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CC-13-365 Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-200834 Permit Number: CC-2-13-365 Inspection Date: October 09,2013 Permit Type: Commercial Construction Inspector: Rodriguez,Jorge Inspection Type: Final Owner: ,SHORES SQUARE INVESTMENTS Work Classification: Alteration Job Address:9005 BISCAYNE Boulevard Miami Shores, FL 33138- Phone Number Project: <NONE> Parcel Number 1132060110060 , I Contractor: CORESTATES CONSTRUCTION Phone: (561)997-6273 Building Department Comments REPLACE EXISTING ATM WIT A NEW MACHINE AND Infractio Passed Comments ASSOCIATED WORK NEEDED INSPECTOR COMMENTS False Inspector Comments Passed PERMIT LEFT WITH MANAGER INSIDE THE BANK Failed El Correction Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. For Inspections please call: (305)762-4949 October 09,2013 Page 1 of 1 t < F Miami Shores Village APR, Building Department 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 ?• Tel:(305)7952204 Fax:(305)756.8972 INSPECTION'S PHONE NUMBER(305)762.4949 FBC 20 lZ5 AUILDING Permit No. PERMIT APPLICATION Master Permit No. Cc-,I 6 —No S Permit Type: BUILDING ROOFING JOB ADDRESS: 9005 Biscayne Blvd City: Miami Shores County: Miami Dade Zip: 33138 FoliolParcel#: 11-3206-011-0060 Is the Building Historically Designated:Yes NO Flood Zone: OWNER:Name(Fee Simple Titleholder):Shore Square Properties LLC —phones. Address:696 NP 125st City eCA M t State. FL Zip; 33161 Tenant/Lessee Name: TD Bank Phone# Email: i CONTRACTOR:Company Name: CoreStates Construction Phone#: 561-997-6273 Address: 751 Park of Commerce Drive,Suite 124 City: Boca Raton State. FL Zip; 33487 Qualifier.Name: Frank Soltess Phone#: 561-897-6273 State Certification or Registration#: CBC034401 Certificate of Competency#: Contact Phones. 561-897-6275 Email Address: lwalyga@core-eng.com DESIGNER:ArchitectlEngineer: William O'Leary Phone#: 215'$09'2125 Value of Work for this Permit:$20,000 Square/Linear Footage of Work: Type of Work: OAddition OAlteration ONew ORepair/Replace ODemolition Description of Work: Replace existing ATM with new ATM and associated work per plans. Color thru tile: Submittal Fee$ Permit Fee$ CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Bond$ Notary$ Training/Education Fee$ Technology Fee$ Double Fee$ Structural Review$ - TOTAL FEE NOW DUES i t t s . Banding Company's Nagle(if applicable) Bonding Company's Address City State Tip 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, is understand that a separate permit must be secured for ELECTRICAL WORK,PLUMBING,SIGNS, WELLS,POOLS,FURNACES,BOILERS,HEATERS,TANKS and AIR CONDITIONERS,ETC..... OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding$2500,Cite applicant must promise in good fait/;that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attach;nent Also a certified copy of the recorded notice of commencement must be posted at the fob site for lire first Inspection wl'c o ctt seven ( days after the building permit is issued. It th absence of such posted notice, the inspection will not be app i a reinspection fee will be charged. Signature Signature er or Agent �n Contractor The foregoing instru ent was acknowledged before me this . The foregoing instrume h was acknowledged before me this__.__ � day of�..� NVQH 20 a,by \�O-fYO �� . , day of 9,5A—, ';20�,by 'R Q0 L+PSE, who is personally kna�vn to me or who has produced who' personally known to me r who has produced As identification and who did take an oath. as identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: Sign: Print Print: Notary PUNC State of Florida My Commission Expires. Jaequeiine Ortia My Co C i e$ Comm.Expires Apt 28.2814 My Commission EE 189837 ''•��F�,. o,• Commission#►DD saw �� pa) Expires 04/15/2018 Bonded Through Natter NoWy AWL $6S4k�F4�3��R+keksk��8�� kkk�aA��3�S,',ek$aY�k3�kafafiR.k f�aaa��+AASM�6 a"+ � +A��$�'kk�AsN�iaask$+8+k'.ERs+�bsk�$A�MaQkak�k§P'kkea3��d��ok��AM�+:+34�+�+b� ' APPROVED BY Plans Examiner Zoning I Structural Review Clerk s E (Revised 3 112/2012)(Re%ised 07 110(07)(Revised 06110/2009)(Revised 3/15109) i r E s MIAMI-DARE COUNTY i'.......... OFFICE OF THE PROPERTY APPRAISER PROPERTY SEARCH SUMMARY REPORT Carlos Lopez-Centere Property Appraiser Prolaerty lnforrnation. Folio 11-3206-011-0060 Property`Address 9005 BISCAYNE BLVD Owner Name(s) SHORE SQUARE PROPERTIES LLC a Mailin Address 696 NE 125 ST .�T 3 p Mailing MIAMI FL i 33161 .ru Primary Zone 6200 COMMERCIAL-ARTERIAL 3 3 Use Code 0081 VACANT LAND . Beds/Baths/Half 0/0/0 �x Floors 0 Living Units 0 a € Adj.Sq,Footage 0 m ` Lot Size 27,731 SQ FTy. Year Built :.. 0 � Legal Description 6 53 42 F'N� Aerial Photography 2012 ASBURY PARK P134-110 BEG 478.01 FTW OF SE COR LOT 5 RUN Taxable Yaiue Infatmatton: W219.07FT ALG N R/W/L NE 90TH ST Current Previous N12.20FT TO E R/W/L BISC BLVD TH NELY210.73FT E85FT S177FT TO POB Year 2012 2011 Assssinent Infarrnation - Exemption/Taxable Exemption/Taxable Current Previous Year 2012 2091 County $0/$610,082 $0/$1,056,000 Land Value $610,082 $610,082 School Board $0/$610,082 $0/$1,102,240 i Building.Value $0 $492,158 City $0/$610,082 $0/$1,056,000 Market Valus $610,082 $1,102,240 Reglonal $0/$610,082 $0/$1,056,000 Sale Informa one Assessed Value $610,082 $1,056,000 Date Amount Recording Qualification Code F.atefnptlan Mfc►rrrlation: Book-Page Current Previous 11/2011 $8,000,000 27902-4847 Sales not exposed to the open- market Year 2012 2011 212005 $0 23079-3255 Sales which are disqualified as Homestead $p $0 a result of examination of the deed 2nd Homestead $0 $0 11/2005 $0 24432-4515 Sales which are disqualified as a result of examination of the Senior '' $0 $0 deed Veteran Disability $0 9/1985 $1,850,000 12653-1995 Deeds include more than one P Civilian Disability $0 $0 Widower) $0 $0 Discialmer. The Office of the Property Appraiser and Miami-Dade County are continually editing and updating the tax roll and GIS data to reflect the latest property Information and GIS positional accuracy. No warranties,expressed or Implied,are provided for data and the positional or thematic accuracy of the data herein,its use,orb Interpretation. Although this website is periodically updated,this information may not reflect the data currently on file at Miami-Dade County's systems of record. The Property Appraiser and Miaml-Dade County assumes no liability either for any errors,omissions,or inaccuracies in the information provided regardless of the cause of such or for any decision made,action taken,or action not taken by the user in reliance upon any information provided herein. See Miami-Dade County full disclaimer and User Agreement at httpJ/www.miamidade.gov/lnfo/disdalmor.asp. Property information inquiries,comments,and suggestions email: pawebmail@miamidade.gov GIS inquiries,comments,and suggestions email: gis@miamidade.gov Generated on:Wednesday,February 13,2013 STATE OF FLORIDA , i DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD (850) 4487-1395 TALLAHASSEE FL STRFFLT32399-0783 k s i i I -SOLT-ESS -- COREST,K 'ES CONSTRUCTION SERVICES INC D PLEASANT HILL RD ST3 0 0 9 0 Reogived JUL 2ezv12 CORES f AT d GA S i i Congratulations! With this license you become one of the nearly one million Floridians licensed by the Department of Business and Professional Regulation. `th: Our professionals and businesses range from architects to yacht brokers,from : .