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CC-11-236INSTALL STRUCTURAL STEEL SPEAKERS STAND FOR MAS NOTIFICATION SYSTEM ON ROOF. Passed eiy Inspector Comments CREATED AS REINSPECTION FOR INSP- 157646. 0-7 Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled re- inspection fee is paid. until Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 i nspection Number: INSP - 157724 Permit Number: CC -2 -11 -236 I Inspection Date: March 29, 2011 Inspector: Bruhn, Norman Owner. , BARRY UNIVERSITY Job Address: 11300 NE 2 Avenue Library Miami Shores, FL 33138 -0000 Project: BARRY UNIVERSITY Contractor: NEW LIVING CONSTRUCTION INC Building Department Commen March 29, 2011 For Inspections please call: (305)762 -4949 Permit Type: Commercial Construction Inspection Type: Final Building Work Classification: Alteration Phone Number Parcel Number 1121360010160 -03 Phone: (954)237 -4731 Page 1 of 1 6KA19/06 Tomorrow's Solution for Today's Buildings U. 8. Patent Na 8A93E27 U.S. Palest Na 6.768.838 DESCRIPTION: The CHEMCURB SYSTEM replaces old -style met pitch pans with versatile, precast components pourable sealants that can usually be i under 15 minutes —and never require mechanical attachment. Designed for use Iated modified bitumen, and asphalt and B.U.R. Also specified for PVC, EPDM, PIB and single ply roofing (Must use Chem LinkTPO Pri with TPO.) When installed properly, this system for a durable, waterproof rubber seal around penetra- tions of any size. A 10 -year warranty against leaks is activated with submittal of completed card. The ChemCurb System has three components: (1) CHEMCURB exterior forms: rings /straights/comers (2) M-1® Structural Sealantfor bonding /sealing /priming. (3) 1-PART'" moisture cure pourable sealer, or PRO PACK"' two -part urethane pourable sealer. CHEMCURB precast forms are composed of gray polyester resin. Round curbs have an inside diameter of 7.5 or 5 inches. 12- and 6 -inch straight curbs are available to extend the round curbs, and to combine with comer curbs to form rectangular seals. All pieces are two inches high. The curved outer sur- faces are impervious to ice, corrosion, UV (ultraviolet Tight) and ponding water. M-1 Structural Sealant is a durable, self - fixturing, moisture cure mastic. Two cartridges of gray M-1 are supplied in each kit and carton of ChemCurbs. 1 -PART is a Tight gray, highly flexible, self- leveling moisture cure pourable sealer that eliminates mix- ing. It is also 100% solid rubber, will not melt or shrink, and is resistant to deterioration. Supplied in 28-oz.cartridges or two -liter pouches (four to a Field Pack).Unused sealer can be capped and reused. PRO PACK is a black, two -part urethane pourable sealer designed for self - leveling, horizontal applica- tions. When properly mixed, it cures to a tough, waterproof rubber mass with excellent low tempera- ture elasticity and adhesion. Pro Packis 100% solid urethane rubber. It is thermosetting (will not melt) and will not shrink. Also highly resistant to weather- ing, joint movement, water and ice. Supplied in pre - measured one - gallon kits. Chem Link® li Advanced Architectural Products er CHEMCURB SYSTEM" Penetration Seals TECTSRVE MAR 1 8 2011 S ' LLATION: Structural Sealant is use d °bond` rb forms firmly in place on the roof surface, se of the penetration and the outside , and to prime the penetration(s). able sealer or PRO PACKis poured curb, orming a 2 -inch deep waterproof al. One gallon (or two pouches) fills two h or six 5 -inch ChemCurb rings. AUTION: Pipes and penetrations should be steel brushed to remove plastic cement and asphalt. SPECIAL CHARACTERISTICS: • Rapid installation— reduces labor significantly. • Excellent adhesion to most roofing materials. • No flashing or