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ELC-14-367Miami Shores Village 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 B ML-1 FBC 20 �O BUILDING PERMIT APPLICATION Permit Type: Electrical Permit No. O-C, ( ^ 9 64- - Master Permit No. Cc _ r i 1v JOB ADDRESS: 9190 Biscayne Blvd. City: Miami Shores County: Miami Dade Zip: 33138 Folio/Parcel #: 11- 3206 - 010 -0030 Is the Building Historically Designated: Yes NO X Flood Zone: OWNER: Name (Fee Simple Titleholder): Ninety One Ninety LLC /Bank of America Phone#: Address:9190 Biscayne Blvd. City: State: Zip: Tenant/Lessee Name: Phone #: Email: CONTRACTOR: Company Name: Industrial Elecrical Systems Corp. Phone#: 305 228 -1384 Address: 10257 Nw 9th Street Circle #205 City: Miami State: FL - - Zip: 33172 Qualifier Name: Nestor I. Corvea Phone#: 305 228 -1384 State Certification or Registration #: EC 13002182 Certificate of Competency #: Contact Phone#: 305 228 -1384 Email Address: iesflodda @comcast.com DESIGNER: Architect/Engineer: Phone #: L"Z7GADC--, .clO / j2��'�'f`l t S 'EG s G" Value of Work for this permit: $23,200-.00-- Square/Linear Footage of Work: Type of Work: DAddress ❑Alteration ONew XRepair/Replace DDemolition Description of Work: Exterior upgrade as approved PLANS Submittal Fee $ <D' `�� Permit Fee $ e fl,©® CCF $ CO /CC $ r 16 Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ Bonding Company's Name (if applicable) Bonding Company's Address City State Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State zip 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 ELECTRICAL 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 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 l9**' dayof ,2oiq,by 14riel �iO , who is personally known to me or who has produced As identification and who did take an oath. NOTARY PUBLIC: Sign: My Commission Expires: APPROVED BY Signature- bf &Q /7-Y 7- - Onae, Contractor The foregoing instrument was acknowledged before me this J, () �( day of reb-0 VIA g:V , 20Lq. , by tE47Z2 T • CeV,�FA , who is personally known to me or who has produced as identification and who did take an oath. Notary Puft - State off ON& My Comm. Expires Sep 21, 2015 Commission # EE 132534 Sided Thmugh NOW Notary Ann. _ Plans Examiner Structural Review (Revised 3 /12=12)(Revised 07 /10107)(Revised 06/10nM)(Revised 3/15/09) NOTARY PUBLIC: FRRF0, 0 P. MORALES Sign: 'F ty we - St8t8 of fl ft Print29,tJCef ,' = ommission 38787 17, 2017 My Commission Expires: Zoning Clerk _wwr +i CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY) 01 -27 -2014 ,THIS CERTIFICATEIS 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 CERTIFICATEOF 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 ADDITIONALINSURED, the policy(ies) must be endorsed. If SUBROGATIONIS WAIVED, subject to the term and conditions of the policy, certain policies may require an endorsement. A statementon this cerdficate does not confer rights to the certificate holder In Ow of such endorsgrnimt(s). PRODUCER PAYCHEX INSURANCE AGENCY INC 210705 P:()— F: (888)443 -6112 P 0 BOX 33015 SAN ANTONIO TX 78265 CONTACT NAME: ' PHONE (A/C No tac,wo): (888)443 -611 ADDRESS: CUSTOMER ID 4: INSURERIS) AFFORDING COVERAGE NAIC d INSURED INDUSTRIAL ELECTRICAL SYSTEMS CORP 10257 N.W. 9TH STREET CIR. APT. 205 MIAMI FL 33172 INSURER A: Twin City Fire Ins Co INSURER R ` INSURER C: 1.0 INSURER D ; $ INSURER E 8 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. LTR TYPE OF INSURANCE MSR WVDI POLICY NUMBER POLICY UP MMIDDIYYYY) I POLICY EXP I I /YYYY) tINrtB GENERAL UABRF Y COMMERCIAL GENERAL LIABILITY CLAIMS-MADE U OCCUR EACH OCCURRENCE 1.0 PREMISES cemwence) $ MED EXP (Any am person) 8 PERSONAL & ADV INJURY $ GENERAL AGGREGATE 8 GENIL AGGREGATE LIMIT A PAS PER: POLICY PRO LOC PRODUCTS - COMP /OP AGG 8 $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS ri COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) 8 BODILY INJURY (Per accident) 8 PROPERTY DAMAGE tPw atzk1am) $ $ $ UNIBRELLA use u OCCUR EXCESS LIM CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DEDUCTIBLE RETENTION $ $ .. =< $ A Womms comm"ATION AND ORWYERS' LIA�nY ANY PROPMETOR/PARTNER/EXECUITVE YIN. �F�tE wy to N EXCLUDED? (� If yes, describe under DESCRIPTION OF OPERATIONS below N'" 7 6 WEG F0618 8 01 / 2 4 / 14 01 / 2 4 / 15 WC STA OTH- El- EACH ACCIDENT 1 000,000 E.L. DISEASE' - EA EMPLOY _$ $ 1 , 000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCR0FnON OF OPERATWNS I LOCATIONS I VEHICLES (Attach ACORD 101. Add(ttaml RwwIm So w", U nwre space is regnirmfl Those usual to the Insured's Operations. OFwnReATF MnLnFR CANCFLLAMM Village of Miami Shores SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED 10050 NE 2 ndAVe BEFORE THE EXPIRATION DATE THEREOF. NOTICE WILL BE Miami Shores, FL. 33138 DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. olriz Fax: 305 756 -8972 1988 -2009 AC01W COHMRX"ON. AN "91128 reserved. ACORD 25 (2009/08) The ACORD name and.,logo are registered marks of ACORD