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RC-08-298INTRADESIGN INTERIORS. INC. GENERAL CONTRACTORS KARL MOKHER President CGC 056640 7360 S.W. 116 Street • Miami. Florida 33156 Cell (305) 206 -3832 • Fax (305) 232-7789 Email: idikfm@aol.com °6%01 KF144. wtttivtath vxttO ... tom( Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 BUILDING PERMIT APPLICATION FBC 2004 Permit Type (circle): KO 2000 BY: A'*----.. Permit No. gCOS'-2-9T Master Permit No. Electrical Plumbing Mechanical Roofing Owner's Name (Fee Simple Titleholder) M-& ER Q L AJ Phone # Owner's Address 1' ?Oa /V E 105 s City 7,6 7� f, State Zip 3 V7 Tenant/Lessee Name S / Aktie �� is � \ - a401 Phone # Job Address (where the work is being done) 1 City Miami Shores Village cos County Miami -Dade FOLIO / PARCEL # 1/ m `2 a. ? c eo Is Building Historically Designated YES NO '( Zip Contractor's Company Name 7 r 9, 4 b j at-k) „J 09,5 Phone # ® — 3 3 Contractor's Address 7 3 / 0 s t.ai / 6, 6 7 City fM , staff C Qualifier Name ? <f Zip Phone # 33I ' �0,- 37'3..2 State Certificate or Registration No. �� i4 <f (� Certificate of Competency No. Architect/Engineer's Name (if applicable) Value of Work For this Permit $® O Type of Work: ❑Addition Describe Work: Phone # ['Alteration Square / Linear Footage Of Work: 35 ['New ,! i Repair/Replace 9 (° = , A) D Demolition - ��E'Tr� Lif ****** * * *** * * * ** * * * * * * * * * * * * * *** * **** *Fees * *** * * ** Submittal Fee $ Permit Fee $ /0 a= *** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** CCF $ CO /CC Notary $ � Training/Education Fee $ I •4p Technology Fee $ Scanning $ 3 " W Radon $ DPBR $ Zoning $ Bond $ Code Enforcement $ Double Fee $ Structural Review. $ Total Fee Now Due $ 2. - See Reverse side 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 instrument was acknowledged before me this Signature Contractor The foregoing instrument was acknowledged before me this day of , 20 , by , ' day oft, , 204,1, by who is personally known to me or who has produced who is personally known to me or who has produced As identification and who did take an oath. NOTARY PUBLIC: Sign: as identification and who did take an oath. NOTARY PUBLIC: Print: &,...f/l.f J Print: My Commission Expires: U O 1®1, f qej ii � 4v. My Commission Expirigt49 '6�'" 'q1 sej �.''•: 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 e Permit No. t�„ 0 ° 2.4/ Master Permit No. BUILDING PERMIT APPLICATION FBC 20 JAN fl 0 1011 Yr Permit Type: BUILDING OWNER: Name (Fee Simple Titleholder): t'2 S41(74002- I' Phone#: e3 'i 3 ^46. Address: City: State: Zip: Tenant/Lessee Name: Phone#: Email: JOB ADDRESS: Vi c c 4.4C vstits.W tcpue, .r-°T Or 71 City: Miami Shores County: Miami Dade Zip: Z2)Z st3 QS Folio/Parcel #: Is the Building Historically Designated: Yes NO y Flood Zone: CONTRACTOR: Company Name: ® mC�� °'r-,1 1.„_a a 14.1 -EIZ, so=vc2.S o 1-9 t , Phone#: 5 Address: 1 3 1#14e:2 City: t-t State: P- a Zip: ,% S Qualifier Name: ttAaaL. t� t 159 Phone#: 2 c7L - 3 i 1-L State Certification or Registration #: aesre Certificate of Competency #: Contact Phone # ::NC> a `I c ,.3 ° ` , Email Address: 0 it"" Nom, FV-t DESIGNER: Architect/Engineer: Phone#: Value of Work for this Permit: $ Square/Linear Footage of Work: Type of Work: OAddress Description of Work: DAlteration DNew DRepair/Replace DDemolition COLOR THROUGH ROOF TILE IS REQUIRED acknowledged by: ** *, * ** ** * *** ** *********r * ** *** era ** Fees*** * ***** *,t****** **** * *r * * *, *** **,t***** ** *yo- Submittal Fee $ Permit Fee $ 64 -" 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) Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) O 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 segued for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC OWNER'S At 1 !DAVIT: 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 b approved and a reinspection fee will be charged Signature ; '1 / Signature Owner or A Contractor The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of ,20 , by , day of ,20 , by who is personally known to me or who has produced who is personally known to me or who has produced As identification and who did take an oath. as identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: on #DD962484 February 18, 2014 . Boded la Talkintawanpe800 APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised 07 /10/07)(Revised 06110 /2009)(Revised 3/15/09Xrev6/4/10) 1 THE SHO1S CONDOMINIUM APARTMENTS 1700 NORTHEAST 105TH STREET ON BISCAYNE BAY • MIAMI SHORES, FLORIDA 33138 • PHONE (305) 893 -6741 To Whom It May Conern: Permission has been granted t Unit # � for the purpose of Date: SA NT t&E ttt EL PST ap9 Vt- CArre Sincerely: Bd. of Directors rI1 /2071,40 )v No-r /2e 1e.vg.( ,1 r v )) %L Stick it! c . eGr2GG IS POLYST POLYGLASS ,r A game! 0 Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) het. Mortgage Lender's Address City State Zip Annliratinn is hereby made to nhtain a nermit to do the work and inatallatinnc ac indiraterl T rertifv that nn work nr inatallatinn ban Bt NUMBER SEE OTHER SIDE DO NOT FORWARD INtRADESIGN INTERIORS INC KARL MOKHER PRES 7360 SW 116 ST PINECREST FL 33156 brill I tilt,,, i1, 1at ,iit *shit ,,Malt til,,,b8,l 01 -30 -2009 ALEX SINK STATE OF FLORIDA CHIEF FINANCIAL OFFICER DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION * * CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law. EFFECTIVE DATE: 03/24/2009 EXPIRATION DATE: 03/24/2011 PERSON: MOKHER KARL FEIN: 650235020 BUSINESS NAME AND ADDRESS: INTRADESIGN INTERIORS INC 7360 SW 118TH ST MIAMI FL 33156 SCOPES OF BUSINESS OR TRADE: 1- CERTIFIED GENERAL CONTRACTOR IMPORTANT: Pursuant to Chapter 440. 05(14), F.S., an officer of a corporation who elects exemption from this chapter by filing a certificate of election ender 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(13), F.S., Notices of election to be exempt and certiflcetes of election to be exempt shall be subject to revocation if, at any time after the filing of the notice or the issuance of the certificate, the person named on the notice or certificate so 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. OWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 09.06 t1UESTIONS7 (850) 413-1609 From:Amy Mende FaxID:FlIer insurance Page 7of13 Date:12/72010 08:07 AM Page:7 of 13 OP ID: AM '4 ski- - RA� CERTIFICATE OF LIABILITY INSURANCE �; „'° 0 "' THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WANED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER FILER INSURANCE, INC. 9440 S.W. 77 Avenue 305 - 270 -2195 Miami„ R.33156 Keith R. Miller NAME: PHQ 1 FAX a , Na Extl: (AFC, No): ADDRESS: CUs OMER ID #: RA01 INSURER(S) AFFORDING COVERAGE NAIC # INSURED Intradesign Interiors, Inc. 7360 S.W. 116 Street Miami, FL 33156 INSURERA: Mt. Vernon Fire insurance Co. UABILITY COMMERCIAL GENERAL LIABILITY INSURER B : INSURER C : CL2360206 INSURER D : 12102!11 INSURER E : $ INSURER F : DAMAGE TO RENTED pREMI$E8 IEe arcwrerue) COVERAGES CERTIFICATE NUMBER: • THIS IS TO CERTIFY THAT THE POUCIES OF INSURANCE USTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POUCY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POUCIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POUCIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE AIND'S°R SUER POLICY NUMBER JPOLICY M/DDIYEYYY1 IMMWWDGI�Y) LIMITS A GENERAL X UABILITY COMMERCIAL GENERAL LIABILITY I OCCUR CL2360206 12t02/10 12102!11 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED pREMI$E8 IEe arcwrerue) $ 100,000 CLAIMS -MADE X MED EXP (Any one person) it 5,000 PERSONAL 8 ADV INJURY S 1,000,000 GENERAL AGGREGATE S 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: n POLICY n jECa n LOC PRODUCTS - COMP /OP AGG $ 2,000,000 $ AUTOMOBILE LIASIUTY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON-OWNED AUTOS COMBINED SINGLE UMIT (Ea accident) $ BODILY INJURY (Per person) S BODILY INJURY (Per accident) S (POOR DAMAGE S $ UMBRELLA UAB EXCESS LIAR _ OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DEDUCTIBLE RETENTION $ $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y! N ANY PROPRIETOR/PARTNERIEXECUTIVE OFFICER/MEMBER In ER EXCLUDEQ? I I (Mandatory N DESCRIPTION OF OPERATIONS below N / A I WC STATU- 1 10TH- O I ER E.L EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ EL DISEASE - POUCY LIMIT $ DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES (Attach ACORD 101, Additional Remarks Schedule, H more space is required) CERTIFICATE HOLDER CANCELLATION MIAMISH Miami Shores Village 10050 NE 2nd Avenue 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 TIE POUCY PROVISIONS. AUTHORIZED REPRESENTATIVE 'Aymara Mencia A269211 ACORD 25 (2009109) ®1988 -2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo ars registered marks of ACORD lest Interiors, I • •• •• • • • •• • • • • • • • •••• • • • •••• • • •••• • • • • •• • • • • .•. • • • • • • •• •• •••• • • •••• • co rn • ate? 7360 South West 118 Street Miami, Florida 33156 CGC 058640 Bathroom renovations For Sachar L. Naghib 1700 NE 2"d Avenue Miami Shores, FI 33138 Apartment 209 Intradesign Interiors, Inc. 305 206 3832 DRYWALL AND TILE WORK 1. Remove existing drywall and ceramic hie at shower area. 2. Replace shower walls with concrete board. 3. Set new showerr pitch to drain. 4. Install new ceramic the at shower wad and floor. GENERAL 1. Install new accessories provided by owner. 2. Remove and replace mirror if necessary. 3. Paint existing ceiling, walls and door in customer color. • •• • • • • • • • • • .• • •• • • • • .•.• • • • • •••• • • • • • • • • • • • • •• •• • • • • •• • ••.• • •• • • • • .• •••• • • • ... • •••t• SH. FAUCET • • •• • • • • • • •. •••• • • 17 s" 178" , 44." 30" PLUMBING 1. Remove and repleme shower pan and drain. 2. Remove and replace two pie trftet and seat. 3. Remove and replace shower vakle. 4. Remove and re install existing vanity cabinet. 5. Remove and replace lavatory valve. ELECTRICAL 1. Remove and replace existing receptacle with GFI receptacle. 2„ Remove and reps exists wall mounted phi fixture. All dimensions .size designations given are subject to verification on job site and adjustment to fit job moons. Intradesign Interiors Sachar L. Naghib 1700 NE 105 Street Miami Shores, Fl 33138 Apartment 209 This is an original design and must not be released or copied unless applicable fee has been paid or job order placed. Designed: 5/3/2007 Printed: 5/3/2007 Sachar Naghib master bath I All I Drawing #: 1 PLUMBING 1. Remove and replace 60" x 30" Bathtub. 2. Remove and replace two piece toilet and seat. 3. Remove and replace tub and shower valve. 4. Remove and re install existing pedestal lavatory. 5. Existing lavatory valve to be re installled on pedestal lavatory. .-N DRYWALL AND TILE WORK 1. Remove existing drywall and ceramic tile at bathtub area. 2. Replace tub walls with concrete board for new tile Installatio 3. Install new ceramic tile at tub surround up to existing ceiling. 4. Set new ceramic floor tile over existing tile floor. L i , „ ; N ti N 60” .. ... . • • • • • • • • • • • • •• ••• •• • • • •• ELECTRICAL 1. Remove and replace existing receptacle with GFI receptacle. 2„ Remove and replace existing wall mounted Tight fixture. GENERAL 1. Install new accessories provided by owner. 2. Remove and replace mirror if necessary. 3. Paint existing ceiling and walls in customer selected color. All dimensions _size $esigpatigjs giypn gm subject to verif c&tiom an job sits and' i i adjustment to fit jpb vpndittonqs,,.• •.• •.• •••• ••••••• • • • • • • • • • • • • • • • • • • Intradesign Interiors Sachar L. Naghib 1700 NE 105 Street Miami Shores, F133138 Apartment 209 This is an original design and must not be released or copied unless applicable fee has been paid or job order placed. Designed: 5/3/2007 Printed: 5/3/2007 Sachar Naghib guest bath • •! All Drawing #: 1 11 -: Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 LY- 'Inspection Number: INSP - 187765 Permit Number: RC -2 -08 -298 Inspection Date: March 20, 2013 Inspector: Bruhn, Norman Owner: NAHIB, SAGHAR Job Address: 1700 NE 105 Street 209 Miami Shores, FL Project <NONE> Contractor: TURIN CONSTRUCTION CORP Permit Type: Residential Construction Inspection Type: Final Work Classification: Alteration Phone Number (305)582 -1346 Parcel Number 1122300500280 Phone: (954)755 -5588 Building Department Comments REMOVE AND BATHTUB, DRYWALL AND CERAMIC TILES. VANITY CABINET TOP SHOWER VALVE AND LAVATORY VALVE ARE EXISTING AND WILL REMAIN. REMOVE AND REPLACE KITCHEN CABINETS TALKED TO HOME OWNER AND SUGGEST HER TO FILE A CHANGE OF CONTRACTOR. 1/22/13 Infractio Passed Comments INSPECTOR COMMENTS True Pass .� Inspector Comments (C___- 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 21, 2013 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 Inspection Number: INSP- 186995 Permit Number: RC -2 -08 -298 Scheduled Inspection Date: March 20, 2013 Inspector: Bruhn, Norman Owner: NAHIB, SAGHAR Job Address: 1700 NE 105 Street 209 Miami Shores, FL Project: <NONE> Contractor: TURIN CONSTRUCTION CORP Permit Type: Residential Construction Inspection Type: Drywall Screw Work Classification: Alteration Phone Number (305)582 -1346 Parcel Number 1122300500280 Phone: (954)755 -5588 Building Department Comments REMOVE AND BATHTUB, DRYWALL AND CERAMIC TILES. VANITY CABINET TOP SHOWER VALVE AND LAVATORY VALVE ARE EXISTING AND WILL REMAIN. REMOVE AND REPLACE KITCHEN CABINETS TALKED TO HOME OWNER AND SUGGEST HER TO FILE A CHANGE OF CONTRACTOR. 1/22/13 Infractio Passed Comments INSPECTOR COMMENTS False Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments CREATED AS REINSPECTION FOR INSP- 186047. CREATED AS REINSPECTION FOR INSP- 75375. Provide designer report. Work covered. NB March 19, 2013 For Inspections please call: (305)762 -4949 Page 25 of 49 wmarthur 11Mar13 Mr. Norm Bruhn Inspector Miami Shores Village 10050 NE 2nd Ave. Miami Shores, Fl 33138 BM. ARTHUR-ARCHITECT / BUILDER Re: Sachar Naghib- 1700 NE 105th Street, Apt. 209, Miami Shores, Fl. Dear Mr. Bruhn, 9867 SW 184th St Palmetto Bay, Florida 33157 T 305153.5057 wmarthurol O gmail.com In the matter of the work completed in the bathroom remodel at the above referenced address, it is my best knowledge and belief the work complies with the approved plans and the Florida Building Code. S(ncere ours, r wl 1 4 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: BUILDING JOB ADDRESS: 01 NT? H 0 D 3 City: Miami Shores County: FBC20,D Permit No. .. Master Permit No. 2° C O & - 2 ROOFING ` f 1,01 Miami Dade Folio/Parcel #: 1° 9 So ° ®,6® ° 0 Z Is the Building Historically Designated: Yes NO Zip: .33 Q 38 x Flood Zone: OWNER: Name (Fee Simple Titleholder): ,4 RN; s MI5 Phone#: 3 V5 7q5 VU LI Address: 0 10 0 Ns p o ST city: ik J ‘, state: fit, Tenant/Lessee Name: p Email: _sk 1r ; �YD 0 k (a a1, Cow% Zip: S Phone#: `y CONTRACTOR: Company Name: 1V-- CADt4TEUC.rn OR COO. Phone #: 7 A ® "259 Address: City: CAR, � l �9 ONLI State: zip: 0 �y 3S `, Qualifier Name: ; 1 \NG 1 llU Q � Phone #: 7 X� e &i 8 813/ �y State Certification or Registration #: C c N, 66 n t, Certificate of Competency #: Contact Phone #: 76 6 4 6 1 9i Email Address: 40 W1A ? T 1'0 CoOSTIcuCnOw Co tiA DESIGNER: Architect/Engineer: Phone #: Value of Work for this Permit: $ Type of Work: DAddition OAlteration Square/Linear Footage of Work: New URepair/Replace ODemolition Description of Work: 0144MAIR. Dr Co.ty.kr:o . it) Ep2)96-ki 1441 qvuego PI till bilgtua, f MO �. , . (Cc-16 k 064114 . �p�1�6 eNI (49rn s Vlikprepoy% fxkovisolOt,DS) 9514Dmi litollkw $4004,1* 921441 Color thru tile: Ilt / j m m + x** ***+ x* **** **** *** *** * ***a:+x *****+x***** Fees **** x*********** * *** ** x**+x+x************ ***** Submittal Fee $ Permit Fee $A 10. 03 CCF $ CO /CC $ Scanning Fee $ 3. 0-3 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 a7 roved and a reinspection fee will be charged. Signature Owner or Agent The foregoing instrument was acknowledged before me this Signature Contractor Q �, The foregoing instrument was acknowledged before me this 4`V day of s;., .; 0 , by c�i.)' `w _L��.t. \\ kt\-AN , day of >0 \, by r Vii who is personally 1 own to me or who has produced S" )1SE...Ae2_ 3 who is personally known to me or who has produced h 4 as identification and who did take an oath. \. .\C_ew ' e As identification and who did take an oath. NOTARY P ' LIC: Sign: Print: My 0 '+t. Notary Public State of Florida ?F , ; Cerra M Camara 3� Commission EE001964 NOTARY P LIC: V194A dIC-J4k Sign: Print: My * * *** * * * * *** ** ** * * * * * * * **** IL • i • om iss o e_: g os° Notary Public S ; > o da Ge.na M Camara sa My Commission EE001984 'lop op* Expires 08/27/2014 * •*< =,* .. -..,* : * * ** ***** **** ** *** * * ** *** APPROVED BY Plans Examiner Zoning Structural Review (Revised 3 /12/2012)(Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) Clerk Miami Shores Viijage Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CHANGE OF CONTRACTOR / ARCHITECT Permit N C. 0. -Z616 Owner's Name (Fee Simple Title Holder): Owner's Address: 0 I OD 1.,1 5 ID City: Mt State : Phone #: h 7q5 LY,94 Job Address (Of where work is being done): V 1 D;l, $4.5 e� City: Miami Shores State: Florida Contractors Company Name: Itelk CoMsinapeli fO ? Address: !c 1I " City: mil? kil- , State: L iii.: Qualifier's Name : ►wy p TOtdm Architect/ Engineer of Record Name: Address: City: State: Zip Code: Zip Code: �.� $3 Zip Code: Phone #: 186 t qi 8159 Zip Code: 35 66 tic. Number: C4 1 � _ Phone #: Describe Work: 4. PA 9* '041016itffie0 Pal.or5 i• • 1 hereby certify that the work has been abandoned and/or the contractor /architect is unable or unwilling to complete the contract. I hold the Building Official and the Miami Shores harmless for all legal involvemen Signature arorAgent The foregoing instrument was aknowl : • ged before mQ Sq. this c day of ,20 ►by``°�` e D___!5 Who is personally known to me or who has produced `%Ac-ervbe as indentification. Notary Sign: Seal: �,►Ve ' Notary Public State of Florida Gema M Camara Q My Commission EE001004 �to, n�� Expires 00/27/2014 Signature C. ntractor or Architect The foregoing instrument was aknowledged before me 0 this day of So•h. , 20 cry , ./cr ., V. 4WD who is personally known to me or who has produced as lndentification. fir °eipFlorida, � Notary Public State of Florid Gems M Camara Q My Commission EEO01984 ?spa Expires 08/27/2014 USPS.com® - Track & Confirm in00 /\t English Customer Service USPS Mobile U 0 Quick Tools Track & Confirm GET EMAIL UPDATES PRINT DETAILS Page 1 of 1 Register / Skin In ECOS Search USPS.com or Track Packages Ship a Package Send Mail Manage Your Mail Shop YOUR LABEL NUMBER SERVICE 70123060000199110306 Check on Another Item What's your label (or receipt) number? 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Postal Se viceTM CERTIFIEb MAILTM RECEIPT Dopiestig atug wt ; NO �n °ranee Coverage`Provtded) us s coma, For`deltvery =fnformetlori visit out website aGwww p HiAMI: FL 3315 6 postage Certified Fee p Return Receipt Fee F p (Endorsement Required) C p Restricted Delivery Fe (Endorsement Required F. p Total Postage & Fee im E Rr @ L . T` Is Total: $0.46 0131 $ 07 Postmark Here Sent To or PO Box No. Sfreet �P city state, z "See>Beverse „forInstructi��o PS Form 3809: August22006: $6.11 $6.11 Paid by: MasterCard $6.11 Account #: XXXXXXXXXXXX5355 ;Approval #: 49090P Transaction #: 189 23 903520559 @@ For tracking or inquiries go to USPS.com or call 1- 800 - 222 -1811. * * *** ire* r. **** ******* * * ** ** **** **** ***** .' ********* * * * ** * * * * * * * * ** * * ** * * * * * * * * * *** BRIGHTEN SOMEONE'S MAILBOX. Greeting cards available for purchase at select Post Offices. ********* ** ** * * * * * * * * * * * * ** * * * * * * * * * * * ** ********* * * * * * *** * ** * * * * ** * ** * * * * * ** * *** In a hurry? Self- service kiosks offer quick and easy check -out. Any Retail Associate can show you how. Order stamps at usps.com /shop or call 1- 800- Stamp24. Go to usps.com/cticknship to print shipping labels with postage. For other information call 1 -800- ASK -USPS. ********* * * ** * * ** * ** * * * * * * * * * * * * * ** * * * ** ********* * * * * * * * **** * * * * ** * * * * * ** * * * * * ** Get your mall when and where you want it with a secure Post Office Box. 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Dispatched to Sort January 31, 2013, 7:22 pm MIAMI, FL 33143 Facility j I Acceptance 1 January 31, 2013, 1:35 pm I MIAMI, FL 33143 Find LEGAL ON USPS.COM ON ABOUT.USPS.COM OTHER USPS SITES Privacy Policy > Terms at Use > FOIA > No FEAR Act EEO Data > Copyright© 2013 USPS. All Rights Reserved. Government Services > Buy Stamps & Shop > Print a Label with Postage > Customer Service > Site Index > https: // tools. usps. com /go/TrackConfirmAction.action About USPS Home Newsroom Mail Service Updates Forms & Publications Careers Business Customer Gateway > Postal Inspectors > Inspector General > Postal Explorer 2/5/2013 CUT"ri MIAMI. BRANCH !UAMI, Fic,riJe .31439998 1158540131 -0097 01/31/2013 (305)661 -0664 01:36:14 PM Product Description Sales Receipt Sale Unit Qty Price Final Price KEY LARGO FL 33037 Zone -1 First -Class Letter 0.70 oz. Expected Delivery: Sat 02/02/13 Return Rcpt (Green Card) $2.55 13 Certified $3.10 Label #: 70122210000038449133 mea ®oaaa $6.11 $0.46 Issue PVI: Total: $6.11 Paid by: $6.11 MasterCard Account #: XXXXXXXXXXXX5355 Approval #: 97791P Transaction #: 329 23 903520559 @@ For tracking or inquiries go to USPS.com or call 1 -800- 222 -1811. ********* * * * * * * * * * * * * * ** * * * * * * * * ** * * * * ** ********* * * * * * * * * ** * * * * * * * * ** * * * * * * ** * ** BRIGHTEN SOMEONE'S MAILBOX. Greeting cards available for purchase at select Post Offices. ********* * * *** * * * * * * * * * * * * ** * *** ** * * * * ** ********* * * * ** * *** * * ** * ** * * * * * * * ** ** * * ** In a hurry? Self- service kiosks offer quick and easy check -out. Any Retail Associate can show you how. Order stamps at usps.com /shop or call 1- 800- Stamp24. Go to usps.com /clicknship to print shipping labels with postage. For other information call 1- 800 - ASK -USPS. ********* * * * * * * ** * * ** ** * * ** * * ** * * * * * * * ** ********* ** ** * * * * * * * * *** * *** *** * * * * * ** ** Get your mail when and where you want it with a secure Post Office Box. Sign up for a bu' online at usps.com /poboxes. ********* * ** ** * * * * * * * * * * * * * * * ** * * * * * * *** •*** ri**** * * * * * * * * * * * * ** * * * * * * * ** ** * * ** ** 5111#: 1000304065708 Clerk: 21 All sales final on stamps and postage Refunds for guaranteed services only Thank you for your business ********* * * ** ** * ** ** * ** * *** * * * ** ** * * * * ** ********* *** * * * ** ** **** * *** * ************ HELP US SERVE YOU BETTER Go to: https : / /postalexperience.com /Pos TELL US ABOUT YOUR RECENT POSTAL EXPERIENCE YOUR OPINION COUNTS Customer Cops m m rR tt' 43 m U.S. Postal Service,. CERTIFIED MAIL,. RECEIPT (Domestic Mail Only; No Insurance Coverage Provided) For delivery information visit our website at ,v wW "as.com� • Postage Certified Fee Retum Receipt Fee (Endorsement Required) Restricted Delivery Fee (Endorsement Required) ru Total Postage & Fees ru 11.1 tiJ r9 N Sent To $0.0U City, State, ZIP+4 PS Form 3800, August 2006 See Reverse for - Instructions S.L. Naghib 1700 NE 105th Street, APT #209 Miami Shores, FL 33138 January 30, 2013 RE: REQUIRED CHANGE OF CONTRACTOR TO CLOSE PERMITS DUE TO YOUR INCOMPETENCE AND NEGLECT; PERMIT #RC08 -298; KARL MOKHER LICENSE #CGC056640 Mr. Karl Mokher, This letter is to inform you that I am required per the City of Miami Shores to send a "change of contractor" letter in order to complete the inspections that you never fulfilled. You have neglected fulfilling the inspections for the two bathrooms that you remodeled in my apartment. You were paid in full for this job and you never completed the work. I want you to know that your neglect has grieved me emotionally and financially. I now have a lien of $43,000 because of your dishonesty, carelessness, and irresponsibility. Indeed, your behavior has affected me. As I have just mentioned, I am grieved. I am also hurt, frustrated, and saddened by your decisions. I trusted you not just because I believe in honest business transactions, but because I trusted you as a fellow "Christian "from my church. In the last 3 years, you have refused phone calls and emails as well as evaded confirmed appointments to complete the inspections. More so, when you did return my phone calls and emails, you promised to get the work done and yet you never fulfilled your promise. In addition, you did not respond to the City of Miami Shores when they called you to complete the work. You have strung me and the City of Miami Shores along for three years. Again, your behavior has affected me. Above all, I want you to know that even though I am forced to change contractors in order to stop the lien from increasing, you are not released from this work. Forgiving you does not make your neglect and dishonesty towards me acceptable or forgettable. S. Leslie Naghib STATE OF FLORIDA COUNTY OF MIAMI -DADE The foregoing instrument was acknowledged to me this 31st day of January, 2013, by S. Leslie Naghib, who is personally known to me, and who did not take an oath. ANA M. AGU AR, Notary Public F; •., ANA M. AGUILAR �J,P I. Notary Public - State of Florida My Comm. Expires Dec 25, 2016 �''•. o ° 0:f Bonded Commission Throsugh National Wary Assn. "(his ccr -h-Fi cake is crtc ch ed +0 0- lel4-cv ad.dvard 40 Mir. Kav1 Mokher, signed bi S. Leslie Na3kb . Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CONTRACTORS REGISTRATION FORM ALL CONTRACTORS MUST PROVIDE COPIES OF LICENCES AND INSURANCES EACH TIME A PERMIT IS SUBMITTED OR THE VILLAGE MAY MAINTAIN A FILE WITH YOUR INFORMATION FOR A $30.00 FEE PER YEAR. IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: A. X COPY OF QUALIFIER'S STATE LIC CARD B. X COPY OF LOCAL BUSINESS TAX RECEIPT C. X COPY OF LIABILITY INSURANCE (CERTIFICATE HOLDER TO BE MIAMI SHORES VILLAGE BLDG DEPT) D. X COPY OF WORKERS COMPENSATION (EITHER CERTIFICATE OR EXCEMPTION) IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY: A. COPY OF CERTIFICE OF COMPETENCY OF QUALIFIER B. COPY OF MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT C. COPY OF LIABILITY INSURACE (CERTIFICATE HOLDER MUST BE MIAMI SHORES VILLAGE BLDG DEPT) D. COPY OF WORKER COMP INSURANCE (EITHER CERTIFICATE OR EXEMPTION) YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE HOLDER AS FOLLOW: MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES, FL 33138 COMPLETE CONTRACTOR'S INFORMATION BUSINESS NAME: Turin Construction Corporation BUSINESS ADDRESS: 10551 NW 41 Street CITY Coral Springs STATE Florida ZIP CODE 33065 BUSINESS PHONE: ( 786 ) 412 -8739 CELL PHONE (786 ) 412 -8739 FAX NUMBER (954 ) 755 -5588 QUALIFIER'S NAME: Howard F. Turin QUALIFIER'S LIC NUMBER: CGC 1516612 E -MAIL ADDRESS (IF APPLICABLE): HowardT @TurinConstruction.com Created on 3119109 BY MLDV/ RV 3126109 MLDV TURIN -1 OP ID: JA ACORUr 4.------ CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 01/28/13 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 lieu of such endorsement(s). PRODUCER 954-731 -5566 W.F. Roemer Insurance Agency 954-731-8438 4752 W. Commercial Blvd Fort Lauderdale, FL 33319 William F. Dowd NAME: PHONE FAX A/C. No. Ext): (A/C, No): ADDRESS: INSURERS) AFFORDING COVERAGE NAIC # INSURERA:Starr Indemnity & Liability Co 38318 INSURED Turin Construction Corporation 10551 NW 41 Street Coral Springs, FL 33065 INSURER B : Travelers 25658 INSURER C:Millings Insurance Company 16632 INSuRER D :Scottsdale Insurance Company $ 1,000,000 INSURER E : 100,000 $ � INSURER F : $ 5,000 CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE 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 TYPE OF INSURANCE INSR WVD POLICY NUMBER (MM/IDD /YYYY) (MPOLICY DJYYYYYY) LIMITS A GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY SIPGGL0043300 10/21/12 10/21/13 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES (Ea occurrence) 100,000 $ � MED EXP (Any one person) $ 5,000 CLAIMS -MADE X OCCUR PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP /OP AGG $ 2,000,000 GENT. AGGREGATE 7 POUCY LIMIT APPLIES PER: X !pa LOC Empl Ben $ 1,000,000 B AUTOMOBILE X LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS SCHEDULED NON - OWED AUTOS BA1A63266012SEL 05/11/12 05/11/13 COMBBIINdED SINGLE LIMIT $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ 500,000 PROPERTY DAMAGE (Per accident) $ $ D x UMBRELLA LIAR EXCESS UAB X OCCUR CLAIMS -MADE XBS0025782 10/21/12 10/21/13 EACH OCCURRENCE $ 2,000,000 AGGREGATE $ 2,000,000 $ DED X RETENTION $ C WORKERS COMPENSATION AND EMPLOYERS' UABILITY Y / N ANY PROPRIETOR/PARTNER /EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A WCV006648303 05/29/12 05/29/13 X WC STATU- TORY LIMITS OTH- ER E.L EACH ACCIDENT $ 1,000,000 E.L DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is requUel) MIAMIS2 Village of Miami Shores 10050 NE 2 Avenue Miami Shores, FL 33138 1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE ACCORDANCE WITH THE O CY PROVIS ONSE WILL BE DELIVERED IN AUTHORIZEDIIREPRESENTATIVE / /J l�t,- e.,..4J ,-. ACORD 25 (2010/05) @ 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT 115 S. Andrews Ave., Rm. A -100, Ft. Lauderdale, FL 33301 -1895 — 954-831 -4000 VALID OCTOBER 1, 2012 THROUGH SEPTEMBER 30, 2013 DBA:TURIN CONSTRUCTION CORPORATION Business Name: Owner Name: HOWARD F TURIN / QUAL Business Location: 10551 NW 41 ST CORAL SPRINGS Business Phone: Rooms Seats Employees 2 Receipt #:GEl E AFL CONTRACTOR (GENE Business Type: CONTRACTOR) Business Opened:01 /02/2009 State /County /Cert/Reg:CGC1516 612 Exemption Code: Machines Professionals For Vending Business Only Number of Machines: • 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: HOWARD F TURIN / QUAL 10551 NW 41 ST CORAL SPRINGS, FL 33065 2012 - 2013 Receipt #01A -11- 00008777 Paid 07/11/2012 27.00 — — Q L7MAILS.1D 11.1.:R'. uktint l.. # 1 A1. c r rmmur ..T.,b .1/ .rUM. irsiro r, STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 TURIN, HOWARD FRANCIS TURIN CONSTRUCTION CORPORATION 10551 NW 41 STREET CORAL SPRINGS FL 33065 Congratulations! With this license you become one of the nearly one million Floridians licensed by the Department of Business and Professional Regulation. Our professionals and businesses range from architects to yacht brokers, from boxers to barbeque restaurants, and they keep Florida's economy strong. Every day we work to improve the way we do business in order to serve you better. For information about our services, please log onto www.myflorldalicense.cont There you can find more information about our divisions and the regulations that impact you, subscribe to department newsletters and learn more about the Department's initiatives. Our mission at the Department is: License Efficiently, Regulate Fairly. We constantly strive to serve you better so that you can serve your customers. Thank you for doing business in Florida, and congratulations on your new license! C#6i4i62 16 DETACH HERE (850) 487-1395 GC15166j.2 .. 2'12 . 118191197 • .TORM ?t, -irattxtr.colst •, CWR • . °PAT I0b.7 • : , • IS CERTIIP/tik under th provisions � ch.4.89 FS • • • I:, . *4-at4:on date AVG 31, 2033 426526004.5.9 THIS DOCUMENT HAS A COLORED BACKGROUND • MICROPRINTING • LINEMARK'' PATENTED PAPER S pf, FLORID ,!! . . ii.W.ARTRENtbk;z:0 - sAgli toNAti. A,* ,..cONSxPxyLIJjB LICRNSIVNBR 05/26j1D1241.819.119t The GENERAL ;... 1.5it61/ .0tont007.1H51W T%TTflA 11 . c4 • LIZATION SEQ# L12052600459 FL 33065 .. • KEN LAWSON SECRETARY Inspection Date: 03/21/2008 Inspector: Levrock, James Inspection Worksheet Miami Shores Village Repi 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Owner: NAHIB, SAGHAR Job Address: 1700 105 ST Street NE 209 Miami Shores Village, FL Project: <NONE> Contractor: MOKHER PLUMBING COMPANY Prmt Permit Type: Plumbing - Residential Inspection Type: Piping Work Classification: Addition/Alteration Block: Phone Number (305)582-1346 Parcel Number 1122300500280 Lot: Phone: (305)446-8266 Building Department Comments Thursday, March 20, 2008 Page 2 of 2 AR 2 4 210 Passed Ij ctor omments Failed Correction Needed Re-Inspection Fee ($75) No Additional Inspections can be scheduled re-inspection fee is paid . until Thursday, March 20, 2008 Page 2 of 2 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 - 2204 Fax: (305)756 -8972 ..::.... ................ Inspection Date: 03/25/2008 Inspector: Devaney, Michael Owner: NAHIB, SAGHAR Job Address: 1700 105 Street NE 209 Miami Shores Village, FL Project: <NONE> Contractor: M&D ELECTRICAL SERVICE INC Permit Type: Electrical - Residential Inspection Type: Underground Rough Work Classification: Addition /Alteration Block: Phone Number (305)582 -1346 Parcel Number 1122300500280 Lot: Building Department Comments ELECTRICAL FOR MASTER Passed Inspector Comments ---CX- g )1-4,2:r— e9 e9 Failed Correction Needed Re- Inspection Fee {$75) No Additional Inspections can be scheduled re- inspection fee is paid . until Monday, March 24, 2008 Page 1 of 2 Project Address Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138-0000 Phone: (305)795 -2204 Parcel Number Applicant 1700 NE 105 ST Street Number: 209 Miami Shores Village, FL 1122300500280 Block: Lot: SAGHAR NAHIB Owner Information Address Phone CeII SAGHAR NAHIB 1700 NE 105 Street MIAMI SHORES FL 33138 -2140 (305)582 -1346 Contractor(s) INTRADESIGN INTERIORS. INC Phone Cell Phone (305)206 -3832 Approved: In Review Comments: Date Approved: : In Review Date Denied: Type of Construction: INTERIOR Stories: REMODELING Front Setback: BATHROOMS Left Setback: KITCHEN Bedrooms: Plans Submitted: Certificate Date: _Bond Retum : Occupancy: Exterior. Rear Setback: Right Setback: Bathrooms: Certificate Status: Additional Info: Classification: Residential Fees Due CCF Education Surcharge Permit Fee - Additions/Alterations Scanning Fee Technology Fee Total: Amount $4.20 $1.40 $210.00 $3.00 $5.25 $223.85 Total Amt Paid I Amt Due $ 0.00 $ 0.00 Payment Type: $ 0.00 .cit-A10fek P a zPAIo Available Inspections: Inspection Type: Tie Beam Fill Cells Columns Insulation Gelling Grid Shutter Final Window and Door Buck Final PE Certification Drywall Screw Framing Shutter Attachment Termite Letter Window Door Attachment Slab In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Futhermore, 1 authorize the above -named contractor to do the work stated March 03, 2008 Authorized Signature: Owner / Applicant / Contractor / Agent Building Department Copy Date Monday, March 3, 2008 1 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 186134 Permit Number: PL -2 -08 -299 Scheduled Inspection Date: February 21, 2013 Inspector: Hernandez, Rafael Owner: NAHIB, SAGHAR Job Address: 1700 NE 105 Street 209 Miami Shores, FL Project: <NONE> Contractor: MOKHER PLUMBING CO Permit Type: Plumbing - Residential Inspection Type: Rough Work Classification: Addition /Alteration Phone Number (305)582 -1346 Parcel Number 1122300500280 Phone: 305 -446 -8266 Building Department Comments 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 February 20, 2013 For Inspections please call: (305)762 -4949 Page 20 of 23 From:Chris Piersol FaxID:305 -270 -2195 Page 1 of 1 Date:1/4/2013 11:00 AM Page:1 of 1 MOKHE01 OP ID: CP '`�� °~ CERTIFICATE OF LIABILITY INSURANCE DATE 01 /04DNYYY) 01 /04/13 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the pollcy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER 305- 270 -2100 FILER INSURANCE, INC. 9440 S.W. 77 Avenue 305- 270 -2195 Miami FL 33156 Keith R. Miller Christine Piersol PHONE FAX WIT., ExE: 305-270-2161 (A/C, No): A E-MAIL cpiersol @f)lerins.com INSURER(S) AFFORDING COVERAGE NAIC 1 INSURER A: Harleysville Mutual Ins. Co. LIABILITY COMMERCIAL GENERAL LIABILITY INSURED Mokher Plumbing Company 3800 Shipping Avenue Miami, FL 33146 INSURER B: Business First Insurance Co. GL00000090631 D INSURER C: 01/01/14 INSURER D : $ 1,000,000 INSURER E : $ 100,000 INSURER F : • • 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. ILTSRR TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF (MMIDD/YYYY) POLICY EXP (MM/DDIYYYY) LIMITS A GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY GL00000090631 D 01/01/13 01/01/14 EACH OCCURRENCE $ 1,000,000 PDREMISES (Ea occcurrronce) $ 100,000 CLAIMS -MADE X OCCUR MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY JECOT I I LOC PRODUCTS- COMP /OP AGG $ 2,000,000 $ A AUTOMOBILE X LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS — — SCHEDULED AUTOS NON-OWNED BA00000048838J1 01/01/13 01/01/14 COMBINED SINGLE LIMIT (Ea accident) 1 000 000 $ r r BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ A X UMBRELLA LIAB EXCESS MB X OCCUR CLAIMS -MADE CMB00000083642N 01/01/13 01/01/14 EACH OCCURRENCE $ 2,000,000 AGGREGATE $ 2,000,000 DED RETENTION $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes. describe under DESCRIPTION OF OPERATIONS below Y1 N N 1 A 52100865 07/24/12 07/24/13 WCSTATU- OTH- X TORY LIMITS I X ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000, 000 E.L. DISEASE- POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS, LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) CANCELLATION CITYO56 City of Miami Shores Building & Zoning 10050 NE 2 Avenue 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 CHRISTINE PIERSOL- A207301 ACORD 25 (2010/05) O 1988 -2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD a c7 '777' 7 a THIS DOCUMENT HAS A COLORED BACKGROUND • MICAOPRIISITING • LIKENIAI4K1' PATENTED'PAER': ^7.7 9 A AC# 6144943 STATE OF FLORIDA NT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION DEPARTMENT CONSTRUCTION INDUSTRY BOARD DATE 0Mtalif 1412053001091 BATCH NUMBER LICENSE 05/30/2012 118194375 CFCO21469 The PLUMBING CONTRACTOR Named below IS CERTIFIED tzider the provisions of Chapter 485 FS. . v, Expiration date: ALTO 31, 2014 MOKHER, JOSEPH A JR,' MOKHER PLUMBING COMPANY - 3800 SHIPPING AVENTIE MIAMI FL 33146 RICK SCOTT • • . • .. , • • GOVERNOR • DISPLAY AS REQUIRED BY LAW KEN LAWSON SECRETARY 026029-9 BuNtliWeN'FtUNVYNg co 3800 SHIPPING AVE 33146 MIAMI THIS IS NOT A BILL - DO NOT PAY RENEWAL EC pw,_ 026029-9 STATEr-CFCM469 11hHEge R PLUMBING CO YignMITho CONTRACTOR THIS ONLY A LOCAL BUSINESS TAX RECEIPT. IT DOES NOT PERMIT THE HOLDER TO VIOLATE ANY REGULATORY OR ZONING LAWS OF THE cOUNTY OR CITIES. NOR DOES IT EXEMPT THE HOLDER FROM ANY OTHER PERMIT OR LICENSE REQUIRED BY LAW. THIS IS NOT A CIMMIFICATION OF ThE HOLDERS au/amok- nom PAYMENT HECEIVED _ MXAM-DADE COUNTY TFOT C° 07/12/2012 60060000172 000045.00 SEE OTHER SIDE DO NOT FORWARD MOKHER PLUMBING CO JOSEPH A MOKHER JR 3800 SHIPPING AVE MIAMI FL 33146 In Lit "11,11,1111,„"1111,1.1„1,1,111,1"1.1.alizI 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. 2J . O ° Z I( Master Permit No. 17 L -2_91 BUILDING PERMIT APPLICATION FBC 20 0 JAN 1 0 2011 Permit Type: PLUMBING 1 OWNER: Name (Fee Simple Titleholder): If t el( > L. Phone#:, ?OS-- 3"13 Y6 9* SP Address: 9 `t A , 7— Mt E City: t-1 t W-t _ State: Zip: ;SrP% 13 Tenant/Lessee Name: Phone#: Email. JOB ADDRESS: VI S City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name: .e_14 F70 F ,I'rtatn L. e Phone#: o ® 4 Address: 3 ,5s6g a ?P City: �q a A.R®fl ( State: .er Zip: Qualifier Name: r o�,t -tom t? Phone#: 3'S 4-4(4=::147_, to �, State Certification or Registration #: Certificate of Competency #: Contact Phone#: 3p$ L#' /r - Z., Email Addresses DESIGNER: Architect/Engineer: Phone#: Value of Work for this Permit: $ d ®° Square/Linear Footage of Work: Type of Work: ®Address ❑Alteration ONew 1 epair/Replace Description of Work: st P u - .—/ sir L -r ODemolition ******************************get ** * * *X7 **** * * * * * * * * * * * * *** * * * * * * * * * * * * * ** *** Submittal Fee $ Permlt Fee 7 CO /CC $ Scanning Fee $ £ Radon Fee $ DBPR $ Bond $ Notary $ Training/Educafion Fee $ Double Fee $ Structural Review $ Technology Fee $ TOTAL FEE NOW DUE $ l (..) Bonding Company's Name (if applicable) Bonding Company's Address City State Mortgage Lender's Name (if applicable) Mortgage Lender's Address City ! tate Zip 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 AlIFIDAVIT: 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: Asa 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 : approved and a reinspection fee will be charged. Signature 61, Owner or Ag 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: ET M. MOKHER Commission # DD 962484 Expires February 18, 2014 same mo Day Fain Mamma 800486-1018 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: ******** ******** 4******************** * * * * * * * * * * * * * * * * * * * * * *** * * * * * ** APPROVED BY Jr-441'4i Plans Examiner Structural Review (Revised 07 /10/07)(Revised 06✓10/2009)(Revised 3/15/09) '1,7 41 ,•6‘ • ' = , 1 '14 '4,4; -•■ tNa' DATE BATCH NUMBER lgikt 4,.iNgiV1 Aktit4044048 40,g&ka, .!‘ VaggWr {0 0 0 g T 14" +1,) SEE OTHER SIDE DO NOT FORWARD MOKHER PLUMBING CO JOSEPH A MOKHER JR 3800 SHIPPING AVE MIAMI FL 33146 213 liAlAnnAdad.InhhhOJIA.Ahail OP ID:CP A(CORD �...,,..- CERTIFICATE OF LIABILITY INSURANCE DATE (MM /DD/YYYY) 01/05/11 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER 305 - 270 -2100 FILER INSURANCE, INC. 305 305-270-2195 9440 S.W. 77 Avenue Miami„ FL 33156 Keith R. Miller CONTACT NAME: PHONE FAX (A/C. No, Ext): (A/C, No): E -MAIL PRODUCER CUSTOMER ID #:MOKHE01 INSURER(S) AFFORDING COVERAGE GENERAL NAIC # INSURED Mokher Plumbing Company 3800 Shipping Avenue Miami, FL 33146 INSURER A :Harleysville Mutual Ins. Co. INSURER B : Business First Insurance Co. GL00000090631 D INSURER C : 01/01/12 INSURER D : $ 1,000,000 INSURER E : PREMISES (Ea occurrenceRENTED ) DAMAGES ( INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE 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 (MM /DD/YYYY) POLICY EXP (MM/DD/YYYY) LIMITS A GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY OCCUR GL00000090631 D 01/01/11 01/01/12 EACH OCCURRENCE $ 1,000,000 X PREMISES (Ea occurrenceRENTED ) DAMAGES ( $ 100,000 CLAIMS -MADE X MED EXP (Any one person) $ 5,000 PERSONAL &ADVINJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GE 'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ 2,000,000 POLICY X PRO- JECT LOC $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTYDAMAGE (Per accident) $ $ $ A UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE CMB00000022148H 08/17/10 08/17/11 EACH OCCURRENCE $ 1,000,000 AGGREGATE $ 1,000,000 DEDUCTIBLE RETENTION $ $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVEY OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS /N N / A 52100865 07/24/10 07/24/11 WC STATU- X OTH- TORY LIMITS ER E.L. EACH ACCIDENT $ 500,000 E.L. DISEASE - EA EMPLOYEE $ 500,000 below E.L. DISEASE - POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) N CITYO56 City of Miami Shores Building & Zoning 10050 NE 2 Avenue 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 ( 4 CHRISTINE PIERSOL- A207301 ACORD 25 (2009/09) © 1988-2009 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 BUILDING PERMIT APPLICATION FBC 2004 1) MOMITTi MR 1 2 2308 L. BY: U.- Permit No. 46p J Master Permit No. gG OK-71Y Permit Type: Plumbing Owner's Name (Fee Simple Titleholder), 0(2, &-1 1.8 Phone # Owner's Address 1`-1 -41:7 '�-� Z AU City State 1 L. Zip �J k 3 �j Tenant/Lessee Name Phone # E- MAIL: V V Job Address (where the work is being done) t'°'1 'sue® 1,-4 C_-. "Lr-- -,k-vtE )61 City Miami Shores Village County Miami -Dade Zip FOLIO / PARCEL # Is Building Historically Designated YES NO K Contractor's Company Name T'1 (214. g. Z Contractor's Address 10,O 8 t-1 L.. j City Qualifier Name State Certificate or Registration No. Q2„.. 1 .4 E -MAIL: Phone # 4 . - -B; , State t=7.71 Zip ' t 4 GP Architect/Engineer's Name (if applicable) Value of Work For this Permit $ Type of Work: ['Addition Phone #�5 Certificate of Competency No. Phone # Square / Linear Footage Of Work: Iteration ['New Describe Work: €. . C 1 -6Nc) 6e Er Repair /Replace ❑ Demolition i71S41��( **xxxxxxxxxxxxxxxx x: Yx9eiew **icw**www*Feesw*******www* c*****xxxxxxx3:xxxxxxxxxxxxxx4 *w.w Submittal Fee $ Permit Fee $ Notary $ Training /Education Fee $ Scanning $ Radon $ DPBR $ Zoning $ CCF $ CO /CC Technology Fee $ Bond $ Code Enforcement $ Double Fee $ Structural Review. $ Total Fee Now Due $ See Reverse side - Bonding Company's Name (if applicable), Bonding Company's Address `^ City State Zip Mortgage Lender's Name (if app[icay — Mortgage Lender's Address City State Zip Application is hereby made to obtain a permit to do the work and installations as indicated. [ 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: [ 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 l eilaiv will tia aoi:, . ... � � at theme rcnn w ose prope as su.lec tome' ff. -Atso, a certified copy ofihe recor&d notice of commencement must be poste i e 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- ,ta °''_'.'- Owner or Agent The foregoing instrument was acknowledged before me this day of 12. , 20y who is personally known to me or who has produced As identification and who did take an oath. NOTARY PUBLIC: Sign: P ,t: as >t�62_�i1R4041 Janet M. Mokher !L ', �. Commission # DD518323 My Commission Expires: '°• Expires February 18, 2010 aalispitfulto %% ➢C * * * ** * * * * * ** * * * * ** * % % % % %if %Y. % •X % % % %iC % % % % % % %% % % % % % % %i: % % % %Jf% w* %XX XXX XXXX % %XY. XX Contractor The foregoing instrument was acknowledged before me this day of l-, , 24c eyby who is personally known to me or who has produced as identification and who did take an oath. Y PUBLIC: Si t: 1111/11 i lfU. My Commission Expires: fr—/71/CL_ Janet M. Mokher 323 2010 unto Truy FOIn .Insurance, In 800.385.7019 APPLICATION APPROVED BY: (Revised 02/08/06) Plans Examiner Engineer Zoning Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores , FL 33138 -0000 Phone: (305)795 -2204 Expiration: 0I0i2000 Project Address Parcel Number Applicant 1700 NE 105 ST Street Number: 209 1122300500280 Miami Shores Village, FL Block: Lot: SAGHAR NAHIB Owner infgr patipn Address Phone Cell SAGHAR NAHIB 1700 NE 105 Street MIAMI SHORES FL 33138 -2140 Contractor(s) Phone Cell Phone MOKHER PLUMBING COMPANY (305)446 -8266 (305)582 -1346 Valuation: Total Sq Feet: Type of Work: plumbing Type of Piping: bathroom Additional Info: kitchen remodeling Bond Return : Classification: Residential Fees Due CCF Education Surcharge Permit Fee - New Construction Scanning Fee Technology Fee Total: Amount $1.20 $0.40 $180.00 $3.00 $4.50 $189.10 Total 1 Amt Paid 1 Amt Due $ 0.00 $ 0.00 Payment Type : $ 0.00 MAR 1 2 PAC $ 2,000.00 0 Available Inspections: Inspection Type : Final Lavatory Water Main Underground Rough Top Out Main Drain Re Pipe Heater Water Service In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes . I understand that separate permits are required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning . Futhermore , I authorize the above -named contractor to do the work stated . March 12, 2008 Authorized Signature : Owner / Applicant / Contractor / Agent Building Department Copy Date Wednesday, March 12, 2008 1 '04 kwfs. i l k CoxTrc,L Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33 (38 Tel: (305) 795.2204 Fax: (305) 756.8972 BUILDING PERMIT APPLICATION FBC 2004 Permit Type: Plumbing Owner's Name (Fee Simple Titlehol Owner's Address Cityt -t 1 s u c-°ILLE__ State _fit Tenant/Lessee Name Permit No. f 1, ,_, 11 FEzi BY: - -- -------------- Master Permit No. CJQ6 d __W 1412 Phone # —19 3.- ,,L-, (A Zip 3 ,i Pa Phone # E -MAIL: S t,_.+i A.Z..„ 44 Job Address (where the work is being done) City Miami Shores Village FOLIO / PARCEL # Is Building Historically Designated YES County Miami-Dade Zip e---� NO x. Contractor's Company Name %t-r r DE-511,1,1 4 ;- �4zy hone # 3C �' 3 `_ Contractor's Address City ‘ry i otsbv--1 , State Qualifier Name L F. I—% iG 1 State Certificate or Registration No. E -MAIL: 1 t4 r' t—t r Architect/Engineer's Name (if applica Value of Work For this Permit $ Zip 33 .� +ia Phone # 2_ rtificate of Competency No. Phone # Square / Linear Footage Of Work: Type of Work: ['Addition ['Alteration ['New oe Repair /Replace El Demolition Describe Work: -121, Et-ic /E. 4 PtsI� v ,°4'Vr', j T.i LE -r 1 Di�4,L,(_ \ t I_V' E. ' ,l r_l h t...,NV --r 2.. VA. LA./ A.,..:7 _,in -/et -.-r r,-J e— A t t") './ ILA_ 2Et- .i ta *******wwxxxxxxxxxxa2* Y*$ *** ww xxxxx*****Fees***xxxic4:****xxxxxxxx xx xxx* **xx* Submittal Fee $ Notary Scanning $ Bond $ Permit Fee $ Training /Education Fee $ Radon $ Structural Review. $ CCF $ I.00 CO /CC Technology Fee $ 4' Zoning $ Code Enforcement $ Double Fee $ Total Fee Now Due $ See Reverse side -* Bonding Company's Name (if applicable) Bonding Company's Address City State Mortgage Lender's Name (if applicable) Mortgage Lender's Address City Zip State Zip Application is hereby made to obtain a permit to do the work and installations as indicated. 1 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. 1 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: 1 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 who is personally known to me or who has produced As identification and who did take an oath. NOTARY PUBLIC: Sigh• Print: My Commission Expir ar**w 4xxxxat***** • ,r* Commis Okher Commission # D } 518323 APPLICATION APPROVED B (Revised 02/08/06) F ,o a exokx*xx 800335.7019 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: Sign: Print: My Com 11. "iciownission # QD518323 xYxxxd Yxx6 'xxxY res `O FteIn*b x li x8 iF n1fl Y x manes, nc xrxxr 811.335.7073 Plans Examiner Engineer Zoning { • • ADDENDUM TO BUILDING PERMIT APPLICATION AN APPLICATION FOR BUILDING PERMIT MUST ACCOMPANY THIS ADDENDUM. IF A MASTER PERMIT HAS BEEN OBTAINED, THE OWNER'S NOTARIZED SIGNATURE NEED NOT BE PRESENT ON SUBSEQUENT APPLICATIONS. PLEASE CIRCLE 0 DISCIPLINE APPLIED FOR: PLUMBING ELECTRICAL PERMIT # MECHANICAL ITEM UNIT FEE ITEM UNIT FEE ITEM UNIT FEE BATH TUB SWITCH OUTLETS SPACE HEATERS DISHWASHER LIGHT OUTLETS CENTRAL HEATING DISPOSAL RECEPTACLES NC (WIND) FLOOR DRAIN SERVICE TEMPORARY A/C (CENTRAL) GREASE TRAP SERVICE SIZE IN AMPS DUCT WORK INTERCEPTOR SERVICE REPAIR/METER CHANGE REFRIGERATION LAVATORY APPLIANCE OUTLETS PROCESS AND PRESS PIPING LAUNDRY TRAY RANGE TOP UNDERGROUND TANKS CLOTHES WASHER OVEN ABOVE GROUND TANKS SHOWER WATER HEATER U.F. PRESSURE VESSELS SINK. POT /3 COMP. MOTORS 0 -1 HP STEAM BOILERS SINK, RESIDENCE. MOTORS OVER 1 -3 HP HOT WATER BOILERS SINK, SLOP. MOTORS OVER 3 -5 HP MECHANICAL VENTILATION TEMPORARY WATER CLOSET MOTORS OVER 5 -8 HP TRANSPORTING ASSEMBLIES URINAL MOTORS OVER 8 -10 HP ELEVATORS/ESCALATORS WATER CLOSET MOTORS OVER 10 -25 HP FIRE SPRINKLER SYSTEMS INDIRECT WASTES MOTORS OVER 25 -100 HP COOLING TOWERS WATER SUPPLY TO: MOTORS OVER 100 HP VIOLATION NC UNIT NC WINDOW REINSPECTION FIRE SPRINKLER AIR CONDITIONERS HEATER -NEW INST. STRIP HEATER HEATER-REPLACE GENERATORS TRANSFORMERS . LAWN SPRINKLER -WELL GENERATORS TRANSFORMERS SWIMMING POOL GENERATORS TRANSFORMERS WATER SERVICE SPECIAL PURPOSE. SEWER CONNECTIONS OUTLETS COMMERCIAL UTILITY -SEWER SIGN TUBES UTILITY -WATER SIGN TRANSFORMERS SEPTIC TANK SIGN TIME CLOCK RELAY FIXTURES FAINFIELD, 4" TILE/RES. t„ ANTENNA PUMP & ABANDON SEPTIC TANK 4` TELEVISION OUTLETS SOAKAGE PIT CU. FT. = VIOLATION ` - CATCH BASIN REINSPECTION DISCHARGEWELL' DOMESTIC WELL AREA DRAIN ROOF INLET ' SOLAR WATER HEATER FIRE STANDPIPE POOL PIPING LAWN SPRINKLER SYSTEM GAS RANGE METER SET (GAS) GAS PIPING Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 -E2ftV Inspection Number: INSP - 187684 Permit Number: EL- 3- 08-424 Scheduled Inspection Date: March 20, 2013 Inspector: Devaney, Michael Owner: NAHIB, SAGHAR Job Address: 1700 NE 105 Street 209 Miami Shores, FL Project: <NONE> Contractor: M&D ELECTRICAL SERVICE INC Permit Type: Electrical - Residential Inspection Type: Final Work Classification: Addition /Alteration Phone Number (305)582 -1346 Parcel Number 1122300500280 Phone: (305)318 -7005 Building Department Comments ELECTRICAL FOR MASTER 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 19, 2013 For Inspections please call: (305)762 -4949 Page44of49 Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 3313$ Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305)762.4949 BUILDING PERMIT APPLICATION FBC 20 JAN 'if :1(1;E 2011 6'g Permit No. / Master Permit No. Permit Type: Electrical OWNER: Name (Fee Simple Titleholder): . ., a g y,� / SA-6-0 t-+ Phone#: 30 Address: SPA A P p * ?e) 7 City: /% /!e m . 5 ►s -S State: F C Zip: 33 1 Tenant/Lessee Name: Phone#: Email: s 7-93 (it'll JOB ADDRESS: vi c7,C7 E. & C'"5- . * 7...e:1 City: Miami Shores County: Miami Dade Zip: b.b o Folio/Parcel #: Is the Building Historically Designated: Yes NO Flood Zone: / V.14'5114 .J4e CONTRACTOR: Company Name: ") G d `ale2Wi ( geoeale34"hone#: '6i) ��r96 r Address: 2/'2 Fs-c& / r �ty:.__.�ls�!'�� Stater /�, Zip: 0 ZAP Qualifier Name: 2 arke0'.c. j/ _,�40 -A c �'4 Phone#: State Certification or Registration #: VW' tre7C.l e) .5Y Certificate of Competency #: Contact Phone#: Email Address: DESIGNER: Architect/Engineer: Phone#: Value of Work for this Permit: $ Square/Linear Footage of Work: Type of Work: ClAddress ❑Alteration CINew CIRepair/Repiace Description of Work:. t- t . -r 4.9 ******** * * * * *** * * * * * * * *** * *** *** * * * **** Fees************* *** * * * * * * *** * * * * *** * * * * * *** **** /‘—eve69l7 ize6)fe4i,02-1- Submittal Fee $ Permit Fee $ yF' /z e s, CCF $ CO /CC $ Scanning Fee $ 3. OD Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ I 88. CP 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 b ' approved and a reinspection fee will be charged Signature ....--.1.16hrerAdV Signature, Owner or Agent Contractor The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of , 20 , by day of , 20 , . , by who is personally known to me or who has produced who is personally known to me or who has produced As identification and who did take an oath. as identification and who did take an oath. NOTARY P LIC: L_. NOTARY PUBLIC: * * * * * * * * * * * * * * * * *+p; *** ***** iii********* * ** *** ***** ** *** *** **** ** ****it l * ****** *** ** F****** ************ /4") �%�,4/' Plans Examiner Zoning Structural Review Clerk (Revised 07 /10/07)(Revised 06/10/2009)(Revised 3/15/09) A o CERTIFICATE OF LIABILITY INSURANCE PRODUCER Ferrero Insurance Agency 10637 SW 88th Street, Suite 7L Miami, FL 33176 Phone (305)275 -7572 Fax (305)275 -0889 DATE (MM/DD/YY} 02/07108 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER: THIS` CERTIFICATE DOES NOT AMEND, EXTIND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC # INSURED M & D Electrical Service Inc. 21152SW128Ct Miami, FL 33177- 7425 COVERAGES INSURER A: First Commercial Insurance Co. INSURER B: INSURER C: INSURER D: INSURER E. INSURER F: THE POLICIES OF INSURANCE LISTED 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 POUCIES, AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED$1! PAID CLAIMS. INSR: ADD'i: fLTR :It SRp' TYPE OF INSURANCE, GENERAL. LIABILITY Ai COMMERCIAL GENERAL LIABILITY CLAIMS MADE OCCUR POLICY NUMBER P'UUCY EFFECTIVE POLICY EXPIRATION EACH OCCURRENCE DAMAGE TO RENTED 11/27/08 PREMISES (Ea occurenne) MED EXP (Any one person) PERSONAL & ADV INJURY GENERAL AGGREGATE PRODUCTS. -`C IPrOPAGG PATE IMMIDDIYY DATE (MM1DDIYYS , UMITS GL -15593 GEN'L AGGREGATE LIMIT APPLIES PE POLICY -'T1 PROJECT LOC AUTOMOBILE LIABILITY ' ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS ,D NON OWNED AUTOS C SIRED SINGLE LIMIT (Ea eccident) 3O0ILY INJURY Per j5eispn) 30DI1LY INJURY Fier accident) $1,000,000 $100,000 $5,000 $1,000,000 $1,=000,000 $1 X00, 000 PROPERTY DAMAGE (Per accident) ' AUTQONLY- EAACCIDENT •j` OTHER THAN EA ACC J. AUTO ONLY AGG ': 'EACH OCCURRENCE AGGREGATE' DEDUCTIBLE RETENTION -`: WORKERS COMPENSATIC Ai AND EMPLOYERS LIABILITY ANY PROPRIETOR / PARTNER f EXECUTIVE' OFFICER / MEMBER EXCLUDED? IT describe under SPECIAL PROVISIONS below OTHER'.', WOSTATU- _ _� OTH -1 t E.L. EACH:ACCIDENT E.L. DISEASE - EA EMPLOYEE EA.. .DISEASE - POLICY. LIMIT , DESCRIPTION OF OPERATIONS 1 LOCATIONS f. VEHICLES 1. EXCLUSII Electrical Work Service S ADDEr) PROVISIONS CERTIFICATE HOLDER Miami Dade County Building Code 140 West flagler Street 1602 Miami, FL 33130 -1563 ACORD 26 (2001/08) CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ornplience Offi 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO ' THE LEFT, BUT FAILURE TO DO 30 SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS RESENTATIVES. AUTHORIZED REPRESENTATIVE © ACORD CORPORATION 1988 f� . 09 25 10 10 :03a Humberto Morales STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REG[JLAT I ON 3052273859 p.2 8R23013962 07/23/10 108013871 REG ELECTRICAL CONTRACTOR MORALES, MOSVANY: D ELECT/1CAL URVXCE INC { INDI 'IDtIA3s lommlawr ALL LOCAL LICENSING RaQUIREMENTS PRIOR TO CONTRACTING IN ANY AREA) HAS REGISTERED under the provisions of ch. 4E19 fixpiretioe date' AUG 31, 2012 L10072201361 09 25 10 10:03a . STATE OF PI.CR>P DEPARTMENT OF F IANCIAI. SERVICES DIVISION OF WoRKERS COMPENSATION CONSTRUCTION C OF t T10 N T INDUSTRY ExEMPT FROM FLAN= WORKERS* COMPENSATION LAW EFFECTIVE 11/19/2009 EXPIRATION DATE: PERStA1k IHOSSVANY MORALES FEIN 204163102 BUSINESS NAME AND ADDRESS: M b n ELECTRICAL SERVICE VC 21152 S W 128TH CT MPAMI. Fl 33t77 Humberto Morales 3052273859 p.1 PLEASE CUT OUT THE CARD BELOW AND RETAIN FOR FUTURE REFERENCE SCOPE OF BUSINESS OR TRADE t• REGISTERED ELECTRICAL CENTRIC? 11/1E/n11 Iti 0 H E ft E IMPORTANT Pursuant to Chapter 440:05(14) F.S., an officer of a corporation who elects exemption from this chapter by filing • certificate of election under this section may not recover benefits or compensation under this chapter. Purulent to chapter 440.05(12). F.S.. Certificates of election to be mumps- cooly catty wiMin the nap c4 the bWSionsa us bade naiad on the mite of election to be exempt Pursuant to Chapter 440.051131, F.S.. Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation if. at any time after the Ming of the notice or the issuance of the certificate, the person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate. The department shell rev dm a certhfias:tc 4 any tin= for fakers of the person named on the certificate to Meet the requirements of this section. (1lSSTIONSf (950) 413-1609 CUT HERE li Curry bottom portion on the job, keep upper portion tor your records. OWC -252 tai i TE OF ELECThliti TO BE EBONY' tteWSSU 11g -06 U *AK Pis Pow t 231 620261 -8 TlSJi3 NOFABLL- oo $OT PAY • :-- f` a > ilij L SERI :.;... 'Cc :21152SW228CT - - 33177 UNIN- DA8E Min! • , z • • Na1yy$ 0 ELECTRICAL SERVICE -IisC .196 E 011ffiCA1. CaNTRAC'Iot: . go�° /art ��Tar/22Ae��@@ .';, -00108112001 000075.00 500 OTHER SIDE • DO NOT FORWARD M 8 0 ELECTRICAL SERVICE INC INOSVANY MORALES PRES 21152 SW 128 CT MIAMI FL 33177 I tail/* 1I/ IIIt ijJl la' t/ iaJJ1 11X111/111111111t1II11fl/i$IR11H Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CONTRACTORS' REGISTRATION FORM ALL CONTRACTORS MUST PROVIDE COPIES OF LICENCES AND INSURANCES EACH TIME A PERMIT IS SUBMITTED OR THE VILLAGE MAY MAINTAIN A FILE WITH YOUR INFORMATION FOR A $30.00 FEE PER YEAR. IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: A. COPY OF QUALIFIERS STATE LIC CARD B. COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF LIABILITY INSURANCE (CERTIFICATE HOLDER TO BE MIAMI SHORES VILLAGE BLDG DEPT) D. COPY OF WORKERS COMPENSATION (EITHER CERTIFICATE OR EXCEMPTION) IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY: A. COPY OF CERTIFICE OF COMPETENCY OF QUALIFIER B. COPY OF MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT C. COPY OF LIABILITY INSURACE (CERTIFICATE HOLDER MUST BE MIAMI SHORES VILLAGE BLDG DEPT) D. COPY OF WORKER COMP INSURANCE HER CERTIFICATE OR EXEMPTION) YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE HOLDER AS FOLLOW: MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES, FL 33138 COMPLETE CONTRACTOR'S INFORMATION BUSINESS NAME: J4 (e),,A3 / BUSINESS ADDRESS: / /7a. sg ,Zirer CITY A4 t' STATE � ZIP CODE . /9-? BUSINESS PHONE: (sow )'rte ®s- FAX NUMBER ( ) CELL PHONE ( ) QUALIFIER'S NAME: - /�,5 QUALIFIER'S LIC NUMBER: E -MAIL ADDRESS (IF APPLICABLE): Created on 3119109 BY MLDV I RV 3126109 MLDV JEFF ATWATER CHIEF AMNN- OFFPCER STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION 10-11-2011 * * IMITIFWATE �J RECTION TO Of EXBVT . FLi» OENMT1ON LAW * * CONSTRUCnON INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers Compensation law. EFFECTIVE DATe ni19/2011 EXPIRATION DATE 111/812013 PERSON; MORALES IHOSVANY 204163102 BUSINESS NAME AND ADDRESS-. M & 0 ELECTRICAL &MICE INC -- 21152 5 V 128TH CT MIAMI Ft. 33177 t�U C44: Itt*IREK-; DA TRAM: 1- IIMIK I:11140 IMPORTANT: Format to Chapter 440 . 014141, P.S., se officer al a corporatina rho elects mania* from this Minn by Min a certificate al alectIna airier this seethe may ant recover benefits or enigmatic* inter this dander- Parnant to Minter 440.0W2). ER.. Certificates of attar= 10 tte emiltPt— MIT oldll NMI the craps of tie business sr limbs listed tut Ike take of Main to ba exempt Pelmet to Captor 441L01413/, LS, Islices of election to be mon and militates el election to be exempt shall be subject to reventias if, et say time altar the Min of in notice or the imam of the certificate, the perm named on the Mice ci certificate no longer meets the netireinente of fliis sectin les ineem of a manificate. The di ment WO revoke a certificate at icy time for fallare of the perm mat on the certificate to meet the regain of this section. MC-252 CEKIRCALIE OF ELIVOM TO 6E EXINFT KEVIO 01-11 41E5110162 (1150) 413-1609 PLEASE CUT OUT THE CARD BELOW AND RETAIN FOR FUTURE REFERENCE STATE 1Ts FL ORtCiA DEARTME T OF FINANCIAL SERVICES D(VIS►,*N O , WORKE'R3 "COMPENSATION CONSTRUCTION INDUSTRY CERTIFICATE OF ELECTION TO OE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW EFFECTIVE: 11/19/2011 EXPIRATION DATE`: 11/18/2013 PERSON: IHOSVANY MORALES FEIN: 204163102 BUSINESS NAME AND . AbIJRESS: M & 0 ELECTRICAL SERVICE INC" 21152'S W 1ZBTH CT AMI, FL 33177 OPursuant to Chapter 440.4), F.S., an a corporation who elects exemption from this 05(1 chapter bya filing officer -a certificate of of election L under this section may not recover benefits or compensation under this D chapter. Pursuant to Chapter 440.05(12), F.S., Certifies of election to be H exempt.., apply only within the scope of the businese or trade listed' on Rthe' notice of election to be ; exempt. E Pursuant to Chapter 440,45413). F.S., Notices pf e)et*ton to be exempt and `certifictoes of election to be exempt shell ='be, sub ect to revocation if, at any time after: the filing of the notice or the rsspance of the certificate, the person nemed,on the notice ar certificate no onger meets the. requfremeante o �thts. section fqr issuance'-of a certificate.01 The department shaft revoke a certificate 'at any time for failure f the person named on the certificate to meet the requirements of this section. IMPORTANT SCOPE Of tdt1SIN 1- ELECTRICAL) EtECTitit1A1 QUESTIONS? (850) 413-1609 CUT HERE Carry bottom portion on the job, : keep upper portion for your records. DWC -252 CERTiF)CA1"E•, `'ELECTION a.: • tie vxa.. ,14i4 2O6O CT truce Trades Qualifying Board S CERTIFICATE OF COMPETENCY E000 40 ELECTRICAL E1 ICE 1 1/30/2013 12:26 PM FROM: 3052757572 Ferrero Ferrero Insurance Inc TO: 3057568972 PAGE: 001 OF 001 "'� CERTIFICATE OF LIABILITY INSURANCE °A�`MM'°°""") 01/30/13 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 policypes) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER CONTACT NAME: Marieta Ferrero Ferrero Insurance Agency PHONE (A/C Ex!): (305)275 -7572 c, No): (305)275 -7572 10637 SW 88th Street, Suite 71 1DRIEss. Ferrerolnsurance@bellsouth.net Miami, FL 33176 INSURERS) AFFORDING COVERAGE NAIC i Phone (305)275 -7572 Fax (305)275 -7572 INSURERA: Accident Insurance Co. $ 100,000.00 I SURER MED EXP (Any one $ 5,000.00 INSURER B : $ 1,000,000.00 M & D Electrical Service Inc. INSURER C : $ 2,000,000.00 21152 SW 128 Ct INSURER D : $ 2,000,000.00 Miami, FL 33177 -7425 (305) 318 -7005 INSURER E : $ rnt1r13 A n=e• ,...- .,......,,�. . .... --- INSURER F : 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. NN�� IN SR TYPE OF INSURANCE ADDLBUBR INSR wvn POLICY NUMBER POLICY E�FpF (MM/DDIYYWI POLICY EXP (MM/DDM'YY) LIMITS A GENERAL LIABILITY 0 COMMERCIAL GENERAL LIABILITY CPP 0006135 00 10/03/2012 10/03/2013 EACH OCCURRENCE $ 1,000,000.00 DAMAGE TO RENTED PREMISES (Ea occurrence) $ 100,000.00 11 MI CLAIMS-MADE OCCUR MED EXP (Any one $ 5,000.00 person) PERSONAL & ADV INJURY $ 1,000,000.00 • GENERAL AGGREGATE $ 2,000,000.00 GEM. AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGO $ 2,000,000.00 • POLICY • j' - • LOC $ AUTOMOBILE LIABILITY • ANY AUTO COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ in ALL OWNED ■ SCHEDULED AUTOS • AUTOS BODILY INJURY (Per accident) $ ■ • HIRED AUTOS NN-OWNED P ncNY � AMAGE (F�er $ • • aEci en $ • UMBRELLA LIAB • OCCUR EACH OCCURRENCE $ II EXCESS LIAB El CLAIMS-MADE AGGREGATE $ C7 I J DED • RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' UABILIT' ANY PROPRIETOR /PARTNER/EXECUTIVE / N OFFICER/MEMBER N / A $ WC STATU- OTH- TORY I MITS EN FR E.L. EACH ACCIDENT $ EXCLUDED? (Mandatory In NH) E.L. DISEASE - EA EMPLOYE $ It yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE- POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS l VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) Electrical Work CERTIFICATE HnI NPR Miami Shores Village 10050 NE 2nd Ave Miami Shores Fl 33138 Fax:305- 756 -8972 I PH:305- 795 -2207 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) CIF ©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 BUILDING PERMIT APPLICATION FBC 2004 Permit Type: Electrical ` � Owner's Name (Fee Simple Titleholder) i ,� 1Gl,Y / , k614) Owners Address CPO N`� City NUAA.1 State 11... REdEiVE MAR 10 2000 r Permit No. ELO &- ' -Z Master Permit No. Tenant/Lessee Name E -MAIL: Job Address (where the work is being done) City Miami Shores Village Phone # 7 .07 09- Zip 33 /36 Phone # Slew qs cb)V FOLIO / PARCEL # County Miami -Dade Zip Is Building Historically Designated YES NO Contractor's Company Name kW Elect cii. .amtc.c. Tnl. Contractor's Address ZLIE Z SI/v 12.7- c_1 City ittOkokk State Fl— Zip '-j'31 ` Qualifier Name' h03\14.101 J fvra 10 * b Phone # 0 c State Certificate or Registration No. EN, .10 Z Certificate of Competency No. 0 $ J,.- 0000 IN Phone # E -MALL: Architect/Engineer's Name (if applicable) Value of Work For this Permit $ (l )O Type of Work: Describe Work: Phone # Square / Linear Footage Of Work: ❑Addition ❑Alteration ❑New fryitcaL Lja44, /4 /14.45Tti ❑ Repair /Replace ❑ Demolition * * * * *r* * ** * ***** * ** * **** ** *** ** * * * *x* Fees* * * ** * *, Fees******************************************** *** Submittal Fee $ Notary $ Scanning $ 3'O Permit Fee $ Training /Education Fee $ d© 040 Radon $ DPBR $ Bond $ Code Enforcement $ Structural Review. $ CCF $ In20 CO /CC Technology Fee $ 3 :1S Zoning $ Double Fee $ Total Fee NowDue$ IS15 3S See Reverse side -a 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, Notice to Applicant: As a conclitient 10 the issuaniv promise in good. a copy of e I law asst Pry iv subject to certified notice la the person for the. w� � � °' he heading pen* is a;r ' inspection will and a _ be charged si_.44Y f2 Owner or *gent ' i day onLeket ..,2o y by Who is pessonally known to we or Who has produced Signature-- Contreugm Tim /! ' of 2eoP by who is :3! c known to we or Wh>a has As identification and who thud take an oath. as ids _ . - NOTARY C: NOTARY PUBLIC: Sign: L eiml%l 'IC C te— Pte: �6 �-t� -- 1')/1 y l _�. " t' anal : Mokher Pr nfszokes: My ' Commission # DD518323 My butane, I Iota ********** ****** *v'i'ii ** x 4: iz *x xxx x* *se t t4x* arse* x** *e. *--*-Wriner APPLICATION APPROVED BY: (Revised 02/08/06) Janet M. Mokher 18323' Bonaedtrsrvetn.e'ruary 18, 2010 h^en.Ins 800485•7019 / /,7:42 Plans Examiner Engineer Zoning Project Address Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Parcel Number Expiration: 09/08/2008 Applicant 1700 NE 105 Street Number: 209 Miami Shores Village, FL Owner Information SAGHAR NAHIB 1122300500280 Block: Lot: Address 1700 NE 105 Street MIAMI SHORES FL 33138 -2140 SAGHAR NAHIB Phone (305)582 -1346 CeII Contractor(s) M&D ELECTRICAL SERVICE INC Phone Cell Phone Valuation: Total Sq Feet: Type of Work: ELECTRICAL Additional Info: KITCHEN AND BATHROOM Classification: Residential Fees Due CCF Education Surcharge Permit Fee - Additions/Alterations Scanning Fee Technology Fee Total: Amount $1.20 $0.40 $150.00 $3.00 $3.75 $158.35 Total Amt Paid $ 0.00 $ 0.00 Payment Type: oui las ey, Amt Due $ 2,000.00 0 Available Inspections : Inspection Type: Relocation Meter Box Service Change Final Alteration Fire Alarm Underground Rough W. W. In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL, PLUMBING, MECHANICAL WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Futhermore, I authorize the above -named contractor to do the work stated March 12, 2008 Authorized Signature: Owner / Applicant / Contractor / Agent Building Department Copy Date Wednesday, March 12, 2008 1 Prepared by and return to: Robert A. Rabin, Esq. Blue Ribbon Title, Inc. 7700 N. Kendall Drive Suite 509 Miami, FL 33156 305- 275 -7001 File Number: 05- 1570 -WR Will Call No.: Parcel Identification No. 11- 2230 - 050 -0280 11111111111111111 111111111111111111111111 li11 CFN 20: 5RO5 1 n732 OR Bk 23393 Pas 1791 - 1792; (2p s) RECORDED 05/20/2005 09:31:04 DEED DOC TAX 11.200,00 HARVEY RUVU4v CLERK OF COURT MIAMI-E ADE COUNTY r FLORIDA Space Above This Line For Recording Data] AG -2 Warranty Deed (STATUTORY FORM SECTION 689.02, F.S.) This Indenture made this 5th day of May, 2005 between Jennifer Gamboa, a single woman whose post office address is of the County of , State of , grantor *, and Saghar Leslie Naghib, a single person whose post office address is 1700 N.E. 105 St., #209, Miami, FL 33138 of the County of Miami -Dade, State of Florida, grantee *, Witnesseth, that said grantor, for and in consideration of the sum of TEN AND NO /100 DOLLARS ($10.00) and other good and valuable considerations to said grantor in hand paid by said grantee, the receipt whereof is hereby acknowledged, has granted, bargained, and sold to the said grantee, and grantee's heirs and assigns forever, the following described land, situate, lying and being in Miami -Dade County, Florida, to -wit: Unit No. 209, THE SHORES CONDOIVHNIUM, according to the Declaration of Condominium thereof, as recorded in Official Records Book 4247, Page 707, of the Public Records of Miami -Dade County, Florida. and said grantor does hereby fully warrant the title to said land, and will defend the same against lawful claims of all persons whomsoever. * "Grantor" and "Grantee" are used for singular or plural, as context requires. In Witness Whereof, grantor has hereunto set grantor's hand and seal the day and year first above written. Signed, sealed and delivered • ' our presence: Witnes Witness N State of Florida County of Miami -Dade The foregoing instrument was acknowledged before me this 7day of [1 is personally known or [X] has produced a driver's license as identification. 4 low" . _Or bli' (Seal) C)t --cy Jennifer Gamboa, who [Notary Seal] Printed Name: My Commission Notary Public State of Florida Robert A Rabin •44 My Commission DD398613 09 DoubleTime®