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RC-12-1034Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 174488 Permit Number: RC -6 -12 -1034 Scheduled Inspection Date: December 26, 2012 Inspector: Bruhn, Norman Owner: RODRIGUES, MARIANA Job Address: 141 NW 96 Street Miami Shores, FL 33150- Project: <NONE> Contractor: HARTZELL CONSTRUCTION INC Permit Type: Residential Construction Inspection Type: Final Work Classification: Alteration Phone Number Parcel Number 1131010250110 Phone: (954)957 -9761 Building Department Comments KITCHEN AND BATHROOM REMODEL 09/28/2012 - PENDNIG NOC 10/2/12 noc in file va,.eaj(4 Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments December 21, 2012 For Inspections please call: (305)762 -4949 Page 2 of 17 NOTICE OF A RECORDED COPY MUST BE POSTED PERMIT NO.9 12.-- )0 1111111 11111111111111111111 1111111111 1111 1111 COMMENCEMENT CFN 201280700703 ON THE JOB SITE AT TIME OF FIRST INSPECTION OR Bk 28296 Ps 1171i (1P9) RECORDED 10/02/2012 14:14400 HARVEY RUVIN, CLERK OF COURT MIAMI -DADE COUNTY, FLORIDA LAST PAGE STATE OF FLORIDA.. COUNTY OF MIAMI -DADE: TAX FOLIO NO. THE UNDERSIGNED hereby gives notice that improvements will be made to certain real property, and in accordance with Chapter 713, Florida Statutes, the following information is provided in this Notice of Commencement. 1. Legal description of property and street / address: 141 NW 98th Street, Miami Shores, FL 33160 2. Description of improvement: iC 11-c NEN � OAI Heplaih R 84'0 t1A7t 04/ C,') 3. Owner(s) name and address: Daniel Freitas / 141 NW 98th Street, Mlaml Shores, FL 33150 Interest in property: Name and address of fee simple titleholder: 4. Contractor's name and address: J & P Electrical Concepts, Inc. / 4813 N. University Drive #463, Coral Springs, FL 33067 5. Surety: (Payment bond required by owner from contractor, if any) Name and Address: 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 and Address: 8. In addition to himself, Owners designates the following person(s) to receive a copy of the Uenor's Notice as provided in Section 713.13(1)(b), Florida Statutes. Name and Address: 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) Print Owner's Name , \)A4/lrL Sworn to and subscribed before me Notary Public: Print Notary's Na My commission expires: day of Prepared by Stri ,20JZ . i • ••. Gott \A 4k -: ./ „/TAT El 0'F `\\\�� b 0 Address: I HEREBY CERTIFY that this original bled m this office on _ _ day of OCT 0 2 2O1, , AD WITNESS my hand and 0 ial Seat. HARVEY yVIN, CLER °mud and County Cowls By O.C. TANASHIA ARNOLO 1144 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) 7624949 BUILDING PERMIT APPLICATION FBC 20 P e r m i t No. .J 1 1 2 7 Master Permit No. Permit Type: BUILDING ROOFING 141 NW 96th Street JOB ADDRESS: City: Miami Shores County: Miami Dade Zip: 11- 3101- 025 -0110 Folio/Parcel #: Is the Building Historically Designated: Yes NO Flood Zone: OWNER: Name (Fee Simple Titleholder): Daniel Freitas Phone#: Address141 NW 96th Street cityMiami Shores State: Florida Zip: 33150 Tenant/l.essee Name: Phone#: Email: CONTRACTOR: Company Name: Hartzell Construction Inc Phone #: 954-957 -9761 Address2301 NW 33rd Court cityPompano Beach state: Florida zip: 33069 Qualifier NameAnderson Pinto Phone#: 954- 957 -9761 State Certification or Registration #:CGC1520258 Contact Phone #954- 658 -0510 Email Address: Anderson (harizeilconstruction.com DESIGNER: Architect/Engineer:Charette International Architecture Phone #: 561 - 756 -6094 Certificate of Competency #: Value of Work for this Permit: $ L/, �� v Square/Linear Footage of Work: Type of Work: ❑Addition DAlteration ONew URepair/Replace ODemolition Description of Work:jlathrnpm remodel, drywall repair, tile installation, vanity and painting Color thru tile: Submittal Fee $ Permit Fee $ � CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ 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 F.T.FCTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDPITONERS, 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 fore oing instrument was acknowledged before me this of , 20 t `-, by 11Z L- P° 1 who is personally known to me or who has pros, i As identification ank1,gtl s NOTARY PUBLIC: _ e� . Print: '% , �,\\� My Commission Expires: ����i,, im T E i 0 ��r'`� Signature Contractor The foregoing instrument was acknowledged before me thi day of leer) b, 20 s3; by and pin+ who is Qersonalwn to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commis _I *************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** APPROVED BY Plans Examiner Structural Review (Revised 3 /12/2012)(Revised 07 /10 /07)(Revised 06110/2009)(Revised 3/15/09) • dabiffaV it rorida Carly Bittlingmeyer My Commission EE 187219 or w* Expires 05/28/2018 * ** ** * Zoning Clerk STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD 1940 NORTH MONROE STREET TALLAHASSEE FL 32399 -0783 PINTO, ANDERSON M HARTZELL CONSTRUCTION INC 4120 NE 22ND AVENUE LIGHTHOUSE POINT FL 33064 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.mytloridalicense.com. There you can find more Information about our divisions and the regulations that impact you, subscribe to department newsletters and leam 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 (850) 487 -1395 THIS DOCUMENT HAS A COLORED BACKGROUND • MICROPRINTING • L.INEMARK' PATENTED PAPER TIO. ._ SEQ#L1.2052301176 BATCH NUMBER S < 23 .2; er "t: wolArilii*Oher Expiration date= . :Attdr 3: 018 AS JOEaOIRED K LAWSQN:.. .$ RE'XARY ACORD CERTIFICATE OF LIABILITY INSURANCE DATE (MINDEINVYY) 9/24/2012 THIS CERTWICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POUCIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSUMR(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER, IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the poticy(Ies) must be endorsed. If SUBROGATION 18 WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER .4cde:CONTAcT Denise page Frank IL Furman, Inc . (954) 943-5050 I FAx fAtc, (SSO 042-631.0 1314 East Atlantic Blvd.. P. 0. Box 1927 Pompano Be..cn F.L., 33061 INSURED Hartzell Construction Ise 2301 N W 33 Court Suite #112 Pompano each FL 33069 COVERAGES Atrinliss; &aril se@formanineacance corn INSURER(S) AFFORDING COVERAGE NAJC *mean A Bridcrefield Employers I= Co 10701. thistmeta; INSURER INSURER 0 INSURER E: INSURER F: CERTIFICATE NUMBER:3.2-13 Renewal SION NUMBER: THIS is TO CERTIFY THAT THE Po LictES OF INSURANCE LISTED BELOW HAVE BEEN INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, REDUCED BY PAID CLAIMS, T TYPE OF INSURANCE AttoL curia POLICY NuuseR Om= EFF gssovroreren fallyvyytY EXP GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY ri OCCUR EACH OCCURRENCE $ — DAMAGE YO Rsurso pRewses (ea tectatarics) $ CLAIMS-MADE MED EXP (Any one POS011) 0 PERSONAL it ACV INJURY $ ..--- GENERAL AGGREGATE GEN'L AGGREGATE LIMIT APPLIES PER POLICY 1-1 /3Pgi= LOC PRODUCTS -COMP/OP AGO $ COMBINED SINGLE UNIT tea socklent1 $ $ $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS BODILY WARY (Pe? Peron) • SCHEDULED MIK AUTOS BODILY INJURY (Per accident) $ MIII Ell NON-OWNED Aw-cs PROPERTY DAMAGE $ treexteLL, 41.14Ei EXCESS UM Ill a uR CLAIMS-MADE EACH. OCCURRENCE $ — III AGGREGATE $ DEO L 1 RETENTIONS A WORNERS COMPENSATION ANDEmpLoyeiss•LtAssury ANY PROMETOR/PARTNE.F0EXECUTIVE OFFICEFUMBABER EXCLUDED? (Mandattety in NH) if ws, &wim!, under DESCRIPTION OF OPERATIONS Y I N N IA 083038373 9/13/2012 /13/2013 x 1 TOFtYsTATu. 1 roa E.L.F.ACH ACCIDENT $ 1,000 ,000 1— 1 0 - MPL et, DISEASE EA F. oyEE $ 1,000 , 000 beW EL Pi$EA$E-POUGY L ti' 1, 000 , 000 DESCRIPTION DESERIPTION OF °FERMI° / LOCATIONS 1 VEH1C (Attach ACORD 101, Andilional Ramarks Schedule, If more vacs is retpared) CERTIFICATE HOLDER (305)756-8972 MIAMI swans VILLAGE WILDING DEPARMENT 10050 NE 2 /WENDT* MIAMI MORES, toz. 33136 CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE MALL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. ACORD 25(2010105) iNSflSninn4nl The *room rsfirrta. strut 'nor" raniettews!ri morlite old arruari AUTHORIZED REPRESENTATIVE Frank Furamn, r/DP 01988-2010 ACORD CORPORATION. All rights reserved. CERTIFICATE OF LIABILITY INSURANCE OP ID: SP DATE YY) 09/24/12 THIS CERTIFICATE 1S INSUED AS A MATIER OF INFORMA TIO ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE .HOLDER. THIS C9oFtTIFLCATE DOES NOT AFF 'NATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BE THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE }*OLDER. IMPORTANT; If the: certificate holder is an ADDITIONAL INSURED, the pa ) must be endorsed. if SUBROGATION IS WANED, st400t to CIO tentis and conditions of the policy, certain Rolm -may require an endorsement. A stattertent on this corlificale doss not confer rights to the certificate holder in lieu of such a meni(s). PRODUCER INNOVATIVE INSURANCE CONSULTANTS, INC. 3461 UNIVERSITY DRIVE, 0103 CORAL SPRINGS, FL 33067 THOMAS J. DEFRANCO 954440-9551 954-340-9458 PHONE I( . NO ID -2 an HARTZELL CONSTRUCTION, INC. 2301 NW 33RD COURT, STE 112 POMPANO BEACH, FL 33089 INSURER A: TARR INDEMNITY COVISIACE LIABIUTY 'CO a :COMMERCE & IN STRYI'CHARTIS 19410 INSURF.R • ! Dz INSURER 5: F: COVERAGE nits IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELow HAVE BEEN ESSUED TO THE INSURED NAMED ABOVE FOR THE POUCY,PERI INDICATED. NOTWITHSTANDING ANY REQUIR , :TPRM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT wmi RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANC€. AFFORDED SY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS E,' OWN MAY HAVE BEEN REDUCED BY PAID S, -ReEr ADM SUER POLICY REF LTR TYPE OF INSURANCE R livvo POucY NINIBER f CERTIFICATE N R R GENem UABILITY A .yX CO10MERCLAL GENERA` LIABILITY X 01.AVWX3E X] OCCA, X BLKT ADDL INSURED X BLKTWAIVER GEN'L AGGREGATE LOST APPLRES'PER. POLICY ri ! a .jG f OG AUTONOBTLE LABIUM ANY AUTO ALL OWNEO AUTOS SCHEOULEIAUTOS HIRED AUTOS NON-OWNED AUTOS MPG-GLOOM-00 PRESARYNOWOONTRIBUTORY 07/28112 07125113 TO iS (Es E n 5 7,UWe ACtuscow LA 3REGA15 ©UCTS «C WORKERS COMPENSATION AND EMPLOYERS' UAa UIZY y ANY PROPRIETORIPARTKERiESECUME (" OFFICER/MEMBER EXCLUDEA7 fhtimelstary In NH) und I er IX SORIPTION (iF OPERATIONS be>Ew. OOMEUVED S INGLE I (Ea oat) 5 5 5 $ $ $ 100,004 5,000 ,000,0 ,000,000 E0OA00 BODILY INJURY(Par FaIsorS Both Y(NJURY(Perasc PROPERTY DAMAGE () $ Ni 8E034243457 001 5112 OCCURREN $ 2,000, 17126/13 AseREGATE 2,000,000 s DEsompTION tiF OPERA1IONE i LOCATIONS WHOM Onset ACORO AddlEcousi ReKKARe SthedUle, RMom eptctr 1$ rapiroRR MIX 7 SHORES VXXLLAG. I TS MAIO : NEM AS ADDITT =St= 11ITgt REBEEcT TO PAX GENERAL # .305 -755 8972 CERTIFICATE HOLDER, .. CANCELLATION IS1 MIAMI SHORES VILLAGE 10050 NE 2ND AVE MIAMI SHORES, FL 33138 SHOULD ANY OF THE ABOVE DESCRIBED POLICIE.S BE CANCELLED BEFCRE 111E EXPIRATION DATE THEREOF, NOTICE Vim.. BE DELIVERED IN ACCORDANCIE WITH THE POUGY PRO A REPRESENTATRVE roc AC D 25 (2 1085 ACORD CO The ACORD nine and a are registered marks of ACORD: TION. An reserved. (2) Permi No: 12 -1034 Job Name: June 11,2012 Miami Shores Village Building Department Building Critique Sheet 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 1) Provide plans signed and sealed by a licensed architect or engineer. 2) The permit application does not match the scope of work. 3) Identify the level of alteration. 4) Identify the interior bearing walls in the area of work. 5) Provide corrections for electrical. Stopped review 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 - 762 -4859 Miami Shores Village Building Department Permit No: 12- /O 3 f Job Name: /- ✓z, /47- -S Date: ‘?,0 ELECTRIC Critique Sheet 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 )9 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. Review Complete by: Michael A. Devaney SR. Chief Electrical Inspector 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 hdri- B L ING PERMIT APPLICATION Permit Type: BUILDING / 4 JOB ADDRESS: /4 / y Ii City: Miami Shores JUN u.6 LU JIE Bar : ®___ ....... o___aoo FIX 20 Permit No. T' 12. \J � f L Master Permit No. ROOFING ami Dade Zip: Folio/Parcel #: Is the Building Historically Designated: Yes NO Flood Zone: OWNER: Name (Fee Simple Titleholder): - .1/L /�� ice` Phone #:� °'�.��� Address: 4i1 /V V S City: 4i' tW � State: Tenant/Lessee Name: Email: CONTRACTOR: Company Name: 93/ Address: City: Qualifier Name: uvo State Certification or Registration #: Contact Phone #: DESIGNER: Architect/Engineer: 141 Phone#: Zip: 3307 V 2 4 e7 "1 X , ,�R*O(i Phone#: 55/ 3%4,097,7 State: Zip: Phone #: Competency #: 1411647J YA-. Cal/ Phone#: Value of Work for this Permit: $ 5-0 0.650 Square/Linear Footage of Work: Type of Work: DAddition UAlteration ONew ORepairlReplace ODemolition Description of Work: O P d! , o dI— Ct, 'A /T "rQ Color thru tile: Submittal Fee $ Permit Fee $ Scanning Fee $ Radon Fee $ CCF $ CO /CC $ DBPR $ Bond $ Notary $ ''� Training/Education Fee $ Technology Fee $ Double Fee J 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 i.' IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROP I RTY.' F XOU INTEND TO OBTAIN FINANCING, CONSULT WITH YO E :rAN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMNC' 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 -�� Sign The for, day o who is NOT oin Owner or Agent instrument was ac . • wledged e V1 20 y rsonally known to me or who has produced Sign: Print: My Commission Expires: YP LIC: cation and who did t ?ke an oath. * * * * * * * * * * * * * * * * * * * * * * ** * ** * fordo ' Contractor g instrument was acknowledged before me this / , 20 by :?*(1 tficl4I) ?r{ ho isT `aiall"y known to me or who has produced as identification and who did take an oath. NOTARY PUB Si gn: Print: My Commissio *********** * * * * * * * * * * * * * * * * * * * * * * * * * * * * *, APPROVED BY Plans Examiner AUGUSTO MARINO VIEIRA '? MY COMMISSION # OD982948 EXPIRES January 16, 2014 Zoning Structural Review Clerk (Revised 3 /12/2012)(Revised 07 /10 /07)(Revised 06 /10/2009XRevised 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 CONTRACTORS' REGISTRATION FORM ALL CONTRACTORS MUST PROVIDE COPIES OF LICENCES AND INSURANCES EACH TIME A PERMIT IS SUBMITTED OR THE VILLAGE MAY MAINTAIN A FILE WITH YOUR INFORMATION FOR A $30.00 FEE PER YEAR. IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: A. 17COPY OF QUALIFIER'S STATE LIC CARD B. COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF LIABILITY INSURANCE (CERTIFICATE HOLDER TO BE MIAMI SHORES VILLAGE BLDG DEPT) D. COPY OF WORKERS COMPENSATION (EITHER CERTIFICATE OR EXCEMPTION) IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY: A. COPY OF CERTIFICE OF COMPETENCY OF QUALIFIER B. COPY OF MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT C. COPY OF LIABILITY INSURACE (CERTIFICATE HOLDER MUST BE MIAMI SHORES VILLAGE BLDG DEPT) D. COPY OF WORKER COMP INSURANCE (EITHER CERTIFICATE OR EXEMPTION) YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE HOLDER AS FOLLOW: MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES, FL 33138 COMPLETE CONTRACTOR'S INFORMATION BUSINESS NAME: M t6A7VZ4 f:At/deit54.5, ,®C) BUSINESS ADDRESS: 3D 4,44 CITY xl_prALveeter STATE FL. ZIP CODE BUSINESS PHONE: ( /) 77 FAX NUMBER ( ) CELL PHONE ( ,) 477 QUALIFIER'S NAME: 4vecATO A91-671-7424.- QUALIFIER'S LIC NUMBER: C6,(1/57 471 E -MAIL ADDRESS (IF APPLICABLE): A ovo e,/v/4644.Ze CoP1 Created on 3119/09 BY MLDV / RV 3/26109 NOV City of Boynton Beach BUSINESS TAX RECEIPT BUSINESS NAME: MAGANZA ENTERPRISES INC LOCATION: 931 SUNSET RD CLASSIFICATION: CONTRACTOR - GENERAL BU MAGANZA BRUNO LIC# CGC1519474 MAGANZA ENTERPRISES INC 931 SUNSET RD BOYNTON BEACH FL 33435 Any changes in name, address, suite, ownership, etc. will require a new application. RECEIPT NO: 12 00028459 CONTROL NO: 24841 DATE ISSUED: BUSINESS TAX FEE: DELINQUENT FEE: TRANSFER FEE: 8/16/11 244.65 fiOTAL AMOUNT PAID: 244.65 #SINESS TAX RECEIPT ISSUED FOR THE PERIOD :August 16, 2011 to September 30, 2012 BUSINESS TAX RECEIPT MUST BE CONSPICUOUSLY DISPLAYED TO PUBLIC VIEW AT BUSINESS LOCATION TI-41C IC NIr1T A RII 1 :! 04 -14 -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: 04/14/2011 EXPIRATION DATE: 04/13/2013 PERSON: MAGANZA BRUNO FEIN: 208678868 BUSINESS NAME AND ADDRESS: MAGANZA ENTERPRISES INC 931 SUNSET RD BOYNTON BEACH FL 33435 SCOPES OF BUSINESS OR TRADE: 1- REMODELING 2- CERTIFIED GENERAL CONTRACTOR * * 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 440.05112), 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. 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 an the certificate to meet the requirements of this section. QUESTIONS? (850) 413 -16C DWC- 252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01 -11 .t`---- . CERTIFICATE OF LIABILITY ..—,-.—,-e'" INSURANCE DATE (MM/DDNYY G 6/1/2012 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS ALTER THE COVERAGE AFFORDED BY THE POLICIES BETWEEN THE ISSUING INSURER(S), AUTHORIZED IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement Astatement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Capricorn Coverage, Inc. 5180 W. Atlantic Ave., Ste. 121 Delray Beach, Florida 33484 A273445 CON IACT NAME: SANDRA VESSECCHIA PHONE A/C, No, Ext): 561 - 499 -3922 i c, No):561- 499 -3716 ADDESS :sandy @capricorncoverage.net INSURERS) AFFORDING COVERAGE NAIC# INSURER A: Republic-Vanguard PGL 001132 -12 INSURED Maganza Enterprises, Inc. 931 Sunset Road Boynton Beach, FL 33435 (561) 706 -6977 INSURER B: EACH OCCURRENCE INSURER C: X INSURER D: DAMAGE TORENTrD PREMISES (Ea occurrence) INSURER E: $ 5,Q.(10_ INSURER F: ^' ^," ,.., -... a ,h en,o• $ 1,000,000 • GOVLI-tAL5t5 I,CR i irma-%a ciw,..uu.. THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POUCIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE °R Mo POUCY NUMBER (MNW`DJWYYY) (MM/DD/YYYY) OMITS A GENERAL LIABILITY PGL 001132 -12 4/2/2012 4/2/2013 EACH OCCURRENCE $ 1,000,000 $ 100 , 000 X COMMERCIAL GENERAL UABIUTY ICLAIMS-MADE I '- r OCCUR DAMAGE TORENTrD PREMISES (Ea occurrence) MED EXP (Any oneperson) $ 5,Q.(10_ PERSONAL BADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP /OP AGG $ 2,000 , 000 GEN'L AGGREGATE LIMIT APPLIES PER: ]( POLICY I (JECT 1 LOC COMBINED SINGLE UMIT (Ea accident) $ $ .1 AUTOMOBILE LIABILITY BODILY INJURY (Per person) $ ANYAUTO ALLOWNED AUTOS HIRED AUTOS SCHEDULED AUTOS NO WNED AUTOS T BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ UMBRELLA IIAB EXCESS LAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ $ DED I I RETENTION $ WORKERS COMPENSATION AND EMPLOYERS LIABILITY YIN ANY PROPRIETOR/PARTNERIEXECUTNE OFFlCERIMEMBER EXCLUDED? ❑ (Mandatory in NH) If yes, describe under OF OPERATIONS below N / A (TORY LIMITS I I0ER E.L EACH ACCIDENT $ E.L DISEASE- EA EMPLOYEE $ E.L DISEASE - POLICY MIT E.L $ DESCRIPTION DESCRIPTION GENERAL OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if morespace Is required) CONTRACTOR CERTIFICATE HOLDER MIAMI SHORES VILLAGE BUILDING DEPARTMENT 10050 NE 2ND AVENUE MIAMI SHORES, FL 33138 FAR: 305 - 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 IC:16A&S, CAN ak-kiNtA0124\ ACORD25 (2010/05) © 1988 -2010 ACORD CORPORATION. Ali rights reserved. The ACORD name and logo are registered marks of ACORD la JUN 0 6 2012 gmcmgwEri B Y: NO POINT ALONG COUNTER TO BE MORE THAN 2 FEET FROM G.F..I PROTECTED RECEPTACLE. PUT DAN RECEPTACLE UNDER SINK. ALL FIXED APPLIANCES ON DEDICATED CKTS. �r 1 ADD SMOK CAR D PTO ANY ANi) AL ? .)T D RUSE INSULATED C NOUC i ORSTO 8E, ° CE Miami Shores Village SUBJECT TO COMPUANCE WITH ALL FEDERAL STATE AND COL INTY RULES AND REGULATIONS feoz‘6X—x°i c/Oz-- BATHROOM Hader-JAL:, , : ?O AMP CKT AND G.F.I PROTECTED fi01)/P��s : 1/ 41 R1/L`` c-) 6 Sr- ,z tor// Al toDic D ✓E.2 ,4�4L30 200,2 1(IIL1-EN v-670 *Lir WA9z .0%y% 6Rea Pews �t 0 COv.v7zW (ti i,vpk✓ v n 2)10iin/f'oRec 5,49.sE ►2R.4//?g 2 eex 3) INsMt J 017- c9/A/ / .PL f .9.4304,s- (p' LJAJ72 R 7z9? 1 :7' /r / // / / / /.�/ •r a c`wL, 9, 4 _ p71 P 7? (op-.11 liuillE, LIP Et; Ala POLOM 70.8 d7) ,ai7-41 4i 2 Ste-.9z. TAIL" "19-6R4(-- 4 SS 2� lZ�i�Gl�l gvOR (t o7? ) 3)/s LL svek. 1' 4'v, , .y✓ /�-r Sow�e, %lPZ1q 711«-5' (y49t9, W,gtZ. oN .4 3 1 QLPLf - 772z--5 0 REo 7-03 097v/ Grp %°-D/ 7F' 3ir? ,eLo,7I V,7// C L,4e- ,rY,'_ ..1)_,y/ rr dctmErk 0 b ADD SMOKE/CARBON MONOXIDE DETECTORS. ANY AND ALL CLOTH AND RUBBER BYoY --------- - -- INSULATED CONDUCTORS TO BE REPLACED. NO POINT ALONG COUNTER TO BE MORE THAN 2 FEET FROM G.FI PROTECTED RECEPTACLE. PUT D/W RECEPTACLE UNDER SINK. ALL FIXED APPLIANCES AN DEDICATED CKTS: t� .�a410 Miami Shores illage SUBJECT TO COMPLIANCE WITH ALL FEDERAL STATE AND COUNTY RULES AND REGULATIONS BATHROOM RECEPTACLE ON 20 AMP CKT AND G.F. 1 PROTECTED C/0 4 J E- 9 6 5r- /22/07/*.e,v/PE:sf Ot/.6€. /-1.eA-1) .2170)2 Gfi R.96E ti LIt AAri/ BATHROOM RECEPTACLE ON 20 AMP C AND G.EI PROTECTED ADD SMOKE/CARBON MONOXIDE DETECTORS, ANY AND ALL CLOTH AND RUBBER INSULATED CONDUCTORS TO BE REPLACED, aosi.f7 0 vos cry.) Acw Z C1-05z,-- Do-a2 rd 2) re4.5.c.ie- Poe/2 &RV (0i) 3.) //117-29-1-4 Vi9A/frvi, N4FAti 7V/2E7-5- 49-"14 LF41 5A/opv4r-fe 11) R-45beelred--- 77'e-e:s (.ripA f 01/411..) 8E-D ??D0A4 NO POINT ALONG C((NTE,.; TO BE MORE THAN 2 FEET FROM G.F i PROTECTED RECEPTACLE. PUT D/W RECUTACLE UNDER SINK. ALL FIXED APPLIANCES ON DEDICATED CKTS. tl air 77744- mi4/... 4 //■99aL---- OPtin)rzK-,ie (4,Vi9 a 9/ 60 4): 2) E Ei4se TA) ene,.062 7W ,^1.S"77)4_ COV /V 6'12421/-14.1 Z 8 X Go `-.9) AiSrig. J L,/- am) ?we 1-11'Ii : 450A: C,9a0V72-W 7VP ptiDe--) e. Lie;d6; Paom • 0 r A 0 4 0,1977/ 41/ go,5 RepL4e-e• Rtcotta &t_F 71/5 09-Aft 7- ALe-ar ag:n ,e040/79 #ij 7 EN,71d/ .4 crate /41' -ty/ PERMIT # CONTRACTOR: 4412... c Z L - CONC CTI, ( SUBMITTAL DATE: 'i 1 as) 20 ►a. ADDRESS: 11Lk 1 N L al Q, NAME: F I rra'S RESUBMITAL DATES: (PROJECT TYPE: ` {v iA ue. ZONING FIRE STRUCTURAL IMPACT FEES ELECTRICAL . a' / 7 HRSIDERM PLUMBING NOC MECHANICAL BLD iY