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PT-17-1458 1 Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 I Inspection Number: INSP-283497 Permit Number: PT76-17-1458 Scheduled Inspection Date: February 23, 2018 Permit Type: Paint Inspector: Naranjo, Ismael Inspection Type: Final Owner: Work Classification: Addition/Alteration Job'Address:9315 Park Drive A Miami Shores, FL 33138-2893 Phone Number (786)574-9767 Parcel Number 1132060530010 Project: <NONE> Contractor: R&L PAINTING INC Phone: (954)493-5357 Building Department Comments PAINT Infractio Passed Comments INSPECTOR COMMENTS False a t I Inspector Comments Passed EJ C �'J Failed Correction ❑ Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. 1 t February 23,2018 For Inspections please call: (305)762-4949 I Page 7 of 30 } ,. Permit NO. PT-6-17-1`458 Miami Shores Village Petmit Type:Paint 10050 N.E.2nd Avenue Pen � woftc.Ctassifcation:AdditiQNAiteration " Miami Shores,FL 3313&0000 Pernlit`Status:APPROVED Phone: (305)795-2204 y��ORIOp' issue nate:6/5/2011 Expiration: 12102/2017 Project Address Parcel Number Applicant 9315 Park Drive Number: A 1132060530010 MAYAC INC Miami Shores, FL 33138-2893 Block: Lot: Owner Information Address Phone Cell MAYAC INC 9315 PARK DRIVE (786)574-9767 MIAMI SHORES FL 33138- 9315 PARK DRIVE MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone Valuation: $1,800.00 R&L PAINTING INC (954)493-5357 _. r .. ..,.. _..._ Total Sq Feet: 0 Type of Work:Exterior Available Inspections: Color: Inspection Type: Additional Info: Classification:Residential Final Color:_Approved Code Comments: Behr Black Doors and Jambs Color:_Approved_ Color:_Denied Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $1.20 Invoice# PT-6-17-64166 Education Surcharge $0.40 06/01/2017 Credit Card $63.20 $0.00 Permit Fee $60.00 Technology Fee $1.60 Total: $63.20 In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans,drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL, PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Fu ore,I authorize the ab ed contractor to do the work stated. June 05, 2017 Authori nature:Owner / Applicant / Contractor / Agent Date Building Department Copy June 05, 2017 1 t I �� oQ�� s� ��3 � �� 3 , . Miami Shores Village r, 1 R��EIVED BuildingDepartment, tment, p 11 10050 N.E.2nd Avenue,Miami Shores; JUN 011017 Florida 33138 (� Tel: (305)795:2204 Fax: (305)756.8972 l ,� INSPECTION'S PHONE NUMBER: (30 5)762.4949 ` BUILDING Permit No.--�>-T Ss PERMIT APPLICATION Master Permit No. FBI 20 Permit Types PAINT OWNER:.. ( P ) 'Ma ac, Inc. Name Fee Simple Titleholder)t Y Phone#: Address: 9315 Park Drive r City: Miami Shores State: Florida Zip.,33138 Tenant/Lessee Name: Phone#: Email: ,IOB ADDRESS: 9315 Park Drive City: Miami Shores County: Miami Dade Zip: Folio&arcel#: ° Is the,Building Historically Designated:Yes NO X Flood Zone: CONTRACTOR:Company Name: R&L Painting, Inc. Phone# (954)493-5357 .Address: 707 NE 45 St. City: Oakland Park State: Florida Zip. 33334 Qualifier Name: Prentiss Hayes Phone#: (954)493-5357 State Certification or Registration#: CGC 1504491 Certificate of Competency#: Contact Phone#: (954)493-5357 Email Address: Value of Work for.this Permit:$ 1,800 Square/Linear Footage of Work: Description of Work: Paint existing green areas of building with white 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 constructionin this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING,'SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS,TANKS and 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 oj'a building permit with an estimated value.exceeding$2500,the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person w�hoseproperty is subject to attachment. Also, a certified copy of the recorded notice of conmtencement must be posted at the job site for the first inspection.which occurs seven(7)days after the building permit is issued. In-the absence of such posted notice,the inspection will not be approved and anis spection fee will be charged Permit Fee$' CCF$` Notary$ Training/Education Fee$ _, / Te6nol6gy`Fee$ Dou6le Fee$. TOTAL FEE NOW DUE$ � . V i J PAINT COLOR APPROVAL AND AGREEMENT I All elements on the site must be listed and indicate the color to be painted DIRECTIONNS: Please circle corresponding number to appropriate color sample. Walls: C' 1 2 3 4 Fascia: n 2 3 4 Attach color sample with name and number Drip edge: 1 2 3 4 Soffit: 1 2 3 4 1. L✓{�ITE Roof: 1 2 3 4 Flower Bins: 1 2 3 4 • Shutters: 1 2 3 4 I2. N Awnings: 1 2 3 4 Chimney: 1 2 3 4 Doors&JambG)eoOpp' �2 ff20fJT 3 4 Garage Doors: 1 2 3 4 Railings: 1 2 3 4 3. Fences: 1 2 3 4 All Brick: 1 2 3 4 Stucco Bands: 1 2 3 4 Other Stucco 4. Feature: 1 2 3 4 1 Accessory Bldg: 1 2 3 4 OWNER'S AFFIDA fstruc a all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulati d nin . r Signature: Signature: er or Ag t Contractor The foregoing instru was acknow edged before me this 30 The foregoing instrument was acknowledge before me this.4$ I day of M ,20 n ,by Mon�cr t Mel o y-i day of 20—/1,by IS. T 2 s , f who is pe onally kno to me or who has produced who is peoDuaUylaown,to me or who jationdoa as i e ALLISON UCI�► ASI NOTARY PUBLIC: MY COMMISSION#FF182828 NOTARY PUB F MY COMMISSIO 1 EXPIRES November 23,2018 ••:�'orr. •' EXPIRES December 10,2018 ••°"`••"` allotaryService.com 1 07)398.0153 FlorldallotaryServicexom Sign: to)7)3� Sign: Si / Print: I Print: +./ryaPAN J�. ,�Gusor� I My Commission Expires: I Z I 1 O I I$ My Commission Expires: I APPROVED BY: Code Official k Preservation Board r 'betail by Entity Name Page 1 of 2 � I Arida Department of State DIVISION OF CORPORATIONS Agorg f- EJI Department of State / Division of Corporations / Search Records / Detail By Document Number/ Detail by Entity Name Florida Profit Corporation MAYAC, INC. Filing Information Document Number P16000085849 FEI/EIN Number APPLIED FOR Date Filed 10/25/2016 State FL Status ACTIVE Principal Address 900 BISCAYNE BLVD.,STE.803 MIAMI, FL 33132 Mailing Address 900 BISCAYNE BLVD.,STE.803 MIAMI, FL 33132 Registered Agent Name&Address i BOLOGNA,STEFANIA 150 S.E.2ND AVE.,STE.#1010 MIAMI, FL 33131 Officer/Director Detail G Name&Address { Title D/P MARAZZI, CAROLINA 450 ALTON RD.,APT.#2408 MIAMI BCH., FL 33139 Title T/S MARAZZI,CAROLINA 450 ALTON RD.,APT.#2408 E' MIAMI BCH., FL 33139 1 Title VP MELOTTI, MONICA 652 N.E. 105TH ST. MIAMI SHORES, FL 33138 http://search.sunbiz.org/Inquiry/CorporationSearch/SearchResultDetail?inquirytype=Entity... 5/4/2017 Detail by Entity Name Page 2 of 2 • "TitIe:VP�• :j RUZZI_MARCO , 652 N.E. 105TH ST. MIAMI SHORES, FL 33138 Annual Reports Report Year Filed Date 2017 04/23/2017 Document Images 04/23/2017—.ANNUAL REPORT View image in PDF format 10/25/2016—Domestic Profit View image in PDF format t Florida Department of state,Divlslon of Corporations i i r 1 4 http://search.sunbiz.org/Inquiry/CorporationSearch/SearchResultDetail?inquirytype=Entity.... 5/4/2017 0KVVUAK1J COUNTY LOCA LI BUSINESS`I�AX RECEIPT 115 S.Andrews Ave., Rm. A-100, Ft Lauderdale ', F I VALID OCTOBER 1 333Q'i-1895—954-831-4000, ,Y ,2016 THROUGH; SEP'"EMBER 30,2017 DBA: .t BusinessName:R & L PAINTING INC i i{e�ceipt#:180-5316. { SUSIneSS T e.GENERAL CONTRACTOR (GENERAL J� iyp CONTRACTOR) f Owner Name:PRENTISS HAVES Business dened:ol/os/2000 Business Location:707 NE 45 ST I t 1 F,P OAKLAND P State/County/+ ert/Reg:CGC 1504491 BUSIneSS Phone:954-493-5357 E0 (-o Code: I ` 4 Rooms Seats. Employees } Margines Professionals Aq I i For Vending Business Only �} Number of Machines- TaxAmount Transfer Fee NSF Fee Penalty g Type: rt = Penalty i P�ior Ye Es Collection Cost Total Paid 27.00 0.00 0.00 0.00 ` `.00 0'.00 a r i THIS RECEIPT MUST BE.POSTED CONSPICUOUSLY INYO RMPLACE OF BUSINE lisiiiess SS THIS BECOMES A TAX RECEIPTThis tax is levied for°the privilege of doln within Broward County and is non-regulatory in nature. You'mustmeet' WHEI County and/or Municipality planning N VALIDATED and zoning requirements: This Business ax Receipt must be transferred when the business is sold, business name 1h changed or you" have moved .the i business location This receipt does not intlk' ate that the business is legal or that it is in compliance with State or loal lawsd regulations. 1 Mailing Address: �, • � � PRENTISS HAVES i 707 NE 45 ST Re ipt #ICP-15-00027132 OAKLAND PARK, FL 33334 aJ i Pas:d 09/23/2016 27.00 2016; - 2017 T.w.+..,.,i.w +K\.+�.J!...�w.�1A �:.... �1 ■I� `'� ..'..y.,��.`"a.�l4.Li,.,��.._n«.'+„L,.,,,.,�,.�� f f RICK SCOTT GOVERNOR f KEN LAWSON,SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND.PROFESSION L REGULATION YL yzx - CONSTRUCTION iNDUSTRY,LICENStNG' "OARD�I I CGC1504491 The GENERAL CONTRACTOR Named below IS CERTIFIED 'n Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2018 HAYES, PRENTISS BYRON JR R& L PAINTING INC 101 S SWEETWATER COVE`BLVD I LONGWOOD FL 32779 t _ r TE(MMCDYYYY) 1A•� CERTIFICATE OF LIABILITY INSURANCE /2oi7 F THIS CERTIFICATEIS ISSUED ASA MATTER OF INFORMATIONONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELYAMEND, 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 REPRESENTATIVBDR PRODUCER,ANDTHECERTIFICATEHOLDER. IMPORTANT:N the certificarehoider is an ADDITIONALINSURED,the policy(ies)must be endorsed.M SUBROGATIONIS WAIVED,subjectto the terms andconditionsofthe policylcertain policiesoayrequireanendorsemerd.A statementon thiscertificatedoes not conferdghts to the ' certificateholder in lieu of such endorsement(s). PRODUCER CONTACT NAMECathy Marshall SOUTHGATE INS AGCY OF POMPANO BEACH INC PHONE FAX ASC,No,Ext: (954)942-4400 ac,No: (954)942-4402 639 N Federal Hwy noeSS: rick@southgateins.com Pompano Beach, FL 33061 INSURER(S)AFFORDING__OVERAGE NMCa INSURERA: Hanover Insurance Group 41602 INSURED R 6 L PAINTING, INC. INSURER B: 707 NE 45th Street INSURER C: FORT LAUDERDALE, FL 33334 INSURER D: 9544 938151 INSURER E INSURERF: I 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 VIMICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONSAND CONDITIONS OF SUCH POLICIES.LMAITS SHOWNMAY HAVEBEEN REDUCED BYPAID CLAIMS. _ s POLICY EFF POLICY EXP TYPE OFINSURANCE POLICY NUMBER MM M LIMITS X COMMERCIALGENERAL UASIUUTTY' EACH OCCURRENCE S 2,000,000 C---DE1 A 1 OCCUR �E occuna— LLL��//7 PREMISES Ea nca $ 300,000 X Deductible $5,000.00 MEDEXP(Anyonaperson) $ 10 000 A L1JA90816501 04/24/2017 04/24/2018 PERSONAL SADV INJURY $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 2,000,000 X POLICY MJPEE. El LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANYAUTO BODILY INJURY(Per Person) $ ALL OWNEDF1 SCHEDULED BODILY INJURY(Par accidem) S AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident S UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAMS-MADE AGGREGATE $ DED RETENTION S - $ WORKERS COMPENSATION PER OTH- ANDEMPLOYERS'LIABILITY YIN STATUTE ER — reowaeraweererwezennne NIA E.L.EACH ACCIDENT $ wcesv (MandatoNn NH) E.L.DISEASE-FA EMPLOYEE $ If yes,describe under DESCRIPTION OFOPERATIONS below E.L.DISEASE-POLICY LIMIT is DESCRIPTION OFOPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remark.Schedule,may be attached if more space is required) Scope of Work: Painting Contractor - License#CGC1504491 CERTIFICATE HOLDER CANCELLATION Miami Shores Village SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 10050 NE 2nd Avenue THE ED(PIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Miami Shores, FL 33138 AUTHORIZED REPRESENTATIVE )Gv.R ®1988-2014 ACORD CORPORATION. All rights reserved. ACORD25(2014/01) The ACORD name and logo are registered marks of ACORD A�& CERTIFICATE OF LIABILITY INSURANCE °"05/10/20 ice' 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 endomement(s). PRODUCER Steve Botkin,State Farm Insurance State Farm Insurance PHONE 954-537-3333 F 954-537-3332 3038 N. Federal Highway EMAILADDRESS.www.stevabotkin.net OFt Lauderdale, FI 33306 PRODUCER INSURER AFFORDING COVERAGE NAICO INSURED INSURER A.State Farm Mutual Automobile Insmnoe Company 25178 R&L Painting, Inc. -INSURERS: 707 NE 45th Street INSURER C: Fort Lauderdale, FL 33334 INSURERD: NSURER E: NSURER 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 ADDTYPE OF INSURANCE L BR POLICY NUMBER ICY EFF PMviopflym OLIY VYM Lam$ GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY 00 PREMISES Ea oorurnmoa S CLAIMS-MADE D OCCUR MED EXP one on $ PERSONAL&ADV INJURY $ tPRODUCTS-COMPIOPAGG ERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: S POLICY PRO. LOC S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S 1,000,000 (Es aoddent) ANY AUTO 3011486-E27�59D 11/27!2016 11127/2017 BODILY INJURY(Per person) s X ALL OWNED AUTOS —1 El X SCHEDULED AUTOS 587 7640-C22-59L 03/22/2017 09/22/2017 BODILY INJURY(Par acddent) S PROPERTY DAMAGE X HIRED AUTOS (Per accident) $ NON-OWNEDAUTOS Comp/Coll Ded.$500 $ 500 PIP $10,000 s UMBRELLA UAB OCCUR EACH OCCURRENCE $ EXCESS LIMB CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION S 'S WORKERS COMPENSATIONX VJC STATU- OTH- AND EMPLOYERS'LIABILITY YIN ANY PRDPRIETORIPARTNERIEXECUTIVE $ OFMERIMEMSEREXCLUDED? El NIA 98-SH-N339-2 02!09/2017 08!09/2017 E.L.EACH ACCIDENT 1,000,000 IMandatoryInNH) E.L.DISEASE-EA EMPLOYE $ 1,000,000 19 (I yes,describe under E.L.DISEASE-POLICY LIMIT S 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES(Attach ACORD 101,Addltlew l Rsmarlrs Schedule,H mon space is ne"Ired) Contractor's License 1! CGC1504491 CERTIFICATE HOLDER CANCELLATION Miami Shores Village t SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE 10050 NE 2nd Ave EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Miami Shores FL 33138 AUTHORIZED RE NTAn S. BOTKIN 59-1862 A026573 Steve Botld RROWARD SOUTH03 f@-igsf-,foo9 ACORD CO TION. All rights reserved. ACORD 25(2009!09) The ACORD name and logo are registered marks f ACORD 1001486 132849.4 02-11-2010