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DEMO-11-810Permit Number: DEMO -5 -11 -810 i Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 inspection Number: I NS P- 159452 Inspection Date: August 04, 2011 Inspector: Bruhn, Norman Owner: MCCLURY, BEVERLY Job Address: 455 NE 91 Street Miami Shores, FL 33138- Project: <NONE> Contractor: MULTITECH BUILDING Permit Type: Demolition Inspection Type: Final Work Classification: Building Phone Number 305 -754 -3181 Parcel Number 1132060140140 Phone: (786)218 -7886 Building Department Comments DEMOLISH ILLEGAL SECOND KITCHEN INCLUDING PLUMBING AND ELECTRICAL PassedO e: Inspector Comments e6.._ Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled re- inspection fee is paid. until August 04, 2011 For Inspections please call: (305)762 -4949 Page 1 of 1 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 BUILDING Permit No.7X -Ac) \ 1 �� PERMIT APPLICATION Master Permit No. FBC 20 KY 0 6 2011 Permit Type: BUILDING OWNER: Name (Fee Simple Titleholder): Address: 13155 SW 42nd St. City: Miami State: FL Zip: 33175 Phone #:?7 JPMORGAN/ GMAC Phone #: 305 551 9400 Tenant/Lessee Name: n/a Email: QA) ( r: ‘3'■ JOB ADDRESS: 455 NE 91st Street City: Miami Shores Folio /Parcel #: 11- 3206 - 0140140 Is the Building Historically Designated: Yes NO K. County: Miami Dade Zip: 33138 V+ (1. 1 ¢-�� .J 1 �v. Phone CONTRACTOR: Company Name: m Address:162 - M g \ket bJR . a lie; ; Z3 Zip: 33 t6S City: W■ ` �t "`'� 0 e, State: d+1 Qualifier Name: t\£ �L. /e� S eA 0 A Phone #: ° u b i 4 State Certification or Registration #: C ..- C c__. '��' Certificate of Com ten #: a Contact Phone #: ?JpS Z1 S t 7- Email Address: U.3 f5 r 14-2" DESIGNER: Architect/Engineer: V\ I ..--- Value of Work for this Permit: $ 1 I 400 Square /Linear Footage of Work: Type of Work: DAddress CiAlteration ONew ORepair /Replace Description of Work: � > l. ' / ILt-t ie. P... Flood Zone: Phone #: 'jDemolition COLOR THROUGH ROOF TILE 15 REQUIRED acknowledged by: Submittal Fee $` C) _ Permit Fee $ /DC 6"1 CCF $ Scanning Fee $ Radon Fee $ DBPR $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ CO /CC $ Bond $ TOTAL FEE NOW DUE $ CO I ° (ii Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must promise in good faith that a copy of the notice of commencement and construct itur lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified coPy cal. 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 b a xgved and a reinspection ill be charged. Signatur Est -Ju O/= az•WtiZ- Signature O er or Agent - or The foregoing instrum nt was ac. ledged for- me this ( "" The foregoing instr iment wa acknowledged before 'te (his day of teSo , 2 , by �_ ' r"�1M ay of , 20 \ , by PEA ` %Pk who is personally known t me or who has produced i who s personally own to e or who has produced As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commission Expires: NO'9',�laY PUBLIC: Sign: Print: AIDA M. VALLEJO AIDA M. VALLEJO My Commission • it :; MY COMMISSION #D0769883 MY COMMISSION #DD769883— EXPIRES: MAR 17, 2012 EXPIRES: MAR 17, 2012 ;Ili 1st State Insurance Bonded through s t�te�lgIN $s $ssF�a(:� -.,.. sB' :f:. riQ ... i .:k :2 ::I: d: g::g:y.:i::i: *:I::k * i:: E: ***H= *: k*= H= k*z ksksk*'ksk**sk*iksk*skek�jk:kskik sk'kik*sksk ation and who did take an oath. APPROVED BY t Plans Examiner Zoning Structural Review Clerk (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) Permit No: 11- d Job Name fia , 2011 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 Building Critique Sheet nv,de .4,- A 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. Norman Bruhn CBO 305 - 795 -2204 Property Information Map My Home Miami -Dade County, Florida Page 1 of 1 Property Information Map Aerial Photography - 2009 0 113 ft This map was created on 5/6/2011 12:53:37 PM for reference purposes only. Web Site © 2002 Miami -Dade County. All rights reserved. SPA(5-L�� Summary Details: Folio No.: 11- 3206 - 014 -0140 Property: 455 NE 91 ST Mailing Address: JPMORGAN CHASE TRS 455 NE 91 ST MIAMI SHORES FL 33138- Property Information: Primary Zone: 1100 SINGLE FAMILY RESIDENCE CLUC: 0001 RESIDENTIAL - SINGLE FAMILY Beds/Baths: 3/2 Floors: 1 Living Units: 1 Adj Sq Footage: 2,067 Lot Size: 6,350 SQ FT Year Built: 1966 Legal Description: MIAMI SHORES SEC 2 PB 10 -37 LOT 20 BLK 49 LOT SIZE 50.000 X 127 OR 24135 -2329 08 2005 1 LEGAL DESCRIPTION ON OR 24134 -1391 Assessment Information: Year: 2010 2009 Land Value: $98,973 $108,518 Building Value: $170,368 $183,215 Market Value: $269,341 $291,733 Assessed Value: $269,341 $291 733 Taxable Value Information: Year: 2010 2009 Taxing Authority: Applied Exemption/ Taxable Value: Applied Exemption/ Taxable Value: Regional: $0/$269,341 $0/$291,733 County: $0/$269,341 $0/$291,733 City: $0/$269,341 $0/$291,733 School Board: $0/$269,341 $0/$291,733 Sale Information: Sale Date: 9/2010 Sale Amount: $100 Sale O/R: 27450 -0568 Sales Qualification Q Description: Deeds to or from financial institutions View Additional Sales http: / /gisims2.miamidade.gov /myhome /printmap. asp? mapurl = http: / /gisims2.miamidade.gov... 5/6/2011 Tale Mp. 2g335PG4042 02R234862 2002 APR 17 11 =51 [WHEN RECORDED RETURN TO] NTC ATTN:DARRELL COLON 101 N. BRAND BLVD., SUITE #1800 GLENDALE, CALIFORNIA 91203 GMACPOA St/Cnty: FLDADE 1 111 d01111111I11 III II IIB Limited Power of Attorney KNOW ALL MEN BY THESE PREMISES: That JPMorgan Chase Bank, (formerly The Chase Manhattan Bank, successor in interest to The Chase Manhattan Bank, N.A.) (the name change is the result of a merger) as Trustee or Indenture Trustee (together with its successors and assigns, the "Trustee "), under Pooling and Servicing or Indenture Agreements pursuant to which Residential Funding Corporation acts as Master Servicer, and such Trustee being, a New York Banking Corporation organized and existing under the laws of the State of New York, and having an office located at 450 West 331a Street, in the City of New York, State of New York, has made, constituted and appointed, and does by these presents make, constitute and appoint Residential Funding Corporation, a corporation organized and existing under the laws of the State of Delaware, its true and lawful Attomey -in Fact, with full power and authority to sign, execute, acknowledge, deliver, file for record, and record any instrument on its behalf and to perform such other act or acts as may be customarily and reasonably necessary and appropriate to effectuate the following enumerated transactions in respect of any of the mortgages or deeds of trust (the "Mortgages" and the "Deeds of Trust ", respectively) and promissory notes secured thereby (the "Mortgage Notes ") for which the undersigned is acting as Trustee for various certificate holders (whether the undersigned is named therein as mortgagee or beneficiary or has become the mortgagee by virtue of endorsement of the Mortgage Note secured by any such Mortgage or Deed of Trust) and for which Residential Funding Corporation is acting as master servicer. This appointment shall apply to the following enumerated transactions only: 1. The modification or re- recording of a Mortgage or Deed of Trust, where said modification or re- recording is for the purpose of correcting the Mortgage or Deed of Trust to conform same to the original intent of the parties thereto or to correct title errors discovered after such title insurance was issued and said modification or re- recording, in either instance, does not adversely affect the lien of Mortgage or Deed of Trust as insured. 2. The subordination of the lien of a Mortgage or Deed of Trust to an easement in favor of a public utility company or government agency or unit with power of eminent domain; this section shall include, without limitation, the execution of partial satisfaction /releases, partial re- conveyances or the execution of requests to trustees to accomplish same. c�l u��e\a., � SZFc 1 5` 1FF.RIC!IL 20335PG4O43 3. The qualified subordination of the lien of a Mortgage or. Deed of Trust to a lien of a creditor that is created in connection with the refinancing of a debt secured by a lien that was originally superior to the lien of the Mortgage or Deed of Trust. . 4. With respect to a Mortgage or Deed of Trust, the foreclosure, the taking of a deed in lieu of foreclosure, or the completion of judicial or non judicial foreclosure or termination, cancellation or rescission of any such foreclosure, including, without limitation, any and all of the following acts: a. The substitution of trustee(s) servicing under a Deed of Trust, in accordance with state law and the Deed of Trust; b, Statements of breach or non - performance; c. Notices of default; d. Cancellation/rescissions of notices of default and/or notices of sale;; e. The taking of a deed in lieu of foreclosure; and f. Such other documents and action as may be necessary under the terms of the Mortgage, Deed of Trust or applicable state law to expeditiously complete said transactions. S. The conveyance of the properties to the Mortgage insurer, or the closing of the title to the property to be acquired as real estate owned, or conveyance of the title of real estate owned. 6. The completion of loan assumption agreements. 7. The full satisfaction/release of a Mortgage or Deed of Trust or full re- conveyance upon payment and discharge of all sums secured thereby, including, without limitation, cancellation of the related Mortgage Note, 8. The assignment of any Mortgage or Deed of Trust and the related Mortgage Note, in connection with the repurchase of the mortgage loan secured and evidenced thereby pursuant to the requirements of a Residential Funding Corporation Seller Contract, including, without limitation, by reason of conversation of an adjustable rate mortgage loan from a variable rate to a fixed rate. 9. The full assignment of a Mortgage or Deed of Trust upon payment and discharge of all sums secured thereby in conjunction with the refinancing thereof, including, without limitation, the assignment of the related Mortgage Note. The undersigned gives said Attorney -in Fact full power and authority to execute such instruments and to do and perform all and every act and thing necessary and proper to carry into effect the powers granted by or under this Limited Power of Attorney as fully as the undersigned might or could do, and hereby does ratify and confuui to all that said Attorney -in Fact shall lawfully do or cause to be done by authority hereof. G A ResCa • DATE: January 28, 2011 To Whom it May Concern: RE: 455 NE 91 Street, Miami Shores, FI.33138 This is to advise that Raul Gonzalez of First Service Realty Inc, is an agent acting on behalf of GMAC Mortgage concerning all matters for the property located at the address indicating above. He is hereby given authorization to pull permits on behalf of GMAC MORTGAGE. Thank You, Camille ckso Camille Jackson Asset Manager Enterprise REO GMAC ResCap Phone: 214.874.6978 Fax: 866.352.1673 An n a. J acks o n ao m a crescap. co m 2711 N Haskell Ave. Ste 900 Dallas, TX 75204 2711 N Haskell Ave Dallas TX 75204 800.799.9250 Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Permit No. 9 'e "Y //-9.9 /z) Job Name CRITIQUE SHEET Multitech Building Technologies, Inc. State of Florida CG C060943 / QB0012928 1/2 DEMOLISH ILLEGAL KITCHEN COUNTER AS PER RE OCCUPANCY INSPECTION OWNER: JPMorgan/ GMAC 13155 Bird Rd., Miami, FL 33175 OWNER PHONE NUMBER 305 551 9400 JOB ADDRESS: 455 NE 91st Street, Village of Miami Shores 5/5/2011 NOT TO SCALE DEMOLISH ILLEGAL KITCHEN INCLUDING PLUMBING AND ELECTRICAL AS PER RE OCCUPANCY INSPECTION REQUIREMENT. Y Y KITCHEN ADD SMOKE/CARBON MONOXIDE DETECTORS. ANY AND ALL CLOTH AND RUBBER E OF MIAMI SHORES INSULATED CONDUCTORS TO BE RE ' NE 91 ST. MIAMI, BEDROOM J_. �� (c NAY 0 6° 2011 coy ❑WNER :J P MORGAN /GMAC 13155 BIRD RD.MIAMI,FL 33175 ukO I\ --�Ib Miami Shores Village APPROVED ZONING DEPT BLDG DEPT BY DATE SUBJECT TO COMPLIANCE WITH ALL FEDERAL STATE AND COUNTY RULES AND REGULATIONS LIVING ROOM BEDROOM BEDROOM 5--/o-(( pLe4 - ELY:.,.._ 10240 Miller Dr. #110, Miami, FL 33165 o 305 275 1229 o workdone @bellsouth.net Multitech Building T e c h n o l o g i e s , Inc. State of Florida CG C060943 / QB0012926 2/2 DEMOLISH ILLEGAL KITCHEN COUNTER AS PER RE OCCUPANCY INSPECTION -, - A 1- , + - ,- . a , T . - .1 L. -: r OWNER: OWNER PHONE NUMBER JPMorgan/ GMAC 13155 Bird Rd., Miami, FL 33175 305 551 9400 JOB ADDRESS: 455 NE 91st Street, Village of Miami Shores 5/5/2011 SCOPE OF WORK: DEMOLISH ILLEGAL KITCHEN COUNTER AS PER RE OCCUPANCY INSPECTION 1. DEMOLISH KITCHEN COUNTER 2. SEPARATE ELECTRICAL PERMIT TO REMOVE KITCHEN CIRCUITS AS NEEDED 3. SEPARATE PLUMBING PERMIT CAP PLUMBING INSTALLATION AS NEEDED 4. NO MECHANICAL WORK DEMOLISH ILLEGAL KITCHEN INCLUDING PLUMBING AND ELECTRICAL AS PER RE-OCCUPANCY INSPECTION REQUIREMENTS SCALE 1 I- 1 /411 X 10240 Miller Dr. #110, Miami, FL 33165 in 305 275 1229 o workdone @bellsouth.net Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 / Inspection Number: INSP - 162763 Scheduled Inspection Date: August 04, 2011 Inspector: Devaney, Michael Owner: MCCLURY, BEVERLY Job Address: 455 NE 91 Street Miami Shores, FL 33138- Permit Number: DEMO -6 -11 -1053 Project: <NONE> Contractor: PINAR ELECTRIC MD INC Permit Type: Demolition Inspection Type: Final Work Classification: Electric Phone Number 305 - 754 -3181 Parcel Number 1132060140140 Phone: (786)256 -0812 Building Department Comments ELECTRICAL WORK TO DEMOLISH ILLEGAL KITCHEN 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- 160791. Add 3 receptacles to kit. counter. Repair water heater connection. Relocate service drop and add main disconnect, Smoke detectors on arc fault ckt.. .„92/2-- 3 August 03, 2011 For Inspections please call: (305)762 -4949 Page 19 of 24 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 BUILDING PERMIT APPLICATION FBC 20 77-0 77 JUN 082011 BY: - Permit No. �'"�� Master Permit No. Permit Type: Electrical OWNER: Name (Fee Simple Titleholder ) ' O rodok ., eirl 4 Phone#: Address: City: State: Zip: _ Tenant/Lessee Name: n/a Phone #: Email: JOB ADDRESS: 455 NE 91st Street City: Miami Shores County: Miami Dade Zip: 33138 Folio/Parcel #: Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name: . l/17(_ / r /29 //'sd Phone#: J r(i 2 " r i� Address: ) Al V V °,j .. ;1:-*:..- City: 9 ,r� State: , < Zip. -'3 / 2' J Q. - Qualifier Name: `a' -" 47 ,-' A (___, s� Phone #: ) . 4 A State Certification or Registration #: � � �' oA Certificate of Competency #: 0' &% 0�%°_=' ' / 0 Contact Phone#: Email Address: /fL/4 y,a3 i . >5 /,e% - /le DESIGNER: Architect/Engineer: Phone#: Value of Work for this Permit: $ .9612 Square/Linear Footage of Work: Type of Work: ❑ ', ess DAlteration New ❑Repair/Replace ❑Demo 'tion Description of Work: _`_ D-X *a****** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** gees********* ********.x***************** **•rya * **** 1'0"-W? ? Submittal Fee $ Permit Fee $ /-' tee CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ Technology Fee $ TOTAL FEE NOW DUE $ 1 Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOIT.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 compliance with all applicable laws regulating construction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be pproved and a reinspection fee will be charged. Signature ,L_ ,,,,,e,„,...,___-, ` 4b &'` (-1 CC�e 0 ,'er o )igent Contractor e me thi T The foregoing instrument was acknowledged before me this /. 6I ay of /ri 47 , 20 .c , by iziCR- c0/7� who is personally known to m o jias produced as identi CI QQ tld ath. NOTARY PUBLIe'+, 881011 State Of eg .00913953 5 Signature The for oing instrume \waS acwledgedibday of , , by who is personally known + me or who has produced As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commission Expires: flooded through 1st State Insurance Sign: Print: My Com +Expiures: ' Florida G :. 453 My 1 -17 -2013 1 * *** *arm *** * *,x******* ,n * * * * * * * * * * * * *** * * * * * * * * ****** * * * * ** * * * *** _,: ,x* t � 14** * * * * * * ** fe /e 7 �� Plans Examiner Zoning APPROVED BY Structural Review Clerk (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) P Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 i‘410 Inspection Number: INSP- 161568 Permit Number: DEMO -6 -11 -1055 Scheduled Inspection Date: July 06, 2011 Inspector: Hernandez, Rafael Owner: MCCLURY, BEVERLY Job Address: 455 NE 91 Street Miami Shores, FL 33138- Project: <NONE> Contractor: JC PLUMBING SERVICES, INC Permit Type: Demolition Inspection Type: Final Work Classification: Plumbing Phone Number 305 -754 -3181 Parcel Number 1132060140140 Phone: 305 - 796 -4663 Building Department Comments PLUMBING WORK TO DEMOLISH ILLEGAL KITCHEN Inspector Comments Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. July 05, 2011 For Inspections please call: (305)762 -4949 Page 17 of 21 1 1 Project Address Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Parcel Number Applicant 455 NE 91 Street Miami Shores, FL 33138- 1132060140140 Block: Lot: BEVERLY MCCLURY Owner Information Address Phone CeII BEVERLY MCCLURY 455 NE 91 Street MIAMI SHORES FL 33138- 305 -754 -3181 Contractor(s) JC PLUMBING SERVICES, INC Phone 305 - 796 -4663 CeII Phone Valuation: Total Sq Feet: $ 300.00 0 1 Type of Demo: Plumbing Additional Info: Classification: Residential Scanning: 1 Fees Due CCF DBPR Fee DCA Fee Education Surcharge Permit Fee Scanning Fee Technology Fee Total: Amount $0.60 $2.00 $2.00 $0.20 $100.00 $3.00 $0.80 $108.60 Pay Date Pay Type Amt Paid Amt Due Invoice # DEMO -6- 11-41177 06/15/2011 Check #: 356 $ 108.60 $ 0.00 Available Inspections: Inspection Type: Final 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. June 15, 2011 Authorized Signature: Owner / Applicant / Contractor / Agent Building Department Copy Date June 15, 2011 1 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 BUILDING PERMIT APPLICATION FBC 20 Permit Master Permit No.5 ' / t - 0 AP Permit Type: PLUMBING! OWNER: Name (Fee Simple Titleholder]: MOO/ ,(11/4, I k Phone#: Address: City: State: Zip: Tenant/Lessee Name: Phone#: Email• JOB ADDRESS: 45_< c SA City: Miami Shores Folio/Parcel #: County: Miami Dade Zip: 33 we Is the Building Historically Designated: Yes CONTRACTOR: Company N Address: CO o City: t4.4 9, State: Name: OWL .\'',k,f Lk, Fri s� NO Flood Zone: C d\ ern," ( Phone#: Q -2 f -$ 6z1 State Certification or Registration #: %47-Co 72_1 Contact Phone#: 6— LS —8, —R C, `1 Zip: 0 Phone#: °° °1` a k 8 _ ° Certificate of Competency #: (-43 ',05)°% tit. DESIGNER: Architect/Engineer: Email Address Phone#: v� Value of Work for this Permit: $ ► — Square/Linear Footage of Work: New ORepair/Replace Type of Work: OAd OAlterationnJ Description of Work: Oj, cm, molition ***************************************F * as* ee**** *** *** ****** *a * * * *** *** ** ** **a *** Submittal Fee $ Permit Fee $ /c i Scanning Fee $ Radon Fee $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ CCF $ CO /CC $ DBPR $ Bond $ Technology Fee $ TOTAL FEE NOW DUE $ Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR EVMPROVEMENTS 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 inspec occurs (7) days after the building permit is issued. In the absence of _f such posted notice, the inspection will ' approv and red i ection fee will be charged Signature Signature Owner dr Agent ` ' . ntractor The foregoing instrument was acknowledged before me this I / The foregoing instrument was acknowledged fore me this d 1 day of V 20 , by 43102,00c2-, day of M � , 20 Iv, br Y �a ,,,40,9 a°� , to me or who has produced who is personally known to me or who has produced identification and who did take an oath. as identification and who did take an oath. NOTARY PUBLIC: AIDA M. VALLEJO MY COMMISSION #007 883 EXPIRES: MAR 17, 2012 Sign: Print: My Commission Expires: NOTARY PUBLIC: Si �� 4 Print 7 My Commission MARIA E VELAZQUEZ MY COMMISSION #DD862986 EXPIRES: MAR 14, 2013 Bonded through 1st State Insurance *******tI******* ** **** ***** ** * sN*R++ x**+ x****** *M S+ *+k *********** **+I* ***** ******** *4+*** *** ********fl*+a*********** 61° m. < ( Plans Examiner Zoning APPROVED BY Structural Review (Revised 07 /10/07)(Revised 06 /10t2009)(Revised 3/15/09) Clerk DATE BATCH NUMBER 07 16/2010 108001336 ' CFC14262.27, The PLUMBING 'e6NtRACTIOR isimettrbelow- IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2012H*, MIAMI -DADE COUNTY TAX COLLECTOR 140 W. FLAGLER ST. 1st FLOOR . MIAMI, FL 33130 2010 LOCAL BUSINESS TAX RECEIPT 2011. FIRST-CLASS MIAMI -DADE COUNTY - STATE OF FLORIDA U.S. POSTAGE ? EXPIRES SEPT. 30, 2011 PAID MUST BE DISPLAYED AT PLACE OF BUSINESS MIAMI, FL PURSUANT TO COUNTY CODE CHAPTER 8A - ART. 9 & 10 PERMIT NO. 231 532116 -1 THIS IS NOT A BILL — DO NOT PAY RENEWAL BUSINESS NAME / LOCATION RECEIPT NO. 555866 -4 - J C PLUMBING SERVICES INC STATE* CFC1426227 3500 MYSTIC POINTE DR 501 33180 CITY OF AVENTURA OWNER J C PLUMBING SERVICES INC Sec. Type of Business WORKER /S' 196 PLUMBING CONTRACTOR 1 THIS I8 ONLY A LOCAL BUSINESS TAX RECEIPT. IT DOES NOT PERMIT THE HOLDER TO VIOLATE ANY EXISTING REGULATORY OR ZONING LAWS OF THE COUNTY OR CRIES. NOR DOES IT EXEMPT THE HOLDER FROM ANY OTHER PLRRLTT OR LICENSE REQUIRED BY LAW. THIS IS NOT A CERTTFICAIION OF tTHE HOLDER'S QUALIFICA- PAYMENT RECEIVED MIAMFDADE COUNTY TAX COLLECTOR: 08/06/2010 60010000319 000045.00 SEE OTHER SIDE DO NOT FORWARD J C PLUMBING SERVICES INC JUAN CARLOS LEON PRES 3500 MYSTIC POINTE DR #501 AVENTURA FL 33180 1111111111111I 111 Till }it17llfill111i61IIttl11 Ii Il I liitl IIF7tll • • ; A.cx-Areer CERTIFICATE OF LIABILITY INSU CE THIS CERTIFICATE IS ISSUED AS A MATTER OF INTMIATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EVEN@ OR ALTER THE COVERAGE AFFORDED IN THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN TM ISSUNG INSURERS), AUTHORIZED REPRESENTATIVE OR PRODUCER. AND THE CERTIFICATE HOLDER. (MPORTANT: If the certificate holder is $11 ADDITIONAL INSUFiED, the perreyges) must he ends md. I1SUGftT1ON 15 WAIVED, subject to the terms and cmcliblons cif the policy, certain policies may requite an endorsement. A slaternerat on Ides certElcate does not caster rights to the certificate holder in lieu of such entiorsetnent(s). PRODUCER Fed USA #1536 18518 W. Dixie Hrigay Ave:Aura, FL 331 Phone (305)933-2600 Fa s (305)932-6J2B INSURED .10 Pturnbing Serviom In0 3500 Weds Pc=intipnr.01 Aventhrs, FL 331140- (786) 251-B027 14C:ArrIPCT $140Ne -NAIL • IP No CvsTONER Ib =totems) AFFoittuNs COVERAGE INSURER A: ASCENDANT INSURANCE INCAIR, : INSURER C: INSURER D INSURER C: INSURER F : COVERAGES CERTIRCATE NUMBER: REVISION NUMBEFt THIS IS TO CERTIFY THAT THE POLICES CF INSURANCE LIZTED EEL= HAVE SEEN ISSUED TO THE INSURED WAIVED ABOVE FOR THE POUCY PERIOD INDICATED. NOTWITHSTANDING ANY REOUIREINMT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DCOLOSSIT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POUCES DESCRIBED MEIN IS SUBJECT TO ALL THE TERMS, '. EXCLUSIONS AND COMMONS OF SUCH MMES. LBWS SHOWN MAY HAVE BEM REDUCED BY PAID CLAWS. hiss . An& lin __ _ rYPE OF INSIA,ANcE PJY POLI_ DV ___m1POL.FD CRP OIC tatifiBER (MMIDDIYV Lima GENERAL LEADILPY 6d txtelMERCIAL OLNERAI_ WHIM n 0 CLANS-MADE WI occut A El ort4L AscRECATE uurr APPI ins PEA FoucY ize; Lac AUTOMOBILE UREP-ITY j ANY AUTO Li ALL OWN4) AUTOS sr-4451)1.04t ALI= El_ n UMBRELLA Lfir$5 ri Excess Um o UEDUCTIECE I 1 REFaITIOR WORICRS CONIPENG4TION AND et:Puma:iv LIMILITY HIRED AUTOS NOWA/I/NM AUTOS n OCCUR 0 GL- 3 SO-0 V ANY PROFREICRIPARTNEWMCURVE 0111cFromiSER ExcLUDED? goledseey is WI) rigoire3 in N OF OPMATIONS Mow N I A 04/0612011 EACH OCCURRENCE s 100.000 DAMAME TO RINSED 1 MOW PR PAALS (En nannT5rIeF) 5 MI) tXP (Any nnn lannvi) 3 5.000 040812012- PERSCEDIL & AUV INJURY . $ 100.000 OMER& AGGREGATE $ 100.000 PRODUCTS -COMP/OP AGG s 100.000 3 CIRARINSII SINGLE MI' (Ea =Meal) BODILY {MAY (Par Inman) 5 SOMLY INJURY (Per incident) 5 FROPERff DAMAGE (Par ancid" ant) 3 EACH OCCURMCF 3 - t.. AGGREGATE 3 3 Wllmic titST M- INOT" I__15,11 EL F.ACI I Accomwr 3 . EL DISEASE -EA EMPLOYE $ FI _ INMASE - POLZCY 'Aar S DIRXRIPTIOR OF OPERATIONS, LOCATIONS PIERICLE$ (Math ACORD 401, Achiltionai Remarks Scheclurn, If mare spans In minted) CERTIFICATE HOLDER City of Miami Shores 10050 N.E. 2 Ave. Miami Shores, Fl 33138 CANCELLATION MOULD 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 LIRIDA MIRABAL ACORD 23 MOM) CIF vow' 01911041188 MORO 120N. All rights reserved. The "CORD mins and too are Istered marks of ACORD • OP ID: GR '4`,�.°R° CERTIFICATE OF LIABILITY INSURANCE ,` "' 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(les) must to endorsed. If SUBROGATION IS WAIVED, subject to the terms and condltlons 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 endorsem = s PRODUCER 305866 -6636 Wilson,Washbum & Forster Ins. 305-662-7778 Email; inf Wwwfns.com 1030190. Dixie Hwy, Ste. 300 Pinecrest, FL 33158 -3151 Philip S 'tartan CONTACT WA. FAX N I: M uces salsrameani , JCPLU -1 S) AFFORDING COVERAGE INSURER A :Associated Industries Ins., NAIC e 23140 _ INSURED JC Plumbing Services 3500 Mysitc Pointe Dr #501 Aventura, FL 33180 INSURER e: INSURERC: INSURER D : INSURER E : INSURER F: DAD eREff,A.CS TO s (Ea a E occarri �ze) COVERAGES CERTIFI REVISION NUMBER: 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 POUCIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. tS TR A3oMOW-- TYPE mums= 1: _ . , ,, POLICY NUMBER rOL4w HD �: ■ ....Agee/ L , >�∎ . , . EXP ,uLLI LIMITS GENERAL LIABIUTY COMMERCIAL GENERAL LIABILITY OCCUR EACH OCCURRENCE DAD eREff,A.CS TO s (Ea a E occarri �ze) s CLAIMS-MADE MED DIP (Anyone poison) 5 PERSONAL 8 ADV INJURY S GENERAL AGGREGATE 5 GENL AGGREGATE LL MIT APPLIES PER Fl POLICY I -1 LOC PRODUCTS - COMP/OP AGG $ S AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON - OWNED AUTOS COMBINED SINGLE LIMIT (Ea aor enn $ BODILY INJURY (Per person) S d� BODILY INJURY (Per aka) $ PROPERTY DAMAGE (Per =Went) S 1 $ $ UMBRELLA MB EXCESS LIAR OCCUR CLAIMS-MADE EACH OCCURRENCE 5 AGGREGATE $ DEDUCTIBLE RETENTION S S 5 A WORKERS AND ANY OFFICERIMEl (yam DESCRRtPeserTION COMPENSATION EMPLOYERS' LIABILITY PROPRIETORPPARTNERtExECLRIVIE Y / N ❑ hew N / A AWC1005793 12124110 12124111 j WCSTATU- "1- X ! TORY URHITS S 100,000 EL EACH ACCIDENT BER EXCLUDED? In NH) OF OPERATIONS EL DISEASE - EA EMPLOYEE S 100,000 EL DISEASE - POLICY LIMIT $ 500,000 DESCRIPTION OF OPERA1MINS I LOCATIONS 1 VEHICLES (MO ACORD WI, Add196nal Remarks StheduIe, II more sp Is required) CERTIFICATE HOLD City of Miami Shores 10050 N.E. 2 Ave. Miami Shores, F133138 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. — AUTHORZED REPRESENTATIVE ACORD 25 (2009109) ©1988.2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: I NS P- 162639 k,,[0S3 0 Permit Number: EL -7 -11 -1380 Scheduled Inspection Date: August 03, 2011 Inspector: Devaney, Michael Owner: MCCLURY, BEVERLY Job Address: 455 NE 91 Street Miami Shores, FL 33138- Project: <NONE> Contractor: PINAR ELECTRIC MD INC Permit Type: Electrical - Residential Inspection Type: Final Work Classification: Repair Phone Number Parcel Number 305 -754 -3181 1132060140140 Phone: (786)256 -0812 Building Department Comments REPAIR OF SERVICE Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments 4-ti Y9- (ij7t f, /9 c(1/77,2 August 02, 2011 For Inspections please call: (305)762 -4949 Page 39 of 47 "114-"IVIiami 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 BUILDING PERMIT APPLICATION FBC 20 Permit Type: Electrical Permit No. tat_- t - 138 o Master Permit No. IDsw - i) -1053 OWNER: Name (Fee Simple Titleholder): JPMORGAN/ GMAC Phone #: 305 551 9400 Address: 13155 SW 42nd St. City: Miami State: FL Zip: 33175 Tenant/Lessee Name: n/a Phone#: Email: JOB ADDRESS: 455 NE 91st Street City: Miami Shores County: Miami Dade Zip: 33138 Folio/Parcel #: 11- 3206 - 014 -0140 Is the Building Historically Designated: Yes NO X Flood Zone: CONTRACTOR: Company Name. 01 L /�Cl�J i;& )46_ Phone# Address V c/6) 2/It) 14 -1-1e State: / Zip:�� City: Phone#:7'';� Qualifier Name: State Certification or Registration #: �� 60/9'7 < I Certificate of Competency ��� ®� Contact Phone #: �o Zc3 8/� Email Address :A4,04,t,# /Cf A,450 • /� DESIGNER: Architect/Engineer: Phone#: Value of Work for this Permit: $ / �67-1 S uare/Linear Footage of Work: 4 g Type of Work: ❑Addres Cl/Alteration , ❑New . ❑Repair/Replace Description of Work: / % 1, G ODemolition ****** ** **** x ***** ****** * *** **** ******* Fees* * ** * * ** x********: x*: x********* **** * ********* Submittal Fee $ 50.0 0 Permit Fee $ /J ' ffe' (t CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ Bonding Company's Name (if applicable) Bonding Company's Address 'City State Zip l 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 ch occurs ev ' ' (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not b appr ved an ection fee will be charged. Sigma u' L 60wner3 ''e?rt��" '\aCC =<i Signature Contractor sir The fore vin instrument was ackn ledged before me this The foregoing instrument was acknowledged before me this day of , - kk, by 1 Li�l` Gt d" 1.0 - day of , 20 it, by Avatel ®i1 who personally kn to me or who has produced who is personally known to me or who has produced /WI' As identification and who did take an oath. identification and who did, an oath. NOTARY PUBLIC: - R Sign: Print: My Commission Expires: AIDA M. VALLEJO MY COMMISSION #0D769883 EXPIRES: MAR 17, 2012 Bonded through 1st State Insurance APPROVED BY NOTARY PUBLIC: Sign: - Print < < 1r ��, }_ % ;-� n::, DD 91 My Commiss. n ls� Exprres 11-17,2013 Through Atlantic "4,4 / fr P"74lans Examiner Zoning Structural Review (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) Clerk 1 .44C1C,NE 1E3r CE=TIFICATE OF U PRODUCER Excellence Insurance Agency 3801 SW 107 Avenue Miami, FL 33165 _ Phone (305)226-3900 Fax (305)226-3997 INSURED Pinar Electric, MD 4910 NW 102 Ave #102 Dora,. FL 33178- BLOW INSURANCE DATE (MMIDD/YY) I 05120/11 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 1 NAIC nauRER k GRANADA INSURANCE COMPANY mum/ 6: ASCENDANT COMMERCIAL INS.INC _INSURER C: INSURER D: INSURER E: COVERAGES INSURER F: ■ THE POLICIES OF INSURANCE LISTED 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 CERTIRCATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDMONS OF SUCH ! _ POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. 'INSR ADM , !POLICY EFFECTIVE ! POLICY EXPIRATION LIR_ DIERD i TYPE OF INSURANCE POLICY NUMBER ! DATE tresoorm , DATE IMWOIWOrl 1 1 GENERAL UABIUTY A LI COMMERCIAL GENERAL LIABILITY LIIfl CiASAS MADE 7 OCCUR I — ;111 GEM, AGGREGATE MITT APPLIES PER:4 - POLICY El PROJECT LI Loc AUTOMOBILE LIABILITY 1! 1 ANTAL/1-0 : ALL (PAINED AUTOS ! SCHEDULED AUTOS HIRED AUTOS L NON OWNED Amos IL; i GARAGE UABIUTY r- L.i ANY AUTO LI excEssrusumatAumnurt OCCUR 11 CLAIMS MADE :71 DEDUCTIBLE RETENTION $ 0185FL00001837-0 08/09/10 WORKERS COMPENSATION AND EMPLOYERS LIABILITY WC62714-0 08/09/11 LIMITS EACH OCCURRENCE DAMAGE TO RENTED PREMISES (Ea occurence) IVIED EXP (Any one person) 1.000,000 50,000 PERSONAL & ADV INJURY GENERAL AGGREGATE PRODUCTS= COMP/OP AGG $500 Ded FropDamage COMBINED SINGLE LIMIT (Ea accident) 1,000 1,000,000 1,000,000 1,000,000 BODILY INJURY (Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE (Per accklent) AUTO ONLY - EA ACCIDENT ANY PROPRIETOR / PARTNER / EIECUTIVE OFFICER MEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below IOTHER DESCRIPTIOif OF OPERATIONS / LOCATIONS / VEHICLES /EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS OTHER THAN EA ACC AUTO ONLY: AGG EACH OCCURRENCE ■ AGGREGATE ; 11/15/10 • 11/15/11 w-IMEt De"- EL EACH ACCIDENT 1,000,000 EL DISEASE - EA EMPLOYEE 1,000,000 E.L. DISEASE - POLICY LIMIT 1,000,000 Certificate for Pinar Electric MD Electrical Contractors CERTIFICATE HOLDER — — Miami Shores Villa G Building Department 10050 NorthEast 2nd Ave Miami Shores Florida ACORD 25(2001/08) OF CANCELLATION I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF. THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN HE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO 00 50 SHALL WOW NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVE& ' iLLITHORIZED REPRES ,2 el?"-A-}27 ACORD CORPORATION 1988 A ° , , ,CERTIFICATE O F LIABILITY INSURANCE PRODUCER Excellence Insurance Agency ' 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. DATE (MM/DD/YY) 05/20/11 3801 SW 107 Avenue Miami, FL 33165 Phone (305)226 -3900 INSURED Pinar Electric, MD 4910 NW 102 Ave #102 Dora!, FL 33178- Fax (305)226 -3997 INSURERS AFFORDING COVERAGE NAIC 5 INSURER& GRANADA INSURANCE COMPANY INSURER B: ASCENDANT COMMERCIAL INS.INC INSURER C: INSURER D: INSURER E: COVERAGES INSURER F: THE POLICIES OF INSURANCE LISTED 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. LT INEERD TYPE OF INSURANCE POLICY NUMBER DATE {maluD GENERAL LIABILITY _] COMMERCIAL GENERAL LIABILITY 0185FL00001837 -0 08/09/10 -1 ❑ CLAIMS MADE OCCUR A GEN'LAGGREGATE LIMIT APPLIES PER: r/I POLICY I- PROJECT Li LOC AUTOMOBILE LIABILITY L._ ANY AUTO I ALL OWNED AUTOS LG SCHEDULED AUTOS 7 HIRED AUTOS C NON OWNED AUTOS [_J _i GARAGE LIABILITY r ANY AUTO [1 B EXCESSIUMBRELLA LIABILITY OCCUR [ ! CLAIMS MADE iU Pi DEDUCTIBLE Li RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR / PARTNER / EXECUTIVE OFFICER / MEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below OTHER POLICY EXPIRATION EACH OCCURRENCE DAMAGE TO RENTED 08/09/11 PREMISES (Ea occwence) MED EXP (Any one person) LIMITS 1,000,000 PERSONAL & ADV INJURY GENERAL AGGREGATE PRODUCTS - COMP/OP AGG $500 Ded PropDamage COMBINED SINGLE UMrr (Ea accident) 50,000 1,000 1,000,000 1,000,000 1,000,000 BODILY INJURY (Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE (Per accident) AUTO ONLY - EA ACCIDENT OTHER THAN AUTO ONLY: WC62714-0 - 11/15/10 EA ACC AGG EACH OCCURRENCE AGGREGATE 11/15/11 WI TORYI MfrS ❑ ER EL. EACH ACCIDENT 1,000,000 E.L. DISEASE - EA EMPLOYEE 1,000,000 E.L. DISEASE - POLICY LIMIT 1,000,000 DESCRIPTION OF OPERATIONS ! LOCATIONS !VEHICLES !EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS !Certificate for Pinar Electric MD Electrical Contractors CERTIFICATE HOLDER Miami Shores Villa G Building Department 10050 NorthEast 2nd Ave Miami Shores Florida ACORD 25 (2001 /08) OF CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POUCR S BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF. THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED "WIVE 6 © ACORD CORPORATION 1988 CTEI Construction Trades Qualifying Board • BUSINESS CERTIFICATE OF COMPETENCY 03E000610 PINAR ELECTRIC MD INC D.B.A.: ORTA ANORES s certified under the provisions of Chapter 10 of Miami-Dade County ' MONTRAOTING NiTIL09/30120143 0001 QUALIFYING TRADE(S) ELECTRIC- %Cf. ATE OF FLORIDA PRES sit, NTRACTORS_=. CENSI LI,RGiso3 DATE,.,- 08/17/2010 ` 108010039 ERQ01478.8 The ELECTRICAL ; CQNTRACT- Named below HAS REGISTERED: Under the provisions ofe""=' Expiration date: AUG 31; (INDIVIDUAL MUST MEET:. AL] REQUIREMENTS ' .PRIOR TO CO ORTA, ANDRES LAZARO PINAR .ELECTRIC; YID I" 4910 NW 102ND AVE DORAL B,,GH4,,�1UIUiBER` CHARLIE CRIST GOVERNO$ 'SPLAY AS REQUIRED BY LA?� MIAMI -DADE COUNTY TAX COLLECTOR 140 W. FLAGLER ST. st FLOOR MIAMI, FL 33130 010 LOCAL BUSINESS TAX RECEIPT 2011 MIAMI -DADE COUNTY - STATE OF FLORIDA EXPIRES SEPT. 30, 2011 MUST BE DISPLAYED AT PLACE OF BUSINESS PURSUANT TO COUNTY CODE CHAPTER 8A ART, .9 & 10 THIS IS NOT A BILL — DO NOT PAY RENEWAL RECEIPT NO. 535477 -4 CC 8 03E000610 512580 -2 BUSINESS NAME / LOCATION PINAR ELECTRIC MD INC 10635 NW 122 ST 33178 MEDLEY OWNER PINAR ELECTRIC MD INC • Sec. Type of Business Tras Is 1196A ELELCTRICAL CONTRACTOR BUSINESS TAX RECEIPT. IT DOES NOT PERMIT THE HOLDER TO VIOLATE ANY EXISTING REGULATORY OR ZONING LAWS OF THE cOUNTY OR OWES. NOR DOES IT EXEMPT THE HOLDER FROM ANY OTHER LICENSE REQUIRED BY LAW. THIS IS NOT A CERRRCATION OF THE HOLDERS QUALIFICA- TIONS. PAYMENT RECEIVED C OEa COUNTY TAX 09/02/2010 02270017002 000045.00 SEE OTHER SIDE MIAMI -DADS COUNTY T AX COLLECTOR 140 W. FLAGLER ST. 1st FLOOR MWMI, FL 337,30,,:, FIRST -CLASS U.S. POSTAGE PAID MIAMI, FL PERMIT NO. 231 WORKER /S 2 DO NOT FORWARD PINAR ELECTRIC MD INC ANDRES ORTA PRES 4910 NW 102 AVE #102 DORAL FL 33178 i,IIiTI =ii.I,Iiii„ Iii,► iI1IiIi /Ii /iI11i,Ili1I „llii„Ii�i461 MUNICIPAL CONTRACTOR'S TAX RECEIPT - M1AMI -DADE COUNTY - STATE OF FLORIDA PURSUANT TO COUNTY CODE SEC. 10-24 ' EXPIRES SEPT. 30, 2011 THIS IS NOT A BILL — DO NOT PAY RECEIPT NO. 30- 5354774 ' CC NO: 03E000610 BUSINESS NAME / LOCATION PINAR ELECTRIC MD INC 10635 NW 122 ST OWNER :PINAR ELECTRIC MD INC SEE BACK OF RECEIPT FOR. A LIST OF NON — PARTICIPATING MUNICIPALITIES Receipt holder must register in the city where work is to be done. PAYMENT RECEIVED MlAMi -DADS couNTY rwc X702/2010 02270017001, - 000200.00 FIRST -CLASS U.S. POSTAGE PAID MIAMI, FL PERMIT NO. 231 RECEIPT HOLDER MAY DO BUSINESS AS A CONTRACTOR AS SPECIFIED HEREON. ELECTRICAL CONTRACTOR DO NOT FORWARD PINAR ELECTRIC MD INC ANDRES ORTA PRES 4910 NW 102 AVE #102 DORAL FL 33178 lat.Ullill Hllil11li11i1111 111111 1111111 111111111111 li ?11