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RC-17-815 nrd -1715 Miami Shores Villageopf hype:kesionti" ,construction 10050 N.E.2nd Avenue NE ►�jjc j;<{ t'TOtf..Add iidttlAltet'atlon ' Miami Shores,FL 33138-0000 it % ,� Phone: (305)795 2204 F'errrtit S#atW ��APIPRO � D l5rJ17 Expiration: 11/0162017 Project Address Parcel Number Applicant 1059 NE 104 Street 1122320290100 WILLIAM MCCAUSLAND k Miami Shores, FL 33138- Block: Lot: Owner Information Address Phone Cell LILLIANA MCCAUSLAND 1059 NE 104 ST MIAMI SHORES FL 33138-2655 Contractor(s) Phone Cell Phone $ 300.00 OZZY'S GOLDEN CONSTRUCTION IN( (305)884-5078 Valuation: Total Sq Feet: 0 ' Approved:In Review Available Inspections: Comments: Inspection Type: Date Approved::In Review Drywall Date Denied: Miscellaneous Type of Construction:TAKE OUT WINDOW AND FILL WIT Occupancy:Single Family Window Door Attachment Stories: Exterior: Tie Beam Front Setback: Rear Setback: Final Left Setback: Right Setback: Framing Bedrooms: Bathrooms: Insulation Plans Submitted:Yes Certificate Status: Final PE Certification Certificate Date: Additional Info:TAKE OUT WINDOW AND FILL WIT Truss Insp Columns Bond Return: Classification:Residential Foundation Fees Due Amount Pay Date Pay Type Amt Paid Amt Due Window and Door Buck CCF $0.60 Fill Cells Columns DBPR Fee $2.00 Invoice# RC-3-17-63444 Wire Lathe DCA Fee $2.00 03/24/2017 Credit Card $50.00 $149.60 Review Building Education Surcharge $0.20 05/05/2017 Credit Card $ 149.60 $0.00 Review Building Notary Fee $5.00 Review Structural Permit Fee $100.00 Review Structural Plan Review Fee(Engineer) $80.00 Declaration of Use Scanning Fee $9.00 F.Termite Letter Technology Fee $0.80 F.Elevation Certificate Total: $199.60 Review Planning Review Mechanical Review Electrical Review Plumbing 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 ELECTRICALjrt Athat4l CHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: I eforeg ing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. horize t e above-namedcontractor to do the work stated. May 05, 2017 Authorized Si at e:Owner / pplicant / Contractor / Agent Date Building Department Copy May 05,2017 1 �� ��r �-� ;��� ��ea � 9) , Miami Shores Villa a ,, . , g = , 0 � Building Department'J� De MAY 032011 � 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 2014 BUILDING Master Permit No. Rc I - B I S PERMIT APPLICATION Sub Permit No. BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: /0 S f I e 10!!Z 5777 City: Miami Shores County: Miami Dade Zip:-33139 Folio/Parcel#: 11-2-2-32- 02-9 -0/00 Is the Building Historically Designated:Yes NO _ Occupancy Type: Load: / Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): �dG !�/G'Gcl 7�" tl� Phone#: _71S6• Z�0 • %Z� Address: lVL�- /0 City: &j4-esP.-n✓ Shin T State: JK= Zip: % 3 0� Tenant/Lessee Name: Phone#: Email: j CONTRACTOR:Company Name:_C,7-?9;jeS � �� G Phone#: Address: 102? 5C I ( 7- City: City: M e_7 lF'o:�'4 / State: Zip: 3:3 0/® Qualifier Name: 0_50n 1J0 C-rC4 Ve'v'AA Phone#: _305_-'76,0-66/_Z- State 5_-`i 6,0-6 6/'Z- State Certification or Registration#:e,-gC./5-f�K20s- Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ 4,/00• Q'�' Square/Linear Footage of Work: 49"-E Type of Work: ❑ Addition 1I Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: dE:;F-u^S�r�� i ryx �yyL j 0 kk!L�'Cj C Case'- ad' w,A L.L. 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$ I GO (Revised02/24/2014) Bonding Company's Name(if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name(if applicable) ✓(1GM G 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 GENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this ( I'-- day of Mrj LA 120 17 by Z- day of 20 ,by LI 11Nyccau�knf4 who is personally known to 1 c1 VC1 Yo 1 is personally known to me or who has produced 1_J rl V�V l 1 CJ'c as me or who has produc d 1 Q q-4(4 identification and who did take an oath. identification and who did take an oath. 11 NOTC: �� NOTARY PUBLIC: Sign: Sign: "YPu''• MAHARAI K GONZALEZ Print: Print: '�:�` "� Myeemmiftem EXPIRES:November2,2020 IEfO Seal: ' YANAD Seal: ' a �p Bonded Thru Notary Public UndQrcn e MY COMMISSION#FF 214031 p;, EXPIRES:March 25,2019 ,. Bonded Thru Public Undenff t m APPROVED BY ( l� Plans Examiner Zoning 9 � Structural Review Clerk (Revised02/24/2014) STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION � CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487-1395 ��"�o 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 GRAVERAN, OSVALDO OZZY'S GOLDEN CONSTRUCTION INC 1441 EAST 8 COURT HIALEAH FL 33010-3325 Congratulations! 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 STATE OF FLORIDA from architects to yacht brokers,from boxers to barbeque DEPARTMENT OF BUSINESS AND restaurants,and they keep Florida's economy strong. .L % PROFESSIONAL REGULATION Every day we work to improve the way we do business in order CGC1514705 ISSUED.: 06/12/2016 to serve you better. For information about our services, please log onto www.myfloridalicense.com. There you can find more CERTIFIED GENERAL CONTRACTOR information about our divisions and the regulations that impact GRAVERAN, OSVALDQ you, subscribe to department newsletters and learn more about OZZY'S GOLDEN CONSTRUDTION INC the Department's initiatives. Our mission at the Department is: License Efficiently, Regulate Fairly.We constantly strive to serve you better so that you can serve your customers. Thank you for doing business in Florida, IS CERTIFIED under the provisions of Ch.489 FS. and congratulations on your new license! Expiration dale: AUG 31,2018• L1606120001423 DETACH HERE RICK SCOTT, GOVERNOR KEN LAWSON,SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD CGC1514705 The GENERAL CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 FS. � ' Expiration date: AUG 31, 2018 GRAVERAN, OSVALDO 0 OZZY'S GOLDEN CONSTRUCTION INC 1077 SE 9 CT HIALEAH FL 33010 f: ISSUED: 06i12i20'1'6" -DISPLAYASREQUIRFD'F3YI.AW' SFQ# L.1606120001423 DATE(MMIDDIYYYY) A,l✓ CERTIFICATE OF LIABILITY INSURANCE 05/02/2017 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. IMPORTANT:If the Certificate holder is an ADDITIONAL INSURED,the policy(les)must have ADDITIONAL INSURED provisions or 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 NAME: PHONE A/C,No,Ext): (800)277-1620 X4800 FAX A/C,No): 727 797-0704 FrankCrum Insurance Agency,Inc. E-MAIL ADDRESS: 100 South Missouri Avenue INSURERS AFFORDING COVERAGE NAICA Clearwater,FL 33756 INSURER A: Frank Winston Crum Insurance Company 11600 INSURED INSURER B: INSURER C: FrankCrum UC/F Ozzy's Golden Construction,Inc. INSURER D: 100 South Missouri Avenue INSURER E: Clearwater,FL 33756 INSURER F: COVERAGES CERTIFICATE NUMBER: 428501 REVISION NUMBER: 1 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. INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSRO WVD (MMIDDIYYYY) (MMIODNYYY) COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE OCCUR DAMAGE TO RENTED $ PREMISES Ea occurrence MED EXP(Any one penwn) $ PERSONAL 8 ADV INJURY $ pGEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY =PROJECT =LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ ANY AUTO BODILY INJURY(Par parson) $ OWNED AUTOS SCHEDULED ONLY AUTOS BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ ONLY AUTOS ONLY Per accident) $ UMBRELLA LIAR OCCUR EACH OCURRENCE $ EXCESS LIAR H CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ PEMPLOYERV KERS COMPENSATION AND WC201700000 01/01/2017 01/01/2018 X PER STATUTE OTH- A LIABILITY Y/N ER ROPRIETORIPARTNER—ETNOFICERIMEMBER EXCLUDED? 0 N/A E.L.EACH ACCIDENT $1,000,000 (Mandatory in NH) If yes,describe under E.L.DISEASE-EA EMPLOYEE $1,000 000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1000000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Effective 09/28/2015,coverage is for 100%of the employees of FrankCrum leased to Ozzy's Golden Construction,Inc.(Client)for whom the client is reporting hours to FrankCrum.Coverage is not extended to statutory employees. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Miami Shores Village Building Department AUTHORIZED REPR SENTATIVE 10050 NE 2nd Avenue ,,..- Miami Shores,FL 33138 ©1988-2016 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD 009940 Local Business Tax Receipt Miami—Dade County, State of Florida —THIS IS NOT ABILL—DO NOT PAY LBT 6171284 \1 - -) BUSINESS NAME/LOCATION RECEIPT NO. EXPIRES OZZYS GOLDEN CONSTRUCTION INC RENEWAL SEPTEMBER 30, 2017 1077 SE 9 CT 6435671 Must be displayed at place of business HIALEAH FL 33010 Pursuant to County Code Chapter 8A—Art.9&10 OWNER SEC.TYPE OF BUSINESS OZZYS GOLDEN CONSTRUCTION INC 196'GENERAL BUILDING CONTRACTOR PAYMENT RECEIVED CGC1514705 BY TAX COLLECTOR Worker(s) 1 $45.00 07/10/2016 CREDITCARD-16-037796 This Local Business Tax Receipt only confirms payment of the Local Business Tax.The Receipt is not a license, permit,or a certification of the holder's qualifications,to do business. Holder must comply with any governmental or nongovernmental regulatory laws and requirements which apply to the business. The RECEIPT N0.above must be displayed on all commercial vehicles—Miami—Dade Code Sec Ba-276. For more information,visit www.miamidade.eov/taxcollector ACOO OR ® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YWY) 05/03/2017 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. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les)must have ADDITIONAL INSURED provisions or 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 Sarai Medina NAME: Emmanuel Insurance&Associates,Inc. a/c No Ext): (305)693-0003 ac N.): (305)691-4381 2370 E 8TH AVE E-MAIL ADDRESS: sarai@emmanuelinsurance.com INSURER(S)AFFORDING COVERAGE NAIC# HIALEAH FL 33013-4236 INSURER A: International Insurance Company INSURED INSURER B: Hartford Insurance Company 38288 OZZY'S GOLDEN CONSTRUCTION,IN INSURER C: OSVALDO GRAVERAN INSURER D: 1077SE9CT INSURER E HIALEAH FL 33010 INSURER 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 SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DDY EFF MMIDD EXP LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000.00 CLAIMS-MADE1 OCCUR DAMAGE TO 50,000.00 PREMISES Ea occurrence) $ MED EXP(Any one person) $ 5,000.00 A IG011004250-00 10/02/2016 10/02/2017 PERSONAL&ADV INJURY $ 1,000,000.00 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000.00 POLICY L]JET 1-1 LOC PRODUCTS-COMP/OP AGG $ 2,000,000.00 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 300,000.00 Ea accident ANY AUTO BODILY INJURY(Per person) $ B OWNED SCHEDULED 84 UEC NG 1259 SA 11/19/2016 11/19/2017 BODILY INJURY Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB HCLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION PER ETH EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? ❑ N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ Ifs describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) General Contractor CERTIFICATE HOLDER CANCELLATION Miami Shores Village SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 10050 NE 2nd Ave THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Miami Shores,Florida 33138 ACCORDANCE WITH THE POLICY PROVISIONS. PH 305.795.2204, Fax:305.756.8972. AUTHORIZED REPRESENTATIVE 1 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD City of Hialeah J City of Business Tax Receipt 2016-17 HIALEAH p Mayor Carlos Hernandez No: 236210-1 (OLD-1641-201) Amount: $ 200. 00 The person,fine or corp. listed here has paid the business tax required to engage in or operate the business specified subject to the regulations and restrictions of the City of Hialeah,Florida Owner: OSVALDO GRAVERAN Type oJBusiness:Industrial Building Construction OZZY'S GOLDEN CONSTRUCTION INC. ATTN• OSVALDO GRAVERAN Business Location: 1441 E 8 CT HIALEAH, FL 33010 1077 SE 9 CT Validating No.: 0000 Expires September 30, 2017 THIS IS NOT A BILL