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RF-12-19Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 NO- Inspection Number: INSP - 168475 Permit Number: RF- 1 -12 -19 Scheduled Inspection Date: January 18, 2012 Inspector: Bruhn, Norman Owner: HIRN, WOLFGANG & NATALIA Job Address: 102 NW 106 Street Miami Shores, FL 33150 -1248 Project: <NONE> Contractor: AFFORDABLE ROOFTEC, INC Permit Type: Roof Inspection Type: Rte# -Repair Work Classification: Repair Roof 6 `k I� Phone Number (786)566 -9669 Parcel Number 1121360080010 Phone: (951)962 -9670 Building Department Comments REVISION TO ORIGINAL STOVE TOP EXHAUST DUCT NOW PENETRATING ROOF IN LIEN OF EXISTING THROUGH THE SOFFIT AS PREVIOUSLY SUBMITTED Passed / Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments hSa January 17, 2012 For Inspections please call: (305)762 -4949 Page 30 of 49 Miami Shores Village Building Department JAN 0 5 nc �Yo e =ae°aeoe°oeevoe . 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. I c l —1 Q1 Master Permit No. RC" /1- /1 -10 F-?- BUILDING PERMIT APPLICATION FBC 20 Permit Type: BUILDING ROOFING OWNER: Name (Fee Simple Titleholder): Warysav j + N4I -660 112-N Phone #: s6- 345 ° a d �Z- Address: (O2- ). 1®64k S� City: NkiAt-A:‘ rtes. State: t' 1 o zip: 331 S Tenant/Lessee Name: Phone #: Email: (NC° 9 Calairaty4,5LI r0 , co e--A-- JOB ADDRESS: l o 14. off ° City: Miami Shores County: Miami Dade Zip: 33 (S 0 Folio/Parcel #: Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name: 4- f OP �- f C Z'_.. Phone #: Address: 4Vii 7 S id 5-7 , ve , f City: 1'it/,' d - � '6LYW ' ,te: ` ieee4 Zip: -3 3C? 3 Qualifier Name: J2/i)f i Je4 /104/161i- ela ` /iii,,.[ ee. u Phone #: —, 6 g —96 `%0 State Certification or Registration #: 0 C-C- 0 57s 3s- Certificate of Competency #: Contact Phone #: 9 4 2— 96, 7 0 Email Address: rdeklid, a--- .. 1/e... 1 h wit, e. e ki . ' DESIGNER: Architect/Engineer: Phone#: -967 '350. Value of Work for this Permit: $ Square/Linear Footage of Work: 'C Z. 5' F Type of Work: DAddition VgAlteration ONew iJRepair/Replace ODemolition Description of Work: Z-€ tits i ® or iD r /Nsbl_. scJ ikAALtA L - s'4 at. 4op Pl_e*.k4us 4' ctu-CJ J ,. L..) ekrn�ir.4 b 6a0f idol (`' J-L 0+C Q..g► i 1,13 o�h -01,e- SDP, PS Freuic,us e' Su. M EV e 1 * ***tit* *** x*a:********** * ******* **** :*** Fees** =ink **** *a:+ x*** ***m ***+ x** *******+x*******+x**** 6.0 Submittal Fee $ Permit Fee $ /0 o CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ V Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building . ermit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature Owner or Agent The foregoing instrument was acknowledged before me this day of S trl , 20 L rby C✓ JO / rye-a- e��' �, r who is personally known to me or who has produced As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commission Expires: APPROVED BY LAUR,y HAMMt �6 �0mrnission Dp aced- , rnN June Fair' Si 1 pr Contractor The foregoing instrument was acknowledged before me thi VIP sc day ofCr 20! by k t Mam 4V w 0 to e or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: / � Print: _ M o ��t•' t• i,J , FLORIDA Li le My Commission Expire'�A d (� x,°920643 1'''i, L s 2. 24, 2013 BONDEDTHRL ATLA:rnC :,T�iNGCO.,INC, (f/--a Plans Examiner Zoning Structural Review Clerk (Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09) OR°° CERTIFICATE OF LIABILITY INSURANCE 1 DATE Ruaroomyrn HIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES JOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIF CATE OF INSURANCE TOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE IOLDER. IV "ANT: H the certificate holder is an ADDITIONAL INSURED, the policy (les) must be endorsed. H SUBROGATION 1S WANED, subject to the terms and a .ns 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 uch endorsement(s). ROOUCER ' RANKCRUM INSURANCE AGENCY, INC. 00 S. MISSOURI AVE. :LEARWATER FL 33756 CONTACT NAME (MC,Ns,E t3 1-800-277-1620 x4800 PA7t Ne}: 727-797-0704 I EMAIL =IVES& INSURER(S) AFFORDING COVERAGE NAIC# INSURER A: FRANK WINSTON CRUM INSURANCE. INC. 11600 (IMBED ,rankCrum 1-800- 277 -1620 00 S MISSOURI AVENUE :LEARWATER FL 33756 INSURER B: INSURER C: INSURER D: INSURER E: INSURER F: ewiawa REVISION NUMBER: oDVesAetae -- - - -- - -- -. THIS 1S TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIRENIENT, TERM OR COMMON OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTWICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLE DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. RISK LTR TYPE OF INSURANCE ADDL NOR SUBR WVD POLICY NUMBER POLICY EPF I Y) POUCYExP (1110100/YYrY) Vans GENERAL LUDO-ITT LIABILITY COMMERCIAL GENERAL ICLAU44MADE 'OCCUR GENT. AQCJREGATE UMIT APPiJEB PER AUTOMOBILE UABEJfY ANY AUTO ALL OWNED AUTOS HIRED AUTOS EACH OCCURRENCE DAMAGE TO RENTED PREMISES (Ea commence) $ MED EXP (Any one person) $ PERSONAL &ADV INJURY $ GENERAL AGGREGATE $ PRODUCTS - COMP/OPAOG $ SCHEDULED AUTOS NON - OWNED AUTOS COMBINED SINGLE LIMIT (Ea agent) $ $ BODILY INJURY (Per person) $ BODILY INJURY (Per QTY DAMAGE (Per) $ $ UMBRELLA LIAR DICERS UAB OCCUR CLAIMS-MADE DED I 1 RETENTION EACH OCCURRENCE ANTE $ A WORKERS COMPENSATION AND EMPLOYERS' UABLITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (wry In NH) Dyes, describe under DESCRIPTION OP OPERATIONS below Y/N NIA WC201200000 1/1/2012 1/1/2013 WC X I TORY UMIT8 I ER $ E.L. EACH ACCIDENT EL DISEASE -FA EMPLOYEE $1,000,000 $1.000,000 EL DISEASE - POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIOIM I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Raub Schedule. If Ban space Is rupees() EFFECTIVE 03/19/2007, COVERAGE IS FOR 100% OF THE EMPLOYEES OF FRANKCRUM LEASED TO AFFORDABLE ROOFTEC, INC. (CLIENT) FOR WHOM THE CLIENT IS REPORTING HOURS TO FRANKCRUM. COVERAGE IS NOT EXTENDED TO STATUTORY EMPLOYEES. CERTIFICATE HOLDER CANCELLATION MIAMI DADE COUNTY BUILDING DEPT ATTN ALLISON 140 W FLAGLER ST STE 1603 MIAMI FL. 33130 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 ACORD 25 (201W05) The ACORD IRMO and logo we registered melltss of ACORD ®1988 -2010 ACORD CORPORATION. An rights reserved ACORD CERTIFICATE OF LIABILITY INSURANCE DATFIMM,,DLNYYYY1 3/16/2011 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. `r IMPORTANT: H the certificate holder is an ADDITIONAL INSURED, the poticy(ies) must be endorsed. 0 SUBROGATION IS WAIVED. subject to I 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). PRODUCE R Armitage Group P 0 Box 935118 Margate FL 33093 INSURED Affordable Rooftec Inc 2117 SW 57th Ave West Park, FL 33023 CONTACT NAME. Christine Nocito PHDNE 954 . 957.7000 r nA,r 404954. 946.2140 (n C,Np ,41 i '- EMAIL service @armita esouth. cam INSURE.RISI AFFORDING COVERAGE SAICB INSURER A Canal Indemnity Company 27790 INS1JriE:R F1 INSt JRF:R LJ INSURER L INSURER F COVERAGESA CERTIFICATE NUMBER: 11000* REVISION NUMBER:000* 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 REOUIREMENT. 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, EXfI USIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS NSR LTR J ADM .TYPE OF INSURANCE INS SUaR VIVO "— POLICY NUMBER POLICY E•FF l POLICY EXP tMRL'DOYYYY, (MM +D0.'YYYY', i iMITS A GENERAL. LIABILITY X 1 COMMERCIAL GENERAL I.IABILITr I X I DCCUR GL101201 ', • 3/22/1163/22/12 • EACti OCCURRENCE S 500,000 OAMA(E 10 RENTED 5O 000 PREMISES kEa acrurrencel ' > t ' ICI AIMS MARE 1 MED EXP ;Any one pert, t! c S 5,000 PERSONAL 8 ADV INJURY $ 500,000 GENERAL AGGREGATE $ 1 , 000 , 000 PRODUCTS COMP'OP AGG ! 500,000 GEN'L AGGREGATE LIMIT ..__.. 1...__I PRO X Poucv JECT APPLIES PER J # 1 Lac ; S ADITPM{RA£ tIABII I t Y ANY At! 10 ~ -:.. ALL. OWNED ..� - -- AUTOS SCHEDULE) AUTOS NON -OWNS EI AUTOS .� CO BBINE"nl SINGLE LIMIT HODN Y INJURY 1Per persnnl ' 5 BODILY INJURY r Per ar.C;gfonl∎! 5 1.___.! �_ HIRED AU I O4 PROPERTY DAMAC'E PR arc +OY . 