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DS-12-533Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 172551 Permit Number: DS -3 -12 -533 Scheduled Inspection Date: April 30, 2012 Inspector: Bruhn, Norman Owner: , DUSA ACQUISITION LLC Job Address: 455 NE 91 Street Miami Shores, FL 33138- Project: <NONE> Contractor: COLONY ACQUISITION CORP Permit Type: Driveways /Sidewalks /Slabs Inspection Type: Final Work Classification: Addition /Alteration Phone Number (305)496 -7442 Parcel Number 1132060140140 Phone: (305)496 -7442 Building Department Comments REPAVE FRONT PARKING WITH STAMP CONCRETE. 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- 171604. Not Ready. NB April 27, 2012 For Inspections please call: (305)762 -4949 Page 19 of 38 BDINGUII: ,N� PE FBC 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 No. ps 2.. ''5� Master Permit No. 'CATION Permit . • BUILDING ROOFING RECEIVED MAR 2.9 2012 BY: OWNER: Name (Fee Simple Titleholder): _ € ie u / r. C, Phones 3c1C- /'9 1=79415.2 Address:_��� WI) _ City: ��!!�� / State: 9 t „ Zip: 33 / �f 3 Tenant/Lessee Name: // Phone#: 36 S° NI t ` ii y2_ Email: E. 4: 1. �� Ain JOB ADDRESS: 4116-g-- /tie II/ City: Miami hores , County: Folio/Parcel #: ,/ � 2L - 0/A1 - Or 0 Miami Dade Is the Building Historically Designated: Yes NO Zip: 331a' Flood Zone: Ac/4 49/0"44, t CONTRACTOR: Company Name: e it 14" Ili C7L If; rap Phone#: c — `'N%��4 -9W2- Address: 73 �� &»,—i . 3/ City: k7; ell Lgaitthic10 State: zip: 333 I a__ Qualifier Name: Phone#: 30-5 - V? G - '7 /%4Z- p� State Certification or Registration #: l _ 4 ( ©5- k 0 Certificate of Competency #: Contact Phone#: 305-- / V C - F q 1/ Email Address: k� spe /la c j t't leI-1 1. e e DESIGNER Architect/Engineer: 1 ir+- -" - gpe //Cu e /'JrcIi l 1s Phone#: 305-- '1 ? C r'7. yY2, " �,J Value of Work for this Permit $ 14 0 Square/Linear Footage of Work: 1430 Type of Work: °Addition °Alteration °New ORepair/Replace °Demolition 1 **********************************F ee+ s s ee*e * **** *** Submittal Fee $..-10 • C Permit Fee $ 7 J e, CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary .$ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ [1:5 I. -� v /() Bdaing ompany'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 sub' ' - to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspe «n w ' h occurs seven (7) days after the building permit is issued th absence of such posted notice, the inspection will no be ap roved and a reinspection fee will be charged / r Signature / Owner or Agent The foregoing instrument was acknowledged before me this day of �I- 1 ) 20 41_, by who is personally known to me or who has produced As identification and who did take an oath. NOTARY PUBLIC: Sign: Print JACQUELYN S. ROBLE00 Aril* !� ;*: MY COMMISSION 1 EE 035515 4 EXPIRES, Fsb'ua y 16, 2015 Bon n' .:.. °, 0"I APPROVED BY Go 9.;:fielL Signature Contractor The foregoin: instrument wa��sacknow.' ged before me thia day of ' 2O/e , by -NgC en , 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 /102009XRevised 3/15/09) Clerk 1 Planning and Zoning Criteria Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Fax: (305)756 -8972 Expires:Not Issued Folio Number:1132060140140 Owner's Name: DUSA ACQUISITION LLC Job Address: 455 91 Street Miami Shores, FL 33138- Owner's Phone: Total Square Feet: Total Job Valuation: (305)496 -7442 430 $ 1,750.00 Contractor(s) COLONY ACQUISITION CORP Phone Primary Contractor (305)496 -7442 Yes Planning and Zoning Criteria and Comments Approved: No Date Denied: 3/29/2012 Comments: PLEASE MODIFY PLANS DRIVEWAY CAN NOT BE LOCATED WITHIN 10 FEET OF SIDE LOT LINE. I I m, ! - 10.0 01 ,54.48-(..4-reL/W to. Alea;11q — WAs" Itt, 5 3w0 11 .-f e, Z--- nil Irti.--"-- -- -• : orA4,40./..VG P/f/i9/1.. •-, 1;-11;‘,,,. • t...-. —,...4„. , 0 it- a. IleAr., ,,t"kormd •VArellit.• i I , 'I• I 1 1 I . - -1-a E.- gy. •,.• _...,-,..., -.....r4. . I. ' ... 44_7.)-Tr a AV, • pi 1 I. :4 'Bur L., I — • 43 ,tflhfl. syer ceAtis xne/t.r.A.to Xpew.K..,G - 1/iS - • - •- • - - • .• • ..... • - • _1 _ ClUt.Pflt.:/* Age I/11.es E. •96:5-,1/G" 9/ Or ,74/A#/ and •*. , n. er% 7 • • • • ACORD, CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 04/09/2012 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 Irving Weber Associates, Inc. 761 Koehler Avenue Ronkonkoma, NY 11779 -7407 NAME: WIITACT Trecia A. Morgan PHONE (C, No, Ext): 800.243.1811 x8233 E-MAIL ADDRESS: (A/C, No): 631.366.2211 INSURER(S) AFFORDING COVERAGE NAIC # INSURED Colony Acquisition Corporation dba Dry Cleaning Depot, BluRoo and CRDN of SE FL & The Treasure Coast 730 W BROWARD BLVD FORT LAUDERDALE, FL 33312 COVERAGES CERTIFICATE NUMBER: 2012 -2013 INSURER A : Argonaut Insurance Company 19801 INSURER B : INSURER C : INSURER D : INSURER E: INSURER F : 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. ILTR TYPE OF INSURANCE AUDL INSR SUt! WVD POUCY NUMBER POLICY EFF •/DD POLICY EXP M/DD LIMITS A GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY LDB 9153172 0 " 03/01/2012 03/01/2013 EACH OCCURRENCE $ 1,000,001 ■ l PREMISES (Ea occurrence 1 1 1 1 1 I CLAIMS MADE X OCCUR . 11, 111 GENERAL AGGREGATE $ 5,000,001 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY ■ JECT ■ LOC PRODUCTS - COMP/OP 1 1 1 1 1 1 ■ • • - ANY AUTO OWNED AUTOS HIRED AUTOS ■ SCHEDULED AUTOS AUTOS 1 * - 1 ■ (Ea accident) $ BODILY INJURY (Per person) $ BODILY -Par. acc.i. devnt; lyr‘ $ • X ■ UMBRELLA UAG EXCESS LUU3 X ■ OCCUR CLAIMS-MADE UMB 9153172 I OW01=12 OaM14M13 EACH OCCURRENCE s 10,000,000 $ 10,000,001 • 10,001 WORKERS AND , • , ANY • • - • EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS b- WC STATU- I 10TH TORY LIMITS ER E.L. EACH ACCIDENT E.L. DISEASE- EAEMPLOYE� '$ E.L. DISEASE - POLICY LIMIT A roperty- Replacement Cost ►pecial Form Wind /Glass LDB 9153172 0 03/01/2012 03/01/2013 Building $2,723,146 BusPersProp $3,664,280 Deductible $2500 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule 11 more space Is required) vidence of Insurance. CERTIFICATE HOLDER CANCELLATION Miami Shores Village 10050 Northeast 2nd Ave 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 POUCY PROVISIONS. AUTHORIZED REPRESENTATIVE Adam Weber/TRECIA A& c;. its ACORD 25 (2010/05) © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ACORD, AGENCY CUSTOMER ID: LOC #: 00013848 ADDITIONAL REMARKS SCHEDULE Page of AGENCY Irving Weber Associates, Inc. NAMED INSURED Colony Acquisition Corporation dba CRDN of SE FL & The Treasure Coast 730 W BROWARD BLVD FORT LAUDERDALE, FL 33312 POLICY NUMBER CARRIER NAICCODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDmONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: ACORD Certificate of Liability Insurance CERTIFICATE HOLDER: Garage Liability INSR ADD'L LTR INSRD Colony Acquisitions Inc. ANY AUTO Automobile Liability Excess/Umbrella Liability SUBR POUCY EFFECTIVE POLICY EXPIRATION WVD POLICY NUMBER DATE (MM/DD/YY) DATE (MM/DD/YY) LIMITS AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ AUTO ONLY: AGG $ POUCY EFFECTIVE POUCY EXPIRATION POUCY NUMBER DATE (MM/DD/YY) DATE (MM/DD/YY) POUCY EFFECTIVE POUCY EXPIRATION POUCY NUMBER DATE (MM/DD/YY) DATE (MM/DD/YY) LIMITS $ $ ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ACORD. CERTIFICATE OF LIABILITY INSURANCE DATE 09/2012 PRODUCER 561.994.9994 FAX 561.997.7087 The Beacon Group, Inc. 6001 Broken Sound Pk . , N . W . Suite 500 Boca Raton, FL 33487 -2730 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC # INSURED Colony Acquisition Corp, DBA: Dry Cleaning Depot,BlueRoo,CRDN of SE FL The Treasure Coast 730 W Broward Blvd Ft Lauderdale, FL 33312 INSURER A: Montgomery Insurance 09084 INSURER B: FCCI Ins Co 03499 02952 INSURER C: LIABILITY COMMERCIAL GENERAL LIABILITY INSURER D: INSURER E: DAMAGE TO RENTED PRFMISFS nrruranr -) COVERAGES 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR I IB ADD'L NEM TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE nATF (MMmnmr) POLICY EXPIRATION nATF (MMmnM/) LIMITS EACH OCCURRENCE $ GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PRFMISFS nrruranr -) $ ICLAIMS MADE OCCUR (Fa MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: POLICY n PRO- n LOC PRODUCTS - COMP /OP AGG $ n A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS 24CC288572 -2 11/01/2011 11/01/2012 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 X BODILY INJURY (Per person) $ X BODILY INJURY (Per accident) $ X PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY ANY AUTO AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ nOCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE RETENTION $ $ 7 $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTNE OFFICER/MEMBER EXCLUDED? describe under If SPECIAL PROVISIONS below WC 11A -64438 06/01/2011 06/01/2012 X I TORYLIMIITT.R I 10 R E.L. EACH ACCIDENT $ 500,000 E.L. DISEASE - EA EMPLOYEE $ 500,000 E.L. DISEASE - POLICY LIMIT $ 500,000 OTHER D P N OFPERA ON L IC TIOEHIEXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS Certificate I r ameInsu ECL CERTIFICATE HOLDER CANCELLATION Miami Shores Village 10050 Northeast 2nd Ave Miami Shores, FL 33138 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Johl K. Rotman /C50 Wok A226982 f�..G�G .0..% ACORD 25 (2001/08) ©ACORD CORPORATION 1988 ALLEY RECEIVED MAR 2 9 2012 EXIST. PAVED DRIVEWAY PAVED W1114 CONC. PAVERS 0 REMOVE EXIST. ASPHALT PAVEMENT. REPLA.CE WITH 80D 010. REMOVE EXIST. ASPHALT PAVEMENT. • REPLACE WITH SOD . • . •-• • tamign 4110EA W/ j Cited-Aped ear7c reite- 11131-ti 201-0' 48-10' 101-01 11011TMEAST MIT STREIT PROPOSED DRIVEWAY CONDITION DENOTES EXISTING RESIDENCE R-S Rai moridez-Spdiacv Architcci PAVEMENT DESIGN 455 NE 91 ST RESIDENCE 455 NORTHEAST 91ST STREET MIAMI SHORES, FLORIDA SiTE_PLAN \\ r,,,2 Mac, H,rici a 23i r2, 777 MW. 72ndAVAVENUE SUITE 3025 MIAMI, FLORIDA 33126 TELEPHONE: (305) 262 -0400 FAX: (305) 262-0401 www.lbarralandsurveyors.com DRAWN BY: NGH r JOHN IBARRA & ASSOC. INC. LAND SURVEYORS SURVEY No. 11 -003129.1 LOT -6 BLOCK - 49 1 BOUNDARY SURVEY SCALE =1 " =20' LOT -5 BLOCK - 49 U. 1 LOT - 4 BLOCK -49 i 3' C.B.W. F.I.P 1/2" NO CAP 10.14 10.31' 3' WIRE FENCE. LOT -19 BLOCK - 49 0.82' CL ONPL" 6' W.F. 5' C.L.F. C.B.S. UTILITY (3.85' X 9') 1.35' CL 10.34' 6' W.F. F.I.P 1/2" NO CAP F.I.P 1/2" NO CAP 205.67' LOT - 21 BLOCK - 49 etc Niwo 10 B.C. F.I.P 1/2" NO CAP PWY Sri LI IT OF PLAT (N.A.P.) EL PORTAL P.B. (9- PG.I0I) ENCROACHMENT N O T E S: (A) South side of the Subject Property Asphalt Parking Encroaching into the Right of Way of N.E. 91st Street SURVEYOR'S • There may be Easements recorded in the Public Records not shown on this Survey. - The purpotte of this Survey is for use in obtaining Title Insurance and Financing and should not be used for Construction purposes.