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RC-14-1420 (2)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 (D \T • • (-A-T.-4AVED JUL 0 2 2014 FBC 20 VD CCtLLMa5ter Permit No. IZC.P4 _ 1 12-C) PERMJT APPLICATION BUILDING Sub Permit No. ,}4UILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑ RENEWAL PLUMBING ❑ MECHANICAL PUBLICWORKS ❑ CHANGE CONTRACTOR ❑ CANCELLATION ❑ SHOP DRAWINGS JOB ADDRESS: City: Miami Shores County: Miami Dade Zip: 33/3ef? Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): `%ori 4,4e \/ O/'Q' -•.1 Address: /0 /71,2- — '?/ 74e,12 City: /vZaCtrii.' Sh4N"e.S Tenant/Lessee Name: Email: .e h l St Phone#: ' �� — 7 t "9io CONTRACTOR: Company Name: �VOO Address: City: /We to,m r Qualifier Name: Lei FePP State: Q //22C7 ,Aa 40t -r Zip: 3/3 /37 / ne#: 366- 9U.6 -9r. (7 Phone#: Zip: 33/Y7 Phone#: 36 b -'5S State Certification or Registration #: ' G / S / 73'85 Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: $ Square/Linear Footage of Work: Type of Work: ❑ Addition Alteration ❑ New ❑ /Re lace Re air p p n Demolition Description of Work: �r > cl x-fe hi id, ,f- tee Az, Specify color of color thru tile: 1A,NCELLED Submittal Fee $ Permit Fee $ CCF $ CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ eq' 40 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. ! 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 no • - approved and a rei I kill Signatu fee will be charged. OWNER or AGE The foregoing instrument was acknowledged before this Signature CONTRACTOR The foregoing instrument was acknowledged before me this Ist day of S 1 , 20� , by / day of / Jl , 20 /V , by Jen int ( JofclJn , who is personally known to 6400/ l4 , who is personally known to as me or who has produced me or who has produced identification and who did take an oath. NOTARY PUBLIC: identification and who did take an oath. NOTARY PUBLIC: Sign: Sign: Print: Print: Seal: as Wet (i *************** * APPROVED BY (Revised02/24/2014) AV COPA" -q§1ON *********** • Plans Examiner Zoning Structural Review Clerk This Document Prepared By and Return to: RICHARD A. GOLDEN, ESQ KRAMER AND GOLDEN, P.A. 1175 N.E. 125TH STREET SUITE 512 NORTH MIAMI, FLORIDA 33161 KGPA File No.77-14R Parcel ID Number: 11-3205-001-0300 Warranty Deed This Indenture, Made this day of RUTH SANTOS, an unmarried woman of the County of Middlesex Jennifer Jordan, a married woman June 1111111111111111111111111111111111111 1111111 :E=PA 207' 4-C145856% OR Ek 292u9 F' ['i :3202 -_ 320'37 RECORDED 06/27/2014 11:0125 DEED DOC TAX :;f:330,,00 HARVEY HARVEY ROV1:Hs CLERK OF COURT MIAMI-DADE COUNTY FLORIDA , 2014 A . , Between , grantor, and State of Massachusetts whose address is: 1022 NE 91 TERRACE, MIAMI SHORES, FL 33138 of the County of MIAMI-DADE , State of Florida , grantee. Witnesseth that the GRANTOR, for and in consideration of the sum of TEN DOLLARS ($10) DOLLARS, and other good and valuable consideration to GRANTOR in hand paid by GRANTEE, the receipt whereof is hereby acknowledged, has granted, bargained and sold to the said GRANTEE and GRANT'EE'S heirs, successors and assigns forever, the following described land, situate, lying and being in the County of MIAMI-DADE State of Florida to wit; Lot 3 and the East 15 feet of Lot 2, Block 2, Watersedge, according to the map or plat thereof as recorded in Plat Book 9, Page 141, Public Records of Miami -Dade County, Florida. ,,A rho r,rn.,r..,. ,L.r•c ,.r.,..,,,t the r,tlr. to cam lanri anri will drfanr1 the came naainct la,z,fnl Jaime of all nrrcnne N hrnncnever Local Business Tax Receipt • Miami—Dade County, State of Florida -THIS IS NOT A BILL - DO NOT PAY 6476709 BUSINESS NAME/LOCATION RECEIPT NO. ELTEC CONSTRUCTION & INVESTMENT UQUIDATIOREViMC 2400 NW 98 ST 6746110 >`MIAMI FL 33147 OWNER ELTEC CNSTION & INVT LIQ GRP INC ":Worker(s) SEPT Must be F Pyl EXPIRES EMBER 30, 2014 lsplayed at place of business suant to County Code CI}apter 8A - Art. 9 & 10 SEC. TYPE OF BUSINESS 196 GENERAL BUILDING CONTRACTOR CGC1517589 PAYMENT RECEIVED BY TAX COLLECTOR $75.00 07/22/2014 CHECK71-14--028885 This Local Business Tax Receipt only confirms payment of the Local Business Tax. The tie9ipt is nota license, permit, or a certification of the holder's qualifications, to do business. Holderrmust comply''jith any governmental or nongovernmental regulatory laws and requirements which apply to the business. The RECEIPT NO. above must be displayed on all commercial vehicles- Miami -Dada Code Sec pa -276. For more information, visit . . u : i o.: , . : _ .11 .r one million Floridians licensed by the Department of Business ano Professional Regulation. Our professionals and businesses range from architects to yacht brokers, from boxers to barbeque restaurants. and they keep Florida's economy strong. Every day we work to improve the way we do business in order to serve you better. For information about our services, please log onto www.myfloridalicense.com. There you can find more information about our divisions and the regulations that impact you. subscribe to department newsletters and learn more about 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, and congratulations on your new license! RICK SCOTT, GOVERNOR LICENSE NUMBER DETAUI- HERE ATION (850) 487-1395 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CGC1517589 ISSUED: 07/22/2014 CERTIFIED GENERAL CONTRACTOR PHILLIPS, ELROD ANTONIO SR ELTEC CONSTRUCTION & INVESTMENT LI IS CERTIFIED under the provisions of Ch. 489 FS. Expiration date AUG 31 2016 L1407220001364 KEN LAWSON. SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AN, PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD CGC1517589 The GENERAL CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2016 PHILLIPS, ELROD ANTONIO SR ELTEC CONSTRUCTION & INVESTMENT LIQUIDAI IC N GROUP INC 2400 NW 98TH STREET r ,_�;:: ..^,.",, MIAMI FL 33147 ISSUED 07/22/2014 DISPLAY AS RFCiUIRED 13Y LAW SEC # L1407220001364 From: Javier Gutierrez Fax: +1 (305) 463-9431 To: Fax: +1 (305) 756-8972 Page 2 of 2 09/10/2014 9:10 A o CERTIFICATE OF LIABILITY INSURANCE D TE(MM2014 Y) 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 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 ALL CITY INSURANCE INC - ACI 275 FONTAINEBLEAU BLVD. SUITE 190 MIAMI FL 33172 CCOONT CT CARMEN RODRIGUEZ PHONE F (305) 463-9431 FAx ( - )' (AIC Noy (305) 436-6797 E-MAILDSS GMAILQALLCITYINS.COM INSURER(S) AFFORDING COVERAGE NAIC I INSURER A:MID-CONTINENT CASUALTY CO 23418 INSUREDI ELTEC CONSTRUCTION & INVESTMENT LIQUIDATION GROUP INC 2400 NW 98 STREET MIAMI FL 33147- ...PROGRESSIVE EXPRESS INSUR 04GL911292 INSURER C : 09/01/2015 INSURER D : 1,000,000 INSURER E: X INSURER F : • ____-_------- wwn n.aIv, n.,... 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 LTR TYPE OF INSURANCE ADDU !KKR SUER WW1 POLICY NUMBER POLICY EFF (YYYY) POLICY EXP (I,POLIC'(EXY) LIMITS A GENERAL LIABILITY 04GL911292 09/01/2014 09/01/2015 EACH OCCURRENCE 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED 100,000 PRFMI SFS (Fa nrrurranra) $ CLAIMS -MADE X OCCURMED EXCLUDED EXP (Anv one person) $ 1,000,000 PERSONAL & ADV INJURY $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRO- GENERAL AGGREGATE PRODUCTS - COMP/OP AGG $ $ 2,000,000 TPOLICY n n LOC $ B AUTOMOBILE LIABILITY 02300142-1 07/10/2014 07/10/2015 (Fa aCOMBINEDccident) SINGLE LIMIT $ 300,000 • ANY AUTO ALL OWNED SCHEDULED BODILY INJURY (Per person) $ X AUTOS X AUTOS BODILY INJURY (Per accident) $ HIRED AUTOS X AUTOS TIED PROPERTY DAMAGE (Per accident) $ $ UMBRELLA LIAB_ OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS -MADE AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN WC STATU- Tf1PY LIMITS OTH- EP ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? N / A E.L. EACH ACCIDENT $ (Mandatory In NH) If yes, describe under E.L. DISEASE - EA EMPLOYEE $ DESCRIPTION OF OPERATIONS below E.L DISEASE- POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS/ VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) LIC# CGC1517589 CmPTIclf`ATc unl nor) _ ---___ ON Al COMMWJ CITY OF MIAMI SHORES BUILDING &ZONING DEPT. 10050 NE 2ND AVE MIAMI SHORES ACORD 25 (2010/05) FL 33138 - SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 11.N.ctivl6 1' 1Gwcl Page 1 of 1 JEFF A1WATER GEEF RNMNCW.OFROE% STATE OF FLORIDA DEPARTMENT OF Fr1A1NNM. SEIMNIMIS ENVISION OF WEER**, C PM1ENSATION E • cERTF1 ATE or EJECTION TO BE EXEMPT FROM FLORIDA WORKERS COMPENSATION LAW e • c0NSTRUC11ON NDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida V kers Compensation law. EFFECTIVE DATE: 513112013 EXPIRATION DAIS: 5131/2015 - PERSON: MUSS ELROD FEIN: 270455737 SLIMNESS NAME AND ADCRESS: - ELTEC CONSTRUCTION 8 INVESTMENT UOUIDATION GROUP INC 2400 NW98STREET MIAMI R. 33147 SCOPES OF BUSINESS OR TRADE: LICENSED GENERAL CONTRACTOR Farselobi arwool(1 F3. :11zrr.�r�rlerwa riFI b ■arBwbddn11.2ter.i:011 wq .nisarW.�aod sifoetlrAAdipr: l smo.% am.N is(111F adie/o.b0..trr.Fl.d dM.Ysbesow. Nod so Iroise ealka bMsiwFllliasse Medi. FB.Niasd��bb cwillestesof dslo.b6.sssPt*dY.fY�e<biwst�w Rdrhri..�rY.ibdb..Ara 4.40.1411aponenemeitallesdlaste prsossmi6bstM stioste fabanis.r.wiertlYr(sM.stdrw.r�.afebrsFislrYws/b. OFSF2OWG252CERTIFICATE OFElECT10NTOBEE7EYPTRE1I E 0712 OUS8110l45r ta5o)as-teoe haps://apps8.fldfs.comlcireportview/r rtViewer.aspx?data=kdvpginc9D7Q3gH6'1'ER.6... 5/31/2013 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 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 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: 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. In these circumstances, Miami Shores Village does not require verification of workers' compensation insurance coverage from the contractor's company. Therefore, you may be personally liable for the worker compensation injuries of any person allowed to work under this permit. Please check with your insurance carrier since most property insurance policies DO NOT cover this type of liability. BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. State of Florida ) County of Miami -Dade ) Sworn to and subscribed before me this 3 0 day of By (SEAL) Type of Identification pr S4, ,20 /y. Contrac or Print Name: Signature: -&r-1 State of Florida ) County of Miami -Dade ) Sworn to and subscrib d before me this J'' day of S,€ _ ,20 y By (SEAL) Type of Identificatio ; COM4r4 SVON # EE 189117 EXPIRES: Jul 14, 2018 socittimiLz, qui •ro• — BUILDING PERMIT APPLICATION ❑BUILDING ❑ ELECTRIC ❑PLUMBING ❑ MECHANICAL JOB ADDRESS: City: Folio/Parcel#: 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 ❑ ROOFING ❑PUBLIC WORKS Miami Shores Master Permit No. 'Rc (Li — 14 20 Sub Permit No. ❑ REVISION ❑ CHANGE OF CONTRACTOR County: Miami Dade ❑ EXTENSION ❑ RENEWAL CANCELLATION ❑ SHOP DRAWINGS z1:_ `33/3e Is the Building Historically Designated: Yes NO Occupancy Type: Load: OWNER: Name (Fee Simple Titleholder): Address: /d 1..2- ^J Construction Type: Flood Zone: JPni S2Pe) &, n 4,, 257`__ .a BFE: FFE: Phone#: City: St-ati Tenant/Lessee Name: Email: State: • 'A Phone#: zip_ 3 3 i ? CONTRACTOR: Company Name: FiT , r4ns'f-xa�,�/on �\4Phone#: •'�,5-,--260,'7 Address: 215/40 i� It)9'4 Tr' City: /M071fii State: A/O' 'i., N Qualifier Name: Eh -did P4i!/Is State Certification or Registration #: C6 GJ�/�03 9 Cer4i c to of Competency #: DESIGNER: Architect/Engineer: Phone#: Zip: ,33N) Address: kValueof-WorkfaTiliirPErmifr$› 4Q(JQ dO Type of Work: ❑ Addition ❑ Alteration ❑ New Description-of•Work:, C497 GP //41/kit City: Square/Linear Footage of Work: State: Zip: ❑ Repair/Replace ❑ Demolition Specify color of color thru tile: Submittal Fee $ Permit Fee $ CCF $ Scanning Fee $ Radon Fee $ DBPR $ Technology Fee $ Training/Education Fee $ Structural Reviews $ (Revised02/24/2014) CO/CC $ Notary $ Double Fee $ Bond $ TOTAL FEE NOW DUE $ 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 ofthe-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 TOWNE:or;AGENT The foregoing instrument was acknowledged before me this day of , 20 , by Signature . CONTRACTOR The foregoing instrument was1acknowledged before me this /' day of 7.kiar, 20 ✓e , by t_, who is personally known to 1;:%70,/ !%/oof who is personally known to me or who has produced as me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: Seal: identification and who did take an oath. oftY NOTARY PUBLIC: VERONICA PHILLIPS * MY COMMISSION # FF 068609 %'EXPIRES: February 22, 2018 Bonded Nu Budget NotaryServicee Sign: �1 _ Print: t/ei-0,7/ GA PildVG WS Seal: **********t*********t4#i#f************************t**********####*t***** *************irk*****#****i******** APPROVED BY Plans Examiner (Revised02/24/2014) Zoning Structural Review Clerk 7 ELTEC CONSTRUCTION & INVESTMENT LIQUIDATION GROUP, INC. 2400 NW 98 ST. MIAMI FL. 33147 CGC1517589 Ce11j386-855-2029 F 305-694-1080 C 305-216-4225 E elrodphillips@att.net This letter is to inform the Building Dept. of Miami Shores that I would like to cancel the building permit at 1022 NE 91st TERR. Elrod Phillips ( CEO ) Work URL