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DS-13-0735Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 nspection Number: INSP- 189112 Permit Number. DS -4 -13 -735 Inspection Date: February 27, 2014 Permit Type: Driveways /Sidewalks/Slabs Inspector: Rodriguez, Jorge Owner: RODDY, ROBERT Job Address: 9490 NE 5 Avenue Miami Shores, FL Project: <NONE> Contractor: ARUBA COSNTRUCTION CORP Buiidina Denartment Comments Inspection Type. Final Work Classification: Addition /Alteration Phone Number Parcel Number 1132060140430 Phone: (954)786 -7292 DEMOS EXISTING CONCRETE SLAB, BUILD A NEW Infractlo Passed Comments INSPECTOR COMMENTS True LANDING STAIRS AND INSTALL CONCRETE PAVERS Inspector Comments Passed Failed Correction Needed ❑ Re- Inspection ❑ Fee No Additional Inspections can be scheduled until re- inspection fee is paid. For Inspections please call: (305)762 -4949 February 27, 2014 Page 1 of 1 Miami Shores Village r. Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 'E Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 s "1 Permit Type: BUILDING I FEB 1 12014 FBC 20 Permit No.-DS-4-15_13S7, Master Permit No. ROOFING JOB ADDRESS: q 4a D t1 f, S_. 4�0t City: Miami Shores County: Miami Dade Zip: 13 �` -- 11 ---7 Folio/Parcem 113 'LO (a o 14 0 4 Is the Building Historically Designated: Yes NO - Flood Zone: OWNER: Name (Fee Simple Titleholder): Phone #. Address: q 4 R ® IJ6 's� X11 C-OU35 city: YWI Aran 1 SZ W0 9-1_--�75 State: eta Zip: 5N,39- 23 Z% TenandUssee Name: Phone# _9_1-Sb3 --°3q,9 9 Email: a R hnc� -' Cori Li I CONTRACTOR: Company Name: A&6A CZ JQ "'i12A YI 1W Phone #: QS4 -° %C-77,12_ Address: MOD 6 LA3 31,10 G"fg- FzF'i `v` -U rie B-3 City: P-MMEA00 'BLACA State: ee' zip: Qualifier Name: t ep 1- - RdbPrIA Phone #: State Certification or Registration #: l.&L I SO 9 b 2,0 Certificate of Competency #: Contact Phone#: -410 -� f-u` 9-1 Email Address: Jf i &A Q a b L Q DESIGNER: Architect/Engineer: Phone #: Value of Work for this Permit: $ Square/Linear Footage of Work: Type of Work: DAddition OAlt�e- r�attiio_n� ONew ORepair/Replace ODemolition Description of Works MgAW T Color thru file: 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 $ Bonding Company's Name (if applicable) Boriding'Company's Address City State Mortgage. Lender's Name (iP diplicable) Mortgage Lender's Address City State zip zip • P .l1 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 _ Owner o )Vent (` Contractor -`� The foregoAi�nJg(instrume was acknowledged before me this The forego' strument was acknowledged before me e this. day of S�T 20, by 20 b day of ti , , by S� who is personally known to me or who has .produced who is personally known to me or who has produced As identification and-who did take an oath. NOTARY PUBLIC: Print: ! S My Commission Expires: APPROVED BY ,COMMISSION # FF012529 EXPIRES: APR 25, 2017 WWW.AMNNOTARYCM Plans Examiner Structural Review (Revised 3 /12/2012)(Revised 07 /10 /07)(Revised 06/10/2009)(Revised 3/15/09) identification and who did take an oath. NOTARY PUBLIC: Print: 1. y v rs-,V ,•" "' 1 mena umz $COMMISSION #FF037834 My Commission Expires: y�;; ' a `�g pARES: IDLY 2i, 2017 WWW.AMONNOTARY. n Zoning Clerk Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shoms, FL 33138 -OM Phone: (305)795-2204 Project Address Parcel Number Applicant 9490 PIE 5 Avenue 1132060140430 Miami Shores, FL Block: Lot ROBERT RODDY ROBERT RODDY 5490 NE 5 AVE MIAMI SHORES FL 33138 -2727 Contrador(s) Phone Cell Phone ARUBA COSNTRUCTION CORP (954)7-7292 In Review Approved:: In Review Denied: of Work: Return nino:1 Fees Due Amount CCF $4.80 DBPR Fee $2,25 DCA Fee $225 Education Swdmp $1.00 PermQ Fee $150.00 Scanning Fee $3.00 Tedmology Fee ".40 Total:— $170.30 M 9 Additional Info: Classification: Residential Invoice # DS- 4- 13.47320 07/22/2013 Chad(* 1359 04/1112013 Check d: 1028 Amt $120.30 $ 50.00 $ 50.00 $ 0.00 �S $7,800 .00 Feet 624 Available Inspections: InspeWon Type: Fc nspections, Call (305) 7624M or Log on at https: //bldg.miam!Shoresvillage comfcapf. Requests must be received by 3 pm for following day inspections. NOTICE: in addition to the mquinmen s of this permit, #Me may be AND THERE MAY BE ADDITIONAL PERMITS REQUIRED FROM OTHER additional restrictions applicable to this property that may be found in GOVERNMENTAL ENTITIES SUCH AS WATER MANAGEMENT tiro pub# *Turret of this county. DISTRICTS STATE AGENCIES, OR FEDERAL AGENCIES. A CERTIFICATE OF LIABILITY INSURANCE CA 1MMIDI oMM THIStCERTIFICATE 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 ((es) 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 CONTACT NAMa purl N% 1 -OM277-1620 x4M 0'rC. 727- 7e7.0704 FRANKCRUM INSURANCE.AGENCY, INC. nova: INSURERS AFFORDING COVERAGE NAIC0 100 S. MISSOURI AVE. INSURER A. FRANK WINSTON CRUM INSURANCE CO. 11600 CLEARWATER FL 33756 INSURED INSURER 6: INSURER C INSURER D: FrankCrum 1-800 -277 -1820 INSURER E: 100 S MISSOURI AVENUE INSURER P COMMERCIAL GENERAL LIABILITY CLEARWATER FL 33758 lrl: 11 wuffluC - "Intl THIS 13 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. PIER LTR TYPE OF INSURANCE ADDL INSR SUBR VWO POUCYNUMBER POLICY OFF (MMMONYYY) POLICY EXP 011JUDDYYYY) LIMITS GENERALUABILI Y EACHOCCURRENCE Si DAMAGETO AEPITED COMMERCIAL GENERAL LIABILITY PREp41SES $ MED ow OR are Fellow $ CLADCSoNIADE =OCCUR PERGONAL &ADV IIdR1RY GENERALAGGREGATE $ GENM AGGREGATE LIMIT APPLIES PER PRODUCTS - COMPIOR AGO $ 7paucy Llama LOC I I COMBINED SINGLE MIr MOBILE UABBJTr a aaddeN $ BODILY INJURY (Pa pm .Ill ANYAUTO ALL OMEO SCHEDULED AUTOS AUTOS BOMLYNAWFwaaddam NON 47AMM PROPERTY DAMAGE HIRWAUTOS AUTOS $ UMBRELLA LIAO OCCUR EACH OCCURRENCE AGGREGATE $ EXCESS UAB CLvMSaADE DEC RETENTIONS $ A NORKERS, COMPENSATION AND WC2014000M 1/1/2014 1/M015 X sTATLI TORY UWM I 'T EMPLOYE IJABOJTY ANY PROPMETORIPARTNEWDEWTIVE OFFICERIMENBER EXC UJDEDT IM, NIA E.L. EACH ACCIDENT $1000000 LAN In *0 Eyes. deem0le Wtft E.L. DISEASE- EA EMPLOYEE 1000 000 DESCRIPTION OF OPERATIONS WOW E.L. DISEASE- POLICY LIMIT $1.000,000 DESCRIPRON OF OPERATIONS i LOCATIONS 1 VEHICLES (At wh ACORD 101, Add UmW Remarlm adodub, ft more apace b requited) EFFECTIVE 07/28!2010, COVERAGE IS FOR 100% OF THE EMPLOYEES OF FRANKCRUM LEASED TO ARUBA CONSTRUCTION AND ROOFING, INC. (CLIENT) FOR WHOM THE CLIENT 18 REPORTING HOURS TO FRANKCRUM. COVERAGE IS NOT EXTENDED TO STATUTORY EMPLOYEES. ®1986.2010 ACORD CORPORATION. AI rights reserved. ACORD 25 (2010108) The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. MIAMI SHORES VILLAGE BUILDING DEPARTMENT 10050 NE 2ND AVENUE MIAMI SHORES, FL 33138 AUTHORJ= REPRESENTATIVE ®1986.2010 ACORD CORPORATION. AI rights reserved. ACORD 25 (2010108) The ACORD name and logo are registered marks of ACORD THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS t 70 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 laws and regulations. Mailing Address: ` ARUBA ROOFING INC 1460 SW 3 ST STE B -3 POMPANO BEACH, FL 33069 2013 2014 Receipt #30A -13- 00000063 Paid 10/01/2013 29.70 CTOu For Vending Business uniy Number of Machines: Vending Type: 115 S. Andrews Ave., Rm. A -100, Ft. Lauderdale, FL 33301 -1895 — 954- 831 -4000 Transfer Fee VALID OCTOBER 1, 2013 THROUGH SEPTEMBER 30, 2014 Prior Years Collection Cost Total Psi 27.00 ®BA- R@Ceipt #: ROOFING /SHEET METAL 2.70 Business Nam@° ARUBA ROOFING INC ° Business Type: (ROOFINC, C'ONTRAC'TOP) I-_ Owner Name: JOSEPH G FLOREA /QUAL Business Opened:05 / 17 / "1006 Business Location: 1460 SW 3 ST STE B-3 State /County /Cert/Reg:CCC 132'7348 POMPANO BEACH Exemption Code: Business Phone: b'- c -a Rooms Seats Employees Machines Professionals THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS t 70 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 laws and regulations. Mailing Address: ` ARUBA ROOFING INC 1460 SW 3 ST STE B -3 POMPANO BEACH, FL 33069 2013 2014 Receipt #30A -13- 00000063 Paid 10/01/2013 29.70 CTOu For Vending Business uniy Number of Machines: Vending Type: Tax Amount Transfer Fee NSF Fee Penalty Prior Years Collection Cost Total Psi 27.00 0.00 0.00 2.70 0.00 0.00 - -,- 2() THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS t 70 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 laws and regulations. Mailing Address: ` ARUBA ROOFING INC 1460 SW 3 ST STE B -3 POMPANO BEACH, FL 33069 2013 2014 Receipt #30A -13- 00000063 Paid 10/01/2013 29.70 CTOu 115 S. Andrews Ave., Rm. A -100, Ft. Lauderdale, FL 33301 -1805 — 954 - 831 -4000 VALID OCTOBER 1, 2013 THROUGH SEPTEMBER 30, 2014 DBA• • ARUBA CONSTRUCTION CORP Receipt #:GENER7A7L0 CONTRACTOR Business Name: Business Type:BUILDER) Owner Name: JOSEPH G FLOREA /QUAL Business Opened:11/17/1997 Business Location: 1460 SW 3 ST STE B -3 State /County /CertfReg :CGC1508020 POMPANO BEACH Exemption Code: Business Phone: Rooms Seats Employes Machine Professionals 1 Years Collection Cost Total Paid 27.00 0.00' '0. ©8 0.00 29.70 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 laws and regulations. Number of Machines: Vending Type: Tax Amount Transfer Fee NSF Fee Penalty v. Prior Mailing Address: ARUBA CONSTRUCTION CORP Receipt #30A- 13- 00000062 1460 SW 3 ST STE B -3 Paid 10/01/2013 29.70 POMPANO BEACH, FL 33069 I I 1 1 �.Ma� -i� a.�r � h -'i. .�•. >a:-, .. .. _,a r - -- t .-�',;. €. > . -�- i "':"i T � rte, d V!4 �. �° Number of Machines: Vending Type: Tax Amount Transfer Fee NSF Fee Penalty v. Prior Mailing Address: ARUBA CONSTRUCTION CORP Receipt #30A- 13- 00000062 1460 SW 3 ST STE B -3 Paid 10/01/2013 29.70 POMPANO BEACH, FL 33069 I I 1 1 �.Ma� -i� a.�r � h -'i. .�•. >a:-, .. .. _,a r - -- t .-�',;. €. > . -�- i "':"i T � rte, d V!4 �. �° Mailing Address: ARUBA CONSTRUCTION CORP Receipt #30A- 13- 00000062 1460 SW 3 ST STE B -3 Paid 10/01/2013 29.70 POMPANO BEACH, FL 33069 I I 1 1 �.Ma� -i� a.�r � h -'i. .�•. >a:-, .. .. _,a r - -- t .-�',;. €. > . -�- i "':"i T � rte, d V!4 �. �° Miami Shores Village / 13 Building Department Idl 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.1949 BUILDING PERMIT APPLICATION Permit Type: UILDING JOB ADDRESS: o Q9 �4 C 5i� P Ve � APR 10 2013 �41 � �e..mmmo'm•emeeo o! e MP91-6��N Permit No. Master Permit N ROOFING City: Miami Shores County: Miami Dade Zip: 3 3) 39/ Folio/Parcel #: Is the Building Historically Designated: Yes NO `_� Zone: OWNER: Name (Fee Simple Titleholder): 't?c) �,rljt Z LA W . Zb W+Phone #: _75 6-"4 Y (� Z Address: y ri 0 N f_ City: AN t 1A inn i S' /-U e r< S State: L Zip: 3 3 1 3 Tenant/Lessee Name: Phone #: Email: CONTRACTOR: Company Name: Phone #: Address: % y G 0 S W 3%�p 51- City: y M�jL�M 0 Zo p%C State: !. I Zip: 3.3 U L9 P� l S- S � � Qualifier Name: a � State Certification or Registration #: Cs L' 190 90 20 Certificate of Competency #: Contact Phone #: qS"Y- ev" a SS ^9 7 Email Address: S 6' da tW aj\ ® p o L • Cam" DESIGNER: Architect/Engineer: Phone #: e:1 TValue of Work for this Permit: $ / �o0. ' Square /Linear Footage of Work: 2A Type of Work: ❑Addition Alteration ❑New ❑Repair/Replace ❑Demolition Description of Work: GNCAdy— rr b d d ."V C-4 -4 Color thru tile: :p:Y�:x:k :t :g•Y•:i::k : k: k: k% k' k•: I:: k :k:;::kx:K:k�:Y:I::K:::k:H•k•:k X :k:I: :k *Fees**: .: k:t:: R�:: E::t: �(::l:: R: k: k: f: a::!••: e: k: kX: F: kok�: k��a% F: k�#:kY- :Y:i+:i::i::k:K:e:6:I::K Submittal Fee $ Permit Fee $ i CCF $ CO /CC $ Scanning Fee $ Notary $ Double Fee $ Radon Fee $ Training/Education Fee $ Structural Review $ DBPR $ Bond $ Technology Fee $ TOTAL FEE NOW DUE $ r 1 PERMIT # CONTRACTOR: SUBMITTAL DATE: ADDRESS: " I G lk. NAME:Robe,4 6d4, RESUBMITAL DATES: STRUCTURAL IMPACT FEES ELECTRICAL HRSIDERM PLUMBING NOC MECHANICAL - Bonding Company's Name (if applicable) Bonding Company's Address City State 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 ;:oust 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. Signatur Signature Owner or Agent Contractor The foregoing instrument was acknowledged before me .this The foreQ tnQ /istrument was acknowledged before me this day of , , 20 -&, by �iaU IOZD 01&1 day of , 20 _, by , who is personally known to me or who has produced F54 who is personally known to me or who has produced As identification and who did take an oath. NOTARY PUBLIC: Sign: / 6 Print: IG My Commi 6 HARD PHILPOT �IMINION S EE175M t � ' EXPRES March 01. 2016 �Y�av�.00m :k: #:g:k:k -k %k h:k�k�k �C:k:k�::k:k::c:k:k:k:k>k:k �k =k:k.: •::... :k .APPROVED BY XL�7� `/ Plans Examiner Stnictural Review t Rwued 3/ 13/'_01 2)( Revised 07i I 0/0-1)( Revised 06i I 0L009 a Rc ised 3i I ;io9 i identification and who did take an oath. NOTARY PUBLIC: Zoning Clerk AC,;!R°® CERTIFICATE OF LIABILITY INSURANCE 7/19/2` 013 ' 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 pcilcy(ies) insist be endorsed. R SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A sbRement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER IMA Insurance amVcT Sean Cabral PHONE (407) 838 -3445 FAX (407) 838 -3460 A5&j6w scabral8lraiarsurance.can 498 S Lake Destiny Rd /23/2013 AFFORDING COVERAGE NAIL 4 WSURER A rIGIMU 9. Insurance Co. $ 1,000,000 Orlando FL 32810 INSURED untuam B MPFRE Insurance Company of PERSONAL 8 ADV KIURY DUKIRERC: Aruba Construction Company & Roofing Inc. uaURERO: $ 2,000,000 1460 SN 3rd Street 113 INSURER E: $ 1,000,000 INSURER F: $ jPompano Beach FL 33069 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. INSR TYPE OF INSURANCE POLICY NUMBER EFF E]D� LIMITS A GENERAL LIAWIM X COMMERCIAL GENERAL UABLIIY CLAIMSAINDE ® OCCUR K=001S380 /23/2013 /23/2014 EACH OCCURRENCE $ 1,000,000 D PREMISES (Es OMRMRW TO $ 100,000 $ EXCLUDED MED EXP we PERSONAL 8 ADV KIURY S 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEM AGGREGATE LIMIT APPLIES PER: 7X POuCY PRO LOC PRODUCTS - COMPIOP AGG $ 1,000,000 $ $ AUTOMOBILE LIABOJTY AN AUTO ALL X ULED AL P X HIRED AUTOS X ANION - GOWNED 150120006333 /14/2012 /14/2013 COMM arcWIED LIMIT 300,000 BODILY ft;URY (Perposm) $ (er ) $ PR DAMACIEE ecesdant $ P11343asic $ 10 000 UMBRELLA LIAR E XCESS L IAB OCCUR CLga IApE EACH OCCURRENCE $ AGGI�GATE $ ED I I RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' L IABHliY YIN ANY PRORRIFTORIP,ARTNEREXECUTIVE OFFIC ERtMEMBER EXCLUDED? (Nyo�, at•-YIn � DESCRIPTION OF OPERATIONS below NIA WC STA - OTH ER E.L. EI�i ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ EL DISEASE - POLICY UNIT $ DESCRIPTION OF OPERATIONS /LOCATIONS I VEHIC ES (Attach ACORD 101, AdMansl Remarks 8clmdut% a mme space Is ) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES LE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Miami Shores Village Building Department ACCORDANCE YMITH THE POLICY PROVISIONS. 10050 HE 2nd Avenue Miami Shores, FL 33138 AMORKEED 10991ESENIIATME wr tww�wMr� Lumbra, Jr. /SEAN' as •wwn wwaw �.....ww ���..._� -�___ ___ _ _ NOTICE OF COMMENCEMENT CFN 2013R®e281347 A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION RECORDED EIM `8576 4/ 1/20 3 (i : 3 RECOROEO r�4�diif2r11v iidi9siar HARVEY RUVINY CLERK OF COURT PERMIT NO. TAX FOLIO NO. V I - 32o6 - 6 a i3® MIAMI-OADE COUi�TYP FLORIDA � LAST FAGS 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. Le�gai � i' description S la v¢ S property d street/ 8/ x: 3 7 1 ©r / c F_ `1 L y i 2- 61 r— S2_ 2. Description of impr vement: �ivS,lAtL �yv�lL� 3. Own r(s) name and address: J "?A&-,e LA 20,00 '1 Cl q q1) N C iM AA'% S 1442 rS Interest in property: Name and address of fee sin1ple titleholder: 4. Contractors rime and address: �Ctv�3A 1.27��S�rLuef'i�nJ Ant) �e►vl��,� �ncC 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 unless a different date is specified) Signature of Owner / Print Owner's Name ��N�" ® Prepared by Sworn to and subscribed before me this 17 day of _'20 . Not Prir My Address: 07/18/2013 11:09 FAX 1 800 885 7530 DATA SCAN FIELD SERVICES TRANSMISSION OK TX/RX NO RECIPIENT ADDRESS DESTINATION ID ST. TIME TIME USE PAGES SENT RESULT TX REPORT 3918 919547887295p4102 07/18 11:08 00,38 OK R 001 Miami Shores Villak-Te Llildill(ly Department 16— "04 Fam NIA110,1t: 04);, 7112,40,19 2wo BUILDING PERNN-11T APPLICATION Nlaster Permit 1.11LDI♦GY" ROOFING JOR \M)RE'SX: M .... ...... MANER: %.wl-;l! l*,,!-'0:,ti:.,i*!*. L W Pll,orrt. 1-4 7 .. ......... ...... .,I . J! " � "� 1 1.4 \(.1`0 R! C 7. -7 7 ....... ....... j' • .... ...... N N ..... ..... Property Search Page 1 of 2 http: / /gisweb .miamidade.gov /PropertySearch/ 4/1/2013 6265015 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD SEQ# L1208130 13/20121128038188 ICGC1508020 GENERAL CONTRACTOR ed below IS CERTIFIED er the provisions of Chapter 489 FS. iration date: AUG 31, 2014 FLOREA, JOSEPH G ARUBA CONSTRUCTION CORP 1460 SW 3RD STREET SUITE B-3 POMPANO BEACH FL 33069 4k RICK SCOTT KEN LAWSON GOVERNOR SECRETARY DISPLAY AS REQUIRED BY LAW empano 10beach_ da's Warmest Welcome NER 'NO. ESS NAME City of Pompano Beach Business Tax Receipt mz*-- =-- -11--Z REGISTRATION NO. NEW RENEWAL DATE ISSUED REGISTRATION FEE DELINQUENT CHG. -ATION TRANSFER FEE a,SSIFICATION TOTAL AMOUNT PAID EFFECTIVE DATE EXPIRATION DATE OCTOBER SEPTEMBER 30 BUSINESSES MUST CONSPICUOUSLY DISPLAY THIS BUSINESS TAX RECEIPT Tq PUBLIC VIEW AT BUSINESS LOCATION CONTRACTORS MUST MAINTAIN ON FILE CURRENT LICENSING AND INSURANCE 'ICE: A NEW APPLICATION MUST BE FILED IF THE BUSINESS NAME. OWNERSHIP OR ADDRESS IS CHANGED, THE ISSUANCE OF A BUSINESS TAX RECEIPT SHALL NOT DEEMED A WAIVER OF ANY PROVISION OF THE CITY CODE NOR SHALL THE ISSUANCE OF A BUSINESS TAX RECEIPT BE CONSTRUED TO BE A JUDGEMENT OF THE CITY TO THE COMPETENCE OF THE APPLICANT TO TRANSACT BUSINESS. C# 6264866 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD —_ SEQ# L12081 08/13/20121128038188 ICCC1327348 The ROOFING CONTRACTOR Named below IS CERTIFIED s Under the provisions of Chapter 489 FS Expiration date: AUG 31, 2014 v, -.ruw FY 17 , RICK SCOTT KEN LAWSON GOVERNOR SECRETARY p *mpano Wbeach_ Florida's Warmest Welcome OWNER ACCOUNT NO. BUSINESS NAME LOCATION CLASSIFICATION City of Pompano Beach BUsiness lax Receil REGISTRATION NO, NEW RENEWAL DATEISSUED REGISTRATION FEE DELINQUENT CHG. TRANSFER FEE TOTAL AMOUNT PAID EFFECTIVE DATE EXPIRATION DATE OCTOBER 1 SEPTEMBER 30 ®ualrvtSSES MUST CONSPICUOUSLY DISPLAY THIS BUSINESS TAX RECEIPT TO PUBLIC VIEW AT e BUSINESS LOCATION CONTRACTORS MUST MAINTAIN ON FILE NOiU'E: E NEW AIVER Q AN MUST Bt N o tf THE HUSINESS NAME:, U "WNEri ;tltP OR AU 3tiE:SS i5 CHANGF:p� H RENT LICENSING AND INSURANCE AS UEEMEU A WAIVER Qf ANY p � AS TO ttiE t ROY1SlC7N QF- ttt OMPETENC.E Qf i£IE APP E' j TX I.UUf. NOR %HAt.I {ryi ;SSUANC.F ?F n SSUANt ( IC ANT rp INANti Ai f f3 ii StNE.SS fit!SINE -SS TAX Ei E qF A BUSINESS IA %- Rf.CEtNT tfT lPr BE t.UNStft Ufl) TO Rf A y .lUUGEMf -NT of T11f f]st p' _ E �_. FLOREA, JOSEPH G ARUBA ROOFING INC. 1460 SW 3RD STREET Tyr- SUITE B -3 POMPANO BEACH FL - '33069 k a } r '4 Yi•ez b k°fi,� FY 17 , RICK SCOTT KEN LAWSON GOVERNOR SECRETARY p *mpano Wbeach_ Florida's Warmest Welcome OWNER ACCOUNT NO. BUSINESS NAME LOCATION CLASSIFICATION City of Pompano Beach BUsiness lax Receil REGISTRATION NO, NEW RENEWAL DATEISSUED REGISTRATION FEE DELINQUENT CHG. TRANSFER FEE TOTAL AMOUNT PAID EFFECTIVE DATE EXPIRATION DATE OCTOBER 1 SEPTEMBER 30 ®ualrvtSSES MUST CONSPICUOUSLY DISPLAY THIS BUSINESS TAX RECEIPT TO PUBLIC VIEW AT e BUSINESS LOCATION CONTRACTORS MUST MAINTAIN ON FILE NOiU'E: E NEW AIVER Q AN MUST Bt N o tf THE HUSINESS NAME:, U "WNEri ;tltP OR AU 3tiE:SS i5 CHANGF:p� H RENT LICENSING AND INSURANCE AS UEEMEU A WAIVER Qf ANY p � AS TO ttiE t ROY1SlC7N QF- ttt OMPETENC.E Qf i£IE APP E' j TX I.UUf. NOR %HAt.I {ryi ;SSUANC.F ?F n SSUANt ( IC ANT rp INANti Ai f f3 ii StNE.SS fit!SINE -SS TAX Ei E qF A BUSINESS IA %- Rf.CEtNT tfT lPr BE t.UNStft Ufl) TO Rf A y .lUUGEMf -NT of T11f f]st p' _ E �_. City of of Pompano Beach REGISTRATION NO, pompano r.Abeach_ Business Tux Receipt Florida's Warmest Welcome NEW RENEWAL OWNER ,. DATE ISSUED _ t ACCOUNT NO. REGISTRATION FEE r BUSINESS NAME ;It.tl 1. °rta t ; , DELINQUENT CHG. LOCATION • TRANSFER FEE CLASSIFICATION TOTAL At OUNT PAID +i "sP# 1 a = ?AC i`OR P. { +EC—} nOr tN(s R: ) EFFECTIVE DATE EXPIRATION DATE OCTOBER 1 SEPTEMBER 30 400 9T / BUSINESSES MUST CONSPICUOUSLY DISPLAY THIS ktc..l'I�,I i BUSINESS TAX RECEIPT TO PUBLIC VIEW AT ti BUSINESS LOCATION r i CONTRACTORS MUST MAINTAIN ON FILE CURRENT LICENSING AND INSURANCE +I NOTICE: A NEW APPLICATION MUST BE FILED IF THE BUSINESS NAME, OWNERSHIP OR ADDRESS IS CHANGED, THE ISSUANCE OF A BUSINESS TAX RECEIPT SHALL NOT BE DEEMED A WAIVER OF ANY PROVISION OF THE CITY CODE NOR SHALL THE ISSUANCE OF A BUSINESS TAX RECEIPT BE CONSTRUED TO BE A JUDGEMENT OF THE CITY AS TO THE COMPETENCE OF THE APPLICANT TO TRANSACT BUSINESS. 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 #:ROOFING %SHEET METAL CONTRAC Business Name: A1zUSA. ROOFING INC Business Type: (ROOFING CONTRACTOR) Owner Name: JOSEPH G FLOREA /QUAL Business Opened:05 /17/2006 Business Location: 14 6 0 SW 3 ST STE B -3 State /County /CertlReg:CCC :1327348 POMPANO BEACH r Exemption Code: .Business Phone: Rooms Seats Employees Machines Professionals 10 For Vending Business Only Tunw Tax Amount Transfer Fee NSF Fee Penalty Prior Years Collection Cost Total Paid 27.00 0.00 0.00 0:00. 0.00 0.00 27.00 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 laws and regulations. BROWARD COUNTY LOCAL BUSINESS TALC RECEIPT 115 S. Andrews Ave., Rm. A -100, Ft. Lauderdale, FL 33301A895 — 954 - 831 -4000 VALID OCTOBER 1, 2012 THROUGH SEPTEMBER 30, 2013. ! DBA: Rec ®ipt #:G� CONTRACTOR (GENERAIi Business Name: ARUBA CONSTRUCTION CORP Business TYPS:BUILDER) i i Owner Name: JOSEPH G FLOREA /:QUAL 'Business Opened:11/1.7/1997 Business Location: 1460 SW 3 ST STE B -3 State !County /Cerit/Reg:CGC1508020 POMPANO BEACH Exemption Code: Business Phone: - i Rooms Seats Employees . Machines Professionals 1 Number of Machines: """" "'n NY Tax Amount Transfer Fee NSF Fee Penalty _ Prior Years Collection Cost Total Paid 27.00 0.00 0.00 0.00• 0.00 0.00 27.00 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 laws and regulations. Mailing Address: ARUBA CONSTRUCTION CORP 1460 SW 3 ST STE B -3 POMPANO BEACH, FL 33069 2012 -2013 Receipt #10B -11- 00005554 Paid 09/11/2012 27.00 I CERTIFICATE OF LIABILITY INSURANCE Z 4/1!2013 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 LD R. IMPORTANT: If the certiflcate holder Is an ADDITIONAL INSURED, the policy (tes) must be endorsed. If SUBROGATION IS WANED, 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 endors men s . PRODUCER CONTACT NAMM 044%U41 1.WO- 277 -1820 x4800 727- 797 -0704 LIMITS AOINUM FRANKCRUM INSURANCE AGENCY, INC. INSURE S AFFORDING COVERME NAICO 100 S. MISSOURI AVE. INSURER A: FRANK WINSTON CRUM INSURANCE CO. 11800 CLEARWATER FL 33758 INSURED INSURER S: INSURER G INSURER 0: FrankCrum I- BOO -277 -1620 INSURER E: VAMAGIRTORWITED 100 S MISSOURI AVENUE INSURER F: CLEARWATER FL 33768 221870 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD WDICATED. NOTWITHSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENTIMTH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN 13 SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INeR LTR YYPEOPINSURANCE AWL DNBR SUER WVO POLICY NUMBER POLICY EFF (0MIDDIYYYYj POLICY ExP (00I)M" LIMITS GENERAL LIABILITY EACH OCCURRENCE $ VAMAGIRTORWITED CMIERCIALOENERMUABILTIY PREMM oaaunetpa 0LAIMS4=9 =OCCUR WED EV one Caen $ PERSONAL 6ADV INJURY $ GGRO MAGGREGATE $ GEN'L AGGREGATE LOST APPLIES PER: PRODUCTS - COMPIOP AGO $ POLICY PROJECT 77toc COMMEDSINGUE LIMIT AUTOMOBILE LIABILITY n awW $ BODILY INJURY f Pmpelsm0 ANYAIna _ BODILY MA R (Pe aoMl� $ ALL SCHEDULED PRGPERTYOAMACae NON -0WRED HIREDAUTOS ALTOS (Aar $ OCCLR EACROCCURRENCE $ ,U.RELLALM AGGREGATE Excess LM OLAIMB -MADE DED RETENTION$ $ A WORKERS COMPENSATION AND W0201300= 1/1/2013 11112014 X I TORY UNITS ER• EMPLOYERW LUUIIUTY ANY PROPRIETORN%RTNERIEMULMNE OFFICERfMEMBER EXCLUDED? NIA E.L EACH ACCIDEAIT $1,000.0m e.L DISEASE - EAEMPLOYER $1, 000000 tMandnlory In RNI Ilya, desmGeunder DESCRIPTION OF OPERATKNNS balm ILL DISEASE. POLICY U NUT $1,000,000 DESCRI MN OP OPERAYI= I LOCATIONS! VENICLEB (AURah AOORD 111, AddBlwml Remarks Soho", B more spas is r"ubad) EFFECTIVE 07t2812WO, COVERAGE IS FOR 100% OF THE EMPLOYEES OF FRANKCRUM LEASED TO ARUBA CONSTRUCTION AND ROOFING, INC. (CLIENT) FOR WHOM THE CLIENT IS REPORTING HOURS TO FRANKCRUM. COVERAGE IS NOT EXTENDED TO STATUTORY EMPLOYEES, CERTIFICATE HOLDER CANCELLA71ON 01866.2010 ACORD CORPORATION. All rlgW reserved. ACORD 26 (2016106) The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. MIAMI SHORES VILLAGE BUILDING DEPARTMENT AUT14ORMSD REPRESENTATIVE 1 0060 NE 2ND AVENUE MIAMI SHORES, FL 33138 01866.2010 ACORD CORPORATION. All rlgW reserved. ACORD 26 (2016106) The ACORD name and logo are registered marks of ACORD s A`°R ° °® CERTIFICATE OF LIABILITY INSURANCE 4/l 013 PRODUCER (407) 838 -3445 FAX: (407) 838 -3460 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION IRA Insurance ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 1498 3 Lake Destiny Rd ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Orlando FL 32810 INSURED Aruba Roofing Inc. 1460 SW 3rd Street B3 FL 33069 COVERAGES INSURERS AFFORDING COVERAGE NAIC # INSURER A Gemini Insurance Co. 10833 I INSURER D: I 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 OFSUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR DD POUCYNUMBER POUCYEFFEECTIVE POUCYEXPIRATION UIYIRS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS MADE FX-I OCCUR, VUbCO015380 6/23/2012 6/23/2013 EACH OCCURRENCE $ 1,000,000 PREMISES Ea occurrence $ 100 000 MED EXP (Any one person) $ Excluded PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE .' $ 2,000,000 GEML AGGREGATE 'LIMIT APPLIES PER 7 X POLICY PRO- LOC PRODUCTS - COMP/OP AGG $ 1 000 000 AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY. INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY ANY AUTO AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC AUTO ONLY: qGG $ $ EXCESS I UMBRELLA LIABILITY OCCUR CLAIMS MADE DEDUCTIBLE RETENTION $ I EACH OCCURRENCE $ AGGREGATE $ $ $ $ WORKERSCOMPENSAT1ON ANDEMPLOYERS'LU181LITY i ANY PROPRIETORIPARTNERIEXECUTIVE Y / N OFFICERIMEMBER EXCLUDED? E -1 (Mandatory in NH) If Yes, describe under I SPECIAL PROVISIONS below I WCSTATU- OTH- E.L EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ E.L. DISEASE - POLICY LIMIT $ OTHER I 7 DESCRIPTION OF OPERATIONS LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT SPECIAL PROVISIONS %,rK I IrK;A It r1ULIJtK L;ANI;CLLA I IUN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN Miami. Shores Village Building Department NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL 10050 NE 2nd Avenue IMPOSE NO OBLIGATION OR LIABILITY OF ANY IOND UPON THE INSURER, ITS AGENTS OR Miami Shores, FL 33138 REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25 (2009/01) S Gerhoff Gerhoff Ins ©1988-2009 ACORD CORPORATION. All rights reserve) INS025 (200901).01 The ACORD name and logo are registered marks of ACORD Miami shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 RECEIPT PERMIT #: DATE: ff-dontractor • Owner • Architect Picked up 2 sets of plans and (other) Address: g q 9 0 lvr S S 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: PERMIT CLERK IN RESUBMITTED DATE: '�I)oi,�5 PERMIT CLERK INITIAL: Mlsseon: Rick Scott Governor To protect, promote & improve the health of all people in Florida through integrated John H. Armstrong, MD, FAGS state, county & community efforts. uC /r, it State Surgeon General & Secretary Vision: To be the Healthiest State in the Nation Robert Roddy 9490 NE 5 Avenue Miami, FL 33138 RE: Contingency Letter Application Document No: AP1107862 Centrax Permit Number: 13 -SC- 1472494 OSTDS Number: 9490 NE 5 Ave Miami, FL 33138 Lot: 1, 2 Block: 52 Dear Applicant: July 02, 2013 Subdivision: Miami Shores Sec 2 This will acknowledge receipt of an application dated 05/14/2013 for a permit to use an existing onsite sewage treatment and disposal system located on the above referenced property. From a review of your completed application, it has been determined your existing system is adequate for the proposed use. This permit is granted for the construction of new concrete landing and stairs and the construction of new concrete pavers. There will be no increase in sewage flow or characteristics and no impact on the unobstructed area. * * * * * * * * * * * *** * * * * ** *APPROVED * * * *** * * * * * * * * * * * **** If you have any questions on this matter, please call our office at (786) 315 -4444. Sincerely, .�/ Erlande Omisca, Engineering Specialist II Enclosures cc: Florida Department of Health www.FloridasHealth.com in DADE COUNTY TWITTER:HealthyFLA 1725 NW 167 St, Opa Locka, FL 33056 FACEBOOK:FLDepartmentofHealth PHONE: (305) 623 -3500. FAX: (305) 623 -3645 1 YOUTUBE: ftdoh of y 1 ,i I ' 34- 104 eIL1,A resigMAIN'DER LOT 2 3 X i 8LK 62 __ __. /I- S• ep 40.00' 30.16' 8.0' .................... ................ ............. .45 • N N � 21.28 �. a.�o.o..' 12:8 1.4 701 an 13.�m 17.25 4 l 11@ PI rater 30. ' I b r yti -i A .» . �l�u �•.:� , i . ... is 20 W Gd D° oo 11.40 ! �► m • 5' Cone-Walk 15' Parkway� � z • N .=.. .Q � _w_.. ro f N `) . 20' Asphalt - 80.00' Total RIW NE' S AVEP cn A 0 O_: C Z. M CA C. M "I 3 �I z �l Z � V I P OPY SKETCH OF BOUNDARY SU "CJ y 4 n c!1 (V O w ul� Zm N Lu tAx�✓� v �.n 20' Asphalt O 25' Parkway 5' Conc.Walk APR 10 2013 95 STREET Ji. 79.50` DL.DG DEPT SUBJECT TO COMPLIANCE WITH ALL FED[ STA ND COl INN RILES AND REGULA i �g i i i Qe� i i 2' Planter I'm L 43.70' ti t2.00, E � .. STORY CBS RESIDENCE # 9490 ry N a m i i 14.00' Conc. oc sr_ ' 14.70' v7 i i 9op0 oTa t 17.55' 25.70' M a 14.10' 8.00' 3' Conc. � � m P- 1= V- 10-25' cri V- 3.601 0 2.00' 2.01: 0 0 c 2.75' ci 2 r 1.00' b ter; r 2' Conc. LF90 °00'04" 8=25.00` L= 39.27F141) ,I,P,1/2' -9 (NO ID) P.1/2" ID) N l� -- W.M 5 0 1 24.05 W * 30.00' FND.I.P.1/2" .i 79.50' FND.I.P.112" WIDT ° 15' ALLEY 9' Asphalt 7. W Q Z 'a t a L) r l`ti N l� -- W.M 5 0 1 24.05 W * 30.00' FND.I.P.1/2" .i 79.50' FND.I.P.112" WIDT ° 15' ALLEY 9' Asphalt 7. W Q Z 'a