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SGN-10-1687Inspection Number: INSP - 151538 Scheduled Inspection Date: November 01, 2010 Inspector: Bruhn, Norman Owner: LLC, MSVC Job Address: 9416 NE 2 Avenue Miami Shores, FL 33138- Project: <NONE> Contractor: CASABONA SIGNS LLC Building Department Comments Passed W j/ Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments INSTALL ALUMNUM LETTER BLADE SIGN AND VINYL LETTERS ON DOOR ONLY. October 29, 2010 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 Number: SGN -9 -10 -1687 Permit Type: Sign Inspection Type: Final Work Classification: Addition /Alteration Phone Number ()_ Parcel Number 1132060132780 -16 Phone: (201)757 -6218 Page 9 of 25 VISUUArLS . COMINU► II►CAI rO>f l E0 "A NNG:$A�� _ 0 I IC DESIGN . OFFSET & LARGE FORMAT PRINTING . WEB D_ : Q BILLBOARDS . VINYL LELTERI G B VEHICLE WRAP_ CASABONA VISUALS . DESIGNS COMMUNICATIONS DANIEL CASABONA Tel: 201.325.8711 Cel: 201.757.6218 Union w or Ave. 3rd Fl Fax 201.325.8713 CASABONAdeSIGNS @AOL.COM ,s. BUILDING PERMIT APPLICATION FBC 20 Permit Type: BUILDING ROOFING tl wner's Name (Pee Simple Ti t eider) : (S \ICJ . ` Phone # `T sok von .'' Address 2 k ' � usiz : d 1_.ilD . .; *City 1 t. OOP State ` Zip 25 (5:-0 Tenant/Lessee N • e e . ` ` P-2 i . ,4 C '.:: � " . ' phone i# Email .. Job Address (where the work is being done) 6 1 4 b fi4G 2- 411. t City,. m_jm3 Shores Vi11age County . Miami-Dade Zip OLIO / PARCEL # Is Building - Iistaricall . Designated _ YES 0 g Y � , : .. Flood .Zone , Contractor's Company Name GrSAIE3Ot -4ra.. is h1 phone* ' o 1 — - .7.T1 Contractor's Address ' 6 f ! � . f .� 3 -- , - : L ,r State � . dip .. 3.� / � Qualifxer Name � 9�G Phone # L : State Certificate or Registration No G 8 rtifivate of Competene yNo Contact Phone 7 " 44 '`: Efmaii. Architect/Engineer's Nanne (if applicable) Phone # 7117 1.11 F`; `: .' +`r`• ....del .. Permit No .1 it) "‘ Master Permit No q t y b cs 0 .. 's o • Value of Work For this Permit $ Sq' a near Footage Qi' Work: .. K ; • Type of Work:: °Addihvn "- Alteration E'i1 erov, 0 Repair/Replace 0 Demolition Describe Work: t li; t LL 4..'0r -, N * ** * ** ***** *******. '****er r ****** ** tkirfees * * * ** *.*** *** ** ** ***** ***** * * * * *** * **** ** $ Submittal Fee $ � * N .- Permit Fee $ /40 13 CCF $ CO /CC Notary $ Training/Education Fee $ Technology Fee $ Scanning $ Radon $ DPBR $ Bond.$ Double Fee $ Violation dater Structural Review. $ Total Fee Now Due $ .)1 r (0 See Reverse slide -a Miami Shores Village Building Department 1 0050 N.E 2nd-Avenue, Miami Shores, Florida. 3313$ Tel: (305) 795 22 Fax (3O5) 756.8972 INSPECTION'S PRONE NUMBER: (305) 762.4949 /. Agent : ` VE 1% .4 , Contractor trutnent wa acknowledged before me this The foregoing in tnunent was acknowledged before tae this 20 , .y ` sag r 5 Kk ( , day of A , 20 10 , by .. 6 c.: (Anti.° known me or who has produced who i ersonally known to a or who has produced 1OT o ,, ` r 4 "1;%61;9• 'a3-t1Eit3leti14iisr is 4..; ? � .,.r Julio c. +rertz!e iI Sign: co «:,MyCor:- niS.1343 44%. b' , Expires + 1 //20 f- As dentitcation and who did take an oath, as . tification.:and who did take an oath. kevised 07 /10/07)(Revised .06 /10 /2009) .. Engineer Signature NOTARY P t i IC: Sign: Print: P a y • ? soion DD733743 FFl.o FYn1< -. .ri 3/201.. ■ My Commission Expires: ********* a** **. *,* * * * * * * ** * * * * *: * * * ** * * * * ** ** ** * *. ** *: ***********k************ * * * * * ** ** * ** ** * ** * * * * * * * * * * *** APPROVED 13Y �� � Plans Examiner Zoning. 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, BEATERS, 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 0 COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMVIPROVEMENTS 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 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 inspe i occurs seven (7) days after the building permit is issued. in . the absence of such posted notice, the inspection will no b appro and a reinspection fee will be charged. 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 INSR SUBR W VD POLICY NUMBER POLICY EFF M/ (MDDIYYYY) POLICY EXP (MM/DDIYYYY) LIMITS A GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY OCCUR 37478 INSURER B : 13SEMNN4154 12/21/200912/21/20f0 '' EACH OCCURRENCE $ 1,000,000 X PREM SES (Ea $ 300,000 CLAIMS -MADE X MEDEXP(Anyoneperson) $ 10,000 PERSONAL &ADVINJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GENII AGGREGATE UMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 POLICY JECT LOC $ A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS 133 N4154 BNN 12/21/2009 12/21/2010 COMBINED SINGLE UMIT (Ea accident) $ 1,000,0008 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ X X $ $ A X UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE 133E 8 N4154 12/21/2009 12/21 /2010 EACH OCCURRENCE $ 2,000,000 AGGREGATE $ 2,000,000 DEDUCTIBLE RETENTION $ 10, 000 $ X $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If Yyes describe under DESG�RIPTION OF OPERATIONS Y / N N / A WC STATU- OTH- TORY LIMITS ER E.L. EACH ACCIDENT $ I E.L. DISEASE - EA EMPLOYEE $ below E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedu e, K more space Is required) Miani Shores Village Building Dept. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE 2nd Ave. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(les) 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 Pavese - McCormick Agency 3759 U.S. Highway 1 South Suite 200 Monmouth Junction NJ 08852 CONTACT NAME: Berni ce Cobb AUTHOR¢EDREPRESENTATIVE ADD T RESS: Miami Shores, FL 33138 NAIC# • INSURER A Hartford Insurance Company of 37478 INSURER B : Bernice Cobb /BERNCO '' ' °® CERTIFICATE OF LIABILITY INSURANCE ei3i/ 010 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(les) 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 Pavese - McCormick Agency 3759 U.S. Highway 1 South Suite 200 Monmouth Junction NJ 08852 CONTACT NAME: Berni ce Cobb 1A No ). (732)247-9800 247 -9800 FAX No): (732)247 -2534 ADD T RESS: PRODUCER �� rn 01 9 955 CUSTOMER ID ^ # INSURER(S)AFFORDING COVERAGE NAIC# INSURED CASABONA SIGNS, ITC 37 GROVE ST PASSAIC NJ 07055 INSURER A Hartford Insurance Company of 37478 INSURER B : INSURER C : INSURERD: INSURER E : INSURERF: COVERAGES CERTIFICATE HOLDER ACORD 25 (2009/09) INS025 (200909) CERTIFICATE NUMBER:CL1082002149 REVISION NUMBER: CANCELLATION ©1988 -2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD