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REV-16-1025 `;OR'r CERTIFICATE OF LIABILITY INSURANCE °" ( Y) /20/2016 3 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY BATISTA INS INC. AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS 4159 F 4'N AVE CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE HIALFAH FL 33010 COVERAGE AFFORDED 13Y THE POLICIES BELOW. JOSE F.BATISTA(305)685-0524 INSURERS AFFORDING COVERAGE NAIC t Mtsumu INSURER A UNDERWRITER OF LLOYDS OF LONDON MIAMI MECHANICAL CONTRACTORS INC INSURER B' PROGRESSIVE 5005 COLLINS AVE# 1018 INSURER C. MIAMI REACH.Fl.33140 INSURER D. COVERAGES INSURER E norGUARD INSURANCE COMPANY 31470 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. NSR AOD L POLICY EFFECTIVE POLICY EXPIRATION LTR INSR TYPE OF INSURANCE POLJCY NUMBER DATE MMID DATE MM/DD/YY ) LIMITS A GENERAL LIABILITY EACH OCCURENCE $1,000,000.00 ® LCYGYF 09/19/2015 09/19!2016 ®COMMERICAL GENERAL LIABILITY DAMAGE TO RE ED PREMISE Ea occurrence $100,000.00 ❑❑CLAIMS MADE ®OCCUR MED EXP(Any one person) $5,000.00 E PERSONAL 8 ADV INJURY $1,000,000.00 E GENERAL AGGREGATE $2,000,000.00 GEN'L AGGREGATE LIMIT APPLIES PER, PRODUCTS-COMROP AGG $1,000,000.00 ®POLICY[—]PROJECT❑LOC $ B ® AUTOMOBILE LIABILITY 47226408 10/30/2015 10/30/2016 COMBINED SINGLE LIMIT $1,000,000.00 ®ANY AUTO (Each Occurrence) ❑ALL OWNED AUTOS BODILY INJURY $10,000.00 ❑SCHEDULED AUTOS (Per person) p HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) 0 PROPERTY DAMAGE $ (Per accident) GARAGE LIABRJTY AUTO ONLY-EA ACCIDENT $ ❑ANY AUTO OTHER THAN EA ACC S AUTO ONLY AGG S EXCESSAJMBRELLA LIABK ITY EACH OCCURRENCE $t OCCUR ❑CLAIMS MADE AGGREGATE $ S ❑DEDUCTIBLE S ❑RETENTION S S ci WORKERS COMPENSATION AND MIWC700532 03/20/2016 03/20/2017 ® `OSTATU- oERR TORY LIMIT'SB ® EMPLOYERS'LIABILITY ITS ANY PROPRIETOR/PARTNER/EXECU- E L EACH ACCIDENT $500,000.00 TIVE OFFICER/MEMBER EXCLUDED? E L DISEASE-EA EMPLOYEE 5500,000.00 It yes,descnbe under SPECIAL PROVISIONS below E L DISEASE-POLICY LIMIT 5500,000.00 ❑ OTHER DESCRIPTION O�TIONS I LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS V` CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCROM POUCIES BE CANCELLED BEFORE THE MIAMI SHORES VILLAGE BUILDING DEPARTMENT EXp"TM DATE THEREOP,TWPOURER AFPDRDMCOVERAGE WILL ENDEAVOR To 10050 N.E.2ND AVENUE MAL 30 DAYS W ArMN NOTICE TD TTS CZRTIFICATF HOLDER NAMED TO THE LEFT,BUT MIAMI SHORES,FLORIDA 33138 FALUMTO0000(SHAD,NAP=NOOIILJGATONOft LJAVIdTYOFANY KIND UPON THE PH.305,795,2204 tN81JFA'a tIs OR REPREEENTATNE& A A ACORD 25(2001/08) ®ACORD CORPORATION 1988 Miami Shores Village - Yv ED Building Department APR 118 2016 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 BY; INSPECTION LINE PHONE NU I ER:(305)762-4949 y C 2011 S BU I LDI NI:R (ON Master Permit No. P93 PERMIT APPLICATION Sub Permit No. 9IZ V I G- 10:2-S ❑BUILDING ❑ ELECTRIC ❑ ROOFINGEVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBINGECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: City: Miami Shores County: Miami Dade zip: l� Folio/Parcel#: Is the Building Historically Designated:Yes NO_ Occupancy Type: Load: Construction Type: Flood Zone: BFE: ` FFCE: i Q� OWNER:Name(Fee Simple Titlholder : Phone#: Address: '`r City: �,1V1�►i State:. Zip: 331 Tenant/Lessee Name: /y�i�• Phone#: Email: ti/4 CONTRACTOR:Company Name: �/"�� ` <<-�cn�c�1 �Ov� h-t•Cl�►,�Phon � ffZ" S 1 Address: `ro0 C' COVk_ 1 d 1 y � // ' / L/0 City: M ( State: �`" L Zip: �� / Qualifier Name: OS-L F Phone#: Y G 2 - 4 S 7 State Certification or Registration#: 1 PLM 0 0 902Q Certificate of Competency#: 12-A4 o©O'> •; DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ Up Square/Linear Footage of Work: A11A. � v Type of Work: ❑ Addition Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: Specify color of col thru tile: Submittal Fee$ Permit Fee$ i CCF$ O 6`�� CO/CC$ Scanning Fee$ ✓ Radon Fee$ `� DBPR$ 2 `W Notary$ 91 Technology Fee$ n 9Q) Training/Education Fee$ `J Double Fee$ //��T",, Structural Reviews$ Bond$ X✓ TOTAL FEE NOW DUE$ 1 U@ ' GO (Revised02/24/2014) r . . Bonding Company's Name(if applicable) Bonding Company's Address lyllF' _ City State Zip Mortgage Lender's Name(if applicable) //f 1 Mortgage Lender's Address N��} 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. W Signa�Ja7'?-X'94ERorA Signature NT NTRACTOR The foregoing instrument was ackn wledged before me this The fo ' ing instrum nt was acknowledged before me this n J day of (� 20 by da of 20( � by �e I 'bil'iZ who is personally known to �� }� who is personally known to me or who has produced as me or who has produced as identification and who did take an oath. identificatio and who did take an oath. NOTARY PUBLIC: NOTARY P IC: Sign: Sign: Print: V\I"6L .`•PHv Pie • Seal: i' > IAtiA,WLAR a Notary Public•State of Florida �• itFF t :• My Comm.Expires Jan 7.2018 ` 19' Commission#FF 074482 i,f Oi ilk\•• !^ •/11111\\\• �ao National Notary Assn. APPROVED BY la aminer Zoning Structural Review Clerk (Revised02/24/2014)