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RC-13-87
Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 184241 Permit Number: RC- 1 -13 -87 Scheduled Inspection Date: March 29, 2013 Inspector: Bruhn, Norman Owner: WALLACE, JOHN Job Address: 518 NE 106 Street Miami Shores, FL 33138 -2046 Project: <NONE> Contractor: ANN CREST CONSTRUCTION INC Permit Type: Residential Construction Inspection Type: Final Work Classification: Addition /Alteration Phone Number Parcel Number 1122310140211 Phone: (305)986 -8981 Building Department Comments ADD MORE CABINETS TO EXISTING KITCHEN. Infractio Passed Comments INSPECTOR COMMENTS False Inspector Comments Passe / 4 )7--fei Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. March 28, 2013 For Inspections please call: (305)762 -4949 Page 10 of 32 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: 519 nifF J 016 JAN 10 B Y: FBC 20 Permit No. L 1 Master Permit No. ROOFING City: Miami Shores County: Miami Dade Zip: Folio/Parcel #: // '-® 1) 2 Is the Building Historically Designated: Yes Flood Zone: OWNER: Name (Fee Simple Titleholder): L 5 I5 to V +4 11 10 b/ Phone#:. F5)41776 1776 Address: 5) 5 N7-- i D (2---'`T City: f141-taYw! 5 Y 5 State: ¥ L— zip:y 3 ) 3 Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Compan'Name: �iyln — C_.1/ J A' w hone#: (31:75) 454,-)19. Address: 1 1 v Svc. y V& City: YY ! 4) n . ,� State: Zip: 3 ' y '4 Qualifier Name: c.50(.71-1) OK) Phone #: e3 (9 `-Y ?? State Certification or Registration #: ,OS5'D b3 Certificate of Competency #: Contact Phone#:%`4 g 8L.-1 9 ! Email Address: / � G DESIGNER: Architect/Engineer: 1 Lliiil 1 � J ' t� �I._ ,,'hone #: C.1�$,2-46-3 `I Value of Work for this Permit: $ % 6 Square/Linear Footage of Work: Type of Work: ❑Addition SrAlteration Desc on �C ' ONew ORepair/Replace %. • or LA /PA Color thru tile: ODemolition ******** ** ** ** *** *** *** ** * *** ** *** * * *** s************** ***. ******* *** ** * **** *** *** * * ** Submittal Fee $ Permit Fee C CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for RT.F,CTRICAL 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 he absence of such , osted notice, the inspection will not be approved and a reinspection fee will be charged. Signature at^— WCO -U0-1/4-0 Owner or Agent The - oing instrument as aalkno. ledged be ore /m� s day o 141 , 20 by l;� s � u ho is pers nally known to me or who has produced cation and who did take an oath. Signature Contractor The for oing instru , ent was ackno . led : - , be day of �` , 20 �! by 1 who is p Sign: Print: My Commission Expires: APPROVED BY Plans Examiner Structural Review (Revised 3 /12/2012)(Revised 07110 /07)(Revised 06 /10/2009)(Revised 3/15/09) N u sorlally kn C° n y 1 to me or who has produced dentification and who did take an oath. TARY PUBLIC: - ti Sign: Print: My Commission ILLOS of Florida My Comm Expires Sep 23. 2015 Commission # EC 128810 Bonded Through National Notary Assn. Zoning Clerk NOTICE OF COMMENCEMENT A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION PERMIT NO. TAX FOUO NO.' - 27/31-*i7 —02-I STATE OF FLORIDA: COUNTY OF MIAMI -DADE: THE UNDERSIGNED hereby gives notice that improvements will be made to certain real property, and in accordance with Chapter 713, Horida Statutes, the following information is provided in this Notice of Commencement. 111111111111111111111111111111111111111111111 F= F4 2011. ZS RCP on 8324 OR Bk 28428 Ps 42401 (1ps) RECORDED 01/04/2013 11:44:49 HARVEY RUVIN, CLERK OF COURT MIAMI -DADE COUNTY► FLORIDA LAST PAGE Space above reserved for use of rreccording office 1. Legal description ofproperty and street/addrJs: 1 11/L1� P2-- %�J Pp,'w4 ,5/ D S &. 5 T GL /fir bS 2. Description of Improvement: 3. Owner(s) name and address: Interest in property Name and address of fee simple titleholder. 4. Contractor's name, add and phone number: v Std 1- I • FL. ice-. Ter 3313 i' 5. Surety: (Payment bond required by owner from contractor, If any) Name, address and phone number: Amount of bond $ 6. Lender's name and address: 7. Persons within the State of Florida designated by Owner upon whom notices or other documents may be served as provided by Section 713.13(1)(a)7., Florida Statutes, Name, address and phone number: 8. In addition to himself, Owners designates the following person(s) to receive a copy of the Uenor's Notice as provided in Section 713.13(1)(b), Florida Statutes. Name, address and phone number: 9. Expiration date of this Notice of Commencement: (the expiration dale Is 1 year from the date of recording unless a different date is spec ied) WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS: UNDER CHAPTER 713, PART I, SECTION 713.13. FLORIDA STATUTES, AND CAN RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT. Signature(s) of Owner(s) Rr One ' Authorized Officer/Director/Partner/Manager Prepared By e' (F-C -Q Prepared By Print Name j.G41 ir. 4414 n . , (i1 Print Name Title/Office Title/Office a, STATE OF FLORIDA COUNTY OF MIAMI -DADE The toygtinitns By Individually, or Personally known, or ❑ ged before me this "f day of //Wit Z13 for roduced the • (lowing type of identification Signature of Notary Public: Print Name: (SEAL) if 111%11 /i LIVMPIAP " VERIFICATION PURSUANT TO SECTION 92.525. FLORIDA STATUTES Under penalties of perjury, I declare that I have read the foregoing and that the facts stated in it are true, to the best of my knowledge and belief. Signature(s) of Owner( ) or Owner(sj's Authorized Officer /Director/Partner /Manager who L r!Q -0 By +.4f„ CLAUDIA V. CUSILLOS '•' "" A`� '� Notary Public • State of Florida ' n4 My Comm Expires Sep 23, 2015 Commission # EE 12881t) Ve °F, °`� ' Bonded Through National Notary Assn. By X. 123.01.62 PAGES SAO STATE °M Man Or DADE 1 HAY GERTIPY yams t8 a true oopy ofttre� WOW fled niisaceOff A0 — of chrcu .tuts P' If, '±� - ..nr ,..vtr, CERTIFICATE OF LIABILITY INSURANCE DATE (MIWODIYYYV) 12117/2012 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the poHcy(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). FnonuCE i Work Comp Associates, Inc. P.O. Box 33297 Palm Beach Gardens, FL 33420 -3297 canner Mae Michael D. Holleman P wc. F (561) 863 -9581 raS Bak Ra �Nak (561) 881 -9745 LAVAL amla mail@WorkCompAssoc.com INSUREFES) AFFORDING COVERAGE NAlca INSURER A: Bndge5eld Employers Insurance Co. INSURED Ann -Crest Construction Corp. 1140 S.W. 84th Avenue Miami, FL 33144 -4118 INSURER B: INSURER c: INSURER D INSURER E INSUREFI F. COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF ASSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE PCUGY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITFI RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PER 1 AIN, 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 ADD/ UBIT INSR WVD POLICY NIRNRFR POLICY EFF POLICY EXP I*1WfDP/YYYi CAM/DDIYYVYI GENERAL LIABILITY COMMERCIAL GENERAL LUIBIUTY CLAIMS-MADE ® OCCUR GEM_ AGGREGATE LIMIT APPLIES PER: POLICY n JECT n LOC EACH OCCURRENCE UANIA(it IU RIMED PRFMIRPR (FR nreartra w} MED EXP (My one person) PERSONAL & ADV INJURY GENERAL AGGREGATE PRODUCTS - COMP /OP AGO $ AUTOMOBILE LIABILITY r- ANY AUTO ALL OWNED AUTOS HIRED AUTOS SCHEDULED AUTOS NON -OWNED AUTOS UMBRELLA UAB OCCUR EXCESS UAB CLAIMS -MADE r tl 4 0 D ED ',RETENTION WORKERS M ENSATION AND EMPLOYERS' LIABIUL�77y�y Y f N A ANY PROPRIETORiPARTNER1EX.ECUT1vE OFFICE/MEMBER EXCLUDED? (Mandatory in N}4) If yes, describe under DESCRIPTION OF OPERATIONS betoar (XJMd1Nto KIN(itt UMI t Ea acid BODILY INJURY (P parson) BODILY INJURY (Per are11ll $ $ $ EACH OCCURRENCE (PRr ar - iderr1) AGGREGATE IA 0830370020000 411/2012 4/1/201 W(:SIAIU- UIH TORY I IMITR ER E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE 100,000 $ 100,000 E.L DISEASE POLICY LIMIT 500,00 DESCRIPTION OF OPERATIONS/ LOCATIONS1 VEHICLES (Attach ACORD ,A km Sshedui , N mare space Is required) CERTIFICATE HOLDER CANCELLATION Miami Shores Village Bullring Dept. 10050 N E 2nd Avenue Miami Shores Village, FL 33138 -2382 SHOULD ANY THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISONS. AUTHORIZED REPRESENTATIVE ACORD 25 (2010/'05) t 1988 -2010 ACORD CORPORATION. AU rights reserved. The ACORD name and logo are registered marks of ACORD .=WNW- .4n. LAM. $C.$ 1 (tL4t $G V-t.J 1 rIV, rays. 1 %A 1 ANNCR -2 OP ID: JJ '4� - CERTIFICATE OF LIABILITY INSURANCE °" 12/17°""'°12 " THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERl1FICAlE 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 INSURER1S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policylles) 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 endorsementls). Brown PRODUCER Brown of Florida, Inc. 407-660 -8282 2800 Lake Lucien Dr., Ste. 330 407-660 -2012 Maitland, FL 32751 -7234 Ifraft House T Julie Jackson y ,Ne, Exit 407 F 0.8282 j ,N,p 407 -660 -2012 "AIL ADDREas: jjadcson(libborlando.com INSURERS) AFFORDING COVERAGE NAIC # INSURER A : Acdderd Inaurnnce Company Inc LIABILITY COMEAIIRata. GENERAL LABILITY INSURED Ann -Crest Construction Corp 1140 SW 84th Avenue Miami, FL 33144 INSURER B: CPP000518100 ENSURER C: 08126113 INSURER D : $ 1,000,000 INSURER E : $ 100,000 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 HEREON IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. @ISR LIR TYPE OF INSURANCE ADiX_ tNSR SUN WV) POLICY RALMBER POLICYEEP IMMIDDMYYY) POLICY EXP IMMIDDIYYYYE LIMITS A GENERAL X LIABILITY COMEAIIRata. GENERAL LABILITY CPP000518100 08126112 08126113 EACH OCCURRENCE $ 1,000,000 DA rtaa,REN1 FD co $ 100,000 CLAIMS -MADE X OCCUR MEDEXP (Any one person) $ 5,000 PERSONAL & ADV IN.BIRY $ 1,000,000 GENERAL AGGREGATE $ 2,000 ,000 GENT.AGGREGATELIa4IT APPLIES —Xi POLICY JPERC PER: LOC PRODUCTS - COMP/OPAGG $ 2,000,000 $ AUTOMOBILEUABELITY ANY AUTO ALL OWNED AUTOS IL RED AUTOS SCHEDULER) AUTOS NON -OWNED AUTOS cO accident) SINGLE LMT (Ea BODILY INJURY (Per person) $ BODILY IN.AMY (Per =ideal) $ PROPERTY Decided) $ UMBRELLA LAB EXCESS UAB ` OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED REPENT ON $ $ WORKERS