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DEMO-1-17-228, 910 NE 99th St`SNORes r,� Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 LVFNi N 8 .. FtoRioA Permit No. DEMO-1-17-228 Permit Type: Demolition Permit Work Classification: Plumbing Permit Status: APPROVED Project Address Parcel Number 910 NE 99 Street 1132060143410 Miami Shores, FL 33138- Block: Lot: Owner Information Address HANS & URSULA KRAUSE 910 N 99 Street MIAMI SHORES FL 33138- 910 N 99 Street MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone BRANCHING OUT INC (305)258-8101 Type of Demo: Plumbing Additional Info: WASDA TO REMOVE WATER METER AFTER D Classification: Residential Scanning: 1 Fees Due CCF DBPR Fee DCA Fee Education Surcharge Jmn Permit Fee Scanning Fee Technology Fee Total: Issue Date: 2/3/2017 1 Expiration: 08/02/2017 Applicant HANS & URSULA KRAUSE Cell (305)751-6529 Valuation: $ 100.00 Total Sq Feet: 0 Pay Date Pay Type Amt Paid Amt Due Invoice # DEMO-1-17-62758 02/03/2017 Check #: 10295 $ 58.60 $ 50.00 01/27/2017 Check #: 10296 $ 50.00 $ 0.00 Available Inspections: Inspection Type: Final Review Plumbing 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 an"oning. Futhermore, I authorize the above -named contractor to do the work stated. i-- February 03, 2017 Authorized Signature: Owner / Applicant / Contractor / Agent Date Building Department Copy February 03, 2017 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 FBC 20 0 Master Permit No. -blfrY10 1(0 — 33 8!S� Sub Permit No. T-�)fXr') () 19 .-.2 ZU ❑ REVISION ❑ EXTENSION [—]RENEWAL OPLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 910 NE 9th Stret City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: 1 1-3206-014-3410 Is the Building Historically Designated: Yes NO X Occupancy Type: Load: Construction Type: Flood Zone: BFE: FIFE: OWNER: Name (Fee Simple Titleholder): Hans Krause Phone#: 305.751.6529 Address:4720 N Bay Road City: Miami Beach State: FL Zip: 33140 Tenant/Lessee Name: Email: CONTRACTOR: Company Name: Branching Out Address: 23300 SW 134th Avenue City: Homestead State: FL Pho n e#: Qualifier Name: Steven Hurst Phone#: State Certification or Registration #: CFC057075 Certificate of Competency #: _ DESIGNER: Architect/Engineer: Phone#: 305.258.8101 Zq�4- - S--'��5�s Zip: 33032rl'��G Address: City: State: Value of Work for this Permit: $ Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace Description of work: WASDA to remove water meter after demolition is complete Specify color of color thru tile: Submittal Fee $ Jy PMb Permit Fee $ %f%© CCF $_ Scanning Fee $ ± Radon Fee $ 2 DBPR $ Technology Fee $ • 30 Training/Education Fee $ Structural Reviews $ �o . J 2 Notary $ Double Fee $ Zip: N Demolition CO/CC $ Bond $ TOTAL FEE NOW DUE $ �V (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 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. Signature Signature OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this 2 day of �61A(AC--,( U , 20 A—f by who is personally known to me or who has produced identification and who did take an oath. NOTARY PUBLIC: Sign: The foregoing instrument was acknowledged before me this 7 i day of IOLAOCAN. 120 1-'r , by 5VRL)L �\Vssv as me or who has produced who is personally known to identification and who did take an oath. NOTARY PUBLIC: Sign: as Print: Print: orpp•..y �,�,�,r pp•••, crista Stefanick Seal: __: �pmmis510n#FF085515 Seal: _:COm6WOn#FF085515 y Expires: FEB. 03, 2018; Expires: FEB. 03, 2018 '•;;;�op{v,0. yyWW AARONNOTARY.com NZ WWW,AARONNOTARY=n ************************************************************************************************************ APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) Miami s .•- Building ,g , j, ,.. i w . 1' 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CONTRACTORS' REGISTRATION IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: A. COPY OF QUALIFIER'S STATE LICENCES B. COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF LIABILITY INSURANCE* D. COPY OF WORKERS COMPENSATION INSURANCE* (Workers Compensation EXEMPTION must have NOTICE TO OWNER form and Contractor Affidavit) IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY: A. COPY OF CERTIFICATE OF COMPETENCY OF QUALIFIER B. COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF STATE REGISTERED CONTRACTOR LICENSE OR MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT, D. COPY OF LIABILITY INSURACE* E. COPY OF WORKERS COMPENSATION INSURANCE* (Workers Compensation EXEMPTION must have NOTICE TO OWNER form and Contractor Affidavit) *YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE AS FOLLOW: Certificate Holder: MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES, FL 33138 Certificate must specify the description of operations or contractor license number. oseeosssossas■■soasaaaeossssarsea■sossesseoassavosse®®so w s®aosssaessoessesa000s®®osos000ee BUSINESS NAME: c. BUSINESS ADDRESS: Z33U6 6W 04- k-k CITY )�04/P--' Qu� _ STATE �� ZIP BUSINESS PHONE: ( ) N 1U t FAX NUMBER ( ) CELL PHONE (} QUALIFIER'S NAME: S�tOt 1 4u<St` QUALIFIER'S LIC NUMBER: C C 0 S -+D4S STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487-1395 2601 BLAIR STONE ROAD TALLAHASSEE FL 32399-0783 HURST, STEVEN HOWELL BRANCHING OUT INC 23300 SW 134 AVE HOMESTEAD FL 33032 Cone~;tulations! With this license you become one of the nearly one million Floridians licensed by the Department of Business and Professional Regulation. Ourprofessionals and businesses range from architects to yacht brokers, from boxers to harbeque restaurants, and they keep Florida's economy strong. Every day we work to improve the way we do business in order to serve you better. For information about our services, please log onto www.myfloridalicense.com. There you can find more information about our divisions and the regulations that impact you, subscribe to department newsletters and learn more about the Department's initiatives. Our mission at the Department is: License Efficiently, Regulate Fairly. We constantly strive to serve you better so that you can serve your customers. Thank you for doing business in Florida, and.congratulations on your new license! RICK SCOTT, GOVERNOR CFC0571 STATE OF FLORIDA DEPARTMENT OF EUSINESS AND PROFESSIONAL REGULATION CFC057075 .''ISSUED: 07/19/2016 CERTIFIED PLUIf 91141' CONTRACTOR HURST, STEVEN:HOV&L BRANCHING OUT INC IS CERTIFIED under the provisions of Ch.489 FS. Expiration date : AUG 31, 201 a L1507190001019 DETACH HERE KEN LAWSON, SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD i Ere rLUIVI[51IVla I-U1N I MAU I UK Named below 13 CERTIFIED Under the provisions of Chapter 489 FS, Expiration date: AUG 31, 2018 HURST, STEVEN HOWELL BRANCHING OUT INC 21355 SW 192ND AVE. MIAMI FL 33187° ISSUED: 07119/2016 DISPLAY AS REQUIRED BY LAW a A SEQ # L1607190001019 OWNER SEC. TYPE OF BUSINESS BRANCHING OUT INC PAYMENT RECEIVED 196 PLUMBING BY TAX COLLECTOR CONTRACTOR 75.00 07/15/2016 Worker(s) 10 CFC057075 0223-16-00f?20 Trus local Business Tax Receipt only con°mis payrrent of the local Bust new Tax. The R ceipt is not at icense, perni t, or a anti ^cation cf the hot does quaff i "cations, to do bust nes& Hdder nest cone y with any goverrvmntel ornongovemrrental regulatory laasandrequirerreMswhichapply tothe business. The REC8PT NQ above crust be displayed an Ell comr ercial vehicles - Mtani-0sde Q)de Sec 8a-716, M®t�ioE Far more i nform3b on, vi sit wrw-wmartidade-gpv/�axcd lector ACORO® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDNYYY) 1/23/2017 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 CONTACT Claudia Sacasa NAME: PC FAX No E:t: (305)247-5121 AC No: (305)248-6543 Brown & Brown Of Florida, Inc. dba T.R. Jones & Co. E-MAIL csacasa@bbinsfl.com ADDRESS: 1780 N Krome Ave INSURERS AFFORDING COVERAGE NAIC # INSURERA:Crum & Forster S2ecialty Insurance 44520 Homestead FL 33030 INSURED INSURERB:PlaZa Insurance Company 30945 INSURERC: Branching Out, Inc. INSURER D: 23300 S.W. 134th Avenue INSURER E : INSURER F: Homestead FL 33032 COVERAGES CERTIFICATE NUMBER:2016 MASTER GL,BA, XS 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 SUBR POLICY NUMBER POLICY EFF N MMIDDYYY POLICY EXP W MMIDDIYV LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS -MADE X❑ OCCUR DAMAGE TO RENTED PREMISES Ea occurrence $ 50,000 MED EXP (Any one person) $ 5,000 EPK-115006 12/1/2016 12/1/2017 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY ❑ JET LOC PRODUCTS - COMP/OPAGG $ 2,000,000 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,000 BODILY INJURY (Per person) $ B I ANY AUTO ALL OWNEDL SCHEDULED AUTOS AUTOS PALGmiO01704-00 12/1/2016 12/1/2017 BODILY INJURY (Per accident) $ Per acPROPERTY DAMAGE c ident $ NON -OWNED HIRED AUTOS AUTOS Medical payments $ 5,000 UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 3,000,000 AGGREGATE $ 3,000,000 A X EXCESS LIAB CLAIMS -MADE DED I X I RETENTIONS 10,000 $ EFX-106507 12/1/2016 12/1/2017 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN PER OTH- STATUTE_ I ER E.L. EACH ACCIDENT $ ANY PROPRIETORIPARTNERlEXECUTIVE OFFICER/MEMBER EXCLUDED? a N I A E.L. DISEASE - EA EMPLOYE $ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT S A Contractors Pollution Liab EPK-115006 12/1/2016 12/1/2017 OCCURENCE LIMIT 1,000,000 Errors & Omissions GENERAL AGGREGATE 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Steven Hurst CFC# CFC057075 GtK I IFIL;A I t MULLJtK Village of Miami Shores 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 s Jones Jr./CLR ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) INS025 (201401) The ACORD name and logo are registered marks of ACORD CERTIFICATE OF LIABILI --[- Date1/13/2017 TYINSURANCE Producer: Plymouth Insurance Agency 1 2730 U.S, Highway 19 N. This Certificate is issued as a matter of information only and confers no rights upon the Certificate Holder. This Certificate does Hciliday, FL 34691 not amend, extend or after the coverage afforded by the policies Wow. (727) 938-5562 Insurers Affording Coverage NAIC # Insured: South East Personnel Leasing, Inc. & Subsidiaries Insurer A: Lion Insurance Company 2739 U-S. Highway 19 N, Insurer Ek Holiday, FL 34691 insurer C: Insurer D: insurer E: Coverages - ed tu lh. ta t, polic:,'i Of liill- belm' [­_n.ssi C tu 1h. i�,swe� r,amsct Zbove !or !he Polcy p�,,Iod indic� 1 wth­p�r,l'. �r; .lay ch lhis mrtifwl(i may bPissuad or pertain, afforded by Ille policies deso"Wa herein is all the telcrl.� exclusions. per in rl�urlirl: fro, rop"Ir"'n"I ZEI-11 1, Wild linn of mi�r corivacter,in,? decume, ' t exclusions, fzpp i-nos si-.0mi may ravi, beer, reduced by paid claims. 7", a and coricitions of such polides. ,gg,sgolls En !s - fINSR Li R 11,15RD Type of Insurance Policy Number Polley Effective licy Expiration Date Date Limits (MPAIDDrYY) (.V1M/0DNY) GENERAL LIABILITY Commercial General Liability Each Occunrenas '0 ' p o' Claims Made 0 Occur , Damage to rented premises, fEA "' p'en"'ea 'EA eau enw) A Sleneral aggregate limit applies per: Personal Ad-v Injury Policy Projeol 0 0 Genera! Aggregate Products Comot0o Agg 5 AUTOMOBILE LIABILITY Caintirled Singie Limit Any Auto TA Accident) A Owned Autos Bodily I—.Nry Schtldtf!ed Autos (Per Person) Nixed Autos Bodily 1n)ury Non Ow—d Autos {Par Accl-dent) Property Damage EXCESSIUMBRELLA LIABILITY (Per Accident) Each Occurrence Occur 0 Claims Mane L_J Aggregate Diofuclibria A Workers Compensation and WC 71949 011101/2017 01101/2018 pry_ Employers' Liability is t_imits E.L. Each Accident Any proprietor/partnedexecutive officedmernber excluded? No E.L, Disease Ea Employee I If Yes, describe under s . Pd eal provisions below. Iii,000,000 E.L. Disease Policy Limits Other -Lion Insurance Comp"n is A.M. Best Company rated A- (Excellent). AMB # 12616 .,bd­l by E,,d—il. -..jSp —1-1 Pr—lits. 0'ent ID: 92-68-659 Coverage only apples to active employee(s) of South East Personnel Leasing, Tric. & Subsidiaries that are Ieased to the following "Client Company': aranchIng Out Inc, Coverage only app'Jen; to injuries incurred by South Cast Personnel Leasing, Inc. & Subsidiaries active employee(s), while working In: FL, Coverage does not appy to statutory employee(s) or independent contractor(s) of the Client Company or any other entity. A list c"the active em.ployee(s) ;eased to the Client Company Can be obtained by faxing a request to (727) 937-2133 or by calling (727) 936-5562, Project Name: ISSUE 61-13-17 (1`0) CERTIFICATE i(OLDE.R CANCELLATION VfLA.LGE OFIMLAMI SHORES Snowid any of the obeys described policies be cancelled befc.st the exP: tion date thereof, the issuing in(a sures ' -will andatswW to mall 30 days -fitten notice to tne ciertficate tu�de, named to the left, but failure to do so shall impose no obligation or flablifty of any kind upon the insurer, As agents or repre, s. 10050 NE 2ND AVENUE FL 33138