Loading...
RC-11-1168Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 161431 Scheduled Inspection Date: September 26, 2011 Inspector: Bruhn, Norman Owner: Permit Number: RC -6 -11 -1168 Job Address: 269 NE 100 Street Miami Shores, FL 33138- Project: <NONE> Contractor: DEERE INDUSTRIES LLC Permit Type: Residential Construction Inspection Type: Final Work Classification: Addition /Alteration Phone Number Parcel Number 1132060134690 Phone: (305)986 -8632 Building Department Comments REPLACEMENT OF KITCHEN CABINETRY, ENLARGMENT OF MASTER BATHROOM CLOSET, REPLACE OF BATH FLOORING, WET AREAS TO STONE. REMOVE TUB AND INSTALL SHOWER. Passed, 9J26-fd- Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments et— September 23, 2011 For Inspections please call: (305)762 -4949 Page 10 of 41 Permit Number: RC -6 -11 -1168 I Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 inspection Number: INSP - 161440 Inspection Date: August 25, 2011 Inspector: Bruhn, Norman Owner: Job Address: 269 NE 100 Street Miami Shores, FL 33138- Project: <NONE> Contractor: DEERE INDUSTRIES LLC Permit Type: Residential Construction Inspection Type: Insulation Work Classification: Addition /Alteration Phone Number Parcel Number 1132060134690 Phone: (305)986 -8632 Building Department Comments REPLACEMENT OF KITCHEN CABINETRY, ENLARGMENT OF MASTER BATHROOM CLOSET, REPLACE OF BATH FLOORING, WET AREAS TO STONE. REMOVE TUB AND INSTALL SHOWER. Passed 0,0.6 Inspector Comments See (.s. iii-e0A-1-- S24/I Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled re- inspection fee is paid. until August 25, 2011 For Inspections please call: (305)762 -4949 Page 1 of 1 Permit Number: RC -6 -11 -1168 I Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 nspection Number: INSP - 163657 Inspection Date: August 25, 2011 Inspector: Bruhn, Norman Owner: Job Address: 269 NE 100 Street Miami Shores, FL 33138- Project <NONE> Contractor: DEERE INDUSTRIES LLC Permit Type: Residential Construction Inspection Type: Drywall Screw Work Classification: Addition /Alteration Phone Number Parcel Number 1132060134690 Phone: (305)986 -8632 Building Department Comments REPLACEMENT OF KITCHEN CABINETRY, ENLARGMENT OF MASTER BATHROOM CLOSET, REPLACE OF BATH FLOORING, WET AREAS TO STONE. REMOVE TUB AND INSTALL SHOWER. Passed C f� Inspector Comments CREATED AS REINSPECTION FOR INSP- 163596. CREATED AS REINSPECTION FOR INSP- 161433. NO ONE HOME NB 8/19/11 Work covered no inspection. NB 5.e. (#3. ��- trot. r J r Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled re- inspection fee is paid. until August 25, 2011 For Inspections please call: (305)762 -4949 Page 1 of 1 DANIEL LOPEZ, P.E FL P.E # 69761 19341 STERLING DR. MIAMI, FL. 33157 PH -305 970 5201 FINAL LETTER OF COMPLIANCE Date: August 22- 2011 MIAMI SHORES Building Department RE: Permit 269 NE 100 ST Dear Building Official, I, Daniel Lopez, having performed and approved the required inspections, hereby attest that to the best of my knowledge, belief and professional judgment, the structural and envelope components of the above referenced structure are in compliance with the approved plans and other approved permits documents. I also attest to the best of my knowledge, belief and professional judgment, the approved permit plans represent the as- built condition of the structural and envelope component of the said structure. This document is being prepared in accordance with Florida Building Code and is being submitted to the MIAMI SHORES Building Department at the time of final inspection. Should you have any questions or need any additional information, please do not hesitate to call me. Sincerely; ANIEL LOPF.Z, . 69761 7 /s /it rA0QM Miami Shores Village ,1III< z S ;yQ Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 BY o.,.;e;..a.<,,aa „, ;.:: Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 BUILDING PERMIT APPLICATION FBC 20 Permit T ROOFING Permit No. �..,) I I1 W Master Permit No. OWNER: Name (Fee Simple i e s older): l & & lky cr i J� Phone #: J t 7 Sc/7. 939Y Address: 4-"� . .`Q g lni I d' a k a o Z City: . C(3.y.j State: FL Zip: 33i 3 0 Tenant/Lessee Name: Fil Ark '3 Iev Phone #: 561. S' 1J 1793 .rr Email: s 1' Li°`t l l• 4 e_■ • o JOB ADDRESS: Zb Nj E., S, City: Miami Shores County: Miami Dade Zip: 33 S 3 Folio/Parcel #: / / 3 7_0 10/ 3 (., �,4o Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name:_' - . YC- ' Con.) s cW c .a.A) Address: Co.2.2.z Sw t5Z t—L.- C_ Phone #:(305-) 2-1-53,---1:3-Q City: Mi AM t State: .- Zip: 3 3 I -CI- Qualifier Name: --R-N-1\ Phone #: State Certification or Registration #: V G k5 01 -1*-4* C1 Certificate of Competency #: Contact Phone #: (TO 6) Zia - y� Z� Email Address: DESIGNER: Architect/Engineer: Phone #: Value of Work for this Permit: $ 2A340 T 500 Square/Linear Footage of Work: Type of Work: Addition ❑Alteration / `` ll�AA -- ❑Neew G tepair/Replace Description of Work: i C L. ' 4 rl'TG CAbik`L� sol, 1 ..Eh1 k ”. re fo'rciLL v La 0, v/�,s 7 d 4-447;411 4 1 � �� � * * * ** * * * * ** * *** * * ** * * * * * * * * * * * * * * * * ** *Fe ************ * * * * * * * * * ** * * * * * * * ** * * ** * * * * * ** Submittal Fee $ Permit Fee $ /'S CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ UDemolition 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 All 1+'IDAVIT: 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. Signature Owner or Agent The foregoing instrument was acknowledged before me this a f day of itrj , 20 , by , who is personally known to me or who has produced As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: $ (% 4A(-4 S My Commission Expires: „o STELA MARIS PRENDES Commission CJ $355155 ires Ja nurZ "!' 2� "� , 201? &M: 'NalThyFmRlfi;y; aCdW6 ************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** APPROVED BY (Revised 07 /10 /07)(Revised 06 /10 /2009XRevised 3/15/09) Signature Contractor The foregoing instrument was acknowledged before me this 2 day of do, , 2011 , who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: vicatAA;0. Print: M s P -7r✓ � �� My Commission Expires: * * * * * * * * * * * * * * * ** Plans Examiner Structural Review Clerk 11111111111111111111111111111111 1 111111111111 NOTICE OF COMMENCEMENT A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION PERMIT NOT 1 If • 11 t TAX FOUO NO. 113 1-0601 3 (-j 00 o STATE OF FLORIDA: COUNTY OF MIAMI -DADE: CFN 2011R0489835 OR Bk 27767 F's 1873; (fps) RECORDED 07/25/2011 10:51:27 HARVEY RUV'IN: CLERK OF COURT MIAMI--CDACDE COUNTY? FLORIDA LAST F'ACE THE UNDERSIGNED hereby gives notice that improvements will be made to STATE LLR DuA � property, and in accordance with Chapter 713, Florida Statutes, the following itirid is provided in this Notice of Commencement. KOWESS my HARVEY RUVR By on day of �uari's r O.C. 1 . Legal description of property and street/address: 7-49 E. Id s , Space above reserved for use of recording offic t- 1r44:4,St, ofrej � X3313 2. Description of improvement: 3. Owner(s) name and addres : 1L4, fi e,+ ,r.1^4s Li..C. Interest in property: Name and address of fee simple titleholder: l (042v M-.L1 d ti—Cl_ Zito SL.J (5 f (/), 190.2. 1.44,. 4. Contractor's name, address and phone number: 5. Surety: (Payment bond required by owner from contractor, if any) Name, address and phone number. t -► /A Amount of bond $ i�(1 6. Lender's name and address: 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 Uenor'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: f/Z s /19 (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 FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT. Signature(s) of Owner Prepared By Print Name Trtle/Office nigay.tutptized Officer /Director /Partner /Manager Prepared By Print Name Title /Office ¢ Kt- s /- STATE OF FLORIDA t/ COUNTY OF MIAMI -DADE The fo •ir,�g iq� b o nt was o g re me this By karr ❑ Individually, or ❑ as for ❑ Personally known, or produced the following type of identification: t I Signature of Notary Public: Print Name: (SEAL) VERIFICATION PURSUANT TO SECTION 92.525. FLORIDA STATUTES Under penalties of perjury, I declare that I have read the foregoing and that the facts stated in it are true, to the best of my knowledge and belief. Si natures of Owner(s) or Owner(s)'s Authorized Officer/Director/Partner /Manager who signed By /7jek,15 day of c 1L..% c;. t above: By Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 163873 Scheduled Inspection Date: September 20, 2011 Inspector: Devaney, Michael Owner: ces? Permit Number: EL -6 -11 -1173 Job Address: 269 NE 100 Street Miami Shores, FL 33138- Project: <NONE> Contractor: ONLY ELECTRIC CO INC Permit Type: Electrical - Residential Inspection Type: Final Work Classification: Addition /Alteration Phone Number Parcel Number 1132060134690 Phone: 305 - 785 -6059 Building Department Comments ELECTRIC - REMODEL KITCHEN AND BATH 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- 163813. CREATED AS REINSPECTION FOR INSP- 161489. Service not to code. Meet with owner meet with owner and electrician. A permit need's to be applied for to repair the service befor the existing permit can be finaled. September 19, 2011 For Inspections please call: (305)762 -4949 Page 14 of 31 Project Address Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Parcel Number Applicant 269 NE 100 Street Miami Shores, FL 33138- 1132060134690 ALBA INVESTMENT II, LLC Block: Lot: Owner Information Address Phone CeII ALBA INVESTMENT II, LLC 690 SW 1 Court MIAMI FL 33130- Contractor(s) ONLY ELECTRIC CO INC Phone 305 - 785 -6059 CeII Phone Type of Work: KITCHEN AND BATH REMODEL Additional Info: Classification: Residential Scanning: 1 Fees Due CCF DBPR Fee DCA Fee Education Surcharge Permit Fee - Additions/Alterations Scanning Fee Technology Fee Total: Amount $0.60 $2.25 $2.25 $0.20 $150.00 $3.00 $0.80 $159.10 Pay Date Pay Type Invoice # EL -6 -11 -41321 07/21/2011 Check #: 1048 $ 109.10 $ 50.00 06/29/2011 Check #: 1035 $ 50.00 $ 0.00 Amt Paid Amt Due Available Inspections: Inspection Type: Final Meter Box Alteration Relocation Fire Alarm Service Change Underground W. W. 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. July 21, 2011 Authorized Signature: Owner / Applicant / Contractor / Agent Building Department Copy Date July 21, 2011 1 Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 JUN N INSPECTION'S PHONE NUMBER: (305) 762.4949 BUILDING Permit No. L 11—I riS PERMIT APPLICATION Master Permit No. RO ' 0 FBC 20 Permit Type: Electrical ��p r OWNER: Name (Fee Simple Titleholder): /lam �- + ' ii3 'G t 1. -�.� -- Phone #: 5D / • S `7 ?.')J 3 Address: 6 q n std i 4 �c...� . s Q Qaz. City: f it ikfw• � _ State: /� Tenant/Lessee Name: MOVE E .r{rp� $ 9 Email: API ..2\t" kk CA S •A, • JOB ADDRESS: Z- l t t 0044 St. Zip: 3710 Phone #: 541. SWl. 9193 City: Miami Shores County: Miami Dade zip: 33/3Y Folio/Parcel #: Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name: Oh L1 e...(1Y l C� Phone #: Address: 3LI 1 N1AJ 10)- ndi 11.4 City: P lfl'.1,N" Jl ml.N State: t' L, Zip: ►": 377214 t Qualifier Name: ,44 t fo,g State Certification or Registration #: rG -13 6023/ , Certificate of Competency #: /'-.) E- aYJ G Y9 Contact Phone #: 505, 71c5-. i(05 1 Email Address: DESIGNER: Architect/Engineer: Phone #: Phone #: Value of Work for this Permit: $ 7 5) Square/Linear Footage of Work: 0 Type of Work: OAddress DAlteration // ONew epair/R lace ODemolition Description of Work: i S4J1 oC `I �/.� 0 G.C444/ �=l` r CT ti;, I 17 7 Qy, -1 w� .1�e�� 1044 4 [.r0-- fr.,ee 0.6 4,A,s 4, e.P® f, l�•l &sL Lit OJ'1, V'vr 5-4;j1 Q,r 7i hg, //g -Yk4V rs 62.4k ******** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Fees************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Submittal Fee U Y � Permit Fee $ /-5-2=9"4"5 ® CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ I ) lJ 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 $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature Signatur Owner or Agent The foregoing instrument was acknowledged before me this 2. day of.UiAL: , 20 11 , by M tt iZ 4 sc who is personally known to me or who has produced As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: 64--e4.4. 4_ el_ 4 My Commission Expires: Contractor The foregoing instrument was acknowledged before me this 21 day of J.-u , 201 <, by kititix► . P , who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: A„„, Svc IIG karts Pre„iate4 My Commission Expires: * * * * * * * * * * * * * * * * ** C?...140;44g Plans Examiner Structural Review (Revised 07 /10 /07XRevised 06 /10 /2009XRevised 3/15/09) STEU.A MARIS PRENDES • Commission # DD 855155 Main ithiqqaPAZ:41414**4***** Ekitiod 1kruT(@pFffit kaeraoca 809-38P,19 Zoning Clerk Jul. 25. 2011 10:44AM KAVA INSURANCE No. 6212 P. 1 ACORD CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DCIYYYY) 07/25/11 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHT$ 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 pollens may require en endorsement A statement on this certificate does not confer rights to the Certificate holder In Ilea of Such endorsement(s). PRODUCER Kava Insurance And Financial Srvc 1217 N W 40th Ave Lauderhill, FL 33313 Phone (954) 583 -5377 INSURED ONLY ELECTRIC CO INC 348 NW 102nd Terrace Plantation, FL 33324 - COVERAGES Fax (954) 727 -9206 INTACT NAME: MARIA/BOBBY PRONE E-MAIL x`954 ( .NO. ( ) 583 -5377 ADDRm vladimirl@kavalnsurance.com INSURERS) AFFORDING COVERAGE INSURER 4: LLOYD'S OF LONDON. 1 INC, No): (954) 727-9206 1 NAIC (954) 817 -5617 INSURER B: INSURER 0 INSURER D CERTIFICATE NUMBER: INSURER E : INSURER F v,vn nvmu,..■• 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, t� EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR I TYPE OF INSURANCe N9R POLICY NUMBER GERPP (Mp / (YYYYTI 03/18/2011 I MM D 03/18/2012 Lou TS EACH OCCURRENCE s 1,000,000.00 A GENERAL LIABILITY ❑ COMMERCIAL GENERAL LIABILITY DAMAGES ENTED $ 100,000.00 . ❑ CLAIMS -MADE III OCCUR occurrence ) MED EXP (Any ace person) $ 5,000.00 PERSONAL &ACV INJURY $ 1,000,000.00 ■ GENERAL AGGREGATE $ 2,000,000.00 GEAPL AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000.00 ❑ POLICY • 5 ❑ LOC AUT06MOL ILE LIABILITY El ANY AUTO ALL OWNED 1 COs INEDSINGLE LIMIT Eaccident) $ BOOILY INJURY (Per perm) $ ❑ uT03 AUTOS LEp AUTOS ■ AUTOS BODILY INJURY (PeraxiGent) 3 IN HIRED AUTOS ❑ AjUTOSED PROPERTY DAMAGE (Par atien0 $ El Mil I. S ❑ UeraREI,L p LtAB ■ OCCUR _ - EACH OCCURRENCE 3 o EXCESS LIAR ❑ CLAIMS.MADE AGGREGATE 3 r�-� I..J DED • RETENTIONS $ WORMS O ERS'U RILIT AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE / N OFFICER/MEMBER EXCLUDED? ^ andatory IfMyes I I N / A OTH- ❑ T_RYLIM ❑ R E.L. EACH ACCIDENT 3 E.L DISEASE •EAEMPLOYEE $ describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE • POLICY LIMIT 3 • DESCRIPTION OF OPERATIONS / LOCATIONS 1 VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more epilog 18 rewired/ ELECTRICAL WORK WITHIN BUILDINGS. 10050 NORTH' EAST 2 AVE MIAMI SHORES, FL 33138 CERTIFICATE wAI npo MIAMI SHORES VILLAGE 269 NORTHEAST 100 STREET MIAMI SHORES,FL 33138 ACORD 25 (2010/05) OF CANCELLATION } 1 SHOULD ANY OP THE ABOVE DaSCRIB • ' PO THE EXPIRATION DATE THEREOIt, NO ' E WI ACCORDANCE WITH THE POUCY PR • r AUTHORIZED REPRESENTATIVE 1VLADIMIR LALBHADOORSINGH IES B - ANCEL 'LIVERED IN • BEFORE © 1988 -2010 ACORD CO - ' 0 The ACORD name and log • are righ eserved. red ma . f ACORD STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESS/ONAL REGULAT/ON ELECTRICAL CONTRACTORS LICENSING BOARD (850) 487-1395 '1940 NORTH MONROE STREET TALLAXAS SEE • PL 32399-0783 ADIXA, YOA7 ONLY ELECTAIC,COMPANT INC 348 NW 102 TERR PLANTATION FL 33324 Congratulatiohil With this licensIgyou become one of the nearly one million Floridians licensed by the Department of BusInese 'and Professional Regulation. Our professionals and businesses range from architects to yacht brokers, from boxers to barbecue restaurants, and they keep Florida's economy strong. Every day we work to Improve the way we do business In order to serve you better For information about our services, please log onto www,myflerldalioense.00m. There you can find more Information about our divisions and the regulations that impact you, subscribe to depa-tment newsletters and learn more about the Department's initiatives. Our mission at the Departmen.: Is: License Efficiently, Regulate Fairly. We constantly strive to serve you 'Natter so that you can serve your customers. Thank you for doing business in Florida, and congratulations on your new license! DETACH HERE • tliFt A 8tt ITOZ/6Z/90 b0 /Z0 39Vd MIAMI•DADE COUNTY TAX COLLECTOR 140 W. FLAGfLER ST. 1st FLOOR MIAMI. FL 33130 2010 LOCAL BUSINESS TAX RECE=IPT • ' ": °.,201't.: ; ' sF; PIRStT •CLASS MIAMI -DADS: COUNTY • STATE 0F. FLORIDA V: , .,.:;;a••,,4�" U.S. POSTAGE i EXPIRES SEPT: 3p, 2011: .. • •.. +:: ' ws T5 ' PAID • • MUST SE DISPLAYED AT PLACE OF BUSINESS:.;:if, MIAMI, FL • PURSUANT TO COUNTY CODE CHAPTER BA ", ART. 0 00 ;4 . PERMIT NO. 231 MI5005 -5 • BUSINESS NAME ! LOCATION ONLY ELECTRIC CO INC DOING BUS IN DADE CO THIS IS NO7 A BILL — DO NOT PAY OWNER ONLY ELECTRIC CO INC Sea. Type of Business 6 E ECTRICAL CONTRACTOR s INSI TAY Rp4A IT CCE5 HOr PERWT THE N=LMBR TO VIOLATE ANY EYIETING REGULATORY OR ZONING AWE OF THE G ONTY Oa OMB. •Nos ER P OU ANYII0q71 5155 N F4�p� B UALIFICA- PAY$ENT RECErymm M1AE9.OALtl COUNTY TAX COLLCCYI■N; 08/27/2010 60000000319 000075.00 SEE OTHER SIDE RENEWAL RECEIPT NO. 401963 -4 CC ill 0E000089 WORKERR /S 00 NOT FORWARD ONLY ELECTRIC 60 INC YOAV ADIKA PRES 348 NW 102 TERRACE PLANTATION FL 33324 „ 1111th,„ lilIli, ililli ,Ilililllil } „i,i,illil,li,1iI11 II� ffJji - ( 3y4 3QISdi'It1S JO NMOI Z0ETI9850E 81:07 1101/63/90 Project Address Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Parcel Number Applicant 269 NE 100 Street Miami Shores, FL 33138- 1132060134690 Block: Lot: ALBA INVESTMENT II, LLC Owner Information Address Phone Cell 1 ALBA INVESTMENT II, LLC 690 SW 1 Court MIAMI FL 33130- Contractor(s) DEERE INDUSTRIES LLC Phone Cell Phone (305)986 -8632 Valuation: Total Sq Feet: $ 4,500.00 200 1 Approved: In Review Comments: Date Approved: : In Review Date Denied: Type of Construction: INT. REMODEL Stories: Front Setback: Left Setback: Bedrooms: Plans Submitted: Yes Certificate Date: Bond Retum : T anItSI BE ON :13 TIME OF PRT1 Bathe Cart Add Classification: Residential Fees Due CCF DBPR Fee DCA Fee Education Surcharge Permit Fee Scanning Fee Technology Fee Total: Amount $3.00 $2.03 $2.03 $1.00 $135.00 $9.00 $4.00 $156.06 Pay Date Pay Type Amt Paid Amt Due Invoice # RC -6 -11 -41316 07/21/2011 Check #: 1048 $ 156.06 $ 0.00 Available Inspections: Inspection Type: Final PE Certification Drywall Miscellaneous Window Door Attachment Tie Beam Final Framing Insulation Truss Insp Columns Foundation Window and Door Buck Fill Cells Columns Wire Lathe Declaration of Use F. Termite Letter F. Elevation Certificate Applicant Copy For Inspections, Call (305) 762 -4949 or Log on at https: // bldg .miamishoresvillage.com /cap /. Requests must be received by 3 pm for following day inspections. NOTICE: In addition to the requirements of this permit, there may be AND THERE MAY BE ADDITIONAL PERMITS REQUIRED FROM OTHER additional restrictions applicable to this property that may be found in GOVERNMENTAL ENTITIES SUCH AS WATER MANAGEMENT the public records of this county. DISTRICTS, STATE AGENCIES, OR FEDERAL AGENCIES. July 21, 2011 2 JEFF ATWAT__ER CHIEF FlNANCIALOFFICER STATE OF FLORIDA • . • DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION * * CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW oe CONSTRUCTION INDUSTRY EXEMPTION • This certifies 'that the Individual listed below has elected to be exempt from Florida Workers' Complain law, r• — 04 -07 -2011 EFFECTIVE DATE: 04107.12011 EXPIRATION DATE: 04/05/2013 PERSON: ADIKA YOAV FEIN:. 650730360 BUSINESS NAME AND'ADDRESS: ONLY ELECTRIC COMPANY INC 348 NW 102 TERR PLANTATION FL 33324 • SCOPES OF BUSINESS OR TRADE: 1- CERTIFIED ELECTRICAL CONTRACTO IMPORTANT: Pursuant to Chapter 440. 00(14}, F.S., an ollleer of s corporation who elects exemption from this chapter by filing a certificate of atomics miller this section may cot recover benefrte or cOmpadsepoo under this the ter Pursuant scope of the besieges or vale listed on the notice of elecifoa o be exempt. IPorseent le Chapter z440 CSi 3i, Certificates olfoelectIone toa'beepexemptplaand certificates( el 'fettles tc be exempt shell be subject to reaocetfon i4 et try time liter the lilrng of Ow notice or the issuance of the certificate. Ike Samoa hawed on the malice et certificate no toogeh - meets, the requirements of this section far issuance of a cart :ficate. The department shell revoke a certificate et soy time tor tenure el the parser named on the certificate le meet the requirements of this section. OWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01 -11 QUESTIONS? (850) 413 PLEASE CUT OUT THE CARD BELOW AND RETAIN FOR FUTURE REFERENCE STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WoRKERS' COMPENSATION CONSTRUCTION INDUSTRY CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW EFFECTIVE: 04/07/2011 PERSON: YOAV ADIKA FEIN: 850730380 BUSINESS NAME AND ADDRESS: • ONLY ELECTRIC COMPANY iNC 540 Mom 102 TERN . PLANTATION, FL 33324 EXPIRATION DATE: 04/0440.17 SCOPE OF BUSINESS OR TRADE: 1- CERTIFIED ELECTRICA. CONTRACTO IMPORTANT (F..) Pursuant to Chapter 440.05(14), F.S., rte officer of a corporation who elects exemption from this chapter by filing a certificate of election l- under this section may not recover benefits or compensation under this D chapter. Pursuant to Chapter 44(1.05(12i, F.S., Certificates of election to be H Rexempt.. apply only within the scope of the business or trade listed or the notice of election to be exempt. E Pursuant is Chapter 440.05(13), F.S., Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation if, at any time alter the filing of the notice or the issuance of the certificate, the person named on the notice or certificate no longer met the requirements of this section for issuance of a certificate. The department shall revoke a certificate at any time for failure of the person named on the certificate to meet the requirements of this section, • . QUESTIONS? 1850) 413-160: CUT HERE it: Cary - bottom portion on the fob, keep upper portion for your records. OWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01 -11 1 Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Project Address Parcel Number Applicant 269 NE 100 Street Miami Shores, FL 33138- 1132060134690 Block: Lot: ALBA INVESTMENT II, LLC Owner Information Address Phone Cell ALBA INVESTMENT II, LLC 690 SW 1 Court MIAMI FL 33130- Contractor(s) DEERE INDUSTRIES LLC Phone Cell Phone (305)986 -8632 Valuation: Total Sq Feet: $ 4,500.00 200 1 Approved: In Review Comments: Date Approved:: In Review Date Denied: Type of Construction: INT. REMODEL Stories: Front Setback: Left Setback: Bedrooms: Plans Submitted: Yes Certificate Date: Bond Retum : Occupancy: Single Family Exterior: Rear Setback: Right Setback: Bathrooms: Certificate Status: Partial Additional Info: Classification: Residential Fees Due CCF DBPR Fee DCA Fee Education Surcharge Permit Fee Scanning Fee Technology Fee Total: Amount $3.00 $2.03 $2.03 $1.00 $135.00 $9.00 $4.00 $156.06 Pay Date Pay Type Amt Paid Amt Due Invoice # RC -6 -11 -41316 07/21/2011 Check #: 1048 $ 156.06 $ 0.00 Available Inspections: I Inspection Type: Final PE Certification Drywall Miscellaneous Window Door Attachment Tie Beam Final Framing Insulation Truss lnsp Columns Foundation Window and Door Buck Fill Cells Columns Wire Lathe Declaration of Use F. Termite Letter F. Elevation Certificate 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. Authorized Signature: Owner / Applicant / Contractor / Agent Building Department Copy July 21, 2011 Date July 21, 2011 1 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 AVot{ Inspection Number: INSP - 161481 Scheduled Inspection Date: July 29, 2011 Inspector. Hernandez, Rafael Owner: Job Address: 269 NE 100 Street Miami Shores, FL 33138- Project: <NONE> Contractor: BARBACCIA PLUMBING Permit Number: PL -6 -11 -1172 Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Addition/Alteration Phone Number Parcel Number 1132060134690 Phone: 954 - 680 -1966 Building Department Comments REMOVE AND REPLACE FIXTURES Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments %-iPi'2U:.►,Z -! �SvF_,�� -- 2:?--// July 28. 2011 Z•d For Inspections please call: (305)762 -4949 LL98-bZ8-90C 1VNOIJYN2131NI Page 3 of 5 897 :50 L.0 co idy 1 Project Address MIamI Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Parcel Number Applicant 269 NE 100 Street Miami Shores, FL 33138- 1132060134690 Block: Lot: ALBA INVESTMENT II, LLC 1 Owner Information Address Phone Cell ALBA INVESTMENT II, LLC 690 SW 1 Court MIAMI FL 33130- Contractor(s) BARBACCIA PLUMBING Phone 954 - 680 -1966 CeII Phone Valuation: Total Sq Feet: $ 450.00 20 Type of Work: REMOVE AND REPLACE FIXTURES Type of Piping: Additional Info: Bond Retum : Classification: Residential Scanning: 2 Fees Due CCF DBPR Fee DCA Fee Education Surcharge Permit Fee Scanning Fee Technology Fee Total: Amount $0.60 $2.25 $2.25 $0.20 $150.00 $6.00 $0.80 $162.10 Pay Date Pay Type Invoice # PL -6-11 -41320 06/29/2011 Check #: 1035 07/21/2011 Check #: 1048 Amt Paid Amt Due $ 50.00 $ 112.10 $ 112.10 $ 0.00 i Available Inspections: Inspection Type: Top Out Final Underground In consideration of the issuance to me of this permit, l 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. Authorized Signature: Owner / Applicant / Contractor / Agent Building Department Copy July 21, 2011 Date July 21, 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 JON 2 c E, Permit No. '1 Master Permit No.� l 1 o I Permit Type: PLUMBING %� !,,' OWNER: Name (Fee Simple Titlehol er): ,4 / i i-d o- 3T CIS et t Lc- Phone #: " r Cy 3, g 3 9 Address: (9r) iorn 1. f City: k1 " a State: rt Zip: 7` 3/ 79 Tenant/Lessee Name: / r L k -i c ,i S toy Phone #: 5D 1. SNl 3. F7 '7 7 Email: ��'/f2 ���@�' cZ�.00 .0 Al �y JOB ADDRESS: '" 6 9' M E. )c.614, S ?. City: Miami Shores County: Miami Dade Zip: /3g Folio/Parcel #: Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name: 19 mil®. 7(1-A4'74 t / 1— LC Phone #: Address: J S 7 7 AA) / 1 itrC City: COOp(,i✓ Cli14 State: FL, Qualifier Name: 4k19/ 1 J 62,( State Certification or Registration #: C C 0C4-7u1 G Contact Phone #: Email Address: DESIGNER: Architect/Engineer: Phone #: Zip: 337k Phone #: ?t`1. CS-g.5315 Certificate of Competency #: Value of Work for this Permit: $ 4/5 Square/Linear Footage of Work: 2 Type of Work: ClAddress UAlteration UNew r Cti(ReJ air �e "place 1 Description of Work: 'h e_4.-►ta� f /41 C t Aga", SALA, �,y Ii cave// -/ J- c,.2�D e- P UDemolition *x ******** ** * **+ x***********+x********** Fees******************* **** * * * *:u*+x***** ***** **** Submittal Fee $. ,Permit Fee $ (5.-e7 CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ 1 I ail 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.F,RS, 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. Signature Owner or Agent The foregoing instrument was acknowledged before me this day of-7.144.1C' , 20 , by 12k- 2 J7 S Z ER. who is personally known to me or who has produced As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: 6fre-/M 7'-'/at S ect44.6es My Commission Expires. Signature Contractor The foregoing instrument was acknowledged before me this, 9 Q day of 4-2/AA:-. , 20 " , by ai Li f3 �3 d who is p ersonall knkn ®me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My C * **** *+x**** : *** ***** x: x: x:**** ******************** ********* Structural Review (Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09) Zoning Clerk From:Velmore Johnson FaxID:954 -735 -2852 Page 3 of 3 Date:7/25/2011 10:12 AM Page:3 of 3 OP ID: VJ '�`. -- -- CERTIFICATE OF LIABILITY INSURANCE DATE 07/25DKYYY) 07/25/11 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 poilcy(les) 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 954- 735 -5500 Gateway insurance Agency Fort Lauderdale Branch 954- 735 -2852 2430 W. Oakland Park Blvd. Fort Lauderdale, FL 33311 CONTACT SICc. , Est): FAX No): E-MAIL ADDRESS: CUUSSTOMER ID 0: BARPL01 INSURER(S) AFFORDING COVERAGE NAIC 0 INSURED Barbaccia Plumbing LLC 5537 S.W. 118 Avenue Cooper City, FL 33330 INSURERA:North Pointe Insurance Company COMMERCIAL GENERAL LIABIUTY INSURER B : INSURER C : 03/21/11 INSURER D : EACH OCCURRENCE INSURER E : 1,000,000 INSURER F : DAMAGETO RENTED PREMISES (Ea occurcence) • THIS INDICATED. CERTIFICATE EXCLUSIONS INSR ISL. V I V I V I. 1\ V IYI . R. IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCE ADUL INSR SUBR wvn POLICY NUMBER (MMIDDIYYYY) (MM/DDI EXP LIMITS A GENERALLIABIUTY COMMERCIAL GENERAL LIABIUTY 3093002437 03/21/11 03/21/12 EACH OCCURRENCE $ 1,000,000 X DAMAGETO RENTED PREMISES (Ea occurcence) $ 100,000 CLAIMS -MADE I X I OCCUR MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ Z000,000 X POLICY PRO- JECT LOC $ 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) $ $ $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ _ AGGREGATE $ DEDUCTIBLE RETENTION $ $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If es, describe under DESCRIPTION OF OPERATIONS Y! N N/A WC STATU OTH- TORY LIMITS I ER E.L. EACH ACCIDENT $ below E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE- POLICY LIMIT $ DESCRIPTION OF OPERATION / LOCATIONS /VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) CFRTIRICATC urn nco LATION MIASH01 MIAMI SHORES VILLAGE 10050 NE 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 9 . 2 4' ACORD 25 (2009/09) O 1988 -2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD From:Velmore Johnson FaxID:954- 735 -2852 Page 2 of 3 Date:7/25/2011 10:12 AM Page:2 of 3 OP ID: VJ A4...,,. ---- CERTIFICATE OF LIABILITY INSURANCE DATE 07 /25 °NY'fY' x7/25/11 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 954- 735 -5500 Gateway Insurance Agency Fort Lauderdale Branch 954- 735 -2852 2430 W. Oakland Park Blvd. Fort Lauderdale, FL 33311 CONTACT PHONE (A//cc, No. Ext): FAX No): E -MAIL ADDRESS: PRODUCER CUSTOMER ID $: BARPI -a1 INSURER(S) AFFORDING COVERAGE NAIC / INSURED Barbaccia Plumbing LLC 5537 S.W. 118 Avenue Cooper City, FL 33330 INSURER A : North Pointe Insurance Company INSURER B: 03/21/11 INSURER C : EACH OCCURRENCE INSURER D : X INSURER E : $ 100,000 INSURER F : CLAIMS-MADE 1 X I OCCUR 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. INSR LTR TYPE OF INSURANCE ADDL INRR SUBR wvn POLICY NUMBER POLICY EFF (MMIDOIYYYY) POLICY EXP (MM/DD/YYYY) LIMITS A GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY 3093002437 03/21/11 03/21/12 EACH OCCURRENCE $ 1,000,000 X PREM SES Ee occurrDence) $ 100,000 CLAIMS-MADE 1 X I OCCUR MED EXP (Any one $ 5,000 person) PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GE 'L AGGREGATE LIMIT APPLIES PER: PRODUCTS- COMP /OP AGG $ 2,000,000 PRO- X POLICY JECT JECT LOC $ 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) $ $ $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ _ AGGREGATE $ DEDUCTIBLE RETENTION $ $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If Yes, describe under DESCRIPTION OF OPERATIONS Y I N N 1 A WCSTATU- OTH- TORY LIMITS ER E.L. EACH ACCIDENT $ below E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) re OTIGIf•A •r LIf11 11,E CANCELLATION LIGP008 City of Lighthouse Point 2200 NE 38th Street Lighthouse Point, FL 33064 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 O 1988 -2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD ATE OF FLORIDA ENESS TRY, L - - BOARD _ Q# L080 st. 3°1 AN D PROFESSIONAL LICENSING BO REGULATION US 81 892 LICENSENBR 08/13/2008 088028003-- CFC056746,. The PLUMBING CONTRACTOR- --_ • Named below IS CERTIFIED Under the provisions of Chapter„140 FS. Expiration date: AUG 31, 2010- BARBACCIA PLUMBING LLCH,..0'0,„/ BA ACCIA,- ANTHONY JOSEPH 5537 SW 118 AVE _1); , COOPER CITY FL 33330 161(,. g7biON itr4 941;q0,4* '07141,1K) PLEASE CUT OUT THE CARD BELOW AND RETAIN FOR FUTURE REFERENCE ruas OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DwismcDF IsfORKERIr COMPENSATION CONSTRUCTION INDUSTRY GEFfrwioATE OF ELECTION TO se EXEMPT FROM FLORIDA WORKERS COMPENSATION LAW EFFFCTIvE 10/08/2002 EXPIRATION DATE PERSON ANTHONY BARBACCIA . FEIN 55083103E BUSINESS NAME AND ADDRESS: SARRACCIA PLIMPRO LLC 5537 SW flSTh AVE FORT LANDER7A1.5, 333110 SCOPE OF BUSINESS OR TRADE: 1- cERT/FiEC) PLUMBING CONTRACTOR IMPORTANT ^Pursuant to Chapter 440_05(14), F,S„ an officer of a corporation who elects exemption from this chapter by filing a certificate of election L under this section may not recover benefits Or compensation under this 0 chapter. Pursuant to Chimer 440.05(1Z), F.S., Certificates of election to be exempt... Apply only within the scope of the business or trade listed on the notice of election to be exempt H R E Pursuant to Chapter 440.05(13), F.S., Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation if at any time after the filing of 'the notice or the issuance of the certificate, the person named on the notice or certificate no longer meetS the requirements of this section for issuance of a certificate. The department shall revoke a certificate et any time for failure of the person named on the certificate to meet the requirementS of this sectiorL CUT HERE QUESTIONS? 1850) 413-160S * Carry bottom portion on the job, keep upper portion for your records. DVVC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REViSED 09-05' ■I=MIMMSOMdali'1 11•11.a.falr.SM1 MSMara1 l[f.XM — — • PE' a M. „MI m f b lar M, • • 1158. Andrews Ave., Rm. A-100, Ft. Lauderdale, FL 33301-1895 — 954-831-4000 VALID OCTOBER 1,2010 THROUGH SEPTEMBER 30; 2011 DOA; Business Name: BAHBACMA PrAUNMEir3 Owner Name: SIMONY JOSEPH HAREACCIA Bulginess Li:lemon:5537 SW. 110 AVE • COOPER diTY BUSINESS Phone: • Rosidpt a311-13U Business rinam,PLussursi/L.Tel SPRINCW Type: (MHO= CONTRATOR) Business OperSed:10/26/1995 fablte/COuntyleert1RewCPC056746 Exemption Cone:Nomaxn THIS RECEIPT MUST BE POSTED. CONSPICUOUSLY IN YOUR PLACE OF BUSINESS nes BEC011nE5 A TAX RECEIPT This tali levied Ibr the privilege of doing business within Sroward County and is non-regaitory in nature. You must meet an County ad/or niluilidaelltY Planting MIEN VALIDATED and zoning fanidlamente This Stainers Tax Receipt must be transferred when the bUSIness is sold, luckless name has changed .or you . have moved the business location. This receipt does not Indicate that the business Is Iaga or that It la In compliance writ! State or lot laws and nagulatIons. ; . Mailing Address: - ANTHONY JOSEPH BARHACCIA. Raaipt 001A-09-00020259, 5537 'SW 118 AVE • •- Paid 09/20/2010 27.00 oop= CITY, FY., 33330. • 2010 .- 2011. L0 �ih3a1e.e cc* t Vik r Pa �.����h CA),,,:ds +o e- SPrEfj0 Cvvcoo• oiI J ✓ • n04 SAi•0 (��X (reek cj- 6 LatAS re-(42%te-- aFcz -01,4615 t 3 GCC"I Tp cod,1#43 cr 1-01 Tp4V14 a, Cif POINT ALONG COUNTER TO BE E 2 FEET FROM , d F 1 PROTECTED 2 POT DAN RECEPTACLE �M Pf!�E� SINK, � Ail FOB AP ,MOB N 4-1 -t F BENCH r • FiSTNG Interior design services MASTER SUITE FLOOR PLAN PROJECT #1026 269 NE 100th St, Miami FL SCALE:1'-1/2" ID 001.1 EQ. EQ. T-0 1 2_77--JY-2 214" ( i1 T 5'41 ELEVATION 2 N._._LEVATION tnteriar design services MASTER SUITE ELEVATIONS PROJECT #1026 269 NE 100th St, Miami FL SCALE:1 '-1/2" ID 002.2 tnter?ur desl©nserNces. MASTER SUITE FINISH PLAN PROJECT #1026 269 NE 100th St, Miami FL SCALE :1' -1 /2" ID 002.1