RC-11-16Inspection Number: INSP - 154638
Scheduled Inspection Date: February 28, 2011
Inspector: Bruhn, Norman
Owner: BORDOWSKI, MARCELO
Job Address: 9418 N MIAMI Avenue
Miami Shores, FL 33150-
Project: <NONE>
Contractor: WEINTRAUB CONSTRUCTION CO INC
Building Department Comments
REMOVE & REPLACE KITCHEN CABINETS. ALL
APPLIANCES AND SINK TO REMAIN IN THEIR EXISTING
LOCATIONS.
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
February 28, 2011
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
For Inspections please call: (305)762 -4949
Permit Number: RC- 1 -11 -16
Permit Type: Residential Construction
Inspection Type: Final
Work Classification: Kitchen Cabinets
V imisowisme Phone Number
Parcel Number 1131010340020
Phone: (305)557 -9398
Page 13 of 33
NOTICE OF COMMENCEMENT
A RECORDED COPY MUST E POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION
11
PERMIT NO. WI"
X 1 11 FOLIO NO.
STATE OF FLORIDA:
STATE • - FLORIDA, COUNTY OF DADE
COUNTY OF MIAMI -DADE: I HEREBY
vrlgfnal Ned
THE UNDERSIGNED hereby gives notice that improvements will be made to certain real
property, and in accordance with Chapter 713, Florida Statutes, the following info
is provided in this Notice of Commencement.
Space above reserved for use of recording office
1. Legal description of property and street/address: 944 1'€S 14 tA tArh lVe e - , Yt+tstt1 fit_ 33 (S
2. Description of improvement: Kt�ca eoti�Fn 04s —t-
3. Owner(s) name and address: AAM urkees `N'
Interest in property:
Name and address of fee simple titleholder:
4. Contractor's name, address and phone number. LJE.ey-t t rL4i...10- 'rt 35::.5 -.S °i f`i't' ->
2ca�oo 1-tE. 3oA•►,duse.- 11vE.,s..5?-a ' l>� _
5. Surety: (Payment bond required by owner from contractor, if any)
Name, address and phone number
Amount of bond $
6. Lender's name and address: A/A
7. Persons within the State of Florida designated by Owner upon whom notices or other documents may be served as provided by
Section 713.13(1)(a)7., Florida Statutes,
Name, address and phone number.
8. In addition to himself, Owners designates the following person(s) to receive a copy of the Lienor's Notice as provided in Section
713.13(1)(b), Florida Statutes.
Name, address and phone number.
9. Expiration date of this Notice of Commencement:
(the expiration date is 1 year from the date of recording unless a different date is specified)
WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT ARE CONSIDERED
IMPROPER PAYMENTS UNDER CHAPTER 713, PART I, SECTION 713.13. FLORIDA STATUTES, AND CAN RESULT IN YOUR PAYING TWICE FOR
IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE
FIRST INSPECTION. IF YOU INTEND TO OBTAIN INANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK
OR RECORDING YOUR QTICE OF COMMENCE ENT.
Signature(s) of Owner(s) or Owner(s)' Authori Offiirector/Partner /Manager
Prepared By _ Prepared By f
Print Name No¢cap.c..-, Print Name b4 c. -35
Title/* - ce AA'1 ►+ycrCca Z - hM Title /Office Akrt irtcies 'TS L4 - 20 . 1 e #'a(a
STATE OF FLORIDA
COU OF MIA -DADE
B pntwi�tiL A wle• /• ,e
By ►w 1 L1�tHST
❑Individually, or as � a
❑ Personally known, or
enntmortrimwawir
or
Signature(s) of
By
. L_O_ day of
for
produced the following type of ident
Signature of Notary Public:
Print Name:
(SEAL)
VERIFICATION PURSUANT TO SECTION 92.525. FLORIDA STATUTES
Under penalties of perjury, I declare at I have read the foregoing and
that the facts stated in it are true, tothe best of my knowledge and belief.
