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DS-7-18-1823, 166 NW 98 StMiami Shores Village 10050 N.E. 2nd Avenue NW Miami Shores, FL 33138-0000 Phone: (305)795-2204 Project Address 166 NW 98 Street Miami Shores, FL Owner Information Address Permit NO. DS-7-18-1823 er itPermit Typt : Driveways/Sidewalks/Slabs Work Clossificaticio Add oniAlteration Permit Status: = APPROVED issue gate: 7/1712018 1 Expiration: 01113i2019 Parcel Number Applicant 1131010260040 JULIO ABARCA Block: Lot: Phone G?l+ JULIO ABARCA 166 NW 98 Street (305)733-2893 MIAMI SHORES FL 33150-1739 Contractor(s) Phone Cell Phone BRICK PAVERS GROUP (305)591-8700 Approved: In Review Comments: Date Approved:: In Review Date Denied: Type of Work: INSTALLATION OF PAVERS Bond Return Scanning: 3 Fees Due Amount Bond Type -Contractors Bond $500.00 CCF $7.20 DBPR Fee $2.63 DCA Fee $2.00 Education Surcharge $2.40 P&Z Review Fee $35.00 Permit Fee $175.00 Scanning Fee $9.00 Technology Fee $9.60 Total: $742.83 Additional Info: Classification: Residential Valuation 12,000.00 Total Sq Feet: 1580 i Pay Date Pay Type .Amt Paid Amt Due Invoice # DS-7-18-68-140 07/17/2018 Credit Card $ 692.33 $ 50.00 07/03/2018 Credit Card $ 50.00 $ 0.00 Bond #: 3831 Available Inspections: a l Insoprtion Tvne' N Final Foundation Review Building»- F Review Buiidinq Review Planning Review Planning _ ,t>�meaes� In consideration of the issuance to me of this perrr t, I agree to perform the work covered hereunder in compli trice wittl 311 ordinances and regulations pertaining thereto and in strict conformity with the plat s, drawings, statements or specifications submitted to the prof ar authorities of Miami Shores Village. In accepting this permit I assume responsibility for all % ork done '.y either ^ ; ", 4; :.;, c : - o: -; i understand that separate permits are required for ELECTRICAL, PLUMBING, MECHANICA ., WINDOWS, DOORS, ROOFING and SWIMMING POOL wor c. OWNERS AFFIDAVIT: � certify, that all the foregoinc information is accurate and that all work will be done in com tliance with all applicable laws regulating construction-aiad zone a. kutfbrtnore: I authorize the above-named-cor;tractor to do the work stated. Adtho�i dSioa—ture: Owner `� Applica it / \Con Building Department Copy July 17, 2018 / Agent Jui ✓ 17, 2018 )ate 1 •••• Gh$AL147703114kdIMAY, SCALE 1"=20' jai k • • i • 120rM '_� • MANSIONS IH MIAW'a „�. --- _ ______ FIELD DATEOP2`r2Gf1 .. �D PHONE: (305)6124226 TYPE OF PROJECT: Land Surveying Services FAX (305)612-1$14 B4UNDARI(;; j RVEY•..:. FRR lUL10.A,ABQRCri LEGAL AESCIRWITO ; A ON OF • • f66 N.W. 98fh StREET, MfAMtStfORES, FL 33J30 LOT: 4 BLOCV ....... S er _..___Kai fr f80NMA1?P� . • i PROP. ADD -_-.___,._.... ---.—..... PLATI _ .... 42 ^_—PAGE SO OF MIAM114' ..*CFLINDDA. • N.W. 98th STREET :... . 75.W Total RNV • • • • • 17'Asphalt • • • • • _. _ .. ....._. ear _ to _ 28' Asphalt ft Lot 3 4"+ Block 2 � t, U` �b o cifCj '"PiaFtter , i v 11.tSI' a 14.55' 11.33' lT r o ONE STORY CBS c RESIDENCE 0 166 e� "• N � n 21.50' b S� 9 I i NDJ.P.Ilr 75.00' ... _.