The URL can be used to link to this page

RC-16-337 (2) Miami Shores Village C' J Building Department 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 7BY: Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 2014 BUILDING Master Permit No. RC 16-337 PERMIT APPLICATION Sub Permit No. ❑BUILDING ❑ ELECTRIC ROOFING ❑ REVISION ❑ EXTENSION RENEWAL [PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ® CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 42 NE 96th Street City: Miami Shores County Miami Dade zip: 33138 Folio/Parcel#: 11-3206-013-0640 Is the Building Historically Designated:Yes NO X Occupancy Type: R-3 Load: Construction Type: 11 B Flood Zone: X BFE: N/A FFE: 12.99 11.50 low OWNER:Name(Fee Simple Titleholder): LUNI USA, LLC Phone#: Address: 235 Llincoln Road#310 Civ : Miami Beach State: FL zip: 33139 �. Tenant/Lessee Name: N/A Phone#: Email: CONTRACTOR:Company Name: RK Builders, Inc(dba for Moonlight Editions, Inc.Ahone#: (954)9804430 Address: 1835 E Hallandale Beach Blvd#736 c°ty: Hallandale Beach State: FL zip: 33009 - Qu3iifier Name: Robert Kirchgessner Phone#: (954)980-4430 State Certification or Registration#: CBC 060255 Certificate of Competency#: DESIGNER:Architect/Engineer: Robert Kirchgessner Phone#: (954)9804430 to Address: 1835 E Hallandale Beach Blvd#736 city,:Hallandale Bch State: FL zip: 33009 Value of Work for this Permit:$ Square/Linear Footage of Work: 29564 sf Type of Work: ❑ Addition FE Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: Interior Renovation: Replace exist plumbing fixtures,add lighting, partially remove a few non-load bearing walls, new floor&wall flnishes, replace existing exterior windows and doors, new kitchan & baith cabinets and fixtures Specify color of color thru tile: Submittal Fee$ Permit Fee$ 95o 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) 42 NE 96th Street 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. Signature Signature OWNER or AGENT NT R The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this 1- day of eC 6� 20 11.o by �day of�e-G 4- to- r 20 IA. ,by Vog-.S who is personally known to Robert Kirchgessner who is personally known to me or who has produced P L, Q as me or who has produced as identification and wh did take an oath. identification and who did take an oath. 9 NOTARY P BLIC: NOTARY PUBLIC: i Sign: h Sign: Print: o C,` a c,C, Print: •� Seal: VICTORIARC1SpO0 Seal: ;`••" ail: VICTORIA Rt)BADC MY COMMISSION#FF971492 •c MY COMMISSION#FF971492 EXPIRES March 15,2020 j EXPIRES March 15,2020 (io7)3% 063 FkVk16N*W .ram :F aK#c*s+p* ��*%& +k pie oY b *ds�k%k k9W*k k+kw+icakkk aR do**+k 4i ekWP+k+i*&kk&+k k8&Mk+kffi+&k8ds ay N�*BeiY+F#Nk N+k k+F k4+ak+k+R*+k APPROVED BY 1 �" Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) 12/18/2009 21:40 9549253063 PAGE 06/06 APPLICATION FOR REGISTRATION OF FICTITIOUS NAME REGISTRATION#G16000006362 ` Fictitious Name to be Registered: RK BUILDERS, INC. Mailing Address of Business: 1835 E HALLANDALE BEACH BLVD #736 HALLANDALE BEACH, FL 33009 i Florida County of Princlpal Place of Business: BROWARD FILED FEI Number: jn.17, 2016 Secr� tarry of State Owner(s)of Fictitious Name: MOONLIGHT EDITIONS,INC. 1835 E HALLANDALE BEACH BLVD#736 HALLANDALE BEACH, FL 33009 Florida Document Number: P97000045837 FEI Number,65-0759480 I . f I the undersigned, being an owner in the above fictitious name,certify that the inf6rmatibh indicated on this form is true and accurate. I further certify that the fictitious name to be registered has been advertised at least once in a newspaper as defined in Chapter 50, Florida Statutes, in the county where the principal place of business is to ated- I understand that the electronic signature below shall have the same legal effect as if made under oath and I am aware that false information submitted in a document to the Department of State constitutes a third degree felony as provided for in s.817.155, Florida Statutes. MOONLIGHT EDITIONS, INC. 01117/2016 Electronic Signature(s) Date f II Certificate of Status Requested(X) Certified Copy Requested( ) I i 12/18/2009 21:40 9549253063 PAGE 02/06 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONA4 REGULATION CONSTRUCTION INDUSTRY LICENSING.BOARD ! (850).487-1396 2601 BLAIR STONE ROAD TALLAHASSEE FL 32359-0783 f l� KIRCHGESSNER, ROBERT FRANCIS RK BUILDERS, INC. 1835 E HALLANDALE BEACH BLVD#736 HALLANDALE FL 33009 i i Congratulationsi With this license you become one of the nearly one million Floridians licensed by the Department of Business and Professional Regulation. Our professionals and businesses range STA OF FLOfRU from architects to yacht brokers,from boxers to barbeque DEP RA restaurants,and they keep Florida's economy strong. `', PRO E . flTION Every day we work to improve the way we do businims.in order CBCosQ255; ; . ._: "O=412016 to serve you better. For information about our services,please log onto www.myfloridalleense.corn. There you can find mored CERTIFIED 8 Information about our divisions and the regulations that impact iCIRCHGESSN " ,subscribe to department newsletters and learn more about RK BUIL.C)E youRS, the Department's initiatives. Our mission at the Department is:License Efiidently,Regulate Fairly.We constantly strive to serve you better so that you can w - .- serve your customers. Thank you for doing business in Florida. IS CER7I Ir=D Oder tA'a.prfilairsns":61.C�i:sBe FS-:''•: , �,. �r and congratulations on your new license! �., '&w date.auc za;e.. .,. DETACH kERE RICK SCOTT,GOVERNOR I KEN LAWSON,SECRETARY _DFP1,1R-WEAFT,tw- �..AS' O SStONl4t REGU�kE'�GI�Y..•- LIC NSiNG 00A11411 G9C�o2*a5:. _ The BUILDING,CONTf? C$Of{ I Ma ed.be(4W.:IS CEftTtElt=D::, <. Undeathe.>prpn �oas 5Cha ter 89 > bnr ate; .AUG•,31 ___.•,, Explrati d' :. . - 1; JR GM114"' R t�K'9t3iLDER^s; -.1635•E• �! ;� •.. HALLAND `" .. r...... .._..r �.. /� r. I♦ w ISSUED: 09ro41201e DISPLAY AS REQUIRED BY LAW SEO 0 I_1609040=388 12/18/2009 21:40 9549253063 PAGE 03/06 i Ywo ' I eek toy CITY OF HOLLYWOOD TREASURY SERVICES DIVISION wrato:v "cw ' e LOCAL BUSINESS TAX yc��r'ottw'R9��'r MOONLIGHT EDITIONS,INC 1835 E HALLANDALE BEACH BLVD I HALLANDALE,FL 33009 i I I _.......—. —. __....._.. ......._,.—... _ _ _.....�_..__......—..--.�__. ..-._.__ .... -- Please contact us with any changes or corrections tb your information. CUSTOMER SERVICE: Our hours of operation are 8 AM to 5 PM, Monda� through Friday. Should you have any questions regarding Loral Business Tax or need to update / correct an�l information related to your Business Tax Account, please contact us by phone at 954-921-3225, by email at t usinesstax@hoiiywoodfi.org or in person at City Hall, Room 103, 2600 Hoilywood Blvd. Please send .all written co rrdspondence to: City of Hollywood, Treasury Services Division,Attn:Business Tax,Room 103,PO Box 229045,Hollywood,FL 33022-90 5. PURSUANT TO STATE LAW, LOCAL BUSINESS TAX 15 LEVIED FOR THE PRIVILEGE OF DOING BUSINESS WITHIN A CITY'S LIMITS, AND IS NON-REGULATORY IN NATURE. .'ISSUANCE OF A LOCAL 13USINESS TAX RECEIPT BY THE CITY OF HOLLYWOOD DOES NOT MEAN THAT THE CITY HAS DETERMINED THAT�.THE EXISTING OR PROPOSED USE OF A LOCATION IS LAWFUL. ISSUANCE OF A LOCAL BUSINESS TAX RECEIPT DOES NOT LEGALIZE OR CONDONE THE NATURE OF THE BUSINESS BEING CONDUCTED IF CONTRARY TO ANl� LOCAL, STATE OR FEDERAL LAW OR REGULATION. THIS IS NOTA BILL.BELOW IS YOUR LOCAL BUSINESS TAX RECEIPT.PLEASE DETACH AND POSTTHIS LOCAL BUSINESS TAX RECEIPT IN A CONSPICUOUS PLACE AT OUR PLACE OF BUSINESS. `° od„ Glty Of - DWW�9 H LL • ,mm 2016/2017 LOCAL BUSINESS TAX R CEIPT Business Name:MOONLIGHT EDITIONS,INC Account Registration#:B9000187-2017 DBA: RK BUILDERS,INC I Expiration Date:9/30/2017 Business Location:1036 JEFFERSON ST Tax'Paid:$190.00- Business 190.00Business Category:SERVICE/LICENSED.BUSINESS Classification:Contractor/Building Tax Basis:1 WORKER(OWNER) i From: GFI FaxMaker To: 13057568972 Page:2/2 Date: 12!7/2016 8:19:42 AM Client#:100502 MOOED ACORD., CERTIFICATE OF LIABILITY INSURANCE [ (MMIDDIYYYY) DAT 12/47/2 10712016 16 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. lRl`PCiR�(f the cerci cafe holder Is an ADDITIONAL INSVRE�polLcy�iesj must i�:endo�sed.{f SUBitOGATION 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 endome17 ent(s). PRODUCER Certificates Department Advanced Insurance Underwriters,LLC --- au No ExI�954 963-6666—_._...�._......._...._ rAle�:954 964-1438 3250 N.29th Ave --1- -- Hollywood, FL 33020 A R ss: certiflcates@advancedlns.com ,rr__ _ _ INSURERIS)AFFORDING COVERAGE NAIC 0 INSURERA a Ess ex Insurance Company 3�tl20 INSURED INSURER B, Moonlight Editions,Inc. INSURER C dba RK Builders,Inc. - --- 1835 E.Hallandale Beach Blvd.#736 INSURER D Hallandale Beach,FL 33009 INSURER E - --- •-------- INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN SSUEO TO THE INSURED NAMED ABOVE FORTHE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRiBFD HERLIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. yds TYPE OF INSURANCE POLICY NUMBER IM YyYY LIMITS A GENERAL LIABILITY 3ED5485 0212412016 02/24/2017 FACH OCCURRENCE $100000 X COMMERCIAL GENERAL-�LIABILITY . $100.000 CLAIMS-MADE i. '#OCCUR MED EXP(Ary one arson) L51000 PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE s2,00,000 GENT AGGREGATE LIMIT APPLIES PER: PRCDUCTS-COMPIOP AGG $1,000,000 _ X POLICY 0 T'RlT- LOC $ AUTOMOBILE LIABILITY CO .FSi E LI ANY AUTO BODILY INJURY(Per parson) $ ALL OWNED I SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ HtREOAUTOS AU70SWNED $ Poe,tzxidenq EUMLIAR OCCUR EACH OCCURRENCE $ EXCESSLIAB Cj.,Agy�3-MADE d1G€.;REGBiTE DEt3 RET`E'NTION$ WORKERS COMPENSATION I gym, AND EMPLOYERS LIABILITY ANY PROPRIET<MPARTNEWEXECUTIvE YIN IXf�B ti:Liit1IIS'. OFFICERadEMBEREXCL.UDED4 � NIA E.LEACtiACCIOENT $ iMandatory in NH) E L I'ISEASE-EA EMPLOYEE $ it yas,describa undar .............._........-S. DESM1PTION OF OPERATIONS below E .DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) License#CBC 060255 CERTIFICATE HOLDER CANCELLATION Miami Shores Village SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 10050 Northeast 2nd Avenue ACCORDANCE WITH THE POLICY PROVISIONS. Miami Shores,Florida 33138 AUTHORIZED REPRESENTATIVE .44��u arm 4x.14 e "rr'' a sura 'sxa, ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD SSIA31 RS/3/M113d9RA3 MAR This fax was sent with GFI FaxMaker fax server. For more information,visit: http://www,gfi.com 12/18/2009 21:40 9549253063 PAGE 05/06 I i i f { JEFF ATWATER j CHIEF FINANCIAL.OFFICER STATE OF FLORIDA i DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS'COMPENSIt1TION "CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA liiORKERS'COMPENSATION LAW"• CONSTRUCTION INDUSTRY EXEMPTION j This cx3rtiftes that the individual listed below has elected to be exempt from Floridai Workers'Compensation law. EFFECTIVE DATE: 2/20/2015 EXPIRATION DATE: 2/19/2017: PERSON: KIRCHGESSNER ROBERT FI FEIN: 650759480 BUSINESS NAME AND ADDRESS: I MOONLIGHT EDITIONS INC RK BUILDERS, INC. 1835 E HALLANDALE BEACH HALLANDALE BEACH FL 33009 SCOPES OF BUSINESS OR TRADE: LICENSED BUILDING CONTRACTOR Pursuant to Chapter 440.06(14),F.3.,an ofacer of a ewporaflon who elecle mcempUan from this chapter by HlAg a CerMicate of election under this section may not recover benefits or compensation under this chapter.PunivaM to Chapter 440.05(12),F.S.,Ceac ites of election to be exempL..apply only within"scope of the business or trsde fisted on the MWIN of election to be wwmpL Pu suant to Chapter 4 40.05(13X F.S.,Notices of eleGlim to be exempt and wfliricates of election to be exempt shag be subject to f0vOcatian If,at any lime atter the fil4V 9 the notim or the issuance of the oertiHcate, the person named an the notice or certificate no longer moats the requirements of Ift section for issuance a certi6cde.The department shay revoke a DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUESTIONS?(850)418-IWS j I I I I i I { I I i I j I