mechanical attachment required. • Flexible to minus 40 degrees F. Stable to 200 degrees F. • 1 -PART accommodates movement. Use on all granulated membranes and details with excessive movement. RESTRICTIONS: • Do not apply below 30 degrees. • Do not apply PRO PACK if rain is expected within four hours. • Do not use on Hypalon or smooth APP modified bitumen membrane. For smooth APP, melt down an overlay of granulated APP before installation. • Must use Chem Link TPO Primer for TPO membrane. Made in U.S.A. 353 E. Lyons Street • Schoolcraft, MI 49087 800 -826 -1681 • www.chemlinkinc.com • FAX: 269 -679 -4448 NARONAL Tim CONTRACTORS MEMBER » an 7.5" i.d. Curb 7.5" i.d. Curb with Straights Ahern Link® Advanced Architectural Products Coin Dr( A/ CHEMCURB SYSTEM'" CHEMCURB Straights 6" & 12" straight sections used to lengthen the CHEMCURB. Fit both curb sizes. C 1= 1 Aerial View Corner Curbs & Straights 12 "ugh' Penetration Pourable Sealer Pipes & HBeam 12"Straight CHEMCURB Corners corner pieces used with straight sections to make box shapes 5" i.d. Curb ComerPiece 5" i.d. Curb with Straights Use either 1- PARemoisture cure pourable Sealer or PRO PACK K Tm two -part urethane pourable sealer. (1 -PART with "P" Curbs shown.) Contractor Hot Line 800 -826 -1681 www.chemlinldnc.com NOTICE OF COMMENCEMENT A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION OF FLORIDA, COUNTY OF DADE PERMIT NO. /,: TAX FOLIO NO STATE OF FLORIDA: COUNTY OF MIAMI -DADS» 1. Legal description of property and street/address: 2. Description of improvement 3. Owner(s) name and address STATE i HERESY CERTIFY that this is copy of the owns' raga to this office on day of WITNESS my HARVEY THE UNDERSIGNED hereby gives notice that improvements will be made to property and in accordance with Chapter 713, Florida Statutes, the following information Is provided In this Notice of Commencement 1111111111 11 1111111111 11111 1111111111 1111 1111 CFN 2011R0147947 OR Bk 27608 P9 3547; Ups) RECORDED 03/07/2011 15:12:13 HARV'E'Y RUVIt4r CLERK OF COURT MIAMI -DADE C :OUNTYr FLORIDA LAST PAGE AD2o // and Carly OM* .1 d.C. Space above reserved for use of recording office 1130°M. Zr A MIW' L CGtoria, 33 t mwtyjr T 41Lli fir Interest in property: Name and address of fee simple titleholder: 4. . - address S. Surety: (Payment bond required by owner from contractor; if any) Name, address and phone number Amount of bond $ 6. Lender's name and address 7. Persons within the State of Florida designated by Owner upon whom notices or other documents may be served as provided by Section 713.'13(1)(a)7., Florida Statutes, Name, address and phone number: 8. In addition to himself. Owners designates the following person(s) to receive a copy of the .Tenor's Notice as provided in Section 713.13(1)(b), Florida Statutes. Name, address and phone number. 9. Expiration date of this Notice of Commencement (th ecplratlon date Is 1 year1mmt a data of reaording unto s a SHterent date Ig spedbed) WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART I, SECTION 713.13. FLORIDA STATUTES, AND CAN 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 COMMENOEMENT. Signature(s) of Owner( s) Print Name Title/Office t/ STATE OF FLORIDA COUNTY OF MIAMI -DADE T f � �t AI Individually, or as NV Personally known, or 0 s) or •. r Authorized Officer/Director/Partner/Manag - Prepared By .. S Print Name WO sj4es s col • /n1 Title/Office ,Einzmortmasir Under penalties of perjury, I declare that l have read that the facts stated in it are true, to the best of my owledged before me this t day of for Signature(s) of • l ` er(s)'s Authorized Officer /DIrector/Partner//Maanager who signed above: By 123.01.52 1 3/10 fearbJA2y /L produced the following type of identification Signature of Notary Public: Print By BUILDING PERMIT APPLICATION FBC 20 Is Building Historically Designated YES Contractor's Company Name 146W UVttC, COlsiSTQ4Crl Contractor's Address 3S E . &AU4NDA(; t3Ec1 BIN. City It ALLANDAL - State Contact Phone 3 0 5 7 Y 'yy Architect/Engineer's Name (if applicable) NO Double Fee $ Violation date: Structural Review. $ 45e. �s4JfCNCi1 17e�• pro t Miami Shores Village Building Department Phone # 9 Ati FEB 1 1 2011 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 1 !