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RC-11-1525Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 163569 Permit Number: RC -8 -11 -1525 Scheduled Inspection Date: August 28, 2012 Inspector: Bruhn, Norman Owner: Job Address: 429 NE 102 Street Miami Shores, FL 33138 -2452 Project: <NONE> Permit Type: Residential Construction Inspection Type: Final Work Classification: Alteration Contractor: ADVANCED CONTRACTOR ROOFING & AIR CONDITIONERS Phone Number Parcel Number 1132060170790 Phone: (305)926 -9281 Building Department Comments NEW KITCHEN REMODEL NOC PENDING. NOC SUBMITTED Passed `L Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments August 27, 2012 For Inspections please call: (305)762 -4949 Page 1 of 17 Miami Shores Village APPROVED BY DATE ZONING DEPT BLDG DEPT SUBJECT TO COMPLIANCE WITH ALL FEDERAL STATE AND COUNTY RULES AND REGULATIONS fze 11/ i1J _ 3 1a --. 1 t 41x2 23 1 Priem., IR 'I ti lel 1Y 4 22 NO POINT ALONG COUNTER TO BE MORE THAN 2 FEET FROM G.E I PROTECTED RECEPTACLE. PUT DIW RECEPTACLE UNDER SINK. AU. AXED APPLIANCES ON DEDICATED CKTS. ADD SMOKEICAH d MONOXIDE DETECTORS. ANY AND ALL CLOTH AND RUBBER INSULATED CONDUCTORS TO BE REPLACED. CI COPY 201 96 341/2 22 06 €NrrZ y. 42 NE 101sT Permit No: 11 -1525 Job Name: August 25,2011 Miami Shores Viiiage Building Department Building Critique Sheet 1) Provide a floor plan and a scope of work. 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 ,cq #1--e e0A-4 F-fa- t ( NOTICE OF COMMENCEMENT A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION OFD P' 27811 F's 3534; (11s RECORDED 09/01/ 2011 11 :05 :28 f--CA HARVEY RIJVINr CLERK OF COURT PERMIT NO. TAX FOLIO NO. R--^' 2.O .Oil— 01y( 11I Mir -DADE COUNTYr FLORIDA LAST PAGE 111111111111111111111111111111111111111111111 CFN 2011R0537333 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 th mf reaS is provided in this Notice of Commencement. stF :. 9 F I J iEREEiC' C rRTIFY e' rat thi z Is a true copy of In 1. Legal description of property and street/ads: 2. Description of improvement: 3. Owner(s) name and address: Interest in property: . CL", crir�rie d cry i r ci'irc �i� ��01 2011" a' .�F.. i jJ. 4' iF:ii 4} I ,din y 'c-''EPR69I�o ' r' Eec I, 4 s3 q 2- • Name and address of fee simple titleholder: 4. Cont toa daaress 2:15)1 hone number _ 3211 $49 -• Ztt 5. Surety: (Payment bond reired by owner from contractor, if�� �t Name, address and phone number. Amount of bond $ 6. Lender's name and address: of recording of isM14 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 Statut s, Name address and phone number. zietx i 4.e * 3313k 30A-- �S& -7/3 L `� ,�•ohr.� f Asa 8. In addition to himself, Owners designates the following person(s) to receive a copy of the Lienor's Notice as provided in Section 713.13(1)(b), Florida Statutes. Name, address and phone number: 9. Expiration date of this Notice of Commencement: (the expiration date Is 1 year from the date of recording unless a different date Is specified) WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART I, SECTION 713.13. FLORIDA STATUTES, AND CAN RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT. Signature(s) of Owner( ) or Prepared By Print Name Title/Office STATE OF FLORIDA COUNTY OF MIAMI -DADE ' Authorized Officer /Director/Partner /Manager Prepared By Print Name Title /Office The foregoing instru ' -nt was acknowledged before me this By i ividuatly, IV= as ' MARIWArnw for ersonally known; or DI produced the following type of identificat' Signature of Notary Public: Print Name: (SEAL) I day of VERIFICATION PURSUANT TO SECTION 92.525. FLORIDA STATUTES Under penalties of perjury, I declare that I have read the foregoing and that the facts stated in it are true, to the best of my knowledge and belief. s) or Owner(s)'s Authorized Officer/Director/Partner/Manager who signed above: By NOTICE OF COMMENCEMENT A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION 1111111 11111 11111111011111 11111 11111 III! 1111 C-FH 2011R0587333 OR Bi. 27811 Ps 3534 tips) RECORDED 09/01/2011 11:05:2 HARVEY RUVINr CLERK OF COURT PERMIT NO. TAX FOUO NO. R--.3 .O to— Oil— O1 ( MIAMI- CDACDE COUHTYr FLORIDA LAST PAGE 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 stATE tt f i f rt or Ems is provided in this Notice of Commencement. HEREBY CERTFY n ?