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DEMO-10-1928Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 nspection Number: INSP - 152793 Permit Number: DEMO -11 -10 -1928 Inspection Date: December 22, 2010 Inspector: Bruhn, Norman Owner: Job Address: 9537 NE 2 Avenue Miami Shores, FL 33138- Project: <NONE> Contractor: SEACOAST CONSTRUCTION INC Permit Type: Demolition Inspection Type: Final Work Classification: Building Phone Number Parcel Number 1132060133910 Phone: (786)888 -8400 Building Department Comments SELECTIVE DEMOLITION OF EXISTING TENANT SPACE Passed z `1r- Inspector Comments ry 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 December 21, 2010 Page 1 of 1 0115t L1 wed,/ /M4rr Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Bi: ,v...........' INSPECTION'S PHONE NUMBER: (305) 762.4949 %NG 1°X10 BUILDING PERMIT APPLICATION FBC 20 Permit No.GE YQ 10 -1 't2' Master Permit No. Permit Type: BUILDING OWNER: Name (Fee Simple Titleholder):. Phone#: / RO0 7 A/6 'Von de, City d � / � �f le, 4.V State: . 3 8 Tenant/Lessee Name. Phone #. 16. 951 - (O(021-6 Email: JOB ADDRESS: CI SY1 1...1,E . 2 City: Miami Shores County: Miami Dade Zip: 331M( b Folio/Parcel #: 11- 32-6 - 0 -3°110 Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name: Stz 1 Address: 2,t 03 Co t- jJ i SU1-M Aeic City: MlAf'1.1 ' �- Qualifier Name: CAE Off.. A� i&OO State: State Certification or Registration #: . C 2 Certificate of Competency #: j Contact Phone #: 1g6''' � 0 S S7(093 lA:' : Email Address: 9ear'9Q . a b €SeaGO as Ccas�'S rut. 1, ,,Y1 . nef DESIGNER: Architect/Enginee : J Ali, 41.AG1 t-ITli6LF Z Phone #: CIS' '° 4.7CIS. "SiZ1.4 poD Value of Work for this Permit: $ Square/Linear Footage of Work: 140g Type of Work: ❑Addresses ❑Alteration New ❑Repair/Replace demolition Description of Work: .,LairI DiMOt. -1Tos J OP. EY)Si 1l 1 spacf Zip: 3314-s s Phone #: 1 o' 0 COLOR THROUGH ROOF TILE IS REQUIRED acknowledged by: �� •*******7* * * * * * * * * * * * * * * * * * * * * * * * * * *,* * ** Fees * * * * * * * * * * * *** ** * * * * * * *** * * * * * * * * * * * * * * * * ** Submittal Fee $ vlJ' CO Permit Fee $ 7J-0 ov CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ 1465 151 —co TOTAL FEE NOW DUE $ Bonding Company's Name (if applicable) 1.1 4 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 constructio law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded otice of c. menc; -nt must ' ; : •sted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. r t, a absence of such ted notice, the inspection will not be ap.roved and a reinspection fee will be charged. Signa a. Owner or Agent The foregoing instrument was acknowledged before me this 7 day / -)n ^ems 1,;_. chelle Nesselt who person., ,,;��� neio has pr duced Pte�,U}�ciation and o did take an oath. Notary Public NO ARY PUI :of Florida Sign: Print: My Commission Expires: Signature Contractor e me this 7 The fore day of who is pe n J, in ent 1 rat sonally knIxortieriMagElhas produc e as.e: Sign: Print: bile d who did d e an oath. My Commission Expires: APPROVED BY Plans Examiner Zoning (Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09)(rev6/4/10) Structural Review Clerk NOTICE OF COMMENCEMENT A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION PERMIT NO. TAX FOLIO NO. STATE OF FLORIDA: COUNTY OF MIAMI -DADE: 11111111111 111111111111111111111111111111 1111 THE UNDERSIGNED hereby gives notice that improvements will be made to certain real property, and in accordance with Chapter 713, FloricgAgr$16E is provided in this Notice of Commencement. / HEREB v CERTIFY that this rs a true cop of tl' ono . ed in this office on ny of 4 a/ %Iu� , A D 20 WITNESS my hand and Official Seal. HARV' ' 'V of C,rcu and Co 8 1. Legal description of property and street/address: CF h4 2010R0828319 OR Bk 27517 Ps 0276; tips) RECORDED 12/10/2010 12 :43:13 HARVEY RUVII4, CLERK OF COURT MIAMI -DADE COUNTY, FLORIDA LAST PAGE 2. Description of improvement: ot 3.Owner(s) narn and address: Q C,K grh, *1%re W1, o4 S l,w r) 33 )1 Interest in property: �J Name and address of fee simple titleholder. 4. Contractor's name, address and phone number: G 5. Surety: (Payment bond required by owner from contractor, if any) Name, address and phon number. Amount of bond $ �t1A 6. Lender's name and address: IVA 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:,, ln.r✓�� "/ lL ?c..- ,/,9":20 7ej sl4 ' 8. In addition to himself, Owners designates the following p1�n(s) to receive a copy- of/the Lienor'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 Is 1 year from the date of recording unless a different date is specified) (RATION OF THE NOTICE OF COMMENCEMENT ARE CONSIDERED ORIDA STATUTES, AND CAN RESULT IN YOUR PAYING TWICE FOR UST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK . (the expired WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER TH IMPROPER PAYMENTS UNDER CHAPTER 713, PART I, SECTION 713.13. IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT OR RECORDING YOUR NOTICE OF COMMENCEMENT. Signature(s) of Owner(,$) or Owner(s)''Autho ed Officer/Director er/Manager Prepared By r - /' : .. f • _ed :pared By Print Name ti , nt Name Title/Office : f?' "e/Office STATE OF ORIDA COUNTY OF IAMI -DADE The • egoi BY ❑ Indi or ❑ as 'Personally known, or owledged me this / 0 , day of )p t 17 ❑ produced the following type of identtlicati Signature of Notary Public Expires 1 V/1/2011 Print Name: Notary Public (SEAL) State of Florida VERIFICATION PURSUANT TO SECTION 92.525, FLORIDA STATUTES Under p e n a l t i e s o f p e r j u r y , I d e c l a r e t f i a t have readt ieforegoTng and — that the facts stated in it are true, to the best of my knowledge and belief. Signatur- :1of • - . s) • er(s)'s Authorized Officer/Director/Partner/Manager who signed above: By I '> �---- By ;y P,QGE3 3/10 �� ..� �;� j11 /� /�/�s•./ ^✓ �G� 21rD cS�r uc)� 1(rZi 33/y5 Client#: 11746 N ACORDTM CERTIFICATE OF LIABILITY INSURANCE DATE 12/102010 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER USI Insurance Services, LLC -CL 200 West Cypress Creek Rd #600 Fort Lauderdale, FL 33309 954 607 -4000 CONTACT PHONE (Plc, No, Ext): 954 607 -4000 (A/C, No): E-MAIL PRODUCER CUSTOMER ID# INSURER(S) AFFORDING COVERAGE NAIC # INSURED Seacoast Construction, Inc. 2103 Coral Way Suite 405 Miami, FL 33145 INSURER A: Crum & Forster Specialty Insura 44520 INSURER B : American Safety Indemnity Compa 25433 INSURER C : Gateway Insurance Company 28339 INSURER D : Republic- Vanguard Insurance Com 40479 INSURER E : PREMISES SES (Ea Eoccurrence) 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 BTJBR WVD POLICY NUMBER POLICY EFF (MMIDDIYYYY) POLICY EXP (MMIDD/YYYY) LIMBS A GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY OCCUR GLO191131 04/15/2010 04/15/2011 EACH OCCURRENCE $1,000,000 X PREMISES SES (Ea Eoccurrence) $50,000 CLAIMS -MADE X MED EXP (Any one person) $0 PERSONAL & ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $2,000,000 7 POLICY PET LOC $ D AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON-OWNED AUTOS CN0100044901 04/15/2010 04/15/2011 COMBINED SINGLE LIMIT (Ea accident) $1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ X X $ B UMBRELLA LIAR EXCESS LIAR OCCUR CLAIMS -MADE XOMW198210 04/15/2010 04/15/2011 EACH OCCURRENCE $2,000,000 $2,000,000 X AGGREGATE DEDUCTIBLE RETENTION $ $ $ C WORKERS COMPENSATION EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVEY OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If DESCRIPTION OF OPERATIONS /N N/A WC70000760001 01/20/2010 01/20/2011 X WC STATU- PT '1- TORY LIMITS FR E.L. EACH ACCIDENT $500,000 N 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) Subject to policy terms, conditions, and exclusions. CERTIFICATE HOLDER CANCELLATION 10 Days for Non - Pavment Village Miami Shores 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 7444/ 04101084 ACORD 25 (2009/09) 1 of 1 #55086016/M5078922 01988 -2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD KMSER Nov, 1. 2010 3:02PM No. 1224 P. 1 Bennett Electric Co. 10007 NE 4 Ave. Miami Shores, El 33318 Ph. 305.759.1665 Ext. 15 Pax 305.754.1877 Tv: Village of Miami Building Department November 1, 2010 Owner: Bennett Electric Co. Tenant: Impact Fitness Re: Property located at 9537 NE 2 Avenue Please let this letter serve as notice that Bennett Electric Co. Inc. has authorized Mr Matt Pack of Impact Fitness to proceed with plans for mechanical, building & electrical for the complete renovation and build out of 9537 NE 2 Avenue. We further explained to MR Pack that he must adhere to all Village of Miami Shores building Department requirements; Florida uniformed Building Code including any other enforcing agencies as maybe required. Si rely, ac President &,, orizing agent Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 BUILDING PERMIT APPLICATION FBC 20 Permit Type: Electrical OWNER: Name (Fee Simple Titleholder)-r� - i✓ Address: /IPA", ;too/Ye- City: ,.� • 9 ®, o ,�fT�J� State: f' �/1 Permit No W)1C 1O 7Z 3B Master Permit No. 7( — /7,26, ,,z)&440 Phone #: 71.A ',} f%% 7M) Zip:.3Y419J Tenant/Lessee Name: Phone #: Email: JOB ADDRESS: .9— 7 / /a► 1/- City: Miami Shores County: Miami Dade Folio/Parcel #: // ° 32-04 - ' /,' , /I? Is the Building Historically Designated: Yes NO Flood Zone: 5/ 9 8 78 • CONTRACTOR. ompany Name: �� /G Phone #: 366 r'�rrri1J Address: t/ 6' 6 /1136 3 City: A-oi /�/ 1/ State: 7 a Qualifier Name: �0 e . 4�/ /O Phone #: cJ d2� ' �3 /— V/0 State Certification or Re istration #: e / / - /t Certificate of Com etenc #: / E ac©(� �� � P Y q Contact Phone 55 /-9-7/0 Email Address: DESIGNER: Architect/Engineer: Phone #: Zip: 59/ .o Value of Work for this Permit: $ c-0® Square/Linear Footage of Work: Type of Work: Address ``ryry DAlteration New J DRepair/Replace }�]�emolition Description of Work: ! ) ( 'f f 1 %/ ®/7 C / &X /S 7`9977 G.Ci,i9-/ 5 ✓ \ l � ******** * * ******* ** ** *** **** ***** *** *** Fees************** ** ** **.* * * ** ****** *** * ** ** ***** Submittal Fee $ Permit Fee $ 7e, ®' 4'90? CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ (OZ(.7) Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) Mortgage Lender's Address /12,, 7 ,z-AP 7 d✓ € City el1,"00.417,/',49,4i State Zip ,'3/.50 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. O Agent / The foregoing instrument was acknowledged be ore me this /�1 ►, 6�\ who isCpersonall know o me or who has produced As identification and who did take an oath. NOTARY PUBLIC: day of• , 2040, b Sign. Print: My Commission Exp : Michelle Nesse t Comm #DD0733337 Expires 12/1/2011 Notary Public Signature Contractor The foregoing instrument was acknowledged before me this 1.S4"' day of Io 0 ,201.0, by I�jY(tk 14 trvidk , who is personally known to me or who has produced Fic V io\ D i t (S 11 CtVUe as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commission Expires: ************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** APPROVED BY "1I v�y , ' #''Plans Examiner Structural Review (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) Zoning Clerk From: Odalys Gonzalez At NCF Insurance FaxID: NCF Insurance To: City of Miami Shores Village Date: 11/12/2010 10:42 AM Page: 2 of 2 PRODUCER )0• CERTIFICATE OF LIABILITY INSURANCE NCF Insurance Associates 8700 West Flagler Street #320 Miami FL 33174 Phone:305- 446 -5474 Fax:305- 444 -8796 INSURED DATE (MM/DD/YYYY) R1OG &AEL- 11/11/10 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC # R & A Electric, Inc. Roberto Rivero P.O. Box 611835 Miami FL 33261 INSURER A: Granada Insurance Company 16870 INSURER B: First Commercial Ins. CO. INSURER C: INSURER D: INSURER E: COVERAGES THE ANY MAY POLICIES. IIVJK POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. s1UU L LTR INSRD TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MM/DD/YYYY) POLICY EXPIRATION DATE (MM/DD/YYYY) LIMITS A GENERAL LIABILITY 0185FL00021772 09/29/10 09/29/19. EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES(Ea oc uence) $50,000 CLAIMS MADE X OCCUR MED EXP (Any one person) $1,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY n ECT n LOC PRODUCTS - COMP /OP AGG $ 2 , 0 0 0 , 0 0 0 7 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) $ PROPERTY DAMAGE (Per accident) $ GARAGE LIABRITY ANY AUTO AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ AUTO ONLY: AGG $ WORKERS EXCESS / UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE RETENTION $ COMPENSATION $ $ B AND EMPLOYERS' ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBEREXCLUDED? (Mandatory If yes, describe SPECIAL PROVISIONS LIABILITY Y / N 16178 -6 10/22/10 10/22/11 X TORY LIMITS OER In NH) E.L. EACH ACCIDENT $100,000 under below E.L. DISEASE - EA EMPLOYEE $ 10 0 , 0 0 0 E.L. DISEASE- POLICY LIMIT $ 500 000 DESCRIPTION OTHER , OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS Electrician CERTIFICATE Hni nFR _ _ _ _ _ __ _ _ City of Miami Shores Village 10050 NE 2nd Avenue Miami Shores FL 33138 ACORD 25 (2009/01) CITYMSH SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHOR REPRES� 988 -2009 RD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 153847 Scheduled Inspection Date: December 21, 2010 Inspector: Bruhn, Norman Owner: Job Address: 9537 NE 2 Avenue Miami Shores, FL 33138- Project: <NONE> Contractor: AIRTROL AIR COND CO INC ‘ Permit Number: DEMO -12 -10 -2123 Permit Type: Demolition Inspection Type: Final Work Classification: Mechanical Phone Number Parcel Number 1132060133910 Phone: (305)226 -7542 Building Department Comments CAPP FREON FOR SAFETY. Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments December 20, 2010 For Inspections please call: (305)762 -4949 Page 16 of 28 Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 BUILDING PERMIT APPLICATION FBC 20 Permit Type: MECHANICAL OWNER: Name (Fee Simple Titleholder):,3C , iiv Address: ,/fop �' ®woe City: , .49 ® f ./ State: �� Tenant/Lessee Name: Email: 2 1' 1C) 131 Permit Nc. 04110 `10 -2c Master Permit No. ��c I 0 i c L- �' � aGt T2J C® �� . Phone #: )1I.2S7.71 Zip: ,3/.18 Phone #: JOB ADDRESS: ff.74/t"vow 4 City: Miami Shores County: Miami Dade Zip: _MyI Folio/Parcel #: , / 3 Z. A ` Vi i. -.79® to Is the Building Historically Designated: Yes NO do, Flood Zone: CONTRACTOR: Company Name: A l E t ; P1 L ' 'a �i Gtr- Phone #: � � � 2 2 7 S 4 2 Address: 4N s S 7 A City: State: Zip: , S Qualifier Name: Phone #: State Certification or Registration #: Certificate of Competency #: Contact Phone #: (30:5-) % Email Address: DESIGNER: Architect/Engineer: Jb Li -II U6 GLEA g- A , Phone #: (9 of Work for this Permit: $ * 06 _ _ -- Square/Linear Footage of Work: Type of Work: DAddress DAlteration DNew DRepair/Replace Description of Work: Coq) 1,1. cffP S WI t cjt�. L �a. c r . Cx , c r -h. ,-.4,...., cm is yT - s z DDemolition es** Submittal Fee $ Permit Fee $ I► D CCF $ Scanning Fee $ Radon Fee $ DBPR $ **** ******** * ***** ******* **0****0** CO /CC $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE 7� b a - (pip Bonding Company's Name (if applicable) ra Bonding Company's Address 4 City State Zip Mortgage Lender's Name (if applicable) ii�:fwAi71�+�l..°f06 f ,i/ �`,p • Mortgage Lender's Address / 017,.14 /dye s City ,,,,,,,,4 n 5 i State /7 Zip fL t 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 $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. 1 Signature Co ..actor The foregoing instrument was acknowledged before me this - The foreg 'ng instrument was acknowledged before me this 30 day of 2060 , by 0 el , day of 0 , 20 4, by SY1 a e O -• C-,L. , who i rsonall known to me or who has produced who is personally known to me or who has produced As identification and who did take an oath. NOTARY PUBLIC: NOTA '_ _ PUBLIC: ‘... / Sign: t a. �� r Sign: g � as identification and who did take an oath. Print: 1V -kJ Iejve CSC 1— Michelle Nesselt My Commission Expi es: Comm #DD0733337 Expires 12/1/2011 Notary Public APPROVED BY * ******* ti,. >.•< ******* ** 2 . N _ public State of Florida •O% ' lI'$ iinan My Commission EE001993 Expires 08/23/2014 *ee *e *e **** ****e**ewxi e * * * * * * *** *xis *** * ** * * **** ** * *** ** /D Plans Examiner Structural Review (Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09) Zoning Clerk Miami Shores village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 AIR CONDITIONING REPLACEMENT DATA PERMIT NUMBER: MC This form must accompany ALL air conditioning replacement permit applications. Each unit change -out must be on its own data sheet. Multiple units on single sheets are not acceptable. Job Address (where the work is being done): 9577 ,/t vb City: Miami Shores Village County: Miami Dade Zip Code: ALL CONDENSING UNITS MUST BE ON A 4 INCH SOLID CONCRETE SLAB ALL UNITS MUST COMPLY WITH F.E.M.A MINIMUM FLOOD ELEVATION A COPY OF THE CONTRACT IS REQUIRED WITH ALL SUBMITALS ARI (AHRI) DATA SHEET REQUIRED Change Disconnecting means: YES ❑ NO Ol ARHI Sheet Attached: YES ❑ NO 1217 Contract Attached: YES ❑ 1. 2. Maximum Overcurrent Protection (Fuse /Breaker Size): 3. Voltage of Circuit (208/240/480): 4. Size Disconnecting Means: Contractor's Company Name: A /47261 ihe UNIT BEING REPLACED DATA NEW UNIT MANUFACTURER AHU or PKG. UNIT MODEL # COND. UNIT MODEL # KW HEAT NOM TONS AHU CU PKG 1) M.C.A AHU CU PKG AHU CU PKG 2) M.O.P AHU CU PKG AHU CU PKG 3) VOLTS AHU CU PKG PKG UNIT / / PKG UNIT / / EER/SEER YES NO REPLACING DUCTS YES NO YES NO REPLACING THERMOSTAT YES NO YES NO NEW 4 "CONCRETE SLAB YES NO YES NO NEW ROOF STAND YES NO YES NO NEW RETURN PLENUM BOX YES NO Cir 6311 L Minimum Circuit Ampacity (Wire Size): State Certificate or R ,'n N.CA 06 Signature 6 ' Phone: 60S - 224,- '7 542 Certificate of Competency N. Date: Oda V ' �P 6 (Qualifier's signature Date: 11/29/2010 Time: 2:33 PM To: Jorge CR 93056756326 MB A Page: %U 4Rd® CERTIFICATE OF LIABILITY INSURANCE OP ID CV DATE D 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 polcy(es) 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 BROWN & BROWN-MA DIVISION 2500 NW 79T1I AVE, SUITE 101 MIAta FL 33122 ~ANAME FAX Exq: (NC, No): WiliFiE IN'. L ADDRESS: PCUSTO°OMER ID ff: AIRTR -1 INSURER(S) AFFORDING COVERAGE NAIC i INSMED Airtrol Aix Conditioning Inc. 4853 S.W. 75 Avenue Miami, FL 33155 INSURERA: *MCI Advantage insurance Co 12842 INSURER B: *acct commercial insurance co 334'72 mums *Bridge laid Employers ins co 10701 INSURER D : $ 1,000,000 INSURER E : $100,000 ENSURER F : CLAIMS -MADE CERTIFICATE NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD I+IDICATED. 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: LAIR TYPE OF INSURANCE Arun INSR eubt+ WWI POLICY NUMBER rULtL1 rr-I (MMIODMYYY) YULILT eXN (MMIDD11 YYY) LIMA A GENERAL X LIABIUW COMMERCIAL GENERAL LIABILITY Fr; OCCUR CPP0004809 05/28/10 05/28/11 EACH OCCURRENCE $ 1,000,000 PREMISES (Ea occurrence) $100,000 CLAIMS -MADE MEDEXP (Any one person) $ 5,000 PERSONAL& ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY n JECT n LOC PRODUCTS - COMP /OP AGG $ 2,000,000 $ 8 AUTOMOBILE _ X _ X X UABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS CA0005819 05/28/10 05/28/11 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ UMBRB -LA LIAB EXCESS UAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ — DEDUCTIBLE RETENTION $ $ $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIErORIPARTNER/EKECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS L NI A 083032281 05/28/10 05/28/11 Ta STAID- RR E.L. EACH ACCIDENT $ 500000 E.L. DISEASE - EA EMPLOYEE $ 500000 below E.L. DISEASE - POLICY LIPNT $ 500000 DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES (Attach ACORD 101, Additional Ramada Schedule, Emcee space Is required) CERTIFICATE HOLDER Village of Miami Shores Building Department 10050 NE 2 Avenue Miami Shores FL 33138 ACORD 25 (2009109) 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 CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 fie, \0`W nspection Number: I NS P- 154434 Permit Number: DEMO -12 -10 -2131 Inspection Date: January 12, 2011 Inspector: Hernandez, Rafael Owner: Job Address: 9537 NE 2 Avenue Miami Shores, FL 33138- Project: <NONE> Contractor: LONCUS PLUMBING CONTRACTORS INC Permit Type: Demolition Inspection Type: Final Work Classification: Plumbing Phone Number Parcel Number 1132060133910 Phone: 305 -383 -9259 Building Department Comments CAPPING OF PLUMBING FOR DEMOLITION Passed ■ Inspector Comments CREATED AS REINSPECTION FOR INSP- 153868. NOT READY RH I . 1.41 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 January 12, 2011 Page 1 of 1 BUILDING Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 B Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 Permit No. VArit (Lk (OW 1 PERMIT APPLICATION FBC 20 Permit Type: PLUMBING Master Permit No. • OWNER: Name (Fee Simple Titleholder):, ivv4W—,�'/ /e/ 4 Phone #: 71 .4 %51.9 Address: Ape, 7 ,t/ yAVG City: ,4 J » ,.4isre del State: Tenant/Lessee Name: Phone #: Email: Zip: )7/y1 JOB ADDRESS: 71 .�'%//4--,.?../d�d City: Miami Shores County: Miami Dade Zip: 53/.3I Folio/Parcel #: // ' 32-1%.4 - AC)), 3''ld Is the Building Historically Designated: Yes NO � Flood Zone: CONTRACTOR: Company Name: k.� i .c rL if",b o ,a Cajtabccue Cov Phone #: Address: � ��� SJ Av-6,4 City: tI )%:"At State: �e ° Zip: p r-` Phone #: `3 °C) -7- 7 Qualifier Name: ZE MtS &23LU- State Certification or Registration #: CP C d ‘a Contact Phone #: (J�'� 2 (07 ` 2-6-1g Email Address: �1 DESIGNER: Architect/Engineer: A), (U t.1 60 84- • A ° Phone #: L9) S ° 5 Certificate of Competency #: Value of Work for this Permit: $ • 5' 0 , o Square/Linear Footage of Work: SF 'emolition Type of Work: DAddress DAlteration Description of Work: 4 !ME li ti's 1,, UNew ORepair/Replace + x+ x******** ***** **+ x*** ********+x*** ****** Fees: ***** ***** ***** ********* ***********:x******* Submittal Fee $ - . CO Permit Fee $ / )r CO CCF $ CO /CC $ 7 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) „P e.s "."0771:A02.) 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 CONDmONERS, 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. r Signature er or Agent The foregoing instrument was acknowledged bee ore me this / day 41/41/4 , 20 IP, by �`' 19t 1 > who icpsersonally known o me or who has produced As identification and who did take an oath. NOTARY PUBLIC: My Commission Expire * * * * * * * * * * * * * * * * * * ** APPROVED BY e' Ali® Nesselt Comm #DD0733337 Expires 12/1/2011 Notary Public State of Florida Signature Contractor The foregoing instrument as acknowledged before m day of A O Vf rf. , 20/0> by (4 Ifl'j \zl@V who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign Print: (-� tf 'Th (fr( ( My Commission Expir Deborah E. Felicie z gr u*.0 .COMMISSION #DD774550 °; EXPIRES: APR. 20, 2012 o• o`' WWW.AARONNOTARXcom * �x ,xx� *�x�x�x�x *,x,xa�,x,x ****,�� *** *,x ***V*�x,ux::,x *x **N*:�:xAR'4** : * *** Plans Examiner Zoning Structural Review Clerk (Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09) ,tvvnum %it 1111./111 C Jr LI/4/10ILI 1 11 II110VR/1r .rG 11/16/2010 )UCER Serial # 125273 A&A UNDERWRITERS, INC PABLO M CONDE A052667 PABLO O 8 ST 8796 MIAMI, FL. 33174 _ _ THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC# RED LONCUS PLUMBING CONTRACTOR CORP.. 1300 SW 70 AVENUE, MIAMI FL 33144 1 INSURER A: SCOTSDALE INSURANCE COMPANY INSURER B: BUSINESS FIRST INSURANCE CO INSURER C: INSURER D: INSURER E: 'ERAGES HE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING NY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR IAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH 'OLICIES, AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. NSRO TYPE OF INSURANCE POUCY NUMBER P DATE IMM/DDIYYt WNW/gimp t/N LIMITS GENERAL UABIUTY COMMERCIAL GENERAL LIABILITY CPS1286506 11/16/2010 11/16/2011 EACH OCCURRENCE $ 1,000,000 X DAMAGE O RENTED $ 100,000 I 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 n jECOT- n LOC PRODUCTS - COMP /OP AGG $ 1,000,000 T1 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) $ — PROPERTY DAMAGE (Per accident) $ GARAGELUABILITY ANY AUTO AUTO ONLY- EA ACCIDENT $ R OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA UABIUTY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ RETENTION $ $ RDEDUCTIBLE $ WORKER'S COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? If yes, SPECIAL gPRO PROVISIONS below 0521 -01010 08/13/2010 08/13/2011 I TORY LIMITS 1 x PA'- EL EACH ACCIDENT $ 1,000,000 EL DISEASE - EA EMPLOYEE $ 1,000,000 EL DISEASE - POLICY LIMIT $ 1,000,000 OTHER :RIPTION OF OPERATIONS ILOCATIONSNEHICLES /EXCLUSIONS ADDED BY ENDORSEMENT /SPECIAL PROVISIONS tTIFICATE HOLDER CANCELLATION MIAMI SHORES VILLAGE BUILDING DEPARTMENT, 10050 N.E.2ND AVENUE, MIAMI SHORES, FLORIDA 33138 I SHOULD ANY OF THE ABOVE DESCRIBED DATE THEREOF, THE ISSUING INSURER NOTICE TO THE CERTIFICATE HOLDER IMPOSE NO OBLIGATION OR LIABILITY REPRESENTATIVES. POLICIES BE CANCELLED BEFORE THE EXPIRATION WILL ENDEAVOR TO MAIL 30 DAYS WRI 1 1 EN NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL OF ANY KIND UPON THE INSURER, ITS AGENTS OR AUTHORIZED REPRESENTATIVE A&A UNDERWRITERS. INC "OF" )RD 25 (2001/08) IIPRO \CERTPROS.FP5 ©ACORD CORPORATION 1988