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EL-15-573Miami 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 BUILDING 1„ t -r Permit No. PERMIT APPLIC' r s b Permit No. ❑ BUILDING ELECTRIC ❑ ROOFING REVISION ❑ EXTENSION CETV r) NOV 25 2015 FBC 20 /b 20 ❑ RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP 6,^- n- CONTRACTOR DRAWINGS JOB ADDRESS: q.D Ai. (475#146- a 2 7 2 City: Miami Shores rf County: Miami Dade Zip: 3/ 3,$ Folio/Parcel#: Is the Building Historically Designated: Yes NO X Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): /IA C3/4 i LO(VjbrI Phone#: 786 - L L; — 74/54 Address: 9°290 / /,i ' s4I 2G pa City: MW)7b t �") > Le5 State: f2. Zip: .&3 f 3 8 Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: UNI Ta0 Ett - Z r"1G Phone#: ! - 21.47--652g7 Address:st/Y /3sc_e City: /41%4E5 s ie i State: i'L Zip: Zy ; 2 - Qualifier Name: I etr•i t 6.7904, A Phone#: 7aO — ZSS— c4 -2q State Certification or Registration #: i(2E 60 O tT Z Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: $ t X706 Square/Linear Footage of Work: Type of Work: n Additions (Z_�❑ Alterationra�❑ New ❑ Repair/Replace ❑ Demolition Description of Work: PidPrev j15to v Det E fig-i*MnR l N 9 siva ec Am est., 4YouI.E GAm-M. wi► fk Stzt rvh A7 e l Ai- r x ua 14 USf 12 Arl(T- Specify color of color thru tile: Submittal Fee $ Permit Fee $ X.Cee> CCF $ CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Notary $ Technology Fee $ Training/Education Fee $ Double Fee $ Structural Reviews $ Bond $ T TOTAL FEE NOW DUE $ rT (Revised02/24/2014) 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 Signature CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this (0 day of Nov e rn YYt f , 20 I C) , by 3.0 day of n OVA. w, b e , 20 I S , by R\ C 1 LoiNcA ort , who is personal!snamaa to JMC+rw a Ga vc+ £ , who is personal! known to me or who has produced as me or who has produced as identification and who did take an oath. NOTARY PUBLIC: identification and who did take an oath. NOTARY PUBLIC: Sign: / \ /N/-- r © Sign: Print: i i $ 1nC� I () Print: Seal: Seal: e`er CHRISTINA FRIGO MY COMMISSION # FF229344 EXPIRES: May 11, 2019 APPROVED BY (Revised02/24/2014) 4'4/4.1.- Plans Examiner /I 7f�''}JORGE ROSSE1ii t MY COMM1SION #FF119045 44 + EXPIRES MAY 4, 2018 j407)393AI53 FloridallolarvSenice.com Zoning Structural Review Clerk • '°"° `', ILP CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 11/24/15 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 Florida Bankers Insurance 7278 SW 8 Street Miami, FL 33144 Phone (305)266-6493 Fax (305)262-0679 CONTACT MARTA ALONSO P/(NCNNoExtr (305)266-6493 FAX No): (305)262-0679 • E-MAIL ADDRESS: marta@floridabankersinsurance.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : FEDERATED NATIONAL INSURANCE COMPANY N INSURED United Electrical Services Inc 26453 SW 135 COURT HOMESTEAD, FL. 33032 (305) 262-6743 INSURER B: TECHNOLOGY INSURANCE COMPANY 10/06/2015 INSURER C : EACH OCCURRENCE INSURER D : DAMAGETOcED PREMISES SES ((Eaa occurrence) INSURER E: MED EXP (Any one person INSURER F : PERSONAL & ADV INJURY 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. INSR TYPE OF INSURANCE ADDLSUBR INSR WVQ- POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MM/DD/YYYY) LIMITS A GENERAL LIABILITY n COMMERCIAL GENERAL LIABILITY ❑ ❑ CLAIMS -MADE V OCCUR ❑ N N GL -0504008126-04 10/06/2015 10/06/2016 EACH OCCURRENCE $ 1,000,000.00 DAMAGETOcED PREMISES SES ((Eaa occurrence) $ 100,000.00 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: V POLICY PRO- .IFDT ❑ LOC PRODUCTS - COMP/OP AGG $ 2,000,000.00 $ B AUTOMOBILE LIABILITY ❑ ANY AUTO ALL ❑ AUTOS OWNED ❑ AUTOSULED A ❑ HIRED AUTOS ❑ NON -OWNED AUTOS • ❑ COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ ❑ UMBRELLA LIAB ❑ OCCUR ❑ EXCESS LIAB ❑ CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ ❑ DED ❑ RETENTION $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) N / A N TWC3508542 11/19/2015 11/19/2016 , WC STATU- OTTH- TORY LIMITS ❑ER E.L. EACH ACCIDENT $ 1,000,000.00 E.L. DISEASE - EA EMPLOYE $ 1,000,000.00 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1 ,000,000.00 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, it more space Is required) LIC # 12E000192 CERTIFICATE HOLDER CANCELLATION VILLAGE MIAMI SHORES 10050 NE 2 AVE 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 ACORD 25 (2010/05) OF © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Miami Shores Village 10050 N.E. 2nd Avenue N Miami Shores, FL 33138-0000 Phone: (305)795-2204 Project Address 9290 N BAYSHORE Drive Miami Shores, FL 33138 - Permit NO. EL -3-15-573 p t Permit Type: Electrical - Residential Work Classification: Alteration Permit Status: APPROVED Issue Date: 6/4/2015 Expiration: 12/01/2015 Parcel Number 1132050270240 Block: Lot: Applicant RICKI LONDON Owner Information Address 9290 N BAYSHORE Drive MIAMI SHORES FL 33138-2949 9290 N BAYSHORE Drive MIAMI SHORES FL 33138-2949 Phone CeII Contractor(s) Phone UNITED ELECTRICAL SERVICES INC (786)797-2188 CeII Phone Valuation: Total Sq Feet: $ 12,700.00 00 Type of Work: NEW ELECTRICAL SYSTEM NEW ELECTRICA Additional Info: Classification: Residential Scanning: 3 Fees Due CCF DBPR Fee DCA Fee Education Surcharge Permit Fee - Additions/Alterations Scanning Fee Technology Fee Total: Amount $7.80 $6.67 $6.67 $2.60 $444.50 $9.00 $10.40 $487.64 Pay Date Pay Type Invoice # EL -3-15-54811 06/04/2015 Check #: 1007 Amt Paid Amt Due $ 487.64 $ 0.00 Available Inspections: Inspection Type: Review Electrical 1 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 zoning. Futhermore, I authorize the above-named contractor to do the work stated. June 04, 2015 Authorized Signature: Owner / Applicant / Contractor / Agent Building Department Copy Date June 04, 2015 1 BUILDING 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 RECUT\JED MAR 17 2015 BY. Master Permit No. FBC 20/0 L.5- 20 PERMIT APPLICATION Sub Permit No. Z--/ J. =S-7 ❑ BUILDING dELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑ RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR JOB ADDRESS: 9C9`Z0 V j kfC,. nr City: Miami Shores 5 DRAWINGS County: Miami Dade Zip: NO V Folio/Parcel#: L1,— / —0 Is the Building Historically Designated: Yes Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder):k,L( 6 .A \(. Addresss:t 13 1 City: '-41State: Tenant/Lessee Name: �j� Email: if l C lC,i tArCiA1-D V' l t9-el'1 VA" ertCL5 S P f _ C .itl CONTRACTOR: Company Name: Address: City: /4 -7r, -,'767- S7-4-,4 State: /-7e-- Zip: Qualifier Name: /‘79491"'4/6"-e, . 0 6,42,42ciA Phone#: State Certification or Registration #: EL2/3D/'/d ,6 9, Certificate of Competency #: i re El to -c: i tic r9 G C' 6-00 Phone#: --) J Phone#: Zip: 313`-) d lv x-/53 5t -t3 /35-C/c Phone#: 3136 zss 05- 2_5 786 5" 2./ 8� 2/ S S DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Square/Linear Footage of Work: Value of Work for this Permit:_$ AI 12_) 10 0 Type of Work: ❑ Addition ❑ Alteration _k bescription of Work:Ql etie f-- r' c -5677lb 041 '.0 New ❑ Repair/Replace / e ,'c /94-0144 9 ❑ Demolition Or:: e„ .b •' % Specify color of color thru tile:/ Submittal Fee $ Permit Fee $ mak/ / 'I.--4? CCF $ CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Notary $ Technology Fee $ Training/Education Fee $ Double Fee $ Structural Reviews $ Bond $ / TOTAL FEE NOW DUE $ < �/ S D cf.. (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. 1 1 "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. +F I 1 Signatur OWNER or AGENT The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged beforemethis �� day of `De_ C- , 20 IL{, by 2/ day of , 20 1 4 by ' %.1CAf�l t--0, t . c , who is personally known to Mit 0.64,7A\ , who is personally known to Signature CONTRACTOR me or who has produced as identification and who did take an oath. me or who has produced identification and wbo did take an oath. :a , `. NOTARY PUBLIC: �IIIIli1111oo/ NOTARY PUBLIC: '' ArlE'n/s' m cn Q�' a` Print: = a : °, 4, 6 : = Print: — — Seal: 3 /i Seal: PI ��...\EXPIRES . i3 //Nil/ illittO• ****************.************************************* ******** ****myJocoRmrls * *********** 2) a' /_C-- /C1/9 -7Z Plans Examiner as APPROVED BY (Revised02/24/2014) Zoning Structural Review Clerk