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WS-17-738 Permit NO. WS-3-1 7-738 `yeortFs y,{ Miami Shores Village Permit Type:Windows/Shutters 10050 N.E.2nd Avenue NE Miami Shores, re Village Per I ork Classification:Window/Door Status: A Rep APPROVED Phone: (305)795-2204 Permit Status:APPROVED �ORI�A Issue Date:3/24/2017 F Expiration: 09/20/2017 Project Address Parcel Number Applicant 1048 NE 99 Street 1132050180180 Miami Shores, FL 33138-2639 Block: Lot: KRISTIN REESE DANIEL TANNE Owner Information Address Phone Cell KRISTIN REESE DANIEL TANNER 1048 NE 99 Street MIAMI SHORES FL 33138-2639 1020 NE 99 Street MIAMI SHORES FL 33138-2639 Contractor(s) Phone Cell Phone Valuation: $ 500.00 AC SHUTTERS AND AWNINGS INC 305-799-2068 �,.. _.......� _ _..... m Total Scl Feet: 0 Type of Work:HURRICANE PANEL TO REPLACE PERMIT B Available Inspections: No of Openings: 15 Inspection Type: Additional Info: Window Door Attachment Classification:Residential Final Scanning: 1 Review Building Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $0.60 Copies Invoice# WS-3-17-63363 $125.00 03/23/2017 Credit Card $392.10 $0.00 DBPR Fee $3.75 DCA Fee $3.75 Education Surcharge $0.20 Notary Fee $5.00 Permit Fee $250.00 Scanning Fee $3.00 Technology Fee $0.80 Total: $392.10 In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans,drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL,PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work. OWNERS 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 an on' g. Futhermor , I utho iz thea a-named contractor to do the work stated. March 23, 2017 Authorized Signat re O ner cant / Contractor / Agent Date Building Department Copy March 23, 2017 1 * _ A. RECEIVED Miami Shores Village MAR 17 Building Department 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 F8C 2014 SA BUILDING Master Permit No.w s 1-1 —1 3 PERMIT APPLICATION Sub Permit No. &�ISLIILDING ❑ELECTRIC ❑ ROOFING ❑ REVISION ❑EXTENSION ❑RENEWAL ❑PLUMBING ❑MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑SHOP CONTRACTOR DRAWINGS C JOB ADDRESS: "�� w 94 59" City Miami Shores County Miami Dade Folio/Parcel#: —_ yls the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: �-y– Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): /� /�/5 T/� / 'A/u�Z._ Phone#: Address: /6- Aq sl City: �Q`.r�,r � .z>, 5 State: Tenant/Lessee Name: Phone#: Email: �- CONTRACTOR:Company Name: /"L �Pf'7 * �/t� 4il�,L0p Phone#: 7a Address: 9190 ,¢yE City: Le=i State• Zip:33al6 Qualifier Name: 4Ir/4r/�a � 1'` Phone#: Q — 7J� 2cg;d' State Certification or Registration#: :J GG o//flf6/7 Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: Gty: State: Zip: Value of Work for this Permit: Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New �O Q�^���G� ❑ Repair/Replace ❑ Demolition Description of Work: ��,Z 13p V S --(Z4 I Specify color of color thru tile: Submittal Fee$ Permit Fee$ CCF$ CO/CC$ Scanning Fee$ Radon Fee$ OBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ taewsedoz/za/zaial r 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. 1 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 constructian 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. t SignatureSignature Axle /J� OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this fo !_1daay of MAa-L*-A 20 1-7 by /� 1 S' day of �a f'�-� 20 1 '7 by L�J "�,4�'-w-ho is personally known to h & m do Com'L CI ,whos personally k on wi'to me or who has produced as me or who has produced as identification and who did take a111tilrtlir/i identification and who did take an oath. NOTARY PUBLIC: SS�`lvF�q//i NOTARY PUBLIC: A� i Sign: _Z S •. N *_ Sign: �Z/// Print: ,O: #FF 954760 ,oma, Print tai �d �����5.