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1069 NE 91 Terr (12)MIAMI SHORES VILLAG BUILDING DEPARTMEN 305- 795 -2204 B ilding Inspection Request <Insp Date Time Pa)\ 0( r Ploynk7a( Permit No. pi - 1 Name Approved Correction Re- Insp'n Fee c_Jc_) parn n Address l Q b`"I v C' \ Vef 1 Company NV LQ.� (k Phone# CtS`1 Q�f - l (A2L1 For Inspector: Pi if li Name & Date MIAMI SHORES VILLAG BUILDING DEPARTMEN 305- 795 -2204 T i lding Inspection Request Date T 3 3 Time Type Insp'n J C P1ur/'J2,rJ Permit No. 121 t Name 50 n Address I O b" I vi E 91 Ver ( Company (,'i IQ) (k) Phone # qs q "t Q � � `\ 2 - For Inspector: PI 1 (1 Name & Date Approved Correction Re- Insp'n Fee Type Insp'n Approved Correction Re- Insp'n Fee Cf�c CSC //"00`c MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Bu'lding Inspection Requ Date Time Permit No. Name fuYflfl Address t o o "l '"e ie r` . Company l Phone # 5 C IO A For Inspector: )(nu, 'ikia-v)s. NA\ MIAMI SHORES VILLAGE BUILDING DEPARTME 305- 795 -2204 Building Inspection Request Data'? \ ) Time ` n Type Insp' Permit No. Name Address ( 0 r b C rY1 , C e n --l aV Compan Phone # }� For Inspector Correction Re- Insp'n Fee ri ate Date Legal Description ignature Date: APPROVED: PERMIT APPLICATION FOR MIAMI SHORES VILLAGE 3 Job Address / 0 ✓iJ E. 9/ Tey) Tax Folio Z ? / Lessee / Tenant f' Owner's Address / f /c/ • ?/ 7 Pry Phone Contracting Co. 41‘,9)-A/fr Vt� Address Qualifier -.,n/ / 47"J7/20 Phone 7-5 o 7S ( /4 J� C State # Municipal # Competency # Ins.Co. Architect /Engineer Address Bonding Company Address Mortgagor Address Permit Type(circle one): BUILDING ELECTRICAL PLUMBI►. MECHANICAL ROOFING PAVING FENCE SIGN WORK DESCRIPTION / J .14,) LAJ / 9 'ref" 5 -Qf i C P I p Se OQ Square Ft. Estimated Cost(value) 4 ' / WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO SO 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). Application is hereby made to obtain a permit to do work and installation as indicated above, and on the attached addendum (if applicable). I certify that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that separate permits are required for ELECTRICAL, PLUMBING, SIGNS, POOLS, ROOFING and MECHANICAL WORK. 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 regulat construction and zoning. Furthermore, I autho'ize the above-named contractor to do the work stat =d. nd /or Condo President Notary as to-Owner dnd /or Condo President My Commission ExpiNO PUT1LTC, STATE a^ ITQ7TT19A. MY C( ::'.":".:5:1;::: ; Ci : ::s: ic.ay :50,1.991 Ni..v l.du 'e.:::J NOTARY PUIILLC UNL2RWkITCI S. ** * * * * * * * * * FEES: PERMIT ,..,2 RADON C.C.F. 3t610 Zoning Building Mechanical Plumbi ontracto gnature at:. ' Notary as tc My Commissi Master Permit # ?R P U Urru;IAL OrARY ebntraore. 1 er A A Own r- Builder H � ei:COMMISSION NUMBER r..qi • Q CC255237 MY COMMISSION EXP. F � OFD JAN. * 26,1991 NOTARY 5/405 TOTAL DUE 6--611541) Fire Other Electrical Engineering * * lw Employers Self Insurers Fund P.O. Drawer 988 • Lakeland, FL 33802 -0988 • Telephone (813) 665 -6060 or 1- 800 - 282 -7648 (Florida) • FAX (813) 666 -1958 ISSUED TO: Village of Miami Shores 10050 N.E. 2nd Avenue Miami Shores, FL 33138 This is to certify that Marbar Plumbing Co., Inc. 4120 N.W. 7th Avenue, Miami, FL 33127 being subject to the provisions of the Florida Workers' Compensation Act, has secured the payment of the compensation by insuring their risk with the Employers Self Insurers Fund COVERAGE NUMBER: 0830 -07454 Statutory -State of Florida EFFECTIVE DATE: April 1, 1993 EXPIRATION DATE: April 1, 1994 REMARKS: CERTIFICATE OF INSURANCE Employers Liability $100,000 (Each Accident) $100,000 (Disease -Each Employee) $500,000 (Disease- Policy`Limit) This certificate is not a policy and of itself does not afford any insurance. Nothing contained in this certificate shall be construed as extending coverage not afforded by the policy shown above'of as affording insurance to any insured not named above. 41.14, Summit Consulting, Inc., Administrator Employers Self Insurers Fund /cah 3/01/93 June 24th, 1993 Date 04/29/92 AUDIT CONTROL NO. LICENSE NO. BATCH NO. AMOUNT PAID ' CF CO35685 41580 $14C.CC CCNSTRUCTION INDUSTRY LICENSIAG EE PCST OFFICE BCX 2 JP ONVILLE, FL 32201 STATE OF FLORIDA DEPARTMENT OF PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD CERTIFIED PLUMEING CONTRACICF ANTHONY. JAMES K MBAR PLUMBING CO INC HAS PAID THE FEE ,FOR T S YEAR EXPIRING REQUIRED' L G C � l i E l S b y F.S., LAWTON 1746528 LICENSEE NATURE r WALLET CARD FOLD HERE GEO'GE STU 4'T, JR. SECRETAR �.P.R. r DADE COUNTY TAX COLLECTOR 140 W. FLAGLER ST. 14th FLOOR MIAMI, FL 33130 LICENSE NO. 01-0991456- CC NO: BUSINESS NAME /LOCATION MARBAR PLUMBING CO INC 4120 NW 7 AVE OWNER :MARBAR PLUMBING CO INC RESTRICTEC TO THE CITY OF: MIAt'1 Licensee must register in the city where wore is to be done. PAYMENT RECD DADE CITY TAX COLLECTOR 2500002_5 00006 .50 DADE COUNTY TAX COLLECTOR 140 W. FLAGLER ST. •t, -; - . 14th FLOOR E.. MIAMI, FL 33130 THIS IS AN OCCUPA- . TONAL TAX ONLY. IT DOES NOT PERMIT THE LICENSEE TO VIOLATE ANY EXISTING REGULA- TORY OR ZONING LAWS OF THE COUNTY OR CITES, NOR DOES IT EXEMPT THE LICENSEE FROM ANY OTHER LI- CENSE OR PERMIT RE- QUIRED BY LAW. THIS IS NOT A CERTIFICATION OF THE LICENSEE'S OUALIFI- • CATION. PAYMENT RECEIVED DADE COUNTY TAX COLLECTOR: 04/14/92 250000214 000027.00 SEE OTHER SIDE 1992 MUNICIPAL CONTRACTOR'S 1993 OCCUPATIONAL LICENSE DADE COUNTY — STATE OF FLORIDA PURSUANT TO DADE COUNTY ORDINANCE 66 -2 EXPIRES SEPT. 3O 1993 . PLUMBING DO NOT FORWARD MARBAR PLUMBING CO INC 4220 NW 7 AVE MIAMI FL 33127 CFCO35685 IS HEREBY LICENSED TO DO BUSINESS AS A CONTRACTOR AS SPECIFIEDI- IEREON. %OC.CUFATIO LICE ADE`COUNTY" -. STATE EXPIRES SEP'1; 4 8 _,D SPLAYE ATi U TY C9Pg 1 099145 -E BUSINESS NAME /LOCATION MARBAR PLUMBING CO INC 4 NW 7 AVE I 33127 MIAMI OWNER MARBAR PLUMBING CO INC Sec. Type of Business 1c6 PLUMBING DO NOT FORWARD MARBAR PLUMBING CC INC 4120 NW 7 AVE MIAMI FL 33127 RENEWAL LICENSE NO 099145 -6 C C # CFCO35685 EMPLOYEES 10 FIRST CLASS U.S. POSTAGE PAID MIAMI, FL PERMIT NO. 231 FIRST CLASS U.S. POSTAGE PAID MIAMI, FL PERMIT NO. 231 2. Description of improvement: 3. Owner(s) name and address: 4. Contractor's name and address: Name and address: Amount of bond $ 6. Lender's name and address: Signature of Owner Print Owners Name WIN H ; E �Ullli� CL By NOTICE OF COMMENCEMENT PERMIT NO. TAX FOLIO NO. 11- 3205 -01 -00801 STATE OF FLORIDA: COUNTY OF DADE: THE UNDERSIGNED hereby gives notice that improvements will be made to certain real property, and in accordance with Chapter 713, Florida Statutes, the following information is provided in this Notice of Commencement. 1. Legal description of property and street address: 1069 N.E. 91st Terrace, Miami Shores, FL Lot 9 and W 1 10 Block 1 r-raavar, S :nv h .rd -4 OPixiat seal. New water service, re- piping of house Susie E. Decker 1069 N.E. 91st Terrace, Miami Shores, FL Interest in property: Name and address of fee simple titleholder: N/A Marbar Plumbing Co., Inc. 4150 N.W. 7th Avenue Miami, FL 33127 5. Surety:(Payment bond required by owner from contractor, if any) N/A N/A 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 and address: N/A 8. In addition to himself, Owner designates the following person(s) to receive a copy of the Lienor's Notice as provided in Section 713.13(1)(b), Florida Statutes. Name and address: N/ 93R315,658 15,;%i8 1993 JUN 24 14? 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) N/A Susie E. Decker Sworn to and subscribed before me this ?4 day of June Notary Publ .- -� — Print Notary's Name Robin u '" : My Commission Expires: NOTARY PUBLIC, STA'T'E OF FLORIDA. BONDED T(thU NOTARY PUBLIC UNDEAWAITERS. STATE OF FLORIDA COUNTY OF DADE I r:ERF'Y CERTIFY t' a this Is a fru cop of 0111 o T „ .:: l•i in fss o'rico on day of , A 9 r9 K of.^,i itan O.C.- , 19 93 . Prepared by: —.J J"� 6914 Address f /') O' /1/. t'`' ' five-- I V lit / Am; 33)77 JUN -24 -1993 08:27 FROM WORLEY HUMPHREY & BALL TO 7568972 P.01 "Since 1935" WORLEY J HUMPHREY & BALL, INC. INSURANCE/ FINANCIAL SERVICES 9500 S. Dadeland Blvd., Suite 200, Miami, FL 33156 • P.O. Box 561567, Miami, FL 33256-1567 (305) 670 -6111 • Fax (305) 670 -9699. Outside Dade (800) 273 -4433 DATE: June 24, 1993 TO: Permit Department Miami Shores FAX #: 756 -8972 FROM: Sheila Dowd RE: Marbar Plumbing, Inc COMMENTS: COMPANY: Village of Enclosed is certificate of insurance for above client. If any additional data is needed, please contract our office. Thanks Sheila This facsimile contains PRIVILEGED AND LEGALLY CONFIDENTIAL information intended only for the use of the addressee(s) named above. If you are not the intended recipient of this facsimile, or the employee or agent responsible for delivering it to the intended recipient, you are hereby notified that any dissemination or copying of this facsimile is strictly prohibited. If you have received this facsimile in error, please immediately notify us by telephone and return the original facsimile to us at the above address via the U.S. mail. �r� k you. This tel PL onsists •f 3 pages including cover sheet. IF YOU FICULTIES IN RECEIVING THIS :::.: :•••:•, '''S"::':Ii: ,;•::=;•,•=?4:4::.•'4:;=. ....:;;;;:di •;.;;;;;;;:;;:::::.::.• ••••• • :••••' '' ••• ...*: :::::•:::: : ; :::',.::::::::...: ",,,,,:::...•:-:,::. . " ' , , a A1 '::''' " •. I . ■ >7. .„:. II • ..k.., PROMOS* Worley, Humphrey & Ball, Ine.G P.O. Box 561567 Miami FL 33256-1567 Phillip C. Lyons 305-670-6111 : : Dam= : Marbar Plumbing, Inc. i 4120 N.W. 7th Avenue Miami FL 33127 ::‘,; DEM DATE (MM/IIDPIY) MO r, r r ••••• o >: '' : ' ;.;' .' . 06/23/93 THIS CERTIFICATE XS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, Errata) OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. COMPANIES AFFORDING COVERAGE i COMPANY A ' LEITER rl Employers Self Insurance Fund COMPANY 0 LETTER 4, COMPANY dr , LEITER k° • COMPANY r, LEITER L' compmfy E LETTER '''''' IWPOW4— '1W ::::;••==',.. '''' .:, :,.:::.,::::.:::; . .., ,, :...V=Va...., ''''' '• ''' ' : THIS IS TO CERTIFY THAT THE POUCIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDCATED, 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 SUB/ECT TO ALL. THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ... . , POLICY EPFECTIYE :POLICY EXPIRATION um; TYPE OF INSURANCE . INYLICT NumasEat LAWITS : I DATR(MM/DD/YY) : DATE (ww/DINTY) ; • GENERAL LIABILITY • • COMMERCIAL GENERAL LIME-ITT cLAIMS MADE i : OCCUR. ; ; OWNER'S R CONTRACTOR 's PRO"T. i • • • : GENERAL AGGREGATE . :• i PRoDucrs.comptop nom ; $ : : PERSONAL & ADV. INJURY • $ i EACH OCCURRENCE : $ : ME DAMAGE (Any ono Era? : S : MW. EXPENSE (Any OM person) ' S AUTOMOB.U.E LIABILITY • . . • ANY AUTO • ALL OWNED Autos !. : SCHEDULED AUTOS HIRED ANTI ' . . • NON-OwNED AUTOS GARAGE LIABILITY : : CONFINED SINGLE : LIMIT : s . BODtLY INJURY : (Pee p60100) 5 : BODILY iNluRY : PROPERTY DAMAGE : S : sxcEssuAluxri . ; GAO; OCCURRENCE . S : • UMBRELLA FORM • I AOGR.EDATE : S OTHER THAN UMBRELLA PORN • : wORIDIR'S COXPENSATICDI !08300745400 04/01/93 04/01/94 STATUTORY LIMiTS A ' . ; • AND EACH AcciDENT !s 100,000 OISEASE—POUCY Umn• : S 500,000 • mil/toner LIARtUTE •• . i DISEASE EMPLOYEE : $ 100 000 • • • . : DESCRIPTION OF OPERATIONPLOC.ATIONSivERICLESSPECAL arms Plumbi g Contractor :: City of Miami Shores Bldg & Zoning Dept. 10050 NE 2nd Avenue ' .:,.. Mimi shores FL 33138 , ,.:. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES 82 CANCELLED BEFORE THE EXPIRATION DATE THEREOF. THE ISSUING COMPANY WILLENDEAvOR TO MAILM. _ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED 'TO THE : LEFT. BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. AuTHoRDBD REPRESMT Phillip C. t. yons JUN-24-1993 08:27 FROM WORLEY HUMPHREY & BALL TO 7568972 P.02 •. %•:<: ;V :.,M%%`% .% V.V. . # .; ' : .,` %.% Vi 1 •% %°:K.%. wr n;^,. nv. ,,,.,..n,,: 3. <. •. .. .: .vw•..e .. :r.v.v •. :.n •..••. n.`.. xi.: 3:,.< v:{ V. I. xh%• Y:,•: W: 1x•,: r. xa .xnY %::;:r:e r:,3. r: L+Vx x..vr. r %,G .2<......i. Y .{x,e., %Y.. %. % °x. %i %Mi%h.<h,F., ny, >:[:xw,:;: >:1:...: .Y:n:::..sa,I:.Y....v. ..... •. ...... . . 3:+..>; n:r•y::;il. : :. ISEURDATE:(MWDDA/ • . . •... r: •. : .:,• * - •. . .:r. : r.,.r. : r .... . : ...:..,.... :. <.. :. :. :.. � • 06/24/93 . . YYY.• . • \ w 5:.: `: L is : : . .:.,:. w x.: :{.:. ,x• %. .. ..: a %,:.. : <: e: .: • °: :<:,;> .... � :< • n • ...:.:..:..:..: a%.:,.Y:. 3:,`: WV: vx• S. VI.>:,. x. x.v: vw• r:,.:,.%. x.% VY. x..: 1. ax. xw:< n: r... nv., :I.n..A.r.. �a.n..: .: :., .a:...{n.. �:.. ` no...na,•n „•n•u.: <.Y•. %•x.v. .IVM1 Y: Y.vt1•Y.1• % %.%n%n. ! % ^:°x:.i<.Y. ... ... ..:,.:.... . ' :.... • ?Revue= Worley, Hunph rey & Ball, I nc. G P.O. Box 561567 Miami Ft 33256 -1567 .Phillip C. Lyons 305.670.611) ., ... ........ • INSURED '• Marbar Plumbing, Inc. : 4120 N.W. 7th Avenue Miami, FL 33127 ; 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. COMPANIES AFFORDING COVERAGE A LETTER U.S. Fidelity & Guaranty Co. COMPANY LETTER COMPANY C LETTER COMPANY D LETTER ............. t ER Y E :,. R: xv.: a:• :: K.: i{. �K:<; r°% rr:{.:°•. Y.. n: sn.{.,: i.:{} a .:.: ., : . :.; } K.%. r. e.:; . %•3:{.:i.:;.:w:�::.:< ... :.�..... � (��� . >. >.°., .° % %. .[,.>.+ . .. t .w. , h. .V., % i! K•% hk%. a%•. �. Y :{ hx.% n• K w;., v ., r., .� y� v {: �,•: ... .: �. . ,..,� •. n n•n w•< n•KV , .K ° < :.,e•v: .,f•n ., nvn.Y nxv....<.:••>; h;•::,.,. x i.: Kr •:S. };K {.;}: ; •xn:1•i:n:•:: < {: I ;I; {h: %I Y % a... ° %xv, %xx .Yl.% V. r.x•ra..:. are. r:,.: K. i} Y: V::.: K< r: n::. i: : .•. ,.!:.a• ::.�::.i::::{�r::i: ., V•.V.,. %%n %V., .<.s% % >. a. wV.K•A :[ Y: r,.. iY:•::•:;;, yv r.%. v,. Yy:;{: s .`;. {::v:V%�.<•; <•?t� >;•1.. % ..: .:.:..:.::.:: •r: .: .: n i •r., n,• n:. ar vn., a.:<..:..: rn• x• x. x.%. x. a3>: i:. i+ e:,.. rx.:{. xwv;,.:{.:K.% ix, x° KS�•.:.% a%` xMeK° Y6x.> :nx:.YOK.;a^.;e;x.:. <e:n�<yw.'t pY.:r ... } ?' ., r .. r................. �,.. .. .. .: .. .. ............. .. ... r r THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR 114E POUCY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT. TERM OR CONDITION OP ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THiS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, WE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LLMITS SHOWN MAY HAVE BEEN REDUCED BY PAiD CLAIMS. CO : TYPE OF INSURANCE POLICY NUMBER : POLICY:FAECTIYE :POLICY CATION LIMITS '. DATE(MM/DD/YY) DATR(MM/DD/YY) : GIUDIRAL LIABILITY : GENERAL AGGRnGAT E : f 2,000,000: • A : X ; COMMERCIAL OENERAI. LIABILITY ; BSC112380221700 : 07/01/92 07/01/93 PRODUCrs•COMP/OP AOG. . f 2, 000, 000. jrr ; CLAIMS MADE ; X OCCUR. ; PBRSONAL R ADV. iNJURY $ 1,000,000. OWNER'S & CONTRACTOR'S PROT. : i EACH OCCURRENCE • 3 1, 000, 000. : FiRE DAMAGE (Arty one Ace) S 50, 000 • MED. EXPENSE (Any one 'mon) ' f 5,000. I. AUTOMOBILE LIABILI'T'Y ANY AUTO AU. OWNED AVTOS SCHEDULED AUTO$ HIRED AL TOS : NON -OWNED AUT03 oAIIAOE LIAaa,r Y : COMBINED STNCLB UMR ' f BODILY Y . BO INJURY ; (Per Person) . E BODILY INJURY Ott ieCidMX) PROPERTY DAMAGE • 5 EXCRSS UABiU Y EACH OCCURRENCE • UMBRELLA FORM : AOGREOATE 18 OTHEII TI[ANUMBRELLA PORM ,K::S.KYa ..K "" " {. {.x .,:.. :....:::;. . ::... WORKER'S COMPENSATION AND , UAB1L1TY STAIVTORY LIMITS ; EACH ACCIDENT ! : DISEASE—I'OLICY LIMIT S • DISEASE —EACH EMPLOYEE 5 077IItR • • • DIt$CRIPTION O4 00BRATIONS/LOCATIoNs/VER ICLESrSPWTAL ITEM Plumbing Contractor * 10 days non payment .. : '. : ' .D . :xb:..;i %: %i::i:e.<.x.x':'''' '' x: %' ..+c:ix:,.. CERTIF�CA� I�O,Lb >. :.,...::.. :,,< x; �> a:{ a «.,. th}::<x,< h: x.%:.• a:,. x. 3%. x.Y:;, K., %..:Kw:K: ....................:.. �.:.............,.,._ City Of Warn; afii Shor es B ldg & Zoning Dept. 10050 NE 2nd Avenue Miemi Shores FL 33138 �. T" :<3 •. •,:' .K.,:n:°:�•.x..Y.• {; . era .. ,:..>.; ., >•.r., ..� ...:: r:... - 6 .. {, %. >:i: <Y %., :..,>:<• S::. aa:;.; Y. x�:, K..,.>:.::_ r:,. x. a}> w: K. :};.::«::,:. { .: .<.. .....:............ :... '�'� < N.>:.,% xr,; �%::.%.><.:. a,{.:<. a:. a: Kh; KK.:.Y.,•:.. Y: K .<., . <. },:.:: ; :. %...• . < r ..: .,:.a.. a.r ..a . : . :. }:..a,;• SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE 5; EXPIRATION DATE THEREOF. THE ISSUING COMPANY WILL ENDEAVOR TO MAIL3O DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR .. LIABILITY OF ANY KIND UPO THECOMPANY, iTS AGENTS OR REPRESENTATIVES. AVT'HORTZED REEmENTA T.. '� Phi nip ip C. Lyons ACO .. OR�'O�#TI011 X990, . . JUN -24 -1993 08 :28 FROM WORLEY HUMPHREY & HALL TO 7568972 P.03 ...x :4* . • • , ..:.:.:44: :. .x...!..:.x. , :ox.x:x44::. , ;i4:4;;;;;;;::•;:::=.1 . 4;;;V . ;::4:•riag.iii:V.4,:in . i .. i:;;;: : :4 . 4:•..■■F••,::;,::ei'.:4F4:1'''''' • ..... ,...., '''''' '''''''• "''' •••• .. - ''''''''' - . - M/DD/TY) ...i. ISSUE DATE (14 , 06/24/93 tIARISCkinl,;:: : ....r.::::::?,...:x.:,.! • q,4%4)4011■10*, • ..' I ti , „c : ,,.:, :.... - — ,. ., '' . '' . ,.. '' '' . ,.:,:::::,,::::::::. .:•,.:.,.: • ,..:. .,......,... <., ' '' :::■;..........':' "Zr.:',.■::;:i.ii4:::;::',■:,•:.:•:!•:=::4:::;. ''' ... ' ::; ' :::.;;:;.:* . ' ''''' .:!•.•.:.'".• :::: r:•n•n:::: '' :s. .... :...'.. PROO&Cilt Worley, Humphrey & Ball, Inc.0 P.O. Box 561567 Miami FL 33236-1567 Phillip C. Lyons 305 -670 -6111 • . ... .H rirstougo . Marbar Plunbing, Inc. 4120 N.W. 7th Avenue Miami FL 33127 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. . : F. COMPANIES AFFORDING COVERAGE ! COMPANY A u. -. i LETTER r' 5 Fidelity & Guaranty Co. .. • .. ... • COMPANY B J.ETTER , • .. • • - .. ... - ...... ... .. COMPANY e. LETTER ' COMPANY IN : LETTER D ' i COMPANY E LET= ....., COV ER A GES :.: ' :: ' .4.,..:::........:, '' • • .I.. .. ,......x....:.• • vet,. W ''''' , A. '' . '' . ' ..,■2i ...**iti;*T.:q=7*.'•'';' ,::,:;:' ,, .. ,,,........ ' ; ' ' , n.., ..,, ..,, '' : '' .4,,K:. ' ' ' ..1' .. :.:.. THIS IS TO CERTIFY THAT THE POLI CIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY i Pf i T tUOR s INDICATED. NOTWITHSTANDING ANY REQuIRENIENT, TERN! OR coNDmoN OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT T w CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED V THE POLICIES DESCRIBED HERETI4 IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. • CO : : POLICY NtAISEst POLICY EppEcTrvz :POLICY ExpiHATiON LIMITS LT! TYPE OF MURAT/CIS • •• i DATE(MM/DD/TY) : DATE (NIWDDYTY) : • • • GENERAL uANLITy ' • : ' . • • . : . A : X i COMMERCIAL OENERAL LIABILrrY :Renewal I Bscl 12380221no : 07/01/93 : 07/01/94 4 t.. •..t.:1 ' K. .:: ', CLAMS MADE : X : occUlt. : : • • . • OWNER'S a CONTRACTOR'S PROT. : • . ' . • . . • . , • • . • . , : • • . . . . . • i OBNBRAL AGGREGATE : 8 2000000 . . . . .. . ; PRODUCTS A00. • 8 2000000 . . * , PERSONAL & ADS'. INJURY : S 1000000 Encl.( OCCURRENCE . $ 1000000 ' . . .... . .. me DANIAGE (Any ore Are) ; S 50000 . . .. .. MED. EXPENSE (Any one prim) : S 5000 . • AUTOMOBILE LIABILITY . • • • : COMBINED SINGLE ''''' • - • • •• • ANY AUTO : • . . : LIMIT i : . . : . ALL owNBOAUTOs •• • • • • • ' •' ' • • • BODILY INJURY • S •' • • . • SCHEDULED AUTOS • . • : .• • . . • :. • • . • i i HIRED AUTOS • • ' • • '• BODILY INJURY • ' . : NON•OWNED AUTOS • , . • i (INs• occident) i 8 . . • . . . • GARAce UAIBLITY • . . • . . • . ' • ' • • : • . . • i PROPERTY DAMAGE i 1 . • • . • • ' • • • EXCESS umuLrry •• . . . ' . : EACH OCCURRENCE : S : : ' • . . . . r ''' . '; • • ! : UMBRELLA FORM . ' : ACORBGATE $ • . , ! • • i OrIERTHANUMEMELLAPCIM ! .• . : <• .:::,... ::::::::!::::::::! ! '' . • . • . •• .• STATUTORY LD4ITS '....r. :::':::: :',.:'• : • ' • . WORKER'S COMPENSATION : • • • • • • • • : EACI4 ACCIDENT : S AND •* • • ' '.. • ' . • • i DISEASE—POLICY LIMIT ; S . • • • EMPLOYERS' unsitrry • : . • • •• : .. DISEASE EMPLOYER : S : On= • . . . • . . . : . • • • • • • . • • :',.. . • . • • . : • • • • , • : • • . • . . • . • . • • . •• DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/SPSCIAL ITEMS P1UMDIA9 Contractor e 10 days non payment XERTIF/CATEIHOLDEE: City of Miami Shores Bldg & Zoning Dept. 10050 NE 2nd Avenue Miami Shores FL 33138 • .,....::::,X.:q: K. „ :,;.:K, .,,K .1:,..,,,K.,!.,:.K::,..}.• K A et . ,.14.4,k / ,,,,,,,,,, :,..., - • • r.' --- ., • ...',.::::::.,.;:.,:,:::::::,;.,,,,•:••••::,.:•,::••,.:,:.1K.X.,1.,..:4 '•:;':' SHOULD ANY OP THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE :.:,.: :.i EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILLENDEAVOR To .... . MAIL 3 DAYS WRITTEN NOTICE To THE CERTIFICATE HOLDER NAMED TO THE ..'< LEFT. BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBUGATION OR .... :•' LIABILITY OF ANY KIND UPQ THE COMPANY. ITS AODITS OR REPRESENTATIVES. ....... :,.. ,...,:: AUTHORIZED REPItESENTA Phil i ip C. Lyons — . . . E., N !.!,:!!:::,..,.: . .f . ...!!:!! , ...,;,:, 1.=;I:1: *" • " iiii CORPORATION 1990 , ,,,,,,,,,,,,,,,.." .:...:..,.!,: .:::-.:-.....:-,. .::,.::.!...!..::.:: Jr,: : :...... :. : ....,...:. ,.....:..,. JUN-24-1993 08:29 FROM WORLEY HUMPHREY & BALL TO 7568972 P.04 MIAMI SHORES VILLAGE BUILDING INSPECTION DEPARTMENT APPLICATION FOR BUILDING PERMIT Application is hereby made for the approval of the detailed statement ur the plans and specifications herewith submitted for the build in or other structure herein described. This application Is made in compliance and conformity with the Building Ordinance of Nttarni Shores Village, Florida. and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division of Miami Shores Village shall be complied with, whether herein speci or not. A copy of approved 19.25. Owner's Name and Address g Lr�P tC .. : ..._ ._ No.... ...0 . Street._... ,l6 �•�1 .' Registered Architect and /or Engineer .,::: rn •••.... »,n,nnwt•t•tr.:t,e'1,11 Name and address of licensed contractor 2 co . Q _ALA) • 3 /rd P/4e _ • plans and specifications must be kept at building during progress of the work. Location and legal description of lot to be built on: Lot 9 Block ,,I., Subdivision ///41 //yy 1 1 •__ /t _ .1. � > .... /.�.. � 0. . ir / Street and Number where work is to be done ./. fY .7.!_. `- l.. 4'.. v_-. . State work to be done and purpose of building (by floors)......_ _......_. _ _._ .. _ 6.,94. ) Cifff . 0 _/.2,,y /2 ic /e _..._ and for no other purpose. New Building Remodeling Addition Repairs i" ------ No. of Stories ' _ To be constructed of hind of foundation Roof Covering T�r t ,1 b — =<--- Estimate Total cost of improvements $ -- Amount of Permit $.. „`'P..t/f V Zone cubage required .Plan Cubage Distance .to next nearest building Size of Building Lot Maximum live load to be borne by each floor I hereby submit all the plans and specifications for said building. All notices with reference to the building and its construction may be sent to 25 6 iii 7 ;Aer(i The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida, Permanent Supplement. anti has complied Stith the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work to be performed under this permit; and will post or cause to be posted for inspection on the site of the work such public notice or notices as arc required by the Act. The undersigned agrees to employ only such subcontractors, on work to be performed under this permit, as are licensed by Miami Shores Village. Remarks... (Signed) STATE OF FLORIDA, COUNTY OF DADE. ss. eace11 /g Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap- peared ._..._ _.. to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the. of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated are true.. Permit No. ' . Date / i ` 1 .... „._._ Read, Sworn to and Subscribed before me. Disapproved e:_..... Date (Signed) Building Inspector Notary Public, State of Florida My Commission Expires PLANNING BOARD DATE Chairman Member \Icrr,ber Member Member Member Council Approved Date Disapproved Date NOTE: A charge of $1.00 will be made for making corrections or changes to this application after approval has been obtained from the Plannir.;; Board. A re•in.iu•ction fce of $1.00 will be charged when such re- inspection is made necessary by Improper notice for inspection or faulty materials and/or workmanship. ✓L Oc..ocltGQir^' Ll�dP� 7' �`` �'� BUILDING p MIAMI SHORES VILLAGE, FLORIDA _ Z ELECTRICAL ❑ Date 119 -.7 PLUMBING tS PERMIT �T i, Q 8371 Contractor's Vi � License No. . 4 t 4 ROOFING ❑ ❑ Work to be performed under this Permit Owner of Building Architect Contractor ,.,_. or Builder ' ` • Legal Lot Description BI Address of T7 f-, , • Building t f f t + This permit is granted to the contractor or builder named above to construct the building or to install the equipment or device described in the applica- tion herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any plans, drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked at any time if the work is not done in compliance with such ordinances or if t plans are changed without authorization. A further condition upon which this permit is granted is the understanding that the contractor or builder named ab a assumes the responsibility for a thorough knowledge of the ordinances and regulations pertaining to the work covered hereby whether phown on the plans r drawings or in the statements or specifications and that he assumes respon- sibility for work done by his agents,fer nts orremployees,✓ Signed � '- (INSNCTOR) BY In consideration of the issuance to me of this permit I agree , the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, tements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done either, 1 elf, my agent, servant or employee. 1 CONTRACTOR or BUILDER JeT T7 e4 44. S '""" 4 e) to• Subdi- /`'. v "� 2./ $, vision Sq. Ft. Value of 11 Amount of ) --- Project $ 11 Permit BY AUTHORITY