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RC-16-2174Permit NO. IBC -8 -'16-2174 Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 Project Address p • Permit Type: Residential Construction Work Classification: Alteration Permit Status: APPROVED Issue Date: 9/23/2016 Expiration: 03/22/2017 Parcel Number Applicant 10682 NE 11 Court Miami Shores, FL 33138-2123 1122320280500 Block: Lot: MARC ALBERT ILLOUZ Owner Information Address 7934 WEST Drive NORTH BAY VILLAGE FL 33141- 1540 MERIDIAN Avenue MIAMI BEACH FL 33139- Contractor(s) Phone SHANNON & SHANNON PROPERTIES (305)891-1220 Cell Phone Phone Valuation: Total Sq Feet: Cell $ 18,000.00 400 Approved: In Review Comments: Date Approved: : In Review Date Denied: Type of Construction: KITCHEN AND BATHROOM REMOC Stories: Front Setback: Left Setback: Bedrooms: Plans Submitted: Yes Certificate Date: Bond Return : Occupancy: Single Family Exterior: Rear Setback: Right Setback: Bathrooms: CAflE D Classification: Residential Fees Due CCF CO/CC Fee DBPR Fee DCA Fee Education Surcharge Permit Fee Scanning Fee Technology Fee Total: Amount $10.80 $50.00 $8.10 $8.10 $3.60 $540.00 $18.00 $14.40 $653.00 Pay Date Pay Type Amt Paid Amt Due Invoice # RC-8-16-60842 09/23/2016 Credit Card $ 503.00 $ 150.00 08/02/2016 Cash $ 150.00 $ 0.00 Available Inspections: Inspection Type: Final PE Certification Window Door Attachment Framing Insulation Drywall Screw Window and Door Buck Fill Cells Columns Review Building Review Plumbing Review Planning Review Structural Review Mechanical Review Electrical 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 zo ' Fu more, I authorize the above -named contractor to do the work stated. September 23, 2016 Date Authorized Sigryature: Owner / Applicant / Contractor / Agent Building Department Copy September 23, 2016 1 cA-veD 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 FBC 2014 Master Permit No. IR G1 (O --et TI Sub Permit No. 251IL 9 ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL JOB ADDRESS: it V 6 O PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS C City: Miami Shores Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: County: Miami Dade OWNER: Name (Fee Simple Titleholder): CA r r Address: t 5 4 0 j AkO. "[ City: v l a vv." State: L Zip: 53 13? Phone#: 4'. 3 I L fr Zip: 33 i 3� Tenant/Lessee Name: Phone#: Email: eV.)c (let . � C7► c`x. CAc>.. - C,(w ri CONTRACTOR:�Company Name:�� L l�r 1 Lh O� A 23' ski g77-girt =-Ciy(I LSClts•�i rA a arQ7aIifier Name: A-44p D. -j LL L Phone#: State Certification or Registration MI1 C C, C/1 ,1 5 11� 5 l Certifica•te of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State/:� Zip: Value of Work for this Permit: $ , 'OOO • C) Square/Linear Footage of Work: `/00 Type of Work: ❑ Addition ❑ Alteration 7 if ® New 161 Repair/Replace .❑ Demolition -3 `1 ^W3' ` ' y Description of Work 1.\.. -:f i �:.;:pp; ,� iY; t� mot' C3^�'t �: `,yyam,��,f Op �v.. j:, ;.;. fi C. Yw� '`'ti ':_- t Vie �/•}:Vl�1e ,) e_v✓ lick U‘ r\e.T$.Rtr, �' 7,4 1 :!is Zip: 3366 . - Specify color of color thru tile: ��, CO Submittal Fee $'��' A(9 Permit Fee $ �0 • GO CCF $ �' ) CO/CC $ BO' Scanning Fee $ 1 - CO Radon Fee $ �v • f 0 DBPR $p . (d Notary $ 0 Technology Fee $ I, • 0 Training/Education Fee $ - €© Double Fee $ Structural Reviews $ Bond $ TOTAL FEE NOW DUE$ 1) 00 (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 ap'plicant 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 not be approved and a reinspection fee will be charged. Signature OWNER or AGENT The foregoing instrument was acknowledged before me this' day of )(..i >n� , 20 6 ?, ,, i�f i,,' 1‘ ,. .,j Y l '*Iby" day of »� VY\e• , 20 `c , by I. C ic-Ar L L I ( 0CJ ' , who is personally known to IVAN,V -�'�" ha.tet'1li, wh`o'is.personaIly kilo' w— me or who has produced re hCL s(�`a SS fJO'�r as me or.. has produced, identification and who did take an oath. \\ 1 NOTARY PUB �y. Print: Seal: V1 Is 0, y4� THOMAS M. KANN ,11I a = %.„ ,;. ; Commission M EE 181909 My Commission Expires 4.;,,ii�;,,or AprIl 11, 2020 The, foregoing': instrument was acknowledged before me this identification and who didtake an oath. NOTARY Seal: as ° , .+•4 THOMAS M. KANN _ _. IS ._ Commission U EE 181909 My Commission Exoues 4:;liFFiffl;i April 1 1 , 2020 ************************* ** ***************************************************************************** 9 R- APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) STATE OF.. FLORIDA t DEPARTMENT OF BUSINESS AND: PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487-1395 1940 NORTH MONROE STREET TALLAHASSEE FL.32399,0783 SHANNON-GRAHAM,,NIK1TA DESHAWN SHANNON 8& SHANNON PROPERTIES INC 14247 MEMORIAL HIGHWAY MIAMI; FL 33161 Congratulations! With this license you become one of the nearly one million Floridians licensed by the Department of Business and, Profession) Regulation. Our professionals and businesses range from architects to yacht brokers,yfrom 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.myfloridaiicense.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! DETACH HERE RICK SCOTT, GOVERNOR :STATE OF FLORIDA DEPARTMENT Of BUSINESS AND PROFESSIONAL -REGULATION CGC1516519 rt ,ISSUED. , 08/21)201.4. CERTIFIED.GENERAL GO,NTRAC QRV SHANNON-GRAHAM; `NIKIi'/ ; DESHAWN • SHANNON. & SHANNON`PROPERTIES INC awqa• ny. " i5 CERTIFIED °tinder the provtsions.of Ch 489 FS. •" Expiration date.: AUG 31, 2018' L1409210001709 KEN'LAAWSON, SECRETARY STATE OFIFLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION _CONSTRUCTION INDUSTRY LICENSING BOARD The GENERAL;CONTRACTOR` Named below IS'CERTIFIED- Under the provisions ofChapter 489 FS. Expiration date:, AUG'31, 2016• ' SHANNON-GRAHAM,•NIKITA DESHAWN ' SHANNON & SHANNON PROPERTIES INC, 14247.MEMORIAL'HIGHWAY 4x MIAMI-- -FL33161 e ISSUED: 08/2112014 DISPLAYAS REQUIRED BY LAW SEQ# L1408210001709 JEFF ATWATER CHIEF FINANCIAL OFFICER STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERSCOMPENSATION * * CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAVV* * CONSTRUCTION INDUSTRY EXEMPTION, This certifies that the individual listed below has elected to be exempt from FloridaWorkers' Compensation law. EFFECTIVE DATE: 7/14/2015 EXPIRATION DATE: 7/13/2017 PERSON: SHANNON JAMES FEIN: 264016978 BUSINESS NAME AND ADDRESS: SHANNON & SHANNON PROPERTIES INC SHANNON & SHANNON PROPERTIES, INC. 28 SW 8 STREET, UNIT B HALLANDALE BEACH FL 33009 SCOPES OF BUSINESS OR TRADE: CONTRACTOR -PROJECT MANAGER, CO Pursuant to Chapter 440.05(14), F.S., an officer of a corporation who elects exeniption from this chaptertiy 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 exernpt.. apply only within the scope of the business or trade listed on the notice of election to be exempt Pursuant to Chapter 446.05(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 DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUESTIONS?.(850)413-1609 JEFF ATWATER CHIEF FINANCIAL 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 WorkersCompensation law. EFFECTIVE DATE: 7/14/2015 EXPIRATION DATE: 7/13/2017 PERSON: SHANNON NIKITA FEIN: 264016978 BUSINESS NAME AND ADDRESS: SHANNON & SHANNON PROPERTIES INC 28 SW 8 STREET, UNIT B HALLANDALE BEACH FL 33009 SCOPES OF BUSINESS OR TRADE: LICENSED GENERAL CONTRACTOR -PROJECT CONTRACTOR, MANAGER, CO 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.Chapter440.05(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 DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUESTIONS? (850)413-1609 - ,'''.BROVVARO-Ctrart--4-gaiNgS.St-TAXLF! ‘g1P 115 S. Andrews Ave., Rm. A-100,'Ff Lauderdale, FL 33301-1895`=-954-831-4000 VALID OCTOBER 1; 261.5 THROUGH SEPTEMBEli 30; 201;6 DBA: Receipt#-180-227095 Business NSHANNON & SHANNON •PROPERTIES INC' :GENERAL CONTRA,,CTOR ame: Business Type. 0Wrier`Name: NIKITA DESHAWN SHANNON-GRAHAM BuSitiess Location: 28. S14 8 sT #B • HALLANDALE Business Phone: (754 ) 703 -4255 'Seats yZooms Employees 1 Business Opened:o 8/28/2009 State/County7CertiReg:CGC1516519, Exemption Code: Machines. Professionals For Vending Business Only • VendingType: Tax Arnount .._...__. _....__.... ' Transfer`Fee ___ . , NSF Fee ' Penalty- _ Prior Years . Collection Cost Total Paid 27:00 ' ' 3.0iY. 0.00 '1.-. 6.75, ' ' ' ' 0.00. 25.00 ' 61.75 THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS THIS BECOMES A TAX RECEIPT WHEN VALIOATED Mailing Address: This tax is levied for the privilege of doing business within Broward. County and is. non-regulatoryin nature. You must meet all County and/or Municipality planning and zening'requirements. This Business TaiRecelpt.must be transferredwhen the business is sold; business name has changed or you have moved the bilsiness location:This receipfdoes not indicate that the businessIs legal or,that it is hr compliance with State or fecal laws and regulations. 1 SHANNON & SHANNON PROPERTIES 28'SW ,8 ST #B • HALLANDALE BEACH, FL - 33,009 .t INC Receipt ftwW-15- 00094211 Paid 02/01/2016 61.75 2015 - 2016 4. CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDIYYYY) 04-39-2016 PRODUCER A.B.S. Insurance Consultants 11402 N W 41 st Street Suite 213 Miami FL 33178 (305) 592-4144 office (305) 715-7227 fax INSURED Shannon & Shannon Properties Inc. 28 SW 8th Street #B Hallandale, FL 33009 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE INSURER A: Interntaional Ins Co of Hanover NAIC # INSURER B: INSURER C: INSURER D: INSURER E: COVERAGES THE POLICIESOFINSURANCELISTEDBELOW HAVEBEEN ISSUEDTOTHEINSUREDNAMEDABOVEFORTHEPOLICYPERIODINDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAYPERTAIN, THE INSURANCE AFFORDED BYTHE POLICIES DESCRIBED HEREIN IS SUBJECTTOALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR ADD'L NSRn TYPF [1F INSIIRANCF POLICY NUMBER POLICY EFFECTIVE RATF IMM/nn/YYYYI POLICY EXPIRATION f1ATF /MM/nn/YYYY) 04/29/2017 LIMITS A GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY IGO6A003771-02 04/29/2016 EACHOCCURRENCE$ 1,000,000 X DAMAGE TO RENTED PRFMISFS (Fa ocrurenc:a) $ 100,000 CLAIMS MADE X OCCUR MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 1,000,000 X POLICY PRO- IFC LOC AUTOMOBILE LIABILITY , ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY ANY AUTO AUTO ONLY - EA ACCIDENT $ EA ACC $ OTHER THAN AUTO ONLY: AGG $ EXCESS I UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE DEDUCTIBLE RETENTION $ AGGREGATE $' $ $ $ WORKERS AND EMPLOYERS' ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER (Mandatory If yes, describe SPECIAL PROVISIONS COMPENSATION LIABILITY Y / N WC STATU- OTH- TQRY 1 IMITR X FR E.L. EACH ACCIDENT $ EXCLUDED? E.L. DISEASE - EA EMPLOYEE $ in NH) under below E.L. DISEASE - POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS CGC1516519 CERTIFICATE HOLDER CANCELLATION Miami Shores Village Dept. 10050 NE 2nd Ave Miami Shores, FL 33138 Phone: (305)795-2207 I Fax: (305)756-8972 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25 (2009/01) <DA> © 1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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). DISCLAIMER This Certificate of Insurance does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25 (2009/01)