� Permit No. CC 6 tC 4 Master Permit No. Permit Type: BUILDING ROOFING Owner's Name (Fee Simple Titleholder) Barry University Phone # Owner's Address 11300 NE 2 Ave City Miami Shores State FL Zip 33138 Tenant/Lessee Name Phone # Email Job Address (where the work is being done) 11300 tIE grid AV - LI g1 AOY µ+4s 1 stator. City Miami Shores Village County Miami -Dade Zip FOLIO / PARCEL # 11- 2136 - 000 -0050 Flood Zone Phone # 9. 237. (('1 3 05 -- 1(e 1-- ' -'-1' - H — oLL Zip 73OV�. Qualifier Name Phone # State Certificate or Registration No. ( LS ) % j ® Certificate of Competency No. ++��� E -mail Newavii/ti ;ouono & 6 /1,41. co r� Value of Work For this Permit $ �' i e00 , 0 0 Square / Linear Footage Of Work: Type of Work: DAddition ['Alteration ❑New ❑ Repair/Replace 0 Demolition Describe Work: £i STALL S MC"i'r112AL T a � s1 D Ep -,c 41 1J NIL - ******** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** F * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** o‘ Submittal Fee $ 3� , Permit Fee $ 076nC( CCF $ CO /CC $ Notary $ Training/Education Fee $ Technology Fee $ Scanning $ Radon $ DPBR $ Bond $ Total Fee Now Due $ See Reverse side - Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State 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 ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and 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 a reinspection fee will be charged. 0 411. Signature Owner or Agent 1 Bk The foregoing instrument was acknowledged before me this day of Cg uA'h/ , 20 , by BRAC GDUJAILP who is personate known to me or who has produced As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commiss APPROVED BY (Revised 07/10/07X Revised 06/10/2009) Engineer Signature Contractor The foregoing instrument was acknowledged before me this 11+4 day of Feb roe .y ,2011 ,byDMi No" who is personally known to me or who has produced d e I %PP It c tr S as identification and who did take an oath. NOTARY PUBLIC: Plans Examiner Zoning Clerk checked 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 15 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 INSR SUBR WVD POLICY NUMBER ; (954) 943 -5050 1 No): (954) 942 -6310 POLICY EFF (I461/DDIYYYY) POLICY EXP (MMIDD/YYYY) LIMITS NAIC 0 A GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY OCCUR INSURER C: CPS1312839 INSURER D : 1/22/2011 1/22/2012 EACH OCCURRENCE $ 1,000,000 X DAMAGE TO RENTED PREMISES (Ea occurrence) $ 100,000 CLAIMS -MADE X MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GENT_ AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP /OP AGG $ 2,000,000 3 ---- d POLICY J a LOC $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS COMBINED SINGLE UNIT (Ea accIderd) $ BODILY INJURY (Per person) $ BODILY INJURY (Peracciderd) $ PROPERTY DAMAGE (Per accident) $ $ $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DEDUCTIBLE RETENTION $ $ $ WORKERS COMPENSATION AND EMPLOYERS LIABILITY ANY PROPRIETORIPARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? (Mandatory In NH) D yes, OF OPERATIONS Y N / A I WC STATU- OTH- TORY LIMITS ER EL EACH ACCIDENT $ I I EL DISEASE - EA EMPLOYEE $ below EL DISEASE - POLICY UNIT $ DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, K more space Is required) Miami Shores Village Building 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 Frank Furman, Jr /LT .i£ A� °® CERTIFICATE OF LIABILITY INSURANCE 2�i DNY ) THIS CERTIFICATE 1S 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 Frank H. Furman, Inc. 1314 East Atlantic Blvd. P. 0. Box 1927 Pompano Beach FL 33061 cmtrAcT Lisa 0' Brien ; (954) 943 -5050 1 No): (954) 942 -6310 A DDR t ESS: i lisa @furman nsurance. com ADDRESS, CUSTOMER m� 00005835 INSURER(S) AFFORDING COVERAGE NAIC 0 INSURED New Living Construction Inc 1835 East Hallandale Beach Blvd Suite 426 Hallandale Beach FL 33009 INSURER A :Scottsdale Insurance Co (bw) INSURER B : INSURER C: INSURER D : INSURER E : INSURERF: COVERAGES CERTIFICATE HOLDER ACORD 25 (2009/09) INS025 (200909) CERTIFICATE NUMBER:2011 -2012 Term REVISION NUMBER: CANCELLATION ©1988 -2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 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. ALEX SINK CHIEF FINAiNCIAL OFFICER EFFECTIVE DATE: 09/13/2010 EXPIRATION DATE: 09/12/2012 PERSON: DAIN DMITRIY P FEIN: 203075304 BUSINESS NAME AND ADDRESS: NEW LIVING CONSTRUCTION INC 1835 EAST HALLADALE BEACH BLVD # 426 HALLADALE FL 33009 SCOPES OF BUSINESS OR TRADE: 1- GENERAL CONTRACTOR IMPORTANT: Pursuant to Chapter 440. 05114). F.S., an off icer 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 Chapter 440.05(12), F.S., Certificates of election to be exempt... apply only within the scope of the business or trade listed on the notice of election to be exempt. Pennant to Chapter 440.05113), F.S., Notices of election to be exempt end certificates of election to be exempt shell 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 seats the requirements of this section for issuance of a certificate. The department shall revoke a certificate at any time fer failure of the person nand on the certifimae to meet Me requirements of this section. QUESTIONS? (850) 413-1809 DWC -252 CERTIFIrATE OF ELECTION TO BE EXEMPT REVISED 09 -06 ALEX SINK 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: PERSON: FEIN: BUSINESS NAME AND ADDRESS: NEW LIVING CONSTRUCTION INC 1835 EAST HALLADALE BEACH BLVD SUITE 426 HALLADALE BEACH FL 33008 SCOPES OF BUSINESS OR TRADE: 1- CERTIFIED GENERAL CONTRACTOR OWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 09 -06 07/28/2009 EXPIRATION DATE: 07/28/2011 GIOIA JAMES 203075304 07 -27 -2010 07 -28 -2009 IMPORTANT: Pursuant to Chapter 440 . 0504), F.S., an off of a corporation who elects exemption from this chapter by 1IMug a certificate of election under this section may not recover benefits or compensation ender this chapter. Pursuant to Chapter 440.05(12), F.S., Certificates of election to be exempt... apply only within the scope of the business or trade listed on the notice of election to be exempt Porstanl to Chapter 440.05119), F.S., Notices of eleclioa to be exempt and certificates of election to be exempt shall be subject to revocation if, at any time aster the tiling of the notice or the issuance of the certif icate, the person earned on the notice or certif(cas 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. QUESTIONS? (850) 413 -1609 ROOF REPAIRS AFTER INSTALLATION OF MASS NOTIFICATION STRUCTURAL UNIT ON LIBRARY ROOF Passe Inspector Comments CREATED AS REINSPECTION FOR INSP- 157471. CREATED AS REINSPECTION FOR INSP- 157205. CREATED AS REINSPECTION FOR INSP- 156472. Not Ready No access. NB C Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled re- inspection fee is paid. until Inspection Number: INSP - 157723 Permit Number: RF -2 -11 -334 Inspection Date: March 29, 2011 Inspector: Bruhn, Norman Owner. , BARRY UNIVERSITY Job Address: 11300 NE 2 Avenue Library Miami Shores, FL 33138 -0000 Project: BARRY UNIVERSITY Contractor: KUYOC ROOFING INC Building Department Comments March 29, 2011 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 For Inspections please call: (305)762 -4949 Permit Type: Roof Inspection Type: Final Roof Work Classification: Repair Roof Phone Number Parcel Number 1121360010160 -03 Phone: (954)675 -1709 Page 1 of 1 f BUILDING PERMIT APPLICATION FBC 20 Permit Type: BUILDING OWNER: Name (Fee Simple Titleholder): 1' /i( rU ` e i Phone #: Address: 1/3eO /47E 20-0,- e / Ci ty f/ ! s Ft- e S State: � Zip: 33/6 6 / � Tenant/Lessee Name: Phone #: Email: JOB ADDRESS: City: Miami Shores County: Miami Dade Zip: FoliofParcel #: Is the Building Historically Designated: Yes Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 LTelt (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 Permit No."Cs' CONTRACTOR: Company Name: C` OC `CVJ. 1 1; , \C_. Phone #: bS R 1 Address: 11 Q7_ t1 E �g C \JQ City: 1 .-V -af\410 Se. PO J\ - State: f i-- Qualifier Name: LoCQ1, - 7 od c.>-o State Certification or Registration #: C-C. \;.29i.:1- L Certificate of Competency #: Contact Phone #: ( I 7 - 0 e i Email Address: DESIGNER: Architect/Engineer: Phone #: Value of Work for this Permit: $ Type of Work: ❑Address Description of Work: 4 0-00-0-° Square/Linear Footage of Work: ❑Alteration ❑New j " epair/Replace NO Flood Zone: Master Permit No. Zip: 33°6 `1 Phone #: CG ) V 9 \�1� = o y©CSOO ►(\ Ga( FEB2 ?Ill CCF $ CO /CC $ ❑Demolition COLOR THROUGH ROOF TILE IS REQUIRED acknowledged by: ********* **** ***** * ********** **** ** * * **F ********** ********* * *********** ** **** * *** ** Submittal Fee 5 Penult Fee $ /vo Scanning Fee $ Radon Fee $ DBPR 5 Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ S0 4 4, 0 % • • $ 1 ?. 0 • ' TOTAL FEE NOW DUE $ 0' 4 Bonding Company's Name (if applicable) Bonding Company's Address City Statc Zip Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State 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 ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and 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 appro. and a reinspection fee will be charged. Signature Sign: Print: My Commission Expi APPROVED BY Owner or Agent The foregoing instrument was acknowledged before me thi day of Mq1411, 20 , by c g ebtoAratt s' who is personally known to me or who has produced As identification and who did take an oath. NOTARY PUBLIC: , t, YfrtYu tY4e* *eY7Y4e, Yx **drvr*ir9r+: *nhhsir +}s4dr4kdr9c *sY* a+rardear3r irie****eF,4kek*iireU*s+ ** +u*'** Plans Examiner )2i � J t / 2..prtructural Review (Revised 07 /10 /07XRevised 06 /10/2009)(Revised 3/15/09)(rev6/4/10) Signature Contractor The foregoing instrument was acknowledged before me this 13 day of W- , 20 tO , by L CUNZO TCd tLe who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: „✓� C.F - Print: C.10kc S5� My Commission Expires: Y: 9t*** *tYicic* ,YieaVir,Y,YaYaYsYsY,Ya ****k Zoning Clerk THIS IS TO CERTIFY THAT THE POUCIES 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 POUCIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LINTS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAMS. LU K R TYPE OF INSURANCE ADDLSUBR Adak oftW - 'sai POLICY NUMBER (MMIDDN� POLICY EXP UM ITS A GENERAL LIABILITY N INSURED KUYOC ROOFING CORP 3020 NE 26th Ave LIGHT HOUSE PT, FL 33064- (954) 675-1709 NS1207171 0910 09129f2011 EACH OCCURRENCE $ 300,000.00 le COMMERCIAL GENERAL LIABILITY • • CLAIMS -MADE n OCCUR ❑ PREMISES (Ea occurrence) PREMISES S (Ea $ 100,000.00 MED EXP (Arty one person) $ 5,000.00 PERSONAL & ADV INJURY $ 300,000.00 • GENERAL AGGREGATE $ 300,000.00 GEM. AGGREGATE UMIT APPLIES PER T POUCY • P ELT • LOC PRODUCTS - COMP/OP AGG $ 300,000.00 $ AUTOMOBILE LIABILITY ❑ ANY AUTO CO SINGLE LIMIT $ BODILY INJURY (Per person) $ ALL OS • A WNED SCHEDULED • AUTO UTOS BODILY INJURY (Per scalded) $ • HIRED AUTOS • AUTOS ED pip p��y pgMq (Per �rde nU GE $ • In $ • UMBRELLA LIAB El OC(uR ❑ EXCESS LIAR ❑ CLAMS-MADE EACH OCCURRENCE $ AGGREGATE $ • DED ❑ RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y 1 N ANY PROPRIETOR/PARTNERTE<ECUBVE N 1 A ❑ TTORY LtM ■ &H- E.L. EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? (Mandatory In NH) EL DISEASE - EA EMPLOYE $ If yes, describe under DESCRIPTION OF OPERATIONS below EL DISEASE - POLICY UMIT $ DESCRIPTION OF OPERATIONS 1 LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remade; Schedule, If more mace Is required) I Miami Shores Village 10050 NE 2nd Ave 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 Adak oftW - 'sai A 9 CERTIFICATE OF LIABILITY INSURANCE � '°' DAT 02/16/11 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 certmcate holder is an ADDITIONAL INSURED, the policyties) 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 Express Service Insurance Agency 900 E. Atlantic Blvd. #10 Pompano Beach, FL 33060 Phone (954)943-7900 Fax (954)943-1810 CONTACT ((Am ro Eno, (954)943-7900 1 mac. Not (954)943-1810 ADDROR expnass@express4u.net INSURERS) AFFORDING COVERAGE NAIC a INSURER A : United States Liability Insular= INSURED KUYOC ROOFING CORP 3020 NE 26th Ave LIGHT HOUSE PT, FL 33064- (954) 675-1709 INSURER B: INSURER C: INSURER D: INSURER E: INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: CERTIFICATE HOLDER ACORD 26 (2010105) QF CANCELLATION © 198 2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAD SHOULD ANY OF ME ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE TTHE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MALI_ 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. IIM TYPE OF INSURANCE POLICY NUMBER P AT S MMI D R Y i n n ln U ITS GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY I CLAIMS MADE OCCUR EACH OCCURRENCE $ FIRE DAMAGE (Any One Fire) $ MED EXP (My one person) $ PERSONAL & ADV INJURY $ GENERALAGGREGATE $ GEM AGGREGATE APPLIES PER POLICY n 7 n LOC PRODUCTS - COMP /OP AGG $ AUTOMOBILE LIAB ILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS C OMBINED SING LIMB (Ea acddeM) $ BODILY INJURY (Perp ) $ BODILY INURY (Peracdent) $ PROPERTY DAMAGE (Per aedera) $ GARAGE LIABILITY ANY AUTO AUTO ONLY- EA ACCIDENT $ OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS UABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE RETENTION $ _ $ $ A WORKERS COMPENSATION AND EMPLOYERS'W481UTY I97C77779991701 04/01/2010 04/01/2 X I ma vT A i lu i6I 1 FR EL EACIi ACCIDHYf $ 1000000 EL DISEASE -EA EMPLOYEE $ 1000000 ELDISEASE -POLICY UNIT $ 1000000 OTHER 3 _ LIMITS $ LIMITS $ lit iron ur urtetwWNW-MA rrorvmvEnIa ab axcLwiuwa nuurst UT ervuw mr70Tis�tuwti rrcowaraMIs 1. This certificate remains in effect, provided the client's account is in good standing with Aspen Staff Leasing, Inc.. Coverage is not provided for any employee for which the client is not reporting wages to Aspen Staff Leasing, Inc.. Applies to 100% of the employees of Aspen Staff Leasin ; Inc. leased to KOYOC ROOFING CORP, effective 04/01 /2010. 2. Insured is afforded Workers Compensation & Employers liability as a co- employer under the policy for employees leased from Aspen Staff Leasing, Inc.. ** *PLEASE SEE ATTACHED EMPLOYEE ROSTER. * ** MIAMI SHORES VILLAGE*** 10050 NE 2ND AVE PH. 305 - 795 -2204 FAX. 305 - 756 -8972 MIAMI SHORES, FL 33138 SHOULD ANY OF ME ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE TTHE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MALI_ 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORa, CERTIFICATE OF LIABILITY INSURANCE PRODUCER Highpoint Risk Services LLC 14160 Dallas Parkway 9500 Dallas, TR 75254 (800) 632 -5096 (972) 715 -0959 Fax: (972) 404 -4450 INSURED: Aspen Staff Leasing, Inc. 1 /c /f: KUYOC ROOFING CORP 3020 NE 28TH AVE LIGHTHOUSE POINT, FL 33064 (954) 675 -1709 Fax: CERTIFICATE NO. / DATE AC11- 12401480- 957178 2/16/2011 8:16:36AM THIS CERTIFICATE 15 ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR AI TFR THE CnVFRA(,F AFFARRFn RY THE PAI ICIFS RFI nW INSURERS AFFORDING COVERAGE INSURERA Cmmnanion Pronarty and Casualty Insurance C INSURERS: INSURER C: INSURER!): INSURER E: CERTIFICATE HOLDER I 1 ADDITIONAL DSURED; INSURER LETIEF CANCELLATION ACORD 25-S (7/97) CERTIFICATE OF LIABILITY INSURANCE EMPLOYEE ROSTER Certificate Number. AC11- 12401480 - 957178 Attached roster includes employees paid through 02/13/2011. To verify employee's who may have been added since 02/13/2011, please call 1- 800 - 728 -0623. * Please note employee roster for this client is updated on a WEEKLY basis. EMPLOYEE LIST: CRUZ, CESAR LOPEZ, EUGENIO MADDOX, JOHN R MARTINEZ, ALFREDO C TODOBERTO, CLARISSA 2/16/2011 Page 1 of 1 Tax Amount Transfer Fee NSF fee ?enalty ?rior Y ars Collection Coat Total Paid 27.00 r 0.00 ::: O.0 ;;.: 0. II' 9 . 0.00 27.00 Owner MAW: SuelneK4 Loc u`alaon: Bus6nass Phone: W - 7 w r% - vrv 3 1.� y'� ` `,. 1 �� t K r MN ate;, ) ►7 `.f c ■ONAN 115 S. Andrews Ave., Pm, A-100, Ft. L uderdAde, FL 33301 -1895 — 954- 831 -4000 VALID OCTOSER 1, 2010 THROUGH SEPTEMBER 30, 2023. VOA: BusPoess IM s' e: KUYOC ROOFING CORP Rooms THIS E1l COPES A TAX RECEIPT Mailing Address: KUYOC ROOFING CORP 3020 NE 28 AVE LIGHTHOUSE POINT, FL 33064 LORENZO TODOBERTO /AQVAL 3020 NE 28 AVIS LIGHTHOUSE POINT 954- 675 -1709 Number of Mactnes: Receipt 4:18s-2295os f uslnem Type: ROOFING /SHEET METAL BuOneee C19ened :09/17/2009 hate Comnty /Cur1R {:; :CCC1329274 Exemption Code :NONEXEMPT 2010 - 2012 Vend T '. THIS RECEIPT FAUST BE POSTEC CONSPICUOUSLY IN YOUR PLACE OF BUSINESS This tax is levied for the pcivllege of doing' iueinesa within Broward County and Is hon- regulatory in nature. You mug =pt meet gall County and/or Municipality planning and zoning redurrements. This = illness 'roc R= apt must be transferred when the bui0ess is sold, business lame h€ s chem .: or you have moved the business locatl®ri. This r$ -= 1pt doss not indicate that the business is legal or that it is In comptianca with State or local laws and regulations. Receipt 0.2A -09- 00008806 Paid 07/21/2010 27.00 co Congratulations! With 6433/cease you 'b .rris sae G me rizady ens mMon Floridians ken by the Deportmftent of Buns and Prefessiscal n eVr.-tt»n. Our praTesgorels am" buslameas range from acrd c s to yam troffers, from boxers to b&.:bew., Taattni7tS. tea they loop Ftr dab ec' em ng. b otter E`er day we work t'-f�- f '�LG rflE 3 -Z 9 YSa b M1-:'�'+.c..:i !rz sc der to serve t; For intern/at ace ssrAces, pt c° ino.r.e .I ✓ante . There you can mere a ; : r t sir dsfr tg a sad , the : _guts: Impact yc4i. sl ; ,"`"3 s e d.rt's i `r.d h_czn men zteut the Department'. yl_ Our mission at the Daps& . oans y, Rc u ate Fay. We =stonily sffs,..e to wive you so that you , :s-Iserite your ouvmmers. Ac# 49938 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION UMW LICENSING BOARD (850) 487 -1395 1940 NORTE NONROE STREET TALLAHASSEE FL 32399 -0783 TODOBERTi O LORENZO HUYOC ROOFING CORP LI PO FL 33064 TORO RRO 'YORWZb KU YOC ROOFING -CORP 3020 NE 28Ta AVENUE LIG TO E PrO CHARL i' CRIST ODOR FL 33064 DETACH HERE tig- • 'L tl a; - OtSP' Y A _ ODU E BY LAW TAYEOF FLORIDA A 499384 2 -.111 OF 2311$1-4299 AND I i> RZ TION . } 3 927'4' 0. 09) X92653 a CERT:I T; RACTOR Tomr- EUYOC _47,- CO t CEITa' a.y.e g ► g' +�2 j c. 06 14/2010 090482652 M R N Tg TI R .." ' : i . - ` N erd be ' Its C � 1 , r +y 'Under the proviiii.eas € Chal3t Expiration date: AUG 31, 2012r; 0#140061400550 .BaSIS .LI gzcaleitmot