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CC-12-438Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 nspection Number: INSP - 185148 Permit Number: CC- 3- 12-438 Inspection Date: February 07, 2013 Inspector: Bruhn, Norman Owner: MILITANA, JOHN Job Address: 8945 BISCAYNE Boulevard Miami Shores, FL Project: <NONE> Contractor: ACE CONSTRUCTION Permit Type: Commercial Construction Inspection Type: Final Building Work Classification: New Phone Number Parcel Number 1132060110140 Phone: (305)892 -8453 Building Department Comments CHIP OUT CRACKED, FALLING STUCCO ON PARAPIT REPLACE PLYWOOD, AS NEEDED APPLY NEW STUCCO. Infractlo Passed Comments INSPECTOR COMMENTS True Passed Inspector Comments CREATED AS REINSPECTION FOR INSP- 184983. CREATED AS REINSPECTION FOR INSP - 183479. CREATED AS REINSPECTION FOR INSP- 183253. CREATED AS REINSPECTION FOR INSP - 171077. Work covered withou framing, sheathing, and wire lathe inspections. Post permit and plans on site. N Permit and plans must be posted. NB Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled re- inspection fee is paid. until For Inspections please call: (305)7624949 February 08, 2013 Page 1 of 1 November 16, 2012 Norman Bruhn Building Official/Director Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138 Re: Permit No. CC -3 -12 -438 Dear Mr. Bruhn: The undersigned as architect prepared the South elevation, parapet detail replacing deteriorated lathe and plaster on the above captioned permit. I have inspected the installation of the wire lathe and determined it meets all code requirements. Sincerely, Ramon F. Camayd, R.A. 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 Permit No(V) 19 Master Permit No. BUILDING PERMIT APPLICATION FBC 20 Permit Type. .1 UILDING ROOFING OWNER: Name (Fee Simple Titleholder): Tt \111 r 1 rGtc G Phone #: 2t6- Z 15 - 6-3q p Address: UO '7 N 5 UAW.) Qj J A City: (°r\ l \ State: F L Zip: 3? l ?' Tenant/Lessee Name: Phone #: Email: JOB ADDRESS: 53 ci` 15 CG4 no ;iv G City: Miami Shores County: Miami Dade Zip: 331 g Folio/Parcel #: 11- '20(3— bl \— O l y Is the Building Historically Designated: Yes NO X Flood Zone: CONTRACTOR: Company Name: I ci C C or15-\ t v[ i o tv Phone #: 'i 0 5- ? Q - 3 9 5 3 Address: \ 19 So v\re Si N X 14 ■i 0 y City: V\ kcAm s (State: F L" Zip: 33) (n I Qualifier Name: P\ an C @ P -N Phone#: '3 05 -s GI -V4 53 State Certification or Registration #: C GC l5\ ( 013 GI Certificate of Competency #: a\GoZbviIthiGce.COrn Phone #: 305-1,77A s � S Contact Phone#: 3 a S- iS a - 5 3 Email Address: DESIGNER: Architect/Engineer: . cc Value of Work for this Permit: $ Z )ZS 0 a o Square/Linear Footage of Work: 2 6 5V-1- Tr + Type of Work: ❑Addition ❑Alteration New Repair/Replace ❑Demolition Description of Work: 0,,,, 9 0 j k c r (0.-e c) - ( Cn \\ x n(,) S-A u C (o o r• Q c G p i l' RRptCAce. Q1.iwo0A a5 nee6e6. RL'Pti r\fvJ 5- -\ dcco• C (S 9' i Arch -LA ec,-\- s Pic-Irl - **** **** *** * ***+x** **** ** ******** * ** *Fees 1 * *** * * * ** *************** * * *** ** **** ***** Submittal Fee $ Permit Fee $ C/c9 CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ F b /bo Technology Fee $ 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 AN'Fl)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 $2500, the applicant must promise in good faith that a copy the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to atta c ent. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which t' ccu seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approves an ii a reinspection fee will be charged. Signature 11 Signature Owner o The foregoing instrument,was ' ledged before me this q Contractor y t The foregoing instrument was acknowledged before me this 9 day of (V\ VCV' ,20 j,b,' .fit kN rIC, C.c..tn, day of M ! ,2012,by / Cit. Ege(- , who is personally known to me or who has produced vQi SanOk \ )1 who is personally known to me or who has produced (*)$ (-Swn A \` I kc. ow rJ As identification and who did take an oath. k I\o. rJ as identification and who did take an oath. NOTARY PUBLIC: Sign: (\45k Cis Print: C'QS (x( CbUraZ.a My Commission Expires: C (� �^ NOTARY PUBLIC: cPs&r ommission Expires: * * * * * * * * * * * * * ** * * * * * * * * * * * * * ** APPROVED BY ,4µ}r ?r''•. C.FSAI2 A COLLAZCSigi 1. • =q °,• �":= MY COMMISSION # DD96914r •�:`;ie;e� EXPIRES May 21, 2014 My FloridallotarySe�.com y Plans Examiner Structural Review (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) ,11; I+`: ss Win (ov) CA1'tROZ 6Z Atm S3NIdX3 IOW # NOISSIWWOO AW :«.�� Zoning Clerk rtl lami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 7952204 Fax: (305) 756.8972 CONTRACTORS' REGISTRATION FORM ALL CONTRACTORS MUST PROVIDE COPIES OF LICENCES AND INSURANCES EACH TIME A PERMIT IS SUBMITTED OR THE VILLAGE MAY MAINTAIN A FILE WITH YOUR INFORMATION FOR A $30.00 FEE PER YEAR IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: A. f COPY OF QUALIFIER'S STATE LIC CARD B. -J COPY OF LOCAL BUSINESS TAX RECEIPT C. J COPY OF LIABILITY INSURANCE (CERTIFICATE HOLDER TO BE MIAMI SHORES VILLAGE BLDG DEPT) D. COPY OF WORKERS COMPENSATION (EITHER CERTIFICATE OR EXCEMPTION) IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY: A. COPY OF CERTIFICE OF COMPETENCY OF QUALIFIER B. COPY OF MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT C. COPY OF LIABILITY INSURACE (CERTIFICATE HOLDER MUST BE MIAMI SHORES VILLAGE BLDG DEPT) D. COPY OF WORKER COMP INSURANCE (EITHER CERTIFICATE OR EXEMPTION) YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE HOLDER AS FOLLOW: MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES, FL 33138 COMPLETE CONTRACTOR'S INFORMATION BUSINESS NAME: A C S Cry n S k c t 11 BUSINESS ADDRESS: 1 \'150 NQs+ (t 9. Hr CITY (' yarn t STATE F L ZIP CODE BUSINESS PHONE: (3bS ) 5393-43 453 FAX NUMBER ( 305 ) Y°t3 - c q tog CELL PHONE (305 ) TV 53 -5cl a C QUALIFIER'S NAME: A W.\ E y( QUALIFIER'S LIC NUMBER: CG C \51k a39 E -MAIL ADDRESS (IF APPLICABLE): G`�an r O U i 44)1/4.1 ctc o C 0 PA Created on 3119109 BY MLDV 1 RV 3126109 MLDV °ATE BATCH NUMBER SEE OTHER SIDE DO NOT FORWARD ACE CONSTRUCTION ALAN SCOTT EGERT PRES 11950 W DIXIE HWY MIAMI FL 33161 18 ACORD.. CERTIFICATE OF LIABILITY INSURANCE CERTIFICATE NO. / DATE AC11- 1501388 - 1028426 07/32/2031 01.23 Ply OF INFORMATION CERTIFICATE EXTEND OR PRODUCER 8lghpoint Risk services LLC 5501 LBJ FREEWAY, SIIITS 1200 Dallas, TX 75240 (800) 728 -0623 (972) 404 -0380 THIS CERTIFICATE IS ISSUED AS A MATTER ONLY AND CONFERS NO RIGHTS UPON THE HOLDER. THIS CERTIFICATE DOES NOT AMEND, INSURERS AFFORDING COVERAGE INSURED: Ants l /c /f: EGERT CONSTRUCTION INC., DBA ACE CONSTRUCTION 11950 WEST DIXIE HIGHWAY MIAMI, FL 33161 (305) 892 -8453 Fax: (305) 892 -9968 INSURERA: Companion Property and Casualty Insurance C INSURERS: Companion Property and Casualty Insurance C INSURER C: AMERICAN ZURICH INSURANCE COMPANY INSURER D: 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 POUCIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE UNITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR 3 TR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE nitro (MMR1nNV), POUCY EXPIRATION nATF (MMInnIVV) LIMITS A GENERAL X UABILITY COMMERCIAL GENERAL LIABILITY ICLAIMS MADE X OCCUR FLG4080762 07/09/2011 07/09/2012 EACH OCCURRENCE $ 1000000 FIRE DAMAGE (Any One Fire) $ 100000 MED EXP (My one person) $ 5 0 0 0 PERSONAL&ADV INJURY $ 1000000 GENERAL AGGREGATE $ 2000000 �GENT AGGREGATE LIMIT APPLIES PER: $ I POLICY n? a nLoC PRODUCTS - COMP/OP AGG $ 2000000 AUTOMOBILE — — — — LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS COMBINED SINGLE LIMIT (Ea accident) BODILY INJURY (Per person) $ BODILY INURY (Per accident) $ PROPERTYDAMAGE (Per accident) $ GARAGE UABILITY ANY AUTO AUTO ONLY -EA ACCIDENT $ OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS LIABILITY OCCUR ❑ CLAIMS MADE EACH OCCURRENCE $ AGGREGATE $ $ DEDUCIBLE RETENTION $ $ $ B WORKERS COMPENSATION AND EMPLOYERS' WC362727400 04/01/2011 04/01/2012 X 1 ACRMATV-r-st 1 Kr E.L EACH ACCIDENT $ 1000000 E.L DISEASE- EA EMPLOYEE $ 1000000 E.L DISEASE - POLICY LIMIT $ 1000000 C OTHER w Scheduled Equipme EC68544214 04/29/2011 04/29/2012 Limns Eauinment $ 31390 LIMBS $ 0 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS 1. This certificate remains in effect, provided the client's account is in good standing with AMS. Coverage is not provided for any employee for which the client is not reporting wages to AMS. Applies to 100e of the employees of AMS leased to EGERT CONSTRUCTION INC., DBA ACE CONSTRUCTION, i effective 04/01/2011 2. Insured is afforded Workers Compensation & Employers liability as a co- employer under the policy for employees leased from AMS. CERTIFICATE HOLDER ADDITIONAL NSURED; NSURER LETTER: THE CITY OF MIAMI SHORES 10050 N.E. 2ND AVE. MIAMI SHORES, FL 33138 CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FALURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 254 (7/97) © ACORD CORPORATION 1988 RAMON F. CAMAYD, R.A. ARCHITECT . ROOF DESIGN. INSPECTOR' -p a! .r de lee-/o i^ctte. d _ 4x114 :5 7 /- 8030 SW 99 AVENUE, MIAMI, FLORIDA 33173 Telephone (305) 598 -5399 • Mvtiami Shores Village g Building Department 10050 N,E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fox; (305) 756.8972 Permit No. ' -3 'a Job Name 4 h� Date F�, /�Z STRUCTURAL CRITIQUE SHEET RANION F. CAMAYD, R.A. cci 12- zd ARCHITECT . ROOF DESIGN. INSPECTOR SUBJECT 10 CCNIPUUANCE WI rH ALL FEDERAL STATE ANU Cr LJN .