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DS-14-810Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-216379 Permit Number: DS -4-14-810 Scheduled Inspection Date: September 04, 2014 Permit Type: Driveways/Sidewalks/Slabs Inspector: Rodriguez, Jorge Owner: SEMIEN, GEORGE Job Address: 448 NE 96 Street Miami Shores, FL 33138-0000 Project: <NONE> Contractor: JC SUVILLAGA BRICKS AND PAVERS INC Inspection Type: Final Work Classification: Addition/Alteration Phone Number (305)793-7911 Parcel Number 1132060140575 Phone: (305)467-9654 Building Department Comments PAVER DRIVEWAY Infractio Passed Comments INSPECTOR COMMENTS False Inspector Comments Passed CREATED AS REINSPECTION FOR INSP-211171. Work not per plans, revise permit. Sod must be restored Failed Correction ❑ Needed Re -Inspection ❑ Fee No Additional Inspections can be scheduled until re -inspection fee is paid. September 03, 2014 For Inspections please call: (305)762-4949 Page 8 of 26 PERMIT APPLICATION j nlILDING ❑ ELECTRIC Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 JUL Master Permit No. 4-154-916 Sub Permit No. ❑ ROOFING REVISION ❑ EXTENSION ❑ RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: -44.? Ale 96 6 Iled City: Miami Shores County: Miami Dade Zip: 33136 Folio/Parcel#: 113 20601 ,9L®5 7 ar Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder) 640CIOl, le '5(?M Je-4 Phone#: 905 793 7 911 Address: 44T &6- 14, ts-Aee City: Aba"n r State: 1_117 Zip: /_3'f Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: �� �. ®��� �il�� �' j��y� ®fie Phone#: 06 f67 %(.6ej Address: City: State: )C--/° Zip: / 6 Qualifier Name: J-4/42,7 `®� ��� /ox Phone#: State Certification or Registration#: Certificate of Competency,#: DESIGNER: Architect/Engineer Phone#: Address:.. � � pCity: State: Zip: Value of Work for this Permit: $ 2)000- ®® Square/Linear Footage of Work: &00 Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: ', /'/feGf fi9�� a ��� ®� G,?/x3,/ 12pilI Z 14--5 hll? ' CCF $ DBPR $ Notary $ Technology Fee $ Training/Education Fee $ Double Fee $ Structural Reviews $ (Revised02/24/2014) Bond $ TOTAL FEE NOW DUE $ L �� ° CO 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 ELECTRIC, PLUMBING, SIGNS, POOLS, FURNACES, BOILERS, HEATERS, TANKS, 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 $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. I bsence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Structural Review Clerk (RevisedO2/24/2014) Signatur Qhs Signatur OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this a 0-1k� day of 20 1 q , by day of %TfA It/20 , by [jr4 who is personally known to 14 04E&96NA/krwho is personally known to me or who has produced r Yew J4666A as me or who has produced /'/ 1�%t �S/� e�{ as identification and who did take an oath. identification and who did take an oath. NOTARY C: NOTARY PUBLIC: c Si Sign: Print: Print: Seal: P&,, Seal: ,Ay AILYIVRAVELO * * MY COMMISSION X EE 055804 �` r GLORIA CABAL 3 s, Q EXPIRES: January 18,2015' 713 BO�ad Tfau Blaiget Notary NOINY Public - Slate of Florida s,� a�, MY Comm• Expires Sep 11, 2016 FLO��o �k�k�k�k�k�k�k�k�k�k�k�k�k�k�k�k�k�k�k�k �R7k �k�kMt7k7kNt�k�ek�k4�k�k�ktkekek�kMt�k��**fie}���Nt�R�letk �k'�i��►�k�F�F�it�ld9���lf�A�9r�f��Q�7k �k7k7k�k7k8t8t7k7k��& U� r/ APPROVED BY Plans Examiner 'Zoning Structural Review Clerk (RevisedO2/24/2014) BY. ,„ /$mue surrr 304j�'_yj j� �t j} r SifJTVk^Y Na. ?0 r 0(SOt B ) 282 J V i N I BARRA -ASS . OC. l C M 5) 762-d40q LAM SURVEYORS SHEET hyo.42 OF,' 2 -- BOUNDARY SURVEY s0ALE -'" . JECTION Florida Health Miami -Dade County O.S.T. D.S. & Well Progr�aJp� C _ Application No.: PL,ATer MIAMI *0 r IRri � 1 7 ' CL D� PAMELD ARE, 864 SP PROFS UNOBST141CIM 1 FIs e P.AG Y8 496 8R IEGf111�R. aLa1 19841 STERLING DRIVE PHONE: (MQ 261-76M CUTLER HAY, FLORDIA FAY-• (m) 2863841 :•: 85167-7721 E MAH.: CDrssuWn ptic.Com ,{/� y/�{+1 _1DAM t. AeUYE DAGIB.!!®ltiNdANDD➢AMIN4DABK19C P60Iti8TYDF'ltidBYtl6tlD.Y.1lH: YAIITf�088BALi. BSCDP®.DI618A®1Odf�8B.OH ffi®IIt OOlG •IGPWOQR DTDRIITDAF PDII TDDNPRCIPICARPnCA9DPFYFDIIWHICJlTHRYDAVB PIIIIVAIIRDflI'IRODT TDD W RRI WY IbI�WYI' OPTIIR DRBItDaDR COIGPAN4. /w "114.664 . 12" 8P. PROVUMR SEALQUALIFIER FOR SEPTIC SYSTEM PROGRAM - DATE' a� (iie®hamm+orEDB�*•S. ine. O RIEPA CEHP °Ic arcT jj "."LIC, Nos - r IRri � 1 7 ' ' io va01 D� PAMELD ARE, 864 SP PROFS UNOBST141CIM P.AG Y8 496 8R IEGf111�R. WDER DE POINT OF YIED :•: TOTAL I11,108871RUGIED AMA '167 a 388. We 8R FEGUMD. /w "114.664 . 12" 8P. 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I "i t 448 S­h� 90th St -L m� ft.,.. nova. 1-_._____---..._ , � '; .- . __ __ ____ - SEPTIC TANK & DRAINFIELD LAN I 9,srr mu ��i�j�dx"ta!; - IN, I It ria],,, r . 0 Ifl PERMIT APPLICATION Miami Shores Village ACEI, u Building Department APR 2 2014 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 BY: INSPECTION LINE PHONE NUMBER: (305) 762-4949 FBC 20 L0 Master Permit NO.D<:!--> t "", 0 Sub Permit No. BUILDING ELECTRIC ❑ ROOFING REVISION ❑ EXTENSION RENEWAL ❑ PLUMBING ❑ MECHANICAL L UBLICWORKS ❑ CHANGE CONTRACTOR ❑ CANCELLATION �F SHOP DRAWINGS JOB ADDRESS: "7 ! �� & -- �� -S- City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): `r -/:p ,4, �I�a Phone#:30-5- 7�3- 2,�11 Address: L/e, City: State: Zip: 23 / T jP Tenant/Lessee Name: Phone#: ?573 Email: TA S-' ig" 90 &2 CONTRACTOR: Company Name: _ �'�� �� �i�i� �1®� t� Phone#: -�?Os S&O &TC/ Address: ,�b 2 City: A24Z State: Zip: Qualifier Name: ��22 ���� & ,p 2 Phone#:305 w � State Certification or Registration M DESIGNER: Architect/Engineer: Address: City: Certificate of Competency #: 0-5-69,6004,22 State: Zip: Value of Work for this Permit: $ 2"Ooy Square/Linear Footage of Work: �®o Type of Work: ❑ Addition ❑ Alteration E3New ❑ Repair/Replace ❑ Demolition Description of Work: zi Specify color of color thru tile: r Submittal Fee $60 c411A 41141!Z0 - 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 $ L 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 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 ence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. is Signa uJ%.AeLSignature OtWer or Agent ' Contractor The foregoing instrument was acknowledged before me this��zr% day of d' 1 20 9 by ao iq e 5, m i who i ersonally known to me or who has produced As identification and who did take an oath. The foregoing instrument was acknowledged before me this`?, ed day of r t I 201 by1=6arI05 6�&n22kZ• who i ersonall known o me or who has produced as identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: 1 7,7 Si