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SGN-07-2039Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP -63103 Permit Number: SGN -10 -07 -2039 Scheduled Inspection Date: October 19, 2011 Inspector: Bruhn, Norman Owner: CABRERIZO, TOM Job Address: 9031 -65 BISCAYNE Boulevard Miami Shores, FL 33138 -0000 Project: <NONE> Contractor: GM SIGN INC Permit Type: Sign Inspection Type: Final Work Classification: New Phone Number (305)779 -8040 Parcel Number 1132060110051 -31 Phone: (954)923 -3081 Building Department Comments 9023 BISCAYNE BLVD Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments October 18, 2011 For Inspections please call: (305)762 -4949 Page 21 of 21 Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 BUILDING PERMIT APPLICATION FBC 2004 Permit No.``'� OCT 1 7 2011 -, - -1.,1- 6 1 3(1 Master Permit No. Permit Type (circle): Buildin Roofing Owner's Name (Fee Simple Titleholder), tV.� !, v - Phone # Owner's Address ASS 0 1114: 1�� - 2,5.,,uL City 141 Ate\ State - Zip c-83 VIZ Tenant/Lessee Name Phone # qty acs-) gl. D ° a lo(o 4 Job Address (where the work is being done) City Miami Shores Village h U-2) �,�, 0 Aimpirmw FOLIO / PARCEL # County of AZ Miami - Dade Zip """� • P Is Building Historically Designated YES Contractor's Company Name Contractor's Address NO F.: ir'h City s N_. V <_ ' i, i v Qualifier Name 1 ,� ��AJ State Certificate or Registration No. State Phone# Zip Phone # C Certificate of Competency No. Architect/Engineer's Name (if applicable) Phone # Value of Work For this Permit $ Square / Linear Footage Of Work: of Work: ❑Addition ❑Alteration ['New ❑ Repair/Replace ❑ Demolition Describe Work: u p t0, ******** ***** * **** * *** ** * * * * ** * * * ** ** ** Fees************* *** *O ***** * * * ** *** * * * *** * * * **** Permit Fee $ e ( ))`\,_- %' Submittal Fee $ Notary $2 Scanning $ CCF $ CO /CC Training/Education Fee $ Technology Fee $ Radon $ DPBR $ Zoning $ Bond $ Code Enforcement $ Double Fee $ Structural Review. $ Total Fee Now Due $ �11 l� „1. o L See Reverse side -) 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 conditio to the issuance of a building permit with an estimated value exceeding $2500, the applicant must promise in _ ood faith that a copy of notice of commencement and construction lien law brochure will be delivered to the person whose prope is subject to attachment. o, a certified copy of the recorded notice of commencement must be posted at the job site for the first ins. ' cti ( n which occurs seven ) days after the building permit is is 'd. I t absence of such posted notice, the inspection will not . ; approved and a reins ;; ec . n fee will be charged. Signature Owner or Agent The foregoing instrument was acknowledged before me this day of , , 6 , 20 k k, by :� H -6.�J� ��) who is personally known to me or who has produced h 1 G As identification and wlOi idth,�� / NOTARY PUBLIC: �e • ,Ore's %g2 '' �031014 , Sign:_ — n = Sign: Print: % s -.• pp 65901•. \ Print: My Commission Expires: ��', /Tzt®tF11�,��```e° My Co ************* �kues x�k**** �kakak******** ok* sksksk** sk* �k** * *sk�kak &sks# * *** * * * * * * * * ** ** ** Signature Contractor The foregoing nstrument was acknowledged before me tip day of L ,20J 1, by p CQ �i��,,�,;� 'L9 who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: g`I si ird flary PUblip State of Florida , Nicole Sullivan oimo Expires 03/11 /2013 APPLICATION APPROVED BY: Plans Examiner Engineer Zoning (Revised 07/10/07) kft 11/5 Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 BUILDING IM@MEWEIT PERMIT APPLICATION OCT o 1 X007.- FBC 2004 BY: ; Permit Type (circle): (Building J Roofin g o4' Owner's Name (Fee Simple Titleholder) rIcge. AM) Phone #3 - r°%(9 • °`n( L1 r Owner's Address 77= - I J (JS 14(D Permit No. *l lip CFI _ -2 i Master Permit No. Cityk ,0/'I/ 1j . 5 State Tenant/Lessee Name L'a a lr L �i.'Q, Zip Job Address (where the work is being done) City Miami Shores Village FOLIO / PARCEL # 33o1(n Phone # 'QS- •,!) County Miami -Dade Zip Is Building Historically Designated YES NO Contractor's Company Name(,91 , n • )� - k 1 Q Contractor's Address LC 77, l (t i �� i-`,r) City'r3r1> ,—;,fl.er'?ri +1. N W State �'(� Zip �'� Qualifier Name i� �' c- (. r� it 11 HIV(_ ri- , Phone # State Certificate or Registration No.—) . <: C"')i . • eicg Certificate of Competency No. Phone # H • L -73-,—R\ . Architect/Engineer's Name (if applicable) Phone # r1, Value of Work For this Permit $ p Poo, Square / Linear Footage Of Work: Type of Work: ['Addition Describe Work: (0. c ['Alteration 0 ['New ❑ Repair/Replace ❑'Demolition Submittal Fee $ Permit Fee $ I 00 2 Notary $ ) —,, Training/Education Fee $ . 40 Technology Fee $ 2 'SO Scanning $ 3 - W 1l Radon $ DPBR $ Zoning $ Bond $ Code Enforcement $ Double Fee $ Structural Review. $ Total Fee Now Due $ f12,10 See Reverse side -* CCF $ I, 2O CO /CC Bonding Company's Name (if applicable) diti` Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) At „, 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 AN'F'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. 1212v n� � l 1 S, F'c rs •!� c -ichs r -F[ o — i �rzl� .> Ia'�I1' e 1 N Ls1✓s s i1=r i I L-LAL Signature Signature Owner or Agent Contractor The foregoing ins ent was acknowledged before me this 2 41441 The foregoing instrument was acknowledged before me this -619 day of _ 20 C,lby E - ice„ , day of ploy , 20 (97 , by , who is personally kno o me or who has produced As identification and who did take an oath. NOT Sign: Print: My Comiissio Expires: * * * * * * *N ;`ea *,Y *sir * /*** * * * * * * ** who is personally known to me or who has produced as identification and w" 'd take an \ath. NOTARY m IFER DIANN 3SKOIAN MY COMMISSIOP `_ D13545892 EXPIRES: A • ?7.2010 tiO f ..-STATE OF FLORIDA y Commission Expir ...,, Da Malzahn * * * * * * * * **x*** * *,� d p yann „.,.. fires: .:;1»i)T:15V ATLANTIC BONDING CO.,INC. (Certificate of Competency Holder) State Certificate or Registration No. Certificate of Competency No. ***************************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** APPLICATION APPROVED BY: Chc 10/14/03 Plans Examiner Engineer Zoning Miami Shores Villages COYE7M Building Department JAN 2 0 2010 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 BY: .s.m...._seso.a a o Permit No. 07 205 ' /zoti 6. Master Permit No. Permit Type: BUILDING ROOFING. Owner's Name (Fee Simple Titleholder) Phone # Owner's Address City State Zip Tenant/Lessee Name Email Phone # Job Address (where the work is being done) q01' 5) e 13I4d . City Miami Shores Village County Miami -Dade Zip FOLIO / PARCEL # // 3.cc -Oti - C O7O. Is Building Historically Designated YES NO Flood Zone Contractor's Company Name OPOA E {�T rites 1 Phone # Contractor's Address •0,1, City MI P v i State I I Zip ,3 31 V Qualifier Name . 641269 f//✓rign deZ Phone # 305- 97O -6305. State Certificate or Registration No. € k 00 l5 1 z ' l Certificate of Competency No. Rg 000.3k Q Contact Phone 86 39(333 6 E -mail Architect/Engineer's Name (if applicable) Phone # Value of Work For this Permit $ IMO, ®° Square / Linear Footage Of Work: Type of Work: ['Addition 71teration ['New ❑ Repair/Replace ❑ Demolition Describe Work: Ss v ©y) ieaCcede . ******** * * ** * * * * * * * * * * * * * * * * ** ** * * * * * ** Fees************* ** * * *x ** * * * * * * * * ** * * * * * * * * * * * ** Submittal Fee $ Permit Fee $ CCF $ CO /CC .$ Notary $ Training/Education Fee $ Technology Fee $ Scanning $ Radon $ DPBR $ Bond $ Double Fee $ Violation date: Structural Review. $ Total Fee Now Due $ See Reverse side - 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 ith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is 1ubje to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first i .pec on hich occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not • oved and a reinspection fee will be charged. Signature 1 1- ' Signature weer or Agent Contractor The foregoing ins . t was acknowledged re me this The foregoing instrument was ackn day of - ' ' , 20 ((loci by r (NA_ Co, 1. ` day of il( , 20 el , by who is personally kno_ wn to a or who has produced who icrersonEttwn me or who has produced as identification and who did take an oath. NOTARY PUBLIC: As identificati \NOTARY PUBLIC: Sign: Print: My Commission Expires: did take an oath. FONSO 1otary Public - State of Florida • y Commission Expires Jul 22, 2910 4. Commission # DD 534911 . F F .`s '' OF ` Bonded By National Notary Assn. a APPROVED BY Plans Examiner Zoning Engineer Clerk checked (Revised 07 /10 /07)(Revised 06/10/2009) Z Miami Shores Village Building Department 10050 NE 2 Ave, Miami Shores, Fl 33138 Tel: (305)795 -2204 - Fax; (305)756 -8972 cn — XRECEIPT PERMIT #: Cn V 1 DATE: D' 2f © / 1 1&'JWIth AHdZk Contractor ❑ Owner ❑ Architect Picked up 2 sets of plans and othe Vie/ C-64, GM 51S 1WL -1F31 Address: From the building department on this date in order to have corrections done to plans And/or get County stamps. I understand that the plans need to be brought back to Miami Shores Village Building Department to continue permitting process. Acknowledged by PERMIT CLEARK INITIAL: RESUBMITTED DATE: PERMIT CLEARK INITIAL: Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138-0000 Phone: (305)795 -2204 Project Address 9023 BISCAYNE Boulevard Miami Shores, FL 33138 -0000 It NO - i -O7 -2039 ... ,5 Peiir3 Type Parcel Number PROVED Expiration: 04/07/200 Applicant 1132060110051 -31 Block: Lot CITY NATIONAL BANK OF Owner Information Cell Contractor(s) GM SIGN INC Phone (954)923 -3081 Cell Phone Type of Sign: Wall Sign Electrical Sign: Yes Height: 24 Width: 10 Color: RED Plans Submitted: Yes Classification: Commercial Elevation: Additional Info: Fees Due CCF Education Surcharge Permit Fee Scanning Fee Technology Fee Total: Amount $1.20 $0.40 $100.00 $3.00 $2.50 $107.10 Total I Amt Paid 1 Amt Due $ 0.00 $ 0.00 Payment Type: $ 0.00 2L4SVOV 3 0 PAM Available Inspections : Inspection Type: Final 1 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 November 30, 2007 Date Friday, November 30, 2007 1 August 29, 2007 City of Miami Shores 10050 Northeast 2nd Avenue Miami Shores, FL 33138 uoiiori P R O P f R T I f S • ' ' • • • • • • • • • ••. • • .••• • • •... RE: GT Drycleaners • • Shore Square Shopping Center • • • • • • Folio #: 11-3206-011-0051 • • • Located at 9023 Biscayne Blvd., Miami Shores, FL 33138 • • "•. • • .••• • • •• • • ••• • .. • •••• • • •••• • • To Whom It May Concern: This letter authorizes G.M. Signs, Inc. to act as Agent to secure a permit required by the City of Miami Shores and to perform the sign installation for the above referenced location as long as the following criteria's are met below and on the attached: • Contractor follows Landlord's criteria; • Any other type of sign will not be allowed; • Contractor acquires the proper permits and performs the work to code and in a professional manner, • Contractor acknowledges that Landlord has no financial obligation to G. M. Signs, Inc., Inc. or its subsidiaries or to GT Drycleaners. GT Drycleaners will be responsible for all payments from this job to the contractor; • Contractor must provide a Certificate of Insurance naming Shore Square Investment, LLC C/o Horizon Properties as additional insured for Liability Coverage. If you have any questions or concerns, please do not hesitate to contact the undersigned. tit kiniii' __4 Cordially, Horizon Properties, As Agent for, SHO j QUARE INVESTMENT, LLC. .4( ICSC E. Benes cipal W/Enclosures- Letter authorizing Horizon from Shore Square Investment, LLC. Legal Description Personally Known or Produced Identification My Commission Expires /0j7 International Council of Shopping Centers 047 MAF ELEt4A M.ARQ�3EZ commit DD0363178 Expires 1W1112008 Bonded ttuu (800)432 -4254. ................................ i ootan: L... ...i Park West Professional Center 7785 NW 146TH Street, Miami Lakes, Florida 33016 Phone: (305) 364 -9945 • Fax: (305) 364 -9980 www.HorizonPropertiesFL.com am • naiop '/•11% "°"7°'"' V ;W The Forum for Commercial Real Estate Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 01- %1D3e1 Inspection Number: INSP -63146 Permit Number: ELC -10 -07 -2046 Scheduled Inspection Date: October 18, 2011 Inspector: Devaney, Michael Owner: CABRERIZO, TOM Job Address: 9031 -65 BISCAYNE Boulevard Miami Shores, FL 33138 -0000 Project: <NONE> Contractor: GM SIGN INC Permit Type: Electrical - Commercial Inspection Type: Final Work Classification: Sign Phone Number (305)779 -8040 Parcel Number 1132060110051 -31 Phone: (954)923 -3081 Building Department Comments ELECTRICAL Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments 41z 26/,P/a frA"P 4CP /1" o e°*e' 0A /z 5 l r .09 October 17, 2011 For Inspections please call: (305)762 -4949 Page 20 of 20 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: Electrical OWNER: Name (Fee Simple Titleholder): git-pg c Jam- 1 •JV . Phone #:At 5iQ3 O - G o( OCT 1 7 011 Permit No.' V 0— 0 1 a V014. Master Permit No. 9-4 CffrtCC,. 5 '-03t1 Address: ��5a i�v► r €,FAQ.. City: )--1 I Ate\ State: [ Zip: A3141 Tenant/Lessee Name: Phone#: Email: JOB ADDRESS: g..ra�s; C City: Miami Shores County: Folio/Parcel #: �,7 ® Ub1 3 ira . Miami Dade Zip: 3 Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name: i Address: 9%7)2/ P l-4r E Sur r z city: P 6 w l--61 o n State: M Qualifier Name: State Certification or Registration #: 3D33-6-) Certificate of Competency #: Zay vv t‘A ciort,:s Phone #: b ° 7 /k3oS Zip: Phone #: Gi Contact Phone #: Email Address: 0/16 aVI Li( DESIGNER: Architect/Engineer: Phone#: Value of Work for this Permit: $ Square/Linear Footage of Work: Type of Work: Address Description of Work: ❑Alteration UNew ❑Repair/Replace ❑Demolition ******* * * * * * * *** * * *** * * * * * * * * * * * * * * * ** *Fee ** ***** **. x******** * * *****x:*************** ** Submittal Fee $ Permit Fee $ Scanning Fee $ �� Radon Fee $ Notary $ 03 Training/Education Fee $ Double Fee $ Structural Review $ CCF $ CO /CC $ DBPR $ Bond $ 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, 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 pro erty is subject to attachment. s a certified copy of the recorded notice of commencement must be posted at the job site for the first s,'ection which occurs seven (7) ::# s after the building permit is iss . In the sence of such posted notice, the inspection will be approved and a rein . 'ction e will be charged. Owner or Agent The foregoing instrument was acknowledged before me this day of ®, - ( , 20.1, by k \J 1 , who is personally known to me or who has produced As identification and wh\q‘clid coc;.� NOTARY PUBLIC: Sign: Print: My Commission Expires: APPROVED BY Signature Contractor The foregoing ' strument was acknowledged before me this 1 day of (�� ,20 11, by who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Plans Examiner Structural Review (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) Sign: Print: My C V17 * V Publio State of Florida Nicole Sullivan My Commission DD888517 40, of. Expires 03/11/2013 Zoning Clerk Miami Shores Village NIEgm_777EFT, Building Department OCT 0 1 2007 L ' p 10050 N.E.2nd Avenue, Miami Shores, Florida 33 138 B �e Tel: (305) (305) 795.2204 Fax: (305) 756.8972 BUILDING PERMIT APPLICATION FBC 2004 Permit Type: Electrical Permit No. e Lei" 204 Master Permit No. SIi6 O- 7 _ O t C\ Prop . cv9 " °r Owner's Name (Fee Simple Titleholder)5%°� ( (�'@,C ✓L�(�j �1 Phone # ' ' 36'24 .0 -R Owner's Address S (UJ 1 tito city/ tQ/mi La State 'PL., Zip ‘0‘1.0 Tenant/Lessee Name , T ,D f Phone # 36 C • (�' E -MAIL: Q ,.�(� Job Address (where the work is being done) ` ®a3 �,4i , �( .p Ai�;��d. City Miami Shores Village County Miami-Dade Zip J�t FOLIO / PARCEL # Is Building Historically Designated YES Contractor's Company Name . l . Contractor's Address k. NO • Phone # C61 • "[ P-3 • City 4i(1,ia ee-P ir° State Zip C1 Qualifier Name i�� 7 i L,..i O! 1 s State Certificate or Registration No C_A300374g Certificate of Competency No. E -MAIL: Phone # Architect/Engineer's Name (if applicable) Phone # Value of Work For this Permit $ - ®O Type of Work: ['Addition ❑Alteration Describe. Work: Square / Linear Footage Of Work: at, ['New ❑ Repair /Replace CO ❑ Demolition es ex Submittal Fee $ Notary $ 5 • Training /Education Fee $ LO Technology Fee $ a4xxxxxxxrxxxxxxxxrxxxxxxxxxxx •xxxxFeesxx • .. xWYYxrxxWxrrxxrrxW :xxxxr Permit Fee $ CCF $ • GO CO /Cc Scanning $ 9. Radon $ DPBR $ Bond $ Code Enforcement $ Structural Review. $ Zoning $ Double Fee $ Total Fee Now Due $ 1 (P2 .SS See Reverse side -� 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. 1 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 I'OUR NOTICE OF COMMENCEMENT." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose properly is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued In the absence of such posted notice, the inspection will not be approved and a Lein. pection fee will be charged S ' =T' li1YifLSiWE T, LLC: Signature Owner or Agerit t�Yh The foryye��goin instrument was acknowledged before me this 1 day of INlA , 20 a by cA D.e I F„. 6.-er...a.. who is personally known to has produced As identification and who did take an oath. NOTAR UB Sign: t i� Print: Vf?Y1.nA (-f _AJI CLAN irl. My Commission ,Expes: 111 %3 2_0 10 x * * * * * * * * * * ** *u *' *******%***** x********* A+ t*** ai, 's *** * * * **dr *,i *St4t+kfr * * * *ir fok * *rtri,+Y4r * * *xiir * * ** * * *rt: oF4r * *ir$tk it tru+h+! ** *tie (Certificate of Competency Holder) State Certificate or Registration No. Certificate of Competency No. Contractor The foregoing instrument was acknowledged before me this& - tesaitvi S, day of Ai V , 2009 , by who is personally known to me or who « produced as identi ,ion and who did take an oath. rvq . .. • IAN f Viep MMISSION # DD.45892 '400,0% EXPIRES: Apr. 27.2010 (407) 398 -0153 Florida Notary S rvica.com Print: My Commission Expir PUBLIC-STATE OF FLORIDA 1 Commission # DD728494 Expires: OCT 31, 2011 di NDEDTHRUATLANTICBONDINGCO.,1NC. ********************* ******* ** ***,r ******** **S * *** ** APPLICATION APPROVED BY: chc 10/14103 /C'j ®f ' Plans Examiner Engineer Zoning Project Address Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 ELC- 10- O7- 2046 Electrical - Commercia !Atari( Classi cation: S Status; APPROVED Parcel Number Expiration: 04/07/2008 Applicant 9023 BISCAYNE Boulevard Miami Shores, FL 33138 -0000 1132060110051 -31 Block: Lot CITY NATIONAL BANK OF Owner Information Cell Contractor(s) GM SIGN INC Phone CeII Phone (954)923 -3081 Type of Work: Additional Info: Classification: Commercial Fees Due CCF Education Surcharge Permit Fee - Additions/Alterations Scanning Fee Technology Fee Total: Amount $0.60 $0.20 $150.00 $3.00 $3.75 $157.55 Total I Amt Paid I Amt Due $ 0.00 $ 0.00 Payment Type: rikAzzic $ 0.00 3 OPAID 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. November 30, 2007 Authorized Signature: Owner / Applicant / Contractor / Agent Building Department Copy Date Friday, November 30, 2007 1 18' vA44,,Irv,A•ArikaAverarovvvroOvrovevoNArrAN'...., '',VArrivrrz 0:954-9'z-3-3081 MN • ..11 II 1k1 !Mb: ci-oS, Ls 1 ITEM LEAsi Aw*Aht., 24" 10'-9" Illuminted Channel letters mounted to a raceway Face color: Red 2283 Trim color: Red Return color: Dark bronze 21.8 sq. ft, • • • • • • • • • • • • • • • • • • s • • • • • • SIGN TYPE wall sign QUANTITY SCALE PAGE DESCRIPTION ELEVATIONS STATUS SHOP DRAWINGS REV. DESIGNER SALES Ea, P.H. JOB NO. DATE 6-28-07 PROJECT CLEANERS All ideas, designs, arrangements, and plans indicated or represented by this drawing are owned by and the property of ingrota, and were created, evolved, and developed far use on and in connection with the specified project. None of such ideas, designs, arrangements, or plans shall be used by or disclosed to any person, firm or corporation for any purpose whatsoever without the written permission of OirAirwan, Written dim- ensions on these drawings shall have • preceilonce wer scalejihgensions: contractors shall • •erifyond resiosible for all dimensions and • wandillons il(nivn* these drawings. Shop details • 'PIIUSt •Iltitted tAis office for approval before • • fobric:ion /pet.. • CLINT PATL • • • • • • • • • • • • • • • • • • • • • • • • • • • • 1_,INCYLOIP..P • PATE: • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • * / • • • • • • PAGE 1 • • • • • • • • IP' • • • • II • • • • • • • • • • • 9549836628 1 O' -9" LLLUMINATED CHANNEL. LETTERS A) 1/8" Thk. Flat Plead Faces w /1" Face Retainers B) 13mm Int. Neon Tube C) Glass Tube Support per NEC 600 -33b D) Glass Cup or Insulated Boot E) Listed GTO Cable F) 20amp Disconnect Switch G) 1/4" Mounting Hardware Min. 4 I beer H) 1" Retainers (jewlite) ` I) Metal Channel Letter Alumn. .080 Back and .063. Return .7) Electrical Raceway with Removable Cover K) Listed Electronic Power Supply, Accessible L) #12 Thwn. Wire to Primary Source, Z" EMT M) 3/8 "x 4" Redheads, 3 44 ELECTRICAL SPECIFICATIONS 2: 12000 Volt /30 Ma @ 3.5 amp 1: 20 amp, External Disconnect Switch Total Load: 7.0 amp Grounding /Bonding as per NEC 250 Primary Wire: #12 Thwn All Electrical Components UL Listed CLE A NERS Miami. Shores PANEL A 250 amp. Breaker: #8 Total Load: 7.0 amp PER FBC 2004 .. A 7 -02 146 MPH DE god O&kfl0 ec13003378 00 ••• • • • • • • • • •0 • 41• • • • ••• DON ARPIN P.E. ASSOCIATED GENERAL KINETICS INC. 4920 N.Dixie I4waij. : .'. •; Ft.Lauderdale FI.333 I • • • Tel: 954 - 772^834• • • • ." 4100 • 0 • • •00 • • • • • • • • • • • • • 000 • • • • • • • • • • • • • • 00 •• • • • 0. 00 000 • • • 0061 • • A 12) CERTIFICATE OF LIABILITY INSURANCE DATE(MM1DD/YYYY) 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 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- 318 -2469 954- 318 -2474 INFINITY INSURANCE SOLUTIONS 6412 N UNIVERSITY DRIVE SUITE 132 TAMARAC. FL 33321 CONTACT NAME: INFINITY INSURANCE SOLUTIONS (a"rco.Nro Extt:954-318 -2469 FAX No): 954-318-2474 Wain: BERNADETTEK @IISFL.COM CUSTOMERID#: INSURER(S) AFFORDING COVERAGE NAIC # INSURED 954 - 275 -6365 954- 342 -2747 GM SIGNS, INC 4332 PETERS ROAD PLANTATION, FL 33317 INSURERA: FEDERATED NATIONAL INS. CO. INSURERB: GL- 0000008308 -00 INSURERC: 07/26/12 INSURER D : $ 1.000 000 INSURERE: PREMISES (Ea occurrence) INSURER F : 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 TYPE OF INSURANCE ADDL W D POLICY NUMBER (MM//DDDI YYY) (PMMIDDIYYYY) LIM GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY OCCUR GL- 0000008308 -00 07/26/11 07/26/12 EACH OCCURRENCE $ 1.000 000 PREMISES (Ea occurrence) $ 100.000 $ 5.000 $ 1,00Q.000 CLAIMS -MADE / MED EXP (Any one person) PERSONAL & ADV INJURY GENERAL AGGREGATE $ 2.000,000 $ 2,000 000 $ GEN'L AGGREGATE LIMIT APPLIES PER: POLICY n El-- n LOC PRODUCTS - COMP /OP AGG 71 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 LIAR EXCESS 'UM OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DEDUCTIBLE RETENTION $ $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY R/ ANY PROPRIETOR/PARTNEEXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS Y N / A W SI TU- T ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ below E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more apace 1s required) 98993 SIGN INSTALLATION, ERECTION & REPAIR CERTIFICATE HOLDER CANCELLATION 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 can' © 1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD 1940 NORTH MONROE STREET TALLAHASSEE FL 32399 -0783 WILLIAMS, RAY E JR GM SIGN INC 4332 PETERS RD BAY H FT LAUDERDALE FL 33317 Congratulations! With this license you become one of the nearly one million Floridians licensed by the Department of Business and Professional Regulation. Our professionals and businesses range from architects to yacht brokers, from boxers to barbeque restaurants, and they keep Florida's economy strong. (850) 487 -1395 JEP ?ROFES. cUS SS Ali REGULATION EC130 0337 03/30/191 107011974 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.myfloridalicense.com. CERTIFIED, EC RZCAL CONTRACTOR There you can find more information about our divisions and the regulations that WILLIAMS': Y S" impact you, subscribe to department newsletters and learn more about the GM SIGN Department's initiatives. Our mission at the Department is: License Efficiently, Regulate Fairly. We constantly strive to serve you better so that you can serve your customers. Thank you for doing business in Florida, and congratulations on your new license! AC# ., DETACH HERE OF STATEggOF FLORIDA DEPAR ENIONNAL BOOAARD IS CERTIFIED under tie provisions of 01.489 Fs 7Sxpiration sstez AUG 31, 2022' W.0083002967 BATCH NUMBER LI CENSE NBR EC13003378 Additional Business The ELECTRICAL CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 409 F Expiration date: AUG 31, 2012 ,TION SE L10083002987 alifica WILLIAMS, RAY E JR am SIGN INC 1300 STIRLING RD. 5A DANIA BEACH FL 33004 CHARLIE GRIST GOVERNOR DISPLAY AS REQUIRED BY LAW ALEX SINK STATE OF FLORIDA CHIEF FINANCIAL OFFICER DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION * * CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law. 11 -16 -2010 EFFECTIVE DATE: PERSON: 08/04/2010 EXPIRATION DATE 08/03/2012 WILLIAMS FEIN: 650544850 BUSINESS NAME AND ADDRESS: GM SIGN INC 4332 PETERS ROAD APT H PLANTATION FL 33317 RAY E SCOPES OF BUSINESS OR TRADE: 1- CERTIFIED ELECTRICAL CONTRACTO 2- SIGN INSTALLATIONS /MAINTENANCE IMPORTANT: Pursuant to Chapter 440. 05(14), F.S., an officer of a corporation who elects exemption Irom this chapter by filing a certificate of election under this section may not recover benefits or compensation under this chapter. Pursuant to Chapter 440.05{12), F.S., Certificates of election to be exempt... apply only within the scope of the business ar trade listed on the notice of election to be exempt. Pursuant to Chapter 440.05(131, 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 an the notice or certificate no longer meets the requirements of this section far issuance of a certificate. The department shall revoke a certificate at any time for !allure of the person named an the certificate to meet the requirements of this section. OWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 09 -06 QUESTIONS? (850) 413 -1609 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 ', J EFFECTIVE 08/04/2010 EXPIRATION DATE: 08/03/2012 PERSON: RAY E WILLIAMS FEIN: 650544850 BUSINESS NAME AND ADDRESS: GM SIGN INC 4332 PETERS ROAD APT H PLANTATION, FL 33317 SCOPE OF BUSINESS OR TRADE: I- CERTIFIED ELECTRICAL CONTRACTO 2- SIGN INSTALL ATIONS /MAINTENANCE IMPORTANT FO Pursuant to Chapter 440.05114). 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 D chapter. H Pursuant to Chapter 440.05(12), F.S., Certificates of election to be exempt.. apply only within the scope of the business or trade listed on Rthe notice of election to be exempt. 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 at any time for failure of the person named on the certificate to meet the requirements of this section. QUESTIONS? (850) 413 -1609 CUT HERE * Carry bottom portion on the job, keep upper portion for your records. OWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 09 -06 BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT 115 S. Andrews Ave., Rm. A -100, Ft. Lauderdale, FL 33301 -1895 — 954- 831 -4000 VALID OCTOBER 1, 2011 THROUGH SEPTEMBER 30, 2012 DBA: Business Name: G M SIGN INC Owner Name: RAY S WILLIAMS JR Business Location: 4332 PETERS ROAD. ,STE H PLANTATION Business Phone: 954-983-0088 Rooms Seats Employees 2 44 Business Receipt Type:SLSC#:181- TR31ICAL /ALARM (ELECTRICAL CONTRACTS /CONTRA OR) Business Opened:11 /o1 /19a5 State /County /CertlReg :EC13 003 37 8 Exemption Code:NONExEmPT Machines Professionals For Vending Business Only Number of Machines: Vending Type: Tax Amount Transfer Fee NpF Fee Penalty Prior Years Collection Cost Total Paid 27.00 3.00 0.00 2.70 0.00 0.00 32.70 THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS THIS BECOMES A TAX RECEIPT This tax is levied for the privilege of doing business within Broward County and is non - regulatory in nature. You must meet all County and/or Municipality planning WHEN VALIDATED and zoning requirements. This Business Tax Receipt must be transferred when the business is sold, business name has changed or you have moved the business location. This receipt does not indicate that the business is legal or that it is in compliance with State or local laws and regulations. Mailing Address: RAY E WILLIAMS JR 4332 PETERS ROAD.,STE H PLANTATION, FL 33317 2011 - 2012 Receipt #O1A -11- 00000244 Paid 10/07/2011 32.70