Loading...
RC-14-475Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 209870 Scheduled Inspection Date: March 31, 2014 Inspector: Rodriguez, Jorge Owner: SCHAEFER, NORAH & PAUL Job Address: 47 NE 93 Street Miami Shores, FL 33138- Project: <NONE> Permit Number: RC- 3- 14-475 Permit Type: Residential Construction Inspection Type: Final Building Work Classification: Alteration Phone Number Parcel Number 1132060130390 Contractor: NATIONAL STRUCTURES INC Phone: (954)300 -8091 Isunamg uepanment comments KITCHEN CABINET REPLACEMENT UPGRADE TO GFI'S OUTLETS AND CHANGE 2 RECESSED CANS TO PENDANT LIGHTS INSPECTOR COMMENTS False Inspector Comments Passed ENGINEER LETTER AS PER REQUEST AT JOB SITE BY B.O -I'M — V __ c— IaF�� Failed Correction ❑ Needed Re- Inspection ❑ Fee No Additional Inspections can be scheduled until re- inspection fee is paid. March 28, 2014 For Inspections please call: (305)762 -4949 Page 18 of 27 "7 � " FTI STRUCTURAL CONSULTING 6737 3W 63 Coup Off: 305.665M47 h4iomi, FL 33143 Fax: 305.6,69.5065 March 28, 2014 Miami Shores Building and Zoning Department 10050 NE 2nd Ave Miami Shores, FL 33138 RE: Schaefer Residence Kitchen Certification 47 NE 93 Street Miami Shores, FL 33138 To Whom it May Concern; On March 28, 2014, I, Thomas Moe, PE, performed a site inspection at the above referenced address in order to verify the structural integrity of the kitchen cabinet connections at said residence. Several screws were verified throughout each of the cabinets and were found to be consistent with loading requirements required to support typical dishware, glassware and similar type loading. As a result of said inspection, I hereby certify that to the best of my belief, knowledge and professional judgment all kitchen cabinets at the above referenced address are safe, secure and free of defects and will support loads intended for its use. If you should have any questions please do not hesitate to call. Respectfully, Tho Moe, PE 63863 PERMIT # CONTRACTOR: / vcjo e SUBMITTAL DATE: ADDRESS: NAME: /" S c a eA RESUBMI DATES: EjdiTAL p 4' C°I PROJECT TYPE: ,L ZONING FIRE STRUCTURAL IMPACT FEES ELECTRICAL RS /DERM �b PLUMBING'- NOC MECHANICAL !� _ 3I� � BUILDING 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 C JLSQ Cy' C_"'D [ 00- - �� M1A_ PERMIT APPLICATION Permit Type: BUILDING JOB ADDRESS: H__7 OE MAR 11 20% FBC 20 Permit No. Master Permit No.R- 14 ROOFING City: Miami Shores County: Miami Dade Folio/Parcel #: 113 a C3 C.0 1"'bo'1'2') 1) Is the Building Historically Designated: Yes NO Flood Zone: OWNER: Name (Fee Simple Titleholder):_ i J6 ��, �� (� Phone# a&5 —E2 1, Address: 2,E Q 2 -Alei- a 5�1 t City:. ryl i 0.YM i State: �. Zip:. 3 3 IS Tenant/Ussee Name: —1 Phone #: Email: h Ov- ® CONTRACTOR: Company Name: A �a #�vnG c-� /td u/�1 Phone #: 47fY Zoa -6,ai Address: S6 I -a-, S� City: - ' Y I data j State: Zip: 1.70 4 f Qualifier Name: G *l� I�; Phone #: State Certification or Registration #: 19 9 Certificate of Competency #: Contact Phone #: �(f ?,o - 'qFdq / Email Address: ral, ell.! 0 ���, ®cam► DESIGNER: Architect/Engineer: Phone #: 7t (-a,zR)9' 'o2n5< Value of Work for this Permit: $ zF2XI CM0 Square/Linear Footage of Work: 'i" 10 ®f;�, Type of Work: DAddition Altei f4pi ONew ORepair/Replace ODemolition Description of Work: r r, G �r�� �C- �e�j;c�c,.• �i e. .rr �I Color thru tile: :... Submittal Fee $ ICJ • gPZ )' Permit Fee $ Scanning Fee $ CCF $ CO /CC $ Radon Fee $ DBPR $ Bond $ Notar Training/Education Fee $ Technology Fee $ Double Fee Structural Review $ 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 roust 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. Signature Owner or Agent The foregoing instrument was acknowledged before me this day of&fflh 20 l' by _A)Q 1 2h S chi a,� all who is personally known to me or who has producedP� lde� 641 33sgl�"7' As identification and who did take an oath. NOTARY PUBLIC: Sign: Si tur Contractor The foregoing instrument was acknowledged before me this �l ti day of JM4,rd4 20_& 1 , by g D /rU ell/ S: who is personally known to me or who has produced_2Fe Z' r/� ?(2-7 7S 320 as identification and who did take an oath. NOTARY PUBLIC: Sign: M Feliciano My Commis o- - - ' esNotery Fubk state of Florida +g Joanna M Fefideno • �S` My COMMMW FF 082753 C wa`" Expireso�n2no�a APPROVED BY - I I/ Plans Examiner Structural Review My (Revised 5 /2/2012XRevised 3/12/2012) XRevised 06 /10 /2009)(Revised 3 /15 /09)(Revised 7/10/2007) Zoning Clerk Miami shores Village Building Department 10050 N ' E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 798.2204 Fax: (305) 756.8972 ALL CONTRACTORS MUST PROVIDE COPIES OF LICENCES AND INSURANCES EACH TIME PERMIT IS SUBMITTED OR THE VILLAGE MAY MAINTAIN A FILE WITH YOUR INFORMATION FOR A $30.00 FEE PER YEAR. IF CONTRACTOR IS.A FLORIDA STATE CERTIFIED CONTRACTOR: A, COPY OF QUALIFIER'S STATE LIC CARD B. COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF LIABILITY INSURANCE (CERTIFICATE HOLDER TO BE MIAMI SHORES VILLAGE BLDG DEPT) D. COPY OF WORKERS COMPENSATION (EITHER CERTIFICATE OR EXEMPTION) IF CONTRACTOR HAS A MIAMI DADS COUNTY CERTIFICATE OF COMPETENCY: A. COPY OF CERTIFICE OF COMPETENCY OF QUALIFIER B. COPY OF MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT C. COPY OF LIABILITY INSURACE (CERTIFICATE HOLDER MUST BE MIAMI SHORES VILLAGE BLDG DEPT) D. COPY OF WORKER COMP INSURANCE (EITHER CERTIFICATE OR EXEMPTION) YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE HOLDER AS FOLLOW MIAMI SHORES VILLAGE BLDG DEPT 10050.NE 2ND AVE MIAMI SHORES, FL 33138 ■ rarrrrararirrrrrA' i�rr# rrr#■ rarr##■# r## rrr�rrrr## grstrrrrrrrrs#### : #�r,arsrrr.a.rr # #: # # # # #ras #rai COMPLETE CfdDI`i'RACTOR'S 1NFOitMATIQN BUSINESS NAME: N,. -+i o^ s t �i`f Jam' yir BUSINESS ADDRESS: tLs yn ITY' a� „lz� STATE L- ZIP CODE Q BUSINESS PHONE: & ) &00 - 90 r FAX NUMBER CELL PHONE 3 —, QUALIFIER'S' NAME: QUALIFIEWS.LIC NUMBER: , t E -MAIL ADDRESS (IF APPLICABLE): r fV . r!. %t , , Cam-► Created on 3119109 BY MWV t RV 3126109 MLOV '� "' °THIS DOC,U_MENT HA`�S CA CA O`LO�RED�B;!>$C° GKGK ROOD .MIG O`PRd;TI ��Lf�NEMA'RK."`P�'RE kTEDtP ERA '' d� �' ���` n ; STATE OF FLORIDA, • _r a• • REGULATION • • N INDUSTRY.LICENSIN BOARD - LICENSE NBR MM;2012 i28027197 1CG C151.9897 The GENERAL.CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 FS: Expiration date: AUG 31, 2011 ELLIS,.RORY GEORGE SR NATIONAL STRUCTURES INC 3624 JACKSON STREET APT 9 HOLLYWOOD FL 33021 RICK SCOTT' KEN LAWSON GOVERNOR SECRETARY DISPLAY AS REQUIRED BY LAW NATIO -5 OP ID: RK '4+4C,.°R°r CERTIFICATE OF LIABILITY INSURANCE DATE 03/12/201/4 03/12/2014 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 policypes) 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 Phone: 334794 -8646 Flowers Insurance Agency LLC P.O. Box 368 Fax: 3347945965 Dothan, AL 36302 Robert P. Heffner, Jr. CNp�E cT Darlene Jordan PNC° No • 334- 794 -8646 a No : 334-794 -5965 E-MAIL flowersinsurance.com ADDRESS: "' darlene@flowersinsurance.com INSURERS AFFORDING COVERAGE NAIC i INSURER A: Brid efield Casualty INSURED National Structures Inc, 953 Quinn Street Palm Bay, FL 32909 INSURER B: INSURER C EACH OCCURRENCE INSURER D DAMAGE PREMISES Ea occurrence) INSURER E: MED EXP (Any one person) INSURER F: PERSONAL & ADV INJURY 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. INSR LTR TYPE OF INSURANCE ADDL LN& SUBR WVD POLICY NUMBER POLICY EFF D POLICY EXP D LIMITS AUTHORIZED REPRESENTATIVE GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS -MADE E] OCCUR EACH OCCURRENCE $ DAMAGE PREMISES Ea occurrence) $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO LOC PRODUCTS - COMP /OP AGG $ $ AUTOMOBILE LUU31LnY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS COMBINED SINGLE LIMIT a accident BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per scold UMBRELLA LAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED I I RETENTION $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N OFFICER/MEMBEREXCLUDED? El (Mandatory In NR If describe under DESCRIPTION OF OPERATIONS below N/A 196- 34514 04/24/2013 04/24/2014 X WC STATU- OTH- TORY LIMITS R E.L. EACH ACCIDENT $ 1,000,00 E.L. DISEASE - EA EMPLOYEE $ 1,000,00 E.L. DISEASE - POLICY LIMIT 1 000 00 $ > > DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, U more space is required) Florida certified general contractor CERTIFICATE HOLDER CANCELLATION MIAMI -1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Miami Shores Village Bid 9 9 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Dept ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE 2nd Ave AUTHORIZED REPRESENTATIVE Miami Shores, FL 33138 ©1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD 03/12/2014 09:06 FAX 3212534646 AG D® CERTIFICATE OF PRODUCER All Brevard Insurance Network, Inc. 452 N. Harbor City Blvd. Melbourne, FL 32935 Phone (321)2553337 Fax (321)2554646 ALL BREVARD INSURANCE 1x001/001 LIABIL17 Y_INSU_RANCE DATE (MNUDDNY) 03/72/14 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.__ — j INSURERS AFFORDING COVERAGES I NAIC 1_t INSURED NATIONAL STRUCTURES, INC IKS}JRERA: TAPCO /SCOTTSDALE _— 953 Quinn St INSURER B;. PROGRESSIVE Palm Bay, FL 32909 INSURER C: •_, _, _ — -- - __ - -' (321) 7266 -2031 INSURER D:- _ -- 1 INSURER E: _ COVERAGES I INSURER F: _ THE POLICIES OF INSURANCE WTED HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY RE4UIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR NWY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TOALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES_, AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED PAID CLAIMS. _ NOR[ ADD -L TYPE OF INSURANCE P POUGY ERPlCTIVI: POLICY EXPIRATION _ POLICY NUMBER ppTE mN� pq SNWDQ� _ LIMITS GENERAL LIABILITY EACH OCCURRENCE _ 1,000,000 [1 COMMERCIAL GENERAL LIABILITY CPS1937493 DAnnAGE'TO RENTED - "" ' ' — ' 12/75/14 12/15/15 PREAAISES (Ea orcurenae), 100,000 A ® ❑❑ CLAIMS MADE U OCCUR MED EXP (Any one person) - ❑ 5,000 PERSONAL 8 ADV INJURY 1.000,000 LJ — GENERALAGGREGATE _ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - CoMP/oP AGO 1,000,000 tCI POLICY ❑ PROJECT ❑ LOC AUTOMOBILE LIABILITY - COMBINED SINGLE LIMIT r ANY AUTO 02354473 -0 08/13/13 06113/14 Eaecdaent) 1,000,000 I� ALL OWNED AUTOS D ® SCHEDULEDAUTOS BODILY INJURY ❑ HIRED AUTOS Per eraon) ❑ NON OWNED AUTOS BODILY INJURY ❑ (Per accldent) - ❑ I PROPERTY DAMAGE acddenq J oe LIABILITY ❑ ANY AUTO EXCESS/UMBRELLA LIABILITY ❑ OCCUR ❑ CLAIMS MADE DESCRIPTION OF OPERATIONS / LOCATIC Concrete Construction, Masonry CERTIFICATE HOLDER MIAMI SHORES VILLAGE BUILDING DEPT 10050 NE 2ND AVE MIAMI SHORES,FL 33136 ACORD 25 (2001108) GIF AUTO ONLY • EA ACCIDENT OTHER THAN F.A ACC — AUTO ONLY: AGG _ EACH OCCURRENCE _ AGGREGATE ....._ ❑TORY 61MIT6 ❑ EFH '- E.L. EACH ACCIDENT E.L. DISEASE . EA EMPLOYEE _ E.L. DISEASE . POLICY LIMIT .l_ ADDED BY HNDORSEMENT / CANCELLATION l SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE I EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ' $0 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE M ACORD CORPORATION 1968 ❑ DEDUCTIBLE ❑ RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR /PARTNER /EXECUTIVE OFFICER r MEMBER EXCLUDED? It yea, describe under SPECIAL PROVISION$ §eipw OTHER " " -- DESCRIPTION OF OPERATIONS / LOCATIC Concrete Construction, Masonry CERTIFICATE HOLDER MIAMI SHORES VILLAGE BUILDING DEPT 10050 NE 2ND AVE MIAMI SHORES,FL 33136 ACORD 25 (2001108) GIF AUTO ONLY • EA ACCIDENT OTHER THAN F.A ACC — AUTO ONLY: AGG _ EACH OCCURRENCE _ AGGREGATE ....._ ❑TORY 61MIT6 ❑ EFH '- E.L. EACH ACCIDENT E.L. DISEASE . EA EMPLOYEE _ E.L. DISEASE . POLICY LIMIT .l_ ADDED BY HNDORSEMENT / CANCELLATION l SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE I EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ' $0 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE M ACORD CORPORATION 1968 s DR Bk 29065 Ps 3617 (1 ps ) " RL4C7fii)ED i�13Ir'rt1wf.tr..El_I1 4 09-54•o._i(. OF 'COURt' NOTICE OF COMMENCEMENT hi1:rNI--is =ADE COUNTY t� LOFFIi: A A RECORDED COPY MUST BE POSTED ON THE JOB SITEAT TIME OF FIRST INSPECTION (-lnST PAGE PERMIT NO. �, �" !•5 TAX FOLIO NO. x -TATE OF FLORIDA. COUNTY OF Di4D@ STATE OF FLORIDA ••, -REBY CERTIFY that this is a tru c y of the COUNTY OF MIAMI -DADE: vn ii d in this Of a on ___ -AD__ day) _ AD 20 THE UNDERSIGNED hereby gives notice that Improvements will be rrlaale3O QsrfrO d ffrclal Seal. property, and in accordance with Chapter 713, Florida Statutes, the foil$ 1 C �r,�n Co n ourts Is provided In this Notice of Commencement. ;v LJ D.G. 1. Legal description of 2. Description. of and street/address: A � -7 3.Owner(s) name and ad&dss: PVe i"" . R Interest in property: Name and address of fee simple titleholder 4. Contr4ctoes name, address and phone number cue1 _ ce_ Space above reserved for use of recording office A ),.t� �, \6 -* 45N k-1 I;t.w►; , �F[ 33 X3'7 5. Surety' (Payment bond required by owner from contractor, if any) Name, address and phone number: 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, address and phone number. 8. In addition to himself, Owners designates the following person(s) to receive a copy of the Uenor's Notice as provided in Section 713.13(1)(b), Florida Statutes. Name, address and phone number. 9. Expiration date of this Notice of Commencement: (tire explration date is 1 year from the date of reeording unless a different date is specified) WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OFTHE NOTICE OF COMMENCEMENTARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART I, SECTION 713.13. FLORIDA STATUTES, AND CAN RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT. Signature(s) of Owner(s) or Owner(s)' Authorized Officer/Director/Partner/Manager Prepared By Prepared By > Print Name a( ®r��t j, S r_6a� r Print Name Title /Office ' Title /Office LJ STATE OF FLORIDA The foregoing instrument was acknowledped before me this a day of By /vim r L-A :< g g g' , ❑ individually, or U as for Personally known, or Pproduced the following type of identification: ' Pl_ Signature of Notary Public: - -- Print Name:e" -- - -a�aD d -� L, °c i rv, �s (SEA-) VERIFICATION PURSUANT TO SECTION 92525, FLORIDA STATUTES o 0 Notary Public State of Florida Under penalties of perjury, I declare that I have read the foregoing and a Joanna M Feliciano that the facts stated in it are true, to the best of my knowledge and belief. gam, My gommission FF 082.753 ' O �o Expires 01/12/2018 Signature(s) of Owner(s) or Owner(s)'s Authorized Officer/Director/Partner/Manager who signed By Gt/./J %- �%�1✓J By 12301-52 PAGE 8112 n crux 'bcy+e Se_c-