�t this is o bus copy eft 1. Legal descriptionnof property and street/address: 2. Description of improvement: 3. Owner(s) name and address: Interest in property: Name and address of fee simple titleholder: 4. Contr- ctor's na , address and •hone number. Criyi"3! rr,; ii t■,:,; (Zit" r;;,._ SEPu'1o1 20If t, .y , l - c ;�, courts . '. rellrager (o S3 dt 2- P;. of recording of ctZit-• S2kl 5. Surety: (Payment bond re fired by owner from contractor, if any) Name, address and phone number: Amount of bond $ 6. Lender's name and address: 7. Persons within the State of Florida designated by Owner upon whom notices or other documents may be served as provided by Section 713.13(1)(a)7., Florida Statutes, /� e n /� Name, address and phone number: dAr-S I� f �X gala �—r 8. In addition to himself, Owners designates the following person(s) to receive a copy of the Lienor's Notice as provided in Section 713.13(1)(b), Florida Statutes. r Name, address and phone number: 3.3/3 _acts— �/'SI -. /4 L 9. Expiration date of this Notice of Commencement: 24o. A at.) �ctrga , Luc l J er- e aahte (the expiration date is 1 year from the date of recording unless a different date is specified) WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART I, SECTION 713.13. FLORIDA STATUTES, AND CAN RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT. Signature(s) of Owner( ) or Prepared By PT: "9. Print Name "r11P', �" Title /Office I� STATE OF FLORIDA COUNTY OF MIAMI -DADE The foregoing instru By a ' Authorized Officer/Director /Partner /Manager Prepared By Print Name Title /Office nt was acknowledged before me this ividually, �1= as AnimrAmar for ersonally known, or ❑ produced the following type of identificat' . Signature of Notary Public: Print Name: (SEAL) VERIFICATION PURSUANT TO SECTION 9,2.525. FLORIDA STATUTES Under penalties of perjury, I declare that I have read the foregoing and that the facts stated in it are true, to the best of my knowledge and belief. .73 / day of fit n 41111 trricrtinWik, 1, s Notary Public - State of Ronda i) .$ My Comm. Expires May 1.2015 %,.. Commission Ir EE 89183 4 Signet e(s) f w r s) or Ow Authorized Officer/Director/Partner /Manager who signed above: Rv c. _ c. ,. i Project Address Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Parcel Number Applicant 429 NE 102 Street Miami Shores, FL 33138 -2452 1132060170790 Block: Lot: REAL ESTATE INC Owner Information Address Phone Cell REAL ESTATE INC 429 NE 102 Street MIAMI SHORES FL 33138- 429 NE 102 Street MIAMI SHORES FL 33138- Contractor(s) Phone ADVANCED CONTRACTOR ROOFING (305)926 -9281 Cell Phone Valuation: Total Sq Feet: $ 3,500.00 0 Approved: In Review Comments: Date Approved: : In Review Date Denied: Type of Construction: KITCHEN REMODEL Stories: Front Setback: Left Setback: Bedrooms: Plans Submitted: Certificate Date: Bond Retum : Occupancy: Single Family Exterior: Rear Setback: Right Setback: Bathrooms: Certificate Status: Additional Info: Classification: Residential Fees Due CCF DBPR Fee DCA Fee Education Surcharge Permit Fee Scanning Fee Technology Fee Total: Amount $2.40 $3.82 $3.82 $0.80 $255.00 $9.00 $3.20 $278.04 Pay Date Pay Type Invoice # RC- 8- 11.41786 08/19/2011 Check #: 2415 09/01/2011 Check #: 2427 Amt Paid Amt Due $ 50.00 $ 228.04 $ 228.04 $ 0.00 Available Inspections: Inspection Type: Drywall Final Framing Insulation 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. September 01, 2011 Authorized Signature: Owner / Applicant / Contractor / Agent Building Department Copy Date September 01, 2011 1 BUILDING PERMIT APPLICATION FBC 20 Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 '' Permit No. l 112 AUG 192619 Permit Type: BUILDING OWNER: Name (Fee S Address: ,,• - 2. V City: G..4 le Titleholder): c! /o 2-./ ROOFING Master Permit 11o. State: . o s • .sue, 7/3f. Phone #: Zip:3 / •� Tenant/Lessee Name: Phone #: Email: JOB ADDRESS: '42- 4 /o a- S7. City: Miami Shores Folio/Parcel #: County: Miami Dade Zip: Is the Building Historically Designated: Yes CONTRACTOR: Company Name: 4:1/"4,-)C.- <O Address: J .101 e‘ Gam' City: State: 1f' /f Zip:; f 7 Qualifier Name: Akciiirci ,4 Phone #:.moo State Certification or Registration #: '�• —'G / �® 77 ?Certificate of Competency #: Contact Phone #:.3 Cis - '9 20 94- F/ Email Address: r. + DESIGNER: Architect/Engineer: Phone#: Flood Zone: ®P- 5Phone #.~A �` 72 2� Value of Work for this Permit: $ Square/Linear Footage of Work: Type of Work: DAddition Description of Work: A•A • P-4 to ■a etc . a s" � ,Y ** **+ x+ x***** Fees**+ x***** ********* ****** ********* * *********** Sub t �� L •,. • $ CCF $ CO /CC $ ScammftVeei Notary $ Double Fee $ Structural Review $ $ DBPR $ Bond $ Training/Education Fee $ Technology Fee $ TOTAL FEE NOW DUE $ P• 04" 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. Owner or Agent Signature Contractor` The foregoing instrument was acknowledged before me this t. 1- The foregoing instrument was acknowledged before me this day of , 201L, by 4-4 , day of , 20 , by who is . ersonall kno , o me or who has pro uced cleidfiel.5 who is personally known to me or who has produced GKCt._. As identification and who did take an oath. as identification and who did take an oath. NOTARY UBLIC: Sign: Print: My Commission Expires: NOTARY PUBLIC: APPROVED BY CP- .—V Plans Examiner Structural Review (Revised 07 /10 /07)(Revised 06/10 /2009)(Revised 3/15/09) Print: j , -Fan My Commission Expi s: Clerk Permit Number: EL -4 -11 -691 I Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: I NSP- 171917 Inspection Date: May 07, 2012 Inspector: Devaney, Michael Owner: Job Address: 429 NE 102 Street Miami Shores, FL 33138 -2452 Project: <NONE> Contractor: DELTA TECH ELECTRIC LLC Permit Type: Electrical - Residential Inspection Type: Final Work Classification: Addition /Alteration Phone Number Parcel Number 1132060170790 Phone: (954)665 -9775 Building Department Comments ELECTRICAL WORK FOR KITCHEN REMODEL Passed Inspector Comments CREATED AS REINSPECTION REINSPECTION REPAIRED. Add smoke / carbon Service not to code FOR INSP- 171879. CREATED AS FOR INSP- 158557. NO ACCESS AND SERVICE NOT monoxide detectors. , repair under separate permit. Failed eicy____ /K2 ot. l� / ?.---- Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled re- inspection fee is paid. until For Inspections please call: (305)762 -4949 May 07, 2012 Page 1 of 1 i Project Address Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Parcel Number Applicant 429 NE 102 Street Miami Shores, FL 33138 -2452 1132060170790 Block: Lot: REAL ESTATE INC Owner Information Address Phone Cell REAL ESTATE INC 429 NE 102 Street MIAMI SHORES FL 33138- J 429 NE 102 Street MIAMI SHORES FL 33138- Contractor(s) DELTA TECH ELECTRIC LLC Phone Cell Phone (954)665 -9775 Valuation: Total Sq Feet: $ 900.00 0 Type of Work: KITCHEN REMODEL Additional Info: ELECTRICAL Classification: Residential Scanning: 1 Fees Due CCF DBPR Fee DCA Fee Education Surcharge Permit Fee - Additions /Alterations Scanning Fee Technology Fee Total: Amount $0.60 $2.25 $2.25 $0.20 $150.00 $3.00 $0.80 $159.10 Pay Date Pay Type Invoice # EL-4-11 -40675 09/01/2011 Check #: 2427 04/19/2011 Credit Card Amt Paid Amt Due $ 109.10 $ 50.00 $ 50.00 $ 0.00 Available Inspections: Inspection Type: Final Meter Box Alteration Relocation Fire Alarm Service Change Underground W. W. In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Futhermore, I authorize the above -named contractor to do the work stated. September 01, 2011 Authorized Signature: Owner / Applicant / Contractor / Agent Building Department Copy Date September 01, 2011 1 if (Al )11- VerrA 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 .r-4 l, l BUILDING PERMIT APPLICATION FBC 20 Permit Type: Electrical OWNER: Name (Fee Simple Titleholder): Address: 8-117.519 APR 1 ,201.' Master Permit No. City: a 4.74a State: dN? d Tenant/Lessee Name: A IA Email: cl.A�c.2nH rl i tip . e I O 2. Phone #: 3 OS– 'i5- ' –'7J3 Zip: ,1!( Phone #: JOB ADDRESS: City: Miami Shores Folio/Parcel #: 11.3 2-0b ©I 1 0 7 a b County: Miami Dade Zip: 3313$ Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Com any Name: De /1i tC)l i '? c,74 Z4 Phone #: 9SV'' C6 - -- ?�-� Address: t 3. / P //4 .i k c'4 (3/ J -5,-/ tt f1 41'9-0 i/a ��rq�j aO ridej J 7Oti City: � � State: � Q Zip: � Qualifier Name: Iratli e3kfd Phone #: State Certification or Registration #: 1.3004('A 2- CertificAii of Competency #: Contact Phone #: P '5 q 77.- Email Address: I �l f o �d" , I :cel i� 1Ti G . 67A? DESIGNER: Architect/Engineer: Phone #: Value of Work for this Permit: $ I' 0• ®� Square/Linear Footage of Work: Type of Work: UAddress ❑Alteration Description of Work: UNew epair/Replace hrh-of 0z-1-Q6-IL of e4)4,. ❑Demolition ******** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Fees************* * * * * * * * * * * *** * * * * * * * * * * * * * * * * ** Submittal Fee $ 4 Permit Fee $ /0, i) CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ nCt °� l Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) AIA 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 $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Owner or Agent The foregoing instrument was acknowledged before me this / J day offJPIRIC. ,20 / , AAl CC-Al Y RieAiDa «EYES, who is personally known to me or who has produced 2a RIVER'S L l CEA) SE. As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: oSE JOSEPH L ANDRE My Commission Expires: * * * * * * * * * * * * * * ** * * *..* APPROVED BY MY COMMISSION # DD910S24 14.0F le EXPIRES: Sept. 6, 2013 (407) 398 -0153 Florida Notary Sery ce.com Signature Contractor The foregoing instrument was acknowledged before me this I et- day of i ,20 (I ,by Valk Plevr who is personally known to me or who has produced kZ ‘ as identification and who did take an oath. NOTARY PUBLIC: 277 /9/2 Z- Plans Examiner Structural Review (Revised 07 /10 /07XRevised 06 /10 /2009XRevised 3/15/09) Sign: Print: My Commission Ex l�l�,f2 -O,► p.5r EXPIRES October 11, 2011 Zoning Clerk { { } (NOlO.) 1.51♦"C! LOT 15 aLOix art Nom} SAT SLOa:8B 3 m F.LP. 1Q (NO ) 0.10` c6 5.10 F.LP. 1W (NOS) BLOCK MAO' R&mI s. CORNER 29 ASPHALTPAIIS EN (759OTAL ) MIL 1 SKETCH OF SURVEY SCALER i'=25' ABBREVIATIONS AND LEGEND NC mAR tREENTICEING PAR FAD FOUNDIVAA t�K LTP.4R.ECTRIC TRANSFOINASR PLO OR. ..OREIRLGE EASEMENT ULE.aLA[R NAINIENANCE ENIENERF FIR...FOUND MR EAR OEMs CWIC. iBTRUCt:RIE -.th -a MAN LEN FENCE NO ID. NO INERIFICATION M a* NOM DLV VALID VITM P40E 1 SIR.. REF IRON BIR Fit FM. FIRE ~ANT CL =CASS RE$. a RESIDENCE Bit...STORY C.B. 0 CATCH BRBR six ofINEVIRK RAY RIEHT OF VW i. IENIMi t Carlin LOSt CONMaCIENCRBE Bent a91ElNAtt R =RANEE ENC. ..ENCROACHMEIN -r-• .00000 RACE 93933.01.9 MIL £ mCU .AIN LE KARL F. KUHN PRWESSDNIAL LAW S{RVETOR Um 5953 3940 N ROTh AVE SUITE MN NUSJ.YVA.iW ft 330931 PA , 706-Ete 4039 705-31 9340 FAX 1 305-071 5977 TYPE IIF PRUECTI BOUNDARY SURVEY AiSS ..tai DATE 08 -16-10 PROJECT LIEAT$tii MNE 1 d S7REET CITY, STATE It ZIP CAE. MIAMI SAS, FLQRH?A 33138 ERN* re. N. W.LO. vORMIN PROJECTNa 10-08-161 BATE or FIELD VUBKw 08 -13-10 SNEETs 2 an 2 4 f: N.@. 164th STREET 1a 11 10 9 S 7 LOCATION MAP. NOT TO SCALE SSIZESIX-8177111= 428 NE 102nd STREET htlA80 SHORES, FLORDA 33139 1"12Int. LOT 18 MOCK 440 AIME PLAT TIK WPM WOOER SECTION ACCONDINOTOTIMPLATTHEREOFASTOCCIONDRIPLATBOOK 1S PARE14 WINE MORES OP INAOI MOE COUNTY, FLORIDA. cE;pnrIca rah a.- REGAL !STATE, INC. b.- BEST BEACH TITLE. LLC. FIDELITY NATIONAL. TITLE. INSURANCE CO. d.° 1 e &ev 3 'S OTESd. ea ea as N# . The lends shaven hence mead abetreated o or en 8e and Ms saner, b say may net be absent en Ode oil* weal Wain not 4eae lrx them to d end 8) Fie ties to beu� efSe *thanes *d814 18) Sawed name Oa *Mule raised seal of a Raids licensed Smarr end 11) Ws lbe Ota Seas* thesect easements= ark, lbese tee es � Try asap toti lNe Instlierioa. no other cos 13j Tlds survey meted by pecessiced Maly emus= now =se INFORUMON: DATE CP POOR X11.2009 lEo 12 PAM: 0302 RAMC I. MUM: X EASEFLOODEIEVETIOR WA' I HEREBY CERTIFY THAT Nan ThIS =MET WAS NAME USER HY REMO= SURVEY N MEETS THE TO TIE TECHNICAL ST AS SET VT NE BOARD CIORGE AND O PRUFECITONN. IAD SINVEYote FLOM .c . S'4ATIiiES elentilelneTive ONE TIBS BIBS lerff SL , BOOLVAtK Na tim tOTEe ONLY VALID VITN POSE 2 ELEVATION: NIA 19OLF.K1991 yeameNANALumosuseeyouftene ORRICCPRUIRA KARL F. KUHN PAIL LAND NI SISVEYLR Na 5963 3940 N 36Th AVE SUITE LOB HIunel® a 93021 PH , 706 -812 4034 700 -306 5348 FAX . 303 -271 3977 TYPE W PealECT, BOUNDARY SURVEY PIRMECT =MOAB 428 NE SCAB AMMO boa 08-16 -10 R. BEILO. DRAWS Na CITY, STATE I. ZIP COD MOAN SHORES, FLORIDA 33138 DATE OF FIELD WIND 08 -13-10 eaaecrua 10-08 -151. SHEET. 1 Ifs 2 Prepared by and return to: Gary Silberman, P.A. Offices at Grand Bay Plaza 2665 South Bayshore Drive, Suite #725 Miami, FL 33133 File Number: BB- 102576 (Space Above This Line For Recording Data) Warranty Deed This Warranty Deed mae 10th day of Augn 2010, between Heinrich Miranda, office address is � a�� FIE 41 if �,a sy �,;. a single man, whose post 7 t M Am; shoal, g3) corporation whose post office address is � � grantor, and Regal Estate, Inc, a Florida 'GJ21 hiss 1a1.�tn . • �t Affl S )Ig f4 35138, grantee: (Whenever used herein the terms "grantor" and "grantee" include all the parties to this instrument and the heirs, legal representatives, and assigns of individuals, and the successors and assigns of corporations, trusts and trustees) Witnesseth, that said grantor, for and in consideration of the sum of TEN AND NO /100 DOLLARS ($10.00) and other good and valuable considerations to said grantor in hand paid by said grantee, the receipt whereof is hereby acknowledged, has granted, bargained, and sold to the said grantee, and grantee's heirs and assigns forever, the following described Iand, situate, lying and being in the Dade County, Florida, to -wit: Lot 16, Block 92, AMENDE PLAT OF THE MIAMI SHORES SECTION 4, according to the Plat thereof, recorded in Plat Book 15, Page 14, of the Public Records of Miami Dade County, Florida. Parcel Identification Number: 11-3206-017-0790 Subject to current taxes, easements, and restrictions of record. Together with all the tenements, hereditaments and appurtenances thereto belonging or in anywise appertaining. To Have and to Hold, the same in fee simple forever. And the grantor hereby covenants with said grantee that the grantor is lawfully seized of said land in fee simple; that the grantor has good right and lawful authority to sell and convey said land; that the grantor hereby fully warrants the title to said land and will defend the same against the lawful claims of all persons whomsoever; and that said land is free of all encumbrances, except taxes accruing subsequent to December 31, 2009. In Witness Whereof, grantor has hereunto set grantor's hand and seal the day and year first above written. Signed, sealed and delivered in our presence: State of F L- County of 1‘-'1 j rrYi "d The foregoing instrument was acknowledged before me this @jJt day of 8 (AU G/ } Heinrich Miranda, a single man„ he ( ) is personally known to me or a) has produ Driver's identification. NOTARY PUBLIC . STATE OF FLORIDA \ Alexandra E. Pineda Commission #DD644287 ur.fi� Expires: FEB. 26, 2011 c t}iRl1NaANTICBONDING CO., O., INC. , 20 10, by wt1se as Printed Name: Alexandra E. Pineda My Commission Expires: 04/19/2011 11:22 Delta Tech Electric State. Certified Lic. EC13004622, Bonded► insured FAX: Date: 4\19\11 Re: _Registration with Building Department No. of pages: (incl cover page): 6 #1058 P.001 1835E. HellandAte Each Blvd. Hallandale FL, 33009 Dade: 305 -588 -6922 Sroward: 954 -665 -9775 Delray: 561-665-0293 West Pai,:n Deb: 561 - 779 -288* Fax: 954-639-7603 Serving 4 /IOfSotddhNerida From: _Keith Pegler Phone #: 954 665 9775 Attention: Miami Shores Village Company: Fax #: 305 756 8972 Phone #: [[ ] Urgent For Review [ ] Please Comment [ ] Please Reply NOTES: 04!„18/2011 11:22 ate: 4/153/2011 Time: 10:22 AM To: Page: 005 ACORa, El 9,19546397803 CERTIFICATE OF LIABILITY INSURANCE #1056 P.002 DATE YYYYj 04/19/2011 THIS CERTIFICATE IS ISSUED AS A MATTE OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. T1116 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 INSURERS), AUTH©RFZED REPRESENTATIVE OR PRODUCER, AND THE cERTIFICATF HOLDER. IMPORTANT; lithe certmcate holder Is an ADDITIONAL, INSURED, the poncy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and con Ejorrs of the poky, certain policies may require an endorsement A statement on this certificate does not cantor Notts to the certificate holder In Neu of such endoivement(s)• PRODUCER Insurance Office of America, Inc. P.O. Box 162207 Altamonte Springs. FL 32716 -2207 Delta Tech Electric 1835 E. Hal1 andal a Beach BI vd. Suite 470 Hallandale, FL 33009 COVERAGES CONTACT No. so: 407.788.3000 ADDRESS: PROrUCtR aUsTOMER S: r>o> 407.788.7933 CERTIFICATE NUMBER: 2010/2011 IPA: sec INSURER »E: INSIMER P mmaeapywnmomoommmum Old Dominion Ins. Co. NAI I 40231 REVISOR NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OFD INSURANCE LISTED BELOW HAVE _ BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOnABITISTANDING ANY REQUIREMENT. TERM OR CONDI"l'loN OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WF6CIF THIS CERTIFICATE MAY BE ISSUED OR MAY PERTTAIN#. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, g EXCLUSIONS AND CONJmONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. L'FR TIPS OFINSLMANCE liFF GENERAL LIAINUTY COMMERCIAL GENERAL LIABILITY CIAINS-MACE OCUJR GE N'LAr GATE LMT APPLIES AIR: X n POLICY n n LOC AUTOMOBILE UNNLEY ANY AUTO ALL OWNED AUTOS sairb r_so AUTOS D AUTOS NON.ONVPIED At MOS --Y tJAaRELI AUeB EXCESS MS 'MW PIIJ11BER MPG2 11/2412010 11/24/2011 EACH o=umeNce MED EXP (Any one person) PERSONAL & ADV INJ. SY GENERAL AGGREGATE PRODUCTS. cx ,roPAGO $ 1 000,000 s 500,000 $ 10,000 $ 1.000,00C $ 2,000,00C- 2.000,000 COTABM SINGLE tb (EA eceiderlt) BODILY INJURY (Per parson) $ BODILY IN.LnY (Per oddcit) PROPERTY DAMAGE (Per AccieortS S DEDUCTIBLE FETE DON $ AND p1 LOVERS' LIABEZrY oANYrFCCf].'A sE cL mvE panclatuyIn �y NH) DESCR OtN OF OPgRATtONS t+ekm S EACH OCCURRENCE AGGREGATE $ YIN NM E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE $ DESDRIPTIOPI OFOPERATIONS /LOCATIONSIVE rA =ORD 707,AQaiEienal Reamers gehedsso, Rmonrpsc Is maim) CERTIFICATE HOLDER E.L. D $Ee$E - POLICY Lear S CANCELLATION Village of Miami Shores Building Department 10050 NE 2 Ave. Ili ' Stores, FL 33138 ACORD 25 (2009109) SHOULD ANY OF THE ABOVE DESCRIBED POLiciEs; BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF. NOTICE WILL FOE DELIVERED DJ ACCORDANCE WM THE POLICY PROVISIONS. ALIIIVRIZEDREPREWITFATIVE • Nark Manfre/TRICIA tLh 1989.200E ACORD CORPORATION. All rights reserved, The ACORD name and logo are registered marks of ACORD 04/19/2011 11:23 ate:' 4/14972011 Time: 10:22 AM To: 9 9,19546397603 Page: 008 A CORE€ , JUGGAM Insurance Office of America, Inc. AGENCY CUSTOMER l: LOC #: ADDITIONAL REMARKS SCHEDULE #1058 P.003 Page of POUOVNIXIgat ADDI'iiONAL REMARKS Now CODE NAME} iNSURED Delta Tech Electric Suite 470 Hallandale, FL 33009 EFFECTIVE OATe; THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM FORMNlUbMIER: 25 FORMTULE: ACORD CCrtificate of Liability Insurance Garage Liability ANY AUTO Automobile Liability L7R Excgessss/Umbrell a Liability tnt Other Liability LEI POLICYS powewmaxm DATE UWt3 auro ohLY - sAacs m $ orfeRmim EAACC $ AU O ONLY: AGO $ :'OLICYMEASE i DA7AM POLICY NUMBER POLICY MOWER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES ACCORD 101 (200SW01) lafeV Flag=y11344 D TI IMES $ UWE e 2008 ACORD CORPORATION. AU rights