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DEMO-15-2027 �Y �M04 X 27 Miami Shores Village ■ Al e� �tt# �o#. �. 10050 N.E.2nd Avenue NE a � 1tYt� ts�FfrcBb Sui�ldiltig Miami Shores,FL 33138-0000 how Phone: (305)795-2204 F RDate. Expiration: 02120/2016 Issue �81 4120415. P Project Address Parcel Number Applicant 1255 NE 99 Street 1132050090100 CURRENT OWNER Miami Shores, FL 33138-2642 Block: Lot: Owner Information Address Phone Cell CURRENT OWNER 1255 NE 99 Street MIAMI SHORES FL 33138-2642 1255 NE 99 Street MIAMI SHORES FL 33138-2642 Contractor(s) Phone Cell Phone Valuation: $ 36,500.00 MCKENZIE CONSTRUCTION LLC (323)533-4151 . ._.. .:. Total Sq Feet: 1321 Type of Demo:Building Available Inspections: Additional Info:COMPLETE INTERIOR DEMOLITION OF EXI Inspection Type: Classification:Residential Review Electrical Scanning:3 Review Electrical Review Planning Review Plumbing Review Building Review Structural Review Mechanical Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $22.20 Invoice# DEMO-8-15-56682 DBPR Fee $16.43 DCA Fee $16.43 08/17/2015 Check#:1010 $150.00 $1,166.06 Education Surcharge $7.40 08/24/2015 Credit Card $ 1,166.06 $0.00 Permit Fee $1,095.00 Plan Review Fee(Engineer) $120.00 Scanning Fee $9.00 Technology Fee $29.60 Total: $1,316.06 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,M CAL,WINDOWS&DS, OOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: I certify that al the forego' ation iand that II work will be done in compliance with all applicable laws regulating construction and zoni Futhermore,I autho' e a e- amed do th ork stated. August 24, 2015 Authorized Signature: / Applicant / Contractor / Agent Date Building Department Copy August 24,2015 1 Miami Shores Village --, Building Department AUG 112015 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 �j ) FBC 20 04 BUILDING Master Permit NOEW— i ,S -2c°274 PERMIT APPLICATION Sub Permit No. ®BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION [—]RENEWAL ❑PLUMBING [:] MECHANICAL ❑PUBLIC WORKS [:] CHANGE OF ❑CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 12 5 5 N E GQ t SkRee,F City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: I I-32 O 5- 00q-O t 00 Is the Building Historically Designated:Yes NO X Occupancy Type:T-es. Load: Construction Type: Flood Zone: N1 BFE: S F+ FFE: OWNER:Name(Fee Simple Titleholder): -Josh W ollow C.K Phone#: 305- 5 31-DA 10 Address: 1255 N1 ggkr) Sk¢ec.i' City: 1%7AM7 S ho meS State: FL Zip: 3 3 t 4- Tenant/Lessee Name: Sash Woltow 7CY Phone#: Email: �osh(6J `cosh Wnl\oW°C.k rnm CONTRACTOR:Company Name: M0K nz?e CCnSkrzv(�-'On LLL Phone#: Address: 224-7 NYS I"1 A-v\ Ikvey)Ut City: MZ AYYi k State: FL Zip: 3-:S I Q 2 Qualifier Name: GaJ Z n M LKe-Y\Z'We. Phone#: State Certification or Registration#: C 61 C 1 Pi I G 135 Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ ��• ��`' Square/Linear Footage of Work: t 32-1 Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ® Demolition Description of Work: Ccorf,kp\e.ke 7nkt2702. Aeyyn\',+,On ni (-K I5A'ao S?n4ie TW,ly "0rfe 102 1Pe'ro1jAt,on 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$ TOTAL FEE NOW DUE$ (Revised02/24/2014) Ja � 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 AA, OWNER i ir AGENT CONTRACT R J The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this f day of TU 1 20 by 24" "'A day of IS 20 !r� by TO `' `, W who is persona` ,�y known to AV J A) ) / who is personally known to me or who has produced !ZL t)li Jr.i'< (-1C-Ck?J1-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: �� � ° Print: .show') Print: �'1 ;o Seal: NOTARY PUBLIC Seal: Notary Public-State of Florida ®j 6 �` .a, My Comm.Expires Mar 1,2018 My commission exp. June 3, ,,a,-,5,oV, Commission# FF 87976 ***t-*t�t'*r APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) COMMONWEALTH OF MASSACHUSETTS County of Berkshire, ss. On this qday of , 20�before me,the undersigned notary public,personally appeared C- proved to me through satisfactory evidence of identification, being(check whatever applies): ( A-driver's license or other state or federal government document bearing a photographic image; ( ) oath or affirmation of a credible witness known to me who knows the above signatory; or ( )my own personal knowledge of the identity of the signatory, to be the person whose name is signed on the preceding or attached document and acknowledged to me that ke- signed it voluntarily for its stated purpose. N�ry Public Name My commission expire® ;,1-4 CECILE C. SNOW NOTARY PUBLIC My commission exp. June 3, 2016 H:\Deposits\FORMS\Notary Acknowledgement (Revised).doc Susmoss Tax ts o COMIC 101" y ARPT jai t5usrr , to!Cqwny code f"'AftMo t, 11 . , TAXctiuiw jR z .00 0 5-7777 r ti V MCKEN-6 OP ID:IG ,�►�,.o�z,oW CERTIFICATE OF LIABILITY INSURANCE °Aosi2a�zo°�'s' 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), AUTHORIM REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: N 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 NAME:CT Brown&Brown of Florida,Inc. 1201 W Cypress Creek Rd 0130Eft Noy P.O.Box 8727 Eft Ft Lauderdale,FL 33310-5727 Eric Martin Woodling INSURERS AFFORDING COVERAGE NAIL A wsURERA:Rockhill Insurance Co.+ 20M INSURED McKenzie Construction LLC mwIR!RB:AIG Specialty Insurance Co+ 26883 Gavin McKenzie 2247 NW 17 Avenue °isURERc Miami,FL 33142 INSURERD: INSURER E- UiSURER F COVERAGES CERTIFICATE NUMBER: 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 SHOVM MAY HAVE BEEN REDUCED BY PAID CLAIMS. JJR TYPE OF INSURANCE INSR V.PM POLICY NUMSM E LIMITS GENERAL LbABILTTY EACH OCCURRENCE $ 1,000,000. A X COMMERCIALGENEmuABILITY GENLO1341800 05/17/2016 05/17/2016 pREW S 100, CLAIMS40ADE ®OCCUR MED EXP(Any are person $ ExcludeA PERSONAL BADV INJURY $ 110001 GENERAL AGGREGATE $ 2,000,0 Gen AGGREGATE LIMIT APPLIES PEP: PRODUCTS-CDMPfOPAGG $ 2,000,b0 POLICY X � LOC $ AUTOMOBILE LIABILITY COMBINEDdmlSl NGLE LIMIT �f ANY AUTO BODILY INJURY(Per pemon) S .. ALL OWNEDSCHEDULED BODILY INJURY(Per®oddem S AUTOS AUTOS HIRED AUTOS NO ED PER AR DAS s UMBRELLA LIAS X OCCUR EACH OCCURRENCE S 5100010 B X EXCESS LwB CLAIMS-MADE BEOGN95491 0511712015 05/17/2016 AGGREGATE $ 51000,0 DED I I RETENTIONS 1 $ WORKERS COMPENSATION WC A OTH AND EMPLOYERS'LIABILITY YIN ANY PROPRIETORIPARTNERIEXECUTNEN i A E.L.EACH ACCIDENT s OFFIGER/MEMSER EXCLUDED? (Mmddm in NH) E.L.DISEASE-EA 2npn4 s K desvlve under ON OF OPMTIONS below E.L.DISEASE-Poucy LIMIT I s iESCMTKIN OF OPERATKlNS I LOCATIONS I VEHICLES(Aaach ACORD 101,Add itmul Rmnaft Sehedula,H mme space is mqulmd) Miami Shores Village is listed additional insured with respect to General Liability if required by written contract. CGC#1516135 CERTIFICATE HOLDER CANCELLATION MIAMISH SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Miami Shores Village THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN g ACCORDANCE WITH THE POLICY PROVISIONS. Building Dept 10060 NE 2nd Avenue AUTHoRMED 11033RESENTATWE Miami Shores,FL 33138 ©1988-2010 ACORD CORPORATION. AN rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD MCKEN-6 Pace 2 NOTEPAD wsuREws NAmr. McKenzie Construction LLC OP 10:IG o„c, 05/21/2015 G 2001 04/13 Primary Non Contributory CG 2011 04/13 Additional Insured Managers/Lessors or Premises ! G 2028 04/13 Additional Insured Lesssor of Leased Equipment G 2033 04/13 Blanket Additonal Insured As required by written contract CG 2037 04/13 Additional Insured Completed Operations ( Blanket where required by written contract - Commercial work only CG 2404 05/09 Waiver of Transfer of Rights of Recovery ( Blanket where ea+,,red by written contract) 0869 12/03 Per Project Agg - $5,000,000 CAP { MCKEN-1 OP ID:PW '4�coRL'- CERTIFICATE OF LIABILITY INSURANCE F °A O7l30H071301 5 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 policypes) must be endorsed, U 