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CC-18-52Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 Project Address Pe mit Permit NO. CC-1-18-52 Permit Type: Commercial Construction Work Classification: Alteration Permit Statas: APPROVED Issue:Date: 1/23/2018 Expiration: 07/22/2018 Parcel Number Applicant 1521 NE 105 Street Number: 1-1 Miami Shores, FL 1122300530490 Block: Lot: 1015 NE 105 ST CORP Owner Information Address Phone Cell 1015 NE 105 ST CORP 1390 BRICKELL Avenue MIAMI FL 33131- (305)771-2423 Contractor(s) CH2 DESIGN GROUP CORP Phone (305) 771-2423 Cell Phone Valuation: Total Sq Feet: $ 30,000.00 0 Approved: In Review Comments: Date Approved:: In Review Date Denied: Type of Construction: Stories: Front Setback: Left Setback: Plans Submitted: Certification Date: Bond Return : Scanning: 3 Occupancy Load: Exterior: Rear Setback: Right Setback: Certification Status: Additional Info: Classification: Commercial Fees Due CCF CO/CC Fee DBPR Fee DBPR Fee DCA Fee DCA Fee Education Surcharge Permit Fee Scanning Fee Technology Fee Amount $18.00 $50.00 $0.00 $13.50 $0.00 $9.00 $6.00 $900.00 $9.00 $24.00 Total: $1,029.50 Pay Date Pay Type Invoice # RC-1-18-66073 01/23/2018 Check #: 1677 01/08/2018 Check #: 1657 Amt Paid Amt Due $ 829.50 $ 200.00 $ 200.00 $ 0.00 Available Inspections: Inspection Type: Final PE Certification Window Door Attachment Framing Insulation Drywall Screw Fill Cells Columns Window and Door Buck Review Planning Review Electrical Review Electrical 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 ssume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRI A , PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS AFFIrAVaT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction any zo/i :. Fu -rmore, I ayZhgrize the above -named contractor to do the work stated. It Authonz*d Signet „,g• Applicant / Contractor / Agent Building Qe . artment Copy January 23, 2018 Date January 23, 2018 1 Ii.t46Q,, BUILDING PERMIT APPLICATION [,UILDING ❑ PLUMBING 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 Master PermitNo. v 5 2 Sub Permit No. ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑EXTENSION ❑RENEWAL ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: t- c 0 E. /05 (%n City:1it: kyr,(4<Miami"Shores, County: -Zip: -'53 13 g=: Folio/Parcel#: , 30-, - W9 ( •. Is the Building Historically Designated: Yes ' NO Occupancy Type: ? 1.Load:, r • Construction.Type: Miami Dade, Flood Zone:”. BFE: FFE:I OWNER: Name (Fee Simple Titleholder): % 0/5 /�1 E / o5.r - O r f - re Phone#: a`� Address: / 3 90 6- / (:. tatei2 °* /c7Zf City: State: Zip: 3 1 T3 7 Tenant/Lessee Name: Phone#:. Email: he r ��3C° `� • (t�'1/1 CONTRACTOR: Company Name: (�a � C SO C7 r Address: ) BOO - ( (o © s n City: Jai State: - Zip: - 1 -�! Qualifier Name: eX C//��' l� «-c} cr-�C~~-��a��- Phone#: c? �! S--• S - 55 �J(o. State Certification or Registration #: _G 1 C- 1-- '' p`-� ' 4 A. Certificate of Competency #: DESIGNER: Architect/Engineer: -Q_' C- -E k.)c -7-i 2— Phone#: O St •-T 9 5 - S- 3c, Phone#: ) �,-e(19 3 - Address ` "%i 4'-(p. O City`a `'U lutJ-k. L state: Value`of Work for this Permit: $ 20,("" Square%Linear'Footage of Work: x • Type of Work: ' ❑ Addition ❑ Alteration ❑ New = ❑Repair%R@pface Demolition • )• - . Zip: r') c� 1 ��j . Des4rlption o ;` O(-�/ �e1� 7,, . < L" ASS ''6: ot374: Specify color of color thru tile: /�'1 E t T7 1 (4 1.t) 0 0 4 Submittal Fee $ • Permit Fee $ 900 CCF $ .9 • 00 - Co/Cc $ , - Scanning Fee $ . (T Radon Fee $ 4=1, DBPR $ (• 150 Notary $ X� Technology Fee $ 2 :` T Training/Education Fee $ % • Co - Double Fee $ 0 Structural Reviews $ Bond $ TOTAL FEE NOW DUE$ B2._Gt• vv (Revised02/24/2014) A re Bonding Company's Name (if applicable) • * (' ..