The URL can be used to link to this page

PAINTOwner's Address Pe S o RI CG PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Date 5/20/98 Job Address 60 N. E. 102 Street Tax Folio Legal Description Historically Designated: Yes No Owner/Lessee /Tenant Spence Rudneck Master Permit # 60 N.E. 102 Street Phone 754 - 4291 Contracting Co. Frank Bruegger Painting Inc. Address 730 N.E. 76 Street Qualifier Frank Brueqqer Phone 754-1577 State # Municipal # 30-0229997 Competency #000011486 Ins Co. A Phoen Architect/Engineer Address Bonding Company Address Mortgagor Address AIDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN Exterior Painting � c''i 1 YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO SO MAY TWICE FOR IMPROVEMENTS TO YOUR PROPERTY (IF YOU INTEND TO OBTAIN FINANCING, 'sNDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.) lv0 App ) obtain a permit to do work and installation as indicated above, and on the attached addendum (if applicable). I cert (i 1 ;rformed to meet the standards of all laws regulating construction in this jurisdiction. I understand that separate pen. __ _ _ _.._ : RICAL, 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. Si ature of owner and/or Condo President ondo President No ary as to Owne My Commission Expires: OF1 CIAL NOTARY SEAL 11iuZr:1F.T ERUEGG NSA::'_ 17,1.1C C 7.'ATI107 FLORIDA NO. CC37T912. r;;; 7 °;; . AUG. 31; FEES: PERMIT RADON Date Date F C.C.F. 1i 81J Estimated Cost (value) $2,498.00 ature of Contra otary as to Co My Commission NOTARY APPROVED: Zoning Buildin Mechanical Plumbing x. es: OFFICIAL NOTARY SEAL HARRIET PRUEGGE' NOTAP PUBLIC STATE OF FLORIDA COMMi:'S1ON NO. CC575942 MY COMMISSION EXP. AUG. 312000 Electrical Owner- Builder TOTAL DUE of Miami Date Date Engineering INTERIOR/ EXTERIOR LICENSED DADE BROWARD PALM BEACH gr arth l . JY rue33er PAINTING AND DECORATING, INC. WALL COVERINGS TEL 754 -1577 FAX 305; 758 -8033 730 N.E. 76 STREET MIAMI, FLORIDA 33138 • DADE COUNTY TAX COLLECT 140 W. FLAGLER ST. 14th FLOOR MIAMI, FL 33130 022999 -7 BUSINESS NAME / LOCATION BRUEGGER FRANK W PAINTING E DECORATING INC 33138 MIAMI ST OWNER W PAINTING E BRUEGGER FRANKBUI`DING Sec. Type of Business ,HIS S 196 IALTY PE PERMIT UCEN ETO VIOLATE ANY REGULATORY OR ZONING LAWS OF NOR COUNTY OR EXEMPT THE LICENSEE FROM ANY OTHER UCENSE LAW. PERMIT HIS IS NOT A CERTI- FICATION O THE LICENSEES OUALIRCM TON. PAYMENT RECEIVED DADE COLLECTOR: COUNTY TAX 2100003 000037. SEE OTHER SIDE DADE COUNTY TAX COLLECTOR 140 W. FLAGLER ST. 14th FLOOR MIAMI, FL 33130 Licensee must register in the city where work is to be done. PAYMENT RECD. DADE CNTY TAX COLLECTOR: 08/19/ 000 199 OCCUPATIONAL LICENSE TAX 1998 DADE COUNTY - STATE OF FLORIDA EXPIRES SEPT. 30, 1998 DISPLAYED AT PLACE OF BUSINESS MUST BE COUNTY CODE CHAPTER 8A - ART. 9 & 10 PURSUANT WORKERS DO NOT FORWARD BRUEGGER FRANK W PAINTING E. DECORATING INC 730 NE 76 ST MIAMI FL 33138 1997 MUNICIPAL CONTRACTOR'S 1998 OCCUPATIONAL LICENSE DADE COUNTY - STATE OF FLORIDA PURSUANT EXPIRES DAD COUNTY Y O 1 DINANCE 66 -2 CC N0: 000011486 30 -0 229997 IS HEREBY LICENSED TO DO BUSINESS NO. BUSINESS g SPECIFIED CONTRACTOR BUSINESS NAME / LOCATION PAINTING r; BRUEGGER FRANK W DECORATING INC 730 NE 76 ST OWNER .BRUEGGER FRANK W PAINTING & SPECIALTY BUILDING HIALEAH>' NOT VALID PINECREST C VILLAGE VILLAGc K FY BISCAYNE DO NOT FORWARD BRUEGGER. FRANK W PAINTING E DECORATING INC 730 NE 76 ST MIAMI FL 3313 FIRST-CLASS U.S. POSTAGE PAID MIAMI, FL PERMIT NO. 2 RENEWAL 22999 — LICENSE NO. C C 41 000011486 FIRST -CLASS U.S. POSTAGE ; PAID MIAMI, FL PERMIT NO. 231 • t. Metropolitan Dade County, Miami, Florida DEPARTMENT OF PLANNING, DEVELOPMENT AND REGULATION CERTIFICATE OF COMPETENCY EXPIRES ON 09/30/99 FRANK W BRUEGGER PAINTING C CC# : 000011486 Q.A. : BRUEGGER FRANK W JR SS# : 361 -30 -4439 This certificate does not permit bearer to contract • W , W; -J I 0 LL Qualifying agent (Q.A.) must supervise. direct and control all work. • Metropolitan Dade County, Miami, Florida DEPARTMENT OF PLANNING/ DEVELOPMENT AND REGULATION CERTIFICATE OF ELIGIBILITY EXPIRES ON 09/30/99 W BRUEGGER FRANK W JR =' c SS# : 361 -30 -4439 0 LL BUILDING SPECIALTY CONTRACTOR TRADE CATEGORY(S) PAINTNG & WATERP Signature of Quali � g nt GUILLERMO E. OLMEDILLO Secretary. Construction Trades OuaNying Board PERSONAL BUILDING SPECIA TRADE CATEGORY(S) PAINTNG & WATER g. Signature of Qualifying GUILLERMO E. OLMEDILLO Secretary. Corutruc ion Trades Ouabtying Board PLACE PHOTO HERE k PARTMENT 0'0 - �� LATION - 111 �� ' 8��K� �� • - ` _ ~~^�~ 10TH FLOOR, SUITE 1010 CONTRACTORS CERTIFICATE OF COMPETENCY - BUSINESS ISSUED AUGUST 13, 1997 THIS ISTO CERTIFY THAT FRANK N BRUEGER PAINTING & DECORATING INC +L/:A+' - _-__ C.C.N. 00001148S TRACE BUlLDINI: HAVING MET THE CODE REQUIREMENTS OF ��" J�3E COUNTY AS AMENDED IS CERTIFIED AS A COMTACT�R IN 7 � �[ O_LD�I*3 TRACE- ` � 36 PAIN|NG & WATERFRFG WITH ALL WOr TO 6t?. DONE UND[C THL CIRDLT SU/`i:kVISIUN AND CON OF OU4LlFY3NG A[ENT bRUEGCER FRANK W JR S 361-30-4439 FRANK W 8RUEGSER PAINTING & DECORAT TH[5 CEF:.TIFICATE IS VALID UNTIL 730 NE 76 ST SEPTEMBER 30 1999 MIAMI FL 33138 BY AUTHORIZATION OF �ECREr4RY, CONST TRADES QUAL BOARD ALTERATION, REPRODUCTION [R TRANSFER OF CETIFICATE IS PROHI8ITE[ FFF F [ lR _ I � w £l 2 PRIrEJIATF, WAS PPTID_ON PROCESS NC' 797172725 39 8323 001 081397 000024000 ' . ��r�' METROCADE PARTMENT^o~ �� .`-," � °.