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RF-16-1978 V74'0'4 7 i CONTRACTING GROUP,INC. MICHAEL GRABER SUPERINTENDENT O (954)781-7663 C(954)995-2230 F (954)943-7833 TOLL FREE(877)690-7663 3440 NW 25th Avenue Pompano Beach,FL 33069 mgraber@certiiiedcontractinggroup.com All i it Corttfied Rooting Specialists AL License#26069 MS License#14772-SC License#CCCO27419 NC License#48110 FLLicense#CGC1504797 SC License#G104438 License#0596604TN License#00046662 F".h License#38000 CRS Associates Certified Energy TeeLnologiea FL License#CGC1510107 FL License#CVC56s42 wwHcoertiffedcontractinggroup.com � s Miami Shores Village Building Department - 21 10050 N.E.2nd Avenue, Miami Shores,Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 'Pv INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 20�y S BUILDING Master Permit No.RF-7-16-1978 PERMIT APPLICATION sub Permit No. ❑BUILDING ❑ ELECTRIC 0 ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL F-]PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑■ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 11300 NE 2nd Avenue o L City: Miami Shores County: Miami Dade Zip: Folio/Parcel#:1121360010160-03 Is the Building Historically Designated:Yes NO X Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder):Barry University Inc. Phone#: Address:11300 NE 2nd Avenue City: Miami Shores state: FL Zip: 33161 Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name: Certified Roofing Specialists, Inc. Phone#: 954-781-7663 Address: 3440 NW 25 Avenue City: Pompano Beach State: FL Zip: 33069 Qualifier Name: Eugene O. Fall Phone#: 954-781-7663 State Certification or Registration#: CCCO27419 Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$114,865.00 Square/Linear Footage of Work: 24,000 Type of Work: ❑ Addition ❑ Alteration ❑ New Q Repair/Replace ❑ Demolition Description of Work: -vc> EX\Gj'7 `tom C-, C2_c:�T 1►-'_X S y ®F v\Dti Specify color of color thru tile: Submittal Fee$ Permit Fee$ CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ `----- Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ '�- Bond$ c' TOTAL FEE NOW DUE$ -S (Revised02/24/2014) P 'd 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. l/ Signature Signature OWNER or AGENT / CR RACTOR The f regoing instrument was acknowledged before me this The foregoing instrument as acknowledged before me this day of QO�� 120 G� by Q-q day ofS T• 20 tL0 by sus 4N k5kAMAL who is personally known to 'P—UQ1E1 3EE 0• FAN-L,who is personally known to me or who has produced as me or who has produced as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: Sign: t�sw uu�� r' ` Print: EFO LERNRJITER � O�°d FlOnaa Seal: ST44TE OF FLORIDA J81fri►J Yao • WWon C*TOW FF9l54110 oiC„ tO�inyzvie tseast . O0. Expires 1/26/2020 APPROVED BY V Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD (650) 467-1395 2601 BLAIR STONE ROAD TALLAHASSEE FL 32399-0783 FALL, EUGENE O CERTIFIED ROOFING SPECIALISTS INC 3440 NW 25TH AVE POMPANO BEACH FL 33069 Congratulations! With this license you become one of the nearly one million Floridians licensed by the Department of Business and STATE OF FLORIDA Professional Regulation. Our professionals and businesses range from architects to yacht brokers,from boxers to barbeque r40-1,11 j DEPARTMENT OF BUSINESS AND restaurants,and they keep Florida's economy strong. -1PROFESSIONAL REGULATION Every day we work to improve the way we do business in order CCCO27419 ISSUED: 10/04/2016 to serve you better. For information about our services,please to onto www.myfloridalicense.com. There you can find more CERTIFIED ROOFING CONTRACTOR in about our divisions and the regulations that impact FALL,EUGENE O you,subscribe to department newsletters and learn more about CERTIFIED ROOFING SPECIALISTS INC the Departments initiatives. Our mission at the Department is:License Efficiently, Regulate Fairly.We constantly strive to serve you better so that you can IS CERTIFIED under the provisions of Ch.489 FS. serve your customers. Thank you for doing business in Florida, Expiration date:AUG 31,2018 L1610040000663 and congratulations on your new license! DETACH HERE RICK SCOTT,GOVERNOR KEN LAWSON,SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION it 8r9 CONSTRUCTION INDUSTRY LICENSING BOARD 1' CCCO27419 K r The ROOFING CONTRACTOR T r, Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2018 FALL, EUGENE O CERTIFIED ROOFING SPECIALISTS INC L 3440 NW 25TH AVE POMPANO BEACH FL 33069 v ISSUED: 10/04/2016 DISPLAYAS REQUIRED BY LAW SEQ# L1610040000663 -BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT 115 S.Andrews Ave., Rm. A-100, Ft. Lauderdale, FL 33301-1895—954-831-4000 VALID OCTOBER 1,2016 THROUGH SEPTEMBER 30,2017 I ' DBA:CERTIFIED ROOFING SPECIALISTS INC Receipt#:ROOFING/SHEET METAL CO CTOR Business Name: Business Type:(ROOFING) Owner Name:EUGENE O FALL Business Opened:02/03/1986 Business Location:3440 NW 25 AVE State/County/CorUReg:CCCO27419/40-OU-88 POMPANO BEACH Exemption Code: Business Phone:954-781-7663 i Rooms Seats Employees Machines Professionals 10 For Vending Business Only Number of Machines: Vending Type: Tax Amount Transfer Fee NSF Fee Penalty Prior Years Collection Cost Total Paid 27.00 0.001 0.00 0.00 0.00 0.00 27.00 THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS i THIS BECOMES A TAX RECEIPT This tax is levied for the privilege of doing business within Broward County and is non-regulatory in nature.You must meet all County and/or Municipality planning WHEN VALIDATED and zoning requirements. This Business Tax Receipt must be transferred whe the business is sold, business name has changed or you have moved the j business location.This receipt does not Indicate that the business is legal or that It is in compliance with State or local laws and regulations. Mailing Address: ,r CERTIFIED ROOFING SPECIALISTS INC Receipt #10B-15-00006288 3440 NW 25 AVE Paid 08/15/2016 27.00 POMPANO BEACH, FL 33069 20.16 - AC40 CERTIFICATE OF LIABILITY INSURANCE DATE(MWDDNYYY) 10/12/2016 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(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 CONTACT Sandi Harrison NAM Frank H. Furman, Inc. PHONE f054)943-5050 1 FAX o.(954)943-5417 1314 East Atlantic Blvd. -MAIL sandi@furmaninsurance.com P. 0. BOX 1927 INSURERS AFFORDING COVERAGE NAIC# Pompano Beach FL 33061 INSURERA: Watford Specialty Ins Cc 15824 INSURED Certified Equipment Leasing Inc INSURERB:National Fire Ins of Hartford 20478 Certified Roofing Specialists Inc. INSURER CAmerican Guarantee & Liability 26247 3440 N W 25 Ave INSURER D'American Casualty Cc of Reading 0427 INSURERE:Continental Casualty Co R0443 Pompano Beach FL 33069 INSURER F: COVERAGES CERTIFICATE NUMBER:May 2016 w/leased 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. rA TYPE OF INSURANCE ADDL SUBR POLICY NUMBER MM/DDY EFF POLICY M DD EXP LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAX COMMERCIAL GENERAL LIABILITY PRE NTED M GETO(Ea Eoccu occurrence) $ 100,000 CLAIMS-MADE X1 OCCUR BRCGL0000500 5/1/2016 /1/2017 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICYFX PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT EaeB,dent 1,000,000 B X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED 5092133409 /1/2016 /1/2017 BODILY INJURY(Per accident) $ X AUTOS AUTOS X NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident Uninsured motorist BI split limit $ 10,000 X UMBRELLA LAB X OCCUR EACH OCCURRENCE $ 5,000,000 C EXCESS LIAB CLAIMS-MADE AGGREGATE $ 5,000,000 DED I X I RETENTION$ CUC534616311 /1/2016 /1/2017 $ D WORKERS COMPENSATION X WC STATU- OTH- LLMTAND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNERtEXECUTIVE Y/N E.L.EACH ACCIDENT $ 11000,000 OFFICER/MEMBEREXCLUDE07 [KN NIA 092133412 5/1/2016 /1/2017 (Mandatory In NH) E.L.DISEASE-FA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 E LEASED/RENTED EQUIPMENT 2076243854 /1/2016 /1/2017 ANY ONE ITEM $350,000 DEDUCTIBLE $2500. PER OCCURRENCE $350,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,K more space Is required) License # CCCO2719 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Miami Shores Village ACCORDANCE WITH THE POLICY PROVISIONS. Building Department 10050 NE 2nd Avenue AUTHORIZED REPRESENTATIVE Miami Shores, FL 33138 Dirk DeJong/CS ACORD 25(2010105) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025 rgmnn.Ft m Tho Anrwn nnmo nnri Innn aro ronictororl mnrirc of Ar'r1Rr1 ♦S�ORs Miami shores Village "" Building Department 0 1 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CHANGE OF CONTRACTOR / ARCHITECT Permit N. R F ^ 7 1 _17:76 Owner's Name (Fee Simple Title Holder): P,,QfP—,Ll th-J J 5'1-t Phone#: sem' 8?-7 o e-fq lAl Owner's Address: // ®® 10� 2 14"efv"� City: 1*1, ,w/ 57ffg�rs State Zip Code: 6(oZ4? Job Address (Of where work is being done): ®/ 3 ®® °�� 4-,or City: Miami Shores State:—Florida Zip Code: ?.?/b f Fd Contractor's Company Name: � L' '�l®mss ��° Phone#: Address: ✓ 9/</" City: State: Zip Code: Qualifier's Name: -10-17W A pied®14 Lic. Number: Architect/ Engineer of Record Name: A' Phone# Address: City: State: Zip Code: Describe Work. Aee< I hereby certify that the work has been abandoned and/or the contractor/architect is unable or unwilling to complete the contract. I hold the Building Official and the Miami Shores rmless of all legal involvement. Sig nature Signature P,-TA Owner or Agent Contractor or Architect The foregoing instrument was aknowledged before me The foregoing instrument was aknowledged before me this day o ,20 Xp,by U this *0(, day of 4F?7,-,+A��LO/6by '3 Who is personally known to me or who has produced who is personally known to me or who has produced as indentifirowpot"��e�._ �i PeQ g J dt/' " as indentification. `` �P�yETTE •i Notary r �. �_. �,� icy Publi uo _ •ma: Sign: z • ea ar Ram z s Jerry J Yao Q i1 O 0 � . .•. My Co mnission FF 16801 to p k ExpMes 11n2no16 , f?, • Heidi Jeanette u ``� 9C ��' •�� STATE OF n `'ri�� County of Cv. qa �`� My Commission Expif -2016 THE GARLAND COMPAC HIGH PERFORMANCE ROOFING AND FLOORING SYSTEMS since 1 8 9 5 3800 EAST 91 ST STREET-CLEVELAND, OHIO 44105 PHONE: (216) 641-7500 - FAX: (216) 641-0633 NATIONWIDE: 1-800-321-9336 Date: October 2,2016 SE Florida Garland Representative To: Miami Shores Village Matt McDermott 10050 NE 2°a Ave. 4032 Park Ave. Miami Shores Village,FL 33138 Miami, FL 33133 Ph: 305-762-4859 Phone: 954-661.0629 Ema i I:m mcdermott@garlandind.com naranjoi@miamishoresvillage.com Re: Abandonment as Roofing Contractor-#RF-7-16-1978 To Whom it May Concern, Garland/DBS,Inc. is abandoning the permit#RF-7-16-1978 as the roofing contractor. We will hold harmless the Building Official(s)and Miami Shores Village of all legal involvement. Thank you again for your consideration and please contact me with any questions. Regards, oe7 Matthew J.McDermott,Area Manager Page 1 of 1