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RC-12-1522
Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 184720 Permit Number: RC -8 -12 -1522 Scheduled Inspection Date: January 29, 2013 Inspector: Bruhn, Norman Owner: BORENSTEIN, NICOLE Job Address: 441 GRAND CONCOURSE Miami Shores, FL Project: <NONE> Permit Type: Residential Construction Inspection Type: Final Building Work Classification: Addition /Alteration Contractor: EJD CONSTRUCTION CONSTRACTORS & INVESTMENT CO Phone Number (786)258 -2484 Parcel Number 1132060170310 Phone: (305)433 -4843 Building Department Comments INTERIOR REMODEL Infractlo Passed Comments INSPECTOR COMMENTS False Passed�i�� Inspector Comments Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. January 28, 2013 For Inspections please call: (305)762 -4949 Page 19 of 22 PERMIT # C, - CONTRACTOR: e130 CO Vj € 61 SUBMITTAL DATE: 1011 ADDRESS: 6 \!48 EyX/' NAME: Poc)f-e)oz-eA.r) RESUBMITAL DATES: IMPACT FEES ELECTRICAL Of\ PLUMBING &14 *B\14 ‘11 MECHANICAL HRS/DERM NOC Miami Shores Village Building Department li ,_,:-..._'S_-_-:1-0,917:g7- i Ji AUG i v 216i2 Yi B: l'... I C, rz,1 t i - ,.. ;, tx ...... , INSPECTION'S PHONE NUMBER: (305) 762.4949 Tel: (305) 795.2204 Fax: (305) 756.8972 ) ( 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 glaa 9011 _— Fa-1. C. FBC 20,1 BUILDING Permit No.",C, 10(—I PERMIT APPLICATION Master Permit No. JOB ADDRESS: 6ge7 aryldocer-x-e-- ROOFING City: Miami Shores County: Miami Dade Zip: 3$ /3 cr Folio/Parcel#: 1/ . 32640 • 017 - o..310 Is the Building Historically Designated: Yes NO v." Flood Zone: OWNER: Name (Fee Simple Titleholder): I iff 1 co le. eorer)S-tfin Phone#: Address: 44/ 61,-.1716 e-ooaot) rcs-e- City: fik cline 5/1,0/7-60 State: F4- Zip: 3.313a Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Natne: t J. 1) Co 4 gret/Gri. r0 in Phone#: 3 5133- V8'3 Address: (700 Ale- / 443 c:=S-jt • City: A1 . in/ t17)-1. I State: FA i zip: g3/8 / Qualifier Name: E t - 5 0096,67 iterlAl Phone#: 0 State Certification or Registration #: C eie- 15 I 9'01 Certificate of Competency #: Contact Phone#:36 3ig LtCn ? Email Address: ..ej(kokicte,1410r‘e a44 . ft..2../ DESIGNER: Architect/Engineer: 6...trait:I BelyaVe.... ba.siTs, (IA. Phone#: 000 ao Value of Work for this Permit: $ it 410, UVY • Square/Linear Footage of Work: Type of Work: ClAddition Alteration IZINew °Re ' IStitia&'1 Description of Work: 401/1#7,.. re of1 4e/it i H,..i.tolio,•,',„P, 4 ' , :1,= -,, ..,,;-:-_-,1,-: Color thru tile: ***************************************Fees******************************************** Submittal Fee $ Permit Fee $ f,, / C-2° cc-T $ Scanning Fee $ Radon Fee $ DBPR $ Notary $ Training/Education Fee $ Technology Fee $ l/W214r. Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ CO/CC $ Bond $ Bonding Cuinpany's Naas; (if aYpla.:tbk j Bonding Company's Address City Stan.. Zip Mort =g= L_nder's Na (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 FI I CTRICAL WORK, PLUMBING, SIGNS, WEI .i S, POOLS, = i MACES, BOILERS, HEATERS, TANKS and .AM. 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 IMPRO V EM ki; TS 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 valve exceeding $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature ' "`CQu"L C - Owner or Agent The foregoing instrument was acknowledged before me this 10 The fo _oing ent was acknowledged fore this) day of , 20/1--, by , day of ' � 201a by .L .f 1 , �/ I who is personally known to me or who has producedL"` w 4 >6,2- - 6A-7.- 0 As identification and who did take an oath. as identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Signature Contractor or who has produced Si Print. My )6? so *** *tory Public - State of Florida 44 My Comm. Expires Oct 18, 2015 .toFt-o ' Commission • EE 132379 ** *** Plans Examiner Structural Review Clerk APPROVED BY Sign: Print My Commission Ex UBILLOS to of Florida 015 s:= Commission # EE 128810 „° ;`,+ss`s Bonded Through Nationa o ary ssn. ** *** **** • ********** ** * • <.* ** *** *** *********** ** ” / /2--Zoning ti) 1(1/07)(Revised 06/10/2009)(Revised 3/15/09) NOTICE OF COMMENCEMENT A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION PERMIT NO. STATE OF FLORIDA: COUNTY OF MIAMI -DADE: TAX FOLIO NOB 3X6. 011. 03/0 STATE OF FLO 1 HEREBY CERTI original flied in this THE UNDERSIGNED hereby gives notice that improvements will be made property, and in accordance with Chapter 713, Florida Statutes, the follow �ry ad 'pm is provided in this Notice of Commencement. By 111111111111111111111111111 11111 111111111 1111 CFN 201280628448 OR Bk 28258 Ps 0423; (1ps) RECORDED 09/05/2012 12:09:33 HARVEY RUVIN? CLERK OF COURT MIAMI—DA DE COUNTY? FLORIDA LAST PAGE A, COUNTY OF LADE that this is Arzio copy aft CO on (% day of AD ncl Official Slat, LE :- Of Ciro. fy Ccurris J.C. Space above reserved for use of recording office 1. Legal description of property and street/address: .� =,-4i1S $i 2. Description of improvement: ,C /kC, /tiQ,1 Zi®1.01/4; -Ii 3.3138 3. Owner(s) name and address: ,V/ D( ®// r') qr%/ (S/ti11 don 33/38 Interest in property: Name and address of fee simple titleholder 4. Contractor's name, address and phone number: <} /) CAP 7 ! C le Cc 5 33 q-6543 /700 A /93 <SI. . /r3r s f=1- 33/8/ e- -efe'- zw. zort_zi,c.Ci -' . 5. Surety: (Payment bond required by owner from contractor, if any) O 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 persons) 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: (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 EXPIRAT1ON OF THE NOTICE OF COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART 1, 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 POS I ED 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) or Owner(s)' Authorized Officer/Director/Partner/Manager Prepared By Prepared By Print Name N i CO IQ 6 v)5 ( \ V\ Print Name Title /Office Title /Office STATE OF FLORIDA COU Q,t(�, -rm f BY for o entl{,A g ylrtB f a thi p�/ 0� day of a.3ed �+J � �'.. _l il�� ... Y. ri: e� i:r.. p, it.(J /L. 80 � ✓1 ❑ Indi — ❑ Pers pe of identifi Public: Print Name: (SEAL) VERIFICATION PURSUANT TO SECTION 92.525. FLORIDA STATUTES Under penalties of perjury, I declare that 1 have read the foregoing and that the facts stated in it are true, to the best of my knowledge and belief. Signature(s) off Owner(s or Owner(s)'s gtjio�rizzed Officer/Director/Partner/Manager who signed above: By , ��YJ "` �1��, N V By 123.01 -52 PAGE 3 3/10 A, Settlement Statement (HUD -1) 0140 Approval No 2502-0255 [3, Typo; of Loa❑ 1. DFHA 2. ❑RHS 3. DCotnt Urdu. 4. DVA 6. Dcam his. 6 Fie Nwi*sc 201 -242 7. Loan Mannar. 8. Madge. beam= Case Number C. Note This form Is furnished to give you a endement ofa settlement costs. Amanda paid to mat by the se t are shown. tens marked (p.o.c.)° bore pfd onside the closing they ere shown hero for Informational purposes and me not Inciudedin Mantels. D. Name &Address srHoneaar. Nicole hippo! BOrmodoi 1 E Nsms &Addressof ease ftsgmond Mateo mkt Dennis #listen 474 NE 95 Street, Mlsml FL 33138 F. Name & Address of Laedsr G. Property Locators 441 Graaf Concourse, Nand Shores FL 33138 H. Detyarrrant Agent Prone Resotrcel'6ta, trss 1110 Bra AM, Site 200 MIA FL 33131 (305) 677 -0164 Settlement Dan: 07/1612012 Macs ofsantemenl: 1110Brlcke5 Ave, Suite208. Moroi FL 33131 ■i 101. Corot sales pries 102. Personal Pr.,.,. 103, Settlement dirges to borrower (litre 1400) 104. 105. 10 GNy/taan tees 107. •. , Taos 108. Assessments 109, 110. 111. 112, 201. Dogrel or eat 202. Prinofpal amount of nob loan(a) 203. Existing {oafs) taken subject to 204. 205. 206, 1,300,00400 6.849.00 1,30,649.00 60000.00 207. 208. 209, 210. Ott taxes 211. County tuns 01101/20121o07/16t2012 212, Assessments 8,310.13 215. 301, Gross Amount doe Ban bonrower (line 120) 302. Less am ouants pail b Ra hammer Bine 220) 58,316.13 1,306,849.00 58,316.13 1,248,532.87 Disbursomeit 1>ato 07/16/2012 401. Contract sales pike 402. Rommel 403. 4. 407. County taxes 408. Assessments 400. 410. 411. 412. sou hislructimsj 602. Settlement charges to seller run 1400) 603. Existing tads) taken aim to 504 040 Meat 508. 607. 508. 609. 4r 610. Ctty/tcwrn tam 511. h• taxes 01101120121007118120'12 612. Aasesareards 613. 614. 515. MB. 517, 510, 519. 601.OrossAmotmt duetoSega (Ona420) 802. lass mduotious n anent Ws sober (tom 620) 1,300,.00 1,300,00000 87.606.00 586,090.70 6,318.13 582,815,83 517,084.17 The Public Reporting Burden for fhb outlect o n of kntormatlau Is estimated al 35 minutes per response for cotleattng, rovinwbng, and reporting the dam. This agency may not collect Ns krformatkm, and you are not required to a0rnptele 0tbi form, unless 3 e96p1aya currently valid OMB dorsal number. No cratidenetity 3 assurer; this disclosure Is mandatary. This is dasi to provide the pantos to RE$PA cowed transaction wilh k$wmatle n during the settlement process, BORROWER Meals Adapt Eimenstetn L. Set;letnept Charges Melon of emnm18610n (fro TOO) as Wows: 701. $39,000.00 to Keller Winne Eagle Realty 702. $38,100.00 to EWe Wormhole! Realty 703. Conamiselonpaid at settlement 801. OM Ortginetktri Mom (from GFE51) 802. Yaw rasdato' etarpe Moints>forthaspechte Wood reoctrosta 803. Yaw adjusted orighatkrt charges (from GFE 52) (from GFE A) 804. (from GFE 13) 805. 806. porn GFE 53) (from GFE i) 807. 808. (from OPE 13) (from OWE 53) 1001. im tlat deposit far gar escrow account 1002 He n owner's immerse (from GFE 39) 1003. Mortgage Inatome 1004. Property taxes 31 $1,28(. m,Wh 1005. 1008. 1007. Aggregate Aajustment $0.00 • 01. The services and ms's Ma Instance rtoe (from GFE 54) 1,010.00 1102 SettIeni 1 or dosing fee to Prime Resource Tltiq Ws. 3885.00 1103. Owner's Gie Insurance to WFG Negate! Title Inswance Company (from CFO 5) 5,826.00 1104, t endefs 40einsurance to WFO A lei The tr manneGompanp 1105. t ee'a We policy Omit 1108. Own 's tile potty lftrli $1,300,000.00 1107. Agate portion of the total tffe Insures= premium 14,077.50 1108. Underwriter's whorl of Om t elute Warrens* 11,747.50 1100. Storagefee to E- ClasIng 525.00 1110. Tab Search & F, a. to Nine Resarew TRth 200.00 1411. Aiken eyfee to Kramer & Golden, PA 1,282.00 1112. Calder fee to Kramer & Golden, PA 69.00 is) 1201. Government recording charges ut� (from GFE 1 ?7) 14,00 1202. Deed 810.00 Mortgage Releases 1203. Transfer Taxes (from GFE 98) . 1204. Cit/Ccuntytexfstemps Deed Mortgage 1205. State tmdetomps Deed $7,803,00 7,800.00 1208. E- Reomdng to Simp0<fle $4.00 from OFF OF 1301. Required services tot yotl can shop far (from GFE 86) 1302. Lm Search to lien Wdts 225.00 1303. ReOc upoloylee 10 Roberts!. Boerne, PA 75.00 1304. 1305. 1400. Total Settlement Charges lemon o+ :lines 103, Section J and 502, Section Kt 87,609.00 The HUD-1 Betlemeo statement which I have pregaiod lea nue rod a means naaown of Ole Rang nation. limn caused or cause the Midi *be dfesbursed In accordance with We Weterrnot Settlentad Argent Dots: Previous acetone we obsolete Page 2 of 2 farm HUD -1(1Jm Prepared by and Return to: Richard A, Golden, Esq. Kramer & Golden P.A. 1175 N.E. 125 Street, Suite 512 N. Miami, FL 33161 KGPA FILE NO,: 95 -12R Parcel ID Number: 11-3206-017-0310 Warranty Deed This Indenture, Made this f day of July Raymond Mateo and D s Mateo, husband and wife of the County of Miami -Dade Nicole Arippol Borenstein ,2012A.D., Between State of Florida , grantors, and whose address is: 441 Grand Concourse, Miami Shores, FL 33138 of the County of Miain --Dade Stale of Florida , grantee. Witnesseth that the GRANTORS, for and in consideration of the sum of TEN DOLLARS ($10) DOLLARS, and other good and valuable consideration to GRANTORS in hand paid by GRANTEE. the receipt whereof is hereby acknowledged, have granted, bargained and sold to the said GRANTEE and GRANTEE'S hefts, successors and assigns forever, the following described land, situate, tying and being in the County of Miami -Dade state of Florida to wit: Lot 21 and 22 and the Southwesterly 1/2 of Lot 23 Block 87 of AMENDED PLAT OF MIAMI SHORES SECTION FOUR, according to the Plat thereof, as recorded in Plat Book 15, Page 14 of the Public Records of Miami -Dade County, Florida. and the grantors do hereby fully warrant the title to said land, and will defend the same a -inst lawful claims of all persons whomsoever, t aSW OCSElated by ®plsiaysystama, rao., 2012 (863) 7634555 Form 07w03-2 Warranty Deed - Page 2 Paareei iD Number: 11-3206-017-0310 In fitness 'hereof, the grantors have hereunto set their hands and seals the day and year first above written. led and de in our presence: Ra atond Mateo P.O. Address: 474 N.E. 95 Street, Miami Shores, FL 33138 Printed Name: Witness P.O. Address: 474 N.E. 95 Street, Miami Shores, FL 33138 STATE OF Florida COUNTY OF Miami -Dade, The foregoing instrument was acknowledged before me this /4' day o f <9-0 f) , Raymond Mateo and Damaris Mateo, husband and s.fe who are personally known to me or who have produced their Florida dri 95.1211. nse as identifi 1 (Seal) (Seal) by Printed N Notary Public My Commission Expires: LH= tieootated by (1/ Dimply Systems, Inc.. 2012 Qi63) 763 -5555 Fe ssPLW D-2 Miami Shores Viiiage Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 RECEIPT PERMIT #:V` 12 —" (522. DATE: .10PNe I, 4. 1CAf .o ,,j Contractor o Owner ❑ Architect Picked up 2 sets of plans and (other) Address: /L/ 1 FJ L ( C 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: 0,„ PERMIT CLERK INITIAL: RESUBMITTED DATE: 9 ,1 1 1 PERMIT CLERK INITIAL: / 1 Miami Shores Village Building Department 1 10050 N.E 2nd Avenu Miami Shores, Florida 3313 Tel: (305) 795 220 Fax: (305) 756.897 Permit No. (2- Z-- Job Name PLUMBING CRITIQUE SHEET f Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Permit No. ke-- / 2— 1 S' 2., Job Name 4 41 47a....-el 6•t C Date 9— I6 -17i STRUCTURAL CRITIQUE SHEET 4:±1: tv% ,S,4;,74 tcuA. 4,3 kti_ 64-4 1/04-1,v4N cf.v4 4.-kowyt, Vost, ° o �.-- j o,•5 i3 L,,s. ke, 1.117,0t p 1r f e, ege uh. 4 az f - C-L1.4.ridd rt Q • p(t, CV V► ti.C. 'v- - £Yo N46 %Az st,,o.r 010.4A4210 eSet; Permit No: 12- /f Job Name: gioyzA( 07—,k/ Date: /7 .„4. ' Miami Shores Viiiage Building Department ELECTRIC Critique Sheet 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 YL,t-E—s 5%- A- 416-' ,c -r,� -i * b t S' e r P A- ve 4 —,7z 1-- 2907 m Air/1' 6 2'- z 0. / tep f rI-i L-J ©' -s'i z2 P pee/ T c/ t f 4 L,L ��D soe j-�a %?,' /7 N' % 3 %" ham- � e�/�c Inc % #7J.t 3/4 ,_r ,'?) c z) ems' fr E AP.-/2-1.e/T: P l� / /- 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. Review Complete by: Michael A. Devaney SR. Chief Electrical Inspector Aug. 14. 2012 2:02PM No. 6144 P. 3 ACOR© CERTIFICATE OF LIABILITY INSURANCE I BATE GAWOIN YT ) 08/1412012 PRODUCER AAA Insurance Consultants 11402 N W 41st Street Suite 213 Miami FL 33178 THIS CERTIFICATE 15 ISSUED AS A MATTER OP INFORMATION HOLDER. AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND. EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC 5 INSURED EJD Conetmction Contractors & Investment Corp. 1700 N.E. 143rd Street North Mlemi FL 331x4 =UREA A Mtd ConUnenl Insurance Co. PLN !CY EFfEET►VE laic iUrr�ettih 46103/12 INSURER B. INSURER C LIABILITY COMMERCUU. GENERAL LIABILITY imam D: X WSURF.R E: ..$ s 100,000 COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE ANY REQUIREMENT. TERM OR CONDI1TON OF ANY CONTRACT OR OTHER POCUM NT WITH MAY PERTAIN, THE INSURANCE AFFORDED BY THE POIICIES DESCRIBED HEREIN IS SUBJECT POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. FOR THE POLICY RESPECT TO WHICH TO ALL THE TERMS. POLICY E7fP OAT@1MN4 06103113 PERIOD INDICATED. THIS CERTIFICATE MAY EXCLUSIONS AND CONDITIONS LUSTS EACH OCCURRENCE NOTWITHSTANDING BE ISSUED OR OF SUCH 000.000 INSR LTR_ 401/11 NSR TYPE OP J NSURANCE POLrVyNUMUER PLN !CY EFfEET►VE laic iUrr�ettih 46103/12 A GENERAL LIABILITY COMMERCUU. GENERAL LIABILITY 04GL000850728 X PREMISE'S DAMAGE a,°„ml ..$ s 100,000 CLNM$ MADE X OCCUR MED EMI Dana+awpm) $ EXCLUDED PERSONAL BAD" INJURY 3 1.000 000 GENERAL AGGREGATE s 2,000,000 GE X HL IJfl APPLES pet MitiNgTS - COMPROP AGG 3 2,000,000 1 POLICY r 1 1 LOC AUTOMOBILE LIAOIUTY ANY AUTO ALL OWNEDAUTOS SCHEDULED AUTOS MIRED AUTOS NON OWNED AUTOS SINGLE LlADT i Bt10ILY INJURY OW pal $ BODILY INJURY (Pc* ) $ (Per s GARAGE LIABILITY ANY AUTO AUTO ONLY- EAAACCIDENT 5 EAACC $ OTHER WJI AUTO ONLY: *ea s EKCESMMMBIEELl A LIABI UTY OCCUR ❑ CLANW3 MADE DEDUCTIBLE RETENTION S EACH OCCURRENCE 3 AGGREGATE $ $ 3 $ T WoRstRB COMPENMATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE IMEEMSER EXCLUDED? Ifrm./kw/be talk, $PECIALPROYISIOHamemar I ILUT OTN- E.I. EACH ACCIDENT 3 EL DISGASE.. FA EMPLOYEE $ E.L DISEASE - POLICY LIMIT $ OTHER DESCRIPTION Of OPERATIONS/LOCATIONS rifEHIGL.ESI EXCLUSIONS ADDEDBYENDORSEMENTI $PECIALPRovisONS • General Contractor CERTIFICATE HOLDER CANCELLATIO City of Mlamt Shores 10050 NE 2nd Ave. Miami Shores, 33138 SHOULDANYOF THE ABOVEDESCR IBEDPOLICIESDECANCELLEDHEPORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE RIMIER NAMED TO THE LEFT, BUT FAILURE TO DO HO sNAU. IMPOSE PIO OBLIGATION OR LIABILITY OF ANY KWD UPON THE INSURER, ITS AGENTS DR REPRESENTATIVES. AUTHORIZED REPNrsoNTATWE CIA`. 4141g6Mm". ACORD 25 (2001 08) fBAWRD CORPORATION 1988 07 -21 -2011 JEFF ATWATER STATE OF FLORIDA CHIEF F64ANC IAL NICER DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS'. COMPENSATION * * CERTIFICATE OF ELECTION TO RE E -FLORIDA WOMBS CONWINSATION LAW * CONSTRUCTION IM3USTRY EXEMPTION This certifies that the individual listed below has elected to be • exempt from Florida Workers' Compensation law. EFFECTIVE DATE: 08!3012011 EXPIRATION DATE 08/29/2013 PERSON: SCARBOROUGH ERIC J FEIN 201222264 BUSINESS NAME AND ADDRESS: E 13 0 CONSTRUCTION CONTRACTORS & INVESTMEVT CORP 1700 NE 143 STREET N MIAMI FL 33181 SCOPES OF BUSINESS OR TRADE 1- NEW CONSTRUCTION 2- R DELINR IMPORTANT: Parsed to Chapter 440. 66(14). F.S., so officer of e corporation ate elects exempting from this demist by 1Ftiy a certifieeee of election ceder this section may eel recover benefits or commensaoa ender ibis chapter. Perseeet to Chapter 440.05(12). F.S.. Certificates of Westin to be exempt... fly wily with% the scope of the hesluess or trade listed on the mace of election to be eaeao-pt. Pars81412 to Chapter 440.05(73). F.S.. Notices of a *ecttau tit be exempt and certificates al elwifoa to he exempt shad be subject to revocation if. at any time after the Mop of the notice or the issuance al the certificate, the person motet on the notice or certificate ee lamer meets the rermiremems of this section for issanoce of a certificate. The dept shall revoke a certificate at any there for talkie of the mien named an the certificate to meet the regairemems of this - soetiuo. QUESTIONS? (8501 413-1603 UWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT MI= 01 -11 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 179684 Permit Number: MC -10 -12 -1885 Scheduled Inspection Date: January 09, 2013 Inspector: Perez, JanPierre Owner: BORENSTEIN, NICOLE Job Address: 441 GRAND CONCOURSE Miami Shores, FL Project <NONE> Contractor: MONTESA SOLUTIONS ENTERPRISES INC Permit Type: Mechanical - Residential Inspection Type: Final Work Classification: Addition /Alteration Phone Number (786)258 -2484 Parcel Number 1132060170310 Phone: (786)399 -5406 Building Department Comments ONE NEW OUTLET AND NEW EXHAUST FAN Infractio Passed Comments INSPECTOR COMMENTS False Inspector Comments Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. January 08, 2013 For Inspections please call: (305)762 -4949 Page 11 of 40 Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 BUILDING PERMIT APPLICATION Permit T , ! CIIANICAL JOB ADDRESS:'/ a rie„,ouE City: Miami Shores Folio/Parcel#: ,1 / • 32 ° 6/7 ° D3/ 0 County: FBC 20 Permit No. Master Permit No hazmEw2-7„_, OCT . 2612 JJ aYa_omo___ :000mo_m� o0 Miami Dade Zip: 5 3/38 Is the Building Historically Designated: Yes NO Flood Zone: OWNER: Name (Fee Simple Titleholder): `& 4-0"» �°v Phone#: Address: 441 a � b Calm r �, City: '44+ oh ai'/» l S State: F� zip: 33) 3? Tenant/Lessee Na ie: Phone#: Email: CONTRACTOR:. Company Name: /U fer677.0-7•5 7afig,Zi,r S Address: 7/2 3 over} /1,0-441"' City: // Qualifier Name://1/6046-7. ame: i/60 e:4-dile:2 State Certification or Registration #: ed41'�' ®�� �� Contact Phone#: State: Ill Phone# J ?2 7e3 Zip: 1�%QC Phone#: cdj 96. —10 %- Certificate of Competency #: Email Address: in) P %eV, ..J 11°) e € 6 DESIGNER: Architect/Engineer: Phone#: Value of Work for this Permit: $ 4 c>- c..7 cy Square/Linear Footage of Work: Type of Work: DAddress Alteration ONew URepair/Replace Description of Work: 0 : ( -011-- ODemolition Submittal Fee $ Permit Fee $ kr 5-6 Scanning Fee $ Radon Fee $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ CCF $ CO /CC $ DBPR $ Bond $ Technology Fee $ TOTAL FEE NOW DUE $ `6A tD LC) 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 wish 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, inspection will not be approved and a reinspection fee will be charged Signature j\ (\i COCL v L r &,,/� Signature ;Owner or Agent .' "" Contractor The foregoing instrument was acknowledged before me this /[D The foreg strument was acknowledged before me this day of , 20 , by , day of 0r,4°- , 20 f 2, by who is personally known to me or who has producedAL I who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: As identification and who did take an oath. NOTARY PUBLIC: Signs' - Jealkizp A. SCARBOROUGH bC. Stste.ol Rota $ .. �� My Comm. Expires Oct 18, 2@IS „ir r„a' Commission # EE 132379 APPROVED BY Sign: Print My Co * * * *** *maw 1'?' t L RODRIGUEZ * **** ** ***000000 *** ** * *** Plans Examiner Zoning Structural Review Clerk Revised 3112/2012)(Revised 07 /10/07)(Revised 06110/2009)(Revised 3/15104) STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRTJCTION INDUSTRY LICENSING BOARD 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 atago, MIGUEL JESUS MONTESA SOLUTIONS ENTERPRISES INC 501 8W 90 CT MIAMI FL 33174 Congratulations! With this license you become one of the nearly one million Floridians licensed by the Depadrnent of Business and Profesdortal Regulation. Our professionals and businesses range from architects to yacht brakes, from boxers to barbeque reslaurards, and they keep Florida's economy strong. Every day we work to Improve the way we do business in order to wave you For information about our atdriceas.pittase log onto www.myfforidalicense.corn.. There you can find-Mott kdomtation about our thvisions and the mutations that : impact you, subscribe to department nevadetters and team mane about the PgilmMW4.1134MW!rs. Our *mission at the Departmenila: Licapse:Etlideally; Rewilate.Fthdlk We con. shandy: :drivel° senreyouffiattersottat you can wive your customers. Thank or deieBeeeleeee Florida; land rxmgratulatorts.on. your new ikons& (850) 487-1395 --DETACH-HERE CH'S DOCUMENT HAS A COLORED :751';CKGROUND • MICROPRINTING • LINEMARK'' PATENTED PAPER DATE BATCH NUMBER LIENSE :- NBR ..' D8/16t2OL2 ' 7190 , -615 *,-;4-7-_,::: .., 'I."-,..f- The CLASS B AIR COI Named • ow 18 CER Under the provisi�l E2FOLeatioil,4a;4e;'. • . GOEIT;',. JESUS • ONTESA'.. ...10g414,1 : ,cr( 2,71_ MThNI • " • • , ACORD,, CERTIFICATE OF LIABIL PRODUCER JCH INSURANCE GROUP 14860 SW 28 ST # 211 MWMI FL 33185 INSURED MON?ESA SOLUTIONS ENTERPRIZES INC 7923 NW 18 LN HIALEAH FL 33016 COVERAGES ITY INSURANCE DATE(MMXID/YYTY1 10117/12 THIS CERTIFICATE IS ISSUED AS A MATTER ONLY AND CONFERS NO RIGHTS UPON THE HOLDER. THIS CERTIFICATE DOES NOT AMEND ALTER THE COVERAGE AFFORDED BY THE OF POLICIES ' INFORMATION CERTIFICATE EXTEND OR BELOW. NAIC# INSURERS AFFORDING COVERAGE INSURER A: ASCENDANT COMMERCIAL INSURANCE INSURER B: INSURER 0: INSURER D: INSURER E _ THE POUCIES OF INSURANCE LISTED BEL,QW 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 !SSUED OR MAY PERTAIN, TI-t INSURANCE AFFORDED BY THE POUCIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDI11ONS OF SUCH POUCIE$, AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED eY PAID CLAIMS. INBR AD • 'L LTk PJ T/PR Q) auSURAUpP GENERAL LIABILITY X COMMERCIAL GENERAL UABILI7Y CLAIMS MADE E OCCUR —GEM_AGGREGATEE LIMITAPPUES PEPt I Policy n Q T fl LOC AUTOMOB1E LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS POLICY NUM9Et; POUCY EFFECTIVE POLICY EXPIRATION MMTDNYI GL -40335 10/02/2012 LIMITS 10/02/2013 EACHOGOURRENCE S 1,000,000 DAMAGE TO-RENTED PREMISES (Ea omu,et $ MED EXP (Any one person) S 6,000 PERSONAL 8 ADV INJURY $ 1,000,000 GENERAL AGGREGATE s 1.000,000 PRODUCTS - COMPIOFAGG s 1,000,000 =MaaDSINGLE LIMIT BODILY INJURY (Per person) BODILY INJURY (Pet 8ckident) GARAGE UABILrrY ANY AUTO EXOESSIUMBRELLA UABIUTY OCCUR E CLAIMS MADE DEDUCTIBLE RETENYION PROPERTY DAMAGE (Peretxldertt) AUTO ONLY EA ACCIDENT .S OTHER THAN AUTO ONLY: EA ACC AGO S EACH OCCURRENCE S AGGREGATE 1 $ 3 WORKERS COMPENSATION AND EMPLOYERS. 4IABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE oFFICER/MEMBER EXCLUDED? If yea, dascrlba under SPECIAL PROVISIONS balaaa OTHER S 1 nv Mrrs E.L. EACH ACCIDENT !OTH- ER 1 E.L. DISEASE - EA EMPLOYEE $ EL DISEASE - POLICY UMrr DESCRIPTION OP OPERA-NONE / LODATIONS I VEHICLES 1 EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS AIR CONDITIONER REPAIR AND INSTALLATION CERTIFICATE HOLDER X CORAL GABLES BUILDING DEPARTMENT 405 BILTMORE WAY 3RD FLOOR CORAL GABLES, FL 33134 ACORD 25 (2001/08) CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAME] TO THE LEFT BUT FAILURE TO DO SO BHALI. IMPOSE NO OsulATItNV OR LIABILITY OF ANY KIND UPON THE IN R, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESEVTATIVE O,ACO CORPORA' ORPORATION 1988 This certifies That the individual listed below has elected to be exempt tram tome vvoncers I.ompensaaon law. ECTIVE DATE 04/18/ FEIN: BUSINESS SA SOLUTI 501 SW 90 CT NI 714 SS: ERPRISES INC FL 33174 SC sf,;.; , 9 OF BUSINESS OR 'FADE: 1- CERTIFIED AC CTORR (RATION DATE 04/17/2013 Mt s' A J IMPORTANT: Pursue to Chapter 440 . 05114). F.5., au officer of a serpentine wbo elects exemption from this demur by lUIoD a certificate of electron trader this section :say not recover benefits or compensation under this chapter. Pursuant to Chapter 440.051121 f.S.. Certificates of election to be exempt.. apply Daly wnhte tae scope of the beslaeas ur trade fisted on the mice of electioo to be exempt. Nosiest to Meier 440.05113), F.S.. Rolkes of election to be exempt and certificates of Mediae to be exempt shall be subject to revocation N, at any time alter the filing of the aalco or the imams of the coral kale. the person Horned on the Mks or certificate no longer resets tba requirements oI this section fm Iasoaaee of a certificate. The department smell revoke a certificate at any Mao for failure of the person named on the certificate to meet the requirements of this section. QUESTIONS? (850) 413 -160! DWC -252 CERTIFICATE OF ELECTION TO EXEMPT REVISED 01 -11 PLEASE CUT OUT THE CARD BELOW AND RETAIN FOR FUTURE REFERENCE STATE OF FLORIDA DEPARTMENT OF L SFAS DIVISION OP WORKERS' CATION INDUSTRY CERTIFICATE Of ELECTION TO BE Fir FROM FLORIDA WORKERS' COMPENSATION LAW EFFECTIVE 04/18/2011 EXPIRATION DATE: 04/17/2013 PERSON: NIGUEL J CAM FEN 208391714 BUSINESS NAME AND ADDRESS: NORTESA SOLUTIONS ENTERPRISES INC 501 SW 90 CT MIAMI. IL 99174 SCOPE OF BUSINESS OR TRADE 1- CERTIFIED AC CONTRACTOR * (Crony bottom portion on MC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01 -11. CUT IMP 0 Pursuant to Chapter 440.05(14), F.S., an officer of a co potation who elects exemption from this .wR by filing a certificate of election L under this section 1y not recover benefits or compensatlon this D chapter. Pursuant to Chapter 440.05(12), F.S., Certificates of election to be exempt_ apply onl p within the scope of the business or trade listed on E the notice of election to be exempt E Pursuant to Chapter 441.05113), 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 an the notice er certificate no longer meets the requirements of this section for issuance of a cerdficate. The department shell revoke a certificate at any tine for Moro of the person named on the certificate to meet the requirements of this section. job, k . QUESTIONS? (850) 413 -1809 upper , ti < =y; on for y • records. THIS IS NOT A BILL — DO NOT PAY RENEWAL 651214 -0 RECEIPT NO. 678237 -0 BUSINESS NAME / LOCATION MONTESA SOLUTIONS ENTERPRISES INC STATE# CAC056955. 7923 NW 188 LN 33015 UNIN DADE COUNTY FIRST-CLASS U.S. POSTAL PAID MIAMI, FL PERMIT NO. 231 MONTESA SOLUTIONS ENTERPRISES I OWNER WORKER/S Sec. Type of Business 196 GENERAL MECHANICAL CONTRACTOR THIS IS ONLY A LOCAL BUSINESS TAX RECEIPT. IT DOES NOT PERMIT THE HOLDER TO VIOLATE ANY EXISTING REGULATORY OR ZONING LAWS OF THE COUNTY OR CITIES. NOR DOES R EXEMPT THE HOLDER ERMIT F ROM R LICENSE REQUIRED BY LAW. THIS IS NOT A CERTIFICATION OF THE HOLDER'S QUALIFICA- TIONS. PAYMENT RECEIVED OI CIO COUNTY TAX 08/03/2012 60000000057 000075.00 SEE OTHER SIDE 1 DO NOT FORWARD MONTESA SOLUTIONS ENTERPRISES INC 7923 NW 68ELNN0 MIAMI FL .33015 i1iii111{ho1„„ 1111 t11111tfilialllfiFf111n11i„11 311 ACORD,„ CERTIFICATE OF LIABILITY INSURANCE P DATE GINUDDIYYYY1 PRODUCER JCH INSURANCE GROUP 14850 5W 2$ ST ti 211 MIAMI FL 33185 • THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 1 • INSURERS AFFORDING COVERAGE. • NAIC 0 INSUREb • MONTESA SOLUTIONS ENTERPRIZES INC 7923 NW 1B LN HIALEAH FL 33015 ■- "1 I INSURER A: ASCENDANTCOMMERCIALI•INSURANCE DU a = , le , r• INSURER IS: i. A INSURER C I GENERAL X INSURER D: GL 40335 INSURER E: 10/02/2013 THE ANY MAY POLICIES, POLICIES REQUIREMENT, PERTAIN, OF INSURANCE LISTED BELOW TERM OR CONDITION THE INSURANCE AFFORDED AGGREGATE LIMITS SHOWN MAY HAVE $tEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE I$$UEp OR BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCK HAVE BEEN REDUCED BY PAID CLAIMS. 1NSR I - . • :`.: ". POLICY NUMBS R DU a = , le , r• . r.y��7�� .1 h, „ IavT7 LIMITS A GENERAL X LABILITY COMMERCIAL GENERAL LIABILITY GL 40335 10102/2012 10/02/2013 E■OH OCCURRENCE s 1,000,000 ( '',! "'y t ,� $ CLAIMS MADE El OCCUR MEO EXP '(Any one person) S 5,000 GEN9, PERSONAL 8 ADV INJURY $ 1,0001000 GENERAL:AGGREGATE S 1.000,000 AGGREGATE LIMIT PPPUESPER: PRODUCTS- COMP/OPAGO $ 1,000,000 POLICY ■ PRy ■ LOG AUTOMOBILE ■ LABILITY ANY AUTO ALtCNNEDAUTO$ SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS • _, ((a a }oue SINGLE LIMIT • $ IL BODY INJURY (Per o $ II BODILY INJURY (Peracc&tdr� $ ■ I PROPS tl'I ' DAMAO$ (Parac tt) $ -- GARAGE UABILITY ANY AUTO . AUTO ONL•Y -EA ACCIDENT $ OTHER THAN AUTO ONLY: EA ACC $ AGG S EXCESS/UMBRELLA LIABILITY OCCUR E CLAIMS MADE DEDUCTIBLE RETENTION • EACH OCL'URRENCE $ AGGREGATE $ t $ $ WORKERS COMPENSATION AND EMPLOYERS LIABILITY • ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER /MEMBER $A .VDED? If Yee tlescfba under SPECIAL PROVISIONS Detour g TORY LAM TI . I OTR- El. EAOH:ACOIDENT $ E.L. DISEASE - EA EMPLOY $ ML. DIEE4SE - POLICY LIMIT $ OTHER • DESCRIPTION OF OPERATIONS i LOCATIONS 1 VEHICLES i EXOLU$IONB ADDED BY ENDORSEMENT 1 SPECIAL PROVISIONS AIR CONDITIONER REPAIR AND INSTALLATION • CERTIrIE`ATF wnt me, Y — - - - - -- - - -- MIAMI SHORES VILLAGE BUILDING DEPARTMENT 10060 NE 2 AVE MIAMI SHORES VILLAGE, FL 33138 ACORD 25 (2001/08) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDSAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TT? THE LEFT, BUT FAILURE TQ DO SO $HALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON ITS AGENTS OR RCPRESL'NTATIYL.$. AUTTIORIM REPRESTNTA11V$ CORPORATION 9888 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 178244 Permit Number: EL -9 -12 -1674 Scheduled Inspection Date: January 28, 2013 Inspector: Devaney, Michael Owner: BORENSTEIN, NICOLE Job Address: 441 GRAND CONCOURSE Miami Shores, FL Project: <NONE> Contractor: QUINTANA ELECTRIC BROTHERS INC Permit Type: Electrical - Residential Inspection Type: Final Work Classification: Addition /Alteration Phone Number (786)258 -2484 Parcel Number 1132060170310 Phone: (305)986 -5893 Building Department Comments ELECTRICAL FOR INT. REMODEL Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments January 25, 2013 For Inspections please call: (305)762 -4949 Page 4 of 28 Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 BUILDING PERMIT APPLICATION Permit Type: JOB ADDRESS: 2?-14 1 C lanv i7 Con r-se- City: Miami Shores County: Miami Dade Zip: 3a Folio/Parcel #: J / • • 0/7 • C.33 / Is the Building Historically Designated: Yes NO Flood Zone: FBC 20 Permit No. r i (D-14 Master Permit Nor- 2-- )522_ OWNER: Name (Fee Simple Titleholder): J 1 ed.e. r+ s Phone#: Address: 44 I (and le a nal Con e 4-e, City: d7) ! ern State: Fl- Zip: 33)3g Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: / s 1 • ' ��' ?' " � G � �'AM r'f" Phonei#: C " l3 Address: /101/ 669/1°S City: / 8JVJ• State: Zip; af Qualifier Name: 4 0 (/L/ f ^A /V'Q -"'"- Phone#: State Certification or Registration #: 06125- Certificate of Competenc, #: Contact Phone# 6 ` - + Email Address: DESIGNER: Architect/Engineer: Phone#: Value of Work for this Permit: $ 1®r 000 Square/Linear Footage of Work: Type of Work: DAddress OAlteration ONew ORepair/Replace ODemolition Description of Work: Submittal Fee $ Permit Fee $ CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ Technology Fee $ TOTAL FEE NOW DUE $ Bonding Company's Name (if applicable) Bonding Company's Address City State Tap 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, BEATERS, TANKS and AIR CONDMONERS, 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 is.d In Bence of such posted notice, the inspection will not be approved and a reinspection fee will be charged Signature Owner or Agent The foregoing instrument was acknowledged before me this day of ,20,by who is personally known to me or who has produced As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commission Expires: APPROVED BY Signature Contractor The foregoing instrument was acknowledged before me this 5 day of 2eytt , 20 /4, by who is personally known to me or who has produced as identification and who did take an oath. NOTARY Sign: Print LA j i s'`2 LUIS My Commission MV COMMISSION R e3 DFZ 7 2012 WIPES., ry Services eye * * * ** * * * ** ***********a* * * * * * *** * * * * * *** * * * * * * * * * * * * *** * * * * * * ** * * * * * * *** * * ** ,c VIP /Z- 0 / Plans Examiner Structural Review (Revised 3 /12/2012)(Revised 07110/07)(Revised 06/10/2009)(Revised 3115109) Zoning Clerk STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL OR CONTR CT ICENSING BOARD (850) 487 -1395 1940 TALLAHASSEE FL 32399 -0783 MENDEZ , JUAN M QUINTANA ELECTRIC BROTHER'S INC 660 E 60 ST HIALEAH FL 33013 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 be For information about our services, please log onto www.myf#ortdaticenae.com. There you can find more information about our divisions and the regulations that Impact you, subscribe to department newsletters and team more about the Department's initiatives. Our mission at the Department is: license Efficiently, Regulate Fairty. We constantly strive to serve you better so that you can serve your customers. Thank you for doing buslpess in Florida, and congratulations on your new license! TION SEA L1208 1100938 EL _ C ; d below 8 CERTIFIED ttader the provisions of Cha Expiration date: AUG 31, 20 JEFF ATWATER CHIEF FINANCIAL OFFICER STATE OF FLORIDA 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: 05/29/2012 EXPIRATION DATE: 05/29/2014 PERSOIt MENDEZ JUAN M FEIN: 650973171 BUSINESS NAME AND ADDRESS: QUINTANA ELECTRIC BROTHERS INC 4801 SW 6 ST MIAMI FL 33134 SCOPES OF BUSINESS OR TRADE: 1— CERTIFIED ELECTRICAL CONTRACTO IMPORTANT: Persannt to Chapter 440. 05(14), F.S., an officer of a corporation who elects exemption from this chapter by filing a certificate of election ewer this section may net recover bastes or computation wafer this chapter. Pursuant to Chapter 440.05(14 F.S., Certificates of election to be exantpt... apply way within the scope al the baatneas or trade listed on tie notice of election to be exempt. Pursuant to Chapter 440.051131, F.S., Notices of Wattles to be exempt and certificates of eleetfon to be except Milli be subject to revocation 0, at any time after the filing of the entice or the Isaaaace of the certificate, the person named on the notice or certificate ne logger meats the regakantents of this section for (seance of a certificate. The department shall revoke a certificate at any time for faifere of the person named on Me certificate to meet Ibe requirements of this settles. QUESTIONS? (850) 413— DWC-252 CERT1FICATE OF ELECTION TO BE EXEMPT REVISED 01 -11 05 -16 -2011 JEFF ATWATER STATE OF FLORIDA CHIEF FINANCIAL 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: PERSON: FEIN: 05/16/2011 EXPIRATION DATE: 05/15/2013 QUiNTANA RAMON 650973171 BUSINESS NAME AND ADDRESS: QUINTANA ELECTRIC BROTHERS INC 4801 SW 6 CT MIAMI FL 33134 SCOPES OF BUSINESS OR TRADE: 1— CERTIFIED ELECTRICAL CONTRACTO IMPORTANT: Pursuant to Chapter 440 . 05(14), F.S., an officer of ■ corporation who elects exemption from ibis chapter by filing a certlffgte of election ender this section may not recover benefits or compensation ander this chapter. Pursuant to Chapter 440.051121, F.S., Certificates of election to be exempt... apply only within the scope of the business or trade listed an the notice of elegies to be exempt Pursuant to Chapter 440.05113), F.S., Notices of election to be exempt sad certificates el election to be exempt shall be subject li revocation it at ea. Kea ara rr. Mu. a ... ..t. . ,.. , u.S.; posrAos PAID Pamir 1410. 231 O 19441 GULLBT EA 33157 CUTLER BAY NTANA ELECTRIC ER swarm_ " ' CAL RT TAX 08/08/2012 60020000419 000045.00 SEE OTHER SIDE OO NOT FORWARD • QUINTANA ELECTRIC BROTHER S INC JOSE E QUINTANA PRES 4801 SW ST CORAL GABLES FL 33134 To: Page 2 of 2 2012 -09-05 20:49:27 (GMT) From: Eastem Insurance Act:miff CERTIFICATE OF LIABILITY INSURANCE 40. -+^'' DA' iNIM'D 9/5/2012 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 ADDmONAL 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 Eastern Insurance Group, Inc. 9570 SW 107 Avenue Suite 104 Miami rL 33176 ' Amanda Nogues PH NExB: (305)595 -3323 1 F( .No: (305)395 -7155 mD :asrEeasterninsurance.net BJSURERISI AFFORDING COVERAGE NAIC B INSURERA Ltd- Continent Casualty Company LIABILITY COMMERCIAL GENERAL LIABILITY INSURED Quintana Electric Brother's, Inc. 4801 SW 6th Street Miami FL 33134 INSURER B : 09 -GL- 000850002 INSURERC: 5/2912013 INSURERD: $ 1, 000 , 000 INSURER E : $ 100, 000 INSURER F : 1 CLAIMS -MADE X OCCUR COVERAGES CERTIFICATE NUMBER Master 12 -13 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUU`1CCC;;VVEED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADM. INSR SUM MD POLICY NUMBER (f AIC