COMPENSATE AND EMPLOYERS' LIAINUTY ANY PROPRIETORIPARTNFR/EXECUTIVE OFFICER/MEMBEREXCLUDED7 (Mandntosy In NH) If yes, descnbs under OESCWI'Tt0NOF OPERATIONS Wow Y f N N/A WC STATU- 1 TORY I IS I OTH- ER EL. EACH ACCIDENT $ EL DISEASE - EA EMPLOYEE $ E.L DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERA1I0NS J LOCAITONS /VEHICLES I ICLES (Attach ACORD NM Addltmret Remedial Schedule, Umora space to required) CERTIFICATE HOLDER CANCELLATION MIAMISI Miami Shores Village Building Dept. 10050 NE 2nd Avenue Miami Shores, FL 33138 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATItON DATE THEREOF, NOTICE WILL BE DELIS IN ACCORDANCE WITH THE POLICY PROVI9ONS. AUTHORIZED REPRESENTATIVE ACORD 25 (2010105) CO 1988 -2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD 1940 NORTH MONROE STREET TALLAHASSEE FL 32399 -0783 CALVO, SIZTO JORGE ANN -CREST CONSTRUCTION CORP 1140 S.W. 84TH AVE. MIAMI FL 33144 Congratulations! With this license you become one of the nearly one million Floridians licensed by the Department of Business and Professional Regulation. Our professionals and businesses range from architects to yacht brokers, from boxers to barbeque restaurants, and they keep Florida's economy strong. Every day we work to improve the way we do business in order to serve you better) For information about our services, please log onto www.myfloridalicense.com. ense.com. There you can find more information about our divisions and the regulations that impact you, subscribe to department newsletters and team more about the Department's initiatives. Our mission at the Department is: License Efficiently, Regulate Fairly. We constantly strive to serve you better so that you can serve your customers. Thank you for doing business in Florida, and congratulations on your new liaensel (850) 487 -1395 128003578 DETACH HERE IS 'OCUNiENT H �LS 1CKGRRO;CJND'.. MICR OPRINTINCI �.LINE:MAR TEU`PAPER- A #61..941 STATE OF FLORIDA :; DEPARTMENT OF S fSINESS PROF . CONSTRUCTION TRY_ L= � BATCH NUMBER LICENSE NEE. 0710612012 128003578 CGC0580 The GENERAL CONTRACTOR Named below IS CERTIFIED. Under the provisions of chaptE Expiration date: AUG 31, 2014 TONAL RE TION SING BO SEt L :2o7060100l CALVO, SIXTO'JORGE ANN -CREST 'CONSTRUCTION CO 1140 S.W. 84TH AVE. MIAMI FL 33144 RICK SCOTT GOVERNOR DISPLAY AS REQUIRED BY LAW KEN LAWSON SECRETARY 357869-8 THIS IS NOT A BILL — DO NOT PAY RENEWAL STATEralt%8063 8�0 SW 84 AVE UCTION CORP 114 33144 UNIN DADE COUNTY "15cro CALVO 1 �� BUILDING CONTRACTOR WORKE2 /S THIS IS ONLY A LOCAL BUSINESS TAX RECEIPT, IT DOES NOT PERMIT THE HOLDUR TO VIOLATE ANY OR ZO OV THE DO NOT FORWARD COUNTY OR CITIES. NOR DOES IT EXEMPT THE HOWE R FROM ANY OTHER POSIT OR UGENSE REQUIRED BY LAW THIS IS NOT A CERTIFICATION OF MAIM REcEWED mumamm amity rYTAX couermlt 60060000104 000075.00 ANN CREST CONTRUCTION CORP SIXTO CALVO 1140 SW 84 AVE MIAMI FL 33144 1 1IIIIUHII�Ifl1 I 1It�,{, 11IIII1I1II11,11,11,111.1.1,1123 FIRET -GiABS U.S. POSTAGE I PAID MIAMI, FL PERMIT NO. 231 373974 -6 SEE OTHER SIDE Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 184271 Permit Number: EL- 1 -13 -88 Scheduled Inspection Date: March 20, 2013 Inspector: Bruhn, Norman Owner: WALLACE, JOHN Job Address: 518 NE 106 Street Miami Shores, FL 33138 -2046 Project: <NONE> Contractor: EMPIRE ELECTRIC MAINTENANCE & SERVICE INC Permit Type: Electrical - Residential Inspection Type: Final Work Classification: Addition /Alteration Phone Number Parcel Number 1122310140211 Phone: 305 -264 -9982 Building Department Comments ELECTRICAL FOR PARTIAL KITCHEN REMODEL Infractlo 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 27Z__ /IPA (.? March 19, 2013 For Inspections please call: (305)762 -4949 Page 15 of 49 BUILDING 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 JAN Y: FBC 20 Permit No.