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RC-16-970��'a L��n-Fc�it�' r•.Kc}j�rS v;�;"��"�'•Ti - � ``F�ji'Z.y�i 1t '•PN.L�V. M,. • � i _ �,�yc' ' .ntK 7 Y t�'•�•.• `��� Z �. ��i9� .?�w��:. ` ['!s'� i -i.! t +� 7'� , L �` '3 = [ x e � ','�i , 1j;•(�',��t},�. r �,t{ its J . yP p ,L,�! .1.w ti JYj• Qrt a �,.�yar. �!.e r.. 4Y 'i'+r�-..r- 4 l J'�".'," oji :=Y. Certificate of Completion L" Miami Shores Village 10050 N.E. 2nd Ave, Miami Shores, Florida 331381, ~ Tel: 305-795-2204 Fax: 305-756-8972"fill �+ti`ti�• •I Building Inspection Department Description: INTERIOR RENOVATION (BATHROOM, KITCHEN) � . ,1 Permit Type Building (Residential) Bldg. Permit No. RC-4-16-970 rf 41 Owner ALFREDO R PATINO Contractor HOME OWNER i Subdivision/Project Date Issued June 10, 2020'` v Construction Type V-B Occupancy Single Family i,?tEt ' Type Square Footage 0.00 Flood Zone X a Location If the building is located in a special flood hazard area documentation of the as -built lowest floor 104 NW 102 ST elevation or lowest horizontal structural member has been provided and is retained in the records of i`•'' x i Miami Shores, FL 33138 Miami Shores Village. ti This certificate issued pursuant to the requirements of the Florida Building Code certifying that at the fly r t ORES time of issuance ihis structure was incompliancewith the various ordinances of the jurisdiction } 1+. �l` • _ << regulating building construction or use. Fit ` t t 14. •q r� r�� F1y�..��F .� .:� K`. •'�. �.� ,���fi w- J.;��`��� as Building Officials Approval Not Transferable POST IN A CONSPICUOUS PLACE 17, •�.�. I'i _f' .t- Y��L.4 3l�i�Y�.. � t �� � • ti tf'• �;arjJ`��A •�).Q'r h� 5 7 ��'~ • � • � ��. ti�i'�'�..�yi`I'✓1 �.� ,l Ismael Naranjo, CBO ITAP OF BOUNDARY SURVEY EDGE OF PAVtM I.: �... 1T=. /1ll✓ /O Ste. _ _ -� ij I7 I•'OY�O®Sfl®� N W 102nd STREFE v. E . .. - IS' ASPHALT'PAVEW'HT yam^`... .. ' T I � .. .. .... .. ... !O• TOTAL RI'JYr OF7 WRY .. .. • .. .. I f 3 t.• � - � � � - .::I ....It EDGE OF PAVEMENT G ry cONC .. .... ..T .: � '®®o* T?' PARKWAY N) RAMP f0• I I a • S M RIGHT OF WAY LIHE .. j i 1 ��j' 1 /N A 3• CCAC slDewAiK ' 0 - 85.26'(R&M) iiffs� .. 2 a s E • }� R g r W NO Lb I�• .' _ NO LO. I .n EONCRETE ICj L+38.12J DR!VEW,VY N :_69 ssse W ' U PORCH Q _ A/C 1 <4 CON 14.77' • $� 1 STORY RES, LOT-5 I No. 104 F.F.E.=72.24' BLOCK-2 ReLuas��a �? lam' 23.58' . 25.00' AST 1/7 n LOTUS n LOT-6 .flC Y9JS• BLOCK-2I ,9i BLOCK-2 I 0g *�A 0 ]� IE R � Y I T '# ■ FP Vr 85.2 (Fi& M) —• P � II 1 wurE rEHDE /JO LO. No L Miami Shcres VII►ane - LOT-7 ALOCK-2 BLOCK-2 A PROVED DATE Z NING DEPT BLDG DEPT SUBJECT CO CChIPIJPNCE 1MTH ALL FEDERAL STATE ANL/ C(-IJN`I •{ RULES APID REGULATIONS LOCATION MAP ^ m . r. j Y o.tai (NOT TO SCALE) 6 Final Survey s E J 6/09/2020 < j Z� 104 nw 102 st " o oQ RC-4-16-970 -E`:= = LULU .•�W .��I2 t7Pd� c Graphic Scale Y.• Lo�I �<.... .. ....... LEGAL DESCRIPTION: Lot 6 the East 112 Lot 5, in Block 2, GOI D CREST, "7 a£ ` =six a` c and of of according d o e b to the plat thereof, as recorded in Plat Book 21, at Page 56, of the Public j r Records of Miami Dade County, Florida. m r'PFLOOD ! t ZONE: WI -IN ZOY=:x =-E'ATION: N•1 ORDERNO.: MADSM FELO300K. 'FI_' PROPERTY ADNESS: 104N.'IV. 102nd Street p = :OMMUNITY: 1__652 �eVF Nr. r{17 Su"',' DATE: •'iAR•',•1 19. 2015 UPDATE: .0 = C. 2D"1 UPDATE Mieml Shore", FL. 33150 FOR: ALFREDO R -ATINO 25.00' 1 a— — — :• — ..... �.. �...' 7 DATE. WWRD9 HEICU tN Iv 1 1 MIS iRfW:Nf RC'REANIS H Wr Q eSMK Dr IIC N -Y N DE S[RNFC FRDPI R I w.D 'F:S P.R<N AG — SA C SJTI• MRC Rd-Pd3� B' 1E UR CwCtR nv DF[C" QI. :HNL 4C AG C•JRDACHRN S _S33rOFM lK■,On. TN:S SUR," � ((MRC, Y/•t,'D WRIWUT 7L SiGN<i ' CM OR'''HLL1P U YCL fF 4 fLCPp _V_•E�D71A Y L'� 1VPFER C • ••'• �,': a..:S NOTES SOR.'ET UOE SND'REPACi OC'ER.U.1V .•'• LL 6. • .•�`(. '� j 4 A F Br n ACTION OF THE C63-R<C- )F "''LE NCVE TORE rn CF'Erd1 NE 0 O) • U I• . 4 O O WCO T RCCOPCED wDEDJ N"S. F Cn.r CFFEC':ND iK D r. RE • -HS YIrv_• 5 E S DEG CL M3. L'M i'gAi ICS F C'-0N�.. PE:iIYf'gA5 DR _ . 