� tr, Bonding Company's Address , L i•City - rHi State 4 , _ ,• Zip Mortgage Lender's Name (if applicable) `,uu :5t'°� '•.r'.r ^`d Mortgage Lende&r's A`ddre s . •( City i!i o,_ ,State Zip ;:a r;,eje t P"` g`�� «� -, 3 Ir �t(� r �.i.�.l� r. , ii€ri-E'''vi. 9F 01 t 1i.+s•i`-1 P., '7 1fV:t' l 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 toithe issuance of a: permit and•that':all=•workwill be perfor'medtomeet the standards of'all lawsiregulating 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....... 4r,v c.t r ,- , r t %r c ' riI , Virg t 1 _,' ) t -. � . i/� 1ii.. i • ' b � : t vh._ 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. • ' ..,per;b "WARNING _TO_ OWNER: -YOUR FAILURE TO RECORD'-A'+NOTICE. OF COMMENCEMENT MAY - RESULT IN YOUR.PAYING TWICEEFOR IMPROVEMENTS -TO YOUR PROPERTY. IF -YOU "INTEND- TO OBTAIMFINANCINGi 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 volue exceeding $2500, the applicantrrritistt 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 attach ent-Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occur seven (7) days after the building permit is issued. In_ the absence„ of such posted notice, the inspection will not be approved and reinspectiorrf `ee will be charged. Signature -OWNER or AGENT "Signature "vn •ia:'lil �� t it Vi zM W iCO TRACTOR The foregoing instrument was acknowledged before me this 'The foregoing instrument was acknowledged before me this 0 - day , 20 I e), • , by - —0-g, day -Of .-1--est ,20-1 ,by ry ' 14-` 0 —144 -5, who is personally known to ri Q.) C00-41ciaGis personally known to me or who has produced tun as me or who has produced �0` 0DA J. U, ''may ( ,. ►a. yr ,, . ._ .�. ' =: s % -- identification -and who'did take an oat - ._"' �4 1,, identification and who did take an oat GOMMl� O''• ;kmbe i0' : NOTARY PU C: ; a _ �t*m, Z •, • ad fin_ ,. ,t = lit 1._.i rt • m..,40 7rEll f .�: s ".• :. Sign: W �.. 7 034 roi% .4 � : .f• NOTARY PUBLIC. Sign: -- Print: Seal: - APPROVED BYu fS 1)411411100 Print: Seal: Plans Examiner _ o .:1i Li•r''c'{''•tl] * Zoning • s -, ti •i (Revised02/24/2014) Structural Review Clerk Page 1 of 1 Property Search Application - Miami -Dade County Summary Report Property Information Folio: 11-2230-053-0490 Property Address: 1521 NE 105 ST UNIT: 1-1 Miami Shores, FL 33138-2114 Owner 1015 NE 105 ST CORP Mailing Address 1390 BRICKELL AVE # 104 MIAMI, FL 33131 USA PA Primary Zone 4900 MULTI -FAMILY - CONDOMINUM Primary Land Use 0407 RESIDENTIAL - TOTAL VALUE : CONDOMINIUM - RESIDENTIAL Beds/Baths/Half 2/2/1 Floors 0 Living Units 0 Actual Area Sq.Ft Living Area 1,507 Sq.Ft Adjusted Area 1,507 Sq.Ft Lot Size 0 Sq.Ft Year Built 1970 Assessment Information Year 2017 2016 2015 Land Value $0 $0 $0 Building Value $0 $0 $0 XF Value $0 $0 $0 Market Value $216,931 $193,688 $154,950 Assessed Value $152,771 $138,883 $126,258 Benefits Information Benefit Type 2017 2016 2015 Non -Homestead Cap Assessment Reduction $64,160 $54,805 $28,692 Note: Not all benefits are applicable to all Taxable Values (i.e. County, School Board, City, Regional). Short Legal Description HARBOUR CLUB VILLAS CONDO TOWNHOUSE 1-1 UNDIV 1/79TH INT IN COMMON ELEMENTS CLERKS FILES 69R143006 & 70R100201 Generated On : 1/8/2018 Taxable Value Information 1 2017 2016 2015 County Exemption Value $0 $0 $0 Taxable Value $152,771 $138,883 $126,258 School Board Exemption Value $0 $0 $0 Taxable Value $216,931 $193,688 $154,950 City Exemption Value J $0 $0 $0 Taxable Value $152,771 $138,883 $126,258 Regional Exemption Value $0 $0 $138,883 $0 Taxable Value $152,771' $126,258 Sales Information Previous Sale Price OR Book - Pa 9a Qualification Description 09/05/2017 $258,000 30687-4951 Qual by exam of deed 03/13/2013 $158,000 28534-2149 Qual by exam of deed 02/15/2012 $100 28001-0262 Corrective, tax or QCD; min consideration 06/21/2011 $130,000 27764-0036 Qual by exam of deed 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/ 1/8/2018 2017 FLORIDA PROFIT CORPORATION ANNUAL REPORT FILED DOCUMENT# P15000015174 Jan 09, 2017 1 Entity Name: 1015 NE 105 ST, CORP Secretary of State CC1175359473 Current Principal Place of Business: 1390 BRICKELL AVE, SUITE 104 MIAMI, FL 33131 Current Mailing Address: 1390 BRICKELL AVE, SUITE 104 MIAMI, FL 33131 US FEI Number: 47-3170281 Name and Address of Current Registered Agent: MLP FINANCIAL GROUP, INC. 4005 NW 114TH AVE SUITE 5 DORAL, FL 33178 US Certificate of Status Desired: No The above named entity submits this statement for the purpose of changing its registered office or registered agent, or both, in the State of Florida. SIGNATURE: Electronic Signature of Registered Agent Officer/Director Detail : Title PDS Name MAS, MARTIN Address 1390 BRICKELL AVE, SUITE 104 City -State -Zip: MIAMI FL 33131 Date I hereby certify that the information indicated on this report or supplemental report is true and accurate and that my electronic signature shall have the same legal effect as if made under oath; that I am an officer or director of the corporation or the receiver or trustee empowered to execute this report as required by Chapter 607, Florida Statutes; and that my name appears above, or on an attachment with all other like empowered. SIGNATURE: MARTIN MAS PDS 01/09/2017 Electronic Signature of Signing Officer/Director Detail Date :Merchant Insurance Solutions To:Cindy (13057568972) 08:58 01/23/18 ET Pg 1-1 ACORLf CERTIFICATE OF LIABILITY INSURANCE �� DATE(MM/DD/YYYY) 01/23/2018 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 Merchant Insurance Solutions 12326 Isabella Drive Bonita Springs FL 34135 CONTACT NAME: Staci Merchant (PAHc°,Nri , Ext): (239) 823-4382 I (arc, No): (866) 406-4983 E-MAIL ADDRESS: AODREss: @merchantinsurancesolutions.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: SECURITY NATIONAL INSURANCE COMPANY INSURED CH2 Design Group Corp 1800 SW 1st AVE, Suite 605 Miami FL 33129 INSURERS : AMERICAN BUILDERS INSURANCE COMPANY A 11240 INSURER C: INSURER D : INSURER E : INSURERF: CATE 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 PAD CLAIMS. INSR LTR TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF (MMlDD(YYYY) POLICY EXP {MMlDD/YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 1,000,000 CLAIMS -MADE X OCCUR DAMAGE TO