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ELC-17-229Project Address Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138-0000 Phone: (305)795-2204 Permit Permit NO. ELC-1-17-229 Permit Type: Electrical - Commercial Work Classification: Addition/Alteration Permit Status: APPROVED Issue Date:1/31/2017 Expiration: 07/30/2017 Parcel Number Applicant 10200 BISCAYNE Boulevard Miami Shores, FL 1122310450010 Block: Lot: MIAMI SHORES VILLAGE Owner Information Address Phone Cell MIAMI SHORES VILLAGE Contractor(s) 0 & J ELECTRIC CONTRACTOR Phone (305)326-8852 Cell Phone Valuation: Total Sq Feet: $ 100.00 0 Type of Work: NEW UNDERGROUND CONDUITS Additional Info: NEW UNDERGROUND CONDUITS Classification: Commercial Scanning: 1 Fees Due CCF DBPR Fee DCA Fee Education Surcharge Permit Fee Scanning Fee Technology Fee Total: Amount $0.60 $2.00 $2.00 $0.20 $100.00 $3.00 $0.80 $108.60 Pay Date Pay Type Amt Paid Amt Due Invoice # ELC-1-17-62759 01/31/2017 Check #: 1468 $ 108.60 $ 0.00 Available Inspections: Inspection Type: Final Meter Box Alteration Relocation Fire Alarm Service Change Review Electrical W. W. Underground , 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 AFFIDAVI • I that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zo ng., ermore, I authorize the above-named contractor to do the work stated. January 31, 2017 Aut Sig ature: Owner / Applicant / Contractor / Agent Buildin • Department Copy Date January 31, 2017 1 BUILDING PERMIT APP 0BUILDING CATION Miami Shores Village 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 RECET\T D I JAN 27 2017 BY: Jt FBC 201 q- Master Permit No. )LC t 11— Z.2-9 Sub Permit No. ELECTRIC ❑ ROOFING ❑ REVISION ❑PLUMBING ❑ MECHANICAL PUBLIC WORKS ❑ CHANGE OF CONTRACTOR JOB ADDRESS: City: Folio/Parcel#: Occupancy Type: / O,-1 0 Miami Shores (;4 sc�/,Il e County: Miami Dade ❑ EXTENSION ❑RENEWAL ❑ CANCELLATION ❑ SHOP DRAWINGS Zip: 33i Is the Building Historically Designated: Yes Load: Construction Type: Flood Zone: NO BFE: FFE: OWNER: Name (Fee Simple Titleholder): 1 ' `i OX S v + It&G 'Q Phone#: 30s - T /S " Z.201 Address: 10050 �-e Z City: (VN arra, LS kek0v 'e S State: Ti6 r +CGI zip: 33)9)8 Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: 0 Q H Ci / FA Address: 3 S 3 3 City: '-i q 0", 1 h' \(9 5\7L State: Phone#:(J03S]2. 6 I3erSX Zip: ).)/ Y 4 Qualifier Name: f P H Ct / CI M.. . „c./t @ / Phone#:(Q 03) ).z 6 - P g' 1^ 2 State Certification or Registration #: T % 0 0 0 0 Pk. ). 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 •L Description of Work: p ❑ New t hdc ! 0 I., o ❑ Repair/Replace C o h CI f / ❑ Demolition Specify color of color thru Submittal Fee $ Scanning Fee $ Technology Fee $ .S0 tile: Structural Reviews $ (Revised02/24/2014) Permit Fee $ 1 Or erel CCF $ e cC 0 co/cc $ Radon Fee $ 2 DBPR $ 2- Notary $ Training/Education Fee $ o Z Double Fee $ Bond $ �— TOTAL FEE NOW DUE$ 108 COO 1: 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 $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature OWNER or AGENT The foregoing instrument was acknowledged before me this Z H day of IOM Signature ii44( CONTRACTOR •� The foregoing instrument was acknowledged before me this 20 -1 , by "Z- day of ri' `4 , 20 / 7 , by o is personally known to Ze.1,04 Q- "414454 , who is personally known to me or who has produced as me or who has produced as identification and who did take an oath. NOTARY PU Sign: Print: Seal: 1't Y YANADYPRIETO •` MY COMMISSION # FF 214031 EXPIRES: March 25, 2019 Bonded Thru Notary Public Underwriters identificatio. = . w mdid take an oa$fa 49 LEYAMIS HERNANDEZ NOTA' PUBLIC: MY COMMISSION # FF 169267 i I ` ;�dt o ded . BThn Budget NatarY Se rvivice$ Sign: Print: G 5f4Z 4t g (-4 u_wc�P'7_____ Seal: •****************ek 5k'8F' k's r: "., ,•`. *******pit******************************R************************** APPROVED BY (Revised02/24/2014) 3di.��Plans Examiner Zoning Structural Review Clerk STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD 2601 BLAIR STONE ROAD TALLAHASSEE FL 32399-0783 HANDSEL, LENARD 0 & J ELECTRIC CORP 9762 NW 8TH TERRACE MIAMI FL 33172 Congratulations! With this license you become one of the nearly one million Floridians licensed by the Department of Business and Professional Regulation. Our professionals and businesses range from architects to yacht brokers, from boxers to barbeque restaurants, and they keep Florida's economy strong. Every day we work to improve the way we do business in order to serve you better. For information about our services, please tog onto www.myfloridalicense.com. There you can find more information about our divisions and the regulations that impact you, subscribe, to department newsletters and learn more about the Department's initiatives. Our mission at the Department is: License Efficiently, Regulate Fairly. We constantly strive to serve you better so that you can serve your customers. Thank you for doing business in Florida, and congratulations on your new license! RICK SCOTT, GOVERNOR LICENSE NUMBER STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL.REGULATION :EC0000122 f ; ISSUED:. 08/17/2016 CERTIFIED NDELECTRICAL C _ T;� HANDSEL, LE VARD ONTR (850) 487-1395 OR - AC" O &:. ELECTRrC CORP / tS1,CE.RTIFIEO under the provisions of;Ch.489,FS. EkP tign date AUG'31, 201"8� . —.- i r L1608tT0003084" DETACH HERE KEN LAWSON, SECRETARY STATE OF FLORIDA— DEPARTMENT LORIDADEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD. ,The ELECTRICAL CONTRACTOR -Naffed below IS CERTIFIED ;Under -the provisions of Chapter.489 FS. 'Expiration date: AUG 31, 2018• -HANDSEL,LENARD f .01 0 & J ELECTRIC .CORP T!/3533 NW 49TH ST MIAMI FL 33142 r'r�+ — ISSUED- og/17/2ote ti•1, 'moi y �• ►4, ,.` Q DISPLAY -AS REQUIRED•BY LAV A-----" - -5EQ L'�6081 0003084E---,� ��J 007882 Local Business Tax Receipt Miami -Dade County, State of Florida —THIS IS NOT A BILL —1)0 NOT PAY 5395686 BUSINESS NAME/LOCATION 0 & J ELECTRIC CORP 3533 NW 49 ST MIAMI FL 33142 OWNER O & J ELECTRIC CORP C/O LENAR HANDSEL QUALIFIER Worker(s) 1 RECEIPT NO. RENEWAL 6634515 LBT EXPIRES SEPTEMBER 30, 2017 Must be displayed at place of business Pursuant to County Code Chapter 8A — Art. 9 & 10 SEC. TYPE OF BUSINESS 196 ELECTRICAL CONTRACTOR EC0000122 PAYMENT RECEIVED BY TAX COLLECTOR $75.00 07/08/2016 ECHECK-16-169305 This Local Business Tax Receipt only confirms payment of the Local Business Tax. The Receipt is not a license, permit, or certification of the holder"s ualifications, to do business. Holder must comply with any governmental or nongovernmental regulatory laws and requirememswhich apply to the business. The RECEIPT NO. above must be displayed on all commercial vehicles — Miami—Dade Code Sec 8a-276. For more information, visit YYl9lw.mlarnld . 