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EL-13-956 1 Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-199477 Permit Number: EL-5-13-956 Scheduled Inspection Date: September 20,2013 Permit Type: Electrical - Residential Inspector: Devaney, Michael Inspection Type: Final Owner: PAVLIK, HENRY Work Classification: Alteration Job Address:58 NW 98 Street Miami Shores,FL 33150- Phone Number Parcel Number 1131010330210 Project: <NONE> Contractor: MATRIX ELECTRIC INC Phone:(561)662-0688 Building Department Comments KITCHEN AND BATH REMODEL Infractio Passed Comments INSPECTOR COMMENTS False Inspector Comments Passed CREATED AS REINSPECTION FOR INSP-199341. 18 sep. 2013 no access at 5:00 p.m.. Failed Correction (� Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. September 20,2013 For Inspections please call: (305)762-4949 Page 26 of 36 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 FBC 20 BUILDING Permit No. PERMIT APPLICATION Master Permit No. p, C'1 Permit Type:Electrical JOB ADDRESS: 58 NW 98 ST City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: 11-3101-033-0210 Is the Building Historically Designated:Yes YES NO Flood Zone: OWNER:Name(Fee Simple Titleholder):THR FLORIDA LLC C'O HENRY PAVLIK phone#: Address:1 OAKWOOD PLAZA STE 250 City: HOLLYWOOD State: FL Zip: 33020 Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name: MATRIX ELECTRIC INC Phone#: 561662-0688 Address: 847 WEST 13 COURT#3 City: RIVIERA BEACH State: FLORIDA Zip: 33404 Qualifier Name: FRANK A SACCOMAN Phone#: State Certification or Registration#: EC13002252 Certificate of Competency#: Contact Phone#: 561 662-0688 Email Address: FRANKYMATRIX @YAHOO.COM DESIGNER:Architect/Engineer: Phone#: Value of Work for this Permit:$ Square/Linear Footage of Work: Type of Work: ❑Address LIAlteration ❑New ORepair/Replace OD olition Description of Work: KITCHEN AND BATHROOM REMODEL Submittal Fee$ Permit Fee$ J 0 f� CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Bond$ Notary$ Training/Education Fee$ Technology Fee$ Double Fee$ Structural Review$ TOTAL FEE NOW DUE$ Rr1*1%j Bonding Company's Name(if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name(if applicable) Mortgage Lender's Address City State Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK,PLUMBING,SIGNS, WELLS,POOLS,FURNACES,BOILERS,HEATERS,TANKS and AIR CONDITIONERS,ETC..... OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant. As a condition to the issuance of a building permit with an estimated value exceeding$2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature—k Signature Owner or Agent Contractor The foregoing instrument was acknowledged before m9 ee this Zt The foregoing instrument was acknowledged before me this day of -1 ,20 ,by go M 10LJ K- , day of 20 11,by r9AO r SOC,COMAW , who is rsonally kno to me or who has produced who i personally know to me or who has produced As identificatio an who did take an oath. as identification and w7id ke a n oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: Sign: �• Print: ® 5 Print: g My Commissi , p B ertK r„I,�p16 My Commission E :••• MARK T PATERld® ed 1 -': •'° MY COMMISSION#EE132265 M � EXPIRES September 21,2015 ` � 10� (407)X8-0153 FbtWallote Setvka.cwn 9F,ksR,ksksk��,FS�,hksk =k�j c4,s�,kiks kaksksk�k%k�skskskskkks kIa,kskskak,ksk,k,k,k,knkkakikkak,kikskskaksk,ksk,k,ksk,fisk.ksk APPROVED BY t ,e! Plans Examiner Zoning Structural Review Clerk (Revised 3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09) 04101/2013 08:07 5618487344 MATRIX ELECTRIC PAGE 01/01 ! its.Kr. M* GAKr4ox P,0-Box 3353,West Palm Beach,FL 384132-3353 "LOCATED AT" eaars7+ ioe+f4 T+uc es4�r gas tsucotleetarpbe.com Tel!(5B�)355-9272 ssraia Po 14t ukCnwat 847 W 13TH CT#k3 RIVIERA BEACH, FL 33404 'PYRE OF BUSINESS OWNER CERTIFICATION# I 'RECEIPT iimAYE PAx) AMT PAID I BILL 9 2-0189 ELECTRICAL CONTRACTQR SAGOOMAN FRANK A BCiaomogt 912.420481-07112112 $27.50 MOM!' ys document its valid only when reeeipted by the Tax Collector's Office. STATE OF FLORIDA PAW REACH COUNTY 201212013 LOCAL BUSINESS TAX RECEIPT MATRIX ELECTRIC INN LBTR Number. 200903886 MATRIX ELECTRIC live EXPIRES: SEPTEMBER 30. 2013 847 W 13TH CT STE 3 This receipt does not constitute a franchise, RIVIERA BEACH,FL r334{04-6733 agreement,permission of authority to perform the i�IIIIlI��1 I�������ri�����IIi/Ilr1It1II1,�IIr services or operate the business described herein when a franchise,agreement or other county commission,state or federal parmisSicn of authority is required by county,s'relte of federal law, - — - _ - - - = - Ci(> * W Luz:l3F ox,:BLVD t: 1 _ i !,Ptilt Year aC}E+t4kx f�1, (} =+rr± -,'e €�*7 - =8:47.:W;7.3th•::.t�3�$#3. : = y rq_ Ni,_ .<:_:-_s _1,:.. -.+1: . .. 8��2,���07_�_ _ :I:�3�1•�d: P ff• .V � ',: WEST-13?M IbT .. .._ ;AT;Yt7T3R,:,,P.S.L&M:OF:;RUST-NESS;: , , , ar , STATE•.Q F s` '!31 CFS a ATItar111 :.•';' u, ...., r• ,r :a; ¢? SE L12032600547 DATE BAT(�H NUMBER jR xYL'". ,` •° � ` r' t irk: •;N Z,�` CE'$"�'�F�•FE,f:..+�';.; �� •:;;per'' .;.-`: 'r�= r. „'':' �,`•: •: ','•, ••JPRA iG adt±r"°'t ilE r v. ol~`i� ap. ;':;t:•t• : ,:`_',::'s;' $ riration date: AlUG 311 103.4' u ' . . '� •-�� .'SZftik. ©w•'X ,.''1:4:mYa•' " ',;i n� :� ,,,.^ -Q +,.. rtd[£�:-,., •t ��,, ,;::••. 12782 `81 .ST".-NOT9. ;1 `�. '�;l ;' ' ;�s ;�`.�•::; ` WEST PALM BEACH FL 3341 rK y% 3•' io;. .ar p v ••i•'''+rt KMY LAWi3O•4,1 `GC)�fiE1 C3R r .: ar,;.. r SECRETARY - L)l1o14 AS R tj... LIAR-28-2013 08:30 From: 9543519913 To:9542511134 Page:111 AOM CERTIFICATE OF LIABILITY, INSURANCE DATE 3/18/13 PRODUCER THIS CERTIFICATI IS XSSUED AN A MA7'TRR OF INFORMATION ONLY AND CONFERS NO RIGHT'S UPON THE CUMFICATE HOLDS L THE CERTIFICATE DOES NOT AMEND,EXTEND,OR BELOW ALTER TIME COVER"ll!AFFORDED F91LT1itd AGENCY,INC. ` S$QO W.CYPRESS CREEK R6AD Sri's$Q4 BY THE Pt�LxGI BELOW. FART LAUDERDALE,FL 33300 COWA►NIES AFFORDING COVERAGE 954 776-9016 r; COMPANY A N TiQNWID SuRANCE CO; NY OF AMERICA INSUI# COMPANY MATRIX ELECTRIC,INC. 847 W 13 COURT,BAY 3 COMPANY , RIVIERA BEACH,FL 33404-6733 C COMPANY IS eoYeIAEEt3 THIS I5 TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED gE{OW HAVE BERN CONTRA T THE OTHER NA -N WITH FOR THE POLICY WHI PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT,TERM, OR CONDITION 4!F ANY CONTRACT OR OTHER C1c7CUMENT VJIYW RESPC-� Tc+WHICH TiIIO CI fk1;YFICATE MAY BE I$SUED DR MAY PERTAIN. THE INSURANCE AFFORDED Sy THE POLICIES De$CRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDP(ION�S OF SUCH POLICIES,LIMITS SHOWN MAY HAVE BEEN REDLIG BY PAIR CLAIMS. W POLICY POLICY LT. TYPE OF INSURANCE POLICY NUMBER 0FFEC7TME EXPIRATION �TE R MM D YY MM DD IYV A GENE L LIA LxTY ACP591$ 1017' 3/x!8/13 �%3$/1q GENERAL AC7ftEGATE BI �3,,1100,000 • PRdDUC'M-COMP}dP Add $1,000,000 COMMERCIAL GENERA(. PERSONAL&AOV INJURY 1,000,000 LIABILITY EACH OCCU4tkEN 1,000,000 ( I CLAIMS MADE FIRE DAMAGE $ 100,000 [ X) OCCUR OWNER`S CONTRACTOR PROT An one Fre GEN`4AG{aREGATE LIMIT MED EitP �F $,000 APPLIES PER: POLICY Aft one rsoft A AUTOMOBILE POLICY ACPS915361i119 2/28/13 2/2$/14 COMBINECr SINGLE L3MTP !� $001000 ,_ANY AUTO BCIDILY INJURYT _:X—ALL OWNED AUTOS (per Pemn) _ ,,,,„X SGHFDULED AUTOS BODILY INJURY� '$ X_HIR.EU AUTO$ (Pgr Accident) ...t_NON OWNED AUTOS PROPERTY DAMAGE !�t EXCESS Ulls'"LTY ,ACP5i915381817 2/28/13 EACH OCCURRENCE $I 1,000,0110 w�X.,._•.UMBRELLA FORM OTHER THAN UMBRELLA FORM AGGREGATE $ 1,40Ct,0OQl WORKER'S"000ENSATION a+CR591S3$1817 2/281/13 2/28/14 WC t}Th{ER , +jR=r..•` `. •"+ AND EMPLOYERS LIABILITY STATUTORY "%'i`aii6?ij"•: "::r Gam, LIMITS EL EACH ACCIDENT ' 1,0001000 EL DISEASE-POLICY LIMIT 1,000,000 EL DISEASE-EA EM[00YEE $ i'400,000 6I CRIPTIONapo eRATxONfLOCATxO fVB11ICWB/3F�TAI IT@MS SAME AND TEMPORARY WORK SITES ELSEWHERE IN THE STATE OF PL ORIDA, QUALIFIER= FRANK SSACCOMAN LICENSE#'EC130022$2. GEIITIIFICATE HOLDER Cp�JICELLATlON VILLAGE t 1+1IAtMI SHORES SHOULD ANY OF'(HE ABOVE OESCRIBW POUCIES BE CANCELI.EG POPORE THE L'XPIRATWN bAM BLDG DEPT T14rkgoF.THE ISSUINO COMPANY WILL ENDEAVOR TO MAIL 10/30 daY'WROTEN NOTICE TO THE •�, 1oB00 NE 2 AVE 00"4A ON OR LLIABUTTV AF ANY KIND UPON zHL}COMPANY,ITS AOFNT50r RCFMESENTATIMS,O MIAMI SHORES,FL.33138 AUTHOR=iI EP ATIYiw (#!A5} ACORP CORPQRATION IM AC4RD 5-5 Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-190742 Permit Number: PL-5-13-955 Scheduled Inspection Date: September 19,2013 Permit Type: Plumbing - Residential Inspector: Diaz,Osvaldo Inspection Type: Final Owner: PAVLIK, HENRY Work Classification: Addition/Alteration Job Address:58 NW 98 Street Miami Shores, FL 33150- Phone Number Parcel Number 1131010330210 Project: <NONE> Contractor: SUNRISE PLUMBING CONTRACTORS INC Phone: (954)565-2952 Building Department Comments REPLACE FIXTURES WITH NEW Infractio Passed Comments INSPECTOR COMMENTS False Inspector Comments Passed / k Failed El Correction Needed ❑ Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. September 18,2013 For Inspections please call: (305)762-4949 Page 1 of 21 Miami Shores Village I'd ® 0 2013 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 FBC 20 BUILDING Permit No. �1 ✓—' PERMIT APPLICATION Master Permit No. Gl Permit Type:PLUMBING JOB ADDRESS: -9 1l H/ q e -9m C ity: Miami Shores County: Miami Dade Zip: Folio/Parcelt 1 1—310—0 3 3°®Z1 o Is the Building Historically Designated:Yes 'lro�-s NO Flood Zone: OWNER:Name(Fee Simple Titleholder): rNA FLt 9144 C-10 hWe-f ��IYuK Phone#: Address: / 0414t AVo AWRAf 8ZYO a'5® City: Aloawyayo State: Zip: 13020 Tenant/I.essee Name: Phone#: Email: CONTRA T R:Coompany Name:�S U.O R I'C)Ifl k '-.� a,�°C� one#: Address: C fJ City: State: -,15 Zip: 3 Qualifier Name: ro Phone#: State Certification or Reelggistratiossnn�#: C 057771® Certificate of Competency#: Contact Phone#:I 7,,55 L� t Email Address: DESIGNER:Architect/Engineer: Phone#: Value of Work for this Permit:$ �U C3-c> Square/Linear Footage of Work: Type of Work: ❑Addre s t]Alteratio / 17New ARRepair/Replace ODernolit Description of Work: P\- Le C £- Submittal Fee$�� t7 J Permit Fee$ CCF$ CO/CC$ f Scanning Fee$ Radon Fee$ DBPR$ Bond$ Notary$ Training/Education Fee$ Technology Fee$ Double Fee$ Structural Review$ TOTAL FEE NOW DUE$ • Bonding Company's Name(if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name(if applicable) Mortgage Lender's Address City State Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK,PLUMBING,SIGNS, WELLS,POOLS,FURNACES,BOILERS,HEATERS,TANKS and AIR CONDITIONERS,ETC..... OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding$2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature Signature Owner or Agent Contractor The foregoing instrument was acknowledged before me this The foregoing instrum��,,,e,, t was acknowledged before me this day of 20,3,,by Q PMVLtk day of � 6 ``;6�3,by Pe-t 0SC-f0a who is personally known to me or who has produced who is personal known to me or who has produced As identifica ion and who did take an oath. as identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: PARKtw Sign: C Sign: * MY C IU1IN A EEB::;(A96 Print: m/emu- e L,<wo Print. 'S_ \ "fEX?1JfAh SePiember 19.2016 (4 ) otexy ea,oe.com My Commission Expires: My Commission Expires: NO MARK T PATER" Flo 8®rvks. 3wly �:OMMISSION#EgE255 *36'10D 3 APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised3/12/2012)(Revised 07 110/07)(Revised 06/10/2009)(Revised 3115/09) Date: 4}24/2013 Time: 10:31 AN TD: 9545652952 Page: 03 Client#:25683 SUNRIPLU ACORD. CERTIFICATE OF LIABILITY INSURANCE DATERMiDDIYYYY) v2v2013 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:It the certificate holder Is an ADDITIONAL INSURED,the pollcy(les)must be endorsed.If SUBROGATION IS WAIVED,sublect 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 E Carissa LaFreniere Cypress Insurance Group R U Ext:954 771-0300 AC No): 954 772 9424 PO Box 9328 E-MAIL CarissaL ADDRESS: @CyP ressinsurance.can Fort Lauderdale,FL 33310-9328 INSURER(S)AFFORDING COVERAGE NAIL# 954 771-0300 INSURER A:Old Dominion Insurance Company 40231 INSURED INSURER B Sunrise Plumbing Contractors,Inc. INSURER C: C/O Peter Greer 1427 NE 26th Ave INSURER D: Fort Lauderdale,FL 33304 INSURER E: 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 CONTRACTOR 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. INSR ADDL UBR pppVO F POL�CY EXP LTR TYPEOFINSURANCE INSR WVD POLICY NUMBER MMiDD MM/DD OMITS A GENERALLIABILITY MPGO213F 3/15/2013 03/1512014 EDpAApCMMHpp��OEECTCURRENCE $11,000,000 X COMMERCIAL GENERALLIABILIIY PREMISES EaocaiErrenoe $500000 CLAIMS-MADE ®OCCUR MED EXP(An one person) $10,000 X PD Ded:250 PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE s2,000,000 GEN'LAGGREGATE LIMITAPPLIES PER: PRODUCTS-COMP/OP AGO s2,000,000 POLICY PRO- D LOC $ A AUTOMOBILE LIABILITY MPGO213F 3/15/2013 03/15/2014 COMBINED SINGLE LIMIT Ea ac.1dat ANYAUTO SO DI LY I NJ URY(Per person) $1 000,000 ALL AUTOS AUTOS SCHEDULED BODILY INJURY(Per acddernI $2,000,000 X HIREDAUTOS X AUTOS NON-OWNED (Per PRO nt)AMAGE $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION WCSTATU- OTH- AND EMPLOYERS'LIABILITY Y ANY PROPRIETOR/PARTNER/EXECUTIVE YIN E.L.EACH ACCIDENT , OFFICERWEMBEREXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If 3res,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space Is required) CERTIFICATE HOLDER CANCELLATION Miami Shares Village Bldg Dept SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 10050 NE 2nd Ave. ACCORDANCE WITH THE POLICY PROVISIONS. Merril Shores, FL 33138 AUTHORIZED REPRESENTATIVE��,,//�r 0 1 988-201 0 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD #S150509/M147786 CAT ■:I A7�1�1R�JV/1�\��:I!F7!tIRUR�1:1.1IJ:1_lq�lil:l�l\I\I.L1711-I'\mil J-tl\t�l\l.YA1�1.11'/I•\-1 YID/•��Vl` .,J♦- \--- AC#>6220425 STATE OF FLORIDA DEPART4$N' :O ` $ JSINESS A3D PROFESSIONp ,BORE ULATION CONSTRUC HIS INDiJ TRY LICENSING SEQ#L12072000784 LICENSE NBR,.;, : .' 107/20,'/2012 120036141 CFC05771p�' r The PLUMBING CONTRACTORx Named below IS CERTIFIED ` Under the provisions of Chapt+i �S .' Expiration date: AUG 31, 2014-- GREIRR, PETER.A . SUNRISE PLUMBING CONTRACTORS,, , 4857 NE 12 AVER OAKLAND PARK FL 33334 RICK SCOTT._ KEN LAWSON GOVERNOR SECRETARY ©tSPJ AA AS REgUIRED BY LAW i 00 1 PLEASE CUT OUT THE CARD BELOW AND RETAIN FOR FUTURE REFERENCE STATE OF FLORIDA DEPARTMENT OF FINANCl/LL.SERVICES IMPORTANT F DIVISION OF WORKERS'COMPENSATION Pursuant to Chapter 440.05114), F.S., an officer of a corporation H CONSTRUCTION INDUSTRY 0 elects exemption from this chapter by filing a certificate of elect CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA L COMPENSATION LAW y WORKERS' under this section may not recover benefits or compensation under '`4» chapter. EFFECTIVE: 04/05/2012 EXPIRATION DATE: 04/05/2014 Pursuant to Chapter 440.05112►, F.S., Certificates of election to be PERSON: PETER A GREIER H exempt... apply only within the scope of the business or trade list i FEIN: 592107567 R the notice of election to be exempt. F BUSINESS NAME AND ADDRESS: E Pursuant to Chapter 440.051131, F.S., Notices of election to be exe SUNRISE PLUMBING CONTRACTORS INC 1 N E 26TH AVENUE and certificates of election to be exempt shall be subject to revoi £ if, at any time after the filing of the notice or the issuance of t FORRT T LAUDERDALE, FL 33304 certificate, the person named on the notice or certificate no longe the requirements of this section for issuance of a certificate. Th department shall revoke a certificate at any time for failure of th SCOPE OF BUSINESS OR TRADE: person named on the certificate to meet the requirements of this 1- CERTIFIED PLUMBING CONTRACTOR 2- PLUMBING section. QUESTIONS? (850) 413 CUT HERE * Carry bottom portion on the job, keep upper portion for your records. III I `Ad Hal, 1. a� FROM :SUNRISPPLUMINGCONTRACTORSINC FAX NQ- :9545652952 May 22 2013 09:06AM P 1 .BUSINESS TA►'vr•- tECElPT CITY OF OAKLAND PAID. 2012-2413 °':"AILING ADDRESS ISSUED DATE: September 26,2012 SUNRISE PLUMBINCY CONTRACT,, r`'~`''"" /4! 4 .•'•',• yC71 'd4i�1 ,.�C ,?•,Fy,9p•.., r''� ���,Y• %l. S �1,�'3`c,,,r v v�,; Yr6 , ..7,W1.�,.•! rlijQi•�'','�'!r'Yy R48a7 NE 12 AVE <� q .!�"k'1i 1.'N'-•oy,',�Y'.f�,•'' Y$.•.�,,,.a{i+:rt 9.•. >y'ra/''V•,Q ".. ,94„F�'�!''gqq•r. /�yj. yy�� ''��TT�'(��'p��p� �!' !ryw ,].,YN "•.a�:'r,'lr'�..:.., •' <•^k.A'�9Yh• ^„ OAKLA1�1�1 l�iu-,.^ 37�t1�r,:ljlJi?%y4 J• /. n..y. A �:v ap1.Y2. ` •,,J�!? Y4 'W' d •: t'fr14'!n 7,y� 'lJ�r ,*AN n7µ'NY•afiY4•E� •M GI'r t V•L^,V•4.Y, },! "TAME AND I, A?;CON OA'LIG"ENSE>a� �� „T�iCE�YSE 1�iUM� R 20 fi- A�2$ A•4' 'A, - It SUN S 'LUMTNG CONTRACTORS09ii AVE „� ' jr -01RIGINAL•NUMBER 860¢.; , 0AKL- 'D PARK,FL 33334 ,., , ...,•T:, 5M; J,p.q, . Y„. _.,.y.•. .;. ;,� , IPENSE EX['I}2Erti1.. ,��tJ Y30A .011-le A••ig,1(: 1.•.. 'yE� s.,�° :tid !lo-j'� ,Y'i '<:^• '•^•,�: •: 'ZY r'C '{:: { +;j:1 IN � .,^s 6 �• ./.«�" �j:,•�''s,;, �i4^'•1>'.. yew, fmT}„ yfy� h,•'^ a"? r "b; ,. ,1' iu,- } Y,..Y i:,jarr,,y.. .,:rk. 'i'i..A,SBii.. ✓'M,,:iai1.,...r.'t .,.. .. .,.,n :•t,: ,+j .,.. .,..•, .,..,.. �n `Y J+. T it •F•'••,'''- :'+�r. »' d{Y r/ y,/°8,r..� nr. hiJ,'i�...f�::4M h.&.n ''°•: T,0Ytl0!¢mDD:rLm;1617YS�Yltl,:.�• X•fi+Ri5914MW^C"464 ht•A.?Ir"'I.vMdSNM'JC19�'A'YWNNaF+mbI*,T'xw kE+N afrurr.ITI'HWPfie W 1�gO1 , �""7 is '%,, y,9 •,.j�> is �� �• ��F[ T.��'�'�RS4N�b1���t��Vi'ED�t};v(�rss'L�Ea�LI�GsT�D.�t�Ckv�,�+G.CI.LNr, .�3� 5 FROFESSION O[t��f�0.�E3 PrA�TtON L1S' ]fa BLOW N TAE CITY OF OAKLAND.r- RK. RIDA, • "N.,f.',',,..•}}``rr����"::..I,,,,j,4'p��S }n,+{`h y t W f� p^t<`S • ,'P'"15'!2M1YM;,Y .y`Cti�- '+J A„ 4'rt:}.1.' ,(M''•,'•✓e•. 4`•,i'•, ' • Ali,9, •.,,.•.rr��e: •r�a�^� .;w .a„t ,�•',�•4i'iu „7 '� h, i •,. '••I �,M'� d .4' A •,,if•Ir1^/ .'(,•/,,1n.'q:M, Y`�e`/:(4:.•�.t�d'•7�iVY IY7�1n•.:. h 4e �.�M•r �t,��'fye.�'{�. :(IV 14, ,, a�IMS?!.r.;y��,•9 bray,•11-Y-..Pe''�.:.rW.,��''':t, e+;,(�';g,�!$;: 'Fj`akP,„'S•,�"' ki,°�(a"Lk 2-••"0 .T... �',1, t'1 'w.' !, >:rr.:•• u L.T. aa. }$Cs<•. b•^ (,. •.a::+::• ...,p• •'•i`^ l:.� liar � a.*.q." • t• ^•,..fr,t_o>144v�'�:�:•`'"£; F%w'�4.�•:s,'1��,,,yfy�,p,$%";�•t:.7g::ir•a5� � , SUS.ENES CODE 06550 13USINM UPSCKU lON PLUMBING CONTRACTOR RESTRIG`1`PONS LICENSE I41UST BE CONSPICUOvmv POSTED AT THE PLACE OF$US1N+SS SHOWN Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-199897 Permit Number: RC-5-13-954 Scheduled Inspection Date: September 27,2013 Permit Type: Residential Construction Inspector: Rodriguez,Jorge Inspection Type: Final Owner: PAVLIK, HENRY Work Classification: Alteration Job Address:58 NW 98 Street Miami Shores, FL 33150- Phone Number Parcel Number 1131010330210 Project: <NONE> Contractor: REO RENOVATORS AND ROOFING LLC Phone: (954)554-2763 Building Department Comments KITHCEN AND BATHROOM REMODEL 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. September 26,2013 For Inspections please call: (305)762-4949 Page 10 of 22 e 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 FBC 20 lL BUILDING Permit No. PERMIT APPLICATION Master Permit No. C- 13— Permit Type: BUILDING ROOFING JOB ADDRESS: 58 NW 98 STREET City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: 11-3101-033-0210 Is the Building Historically Designated:Yes YES NO Flood Zone: OWNER:Name(Fee Simple Titleholder):THR FLORIDA LLC CIO HENRY PAVLIK phone#: Address: 1 OAKLAND PARK BLVD STE 250 City: HOLLYWOOD State: FL Zip: 33020 Tenant/Ussee Name: Phone#: Email: CvrrV9x; •, Coxb aced eaq- �- CONTRACTOR:Company Name: REO RENOVATORS& ROOFING Phone#: 954 639 7626 Address: 1039 BUCHANAN STREET City: HOLLYWOOD State: FL Zip: 33019 Qualifier Name: DAVID JOHNSTON Phone#: 954 554 2763 State Certification or Registration#: CGC1517059 Certificate of Competency#: Contact Phone#: 954 554 2763 Email Address: DAVID @REORENOVATORS.COM DESIGNER:Architect/Engineer: Phone#: Value of Work for this Permit:$18,000 Square/Linear Footage of Work: Type of Work: ❑Addition ❑Alteration ONew ❑Repair/Replace ODe olition Description of Work: KITCHEN AND BATHROOM REMODEL Color thru tile: c� Submittal Fee$ � C� ermit Fee$ CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Bond$ Notary$ Training/Education Fee$ Technology Fee$ Double Fee$ Structural Review$ TOTAL FEE NOW DUE$ MEW r P ' Bonding Company's Name(if applicable) r Bonding Company's Address City State Zip Mortgage Lender's Name(if applicable) Mortgage Lender's Address City State Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK,PLUMBING,SIGNS, WELLS,POOLS,FURNACES,BOILERS,HEATERS,TANKS and AIR CONDITIONERS,ETC..... OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding$2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issue In the absence of such posted notice, the inspection will not be approved and a rein_specctioon fee will be charged. Signature Signature Owner or Agent Contractor The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of YKAAC-bf ,20�3_by UMAAL P411U K day of AM C� ,20 11,by DMI00�4 who i personall know to me or who has produced who is personally known to me or who has produced As identificatio ho did take an oath. as identification anZwho ta ke an oath. NOTARY PUBLIC: NOTARY PUBLIC Sign: Sign: Print: t,,,, L 5 Print: `lW RNO OA`f 0 i 1,2016 :* .• .•*_ My Commission Expir N. _ P1R lem�r nom My Commission Expires: = _ AAV COMMISSION#EE132255 EXPIRES September 21,2015 p153 (407)398-0153 FIod d.N.WyS.Mr... sk�:k rk rk k rk 9k sk rk�rk rk��ag rk z�z sk=k sg pis a$8s sR�$s g:$s$+Xa ik rk s(s�ak�=k rk>k=k>k gs k rk rk=k k sk>k jk=k>k as zk rk sk sk:k sIs rk�rk rk rk rk$z:g a$aY ak k=k'k ak ak=k�F$z s#sp ag$s zk=k gs 9k 9k 9k a$a4:k zg k 9k rk sg gr=k a$sg r#sg i+�sk�sk APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised 3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09) _ a° pie MW7, �am A . �'. DZPARTMENT OF B 2- PROFESSIONAL REGULATION i CO T L7' TRIE WR LICENSING BOARD SEQ#L12060601271 3. 13,0414879 C °151.7 5 .: The GENERAL CONTRACTOR Named below IS CERTIFIED Under theprovisions of Chapter Expira tion date: AUG 31, 2014 JOHN9TON, DAVID VICTOR O RENOVATORS & ROOFING., L C ; 1039 BUCHANAN STREET HOLLYWOOD FL 33019 RICK SCOTT KEN LAWSON OR SECRETARY DISPLAY AS REQUIRED Y LAW ............ 4 ' STATE F FLORIDA AC# 6152517 DEPARTMENT 0 F BUSINESS AND PROFESSIONAL REGULATION .CONSTRUCTION INDUSTRY LICE ING BOARD a a5aa 0 0 L10413446 13 963. , The ROOFING CONTRACTOR .. Named below IS CERTIFIED Under- the provisions of Cha t Expiration date: AUG 31, 2014 S JOHNjTON, :DAVID VICTOR s: REO RENOVATORS & ROOFING, LLB 1039 R STREET HOLLYWOOD `L 33019 RICK SCOTT KEN LAWSON GOVERNOR SECRETARY DISPLAY AS REQUIRED By LAW 03/27/2013 02:28 9548931174 #3063 P. 001A'002 CERTIFICATE OF LIABILITY INSURANCE DATE(MINIISOrrvYY) 0SA27I43 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS No RIGHTS UPON THE CERTIFICATE HoMbER.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 j REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certlfic0a holder is an ADDMCMIAL INSURED,the policy(ies)must be endorsed. it SUBROGATION IS WAIVED,subject to the terms and condr'fions of the policy,certain policies may require an endorsement.A staterneat on this certificate does not confer sights to the *OrMlege holder in I"eu of such endom3ement(s). PRODUCER E T Jt}SEPH BRACCIO I J&J insurance Associates ; (�H°4 N�Eads: (954)693 5558 aAX.Nog (954)8G3-1 114 7937-B Taft St. I a rnari irrt llsouthmst Hollywood,FL 33024 INSURERS)AFFORDING COVERAGE NAIC# Phone (954)893-5553 Fasc (954),$93-1174 I ill=RERA: ESSEX INSURANCE COMPANY INSURE I INSURER 2! ... _. REO RENOVATORS LLC. INSURER C: 13M STIRLING ROAM 4A-S INSURER D: - DANIA BEACH,FLORIDA 33004 SNSLIIlPriE: _ 1 INSURER r: _ COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS is TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED$FLOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD i INDICATED. NQTiNITHSTANDING ANY REQUIREMENT,TERM OR CONDMON 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_ TYPE OF INSURANCE A00LjWRR I POLICY EFF' ' POLICY EXP INSR.LYVD I POLICY NUMBER (ARiYf1DD1YYYYj ((yLpAfDD1YYYY)• LIMITS GENERAL LIABILITY I I I EACH OCCURRENCE s 2.0013 OW.00 RENT ED Cb1NMCRGIAL GENE�ur 4L LL1811 CrY DAMAGE TO PREMIISES tEa eeCinrenc2O $ 4 00,000.00 ! ❑ ❑ CLAIMS•IwADC ® OCCUR 3DM 23tta ! MED EXP(Any o.p..) s 5.000.00 A ❑ 12lQ^ la ;12/02tZfl43 I PERAONAI-r„ADViNJURY '$ 2,000,000.Do ❑ i ! i GENERAL AGGREGATE : s 2,0m,000.00 — I GEML AGGREGATE LIMrf APP!_fE$PEk I I j ! PRODUCTS.COMPIOP AGG. 5 2,000,()(10,00 ! ❑P�LiCY ❑ PRO. ❑ Lac I $ AUTOMOBILE LIABILITY j I ; NQL ❑ ANY AUTO IjOQELY INJURY{! 'per pn} $ ALL GtiA/NL'D SCNEpULED j BODILY INJURY(Per xcidcni i 5 ❑ AUTOS ❑ AUTOS NON-OWNED PROPERTYUAMaGE .5 ❑ RRSOAIr,OS ❑ AUTOS i , �fPeracudentl !❑ ❑ I 5 - ❑ 4lAASREUA L" El I ! I EACH L RENGE 5 ❑ EXCESS LAB ❑CLAiM&MADE I I I AGf�REGAtE S •❑ DED ❑ RE(ENTIDN S WORKERS COMPENSATION —' 1NC SrATLA- OTH AND EMPLOYERS LIABILITY Y 1 N . �❑MRY Umrrs- ❑ER ANY PROPRIErOR1PARTNEWEXECUTIVE E.L.EACH ACCIDENT :S OFFICERMFMP,FReCCLUDEC}? i (Mandatory In NH) _i: EL_DISEASE-EAEMPLOYE: $ 19 yes deauibd�en&w ! i _DFSCRIPn0N OF OPERATIONS bskm I ! I EL DISEASE-POLICY LSMIT': $ DESCRIPTION OF OPERATIONS f LOCATIONS I VEHICLES{Attach ACORD 481,Additional Reaskr"Schedulq if more 5paw is mquirad) — GENERALCONTRACTOR CERTIFICATE HOLDER CANCELLATION _..._.. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE MIAMI$HORS$VILLAGE BUILDING DEPARTMENT I THE EXPIRATION DATE THEREOF,NOTICE VALL I*DELIVERED IN j 10(]50 N.E.2ND AVE ACCORDANCE WITH THE POLICY PROVISIONS. MIAMI SHORES FLORIDA 33138 AUTHORIZED REPRESENTATIVE I JOSEPH BRACCIO Q ISM-20 A D CORPORATION. All rights reserved. ACORD 25(2040105)OF The ACO and ktgrs are registered marks of ACORD .................. . ............................. ....................................... ...................................... ............ ..................... ........... .............................. BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT - 115 S. Andrews Ave., Rm. A-100, Ft. Lauderdale, FL 33301-1895—954-831-4000 VALID OCTOBER 1,2012 THROUGH SEPTEMBER 30,2013 DBA: Receipt#,180-8860 REO RENOVATORS LLC GENERAL CONTRACTOR (GENERAL Business Name: Business TYPe'CONTRACTOR) 'Owner Name.DAviD JOH14STON Business Opened:04/27/2009 Business Location:1039 BUCHANAOX ST State/County/CerVRog:C','C1517059 HOLLYWOOD Exemption Code: Business Phone: Rooms is Employees Machines Professionals 2 For Vending Bus! ass Cwy Number of Machines: �., Vending Type: �rior 'ears Collec o Pald 'Fax Amount Transfer Fee NSF Fee Penalty li n Cost Total 00 Pa �2�70 27.00 0.00 0�00 0.00 0,00 0.00 THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS THIS BECOMES A TAX RECEIPT This tax is levied for the privilege of doing business within Broward County and is non-regulatory in nature.You must meet all County and/or Municipality planning WHEN VALIDATED and zoning requirements. This Business Tax Receipt must be transferred when the business is sold, business name has changed or you have moved the business location.This receipt does not indicate that the business is legal or that it is in compliance with State or local taws and regulations. MallIng Address: r Receipt #OJC-11-00009482 .�AVTD JOHNSTON joaj BUCHANAN ST Paid 07/1012012 27.00 ROLLYWOOD, F1, 33019 2012 . 2013 .............. ....................................... ........... ............................................... ................................................................ 40 OF Kitchens By Us GC Mark-58 98 ST Miami Shores Your Company Address Your Company Address Your Company Phone [04-30,9] Not To scale Room 1 4 i y 146114 1 Lx 1 �sh�a ashes .W1n6 15 30 24 8 9 11 10 0 t 24 ..DW2 T. POINT ALONG COUNTER TO RE MORE THAN ?DEFT FROM G.F.I PROTECTED RECEPTACLE ' PUT D..M RECEPTACLE UNDER SINK. ALL FIXED APPLIANCES ON DEDICATED OKTS, e EF36 ..ST 5 14 22•• 1 30 27 21 19 18 24 1 'I it z7 30 27 -36- `J I .2 t�1�Cl�l�a-Je. 147 SCvP� b� 1►SoQ..�.. �.o�c. 1�:�c�,.•e_c� c.,c�v�..�-ec�o S � c�L� C�tR�c� Q C c,v�o1� C� `� Jt s �s 7-EJ ly��T SATE IROOM REMODEL � �� IJ REPLACE SINK VANITY' WITH NEW DSL Miami Shores Village � � I �= � `� ��i,�',I � �� �� 2J REPLACE WATER CLOSET WITH NEW APPROVED BY DATE _ _ j 3J REPLACE ALL 1/2' DRYWALL WITH NEW 4J REPLACE ALL WET AREAS WITH NEW OUROCK BOARD ZONING DEPT C ` 5J PLACE CERAMIC TILES ON FLOORS AND 12' HIGH ON WALLS - WET AREAS ONLY. BLDG DEPT lf��% {° .� 4' 6d REPLACE TUB WITH NEW 5 4" '-b' NOTEI NO NEW ELECTRIC TO SE ADDED SUBJECT 10 CChIRI.IfPICE WI FN All FEUER4L STATE ANL)U-I-N, {RULS AND REGULATIONS 2'-6' 9" 2'-0' ADD NEW LAV �' ���13 Z3, VANE �za r EXIST EXIfi7 OEXIST .y DINING R'"I -C�- FLORIDA !�J20M EXIST i I i f I -- EXIST EXIST m 5ATH w i i1 1� I 147. EXIST 5700 — 8. S, 11-2" 4' -r'-l0" N BATHROOM RECEPTACLE ON 20 AMP CKT AND G.F.I PROTECTED ADD SMOKE/CARBON MONOXIDE DETECTORS, EXISTING PARTIAL FLOOR FLAN ANY AND ALL CLOTH AND RUBBER MALE: f/4' s V-0' INSULATED CONDUCTORS TO BE REPLACED. FN 2013RO392773 NOTICE OF COMMENCEMENT OR 2-k 28635 P9 3217; QP9) A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION RECORDED 05117/2013 15g32,30 HARVEY RUVINP CLERK OF COURT MIAMI-DADE COUNTYP FLORIDA LAST PAGE PERMIT IL 6 TAX FOLIO NO.11-3101-03M210 STATE OF FLORIDA: COUNTY OF MIAMI-DADE: THE UNDERSIGNED hereby gives notice that improvements will be made to certain real property, and in accordance with Chapter 713, Florida Statutes,the following information is provided in this Notice of Commencement. 1. Legal description of property and street/address: 58 NW 98 STREET MIAMI SHORES FL,MIAMI SHORES SEC 6 PB 10-39 LOT 8 E112 OF LOT 9 BLK 129 2. Description of improvement: REPLACE KITCHEN CABINETS,BATHROOM REMODEL 3. Owner(s)name and address: THR FLORIDA LLC C/O HENRY PAVLIK I OAKWOOD PLAZA STE 250 HOLLYWOOD FL Interest in property:OWNER Name and address of fee simple titleholder: 4. Contractors name and address: REO RENOVATORS&ROOFING LLC 1039 BUCHMAN STREET HOLLYWOOD FL 33019 5. 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 Statutes. Name and Address: 9. Expiration date of this Notice of Commencement: (the expiration date is 1 year from the date of recording u different date is specified) ,TATS OF FLORIDA,COUNT OF DADE cou I HEREBY CERTIFY that this IS a t the 0 )riginal filed n this office on 4 day f e:=.—, A D 20 i 9 natur o VITNFSS my hand and ACIal Seal. - of nyy) ! Print Owner 1ARV �p E d 0 s Name PQ& i I 1< C Ay Sworn to and subscribed before:,me*iis a 20 i7 Address: Notary Public: Print Notary's Name:_AP9MJ4_j=__' My commission expir i, PERMIT# CONTRACTOR: -� G�1 , SUBMITTAL DATE: ADDRESS: NAME: RESUBMITAL DATES: PROJECT TYPE: - i ZONING FIRE -STRUCTURAL IMPACT FEES l' Ira v ELECTRICAL HRS/DERM - _ - NOC MECHANICAL _ - 08-10-2011 JEFF AT`VVATER STATE OF FLORIDA CHIEF FINANCIAL OFMCER DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPi~NSATION CERTIFICATE OF ELECTIO 0 BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW � CONSTRUCTION INDUSTRY EMPTION This certifies that the i idual listed below has elected to be exempt from Florida Workers' Compensation law, EFFECTIVE DATE: 07/2612011 EXPIRATION DATE`_ 0712512013 PERSON: JOHNSTON DAVID FEIN: 262704165 BUSINESS NAME AND ADDRESS: RED RENOVATORS & ROOFING LLO 1039 BUCHANAN ST HOLLYWOOD FL 33018 • II SCOPES OF BUSINESS OR TRADE: 1 ROOFING CONTRACTOR 2- GENERAL CONTRACTOR If.100tTANT: Parsaaui to C4aptvr 440 , 65(14), F.S., an officer ai s corporation who eleeta eYomptlan from 1114 chapter by filing a cartilkare of election under this section may oat recover benefits or compensatloa under ibis chapter. pai9oont to Chapter 40,01E1. P.S., Cef[ifiaetea of alettion to be acemnL., apirly only within [he stops of the bssloeca at trade listed on the notice of election to ae exempt. 6ersnaat to Cbapler 440,050%, F.S„ notices of election In be exempt and aertil(cates of eleotlon to be exempt short be sublets to revocatlab 11, at any time after the filing of 14e aotice or the lssuaoce or the certificate, the parson named on the notica or conificals no longer meals the raquTremeoia of 1114 section for Issuanas oI a certifleate. The department shall revoke a eertillcate at any time tar failure of the person named oa the certificate to meet the regafrements at (fits section. • QUESTIONS? (850) 413-1609 DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01-11 PLEASE CUT OUT THE CARD -BELOW AND RETAIN FOR FUTURE REFERENCE STATE OF FLORIDA IMPORTANT DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS"GOI►IMPI_•NSATION 0 Pursuant to Chapter 440.05(14), FS.. an officer of a corporation who CONSTRUCTION INDUSTRY elects exemption from this chapter by filing a Certificate of election GEitr,FiCATE OF ELECTION YO BE FatEMI'r FROM FLORIDA L-under this section may not recover benefits or compensation under this WCttKERS'COMPENSATION I.AW 0 D chapter, EFFECTIVE: 07/26/2011 EXP3RATION DATE; 07/25/2013 pursuant to Chapter 440,0502!, FS,. Certificates of election to be PERSON: DAVID %JOHNSTON H exempt,- apply only within the scope of the business or trade listed on FEIN; 262704165 E the notice of election to he exempt: R BUSINESS NAME ANO ADDRESS: E Pursuant to Chapter 4411.05(13). F.S., Notices of election to be exempt A90 RENO ATOR5 & ROWING LLC and certificates of election to he exempt shall be subject to revocatian 1L139 WtHANAN ST if, at any time after the filing of the notice or the issuance of the so,aYWO00, FL 99019 aerL'Ificate, the person named on the notice or certificate no longer meets Via requirements of this section for Issuance of a certificate, The department Shall revoke a certificate at any time for failure of the SCOPE OF BUSINESS OR TRADE;. person )tamed•an the certificate to meet the requirements of this +• P.00FIr4d CONTRACTOR z• GENERAL CONTAALTOR Section. QUESTIONS? (830) 413-1609 CUT HERE * Carry bottom portion on the jots, keep upper portion for your records. OWC^252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01-11