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RC-13-1429Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 206215 Permit Number: RC -6 -13 -1429 Scheduled Inspection Date: January 29, 2014 Permit Type: Residential Construction Inspector: Rodriguez, Jorge Owner: KNOWLES, HAROLD & AMY Job Address: 129 NE 109 Street Miami Shores, FL 33161- Project <NONE> Contractor: JMR CONSTRUCTION CO INC. rsunaing uepanment comments BATHROOM REMODEL Inspection Type: Final Building Work Classification: Alteration Phone Number 305 - 758 -8193 Parcel Number 1121360040530 INSPECTOR COMMENTS False Inspector Comments Phone: 305 - 672 -8055 Passed CREATED AS REINSPECTION FOR INSP- 205560. CREATED AS REINSPECTION FOR INSP- 205526. Need to pass electric NO ONE HOME Failed Correction ❑ Needed Re- Inspection ❑ Fee No Additional Inspections can be scheduled until re- inspection fee is paid. January 28, 2014 For Inspections please call: (305)762 -4949 Page 32 of 39 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 BUILDING PERMIT APPLICATION Permit Type: UILDING :> FBC 20 Permit No. PLC Master Permit No. ROOFING JOB ADDRESS: / 2- !!� ! v Eo Zp.q 157- 2 City: Miami Shores County: Miami Dade Zip: �! 13 A)—r Folio/Parcel #: I / — d,13 & —00 � �f�cS�� ® , Is the Building Historically Designated: Yes NO Zone: OWNER: Name (Fee Simple Titleholder): 6?W C— 4 -hM !I K /) CX0 CZr Phone#: 7 7` Address: �f Ala / O ! City: s State: A, Zip: TenandUssee Name: Phone#: Email: CONTRACTOR: Company Name: �" t A— CP4S7h-c)c7l cL4 Phone#: /r 2a ((-(13 �' Address: I L L °l a L 11 Y— f% ''i City: A�-- p6cs State: P4A— Zip: C Qualifier Name: f5 fV /y�� 7&0.465- 1 Phone#: State Certification or Registration #: C-1 2.r 1-4- :� 6 Certificate of Competency #: Contact Phone#: 2 L--49� Email Address: DESIGNER: Architect/Engineen Phone#: dd Value of Work for this Permit: $ Square/Linear Footage of Work:f� S Type of Work: OAddition rffteration ONew l]Repair/Replace ODemolition Color thru tile: Submittal Fee Scanning Fee $ Notary $ Permit Fee $ Z22 CCF $ CO /CC $ Radon Fee $ DBPR $ Bond $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ 141 ' a. 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 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 comment went must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued In tli,absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Owner or Agent If Contractor The foregoing instrument was acknowledged before me this day of 3 &, 20, by 106)1-C—� who is personally known to me or who has produced As identification and who did take an oath. NOTARY PUBLIC: bom ftw it gl • IE I" a APPROVED BY The foregoing instrument was acknowledged before / me this day of 20 ./by / Ci' L¢ ° , who is known to me or who has produced as identification and who did take an oath. Plans Examiner Structural Review (Revised 3 /12/2012)(Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) 1 ' My Commission Exp otary Public State of Florida aria Isabel Zvolenski rlrf eT y Co mmisa w EE 191758 Zoning Clerk NOTICE OF COMMENCEMENT C:FN 2013RO507117 A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTIOhbr,, P-P, 28696 Ps 3422f Qps) RECORDED 06/26/2013 ►9'.51;S5 IA VEY r, W IN, CLERK OF COURT R PERMIT. NO. t '4 TAXFOLIONO. IAMI-DADE COUNTYP FLORIDA AS PAGE STATE OF FLORIDA- STATE CF FLOPWA, C OUWY CF LAM COUNTY OF MIAMI-DADE: I HCROY (lq-rf Y SW 10 it RJP*,PW 'r— fc=* THE UNDERSIGNED haraku gives n^+ra that improvements will be mor— + ^znin property, and in accordance with Chapter 713, Florida Statutes, the foliot is provided in this Notice of Commencement. iv 1. Legal description of nroperty and street address: 2. 3. Owner(s) name and address: �z &W-1 Interest in property: . VgL' Name and address of fee simple titleholder. C. WV e-le-1 . 