>,'� .., .<.< a . "+`r5� . wr- iT hboxers to barbeque restaurants,.and they keep Florida s economy strong. w 128012,Every day we work to improve the way we do business in order to serve you better. _ ., '>.:;;. :';', For information about our services,please log onto www.myflotidalleense.com. f9:? m k OR• 4' '1 There you can find more information about our divisions and the regulations that ;>: , SOLT} 5�,1' na impact you,subscribe to department newsletters and learn more about the � Ct STi?iT7 r ir1I6�,i,ER'�T Department's initiatives. <` ,x F'ry 11 Our mission at the Department is:License Efficiently,Regulate Fairly.We constantly strive to serve you better so that you can serve your customers. ;• ' ;;: a,. : '::. Thank you for doing business in Florida,and congratulations on your new license!'' xaR�s• .4 '�{s�� a's: as�T' c $s "End ? ,y on•dasgr' u , r 712p7;�ff"744. q.• j i i s 1 j DETACH HERE i .. . .- ':t ? .. C. : ce-.f/. 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Te _.: �e :.SFa.��"��?��%k��"7q "t?�a yes. `�;,r '�fa. u + �4� ��' ..�:�Z�s' .,.;r�'fr$l6•�cF�'` �; try �+ pr', — .. � .� �t • �.s �x �t"� � vim,. Y� Co��,^�3.aH�.-; C L h��C�F ��I �a, J e�3� ��. c,'� � �� . U:�k�ia E. a'�e Ca 4$!r.�:..m :E @L✓'�'v U k . �L.�.t. �'F ..v, .�y-�z5:. .�' _�� 'tw'"'�?��"';,`._ -�"'.q,r�� ,�� SS'G�*-,��. - � f �.g t .,�...� < �.€i-�°.�r,,�,g'a`s�.��+... � -,.a, +`�k '-�-..��'��`-�s-,, � ��-. :•s�`s t av'i e �--��2L�' cv �E � i�;F1 �e,��f� ��„ "� �� r��u�'�� err-�rsr3�,..��... __ .. �'tom. r� �� s• i ." _ � °.: •- -_..' -, a e x. C 4(i ✓:^ ,e`e P [ r J-a � 2,� v � �.iy �tat •�,. 's€» t F:�' et°r� �,ti �:-. R a v+LSx �>.. =� �.1. �- '-'OL_s. ,!,;r. f � P�' R eF 4��f ! + (.4r rS`” y t �C'• f V-�E'- F"��"�l E ik��---' - � ms!F G � --yr —t 3 0�'�• �`�. 't�r �i:u't,.6 3 t t 4 1,.x.5� r� '�T'° a�,+��`:._ � y,.}'� :c*. �� + �• .e'y��,. 'csz � xx<^'�" -_ �, '"'.,.�`�i��{.�., _ mss. a �a` =asa'�'�er�� S } f . a �' '� �„s � � _ � ,� � � � ��-�- {�,; �i.� °�'��.,�"• ate, x,_ fiS+s" ,�•-•.� CORECON OP ID:MCW ACORD® DATE(MMIDD/YYY`/) CERTIFICATE OF LIABILITY INSURANCE 0312512013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the policy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER Phone:770-509-9878 CONTACT Roselle Wilkinson Corporate Risk Advisors NAME:ONE FAX P O Box 70636 Fax:770-509-5459 IPA Exr:770-509-9878 A/C No):770-509-5459 Marietta GA 30007 ADDRESS:RWlkinson @cr-advisom.com Roselle WIkInson INSURER(S)AFFORDING COVERAGE NAIC# INSURERA:Valley Forge Insurance Company 18313 INSURED Corestates Contruction INSURER B:Transportation Insurance Compa 18313 Services,Inc. INSURER C:Evanston Insurance Company Danett Norrid 4191 Pleasant Hill Rd STE 400 INSURER D:Columbia Casualty Company 18313 Duluth,GA 30096 INSURERE: 18313 INSURER F: COVERAGES CERTIFICATE NUMBER: 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 REDUCED BY PAID CLAIMS. INS DDL U R POLICY EFF POLICY EXP LIMITS TYPE OF INSURANCE POLICY NUMBER MM/DD MM/DD GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 A X COMMERCIAL GENERAL LIABILITY 04034554016 12/04/2012 12/0412013 PREMISES Ea occurrence $ 300,000 CLAIMS-MADE FK OCCUR MED EXP(Any one person) $ 5,00 PERSONAL&ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,00 X POLICY PRO- LOG Pollution $ 2,000,00 JECT AUTOMOBILE LIABILITY CEO eBBIINdEDtSINGLE LIMIT $ 1,000,00 A X ANY AUTO C4034WS333 12/04/2012 12/04/2013 BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS X H RED AUTOS X NON--OWNED PROPERTY DAMAGE $ AUTOS Per accident UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 4,000,000 C X EXCESS LIAR CLAIMS-MADE XOVA526711 12/04/2012 12/04/2013 AGGREGATE $ 4,000,000 DED I X I RETENTION$ -0- Foil Form $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY X TORY LI IT B ANY PROPRIEiOR/PARTNER/EXECUTIVE Y/❑N N/A WC4034554002 12/04/2012 12/04/2013 E.L.EACH ACCIDENT $ 1,000,00 OFFICERIMEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEd$ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1$ 1,000,00 E Equipment coverage 04025688873 12/04/2012 12/04/2013 Rented 50,00 Equipment DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,I more space Is required) CERTIFICATE HOLDER CANCELLATION MIAMISH SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Miami Shores Village ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE 2nd Ave Miami Shores,FL 33138 AUTHORUED REPRESENTATIVE p0a XyLlt ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 26(2010/05) The ACORD name and logo are registered marks of ACORD CFN 2013RO302034 NOTICE OF COMMENCEMENT IR Bk 28537 P9 0546; (Ips) RECORDED 04/17/2013 14:16:44 A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION HARVEY RUVIN, CLERK OF COURT MIAMI-DADE COUNTYf FLORIDA PERMIT NO. TAX FOLIO NO.11-3200-oit-om LAST PAGE STATE OF FLORIDA* STATE OF FLOR100,QOWM OF LADE COUNTY OF MIAMI-DADE: I HEREBY GENTAPY 9k *A M a ft OW of Me WPM ftd by on 001kao of THE UNDERSIGNED hereby gives notice that improvements will be ma A 0 20 property,and In accordance with Chapter 713, Florida Statutes,the foll O IS00. is provided In this Notice of Commencement. fffift W11 pota 1. Legal description of property and street/address: TD Bank-9006 ftosyne SIWA 63 42 wbury park PS 4-110 8"478.01FTW*f SE car lot run W219.074 sign rMA NE loth sweat nm=to a tmA also Nyd th newt0.73ft eff7ft to pot 2. Description of Improvement Replwe ATM with new ATM mW associated wok 3. Owner(s)name and address: Shore Square Properties LLC 696 NE 1269L Main],FL 33161 Interest In property:0-or Name and address of fee simple titleholder: 4. Contractors name and address: comstates 751 Pink of Commerce De",Suite 124,Boca Ratan,FL 33467 6. Surety:(Payment bond required by owner from contractor,if any) Name and Address: 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 and Address: 8. In addition to himself,Owners designates the following person(s)to receive a copy of the Lienor's Notice as provided in Section 713.13(1)(b),Florida. tatutes. Name and Address: .0 9. Expiration d f thl otice of Commencement (the expiration date Is I year from the date of recording unless a different dal s ified) tj>of thl�,*, is Ifial Sign f Owner Print Owner' e1 2Z Prepared by Swom to and su�peribed before me this day of YUj3�j 20 1' _ 5 Address: Notary Public: Print Notary's lAme: My commisslon*pIres. �J Notary Public State of Florida Jacqueline Ortiz M M Y COMMIssion EE 189537 00 tv Expires 04/1512016 W.O�� Detail by Entity Name Page 1 of 3 ON Home Contact Us E-Filing Services Document Searches Forms Help No Events No Name History Entity Name Search Return to Search Results Detail t6 Florida Limited 1-lablilly Company SHORE SQUARE PROPERTIES,LLC Filing Information Document Number L11000075982 FEI/EIN Number 452672348 Date Filed 06/30/2011 State or Country FL Status ACTIVE Effective Date 06/28/2011 Princi al Address 696 NE 125TH STREET NORTH MIAMI,FL 33161 Mailing Address 696 NE 125TH STREET NORTH MIAMI, FL 33161 Registered ent Name &Address ROBERT A. BRANDT, PA 696 NE 125TH STREET NORTH MIAMI, FL 33161 Manager/Member Detail Name&Address Title MGR IZHAK,YORAM 696 NE 125TH STREET NORTH MIAMI, FL 33161 Title MGR LIPTON,ALAN 649 OCEAN BLVD GOLDEN BEACH, FL 33160 Annual Re orts Report Year Filed Date 2012 03/29/2012 http://search.sunbiz.org/Inquiry/CorporationSearch/SearchResultDetail/EntityName/flal-11... 