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RC-07-1515Miami Shores Village g 01 2007 Building Department JUL 2 0 -- /i .2nd Avenue, Miami) Shores, Florida 33138 BY- __old_ -- -- _ -_ - -_ OOSQ N.E, Tel','(305) 795.2204 Fax: (345) 756.8972 BUILDING 01 Permit No. -1516 PERMIT, AP LIGATION Master Permit No. FBC 2004 Permit Type (circle): Building Electrical Plumbin Mechanical Roofing 7r4 Skfl4 T ve4j m-evA MifvW,i tnir Owner's Name (Fee Simple Titleholder) R ►Q t A yd &,O V- _ i TIC i4 L Phone # 365 - q ?Q - U L41A 4 Owner's Address'', c% �I/ 0 P -e-(l T i� I Vii City � l A M i L 11 0 y State F L Zi p 3.1 0 1- Tenant/Lessee Name Phone # Job Address (where the work is being done) g H1,5 N M I R M V A up Village County Miami -Dade Zi City Miami Shores FOLIO / PARCEL # S A N(!Cl lcn Designated YES NCl ---- --'- Is Building Elistorically Contractor's Company N� e l S T t i/1. C ! 61) Phone # Contractor's Address Z State Zip I l City Qualifier Name L Phone # State Certificate or Registration No. �.(j l �d Certificate of Competency No. Architect/Engineer's Name (if applicable) Phone # Value of Work For this F ermit$ _ Square / Linear Footage Of Work: Type of Work: Addition []Alteration ew� [�., Repair/Replace ❑ Demolition Describe Work 9YACYCITC�SIYY3CSF �& �tCSQ7TC7Y�'! �" 16' lCit7C1t" 1G7t1Y7Y11C7CkSCDflL ''Il'lCA'1YSTC 9T C9�Ci' 7iCit[ df& �t 9t' Y' iC' J�9kttlY9ti' 7k' �' lY7Tt' �$ I�t7YiF9YtY& 9Y7TL�C7Y�flF�91C4[1Y7rft1C &�G�& Fees Submittal Fee $ Permit Fee $ r T CCF $ • 2® CO /CC Notary $ "' Training/Educafion Fee $ o Technology Fee $i5 Scanning $ 5- Radon $ DPBR $' Zoning $ Bond $ Code Enforcement $ Double Fee $ (-50 Structural Review. $ 2 _ Total Fee Now Due $ See Reverse side -+ 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 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 EWROVEMENTS 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 promise in good faith` that u copy of the notice of commencer whose property -is subject to attachment :also, a cer for the first inspection which occurs seven (7) day . i inspection will not be approved and are * ectio e Aw e Owner or Agent The foregoing instrument was acknowl ed fore me this day f 20 nc y F who on 11 . ow or wh produced r NOTARY Sign: Print: My Commi: As identification and who did take an oath. Expires: APPLICATION APPROVED BY: (Revised 02/08/06) ?OII i g c permit is issued. In the absence of such posted notice, the. Signature Contractor The foregoing instrument rwgaass_acknowledged before me thyis n day of 2W T byEM4% i s who is personally known to me or who has produced NOT Sign: Print: My CoAtmission Expires -111— J who did take an oath. Plans Examiner Engineer Zoning cA � K)96 ups 0--6J u� a It p y 0AI, 0000 0.00.0 0 000 .. . . 0000 `' • • • • .. 0000. .0000. ' "" 0000 • . . • , 0000. 0. .. 0000. � . ,� !2 OF .. 0000.. Q, A� 'je, k. v� JUL 2/// Q 2007 V V A � PERMIT C -151 Miami Shores Village APPROVED BY DATE ZONING DEPT BLDG DEPT SUBJECT TO COMPLIANCE STATE AND.000NTY WITH ALL FEDERAL ULES AND REG,JLATIQNS k 6,LYJM4 ZP 10, JA .. -- CERTIFICATE OF LIABILITY INSURANCE °A� ;1'3 THIS CERTIFICATE IS ISSUED $iis A. MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIfICA`rE HaLTlRR. THIS` CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE .POLICIES BELOW, THIS CERTIFICATE Of INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING: INSURER(S), AUTHORIZED REPRESENTATIVE OR;PRO1JliC AND THE CERTIFICATE HOLDER, IMPORTANT: -If the Certificate holder Is an .