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RF-13-1726 • Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-196268 Permit Number: RF-7-13-1726 Scheduled Inspection Date:August 26,2013 Permit Type: Roof Inspector: Rodriguez,Jorge Inspection Type: Final Owner: CAGUAZZI,STEPHEN Work Classification: Gutters Job Address:1550 NE 104 Street Miami Shores, FL 33138- Phone Number Parcel Number 1122320320380 Project: <NONE> Contractor: ANOTHER GUTTER COM Phone: (305)992-0055 Building Department Comments NEW GUTTERS ON HOUSE 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. August 23,2013 For Inspections please call: (305)762-4949 Page 8 of 24 ti Miami Shores Village 1� Building Department I 4M50 N.E.2nd Avenue,llTami ShM,Merida 33138 JUL 31 2013 l Td:(305)795.2204 Fax..(305)7561972 INSPECTION'S PHONE . NUMBER:(305)764949 BUILDING I+BC 20 `"O PERMIT APPLICATION Permit No. Masher Permit No °1� Permit Type: BUILDING ROOFING JOB ADDRESS: /9570 >,/ /o(/A S; City: Mami Shores �._County:- Najd Dade Foliofi*col#: h Is the Ulding HistorlcaAy Dedpated:Yes —NO OWNER:Name(Fee Simple Titleholder):_ mpk Address: p�c p City: —State. Tenant2essee Nary: Email: Phone#: i CONTRACTOR:Company Name: An o4tQ J1 G&jTg2 Co Q�� Phone#. 3 ZL Address: 7 /00 4✓ 1,06 ,q7,,Q -- Mf'A state: C QualifierName: � , QQ /r61 Pon # zip: 3 State Certification r Registration „�-3oS Contact Phon # caw of Cgmpeteny#: f3. � Emil Address: DPSIGNE b ArcWteaVEnginew.. -Phonet. Vabe of Work for this Permit:$__j 879, Qb ` � Type Work: DAddition �Aheration $ °u '�near$'ootage of Work: 1 S go 1 , 1+wa3ptlon of Work: a -0 -12inc CPA ` w ODemobtion m Color thru tile: Submittal Fee Permit Fee$ CCF$ St&Wft Fee$ Radon Fee$ DBPR$ /CC$ —._. _ B�$ . Notary$, Trah hWAuc ation Fee$,�T�o�y Fee$ Double Fee$ S&M ttual Review$ TOTAL FEE NOW DUE$� _ t r. r 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 �p 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 rum 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 mast 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 cenVied 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 rek7ection fee will be charged Signature � Si Owner or gem 1 Contractor The *instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of— 1 .20 by �iP of UL; .20 by',)C -�--C who is personally known tome or who has ! produced = who is personally known tome or who haaprodttcedC-C- l,%C As identification and who did Ott oath. as identification and who did take an oath. NOTARY PI)BLIC: ,.�` ais Si/�'°°°•,, NOTARY PUBLIC: e' x i'r ' �°�" ��a►u i u nua� Sign: 0 1201 °` x /& Sign: •.o'_" Print: = C o Print: = j� My Commission Expires: %��F 173059 ,�Q<�`�� My Commission Expires: � Frl jsslO OF Flo ��`` ��' • FLOR��` APPROVED BY Plans Examiner. Zoning Structural Review Clerk (Revised 3n212012)otevised 07n W7XRv used 0fin0aWXRcv1sed 3/15/09) ■■■■ an■l" IP� y� �J=ORD� CUMULATIVE SUBSTANTIAL M P'ROVEMENT VERIFICATION WORK SHEET In accordance with FEMA regulation and Miami Shores Village Flood Damage Prevention Ordinance the costs of all improvements must be monitored. The costs of any improvements in the past 12 months and the costs of any proposed improvements must be shown on the worksheet.The cost of improvements must include demolition,raw and finished materials (include those donated), labor (including volunteer and self-performed), construction supervision and management,and overhead and profit.A list of items the costs of which are to be included as well as those excluded is attached for your reference.(A Copy of the Contract must be attached) PROPERTY OWNER: Stephen Cagnazzi PERMIT# ADDRESS: 1550 N E 104th Street FOLIO NUMBER: 11-2232-032-0380 FLOOD ZONE:AE BASE FLOOD ELEVATION: 9.00" FREEBOARD: EAST OF FL.CCCL: COST OF PAST IMPROVEMENTS(12 MONTHS: Zero COST OF PROPOSED IlVIPROVEMENTS: 1879.75 (ATTACH COPY OF CONTRACT) TOTAL CUMULATIVE COST OF BWROVE1VHOM(past and proposed): 1879.75 VALUE OF PRINCIPAL STRUCTURE(attach appraisal): 9 68• oktt OWNERS SIGNATURE: DATE: 31 ?h P PLAN REVIEWER SIGNATURE: DATE: Created on June 2009 D ntq)://gtsweoxmammm.gov/kTOpertybearcn/pnntmapjimi MIAMI-BADE COUNTY OFFICE OF THE PROPERTY APPRAISER Print Report PROPERTY SEARCH SUMMARY REPORT CWf6StqjWz Prop"Appubw property brormation: ` Follo 11-2232-M-0380 Property Address 1550 NE 104 ST i Otis Narne(s) STEVEN FUHR&W LORIE GLEIM 3 Mailing Address 1550 NE 104 ST x , MIAMI SHORES Fl. 33138-2656 F P, Primary Zorn 1100 SGL FAMILY-2301-2500 SQ Use Cede 0001 RESIDENTIAL-SINGLE FAMILYp ' Beds►BafhslHalf 2/7J1 � �� Floors ' Living Units 1 A4_Sq.Footage 2005 x, 1.01 8120 865o sct FT Year Built 1855 Aerial Photograph,2612 Full Legal Description RIVER BAY PARK ADDN PS 40-72 N LOT SEE 7 75.4 Taxable Value Informations LOT SIZE 000 X 118 COC 24691-28M 06 2006 6 Current Previous Previous 2 A&Bessment Information: Year 2013 2012 2011 Current Previous Previous 2 Exemption/ Exemptiord Exemption/ Year 2013 2012 2011 Taxable Taxable Taxable Land Value $119570 $152704 $127493 Courtly $0!$245538 $01$296798 $0)$272343 Building Value $125988 $144092 $144850 School Board $0/$245538 $0/$286796 $01$272343 Market Value $245538 $296796 $272343 City $01$245538 $01$296796 $0/$272343 Assessed Value $245538 $296700 $272343 Regional $01$245538 $0/$296796 $0!$272343 Benefits Information: Sale Information: Cunrmlt Previous Previous 2 Date Arnounti OR Book-Page Clrsli ication Code Bertetit iype 2013 2012 2011 612006 $680000 24691-2850 Other disqualified 5!2006 $680000 24691 2847 Other disqualified 91=2 $0 20742-4713 Sales which are disqual isd as a result of examination of the deed 712001 $30WW 19842-0013 Sales which are qualified 311993 $1170001 158561476 Sales which are qualified 611990 $0 00000-0000 Sales which are dieWaQtied as a result of examination of the deed Dtadaianw. The Office of the Property Appraiser affil MiamWade County are continnWly editing affil updating the tax roll and GIS data to reflect the latest paopmty infmudon ai GIS positional y.No wa mmm. or implied,era provided for data and the posihoW or themadc ac muuq of the&atahmein,ifs use,ea its iuterpmeWon.Although dtfs websfte is periodically%pasted,this information may not reflect the data cvaently on 81e at Miami Dade County's systems of recamd.The Property Appraiser and Miami-Dade Coumy Mum-no liability either for ay actors,omissions,em irecct%acies in the information pmov!cW regardless of the cause of such or for any decision made,action taken,or action net taken by the Weer fn reliance upon my inforution provided herein.See Miami Dade County fall disclaimer and user Agreement at htV://wwwmiamidade gov finfo/disclain—asp. PMPmty infommtion inquiries,comments,MW suggestions email:pawebmailOrniemidade pov CM fnquides,comments,and suggestions emnik gisamiamide ftov Generated on:Thu Jul 25 2013 1 of 1 712511310:09 AM 1 ti ► CFN:20130566693 BOOK 28730 PAGE 4681 t DATE:07/18/2013 04:42:46 PM DEED DOC 3,000.00 Td d=Titk,PLC HARVEY RUVIN,CLERK OF COURT,MIA DADE CTY 1ND MOOM Ave.Sub 101 t1 N24FL331" 101a Alarabesr: 1dB8wu (( Genend Warmuty*DeW U36 d�hma 1 .2013 by door a/k/a Steven i!'I)a1�r sad Lerb Glom&Wa LK*PL GlahN basbaitd and w1k vc add k 216: �PahatBeaeb,FL 33480, adW dm VaAW,to Theta"Jeb a,a dngle Wren,asul Stapkm y= a dse mar°"'� ai 1 ad3Ce P.O.Batt 78840,Cwoft CA c wd aid•�Eeo• � � �b +,bait t vas�er of � f ttbea wtatteof h dm f £grand to t►fdaa aunt ed'1'aa1Dc118ia,($10.00) Oft vabmble elltbat a >md rn �d+Y ,elites,zmsi ,ealeaees,eestvoysash a tsar clmgem4eq Lot 17,Bloek 4.River Hay Farts Addiden,a sulpilivfulm actuftg to the plat thereof reLrorded at P1stBook 4%Pap 7Z,ltn*a Public Records of MWm&Dade County,Xoeida Fared IDNmaba;ll• Sa Togetherva m the and Wmmmum dwmbelor4ft aria s fig, To Hare and to m4 en mm is f" t3nb U And dte hm*omataft vs6 said vmft.dent tfse kwthlly salted admid land in be$hV*that ttie�a a ft tent kv w tasdeorlty to mU and tsoavey tatLt tartd;etas drop hanebY NlY warn the tftia to sadd tend cad wlti dekad kq1 a alell whanwww'td dta!Odd lead is&aG of aU cwumWmww�sub"fd t 31.2012 asst all ate,mm em sad llmttatlom Vi a.assa naata 10 W HOGN W+heM4 the scald Wades bw Msmdmd soatad dme remb dm day tatd yanr f bu shave wrWm. DW-lAptanFm CFN:20130566683 BOOK 28730 PAGE 4682 fib: Deane SandwAd Tikwd T21%LLC 163!33 AV%Site 101 Mbmi.EL 33139 File Xmnber WB13-0124 SYREEA sealed amd deltw*d In owp%mmee: Sty ralhte Shmm AL Fahr { - 4 Addtew 6 Tn devdad DrW%Pekin DgWk FL33M Al 11.4 Q VIA, tdlda 14 Ede (Seed} w etPdcmmdtte� Aa=216'1;e Drtve,Pdm Bem,FL 336$0 STATE AF 1t1Dtl COIIMTY(W �3 A The fategatng bdn memt vase acknowleW bdom me this day un% 2013,by Steven Fuhr LWa Stevan A Fuhr and U do Gldm a/k/a Lone M.01chu,husband and wife, who axe pt�sanatly�Z%to or (�who have produced a as catioa. >f� 1?'t�OntPfame: DOM WMTMW WILUAW 9.MA Another Gutter Co. Date Address, Phone, 1-2-014 37: -s 8'3• i 'r I► Copper r . •.•" • • • r• . • • .- -r .' ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■w■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ RORRORR��e,RRR''Rio®��®®o��ii®�ioi��®�®�i��i1R®RRRRRRRRRR®RR RRRRRRRRRRRRRRR:::RRRR::R:RRRRRRRRRR:R:RRRRRRRR:�:RR:: RRRR::R:R: .■..a■..w■.mom.■.■■■■.....■.....■■.......■..■.�.■ ..■■■.■■. ai.■.■..■..■■■!■■■■....■...■■..■■■■■■■■■■■■■■i■I■■ ■....■... ■■■■■■■■■i■■■■■l■■■■........■...■.■...■■■■......�.■ ...■...■. IRR��RRR��RO�RR�R��RRRR�®Rt�RRRRRRORR;R��®®R!l�► � t��RRRR'.R ■■■■■■■■.. ...■.■..■■■......■.■.■.... ....■...,�■ ■■■■■■■■■ ■■■i■■i■iiiil■■■'■■■■■■■■■i■■■■■■■■■■i■ i■■■■■■11■■ ■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■I[MEN■■R■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■1[■■ ■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■f1■■■■■■■■■■■[I■ \■■■■■■1[■■R■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■r�i! ■■■I■■■■■■■■■■■LJ_��i ■■■■■■■■■■■ Balance is due upon completion 0• per •. : to,,: Amount $ MIMI 1 f� l Deposit R�S Miami Shores Village Building Department 10050 N.E.2nd Avenue awe Miami Shores, Florida 33138 "�k ff- Tel: (305) 795.2204 xORto Fax: (305) 756.8972 JULY 31, 2013 Permit No: RF13-1726 Building Critiaue Review 1. The plans are illegible. Provide legible dimensioned plans and details. 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. i i e: if Zo., Another.Gutter .C'o. ,y i i; • .. —/S--T—o 1 city. 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V1 2 Address, ,►, city, 1,egA-I Referred By, UNA iiiiiiiiiiiiiiiiiiiiiiiiiii ■■■■■■■■Y■■■■e■■■■■■■■■■■■■■■�If.111■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ "' ■■■■■■■■■■■■e■■■■■■■■■■iii ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■L.CI■■."��r■■■■.■1■■ ■■■ ■ ■■■ ■■t��■�I[�■�■■■■■■■■'i7mr-011101 ■■■■ ■■■iZt.■e■O■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■L�e�!aJI/■■■■■■ MEMO snow iiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiaiiiiiiiiiii ■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■a■e■■■■■■■■■ iiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiii■°iii ■■:�■■:�■::■::■::::::::::::Ial;:■::■::■C:■■::■■:C■■::■e■C:■■:■■:C■■::■■G:■■::■■:■�:w:■:■:■O■C:■:■:■:■:■:■!.■■i� ialY�CI■�.:e■�:■■�i!�e■�i■■�i•: :: : ■■�i1'.iii:i■iC'c■;:■:•:i■C•i■:•: :C:: ::C::::: : :i ■ • :::: I ■■ ■■■■ :C ::UNI■■■ ■■. � ::C:G ■ . n! � 11■■■ ■■ ■■ iiiiii ■ ■ ■ IV�■■ ■ ■ ■ :6■ � .0100■■■■■i1■i:■i•■■iei•■■i:■•i■■i:■i•IS■■■■■■■■■■L.■■■■■■■■■■■■I 11i��L�I��•� I■ICGpJII■■■.■■■■■■■■■■■ ■!!■Ic.��>>■■ ■■■■■■.■■■■ Solii°vziii� 'aiiiieiii ii �iiiiFA ■►i-■■I r�7■�■L'iY■■■■■■SI//1.1!>■■■■■■■■■i�LIAw0001�_��i■■fir/Y■■■■■ Amount I - • • /- Total Deposit AUG-05-2013 15:41 From: To:30575Ge972 Pase:1/4 ' x � "" °°�`� � o0'1J Miami Shores v Building Department AA's -3 71% 8,772, 10050 N.E.2nd Avenue Miami Shores, Florida 3393$ Tel: (305) 795.2204 CONTRACTORS' REGISTRATION Fax: (305) 758.8972 ALL CONTRACTORS MUST PROVIDE COPIES OF LICENCES AND INSURANCES EACH TIME A PERMIT IS SUBMITTED, IF CONTRACTOR IS A KORIDA STATE CERTIFIED CONTRACTOR: A. COPY OF{QUALIFIER'S STATE LICENCES B• COPY OF LOCAL BUSINESS TAX RECEIPT C• _.,COPY OF LIABILITY INSURANCE(CERTIFICATE HOLDER TO BE MIAMI SHORES VILLAGE BLDG DEPT) COPY OF WORKERS COMPENSATION(EITHER CERTIFICATE OR EXCEMPTION) IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY: A. COPY OF CERTIFICE OF COMPETENCY OF QUALIFIER B.- COPY OF LOCAL BUSINESS TAX RECEIPT B. COPY OF MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT C• COPY OF LIABILITY INSURACE(CERTIFICATE HOLDER MUST BE MIAMI SHORES VILLAGE BLDG DEPT) D. COPY OF WORKERS COMP INSURANCE(EITHER CERTIFICATE OR EXEMPTION) YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE HOLDER AS FOLLOW, MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES, FL 33138 ■sssssesssssr■".■■sssssssssas■ COMPLETE CONTRACTOR'S INFORMATION ■■■■.■..■■■■s.■s■■■■■■■■■■""■"` BUSINESS NAME:_ / �7'j, ?�,,, �`��- C,Q •�� BUSINESS ADDRESS: .�` l ® /4y Cry M /jg/V�+ STATE—? ZIP CODE V (I BUSINESS PHONE:{ 3Nn ) 992-' 60:r FAX NUMBER L---j CELL PHONE (� 9 92 oLAI: QUALIFIER'S NAME:�Gi 4�ez— QUALIFIER'S LIC NUMBER: 06 E-MAIL ADDRESS(IF APPLICABLE): Created 4n 31190 BY NLDV1 RV 3rZM mj DV/RV 6d27l11 AS AUG-05-2013 15:44 From: i To:3057568972 Pa9e:3/4 Conshvdiori Trades Llt�iifyirtg Board SUSINES'8•CERTIPICA7'i Oi`'COmpp.,ENCYI 06BS-0161 A1110THER GUTMR COMPANY' K-VAL'LE JORGE ills cerow Ilndw vm proviwons of CliW frier t 0'of MIarM-Daft Caurs 4 ►OWH- lvii� y� ,..r /�y� yt,..., i•L�.IL.6u � � Sid 7e �Li'��' 'Y'FC4��+t;,'TK. '•v a,�.'.:�5 .. =TFUSfiAi� •' y CC NO: 06WO'1518 ,BU61NlSlC NAIN,E%L4GY� N' RfE EIPT•. .. •• . ANbTME8k GUTfF13.COMPALd!' 21QO SW 1 QO AVE 1>t1311tl f�tiJ9I '':'; Mbitft.•-0;'20:1 MIAMI,FL 11165 .. 7433553' 'Mus4b®4isplby®'d•lat Waw of businea® ,P:ursuart•to County Code ,i•--�° .., �.-..-;� •• - 'S®4'70-24 W ER TY L OF BY6FN�S8 `` 1 J j SP C1tr u II.DI G CO i FOR PAYPiIII}ror.7i6CE1VE•D ER R MANY SY T COLbEt�fO�i 18.7 '08/•%no 13_4 %f Re tic to Gi �^ 0270-13-ow so i3lianti Sho s Mar» � .• E K, g�01a 9Non,nr GJ *' FIRST-CLASS U-S.POSTA(IE PAID MIAMI,FL PERMIT NO.231 4 , 593993-0 THIS IS NOT A BILL-•DO NOT PAY RENEWAL M"I S6 ORCOMPANY CC Olwiyg35i$ 619667-9 33165 UNINODADEECOUNTY 0WROTHER GLITTER COMPANY L & QTY BUILDING CONTRACTOR WORKER/S TW ni OWY A LOOA{, i BSI_IV TAX APCEI 1r SHOW �°�pSgLA TH6 �Q/I0176RiTo LA70AY OI! IT E I 'THE DO NOT FORWARD PE R Ffl a OTHEHR� ANOTHER GUTTER COMPANY v BY uw n,ts F JORGE DE VAL LE PRES Nor A ex THE W c°a 2100 SW 100 AVE MIAMI FL 33165 vaYraetvr a CO A4=TAX 10/15/2012 09010073001 000082.50 1.,ills fill,,+11111,,11,111 1,:l,l$It#I i„t„Nijitist.114 SEE OTHER SIDE= AUG-05-2013 15:46 From: To:3057568972 Paee:4/4 oP 11-13-2012 a JEFF ATWATER STATE OF FLORIDA C1,111W PIN"Cift oFPtcek 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 bm exempt from Florida Workers' Compensation law. EFFECTIVE DATE:, 11/1312012 EXPIRATION DATE: 11/13/2014 _ PERSON: DEL VALLE JORGE FEIN: 205437447 BUSINESS NAME AND ADDRESS: AIWTNER GUTTER COupANY 2100 SW 100Th AVE MIAMI FL 33165 SCOPES OF BUSINESS OR TRADE: 1- SHEET METAL (5535) IMPORTAWri Pursuant to Chapter 440 . 05114), F.S., an officer of a corporation who elects exemPtioo from this chapter by filing a certificate of alectiao onder this Section may alit reeo-at beaefiis or campeasation under ibis chapter. Patsmeat'to Chapter 440.05(121, F.S., Certificates of election to be exempt... apply only within the some of tiro oasiaess or trade listed an 4he notice of election to be exempt. Punsuaot to chapter 44D.a%13). F.S., Notices of election to be exempt and certificates at election to be exempt goal, be sabiect to revocation it, at any time after the filing of too notice or the issuance of the certificate, the person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate. The department abaft revoke a cart(licate at any time for failure of the person aamad an the certilicete to Intel the re4airaments of this sectiA. DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01-11 QUESTIONS? (850) 413-16 PLEASE CUT OUT THE CARD BELOW AND RETAIN FOR FUTURE REFERENCE STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES IMPORTANT DIVISION OF WORKERS!COMPENSATION F Pursuant to Chapter 440,05(14), F.S., an officer of a corporation who CONSTRUCTION INDUSTRY O elects exemption from this chapter by filing a certificate of election CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA L under this Section may not recover benefits or compensation under this WORK ' ER5 COMPENSATION LAW EFFECTIVE: 11/13/2012 EXPIRATION DATE: 11/13/2014 D chapter. PERSON: JORGE DEL VALLE i„1 Pursuant to Chapter 440.05,121, F.S., Certificates of election to be exempt. apply only within the scope of the business or trade listed on FEIN 205437447 RE the notice of election to be exempt ANOTHER GUTTER NAME AND ADDRE$$: E Pursuant to Chapter 440.05(13), F.S., Notices of election to be exempt ANOTHER OOTH COMPANY and certificates of election to be exempt shall be suD ect to revocation 2 MIAMI,sw 10185 AVE If, at an time after the filing of the notice or the issuance of the MIAMI FL 33iB5 certificate, the person named on the notice or certificate no longer meets the 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 named on the certificate to meet the requirements of this I- SHEET METAL (5585) section. allESTiONS? (860) 419-1809 CUT HERE Carry bottom portion on the job, keep upper portion for your records. DWC-251 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01-11 �I .: Another Gutter Co. r. r + . .. 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DATE(MnnTDh'i%j. . : .:.•.;,� �:: :.•.<. ;•:. 