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RC-12-458Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 188077 Permit Number: RC -3- 12-458 Scheduled Inspection Date: March 27, 2013 Inspector: Bruhn, Norman Owner: QUILLIOT, REMY Job Address: 1020 NE 104 Street Miami Shores, FL Project: <NONE> Contractor: G FOSTER CONTRACTING INC Permit Type: Residential Construction Inspection Type: Final Building Work Classification: Alteration Phone Number (786)925 -4181 Parcel Number 1122320290250 Phone: (954)467 -9694 Building Department Comments REPLACE KITCHEN CABINETS AND DRYWALL REPAIR IN KITCHEN !!ALL WORK MUST BE DOUBLE FEE!!!! SEE INSP COMMENT ON 11/21/2012. Infractio Passed Comments INSPECTOR COMMENTS False Inspector Comments Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. March 26, 2013 For Inspections please call: (305)762 -4949 Page 15 of 20 111 ri 1.1 s)is •a- urt k-t)i BUILD G PERMIT APPLICATION FBC 20 -111- Clovit- iami 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 RECEIVED MAR 1 6 2012 Permit No. 1 Master Permit No. C4 • °' 1S r Permit Type: BUILDING ROOFING OWNER: Name (Fee Simple Titleholder): ' LL( Address: AD 6,75‹ 61( "32 4 g City: i 4(1,1 State: { L Tenant/Lessee Name: Email: %) P- d 11jce v4 ( carp- Cps• Phone#: i C c „S (t101 Zip: e-;' Z61 Phone#: JOB ADDRESS: /0'1_0 iV .4O1 S City: Miami Shores County: Miami Dade Zip: Folio/Parcel #: Is the Building Historically Designated: Yes NO Flood Zone: 7tte 513-3kd'L 43 • 57617.- pt.) 7 4c7i.v c %Ne Phone#:.74 4 467 -94, CONTRACTOR: Company Name: Address: // /S SW Z e s I qrE. City: fr• L D i4i State: 33' Qualifier Name: ro V A. iV57. Phone#: 7S 25¢- &7 0 `7 State Certification or Registration #: 1 5-0458g Certificate of Competency #: 7r6 6-43 3 ere e Contact Phone#: S4 'SSA —81 ®7 Email Address: 94; S-%e-r 4.0 F■4-r@ 6 el /5 u eJ'i"ti . i'l e t DESIGNER: Architect/Engineer: Value of Work for this Permit: $ Type of Work: OAddition Description of Work: Phone#: Square/Linear Footage of Work: teration L. ❑New 4, Repair/Replace emolition ***v_****** ** ************************F ** * * * * * ****w*** ****a** xis. * * * ***** * ** ******* Submittal Fee $ Permit Fee $ 57 / G� CCF $ Scanning Fee $ Radon Fee $ DBPR $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ CO /CC $ Bond $ Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for FT.RCTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection ee will be charged. Signature The fo day of Owner or Agent trument was acknowledg 20 / 1 by who is personally known to me who has As identification and who did take an oath. Signature Contractor The foregoing instrument was acknowledged before me this 7 day of M 4c , 20l Z , by Gay , who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: STEPHEN HIDEKEL NOTARY PUBLIC STATE OF FLORIDA APPROVED BY 7,142 Plans Examiner Zoning Structural Review (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) Clerk DATE BATCH NUMBER BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT 115 S. Andrews Ave., Rm. A -100, Ft. Lauderdale, FL 33301 -1895 — 954 - 831 -4000 VALID OCTOBER 1, 2011 THROUGH SEPTEMBER 30, 2012 DBA: Business Name: G FOSTER CONTRACTING INC Owner Name: GARY ALAN FOSTER Business Location: 1615 SW 2 AVE FT LAUDERDALE Business Phone: 954 -467 -9694 Rooms Seats Employees 1 Receipt #:180 -5047 Business Type: GENERAL CONTRACTOR (GENE BUILDING CONTRACTOR) Business Opened:o2 /o1/2001 State /CountylCert/Reg:CBC 1504588 Exemption Code:NONEXEMPT Machines Professionals For Vending Business Only Number of Machines: Vending Type: Tax Amount Transfer Fee NSF Fee Penalty Prior Years Collection Cost Total Paid 27.00 0.00 0.00 0.00 0.00 0.00 27.00 THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS THIS BECOMES A TAX RECEIPT This tax is levied for the privilege of doing business within Broward County and is non - regulatory in nature. You must meet all County and /or Municipality planning WHEN VALIDATED and zoning requirements. This Business Tax Receipt must be transferred when the business is sold, business name has changed or you have moved the business location. This receipt does not indicate that the business is legal or that it is in compliance with State or local laws and regulations. Mailing Address: GARY ALAN FOSTER 1615 SW 2 AVE FORT LAUDERDALE, FL 33315 91111 _ 91119 Receipt #034 -10- 00003732 Paid 09/19/2011 27.00 At R " CERTIFICATE OF LIABILITY INSURANCE FOSGC01 OP ID: NX DATE (MMIDD/YYVY) 03108/12 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL. INSURED, the policy(Ies) must be endorsed. If SUBROGATION IS 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 Gateway Insurance Agency Surety Corp 2430 W. Oakland Park Blvd. FL Lauderdale, FL 33311 954 - 735 -5500 UEcr 954- 735 -2852 a Ed): • ADDRESS: ! (M, Nc): INSURERS) AFFORDING COVERAGE INSURER A: First Mercury Insurance Co NAIL f INSURED G. Foster Contracting, Inc. Attn: Mr. Gary Foster 1615 S.W. 2 Avenue Ft Lauderdale, FL 33315 NUM/a: CastlePoh1t Florida Ins. Co. INSURER C: INSURER D : INSURER E : INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY THE INSURED NAMED ABOVE FOR THE POLICY PERIOD OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, PAID CLAIMS. LIR TYPE OF INSURANCE WIG POLICY NUMBER 3MMIDDIYYYY) JMMIDDtYYYYL LIMITS A GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY 1 OCCUR FMGA002029 04/14111 04114112 EACH OCCURRENCE $ 1,000,000 X pR A ses (a oau ence) $ 100,E JCLAIMS -MADE [ X MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'LA(iGRBGAIEUMII APPLIES PER: D1-1 POLICY lFse nLac PRODUCIS- COMP/OP AGG $ 2,000,000 7 $ AUTOMOBILE _ LMABEJTY ANY AUTO ALL OWNED AUTOS HIRED AUTOS - SCHEDULED AUTOS NON -OWNED AUTOS CoMEANED §INGLE L1f,1lT (Els Accident) BODILY INJURY (Per person) $ $ ROM Y MIRY (Per Accident) $ PROPER I Y DAMAGE. (Per accident) $ $ UMBRELLA LIAR Excess WAS OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED 1 !RETENTION $ $ e IMAMS AND OYERSELIIABI�UIY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Alandatery In NH It yes, describe under DESCRIPTION OF OPERATIONS Y/ N N f A WCP760831700 06/14/11 06114/12 II II II X 1 TORY LIMITS f 1 DER E.L. EACH ACCIDENT $ 100,000 I E.L. DISEASE - EA EMPLOYEE $ 100,000 below E.L. DISEASE - POLICY UMIT $ 500,000 DESCRIPTION OF OPERATIONS: LOCATIONS 1 VEHCLES (Attach ACORD 101, Addt ional Remarks Schedule If more apace le required) 1 CERTIFICATE HOLDER CANCELLATION MIAMI SHORES VILLAGE BUILDING DEPARTMENT 10050 N.E. 2 AVENUE MIAMI, FL 33138 ) MIASH01 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 9.09,14k-- ®1988 -2010 ACORD CORPORATION. All rights reserved. w LL 0 z 0 U EE 0 J LL LL 0 en Permit # CC ' 'Folio # /l- Z232..0'a NOTICE OF COMMENCEMENT The undersigned hereby gives notice that improvement 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 : 111111111111111111111111111111111111111111111 CFN 2012R0363484 DR Bit 28120 P9 23971 (1 P s ) RECORDED 135/22/2012 12t54:13 HARVEY RUVIN, CLERK OF COURT MIAMI -DADE COUNTY, FLORIDA LAST PAGE 1. Legal Description of Property: Lot Block Unit tf_ Bldg ti ❑Lengthy legal attached Subdivision /Condominium: Street Address if available: / 0 Le) NE E / 0 4 57, Mi JA.M 1 2. General description of Improvement: KIT 414E04 jao7H ,lQtc./4oDEL f2B.Ai. 7 e.-i. G. /oz° NE /cep '5 o%-z•5‘ r-+..3 3/39 5 T . M /4 M No S, F1- 'S 3,3g 3. a. Owner name and address: b. Interest In property: c. Name and address of fee shmpie titleholder (if other t an Owner): 4. a. Contractor name and address: b. Contractor's phone number: 6. a. Surety name and address: b. Surety's phone number. c. Amount of bond: 6. a. Lender name and address: b. Lender's phone number: 6. rvs715e. 4,b0711-e 4-7/"4, Iroc, 1 Lids Si., z ' INVE. P7• 1.A waB- P- D®-e4i 333)4, � s44(.7.9 4.9¢ 7. a. Persons within the State of Florida designated by Owner upon whom notices or other documents may be served as provided by Section 713.13(1Xa)7., Florida Statutes: Name: Address: b. Phone number: 8.a. In addition to himself the or e Owner designates 7i god S to receive of Llenor's Nome per Section 713.13(1)(b), Florida b. Phone number of person or entity designated by owner 9. Expiration date of notice of commencement : 0/50/1 ' (the expiration dare Is year from the date of recording unless a different date Is sperm WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART I, SECTION 713.13, FLORIDA STATUTES, AND CAN RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB.Sl E BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT. Signature(s) of Owner(s) or • Off cer!DirectorlPartnedManager By • Enid Mune Print Name STATE OF FLORIDA COUNTY OF BROWARD n ee foregohtg I6ty� acknowledged before me this IO day of /%?G.. J • By %K .Q--� or 0as O�ll � knoem,or flproduced thefollowkg type ofl rc :.17C ... • j ;ti _ j T for Signature of Notary Public: Print Name: (SEAL) 1 �•r.i's 7 _ tJr Under penalties of perjury,1 declare that I have read the foregoing and that the facts stated In it are true, to the best of my knowledge and belief. Signatures) of Owner(s) or Owners)' Authorized OfficerlD (rectodPartnerlfitanager who signed above: By NOTARY PUBLIC STATE Of FLORIDA • Qomm#EE181218 Ima 1/18,2018 By noticed omm as ns&ed73.074 o PQL 7LLc. /ozo N& /04 wi&#t p 3 kit r- 331(9. r\/ k )3; r tyz 6 P1�6 /<' e iv' arri Shores Village APPROVED ZONING DEPT BLDG DEPT TE /s-,NU HI.,LES AND REGULATIONS NO POINT ALONG COUNTER TO BE MORE THAN 2 FEET FROM G.EI PROTECTED RECEPTACLE PUT DAN RECEPTACLE UNDER SINK. ALL FIXED APPLIANCES AN DEDICATED CKTS. ADD SMOKE/CARBON MONOXIDE DETECTORS. ANY AND ALL CLOTH AND RUBBER INSULATED CONDUCTORS TO BE REPLACED. MAR 1 6 2C', m LAMVERW5X.11 la APR 2 4 202 Gr, -eft s . ef4eAs ,1-7 vv.- a ije41 , w. Q /OZ( r/ElOLr �u 3 ss 13 r/oc, ei1k 0 -,4 D. ?I vv , c:rq:42. r re,.i vv. Ce se ks nQt 5Aow ir; )e,,,P ite /OW J6 /04 3 giAMC she_ 33 )35 CL- 0 1 0 L&'@MEIVZ; ZU 12 0 I lAY 1 • BY; _ oo---------- - - - - -- CUMULATIVE SUBSTANTIAL IMPROVEMENT VERIFICATION WORK SHEET In accordance with FEMA regulation and Miami Shores Village Flood Damage Prevention Ordinance the costs of all improvements must be monitored. The costs of any improvements in the past 12 months and the costs of any proposed improvements must be shown on the worksheet. The cost of improvements must include demolition, raw and finished materials (include those donated), labor (including volunteer and self - performed), construction supervision and management, and overhead and profit. A list of items the costs of which are to be included as well as those excluded is attached for your reference. (A Copy of the Contract must be attached) PROPERTY OWNER: PERMIT # a. a 0- i 58 ADDRESS: AO ri IV A to C ST FOLIO NUMBER: FLOOD ZONE: BASE FLOOD ELEVATION: FREEBOARD: EAST OF FL.CCCL: COST OF PAST IMPROVEMENTS (12 MONTHS): COST OF PROPOSED IMPROVEMENTS: (ATTACH COPY OF CONTRACT) ,7-efe31 D TOTAL CUMULATIVE COST OF IMPROVEMENTS (past and proposed): VALUE OF PRINCIPAL STRUCTURE (attach apprais 5ZS OWNERS SIGNATURE: - DATE: 05/0 ((29(2 PLANREVIEWER: PLAN SIGNATURE: DATE: REVIEWER SUBSTANTIAL IMPROVEMENT / DAMAGE LIST (NOTE: THIS LIST IS INTENDED FOR GUIDANCE ONLY, AND IS NOT ALL INCLUSIVE) ITEMS TO BE INCLUDED ALL STRUCTUAL ELEMENTS, INCLUDING Foundations including; Spread footing, Continuous footing, isolated footing, piles and pile caps Slabs including; Monolithic, floating, elevated Walls including; Exterior walls, Bearing walls, Shear walls Beams, Tie Beams, Columns and Posts Wood decking, Floor and Roof Sheathing Trusses, Joist Windows /Doors ALL BUILDING ELEMENTS, INCLUDING Interior Partitions, Walls, Columns Drywall, Ceilings, Built in Furniture, Cabinets, Vanities All Fixtures Flooring, Tile, Carpet, Stone, Linoleum, ect. All Finishes including Drywall, Paint, Stucco Plaster, Paneling, Tile, Marble, and Moldings Roofing Material ALL HARDWARE ALL UTILITY and SERVICE EQUIPMENT HVAC Electrical System and Equipment Plumbing System and Equipment Security System and Equipment Central Vacuum System Plumbing Fixtures Lighting Fixtures and Ceiling Fans Water Systems including Softeners /Filtration Created on June 2009 ALSO: All Labor and other Costs associated with Demolition, Removing, Replacing, Installing Building or Altering Building Components Construction Management / Supervision Overhead and Profit Equivalent cost for: Donated Materials Volunteer Labor (including owners and friends) Any Improvements Beyond Pre - damaged Condition, including; Utility Upgrades Code Upgrades ITEMS TO BE EXCLUDED Plans and Specifications Survey Costs Elevation Certificate Costs Permit fees Debris Removal Items not considered to be REAL Property Rugs, Furniture, Refrigerator, Appliances not Built -in Outside Improvements, Including; Landscaping Sidewalks Patios Fences Yard lights Sheds Gazebos Irrigation Pool A "substantially improved" structure in a Flood Zone must be brought into compliance with Miami Shores Village Flood Damage Prevention Ordinance for new construction. This means a residential structure must be elevated to or above the level of the 100 -year or base flood and a commercial structure must be effectively "flood proofed" and meet other applicable requirements. These regulations are based upon the Federal Emergency Management Agency (FEMA) requirements and affect your flood insurance costs. Existing residential structures can be "substantially improved" by interior renovations or new additions or other improvements. EXAMPLE: In order to determine whether a proposed construction project would be classified as a substantial improvement, the market value of the building needs to be determined. This value is found on the official tax assessor's card for the property or may be obtained by a licensed property appraiser. That number is then divided by 2 to determine the substantial improvement threshold. Therefore, a home with a market value of $100,000.00 could have no more than $50.000 worth of new construction /renovations and /or repairs before the house would have to be elevated above the 100 year base flood elevation as shown on the Flood Insurance Rate Maps. It is the responsibility of the Building Department staff to ensure that the market value estimates are accurate and the cost estimate reflects the actual costs to fully repair the damage and make any other improvements to the structure. The staff requires that the permit applicant or owner of the building supply the proposed construction cost estimate, or contractor's contract, to make the determination. The staff then uses the latest "Means Square Foot Costs" and "Means Construction Cost Data" books to determine the accuracy of the estimate. These are nationally accepted manuals, which itemize all components involved with construction. The manual provides adjustment rates to handle the varying construction costs throughout the country. Q: What should be included in a contractor's estimate? A: Basically, the only items that are not included in the cost include plans, specifications, surveys and permit fees. All materials that are permanently a part of the structure should be included in the cost estimate. These items include, but are not limited to: windows, doors, hardwood floors, wall to wall carpeting, sheetrock, lumber, roofing material, footings, pilings, kitchen cabinets and counter tops, bathroom vanities, tiling, plumbing fixtures, new furnaces, hot water heaters, heating and air conditioning systems, electrical work and labor. The cost of all materials involved in new construction or replacing and restoring a structure to its pre- damaged condition must be included. Even if volunteer labor or self -labor is used, it must be estimated based on minimum -hour wage scales for the type of construction work that is done. Created on June 2009 Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Several properties in Miami Shores Village are located in a Special Flood Hazard Area (SFHA) as determined by the Flood Insurance Rate Map (FIRM). Development in a SFHA requires special attention to help protect life and property in the unfortunate event of a flood. Miami Shores Village Flood Damage Prevention Ordinance requires that the Building Department determine if a structure will be "Substantially Improved" prior to issuing any permits for improvement or repair. "Substantial Improvement" is defined in Miami Shores Village Flood Damage Prevention Ordinance as follows: "any reconstruction, rehabilitation, addition, or other improvement of a structure, the cost of which equals or exceeds 50 percent of the market value of the structure before the "start of construction" of the improvement. This term includes structures that have incurred "substantial damage" regardless of the actual repair work performed." The starting date to determine cumulative costs will be 12 months prior to the issuance of any permit under consideration. All future work considered would require appropriate approvals prior to construction. All cumulative costs will be re- evaluated at the time the permits are issued. Q: Why was the 50% figure chosen as the substantial improvement threshold? A: The 50% threshold was chosen as a compromise between the extremes of 1) prohibiting all investment to structure in SFHA and 2) allowing structures to be improved in any fashion without regard to the hazard present. In the first alternative there is potential for causing hardship to those who have located in a SFHA without knowledge of the risk because the structure was constructed prior to the designation of the area as flood prone. These individual could not improve their structures as damage or age contributed to their deterioration. The second alternative provides no mechanism to ensure that increased investment in SFHA will receive needed protection from flood risk, thus contributing to the increased peril of life and property. The threshold is thus a compromise at a halfway point. "Market Value" is defined in Miami Shores Village Flood Damage Prevention Ordinance as follows: " the building value, which is the property value excluding the land value and that of the detached accessory structures and other improvements on site (as agreed to between a willing buyer and seller) as established by what the local real estate market will bear. Market value can be established by an independent certified appraisal (other than a limited or curbside appraisal, or one based on income approach), Actual Cash Value (replacement cost depreciated for age and quality of construction of building), or adjusted tax- assessed values." Note: The "Market Value" does not include the value of the land or other improvements on the property. (ie: pool, gazebo etc.) Created on June 2009 O. facer Contracting, thc. 1615 SW 2nd Avenue o t Lauderdale,. FL 33315 05,1)4e7,9594 (554)467 -9925 license No: GGC 1 Remodeling of kites and Bathiuerns: install hardy hacker board in showers Pour new slabs in showers Redrptall vwith green bcerd :u *40 SAMS Plaster and serer Total 1700.E Witham' Install new ar - : . . . . . : ?;now ll cabinets ': :, : . Paiht errOre house Repair ::racks, caulk Apply two coats on walls and trim Toil Contract :. itchern cabinets eS 13513_O13 .Note: Bid doesrpt include cdyntem sinks files or par a l e to *..tr pan dt -and materials to corn w the above spec ations for the sum ot to be paid as'oliows: to be ne •dieted rna teriat',a be asspecified and al; wc:lc to be completed in a manner cos ilt nt standard ust F prate and itdi ng cedes. Any change to the above description of work or the specified materials involving exi-a costs will be consiCeTed a change and will be execute upon vrnt?e 7 rang order GontFa:. or WI provide liability and workmen's compensation insurance as reqUtred by Late L31,_ .: The above o AC Id circuit and - outlet for garbage disposal. o Add circuit & outlet for dishwasher. • _Add circuit &. outlet formicrawave. c. Add circuit & outlet for,rrefriaerator. c Acid 9 smoke detectors throughout the home. .TOTAL COST $ &500 Method of the payment.