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RC-12-2033Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 nspection Number: INSP- 183563 Permit Number: RC -10 -12 -2033 Inspection Date: December 28, 2012 Inspector: Bruhn, Norman Owner: PEARSON, LEONARD Job Address: 246 NE 103 Street Miami Shores, FL 3138 -2431 Project: <NONE> Contractor: BUILDING CONCEPTS OF FLORIDA Permit Type: Residential Construction Inspection Type: Final Building Work Classification: Alteration Phone Number Parcel Number 1132060134880 Phone: (305)796 -0096 Building Department Comments REMOVE AND REPLACE KITCHEN CABINETS Infractio Passed Comments INSPECTOR COMMENTS False Passed Inspector Comments Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled re- inspection fee is paid. until For Inspections please call: (305)762 -4949 December 28, 2012 Page 1 of 1 \Jlc1�_ l y --IVY Q UILDIG PERMIT APPLI Permit Type: BUIL JOB ADDRESS: 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 ATION ING OCT 5 2U1 1 FBC Permit No. Master Permit No. gal, 2 ROOFING City: Miami Shores Folio/Parcel #: Is the Building Historically D County: Miami Dade Zip: ated: Yes NO is Flood Zone: OWNER: Name (Fee Simple Titleholder): LjZ)1"f"-3) Pte' 04J Phone #: Address: C-\ e .406A City: y Tenant/Lessee Name: T Email: 'DCSAknea L_I 4 C n. vr% CONTRACTOR: Company N Q . 1 Address: �q V��`W 6`) y� City: 1! AIM State: f (i Q»alifierName: ''I5(L- t $J'. State Certification or Registration #: ✓ C- Z (841 `Ce' cate of Cot etency Contact Phone#: F / 0 . ` " Email Address: V I can 1 G ��e-owt AI a (-owl Ole ItA r0r) State: im'' a \oc6 4'4 (i Name: G1•iCf � � zip: 333o Phone #: 7S I5' Phone#: 1 Zip: Phone #: 7% O( /( (a DESIGNER: Architect/Engineer Value of Work for this Permit Type of Work: DAddition OAlteration New Repair/Replace ODemolition Description of Work: f l Ate' hsl `� - i K.IMM i Phone #: a-� Square/Linear Footage of Work: Color thru tile: ******** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Fees************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Submittal Fee $ Scanning Fee $ Notary $ Double Fee $ Permit Fee $ Radon Fee $ Training/Education Fee $ Structural Review $ zed CCF $ CO /CC $ DBPR $ Bond $ 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 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 wil not be approved .. d a reinspection fee will be charged. Owne %N r Agent Contractor The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this 22 Signature e„,„ day of ' ; ! . by V' e, %. 0 who is e or who has produced As identification and who did take an oath. day of CA- , 20 ! by Vi 12_ , who is personally known to me or who has produced as identification and who did take an oath: NOTARY PUB NOT Sign: Print: My Commission Expires: ALAN B. SCHIEDER MY COMMISSION # EE 157534 EXPIRES: February 5, 2018 Banded Ttuu Notary Public Watery/Titers Sign: .1&�!'`,• C Print: - •syii:getii•,'ref%Ir My Commission Expires: _ _ _ ®s IL. - .. 0 C: CARLOS G MENZEL ublic - State o. lorida Cr "mm : ' pr 5, 2014 Fission # DD 978958 4*. Hi *+ k+ k* ************** ** * * * * * **** ** *d: * * * * *** * ****** skis**** A: **** * * ***N=sk *N:*** ** *** * * **** *+ k **+k**** ******** * ** * * ** * APPROVED BY /07i Plans Examiner Zoning Structural Review Clerk (Revised 3 /12/2012)(Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) 12 CIT CO 74' E-1 11401104e 17064F., aibl a R.sfiA N »Y sty 1 Dv—AA s}ic epv;e? LA p NS E) v ®� rm -v c n C:tmn7® m m Dc°m C rn cn r 1r man Ira S41 G DEF'r s5 OCT 2 5 2012 O NIPLIAI ID L(i rN f riULES Ai' D REGULATIONS i2- -a�'�3 rPeasot,-1 V.17_1-\0:X Aec•..R °® CERTIFICATE OF LIABILITY INSURANCE iiie� oi/Yi 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 pollcy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endolsement(s). PRODUCER Heritage Insurance Services PO Box 1508 Palmetto FL 34220 CONTACT Amanda Harvin NAME: PHONE , (941) 723 -1400 1 No): (941) 723 -1440 ADDRESS :amends @heritagefla.com INSURERS) AFFORDING COVERAGE NAIC S INSURERAAmerican Vehicle Insurance Co 10790 INSURED Building Concepts of Florida 8089 NW 67th ST Miami FL 33166 INSURER B : GE- 0506005453 INSURER C : 11/29/2012 INSURERD: $ 1,000,000 INSURER E : $ 100,000 INSURER F: CLAIMS -MADE COVERAGES CERTIFICATE NUMBER:2011 -2012 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES UMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDLISUBR INSR W VD POLICY NUMBER POLICY EFF (MM/DO)YYYY1 POLICY EXP IMMIDDIYYYYI LIMITS A GENERAL X LIABILnY COMMERCIAL GENERAL LIABILITY GE- 0506005453 11/29/2011 11/29/2012 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES (Ea occurrence) $ 100,000 CLAIMS -MADE X OCCUR MED EXP (Any one person) $ 5,000 PERSONAL& ADV INJURY $ 1, 000,000 GENERAL AGGREGATE $ 2,000,000 GEEN'L AGGREGATE LIMIT APPU�ES PER: XIPOLICY7j I F T LOC PRODUCTS - COMP /OP AGG $ 2,000,000 $ AUTOMOBILE _ _ LIABILny ANY AUTO AUTOS HIRED AUTOS - _ AUTTEOSDULED NON -OWNED AUTOS CZ aBINEDt SINGLE LIMIT $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ ' UMBRELLA LIAR EXCESS I IAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED 1 RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y / N N / A I WCY LIMITS I I OTH- ER E.L EACH ACCIDENT $ E.L DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY UMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) CERTIFICATE HOLDER Miami Shores Village 10050 NE 2nd Ave Miami Shores, FL 33138 -2207 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DEUVERED IN ACCORDANCE WITH THE POUCY PROVISIONS. AUTHORIZED REPRESENTATIVE David Clements /AMANDA 1141s52.' ACORD 25 (2010/05) INS025 (2(11nrn nt © 1988-2010 ACORD CORPORATION. All rights reserved. Tho Artmmn namo anri Innn area ronlctoroei marine of Annan PERMIT # CONTRACTOR: SUBMITTAL DATE: t O a o t 112 ADDRESS: p\LicD NFL-- ' 103 ,3'( NAME: rpe.a._-so f RESUBMITAL DATES: PROJECT TYPE: W CA6INicei ZONING FIRE STRUCTURAL IMPACT FEES ELECTRICAL HRSIDERM ve/7-V/-2-- NOC MECHANICAL �,Y STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD 1940 NORTH MONROE STREET TALLAHASSEE FL 32399 -0783 LEONI, VICTOR BUILDING CONCEPTS OF FLORIDA INC 2011 HARDING STREET HOLLYWOOD FL 33020 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 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, l (850) 487 -1395 AC#6300255 fi OCUNMENT HA; b,8 DETACH HERE STATE of FLORIDA AC# E,300 2 5 DEPART OF BUSINESS AND PROFESSIONAL;+. REGULATION CEC031847 24112 120089340 CERTIFIEDO: i LEONI, VICTOR BUILDING ;C0NCE= NTRACTOR FLORIDA INC IS CUTIFIBD under the provisions of ch.489 Fs Expiration dates AUG 31, 2014 L12002401732 ,p0mtg STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL 'REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD SEQ# 12082401732 The BUILDING CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapt$ Expiration date: AUG 31, 2014 LEONI, VICTOR BUILDING'CONCEPTS OF FLORIDA 80089NW 67TH STREET MIAMI FL 33166 RICK SCOTT GOVERNOR DISPLAY AS REQUIRED BY LAW KEN LAWSON SECRETARY THIS IS NOT A BI- DO NOT PAY 6 08593- 0 RENEWAL Bumenag La /uu7OPTS OF FLORIDA -INC STATEWE t 1847 38089 W IN 7 DAT E COUNTY GILDING CONCEPTS OF FLORIDA INC swl§y$ eMi ERAL BLDG CONTRACTOR THIS IS ONLY A LOCAL BUSINESS TAX RECEIPT. IT DOES NOT PERMIT THE HOLDER TO VIOLATE ANY EXISTING REGULATORY OR ZONING LAWS OF THE COUNTY OR CITES. NOR DOES IT EXEMPT THE HOLDER FROM ANY OTHER PERMIT OR LICENSE REQUIRED BY LAW. THIS IS NOT A CERTIFICATION OF THE HOLDER'S QUALIFICA- TIONS. PAYMENT RECEIVED MIAMI -DADE COUNTY TAX ""1i8 /09/2012 60000000091 000075.00 SEE OTHER SIDE WORKER /S 1 DO NOT FORWARD BUILDING CONCEPTS OF FLORIDA INC ADOLFO M ZUNINO PRES 8089 NW 67 ST MIAMI FL 33166 kiiitllim.iiiiini11 rr 1.11.1,1,lflai1trrt 1,1,ts!li7i71' FIRST -CLASS U.S. POSTAGE PAID MIAMI, FL PERMIT NO. 231 634849 -4 CERTIFICATE OF LIABILITY INSURANCE � DATE S 11/812012 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 holier Is an ADDITIONAL INSURED, the policy (les) must be endorsed. If SUBROGATION 13 WANED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer eights to the certificate holder In lieu or such endorsement(s). PRODUCER FRANKCRUM INSURANCE AGENCY, INC. 100 S. MISSOURI AVE. CLEARWATER FL 33758 CONTACT NONE OLNo,574 MUM 1- 800.271 -1620 x4800 114 727. 787-0704 INSURER A: INSURERS) AFFORDING COVERAD NAICs FRANK WINSTON CRUM INSURANCE, INC. 11800 INSURED FrankCrum 1-800- 277 -1820 100 8 MISSOURI AVENUE CLEARWATER FL 33758 Goya es INSURER B: INSURER INSURER D: INSURER 0 INSURER F; 213441 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NO1WnHBTANDING ANY REQUIREMENT, TERM OR CONDRION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THUS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJEOTTO ALLTHE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. DI LTR TYPE OF =CRAKE ADM IN= BUE WO POLICY NUMBER PPM,/ ePP ESSUISONYWI POLICY BXP EENOCETTTT1 L�IDI'8 GENERAL UAEUAY coMMERcIAL GENERALtVCRUTY ICLAIM9dIADE OocCUR EAOHOCCURRENCE $ DAMAGE TO RENTED PRFANGE8(Eseeamatee) $ AEDEXP(Any ene person) - $ PERSONAL &AIN INJURY OBNERALAOOREGATE $ iATE•U EB PERC 1---1..1.00 PRODUOTS -CO OP AGO $ 'q''E^N'y460 'POLICY I I PRAM $ AUIONOHLB LVIBUJTY O AIPf NON 4UMED AUTOS I COMBINED MOLE LSEWT {Ee aaeldmrq $ MANY B�LYfNJURYQ>atpeteon} $ BaDILYMAIRY(Porsoddeny �HiiBDAUT08 PROPERTY DAMAGE {Per mddaiq $ $ UMRIRF.IAAUAB EXDESBUAB 000tJR OLAIMB•MAOE EACH CCCURRENOB T_ __ AGGREGATE $ DED I 1 RETENTION $ $ A woman COWPENEATIONAND VAIPLOYE te=BEM ANY PROPRIEMPA OFFICER/IS R EXCLUDED? b andetary Eyes, describe under OFBORIPTIDNOP OPERATIONS eWpw WA WM01200000 1/1/2012 11112013 WOSTATU- I OTH X 1 TORY UNITE BR EL. MN ACCIDENT 81,000,000 $1,000,000 VE LDIBEABE -EA ESPLoyea E.LOISEABE- POLIDYLIHTT 81,000,000 DEECmPTWNOPOPBRATESEMOOATIONatVENIDLEE (Attaak AMMO 101, Additional Raemarks8ottetide ,Bmore spWeebregUired) EFFECTIVE 08/16/2011, COVERAGE 13 FOR 100% OF THE EMPLOYEES OF FRANKCRUM LEASED TO BUILDING CONCEPTS OF 8 FLORIDA CORP (CLIENT) FOR WHOM THE CUENT IS REPORTING HOURS TO FRANKCRUM, COVERAGE 13 NOT EXTENDED TO STATUTORY EMPLOYEES. CERTIFICATE HOLDER CANCELLATION Miami Shores Village 10050 NE 2nd Ave. Miami Shores, FL 33138 SHOOED ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREON, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AIrrNORE=REPRE81'NTATR!$ ,.. ACORD 26 (201010E) The ACORD name and logo are registered marks ad ACORD 91888 -2010 ACORD CORPORATION. MI Tights reserved, NOTICE OF COMMENCEMENT A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION PERMIT NO. /2 - go*, TAX FOUO NO. 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. 1. Legal description of property and street/address: 1111111011111111 11111 11111 11111 11111 11111111 CFN 201280809694 OR 8k 28352 P9 2652; (1vs) RECORDED 11/09/2012 13017 :16 HARVEY RUVINF CLERK OF COURT MIAMI -DADE COUNTY? FLORIDA LAST PAGE Space above reserved for use of recording office I∎44, /e,,3 577z- 2. Description of improvement /l 1/ , /Te-we-4i 616/.44-17-5 3. Owner(s) name and address: . --tithe % $ $4V / Interest in property: !1._ /Z //kW F 53 /x. Name and address of fee simple titleholder: 4, Contractor's name, ad � an one number 73'4'/ -)/ids &) '� 9'7 SO K9' � / / fir / A 3 �"i44 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 Uenor'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 OWNErR: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT RE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART I, SECTION 713.13. FLORIDA STATUTES AND CAN RESULT IN YOU ,AYING TWICE F- IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST �, >; �Q$p��D��YC24F le s ���. SITE BEFO FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH Y1HER L TIFY 7rt�t�t r515 �'tYup / tMENCIN OR RECORDING Y,e( R NOTICE OF COMME. CEMENT. U0 1 �rrgrnaf filed rh thu offic ,q Slgna ed B . II 4, 0, or Own s) f , , / • Offi , r i ctor/Partner /Manage ► 1 ®9 U Prepared By III 1 I1 ' Preparecj �r %' Print Name ;L': 1, ;...i ►1c Print Nark -1 Title /Office Title /Offic I STATE OF FLORIDA Sy i COUNTY OF MIAMI -DADE The foregoing instrument acknowl ged before me this By # , 9P le ❑ Individually, or ❑ as for ersonally known, or ❑ produced the following type of identificatio Signature of Notary Public: Print Name: (SEAL) 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. Signature(s) of Owner(s) or Owner(s)'s Authorized Officer/Director/Partner/Manager who signed above: By By 1 day of aoS �e� • ,o KELLE * MY COMMISSION EE 069085 EXPIRES: July 1, 2015 Prgl ` _' P cr Bonded Thru Budget Nay Services FOFF>,o 123.01.52 PAGE 3 3/10