Sign• Print: ' 'l fi V Ali' Print• 7 V av Poe AILYN RAVELO My Commission Expires: ro�P:•••.,�% * MY COMMISSION# EE 055604 My Commission Expires: a. ; ;���, AILYNRAVEL * 2015 EXPIRES: January 18, • MY COMMISSION I# EE 055604 *EXPIRES: January 18,2015 OF OP\oc Bonded Thtu Budget Notary WW` Bondeamu Budget ry �r9jEOF E�OPO NOt'd Seiwces �kak�k�k�k&eke<4�kffi�k&�k�k�k�k�k�k&#�kMe�k�kffi �k�k�k�k *&ok�k e<�k�N�h+kik**�k�k�k�k�k�k+k�k�k*�k�k�k�k�kN��k�k�k*�k�K**�k�k�k#&�k�k�k�K�k&�k�k�k�kak&�k�k�ktktk�k�kak�k�k�k*�k�k�k�k�k�k /4 APPROVED BY 1 G� Plans Examiner Zoning Structural Review (Revised02/24/2014)(Revised 5/2/2012)(Revised 3/12/2012) )(Revised 06/10/2009)(Revised 3/15/09)(Revised 7/10/2007) Clerk JEFF ATWATER CHIEF FINANCIAL OFFICER STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION * * 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: 12/20/2013 PERSON: GARCIA FEIN: 731687716 BUSINESS NAME AND ADDRESS: J C SUVILLAGA BRICKS & PAVERS INC 10245 SW 35 TERRACE Al U_lull EXPIRATION DATE: 12/20/2015 RAFAEL FL 33166 SCOPES OF BUSINESS OR TRADE: CONCRETE OR CEMENT WORK - FLOO Pursuant to Chapter 440.05(14), F.S., an officer of a corporation who elects exemption from this chapter by filing a certificate of election under this section may not recover benefits or compensation under this chapter. Pursuant to Chapter 440.05(12), F.S., Certificates of election to be exempt... apply only within the scope of the business or trade listed on the notice of election to be exempt. Pursuant to Chapter 440.05(13), F.S., Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation if, at any time after the filing of the notice or the issuance of the certificate, the person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate. The department shall revoke a certificate at any time for failure of the person named on the certificate to meet the requirements of this section. DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 07-12 QUESTIONS? (850)413-1609 , *.w 01-23-2013 JEFF ATWATER STATE OF FLORIDA CHIEF FINANCIAL OFFICER DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION * * 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: 01/23/2013 PERSON: OONZALEZ FEIN: 731667716 BUSINESS NAME AND ADDRESS: JC SUVILLAGA BRICKS & PAVERS INC 10245 SW 35 TERRACE MIAMI FL 33165 SCOPES OF BUSINESS OR TRADE: 1- CONCRETE OR CEMENT WORK - FL00 EXPIRATION DATE: 01/23/2015 JUAN C IMPORTANT: Pursuant to Chapter 440 . 05114), F.S., as officer of a corporation who elects exemption from this chapter by filing a certificate of election under this section may not recover benefits or compensation under this chapter. Pursuant to Chapter 440.05(12), F.S., Certificates of election to be exempt... apply only within the scope of the business or trade listed on the notice of election to be exempt. Pursuant to Chapter 440.05(13), F.S., Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation if, at any time after the filing of the notice or the issuance of the certificate, the person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate. The department shall revoke a certificate at any time for failure of the person named on the certificate to meet the requirements of this section. DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01-11 QUESTIONS? (850) 