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RC-13-48■ Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 189772 Permit Number: RC -1 -13-48 Scheduled Inspection Date: April 23, 2013 Inspector: Bruhn, Norman Owner: STOHL COOPER, ETHEL Job Address: 511 NE 94 Street Miami Shores, FL 33138- Project: <NONE> Contractor: JM GENERAL CONTRACTORS, INC Permit Type: Residential Construction Inspection Type: Final Work Classification: Addition /Alteration Phone Number Parcel Number 1132060140855 Phone: (754)235 -6136 Building Department Comments DEMOLITION OF TWO NON - BEARING WALLS IN LIVING ROOM AND KITCHEN. REMODEL 2 BATHROOMS AND RELOCATION OF KITCHEN ISLAND. Infractio Passed Comments INSPECTOR COMMENTS False Passed Failed Inspector Comments CREATED AS REINSPECTION FOR INSP- 183984. REPAIR SOD FROM �/ 2■2r DUMPSTER Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. April 22, 2013 For Inspections please call: (305)762 -4949 Page 25 of 25 PERMIT # CONTRACTOR: V013-46 SUBMITTAL DATE: i q ADDRESS: S 6 \ NE -t NAME: RESUBMITAL DATES: ZONING FIRE STRUCTURAL , IMPACT FEES '9 1' . ELECTRICAL cK PLUMBING HRSIDERM MECHANICAL 1 i 0`40 1 13 Sancrp 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 1 F - k- UILDING PERMIT APPLICATION Permit Type: JOB ADDRESS: BUILDING ), 13 quI ct JAN 09u_.J �FBC 20 Permit No. l3 ° 4-1? Master Permit No. ROOFING City: Miami Shores County: Miami Dade Folio/Parcel #: Is the Building Historically Designated: Yes NO ✓ Flood Zone: Zip: 3.3 138 OWNER: Name (Fee Simple Titleholder): Address: 67/ 4/ C 79 f4 S City: / %c.� ttf i vti tP_, C rcev.1 22� State: �rt Phone #: Zip: 3 /7 Tenant/Lessee Name: Phone #: Email: (' re. Dp tf µ o(. Cots-. CONTRACTOR: Company Name: J H tt' 6N -tat teAfx4r.Tras e Phone #: 766 31 q C433 8i(6.9 %ow to pit-`'l (r' Address: City: VI/AA-44 , State: PL 1 g5 1. Zip: 3 31 .81 Qualifier Name: A ,5 .AA.) baz J f 1-4 a-0J 4 Phone #: 4 -e& 3rei al 33 State Certification or Registration #: G) L- I) 8Q& 9 • Certificate of Competency #: Contact Phone#: 7e ? 1'1 04 33 Email Address: oLej ,..ie4evej 5 CO ttet c..eI.a DESIGNER: Architect/Engineer: Phone#: Value of Work for this Permit: $ l 000 , >6 Square/Linear Footage of Work: Type of Work: DAddition OAlteration Description if Work: $ /) j 1% 9�l , �- S Le-c- 1 d Yl ) ONew 4Repair/Replace gIDemolition �/► � 6 , -e 4 01 , • �1 /rte_ b11-h If) ©uAI Qel (Tr . ¢cte'' /'r'a d. Color thru tile: *************************************** F************* * ** * * * * * ** ** ** * ** * * * * * * * * * * * * ** x-70 Submittal Fee $ Permit Fee $ Scanning Fee $ Radon Fee $ CCF $ CO /CC $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ abn.x-) 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 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. he absence of such posted notice, the inspection will t be approved and a reinspection fee will be charged. Owner or Agent The foregoing instrument was acknowledged before me this own to me or w \aa'(� �d� ed'jb/ As identificedif Ric NOTARY PUBLIC: 311984 Signature Contractor The foregoing instrument was acknowledged before me this , day of etly 4`x,20 1.3, by �01Illllitlf1 // // own to me or who \b p�`p�'�1y`°`'`q�pp1Q '' %, as identificatioOnawliMiill oith. 0210712016 0011., Aseauk,z,iii4, I/ °4 o Print:je ern, ED .46 r- , 46 ai .oath. Main Print: -‹.0enZ My Commission Expires: NOTARY PUBLIC: '11,,`_i - My Commission Expires: * **** arty** *********** +***** *+x**w*x *** *** **+x*+x *+x*+x*** ** * *** ** * ** * **************> Hex *+x*** *** *+ *** *** **+i * ***>r*** APPROVED BY 40-.9?Co Plans Examiner Structural Review (Revised 3 /12/2012)(Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) Zoning Clerk This instrument prepared by or under the supervision of (and after recording should be returned to): Name: Danielle Gonzalez, Esq. Address: Greenberg, Traurig, P.A. 333 Avenue of the Americas Miami, Florida 33131 (Space Reserved for Clerk of Court) Parcel I.D. No. 11- 32 -06- 014 -0855 WARRANTY DEED This Warranty Deed is made and entered into as of the 3 "4 day of January, 2013 by IDA STOHL, an unmarried woman and ETHEL STOHL COOPER f/k/a ETHEL STOHL, joined by STUART D. COOPEA, her husband ( "Grantor "), whose mailing address is (I t *al re.4t r. Za�,( !r31� r40. 3 y7:: to DANIEL GREEN and COUREY GREEN, husband and wife (Grantee ), whose mailing address is 511 NE 94th Street, Miami Shores, Florida 33138. Wherever used herein, the terms "Grantor" and "Grantee" shall include all of the parties to this instrument .and their successors and assigns. WITNESSETH: GRANTOR, for and in consideration of Ten and No /100 Dollars ($10.00) and other good and valuable consideration, the receipt and sufficiency of which is hereby acknowledged, has granted, bargained and sold, and by these presents does hereby grant, bargain. and sell to Grantee and Grantee's heirs, successors and assigns forever, the following described land situate and being in Miami -Dade County, Florida (the "Property "), to wit: Lots 14 and 15 less the West 1/2 of Lot 14, Block 55, Miami Shores Section No. 2, according to the map or plat thereof, as recorded in Plat Book 10, Page(s) 37, of the Public Records of Miami - Dade County, Florida. TOGETHER WITH all the tenements, hereditaments and appurtenances thereunto belonging or in anywise appertaining. THIS CONVEYANCE is subject to: (a) taxes and assessments for the year 2013 and all subsequent years; (b) all laws, ordinances, regulations, restrictions, prohibitions and other requirements imposed by governmental authority, including, but not limited to, all applicable building, zoning, land use and environmental ordinances and regulations; and (c) conditions, declarations, restrictions, limitations and easements of record, if any, but this reference shall not operate to reimpose same. TO HAVE and to hold the same in fee simple forever. GRANTOR hereby covenants with Grantee that it is lawfully seized of the Property in fee simple, that it has good right and lawful authority to sell and convey the Property, that it hereby fully warrants the title to the Property and will defend the same against the lawful claims of all persons whomsoever. [Signature Page To Follow] lirabrilbialrilbmillorillisarlhafilmaillhoillime ''y AVA M. KILPATRICK ' 1 1 Notary Public - State of A rida t 1 *SI.% ! My Comm. Expires Jun 3, 2014 j ••,to 0 ' Commission 9 DD 979624 IN WITNESS WHEREOF, Grantor has hereunto set its hand and seal as of the day and year first above written. Print Name: Pri ame: HI'rtc -o ame: ijsrATGTfult STATE OF FLORIDA ) ) ss: COUNTY OF MIAMI-DADE ) The foregoing instrument was acknowledged ETHEL STOHL COOPER f/k/ L ETHEL STOHL. 7Elor da , /)r? Vef5 GRANTOR: LDA STOHL f/k!a ETHEL STOHL ESTOHL COOPER STUART D. COOPER before me this 3 day of January, 2013 by He /She is personally known to me or produced s identification. I1! / ,l / /, ame: Notary Public, State of Florida My commission expires: Commission No. [Notarial Seal] STATE OF FLORIDA ) ss: COUNTY OF MIAMI -DADE ) The foregoing instrument was acknowledged before me this ems+ day of January, 2013 by T D. COOPER. ' He /She is personally known to me or produced f Y G" ,-.,) as identification. _ — _ J. .r I►...._ 0 — � ¢ AVA M. KILPATRICK 1 x Notary Public - State of Florida I 1 # • My Comm. Expires Jon S, 2014 1 f ,,„ fi(�r`,�`- Commission. DD 971624 drilinrweriwirwirowormorwiermr ��Ii�tt.'•••• STATE OF FLORIDA ) ss: COUNTY OF MIAMI-DADE Name: Notary Public, State of Florida My commission expires: Commission No. [Notarial Seal] The foregoing instrument was acknowledged before me this j day of January, 2013 by IDA STOHL H is personally known to me or produced F/DY� /0 Med AVA M. KILPATRICK 1 1 a Notary Public - State of Florida My Comm. s' ° Commission Expires D Jan 3, 979624 4 MIA 182,986,510v4 1 -3 -13 077707.500032 as identification. Id!:!'� ! I / i' /, Notary Public, State of Florida My commission expires: Commission No. [Notarial Seal] NOTICE OF COMMENCEMENT A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION PERMIT NO. 1,- STATE OF FLORIDA: COUNTY OF MIAMI -DADE: TAX FOLIO NO.11 -3206- 014-• 0 fi3S( THE UNDERSIGNED hereby gives notice that improvements will be made to certain real property, and in accordance with Chapter 713, Florida Statutes, the following information is provided in this Notice of Commencement. 1. L.N.A. description of property and street/address: . 7l 17 2. A 5 i -ln+^i dam., 13 13$3 L...of . 22 - 034'91 - 03 9 - c( 2. Description of improvement: 4 M- 0r L. , ,.i* A 5. 111111111111111111111111111111111111111111111 CFH 20138004249 OR Bk 28447 F's 1372 °s Ups) RECORDED 1:11/16/2013 10:41.1.33 HARVEY R'UVIH, CLERK OF COURT MIAMI—DADE COUhlTYp FLORIDA LAST PAGE Space above reserved for use of recording office 3. Owner(s) name and address: J i �-� G ,re•v1 Interest in property: Name and address of fee simple titleholder: 4. Contractor's name, address and phone number J £ O aG 62.4 t +4,9Ti2:4c,..Ta „ 'ic ? AA 9 0 4M4 f • "34/4e 663i9 °9 3 5. Surety: (Payment bond required by owner from contractor, if any) Name, address and phone number. Amount of bond $ 6. Lender's name and address: 7. Persons within the State of Florida designated by Owner upon whom notices or other documents may be served as provided by Section 713.13(1)(a)7., Florida Stat /� Name, address and phone numbeq ✓ri�� CQ re rr, 4/ /nc. 9'S/sit. , /64'4 wt, SkYcS i 2 ?S/ 3 fi C..ou r•E in e/ 6� teen, 5 //n e `� (717'464 /its. r 4o�,� 331 8. In addition to himself, Owners designates the following person(s)ltmii/ 713.13(1)(b), Florida Statutes. ar i r14 NM In P Name, address and phone number. 9. Expiration date of this Notice of Commencement: liktitligt 1J fr 0 provide wr � iurss � n a' B LS V, .�� ;1 (the expiratiy date is 1 "• the date of recd • dew df t ° v ii WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION THE NOTICE OF COMMENCNM ARE CONSit EREQ. IMPROPER PAYMENTS UNDER CHAPTER 713, PART 1, SECTION 713.13. FLORIDA STA S, AND CAN RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT. iignature(s) of Owner(s) or O wner(s)' Authorized Officer/Director/Partner/Manager Prepared By Prepared By Print Name a 1 Print Name Title /Office Title /Office STATE OF FLORIDA COUNTY OF MIAMI -DADE 9 1,0k The fore of l �� ac owledg before me this V day of By ■ ❑ Individual) or ❑ as for ❑ produced the following type of identification: Signature of Notary Public: Print 451 rrirE): (SEAL) VERIFICATION PURSUANT TO SECTION 92.525. FLORIDA STATUTES Under penalties of perjury, I declare that I have read the foregoing and that the facts stated in it are true, to the best of my knowledge and belief. !NI `\\t�tittiru iul��� / Sg00rtigos %,,,� e29. : ✓421.0412016 wOTARY PUBLIC • 51011 r,tfi.iuo¢� Signat . .) of o r er( or Owner(s)'s Authorized Officer/Director /Partner /Manager who signed above: By l By. / c PV e f reef? 123.01 -52 PAGE 3 3/10 Miami Shores Viiiage Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 January 10, 2013 Permit No: EL13 -49 Electrical Critique — Michael Devaney 1. Add smoke / carbon monoxide detectors. N.E.C. 210 2. Bathroom receptacle on 20 amp. ckt. 3. Kitchen counter receptacles on 20 amp ckt. and spaceing. 4. Panel schedule,and arc fault breakers. Plan review is not complete, when all items above are corrected, we will do a complete plan review. If any sheets are voided, remove them from the plans and replace with new revised sheets and include one set of voided sheets in the re- submittal drawings. Miami Shores Viiiage Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 January 23, 2013 Permit No: RC13 -48 Building Critique 1. Provide a roof framing plan showing all of the interior bearing walls. This structure is conventional framed roof and ceiling. Identify the span and size of the ceiling joists.. Norman Bruhn CBO 305 - 762 -4859 Plan review is not complete, when all items above are corrected, we will do a complete plan review. If any sheets are voided, remove them from the plans and replace with new revised sheets and include one set of voided sheets in the re- submittal drawings. PERMIT #: Miami Shores Vinage Building Department RECEIPT e-/- Ye DATE: I, S ecA>opz! D/ 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 2V/ 24 /j Contractor o Owner o Architect. Picked up 2 sets of plans and (other) C c c Address: 6// NE W7/4. e ; 14 '0 .e f 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 permitting process. Acknowledged by: r PERMIT CLERK INITIAL: RESUBMITTED DATE: - 5 PERMIT CLERK INITIAL: Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 RC r3 -`lv nspection Number: I NS P- 187763 Permit Number: EL -1 -13-49 Inspection Date: April 09, 2013 Inspector: Devaney, Michael Owner: STOHL COOPER, ETHEL Job Address: 511 NE 94 Street Miami Shores, FL 33138- Project: <NONE> Contractor: PROSTAR ELECTRICAL CONTRACTOR INC Permit Type: Electrical - Residential Inspection Type: Anal Work Classification: Addition /Alteration Phone Number Parcel Number 1132060140855 Phone: (786)307 -4295 Building Department Comments 17 NEW RECESSED LIGHT FIXTURES. RELOCATE 3 OUTLETS AND TWO SWITCHES. Infractio Passed Comments INSPECTOR COMMENTS True Passed Inspector Comments CREATED AS REINSPECTION FOR INSP- 184014. Sri ��' 9' , 2c, / ''' � ,/j)--/";2°- z,, 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 April 09, 2013 Page 1 of 1 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 No. Master Permit No. iAr C Permit Type: Electrical JOB ADDRESS: 3 1/ Al. & 9 Y s City: Miami Shores County: Miami Dade Zip: 3 3/38 Folio/Parcel #: Is the Building Historically Designated: Yes - NO Flood Zone: OWNER: Name (Fee Simple �Titleholder): , I) ✓1 t L-� wt "\ Phone#: 3 Or- 2. 8-923 Address: 5 tl i e- S`I dam@ City: iGX4.1 c� lure C State: Pon . zip: 33 /3 Tenant/Lessee Name: Phone #: Email: J youN a ©04 a, .0(.c.-0 �.-. CONTRACTOR: Company Name: P ,5::T 12- 2 . .'Ci u .1 '- ,i 4 CO C0 4 Phone #: Address: 6' o W ) City: c/1. -4•44 r State: 1, Zip: 37 / ) V Qualifier Name: A-'? k... A. iJi,b X (j ii Phone#: %(9(;3 5) ` ToL f S` ' State Certification or Registration #: ~C id ®D 0 yQ,S Certificate of Competency #: Contact Phone #: ‘`30)--(4.29_1- Email Address: 4 Aea yJ f ito,ST A-L Qcri`C- t. co I-4 DESIGNER: Architect/Engineer: Phone #: Value of Work for this Permit: $ 1, (2P . O 0 Square/Linear Footage of Work: Type of Work: ❑Address ❑Alteration I New ;1lRepair/Relplace_ ODemolition Description of Work: / 4J G'!,() /'o- co Sse cL /I c:� ►'� 4- rt JC. d �/ -C t o Cam. . 2 ®i xt-Ge r ttA ct 7. ,S 1 -1-C 4„...3 ** ** **** * ***** ** :: n***** ***m ************ Fees****+ x*+ x****+x************** x********* *** ***** Submittal Fee $ Permit Fee $ 7-4-70 CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ l 1,0 10 Bonding Company's Name (if applicable) Bonding Company's Address City State . Zip Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will be approyep' and a reinspection fee will be charged. Signature O wneerr or Agent The foregoing instrument was acknowledged before me this 20Ji,by x0\11111u/////0, wn to me or who has prQ,d el0'rtig06, s•� As identification a I' w'o•'t &a' n. oats k 02101120,6 NOTARY PUBLIC: PUBLIC Commission # ' EE160045 . ° sr Print: S'``--a_;~ My Commission Expires: U0n1omoOx Signature Contractor The foregoing instrument was acknowledged before me this 2012 b \\�,1u1nuw// // , y ��\\ age 0 rtig0 ' %,' own to me or who ha��iit p l ///////// L..4 • as identification ancL vho;iiia 210141A attl. PUBLIC C mmissi 45 NOTARY PUBLIC: Sign:,s 6. kDr2�„ Vim. Print: C.�C My Commission Expires: ****** *****: x*+ x************** ********** x: x:******************+ x***** a: *+ x+ x**** ************ *******:x **** * * ** *+rx:*m*** 74, i� 521_ // / W.0 Plans Examiner APPROVED BY Structural Review (Revised 3 /12/2012)(Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) Zoning Clerk ACC)RIEPv CERTIFICATE OF PRODUCER Nations Insurance 8 Financial Services 8040 NW 155th St, Suite 204 & 205 Miami Lakes, Florida 33016 IABILITY JNSIJRANCE ersupro Armando Loon DOA Frusta Electrical Contractors Inc. 610 SIN 114(11 Avenue, Unit 81 Miami, FL 33174 COVE 5/2212012 TH CERTIFICATE IS ISSUED AS A MATTER OF INFORMATIoN ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMENO, EXTEND OR Ai, ER THE COVERAGE AFFORDED BY 711E POLICIES BE .0W. INSURERS AFFORDINci COVERAGE 1Nsv R 0 A;cendsnt 1fltWanc� Corn o INSURER iNSURSR THE POLICIES OF INSURANCE LIST D BELOW HAVE BEEN ISSUED To THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOIWTHSTAN ANY REQUIREMENT, TERM OR CONDMON OF ANY CONTRACT OR OTHER DOCUMENT k.MTH RESPECT TO WHICH THIS CERTIFICATE MAY 13E ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREOATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CIAIMS, h..541;t$: = if■ POLICY OtMp R 018 F 00 0312912012 03/29/2013 s 2 000 000 s2 000 000 AUTOMOBILE I wed Ty ANY AUTO ALL OWIEO AUTOS scHEDULED AUTOS HIRED AUTOS NON-OWNED AVMs GARAGE mature ANY AVTO Exce6s ums OCcvR AUTO oNLY- GA DENT $ ABIUTY AIMS AGGREGATE DECUCTIBLE RETENTION 5 WoRKERS COMPENSATION MO EMPLOYERS- LIABILITY 8 ANY FROPRGTERVPARTN OFFICER/MIASMA EXCLUDED? (MantIMPTY In )04) gr "WPflie CSt C42S0001 03/1412011 09/14/2012 EL EACH CCIDENT $100 000 DESCCuPTKIN OF OPERATIONS / LOCATIONS 'VEHICLES 1 EXCLUSIONS ADDED BY eNtfoRstmeNT/ SPECIAL. FROWSIONS Electrical Contractor CERTJECATE HOLDER City of Miami Shores Building and Zoning 10050 NE 2nd Ave. Miami Shores, Florida 33138.2304 ACORD 2 CANCE LAT fN ANY OF THE AROVEDESCRISED POUCIES OE CANCELLED BEFORE THE sxelmAtios gait THEREOF. THE ISSUING INSURER WILL ENDEAVOR TO MAIL n DAYS WRITTEN NOTICE CRYiptcm HOLDER NAMED Tu THE LEPT, BUT rati Un TO DO SO SHALL uuiy OF ANY RIND UPON THE INSURER, ITS AGENTS OR NTATtV 'd 18 °N The ACORD nine and • 4i ered mark s oT ACORO RPORATION. Al nht u! 1s anvinsui suo!mi /I ACT)Rill CERTIFICATE OF LIABILITY INSURANCE DATE IMMIDONYTYI 02/28/13 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 shower is an ADDITIONAL INSURED, the policy(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 endohsernentls). PRODUCER CONTACT NAME: May thread tAjZFAINeo. Extr. (305) 267-4541 G-Mar Insurance FAx 8040 NW 155 St Suite 204-205 ApoREss: tlifitinnsuranceComail CCM (A/C, Noy: (305) 267-4543 Miami Lakes, FL. 33016 issueen(s) AFFORDING COVERAGE NAIL a Phone (305) 267-4541 Fax (305) 267-4543 INSURER A Granada Insurance Company INSURED INSURER 0 Electrical Contractor Inc., Prostar INSURER C : 610 SW 114 AVENUE UNIT# 1 INSURER MIAMI, FL 33174 (786) 307-4295 INSURER E : INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES or iNsurtANcE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION CF 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 15 SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDLSUBR POLICY sFy POLICY EXP LTR TYPE OP INSURANCE uriiTS INSR WVD POLICY NUMBER IMSLOOP/TYY) IfiltUDDIYVYY) GENERAL LIABILITY g 1,000,000 00 EACH OCCURRENCE 4 CO IAL MMERC GENERAL LIASILITY PREMISES En occurt0000) DAMAGE TO RENTED 3 100,000 09 CLAIMS-MADE irr OCCUR 0185F10018257 03/29/2012 03/29/2013 mED E XP (Any one Raison) s 5000000:0000 A 0 PERSONAL ADV INJURY $ 100000000 GENERAL AGGREGATE 2,000,000 00 GEML, AGGREGATE LIMIT APPLIES PER PRODUCTS • COMPiOP AGG 3 2,000,000 00 poucy .71 78, Loc comeiNED SINGLE LIMIT AUTOMOBILE LIABILITY SODa.Y INJURY (Pe/ Meson) 3 BODILY INJURY (Pal *Minim) 3 PROPERTY DAMAGE (Pei ac000ni, $ ANY AUTO 26LTECAVNE tStr'SguLE° msEoAuTos rPos'°'"" • - • • UMBRELLA LAD occuR Li EXCESS LIAR fl CLAIMS4ADE L_ DE0 CI! RETENTIONs • WORKERS COMPENSATION AND EMPLOYERS LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFF CERIMEMSFR F XCLUDE07 Mandatory In NH) V yea. Aesubt under DESCRIPTION OF OPERATIONS Wow N i A DESCRIPTION OE OPERATIONS I LOCATIONSIVEISCLES (Aitooh ACORD 101, Additional Remarks schedule, if rArkt t Elerical Contractor Class Code 5190 Fed ID # 900525829 CERTIFICATE HOLDER CANCELLATION Komi ShoreS 10050 Northeast 2n0 Avenue Miami Shores, Florida 33'38 EACH OCCURRENCE AGGREGATE $ WC STATU- TORY LAITS E L EACH ACCIDENT 3 E L. DISEASE • EA EMPLOYEE $ E L. CISEASE • POLICY LIMO 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 61988-2010 ACORD CORPORATION. Alt Vita reserved, ACORD 25(2010105) QF The ACORD name and logo are registered marks of ACORD CERTIFICATE OF LIABILITY INSURANCE 03/01 /2013 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 PAYCHEX INSURANCE AGENCY, INC. 150 SAWGRASS DRIVE ROCHESTER, NY 14620 CONTACT Paychex Insurance Agency Inc NAME: PHONE . EXT): 877-266 -6850 (a . No): 585- 389 -7426 E -MAIL Certs @paychex.com ADDRESS' INSURER(S) AFFORDING COVERAGE NAIC # INSURED PROSTAR ELECTRICAL CONTRACTING INC 610 SW 114TH AVE #1 MIAMI, FL 33174 INSURER A: NorGUARD Insurance Company 31470 INSURER B: INSURER C: INSURER D: INSURER E: 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 SUBR WVD POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MM/DD/YYYI) LIMITS GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED PREMISES (Ea occurrence) $ LAIMS- MADEF7OCCUR MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PROJECT LOC PRODUCTS - COMP/OP AGG $ $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS I SCHEDULED AUTOS AUTNO -QWNED COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY Per person) ( ) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ UMBRELLA LIAR EXCESS LIAR OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ $ DED RETENTION $ A WORKERS COMPENSATION AND EMPLOYERS' LIABIUTY ANY PROPRIETOR/PARTNER /EXECUTIVE OFFICER/MEMBER EXCLUDED? Y/N (Mandatory In NH) N If yes, describe under OFSCRIPTION OF OPFRATIONS haloes N/A PRWC442040 01/01/2013 01/01/2014 �( WC STATU- OTH- TORY OMITS FR E.L. EACH ACCIDENT $ 100,000.00 E.L. DISEASE - EA EMPLOYEE $ 100,000.00 E.L. DISEASE - POLICY LIMIT $ 500,000.00 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) CERTIFICATE HOLDER MIAMI SHORES VILLIAGE 10050 NORTHEAST 2ND AVE MIAMI SHORES, FL 33138 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, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25 (2010/05) ©1988 -2010 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 Inspection Number: INSP - 184017 Permit Number: PL- 1 -13 -50 Scheduled Inspection Date: April 10, 2013 Inspector: Hernandez, Rafael Owner: STOHL COOPER, ETHEL Job Address: 511 NE 94 Street Miami Shores, FL 33138- Project: <NONE> Contractor: SLAZAR CONSTRUCTION INC Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Addition /Alteration Phone Number Parcel Number 1132060140855 Phone: (365)412 -6355 Building Department Comments PLUMBING WORK FOR 2 BATHROOM REMODEL 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 April 10, 2013 For Inspections please call: (305)762 -4949 Page 6 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 0 FBC 20101 7, Permit No. l l 3 Master Permit No. J 134 Permit Type: PLUMBING JOB ADDRESS: S I Ni a I �:25?� . City: Miami Shores Folio/Parcel #: County: Miami Dade Zip: Is the Building Historically Designated: Yes NO Flood Zone: OWNER: Name (Fee Simple Titleholder): ` J � � i Q mei-) Phone#: 3 ©S S 2 g.7 2.1 Address: 6// v8- (1-÷1.' GkrnQ -4- City: L ht tA.n l $,L O S State: ..-C. i or,. 4 c... Zip: 7:3128 Tenant/Lessee Name: Phone#: Email: ey CA" e qO'i@ 005(. CONTRACTOR: Company Name: L- %2.NT2- Go NSTP -V c.V -A.014 114C.. Phone #: 30 %— 4 t Z (o -S; S Address: 10 3 S6 1 sw v5c6 e6 City: Mt kettLt State: Zip: 33 CS G Qualifier Name: QV.`C.- % PA-N "- Phone #: 30 — 4-17-401 %S State Certification or Registration #: C-- C- ‘4"2:1 k R Z Certificate of Competency #: Contact Phone #: Email Address: S lgZgt'C/ ‘09.1`%ot . DESIGNER: Architect/Engineer: Phone #: 0u Value of Work for this Permit: $ I 0 0 Square/Linear Footage of Work: Type of Work: °Address °Alteration New , Repair/Replace °Demo 'lion Description of Work: ACtx -) S t N / `n ` Wass-Er T Q (21) 401 lQ. C. ******** ********* **************+x** **** *F **** * * ** ** ****m+ x+ x*+ n******* *****+x***+x ******** Submittal Fee $ Permit Fee $ / �� CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ 8 00 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 FT.F,CTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commen , 1 rust be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. I posted notice, the inspection will not provprl and a reinspection fee will be charged. Signature , "k /� (� `� • Signature Owner or Agent The foregoing instrument was acknowledged before me this The foregoing instrument was a owledged before me this day of day of ... �'' , 20 llt , by own to me or w h o`h v io'dut ed w is personall own to me or who has produced � .e �. -:� ��I�ItIIIIUIr;II� As identific tion.and Who did take an oath. as identification a %tr did ^ oth. NOTARY PUBLIC: �p l�s'' •�' `r iI 6 0210 [11,7 NOTARY PUBLIC: My Commission Expires: Print: -� My Commission Expires: i, //11111111 \1 * * * * * * * * * * * * * * * * * * * * * ** * * ** ************************************************ ** ********** ******************* APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised3 /12/2012)(Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09)