5. UMBRfaI.A t LAB L__ • ' EXCESS LIAR 1 I OCCUR �(a AIMS MADE - EACH OCCURRENCE AGGREGATE '. ( DEL) RETENTIONS I $ WORKERS COMPENSATION ' AND EMPLOYERS' I.IABII IT1 ANY uROPNCIOWRAHTNEHE,F'u { QFFICFRfMEf1BF. R E<C.I.L;OF0 Mandatary in NH) 11 yes, des!:nbe under DESCRIPTION OF C3T'ERAtUONS rrN In„•'F N r A . I WCSTATIL 1 0TH." 1 TORT' LIMITS ! � ER i . -. .__.._ v_..__... I....,. .. ,_, ...._ .. E 1 EACH ACCIDENT i 5 1 F. I. DISEASE EA FMK 0YE 5 oeura F L DISEASE POLICY OMIT ' 5 DE SCRIPT ION O$. OPERA DONS • LOCAL IONS VEHICLES tA5.a rt ACORi1 ' + +t. Agd+t•n• +a; Remarl c, S.�h Roofing All Kinds Ie .f more W4v.lt r.,p..o CERTIFICATE HOLDER A CANCELLATION Miami Shores Village 10050 North East 2nd Avenue Miami Shores, FL 33138 3057568972 *C #047 *R 4000 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS At ITHORI?F El RI"PRE SFN TATA, ChuitildiR etit 1988 -2010 ACORD CORPORATION Ail rights reserved ACORD25(2010 /05) The ACORD name and logo are registered marks of ACORD OR 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: AFFORDABLE ROOFTEC INC Receipt #:185 -1125 Business Type:ROOFING /SHEET METAL CONTRAC (ROOFING CONTR) Owner Name: MIORIKA MONICA MALINETESCU Business Opened:11/06/1998 Business Location: 2117 SW 57 AVE StatelCounty /CertlReg:CCC057535 WEST PARK Exemption Code:NONEXEMPT Business Phone: 954- 456 -0217 Rooms Seats Employees 3 Machines Professionals For Vending Business Only Vending Type: Tax Amount Transfer Fee NSF Fee Penalty Prior Years Collection Cost Total Paid 27.00 0.00 0.00 0.00 0.00 0.00 27.00 4 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: MIORIKA MONICA MALINETESCU 2117 SW 57 AVE HOLLYWOOD, FL 33023 2011 - 2012 Receipt #138 -10- 00005884 Paid 07/19/2011 27.00 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 pot DEC2 0 2011 Permit No. Master Permit No. 'R - \‘'-k - "Wlir Permit Type: BUILDING ROOFING OWNER: Name (Fee Simple Titleholder): (..001P0441 aND Nek-I-414) rgJ Phone #: 3 - 3 -4S -off 92. Address: i° `_ ',V.) 40 644 S+, City: Skis, ®9- E3 Tenant/Lessee Name: Email: /C'b e Gier AN it ;9'ev. CO 44 JOB ADDRESS: 102— NW. 10 eC . State: o DA. Zip: —331 S Phone #: City: Miami Shores County: Miami Dade Zip: 33 1 S Folio/Parcel #: /1- 2®3(- 00 g - o0/ Is the Building Historically Designated: Yes NO � Flood Zone: CONTRACTOR: Company Name: S e P 1 CO's" ) Li. c • Phone #: q 5 Y " 2,3 Address: 3 3 ZS* +der'.i f1 �r P. 4 l 0 City: "3 k U t State: -F(.0 0.1 :)A Qualifier Name: kac'r-i- 1. S-epi<L.L.i State Certification or Registration #: Si zip: 333 Z.? Phone#: g SY ` C)3 l —KW/ Certificate of Competency #: Contact Phone #: S Y' 931 - cq d / Email Address: %Z.SEP C S EP /co Re DESIGNER: Architect/Engineer: /+Jeeri l Phone #: CPS Y- RI/ /Z32_ Value of Work for this Permit: $ /fib --41144166 Square/Linear Footage of Work: Type of Work: DAddition DAlteration New DRepair/Replace DDemolition Description of Work: C...44/0 /N Skac-104,a e S i l y�grood ;� W �� a' /1l.4cl �+os o( LUG/ �'uN of -*API sire i J lied or . z� 4' �, 121"e) Cl/L 0, 4:e 1, / os 6664, v eh i -A/ a _ **+x+xx:+x•x+x***** *** ** x**** *a:****** ********Fee * *** x****, x**+ x** **• x**+ r**** **x •*****•x**•x+x*•x **** Submittal Fee $ Permit Fee $ j J Scanning Fee $ Radon Fee $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ CCF $ DBPR $ CO /CC $ Bond $ Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature Owner or Agent The foregoing instrument was acknowledged before me this de: day of / , 20/! , by l/,i/J l re. C, cc y h'/ � ✓J who is personally known to me or who has produced As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commissio LAUREN am' 4= Comrnission - Expires June 5, 2012 Rondo mm Troy Fa1/2 m`urano y00- 385-7019 **** ** *** ************** **.**** ** APPROVED BY Signature Z,51f Contractor The foregoing instrument was acknowledged before me thi day of ,O -e( , 201/ , by /Cob who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: ***************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Plans Examiner Structural Review 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) 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 Permit No. Master Permit No. , t Permit Type: MECHANICAL OWNER: Name (Fee Simple Titleholder): G.Joiryol alb N/ AI1e \. ■RAl Phone #: 9'86 -35 - O647. . Address: /02- N.W. tD6 e' .Xi: City: NcuSt . ■ SlnorLf State: lot t, Zip: 33/.5d Tenant/Lessee Name: Phone #: Email: 1 N o 4-#F ri . JOB ADDRESS: t02. N CO tog ` .5+. City: Miami Shores County: Miami Dade Zip: 331S° Folio/Parcel #: /( 36 — 0D $- 0010 Is the Building Historically Designated: Yes NO Flood Zone: ICONTRACTOR:,Company Name: e' rAL C Phone #: MS' t( 1 15 Address: °q) ` i S 02.. ANe. City: Irv-6 A i 1 State: t Lk Qualifier Name: State Certification or Registration #: L 3 51 5 5 � Certificate of Competency #: Contact Phone #: (3o €, 2_,54, 11 ° Email Address: DESIGNER: Architect/Engineer: Phone #: Zip: 33 Phone #: Value of Work for this Permit: Type of Work: ❑Address • Square/Linear Footage of Work: New ORepair/Replace ... N' ..:51. • MERIMMEMEKTA ******** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Fees************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Submittal Fee $ Permit Fee $ CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ \PAW Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature Owner or Agent The foregoing instrument was acknowledged before me this day of ,20,by who is personally known to me or who has produced As identification and who did take an oath. NOTARY PUBLIC: Signature LIf.A-/ ' 1rhAL Contractor The foregoing instrument was acknowl dgecefore me this day on) ee ,2011 ,b is personally known to me or w i. e has produced as identification and who did take an oath. NOTARY PUBLI Sign: Sign: Print: Print: My Commissi My Commission Expires: Notary Public - State of Florida '� MY C Commission Expires EE 78895 ***** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** **************************************** * * ** * * * * * * * * * * * * * * * * * * * * * * * * * ** APPROVED BY OiNfro Plans Examiner Zoning Structural Review Clerk (Revised 07 /10 /07XRevised 06 /10 /2009)(Revised 3/15/09) SEPICORP Hirn Residence Structural Revision To: Chief Structural Inspector, Village of Miami Shores From: Sepicorp, LLC. Re: Structural Revision #1, Him Kitchen re -model Address: 102 NW 106th St. Miami Shores, FI. 33150 Date: 12/19/2011 Dear Sir, The following is a narrative for the structural changes pertaining to the home at the above referenced address. After exposing the structural members of the roof /ceiling rafters in our selective demolition it became obvious we would not be able to place the new LVL beams in the previously proposed location. Additionally we found that it would not be possible to route the exhaust vent through the rafters and out the exterior soffit as previously proposed. The following are the revised structural attachments for the LVL beams and existing rafters as well as the re- routed 6" round exhaust duct for the cook top. 1.) 5-1- Revision #1- Roof Repair plan- (5=2 - corresponding details) A.) install (3)1.75" x 14" LVL beams to east side of existing (girder truss) Use Twist straps to secure as per plan. Add 12 "L x 4" x 4" x 1/4" Steel angle at each end and secure to block wall with (6)1/4" x 3 -1/4" Tap Cons, and to LVL beam with (6) 1/4" x 5" Lag screws. B.) Install (2) Simpson twist straps to existing 2" x 8" beam running parallel to ceiling rafters C.) Add (12) Simpson Twist straps to (4) ceiling rafters starting at west wall, and attach to (3) roof trusses across the above locations. D.) Re -route 6" round, Exhaust duct vertically through roof above, use galv. metal roof jade, flash as required. Sincere Robert Sepielli President Sepicorp, LLC. General Contractors J -VENTS DESIGN PROVIDES MAXIMUM FREE AREA FOR GREATER EFFICIENCY • For pitched or flat roofs. • Provides low silhouette. • Open on all sides for better air flow. • Helps eliminate moisture within buildings. • Quality constructed in galvanized, aluminum or painted. • #8 insect screen installed. FRESH AIR MANUFACTURING CO. Technologies in Ventilation 649 N. Ralstin St., Meridian, ID 83642 * (208)884 -8931 * 800 - 234 -1903 * FAX: (208)884 -8943 J -VENTS OPTIONS: • Greater clearance between flange and hood. ( "G" dimension) • Larger flange sizes. • Curb mount models. • Special materials (Le., copper, stainless steel, etc.). r 1 D1116VDI6SAPE NOfTO SD LE T 1 OS Model with Stem Standard J-VENT DETAIL Size A B C D E F G Free Area in sq. in. "" 3" 8.5" 8.5" 3" 5" 325" 1.5" 125" 7 4" 8.5" 8.5" 4" 6.5" 3.5" 1.75" 1.75" 12.6 6" 12" 15" 6" 9.5" 5" 3" 2" 28.3 7" 12" 15" 7° 11" 5" 325" 1.75" 38.5 8" 15" 15" 8" 13.5" 5.25" 2.75" 2.5" 50.3 9" 15" 18" 9° 14" 5.75" 4" 1.75" 63.6 10" 15" 20" 10" 16" 6.5" 4.5" 2" 78.5 12" 20" 24" 12" 19" 7.5" 5" 2.5" 113.1 14" 22" 24" 14" 19" 7" 4.25" 2.75" 153.9 Free area is calculated without screen. F SHAIR MANUFACTURING CO. Technologies in Ventilation INSTALLATION INSTRUCTIONS FOR J -VENTS WITH AND WITHOUT EXTENSION Nails or staples Shingles J-Vent Flashing The installation of the FAMCO J-Vent is similar to any other roof mounted vent with flashing. Follow these instructions: 1) Make sure that the area of the roof where the J-Vent is to be mounted is clear of any obstructions (roof trusses, electrical wiring, etc. {NOTE: DO NOT cut any roof trusses, electrical wiring, etc.1). 2) Cut a round hole in the roof 1/2" larger than the diameter of the J-Vent throat. {For RETROFIT: then loosen shingles so that J-Vent flashing can be slipped under them.} 3) Place J-Vent so that it is centered over the hole you just cut. If this model has an extension be sure that it is placed so that you have approximately equal clearance on all sides. {For RETROFIT: place J-Vent so that the flashing slides under the shingles from the bottom edge of the hole up and that it is on top of the singles from the bottom edge of the hole down..} 4) Nail or staple flashing down to roof being sure that all nails or staples are placed under the shingles. { NOTE: DO NOT nail or staple the exposed flashing areas, this will cause roof leaks and water damage.} 5) If you are attaching ducting for exhaust/intake purposes please follow local or state codes in attaching it to this J-Vent. (Some state codes call for solid ducting while other allow flex, etc.) 4, FRESH AIR MANUFACTURING CO. FAvit0 Permit # 'R G (t -11- ZQ$-+ Folio # 111111111111111111111111111111111111111111111 CFN 2011R079815. 4 OR fik 27908 Ps 0346 "r (1P9) RECORDED 11/29/2011 10:07:53 HARVEY R:UVIN, CLERK OF COURT MIAMI -DADE COUNTY? FLORIDA 11- 2136 - 008 -0010 LAST PAGE NOTICE OF COMMENCEMENT 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. 1. Property Legal Description: Dunnings Miami Shores EXT 4 PB 48- 20 Lot 1 BLK 204 OR 11464 -1660 05821 OR 27697- 1009 0511 01 General Description of Improvement: Interior Kitchen renovation- remove 2 walls; patch and paint walls and ceiling, replace wood floors, provide structural upgrade to ceiling/roof structural members, refinish floors throughout, miscl plumbing and mechanical connection of appliances 3. Owner (Leasehold) N/A 4. Owner (.Fee Simple): Natalia Maria Him Wolfgang Hirn 102 NW 106 St. Miami, FL. 33150 5. Contractor Information: Sepicorp, LLC. 3325 S. University Dr. Suite 109 Davie, Florida 33328 954- 237 -7487 6. urety: 7. N/A Lender. N/A 8. Person within the State of Florida. designated by Owner upon whom notices and other documents may be served as provided in Section 713.13(I)(a)(7), Florida Statutes: In addition to itself Owner designates the following persons to receive e copy of the Lienor's No4e as provided in Section 713.13(1)(b), Florida Statutes: 10. Expiration Date of Notice of Commencement: One Year from the date of recording. 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 1, Section 713.13, Florida Statutes, and can result in your paying twice for improvements to your property. A Notice of Commencement must be recorded and posted on the job site before the first inspection. If you intend to obtain financing, consult with your Lender or an attorney before commencing work or recording your Notice of Commencement. Signature(s) of Owners(s) or Owner(s)' Authorized Officer /Director/Partner /Manager STATE OF FLORIDA ) ) SS COUNTY OF BROWARD ) r r(_ ` By: Woflgang Hirn Owner Q f The foregoing instrument was acknowledged before me this! a y of "0l. 2010, by����as �of the authorized management agent of the Owner, freely and voluntarily under authority duly vested in her by said company. She is pperersoonallj known tome. 4 a a Art, A; 4 �,.1PaY'if"e.,, SHARON L. WILBANKS t `;.ii 4 2° `' n Notary Public - State at u My Commission expires :Na ' vI My Comm. Expires Oct169Epi ,;,._ Commission Commission # EE 12882 UVERIFICATION PURSIT' 69 Wlllilibt araPy Under penalties of perjury, I declare that I have read the foregoing and that the facts stated in it are true, to the best of my knowledge and belief. Signature(s) or Owner(s) or Owner(s)' Authorized Officer/Director/Partner /Manager who signed above: By Owner: Wolfgang Hirn STATE OF FLORIDA, COINCY OF t I HEREBY GERM'? that Milks ewQuite aigmailgemija Ihisuf�eeis , AEit7 , A '©2t# WITNESS frry hand end .t let Seat HARVEY RIMN, CLE'y. ot* ino 14141- C1111 12ISI t i $UYLDING PERMIT APPLICATION FBC 20 Miami Shores Village Building Department NOV 0 9 2611 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.PC I ` I w`D 7 Master Permit No. Permit Type: BUILDING ROOFING OWNER: Name (Fee Simple Titleholder): UoLJAN 1 R.1f-t Phone#: �6 - 3 F5 - 064 2-- Address: 102- NO (06�` City: l dim' State: 1Fl . Zip: 33( 5 0 Tenant/Lessee Name: Phone#: Email: NF° e I.�Jotc3,03�irN . Cu JOB ADDRESS: 1 0 Z N LI.1 (0641' 5+, City: Miami Shores County: Miami Dade Zip: 331S0 Folio/Parcel #: 11- Z13G - 00 is - o ca 10 Is the Building Historically Designated: Yes NO ✓ Flood Zone: �£f ico f (�.� . Phone#: Q SY -233-- 34 - W+"' CONTRACTOR: Company Name: p Address: 332.5 5, (APJ+kter s i �y pr. 10'� City: ID AO t E ( State: Fl . Qualifier Name: v b€' --% Sep le (l ui State Certification or Registration # GC 151 3 O A- Contact Phone#: GPs Y -Z3÷-1 w 1" 3" Email Address: DESIGNER: Architect/Engineer: -€ Et`'S i 0e-gr ° Zip: 33322i' Phone#: q s tt- q 31- 6Y6 I e Certificate of Competency #: �S�PIECL e pI Cowj'. ZNc P h o n e # : S- • - ‘ , 1 3 , 1 • Value of Work for this Permit: $ 10; O0 Square/Linear Footage of Work: Type of Work: °Addition Alteration New °Repair/Replace Description of Work: K itdne N re.- i bEL Ago b M O b if' i cA+{o0al GOO h °Demolition *** * *** * ***** ** yes * ** ** gar+ *** **** * * * **#F ** * ****** * ******** ** *** ** ****** ********** ** of Submittal Fee $ Permit Fee $ 50 0 CCF $ Scanning Fee $ Radon Fee $ DBPR $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ CO /CC $ Bond $ TOTAL FEE NOW DUE $ g� C y Tev 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 FT RCTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature Owner or Agent The foregoing instrument was acknowledged before me this ._ day of NovL. M Q'20 l( , by Upt7A //616 k who is personally known to me or who has produced As identification and who did take an oath. NOTARY PUBLIC: Sign: Print My Commiss 0'01 ''''''' - - �i'6_ v SHARON L. WiLBANK8 ytu, of Florida •3 My Comm. ires Oct 22, 2014 Commission # EE 12882 '''' +°'�` ''''�, Bonded Through National Notary Assn. • Signature e� . Contractor • The foregoing instrument was acknowledged before me this � dayof4�t fQ9vo�� "��' ,20 ,by ?- -l�Jb S- #'(e�p9e , who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign SuuAAR P _ Notary Public - State of Florida Rirftinm. Expires Oct 22, 2014 • :,`P :" ../ Commission # EE 12882 '1 0's Bonded Through National Notary Assn. ************************************ ** * ***** ***** * * * * ***** * * ******* 44)1/ Plans Examiner APPROVED BY Structural Review (Revised 07 /10/07)(Revised 06/10/2009)(Revised 3/15/09) Zoning Clerk Miami Shores Viiiage Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CONTRACTORS' REGISTRATION FORM ALL CONTRACTORS MUST PROVIDE COPIES OF LICENCES AND INSURANCES EACH TIME A PERMIT IS SUBMITTED OR THE VILLAGE MAY MAINTAIN A FILE WITH YOUR INFORMATION FOR A $30.00 FEE PER YEAR. IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: A. "' COPY OF QUALIFIERS STATE L.IC CARD B. _ COPY OF LOCAL BUSINESS TAX RECEIPT C. V COPY OF LIABILITY INSURANCE (CERTIFICATE HOLDER TO BE MIAMI SHORES VILLAGE BLDG DEPT) D. —7 COPY OF WORKERS COMPENSATION (EITHER CERTIFICATE OR EXCEMPTION). IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY: A. COPY OF CERTIFICE OF COMPETENCY OF QUALIFIER B. COPY OF MIAMI DADE COUNTY MUNICIPAL CONTRACTORS TAX RECEIPT C. COPY OF LIABILITY INSURACE (CERTIFICATE HOLDER MUST BE MLf MI SHORES VILLAGE BLDG DEPT) D. COPY OF WORKER COMP INSURANCE (EITHER CERTIFICATE OR EXEMPTION( YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE HOLDER AS FOLLOW: MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES, FL 33138 COMPLETE CONTRACTOR'S INFORMATION BUSINESS NAME: S P,i 9 BUSINESS ADDRESS: 3 3Z 5 3 . 4-1" v"ers' �� CITY -D Au 't STATE T. to tekba ZIP CODE 3332 -5 BUSINESS PHONE: ( S f ) 2-3 4=3-'15'9" FAX NUMBER (05`1 3 5 °` 'I CELL PHONE (c) S i) 931- ng I QUALIFIER'S NAME: 'b'n -!! 56. P;e ll; QUAUFIER'S LIC NUMBER: C go } E -MAIL ADDRESS (IF APPLICABLE): Created on 3119109 BY MLDV I RV 3126109 MLDV EPi e- % 0 5'cP i conic. co rK BATCH NUMBER PLAY AS REQUIRED'BY ..Yi`® 115 8. Andrews Ave., Rm. A -100, Ft. Lauderdale, FL 33301 -1895 — 954-831-4000 VALID OCTOBER 1, 2011 THROUGH SEPTEMBER 30, 2012 DBA: Business Name: SEPICORP, LLC Owner Name: ROBERT J SEPIELLI Business Location: 3325 s UNIVERSITY DRIVE STE DAVIE Business Phone: 954 -931 - 6461 Rooms Seats Receipt #:180-229403 Business Type:GENERAL CONTRACTOR t } Business Opened:11 /20/2009 1 lState /County /Cer't/Reg: CGC1517807 Exemption Code:NONExBMPT Employees 2 Machines Professionals For Vending Business On Number of Machines: Vending Type:: Tax Amount Transfer Fee NSF Fee' Penalty Prior Years Collection Cost Total Paid 27.00 0.00 0.00 0.00 0.00. 0.00 27.00 THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS THIS BECOMES A TAX RECEIPT WHEN VALIDATED This tax is levied for the privilege of doing business within Broward County and is non- regulatory in nature. You must meet all County andlor Municipality planning 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 legator that it is in compliance with State or Local laws and regulations. Mailing Address: SEPICORP, LLC Receipt #031 -10- 00003914 3325 'S UNIVERSITY DRIVE STE Paid 08/23/2011.27.00 109 DAVIE, FL 33328 2011 = 2012 Client#: 88504 SEPLL ACORD,. CERTIFICATE OF LIABILITY INSURANCE DA'E(MM100 YYY) 10/31/11 DP 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 1S 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 Advanced Insurance Underwriters 3250 N. 29th Ave Hollywood, FL 33020 CONTACT PHOO,N No, ):954 963 4666 I Fax 9549641438 (ac, No: ADD Rte: Certificateofinsurance@advancedins.com INSURER(S) AFFORDING COVERAGE NAIC # INSURERA: Mid - Continent Casualty Company LIABILITY COMMERCIAL GENERAL LIABILITY INSURED Seplcorp, LLC 3325 S University Dr Suite 109 Davie, FL 33328 INSURER B : Association Ins Co 04GL000808236 INSURER c : 12/10/2011 INSURER D $1,000,000 INSURERS: $100,000 INSURER F : X COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDfrIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE INSR W W POLICY NUMBER (MM/DD!Y EFF ( MIDDIjYYYY) LIMITS A GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY 04GL000808236 12/10/2010 12/10/2011 EACH OCCURRENCE $1,000,000 PREM,SE31Ea r arcs) $100,000 X CLAIMS -MADE X OCCUR MED EXP (Any one person) $ Excluded X PD Ded:1,000 PERSONAL & ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEM. AGGREGATE —I POLICY LIMIT APPLIES PER JECT n LOC PRODUCTS - COMP/OP AGG $2,000,000 $ A AUTOMOBILE X LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS _ X SCHEDULED AUTOS NOItOSWNED 04GL000808236 12/10/2010 12/10/2011 (Ee