PT-16-1080 Perr»it nro. PT-4-16-1080
�st!O1S y,� Miami Shores Village Permit Type:Paint
10050 N.E.2nd Avenue NE
OCC CiasSltlCatiOr?:Now
Miami Shores, FL 33138-000,, Permit Status:APPROVED
eN' �S Phone: (305)795-2204
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Issue Dates 4128/2016 Expiration: 10/25/2016
Project Address Parcel Number Applicant
597 NE 93 Street 1132060141040
Miami Shores, FL Block: Lot: IPI HOLDINGS LLC
Owner Information Address Phone Cell
IPI HOLDINGS LLC 1441 BRICKELL Avenue (786)763-2813
MIAMI FL 33131-
1441 BRICKELL Avenue
MIAMI FL 33131-
Contractor(s) Phone Cell Phone Valuation: $ 2,450.00
MAXIM CONSTRUCTION GROUP,COF (954)662-3341 Total Sq Feet: 1400
Type of Work:Exterior Available Inspections:
Color:SHERWIN Inspection Type:
Additional Info:EXTERIOR PAINTING AND SOME STUCCO R Final
Classification:Residential
Color:SHERWIN–Approved Code Comments:SHERWIN WILLIAMS-WALLS,FE
Color:SHERWIN_Approved_ Color:SHERWIN–Denied
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $1.80
Invoice# PT-4-16-59495
Education Surcharge $0.60
04/21/2016 Credit Card $69.80 $0.00
Notary Fee $5.00
Permit Fee $60.00
Technology Fee $2.40
Total: $69.80 11
In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans,drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In
accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are
required for ELECTRICAL,PLUMBING,MECHANICAL,WINDOWS, DOO S,ROOFING and SWIMMING POOL work.
OWNERS AFFIDAVIT: I certify that all the foregoing information is urate and that all work will be done in compliance with all applicable laws regulating
construction and zoning. Futhermore, I authorize the above-name cotractor to do the work stated.
April 28, 2016
Authorized Signature:Owner / Applicant T—Cofadw,_-L--6gent Date
Building Department Copy
April 28, 2016 1
1� Miami Shores Village
EBY:
21 ;1 16
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305)795-2204 Fax:(305) 756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949 50`
FBC 20114
PAINT Master Permit No. 1026
PERMIT APPLICATION Sub Permit No.
JOB ADDRESS:5 59:7 WE -1 3'yj,a V i±
City: Miami Shores County: Miami Dade Zip: 33139
Folio/Parcel#: Is the Building Historically Designated:Yes NO V
OWNER: Name(Fee Simple Titleholder)::rPI ['IUM c,. ..1_c. Phone#:m-7 to 3-"�9/�
Address: I q y I Rlrl c_KQ 11 /TVP. 41 )L4 U Q
City:MI Cknn( State: FL- Zip: 33) 3 1
Tenant/Lessee Name: Phone#:
Email: /
CONTRACTOR:Company Nam : M(nzim. Coflc14v, 1 Z*Wphone#:
Address— d
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City: �Sate: F �— Zips: 2 I
r � F Phone#: - /
Qualifier Name:
State Certification or Registration#,C-, S �� Certificate of Competency#:
Value of Work for this Permit:$ 21� z/�. �'' Square/Linear Footage of Work: 101
Description of Work:EXTT�0f)P 841617W& AAlb 78kF_; 9/TC(_Q &ffje&e�, & , .
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 ELECTRICAL,PLUMBING,SIGNS,WELLS, POOLS,FURNACES,BOILERS,
HEATERS,TANKS,AIR CONDITIONERS,ETC.....
"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 o building permit with an estimated value exceeding$2500,the applicant must promise in good faith that a
copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also,o certified
copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven(7)days after the building permit is issued.
In the absence of such posted notice,the inspection will not be approved and an inspection fee will be charged.
�^ 90 00
Permit Fee$ to CCF Fee$ Notary$ 5
Technology Fee$ Training/Education Fee$ Double Fee$
`Q d
TOTAL FEE NOW DUE$ (�R,
PAINT COLOR APPROVAL AND AGREEMENT
All elements on the site must be listed and indicate the color to be painted
Lk;
DIRECTIONS: Please circle corresponding number to appropriate color sample.
Walls: 1 LI 2F� 6&,EW4
Attach color sample with name and number
Fascia: 1 W14'1V__K- 2 3 4 -- -
Drip edge: 1 2 3 4 6ODY
Soffit: 1 2 3 4
Flower Bins: 1 2 3 4
T
f0
Shutters: 1 2 3 4
t
Awnings: 1 2 3 4 Ln c
L
Chimney: 1 2 3 4 0
Doors&Jambs: 1 2 3 4 Ln J
Garage Doors: 1 h} ,�T 2 3 4
Railings: 1 2 3 4
Fences: 1 L1416- 2 P?f4ZLE-3 &JW4 (cy) 3. _P 11�
All Brick: 1 Int lel P 2 3 4
Stucco Bands: 1 2 3 4
Other Stucco l
Feature: 1 2 3 4 4•
Accessory Bldg: 1 2 3 4
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all ork w I be done in compliance with all
applicable laws u ati g construc on Hing.
Signature Signature
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before
day of^�� 20/ 5'_� by 2 day of 2t�- 20 by
✓%; , ✓� �r►+ntC� �/NN ,who is personally known to p,/lArl.GSl r'1 L�rl�arhfo is personally known to
me or who has produced r— as me or who has produced rL— 1 Y21\l(;�q— as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUB NOTARY PUBLIC:
r r9 �lZj/a' /�G' �/`j✓GGC� �: „;.cS `•�dOjY
Sig Sign:
" •sPATRICIA K.PARKER ZK
Print: �: Notar PuEI - Print: �. u 3: ;
_�
3 •• Y Comm.Ex it 'y `.'� ;• ��
;y . Pea Aug 12,2017 Seal: :• `��
S al: °•• CommlaSion FF 039797, `'.; °•.. . ..•y \��
g�1ZBonded ThroupA NeNpgl Notary �r'�j����*►I N0,,�����
APPROVED BY: ul Code Official
Historic Preservation Board
r
STATE OF FLORIDA,
pP. DEPARTMENT OF BUSINESS AND
PROFESSIONALyREGULATION
CGC1511745 • t JSSUED. ,06/15/2014
CERTIFIED GE NERA�CONTRACTQR
r SADIK, MAXIM!.;:
MAXIM CONSTRUCTION,GROUP,CORP
IS CERTIFIED under the provisions of Ch.489 FS.
Expiration date :`AUG 31,2016:: L1406150001524
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BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT- `
115 S.Andrews Ave., Rm.,A-100, Ft. Lauderdale, FL 33301-1895_954-831-4000 f
VALID OCTOBER 1,2015-THROUGH SEPTEMBER 30,2016 1
iz DBA:MAXIM CONSTRUCTION GROUP CORP Receipt#:GE EPAL CONTRACTOR ('CERT
Business Name: Business,Type:cENERAL CONTRACTOR)
Owner Name:m.kxim SADzx Business Opened:05%16/2011
Business Location :1835 E HALLANDALE BEACH BLVD St6te/County/Cert/Reg:CGC1511745 �
HALLANDALE Exemption Code:
I Business"Phone:,954-662-3341
Rooms Seats Employees Machines Professionals
1 ",E ,
J
i t For Vending Business Only '
I Number"of Machines: Vending Type:
l mount Transfer Fee NSF Fee i Penalty Prior Years Collection Cost Total Paid
.:.., I
27.00 3.00 0.00 0.00 0.00 0.00 -30.00-
THIS
30.00 THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS '
THIS BECOMES A TAX RECEIPT This tax is levied for the privilege of doing business within Broward County,and is
non-regulatory in nature.You must meet all County and/or Municipality planning
WHEN VALIDATED and zoning requirements.This Business Tax{Receipt must be transferred when
the business is sold, business name has changed or you have moved the
l business location.This receipt does not indicate that the business is legal or that
{
it is in compliance with State or'local laws and regulations.
1 Mailing Address:
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" MAXIM CONSTRUCTION GROUP CORP Receipt M10B-14=00011157
1835 E HALLANDALE BEACH Paid 09/17/2015 30.00
BLVD #301
HALLANDALE BEACH, FL
33009
i
# 201$ - 2016
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ROWA EF.668"_WE'd B SINE CEfl F
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1:11enuv: Tuziov MAJ&VUT
ACOR0. CERTIFICATE OF LIABILITY INSURANCE DADD/YYYY)
4/1`21/221/2016
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(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 NA Certificate Department
Advanced Insurance Underwriters, LLCa/c°Nr�o �:954 416 9780FAX
3250 N.29th Avenue E-MAIL a/c'N13: 954 963 9776
ADDRESS: Certificates@advancedins.COm
Hollywood, FL 33020 INSURER(S)AFFORDING COVERAGE NAIC
INSURER A:Colony Insurance Company 39993
IN INSURER B:Travelers Indemnity Co.of Amer 25666
Maxim Construction Group,Corp INSURER C:Allied World Surplus Lines Ins. 24319
1835 E Hallandale Beach Blvd#301
Hallandale Beach, FL 33009 INSURER D
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 CONTRACTOR 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 ADDL UBR POLICY EFF POLICY EXP
LTR TYPE OF INSURANCE INSINSR WVD POLICY NUMBER M/DD/YYYY MM/DD/YYYY LIMITS
A GENERAL LIABILITY x BR706303 4/21/2016 04/13/201 ROME
OEC7CURppRENCE i $1,000,000
X COMMERCIAL GENERAL LIABILITY PREMISES EaEoccuErrOence $100,000
CLAIMS-MADE FXOCCUR MED EXP(Any one person) s5,000 i
X BVPD Ded:250 PERSONAL&ADV INJURY $1,000000
GENERAL AGGREGATE' s2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG' $Included
X POLICY j RO LOC $
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
Ea accident
ANYAUTO BODILY INJURY(Per person) $
I ALL OWNED SCHEDULED tid
c
P
BODILY INJURY(Per accident)AUTOS AUTOS ) $
NON-OWNED PROPERTYDAMAGE $
HIRED AUTOS AUTOS Per accident
F I I 1 1 $
UMBRELLA LIAR OCCUR EACH OCCURRENCE $ i
EXCESSUAB CLAIMS-MADE AGGREGATE $
t DED I I RETENTION$ $
B WORKERS COMPENSATION BR706164 4/21/2016 04/21/201 WCSTATU- OTH-
AND EMPLOYERS'LIABILITYOR,
ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT 400,000
OFFICER/MEMBER EXCLUDED? a N/A
(Mandatory In NH) E.L.DISEASE-EA EMPLOYEE S500,000
If yes,describe unde
DESCRIPTION O rOF below E.L.DISEASE-POLICY LIMIT 1$500,000
C Professional Liab 03100975 4/13/2016 04AW2017 $1,000,000/Ded$1,000
$500,000 Punitive Dmg
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101;Additional Remarks Schedule,If more space is required)
Lic#CGC1511745 I
1
CERTIFICATE HOLDER CANCELLATION
Mami Shores Village Bldg Dept. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
3 10050 NE 2nd Avenue ACCORDANCE WITH THE POLICY PROVISIONS.
Miami Shores, FL 33138
AUTHORIZED REPRESENTATIVE
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UNANIMOUS WRITTEN CONSENT ACTION OF THE MEMBERS
OIC
11'1 HOLDINGS LLC
IPI HOLDINGS,LLC (the "Company'), a Delaware limited liability company, filed its Certificate of
Formation on July 18"', 3014. Pursuant to the authority contained in the Delaware Limited Liability
Company Act (the "Act").the members(the"Members•"I of the Company do hereby take the following
actions and adopt the followin-resolutions by writtenconsent in lieu oi'a meeting-
CERTIFICATE OF FORMATION
RESOLVED,that the Certificate of Formation of the Company that was liled with the Secretary of Stute
of the Stine of Delaware on July 18'", ''013,true and correct copy of which is attached hereto as Exhibit
6.is hereby approved by the Members and that said Certificate of Formation be filed by the Managers of
tite Company among the permanent records of the Company.
MANAGERS
RESOLVED, that Stewart James Cameron and Nichola+ Farrell aro named its the Managers of the
Company, and they hereby accept their appointments to such office and hereby agree to serve as
Managers of the Company until their successors ane duly elected and qualified or until the earlier of their
death,resignation,retirement,disqualification or removal from office.
FISCAL,YEAR
RESOL'''ED.that the Company adopts a fiscal year ending December 31 for financial and tax reporting
purposes.
BANKING AUTHORIZATION
RESOLVED,that the Managers are hereby authorized and empowered for and on behalf of the Company
to designate in writing such banks, trust companies or other financial institutions as depositories for the
fuutds of the Company to be carried in an account or accounts as styled by the Managers in their
discretion. and Such depository is authorized and requested to accept, honor and pay, without further
inquiry and until written notice of the revocation of such authority granted is received by it, all checks,
drafts and other orders for the payment or withdrawal of Such funds of the Company, including any
instruments payable or endorsed to the order of the Company by Ute Managers;and he it further
RESOLVED,that Managers are hereby authorized to execute and cenify any resolutions required by any
depository, and such resolutions will he included in this Consent as if duly considered and adopted by
said Managers.
ORGANIZATIONAL EXPENSES
RESOLVED, that the Managers are hereby authorized to pay all fees and expenses related to the
organization of the Company.
QUALIFICATION IN FOREIGN JURISDICTIONS
RESOLVED,that for the purpose of authorizing the Company io transact business in any state.territory
or dependency of the United States or any foreign country in which it is necessary or expedient fir the
Company it)transact business,the Managers are hereby authorized to appoint and substitute all necessary
agents or attorneys for service of process.to designate and change the location of all necessary statutory
officee and to execute,acknowledge.deliver and file all necessary certificates.reports..powers of attorney
and other instruments as may he required by the laws of such state. territory. dependency or country to
authorize the Company to transuct business tlkrein and. whenever it is exped'tem for the Company to+
cense transacting business therein and to withdraw therefrom. to revoke any appointment or agent or
attorney for service of process,and to execute. acknowledge. deliver and file such certificaies, reports.
revocation of appointment or surrender of authority that may be necessary to terminate the authority of
the Company to transact business in any such nate.territory,dependency or country.
IRS FILINGS
RESOLVED, that the Managers of the Company, ars authorized in such capacity. For as long as is
necessary. to execute on behalf of the Company the Application for the f=ederal Identification Number
(t`orin SSd)with the Imernal Revenue Service.
FURTHER ACTION
RESOLVED, that the Mumigcrs are hereby authorized to execute. acknowledge, deliver and file such
tither documents and to take such further actions as it may decnt necessary or appropriate to effect the
intent and accomplish the purposes of the preceding resolutions.
7 hip:Conwnt•Action-is signed this y of Septcmber201�1 to he2ffectivtra pt lu1�18'''�Oi�,
M1IMBER(S)SIGNATURES:
IPI A E IANAGF.i\ ENT LLP.
By: -
Namc:
Title:_ MAn)Atd.w_6 P40Aj
IPI A GEMS\7',IN
By:
Stewart lames Cameron, President
2