12 q A45: I cl:� W_ J77 ORM 4. Contractor's n, e and address- Az' 5. 6. Surety: (Payment bond required by owner from contractor, if any) Name and Address: Amount of bond $ 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 datd is 1 year from the date of recording unless a different date is spep ftfied) 11Wj0W1 a Ur %JW1 im Print Owner's Name 'i Prepared by�,,L Swomlo and subscribed before me this wof 20 V A ROBERTSOh _j Adc Iress: ',77T Notary Public: te of Flor, AN 7 EWT.' Print �Notary's �Name: My commission expires: M Miami Shores village Building Department 90050 N.E.2nd Avenue, Miami Shores, Florida 33138 JUN 24- 2013 [,;I- Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 —� FBC 20 d 1Gt BUILDING z+ tii:�o Permit No. PERMIT APPLICATION Master Permit Noy'c 1. —" 1 Permit Type: BUILDING ROOFING JOB ADDRESS: A-J6— City: Miami Shores County: Miami Dade Zip: Folio/Parcel #: 11" 9- f'Y b VJ-3 (3 a s Is the Building Historically Designated: Yes NO I/ Flood Zone: OWNER: Name (Fee Simple Titleholder) Address: 0 7-- City: All Tenant/Les ee Name: Email: -W- A-m i !� •r�D State:,, Zip: Name_ 0�4 C '7 3t-c� C► Address: City: State: - Qualifier Name:. :5a _ e e" -07 ---rso al State Certification or Re station #: �- l a- �� G Contact Phone#• '' ! Email Address. i. DINIGNIFIR- Arrh;tart/Rno;n d H Value of Wo for Permi� $ �.�. /,' Squ� Type of Works ;'ClA tioti aeration ONew Description of AWork: _. IJW f- r.' Z-e , Y-4", /j Submittal Fee $S-0 - CJ'2' Permit Scanning Fee $ Radon Fee Notary $ Training/Education Fee $ Double Fee $ Structural Review $ 304/9;F.6— q,*-7 P Zip: 390 7 7 sear Footage of Work• • So` ORepair/Replace Demohhon np/ PCF $ CO /CC $ DBPR $ Bond $ Technology Fee $ TOTAL FEE NOW DUE $ ft e — '1 1% 6 Banding 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 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 broc e— Wit* delivered to-the person whose property is subject to attachment. Also, a certified copy of the recorded noticf comme nt must le Hosted a the Jok,,site for the first inspection which occurs seven (7) days after the building permit is issue jn sense o suu 11 posted notice, 4he inspection will not be qpprovSdav4 a reinspection fee will be charged Signatur Signaturev 6706tr or Agent IV Contractor The foregoing instrument was acknowledged before me this �'' ' The foregoing instrument was acknowledged before me this 2� day of �, 20 C by /� �� 1 day of J 20 D, by O� I A, who is personally known to me or who has produced who is personally known to me or who has produced 8ti `e As entification and who did take an oath. LIL6- -' 192 - *'106 / —Ps identification and who did take an oath. NOTARY PUBLIC: APPROVED BY " X0/'17 Plans Examiner Structural Review (Revised 3 /12J2012)(Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09) NOTARY PUBLIC: I' Sign: Print: �J My C6mmission Expires: Zoning Clerk I., I JMRCO -1 OP ID: CM '4`_°RO® CERTIFICATE OF LIABILITY INSURANCE °A05117120 3 05/17/2013 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 HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terns 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 endorsemen s . P emier Protection Insurance Phone: 954.467 -8738 409 SE 7th St Fax: 954 - 9441881 Fort Lauderdale, FL 33301 Douglas A. Levy A PHONE FAX A/C No E -MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC 0 06/15/2013 INSURER A: Accident Ins. CO. EACH OCCURRENCE $ 1,000,00 INSURED JMR Construction Co. 11690 NW 19th Drive INSURER B: MED EXP (Any one person) $ 5,00 PERSONAL B ADV INJURY Coral Springs, FL 33071 INSURER c GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY PRO- MT L-1 LOC INSURER 0: $ 2,000,000 INSURER E: $ INSURER F: LIABILITY ANY AUTO AAL� ED SCHEDULED NON -OVMVED HIREDAUTOS AUTOS COVERAGES CERTIFICATE NUMBER- REVISION NUMBER! THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. I�SR TYPE OF INSURANCE DDL BR POLICY NUMBER MMMOO EFF MMILIDD EXP LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE Fx] OCCUR CPP 0002696 06/15/2013 05/15/2014 EACH OCCURRENCE $ 1,000,00 PREMISES Me ocaurerna $ 100,00 MED EXP (Any one person) $ 5,00 PERSONAL B ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY PRO- MT L-1 LOC PRODUCTS - COMP /OP AGG $ 2,000,000 $ AUTOMOBILE LIABILITY ANY AUTO AAL� ED SCHEDULED NON -OVMVED HIREDAUTOS AUTOS COMBINED SINGLE LIMIT Ea accident BODILY INJURY (Per person) $ BODILY INJURY (Per aoddeni) $ PROPERTY DAMAGE Per accident, $ UMBRELLA LIAR EXCESSL1AB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED I I RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBEREXCLUDED? F (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATION below NIA WC STATU- OTH- E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, K more space Is rpulrmi) General Contractor CERTIFICATE HOLDER CANCELLATION MIAMISH SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Miami Shores Village THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Building Department ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE 2nd Avenue AUTHORIZED REPRESENTATIVE Miami Shores, FL 33138 ©1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD Property Search - Report 1 1 � 1,. Property Information: Folio 11 -2136- 009 -0160 Property Address 102 NE 109 ST Owner Name(s) ELAN HERSH ANNE CAMILLE HERSH Mailing Address 102 NE 109 ST MIAMI FL 33161 - Primary Zone 1000 SGL FAMILY - 2101 -2300 SQ Use Code 0001 RESIDENTIAL -SINGLE FAMILY Beds /Baths /Half 2/2/0 Floors 1 Living Units 1 Adj. Sq. Footage 1,698 Lot Size 9,254.12 SQ FT Year Built 1950 Full Legal Description DUNNINGS MIAMI SHORES EXT NO 5 PB 48 -21 LOT 8 BLK 216 LOT SIZE 74.630 X 124 OR 18340 -3930 1098 1 CDC 24905 -1225 09 2006 1 Assessment Information: Current Previous Previous 2 Year 2013 2012 2011 Land Value $87,570 $75,474 $83,860 Building Value $116,222 $129,835 $129,835 Market Value $203,792 $205,309 $213,695 Assessed Value $203,792 $205,309 $213,695 Benefits Information: Current Previous Previous 2 Benefit Type 2013 2012 2011 Homestead Exemption $25,000 $25,000 $0 Second Homestead Exemption $25,000 $25,000 $0 Note: not all benefits are applicable to all Taxable Values (is County, School Board, City, Regional). Disclaimer: Page 1 of 2 MIAMI -DARE COUNTY OFFICE OF THE PROPERTY APPRAISER PROPERTY SEARCH SUMMARY REPORT Carlos Lopez - Canters Property Appraiser Aerial Photography 2012 Taxable Value Information: Current Previous Previous 2 Year 2013 2012 2011 Exemption/ Taxable Exemption/ Taxable Exemption/ Taxable County $50,000/$153,792 $50,000/$155,309 $0/$213,695 School Board $25,000/$178,792 $25,000/$180,309 $0/$213,695 City $50,000/$153,792 $50,000/$155,309 $0/$213,695 Regional $50,000/$153,792 $50,000/$155,309 $0/$213,695 Sale Information: Date Amount OR Book -Page Qualification Code 9/2011 $239,900 27836 -2874 Deeds to or from financial institutions 1012010 $100 27468 -4048 Deeds to or from financial institutions 9/2006 $430,000 24905 -1225 Sales which are qualified 10/1998 $119,000 18340 -3930 Sales which are qualified 6/1979 1 $65,000 1 10437 -2048 Sales which are qualified The Office of the Property Appraiser and Miami -Dade County are continually editing and updating the tax roll and GIS data to reflect the latest property information and GIS positional accuracy. No warranties, expressed or implied, are provided for data and the positional or thematic accuracy of the data herein, its use, or its interpretation. Although this website is periodically updated, this information may not