•''�••EXp''• ///i �9qf'• 'aYc+::�o s Seal: Seal: . ai "� a:k i►ii«►i««►«►.«ilii«««It►i►►«««i« i .. ►►►« •«►ti►►i«i«►►►►►««iii►i►i««►►«ilii«►;iii►«�tRRgy►t`��e ��� Pubfir APPROVED BY Plans Examiner Structural Review Clerk (ReviseM2/24/2014) gY OREs Miami Shores Village Building Department OR 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 iallows corporate officers in the construction industry 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. I. The officer owns at least IO 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 and has acknowledge that he or she will not use day labor,part-time employees or subcontractors for your project.The contractor has provided an affidavit stating that he or she will be the only person allowed to work on your project.In these circumstances,Miami Shores Village does not require verification of workers'compensation insurance coverage from the contractor's company for day labor,part-time employees or subcontractors. BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS i ' Signature: Owner i I State of Florida County of Miami-Dade l ^n^ � The foregoing was acknowledge before me this day of By V— `A 5T1 N (AN tv��� who is personally known tome or has produced *e�,ti,1;N11 / aside c n `��LVERq ��4i ,•'SOON Qp'•. i Notary J�` r6,2020/9C�`s; G Z SEAL: S: 0 ro �A�''�ititPiiu ii, \\`\ Mar 231703:16p WILVERALMARALES 305-382-6777 p.1 CERTIFICATE 4F LIABILITY INSURANCE �►1131232017Y) 03/23/2017 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. i IMPORTANT. If the certificate holder is an ADDITIONAL INSURED,the policylies)must be endorsed. If SUBROGATION IS AIVED,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 endorsemenl(s). PRODUCER CONTACT WILVERALMARALi—ES NAME: Wam Insurance Corp PHONEr (305)274-4353 FAX 305 2749994 10637 SW 88th St.Ste 7-1 EMAIL -ADRliFSs: -_-- Miami, FL 33176 LN RE. AFFORDIN covIk NIUc r Phone (305)274-4353 Fax (305)2749994 INSURERA. SCOTTSDALE INSURANCE CO INSURED _ _...--. -- _......_._._ INSURER B: A C SHUTTERS,AND AWNINGS, INC rNSURER C: 8190 W 26 Ave INSURER D: T INSURER E: Hialeah FL 33016- - — - ----- ------.._._. _...._ .. ..-__- - INSURER F. COVERAGES CERTIFICATE NUMBER: _ R ISION 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 CONTRACTOR OTHER DOCUMEN WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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. INSR 'ADDLSUBR ._....-....__POLICY EFF POLICY EXP ----- 7R.. ,-_----_- TYPE OF INSURANCE LINTS COMMERCIAL GENERALUA80.I1Y EA HOCCURRENCE $ 1,000,000.00 __7.. J CLAIMS-MADE Lyme OCCUR DAMAGE TOI2ENTED-.-___ I. 100,000.00 _PRMISES-LEa oocurtancel $ _._-.._._. — - LI CPS2508483 0812612016,08/26/2017 EXP(Any ane person) t$ 5,000.00 A PE SONALBAOVINJURY $ 1,000,000.00 GEN'L AGGREGATE LIMIT APPLIES PER _GE ERAL AGGREGATE_ $ 2,000,000.00 POLICY F] jECj LOC PR DUCTS-CONP/0P AGG S 1,000,000.00 L I OTHER $ AUTOMOBILE LIABILITY CO BINED SINGLE LIMIT ANYAUTO BO 3ILY INJURY(Per person) $ ❑ ALL OWNED I 1 SCHEDULED — - AUTOS _J AUTOS BO ALY INJURY(Per accident) $ — 1j HIRED AUTOS _71 AUTOS NON-OWNED --P. .