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DS-06-23-1651Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Permit NO.: DS-06-23-1651 Permit Type: Driveways/Walkways/Slabs,- Work Classification: Addition/Aiterdtion Permit Status: Approved issue Date:08/07/2023 Expiration: 02/07/2024 Location Address Parcel Number 1284 NE 92ND ST, Miami Shores, FL 33138 1132050270520 Contacts ARLEEN POITIER Owner ALL FLORIDA CONSTRUCTION COMPANY Contractor 1284 NE 92 ST, MIAMI SHORES, FL 331382937 CHARLES EDWARD SR JOSEPH 3701 W MCNAB RD E-365, POMPANO BEACH, FL 33069 Business: 3057997507 zaragozi@bellsouth.net Inspection Requests: i Description: INSTALLATIN OF CONCRETE PAVERS ON CIRCULAR Valuation: $ 16,000.00 n DRIVEWAY 1305-702-4949 y. Total Sq Feet: 2,000.00 s Fees Amount Application Fee - Other $50.00 CCF $9.60 Concrete/asphalt/pavers, slabs, dways, $125.00 swalks DBPR Fee $2.63 DCA Fee $2.00 Education Surcharge $4.80 Planning and Zoning Review Fee $70.00 Scanning Fee $15.00 Technology Fee $17.50 Total: $296.53 Payments Date Paid Amt Paid Total Fees $296.53 Credit Card 08/07/2023 $246.53 Credit Card 06/30/2023 $50.00 Amount Due: $0.00 Building Department Copy In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: certify that all the foregoing information is accurate and that all work will be done in complian a with all applicable laws regulating constructi n zoning. Futhermore, I authorize the above named con ctor to do the work stated. Authorized Si t e: Owner / Applicant / Contractor / Agent Date August 07, 20# Page 2 of 2 Miami Shores Village Building Department Julv 30 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 B INSPECTION LINE PHONE NUMBER: (305) 762-4949 FBC 20 BUILDING Master Permit No.'VS —00 4z — tbs�' PERMIT APPLICATION Sub Permit No. OBUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 1284 NE 92 STREET City: Miami Shores County: Miami Dade Zip Folio/Parcel#:11-3205-027-0520 Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder):JOSEPH W POITIER & W ARLEEN L Phone#:786-251-5155 Address:1284 NE 92 STREET City: MIAMI SHORES State: FL Zip: 33138 Tenant/Lessee Name: Phone#: Email: juliogonzalez9707@gmail.com CONTRACTOR: Company Name: ALL FLORIDA CONSTRUCTION CO Phone#: (305) 799-7507 Address: 3701 W MCNAB ROAD, SUITE E-365, POMPANO BEACH, FL 33069-4937 Email: _allfloridaconstructionco yahoo.com Qualifier Name: CHARLES E. JOSEPH, SR. Phone#: (305) 799-7507 State Certification or Registration #: CGCO05798 Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: $16,000.00 Square/Linear Footage of Work: 2,000SF Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: INSTALLATION OF CONCRETE PAVERS ON CIRCULAR DRIVEWAY Specify color of color thru tile: Submittal Fee $ 130` Permit Fee $ [On- o*3 CCF $p_ l • (Q(0 CO/CC $ Scanning Fee $ ,.Do DCA Fee $ 2-�� DBPRR $ Notary $ Technology Fee $ 11- 5u Training/Education Fee $ A- - 60 Double Fee $ Structural Reviews $ P&Z Review $ ,QOc7 Bond $ TOTAL FEE NOW DUE $ (Revised04/05/2022 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. t Signature `� v � Y h OWNER or AGENT The foregoing instrument was acknowledged before me this day of IJAAE. 20 ashi by © y who is personally known to me or who has produced IQbL as identification and who did take an oath. NOTARY PU LIIC: Sign: Print: i Seal: �otN'y ►ue,�c JORGE MANUEL ZARAGOZI * Commission # HH 084026 t Expires January 24, 2025 N�IFo vop��� Bonded Thru Budget Notary Services Signature CO TOR The foregoing instrument was acknowledged before me this —�—day of 20 by whrs-06rsonally known to me or who has produced as identification and who did take an oath. NOTARY PUB111� Fvo�\�� Sign: Print: �,C�,e�„1� Seal: JORGE MANUEL ZARAGOZI �,OY,?ue,,o Commission # HH 084026 ** Expires January 24, 2025 Ro Bonded Thru Budget Notary Services Ff F APPROVED BY 'Z�Z? Plans Examiner 10 Zoning D -!1z z-3 Structural Review Clerk (Revised04/05/2022) PREPARED BY: AINL 3 0 2023 -4� 0\ DECLARATION OF USE Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 KNOW ALL MEN BY THESE PRESENTS: WHEREAS, the undersigned JOSEPH W POITI ER & W ARLEEN L is/are the fee simple owner(s) of the following described property ('Property") situated and being in Miami Shores Village, Florida: Lot(,) 15 & 16 Block 3 of BAY LURE Page of the Public Records of Miami -Dade County, Florida, (address) (Subdivision), according to the plat thereof, as recorded in the Plat Book 1284 NE 92 ST MIAMI SHORES, FL 33138 and WHEREAS, the undersigned owner(s) have sought certain development approval from Miami Shores and are providing this document in consideration thereof and to induce the Village to grant same: agree: NOW, THEREFORE, for good and valuable consideration, the receipt and sufficiency of which is acknowledged, the undersigned do(es) hereby declare and 1. That the Property will not be used in violation of any ordinance of Miami Shores Village or Miami -Dade County now in effect or hereinafter enacted. 2. That the property will be used for a single family residence only. 3. That he/she will not convey or cause to be conveyed the title to the above property without requiring the successor in title to abide by all terms and conditions set forth herein. FURTHER, the undersigned declare(s) that this covenant is intended and shall constitute a restrictive covenant concerning the use, enjoyment and title to the above Property and shall constitute a covenant running with the land and shall be binding upon the undersigned, his/her successors and assigns and may only be released by Miami Shores Village, or its successors, in accordance with the codes, rules and regulations of said Village then in effect. IN WITNESS WHEREOF, the undersigned has/have caused-, /, T= hand(s) and seal(s) to be affixed hereto on this � day ofS/� 2012b . WITNESS(ES) OWNERS: Signature_ `_ Signature and Print Vt-4N2= and Print Signature and Print STATE OF FLORIDA COUNTY OF MIAMI-DADE Signature and Print I HEREBY CERTIFY that on this day personally appeared before me who is personally known to me or has produced /=7L b�=-/v� —y- �i h V =C (type of identification) as identification and he/she acknowledge that he/she executed the foregoing, freely and voluntarily, for purposes therein expressed. SWORN TO AND SUBSCRIBED before me on this IV day of 20Q3 My commission expires: 2o1r?;r,Pue<,c JORGE MANUEL ZARAGOZI * Commission # HH 084026 Expires January 24, 2025 NOTARY PUBLIC, STATE OF FLORIDA N9rFor F`o�o Bonded Thru Budget Notary Services ; 1� RCS logo I-,LI - \LOR Miami shores Village Building Department 10050 N.E.2nd Avenue 'y Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 SURVEY AFFIDAVIT STATE OF (FLORIDA) COUNTY OF (DADE) The undersigned Affiant, JOSEPH W POITIER & W ARLEEN L —does hereby attest that (Property owner) ! The attached survey, performed by vE-,76- (Name of surveyor's company) For address: 1284 NE 92 STREET MIAMI SHORES, FL 33138 Performed on llgyl (date of survey) is an accurate representation of the existing conditions and locations of all structures on the property as of this date. The purpose of this Affidavit is to induce Miami Shores Village to issue a building permit for the property without first providing a survey less than seven (7) years old old. The Affiant, as property owner, further agrees to remove or obtain permits for any structures which now may exist on the property which are not permitted or which may violate zoning or building code regulations. The Affiant further understands that the existence of any such structures may affect final inspections as applicable to this or other permits. Further Affiant say eth naught. Property Owner Signature Property Owner Print Name SWORN TO AND SUBSCRIBED before me this D 1 day off Affiant is personally known to me, ""� produced as identificatio . otpgv rue�c JORGE MANUEL ZARAGOZI a commission # HH 084026 * Expires January 24, 2025 Notary Revised on 5/22/2009/ Revised on 6/12,109 N9 ORP`®���e PACOTWQwBetNotarySWIM ti IAI�17> 1-Z SCALD: J_ 61- D' S. I. P. = S e t - r o n i�ibuao777 �14J_6� AA WIn F. 1. P. = Foun r d on pip P.C.P. = Permanent Control Point C.B.S. = Concret e Block Stucco JUL d cc C" 0 o u) E Q) A 39 27 cD T= cE Re- Residen,ce t4. 