__...... ^� _ ...... 13,5' Asphal& 15' ALLEY SURVEYOR'S NOTES_ i.)'THE 'LWRVCY OF I'HE PROPERTY SHCdM HEREON S, RACCaii6MlCEWTH THE OF' CAPTIONFLRNS}EDBYCUENC. 2.} tRME.SS A COMPARIM4IS SHOWN, ALL SEARING.. ANGLES ANO DISTANCE$ SHOM ARE THE SAME AS PLAT VALUE;;, 3.) THE LANDS SFIOMN HEREON N£RE:' OT ABSTRACTED FOR EASc AWTS OR OTHER RFCON EDEND AWERMI ES NOT SIICMM ON TIEF.AT AM)?N% SAME, IFAW MAY W )T fiE Sti()LM70NTHE SI�TCN 4.1 IN RU:2AUND PORTIONS OF FOOTINGS, FIMEAM S OR OTHER IMPROVEMENT VJER NOT LOCATED. S))FENCES TIES A, T lHE CVNrER NE DF'HE'FA.,::E 8.}Y34L-t£9'i'O Tl4); FALEOPTHESAVE <<".)E.EVA ONV°MEM SF5,+4rs47AREG�.,SEG.ClN NATt(yNA GEOCYe"7iCVERT7GL. O4T ldA (ice: tX_�.E OTHEifiM NOFED. E.)T?ICRE NO ASOVE?3R0l:NON%'Y .A:XMES%TS.^.TFEiaYKANTH05'c SH0I N. 9.t7tNS IJCT70NVEYtSfPORW2AOE PURPOSES ONLY, NOTTOBELSWFOR CDYSTRIIRFOSES (FLOOD ZONE INFORMATION) ZONE:. X._COMM: 120652 PANEL_12q§�' SUFFIX: 1_ DATE 41 T t-2 BASE; N__/, NOTE: DE1 ERMINA71ON OF FLOOD ZONE UNE. S 1ASRE BASED ON SC,AUNG OF FIRMA MAP LISTED ABOVE. NOTE ALL DEARNNS NEREON ARE BASED TO THE FLAT BEARING OF ON THE CENM LINE OF... ._.... PROPERTY LINE EASEMENTVIOLATIONS; =YES 09no APPARENT VISIBLE ENCROACNMENTIfx f:'ITES MIND COMENTS................._.................. . ..... _.. s � .....Cr � tV Q 11.3d'* Q C rn C) ,gyp < W ` LL v Q C 0.60 I Go Z O LL. li �! C� -> FNDJ.P.tf1 �__� LU a ci'U ftp > © L1J cc ....... CERTIFIED Tor � c C' I _ JUDO A. ABARCA. -� PREFERRED MORTGAGE LE.NDE'kS.00AUP tPd€ , SUCCEMORS ANDIOR AnGNS_ GUARANTY 'TRUST R JULE, WC. PC)R TY NATIONat. TTTLE 9ISURA,N,'CE COMPAN".1. ABBREYIA TION& SM1^AC� S&Gawa�. CSS< Cnresa: E�kaG Ssn:^.9src. ; :.p> Cyx!n lip rznrx. s"Lz Pr.E¢r;y L's,2, �)h %'DB`•Y Einx[[s.ti,'P=rx Fit,. e Y� t` W, RES. �.R' tip. hp< R@tSX, G z L'Htf ICA mCl ..+J' ,,0. c S ,. t3i'J=?T)T, cm YiBY. [k•, Rak'i^,$,"R - m, ^.A� Clef. _d On °Jcomp = FA;:KA&. fAc MaawreA, ,i'z- R1w a 01 E?Y:Rv Ett�aceu+mam.0 df Gm:7w'Lar,?SFH�A'4:P_ft.�8Cd5x., S= Set ,_ F -o Reap EtVmz V, Ofa —, % F' VWW Pa3R, OHP=t7. sxxsd Pt v�ti+c.Vdd=+Abtes Almrs. i'�P=VSbu,I9mvaeg� _.M.-F`,ezair_ M� . � F=MFEV FentE, P F:�.�' Fence. CtDd.E _ze Mti+t�pmza Eaaearrnt GM-E=zwfai Mwraena� csaemers;, td'.,. -.ek 1§alrNsic+rce faaenient M:E.• M�tenwtw E;a�eni. B.G=Elack. wrser., "^.G ='!7tt^t or C::rvgq;re, FP'{p.fea:iM1fl, i� II'#ti:: I,ienSGrvEct:. 1 DAWD L FUTCH REGISTERED LAND SURVEYOR S 4W STATE OF FLORIDA LB # DDOW, 4 vauDs SHEET 1 Or 1 oaw steal STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL, SYSTEM EXISTING SYSTEM AND SYSTEM REPAIR EVALUATION CONTRACTOR / AGENT 5�'� -b ... . t • • 0000 • • • • • • • • • ' .....'