( -1LLES AND REGULATIONS ,Agiviac_e_dekey'o ride d 1.4214 ,iptiof te 8030 SW 99 AVENUE, MIAMI, FIORIDA 33173 Telephone (305) 598-5399 44. r • T 71.G_ 4 ,4.77 t I W Poi. \1 fro : 6g -h !p' !' xis PAVCA PA2kiN+i,, /o' AQzt4 V)' ZDNE SSY• c$4 -- CoHM L i5 t. O6. a.54.5 -- .3,9s .- &44.40fry 14 E. 1310, MIAMI 514,02 at 0.3'1 UTIL +Ty SHED (ENC12) P. 4.24 p,eop uv,E G3• ea2 t 6.8�' 20 � E_. (es for ra •1 MAtt' ov 4440 AUG /02/2012/THU 11:52 AM Ace Construction FAX No, 3058929968 P. 001/001 CERTIFICATE OF LIABILITY INSURANCE CONFERS NO RIGHTS UPON THE CERTIFICATE OR ALTER THE COVERAGE AFFORDED BY THE BETWEEN THE ISSUING INSURER(S), AUTHORIZED DATE lanlwnrrnq 03,27/2012 11:00 PM HOLDER. THIS POLICIES BELOW. REPRESENTATIVE THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT • = Ii: • ' - :. D THE CERTIFLCATE HOLDER. IMPORT • • Nth* coricate 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 dues not confer rights to the certificate holder in Lieu of such endorsement(s). PRODUCER >3ishvolat $(iek Services LLC 5510 x.Ba Freeway, Smite 1200 Dallas, TX 75240 DIOm Apsii - IN, NP, e* (gyp)7aa -oan3 lent Wa.an (972)404.0380 satn�a,oW= ' - - INSURERS AFFORDING COVERAGE 54155 INSURER A,Compafin`t Yoopasby ana annul by ffi•uraaon enamay 12157 INSU •� .: AMS 1 /C /f i EOM CONSTRUCTION INC., DBA ACS CONaTRssr'Yos 11950 WEST =axe 15TG$WAY MANX, SI. 337.61 Phones 1305) 892 -8453 Fax (305) 892 -9968 INSURER EkI npenioa AsOaOOty aaa COaualty Laausaaoa Company FS.G ®080762 IN$URRR O:A"ZU1Oirl SUUD, LYMANC= t1Li,A9y 07/09/2012 INSURER 0: 5 1000000 INSURER E: 5 7,00000 INSURER F: I CLAIMBMADE x COCU1 AC12- 1501388- 7.08941.5 • THIS IS TO NOTWITHSTANDING PERTAIN, MAY)-IAYE CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAME AI30Ve FOR T14 POLICY PERIOD INDICATgI. ANY REQUIREMENT, TERM OR '0 NDIYtON QF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY THe INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN 6EEN RDOUCEp 9YRAI J1 AIM MP TYPE OF IN8URANCE �APM t� POLICY NUMBER POLICY EPF HAT, IMM/fDiYYI POLICY EXP DATE IMM,Dfltrn LIMITS GENERAL K LIABILITY COMMERCIA6GENERAL LIABILITY FS.G ®080762 07/09/2011 07/09/2012 FACHOCCURRENC2 5 1000000 {Enemmrmes a 5 7,00000 I CLAIMBMADE x COCU1 MOD tl(P(MI=ena all $ 5000 PERSONALS ADVINJURY $ 1000000 GENERAL AGGREGATE $ 2000000 0— �t AGGREGATE LIMIT APPI'ESPER: 7C {'auoY PRO- JECT LOC PRODUCTS - COMPIOPAGG I 2000000 $ AUTOMOBILE ]ANYAUTD _ALL _ _ LIABILITY OWNBC AUTOS SCHEDULED AUTOS HIR$P AUTOS NON -OWNED AUTOS ❑ CCMaiNEOSSIGLHLIMIT (Ea amlmnq 5 SOD ELY INJURY (Per pera00) $ BODILY IrouRY {Per aOmEem1 I PROPERTY DAMAGE (Peraath snq 5 5 5 — UMBRt UAE HCLA MS -MAOB MOOR LIAR OCCUR ❑ ,,..y IL_II EACH OCCURRENCE 5 _ AGGREGATE $ r EDUOTISLE RETENTION 5 5 $ B WOQKFl5B COMPb laSATION AND SIYIPLOYE Rs LIABILITY YIN ANY PROPEFUEtORA7cSCUTNE (DFFICd�EaStJO�mEMBEREXCLUDE7A H end tosErl undm SPECIAL PROVISIONbeIOW l�A n) 52627274 04/01/2012 04/01/2013 WW ppTTUU.... X TGRY %IMIT.c I ° '' , EL EACH ACCIDENT 5 1000000 LL DISEASE -FA EMPLOYEE $ 1000000 LL DISEASE. POLICY Lean' $ 1000000 C Scheduled Equi E068544214 4/29/2011 4/29/2012 EquiPxnent 31390 4$$CRIPYWN OPOPKRATIONS /LOCAYbNIlI'VEHICL55(Atta00eY ACORD101 AOAUronal Ro1,Nrks 8otedula, II Duna spars is pagelrnt 1. Thia certificate i oiin. vefgee rsovjded ien 's account is in od atan wi AML. wilarint:i r°� aSBeB oi_ leg°eed the 8� 5 i. IEiltI>�SP°� Argils !$ o 00-em}? Oyez /7 the obi 2511-41: ees ci o k rB nation A Mu:id:Vera nab ty as a ' 'policy EDP y leased troy: A . ae OT, letw A•rm uwr wow • - - CITY D P NiAMI SHORES NYANx Maims saYr.bzss DEFT . 10050 N.E. ',End ASS,. NXX4 SNORES. FL 33138 At nR)7 75 12arolns► SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILLIE DEUVIRSO IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHOR® REPREBENTATNE= .r+—'` ..- • _ -- a 2010 ACClRD CORPORATJON. Ali rlght reserved $.� 12 A1�Pn_ 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 ECEIVE J10. 3J FBC 2010 Permit No. PERMIT APPLICATION Master Permit No. - 3 - t z - V3 r Permit Type: BUILDING JOB ADDRESS: g D t g t 5 c Gore, G l J a ROOFING City: Miami Shores County: Miami Dade Zip: 3 S1 - Folio/Parcel #: i\- 3 2 o b- O Z 3- Is the Building Historically Designated: Yes NO iC Flood Zone: OWNER: Name (Fee Simple Titleholder): -3 Oh r. M t I � t Gkll Phone #: 3bS - 2 15- QZ a q Address: �� 01 `715 np 7 (v A City: Nl \ c/1V1q. t State: FC Zip: 3 313 Tenant/Lessee Name: Phone #: Email: CONTRACTOR: Company Name: A G t C l u C t on Phone #: 3 05- SSG a- '`)S-.3 Address: 1 I e1So \f‘r t Xe e w -( City: M 1.001 -1 State: (- Qualifier Name: A, (An Q (-4 State Certification or Registration #: C ('C 1511 x361 Certificate of Competency #: Contact Phone#: • DESIGNER: Architect/Engineer: Phone #: Zip: 3 3)1.1 `' Phone #: 2i fl y° 8 q- �'t S 3 Email Address: \c,AtZ boittbyare, co Value of Work for this Permit: $ i b ohs P Square/Linear Footage of Work: Type of Work: UAddition DAlteration UNew L3Repair/Replace molition Description of Work: Color thru tile: Submittal Fee $ Permit Fee $ / CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ _ Training/Education Fee $ Technology Fee $ Structural Review $ TOTAL FEE NOW DUE $ 155 TH( ) Bonding Company's Nagle (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 A11 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 o - tice of commencement and construction lien law brochure will be delivered to the person whose property is subject for the first inspection inspection will not be lso, a certified copy of the recorded notice of commencement must be po ted at the job site en (7) days after the building permit is issued. In the absence of s- Este' notice, the einspection fee will . ' charged. Signature Contractor The foregoing ins ent was acknowledged before me this OS- The foregoing instrument was acknowledged before me this a S day of Juf ,20tZ ,by lour` P\L 1 *u/`A who i ersonally kno J me or who has produced who is ersonall known to or who has produced As identification and who did take an oath. as identification and who did take an oath. NOTARY PUBLIC: , day of 3,-)1 , 20 tZ , by A. t oi.n A Se , NOTARY PUBLIC: Sign: Print: ,e:ki , CESAR A COLLAZO A, 7. MY COMMISSION # D0969877 Sign: %! EXPIRES May 21, 2014 P ("O.