7 cl. clear \J M 1�/ C Air Conditioner �5 7 �5 �6 W co LIJ Arc ta 7. cr) Del Radius P C1) (J) n Altim. = Alii.minum. (2 J -Z Centerli— t? 0/- e-l C. LvA _51 Bench Mark N.G.V. National Geodetic Vertical z M. S. L = 'lean Sea Level 0 3 'RES V11 I A G _ Fli-on M I S F.F.EL. Fin J' sh F.00r Elevat CITY CC)�'Y vy % ie BLJC+ \/YORKS REVIEW W1 DATE q co S V. �e 3' J b.. r 'z Miami ores Vl�la ge e Building , Bu g Zoning Depot. Date Building Dept. to Subject to compliance with all Fled ral State and County rules and regulations, NOTE: THIS SURVEY IS COMPOSED OF MULTIPLE SHEETS AND ONE IS NOT VALID WITH OUT THE OTHERS SEE SHEET 1 FOR CERTIFICATION. ORIGINAL SIGNATURE AND RAISED SEAL. to C'4 0LL Cq W W C6 L'_, 0, U) V) Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Expiration: 02/07/2024 Location Address Parcel Number. 1284 NE 92ND ST, Miami Shores, FL 33138 1132050270520 Contacts ARLEEN POITIER Owner ALL FLORIDA CONSTRUCTION COMPANY Contractor 1284 NE 92 ST, MIAMI SHORES, FL 331382937 CHARLES EDWARD SR JOSEPH i 3701 W MCNAB RD E-365, POMPANO BEACH, FL 33069 Business: 3057997507 zaragozi@bellsouth.net Inspection Requests: Description: INSTALLATIN OF CONCRETE PAVERS ON CIRCULAR Valuation: $ 16,000.00 949 DRIVEWAY 305 762 4 Total Sq Feet: 2,000.00 i Fees Amount Education Surcharge $4.80 Public Works Permit Fee $100.00 Scanning Fee $15.00 Technology Fee $10.00 Total: $129.80 Payments Date Paid Amt Paid Total Fees $129.80 Credit Card 08/07/2023 $129.80 Amount Due: $0.00 Building Department Copy In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS AFFID V l I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating constr c 'o and zoning. Futhermore, I authorize the above Pmed contractor to do the work stated. Authorized i ature: Owner / Applicant / Contractor / Agent Date August 07, 2023 Page 2 of 2 _ 0 � 2 T n T Miami Shores Village JUL 0 5 Public Works Department JUL (305)795-2210 11 'r Public works forms are available from the building department, 10050 NE 2"d Ave., Miami Sho yFL 33138 44A PUBLIC WORKS PERMIT APPLICATION Permit Type: Work in the Right -of -Way on Miami Shores Village or Miami -Dade Property Permit#: p ,geJ&',>3I&Sfd Name of Applicant (if utility see below):"V;�.�L-7- Owner off the following described property: Legal Description: Lot ,ce& Block _t�5 Subdivision '�'Vaz Folio #; ,//46, dC? -7 — D 4: _-)-b / Address: /13OR d Alu J 9;4rx_..5cr. UTILITY NAME: Qualifier/Authorized Agent: Address: City: Telephone: State Certification or Registration #: CONTRACTOR NAME: Qualifier/Authorized Ag nt: Addres _--�;. City: Email: State: e: Certificate of Competency # Telephoner - Email: 44WIxile ufi fi State Certificatio or Registration #: �,�'" Certificate of Com N Requests permission to install Sdescribe work, attach separate page if necessary) in the adjoining right of way: .iJL01 e-.¢•tr> OA ✓lzr— d, ", ✓o LC za 4 Type of Work: / Paving ❑ Utility ❑ Landscape ❑ Antenna DESIGNER: Architect/Engineer: Address: City: Telephone: Registration #: State: Email: ❑ Sidewalk ❑ Electric ❑ Irrigation ❑ Other: ZIP: Value of Work for this Permit: $ lG�. //r1dz Square/Lineal Footage of Work: pro C ***** Fees ***** Permit Fee $ 100.00 Notary $ Training/Education $ 0.20 Technology Fee $ 0.80 Scanning $ Bond $ (if required) Total Fee Now Due $ Q IPdt� Bonding Company's Name (if applicable): Bonding Company's Address: City: State: ZIP: Application is hereby made to obtain a public works permit to do the work in the right of way 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, regulation construction in this jurisdiction. I understand that separate permits must be secured for APPLICANT'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with applicable laws regulating construction and specifically construction in the right-of-way. "WARNING TO APPLICANT: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO THE RIGHT-OF-WAY. 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 public works permit with an estimated value exceeding $2,500, 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 the 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 public works permit is issued. in the absence of such posted notice, the inspection will not be approved and a reinspection will be charged. Signature %;_ Applicant or,Authori ed Agent The foregoing instrument tiara§ acknowledged before me this t•� day of20 by is identification. or,rVho has produced i as Signature Company/Utility Agent The foregoing instrument was acknowledged before me this day of . 20 by w1lo - - is personally known to me or who has produced as identification. Sign: Sign: �o�trY-Pua,�c JORGE MANUE Print: Com-.Hss'ion#HH084026 print: SEAL: N„ a� Erpirss.anu SEAL: ��oFF�°P B�edT�Budget NOLVYSwim APPROVED BY: tA—,3 Public Works Director, or Designee 2017-04-15 Miami Shores Villa g I Public Works Depart t JUL 0 5 '1­'02-3 tl (305)795-2210 By Public works forms are available IICI!lllillllllllli I!II! II!II!IIII IIII IIII C-1—'!}I 2i_125R04-5Z3Z3 I I OR Bh. .j.j775 P9 2476 (1P9si) fUAN r f r�Li_ir I_E_I,!i; OF I. IT': t:[il-i1;'"r i::f1i"li' I H°Crl._L.Eh: from the building department, 10050 NE 2nd Ave.; Miami Shores, FL 33138 STATE OF FLORIDA, COUNTY OF MIAMI-DADE I HEREBY CdR'rIFY that thi is a true copy of the -_-.--r C:r Ir ;,, fwc nffice n� day of COVENANT OF CONSTRUCTION WITHIN RIGHT OF WA Whereas, (hereby referred to as the owner) JOSEPH W POITIER & Of the following described property: Legal Description: Lot 15 & 16 Block 3 Subdivision BAY LURE Address: 1284 NE 92 STREET MIAMI SHORES, FL 33138 _, AD 20 Seal. Lt and County Courts CLERK C'�\ 10 U N 3 C oa_• ' LEEIv - lessie Merritt Folio #; 11-3205-027-0520 Requests permission to install (describe work, attach separate page if necessary) in the adjoining right of way: INSTALLATION OF CONCRETE PAVERS ON CIRCULAR DRIVEWAY IN CONSIDERATION of the approval of this permit by the village, the owner agrees as follows: 1. To maintain and repair, when necessary, the above -mentioned item(s) installed within the dedicated right of way. If it becomes necessary for Miami Shores Village or Miami -Dade County to make repairs or maintain said items within the public right of way including restoration of the street by reason of the Owner's failure to do so, such expense shall be paid by the Owner or shall constitute a lien against the above described property until paid. 2. The owner does herby agree to indemnify and hold Miami Shores Village or Miami -Dade County harmless from any and all liability, which may rise by virtue of permitting the installation of these items within the public right of way. 3. The Owner does hereby agree to remove or relocate their facilities at their own expense, within 14 days' notice by the Village to do so. Failure to comply with this notice will result in the Village causing the item(s) to be removed and a lien being placed on the property and/or assessed against the Owner for all costs incurred in the removal and disposal of the item(s). 4. The undersigned further agrees that these conditions shall be deemed a covenant running with the land and shall remain in full force and effect and be binding on the undersigned, their heirs and assigns until such time as this obligation has been cancelled by an affidavit filed in the Public Records of Miami -Dade County, Florida by the Village Manager of Miami Shores Village (or his fully authorized representative). f�( Signature `�� Owner or Aduthorized Agent State of County of The foregoi�g instrument was acknowledged before me this.-;' i day of 120 ' , , by who is personally known to me or who has produced r -4 1 r- •>' } as identification. NOTARY PUBLIC: Sign: Print:SEAL Pue,,o JORGE MANUEL ZARAGOZI 2o-0v Commission # HH 084026 r oe Expires January 24, 2025 9TPpF F�OQ' Bonded Thru Budget Notary Services Documents are recorded at the Clerk of the Courts, MIAMI-DADE COUNTY RECORDER, COURTHOURSE EAST, 22 N.W. First Street, 1 st Floor, Miami, FL 33128. 2017-04-11 Miami Shores Village - BUILDING DEPARTMEI I 10050 NE 2 Ave Miami Shores, FL 33138 �I 305-795-2204 www.msvfl.gov JUN 3 0 2U23 11 By Contractor Registration Form BusinessName: ALL FLORIDA CONSTRUCTION CO Address: 3701 W McNAB ROAD, SUITE E-365 POMPANO BEACH FL 33069-4937 Phone:( 305 ) 799-7507 _ E-mail: allfloridaconstructionco@yahoo.com Qualifier Name: CHARLES E_JOSEPH, SR. Qualifier Lic Number: CGCO05798 Contractor may register license and insurance information with the Village on an annual basis. The initial fee will be $50 with an annual update fee of $30. Contractors that elect not to maintain their information on file will need to provide their information with each permit applied for. Please confirm if you would like to register your Contractor for a fee of $50. A FLORIDA STATE CERTIFIED CONTRACTOR: A. _ X Copy of Local Business Tax Receipt B. X Copy of Qualifier State Licenses C. X Copy of Liability Insurance* D. X Copy of Workers Compensation Insurance* Provide proof that the contractor has secure compensation for its employees as required under section 105.3.5 of the 61" edition to the 2017 F.B.C. (Workers Compensation FEIN EXEMPTION must have Notice to Owner form and Contractor Affidavit) A MIAMI DADE COUNTY CONTRACTOR: A. Copy of Certificate of Competency of Qualifier B. Copy of Local Business Tax Receipt C. Copy of State Registered Contractor Licenses or Miami Dade County Municipal Contractor's Tax Receipt, D. Copy of Liability Insurance* E. Copy of Workers Compensation Insurance* Provide proof that the contractor has secure compensation for its employees as required under section 105.3.5 of the 6" edition to the 2017 F.B.C. (Workers Compensation FEIN EXEMPTION must have Notice of 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. r� TOE Ron DeSantis, Governor STATE OF FLORIDA Melanie S. Griffin, Secretary DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD THE GENERAL CONTRACTOR HEREIN IS CERTIFIED UNDER THE PROVISIONS OF CHAPTER 489, FLORIDA STATUTES JOSEPH, CHARLES EDWARD SR ALL FLORIDA CONSTRUCTION COMPANY 3701 WEST MCNAB RD SUITE 0-216 POMPANO BEACH FL 33069 LICENSE NUMBER: CGCO05798 EXPIRATION DATE: AUGUST 31, 2024 Always verify licenses online at MyFloridaLicense.com 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 LOCAL BUSINESS TAX RECEIPT 115 S. Andrews Ave., Rm. A-100, Ft. Lauderdale, FL 33301-1895 — 954-831-4000 VALID OCTOBER 1, 2022 THROUGH SEPTEMBER 30, 2023 DBA: ALL FLORIDA CONSTRUCTION COMPANY Receipt #:GENE38RALCONTRACTOR (GENERAL Business Name: Business Type:CONTRACTOR) Owner Name: CHARLES E JOSEPH SR Business Opened:o8/25/2004 Business Location: 3701 W MCNAB RD STE E-365 State/County/Cert/Reg:CGC005798 POMPANO BEACH Exemption Code: Business Phone: 7542348897 Rooms Seats Employees Machines Professionals 1 For Vending Business Only Number of Machines vo.,.Ii.... Tun — Tax Amount Transfer Fee NSF Fee Penalty Prior Years Collection Cost Total Paid 27.00 0.00 0.00 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 -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: ALL FLORIDA CONSTRUCTION COMPANY Receipt #WWW-21-00257119 3701 W MCNAB RD STE E-365 Paid 09/15/2022 27.00 POMPANO BEACH, FL 33069 2022 - 2023 BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT 115 S. Andrews Ave., Rm. A-100, Ft. Lauderdale, FL 33301-1895 — 954-831-4000 VALID OCTOBER 1, 2022 THROUGH SEPTEMBER 30, 2023 DBA: ALL FLORIDA CONSTRUCTION COMPANY Receipt#:180-308650 Business Name: Business Type: GENERAL CONTRACTOR (GENERAL CONTRACTOR) Owner Name: CHARLES E JOSEPH SR Business Opened: 08/25/2004 Business Location: 3701 W MCNAB RD STE E-365 State/County/Cert/Reg:CGC0o5798 POMPANO BEACH Exemption Code: Business Phone: 7542348897 Rooms Seats Employees Machines Professionals 1 Signature For Vending Business Only Tax Amount I Transfer Fee NSF Fee I Penalty Prior Years Collection Cost I Total Paid 27.001 0.001 0.001 0.00 0.001 0.001 27.00 Receipt #WWW-21-00257119 Paid 09/15/2022 27.00 ,a`oRo� CERTIFICATE OF LIABILITY INSURANCE DATE(MWDDrrCM 06/27/2023 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 have ADDITIONAL INSURED