BY
er(s) or Owner(s) Authorized Officer /Director /Partner /Manager who signed above:
11111 111111 11111 111111 1111 1111111 1111 1111111 1
C F N 2011 R0062108
OR Bk 27568 Ps 22736 (fps)
RECORDED 01/28/2011 10:51 :22
HARVEY RUVIFlr CLERK OF COURT
t1IAMI -DADE COUNTY, FLORIDA
LAST PAGE
RTIFY that this Is y of the
on
A D20` /
handaad Metal Seel
County Cowls
D.C.
NOTAiRY PU3UC -S aATE 0 I}I RTDA
Claudia C ubi;las
`Commission #DD717923
% ,. ` Expires: SEP 23, 2011
Do4ib 7T 1 MU= BOND1110 txk,
By
Miami Shores Village
BUILDING
PERMIT APPLICATION
FBC 20
Permit Type: BUILDING ..`
OWNER: Name (Fee Simple Titleholder): l� p .J.}. ' MENT; LL(- Phone #:
Address: Ot, E / T LT `3i8
/
State:
:
City: VE NV RL1
Tenant/Lessee Name: Phone #:
kk_kg_
Email: Lrzl Elea . GD/i
JOB ADDRESS: *118 IV • Ma/2v/ Ayr_
City: gg Miami Shores
Folio/Parcel #: l 131 !) I D 3 q01
Is the Building Historically Designated: Yes
DESIGNER: Architect/Engineer:
Value of Work for this Permit: $
Type of Work: Address ❑Alteration
Description of Work: ii
Zhird.d.____Aara72,42e__Lan rfl/u_
ouble ee
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 ... .......
Tel: (305) 795.2204 Fax: (305) 756.8972 b •
INSPECTION'S PHONE NUMBER: (305) 762.4949
6
CD
County:
Structural Review $
Building Department
� J
Permit No. , , —`. l( Q
Master Permit No.
Zip: 33/go
Miami Dade Zip:
NO Flood Zone:
CONTRACTOR: Company Name: /UT WE1 1.6 COA)/TeliaDA) Co . Phone #: '' S' ? 9398
Address: DO ,/V E ✓``� rh ,�JYE 547 3a
Cit 4)% EAJ7e//2i4 State: Zip:
Qualifier Name: A / 44 4 //t Phone #: 4 (
State Certification or Registration #: 6 ( ®3/`'3..13 Certificate of Competency #:
,
Contact Phone #: �'Si 99! /91)z Email Address: Gv4/A/7,Qn✓6 //v4 a Aoh . awn
Phone #:
Square/Linear Footage of Work:
❑New XRepair/Replace
2zI
❑Demolition
•eei' C _ J
5 AI y Kgm►,N J�
COLOR THROUGH ROOF TILE IS REQUIRED acknowledged by:
********** * ** ** ** * *** * * ** * * ** ** * * ******F ************* *** ** ** ** *** **** * ** * *** * ** *** **
Submittal Fee $ U' l.1lJ Permit Fee $ 1 'e eic-' CCF $ CO /CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $ Technology Fee $
TOTAL FEE NOW DUE $ 1 •
75144-Li142 7,0
Bonding Company's Name (if applicable)
Bonding Company's Address
City State Zip
N�Q
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) ays after the building permit is issued. In the absence of such posted notice, the
inspection will not be ap oved and a reinspectioi fee will be charged.
Signature "� Signature
ner or Agent
The foregoing instrument was acknowledged before me this 2®
day o rerAt i&7L , 20 by Msf2 tezo 1 4iZV woo s 1 ,
who is personally known to me or who has produced
As identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
rAvo
My Commission Expires:
APPROVED BY
PJLIC -STATE OF FLORIDA
Gustavo Gomez
:Commission # EE018480
•.,,,,,,,. Expires: AUG. 18, 2014
BONDED THRU ATLANTIC BONDL\G CO., INC.
(Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09)(rev6/4/10)
Plans Examiner
Structural Review
Contractor
The foregoing instrume- t was acknowledged before me this2'O
day °Oren tea- , 20 ID , by MI,LJ L 12012,
who is personally known to me or who has produced
as identification and who did take an oath.
NOTARY PUBLIC:
Sign: -
Print: 05
My Commission E
Gustavo Gomez
z Commission # EE018480
Expires: AUG. 18, 2014
BONDED THRU ATLANTIC BONDING CO.,INC.
** air * * * * * * * * * * * * * * * * * * * * * * * * * * ** ********************************************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
Zoning
Clerk
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE NSURANCE 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.
11LTSRR
TYPE OF INSURANCE
1..
INSR
sum
WVD
POLICY NUMBER
POLICY €FF
(MM/DD/YYYY)
PauEYBXP
(MMIDD/YYYY)
VAS
A
GENERAL
LIABILITY
COMMERCIAL GENERAL LIABILITY
OCCUR
BCS0023516
11/14/10
11/14/11
EACH OCCURRENCE
$ 1,000,000
X
P
$ 100,000
CLAIMS -MADE
X
MED EXP (Any one person)
$ 5,000
PERSONAL & ADV INJURY
$ 1, 000 , 000
GENERAL AGGREGATE
$ 2, 0 0 0, 0 0 0
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP /OP AGG
$ 2 , 000 , 000
1 POLICY F jEa LOC
Emp Ben.
$ 1,000,000
AUTOMOBILE
LIABILITY
ANY AUTO
ALL OW NED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON -OW NED AUTOS
COMBINED SINGLE LIMIT
(Ea accident)
$
BODILY INJURY (Per person)
$
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
per accident)
$
$
$
UMBRELLA LIAR
EXCESS LUAB
OCCUR
CLAIMS -MADE
EACH OCCURRENCE
$
AGGREGATE
$
DEDUCTIBLE
RETENTION $
$
—
$
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIV
OFFICER/MEMBER EXCLUDED?
(Mandatory In NH)
if yes, describe under
DESCRIPTION OF OPERATIONS
Y / N
N / A
WC STATU- OTH-
TORY LIMITS ER
E.L. EACH ACCIDENT
$
E.L. DISEASE - EA EMPLOYEE
$
below
E.L. DISEASE - POLICY LIMIT
$
DESCRIPTION OF OPERATIONS/ LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required)
dt OR ® CERTIFICATE OF LIABILITY INSURANCE OP ID GBG 1 DATE ( �2 7/ )
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WANED, subject to
the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
certificate holder in lieu of such endorsement(s).
PRODUCER
INSURED
BROWN & BROWN OF FLORIDA, INC.
14900 NW 79th Ct Suite #200
Miami Lakes FL 33016 -1588
Weintraub Construction Co Inc
20900 Ne 30 Ave $te 318
Aventura FL 33180
GONIAGI
NAME:
PHONE
(A/ No, Ext):
ADDRESS:
FAX
(A/C, No):
PRODUCER
CUSTOMER ID #: WEINT -1
INSURER(S) AFFORDING COVERAGE
INSURER A : *Scottsdale Insurance Company
INSURER B :
INSURER C :
INSURER D :
INSURER E :
INSURER F :
NAIC
41297
COVERAGES
CERTIFICATE HOLDER
ACORD 25 (2009/09)
CERTIFICATE NUMBER:
CANCELLATION
REVISION NUMBER:
MIAMI SHORES VILLAGE
10050 NE 2 AVENUE
MIAMI SHORES FL 33138
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
-ZOO ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
Inspection Number: INSP - 155888 Permit Number: EL- 1 -11 -17
Scheduled Inspection Date: February 23, 2011
Inspector: Devaney, Michael
Owner: BORDOWSKI, MARCELO
Job Address: 9418 N MIAMI Avenue
Miami Shores, FL 33150-
Project: <NONE>
Contractor: RELIABLE ELECTRIC CORP
Building Department Comments
ELECTRICAL WORK FOR KITCHEN REMODEL
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
CREATED AS REINSPECTION FOR INSP- 155702. Repair service and
remove all nonraintight equipment from outside the building.
S�
6 - 4 do,//
February 22, 2011
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
For Inspections please call: (305)762 -4949
Permit Type: Electrical - Residential
Inspection Type: Final
Work Classification: Alteration
Phone Number
Parcel Number 1131010340020
Phone: (305)218 -8653
Page 19 of 29
BUILDING
PERMIT APPLICATION
FBC 20
Type of Work: ❑Address
Miami Shores Village
Building Department
JOB ADDRESS: (7l8 N. 193/4 / AVE
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949 1 1l
Permit No. E.1 I 1 — n
Email: ____12 QGZez f /e4e s . 6D/77
Master Permit No. . Il a I
Permit Type: Electrical -- WOW
OWNER: Name (Fee Simple Titleholder): AA in TA,v ,�'$7;11En S LLc Phone#: '""t ' 1
Address: 20,00 gJ 711 AVE
City: A v ' �EtTTt,�2,q State: l=L Zip: 9318o
Tenant/Lessee Name: Phone #:
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel #: /13/0 /03/ ,Z
Is the Building Historically Designated: Yes NO Flood Zone:
CONTRACTOR: Company Name: f.
14 61..:c .1.' U Phone #: 3b5 — Z 8
Address: /70/ S J c q Rv.-
City: /4/ State: �L Zip: 33005
Qualifier Name: - ' - ayiial. -DO { ()� ,r1 Phone #: 5 .
State Certification or Registration #: EC 1 3t o t 7 , 6 Certificate of Competency #:
Contact Phone #: SA it F, Email Address:
DESIGNER: Architect/Engineer: Phone #:
IrD
Value of Work for this Permit: $ 076)0 I— Square/Linear Footage of Work:
❑Alteration DNew epair/Replace
Description of Work: _ � `•- 47)GEm5N7 lit /(/7/d) e-46, A.413
❑Demolition
***** ****:x*:x::u : x: x: x: **** * ***** ** *** * * ****F :** ** *** *** ** **** :***** ** * * ** x **** * * **
Submittal Fee $ �O 'CO ` Permit Fee $ /1"V'/e-P4 CCF $
Scanning Fee $ Radon Fee $ DBPR $
Notary $ Training/Education Fee $ Technology Fee $
Double Fee $ ff 0 Structural Review $
CO /CC $
Bond $
TOTAL FEE NOW DUE $ o . 1
a .
Bonding Company's Name (if applicable)
Bonding Company's Address
City State Zip
/44
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, BOIL FRS, 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 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 aiproved and a reinspect n fee will be charged.
Signature
wner or Agent
The foregoing instrument was acknowledged before me this 23
day of'aatirb -, 20 10, by HAiZL€ .O e:1S10.41)3XNArvi.si,
who is erson or who has produced
As identification and who did take an oath.
NOTARY PUBLIC:
Sig Sign:
Print: 6gTiW O Print: c�E, O ,Og
My Commission Expires: N ��� � � y p y My Commission Expires:t30 �; ,` 0.2L1 4 pt1 # 3,20
• ti .. gs: tiMG.: 1022014 .tti :° : 7 i 2 :g
APPROVED BY
(Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09)
N/n
,7,9; Plans Examiner
Structural Review
Signature
Contractor
The for _oina instru d ent w ackno ledoed
day of 1 . 1 ' " , 201 , by
who is pe sonally knot'y to me or who h produced
N
tification and who did take an oath.
Zoning
Clerk
THE
ANY
MAY
POLICIES.
INSR
POLICIES
REQUIREMENT,
PERTAIN,
PRODUCER 305- 642 -4541
ROYAL CARIBBEAN INS. AGENCY II, CORP
1772 WEST FLAGLER STREET
MIAMI, FL 33135
OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE
TERM OR CONDITION OP ANY CONTRACT OR OTHER DOCUMENT WITH
THE INSURANCE AFFORDED SY THE POLICIES DESCRIBED HEREIN IS SUBJECT
AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
FOR THE POLICY
RESPECT TO WHICH
TO ALL THE TERMS,
POLICY @1(PA •
„ . , . IRTN • j J
PERIOD INDICATED, NOTWITHSTANDING
THIS CERTIFICATE MAY BE ISSUED OR
EXCLUSIONS AND CONDITIONS OF SUCH
ADD•L
I . ; . ,
POLICY NUMBER
POUOYEFFE� VE
r r •)
INTO
A
GQNERALLIABILITY
COMMERCIAL GENERAL LIABILITY
01L0000777 -03
•
05/21/2010
05/21/2011
EACH OCCURRENCE
$ 1,000,000
X
RFMI(S n ureen«r1
$ 100000
$ 0
I CLAIMS MADE X OCCUR
MEDEXP (Any one person)
PERSONAL 8 AOV INJURY
$ 1,000,000
GENERAL AGGREGATE
$ 2,000,000
GEN'LAGGREGATE
LIMIT APPLIES PER:
POLICY n . r1 LOC
PRODUCTS >COMP/OPAGO
$ 1,000,000
7
•
AUTOMOBILE
LIABILITY
ANY AUTO
ALL flWNEb
SCHEDULEDAUTOS
mREDAUTOS
NONIOWNEDAUTOS
COMBINED SINGLE UMIT
(Ea accident)
$
_
BODILY INJURY
(Per person)
$
—
—
BODILY INJURY
(Pereccitlent)
$
—
PROPERTY DAMAGE
(Peraco4aant)
$
GARAGE
LIABILITY
ANY AUTO
AUTO ONLY >EA ACCIDENT
$
OTHERTHAN EA A00
1
A OONL AGO
$
EXCESSIUMBRELLALIABIUTY
EACH OCCURRENCE
S
OCCUR CLAIMS MADE
AGGREGATE
$
DEDUOTIBLE
RETENTION $
S
$
$
5
WORKERS COMPENSATION AND
EMPLOYERS'UABILITY
ANY OFFICER/MEMBER EXCLUDED?
yE I il I AL
$PE( PROVISIONS below VISffl
WC- 602385
07/23/2010
07/23/2011
I TARYtIMITR I 15R
El.
.L
S 100,000
GI. DISEASE )8A EMPLOYEE
$ 100,000
E.L. DISEASE > POLICY LIMIT
S 500,000
OTHER
DESCRIPTION OF OPERATIONS 1LOOATIONS (VEHICLES EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
ELECTRIC CONTRACTOR.
ACORD, CERTIFICATE OF LIABILITY INSURANCE
o % /2/2 i )
PRODUCER 305- 642 -4541
ROYAL CARIBBEAN INS. AGENCY II, CORP
1772 WEST FLAGLER STREET
MIAMI, FL 33135
THIS CERTIFICATE 1S 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
RELIABLE ELECTRIC CORP,
1701 SW 99 AVENUE
MIRAMAR, FLORIDA 33025
I
IN$URERA: NATIONAI. INSURANCE COMPANY
INSURERS: ASCENDANT INSURANCE COMPANY
NSURERC:
INSURER D:
INSURER E:
COV ERAGES
01- 05 -'11 13 :23 FROM -ROYAL CARIBBEAN INS, 3056421087
CITY OF MIAMI SHORES
10050 NE 2 AVENUE
MIAMI SHORES, FL 33138
ATrN: VIVIANA CUBILLO
PERMIT :RC11116
I PERMIT :RC11117
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES 8E CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN
NOTICE TO THE C$ ` + CATE HOLDER NAMED TO TH8 LEFT, BUT FAILURE TO DO BO SHALL
IM - < : - - . . EL ATI'' N OR LIA - ITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
�S.
