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DEMO-18-844Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 Project Address Permit Permit NO. DEMO-4-f 8-844 Permit Type: Demolition Work,Ciassitication: Mechanical Permit Status: APPROVED Issue Date: 4/5/2018 Expiration: 10/02/2018 Parcel Number Applicant 1250 NE 91 Terrace Miami Shores, FL 1132050010550 Block: Lot: GREG BAUMANN Owner Information GREG BAUMANN Address 1250 NE 91 MIAMI SHORES FL 33138- Contractor(s) GABY AC CORP Phone Cell Phone (786)290-1982 Phone (305)467-8655 Cell Valuation: Total Sq Feet: $ 500.00 0 Type of Demo: Mechanical Additional Info: DEMO ALL DUCK WORK IN PROJECT AREA Classification: Residential Scanning: 1 Fees Due CCF DBPR Fee DCA Fee Education Surcharge Permit Fee Scanning Fee Technology Fee Total: Amount $0.00 $0.00 $0.00 $0.00 $50.00 $3.00 $0.00 $53.00 Pay Date Pay Type Amt Paid Amt Due Invoice # DEMO-4-18-67003 04/05/2018 Check #: 5528 $ 53.00 $ 0.00 Available Inspections: Inspection Type: Final L 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, CHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: I certify at construction and zoning. Futher e II fore•.ing information is accurate and that all work will be done in compliance with all applicable laws regulating horize the above -named contractor to do the work stated. April 05, 2018 Authorized Signature: Owner / Applicant / Contractor / Agent Date Building Department Copy April 05, 2018 1 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 20la" Master Permit No. D M(Dt&r-q W Sub Permit No. 0 t -eq BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑ PLUMBING NMECHANICAL ❑ PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP qr CONTRACTOR DRAWINGS JOB ADDRESS: I Z& 4E. `1 nn I fMce City: Folio/Parcel#: 11' 3'Q0 5 - o 0 I ` 0550 Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: 331 3$ Miami Shores County: OWNER: Name (Fee Simple Titleholder): City: (h11AA Tenant/Lessee Name: 1l ��p r� " Email: NAMA � 1. • 6 luimn Rxwft4, Address: !KO N 110A kei t . A'4 14O5 State: f1 Miami Dade Zip: Phone#: 305. ts654 Zip: !� LL�1� o Q �p Phone#: T.()� 40 T. e CONTRACTOR: Company Name: 6,,oi q%by), / lyl� Phone#: 'b _ 1?Y1 Address: // 13 9-5 t 5 J.}- City: 1 f .i/ State: �r/ `I Zip: 3 ,?O / 2- Qualifier Name: f /1 /A1/ 9 Phone#: ' b ` Zcta an State Certification or Registration #: PC a 1 7 Yi, Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: $ Type of Work: ❑ Additio ❑ Alteration / ❑ New Description of Work: f��m 1 r- �Ni0 -3 Square/Linear Footage of Work: QRepair/Replace ,n Demolition Specify, color of color thru tile: Submittal Fee $ Permit Fee $ i - Cri CCF $ CO/CC $ Scanning Fee $ 3 • Radon Fee $ DBPR $ Notary $ Technology Fee $ Training/Education Fee $ Double Fee $ • i Structural Reviews $ Bond $ TOTALFEE NOW DUE $ . G• (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 CM City Nctit 1 9?c4,1► Hai actyke bb\id State Zip 3313 & 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 g4,gJ i;d and a reinspection fee will be charged. Signature OWNER or AGENT The foregoing instrument was acknowledged before me this 2^14 day of ApR^ , 20 k 45 , by bilE An Li /r) R fj , who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: Seal: , ,•� '�S_ Commisslon # GG 137579 ;* Expires: August 24, 2021 Bonded thru Aaron Notary Signature CONTRACTOR The foregoing instrument was acknowledged before me this a9 ay of f\i\afch ,20 \ 6 by tU C0. 1" i en(3.l o `C , who is p own to me or who has produced identification and who did take an oath. NOTARY PUBLIC: Sign: Print: Seal: as ES BETANCOURT ##################################### ## **** ####y,##,R####################################################* APPROVED BY Fa Examiner Zoning (Revised02/24/2014) Structural Review Clerk Utk I It-ILJ I t Ut LIIkbILI I T 03/12/18 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 South Pacific Professional Ins. 500 K W. 49th Street Hialeah, FL 33012 Phone (305)825-3535 Fax (305)825-5694 ;INSURED GABY A/C CORP 8853NW151ST HIALEAH. FL 33018 GABYACINSTALLATION@B 186-290-1788 COVERAGES CERTIFICATE NUMBER: CONTACT NAME: PHONE 191C No, Ext): IE-MAIL gODftESS: (305)825-3535 IN7C. No): (305)825-5694 sppinsurance@hotmail.com INSURER(S) AFFORDING COVERAGE NAIC'o _INSURER A : GRANADA INSURANCE COMPANY INSURER B : INSURER C : INSURER D: INSURER E : NORMANDY INSURANCE COMPANY INSURER F: 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 { TYPE OF INSURANCE AOOLSUBRi POPOLICY NUMBER LMIM ODI EFF (POLICY EXP LIMITS LTR ; INS WVD} MMIDDIYW MM/DDTYYYY) GENERAL LIABILITY I COMMERCIAL GENERAL LIABILITY A 0 0 CLAIMS -MADE Q OCCUR GEM. AGGREGATE LIMIT APPLIES PER: ❑ POLICY 0 4EP 0. ❑ LOC AUTOMOBILE LIABILITY ❑ ANY AUTO ❑ ALL OWNED AUTOS 0 HIRED AUTOS ❑SCHEDULED AUTOS NON -OWNED ❑ AUTOS ❑ ❑ ❑ UMBRELLA LIAR ❑ OCcuR ❑ EXCESS LIAB ❑ CLAIMS -MADE ❑ DED ❑ RETENTION S WORKERS COMPENSATION AND EMPLOYERS' LIABIUTY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) i I If yes. describe under DESCRIPTION OF OPERATIONS below NIA 0185FL00000033842 NHFL0050702016 02/15/2018 02/152019 03/23/2018 03/23/2019 EACH OCCURRENCE 15 1,000,000.00 DAMAGE TO RENTED I T OO,000.00 PREMISES (Ea occurrence! ' S MED EXP (Any one person) L s 5,000.00 PERSONAL 8 ADV INJURY I S 1,000,000.00 GENERAL AGGREGATE S 2,000,000.00 PRODUCTS - COMP/OPAGG 5 2,000,000.00 COMBINED SINGLE LIMB i _(Esa accidenq•_5 BODILY INJURY (Per person) S I BODILY INJURY (Per accident), S PROPERTY DAMAGE (Per accident) S EACH OCCURRENCE i S AGGREGATE i S WC STATMU• G TH- i ------�---- ❑ TORy LITTs E.L. EACH ACCIDENT , 5 100,000.00 E.L. DISEASE- EA EMPLOYE; 5 100,000.00 E L. DISEASE - POLICY Ux1IT s 500.000.00 4 b L 1 DESCRIPTION OF OPERATIONS 1 LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) CAC1817046 CERTIFICATE HOLDER CANCELLATION G — MIAMI SHORES VILLAGE BUILDING DEPT 10050 NE 2D AVE, MAIMI 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 (2010/05) QF © 19882010 ACORD The ACORD name an ORATION. All rights reserve o are registered marks of ACOF