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CC-12-1804Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 183482 Permit Number: CC -9 -12 -1804 Scheduled Inspection Date: January 02, 2013 Inspector: Bruhn, Norman Owner: MIAMI SHORES LLC, COCHRAN Job Address: 9705 NE 2 Avenue Miami Shores, FL Project: <NONE> Contractor: FAB INTERIOR & EXTERIOR INC. Permit Type: Commercial Construction Inspection Type: Final Building Work Classification: Alteration Phone Number Parcel Number 1132060134230 Phone: (305)751 -4447 Building Department Comments CHANGE OF USE, FROM MERCANTILE TO BUSINESS FOR A NEW BARER SHOP, AND TAX SERVICES Infractio Passed Comments INSPECTOR COMMENTS False Passed 2 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- 183391. Plans and permit must be posted. No access. NB December 28, 2012 For Inspections please call: (305)762 -4949 Page 13 of 22 PERMIT # CONTRACTOR: SUBMITTAL DATE: "1, 2 a' ADDRESS: Cr CS 2 I NAME: 1, 1 J ink I iscrt RAIIMITAL DATES: PROJECT TYPE: _At` i r JS eD ZONING _ FIRE STRUCTURAL IMPACT FEES DEC /- / PLUMBING NOC MECHANICAL va4 1 potb-r--- Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 7952204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 BUILDING PERMIT APPLICATION Permit Type: BUILDING JOB ADDRESS: 9702 - 9'05" N E City: Miami Shores 2iwz, 4 ✓6. IMCM5MriII ff � SEP 2 3 N iZ !J F�B�C20 X'�� Permit No. CC n 1 -- I E " Master Permit No. ROOFING County: Miami Dade Folio/Parcel #: i\ 2.0Xo ° CUB 3 ° X12 3 Zip: Is the Building Historically Designated: Yes NO ' OWNER: Name (Fee Simple Titleholder): Address: 1 BOD (ELF - F' 2 Da . tt 22z_ City: Fr. L/ ') ® State: Tenant/Lessee Name: a}1050J' Email: %A O M. cM ,YY14 t aC.(.JY"i CONTRACTOR: Company Name: '✓ t i n€ Oti- +' ard2k.X LIZ Flood Zone: Zip: 33 3 P to Phone #: 7'7 a' yv- -egt 7 Address: /IC Pe `3;- ST' City: (, p AA 1 CA49101 State: a.- Phone #: 9f•5-Lii i 1 Ziip_:,pyS3 t 3 Y / Phone#: TpV° 2.11- 4o Qualifier Name: 1 State Certification or Registration #: GG' C. I ©<0 ( ? Certificate of Competency #: Contact Phone #: Email Address: DESIGNER: Architect/Engineer: Phone #: Value of Work for this Permit: $ 4CIO Square/Linear Footage of Work: Type of Work: Addition Description of Work: C !05 e CQ 0 .- OAlteration ONew ORepair/Replace ODemolition bieJ l t . I ' / 5 " , I a r .x 6 . 4 e / d 1 4 e / 9 1 7 1 4 Color thru tile: ***************************************Fees**** **** **** ****** ** u * **** •** ***** * ***** *** Submittal Fee $ Permit Fee $ e*0°J CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL I+ 'EE NOW DUE $ Bonding Company's Name (if applicable) NI I d>6. Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) (1/4-.1 / 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 attach lent. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection w 'ch ,} . rs seven (7) days after the building permit is issued. In the absen of such posted notice, the inspection will not and a reinspection fee will be charged. Owner or Agent The fo :et .''g instrument was acknowledged before me this 624 day of 2012—_.., by who is rsonally know )to me or who has produced As identification and who did take an oath. NOTARY PUBLIC: Sign: ® L� Print: g•e& t r L.. VV) eLse- o..0 -e f It My Commission Expires: *+sway *sins**** ** Signature Contractor The fo - • oi: g ins m was aacknow1 -1ged b day of . � " U']' I 2012; by at i) • ., is pe .onally known to me or u ho has produced ' p and who did take an oath. NO ARY PUBLIC: My Color. Eitintos Feb 10. 