3/26/2013 Miami Shores Village 7_1�_-I T,777'" Obxtb Building Department 22, VL,� iLl 10050 N.E,2nd Avenue,Miami Shores,Florida 33138 Tel:(305)795.2204 Fax:(305)756.8972 B Y: INSPECTION'S PHONE NUMBER:(305)762.4949 FBC 20 BUI r�%, ING Permit No.c PERMIT APPLICATION. Master Permit No. Permit Type: BUILDING ROOFING JOB ADDRESS.- 9005 Biscayne Blvd City: Miami Shores County: Miami Dade zip: 33138 Folio/ParceW.1 1-32065,011-0660 Is the Building Historically Designated:Yes NO Flood Zone: OWNER:Name(Fee Simple Titleholder):Shore Square Properties LLC Phone#: Address-696 NE 125st Citv. Miami State: FL zip: 33161 1. Bank Tenant/Lessee Name. TD Ban Yhonet. Email: trifibil -997-6273 CoreStates s on� 561 CONTRACTOR:Company Name: Phonch. Address: 751 Park of Commerce Drive,Suite T24 City. Boca Raton State. FL Zip: 33487 Qualifier.Name: Frank Soltess Phone#: 561-997-6273 State Certification or Registration#: CBC034401 Certificate of Competency#: Contact Phone#: 561-997-6273 Email Address: lwalyga@core-eng.com DESIGNER:ArchitectlEngineer: MIllarn O'Leary Phone#: 215-809-2125 Value of Work for this Pernilt:$,20,000 Square/Linear Footage of Work: Type of Work: DAddition CiAlteration QNew ORepair/Replace CIDemolition DescrVntd"ok.mReplwemmktWg-*T-M,,,with new ATM and associated work per plans. Q, Z. '11-7; - I Submittal Fee Permit Fee$_ CCF$ CO/CC$ Scanning Fee$ Radon Fee$- DBPR$ Bond$_ Notary$_Training/Education Fee$ Technology Fee$ Double Fee$ Structural Review$ TOTAL FEE NOW DUE$ f Bonding Company's Name(if applicable) Bonding Company's Address City • State zip Nfortgage Lender's Name(if applicable) Nfortgage Lender's Address City n m 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 lire issuance of a building permit with an estimated value exceeding$2500,the applicant must promise in good fartit tJ (a 'apytlu notice of colr�rencernent and construction lien law br Jtr a will be delivered to cite person whose property is subte n "ttaclpnent,Also c t3�� copy of the recorded notice of corer epee tent must be posted at the job site 11 �'T: for the first inspection lrtch occurs st*l�en )da��si r the building permit is issued. t the bsence of posted notice, the inspection will not be ap r roved an4b I fee)tai,' be charged Sign ure Signature Owner or Agent Contractor The foregoing instrument was acknowledged before me this The foregoing' trument was acknowledged before me thi day of 20 Ja,by L-& \�e.\\y-_ - day of ,20 L3,by—fir Y: who is personally known to me or who has produced or who has produced As identification and who did take an oath. as identification and who did take an oath. NOTARY PUBLIC:, NOTARY PUBLIC: e � Sign 0414�n, rn� Sign: 2 fi...L. Print: Ivio My Commission Expires: Notary Public,State of New Jersey My Co s ' es: CLAUDIA MENDEZ . No. 2181623 �' �`. Noty PWMC•etas of Rorw MY Commission Expires October 30,20 Comm.Expires Apr 28,2014 Commission#DD 988887 APPROVED BY Plans Examiner zoning i Structural Review Clerk i (Revised 3/12/2012)(Revised 07 110/07)(Revised 06110/2009)(Revised 3115109)