reserved. The ACORD name and logo are registered marks of ACORD niacH Numrit:R. M N DELTA TECH ELECTRIC, LLC 1835 E HALLANDALE BEACH BLVD, STE 470 HALLANDALE, PL 33009 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: DELTA TECH ELECTRIC, LLC Business Type:ELECTRICAL /ALARMS /COxr Receipt #:181-237554 Owner Name: KEITH PEW..ER, QUALIFIER Business Opened :11/23/2010 Business Location: 1835 E HALLANDALE BEACH BLVD, StatelCountyFCerfReg :EC13004622 HALLANDALE Exemption Code:NONEMPT Business Phone: 954 -6 65 - 9775 Rooms Seats Emplpyees 2 Machines Professionals 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. Malting Address: N 07 ct 2010 - 2011 Receipt #03A- 10- 00002503 Paid 11/23/2010 27.00 For Vending Bustnese Only Number of Machines: Vending Type: Tax Amount Transfer Fee NSF Fee Penally Prior Years Collection Cosi Total Paid 27.00 0.00 , iii j _• 0.00..- 0.00 =; 4.00 27.00 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 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. Malting Address: N 07 ct 2010 - 2011 Receipt #03A- 10- 00002503 Paid 11/23/2010 27.00 04/18/2011 11:24 #1058 P.008 ACORD, CERTIFICATE OF LIABILITY INSURANCE PRODUCER Zntego Insurance Services, *TA 2000 W4ntOA Rd South Rochester NY 14618 INSURED Delta Tech Electric MG 1835 E aalleaaaie Beach Elva 4 Nsllandalc FL 33009 COVERAGES aert ID 2889 DATE ¢QNDDAY T) 12/15/2010 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. 'MIS CERTIFICATE DOES NOT AMEND EXTEND OR ALTER THE COVERAGE AFFORDED SY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE INSURER A: Twin City Fires Insurance Cnspa NAIC 0 29459 INSURERS: INSURER C: INSURER D: INSURER E 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. DLSR ADD`L POLICY NUMBER POLICY POLICY GKAI. uABAJTY COL8b1ERCAL GENERAL LABILIIy ( CLAWS MADE El OCCUR C N'LAGGREGATELRW APPLES PER POIIQY pE 1 LOG LOOTS EACH OCCURRENCE $ DAMAGE TO RENTED PREMiSeS Gen ttcurence $ mar EXP(Ann one maw) 5 PERSONAL & ADV INJURY S GENERALAGOREGATE 3 ,PRODUCTS - COMPIQP AGO $ AUiOMOBILEUABILITY ANYAUTO ALL OWNED AUTOS WHEW= FIRED AUTOS NON -OWNED AUTOS (COMBINED SINGLE LZM (PerpasonIN)) P�aosdert) GARAGE I.IABLIIJY ANY AUTO (Par DAMAGE ma:WO AUTO ONLY EA ACCIDENT $ OTHER THAN Oisar EA ACC $ EXCIRISAWISHELIA LIABILITY OCCUR ❑ CLAIMS MADE DEDUCTIBLE RETENTION II WCNOKEISCOM ENSATIaNAND !m@LOYER5' DIY ANY PROPRIETORPARI NEReCECUTIVE OFyFIe,, C ER EMBER EXCLUDED sPECIAL PROVISIONS beim OTHER 021WsGS.x47oz EACH OCCURRENCE AGO AGGREGATE $ $ 11/24/2010 11/24/2011 DEselavnokOFOPERATIONS /LOCATIONS / VEHICLES/ ECL ONSADDED BYa IMIENY/SFUcw.P OVLCONS CERTIFICATE HOLDER Proof of Coverage TDRRyiARYIrm I I ER S EL EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ EL DISEASE - POLICY LIMIT $ 100,000 100,000 500,000 ACORD 25 (200110$) CANCE=LLATION SHOULD ANY OFTNEABOVEDf ` SED POLIGIES BE CANCELLED BEFOTTE THE EXPIRATION DATE THEREOF. THE MSIANG INSURER WILL @NDEAVOR TO /RAE. 10 DAYS WRITTEN NOTICE TO THE CERTN7cATE HOLDER RARER TO THE LEFT, BUT FAILURB TO LID So SHALL IMPOSE NO OBLIGATION OR UABILIVf OF ANY KIND UPON THE HOMER, RB AGENTS OR REPR 'ATNFG AUTHORIZEDREPRESENT /um • ' •.. •• : •.•••••• . ••fL4Pi.r.�: ®ACORD CORPORATION 1988 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 I w -i Inspection Number: INSP- 173436 Permit Number: PL -8 -11 -1526 Scheduled Inspection Date: May 14, 2012 Inspector: Hernandez, Rafael Owner: Job Address: 429 NE 102 Street Miami Shores, FL 33138 -2452 Project: <NONE> Contractor: I & M SERVICE AND REPAIR Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Addition /Alteration Phone Number Parcel Number 1132060170790 Phone: (786)380 -6911 Building Department Comments PLUMBING WORK FOR KITCHEN REMODEL PERMIT PAID. MISSING PAPER WORK FROM CONT. PLEASE DO NOT SCHEDULE INSP UNITL PAPER IS VALID AND UPDATE 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- 172105. CREATED AS REINSPECTION FOR INSP- 171856. CREATED AS REINSPECTION FOR INSP- 163572. no access no access 12:00 THIRD TIME INSPECTOR SHOWS UP NO ACCESS. RH5/11/12 May 11,2012 For Inspections please call: (305)762 -4949 Page 30 of 36 I Project Address Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Parcel Number Applicant 429 NE 102 Street Miami Shores, FL 33138 -2452 1132060170790 Block: Lot: REAL ESTATE INC Owner Information Address Phone Cell REAL ESTATE INC 429 NE 102 Street MIAMI SHORES FL 33138- i 429 NE 102 Street MIAMI SHORES FL 33138- Contractor(s) IDM SERVICE AND REPAIR Phone (305)926 -9281 Cell Phone Valuation: Total Sq Feet: $ 350.00 0 I Type of Work: PLUMBING Type of Piping: KITCHEN REMODEL Additional Info: Bond Retum : Classification: Residential Scanning: 1 Fees Due CCF DBPR Fee DCA Fee Education Surcharge Permit Fee Scanning Fee Technology Fee Amount $0.60 $2.25 $2.25 $0.20 $150.00 $3.00 $0.80 Total: $159.10 Pay Date Pay Type Invoice # PL -8 -11 -41788 09/01/2011 Check #: 2427 08/19/2011 Check #: 2415 Amt Paid Amt Due $ 109.10 $ 50.00 $ 50.00 $ 0.00 Available Inspections: Inspection Type: Top Out Final Underground 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. September 01, 2011 Authorized Signature: Owner / Applicant / Contractor / Agent Building Department Copy Date September 01, 2011 1 BUILDING 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. Pi 11— MD PERMIT APPLICATION FBC 20 Permit Type: PLUMBING OWNER: Name (Fee Simple T' eholder): X47 . Phone S 16-0- 7/3 Address: �' "' F+' �-• �%© 2• S ° a 4 ,eg.,, ,4.9a / 4 a City: � x. ... -04 State: - rte- 72 p; % Tenant/Lessee Name: Phone #: Email: BY: aso0060o.Ooopaee0o4■000. Master Permit No. JOB ADDRESS: 4-2 City: Miami Shores Folio/Parcel #: Is the Building Historically Designated: Yes County: Miami Dade Zip: 3 3 Flood Zone: CONTRACTOR: Company Name: f4 f44 SQY ✓i. G.. 60,4 (L //. I3' Phone #1 d iLI Address: C '07 ,frw 2. '/ 7-32,, . City: Ait'at, 144 j' r� "Staat�e: FL- Zip: .3 .3t %fj Qualifier Name: �� et/t/ .S/ �-.c -t Phone #: State Certification or Registration #: (PC / y2 r (jO l Certificate of Competent #: Contact Phone #: 7,6=3 8o (t// Email ddress: Y# kw 0 • 14 vi' 4 -4100 • Co DESIGNER: Architect/Engineer: 444' 4 Phone#: Value of Work for this Permit: $ S'e? Square/Linear Footage of Work: Type of Work: DAddress DAlteration DNewepair/Replace DDemolition Description of Work: * * * ** x*** ************ *** *************** Fees******** **** ********* ********* *** ******** * ** Fee $ Permit Fee $ l�� `r- Submittal CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ 1 Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC OWNER'S AFFIDAVIT: I certify that all the foregoing information is-accurate. and that all work will be done in compliance with all applicable laws regulating construction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose 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 The fore day of Owner or Agent oing instrument was acknowledged before me this 2011 ,by• who is personally known to me or who has produced 1Z. As identification and who did take an oath. NOTARY P ARIADNA GARCIA MY COMMISSION #00773432 EXPIRES: MAR 30, 2012 -- — Bonded through 1st State Insurance Sign: f.Fii�I/ Tr 1K, - Print: f1 . �' ! My Commission Expires: APPROVED BY 3 (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) Contractor The foregoing instrument was ackno day of et, d5-1 ,20ifL ,b who is personally known to me .r; `o has produced ge y' a efore me this as ident''fication and who did take an oath. NOTARY P " /A—C, Sign: Print: My Commission Expires: A•ImN GAR IA MY COMMISSION #00773432 4. EXPIRES: MAR 30, 2012 °FP Bonded . arou h 1st State Insurance 3 30 Alit Plans Examiner Zoning Structural Review Clerk SEE OTHER SIDE DO NOT FORWARD I & M SERVICE AND REPAIR INC JUAN R STEELE PRES 6407 NW 201 TERR HIALEAH FL 33015 ISIIIII11111111)5111)11111111,1111111111111111111,111111171111 04-22-2011 JEFF ATWATER STATE OF FLORIDA CHIEF FINANCIAL OFFICER DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION * * CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS COMPENSATION LAW * CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law. EFFECTIVE DATE: PERSON: FEIN: 04/22/2011 EXPIRATION DATE: 04/21/2013 STEELE BARRIOS JUAN 651297102 BUSINESS NAME AND ADDRESS: / & bi SERVICE AND REPAIR INC 8407 NW 201ST TER HIALEAH FL 33015 SCOPES OF BUSINESS OR TRADE: 1° METAL WORK 3- PLUMBING 2- DOOR INSTALLATION IMPORTANT: Pursuant to Chapter 440 . 05(1 F.S., as officer of a corporation who elects exemption from this chapter by filing a certificate of election under this section may not recover benefits or compensation under this chapter. Pursuant to Chapter 440.05(12), F.S., Certificates of election In be exempt... apply only within the scope of the business or trade listed on the notice of election to he exempt. Pursuant to Chapter 440.05(13), r.s., Notices of election to be exempt and certificates of election In he e mint shall be subject to revocation il, at any time otter the filing of the notice in the Issuance of the certificate, the person named on the notice of certificate no longer meets the requirements of this section for Issuance of a certificate. The department shall revoke a certificate at any time for failure of the person named on the certificate to meet the requirements of this section. QUESTIONS? (850) 413-16 DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01-11 PLEASE CUT OUT THE CARD BELOW AND RETAIN FOR FUTURE REFERENCE STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION CONSTRUCTION INDUSTRY CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW EFFECTIVE: 04/22/2011 EXPIRATION DATE: 04/21/2013 PERSON: JUAN R STEELE BARRIOS FEIN: 851297102 BUSINESS NAME AND ADDRESS: I & M SERVICE AND REPAIR INC 0402 NW 201ST TER IIIALEAH, FL 330 15 SCOPE OF BUSINESS OR TRADE: 1- METAL WORK 2- DOOR INSTALLATION 3- PLUMBING F 0 L D H E R E Pursuant to Chapter 440.05(13), F.S., Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation if, at any time after the filing of the notice or the issuance of the certificate, the person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate. The department shall revoke a certificate at any time for failure of the person named on the certificate to meet the requirements of this section. IMPORTANT Pursuant to Chapter 440.05(14), F.S.. an officer of a corporation who elects exemption from this chapter by filing a certificate of election under this section may not recover benefits or compensation under this chapter. Pursuant to Chapter 440.05(12), F.S., Certificates of election to be exempt... apply only within the scope of the business or trade listed on the notice of election to be exempt QUESTIONS? (850) 413-1609 CUT HERE * Carry bottom portion on the job, keep upper portion for your records. STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD 1940 NORTH MONROE STREET TALLAHASSEE FL 32399 -0783 STEELE BARRIOS, JUAN R I & M SERVICE AND REPAIR INC. 6407 NW 201ST TERRACE HIALEAH FL 33015 (850) 487 -1395 Congratulations! With this license you become one of the nearly one million Floridians licensed by the Department of Business and Professional Regulation. Our professionals and businesses range from architects to yacht brokers, from boxers to barbeque restaurants, and they keep Florida's economy strong. Every day we work to improve the way we do business in order to serve you better. For information about our services, please log onto www.myfloridalicense.com. There you can find more information about our divisions and the regulations that impact you, subscribe to department newsletters and learn more about the Department's initiatives. Our mission at the Department is: License Efficiently, Regulate Fairly. We constantly strive to serve you better so that you can serve your customers. Thank you for doing business in Florida, and congratulations on your new license! DETACH HERE CFC142840' CERTIFIE STESLE, . $A I ..M SER OF BUSINESS`. A' •PROFE Sr ?N 3TRU'CTION;_ INDUSTRY ` L. ENSINs PLAY AS REQUIRED BY L From:Jimenez Ins. 305 264 5382 08/04/2011 17:12 #722 P.001 /001 CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDNYTY) 08/04/11 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WANED, 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 • CONTU1` I Jimenez & Co., Inc. PHONE I A/C, No. AX 8000 Coral Way E-MAIL )' `j Miami, FL 33155 1. R0DUCEFF CUSTOMER ID 4: Phone (305) 264-9900 Fax (305) 264 -5382 IJSURER(SLAFFORDING COVERAGE I NAIC C INSURED : INSURER A; NATIONAL GROUP INSURANCE -1 I & M SERVICE AND REPAIR INC INSURER B : 1 6409 NW 201 TERR IN9UgEg q: ) Miami, FL 33144 1 INSURER D : AIM-1. E : INSURER P : 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 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 IS SUBJECT TO ALL THE TERMS, j EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. AM&Rr___ . POLICY NUMBER POLICY EFF _POLICY EXP GENERAL UABIUTY ® COMMERCIAL GENERAL LIABILITY ❑ ❑ CLAIMS -MADE ❑I OCCUR A !❑ GEN'L AGGREGATE LIMIT APPLIES PER: ❑ POLICY ❑ iJ LOC i AUTOMOBILE UABILITY ❑ ANY AUTO ❑ ALL OWNED AUTOS ❑ SCHEDULED AUTOS +❑ HIRED AUTOS • ❑ NON -OWNED AUTOS ❑ UMBRELLA LIAR ❑ OCCUR `El EXCESS LIAR CLAIMS -MADE ❑ DEDUCTIBLE _.' ❑_FjE1'ENTION _. ._.. WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y NI ANY PROPRIETOR/PARTNER✓EXECUTNE;— (Mandatory In N ER EXCLUDED? N / A (Mandatory In NH) Eyes, describe under DESCRIPTION OF OPERATIONS below I ! 01L000412000 LIMITS EACH OCCURRENCE r $ 1,000.000j • DAMAGE TO RENTED • i .RR Mt8EL(Ea occurrence) . $ 100.000 I ' i OED EXP (Any one Person) • $ 5000 I p'•11/11/2010;11/11/2011 • PERSONAL &ADVINJURY ; $ 1,000,000: { GENERAL AGGREGATE $ 2,000,0001 PRODUCTS - COW/OP AGG • $ 1,000,0001 I$ COMBINED SINGLE LIMIT (Ea accident) 1$ BODILY INJURY (Per parson) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) DESCRIPTION OF OPERATIONS i LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, K more space is required) CERTIFICATE HOLDER MIAMI SHORES VILLAGE 10050 NE 2 AVE MIAMI FL 33138 ACORD 25 (2009/09) QF CANCEL I ..S •$ • EACH OCCURRENCE I $ I AGGREGATE $ i$ i$ • I ❑ WC STATU- 0TH - TORY 1_tMITS ❑ ER t¢ E.L. EACH ACCIDENT 1 $ .` E7 DISEASE - EA EMPLOYEE_$ EL DISEASE-POLICY LIMITj $ TION OF THE BOVE DESCRIBED POLICIES BE CANCELLED BEFORE TION DAT THEREOF, NOTICE WILL BE DELIVERED IN CE WITH () POUCY PROVISIONS. THE 0; 988 -2009 ACORD CORPORATION, All rights reserved. The ACORD name and logo are registered marks of ACORD