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DJD 19T ��Ci�� Project Address Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 Parcel Number Expiration: 04/10/2017 Applicant 800 NE 91 Terrace Miami Shores, FL 1132060050390 Block: Lot: BANCROFT INVESTMENTS, LLC Owner Information Address Phone Cell BANCROFT INVESTMENTS, LLC 7950 NE BAYSHORE Court MIAMI FL 33138- (786)241-6627 7950 NE BAYSHORE Court MIAMI FL 33138 - Valuation: Total Sq Feet: $ 3,850.00 246 Type of Demo: Building Additional Info: TO BE IN LIKE WITH THE CITY CODE TH Classification: Residential Scanning: 4 Fees Due CCF DBPR Fee DCA Fee Education Surcharge Permit Fee Plan Review Fee (Engineer) Scanning Fee Technology Fee Work without Permit Fee Total: Amount $2.40 $2.00 $2.00 $0.80 $115.50 $80.00 $12.00 $3.20 $115.00 $332.90 Pay Date Pay Type Amt Paid Amt Due Invoice # DEMO -8-16-60919 08/08/2016 Credit Card $ 50.00 $ 282.90 10/12/2016 Credit Card $ 282.90 $ 0.00 Available Inspections: Inspection Type: Final Review Plumbing Review Electrical Review Electrical Review Building Review Building Review Building Review Structural Review Mechanical , 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: • -rtify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and ze ng. uthermore, I authorize the above-named contractor to do the work stated. October 12, 2016 Aut)iori - Signature: Owner / Applicant / Contractor / Agent Building Department Copy Date October 12, 2016 1 Project Address Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 Parcel Number Expiration: 04/10/2017 Applicant 800 NE 91 Terrace Miami Shores, FL 1132060050390 Block: Lot: BANCROFT INVESTMENTS, LLC Owner Information BANCROFT INVESTMENTS, LLC Address 7950 NE BAYSHORE Court MIAMI FL 33138- 7950 NE BAYSHORE Court MIAMI FL 33138- Contractor(s) Phone Cell Phone CONWELL & ASSOCIATES CONSULT (305)962-5673 (305)926-5673 Phone (786)241-6627 CeII Valuation: Total Sq Feet: $ 1,500.00 0 Type of Demo: Plumbing Additional Info: DEMO OF GARAGE IT WAS BEDROOM & BAT Classification: Residential Scanning: 1 Fees Due CCF DBPR Fee DCA Fee Education Surcharge Permit Fee Scanning Fee Technology Fee Work without Permit Fee Total: Amount $1.20 $2.00 $2.00 $0.40 $100.00 $3.00 $1.60 $100.00 $210.20 Pay Date Pay Type Amt Paid Amt Due Invoice # DEMO -9-16-61522 10/12/2016 Credit Card $ 210.20 $ 0.00 Available Inspections: Inspection Type: Final 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 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 and zoning. Futhermore, I authorize the above-named contractor to do the work stated. October 12, 2016 Authorized Signature: Owner / Applicant / Contractor / Agent Building Department Copy Date October 12, 2016 1 Protect Address Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 Parcel Number Expiration: 04/10/2017 Applicant 800 NE 91 Terrace Miami Shores, FL 1132060050390 Block: Lot: BANCROFT INVESTMENTS, LLC Owner Information Address Phone Cell BANCROFT INVESTMENTS, LLC 7950 NE BAYSHORE Court MIAMI FL 33138- (786)241-6627 7950 NE BAYSHORE Court MIAMI FL 33138- Contractor(s) AIROLOGY INC Phone (754)366-5380 CeII Phone Valuation: Total Sq Feet: $ 100.00 0 Type of Demo: Mechanical Additional Info: THE REMOVAL OF EXISTING AIR HANDLIN Classification: Residential Scanning: 1 Fees Due CCF DBPR Fee DCA Fee Education Surcharge Permit Fee Scanning Fee Technology Fee Work without Permit Fee Total: Amount $0.60 $2.00 $2.00 $0.20 $100.00 $3.00 $0.80 $100.00 $208.60 Pay Date Pay Type Amt Paid Amt Due Invoice # DEMO -9-16-61505 10/12/2016 Credit Card $ 208.60 $ 0.00 Available Inspections: Inspection Type: Final Review Mechanical 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 and zoning. Futhermore, I authorize the above-named contractor to do the work stated. October 12, 2016 Authorized Signature: Owner / Applicant / Contractor / Agent Building Department Copy Date October 12, 2016 1 Project Address Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 Parcel Number � t �I 6-2660 Type Demolition 'emait Sttrs: APPROVED Expiration: 04/03/2017 Applicant 800 NE 91 Terrace Miami Shores, FL 1132060050390 Block: Lot: BANCROFT INVESTMENTS, LLC Owner Information Address Phone CeII BANCROFT INVESTMENTS, LLC 7950 NE BAYSHORE Court MIAMI FL 33138- (786)241-6627 7950 NE BAYSHORE Court MIAMI FL 33138 - Valuation: Total Sq Feet: $ 100.00 250 Type of Demo: Electric Additional Info: REMOVAL OF EXISTING LIGHT SWITCHES Classification: Residential Scanning: 1 Fees Due CCF DBPR Fee DCA Fee Education Surcharge Permit Fee Scanning Fee Technology Fee Work without Permit Fee Total: Amount $0.60 $2.00 $2.00 $0.20 $100.00 $3.00 $0.80 $100.00 $208.60 Pay Date Pay Type Amt Paid Amt Due Invoice # DEMO -9-16-61497 10/12/2016 Credit Card $ 208.60 $ 0.00 Available Inspections: Inspection Type: Final Review Electrical 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 and zoning. Futhermore, I authorize the above-named contractor to do the work stated. October 12, 2016 Authorized Signature: Owner / Applicant / Contractor / Agent Building Department Copy Date October 12, 2016 1 qfr9P \CAt\\\QcpC)" BUILDING PERMIT APPLICATION ". 51 Miami Shores Village 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 UILDING ❑ ELECTRIC ❑ ROOFING ❑PLUMBING ❑ MECHANICAL PUBLIC WORKS JOB ADDRESS: City: Folio/Parcel#: go -0 t E cos' Miami Shores FBC 20 (` Master Permit No.. ® (b ` Sub Permit No. ❑ REVISION ❑ EXTENSION ❑ CHANGE OF ❑ CANCELLATION CONTRACTOR County: • ❑ RENEWAL ❑ SHOP DRAWINGS Miami Dade Occupancy Type: J Load: Zip: 3 3 I J e NO Is the Building Historically Designated: Yes Construction Type: C8 r Flood Zone: BFE: FFE: p l 241d/�z7 OWNER: Name (Fee Simple Titleholder): �G Tv1 ..17 LLC Phone#: -- I el -4 2 3.4. 0 Address: �- 1 S 0 tJ l� (iy ‹kov-ems Ck t � City: i 600,-‘i S State: i Zip: 3 31 32 Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: (IL( \` I L L C Address: ! (J iZ C City: LL State: Qualifier Name: Phone#: 9Vs/55fe Phone#: State Certification or Registration #: CC) C t' s 247 5, 0 Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Zip: ? Value of Work for this Permit: $ 3 SO'LXX Square/Linear Footage of Work: gaNt Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace 12<molition Description of Work: lO bei S b, \, &--ate c,.) I \ c C.0 d.te- 5 (N, 60,3,i✓ Troretry.Nokk. c kt15 6 Lk:iq .foU,31.,‘, C (4,e 0Vi oCo "y c ; Specify color of color thru tile: Submittal Fee $' O Permit Fee $ j B. Ck CCF $ (9.• co/as Scanning Fee $ CA) Radon Fee $Q .03 DBPR $0-.03 Notary $ Technology Fee $ 3 2 0 Training/Education Fee $ 0 -go Double Fee $ I S -Q Structural Reviews $(30 - Bond $ 52) (Revised02/24/2014) TOTAL FEE NOW DUE $ 28 2 - I 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 OWNER or AGENT Signature CONTRACTOR The foreing instrument was acknowledged before me this The fore ing instrument was acknowledged before me this _ day of ,/ ir6s'', 20 /6 , by _ 24 day of _} , 20 / , by 4, 5w/exr , who is personally known to� ho is personally known to me or who has produced identification and who did take an oath. NOTARY PUBLIC: Sign: Print: Seal: as me or who has produced as identification and who did take an oath. NOTARY PUBLIC: �..-.o :. ..' -tii ;•"s MY COMMISSION # a April pril 14, 2017 ''.„le or F;°='Service.com '.,,i^, . 'PortdaNbtary ��ry sgB=0153” ******************************** T.. APPROVED BY (Revised02/24/2014) L('r Sign: Print: Seal: Plans Examiner +° "G"et, 1NETTE FLETCHER * MY COMMISSION # FF 087245 !min. EXPIRES: March 14, 2018 „di,. Bonded Thru Budget Notary Sergi ceo Zoning Structural Review Clerk 8/3/2016 A )on' Husted Ohio Secretary of State Printer Friendly Report Jon Husted & the Office l Elections & Voting Campaign Finance I Legislation & Ballot Issues i Businesses i Records I Media Center Publications Business Filing Portal Corporation Details your BUS NESS begins here http://www5.sos.state.oh.us/ords/f?p=100:18:9777833340630::N O:18:P18_TYPE,P18_N U M:CORP,1555208 1/1 Corporation Details Entity Number 1555208 Business Name BANCROFT INVESTMENTS, LLC Filing Type DOMESTIC LIMITED LIABILITY COMPANY Status Active Original Filing Date 07/08/2005 Expiry Date Location: County: State: Agent / Registrant Information EDMUND PHILLIPS 224 NORTHWOOD AVE APT 1 DAYTON,OH 45405 Effective Date: 07/08/2005 Contact Status: Active Incorporator Information ANGHARA PHILLIPS I.Filings Filing Type Date of Filing Document Number/Image ARTICLES OF ORGANIZATION/DOM. LIMITED LIABILITY CO 107/08/2005 200519202722 http://www5.sos.state.oh.us/ords/f?p=100:18:9777833340630::N O:18:P18_TYPE,P18_N U M:CORP,1555208 1/1 Limited Power of Attorney BE IT ACKNOWLEDGED that I, 6q(35W6 i Social security number limited power of attorney to Address as my attorney-in-fact. r Full name f2 20 T 77 4 ! e undersigned, do hereby grant a 1 D 'ver cense �.p t6i ,til oty" c��r� t Full N e er 4,470 Phone of '7'4%1 Otos3,5,131? iii244(a7 Said attorney-in-fact shall have full power and authority to undertake and perform only the following acts on my behalf sign for and do all thingsp cessary to this appointment (check only one option): $ , /1 1. 