DS-10-8New paver drive and walks.
Passed 7
t
Inspector Comments
,
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled
re- inspection fee is paid.
until
Inspection Date: July 13, 2010
Inspector: Bruhn, Norman
Owner: CALPINI, SEAN
Job Address: 312 NE 101 Street
Project: <NONE>
Contractor: HERRINGTON BRADLEY CONSTRUCTION
Building Department Comments
July 13, 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
Inspection Number: INSP - 148358 Permit Number: DS- 1 -10 -8 1
For Inspections please call: (305)762 -4949
Permit Type: Driveways /Sidewalks /Slabs
Inspection Type: Final
Work Classification: Addition/Alteration
Phone Number
Parcel Number 1132060135320
Page 1 of 1
1121\'2010 Lcfl'*69
alk) x
BUILDING
PERMIT APPLICATION
FBC 20
Contact Phone
Value of Work For this Permit $
Type of Work: ['Addition
Describe Work: _
b
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 Type: BUILDING ROOFING
Owner's Name (Fee Simple Titleholder) cE4 t/ �'QLpifl / Phone #
Owner's Address /2
City
Tenant/Lessee Name
Email
3
Job Address (where the work is being done
City Miami Shores Village County Miami -Dade
FOLIO / PARCEL #
Is Building Historically Designated YES
NO
Contractor's Company Name ,j/V s .47)
Contractor's Address L ' /hr, )i • /'7 ill ST
City I1,4 /A MI 6 .4G tA/ State Zip
Qualifier Name Phone #
State Certificate or Registration No. Certificate of Competency No.
['Alteration
E -mail
ECOVED
JAN 22 2010
Permit No.
Master Permit No. DS.- /- /Q _g
Zip
Flood Zone
Phone # ( Qs=
Architect/Engineer's Name (if applicable) Phone #
Square / Linear Footage Of Work:
❑ Demolition
['New ❑ Repair/Replace
GVii/G d G4
******** ** * * * * * * * * * * *** *** * *** **** * * * ** F ees * ** ** * * * * * * * * * ** * * * *** *er ** * ** * * ****** ** **
Submittal Fee $ Permit Fee $
CCF $
COi$r
Notary $ Training/Education Fee $ Technology Fee $
Scanning _ Radon $ DPBR $ Bond $
Double Fee $ Violation date:
Structural Review. $ Total Fee Now Due $ be•00
See Reverse side -4
Signature Signature
Owner or Agent
The foregoing instrument was acknowledged before me this The fo a :o
•
day of , 20 by , day of a 4..4 AU.
who is personally known to me or who has produced who // per
As identification and who did take an oath. 52"x - 0
NOTARY PUBLIC:
Sign:
Print:
My Commission Expires:
(Revised 07 /10 /07)(Revised 06/10/2009)
a Engineer
onally kno
N
Sign:
Print:
ARY PUBLIC:
My Commission Expires:
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
Contractor
instrument was aokn. > le ged before me
20 (.O, by
to me o . ho has produc
idn and who did take an oath.
ie4r9r*ie4rk{ t9ede***9rdnkde*ir*9e*@ *tit9e9tBrirdrde*9Fiedek *9 e*ie4e9e4t4e****k 4tde4r*9t***** s6**** * dric4e4tie****** aYYr *de4e* 4e #dF9edc4edt*3e ~9t *tk *4ei ******
APPROVED BY Plans Examiner
Zoning
Clerk checked
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 Y ch posted notice, the
inspection will not be approved and a reinspection fee will be charged..
n n and Z ping Criteria
Owner's Name: SEAN CALPINI
Job Address: 312 101 Street
Miami Shores, FL
Miami Shores Village
10050 N.E. 2nd Avenue
Miami Shores, FL 33138-0000
Phone: (305)795 -2204 Fax: (305)758 -8972
1/22/10
SIDEWALK CAN NOT EXCEED 3 FEET IN WIDTH.
2/3/10
NEW PLANS OK PROVIDED NO WALKWAY EXCEEDS 3 FEET IN WIDTH.
Folio Number:1132060135320
Owner's Phone:
Total Square Feet: 1200
Total Job Valuation: $ 5,300.00
Contractor(s)
HERRINGTON BRADLEY CONSTRUCTION
Phone
Primary Contractor
Yes
Planning and Zoning Criteria and Comments
Approved: No Date Denied: 1/22/2010
Comments: DRIVEWAY IN SWALE IS NEW OVERLAY /LIFT AND ORIGINAL ASPHALT NOT TO BE REMOVED.
APPLICANT IS RESPONSIBLE TO MAKE SURE THAT THIS DOES NOT RESULT IN PONDING ON THE ROAD AND
WATER IS STILL ABLE TO DRAIN FROM THE ROAD TO THE SWALE.
v I
v
9 ■-
BLDG DEPT
Pt"
r
CT 9 CrM;LI • CE
r - 441 (017
S AND REGULATIONS
1ov /6-,W / ASPHALT aVERLA y
eR ousrfiva PAEgI,
Nevi OvER'(,4Y ro Dizm 703W,4( A AREA
A • /24
/ V
%AI I
AND 1 111 'WA
11.111411i
AM) hl
• • • •
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'cave.
AL/(
REMOVE EXISi7N4 DRIVE
dlAIST /JEW BRItie
e& ow
°ma.
/7.2 o •
/ 40
0
wm..■■■•••—■■—■*1
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8Iw
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•
SURVEY
• I st ih t ..envey more.
g ff,),T eta% meets glle innthnuM
let him al ierpw.tuals by Me Bumf
ill land Surveynrs In chapter 6)C,17.6
Ilut1114 Atinunottethve Code pursuant to
e 4144. so a ., lutes. Mere are no
•maim ',moans, • rae•riam, easements
2pittatIng; 94 Iv :1.1,1."i1, 111 as
sliown heirria). -.. .
r t
. . i ka," '
J
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7
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,e. facer•suovvernsesno a tarrraau. - " -
• • • •
•• • • •
90
EIEJ,I) DATE
cT)
This property described as :
, The West of
Lot 10 and ALL of
Lot 11, Block 39
— AN AMENDED PLAT OF
MIAMI SHORES SECTION NO. 1
according to the Plat
thereof , as recorded in
ARIMbik i t c
ade Courvrpi TibeErialage
APPROVED DATE
ZONING DEPT
• 0. REMOVE Oa. DRIVE.4.
AISTAZZ 4'13R1Ce PAO'S
3.1RXTRAID cog°, vazx
" REVS/01J
,
.:/4
eAl
1 e7eV kUt
2'
ist owileps ; BERVAIE'LASSEIN I 4- SEAN CALPIAll
312 N.E. 101st Street, Miarai
SCALE
/1/.
5-23-08 Re ce4,CI, f: (II: Ceti: 4. er 74, Name and Flood Inf. °motion Revised,
/0/ 51- 5
70
1
/3 ; /4 \/ 5 /6 i /7
5o ,.I ,,. ....
6(7
m... , ■ , ■.■ ••■••••‘■••■
71 911, i /i
RENE AlCUESVIVES P.S.M. N 4327
Dit41YN BY
FCMIMMI
AR FEB V 2010 IP
BY:—
Shores', Florida
33138.
LANtslES AND GARCIA, INC.
L.13. H 2098
SURVEYORS-MAPPERS-LAND PLANNERS
FRANCISCO F. FAJARDO #4767
()fflkt sthirtty: 359 Alcaaar Aveaut, Coral Cables, Florlda'.1.11.1.1
(305) 666.7909 (954) 5234643
DRWG. NO
82553
-- 52j/ 76 7 212963
ht Nk alc�) VIVES P._;S.1.14317 •s r�rnRDO #4767
O(fter Rddr ,; 35'J �Ie++��` r L Cables, Florlde 33134
5;1 13O) 666= J Y(9 .1) -663
FIELD DATE SCALE DR WN BY DRWG. NO
.- rqr . lei, .7Q' /1-7 • 82553
4°
At/& W / ASPHALT "V6RLAY
nvVR tiX /STIW PARICIA14
/ RENpQY6' ll /Ga$1. LT'_sgyomb
'Z9'/i4.
,L/E, /D/ sr r
Ill
Q O 1G
vi G 11,17
Ni
PPRO \ /ED
STATE AND CO IJN j
,uI 1AI II71f•FHifTlri' \ I 'AdIt 1'•
.1M1 1111 Illut.I...tI I te.1 ID \I;fl }t1N •
tl.ul4Il/All;IN'lIIN141 11110.i ••:
ANII 111 11•I•4
• •• • •
MamiSho
,)r!
ED
AND R
,.•
IC�rT�NS��i
•
• ..• T ••- ..- • StAWY
• 1 wnoh,• t e Illy that the larvey repro.
I'entelh.l■er4lln meets 41 e minimum
Iet hnts al tit'arK(u,hxr'urtl by the Baud
Ill 14n1 Surveyor% in chapter 61(19.6
• ••• • • • ; • LI.1nda 4t6reonis•ahve C.nde pursuant to
• • • • • entnn 47:1.01: II :. Statutes. (here are no
• • • • • • enrryalhgtrnl} • nvrrlaln. eatrmentt
•• • •
• ••
• : • appeattne'n•IIe Plat. l 1e than at • shown hesi�dltu. • �j
r. ' ,1 / i • •r-
••• • • • • •• � 4. • �/IG
• • • • O. PPllr WIYr.Yt1R AND MArrr.RNtl. 6
• • • • • • • •
la • • • • • • • •
awaw-
01
f":514:
}
42/ v-
r �')
O
/z
i
/3
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■
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P EXTE 0 1 REMOVE EX1SjjA14<, pRlV .
r _.
�ta , �i� � .5 -0 � � "GOA/C_. Al NEZt/ 4 „Sb?IClC `
C®N�SW/<• 4LK rAVE/ZS AS 0W1.1
6 ,7 4,-) /7/4
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, / ' c , c :, . a To . •N ERIC — 0 \A 0 1 N
:. vi . ) ��` �`� / � �� N N. This property described as:
7. alto. �� 'v r .. v• 6 ,a' . The West } of
,--N,0"-t; � 9 i o. l � N'� ;a // Lot 10 and ALL of
>`” Lot 11, Block 39
C. l' w Q — AN AMENDED PLAT OF
/S. 5S' 0 0 i� PG • MIAMI SHORES SECTION NO.
N /9,40 11.. ` according to the Plat
''; thereof, as recorded in
1 m Plat Hook 10, Page 70
llj 0
" n ' tY) of the Public Records of
0L vi Dade County, Florida.
\ ey e
/6 ,4o' //r 5.'0' N o
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a; G " in ` 1
/.. 2o • 5/04 5.0 r. H• .��
37. on '
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r
PL _ ,.
t A/6W 's' ALT OVERLAY
2. RENat ' CAC. DR/V .4
/118TALL 4'' BRIM PA
t./., FA/b 4 " ' Ce W'rLLC
ru r
if
I!
SEAN CALPI JVI
2 N.E. 101st Street, Mini Shores, Florida
ECEO V ED
JAN 2 2
5 -23 -08 ReceDeifiecP, eertifitd 'Po, Name and Flood Information Revised.
- -- 767 212963
'VOL
5-23-08 ReCeerffiett LefCtfted 'To, Name and Flood Information Revised.
Pne 1 012
1
t 33138.
N At GARCIA, INC.
L.1-2098
0 S XPPER %LAND PLANNERS
ES P.S.M. M 4327
•
FRANCISCO F. FAJARDO #4767
A444oar ue, Coral Cables, Florida 33134
(305) 666.7%)9 (954) 5233663
FIELI)DATE SCALE DRAWN I3Y DRWC. NO
5:4 P '2 /1-7". 82553
GM'
CoNe.al
G
4 20 °
/.40
Cc
A/6 //` ASPHALT OVERcAy
av&R axisTin /0 PAEXIA14
/REMOVE atISA A Itilytwa pReppur coRtiaR-
fiA0,11 Pavel/22,0r)/
E. /o / 52 : -
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• • • •
• • •
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Aro 1111 II flit o set. (
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• • • • • ••
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• •
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, vi.
This property described as:
The West of
//Ss Lot 10 and ALL of
Lot 11, Block 39
-\ AN AMENDED PLAT OF
, MIAMI SHORES SECTION NO. 1
according to the Plat
thereof, as recorded in
Plat Book 10, Page 70
40' of the Public Records of
-
.Dade County, Florida.
77 1 4
STATE AND COUNTY RUZRE
REMOVE eXrsi7v4 playa
dlivsma /JEW 41"13Ritie
PAVER6 6 .5 OWAL
00 '
/72'o
, 1,
1,-----P,
wr
M ', S hori Iag 11111111110
IIIIM,
111111111
LIANCE WIT1
: A ZATONDARY
IV– alb e— 0 SilkVEY
I* •tlIrly 1 efilltly that the V.Itvey rem.
teilleir..gi$on meet, .11,c minimum
IC* hem al ireeKikuJyr,:rfort11 by the lioatti
tit 1 and Starveyott in chapter 61C17•6
• liwttlateiettlemnict alive Csode pursuant to
• !truitren t2.01. 13a. Sistine,. There are no
entemat lismcno. • •rortlapi, casement%
• eive.milje,p
li 1.14i. 1 7 Than i
thowst hey t te„,
.""
".
10* t • '.---7174T1717
Me7110103UllYtql011 AND MAMA OU. "
• • •
• • • •
48 ruisa.
O
)t.
oda
A
° it
12 N.E. 101st
11
tfio
, re)
1 50'
e '7
/2 7 '
1 ,
\ \ /5 \l6V7
1 4.
• .3_
iez
,4%1 9 / *e'
PLi
VEW 3 P AT OVERLAY
2.
Rt/IPVE CNC. DRIVE /1/87a f Bee/<' Man
eCoNC, WALX
1
l c) E$/ML
14
c RECEIVED
JAN 2 7 2010
•
X
Miami Shores Plorida
L,3
:-"714767 212963
Address:
PERMIT CLERK INITIAL:
PERMIT CLERK INITIAL:
RECEIPT
PERMIT #: ` 0 — U DATE:
RESUBMITTED DATE: A I got 0
M iami Shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
- rdo o 9-j c9010
Contractor
❑ Owner
❑ Architect
0%0 YrC7� CHV122d-1(94S rwACl(9Y)
nb2 NC O
From the building department on this date in order to have corrections done to plans
And /or get County stamps. I understand that the plans need to be brought back to Miami
Shores Village Building Department to continue Pe ing process.
i
Air
Acknowledged by:-
tannin
Owner's Name: SEAN CALPINI
Job Address: 312 101 Street
1/22/10
an Zoning Criteria
Miami Shores Village
10050 N.E. 2nd Avenue
Miami Shores, FL 33138 -0000
Phone: (305)795 -2204 Fax: (305)756 -8972
Miami Shores, FL
23C cS 5
Permit NO. DS- 1 -10 -8
Folio Number:1132060135320
Owner's Phone:
Total Square Feet: 1200
Total Job Valuation: $ 5,300.00
Contractor(s)
HERRINGTON BRADLEY CONSTRUCTION
Planning and Zoning Criteria and Comments
Approved: No Date Denied: 1/22/2010
Comments: DRIVEWAY IN SWALE IS NEW OVERLAY /LIFT AND ORIGINAL ASPHALT NOT TO BE REMOVED.
APPLICANT IS RESPONSIBLE TO MAKE SURE THAT THIS DOES NOT RESULT IN PONDING ON THE ROAD AND
WATER IS STILL ABLE TO DRAIN FROM THE ROAD TO THE SWALE.
SIDEWALK CAN NOT EXCEED 3 FEET IN WIDTH.
Permit No: 10- r
Job Name
,200
40cAle ZoAletr.,oporAGO/
Building Critique Sheet
Norman Bruhn CBO
305 - 795 -2204
Miami Shores Viiiage
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
Page 1 of 1
Plan review is not complete, when all items above are corrected, we will do a complete plan
review.
If any sheets are voided, remove them from the plans and replace with new revised sheets and
include one set of voided sheets in the re- submittal drawings.
3ri3�8.: tt.r 1,�],�.'r ,I eti ��. �.. v'.P- a.;;/fRt.(ot`. 71J//.YeN1 l / ?> �'VY 5<.:l,1ttA,' i� , Jf. l4tF- ,YnS..,:111y/!,<1.L: A:N'1S"Sa ).�. hk'6°YF
Job Address: 312 101 Street Total Square Feet: 1200
Planning and Zoning Criteria and Comments
Approved: No Date Denied: 1/22/2010
Comments: DRIVEWAY IN SWALE IS NEW OVERLAY /LIFT AND ORIGINAL ASPHALT NOT TO BE REMOVED.
APPLICANT IS RESPONSIBLE TO MAKE SURE THAT THIS DOES NOT RESULT IN PONDING ON THE ROAD AND
WATER IS STILL ABLE TO DRAIN FROM THE ROAD TO THE SWALE.
1/22/10
Miami Shores, FL
Contractor(s) Phone Primary Contractor
HERRINGTON BRADLEY CONSTRUCTION Yes
SIDEWALK CAN NOT EXCEED 3 FEET IN WIDTH.
Total Job Valuation: $ 5,300.00
NO zZns�I
T JNHS Sd9Vd
SZ,TO HO HMI
85 :ST TO /ZO MILL 'ZS
QI NOIZVNIZSXQ
5ZZ917Z950S6 SMITH LNaIdIOHH
98St ON IN / %Z
ssss *** *sss *ss * * *s * **
* ** IU0ddU YZ * **
ss * * * * * * * * * * * * * * * * * **
310 NOISSINSANVILL
TOOIj
Sd0IAHH8 OlaId NVOS VIVO
0£5L 589 008 T %Vd 69 :9T OTOZ /TO /Z0
Project Address
Miami Shores Village
10050 N.E. 2nd Avenue
Miami Shores, FL 33138 -0000
Phone: (305)795 -2204
Parcel Number
312 101 Street
Miami Shores, FL
1132060135320
Block: Lot:
SEAN CALPINI
Owner Information
Address
Phone
SEAN CALPINI
312 101 Street
MIAMI SHORES FL 33138 -2425
Contractor(s) Phone
HERRINGTON BRADLEY CONSTRUC1
Cell Phone
Valuation:
Total Sq Feet:
Approved: Yes
Comments: DRIVEWAY IN SWALE IS NEW OVERLAY /LIFT AND ORIGINAL ASPHALT NOT TO BE REMOVED.
Date Approved: 1/6/2010 : Yes
Date Denied:
Type of Work: DRIVEWAY
Bond Retum :
Additional Info: ASPHALT AND BRICK
Classification: Residential
Fees Due
CCF
Education Surcharge
Permit Fee
Scanning Fee
Technology Fee
Total:
Amount
$3.60
$1.20
$159.00
$9.00
$4.80
$177.60
Authorized Signature: Owner / Applicant / Contractor / Agent
Building Department Copy
Invoice #
DS -1 -10 -36734
DS -1 -10 -36734
Total Amt Paid Amt Due
$ 177.60 $ 50.00
$ 177.60 $ 177.60 $ 0.00
Applicant
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.
January 12, 2010
Date
Expiration: 07/11/2010
Cell
$ 5,300.00
1200
For Inspections please call:
(305)762 -4949
Available Inspections:
Inspection Type:
Final
Sidewalk
Landscaping
Foundation
January 12, 2010 1
02/02/2010 12:54 FAX 1 800 685 7530
TRANSMISSION OK
TX /R% NO
RECIPIENT ADDRESS
DESTINATION ID
ST. TIME
TIME USE
PAGES SENT
RESULT
saasssassssaaasaaasss
aas TX REPORT ass
ssassasssassaaasaaasa
4589
93056245225
02/02 12:53
01'19
1
OK
Nam_
3 and Zoning Criten
Owner's Name: SEAN CALPINI
Job Address: 312 101 Street
1/22/10
Miami Shores Village
10050 N.E. 2nd Avenue
Miami Shores. FL 33138 -0000
Phone: (305)795 -2204 Fax: (305)756 -8972
Miami Shores, FL
Contractors)
HERRINGTON BRADLEY CONSTRUCTION
SIDEWALK CAN NOT EXCEED 3 FEET IN WIDTH.
DATA SCAN FIELD SERVICES
0001
P"
Permit NO. DS-1-10-8
Issue Date: 111212010
ermit
+3t ^,Y�trlS
; ir.C�tgG..ti✓F'.S w�;::,,ey. „;�
n;'/I1 +;•�l<t Y/;'•';uG0 . :.nns¢iit,4;`o-<cf•!fi.
Owner's Phone:
Total Square Feet:
Total Job Valuation:
Phone Primary Contractor
Yes
din* j�$ id tntalksiSlabs
cfilAlteratian •:
Expires:1 /12/2010
Folio Number:1132060135320
1200
$ 5,300.00
Planning and Zoning Criteria and Comments
Approved: No Date Denied: 1/22/2010
Comments: DRIVEWAY IN SWALE IS NEW OVERLAY /LIFT AND ORIGINAL ASPHALT NOT TO BE REMOVED.
APPLICANT IS RESPONSIBLE TO MAKE SURE THAT THIS DOES NOT RESULT IN PONDING ON THE ROAD AND
WATER IS STILL ABLE TO DRAIN FROM THE ROAD TO THE SWALE.
PERMIT NO.
NOTICE OF COMMENCEMENT 1 111111 1 1111 1 1111 1 1111 11111 11 1 11 111 11 1111 11 11
A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION
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.
1. Legal description of property and street/address: 3/2.. me Am* sikees
' — 1
.1
2. Description of improvement:
3. Owner(s) name and address:
a
Interest in property:
Name and address of fee simple titleholder: •
A l L' i r 1 4l
by owner from contractor, if1 °� ¢° "m. _ "` f'
4. Contractor's name and address:
il
5. Surety: (Payment bond requi
Name and address:
Amount of bond $
6. Lender's name and address:
TAX FOLIO NO.
7. Persons within the state of Florida designated by Owner upon
provided by Section 71 .13(1)(a)7., Florida Statutes,
Name and address: �12 U-E
9 /
notices or other documents may be served as
CFN 2010R0006718
OR Bk 27134 Ps 3186; (1Ps
RECORDED 01/06/2010 11:17:16
HARVEY RUVIN► CLERK OF COURT
I'IIAIII -DADE COUNTY► FLORIDA
LAST F'AGE
D.C.
8. In addition to himself, Ow ers designates the following person(s) to receive a copy of the Lienor's Notice as provided
in Section 713.13(1)(b), Florida Statutes.
Name and address: •
9. Expiration date of this Notice of Commencement (the expiration date is 1 year from the date of recording unless a
different date is spec
Signature of Owner
Print Owner's Name
Sworn to and subscribed before mc this
Notary Public
Print Notary's
My commission expires:
113_01-39 7/05 PAGE 3
ed)
Toa..•Atryr
Prepared by
day of llJi , 20
..... nuoe1taa nna...Pdd ress:
WALDO LAURENCIO
1 I 12 Izaa th eMC , ' .
BUILDING
PERMIT APPLICATION
FBC 2001
Permit Type (circle): ( Building ) Electrical Plumbing Mechanical Roofing
8a r1 e LAs V j
Owner's Name (Fee Simple Titleholder) ,S(>A.V C4I P, i/ Phone # � ` '° •3r��
Owner's Address 3/2 /1.1 • • /D/ s T
City State Zip
Tenant/Lessee Name
Job Address (where the work is being done) 3/ Ate:
City Miami Shores Village County Miami -Dade Zip 33/3»
Is Building Historic ally Designated YES NO x
/ 8W-4S/ A �. FQ_ "
Contractor's Company Name et ij '. , Z . Phone # _j ,f �e 1q 5 J
Contractor's Address b /5/919 /V (// /4 7 / ,1 T 4b /o2 � - J . �Q 6
cit . 11 / k A tate L. Zip 3304
Qualifier &4,2 - A/e : L im/v6r'/1/__
Architect/Engineer's Name (if applicable) Phone #
$ Value of Work For this Permit
Total Fee Now Due $ 12 4 ' (o O
(Continued on opposite side)
Miami Shores Village
Building Department
f6 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
5 , 300
Master Permit No.
Phone #
,33/35
* * * * * * * * * * * * * ** * * ** * * * ** * * * *F ee * * * * * * * * * * * * * ** * *lb * * * * * * ** * * *
JAN 0 5 RECD e&.
Permit No. D I 0 -8
Square Footage Of Work: 30P S F •- RRIGK
Type of Work: ❑Addition ❑Alteration ❑New ® Repair/Replace 0 Demolition
Describe Work: , 1-- /VF W ,45p/ L7 DVE L4 y e. g)(sr& PA11214Ill(y
2 - / EMo ve 15x13TA 40(6. Del V j /gam LL. 'Jaw 4'' ,8tc ieK PAVE-g3
3. - 1v7) coh• WALT W14 y
'` ^ Permit Fee $ / J f �� CCF $ � 'CC/0
n bmittal Fee $ � � )•
Notary $ Training/Education Fee $ 1. ' Technology Fee $ •
Q
Scanning $ - L• `O0 Radon $ Bond $
Code Enforcement $ Structural Plan Review. $
Bona ling Gompany's Name (if applicable)
Bonding Company's Address
City State Zip
Mortgage Lender's Name (if applicable) / V
Mortgage Lender's Address
City State Zip
Application is hereby made to obtain a pennit 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."
N ttice to A licant: As a concision to the issuance of a building permit with an estimated value exceeding $2500, the applicant must
romise in g od faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
hose prope is subject to attachment Also, a certified copy c f the recorded notice of commement must be posted at the job site
r the first sec which ' curs seven (7 ., s after the building permit is issued In the absence of `- posted notice, the
ection wi rei' 4 on it � -1 be barged
r I
Ag -
The forego g instrument was acknowledged before me • 's S The foregoing instrument was acknowledged before me this S
day o' i !! 20 Dcl, by P1... , day o _ 206 , by fs t t211A
who is personally known to me or who has produced btu who is personally known to me or who has produced 4r)
n As identification and who did take an oath. as identification andOintolidttp oath.
, \ NOTARY PUBLIC: ' '
�.. ! ..,u S _
Print: ,•s0 30 3 . / 6 1 'x ' , , Print: _ i r �Q ��'t
My � 651.004 ' s % My �
Is
y Commission E xP ' ::
.°'.
6y4ffi: � y Commission Expires: ti`s kS.: f?›. * *** ******** ** * ** **** ** f ,c1 l�ltlgy,t's **4 * * ** *a ** * *** **** **** * *t, ** *** *, * ** *, *** *, * * * *,60*Sii}�,v 1 ***
i k toil 1 to r, Certificate of Competency Holder) � s tlSA1 1c S ` ���‘ ���
% t „
State Certificate or Reg du .NSE aY;6 j4/Q Certificate of Competency No.
, 4 , e l Anns '
NOTARY PUBLIC-
APPLICATION APPROVED BY:
Chc 10/14/03
Plans Examiner
Engineer
Zoning
5 -23 -08 Recertified, Certified To, Name and flood Information Revised.
1'si);c I n1'2
• • •
• •
LANNES AVID $?I 12C1R, INC.
• • 331.3.8.:•
• •
L.11'.14 2098 • •". •
SU RV EVORS- MAPPERS- LANIItANNERS
11.11NI. AICUk:SVIVES P.S.M. H 4327
FRANCISCO F. FAJARDO #4767
()(ftcr addrtss: 359 Alcazar Avenue, Coral Cables, Florida JJ134
1305) 66&.794Y (954) 52346.63
•
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I tttatrhy 1tltidy that I
the!u
'vey 'ewe-
sentelr`h.,! eretln sleets 4te minimum
ter him a1 it7»aiutla. r1'urtit by the timid
ul land Sutveymt in chapter 610,17.6
I lunda Administrative C.nde pursuant to
Section 471.017. I la. Statutes. There are no
✓ ot trail lime/us , 13v•rlapt, ratrntrnls
J OIN. 41111K 9,n lite I'I+I t try than at
thaws he)dto. i
rl. rR11r AVIYr..YIIJ AMO alAtrr.a
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This property described as:
The West } of
Lot 10 and ALL of
Lot 11, Block 39
•"\ AN AMENDED PLAT OF
MIAMI SHORES SECTION NO. 1,
A
accordin the ''P
a thereof, as a rd in
g P1at Bo age 70
of the Pub1 eco s of
,
.Dade
• r..
P. ,.
r /VEW 8P ALT OVERLAY
2. ,4ENVe LINO DRIVE -4
/N8TALL 1 "BRIG!! PAM
3. j 'Iir) ewe. WALK'
•••• •
••••
• •
•• ••
• ••••
• •
•
•
•
312 N.E. 101st Street, Mialns• Shores•,41orxdre
•
• •
.r 212963
in an Zoning Criteria
Owner's Name: SEAN CALPINI
Job Address: 312 101 Street
Miami Shores, FL
Miami Shores Village
10050 N.E. 2nd Avenue
Miami Shores, FL 33138 -0000
Phone: (305)795 -2204 Fax: (305)756 -8972
Folio Number:1132060135320
Owner's Phone:
Total Square Feet: 1200
Total Job Valuation: $ 5,300.00
Planning and Zoning Criteria and Comments
Approved: Yes Date Approved: 1/6/2010 : Yes
Comments: DRIVEWAY IN SWALE IS NEW OVERLAY /LIFT AND ORIGINAL ASPHALT NOT TO BE REMOVED.
APPLICANT IS RESPONSIBLE TO MAKE SURE THAT THIS DOES NOT RESULT IN PONDING ON THE ROAD AND
WATER IS STILL ABLE TO DRAIN FROM THE ROAD TO THE SWALE.
2Q08 LOCAL.BUSINES$ TAX RECI
MIAMI DADE.COUNTY
EXPIRES
MU$T SE DISPLAYED AT P
PU RSUANT TO, COUNTY CODE c
MIAMI -DADE COUNTY
TAX COLLECTOR
140 W: FLAGLER
.1st FLOOR'
MIAMI 'FL 331
OWNER
HERRINGTON BRADLEY CONSTR UCTION;
Sec T of Business
1 ' °SPECIAL ENGINCIEI ;NO ;' CON
THIS IS ONLY. * LOCAL
BUSINESS TAX RECEIPT, IT
00E9 NOT yERMIT THE
HOLDER - TOVIOLATE ANY
EXISTING REGULATORY'OR
ZONING LAWS OF THE
COUNT OR CITIES. NOR
.': DOES I T EXEMPT THE
HOLDER FROM ANY OTHER
PERMIT OR ; LICENSE
REOUIRED BY LAW. THIS Is
NOT A = CERTIFICATION OF
THE HOLDER'S OUAUFICA•
TIONa.'
PAYMENTRECEIYED .
+ MUUdIAADE COUNTY - TAX
COLLECT o/2
` -09/08358
/2009
t 60030 00007000-.
5,,00
S OTHER SIDE
DO NOT FORWARD
HERRINGTON BRADLEY CONSTRUCTION
CLARENCE L HERRINGTON
5190 NW 167 ST 102
MIAMI GARDENS FL 33014
1111 1111))1) 1111 1111) 1i11i1111111111)111))1i)111i10 11111
` FIRST -CLAS
U.S. POSTAGE
PAID
MIAMI, FL
RMIT NO.. 231
N: TRUCT
NSTR7CON
CO NTRACT
37827
(MESS NAME! LOCATION `.;
, HERRINGTON BRAAL,
CONTRACTING -INC
-5190 1'NW 167 ST
33014 UNI .
. ER
HERRINGTON B
Two of Businese
196 GENERAL
<TNIB } IS' ONLY A ;LOCAL
;BUSINESS 'TAX RECEIPT. IT
DOES: NOT:; PERMIT ;THE
HOLDER> TO VIOLATE ANY
EXISTING REGULATORY OR
''ZONING LAWS " OF THE.
COUNTY:: OR C.MEB.' NOR
DOES IT EXEMPT THE:
HOLDER.PROMANY OTHER
, PERMIT " OR..., UCENSE
,REOUIRED BYLAW. THIS IS
NOT A CERTIFICATION OF
THE HOLDERS _ QUAUFlCA-
634206 -7
BUSINESS NAME 1 LOCATIO .-
HERRINGTON`'=BRADL
CONSTRUCTION -INC
5190,' NW ST
33014 UNIN DAD
ER
ERRINGTONBRA
c. Type of Business
,_,2 SPEC_ MECHANI
THIS IS'- 'ONLY -- A LOCAL
BUSINESS TAX RECEIPT. IT
DOES NOT PERMIT r- THE
= =, -'"
HOLDER TO.VIOLATE ANY
EXISTING REGULATORY OR
ZONING LAWS. OF THE
COUNTY' OR CITIES. NOR -:.-
DOES -' IT - EXEMPT THE
HOLDER FROM ANY OTHER
PERMIT -- -OR' UCENSE
REOUIIED BY LAW. THIS IS
NOT A CERTIFICATION OF
THE HOLDERS GUAUFlCA-
TIONS.
.PAYMENT - RECEIVED::
MIAMI -DADE COUNTY TAX,
COLLECTOR: ,p
09/08/2009
:'60030000357
000075r. 0 0
SEE OTHER SIDE
DO NOT FORWARD
HERRINGTON BRADLEY CONSTRUCTION
CONTRACTING INC
CLARENCE L HERRINGTON PRES
5190 NW 167 ST STE 102
MIAMI GARDENS FL 33014
111111111 11111 111 11111111)1111111111111i)1111 11{II�I III
Isis NOT A
MIAMI- DADE'COU
TAX COLLECTOR
140 W. FLAGL ST;
1st FLOOR
MIAMI, FL 33130
LOCAL`BUSINESS.TAX RECEIPT
A WADE COUNTY` STATE OF FL.O
EXPIRES SEPL 30,`2010
RU -BE DISPLAYED AT PLACE OF BUSIN
IRSUANT TO COUNTY CODE, CHAPTER,
DO NOT FORWARD
HERRINGTON BRADLEY
CONSTRUCTION INC
CLARENCE L HERRINGTON
5190 NW 167 ST 102
MIAMI GARDENS FL 33014
18 II)111i)1111)181 11111 1111111111)1111)Ilii11111111111 1h
AC#
AC# •
BATCH NUMBER
The GENERAL CONT
Named below IS C
Under the provis
Expiration date:
CHARLIE CRIST
GOVERNOR
70
BATCH NUMBER
CHARLIE CRIST
GOVERNOR
AC# 3876385
DATE • BATCH NUMBER
07/26/2008
088015294
CHARLIE CRIST
GOVERNOR
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
CONSTRUCTION INDUSTRY LICENSING BOARD SEQ# L08072600387
LICENSE NBR
0880152 GCO58412
TOR
RTIFI D
ons Of Chapter
31, 2010
HERRINGTON, CLARENCE L
HERRINGTON BRADLEY CONSTRUCTION CONTRACTING INC
111 NW 183RD ST STE 108A
MIAMI FL 33169
LICENSE NBR
07/26/2008 088015294. CUCO56860
LICENSE -NBR
The UNDERGROUND UTILITY & EXCAVATION CO
Named below IS CERTIFIED
Under the provisions of Chapter 489 FS.
Expiration date: AUG 31, 2010
STATE OF FLORIDA
DISPLAY AS REQUIRED BY LAW
STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
CONSTRUCTION INDUSTRY LICENSING BOARD SEQ# L08072600494
HERRINGTON, CLARENCE L
HERRINGTON BRADLEY CONSTRUCTION CONTRACTING INC
111 NW 183RD ST STE 108A
MIAMI FL 33169
DISPLAY AS REQUIRED BY LAW
STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
CONSTRUCTION INDUSTRY LICENSING BOARD SEQ# L08072600509
PCCO5677 `
The POLLUTANT STORAGE SYSTEMS CONTRACTOR
Named below IS CERTIFIED
Under the provisions of Chapter 489 FS.
Expiration date: AUG 31, 2010
HERRINGTON, CLARENCE L
HERRINGTON BRADLEY CONSTRUCTION CONTRACTING INC
111 NW 183RD ST STE 108A
MIAMI FL 33169
DISPLAY AS REQUIRED BY LAW
CHUCK DRAGO
INTERIM SECRETARY
CHUCK DRAGO
INTERIM SECRETARY
CHUCK DRAGO
INTERIM SECRETARY
EFFECTIVE DATE:
PERSON:
HERRINGTON
FEIN: 650728542
BUSINESS NAME AND ADDRESS:
HERRINGTON BRADLEY CONSTRUCTION INC
5190 NW 167TH ST 102
MIAMI LAKES FL 33014
DWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 09 -06
OWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 09 -06
SCOPES OF BUSINESS OR TRADE:
1- UNDERGROUND UTILITIES 2- CERTIFIED GENERAL CONTRACTOR
07/08/2009 EXPIRATION DATE: 7/08/2011
06 -01 -2009
/
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.
CLARENCE \ L
IMPORTANT: Pursuant to Chapter 440 . 05(14), F.S., an officer of a corporation who elects exemption from this chapter by filing a certificate of election under this
section may not recover benefits or compensation under this chapter. Pursuant to Chapter 440.05(12), F.S., Certificates of election to be exempt... apply only within the
scope of the business or trade listed on the notice of election to be exempt. Pursuant to Chapter 440.05(13), F.S., Notices of election to be exempt and certificates of
election to be exempt shall be subject to revocation if, at any time alter the 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 any time for failure of the person
named on the certificate to meet the requirements of this section.
QUESTIONS? (850) 413 -1609
PLEASE CUT OUT THE CARD BELOW AND RETAIN FOR FUTURE REFERENCE
*
STATE OF FLORIDA
DEPARTMENT OF FINANCIAL SERVICES
DIVISION OF WORKERS' COMPENSATION
CONSTRUCTION INDUSTRY
CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA
WORKERS' COMPENSATION LAW
EFFECTIVE 07/08/2009 EXPIRATION DATE: 07/08/2011
PERSON: CLARENCE L HERRINGTON
FEIN: 650728542
BUSINESS NAME AND ADDRESS:
HERRINGTON BRADLEY CONSTRUCTION INC
5190 NW 167TH ST 102
MIAMI LAKES, FL 33014
SCOPE OF BUSINESS OR TRADE
1- UNDERGROUND UTILITIES 2- CERTIFIED GENERAL CONTRACTOR
IMPORTANT
Pursuant to Chapter 440.05(14), F.S., an officer of a corporation who
elects exemption from this chapter by filing a certificate of election
L under this section may not recover benefits or compensation under this
D chapter.
H Pursuant to Chapter 440.05(12), F.S., Certificates of election to be
exempt.. apply only within the scope of the business or trade listed on
E the notice of election to be exempt
R
E Pursuant to Chapter 440.05(13), F.S., Notices of election to be exempt
and certificates of election to be exempt shall be subject to revocation
if, at any time after the 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 any time for failure of the
person named on the certificate to meet the requirements of this
section.
QUESTIONS? (850) 413 -1609
CUT HERE
* Carry bottom portion on the job, keep upper portion for your records.
VGR III IG nvGVGla
Y IN $UKANUt 01/ 11)
0
—•••-----•--•-
TM
PRODUCER
ALL CITY INSURANCE INC - ACI
PO BOX522484
MIAMI FL 33152
(305) 463 - 9431
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
THE ISSUING INSURER WILL ENDEAVOR TO MAIL 0 DAYS WRITTEN
VILLAGE OF MIAMI SHORES
NAIC #
INSURED
DATE THEREOF,
SO SHALL
BUILDING DEPARTMENT
23418
INSURER a
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO
10050 NE 2ND AVENUE
10/09/2
INSURER Cr.
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER ITS AGENTS OR
MIAMI SHORES
FL
33138 -
REPRESENTATIVES.
DAMAGE TO RENTED
PRFMISFS /Pa ncruranr a)
$
100,000
AUTHORIZED REPRESENTATIVE ,k .4 %
L.
MED EXP (Anv one person)
$
$
$
. ... ••• A rlr.0 4 nee
AVM') CERTIFICATE CAF LIABILI
Y IN $UKANUt 01/ 11)
0
OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED
TERM OR CONDITION OF ANY CONTRACT OR OTHER
THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN
AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
TM
PRODUCER
ALL CITY INSURANCE INC - ACI
PO BOX522484
MIAMI FL 33152
(305) 463 - 9431
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
NAIC #
INSURED
HERRINGTON BRADLEY CONSTRUCTION CONTRACTING INC
5190 NW 167TH STREET
SUITE 102
HIALEAH FL 33014-
I
INSURER A MID - CONTINENT CASUALTY COMPANY
23418
INSURER a
04GL771092
INSURER 0:
10/09/2
INSURER Cr.
EACH OCCURRENCE $
INSURER E
THE
ANY
MAY
POLICIES.
INSR ADD'L
I TR
POLICIES
REQUIREMENT,
PERTAIN,
NQRn
OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED
TERM OR CONDITION OF ANY CONTRACT OR OTHER
THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN
AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
NAMED ABOVE
DOCUMENT WITH
IS SUBJECT
POLICY EFFECTIVE
naTF (mmtnntVV)
FOR THE POLICY
RESPECT TO WHICH
TO ALL THE TERMS.
UCY PI TION
naTF (M
PERIOD INDICATED. NOTWITHSTANDING
THIS CERTIFICATE MAY BE ISSUED OR
EXCLUSIONS AND CONDITIONS OF SUCH
TV= nF lug! IRANrF
--
POLICY NUMBER
LIMITS
A
GENERAL
LIABILITY
COMMERCIAL GENERAL LIABILITY
04GL771092
10/09/2009
10/09/2
0 ,
EACH OCCURRENCE $
300,000
X
DAMAGE TO RENTED
PRFMISFS /Pa ncruranr a)
$
100,000
CLAIMS MADE X OCCUR I
MED EXP (Anv one person)
$
$
$
EXCLUDED
300,000
300,000
PERSONAL & ACV INJURY
GENERAL AGGREGATE
GEN 'L
X
AGGREGATE LIMIT APPL PER:
PRO. i L OC
POLICY
PRODUCTS - COMPIOP AGG
$
300,000
AUTOMOBILE
.1
LIABILTY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON -OWNED AUTOS
COMBINED SINGLE LIMIT
(Ea accident)
BODILY INJUPY
(Per person)
BOXY INJURY
Per accident)
PROPERTY DAMAGE
(Per accident)
GARAGE
LIABILITY
ANY AUTO
AUTO ONLY - EA ACCIDENT
$
EA ACC
$
OTHER THAN
AUTO ONLY: AGG
$
EXCESS/UMBRELLA LIABILITY
EACH OCCURRENCE
_
OCCUR 1 CLAIMS MADE
AGGREGATE
$
E
$
$
---
$
RETENTION $
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
ANY PROPRIETORIPARTNEREXECUTI'VE
OFFICERIMEMBER EXQA$DED?
If res, describe under
SPECIAL PROVI5IGNS below
Q S LIMI T- 1 ER
TQRV LIMITS I ER
E.L. EACH ACODENT
E.L. DISEASE • EA EMPLOYEE
$
E.L. DISEASE- POLICY LIMIT
$
OTHER
DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES 1 EXCLUSIONS ADDED BY ENDORSEMENT 1 SPECIAL PROVISIONS
GENERAL CONTRACTOR
Al flfl/l4 4
COVERAGES
ACORD 25 (2001108)