2016 Commission • EE i3d2 APPROVED BY kr Structural Review xaminer Sign: Print: My Corn ission wwwwwwwwwa:a:www (Revised 3 /12/2012)(Revised 07110 /07)(Revised 06/1012009)(Revised 3/15/09) v o",' CLAUDIA V. CUBILLOS `o ary • ; •: tik+ 4 My Comm. Expires Sep 23, 2015 ;r9rrg:-P,` Commission # kE 128810 ' ,`'''' Bonded Through National Notary Assn. w wwww*w Zoning Clerk 116/17/261 11 :05 ft9 353 8615 CQCH City, or least utilize this letter a our ProPetTY locates at 9701 Sites, Sttch docurnettts shall Violation. Cotvectjve AetiOns, day operation of teal, estate. ThIsdocumtnit Wit otat he mortgage anti/or tai, Should the bonny quests Cochran Miami Shorea, LLC Shelia Colleen. :t CU MIMAI <:MoltES, LLC e° ye. Suite 2` auderdnitw FL 333 Ui 4-700-060 6O PAGE Ell. rity for §,heihy O., Smith to execute doeuments related to 1 7" Avenue and 21,1417 NE 97" Street, Miami It limited to Pmt Applications and related documents mid other city documents required within the new} day to alt : C • please feel free to <edinact. du: cot xorate re t cettiry tinder ; penalty referenced OWL d*cu 16n$ r under .any d by tt i rit ideal interior & exterior, Inc. W40 NE 93`11 Street, Miami Shores, F133138 Phone: (305) 751 -4447 / Fax: (305) 754 -1851 E -mail: fabi @bellsouth.net September 20, 2012 215 NE 97th Street Miami Shores FL 33138 Miami Shores Village Planning and Zoning Board Village Hall 10050 NE 2"$ Avenue Miami Shores, FL 33138 Re: Contractor Inspection Fire - raided walls 9703 NE 2 `i ay. Precision Barber Club LLC The Lessee Ray Pollock has retained Fab interior& exterior, Inc. for fire raiding inspections at 9703 NE 2"d ay., currently occupied by Precision Barber Club LLC. The left side wall doorway has been closed with 2 518th inch fire - raided drywall sheets. Inspections conducted September 20, 2012 11:08 am. The inspections meeting with building official is Friday September 21, 2012, if so directed by building official a second layer of fire- raided drywall can be installed to the left side wall. If you have any questions please call 305- 751 -4447. Best, STATE OF FLORIDA AC # 2 8 -2 :. DEtArtmilitt ::OF BUSINESS PROFESSIONAL REGULATION CCC150667 ` W/3 / 2 128024697 8 CERTIkIRI1 wide EJpi etl.on ti�::' Department of Regulatory and Economic Resources Miami -Dade County Plan Review Summary Process Number: 2012100111350341 FINAL CORE REVIEW DATE: 10/12/2012 OVERALL STATUS: Overall Approval PROJECT DETAILS: CONTACT DETAILS: FOLIO: 11- 3206 -013 -4230 NAME: RAY POLLOCK ADDRESS: 9703 NE 2 AVENUE MIAMI SHORE EMAIL: PERMIT TYPE DESC.: PHONE #: 7864063930 NO DISAPPROVAL CODES TASK REVIEWED BY STATUS DATE STATUS Initial Core Review Julio Diaz 10/12/2012 Specialty Reviews Not Required Comments: PERMIT FOR INTERIOR BUIL -OUT OF 1,275 SF BARBER SHOP /RETAIL FACILITY. (PRECISION BARBER SHOP CLUB) CITY OF MIAMI SHORES BUILDING PROCESS #CC121804. SEWAGE LODING CALCULTIONS: 961 GPD X 43,560 SF /ACRE DIVIDED BY LOT SIZE APP. 22,625 SF = 1,850 GPD PER ACRE. LIST OF ALL USES: #1 MEDICAL OFFICE 1,296 SF = 259 GPD #2 ART SCHOOUGALLERY 1,450 SF = 145 GPD #3 OFFICE 1,225 SF = 61 GPD #4 BARBER SHOP (THIS SPACE) 1,275 SF = 191 GPD #5 CHAMBER OF COMMERCE OFFICE 790 SF = 40 GPD #6 SHOE REPAIR 684 SF = 68 GPD #7 CLOTHING DESIGNER 624 SF = 62 GPD #8 OFFICE 500 SF 25 GPD = 110 GPD #9 MEDICAL CENTER 550 SF = 110 GPD 10- APARTMENTS @ 150 GPO EACH = 1,500 GPD/2,461 GPD X 43,560 SF /ACRE DIVIDED BY LOT SIZE 22,625 WITH RO.W. = 4,738 GPD /ACRE THIS FACILITY DOES NOT MEET SEWAGE LOADING CALCULATIONS. (4A) COVENANT UNDER:COCHRAN MIAMI SHORS, LLC /SHELBY SMITH AGENT. CFN #2012R0639645. ASBESTOS SECTION N/A AS PER CHECKING WITH ELI GONZALEZ IN ASBESTOS SECTION. PLEASE NOTE: THIS FACILITY WAS PREVIOUSLY APPROVED FOR RETAIL USE ONLY UNDER CU #2012- OL -05520 AND THE CASE WAS DISCUSSED WITH FRANK LEZCANO, RER. SUPERVISOR AND CLIENT. AS PER FRANK LEZCANO, MINOR DEPARTAMENTAL REVIEW WILL BE REQUIRED. FOR 241: REQUIRES (MDR) MINOR DEPARTAMENTAL RERVIEW. CONTACT FRANK LEZCANO, RER SUPERVISOR FOR APPOINTMENT. #305 - 372 -6860 OR #305 - 372 -6633. Julio Diaz/PH (305)372- 6534 /email: diazju @Miamidade.gov. My supervisorLs e-mail: lezcaf@Miamidade.gov.1,11 respond within 24 -hours unless out of the office. 