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RC-12-1460Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 189706 Permit Number: RC -8 -12 -1460 Scheduled Inspection Date: April 25, 2013 Inspector: Rodriguez, Jorge Owner: Job Address: 54 NW 95 Street Miami Shores, FL 33138- Project: <NONE> Contractor: STAMBUL LLC Permit Type: Residential Construction Inspection Type: Final Building Work Classification: Alteration Phone Number Parcel Number 1131010340060 Phone: (305)979 -9710 Building Department Comments BATHROOM RENOVATION. REPLACE TILE WALL AND FLOOR. REPLACE OLD TOILET AND BIDET WITH A NEW ONE. REPLACE BATH SINK CABINET WITH A NEW ONE. NO PLUMBING OR ELECTRICAL CHANGES. 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 25, 2013 For Inspections please call: (305)762 -4949 Page 18 of 49 V3AilIVIktAtk, 6 site P 14 Z STRUCT PL EL /..0, P^O" 0 12-- MC BLDG likb (di BUILDING 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 RECEIVED AUG 022012 FBC 2010 Permit No. PERMIT APPLICATION Master Permit No. RC- ► z - H(.� 0 Permit Type: BUILDING ROOFING JOB ADDRESS: 5-4 x) R 6" .STET City: Miami Shores County: Miami Dade Zip: 0' / 50 Folio/Parcel #: // —3/0/ r0 3 - 00 P4 Is the Building Historically Designated: Yes NO Flood Zone: OWNER: Name (Fee Simple Titleholder): l *4 T t Ad 60 /2 Phone #: Vc3 is -99 3 >e Address: 0-0 U)€.S 74/ 07/ D City: 14-1/' a 41; /3 -. State: F10411./A. Zip: aa /C3 Tenant/Lessee Name: Phone #: Email: 4 /tIn -/2/ Q // ti% /. 40+y7 CONTRACTOR: Company Name: 51 -Ct i c4 It C Phone #: 3 05- 79 q -?? /t) O Address: / / 38 Ate / Y 9 -b Si City: 16 r 4 Me '0.4402; State: 71. zip: 33i8/ Qualifier Name: 75 0.444`el ?ate_ 6i' ii 4' Phone #: 3Z3-47f9'%5'l© State Certification or Registration #: C LAC /S/ 24IfJ �rCertificateof Compet ncy #: Contact Phone #: 30 5 9 i 9 9/C Email Address: CJ } 4 PU'' / St i• CO 1 DESIGNER: Architect/Engineer: Phone #: Value of Work for this Permit $ 2 0 0 0 1179k( Square/Linear Footage of Work: Type, of W ki ❑Addition ❑Alteration New *Repair/Replace Description of Work: A- 4 0,4 440_44n //s ig R e2-#A.B� T /e- Waft e 4d. r/fJ o /Z, l e e 11-. et- 49 lot ` /e-i- '4d b, c 7 a) i Cc flew ®.7e, riee W-- 5i✓1I4 10; 461 GO i G i'/ "e ❑Demolition Color thru tile: 07 r`/v * *** * ******** : x:********* *** * ********* ** Fees+ x******** *****+ xx:******** ***:x**************** Submittal Fee $ ,SZ? ° ®D Permit Fee $ / CCF $ CO /CC $ PA Scanning Fee $ ° 9 Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ 11 CD Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature Signature _ p t: caner or Agent n The foregoing instrument was acknowledged before me this 2•� The foregoing instrument was acknowledged b1 fore me this?-8 day of -5 , 20 it, by L - 11 aft Cos -ALL3 day of L J vQ , 20 a, by Contractor who is personally known to me or who has produced 1� tiiio is personally knowillomei who has produced as identification and who slid take an oath. NOTARY PUBLIC: As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: 1111MMIN■ # a0issio,WO3 : CP 01190d 1NVJON FE 96011901E0 ******************************1 4 * ** ** ***:k:k***** My Commission Expires: APPROVED BY Plans Examiner Sign: Print: My Co t. (4u7) 398.0153 ion Expires: FloddsNooe rilokaoan Structural Review (Revised 3 /12 /2012)(Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09) ************* * * * * * * * * * * * * * * * * *' * * * * * * * * * * * ** Zoning Clerk CONSTRUCTION INDUSTRY LICENSING BOARD 1940 NORTH MONROE STREET 32399 -0783 TALLAHASSEE FL STAi B'OI C 1958 � 149ME ST FL 33181 Congratulations! Wit h this license you become one of the nearly one million ion. Florkilans Our professionals and businesses e range from architecis.tooyyaaschitbrokkers from boxers to barbeque restaurarris, and they keep Florida's economy strong. Every day we work to improve the way we do business www.my !ot!