353 NE 94 St (13)I�
APPLICATION FOR BUILDING PERMIT
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the build-
ing or other structure herein described, This application is made in compliance and conformity with the Building Ordinance of Miami
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 specified or not. A copy of approved
plans and specifications must be kept at building during progress of the work.
Owner's Name and Address / Al 4 Lf
Registered Architect and /or Engineer
c C A / t2. eQ nc /). # Yeito,✓ /A( c •r! N (Ai S/ //: (
Location and legal description of lot to be built on:
Lot Block
Street and Number where work is to be done
Name and address of licensed contractor
State work to be done and purpose of building (by floors)
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPARTMENT
Subdivision._._ -._
3J''3i✓
4t_
Date U - C
No,,3• Street 4/ 6-, 95 5-7!
and for no other purpose.
New Building Remodeling .. ____ _._ Addition -__ Repairs No. of Stories _. -
To be constructed of Kind of foundation. Roof Covering - -
Estimated Total cost of improvements $ 4 2-1-0 J Amount of Permit $ r' v r .-
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
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,
and has complied with 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 are required by the Act. The undersigned agrees to employ only such subcontractorsg4.6erz_1;,
o work to be performed under this
Remarks (Signed) /4
permit, as are licensed by Miami Shores Village. 1
STATE OF FLORIDA,
COUNTY OF DADE. ss.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally ap-
peared
and who, being by me
of the above described
therein by him stated
Permit No
Disapproved
(Signed)
first duly sworn, upon oath deposes and says that he is the
construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts
tru
to me well known,
Date 7- 7'- _ -_ Read, Sworn to and Subscribed before me.
Date -.
h Notary Public, State of Florida
+t(_ (.
Building Inspect 8'r � My Commission Expires
PLANNING BOARD DATE
Chairman Member
Member Member
Member . ._ - Member
Council Approved Date Disapproved
NOTE: A charge of $1.00 will be made for making corrections or changes to this application after approval has been obtained from
the Planning Board.
A re- inspection fee of $1.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty
-ials and /or workmanship.
Date
s �.• PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Legal Description
93 Job Address C3 /U E qq ' 1 Tax Folio y , / 6/I 6
u 044 , A446,
Master Permit # 39? SS
/ Lessee / Tenant , -b->/Y / ; /4(S
Owner's Address 3.53 dV E ?l( s 1
Contracting Co. 6 11000/ r NeGh (J
Qualifier ,,; fid.li /. .` : JI,■ SS#
State 11QM Q O po 1 Municipal
Architect /Engineer
Bonding Company
Mortgagor
Permit Type(circle
WORK DESCRIPTION
one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
Reltace Cf Oh+ C�1
Square Ft. Estimated Cost(value)
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 'n compliance with all applicable laws regulating construction and zoning. Furthermore, I
auth• i - the above -named contractor to do the work stated.
Notar s to • er and or Condo Pre
My Comunission Expires: ('
Address
arm - s to Con ractor o Owner -
` My Commission Expires: 4,1 ac
4ui israin
* /V . dttliiliilItiAt ' e#plrod torll no ,� *
11
FEES: PERMIT / t '?' f RADON
** * . •*' * . - *
APPROVED:
Zoning
Mechanical
Phone
Address /1 7a�? 12-le
_
g2Phone "l !b 7' b
N. ten
W• mpecy 4f r Ins.Go.
Address
Address
F!d Puaild, Mato of FUrtd
or or Owner- Builder
C.C.F. t, NOTARY TOTAL DUE 7
Fire Other
Building Electrical
lumbing Engineering
DADE COUNTY
TAX COLLECTOR
140 W. FLAGLER ST.
11111 FLOOR
MIAMI, FL 33 130
00- 0748567 CC NO: 000011{,83
LICENSE NO. IS HEREBY LICENSED TO DO
BUSINESS NAME /LOCATION BUSINESS AS A CONTRACTOR
GOLDCOAST MECHANICAL INC AS SPECIFIED HEREON.
14725 N MIAMI AVE
UNNER :GOLDCOAST MECHANICAL INC
NUT VALID IN:
HIALEAH
VILLAGE OF KEY BISCAYNE
Licensee rnust
register in the city
where work is to
be done.
PAYMENT RECD.
DADE GNP( TAX
COLLECTOR:
09/09/92
270000114
000200.00
' DADE COUNTY
TAX COLLECTOR •
140 W. FLAGLER ST.
141h FLOOR _
MIAMI, FL 33130
BUSINESS NAME /LOCATION
t;ULUCOAST MECHANICAL INC
14725 N MIAMI AVE
33168 UN.IN DADE COUNTY
OWNER
GOLDCOAST MECHANICAL INC
c
Se. Ty a of Business
196 (ENERAL MECHANICAL
n+iS IS AN OCCUPA-
TIONAL 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 UCENSEE
FROM ANY OTHER LI-
CENSE OR PERMIT RE-
OUIRED BY LAW. THIS IS
NOT A CERTIFICATION OF
THE UCENSEE'S OUAUFI-
CATION.
PAYMENT RECEIVED
DADE COUNTY TAX
COLLECTOR:
09/09/92
270000 10
000045.00
SEE OTHER SIDE
1992 MUNICIPAL CONTRACTOR'S 1993
OCCUPATIONAL LICENSE
DADE COUNTY — STATE OF FLORIDA
PURSUANT TO DADE COUNTY ORDINANCE 66 -2
EXPIRES SEPT. 30, 1993
GENERAL MECHANICAL
DO NOT FORWARD
14725ONSMIAMIINCAL INC
AVE
N MIAMI FL 33168
2 s y, . OCCUPATIO ALIICENg
- 1 1 , r�
DADE STATE OF FLORIDAI,
EXPIRES SEPT 30, 1993 YI
MUST BE DISPLAYED AT PLACE OF BUSINESS
PURSUANT TO.COUNTY CODE CHAPTER 8A- ART&; 10
LUCU ISE��i7��d arRUNC
N MIAMI EL 33160
RENEWAL
LICENSE NO. C C C U 000011663
_
EMPLOYEE
10
FIRST CLASS
U.S POSTAGE
PAID
MIAMI, FL
PERMIT 00. 231
FIRST CLASS
U.S. POSTAGE
PAID
MIAMI, FL
PERMIT NO. 231
•
•
DEPARTMENT OF PROFESSIONAL REGULATION
CONSTRUCTICN INDUSTRY LICENSING BOARD
CONSTRUCTION INDUSTRY LICENSING et
POST OFFICE BOX 2
JACKSONVILLE. FL 32201
DAT6tit=
05/08/91 I RR 0019191
THE REGISTERED MECHANICAL CONTRACTOR
NAMED BELOW HAS REGISTERED
UNDER THE PROVISIONS OF CHAPTER 489 F.S., FOR THE YEAR
EXPIRING AUG 31. 1993 (MUST MEET ALL LOCAL LICENSING
REQUIREPENTS PRIORI TO CONTRACTING IN ANY AREA)
lJ�� C 4
LAWTON CHILES
GOVERNOR
r .
STATE OF FLORIDA ( i 05/08/91
WALCOFF• BARTON L
GOLDCOAST MECHANICAL INC'
4001 S OCEAN DRIVE
HOLLYWOOD FL. 33019
DISPLAY IN A CONSPICUOUS PLACE
BATCH NCW.
40072
GEORGE STU
SECRETARYUD.P.R. _.
LICENSE NO.
R 0019191
8 AUDIT CONTROL NO. 14 2 8 8 8 0
BATCH NO. FEE AMOUNT
40072 5113_C0
LICENSEE SIGNATURE
r NNLLET CARD - FOLD HERE - 1 . _ - _ �. .
STATE QQ OF FLORIDA Sg
DEPARTMENT EG qq
C ONSTRUCTI O N O L N DU STRY � oN
LICENSING BOARD
REGISTERED MECHANICAL CONTRACTOR
HALCOFF. BARTON L
GOLDCOAST MECHANICAL INC
CINDIV@ MUST MEET LOCAL LICENSINI
REQ.. PRIOR TO CONTR.. IN ANT. AREA)
HAS PAID THE FEE REQUIRED BY C AYTEFR 4 89 F. . S.
FOR T E YEAR EXPIRING AU6 7 1553
LAWTON CHILES
_ GOVERNOR
GEOVGE STU
SECRETAR
T. JR
P.R.
1 , �....._...._.. - ., t+ M...1- t DG:> }X ... Sf,
fl r o �t� i.���� ®IY�
b T-s•
..� .,,,,w.... + t C(. Y S _ harzt. :'�
PRODUCER •
B. A. C. RISK MANAGEMENT, INC. •
P. O. BOX 16717
} 5 " _. :p:. -E•+ t.. .
y � �e r� ISSUE DATE (MM /DD/YY)
d ,:Q. P E,. x',�, f ,
AN -.�A �" Fi. Kb1AT.3wl • • 11
•
- 1 r , r
CONFERS NO RIGHTS UPON THE CERTIFICA1EI OLDER: THIS CERTIFICATE
DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE
POLICIES BELOW.
7900 PETERS ROAD
PLANTATION, FLORIDA 1 COMPANIES AFFORDING COVERAGE
33318 -6717
COMPANY
(305) 424 -1500 LETTER A GENERAL ACCIDENT INSURANCE COMPANY
COMPANY B
LETTER
INSURED
GOLDCOAST MECHANICAL, INC.
14725 NORTH MIAMI AVENUE ,
MIAMI, FLORIDA
33168 .
COMPANY
LETTER C
_-
COMPANY D
LETTER
. COMPANY E
LEVI
COVERAGE'S y ,n ... L•t F .-4Vd K ? r r 4 ' -- * i- ; #'*.i;, J - ''
- iit :a3 .u;zsr . . .
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.
CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION. LIMITS
LTR DATE (MWDD /YY) ' DATE (MWDD /YY)
GENERAL LIABILITY MCP 0933174
X COMMERCIAL GENERAL LIABILITY
T CLAIMS MADE X OCCUR.
OWNER'S & CONTRACTOR'S PROT.
09/09/92 ; 09/09/93 GENERAL AGGREGATE $ 1,500,000.
I. PRODUCTS- COMP /OP AGG. $ 1,000,000.
$ ..... ,000 . ..
PERSONAL & ADV. INJURY
EACH OCCURRENCE i 300,000.
A .._ E(yon _ - -' 50,000.
FIRE DAMAGE (Any one fire) $
MED. EXPENSE (Any one person) $ 5,000.
AUTOMOBILE LIABILITY
A X ANY AUTO 92215
ALL OWNED AUTOS
COMBINED SINGLE
09/09/92 09/09/93 LIMIT $
300,000.
.._- -..._ .... ..__...- _._...._.... -._ __-... -. .. .
I
BODILY INJURY $
(Per person)
BODILY INJURY $
(Per accident)
PROPERTY DAMAGE $ C s T L
s
—Y
SCHEDULED AUTOS
X HIRED AUTOS
X NON -OWNED AUTOS
GARAGE LIABILITY
EXCESS LIABILITY
UMBRELLA FORM
OTHER THAN UMBRELLA FORM
EACH OCCURRENCE $
AGGREGATE $
— -
WORKER'S COMPENSATION STATUTORY LIMITS
• EACH ACCIDENT $
AND +
DISEASE — POLICY LIMIT $
EMPLOYERS' LIABILITY ...
DISEASE —EACH EMPLOYEE $
OTHER
DESCRIPTION OF OPERATIONS /LOCATIONS /VEHICLES /SPECIAL ITEMS
CERTIFICATE:HOLDER �. l 0,=1 s " ' `�` �, ` ;CANCELIION
� n . Xf , -...i :.x
CITY OF MIAMI SHORES �
BUILDING & ZONING DEPARTMENT
10050 N. E. 2ND AVENUE
MIAMI SHORES, FLORIDA
:A;T t •�y� K' x� t T*tj, ' -.
'LL tgrg.rF r' T_.t'_r. k "�' ;,i •s>a:: +�i. v` . 1' - E w.�,ih' , 14L'. 3Y:S �b�"iG1: .i.titcL.•
S. _ d
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO
MAIL .30_ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE
LEFT, BUT FAIL T MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR
L :: ITY •' ANY 1N D UPON THE C• PANY, ITS AGENTS OR REPRESENTATIVES.
33138 ':
TACO ISTft Oj ;">r , „ 4 _ , F V
AUTHO +' ES • AT
�� � OBERT B._ MA
COLN
:./ 4 i E E v ' �"� O, Q " 4 ) I fl
1 s h z :t• 4
Y
CERTIFICATE OF INSURANCE
Producer B.A.C. RISK MANAGEMENT
P. O. BOX 16717
PLANTATION
FL 33318 -6717
(305)424 -1500 Ext
Insured
GOLDCOAST MECHANICAL, INC.
14725 N. MIAMI AVENUE
MIAMI
305 -945 -8387 ext.
COVERAGES This is to certify that 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.
CO
LTR
A
TYPE OF INSURANCE
GENERAL LIABILITY
[ ] Commercial G.L.
[ ] Clme -Made [ ] Occur.
[ ] Owner's /Cont's Prot.
[
[
AUTOMOBILE LIABILITY
[ ] Any Auto
[ ] All Owned Autos
[ ] Scheduled Autos
[ ] Hired Autos
( 1 Non -Owned Autos
[ ] Garage Liability
[ 1
EXCESS LIABILITY
( ] Umbrella Form
[ ] Other Than Umbrella
WORKER'S COMPENSATION
AND
EMPLOYERS' LIABILITY
OTHER
CERTIFICATE HOLDER
CITY OF MIAMI SHORES
BUILDING & ZONING DEPARTMENT
10050 N. E. 2ND AVENUE
MIAMI SHORES, FLORIDA
33138
= ACORD 25 -S (07/90)
FL 33168
ext.
POLICY NUMBER
193 -006
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.
Company Letter
Company Letter
Company Letter
Company Letter
Company Letter
POLICY EFF. POLICY EXP.
DATE mm /dd /yy DATE mm /dd /yy
01 -01 -93
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / SPECIAL ITEMS
Authorized Representative:
COMPANIES AFFORDING COVERAGE
A THE FLORIDA CHAMBER FUND
B
C
D
E
01 -01 -94
LIMITS
General Aggregate
Prod- Comp /Operations Agg.
Personal /Adv. Injury
Each Occurrence
Fire Damage (Any 1 fire)
Med Exp (Any 1 person)
Date: 01 -04 -93
0
0
0
0
0
0
Combined Single Limit $ 0
Bodily Injury
(Per person) $ 0
Bodily Injury
(Per accident) $ 0
Property Damage $ 0
Each Occurrence $ 0
Aggregate $ 0
[X] Statutory Limits
Each Accident
Disease- Policy Limit
Disease -Each Employee
$ 100000
$ 500000
$ 100000
n seen====..==== a== a===== n===____ ..... ____________====== o=====________________===== o===== ____________= == == a =o = = = =o == = ==
CANCELLATION: Should any of the above described policies be cancelled before
the expiration date thereof, the issuing company will endeavor to mail 30
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 repreeentati
i
1
Date 10-D(0 Time Z'.L{5 �•r
Type Insp'n 1( • t'`'L
Permit No. 1`4G
(Alf W3 11 0
Name (• (Alfa STt L 'mil 9_1_0
�llC rv� t
Address 5S3 -
Company Din StOtTe. Qti • TL G
Phone # 3o s - S g ' ®L
For Inspector: 10-31-0314r4Nlame & Date
Approved
Correction
Re- Insp'n Fee
MIAMI SHORES VILL GE
BUILDING DEPARTM
305- 795 -2204
Building Inspection Request