EL-14-2064 Miami Shores Village 17-ZECEIV�D
Building Department SEP 28 201
10050 N.E.2nd Avenue,Miami Shores,Florida 33138 j
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949
FBC 20
BUILDING Master Permit No. '&iZ4 - :i 49-
PERMIT APPLICATION Sub Permit No. EL.114 =?10(6L¢
❑BUILDING �ECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 44100
City Miami Shores County: Miami Dade Zip:
Folio/Parcel#: /I - 20249S- INV Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder): -419 11VE PVUWC lLI Phone#:
Address: 6111047 '70V;7d RQW902S W- .
City: MlAmi eWoogs State: PC Zip: ' 'sh$o
Tenant/Lessee Name: Phone#:
Email: / /
CONTRACTOR:Company Name: LA_.Volaa ] ( 7i�iuc Phone#: '7/44n6*-aa—
Address: 1417 Z '_&w
City: 4f / State: Zip: 42.4
Qualifier Name: tTPJ�i D t��a llyd Phone#: 3/¢
State Certification or Registration#: /,4 6000 ;Z7 7 Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
7 0,
Value of Work for this Permit:$ ld Square/Linear Footage of Work:
Type of Work: ❑ Addition 0 Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work: JZELVOW IvLgcTrUGAL, sWPre/jr-S Alpw d 4urc 5 DOTEOeA.
Specify color of color thru dler
Submittal Fee$ ''`i�ci't4ilt"�ee'$ �$ '' CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$
(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.
"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$2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also,a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
0-
Signature Signature
OWNER or AGENT I WCCTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
_day of 20 by 010) day of �V 5 �" ,20 by
1��'e "t(4 I ,who' personally know o '1>rf 1)12 OVAL 1) ,who is personally known to
me or who has produced a$ me or who has produced as
identification and who did takes �,th. Lori C. (orris identification and who did take an oath.
.:°' OMMISSION#EE218753
NOTARY PUBLIC: - �CNOTARY PUBLIC:
9' " EXPIRES:AUG.05,2016
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Sign: Sign:
Print: Print:
Seal: 1P�e'•.y CARMEN DE BERNARDI
°{§ Notary Public-State of Florida
My Comm.Expires Mar 1,2018
Commissisu FF 87
A �
�e* *e **s�s�** *•• * s��s*a*a��x**www www*e��aa�* ** �r �s�x *sa•e*e *
APPROVED BY a0 09'4,7' Plans Examiner Zoning
I
Structural Review Clerk
(RevisedO2/24/2014)
COMSIMLOWowd
W BUSINESS CERTWCATE OF COWETEtdCY
14E000277
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OG7776
Local Business Tax Receipt
Miami—Dade County, State of Florida
-THIS IS NOTA BILL - Ct3 i`tC37 PA'a'
'� LBT
7172246 v t
BUSINESS NAME/LOCATION RECEIPT NO. EXPIRES
WINGLOAD ELECTRICAL CONTRACTOR CORP RENEWAL SEPTEMBER 30, 2015
14672 SW 99 ST 7451193 Must be displayed at place of business
MIAMI El 33186 Pursuant to County Coda
Chapter 8A-Art.9&10
Pl) SEC.TYPIS"C#P BUSINESS
OWNERil= PAYMENT RECEIVED
4VINGLOAD ELECTRICAL CONTRACTOR 196 ELEL 1CAL CONTRAC t':F BY TAX COLLECTOR
CORP 14EO00277 $75.00 09/14/2014
Worker(s) 1 CREDITCARD-14-037178
This Local BusinesoUx-Receipt only confirms payment of the Local Business Tax.The Receipt is not a Room,
pennif ora certificallmof the holders qualifications,to do business. Holder must comply with any govet
ornougaiiarnmentaffieplatory lawsand requirements which apply to the business.
The RECEIPT N8,above must be displayed on all commercial vehicles-Miami-Dade Code Sec 8a-276.
Formore information,visit www.miamidade.gov/taxcoilector
First Solution Insurance 3057408211 P.1
DATE IM?4'DDiYYYY)
ACORDCERTIFICATE OF LIABILITY INSURANCE 06;25114 ,
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER r)F INFORM".TinN
FIRST SOLUTION INSURANCE ONLY AND CONFERS NO RIGH•.S UPON THE CE�:TI1=I�;iT
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EYTEND OR
6530 CORAL WAY ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
MIAMI,FL 33155
INSURERS AFFORDING COVERAGE 1 NAIC#
INSURED INSURER,.: GRANADA INSURANCE COMPANY
WINGLOAD ELECTRICAL CONTRACTOR CORPORATION INsuR_Rs
14672 SW 99 STREET IWUR-R C:
MIAMI,FL 33188 I--- .- ... .-----__.. __ _.__.____... _ __—. -•---....... _ ._..... . ._I
COVERAGES —
T'r{E POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDJCAI'EU.NO I WI'11-ISTA'401N�-z—
ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRAC-OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERIIFICATC WAY BE ISSVkD O R
MAY PERTAIN.THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED I-EREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUC-
POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDOCED BY PAID CLAIMS.
Y�Prt OF INSURANCEIM.SR-00' ~4 POLICY NUMBER POLICY EFFECTIVE POUCF fiP.RAT10NT- —•-LIMITS - - -
_GE.NCRALLIABILITY ' EACHOCCURRENGr _I s 1,OCp,000 _
X COJIMERCIr.LGENERALLMILTY 0186FL04060212 O6/t2/2v14 0611212015 Fl ism 5fis Eap2c re}r_>r,.ol I s 100,000
C 000
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A X -- —� LIMB++IADE �u OCCUR ( bI1EI i t°.nf?!A7y a!tr.�en;xii___.I.=_5,. .�
F---RSCNAL a AS)V INJURY is 1,000,000
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GEN:AtiGREGATELIMIT AFPUESPER; ty..ic a:Iii g`Jt'Pi01?ACC i.S.2XQ,000,
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GARAGE LIABILITY
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' EXCE35AI6IBRELLA LIABILITY EACH OCCURRENCE 5
^J OCCLR �CLAIMS MADE
DEDLICTI3LE I I •S .. .. _.....
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WORKERS COMPEKSATIONAND -_ i.JtJ3Y L.8[IxS
EMPLOYERS'LIABILITY i
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AI41 PROPIIIETOR1PARTNEWIZXECUTIV": ... ...-----•-- - ••------._ ...._
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OESCRIPT:ON OF OPERATIONS 1 LOCATIONS!VEHICLES I EXCLUS'ONS ADDED BY ENOORSETAENTI SPFCIAI-PROVISIONS
ELECTRICAL WORK INiOUT RESIDEN-IAL AND COMMERCIAL
i
CERTIFICATE HOLDER CANCELLATION
MIAMI SHORES VILLAGE BLDG DEPT SHOULD ANY OFTHE ABOVE DESCRIBED POLICIES BE CANCELLC-D BEFORE THE EXPIRATION
MIAMI NE 2ND AVE DATE THEREOF,THE ISSUING INSJRER WILL 5IJDEAVOR TO MAIL 30 DAYS WRITTEN
MIAMI SHORES,FL 33138 NOTICE TO THE CERTIFICATE HOLDER NAME TO THE LF1T,BUT FAILURE TO 00 SO SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF NY KIND UPON THE INSURER.ITS AGENTS OR
i REPRES6"1TAT.VES ._ .-......--.-.—.__
AUTHORIZED REPRESENTAT r
ACORD 25(2001108) / ACOR0 CORPORATION 1988
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Miami shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305)795.2204
Fax: (305)756.8972
Notice to Owner - Workers' Compensation Insurance Exemption
Florida Law requires Workers' Compensation insurance coverage under Chapter 440 of the Florida Statutes. Fla. Stat. §440.05
allows corporate officers in the constructionindustry to exempt themselves from this requirement for any construction project
prior to obtaining a building permit. Pursuant to the Florida Division of Workers'Compensation Employer Facts Brochure:
An employer in the construction industry who employs one or more part-time or full-time
employees, including the owner, must obtain workers' compensation coverage. Corporate
officers or members of a limited liability company (LLC) in the construction industry may
elect to be exempt if
1. The officer owns at least 10 percent of the stock of the corporation,or in the case
of an LLC,a statement attesting to the minimum 10 percent ownership;
2. The officer is listed as an officer of the corporation in the records of the Florida
Department of State,Division of Corporations;and
3. The corporation is registered and listed as active with the Florida Department of
State,Division of Corporations.
No more than three corporate officers per corporation or limited liability company members
are allowed to be exempt. Construction exemptions are valid for a period of two years or until
a voluntary revocation is filed or the exemption is revoked by the Division.
Your contractor is requesting a permit under this workers'compensation exemption.In these circumstances,Miami Shores Village
does not require verification of workers'compensation insurance coverage from the contractor's company. Therefore,you maybe
personally liable for the worker compensation iniuries of any person allowed to work under this R rit Please check with your
insurance carrier since most property insurance policies DO NOT cover this type of liability.
BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS
CONTENTS.
Avner Contractor
Print Name: Print Name: 0 � =
Signature:4
Signature: i;
cs09 "
3' a �
State of Florida) State of Florida) a 1Q m
County of Miami-Dade) 1 County of Miami-Dade} o
Sworn t d subsc 'bed before me this Sworn to and subscribed before me this/� 'a « C m
day of ,20 day of t,r/l ,20_L!I.
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to, -n
By �e�ntif�ication
,y�IIFs L Ary Th By K / D Jul �, o
(SEAL} (SEAL) LyofI roduced Type of Identification priduced
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SION#FF031056 June 25,2017tenYSen+ice.�n