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RC-17-2318 J - D Miami Shores Village SEP 7 2017 Building Department ��--- �� 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 t Tel:(305)795-2204 Fax:(305)756-8972 \b� C INSPECTION LINE PHONE NUMBER:(305)762-4949 S}h FBC 20 14 BUIL ING �� Master Permit No. P (C 1-1 -2315 PE MIT APPLICATION Sub Permit No. BUILDING ❑ ELECTRIC ❑ ROOFING REVISION EXTENSION RENEWAL ❑PLUMBING F—] MECHANICAL [:]PUBLICWORKS CHANGE OF CANCELLATION SHOP G� / �+ / CONTRACTOR DRAWINGS JOB ADDRESS: �C/ S /V 6 96 V 4 ?'� 2 p City: Miami Shores County: Miami Dade Zip: 33 JC Folio/Parcel#: '39L05 ' 01 035 U Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flo Zone: BFE: FFE: OWNER: Name(Fee Simple Titleholder): S v I one#: -?86 ` 87-- 356 Address: 8 XJ6 9a< SLgg� City: f am% h S State: /,` Zip: 3 -3/ 5S Tenant/Lessee Name: Phone#: Email: I 1 1 !!ll CONTRACTOR:Company Name: lJ�'n�VO( \ `fVLQ \�►r1 Phone#: 7S�' SZZ S Address: /441 7 City: ugjlevay( State: f`� Zip: 33 009 Qualifier Name: a60,/;C.-, I�(� y��G�. / Phone#: / J� S7- State Certification or Registration#: C� 6 / `J S/�J Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: /�j City: State: Zip: �j- Value of Work for this Permit:$ ��0 27 31(D Square/Linear Footage of Work: .SA T1 Type of Work: ❑ Addition ❑ Alteration ❑ New Repair/Replace ❑ Demolition Descr1 tion of Work: X F-l. 00,0,",T, � C`PP 9)0" T-Qmi!�I mom- i+cn�h Specify color of color thru tile: ��11 k' Submittal Fee$ G Permit Fee$ �V • CCF$ CO/CC$ ' CX Scanning Fee$ Radon Fee$ S.OS DBPR$ k 2.0-� Notary$ 0 Technology Fee$ Training/Education Fee$ Double Fee$ .0 Structural Reviews$ Bond$ soo-Q TOTAL FEE NOW DUE$ 82-:� • 31 (Revised02/24/2014) 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 po ted notice, the inspection will not be approved and a reinspection fee will be charged. _ Signature Signature i� OWNER or AGENT CONTRACTOR The for oing instrume was ack::sonally before me this The foregoing instrum t was acknowledged before me this day of 20 by day of 20 / by known to n J/ �-- ,who is personally known to me or wh as produced ) L as me or who has produced as identification and who did take an oath. identification and who did take an oath. NOTARY P LIC: NOTARY PUBLIC: s Sign: Sign: Print: ah l� Print: �>a A�''• JANNETTDF ,,d Seal: Y� ANGELICA DUTRA Seal: r Not!, -State MY COMMISSION#FF129�7 i' CommissionMEXPIRES:JUN 04,2018My Comm.ExpireBonded throug 1 st State Insurance ' Bonded through NatWWWWW WWWWWWWWWWWWWWWWWWNNF M#MF WNMNh F M APPROVED BY ' Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) Property Search Application - Miami-Dade County Page 1 of 1 4OFFICE OF. THE PRUNERTY APPRAISER Summary Report Generated On:9/1/2017 Property Information . JE Folio: 11-3205-018-0350 r. 1098 NE 98 ST Property Address: ' u Miami Shores,FL 33138-2506 ,•- Owner CODY SAVITS 1098 NE 98 ST " Mailing Address MIAMI SHORES,FL 33138 USA !S PA Primary Zone 1100 SGL FAMILY-2301-2500 SQ Primary Land Use 0101 RESIDENTIAL-SINGLE �r x. FAMILY: 1 UNIT - Beds/Baths I Half 2/2/0 Floors 1 M Living Units 1 Actual Area 2,086 Sq.Ft u Living Area 1,691 Sq.Ft , Adjusted Area 1,881 Sq.Ft Taxable Value Information Lot Size 8,475 Sq.Ft 2017 2016 2015 Year Built 11948 County Assessment Information Exemption Value $50,000 $50,000 $50,000 Year 2017 2016 2015 Taxable Value $245,633 $239,553 $237,541 Land Value $305,135 $284,188 $258,352 School Board Building Value $130,918 $130,918 $130,918 Exemption Value $25,000 $25,000 $25,000 XF Value $29,328 $29,640 $19,248 Taxable Value $270,633 $264,553 $262,541 city Market Value $465,381 $444,746 $408,518 Assessed Value $295,633 $289,553 $287,541 Exemption Value $50,000 $50,000 $50,000 Taxable Value $245,633 $239,553 $237,541 Benefits Information Regional Benefit Type 2017 2016 2015 Exemption Value $50,000 $50,000 $50,000 Save Our Homes Assessment Taxable Value $245,633 $239,553 -_$237,541 Cap Reduction $169,748 $155,193 $120,977 Homestead Exemption $25,000 $25,000 $25,000 Sales Information Second Previous Sale Price OR Book-Page Qualification Description Homestead Exemption $25,000 $25,000 $25,000 05/17/2017 $321,200 30544-2944 Qual by exam of deed Note:Not all benefits are applicable to all Taxable Values(i.e.County, 10/01/2007 $440,000 26018-3960 Sales which are qualified School Board,City,Regional). Short Legal Description REV PL MIAMI SHORES SEC 8 PB 43-69 LOT 18 BLK 180 LOT SIZE 75.000 X 113 COC 26018-3960 10 2007 1 The Office of the Property Appraiser is continually editing and updating the tax roll.This website may not reflect the most current information on record.The Property Appraiser and Miami-Dade County assumes no liability,see full disclaimer and User Agreement at http://www.miamidade.gov/info/disclaimer.asp Version: http://www.miamidade.gov/propertysearch/ 9/1/2017 '-STATE:OF FLORIDA-"•` �¢. N '� DEPARTMENT OF�BUSINESS AND PROFESSIONAL,REG ULATION W -'` NSTRU 10_ G'BOARDtl' . 0 CT N INDUSTRY4LICENSIN `�',.'`CGC1515515,�� -"»'_ ,—..,,�.�...:,."° - �,`� 4-�-•�.�e,a'`�."'-`""-.` ��"'•�.:���:.�"'"'v'�'� «,,,;�.` '� i k i -"'TFie°GENERAL CONTRACTOR" Named below IS CERTIFIED„; "" Uncles the.provisions of Chapter.489.FS _ "" � i -Expiration daEe:-AUG,,31;'20.18" - �` '� -•; .,° . FIs,,, ,,„,,.+, �,...-. .,»'"p^..»..`-' «a.±.-.... ,.'�*�.,�,�•s� �"`,"' �,. �. �,,,.DUTRX,,,,%NGELICAA i rr UNIVERSAL HOME REMOE}ELIIVG,INC." �� 2828 N:UNIVERSITYs 6R&A .`. " SUNRISE, FL"33322 . __ �,-�.. t"' ` �=,,. `"-" t•' Ile ISSUED`. 08/28/2016 DISPLAYAS-REQUIRED BYLAW_ SEQ# L1608280003208 . �. �4 BROWARD COUNTY'LOCAL BUSINESS TAX RECEIPT i 1,15_S. Andrews,Ave , Rm: A 100,'Ft. Lauderdale; FL 33301=1895.-954-831'=4000 ,r VALID OCTOBER`.;2016 THROUGHi SEPTEMBER 30i 2017 DBA:. Receipt#:180-251498 I " - " UNIVERSAL HOME REMODELING 4INC GENERAL CONTRACTOR' (CERT I - i Business Name: - BUsinesstType:GENERAL CONTRACTOR) i Owner Name:DUTRA,ANGELICA A 'Business Opened:10/11/2012 ( Business Location:2828 N UNIVERSITY DR State/County/CerURe'g:CGC1515515 SUNRISE Exemptiontode: j i +Business Phone:954-709-_6.659_ If Rooms - Seats Employees, Machines Professionals a al� 1 For Vending Business only _ } Number of Machines: Vending Type: �. 1 Tax Amount- Transfer FeeP NSFzFee; Penalty_ x. Pnor Years j Collection Costa Total Paid i 27.00 0.00 0.00 - 0.,00 0.00' 0:00' 27.00{ i - i I 1 THIS RECEIPT,MUST BE POSTED CONSPICUOUSLY.IN YOUR P..L•ACE,OF BUSINESS $ i THIS BECOMES rA=TAXRECEIPT This tax is levied'for the privilege of doing business within Broward County and is non-regulatory in nature. You must meet all Countyand/or Municipality planning WHEN VALIDATED and zoning requirements. This Business Tax Receipt'must beJeansferred when II the business is sold, business•name has changed nor you have-M—ovedt'tWe �I I -business location.-This receipt does'not indicate that the business is legal,o�that ;it is in compliance with State or local laws and regulations. Mailing Address: UNIVERSAL HOME REMODELING INC Receipt #03C-15-000.04030 2828 W UNIVERSITY_'DR' . Paid-09/20/2016 27 :00 SUNRISE, FL' _ 33322 ` i }5 2016 - 2017 '—- — — — DDCNIAIA'On f`nll IAITV i flf`A1 RI ICIAICCC_'TAY DGf`�1=1DT _�4Y'°" _�..�.�.__.w__®�..,._ ~- .._!lam_ .. __,._ __ .___---_ _._._._.__.•_____._._—_.._..._. __:. . _...._ .. J M , I i F' e � y CERTIFICATE OF LIABILITY INSURANCE DATE(MMiDDNYYY) �. 05/2812017 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 OWPRODUCER,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 lies of such endorsement(s). PRODUCER CONTACT REEL INSURANCE AGENCY PHONE Et)!954}956-0006 FAX 5800 W.ATLANTIC BLVD, E-MAIL REELINSURANCE YAHOO.COM MARGATE FL 33063 N R AFFORDING E NAIC# IN URERA: UNITED SPECIALTY INSURANCE CO, 112537 INSURED INSURER B: UNIVERSAL HOME REMODELING INC INSURER C: 19251 N.GARDENIA AVE INSURER 0. WESTON FL 33332 INSURER E 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. INSR TYPE OF INSURANCE DDL SUBR POLICY EFF POLICY EXP POLICY NUMBER f LIMITS GENERAL LIABILITY EACH OCCURRENCE $1 000,000 DAMAGE TO RENTED A X COMMERCIAL GENE L LIABILITY cc c- na $100000 __ CLAIMS-MADE l.X OCCUR DCG02246-01 1011912016 1011912017 MED EXP(Any one oerson $5,000 PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG s2,000,000 X I POLICY PRO i LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT IF,wide4 ANY AUTO BODILY INJURY(Por poison) $ ALL OSCHEDULED AUTOS AUTOS BODILY INJURY(Por accldont) $_- I _ NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS ,Perar S UMBRELLALIAB �. OCCUR EACHOC URRENCE I r. EXCESS LIAB CLAIMS-MADE AGGREGATE $ d DED I i RETENTI N$ I WORKERS COMPENSATION WC STATU- DTH- AND EMPLOYERS'IJABILIYY - ----•-----••- ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ i OFFICER/MEMBER EXCLUDED? NIA I (Mandatory In NH) E.L.DISEASE-EA EMPLOYE- $ N yes,describe under bESCRIPTION OF OPERA NS belrnv E.L.DISEASE•POLICY LIMIT $ l f i ) DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space to requlmd) CGC1515515 Flooring, Electrical, Plumbing, Carpentry, Etc. a a a CERTIFICATE HOLDER CANCELLATION I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Miami Shores Village THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 0050 ACCORDANCE%M E PO Y PROVISIONS, 1. NE 2nd Avenue Miami Shores,FL 33138 AUTHORIZED REPRESENT EMAIL UTG BELLSOUTKNET O 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD i a I 'ro OOD WE JEFF ATWATER CHIEF FINANICAL OFFICER STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS'COMPENSATION **CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS'COMPENSATION LAW CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers'Compensation law. EFFECTIVE DATE: 9/9/2016 EXPIRATION DATE: 9/9/2018 PERSON: DUTRA ANGELICA FEIN: 800819946 BUSINESS NAME AND ADDRESS: UNIVERSAL HOME REMODELING INC 2828 N UNIVERSITY DR SUNRISE FL 33322 SCOPE OF BUSINESS OR TRADE: Licensed General Contractor Ceramic Tile,Indoor Stone, Floor Covering Installation- Contractor-Project Manager, Marble,or Mosaic Work Resilient Flooring-Carpet and Construction Executive, Laminate Flooring Construction Manager or Construction Superintendent I IMPORTANT:Pursuant to Chapter 440.05(14),F.S.,an officer of a corporation who elects exemption from this'chapter by filing a certificate of election under this section may not recover benefits or compensation under this chapter.Pursuant to Chapter 440.05(12),F.S.,Certificates of election to be exempt...apply only within the scope of the business or trade listed on the notice of election to be exempt.Pursuant to Chapter 440.05(13),F.S.,Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation if,at any time after the filing of the notice or the issuance of the certificate,the person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate.The department shall revoke a certificate at any time for failure of the person named on the certificate to meet the requirements of this section. DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUESTIONS?(850)413-1609 i I I i i 6 I f I I ♦5�6Rft Miami shores Village 0111 111forn Building Department a'�,- 'rGwae 10050 N.E.2nd Avenue �LGil tDp' 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 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. Signat Owner t,vr r „o""'....�B ANGELICA DUTRA � State of Florida ?` MY COMMISSION#Ff12g3gj rR EXPIRES:JUN 04,2018 °°i,=^ Bonded through 1st State Insurance County of Miami-Dade 4 The fo o g was acknowledge before me this_/�day of ,20�. By who is personally known tome or has produced / as i entification. Notary: Ov SEAL: UNIIVERSAL HOME REMODELING, INC. FLOORING SPECIALIST• BUILDERS • DESIGNERS • BROKERS • MORE Date: State ofl County of G( Before me this day personally appeared t , being duly sworn, deposes and says: That he or she will be the only person working on the project located at: IC06 Nk qVIST Miami shoes , F-L 2,3108 Contractor Signatur Sworn to (or affirmed) and subscribed before me thisk day of 20L7, by Personally know OR Produced Identification��L Type of Ide tification Pr d ced vu Print,Type or Stamp Name of Notary ;'t►aYPu'• JANNETTEVERETT O _ Notary Public-State of Florida Commission#GG 115231 �Ae My Comm.Expires oct lo,1o21 Bonded through National Notary Assn. a UNIVERSAL HOME REMODELING,INC. 1983 S.PARK ROAD,#4,HALLANDALE BEACH,FL 33009 OFFICEI.(954)456-5225.OFFICE2.(954)9GI-3899•FAX.(954)9135-9744 UTGCBELLSOUTH.NET WWW.G02UTGHR.COM �� CA Shores Village RECEIVED 1� Building Department JAN 2119 2018 10050 N.E.2nd Avenue, Miami Shores,Florida 33138 Tel:(305)795-2204 Fax:(305)755-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 20ILt BUILDING Master Permit No. �G 1�1 -231%6' PERMIT APPLICATION sub Permit No. 'BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS A CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS:�(/� d" ��J S� l C City: Miami Shores c CountV: Miami Dade Zip: Folio/Parcel#: � - 3a UN 04 a a35-0 Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: �. Flood Zone: BFE: FFE: OWNER: Name(Fee Simple Titleholder):_ 4 (4 Phone#: ` Address:l�9(� 1�v1 �/ � — City: 1 / . S �/ _ _State:-----Its__ _ Zip: ! J3 Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name: l�n� y2c% _� T Phone#: Ql�� �511��2 S Address: lcoloo �- T) City: ^State: ��� Zip: �?`7( Qualifier Name: (� �'�'� Phone#: 'I 'T 71 © 5 State Certification or Registt5l on#: C'Gc 52��1 S� Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: // City: State: /Zip: Value of Work for this Permit:$ tD Square/Linear Footage of Work: J Type of Work: ❑ Addition ❑ Alteration ❑ New y� , epair/Replace ❑'_Demolition Description of Work: 121* av CLI 11,4 T �CA_s I}2-y' �GL-�, k "-�'�' 1 Specify color of color tthru tile: /. �+� i Submittal Fee$ �' w Permit Fee$ ' CCF$ 16 -'20 CO/CC$ Scanning Fee$ 1 •"y Radon Fee$ OJ DBP�R($� z • Notary$ • C:;� Technology Fee$ Training/Education Fee$ S TV Double Fee$ Structural Reviews$ Bond$ cz—mQ TOTAL FEE NOW DUE$ —/ ZZ • �Z (Revised02/24/2014) 2 2• 3 2 w 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 i 4 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 t 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 s h posted notice, the inspection willnot be approved and inspection fee ill be charged. Signature Signature R or AGENT CONTRACTOR The foregoing instrument/was acknowledged before me this The fo oing instrument was acknowledged beforemethis j� day of_ (TaP1- 20 / F , by q day of 20 /d by who is personally known to f'�/`P����-Q 1 4ho is personally known to me or w o has produced /L as me or who has produced V/C/Zl as identification and who did take an oath. identification and who did take an oat\\\������11FIIIIJIJIJJPPPP// NOTARY PUBLIC. ANGELICA DUTRA NOTARY PUBLIC: fi� 4en MY COMMISSION#FF129967 `��; MV EXPIRES:JUN 04,2018 �� 2 „, Bended through 1st State InsuranCe Sign: Sign: Print: Print: p Seal: Seal: is//�� AIDilt 1 \\\``\\` UU/ APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) �c CERTIFICATE 4F LIABILITY INSURANCE DA7E(MM/DDmm) lk� 1012612017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NQT 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,'RODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the ce4ificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditiods of the policy;certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lied of such endorsement(s). PRODUCER CONTACT REEL INSURANCE AGENC PHONE 954 956-0006 FAX 954 956.0555 D1BlA1 COVER ALL INSURACE E-MAIL REELINSURANC YAHOO.COM 5800 W.ATLANTIC BLVD. INSURER(S)AFFORDING COVERAGE NAIC 1 MARGATE FL 33063 _ W3yAFR A-WESTERN WORLD INSURANCE COMPANY 13196 INSURED INSURER UNIVERSAL TILE GROUP&HOME RENOVATIONS,INC. INSUREftr__ 1983 S.PARIf RD.,BAY#4 INSURER HALLANDAL�.BEACH FL 33009-2013 INSURER E. _. INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY TH T THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. N07WiTHSIANDING 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. NSRLTR TYPE OF INSU NCE ADDL UBR Wyn P IC UMBER POLICY EFF POLICY EXP LIMITS X COMMERCIAL GENEFOLL LIABILITY EACH OCCURRENCE $1,000,000 A CLAIMS•MADE OCCUR DAMAGE.TO RENTED $100,000_ NPP8432270 81312017 8/312018 MED EXP(Anyoneperson)! 55,000__ PERSONAL&ADV INJURY__ S 1,000,000 GEML AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE_ s2,000000_ POLICY a PRO• a LOC PRODUCTS-COMP/OP AGG s2,000,000 JECT OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Es eccitlenu ANY AUTO BODILY INJURY(Pe(person) Su ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE E $ HIRED AUTOS AUTOS $ UMBRELLA LIAR HOCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ CED RETENTI V N$ $ WORKERS COMPENSATIO4 PER OTH- AND EMPLOYERS'LiABILirf YIN ANY PROPRIETOR/PARTN�g�IEEXECUTIVE ❑ NIA E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ ._ I? desarbe under DESCRIPTION OF OPERAT, NS below E.L.DISEASE-POLICY LIMIT $ i DESCRIPTION OF OPERATIONS&OCATIONS I VEHICLES (ACORD 1011,Additional Remarks Schedule,may be attached Ii more space is required) CGCISISSIS CERTIFICATE HOLDER CANCELLATION Village of Miami Shores SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Building Department THE EXPIRATION DATE THEREOF, NOTICE WILL' BE DELIVERED IN 10050 NE 2nd Ave ACCORDAN WITHTHE POLICY PROVISIONS. Miami Shores, FL 33138 AUTHORIZED REP 1 ' ©1988-2014 ACORD CORPORATION. All rights reserved ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD 0 woo ��lo I/ CITY OF HOLLYWOOD F DIAMOND TREASURY SERVICES DIVISION OFTHG GOLD COAS LOCAL BUSINESS TAX ,yC0 RA't89,�ryh UNIVERSAL TILE GROUP&HOME RENOVATIONS,INC 1600 S DIXIE HWY HOLLYWOOD,FL 33020 a Please contact us with any changes or corrections to your information. :USTOMER SERVICE: Should you have any questions regarding Local Business Tax or need to update / correct any nformation related to your Business Tax Account, please contact us by phone at 954-921-3225, by email at )usinesstax@hollywoodfl.org or in person at City Hall, Room 103, 2600 Hollywood Blvd. Please send all written :orrespondence to: City of Hollywood, Treasury Services Division, Attn: Business Tax, Room 103, PO Box 229045, -lollywood, FL 33022-9045. )URSUANT TO STATE LAW, LOCAL BUSINESS TAX IS LEVIED FOR THE PRIVILEGE OF DOING BUSINESS WITHIN A :ITY'S LIMITS, AND IS NON-REGULATORY IN NATURE. ISSUANCE OF A LOCAL BUSINESS TAX RECEIPT BY THE CITY OF iOLLYWOOD DOES NOT MEAN THAT THE CITY HAS DETERMINED THAT THE EXISTING OR PROPOSED USE OF A _OCATION IS LAWFUL. ISSUANCE OF A LOCAL BUSINESS TAX RECEIPT DOES NOT LEGALIZE OR CONDONE THE VATURE OF THE BUSINESS BEING CONDUCTED IF CONTRARY TO ANY LOCAL, STATE OR FEDERAL LAW OR tEGULATION. I THIS IS NOT A BILL. DO NOT PAY. E BELOW IS YOUR LOCAL BUSINESS TAX RECEIPT. PLEASE DETACH AND POST THIS LOCAL BUSINESS TAX AKIL- RECEIPT IN A CONSPICUOUS PLACE AT YOUR PLACE OF BUSINESS. I woOo CITY O oYNk4 pro C1 DIAMOND -HE .y Iti GOLD COAS h OAfFLI ORA'f09,gh 2017/2018 LOCAL BUSINESS TAX RECEIPT Business Name:UNIVERSAL TILE GROUP&HOME RENOVATIONS, Account Registration#:B9060320-2018 INC Expiration Date:9/30/2018 DBA: Tax Paid:$251.00 I Business Location: 1600 S DIXIE HWY Business Category:SERVICE/LICENSED BUSINESS I Classification:Contractor/General Tax Basis:2-4 WORKERS h STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD (850)•487-1395 •a'�... 2601 BLAIR STONE ROAD - TALLAHASSEE FL 32399-0783 DUTRA,ANGELICA UNIVERSAL TILE GROUP&HOME RENOVATIONS INC 1600 SOUTH DIXIE HIGHWAY HOLLYWOOD FL 33020 f 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 STA'TEF F - from architects to yacht brokers,from boxers to barbeque 13EPA1 ' restaurants,and they keep Florida's economy strong. -PR _... Every day we work to improve the way we do business in order E to serve you better. For information about our services,please --r- log onto wwmyftorldalicerwe.com. There you can find more information won 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! ° ......... ....... .. ............................_... .......... . -... ........................ -QTAGH.:.NERE........ ...... ...... ....... RICK SCOTT,GOVERNOR JONATHAN ZACHEM,SECRETARY h STATE _FCQ,R(Q/�r DEP„ NT OF H E y!N!1 •,` • u , ISSUED: 09/1 a/2017 DISPLAY AS REQUIRED BY LAW SEQe L1709180001460 ACC> ©® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 164 . 11/28/2017 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 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: Automatic Data Processing Insurance Agency,Inc. PHCNNo. Ext): A/C No): 1 Adp Boulevard ADDRESS: Roseland,NJ 07068 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: NorGUARD Insurance Company 31470 INSURED UNIVERSAL TILE GROUP&HOME RENOVAT INSURER B: DBA:UNIVERSAL TILE GROUP&HOME RENOVATIONS INSURER C: INC 1600 S DIXIE HWY INSURER D: Hallandale,FL 33009 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 787277 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 ADULSUBR POLICY EFF POLIC LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DD MM/DDY EXP LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ T CLAIMS-MADE F OCCUR PREMISES Ea occurrence $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY PRO ❑ LOC JECT PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ } ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ PRPERTY DAMAGE HIRED AUTOS AUTOS NON-OWNED $ AUTOS (Pero accident $ UMBRELLA UAB OCCUR EACH OCCURRENCE $ EXCESS LIAR HCLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY �,/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVEE.L.EACH ACCIDENT $ 500,000 Al OFFICER/MEMBER EXCLUDED? N/A N UNWC861956 10/04/2017 10/04/2018 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 I 1 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached it more space is required) CGC1515515 CERTIFICATE HOLDER CANCELLATION Village of Miami Shores SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE g THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Building Department ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE 2nd Ave Miami Shores, FL 33138 AUTHORIZED REPRESENTATIVE A©1988-2014 ACORD CORPORATION.All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD RECEIVED `OCT 18 1017 q_._ ,ri , I 9va 2. J v , Is .�.�.r� Mf. �V•.:..y .<.. M1:UN VI:•`]aM1.L.,.IM1tw.M1....,y....., tVl,� � 7 15.� J w ¢ ]C V S - � d Z O O V LLJ I Vip LLJ w LZJ CC m Cr O p � « ,,,.,•wKW..I / ..,..aw.., ..,....... u ... .,Ar "'r�r'r' �. C:) cc LLJ Z z o LU Q • NO POINT ALONG COUNTER TO BE MORE THAN Cr LUC3 o C1. z 1 C 2 FEET FROM G.F.i PROTECTED RECEPTACLE. t .-a! � Ea PUT D/W RECEPTACLE UNDER SINK. ® ALL FIXED APPLIANCES ON DEDICATED CKTS. r •••••• a CC Q D y/ Q {� ••••4 •••• •• X ` �_J _' •••••• ••• •••••• O w w �7G • • • a- w J •••••• • LA— C) •••••• N Q wM�+alT�,e., i •••• • • • X HT .... 17 ...... . . ..... IL . . . F L LU Of QA<Y, (EN 41w 'I n I 120 C,4;t...4 THOMAS JAW uif• • , Notary Public-State of Florida a �'��3 Q p,ZgCommission K FF 205368 - — _ _ _ rMy Comm.Expires May 4,2019 � BprldpA thrnnn' yon n�i1 M.t!ry Accr Panel A r 1 1. PANEL C 9 2. RANGE 3. PANEL C 4. . RANGE 5. 'SPRINKLER 6. WATER HEATER 7. SPRINKLER 8. WATER HEATER. 9. POOL PANEL B 10. FLA ROOM RECEPTACLES 11. POOL PANEL B 12. REFRIGERATOR 13. MASTER BATH LTS 14. LIVING ROOM RECEPTACLES ti 15. MASTER BR A/C 16. BEDROOM RECEPTACLES 17. BEDROOM RECEPTACLES 18. KITCHEN LIGHTS 19. ATTIC FAN 20. FAMILY ROOM LIGHTS 21. BATH LTS 22. DISPOSAL 23. LIVING ROOM RECEPTACLES 24. GARAGE LIGHTS 25. 26. OUTSIDE LTS REAR 27. DRYER 28. 29. DRYER 30. KITCHEN GFCI 31. EAST WALL GARAGE 32. BEDROOM LIGHTS 33. AIR COMPRESSOR 34. GARAGE GFCI 35. BATHROOM GFCI 36. GARAGE SCONZE LIGHTS 37. FAMILY ROOM A/C 38. 39. 40. co FAPPROVEZ.9 TRIW �t ly BATHROOM RECEPTACLE ON 20 AMP CKT DATE_______i AND G.F.I PROTECTED r fees 90)e 1 �' 3 a��7 OU •. . • . . . . . "st""l+il,;0 As • THOMAS J AD905368 Notary Public-StsCommission#F FMytomm:E*r4�°;i:,�'� :9onr<eAWroSgh 000 0 1 / ` __ _.-._.. ._.._ ... __. I , -. r - " 1 { _ !' ti; - - .. y- ' /l:,,/ ,3,' ti.ao!'.. ,.rc 17 '<- 1' N1•(Il}L r. S1 }r oE., .. ... -_.. _ r ; - _ , _ �a `-_ _. -..._ r°:.: r /h 9 _ .. 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NIVI-111 I Lei 0 b--j I tM ........... ;qN. ml,�w Ike, rV ............ I INSPECTION RECORD r-- POST ON SITE �f�e,7r,1rNO. RC-9-17-2318- 5troe s Miami Shores Village 9 g �. 'Permit Type:Residential Construction, 1 10050 N.E.2nd Avenue 110 - �.�.. Miami Shores,FL 33138-0000 Work Classification:Alteration res 1;or° Phone: (305)795-2204 Fax: (305)756-8972 F�OR>lvis Issue Date: 2/512018 p ,/ Expires: 08/04/20 1 8 [a. ewer INSPECTION REQUESTS: (305)762-4949 or Log on at https://bidg.miamishoresvillage.com/cap REQUESTS ARE ACCEPTED DURING 8=AM-3:30PM FOR THE FOLLOWING BUSINESS DAY. Requests must be received by 3 pm for following day inspections. Residential Construction Parcel #:1132050180350 Owner's Name:CODY SAVITS Owner's Phone: (786)877-3564 Job Address: 1098 NE,98 to OWN 9" r Total Square Feet: 843 Miami Sh rps FI too– -am Bond Number: 3634 41- Total Job Valuation: $ 26,833.10 hill W 111 WORK IS ALLOWED: Contractor(s) p m ��a�. MONDAY THROUGH FRIDAY,8:00AM-7:OOPM. rYnerr or SATURDAY 8:00AM-6:OOPM. UNIVERSAL TILE GROUP& HOME ITI — BUILDING 52�Z5 ��'eS . NO WORK IS ALLOWED ON SUNDAY OR HOLIDAYS. !� AND ROOFING INSPECTIONS ARE DONE MONDAY THROUGH FRIDAY pad fe"A/K l �a "J"" 4)a � s/14(_j NO INSPECTION WILL BE MADE UNLESS THE PERMIT CARD IS DISPLAYED AND HAS BEEN APPROVED. PLANS ARE READLY AVAILABLE. IT IS THE PERMIT APPLICANTS RESPONSIBILITY TO ENSURE THAT WORK IS ACCESSIBLE AND EXPOSED FOR INSPECTION PURPOSES. NEITHER THE BUILDING OFFICIAL NOR THE CITY SHALL BE LIABLE FOR EXPENSE ENTAILED IN THE REMOVAL OR REPLACEMENT OF ANY MATERIAL REQUIRED TO ALLOW INSPECTION. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE aRECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORD OR RECORDING YOUR NOTICE OF COMMENCEMENT. INSPECTION RECORD STRUCTURAL WIN66WS DOORS INSPECTION DATE S INSPECTION I DATE I INSP INSPECTION DATE INSP Foundation I Attachment ` Stemwall Slab Rough = Wat Service`� 1 Columns,(ist Lift) e 2"dQugh ` Columns(2nd Lift) PUBLIC WORKS Top Out Tie Beam INSPECTION DATE INSP Fire Sprinklers Truss/Rafters Excavation Septic Tank Roof Sheathing _ Sewer Hook-up Bucks Roof Drains Interior Framing ' Gas Insulation INSPECTiDATE INSP LP Tank Ceiling Grid-! Temporary Well Drywall 30 Day Temp,nary Lawn Sprinklers Firewall Pool Bonding Main Drain Wire Lath Pool Deck Bonding Pool Piping Pool Steel p g Pool Wet Niche Backflow Preventor Pool Deck Underground Final Pool Interceptor Footer Ground 'Catch Basins FinalFence Slab Condensate Drains Screen Enclosure Wall Rough HRS Final Driveway Ceiling Rough !.J 21111 Driveway Base Rough 7119,Y A PLUMBING COMMENTS Tin Cap Telephone Rough Roof in Progress Telephone Fina_ I Mop in Progress TV Rough Final Roof TV Final Shutters Attachment Cable Rough [Final Shutters Cable Final Rails and Guardrails Inter om Rough [ADA compliance ` Int.: om FinalMECHANICAL o Alarm ROUgk► )ON, DATE INSP Alarm Final d pipe DOCUMENTS Fire Alarm Rough Soil Bearing,Cert Fire Alarm Final oil-Treatment Cert - Service WorkWtth- Vloor Elevation Survey Ventilation Rough '�einf Unit Mas Cert ELECTRICAL COMMENTS Hood Rough sulation Certificate wt ` Pressure Test spot Survey final Survey _x T Final Hood Final Ventilation russ Certificationfc Final Pool Heater u STRUCTURAL COMMENTSfl%y Final Vacuum 1 MECHANICAL COMMENTS NSPECTION DATE INSP Final Sprinkler Final Alarm '