ACORD 25 (2001/08)
CANCELLATION
T -713 P001/001 F -379
ACORD CORPORATION 1988
Inspection Number: I NSP- 154967 Permit Number: PL- 1 -11 -78
Scheduled Inspection Date: February 04, 2011
Inspector: Hernandez, Rafael
Owner: BORDOWSKI, MARCELO
Job Address: 9418 N MIAMI Avenue
Miami Shores, FL 33150-
Project: <NONE>
Contractor: HMF CONSTRUCTION CO
Building Department Comments
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
PLUMBING WORK FOR KITCHEN REMODEL.
INSTALLATION OF FAUCET AND DISHWASHER
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
February 04, 2011
For Inspections please call: (305)762 -4949
\ \AY
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Addition /Alteration
Phone Number
Parcel Number 1131010340020
Phone: (954)931 -9886
Page 6 of 8
BUILDING
PERMIT APPLICATION
FBC 20
Permit Type: PLUMBING
OWNER: Name (Fee Simple Titleholder): , `osa Phone#: 3 b 4 -y2
3
Address: /05 al) 14V E
City: AV E MT state: ,- zip: /
Phone#: A` /A
Tenant/Lessee Name: Ad /
Email. 12C , Lo a 4DDEVEI-o 'E& • C.o41
JOB ADDRESS: 9'/' Ate MA /971 AV
City: Miami Shores County: Miami Dade
Folio/Parcel#: 1/ 3/o /2;1 3VOOZ-
Is the Building Historically Designated: Yes NO Flood Zone:
ThM any Name: � ,p Phone#:
Phone#:
E12.:17144 s () c)) i0 f
CONTRACTOR: Co
Address:
City:
Qualifier Name: e
State:
State Certification or Registration #: C C Q U/ 2
/1 Certificate of Competency #:
7
Contact Phone#: `7 - 9864 Finail Address: ebViaGOA��l/GT e. Co+97f9JT AZT
DESIGNER: Architect/Engineer: 1 Phone#:
‘00 Value of Work for this Permit: $ Square/Linear Footage of Work:
X Repair/Replace ❑Demolition
Type of Work: ❑Address ilte
Scanning Fee $ Radon Fee $
Notary $ Training/Education Fee $
Double Fee $ A 0 b Structural Review $
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949
❑New
3/
Permit No. v I 11-1
* * * * * *** * * * * * **** *** * * **** see * * *** *** *** ** * * **** ******* ** *** * * **m * * * * *** ** * *** ****
Submittal Fee $ Permit Fee $ / `,
JAN 1 2 2011
BY: .
Master Permit No.
l
Zip: 3
Description of Wor :
zZ 7 f H'f A"EN /,U 491,c67 5 /ae/As /l/L
CCF $ CO /CC $
DBPR $ Bond $
Technology Fee $
•
Boning Company's Name (if applicable) Aikt
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 FTFCTRICAL 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 commenc t must be po - the job site
for the first inspection which occurs seven () days after the building permit is issued. In t ' abse ce of such osted ° ' tice, the
inspection will not be approved and a reinspecjion fee will be charged
Sign:
Owner or Agent
The foregoing instrument was acknowledged before me this Iz
day of :...:_ �� ( by M "I ati) sVu 1 ,
who is personally known to me or who has produced
r 1
As identification and who did take an o
NOTARY PUBLIC:
RIDA
Print: 74?+,10 0. Gustavo Gomez
'.
^ � = Commission # 1JEU18480
My Commission Expires: 6/ld /26)/ * \, ;,..•°� Expires: AUG.18, 2014 , .
` BOND TH RU A BONDING 0.
INC
** ******* *******R**** *** *********:*****************B********************** *.R*R *9 *****AA* * *****3***** *****
APPROVED BY L' ` � �` Plans Examiner
Structural Review
(Revised 07 /10/07)(Revised 06 /10/2009)(Revised 3/15/09)
aI n
Contractor
The fore oing instrument was acknowledged before me this 12
day of 20 (, by Li 5 LI G TZ K 1 6 -
who is personally known to me or who has produced — '
. L_ • as identification and who did take an oath.
NOTARY PUBLIC:
# EE018480
Si
Print
My Commission ExpiARED
NOTARY PUBLIC -STATE OF FLORIDA
,,.,,
r . .
LADING CO., INC.
Zoning
Clerk
ACCORD CERTIFICATE OF LIABILITY INSURANCE
I 1/1
PRODUCER (954) 724 -7000 FAX: (954) 724 - 7024
Keyes Coverage, Inc.
5900 Hiatus Road
Tamarac FL 33321
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
HMF Construction Co.
Attn: Leslie
9778 Napoli Woods Lane
Delray Beach FL 33446
INsuRERAMid Continent Casualty Co
23418
INSURER B:
INSURER C:
INSURER D:
INSURER E:
COVERAGES
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.
AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
LTR
ADD'L
INSRD
TYPE OF INSURANCE
POLICY NUMBER
04 GL000782597
POLICY EFFECTIVE
DATE (MM/DDIYY)
2/22/2010
POLICY EXPIRATION
DATE (MM/DD/YY)
2/22/2011
LIMITS
A
GENERAL LIABILITY
EACH OCCURRENCE
$ 1,000,000
X
COMMERCIAL GENERAL LIABILITY
P AMA
(E oxur�ience)
100,000
$ 100 , 000
I CLAIMS MADE
X
OCCUR
MED EXP(Anv one Person)
$ EXCLUDED
PERSONAL 8 ADV INJURY
$ 1,000,000
GENERAL AGGREGATE
$ 2,000,000
GEM_ AGGREGATE U APPLIES PER:
POLICY f JECT fl LOC
PRODUCTS - COMP /OP A(30
$ 2,000,000
AUTOMOBILE
_
LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON -OWNED AUTOS
COMBINED SINGLE LIMIT
(Ea accident)
$
BODILY INJURY
(Per person)
$
BODILY INJURY
(Per accident)
$
PROPERTY DAMAGE
(Per accident)
$
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
$
ANY AUTO
OTHER THAN EA ACC
$
AUTO ONLY: AGO
$
EXCESS/UMBRELLA LIABILITY
7 OCCUR CLAIMS MADE
EACH OCCURRENCE
$
AGGREGATE
J
3
$
DEDUCTIBLE
RETENTION $
$
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
If yea, describe under
SPECIAL PROVISIONS below
AMPS LIMI
I E
E.L. EACH ACCIDENT
$
E.L. DISEASE - EA EMPLOYEE
$
EL. DISEASE - POLICY LIMIT
$
OTHER
DESCRIPTION OF OPERATIONS /LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT /SPECIAL PROVISIONS
CERTIFICATE HOLDER
(305)756 - 8972
Miami Shores Building Dept.
10050 NE 2nd Ave
Miami Shores, FL 33138
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT
FALURE TO DO SO SHALL IMPOSE NO OBUGATION OR LIABILITY OF ANY KIND UPON THE
INSURER, ITS AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
Carey Keyes /KN
ACORD 25 (2001/08)
IMCn9F % rat.
From: 954 - 724 -7022 To: 13057568972 Page: 1/2 Date: 1/12/2011 8:54:05 AM
CANCELLATION
®ACORD CORPORATION 1988
Par. n
This fax was sent with GFI FAXmaker fax server. For more information, visit http: / /wvwv.gfi.com
PLUMB!'
MECHANIL.
BLDG.
PROPERTY ANDREgS A-ARCHITEGT:
9418 N. MIAMIIAVE,v OLE' Ti S. 'LAO,
MIAMI SHORES, 3.34-50.
LIC:
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LIVING ROOM
(
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$
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PROPERTY ANDREgS A-ARCHITEGT:
9418 N. MIAMIIAVE,v OLE' Ti S. 'LAO,
MIAMI SHORES, 3.34-50.
LIC:
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