� PERMIT APPLICATION Master Permit No. Permit Type: Electrical � JOB ADDRESS: 5) [/ lJW 1 V [7'5 City: Miami Shores County: Miami Dade Zip: Folio/Parcel #: 2,2".3 0 -0 1'' Is the Building Historically Designated: Yes NO Flood Zone: OWNER: Name (Fee Simple Titleholder): 1—'6.5 Lim 1A1 »j,) n Phone#:C2 0 .) S— 2'l i' Address: 5 / f D I 5- City: fln Yt I State: rt.- zip: 3313 Tenant/Lessee Name: Phone #: Email: CONTRACTOR: Company Name: trn r re. E led-re Ci Tillei Phone#: — Address: (®4t cal! 67 +4 AV (-- City: M1 am t S te: _R o Zip: 3 3 ( Qualifier Name: A- yf n t o E non f-e_2- Phone #: W5-796 — -0691D c/ State Certification oo r Registration #: EC OM 1 r 14 Certificate f Competency #: Contact Phone #: DESIGNER: Architec Value of Work for this Permit: $ 1-2 ' Square/Linear Footage of Work: Type of Work: ❑Address ialteration New URe.air/Replace Description of Work: cf 5 Sy Ft ODemolition ** ** **** ** ****** ** ********x:+x*** **** *** Fees**** *****+ xx:**** ** **** ** **«s***:x***** * ******** Submittal Fee $ Permit Fee $ 1.49 P® v CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOIT.RRS, 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. I , . bsence of such , osted notice, t inspection will not be approved and a reinspection fee will be charged. 4 071/1/ 7p Apr XSignature Owner or Agent The for oin instrumegt as ac o e4 ed before e day of , 20 I , by 1 Signature The foreg day of ho is p sonally known to me or who has produced l� t who is i� cation and who did take an oath. NOTA Sign: Print: My Commission Expires: Commission # Assn. Bonded Through National Notary w Contractor •s r g instrument was yacknowledge. before me 1 0fJ,by if (1.1 0 y to or who has produced ation and w I did take an r1i I tar" 1■4 i & 1,; kno as id Sign Pri D a My Commission E * 45 4: 4: 4:: k, �e�k�k�k�k4r4: 4:******************************* ********** * *** * ************ **** APPROVED BY 22 /6-tr) --% 24°LPlans Examiner 407 3 MARIAN M FERNANDEZ MY COMMISSION # EE040716 EXPIRES January 24, 2015 53 F Zoning Structural Review Clerk (Revised 3 /12/2012)(Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) a` °RO® CERTIFICATE ILITYr INSURANCE THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION£ONbY AND, CONFERS. NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEFMEXTENQ' OR ALTER THE COVERAGE AFFORDED BY THE POUCIES BELOW. THIS CERTIFICATE OF INSURANCE DOES `Nor CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED. 'PRESENTATIVE OR PRODUCER, AND THE CERTIFICATE'HOLDER. L DATE (MM/DDIYYYY) 3/30/2012 PORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(fes) must be indorsed. If SUBROGATION 1S WAIVED, subject to the terms and conditions of the policy, certain policies' may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in Ileu of such endorsement(s). PRODUCER Fortun Insurance, Inc. 365 Palermo Ave. Coral Gables FL 33134 -6607 CONTACT Neyza Dias EtigNH . Eo. (305) 445 -3535 (AIC. Not: (866) 415 -0825 MAIL ADDRESS: y Ne za.Diaz @fortuninsurance.com A INSURER(S) AFFORDING COVERAGE NAIC B INSURERA:Chartis Insurance Company INSURED Empire Electric Maintenance & Services, Inc., Empire Fire Safety, LLC 1041 SW 67 Avenue Miami COVERAGES FL 33144 INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : CERTIFICATE NUMBER:CL1233003854 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 IMiICH.THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED •BY THE POUCIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH. POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED•BY PAID CLAIMS INSR TYPE OF INSURANCE ADM -SUM INSR WVD POLICY NUMBER POLICY EFF (MM/DD)YYYYI POLICY EXP MMIDDIYYYY1 LIMITS A • GENERAL X LIABIUTY COMMERCIAL GENERAL L� LIABILITY X X Binder #31233005814 3/31/2012 3/31/2013 EACH OCCURRENCE $ 1,04U400 DAMAGE TO RENTED PREMISES (Ea occurrence) $ 300,000 NED FA. (Any ore fin) $ 5, 000 1 CLAIMS -MADE I x OCCUR PERSONAL 8 ADV INJURY $ 1,006,000 GENERAL AGGREGATE $ 2,000,000 PRODUCTS $ 2,000,000 GEN'LAGGR : EGATEUMIT APPLIESPER )—C-1 POLICY n JEGT I LOC $ i `- �AUTOMOBILELIABIUTY I X X ANY AUTO �OOSWNED HIRED AUTOS X �EEDULED NON -OWNED AUTOS X Binder #31233005814 3/31/2012 3/31/2013 COMBINED SINGLE LIMIT (Ea accident) • $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per aoctdent) $ Medial payments $ 5,000 A X UMBRELLA UAB EXCESS LIAB X _ _ OCCUR CLAIMS -MADE Binder #131233005814 3/31/2012 3/31/2013 EACH OCCURRENCE $ 3,000,000 AGGREGATE $ 3,000,000 $ DED 1 X 1 RETENTION$ 0 A WORKERS COMPENSATION AND EMPLOYERS' UABIUTY ANY PROPRIETOR/PARTNER/EXECUTIVE Ya OFFICER/MEMBER EXCLUDED? (Mandatory In NH) Kyea deantbe under DESCRIPTION OF OPERATIONS below NIA Binder #B1233005814 3/31/2012 3/31/2013 X t TORY LIMI�TB 1 I ER E.L. EACH ACCIDENT $ 500,000 EL DISEASE - EA EMPLOYEE $ 500,000 $ 500,000 EL DISEASE - POUCY LIMIT DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, H more apace Is required) CERTIFICATE HOLDER CANCELLATION Miami Shores Village 10050 NE 2 AVE Miami Shores, FL 33138 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Sector Fortiun /ND ACORD 26 (2010105) INS026 (201005).01 The ACORD name and logo are registered marks of ACORD © 1988-2010 ACORD CORPORATION. All rights reserved. rcD`OCUMENTI ORES BA©KGn "QUt ICRORIN71 EM F Eh1TED Rir fz� d.;b.lotnr..:'. CLRTIFI rider 'tlid' p visions a; EXpiratian date: AUG: 3 231894 -7 BUSINESS NAME / LOCATION EMPIRE ELECTRIC MAINTENANCE & SERVICE INC 1041 SW 67 AVE 33144 WEST MIAMI OWNER EMPIRE ELEC MAINTENANCE & SVC IN Sec. Type of Busineas WORKER /S 196 ELECTRICAL CONTRACTOR 5 THIS IS ONLY A LOCAL BUSINESS TAX RECEIPT. IT DOES NOT PERMIT THE HOLDER TO VIOLATE ANY =STING REGULATORY HE ZONI G F T DO NOT FORWARD COUNTY OR CRIES. NOR DOES IT EXEMPT THE HOLDER FROM ANY OTHER PERMIT OR LICENSE REQUIRED BY LAW. THIS IS EMPIRE ELECTRIC MAINTENANCE NOT A CERTIFICATION OF THE HOLDER'S OUALIFlCA- & SERVICE INC TIONS. THIS IS NOT A BILL - DO NOT PAY RENEWAL RECEIPT NO. 243764 -8 STATE &..E00001274 FlRST -CLASS U.S. POSTAGE I. PAID MIAMI, FL PERMIT NO. 231 ANTONIO HERNANDEZ PAYMENT RECEIVED 1041 SW 67 AVE COLLEcTToo1 COUNTY TAX W MIAMI FL 33144 07/10/2012 09010430001 000045.00 SEE OTHER SIDE tId1almilliliilllll Infltrlitttlh lddii fnH49ll