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RF-19-2861Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Issue Date:12/20/2019 Location Address Parcel Number 174 NW 110TH ST, Miami Shores, FL 33168 1121360030150 Contacts Permit NO.: RF-12-19-2861 Permit Type: Roof Work Classification: Tile/Flat Permit Status: Approved Expiration: 06/ 17/2020 ELIZABETH GABOTON Owner 174 NW 110 ST, MIAMI SHORES, FL 331684321 BESSARD ROOFING LLC Contractor BESSARD JASMIN Business: 7864191876 Description: RE ROOF TILE AND FLAT ROOF Valuation: $ 18,000.00 Inspection Requests: Lj Total Sq Feet: 2,850.00 Fees Amount Payments Date Paid Amt Paid 50% Renewal Fee $150.00 Total Fees $150.00 Credit Card 12/20/2019 $150.00 Total: $150.00 Amount Due: $0.00 Building Department Copy 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 zoning. Futhermore, I authorize the above named contractor to do the work stated. Authorized Signature: Owner / Applicant / Contractor / Agent Date December 20, 2019 Page 2 of 2 Miami Shores Village VNTEnFI •\�� o�c o �0�9 Building Department � g 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 $Y: Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 (FFB�C 20 [-7 �./ BUILDING Master Permit No. \F--t—IZ—� 1 — ZE)1� PERMIT APPLICATION Sub Permit No. ❑BUILDING ❑ ELECTRIC Ff ROOFING ❑ REVISION ❑ EXTENSION EfRENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP /� ,, / CONTRACTOR DRAWINGS JOB ADDRESS: / 77 /V ' G(� l�D st' City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: 1 1 - 13 (e 00'3 nl 5 Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): �j�l 64340�0k) Phone#: ��- 7.6� - 7[) Oy Address: / %�{ N- tti //� City: 16Arn i 5Acre5 State: �� Zip: 33 /69' Tenant/Lessee Name: PCe5OA f VC- 7t- ( Phone#:3D5 ' %Af'K %y 7 - Email CONTRACTOR: Company Name: �eSS��C'1� 0 r1y)!T _ L L C- Phone#: 7M -6 49 - 76lt- Address: `/ 'C cq n9' 4I%»0e- City: ,Af fArn r State: �� Zip: 33/37 _ Qualifier Name: xs n?1A &5501-/Phone#: State Certification or Registration #: /0yo Certificate of Competency #: DESIGNER: Architect/Engineer: City: Phone#: _State: Zip: Value of Work for this Permit: $ �o �y I OW • C53 Square/Linear Footage of Work: Type of Work: ❑ Addition El Alteration ❑/ New /❑ Repair/Replace Description of Work: 9e, 4oF/r1-9 % /� Ar—T�i¢/ /COCA a7s0 TO ?-Ng-AR - �t�'_ —02 — jo` — 27 2 Specify color of color thru tile: Submittal Fee $ Scanning Fee $ Technology Fee $_ Structural Reviews $ (Revised02/24/2014) Permit Fee $ Radon Fee $ Training/Education Fee $ ❑ Demolition CCF $ CO/CC $ DBPR $ Notary Double Fee $ Bond $ TOTAL FEE NOW DUE $ UO Bonding Company's Name (if applicable) Bonding Company's Address City State Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip 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 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. & , of The foregoing instrument was acknowledged beforeme this day of /(%VePvL 6 e,- 20 I �1©by / Et who is personally known to me or who has produced u• C-� Sri37g 71�s identification and who did take an oath. NOTARY PUBLIC: Print: "'Y K/ TZA6f413WC0'SEPI:V ?r°, c , Notary Public - State of Florida Seal: ?• ; �; Commission # GG 034075 'NyTFF`O,` • My Comm. Expires Sep 27, 2020 OF Bonded through Nation Notary Assn. APPROVED BY Signature C l" CONTRACTOR The foregoing instrument was acknowledged before me this 6 day of AWewlbel 20 / 9 by hJ!►19 who is personally known to me or who has produced L��. c,Z63 �'�fJr 00 70as identification and who did take an oath. NOTARY PUBLIC: Sign:_ 9 /i Print: Seal: •o .I r � iNf V 1 •'~rF OF F�� Plans Examiner Structural Review FRITZ NADER JOSEPH Notary Public - State cf Florida `- Commission # GG 034075 ;c My Comm. Expires Sep 27. 2020 Zoning Clerk (Revised02/24/2014) Local Business Tax Receipt Miami -Dade County, State of Florida -THIS IS NOT A BILL - DO NOT PAY 6661061 RECEIPT NO. RENEWAL BUSINESS NAME/LOCATION 69323013 BESSARD ROOFING LLC 6400 NW 11TH AVE MIAMI, FL 33150 LET EXPIRES SEPTEMBER 30, 2020 Must be displayed at place of business Pursuant to County Code Chapter 8A - Art. 9 & 10 OWNER SEC. TYPE OF BUSINESS PAYMENT RECEIVED BESSARD ROOFING LLC 196 SPECIALTY BUILDING BY TAX COLLECTOR C/O JASMIN BESSARD MGR CONTRACTOR 49.50 10/01/2019 Worker(s) 1 1OBS00180 0208-20-000004 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 Ba-276. MI® �• ^•� For more information, visit ^• miamidade gov/taxcollector • AC'' � CERTIFICATE OF LIABILITY INSURANCE OATE(h11'VDDIYYYYJ 11/27/2019 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(les) 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 rlot confer rights to the certificate holder In lieu of such endorsemeni(s). PRODUCER wnrn� r NA E. First Class Insurance Market PHONN Ext : (305) 441-2997 {ac, No};.. (305) 441-6443— 4101 NW 9th Street l,Ns. fc mc@aoLcom Miami, FL 33126 INSURE S AFFORDING COVERAGE I NAIC # Ph- eAnl;%AA1_9Q07........ _. ..,.�ov /Qnr.LAA11.AAA...... _ I AR(`..1-1.CpC(`.IAITVINQ1'0AAPAMV INSURED INSURER B BESSARD ROOFING, LLC INSURERC:—_.-.__-.-- 5625 NE 2 AVENUE INSURER Dom_ MIAMI, FL 33137 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 - ADDLSUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE L LIMITS _ _.... .. ...,. INSR WVO Pt7 ICY NUMBER...---__-__ MMID MMIDDIYYYY ❑ COMMERCIAL GENERAL LLUILITY EACH OCCURRENCE_ $ 300,000.00 DAMAGE TO RENTED ❑ CLAIMS -MADE❑/ OCCUR PREMISES Ea ooc-xiencel S 100,000.00 A ❑ AGLOO57229-00 12/17/2018 12/17/2019 MEo EXP (Lmy one erson $ 10,000.00 ❑ PERSO. - - .." - NAL &AOV INJURY S 300,000.00 S 600,000.00 GEHL AGGREGATE LIMIT APPLIES PER 11 POLICY ❑ JECT ❑ LOC ❑ OTHER GENERAL AGGREGATE PRODUCTS - COIAPIOP AGG S 600,000.00 $ .._..-..-. AUTOMOBILE LIABILITY ❑ ANYAUTO ❑ ALL OWNED ❑ SCHEDULED ❑ HIRED AUTOS AUTOS NON -OWNED ❑ AUTOS ❑ ❑ ❑ UMBRELLA LIAB []OCCUR ❑ EXCESS LIAB ❑ CLAIMS-6WDE_ CC?,IsINEOtSINGLE LIMIT an S BODILY INJURY (Per person) BODILY INJURY (Per accident, S S $ P OPERaY D er ent AMAGE EACH OCCURRENCE $ $ AGGREGATE S S S ❑ DED ❑ RETENTIONS WORKERS COMPENSATION ANDEMPLOYERS'LWBILITY YIN ANY PROPRIETOR/PARTNERIEXECUTiV OFFICERMIEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS belan N / A El PER f-1 OTH- LJER_ E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYE S E.L. DISEASE -POLICY LIMIT 1 _ $ — DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) Roofing Contractors Lic # 1 OBS00180 CERTIFICATE HOLDER MIAMI SHORES VILLAGE 10050 NE 2 AVE MIAMI SHORES, FL 33138 ACORD 25 (2014/01) QF CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE PIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORITANCE WITH THE POLICY PROVISIONS. ©1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 12/20/2019 I Jasmin Bessard want to restrict permit pickups for: Only the qualifier is able to pick up permits and must present valid id. Jasmin Besssard " ' ` CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 12/19/2019 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(les) 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 CONTACT NAME: First Class Insurance Market PHDNENo. (305) 441-2997 aC No): (305).441-6443 E-MAIL fcimc@aol.com 4101 NW 9th Street INSURE S AFFORDING COVERAGE NAIC # Miami, FL 33126 INSURERA: ARCH SPECIALTY INS COMPANY Phone (305) 441-2997 Fax (305) 441-6443 INSURED INSURER B INSURER C : BESSARD ROOFING, LLC INSURER D : 5625 NE 2 AVENUE INSURER E : MIAMI, FL 33137 INSURERF: 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. ILTIR TYPE OF INSURANCE ADD UBR POLICY NUMBER MWDDY EFF MM/DD EXP LIMITS A © COMMERCIAL GENERAL LIABILITY ❑ CLAIMS -MADE W OCCUR ❑ AGL0057229-00 12/17/2018 02/06/2020 EACH OCCURRENCE $ 300,000.00 PRENTED REM SES GE ToEa occurrence $ 100,000.00 MED EXP (Any one person) $ 10,000.00 ❑ PERSONAL & ADV INJURY $ 300,000.00 GEN'L AGGREGATE LIMIT APPLIES PER ❑ POLICY ❑ PRO- ❑ LOC ❑ OTHER GENERAL AGGREGATE $ 600;000.00 PRODUCTS - COMP/OP AGG $ 600,000.DO $ AUTOMOBILE LIABILITY ❑ ANY AUTO ❑ ALL AUTOS OWNED ❑ SCHEDULED AUTOS NON -OWNED ❑ HIRED AUTOS ❑ AUTOS ❑ ❑ Ee COMBINED LIMIT $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident $ PPReOPatl DAMAGE $ $ ❑ UMBRELLA LIAB ❑ OCCUR ❑ EXCESS LIAB ❑ CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ ❑ DED ❑ RETENTION$ 7 r $ WORKERS COMPENSATION EMPLOYERS' LIABILITY Y / NJTE ANY PROPRIETOR/PARTNER/EXECIIr OFFICER/MEMBER EXCLUDED? u (Mandatory in NH) ff yes, describe under DESCRIPTION OF OPERATIONS below N / A ❑ PER ❑ FORTH E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) Roofing Contractors Lic # 1 OBS00180 CERTIFICATE HOLDER CANCELLATION MIAMI SHORES VILLAGE _ 10050 NE 2 AVE MIAMI SHORES, FL 33138 ULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ORDANCE WITH TdE POLICY PROVISIONS. REPRESENTA ACORD 25 (2014/01) QF ©1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD V 1 1j Construction Trades Qualifying Board BUSINESS CERTIFICATE OF COMPETENC` OBS0018O BESSARD ROOFING LLC D.B.A.: _j � ' t� TT, BESSARD JASMIN Is certified under the provisions of Chapter 10 of Miami -Dade County 0044 ROOFING MF= Jaim` e D. Gascon, P.E. ,Y��� Secretary of the Board www.miamidade.goWeconomy Miami -Dade County retains all property rights herein.