413-1609 PLEASE CUT OUT THE CARD BELOW AND RETAIN FOR FUTURE REFERENCE STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS COMPENSATION CONSTRUCTION INDUSTRY CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW 9 EFFECTIVE: 01/23/2013 EXPIRATION DATE: 01/23/2015 PERSON: JUAN C GONZALEZ FEIN: 731687716 BUSINESS NAME AND ADDRESS: JC SUVILLAGA BRICKS & PAVERS INC 10245 SW 35 TERRACE MIAMI, FL 33165 SCOPE OF BUSINESS OR TRADE 1- CONCRETE OR CEMENT'WORK - FLOO IMPORTANT OPursuant to Chapter 440.05(14), F.S., an officer of a corporation who elects exemption from this chapter by filing a certificate of election L under this section may not recover benefits or compensation under this D chapter. H Pursuant to Chapter 440.05(12), F.S., Certificates of election to be exempt.. apply only within the scope of the business or trade listed on Rthe notice of election to be exempt E Pursuant to Chapter 440.05(13), F.S., Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation if, at any time after the filing of the notice or the issuance of the certificate, the person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate. The department shall revoke a certificate at any time for failure of the person named on the certificate to meet the requirements of this section. QUESTIONS? (850) 413,-1609 CUT HERE * Carry bottom portion on the job, keep upper portion for your records. OWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01-11 Local Business Tax Receipt Miami—Dade County, State of Florida —THIS IS NOT A BILL —DO NOT PAY 5515573 BUSINESS NAMEA.CCATION RECEIPT NO. EXPIRES JC SUV LLAGA BRICKS & RENEWAL SEPTEMBER 30, 2014 PAVERS NC 5755815 5161 NW 79 AVE STE 13 Must be displayed at plays of business DORAL, FL 33166 Pursuant to County Code Chapter 6A — Art. 9 & 10 OWNER SEC. TYPE'OF BUSINESS JC SUVILLAGA BRICKS & PAVERS 196 SPECIALTY BUILDING PAYMENT Y TAXE couEc OR INC CONTRACTOR 56.25 01!282014 Worke0s} 1 05BS00197 0228-14-004481 This local Business Tax Receipt only confirms payment of the Local Business tax. The Receipt is not a license, permit, or a certification of the holder's qualifications, to do business. Holder must comply with any governmental or uougoveroniental regulatory laws and requirements Which apply to the business. The BEC13FF N0. above mnstbe displayed on all commercial vehicles -Mismi=Dade Code See ria 276. M® For more Information, visit www.mlamidado.goy taxnulleatar Municipal Contractor's Tax Receipt Miami—Dade County, State of Florida THIS IS NOT A BILL —DO NOT PAY CC NO 05BS00197 MC BUSINESS NAME/1-CATION RECEIPT NO. EXPIRES JCS PA NEW BUSINESS SEPTEMBER 30, 2014 5161 NW 79 AVE STE 13 7444064 DORAL, FL 33166 Must be displayed at place of business Pursuant to County Code Chapter 8A - Art. 9 & 10 OWNER TYPfi OF BUSINESS 1C SUNILLAGA BRICKS & PAVERS INC SPECIALTY BUILDING CONTRACTOR PAYMENT RECEIVED W! TAX cou.EcroR 175.00 01/28/2014 0228-14-004481 M For mors information, visit www.miamidgdg,.goy/4gaoolloctor ac©a� ^` CERTIFICATE OF LIABILITY �- INSURANCE DAT04121/DO/YY) PRODUCER Accurate 8300 West Flagler Suite 114 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 Miami, FL 33144 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE MAIC # Phone (305)226-8727 Fax (305)226-8767 INSURED JC Suvillaga Bricks & Pavers Inc 3408 NW 84 Street G312 Hialeah, FL 33018- (305) 362-6381 INSURER A: Ascendat Commercial Insurance INSURER B: INSURER C: INSURER D: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR ADD L NSRD TYPE OF INSURANCE POLICY NUMBER (POLICY EFFECTIVE DATE MWDONM POLICY EXPIRATION DATE(MMIDOMM LIMITS GENERAL LIABILITY EACH OCCURRENCE 1,000,000 Q COMMERCIAL GENERAL LIABILITY GL -43078-0 10/04/2013 10/04/2014 PREMISES ERENTED occu rents 100,000 MED EXP (Anyone person) 5,000 ❑❑ CLAIMS MADE W OCCUR A ❑ ❑ PERSONAL&ADV INJURY 1,000,000 GENERAL AGGREGATE 1,000,000 ❑ PRODUCTS - COMP/OP AGG 1,000,000 GEMLAGGREGATE LIMIT APPLIES PER: © POLICY ❑ PROJECT ❑ LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ❑ ANY AUTO (Ea accident) BODILY (Per persIon) ❑ ❑ ALL OWNED AUTOS El SCHEDULED AUTOS ❑ HIRED AUTOS ❑ NON OWNED AUTOS BODILY INJURY (Per accident) ❑ PROPERTY DAMAGE (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT ❑ ❑ ANY -AUTO OTHER THAN EAACC ❑ AUTO ONLY: AGG EXCESS / UMBRELLA LIABILITY EACH OCCURRENCE AGGREGATE ❑ OCCUR ❑ CLAIMS MADE ❑ ❑ DEDUCTIBLE ❑ RETENTION s WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR ( PARTNER/ EXECUTIVEYM OFFICER /MEMBER EXCLUDED? OWLT TU- ❑ ETH - E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE (Mandatory In NH) EL DISEASE -POLICY LIMIT N yes, describe under SPECIAL PROVISIONS below OTHER DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS Certificate holder is listed as additional name insured. License # 058SO0197 CERTIFICATE HOLDER CANCELLATION Miami Shores Village Building Department 10050 North East 2nd Avenue Miami Shores, FI 33138 Fax: 305-756-8972 ACORD 25 (2009101) QF SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO $O SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS S Rf.PIkESMTATIVES. AUTHORIZED REPRESENTATIVE Lucia Estrella ©1988-2009 ACORD CORPORATIQN. All rights reserved. The ACORD name and logo are registered marks of ACORD .`�= T1R1iaElME SUfM;"2B $URt "NOL 10 - Wa®tiFLQMVA33128 JOHN IESARRX -ASSOC., �;F: (304 20 -NO PAX: (3" 282°oW Lr"Ain SURVE' R'S' r�nver. K�YIN 4 WfEUNO 2 OF 2 BOUNDARY SURVEY NO OBJECTION scALE c"*-"• Florida Health Miami -Dade County ffF-, ED O.S.T.D.S. & Well Pro ram MAY 28 2014 Application No.: 14,115 E Date: p� LA'r OF' m Alibi tmogt S St=m oS l ff?d ! I f e . i �•;��,.,, .�i -:f :till`-�+, 4�. x�•a �r rrd:R�YJ��knF°ip�."� .r�.,�'°i3 cd X ,}1+thk �hV - r '%'l. � (y�i r4 � �"1� �A�` q,r-g.'' a �, � a it ''k N 1 . a ry r. ,.YW S' a - . p-i..-.-� .� r� (�ryf , .,R. �� �,; a°!• *( p��,,{.yx�,a i a t �, v � r � '9 ;� > y 1fZ .�fa.t9.£A'+'c '`l ^�' - F r� t -`,• "ewe-,� i �7 i s _�" '�i .t�a��.��,^� r s rtc y X s i. + ; �j�..� r r I - • ^e c y¢E;2 a ,,a� qtr �. v;� � . . �`P��T`�°„a. � �' ��a`'�,��,* ,s � 5 . , i t i7 PWY ' F iff FIP f �: ;3�f'.•I@f¢t�BiNltr'. z *.L::a+:• .r: �� "n: r- ir�yr rt. 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THE CATE GROUP, LLC a a�6 a� �a5ag„ f 490 Northeast 102nd Street lll8) 784-1874 FAami Shores, Flrida 83188 oGa Bo B TE4• (30X (808) 784-1974 ,�.P'., .. w.. .• .. 1�.p.: y 999 tq-� r I �1,PPP 0VED BY DA art 70flNG DEPT BLDG DEPT SUBJECT TO COMPLIANCE WITH ALL FEDERAL STATE AND CO! 1NTY RULES AND REGULATIONS i The Cate Residence $ 9 448 Naru..t om st— SEPTIC TANK & DRAINFIE", PLAN 8q w