9.gpflhaxeaHaetar A�� CERTIFICATE OF LIABILITY INSURANCE 05/26/2o 6 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 SUPERIOR INSURANCE CONSULTANT 12401 Orange Drive Suite 135 Davie FL 33330 CONTACT Jennifer Gordon (PH/CNNFAX AExt): (954)862-1411 A/CNO):(954)862-1769 E-MAIL • ADDRESS: ennifer@sicfl.com INSURER(S) AFFORDING COVERAGE NAIC # INSURERAMAPFRE INSURANCE CO OF FL UABIUTY COMMERCIAL GENERAL LIABILITY INSURED 0 & J ELECTRIC CORP AND N & 0 LEASING MANAGEMENT CORP 3533 NW 49 Street MIAMI, FL 33142 Vendor ID - 738130 INSURER B: 4250150020398 INSURERC: 05/01/2017 INSURERD: $ 1,000,000.00 INSURER E : $ 100, 000.00 INSURERF: CERTIFICATE NUMB • 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. INSR TYPE OF INSURANCE ADDL USSR SUBR wvn POLICY NUMBER POUCY EFF (MM/DD/YYYY) POLICY EXP (MM/DD/YYYY) LIMITS A GENERAL X UABIUTY COMMERCIAL GENERAL LIABILITY X Y 4250150020398 05/01/2016 05/01/2017 EACH OCCURRENCE $ 1,000,000.00 DAMAGE TO RENTED PREMISES (Ea occurrence) $ 100, 000.00 CLAIMS -MADE X OCCUR MED EXP (Any one person) $ 5,000.00 PERSONAL & ADV INJURY $ 1,000,000.00 GENERAL AGGREGATE $ 2,000,000.00 GEN'L AGGREGATE LIMIT APPLIES PER: il POLICY Ti PF n LOC PRODUCTS - COMP/OP AGG $ 2, 000, 000.00 $ A AUTOMOBILE X X LIABILITY ANY AUTO— ALL OWNED AUTOS HIRED AUTOS X x SCHEDULED AUTOS NON -OWNED AUTOS 4150130008116 04/30/201604/30/2017 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000.00 BODILY INJURY (Per person) $ BODILY (Per ( ) $ PROPERTY DAMAGE (Per accident) $ P.I.P $ 10,000.00 UMBRELLA UAB EXCESS UAB — OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENT ON $ $ WORKERS COMPENSATION AND EMPLOYERS' UABIUTY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y / N N/A WC STATU- OTH- TORY I IMITS ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) Certificate Holder is listed as Additional Insured Contractor's License # EC 0000122 ATE HOLDER CANCELLATION MIAMI SHORES VILLAGE 10050 NE 2 AVENUE MIAMI SHORES, FL 33138 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Roger Guerrero/AGT ACORD 25 (2010/05) INSA9!5 rsntnnsl m © 1988-2010 ACORD CORPORATION. All rights reserved. Tho Ar f1Rll name anti Innn ara ranicfnrnri marIc of Armen Arco CERTIFICATE OF LIABILITY INSURANCE DATE n 7/5/2016 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 policy(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 Eastern Insurance Group, inc. 9570 SW 107 Avenue Suite 104 Miami FL 33176 CONTACT Amanda Nogues CN(305)595-3323 aC No:(305)595-7135 o. Ext): E-MAIL amanda@easterninsurance.net ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INsuRERABridgefield Employers Insuranc INSURED 0 & J Electric Corp. 3533 NW 49 Street Miami FL 33142 INSURER B : INSURERC: CLAIMS -MADE INSURERD: OCCUR INSURER E : $ INSURER F: CERTIFICATE NUMBERktaster 16-17 • • 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. INSR LTR TYPE OF INSURANCE ADDL INRJ) SUBR WVD POUCY NUMBER (MM/DDY/YEYm (MM/ POLICY EXP LIMITS EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR DAMAGE TO RENTED PREMISES (Ea occurrence) $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GEN'L AGGREGATE POLICY OTHER: LIMIT APPLIES PRO - JECT PER: LOC GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ $ AUTOMOBILE UABIUTY ANY AUTO ALL OWNED AUTOS HIRED AUTOS SCHEDULED AUTOS NON -OWNED AUTOS COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY(Per accident)$ PROPERTY DAMAGE (Per accident) $ $ UMBRELLA UAB EXCESS LIAB — OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTON$ $ A WORKERS COMPENSATION,PER AND EMPLOYERS' UABILfTY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y / N y N / A 830-54655 7/9/2016 7/9/2017 STATUTE OTH- ER E.L. EACH ACCIDENT $ 100,000 E.L. DISEASE - EA EMPLOYEE $ 100,000 E.L. DISEASE - POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) electrical contractor Contractor's license #EC 0000122 CERTIFICATE HOLDER CANCELLATION Miami Shores Village 10050 NE 2 Avenue Miami Shores, FL 33138 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE David Lopez/DAVID ACORD 25 (2014/01) INS025 (2m4nn © 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD