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RC-10-2020
Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 153286 Permit Number: RC -11 -10 -2020 Scheduled Inspection Date: August 04, 2011 Inspector: Bruhn, Norman Owner: Job Address: 638 NE 97 Street Miami Shores, FL 33138- Project: <NONE> Contractor: MICHAEL ARIAS RESIDENTIAL CONTRACTOR CORP Permit Type: Residential Construction Inspection Type: Final Work Classification: Kitchen Cabinets Phone Number (305)606 -3635 Parcel Number 1132060171660 Phone: (786)256 -5358 Building Department Comments REMOVE AND REPALCE KTICHEN CABINETS Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments cc_ August 03, 2011 For Inspections please call: (305)762 -4949 Page 2 of 24 133 4� ! 141 408 Ala ?9c P3 1:33 C'Cio :WO :UII,IFCT TO COMPI IANCE WITH ALL FEDERAL L TI ' ; I A i l AND COUNTY RULES AND REGULATIO NS peRf �°)-- zepick ereex -7 -v/t ,ye, 14 "494 /l• /7'ec 11112111 Pia JULIO C. CASTILLO .� vF Comm# 000€366299 L. t. Expires Florida NotaryAsso., Inc fig 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 Type: BUILDING OWNER: Name (Fee Simple Titleholder): Greatest Permit No. V-C-' 1 `J Master Permit No. Enterprises, LLC Address: 1835 NE Miami Gardens Drive #232 Phone #: 305 - 606 -3635 City: North Miami Beach State: Tenant/Lessee Name: Email: JosephDahan @Yahoo.com FL Zip: 33179 Phone #: JOB ADDRESS: 638 NE 97 Street City: Miami Shores County: 11- 3206 - 017 -1660 Folio /Parcel #: Miami Dade Zip: 33138 Is the Building Historically Designated: Yes INOI Flood Zone: X CONTRACTOR: Company Name: Michael Arias Residential Contracor Corp. Phone #: 786- 256 -5358 Address: 14361 SW 37 Street City: Miami State: FL Qualifier Name: Michael Arias Phone #: State Certification or Registration #: Certificate of Competency #: Contact Phone #: 786 - 256 -5358 Email Address: arimc7 @aol . com DESIGNER: Architect/Engineer: Phone #: `e ®®0 Value of Work for this Permit: $ Square/Linear Footage of Work: 130 sf Zip: 33175 786 - 256 -5358. Type of Work: ClAddress UAlteration ONew ZiRepair /Replace Description of Work: Remove and replace Kitchen Cabinets ODemolition COLOR THROUGH ROOF TILE IS REQUIRED acknowledged by: ****,****,** * ******** * ****** ** * * *,* **** * ** Fees * * * * * *** **** * *, * *** ,* **** * * * * * * * ** *,* **** ** ** Submittal Fee $ Permit Fee $ T4004216 Scanning Fee $ Radon Fee $ Notary $ Training /Education Fee $ Double Fee $ Structural Review $ CCF $ CO /CC $ DBPR $ Bond $ Technology Fee $ TOTAL FEE NOW DUE $ p (3`-D 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: 1 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 w 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 approved and a reinspection fee will be charged. Signature Owner or Agent The foregoing instrument was acknowledged before me this OZ day of November, 2010 , by Joseph Dahan who is personally known to me or who has produced As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commission Expires: *** * * *xxxxxxxxx * *xxxxx *x * * * ** APPROVED BY Signature ' Contractor The foregoing instrument was acknowledged before me this /L day of November , 2010 , by Michael Arias who is personally known to me or who has produced as identification and who did take an oath. ERIC MARKZIMEI.MAN Notary Public -State of Florida Commission #DD734368 (Revised 07/10/07X Revised 06/1 0/2009)(Revised 3 /15 /09)(rev6 /4 /l0) Plans Examiner Structural Review NOTARY PUBLIC: Sign: Print: M Commission Et- pires: ERIC MARK ZIMELMAN Notary Public - State of Florida 4 Commission #DD734368 My Commission Expires Nov.13, 2011 Zoning Clerk IN THE CIRCUIT COURT OF THE ELEVENTH JUDICIAL CIRCUIT IN AND FOR MIAMI -DADE COUNTY, FLORIDA JPMORGAN CHASE BANK (NA) Plaintiff(s) / Petitioner(s) VS. LERA, LUZ ELENA , et al. Defendant(s) / Respondents(s) 111111111111111111111111 10111111111111111111 CFINt 2O1OR 30016 OR Bk 27423 Ps 2711► 109) RECORDED 09/16/201 :15:07:04 DEED DOC TAX 1,162 20 HARVEY RUVIN, CLERK OF COURT MIAMI -DADE COUNTY, FLORIDA LAST PAGE GENERAL JURISDICTION DIVISION Case No: 09014617CA01 Section: 10 Doc Stamps: $1,162.20 Surtax $0.00 Consideration: $193,700.00 CERTIFICATE OF TITLE The undersigned clerk of the court certifies that a Certificate of Sate was executed and filed in this action on September 03, 2010, for the property described herein and that no objections to the sale have been filed within the time allowed for filing objections. The following property in Miami -Dade County, Florida: LOTS 6 AND EAST 1/2 OF LOT 7 , BLOCK 100, AMENDED PLAT BIL4MI SHORES SECTION NO, 4, ACCORDING TO THE PLAT THEREOF AS RECORDED IN PLAT BOOK 15, AT PAGE 14, OF THE PUBLIC RECORDS OF MIAMI -DADR COUNTY, FLORIO& Property Address: 63B NE PITH STREET, M AMI MCIREA FL 33133 was sold to: GREATEST ENTERPRISES, LLC. AS TRUSTEE OF BSD18 -17 LAND TRUST DATED 8/31/2010, WITH POWER TO PROTECT, CONSERVE AND TO SELL OR LEASE AND ENCUMBER OR OTHERWISE TO MANAGE AND DISPOSE OF SUBJECT REAL ESTATE. 1835 NE Miami Gardens Drive Suite 232 North Miami Beach , FL, 33179 e- t[) ■5, et7 CC? )-c uo :c. TAA470. cs GJ GO • rIc cJq .., it r.r -w FILED FOR RIC Rev. 1015/2009 WITNESS my hand and the seal of this court on September 14, 2010 . 1 Harvey Ruvin, Clerk of Courts Miami -Dade County, Florida Book27423/Page2711 CFN #20100630016 Page 1 of 1 NOTICE OF COMMENCEMENT A RECORDED COPY MUST BE POSTED ON THE JOB BITE AT TIME OF FNIST INSPECTION PERMIT NO. ROO '4°2° TAX FOU0 NO. 11- 3 2 0 6 - 017 - 166 0 STATE OF FLORIDA. COUNTY OF MIAMI-DADE: THE UNDERSIGNED hereby gives notice that imOteveniente WM be made to certain real property, and hi accordance with Chapter 713, Florida StatUtee. the following information is provided in this Notice of Commencement 1. Legal description of property and street/address: 111111111111111111111111111111111111111111111 CFN 2010R0776508 OR Bk 27491 Ps 3027; (1ps) RECORDED 11/16/2010 11:34:24 HARVEY RUVIN, CLERK OF COURT MIANI-DADE COUNTY? FLORIDA LAST PAGE Lot 6 & E 1/2 of 7, B1ock 100, o Miami Shores Sec 4 AMID PB 15-14 2. Description of improvement: Replace kitchen cabinets and install 3 exterior doors 3. Owner(s) name and address: _ Greatest Enterprises,_ Interest in property: Name and address of fee simple titleholder 4. Contractor's name and address: _Michae1 Arias Residential Contractor Corp. 14361 SW 37 Street, Miami, FL 33175 -./) 5. Surety: (Payment bond required by owner fn:fin contractor, if any) Name and address: Amount of bond $ 6. Lender's name and address: 0 0 s office on 9 z < T m Signature of Owner 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 and address: G--test t ra. 1835 NE Miami Ga.rdens Drive #232, N. Miami Beach, FL 33179 8. In addition to himself, Owners designates the follOvving person(s) to receive a copy of the Uenor's Notice as provided in Section 713.13(1)(b), Florida Statutes. Name and address: Expiration date Of this Notice of Corrithencement the expiration date is 1 year from the date of recording unless a different date is specifie • print Owner's Name Joseph Da.han _ Prepared by •jor424 1)4414 Sworn to and subscribed before me thiS Milday of Akee.4iver .,20 Address: 41,CA/gfilliWi .41446-19re-23 Atvg--14- Pift4-wiert,CK 3301 Notary Public Print Notary's Name My commission expires: 123.0142 PAW 4 0102 .--Eftle-MARKZINEMAN7-- Notary Public - State Of Flarida 4 Commission #01:4734368 4 My CommIssion Explrfas Nov.13,2011 driirmanomirmworgro"."1"1"..""ti OP ID: AH A4i. -- CERTIFICATE OF LIABILITY INSURANCE DATE 10122!110 0 10122 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 WAIVED, 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 800- 742 -1691 Hallandale Branch 954- 454 -95552 Riemer Insurance Group PO Box 250 Hallandale, FL 33008 -0250 Stephen l Riemer CONTACT PHONE FAx WC, (AK'N�> li')' ADDRESS: PRODUCER MICHAE2 CUSTOMER ID t. INSURER(S) AFFORDING COVERAGE NAIC # INSURED Michael Arias Residential Contractor Corp 14361 SW 37th Street Miami, FL 33175 INSURER A : Western Heritage Insurance Co LIABILITY COMMERCIAL GENERAL INSURER B: INSURER C SCP0817136 INSURER D : 08/24/11 INSURER E : $ INSURER F : PREMISE OERE0NceTuED me) COVERAGES CERTIFICATE NUMBER: 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 POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE �DDL INSR SUBR WVD POLICY NUMBER POLICY EPF (MMIDDIYYYY) POLICY EXP (MMIDDIYYYY) LIMITS A GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY X OCCUR SCP0817136 08124/10 08/24/11 EACH OCCURRENCE $ 1,000,000 PREMISE OERE0NceTuED me) $ 50,000 CLAIMS -MADE MED EXP (Anyone person) $ 5,000 GENT 7 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 1,000,000 AGGREGATE LIMIT APPLIES PER POLICY FRO- JECT LOC PRODUCTS - COMP/OP AGG $ 1,000,000 $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS H RED AUTOS NON -OWNED AUTOS COMBINED SINGLE LIMIT (Ea accident) BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ $ UMBRELLA LIAR EXCESS LIAR OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DEDUCTIBLE RETENTION $ $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y 1 N ANY PROPRIETOR!PARTNERIEXEO_UTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If VOL describe under DESCRIPTION OF OPERATIONS below N IA WC STATU- OTH- TORY LIMITS ER E L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES (Attach ACORD 101, Additlanal Remarks Schedule, If more space Is required) CARPETRY - Interior Residential TION Miam i Shores Villa a MIAMSH1 g 10050 N.E. 2nd 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 ,ye ACORD 25 (2009109) @ 1988 -2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 07- 28 -'11 07:13 FROM- T -275 P0005/0007 F -864 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756 -8972 Inspection Number: INSP -1 53290 Permit Number. PL -11- 10.2023 Scheduled Inspection Date: July 27, 2011 Inspector: Hernandez, Rafael Owner: Job Address: 638 NE 97 Street Miami Shores, FL 33138- Project: <NONE> Contractor: DIAL PLUMBING CORP Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Addition /Alteration Phone Number (305)606-3635 Parcel Number 1132060171660 Phone: (305)221 -8569 Building Department Comments KTICHEN REMODEL Inspector Comments Passed Failed Correction Needed Re- Inspection Fee No Additional InspectionS can be scheduled until re- inspection fee is paid. July 26, 2011 For Inspections please call: (305)7624949 Page 3 of 30 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756 -8972 Inspection Number. INSP- 153290 Scheduled Inspection Date: July 27, 2011 inspector: Hernandez, Rafael Owner: Job Address: 638 NE 97 Street Miami Shores, FL 33138- Project: <NONE> Contractor: DIAL PLUMBING CORP Permit Number. PL-11-10-2023 Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Addition /Alteration Phone Number (305)606 -3635 Parcel Number 1132060171660 Phone: (305)221 -8569 Building Department Comments KTICHEN REMODEL Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments July 26, 2011 L•d For Inspections please call: (305)762 -4949 LL98-i 8-900 1VNOLLV■2:131NI Page 3 of 30 B917:90 1.0 CO adV 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 Type: PLUMBING OWNER: Name (Fee Simple Titleholder): Greatest Enterprises, LLC auto —?f Phone #: 305 - 606 -3635 Address: 1835 NE Miami Gardens Drive #232 Email: City: North Miami Beach State: FL gip; 33179 Tenant/Lessee Name: Phone #: JosephDahan@Yahoo.com JOB ADDRESS: 638 NE 97 Street City: Miami Shores Folio/Parcel #: 11- 3206 - 017 -1660 County: Miami Dade Zip: 33138 Is the Building Historically Designated: Yes NO Flood Zone: X CONTRACTOR: Company Name: Dial Plumbing Corp Phone #: 786 -412 -6720 Address: 9940 SW 22 Street City: Miami Qualifier Name: State: FL Zip: 33165 Francisco Fonteboa Phone#: 786- 412 -6720 State Certification or Registration #: QB 6 7 0 4 0 Certificate of Competency #: 14 319 Contact Phone #: 786-412-6720 8 6- 412 - 6 7 2 0 Email Address: DESIGNER: Architect/Engineer: Phone #: Value of Work for this Permit: $ 3 5 0 . 0 0 Square/Linear Footage of Work: /30 sF Type of Work: Address ❑Alteration ONew ®Repair/Replace ODemolition Description of Work: Remove and replace existing kitchen Sink, faucet, dishwasher, & garbage disposer due to installation of new kitchen cabinets. ********* * * * * * * * * * * * * ***:u **** **** * * * * ** Fees * ** *:x ****** * * * * ** *** * ** * ** * *** * ** ** x****** Submittal Fee $W s V Permit Fee $ /PO-- CCF $ CO /CC $ Scanning Fee $ 1 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 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 CONDIITONERS, 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 posted at the job site for the first inspection which occurs seven (7) days after the building permit issued. In , absen ` of su'. posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature Owner or Agent The foregoing instrument was acknowledged before me this 27th day of October, 2010 , by Joseph Dahan , who is personally known to me or who has produced As identification and who did take an oath. NOTARY PUBLIC: Sign: .. ° Print: My Commission Expires: * * * * * * * * * * * * * * * * * * * * * ** APPROVED BY ERIC MARX ZIMELMAN Notary Public - State of Florida Commission #DD734368 My Commission Expires Nov 13, 2011 Contractor The foregoing instrument was acknowledged before me this 27th day of October, 2010 , by Francisco Fonteboa, who is personally known to me or who has produced FL DL as identification and who did take an oath. NOTARY PUBLIC: 4►.4111 Sign: Print: __j ERIC MARK ZIMELMAN Notary Public - State of Florida My CommissiOn ExpireEom mission #DD734368 I q My Commission Expires Nov.13, 2011 ( ************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** dl - fr - - /a" Plans Examiner Structural Review (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) Zoning Clerk 0� 1�� r f 400 DATE (MM(DDmm) Ac 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 POUCIES 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 poiicy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and condWons 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 Pat Del Vecchio Insurance Agency 263 N.E. 8th St. Homestead, FL 33030 Phone (305)246 -9500 Fax (305)246 -9502 CONTACT NAME: (PHONE E-MAIL COVERAGES CERTIFICATE 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 POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. POUCY EXP (MMIDDNYYY) REVISION NUMBER: INSR TYPE OF INSURANCE GENERAL LABILITY ❑ COMMERCIAL GENERAL LIABILITY ❑ ❑ CLAIMS -MADE 5 OCCUR GENL AGGREGATE UMIT APPUES PER ❑ POLICY ❑ s & ❑ LOC AUTOMOBILE LABILITY ❑ ANY AUTO ❑ ALL OWNED AUTOS ❑ SCHEDULED AUTOS ❑ HIRED AUTOS ❑. NON -OWNED AUTOS ❑ _t ADDL INSR SUER WVD POUCY NUMBER (MAM!DCD/YYFYY) uMrrs EACH OCCURRENCE DAMAGE TO RENTED PREMISES (Ea occurrence) MED EXP (My one person) PERSONAL & ADV INJURY GENERAL AGGREGATE PRODUCTS - COMP /OP AGG COMBINED SINGLE UMIT (Ea accident) BODILY INJURY (Per person) BODILY INJURY (Per accident, PROPERTY DAMAGE (Per accident) ❑ UMBRELLA LAB ❑ OCCUR ❑ EXCESS LAB ❑ CLAIMS -MADE ❑ DEDUCTIBLE ❑ RETENTION $ `« EACH OCCURRENCE AGGREGATE WORKERS COMPENSATION AND EMPLOYERS' LABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yyes� desaibe under DESORPTION OF OPERATIONS below NIA OTH n auks n ER E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE E.L. DISEASE - POLICY UMIT DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, 11 more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. ACORD 25 (2009/09) OF ©19 :: 009 ACORD CORPORATION. All rights reserved The ACORD name and logo are registered marks of ACORE Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 \0f Inspection Number: INSP- 162623 Scheduled Inspection Date: August 02, 2011 Inspector: Devaney, Michael Owner: Job Address: 638 NE 97 Street Miami Shores, FL 33138- Project: <NONE> Contractor: LIGHTGATE INC Permit Number: EL -11 -10 -2021 Permit Type: Electrical - Residential Inspection Type: Final Work Classification: Alteration Phone Number (305)606 -3635 Parcel Number 1132060171660 Phone: 305 - 554 -4820 Building Department Comments REPLACE CARBON MONOXIDE/ SMOKE DETECTORS AND 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- 162558. Add smoke / carbon monoxide detector, on arc fault protected circuit. August 02, 2011 For Inspections please call: (305)762 -4949 Page 18 of 26 Miami Shores Village ` /.2 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 No.EL1O —202 Master Permit No. Permit Type: Electrical - ,/ OWNER: Name (Fee Simple Titleholder): �1 /reedes /e/fi 5. cc C . Phone #:305 -lob -3635. Address: 63 e /r35 Aft '1/ ` / 641491/6" Pe . *232— City: 1/i 9 -i/ Bead/- State: Zip: 331 `i Tenant/Lessee Name: Phone #: Email: ..roS f /a DA-/MAJ yfr/760 . Cevi7 JOB ADDRESS: 63 ' ,/fig 99- gfi'eeT City: Miami Shores Folio/Parcel #: //-3240‘ ° t} /? m /66o Is the Building Historically Designated: Yes i O Flood Zone: County: Miami Dade Zip: 33/3g CONTRACTOR: Company Name: e..--rot V}Z Phone #: i300 Address: 10(1Z.. kick) City: Ili ,4 ! State: Qualifier Name: �� a�� ,��,� Y State Certification or Registration #: 'd`.a)C30`?,12 O Certificate of Competency #: Contact Phone #: 2 . „ 2rNOO Email Address: DESIGNER: Architect/Engineer: Phone #: Phone #: Zip: 3 3 12--2 Value of Work for this Permit: $ 11 100 Square/Linear Footage of Work: Type of Work: OAddress ❑Alteration ONew l3Repair/Replace ODemolition Description of Work: R� Q_,Q, 0 ILVILN4e... aea C.. A *********** *m***** ****+x***m**+x*********Fees:******* * * * ********* * **x:**:u ***** ** ***m*x:+ *** Submittal Fee $'3 ° CO Permit Fee $ / 6'f, P' ® 4°- 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 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, BOTT .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 $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Owner or Agent The foregoing instrument was acknowledged before me this , day of MrAffee,60 / ®, by -TESE P 14 0/4 (440%..) who is personally known to me or who has produced re- Di. As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commission Expire Notary Public - State of Florida Commission #0D734368 My Commission Expires Nov.13, 2011 * * * * * * * * * * * * * * * * * * ** Signature Contractor The foregoing instrument was acknowledged before me this ,20 tO,by 4zd 120 as..411-6 own to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: APPROVED BY r �y / P%L / /6'01/Plans Examiner Structural Review (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) Sign: Print: My Commis$ . mm# 0008 Expires 1;(2013 Florida Notary Assn., Inc Zoning Clerk NOV -04 -2010 09:26 AM LIGHTGATE , INC ACORty°' CERTIFICATE OF LIA THIS CERTIFICATE 18 ISSUED AS A NAM* OF INFORMATION ONL` CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, BELOW. THIS CERTIFICATE OP INSURANCE DOES NOT CONST1Ttl1 REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: if the certlflcate holds ter s n ADDITIONAL INSURED, the terms and conditions of the policy, certain pollclas may require an e certIAost. holder in Ilea of su - ch endors,ment(s).. PRODUCER Fort= Insurance, Inc. 365 Palermo Ave Corals Gables INSURED LIGliTGATE, INC 1421 SIN 107TE AVENUE SUIT* 103. MIAMI FL. 33134 -6607 St 333.74 3055592183 P. 02 SULITY INSURANCE I AND CONFERS NO RIGHTS UPON THE CERTIFICATE ND OR ALTER THE COVERAGE AFFORDED rE A CONTRACT BETWEEN THE ISSUING INSURER(S), pA �1r' o HOLDER. THIS BY THE POLIOIES AUTHORIZED policy(Ies) must be endorsad. If SUBROGATION IS WAIVED, subject to Itdorsemuat A etafement an this certlloats doss not confer rights to the "• 1 aCT Ifeutc3!' Campuaano ttr. " - , a .. _.. << • pm) 425 -0825 ' . I L� �•;;i ,:_ - roar .cumptuvanoSforturansuranos.o0o : "'`. /0050209 • „V•,;1,;4 -: APf O` ROSO) ,...4.,L,..; GE INSURER A Granada Insur+a nos Co NM NM :.,; - . - • echnol - • ►, Ins Co I i- COVERAGES CERTIFICATE NUMBER:CL7.0101902461 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 1S SUBJEOY TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. REVISION NUMBER: .t7 TYPE OP PM/DANCE a6NIN1AL LIABILITY n low el? COMMERCIAL GENERAL IJAS r1Y CLA3MS -MADE fl CCCUR AGGREGArEpearrr' APPLIES PER: X POLICY 1 1 Ms; I] LOC AUTDMOIELE LIABILITY ANY AUTO ALL C YNED AUTOS SCHEDULED AUTOS M ED AUTOS NOM -OWNED AUTOS 1:41; Elie POLICY ,I y' ;'?AU_ TINS: 018S1PL0000432T 30/20/20 %0 110/20/2013 UMSRELLA LMAE antes LIA5 I—” OCCUR CLAM-MADE DEDUCTIELE N WORKERS COMP' :: ATM AND MIFpLOOYERV UAnILITY Y11,4 =a EXOI.UD E 0 (Mannany In NN) OI+ PERATIONS NIA Tat 3232370 4/23/2010 4/22/2011 OSSCRlPIION OP OPERATIONS T LOCATIONS /MECUM Flinch ACORD 101, AddWonsl *Wants SaAOdula,11 mere aptOs Is raqu(ndl 0 TIRO TE HOLD R MIAMI SHORES VILLAGE 10050 N.E 2nd AVE MIAMI SHORES, FL 33138 ACORD 20 (2009109) INS025 cr CELLATI„QN EACH OCCURRENCE M8O EXP (Any vn0 MOM) PERSONAL 5 lair/ INJURY Dooms. AGGREGATE PRODUCTS • 0011MVOP A 50,000 1,000 7.,000,000 2,000,000 2 000 000 GOMBWED SINGLE UMIT (Ea 110448444) 1 SODDY INJURY Doer pow) $ 5 BODILY INJURY (PaT40WIM PROPERTY DAMAGE (Pst sat) SACH OCCURRENCE ADDRSDATE 1 E1.. EACH ACCIOgIYT E.L. DISEASE - EA EMPL E DISEASE - POLICY LIAUT SHOULD ANY OF THE ABOVE DESCRIBED POLICIES DE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL SE DELIVERED IN ACcORDANCO WITH THE POLICY PROVISIONS. AUTHORIZED 14EP ESENTA1WS Heat= IPorton /SCLO --e V& ACORD CORPORATION. All rights r�rrved. The ACORD ROM and logo are rsgistsred narks of AGED