- . 1. Depost upon signing the contract For ordering materials. 11. Final draw upon completion citric cab. Notes: • The :work will commence s,iurtly after obtaining the building peririit A1_ work oe-torrned by RC! will be tinder warrant- for one year fr em the date of cutupletit)i►., . • his cDnifact price is guaranteed for 3.0 days from, !%s date of creatlan. • Any work noerentioned lit this contract, udirg inspector requests for aciclitio nal work, can be added lat,rhiachan order after reviewed by tine owner andRCL • tit rr.y u n fo r rs ?e.n z ircamstances pc rta n i p•:b to the e)d3t?ng structure, which may be discovered di gin reyieweJ by t,`le uwnerand RCl and if additional work is required; it may he charged as a change order. • Payments used for me order or purchase of material will not be rciancted. • i1Ci Design and ConstTuction, Inc_ is a Ger ~eralCorttractor licensed &insured in the state of Florida. i.ice:rse t CGC1S14 10. $ 3,000 rjrt $ 1,500 _1r. Raiszadeh /7 The prt ,ect: I c!; Lal Work Located at: 1020 NE 104 St, Miami, FL 33138 Hei PEfRRP UIITH r €j 2355 MAGNOLIA DR VE TEL SE4 3 ,92 8289 1' OR i H MIAMI FL 331$.1 Fr.*: 30E PS1 7883 www, RCIBU LD .coat ALT 305 89.C1 28 8 CO"C11'RACTLkGRE MENT ivlade th!S i'�. :':i1 of Mardi iv. the veal two thousalo oo c Roal 7 (P.O. Box 613:48, iw ; ! ?:1, i i 33261) and the contr:cfor RC 17esinn and Construction, nc..�_} L c•mract documents consist of the a2rcc1netlt betvwrzen o ncr and coca saetor, con conditiolts tai -ate con ct (Lend -ai., supp_ementary and other oond +:.'1 ?ns), spt.,,:ifications, addenda issu d prior R) execution o[ the ticntract_, other decumelis listed in the a .; went and r cdi Icattions issued after execut o. oFth contract. THE E WORK Permitting: Acquiru liarni Shores bu:'di department- electricaI.perniit for the electrical .,urk detailed below in this contract. • Permit runner foes. 3 Interior Electrical. • Add 5 high hat recessed fights in the kitchen. Add 8 GFIs in Vac kitchen. o Add 3 circuits for ( is. o Add 5 I-4,1t hat recessed lights :n.the bathroom -i- .Miami-Dade My Home My Home iTliami • Dade. o Show Me: Property Information Search By: Select Item N Text only Property Appraiser Tax Estimator Property Appraiser Tax Comparison Portability S.O.H. Calculator Summary Details: Folio No.: 11- 2232 -029 -0250 Property: 1020 NE 104 ST Mailing HEINZ GASSER &W Address: SHANAZ Living Units: 1020 NE 104 ST MIAMI Adj Sq Footage: SHORES FL Lot Size: 33138 -2656 Property Information: Primary Zone: 1100 SINGLE FAMILY RESIDENCE CLUC: 0001 RESIDENTIAL - SINGLE FAMILY Beds /Baths: 4/3 Floors: 1 Living Units: 1 Adj Sq Footage: 2,994 Lot Size: 11,520 SQ FT Year Built: 1951 $50,000/ $188,725 EVENINGSIDE PB 44 -53 Legal LOT 12 BLK 2 LOT SIZE Description: SITE VALUE OR 16491- 2011 0894 4 OR 16491- $25,000/ $213,725 2011 0894 01 Assessment Information: Year: 2011 2010 Land Value: $165,888 $69,120 Building Value: $342,558 $343,376 Market Value: $508,446 $412,496 Assessed Value: $238,725 $235,198 Exemption Information: Year: 2011 2010 Homestead: $25,000 $25,000 2nd Homest ad: YES YES Taxable Value Information: Year: 2011 2010 Applied Applied Taxing Authority: Exemption/ Taxable Exemption/ Taxable Value: Value: Regional: $50,000/ $188,725 $50,000/ $185,198 County: $50,000/ $188,725 $50,000/ $185,198 City: $50,000/ $188,725 $50,000/ $185,198 School Board: $25,000/ $213,725 $25,000/ $210,198 Sale Information: Sale Date: 18/1994 Page 1 of 2 ACTIVE TOOL: SELECT 4t CI GI 64 BE Aerial Photography - 2009 0 116 ft My Home 1 Property Information 1 Property Taxes 1 My Neighborhood 1 Property Appraiser Home 1 Using Our Site 1 Phone Directory 1 Privacy 1 Disclaimer If you experience technical difficulties with the Property Information application, or wish to send us your comments, questions or suggestions please email us at Webmaster. Web Site © 2002 Miami -Dade County. All rights reserved. Legend Property N Boundary N N Selected Property Street Highway Miami -Dade County Water http: / /gisims2. miamidade .gov /myhome /propmap.asp 4/24/2012 Pe milt o 12 58 Job Name: April 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 Page 1 of 1 1) Provide a "substantial improvement verification worksheet" available at the front counter or www.Miamishoresvillage.com 2) Provide a layout of the house showing the location of the area of work. 3) Provide a detailed scope of work on the plans. 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 Fnx, �I- 4fr1 -�9�5 ufilz/zuJL 14:57 FAA 1 S00 685 7530 DATA SCAN FIELD SERVICES e1001 * * * * * * * * * * * * * * * * * * * ** * ** TX REPORT * ** * * * * * * * * * * * * * * * * * * * ** TRANSMISSION OK TX /R% NO 2443 RECIPIENT ADDRESS 919544679925 DESTINATION ID ST. TIME 04/12 14:57 TIME USE 00'19 PAGES SENT 1 RESULT OK "1 1111 .-e121)1 Pe mit o: 12 -c 8 Job Name: April 11, 2012 Miami Shores Viiiage Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Page 1 of 1 Building Critique Sheet 1) Provide a "substantial improvement verification worksheet" available at the front counter or www.Miamishoresvillage.com . 2) Provide a layout of the house showing the location of the area of work. 3) Provide a detailed scope of work on the plans. 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 FAx q-q25 Llie9Q112rt-r1 ermi No: 12-45 Job Name: March 22, 2012 Miami Shores Village Building Department Building Critique Sheet 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 7952204 Fax: (305) 756.8972 Page 1 of 1 Provide all permit applications prior to any further review. ) Provide a "substantial improvement verification worksheet" available at the front counter or www.Miamishoresvillage.com . Provide a layout of the house showing the location of the area of work. Provide a detailed scope of work on the plans. 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 gp() s-rE.re„coNt-c2Q__. . Nrz-T 04/27/2012 13:05 FAX 1 800 685 7530 DATA SCAN FIELD SERVICES 2001 * * * * * * * * * * * * * * * * * * * ** * ** TX REPORT * ** * * * * * * * * * * * * * * * * * * * ** TRANSMISSION OK TX /RX NO 2494 RECIPIENT ADDRESS 919544679925 DESTINATION ID ST. TIME 04/27 13:05 TIME USE 00'19 PAGES SENT 1 RESULT OK Perm No: 12 -458 Job Name: April 11, 2012 Miami Shores Viiiage Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Page 1 of 1 Building Critique Sheet 3rd 1) Provide a "substantial improvement verification worksheet" available at the front counter or www.Miamishoresvillage.com . The plans submitted do not match the value of work shown on application. Provide a copy of an executed contract including a detailed list of material and labor. 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 replacewith new revised sheets and include one set of voided sheets in the re-submittal drawings. Norman Bruhn CBO 305 - 762-4859 F - V - 99 Q 5 Arienis Silvers From: Postmaster [postmaster @isp.att.net] Sent: Thursday, March 22, 2012 10:38 AM To: Arlenis Silvera Subject: Delivery Notification Attachments: ATT00001; FW: Message from KMbhC552 Your message was successfully relayed via mx.bellsouth.yahoo.com for delivery to: GFOSTERCONTR(abellsouth.net The Remote mail system does not support confirmation of actual delivery. Unless delivery fails, this will be the only delivery status notification sent. BUILDING PERMIT APP FBC 20 Miami Shores Village Building Department 10050 NE.2ad Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER (305) 762.4949 ON ROOFING Di . „, . ttleholder): ke.02.12-4. Id Mdress Pa S o 13 2, ts City: j1Ii1i State: PC ra FEB 1, 4 2013 Permit No. 1 Master Pewit No. (247-'• %-'4 Phonet TV' 33 zel Monet ttus.c,„..T• caw, JOB ADDRESS: 9.0 kte Cf City: Miami Shores County: Miami Dade Zip: k Folio/Parcel#: Is the Building Historically Designated: Yes NO Flood Zone: CONTRACIVR: Company N Address: -46A5 S).0 ? AVe: City: Viikir (6001(kiit_14-ag6 State: Pima" 78c 56( 3 7gW( TIP: 3 3 9 Quarter Name: Monet State Certification or Registration #: 1SrA g 8 Certificate of Competency 4t: Contact Flume: Address: Phone: DESIGNER: Architect/Engineer: Value of Work for this Permit: $ ' r Square/Linear Footage of Work: Type of Work: °Addition °Alteration ONew CiRepair/Replace °Demolition Desesiption of Work: ft.tv-c-AA-tt, Si( P/V.-c-uvrtHwei kt C- frv9 0.--z aPt sul,C (-14 44.„ 0 120 t".1. - • bit*, Nisi A id istoth it ,_-:,-,„ 111111111•1111111111.111611M111 .................................... . ....... C-2-____Vu_v 1-v__ _ C IC - rip u .. ,.., -4, ' OF ,......„...,0 -- 4° • •- '''' ee CO/CC $ tr41-17 Scanning Fee $ ee $ 7:600 0(3 DBPR $ Bond $ Notary $ Trandng/Education Fee $ Technology Fee $ Cirle Fee $ Structural Review $ TOTAL FEE NOW DUE $ dal 1 ,Bonding Co►'npany's Name (if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature The fore day of. L . , 20 Owner or Agent instrument was ac Signature Contractor wledged • pfore me /this "The foregoing instrument was acknowledged before me this if it ;�, ��, �,L') day of , 20 (3 , by (3,42v , who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUB C: who is . rsonally known to me or who has produced '1 identification and who did take an oath. NOTA Y PUBLIC: Sign: Print: My Commission Expi * * * * * * * * * * * * * * * * * * ** APPROVED BY "if,963.2/ Sign: Print: My Commis ******************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Plans Examiner Structural Review (Revised 5 /2 /2012)(Revised 3/12/2012) )(Revised 06 /I0 /2009)(Revised 3/15/09X Revised 7/10/2007) Zoning Clerk vt, wx7tIsaittz,org 7 Department of State http://wwwsunbiz.orgiscriptskordet.exe?actioDETF1L8ting... Next on LW, Rettic No Events No Name History Detail by Entity Name Florida Limited Liability Company REAL 7 LLC Filing information Document Number utt000tiun FEUEIN Number 273951482 Date Filed 11/15/2810 State FL Status ACTIVE Principal Address 5946 SW 135TH TERR MIAMI FL 33156 Mailing Address PO SOX 565715 MIAMI FL 33256 Registered Agent Name & Address QUILLIOT, REMY 5946 SW 135TH TERR MIAMI FL 33156 US Manager!Member Detail Name & Address QUIWOT, REMY 5946 SW 135TH TERR MIAMI FL 33158 Annual Reports Report Year Filed Date 1 of 2 2/21/12 10:08 PM wwwsun 1of2 Department of State http: / /www.sunbiz.org/ scripts /cordetexe ?action= DETF11.&inq... Previous on List Next on List Return To List No Events No Name History Detail by Entity Name Florida Limited Liability Company REAL 7 LLC Filing Information Document Number 110000118277 FEUEIN Number 273951482 Date Filed 11/15/2010 State FL Status ACTIVE Principal Address 5946 SW 135TH TERR MIAMI FL 33156 Mailing Address PO BOX 565715 MIAMI FL 33256 Registered Agent Name & Address QUILLIOT, REMY 5946 SW-135TH TERR MIAMI FL 33156 US Manager /Member Detail Name & Address Trite MGR RODIER, ALEXANDRE 2325 MAGNOLIA DRIVE MIAMI FL 33181 TRW MGR QUILLIOT, REMY 5946 SW 135TH TERR MIAMI FL 33156 Annual Reports Report Year Filed Date LTL 1/17/12 10:59 AM DEPARTMENT OF THE TREASURY REVENUE SERVICE CINCINNATI OH 45999 -0023 REAL 7 LLC ALEXANDRE ARMAND MARE, RODIER PSBR PO BOX 565715 MIAMI, FL 33256 Date of this notice: 11 -14 -2010 Employer Identification Number: 27- 3951482 Form: SS -4 Number of this notice: CP 575 B For assistance you may call us at: 1- 800 - 829 -4933 IF YOU WRITE, ATTACH THE STUB AT THE END OF THIS NOTICE. WE ASSIGNED YOU AN EMPLOYER IDENTIFICATION NUMBER Thank you for applying for an Employer Identification Number (EIN). We assigned you EIN 27- 3951482. This EIN will identify you, your business accounts, tax returns, and documents, even if you have no employees. Please keep this notice in your permanent records. that WWhheenfiling any documents, pats, and related correspondence, it is very important that cyose a delay E complete name and address exactly as shown above. Any variation y processing, result in incorrect information in your account, or even cause you to be assigned more than one EIN. If the information is not correct as shown above, please make the correction using the attached tear off stub and return it to us. Based on the information received from you or your representative, you must file the following form(s) by the date(s) shown. Form 1065 04/15/2011 If you have questions about the form(s) or the due date(s) shown, you can call us at the phone number or write to us at the address shown at the top of this notice. If you need help in determining your annual accounting period tax Accounting Periods and Methods. ( �'eaz) • s Publication 538, We assigned you a tax Classification based on information obtained from you or your representative. It is not a legal determination of your tax classification, and is not binding on the IRS. If you want a legal determination of your request a private letter ruling from the IRS under the y tax classification, RevnProcedure you may 2004-1, 2004 -1 I.R.B. 1 ors guidelines in Revenue Procedure Certain tax classification elections caan. be requested Procedure for the year at issue). Note: Classification Election. See Form 8832 and its instructions for Fadditioonal information. ormation. A limited liability copy (LLC) may file Form 8832, Entity Classification Election, and elect to be classified as an association taxable as a corporation. the LLC is eligible to be treated as a corporation that meets certain tests If will be electing corporation w Elecs and it g rperation status, it must timely file Form 2553, Election by a Small Business Corporation. The LLC will be treated as a corporation as of the effective date of the S corporation election and does not need to file Form 8832. To obtain tax forms and publications, including those referenced in this notice, visit our Web site at www.irs.gov. If you do not have access to the Internet, call 1 -800- 829 -3676 (TTY /TDD 1- 800 - 829 -4059) or visit your local IRS office. - • 1420112701047 , ,...j... ,. : .1: 40,00_0Y' _,..,., ep.! • • AlmiligNet •:* BROWARD COUNTY BUSINESS TAX RECEIPT 115 S. Andrews Ave., Rm. A-100. Ft. Lauderdale, FL 33301-1895 — 954-831-4000 VALID OCTOBER1,2011.2 THROUGH SERENER 30, 2013 Reggio gligiat47 1:A47A-a .CONTBACTOR (1201exr.E. Business TYluninumnre comanewon . • - Business Opened:02/ 83.12001. SixdalCounigiertlites:CC 1504588 Exemption Cade: ausbuiss itame: FOSTER • CONTRACIING INC Owner Namec GMT ALM. POSTER Business Location: 1615 SW- 2 AVE PT SADISESSALS Boehm:its Phone: 954-467-9694 ROOMS Seals EllsidoPees 1 leashines Professionals Farlleading Redness Oa* • Tannin:nod ......... -- Monster Fee SF NFee _ P anne' PriorYeass Colleefion Cosi . Total Paid 27.00 0.00 0.00 0.00 0.00 0.00 27.00 THIS REcerronusir �EPOSTED CONSPICUOUSLY IN YOUR PLACE OPBUSINESS THIS BECOMES A TAXIMCMPT Thisbe is levied for the Waage of doing bw4ness within ?rev/ad Gaudy and is nameguistwy fn name. You nwstinta� Con/ and/or Municipality planning WHEN RAMMED - and zonh:g nequilentents. This Business Tax Receipt must be bansferred when the business Is sold, bustness name has changed or you have moved the tombless location. No receipt dews not Indicate Mat the business is legal or that R is in Conga= with Sate or load hum and mutations. hialling Address: GARY AIM FOSTER. -- 1615 SW 2 AVE - - - PORT LAUDKRESILS, FL 33315 Reesipt-0018-11-00019648 Paid 00/20/2032 27.00 FOSGC01 OP N•: LO CERTIFICATE OF LIABILITY INSURANCE ' TES CERTIRCATE M ISSUED AS A MATTER OF INFORMATEN ONLY AND CONFERS NO tuff 5000 THE ATE HOLDER. THIS ATE DOM NOT AFFIRMATIVELY OR NEGATAMLY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES SOW. TINS ATE OF INSURANCE E DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING anthem, AUMOREED REPRESENTATIVE OR PRODUCER, AND THE MATE 1*0100R. IMPORTANT: N the saratats bottler is an ADDITIONAL INSURED, the Fa0 (Z s must be enclosed. 11 SINIROCIAMON M WAIVED. sagest to Oo ten= and somMtions of de policy, certain po may require an eadersament. A statement an Ns certificate does oat soarer rigitstotba alaNfists imlderla has death PROVACER Elatomagarpfasusaaas Agency Ft. Lawasdals, . Oakland X11 tegahael 6 Pooh* 984. 738 -5500 984 -738 -Xf52 ra.* MEUREROAASVARDINGCOVCRAGE saw= A :First lasiButy h15Urafbe Co meat G. Faster Cantracthnt, Inc. LW Consbuctlan Writ LLC Ada Mr. Gary Fob Fi5a a FL33315 COVERAGES assumes : Ins Co SISINERC: *AMAMI,: 10701 CERTIFICATE PIWAINSIb REVISION BER: INS M TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED i lY HAVE SEEN TO THE MUM NAMED ABOVE FOR THE POLICY P000D INDICATED. NOTWITHSTANDWG ANY REOUIRMENT, TERM CM CONDITION OF ANY CO TRACT OR OTHER DOCUMENT WITH RESPECT TO WHEN TEES CERTIFICATE MAY 50 MED OR MAY PERTAIN. THE ISISURAISZE Ate BY THE PCOCIES DEN3R0303 HEREIN M EJECT TO Ate 1HE TEIDdS, EXCWSIMS AND ODNISTIONS OF SUCH PCLICIES. uI �_ 7t.MSTS 1MAY HAVE BEEN 0Y PAID CLAI CLAIMS IVEDEAPpayanspenna PEASOKALAADVINAAW • ACHE P IS- COrfAW Ae G $ 1,0,006 $ 100,000 S SMIS CWITWICAIE HOLDER ACS 26 (20102E5 CANCELLATION ant OF FORT LAUDERDALE 700 N W 79th avenue FQRTLAUDERDALE FL33311 SIAMILD ANY of, TNE PCNICIESSE C .ED SEFoRe TIE ENWEATION RATS 'THEREOF, NOTICE WILL BE ESMOND IN ACCOPIDANCEWITWTHEPoLICYINKanelotalL 421.#11 0 1668.010 ACORO CORPORATION. AS rights reserve& T1mACORD came and logo are registered marks of MORO CID/Z1//ill/ 11:36 No.285 4002 •� T OP ID: NX '"�� '� CERTIFICATE OF LIASIL ITY INSURANCE THIS CERNRCATE iS ISSUED AS A NATTER OF REFININIATION ONLY AND CO FEIN NO RIGHTS UPON ISP CERTIFICATE HOLDER. TM CERTIFICATE COES NOT AFFI RMA1WELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURERS), Ammons REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: ditto codifies s holder is an AoiNTIOMAL INSURED, the pWbz (e!) must 6o endorsed. R suBROQA[IWY R 1lYMVED, subject to the terms mid condtln ns alms pniley, certain -pandas may require an endorsement. A statement on tMs certificate does not confer dgf+ts te the certificate holder inn lieu arrant, endrasemodieL PRONE Gateway B re Agency Sir om 2430 W. Oakland Park Blvd. Ft. Lallderdate, FL 33311 954- 73545501 Mk 954- 736 -2 G. Foster Contracting, Inc. Attn: Mr. Gary Faster 9615 S.W. 2 Avenue Ft Lauderdale, FL 33315 AFFORDING COVERAGE mum A : first Mercury lissom= = Co HNC 1 MUM 04 CastlePelnt Florida Ms. Co. eaLiMates ego: POURER E F: VERAGES CERTIRCATE NUN THIS IS TO CERTWYTHAT THE PCP-ICES OF INSURANCE LISTED BELOW HAVE BEEN ESUED TO THE SEURP.0 NAMED ABOVE FOR THE POUCY PERK INDICATED. NO1WJTHSTANDING ANY REQt1NElENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUBBENT WITH RESPECT TO WHICH 'Dos CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE IHRIRANCE AFFORDED BY THE PEES DESC EED HEREiN M MUM,' TO ALL THE TERMS, EXCWSIONS AND Cn NumON$ OF SOW POLICIES. LsIIITSSHOWN MAY HAVE DWG KWUCED SY PAID CLAIMS. IN A tYPEeISWWiCE ,'jai tJeafs asteatettmosnor 6ACGL000000953801 04114riz 04014013 estaiOCCJRRENa WW1" ' a } _ Y 1,008,000o X r cowman ono-RN ItAn sir/ IO to C1 s 403,�l t:H•D ROM » $ 5,000 PISISONAL & MN MAO B 1,000,000 tit •td, AGGREGATE S 2,000,000 i#kArL AGBRFrarit tlt#T 011:4 if3P[tt —1 POLICY i i i .t f:/ 111.0c asssnuas.. t>otOP AGO s ' Z:000,000, Marl ,_ t t S $ $ ti nemensne MUM ANY ALTO ,amtat Y Rt.AtRV V:* perond $ Viif Atfr . -.--4 ttt AUTOS LED NON tread) a .re1AHrt earAid+d,t} s ,�� r' Y+n� a r* WARAELLA UAB EXCESS ME OW IS O,� EAO4OL AREWICL $ t .GAti: $ —• EO 1 l memos., $ Et IVORKERE GosPONSmlog ANC EMPLOY taatmuY star Er tl Y ekend l tP1 L __ l ows. Omega emits DESCPPEONce tiltititt KINSIISPT NI A �AtCP7BOB31 05114/i 1 IEM4112 X (T, t items l )ate`'' s 100,000' $ 109,000 E 500,00G El- exert An:c Hy EL OLEEA'E. at non OlTT' E.L.IMANt IIXICY U$T Oslo fl1o$ or CPoWREA$1 t.00ATiONS I V6 IcLE5 IAttavhACOR0161. Atitspt nal Reno*" Schedule Wmata ems ASraimd CANCELLATION City of Miami Sire snoULD ANY OF THE ABOVE DESCRIBED POLfiCESS 8E CANCELLED BEFORE IDE EXPIRMiON DATE TosesoP. NOTWCE WU RE DELIVERED 111 ACCORDANCE vnm THE PUUCY PROVIIRCHIG, AUFHO>rlZED REPRESENrA1we 9Q9- ACORD 25 (2010035) 0 1808.2010 ACORD CORPORATION. AR rights removed. The ACORD name and logo are registered masks of ACORD 05/21/2012 11:18 NO.284 #001 , ;d.,>'.?yr.�:��t�l =inn n; f!•;? • }r; a4 i ;.•yes:" i'.v 7kfit;'o�T.:{,;! �•i3 eiu' '•n! rlt'•a: 44 oikli. �4!�7C�li�lyi Y,6•i•�ttia�al BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT 115 S. Andrews Ave., Rm, A -100, Ft. Lauderdale, FL 33301 -1895 — 954- 831 -4000 VALID OCTOBER 1, 2011 THROUGH SEPTEMBER 30, 2012 DBA: Receipt # :180 -5047 Business Name• G FOSTER CONTRACTING INC I�usiness Type• E CONTRACTOR !GENERA • '>3IrII�1�1NG CONTRACTOR} Owner Name: GARY ALAN FOSTER Business Opened:02 /01/2001 Business LOcation: 1615 SW 2 AVE StatelCountylCert/Reg :cBC 1504588 FT LAUDERDALE Exemption Code:NONFXI;MPT Business Phone: 954 - 467 -9694 LTax Amount Rooms Seats Employees Machines Professionals 1 Number of Machines: For Vending Retsiness Only 37,00 Transfer Fee NSF Fee .90 0.00 Penalty Vending Type: Prior Years Collection Cost 0.00 0.00 Total Paid 0.00 27.00 THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS THIS BECOMES A TAX RECEIPT This tax is levied for the privilege of doing business within Broward County and is non - regulatory in nature. You must meet WI County and /or Municipality planning and caning requirements. I•his Business Tax Receipt must be transferred when the business is sold, business name has changed or you have moved the business location. This receipt dons; not indicate that the business is legal or that 1l is in compliance with State or local laws and regulations. WHEN VALIDATED Mailing Address: GARY ALAN FOSTER 1615 SW 2 AVE FORT LAUDERDALE, FL 33315 -201 - 2012 Reacipt #034 -10- 00003733 paid 09/19/2011 27.00 361 I l3 14-1' c Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 Permit No. CI — } Master Permit No. l 2 kiSTS—" BUILDING PERMIT APPLICATION FBC 20 b ?13 Permit Type: MECHANICAL OWNER: Name (Fee Simple Titleholder): t c-/k1. LLC' Phone #: SZ3S $a 4- Address: /WO N.F.4 Oil S-67-7- City: TUAra SkOR.ES State: WO AM Zip: g3)38' Tenant/Lessee Name: Phone#: Email: JOB ADDRESS: City: Miami Shores Folio/Parcel#: Is the Building Historically Designated: Yes County: Miami Dade NO Flood Zone: CONTRACTOR: Company Name: Y1.01 -0 `�-` 1 A `� lc Phone #: 30S 2. ' 61C Z Address: k '% 7 S S\n. (L0 \Ayr- ...Q City: (\ AA \- State: r L _ Zip: ��121- Qualifier Name: N' 1 1'VOS Phone#: 3a.5 23$' 63 CZ_ State Certification or Registration #: (.0 5 I2_C Certificate of Competency #: Contact Phone#: Email Address: DESIGNER: Architect/Engineer: Phone #: Value of Work for this Permit: Type of Work: °Address °Alteration Description of Work: : d . �G'�%I, %/ $ �, Square/Linear Footage of Work: N A °New °Repair/Replace °Demolition ** * * * * * * * ** * * * * * * * * * * * * * * * * * *% Permit Fa Submittal Fee $ $ Scanning Fee $ Radon Fee $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ * * * * * * * * * * * * * * * * * * * * * * * * * ** CCF $ CO /CC $ DBPR $ Bond $ Technology Fee $ TOTAL FEE NOW DUE $ Bonding Company's Name (if applicable) Nf 4 Bonding Company's Address City State Zip A. Mortgage Lender's Name (if applicable) Mortgage Lender's Address 140,- City State Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for FT.RCTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC OWNER'S AFNIllAVIT: 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 attaclunent. 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 ,• •,: einspection fee will be charged. Signa Owner or Agent The foregoing instrument was acknowledged before me this day of Lc (kfte,f20 NI, by ieeoe who is personally known to me or who has produced As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Co APPROVED BY STATE OF LO omm# EE161218 te1® Expires 1/18/2016 - * * * * * * ** Contractor The foregoing instrument was acknowledged before me this day of ° 25 , 20 by /IAN ! LJ�rd r svi S , who is personally known to me or who has produced 2.1t) as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commission Expires: * * * * * * * * * * * * * * * * * * * * * * ** s Examiner Structural Review (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) STEPHEN HIDEKEL NOTARY PUBLIC =STATE OF FLORIDA /fie s► Expires 1/18/2016 Zoning Clerk Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 BUILDING PERMIT APPLICATION Permit Type: Electrical JOB ADDRESS: /0.2- O A /0Y1 6 ' FBC 20 1.0 Permit No. -�-- -' L J _ — Master Permit No. l . , i -1 City: Miami Shores County: Miami Dade Zip: 3 7 .3c1 Folio/Parcel #: Is the Building Historically Designated: Yes NO Flood Zone: OWNER: Name (Fee Simple Titleholder): aeeor 7 .' Cf, Phone #: 3 0 7 7 P-° l'717 Address: "f 7 4g-a lC / 3 Z 4/1,0 City: /1r c "1'7 ® State: ® Zip: 3 Tenant/Lessee Name: Phone #: Email: CONTRACTOR: Company Name: C�i 7 €1 C Phone #: -c9 25—�v�� Address: 4-2,' -- City: State: ( Zip: a 3 fe ,- Qualifier Name: -t t Phone #: " State Certification or Registration #: ..e.---/.,47e/s)70 Certificate of Competency #: Contact Phone #:304/6 ®°->17-47 Email Address: DESIGNER: Architect/Engineer: Phone #: Value of Work for this Permit: $ ®C) • 4 Square/Linear Footage of Work: Type of Work: ❑Address Description of Work: teration New DRepair/Replace //6 e ' . ODemolition 1/1 JEAMILIMISIM * * * * * * * * * * * * * * * ** * * * * * * * * * * * * * * * * * * * ** Fees************* * * * * * * * * * * * * * * * * * * *** * * * * * * * * ** /gym'•A'6�° / W Submittal Fee $ 0 : _'0 Permit Fee $_L S 5e2-- CCF $ CO /CC $ rip 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 issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature Signatur" Owner or Agent The egoing instrument was acknowledged before me this 1 20 5, by r.9( ze, app )114-2,,, day of- who is personally known to me or who has produced PL.- )D As identification and who did take an oath. I�t ? NOTARY PUBLIC: Sign: Print: My Commission Expires: Wnu��hr • d )(IKON iii . SI• �s> Contractor The foregoing ins ent was acknowledged before me this" e, n day of r� % , 20 /3 , by who is personally known to me or who has produced as identification and who did take an oath. NOTARY P IC: Sign: Print: % t) t � 2E�r s4/'•� My Commission Expire� , Pteo LUIS FERN N-4/4 '9/ MY COMMISSION # EE838180 ��aimtilnr + + + +` * =:- �`a�:`i *EXPIRES:Novem ,�}q�= � �o° gTMt8t�d9e1 :YoYk:Y:Y YoY4:9:koYaYoY:@eYnY4e9: k& Y�Fk:Y:Y�::F Y3:: FAY: Y3e9e�Y dr�YaYae�Y�Y�Y�Y:F:F:Y3e9e9:& Y9:3roY�YaY�Y9e:Y�Y:F:F�F -k�Y3: k9F3e9:4e:F9: Yk9: Y9r�Y�Y4e�Y APPROVED BY / lip . Plans Examiner Zoning Structural Review Clerk (Revised 3 /12 /2012)(Revised 07 /10 /07XRevised 06 /10 /2009XRevised 3/15/09) r. Miami Shores Village Building Departme 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4 BUILDING PERMIT APPLICATION FBC 20 Permit No. 014-4 l)_ Master Permit No. Permit Type: PLUMBING OWNER: acne (Fee Simple Titleholder): (&4J ' (,L PhPima: 'C(2 S Li I Address: cO osc 6124 % City: F 1t State: 4 C Ely- 3326' Tenant/Lessee Name: JOB ADDRESS: 4'02-c2 flir 6 AO C/- City: Miami Shores County: Folio/Parcel#: Is the Building Historically Designated: Yes CONTRACTOR: Company Name: A (J T 6(.4 yy sc,�f 7' j(ak d4 Phone#4 3 3 [1 �d Address: A4 7__po at) F%./ A s'rPOi- City: Ik ; e State: : 33 3i5 Qualifier Name: Pbone#: State Certification .orrRegistration #: C A 4'L 1 1" ' Certificate of Competency #: } Contact Phone#: - 94 3 1384 Email Address: DESIG t Di' chi ' • et / `" `r4- 0 '4 0 Cci1A— 1.--5 am_ Value of Work for this Permit: $ 0 Type of Work: DAddress Description of Work: Photo#: 3v i 5 • 527 3 Square/Linear Footage of Work: []Alteration ONew ORepair/Replace ODemolition 1).„0 v (157 et_yvt o *swew+rwssuau+ ********** *woae,****t. **rs**Fees +�aarass+s --! 4tn P�,7 k'. (l'a Submittal Fee $ Permit Fee $ 7� CF; b r C $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/lineation Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ tl- Bonging Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection f e will be charged. Signature er or Agent The fore of i a. day of Y , who is per ;onall kw non to me or who has produced \ g mentvas ac, owledged NOTAR PUBLIC: Sign: Print: My Commission Exp. fore m; Signature Contractor The foregoing instrument was acknowledged before me this y// day of , 20 J by / who is personally known to me or who has produced ntification and who did take an oath. � P Ii L `v. CUBfLLOS e of Florida My Comm. Expires Sep 23, 2015 s: ,,,,,,,,, ' Bonded Through National Notary Assn. * * * * * * * * * * * * * * * * * * * * * * * * * * ** APPROVED BY as identification and who did take an oath. OTARY PUBLIC: Sign: Print: emu' l V 4r�(.. J. My Commission RE 829401 gIF Expires 10/14/2016 My Commissio c State of Florida *********************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Plans Examiner Zoning Structural Review Clerk (Revised 5/2/2012)( Revised 3/12/2012) )(Revised 06 /10/2009XRevised 3 /15 /09)(Revised 7/10/2007) 'THIS UOCUMENT HA !;,' A COLORED BACKGROUND - F4ICROPRiNTING LINFAIARK'" PATENTED PAPER $'3!".• 'ST TE OF FLORIDA. • - • 4' s TION - ne SEW Lii061900946 DATE " BATCH NUMBER 3fc 043:64 CO Iii SST 'S CERStrx Tinder ''`Ehliit:41.46;vi a iiiirti3 of.:-:,dha Expiration date: AUG 31, 20 .: .•-•,,,:. ,:i•:, ':; ,'''' '.• •,. ,'.k,k ...`,1 :',. ::.. • -: c , . Comorii, aos m,... • '''':=A & rOINTER ISE A5i‘S'16414irifi 4i'l 14720 SW 20TH STREET i,',,,I, — - "'" ''''''";_. • DAVIE I FL 33325 ,,., ,,, ,,,. ,..; ,.:: 1::• , : * " !-• ' . •:,.: ::- „, •::L.,:•:;.; „ _ , :.> .,..!,•.1 •..- • :i1; •:' :,,: ::.'. •!!,•. ,,., •': :s t .2.; • . : -. ,•:: •,,,,, ,:. •• •• .,•,., '%.,.\.:;, • Li= F:, ;;;'. e t:=:-:‘,..,;‘, .!'; :•.= •::,..•,,,,.... ,.: • :. T.; '!. !, .''•: .,;..,,,, en p ,,nzn, c,, ,,,,,;, . %.1 4 r ij BROWARD- COUNTY- LOCAL BUSINESS TAX-11 - 115 S. Andrews Ave., Rm. A -100, Ft. Lauderdale, FL 33301 -1895 – 954- 831 -4000 VALID OCTOBER 1, 2012 THROUGH SEPTEMBER 30, 2013 DBA: Business Name: IBC I ENTERPRISES Owner Name: JOSHUA A COHEN /QUAL Business Location: 2113 LINCOLN ST HOLLYWOOD Business Phone: Rooms Seats OF SOTJTH FLORIDA Receipt # 82 — 22 00 Business Type: (PLUMBINGLCONTRAc!r Business Opened:06 /15/2004 State /County /Ceft/Reg :CFc1425 717 Exemption Code: Employees 12 Machines Professionals THIS RECEIPT MUST BE THIS BECOMES A TAX RECEIPT WHEN VALIDATED POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS This tax is levied for the privilege of doing business within Broward County and is non - regulatory in nature. You must meet all County and/or Municipality and zoning requirements. This Business Tax Receipt must be tra eed when the business is sold, business name has changed or you have moved the business location. This receipt does not indicate that the business is legal or that it is in compliance with State or local taws and regulations. Mailing Address: A & I ENTERPRISES OF SOUTH FLORIDA 2113 LINCOLN' ST HOLLYWOOD, FL 33020 --2012 -2013 Receipt #04A -11- 00011427 Paid 07/17/2012 54.00 ACCORD CERTIFICATE OF LIABILITY INSURANCE DATE 6/13/2012 THIS CERTIFICATE 18 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 poticcy(Ies) must be endorsed. If SUBROGATION 15 WAIVED, subject to the terms and conditions of the policy, certain policies may regadre an endorsement A statement on this certlftcate does not confer rights to the certificates holder in lieu of such nt(s). PRODUCER PrimeGroup Insurance Services, Inc. 5440 Beaumont Center Blvd. Suite 8445 Tampa FL 33634 COW CT wee Jessica Etorneault - >561 -578 -6667 (813)890 -0415 I micFAX INC. ($13)B05 -4311 A s: jmornaault@primegroup3.as.cos AFFORINNS COVERAGE NAIL e INSURERA Harleysville Mutual IDS . Co . 14168 mew A 6 I Enterprises of South Florida 2113 Lincoln Street Hollywood FL 33020 DOURER s AIDCO Allied Property & 42579 INSURERC RetailFirst Insurance Company 10700 INSURER O : INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER:CL1261310182 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 POUCIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY P��AIIDDC�CLAIM S. f IR TYPE OF INSURANCE (N3R y POLICY NUMBER [M IYMI lkel(ODDJIWYYI UNITS A B GENERAL IMAM X COMMERCIAL GENERAL LIABILITY 1 CLAIMS -MADE a OCCUR GEM. AGGRE�G�ATE( UMIT APPLIES PER' X POLICY! I Ter n LOC AUTOMOBILE LUUNIJIY X ANY AUTO — ALL OWNED _ AUTOS X HIRED AUTOS GL00000096521A 6/17/2012 S/17/2013 EACH CCCURRENCE $ 1,000,000 DAMAGE ID RENTED PREMISES (Ea otdsre T ) $ 100,000 MED EXP (Any one person) $ 10,000 PERSONAL& ADV INJURY $ 1,000,000 GENERAL AGGREGATE s 2,000,000 PRODUCTS - COMP/OP AGG 5 2,000,000 SCHEDULED w AUTOS D _ AUTOS SCB5905150997 7/27/2011 7/27/2012 CO SINGLE UMJT BODILY INJURY (Per person) 5 s 500,000 5 BODILY INJURY (Perm/dent) $ PROPERTY DAMAGE $ AaRaston UMBRMA A UAB OCCUR EXCESS LIAO CLAIMS -MAZE DED 1 1 RETENTION S EACH OCCURRENCE $ AGGREGATE $ $ c WORKERS COMPOISATION AND EMPLOYERS' LIAINUTY ANY PROPRIETOWPARTNEPADECUTIVE (Mandatory yy�. ht NIt) EXCLUDED? DESCRIPTI ORATIONS below YIN 0 NIA 0520 -40541 5/1/2012 5/1/2013 IO A SI I ER� T MIT ER EL EACH ACCIDENT EL DISEASE - EA EMPLOYEE EL DISEASE - POLICY UMIT 5 1,000,000 s 1,000,000 s 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / YEWcLES (Attach AOORD IB1. Additional Rama/Its Schedule, more space Is required) CERTIFICATE HOLDER CANCELLATION Miami Shores Village 10050 NE 2nd Ave Miami Shores, FL 33138 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 E Ellsasser #A077187/ ACORD 25 (2010/05) INS025 mum vn 4 1988 -2010 ACORD CORPORATION. All rights reserved. This eerten nanra end Innn are raftlataar.A mmr)ra ni ar`ADn Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 'Inspection Number: INSP - 188037 Inspection Date: March 26, 2013 Inspector: Perez, JanPierre Owner: QUILLIOT, REMY Job Address: 1020 NE 104 Street Miami Shores, FL Project: <NONE> Contractor: FLORIDA STATE A/C Permit Number: MC- 3- 13-494 Permit Type: Mechanical - Commercial Inspection Type: Final Work Classification: Addition /Alteration Phone Number (786)925 -4181 Parcel Number 1122320290250 Phone: 305 - 238 -6362 Building Department Comments RELOCATE AC COMPRESSOR Infractio Passed Comments INSPECTOR COMMENTS False -- Inspector Comments s CREATED AS REINSPECTION FOR INSP- 187255. +\4 •"4 \,..7./., 1) /2) .k‘ 1 01 Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled re- inspection fee is paid. until March 26, 2013 For Inspections please call: (305)762 -4949 Page 1 of 1 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 CL Inspection Number: INSP - 187255 Permit Number: MC- 3- 13-494 Scheduled Inspection Date: March 18, 2013 Inspector: Perez, JanPierre Owner: QUILLIOT, REMY Job Address: 1020 NE 104 Street Miami Shores, FL Project: <NONE> Contractor: FLORIDA STATE A/C Permit Type: Mechanical - Commercial Inspection Type: Final Work Classification: Addition /Alteration Phone Number (786)925 -4181 Parcel Number 1122320290250 Phone: 305 - 238 -6362 Building Department Comments RELOCATE AC COMPRESSOR Infractio Passed Comments INSPECTOR COMMENTS 3 False Inspector Comments Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. March 15, 2013 For Inspections please call: (305)762 -4949 Page 31 of 54 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 20'1.0 Permit No. j Master Permit No. T f y� 1 C t 3 `Ln `'R Permit Type: MECHANICAL OWNER: Name (Fee Simple Titleholder): P.a. Az74.6 e ' , Phone #: '8 6 Q ZS ti l81 Address: / ®.2' 0 4(4e."-'. Ao 9. 5 f City: _‘.i .4 ' State: _ Zip: 3 3 / 3g A- Tenant/Lessee Name: b Phone #: Email: JOB ADDRESS: divv-0d ,ie) V5 Miami Shores County: �fi City: Folio/Parcel #: l g.2.....39._0/2.9 eD 3-5—o Is the Building Historically Designated: Yes NO Miami Dade Zip: Flood Zone: CONTRACTOR: Company Name:L.O Address: �% A-)`1 l� City. W 0 P 4 Phone# 3 Er° e2 � State: ,.. Zip: l j Qualifier Name: '/- 1 5 0 3 State Certification or Registration #: C y 1 0 r ` j Certificate of Competency #: 4 0 S > C 2— Contact Phone #: Email Address: DESIGNER: Architect/Engineer: /fh'lt /C CGifie l� Phone #: S 3 6 c Phone #: 30r— Ce7- l";l'6? Value of Work for this Permit: $ 5"O& • a) 0 Square/Linear Footage of Work: 4,-, Type of Work: Address ❑ teration ❑New ❑Repair/Replace ❑Demoliti Description of Work: ��k lr!? V i/0 i�"�®<� ®/u tea. 641/41,5•96., ,& '�?• ellt 1N'1 ®!a7 .Q* ?7' * * * * ** Submittal Fee $ .D Permit Fee $ Scanning Fee $ v Radon Fee $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ * * * * * ** *x1,0 * ** * * * * * * * ** *Fees' CCF $ CO /CC $ DBPR $ Bond $ Technology Fee $ TOTAL FEE NOW DUE $ / 5U r 60 Bonding Company's Name (if applicable) Bonding Company's Address City State Mortgage Lender's Name (if applicabl) /1l ,/,.." Mortgage Lender's Address Zip City State Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature Owner or Agent The foregoing instrument was acknowledged before me this day of ,20_,by A L nitN01 z who is personally known to me or who has produced — i lTh As identific.tion and who did take an oath. NOTARY PUBLIC: f Sign:. Print: )%'1 Y _ , jI I °L Z My Co Signature ° Contractor • The foregoing instrument was acknowledged before me this day of 3 - , 2013 , by AN T L L" k `2 t S who is personally known to me or who has produced as identification and who did take an oath. NOTARY ' UBLIC: JPlans Examiner Structural Review (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) Zoning Clerk 3/6/2013 4:15 PM FROM: Fax Pan Am Assurance Agency, Inc. TO: 3057568972 PAGE: 002 OF 003 . . . ... . • • ..• ...... ACORP. CERTIFICATE OF LIABILITY INSURANCE DATE AW/DD/IrTer 03/06/101,3 .c. PRODUCER (105) 210-1424 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION QNLY AND CONFERS NO MOWS WON THE CERTIFICATE : paia &It li.estOratide Atteildy, , pad IVLDER, THIS CERTIFICATE Dcms. :NOT AMEND, EXTEND OR 9 100 SunBet Dr ive AU HE ER TRE COVERAGE AFFORDED BY T POLICIES BELOW. .. .... .. . , ..... -*sintEr? : :FLORID 4 .6TAIR AIR CONDITIONING & ggimzoogx.wx(ar,. :3.3.6215 8W 142: AVE :lama FL 331.8:6 - COVERAGES 17t, 1317.J-3433: I SURERSA.FFORDING COVERAGE Dgiu ERA4TORTE POINT E OAS Iklair Xlqg Ic #. 39462 INSURER B:. INSURER Or. INSURER Lk' INSURER Et THg POLICIES OP INSURANCE LIVED BELOW HAVE BEEN ISSUEDTO THE INSURED.NAIVIED-ABOVE FOR THE .POLICY PERIOD INDICA f•1). NOTWITHSTANDING ANY .REQVIREMENT TER$11-01i CONDITION Of 'ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THJS:CERTIFIPATE MAY BE IBSUED. OR MAY ptferol, : , • THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. .sycLusums AND CONDITIONS- OF :SUCH POLICIES. AOGF7EGATE LIMITS SHOWN MAY 14AVEBEENREDUCE0 BY PAID CLAIMS INSR •: LTR A. ADM, :NBRD 1 P INS EOPk........i..........._L____.....................TY RANCE : POLICY NUMBER POLICY EFFECTIVE °ATE iwtmarey POLICY(DXFIRATION pATE- . . LGSMS. • : 3 0 9022:2 38 B2./22/2013 / / / / / / • :02/22/2:014 1 / / / / i EACH OCCURRENCE. . I.. 00 000 X - COMmERCIAL GENERAL LiAstifre .DAMGE.TURENTED* • .• - PREMISES .(EA:ociwrterl eni9 Om IC O., 0:0 O. 5., -0•00. I CLAW-MADE :OCCUR :14Erl'...8.41'4•Ani PERSONALTiAmtmLBAY $ 1).00 ',BOO .. 6ENEGG1 E 2, 0 00., .0:0.0 dt;,91.A0c;iittiArt X. Lifet-APPLIE PER: wcY yea ni.... !3•ROITUcTS.. COMP/Op.AQG $ 1,00 0, 00 0 ApTo$10131LE X. 1.4A5t2rf ANY AUTO ALL OWNER AUTOS- SCHEDULED AUTOS HIRED AUTOS NON-OwNED.AUTOR • 094122238 . . Q2/22/20.3 / / / / / / .02422 /2 0 4 / 1 / / 1 / comBINED-siNGLEsuma- .(Eastior;lefenq $ X0(40.00 'BODILY INJURY -(Per person) RGOILY INJURY .{PerizKOMMI PROPERTYDAMAGE (Per OrPfl:OPB . . . cATimie 1 1.*sitsre ANY AOTO. . ./ / .1 / AUTO ONLY*-EA.ACCIDENT $ OTHER THAN EA ACC /VI TO ONLY: AGG• • EXCESS/UMBRELLA sLIASILFrY OCCUR III CLAIMS MADE; / / / / 1 1 EACH OCCURRENCE AGGREGATE_ b*MuCTMLE AtraritON $ .. ... , . 1 / ........ - • $. $. WORKERS COMPENSATION.AND alPLOYERIF LIABILITY ANY FROPRIETORMARTNEpJEXECKIvt: OFFICERAMEMBER EXCLUDED? 11 V84, clee.0.111)/ ur.deT SPECIAL.P.ROVIVONStelow , / / / / ./ / P147041 lir 'o. FACHACCIDEN 4 / / El,..DIBEASE t EA EMPLoYEE.$ Est,. OISEASE - POLICY L rr $. OTHER: / /. • 1 / 1/ / / 1 / 1 / DESCRIPTION OF eplewnomti40ATIQN$114a4MEsiExcLusioNsAupe,DBYENDOBSEMENTJEPECIAL PROVISIONS - - -K0 fiespa..i.r: siii.4 To4t4Iiet-i-QA: r*Clartr.e.lt TIM • tini. etir.,r1 ,-----..v • City of :Ntiami taores 1/111-age 1'50 142: .2rui .Ave . :011.0tett ACORD 25' (2001/00): INS02454010.0).0$ rio. 3313.8, CANCELLATION . . . SHOULD ANY OE 'THE ABOVE DESCRI ED POL EXPIRATION: DATE THEREOF; THE r•CUING t DAYS WRITTEN NOTICE TO THE ERTIRCA. FAILURE. 110 $O SHALL IMPOSE NOD LIGAI1ON INSURER. ITS AGENTS-OR REPRESENTA AUTHORIZTED REPRESENTATIVE BL:ECT.RPNICIA3ETI FDPME, INC. ,•($0013.?7-1V4$ ES BE CANCELLED- BEFGRE THE R eurie.00R. TO MAIL HOLDER NAMED TO. THE LEFT, BUT R LIABILITY OF ANY IOW UPON.THE ... ::• ." ..... VACORD CORP'ORATION 986 Rego 1 of 2 t$ 9( ttflftr lfitititllltfif! liilt fftttffltllttllllttf1tli9fl41 98t££ ld IWVIW 3M Zht MS SZB£I S3?Id SONI2IIH3 AQNV 3NI 03 9I2Id321 8 3 V 31V1S VQId01d UHVMHOd _ON 00 OI S /N3NSON W I LS 03V3 113IVIS h- £47h0h0 'ON 1dI303H 1VM3N321 AVd ION Oa - 1119 V ION SI SIHI. 00'SL0000 I00£t0017ZZO Zt0Z /6t/60 ::30103110 4411 A111)4 = 11V41-lW41f1 C1.tiF,t3':3'1 11 = INfA'7d SYvOt3 31 40 N ii.LC S P 13 G Uhl f "..'�S 1311-;10 ntet eta 'd J.1fl 11-1 3P:!. 1.d'e'_;:.3 14 5-404 404' F.3:.l.IJ 5b A1410:J 3h.1 30 4, '41`' 414444/4 ,460.1,1-.11 ark ANtl a Lt. :PE' : °d r' 4 vCt:i .Lci':t'J !i't. ,93 N01Otl211NO3 1V3INVH33W UpdS 09 T, NI 03 9ISA321 S 3 '1 31ViS vaI210lt3„o AJNn03 3QVQ NINn 98I£2 3AV Z!I MS SZ8£I ONI 03 9Idd3S 8 3 Noild VIS3 V0INOlid1 h- £hh0h0 LEi 'ON 1)tlH3d ld `IWVIW aIVd 39ViSOd SSV13-1SHId 07 -26 -2012 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' COMPENSATiOIJ LAW * :ONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law. EFFECTIVE DATE: 07/26/2012 EXPIRATION DATE: 07/26/2014 PERSON: CHIRINOS ANU T FEIN: 592153811 BUSINESS NAME AND ADDRESS: FLORIDA STATE AIR CONDITIONIG & REFRIGERATION COMPANY 13825 SW 142 AVE MIAMI FL 33188 SCOPES OF BUSINESS OR TRADE: 1- HEATING, VENTILATION, AIR -COND IMPORTANT: Pursuant to Chapter 440 . 05(14), F.S., an officer of a corporation who elects exemption from this chapter by filing a certificate of election under this section may not recover benefits or compensation under this chapter. Pursuant to Chapter 440.05(12), F.S., Certificates of election to be exempt... apply only within the scope of the business or trade listed on the notice of election to be exempt. Pursuant to Chapter 440.05(131 F.S., Notices of election to be exempt and carrlIJtates 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 oo the notice or certificate no longer meets the requirements of this section for issuance of a certificate. The department shall revoke a certificate at any time for failure of the person named on the certificate to meet the requirements of this section. QUESTIONS? (8501 413 -1609 -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01 -11 DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD OCUtiF L12072500995 BATCH NUMBER LICENSE NE 07/25/2012.128017145 CA9057124% The ,CLASS B AIR CONDITIONING °Ca Named below IS CERTIFIED Under the provisions of Chapte` Expiration date: AUG 31, 2014 ANU TFRTTU FLORIDA STATE A/C &:REFRIGERAT,' 13825 S W 142ND AVENUE MIAMI FL 33186 RICK SCOTT GOVERNOR DISPLAY AS REQUIRED BY LAW,_ KEN LAWSON SECRETARY Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 188076 Permit Number: PL -4 -12 -612 Scheduled Inspection Date: March 27, 2013 Inspector: Hernandez, Rafael Owner: QUILLIOT, REMY Job Address: 1020 NE 104 Street Miami Shores, FL Project: <NONE> Contractor: A&I ENTERPRISES OF S FL INC Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Addition /Alteration Phone Number (786)925 -4181 Parcel Number 1122320290250 Phone: 000 -424 -0226 Building Department Comments PLUMBING WORK FOR TWO BATHROOM REMODEL Infractio Passed Comments INSPECTOR COMMENTS False Passed -)( Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments March 26, 2013 For Inspections please call: (305)762 -4949 Page 14 of 20 Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 BUILDING PERMIT APPLICATION FBC 20 Permit No. Master Permit No. la APR 0 2612 ii B Y -- - - -- Ir- 42- Zip: 1 `45K Permit Type: PLUMBING OWNER: Name (Fee Simple Titleholder): 6 /V e= 7 Z--4 Phone #: l &� Z k 4/r/ Address: mo £cX 6/ 3; f 8' City: s y� 9!t- -o State: fL. Zip: 33,A6.7° Tenant/Lessee Name: Phone#: Email: JOB ADDRESS: /agILI N6 /0t7 City: Miami Shores Folio/Parcel #: Is the Building Historically Designated: Yes County: Miami Dade NO / CONTRACTOR: Company Name: /41r-Z- . e /dry ,f �'A /fe-r G .� /CA Address: t..if 3 ,/d09u6' -e,1 IT City: a� 06/6 State '`9' Qualifier Name 00 �; <144 (—JO- 01� ^,l State Certification or Registration #: CFC �i. ."� ,( �� Contact Phone#: 717 79-0 ' 01 7 3 a Email Address: Flood Zone: Phone #: 7(r-7 O -073 t Zip: 5 3 oeO Phone#: G Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Value of Work for this Permit: $ ! / Square/Linear Footage of Work: Type of Work: Description of re ❑Address teration ❑Newepair/Repla ODe�litio II ork: C'. " / h 4 �c.. -cam �iv`,.� -� eitr/i Submittal Fee $ Permit Fee $ Scanning Fee $ Radon Fee $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ /5 —;' CCF $ CO /CC $ DBPR $ Bond $ TOTAL FEE NOW DUE $ O :10 Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature Owner or Agent The foregoing ins ment was acknowledged before me this 490-- c day of r• ,20.12,-by who is personally known to me or who has produced As identification and who did take an oath. NOTARY P : L Sign: Print: My Co STEPHEN `HIDEKEL NOTARY PUBLIC STATE .F FLORIDA es 1/18/2016 /1 Signature Contractor The foregoing instrument was acknowledged before me this/ le day of IAD^ Q � ,2O, by me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Co * * * * * * * * * * * * * ** x0/ *e** e:xm**** ** * **** ** **e * *e * *** * ****:x**** APPROVED BY 11'Plans Examiner Structural Review (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) Public State of Flo pa sne Gale EI a g799 MY commission E% Was 10120/2015 * * * * * * * * * * * * * * ** * * * * * ** Zoning Clerk Permit Number: EL -4 -12 -573 j Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 inspection Number: INSP - 188033 Inspection Date: March 26, 2013 Inspector: Devaney, Michael Owner: QUILLIOT, REMY Job Address: 1020 NE 104 Street Miami Shores, FL Project: <NONE> Contractor: MESA BROTHERS INC Permit Type: Electrical - Residential Inspection Type: Final Work Classification: Addition /Alteration Phone Number (786)925 -4181 Parcel Number 1122320290250 Phone: (305)345 -1974 Building Department Comments ELECTRICAL WORK FOR KITCHEN AND BATHROOM REMODEL Infractlo Passed Comments INSPECTOR COMMENTS False Passed Inspector Como, - • -- - , /00/ 76 ;- l 7C-- e'l. /Y 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 March 26, 2013 Page 1 of 1 r ami Shores V wilding Dep 1OYiUibUN. 2En Airs y 33I Tek 22041 Vac (;YFh , 1561912 iNspEcnows ipHoNE t, V° OM 762.4949 Permit Typc 0 Adibmt Bo)( K(3 2 4 cay: Al 4� ry s t►i,t��ili ,,r1; //�� 0 /y� 4 Sinna {o'.iE"g'u�lsaSaoiMO: �. ®.11 I- L G Amok. 3V S 3- O O � Q 332 --c9 Milli 0" 01 Penult ,. LI E'S13 Wallin' Permit No.(2-0 ss-: rr c tit.. ckik. Car Pheineit C A4 RP M :cLoni 2 ER ekvAti:e.com .4o Zra ,(6 .104 sf 1 Iwo' raix '33 X32 aY1B�l1%PIp' 9.J tiavaci:addti Designaeot Yes 146-) Hated ase: CRY: afr7` e P :30 6 1 7? cornea i "lcemu,w''> 3,6b as- 4181 K.+1011-' ci DESIGNEE: moues.. 'Witty) a¢: fl t Value of Work for Peisift $ 3®® StrarefLinrerF Type of ate CIMiless CiAltenfien of . o,v irk P: te..) ec a #Vf SubmIllel Fee $ Fermat Fee$ )5 v I0 Seaming ee 03 ,�j Baden fee$ lielluy $ � T Fee $ Double Fee $ Flainelawel Review $ MCC $ �Ba►w7 $ • :i.1 nue ti,4: m. PEE • UE ffi ) S' 0 �nRSn #9 „1r�. Nome Of ;E�ngndlew'EU C Sys Atibilmas City Sate Mortgage Yd's 1[ tar' il." (f C 1uo�vn`ii .wucum,a 4U ® *3 V: appEmble Dams 1 ts_ IC 11199fr. +I Z CAD ?I @1.YSi It441P01 /1 \t\'';:�i ;r e CO 01 'CEMENT MAY ® S TO YO FINANCING, CO OSLLT WITH maaaa I vu ■I &ll111 FAIL YO e 191r TO aiaII lr<11R13111dllellIE.” RECO A y'ate CE •IT PAYING TWICE FO YOU INTEND TO 0 TAIN 0 AN ATTORNEY ! of • RE RECO '1 ThiG YOUR OF CO ' 1}', `Il , :' ! I! promise' Y "e urn ,;F "ki'x itioa a copy the woke' of coormeneetneot e will be TAMP is subject d. el. ,diear �;1 jLr Ic ,cis, notice commencement pr the fNUbS �,l ,,,,,..,Z, v which ocean .k '$t2 1) pewit is .,.... . the inspeaion wall be approved and reinspect-um' re will be "JIC „!1199 [ fi17 i� °'r r tar A •tt 41 lodged brfore Feastmany brown to me al. Who I As ideartificarion and isto »AM sigsc POOt 'LIB r (U SOfi A119 ��Ge'i'!6 tar. I II ... .11 r 0711 C, ✓ +Q 111 ,bcao II liinuo,_ e`,: Beni$ s %„% ■ ■ Ki [L: dr:Everett to ?I7s' pawn sti > make, she ev:: aF v 't$ I: 111 tiV +38.119F�9B I uI i to 9: c . 11/ . J 1 ,09 Brmrirear S ]NOTARY Co .Y' dAYA 'GYii.tQU?.at 1� S j � rn: •,• a I1� H� or Who irol.�earidncwceGxll s Sig= 9:1 4%, e9f1 Wise 121110 r0 trl:;r ro9ad I.u1s�.Q k OF MY_ GOMMiSS10N i EE8�184 EXPIRES: N ' 2 q CERTIFICATE OF LIABILITY INSURANCE MESa6.1 OP ID:) I DATE (YWDD/YYYY THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS 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 BROWN & BROWN OF FLORIDA INC 14900 NW 79th Court Sulte#200 Miami Lakes, FL 33016 -5869 Ramon A Rodrigues INSURED Mesa Brothers Inc. 5215 SW 103rd Avenue (Rear) Miami, FL 33165 305364.7800 305 - 714.4401 CONTACT PHONE E Myrna°.Ex�` ADDRESS: IFAX (A/C. No) COVERAGES CERTIFICATE NUMBER: REVISION NUMB THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOUR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS INSRCERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, LTR EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TYPE OFINSURANCE e�DD'. wvn POLICYEFF POLICY EXP POLICY NUMBER IMMIDDIYYYYI NAMIDi1/YYYYI LIMITS INSURERS) AFFORDING COVERAGE INSURER A : FCCI Insurance Company INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : NAIC I 10178 GENERAL LIAB LRY A X COMMERCIAL GENERAL LIABILITY ICLAIMS -MADE © OCCUR GEN'L JC I AGGREGATE LIMIT APPLIES POLICY n n PER LOC AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUT HIRED AUTOS AUTOS ULED AAUITOS NED UMBRELLA LIAR H oCCUR EXCESS LIAR CLAIMS -MADE DED I I RETENTION $ ViDRICERS COMPENSATION AND EMPLOYERS' LIABILITY Y ANY PROPRIETOR/PARTNER/EXECUTNE OFFICER/MEMBER EXCLUDED? in dR yes,describe under DESCRIPTION OF OPERATIONS below GL00147261 GL00031919 01/01/13 12/18/12 01/01/14 01/01/13 EACH OCCURRENCE $ UAMA PREMISES (Ea occurrence) $ MED EXP (My one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ N/A $ COMBINED SINGLE LIMIT (Ea accident) BODILY INJURY (Per person) $ BODILY INJURY (Per a elde t) PROPERTY DAMAGE (Per accident) EACH OCCURRENCE 1,000,000 100,000 5,00r 1,000,000 2,000,00. Z000r00t AGGREGATE TORY LIMITS I I °ER $ DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Addlf o al Remarks Schedule, If more space Is required) CERTIFICATE HOLDER City Of Miami Shores 10050 N.E. 2Nd Ave Miami Shores, FL 33138 ACORD 25 (2010/05) CANCELLATION EL EACH ACCIDENT EL. DISEASE - EA EMPLOYEE EL DISEASE - POLICY LIMIT $ SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZEDREPRESENTATIVE ®1988 -2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD AC #62706.86 DATE OS 15 2012 THIS DOCUMENT HAS A COLORED BACKGROUND • MICHOpRINTING • LIINNEMA RK ' PATENTED . D .,... _ STATE OF FLORIDA DEPART NcTRICALSCONTRACTORSRLICENST ,N®�'p REGULATION �L BOARD SEQ# 1'12081301003 BATCH NUMBER 000000000 The ELECTRICAL CONTRACTOR EC1300187 Naamed. below IS CERTIFIED tinder the provisions of Chaptet 4 . PS. Expiration dates AUG 31, 2014 MESA, RAUL MESA BROTHERS /NC 5215 SW 103 AVE MIAMI • RICK SCOTT GOVERNOR ?L 33165 DISPLAY AS REQUIRED BY LAW KEN LAWSON SECRETARY `SAX RECEIPT 2013 FIRST -CLASS _OFF FLORIDA U.S. POSTAGE OF HUSINESS PAID MIAMI, FL ;, .4A rER,BA • ART. 9 & 10 PERMIT N0.231 THIS IS NOT A BILL - DO NOT PAY RENEWAL 040577 -9 BU $5 fimaillMTNc 33165 UOAVE UNIN NDAEC0 iFY tSSA BROTHERS INC STATE* EC 30b1870 040577 -9 81 W LVeT CAL CONTRACTOR WORKER /S TNI8 IS ONLY A LOCAL 1 0 0 0E E8E TAX 8 NOT PERECEIPT. I THE HOLDER TO VIOLATE ANY SUITING REGULATORY OR ZONING LAWS OP THE COUNTY OR C,TIES. NOR DO NOT FORWARD HOLD "0144 ANY OTHHIEI RAW fl BLAW THIS IBS NOT A CERTIFICATION OP MESA BROTHERS INC THE HOLDER'S OUALIPICA. RAUL MESA PRES 5215 SW 103 AVE PAYMENT IAMI.O CE COUNTY FL 33165 COLLECTOR COUNTY TAX COLLECTOR: 60010000347 000075.00 SEE OTHER SIDE ,Ili,I,,,,I1,11,„„11,l,431,lt COir? �''� CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 12/27/2012 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: if the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION 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 Andrew Atsaves Go Artex Risk Solutions, Inc. 8800 E. Chaparral Rd, Suite 230 Scottsdale, AZ 85250 CONTACT NAME: PHONE I/ Est): (480) 951-4177 FAX No): (480) 951 -4266 E -MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: American Zurich Insurance Company 40142 INSURED First Financial Employee Leasing IV, Inc. Alt. Emp: Mesa Brothers Inc 11400 Parkside Dr Ste 500 Knoxville, TN 37934 INSURER B : INSURER INSURER D : $ INSURER E : $ INSURER F : $ $ COVERAGES CERTIFICATE NUMBER: 13TN008841522 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF (MDD/YYYY) POLICY EXP IMM/DD/YYYY) OMITS GENERAL LIABIUTY COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE occurrence) $ MED EXP (Any one person) $ $ CLAIMS -MADE OCCUR PERSONAL & ADV INJURY GENERAL AGGREGATE $ PRODUCTS - COMP /OP AGG $ GEN'L AGGREGATE 7 POLICY LIMIT APPLIES PRO- PER: LOC $ AUTOMOBILE LIABIUTY ANY AUTO ALL OWNED AUTOS HIRED AUTOS SCHEDULED AUTOS NON -OWNED AUTOS COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ $ DED RETENTION $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY OFFICER/MEMB�REXCLUDEECUTIVE (Mandatory In NH) If Yes, describe under DESCRIPTION OF OPERATIONS below Y/N NIA WC 47 -58- 218-01 01/01/2013 01/01/2014 X WC STATU- OTH- TORY LIMIT__ ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 Location Coverage Period: 01/01/2013 01/01/2014 Client# 5362 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Addltlonal Remarks Schedule, If more space is required) Mesa Brothers Inc Coverage is provided for 5215 SW 103rd Ave only those employees leased to but not Miami, FL 33165 -7016 subcontractors of: CERTIFICATE HOLDER CANCELLATION City of Miami Shores 10050 NE 2nd Ave Miami Shores, FL 33138 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 (2010/05) © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 Permit No. � )2-513 Master Permit No.f"i,J ) L� 4455 BUILDING PERMIT APPLICATION FBC 20`0 Permit Type: Electrical OWNER: Name (Fee Simple Titleholder): iee / 7 ,z Z 043 a,i � �' 8 ,�,..2? -; r °(2 State: gIZIEIIVU`j'iI 0 4 2012 L BY: Address: City: Tenant/Lessee Name: Phone #: 7O Zip: a.3 z Phone #: /1/ Email: �p JOB ADDRESS: /0 /'4F-- /©�` City: Miami Shores Folio/Parcel #: Is the Building Historically Designated: Yes Miami Dade Zip: 3 NO Flood Zone: CONTRACTOR: Company Name: e �kc ". e ° . Phone #: � ° �`� � - Address: 4-2, 763 City: <` State: ,,r7 " (14)0 1 41Mo•11541 Zi. / 6" Phone #: 34077e ° 21°2r? Certificate of Competency #: °-° /?O0 /87t fier Name: V Qualifier State Certification or Registration #: �°'/ CcfS'7o Contact Phone #: Email Address: DESIGNER: Architect/Engineer: Phone #: Value of Work for this Permit: $ (P---07!? 0 . Square/Linear Footage of Work: Type of Work: OAddress Alteration UNew URepair/Replace ODemolition Description of Work: / - mod.' "X ************ ** ****+ x **+x**** ***+x********* Fees* *******+ x**+ x******** ** ************+x*+x**** *** Submittal Fee $ Permit Fee $ / J ' ®O CCF $ Scanning Fee $ Radon Fee $ DBPR $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ CO /CC $ Bond $ TOTAL FEE NOW DUE $ Bonding Company's Name (if applicable) Bonding. Address o- City State Zip Mortgage Lender's Name (if applicable) Mortgage Lender's Address City , :, State Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspecti r - fee will be charged. 41# Signature er or Agent The foregoing instrument was acknowledged before me this day of ,20_,by who is personally known to me or who has produced As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commission Expires: * * * * * * * * * * * * * * * * * * ** APPROVED BY �cYp °eL. Ana Elizabeth Raiszadeh COMMISSION # DD895323 %�'"``o-` EXPIRES; SEP. 22, 2013 °j«,n P WWW.AARONNOTARY.com Signature Contractor The foregoing instrument was acknowledged before me this day of , 20 _, by who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Plans Examiner Sign: Print: My Commission Exp. Structural Review . (Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09) no Izai isza CoMMISSION # DD895323 11y4. o4 EXPIRES: SEP. 22, 2013 *o.n .... WWW.AARONNOTARY.com Zoning Clerk PERMIT # '1 CONTRACTOR: '31 S- -1.6.0 SUBMITTA.. DATE: gs, 1 1 190 1 3 ADDRESS: 1,(_ Z,c NJ k ( NAME: RESUBMITAL DATES: PROJECT TYPE: It'$ ZONING STRUCTURAL IMPACT FEES PLUMBING ` ` NOC MECHANICAL S T CATION WO 1 116/1124W kl111.11)1t11 i` r'?;1i1. 11111 11I1PAUbt .1Y1'C4IIUEiw`11AI6;. IR111Ps11 01i ".i.0 Aiinlot 0) vFa.lbtC +.➢V.11;1: I1111T1�TI?1ii4:7411 SCif! A!(1:a 41.1111111116,11111.1.1— I It 11 i18i111 11111147Fi 11) ;.7.11➢V1:1111114f: 11E{13LI13P 1. 11E111AA ill Cwl 1(0 1111111.,`91 iN07111.311, UtPSlih 1pol •,11..:11,1 1c ik110 :; 9 :Ei+l 11.'11, I ��11li�si COST OF P nnrvc¢tua ^=;- nunaTl , L , -3_2,t(49 q ►so o / © 'to M lc 44 = 7- -S0 D ELEVATI TOTAL VAL ii -" OF CWAL ECTERE r ‘1,,‘,, !!N " ri4,0"1011 COST OF D ZONE: '32 1 D© o PLAN :e"; is DATE: ilk, 4 ' ;.: