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RC-10-1906Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 166469 Scheduled Inspection Date: December 05, 2011 Inspector: Bruhn, Norman Owner: WINN, DAVID & TRACI Job Address: 1225 NE 92 Street Miami Shores, FL Project: <NONE> Contractor: CALDWELL DEVELOPMENT INC Permit Number: RC -10 -10 -1906 Permit Type: Residential Construction Inspection Type: Final Building Work Classification: Alteration Phone Number (305)751 -9333 Parcel Number 1132050270300 Phone: (786)402 -9826 Building Department Comments 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- 166299. CREATED AS REINSPECTION FOR INSP- 166238. CREATED AS REINSPECTION FOR INSP- 152686. NO ACCESS. NO ONE HOME. DOOR NOT WORKING. KNOCK HARD. MISSING PERMIT CARD. JR 11/3/11 Work not complete. NB December 02, 2011 For Inspections please call: (305)762 -4949 Page 17 of 46 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 to--vde Inspection Number: INSP - 164817 Scheduled Inspection Date: September 27, 2011 Inspector: Devaney, Michael Owner: WINN, DAVID & TRACI Job Address: 1225 NE 92 Street Miami Shores, FL Project: <NONE> Permit Number: EL -5 -11 -922 Contractor: CARIBBEAN ELECTRICAL CONTRACTORS INC Permit Type: Electrical - Residential Inspection Type: Final Work Classification: Temp for Construction Phone Number (305)751 -9333 Parcel Number 1132050270300 Phone: (954)562 -0377 Building Department Comments 30 DAY TEMPORARY SERVICE PER INSPECTOR FOR POOL PUMP AND AIR CONDITIONER 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- 160010. September 26, 2011 For Inspections please call: (305)762 -4949 Page 13 of 16 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's Name (Fee Simple Titleholder) Fs 18 Permit No. FLA I "° Master Permit No. Owner's ddress ) �." �. City r�iv[.K State F Zip Tenant/Lessee Name Phone # �� — D-dc— Email %)1 ' v G D4-r t Phone # Job Address (where the work is being done) /',� ®Z s WE y_2 1-wi S City Miami Shores Village County Miami -Dade Zip 13 FOLIO / PARCEL # Is Building Historically Designated YES NO Contractor's Company Name EIec f t1 cqf CaTrrone # Contractor's Address 30.5M7 3w 3 0 AU t° Flood Zone T'${-5(D:2 -437 % City No t t c70 c State 'Ft-- Zip 3 3 1 `�- Qualifier Name z CA i t/ Phone # State Certificate or Registration No. EC — (3 C)cY -6911 Certificate of Compe cy No. Contact Phone i &m e" ®J C c ! WSO-t E -mail A4 Ct goe Q C-t . covt/t. Architect/Engineer's Name (if applicable) Phone # Value of Work For this Permit $ ca00 Type of Work: ['Addition ❑Alteration ❑New ❑ Repair/Replace r ep _ 0 Demolition Describe Work: �?j Cj cL \, -r,t4A f'M ( .SCCC, i Ce, per. -� edr Ear FOC:5c pop Ads- ritY( cer Square / Linear Footage Of Work: * * * * * ** *** * ** ** * **** r *,r: *** *** ** **** Fees************** ** ** ** *** ** * ** ****** ** * ** *** ** Permit Fee $ / ®�'��� CCF $ CO /CC $ Submittal Fee Notary $ Training/Education Fee $ Technology Fee $ Scanning $ Radon $ DPBR $ Bond $ Double Fee $ Violation date: Structural Review. $ Total Fee Now Due $ 1 9 39 JiJ 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 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 commencem must be po• e' at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the ce of su ` p'sted notice, the inspection will not be approved and a re- inspection fee will be charged. Signature Signature Owner or Agent Contract r The foregoing instrument was acknowledged before me this OP The foregoing instrument was acknowledged before me this (r day of f1 l , 20 \ I , by‘DAV 1'crK , day of , 20/4, , by ko-ock. lO O who is personally known to me or who has produced RA D As identification and who did take an oath. NOT Y PUBLIC: Si Print: My \d S • AZ 77 0`0 Plans Examiner * * * * * * * * * * * * * * * * * * * * * * ** APPROVED BY who is personally known to me or who has produced t D as identification and who did take an oath. e\0uu1uriii,, NOTARY PUBLI, : ,\```, iris/ Sign: Print: My Commission Expires: % .. s ",,,, `rre1 O, iS\`\e\\�� Zoning Engineer Clerk checked (Revised 07 /10 /07)(Revised 06/10/2009) MIAMaDADE COUNTY Building 11805 SW 26th Street Miami, Florida 33175 -2474 786 - 315 -2100 AFFIDAVIT FOR 30 DAY TEMPORARY ELECTRIC SERVICE ELECTRICAL CATEGORY 26 miamidade.gov ELECTRIC SERVICE WILL BE DISCONNECTED "WITHOUT NOTICE" UPON 30 DAY TERMINATION UNLESS APPLICATION IS RENEWED OR CERTIFICATE OF OCCUPANCY OBTAINED. It is understood that the temporary electrical approval by the Miami -Dade Building Department is given in connection with the building being constructed under the Building Permit # and Electrical Permit# at address for owner: and is being given only for construction purposes or for testing the following equipment in said structure: The owner does hereby agree to assume the responsibility of maintaining the installation in such manner that there is no hazard to life or property. Such approval is in no event to be considered a RELEASE of said structure for the purposes of use and occupancy, and no occupancy shall be granted or permitted until final inspections have been called for and approved by the inspection divisions concerned, and /or a Certificate of Occupancy or Completion is obtained. The undersigned also understands that the temporary electric approval is subject to rescission and cancellation and electric power can be cut off at the discretion of the Building Official and will be disconnected if the building concerned is occupied before final inspections are approved and /or a Certificate of Occupancy or Completion is obtained. ,_j ' I 1ta.4- '(7) Wr (t 1.1 , being first duly sworn, depose and say that I am the owner of the above described property, and that I agree that the structure covered in this agreement shall not be occupied until the building contractor has obtained approval of final inspections and /or obtained a Certificate of Occupancy or ,Abtain Completion. Note: Failure to compl with the provisions of this affidavit will res • It in your being,\un� P ' e empo ry or Test mits ) '.) 11 Vi ®. Sigri.f Nom- °N — ° _ p :v= A�� MyCommission Expires: 7- )7P °•f \ , \...Q� 1, J\ AZ t .. ✓t being duly sworn, depose an\d 'I�at,j,�am the El etric�i *t.Mt i;�r the above- descri %ed property and t' . the electrical installations as nn a...)49{4 vi/rk� not crey a saf.� if temp�lra servi e is 'n.ected ` ��� o ®o`' �'����rnn��'�`,• Signature of :; ectrical Contract .,'r, Signal �'1 =�±� 4,., Cog.' is td, rkrgs: _ _ e gse artd•sa i a1 fThm the Building Contractor of the above .escri: d property aid that I will not permit occupancy ofo iisel iL Mig until final inspections have been called for by the contractors and sub- contractors concerned and final "approval by the inspection division obtained and that I have the authority insofar as the owner of said property is concerned to prohibit occupancy until such fi ► .1 spection r- ob -.... or a Certificate of Occupancy or ampletion is issued T f w• nature o •wne gnatu e of Buil ng ntractor Signature of Electrical Inspector 123_01 -124 6/06 -11B7tIzAG Signature of Notary /}�� My Commission Expires: 7 Date: is 02©// t FPL: od`V Poet Notary Public State of Florida c+ Veronica Perez � �° My Commission 0/3819771 40, co Expires 09/03/2012 Y Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: I NS P- 164875 Scheduled Inspection Date: October 12, 2011 Inspector: Devaney, Michael Owner: WINN, DAVID & TRACI Permit Number: EL -1 -11 -113 Job Address: 1225 NE 92 Street Miami Shores, FL Project: <NONE> Contractor: CARIBBEAN ELECTRICAL CONTRACTORS INC Permit Type: Electrical - Residential Inspection Type: Final Work Classification: Alteration Phone Number (305)751 -9333 Parcel Number 1132050270300 Phone: (954)562 -0377 Building Department Comments REMODEL KITCHEN, NEW PANEL, NEW GFI EXTERIOR Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments CREATED AS REINSPECTION FOR INSP- 164816. Garage & toilet room receptacles to be G. F. I .Protected. Put connector on A, H, U, t stat cables. Add switch for water heater. Add ind. cover for D/W & diap rec. Closet fixtures to have globes. CREATED AS REINSPECTION FOR INSP- 164704. 3 /2 Aca'r/-er:b October 11, 2011 For Inspections please call: (305)762 -4949 Page 16 of 28 V-I\'w/au 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 ` `� Permit N i }+ 11 1 �✓ _ Master Permit No° v.J 1Q" IT) (-9 BUILDING PERMIT APPLICATION FBC 20 ECETNE SEPL02011 Y: 000000000 e..00 000000 0*0 Permit Type: Electrical �--� OWNER: Name (Fee Simple Titleholder): T h9 c•� /, j c v1. v . Phone #: '— Address: G City `JJ $ State: �i Zip: � 3l 3 Tenant/Lessee Name: Phone #: Email: JOB ADDRESS: City: Miami Shores County: Miami Dade Zip: Folio/Parcel #: Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name: t�c�.,1�1 ru twit l .cj Ih C Phone #: 15r---569-03Z2 Address: 702 j' ,> (� c eot �ltl� ' f 117 City: ®C State: F 1Qualifier l ine: k CkCC.C■ � 01A State Certification or Registration #: . t30®cc`s� 79 Certificate of Competency #: Contact Phone #: / `-SG.2 --637 7 Email Address: I-1([ k °L- �Ai 1 blo -' U'( E(edf tc • e®trt 4.., DESIGNER: Architect/Engineer:., Phone #: Zip: 3 & r 1 Phone#: �`� alue of Work for this Type of Work: ❑ Description of v <4 ** *** * * * * * * * * * * * * * *** * * * * * * * * * * * * * ** Fees************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Submittal Fee $ Permit Fee $ >. , e'4 CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Alteration f T5 Square/Linear Footage of Work: UNew ❑Repair/Replace `Ref).. 2. UDemolition Bond $ Structural Review $ TOTAL FEE NOW DUE $ Bonding Company's Name (if applicable) Bonding Company's Address City ° State Zip Mortgage Lender's Nante (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 AI1+'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 appli 'r t must promise in good faith that a copy of the notice of commencement and construction lien law brochure e delivered to person whose properly is subject to attachment. Also, a certified copy of the recorded notice of commencem ' t mu : t be posted i t e job site for the first inspection which occurs seven (7) days after the building permit is issued. In the #.%sence of such pos 'd notice, the inspectio I not be approved and a reinspection fee wi be charged. Owner or Agent The foregoing instrument was acknowledged before me this Qj day of d ,20 \\ ,byDIN J 0\3 who is personally known to me or who has produced As identification and who did take an oath. \\ \` \I�► ►11111111 OS/ NOTARY PUBLIC: Sign: Print: My Commission Expires: * * * * * * * * * * * * * * * * * * * * ** APPROVED BY s- 'r41)"'�' Contractor The foregoing instrument was acknowledged before me this day of c- , 20 , by nr\ NkCit Jl uA who is personally known to me or who has produced 4:74---1 I T as identification and who did take an oath. NOTARY PUBLIC: \ \ \ \\\��►t►►nHilu„�/ / /// Sign: Print: My Commission Expires: : ******************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Plans Examiner (Revised 07 /10 /07XRevised 06 /10 /2009)(Revised 3/15/09) Structural Review Zoning Clerk 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 MEN JAN 2 4 2011 Permit No. E1 \ 1 Master Permit No. Permit Type: Electrical dceg 2.05- 3 3 OWNER: Name (Fee Simple Titleholder): Ji ij,tI Phono#: 751-1333 Address: /P-?...1- f" 51— City: r e' A State: 1C2-- Tenant/Lessee Name: Q/( r Zip: �� / Phone#: 30, 75 /— f3.3s Email: t. e et / JOB ADDRESS: 42-?-5". City: Miami Shores County: Miami Dade Zip: g3/..se Folio/Parcel#: Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name: C-6414 641 kMe gled`tCO( C•014 Phone#: 154 "S. 6 a- Oa'? 7 Address: City: HOE ui, oci Qualifier Name: ) i dt qe i State Certification or Registration #: Contact Phone#: t AMC DESIGNER Architect/Engineer: State: T i Zip: 350147 Phone#: SAM' Ed €t 4 ,'. (,'S 06412 79 Certificate of Competency #: Email Address: %M ,1 ■ �a�'+W CZ re. • C0 Phone#: Value of Work for this Permit: $ 3S® �° Square/Linear Footage of Work: t`�d® Type of Work: ClAddress (Alteration UNew ORepair/Replace ODemolittion D e s c r i p t i o n o f W o r k : Re w v o 1 1 / . , , $ G i A , e (^ td AAA p 414EJ J T J J W Submittal Fee $ CC :CO Permit Fee $ 2 Z 6' �' ' CF $ CO /CC $ 111_ Radon Fee $ DBPR $ Bond $ Training/Education Fee $ Technology Fee $ Structural Review $ Scanning Fee $ Notary $ Double Fee $ TOTAL NEE NOW DUE $ 10 . 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 FI.FCTRICAL 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 broc re will be deliv whose property is subject to attachment. Also, a certified copy of the recorded notice of co must be for the first inspection which occurs seven (7) days after the building permit is issued. In ' , sence of inspection l not be approved and a reinspection fee will be harged. Signature Owner or Agent �A The foregoing instrument was acknowledged before me this _ —1 day of 1 , 20 , by VANN 1'b hl t ti who is personally known to me or who has produced Fc- A ) As identification and who lid take an oath. \`O�IIN tulaw /4// NOTARY PUBLIC: Sign: Print: we f® b �• cos: .3.- My Commission Expires: = * ** *********,8 ****k* APPROVED BY IMO//// \ Signature to the person d at the job site osted notice, the Contrac s r The foregoing instrument was acknowledged before me thiVI day of , 20 k , by M 10-1 Aar- N)0,6 , JJ/°N7 who is personally known to me or who has produced C4-( » as identification and who did take an oath. NOTARY PUBLIC: Sign: re Print 'A ll e, vtillll /, 0P 4310*- 0 My Commission Expires: * p ******# *,R ****a',**b***ek,E *** * * **** **** NaD ***** *********,R,k**** *31 * ******* 6 ) ''"Plans Examiner Structural Review (Revised 07 /10/07)(Revised 06/10/2009)(Revised 3/15/09) Zoning Clerk Miami Shores. Village Building Department FEB 6 2011 Y. 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 BUILDING Permit No. EL- 11- I l 3 PERMIT APPLICATION Master Permit No. FBC 20 Permit Type: Electrical �,-'� J (Fee Simple ) D p OWNER: Name ee Sim le Titleholder : .�/� iA l�a✓c +o+ t✓e. Phone#: 3 ec ° 9-0C -3,91 Address: ? P. City: rain;- 5 State: �- Zip: �-1 /, Tenant/Lessee Name: Phone #: Email: L 0_0.6 (. cow JOB ADDRESS: 22 - S ,4E p-.4 "`/ 57/- City: Miami Shores County: Miami Dade Zip: 33 / "(17 Folio/Parcel #: Is the Building I3istorically Designated: Yes NO X Flood Zone: CONTRACTOR: Company Name: CCM.i bber&vt Eie t at C0 f #r` tSYS -a- s3 ?7 Address: sesv, 36 A L) t. City: 40 ( t ! W State: -"F / Zip: 33 / a- & Qualifier Name: i cha.e l rr 13 . /1/4) Z c keraSV1 Phone#: State Certification or Registration #: EC 13004.1247 Certificate of Competency #: Contact Phone #: SAM! ®� Email Address: 1 k'e G a . e ■ � i a ea t/l Pre • C:.0V�t DESIGNER: Architect/Engineer: ebh i Ut ,44 r' S kV Phone#: 15q-- 944-/- .,®5-5 Value of Work for this Permit: $ 3 oo Square/Linear Footage of Work: Type of Work: °Address ©Alteration °New ›`Repair/Repiace Description of Work: Rot pi A Cr C ( / ML -. f' tecki. cc..i Dcf N- CO CC°1-3 t- -i (e,rt ODemolition Submittal Fee $ Permit Fee $ -.-4--,: 6',9 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 a Mortgage Lender's Address Cityr:L���� 1C1 licable) State t_1 tt i c� Zip 4/c. S- CS© 1 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 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 'e posted at 'oh site for the first inspection which occurs seven (7) days after the building permit is issued. In the able such post • no 'ce, the inspection ill not be approved and a reinspectioy4ee will be charged. Signat Owner or Agent r}£ The foregoing instrument was acknowledged before me this oC J day of FEB . , 20 /j , by itcc L . 1iln n who is personally known to me or who has produced �• It As id- s• c.ti.n. dw odidtakeanoath. NOTARY PUBLIC: Sign: Print: VCfO,t(Ca, P AWN, Notary Public State of Florida Veronica Perez ir My Commission of Expires 09/03/2012 0 9 03/2012 81 9771 My Commission Expires: * * * * * * * * * * * * * ** * * * ** APPROVED BY 2''O 207P-e9 Plans Examiner Zoning Signature ntractor The foregoing instrument was acknowledged before me this � 5 day of M • , 201, by i-kklA el tic V.e (50n who is personally known to me or who has produced f.• �1."), as identifica • NOTARY PUBLIC: Sign: Print: Notary PubU State at Florida f- If Veronica Perez • My Commission 00819771 %o ao Expires 09/03/2012 0 My Commission Expires: Structural Review (Revised 07 /10 /07)(Revised 06/10 /2009)(Revised 3/15/09) Clerk ... -J r..lr rr.,r ea r irn.r �.��x�r,k .r rw: al/ .111 rte= 1 . r i�egmF:�r�si.. 4 �R�..r.�:Y,.�.�s:'�... r - W. • 115 S. Andrews Ave., Rm. A -100, Ft. Lauderdale, FL 33301. -1895 — 954 - 831 -4000 VALID OCTOBER 1, 2010 THROUGH SEPTEMBER 30, 2011 DBA: Business Name: CARIBBEAN ELECTRICAL CONTRACTORS Owner Name: MICHAEL BRIAN NICKERSON ' SR Business Location: 3858 SW 30 AVE HOLLYWOOD Business Phone: - Rooms Seats.:: Employees '2 Race' Business T t#:181-228921 -. .ELECTRICAL/ALARMS/C0NTF ECTRICAL CONTRACTOR) Business Opened 11/04/2009 StateICountyICert•IReg EC13D04299 Exemption Code taOlSm Machines Professionals For Vending Business Only Vending Type: Tax Amount Transfer Fes NSF Fee Penalty Prior Years Collection Cost Total Palo 27.00 6.00 ". 0 00 :b 00 p 0.00 33.00;: 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 VAUDATED 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: CARIBBEAN ELECTRICAL CONTRACTORS I 3858 SW 30 AVE HOLLYWOOD, FL 33312 Receipt #05A- 09- 00028956 Paid 08/31/2010 3.00 R 01124/2011 H 4.V�L7 10:32 PRODUCER Phone - 994 583 -5444 Fax - 954 -5B3 -2820 Pelican Insurance Agency 6950 Cypress Rd Ste 20817 Plantation, Fl 33317 Caribbean Electrical Contractors, Inc. 3725 South Ocean Drive, Unit 1117 Hollywood, FL 33019 9545832820 CERTIFICATE COVERAGES THIS IS TO CERTIFY THAT THE POLICIES OP 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. 67R - TYPE OF INSURANCE POUCY NUMBER POLICY EFFECTIVE POUCY EXPIRATION DATE (11011/00/111 DATE IMM/Dblrv) EMS PELICAN INSURANCE OF LIABILITY INSURANCE PAGE 01/01 DATE (MWPD/yy) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION 1/24/2011 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW INSURERS AFFORDING COVERAGE NAIC # INSURER A: Seminole Casualty ty INSURER B: INSURER C: INSURER b: INSURER E: A GENE LRA LIABIU COMMERCIAL GENERAL LIABILITY CLAIMS MADE (i OCCUR 9GL -000306668.0 9/30/2010 9/30/2011 GENT, AGGREGATE LIMIT APPLIES PER: POLICY - J cT LOC AUTOMOTA/E LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NDNd1UVNpn Al Jros pEpACCHH OCCUNENCE MED EXP (My one parson) PERSONAL R ATV INJURY GENERAL AGGREGATE PRODUCTS • COMP/OP AGO 1 ,000,000,00 100,000.00 $5,000 9,000,000.00 2 000 000.00 $1,000,000 GARAGE LrA®ILnY ANY AUTO (COMBINED o 9 INGLE LIMIT BODILY INJURY (Pet person) BODILY INJURY (e'er nocIdet i) (Pe accident) AUTO ONLY - EA ACCIDENT OTHER THAN EA AOC AUTO ONLY: AGO EACH DCOURENCE AGGREGATE DEDUCTIBLE RETENTION $ WORKER'S COMPENSATION AND LIABILITY ANY EE OFFICER/MEMBERREEXC UDED�OUtIVf3 BOSPECIALPROY INS belay • OTHER TQBy_UMiT E.L. EACH ACCIDENT >; « DISEASE - EA EMPLOYEE EL DISEASE - POLICY LIMIT $ 100,000.00 100,000.00 $ 500 000.00 IESCRIPTION OF OPERATIONS /LO ATIONS/VEHIC LU910NS ADDED DY ENDORSEMENT/SPECIAL PROVISIONS 'ERA ATE HOLDER liami Shores Village Ittn: Building & Zoning Department 0050 N.E. 2nd Avenue 'iami Shores, FL 33138 .05 -756 -8972 1 .CORD 26 (2001/08) 1 of 2 DDITIONAL INSURED; INSURER LETTER: A CANCELLATION (See Below SHOULD ANY OF THE ABOVE DESCRIBED POLICIES 9E CANCELLED BEFORE THE EXPIRATION DAT THEREOF, THE I$SIUING COMPANY WILL eNergAvon TO MAIL I O DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER WED 'TO THE LEFT 'SOT FAILURE TO MAIL SUCH NOTICE SHAM., IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, [Ts AGENTS OR REPRk ENTATIVE9.. . AVIIT OR1ZED REPRESEIS TATNE Samuel Jacks OACORD CORPORATION 1988 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS-LICENSING BOARD 1940 NORTH MONROB.STREET . TALLAHASSEE FL 32399 -0783 NICKERSON, MICHAEL BRIAN SR CARIBBEAN ELECTRICAL CONTRACTORS, INC. 3725 S OCEAN DRIV'E UNIT 1117 HOLLYWOOD FL 33019 Congratulations! With this license you become one of the nearly one million Floridians license by the. Department of Business and Professional Regulation. Our professionals and businesses range from architects is to yacht brokers, from boxers to barbeque.restaurants, and they keep Florida's economy strong. Every day we work to improve the way we do business in order to serve you better. For information about our services, please log onto vwawdalicense.aom. There you can find more information about our divisions and the regulations that impact you, subscribe to department newsletters and learn more about the Departments initiatives: Our mission at the Department !s• License Efficiently, Regulate Fairly. We constantly strive to serve you better so that you can serve your customers. Thank you for doing business in Florida, and congratulations on your new license! (850) 487 -1395 BraiOH h?A BER SUOMOD Puma* d aaedvs ssy imt Romer s ' sbaati7iiiins titAlaki:.. -1 mps was elt, swad =seise R ffis:`: ei This Wit$ RA. as mace Ai et Anersion EVUEOP . .. 1 _ .. . OPP FiimtA womentettuiftwOOrtumr- BUVE - 12/11/209 ineiOgnati Des 12111/2011 PERM% MEWL. NICKERson Fan 43 EUMEE MAW weetnak 1337 $r27111ec k�! IMMEIDAIR, R 88814 .. PLEASE CET OUT THE -SARK DELOS! =CM OF MOMS 0*.11ME • -resonse unneanstisisesniin:- 1 .44auntaF,S, Certificates ef: y 'indOidthie be amps of Woes - tiniks as Ethe nether -af: diodes to be E Pursuant iv ter 44001MEL 1F.S,- .. tintki to ks+.s and eartifisates e# ethatior is he exigieknOrth ki: in revantho et aft lime + : ::+ sr stni. hathein of the ttia. paa.aatl? er siailfbite A8 Wear an,' :. -tads Of egertithate. The sr el; a ?R:say time for face at the ithitiffiltegonent the rendremeras of We 413= • Mr HIRE • Cony bottom potion to tint job, keop tipper portion for l OF GOMM 1'EE OEM fORIND WEI 1 Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Project Address Parcel Number Applicant 1225 NE 92 Street Miami Shores, FL 1132050270300 Block: Lot: MARIA FENTE Owner Information Address Phone Cell MARIA FENTE 1225 NE 92 ST MIAMI SHORES FL 33138 -2936 Contractor(s) Phone CeII Phone CARIBBEAN ELECTRICAL CONTRAC (954)562 -0377 Valuation: Total Sq Feet: $ 3,500.00 2800 1 Type of Work: KITCHEN REMODEL NEW MAIN PANEL Additional Info: ELECTRICAL Classification: Residential Scanning: 1 Fees Due CCF DBPR Fee DCA Fee Education Surcharge Notary Fee Permit Fee - Additions /Alterations Scanning Fee Technology Fee Amount $2.40 $3.37 $3.37 $0.80 $5.00 $225.00 $3.00 $3.20 Total: $246.14 Pay Date Pay Type Amt Paid Amt Due Invoice # EL -1 -11 -39881 01/24/2011 Credit Card $ 50.00 $ 196.14 02/03/2011 Credit Card $ 196.14 $ 0.00 Available Inspections: 1 Inspection Type: 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. February 03, 2011 Authorized Signature: Owner / Applicant / Contractor / Agent Building Department Copy Date February 03, 2011 1 FROM 954 942 6310 ACRD (FRI)FEB 25 2011 16: 14/ST.16: 13/No.7522053412 P 1 04:44:37 p.m. 02 -25 -2011 CERTIFICATE OF LIABILITY INSURANCE 2 /2 DATE tMWp0r1YYY) 2/25/2011 THIS CERTIFICATE 1S 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(5), 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 cond loons of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate bottler In lieu of such endorsement(s). PeoouCER Frank H. Furman, Inc. 1314 East Atlantic Blvd. P. 0. Box 1927 1?ornpano $Hach , INSURED FL, .33051 Caribbean 81ec.t:rical Contractors, Inc 3858 S14. 30th Avenue ,Hollywood FL 3333.2 "miltaT Deborah Dingle NAME......__. 9; �GNtIEo.E><q; (954)943 -5050 ,� /���.`lyss >ysa.3TIQ EdMAIL deborahmfurmanin6urance.cocF PRODUCER A0008875 ClisiONER.IL k--_ —_._ INSURER(S)AFFORDING COVERAGS _ . NAICE INSURERA:Bridgef E!1d Employers Ins CO ,INSURER 2 : INSURER G : —_ „—^ • INSURER E .07Q1, .._ INSURER F : COVERAGES CERTIFICATE NUMBER :Maatex COI _ REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BLOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOve FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM DR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CIATINICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE' BEEN REDUCED BY PAID CLAIMS, LTR ! TYPE Of INSURANCE IADOLj$U6Rj- : P O L I C Y EFF f PQLICYb(P ' ° - -"”- -- --- ! • - :. di. I POLICY NUMBER I MMIVOh'YTY IAM!DD?YY LIMITS I GENERAL LIABILITY COMMERCIAL GENERAL. LIABILITY CLAIMS -MADE I— �.1 OCCUR • GERI AGGREGATE LIMIT APPLIES PER: .LJ. POLICY • I 1 CT. �_— LOC AUTOMOBILE LIABILITY ANY AUTO . ALL OWNEb AUTOS SCHEDULE° AUTOS (TIRED AUTOS NON- Y'.yNEDAUTOS UMBRELLA UAS °.^.CUR - • MEXCESS LIAO . I CIAL115 N .DE DEDUCTIBLE •RETENTION 5 )) WORKERS COMPENSATION AND EMPLOYERS` LIABILITY Y 1 N ! p.NV PPOPRIE:'?OVPARTNER1CXLCUTIYE OF•!CERIMENBER EXCL.! MED? I N 1 A jMInddtoiy h1 NH) 11 yes, describe under DESCR:PTIQN OF OPERATIONS bow+ EACH OCCURRENCE . ! S R"IA,.'faEGE:7tS-fIE17i'EH •- ,— .- �I- �-- ...,.- ,......�....._ ..., M£D CXP (Arypfe 7a n) S - F_ RsoNni. & Ally, INJURY 5 WIRRAL AGGREGATE ! 5 PRODUCTS- COMP/OP A$, f $ 3 COMBINED SINGLE LINIT 1 S IEa acclacrd DODILY IN,IUR;: (Par pewit) $ BODILY INJURY IPa edcidenp j 1 PROPERTY DAMAGE ii $ (Per am ide+d) j IS IS EACH OCCURRENCE S AG�RCGATT: S I$ I•— • 0330411893 /2 /SC�2 1 /1/20x2 Li WC TATtt. i :(JtH -1 .x—L. �wrr� • J .CR I DLSCFPTION Or OPERATIONS 1 LOCATIONS /VEHICLES IAltach ACORD 18.1, AddklMal Remarks Schedule, If more spaca Ia raorukedl E L,6ACH!1cciuENT s _ 10Q, 000 C.L. DI.AAG - EA EMPLOYE • 1 100,909 E.L. DISEASE -POLICY LIMIT $ 800, Oda CERTIFICATE HOLDER City of Miami Shores 10050 NE 2nd Ave Miami Shores, FL 33138 CANCELLATION SHOULD ANY OP THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE. EXPIRATION DATE THEREOF, NOTICE WILL BE DELNVRED tN ACCORDANCE WITH THE POLICY PROVISIONS. AI,mfoaIzED REPRESENTATIVE 'Prank PsIiTnA71. .TY /TIA.R cs: Exemption Detail Page Page 1 of 1 SERVICES Alex Sink (1-inandia(ItTtarolTbritk• FOOS NOME CIPPITSET US SEARCH BY SUSPECT lino Eli ESEAHOP. SEARCH FLOPS MMus Carp Home Abut' Us Assesomert Rat= Denelll Delivery Process Centralized Pedestrian= Sysfern Ch. 440 FL Striates Omani Us Databases Llrectory Ofices EDI Ftexanal Qcsesitre Hider( tnarourandalfluiredre Pads:Mans Retried Lints Rule* & Fawns Saialy Slated= Mats New Exemption Detail Page Ma Database was Last Updated: 2111201111t11 PM Realm ki Qurj1oni Exemption Details . ... ..... _ • - - - 1 Name ._- Tike _ Melee Dale 'Termination Exemption Delo — eweleyer Nante .... ___.. .... . PiCIPERSON ve OW it >RS ' __.1 Dec 112011 1 connosare CARRESEPN ELECTRIEVL - -....-..... .._. CLOTRACTORS NG . ' ToobsOFLFAIHAthouSASPL LOLL:CFOs-WI-FA AAA.FPAA.LALAPAAL-C4 to sompkaa. a ImAtAike 4 Mare bre.issAA no ecansAca Return to Many FORA DIVISIOM OF WORKERS' OOMPEMSA710114800) 142-2214 or WO) 413.16G1 Rattle Division el Mloskant Compestaation • 2DD East Daiwa area. TaibbessoD, Florida 32305•422a • • Leaal Hollow UnAwFkoia Ame-asailaSiossesampttlaiscoAso KRA go ralusAysso end addossoleasebla respostro Koala wools raossi.ebnorl repardsOns*: smilfolis telly. fralead. colaotthisaloott Ono or hod**. AKAecA • a http://wwwanylloridaefo.com/WCAPTS/Compliance POC/wScripts/Exemptions.asp7PER1... 2/4/2011 • . • Exemption Detail Page RioN1 L11 , FLORIDA i4gg010 AL j SERVICES Page 1 of 1 Alex Sink Chkr Financial Officer of Fitvide FLDFS HOME CONTACT US SEARCH BY SUBJECT HELP EN ESPAROL SEARCH FLDFS Woncers' Comp Hem* About Us Assessment Rates Benefit Delivery Process Centralized Performance System Ch. 440 FL Statutes Contact Us Databases Directory District Offices EDI Frequent Questions History Memoranda/Bulletins PubficatIons Related Links Rules & Forms Safety Statistics What's New Exemption Detail Page This OstabaSe was Last Updated: 2131201111:11:61 PM Return to Quail, Farm 73—Lal Exemption Details Name Title Effective ; *Termination Date Date • 1 NICKenson , Dec 11 2008 1 Dec 11 2011 I 1 • 1 CARRIBSEAN ELECTRICAL i CONTRACTORS INC ; MICHAEL I 1... . • — • Terrninttron may be through the revocation ot the exemptio, expiration of the ekerrtption, or invalidation by failure to re-issue the exemtion. Exemption Employer Name Type Return to Query Form DIVISION OF WORKERS COMPENSATION ISOM 742-2214 or (850) 413-1601 Florida Division of Worker' Compensation - 200 at Gaines Street • Tallahassee, Ftoride 323994228 • • Legal Notices Under Florida law, e-ma2 Add e outdo recool. !rya, do not want yOUt Oddrets releasissi frt response to a public records request. do not Send electronic Inen t WS entity. instead, contact we ogee by plum or n writing. 7 - http:4" .dw.n6 s 8 :0-N 1cfo.com/WCAPPS/Comp1iance_POC4Scripts/Exemptionsig EE:8 1 ile/ .14 .ciaj ZiaNI —(5" :SNs Miami Shores Village To m Cgr Building Department g 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 BY: ................... INSPECTION'S PHONE NUMBER: (305) 762.4949 BUILDING Permit No. (� ., I v tq PERMIT APPLICATION Master Permit No. FBC 20 Permit Type: BUILDING OWNER: Name (Fee Simple Titleholder) V 7 ) YaC 1 (Any-) Phone #: "48'6385 S g 9 Address: 1 P /J (? City: RA r i ay r®i State: F L Zip: 33 3g Tenant/Lessee ame: e1 �'i-Q Phone #: Email: ((R..) i r'1'Yl 6_ a l°Yl • C 0 r7 ) JOB ADDRESS: 10 g5 9 s City: Miami Shores County: Folio/Parcel#: 1— '39-0 5- OD-7 -- Miami Dade Zip: 3cj1 3A Is the Building Historically Designated: Yes NO Flood Zone: Y� 7 CONTRACTOR: Company Name: 040 e ThIvQ( _ ., _ 46P r1 G A Address: / d4 ��-� 71 City: V/14borl 0 LC ��- State: FL Qualifier Name: _1®@f 0. Oa id w 9 /) Phone #: W6.46 G 8 , State Certification or o�rp Registration #: C (C 9s- 14. (�8 Certificatepf Competency #: Contact Phone #: T 'r % /� Pco Emai Addre s: i �t ®!�?9� 1Q� `I'�P('1 Phone #: a� Zip: 3 3 U I DESIGNER Architect/Engineer: C VI 9j� 4 3055 ® p�,� Z73 Value of Work for this Permit: $ (3�- 0 ® Square/Linear Footage of Work: '-frtf °Demolition Type of Work: °Address Description of Work: CIAlte ation °New DRepair/Replace COLOR THROUGH ROOF TILE IS REQUIRED acknowledged by: ******** * * * * * * * * * * * * * * * * * * * ** ** * * * * * *** Fees***e********* ** * * * * ** * *** * * * ** * * * * * * * * * * * * ** Submittal Fee $ Permit Fee $ 6 CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ 5 ' 9 tL Bonding Company's Name (if applicable) Bonding Company's Address City State Zip VIM e Mortgage Lender's Name (if applicable) t,tV\- Mortgage Lender's Address ID rQ LI 44 City C _N) J (fsseca,w. State 1 L Zip 0)/q 7— aC1i1/4) 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 cynce of such p' te'. notice, the inspection will not be approved and a reinspec 'on fee will be charged. Owner or Agent The foregoing instrument was acknowledged before me this day of f , 20 00 , by v:CJL, 1. 1Avt. who is personally known to me or who has produced FGI:0 As identification and who did take an oath. NOTARY PUBLIC: t)eRO Sign: Print: Signature Contractor The foregoing / nstrument was acknowledged before me this2\ day of 1 0 , 201 byMri who is personally known to me or who has produced ' I7 as identification and who did take an oath. NOTARY PUBLI , : My Co mission Expires: 95/20,2. ************************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** APPROVED BY /1/ Plans Examiner Sign: Print: o►►►u 1110/0 enis f•.d 5 My Commission Expires: • yp„,„0671287/0). -_ %,1�: • two. nnQQ.• *************** * * * * * * * * * * * * * * * * * * * * * * * * *'��ir� i i*MW‘�`��\\ Structural Review (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09)(rev6/4/10) Zoning Clerk CUMULATIVE SUBSTANTIAL IMPROVEMENT VERIFICATION WORK SHEET In accordance with FEMA regulation and Miami Shores Village Flood Damage Prevention Ordinance the costs of all improvements must be monitored. The costs of any improvements in the past 12 months and the costs of any proposed improvements must be shown on the worksheet. The cost of improvements must include demolition, raw and finished materials (include those donated), labor (including volunteer and self - performed), construction supervision and management, and overhead and profit. A list of items the costs of which are to be included as well as those excluded is attached for your reference. (A Copy of the Contract must be attached) PROPERTY OWNER: D fikY'f I \ra L+ h e1 PERMIT # ADDRESS: 1 g d`s D" l'P4 Aim; 5( re 3313 t FOLIO NUMBER: f (— 590S— C2 7 4 OOD ZONE: ti,eS BASE FLOOD ELEVATION: FREEBOARD: EAST OF FL.CCCL: COST OF PAST IMPROVEMENTS (12 MONTHS): fl ®V Q COST OF PROPOSED IMPROVEMENTS: 9 3S0. °C!) (ATTACH COPY OF CONTRACT) TOTAL CUMULATIVE COST OF IMPROVEMENTS (past and proposed): VALUE OF PRINCIPALRUCTURE (attach appraisal): /046,1"o 6(,6)© OWNERS SIGNATURE: PLAN REVIEWER: PLAN REVIEWER SIGNATUR DATE: 11 -12 -08 Miami -Dade My Home My Home Show Me: Property Information Search By: Select Item LJ Text oriiy " Property Appraiser Tax Estimator Property Appraiser Tax c:n par son 1.1 Portability S.O.H. Calculator Summary Details: Folio No.: 11- 3205 - 027 -0300 Property: 1225 NE 92 ST Mailing DAVID & TRACI WINN Address: 1 Living Units: 1225 NE 92 ST MIAMI Adj Sq Footage: SHORES FL Lot Size: 33138 -2936 Property Information: Primary Zone: 1100 SINGLE FAMILY RESIDENCE CLUC: 0001 RESIDENTIAL - SINGLE FAMILY Beds /Baths: /3 Floors: 1 Living Units: 1 Adj Sq Footage: ,665 Lot Size: 12,500 SQ FT Year Built: 1959 $50,000/ $343,840 53 42 BAY LURE PB City: 4 -63 W5OFT OF LOT 18 Legal & E5OFT OF LOT 19 BLK Description: LOT SIZE IRREGULAR OR 20064 -3613 11 2001 1 Assessment Information: Year: 2010 2009 Land Value: $150,000 $219,000 G:Y.rn ... ,z e:r777r- —T•.. . , 78 783 Market Value: .411,610 $497,783 Assessed Value: $393,840 $383,486 Exemption Information: Year: 2010 2009 Homestead: $25,000 $25,000 2nd Homestead: YES YES Taxable Value Information: Year: 2010 2009 Applied Applied Taxing Authority: Exemption/ Taxable Exemption/ Taxable Value: Value: Regional: $50,000/ 5343,840 $50,000/ $333,486 County: $50,000/ $343,840 $50,000/ $333,486 City: $50,000/ $343,840 $50,000/ $333,486 School Board: $25,000/ $368,840 $25,000/ $358,486 Sale Information: Sale Date: 11/2001 Page 1 of 2 ACTIVE TOOL: SELECT Aerial Photography - 2009 0 113 ft My Horne 1 Property Information 'Property Taxes 1 MY Neighborhood 'Property Appraiser Home j Using Our Site 1 Phone Directory !Privacy 'Disclaimer If you experience technical difficulties with the Property Information application, or wish to send us your comments, questions or suggestions please email us at Webmaster. Web Site © 2002 Miami -Dade County. All rights reserved. Legend Property Boundary Selected Property Street /*f Highway Miami -Dade County Water http: / /gisims2. miamidade .gov /myhome /propmap.asp 10/25/2010 Project Address Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Parcel Number Applicant 1225 NE 92 Street Miami Shores, FL 1132050270300 Block: Lot: MARIA FENTE 1 Owner Information Address Phone CeII MARIA FENTE 1225 NE 92 ST MIAMI SHORES FL 33138 -2936 Contractor(s) CALDWELL DEVELOPMENT INC Phone CeII Phone (786)402 -9826 Valuation: Total Sq Feet: $ 9,350.00 273 1 Approved: In Review Comments: Date Approved: : In Review Date Denied: Type of Construction: KITCHEN REMODEL Stories: Front Setback: Left Setback: Bedrooms: Plans Submitted: Yes Certificate Date: [Bond Return : Occupancy: Single Family Exterior: Rear Setback: Right Setback: Bathrooms: Certificate Status: Additional Info: Classification: Residential Fees Due CCF DBPR Fee DCA Fee Education Surcharge Notary Fee Permit Fee Scanning Fee Technology Fee Total: Amount $8.00 $4.21 $4.21 $2.00 $5.00 $280.50 $6.00 $8.00 $315.92 Pay Date Pay Type Invoice # RC -10 -10 -39267 10/28/2010 Credit Card 02/03/2011 Credit Card Amt Paid Amt Due $ 50.00 $ 265.92 $ 265.92 $ 0.00 Available Inspections: 1 Inspection Type: Final PE Certification Shutter Final Window Door Attachment Tie Beam Slab Termite Letter Framing Insulation Drywall Screw Shutter Attachment Window and Door Buck Ceiling Grid Fill Cells Columns Declaration of Use 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 clone 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. February 03, 2011 Authorized Signature: Owner / Applicant / Contractor / Agent Building Department Copy Date February 03, 2011 1 Parcel Owner Report Parcel Number: 1132050270300 1225 NE 92 Street Miami Shores FL Tax ID: 1132050270300 Owner Information MARIA FENTE Phone: MANUEL FENTE Phone: Current Owner: Yes Current Owner: Yes Related Permits Electrical - Residential Imported Permit Imported Permit Residential Construction Windows /Shutters Windows /Shutters Permit Number EL -1 -11 -113 BP2002 -120 BP2002 -111 RC -10 -10 -1906 WS -2 -10 -242 WS -1 -09 -105 Application Date 01/28/2011 01/18/2002 01/17/2002 10/28/2010 02/17/2010 01/22/2009 Expiration Date Status 07/27/2011 A 07/17/2002 07/16/2002 07/27/2011 01/01/2999 01/01/2999 ROVED CLOSED CLOSED cut_wit_ ,EeP( 2k_ pcs24---tc-cs w Wednesday, February 2, 2011 Page 1 of 1 NOTICE OF COMMENCEMENT A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION PERMIT NO.it.'(t -(0 iCiart TAX FOLIO NO. 1 /- j ' 02-7 - STATE OF FLORIDA: COUNTY OF MIAMI -DADE: THE UNDERSIGNED hereby gives notice that improvements will be made to certain real property, and in accordance with Chapter 713, Florida Statutes, the following information is provided in this Notice of Commencement. 111111111111111111111111111111111111111111111 f :FN 2010R0760381 OR Bk 27484 Ps 0452; (1ps) RECORDED 11/08/2010 14:5337 HARVEY RLIVIW, CLERK OF COURT 11IAMI -DADE COMM FLORIDA LAST PAGE Space above reserved for use of recording offic4 4 Lot- .r - _ (3 •► m �7 J1 7111 ascription of • 1,U' 3. Owner(s) name and address: Interest in property: Name and address of fee simple titleholder. 4. C. t. -ct• 's - -, a•;.ress = .c phori n '111 5. Surety: (Payment bond required by owner fro con ■ - ctor, if any) Name, address and pho e number fl� Amount of bond $ V\ Q 6. Lender's name and a dress: )CW.os Tel lxf�y- ((' -b Coro( S-i1Cam.r .LL.. 401611-W140 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. STATE OF FLORIDA, COUNTY OF DADS 1 Mfr EBY UER 1 T FY ifl-a Irils is , ,) Oi UV , ,-fi a lklk. 20 8. In addition to himself, Owners designates the following 'g 713.13(1)(b), Florida Statutes. Name, address and phone number: WITNESS t Not roe / P1 r1d CPU u/ vial Se- if" IfiLf41•" ection 9. Expiration date of this Notice of Commencement: (t = expiration date Is 1 y fro 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. Sianature(s) By Print Name er(s) r Ow er s ' Au horiaed Officer/Director /Partner /Manager !i- Prepared By a-- Print Name L.)i ,t Atalad iaa5 1� .-5 day of C)C71- ✓ +GC L ;rent t/ . Title /Office 4e.:ne'' STATE OF FLORIDA COUNTY OF MIAMI -DADE The foregoing instrument was acknowledged before me this By - ' t r■l r-1 i idividually, or as for ❑ Personally known, or .roduced the following type of identification: Signature of Notary Public: Print Name: :1 tf.sa a,.; .9ittot F4- `Now m �urr�i, fi ,c\\ fpse`s 6r�`�f.`% 12012 (SEAL) ROTARY PUBLIC _= VERIFICATION PURSUANT TO SECTION 92.525. FLORIDA STATUTES �p(OttiISSIOA Under penalties of perjury, I declare that I have read the foregoing and ., pD7�.gQ( �- that the facts stated in it are true, to the best o, . y knowledge and belief. ' l,N• , .• .< \��` S' • nat e(s) of • s) or Owner :, uth z @d Officer/Director /Partner/Manager who signed above''/,O F i F ... B _a�i�K4OF .__. ' By 123.01.62 PAGE3 3/10 it IbI10-5)-kr•)) Permit No: 10 -1906 Job Name: November 5, 2010 Miami Shores Viiiage Building Department Building Critique Sheet 1) Provide an electrical permit application. 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Page 1 of 1 Plan review is not complete, when all items above are corrected, we will do a complete plan review. If any sheets are voided, remove them from the plans and replace with new revised sheets and include one set of voided sheets in the re- submittal drawings. Norman Bruhn CBO 305 - 795 -2204 Miami Shores Viiiage Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 RECEIPT PERMIT #: G 10-1110 DATE: 2-0ii I, Qvc c Li ❑ Contractor ❑ Owner ❑ Architect plan = other) Address )11,2S e Ni c 2 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 Buildin Department to continue permitting proces Acknowledged by: 9�. PERMIT CLERK INITIAL: RESUBMITTED DATE: I`� h, `, I 1 PERMIT CLERK INITIAL: .,,. :o.: r:�. • �•?� to - .�_,;. ,lam 6A7%Y. R:LSIUIB ci 3io • R'.t gam:.g� sky ice^ 1. r, d "'�rl,Y' �' dtiy� r 954 942 6310 08:23:09 a.m. 10 -28 -2010 1/1 "e'�°. -R° CERTIFICATE OF LIABILITY INSURANCE DATE T 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 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 'rank H. Furman, Inc. 1314 East Atlantic Blvd. P. O. Box 1927 Pompano Beach FL 33061 CONTACT NAME: VH3' { .No Exit (954)943 -5050 {AtCNo): (951)942 -6310 E-MAIL ADDRESS: mal ,aada�fuxaaasuranCe.com FFC CER1Df00007150 INSURER(S) AFFORDING COVERAGE NAIL INSURED Caldwell Development, Inc 8004 NW 154th Street, 9171 Miami Lakes FL 33016 INSURER A:Atlantic Casualty II18 Co 42846 INSURER 8 : ENSURER C INSURERD: INSURER E : INSURER F: :Or, 720142 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 POUCIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. UMrrS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR TYPE OF INSURANCE -1A SUER POLICY EFF POLICY EXP tNSR WVD ( POLICY NUMBER (MMtPD/YYYYI (MM/DQ/YYYY) L1t1iTS GENERAL LIABILITY EACH OCCURRENCE $ 300,000 . •171, X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE X OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO- JECT LOC L144000576 -1 10/5/2010 10/5/2011 f , PREMISES (Ea occurrence) MED EXP (Any one person) PERSONAL B.ADVINJURY $ 100,000 5,000 $ 300,000 GENERAL AGGREGATE 5 600, 000 PRODUCTS - COMP/OP AGG $ 600, 000 AUTOMOBILE UAIKUTY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON - OWNED AUTOS COMBINED SINGLE LIMrr (Ea accident) 5 $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) PROPERTY DAMAGE (Per accident) $ UMBRELLA UAB EXCESS UAB OCCUR CLAIMS -MADE DEDUCTIBLE RETENTION $ WORKERS COMPENSATION AND EMPLOYERS LIABILITY ANY PROPRIETOR/PARTNER/EXECt Y / N J OFFICER/MEMBER EXCLUDED? N / A (Mandatory in NH) I describe under DESCRIPTION OF OPERATIONS below $ EACH OCCURRENCE AGGREGATE $ $ WC STATU- 1 jOTH- TORY LIMITS I , ER E.L EACH ACCIDENT E.L DISEASE - EA EMPLOYEE DESCRIPTION DE OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101. Additional Remarks Schedule, !freers epace is required) EL DISEASE - POLICY LIMIT $ CERTIFICATE HOLDER CANCELLATION (305)756 -8972 Miami Shores Village Ball 10050 NE 2nd Avenue Miami Shores, FL 33138 ACORD 25 (2009109) INS025 (200909) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTNORIZED REPRESENTATIVE Frank Furman, Sr /All 1988 -2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 954 942 6310 08:23:33 a.m. 10 -28 -2010 1 /1 CERTIFICATE OF LIABILITY INSURANCE DATE(M98130/YYYY) 10/28/2010 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 poiicy(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 Frank H. Furman, Inc. 1314 East Atlantic Blvd. P. O. Box 1927 Pompano Beach FY, 33061 CON ACT Amanda Harvey ( Eat): (954) 943 -5050 1 w e . FAX L ; a mandaSfurmaninsurance. coca �uRIDe00007150 INSURER(;) AFFORDING COVERAGE NAM # INSURED Caldwell Development, Inc 8004 NW 154th Street, #171 Miami Lakes FL 33016 nt-XM 12Armet .- --- .- --- - -- -•- ---- ----- -- -- - INSURER A:Atlantic Casualty Ins Co 42846 INSURER 9: INSURER C: INSURER D : INSURER E : INSURER F: --- REVISION NUMBER; THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE USTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POUCY 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 SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INR TYPE OF INSURANCE ADM SU7 R POUCY EFP POUCY EXP INSR WVD POLICY NUMBER ((MM/D0/YVYY) (MM/PD/YYYY) GENERAL UABILITY X COMMERCIAL GENERAL LIABR.UTY CLAIMS -MADE X OCCUR GEN'L AGGREGATE LIMIT APPLIES PER X POLICY 1T LOC W.44000576 -1 0/5/2010 0/5/2011 LIMITS EACH OCCURRENCE 5 300, 000 PREMISES tea oaxarenwl $ 100, 000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 300, 000 GENERAL AGGREGATE $ 600,000 PRODUCTS • COMP/OP AGG AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS COMBINED SINGLE LINT (Ea ac®dent) $ 600,000 $ BODILY INJURY (Per pew) 5 BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ UMBRELLA UAB EXCESS UAB OCCUR CLAIMS -MADE DEDUCTIBLE RETENTION WORKERS COMPENSATION AND EMPLOYERS' UABILITY ANY PROPRIETORIPARTNERIEXECUTIVE OFFICERiMEMBER EXCLUDED? [_ __ (Mandatory In NH) It yes, describe under DESCRIPTION OF OPERATIONS below EACH OCCURRENCE $ AGGREGATE $ N/A WC STATU- 1OTH- TORY LIMITS I ER E.L. EACH ACCIDENT $ E.L. DISEASE • EA EMPLOYEE $ OESCRIPiloN OF OPERATIONS / LOCATIONS/ VEHICLES (Attach ACORD 101. Add/tjonal Remarks Schedule, if more space EL DISEASE - POLICY LIMIT $ required) CERTIFICATE HOLDER CANCELLATION (305)756 -8972 Miami Shores Village Hall 10050 NH 2nd Avenue Miami Shores, FX, 33138 ACORD 25 (2009/09) INS025 (200909) 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 Frank Furman, Jr /AB :r2. rOIL The ACORD name and logo are registered marks rrks of AACCORACORD CORPORATION. All rights reserved. 954 942 6310 08:27:32 a.m. 10 -28 -2010 1 /1 ACS. IR° CERTIFICATE OF LIABILITY INSURANCE a;2 © ) 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 INSURERS), 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 Frank H. Furman, Inc. 1314 Bast Atlantic Blvd. P. O. Box 1927 Pompano Beach FL 33061 CONTACT NAME/ Amanda Harvey O 040, Ext}: (954) 943 -5050 I (kt, Nsk (964) 942 -6310 EMAIL ApDRe� am nda @£urmaninsurance.COM emmucul 00007150 CUSTOMER Mk INSURER(S) AFFORDING COVERAGE NAIC It INSURED Caldwell Development, Inc 8004 NW 154th Street, #171 Miami Lakes FI. 33016 INSURER A :At laatLc Casualty Ins Co 42846 INSURER B : INSURER C: INSURERD: INSURER E INSURER F k COVERAGES CERTIFICATE NUMBER:CL1010720142 ttcutclnet MIlaaauts. 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. UMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. `}• Wr kid TYPE OF INSURANCE INsR UYVb POLICY NUMBER POLICY EFF POUCY EXP (MMIDD(YYYY) (MM/DOVYYYY) GENERAL UABILITY X COMMERCIAL GENERAL LIAB&.ITY A ■ CLAIMS -MADE I X I OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY ECT LOC AUTOMOBILE UAB)UTY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS 144000576 -1 0/5/2010 UMITS 0/5/2011 MEDEXP one ..::., PERSONAL & ADV INJURY $ 300,000 $ 100,000 $ 5, 000 $ 300, 000 GENERAL AGGREGATE $ 600, 000 PRODUCTS• COMP/OP AGG $ 600,000 COMBINED SINGLE LIMIT (Ea accident) BODILY INJURY (Per person) BODILY INJURY Per saddest) PROPERTY DAMAGE (Per accident) UMBRELLA UAB EXCESS UAB OCCUR CLAIMS -MADE DEDUCTIBLE RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' UABIUTY ANY PROPRIETOR/PARTNER/EXECUTIVE ri OFFICERiMEMBER OCCLUDED? (Mandatory In NH) It yes. describe under DFPr`RIPTION OF OPERATIONS EACH OCCURRENCE $ AGGREGATE $ N/A WC STATU- OTH- TORY LIMITS ER EL EACH ACCIDENT EL DISEASE • EA EMPLOYEE $ DESCRIPTION OF OPERATIONS / LOCATIONS/ VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) E.L DISEASE - POUCY LIMIT ( $ CERTIFICATE HOLDER CANCELLATION (305)756 -8972 Miami Shores Village Hall 10050 NE 2nd Avenue Miami. Shores, FL 33138 ACORD 25 (2009/09 INS025 (200009) 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 Frank Furman, Jr /AH 1988 -2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORO