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CC-17-1287Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 Project Address Pei Parcel Number it Permit NO. CC-5-17-1 287 Permit Type: Commercial Construction Work Classification: Alteration Permit Status: APPROVED Issue Hate. 611412017 1530 NE 105 Street Miami Shores, FL 33138- PARC2003-22 Block: Lot: Expiration: 12/11/2017 Applicant HARBOUR CLUB VILLAS Owner Information Address Phone Cell HARBOUR CLUB VILLAS Contractor(s) Phone DECORATIVE MASONRY INC (305)757-7765 Cell Phone Valuation: Total Sq Feet: $ 1,600.00 450 Approved: In Review Comments: Date Approved:: In Review Date Denied: Type of Construction: REMOVE STEPPING STONE PATIO Stories: Front Setback: Left Setback: Plans Submitted: Yes Certification Date: Bond Return : !Scanning: 3 Occupancy Load: Exterior: Rear Setback: Right Setback: Certification Status: Additional Info: Classification: Commercial Fees Due CCF DBPR Fee DCA Fee Education Surcharge Notary Fee Permit Fee Scanning Fee Technology Fee Total: Amount $1.20 $2.25 $2.25 $0.40 $5.00 $150.00 $9.00 $1.60 $171.70 Pay Date Pay Type Invoice # CC-5-17-63978 05/10/2017 Cash 06/14/2017 Credit Card Amt Paid Amt Due $ 50.00 $ 121.70 $ 121.70 $ 0.00 Available Inspections: Inspection Type: Window Door Attachment Tie Beam Slab Termite Letter Framing Store Front Attachment Insulation Drywall Screw Window and Door Buck Ceiling Grid Fill Cells Columns Final PE Certification Review Electrical Review Planning Review Building Review Plumbing Review Structural Review Mechanical 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: -rtify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction . • - •Wing. ,/-•:.aiur• : �j1ii <a�:: above -named contractor to do the work stated. thorized Sign wner / Applicant / Contractor / Agent June 14, 2017 Date Building Department Copy June 14, 2017 1 Miami Shores Village l.•� Building Department artment 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 L3Y Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 FBC 20 l'q BUILDING Master Permit No. 0`(� -1 2 gl� PERMIT APPLICATION Sub Permit No. (UILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION El RENEWAL RECTI7T- ig 10 2017 ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP ? .y� CONTRACTOR DRAWINGS /JJ JOB ADDRESS: OA/�`(/ .57�7.1e 4 2 City: Miami Shores County: Miami Dade Zip: -K3/3 Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: Ljeer vie p OWNER: Name (Fee Simple Titleholder): /7%f%,i�i ��-U:/ /� Phone#ifee.7 LP1Z Address: /J :-.V-r i..c-71 ,, City: _i�%TA�_6�� ��� State: �� Zip: ,3% Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: ?c L 9// 7,e.`%f50/0" ,., e: ( Phorie#: `." a_::. - E Address: /y,_rS r ©�' ,...s- 'ae ~ City:/ Jj,J�%/J�4%_State:Zip: , 4r Qualifier Name: 4��/4Q / e-ShA/ Phone#: 7Sk:229 2Z5 7 State Certification or Registration #:/ft Certificate of Competency #: C681af4,S-58" DESIGNER: Architect/Engineer: Phone#: Address: � City: State: Zip: Value of Work for this Permit: $/�`'/g Square/Linear Footage of Work: 9�0 Type of Work: ❑ Addition ❑ Alteration ❑ New Repair/Replace ❑ Demolition Description of Work: A".97: A.s4,% Ci/1�Le Specify color of color thru tile: Submittal Fee $ (50 Permit Fee $ t S 0 CA CCF $ CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Notary $ ' Technology Fee $ Training/Education Fee $ Double Fee $ Structural Reviews $ Bond $ TOTAL FEE NOW DUE$ 2-I 9'% (Revised02/24/2014) 41. 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. a "WARNIN'G' 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.;' f Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2. 00,°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 posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature Sigma OWNER or AGENT The foregoing instrument was acknowledged before me•this lO day of M^p•-{ , 20 0 a (( RI�I , who is personally known to me or who has produced LAla ,LItaNS--- as identification and who did take an oath. NOTARY PUBLIC: by 4 Sign: Print: SI Nc) lam L��)JJJ Seal: APPROVED BY oS�Y IN.. Notary Public State of Florida Sindia Alvarez oK My Commission FF 156750 t. ',$04°F Expires 0910312018 Jn • CONTRACTOR • ti t s The foregoing instrument was acknowledged before me this tG day of a. « by �A1J1�� f eiNCdS ▪ vho is personally known to me or who has produced L .I' - �..1 QX.N - as identification and who did take an oath. NOTARY PUBL: Sign: Print: Plans Examiner Structural Review Y °ite Notary Public State of Florida � Sindia Alvarez. a My Commission FF 156750 ''n,•!AP cxpiresD9;03/2018 s Zoning Clerk (Revised02/24/2014) DECOR-1 OP ID: LC ACORD `„_--- CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 06/14/2017 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(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: PHONE FAX (A/C, No, Ext): 305-446-2271 (A/C, No): 305-448-3127 E-MAIL ADDRESS: certificates@kahn-carlin.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : Travelers Prop & Cas Co of Am 36161 INSURED Decorative Masonry Inc 1438 NE 105 Street Miami Shores, FL 33138 INSURER B : INSURER C: 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 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 LTRINSD TYPE OF INSURANCE ADDL SUBR WVD POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MM/DD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY I6606C47808A 12/22/2016 12/22/2017 EACH OCCURRENCE $ 1,000,000 PRRENTED PREEMIMI ESESS (RENTED occurrence) $ 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 PRO- JECT PER: LOC PRODUCTS - COMP/OP AGG $ 2,000,000 $ AUTOMOBILE _ LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS NON -OWNED AUTOS COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ $ DED RETENTION $ 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 N / A PER STATUTE OTH- ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Re: Unit Masonry, brick, stone, tile, mosaics and marble. ANCELLATION CITY-70 Miami Shore Village Building Department 10050 N.E. 2nd Avenue Miami Shores, FL 33138 1 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 -j 77 ACORD 25 (2014/01) © 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Local Business Tax Receipt Miami -Dade County, State of Florida -THIS IS NOT A BILL - DO NOT PAY 646894 BUSINESS NAME/LOCATION DECORATIVE MASONRY INC 1438 NE 105 ST MIAMI SHORES, FL 33138 OWNER DECORATIVE MASONRY INC Worker(s) M`AM 10 RECEIPT NO. RENEWAL 646894 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 SPECIALTY BUILDING CONTRACTOR 000013558 PAYMENT RECEIVED BY TAX COLLECTOR 49.50 10/18/2016 0225-17-000136 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's qualifications, to do business. Holder must comply with any governmental or nongovernmental regulatory laws and requirements which apply to the business. The RECEIPT NO. above must be displayed on all commercial vehicles - Miami -Dade Code Sec 8a-276. For more information, visit www.miamidade.riovftaxcollector CTCB Construction Trades ualifying Board BUSINESS CERTIFICATE OF COMPETENCY 000013558 DECORATIVE MASONRY INC D.B.A.: AULTCSN DANIEL F Is certified under the provisions of Chapter 10 of Miami -Dade ty Municipal Contractor's Tax Receipt Miami -Dade County, State of Florida -THIS IS NOT A BILL - DO NOT PAY CC NO: 000013558 BUSINESS NAM E/LOCATION DECORATIVE MASONRY INC 1438 NE 105 ST MIAMI SHORES, FL 33138 OWNER DECORATIVE MASONRY INC MIMI®UADE RECEIPT NO. 7495731 MC EX PIRES SEPTEMBER 30, 2017 Pursuant to County Code Sec 10-24 TYPE OF BUSINESS 3LGALTY BUILDING CONTRACTOR Restricted to City of Biscayne Park For more i nforrrBti on, visit www.rniamidade.goy/taxcol lector PAYM ENT RECEIVED BY TAX COLLECTOR 25.00 10/18/2016 0225-17-000136 .ACORO® CCP CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 5/9/2017 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(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 TriGen Insurance Solutions, Inc. 315 315 SE Mizner Blvd Suite 213 Boca Raton FL 33432 CONTACT NAME: (A/C.NNo. Ext): (877) 987-4436 FAX (954) 252-4426 E-MAIL ADDRESS: certs@trigensolutions.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Guarantee Insurance Company 11398 INSURED (904) 731-9014 Convergence Employee Leasing, Inc. Convergence Employee Leasing II, inc. Convergence Employee Leasing III, Inc. 3951 Baymeadows Road Jacksonville FL 32217 INSURERS: INSURERC: INSURERD: INSURERE: INSURER F : COVERAGES CERTIFICATE NUMBER: Cert ID 19361 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 LTA TYPE OF INSURANCE ADDL 1Nsn SUBR WVD POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MM/DD/YYYV) LIMITS COMMERCIAL GENERAL LIABIUTY EACH OCCURRENCE $ DAMAGE RENTED PREMISESO(Ea occurrence) $ CLAIMS -MADE OCCUR MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PRO- JECT PER: LOC PRODUCTS - COMP/OP AGG $ $ AUTOMOBILE LIABILITY SCHEDULED COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ $ DED RETENTION $ A WORKERS COMPENSATIONPER AND EMPLOYERS'LIABILITV ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y/N N / A WCP500075002GIC 9/30/2016 9/30/2017 X STATUTE OTH- 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 / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if mo a space is required) Coverage provided for all leased employees but not subcontractors of: Decorative Masonry, Inc. Location coverage effective: 9/30/2016. I@msvfl.gov CERTIFICATE HOLDER CANCELLATION Miami Shores Village Bldg Dept 10050 NE 2nd 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 Page 1 of 1 harbour club .vilIas 1530 N.E. 1051h StreeI, MINN Shores, Florida 33138 • Phone 893-8178 April 18th 2017 To Friedhelm Schock The board of directors of Harbour Club Villas has approved your request based on your drawings to install pavers in sand at your unit 1540 NE 105 st. in the limited common area. If you have any questions, please leave a voicemail at 305-893-8178 and your call will be returned as soon as possible. Sincerely yours, Bruce C Rich, Vice President For the Association.