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RC-09-2020MOLD REMEDIATION. REPLACE DRYWALL & INTERIOR REMODEL Passe r Inspector Comments 6._. /7� a Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled re- inspection fee is paid. until nspection Number: INSP - 131076 Permit Number: RC -12 -09 -2020 1 Inspection Date: November 23, 2010 Inspector: Bruhn, Norman Owner: Job Address: 131 NE 96 Street Project: <NONE> Miami Shores, FL Contractor: HOME OWNER Building Deaartment Comments November 24, 2010 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Permit Type: Residential Construction Inspection Type: Final Work Classification: Addition/Alteration Phone Number Parcel Number 1132060132590 For Inspections please call: (305)762 -4949 Page 1 of 1 Inspection Number: INSP- 149833 Permit Number: RC -12 -09 -2020 Scheduled Inspection Date: November 23, 2010 Inspector: Bruhn, Norman Owner: Job Address: 131 NE 96 Street Project: <NONE> Contractor: HOME OWNER Building Department Comments MOLD REMEDIATION. REPLACE DRYWALL & INTERIOR REMODEL Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments CREATED AS REINSPECTION FOR INSP- 131085. Work covered with no inspections NB November 22, 2010 Miami Shores, FL 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: Residential Construction Inspection Type: Insulation Work Classification: Addition /Alteration Phone Number Parcel Number 1132060132590 Page 3 of 31 BUILDING PERMIT APPLICATION FBC 20 Permit Type: BUILDING ROOFING. Owner's Name (Fee Simple Titleholder) , QUA 1 �'S alega6APhone # Y) :24 . 2 Owner's Address 1 ND " Zip3 / J� City alitibiAotvfs State Tenant/Lessee Name Email Qualifier Name Architect/Engineer's Name (if applicable) Value of Work For this Permit $ Type of Work: ❑Addition ❑Alteration Describe Work c ' VOA 14_f _ . - drys L - Miami Shores Village Buil ding 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 Ct 114 Job Address (where the work is being done I ► �"1b S'1' City Miami Shores Village County Miami - Dade FOLIO / PARCEL # L I -- f b a c am , — (O 1' ? ✓ o Ls- ?O Is Building Historically Designated YES NO ki Contractor's Company Name Contractor's Address [ b( ( j City t 111 DVIA10 lees . State 'L- Permit No. QC/0 OZcO Master Permit No. Phone # Phone # l a ( fA0 Zip 53 / ' Phone # Phone # ZiP 51'68 120. 11 i DEC 0 8 200 BY: Flood Zone State Certificate or Registration No. Certificate of Competency No. 'Contact Phone E-mail Square / Linear Footage Of Work: ❑New ❑ Repair/Replace ❑ Demolition t-rextr& th4e21 VI/ 4 ( 1(11 I 7 I , � 4A-1-‘41/0,1,L'h s, ******* * * * * * *** * * * * * * * * * * * * * * * * * ** * * ** F ees * *, ********** *** ** *** ** * * ** *** * * * ** **** * * *** Submittal Fee $ Permit Fee $ }Q CCF $i CO /CC $ Notary $ Training/Education Fee $ a'a0 Technology Fee $ Ic• Scanning $ L2 Radon $ ) .11l.J DPBR $ i • CO Bond $ Double Fee $ Violation date: c Structural Review. $ Total Fee Now Due $ 44 30 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 COM1VIENCE1VIENT." 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 and a reinspection fee will be charged. Signature Owner or Agent r� Contractor The for oing instrument was ackno ledg + be • re me ! The foregoing instrument was acknowledged before me this day of�, 2063 by y of , 20 , by who is personally known to me or who . : produced who is personally known to me or - who has produced As identification and who did take an oath. as identification and who did take an oath. NOTAR PUBLIC: 4t% NOTARY PUBLIC: ee Sign: Print: My Commission Expires: APPROVED BY (Revised 07 /10 /07)(Revised 06/10/2009) Sign: Print: My Commission Expires: s o ***** ** ** ** **** * * ** * **** *** ** * * ***** x, *x * *a ** **** ** *** *, * * *x * ****, * *, * **** * **** * ** *** ***** * *,��e,�:��e�e**** / �+lans Examiner Zoning Engineer Clerk checked OV,a ti cvAL ' "fo e 11y , November 13 2010 Job Address: 131 NE 96 Street Miami Shores. FL. 33138 Permit #: RC- 092020 Sincerely. Cesar A. Jofre Engineering Claudio A. Jofre PEE. 28531 Cesar A. Jofre Engineering Claudio A. Jofre P.E. #28531 334 NE 102 Sheet. Miami Shores, Florida 33138 786 - 382 -1695 ; Fax:305- 835-0951 E -mail: cjofre@bellsouth.net ff A . NOV 1 ;211 Re: Field Engineering Inspection Report. CEILING INSULATION. TO Mr. Norman Bruhn. Miami Shores Building Official: Our firm did an inspection, at the owner's request, of the insulation in the ceilings of the address above. We have concluded the following. 1. The ceiling space over the dining and kitchen areas has received a recent application of blow -in insulation, F.R. treated celluloseffiber type, of 5 "-6" variable depth. Estimated insulation R value is 3.6 R per 1". Total insulation = R18 -19 2. There is also additional insulation over other parts of the ceiling, fiberglass layer type. This job meets the codes and standards for interior build out in the State of Florida. 3. We certify that our findings are verifiable. See attached picture. The above field survey was done under the professional supervision of Claudio A. Jofre PE #28531. Address: 131 NE 96th Street, Miami Shores, FL. RE: Ceiling Insulation Picture. New blow -in insulation covers well over the truss bottom framers. PASS (11) Claudio A. Jofre P.E. 28531 coD 09/07/2010 131NE96St Miami Shores, Fl 33138 To Whom It May Concern: panY311)1 I am writing to you in reference to the permit for remodeling of the property at 131 NE 96 St. I would like to ask for the extension of the permit in order to resolve the problems that we are having with the completing of the inspections. The delay is caused by my Dad's terminal illness and his passing away (we've just found out about his inoperable cancer about 3 months before he suddenly passed away) and the fact that I am having some tough time with my pregnancy. I am truly trying the best I can and I am trying to select the best professionals in the place that we have just moved into. I appreciate your patience with me that you have shown so far and please know that your input and advice is really always appreciated. I have really tried to do the best and I really thought that I am doing well, but now I just need to correct the mistakes that I have made and we will enjoy living in this lovely area that we have become to love soon after we have moved here. Thank you, Sincerely, Magdalena Cauchi r Inspection Number: INSP- 131297 Permit Number: PL -12 -09 -2035 Scheduled Inspection Date: February 11, 2010 Inspector: Hernandez, Rafael Owner: Job Address: 131 NE 96 Street Project: <NONE> Contractor: DIAL PLUMBING CORP Building Department Comments REPAIR DAMAGE SANITARY CAST IRON PIPE. AND CONNECT WITH WATER SUPPLY PROPERLY AND MAKE FIXTURES CONNECTIONS Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments February 10, 2010 Miami Shores, FL 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: Plumbing - Residential Inspection Type: Final Work Classification: Addition /Alteration Phone Number Parcel Number 1132060132590 Phone: (305)221 -8569 Page 7 of 29 Miami Shores Village - Building eeartment 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 Permit No. T I0 ` -- 0(J 5 Master Permit NaV Coq -,7-320 BUILDING PERMIT APPLICATION FBC 20 Permit Type: PLUMBING Owner's Name (Fee Simple Titleholder) M44 qIA/ELFI 640 ci Phone # 3 OS - 22 0 _ Owner's Address / 3 7 1U2. 16 S +d City / igt,.ti .5 2 €‘ State Zip 33/39 Phone Tenant/Lessee Name Email Job Address (where the work is being done) City Miami Sham Villaee County Miami -Dade Zip 313 FOLIO / PARCEL # Is Building Historically Designated YES NO Contractor's Company Name NAL PL (MI ,BENCg Grp. Phone # L 4 t112 t� Contractor's Address ��c) '"?_`Z. City Qualifier Name Contact Phone ,.�Z \5?-aciG State E -mail 13/ )z el 5 Zip 31ko5 Flood Zone P l'X- State Certificate or Registration No. Certificate of Competency No. Ue jl ,(:\ Architect/Engineer's Name (if applicable) Phone # Value of Work For this Permit $ ) ) Square/Linear Footage Of Work: Type of Work: []Addition 11 QAlteration [New [�Repair/Replace Describe Work: `r a i4v.4. ; C 4- •1,..° y 40 % , . 4.... Submittal Fee 5 ** * * * * * * * * * * * * * * * ** *** * * * Permit Fee $ ,46.h c h ue 0k ❑ Demolition t ce **F * ********** 1 ******************************* CCF$ l -�' I . DEC 10 2000 BY: - - -.. CO1CC $ Notary $ Training/Edut Fee $ 0 AO Scanning $ )' no Radon $ DPBR $ Bond $ Double Fee $ Violation date: Structural Review. $ Total Fee Now Due $ I9(Q' Technology Fee $ 1. ( See Reverse side -a 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 abs . ° of such posted notice, the inspection will not be approved and a reinspection fee will be charged. 1 „ NIS k4A V. Signature g Owner or Aggeent e f o insh�um�en� acic�fow1 day of , 20�, by who is personally known to me or wh has produced As identification and who did take anoath. eiz 4 4 e �x o 4 e, P � NOT Y PUBLIC: Sign: Print: My Commission Expires: APPROVED BY + *** ******* ***, Contractor �/ The foregoing ` 4 instrument was acknowledged before me this y of be' ,20 ( /J, b Plant- &Q . Engineer Signature NOTARY PUBLIC: ho is personally known to me or who has produced as identification and who did take an oath. Sign: Print: � � ` ' f`°, - ' ■�� ,., ; r Commission DC 734374 My Commission :. Expires November 14, 2011 Thu 800,185-7019 **** *lt' '1t ****1Z***** ' **Lt*$1@A♦<lT!lti if'Q`******** t *** *LS`1***71 ***** Zoning Clerk checked .1TY INSURANCE DATE /(Q09m 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 NAIL # ABOVE FOR THE POLICY RESPECT TO WHICH AU. THE TERMS. POLICY EXPIRATION DATE: (MMIDDIYY) INSURER A CYPRES S PROPERTY & CASUALTY INS LIMITS A INSURER B: GENERA'. UABIUTY 41 COMMERICAL GENERAL LIABILITY ❑❑ CLAIMS MADE r.4 OCCUR 0 f3FI,_ i 007254 INSURER C: 07/25/10 EACH OCCURENCE INSURER 0: � 1 DAMAGE TO RENTED PREMISES (Ea cwrrcncAI INSURER E: MED EXP (My ons Person) THE ANY PERTAIN, POLICIES. NSR LTR POLICIES REQUIREMENT, ADM. INSRC OF INSURANCE LISTED BELOW TERM OR CONDITION THE INSURANCE AFFORDED BY THE AGGREGATE LIMITS SHOWN MAY TYpg OF INSURANCE HAVE BEEN ISSUED TO THE OF ANY CONTRACT OR OTHER POLICIES DESCRIBED HEREIN HAVE BEEN REDUCED BY POLICY NUMBER INSURED NAMED DOCUMENT WITH IS SUBJECT TO PAID CLAIMS. P • EPFE DATE (MMIDD/YY) ABOVE FOR THE POLICY RESPECT TO WHICH AU. THE TERMS. POLICY EXPIRATION DATE: (MMIDDIYY) PERIOD INDICATED. NOTWITHSTANDING THIS CERTIFICATE MAY BE ISSUED OR MAY EXCLUSIONS AND CONDITIONS OF SUCH LIMITS A GENERA'. UABIUTY 41 COMMERICAL GENERAL LIABILITY ❑❑ CLAIMS MADE r.4 OCCUR 0 f3FI,_ i 007254 07/25/09 07/25/10 EACH OCCURENCE si'000,000 � 1 DAMAGE TO RENTED PREMISES (Ea cwrrcncAI 5100,000 MED EXP (My ons Person) 35,000 PERSONAL aADV INJURY $1,000,000 II GENERAL AGGREGATE 5I,000,000 GENII AGGREGATE LIMIT APPLIES PER: EI POLICY ❑ PROJECT ❑ LOC PRODUCTS - COMP /OP AGG S1,000,000 p .. $ ❑ AUTOMOBILE LIABILITY ANY AUTO ❑ ALL OWNED AUTOS ❑ SCNEOULED AUTOS ❑ HIRED AUTOS El NON-OWNED AUTOS COMBINED SINGLE LIMIT (Each Oewrrenee) S BODILY INJURY (Per On) 5 BODILY INJURY (Par atdtlerri) s PROPERTY DAMAGE (Per =Went) 5 GARAGE LIABILITY ❑ ANY AUTO ❑ AUTO ONLY - EA ACCIDENT 5 IM OTHER THAN EA ACC S AUTO ONLY: AGO S ❑ EXCESSIUMBRELLA LIABILITY ❑ OCCUR ❑ CLAIMS MADE ❑ DEDUCTIBLE ❑ RETENTION $ EACH OCCURRENCE $ AGGREGATE $ 5 $ 10 WORKERS COMPENSATION AND EMPLOYERS LIABILITY ANY PROPRIETORIPARTNER/EXECU- TIVE OPFICERJMEMSER EXCLUDED? K yes, describe under SPECIAL PROVISIONS below O- ❑ TORY O 8T LIMITS T ❑ ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POUCY LIMIT $ ❑ OTHER DESCRIPTION OP OPERATIONS 1 LOCATIONS 1 VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT /SPECIAL PROVISIONS PLUMBING CONTRACTOR A CRD° CERTIFICATE OF LIABI • P PAT DEL VECCHIO INSURANCE 263NE ST HOMESTEAD FL 33030 INSURED DIAL PLUMBING CORP 9940 SW 22 ST MIAMI FL 33165 COVERAGES CERTIFICATE HOLDER VILLAGE OF MIAMI SHORES 10050 NE 2t' AVE MIAMI SHORES. FL 33138 FX: 305 - 7564972 ACORD 25 (2001108) CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE INSURER AFFORDING COVERAGE WILL. ENDEAVOR TO MAIL 31 DAYS WRITTEN NOTICE TO . a FICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO BO SHALL IMPO • • OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER. ITS AGENTS 0 - • RESENTA AUTHORIZED REPRESE (�7 ACORD CORPORATION 1888 nntiu,lnnill AIIInn,A 11/1 1W-I WNOC' I 1 ann7 'C '9nd Inspection Number: INSP- 134699 Permit Number: EL -12 -09 -2024 Scheduled Inspection Date: February 03, 2010 Inspector: Devaney, Michael Owner: Job Address: 131 NE 96 Street Project: <NONE> Contractor: VETERANS ENERGY SOLUTIONS Building Department Comments UPGRADE EXISTING ELECTRICAL SERVICE FROM 100 AMPS TO 200 AMPS AND UPGRADE SERVICE IN KITCHEN IN ACCORDANCE WITH NEC Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments eii February 02, 2010 Miami Shores, FL 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: Electrical - Residential Inspection Type: Final Work Classification: Addition /Alteration Phone Number Parcel Number 1132060132590 Phone: (305)593 -9191 Page 20 of 22 BUILDING PERMIT APPLICATION FBC 20 Permit Type: ELECTRICAL Owner's Name (Fee Simple Tideholder Owner s Address cit Tenant/ Lessee ame Ema State to bfi 4 11 Job Address (where the work is being done) Of 1E7' City yjni Shores Coun FOLIO / PARCEL # Is Building Historically Designated YES Value of Work For this Permit $ Type of Work: ['Addition Submittal Fee $ 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 Permit No.elpq, -- Rog/4 Phone # 10 'Dade Contractor's Company Narn Contractor's Address 133( City 14.001- state FL Zip 3 Qualifier Name 54 — State Certificate or Registration No, EC /30O 3 la Certificate of Competency No. Contact Phone 305 — - /59 E-mail i Architect/Engineer's Narne (if applicable) Ccfrk26_P_S:teve-2_Phone # f 22.* .-f4 L (="Alteration 1, — Square / Linear Footage Of Work: A f Repair/Replace frp 1-"e- ['New Describe Work: 4.4tordaptee. _Lvd 4/EL. * * * * * *** * * * * * * * *****F Permit Fee $ lee Master Permit No 36s- 7 1Z -2 .0 )RottilSalkill_Phone# -.40weq;5 Phone it 7'/T6 - 423— 46 044 ******************************** CCF $ 110 co/CC s Notary $ Training/Education Fee $ 0 - t00 Technology Fee $ Scanning $ `lX) Radon $ DPBR $ Bond $ Double Fee $ Violation date: Structural Review. $ Total Fee Now Due $ I till. See Reverse side —* Z ip Flood lo Dia; 0..8 2009 •11) BY: 4t) 0 Demolition Bonding Company's Name (if applicable) Bonding Company's Address City Mortgage Lender's Name (if applicable) Mortgage Lender's Address City 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 CO 1 NCEMENT 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 COMMENCE 1 NT." 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 afier the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a re-inspection fee will be charged. Owner or Agent The foregoing instrument was acknowledged before me this F day ofc?›2‘.&44b.e(200 by Atuv /er4q who is personally known to triewho has produced As identification and who did take an oath. NOTARY PUBLIC: Sign: Print My Commission Expires: elt APPROVED BY (Revised 07/10/)7X Revised 06/10/2009) State State OTARY PUBLIC-STATE OF FLORIDA A Russell Otway Commission SD0723933 Expires: OCT. 10, 2011 Zip c bins Examiner Engineer Signa ture Zip Contractor The foregoing instrument was acknowledged before me this day ofJ)pred4ber f, 20 (21, by _$1e„ who i6;;;Tonally known to nor who has produced as identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC-STATE OF FLORIDA : 0,1■ I oke . ) comi t s is si s Otwa Aboieir, .4 ) Sign: .... . ... wen: OCT. 10,2011 Print: EL,iDTHRU My Commission Expires: * * * Zoning Clerk checked INSR ADM ' LTR IINSRD TYPE QF INSURANCE POLICY EFFECTIVE POLICY NUMBER DATE(MM/DDIYY) POLICY EXPIRATION' DATE (MM/DD/YYI LIMITS GENERAL X LIABILITY I COMMERCIAL GENERAL LIABILITY GL-30049 09 -23 -09 09 -23-10 EACH OCCURRENCE $ 1 - 000_,_ 000 PPRREMISESUi rce nco) ' $ 100,000 GEN'L X CLAIMS MADE X I OCCUR MED EXP (Any one person) ; $ 5,000 PERSONAL a ADV INJURY -$ 1 000 ;GENERAL AGGREGATE :$ 2_,000 000 AGGREGATE LIMIT APPLIES PER PRO - POLICY r I JECT I LOC • PRODUCTS - COME /OP AGG $ 1 000 2 ,000 I AUTOMOBILE F LIABILITY ANYAUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS COMBINED SINGLE LIMIT $ (Ea accident) BODILY INJURY (Per person) $ BODILY INJURY : (Per accident) $ PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY ANYAUTO AUTO ONLY -EA ACCIDENT $ L EA ACC ; $ OTHER THAN -- --- t- ---- _.._---- ._. —_._.. AUTO ONLY AGG $ EXCESS — I /UMBRELLA LIABILITY OCCUR CLAIMSMADE DEDUCTIBLE RETENTION $ 1 EACH OCCURRENCE AGGREGATE 4 _$___ ----- _ „ _ - __ - __ .----- $ r $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORlPARTNERlEXECUTIVE OFFICER MEMBER EXCLUDED? Ityes, de untler SPECIAL PROVISIONS below ff WC- 30162 -1 09- 24 -09' 134/01/10 I WCSTATU- ' 'OTH -' X TORY LIMITS ER `� E.L. EACH ACCIDENT $ 100, 0 E L DISEASE - EA EMPLOYEE $ 100,000 - E L DISEASE - POLICY LIMIT $ 500,000 OTHER 14 CSR® DATE(MM/DD/YYYY) l� CERTIFICATE OF LIABILITY INSURANCE 12/9/2009 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Doza Insurance Services,Inc. 5201 Blue Lagoon Dr. Penthouse Miami, FL 33126 305 -444 -3692 INSURED Veterans Energy Solutions, LLC. COVERAGES 345 Ocean Dr Miami Beach, FL 33139 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE INSURER A: Ascendant Underwriters , LLC INSURER B: Citrus, Buisness Owners INSURER C INSURER D INSURER E NAIC# 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 CLAIMS. DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES! EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS 1 Electrical Services Standard Policy Provisions & Exclusions Apply. No Additional Insured Applies CERTIFICATE HOLDER ACORD 25 (2001/08) Miami Shores Village 10050 NE 2nd Ave. Miami Shores, FL 33138 CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL30 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 REPRESENTA © ACORD CORPORATION 1988 Mal IMO .^c C3 ...ea. Cr. t r ' >4 CC =1 This I Name Address Permit No. STATE OF Tei //__ COUNTY OF at . " Lt/ re ed B ri • NOTICE OF COMMENCEM ENT Sleles, L 4bb i 3� s Signe( of Partner /Manager Signatory's a /Office as a knewledged before me this ay of ame of person) as authort ...e.g. officer, trustee, attorney In Fact) for behalf of whom instrument was executed). NOTARY pt3BLIC -11• :!ATE OF FLORIDA ,,,...,4. Ciett4A V. CObiliOS Cow' 03I1717923 lip Wires: : SE. 23, 2011 BOAIDID THTtU ATt:AY7r " c BON VIIAGC0.,INC. /. Tax Folio No. THE UNDERSIGNED hereby gives notice that Improvement 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. Description of property: (legal description of property, and streaaddress if available) (?mot 66 S {- IW6 A4,4..( 're; z✓ 3 i �?l 2. General description of improvement otat - �t�+...5c w I t�.E•'•r`d. ju ° � 2�, 2 b► .gyro s 3. a. � `e, t-Fitr thtold: ;�.ea��o_ - u, na andab dress: A/ p � i ` p_ a. Name and address• �{, W (,$�,�(, b. Interest in properly: Of-t Yte,YSI/Vt` c. Name and address of tee simple titteho der (if other than owner): 4. Contractor: SO a. 'ame an address: b. Phone number: b®yJ 1 240 EAZ 5. Surely a. Name and address: b. Amount of bond $ c. Phone number: 6. er T -1'"� t kg a. Name and address:. ©Vd YL b. Phone number: 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: a. Name and address: b. Phone number: 8.1n addition to himself, Owner designates (he following person(s) to receive a copy of the Lienors Notice as provided In Section 7.13.13(1)(b), Florida Statutes; a. Name and address :. b. Phone number B. Expiration date of notice of commencement (the explration date is 1 year from the date of recording unless a different date is specified) 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 1, 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 COMMENCEM er or Owner's Authorized Officer /Director r) by (type of (name of party on re of Notary • • , tic — tat o Florida Print, Type, or Stamp Commissioned Name of Notary Public Commission Number • Personally Known or Produced Identification Verification Pursuant to Section 92.625, Florida Statutes Under penalties of perjury, I declare that i have read the foregoing a •• that the acts stated in it are true to the best' of my knowledge and belief. Sign • ure of Nat ural Person Signing Above OWNE NAME: Pad ADDRESS: 1 31 NEJ UILDE 9c24 DISCLOSURE STATEMENT TE: M iami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Do hereby petition the Village of Miami Shores to act as my own contractor pursuant to the laws of the State of Florida, F.S 489.103(7). And I have read and understood the following disdosure statement, which entitles me to work as my own contractor, I further understand that I as the owner must appear in person to complete all applications. State Law requires construction to be done by a licensed contractor. You have applied fora permit under an exception to the law. The exemption allows you, as the owner of your property, to act as your own contractor even though you do not have a license. You must supervise the construction yourself. You may build or improve a one- family or two-family residence. You may also build or improve a commercial building at a cost of $25,000.00 or less (The new form states 75,000). The building must be for your own use and occupancy. It may not be built for sale or lease. If you sell or lease a building you have built yourself within one year after the construction is complete, the law will presume that you built for sale or lease, which is a violation of this exemption. You may not hire an unlicensed person as a contractor. It is your responsibility to make sure the people employed by you have licenses required by state law and by county or municipal licensing ordinances. Any person working on your building who is not licensed must work under your supervision and must be employed by you, which means that you must deduct F.I.C.A and with - holdings tax and provide workers' compensation for that employee, all as prescribed by law. Your construction must comply with all applicable laws, ordinances, buildings codes and zoning regulations. Please read and initial each paragraph. 1. !understand that state law requires construction to be done by a licensed contractor and hive applied for an owner- builder permit under an exemption from the law. The exemption specifies that I, as the owner of the property listed, may act as my own contractor with certain restrictions even though I do not have a license. Initial el (/ 2. I understand that building permits are not required to be signed by a property owner unless he or she is responsible for the construction and is not hiring a licensed contractor to assume responsibility. 5. I understand that, as the owner - builder, I must provide direct, onsite supervision of the construction. Initial ,-` 3. I understand that, as an owner builder, I am the responsible party of record on a permit I understand that I may protect myself from potential financial risk by hiring a licensed contractor and having the permit filed in his or her name instead of my own name. I also understand that the contractor is required by law to be licensed in Florida and to list his or license numbers on permits and contracts. Initial 4. I understand that I may build or improve a one family or two-family residence or a farm outbuilding. I may also build or improve a commercial building if the costs do not exceed $75,000. The building or residence must be for my use or occupancy. It may not be built or substantially improved for sale or lease. If a building or residence that I have built or substantially improved myself is sold or leased within 1 year after the construction is complete, the law will presume that I built or substantially improved it for sale or lease, which violates the exemption. Initial Initial v Initial f lit (./ 6. I understand that I may not hire an unlicensed person to act as my contractor or to supervise persons working on my building or residence. It is my responsibility to ensure that the persons whom I employ have the license required by law and by county or municipal ordinance. 7. I understand that it is frequent practices of unlicensed persons to have the property owner obtain an owner- builder permit that erroneously implies that the property owner is providing his or her own labor and materials. I, as an owner- builder, may be held liable and subjected to serious financial risk for any injuries sustained by an unlicensed person or his or employees while working on my property. My homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an owner- builder and am aware of the limits of my insurance coverage for injuries to workers on my property. f Initial C L C 8. I understand that I may not delegate the responsibility for supervising work to be a licensed contractor who is not licenses to perform the work being done. Any person working on my building who is not licensed must work under my direct supervision and must be employed by me, which means that I must comply with laws requiring the withholding of federal income tax and social security contributions under the Federal Insurance Contributions Act'(FICA) and must provide workers compensation for the employee. I understand that my failure to follow these may subject to serious financial risk. 9. I agree that, as the party legally and financially responsible for this proposed Construction activity, I will abide by all applicable laws and requirement that govem owner - builders as well as employers. I also understand that the Construction must comply with all applicable laws, ordinances, building codes, and zoning regulations. j� Initial °' 10. I understand that I may obtain more information regarding my obligations as an employer from the Internal Revenue Service, the United States Small Business Administration, and the Florida Department of Revenues. I also understand that I may contact the Florida Construction Industry Licensing Board at 850.487.1395 or htta : /lwww.mvforidalicense.com/dbpr /pro/cilbfindeex.html Initial 'tie/ 11. I am aware of, and consent to; an owner - builder building permit applied for in my name and understands that I am the party legally and financially responsible for the proposed construction activity at the following address: 12. I agree to notify Miami Shores Village immediately of any additions, deletions, or changes to any of the information that I have provided on this disclosure. Licensed contractors are regulated by laws designed to protect the public. If you contract with a person who does not have a license, the Constr4uction Industry Licensing Board and Department of Business and Professional Regulation may be unable to assist you with any financial loss that you sustain as a result of contractor may be in civil court. It is also important for you to understand that, if an unlicensed contractor or employee of an individual or firm is injured while working on your property, you may be held liable for damages. If you obtain an owner - builder permit and wish to hire a licensed contractor, you will be responsible for verifying whether the contractor is properly licensed and the status of the contractor's workers compensation coverage. Before a building permit can be issued, this disclosure statement must be completed and signed by the property owner and retumed to the local permitting agency responsible for issuing the permit A copy of the property owner's driver license, the notarized signature of the property owner, or other type of verification acceptable to the local permitting agency is required when the permit is issued. Was acknowledged before me this 1 day of Produced there License or wht> &as rs nall_knQwn tome or who has as identification. Initial Initial IK v The fol[ovving pages were originally attached to plans with the following permit # _EL9-gND etk. ....'"Mt linirrY0if lia HE00 Nk a t Mr-:=11A i VIVI V EV=.7"..: jd . , ■ :'" "fr ''''. '' ' .. ' . 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