. •• • •• • LOT: BLOCK: SUBDIV: TO BE COMPLETED BY FLORIDA REGISTERED ENGINEER, DEPARTMENT EMPLOYEE, SEPTIC TANK CONTRACTOR OR OTHER CERTIFIED PERSON. SIGN AND SEAL ALL SUBMITTED DOCUMENTS_ COMPLETE ALL APPLICABLE ITEMS. COMPLETE TANK CERTIFICATION BELOW OR NOTE IN REMARKS WHY THE TANKS CANNOT BE CERTIFIED. EXISTING TANK INFORMATION GALLONS�I��PD ATU LEGEND: �� MATERIAL,: :�G BAFFLED: [Y / N� [ ] GALLONS SEPTIC TANK/GPD ATU LEGEND: MATERIAL: BAFFLED:[Y / N] [ ] GALLONS GREASE INTERCEPTOR LEGEND: MATERIAL: [ ] GALLONS DOSING TANK LEGEND: MATERIAL: # PUMPS:[ ] I CERTIFY THAT THE LISTED TANKS WERE PUMPED ON /Bjl(" G�i C-('c [UHAVE THE VOLUMES SPECIFIED AS DETERMINED BY DI FILLING / LEGEND ], ARE FREE OF OBSERVABLE DEFECTS OR LEAKS_ AND RAVE A_L. SOLaw-DEFLECTION DE �QUT+IL�TE! VICE ] INSAI��D)l� SIGNATURE OF LICENSED CONTRACTOR BUSINESS NAME DATE EXISTING DRAINFIELD INFORMATION [ )co ] SQUARE FEET PRIMARY DRAINFIELD SYSTEM NO. OF TRENCHES [ [ ] SQUARE FEET SYSTEM NO. OF TRENCHES [ TYPE OF SYSTEM: [ STANDARD [ ] FILLED [ ] MOUND [ ] CONFIGURATION: [ ] TRENCH ¢p] BED ( ] DESIGN: [] HEADER [ ] D-BOX [�pl GRAVITY SYSTEM ELEVATION OF BOTTOM OF DRAINFIELD IN RELATION TO EXISTING GRADE SYSTEM FAILURE AND REPAIR INFORMATION [ 1q*'D ] SYSTEM INSTALLATION DATE [ --bC) ] GPD ESTIMATED SEWAGE FLOW BASED ON SITE [ ] DRAINAGE STRUCTURES [ ] POOL CONDITIONS: [ ] SLOPING PROPERTY [ ] NATURE OF [ HY ULIC OVERLOAX[r ] SOILS FAILURE: [ ] INAGE / RUN OF ] ROOTS FAILURE ( ] S AGE ON GROUND ] TANK SYMPTOM: [ ] PLUMBING BACKUP ] REMARKS/ADDITIONAL CRITERIA S `T ' \u[ ] DIMENSIONS: ?c X to DIMENSIONS: X [ J DOSED SYSTEM INCHES ( ABOVE FLOW] TYPE OF WASTE [] DOMESTIC [ ) COMMERCIAL [ ] METERED 'WATER [I<jl] TABLE 1, 64E-6, FAC [ ] PATIO / DECK [] PARKING YD INTENANCE [ STEM D G -TER 'FABLE]BOX/HEADER [ ] DRAINFI D S(ov�s L-: -7` W.: �3-as :D1 SUBMITTED BY: TITLE/LICENSEp ( 3 DATE: DH 4015, 08/09 (Obsoletes previous editions which may not be used) Incorporated 64E-6.001, FAC Page 4 of 4 11 ---71�-- it tb �av C-S Notes Site Plan submitted by: r W (�C o- Plan Approved Not Approved Date gy County Health Department ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT DH 4015, 08/09 (Obsoletes previous editions which may not be used) Incorporated: 64E-6.001, FAC Page 2 of 4 (Stock Number: 5744-002-4015-6) Site Plan submitted by: r W (�C o- Plan Approved Not Approved Date gy County Health Department ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT DH 4015, 08/09 (Obsoletes previous editions which may not be used) Incorporated: 64E-6.001, FAC Page 2 of 4 (Stock Number: 5744-002-4015-6) •••• Mission: Tbpdect, promote & irrprokethe health of all people in Florida trough integrated , state, county & oomm* efforts. a_ x ... s HEALTH • • •••• •••••• •••••• •• •••••• • . • : • . Rlyk Scott • • Gp�,gppr • • • • . • •••• •••• • • Celeste Phi14,146, MPH • • Mato • • Geno a9J $cretary ..... ••..•• • Vision: To be the Healthiest State in the Nation • • • • • • • • ' • • • • • June 21, 2018 0 0• 00 Brick Paver Group 166 NW 98 Street Miami, FL 33150 RE: Modification to a Single Family Residence - No Bedroom Addition Application Document Number: AP1330429 Centrax Permit Number: 13-SC-1825642 166 NW 98 Street Miami, FL 33150 Lot: 4 Block: 2 Subdivision: Bonmar Park Dear Applicant, This will acknowledge receipt of a floor plan and site plan on 02/23/2018 for the use of the existing onsite sewage treatment and disposal system located on the above referenced property. NO OBJECTION Installation of pavers at driveway, walkway, front porch and to rear of property. A.E. This office has reviewed and verified the floor plan and site plan you submitted, for the proposed remodeling addition or modification to your single-family home. Based on the information you provided, the Health Department concludes that the proposed remodeling addition or modification is not adding a bedroom and that it does not appear to cover any part of the existing system or encroach on the required setback or unobstructed area. No existing system inspection or evaluation and assessment, or modification, replacement, or upgrade authorization is required. Because an inspection or evaluation of the existing septic system was not conducted, the Department cannot attest to the existing system's current condition, size, or adequacy to serve the proposed use. You may request a voluntary inspection and assessment of your system from a licensed septic tank contractor or plumber, or a person certified under section 381.0101, Florida Statutes. If you have any questions, please call our office at (305) 623-3500. :Strid ncere , V. Edwards Engineering Supervisor III Department of Health in Dade County Florida D•parbn•nf of N•aNh www.Dorldah•aNh.Dov in Dade County • - , Florida TWITTER:HealthyFLA PHONE: (305) 623-3500 FACEBOOK:FLDepartmentofHealth I YOUTUBE: Mon 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 20 I--� Master Permit NO!�S( 0 - 1 Sub Permit No. 'BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL PLUMBING ❑ MECHANICAL DPUBLICWORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: I ro & 'R G sA r-e-e-+ City: Miami Shores County: Miami Dade Zip: 3 3 1 50 Folio/Parcel#: 1 \ — 3 i ()1' 0 a (o- 001¢ 0 Is the Building Historically Designated: Yes NO ✓ Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): :' u11A �ag-C_E=_�_ Phone#: 20 - ; y J " b' 70 O Address: i 4P (; N UJ Ott �e�T City: State: L Zip: Tenant/Lessee Name: Phone#: Email: Ci';w-\e_ (��� iCKPavex—UCP•Gnrv► e r- �— CONTRACTOR: Company Name: Phone#: Address:: -�3J50 u1• City: State: F L Zip: 3 1 7a) Qualifier Name: J O uC c Cld ,r\ Phone#: O � - S4 1 7 0 0 State Certification or Registration #: F-O q OCR Certificate of Competency #: E O c� 0 0 t t !