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339 NE 100 St (8)Type Insp'n Permit No. Name MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Request Date 3- 2 7 -42 Time e Adi CQ 1- Address 33 9 /t/C /DO.$* Company Phone # 30r For Inspector: 3_ )8_ Name s • to Approved J S L Z Correction ❑ Re- Insp'n Fee ❑ MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Request Date 3 -27-d2 Time Type Insp'n /'t ti t Permit No. Name C 4,zjz aget e 4) Address 33 9 Ye 9O51 Company ftc 'LS Phone # 30i 7 S P 2 T For Inspector: 3_ 02g..0 2 Name i'. to Approved 1/7 ,V Z Correction ❑ Re- Insp'n Fee ❑ MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Request Date ) Z D Time Type Insp'n Permit No. Name C am, Address AD - yy Company Phone # 3 0-S - 1 -C �S l For Inspector:3 /13/0"-__ Name to Approved -III Correction Re- Insp'n Fee .. • • • • • • • •• • • •0•• • • 0000 • • • • • • • • • • • • • . .• • • • •• • • • • • • . • • • •• • • • 0000 ••0• • • .• •••• • ... - • - • • • , Village of Miami Shores 10050 NE 2nd Avenue Miami Shores, FL 33138 Phone: 305-795-2204 "N.) Printed: 3/4/2002 Applicant: CAROLYNE Owner CADWALLADER Contractor Address: Cellular: Local Phone: Building Permit Permit Number: BP2002 -444 CADWALLADER CAROLYNE Parcel # 1132060135360 Legal Description: 1 53 41 6 53 42 MIAMI SHORES SEC 1 AMD PB 10 -70 LOT 17 W1 /2 OF LOT 18 BLK Job Address: 339 NE 100 ST Fees: FEE2002 -1285 FEE2002 -1286 CCF $1.20 FEE2002 -1287 Notary Fee $5.00 Total Fees: $66.20 Permit Status: Approved Permit Expiration: 9/1/2002 Construction Value: Work: EXTERIOR PAINTING AS PER AGREEMENT (OWNER BUILDER PERMIT) Description Amount Building Permit Application Fe*60.00 $2,000.00 Page 1 of 1 Total Fees: $66.20 Total Receipts: $0.00 If there is no permit package accessible on the job -site for inspectors to verify, there will be no inspections. Re- inspection fee is $50.00, which must be paid in advance before calling for another inspection. This Permit is granted to the contractor or builder named above to construct th^ 1-- ordinances pertaining thereto and with the understanding that the work will be pei — �_ and approved by the proper municipal authorities. This Permit may be revoked a CAROLYNE R. CADWALLADER g3_g43/631 authorization. A further condition upon which this permit is granted is the underst ordinances and regulations pertaining to the work covered hereby whether shown by his agents, servants or employees. BRANCH 89232 339 NE 100TH ST. • MIAMI SHORES. FL 33138-2420 Date Signed: (INSPECTOR) pay to the oilier of pollars 8 In consideration of the issuance to me of this permit, I agree to perform the work — _ ��" /'�' .�� with the plans, drawings, statements or specifications submitted to the proper auth SO h St rrr r Ye myself, my agent, servants or employes. Bank Signed: (Contractor or 1 �4 For cl 01: 49 5 LO 5970 0 8 n�,�L0�43 Date Type Insp'n Permit No. Name Approved Correction Re- Insp'n Fee MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305 -795 -2204 Building Inspection Request C CJP 4-72-- Uekl b/12 Address 3 l ' r. l o PA Company Phone # 3 — 1 S 1 For Inspector:3 /13/ D Name to MIAMI SHORES VILLAGE Paint Color Approval and Agreement DATE: 1 D ire) A-R 6? 7 02 !' 0,2 OWNER'S NAME: CA 4,91.y' ? 01140 iva uAPE4 PHONE: c - 9 /iy --a 7' ADDRESS: • / 4 `'S : ��— / � )9- pi/ /c8' ************************:**********/* * * * * * * * * * * * * * * * *4 * * * * * * * * * * ** ... ADDRESS OF SITE J39 /DD - t o 5�7- /��ffhr/ cSD""�� 33 /8 CONTRACTOR & LICENSE (if applicable) COMPANY NAME: PHONE: APPROVED: ********************************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** All Elements on the site must be listed and indicate the color to be painted. Walls 1/vS ; / G Fascia T/'Np ¢? £A0zv ope Drip Cap/Drip Edge /y /p Soffit owdEA <ouv G-RA Roof LLE, &] Mi ro ccd}Y Oftict Flower Bins /vj16 Ty Shutters J�/ /�¢ ,'1+ 1 Awnings wiq )" 77 ,C4 GROY ( - Chimney /►/,s i y Doors and door jams 14✓H i r E Garage Doors w Hi Railings 13,440.1 Fences A//i9 Decorative Metal /09 All brick (simulated or regula) Jy'4 T'R4'- Stucco Banding 2 l Any other stucco features /y Q / I thun cl erc�o ud g ra y Accessory Buildings Al//!/ Other , /.� 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. I authorize the above -named contractor, if applicable, to do the work stated. Furthermore , the paint colors will be as per the attached pies. c/r /D)— i ature of Owner Date Signature of Contractor Date *********************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** 3 ///0. Building Offici Date WHEN PAINTING IS FINISHED, CALL FOR FINAL INSPECTION 4/23/01 PROPERTY OWNER Name C iv) L,vit4 g oil J7 w At14. 4Lb 6.a Address �(� /,,� a 09 / f i4o "s /'I,bI11J 5J ' Home Telephone 0 ��,�,5-e� g .5 O / Business Telephone Fax TYPE OF MANAGEMENT (✓ ) New Construction Enclosure Alteration Exterior Repair Alteration Interior Demolish Relocation of Structure Shell Only Foundation Only Add'I Attachment Other Add'l Detachment Other INSTRUCTIONS - The following steps must be taken to obtain a permit from the Miami Shores Village: Step 1. Complete the attached permit application which must be signed by the property owner and qualifier. Both signatures must be notarized. Please print or type to allow for a more accurate processing of your application. If roofing work will be done, a roofing application must be submitted along with this permit application. Step 2. Submit the completed application with all necessary documents to the Building, Planning and Zoning Department for processing. During the processing of your application, you may be asked to submit additional information. APPLICATION Job Address: Zip Folio Number 1/ 3 / Description of Work PA//(/r / - ER /r2,' 14 Lot Block Subdivision PB PG Zoning_ QL . [pt =/�TIA L Linear Feet Address Current Use of Property i-/ o M 5 %gyp Proposed Use of Property x Value of Work (72000 00 Bldg Value Tenant Information Tax Assessed/Appraised Value Flood Zone Base Floor Elev. PERMIT TYPE (✓ ) Building PfIl ( Electrical Mechanical Plumbing LPGX Roofing Fence Other 0 -/-h s Apt. PERMIT CHANGE (✓ ) Chg. Contractor Renewal Revision Extension Supplement Reinspection ARCHITECT Name License No. Address Telephone Fax Master Permit No. • Subsidiary Permit No City L5 State PERMIT APPLICATION Square Feet Units Floors 6/00) ,p ENGINEER Name License No. Address Telephone Fax CONTRACTOR Name License No. Address Telephone Fax Qualifier Name Page 2 Ii\IPORTAN'I' NOTICES DO NOT BEGIN ANY WORK WITHOUT HAVING RECEIVED YOUR VALIDATED PERMIT AND PERMIT CARD. Applying for a permit does not grant the right to begin construction. HOURS OF CONSTRUCTION are limited to: Monday through Friday from 7:30 a.m. to 6:00 p.m., and Saturday from 8:00 a.m. to 5:00 p.m. No inspections will be conducted on weekends or holidays. 2. All construction of demolition areas MUST BE MAINTAINED IN A CLEAN, NEAT AND SANITARY CONDITION free from construction debris. 3. STREETS AND NEIGHBORING PROPERTIES SHALL BE KEPT FREE FROM DIRT AND DEBRIS. 4. SWALES MUST BE PROTECTED FROM BEING DAMAGED BY EQUIPMENT OR VEHICLES, AND MAY NOT BE USED FOR STORAGE. A bond is required for work in or near the street/sidewalk. 5. CONSTRUCTION TRAILERS ARE PROHIBITED ON SINGLE FAMILY RESIDENTIAL CONSTRUCTION SITES. Other construction may have a trailer which requires a separate permit. 6. PORTABLE TOILETS for a construction site require a separate permit. 7. DO NOT DISCHARGE WATER INTO THE RIGHT OF WAY OR STORM DRAINS without approval from the Building, Planning and Zoning Department. 8. EQUIPMENT AND MATERIALS SHALL BE STORED at least 10 feet from the edge of pavement. 9. Department of Health and Rehabilitative Services (HRS) approval is required for applications involving septic tanks. Department of Environmental Resources Management (DERM) and/or Miami -Dade Water and Sewer Department (MDWASD) approval is required for applications involving sewers. AFF1 DAV'1'1' - Please read carefully. Application is hereby made to obtain a permit to do work and installation as indicated. I, the OWNER of the property, 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, POOL, EXTERIOR DOOR, MECHANICAL, WINDOW, FENCE, DRIVEWAY, ROOFING and SIGNS and there may be additional permits required from other governmental agencies. I, the OWNER of the property, have disclosed all information related to any work at the property performed in the prior twelve months to the Building Official. Further, I am fully aware that if the cumulative cost of work to my home or business under this and any other permit equals or exceeds fifty percent (50 %) of the fair market value of the structure, the entire structure must meet the present federal flood criteria for finished floor elevation. I am also fully aware that if the total cost of work to my home or business under this and any other permit exceeds fifty percent (50 %) of the replacement cost of the structure, then the entire structure must conform to the current code requirements of the Building Code. WARNING TO OWNER: Your failure to record a NOTICE OF COMMENCEMENT may result in you paying twice for improvements to your property. If you are spending more than $2,500 or intend to obtain financing, you may wish to consult with your attorney or lender before recording your Notice of Commencement. The Notice of Commencement must be recorded at: 22 N.W. 1st Street, 1 Floor, (305) 679 -1078. Once recorded, the Notice of Commencement must be POSTED AT THE JOB SITE in accordance with Section 713 -35 of Florida Statutes. Review the brochure at Village Hall on Construction Lien Law and Choosing a Contractor. STATE OF FLORIDA, COUNTY OF MIAMI -DADE STATE OF FLORIDA, COUNTY OF MIAMI -DADE Signature of Owner Signature of Contractor / Qualifier Print Name N Print Name Sworn to and subscribed before me this day o gnature of N. ry Public »rate o Flan: • ! Signature of Notary Public - State of Florida C)`: U�� A;.Cai.A P.7 Elec:triw \ ': " c GD::. .:.: ON i:Uui.:::7 , } CU76GG97 ' 4) "V en " :1[r. t Personally known ' \ OR, Piotittce ll& f Personally known OR, Produced Identification SEAL: Sworn to and subscribed before me this day of SEAL: PERMIT APPLICATION Type of Identification Produced: j . 11 L � 3 y 3 ))1j- 33' j e l VType of Identification Produced: ELECTRICAL 7 Minimum Fee Q TYPE Dryer QTY. .1.1,1,1,, Outlet, Appliance QTY. .1 Service Repair Q A/C Central 1 -3 Ton Cooling Tower Fan Outlet, Wall Service, Temporary A/C Central 4 -7 Ton - Paint Booth Fire Pump Ventilation, Cost Outlet, Switch Air Handler, Tons Signs Ductwork, Cost of A/C Central 8 -15 Ton Fixture - Fluorescent Oven Space Heater (kw) - Process/Pressure Piping A/C Central 16-20 Ton Fixture Light Bath Fan - Vented, # Parking Lot Lights Fireplaces, Number of Spas/Hot Tubs A/C Central 20+ Ton Flood Lights Plugmold/Strip Subfeeds, No. of Amps A/C Window FPL - Load Central Posts Swim Pool, Commercial Air Conditioners Garbage Disposal Range/Range Top Swim Pool, Residential Chiller Generators, etc. Receptacles Switchboards Clear Violations Heat Recovery Refrigerator, Comm. (p/PH) Temp Serv., Construction Compactor Low -volt, Burglar Refrigerator, Domestic Temp for Test - 30 days Deep Freezer Low -volt, Fire Renew - Temp Service Water Closet Demolition Low -volt, Intercom/Teleph. Repair Circuits Water Heater Dishwasher Low -volt, Television Service, Number of Amps Water Heater New MECHANICAL TYI'E Minimum Fee QTY TYPE Condensate Drain QTY TYPE: Generator Q TYPE Refrigeration, Tons QTY. A/C Central, Tons Bath Tub Cooling Tower Heating Strips, each Vent Hood, Cost A/C Wall/Win. Tons Dryer Vents, Number of - Paint Booth Filter Replace Ventilation, Cost Pool Piping Air Handler, Tons Sprinkler Repair Ductwork, Cost of Piping, Flammable Liquid Periodic Inspections Barbecue Fire Sprinkler System - Process/Pressure Piping Cap - Water Gas - Appliance Bath Fan - Vented, # Pump, Domestic Fireplaces, Number of Pressure Vessel Cap - Sewer PLUIIBING TYI'I? A/C Condensate QTY. TYPI.. Drains, Roof QTY. TYI'I; Miscellaneous Fixture Q'I'Y. 'fYI'E Soakage Pit ()Ty. Bath Tub Drinking Fountain Miscellaneous Repairs Solar Water Heater Bidet Filter Replace Pool Piping Sprinkler Repair Cap - Fixture Fountain Pump and Abandon Sprinkler System Cap - Water Gas - Appliance Pump, Domestic Supply, AC Well Cap - Sewer Gas - Natural Pump, Fire Stand Temporary Toilet Catch Basin Gas - Propane Pump, Re- circulate Temporary Water Closet Clothes Washer Gas Piping Pump, Replace - Pool Urinal Dental Chair Grease Trap Pump, Sprinkler Utility - Sewer Discharge Well Ice Maker Pump, Sump Utility - Water Dishwasher Indirect Wastes Relay Repair Vacuum Pump Disposal Interceptor Roof Inlet Water Closet Domestic Well Laundry Tray Septic Connection Water Heater Drainfield, 4" Tile/Res. Lavatory Septic Tank Water Heater New Drains, Area Meter Set (Gas) Sewer Connection Water Re -pipe Drains, Floor Minimum Fee Shower Water Service Drains, French Miscellaneous Equipment Sink Well, Supply Page 3 PERMIT APPLICATION INSTRUCTIONS: Please indicate the type of work being performed and quantity(ies) in the space provided below. RECEIVED AND REVIEWED BY: DATE: SECTION BY BATE 74- Zoning (71f' (,<_ Electrical (' Mechanical , Plumbing `Tire Public Works Structural Building Official Page 4 OFFICE USE ONLY CHECKLIST U OWNER - BUILDER FORM (Attach) LI FIRE DEPARTMENT APPROVAL (Commercial / multi- family) LI CONCURRENCY (New Construction) ❑ OTHER (Specify & Attach) $3.00 per page (Scanning Fee) Miami Shores Village Bond Metropolitan Dade County (C.C.F.) $ Inspector State Educational Fund $ State DCA (Radon) $ Code Enforcement Fine Zoning Review ❑ PROOF OF OWNERSHIP (Attach) ❑ HRS / DERM APPROVAL (Septic / Sewer) ❑ IMPACT FEE (New Construction) ❑ OTHER (Specify & Attach) PERMIT FEES $ ISSUING OFFICIAL REVIEWED AND PREPARED BY: (sq.ft. = x/1000 x ¢.60) (¢.005 / sq.ft.) (¢.01 /sq.ft.) CONDITION OF APPROVAL 10050 N.E. 2ND AVE., MIAMI SHORES, FL • (305) 795 -2207 • FAX (305) 756 -8972 • http:/ /www.miamishoresvillage.com PERMIT APPLICATION ❑ CONDO ASSOCIATION APPROVAL (Attach) ❑ BPR APPROVAL (Restaurants) ❑ CONTRACTOR REGISTRATION (On File) TOTAL $ DATE: Revised July 2001 PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Date -0: Job Address 33 ti" //L s/ Tax Folio /9 3..ZA - /g 5345 Legal Description LOT / ' 4 /g �L�S g 37 ///h ife-� / �-'�® tg / e Lessee / Tenant �, OL 4. Alr B04/49 EJZ Master Permit # /l/.� 22 Phone 5F - .0 Owner's Address � � T P n /v (? � / ._Contracting Co. T S Address — Qualifier < -\C- 1vm.0 v\ SS# ` Phone SS3'3''S2 l —State #C GCOP -1 I ?U # Competency # Architect /Engineer P/Cisl° Cumulus TWT SW2277 Bonding Company — Mortgagor Permit Type(circle on . BUILDINQ LECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN WORK DESCRIPTION ' l4" T �/�� ' a ti S gnatur Date: No as to • - i )and /or Co do President My ICommission xpires: * 6771/16' ** * * * * * * * * k * FEES: PERMIT 31 RADON C.C.F. l-) v Fire APPROVED: IS 6, Address 0 6 \1 • .1 SOU, 1-u Square Ft. Estimated Cost(value) b. µY ?U Ur I IAL Nut ARV SEAL Not r as tp uTit5ffripmvar My qo lircdlgp3s es NUMBER 11 Q CC255237 �r "" cO MY COMMISSION EXP. ` OFF O JA0I 26 1997 oc, WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO SO MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY (IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT). Application is hereby made to obtain a permit to do work and installation as indicated above, and on the attached addendum (if applicable). I certify that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that separate permits are required for ELECTRICAL, PLUMBING, SIGNS, POOLS, ROOFING and MECHANICAL WORK. OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Furthermore, I authorize the above -named contractor to do the work stated. n �' , gnature o ontractor r Owner- Builder Date: er- Builder * * * NOTARY �4 ® TOTAL DUE 9 Other Zoning Building Pi ti ip Electrical Mechanical Plumbing Engineerin „ BUILDING AND ,ZONING .DEPARTMENT ., 11 1_ NW 1ST STREET FL. . 33128 - �; ,,. 10TH..FLO•OR,_SUI TE 1010 STATE CONTRACTORS' CERTIFICATE .OF REGISTRATION I SSUED `SEPTEMBER: `,18_, , ETRGDADE 1.„_1HJ$ _j&._IO. CERT IFY, . R :.8 S ENTERPRISES INC ;•,. �,.C..C..N.....CGC041804_, TRADE.- BUILDING A.J&YING THE REGISTRATION REQUIREMENTS OF_METROPOADE COUNTY, IS HEREBY, REGISTERED.. AS A CONTRACTOR IN THE FOLLOWING ATEGORY(S) -..04_,.GENERAL ,(STATEL._. y -- ,WUH_ALL,_ WORK TO BE,.DONE: UNDER THE DIRECT SUPERVISION AND CONTROL OF QUALI FYI NG -,AGENT. GOULDY.,.RUSSELL . �.. S. S. N. 267 -02 -3321 R._ _S. INC .,.. , . .; ';; THIS REGISTRATION _IS, VALID_ UNTIL ' 9,1Q..S00H . 6 .S T .r SEPTEMBER .30, * .1993. AKE..WORHT_ ... , .. FL ,33460 _ BY ? OF JORGE .S.,,,RODRIGU SECRETARY, CONST TRADES QUAL_ OOARD _ ALIER.ATION.,_REPRO.DUCTION, OR TRANSFER OF THIS CERTIFICATE _IS PROHIBITED 1 Ac. 1782399 STATE OF FLORIDA DEPARTMENT OF PROFESSIONAL REGULATION CONSTRUCTICN INDUSTRY .LICENSING BOARD 05/ /RTT 1 II 5/ /�I 92 THE cERT WED .0 AE NAMED II tt UNDER THE PROVISIONS EXPIRING AU G 31. 15 LAWTON CHILES GOVERNOR CG CC41PC4 RAL °CONTRACTOR O F .IHAPTER 4E9 GCULDT. RUSSELL R & S ENTERPRISES INC 618 SC C. STREET LAKE WCRTF FL 334.60 4147 F.S., FOR THE YEAR DISPLAY IN A CONSPICUOUS PLACE GEC E STU �- , .JR. SEC MARY P.R. GENERAL CONTR CGC0418O4 93- 12773 R & S ENTERPRISES INC GOULDY RUSSELL 404 EAST COAST STREET LAKE WORTH FL 33460 IS HEREBY UCENSED AT ABOVE ADDRESS FOR THE PERIOD BEGIN- NING ON THE FIRST DAY OF OCTOBER AND ENDING ON THE THIRTI- ETH DAY OF SEPTEMBER TO ENGAGE IN THE BUSINESS, PROFES- SION OR OCCUPATION OF: GENERAL CONTRACTOR JOHN K. CLARK TAX COLLECTOR, PALM BEACH COUNTY COUNTY OCCUPATIONAL LICENSE PALM BEACH COUNTY, STATE OF FLORIDA COUNTY ORDINANCE NUMBER 72 - THIS LICENSE IS IN ADDITION TO AND NOT IN LIEU UCENSE REQUIRED BY LAW OR MUNICIPAL ORDINANCE TO REGULATIONS OF ZONING, HEALTH AND ANY AUTHORITY- 1 OF ANY OTHER AND IS SUBJECT OTHER LAWFUL 1 1 * *LO ATE SAME A CLASSIFICATION C °O THIS LICENSE VALID ONLY WHEN RECEIPTED BY TAX COLLECTOR PAID. PBC TAX COLLECTOR CA $3.00 OCC 21 6017 06- 01 -93 DE MUNICIPAL LICENSE TRNSFR $3.00 TOTAL $3.00 UCENSE MUST BE DISPLAYED CONSPICUOUSLY AT ESTABUSHMENT OR PLACE OF BUSINESS CO LTR TYPE OF INSURANCE • POLICY NUMBER POL. EPF. DATE POL. EXP. DATE LIMITS o GENERAL LIABILITY GENERAL AGGREGATE $ 300,000 A (X] COMMERCIAL GENERAL LIABILITY GLA160927 09/27/92 09/27/93 PRODUCT- COMP /OPS AGG. $ 300,000 [ ] CLAIMS MADE (X] OCCUR. PERSONAL i ADV. INJURY $ 300,000 1 ] OWNER•S i CONTRACTOR'S PROT. EACH OCCURRENCE $ 300,000 (X] PREMISES /OPERATIONS FIRE DAMAGE (Any one fire) $ MED. EXPENSE (Any one person) $ AUTOMOBILE LIABILITY ( 3 ANY AUTO COMBINED SINGLE LIMIT $ ( ] ALL OWNED AUTOS ( 3 SCHEDULED AUTOS BODILY INJURY (Per person) $ ( ] HIRED AUTOS [ ] NON -OWNED AUTOS BODILY INJURY (Per Accident) $ [ ] GARAGE LIABILITY [ ] PROPERTY DAMAGE $ EXCESS LIABILITY ( ] UMBRELLA FORM EACH OCCURENCE $ ( ] OTHER THAN UMBRELLA FORM AGGREGATE $ WORRER•S COMPENSATION STATUTORY LIMITS B AND 77WZZCO357 09/27/92 09/27/93 EACH ACCIDENT $ 100,000 DISEASE - POLICY LIMIT $ 500,000 EMPLOYER'S LIABILITY DISEASE -EACH EMPLOYEE $ 100,000 OTHER C (X] PALM BEACH COUNTY LICENSE 41951356 10/01/91 09/30/93 $ 2,000 $ PRODUCER L.W. Myers \ Li i Associates 2112 South Congress Avenue Suite 207 West Palm Beach, FL 33406 INSURED R i S ENTERPRISES, INC. 1353 PERIWINRLE PLACE WEST PALM BEACH, FL 33414 DESCRIPTION OF OPERATIONS /LOCATIONS /VEHICLES /SPECIAL ITEMS •30 DAYS NOTICE ON W /C* DRYWALL /WALLBOARD INSTALLATION CERTIFICATE HOLDER CITY OP WEST PALM BEACH PLANNING i ZONING DEPT. P.O. BOX 3366 (200 2ND STREET) WEST PALM BEACH, PL 33402 FORM 25 -S (7/90) CERTIFICATE OF INSURANCE ISSUE DATE 10/29/92 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 TEE COVERAGE AFFORDED BY THE POLICIES BELOW. COMPANIES AFFORDING COVERAGE COMPANY LETTER A: ACCEP. INS. CO - HULL i CO. COMPANY LETTER 8s HARTFORD UNDERWRITERS INS CO COMPANY LETTER C: WESTERN SURETY COMPANY COMPANY LETTER D: COMPANY LETTER Es COVERAGES TBIS IS TO CERTIFY THAT POLICIES OP 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 88 ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN I8 SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OP SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CANCELLATION SHOULD ANY OP THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO NAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY RIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Qualifier's Name 1 550 60JLL Certification Number(s) i Company Name f a S Extn-ssY-P 4u25 Address Cv18 8 City, State, Zip t4k V &TH FLae/110f1 '53 Phone I hereby authorize the Palm Beach County Planning, Zoning and Building Department to issue permits for the above referenced company to: R/Ck rmvyt (print name of authorized person) I certify, that the above person is employed by the company and I understand, that I am fully responsible and liable for all acts performed under said permits. Signature of Authorized Agent / %a au / oriz.sig REV. 6/91 PALM BEACH COUNTY . PLANNING, ZONING ! BUILDING DEPARTMENT BUILDING DIVISION AUTHORIZED SIGNATURE FORM Sworn to and subscr' ed before me this 0-7.5 day of , 19 9a My commission expires MARY ANN (. LAr . NOTARY PUBLIC STAT^ ORIOA MY COMMIS;,rv;v EMPIRES 5/20/94