07/31/2013 jk TFIRS CEitTIFICATE 15 ISSUED AS OA��MATi ER+OF IN RMA'TION NESPRAI.INSURANCE,INC. ONLY AND CONFERS NO RIt,�F1T8 UPON THE CERTIFICATE 2500 SW 107 AVENUE 3t11TE 3 WOLDER. THIS CEI2TIFICA 8 aoES NoT AM MIAMI,FLORIDA ALTER THE COVERAG POLICIES EXTEND OR 33165 6 AFFORDED BY THE POLICIES SELO TLL:305-227-6417 Co„ MPANIES A9;FO01yMG COVERgGE W COMPANY INSURED A ASCENDANT COMMERCIAL INSURANCE,INC - ANOTHER GUTTER COMPANY 2100 SW 100 AVE COMPANY MIAMI FL 33185 E COMPANY C COMPANY p D ,4 { Su1tx ',"'A' •,:, i'�,,'',, c• yry!�:•1 per. y,, �.nti " idfi:4V. "�•''P' ''.•�f,: ""P„�° 3•:.lRf:lm:•�r.r.s ,.... THIS IS TO CERTIFY 'a` ` (`1, wi �:LsCrni •.il' G. qY. Y^'�'` ;.' ,:•' °y.'E':.'v' ';d�l. '�.•";C•rre•;t..• .,., THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TplE $ NAMED A80V1=FOR THE POLICY PERIOD INDICATED,NO MAY BE ANY RERUt)4EMENT, )ERM OR COND)TTON OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WCY P THIS CERTf1 KATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED B Y THE POLICIES DESCRIBED HEREIN IS SUB.IECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLIClEg,uM(T3 SHAWN MAY HAVE BEEN REDUCED BY PAID S AIMS, LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFKECTME POLICY EXPIRATION GENERAL LIABILITY DATE(MMlDbNY) DATE(MMIDO" LIMITS A X COMMERCIAL 0"RAL LIABILITY GL-37324-1 GENM;tALAGGRrpATE $ 1,000,000 C OCCUR 05/212013 05/2112014 PRODUCTS-COMProP AGG OwNER's�c;C $ .1.000NTRACTOR S PROT ,000 PERSONAL a AQV INJURY S 1000 .�^ _ EACH OCCURRENCE $ 11000,0, 00 �— FIRE DAMAGE (Anyone fete} $ 100.'000 . AUTOMOBILE LIABILITY ANY AUTO "ED EXP(Anyone penqn) $ $,000 fX)MOINED StNOLE L#Mrr' $ ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY g HIRED AUTOS (Per pwoon) NON-OWNED AUTOS BODILY INJURY $ (f+er vo*en!) GARAGE LIABILITY PROPERTY DAMAGE S ANY AUTO AUTO ONLY-EA ACCIDENT S —� OTHER THAN AUTO ONLY; CH ACCIDENT $ EXCESS L N IABILITY AGGREGATE III UMBRELLA FORM EACH OCCURRENCE $ OTHER THAN UMBRELLA FORM tEt GAY E $ WORICER`S COMPENSATION AND $ EMPLOYERS'LIABILITY yv0. ST,1rU- Q 71*m PROPMErml To�JdAara PARTNIUmmmu-9 INCL EL EACH ACCIDENT $ OFROMM ARR EXCL EL DISEASE-POUCy LIMIT $ OTHER EL DISEA12-EA EMPLOYEE $ 7ESC PTION OF PERA71OW9ILOCATiON ENICL IAL RSUS CE T7F,IG 4 - 'a'E�Td L"DE � ;�;•r;1�.'s�. �wriC'` : ::t„ay r';•,u '4yj'~M'r'�`' „,a}�;•°, y�''._•'w•"'•:. �{'"••.i s ':T p,�.,:,r;'s,3�,:+% •,'C N .;K;�i .�,.i�3.:•CANC.EL'I�iT10N.f.,"'' i,:.,�*;��•�:'��: - ' w••:3'=�• ,.*":.•..w MIAMI SI"10 sKOULD ANY "c�„�s°st• �..r��•,._,.;.,.�'r°I,��`.'_.,;ri'•dP.�--.,; �;I� r,�r.��a;•;.,�<�„� RE VILLAGE BUILDING DEPARTMENT SXI'IRA790N DATE�TtEiHRB DESCRIBfiD POLICIS$ BE NC .ter 10050 NE 2ND AVE SLLED BEFORE THE r 7S9UINfl O PANY ENDEAVOR TO MAIL MIAMI SHORE.Fl,$3138 30 DAYS WRITTEN NOTICE CERTIF 773 NO NAMED TO y"C LEFT” OUT FAILURE TO MAIL SUCK N I7 LL IN SE 0 IGAT ION Or?LIABILITY OF ANY IND U ON OM A AGB R BPRfs AUTHORIZE[)RrPRESENTA E ICORD 2S-5 ACO [1.CORPORA� TIN 1 �8