g SINGLE LIMIT $1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ (Per aociE DAMAGE dent) $ $ UMBRELLA MB EXCESS LIAR _ OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DFSCRPTION OF OPERATIONS below Y / N Y N / A WCV007803201 01/09/2011 01/09/2012 X l wC STATU TORY LIMITS 1R11111- E.L EACH ACCIDENT $100,000 E.L. DISEASE - EA EMPLOYEE $100,000 E.L. DISEASE - POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) REF: Natalia & Wolfgang Him, 102 NW 106th Street, Miami Shores, FL 33150 ** Workers Comp Information ** Blanket waiver of subrogation applies Proprietors/ Partners /Executive Officers/Members Excluded: Juan Del Moral, Pres.; eGllbert Jolicoeur, V. P. CERTIFICATE HOLDER I Miami Shores Village Building Dept. 10050 NE 2nd Avenue Miami Shores, FL 33138-2304 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Ai T iORiZEDaRE_PRE�SENTATIVE f .44 s .41144‘90 ■.' © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD #S8043151M772329 DAS W— Prisl%ru --' Permit No: 11 -2087 Job Name: November 16, 2011 Miami Shores Viiiage Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Page 1 of 1 Building Critique Sheet 1) Provide all permit applications for mechanical and plumbing prior to any further reviews. 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 Dec 0811 02:10p Sepicorp ACORD -M 9543570944 Cllent4: 88504 SEPLL CERTIFICATE OF LIABILITY INSURANCE p.2 DATE (MWDD/YYY o 12/3/11 LSA THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPOM TI4F /PRTIFICATF Tin! r}FR. 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 pallcy(ies) must be endorsed. if SUBROGATION IS WAIVED, subject to the terns 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 Advanced Insurance Underwriters 3250 N. 29th Ave Hollywood, FL 33020 954 953 -6666 NAME: PHOOa Ext): I FAX Noy: E-MAIL SS INSURERS) AFFORDING COVERAGE NAIC 0 INSURER A: Mid - Continent Casualty Company 23418 INSURED Sepicorp, LLC 3325 S University Dr Suite 109 Davie, FL 33328 INSURERS: Association Insurance Company 11240 INSURER C: 049L000837166 INSURER D: 12/10/2012 INSURER E $1,000,000 $100,0000 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POUCIES OF INSURANCE LISTED 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 POUCIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. L R TYPE OF INSURANCE INSR WVG POLICY NUMBER POUCY EFF {Md11DD/YYYY) POLICY EXP {MMIODIYYYY) LIMITS A GENERAL X LIABILITY COMMERCIAL GENERAL UABa.ITY 049L000837166 12/10/2011 12/10/2012 EACH OCCURRENCE $1,000,000 $100,0000 PREMr"aES IEa crrence] OLA1MS -MADE . XI OCCUR MED EXP (Any one person) SO X PO Ded: $1,000 PERSONALBADVINJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE UMITAPPUES PER POLICY ri J 1-7 LOC PRODUCTS - COMP/OPAGG $2,000,000 $ A AUTOIVIOBIlEUABILm X ANY AUTO ALL HIRED AUTOS ASS LED NON -OWNED AUTOS 04GL000837166 12/10/2011 12110/2012 aliNZWINGLE LIMIT r $1,000,000 $ BODILY INJURY (Per person) BODILY INJURY (Peruoddent) $ PROPERTY DAMAGE (Per accident) $ $ UMBRELLAUAB EXCESS UAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE S OED 1 1 RETENTIONS $ rt B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY tatcp PR PJUi'fNEWD,�CECUTIVEVIN (Mandatory In NH) tScc Iryee, describe under DESCRIPTION OF OPERATIONS below NIA WCV007803201 01/0912011 01/0912012 X ToATaturRs I I E.L.EACH ACCIDENT $100,000 $100,000 s500,000 E::.. DISEASE - EA EMPLOYEE E.L. DISEASE - POLICY LIMIT DESCRIPTION OF OPERATIONS/ LOCATIONS /VEHICLES (Attach ACORD 101, Additional Remarks Scleedtde, If more space is required) '*Workers Comp Information *' Blanket waiver of subrogation applies Proprietors / Partners /Executive Officers/Members Excluded: Allison Sepieili CERTIFICATE HOLDER CANCELLATION Miami Shores Village Building Dept. 10050 NE 2nd Ave Miami Shores, FL 33138 -2304 ACORD 25 (2010105) 1 of 1 #S8133621114813342 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 X31988- 2010ACC RD CORPORATION. All rights reserved The ACORD name and logo are registered marks of ACORD LSA