provisions or 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 Finney Insurance Corporation 5601 Sheridan Street Hollywood, FL 33021 CONTACT NAME: Monica Mendez a/co"Iv EXt: 954-966-5533 p� No; 954-989-8208 E-MAIL ADDRESS: monicam@finneyinsurancecorp.com INSURER 5 AFFORDING COVERAGE NAIC# INSURERA: Evanston Insurance Company 35378 INSURED INSURER B : All Florida Construction Company 12080 SW 127TH AVE SUITE B-1 #223 Miami, FL 33186 INSURERC: INSURERD: INSURERE: INSURER F : COVERAGES CERTIFICATE NUMBER: OnO05353-25d2573 RFVICI0N1 NUMBER: 794 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 INSD UBR WVD POLICY NUMBER MM/DD MMIDD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE 41 OCCUR 3AA583506 07/14/2022 07/14/2023 EACH OCCURRENCE $ 11000,000 DAMAGE 11 Ea occu ence $ 100,000 -PREMISES MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 AGGREGATE LIMIT APPLIES PER: POLICY a JE � LOC GENERAL AGGREGATE $ 2,000,000 GENT PRODUCTS - COMP/OP AGG $ 2,000,000 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY Per accident ( ) $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE Per acc dent $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED RETENTION $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? N / A _ STATUTE EERH E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ (Mandatory In NH) If yes, describe under E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached N more space is required) CERTIFICATE HOLDER CANCELLATION Miami Shores Village Bldg Dept 10050 NE 2 Avenue Miami Shores, Florida 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 // U 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Printed by MIM on 06/27/2023 at 12:58PM ACORO® CERTIFICATE OF LIABILITY INSI 2023 DATE(MMIDD/YYYY) 07/03/2023 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO TS UPON -THE CERTIFICA HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER T E COVERAGE AFF BY HE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BE EWZK€�1 IG I AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or 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 Finney Insurance Corporation 5601 Sheridan Street Hollywood, FL 33021 CONTACT NAME: Monica Mendez AID"Ne Ext: 954-966-5633 Ac` No: 954-989-8208 E-MAIL ADDRESS: monicam@finneyinsurancecorp.com INSURERS AFFORDING COVERAGE NAIC # INSURERA: Evanston Insurance Company 35378 INSURED All Florida Construction Company 12080 SW 127TH AVE SUITE B-1 #223 Miami, FL 33186 INSURERB: Retail First Insurance Co. 10700 INSURERC: INSURERD: INSURERE: INSURER F : COVERAGES CFRTIFICATF NIIMRFR: 00005353-2542573 REVISION NUMBER: 261 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 CONTRACTOR 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. IN SR LTR TYPE OF INSURANCE ADDL INSD SUER WVD POLICY NUMBER POLICY EFF MMIDD/YYYY POLICY EXP MMIDD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE Ik OCCUR 3AA583506 07/01/2023 07/01/2024 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES Ea occurrence $ 100.000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 POLICY JE O LOC OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ ANY AUTO BODILY INJURY (Per accident) $ OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED RETENTION $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY N ANY PROPRIETOR/PARTNER/EXECUTIVE YIN OFFICER/MEMBER EXCLUDED? (Mandatory in NH) N / A 07/01/2023 07/01/2024 PER52040265 X STATUTE OERH E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYE $ 1,000,000 E.L. DISEASE -POLICY LIMIT $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached ff more space is required) Charles E. Joseph, Sr - CGCO05798 CERTIFICATE Hni nFR CANCELLATION Miami Shores Village Bldg Dept 10050 NE 2 Avenue Miami Shores, Florida 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 /11 1_ `A�- lcJ"lytitf-LU70Al.VftUl.Vf[f•'VfctatlVlY. f�unynwreaCrveu. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Printed by MIM on 07/03/2023 at 1:35PM WE JIMMY PATRONIS CHIEF FINANCIAL OFFICER STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION * * CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW * * CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law. EFFECTIVE DATE: 1/27/2023 PERSON: CHARLES E JOSEPH SR FEIN: 650327731 BUSINESS NAME AND ADDRESS: ALL FLORIDA CONSTRUCTION COMPANY 7360 55 AVE E BRADENTON, FL 34203 EXPIRATION DATE: 1/26/2025 EMAIL: CEJOSEPHO@GMAIL.COM This certificate of election to be exempt is NOT a license issued by the Department of Business and Professional Regulation. To determine if the certificate holder is required to have a license to perform work or to verify the license of the certificate holder, go to www.myfloridalicense.com. IMPORTANT: Pursuant to subsection 440.05(13), F.S., an officer of a corporation who elects exemption from this chapter by filing a certificate of election under this section may not recover benefits or compensation under this chapter. Pursuant to subsection 440.05(11), F.S., Certificates of election to be exempt issued under subsection (3) apply only to the corporate officer named on the notice of election to be exempt. Pursuant to subsection 440.05(12), F.S., notices of election to be exempt and certificates of election to be exempt shall be subject to revocation if, at any time after the filing of the notice or the issuance of the certificate, the person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate. The department shall revoke a certificate at any time for failure of the person named on the certificate to meet the requirements of this section. DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT E01658556 QUESTIONS? (850) 413-1609 RULE 69L-6.012, F.A.C. REVISED 01/2023 AI-4.:-- 4. r% Iwi_ _� FiUM'3 0 2023 1 A Miami shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 WVV - VVU1lijIa %#Uilipunsativn insurance txemotion Florida Law requires Workers' Compensation insurance coverage under Chapter 440 of the Florida Statutes. Fla. Stat. § 440.05 allows corporate officers in the construction industry to exempt themselves from this requirement for any construction project prior to obtaining a building permit. Pursuant to the Florida Division of Workers' Compensation Employer Facts Brochure: An employer in the construction industry who employs one or more part-time or full-time employees, including the owner, must obtain workers' compensation coverage. Corporate officers or members of a limited liability company (LLC) in the construction industry may elect to be exempt if: 1. The officer owns at least 10 percent of the stock of the corporation, or in the case of an LLC, a statement attesting to the minimum 10 percent ownership; 2. The officer is listed as an officer of the corporation in the records of the Florida Department of State, Division of Corporations; and 3. The corporation is registered and listed as active with the Florida Department of State, Division of Corporations. No more than three corporate officers per corporation or limited liability company members are allowed to be exempt. Construction exemptions are valid for a period of two years or until a voluntary revocation is filed or the exemption is revoked by the Division. Your contractor is requesting a permit under this workers' compensation exemption and has acknowledge that he or she will not use day labor, part-time employees or subcontractors for your project. The contractor has provided an affidavit stating that he or she will be the only person allowed to work on your project. In these circumstances, Miami Shores Village does not require verification of workers' compensation insurance coverage from the contractor's company for day labor, part-time employees or subcontractors. BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. Signature: PJ(T�e,�, Owner State of Florida County of Miami -Dade The foregoing was acknowledge before me this day of V i/A)2E7 , 20 a BY who is personally known to me or has produced Piro - Z il - © as identification. Notary: —t- SEAL: �,0y ?ua, JORGE MANUEL ZARAGOZI + * Commission # 1111084026 F7MM rhru ®udget Notary Services