� DESIGNER: Architect/Engineer: Add ne#: City: State: Zip: Value of Work for this Permit: $ Square/Linear Footage of Work: ---+4-� C/ Type of Work: ❑ Addition ❑ Alteration ❑ New % Repair/Replace ❑ Demolition Description of Work: a u n o (2a U e- yS Specify color of color thru tile: Submittal Fee $ I'M, 0� Permit Fee $ Scanning Fee $ Technology Fee $ Structural Reviews $ Radon Fee $ Training/Education Fee $ CCF $ DBPR $ CO/CC $ Notary $ Double Fee $ Bond $ �(7Q (Revised 02/24/2014) TOTAL FEE NOW DUE $ 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 corimencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is i ued the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. j Signature _ Signature NERorAGENT CONTRACTOR The foregoing instrument was acknowledged before me this day of _5 c\yX k�s c- 20 1 as by i � k: ; c who is personally known to me or who has produced identification and who did take an oath. The foregoing inskrument was acknowledged before me this day of20 t ' by Pe c­,�, c,,,tr_t z, who is personally known to as me or who has produced identification and who did take an oath. NOTARY PU LIC: NOTARY PUB i ') Sign: Y��'ill Sign: 41 Print: Print: ,o;�PP� WENDY SOTO Seal: ;_�' e°:State of Florida -Notary Public Seal: *= Commission # GG 172254 My Commission Expires January 12.,2022 State of Florida -Notary Public Commission # GG 172254 My Commission Expires January 12, 2022 as X;;�' APPROVED BY 4711711'1 Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) 7/3/2018 Property Search Application - Miami -Dade County OFFICE OF THE PROPERTY APPRAISER Summary Report Property Information Folio: 11-3101-026-0040 Property Address: 166 NW 98 ST Miami Shores, FL 33150-1739 Owner J U LIO A ABARCA Mailing Address 166 NW 98 ST MIAMI SHORES, FL 33150 USA PA Primary Zone 0800 SGL FAMILY - 1701-1900 SQ Primary Land Use 0101 RESIDENTIAL - SINGLE FAMILY: 1 UNIT Beds / Baths / Half 2/1/0 Floors 1 Living Units 1 Actual Area Sq.Ft Living Area Sq.Ft Adjusted Area 1,115 Sq.Ft Lot Size 7,725 Sq.Ft Year Built 1940 Assessment Information Year 2018 2017 2016 Land Value4 $169,767 $169,767 $169,767 Building Value $101,744 $111,388 $112,894 XF Value $564 $574 $584 Market Value 1 $272,075 $281,729 $283,245 Assessed Value $198,156 $194,081L $190,090 Benefits Information Benefit Type 2018 2017 2016 Save Our Homes Cap Assessment Reduction $73,919 $87,648 $93,155 Homestead Exemption $25,000 $25,000 $25,000 Second Homestead Exemption $25,000 $25,000 $25,000 Note: Not all benefits are applicable to all Taxable Values (i.e. County, School Board, City, Regional). Short Legal Description I RESUB OF BLK 2 OF BONMAR PARK PB 42-59 LOT 4 BLK 2 LOT SIZE 75.000 X 103 OR 13579-876 0288 1 Generated On: 7/3/2018 Taxable Value Information 20181 20171 2016 County Exemption Value $50,0 00 $50,000 $50,000 Taxable Value $148,156 $144,081 $140,090 School Board Exemption Value $25,000 $25,000 $25,000 Taxable Value $173,156 $169,081 $165,090 City Exemption Value 1 $50,000 $50,000 $50,000 Taxable Value $148,156 $144,081 $140,090 Regional Exemption Value $50,000 $50,000 $50,000 Taxable Value $148,156 $144,081 , $140,090 Sales Information Previous Price OR Book- Qualification Description Sale Page j 10/25/2012 $245,000 28331-3749 Qua[ by exam of deed 06/04/2012 $100 28137-4443 Corrective, tax or QCD; min consideration 06/04/2012 $100 28137-4442 Corrective, tax or QCD; min consideration 06/04/2012 $135,000 28137-4440 Trustees in bankruptcy, executors or guardians The Office of the Property Appraiser is continually editing and updating the tax roll. This website may not reflect the most current information on record. The Property Appraiser and Miami -Dade County assumes no liability, see full disclaimer and User Agreement at http://www.miamidade.gov/info/disclaimer.asp Version 1 Construction radiesgua ifying Board INESS CERTIFICATE OF COMPETENCY E0900 i 15 r-r-NNA1` DEZ JOSE A Is certified under the Prams of Cha 10 M-Ct QUALIFYING TRADE(S) 0008 CONCRETE ENGINEER jW— H E.W, P E am Sec -1 t�,- Bo� mi6m 004059 Local Business Tax Receipt Miami -Dade County, State of Florida -THIS IS NOT A BILL - DO`NOT PAY LBT 6402341 BUSINESS NAME/LOCATION RECEIPT NO. EXPIRES BRICK PAVER GROUP INC RENEWAL SEPTEMBER 30, 2018 350 W PARK DR 101 6670435 Must be displayed at place of business MIAMI FL 33172 Pursuant to County Code Chapter 8A — Art. 9 & 10 OWNER SEC. TYPE OF BUSINESS BRICK PAVERZROUP'iNC 196 SPECIALTY ENGINEERING CONTRACTPAYnnENT RECEIVED EO9OO115 BY TAX COLLECTOR Worker(s) 1 $75.00 07/31/2017 .. FPPU08=17-009685 This Local Business Tax Receipt only confirms payment of the Local Business Tax. The Receipt is not a license, permit, or a certification of the holder's qualifications, to do business. Holder must comply with any governmental or nongovernmental regulatory laws and requirements which apply to the business:. The RECEIPT'ND: above must be displayed on all commercial vehicles - Miami -Dade Code Sec 8a-276. For more information, visit www miamidade.aov1I"QReaWr 017404 Municipal Contractor's Receipt Miami -Dade County, Stateof Florida -THIS I$ NOT A BILL- DO NOT PAY 6402341 M, C BUSINESS NAME/LOCATION RECEIPT NO. EXPIRES BRICK PAVER GROUP INC ' NEW SEPTEMBER 30,, 2018 350 W PARK DR 101 7516986_ Must be displayed at place ofbusiness MIAMI fL 33172 Pursuant to County Code Chapter 8A Art. 9 & 10 OWNER SEC. TYPE: OF BUSINESS IT BRICK PAVER GROUP INC MMC SPECIALTY ENGINEERING CONTRA#r' RECEIVED E0900115 AX COLLECTOR Category(s) 1 $175.00 09/20/2017 CHECK21-17-088476 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 N0, above must be displayed on all commercial vehicles —Miami -Dade Code Sec 8a-276. For more information, visit www miamidade,govhaxcoltector i°s.c..... �I�l:�►� DATE CERTIFICATE OF LIABILITY INSURANCE (MM/DDIYYYY) 07/03/18 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). _. __............... .... ..... .. _._ :' CONTACT ................. ____........ PRODUCER l.. NAME._ . Marcos Alvarez AX Excellence Insurance Agency PHONE 305 22 - A, Nol (-_.. ,xtl ( �) 63900 _ - __ F., )_ C .... _...._... E-MAIL 05 226 i 3801 SW 1 O7 Avenue _ ADDRESS, malvarez@Excellenceinsurance.net Miami, FL 33165 INSURERS) AFFORDING COVERAGE NAIC # _ I m_a ..__ _ ..._. . Phone (305) 226-3900 Fax (305) 226-3997 INSURER A; Nationwide (Allied Property & Casualty Ins Co) 42579 _ ..- . _ _�— __...._ . .... _..... —.........._.... INSURED INSURER B: National Liability & Fire Insurance Company 20052 Brick Paver Group Inc. And 2745-47 W 78 ST LLC INSURER C . 350 West Park Drive #101 —,INSURER D Miami, FL 33172 305-554-6570 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 . GENERAL LIABILITY PE OF INSURANCE ,INSR _W,�1 ,D_ , POLICY NUMBER tMMIDD/YYYY}, tMMIDDIYYYY] LIMITS _ BILITY I ...-... N.. I i EACH OCCURRENCE $ 1,000,000.00 DAMAGE TO RENTED 100,000.00 COMMERCIAL GENERAL LIABILITY ( j PREMISES (Ea_occurrencel $_, ... I CLAIMS -MADE ❑d OCCUR I ACP 3007879830 MED EXP (Any one person) $ 5,000.00 A n Y Y 08/21/201708/21/201$ PERSONAL & ADV INJURY $ 1,000,000.00 ❑ ` GENERAL AGGREGATE I $ 2,000,000.00 GEN'L AGGREGATE LIMIT APPLIES PER ,'! PRODUCTS COMP/OP AGG $ 2,000,000.00 r POLICY FV] PRO..._ .❑ LO_C ... $ ... . ANY AUTO �.. _......._...... ......—.........-. _... :.................................—.. __.. BODILY NJtURY(Perperso. .0 AUTOMOBILELL LIABILITYBILITYIMI SCHEDULED $ 1,000,000 QQ B ❑ AUTOS ❑ AUTOS Y , Y ?ACP3007879830 08/21/2017 OS/21/ZO18 BODILY INJURY (Per accident; i $ HIRED AUTOS I� NON -OWNED PROPERTY DAMAGE ❑ AUTOS ` (PeraccldenU I $ ❑V Collison _yri UMBRELLA LIAB OCCUR -f xcess LACP 3007879830 A EIAB _ U CLAIMS MADE Y LJ _DED ❑ RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ' ANY PROPRIETOR/PARTNER/EXECUTIVE V9WC799401 B OFFICER/MEMBER EXCLUDED? -1N / A Y (- (Mandatory in NH) YY If yes, describe under A !CONTRACTORS EQUIPMENT Y Y 'ACP 3007879830 Como/Coll Deductible 1 $ 1.000.00 EACH OCCURRENCE $ 3,000,000.00 08/21/2017 08/21/2018 1' AGGREGATE $ 3,000,000.00 WC STATU OTH C!ORY 1 1MITs ..1 09/07l2017 109/07/2018 E L. EACH ACCIDENT „ $ 1,000,000.00 W—__...�..—....—.—.. E L. DISEASE - EA EMPLOYE4 $ 1,000,000. 00 E,L.DISEASE-POLICY LIMIT' $ 1,000,000,00 08/21/2017 ; 08/21/2018 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Contractor license #EO900115 CERTIFICATE HOLDER Miami Shores Village Building Department 100500 NE 2nd Ave Miami Shores, FL 33138 CANCELLATION $10,000,00 CANCELLED BEFORE 1VERED IN CORD .,CORPORATION. All rights reserved. ACORD 25 (2010J05) QF r '',1 Frame and logo are registered marks of ACORD Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-310573 Permit Number: DS-7-18-1823 Scheduled Inspection Date: September 21, 2018 Permit Type: Driveways/Sidewalks/Slabs Inspector: Naranjo, Ismael Owner: ABARCA, JULIO Job Address:166 NW 98 Street Miami Shores, FL Project: <NONE> Contractor: BRICK PAVERS GROUP Building Department Comments INSTALLATION OF PAVERS Inspection Type: Final Work Classification: Addition/Alteration Phone Number (305)733-2893 Parcel Number 1131010260040 INSPECTOR COMMENTS False Phone: (305)591-8700 Inspector Comments Passed CREATED AS REINSPECTION FOR INSP-307845. Not ready. Failed Correction ❑ C� Needed Re -Inspection ❑ Fee No Additional Inspections can be scheduled until re -inspection fee is paid. September 20, 2018 For Inspections please call: (305)762-4949 Page 14 of 21