� Saco For information about our services, please log There ue � � our �and �ut . you, subscribe ha about team more about the Departments initiatives. Our mission at the Department is: License Efficiently, Regulate Fairly_ We constantly strive to serve you better so that you can serve your customers. Thank you for doing business in Florida, and congratulations on your new license! DETACH HERE (850) 487 -1395 ACS STATE OF FLORIDA . taZir3SOTZIENT. ©a'� BiaaIN893.= D -ikOT SSI0 _ R GIVIATTON GC3.53 Z�6t3 : 09/02/10 01 -012609 - CARTIMA,- =NEM CONTRAC:TO, VAISitIL / vi BADE COUNTY TAX COLLECTOR" 140 W. FSADLER ST. lst. FLOOR ;- T -_ MIAMI, FL 331 596570 -3 BUSINESS NAME 1 LOCATION STAMBUL LLC 1958 NE 149 ST 33181 NORTH MIAMI OWNER STAMBUL LLC Sec. Type of Business LOCAL BUSINESS TAX RECEIPT MIAMI -DADE COUNTY - STATE OF FLORIDA EXPIRES SEPT. 30, 2012 MUST BE DISPLAYED AT PLACE OF BUSINESS URSUANTTO COUNTY CODE CHAPTEFiSA ART. 9 & 10 RENEWAL RECEIPT NO 622352 -3 STATE* CGC1512660 FIRST -CLASS U.S. POSTAGE, PAID ft PERMIT NO. 231 19_6 G +IERAL BUILDING CONTRACTOR WORKER /S' This rs ONL n Ah. Bps Tax PERMIT rr 1 HOLDER TO VIOLATE ANY EXISTING REGULATORY OR ZONING LAME OP THE 03UNTY OR arms. non HOLDER FROM ANY OMER PERMIT OR mans REQUIRED BYLAW (HOT A CATION OF TIONEL PAYssa COLfNiY TAX mccussfh 07/05/2011 09010965001 000045.00 SEE OTHER SIDE DO NOT FORWARD STAMBUL LLC DANIEL PENA MGR 1958 NE 149 ST NORTH MIAMI EL 33181 thhll,hhll mIllhtlhhhhithhhllhhh11h11hhhhl nhh1 hltitr41 PR CERTIFICATE OF LIABILITY INSURANCE OOUCk R Coastal Insurance Group, Inc. 150 Westward Drive Miami Springs FL 33166 -1660 Phone:305- 887 -5999 DATE (MMODNYYY) °STIAR 1 08/23/12 THIS CERTIFICATE IS ISSUED AS A MATTER OF IN + ' TION 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 # INSURED FrO2th.asmn COVERAGES INSURERA MID - CONTINENT CASUALTY CO. INSURER B: MID CONTINENT GROUP INSURER C: Zurich Insurance Company INSURER O: INSURER E: 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 AU. THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. Dam LTR Awn ISRO TYPE OF INSURANCE POLICY NUMBER o (tyi � �pp�ppl D/YYYY) LB19TS A GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY 04GL000827367 04/08/12 04/08/13Mls EACH OCCURRENCE $ 1000000 X s(Ee "o'x) $100,000 CLAIMS MADE n occult NED EXP (Any one person) $ 5 , 000 X Owner /Cont Prot. PERSONAL & ADV INJURY $ 1000000 X HIRED /NON OWNED GENERAL AGGREGATE $ 2000000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP /OP AGG $ 2000000 $ri POLICY n PRO- 1 LOC C AUTOMOBILE U BUJTY ANY AUTO ANY AU. OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS SCP05100807 -1 02/15/12 02/15/13 COMBINED SINGLE LIMIT accident) $ 1,000,000 BODILY INJURY (�') $ X X BODILY INJURY (Per accident) $ X PROPERTY DAMAGE (Per accident) $ GARAGE LABILITY ANY AUTO AUTO ONLY- EA ACCIDENT $ OTHER THAN EA ACC $ AUTO ONLY: AGG $ B EXCESS/ UMBRELLA UABI.RY 04 XS 175775 04/08/12 04/08/13 EACH OCCURRENCE $ X OCCUR I I CLAIMS MADE AGGREGATE $1,000,000 $ DEDUCTIBLE RETENTION $ 10000 $ _ X $ WORKERS met EMPLOYERS ANY PROPRIETORIPARTN OFFICER/MEMBER If yes, describe SPEG�IAL COMPENSATION UABtTY ERIEXECUTNE{ / ] I loin- 1TOORRY SITS I 1 E L EACH ACCIDENT $ EXCLUDED? EL DISEASE - EA EMPLOYEE $ BEER under PROVISIONS below E.L DISEASE - POLICY UMIT $ OTHER DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES /EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS Contractors CERTIFICATE HOLDER CANCELLATION MIAMI SHORES VILLAGE Building & Zoning Dept. 10050 NE 2nd Avenue Miami Shores FL 33138 ACORD 25 {1) MIAMISH SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE LRSUBIG INSURER WUi. ENDEAVOR To man. 10 DAYS WRITTEN NOTICE TO THE CERTVICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR IJAB .ITY OF ANY KIND UPON THE INSURER, WSAOENTS OR REPRESENTATIVES. The ACORD name and logo are registered marks STAB -1 PAGE 2 OP ID MM DATE 08/23/12 AIC�R» CERTIFICATE OF LIABILITY INSURANCE �....� DA's( ) 8/23/9012 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: if the certificate holder is an ADDITIONAL INSURED, the pollcy(tes) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and condition of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certif sate holder in lieu of such endorsement(s). PRODUCER Alliance Insurance Solutions LLC. ID: (RMI) c/o Resource Management, Inc. 281 Main Street Fitchburg, MA 01420 corn-Aar NAME; Jennifer Dodge PHONE NQ Elm: 978-343-0048 FAX MX. N,r. earku. ADDRESS; Jdodge@rmi- solutions.com INSLRER(S) AFFORDING COVERAGE NAM INSURER A : S(iNR Insurance Company 34782 INreEsop urce Management, Inc. 281 Main Street Fitchburg MA 01420 e : Re - London - Best Rating "A" INSURER C : Catlin Syndicate - Lloyds - Best Rating "A" INSURER D : Brit Syndicate LI yds - Best Rating "A" $ -- INSURER E: $ INSURER F : $ • 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 LTR TYPE 0P NSURANCE IMvD POUCY NUMBER 01111%/1=1 t�D/YYYYL LIMITS GENERAL LIABIUTY COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ PREMS (ta Daurence) $ MED EXP (Any one person) $ CLAIMS -MADE OCCUR PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ PRODUCTS - COMP /OP AGO $ G''E'N'L AGGREGATE LI1Arr APPLIES PER '-j 1 POLICY r---1 .PA:o' n LOC $ AUTOMOBILE — _ _ LIABILITY ANY AUTO AUTOS HIRED AUTOS AUTOS AUTOS COMB &INIGLE UMrr $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ �' � GE $ $ $ ( BREU.A UAB EXCESS UAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ $ DED _, RETENTION $ $ A atoRlCERSCOePe7N8AT>oel AND EIPLOYESOP UA TNER/ Y/ N A PROPRIETO NY R/PARTNER/EXECUTNE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) D d render DESCRIPTION OF OPERATIONS below N/A WCPE0000305902 1/1/2012 1/1/2013 I ) is - NY EL EACH ACCIDENT $ 1,000,000 EL DISEASE - EA EMPLOYEE $ 1.000.000 EL DISEASE - POLICY UMIT $ 1,000,000 B C D Excess ove agesation Excess Coverage and nothing shad create any right under such teinsurance. DESCRWTION OF OPERATIONS/ LOCATIONS/ VEHICLES (Attach ACORD 101, Additional Rem e,ke Schedule, If more apace la rued) Coverage provided for all lewd employees but not subcontractor of: STAMBUL, LLC Client Effective Date: 1/1/2011 CERTIFICATE HOLDER CAP_CELLATIP$ 401162 Miami Shores Village 10050 Northeast 2nd Avenue Miami Shores FL 33138 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELWERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHQRDEDREPRESE(NTATNE cis Glen J Distefano ACORD 28 (2010/05) Ito 19884010 ACORD CORPORATION. AO rtgMs resen►ed. The ACORD name and logo are registered marks of ACORD ream an., 11994799 .Tnnn1for nn,no A/91/7n19 11, &R.17 AM Dana 1 of 1 16;1 e a -I /Zoom t .'E M 9 : Rc--12_k (o M arni Sgores Village APPROVED BY DATE ZONING DEPT r� � BLDG DEPT SUBJECT i'O CCMPIJANCE Wl fri ALL FEDERAL ATE ANL) Cr. L111:1 f HULES AND REGULATIONS) /v" 1 UATHROOM RECEPTACLE ON 20 AMP CKT ANO 611 PROTECTED c � 4 RECEIVED AUG 0 2 2012 pLG tie i2 L-Th <:. 40 ',,1 e.2 "o.9, 2 ADD SMOKEICARBON MONOXIDE DETECTORS. ANY AND ALL CLOTH AND RUBBER INSULATED CONDUCTORS TO BE REPLACED. C,) 20 . 19 c/'-T APtip 1'1249 a ere", (BA + //as 3°,o 4€/ .9 A1P4 x i' . da, e 7 ,zf ace/Zoom 6/ a) /2.- 6-56 /ad qf trigAzel 3 3ir-0 eff, Plan SCALE: 3/8° =1'-0° BATHROOM RECEPTACLE ON 20 AMP CKT AND G.EI PROTECTED Elevation -1 SCALE: 3/8° =1'-0° 0" 1, -4" 6, CHANGE TOLET CHANGES _ _ 6' -8" ■ CHANGE BIDET Elevation -3 SCALE: 3/8° =1'° 4" NEW GLASS SHOWER Elevation -2 SCALE: 3/8"= V-0" 3' -2" 3' -6" Elevation -4 SCALE: 3/8" =1 r,0° —'k D1.00 LARITZA BLANCO RESIDENCE girt 54 NW 95 ST M I AM I. SH OR E S, FL, 33150 °mr AWGJ awn 06/20/2012 ire SCALE: AS SHOWN aradweora PLAN /ELEVATION F 0 Ob -20 -2012 Wan N N 0.1 0 0 1, -4" 8' 6' -8" 0 CHANGE BIDET \�� r Elevation -4 SCALE: 3/8" =1 r,0° —'k D1.00 LARITZA BLANCO RESIDENCE girt 54 NW 95 ST M I AM I. SH OR E S, FL, 33150 °mr AWGJ awn 06/20/2012 ire SCALE: AS SHOWN aradweora PLAN /ELEVATION F 0 Ob -20 -2012 Wan N N 0.1 0 0 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 ■ Inspection Number: INSP- 176776 Permit Number: PL -8 -12 -1461 Scheduled Inspection Date: January 14, 2013 Inspector: Hernandez, Rafael Owner: Job Address: 54 NW 95 Street Miami Shores, FL 33138- Project: <NONE> Contractor: NAVARRO PLUMBING & MECHANICAL CO Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: New Phone Number Parcel Number 1131010340060 Phone: (305)244 -5832 Building Department Comments FIXTURES SET. TOILET LAVATORY SHOWER. Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comm t January 11, 2013 For Inspections please call: (305)762 -4949 Page 2 of 33 Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 BUILDING PERMIT APPLICATION FBC 20 IC Permit Type: PLUMBING :CEI \TED AUG 2 9 2012 Permit No. ?L 12-14G Master Permit No. ec.- 2 -tom® OWNER: Name (Fee Simple Titleholder): L A-it T 2::1 4 SPhone #: -PSG 797 7G fi Address: 54' 0 vi 942 �J City: At®24 i H'® State: Zip: Tenant/Lessee Name: Phone #: Email: JOB ADDRESS: MA/ T City: Miami Shores County: Miami Dade Folio/Parcel #: Zip: Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name: A � 0 PL14.1e cic.)G Phone #: - 1-63 2 Address: City: 40 e Qualifier Name: State Certification or Registration #: ¢ 2 72 e I Contact Phone #: , p C1 a2 Email Address: DESIGNER: Architect/Engineer: Phone #: )C 2Z02giS � et y' W State: , '9"2"Y✓I 22-2- Phone#: S' v Certificate of Competency #: Value of Work for this Permit: $ (10 e Square/Linear Footage of Work: Type of Work: DAddress ❑Alteration UNew !J epair/Replace UDemolition Description of Work: k), (4.. 7; 1-- 0-140fird ar ,,tia 0 . i a-7e_ ***+ x***** ******* ** * *** *****+x *a:********* Fees***** *+ x*x: ************ * * *a:****+x********* * **** Submittal Fee $ 1 ft Permit Fee $ 1 (7 CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ I n 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 la brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of 'o mencement must be posted at the job site for the first inspect'. - w ich occurs seven (7) days after the building permit is issu d In th . sence of such posted notice, the inspection will no oved and a reinspection fee will be charged. Signature er or Agent Contractor Th e foregoing instru a was ackn Jwledged before me this" The foregoing instrument was acknowledged before me this �� day o f , 2012 -, by /�/j , l4 4 e0 f ` ya of AU , 201 L , by A) 44/4144€1, who is personally known to me or who has produced // ) who is personally known to me or who has produced NOTARY PUBLIC: Sign: Print: uossiur My Commission Expires: as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Co ***************************************** **** ** ** ** *** * * * * * * * ** * * * * * * * ** APPROVED BY 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 INSPECTION'S PHONE NUMBER: (305) 762.4949 BUILDING PERMIT APPLICATION FBC 2010 .. Permit Type: PLUMBING OWNER: Name (Fee Simple Titleholder): / Cell) � Phone#: 7e 9 ij Address: VW 'J 7t2 City: / -i 4 410 Shaw ECEIVED AUG 022012 BY : _.__ 40 _ Permit No. PL Master Permit No. R �_ 112-° State: Tenant/Lessee Name: phone#: Email: Zip: 83 &Ib JOB ADDRESS: IV /UI0 City: Miami Shores County: Folio/Parcel#: /i / 0 % °- 03S1- -0(),16,0 Is the Building Historically Designated: Yes Miami Dade Zip: 3? i NO Flood Zone: CONTRACTOR: Company Name: P "v� r P Y ame. ✓/� F (\)-■ Lit-A Lid Phone#: 30 5 ff' Address: / City: C o _ 2,2 ,4 Z5t State: 1C( Zip: 372.2 Qualifier Name: OA 1&ac VV Phone#: 3o5- b- 832. State Certification or Registration #: ere '172-91,9'1 Certificate of Competency # Contact Phone#: -® 5 < S9 3 2- Email Address: DESIGNER: Architect/Engineer. Phone #: Value of Work f or thisPermit: $ 1'260 Square/Linear Footage of Work: ODemolition ********* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *F ************* * * * * * * * * * * * * * * * * * ** * * * * * * * * * * ** Submittal Fee $ 5' • 0 -b Permit Fee $ /0 C� CCF $ Scanning Fee $ ?P t D Radon Fee $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ CO /CC $ DBPR $ Bond $ Technology Fee $ TOTAL }'Er, NOW DUE $ 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.'. subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first i 1 L 'n which occurs seven (7) days after the building permit is issued In the absence of such posted notice, the inspection wt Q • ; ' approved and a reinspection fee will be charged. Signature Signature Owner or Agent Contractor The foregoing instrument was acknowledged before me this 2-- The foregp instrument s acknowledi before me this 2e) day of r , 20 12- by UN., rt 'rZ ,... �,- J day of s% tb . , 2t a, by , who is personally known to me or who has produc who is ';. nally known o me or ; o has produced As identification and who did take an oath. as i entific on and who did take an oath. NOTARY ' UBLIC: • Sign: Print: CLAUDIA V. CUBILLOS ry Public - State of Florida ' 1) Comm. Expires Sep 23, 2015 � ������ . ,., ... 128810 onded Through National Notary Assn My Commission Expires: OTARY P t: My Commission Expires: ***************** * * * * * * * * * * * **** ** *** * * * * * * * ** ** *** *+n*M+a****** **** *** * *** * * **** x * *** * ** **** ** *** * ** *** ** APPROVED BY C < Plans Examiner Zoning (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) Structural Review Clerk MIAMI -DADE COUNTY TAX COLLECTOR 140 W. FLAGLER ST. 1st FLOOR MIAMI, FL 33130 664225-1 su FVs o E�,ILtumilIQNG & MECHANICAL 2011 LOCAL BUSINESS TAX RECEIPT 2012 MIAMI -DADE COUNTY - STATE OF FLORIDA EXPIRES SEPT. 30, 2012 MUST BE DISPLAYED AT PLACE OF BUSINESS PURSUANT TO COUNTY CODE CHAPTER 8A - ART. 9 & 10 THIS IS NOT A BILL - DO NOT PAY RENEWAL 691293 -6 STATE MM27281 CONTRACTORS INC 9064 SW 153 CT 33196 IJNIN DADE COUNTY D161ARRO PLUMBING & MECHANICAL Sec1Tygbbe 1 e a11'Lr G THIS IS ONLY A LOCAL BUSINESS TAX RECEIPT. IT DOES NOT PERMIT THE HOLDER TO VIOLATE ANY EXISTING REGULATORY OR ZONING LAWS OF THE COUNTY OR CITIES. NOR DOES IT EXEMPT THE HOLDER FROM ANY OTHER PERMIT OR LICENSE REQUIRED BY LAW. THIS IS NOT A CERTIFICATION OF THE HOLDER'S QUALIFICA- TIONS. PAYMENT RECEIVED MIAMI -DADE COUNTY TAX COLLECTOR: 09/15/2011 02210006001 000075.00 SEE OTHER SIDE CONTRACTOR FIRST -CLASS U.S. POSTAGE PAID MIAMI, FL PERMIT NO. 231 4 WORKER /5 1 DO NOT FORWARD NAVARRO PLUMBING & MECHANICAL CONTRACTORS INC DENEY NAVARRO PRES P 0 BOX 226288 MIAMI FL 33222 i�>, ii,►, ii► ��4�i„ i�lt�i�l, iiF� „1�1i „f>:}„},}a,isi�}i�?��I 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: 03/01/2011 EXPIRATION DATE: PERSON: DENEY NAVARRO FEIN: 208216297 BUSINESS NAME AND ADDRESS: NAVARRO PLUMBING & MECHANICAL CONTRACTORS INC P 0 BOX 226288 MIAMI, FL 33222 SCOPE OF BUSINESS OR TRADE: 1- AIR CONDITIONING 2- PLUMBING 02/28/2013 IMPORTANT OPursuant 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(121, 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 IS .CERTIFIED under the provisions of ;12,489 FS ;8xp nation. dates AUG 31, 20.12._ L10082900225 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 187007 Permit Number: EL -8 -12 -1462 Scheduled Inspection Date: March 14, 2013 Inspector: Devaney, Michael Owner: Job Address: 54 NW 95 Street Miami Shores, FL 33138- Project: <NONE> Contractor: NAVARRO PLUMBING & MECHANICAL CO Permit Type: Electrical - Residential Inspection Type: Final Work Classification: Alteration Phone Number Parcel Number 1131010340060 Phone: (305)244 -5832 Building Department Comments REPLACE BATHROOM RECEPTACLE ON 20 AMP CRT AND GFI PROTECTED. 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 /./-/ Hi2o- March 13, 2013 For Inspections please call: (305)762 -4949 Page 20 of 37 SSTATE OF FLORIDA AC# 510.9.2 ? El 7 DEPART/MU OF BUSINESS AND FRO'ESSi REGULATION EC13004818 , 117008101 C ERTI$'IEI RP. hs:Co, WIZ ?' IS C)I RTIFIEt . under the provision of ch.489 Fs Ei at on Hate; AVG.: 31m. 2Q12 L11112201.001 MIK.' SHORES VILLAGE 10050 NE 2ND AVE MIAMI SHORES, FL 33138 (305) 7952207 1 1 BLi,'.:ip.. PERMIT Dili 118. r�0 TL $168.70 .i.A ?a ;16r+.70 307 ,59 I agree to Pay abo - otal t according to card -s -r , ment (Merchant agreement if r • her) Merchant Copy Invoice Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Fax: (305)756 -8972 For Inspections please call: (305)762 -4949 , Invoice Number: PL -8 -12 -45001 Invoice Date: August 02, 2012 Permit Number: PL -8 -12 -1461 Bond Number: {Comments: 1' u% leg) W Fee Type Fee Amount 08/02/2012 Education Surcharge 08/02/2012 Permit Fee 08/02/2012 Technology Fee 08/02/2012 CCF 08/02/2012 Scanning Fee Calculated Calculated Calculated Percentage Calculated Calculated Calculated $2.00 $2.00 $0.40 $100.00 $1.60 $1.20 $3.00 Total Fees Due: $110.20 Payments Date Pay Type Check Number Amount Paid Change 08/02/2012 Credit Card $50.00 $0.00 08/29/2012 Credit Card $50.00 $0.00 Total Paid: $100.00 Wednesday, August 29, 2012 Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 BUILDING PERMIT APPLICATION FBC 20 LO Permit Type: Electrical OWNER: Name (Fee Simple Titleholder): "36P-n 0 /r�/�0 4 Phone #: h 6 Address: °71 42t0 cfc City: / «sues 6/i 4e4 State: Tenant/Lessee Name: Phone #: Email: Z' 1.,4 a ts.,12, J? (12 /.(7 ;/. RECET AUG 022012 Permit No. El,- I Z' 1y ki Master Permit No. RC- 12 -1 (Q 0 - _ ) JOB ADDRESS: 54 i/Ul 15 5-re City: Miami Shores County: Miami Dade Zip: '$ 3 f Folio/Parcel #: !7 - 3 i 0 i- 9 9 00 60 Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name: N o kiy,,yvi) V1/4,1/ wo, ca �N Phone #: 'SO'S 2tig 5 t>2 Address: P D �_'( 22 CZ City: iltAg ,.-1. Qualifier Name: ' t S 4- eat, ✓005 c D State: C Zip: 33 2 Z z -' 1 Phone #: 36 r 2 �/G[ 5$31 �J State Certification or Registration #: L [.. 60 Certificate of Competency #: Contact Phone #: 36 5 2- (.(C4 510 3 2 - Email Address: DESIGNER: Architect/Engineer: Phone #: Value of Work for this Permit: $ • Qv Square/Linear Footage of Work: Type of Work: ❑Address f ❑Alteration O ,, New 'R pair/Replace ODemolition g� �p Description of Work: (0041 (q f kLe E ?4 2 i CJLT a//d 0. el dD k It:.6 ax **** ********* ****** ***** Fees***** ***** *** ***** ****** ***x: ******a:*** ** **** Submittal Fee $ 7 )- OO Permit Fee $ ifiR/-9 a CCF $ CO /CC $ Pa Scanning Fee $ is Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ 10 r � 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 Aln:AVIT: 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 insp .n w ich occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will n.' ap % `oved and a reinspection fee will be charged. Signature 1 / Signature wner or Agent Contractor The foregoing s ; ent was acknowledged before me this The foregoing instrument was acknowledged before me this 0/ day of %wSl° , 201'?! by liar 1 f 054.1e.3" , day of og'-- , 20 t'2, by .40V- C&c , who is personally known to me or who has prod As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commission Expires: fr �t� CIA V. CUBILLOS . ublic - State of Florida Expires Sep 23, 2015 who is personally kn wn to me or who has produced as identification and who did take an oath. NOTARY P > c LIC: Commission # EE 128810 Sign: Print: A`-eY /l�d,✓�''y e Bonded Through National Notary Assn. My Commission Expires: w e.G.L 1(- /G APPROVED B Plans Examiner NAB '70 MT ION 0ETI39072 EXPIRES: !mum 11, 2W Zoning Structural Review Clerk (Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09) EX MIAMI -DADE COUNTY TAX COLLECTOR 140 W. FLAGLER ST. 1st FLOOR MIAMI, FL 33130 2011 LOCAL BUSINESS TAX RECEIPT 2012 MIAMI -DADE COUNTY - STATE OF FLORIDA EXPIRES SEPT. 30, 2012 MUST BE DISPLAYED AT PLACE OF BUSINESS PURSUANT TO COUNTY CODE CHAPTER 8A - ART. 9 & 10 FIRST -CLASS U.S. POSTAGE PAID MIAMI, FL PERMIT NO. 231 692058-2 THIS ISNOT ABILL - DO NOT PAY NEW BUSINESS NAME / LOCATION RECEIPT NO. 719666-0 NAVARRO PLUMBING & MECHANICAL STATE# EEC130049,18 CONTRACTORS INC 15076 SW 20 LA 33185 UNIN DADE COUNTY OWNER NAVARRO PLUMG & MECH CONTRS INC Sec. T e usis 1 9�g ELECTRICAL THIS IS ONLY A LOCAL BUSINESS TAX RECEIPT. IT DOES NOT PERMIT THE HOLDER TO VIOLATE ANY EXISTING REGULATORY OR ZONING LAWS OF THE COUNTY OR CITIES. NOR DOES IT EXEMPT THE HOLDER FROM ANY OTHER PERMIT OR LICENSE REQUIRED BY LAW. THIS 1S NOT A CERTIFICATION OF THE HOLDER'S QUALIFICA- TIONS. =mum. M1AM1 -DADS COUNTY TAX COLLECTOR 01/03/2012 02290014001 000075.00 CONTRACTOR WORKER /S 1 DO NOT FORWARD NAVARRO PLUMBING & MECHANICAL CONTRACTORS INC DENEY NAVARRO PRES PO BOX 226288 MIAMI FL 33222 1 11 ti 11 1 1 ..21 Aug, 29. 2012 2:56PM FLORIDA BANKERS INSURANCE No. 8274 P. 1/1 A_. CERTIFICATE OF LIABILITY INSURANCE DATE 0829/120 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: Uthe certificate holder is an ADDITIONAL INSURED, the policypes) 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 Florida Bankers Insurance 7278 SW 8 Street Miami, FL 33144 Phone (305)266 -6493 Fax (305)262-0679 CONTACT NAME: MARTA ALONSO PHONE FAX (A/C, No, Extl: (305) 266 -6493- (A/c, No): (305) 262 -0679 E-MAIL ADDRESS: marts @florldabankersinsurance.COm PRODUCER CUSTOMER ID #: INSURERS) AFFORDING COVERAGE NAIC # INSURED NAVARRO PLUMBING & MECHANICAL CONTRACTORS, INC PO Box 226288 MIAMI, FL 33222- (305) 244 -5832 INSURER A: ATLANTIC SPECIALTY MAX 011601003995 INSURER B: 10/06/2012 INSURER C : $ 1,000.000.00 INSURER D : $ 100.000.00 INSURER E : MED EXP (Any one person) INSURER F : PERSONAL & ADV INJURY CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFYTHAT 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 MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BYTHE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ��ggR�EXCLUSIONS L1R TYPE OF INSURANCE ADDLISUBR INSR WVD POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MM/DD/YYYY) LIMITS A GENERAL LIABILITY V COMMERCIAL GENERAL LIABILITY N N MAX 011601003995 10/06/2011 10/06/2012 EACH OCCURRENCE $ 1,000.000.00 DAMAGt 10 REN1tD PREMSES (Ea occurrence) $ 100.000.00 ❑ ❑ CLAIMS -MADE a OCCUR ❑ MED EXP (Any one person) $ 5,000.00 PERSONAL & ADV INJURY $ 1,000.000.00 ❑ GENERAL AGGREGATE $ 1,000.000.00 GEN'L AGGREGATE LIMIT APPLIES PER: 0 POLICY • JECT • LOC PRODUCTS - COMP /OP AGG $ 1,000.000.00 AUTOMOBILE LIABILITY ❑ ANY AUTO ❑BODILY ALL OWNED AUTOS COMBINED SINGLE LIMIT (Ea accident) $ INJURY (Per person) $ BODILY INJURY (Per accident) $ • SCHEDULED AUTOS ❑ HIRED AUTOS ❑ NON -OWNED AUTOS ❑ PROPERTY DAMAGE (Per accident) $ $ $ ❑ UMBRELLA LIAB ❑ OCCUR ❑ EXCESS LIAB ❑ CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ • DEDUCTIBLE ❑ RtILNITION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/ N N / A — WC STATU- I OT}i I I TORY LIMITS 1 ER ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? I E.L. EACH ACCIDENT $ (Mandatory in NH) If yes, describe uncle DESCRIPTION OF OPERATIONS below E.L. DISEASE- EA EMPLOYEE $ E.L. DISEASE- POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) r=15- mew..,C u�, wow ANCELLATION MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2nd AVE MIAMI SHORES, FL 33138 fax305- 756 -8972 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25 (2009/09) OF © 1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD From: 09/01/2012 02:35 #036 P.001/001 AHCIC'Sitit, CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) '....__ _ ..__---- __.........••_w- ......� 08/31/12 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) 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 Accurate 8300 West Flagler Suite 114 Miami, FL 33144 Phone (305)226 -8727 Fax (305)226 -8767 INSURED Navarro Plumbing & Mechanical Contractors Inc P.O. Box 226288 Miami, FL 33222 -6288 CONTACT __ -..- .........— _ ..._ —..... .... _ -- N�A#pME; .. Lucia Estrella — _ -.__ _ ............ �.,r .._•_ -- �PAlC Na, �)- (305) 226 -8727- oj: (305) 226 -8767 'L Iuclaesfrelia bellsouth net _ PRODU_�s:......___ . - - -.... ;..._...._._._.: _ PRODUCER _^ _US _QMER M-# INSURERMAPFORDING COVERAGE NAIL # INSURER A; Ascendant Insurance Co. 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. R-II TYPE OF INSURANCE .114.48 yyyp POLICY NUMBER (M�q(D�p/YY % Q iMM/pprYYYy� _ UMITS _ GENERAL UAB�ITY EACH OCCURRENCE ; $ — — ❑ COMMERCIAL GENERAL LIABILITY i OAMAGE'7'0 RENTED— — — i ! I P,(tSMLSEE,g9 r(ence) $ ❑ (:=1 CLAIMS -MADE ❑ OCCUR } . ! MED EXP (Any one person) ; $ ; AI PERSONAL & ADV INJURY $ ❑ .GENERAL AGGREGATE ; $ —_ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGO $ ❑ POLICY ❑ PJECT ❑ LOC . • AUTOMOBILE UABIUTY COMBINED SINGLE LIMIT- — (Ea accident) 1 $ ❑ ANY AUTO -- -- ❑ parson) BODILY INJURY (Par . $ , —__ .__ T ALLOWNEDAUTOS . _ BODILY INJURY (Per accident) $ 1 PROPERTY DAMAGE ❑ SCHEDULED AUTOS ❑ HIRED AUTOS ❑ NON -OWNED AUTOS ❑ UMBRELLA LIAR ❑ OCCUR ❑ EXCESS MB ❑ C1AJMS_MADE _• ❑ DEDUCTIBLE ._ RETENTI.[V _..$_...— — a ' WORKERS COMPENSATION AND EMPLOYERS' UABIUTY A : ANY PROPRIETOR/PARTNER/EXECUTIVEY / ; 000278478 OFFICER/MEMBER EXCLUDED? Y ; N /A (Mandatory in NH) tf yes describe under DESCRIPTION OF OPERATIONS beIow • (Per accident) $ $ • $ • • a EACH OCCURRENCE $ L AGGREGATE WCSTATU- ..._.. 0T - � T- Q8Y.LIMLTS . 03/20/2012 03/20/2013 E.L —EACH ACCIDENT _ $ 100,000 DISEASE - EA EMPLOYEE $ -- 100_000 EL; DISEASE - POLICY LIMIT $ 500,000' F• ...• ... ._.... ._...._.......- -..... ___- DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES {Attach ACORD 101, Additional Remarks Schedule, if more space Is required) CERTIFICATE HOLDER Village of Miami Shores 10050 NE 2nd Ave North Miami, FL 305 -756 -8972 ACORD 26 (2009/09) QF The ACORD name and logo are registered marks of ACORD CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED :• THE EXPIRATION DATE THEREO •TI ' ACCORDANCE WITH THE PO �- i". • AUTHORIZED REPRESENTATIY ' Lucia Estrella ��_ LICIES BE CANCELLED BEFORE LL BE DELIVERED IN s. © 1988-2009 ACORD CORPORATION. All rights reserved.