( o (� �t Z,� �St„ Print: (auoduo -0193 .luuAuu My Commission Expires: My Commission Expires: 51 a' (aoty es ( I CESAR A COLLAZO r�[ o. _ MY COMMISSION # DD969677 ' c' EXPIRES any zi, 2014 Ice.00rn ***************************************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** APPROVED BY V Y1..•1 - Plans Examiner Zoning Structural Review Clerk (Revised 3 /12/2012)(Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY) 03/27/2012 11:08 PM 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 cerflcate 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 Ileu of such endorsement(s). PRODUCER Highpoint Risk Services LLC 5510 LBJ Freeway, Suite 1200 Dallas, TX 75240 COMTACTNAMM Puose NO.rb.ad): (800)728-0623 Ine WC. rwp(972)404 -0380 RAWL amRESx INSURERS AFFORDINOCOVERAGE NAIOIt INSURER A: COmpmioa Property and casualty Insurance Company 12157 INSURED: may, 1 /c /f : EGERT CONSTRUCTION INC., DBA ACE CONSTRUCTION 11950 WEST DIXIE HIGHWAY MIAMI, FL 33161 Phone: (305) 892 -8453 Fax: (305) 892 -9968 INSURER B' Co mP mioa Pro perty and Casualty Insurance Company 12157 NSURER C:"MERICnN ZURICH IRanReNCe COMPANY 07/09/2011 JNSURER D: EACH OCCURRENCE INSURER E: DAMAGE TO RENTED PREMISES Ma occonence) INSURER F: ' CLAIMS MADE CERTIFICATE NUMBER: AC12- 1501388- 1089415 ION NUMBER: THIS IS TO CERTIFY THAT THE POUCIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAME 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 POUCIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMBS SHOWN MAX HAVF RFFN REDI ICFI RY PAID C1 AIMS INSR TYPE OF INSURANCE AooL sum POLICY NUMBER POLICY EFF DATE(MM/DDIYYI POLICY EXP DATEIMM/DD/YY) LIMITS A GENERAL X UABIUTY COMMERCIAL GENERAL LIABILITY X OCCUR ❑ ❑ FLG4080762 07/09/2011 07/09/2012 EACH OCCURRENCE $ 1000000 $ 100000 DAMAGE TO RENTED PREMISES Ma occonence) ' CLAIMS MADE MED EXP (Any one person) $ 5 00 0 PERSONAL&ADV INJURY $ 1000000. GENERAL AGGREGATE $ 2000000 GEM. AGGREGATE LIMIT APPLIES PER: POLICY El TN, n LOC PRODUCTS - COMP/OP AGG $ 2000000 $ AUTOMOBILE — LIABILITY ANY AUTO AU. OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS ❑ COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ UMBRELLA UAB EXCESS LIAB �g -MODE OCCUR ❑ 0 EACH OCCURRENCE $ AGGREGATE $ DEDUCTIBLE RETENTION $ $ $ g WORKERS COMPENSATION EMPLOYERS' UABIUTY ANY PROPERIETORIEXECUTNE OFFICER.MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under SPECIAL. PROVISION below AND YM N/A 0 DPE2627274 04/01/2012 04/01/2013 X I Twc STATU- 1 I DM/- E.L. EACH ACCIDENT $ 1000000 in E.L. DISEASE -EA EMPLOYEE $ 1000000 E.L. DISEASE - POLICY LIMIT $ 1000000 c Scheduled Equi ❑ ❑ EC68544214 4/29/2011 4/29/2012 Equipment 31390 DESCRIPTION OF OPERATIONSILOCATIONSNEHILES (Attached ACORD101, Additional Remarks Schedule, it more space Is required 1. This certificate remains in effect, ro ided the c ien 's ac ount is in cod standin with AMS. cov zags is $ ov de f ran a o or whit t nt of or pv1� p S et)Plieq to 1I0i § Ale gmp!ovee8 o ik .e$saddNttokirs m ens tion�& Emplby rsgli4 lab S>vVt d9 a10N, e act ve 04 1/ 1 n cuared is a for g pp co- employer under t e policy for employees leasedd from AMS. CERTIFICATE HOLDER CANCELLATION MI OF OIESI SHORES MIAMI I SHORES BUILDING DEPT. 10050 N.E. 2nd AVE. MIAMI SHORES, FL 33138 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHOREFD REPRESENTATIVE-'1/4 0 © 1988-2010 ACORD CORPORATION. All right reserved RAMON F. CAMAYD, ARCHITECT • ROOF DESIGN. INSPECTOR .62440101,41 r4.0 ertor,7404EAdC. Miami hores Village APPROVED 13V DATE ZONING DEPT BLDG DEPT SUBJECT TO COMPUANCE WITH ALL FEDERAL STATE AND COL I TY RULES AND REGULATIONS niembef--.6 01- ZidelAelti ‘AA/6- 014 eaeh 514/e" .14ditilher-fi .yep"174,1e:*. h "orii4/e _awed/ 6,6,t4,/de ..,edoweyeat tet,4t 99 AVENUE, MIAMI, FLIMIDA 33173 Tekplione (305)590-5399 24:14/ J. 6.z-21'2,(7'w. a74.771 LLJ 0 Si cff AE612," lori0-410) ettfie).4/40 . FOIE .‹) 01/ a ,,,,, v ‘64 A i v ..? A UV /7 ,4 6,9 , 41 / sy r9 - NO • P4vep ra2ki4G1 &tee4 a., ONE. STY. CS'S: Comp-4 tat.. Oa .81.9,4S igeSS0 alegoeosy E. Mif-fl S)-6,Ze61 FLA. 40-1 ovu '44 . .)%11 UTIL4rY SPIED (ENCa) y el 4 eA NM, 110•1=011. Zc 4. 51 riAtte 4•1341.1- 1.10 .2tou4V. MAR/23/2012/FRI 12:27 PM Ace Construction AC#. 498840 FAX No, 3058929968 P. 001 .•• • 2., • . ST TE O�RiDA • _• _ . •:. s ...EV3H SSE:M4;:PaGEMigiV, COlISTRIMTION• eagnaulo-i• 7. • ..... • , , • • ., . zaasasolia‘s • •-• •••• ...'......"Ftr.;„':',•:•:'•••• '•"•— •rr:"'-' 4," •t• •.• •• • .... , . • ••• • • ..4., ••• . •,..........- ..,,.. . -.. ••:.-::,. :,.....• ••:• :-••• .: • • :: •-•• • , -4-"•.:-..:...:',...:■..."-'`,,::::. ' ':-:;.7 IL,' .::• •-•• • .:1:4.,::•.: DATE EATCH NUMBER • ^ .7-••••". • " • • • Li. • . .• • ••• .1..!:•■•• , • • I ••:- • .8.....*1.,„}t.-4 - • • -0•Trt. :Ri;•%Va., : $011:=Migi..;.X.TaiRCB.0:07 . . mini. - lotb„.gt..z..7:?2.7.• • • ..",•;„.-,:•........-, ...,.-tri•-::--.: .-.:•:•:: • ...: ,... 4.•.r., 4•47:de•%7,_ 1-1P--,..,,fe".•• . • •• • •:47..--,Ttrin• s ..%; .: .:*; , .;:' . -* ell • '6i4.• .::t'':- • vu '''' •••.'0'-'-•** ' '''• • : :'• • • , • ;. • LI: : :‘3.••••, ' • • : . • . ;!I • .-. . Or,s."0.16AY.:6 : • 4.. ; •' - • .4 • • , • • • • • . • 3 • • ••• • .• : • ••. ••• :*** • • * • 7-z" • '.4;• **•.:1;" *1.'1:4; • ;Cpi • -' 7 SEE OTHER SIDE ,bxvk zir Agg *d.a. 00NOTFoRwAml ACE CONSTRUCTION ALAN SCOTT EGERT PRES 11950 W DIXIE HWY MIAIIX FL 33161 18 MAR /23/2012/FRI 12:28 PM Ace Construction FAX No, 3058929968 P, 002 ACORD, CERTIFICATE OF LIABILITY INSURANCE CERTIFICATEND DATE AC11- 1E6139S•10284 1028a2d iv,i,, 9! PRODUCER mist 33sit Services I,EC 5501 5501 z,g,T gR75 sT xr 1.209 Dalla6, T% 75240 349 (800) 72a -0623 (972) 404 -0380 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR - - INSURERS AFFORDING COVERAGE INSURED; Ams licit., sESRT =INSTRUCTION IMO., sea ACE CONSTRUCTION 11996 XE T DEBIE MGM''S IaYami, FL 33161 13051 892 -3453 Fax: (305: a t2- opg 3 — INSURER?4 Companion Pronertb and CaeualCV Insu.anrx C INSURER B: Companion Propert'r and Casualty Insurance �.. IN8URERC: AMERICAN ZURICH IN$!(T9ANCE COMPANY INSURER O: INSURER E: THE POLICIES OF INSURANC2 LISTEC BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE POR THE POLICY PERIOD INUICATEb. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OYHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY REISSUED OR MAY PERTAIN, THE INSIJRANCEAFFORDEO BY THE POLICIES DESCRIBED HENFIN IS SUBJECT T'O F uL THS TERMS, EXCLUSIONS AND CONDITIONS OF SUCH rD4oISSI. AGIORE0ATE LJM1TS SHOWN MAY HAVE RE N RBDUCED EY PAID a1.AIMS. NgR 7YPE of INBU fzAp10E POLICY NUMBER FLG4080782 POLICY EFFECTS dery lunmm�rvv�+ 97/09/2011 POLICY EXPIRATIO nnser 07%09/3013 V LIMITS BACH OCCURRENCE s 2000000 A 4 ERALLIABILITY 00MmsRCIAI.4ENEI�ALL1A8tLITY PI1g0IAMAGE(AnyOnaFira) 3 100000 CLAtmarkuDE rip OCCUR MEDEXP(Anyonsparaon) $ 5000 ■ PERSONAL &ADVINJURY S 1000000 -- GENERALADDREOATE s 2000000 OENLACy6RE4'A�TE LNITAPPues PER: ,( POLICY 1 ]0f n •OC PRODUCTS- COMPNOPALiM a 2000000 AUTOMOBILE ■ ■ ■ LIABILITY ANY AUTO ALL OWNED AUTOS SCHEbULEORUTOS HIRED AUTOS NI7N.OWNED AUTOS CO MBINEOSWOLSLIMIT SEA 84 1080 BODILY INJURY (Per parson) S BODILY erm -NOURY (Perm-NOM PROPERTY DAMAGE (Par acamen0 QARA ■ ©E LIA8ILITY ANY AUTO AUTO ONLV.EAACCIOENT 8 OTHER THAN EA ACC S AUTO ONLY: AGO 8 EXCE89 ■ INABILITY OCCUR OGLAHAS MADE EACH OCCURRENCE 8 ADGREOATE S $ og9VrngLLE �. RETENTION S 8 $ WORKERS COMPENSATION AND EMPLOYERSLUIBILITY _.— WC362727400 04/01/2011 04/0%/2012 We BTA1 J TH- , � �Fa 1 EA0H E,L, ACHACCIDENT s 1000000 e.L.DBEASE- 8A8MPLOYEE s 1000000 e.LOL4@aSE- POLICYUAIIT $ 1000000 C OTHER Schedulad ECtLLip Dte SC68544214 ----- 04/29/2011 ---� -- 04/29/2013 _ LIMITS Frrntrimenh S 31390 ■ LASTS 5 0 DESCRIPTION OF OPERATIDN5 7LOCATIONENEHICLE3IEXCLUBIONB ADDED BY SNOORS$M$NY SPECIAL PROVISIONS 1. This certificate remains in effect., provided the client's account is in good standin with AM$. Coverage is not provided for any emp3,oyes for which the client 13 not reporting wagem Ea AMS. A 1�lies ra 44,0% of the employees of AMS leased to EGZRT CONSTRUCTION INC., DBR ACE CONSTRUCTION, i eszec_ive 04/01:2011 2. Insured s afforded Workers Compensation a Employers liability as a co- employer under the policy for employees leased from AMR. CERTIFICATE_HDLDER 1 j ADDIT70NAL INSURED; MEURER THE QST'L OP N -*.1143 sous 10DED N.E. 211D AVE. NUKE SHORES, FL 33138 er_Cllah ,Sx_c /we:7A SHOULD ANY OF THE ABOVE DESCRIBED POLICIES SE CANCELLED BEFORE THE EXPIRATION DATE THEREOF. THE ISSUING INSURER WILL ENDEAVOR TO MAI. 3 0 DAYS WRITTNN FAILURE To THE CERTFICATE HOLDER NAMED TO THE LEFT, BUT FAIRE TO OO 90 SHALL IMPOSPI NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE MEURER. RS AGENTS OR REPR.EaENTATNSS. AUTHORREQ AtPASSI$?aTNe _� _ •�.�•e... ewE a >" 41 ACORD CORPORATION 1488