2. 3. The authority herein shall include such incidental acts as are reasonably required to carry out and perform the specific authorities granted herein. My attorney-in-fact agrees to accept this appointment subject to its terms, and agrees to act and perform in said fiduciary capacity consistent with my best interest, as my attorney-in-fact in its discretion deems advisable. This power of attorney is effective upon execution. This power of attorney may be revoked by me at any time, and shall automatically be revoked upon my death, provided any person relying on this power of attorney shall have full rights to accept and reply upon the authority of my attorney-in-fact until in receipt of actual notice of revocation. Signed this ( 7 day of b 6 ,20 /is • Signature STATE OF FLORIDA COUNTY 0 Pliant_ ' D -C .. T going i r as acknowledged before me this _day of f. -L , 20 /(e, by amb n 4 111 was I who is rsonally known to me or ❑ who has produced Ili !' - , ification and who did (did not) take an oath. riq 1911 Signature 60101t, Print or type name Notary Public - State of Commission No. ivy Commission Expires: P111, Marie Sandra Pierre ' Commission#FF065496 ry . ^'.. aS Expires: Oct. 23,2017 ,%4 g ,,, WWW.AARONNOTAAY.00m Aburi Constructions LLC 2331 N State Rd 7, STE 203, Lauderdale Lakes, FL 33313 Tele: 954-548-1765 Fax: 954-484-7784 DateC O 2Q f State of (��( County of Before this day personally appeared and says: That he or she (and accompanied) • jrn.1 f ( / fl fl C' 1 who, being duly sworn, deposes will be the only person(s) working on the project located at: ab6 IvE 9141 fear - Swo to (or affirmed) od subscribed before me this day of 20 /6, by Personally known Or Produced Identification Type of Identification Produced .g.%MY COMMON FF . * EXPIRESd4larh.14, 19 %top .asp°! Ended tbru9udedNotriSri116 Print, Type or Stamp Name of Notary a) -37 Miami Shores Viiiage Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Notice to Owner — Workers' Compensation Insurance Exemption . f Florida Law requires Workers' Compensation insurance coverage under Chapter 440 of the Florida Statutes. Fla. Stat. § 440.05 allows 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 foil -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 1. The officer owns at least 10 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. Signature - Owner State of Florida County of Miami -Dade The foregoing was acknowledge before me this U day of d Ski lit L. , 20 By -Kiroi m 1/4 ' who is personalty known to me or has produced as identification. 552© Notary: SEAL: onda i_. em My Commission FF 063558 Expires 10/16/2017 2601 BLAIR STONE, ROAD TALLAHASSEE FL 32399-0783 FIAGOME, CLEMENCE KUDJO ABURI LLC P.O. BOX 22271 FORT LAUDERDALE FL 33335 • 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 from architects to yacht brokers, from boxers to barbeque restaurants, and they keep Honda's economy strong. Every day we work to improve the way we do business in order log onto you www yflorriidalicenee com, There you r information about our ryc�an findl moue information about our divisions and the regulations that impact you, subscribe to department newsletters and Team more about the Departments initiatives_ Ourmission 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, and congratulations on your new license! '--RICKSCOTT;"GOVERNO LICENSE NUMBER STATE OF FLORIDA. DEPARTMENT.OF BUSINESS AND PROFESS'iCNAL;REGULATION . CGC1512890 CERTIFIED GEN I 'IAGOME,'CL, ABURI LLC ES, C•ERTIFtFp• undef•.the'pPbtYi'sions df Ch.489 FS,• Exp an data : 4U0 31.2018 : ' ' 41008300002546 • • DETACH HERE —� .- —_ _ _ _ 7._.._ KEN-InNWS@N;-SEGRETARN • STATE'Ofr .FLORIDA -DEPARTMENT OP BUSINESS AND PROEESSI.ONAL•REGULATION CONSTRUCTIONINDL•ISTRY•LICENSING'BOARD• T The GENERAL CONTRACTOR • • • • Named below. IS CERTIFIED • Under the -provisions Of Chapter 489.F. S. Ekpirafon date: AUG 31, 201$ - FIAGOME, CLEMENCE • KUDJQ?.. • ;.... , . ABURI LLrr P.O. 80X 22271 FORT LAUDERDA ;E . .. •.'?" '''a: "2a` °f4;