RENTED $ 100,000 PREMISES (Ea occurrence) MED EXP (Any one $ $ 5,000 A x SES1347833 01122/2018 01/22/2019 person) PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PRO- PER: GENERAL AGGREGATE $ 2,000,000 X POLICY I JECT LOC PRODUCTS - COMP/OPAGG $ 2,000,000 OTHER AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ A ANY AUTO ALL OWNED SCHEDULED BODILY INJURY (Per person) $ A AUTOS A AUTOS NON BODILY INJURY (Per accident) $ H HIRED AUTOS -OWNED AUTOS PROPERTY DAMAGE (Per accident) $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS -MADE AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N X PER STATUTE H _ ER B ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED'?EL N N / A WCV 0229411 01 01;22/2018 01/22/2019 EACH ACCIDENT $ 1,000,000 (Mandatory in NH) If yes, describe under E.L. DISEASE - EA EMPLOYEE $ 1,000,000 D DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) License #CGC1522641 Miami Shores Village Building Department is listed as an additional insured with respect to all policies referenced herein. r GRTIC1rATc unl noo ION Miami Shores Village Building Department 10050 NE 2nd Ave 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 Certificate of Completion Miami Shores Village 10050 NE 2 Ave, Miami Shores Fl, 33138 Tel: 305-795-2204 Fax: 305-756-8972 Building Inspection Department This certificate issued pursuant to the requirements of the Florida Building Code 106.1.2 certifying that at the time of issuance this structure was in compliance with the various ordinances of the jurisdiction regulating building construction or use. For the following: Permit Type Owner COMMERCIAL CONSTRUCTION 1015 NE 105 ST CORP Subdivision/Project HARBOUR CLUB VILLAS Construction Type V-B Square Footage 0 Description of CHANGE FLOOR AND INSTALL NEW Work FIXTURES IN THE BATHROOMS. Location 1521 NE 105 ST UNIT: 1-1 Miami Shores FL 33138 Bldg. Permit No. CC-1-18-52 Contractor Date Issued Occupancy Load Occupancy Type Applicable Code CH2 DESIGN GROUP CORP 10/24/2018 N/A R-2 20145TH FLORIDA BUILDING Building Officials Approval Ismael Naranjo, CBO Not Transferable POST IN A CONSPICUOUS PLACE 4 Inspection History Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores FL 33138-0000 Phone: (305)795-2204 Fax: (305)756-8972 PLC-1-18-67 Piumbi Project: <NONE> Owner: Phone: (305)771-2423 Job Address: 1521 NE 105 Street 1-1 Miami Shores, FL Parcel: 1122300530490 Block: Lot: Scheduled Insp # Inspection Type 02/13/2018 INSP-295114 Final 01/01/2999 INSP-295108 Top Out 01/01/2999 INSP-295112 Re Pipe Inspection Status APPROVED NONE NONE Inspector Date Completed Rafael Hernandez 2/13/2018 Default Inspector Not Complete Default Inspector Not Complete 01/01/2999 INSP-295109 Main Drain NONE Default Inspector Not Complete 01/01/2999 INSP-295106 Underground NONE Default Inspector Not Complete 01/01/2999 INSP-295113 Heater NONE Default Inspector Not Complete 01/01/2999 INSP-295111 Water Service NONE Default Inspector Not Complete 01/01/2999 INSP-295110 Lavatory NONE Default Inspector Not Complete 01/01/2999 INSP-295115 Review Plumbing NONE Default Inspector Not Complete 01/01/2999 INSP-295107 Water Main NONE Default Inspector Not Complete 01/25/2018 INSP-295964 Rough APPROVED Rafael Hernandez 1/25/2018 1/25/2018 SHOWER LINE INSPECTION BY :MIGUEL CABRERA Friday, June 29, 2018 Page 1 of 2