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BP-05-1288Project Address 160 99 Street Miami Shores, FL 33138- Owner Information Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Contractor(s) SARABANDA INC. Phone CeII Phone (305)756 -7622 (305)282 -2133 Fees Due RENEWAL Total: Amount $150.00 $150.00 Building Department Copy Address Expiration: 05/31/2010 Parcel Number 1132060132250 Block: Lot: Authorized Signature: Owner / Applicant / Contractor / Agent Phone Applicant 160 ENTERPRISES LLC CeII 160 ENTERPRISES LLC 160 NE 99 ST Miami Shores FL 33138 Perm Type: Building Alpha Two: REPAIR Alpha Four: REPAIR Alpha Five: RESIDENTIAL Alpha Six: SINGLE FAM Pay Amount: 161.3 Bond Retum : Pay Date: 9/12/2005 Pay Comments: PD BY CK # 1015 Invoice # imp -11 -09 -36361 $ 150.00 $ 150.00 $ 0.00 Check #: 335 Total Amt Paid Amt Due Valuation: Total Sq Feet: $ 300.00 0 For Inspections please call: (305)7624949 Available Inspections: Inspection Type: Footing In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS 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. Futhermore, I authorize the above -named contractor to do the work stated. November 09, 2009 Date November 09, 2009 1 BUILDING PERMIT APPLICATION FBC 20 Permit Type: BUILDING ROOFING. Owner's Name (Fee Simple Titleholder) 1 6 0 va R s e 1 12-C. Phone # 30S-432-C44 Z Owner's Address /6 NE ? r / Cit ,% Cli.• - Aarti State .3 3 / 3g Zip Tenant/Lessee Name Email Job Address (where the work is being done) City Miami Shores Villa : e County Miami -Dade Zip 3 3 ( 3 d FOLIO / PARCEL # Is Building Historically Designated YES NO. x Contractor's Company Name Sot re-.AA, (A t'L `. Phone # Contractor's Address /// /Are' /. St � ' 4 ? """f ^ y • 0 �. City r Q' -t State et— , [. Zip Qualifier Name 1 0/41A -A/ &l a. 0 Phone State Certificate or Registration No. C5 C 15 0 . ) - 0O 0 Certificate of Competency No. 'Contact Phone / E - Architect/Engineer's Name (if applicable) Value of Work For this Permit $ Square / Linear Footage Of Work: Type of Work: ❑Addition ❑Alteration ❑New 11 Repair/Replace ❑Demolition Describe Work: /e -- a p�� e x; k dC 4 ,'7 • A ?AN* eX /S Al 0h Os. . d e� /'' asp ***** * * * * * * * * * * * * ** * * * * * * * * *,** *F * * * *,r 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. eya.-- lob 6'6 Master Permit No. Permit Fee $ (6 N& R' S� w/4- Phone # Phone # * * * * * * * * * * * ** CCF $ Notary $ Training/Education Fee $ Scanning $ Radon $ DPBR $ Double Fee $ Violation date: � NOV 0 9 2009 : � Flood Zone 30$1-632 33132— # 3u' 2.k2 /3 CO /CC .$ Technology Fee $ Bond $ Structural Review. $ Total Fee Now Due $ 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 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 Owner or Agent The foregoing instrument was acknowledged before me this day of ,20 who is personally known to me or who has produced As identification and who did take an oath. NOTARY PUBLIC: Sign: Print:. My Commission Expires: APPROVED BY (Revised 07 /10 /07)(Revised 06/10/2009) Engineer Signature Contractor The foregoing instrument was acknowled • before me this 9 day of k - 1 6 1 3 1 9 4 4 _ , . 2 0 ! , b who is personally known to me or has produced "Pt-- /` as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: . My Commission NOTARY PL'E:.ii•ST ' = V L. Goldman _ Coulmissian #DD910671 ` , Expires: AUG. 08, 2013 EONDED THHU ATLANTIC BONDING ee., Plans Examiner Zoning 1 9 Clerk checked MIA HORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Bu'lding Inspection Request Date t 2 _ Type Insp'n - I r"Ic=1"1 Permit No. b POS ' 12.8 B Name 1 (cX) iexpy Address 1 (0 0 WS cC Compan���1JC =-6 Phone # Approved Inspection Date Correction Re- Insp'n Fee ❑ BUILDING PERMIT APPLI ATION FBC 2001 Permit Type (circle): Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Owner's Name (Fee Simple Ti p . /60 EA/ 7 -- l iL ' Phone # 3 0 s 2-2 z d2 1 3 3 Owner's Address 7 2 N - 7 9 " S' j Cit Ii i A(H 1 State — Zip 3 S / 3 r Tenant/Lessee Name Phone # Job Address (where the work is being done) 1 b 0 /v sf c 15 T City Miami Shores Village County . Miami -Dade Zip 3 3 / 31 Is Building Historically Designated YES NO Contractor's Company Name S4i 134i v b4-- / Phone # Contractor's Address 7 Z 5 7'1 / City ( ``�� / State e1/L-- Zip Qualifier /1 l , , c2 4/ State Certificate or Registration No. (9 C 1 S® `Fc v 0 Architect/Engineer's Name (if applicable) $ Value of Work For this Permit Submittal Fee $ Notary $ $ 3 . W Code Enforcement $ Total Fee Now Due $ (Continued on opposite side) Permit No. 1 DS Master Permit No. Electrical Plumbing Mechanical Roofing Certificate of Competency No. Phone # Square Footage Of Work: 305 orY3 -5 33/3 - OR ENZ SP 1 2 Type of Work: ['Addition ❑Alteration ' "' DNew ._� Repair/Replace D Demolition Describe Work: 644 6 )(/ S 7, v 5 G✓�'LL 1� / . g 6-r) '6V Hirai, ' * * * * * * * * * * ** * * ** * * * * * * * * * *, Fees* * * * * * * *** *** ** * * * ** * * * * * ** Permit Fee $ 1 � � � � �2- 1N5 CF $ O. W) CO /CC l Training/Education Fee $ 0 • 2 0 Technology Fee $ Z �0 Zoning Bond $ Radon $ r Structural Plan Review. $ Bonding Company's Name (if applicable) Bonding Company's Address City Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State 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 approv ' and : inspection fee will be charged The forego g ins day of who is personall NOTARY Print: My Comm ssion Expires: ********************** * * ** * * * * * * * * * * * * * * * * * * * * * * * * * ** APPLICATION APPROVED BY: chc 05/13/03 State Owner or Agent ent was acknp ledged before me this , by to me or who has produced As identification and who did take an oath. iv tOex "areas mmission ; `lj) li r C n60 0 •ren iS Signature The foregoing ins day of who is personally kn NOTARY PUBLI Sign. Print: My Co 1V * * * * * * * ** * * * * * * * * * * * * * * * ** * * * * * * * * * ** * * * * * * * * * * * * * * * * * * * * * * * * ** / 7 OS Contractor ent wasaso dgged before me� this 2O by 11 sion;Exp rCP C ° l n h�a��ti Plans Examiner Engineer Zoning o me or who has produced entification and who did take an oath. 111 4 th * * * * * * * * * * * ** ** ***** * * * * * * * * * * * * * * * * * * * * * * * * * * ** Miami Shores Village 10050 NE 2nd Avenue Phone: 305 - 795 -2204 Printed: 9/9/2005 Applicant: 160 ENTERPRISES Owner: LLC JOB ADDRESS: 160 NE 99 Contractor SARABANDA INC. Local Phone: 305 - 308 -8325 Parcel # 1132060132250 Signed: (INSPECTOR) Signed: (Contractor or Builder) Building Permit Permit Number: BP2005 -1288 LLC 160 ENTERPRISES ST Contractor's Address: 160 NE 99 STREET Permit Status: APPROVED Permit Expiration: 3/1/2006 Construction Value: $300.00 Work: REPAIR EXISTING WALL DAMAGED BY DEMOLITION BY: Page 1 of 1 Legal Description: MIAMI SHORES SEC 1 AMD PB 10 -70 LOTS 6 -7 & 8 BLK 17 LOT SIZE 150 X 115 OR Fees: FEE2005 -12203 FEE2005 -12222 FEE2005 -12223 FEE2005 -12224 FEE2005 -12225 FEE2005 -12226 FEE2005 -12227 Description Building Fee CCF Notary Fee Training and Education Fee Technology Fee Scanning Fee Total Fees: Amount $150.00 $0.60 $5.00 $0.20 $2.50 $3.00 $161.30 Total Fees: $161.30 Total Receipts: $0.00 SEP 12 PAID etc. 1,015 In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit 1 assume responisibility for all work done by either myself, my agent, servants or employes. r 14 13 12 17 11 . 18 10 ir r r 10.904 15 16 19 20 21 22 23 SET DH St WALK 0.05' �® I.P. 0 Lri GRASS SITE PLAN 2' ASPHALT ALLEY PAVEMENT • • • • • • • • • • • • SCALE = N.T.S. ASPHALT PAVEMEN' • • ••• • • • • ••• • • • • • • • • • • • ••• • • • • • • • • • • • • • •• •• • • • •• •• • • • ••• • • • ••• 0 E.B. • . . • • • • • • • • • • • 150' 5 C.B.S. WALL SCALE = N.T.S. • GRASS 5' SIDE WALK 12' ASPHALT ALLEY 4 PAVEMENT WD. POLE. WD. P ti 0 0 WD. POLO* WD. POLED• 2- r F- M 0) W • • • N1:E. i --• -i - -E-4 -wrier •ti' • • • • • • • • • • • •• •• • •• • ••• • • L E G A�. .ESC R! PTO!✓: Lots 6 7 AND 8 9LocKi'7 EXISTING WALL WALL PLAN VIEW SCALE = 3/8" = 1'0" Rei fiVE 54x oAbo Covi M 16 VERr WALL ELEVATION SCALE = 3/8" = 1'0" 5/8 STUCCO FINISH ALL ARROUND I I I I I I ICI I I I I. I I t5 WALL SECTION 0 Px15 WALL REPAIK(A iCo WE 9 J 57 H14/-ii S 1-#- o P, E s 1'L. 3313 20' 5/8 STUCCO FINISH ALL ARROUND CONC. FOOTING 12 "X16" W/2#5 CONT SCALE = 3/4" = 1'0" NEW CONC. BLOCK 1 #5 ® 48" � ALL ARROUND 7 ` ® T / � f T r"A '' O LL CFL •• • •• • • • • • • • • • • • • • • • •• ••• •• • • • • • �,n • •• •• • • • .� 11/410A) •• • •• ••• • • • • • • • • • • • • ••• • • • • •••• ••••••• • • • • • • • • • • • • ••• • • • • • • • • • • • • • • •• •• • • • •• •• ••• • • • ••• • • REVISIONS: 0 CO DATE. 08 -31 -05 CVA DRAWN BY: CHECKED BY• JOB NO • 725 -79 SHEET NO. OF 1 1 • • • .. . . .. • • .• • ••• • • • • • . . • •••• •• • . • • •.. 11 • • • • • • •• ••• •• •. • • .. •. • • • • • ••• • • • • .•• • ••••• •• • . • • • ••• . • • • • ••• • ••••e • .. •. • • • • •• .. • • • . .. • • . ... • • • • • • ••• • • SP-t6-frbb • • • •• ••• • • • • • • • • • .. ••• •• • • • . • • • ••• • 1 • • ••• • • • • • • • • • • • • . • • •••. • •• • •• • • • ••• • • • • ••• • • • • • •••• • • • ••• • • • •. ...••• . • .. •• • • 0. •. •• .... ... • • •. • . • • . 1 P ik rya 1150 E. ATLANTIC BLVD. ACCURATE LAND SURVEYORS, INC. FLORIDA 33060 L.B. x/3635 POMPANO BEACH ADDRESS: 160 NE 99TH STREET MIAMI SHORES, FL 33138 FLOOD ZONE: BASE FLOOD ELEVATION: CONTROL PANEL NUMBER: EFFECTIVE: LOWEST FLOOR ELEVATION: N/A GARAGE FLOOR ELEVATION: N/A LOWEST ADJACENT GRADE : N/A HIGHEST ADJACENT GRADE : N/A REFERENCE BENCH MARK: N/A CERTIFY TO: 1. MADELINE ROMANELLO 2. 3. 4. 5. 6. ELEVATIONS BASED ON N.G.V.D. FH - FIRE HYDRANT - A - ARC LENGTH C.B. - TANGENT C.O.S. . - CONCRETE BLOCK STRUCTURE R/W - RIGHT -OF -WAY P.C. - POINT OF CURVATURE PP - POWER POLE WM - WATER METER N.H. OVERHANG NORTH S - SOUTH W - NEST CONC. - CONCRETE D.B. (C ) F. ALUM. BLVD. ENCH. I.P. I.R. P.R.M. NGVD U.E. D.E. A.E. MAINT. ESM T. ELEV. B.M. SHEET 1 OF 2 1 X N/A 120653 - 0093 -J REVISED: 3/2/1994 EASEMENTS ACCORDING TO THE PLAT THEREOF: NONE NOTES: 1. THIS SURVEY CONSISTS OF A MAP AND TEXT REPORT. ONE IS NOT VAUD WITHOUT THE OTHER. 2. OWNERSHIP OF FENCES AND WALLS IF ANY, NOT DETERMINED. 3. THIS SURVEY IS MADE FOR THE EXCLUSIVE USE OF THE CERTIFIED HEREON, TO BE VALID ONE YEAR FROM THE DATE OF SURVEY AS SHOWN HEREON. LEGEND OF ABBREVIATIONS: DEED 800K CHAIN LINK FENCE CALCULATED ALUMINUM BOULEVARD ENCROACHMENT IRON PIPE IRON ROD PERMANENT REFERENCE MONUMENT NATIONAL GEODETIC VERTICAL DATUM UTILI EASEMENT DRAINAGE EASEMENT ANCHOR EASEMENT MAINTENANCE EASEMENT ELEVATION BENCH MARK SQ. FT. P.C.P. P ).C.R. N&D A C F D. P.O.C. CHATT. STA. N.T.S. B.C.R. D.C.R. PT. SQUARE FEET PERMANENT CONTROL POINT PALM BEACH COUNTY RECORDS RADIUS NAIL AND DISC POINT OF BEGINNING AIR CONDITIONER FOUND POINT OF COMMENCEMENT CHATTAHOOCHEE STATION FLORIDA POWER AND UGHT NOT TO SCALE BROWARD COUNTY RECORDS DADE COUNTY RECORDS POINT OF TANGENCY o/s P.B. O.R.B. F.F. ELEC. F.F. ELEC. SEC. R GE. MM P ASPH. LP P.B. O.R.B. TEL. (954) 782 -1441 FAX. (954) 782 -1442 TYPE OF SURVEY: BOUNDARY JOB NUMBER: SU- 05 -2366 LEGAL DESCRIPTION: LOTS 6, 7 AND 8, BLOCK 17 OF AN AMENDED PLAT OF MIAMI SHORES SECTION NO. 1, ACCORDING TO THE PLAT THEREOF, AS RECORDED IN PLAT BOOK 10, PAGE 70, OF THE PUBLIC RECORDS OF MIAMI -DADE COUNTY, FLORIDA. ENCROACHMENTS ACCORDING TO THE PLAT THEREOF: ASPHALT APRON ENCROACHES NE 99th STREET RIGHT OF WAY ADJACENT TO THE NORTH BOUNDARY E. A < NOT VALID WITHOUT THE SIGNATURE AND THE ORIGINAL RAISED SEAL OF A FLORIDA LICENSED SURVEYOR AND MAPPER. OFFSET ▪ PLAT BOOK - OFFICIAL RECORDS BOOK - FINISH FLOOR - ELECTRIC - FINISH FLOOR - ELECTRIC SECTION - TOWNSHIP - RANGE CENTERUNE ASPHALT MANHOLE MEASURED UGHT POLE PLAT BOOK OFFICIAL RECORDS BOOK 0) W z DATE OF SURVEY 4/13/05 1150 E. ATLANTIC BLVD. POMPANO BEACH FLORIDA 33060 FOUND 3/4' IRON PIPE NO ID 37.50' ASPHALT APRON ASPHALT APRON 37.50' REVISIONS DRAWN BY ODI BLOCK a CORNER O • 0 T, 24.84 • P.P. :': : r 24.80 FOUND 1/2° RON ROD NO ID ACCURATE LAND SURVEYORS, INC. L.B. #3635 I SHEET 2 OF 2 I LOT 1 BLOCK 17 CHECKED BY SPW LLLLL L TILE L LL L LLLLL LLLLL DATE 10.10' 10.00' NOTES: 1. UNLESS OTHERWISE NOTED FIELD MEASUREMENTS ARE IN AGREEMENT WITH RECORD MEASUREMENTS. N/A ALONG 2, BEARINGS SHOWN HEREON ARE BASED ON A BEARIN BOOK ,PAGE THE COUNTY RECORDS. 3. THE LANDS SHOWN HEREON WERE NOT ABSTRACTED FOR OWNERSHIP, RIGHTS —OF —WAY, EASEMENTS, OR OTHER MATTERS OF RECORDS BY ACCURATE LAND SURVEYORS, INC. 4. THIS SURVEY IS FOR TITLE AND MORTGAGE PURPOSES ONLY, NOT FOR DESIGN OR CONSTRUCTION. 5. THIS DRAWING IS THE PROPERTY OF ACCURATE LAND SURVEYORS INC. AND SHALL I NOT BE USED OR REPRODUCED IN WHOLE OR IN PART WITHOUT WRIT AUTHORIZATION. 6. THIS SURVEY CONSISTS OF A MAP AND TEXT REPORT. ONE IS NOT VALID WITHOUT THE OTHER. BY 1 6.10' 5.90' 7.05' l FIELD BOOK 2347/28 1 STORY RESIDENCE #160 40.10' 115.00' LOT 9 BLOCK 17 LOT 2 BLOCK 17 15' ALLEY R/W (10.3' ASPHALT PAVEMENT) 115.00' P.P. P.P. LOT 6 BLOCK 17 23.58' 2.58' to to m ai— x— x —x —x 3.0'X4.0' A/C PAD r 0 TEL (954) 782 -1441 FAX. (954) 782 -1442 37.41 LOT 7 BLOCK 17 40.05 BB : 7 : • ••• • • -•-•- • • • •• • • •• •••• 3 • :$IISCK 17.. FOUND 5 /S' • IRON RON • ..• • NO ID o/s 1.09' N 071' W • • ob, • • • • •••• •••• •• •• IRON PIPE NO ID o/s 0.18' N • • • • • • • • . • • • •• •• • • CERTIFICATION: •. • • THIS IS TO CERTIFY THAT I HAVE RECENTLY SURVEYED THE PROPERTY. DESCRIBED IN THE FOREGOING 11TLE CAPTION AND HAVE SET OR 'MUM ) MONUMENTS AS INDICATED ON THIS SKETCH AND THAT SAID ABIAND • • • GROUND SURVEY AND SKETCH ARE ACCURATE AND CORRECT TO THB9 BEST OF MY KNOWLEDGE AND BELIEF. I FURTHER CERTIFY THAT•Ili1S'• • • SURVEY MEETS MINIMUM TECHNICAL STANDARDS UNDER RULE 61C —6 • FLORIDA ADMINISTRATIVE CODE, ADOPTED BY THE FLORIDA BOAT OP • • LAND SURVEYORS, MAY 1995. ROBERT L THOMPSON (PRESIDENT) PROI•t»IONAL SURVEYOR AND MAPPER No.3869 — STATE OF FLORIDA 1 SCALE 1"=20' •• • •• • •. • •• • r • •• • • • •• • • •• Crib •• • N M N h- 0 0 N N N Y 00 CO N N Y I- 0 0 CO • • • •••II •• • • • • • •• • t • •. •••• • •••• • • • ••• • • • • • •• • •• • • • • • • ••• • • •••• • • • • •••• • •. ••• • • ••• A • NO1 VALID WI1 IM'r m ES�IIGNATURE AND ORLGINAL iO SEq� •ddFF A FLORID LICENSED SUR • • N!1 • MAPPER* M APP • • • NU'MaER' SU -05 -2366 • •• • • • • •••• • •• • • • • • •••• • • • • • • • • • • • • • • • • • • •• • • • ••• • • • • • • • •• • • • • • • •••• •••• • • • • •••• •••• • • • •• • • • • • •• • •• •• • • • • • •••• • • • • •••• • • • • • • • ••• • • •• • • • • •• • • • •• •• • • • • •••• • • • • • • •• • •• •• • • • • • • • • •••• •• • • • • •••• •• • • •••• • • • • • •• • • •• • • • • •••• • • • • Ar Miami Shores Village Building Department BUILDING CRITIQUE SHEET 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Permit No. 0 5 r 1A Job Name ((QO Date 1 Ce /o S oar&72 We a.) c iZ Xts ,u Du.) ) /s /LQca Cre //s 14 rQ 2 0 a x, S" c rye ze C4- wit / it r" God 77;060.c .4,u cLIAD TO EX , /;44,5 c).6,017/ f e 4//P /UU7" C /QArJ2. 6cJ/ 7 Reviewer: Claudio Grande C.B.O 305- 795 -2204 Ext 430 05/13/2009 14:14 954 - 963 -8519 ACORO CERTIFICATE PRODUCER Newman Insurance Agency, Inc. 5700 Stirling Road Hollywood FL 33021 - Phorie : 954 -963 -9626 1NSORED Sarabande 67 N 6 Ave Biscayne Park FL 33161 COVERAGES THE POLICIES OF INSURANCE USTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POUCY PERIOD INDICATED, NOTWM- ISTANDIN© ANYREouszEmENT,TERMORCONDITIONOPANYCONTRAcTOROTHEADOCUMENT MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONpmoNs OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED By PArp CLAIMS INSR LTR OTHER TYPE OF INSURANCE GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS MADE C OCCUR GEN L AGGREGATE LIMIT APPLIES PER: PO- PRO- LOc AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCI. wuL1 D AUTOS HIRED ALTOS NON - OWNED AUTOS GARAGE UABIUTY ANY AUTO EXCESS/UMBRELLA LIABILITY OCCUR E CLAIMS MADE i DEDUCTIBLE RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNSRlIXECUTIV6 OFFICER1ME9ABER ExcLUDEO? It yes, describe under SPECIAL PROVISIONS below DEBCRIPFION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT 1 SPECIAL PROVISIONS 305- 756 -8972 'ERTIFICATE HOLDER Village Of Miami Shores Miami Shores Village Hall Bldg Department 10020 Northeast 2nd Avenue Miami Shores PI, 33138 CORD 25 (2001/08) OF LIABILITY INSURANCE °I) la41 POLICY NUMBER GLF000009417 -02 NEWMAN INS DATE (MMND/YYYY) X13/09 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATI( HO CER ATE D OES NOT AMEND, EXTEND OF ALTER THE COVERAGE AFFORDED BY THE POUCIES BELO INSURERS AFFORDING COVERAGE INSURER A: National Contt;ctora Us. Co . INSURER B: INSURER C: INSURER D: INSURER E: ■- , I -- .■,.. DATE ; :1 .11 DATE(MMVDD/YV) 04/15/09 04/15/10 EACH OCCURRENCE ve rt./ "(knit].) MED EXP (Any nos person) PERSONAL $ ADV INJURY GENERAL AGGREGATE PRODUCTS . COMP/OP AGG COM &N® SINGLE LIMIT (ES accident) BODILY INJURY (Per person) ( ee INJRY U PROPERTY DAMAGE AUTO ONLY EA ACCIDFpvT oTHER THAN AUTO ONLY: EACH OCCURRENCE AGGREGATE EL EACH ACCIDENT E L. DISEASE - EA EMPLOYEE EL. DISEASE - POLICY OAR CANCELLATION SHOULD ANY OP 711E ABOVE DE$OR►BED POUGIES SE cancel= BEFORE THE EXPIRATION DATE THEREOF. THE ISSUJNa INSURER Wt{ L BNDEAYDR TO MAIL, 10 LAYS 1NR J NOTICE T THE CERTIFICATE HOLDER NAPA E5 TO THE LET, BUT FAILURE TO DO SO SHALT IMPOSE N 710N eo OF KIND UPON THE INSURER, ITS AGENTS OR EA ACC LIMITS AGG (TORY L S • I ER PAGE 01/01 $ $ 5 5 $1000000 5 2000000 3 1000000 5 S 3 5 $ $ $ $ 5 5 NAIC # 51000000 5 50000 $ 5000 � ® ACORD CORPORATION 91