DEMO-11-1821Id 411 -c $(i1 i'
BUILDING
PERMIT APPLICATION
FBC 20
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 Type. UILDING--...,,,, ROOFING
OWNER: Name (Fee Simple Titleholder): r'-(3 X ' A- .� t lb Phone #:
Address: A \ 0 \C '0- . Fl_. C 8.1/4_ ��'c +g-i
Cityn ( (` - �Pl- State:
q`k-� ` ,
Tenant/Lessee Name: � v (� ��'�1 �l� � � d� k�` t1�'��') Phone#:
Email:
Permit No. 1 '
Master Permit No.
S
JOB ADDRESS: q"
City: Miami Shores County: Miami Dade Zip: `a 3 \ ■
Folio/Parcel #: ) \ - 3 .D- C.'' V, -- 0 \ 1 —G` 1 0
Is the Building Historically Designated: Yes NO Flood Zone:
-" mac' 1
CONTRACTOR: Company Name:.y', �� `' 1N Phone #:� ��
Address: D6.), Q N v:\,) . s'9 \° a <® ,c ,e,1
City: Ater s �`'.. State: 1,-- Zip: ��
Qualifier Name: 1 v QX Q (CC . (2Nrfitis\\ , Phone#: i - 0 4-k-kk le
State Certification or Registration #: L- C \:-'0 03'0 91-1 , Certificate of Competency #:
Contact Phone#: ° c1 33— l 913 5 Email Address: JMI
DESIGNER: Architect/Engineer: Phone #:
Value of Work for this Permit: $ ° C
Type of Work: DAddition ❑Alteration New ORepair eplace
Description of Work: 34^°N,`L= 1i `NCLk- Si���°
Square/Linear Footage of Work:
emolition
*** *r�x*, *�+, x+ x**********+ x+ x*****x:************ Fees * ***** *m a: *** **a: *a: **x :****+x****** ****+xx:* * **
Submittal Fee $ - tD Permit Fee $ /C, d CCF $ CO/CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $ Technology Fee $
Double Fee $ Structural Review $
TOTAL FEE NOW DUE $ 315 4(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 $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspect n which oc urs s den (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not app 'ved a � a re ,�' ection fee will be charged.
Signature t.r \\ Signature
/ M
Owner or Agent
The foregoing i f.trument was acknowledged efore m; this The fore
day of ' v' -'l17 , 201/ , by h , day of it
mg instru
tractor
ent was aacknow
,2011,by
ed before me
who is personally known to me or who has produced who is personally known to me or who has produced
As identification and who did take an oath. as identifi d who did take an oath.
NOTARY PUBLIC:
Sign : 'tea
Print: 7Z-J4 1I C r/
My Commission Expires: 01 , 7] Z01]`
ROSA RICARDO
Notary Public - State of Florida
•= My Comm. Expires Jan 12, 2014
oea Commission # nn 930272
t''''''''t'''' Bonded Through National Notai y Assn
+
NOTARY
Sign:
Print
LI
My Commission Expires:
*** x=> K+ s: x************** Aux: ****m x: *x• s x******* *> bx• *> k*** **> k+ x*+ x+ x* *********+x+x**** *+x+x*s ***
APPROVED BY
Plans Examiner
Structural Review
(Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09)
ROSEMARIE ANNE LANGLEY- WEBSTER
*E MY COMMISSION # DD882157
EXPIRES April 20, 2013
153
* > * * * * * * * * * * ** * * * *) * * * * * * * **
Zoning
Clerk
OCT 0 4 201
13Y .......: ...o
0 \t- -1`�•I
SUBJECT TO COMPLIANCE WITH ALL FEDERAL
STATE AND COUNTY RULES AND REGULATIONS
If
4
9543373805
AMERICAN DIGITAL DES
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PAGE 02/02
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1 d11.t''� �,'i$ � _ _ a �:s_9.�( v. •�� i r •1lt i.�.• °t�;, �1 •
• BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT
116 S. Andrews Ave., Rm. A -100, Et. Lauderdale, FL 33301 - 1895 -- 954_831 -4000
VALID OCTOBER 1,2011 THROUGH SEPTEMBER 30, 2012
DBA:
Business NameTAMER /CAN DIGITAL DESIGN INC
Owner Name: svEldkan B BROWN'
Business Location: 2951 NW se ST
FT LAUDERDAL$
Business Phone:
Rooms
Seats
Employees
3
Receipt #:181 -'3291
Business Type ;BLECrR.IC.AL /TAIUte/co A
(CERT ELECTRICAL CONTRA
Business Opened :03 /10/2008
S tate1Cou my /Ce rt/Reg; 8013 0 0 3 0 9 7
Exemption Code:N XEMPT
Machines
Professionals
THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS
This tax is levied for the Privilege of doing business within Broward County and is
non-regulatory in nature. You must meet all County and/or Municipality
end zoning requirements. This Business Tax Receipt must be transferred when
the business is sold, business name has changed or you have moved the
business focatfon. This receipt does not indicate that the business is legal or that
it Is In compliance with State or local laws and regulations.
THIS BECOMES A TAX RECBIPT
WHEN VAUDA'f ED
Mailing Address:
EVE ARD F3 BROWN
2951 NW 68 ST
FORT LAUDERDALE, FL
33309
2011 - 2012
Receipt #03B -1Q- 00008122
Paid 09/29/2011 27.00
02/01/2009 08:29
9543373805
AMERICAN DIGITAL DES
ACQRDW CERTIFICATE OF LIABILITY INSURANCE
PRODUCER
SO'UT'H FLORIDA CASUALTY
415 North 4th Street
Lantana, FL 33462
tom ) g
INSURED
American Digital Design,
Hvii°
2951 NW 68th Street
Ft. Lauderdale, FL 33309
124
CO ERA :33 '3' 35
Inc.
PAGE 01/02
DATE (MIWAA/YYY Y)
THIS CERTIFICATE IS ISSUEDAS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER 'THE COVERAGE. AFFORDED BY THE POLICIES BELOW
INSURERS AFFORDING COVERAGE
INSURER A: Maxum Specialty .Insurance Grou
ENSURER a: Southern Insurance Company
INSURER C Intros National Insurance C4
rNSURER
iN8URER E:
NAIL
1$653
19216
29742
THE POLICIES OF INSURANCE LISTEDBELOWHAVE SEEN Muff) TO THE INSURES/ NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NQtVNTHST'ANDING
AM' REQU?REMENi TERM OR CONDITION or MY CONTRACT OR oTHIN DOCUMENT NTH RESPECT TO WHICH THIS GER7il7CATE IIRY BE (BSUED OR
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLIcIESDESERIBED HEREIN ISSUB,IECT rOALLTHE TERMS, EXCLUSION AND CONOMONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
V/PEOF INSURANCE
GENERAL LJABR1TY
COMMERCIAL GENERAL LLA$ILITY
CLAIMS MADE bbl OCCUR
POLICY NUMBER
PR00045700 -02
01/19/11
01/19/12
PERSONAL A ADv /NJURY
AUTOMOBILE LIASI JTY
ANYA=ITO
ALLOVIAISo AUTOS
SCHEDULER AUTOS
HIRED AUTOS
- NON-ovvNEb afros
E'LC0905676
04/13/11
04/13/12
BODILY IM1uRY
(Per Accident)
20,000
AUTO ONLY - EAACCI(ENT
GEDUCTIELE
RETENTION
WORItD-RS COMPENSATION AND
EMPLOYERS' L(ABILTTY
O R x<x rnvE
IfYes, describe under
SPECIAL PROVISIONS bsipw
OTHER
MWc0010860 -01
08/23/11
08/23/1.2
TORY LIMITS
EL EACH ACCIDENT'
8.L DISEASE- 1:A EMPL01 EE
DESCRIPTION OF OPERATIONS /LOCATIONS /VEHICLES rEXCL.US1C ISADD b BYcNDORgeMENr JSPEC,lALPROytS INS
Alarm Installation/ Electrical Installation;
'RTIFICAiE HOLDER
CANCELLATION
Miami Shores
10050 NE 2nd Ave
Miami shores, FL 33138
T:305-795-2204
F:505-756-8972
C'ORD25 (2001/08)
SHOULD ANY OF THE ABOWDESCNialan POLICIES SE CANcE 3 ED SORE THE EXPIRATION
DATE 'THEREOF, THE ISSUING INSURER WILT, ENDEAVOR TO MAIL
NOTICE TO THE CiEiRTIPIOATE HO 10 DAYS SHALL
.DER NAMED To THE LEFT, r. 50? FAILURE TO DO SO SHALL
IMPosR NO O uGr4T1oN OR LUASIL[rY OF Ato, WNO Upon 'me rNSUREN, ITS AceNTS oR
REPRESENTA
I
(►ACORG CORPORATION 9988