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RF-14-360Miami , 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 FBC 20 Permit Type: BUILDING ROOFING FEB 2,Q 2014 Permit No. 1 CJI►—' 1 d � 0 Master Permit No. OWNER: Name (Fee Simple Titleholder): Mike Kovensky Phone #: 321 —442-2608 Address: 534 NE 92 Street City: Miami Shores State: Fla. Zip. .33138 Tenant/Lessee Name: Phone #: Email: JOB ADDRESS: 5 3 4 NE 92 Street City: Miami Shores County: Miami Dade Zip: 3 313 8 Folio/Parcel #: Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name: Ar i on Inc. Phone #:3 0 5 — 2 51 —1 2 7 9 Address: 8723 SW 129 &Terr. City: Miami, Fla. 33176 State Zip: Qualifier Name: Rick Wynne Y• g, Phone #: 305-251-1279 State Certification or Registration #: n / a Certificate of Competency #: 0 0 0 01 3 3 71 Contact Phone #: 305' -251 -1279 Email Address: arionihc @belbs6u'th.net DESIGNER: Architect/Engineer: Phone #: Value of'iWork for this Permit: $ $ 9 9 0.0 0 Square/Linear Footage of Work: 18 0 1 i n . ft. Type of Work: DAddition DAlteration XXzXAV ORepair/Replace ODemolit4n Descriptionof r . - Ins`Yaall -ft VI ite aluminum rain gutt &r "a n uts' Submittal Fee $�Q' Cj._� Permit Fee $ CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ Technology Fee $ TOTAL FEE NOW DUE $ 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 commencement must be poflted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of su posted notice, the inspection will no roved and a reinspection fee will be charged. Signature Signature Owner or Agent Cog6actor The foregoing instrument was acknowledged before me this ,4_ The foregoing instrument was a�ed ed before me this X t day ofa�, 20th, by rfi4VPa�✓fk�/ , day of i•" 20 L, by a�- �/�.�/�✓'��, who is personally known to me or who has produced )dho is personally known to me or who has produced „111, 1 take an oath. oath. P F M NE aY 1'�e,,�� NOT Notary. Public .= State ofi Florida NOT '' &tary. Public - 'State of Florida • + •,'�y Comm, Expirds Alov_'16, 2016 5' « .e=.filly Comm. Expirds Nov. 16, 2016 Commisslon.# EEW584 '% g�� Commission.# EE850584 c.` OF iid Thra h atjynal Notary Assn. Bo ed rough as]Q Notary Assn. My Commission Expires: f1/CO/p2616 APPROVED BY (Revised 07 /10 /07)(Revised 06 /10/2009 )(Revised 3/15/09) 7I` rPlans Examiner Structural Review My Commission Expires: ��/ /�(b�a 0 Zoning Clerk Miami shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CONTRACTORS' REGISTRATION ALL CONTRACTORS MUST PROVIDE COPIES OF LICENCES AND INSURANCES EACH TIME A PERMIT IS SUBMITTED. IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: A. COPY OF QUALIFIER'S STATE LICENCES B. COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF LIABILITY INSURANCE* D. COPY OF WORKERS COMPENSATION INSURANCE* 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* D. COPY OF WORKERS COMPENSATION INSURANCE* *YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE HOLDER AS FOLLOW: MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES, FL 33138 ■■ aaaaaaaaaaaaaaaaaanaaaaSaaaamaaaaamaaaBananaaaaaaaaaaaaaaaaamanananaamaaaamaamanamasaaSal COMPLETE CONTRACTOR'S INFORMATION BUSINESS NAME: Z(/L► b a T.r c- BUSINESS ADDRESS: $-7,2-3 sw4 19 9 CITY ` %V p �• STATE F.Z. ZIP CODE 3.7/ 14 BUSINESS PHONE: of ) al" -1 z 19 FAX NUMBER f 3v /) a2.0 — 31 -') '7 CELL PHONE �_) �► QUALIFIER'S NAME: QUALIFIER'S LIC NUMBER: 0 0 C" ,1-7� Created on 3119109 BY MLDV I RV 3126109 MLDV I RV 6127111 AS OP ID: DT ^ : °A0 1 CERTIFICATE OF LIABILITY INSURANCE 70212P4114 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: H 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 endotsemen s . PRODUCER Phone: 305 - 270 -2100 FILER INSURANCE, INC. Fax: 305 -270 -2195 9440 S.W. 77 Avenue Miami, FL 33156 Mark t$1. Bluh kZATF-ACT PHONE AX No ACCORDANCE WITH THE POLICY PROVISIONS PRODUCER ARION01 CUSTOMER 0 #- INSURERS) AFFORDING COVERAGE NAIC # INSURED Arlon, Inc. MVP Metals, Inc. 8723 SW 129th Terr Miami, FL 33176 INSURER A: FCCI Insurance Company 10178 INSURER B: 07105!14 INSURER C: $ 500,09 INSURER D $ 100,00 INSURE! E: $ 5,00 IN F: $ 500,00 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. L TYPE OF INSURANCE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Miami Shores Village POLICY NUMBER O ACCORDANCE WITH THE POLICY PROVISIONS LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE I OCCUR AUTHORIZED REPRESENTATIVE Miami Shores, FL 33138 CPP0007405 07/05113 07105!14 EACH OCCURRENCE $ 500,09 PWNSES ° a=mnce) $ 100,00 MED EXP (Any one parson) $ 5,00 PERSONAL & ADV INJURY $ 500,00 GENERAL AGGREGATE $ 1,000,00 GEITL AGGREGATE LIMIT APPLIES PER POLICY 7 PRO- LOC PRODUCTS - COMP /OP AGG $ 500,00 $ A AUTOMOBILE LIABILITY X ANY AUTO ALL OWNED AUTOS SCHE ULEDAUTOS HIRED AUTOS X NONZWNEDAUTOS CA0009153 07/05113 07105!14 COMBINED SINGLE LIMIT (Ea acrd) $ 500,00 SLY INJURY (Per person) $ BOtXLY INJURY (Per aaldeM $ PROPERTY DAMAGE (Per auddarr) $ $ UMBRELLA LIAB EXCESS LLAB OCCUR EACH OCCURRENCE $ HCLAIMS-MADE AGGREGATE $ DEDUCTIBLE RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ONlF CPERR�RiE EBME"R EAXRUT''DE C' F-1 (Mandatory M NH) gr mmolbo Corder RIP110N OF OPERATIONS below NIA -T I WCSTATU- I OTii- r ER $ E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE .POLICY LIMIT $ DESCIWWN OF OPERATIONS I LOCATIONS I VEHICLES Attach ACORD 111, Add! wW Remarks Seharlule, if more apace 1s re*dred) Installation of rain gutters and downspouts CERTiFICOTE NnLnFR cewcELLA"nnM MIAM109 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Miami Shores Village THE EXPIRATION DATE THEREOF, E WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS Building Department 10050 N.E. 2nd Avenue AUTHORIZED REPRESENTATIVE Miami Shores, FL 33138 7 ' , DARY_ TC#fi RFS - rii 9 ;$"ems- ®1988 -2009 ACORD CORPORATION. Ali rights reserved. ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD CERTIFICATE OF LIABILITY INSURANCE °M'�(241201 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 BYTHE 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: N She certMcate holder Is an ADDITIONAL INSURED, the pollcy(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 cer0cate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER NAME: Risk Transter Programs, LLG 219 East Livingston Street PHONS 86&481.9363 A/C ADDRESS: Orlando, FL 32801 INSURERMAFFORDINGCOWERAGE NAIC d $ INSURER :Cestleftnt National Insurance Company 40134 MED EXP ON one n INSURED Outsourcing, ll, III, IV V & VI Inc. Shaft INSURER B :Tower Insurance Com of New York 44300 INSURER C : 1776 N. Pine Island Road Sulte 106 Plantation, FL 33322 INSURER D : PRODUCTS - CCMPIOP AGO INSURER E $ INSURER F AUTOMOBILE L 46UM ANY AUTO ALL AUTOS SCHEDULED HIRED AUTOS AAUUTOS COVERAGES 1, CEKTIFIGATE NIJ1M13EK:35K9QGTF REVISION NUMEIER_ THIS IS TO CERTIFYTHAT 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. LTR TYPE OF INIKIRANCE POLICY NUMSER LIM" GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMSMADE F-1 OCCUR EACH OCCURRENCE $ PREMISES Me occur rice $ MED EXP ON one n $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GEML AGGREGATE LIMIT APPLIES PER: PoucYO Loc PRODUCTS - CCMPIOP AGO $ $ AUTOMOBILE L 46UM ANY AUTO ALL AUTOS SCHEDULED HIRED AUTOS AAUUTOS COMBINED SINGLE UNT �DILY INJURY (Per person) $ BODILY INJURY (Per ) $ r Rl Y $ URA UAB EXCESS LRAB OCCUR CLAIMSMADE EACH OCCURRENCE $ AGGREGATE $ DEO I I RETENTION $ A B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROMETORIFARTNERIEXECUTIVE 0FRC9WEMBER EXCLUDED? (Mandatory In NH) If�s, desarbe under DESCRIPTION OF OPERATIONS bebm NIA WSLTHPE0002DO09 SLTHPE00014904 03101/2013 03/0112014 X ,hMCSTATU OrH- E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 11000,000 E.L. DISEASE - POLICY LIMIT $ 1 $ $ $ $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additlaral Remarks Sehedule, Name space Is required) Coverage is extended to the leased employees of alternate employer in all states except in monopolistic states (ND, OH, WA, WY): Arlon, Inc. #1154 This certificate applies to: Llcense # 000013371 VtK11r1%;A1C nULUCK 6ANGCLLAIIUN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATETHEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Miami Shores Village AUTHORIZED REPRESENTATIVE 10050 NE 2nd Avenue Miami Shores, FL 33138 Page 1 of 1 ®1888 -2010 ACORD CORPORATION. All rights d. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD ,.� a ,� LWOW JTT . . . . . . . . . . M Print Page 1 of 1 As per the Building Official you may submit your permit application. Arlenis Silvers Permit Clerk Supervisor Miami Shores Village 10050 NE 2 AVE Miami Shores, F133138 305 -795 -2204 https : / /us- mg204.maii.yahoo.com/neo/launch ?.partner=sbc&retry_ ssl =1 2/25/2014 Ac ©Rbo CERTIFICATE OF LIABILITY INSURANCE 02122712014 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 BYTHE 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 pollcy(les) must be endorsed. P SUBROGATION 18 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 endorsement(s). PRODUCER Risk Transfer Programs, LLC 219 East Livingston Stmt P .866 481-9363 AC N* J: Orlando, FL 32801 ADD> &SS: INSU s AFFORDING COVERAGE NAIC 0 INSURER A.-Technology Insurance Compan trio. 42376 DAMAGE TO RENTED PREMISES Ea oa r ence INSURED Ink Outsourcing, 11, 111, IV, V & VI Inc. INSURER s COMMERCIAL GENERAL LIABILITY CLAIMS -MADE E] OCCUR 1776 N. Pine Island Road INSURER C: Suite 108 Plantation, FL 33322 INSURER 0: PERSONAL & AM INJURY INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:DPSYSVGU 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 NOTWITHSIANDING 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. TYPE OF INSURANCE Miami Shores Village 10050 NE 2nd Avenue POLICY NUMBER Miami Shores, FL 33138 LIMITS GENERA. LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED PREMISES Ea oa r ence $ COMMERCIAL GENERAL LIABILITY CLAIMS -MADE E] OCCUR MED EXP Any one ) $ PERSONAL & AM INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP AGG $ $ POLICY PRO- LOC AUTOMOBILE LIABpn11 COMBINED 81012—UNMT- Me accident BODILY INJURY (Per person) $ ANY AUTO ��4® AUTOS SCHE LED BODILY INJURY (Per accident) $ HIRED AUTOS NON-OWNED PROPE d E $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ IM AGGREGATE $ L1AB CLAIMS -MADE RETENTION $ $ A tAFORItFttg ENSATION AND EMPLOYERS' LIABILITY _ YIN OFFICER l=xcLUDED9 (MarwW Y in W If yes desaihs under DESCR�TIOW OF OPERATIONS below N / A TWC3404060 03/01/2014 03/01/2015 X WC $ 1,000,000 E L EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE $ 110001000 El. DISEASE - POLICY LIMB $ 11000,000 $ $ DESCRIPTION OF OPERATIONS / LOCATIONS !VEHICLES (Atfaeh ACORD 101, Additional RerrmMca Satreduk, H more space is required) Inc. erage (Effective extended the leased employees of alternate employer in all states except in monopollstie states (ND, OH, WA, WY) and other states (Alf, Hl, ID, OK): Arlon, This cerdfcate applies to: License # (100013371 CERTIFICATE HOLDER CANCELLATION Page 1 or 1 0 1885 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATETHEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Miami Shores Village 10050 NE 2nd Avenue AUTHORIZED PJWRESENTAnVE Miami Shores, FL 33138 Page 1 or 1 0 1885 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD