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DEMO-12-975
4 Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 nut; (305) 756.8972 5,6e. INSPECTION'S PHONE NUMBER; (305) 762.4949 ILDING PERMIT APPLICATION FBC 20 Permit Typ BUILDING ROOFING OWNER: Name (Fee Simple Titleholder): VC Si S, Pic- phone., gq --7 7 .Address, ,ry©5b0 City: �`'�LCUI i SrlDr•2„s State: 3"3/'3g �— Zi Permit No. Master Permit No. -0)F_VMEWM:-.n MAY 2 9 26i2 BY: m�me�e�wm ®ma°o�o°o�� Tenant/Lessee Name: Phone#: Email: 1013 ADDRESS: _i 05. , iscavne Blvd City: M . S Miami Shores Folio/Parcel# Is the Building Historically Designated: Yes NO Y Flood Zone: County: Miami Dade ... _, ,Zip; CONTRACTOR: Company Name: AbsoIL � Pg- no1jtirsn, TNr Phone#; 305 /232 -8003 Address,: 17921 SW 9 7 Avenue 141 City: State: —33.3 2 Qualifier Name: Tne3r1 IvItz4 1 e rd Phone#: 7 R 5 / 41 7 — (].8 4 2 State Certification or Registration #: N / Certificate of Competency #: 9 8BS 0 0 2 2 0 Contact Phone #: 4) S /2.'2 —R Oft I Email Address: f]rances(a de absg'ttp. cb 'n DF.aSIGNER: Architect/Engineer: N/A Value of Work for this Fermat: $ /500 ° 6 Type of Work: OAddition Description of Work: Haulin all awa ©Alteration Phone #: Square/Linear Footage of Work: C7New ORepair/Replace demolition Submittal Fee $ ... Permit Fee $ Scanning Fee $ . Radon Fee $ Notary $ Double Fee $ * * *F see***** s****** * * * * * * * * * *** * * * * * * * * * * * * * * * * * ** 42 alb CCF $ CO /CC $ DBPR $ Boni $ Training/Education Fee $ Technology Fee $ Structural Review $ TOTAL FEE NOW DUE $, C t Bonding Company's Name (if applicable) N /A Bonding Company's Address City State • Zip Mortgage Lender's Name (if applicable) N/A 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. 1 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 he 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 $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be r livered t the person whose property is subject to attachment Also, a certified copy of the recorded notice of commencement nsust ' sic ' the job site for the first inspection which occurs seven (7) days after the building permit is issu =d. t absence of s h po, notice, the inspection will not be approved and a relnspection fee will be charged. t*�"w Signature Owner v gerrt ' 71-'°- ( Todd Melgaar ,ntractor a The for e►g�ing instrument 27 acknowled ed before a this The foregoing instrument was acknowledged before me this ZZ� d day of ` ' , nil . by M1I �.. _.mt iU �..UO 3 day of I a�j , 2p 12, by T eld H ( a act rFf who is personally nown to me • as r' . used � � • who is personally to m or who has produced OLIV.LpfL Y p Pe Y P NOTARY 1P ho did to My Commission Expires: X4,0,00 MY CQMMIS310N I DD9223 as enttfication and who did take an oath. NOTARY PUBLIC: EXPIRES: June 27, 2014 My Commission Expires: Sanded Teu Budge y Services APPROVED BY (1_12—Plans Examiner Structura1 Review (Revised o7t101O7XRevised Obt10f2009)(Revieed 3t15tt$) Zoning Clerk NOTICE OF COMMENCEMENT A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION PERMIT NO +lD .5-1CR TAAX°5 UONO. 11 -2230 —_001 -0500 STATE OF FLORIDA COUNTY OF MIAMI -DADE: 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. CFN: 20120411108 BOOK 28144 PAGE 4645 DATE:06/11/2012 05:34:32 PM HARVEY RUVIN, CLERK OF COURT, MIA -DADE CTY Space above reserved for use of recording aide 1. Legal description of property anti•street/addrass: j_QUO___Bj'Apaynra Blvd 2. Description of improvement: nevolit on end salltoval of swimming pool.. 3.Owner(s) name and address; interest in property: 71 71 pprtr-ri Op Lein R1 vrl # 71 1 Cora 1 Gah1es Fl 33134 Name and address of fee simple titleholder: 4. Contractor's name, address and phone number Absolute Demolition, Inc. :,a 5. Surety; (Payment bond required by owner from contractor, If any) Name, address and phone number ST 74. Amount of bond $ Al /A 6. Lender's name and address: 7. Persons within the State of Florida designated by Owner upon whom notices or other documents may be saaeted as provided by Section 713.13(1Xa)7., Florida Statutes, Name, address and phone number S. In addition to himself, Owners designates the following person(s) to receive a copy of the Lienor's Notice as provided in Section 713.13(1)(b), Florida Statutes. Name, address ani3 phone number: 9- Expiration date of this Notice of Commencement: Ohs aspiration date is 1 year from the date of recording unless a different date fa swilled) WARNING TO OWNER; ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713. PART I. SECTION 713.13. FLORIDA STATUTES, AND CAN RESULT IN YOUR RAYING TWIOE 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 COMMENOEtu]NT Ft.-841.i. s Me' n :: of % er(s) or O' -� tam thorizad\C)fficer /Director /Partner /Manager �J'I 8 — _ Prepared By rt ei sw q7 4,x2 " f 0 /h Print Name — 114.1 a U + Print Name Title/Office Title/Office STATE OFFLORIDA COUNTY OF MIAMI-DADE r w (_,{ The ft ggpirttstrumfittwogkn vglQdgedietore me this 1 day of "� / f ( Zvi uGIyy, 1s l �UQQlIVV I Gv 'JO YIN d Individually, or d as �-A► for a Personally known, or ' produced the foSowing type of identification: - ' , YRa. ;.C1 1' Signature of Notary Public: Print Name: (SEAL) /11 :.c .I +. k • • <r r` 7 ' Y :1 Fir Under penalties of perjury,1 declare that 1 have read the foregoing and that the facts stated in it are true, to the best of my knowledge and belief. r(s) or • ,, s)'s uthorlzed Officer/ Director /Pa tner/Managar who signed above: By Aso SCI ��/qp�.D ypll.: •1�i 1^7F"W �7M"1� FL -'"^I MY COMMISSIONID09B8223 EXPIRES: June 27,20)4 yid Bnabd Tin St ltidallSadam lasm -&t PAdt Anu STATE OF FLORIDA, COUNTY OF DADE I HEREBY CERTIFY that the foregoing Is a true and correct copy bi the original en file office J une AD 20 kills HARMEY RININ. CLERK, of Circuit and County Courts. Deputy Clerk �vr+arli Harvey R M,,. Clerk 3116 se-. ABSOLUTE DEMOLITION, INC. 17994 S.W. 97th Avenue Suite 101 Palmetto Bay, FL. 33157 May 29, 2012 Miami Shores Village Building Department 10050 NE 2nd Ave Miami Shores, FL 33138 RE: 10500 Biscayne Blvd — Pool Demo 305/ 232- 8003 305/ 232- 8008 FAX To Whom It May Concern: We are demolishing the above referenced pool at the request of the owner. The demolition will take place as soon as the required permits are issued in order to comply with the Violation on record. Res ,r Todd Melgaard Qualifier State of A D doi County _Lutaroi Signed and sworn before me this 2q4/Iday of Na 2012. Notary Public. My Commision expires: ABSOLUTE DEMOLITION, INC. 17994 S.W. 97th Avenue Suite 101 Palmetto Bay, FL. 33157 May 29, 2012 Miami Shores Village Building Department 10050 NE 2nd Ave Miami Shores, FL 33138 RE: 10500 Biscayne Blvd — Pool Demo 305/ 232- 8003 305/ 232- 8008 FAX To Whom It May Concern: We are demolishing the above referenced pool at the request of the owner. Electrical and plumbing disconnection permits will be secured along with demolition permit. Underground locations have been marked by Sunshine and Ticket No. 144207045 has been issued. To • elgaard Qualifier State of riff i do County Horn t -Da6t Signed and sworn before me this 2.1 `04 day of Notary Public. 2012. My Commision expires: Cely Gonzalez From: irth_host @callsunshine.com Sent: Friday, May 25, 2012 4:44 PM To: cely @absodemo.com Subject: Response to Sunshine State One CaII ticket 144207045 The following facility operators have responded for this locate request: Ticket 144207045 FL : DADE County, MIAMI SHORES Village 10500 BISCAYNE BLVD CITY OF NORTH MIAMI - Marked FLORIDA POWER & LIGHT - -DADE - Clear No Facilities A T & T/ DISTRIBUTION - Clear No Facilities DADE COUNTY PUBLIC WORKS AND TRAFFIC - Unmarked - Marking delay requested by locate technician and agreed to by excavator per agreement. MIAMI -DADE WATER & SEWER - No Conflict - utility is outside of the requested work site LEVEL 3 COMMUNICATIONS - No Conflict - utility is outside of the requested work site COMCAST CABLE - Clear No Facilities TECO PEOPLES GAS SOUTH FLORIDA - Clear No Facilities AT T - No Conflict - utility is outside of the requested work site The most up -to -date response status can always be gathered at http:/ /www.online811.com /IRTHOneCal1/ or by calling 1 - (800) 852 - 8057. Miami Shores Village Building Department 10050 N E 2 "d Avenue Miami Shores, F1. 33138 RE: 10500 Biscayne Blvd. — Miami Shores , Fl. To Whom It May Concern: As owner of the above referenced property we have contracted Absolute Demolition, Inc. to demolish the Pool and fill in the cavity to leave area level with surrounding grade. We thank you in advance for your assistance in this matter. State of County of M 1 N DG, Sworn and signe before me this 7 day of My Co „' s 4 expires: 2012. MARK S. S(HECHNER MY COMMISSION # DD . : .223 EXPIRES: June 27, 2014 �T1401, RIOQ. "' wed Thru Budget Notary Set** ABSODEM -02 MATERAT A' E'@ CERTIFICATE OF LIABILITY INSURANCE DATE(MMUDD/YYYY) 5/22/2012 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 Insurance Office of America, Inc. P.O. Box 162207 Altamonte Springs, FL 32716 -2207 CONTACT PONE FAX (A/c. No Exg: (800) 243-6899 (A/c, No): (407) 788 -7933 E -MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A :American Safety Indemnity Co 25433 INSURED Absolute Demolition, Inc. 17994 SW 97th Ave., Ste. 101 Palmetto Bay, FL 33157 INSURER a : Praetorian Insurance Company 37257 INSURER c : Travelers Property Casualty Company of America 25674 INSURER D : INSURER E : X INSURER F : MED EXP (Any one person) COVERAGES CERTIFICATE 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 POLIC ES 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 SUER WIVD POLICY NUMBER POUCY EFF (MM/DD/YYYYL(MM/DDIYYYYL 7/15/2011 POUCY EXP 7/15/2012 L1MTS EACH OCCURRENCE $ 1,000,000 A GENERAL X LIABWTY COMMERCIAL GENERAL LIABILITY ENV0200501104 DAMAGETO RENTED PREMISES (Ea occurrence) $ 50,000 CLAIMS -MADE X OCCUR MED EXP (Any one person) $ 5,000 X Hired /Non -Owned Auto PERSONAL &ADVINJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE X POLICY LIMIT APPLIES JE ° PER: LOC PRODUCTS - COMP/OP AGG $ 2,000,000 H /NonOwned Auto $ 1,000,000 B AUTOMOBILE _ LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS X ' SCHEDULED AUTOS NON -OWNED AUTOS PICFL0002025 7/16/2011 7/16/2012 (Ea arBIclNEDiDSINGLE LIMIT $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY Per accident) $ PROPERTY DAMAGE (Per accident) $ $ UMBRELLA LIAB EXCESS LIAR OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under' DESCRIPTION OF OPERATIONS below Y / N NIA WC STATU- TORY LIMITS OTH- ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ C Inland Marine QT6605494M353TIL11 7/16/2011 7/16/2012 $300,000 leased/rent DESCRIPTION OF OPERATIONS /LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule If more space Is required) CERTIFICATE HOLDER CANCELLATION Miami Shores Village Attn: Claudio H. Grande Building Official 10050 NE 2nd Ave MMiami 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. AUTHORIZED REPRESENTATIVE ACORD 25 (2010/05) © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD .�tC9RD CERTIFICATE OF LIABILITY INSURANCE DATE (;"Do;;") 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 ALTERTHE COVERAGE AFFORDED BYTHE 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 Risk Transfer Programs, LLC 219 East Livingston Street Orlando, FL 32801 CONTACT pN ONE re (A/C. No. Ext): 866 481 "8363 I (AIC. No): E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIL # INSURER A :CastlePoint National insurance Company 40134 INSURED CoAdvantage Corporation 3350 Buschwood Park Drive Suite 200 Tampa, FL 33618 INSURER B :Tower Insurance Company of NewYork 44300 INSURER C : INSURER D : $ INSURER E : $ INSURER F : $ COVERAGES CERTIFICATE NUMBER:T1665ZDQ REVISION NUMBER: THIS IS TO CERTIFY THAT THE POUCIES 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 POUCIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE IN SR SINVD POLICY NUMBER (MMIDDIYYYI) (M!DCDNYYYYY) LIMITS GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ AMAGETO RENTED PREMISES (Ea occurrence) $ MED EXP (Any one person) $ CLAIMS -MADE [] OCCUR PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ GEN1 AGGREGATE LIMIT APPLIESPER: 7 POLICY n J RE a n LOC $ AUTOMOBILE — LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS — SCHEDULED NON -OWNED AUTOS COMBINED SINGLE LIMIT $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ UMBRELLA LIAB EXCESS LIAR _ OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ $ DED 1 I RETENT ON $ A B WORKERS COMPENSATION AND EMPLOYERS' LABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A WSLTHPE00008208 WSLTHPE00030002 01/01/2012 01/01/2013 X I TWORY L�IM I I Eli E.L EACH ACCIDENT $ 1,000,000 E.L DISEASE - EA EMPLOYEE $ 1,000,000 E.L DISEASE - POLICY LIMIT $ 1,000,000 $ $ $ $ DESCRIPTION OF OPERATIONS 1 LOCATIONS /VEHICLES (Attach ACORD 101, Additional Remarks Schedule, 11 more space Is required) Coverage is extended to the leased employees of alternate employer in all states except in monopolistic states (ND, OH, WA, WY): Absolute Demolition, Inc. #4105036 (Effective 1/18/06) CERTIFICATE HOLDER CANCELLATION Miami Shores Village Attn: Claudio H. Grande Building Official 10050 NE 2nd Ave Miami Shores, FL 33138 SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE THE EXPIRATION DATETHEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POUCY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25 (2010/05) Page 1 of 1 ©1888 -2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD tixeu+ryic r�vn t ULIP11 x ry1 t OCR[. t3EUSINESS Ti "EIPT 1 �° FI T TAX - COLLECTOR MIAMI ?AOE COLIN Y STA3 E OF ' U.S. POSTAGE FLAB. EXPIRES EPT 2 PAID 1 FLOO f S l I I T AT P# 0 E 4° MIAMI, M T N PL. TO Y COQ CFt SA ART ii * PERMIT O.231 Tkii IS Not A B h DC NoT PAY rr 395722 -3 RENEWAL BUSINESS NAME / LOCATION `: RECEIPT NO 412936- ABSOLUTE DEMOLITION INC CC B .98B$00220 17994 SW 97 AVE 701 33157 UNIN DADE COUNTY { OWNER ABSOLUTE DEMOLITION I>� Sec. Type of Business ,s 42,6 A '' ECIALTY BUILDING HOLDER TO VIOLATE ANY EXISTING REGULATORY OR LAWS OP 011158. NOR' DOES IT EXEMPT THE LOA AOA ANY OTHER, REQuIREO BY LAW THIS TS A CERIIROATION OF F HOWEWS OUALIFICA- PAYMENT REOEI MIAMI.DADEL^ COLLECTOR : 08/18/2011 60060000024i 000075.00 SEE OTHER SIDE CONTNAC DO NOT FORWARD ABSOLUTE DEMOLITION INC TODD L MELGAARD PRES 17994 SW 97 AVE 101 MIAMI FL 33157 1111111fl1, till AAA 11111111111F111 III fIII 11�141 411 MIAMI -DADE COUNTY 2'011 MUNICIPAL CONTRACTOR'S TAX COLLECTOR TAX RRCEIP'T 140 W. FLAGLER ST $AM -DADE COUNTY • -STATE OF FLORIDA let FLOOR PURSUANT TO COUNTY CODE SEC. 10 -24 Mme, FL 33130 EXPIRES BEPT. 80, 2012 FIRST,CLASS U.S. POSTAGE PAID MEAMI, PL. PERMIT NO.2:ffi THIS IS NOT A SILL — DO NOT PAY RECEIPTNO. 30- 4129367 CC NO; 98BS00220 BUSINESS NAME / LOCATION ; RECEIPT HOLDER MAY DO ABSOLUTE DEMOLITION I C BUSINESS AS A CONTRACTOR 17994 SW 97 AVE AS SPECIFIED HEREON. OWNER :ABSOLUTE DEMOLITION INC SEE BACK OF RECEIPT FOR A LIST OF NON - PARTICIPATING MUNICIPALITIES SP CIALTY BULDING CONTRACTOR Receipt hoiden must 1egister kr the City where work is to be done. PAYMENT R EIVED MIAMI.OAOE NTY T cO o18 /2011 60060000025 000175.00 DO NOT FORWARD ABSOLUTE DEMOLITION INC TODD U MELGAARD PRES 17994 SW 97 AVE 101 MIAMI FL 33157 1 1111 11411111111111111111111,1L 1111111111t11111111$111111f • NO11110020 (S)BOVIII. ONIAAriVrIO 91.00 Florida Department of Environmental Protection Division of Air Resource Management NOTICE OF DEMOLITION OR ASBESTOS RENOVATIO TYPE OF NOTICE (CHECK ONE ONLY): ORIGINAL TYPE OF PROJECT (CHECK ONE ONLY): C'DEMOLITION IF DEMOLITION, IS IT AN ORDERED DEMOLITION? IF RENOVATION: IS IT AN EMERGENCY RENOVATION OPERATION? IS IT A PLANNED RENOVATION 'iWOVATION OPE,RRATION? I. Facility Name Ht� f-t ) bre & t ,* Address (050b scrap ' B (vet. City M+ ,SYIO(•CS State FL Zip County Nicarpi - Paote Site Consultant Inspecting Site Al2-.6 n V t r DY) riAtitf tui Building Size fho 1 &till (Square Feet) # of Floors Building Age in Years 5? c j s - Prior Use: ❑ School /College/University ❑ Residence ❑ Small Business Other t Present Use: ❑ School /College/University ❑ Residence ❑ Small Business Other 1"l e J✓ Q÷e-4 / p 06 1 11. Facility Owner Phone Address City Demo State Zip 305-2:3 I11. Contractor's Name ft b O't"e Demo 1t fit on/ Inc-- Phone Z -8'60 3 ❑ REVISED ❑ CANCELLATION ❑ RENOVATION ❑ ROOFING ❑ YES CHINO ❑ YES CYNO ❑YES L'NO MIAMI COUNTY Miami -Dade DERM Air Quality Management Division 701 N.W. 1st Court, 2nd Floor Miami, Florida 33136 File # Process # Address fl 1I N 3 \i' c l`A4 -"WI, .. 31 a 1 City tit 't Gir"Y)! State CL Zip 3 I 5---7 Is the contractor exempt from licensure under section 469.002(4), F.S.? ❑ YES ❑ NO IV. Scheduled Dates: (Notice must be pos arked 10 worki�flnyg�j a s before the project start date) t ,' / Asbestos Removal (mm/dd/yy) Start: NI/A- Finish: F / ?r Demo /Renovation (mm/dd/yy) Start fJ +4inish: V. Description of planned demolition or renovation work to be performed and methods to be employed, including demolition '.r re ovation techniitues to be used and description Qf affected facility components. v` e- e-I -itetO st c c r QA a t /2. Procedures to be Used (Check All That Apply): ❑ I and Removal ❑ Glove Bag 13'.-Bulldozer ❑ Wrecking Ball -Strip j' Wet Method ❑ Dry Method ❑ Explode ❑ Burn Down OTHER: r iE , P EA.P1li, VI. Procedures for Unexpected RACM: 14 1M Address y 1 119L4 6 V% e3-rt-vi PrVe . "tt' -d i� C l '�J 1 J� 1 City 1-" { 1%ii�t State VL• Zip VIII. Waste Disposal Site: Name Vt3O� �42 [.- Address City ev.k_erk.ecl State Flo Zip '',...31 IX. RACM or ACM: Procedure, inciurlin analytical methods, empl d to detect the resence of RACM and .ST0 P ail 0 tf,_ -77 .1 b a''t VII. Asbestos Waste Transporter: Name Phone s to certiiythat the required :,aur�ing estos have been 1i-tied Iii •rnpliance with 4; /gory I and II nonfriable ACM. D(AinGZ Amount of RACM or ACM* square feet surfacii,g material square feet cementitious material linear feet pipe square feet resilient flooring cubic feet of RACh1 off facility components square feet asphalt roofing *Identify and describe surfacing material and other materials as applicable: wive_ , prepor I certify that the above informatiu,: is correct and that an individual trained in the provisions of this regulation (40 CFR Part 61, Subpart M) will be on- site during the demolition .r revs A to and evidence that the required training has been accomplished by this person will be available for inspection duriramal ness h. rs. have r d and nderstood the additional information provided on the back of this form. (Print N. eof,• • � . . ilir ' .52 1 05 22 3 (Sign'ure of Owner /O e :tor) P ate) (Coma phone #) ''{{�� T Y ;cF {,�Y �jlb✓ /k }v? 4;nM inark/D:1te Received (:, rAHK .... x };'3R�y}?•2'h ..�:;..� ,..i vn�.._- a'..�. _ ... :. . w P , �.t �v" 'Ci+ r YY.. �y .tS �a a�,{ > 1 .', iw.... >.t - , S �^ J YSY,M,tiv"v'LID ,. }... 'a ... w. i'A \ .. n..t s �,?. y �J \ F .�.Y _ i... / . .. ... ....... Cn^.,a.. A >..... �Sw} .✓ Y. T\ _ .. ......... 161_01-158 10/10 DI ' { ;ntUTION: White -DERM Yellow- Applicant Pink - Reserve Gold- Reserve easerernents ; !. Lea 4ivironmenta ('Consuktinq .Services sbestos Business 1..icense, #4A- 00001.64 Ott Air v eiti i Tesi -l+t� Prepared For: Frances Melgard Absolute Demolition 17994 Sw 97 Ave, Suite 101 Palmetto Bay, Fl 33157 Job Site: Motel Shores At Biscayne Limited To Pool Area 10500 Biscayne Boulevard Miami Shores, Fl Asbestos Survey — Project Summary Pursuant to your request; ARS Environmental, Inc., has performed an Asbestos Building Survey on 5/15/2012 and limited to the above referenced location. The Exterior of the above referenced location was visually inspected to identify building materials that may contain asbestos. Suspect materials were collected and samples sent to laboratory for analysis. The Interior/Roof was not sampled. If the Interior/Roof system will be disturbed by renovation or demolition samples of the materials that will be affected should be obtained and analyzed to determine asbestos content prior to any disturbance. Laboratory Results Based On The Laboratory Analysis, No Asbestos Was Detected In A E ounts Greater Than 1% In The Secured Bulk Samples. It has been a pleasure working with you. Please call on us again. Regards, ex Front, ARS Environmental, Inc. 10097 Cleary Boulevard • #305 • Plantation, FL 33324 • Phone: 954-227-2402 • Far S66-816-5110 rvwcv.arsenvironrnentat eorn • sates©arsenvironmenta(eom ENVIIWNMENTAL, bvc. tvironmental Consulting Services Asbestos Business License #ZA- 0000164 Asbestos Consulting • Radon Measurements • Lead Assessments • Indoor Air Quality Testing • Mold Investigations Today's Date: 5/15/2012 Project Number: 20120718 Page 2 of 10 Prepared For: Frances Melgard Absolute Demolition 17994 Sw 97 Ave, Suite 101 Palmetto Bay, Fl 33157 Job Site: Motel Shores At Biscayne Limited To Pool Area 10500 Biscayne Boulevard Miami Shores, Fl Asbestos Surve ePikGcl%0�1 I, Timothy performed C1R., Part 707.5:1F Timothy Florida F. Caughey, hereby certify that this asbestos survey was conducted at the above referenced Job Site on 5/15/2012, by Alex Front, accredited by the EPA as AHERA Inspector(s), utilizing the code of the Federal Regulation Standards, 763, Subpart E, Section 763.80- 763.99 and the State Asbestos Regulations, Florida Statutes 469.003. i 0, ∎Ka'`9" mW ', .� . �`.s:' 'kT 11 OQCUM+ Iy7J klik?$,w ;cal: 9EL) t3FYGKGFiOUMti Mi6,.H(I'fll TING "• hir C' iAni TCNTri pAAP Hz ∎`i . , '1)�u0 1'1 „ +t;; ;ra+ 0; EIVUIIWNMENT !NC, jvironmental Consulting Services Asbestos Business License #ZA- 0000164 Asbestos Consulting • Radon Measurements • Lead Assessments • Indoor Air guallty Testing • Mold Investigations Today's Date: 5/15/2012 Project Number: 20120718 Page 3 of 10 Prepared For: Frances Melgard Absolute Demolition 17994 Sw 97 Ave, Suite 101 Palmetto Bay, F133157 Job Site: Motel Shores At Biscayne Limited To Pool Area 10500 Biscayne Boulevard Miami Shores, F1 slaestA 'echniciian Certification this is to.Gertl thaf' Aldo 100"7,01019 Blvd, X6908 t+kwbaUon` successfully ccmptetetal antrg!rislt . 1,04:1���ii�;il�i� �J;1'u11iL fr�Ytar 12 TQft'ls beBYY o01.9 bttrK�r oo,*00ONNr0gw0¢4b*0N'8 0, 0000 NgWI'.7�U P` M C.amro•repnMOmgnb 0 1'I.4%�0D1020CN•a300d78n NOMO hlWlder 9481 . Tminm( §)• !mime F. BWnfp Tiahnln6 {1Mkeni; 900 Norlban,iit FlfdtAvo.. Fort 4diidr d1du14.Ff.' •i�� "81rom8a1d1:0o1n0 aompled0n boeodory imam H90t@ 0111'10■M8r.18 `..: This Certiflcate Expires > • 1 AUNOn�fo8le coittnoa 1�.9n81reh1lli,aa Alex Front Certified Asbestos Surveyor ARS Environmental, Inc. 10097 Cleary Boulevard • #305 • Plantation, FL 33324 e Phone: 954-227-2402 • Fax: 866. 816 -5110 cvcva.arsenvironmental.com • sales@arsenvironmentafeom EIVC/IRONMENTAL wc. avironmental Consulting Services Asbestos Business License #ZA- 0000164 Asbestos Consulting • Radon Measurements • Lead Assessments • indoor Air Quality Testing • Mold investigations Today's Date: 5/15/2012 Project Number: 20120718 Page 4 of 10 Prepared For: Frances Melgard Absolute Demolition 17994 Sw 97 Ave, Suite 101 Palmetto Bay, F133157 Job Site: Motel Shores At Biscayne Limited To Pool Area 10500 Biscayne Boulevard Miami Shores, F1 .sbestas Survey -- B k Sample Iterniza Sample Sample Physical Water Material Sample Number Material Class / Sample Description / Location Condition Damage Damage Contact Friability Layer Layer Approximate Size Positive Stop Asbestos Detected Miscellaneous e High Non - friable 1,500 Sq. Ft. No Asbestos Detected Concrete Deck Throughout Pool Area Miscellaneous i x o one , High Non - friable &a e 3 5 + No Asbestos Detected Concrete Deck Throughout Pool AreaF "' Miscellaneous Roof Material; Membrane Covering Pool t m Area High Non - friable 1,200 Sq. Ft. No Asbestos Detected Miscellaneous �b c Y o , r on High Non- friable 1,900 Sq. Ft. No Asbestos Detected Pool Marche Throughout Interior Of Pool Miscellaneous High Non - friable A e� T'fi`x 'v...a No Asbestos Detected Pool Marcite Throughout Interior Of Pool ±Miscellaneous High Non - friable 1,500 Sq. Ft, No Asbestos Detected Grout Ceramic Tiles Throughout Pool Area The following non - suspect materials were observed during the survey (no samples were taken): Limited to pool deck only. Ceramic tiles. 10097 Cleary Boulevard • #305 • Plantation, FL 33324 • Phone: 954-227-2402 • Far: 866-816-5110 WWW,arsenoironmental.com • sales@arsenviranmental.com EivwRoNMiivTA 4 INC. vironmental Consulting Services Asbestos Business License #ZA- 0000164 Asbestos Consulting • Radon Measurements • Lead Assessments • Indoor Air Quality Testing • Mold Investigations Today's Date: 5/15/2012 Project Number: 20120718 Page 5 of 10 Prepared For: Frances Melgard Absolute Demolition 17994 Sw 97 Ave, Suite 101 Palmetto Bay, F133157 Sample Number Description / Material Class Location Job Site: Motel Shores At Biscayne Limited To Pool Area 10500 Biscayne Boulevard Miami Shores, Fl Sample Physical Water Material Sample Approximate Size Condition Damage Damage Contact Friability Asbestos Detected Friable: any material containing more than one percent asbestos which has been applied on ceilings, walls, structural members, piping, duct work, or any other part of a building, which when dry, may be crumbled, pulverized, or reduced to powder by hand pressure. The following work practice should be followed whenever demolition/renovation activities involving RACM occur: Notify EPA of intention to demolish /renovate, remove all RACM from a facility being demolished or renovated before any disruptive activity begins or before access to the material is precluded, keep RACM adequately wet before, during, and after removal operations, conduct demolition /renovation activities in a manner which produces no visible emissions to the outside air, and handle and dispose of all RACM in an approved manner. The above building material is considered friable and must be removed by a Florida Licensed Asbestos Abatement Contractor, prior to any disturbance caused by renovation or demolition. When implementing the response actions, parties responsible for final selection should remember that actions shall be sufficient to protect human health and the environment, but may also be the least burdensome method. Nothing in these recommendations should be construed as prohibiting or discouraging removal. In the event that demolition or renovation is deemed necessary, parties shall comply with all applicable laws, ordinances, rules and regulations of Federal, State and Local Governmental Agencies, including any National Emissions Standard Hazardous Air Pollutants (N.E.S.H.A.P.) Notification requirements 10097 Cleary Boulevard • #305 • Plantation, FL 33324 • Phone: 956. 227 -2402 • Fag: 866-816-5110 tvu/u.arsenvironmental.com • sates@arsenvironmental.com Ev(J!gO,vMiNr,4 L IJNC. Buss mentai Consulting Services Asbestos Business License #ZA- 0000164 Asbestos Consulting • Radon Measurements • Lead Assessments • indoor Air Quality Testing • Mold investigations Today's Date: 5/15/2012 Project Number: 20120718 Page 6 of 10 Prepared For: Frances Melgard Absolute Demolition 17994 Sw 97 Ave, Suite 101 Palmetto Bay, F133157 Job Site: Motel Shores At Biscayne Limited To Pool Area 10500 Biscayne Boulevard Miami Shores, Fl Category 1 Non - Friable Asbestos Containing Material Sample Number Description / Material Class Location Approximate Size Sample Physical Water Material Sample Asbestos Condition Damage Damage Contact Friability Detected Recommendations The above referenced Asbestos Contained Building Materials may be left in place if deemed to be in good condition and no repairs or renovations are scheduled which would disturb them. Care should be taken to ensure that the materials not be disturbed during repair, renovation or remodelling activities which could possibly release fibers into the air. To reduce the intrinsic liability to the owners, the ultimate solution may be to have the material removed. However, at the minimum, a formal Operations and Maintenance (O &M) Program is recommended to minimize potential fiber releases, monitor any future deterioration, and to ensure proper record keeping. Under the FDEP regulations, Category I non - friable asbestos - containing materials may be left in place during demolition under wet conditions. However, OSHA regulations require that disposal of asbestos- containing materials and debris is disposed of in a leak -tight and labeled container. The container may be plastic bags so long as the holding is leak - tight. All materials must be disposed of in a Class I landfill and manifest as Category I Non - Friable Asbestos containing material. To meet the requirements of a wet demolition, it is the responsibility of the demolition contractor to control any visible emissions by adequately applying water on the structure. Furthermore, the work practices for the demolition of a building containing asbestos must be in regulatory compliance with OSHA 1926.1101. All materials must be kept thoroughly wet or saturated during the demolition to assist in preventing the release of asbestos fibers. A certified asbestos supervisor must perform or supervise the work. If during the demolition process visible emissions are observed, the asbestos - containing materials must then be abated. The regulations of the Occupational Safety and Health Administration (OSHA) applies to any detectable amount of asbestos in building materials or on facility components. This requirement covers worker training, work practices, and disposal methods. In summary, removing asbestos in a commercial setting requires training, specific work practices, and disposal methods for the asbestos and asbestos - containing debris. However, if Category I Materials have become friable or are in poor condition, they must be removed before demolition or renovation begins by a Florida Licensed Asbestos Abatement Contractor. When implementing the response actions, parties responsible for final selection should remember that actions shall be sufficient to protect human health and the environment, but may also be the least burdensome method. Nothing in these recommendations should be construed as prohibiting or discouraging removal. 10097 Cleary Boulevard • #305 • Plantation, FL 33324 Phone: 954-227-2402 • Fair: 866 - 816 -5110 utufu.arsenvironmentatcon • sates@arsenvironmental.com EAI/IIWNMENTAL ,NC. ,vironmental Consulting Services Asbestos Business License #ZA- 0000164 Asbestos Consulting • Radon Measurements • Lead Assessments • Indoor Air Quality Testing • Mold lnoestigations Today's Date: 5/15/2012 Project Number: 20120718 Page 7 of 10 Prepared For: Frances Melgard Absolute Demolition 17994 Sw 97 Ave, Suite 101 Palmetto Bay, Fl 33157 Job Site: Motel Shores At Biscayne Limited To Pool Area 10500 Biscayne Boulevard Miami Shores, F1 Category 11- Non - Friable Asbestos Containing :Material Sample Number Description / Material Class Location Sample Physical Water Material Approximate Size Condition Damage Damage Contact Sample Asbestos Friability Detected The above referenced Asbestos Contained Building Materials may be left in place if deemed to be in good condition & no repairs or renovations are scheduled which would disturb them. Care should be taken to ensure that the materials not be disturbed during repair, renovation or remodelling activities which could possibly release fibers into the air. To reduce the intrinsic liability to the owners, the ultimate solution may be to have the material removed. The above building materials are considered Category II Non - Friable and are likely to become crushed, crumbled, pulverized or reduced to powder during demolition or renovation therefore must be removed before demolition or renovation begins by a Florida Licensed Asbestos Abatement Contractor. To meet the requirements of a wet demolition, it is the responsibility of the demolition contractor to control any visible etissions by adequately applying water on the structure. Furthermore, the work practices for the demolition of a building containing asbestos must be in regulatory compliance with OSHA 1926.1101. All materials must be kept thoroughly wet or saturated during the demolition to assist in preventing the release of asbestos fibers. A certified asbestos supervisor must perform or supervise the work. If during the demolition process visible emissions are observed, the asbestos - containing materials must then be abated. The regulations of the Occupational Safety and Health Administration (OSHA) applies to any detectable amount of asbestos in building materials or on facility components. This requirement covers worker training, work practices, and disposal methods. In summary, removing asbestos in a commercial setting requires training, specific work practices, and disposal methods for the asbestos and asbestos - containing debris. However, if Category II Materials have become friable or are in poor condition, they must be removed before demolition or renovation begins by a Florida Licensed Asbestos Abatement Contractor. When implementing the response actions, parties responsible for final selection should remember that actions shall be sufficient to protect human health and the environment, but may also be the least burdensome method. Nothing in these recommendations should be construed as prohibiting or discouraging removal. 10097 Cleary Boulevard • #305 • Plantation, FL 33324 • Phone: 954-227-2402 • Fax: 866416 -5110 tvtvtvarsenvironmental.com • sales@arsenvironmental.cam EM/IIWNMENTA L INC. lvironmental Consulting Services Asbestos Business License #ZA- 0000164 Asbestos Consulting • Radon Measurements • Lead Assessments • Indoor Air Quality Testing • Mold Investigations Today's Date: 5/15/2012 Project Number: 20120718 Page 8 of 10 enelrai Terms and. Conditions Scope of Work ARS Environmental's inspections are limited and non - destructive in nature. Any conditions or materials which were not able to be visually observed on the surface, or in easily accessible areas, were not inspected and may differ from those observed. It was not within the scope of this investigation to remove surface materials to investigate portions of the structure or materials which lay beneath the surface. Our selection of sample locations and frequency is based upon our observations and the assumption that like materials in the same area are homogeneous. This inspection report is the result of a diligent search of the facility for Asbestos Containing Building Materials (ACBM). The purpose of this inspection was to identify those materials which may pose a health hazard to occupants of a building and impart future liability to the owners and insurers of the property. However, we do not claim to have identified all of the asbestos containing building materials present in the facility. Materials such as underground pipes, any material inside walls, ceilings, floors, or other enclosed and inaccessible areas were not sampled and are not covered in this report. This report is designed to aid the building owner, architect, construction manager, general contractor, and potential asbestos abatement contractor in locating asbestos containing building materials. Under no circumstances is this report to be utilized as a proposal or a project specification document. This report is based upon conditions and practices observed at the property and information made available to the surveyor. This report does not intend to identify all hazards or unsafe practices, nor to indicate that other hazards or unsafe practices do not exist at the premises. In the event that demolition or renovation is deemed necessary, parties shall comply with all applicable laws, ordinances, rules, and regulations of federal, state, and local governmental agencies, including any National Emissions Standard Hazardous Air Pollutants (NESHAP) notification requirements. Right of Entry The client will provide for right of entry to ARS Environmental's personnel in order to complete the above referenced work. Invoices ARS Environmental will submit invoices to client upon completion of services. Ownership of Documents All reports, field data, field notes, laboratory tests data, calculations, estimates, and any other documents prepared by ARS Environmental as instruments of service shall remain the property of ARS Environmental. Assumptions and Limitations The results, findings, conclusions, and recommendations expressed in this report are based only on conditions which were observed during inspections by this report, ARS Environmental makes no representation or assumptions as to past conditions or future occurrences. Assigns Neither the client nor ARS Environmental may delegate, assign, sublet or transfer his duties or interest in this agreement without the written consent of the other party. Roof Cuts To obtain accurate information in a roof investigation, roof cuts approximately four inch 4" squares, may be deemed necessary. It is the responsibility of our client to make appropriate repairs to these roof cuts, using materials consistent with the roofing system and in accordance with any existing material manufacturer's warranties. A roofing contractor or maintenance personnel selected by our client should be on the roof to make any necessary repairs at the time the samples are being obtained. Although, every attempt will be made to make these repaired areas water tight, ARS Environmental will in no way be responsible for any water damage to the roofing system, building, or it's contents resulting from ARS Environmental temporary repairs. Disclaimer If in the course of a renovation or demolition activity, suspect materials become exposed, ALL FURTHER ACTIVITY SHOULD IMMEDIATELY CEASE AND THE STATUS OF THE MATERIAL SHOULD BE DETERMINED BEFORE PROCEEDING. 10097 Cleary Boulevard • #305 • Plantation, FL 33324 • Phone: 954-227-2402 • Fax 866416 -5110 cvuww.arsenvironmentaLcom • sales@arsenvironmental.com Eiw1lwiVAvrAL INC. ' ,4 vfranmental Consulting Services Asbestos Business License #ZA- 0000164 ,Asbestos Consulting • Radon Measurements • Lead Assessments • Indoor Air Quality resting • Mold Investigations Today's Date: 5/15/2012 Project Number: 20120718 Page 9 of 10 Prepared For: Frances Melgard Absolute Demolition 17994 Sw 97 Ave, Suite 101 Palmetto Bay, F133157 Job Site: Motel Shores At Biscayne Limited To Pool Area 10500 Biscayne Boulevard Miami Shores, Fl Asbestos Survey Technician Chain of Custody Forms and Field Notes ARS ENVIRONMENTAL, INC. C AN OFCUSA''DY Positive Stop Requested Point Mount Requested On Page P 1. Of els: As tees!, That Report Lees Than 1% Turnaround Time Requested Sampling ate: 5 In% Samples Taken By: �1 fca,c)r\l' Project Number: a'1"'� 11� NT XTP Project Location! '10 Cl, S1AoZ •s 0:) P3 tYS `(t' C' 1, ti otoo ulk -ant les y • 24 NOW • 48 Hour ' 72 Hour Sc, v IP` Matti t ple0aertptlen ■1 I IIIGI Puununa ME Phyla! orator Mame y= Dome Mateesal OebteetCe lts uJ!U1 11111 I A a.., 110 1,,,k Fn c Cw :Cl'4te..,., r4 "1`, n S? .,\ IMINIENIM (o70, ' 4 J %'. a1,`.. '� 9.3.!4\ ,:w ial um °"'1 °`1111111111111111111 uua .w.`.+115n rr :4 ' :tii'r t;, v. , s C . �1;t t' 1PY'I` E ..r- y�.._.,�_ _ . ,7a- .,,,,, o�a: �� 1;'r� -n, T 7 «• . .11 .V71-. ,mexa,,eorum, , ,,nu" ., or . as . Transfe moue powde by preeourej tdmetm r ,%%.,ed ece vs a t//i%/1.�► • {� 10097 CM OS, to evaao • #305 • PLANTATION, F • 9 .24 • TOLL Fises: 877427-24 midland topmxderby e: 0042274402 • Fnxt 080.818411 10097 Cleary Boulevard • #305 • Plantation, FL 33324 • Phone: 954 -227 -2402 • Fax: S66- 816.5110 cvcvcv arsenvironmental.com • sates@ arsenvironmentat.com 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) 7614949 BUILDING PERMIT APPLICATION FBC 20 Permit No. MAY 292E2 JJ BYo _�' _emm____s000000 atA0 1-91(0 Master Permit Na fin ) ®° � Permit Type: Electrical JOB ADDRESS: B- air p vij p City: Mian}j Shores County: Miami Dade Folio/Parcel #: Is the Building Historically Designated: Yes ,. Zip: NO. —._.fit Flood Zone; C - �i31 -D it\I (13 ,7`,D C. SOS/ 1/3 "77 q OWNER: `l+iarP Simp�ITitlehol�er): C Phone #: City; )4r i s Tennant/Lessee Name: Email' , State: L •hone #: 3g" CONTRACTOR: Company Name: L& J C lis t run+ ; nn Phone#: 786/ 2 5 5 -1 9 8 0 Address: City: State: F-1 9 Qualifier Name: Luis Hernandez State Certification or Registration #: C' /30 0 3 S'o / Certificate o Contact Phone #: ?ft- 2-0.1"/ 9 to Email Address: Zip: 30 33 hone #:786 /255 -1980 ompetency #: DESIGNER: Architect/Engineer: Phone#: Value of Work for this Permit: $ go o Type of Work: DAddress DAiteration Description of Work: Square/Linear Footage of Work: DNew DRepair/Replace demolition ******** * * ** * * * * * * * * ** * ** * * * ** * * * ** *• ** Fees************* * * ** * * * * * ** * * * *44** * * * * * * ** **** Submittal Fee $ Permit Fee $ e CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Double Fee $ _Structural Review $ Technology Fee $ FEE NOW DUE $ ELECTRICAL CONTRACTING LLC ESIDENTIAL • COMMERCIAL • INDUSTRIAL VIOLATIONS.• EXPIRE T FERIA ITS • OPEN PERMITS NEW CONSTRUCTION -i. ! REMODELING r�. LUIS} HERNANDEZ www.landjcontractor.coln 786-255-1980 STATE LIC. & INS. EC13003509 e. Bonding Company's Name (if applicable) , N/A Bonding Company's Address City State Mortgage Lender's Name (if applicable) Mortgage Lender's Address City N /A® Zip 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 whore properly is subject to attachment, Also, a certified copy of the recorded notice of commencement in be potted al the job site for the first inspection which occurs seven (7) days after the building permit is issued. In he absence f such posted notice, the inspection will not he approved and a reinspection fee will be charged. Signature The foregoing instrument was day of ,20a,b y ho is personally known to me IILdMlNfirLUb" ' or wh ilLeroti CA L O' y' �'� As identification and _s ±. did take an oath. NOTARY PUBLIC; Sign: Pri Signatu Luis Hernandez Contractor The foregoing instrument was acknowledged before me this2 day of , 2012.; by � uiS /krA A.c {Z who is personall known to me or who has produced My Commission Expire% APPROVED BY EXPIRES: June 27, 2014 9rF PLO goaded Thai ei t,Neepy Servias 4"Y Plans Examiner Structural Review (Revised 3 /12/2012)(Reviscd 07 /10/07)(Revised t /i0/2(X)9)(Revised 3/15/09) as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commission Ex elle '146 Notary Pu is State of Florida Frances Melgaard My Commission EE011069 of aa" Expires 07/22/2014 Zoning Clerk From: 05/24/2012 09:59 #402 P.002/002 A c' CERTIFICATE OF LIABILITY INSURANCE DATE`"" PI ) 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 POUCIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: lithe certificate holder Is an ADDITIONAL INSURED, the softiies) must be endorsed. R SUBROGATION 18 WAIVED, subject to the terms and conditions of the policy, certain poikfes may require an A statement an this ceoUfate does not confer rights to the certificate holder In lieu of such endomeinent(s). PRODUCER Gruber & Associates 1135 N. Krome Ave. Homestead, FL 33030 Phone (305)248 -5453 Fax (305)246 -7090 CONTACT JOHN BARNES alLswk (305)248-5453 TX, Net (305)248 -7090 ADDRESS: bames)s(bensouth.net INSURERS) AFFORDING COVERAGE NINC ft (Nahum A : GRANADA INSURANCE COMPANY 0185FL00028842 INSURED LUIS HERNANDEZ L & J ELECTRICAL CONTRACTING, LLC. 16351 SW 285 ST. HOMESTEAD, FL 33033 (786)255 -1980 INSURER e DAMAGE TO RENTED FREmsEs tee accurreamo INSURER C : � � (Any one person) INSURER 0 : PERSONAL a ADV INJURY INSURER E : ❑ _ INSURER P ; $ 2,000,000.00 CERTIFICATE NUMBER: REVISION NUMBER: THIS INDICATED. CERTIFICATE EXCLUSIONS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD NOIW ITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POUCIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. __IA A TYPE OF INSURANCE IN YYYD POLICY NUMBER EFF (tlf;faIDtl l'YYf 09/15/2011 (�m1 09/15/2012 UtUTS GENERAL LIABILITY L COMMERCIAL GENERAL LIABR.m • • CLAIMS -MADE ® occuR • 0185FL00028842 EACH OCCURRENCE $ 1,000.000.00 DAMAGE TO RENTED FREmsEs tee accurreamo $ 100.000.00 � � (Any one person) $ 5.000.00 PERSONAL a ADV INJURY $ 1.000,000.00 ❑ _ GENERAL AGGREGATE $ 2,000,000.00 GEN'L AGGREGATE LIMIT APPLIES PER II POLICY ❑ • LOC PRODUCTS - COMP/OP AGG s 2,000.000.00 $ ,IPPRf AUTOMOBILE LABILITY • ANY AUTO • A �OWNED ❑ SCHEDULED • HIRED AUTOS • AUTWNED ❑ O SINGLE UNIT $ BODILY INJURY (Per person) $ �1)ILY1PIAiRY(Per accident $ PROFERTI)AMAGE 'i leer a�tden $ $ ❑ UMBRELLA UAS 1 OCCUR ❑ EXCESS LAB ❑ CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ ❑ DED ❑ RETENTIONS $ WORKERS COMPENSATION AND EMPLOYERS' UABILiTY YIN ANY PROPRIETORIPARTNERIEXECUTWE N I A �❑ WC STATU- ❑ OTH- E.L. EACH ACCIDENT OFFICERNAEMEIER EXCLUDED? 1 (Mandatory Is H) seRIPTION OF OPERATIONS below E.L. D E- EA EMPLO $ E.L DISEASE - POUCY LIMIT $ DESCRIPTION OF OPERATIONS J LOCATIONS/ VEHICLES (Attach ACORD 101. Additional Remarks Schedule, U more space le required) ELECTRICAL CONTRACTOR. $500 DEDUCTIBLE PER CLAIM. CERTIFICATE HOLDER CANCELLATION i MIAMI SHORES BUILDING DEPARTMENT 10050 NE 2 AVE MIAMI SHORES, FL 33138 SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25 (2010/05) QF ®1998 -2010 ACORD CORPORATION. Aft rights reserved. The ACORD name and logo are registered marks of ACORD DEPARTMENT OF ausirms AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD 1940 NORTH MONROE STREET - TALLAHASSEE FL 32399-0783 HERNANDEZ, LUIS L & J ELECTRICAL CONTRACTING LLC 16351 SW 285TH STREET HOMESTEAD FL 33033-1034 Congratulations) With this license you become one of the nearly one million Floridians licensed by the Department of Business and Professional Regulation. Our professionals and businesses range from architects to yacht brokers, from boxers to barbeque restaurants, and they keep Florida's economy strong. Every day we work to improve the way we do business in order to serve you better For information about our services, please log onto www.myfforidalicense.com. There you can find more information about our divisions and the regulations that impact you, subscribe to department newsletters and learn more about the Department's 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! (850) 407-1395 DETACH HERE 06030266 03 -04 -2011 JEFF ATWATER STATE OF FLORIDA HIEF fhNANcIAL OFFICER DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION * * CERTIFICATE OF ELECTION .TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW * * CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law. EFFECTIVE DATE: 03/04/2011 EXPIRATION DATE: 03/03/2013 PERSON: FEIN: HERNANDEZ LUIS ' 208029507 BUSINESS NAME AND ADDRESS: L & J ELECTRICAL CONTRACTING LLC 16351 SW 285TH STREET HOFlLSTEAD FL 33033 SCOPES OF BUSINESS OR TRADE: 1- ELECTRICAL/ ELECTRICIAN IMPORTANT: Pursuant to Chapter 440. 051141, F.S., an officer of a corporation who elects exemption from Ibis chapter by filing a certificate of election ender this section may not recover benefits or compensation ender this chapter. Pursuant to Chapter 440.05{12), F.S., Certificates of election to be exempt... apply only within th0 scope of the business or trade listed on the notice of election to be exempt. 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 it, at any time after the filing of the entice er the issuance of the certificate, the person named on the entice 01 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 no the certificate to meet the requirements of this section. OWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01 -11 QUESTIONS? (850) 413 -1609 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 LAWN EFFECTIVE 03/04/2011 EXPIRATION DATE: 03/03/2013 PERSON LUIS HERNANDEZ FEIN 208029507 BUSINESS NAME AND ADDRESS: L & J ELECTRICAL CONTRACTING LLC 16351 SW 285TH STREET HOMESTEAD, FL 33033 SCOPE OF BUSINESS OR TRADE: 1- ELECTRICAL/ ELECTRICIAN IMPORTANT F Pursuant to Chapter 440.05(14), F.S., an officer of a corporation who ® elects exemption from this chapter by filing a certificate of election L under this section may not recover benefits or compensation under this D chapter. Pursuant to Chapter 440.05(12), F.S., Certificates of election to be exempt.. apply only within the scope of the business or trade listed on the notice of election to be exempt E Pursuant to Chapter 440.05(131, F.S., Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation if, at any time after the filing of the notice or the issuance of the certificate, the person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate. The department shall revoke a certificate at any time for failure of the person named on the certificate to meet the requirements of this section QUESTIONS? (850) 413-1609 CUT HERE * Carry bottom portion on the job, keep upper portion for your records. DWC--252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01 -11 NESS TAX SEE cis ME L & J ELECTRICAL CONTRACTING LLC HERNANDEZ LUIS PRES 16351 -SW 285 ST HOMESTEAD FL 33033 101. 111111141111!0111►Ol1l►1 1A1LM11111OOtl11'►►11f11b it DRIVER .ICE S H65 ERNANDU SW ST -2009 4 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 174185 Scheduled Inspection Date: June 29, 2012 Inspector: Devaney, Michael Owner: Permit Number: DEMO -5 -12 -977 Job Address: 10500 BISCAYNE Boulevard Miami Shores, FL 33138- Project: <NONE> Contractor: ALL PRO SEPTIC & SEWER INC / ALL PRO PLUMBING SEP' Permit Type: Demolition Inspection Type: Final Work Classification: Plumbing Phone Number Parcel Number 1122300010500 Phone: (305)635 -3002 Building Department Comments total demolition and removal of commercial swimming pool. complete plumbing disconnection to accomplish above work Inspector Comments Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. June 28, 2012 For Inspections please call: (305)762-4949 Page 5 of 7 r 1 Miami Shores Village Building Department 10050 N.E,2nd Avenue, Mianai Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 BUILDING PERMIT APPLICATION FBC 20 Permit Type: PLUMBING lc]) IECMEWM71 LUI MAY 2926Ci2 Permit No. 100.0 .1 Master Permit No. t OWNER: Name (Fee Simple Titleholder): J G U C I ding s, Inc. Address 10500 c gj 3 Ivd. City: 511 or __ State: Pi_ Tenant/Lessee Name: Email: JOB ADDRESS: City: Miami Shores County: Miami, Dade Folio/P=0#: -9 1-7 Phone #305- 8/3 ` 7 7`7 j --ZIP: 3 g Phone# Is the Building Historically Designated: Yes Zip: NO x Flood Zone: CONTRACTOR: Company Name: , All Pro P1u•nbitg `� Phone# / 635 -3002 Address: 2700 NW 27 Avenue City: Miazt, State: p'1. Zip: 33142 Qualifier Name: Barry Teixeira Phone#: 3 lr /f 1e,- 3002 State Certification or Registration #: Q- FC---- [ Certificate of Competency #: Contact Phone #: Email Address: allpross@bel lsouth. rtes. ............. DESIGNER: Architect/Engineer: N/A Phone#: Value of Work for this Permit: $ Type of Work: OAddress Description of Work: CI75 OAlteration __ Square/Linear Footage of Work: JNew ❑Repair/Replace x151Deroiition * * * * * ** * * * * * * * * * *a * * * * ** *1.v * * * ****4. ** Fees****+******** * * * * * * * * * * * ** * * * * * * * * * * * * * * * * ** Submittal Fee $ Permit Fee $ _16C Scanning Fee $ Radon Fee $ Notary $ Training/Education Fee $ Technology Fee $ CCF $ CO /CC $ DBFR $ Bond $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ L �1. Bonding Company's Name (if applicable) Bonding Company's Address City State Mortgage Lender's Name (if applicable) Mortgage Lender's Address City N/A N/A Suite Zip Zip, Application i5 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, BEATERS, 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 w Applicant: A. a condition to the issuance ofa building permit with on 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 w the person whose property is subject to attachment. Also, a cert(red copy of the recorded notice of commencement must be posted at the job site fur 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 retnspection fee will be charged. Signature--1.. Owner rAgent A, .-/V Barry Teixeira Contractor The fore tin instrument �was acknow a ed before met .is The fcirego „in instrument was acknowledged before me this nd day of O ,20I Wby.M` i� (� I, day of Isla ,20 12-, by f3al iti 1 IK- et(,®1 y who is personally known to me or wh as produced L t” , is •ersonall known + me or who has produced As ,j tlfleation . d w'.. u aka an +2h. as identification and who did take an oath. NOTARY FU Sign. 'riot; My Commission Expires: MY COMMISSION #DD93 EXPIRES: June 27, 2014 Bontial Tint) Budget Notay Services NOTARY PUBLIC: Sign: Print: I ✓i II 5 ► .,4 • My Commission Expires: **** * * * * * * * * * ** * * * * ** * * * *** ****************************e******************* 02-..— Plans Examiner APPROVED BY Structural Review (Revised 07/111107)(Ravi d 06/10/2009)(Revised 3/15/09) Notary Public State of Florida Vanessa Koppel j My Commission EE154908 per Expires 12/20/2015 Zoning Clerk 04/17/2012 16:05 3056357473 ACOIR'Dr. CERTIFICATE OF LI THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, E BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMAORTANT: If the certificate older is an ADDITIONAL INSURED, the the terms and conditions of the Policy, certain policies may require an e oe111fieate holder in lieu of such endorsemeM(s), PRODUCER Keen Rattle Mead & Company 7850 Northwest 146 Street Suite 200 Miami Lakes, FL 33016 INSURED All Pro Plumbing Corp;A11 Pro Septic & Sewers Inc;A11 Pro Plumbing Septic & Sewers Inc;A17 Pro InveStment ;Al1 Pro Investment Holdings 2700 NW 27 Avenue Miami, FL 33142 COVERAGES— CERTIFICATE NUMBER: 12 -13 G THIS IS TO Q5RTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEQJ/139U5D YO THE INSUR €D NAM p�iASOVE FORTH p0( ICY PERI0! INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITioN OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPEOT TO WHICH THIS isseCERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED EY 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. ALL PRO PLUMBING PAGE 02/02 81 ,1TY INSURANCE m mireMaroorr"Y) 03/27/20X2 GENERAL LIABILITY X COMMERCIAL GENERAL. LIABtUTT CLAIMS-MADE U OCCUR GEM AGGREGATE LIMIT APPLIES PER: ^^ P AUTOMOBILE Luietury X ANY ArrO ALLOWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS UMBRELLA LIAR EXCESS LIAB x LOC OCCUR CLAIMS -MADE _ DEDUCTIBLE X RETENTION 3 10,000 WORNaliS OMPF.N$A AND EMPLOYERS't.IA91LITY c ANY y IN ECUiV6� O ICEW B )(CwDED J N (Mandatory h NH) its. DEscR4PT do-to OF OPERATIONS below POLtCYNUMIR Ep1rY'i [Mtdii' 21UENQ0729102101/2012 02101/2013 8A0326R110 05120/2011 03120120 UMITs EACH OCCURRENCE MED EX? (My one perxon) PERSONAS 8 ADM INJURY GENERAL AGGREGATE PRODUCTS- COMP/OPAGO S 1 000 t0 s 30I7,00 5,000 1; 1,000,000 S 2,0003000 s 200 ,000 COMBINED SIM S LIMIT (Es eeeident BODILY INJURY (Per Denson) BODILY INJURY (Per accident) P MANAGE (PSr soccent) 0 $ 5 1,000,000 $ 21,14111X107291 02/01/2012 02/01/2013 0AOH00cunRENCEE AGGREGATE • 1,000,000 • 1,000,000 0830 —Z 445 04/08/2012 04406/2013 /IAT� E.L. EACH ACCIDENT E.L. DISEASE • EA EMPL©YEE st DISEASE. POLICY uMIT DESCRIPTION OF OPERATIONS 1 LOCATIONS N$ J VEFIIGL{ g (peach ACORD 101. Additional Remarks Schedule. Ff more epos la required) FAX; 305.756.8972 C'i'ty of Miami Shores 10050 NE 2 Ave Mti.mi Shores, FL 33137 ACORD 25 (2000109) OTH- ER $ 1,000,000 O 1,.000,000 0 1 000,000 CANCELLATION SHOULD ANY OF THE ASOvE DESCRIBED POLICIES BE CANCELI D BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE 0EL1YERED IN ACCORDANCE WITH THE POLICYPROVIs10NS. AUTHORIZED REPRESENTATIVE Alex Perez MC The ACORD name and logo are registered markssooffAACORp RD CORPORATION. All rights reserved. 04/17/2012 16:03 3056357473 • -: NU+1lMFD'AGE• COUNTY • ' ; : TAX .t;0LE CTOR, ' 140VA. FLAGLER ST. • yst'FL00R : •• •• MIAM1, FL 331.30 608414-9 ALL PRO PLUMBING PAGE 01/02 • 2011 • • L• OCAL. SUS1NESS;.TAX PE iPT. • M11iliAl-a:R}y,�a..����C��py�,t:.Jr��Srf.... S! FyATtOy.}F.�FLOI3iDA '•• MU ST BEDiSPLAYEtaAT.PLACE'0F•SUSK... • • PUiRSLI ANT I.4y:c LINTY' cGC1E cHAP.;ER•'$'A —Amt. t. :. ".7:•' • ••L ii . ••'4.' .iA • "• ?i:. •:` } Y:ariyn . JU: S... eil;•. I' V..C.::iu.::,gVei.' {.wve., THIS IS NOT A SILL- DO NOT PAY , RENEWAL RUMNESS NAME / LOCAi1ON • RECEIPT NO_ 634664-7 ALL •PRO PLUMBING SEPTIC AND SEWER STATE# CFC1427464 INC 2700 NW 27 AVE 33142• MIAMI' OWNER ALL PRO. PLUMBING SEPTIC AND SEWE Sot. Ty• of Ottainaaa 196 PLUMBING CONTRACTOR Asa- -LASS U.S. POSTAGE PAID MIAMI, FL PERMIT NO: 231 Tits 13 WEEVERS TAX ONLY RECE PST. °tt ODES NOT PEANUT THE SOLDER TO VIOLATE ANY EXXIATING REGULATORY OR WPM COUNTY OR DOES IT EXEMPT THE HOLDER FROM ANY OTHER N uIMD I.AW WIs OR LICENSE NOT A CERTIFICATION OP T HOLDERS OUALPrTCA+ PA MFDAD @R COMM. TAX OOLLEDTOR: 07/06/2011 60060000371 000045.00 SEE OTHER SIDE WORKER /S • 1. DO NOT FORWARD ALLCPRO PLUMBING SEPTIC AND SEWER BARRY*TEIXEIRA PRES 2700 NW 27 AVE MIAMI FL 33142 ' h L1bollLLLIdRRI ILIRI,•11•LLtI,l,►IIJLiur1nmlh 19L,1 06/12/2012 14:09 3056357473 ),. • ALLPRO SEPTIC SEWER PAGE 02/02 -e • .....