'ETU J.tRWT PR;]LEELgnNNI LANG u... .j V LJKW S OE FE'.DW LlrC Cl T'LE-0 o W W LED. DESCPP'SE T:C, Fr. RY FN' K IK LTTE LX T - JALCS' DTNCraY SE NDT=C. TN S =-1d1 HAS nJ' <n xTT[M'CD -0 LD[ATC rDJTN6 • �.IAiPFR .1TO9 TA HtD : • F1cN •NDY SOLE E1.rt5CWCN"5YRrClFt N'HE PRDPRrv, UE55540N :F WM EL -VAT S ARRrrvXD -oN.9Y.0 `1 'S 12TZO6JTEriiM.E,•• v `• • GCNOi n.NN J D - n-S.% LJCA'DR ELEYA- y 0.iI' ♦:q Mt»d .. • •' �V� ` 7MEL �03t 591tfB0A SKiDScoeo•vaAl F-MAN •wMnrA11.MHIvbYh w ARc. E-P i 5 50t;RGAQNksVVL-%o%J INSPECTION RECORD ` SHuR.Es y�`c Miami Shores Village FT 1005D N E. 2nd Avenue Miami Shores. FL 331.48-0000 Phone (305)795.22C4 Fax (305)756.8972 ��ORIDp I�Z�VFL ,sbo- Permit NO. RC-4-1647 Q Permit Type: Residential Construction Work Clessificaiion: Alteration Issue Date: 5/6/2016 Expires: 1 1/02/2016 INSPECTION REQUESTS: (305)762-4949 or Log on at https://bidg.miamishoresvillage.com/cap REQUESTS ARE ACCEPTED DURING 8:30AM - 3:30PM FOR THE FOLLOWING BUSINESS DAY. Requests must be received by 3 pm for following day inspections. Residential Construction IIJI�i , 1;1 ili ( I -, Owner's Name: ALFREDO R PATINO,� Om Job Address: 104 NW 102 Street Miami Shores. FL 33138- rUI IUJ.I. _ I1 1 it I . Or Bond Number: II` Contractor(s) Phone Primary Contractor HOME OWNER Yes rcel #:113101022013( Phone: Ii� � I i Total Square Feet: 0 , Total Job Valuation: $ 15,000.00 r WORK is ALLOWED: MONDAY THROUGH FRIDAY, 8:OOAM - 7:0013M. SATURDAY 8:OOAM - 6:OOPM. NO WORK IS ALLOWED ON SUNDAY OR HOLIDAYS. BUILDING AND ROOFING INSPECTIONS ARE DONE MONDAY THROUGH FRIDAY. <,A o�yt e4 Vd)1— +S- P, 'b 0,�CZ,A &ik . 1) 4 0/11V L .ter •�of U� jr,�� - h�✓r,�.�-�/ ��el�-. �;r PT, e4F S- l /�� NO INSPECTION WILL BE MADE UNLESS THE PERMIT CARD IS DISPLAt ED AND HAS BEEN APPROVED PLANS ARE READLY AVAILABLE. IT IS THE PERMIT APPLICANTS RESPONSIBILITY TO ENSURE THAT WORK IS ACCESSIBLE AND EXPOSED FOR INSPECTION PURPOSES NEITHER THE BUILD.NG OFFICIAL NOR THE CITY SHALL BE LIABLE FOR EXPENSE ENTAILED IN THE REMOVAL OR REPLACEMENT OF ANY MATERIAL _ REQUIRED TO ALLOW INSPECTION WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE Or COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT. f�LI�Y_l. ��7 •� 71&1,. INSPECTION RECORD STRUCTURAL INSPECTION DATEi IN Foundation Stemwall Slab Columns 1 st Lift Columns 2nd Lift Tie Beam Truss/Rafters Roof Sheathin Bucks W indows/Doors Interior Framin Insulation / Ceiling Grid Drywall Firewall Wire Lath Pool Steel Pool Deck Final Pool Final Fence Screen Enclosure Driveway Driveway Base Tin Ca Roof in Progress Mop in Progress Final Roof Shutters Attachment Final Shutters Rails and Guardrails ADA com liance DOCUMENTS Aid Soil Bearing Cert Soil Treatment Cert Floor Elevation Survey Reinf Unit Mas Cert Insulation Certificate Spot Survey__ Final Survey Truss Certification STRUCTURAL COMMENTS Temporary Pole 30 Day Tem or Pool Bonding Pool Deck Bond Pool Wet Niche Underground Footer Ground Slab Wall Rough Ceilin Ro � Telephone Rouc Telephone Final TV Rough TV Final Cable Rough Cable Final Intercom Rough Intercom Final y/ Alarm Rough I� Alarm Final Fire Alarm Rouc Fire Alarm Final Tank C Hood 110 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 L 1,9 2018 C FBC 201 BUILDING Master Permit No.2cI - I PERMIT APPLICATION Sub Permit No. BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑P UMBING -]MECHANICAL ❑PUBLIC WORKS CHANGE OF ❑ CANCELLATION [:]SHOP CONTRACTOR DRAWINGS JOB ADDRESS: I O LI I) W 102 'rJ . City: Miami Shores County: Miami Dade Zip:3 1 Folio/Parcel#: Is the Building Historically Designated: Yes NO X Occupancy Type: Load: /� Cornstruction Type: Flood Zone: BFE: FF�E:-/ R OWNER: Name (Fee Simple Titleholder): A�- PAO ��,'��v�b Phone#: Address: IInLl NW jOZ- S't, City: W -3\�A'\ S ymQ_cS State: Zip: 33 1570 Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: '-- N ! . �� � Y"� (I Monett: 9 J �1 J3 l "142 Address: �� `�At� 1�—�•J�(1� Q� - ��^^ __ City: V y� State: L3G�' KZip: 1SyZ Qualifier Name: 1 „r�y ��\L d Phone#: State Certification or Registration #: L.0L - i SclS 3 Certificate of Competency #: `— DESIGNER: Architect/Engineer: Ad hone#: City: State: Zip: Value of Work for this Permit: $ 15 COO ' 01_� Square/Linear Footage of Work: Type of Work: ❑ Addition Alteration ❑ New ❑ Repair/Replace Specify color of color thru tile: Submittal Fee $ Permit Fee $ Scanning Fee $ Radon Fee $ Technology Fee $ Training/Education Fee $ Structural Reviews $ ❑ Demolition CCF $ CO/CC $ DBPR $ Notary Double Fee $ Bond $ TOTAL FEE NOW DUE $ (Revised02/24/2014) 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 w ich occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be a ved and a reinspection fee will be charged. Signature Signature O R or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this day of- " 20 I(D by v, V h , who is personally known to me or who has produced �6 � as identification and who did take an oath. NOTARY PUBLIC: Print: � Seal: I �q'�+ ; X05 APPROVED BY The foregoing instru ent 1 as acknowledged before me this 3 day of � 20'k-'y by who is personally known to A4Dy,-J--) bAl me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign Prirr Seal Plans Examiner Structural Review Zoning Clerk (Revised02/24/2014) 6r7/2016 Scan 2.j peg STATE OF FLORIDA DEPARTLIENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD 1940 NORTH MONROE STREET (850)487-1395 TALLAHASSEE FL 32399-0783 DELIGIO, ANTONIO BARI NATIONAL BUILDERS, LLC 20916 SHERIDAN STREET PEMBROKE PINES FL 33332 ,:'Drigratulafflons' Nth this license You become one of the nearly ,3 r%�ton'Flofldians licensed by the Department of Business and _ft .. I Regulation- Our professionals and businesses range t'-'m architects to yacht brokers, from boxers to barbeque restaurants, and they keep Florida's economy strong, .'pry day we work to improve the way we do business in order to Elrje you better. For information about our services please log onto 011AN.My-florldalicense.com. There you can find ;;;re information zbc-ut our divisions and the regulations that Impact you subscribe :: department newsletters and team more about the Departments .�:'Iatives. - . ssion at the Department Is: License Efficiently. Regu:--Ie Fairly. A—nstantly strive to serve you better so that you ;an serve your :;storners. Thank you for doing business in Florida. �'j congratulations on your new ficensel DETACH HERE RICK SCOTT, GOVERNOR STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION - CGC1 522573 ISSUED: 09/16/2014 CERTIFIED GENERAL CONTRACTOR DELIG:O, ANTONIO BARI NATIONAL BUILDERS, LLC IS CERTIFIED under the rovisjon P r , of Ch.4gq FS. E�lr,'fl*n E318 -. AUG 31, Zo-,3 L140--*IC00'gn23 KEN LAWSON, SECRETARY STATE OF: FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULA-nON CONSTRUCTION INDUSTRY LICENSING BOARD ,--GC1522573 lie GENERAL CONTRACTOR , med below IS CERTIFIED nder the provisions of Chopter 489 FS_ xoiration date: AUG 31, 2016 DELI GI0,ANTONI0 BARI NAMONAL BUILDERS LLC 20851 JOHNSON STREETi104 PEMBROKE-: PINES FL 13 0 2 9 https://mail.google.com/mail/L#0/?tab--wmAnbox/15528ac5l98e3398?projector=l 1/1 BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT 115 S. Andrews Ave., Rm. A-100, Ft. Lauderdale, FL 33301-1895 — 954-831-4000 VALID OCTOBER 1, 2015 THROUGH SEPTEMBER 30, 2016 DBA:DIVISIONV', cO TtAC'roR L Receipt#-180 _ 42806TRACTOR Business Name BARI N.a.TIC?NAL hl T.,[)�.E Business Type: Owner Name: A:NTONIO DELI'SI", Business Opened:07 /29/2011 Business Location:20916 ;SHERIDANvi :r State/County/Cert/Reg:CGC15225-73 . PEMBROKE PINES S Exemption Code: Business Phone: Rooms Seats Employees Machines Professionals ,1 _._.................. _..- -- �� For Vending Business Only Vendina Tvae: Tax Amount Transfer Fee NSF Fee Penaliy Prior Years Collection Cost Total Paid 27.00 O.00 J. C; _ 0 00 0.00 27.00 THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS THIS BECOMES A TAX RECEIPT This tax is levied for the privilege of doing business within Broward County and is non -regulatory in nature You must meet all County and/or Municipality planning WHEN VALIDATED and zoning requirements. This Business Tax Receipt must be transferred when the business is sold, business name has changed or you have moved the business location This receipt does not indicate that the business is legal or that it is in compliance with State or local laws and regulations. Mailing Address: BAR NATIONA:, BTJI7.%)r:R1; _.-,,,. ?.0916 SflEFtIDAIv ST PEMBROKE PINES, FL _t 2015 - 2016 Receipt #10B-14-00009630 Paid 07/29/2015 27.00 A oRo CERTIFICATE OF LIABILITY INSURANCE UA1t(MWUU/YYY1) 6/10/2016 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 Turner, Wood, & Smith Agency, Inc. 100 Brenau Ave PO Box 1058 Gainesville GA 30503 CONTACT NAME: Peggy Kanaday PHONE (770)536-0161 Fi. Ja, Na:(770)536-1283 E-MAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIC X INSURERA:Selective Insurance Company 39926 INSURED Bari National Builders, LLC and Division 7 Contractors, LLC 1610 Oakbrook Drive GAINESVILLE GA 30507 INSURER B MusinessFirst Insurance Company INSURERC: INSURERD: INSURER E : INSURER F : '_OVERAGES rFRTIFICOTE NUMRERCL1651207056 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 LTR TYPE OF INSURANCE ADD UBR POLICY NUMBER MM/DD/YLIYEFF POLICY XP LIMITS S COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGETO RENTED $ 100,000 A CLAIMS -MADE ❑R OCCUR PREMISES Ea occurrence) MED EXP (Any one person) $ 10,000 S2191505 10/6/2015 10/6/2016 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OPAGG $ 2,000,000 % POLICY PRO- ❑ LOC JECT Empi Practices Liab Ins $ 100,000 OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea acc dent $ 1,000,000 BODILY INJURY (Per person) $ % ANY AUTO A ALL OWNED SCHEDULED S2191505 10/6/2015 10/6/2016 BODILY INJURY (Per accident) I $ AUTOS AUTOS NON -OWNED PROPERTY DAMAGE Per accident Is HIRED AUTOS AUTOS Medical Payments $ 5,000 UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED I I RETENTION $ $ WORKERS COMPENSATION S PER OTH- STATUTE ER AND EMPLOYERS' LIABILITY Y/ N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ 100 000 E.L. DISEASE - EA EMPLOYE $ 100,0001 8 OFFICER/MEMBER EXCLUDED? ❑ ,(Mandatory in NH) N/A 0521-14249 5/2/2016 5/2/2017 E.L. DISEASE - POLICY LIMIT 1 $ 500,000 If yes, describe under DESCRIPTION OF OPERATIONS below I DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) Project Description: Demo back porch sunroom area with roof and rebuild new enclosed porch with new flat roof per plans I CERTIFICATE HOLDER UANLotLL.A 11UN Miami Shores Village Buidling 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 gy Kanaday/PJK /' — �5 01988-2014 ACORD CORPORATION. All rights reserves. A f`/1Dn 7S 10AII AA111 Th. A/"f1Qn nome ..A I- or. rnnicfnrnA m­iL of At f%on BARI NATIONAL BUILDERS, LLC ANTONIO DELIGIO 20916 SHERIDAN STREET PEMBROEE PINES FL 33332 CITY OF PEMBROKE PINES 10100 PINES BOULEVARD, PEMBROKE PINES, FL 33026 ACCOUNT -NO: 2013C150/01 RECEIPT -NO: 155786 LOCAL BUSINESS TAX RECEIPT RECEIPT -YEAR; OCTOBER 1, 2015 thru SEPTEMBER 30, 2016 NOTICE IM11112111110110 BUS -NAME BARI NATIONAL BUILDERS, LLC In the event the business to which this BUS-ADDR 20916 SHERIDAN STREET receipt was issued changes hands, the receipt PEMBROKE PINES FL 33332 will become null and void. An application for a new receipt must be made. BUS-DESCR GENERAL CONTRACTOR RECEIPT -TYPE: REGULAR LICENSE BUSINESS -CLASSIFICATION INV/UNITS EFFECTIVE PERMIT-NUMBER/CCHbMNTS RCT-TYPE .CGC CONTRACTOR - GENERAL 0 10/01/20,15 P/Pines SIGN BUSINESS SIGN 1 10/01/2015 P/Pines ITY OF PEMBROKE PINES 2015-2016 SIGN PERMIT v i ® A�coRO CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 6/9%2016 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 Turner, Wood, & Smith Agency, Inc. 100 Brenau Ave PO BOX 1058 Gainesville GA 30503 CONTACT Pe Kanada NAME: Peggy y PHONE0. (770) 536-0161 AX.. ): (770)536-1283 E-MAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIC # INSURERA:Selective Insurance Company 39926 INSURED Bari National Builders, LLC and 'Division 7 Contractors, LLC 1610 Oakbrook Drive GAINESVILLE GA 30507 INSURER B $usinessFirst Insurance Compan. INSURER C : INSURER D : INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER-CL1651207056 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 LTR TYPE OF INSURANCE ADDL S BR POLICY NUMBER MM/DDOLIY /YYYY MMI D/YYYY LIMITS A X I COMMERCIAL GENERAL LIABILITY CLAIMS -MADE ❑X OCCUR S2191505 10/6/2015 10/6/2016 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES Ea occurrence 100 , 000 $ _ MED EXP (Any one person) $ 10,000 PERSONAL BADVINJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO LOC X JECT OTHER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 Empl Practices Liab Ins $ 100,000 A AUTOMOBILE LIABILITY X ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS S2191505 10/6/2015 10/6/2016 COMBINED SINGLE LIMIT Ea accident $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ — Medical payments $ 5,000 UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED i I RETENTION $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A 0521-14249 5/2/2016 5/2/2017 X PER OTH- STATUTE ER E.L. EACH ACCIDENT $ 100,000 E.L. DISEASE - EA EMPLOYE $ 100L000 E.L. DISEASE - POLICY LIMIT $ 500,000 7 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) I IL" aC4112LefG\I;0:NJ01s1a: or 1-11 Lai Miami Shores Village Buidling 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 Peggy Kanaday/PJK ACORD 25 (2014/01) INS025 rmmdni i ©1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD jjj . Vn ,�r;f1"ViJV Jy 4Au h iN T."X N yl �L co C L r BARI NATIONAL BUILDERS, LLC ANTONIO DELIGIO 20916 SHERIDAN STREET PEMBROKE PINES FL 33332 CITY OF PEMBROKE PINES 10100 PINES BOULEVARD, PEMBROKE PINES, FL 33026 ACCOUNT -NO: 2013C150/01 RECEIPT -NO: 155786 LOCAL BUSINESS TAX RECEIPT RECEIPT -YEAR: OCTOBER 1, 2015 thru SEPTEMBER 30, 2016 NOTICE IMM MMINUAMMwINNU BUS -NAME : BARI NATIONAL BUILDERS, LLC In the event the business to which this BUS-ADDR 20916 SHERIDAN STREET receipt was issued changes hands, the receipt PEMBROKE PINES FL 33332 will become null and void. An application. for a new receipt must be made. BUS-DESCR : GENERAI, CONTRACTOR RECEIPT -TYPE: REGULAR LICENSE BUSINESS -CLASSIFICATION INV/UNITS EFFECTIVE PERMIT-NUMBER/CANTS RCT-TYPE CGC CONTRACTOR - GENERAL 0 10/01/2015 P/Pines SIGN BUSINESS SIGN 1 10/01/2015 P/Pines ITY OF PEMBROKE PINES 2015-2016 SIGN PERMIT e State of Florida Department of State I certify from the records of this office that BARI NATIONAL BUILDERS, LLC, is a limited liability company organized under the laws of the State of Florida, filed on April 6, 2010, effective April 5, 2010. The document number of this company is L10000037246. I further certify that said company has paid all fees due this office through December 31, 2015, that its most recent annual report was filed on January 11, 2015, and its status is active. Given under my hand and the Great Seal of the State of Florida at Tallahassee, the Capital, this the Eleventh day of January, 2015 1� Secretary of State Authentication ID: CC0414830678 To authenticate this certificate,visit the following site,enter this ID, and then follow the instructions displayed. https://efile.sunbiz.org/certauthver.htmi 9RTWƒ gttORES Miami Shores Village 10050 N.E. 2nd Avenue NW •'__ J ""'�' Miami Shores, FL 33138-0000 Phone: (305)795-2204 ORIOP Permit NO. RC-4-16-970 Permit Type: Residential Construction rill' Work Classification: Alteration Permit Status: APPROVED Issue Date: 5/6/2016 1 Expiration: 11/02/2016 Project Address Parcel Number Applicant 104 NW 102 Street 1131010220130 ALFREDO R PATINO Miami Shores, FL 33138- Block: Lot: Owner Information Address Phone Cell ALFREDO R PATINO 104 NW 102 Street MIAMI SHORES FL 33138- 104 NW 102 Street MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone HOME OWNER In Review Comments: Date Approved:: In Review Date Denied: Type of Construction: INTERIOR RENOVATION (BATHRO Occupancy: Single Family Stories: Exterior: Front Setback: Left Setback: Bedrooms: Plans Submitted: Yes Certificate Date: Fees Due Amount CCF $9.00 DBPR Fee $6.75 DCA Fee $6.75 Education Surcharge $3.00 Notary Fee $5.00 Permit Fee $450.00 Scanning Fee $21.00 Technology Fee $12.00 Total: $513.50 Rear Setback: Right Setback: Bathrooms: Certificate Status: Additional Info: Classification: Residential Valuation: $ 15,000.00 Total Sq Feet: p Pay Date Pay Type Amt Paid Amt Due Invoice # RC-4-16-59372 05/06/2016 Credit Card $ 463.50 $ 50.00 04/11/2016 Credit Card $ 50.00 $ 0.00 Available Inspections: Inspection Type: Final PE Certification Window Door Attachment Framing Insulation Drywall Screw Window and Door Buck Fill Cells Columns Review Electrical Review Electrical Review Building Review Building Review Planning Review Mechanical Review Plumbing Review Structural 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. �— -xf::T7 y May 06, 2016 Authorized Signature: Owner / Applicant / Contractor / Agent Date Building Department Copy May 06, 2016 1 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 BUILDING PERMIT APPLICATION BUILDING ❑ ELECTRIC ❑ ROOFING Master Permit No Sub Permit No. R 1 � 2096 FBC 20 ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL [:]PUBLICWORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: I k 4J. W• 10 Z SA City: Miami Shores County: Miami Dade Zip: q')W Folio/Parcel#: 11 — 3101 ` Z Z - 61 3a Is the Building Historically Designated: Yes NO Occupancy Type: I Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): � z ?AA Phone#: •��G' J7�� ��I� Address:, ,W5 LA 0 M. 102 -1 City: Mn.�A/Ll C-Alnkn State: -t;�L Zip: 9!31 S-1) Tenant/Lessee Name: Phone#: Email: S kiN Apo0 'In O*V-Acu I. coiN1 CONTRACTOR: Company Name: jjg ' 0LQy 'V Phone#: Address: City: Qualifier Name: State Certification or Registration #: DESIGNER: Architect/Engineer: Value of Work for this cip: Phone#: Certificate of Competency #: n e#: r Footage of Work: State: Zip: Type of Work: ❑ Additiron A./llt�te�ration `j El New , ® Repair/Replace ❑ Demolition Description of Work: -1v11hj K4 uL44eAlfi" /� 1�41 Specify color of color thru tile: Submittal Fee $ JlJ w Permit Fee $ —1" 00 CCF $ - � CO/CC $ !G� Scanning Fee $ a ( Radon Fee $ �• _`C DBPR $ (D • -::)C Notary$ri Technology Fee $ 1 2 ' CA� Training/Education Fee $ 3 ' C-0 Double Fee $ Structural Reviews $ Bond $ TOTAL FEE NOW DUE $ ctr 5 • 5V (Revised02/24/2014) 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 Zi 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 po3teii at the joFs-ite 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. Signatur Signature OWNER or AGENT CONTRACTOR The foregoing instrum/e�ntAwas acknowledged before me this The foregoing instrument was acknowledged before me this day of �"�c L 20 �'� by day of 20, by Q o Is personally known to me or who has produced L bi1—{\� t ars ��me or who has produced identification and who did take an oath. NOTARY Sign. T,�v oye Notary Puhlic State of Florida Sindia Alvarez y G A< My COMMi85^On FF 156750 1W7** % %A APPROVED BY who is personally known to identification and who did take an oath. NOTARY PUBLIC: Sign: Print: Seal: as ****************************************************************** Plans Examiner Zoning (Revised02/24/2014) Structural Review Clerk F" Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 1� ii(� OWNER BUILDER DISCLOSURE STATEMENT NAME: I1'C�Pp&, DATE: L( ' i (' V ADDRESS: O k W W, i ©2 - 33 j 5 u Do hereby petition the Village of Miami Shores to act as my own contractor pursuant to the laws of the State of Florida, F.S 489.103(7). And I have read and understood the following disclosure statement, which entitles me to work as my own contractor; I further understand that I as the owner must appear in person to complete all applications. State Law requires construction to be done by a licensed contractor. You have applied for a permit under an exception to the law. The exemption allows you, as the owner of your property, to act as your own contractor even though you do not have a license. You must supervise the construction yourself. You may build or improve a one -family or two-family residence. You may also build or improve a commercial building at a cost of $25,000.00 or less (The new form states 75,000). The building must be for your own use and occupancy. It may not be built for sale or lease. If you sell or lease a building you have built yourself within one year after the construction is complete, the law will presume that you built for sale or lease, which is a violation of this exemption. You may not hire an unlicensed person as a contractor. It is your responsibility to make sure the people employed by you have licenses required by state law and by county or municipal licensing ordinances. Any person working on your building who is not licensed must work under your supervision and must be employed by you, which means that you must deduct F.I.C.A and with- holdings tax and provide workers' compensation for that employee, all as prescribed by law. Your construction must comply with all applicable laws, ordinances, buildings codes and zoning regulations. Please read and initial each paragraph. 1. I understand that state law requires construction to be done by a licensed contractor and have applied for an owner -builder permit under an exemption from the law. The exemption specifies that I, as the owner of the property listed, may act as my own contractor with certain restrictions even though I do not have a license. Initial 2. 1 understand that building permits are not required to be signed by a property owner unless he or she is responsible for the construction and is not hiring a licensed contractor to assume responsibility. Initial J� 3. 1 understand that, as an owner builder, I am the responsible party of record on a permit. I understand that may protect myself from potential financial risk by hiring a licensed contractor and having the permit filed in his or her name instead of my own name. I also understand that the contractor is required by law to be licensed in Florida and to list his or1build bers on permits and contracts. Initial 4. 1 understand that I may build or improve a one family or two-family residence or a farm outbuilding. I maymprove a commercial building if the costs do not exceed $75,000. The building or residence must be for my use or occupancy. It may not be built or substantially improved for sale or lease. If a building or residence that I have built or substantially improved myself is sold or leased within 1 year after the construction is complete, the law will presume that I built r substantially improved it for sale or lease, which violates the exemption. Initial 5. 1 understand that, as the owner -builder, I must provide direct, onsite supervision of the construction. Initial 6. 1 understand that I may not hire an unlicensed person to act as my contractor or to supervise persons workJQ n m building or residence. It is my responsibility to ensure that the persons whom I employ have the license required by k1laandO by county or municipal ordinance. Initia I understand that it is frequent practices of unlicensed persons to have the property owner obtain an owner -builder permit that erroneously implies that the property owner is providing his or her own labor and materials. I, as an owner -builder, may be held liable and subjected to serious financial risk for any injuries sustained by an unlicensed person or his or employees while working on my property. My homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an owner -builder and am aware of the limits of my insurance coverage for injuries to workers on my property. Initial I understand that I may not delegate the responsibility for supervising work to be a licensed contractor who is not licenses to perform the work being done. Any person working on my building who is not licensed must work under my direct supervision and must be employed by me, which means that I must comply with laws requiring the withholding of federal income tax and social security contributions under the Federal Insurance Contributions Act (FICA) and must provide workers compensation for the employee. I understand that my failure to follow these may subject to serious financial risk. Initial I agree that, as the party legally and financially responsible for this proposed Construction activity, I will abide by all applicable laws and requirement that govern owner -builders as well as employers. I also understand that the Construction must comply with all applicable laws, ordinances, building codes, and zoning regulations. Initial 10. 1 understand that I may obtain more information regarding my obligations as an employer from the Internal Revenue Service, the United States Small Business Administration, and the Florida Department of Revenues. I also understand that I may contact the Florida Construction Industry Licensing Board at 850.487.1395 or hftp://www.myfloridalicense.com/dbpr/pro/cilb/indexbtml Initial 11. 1 am aware of, and consent to; an owner -builder building permit applied for in my name and understands that I am the party legally and financially responsible for the proposed construction activity at the following address: 10�1 Nw Ib2 1-� Stb�RL3s�L331S•� Initial 12. 1 agree to notify Miami Shores Village immediately of any additions, deletions, or changes to any of the information that I have provided on this disclosure. Initi Licensed contractors are regulated by laws designed to protect the public. If you contract with a person who does not have a license, the Constr4uction Industry Licensing Board and Department of Business and Professional Regulation may be unable to assist you with any financial loss that you sustain as a result of contractor may be in civil court. It is also important for you to understand that, if an unlicensed contractor or employee of an individual or firm is injured while working on your property, you may be held liable for damages. If you obtain an owner -builder permit and wish to hire a licensed contractor, you will be responsible for verifying whether the contractor is properly licensed and the status of the contractor's workers compensation coverage. Before a building permit can be issued, this disclosure statement must be completed and signed by the property owner and returned to the local permitting agency responsible for issuing the permit. A copy of the property owner's driver license, the notarized signature of the property owner, or other type of verification acceptable to the local permitting agency is required when the permit is issued. Was acknowledged before me this. 1, t day of SNF IeA `- , 20P_ � `�. �� I.�v By tit' Via_ who was personally known to me or who has Produced there License or as identification. R NOTARY pti#%y Pue, Notary Public State of Florida ^ Sindia Alvarez c ` My Commission FF 156750 orF�o Expires09/03/2018 M GLOBAL • GLOBAL ELECTRIC SERVICES, LLC MAY 032016 INVOICE Attention: Alfredo Patino BY' Title: Owners Address Location 001-104nw102st 104 NW 102 st Miami Shores, FL 33150 osmanigmCyahoo.com Date:3-15-16 15905 SW 105th Ct. Project Title: Electrical Work Miami, FL 33157 Terms: 30 Days Ph# 305-218-0752 All electrical work to be performed 1 $ 1,500 $ 1,500 according to architectural drawings and present electrical code of Miami Dade County Subtotal $ 1,500 Tax 7.00% $ 105 Total $ 1,605 All material is guaranteed to be as specified. All work to be completed in a workmanlike manner according to standard practices. Any alterations or deviations from specifications above involving extra cost will be executed only upon written orders and will become an extra charge over and above estimate. all agreements contingent upon strikes, accidents or delays beyond our control. Owner to carry fire, tornado and other necessary insurance. Our workers are fully covered by Workman's Compensation Insurance. The above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified. .. ... . . . . . .. . .. . . . . ..: . .. ... .. . . . .. . . . . . . . . . . . .. . . . . . . .. . . .. . ... . ... . ... . . . . ... . . 1 . . . . . . . . . . ... . . . ... . .