dL-f h ********** ********** ** ********* * * ******F *** *** * * * * * ** * * ** * * * ** *** * * *** ****+x**** *** Submittal Fee $ Permit Fee $ dam' ' ®® Scanning Fee $ Radon Fee $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ CCF$ CO /CC$ DBPR $ Bond $ Technology Fee $ 5� TOTAL FEE NOW DUE $ 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 FT FCTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and 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 n wh• occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection ill not b a ; %ved arrgl a reinspection fee will be charged. Sign Owner or Agent The foregoing instrument was acknowledged before me this i3 The foregoing instrument was acknowledged befor me this / day of bgreeJ,20 . , by( C'� LieheriniliklatlY of De-e- , 20 !a , by074 nr.e.4 rf•cJ.e 2 e who • rsonally knownn me or who has produced As identification and who did take an oath. NOTARY PUBLIC: who is rsonally known to me r who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: Sign: Print:Q I if a . / s' ! Print: My Commisysion Expires: 11- Zs_ / My Co ao�..•. ; o CECH IA ROMAN * * MY COMMISSION # EE034203 EXPIRES November 29, 2014 ****x44 * ...::,.. diekw********** * ** **+x *************s«* Plans Examiner �s , ._' ' o,''xpires :HELENA RODRIGUEZ ` - Notary Public - State of Florida ,, •s" My Comm. Expires Apr 28. 2018 '��rf'�: e Commission # EE 54565 cos. ` Zoning Structural Review Clerk (Revised 3 /12/2012)(Revised 07 /10/07)(Revised 06/10/2009)(Revised 3/15/09) Trades Qualifying Board BUSINESS CERTIFICATE OF COMPETENCY SANC NUELA Is certifi t under'the provisions of,Ct STATE OF FLORIDA AC# Er 2 4 'i ? 5 4 DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION 128031086 REG ELECT RI CQitTT ACTOR SANCHEZ JANDRO MAS ELECTRICAL CONT CTORS INC (INDIVIDUAL MUSTS ET ALL LOCAL LICENSING REQUIREMENTS PRIOR TO CONTRACTING IN ANY AREA) HAS REGISTERED under the provisions of Ch.489 xpiration date AUG 31 , 2014 L120806:01418 DEC-10 -2012 MON 10:45 AM FLAMINGO INS AGENCY FAX No. 3055583569 P. 002/002 ACORD. CERTIFICATE OF LIABILITY I •RODUCER Flamingo Insurance Agency, Inc. 2189 West 60th Street, Suite 202 Hialeah, FL 33016 305 - 828 -4847 VSURED MAS Electrical Contractors, Inc. 14337 S.W. 135 Avenue Miami., FL 33186 786 - 390 -0035 NSURANCE DATE(MM/DD/YYYY) 12/10/2012 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC# INSURERA Granada. Insurance Company INSURERS: INSURER C: INSURER 0: INSURER E: OVERAGES 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. 9t .m W 1. TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE(MM/DDNY) POLICYEXPIRATION DATE(MMIDD/YY) LMIITS A GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY 0185FL00031298 11/09/12 11/09/13 EACH OCCURRENCE $ 500,000 X DAWGE TO RENTED PREMISES (Ea eccurence) $ 100,000 1 CLAIMS MADE X OCCUR MED EXP (Any one person) $ 5,000 PERSONAL &ADYNIURV $ 500,000 GENERAL AGGREGATE $ 500,000 GEN L AGGREGATE UMIT APPLIES PER: I POLICY n ,(ECT n LOC PRODUCTS - COMP /OP AGG $ 500,000 " AUTOMOBILE LIABILITY ANYAUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON- OWNEDAUTOS COMBINED SINGLE LIMB (Ea accident) $ BODILYINJURY (Per person) $ BODILYINJURY (Peraccldent) $ PROPERTY DAMAGE (Peraccloent) GARAGE LIABILITY ANYAUTO AUTO ONLY- EA ACCIDENT $ EAACC OTHER THAN $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY OCCUR ri CLAIMS MADE DEDUCTIBLE RETENTION $ EACH OCCURRENCE $ -I AGGREGATE $ $ WORKERSCOMPENSATIONAND EMPLOYERS' LIABILITY AN Y TOanatMEER fCcur OFFlCMMW IXQUe ®7 ryes. describe under SPECIAL PROVISIONS below WC STATU- I TORYLIMITS I IOER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POUCY UM1T $ OTHER )ESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS Electrical Work Deductible: $500 PD per claim :ERTIFICATE HOLDER CANCELLATION Miami Shores Village Department 10050 NE 2nd Avenue Miami Shores, FL 33138 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES.- ,..zl� AUTHOR PRESENTATIVE 4CORD25(2001/08) OACORD CORPORATION 1988 DEC -12 -2012 WED 11:45 AM FLAMINGO INS AGENCY FAX No 3055583569 P.001 05 -07 -2012 JEFF ATWATER STATE OF FLORIDA CHIEF FINANCIAL OFFICER DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION * * CERTIFICATE OF E1.ECT1ON Teo XXXMPT FROM FLORIDA WORKERS' COMPENSATION LAW CONSTRUCTION INDUSTRY EXEMPTION This certifies That the individual listed below has elected to be exempt from Florida Workers' Compensation law. EFFECTIVE DATE: PERSON: FEIN: 06/15/2012 SANCHIZ 261724:170 BUSINESS NAME AND ADDRESS: MAS ELECTRICAL CONTRACTORS INC 14337 SW 135TH AVE MIAMI FL 3218e SCOPES OF BUSINESS OR TRADE: 1- REGISTERED ELECTRICAL CONTRACT EXPIRATION DATE: 06/15/2014 MANUEL A IMPORTANT Pursuant to Chapter 440. 051144, F.S., an officer of a corporation who elects exemption From this chapter by filing a certificate of alectian tinder this section may net renover benefits or compensation ander ON chapter. Pursuant to Chapter 4411.06(12% F.S, Certificates of elective to be exempt... apply ably within the scope of the business or trade listed en the notice of election to be exempt Pursuant to chapter 440.06(19), F.S., Notices of election to be simmer and certificates of • election to be exempt shall be sublet? to revocation if, at any time after the filing of the Mica or tha issuance of the certificate, the careen named on the notice or certlffoals no longer greets the requirements of this section for issuance of a certificate. The department shalt revoke a ceniftcats al my time for failure of the person nomad ea the certificate to meet the requirements of this section. OWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01-11 QUESTIONS? 1 5U) 413 -1609 PLEASE CUT OUT THE CARD BELOW AND RETAIN FOR FUTURE REFERENCE STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION CONSTRUCTION INDUSTRY CERTIFICATE of ELECTION TO BE EXEMPT PROM FLORIDA WORKERS' COMPENSATION LAW EFFECTIVE: 08/15/2012 EXPIRATION DATE: 08/15/2014 PERSON: MANUEL A SANCHEZ FEIN: 281724570 BUSINESS NAME AND ADDRESS: MAS ELECTRICAL CONTRACTORS MC 14337 SW 135711 AVE MIAMI, PL 33195 SCOPE OF BUSINESS OR TRADE: 1- REGISTERED ELECTRICAL CONTRACT IMPORTANT Pursuant to Chapter 440.05(14), F.S., an officer of a corporation who elects exemption from this chapter by filing a certificate of election L under this section may not recover benefits or compensation under this D chapter. Pursuant to Chapter 440,05(12), F.S., Certificates of election to be H exempt_ apply only within the scope of the business or trade listad on Ethe notice of election to be exempt E Pursuant to Chapter 441L05113), F.S., Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation if, at any time after the filing of the notice or the issuance of the certificate, the person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate. The department shall revoke a certificate at any time for failure of the person named on the certificate to meet the requirements of this section. QUESTIONS? (850) 413 -1609 CUT HERE * Carry bottom portion on the Job, keep upper portion for your records. DWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01 -11 DEC -12 -2012 WED 11 :45 AM FLAMINGO INS AGENCY FAX No. 3055583569 624306-7 USINESS NAME / LOCATION MAS ELECTRICAL CONTRACTOR 14337 SW 135 AVE' 33186 UNIN DADE COUNTY THIS 1S NOT A BILL. - p0 NOT PAY OWNER .MAS ELECTRICAL Soo, Type of SUSinea • IE A F CTRICAL liMim 86 TAx HEGSPT fT • POES NOT PERMIT TIN HOLDER TO VIOLATE ANY arm REOuLAToav ok Ne LAWS OF 1M cQ • UNW OR.cij?an• NOR • 001E$ rr e MT THA Kum • Amur FxQOA UI N8E NOT A O by CWATIANN of Mvu lU COUNryrAx OoLLEcTQr. 08/06/2012 000075.00 090102630 S 09010263001 C OWNER SIDL INC P. 002 FIRST-CLASS U.8. POSTA3E PAID MIAMI, FL PPRMIT NO. 231 RENEWAL RECEIPT NO. 650759-5 CC 4t 08E000252 CONTRACTOR INC CONTRACTOR WORKER/S 1 DO NOT FORWARD MAS ELECTRICAL CONTRACTOR INC MANUEL. A SANCHEZ PRES 14337 SW 135 AVE MIAMI EL 33186 11060ti•41,4 1l1l `4i }11171LLatild iiigg . v.