The URL can be used to link to this page

RC-12-1837I 1)11247-G-W\I\I PERMIT APPLICATION Permit Tom: BUILDING .Mir: Shores Village Building ,g Department 0001'142w Ma e, $iami Sims, Hari it 33I.38 TRU (30.. 5i /9323114 Miler On 735 9fl IT cI'IOON'S FF,10* ie PMDEB: (305)71$1 P311,ADitOSSI. city AtthOtbarss. Fore; Bufhting Ilistorlenny :Yes NO VP/ if ECM E OCT 0 3 20h2 EB .20dD Pit Mister Peimit Rte' I &31- ROOFING ;'a t 5 93/3 N td PA_ c, -z,: _13_22J_ Minna' tee 'Fiend .. owmigNamoyersirrivoindowery o v55 dvitM 30 r 7- 0, f/X tei Address: . / 9 0 1/d 5-/,e e e " / co:. e f sue:. F- R _ - Email .! et.4 �� :m9 C dpi . K° ® Cohe i ACF0 .,,*01niperlyNaomi``' Ada.sai l ito ` .. 1,... • City7 Ve swot . 4..11; 13.301 QuEdifitimuirwhonette •$ teni#iedinn•or ' . ioa ii: C )c f Citit Y tit* e Tenane•14 SeluceS pix,nek,3116 AVS- einnetL1 Addi .DFSIONFAr Arelitder/Beigneer: .Mane* D V** of Work for th11$ii emti; $ e�i: r F Type °Mork: C]l ►ddi#iOut lJMtetadon aNew lotWoORa V" ghee C]•Iiemaiition Color flip: --__----- **e rteioa+reaa ompitiudoire ***'as*****I iF eeiblo sam******meste+t *w104**Po r Sabzgi l Fon $ Permit fiee; , CcF$• 'CSC$, Eicanginifitik S. R a d o n . 140 ix... _ D3PR d $ Notary $ Trehdrinigdneaden Fee $ . . , TeelmolOgf File $• _ .. Doihk.F e $ Stru#nra! Review* 00 /Z0 3JVd TOTALSEENOVITDUE $ Orr- • X135 W NBIS3Q DIIWNAQ 608L178850E BZ :Ot ZtOZ /8Z /60 a n critr�patrY's Nate e (f a ipli lle)* Bonding Conmany/s A idtess City tal WOO** Lender's l rile lif applictitrle) M ge.Lerlder's. id Tess City Application is hereby made to obtain a permit to do the ;work and in law as indicated tcerti ,. commenced prior to the issuance of a permit and that all work will be performed to meet the S......... tonstmction in this Jurisdiction, 1 understand that a separate permit must be secured for ELECTRICAL .Wt tl WELLS. POOLS. FURNACES, BOILERS. IIEA Tl ,TANKS and MR commit: +t s; .;... OWNER'S AFFIDAVIT; I certify that all the :foregoing information is °accurate i applicable Jaws regulating construction and zoning- WARNING G TO "OWNER: YO R 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 :C J U M CEMENT." has regutatin EI, $KINS, that all wet wit*, done in: °cbmphance witty all Notice -to Applicant: A. As-a a ittan to he issue. it;pe.mit'turrh ni; estrinakd-vaIU . the appikain m sI promise .goodfaitk Brat a copy of the notice of commencemem and c ruerittn ,lien ip a brochure a+iI3 b ds ntr'ej to the person whose pmpei ly 's.subject to attachment Aft, a cerd:fled copy oldie recorded node + of cr »i0 n** mum ire posted a the • she evett (7) Lays +queer the b!gtiding permii ta,isaued Iiat:the abaen+e 4 such pasted nrrtreer. the ,fir the first trt;tirm wtrft inopeenrm wifl not k app x'e >' ,t ' , n t-ri and be e#rurgc , Signature; The Owner = 'Agent moment was acknowledged before me tll: •t' day of__ .2O.1 b who is nalfiy known :; me or•: who has produced iaeritification >and who did takean:oath. NOTARY PUBLIC: Sign; Priifl: My Co n alA ** $Y korhat �/17L��at•% ! l MERCEDES OUINTERO -TERI MY COMMISSION # EE 182966 EXPIRES: March 26, 2016 4 alt Signature_, , t� Contractor The foregoing inStrtivitOii WaaeekrOwleddged °before me thi °r day or a ._. Who is Q ll�r lcnovrn � meorwhO `ltas WS Examiner Summit! Rev ew 2�l213U4')tl�dsised NOTARY PUBLIC: /i/ .4 %' z2 eve, MY CCMMISSION # EE 182986 EXPIRES: March 26, 2016 CERTIFICATE OF LIABILITY INS J CE DATE /28/12 f - . ti91;?a11.2 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY'AND CONFERS No RIGHT UPON THE- CERTIFICATE HOLDER: THIS CERTWFL(ATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND t R ALTER me COVERAGE AFFORDED . f THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEENTHE ISSUING :1NSURER(Sj, AUTHOR REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: if#tie+ tifttate holder is an Atiorn NAL INStlt ED, the po lcy{ es/ must to endorser!. If SUBROGATION ISW MyER sect# the terms *84 conditions r fthe policy, certain poncho may r$gulr$ an endor nt A s mein on this eartfficate does not confer del*. to;tne cerilticate holder In lieu of such ends emend$. PRODUCER Accurate 8300 West Flagler Suite 114 Miami, R 33144 Phone (305)226-8727 Fax (315 )226 -8787 NM -MED' • Dynamic Design & Services 1740 West 32 PI / 1750 West 32 PI Hialeah, FL 33012 UST LUC IE Estrella (305 .228767- lucisestrellaOheltsotdit. net COVERAGES CERTIFICATE NUMBER: THIS IS TO CERTIFY THAT THE POLICIES O 1PtSURANGE Ll U INSURER81 AFFORDING COVERAGE IN Accident lnsurance.Company INSU► a: Guarantee insurance Company MSURER C: INSURER D: INSURER'S : €_INSURER F: REVISION NUMBER: D. ELO4b TVIV =CM ISSUED TO THE 8RANiED NAB ABOVE FOR THE POLICY PERIOD INDICATED. NQTWTTHSTANDINO -ANy REQUIREMENT, TERM OR. CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WTTH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,. THE INSURANCE AFFORDED BY THE POL;ICIE3 DESCRIBED HEREIN IS SUBJECT TOM. THE TERMS. EXCLUStONSAND CONDITIONS OF SUCH PQUCIES. LIMITS' SHOWN. MAY HAVE BEEN REDUCED BY PAID CLAMS. L TYPE OP INSURANCE ,,. i Y lr4,. Y Y PDLtCY NUMBER CP0002504 GW +C361�0819-112 , .*T€i , a : ;::i .A..°.: iAiif 05102/2012 04122412012 err ui°,. € .. :,j,; X11 ' MASTS A GENERAL .17Y 4 commute_ 6ENEIiAI LIABILITY L € ❑ CLAIMS -MADE OCCUR ❑ O 102/,2013 , EACH.00GURRENCE. $ 1 X0,000'. .77'(ri 9..i PffB IEa aaa€rrenc�l 5fl, EXP (Antt or>e____ $ 6,000 peesoN,N,. a ADV INJURY $ 11100.000 0 -lt I` GENERAL AGGREGATE- S 2,000,000 ��t3^^EP i A RE(R PE LIMp P -PLIES PER 0 POLICY .❑ SECT 0 Loe AUTOMOBILE LIABILITY ANY AUTO ❑' ALL OWNED AUTOS ❑ S£HEOI/LtEli AUTOS ❑ HIRED AUTOS r^� o NON-OWNED AUTOS 0 0 umesEurwAB ❑ OCCUR` EXCESSt.1tB ❑ CLa aADE PRODUCTS; 0CMPIQF AGG s 1,000 ,0 SINGLE LIMIT (Eat) ' - IIOOiLY tN FtlRY (Parpereon) . $ eOrni Y INJURY (Per ,t $ PROPERTY DAMAGE ti (Per +dent) $ EAL$4O0CiIRRF AGi3REGA1E $ i9�T €0 DEDUCTISI.E 0 RETENTION $ O ST :. OiN E B WDRi(HRSCOtamesATdA1 AND EMPLOY UABUJ$Y RO > e alleoy Y r IA � If nbe.und DESCRIPTION OF OPERATIONS t 04/24/2013 El" EACHACOU)ENT s 500,000 E L Lii8EA5E -EA EMPLOYEE $ 500,000 EL DISEASE - POLICY LIMIT $ 800,000 rDESCRIPTIONOP OPERATORS fLOGAY1ONBtVEHICLES ( Certificate Holder Is named as an addlilonel insured. nPi2TtFICe`I`1 mini notes Attact,AGORD1M , Additional Remoke -B ole N more spatsIIrepuN,�y) ._ _ c,__._ - _ —. LLATl3W City of Miartll Shores 9313 NW 2nd P1 Miami Shores, R 33161 ACORD (2008109) OF SHOULD ANY OF THE ABOVE DESCtteED POLICIES OE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE INTIM THE PoUCY PROVISIONS: ORPORATION. Ail rightsreeerver. and logo are registered marks of ACORD Construction Trades Qualifying Board BUSINESS CERTIFICATE OF COMPETENCY 09BS00498 DYNAMIC DESIGN AND SERVICES INC D.B.A.: FIGUEROA IVAN Is certified under the provisions of Chapter 10 of Miami-Dade CoUnty _N. UP,1111.- MIAMI-DADE COUNTY TAX COLLECTOR 140 W. HAGLER ST. let FLOOR MIAMI, FL 33130 2011 OCAL BUSINESS TAX RECEIPT 2012 ADE CCAI- STATE OF FLORIDA EXPIRES SEPT. S 30,2012 MLIST SE DISPLAYED AT PLACE OF PURSUANT TO COUNTY CODE CHAPTER BA - ART. 10 FIRST-CLASS U.S. POSTAGE PAID MIAMI, FL PERMIT NO. 231 111-M3 NOi A BILL -- DO NOT PAY RENEWAL RECEIPT NO. 675102-9 CC * 098500498 648150-1 BUSINESS NAME 1 LOCATION DYNAMIC DESIGN & SERVICE INC 1740 W 32 PL 33012 HIALEAH DYNAMIC DESIGN & SERVICE INC Sec. Type of Business WORKER/S oWt4ER This ts clotf, A IrctCIALTY BUILDING CONTRACTOR BUSINESS TAX RECEIPT. IT DOES NOV PERMIT me HOLDER TO VIOLATE ANY EXISTING REGULATORY OFI &TA OAR% T fig 1:141 NOT A CERTIFICATION OF DYNAM GN IC DESI & SERVICE INC DOES IT EXEMPT THE HOLDER FROM ANY OTHER PERMIT 011 LICENSE THE 14OLDERS OUALIFICA. IVAN FIGUEROA PRES REWIRED BY LAW. THIS IS TIONS ..........0,a21z,...... ...4...............,___................. DO NOT FORWARD 10, THIS IS NOT A BILL - DO NOT PAY 648150-1 BUSINESS NAME / LOCATION DYNAMIC DESIGN & SERVICE INC ° 1740 W 32 PL ' 33012 HIALEAH OWNER .. DYNAMIC DESIGN & SE Soc. Type of Business 196 SPECIALTY BUILD THIS IS OtILY A LOCAL SIISMSS 'TAX RECEIPT. IT GOES PERMIT THE ,iOLDER TO vIOLATE Mr( EA,S•TINCI. f4SC,,JLATORY OF me HC nt; clne5. Nort PERMIT , REQUIRED NOT CESIl;FSAT:014 HOLDEF QUALIF;L:z: TlotzS. RVICE INC ING CONTRACTOR ,A‘MEW b3s;:■, E,› ',/,MAI-OADECOLtta, TkX COLLECTOR 07/18/2012 60010000303 000045.00 SEE OTHER SIDE FIRST-CLASS U.S. POSTAGE 1 PAID MIAMI, FL PERMIT NO. 231 RENEWAL RECEIPT NO. 675102-9 CC * 09BS00498 WORKER/S 1 DO NOT FORWARD DYNAMIC DESIGN & SERVICE INC IVAN FIGUEROA PRES 1740 W 32 PL HIALEAH FL 33012 94 FSC Mixed Sources INKS PRINTED WITH Cava. IX.O.CITIS ENVIRONMENTALLY FRIENDLY PRINTED WITH ENVIRONMENTALLY FRIENDLY INKS No: ‘137110A209 City of Hialeah Business Tax Receipt Mayor Carlos Hernandez 2012-13 Amount: $ 65.00 The illaetiso°nns*alnid resertriwctriPc;es of the City of flialeall, Florida co, to eDitilemillAmblISInt,celstipsi$1770NirledyiNDsubje‘l to the the business tax legut SERVICES regulations ygpue of Business: Wood Kitchen Cabinot and Countertop DYNAMIC DESIGN 241s1D S ItVICES INC 1740 W 32 PL HIALEAN, FL 33012 Validating No. : 0000 FSC Mixed Sources ...twat Ow masa. mama Con mr44120095726 OMPerrose Sweat. tom No: 327991211011 THIS IS NOT A BILL Business Location: 1740 W 32 EL Expires September 30, 2013 City of Hialeah Business Tax Receipt Mayor Carlos Hernandez 2012-13 Amount: $ 65 00 The person, firm or coil:). listed here has paid Me business tax required to engage in or operate the business specified subject to the regulations and restrictions of the City Of Illideak, Florida Type of Busaness: Cut Stone and Stone Product Manufacturing Owner IVAN FIGUEROA DY141AIVIEC DESIGN AND SERVICES IN DYNAMIC DESIGN AND SERVIC 1740 W 32 PL HIALEAH, FL 33012 Validating No: 0000 THIS IS NOT A BILL Business Location: 1740 W 32 PL Expires September 30. 2013 NOTICE OF COMMENCEMENT A RECORDED COPY MH 8E POSTED ON THE JOB SITE AT TIME OF FIRST NFECILN PEWIT NO. TAX FOLD NO. STATE OF FLORIDA COUNTY OF MIAMI-DADE: Ti-E UNDERSIGNED hereby gores notice that enprovements wi be made property, and in =oder a with titer 713, Florida Statutes, the is provided h this Notice of Commencement. 111111 111111 1 11111111111111111111111111111111 CFN 2012R0767,343 OR E k 28330, F's 2015 (1 p s ; RECORDED 10:2812012 09g24:37 HARVEY VI l4 r CLERK OF COURT NIAi1I -C'ACE COUNTY? FLORIDA LAST PAGE STATE OF Fit?; :DA, COUNTY OF LADE I HEREBY CER i P: Y that this isaeopy of the (Aline! P in this . ; �5 on �►► (fa y of certain teal AD20 �� offlae sir , c 1. Legal description of property and str t/ ress: 9313 //A> c IP ,L , `'` cher 5 /L .3/761 2. Description of improvement: 3. Owners, name and address: '!/(``i4iz,, 2o,0,pit Iv a f o / E !l( $7i,'eef ( �, /c/o,�Ps, cs4 35/4 L Interest in property: Name and address of fee simple titleholder. 4. Contractor's name an addrs: e 5. Surety: (Payment bond required by owner from contractor, if any) Name and address: 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 Statute s, Name and address: It *EP , /kg' I/ 610 14.1E. 1`l 5tFee°f f, f % a 5, r5 4 I / 8. In addition to himself, Owners designates the following persons) to receive a copy of the t_ienor's Notice as provided in Section 713.13(1)(b), Florida Statutes. Name and address- 9. Expiration date of this Notice of Commencement: (the expiration date is 1 year fromthe date of recording unless a • different date i l `/ I Signature of Ow =r , /--',,�� d fRo e,� T c t /qv il f Ze. C Print Owner's Name ,G"7r A/ a A 11 e • ! Prepared by Sworn to and subscribed before me this day of CAleiar , 20 i-2 Notary Public Print Notary's Name My commission expires: 113 01-39 8104 PAGE3 / /// J % e(4 • Address. ACC,, BATHROOM RECEPTA ON 20 AMP Girl AND G.EI >rc\cci NO POINT ALONG COUNTER TO BE MORE THAN FEET FROM GI I PROTECTED RECEPTACLE. UT DM RECEPTACLE UNDER SINK ALt . IANCE8 QN DED0Tro mg; 13& 6 74; 1 Pec 54,104-eje-T eci 6it ADD SMOKEJCARBON MONOXIDE DETECTORS. ANY AND ALL CLOTH AND RUBBER INSULATED CONDUCTORS TO BE REPLACED. cA 1 ( 3 ou 744 BATHROOM RECEPTACLE ON 20 AMP GK D G.F.1 PROTECTED Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 iZC IZ° 1F3-7 Inspection Number: INSP- 182582 Permit Number: EL -10 -12 -1838 Scheduled Inspection Date: December 10, 2012 Inspector: Devaney, Michael Owner: , MIAMI PROPERTY SOLUTIONS Job Address: 9313 NW 2 Place Miami Shores, FL 33150- Project: <NONE> Contractor: DAW ELECTRIC, INC Permit Type: Electrical - Residential Inspection Type: Final Work Classification: Alteration Phone Number Parcel Number 1131010150230 Building Department Comments KITCHEN REMODEL AND SMOKE Detectors Infractio Passed Comments INSPECTOR COMMENTS False Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments /Z-2 q;)------eC 2c., / December 07, 2012 For Inspections please call: (305)762 -4949 Page 31 of 41 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 FBC20i0 Permit Type: Electrical OWNER: Name (Fee Simple Titleholder): Address: 170 We- 1/1 City: > ,» -,e4 ® 57L6 ae�s Tenant/Lessee Name: Email: PR ECM ED OCT 0 3 2012 Permit No. ` _ ces Master Permit No. �1 , Us' - 3 Coh5 hone #: State: Phone #: •a y --p7- Zip: ,, '3 /C JOB ADDRESS: 3/3 VW ? '' /,f '9 City: Miami Shores County: Miami Dade Folio/Parcel #: Is the Building Historically Designated: Yes Zip: ?A I NO Flood Zone: CONTRACTOR: Company Name: i 4/1 L) Phone#: '7�' g ° > ° Address: 2 © D /2 � LL- City: 114.42 n / ale/ Qualifier Name. e62 /2 c/l G w- 13 o Quali State Certification or Registration #: Contact Phone #: Email Address: DESIGNER: Architect/Engineer: Phone #: Zip: 3- IC? Phone #: 766 Certificate of Competency #: ®4'&O t / (4'4 Value of Work for this Permit: $ /(� i/ 00 Square/Linear Footage of Work: `b Type of Work: UAddress DAlteration On, Description of Work: ONew ORepair/Replace UDemolition **** ***** **** **** ***:x***** * ** ** x*:x**** *Fees** ******* ********* * * **4 x+ *** *a**** * *. Submittal Fee $ �11,0 Permit Fee $ / 0'79/ 0 # Scanning Fee $ Radon Fee $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ CCF $ CO /CC $ DBPR $ Bond $ Technology Fee $ TOTAL FEE NOW DUE $ 1 L0 1' Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage Leiide '`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 s en (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be ap dik , 07P 1 a reinspection fee will be charged. Signature ! 41` 0 fr or Agent The fore oing instrument was acknowledged before / e this l� 20 .Z,, by E € i€ her day of ,� , y ..�. w personally known me or who has produced As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Com 7/ % /// Yr. 4 11,, MY COMMISSION # EE 162986 EXPIRES: March 26, 2016 Bonded Thru Notary Public Underwriters APPROVED B // 1l Signatur°�°5,%1,, The foregoing instru day of Se who is person Contractor ent was acknowledged before me this ,201Z,by Wi1110,P 45 known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: 3 e Plans Examiner Structural Review (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) Sign: Print: My Commission Expires: 0 k C' y-` d � sL� a3 fiCioNDING.Co., INC. Zoning Clerk .ACa D 1 CERTIFICATE OF LIABILITY INSURANCE KPM U022 DATE (MM /DD:YYYY) 09 -26 -2012 THIS CERTIFICATEIS 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 ADDITIONALINSURED, the policy(ies) must be endorsed. If SUBROGATIONIS 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 NORTHEAST AGENCIES INC /PHS PHONE FAX 210204 P: (866)467 -8730 F: (800)308 -5459 E�C,No.Est) (866)467-8730 A /C. No) (800)308 5459 301 WOODS PARK DRIVE ADDRESS: CLINTON NY 13323 CONTACT NAME INSURED D.A.W. ELECTRIC INC. 20200 NW 2ND AVE STE 301 MIAMI FL 33169 INSURER A INSURER B INSURER C INSURER D INSURER F INSURER F INSURERISI AFFORDING COVERAGE Hartford Casualty Ins Co NAIC /T 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LTR INSR WVD POLICY NUMBER (MM /DD /YYYY1 IMM /DD /YYYYI A GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS -MADE X OCCUR X General Liab GEN'L AGGREGATE LIMIT APPLIES PER: POLICY X PRO LOC JECT AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS UMBRELLA LIAR EXCESS LIAR SCHEDULED AUTOS NON -OWNED AUTOS OCCUR CLAIMS -MADE DED RETENTION S WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y ! N ANY PROPRIETOR /PARTNER /EXECUTIVE OFFICER'MEMBEREXCLUDED? N/A (Mandatory In NHI If yes, describe under DESCRIPTION OF OPERATIONS below 01 SBM AM8606 LIMITS 51,000,000 $ 300,000 $ 10,000 $ 1,000,000 $2,000,000 $ 2,000,000 EACH OCCURRENCE DAMAGE TO RENTED PREMISES (Ea occurrence) MED EXP (Any one person) 06/01/2012 06/01/2013 PERSONAL& ADV INJURY GENERAL AGGREGATE PRODUCTS - COMP/OP AGG DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES /Attach ACORD 101, Additional Remarks Schedule, N more space is requited) Those usual to the Insured's Operations. CERTIFICATE HOLDER CITY OF MIAMI SHORES 10050 NE 2ND AVE MIAMI SHORES, FL 33138 COMBINED SINGLE LIMIT (Ea accident) BODILY INJURY IPer person) BODILY INJURY (Per acadent) PROPERTY DAMAGE IPer accident) EACH OCCURRENCE AGGREGATE E.L E.L E.L WC STATU- OTH- TORY LIMITS ER EACH ACCIDENT DISEASE -EA EMPLOYEE DISEASE - POLICY LIMIT CANCELLATION 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 1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD 04 -24 -2012 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: 06/17/2012 EXPIRATION DATE: 06/17/2014 WILLIAMS DERRICK 201184033 BUSINESS NAME AND ADDRESS: D A W ELECTRIC INC 1098 N.W. 155 TRAIL PEMBROKE PINE FL 33028 SCOPES OF BUSINESS OR TRADE: 1- ELECTRICAL/ ELECTRICIAN IMPORTANT: Pursuant to Chapter 440. 05(141, F.S., an officer of a corporation who elects exemption from this chapter by Iiling a certificate of election under this section may not recover benefits or compensation under this chapter. Pursuant to Chapter 440.05021, 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 440.05113), F.S., Notices of election to be exempt and certilicates of election to be exempt shall be subject to revocation 11, 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. DWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01 -11 QUESTIONS? (850) 413 -1605 PLEASE CUT OUT THE CARD BELOW AND RETAIN FOR FUTURE REFERENCE STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION CONSTRUCTION INDUSTRY CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW EFFECTIVE: 06/17/2012 EXPIRATION DATE: PERSON: DERRICK WILLIAMS FEIN: 201184033 BUSINESS NAME AND ADDRESS: D A W ELECTRIC INC 1098 N.W. 155 TRAIL PEMBROKE PINE, FL 33028 SCOPE OF BUSINESS OR TRADE: 1- ELECTRICAL/ ELECTRICIAN 06/17/2014 IMPORTANT O 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. Pursuant to Chapter 440.05(12), F.S., Certificates of election to be H exempt... apply only within the scope of the business or trade listed on E the notice of election to be exempt. R 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 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 ?r3-1- Inspection Number: INSP- 179421 Permit Number: PL -10 -12 -1839 Scheduled Inspection Date: December 19, 2012 Inspector: Hernandez, Rafael Owner: , MIAMI PROPERTY SOLUTIONS Job Address: 9313 NW 2 Place Miami Shores, FL 33150- Project: <NONE> Contractor: PSG PLUMBING SERVICES, INC Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Addition /Alteration Phone Number Parcel Number 1131010150230 Phone: (305)796 -7304 Building Department Comments KITCHEN REMODEL AND REPLACE BATHROOM FIXTURES Infractio Passed Comments INSPECTOR COMMENTS False Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments December 18, 2012 For Inspections please call: (305)762 -4949 Page 6 of 33 ECEOVE OCT0 ',2012 . - -fit 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) 762A949 BUILDING PERMIT APPLICATION FBC20 Permit Type: PLUMBING OWNER: Name (Fee Simple Titleholder): �o Address: D ? 0 NE 0/! , 1/_ fired— City: 41 l eq-n1 a 54 0 g e Tenant/Lessee Name: Pho Email: Permit No. ICI 2-- I Cj Master Permit No. 2--- l )5.-E] ©X44 5O41-,H o /4e 3a 5- 8,0 ? -54V3— State: F L 3/4 JOB ADDRESS: City: Miami Shores Folio/Parcel#: Is the Building Historically Designated: Yes 13/ 3 County: Miami Dade Zip: 3. NO Flood Zone; CONTRACTOR: Company Name: 1),S /2 1,1j -514- /Ate. Phone#: Address: 3 tv ,i,Z. , s, City: fe State: P71 Qualifier Name: P� 11 (� C 3 wn �y "� Phone*: State Certification or Registration # (r .1 Y2 6 2:-:;"'7 Certificate of Competency #: Contact Phone#: 3 0-3— 77r ~7 30 ), Email Address: DESIGNER: Architect/Engineer: Phone#: Zip: Value of Work for this Permit: $ /13(0 0 Square/ Linear Footage of Work: Type of Work: °Address °Alteration °New °Repair/Repl Description of Work:, 0_4► Ti-c-414/4 -5/Pk °Demolition e- **************************** ******* * ***F* *** * ************** ** * **** Submittal Fee $ 56 -CP Permit Fee $ i�5 CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/EducationFee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ , 7. 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 O 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 trust be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In tjce absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature r `� l Signature Owner or Agent The foregoing instrument was acknowledg day of 5 TIP ,20/2, by who is personally known to Contractor re me this li The foregoing instrument was acknowledged day of 5''_'c P , 20 L, by who is personally known to me or NOTARY PUBLIC: Sign: Print: My Commission Expires: Q� -f3 °f� My Commission Expires: ®7/3 ************ * * * * * ***** * * * * *** * * * * *+ * * * * *** *** * * * * *** * * ******* *a,*,*** *** * * ** * ** * *m *, * * * **** ****** **** APPROVED BY ti ^ "' / c' °` Plans Examiner Zoning Structural Review Clerk (Revised 07 /10/07)(Revised 06l10t2009)(Revised 3/15109)