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RC-10-2087Scheduled Inspection Date: February 08, 2011 Inspector: Bruhn, Norman Owner: SADUSKY, VINCENT Job Address: 195 NW 96 Street Miami Shores, FL 33150- Project: <NONE> Contractor: CLEMVAL ENTERPRISES INC Building Department Comments February 07, 2011 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 155549 Permit Number: RC -11 -10 -2087 For Inspections please call: (305)762 -4949 Permit Type: Residential Construction Inspection Type: Final Work Classification: Addition /Alteration nolo' Phone Number Parcel Number 1131010250160 Phone: (954)981 -6600 KITCHEN AND BATHROOM RENOVATION 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- 153659. Need MEP first NB io 4moti? ciu seilo7J2 Page 12 of 18 BUILDING PERMIT APPLICATION FBC 20 Permit Type: BUILDING OWNER: Name (Fee Simple itleholder): 1/Ineffi J J dk k t/ Phone #: � . 3 3 2 7 / Zip: %3 1.3d2 Address: City: City: Miami Shores Folio/Parcel #: T of Work: DAddress Description of Work: 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 X9° A/ 9:3" Tree" ✓� ! o h12/r cJ' State: FL-- Tenant/Lessee Name: / V / //J' Phone #: Email: JOB ADDRESS: 195 AM) '4 h J ✓ 1' �2�� 0/ - County: MO Is the Building Historically Designated: Yes CONTRACTOR: Company Name: C1 M . tf M -.. EN TWZPtrSe s , LAI c - Phone #: Address: 3500 M ittaiSoM S 7 City: f� f erDt3 State: (. �1-` � Zip 3 a 0 u Qualifier Name: ___//3&27 /*WZN I Phone #: - - State Certification or Registration #: CG C O f �.5 Certificate of Competency #: () ntact Phone* 9 ' 4 /fie ' Email ("I -E^/ VAt-(- 9 L co t4 e» F r' Nki DESIGNER: Architect/Engineer: Phone #: 9%5 Value of Work for this Permit: $ Square/Linear Footage of Work: Z 000 /'l % fi `' /a t � ."d / /L /::�/ � Crt1� :J� � ' . ; , - A. 1 - / ■ /1! ❑Alteration ❑New COLOR THROUGH ROOF TILE IS REQUIRED acknowledged by: Submittal Fee $ Permit Fee $ /C CF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ Miami Dade Permit No.6 O —# 2D fl Master Permit No. NO (�. Flood Zone: epair/Replace TOTAL FEE NOW DUE $ \ - 02 v-ow NOV 2A 20 BY: ......... ............ Zip: S3 /6 95- TI-6600 ❑Demolition Technology Fee $ Bonding Company's Name (if applicable) Bonding Company's Address City 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 not be approved and a reinspection fee will be charged. Signature this 1 U S who is p son 11 known to me or who has produced 1 '50+0 J'�.. 2.4 9Q dentification and who did take an oath. ins m O 10, by PUBLIC: • m h is personally known NOT t The foreg day of NOT Sign: Print: My Commission Expires: t was ac * * * * * * * * * * * * * * * * * * * * * * * ** APPROVED BY State Own -r or Agent p owledgec be IIACQ , C v 0' $ sae; (Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09)(rev6/4/10) NI Pr Zip Signature Contractor The forego'n instrument was ac le ged before me th �J day o 0 by 004Q. • me or who has produced UBLIC: entification and who did take an oath. fl. BI'L'E 07 FLORIDA °" ?.)7 a I Fx sinan 12, 2012 BONDED TRI:U PILL ?x"; ilVG CO INC. My Commnasl. >ya cres ********************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** • /2`J' 3 7% Plans Examiner Structural Review Zoning Clerk THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR IIIL A TYPE OF INSURANCE .1. •! INSR =<ri - WVD POLICY NUMBER PCLICYEFF SMMIDDIYYYY) POUCY EXP (MM!DDJYYYY) LIMITS INSURER(S) AFFORDING COVERAGE GENERALLIABMLITY X COMMERCIAL GENERAL LIABILITY X OCCUR INSURER B: 06238248701509.09 02115110 02115/11 EACH OCCURRENCE $ 1,000,000 PR MAGE70 RENTED PREMISES tEa occurrence) $ 300,000 i CLAIMS -MADE MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: POLICY n jE&T n LOC PRODUCTS- COMP/OP AGG $ 2,000,000 $ AUTOMOBILE LIABILITY ANY AUTO 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) $ $ UMBRELLA LIAR EXCESS LIAB _ OCCUR CLAIMS-MADE EACH OCCURRENCE $ AGGREGATE $ DEDUCTIBLE RETENTION $ $ S WORKERS COMPENSATION AND EMPLOYERS' LIABILfY ANY PROPRIETOR/PARTNER/EXECUTIVE Y 1 N OFFICERMEMBEREXCLUDED? ( (Mandatory in N14) If s. describe under DESCRIPTION OF OPERATIONS below NIA WC STATU- OTH- I TORY LIMITS ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS 1 LOCATIONS r VEHCLES (Attach ACORD 109, Additional Remarks Schedule, If more space Is required) Miami Shores Villa a MIAMSH1 9 10050 N.E. 2nd Avenue Miami Shores, FL 33138 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE c,, , 4 044,,_ . (;)e/e.yjsx, AC :MT"' 4......----- CERTIFICATE OF LIABILITY INSURANCE DATE (MhYDDNYYY) 11/19/10 THIS CERTIFICATE 1S ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURERS), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy()es) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER 800 -742 -1691 Hallandale Branch 954- 454 -9552 Rlemer Insurance Group PO Box 280 Hallandale, FL 33008 -0260 Rifle Schiff carrrAcT NAME: PHONE Fax tA+� Na> AU3RESS` CISTOMERID* CLEMENT INSURER(S) AFFORDING COVERAGE NAIC • INSURED Clemval Enterprises, Inc. 3900 Madison Street Hollywood, FL 33021 INSURER A: Auto Owners Insurance Co 18988 INSURER B: INSURER C: INSURER 0 : INSURER E : INSURER F : From:Risa Schiff FaxID:Riemer Insurance COVERAGES ACORD 25 (2009109) Page 2 of 2 Date:11/19/2010 11:17 AM Page:2 of 2 REVISION NUMBER: OP ID: RI O 1988 -2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SCOPES OF BUSINESS OR TRADE: 1- GENERAL CONTRACTOR 06- 02-2010 ALEX SINK STATE OF FLORIDA CHIEF FINANCIAL OFFICER DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION * * CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law. EFFECTIVE DATE: 06 /30/2010 EXPIRATION DATE: 06129/2012 PERSON: AUSTIN CLEMENT P FEIN: 650516833 BUSINESS NAME AND ADDRESS: CLEMVAL ENTERPRISES INC 3900 MADISON STREET HOLLYWOOD FL 33021 IMPORTANT: Pursoant to Chapter 440. 061141, F.S., an officer of a corporation who elects exemption from this chapter by filing a certificate of election finder ibis section may not recover benefits or compensation under this chapter. Pursuant to Chapter 440.061121, F.S., Certificates of election la be exempt... apply only within the scope of the business or trade listed on the notice of election to be exempt. Pursuant to Chapter 440.061131, F.S., Notices of election to be exempt and certificates of election to be exempt shell be subject to revocation if. at any time alter Ibe filing of the notice or the issuance of the certificate, the person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate. The department shall revoke a certificate at eny time lor failure of the penal named on the certificate to meet the requirements of this section. QUESTIONS? (850 DWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 09 -06 6 NOTICE OF COMMENCEMENT A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF RRST INSPECTION NO. TAX FOLIO .NO. /1 - 3/0 - 02‘.5 -7- 0/47/9 STATE OF FLORIDA: COUNTY OF MIAMI -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. tion ption of ip 2. De, -*al . es s ri 3. Owner(s) name = d address: Interest in property: Joe /" 4. Contracto9Name and address of fee simple titleholder: 4. Contracto s e, a d nd p ne n ber. r. 5. Surety: (Payment bond required by owner from contractor, if any) Name, address and phone number. Amount of bond $ 6. Lender's name and address: fil 7. Persons within the State of Florida designated by Owner upon hom notices or other documents may be served as provided by Section 713.13(1)(a)7., Florida Statutes, Name, address and phone number 8. In addition to himself, Owners designates the following person(s) to receive a copy of the Uenor's Notice as provided in Section 713.13(1)(b), Florida Statutes. Name, address and phone number 9. Expiration date of this Notice of Commencement: (the expiration date Is 1 year from the date of recor urdess a different date is qw0 ec� WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT ARECONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART I, 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 ST7 OR RECORDING YOUR NOTICE OF COMMENCEMENT. ,• P 07-7 ._ . c- P Cr ; Authorized Officer /Director/Partner/Matra9ef r tf ' �'i V C ' Signature(s) of Own Prepared By Print Name Title /Office % /1/ff[°/" STATE OF FLORIDA COUNTY OF MIAMI -DADE of • ro rty and street/address L/ 6 r U proveme I1r , s r z.; The fgr�gQi�� JOnt was acknowled eg d befgre me this ❑ Indivldualiy, or la as for ❑ Personally known, or Kroduced the following type of identification: Signature of Notary Public: By t //' Print Name: (SEAL) 11 0 i9_ •a • �.�l1 Prepared By ''" Print Name Title /Office 4 day of 1 111111111111 111111111111111111111111111111 CFN 2010R0779705 OR Etc 27493 Ps 11891 (1P9) RECO D 11/17/2010'11:26:28 HARVEY RUVIHr CLERK OF COURT MIAMI —DADE COUNTY, FLORIDA LAST PAGE , , Space above reserved for use of recording office . , /i ` . *Jo ys ®_rd' s / /A / .iI _ fr 1 1.. otAnifuly a : O,j' �m ; co _ � • ` �l'p 4 1 , ft p � ? o "7 . D e li * " / / t-.; 1 C._ j O c • U : ,..,. TO .SEC Under penalties of perjury, I declare that I have read the foregoing and that the facts stated in it are true, to the best of my knowledge and belief. S ii e r Owner(s)'s Authorized Officer/Director/Partner/Manager who sin s 1 " ' �� By By / / � •,, � PL 0 R i I ©P� ` �`�� ` 10.0142 a+e u • Scheduled Inspection Date: February 04, 2011 Inspector: Hernandez, Rafael Owner: SADUSKY, VINCENT Job Address: 195 NW 96 Street Miami Shores, FL 33150- Project: <NONE> Contractor: MG PLUMBING & SPRINKLER SERVICE Building Department Comments February 04, 2011 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 153678 Permit Number: PL -11 -10 -2088 For Inspections please call: (305)762 -4949 Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Addition /Alteration Phone Number Parcel Number 1131010250160 Phone: (305)525 -9236 PLUMBING WORK FOR BATHROOM REMODEL AND KITCHEN REMODEL Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments Page 3 of 8 KEY KNOWLEDGE INS A R Date Entered: 9/21/2007 Policy Number; CA -247 `�� CERTIFICATE OF LIABILITY INSURANCE , ; THIS CL�RTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS I 12 CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY POLICIES BELOW THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTI? A CONTRACT BETWEEN THE ISSUING INSURERS), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT; If the certificate holder is an ADDITIONAL INSU ED, the poilcy(leg must be endorsed. f SUER AT ION IS DIVED, s wject to certificate holder In lieu of such endorsements the tefms and Conditions of the policy, certain policies may require an endorsement A statinent on this oertlfleate does not Confer rights to the PRODUCER INSURED 12/10/2010 10:1' 9543820080 CERTIFICATE HOLDER KEY RNQWLE0® INSURANCE, INC. 9101 -C S. W. 19TH. PLACE FORT LAUDERDALE, SL. 33324 M. G. PLUMBING & SPRINGELERS SVCS., INC. MERVIN TROY GORDON 1265 NW 203TH STREET Mix, St. 33169 GENERAL IMAM COM1MERCmAL GENERAL LIABILITY CLAIMS -MADE OCCUR GENT. AGGREGATE UM)tAPPuse FER: _POUCYf f LOC A 4IAB►NTY ANY AUTO AU. OWNED AUTOS SCHEDULED AUTOS WIRED AUTOS NON-OWNED AUTOS UMBRELLA LAS - EKCE3s LIAR DEDUCTIBLE ng_ 1oN $ OCCUR cut/MS WOMEN COMPENSATION AND IIMPLOVISMY LIABILITY ANT PROPRIETOR/PARTh� OFFICER/REIMER EXCLUDED? (M tory In NH) flesalbe under DBScRIFTION OF OPERATIONS bet= ifLAM1 8E08E8 vi .,taaE 10050 N.E. 2ND AVENUE MIA= SHORE$, FL. 33138 30 5- 756 -8972 N /A 61,30092 -11 CA 24753 -11 N/A DESCRIPTION OP OPERA'RON9 / LOCATIONS 1 VEtt1CLUS (MO ACORD 1O$, MOWN ReMIIHIO Setnsiute, ['Mete ewe Is m9alual RESIDENTIAL AND CONI ERCIAL PLUMBING CONTRACTOR corm _NAME/ rue - .. JASIu (954) 382 -5255 1 1'14 , Nos (954) 392 -0060 _ Ab .. nR. ... SS: K®Yk Owlinn @aol . com PROMicaR . CUSTOMJLt.ID.S: - IN3URERM AFFORDING COVET ASE DisunkR A 4 Ascendant Commercial insurance, inc. INSUR R s r Ascendant Commercial, Zneuraneg nc LAutta c e MAIM D r INSUIWR E INSURER F COVERAGES REVISION NUMBER: CERTIFICATE NUMBER: m8 IS TO CERTIFY THAT THE POJCIES OF INSURANCE usTED BELOW HAVE SEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWITHSTANDING ANY REOUIREM TERM DR CQN oN OF ANY 00NTIiACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFIOATE MAY DE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED - B� Y �cIES_DE,S_CAKOJIEREIN IB�r, i�I TD NT. Rlt95 PECI U$10N3 9ND COWGLIR XIS. OF H S TYPE CC arm A POLICY Na>Ixa>9e PCLIai BFF 4i , awr� Lvyav Ia►1v BEEN RS!2�lGP,D. BY Pan�V��hJS '. U. * uli, UM i 9 / 23 /2010'- /23/2011 9/23/2010 w/23/2011 CANCELL. TION DA �OCC O RRE I _ MED ErP aly cnnpawn) PERSONAL & AOV IN,wRY I CRACAGGREGATE PRODUCTS- COMP/oP COMBINED SINGLE LIMIT (Ea emla nt) BODILY INJURY (Pot Pe) BODILY INJURY (Per accident) PRDPPRr?DAMAGE (Per accident) EACH OCCURRENCE AGGREGATE WC STAID- TORY I DATA l PR E.L. EACH ACCIDENT S.L. DISEASE -EA EMPLOYE E. DISEASE - POLICY LIMIT MARIA A. mum, WW1 �' 3 $ $ PAGE 01/01 s1,000,000 $ 100,000 $ 5,000 =1,000,000 $2,000,000 $1,000,000 3 $N /A 315,000 s30,000 45,000 $ 3 $ $ SHOULD ANY OF THE ABOVE DESCRIBED PCLIOIE$ BE UANCELLSO BEFORE THt: EXPIRATION DATE THEREOF. NOTICE WILL DE DELIVERED IN C ORDANCE ITN POLICY FROMSIO AUTNIDNIZED REPRESENTATIVE ,. ACORD (2009109) 019n-2009 ACORD CORPORATION. All rights reserve The ACORD name and logo arf3 registered marks of ACORD minced wins Forms Bess PIu1 so/Nave, www.FormeBons eeun; ImpressIvp PeblIsINnn 8D0.203 -1977 N/0C$ Dec. 10. 2010 9:19AM — A W RIIY DATE (MM/DD YYY) 12/10/10 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATWE OR PRODUCER, AND THE CERTIFICATE HOLDER. PRODUCER Workers Compensation Group PO Box 410 Boca Raton, FL 33429 -0410 Workers Compensation Group INSURED CERTIFICATE OF LIABILITY INSURANCE M.G. Plumbing & Sprinkler Sery 1265 NW 203rd St Miami, FL 33169 561 - 392 -3300 561 - 361 -1132 E-MAIL RESS: certstworkerscompgroup.com PRODUCER CUSTOMER ID et MGPLU -1 1 IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). -CONTACT Greg Carlgnan PHONE (A/C No. Ext): 561 -392 -3300 , No): 561461-1132 INSURER(S) AFFORDING COVERAGE INSURERA: Castlepolnt Florida Ins Co INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : NAIC COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR SUER A POLICY NUMBER rM mn wv�n IMMIDD vvw� WCP760535400 TYPE OF INSURANCE GENERAL LIABILITY GEdL AGGREGATE UMTAPPUES PER CY . � LOC AUTOMOBILE LIABILITY DED1k 11BLE RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECU E OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below COMMERCIAL GENERAL UABIUTY 1 C LAIN6MADE OCCUR ANY AUTO ALL OWNED AUTOS SCI AUTOS HRED AUTOS PM-OWNED AUTOS UMBRELLA LIAB EXCESS LIAB OCCUR cLAIMISMADE YI N ADDL NIA DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, POLICY EFF 10/12/10 If more space Is POLICY EXP 10/12/11 required) EACH OCR :,.,,: d . -4 Z. PREMISES (Ea occurrence) LIMITS S PROPERLY DAMAGE (Per accident) WED EXP (Any one person) S PERSONAL BADV INJURY $ GENERAL AGGREGATE PRODUCTS - COMP/Op AGG $ ccafE NED SINE UMT (Ea accider0 $ BODILY INJURY (Per person) $ BODILY INJURY (Per acclder0 5 $ EACH OCCURRENCE $ S AGGREGATE 5 $ $ X I TORYLIMTS I I OTH- ER E.L. EACH ACCIDENT $ 100,000 E.L. DISEASE - EA EMPLOYEE $ 100,00C E.L. DISEASE - POUCY UMT $ 500,000 CERTIFICATE HOLDER Village of Miami Shores 10050 NE 2nd Ave. Miami Shores, FL 33138 MIAMIS3 CANCELLATION_ SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORED REPRESENTATIVE No. 1200 1/1 OP ID: FH © 1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD BUILDING PERMIT APPLICATION FBC 20 Permit Type: PLUMBING OWNER: Name (Fee Simple Titleholder): , Phone #: e0� 342 — ....4 - Y3 2 Address: /293 rke 9.�Th JIte-e7 City: 1 f V �J(�/" State: F)- Zip: 33,34 Tenant/Lessee Name: A//J' Phone #: Email: JOB ADDRESS: /95 4//J 96 ,1 l7tee7 City: Folio/Parcel #: Miami Shores County: / 0 Is the Building Historically Designated: Yes 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 al(L Permit No. Master Permit No. NO l Email Address: Miami Dade Flood Zone: V � %0V 2 Q 2010 zip: 32/. Phone CONTRACTOR: Company Name: Address: d f kiCe City :° ,r E la �y State Qualifier Name: S) ®® Phone#: _ r V 0 Certificate of Competenc #: b 0611 zi 1 State Certification or Contact Phone # :T7 DESIGNER: Architect/Engineer: Phone#: Value of Work for this Permit: $ fef."L/0" Square/Linear Footage of Work: Type of Work: DAddress DAlteration ONew % , � epair/Replace ` ODemolition Description of Work: 4-1 t P I / P [�✓ cl - /(66' e pe.e hOt i .i ************* ****m+x***+x+x** **** * *** * * *** F x*********** *****+ x*********+x*** ************* Submittal Fee $ Permit Fee $ 2 7-,3 ® CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ \PI 1, , 19 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 not be approved and a reinspection fee will be charged. Sign: Print: My Commission Expires: (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) Signature Signature &AC • Owner®or Agent Contractor The foregoing instrument was acknowledged before me this ( Tile foregoing instrument was acknow ed before me tla day of NO- , 20 (®, by , day of ►�,�"„� `�/ . 'i,.' by . Q/llfS' who is personally known to me or who has produced 17 ' w ; As identification and who did take an oath. NOTARY PUBLIC: NOTARY me or who has produced as identification and who did take an oath. BLIC: /!.I..ei- ;4 11 • ,.',,,.,7.0 fission C.STATEOFFIa ■ iD• o �� .