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RF-19-1285Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Location Address 549 NE 106TH ST, Miami Shores, FL 33138 Contacts Issue Date: 07/26/2019 Parcel Number 1122310140130 Permit No.: RF-06-19-1285 Permit Type: Roof Work Classification: Tile Permit Status: Approved Expiration: 01/27/2020 Nicolas Gertie Owner ROOFS TO GO INC Contractor 3300 DEER CREEK ALBA CIR, DEERFIELD BEACH, FL 33442 JOSE L ROMERO 3300 NE 13 TER, POMPANO BEACH, FL 33064 Business: 9545733532 ti Description: TILE ROOF REPLACEMENT ONLY TO REPLACE Valuation: $ 13,500.00 on Requests: Inspection 4949 PERMIT#RF-7-18-1893 Total Sq Feet: 1,845.00 Fees Amount 50% Renewal Fee $87.50 Application Fee - Other $50.00 Total: $137.50 Building Department Copy Payments Date Paid Amt Paid Total Fees $137.50 Credit Card 06/05/2019 $50.00 Credit Card 07/26/2019 $87.50 Amount Due: $0.00 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 constru4on andAning. Fyfhermore, I authorize the above named contractor to do the work stated. Authorized Signature: Owner I / 1 Applicant / Contractor / Agent Date July 26, 2019 \J Page 2 of 2 BUILDING P F 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 7-1 y-13rq"3 PERMIT APPLICATION [—]BUILDING ❑ ELECTRIC : ROOFING DECEIVED JUN 0 a 2001^9,, FBC 20 Master Permit No� Sub Permit No. ❑ REVISION ❑ EXTENSION RENEWAL F-] PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS [:]CHANGE OF [:]CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOBADDRESS: City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: 3 BFE: FFE: OWNER: Name (Fee Simple Titleholder): lV l rol x s5 GGR 7/ E Phone#: 5 05 ' 61161/ t?-elcl Address: ,COL'gw e(tq . City: OFq ef:le State: Zip: Tenant/Lessee Name: Email: /V/e-&,4 A S "A-ty' � Q/id 7')'14IL - ea/'1 one#: CONTRACTOR: Company Name: /(�®< ✓� 7-O �B �/� �� Phone#: City: 'Pr "f ��ell Q State: ,ram �• Zip / :3 < Qualifier Name: -C� ' (/'l Phone#: �J/ 7 )r State Certification or Registration #: CCC f32 376.2 Certificate of Competency #: DESIGNER: Architect/Engineer: one#: Address: City: State: �Zip: Value of Work for this Permit: $� � , �A�J V Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New EE Rep r/Replace ❑ Demolition Description of Work: R ENE WA) 0 F F -,X-P/Rr- 0 /TOO f Pf= /7r7/ 7 )re td 7W Od F Ro5P/A Ct-:tjFArr ©tiny -A0 Vq��(OC'-e- V)� Specify color of color thru tile:-544,17-4 = C T/�G, /�E� = C�� ��A�lie 20 °b Coc-04,1010o Submittal Fee $ �� Permit Fee $ Scanning Fee $ Technology Fee $ Structural Reviews $ Radon Fee $ Training/Education Fee $ CCF $ DBPR $ CO/CC $ _ Notary $. Double Fee $ _ Bond $ TOTAL FEE NOW DUE $ P1-� (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 $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be_approved and a reinspection fee will be charged. Sign OWNER or The foregoing instrument was ackno'6r(,e(iged before me this 7 day of i� R Y 20 / 9' by h'1 ea/A s G/-r� -t Y , who is personally known to me or who has produced Vl? Aas identification and who did take an oath. NOTARY PUBLIC: Sign: �2 ��w (:1 Q, lo Print: Signature Y CONTRACTOR The foregoing instrument was acknowledged before me this 9 day of Y . 20 / F by fI,—/ ?m/Y/=—who is personally known to me or who has produced ��1�1 VAR �l�i/`lV% as identification and who did take an oath. NOTARY PUBLIC: Sign:_ Print: Seal: Yer.gee , Loreley Greene Seal: Commission # GG025350 co nmisssieon i GG025350 = "= Expires: August 28, 2020 .. g Expires: August 28, 2020Bonded thru Aaron Notary Rp*%ad************************.''**************************** APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) RICKSCOTI, GOVERNOR JONAlHAN ZACHEM, SECRETARY bpr a STATE OF FLORIDA DEPARTMENT OF BUSINESS AN PROFESSIONAL REGULATION CCENSTRUCTIpN .WbU$ L—Ic '. :. ING BOARD THE ROOFIN,G�ON`fRAETOR-H E N I5 ` ; PROVIStO`N'pF O� �gpTR�.$ ERTIFIED.,UNDER THE ,,.. 9, ER TAT, C 0 fE . > 3b0 N :13-T H TERR�4CE ��� P,C)IMPAN.O BEAN Fl, 33QE; Ll'CIE SE;-N;l1MBEj iC132a762 u%My"_aK2.t•amalyl�m.cw.�.. �_.. .INVI...q.pENJ; �.11C EXPIRATION DATE:. AUGUST 31, 2 0r.b1. Always verify licenses online at MYFloridaLicense.mm v •o Do not alter this document in any form. • This is your license. It is unlawful for anyone other than the licensee to use this document. BROWARD COUNTY 115 LOCAL BUSINESS TAX RECEIPT S. Andrews Ave., Rm. A-100, Ft. Lauderdale, FL 33301-1895 — 954-831-4000 VALID OCTOBER 1, 2018 THROUGH SEPTEMBER 30, 2019 DBA: Business Name: ROOFS To GO INC Receipt #:185-1926 Owner Name: DOSE L ROMERO Business T ROOFING/SHEET METAL CONTRACTOR ype:(ROOFING CONTRACTOR) Business Location: 3300 NE 13 TERR Business Opened:04/07/2009 POMPANO BEACH State/County/Cert/Reg:CCC1328762 Business Phone: 954-573-3532 Exemption Code: Rooms Seats Employees Machines 1 Professionals Number of Machines: For Vending Business Only Tax Amount Transfer Fee NSF Fee Vending Type: Penalty 7.00 0.(0 0.00 Prior Years Collection Cost Total Pald 0.00 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-rMunicipality plannin WHEN VALIDATED and zon ngorequirements This Busin ss Tax Recin nature. You must meallteipt or m/ st 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: JOSE L ROMERO 3300 NE 13 TERR Receipt #1CP-17-00022176 POMPANO BEACH, FL 33064 Paid 09/07/2018 27.00 2018 - 2019 A0C> v' CERTIFICATE OF LIABILITY INSURANCE DATE (MWDDNYYY) 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. IIMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy (les) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS I 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 certMcate holder in lieu of such endonsement(s). FrankCrum Insurance Agency, Inc. 100 South Missouri Avenue FrankCrum L/C/F Roofs To Go, Inc. 100 South Missouri Avenue rFRTIFIr:ATF MIIMRFR- PHONE 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 INSRD 8UBR INVD POLICY NUMBER POLICY EFF (MWDwrfw) POLICY EXP (MMMDM/YY) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED PREMISES eocwnence $ MA CLAIMS -DE OCCUR MED EXP (Any one person) $ PERSONAL S ADV INJURY $ GENL AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ PRODUCTS-COMP/OP AGG $ POUCY a PROJECT �LOC $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ee d rt S BODILY INJURY Per wn $ ANY AUTO OWNED AUTOS SCHEDULED ONLY AUTOS BODILY INJURY (Per ea Ident) $ PROPERTY DAMAGE raxlderrt S HIRED AUTOS NON -OWNED ONLY AUTOS ONLY a UMBRELLA LIAB OCCUR EACH OCURRENCE AGGREGATE $ EXCESS LIAR CLAIMS -MADE DED RETENTION S $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN WC201900000 01/01/2019 01/01/2020 X PER STATUTE OR ER E.L. EACH ACCIDENT $1,000,000 ANY PROPRIETORIPARTNERIEXECUTIVE OFFICER/MEMBER EXCLUDED? N/A (Mendetory In NH) N yes, describe under E.L. DISEASE -EA EMPLOYEE $1,000,000 DESCRIPTION OF OPERATIONS below LIMIT__ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached I/ more space Is required) Effective 07/27/2015, coverage is for 100% of the employees of FrankCrum leased to Roofs To Go, Inc. (Client) for whom the client is reporting hours to FrankCrum. Coverage is not extended to statutory employees. reonev-ATF wnl new L:AIe[:CLLL I lun SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS, Miami Shores Village Building Department 10050 NE 2 Ave. AUTHORIZED REP SENTATN Miami Shores, FL 33138 C�- 01988-2016 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD