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RC-11-844Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 177502 Permit Number: RC -5 -11 -844 Scheduled Inspection Date: August 21, 2012 Inspector: Bruhn, Norman Owner: BECHT, CLAUDE Job Address: 1610 NE 105 Street A -12 Miami Shores, FL 33138 -2118 Project: <NONE> Contractor: THE NARSHA GROUP, LLC Permit Type: Residential Construction Inspection Type: Final Work Classification: Addition /Alteration Phone Number Parcel Number 1122300530120 Phone: (786)222 -1876 Building Department Comments KITCHEN & BATHROOM REMODEL, NEW FLOORS AND SECOND FLOOR, CERAMIC TILE INSTALLATION AND NEW WALL PARTITION 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- 159611. ON HOLD CANCEL. August 20, 2012 For Inspections please call: (305)762 -4949 Page 16 of 19 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 FBC 20 10 BUILDING Permit No. PERMIT APPLICATION Master Permit No. et. ( 3 44 Permit Type: BUILDING ROOFING JOB ADDRESS: City: Miami Shores Folio/Parcel #: (G LO (ol- fl County: Miami Dade Zip: Is the Building Historically Designated: Yes NO Flood Zone: OWNER: Name (Fee Simple Titleholder): - kic-C- (1_1400C- Address:/(00 /0 ST- City: f1' et \' S H-atrz-� Tenant/Lessee Name: State: Ft_ Email: Ctau1/4J, _b cLF CONTRACTOR: Company Name: Address: (1,100 Kt 41 C 0 Ut1 City: t rY1 Qualifier Name: (../.) iS f e-f. Wkran' State Certification orr� Registration #: C6 C Contact Phone #: L �� 22.1 16`16 CA- Phone #: 265 7ve zip: 3 ?.--f 3e Phone #: 0°33 b g '10 'Eke, 1L a r.S\ o,, ,,„o? (cc, Phone #: State: 11016 Zip: 331 '38 Phone #: rigG ZZZ L8 -1 Certificate of Competency #: Email Address: DESIGNER: Architect/Engineer: Phone #: Value of Work for this Pernut: $ Square/Linear Footage of Work: Type of Work: UAddition OAlteration, ONew 'ORepair/Replace Demolition Description of Work: Iegm o Color thru tile: ******** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Fees********:**** * * * * * * * * * * * * * * * * * * * * * * * * * * ** *** Submittal Fee $ Permit Fee $ 1 a) .00 Scanning Fee $ 3 •DD Radon Fee $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ CCF $ CO /CC $ DBPR $ Bond $ Technology Fee $ TOTAL FEE NOW DUE $ 153 . &) Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencem ' t be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In t ch 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 17 day of bik , 20 )12-, by £U0rUO%f- 0/C047 , Signature Conr pr The foregoing instrument was acknowledged before me this 4° day of a I , 20 , by LIM S fair2pc-Aikezzo who is personally known to me or who has produced APM who is personally known to me or who has produced 5a_ j pj S ?c1GL7 As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: as idee S llllll' Ovho did take an oath. `NN UtfiiIU►ry NOTARY PUSS - No 4s, 11%. v-11.? Sign: # ._.ir,,„ : !z., My Commission Expires: APPROVED BY ,vfi 9/ '�d'd, "',� 1 co = Print: �' s �a'`�`'s My Commission E'I(9ije hump ►��►`'�\ 5 %.;1.11X3V Sal 114 ► ►nuu ��0-°/ Plans Examiner Zoning Structural Review (Revised 5/2 /2012)(Revised 3 /12 /2012XRevised 07 /10 /07XRevised 06 /10 /2009)(Revised 3/15/09) Clerk Miami, October 26, 2011 Village of Miami Shores Building Department. I Luis Felipe Naranjo, qualifier for The Narsha Group LLC, request to "RELEASE THE HOLD" on any of the permits registered under my license and related with the following address: 1610 NE 105 Street, Miami Shores FI, Owner: Claude Becht CGC1511070 7500 NE 4th Court , Miami FI 33138 Phone (305) 757 -1110 Email: Felipe @narshagroup.com NOTICE OF COMMENCEMENT A RECORDED COPY MUST BE POSTED ON THE JOB SITEAT TIME OF FIRST INSPECTION PERMIT NO. TAX FOUO NO. I/ .Fa34" L'5 0 STATE OF FLORIDA: COUNTY OF MIAMI -DADE: THE UNDERSIGNED hereby gives notice that improvements will be made to certain real property, and in accordance with Chapter 713, Florida Statutes, the following information is provided in this Notice of Commencement. 111111111111111111111111111 1111111111 11111111 CFN 2011R0398484 OR Bk 27725`Fs:44261 (lns) RECORDED 06 /17/2011 13:02:27 HARVEY RtJVIfl. CLERK OF COURT MIAMI-LADE COUNTY, FLORIDA LAST PAGE Space above resented for use of recording office 1. Legal description of property and street/address: 1010 1L% .' /D :S 2. Description of improvement: D:1 7(El — -O (.. 'R tc::› L.(d�G • 3. Owner(s) name and address: CL-1341-7r; /c,ip■ tJ 1F :" "° #-/ A.(2. Interest in property; Name and address of fee simple titleholder: 4. Contractor's name, address and phone number: T = '< y' i,-c e )4S -t4;(L q{ 5. Surety: (Payment bond required 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, Name, address and phone number 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 fs 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 QF 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. Signatture(s) Own_ or Owner(s)' Authorized, Officer /Director/Partner/Manager Prepared By Prepared By Print Name Print Name , Title/Office — Title/Office STATE OF FLORIDA COUNTY OF MIAMI -DADE , The foregoing instrument was acknowledged before me this , % "7 . - day of By individually, or 1: fas sjOkte for Personally known, or Q produced the following type of identffica Signature of Notary Public: Print Name: (SEAL) . ; • Under penalties of perjury,1 declare that i have read the foregoing an that the facts stated in It are true, to the best of my knowledge and belief: Signature(s) of Owner(s) or Owner(s)'s Authorized Officer/Director/Partner/Manager who signed above: By By lar.9eMs in it.!il t., "•.uA_�!•s 1c 74 - CommissiO4.014'8$74� � ov , , a, .Beaded ThreugbNpUgnaINotaPi STATE OF FLORIDA, COUNTY OF DACE I HEREBY C,ERT1FYiifat is a Ow copy tr, rsigiss1 /side, Ace a carHof JUN 1,7.12911 IffiTNESS Y s F and Of S. How � 5 o/f D.C. Miami, October 26, 2011 Village of Miami Shores Building Department eC, 1 — 44_ I Luis Felipe Naranjo, qualifier for The Narsha Group LLC, request to "PUT A HOLD" on any of the permits registered under my license and related with the follovving address: 1610 NE 105 Street, Miami Shores FI, Owner: Claude Becht The reason of that, is because I have Money issues with Mr. Becht and he doesn't allow me to get the final inspections for those permits and denied me the opportunity to get into the property. Mr. Becht is a foreign customer, and he bought the property as a vacation home, he flew back to France without giving us the chance to close the permits since the end of August CGC1511070 7500 NE 4th Court, Miami FI 33138 Phone (305) 757-1110 Email: Felipe@narshagroup.com Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 162477 Permit Number: RC -5 -11 -844 Scheduled Inspection Date: August 08, 2011 Inspector: Bruhn, Norman Owner: BECHT, CLAUDE Job Address: 1610 NE 105 Street A -12 Miami Shores, FL 33138 -2118 Project: <NONE> Contractor: THE NARSHA GROUP, LLC Permit Type: Residential Construction Inspection Type: Drywall Work Classification: Addition /Alteration Phone Number Parcel Number 1122300530120 Phone: (786)222 -1876 Building Department Comments KITCHEN & BATHROOM REMODEL, NEW FLOORS AND SECOND FLOOR, CERAMIC TILE INSTALLATION AND NEW WALL PARTITION 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- 159613. Work covered. NB August 05, 2011 For Inspections please call: (305)762 -4949 Page 19 of 37 JCD ARCHITECT, INC •• 1385 CORAL WAY SU # 407 MIAMI, FL 33145 August 3, 2011 Village of Miami Shores 10050 NE 2nd Avenue Miami Shores, FL 33138 Permit # BL11846 Owner: Claude Becht Address: 1610 N.E. 105 St. Miami Shores, FL 33138 Dear Sirs: A.A. #26001560 "DRYWALL/LATHING CERTIFICATE" TEL. # (305)285 -4343 FAX # (305)285 -4330 The undersigned, Juan C. David RA #15344, Architect of Record for the above Property, certifies herein that having performed an inspection to the above property, I can attest to the best of my knowledge, belief and professional judgment that the drywall/lathing installation is safe and sound. Upon visual inspection of the installed drywall/lathing I could see the drywall screws were type "S" @ 8" O.C. at field and 6" at edges as specified on the attached approved set of plans which can therefore be considered in compliance with the Florida Building Code, and can be approved by the Village of Miami Shores. Should you have any questions or need any additional information please do not hesitate to contact me. Sincerely, R.A. Tel# (786) 443 -6750 Cc/ File Claude Becht FULL ARCHITECTURAL SERVICES cs RESIDENTIAL cis COMMERCIAL cs CUSTOM DESIGN LEED CERTIFICATION JUANCDAVID @JCDARCH ITECT.COM Project Address Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Parcel Number Applicant 1610 NE 105 Street Number: A -12 Miami Shores, FL 33138 -2118 1122300530120 Block: Lot: CLAUDE BECHT Owner Information Address Phone Cell 1 CLAUDE BECHT 1610 NE 105 Street MIAMI SHORES FL 33138 -2118 1 1610 NE 105 Street MIAMI SHORES FL 33138 -2118 Contractor(s) THE NARSHA GROUP, LLC Phone CeII Phone (786)222 -1876 Valuation: Total Sq Feet: $ 15,000.00 0 1 Approved: In Review Comments: Date Approved:: In Review Date Denied: Type of Construction: INTERIOR REMODEL Stories: Front Setback: Left Setback: Bedrooms: Plans Submitted: Yes 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 Work without Permit Fee Total: Amount $9.00 $6.75 $6.75 $3.00 $450.00 $18.00 $12.00 $450.00 $955.50 Pay Date Pay Type Invoice # RC -5 -11 -40902 06/21/2011 Check #: 1070 05/11/2011 Credit Card Amt Paid Amt Due $ 905.50 $ 50.00 $ 50.00 $ 0.00 Available Inspections: Inspection Type: Final PE Certification Drywall Miscellaneous Window Door Attachment Tie Beam Final Framing Insulation Truss lnsp Columns Foundation Window and Door Buck Fill Cells Columns Wire Lathe Declaration of Use F. Termite Letter F. Elevation Certificate 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. June 21, 2011 Authorized Signature: Owner / Applicant / Contractor / Agent Building Department Copy Date June 21, 2011 1 Miami Shores Viiiage Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 RECEIPT PERMIT #: �-- �? 11-1 DATE: o7 17/ 1, -feA lI- ry 6 $Contractor ❑ Owner ❑ Architect f Picked �p 2 sets •f plans and (other) H S Address: From the building department on this date in order to have corrections done to plans And /or get County stamps. I unders - • gat the plans need to be brought back to Miami Shores Village Building Departme t to •�- itting process. Acknowledged by: PERMIT CLERK INITIAL: RESUBMITTED DATE: PERMIT CLERK INITIAL:L� Permit No: 11 -844 Job Name: May 13, 2011 Miami Shores Village Building Department Building Critique Sheet 1) Plans must be approved by Miami dade DERM. 2) Plans must be approved by HRS for the septic system. 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 doa complete plan review. If any sheets are voided, remove them from the plans and replace with new revised sheets and include one set of voided sheets in the re- submittal drawings. Norman Bruhn CBO 305- 795 -2204 Miami Shores 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 r,• f Permit No. BUILDING PERMIT APPLICATION FBC 20 Master Permit No. Permit T e: BUILDING = ROOFING OWNER: Name (Fee Simple Titleholder): C(a teke le' Phone#: 415 �� d Address: AG, t, /J 16 City: Am( sole, State: Zip: Tenant/Lessee Name: Phone #: _ Mme _ s Email: ita/ f aeCVO Uttlti e -( JOB ADDRESS: AGt,Q City: Miami Shores County: Miami Dade Zip: Folio/Parcel #: Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name: Address: 648 �7hON City: Nl+awi► 1-9411, Qualifier Name: tan t State Certification or Registration #: (1BB)222 DESIGNER: Architect/Engineer: Contact Phone #: filar s lui Ct 1VL41 JC 4 Coz, Phone #: t.'lisc) 7 ZZ IB 1C State: - Zip: 3313) Po h n Phone #: tie() 21.1811 C.4id1J" I to IO Certificate of Competency #: 1614 Email Address: f tift6) lAart1►AQJj reel � C,0 JOCM C.. David cJ j Phone#: (i ) 44 3 C) T Value of Work for this Permit: $ 1 51'3'°° Type of Work: DAddition UAlter ?tion Description of Work: P 4z, i° Of e)4151101 GVo®4 66rt� Q.1 - &'ovtd . .DoT voU) $/ Tar -it -Pon L Qr& tt tt Square/Linear Footage of Work: UNew epair/Replace dDemolition r-14, AA a wi l rntln mows tc>k r ,14 f :Wu) 4V . U�a�� w�wa�. c,� -►ru, ice ., ►� * * * * * * * * * * * * * * * * ** * * *** :************** Fees*** *******a: *m **+ x******* ** *** ********+x **** *** av Permit Fee $ � CCF $ CO/CC $ Radon Fee $ DBPR $ Bond $ No Training/Education Fee $ Technology Fee $ Structural Review $ Submittal Fee $ Scanning Fee $ TOTAL FEE NOW DUE $ 9 sr) B B C M M Ci Ar co] col WI O1 apl «` 0 Ili F] R No prc --!* P — for for _ _ _ ..... w. .,c,tirr 1/1 uuya after me matting perrnn w waueu. inspection will not be approved and a reinspection fee will be charged. 1- 2 W a z 5 re 0 0 • z 0 J RESUBMIT W cc 2 1 cc a z 0 Owner or Agent The foregoing instrument was acknowledged bef a me this 1® day of 114°A , 20 II , by GLaU014 eC 1-It who is personally: known.to me or who has produced As identifica n and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commission Expires: APPROVED BY • lr Signature [rt ec - uucrc Aid - i or it installation has I laws regulating MBING, SIGNS, mpliance with all 1TICE OF CE FOR OBTAIN BEFORE e applicant must •ed to the person ed at the job site posted notice, the The foregoing instrument was acknowledged before me this C O day of PI 1 20 I 'I YutJ who is personally known to me or who h produced as identification . • d ho did take an oath. NOTARY PUBLIC: Sign: Print: My Commission Expires: ******************* **, x** ****** *,x*,x****+x*x:*************** a:* ********x:*m,xx:** **** *** .�/ Plans Examiner Zoning Structural Review Clerk (Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09) .4, CERTIFICATE OF LIABILITY INSURANCE >�►TE(eAteroDiYYYt) 05117/11 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 WSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: B the certificate holder is an ADDITIONAL INSURED, the Po y(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the toms and conditions of the policy, certain policies may raqufre an endorsement. A statement on thls certificate does not confer fights to the certtticate holder In lieu of such endorsement(s). PRODUCER USA Genera] Insurance/USA !nett/mice Agency 5841 S.W. 137th Ave. Muni, FL 33183 Phone (305) 386 -3305 Fax (305) 388.6778 N Nor. riAN j l- - -tee• :,∎ ", ... CUSTOMER ID It INSURER(0) AFFORDING CAE NA1G# INSURED The Narsha Group L L C 848 Briciceil Avenue #802 Miami, FL 33131 INSURE! A: Accident Insurance Company AGL9000409 INS B :. 08/04/2011 utsuseR C: $ 1,000,000 INSURER D: s 100,000 INSURER E : IVIED EXP (Any one Pte) INSURERF: PERSONAL & ADV INJURY COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THiS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAKED 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 13 SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAO CLAIMS. r o- LTR TYPE OP INSURANCE W ,i INSR -31,: -. 1 POLICYNUMl ER • , �r WMttDDIYYYYL l- - -tee• :,∎ ", ... LIMITS A GENERAL LIABILITY ® COMMERCIAL GENERAL. UABIUW AGL9000409 08/0412010 08/04/2011 EACH OCCURRENCE $ 1,000,000 DAMAGE RENTED PREMISES T ) s 100,000 ❑ ❑ CLAMS -MADE n OCCUR ❑ IVIED EXP (Any one Pte) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 ❑ GENERAL AGGREGATE $ 2000,000 GENT AGGREGATE LIMIT APPLIES PER: ❑ POLICY ❑ • LOC PRODUCTS - COMP1OP AGG $ 2.000,000 $ AUTOMOBILE UABIUTY ❑ ANY AUTO COMI3INED SINGLE LMIT (Ea accident) $ BODILY INJURY (Per Person) $ • ALL OWNED AUTOS BODILY INJURY (Per accident) $ ❑ SCHEDULED AU TICS $ • HIRED AUTOS ❑ NON-OWNED AUTOS ❑ a�enij GE $ $ • UMBRELLA A UAB ❑ OCCUR • EXCESS LIAR ❑ C:LAMS-MADE EACH OCCURRENCE AGGREGATE $ ❑ DEDUCTIBLE ❑ RETENTION $ $ WORKERS COMPENSATON AND EMPLOYERS' UABILITY N I A ❑ T STATUU -S ❑ OTH- ER E.L. EACH ACCIDENT $ ANY �IYI I i E.L. DISEASE -EA EMPLOYE $ (Mandatory In NH) DESCRIPTION OFOF OPERATIONS below E.L. DISEASE- POLICY LMiT S DESCRIPTION OF OPERATIONS/ LOCATIONS /VEHICLES (Atach ACORD 101. Addhiona) Remarks SoiredWe, Emare space Is required) General Contractor CERTIFICATE HOLDER CANCELLATION Miami Shores Wage Building Dept. 10050 N.E. 2nd Avenue Miami Shores, FL 33138 SHOULD ANY OF TIE ABOVE DESCRY POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WiTH THE POLICY PROVISIONS., AUTHORIZED ACORD 26 (2008/0 QF CORPORATION. All rights reserved. The ACORD name are registered marks of ACORD W. FLAT R.00R: III, PL .3. L BUSINESS TAX RECEIPT E C{# INTi� ST T OF FLORIDA FSHM SEE OTHER SIDE DO NOT FORWARD MARSHA GROUP LLC THE LUIS FELIPE NARANJO MGR 848 BRICKELL AVE 602 MIAMI FL 33131 18 CERTIFICATE OF LIABILITY INSURANCE Date 1 6/172011 Producer: Lion Insurance Company 2739 U.S. Highway 19 N. Holiday, FL 34691 (727) 938 -5562 This Certificate Is rued as a matter of Information only and confers no rights upon the Certificate Holder. This Certificate does not amend, extend or alter the coverage afforded by the policies below. Insurers Affording Coverage NAIL • Insured: South East Employee Leasing Services, Inc. 2739 U.S. Highway 19 N. Holiday, FL 34691 Insurer A: Lion Instrrartmtomparty L1075 Insurer B: Insurer C. Insurer D: Insurer E: Coverages The potties of insurance fisted below have been issued to the insured named above for the potty period-indicated. Notwithstanding any requirement, term or concfrbon of any contact or other document with respect to which this certificate may be issued or may pertain, the insurance afforded by the potties described herein is subject to at the terms, exclusions, and conditions of such potties. Aggregate emits shown may have been reduced by paid claims. INSR LTR ADDL INSRD Type of Insurance Policy Number Policy Effective Date (MM/DD/YY) Policy Expiration Date (MM/DD/YY) Limits GENERAL LIABILITY Commercial General Liability Claims Made 0 Occur I, Each Occurrence $ Damage to rented premises (EA occurrence) $ Med D $ Personal Adv Injury $ General aggregate Emit applies per: DPotcy ❑ Project ❑ LOC General Aggregate $ Products - ConcfOpAgg $ AUTOMOBILE — LIABILITY Any Auto At Owned Autos Schedtied Autos Mred Autos Non-Owned Autos Combined Single Limit (EA Accident) $ BodiY k$urY (Par Person) $ Booty frurY (Per Accident) $ Property Damage (Per Accident) $ EXCESS /UMBRELLA LIABILITY IOccur ❑ Claims Made Deducible Each Occurrence Aggregate A Workers Compensation and Employers' Liability Any proprietor/partnerlexecutIve officer/member excluded? If Yes, describe under spacial provisions below. WC 71949 01/01/2011 01/01/2012 X 1 WC ry L 1 ani- 1 ER E.L. Each Accident $1,000,000 E.L. Disease - Ea Employee $1,000,000 E.L. Disease - Policy Limes $1,000,000 Other Lion Insurance Company ie A.M. Best Company rated A- (Excellent). AM B # 12616 Descriptions of Operations /LocationsNehicles/Exciusions added by EndorsementlSpecial Provisions: Client ID: 80- 65-984 Coverage only applies to active employee(s) of South East Employee Leasing Services, Inc. that are leased to the following "Client Company": The Narsha Group, LLC Coverage only applies to injuries incurred by South East Employee Leasing Services, Inc. active employee(s) , while working in Florida. Coverage does not apply to statutory employee(s) or independent contractor(s) of the Client Company or any other entity. A list of the active employee(s) leased to the Client Company can be obtained by faxing a request to (727) 937 -2138 or by calling (727) 938 -5562. Project Name: FAX 786- 866 -6455 / ISSUE 05 -09-11 (TD) / REISSUE 06 -17 -11 (TD) Begin Date: 1/21/2011 CERTIFICATE HOLDER CANCELLATION VILLAGE OF MIAMI SHORES BUILIDNG DEPARTMENT 10050 NE 2ND AVENUE MIAMI SHORES, FL 33138 Should any of the above described potcies be canceled before the expiration date thereof, the issuing insurer will endeavor to mail 30 days written notice to the certificate holder named to the left, but failure to do so shall impose no obfgaion or tabihty of any land upon the insurer, its agents or representatives. "l i fr STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487 -1395 1940 NORTH MONROE STREET TALLAHASSEE FL 32399 -0783 NARANJO LUIS FELIPE THE NARhEA GROUP, LLC 848 BRICKELL AVENUE SUITE 3 60 2 Congratulations! With this license you become one of the nearly one million Floridians licensed by the Department of Susiness 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.rnyltoridancense.com. There you can find more information about our divisions and the regulations that impact you, subscribe to department newsletters and team 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 t'n2_JD1 loo cc0-90- NOT: ALL SHEET MUST BE REVIEWED MIAMI -DADE COUNTY BUILDING AND NEIGHBORHOOD COMPLIANCE DEPARTMENT Herbert S. Saffir Permitting and Inspection Center 11805 SW 26th Street (Coral Way) • Miami, Florida 33175 -2474 • (786) 315 -2100 APPLICATION FOR MUNICIPAL PERMIT APPLICANTS THAT REQUIRE PLAN REVIEW FROM MIAMI -DADE FIRE RESCUE AND /OR DEPARMENT OF ENVIRONMENTAL RESOURCES MANAGEMENT PROVIDE MUNICIPAL PROCESS NUMBER HERE LOCATION OF IMPROVEMENTS Job Address pia )V& ��`rsr Loin( v*41 t m CONTRACTOR INFORMATION Contractor No. CG /5/1070 Last four (4) digits of Qualifier No. L qpg � Folio ' f 3 3C) - 053 " 01 0 Contractor Name i(J$ LMd 6 /vp 4' ,, Lot Block Qualifier Name .S 1 �Jid 0 _ ®' Subdivision PBpg Address 81eiC(Ct /( /\1/E £ C Metes and bounds City jr-1J ( 014( State Zip S3 if 3 TYPE OF IMPROVEMENTS [ 1 New Construction on Vacant Land Alteration Interior [ Alteration Exterior [ ] Relocation of Structure [ ] Enclosure [ ] Repair [ ] Repair Due to Fire [ ] Demolish [ ] Shell Only [ ] Addition Attached [ ] Addition Detached [ ] Re -Roof [ ] Foundation Only [ 1 Tent Current use of property / L Description of Work./114 -e &' k `11A25 �j Sq. Ft. Units Floors Value of Work /- 7G 7 PERMIT TYPE [MBLD* Category 0 REVIEW STATUS [ ] Chg. Contractor [ ] Re -Issue [ ] Re -Stamp [ ] Revision [ ] Not Applicable for Fire OWNER'S NAME Owner Address City State [ ] MELE [ ] MLPG _Zip Phone Last four (4) digits of Owner's Social Security No. [ ] MMEC [ ] FIRES PERSON TO PICK UP PLANS MName A1-W Pr u t L M ARCHITECT / ENGINEER Owner Address Address 115S7? J .3 £ City State / City ( /d'�(1/�( State& Zip 33 i0 ( _Zip Phone Phone FIRE SPECIAL REQUEST PLAN REVIEW (SRI) I am requesting a Special Request Plan Review (SRI) to be scheduled as soon as possible at the rate of $190 for the first hour and $65 per each additional hour in addition to the review fees. Minimum charge one -hour. 1st Request: Date: 2"d Request: Date: 3rd Request: Date: GERM OPTIONAL PLAN REVIEW (OPR) I am requesting Optional Plan Review (OPR) to be scheduled as soon as possible at the rate of $75 for each discipline. Additional review fees may apply. 1 st Request: Date: 2nd Request: Date: 3rd Request: Date: 123_01-192 6/10 BUILDING PERMIT CATEGORIES CATEGORY DESCRIPTION PERMIT TYPE BUILDING 01 GENERAL BUILDING - COMMERCIAL MBLD 02 SUB - GENERAL BUILDING - RESIDENTIAL MBLD 08 CANVAS AWNING MBLD 10 COMMUNICATION TOWER MBLD 15 DEMOLITION MBLD 29 METAL AWNING & STORM SHUTTER MBLD 48 SCREEN ENCLOSURES MBLD 55 SWIMMING POOL MBLD 56 TENNIS COURTS (SURFACE PAVING) MBLD 86 TRAILER TIE DOWN MBLD 88 WALK -IN COOLER MBLD 91 MARINAS MBLD 92 LOW SLOPE APPLICATIONS (GRAVEL, SMOOTH MODIFIED, SINGLE PLY) MBLD 95 SHINGLES (ASPHALT, FIBERGLASS) MBLD 96 SHINGLES (METAL ROOFS/WOOD SHINGLES & SHAKE) MBLD 97 STAGE 2 VAPOR RECOVERY SYSTEM MBLD 99 SOIL IMPROVEMENT MBLD 0100 BULK STORAGE PROPANE TANK MBLD 0101 REMOVABLE STORM PANELS MBLD 0107 TILE ROOF MBLD 0110 WATER MAIN MBLD 0111 SITE PLAN MBLD 0112 INDOOR EVENT /EXHIBIT MBLD ELECTRICAL 04 FIRE ALARM SPECIALTY MELE 16 SPECIALTY WIRING MELE 38 GENERATORS MELE LPGX 01 LIQUEFIED PETROLEUM GAS MLPG 02 MISCELLANEOUS MLPG 04 LIQUEFIED PETROL. GAS /STATE MLPG MECHANICAL 09 ABOVE/BELOW GROUND TANKS/PUMPS & POLLUTANT STORAGE SYSTEM MMEC 38 COMMERCIAL HOODS MMEC 43 FIRE CHEMICAL MMEC 46 SPRAY BOOTHS MMEC 48 SMOKE CONTROL MMEC 52 RESIDENTIAL ELEVATOR MMEC FIRE 32 FIRE SPRINKLER FIRE Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 159633 Permit Number: EL -5 -11 -845 Scheduled Inspection Date: August 08, 2011 Inspector: Devaney, Michael Owner: BECHT, CLAUDE Job Address: 1610 NE 105 Street A -12 Miami Shores, FL 33138 -2118 Project: <NONE> Contractor: FIALLO ELECTRIC CORP Permit Type: Electrical - Residential Inspection Type: Final Work Classification: Addition /Alteration Phone Number Parcel Number 1122300530120 Phone: (786)399 -0832 Building Department Comments ELECTRICAL WORK FOR INTERIOR REMODEL Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments "00. 4/or August 05, 2011 For Inspections please call: (305)762 -4949 Page 5 of 37 1 1 Project Address Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Parcel Number Applicant 1610 NE 105 Street Number: A -12 Miami Shores, FL 33138 -2118 1122300530120 Block: Lot: CLAUDE BECHT Owner information Address Phone Cell CLAUDE BECHT 1610 NE 105 Street MIAMI SHORES FL 33138 -2118 1610 NE 105 Street MIAMI SHORES FL 33138 -2118 Contractor(s) FIALLO ELECTRIC CORP Phone (786)399 -0832 Cell Phone Valuation: Total Sq Feet: $ 2,500.00 0 1 Type of Work: ELECTRICAL Additional Info: INTERIOR REMODEL Classification: Residential Scanning: 3 Fees Due CCF DBPR Fee DCA Fee Education Surcharge Permit Fee - Additions/Alterations Scanning Fee Technology Fee Work without Permit Fee Total: Amount $1.80 $2.25 $2.25 $0.60 $150.00 $9.00 $2.40 $150.00 $318.30 Pay Date Pay Type Invoice # EL -5-11 -40903 06/21/2011 Check #: 268.30 05/11/2011 Credit Card Amt Paid Amt Due $ 268.30 $ 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. June 21, 2011 Authorized Signature: Owner / Applicant / Contractor / Agent Building Department Copy Date June 21, 2011 1 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.1 Master Permit No. Permit Type: Electrical OWNER: Name (Fee Simple Titleholder): C (_AVM N� Phone #: Address: 1 tP t C, I J E- ko \ City: M I Awl ( S AC, f? r, State: 00. Zip: Tenant/Lessee Name: Phone#: Email: JOB ADDRESS: (P 10 NI E 1 D S- S 1 P y2._ City: Miami Shores County: Miami Dade Zip: Folio/Parcel #: /1 -2.2 3o -0S3 - v I a o Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name: i'( P [ 10 F( ,,T, Fig g' G Cc el') Phone #: 786 3 7 f 9 3 I Address: 7 0 c 5- S t / 7 ! '�'r', 6 City: fy / AHi' State: Zip: 3 3 )6-6 Qualifier Name: L, /4 A 3° A 1 AS Phone #: 7 86 3? 0 ii D A), State Certification or Registration #: E C 6 ®c 31 & 3 Certificate of Competency #: Contact Phone #: Email Address: DESIGNER: Architect/Engineer: Phone#: Value of Work for this Permit: $ 4 -000 Square/Linear Footage of Work: Type of Work: DAddress liAlteration ONew ; 1Repa /Replace ODemolition Description of Work: D\J IL (`-C- H E t 3 ttA (f HAT tk ut_- ` ` 5 I z- . ******** ****** * ******** ***** ** * **** **** Fees************* ** ************ *** * ** * * ***** * *** Submittal Fee $ Permit Fee $ CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ Technology Fee $ TOTAL FEE NOW DUE $ 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 MR 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 1/ day of , 20 // , by who is personally known to me or who has produced As identification and who did take an oath. NOTARY PUB IC. , uu,, ) WAYNE SLAVENS .4-11 ---, .4, Notary Public -Slate of Florida Sign: ± !,v, • _ My Commission Expires Jul 22, 2011 T., e ° iasio iY DO 88748t .l Print: i latiriafitatary Signature v„„,,N' ()la}, Contractor The foregoing instrument was acknowledged before me this day of ,20 f J,by L-ti5 N. 9 p %A3, who is personally own to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: vtELgZQG itupi//f S q�•• -. • Sign: Print: • r • My Com ssion-Expires: My Commissi �F�d'A T *:x**:x****: ****** ***** *** *****: x* **:x****:x**x:******m*:xx **** ************* **: x**** x:** iagiJ11N11ot*****:x***:x*a:** ***** 2 e, /7 APPROVED BY � .9/2 / ,reefr'e-Plans Examiner Zoning Structural Review Clerk (Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09) STATE OF FLORIDA DEPARTEKINT..OF MIMS AND PROFESSIONAL IGIGULATION macrucem CONTRACTORS LICENSING BOARD intaligeORROR STRET32399.0783 4. -t• LUIS ANDRES W K 88 J AELECTRIC CORP NTE FL 33%65-7847 ..•••••■•■• =dont liVith this Howe you become one oldie one million liosneed by the Department of Busineee and Pmteuhbnat Regulatioit fur profesebnals and businesses range from Grahlies* to yacht learn, flom =re to hatheque re0autarda, end they keep Florida's economy dr** Every day we work to Irnpnwe the way we do business in order ID nerve you better 1 Icy irdormetion about our services,. Peon ho onto wwviaksittallwriseicaM Mere you am find more information about our divisions the regulations that mead you subscribe to deparbnent newsletter* and team mom about the initiatives. Our mission at the Department la: Mmes 6:Warty, Regulate Fans. We constantly strive to serve you better no that von can serve your cashews. Thar* you for doing business in Florida, and congratulations on your new 11000001 (850) 487-1395 DETACH HERE undar the provisbillii.:61 c.489 n WO 33., 203,2. 01211)1153 Tit• ELECTRIC.AL: CONTRA •Named .beitsw• : =Tin Uhder• the prOvieicine a Expiration datel*AUG 3 • • SA4A61' 14Uti3 ANDRES 11-4,11141mVral 025 0W.17 %TERRACE MIAMI ' -489 BIN •* 155 • L !.‘k.12.4;• ZE LIEN: I FlAtIO 14 J ELECTRIC CORP 1 Sea TAN* of WORKERS ,Im a AA CTRICAL CONTRACTOR 1 Are CIF 0O ROT FORWARD Non nouns EZIoula NiANSDADE COUNTY TAX COLLECTOR 14 W. RA i1A 0, FL 33130 LOCAL MAWS TAX RECEIPT 2011 muiamor cowry - STATE OF FLORIDA ENVIES SEM 30, 2011 - RUST BE DISPLAYED AT PLACE OF RUSINIAIS PUi$C1ANTTO COUNTY CODE CHAPTER OA - ART. S 10 THIS IS NOT A SILL — DO NOT PAY U.S. pasrACE PAW MINT N0.231 ' RECEIPT INSINESS NAM/ LOC 696320 -0 FIALLO 14 J ELECTRIC CORP STATE* EC0003163 7025 SW 17 1ERR 33155 UNIN DADE COUNTY 600200239 60$075.00 SEE Q0fER S FIALLO M J ELECTRIC CORP ROBER1D FIALLO PRES 7025 SW 17 TERR MIAMI FL 33155 b,3J,1r% ae3 ea sa :aaa511e01103ea1:t ►altr��ss Jun.20. 2011 11 :54AM No.0229 1/1 �--- - CERTIFICATE OF LIABILITY INSURANCE °A'�`MM/°°"""' 0620/11 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: lithe certificate holder Is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in Ileu of such endorsement(s). PRODUCER Florida Bankers Insurance 7278 SW 8 Street Miami, FL 33144 Phone (305)266 -6493 Fax (305)262 -0679 CONTACT NAME: MARTAALONSO PHONE uvc. No. Ext): (305) 266 -6493- 1 FAx (A/c, No): (305) 262 -0679 E -MAIL ADDRESS: martaf )floridabankersinsurance.COm PRODUCER CUSTOMER ID INSURER(S) AFFORDING COVERAGE NAIC e INSURED Hallo M.J. Electric Corp. 7025 SW 17 Terr MIAMI, FL 33155- (786) 389 -7152 INSURERA: AMERICAN VEHICLE INSURANCE COMPANY GL- 0504004673 -01 INSURER B : 04/182012 INSURER C : $ INSURER D : PREMISES (Ea oco occurrence) INSURER E : 100.000.00 INSURER F : MED EXP (Any one person) CERTIFICATE 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. NOTWITHSTAND ING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BYTHE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAYHAVE BEEN REDUCED BY PAID CLAIMS. �Ny�EXCLUSIONSAND LTR TYPE OF INSURANCE AD DL INSR SUER WVD POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EE�(�P (MM/DD/YYYY) LIMITS A GENERAL LIABILITY '►J COMMERCIAL GENERAL LIABILITY GL- 0504004673 -01 04/18/2011 04/182012 EACH OCCURRENCE $ 1,000.000.00 PREMISES (Ea oco occurrence) $ 100.000.00 • • CLAIMS -MADE A OCCUR MED EXP (Any one person) $ 5.000.00 PERSONAL & ADV INJURY $ 1,00.000.00 • GENERAL AGGREGATE $ 2,000.000.00 GEN'L AGGREGATE UMIT APPLIES PER PRODUCTS - COMP /OP AGG $ 2,000.000.00 POUCY JET • LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE UMIT (Ea accident) $ 1111 ANY AUTO BODILY INJURY (Per person) $ III ALL OWNED AUTOS • SCHEDULED AUTOS • HIRED AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ • NON -OWNED AUTOS $ $ M • UMBRELLA LIAB • OCCUR EACH OCCURRENCE $ • EXCESS LIAB • CLAIMS•MADE AGGREGATE $ MI DEDUCTIBLE • RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N N I A I-1 WC STATU- �-7 OTH- I I TORY LIMITS I I ER ANY PPROPRIETOR/PARTNER/EXECUTIVE R IM E.L. EACH ACCIDENT $ (Mandatory In NH) If yes, describe unde DESCRIPTION OF OPERATIONS below E.L. DISEASE - EA EMPLOYE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES CtFRTIFICATR Ynr nen (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) - ------ _ _ —__ CITY OF MIAMI SHORES 10050 NE 2AVE MIAMI SHORES, FL 33138 1305-756-8972 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25 (2009/09) QF ©1988 -2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 03 -04 -2010 ALEX SINK STATE OF FLORIDA CHIEF FINANCIAL OFFICER DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION * * CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law. EFFECTIVE DATE: PERSON: 03/04/2010 EXPIRATION DATE; 03/03/2012 SALAS FEIN: 204232837 BUSINESS NAME AND ADDRESS: FIALLO M J ELECTRIC CORP 70213 SW 17 TERRACE MMANI FL 331E8 SCOPES OF BUSINEESS OR TRADE: 1- ELECTRICAL CONTRACTOR LUIS A IMPORTANT: Pursaaht to Chapter 440 . 061141, F.S., an shiver oI a corporeeoa who elects exemption treat (Ate eitepter try titian a certlitcata et eitiction Wider la MI5 rha secllod Amy net recover hehaiits er compensation under this chapter. Pursued to Chapter 440.0611E1, F.S., Cerilfleetes el election to Mt sxampt... +Pp Y Y scope et the business or trade lilted on the notice 01 etectb5 to be exempt. Pursuant 10 Chwpter 440.UMt61. F.5., Notices Of elective to be eeetnllt end cerliltcatae of eleuian to be moot obeli be subtext to revocation It, el any thne altar the nag of the settee at the issuance o1 the certttkcete, the person name4 oa the mites ar rn /Elcata AO lan¢at meats the rngcirements of this section tat issasnte ale cerlticete. The deparlmept shin revakv a earOliesta et nay time tar lettere al the 1650) 413 ^11 nomad en the eestinule to meet the requirements of this saellun OWC -262 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 09-08 PLEASE CUT OUT THE CARD BEI,OW AND RETAIN FOR FUTURE REFERENCE STATE OF FLORIDA DEPARTMENT OF FINANCIAL. ¥FRVIOES IV SON WORK E S' CoMTEENSATI0N CERTIFICATE 8' OMPENSATION TO Aw EXEMPT FROM FLORIDA EPPI"CTNE 03/04/2010 PERSON: LUIS A SALAS FEIN: 204232837 BUSINESS NAME AND ADDRESS: PIALLO M 4 ELECTRic CORP 7025 sw 17 TERRACE mean, FL 83 155 EXPIRATION DATE: 03/03/2012 SCOPE OF BUSINESS OR TRADE 1. 0.ECTRICt1L CONTRACTOR IMPORTANT F Pursuant to Chapter 440.05114h F.S., an officer of a carparation Wba O elects exemption from this chapter by filing a certificate of election I- under this Section may not recover benefits or compensation under this D chapter. Pursuant to Chapter 440.05(12), F.S., Certificates of election to be exempt.. apply only within the toape a the business or trade listed on the notice of election to be exempt. Pursuant to Chapter 440.05(13), F.S., Notices of election to be exempt and certificates of election to be exempt shall be sub)eet t0 revocation H, at any time after the filing of the notice or the issuance of the certificate, the person nemed on the notice or certificate no longer me the requirements of this set tiOrt for issuance ine foycertificate. the department shall revoke a pertificate at any person named en the certificate to meet the requirements of this section. QUESTIONS? (550) 413 -160 E R E CUT HERE * Carry bottom portion on the job, keep upper portion for your records. DWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 09-06 C00 f(3j %V3 Se :CT TTOV%Z /CO e _ , Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 7952204 Fax (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 BUILDING PERMIT APPLICATION FBC 20 Permit No. Master Permit No � 1775 MAY 1 1 2011 Permit Type: Electrical OWNER: Name (Fee Simple Titleholder): C, I Ct U e, e okt Phone#: 0;3 Lgo c so 68S Address: k 6 tO 1(Q- t ©J TT City: . ha vim S koYt' State: Zip: Tenant/Lessee Name: Phone*: Email. JOB ADDRESS: 10 14 t [Or sr. City: Miami Shores County Folio/Parcel #: Miami Dade Zip: Is the Building Historically Designated: Yes CONTRACTOR: Company Name: 1 Address: $ OO . (40 Et, s3 NO Flood Zone: eCs.t.gC 01101d ��rdt j Phone#: (30r) (794z4-, +.. City: i\la rt In t.I ict it i ,.Y zip: 33 l Qualifier Name: Ft e. old 1 c1 Phone#: t 32 J) 7 q4 l4 o4 State Certification or Registration #: ta- C-' £ 300 LC XI • - rtificate of Competency #: Contact Phone#: F.mail Address: DESIGNER: Architect /Engineer: Phone#: Value of Work for this Permit: $ ` P° Square/Linear F e of Work: Type of Work: ❑Address CIAlteration ONew ! Repair/Replace ElDemolition Description of Work: New IGt+C.PM NA440 d e (t v u� i4 ec.t '�, t In u I'S [ 191► kS tin a Fo u � -Kte VtGOS� J �1 **** ** ayes ss *ssssse ***************,ts,arwF ss s+*srs*****s** **** **** * ******e+* *e Submittal Fee $ Permit Fee $ /5:0 119 P CCF $ CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Training/Education Fee $ Technology Fee $ Structural Review $ 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 big pernrit with an estimated value exceerfing $2500, the apprscant must promise in good faith that a copy of the notice of commencement and construction lien law bmocluwe will be delivered to the person whose properly is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the j site for the first inspection which occurs seven (7) days after the burg permit is issue& In the absence of such poet notice, the inspection will not be approved and a reinspection fee will be charged Signature ® Owner or Agent The fo ping instrument was admowledgc dbefore me this _ The f.. _ ,' � was acknowledged before nn this 10 day of , 201 \ , by L..LOVIL e-ICHT, day of H 011 .20 i t , by -Tie dd 1 & o j" , who is personally known to me or who has produced erf1 who is personally known to r . • ho has produced ______________As identification and Ik=la rrr 4 NOTARY PUBLIC: ��` Q�`'' 06/20`12 xp ii//p�Oi� �''�� NOTARY P Sign:" / 111 P - Sign: Print i'� DD I ' Print: My Commission My Commission Expires: Structural Review Clerk (Revised 07 /10 /07)Revised 06/10/2009)(Revised 3/15/09) 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 No. RA l� PERMIT APPLICATION Master Permit No. FBC 20 Permit Type: PLUMBING /� OWNER: Name (Fee Simple Titleholder): C L A v ®F V 6- C y T- Phone #: Address: t C0 i CD /U City: Kilt -0/ l 006 - s State: —F-LC)/2(J Zip: Tenant/Lessee Name: Phone #: Email: JOB ADDRESS: 1 6) 0 Ai E. IOC A City: Miami Shores County: Miami Dade Zip: Folio/Parcel #: / / a a 30 053 01,70 Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name: EL mM. PLI._JIJ9 Phone #: 36 I-- 2Cf -3 ci V2 Address: Li / 5--(f 5 C.ti 7 ,c v4 AC City: V' V� 1 ^State: F(. Zip: 3 2 / 73 n Qualifier Name: � V ► 3 F I �. 0 V /Z 1g uee2_ Phone #: State Certification or Registration #: 2 F o 0 3'%- 2- 0 la Certificate of Competency #: 1900 0 r7 g's-S- G Contact Phone #: Email Address: DESIGNER: Architect/Engineer: Phone#: Value of Work for this Permit: $ Square/LinearFootage of Work: Type of Work: ❑Address `Alteration ❑New ORepair/Replace C1Demolition Description of Work: kE)rtiNDW Bums ************* * * *** **x:**+x*x:+x****m**x * ** Fees* ***** *** ********** * ***:x******** * ***x:**** nix* Submittal Fee $ Permit Fee $ stAr CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name (if 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 is ed. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature Signature Owner or Agent Con i tor The foregoing instrument was acknowledged before me this // The foregoing instrument was acknow • ged before me this / / day of !t'lLit Y , 20 % (, by , day of f1,1 " 7' , 20 1( , by 1i `3 who is personally known to me or who has produced who is persona11 own to me or who has produced As identification and who did take an oath. as identification and who did take an oath. NOTARY PUBL Sign: Print: My Co ss WAYNE SLAVENS ' 4? Notary Public - State of Florida rn - -,4,1.--.11,4„.4?„ o 7/'oF fl.`p. Bonded Through National Notary ' • Sign: Print: My Commissio ......................................................................... 4: APPROVED BY (Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09) Plans Examiner Structural Review Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 YM Inspection Number: INSP- 159638 Permit Number: PL -5 -11 -846 Scheduled Inspection Date: July 22, 2011 Inspector: Hernandez, Rafael Owner: BECHT, CLAUDE Job Address: 1610 NE 105 Street A -12 Miami Shores, FL 33138 -2118 Project <NONE> Contractor: NELMAR PLUMBING INC Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Addition /Alteration Phone Number Parcel Number 1122300530120 Phone: (305) 261 -3942 Building Department Comments PLUMBING WORK FOR BATHROOM REMODEL Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments July 21, 2011 For Inspections please call: (305)762=4949 Page 4 of 9 1 Project Address Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Parcel Number Applicant 1610 NE 105 Street Number: A -12 Miami Shores, FL 33138 -2118 1122300530120 Block: Lot CLAUDE BECHT 1610 NE 105 Street MIAMI SHORES FL 33138 -2118 1610 NE 105 Street MIAMI SHORES FL 33138 -2118 Contractor(s) NELMAR PLUMBING INC Phone CeII Phone (305) 261 -3942 Valuation: Total Sq Feet: $ 1,500.00 0 1 Type of Work: PLUMBING Type of Piping: INTERIOR REMODEL Additional Info: Bond Retum : Classification: Residential Scanning: 2 Fees Due CCF DBPR Fee DCA Fee Education Surcharge Permit Fee Scanning Fee Technology Fee Work without Permit Fee Total: Amount $1.20 $3.37 $3.37 $0.40 $225.00 $6.00 $1.60 $225.00 $465.94 Pay Date Pay Type Invoice # PL -5-11 -40904 05/11/2011 Credit Card 06/21/2011 Check #: 1070 Amt Paid Amt Due $ 50.00 $ 415.94 $ 415.94 $ 0.00 Available Inspections: Inspection Type: Top Out Final Underground 1 In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Futhermore, I authorize the above -named contractor to do the work stated. June 21, 2011 Authorized Signature: Owner / Applicant / Contractor / Agent Building Department Copy Date June 21, 2011 1 w Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax (305) 756.2 INSPECTION'S PHONE NUMBER: (M$) 762.4949 BUILDING PERMIT APPLICATION FBC20 MAI 1 1 2011 H e ee o-r esr +rrerr reeaaaa a8 Permit Type: PLUMBING OWNER: Name (Fee Simple Titleholder): C Lau de. 13 €.c H } Phone#: b 33 6 g1)0$O b B 3 Address: 1610 1J E 1 or -It City: G'L (GYVtf SlApre{ State: • Zip: Tenant/Lessee Name: Phone#: Email: JOB ADDRESS: City: FoliotParcel #: "} Vii► `�` Is the Building Historically Designated: Yes CONTRACTOR: Company Name: E el d 11 N Gi r t VL ez .19 Phone#: ( Z j'I 3e ( C Address: 1 d z sro so) City: 1-•4 t MI State: Qualifier Name: Ed el LI 1 p -'t , a rf n i✓Z State Certification or Registration #: C, -FC, ox-occrt zip: 331 ri . Phone#: (? 86) 47/ 3 S 1 G Certificate of Competency #: Contact Phone#: Email Address: DESIGNER: Architect/Engineer: Phone#: Value of Work for this Permit: $ 1 e Square/Linear Footage of Work: Type of Work: DAddress DAlteration ONew JiRepair/Replace ODemolition Description of Work: OW) b01-411 ro0MS (Z tit ) V 4 uJ k. d} cu ev► IZe34 %4.-+o Lrn vc 4o ri Si a 1-4414t1 ba-� roue„ y da►b of ex► J A i v�3 oint 1 Submittal Fee $ Permit Fee $ 2 ?- S^>'".7...-- ccF $ co/cc $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Training/Education Fee $ Technology Fee $ Structural Review $ TOTAL FEE NOW DUE $ a • d Bonding Company's Name (if applicable) Bonding Company's Address City State Zap 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 brig permit with an estimated value exceeding $2500, the applicmat 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 anacbment. Also, a ceased copy of the recorded notice of ' , . , must be posted at the j site for the first inspection which occurs seven (7) days after the buddzng permit is YM In , ; 7-a «> o!such posted notice,, the inspection will not be approved and a reinspection fee will be charged. Owner or Agent t The foregoing instru t was acknowledged before o f i : l� day of ‘A/Pe- , 20 by by , who is personally known ° to me or who has produced fail CA t Signature The foregoing ingrament as d a y o f Hal ,20 61 ,by Ed dy ,�, -mot who is personally known to me or f:t �°' u As identification and who did take an oath. as identificati NOTARY PUBLIC: NOTARY PUBLIC Sign: Print: • /Ai - aq /15,e' o- My Commission Expires: Sign: Print: My Commission has produced and who did take an oath. TaS WVENS ubtic - State of Florida y Expires Jul 22' 2°11 Structural Review (Revised 07 /10107)(Revised 06/10/2009)(Revised 3/15109) Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Permit No. ecu - 4 z y Job Name PLUMBING CRITIQUE SHEET Aleel L4/4 4.