�H' APPROVED BY Af /f ' ' ''i, l P ,,, � ®0 °� ° �� )(miner Zoning Structural Review Clerk Inspection Number: INSP- 155230 Permit Number: EL -12 -10 -2122 Scheduled Inspection Date: January 25, 2011 Inspector: Devaney, Michael Owner: SADUSKY, VINCENT Job Address: 195 NW 96 Street Miami Shores, FL 33150- Project: <NONE> Contractor: AC ELECTRICAL CONTRACTOR Building Department Comments January 24, 2011 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 1131010250160 Phone: (305)635 -9093 BATHROOMS AND KITCHEN REMODEL./ INSTALLATION OF 6 SMOKE DETECTORS. 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- 153840. ADD RECEPTACLES TO COUNTER AND Arc fault breakers. 7,/, 7-6P /7 Page 19 of 19 BUILDING PERMIT APPLICATION FBC 20 Permit Type: EL Owner's Name (Fee Si ple Titleholder) I dddf '' Owner's Address p 3 ,VE 9� 7 "e'er" city 11 / �j®re, State FL Tenant/Lessee Name Email Job Address (where th City Miami FOLIO / PARCEL # Is Building Historicall Contractor's Address Contact Phone Submittal Fee $ Notary $ Scanning $ Double Fee $ Structural Review. $ 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 DY/R Permit No. Zip 33 L3 cP Phone # work is being done) /957 We! 9o/ hores Village County Miami -Dade Zip 3 3 /57 l / - 3 /,2l -- 025 — 40/20 NO L. ( VIri Designated YES Contractor's Company Name C.. g i'' City Pt ( 0 / State F Qualifier Name J Se t4 tea Zip Phone # 50.0 '7 '7'7P 2 i 7 $ E -mail . l am r l to d ,a.e. o a - Pte/. ' Architect/Engineer's N (if applicable) Phone # State Certificate or Registration No. C. . / 3 (t O/ W."' Certificate of Competenc No. Value of Work For this Permit $ 7dd- Square / Linear Footage Of Work: Type of Work: ©Addition teratip QNew Repair/Replace `' � Demolition Describe Work: n Phone ECTEWED NOV 3 0 2010 BY: ElL0-212Z Master Permit No. RA 0 21 0 Phone # 305 4L3 2 Flood Zone g33' - 0.93 sI r a / _ j .33t �. *** * * * ** * * * * * * * * * * * * * * * * * ** * * *, * Fe * * * * * ** * * ** * * * * * ** * * * * * * * * * * * * * * * * * * * * * * * * * Permit Fee $ 2 iodr.) ? o�-5i CF $ CO /CC $ Training/Education Fee $ Radon $ DPBR $ Violation date: Total Fee Now Due $ Technology Fee $ Bond $ 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 WITII 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 not be approved and a re- inspection fee will be charged. ,14/ Agent The foregoing instrument was acknowledged before me this 1 day of NOV ,20,0, by who is personally known to me or who has produced Signature NOTARY PUBLIC: Sign: Print: My Commission Expires: * * * * * * * * * * * * * * * * * * * * ** APPROVED BY As identification and who did take an oath. (Revised 07 /10 /07)(Revised 06/10/2009) ,00011111 11 II Ill O " D EJr •: �% �'1. Contractor The foregoing instrument was acknowledged before me this 27 day of 11 0(1 , 20 10 , by who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: * ***** ****** * *** * ***, + oR} om**** * * ** * * * **** ***** ** **** ** **** *** sir ** ** ************* ** My Commission Expires: g _ . P`e f /OPlans Examiner Zoning Engineer Clerk checked 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,T,HE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCE ADM INSR SUBR WVD POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MM/DD/YYYY) LIMITS A GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY OCCUR - INSURER B : GL 0010017 3/17/2010 3/17/2011 EACH OCCURRENCE $ 1,000,000 Eg PREMISES Ea $ 100,000 INSURER F : CLAIMS -MADE X MED. EXP (Any one person) $ 5,000 PERSONAL BADVINJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: LOC PRODUCTS - COMP/OP AGG $ 2,000,000 X POLICY JEC $ AUTOMOBILE LIABILITY ANY AUTO 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) $ $ $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DEDUCTIBLE RETENTION $ $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER /EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If Yes describe under DESCRIPTION OF OPERATIONS Y / N N/A 001 -WC09A -62641 9/15/2010 9/15/2011 TORY LIMITS T ER E.L.' EACH ACCIDENT $ 100,000 E.L DISEASE - EA EMPLOYEE $ 100,000 below E.L. DISEASE- POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) Miami Shores village Hall 10050 Northeast 2 Avenue Miami Shores, FL 33138 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Joe Avetrani /CH AC•RI70 CERTIFICATE OF LIABILITY INSURANCE `,../ DATE(MM/DD/YYYY) 11/29/2010 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Gil, Garden, Avetrani Insurance Group 10689 N. Kendall Drive Suite 208 Miami FL 33176 CONTACT NAME: Clara Huck (A/CC No Ext): (305) 630 -4777 1 ft g No,: (305) 279 -3022 n o DR l e ss:chueck @ggaig.com PRODUCER Q 0000410 CUSTOMER ID #. INSURERS) AFFORDING COVERAGE NAIC # INSURED A.C. Electrical Contractor, Inc. 3451 NW 48th Street Miami FL 33142 INSURER A :FCC/ INSURER B : INSURER C : INSURERD: INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER:10 /11 WC REVISION NUMBER: ACORD 25 (2009/09) INS025 (200909) ©1988 -2009 ACORD CORPORATION. All nghts resery e d. The ACORD name and logo are registered marks of ACORD Kitchen Scope of Work 1293 NE 95 Street ** drywall replacement of damaged areas only — due to removal of old cabinetry and placement of new outlets . ** installation of new cabinets ** installation of (5) GFI outlets & (3) appliance outlets (micro /DW /fridge) ** install lighting over sink ** install new sink/ hook up of water lines for dishwasher & fridge ** No garbage disposer Bathrooms (2) ** drywall replacement for damaged areas only- due to demo ** install (2) toilets * *install (2) sinks w /vanity ** install (1) shower pan ** switches for (3) overhead lights * *(2) GFI outlets ** (2) exhaust fans ** installation of floor & wall tile to (2) bathrooms Electrical & Plumbing Permits shall be pulled as required for completion of said project. ess L. 14004 Jj s,kv-ra-r I I s `do, toe. o .trL -r it 6fD /4;6 1.-/ tit Cab M) pp E RTo ( fS i r IBC= i -s C. 1 Li e<firr 0 lina i4K D wiPoks' gatigbo I Difti . &HT ar--1 smik-us‘-r- Pt t1/4( rP,t Up% tis LA? 7 Q. 1 4 ; 7 7� W C7 0 1- 6 CO 2, 6 VER. 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It is not me 'to Qe an exact rwncy:gn. • • • • ••• • • • • •• • • • • • • • • ••• • • • • • •• •• • B180BE6B.KIT • •• ••• • • • • • •i • • • • • • • • •• •• •• • •• • • • • • • • • • • ••• • • •• •• •• • • •• • 4' I All I Designed: 11/18/2010 Printed: 11/18/2010 Drawing #: 1 Note: This drawing is an artistic interpretation of the general appearance of the design. It is not meant to be an exact rendition. B180BE6B.KIT All Designed: 11/18/2010 `tinted: 11/18/2010 • • • ••• • • '•' • • •• • • • •• • •• • • • • • • • • • • • • • ••• • • • • • • • • • • • • • • • ••• • !Y • • •`� • • a `. • • • • • • • • ••• • • • • • • • •• •• • - , , • • • • • • • •• • • • • • .• • ••s ••• •• .. • •` • •• • • • • • • • • • , `.. • • • • i ;• • • • • • Ems. • • ' ' � • s.. � • • • • • 1,0 APPROVE ZONING STRUCTI.P.A. ELECTRIC `. H ALL FEDERAL 4 ,; -' �L Are diting 1 � nn� THESE PLANS ARE BEING PROCESSED BY: Xpediting by Tonya, LLC Plan & Permit Processing 786.290.1908 or 786.229.5346 xpedbytonya @yahoo.com