-.ERTY AMAGE L_.J ..._I AUTOS a 'dant $ UMBRELLA use I occuR I EA 1H OCCURRENCE $ EXCESS LAB ' IU CLAIMS-MADE -- — --- _ AG REGATE $ OED '—J RETENTION$WORKERS I ' AND EMPLOYERS COMPENSATIOY .._.. Y/N r--I PER ANY PROPRIETOR/PARTNER/EXECUTIVE-- I E. EACH ACCIDENT I $ OFFICERIMEMBEREXCLUDED? NIA _- (Mandstory in NH) If yes.describe under E. DISEASE-EA LOYE $ _ ..._ DESCRIPTION OF OPERATIONS belay E. .DISE EMPDISEASE-POLICY LIMIT $ _ I . i DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD'101,AdditionalRamn space Is nqulmd)arkeSehedule,irma —� j CONTRACTOR LIC*SCC131149617 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE JDESISED POLICIES BE CANCELLED BEFORE MIAMI SHORES VILLAGE THE EXPIRATION DATE THERTICE WILL BE DELNERED IN BUILDING DEPARTMENT ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE 2 AVE AUTHORIZED REPRESENTATIVE — —` MIAMI SHORES VILLAGE,FL 33138 305.756-8972 WILVER ALMARALES j ®1988-2014 AC RD CORPORATION. All rights reserved. ACORD 25(2014101)QF The ACORD name nd logo are registered marks of ACORD R wA JEFF ATWATtR CHIEF FINANCIAL OFFICER STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS'COMPENSATION "•CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS'COMPENSATION LAW" CONSTRUCTION INDUSTRY EXEMPTION This certifiers that the individual listed below has elected W be exempt irgm Florida Workers Compensation lane. EFFECTIVE DATE: 12130!2016 EXPIRATION DATE: 12!3012018 PERSON: COLON ARMANDO FEIN: 061657932 BUSINESS NAME AND ADDRESS: AC SHUTTER AND AWNINGS INC 8180 W 26 AVE HIALEAH Fl. 33016 SCOPES OF BUSINESS OR TRADE: DOOR AND VONDOW INSTALLATION Ftartima to Chopw 44.05(141,F.S..an ORrow Of a cerporoS:on who ekds exerrvtm true:•tis duni tw by film 6 crrlifr39M/of e"iw unMv this Seam may not iecovtA b4tWts or=npcnss6on"or the crteptw-Pwwarvi to CAaitter 440.05117).F 5-,c rtrrmes d efecum to be exenpt-.apply v* WWAI•»Kupe of the tumess or bade Isteo on em ntl4ca of olection t0 Da exanpt tisrsaard to ChWsr 440.05(111),F.S..Naticrt d ate 60a to be suempl arta ce-ftbcaks d ekdion to be exerrgA shell be wblyd to reaocatmn S.m my lrne otter the 9j-V of the nice tr r*ise sm*d was drift—de• am perun narnet4 on the nates 9r CMCiirhic rte tenger meats M requvem its Ot this aettiorr for WiiigtrM ef■errytli-el4,yhr tlrFatmre Out rewte a DF&f2-13M-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED W13 UUEsrIONS?(950}413.1609 Local Business Tax Receipt ;tiliami-DaaCounty.slat'_�of Florida LB 54R00a1 WIA1TNU, EXPIRES RtNEWAL SEPTEMBEFC30r 2017 AC SAJI7(R5 4141/AYKING"NC 1{7197[9 M:r.tc s Wd N Paas al d/iMi 6':9011 ax Alli IV la/r/In Ccu-1/ HULLS 44 FT 33316 :herr FA-A.i ,t 52 c.itRt�p�11cMCT'S rw.,MR/+1 R2:CenW Q.— sKcLw Ty wuP1YG CvMRM1GTDR av TTo. /C911:1TF75 AND N\hpfm IAG5 ftC 50CI7:tt^_4i7 Y'15AU L�/24,�gtG y0•vtWNCr fN n,; lMri.,*-ARD 1C QMMO wolke�4^5 Iw lser•6nas//.mail ri/ueFraR�sAalr la+.l Neew.,aa,aa loco fl.f slrfw wl �{11l H 1 p"r a.N[a`M1Nka..P�/r►lau•a/.4wm IiltlN atoll ttaiti N/2 rw 1wr^ Nnyew'r�lMIY Itn Lwa n/.aY/Treti NAal ayyll grrr.'YallFf Rr l2[ItiT lq/�saw�ll�/Nwc1 tlA rtaaJ'ni:/wttM•��"�'��nt¢NaK N.rr+.hMaa.�"/aMy �rl,aKthlL LM IM01 rIL-M:C RICK;iCQT .GO+YERWR KEN,.AIYSLI4,—CRFTARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTMO INDUSTRY LICENSING BOARD Tnr.SPECIALTY STRUCTURE M14TRACTUR N,mT,e3 b-13w IS CERI:FIEC e' Urxiar the provAimS Of CT2pk/L89 FS EKclratundax: AUCs 31 7019 COLON,ARAIANIX)R AC SHUTTERS AND AWNMIGS INC 14995 NVIBTCT =_ MAI FAH FL33013 Is'sum. 07mee-v16 DISPLAYAS REQUIRED BYLAW SE0e L1007W=1212 Accordion Shutters■Storm Shutters■Bahama Shutters■Roll-ups Aluminum Awnings■Canvas Awnings■Retractable Awnings■Aluminum Roofs Screen Patios and Repairs 3/19/2017 State of Florida County of Dade Before me this day personally appeared Armando Colon who, being duly sworn, deposes and says: That he or she will be the only person working on the project located at: 1048 NE 99 ST Miami Shores, FL, 33016 Sworn to (or affirmed)and subscribed before me this 9P day of 20/2, by ersonally know Or Produced Identification Type of Identification Produced WDO JR AV CV5 Print,Type,or StiimR ame+ ot'JW r• � �* ••. 8ondsa rbe:AZ.`� !1!/df ili411!!41 8190 W 26-Ave. WIMeah Gardensq FL 33016 OFFICFa 305-828-1444 FAX#305-828-708Z r m-la ni iOadc C'.Du;nt,'Y,. S{al-2 G# Florida i! 11 l4PAWA I iaavEs5—tra P¢rii.0 cA ex PIRES HENEli.Rid�4M. SEPT EI BE 30 N' �,a ltir G moi= l lr �2' P�r, ��S R t'' p{}iRL�t :rr�r waanPR �afffY i Ci F. i!ki=� F ?;=�47Cra ay Tax dXXM.LtT� re �L ����_���_� i�D:7,a+1.l1 Ceti 1f'LtA X71: PIRES rh,;kcYtrwa m frurastl wul'' `.I *fr c:�il Cs�i[ Q!f+t.�Tas 'irk Esc i,ici u; ks . a�ezi s rri kcsrrn a�4�'tylor�a�ye:r'Pr+�i�'7 iii�.aier.� riek3r::3�.: a5 �,rrs q�-.�rsl aWmm-j°fig i . lq*f e7lf *;z=y4.akkk-,, {�.�af�lE��e��s rlr.aril PAC Pl;tl.pr.93 t �C l f Yll=F. ?�Iv mar 43 GVE:7 ►ORK'NIAV30N. SEC.RKAWY TAT,9 QF Fli0RIDA CONSTRUC M4 WDUSIRY LiCIMSi[NO BoAi� RD i f Y'I t:'a 11 ry i l�"a!l,Twi',11'T E 'Li 4.•a ii F is CONTRACTOR Ns—r e f lbekrw IS:CM—n FiiEG �S !1r X:ef tN VGwl-:USSf C')eiVer d;89 FS. ;-xrir flC n date: AUG 31 2DI-3 J — r q T � � A a � r SEPPATWATER CHIEF FlNANCIAL.OFFICER STATE OF KORIDA DEPARTM51SI5? OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION CERTIFICATE. OF ELECTION TORE EXEMPT FROM FLOVAi WOkKEI S` OMPERSATION.LAW TNN oortifies 4W the individual Jlstn+d belm Inas e1 ed to be exempt orrt Flanda Wcck a &npan-snllaon law. EFFECTIVE DATE,: 121-3012016 0,12IR I,TION DATE,. 12??3=018 FE11M1 M1657932 932 BUSINESS NAME AND ADDRESS-. AC SH,UTTER AND AWNINGS INC 1 00 W 28 AVE HIALEAH FL 3-sI}pa SCOPES OF BUSINESS OR, TRADE DOOR AND WINDO W T LLATION to crtrt to Chopw drl .4't5(1 't,F. titt�tti sur A ccr m v. c 3ccfi exam ren his ;a a+'c�by rJFj)4,1'oeyb r,.or tt t,'�;i Un►i this baa ftwy nota ger t-je-ft er€ 'n eis nt3rs "w tt t didptt^. RUM–c"to NEI[O r a41D #1,21). F ".. Cafiffkatft cel'd6wim as a overt _tip �. �m -,qhn fit-opo 01[W sm "ort Balm cin este nodro of a iae t*bf; dxftnpk PW' Want to Cha mr d4045(13N F.S.,Na its d 4*0on to W mrfl pod Leftcbtes&e*dkm Lb be examrA fow bo stitoct ia'.r*m3c Yxn 9_M any time otr LP.*—mi olito mal"or ft isptto or ihn nogmr--+tom, q►4 pomic'+nmrvd m Ihm rxtc6 a comflow ito imw ffxms X14! rc. F gi ihim neon (br Ii-UUwK*co,a comflcals. Tho do Mau myoto a DFST.27 D'i -2 -2 CER'TIF'ICATE OF ELECTION TO IBE EXENWIf FCEVI$F I„) 0 -13 OUES iI NS? (&50)413-1009 Miami Shores Village Building Department 10050 NE 2 Ave, Miami Shores, FI 33138 Tel: (305)795-2204 • Fax; (305)756-8972 12/10/2015 To: Current Owner 1048 NE 99 Street Miami Shores, FL 33138 Permit: BP2005-1241 Address: 1048 NE 99 Street Miami Shores FL 33138 Date Expired:2/18/2006 Dear Sir or Madam, Our records indicate that the above referenced permit has expired without obtaining the proper final inspection. In order to serve you better, we need to keep our files up to date. As per section 105.4.1 of the Florida Building Code, "Every permit issued shall become invalid (expired) unless the work authorized by such permit is commenced within six months after its issuance, or if the work authorized by such permit is suspended or abandoned for a period of six months after the work is commenced, or completed without obtaining the final inspection of the work performed.." Please be advised that open permits will hinder your ability to refinance or sell this property Please contact the Building Department, within 15 days of receipt of this letter in order to take care of this matter. Sincerely, Ismael Naranjo (CBO) Building Director