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RC-12-1522Inspection 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
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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