10/12/12 THIS FACILITY WAS APPROVED THROUGH MDR #2012 -164. FOR 231: PENDING MDWASD VERIFICATION LETTER. Final Core Review Julio Diaz 10/12/2012 Overall Approval PLAN CONDITIONS: NO CONDITIONS /0 cr-,D% PA7 ,$ • 0 ci PLAN REVIEW FEES (FEES ARE SUBJECT TO CHANGE PENDING FINAL APPROVAL): FEE CODE DESCRIPTION USER DATE UNIT TOTAL A025 Misc Fees (Manual Entry) JFDLLG 10/04/2012 120 $120.00 D062 Commercial & Multifam Min Review JFDLLG 10/04/2012 1 $90.00 Total $210.00 Coastal: EQCB: FOR MORE INFORMATION PLEASE CONTACT: YOUR DERM CORE REVIEWER: diazju @miamidade.gov DERM PERMITTING AND INPECTION CENTER, 11805 SW 26 ST, 786 -315 -2800 DERM OVERTOWN TRANSIT CENTER, 701 NW 1 CT, 305 - 372 -6899 dermcr @miamidade.gov eqcb@miamidade.gov Specialty Engineering Reviews (industrial, storage tanks, industrial waste pretreatment, asbestos, paving & drainage, trees): dermengreviews @miamidade.gov Tree Permit applications: dermtreeprogram @miamidade.gov Water Control: dermwatercontrol @miamidade.gov Wetlands: dermwetlands @miamidade.gov Ni iami Shores Viiiage Building Department 10050 N. E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 RECEIPT PERMIT #: CC2'LHO I DATE:) 1, avo Contractor Owner Architect Pic ed up 2 sets of plans and (o er) ]-(Afrj Address: From the building department on this date in order to have corrections done to plans And /or get County stamps. I understand that the plans need to be brought back to Miami Shores Village Building Department to continue pe ;'iting process. Acknowledged by: PERMIT CLERK INITIAL: RESUBMITTED DATE:> t -) PERMIT CLERK INITIAL: - 201Z Ri �S,r tt John H. Armstrong. MD, FACS State Surgeon General November 28, 2012 Ray Pollock 9703 NE 2 Avenue Miami. FL 33138 RE: Contingency Letter Application Document No: AP1 Q86218 Centrax Permit Number: 13- SC- 1435588 OSTDS Number: 9703 NE 2 Ave Miami, FL 33138 Lot:13-14 Block:31 Subdivision: Miami Shores Dear Applicant: This will acknowledge receipt of an application dated 10/17/2012 for a permit to use an existing onsite sewage treatment and disposal system located on the above referenced property. From a review of your completed application, it has been determined your existing system is adequate for the proposed use. This permit is granted for the Change of Tenancy of Unit 9703 from a Talent Agency /retail with two (2) bathrooms to a Barber Shop (Precision Barber Club) with three (3) choirs. there will be no increase in sewage flow or characteristics and no impact on the unobstructed area. If you have any questions on this matter, please call our office at (305) 623 -3500. Enclosures cc: Sincerely, Astrid Edwards, Engineer Specialist II Miami -Dade County Health Department 1725 NW 167 St. Opa Locka. FL 33056 Phone: (305) 623 -3500 . Fax: (305) 623 -3645 . http :!!w«w.MyFloridaEH.corm Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 —1 e( DH Inspection Number: INSP- 177870 Permit Number: PLC -8 -12 -1610 Scheduled Inspection Date: December 19, 2012 Inspector: Hernandez, Rafael Owner: MIAMI SHORES LLC, COCHRAN Job Address: 9705 NE 2 Avenue Miami Shores, FL Project: <NONE> Contractor: GREEN TEAM PLUMBING LLC Permit Type: Plumbing - Commercial Inspection Type: Final Work Classification: Addition /Alteration Phone Number Parcel Number 1132060134230 Phone: (954)266 -4037 Building Department Comments SINK INSTALLATION - PRECISION BARBER #9703 Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments December 18, 2012 For Inspections please call: (305)762 -4949 Page 4 of 33 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: PLUMBING JOB ADDRESS: 005 NE G 51 -'tax. City: Miami Shores County: Folio/Parcel #: (I - 320(0 " 613 'f �3 FBC20(C' Permit No. PLCQI2 --1 (o( C) Master Permit No. Miami Dade Zip: 33("3 Is the Building Historically Designated: Yes NO )e2 Flood Zone: OWNER: Name (Fee Simple Titlehold ) �'�°' S41e' �'j e/�S h'1 "4- Phone#: ZJ —7t, p - 7 Address: /� �/ �� %(-i ��� ��-t' �` City: �` G a P State: 4i - Zip: S (.0 Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: G)/pc,n') /- /t1-47 b/% C - tone#: (i59- c - r37 Address: °Ai' Sb) i7 iLt City: . State: Zip: JJ ) Qualifier Name: C 7--e,r-rNi Phone - 3? / -3.6.7 State Certification or Registration #: Certificate of Competency #: ®r 0 Contact Phone#: — 3(4) Email Address o DESIGNER: Architect/Engineer: Phone #: ®' Value of Work for this Permit: $ Type of Work: DAddress OAlteration Description of Work: 750 ■ Square/Linear Footage of Work: New ORepair/Re lace i r ODemolition Submittal Fee $b -� Permit Fee $ ie', 6 CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ No $ Training/Education Fee $ Double Fee $ \ Structural Review $ Technology Fee $ TOTAL FEE NOW DUE $ eLO 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 whose property is subject to attar for the first inspection inspection will no tice of commencement and construction lien law brochure will be delivered to the person Also, a certified copy of the recorded notice of commencement must be posted at the job site rs seven (7) days after the building permit is issued. In the absence of such posted notice, the and a reinspection fee will be charged. Owner or Agent The fore ' L instrument was acknowledged before me this The fore day of - 1�y 16t-, , day of 20 Jam, by S 1'0(/- ix s orally known to me who has produced who is pers ally known to me or who has produced Contractor ent was acknowledged before me this As identification and who did take an oath. as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: /e-e5 L. V61-6 eiet-r- ;l ( My Commission ExpjIes; _ _ 9 _awl to * * * * * * * * * * * * * * ** APPROVED BY NOTARY PUBLIC: Sign: Print: My Co 1 % _▪ 3, ° , Notary Public - State of Florida N 'i.iil ►v. 'My Comm. Expires May 3, 2015 "'' o''P � Commission # EE 90400 * * * * * * * * * * * * * * * * * >srT( * * * * ** * * * * * ** * * * * * * * * ** xaminer Zoning Structural Review Clerk (Revieed3 /12/2012)(Revieed 07/10 /(17)(Revieed 06/10/2009)(Reviaed 3/15/09) Sep - 10-2012 05:16 PM Bank of America 305 -762 -3206 89/8412812 11:18 3859819527 1 OWIVa 13): Pa Sign PAC 1/5 BK 288263 PG 4518 • ST PAGE i ii�' - r... Adtimm STATE OPLOR.i,,A,cth +yOPJfAD3 i:. ibrogoing :anent WAS acknowledged beam me this, by who is day of 20 identification and who did tae an, mealy known pan or who as • NOTARYVOBLIC: sicazat4tam Sign State ofMutid& at Larp Pte,) lily Commission Expires: C ,..tpic.aaQ.�.� rt Dratt' e 7 Signes% Print Print Tate tom.-. Address 'I` TB OP PLO, COUNTY OF 3t7��. a., ( _ ttxa..�,� rn7— 331 t c� t The fore i by x� = ins .. .4.. - t will ac�owied� b me y- co , on behalf of the H C •11. ti. K' ^ ,r "'a�da identification and ice'; me or has. produced did NOTAR. PUiBLt Sign, �` Phase THIS Thism` I`.RBFA BY: 41805 SW 26 STREM surrn 124 MA. 33175 . 't • f? .B :9 y a=a;v 4„�• - t . y�r % L �State ofa aide at Large (Seal) l9TUi It1:,;.io' Expires: • Sep -40 -2012 05:16 PM Bank of America 305 - 762 -3206 09/94/2012 11:10 rya_ 3059819527 DADE tie undendmed, 'fie) �iag 1 the present „ . � �.� � (hereinafter railed "rte 2/5 111111111111111111111111111111111111111111M L0 i- IL fl 'if <C'�`�1 14 ,'1K,3 J et 'id - 4 .� 7"1 �� l4, a. j G� orb ��6e 4, . 0/� 4,,,,, 0 e,''7�)t�z "�'ki, }; 3'C,�� t rtb f3r�8k l� c' c� s oe rn,/Th1 -- qj d g Cou k � . Y. t(a) this �d comsat to nni -) of the c of d with the lend fiG.f�t�t�' 1�'M�1�Mlid@ Ohunry The undersigned agree(s) and coveting* to the faltnwbtg t 1.:. TTi:e, only' liquid waste (excluding eiu€ i wastes associated with the processing of a 1 wash produce a ulbal packing ians: �� and nod wf t a s c aed wade recycling y, ptoVided meta fudlftg does nut backwash t recycling Stem) T e shall, , be i. d1 etdisehatged, or ?rePestY shall be domes& sewage �ml Quality Gss�tcel Hoard,,, lament �Chapter udo a septic tank, makes "s, t►arls�x(s) � Panted by the it�� the of liquid waste to be � � of the of ri�mi�e�'�ndy. � If so Dade that permitted by any such variance by y � d °�rgad, at stored' + nn, �t,h�ii oar yam° 1 will t �� � Cannot � Y.1 hY.YIan& CFN 201280839645 OR Bk,28263 Pss 4517 - 4.518 (Ins/ RECORDED O9/1O/2012 12 :36 :17 HARVEY RUVIHI. CLERK OF COURT . 4tlf#t t -DADE COUHTYI FLORIDA 2. Prior to the any into Q landlord - tenant relatienship 1 t gsIl p� tonn a of the Property of tote existence a o3 �� �� ��� to notify 3`• The �� mss} and covenant(s) by the A3zector of "en s) t this Covenant and the I 'Prow= contained. ( be enforced cheats as as or =roe � ' � p� and riatcm�► T and Commit shall be ��tr t Pe blic Records ' o f �g� TnOv3sione here of AO I Covenant Ra g with the Lend and shall remain in be Waling tbn koh f and Florida and the } ejg n flack h i , I entetives, estates, oucceme's, g adeee and asaigne. � on r by the �� be released by the Mogul' dale his designee when t o#Hn or been to a public water and en op epubic sanitary IN day 20 wriftS fig, the undersigned d this Covenant to be executed fps 1 Sep-10,-2012 05:16 PM Bank of America 305- 762 -3206 4/5 PRIOR TO ISSUANCE OF THE LOCAL BUSINESS TAX RECEIPT, THE FOLLOWING VILLAGE DEPARTMENTS/COUNTY AGENCIES AAt,.ST! APPROVE THE COMPLETED APPLICATION. The Village's Planning Department and/or the Building Department will advise Iapprovai by the Planning Board Is necessary and/or if any Building Permits are required. Please note that failure to obtain the necessary approvals may delay, or cause the dental of issuance of a Business Tax Receipt by the Village. David Dacquisto - Village Planning Departmen Comments: Norman Bruhn " - Village Building Department Comments: Miami -Dade County Dept of Environmental Resources (DERM) — STAMP REQUIRED Miami -Dade County Health Department Comments: Miami Dade Fire Department — Plans to be stamped (if applicable) or Fire Inspection Completed and paperwork submitted to the Clerk's Office. Sep -10 -2012 05:16 PM Bank of America 305 - 762 -3206 TO THE VILLAGE CLERK 5/5 APPE.�A MIAMI SN�S -t�ttt..g (Fonnerty Occupational License) DATE: piiiA As required by the Miami Shores Code of Ordinances, I hereby make application for a Business Tax Receipt for: 1) R - name of perscm(s), firm or c:orporafion: Telephone It: 7$ t,. -94 la -341a E Matz Address: r e e i ci_anLrk tf?g. nAtis „ 2) Fictitious name of person(s), firm or corporation (if used in business): 3) Federal Employer ID /Modal Security Number, q(.0-- (a S 3‘04, 4) Sales Tax Certificate* *72 '77 ► j— � 5) Location of business (License i r U apply to only one location): '703 6) If a firm, the names of the members of the firm, and If a corporation, the names of the officers of the corporation: Pres. ifitki . Oki" Sec. Vice -Pre 'i e * Treas 7) Name of person(s) who will manage, control or direct the business to be transacted In Miami; __ ores 1. a, e: 8) Nature of Business: (Be specific: if merc• hant, list generel• Vries of merc▪ handise; it professional or service establishment, kinds of services rendered, if insurance or real estate office, list how many sales people, if retail store, list opening worth of Inventory/stock if resigurant, list how many seats, etc.) • - a • • LICENSE COST $ SIGNATURE OF APPLICANT: Sep-10-2012 05:09 PM Bank of America 305-762-3206 111 jp4, az% .Ii` Vi ..°84""$41 e, P.: P. . • y vain 1111: RPSOURC F.!z astERBVIBWBR MINIM 'AP SKINXIILIRE DATE Z 7 ,5 0 P. E.1-1".; L. tz4 fa-4E •reAt; c-JS cbd,-/ i L L IL. L 1 ID: 2012-0L-05520 Contact Name: RAY POLLACK Contact Phone: 7864063430 Follo:11-3206-013-4230 ADM Name: PRECISION BARBER CLUB LLC Date: 013/29,2012 Reviewer: Julio Diaz 1/3 Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Date: Date: Permit #: /l Planning & Zoning Critique Sheet ( P 1`, ,aka r °d► i i od _ Review Completed by: David A. Dacquisto (4535 06/17/2011 11:05 3019518819 September 23, 2011 City or Miami Shores: COCHRAN COCHRAN MIMAI SHORES, LLC 1800 Eller Drive. Suite 222 Fort Lauderdale, FL 33316 954-760 -4360 PAGE 01 Please utilize this letter as authority for Shelby Cl. Smith to execute documents related to our property located nt 9701 -9711 NE 7th Avenue and 211 -217 NE 97th Street, Miami Shores. Such documents shall be limited to Permit Applications and related documents: Violation Corrective Actions; and other city documents required within the normal day to day operation of real estate. This document shall not be used to commit the property or Its owner /s under any mortgage and/or loan. Should there be any questions, please feel free to contact the corporate representative at Cochran Miami Shores, LLC Shelia Cochran, as Trustee I certify under penalty of perjury that this document has been executed by the individual referenced above. _11_ gilt - -. h9kQ AAA. 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 CONT RACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: T A. /COPY OF QUALIFIER'S STATE LIC CARD B. OPY OF LOCAL BUSINESS TAX RECEIPT C. PY 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 (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: GreF/)7eU7) P)um barn BUSINESS ADDRESS: 'VW Sid ?1'54z C ,42_124,2:12:02-4 STATE till t ZIP CODE / Z BUSINESS PHONE: (Q5 T) c24 " 4110 FAX NUMBER ,) 7 es -d CELL PHONE ) 34/ - 335/ QUALIFIER'S NAME: .. i% QUALIFIER'S LIC NUMBER: (CPC. 5Aa�� E -MAIL ADDRESS (IF APPLICABLEU Ctyyr G>S 69j ri.L°.Y1 Qirn P l bir- . coy) Created on 3119109 BY MLDV 1 RV 3126109 MLDV fATE OF FLORIDA OF IMINIISS MID PROFESSION/et RECDLM] N INDUSTRY LICENSING BOARD 194 NORTH MONROE STREET FL 32399-0783 F I t * TERRY, MOMS tIOSEEN TUX PLUNBIDNG 28TE VENUE FL 33312 (850) 487-1 95 trosiisffirates ACit& 2 S300 this license you become one °idle newly *y11441011 MART:MOW OF BUSINESS ASV the Department of Business and Professioral PROFESSI businesses ffifl5 tom atthitedIS 10 yedtd evokrs* worn restawnts4 ke" Fictlid" °mum" str°1142* 1 en1428141 01 12 118192995 Every day we work to enema tha way we do business in cater serve you better.' For intimation about our smite* Please kV onto www - ; CaRnEIND ' R These you cart find more information about our divisions ' Y J Impanp% - ,. — ,, to depattrat newsiedeus and team Deparanent's Sedatives. Our mission at the Department Is: License Reeler*, Regulate Fa*, We constantly Oise to you better so that ssisve your customs. =der th4t )91021* -of 4336. 489 vs Thank you for doing business in Rorida and — ,.! ,, i, d',-, ." On your new license 31s 2014 * za2Patsams , ACM MEt -n-uS, DOCUMENT HAS A COLORED EDV;KGROUNO.,' MiCRO PRi NI-MG Llt:/EMAR:W.. pATERTEO W142072100340 t)ATE f3A.TC.H. NUMBER • 07 /23.(21 mai 2595 CEC1420181 ING CONTRACTOR Named below IS CERTIFIED Under the provision* of Expiration date: AUG 31, 2014 4 11SW28A vet LADDINWALB FL 33312 RICK SCOTT GOVERNOR room AN1 c ovnt irsovrt SW 1 Allif 115 $. Andrews Ave., A ►- , Ft Lau VALID OCTOBER 1, 2012 TI WAN 3 49 ;02123/2010 142 aslai T Tree Y ` T*W 27 0 O OO 0.Q 0. OwQ ,.. 27.0 OP ID: SL '4C4........--- CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 06/18/12 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS ' CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the 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 386 -252 -9601 Brown & Brown of Florida, Inc. Daytona Beach Office 386- 239 -5729 P.O. Box 2412 Daytona Beach, FL 32115 -2412 CNA°IwECT DENISE DABATO 12210. ea 386.239.7281 (A/C, No): ADDRESS: bda ona com PRODUCE: PRODUCER GREEN22 CUSTOMER ID #: GREEN 22 INSURER(S) AFFORDING COVERAGE NAIC S INSURED GREEN TEAM PLUMBING, LLC JAMES TERRY 4811 S.W. 28TH AVENUE FORT LAUDERDALE, FL 33312 INSURER A:Ohio Casualty Insurance 24074 INSURER B :West American Ins Co 44393 INSURER C : Associated Industries Ins Co 23140 INSURER D : 06/22/13 INSURER E : $ INSURER F : X 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. L TYPE OF INSURANCE NSR W VD POLICY NUMBER POLICY (/D/YYYY) POLICY (MMDD//YYTY) LIMITS A '7 GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY X OCCUR BKO1355163597 06/22112 06/22/13 EACH OCCURRENCE $ 1,000,000 X DAMAGES ((RENTED PREMISES (Ea otxurrence) $ 100,000 CLAIMS -MADE MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GENL AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP /OP AGG $ 2,000,000 POLICY X 1248: LOC $ B AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS BAW1355163597 06/22/12 06/22/13 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 X BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ $ A X UMBRELLA LIAR EXCESS LIAR OCCUR CLAIMS -MADE US01355163597 06/22112 06/22113 EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5,000,000 DEDUCTIBLE RETENTION $ 10,000 $ X $ C WORKERS AND ANY OFFICER/MEMBER (Mandatory If yes DESIPTION COMPENSATION EMPLOYERS' LIABILITY PROPRIETOR/PARTNER/EXECUTIVE EXCLUDED? In NH) Y I N n below N / A AWC1015272 06/22/12 06122/13 X 'l C ATTS EAR EL EACH ACCIDENT $ 500,000 EL DISEASE - EA EMPLOYEE $ 500,000 CR describe under OF OPERATIONS EL DISEASE - POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, H more space Is required) CERTIFICATE HOLDER CANCELLATION MIAMSO4 MIAMI SHORES VILLAGE BUILDING DEPARTMENT 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 THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25 (2009/09) © 1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 09/04/2012 10:19 FAX 1 800 685 7530 DATA SCAN FIELD SERVICES 2001 * ** TX REPORT *** TRANSMISSION OK TX /RX NO 2892 RECIPIENT ADDRESS 93056535509 DESTINATION ID ST. TIME 09/04 10:19 TINE USE 00'34 PAGES SENT 1 RESULT OK Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Date: Permit #: 7,3 /l / Planning & Zoning Critique Sheet