reflect the data currently on file at Miami -Dade County's systems of record. The Property Appraiser and Miami -Dade County assumes no liability either for any errors, omissions, or inaccuracies in the information provided regardless of the cause of such or for any decision made, action taken, or action not taken by the user in reliance upon any information provided herein. See Miami -Dade County full disclaimer and User Agreement at http: / /www.miamidade.gov /info /disclaimer.asp. Property information inquiries, comments, and suggestions email: pawebmail@miamidade.gov GIS inquiries, comments, and suggestions email: gis@miamidade.gov M http: / /gisweb. miamidade. gov /PropertySearch /printMap.htm Generated on: Tue Jul 2 2013 7/2/2013 FIRST -CLASS U.S. POSTAGE PAID MIAMI, FL PERMIT NO. 231 602136-4 THIS IS NOT A BILL - DO NOT PAY RENEWAL BUSINESS NAME / LOCATION SOUTHWEST PLUMBING RECEIPT NO. 628202-4 SERVICES INC STATE* CFC037090 12925 SW 134 CT 33186 UNIN DADE COUNTY OWNER SOUTHWEST PLUMBING SERVICES INC WORKER /S S lyge LUMB�NG CONTRACTOR so THIS IS ONLY A LOCAL BUSINESS TAX RECEIPT. IT DOES NOT PERMIT THE HOLDER TO VIOLATE ANY EXISTING REGULATORY OR ZONING LAWS of THE COUNTY OR CITIES. NOR DO NOT FORWARD DOES IT EXEMPT THE HOLDER FROM ANY OTHER PERMIT SOUTHWEST PLUMBING SERVICES INC OR LICENSE REQUIRED BY LAW. THIS IS THOMAS WATSON PRES NOT A CERTIFICATION OF THE HOLDER'S OUALIFICA- 12925 SW 134 CT TINS. MIAMI FL 33186 PAYMENT RECEIVED MIAMMADE COUNTY TAX COLLECTOR: 07/25/2012 60040000501 000275.00 SEE OTHER SIDE STATE OF FLORIDA - - DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487 -1395 1940 NORTH MONROE STREET .a' .�' TALLAHASSEE FL 32399 -0783 WATSON, THOMAS M SOUTHWEST PLUMBING SERVICES INC 12925 SW 134 CT MIAMI FL 33186 Congratulations! With this license you become one of the nearly one million !' STATE oF'FLtraioA' AC# 6 5 58 3 6 Floridians licensed by the Department of Business and Professional Regulation. Our professionals and businesses range from architects to yacht brokers, from DEPARTMENT OF BUSINESS AND i?ROFES.SZONAL REGULATION boxers to barbeque restaurants, and they keep Florida's economy strong. CFC037090 06/07/12 110418717 Every day we work to improve the way we do business in order to serve you better.! For information about our services, please log onto www.myfloridalicense.com. ! CERTIFIED PLUMBING CONTRACTOR There you can find more information about our divisions and the regulations that WATSON,, TIiO?AS ,N impact you, subscribe to department newsletters and learn more about the SOUTHWEST PLUMBINfl SERVICES INC Department's initiatives. Our mission at the Department is: License Efficiently, Regulate Fairly. We constantly strive to serve you better so that you can serve your customers. I Thank you for doing business in Florida, and congratulations on your new license! ; IS CERTIFLEa under Lt a provisions of Ch. 489 Fs axp cation date: U, 32: :2014 L12060700874 , DETACH HERE .�$C SOUTH -9 OP ID: EC CERTIFICATE OF LIABILITY INSURANCE DATE(MM /DDNYYY) 12/26N2 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 ATE 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(ies) 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 305 - 446 -2271 CONTACT Kahn - Carlin 8r Company, Inc. NAME: 3350 S. Dixie Highway 305- 448 -3127 PHONE FAX Miami, FL 33133 -9984 A/C No Ext : EMAIL Diane Mack -Berk ADDRESS: INSURED Southwest Plumbing Svcs, Inc. Tom Watson 12925 SW 134th Court Miami, FL 33186 -5869 COVERAGES P`GOTIGIf%A Tr . INSURERS) AFFORDING COVERAGE INSURER A: Security National Insurance Co NAI 33120 INSURER B: Travelers Indemnity Company 25658 INSURER C: North River Insurance Co. 21105 INSURER D: Bridgefield Employers Ins Co 10701 It THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE KLVI,IUN NUMBER: BEEN ISSUED TO THE INSURED INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT NAMED ABOVE FOR THE POLICY PERIOD OR OTHER CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED DOCUMENT WITH RESPECT TO WHICH THIS BY THE POLICIES DESCRIBED EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED HEREIN IS SUBJECT TO ALL THE TERMS, INSR BY PAID CLAIMS. DL UBR LTR TYPE OF INSURANCE POLICY NUMBER MM /DDmYY MM DDIYYYY LIMITS GENERAL LIABILITY A X EACH OCCURRENCE $ 1,000,000. COMMERCIAL GENERAL LIABILITY SES110358500 11/10/12 11/10/13 PREMISES Ea occurrence) $ 100,000 CLAIMS -MADE OCCUR MED EXP (Any one person) $ 5,000 X PER PROJ AGGREGAT PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: PRO PRODUCTS - COMP /OP AGG $ 2,000,00 POLICY LOC Emp Ben. $ 1,000,00 AUTOMOBILE LIABILITY CO MBINED SINGLE LIMIT B X Ea accident $ 1,000,00 ANY AUTO BA0069T262 11/10/12 11/10/13 BODILY INJURY (Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE $ Per accident $ UMBRELLA LIAB X OCCUR C EXCESSLIAB CLAIMS -MADE 5821009659 11/26112 11110/13 EACH OCCURRENCE $ 2,000,000 X AGGREGATE $ 2,000,000 X $ DED RETENTION$ 0 WORKERS COMPENSATION D AND EMPLOYERS' LIABILITY Y / N STA X TORY IMITS ER E.L. EACH ACCIDENT $ 1,000,000 ANY PROPRIETOR/EXCLU R/EXECUTIVE ER EXCLUDED? ❑ NIA 083035571 01/01/13 01/01/14 (Mandatory in (Mandatory In E.L. DISEASE - EA EMPLOYE $ 1,000,000 If yes, describe under Under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,00 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) CFDTI Ct/`ATC ufll nCe I11 \VLLL/'911V1\ MIAM -04 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Miami Shores Village THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Building Department ACCORDANCE WITH THE POLICY PROVISIONS. 10050 N.E. 2nd Avenue Miami Shores, FL 33138 AUTHORIZED REPRESENTATIVE W 1V55 -ZU1U ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD QUALIFYING TRADE(S) 0001 ELECTRICAL Charles anger P.E. searah" of the Board „aw.ryarradr�e.govmWl6rg Mama -ads Coway rNalns all ProPeKY d¢ta� i f j �1 -. - - -------------------- y* A R 2113 «I k U.S. P POSTAGE _ I Ain N10. 2M i THIS: IS NOT A BILL:- DO NOT PAY. 577238 -0 RENEWAL. 1 BUSINESS NAME I LOCATH RECEIPT NO. 601904 -6 MV ELECTRICAL SERVICES INC CC # 06E000405 18311 .NW 82 CT 33015. - UNIN DADE- COUNTY - OWNER .:MV ELECTRICAL SERVICES INC. . sec. Typti ar ais� . WORKER /S -196 .E LLE n0-o r a CTRICAL: CONTRACTOR 1 YAx lilsr�Pr. R r�r r me ao»t Yo vaou►te AMf — - - -- - - -- -- DO NOT FORWARD MV ELECTRICAL SERVICES INC MAARIO A VALDES PRES 18311 NW 82 CT MIAMI FL 33015 PAYMMAECEMM 08/24/2012 60000000317 !! }} {{}} ��yy jj JJ all jj tt {{ yy pp jj g 000075.00: Itt�ltlitlftlli111i' t} J} 111 111Ifl111ItIf11111If $III1 1111111 1 98 SEE OTHER SIDE i JMR CONSTRUCTION, CO., INC. CBC #1252630 305/970 -4434 JOB ADDRESS: 102 NE 109 ' Street, Village of Miami Shores, FL 33138 BATHROOM RECEPTACLE ON 20 AMP CKT AND G.F.I PROTECTED 3� ADD SMOKE/CARBON MONOXIDE DETECTORS. ANY AND ALL CLOTH AND RUBBER INSULATED CONDUCTORS TO BE REPLACED. H ®lei err SCOPE OF WORK: 1. Install new floor and wall the over durarock cement board; 2. Remove and re -set existing toilet; remove and replace tub; remove and replace vanity lavatory, 3. Install new mirror; and, 4. Install (2) new GFI outlets, 2 recessed lights and switch. FLORIDA ROOM i 22 �Z- A/ &- 110 C? FLORIDA ROOM s° 7-1. 1 A 7-pl / 5 e I ADD SMOKEURBON MONOXIDE DETEa CTORS, ANY AND ALL CLOTH AND RUBBER INSULATED CONDUCTORS TO BE REPLACED i N ELECTRIC PERMIT #: MIAMI SHORES VILLAGE APPROVED BY DATE ZONING STRUCTURAL ELECTRICAL 2�iA- Pop " PLUMBING MECHANICAL BLDG. SUBJECT TO COMPLIANCE WITH ALL FEDERAL STATE AND COUNTY RULES AND REGULATIONS CITY COPY JUN E42013 J,