EL-14-269Miami Shores Village
Building Department
artment
`
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 € _
Tel: (305) 795.2204 Fax: (305) 756.8972,
INSPECTION'S PHONE NUMBER: (305) 762.4949
FBC 20 e _
BUILDING
PERMIT APPLICATION
Permit Type: (Electrical
Permit No.�
Master Permit No. F "� 3 — �S �✓
JOB ADDRESSAii55� ��%cC� m Qj p�i`e l) EKY
City: Miami Shores County: Miami Dade Zip:�33 1 � S
Folio/Parcel#: \� 5Q C_ 50`C- 0OUG
Is the Building Historically Designated: Yes
NO Flood Zone:
OWNER: Name (Fee Simple Titleholder): th F% t3,j,n k\V E RA Phone#: C�� �� to C)
Address:wz� s_
City: ��1�°:s' State:�'Z(a 4P
Tenant/Lessee Name: Phone#:
CONTRACTOR: Company Name: V ��t a �,..s Phone#:
Address: G�Zd 5:i'( (-z 7?
City: ftgf&/— State: )F�Em Zip: 11"U011
Qualifier Name: Phone#:
State Certification or Registration #: ga::-_4 7�2_ Certificate of Competency #:
Contact Phone#: Email Address:
DESIGNER: Architect/Engineer.. Phone#:
Value of Work for this Permit: $ ig6p 1�12e/Linear Footage of Work:
Type of Work: DAddress ' OAlteration CNew ORepair/Replace
Description of Work: Nwt-q_ r_wZ ! ry�
Submittal Fee $� Permit Fee $ f��'G' CCF $ CO/CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $ Technology Fee $
ODemolition
Double Fee $ Structural Review $
TOTAL FEE NOW DUE $ c�
P]
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 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 m 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.
a.
Signature Signature
O er or Agent Contractor
The foregoing instrument was acknowledged before me this The foregoin instrument was acknowledged before me this
day of , 20)x, by 9- �Ar -� day of 20/� by
who is personally known to me or who has produced who is ptenonally4mu�m tb me or who has produced
As identification and who did take an oath.
NOTARY PUBLIC: �
Notary Pu�stat,f FloridaSign: 8
PU p Commission
Print: E
xokeB 0110712018
My Commission Expires:
APPROVED BY
C47 Plans Examiner
Structural Review
(Revised 3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15109)
as identification and who did take an oath.
NOTARY PUBLIC:
P Notary Public sty Of Florida
Sign: Elsa Alvarez
Print: _ -L o1ro7t2018
My Commission Expires:
Zoning
Clerk
AmSTATE OF FLORIDA
DZPARTMM OF BUSINESS AND PROFESSIONAL REGULATION
ELECTRICAL CONTRACTORS LICENSING BOARD
1940 NORTH NONROE STREET
TALLAHASSEE FL 32399-0783
GRANT, GLEN EDWARD
VICOM ELECTRIC INC.
520 SOUT_ ST 63RD TERRACE
VAARGLTE FL 33068
(850) 487-1395
COngratulationsl With this license you become one of the nearly one million
OF FLORMA AC is
Floridians licensed by the Deparb-n-ent of Business and profwWonal Regulation
Our professionals and businesses range from architec
is to brokers, from
T -MM., - OF:`-AUSIXESS. A1.0
*X8 S-1 fl'&%k
LATION
yacht m
boxers W barbeque restaurants, and they keep Florlda's economy strong.
Every day we work to improve the way we do business In order to serve you better.11
For
XCO 0 02 07 2,,,:_, D7t12�� 128007499
Information about our services, please log onto 1dalicense.com.
There you can find more information about our divisionsRIC
w;"nTtP*h'e1reguIatIons
CERTTPTIM�, BLUCT- AL�, JLM N RACT09
that
Impact you, subscribe to department newsletters and learn more
e about the
Departments Initiatives.y
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Our mission at the Department W License Efficiently, Regulate Fairly. We
constantly shive to serve you better so that you can serve your customers.
Thank you for doing business In Florida, and congratulations on your new license!
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DETACH HERE
STATE -OF FLORIDA
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ROFEMICALOW&MRS1C,
IONAL -REM
SING:, BOARD
SEQ#1.12071201166
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RICK 8-COTT
WVIDWOR XEN LAWSON
SECRETARY
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•`• �"`,• CERTIFICATE OF LIABILITY INSURANCEohmoam w"
X110/2014
THIS CERTIFICATE IS ISSUED AS A HATTER 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 SY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BVrWEEN THE ISSUING INSURERM AUTHORM
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER
IMPORTANT: If the cerifficate hoider is an ADDITIONAL INSURED, ft poilcy(les) must be endorsed. N SUBROGATION IS -WAIVED, subject to
ON) terms and er In l lieu o of the policy. certain POftles may require an endorsement. A statement on this cwffflede don not confer flghts to the
certificate balder In Ileo of such eTldoreme s .
PRODUCER Ott; I
Reyes Coverage Insurance NAS David R
5900 Hiatus Road PHONE 954--72-4-7000
Tamarac FL 33321 __ gn�--
INSURED
Vicon Electric, Inc
520 SW 63 Terrace
Margate FL 33068
THIS IS TO C
PERIOD IND]
WHICH THIS
TO ALL THE
GENERAL LIABILITY
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MERCIAL GENERAL UABIUTY
CLAJD OCCUR
LIMIT APPLIES PER:
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DOCIMMOtN OPOPERATtM /LOCATIONS I VEHWM (Atfad, ACORD 101. AddU ma1 Remmke Schedule, if mwe epece Ie moo
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COMBINED SINGLE umrr $
SODILYWAIRY(Perpman) $
BODILY IN tURY (Per M=Ww f) $
PROPERTY DAMAGE
(per awde )
$
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SHOULD ANY OF THE ABOVE DESCRIBED POL CIES BE CANCELLED
BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELdNERED
Miami Shores Village
IN ACCORDANCE WITH THE POLICY PROVISIONS,
Building Department
10050 NE 2nd Ave
Miami Shores Village FL 33130 AUTHORIZEDREPUMENrAywE
019W2009 ACORD CORPORATION. AN rights reserved.
ACORD 25 (2009/09) The ACORD name and logo are reglstomd marks of ACORD
CERTIFICATE
OF LIABILITY INSURANCE VANWVfM
THIS CiERTfFICATE Is ISSttED AS A MATTER OF INFUFMATION ONLY AND COI .NORIGHTS UPON THE CERT{FICA7E HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATPA9.Y OR NEGATMELY AVAM EXTEND OR ALTER THE COVEItAM AFFORDED BY THE POLICIES
BELOW. TMS CERTIFICATE OF INSURANCE DOES NOT CONSTMITE A CONTRACT SEMEN THE M$tHDttlt MMURER(S), piTHORG!£D
REPRESENTATIVE
CER. AND THE CERTATE ROCKIER.
i iNf?R?RTANT: Ki1re . Ott PROW)� iro is an ADDIT1bAi
ae=cde holder In tiers of suchendo►sement{8y , mud be endorsed. 8 TO IS WAlVts,D, to
the tenns and conditions of the poticY, ceftn poncles may requlm an endorsemerrt A statement on gds Ce tete does pill coli?er> tds to the
PRODUCER
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, FL 33328.
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MIAMI SHORES VILLAGE. BUILDING DEPARTMENT
10150 NE 2ND AVENUE
MIAMI SHORES VILLAGE, FL 33130
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