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DEMO-16-3018Project Address Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 Permit Permit NO. DEMO -11-16-3018 Permit Type: Demolition Work Classification: Electric Permit Status: APPROVED Issue Date: 12/15/2016 Expiration: 06/13/2017 Parcel Number Applicant 1276 NE 93 Street Miami Shores, FL 33138- 1132050270230 Block: Lot: SEYMOUR & JILL KANTOR Owner Information Address Phone Cell SEYMOUR & JILL KANTOR 1094 NE 91 Terrace MIAMI SHORES FL 33138- (305)336-7100 Contractor(s) KILBY ELECTRIC CO Phone (305)233-2965 Cell Phone Valuation: Total Sq Feet: $ 200.00 0 Type of Demo: Electric Additional Info: ELECTRICAL DISCONNECTION FOR TOTAL Classification: Residential Scanning: 1 Fees Due CCF DBPR Fee DCA Fee Education Surcharge Permit Fee Scanning Fee Technology Fee Total: Amount $0.60 $2.00 $2.00 $0.20 $100.00 $3.00 $0.80 $108.60 Pay Date Pay Type Amt Paid Amt Due Invoice # DEMO -11-16-61916 12/15/2016 Check #: 14306 $ 58.60 $ 50.00 11/03/2016 Check #: 14224 $ 50.00 $ 0.00 Available Inspections: Inspection Type: Final 1 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. December 15, 2016 Authorized Signature: Owner / Applicant / Contractor / Agent Building Department Copy Date December 15, 2016 1 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 t» -u3 -301-1 Inspection Number: INSP-270500 Permit Number: DEMO -11-16-3018 Scheduled Inspection Date: December 19, 2016 Inspector: Devaney, Michael Owner: KANTOR, SEYMOUR & JILL Job Address: 1276 NE 93 Street Miami Shores, FL 33138 - Project: <NONE> Contractor: KILBY ELECTRIC CO Permit Type: Demolition Inspection Type: Final Work Classification: Electric Phone Number (305)336-7100 Parcel Number 1132050270230 Phone: (305)233-2965 Building Department Comments ELECTRICAL DISCONNECTION FOR TOTAL DEMOLITION. FPL CLEARANCE LETTER ATTACHED. Infractio Passed Comments INSPECTOR COMMENTS False Passed Failed Inspector Comments Correction Needed Re -Inspection Fee No Additional Inspections can be scheduled until re -inspection fee is paid. /s//,6' December 16, 2016 For Inspections please call: (305)762-4949 Page 22 of 60 BUILDING PERMIT APPLICATION 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 RECEIVED Hoy 0 3 2016 +- A —144 FBC 20 I`± Master Permit No.PENQ IG— 30 I Sub Permit NoEtQ (G-30 (9 ❑BUILDING • ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 1276 NE 93rd street City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: 11 3205 027 0230 Is the Building Historically Designated: Yes NO X Occupancy Type: Load: Construction Type: OWNER: Name (Fee Simple Titleholder): Seymour and Jill Kantor Address: 172 Golden Beach Drive Flood Zone: BFE: FFE: Phone#: City: Golden Beach State: FI zip: 33160 Tenant/Lessee Name: N/A Phone#: Email: Kantorjill@gmail.com CONTRACTOR: Company Name: Kilby Electric Phone#: 305/233-2965 Address: V7573- SL) to •(f`" Arc • City: t4I QP,I/r I _ G State: 1 c L. Qualifier Name: Vk IDP' us 1-, Ar ( 5 Zip: 315% Phone#: 365 - 233 - 2-%5 State Certification or Registration #: ( 5-10. Certificate of Competency #: DESIGNER: Architect/Engineer: N/A Phone#: Address: City: State: Zip: Value of Work for this Permit: $'+20C)iffd -, Square/LinearFoota f.Vl Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑■ Demolition Description of Work: Electrical disconnection for Total demoltion FPL clearance letter attached Specify color of color thru tile: Submittal Fee $ `V • CKs) Permit Fee $ Arazoo CCF $ CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Notary $ Technology Fee $ Training/Education Fee $ Double Fee $ Structural Reviews $ Bond $ e TOTAL FEE NOW DUE $ (Revised02/24/2014) 1 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 ottachment. 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 ap roved and a reinspection fee will be charged. Signature S31.../yjilarg.r AGE aii..-54( Signature The foregoing instrument was acknowledged before me this 2`T day of ©c-' r , 20 /4z' , by /? OLY— 47‘77-0C—, whoiprsonally kn wn to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: O\)\ \ Sign: ` Print: Seal: • c,4 `` FRANCES MELGA 1 01440 MY COMMISSION 8 FF 161297 dr EXPIRES: September 18, 2018 VL.(444% CONTRACTOR The foregoing instrument was acknowledged before me this day of , 20 t , by Moret, E , whc(s persona II y known t5> me or who has produced identification and who did take an oath. NOTARY PUBLIC: Sign: Print: Seal: as FRANCES MELGAARD MY COMMISSION 8 FF161297 NIIIPIromo,EXPIRES: September 18, 2018 **t**********t*********•**t***************t+k********************************************************tit*#i* APPROVED BY (Revised02/24/2014) 3/i,691r/c Plans Examiner Zoning Structural Review Clerk FPL October 24, 2016 Lorna Arocena 17794 SW 97th AVE Palmetto Bay FL 33157 Email: absolute@absodemo.com Phone: (305)-232-8003 Re: 1276 NE 93RD ST, Miami Shores, FL 33138 Effective October 19, 2016, FPL has removed the meter and disconnected the FPL service wire to the above referenced address. However, before demolishing the structure, you should have the premises checked by a qualified individual to assure that electricity is not being supplied to the structure from any possible source. If there are any questions, or if I may be of further assistance in this matter, please contact me at the telephone number below. Sincerely, of� e Associate Engineer (305) 770-7930 A NEXTera ENERGY Company RICK SCOTT, GOVERNOR uc 1r1L,11 ncmc -STATE OF FLORIDA •. DEPARTMENT OF BUST . ESSANP PROFESSIONAL REGULATION ELECTRICALC..1 TRACTORS LICENSINGBOARD KEN LAWSON, SECRETARY Til ELECTRICAL CONTRACTOR N� ed.belaw.1S=CERTIFJED... l "�Un'def th'e-prizig 6' £Gha r-Exprration date::p ,3/, 8 .. -- S EGE -1872@ y •MIAMI • ISSUED: 08/11/2016 '`�'t- DISPLAY AS REQUIRED BY LAW SEQ # 11608110003085 _s 0111d4 Local Business Tax Receipt Miami -Dade County, State of Florida -THIS IS NOT A BILL - DO NOT PAY 6539010 BUSINESS NAME/LOCATION KILBY ELECTRIC CO 18720 SW 107 AVE MIAMI FL 33157 OWNER KILBY ELECTRIC CO Worker(s) 16 0000Th RECEIPT NO. RENEWAL 6809595 LBT EXPIRES SEPTEMBER 30, 2017 Must be displayed at place of business Pursuant to County Code Chapter 8A - Art. 9 & 10 SEC. TYPE OF BUSINESS 196 SPEC ELECTRICAL CONTRACTOR EC13002956 PAYMENT RECEIVED BY TAX COLLECTOR 8105.00 07/14/2016 CREDITCARD-16-040615 This Local Business Tax Receipt only confines payment of the Local Business Tax. The Receipt Is not license. permit ora certification of the holder's qualifications. to do business, Holder must comply with any governments) or nongovernmental regulatory laws and requirements which apply to the business. The RECEIPT NO. above must bo displayed on all commercial vehicles - Miami -Dade Code Sec 111-276. For more information, visit wvvw.miemidede liAgce'M^II Local Business Tax Receipt Miami -Dade County, State of Florida -THIS IS NOT A BILL - DO NOT PAY 1764597 BUSINESS NAME/LOCATION KILBY ELECTRIC CO 18720 SW 107 AVE MIAMI FL 33157 OWNER KILBY ELECTRIC CO Worker(s) 16 RECEIPT NO. RENEWAL 1784597 LBT1 EXPIRES SEPTEMBER 30, 2017 Must be displayed at place of business Pursuant to County Code Chapter 8A - Art. 9 & 10 SEC. TYPE OF BUSINESS 196 ELECTRICAL CONTRACTOR EC0002064 PAYMENT RECEIVED BY TAX COLLECTOR 8105.00 07/14/2016 CREDITCARD-16-040615 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'squelificatdons, to do business. Holder must comply with any governmental or nongovernmental regulatory laws and requirements which apply to the business. Tho RECEIPT NO. shove must be displayed on ell commercial vehicles - Miami -Dada Code Sec Sa-276. For more information, visit www.migpjflete gpy4mgth, pr KILBY-1 OP ID: EJ ACORD` 4/Imees/- CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YYYY) 11/02/2016 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(ies) 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 Kahn -Carlin & Company, Inc. 3350 S. Dixie Highway Miami, FL 33133-9984 CONTACT NAME: PHONEFAX (A/c, No. Ext): 3054464271 (A/C, No): 305448-3127 E-MAIL iiSS: certfcates@kahn-carlin.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : Brierfield Insurance Company 10993 INSURED Kilby Electric Co. 18720 SW 107 Avenue Miami, FL 33157 INSURERB:Bridgefield Employers Ins Co 10701 INSURER C : National Trust Insurance Co 20141 INSURER D : FCCI Insurance Company 10178 INSURER E : $ 100,000 INSURER F : RTIFICATE 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 INSR LTR TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF (MM/DDIYYYY) POLICY EXP (MM/DD/YYYYI LIMITS A X COMMERCIAL GENERAL LIABILITY CPP002069202 07/01/2016 07/01/2017 EACH OCCURRENCE $ 1,000,000 PREAMAGE MISES occurrence) PREM $ 100,000 CLAIMS -MADE X OCCUR MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GE 'L AGGREGATE POLICY OTHER: X LIMIT APPLIES JECT PER: LOC PRODUCTS - COMP/OP AGG $ 2,000,000 $ D AUTOMOBILE X LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS _ SCHEDULED AUTOS NON -OWNED AUTOS CA10000314301 07/01/2016 07/01/2017 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ C X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE UMB002139402 07/01/2016 07/01/2017 EACH OCCURRENCE $ 2,000,000 AGGREGATE $ 2,000,000 $ DED X RETENTION $ 10,000 B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below / N NIA 83030922 01/01/2016 01/01/2017 X STATUTE ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Re: EC13002956 CANCELLATION MIAM-04 Miami Shores Village 10050 NE 2 Avenue Miami Shores, 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 ACORD 25 (2014/01) © 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD