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PLC-12-702Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: 005)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 172619 Permit Number: PLC -4 -12 -702 Scheduled Inspection Date: March 13, 2013 Inspector: Hernandez, Rafael Owner: PROPERTIES LLC, SHORE SQUARE Job Address: 9031 -9069 BISCAYNE Boulevard Miami Shores, FL 33138- Project <NONE> Contractor: BLUE BAR PLUMBING INC Permit Type: Plumbing - Commercial Inspection Type: Final Work Classification: Addition /Alteration Phone Number (305)779 -8040 Parcel Number 1132060110051 -31 Building Department Comments RELOCATE BATHROOM DRAINAGE LINE Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments March 12, 2013 For Inspections please call: (305)762 -4949 Page 5 of 43 F ESPI RITO r a 1=* Telephone 305 -46 1 -2882 jobs@esgraphics.net Fax 3A-461-2880 1 ACCOUNT MIAMI SHORES VILLAGE CITY HALL- BLDG DEPT. 10050 NE 2nd AVENUE MIAMI SHORES, FL 33138 Invoice # 46970 II 2 Hof viv\s— I t �I . SPECIAL INSTRUCTIONS : ORDER BY: ARLEEN (305) 795 -2204 Date Due Date PROJECT / JOB NUMBER 10/10/2012 11/9/2012 SHORT SQUARE SHOPPING Item Qty Description Rate Amount 00.00 1 5 OPAQ. ORIG. 24X36 - 1 SET ES PRINTS ON BOND -BOUND Sept 2010 - Minimum Order Charge 25.00 25.00 Fr Remember We Take Credit Card y is " Subtotal $25.00 MAILING ADDRESS : 9592 SW 88th STREET * MIAMI * FLORIDA * 33176 LOCATION ADDRESS : 275 UNIVERSITY DR * CORAL GABLES * FLORIDA * 33134 Sales Tax (7.0 %) $0.00 PLEASE_ SIGN & PRINT : Total $25.00 } E S P1 R 1 Tc, NJ TD ON INI AD SI Ow TELEPHONE (305) 461 - 2882 FAX (305) 461 - 2880 ESGRAPHICS @BELLSDUTH.NET COMPANY NAME: I A VILLADE: ORDER BY: 1c�j S, f-L_ TELEPHONE: PROJECT NAME: (Q5_. --7 L1 TIME Sc DATE NEEDED:; BILL TO: DELIVER ORIGINALS TO: DELIVER PRINTS TO: DIGITAL NO OF ❑ENLARGE TOTAL FILES SIZE ❑REDUCE BINDING SETS 5 3Y,xatj % OYES ONO O�O ❑ YES ONO INSTRUCTIONS: ND OF DRIG. PH®ToC SIZE FINISHING ®PIES BINDING TOTAL SETS TOTAL SETS B.Sx 1 1 ❑ 8.5x14 11x17 ❑ SGLE 510E0 DSLE SIDED 0 SPIRAL GSC , ❑ SCREW POST ❑ MATTE ❑ GLOSSY SGLE SIDED 0 DSLE SIDED ❑ S.Sxt 1 ❑ 6.5x3a ❑ 1 1x1'7 SGLE SIDED DSLE SIDED 0 SPIRAL GSC ❑ COIL ❑ SCREW POST; 0 S.Sxt I ❑ t 2xt 7 NO OF ORIGINALS SIZE COLOR COPIES PAPER FINISHING BINDING TOTAL SETS 6.5x1 1 t 1x17 ❑ 1 2x1 a ❑ LASER PAPER ❑ CARD STOCK ❑ MATTE ❑ GLOSSY SGLE SIDED 0 DSLE SIDED t-�1 I..1 SPIRAL' 61:10 0 COIL SCREW POST 0 S.Sxt I ❑ t 2xt 7 LASER PAPER ❑ CARD STOCK MATTE ❑ GLOSSY 0OGLE SIDED ❑ SPIRAL SSSC 0 COIL ❑ SCREW POST NS: INSTRUCTIONS: SCAN NO CIF ORIGINALS COLOR DB /W SIZE SAVE FILE AS ❑PDF❑ TIFF ❑ JPG OUTPUT ['EMAIL 000 BURN MDUNTI NO OF ORIGINALS SIZE N 6 / C__AMIN MOUNTING ATI NG LAMINATING TOTAL ❑FOAM ❑ GATOR ❑ 3/ 1 6" 0 1 /2" ❑3 MIL ❑5 MIL ❑1 O MIL ❑ MATTES 0 GLOSSY ❑ FOAM ❑ GATOR 0 3/ 1 6" 0 1 /2" C13 MIL O5 MIL ❑1 0 MIL ❑ MATTE GLOSSY . RECIEVED BY': PRINT NAME: DATE: / / P11 Viiiage iami Shores Building Department RECEIPT PERMIT #: [/7--RZ DATE: I, 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 ❑ Contractor ❑ Owner o Architect Picked up 2 sets of plans and (other CopL Address:' °mil Out5 IS fir___ BwITh From the building department on this date in order to have corrections done to plans And /or get County stamps. I understand that the plans need to be brought back to Miami Shores Village Building Department to continue permitting process. Acknowledged by: PERMIT CLERK INITIAL: RESUBMITTED DATE: I O c 17i PERMIT CLERK INITIAL: (2_5 51aq °N- �Xl iiii•IGFIlt) 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 APPLICATION FBC 20 Permit Type: PLUMBING OWNER: Name (Fee Simple Titleholder Address: 696 %t 1 City: APR 1 2u iZ Permit No.Vb gC:-/CYL Master Permit No. Tenant/Lessee Name: Finail• JOB ADDRESS: (ictelisdkAPoc, (Att, tuiDoLutc City: Miami Shores Folio/Parcel #: Is the Bu tiding Historically Designated: Yes NO Flood Zone: County: Miami Dade Zip: CONTRACTOR: Company Name:'Vf.9 € LA ,A-4-4-5 +3 Address: S P b )L)� Phone#Ecj g‘ D7_ S) City: A.l.P Qualifier Name: State: Zip: —3- i cep Phone#: 1-86-6 7.-3 State Certification or Regis • ` • on #c.42�-DS-6 ci Certificate of Competency #: Contact Phone#:5 `� 86 D2-1'4 p Email Address: DESIGNER: Architect/Engineer: Phone#: Value of Work for this Permit $ 2-0/ 000. 00 Square/Linear Footage of Work: Type of Work: °Address °Alteration °New DRepair/Replace °Demolition Description of Work: 12 C4 -40-tt otUvfra,. -c_ e ********* * * * * * *** * * * * * * * * * * * * * * * *** * * * *F * * * * * *** * * ***** * **** yea * *** *** ** * **** **** *** Submittal Fee $ Permit Fee $ CCF $ Scanning Fee $ Radon Fee $ DBPR $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ CO /CC $ Bond $ TOTAL FEE NOW DUE $ (01 a 00 OPP Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approv '. a reinspection fee will be charged. Signature /40, r or Agent q The foregoing instrument was ackno ledged before me this 16 2019. by 0 MYY \ °'' 2 _, day of w is personally kno . me or who has produced As identification and who did take an oath. NOTARY PUBLIC- Sign: Print: My Commission E * * * * * * * * * * * * ** APPROVED BY ca "!:3'' RICARDO E. B o NOTARY PUBLIC STATE OF FLORIDA Comm# DD971115 * Contractor The foregoing instrument was acknowledged befo me this ,20j , by own to me or who has produced as identification and who did take an oath. NOTARY P I LIC: Sign: Print: My Commissi NOTARY PUBLIC STATE OF FLORIDA Comm# DD971115 14******* * * * * * * * * * * *** * * **** *** * * *** * *es Plans Examiner Structural Review (Revised 07/ 10 /07XRevised06/l0/2009)(Revised 3/15/09) /z Zoning Clerk LI la Permit o:12 -7020 Job Name: April 20, 2012 Miami Shores Viiiage Building Department Building Critique Sheet 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 1) Provide letter of acknowledgement from the building owner. 2) Provide approval from Miami Dade County DERM. 3) Provide a building permit application for the slab and drive repair. 4) Provide details of slab repair by designer at job prior to pouring. Page 1 of 1 Plan review is not complete, when all items above are corrected, we will do a complete plan review. If any sheets are voided, remove them from the plans and replace with new revised sheets and include one set of voided sheets in the re- submittal drawings. Norman Bruhn CBO 305 - 762 -4859 413011 z v-41\r✓ Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Date: Date: Permit #: Pl e 1 x ` 7!1 2- Plumbing Critique Sheet Review Completed by: Rafael Hernandez Chief Plumbing Inspector www.sunbiz.org - Department of State •FLORIDA EP:ART;MEN' OE TATS • Home Previous on List Page 1 of 2 Contact Us E- Filing Services Document Searches Forms Help Next on List Return To List No Events No Name History Detail by Entity Name Florida Limited Liability Company SHORE SQUARE PROPERTIES, LLC Filing Information Document Number L11000075982 FEUEIN Number NONE Date Filed 06/30/2011 State FL Status ACTIVE Effective Date 06 /28/2011 Principal Address 696 NE 125TH STREET NORTH MIAMI FL 33161 US Mailing Address 696 NE 125TH STREET NORTH MIAMI FL 33161 US Registered Agent Name & Address ROBERT A. BRANDT, PA 696 NE 125TH STREET NORTH MIAMI FL 33161 US Manager/Member Detail Name & Address The MGR IZHAK, YORAM 696 NE 125TH STREET NORTH MIAMI FL 33161 US Title MGR LIPTON, ALAN 649 OCEAN BLVD GOLDEN BEACH FL 33160 Annual Reports No Annual Reports Filed Document Images Entity Name Search Submit 1 http:// www .sunbiz.org/scripts/cordet.exe ?action =DETFIL&inq_doc number= L11000075982&inccame... 4/18/2012 www: sunbiz.org - Department of State Page 2 of 2 06/30/2011 -- Florida Limited Liability I View irnage in PDF format Note: This is not official record. See documents if question or conflict Previous on List Next on List Return To List No Events No Name History 1 Home J Contact us J Document Searches J E -Fling Services 1 Forms J Help 1 Copyright © and Privacy Policies State of Ronda, da, Department of State Entity Name Seam Submit http://www .sunbiz.org/scriptsicordet.exe ?action= DETFIL&inq_doc number =L 11000075982&inq_came... 4/18/2012 MiamiShores Viitage Building Department RECEIPT PERMIT #: Pb 1 I " )O • DATE: o Contractor o Owner o Ar 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Picke Address: From the building department on this date in order t have corrections done to plans And /or get County stamps. I understand that the plans need to be brought back to Miami Shores Village Building ► -p. ment to continue .•-rmitting process. Acknowledged nowledged by: PERMIT CLERK INITIAL: V RESUBMITTED DATE: PERMIT CLERK INITIAL: 1 MAY -30 -2012 11:05 From: To:3057568972 Page :1'1 '`'' !� r CERTIFICATE OF LIABILITY INSURANCE DA 5/30/120 PRODUCER AIIstar Assurance 1398 SW 160th Ave, Suite 20 Weston, FL 33326 Phone (954) 618 -5092 Fax (305) 974 -1358 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERT FICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLIC ES BELOW. INSURERS AFFORDING COVERAGE NAIC # INSURED BLUE BAR PLUMBING INC. 11011 NW 18th St Pembroke Pines, FL 33328 1 (954) 447 -6474 INSURER A: Granada Insurance Co. 33545 INSURER 0: Progressive Insurance Co LIMITS INSURER 0: Castle Point National Insurance Co INSURER D' 0185FL00025785 INSURER E: 04/15/2013 THE ANY MAY POLICIES. POLICIES REQUIREMENT, PERTAIN. OF INSURANCE LISTED HAVE BEEN TERM OR CONDITION OF ANY THE INSURANCE AFFORDED BY THE AGGREGATE LIMITS SHOWN MAY HAVE ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH BEEN REDUCED BY PAID CLAIMS. INSR UR ADD 1- NERD TYPE OF INSURANCE POLICY NUMBER POLICY EPFECTIvE DATE MMIDD/YYYV POLICY EXPIRATION DATE MM/D' LIMITS © GENERAL LIABILITY R/ COMMERCIAL GENERAL LIABILITY ❑ El CLAIMS MADE • OCCUR • 0185FL00025785 04/15/2012 04/15/2013 EACH OCCURRENCE 1,000,000 PREMISES Ea occurrence) 100,000 MED EXP (Any one person) 5,000 PERSONAL & ADV INJURY 1,000,000 ❑ GENERAL AGGREGATE 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: n POLICY • PROJECT ❑ LOC PRODUCTS - COMP/OP AGG 2,000, 000 B I n AUTOMOBILE LtABiL1TY ❑ ANY AUTO • ALL OWNED AUTOS J SCHEDULED AUTOS • HIRED AUTOS • NON OWNED AUTOS ❑ 05486506 -2 07/12/2011 07/12/2012 COMBINED SINGLE LIMIT (Ea acoldent) 100,000 BODILY INJURY (Per person) BODILY INJURY (Per accident) • PROPERTY DAMAGE Per accident) ❑ GARAGE LIABILITY ❑ ANY AUTO AUTO ONLY - EA ACCIDENT OTHER THAN EA ACC • AUTO ONLY: AGG • WORKERS EMPLOYERS' ANY PROPRIETOR OFFICER (Mandatory If yes, describe SPECIAL.. EXCESS / UMBRELLA LIABILITY EACH OCCURRENCE • OCCUR • CLAIMS MADE AGGREGATE ❑ DEDUCTIBLE ❑ RETENTION S COMPENSATION C AND LIABILITY Y/N / PARTNER / EXECUTIVE / MEMBER EXCLUDED? in NH) under PROVISIONS Detour WSAUIEC12120802 10/22/2011 10/22/2012 ® We STATU- ❑ OTH- TORY LIMITS ER E.L. EACH ACCIDENT 100,000 E.L. DISEASE - EA EMPLOYEE 500,000 EL DISEASE - POLICY LIMIT 100,000 OTHER DESCRIPTION PLUMBING OP OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT 1 SPECIAL PROVISIONS CERTIFICATE HOLDER MIAMI SHORE VILLAS 10050 NE 2ND AVE MIAMI, FL 33138 FAX# 305 - 756 -8972 ACORD 25 (2009/01)14F CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBUGATION OR LIABIUTY OP ANY KIND UPON THE INSURER, ITS _ . TS OR REPRESENTATIVES. AUTHORIZED REPRESENTA ®199 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD NOTICE OF COMMENCEMENT A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION PERMIT NO.201204I l TAX FOLIO NO. STATE OF FLORIDA.. COUNTY OF MIAMI -DADE: THE UNDERSIGNED hereby gives notice that improvements will be made to ce 1 property, and in accordance with Chapter 713, Florida Statutes, the following inftwatkIn is provided in this Notice of Commencement. BY,— 11111111111111111 111111111111 11111111 11111111 CFN 2012R0382394 OR Bk 28130 Ps 0642; (fps) RECORDED 05/31/2012 10:14:07 HARVEY RUVIHv CLERK. OF COURT MIAMI -DADE COUNTYr FLORIDA LAST PAGE COW ff DPZE copy of ;re /PAY A D s— .c. Space above reserved for use of recording office 1. Legal description of property and street/address: -7 /,` .� . rj C.Cj/ B / s-t"� d c/ [i.a. T,', A-4.-- 2. Description of improvement: ,? 3. Owner(s) name and address: Interest in property: Name and address of fee simple titleholder: _ 4. Contractor's name, address and phone number C ZF 5. Surety: (Payment bond required by owner from contractor, if any) Name, address and phone number Amount of bond $ 6. Lender's name and address: 7. Persons within the State of Florida designated by Owner upon whom notices or other documents may be served as provided by Section 713.13(1)(a)7., Florida Statutes, Name, address and phone number. 8. 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 and phone number: 9. Expiration date of this Notice of Commencement: ?— JD —.�.i? (the expiration date is 1 year from the date of recording unless a different date is specified) 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 PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT. Signature(s) of Owner(s) Prepared By Print Name efeAs=Tin. r✓ Title /Office [;01..).07 e/ f .e-et Title /Office STATE OF FLORIDA COUNTY OF MIAMI -DADE The foke9oing in runer}k w s acknowledged before me this day of By e,'1.(� k:01151\ .Individually, or ❑ as acitirm for rsonally known, or ❑ produced the following type of id r(s) • rized .� per /Director/Partner /Manager Prepared B Print Name Signature of Notary Public: Print Name: (SEAL) VERIFICATION PURSUANT TO SECTION 92.525. FLORIDA STATUTES Under penalties of perjury, I declare that I have read the foregoing and that the facts stated in it are true, to the best of my knowledge and belief. Signature(s) of/a • - By r r`(s) or Owner(s)': Autho 123_01 -52 PAGE3 3112 4 SUNEYT MARTINEZ F. Bonded Through National Notary Assn. Notary Public • State of Florida My Comm. Expires Jan 12, 2013 Commission # DD 848562 P"411"v I ed Officer/Director /Partner /Manager who signed above: By Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 179941 Permit Number: DS -5 -12 -884 Scheduled Inspection Date: November 19, 2012 Inspector: Bruhn, Norman Owner: PROPERTIES LLC, SHORE SQUARE Job Address: 9031 -9069 BISCAYNE Boulevard Miami Shores, FL 33138- Project: <NONE> Contractor: QUICK CUT CONCRETE CUTTING INC Permit Type: Driveways /Sidewalks /Slabs Inspection Type: Final Work Classification: Addition /Alteration Phone Number (305)779 -8040 Parcel Number 1132060110051 -31 Phone: (954)776 -5188 Building Department Comments SLAB CUTTIN FOR SEWER LINE TRENCHING. CONCRETE SLAB REPAIR AFTER PLUMBER BACK FILLS OPEN PIPES Infractio Passed Comments INSPECTOR COMMENTS False Passed ,';;; //777'9/ Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments CREATED AS REINSPECTION FOR INSP- 173751. Flooring must be complete. Bath floor and base must be impervious. No plans or permit. NB November 16, 2012 For Inspections please call: (305)762 -4949 Page 15 of 29 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 PLc-12 -1O2 Inspection Number. INSP - 173752 Permit Number: DS -5- 12-884 Scheduled Inspection Date: June 07, 2012 Inspector. Bruhn, Norman Owner: Job Address: 9031 -9069 BISCAYNE Boulevard Miami Shores, FL 33138- Project <NONE> Contractor: QUICK CUT CONCRETE CUTTING INC Permit Type: Driveways /Sidewalks/Slabs Inspection Type: Foundation Work Classification: Addition /Alteration Phone Number (305)779 -8040 Parcel Number 1132060110051 -31 Phone: (954)776 -5188 Building Department Comments SLAB CUTTIN FOR SEWER LINE TRENCHING. CONCRETE SLAB REPAIR AFTER PLUMBER BACK FILLS OPEN PIPES Inspector Comments Passed L Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. June 06, 2012 For Inspections please call: (305)762 -4949 Page 15 of 24 Mau 31 2012 12:34PM QUIK CUT 9547764775 page 1 CERTIFICATE OF LIALITY INSURANCE BI I. Data 5242012 Producer: Lion Insurance Company 2739 U.S. Highway 19 N. Holiday, FL 34691 (727) 938 -5562 This Certificate Is issued es 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 me policy below. insurers Affording. Covelage NAIC # • Insureds South East Personnel Leasing, Inc. & Subsidiaries 2739 U.S. Highway 19 N. Holiday, FL 34691 Insurer uonUlsura7ua0ompally :i°i5 Insurer B: Insurer C: Insurer D: Insurer E: Covers S ttb masticate paid claim trance maybe : stedbobw have been issuadtolhehmwedri mama above tart* poky pwiodlndlomed .NobrtiFarardln9any requiernenk been oroondlsanof any corked * : other document web respect* vides issued ar may pavan the insurance atruzded byte pdfdas desodbed herein le subject to alto terms, exclusions, and carffitons of sixth bbtldee. Aggregala rmie 'shown rneytew beenredwad by INOR LTR ADOL NSRD Type of Insurance PoOcy Number Potty Effective Dale . (MM/DD/YY) ' Policy Expiration Data (MM/DD/YY) LIMBS . h...�..r.r GENERAL General LABILITY Commercial General LlabIIty Claims Made ❑ Occur eachooamanoe $ Damage tc retied premises (EA occurrence) ty Med Er0 $ aggregate limit applies per Poky 0 pea ❑ LOC Personal Advinjury t General Aggregate $ Produce - CompGp Ago $ AUTOMOBLE we LIABLITY Anf Auto AOOaavned Autos Scheduled Autos HiredAutas Nat•OwwredAulas Combined Single umit (SA AcddrrQ $ 6odiV hull {Per Pelson) $ Bod+H Intizy iper Avoids nt) t Property Damage (Pet•Accderd) $ EXCESS/UMBRELLA JA ABILITY / Eathoaztrrsrce Omer 8...1 Claims Made Aggregate OaducBbb A Workers Compensation and • Employers' Liability Any proprietodparbierlexecutive officer/member NO If Yea, describe under special prov)slone below. WC 71949 01/01/2012 • • 01/01/2013 x I I I EC. Eedr Accident • Kamm E.L. Disease - Ea Employee 81.000.000 L.L. Disease - Polley Units KOLA= other Lion Insurance Company Is A.M. Best .Conipariy rated A- (Excellent). AMB #12616 Descriptions of Operations /LocationsNahk;les/Excluslons added byEndoreement/Speeial Proviebns: Client ID: „3 Coverage only applies to active employee(s) of South East Employee using Services, Inc. that are leased 1• the following "Client Company": • Quik Cut, Concrete Cutting, Inc. Coverage only applies to injuries Incurred by South East Personnel Leasing, Inc. & Subsidiaries active employee(s) , whlle worldng In Florida. Coverage does not apply to statutory employee(s) or Independent cantractor(s) of the Client Company or any other entity. A Ilst of the alive employee(s) leased to the Client Company can be obtained by faxing a. request to (727)937-213S or by calling (727) 9385562. • Project Manse: FAX:9&4 -776 -4778 & 305 -T58 -88721 ISSUE 05 -04-12 (SS) / REISSUE 05 -24-12 (SS) . . . Beep+ Dater 3/21/2010 CEiTIFICATEHOLDER . DANSEL ATION MIAMI SHORES VILLAGE BUILDNGREPAiMENT 10050 N.E.2ND AVENUE MANE SHORES, FL 3313® rd ryofdra sbwedee tbedpOciesbecaeeeaed baray aaxyxtratlondaleoer�thalei rgtnarerww aartomall3odayetautenri tothece, tcatehnamedtttei�tbutEatk doao•ah1imposer tonorIaleIVofaejkindupon8reIrgs er. be agenb3ce• seeedeniatleea • L�r 1 ,(00/ik Co f TERMINIX 96q 77 �CifI ACTOR'S NOTICE OF TERMITE PRE - TREATMENT Ter 'nix intends to perform a soil pre- treatment at: -6 LID Liu On (date): LP 12 Product to be Applied: At (time) J 19.-. Prelude (EC) - Permethrin at 0.5% [ ] Premise 0.5 (SC) — Imidacloprid at 0.05% Premise 75 (SP) — Imidacloprid at 0.05% Termidor 80 (WG) — Fipronil at 0.06% (Product Name) (Active Ingredient) ( %) It is the contractor's responsibility to notify construction workers and other individuals to leave the treatment area during application and to remain off the treated area until the termiticide is absorbed into the soil. Sig i ature of ,' o ract y. • struction Superintendent, or simi ar esponsible party: Date: ' 2 Tdchnician: © 2002 Terminix Intemati nal Co. L. Key # 31226 Rev. 7/02 R/P 7/0 White Copy - Branch Yellow Copy - Responsible Party at 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 Permit No. PERMIT APPLICATION FBC 20 MAY i7Z1 BY: ... ® Master Permit No. 1 2-- ° Permit Type: BUILDING ROOFING , q � OWNER: Name (Fee Simple Titleholder): >,u� r� S �+ u �./'.a� P'� �`'" ' i Phone# 4.1 Address: io ri to 14 E. V L.& ' &I- . City: INA e Ern ' rA,) 1 State: F Tenant/Lessee Name: Fc- 1 1 I c 1 Email: JOB ADDRESS: 9 4°S ' S c- Q-1 *"3""" City: Miami Shores FoliolParcel #: Is the Building Historically Designated: Yes NO Flood Zone: Zip: 3 I k Phone#: 0 S - 9 `i 0 - ® (p (©9. I (.) ) rr'N. ) S o County: Miami Dade Zip: CONTRACTOR: Company Name: Q V �`( Co eonci(ck— C4 -/An) Inc- Phone#: q [ 11 (9 st 8' Address: 3 C� N�����' S- S t -kr C. City: rock_ LamciQ.tdaL&. state: Zip: 3333LI Qualifier Name: \J aVINfS 8 i Sh o,P Phone #: 9 SLL 1) ( S(' 2 State Certification or Registration #: C,(7C 1St/ (4 '( Certificate of Competency #: Contact Phone#: Email Address: DESIGNER: Architect/Engineer: Phone #: Qvi kc,v+ e ems-o • v‘ e)— Value of Work for this Permit: $ I I Type of Work: ❑Addition ❑Alteratiyonn, Description of Work: S 1 cy. L. u 7 1 i e� 9 Square/Linear Footage of Work: UNew ❑Repair/Replace 1 Demolition x�x��x�x:x+x�x* * x��x*** *�x�x�x�x**** * **�x�x *�x�x�x **** Fees********************* �x****�x�: ****x�+�***�:w�x�x*** Permit Fee $ AD ©3J CCF $ CO /CC $ Radon Fee $ DBPR $ Bond $ Training/Education Fee $ Technology Fee $ Submittal Fee $ Scanning Fee $ Notary $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ COO 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, BOTT,FRS, 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 properly is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs sever/ 7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved a spection fee will be charged. Signature f / Signature er or Agent • • ntractor The foregoin ins 1 m''t was acknowledged before me this The foregoing instrument was acknowledged before me this day of , 20 , by ilk «Ur 1-2,hatif— , day of 2012', by —J a Vl S c61 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 identification and who did take an oath. NOTARY PUBLIC: Sign: Print: lido Ut'of, L o D Commission Expires: ** ** * * * * # * * * * * **** ** ** APPROVED BY of Notary Public State of Florida Jacqueline Ortiz *Alridinuta iixlsesor * ** Expires 04/15/2018 lans xaminer NOTARY PUBLIC: Sign: Print: My Commissi i e s: HO -STATE OF FLORIDA Karen B. Small `Commission #DD878950 Expires: MAY 26, 2013 CBOND[ \G CO. g/l0 /1i' Zoning Structural Review Clerk (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) PROPOSE TRENCH 1.111iL 4••• .4 It I b1,1 "FAMILY DOLLAR" TENANT 9045 0111110 .111.1111W- :11111111111 TENANT 9045 PARTIAL FLOOR PLAN. TRENCH FOR SANITARY BLDG DRAIN RELOCATION SCALE: N.T.S. Scope of work: HANDSAW, REMOVE HAUL THK SLAB FOR PLUMBING TRENCHES IN HALLWAYS AND/OR BATHROOM. NEW CONCRETE AFTER PLUMBER BACKFILLS OVER PIPES TO 1° ABOVE SLAB BOTTOM, INCLUDES TAMP, TERMITE PRETREAT, VISQUEF_N, MIS # 5 REBAR DOWELS, 3000 PSI CONCRETE WITH STEEL TROWELL FINISH. EXISTING SLAB ON GRADE #5012"o.c. x 2'-6" LONG. DRILL & EPDXY W/HILTI HY150-6" MIN. EMBEDMENT INTO EXIST. CONCRETE SLAB EL FIELD VERIFY TOP OF SLAB ?411111111111111111111- I I =1 1 I. 1. 2'-op #5012" O.C. TWO WAY REPLACE THE CUT—OUT PORTIONS OF THE EXISTING FLOOR SLAB ON GRADE WITH 4" MIN CONCRETE SLAB ON VAPOR BARRIER OVER WELL COMPACTED FILL, REINFORCED WITH #5©12" O.C. TWO WAY PLACED I" MIN FROM THE TOP OF SLAB CONCRETE SLAB ON GRADE REPAIR DETAIL SCALE N LS NOTES: 1—FINISH TO MATCH EXISTING. 2—ALL WORK TO COMPLY WITH FBC. B.D.R. 05.04.2012 SKETCH SCALE: N. SHORE SQUARE SHOPPING C CLIENT: SHORE SQUARE INVESTMENT, LLC PROJECT LOCATION: MIAMI SHORES, FL 33138 CLIENT ADDRESS: 3850 BIRD ROAD, MIAMI, FL 33146 LAN C. 2 N. 79 AVENUE AMI LAk S, FL 33016 TEL 305.828.0644 FAX 305.828.6484 • ; reyesgavilarrang@bellsouth.net C.A. No. 8464/ P.E. No. 48181