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 M lieu of such endomemen s. PRODUCER Phone:772-231-2828 E; Sand F® s Brown&Brown Insurance-Vero Fax:772-231-441 PHONE 772.468-1512 FAX Vero Division Arc No 617 Beachiand BlvdD L .sfeys@bbvero.com Vero Beach,FL 32963 Brown&Brown Insurance INSURE AFFORDING COVERAGE NAIL 0 INSURERA:*American Builders Ins.Co. 11240 INSURED McKenzie Construction LLC INSURERS: 2247 NW 17th Avenue Miami,FL 33142 INSURER c INSURER D INSURER E. COVERAGES CERTIFICATE NUMBER: 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. INS TYPEOFINSURANCE A DrYYMLI EXP uMITs GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY PREMISES Me accurrermi $ CLAIMS-MADE D OCCUR MED EXP one parser) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ POLICY PR0. LOC $ AUTOMOBILE LIABILITY ANY AUTO BODILY INJURY(Per parson) $ ANON ED AUTOS BODILYINJURY(Per soddent) $ NON•OWNED $ FHIRED AUTOS AUTOS Per scald UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESSLIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION S $ WORKERS COMPENSATION A OTH AND EMPLOYERS'LIABILITY YIN QLt MI' A ANY PROPRIETORIPARTNEMEXECUTIVECV0197728-M 07103115 07/03116 E.L.EACH ACCIDENT $ 1,000,0 OFFICERIMEMBER EXCLUDED? F-1 N f A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,00( If M describe under DESCRIPTION OF OPERATIONS bakm EL DISEASE-POLICY LIMIT $ 1,000, DESCMPTtbt4 OFOPERAMONS i LOCATIONS/VEHICLES(Attach ACORD 101,Additnal Remaft Schedule,If more space isrequired) CGC#1516135 CERTIFICATE HO CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Miami Shores Villages ACCORDANCE WITH THE POLICY PROVISIONS. Building Dept. 1005ONE 2nd Ave AU'rHOREDREPRESENTATIVE Miami Shores,FL 33138 ©1888-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD v CFN:20150195194 BOOK 29552 PAGE 3101 DATE:03/26/2015 08:28:00 AM DEED DOC 3,240.00 HARVEY RUVIN,CLERK OF COURT,MIA-DADE CTY Prepared by, Record and Return to:. Stephen A. Taylor, Esq. 10800 Biscayne Boulevard, Suite 700 Miami, FL 33161 Ph: (305)722-0091 Folio No.: 11-3205-009-0100 WARRANTY DEED THIS WARRANTY DEED made this I bT� day of 2015, by Lisa immn Packard,as Sucosssor Trustee of the.BYS Trust,Wd August 1,20'12;with a place of business at 585 NE 95h Street,Miami,FL 33138, (the GRANTOR'), to Josh Wollowick, an unmarried man (the GRANTEEI, whose post office address is 1255 NE 99"'Street, Miami Shores, FL 33138. GRANTOR, for and In consideration of the sum of TEN AND 00/100S ($10.00) Dollars and other good and valuable considerations to said grantor in hand paid by said GRANTEE, the receipt whereof is acknowledged, has granted, bargained and sold to GRANTEE and GRANTEE'S heirs and assigns forever, the following described land located in the County of Miami-Dade, State of Florida(the Property): Lot 133 and the West one half (112) of Lot 14, Block 1, EARLETON SHORES, according to the plat thereof, recorded in Plat Book 43, page 80 of the Public Records of Dade County, Florida, The Property is not the homestead of the Grantor listed above as defined by the Florida Constitution,and that the property is not contiguous to the Grantor's homestead. AND, the Grantor hereby covenants with said Grantees that the Grantor is lawfully seized of said land in fee simple; that the Grantor has good right and lawful authority to sell and convey said land, and hereby warrant the title to Said land and will defend the same against the lawful claims of:all persons whomsoever; and that said land is free of all encumbrances, except taxes accruing subsequent to December 31, 2014. SUBJECT TO: 1. Taxes for the year 2015 and subsequent years, which are not yet due and payable. 2. Conditions, restrictions, limitations, easements, dedications, agreements, reservations and other matters of record; as well as all matters disclosed on the above-described plat; provided, however, that the foregoing shall not serve to impose or re-impose same.