CC-10-2259Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 154542 Permit Number: CC -12 -10 -2259
Scheduled Inspection Date: May 04, 2011
Inspector: Bruhn, Norman
Owner: CHURCH, ST ROSE OF LIMA CATHOLIC
Job Address: 10690 NE 5 Avenue
Miami Shores, FL
Project: <NONE>
Contractor: JFL DESIGNS
Permit Type: Commercial Construction
Inspection Type: Final
Work Classification: Alteration
Phone Number (305)758 -0539
Parcel Number 1122310430010
Phone: (954)435 -7412
Building Department Comments
REMOVE AND REPLACE DAMAGE HALLWAY DRYWALL
AND INSTALLATION OF INSULATION. REPLACE AIR
VENTS, CLEAN UP A/C DUCTS.
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
May 03, 2011
For Inspections please call: (305)762 -4949
Page 3 of 21
PERMIT #
e- C [ L - 2 2.. 9
CONTRACTOR:
SUBMITTAL DATE:
ADDRESS:
4;2`'S 'N LOS
NAME:
RESUBMITAL DATES:
PROJECT TYPE:
-,\(. ZONING
FIRE ,
p
\.)
STRUCTURAL
IMPACT FEES IN A
ELECTRICAL —12'PA 76Y(
DER
I)('Ce
PLUMBING
Q
C ,
K- 3 /2bi IBLDG
MECHANICAL
I,�`�
, v
,1
ttcot-uri
05leaol -Lrt
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949
BUILDING
PERMIT APPLICATION
FBC 20
Permit No.
1EC
BY:
ccAO-a251
Master Permit No.
Permit Type: BUILDING , J
OWNER: Name (Fee Simple Titleholder): A rc' h U I CCE Se QP \ 1 Phone #:
Address: 4O) 'isc'a1 Yle. b1V'd .
City: T1 QP State: P- Zip: 33 )38
Tenant/Lessee Name: Phone #:
Email:
JOB ADDRESS:
City:
Ll.as Nu 1 use S+it t
Miami Shores County:
Miami Dade
Folio/Parcel #: I 043-- ICU) 0
Is the Building Historically Designated: Yes NO
V
Zip: 33138
Flood Zone:
CONTRACTOR: Company Name: 43 De3 i qn s Phone #: 615%7)435-14 t.)
Address: \� 1 NI (A p an AV't' U
City: I P.vM (� k. f€ 1� 1(I -e3 State: �-' Zip: 330,49
Qualifier Name: both h % n a Phone #: 9 5q-c435 -14 1 )-
State Certification or Registration #: CB C.. ( 53x3 o Certificate of Competency #:
Contact Phone #: Email Address: J rte - b.5'i T 5e Cl ®) , CC M
DESIGNER: Architect/Engineer: Phone #:
Value of Work for this Permit: $ 4) -LJ� .O Square/Linear Footage of Work:
Type of Work: °Address °Alteration °New�pepair/Replace °Demolition
Description of Work: fepp ctc e. dam "` d (ivy Oa 1 1
I, i1
4
COLOR THROUGH ROOF TILE IS REQUIRED acknowledged by:
Submittal Fee $ Permit Fee $ /SC P6
Scanning Fee $ Radon Fee $
Notary $ Training/Education Fee $
Double Fee $ Structural Review $
i.iq
CCF $ CO /CC $
DBPR $ Bond $
Technology Fee $
TOTAL FEE NOW DUE $ \.3 V ' 5o
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 no einspection f will be charged.
Signature
Owner as or acknow Agent �/
The foregoing instrument wledged before me this 13
day of 1 i 20 tp, by � ( \ i1 \Q1
who is personally known to me or who has produced .FI(jiid
�'I1
1013 L;02 1,Y-As identification and who did take an oath.
Signature ClitAk--4(_. --.0-6,"Q
Contractor
The foregoing instrument was acknowledged before me this,,.�,
day of ,.s''(QV �'1 ,i , 20 10, by Da VA: 41 1 C. J of i Ito
f��who is o m or who has produced
- --as46 entification and who did take an oath.
NOTARY ' : LIC:
NOTARY PUBLIC:
Sign:
Print:
My Commission Expires:
TATE OF FLORIDA
Commission #DD793915
'',., ,...� Expires: JUNE 02, 2012
BONDED TBRII ATLANTIC BONDING CO., INC.
Sign: ! %Gr;
Print: 1: 111014 'I =% c
My Commission Expires . ' ; Commission # DD793915
. „..,,1 Expires: JUNE 02, 2012
BONDED VOW ATLANTIC BONDING CO.,INC.
,•1u*
** sir******************************************&*&*********' k********** *******************4 *********** *********
APPROVED BY
(Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09)(rev6/4/10)
Plans Examiner
Structural Review
Zoning
Clerk
04/08/2011 FRI 13:04 FAX
11001 /001
CERTIFICATE OF LIABILITY INSURANCE
DATE
1
PRODUCER Annette Willis Insurance
4759 N W 183rd St.
Miami, FL 33055
Phone (305)625 -8131 Fax (305)625 -3694
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
INSURERS AFFORDING COVERAGE
NAIC #
INSURED Los Vagos Diversified Services Inc. dba JFL Designs
P. O. Box 297584
Pembroke Pines, FL 33029
I
INSURER A: ATLANTIC CASUALTY
INSURER B: FUBA
INSURER C:
INSURER D:
INSURER E:
COVERAGES
INSURER F:
THE POLICIES OF INSURANCE LIS_ TED 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 CLAIMS.
INSR
LTR
ADM.
INSRD
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
DATE (69M/DDIYY)
10/25/10
POLICY EXPIRATION
DATE (IIOMIDDIYY)
10/25/11
LIMITS
EACH OCCURRENCE
1,000,000
A
❑
GENERAL
❑ COMMERCIAL
❑ ■
❑
LIABILITY
GENERAL LIABILITY
CLAWS MADE ® OCCUR
101730
DAMAGE TO RENTED
PREMISES (Ea occurence)
50,000
MED EXP (Any one person)
5,000
PERSONAL &ADVINJURY
1,000,000
❑
GENERAL AGGREGATE
1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
❑ POLICY .0 PROJECT ❑ LOC
PRODUCTS - COMP /OP AGG
1,000,000
B
❑
AUTOMOBILE
•
•
❑
❑
•
•
LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON OWNED AUTOS
COMBINED SINGLE LIMIT
(Es accident)
B INJURY
(Per p pers ersonn} )
BODILY INJURY
(Per accident)
PROPERTY DAMAGE
(Per accident)
AUTO ONLY - EA ACCIDENT
•
GARAGE LIABILI Y
❑ ANY AUTO
•
OTHER THAN EA ACC
AUTO ONLY: AGG
•
EXCESS/UMBRELLA LIABILITY
❑ OCCUR ❑ CLAIMS MADE
• DEDUCTIBLE
• RETENTION $
EACH OCCURRENCE
AGGREGATE
B
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
ANY PROPRIETOR / PARTNER / EXECUTIVE
OFFICER / MEMBER EXCLUDED?
If yes, describe under
SPECIAL PROVISIONS below
10634375
04/01 /11
04/01/12
WC STpTU- ❑ O
TORY LI ITS M
100,000
E.L. EACH ACCIDENT
500,000
EL DISEASE - EA EMPLOYEE
100,000
EL DISEASE - POLICY LIMIT
OTHER
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
•
r•=criet•s•e u/1, ncs
CANCELLATION
MIAMI SHORES BUILDING DEPT
10050 NE 2 AVE
MIAMI SHORES, FL. 33138.
ACORD 25 (2001/08) OF
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
10 DAYS W._, N OTICE TO THE CERTIFICATE HOLDER NAMED TO
THE LEFT, BUT.FAILURE 4' DO SO HALL IMPOSE ' OBLIGATION OR LIABILITY
OF ANY KIN -. `�� - URER, ( AGENTS OR = RESENTATIVES.
AUTHO EPRES
ACO
CORPORATION 1988
NOTICE OF COMMENCEMENT
A RECORDED COPY MA' BE POSTED ON THE JOB SITE AT TIME OF FIRST NEFECIEN
PST NO. TAX FOUO NO.
STATE OF FLORIDA:
COUNTY CF MIAMI -DADE
THE UNDERSIGNED hereby gives notice that dents will be made to certain real
property, and in accordance with Chapter713, Florida Statutes, the following information
is provided in this Notice of Commencement
111111111111111111111111111111111111111111111
EFTA . 2010R0868025
OR 8k 27537 Ps 0385; (1ps)
RECORDED 12/29/2010 13:52 :39
HARVEY RUVItty CLERK OF COURT
MIAMI -DADE COUNTY, FLORIDA
LAST PAGE
1. Legal description of property and street/address: 43-5 11L 4D5'' &Pee`
(.14. 84 Pc n ' \. o . ' f 5 . P 4 _ -4
x ..FFe*
2. Description of improvement: !f/ i/1 Pa.* p,9 t' i
LI
3. Owner(s) name and address: is r e c ‘ l) C f3 t.. 043 Wiwi i mt
9 -t of
Interest in property:
Name and address of fee simple titleholder:
4. Contractor's name and address:
L 3 o
5. Surety: (Payment bond required
Name and address:
� 1=L bey- YN.3 P O cac '1S8
by owner from contractor, if any) I. HEREBY CERTIFY that
original fil ., o_e on
to e_ ., nes
Amount of bond $ WITNESS my hand and Official Seal.
HARV r t N, C % of Circuit and County Courts
6. Lender's name and address:
By mom ►'i>i1i� T I .C.
7. Persons within the state of Florida designated by Owner upon whom notices or ! er documents may be served as
provided by Section 715:141.))7., Florida Statutes,
Name and address:
8.1n addition to himself, Owners desi
nates the followin
•
on s
to receive a co • of the Uenor's Notice as
rovided
in Section 713.13(1)(b), Florida Statutes.
Name and address:
9. Expiration date of this Notice of Commencement (the expiration date is 1 year from the date of recording unless a
different date is specified)
ipp30-7"1/,11,77—
Signature of Owner
'-Print Owner's Name 'ry h1406 ry Prepared b - P- b9N +.
Sworn to and subscribed before me this 134day of ...3214220,4e.,1_, 20 IQ.
Address: kV 4
L, Ira p
_
Notary Public
Print Notary's Name
My commission expires*
1130134 8104 PAGE3
Janet Velas uez
mrmssion ' : D
••, ✓1.11 ¶..:" • 7
rAIUN1zc.soxnnNo-co,nrc.
Miami Shores Village Building Department,
This letter authorizes JFL Designs to remove and replace sections of
damaged drywall in the hallway and dormitories on the 2nd floor of the
Convent at 10500 NE 5th Avenue on the property of St. Rose of Lima
Church in.!.:r��,:__ hores.
James Doyle
Pastor
St. Rose of Lima Church
415 NE 105th Street
Miami Shores, FL 33138
(305) 758 -0539
AFL DESIGNS
•••
P.O. BOX 297584 PEMBROKE PINES, FL 33029 (954) 435 -7412 FAX: (954) 430 -3264 CELL: (954) 646 -3839
Date December 13, 2010
ATTN: Miami Shores Village
Building Dept.
10050 N E Ave
Miami Shores, FL 33138
Attn: Permitting
I, Deborah C. Ladino, as qualifier for Los Vagos Diversified Services, Inc. d/b /a J1L Designs,
authorize Jose F. Ladino as having the ability to drop off and pick up all permits being applied
for by our company.
Sincerely,
Deborah C. Ladino
Vice President
SUE SUOLONG
Notary Pudic, State of Florida
Commission# DD634314
My corm. expires Mar. 9, 2011
LOS VAGOS DIVERSIFIED SERVICES, INC.
FAX
gi 001 / 0 01
....„.......,N
.445.:,,„comor CERTIFICATE OF LIABILITY INSURANCE
-
PRODUCER Annette Willis Insurance
4759 N.W. 183rd St
Nava FL 33055
Phone (305)525-8131 Fax (305)625-3894
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE covemeg AFFORDED BY THE PPLICIIES BELOW.
INSURERS AFFORDING COVERAGE-
NAIC #
INSURED Les Vegas Diversified Services Inc. dba EL Designs
P.O. Banc 297584 •
Pembroke Pines, FL 33029
I
INWRAR A: ATLANTIC CASUALTY
INSURER B FUBA
INSURER C•
'RBI/FIER D:
INSURER E:
COVERAGES
INSURER F:
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT
MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICES DESCRIBED HEREIN
POLICIES. AGGREGATE LIMTS SHOWN MAY HAVE BEEN REDUCED SY PAID CLAIMS.
VWTH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
IN=
LTFT
Atitri.
NANO
TYPE OF INSURANCE
POLICY NUMBER
PO= EFFECTIVE
DATE RitAXENITY)
POLL'Y EXPIRATION
DAM (MINDIXTT)
LINTS
A
El
GENERAL Lawry
O COMMERCIAL GENERAL LIABILITY
DO CLAWS MADE Eil OCCUR
0
101730
10/25/10
10/25/11
EACH OCCURRENCE
1,000,000
DAMAGE TO RENTED
PReNTISES (Ea DOCUrenne)
50,000
NED EXP (Any one person)
5,000
PERSONAL & ADV INJURY
1,000,000
GENERAL AGGREGATE
1,000,000
0
PRODUCTS - COMP/OP AGG 1,000,000
GEM AGGREGATE LIMIT APPLIES PER:
n POLICY 0 PROJECT 0 LOC
•
•
•
AUTOMOBILE
0
0
•
0
•
0
LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIREDAUTOS
NON OWNED AUTOS
S
COMBINED SINGLE LOST
(Ea accident)
BODILY INJURY
(Per person)
BODILY INJURY
.
(Per accident) •
PROPERTY DAMAGE
_Tar accident)
AUTO ONLY- EKACCIDENT
0
0
GARAGE LIABILITY
0 ANY AUTO
0
'
OTHER THAN EA ACO
AUTO ONLY: Ma__
EACH OCCURRENCE
•
EXCESSARIBRELLA LIABILITY
0 OCCUR 0 CLAIMS MADE
• DEDUCTIBLE
0 RenitatoN $
.
AGGREGATE
B
woman CONVERSATION atco
EMPLOYERS' UASIUTY
ANY PROPRIETOR! PARTNER! EXECUTIVE
OFFICER / MEMBER EXCLUDED?
II yes, describe under
SPECIAL PROVISIONS below
10634375
04/01/10
04/01/11
SafttrEs_Pit 100,000
EL EACH ACCIDENT 500,000
EL DISEASE - EA EMPLOYEE 100,000
E.L. DISEASE - POUCY cattr
OTHER
DEscrtirnoN OP OPERATIONS /LOCATIONS I VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT 1 SPECIAL PROVISIONS
. , • • .
,
.
•
CANCELLATION.
I---
•
MIAMI SHORES VILLAGE ,
10050 NE 2 AVE
MIAMI SHORES, FL 33138
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES
EXPIRATION DATE THEREOF, THE ISSUING INSURER
10 DAYS WRITTEN NOTICE TO THE CERTWICATE
BE CANCELLED BEFORE THE
WILL ENDEAVOR TO MAIL
HOLDER NAMED TO
NO OBLIGATION OR LIABILITY
;'..• REPRESENTATIVES.
THE LEFT, BUT FAI . - E TO O0 :..* SHALL IMPOSE
OF ANY KIND i " ',1, .1 1 .;. -,i•- ITS A (1 ..
AUTHO ' * - - ' - i • SENTA t •
----- —.. --
ACORD 25 (2001/08) QF
Miami Shores Village Building Department,
This letter authorizes JFL Designs to remove and replace sections of
damaged drywall in the hallway and dormitories on the 2 "d floor of the
Convent at 10500 NE 56 Avenue on the property of St. Rose of Lima
Church in hores.
James Doyle
Pastor
St. Rose of Lima Church
415 NE 105th Street
Miami Shores, FL 33138
(305) 758 -0539
)FL DESIGNS
•••
P.O. BOX 297584 PEMBROKE PINES, FL 33029 (954) 435 -7412 FAX: (954) 430 -3264 CELL: (954) 646 -3839
Date December 13, 2010
ATTN: Miami Shores Village
Building Dept.
10050 N E 2' Ave
Miami Shores, FL 33138
Attn: Permitting
I, Deborah C. Ladino, as qualifier for Los Vagos Diversified Services, Inc. d/b /a JFL Designs,
authorize Jose F. Ladino as having the ability to drop off and pick up all permits being applied
for by our company.
Sincerely,
Deborah C. Ladino
Vice President
SUE 6DOLONG
Notary Public, State of Florida
Commisslon# DD634314
My i mm, eyt) fas Mar. 2011
t -one
LOS VAGOS DIVERSIFIED SERVICES, INC.
FAX
la 001/001
Att.....,,400Nlipr CERTIFICATE OF LIABILITY INSURANCE
MIAMI SHORES VILLAGE
10050 NE 2 AVE
MIAMI SHORES, FL 33138
PRODUCER Annette WIES Insurance
4769 N.W. 183rd St
Miami, FL 33055
Phone (305)625-8131 Fax (306)825-3604
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND
ALTER THE COVERAGE AFFORDED BY THE POIXCIES
OR
BELOW.
INSURERS AFFORDING COVERAGE-
NAM S
INSURED Los Vegas Diversified Services Inc. dba JFL Designs
P.O. Box 297584
Pembroke Pines, FL 33029
1
; AT
wiscRER A LANTIC CASUALTY
fr FUBA
INSURER C:
INSURER Cr
INSURER E:
COVERAGES
INSURER F:
'
TM Fvuutto La- todAaume Llo i E.Lr Have sa.le ItsbiltU IV ni w/soNr.0 meow pusOVE FuR 1 HE rOuCY PERILILI INLoCA i cu. rial inifiliSTANOWIG .
ANY REQUIREMENT, TERM OR CONOMON OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES MOWED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LINTS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
1/03R
LIR
AIM
RAM
TYPE OF INSURANCE
POI-ICY Mum
POLICY EFFECTIVE
oATE thINDO/11)
PO= EXPIRATION
DATE (NVOINYY)
LENTS
A
0
GENERAL
•
li
0
0
GEHL
LIABLITY
COMMERCIAL GENERAL LIABIUTY
0 CLAIMS MADE 10 OCCUR
101730
10/25/10
10/25Ii 1
EACH OCCURRENCE
1,000,000
DAMAGE TO RENTED
PREellSES (Ea acquience)
50,000
MED EXP (Any one pawn)
5,000
PERSONAL & ADV INJURY
1 .000.000
eENERALAGGREGATE
1,000,000
PRODUCTS - COMP/OP AGO
00
1,000,000
AGGREGATE LIMIT APPLIES PER:
POLICY 0 PROJECT • LOC
-
•
•
AUTOMOBILE
El
0
•
1:1
El
0
ri
LIABILITY
ANT AuTo
ALL OWNED AUTOS
SCHEDULED AUTOS
mammas
NON OWNED AUTOS
COMBINED SINGLE LSAT
(Ea =Went)
BODILY INJURY
(Per person}
EMMY INJURY
(Per accalent)
.
PROPERTY DAMAGE
0
GARAGE LIABLITY
0 ANY AUTO
0
-
.
AUTO ONLY - EAACCIDENT
OTHER THAN EA ACC
AUTO ONLY: AOD
EACH OCCURRENCE
•
EXCESSIUMBREUA LIABILITY
0 OCCUR 0 CLAIMS MADE
• DEDUCTIBLE
El RETENTION $
AGGREGATE
B
WORKERS CWENSATION AND
EmPLOTERO' umiluri
ANY PROPRIETOR / PARTNER / EXECUTIVE
OFFICER! MEMBER EXCLUDED?
oyes, descrte under
SPECIAL PROVISIONS below
10534375
S
04101/10
04/01/11
0 arta 0 gii-
100,000
EL EACH ACCIDENT
500,000
EL DISEASE - EA EMPLOYEE
100,000
EL DISEASE - POLICY Latr
OTHER
DESCRIPTION OF OPERATIONS /LOCATIONS I VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISION
•
•
• .
" ,
•
•
CERTIFICATE, OLDER
CANCEU.ATION.
I
MIAMI SHORES VILLAGE
10050 NE 2 AVE
MIAMI SHORES, FL 33138
SHOULD ANY
EXPIRATION DATE
10 DAYS
OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO
FPJ TO DO • SHALL IMPOSE NO OBLIGATION OR UAINLITY
. ,' , , -4, - ITS A c z . , - REPRESENTATIVES.
THE LEFT, BUT
OF ANY KRM3
AUTHOR '. ,
'i. .,-
SEM r 9
144
ACORD 26 ( 1/08) QF
ACORD CORPORATION 1988
Apr 04 2011 11:09AM HP LASERJET FAX 9544361290 p.1
March 31, 2011
To: Vglage of Miami Shores Building Department
Regard: St Rose De Lima Convent Drywall Repairs
In response to the c omn ants to permit number 102259, ike have the following responses:
1. how electrical devices to be removed and reinstalled.
Response - All existintelectrical devices to remain. No removal and reinstall nay.
Review
l�n
1.
tkt.,.
t -
't E T
r s z�y`
v.s.:
vms v�3F"'h - . ��{ -ji. s.
'. how mechanical devices to be removed and reinstalled.
Response - All existkrg mechanical ductwork, controls, and units to remain.
•
-
a.- how plumbing fixtures to be removed and reinstalled.
' , - , , I se - All existing plumbing fractures are to remain with drywall work being done around the fixtures.
Please contact me if you have any questions.
Sincerely,
Robert Brown, Architect, RA#AR92824
ROBERT BROWN ARCHITECT r RA0AR82024 ( 325 MERIDIAN AVE.. MIAMI BEACH, 33130 ( P.305408-9059
RSBARCHOHOTMAIL.COM
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