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DEMO-17-1893City of North Miami Beach Community Development Division Business Tax Receipt 17050 NE 19 Avenue North Miami Beach, FL 33162 MAIL TO: NEWMAN BROTHERS CONST. & DEV. 2079 NE 155 STREET NORTH MIAMI BEACH,FL 33162 Thank you for choosing the City of North Miami Beach! You can now visit us on-line at www.citynmb.com or you can e-mail us at NMBBTR@cilynmb.com The Cm d North \lizni Heidi --t ___ N1\thb Now More Beautiful! THIS IS YOUR 2018-2019 BUSINESS TAX RECEIPT. important Reminders: Business Tax Receipts expire September 30th of each year You must submit all fees and documents (if applicable) prior to that date or you may be subject to delinquency fees, an additional Cost Collection Fee of $250.00, placement of a Tien on the property, andlor Involuntary shutdown of this business by the Police Department. You are required to notify the City, in writing. if there have been any changes in ownership, location, nature of business, any contact information. andlor when this business ceases operations This is in order to ensure that you are not billed in error. Failure to notify this office of such changes may result in the assessment of penalty fees and collection activities. Have any more questions? Our friendly staff is here to assist you by phone (305) 948-2917, Monday -Friday from 8 30 a.m - 5.00 p m., or at our office Monday -Friday from 9 00 a.m - 4.00 p m. We would love to hear from you! *** THIS IS NOT A BILL — DO NOT PAY *** Please detach the below receipt and display in a conspicuous place. 2018-2019 City Of North Miami Beach BUSINESS TAX RECEIPT No• 181572 - RENEWAL Acct No: 794849 DBA: NEWMAN BROTHERS CONST. & DEV. Location: 2079 NE 155 STREET NORTH MIAMI BEACH, FLORIDA Activity: OFFICE ONLY: CONTRACTOR Remarks: Valid 10/01/2018 09/30/2019 Taxes: 142.05 Penalty Fee: 0.00 Credit: 0.00 TOTAL PAID: $ 142.05 This receipt is non -transferable without City approval and is only valid at the location(s) listed herein NowMoreBewtifui! 26th day of September 2018 Miami Shores Village Building Department To whom it may concern, This letter is to request an extension to our permits, detailed below, because the work has not been completed and contactors need more time. Master Permit Number DEMO-7-17-1893 Electrical Permit Number DEMO-8-17-2061 Mechanical Permit Number DEMO-8-17-2063 Plumbing Permit Number DEMO-8-17-2062, DEMO-4-18-843 Thank you in advance for your help. Greg Bauman y cfc `off BUILDING PERMIT APPLICATION ❑BUILDING ❑ ELECTRIC ❑PLUMBING ❑ MECHANICAL 0414titta - 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 7�1a - (3,2Z' -I'.Zi , RED., ' V t r ' C! OCT 0 2 1018 Q e FBC 20 Master Permit No t 4O . 1• rim Sub Permit No. ❑ ROOFING ❑ REVISION ❑ EXTENSION j 4RENEWAL ❑ PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: VIM Q1 Si .2 C f G Ce City: Miami Shores Folio/Parcel#:lt• 3205.001 .0550 Occupancy Type: County: Miami Dade Zip: 33Gg Is the Building Historically Designated: Yes NO V/ Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fees Simple Titleholder):G'f Q. G ,,,QC Phone#:305 4b1 8b55 Address: 1200 `%•%Oki4Ctle Of we, Afoi10O5 City: MI ; State: FL Zip: 33132 Tenant/Lessee Name: Phone#:305 II (01 2(055 Email: Ve NMelC1Cyr')CL \. COMr` % CONTRACTOR: Company Name: NQ J flOL ( Cb Cob'U MX Phone#: 5 (b ZSVJ Address: a01°1 kJF. 15S •• City:Wert�'\U n ro.•. State: f I 7c G Q1/40rn0.c1 State Certification or Registration #: C. GC t5f1330 Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: $ Qualifier Name: Zip: 331b2 Phone#7186 4CICI 11 bl Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New /❑ Repair/Replace Description of Work: Per �� . Renew clot `C x k-en st 0 Demolition Specify color of color thru tile: Submittal Fee $ Permit Fee $ CCF $ CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Notary $ Technology Fee $ Training/Education Fee $ Double Fee $ Structural Reviews $ Bond $ TOTAL FEE NOW DUE $ `i] 5 CO (Revised02/24/2014) Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) *-17 ` R �G(\f--. Mortgage lW: Lender's Address a005 C�•SCCAAAV IL VJVI o City Y,\G\ State Zip Z3130 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 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 OWNER or AGENT The foregoing instrument was acknowledged before me this aC) day of Sec' , 20a , by O'f G ,...Lf 1Gc1 , who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBUC: Sign: `p f7`I i1 Print: A\Viksoei M04Lx‘Oku0 Seal: APPROVED BY rtM-u&0110 coMwss #4 WNW.. cas Ctl� Signature The foregoing instrument was acknowledged before me this Q.0 d`ayy of be l2 , 20 \$ , by NQ.0 "ckn , who is personally known to me or who has produced as identification and who did take an •th. NOTARY PUBLIC: Sign: ` A Print: 1`�`t\ Yiei N`u.0 cL O Seal: 44****** *4********* t Plans Examiner Structural Review Miles *Chid° __- COMMISSION IFF022041 44�21.9f11! Wm/M.c Zoning Clerk (Revised02/24/2014) Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Notice to Owner — Workers' Compensation Insurance Exemption Florida Law requires Workers' Compensation insurance coverage under Chapter 440 of the Florida Statutes. Fla. Stat. § 440.05 allows corporate officers in the construction industry to exempt themselves from this requirement for any construction project prior to obtaining a building permit. Pursuant to the Florida Division of Workers' Compensation Employer Facts Brochure: An employer in the construction industry who employs one or more part-time or full-time employees, including the owner, must obtain workers' compensation coverage. Corporate officers or members of a limited liability company (LLC) in the construction industry may elect to he exempt if: 1. The officer owns at least 10 percent of the stock of the corporation, or in the case of an LLC, a statement attesting to the minimum 10 percent ownership: 2. The officer is listed as an officer of the corporation in the records of the Florida Department of State, Division of Corporations: and 3. The corporation is registered and listed as active with the Florida Department of State, Division of Corporations. No more than three corporate officers per corporation or limited liability company members are allowed to be exempt. Construction exemptions are valid for a period of two years or until a voluntary revocation is filed or the exemption is revoked by the Division. Your contractor is requesting a permit under this workers' compensation exemption and has acknowledge that he or she will not use day labor, part-time employees or subcontractors for your project. The contractor has provided an affidavit stating that he or she Nvill be the only person allowed to work on your project. In these circumstances, Miami Shores Village does not require verification of workers' compensation insurance coverage from the contractor's company for day labor, part-time employees or subcontractors. BY SIGNING BELOW YOU ACKNOWLEDGE TI-IAT YOU 1-IAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. Signature: ,•/ Owner State of Florida County of Miami -Dade ec�� The foregoing was acknowledge before me this d0 day of bei, , 20 . By ` .re-Ct, �CAAA-V "'%U A who is personally known to me or has produced `1 as identification. Notary: SEAL: • 1, tcu ctthc Milts* Mda00 COMMISSION 0012$1141 EXPIRES: Ss$s V.!OM NNW.AMIOImOTAIIY.COM City of North Miami Beach Community Development Division Business Tax Receipt 17050 NE 19 Avenue North Miami Beach, FL 33162 MAIL TO: NEWMAN BROTHERS CONST. & DEV. 2079 NE 155 STREET NORTH MIAMI BEACH,FL 33162 Thank you for choosing the City of North Miami Beach! You can now visit us on-line at www.citynmb.com or you can e-mail us at NMBBTR ajcitynmb.com •t' „tt\t t%t ti,Ek h NIVI 1 )):0.'' Now MoreBeautiful! THIS IS YOUR 2017-2018 BUSINESS TAX RECEIPT. important Reminders: Business Tax Receipts expire September 30th of each year. You must submit all fees and documents (if applicable) prior to that date or you may be subject to delinquency fees, an additional Cost Collection Fee of $250.00, placement of a lien on the property, and/or involuntary shutdown of this business by the Police Department. You are required to notify the City. in writing, if there have been any changes In ownership, location, nature of business, any contact information. and/or when this business ceases operations. This is in order to ensure that you are not billed in error. Failure to notify this office of such changes may result in the assessment of penalty fees and collection activities. Have any more questions? Our friendly staff is here to assist you by phone, (305) 948-2917, Monday -Friday from 8:30 a.m.• 5-00 p.m., or at our office Monday -Friday from 9:00 a.m.- 4:00 p.m. We would love to hear from you/ *** THIS IS NOT A BILL — DO NOT PAY *** Please detach the below receipt and display in a conspicuous place. 2017-2018 City Of North Miami Beach BUSINESS TAX RECEIPT No.: 176405 - RENEWAL Acct No: 7 94 84 9 DBA: NEWMAN BROTHERS CONST. & DEV. Location:2079 NE 155 STREET NORTH MIAMI BEACH, FLORIDA Activity: OFFICE ONLY: CONTRACTOR Remarks: valid 10/01/2017 - 09/30/2018 Taxes: Penalty Fee: Credit: TOTAL PAID: $ 142.05 0.00 0.00 142.05 This receipt is non -transferable without City approval and is only valid at the location(s) listed herein NI\'iB; Now Mo+ Bc autiful! El CI CI RICK SCOTT, GOVERNOR JONATHAN ZACHEM, SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESSAND-PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY L LENSING BOARD f EREIN EIE UNDER THE THE GENERAL CONTRA -MU -It EREIN,IS`CER IF.IED PROVISI IM CC APTER 489;=F DRTTATUTES N,EV1.MAN JOEY4ARRE.T9 NEWMANIBROTHERS GONST UCTION &'D OP,MENT INC r1111'� F b7 9'NE'1t55TH51=,�►, NORT_ MIAMI BEACH'S 1 LICENSE NUMBER: CGC1517.330 EXPIRATIONVATEt AUGUST 31, 2020 Always verify licenses online at MyFloridaLicense.com Do not alter this document in any form. I This is your license. It is unlawful for anyone other than the licensee to use this document. Florida ' ��....4 NEWMBRO-01 /ACORO C CERTIFICATE OF LIABILITY INSURANCE ABEL M/ DATE (MDDIYYYYI 09/18/2018 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(lei) must have ADDITIONAL INSURED provisions or 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 sucCChppeeNTTnppdorsement(s). PRODUCER CKP Insurance LLC 21845 Powerline Road Suite 205 Boca Raton, FL 33433 WW1. (NCC,, No, Ext): (581) 807-0900 I ic, N0):(561) 826-3782 itffiss, Public@ckpinsurance.com INSURERS) AFFORDING COVERAGE NAIC # INSURER A : Colony Insurance Company 39993 INSURED Newman Brothers Construction & Development, Inc. 2079 NE 155th St North Miami Beach, FL 33162 INSURER 13 : Progressive Express Insurance Company 10193 INSURER c :American Builders Insurance Company 11240 INSURER 0: INSURER E : INSURER F : ISION 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 POLIC ES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL INCf_NND SUBR POUCY NUMBER POLICY EFF IMMIDD/YYYY) POUCY EXP IY (MMIDDYYYI LIMITS A X COMMERCIAL GENERAL LIABILITY X X 103GL0020102-01 09/15/2018 09/15/2019 EACH OCCURRENCE S 2,000,000 DAMAGE TO RENTED DAMAG ET (Fe Occurrence) S 100,000 CLAIMS -MADE X OCCUR MED EXP (Any one person) $ 5,000 PERSONAL & AINJURY 5 2,000,000AM GENERAL AGGREGATE $ 2,000,000 GENL X AGGREGATE LIMIT APPLI S PER: POLICYL LOC OTHER: PRODUCTS - COMP/OP AGG $ 2,000,000 S B AUTOMOBILE — _ LIABILITY ANY AUTO AUTOS ONLY AU7a ONLY X _. AUTOS AUTOS ONLY 03911461-0 09/15/2016 09/15/2017 (C0MBINEa d OSINGLEUMIT ntl S 1,000,000 BODILY $ BODILY INJURYpA(Per accident) $ (PeOr and nU MAGE $ $ A X UMBRELLALUAB EXCESS LIAR X OCCUR CLAIMS -MADE X5172605 09/15/2018 09/15/2019 EACH OCCURRENCE $ 1,000,000 AGGREGATE $ Per & Adver $ 1,000,000 DED X RETENTION$ 10,000 C WORKERS COMPENSATION AND EMPLOYERS'UABIUTY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN QpFtCE_ io/ EM BER EXCLUDED? I I ( nd ory in NH) t( yes, desaibe under DESCRIPTION OF OPERATIONS below NIA X WCV-0202866-03 09/15/2018 09/15/2019 X STATUTE OTH- ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE • EA EMPLOYEE 1,000,000 S ' E.L. DISEASE • POLICY UMIT 1, 000,000 $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule may be attached I more space Is required General Liability - Blanket Additional Insured On Going Operation On A Primary And Non -Contributory Basis and Waiver of Subrogation As Required By Written Contract Per Form (BIG GLECEF 0413) General Liability - Blanket Additional Insured Completed Operation As Required By Written Contract Per Form (CG 20 37) Workers Compensation - Blanket Waiver of Subrogation As Required by Written Contract Per Form (WC 00 03 13) GC License: CGC1517330 CERTIFICATE HOLDER Miami Shores Village - Building Department 10050 NE 2nd Avenue Miami Shores, FL 33138 ACORD 25 (2016/03) CANCELLATION 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 CoLde_ A4e-Lthi 01986-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 26th day of September 2018 Miami Shores Village Building Department To whom it may concern, This letter is to request an extension to our permits, detailed below, because the work has not been completed and contactors need more time. Master Permit Number DEMO-7-17-1893 Electrical Permit Number DEMO-8-17-2061 Mechanical Permit Number DEMO-8-17-2063 Plumbing Permit Number DEMO-8-17-2062, DEMO-4-18-843 Thank you in advance for your help. Best r rds, Greg Bauman