-DDITIONAL INSURED, the pollcy(les) must be endorsed. If. SUBROGIATION'1S WAIVE Dr Subject to the terms and condition§ of tkle: p011cy, certain policies may require an endorsement: A statement on this ceitiflcate does no# confer righ t0 the ft ate o I II` u of such endorse s` PRODUCER, 954-731 -556 W.F. Roemer In$ElCanC@ Agency 752 dU. Commercial B1�iid 854. 731 -84 Fart Lauderdale, :FL 35319 onathan F. Retries NAME: PH NE FAX N E.6: No :. Moss., INSU S AFFORDING-COVERAGE A INSURERA: Mid - Continent CasUaft. Co 2W 8 94SURED AlWosh C.O. nstrudtion,;[no. 18973 SW 33 Court Miramar, FL 33029_ INSURERS: 02122113 INSURERC EACH NRRENCE (N$URER D : PREMISES Ea occurrence) INSURER E MED. EXP ( oie person $ EX.CLUDE C. PERSONAL & ADV INJURY' COVERAGES Clrl?TWItIATM MI IM91ty. 12mm 1r11U lufff urp. THIS IS TO CERTIFY THAT THE POi {C(ES OF INSUI f+tCE LISTED MOW HAVE BEEN ISSUED TO THE INSURED NAMED AWVE FOR THE POLICY PERIOD' INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO MICH THIS CERTIFICATE MAY BE, .ISSUED °pR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES' DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF:SUCH POLiCtES. LIMITS SHOV. M MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCE LIMml A GENERAL LtARIL" X COMMERCIAL GENER�AL:-. L�IABILTY CLAIMSMADE i ± i OCCUR 040L0t10t WSI 02122113 02!22114 EACH NRRENCE PREMISES Ea occurrence) $ 100,00 MED. EXP ( oie person $ EX.CLUDE C. PERSONAL & ADV INJURY' $ 11000100 GENERAL AGGREGA`E $ 2,000, D; GEN L AGGREGATE LIMrr APPLIES ;PER: POLICY 'M LOC PRODUCTS - COMPIOP AGG $ Ar AUTOMOBILE LIIIBII fTY ANY AUTO,. ALL OWWD SCHEDSl1 ED AUT{75 AUTOS' '9 SYINED X HIREDAUTO$ X AS:, 04GL000870051 02%22/13 02!22114.. Ea accLdsr t $ 1,00, .. BODILY INJURY (Per person) BODILY INJURY (Per, aceidel) $ PRO f RAMUE Per accitler� LIMBRELLALIAB- EXCESSLIAB. CUR' CLAIM$-MA.DE EACH OCCURRENCE $ AGGREGATE: $ WORKER$ COWENSATION AND EMPLOYERS' LIASILRY Y i ANY RROPRIETORIPARTNER/EXECUTIVE y OFPICE , EXCLUDED (Mandatary in NH) IP es. describe kntler I OF T S below! NJ.A WC'STATi Lt4-I E.L. EACH ACCIDENT $ E.L. DISEASE -EA I= MPLOYE $ E.L DISEASE - POLICY LIMIT $ DESCRipm OF OPERATIONS P LACATIONSi VEHICLES (Attach ACoRD 4m, Addrdmw Remarks Schedule; if more apace Is ►equiredl Village of MlBml'Shores 10050 NE 2Ave.. Miami Shores, FL ;33138 SHOULD ANY OF THE'ASOVE DESCRIBEDD, POLICIES BE CANCELLED SEFDR9 THE EXP1RrsfT1ONN bMi THEREOF, NOTICE wl; RAE o ,- II"RED tN' ACCORDANCE VATH THE POLICY PROIASIONS - ACORD 25 (2010105) The ACORD name and logo are registered marks of / ACORD " CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW ` < CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law. EFFECTIVE DATE: 2/5/2013 EXPIRATION DATE: 215/2015 PERSON: LEVY FN $HA LES M FEIN: 203641258 BUSINESS NAME AND ADDRESS: ALYJOSH CONSTRUCTION INC 18973 SW 33 CT MIRAMAR FL 33029 SCOPES OF BUSINESS OR TRADE: LICENSED GENERAL CONTRACTOR Pumuard to Chapter 440.05(14), F.S., an officer of a corporation who elects exemption from this chapp1tear by filing a certificate of election under this section may not reeover bans or aoto nation under this chapter. Pumuent to Chapter 440.05(12), F.S., Cert(ficates of election to be exempt.. apply only wWri the scope of the business ortrade IfaOad on the notice of election to be exempt Pursuarltto Chapter 440.05113)), F.S., Noficos of eleetton to be exempt aM mrwtcetw of election to be exempt shall be subject to revorabon if at any dms after the filing of the notice or the Issuance of the cor ificate, the pawn named on the rrotlea or caNflcata no longer meete dre requirements of this secton for Issuance of a certificate. The department shag revoke a certificate at any time for fagure of the pawn named on the certificate, to meet the requirements of this section DFS- F2- DWG252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 07 -12 QUESTIONS? (850)413 -1809 yEE � BUSINESS TAX RECEIPT This is to certify that the person or firm named fierain ltds paid into gray hands mirliMm MrM. Mt:Of tai as set seat hareln for the ccse - -her #it Of the City aforesaid, and is licensed to engage in the business of: CONTRACTOR CONTRACTOR 15356 $�,�- Braseti Restrictis Only Mail & Phone Only No Employees at Rome No Work on Prernl No Clients at Home No Oellveries to Morne Office Only Ootta�,e -� _estrrotions Cartage fond businesses are allowed in accordance with Flor+de Statute 500.80, a t that the home shall cart be for retail. Ma" see regulations title 21 part 101. Only one employee allowed which includes family members residing at thO home. No commercial vehicles peftd,ovemight ore the prarnis. -TEST M5 . e is T Tr Bee b e Your Business Tax Receipt Must be displayed, Miami Buildi 10050 N.E.2nd A Tel: (3o5), INSPECTION'S, BUILDING PERMIT APPLICATION Permit Type: BUILDING JOB ADDRESS: qJ4 Z S City: tAm; Shores County. Folio/parcxl#: — W r Is the Building Historically Desitttated: Yes OWNER: Name (Fee Simple M1 � City: — %% w 1 -a State: Tenant2essee Name: Email: Le°vV I i_ CONTRACTOR: Company Name: Address: — 1 X9 7 3 City: —M- i CA v► oqv-, Qoaiifier Name: /L,4-- State Certification or Registration #: Contact Phone#:_3ettj DESIGNER: Arcl itecftgineer: — Value of Work for this Permit: Type of Work:: i CJAddition' Description of Work.. -To O� Q e _ C]Alteration Village )epartment Gami Shores, Florida 33138 Fax: (305) 756.8972 NUMBER: (305) 762.4949 Permit No. NGV 13 2013 I ado RE Y-. ©o - � - - � - FBC 2010 Master Permit No. �;C 13 — 2 S (o(c ROOFING Zone: gip: -'tM .L__ W* _3a5 9 %t t092. ie or competency #: C4�"' +ti�LQe. G Footage of Wort:: CA�- Submittal Fee $ Permit Fee $ CCF $ Scanning Fee $ Radon Fee $ CO /CC $ _ DBPR $ Bond $ Notary $ Tn"g/Education Fee $ - - -"— Technology Fee $ Double Fee $ _ Sttrgcttuw Review $ — TOTAL FEE NOW DUE $_JT11 IL (00 Bonding Company's Name (if applicable) Bonding Company's Address City „-I--- 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 E%IpROVEMENTS 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 cqy0nrnvfmenr must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issu I bsence of such posted notice, the inspection will not be approved A e �ectio� will be charged. O�orAgent 'y The foregoing instrumen acknowled ' before me s Za day of ! , 20 J& by r .1-- who Tinally known to me r o has produced As i 'on and who did take an oath. NOPUBLIC: Print: my APPROVED BY The foregoing t was ackno edged before we this'd day of 20 A by �i�✓�°s wh kno to me or aced as identi5cati wbo did take an oath. NOTARY PUBLIC: tPlans Examiner Structural Review (Revised 3n2 2w)(Revised o7noin(Reviwd o6n0)2009)(RevhW 3/15109) Sign: aPr N°'•• Fs . Print: e tt �c �® My Commission Exii p a 7ming Clerk Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CHANGE OF CONTRACTOR / ARCHITECT -permit N. - 1 61 — «l S Ouvner'S NBtne .(Fee Simple Title Hohierj: 1 civil Phone Owners Address: G City: dl`s o State: Tip Code: a31"-�5 _Q) Job Address (Of where work is being done) :_ Qq�L a � � VC . City: Miami Shores State:_Flodda Tip Code: Contractors Company Name: - � � t �l I ne # 3)6 °�An ' I Aa City: 1 t l\ Q. 1( State: L Tt Code: Qualifier's Name . I Lic. Numb G � d S q J - Architect/ Engineer of Record Name: Address: City: State: Describe Phone#: Zip Code: l(Ae4s I hereby certify that the work has been abandoned and/or the contractorlarchitect Is unable or unwilling to complete the contract. I hold the Buli g fficlal and the ins Snares harmless for all legal lnv7qP1e"'rnenV j Signature 019RtP - QI' -Ag$11 /'! �b The foregoing instrum It was owledged before me this —Iday of Ot.� .20 , y Who Is personally known to me or who has produced �gHF4446Spg'� as indentiticetion. IUotm Fu , tuber 3, O9 Sign: e Seel: ° °.° OnCU3d ��yi�`�0 X E Signature �7y r�� OrAM e5The fo in was aknow l before me this day of 0 e "- 2 y a arc who Is persON1 ° 1Fr j,��yho has produced �aa ��M�SSIONF °•, N o er �7A as IndenNicatian. Notary C: OEE 832060 I i Vk F Complete tents 1, 2,.and 3 Also complete A: SI -item d, N Restrioted Delivery le desired. . ■ Print your name and address on the reverse so that we, can return the card to ycu Q Addressee ■ Attaoh_.this card to ilia =back cf the malipiece, or on the front N space B. Ivy by ( hied Afame) C: Hate of Dellvery - permits. _30'a it Artiisie °9tldressed to: D. is dsltvery address different from rtem 1? © Yes if YES, enter deliueryaddress below p No 0 f--%? L? Ter' rce rype l d � � {O }� Ceriifled Mall d E few mall Registered ❑Return Receipt foF_ Merchandise 0 fnsuredFinail [3 DAD, 4. Restricted Delivery? Xxtu Fee} ❑ Y,� 2r Article Numbsr eri 7010 1870 0000 7444 3820 PS 'Form 3811, February 2004, Domestic Return Recelpt 1oz ai -isav< r d"" VU LCAN 9W SW 27 Terrace Miami, R 33:1665 RE- Property located at 9425 N. Miami Avenue, Miami Shores Village, Florida Mr. Mesa arty I would like:to:lfnfbrm you that we have contracted a new ll-um,nspectedwork. Please let this letter serve as:.an official tor,of record for this property. fore me on this day of 1 2013 p -BLIC.ITAT�OFI' -JDA NOTARYP' Cajq(,-: ,jc)squera I - --on COMI'd #Db931431 -)CT, ©7, 203 !JND Vukan fmvesbneM Partners, LLC Latitude RuNing 175 SW 7th St Suite #1107 Miami, FL 33130 Teh (305) 507S"2 Fax (786) 3516756