DEMO-11-196341(N' DING
PERMIT APPLICATION
FBC 20
Miami Shores Village
Buildin g Department artment i 2 �_ 2011
nom.
E.
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949
Master Permit No.
Permit Type: BUILDING ROOFING
OWNER: Name (Fee Simple Titleholder): Phone#: 30S- -2O/ 8Z
Address: IA/ Jc/�° /®,r/
City: '4I41114 / State: Ft-
Tenant/Lessee Name: Phone#:
Email:
2- 64, /1414t.-
JOB ADDRESS: (v/ Pe— /0
City: Miami Shores County: Miami Dade Zip: 33/LI1
Folio/Parcel#:
Is the Building Historically Designated: Yes NO w"-. Flood Zone: Xi 0
CONTRACTOR: Company Name: e /azji glide4r44.254, Phone#:. % iii
Address: / /,2? C ph..",.. ,u6. / Ll ®S
City: e®/ �.reld,b State:
[
Qualifier Name: r 5 4 ,.
State Certification or Registration / 7 j �C" Certificate of Competency #: /
Contact Phone#: Email Address: (ir�itS a 4fQG4S/h� OGe�v�q�i'c►.
DESIGNER: Architect/Engineer Phone#:
Zip: / /C
Phone#: 4- ./I
Value of Work for this Peimit: $ NoQ • OD Square/Linear Footage of Work:
°New °Repair/Replage
Type of Work: °Addition 'literati'
Alteration
°Demolition
Descri Lion of Work:
1/S 4'1 ILD0409 k Pe*Vile 640tl;n01s
**** *** **e+ *a<**x•*********** ****** •******Fees*x ******** .* * * *+n *************** * * * ** *****4∎ **
Submittal Fee $ Permit Fee $ /40 Q CCF $ . CO /CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $ Technology Fee $
Double Fee $ Structural Review $
TOTAL FEE NOW DUE $ (,f) • Zi J
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 $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged
;'Signature tv%LaLyta
/Owner or Agent
The foregoing instrument was acknowledged before me this 2c,
day of cx./Dat , 20 !/ , by SCe- fa /vA
Signature
The for g in
day of
who c._to me or who has produced . +o is pe
As identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
NOT Pvatrc
Chr i »rr,rhA F WDA
r 1\,-; =c• taus
l
Contractor
20 11
me or who has prod
cation and who did take an oath.
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Sign: '► 1 if
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Print:
+toy .a$'rr
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.?ia My Commission Expires:
B4.r��1;, l ,t i IfYAt ite)y *AC8R**** A****M RNk6 NPAA ****b*AdNpNkAM** HHhNn* P****NHeN***
* Nd**** *e*Fh****k *ANNk***
/�:i.t"•/ Plans Examiner Zoning
APPROVED BY
Structural Review Clerk
(Revised 07 /10107)(Revised 06/10/2009)(Revised 3/15/09)
STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487 -1395
1940 NORTH MONROE STREET
TALLAHASSEE FL 32399 -0783
CLAUSING, CHRISTOPHER DEAN
CLAUSING BUILDERS INC
4700 SW 74TH STREET
MIAMI FL 33143
Congratulations! With this license you become one of the nearly one million
Floridians licensed by the Department of Business and Professional Regulation.
Our professionals and businesses range from architects to yacht brokers, from
boxers to barbeque restaurants, and they keep Florida's economy strong.
Every day we work to improve the way we do business in order to serve you better.
For information about our services, please log onto www.myfloridalicense.com.
There you can find more information about our divisions and the regulations that
impact you, subscribe to department newsletters and leam more about the
Department's initiatives.
Our mission at the Department is: License Efficiently, Regulate Fairly. We
constantly strive to serve you better so that you can serve your customers.
Thank you for doing business in Florida, and congratulations on your new license!
DETACH HERE
a ff c4� • J'
5
CERTIFICATE OF LIABILITY INSURANCE
PRODUCER All Nation
8520 S.W. 401 81.
Miami, FL 33155
Phone (305) 220.0!00
Fax (305) 220.3028
DATE lameDD/YY)
08/20/11
THIS CERTIFICATE IS ISSUED AS A MATTER OF BIFORMA11ON
ONLY AND COWERS NO RIGHTS UPON THE CERTIFICATE
HOLDER THIS CERTIRCATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFOIWED BY THE POLICIES HOW.
INSURERS AFFORDING COVERAGE
NAIC #
MNStEM CLAUSING BUILDERS INC
4700 SW 74th Street
Mani, FL 33143-
1(786) 970-3642
COVERAGES
USURER a APPALACHIAN UNDERWRITERS
INSURER 0: FUBA
INSURER C: LEXINGTON INSURANCE CO
INSURER 0:
INSURER E:
INSURER F:
THE POLICIES OF INSURANCE LISTED HAVE MEN ISSUED TO THE INSURED NAMED ABOVE FOR THE PCU[CY PERIOD INDICATED. NOTWITHSTANDING
ANY REGLEMENT, TERM OR MOTION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WH4H THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAMi. THE ANCEAFFORDED BY THE PAS DESCRIBED HEREIN I8 SUBJECT TO ALL THE TEI S, EXCLUSIONS AND CONDMONS OF SUCH
POUC ES. AGGREGATE UISTS SHOWN EMY HAVE BEEN REDUCED BY PAID CLAD.
ORR
LTR
A
Ali.
INSRD
0
TYPE OF OINIIRANCE
POLICY NUMBER
ORAL LIABILITY
COMMERCIAL GENERAL LIABILITY
00 CLAMS MADE ® OCCUR
500.00 deductible
❑
GEML AGGREGATE LIMIT APPLIES PER:
POLICY 0 PROJECT ❑ LOC
158AUI1541200
mecum
DATEJIMUDDRA
08/20/11
POUDY =MAT=
a
DATE (am)
LBWS
08/20/12
EACH OCCURRENCE
DAMAGE TO NNrED
PREMISES (Ea *neurones)
MED EXP (Anyone person)
1.000,000
100,000
5,000
PERSONAL &ADV INJURY
1.000,000
GENERAL AGGREGATE
1.000,000
PRODUCTS - COMP/OP AGG
1.000,000
B
C
AUTOMOBILE UABI TTY
❑ ANY AUTO
❑ ALL OWNED AUTOS
❑ SCHEDULED AUTOS
❑ HIRED AUTOS
❑ NON OWNED AUTOS
n
COMBINED SINGLE LEITT
Ere accident)
•
BODILY INJURY
(Per person)
BODILY INJURY
(Per accident)
PROPERTY DAMAGE
(Per accident)
GARAGE LIABLTTY
❑ ANY Amp
❑
AUTO ONLY - EAAWDERT
OTHER THAN
AUTO ONLY:
EA ACC
AGG
❑
Ex LIABUITY
❑ OCCUR ❑ CLAIMS MADE
❑ DEDUCTIBLE
❑ RETENTION $
EACH OCCURRENCE
AGGREGATE
B
C
WORKERS COMPENSATION
ERPLOYERS' UABUiTY ASR?
ANY PROPRIETOR/ PARTNER / EXECUTIVE
OFFICER / NEWER EXCLUDED?
Ryes, dese under
SPECIAL PROVISIONS below
OTHER
PROFESSIONAL LIABILITY
WC10840232
08/30/10
08/30/12
TORT( ❑ ER
E.L EACH ACCT
1,000,000.
E.L. DISEASE _ EA EMPLOYEE
1,000,000.
E.L. DISEASE • POLICY LOAT
1,0X,000.
E0424072
07/18/11
07/18/12
DEFENSE INCLUDED I
500,000
DESCRIPTION OF OPERATIONS / LOCATIOPE / VEHACLES / EXCLUSIONS ADDED BY EtWORSEEENT / SPECIAL PROVISIONS
CERTIFICATE HOLDER
CANCELLATION
Miami Shores Village Building Dept.
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
SHOULD ANY OF THE ABOVE INSCRIBED POLICIES BE CANCELLED BEFORE THE
EXPEIATION DATETHIBIEON:,THE =MG INSURER vat erateavoa ToMAIL
30 MITER
30 ALABIUTY
THELL n,BUTF L N
OF L t MUM%ITS A TS Ate'
AUTHORIZED AflVE
MANUELGONZALEZ % ~ __ -_ ________ -__ ____
ACORD 25 (20011(4) QF
10 -10 -2011
JEFF ATWATER STATE OF FLORIDA
CHIEF FINANCIAL OFFICER DEPARTMENT OF FINANCIAL SERVICES
DIVISION OF WORKERS° COMPENSATION
* * CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW * *
CONSTRUCTION INDUSTRY EXEMPTION
This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law.
EFFECTIVE DATE:
PERSON:
FEIN:
10/10/2011 EXPIRATION DATE: 10/09/2013
CLAUSING CHRIS
261735060
BUSINESS NAME AND ADDRESS:
CLAUSINQ BUILDERS INC
4700 SW 74TH ST
MIAMI FL 33148
SCOPES OF BUSINESS OR TRADE:
1- CONSTRUCTION
IMPORTANT: Pursuant to Chapter 440 . 05(14), F.S., an officer of a corporation who elects exemption from this chapter by filing a certificate of election under this
section may not recover benefits or compensation under this chapter. Pursuant to Chapter 440.05(12), F.S., Certificates of election to be exempt... apply only within the
scope of the business or trade listed on the notice of election to be exempt. Pursuant to Chapter 440.05(13), F.S., Notices of election to be exempt and certff!cotes 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 certificote, the person named on the notice or
certificate no longer meets the requirements of this section for issuance of a certificate. The department shall revoke a certificate at any time for failure of the person
named on the certificate to meet the requirements of this section.
QUESTIONS? (850) 413 -1609
DWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01 -11
PLEASE CUT OUT THE CARD BELOW AND RETAIN FOR FUTURE REFERENCE
STATE OF FLORIDA
DEPARTMENT OF FINANCIAL SERVICES
DMSION OF WORKERS' COMPENSATION
CONSTRUCTION INDUSTRY
CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA
WORKERS' COMPENSATION LAW
EFFECTIVE 10/10/2011 EXPIRATION DATE: 10/09/2013
PERSON: CHRIS CLAUSINQ
FEIN: 281735060
BUSINESS NAME AND ADDRESS:
CLAUSING BUILDERS INC
4700 SW 74TH ST
MIAMI, FL 33146
SCOPE OF BUSINESS OR TRADE
1- CONSTRUCTION
!IMPORTANT
F 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
L under this section may not recover benefits or compensation under this
D chapter.
H 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
Rthe notice of election to be exempt
E Pursuant to Chapter 440.05(13), F.S., Notices of election to be exempt
and certificates of election to be exempt shall be subject to revocation
if, at any time after the filing of the notice or the issuance of the
certificate, the person named on the notice or certificate no longer meets
the requirements of this section for issuance of a certificate. The
department shall revoke a certificate at any time for failure of the
person named on the certificate to meet the requirements of this
section.
QUESTIONS? (850) 413 -1609
CUT HERE
* Carry bottom portion on the job, keep upper portion for your records.
DWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01 -11
Miami -Dade County - Local Business Tax - Receipt Details Page 1 of 1
MIAMI -DADE COUNTY - LOCAL BUSINESS T
Receipt Number: 655358 -1
BUSINESS NAME: CLAUSING BUILDERS INC MAILING ADDRESS: 1172 S DIXIE HWY 408
BUSINESS ADDRESS: 1172 S DIXIE HWY 408 MAILING CITY: CORAL GABLES
BUSINESS ZIP: 33146 MAILING STATE: FL
MAILING NAME: CLAUSING BUILDERS INC MAILING ZIP: 33146
Description: GENERAL BUILDING CONTRACTOR
MESSAGE: Payment received but it should be applied in your account within 1 -2 business days.
https: / /wasexp.nniamidade.gov /OCLWeb /OCLLicenseDetail jsp ?ln=1553581 &bn= CLAUS... 10/5/2011
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