^'", 111 NW 1ST STREET MIAMI, FL 33128 10TH FLOOR, SUITE 1010 TRADESMAN PERSONAL CERTIFICATE OF ELIGIBILITY ISSUED AUGUST 13, 1997 THIS IS TO CERTIFY THAT BRUEGGERFRANK W JR S.S.N. 361 TRADE BUILDING HAVING MET THE REQUIREMENTS OF ME DADE COUNTY, IS HEREBY CERTIFIED AS ELIGIBLE IN THE FOLLOWING TRADE CATEGORY(S) 36 PAINTNG & WATERPRFG RRUEGCER FRANK W JR 730 NE 76 ST MIAMI THIS CERTIFICATE DOES NOT PERMIT BEARER TO CONTRACT THIS CERTIFICATE IS VALID UNTIL SE;'rEMBER 30, 1999 FL 33138 BY AUTHORIZATION OF SECRETARY, CONST TRADES QUAL BOARD ALTERATION, REPRODUCTION- OR TRANSFER UF THIS CERTIFICATE IS PROHIBITED FEE FOR THIS CERTIFICATE WAS PAID ON PROCESS NO. T97172725 010 02 05971727250 000024000 ACORD. lg PRODUCER American Phoenix of Miami 2301 S.W. 27 Avenue P 0 Box 450549 Miami, FL 33245 INSURED Frank W. Bruegger Painting and Decorating, Inc 730 N E 76 Street Miami, FL 33138 COVERAGES FOR THE POUCY PERIOD THIS IS TO CERTIFY INDICATED, NOTWITHSTANDING ANY EOUIEE M TERM OR CONDITION OF HAVE ISSUED CO INSURED ANY NTRACT OR OTHERDOCUMENT WI H 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. CO LTR A A TYPE OF INSURANCE GENERAL LIABILITY X C OMMERCIAL GENERAL LIABILITY CLAIMS MADE 'XI OCCUR OWNER'S & CONTRACTORS PROT X PD Ded:1,000 AUTOMOBILE LIABILITY X ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS GARAGE LIABILITY ANY AUTO EXCESS LIABILITY UMBRELLA FORM OTHER THAN UMBRELLA FORM WORKERS COMPENSATION AND EMPLOYERS LIABILITY THE PROPRIETOR/ PARTNERS/EXECUTIVE OFFICERS ARE: INCL EXCL OTHER POLICY NUMBER CFP23245534 CFP23245534 CERTIFICATE HOLDER City of Miami Shores Bldg. & Zoning - Atten: Josephine 10050 N.E. 2 Avenue Miami Shores, FL 33138 ACORD2S•S(3/93)1 011 #S12903/M12898 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. COMPANIES AFFORDING COVERAGE COMPANY Casualty Company COMPANY B COMPANY c . COMPANY D POLICY EFFECTIVE DATE (MM /DD/YY) 08/01/97 08/01/97 POLICY EXPIRATION DATE (MM /DD/YY) 08/01/98 08/01/98 AUTHORIZED REPRESENTATIVE LIMITS GENERAL AGGREGATE PRODUCTS - COMP /OP AGO PERSONAL & ADV INJURY EACH OCCURRENCE FIRE DAMAGE (Any one 1tre) MED EXP (Any one person) COMBINED SINGLE LIMIT BODILY INJURY (Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE AUTO ONLY -EA ACCIDENT OTHER THAN AUTO ONLY: EACH ACCIDENT AGGREGATE EACH OCCURRENCE AGGREGATE STATUTORY LIMITS EACH ACCIDENT DISEASE - POLICY LIMIT DISEASE -EACH EMPLOYEE DATE (M M/ D D/YY) 07/15/97 :600, 000 :600, :300,000 :300, :50,000 $5,000 :300,000 : : $ : : $ : : : $ DESCRIPTION OF OPERATIONS /LOCATIONS /VEHICLES /SPECIAL ITEMS CANCELLATION SHOULD ANY OF 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 MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. DMC O ACORD CORPORATION 1993 DATE (MM /DD /YY) 'MOOD. CERTIFICATE OF INSURANCE ; 07/15/97 PRODUCER American Phoenix of Miami 2301 S . W . 2 7 Avenue P 0 Box 450549 Miami, FL 33245 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. COMPANIES AFFORDING COVERAGE COMPANY AMaryland Casualty Company INSURED Frank W. Bruegger Painting and Decorating, Inc 730 N E 76 Street Miami, FL 33138 I COMPANY B COMPANY C COMPANY D COVERAGES 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. CO LTR TYPE OF INSURANCE POLICY NUMBER PO UCY EFFECTIVE DATE(MM /DD/YY) PO UCY EXPIRATION DATE(MM /DD/YY) LIMITS A GENERAL LIABILITY CFP23245534 08/01/97 08/01/98 GENERAL AGGREGATE 5600 000 X COMMERCIAL GENERAL LIABILITY PRODUCTS- COMP /OP AGO :600 000 CLAIMS MADE X OCCUR PERSONAL & ADV INJURY 000 000 X OWNER'S a CONTRACTOR'S PROT PD Ded : 1,000 EACH OCCURRENCE 3300,000 FIRE DAMAGE (Any one fire) $50,000 ME D EXP (Any one person) :5,000 $300, 000 A AUTOMOBILE X — LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULE 0 AUTOS HIRED AUTOS NON -OWNED AUTOS CFP23245534 08/01/97 08/01/98 COMBINED SINGLE LIMIT BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ GARAGE LIABILITY AUTO ONLY -EA ACCIDENT $ ANY AUTO OTHER THAN AUTO ONLY: EACH ACCIDENT $ AGGREGATE $ EXCESS LIABILITY EACH OCCURRENCE $ UMBRELLA FORM OTHER THAN UMBRELLA FORM AGGREGATE $ $ WORKERS COMPENSATION AND EMPLOYERS LIABILITY STATUTORY LIMITS EACH ACCIDENT i THE PROPRIETOR/ PARTNERS /EXECUTIVE OFFICERS ARE: — INCL EXCL DISEASE - POLICY LIMIT $ DISEASE -EACH EMPLOYEE $ OTHER DESCRIPTION OF OPERATIONS /LOCATIONS/VEHICLES /SPECIAL ITEMS CERTIFICATE HOLDER "'CANCELLATION Village of Miami Shores Attn: Building & Zoning 10050 N. E. 2 Avenue Miami, FL 33138 1CORD25- S(3/93)1 01 1 #S12922/M12898 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 1 Q DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE DMC o ACORDCORPORATION1993 A4101t11. CERTIFICATE PRODUCER American Phoenix of Miami 2301 S.W. 27 Avenue P 0 Box 450549 Miami, FL 33245 INSURED Frank W. Bruegger Painting and Decorating, Inc. 730 N E 76 Street Miami, FL 33138 GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY) CLAIMS MADE 7 OCCUR' OWNERS & CONTRACTOR'S PROT AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS _ SCHEDULED AUTOS HIRED AUTOS _ NON -OWNED AUTOS GARAGE LIABILITY ANY AUTO EXCESS LIABILITY UMBRELLA FORM OTHER THAN UMBRELLA FORM A WORKERS COMPENSATION AND 00 1WC9 7A0 7 0 6 0 EMPLOYERS' LIABIUTY THE PROPRIETOR/ PARTNERS /EXECUTIVE OFFICERS ARE: OTHER CERTIFICATE HOLDER INCL EXCL DESCRIPTION OF OPERATIONS /LOCATIONS /VEHICLES /SPECIAL ITEMS City of Miami Shores Bldg. & Zoning- Atten: Josephine 10050 N.E. 2 Avenue Miami Shores, FL 33138 ACORD25- S(319311 Of 1 #S15680/M156 DATE (MM /DD/YY) 01/19/98 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. COMPANIES AFFORDING COVERAGE COMPANY AFCCI COMPANY B COMPANY C COMPANY D COVERAGES FOR THE POUCY PED THIS IS TO CERTIFY THAT THE INDICATED, NOTWITHSTANDING ANYOREQUIREMENT, TERM LISTED OR CONDITION OF ANY E CONTRACT OR OTHER DOCUMENT WITHH TO WHICH RIO CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POUCIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. UMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. POLICY NUMBER 'POLICY EFFECTIVE POLICY EXPIRATION' T ' TYPE OF INSURANCE ' DATE (MM /DD /YY) DATE (MMIDD /YY) LTRI AUTHORIZED REPRESENTATIVE ' AGGREGATE Is I PRODUCTS - COMP /OP AGG I $ PERSONAL 8 ADV INJURY IS EACH OCCURRENCE IS FIRE DAMAGE (Any one lire)'S MED EXP (Any one person) !S I COMBINED SINGLE LIMIT S BODILY INJURY (Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE !AUTO ONLY -EA ACCIDENT S OTHER THAN AUTO ONLY: EACH OCCURRENCE .AGGREGATE 01 /01 /98101 / 01 / 99 I X STATUTORY LIMITS EACH ACCIDENT LIMITS 3 EACH ACCIDENT .3 AGGREGATE S S S $100,000 DISEASE- POLICY LIMIT 5 0 0, 0 0 0 DISEASE -EACH EMPLOYEE .S1 0 0 , 000 CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL (0 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. _ LEA 0 ACORD CORPORATION 199 A4:011111. It11. CERTIFIGATE OF INSURANCE PRODUCER American Phoenix of Miami 2301 S . W . 27 Avenue P 0 Box 450549 Miami, FL 33245 DATE (MM /DD/YY) 01/19/98 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. COMPANIES AFFORDING COVERAGE COMPANY AFCCI INSURED Frank W. Bruegger Painting and Decorating, Inc. 730 N E 76 Street Miami, FL 33138 I COMPANY B COMPANY c COMPANY D COVERAGES THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. I ■ POLICY EFFECTIVE TYPE OF INSURANCE POLICY NUMBER i DATE (MM /DD/YY) L T O R POLICY EXPIRATION D/YY DATE (MWO) LIMITS GENERAL LIABILITY 1-– GENERAL AGGREGATE IS PRODUCTS- COMP /OP AGGIS I COMMERCIAL GENERAL LIABILITY( — 1 1 ,CLAIMS MADE'_; OCCUR' PERSONAL 8 ADV INJURY S OWNER'S & CONTRACTOR'S PROT, ' EACH OCCURRENCE IS FIRE DAMAGE (Any one fire)($ MED (Any one person) IS AUTOMOBILE LIABILITY I COMBINED SINGLE LIMIT IS — _ ANY AUTO ALL OWNED AUTOS BODILY INJURY � (Per person) _ SCHEDULED AUTOS HIRED AUTOS BODILY INJURY S , (Per accident) — NON -OWNED AUTOS PROPERTY DAMAGE IS • GARAGE LIABILITY I ! AUTO ONLY -EA ACCIDENT IS . OTHER THAN AUTO ONLY: ANY AUTO EACH ACCIDENT IS AGGREGATE S . EXCESS LIABILITY j j , EACH OCCURRENCE : S UMBRELLA FORM : AGGREGATE I S OTHER THAN UMBRELLA FORM I S A i WORKERS COMPENSATION AND 001WC97A07060 I EMPLOYERS' LIABILITY 01/01/98 101/01/99 I x , STATUTORY LIMITS EACH ACCIDENT 510 0, 0 0 0 THE PROPRIETOR/ INCL I DISEASE - POLICY LIMIT 1500,000 PARTNERS /EXECUTIVE — OFFICERS ARE: EXCL ' DISEASE - EACH EMPLOYEE I S1 0 0 , 0 0 0 OTHER DESCRIPTION OF OPERATIONS /LOCATIONS /VEHICLES /SPECIAL ITEMS CERTIFICATE HOLDER Village of Miami Shores Attn: Building & Zoning 10050 N . E. 2 Avenue Miami, FL 33138 ACORD 25 -S (3/93)1 01 1 #S15701/M15673 CANCELLATION SHOULD ANY OF EXPIRATION DATE 3 0 DAYS WRITTEN THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT. MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. BUT FAILURE TO OF ANY KIND AUTHORIZED REPRESENTATIVE LEA 0 ACORD CORPORATION 1993 PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Date /- A / �5 Job Address 0 if) /,_ / o Z - t Tax Folio Legal Description � / / Historically Designated: Yes No + 7 Q Owner/Lessee / Tenant ex, c se f- / C" `mil d 'v l' Gk Master Permit # 11 Z 3 7 Owner's Address r' 0 4) r /0 Z S r Phone '7S - 4'- 9/ Contracting Co. C b 4, ,a Woo f Co, e Address /6 / G ti / 7 ' S Qualifier e Q% /tie e (e)e ('. Phone Q c/ ? r'6 6 v State # Municipal # D 3 1 Z - Competency # (/ 3 S — v Ins. Co. 6 Architect/Engineer Address Bonding Company Address Mortgagor Address Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN WORK DESCRIPTION CZ e 4, P' ti7 w 1 i f� ` L - 'e (2 o 0 7 w A De- Square Ft. Estimated Cost (value) 6 t O . — 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 regal; g constructio d zoning. Furthermore, I authorize the above -named contractor to do the work stated. er and/or Condo Preside i t Sign: e of owner and/or Condo President L L . . /.■ // • Notary as to My Co OTARY SEAL ARLENE WEAVERLING NOTARY PUBLIC STATE OF FLORIDA COMMISSION NO. CC390429 MY COMMISSION EXP. SEFT 20,1998 RADON L Date /f Date it APPROVED: Zoning Building Mechanical Plumbing Signature of Contractor or Owner - Builde ,ep 4 ,44, 1 d Notary as to Contractor or Owner - Builder My l omcirk'dCYP SEAL ARLENE WEAVERLING NOTARY PUBLIC STATE OF FLORIDA COMMISSION NO. CC390429 MY COMMISSION EXP. SEPT 20,1998 • �, z7 — %f Date Date Engineering Date Job Address d / Sr Tax Folio // ®,6 /3 /4/3 Legal Description /( Lt Owner / e / Tenant // A $ Sep' /4* Master Permit # 3 Owner's Address Contracting Co.(6 Qualifier pre �C e �Z/� - l�rJ t'/ZA- # 95i7 ?60 2--- State # Architect /Engineer Address Bonding Company Address Mortgagor Address Permit Type(circle one): WORK DESCRIPTION J Ca6 ( /Leer( 16- Square Ft. 3 7/ 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 be done authori Signa ure of owne Condo President esident Dat Apr Notary as to Owner " Cof i tms Amt LESLIE K. BUGGERT My Commission Expires Feb. 29, 1996 My Commission ExP . .,�L,' • • FEES: PERMIT APPROVED: PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Municipal # 4,23 /60-3 Competency # // 3,5� Ins.Co. 115 r AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will in compliance with all applicable laws regulating construction and zonin_. Furthermore, I e the abovjnamed contractor to do the work st= ed. �LG 4 C ** * * * .. Corm No *CC 176179 �i / �/� Phone F ( ��7 Address �t/ me _ (? S T BUILDING ELECTRICAL PLUMBING MECHANICAL ROOPING PAVING FENCE SIGN S ee C�� RADON C.C.F. Fire Zoning Buildin Mechanical Estimated Cost(value) L9 ®e5? Notary as to My Commissio* * * * * * + mo d+ ' * C•:mm *No. CC k76579 ** Signature o Date: NOTARY Plumbing er or obF1RE - /der LESLIE K. BUGGERT S My Commission Expires Feb. 29, 1996 TOTAL DUE Other Electrical Engineering