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RC-14-1288 (2)Miami Shores Village Building Department 10II50 N.E,2nd Avenue, Miami Shores, Florida $313$ Tel: (305) 79S-2204 Fax: (305) 756-8972 INSPEcnON LINE PHONE NUMBER: (305) 7624949 BUILDING PERMIT APPLICATION MBUILDING 0 ELECTRIC ROOFING JUN 1 8 2014 FBC 20 10 Master Permit NOUL _ A �A Sub Permit No. ❑ REVISION: ❑ EXTENSION ❑RENEWAL; 0PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS 0 CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS josADDREss. 150 IVW 101 STREET City: Miarnl Shores County, Miami Dade Zia: 33150 Folio/parcaw. 11-3'� 01-023-0210 is the Building Historically Designated:: Yes No X Occupancy Type: Load: Construction Type: Flood Zone:i3FE: ':_TFFE: OWNER:Name (Fee Simple Titleholder): RICARDO GONZALEZ phone#786.715.0071 Address: 465 BRICKELL AVE #3503 City: MIAMI State: FLORIDA Zip: 33131: TenantOssee Name: Phone#:. - 4 Email: RGONZALEZa-BASINGEN.COM CONTRACTOR: Company Name, MG3 DEVELOPER GROUP. LLC . Phones: 954.929:5229 Address: 1915 HARRISON STREET City: HOLLYWOOD state: FLORIDA:, 3.3.020 .. .. Qualifier Name: GUSTAVO BOGOMOLNI Phones: 954.929.5229 State certification or Rogistratlon* CGC1508870 Certificate afCompetoncy# DESIGNER: Architect/Engineer. JOSE RU BEN J I M EN EZ Phone#- :305.582. 836 Address: 7950 NW 53 STREET, STE 337 City: MIAMI state: . FL ZIP:66 Value of Work for this Pernft $ 7,000.00 Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑New f RepairjReplace ❑ Demolition Description ofworic KITCHEN AND BATHROOM REMODELING 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 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 low 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 OWNERr NT The foregoing instrument was acknowledged befor me this day of 20 , by C1 -who is personally known to me or who has produced 2-4 ""-12Z- V I - CA -0s Identification a d who did take ath. NOTARY BLI Sign: Print: Seal:` LOU ES A. CHANG MY CO SSION # FF094767 : Jwe09, 2018 AAAAAAAAAAM APPROVED BY (Revised02/24/2014) The foregoing inst I —1 day of u.S�.Yo me or who has Identification J Print: Seal: yrPlans Examiner Structural Review acknowledged before me this . 20 by did take an A. Nho is personally known to FFOM707 1.2019 as Zoning Clerk Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-218886 Permit Number: RC -6-14-1288 Scheduled Inspection Date: September 03, 2014 Inspector: Rodriguez, Jorge Owner: GONZALEZ, RICARDO Job Address: 150 NW 101 Street Miami Shores, FL 33138 - Project: <NONE> Contractor: MG3 DEVELOPER GROUP LLC Permit Type: Residential Construction Inspection Type: Final Building Work Classification: Alteration Phone Number Parcel Number 1131010230210 Phone: (954)929-5229 isunamg Department comments KITCHEN AND 1 BATHROOM REMODELING Infractio Passed Comments INSPECTOR COMMENTS False September 02, 2014 For Inspections please call: (305)762-4949 Page 30 of 30 Inspector Comments Passed Failed Correction Needed ❑ Re -Inspection Fee No Additional Inspections can be scheduled until re -inspection fee is paid. September 02, 2014 For Inspections please call: (305)762-4949 Page 30 of 30 Miami Shores Village Building Dpartmlent 10050 N.1=,2nd Avenue Miami Shores, Florlde 33138 Tal: (305) 795.2204 Fax: (805) 755.8972 CONTRACTORS' REGISTRATION! ALL CONTRACTORS NM PROVIDE COPIES OF LICENCES AND INSURANCES EACH TIME A PERMIT -13 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 DARE COUNT' CERTIFICATE OFL COMPETENCY. A. COPY Of CERTIFICE OF COMPETENCY OF QUALIFIER B. COPY OF LOCAL BUSINESS TAX RECEIPT B. COPY OF STATE REGISTERED CONTRACTOR LICENSE OR MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT. C. COPY OF LIABILITY INSURACE* 0. COPY OF WORKERS COMPENSATION INSURANCE` YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE AS FOLLOW: CerifScate Holder: MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES, FL 33138 Certificate must spe lk the description of operations or contractor license number. •rrrrrrur�frae��o�r�errra.e.■�rrsre■u®•rrrrrurrar�r�rr�r«�raArr-���rrArwe■r�rrrnr�rrrprl BUSINESS NAME: MG3 DEVELOPER GROUP LLC BUSINESS ADDRESS:. 1915 HARRISON STRFET CITY.}�n11 Y1Nn(�D -STATE_FLORIDA ZIP CODE 33020 BUSINESS PHONE.9(,54 } 929.5229 FAX NUMBER9�j 929.5226 CELLPHONE QUALIFIER'S NAME: GUSTAVO BOGOMOLNI QUALIFIER'S LIC NUMBER: CGC1508870 STATE OF FLORIDA DEPARTMENT OF 13 SMESS AND PROFESSIONAL REGULATION' CONSTRUCTION INDUSTRY LICENSING BOARD (850) 407-:3.395. 1.940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 HOGGKOLNI GUSiTAV'O BERNARDO -3 D +VALJ6PRR GROUPTLLC HOLL;FL 33020 Congratulations! 1Nith this license you become one of the nearly one million Fbridlans Ikensed by the,_ rtment of Business and Professional Regulation 4, Our: professionals and businesses range from architects to yacht brokers, from boxers to barbeque restaurants, and they keep Florida's economy strong. Every day we work to improve the way we do business in order to serve you better. For information about our Services, please tog onto www.myfioridalleense.com T r¢ ran find more in'formatlon about our lvlslons and the regulations that Yl M'W' amu, subs�'ibe to department newsletters and Is more about the, Department s initiatives. Our mission at the Department is Ucense Eflicdentiy, Regulate Fairly. We constantly strive to serve yyoouu better so that you can serve your customers. Thank you for doing buslt5essirr Florlda, and congratulations on your new license! _ . L DETACH HERE F0: 49" BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT 11S.S. Andrews Ave., Rm. A-100, Ft. Lauderdale, Ft_ 33301-1895 — 954-01-4000 VALID OCTOBER 1, 2013 THROUGH SEPTEMBER 30, 2014 DBA: Recei la: g� WMCTM Business Marne- W3 pMLOgER a3ROt>P, LLC eusitt�s T pe: Owner Name wsmo somoLn Business Oponedm/24/mo Business Location: x:915 HARRISON STREET State/CountylC*Weg-CGC .S0s870 HOLLYWOOD Exemption Code: BW8lness P1101M.954-929-52,�9 Rooms Sys Employees momwo Professionals 7 Farvendipg ase W,nnha► of fi%whinua• - .V d,1.6 Z Tax Amount 1rmnsbrFes ] -- ' ,: Wenetty `.:P4 ltea - a~ogeaiQci Torsi Ps1t1 27.00 0.00 0.00 1 0.00' 0;110 V-00127.00 THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS TMS SECOi1dEt3 A TAX RECEIPT This tax is levied for the prNege of doing business within froward County and is non -regulatory to nature. You miler meet alt County And/or lkl Idpol#yr planning WHEN VALADATED and zoning mquiu ments. We Suslnesa Tex Receipt must be bansWed when Me business is sold, business narno has changell or you have moved the buskum location. This receipt does not indicate that the businees Is legal or that it is in compliance with State or local tam and regulations. 2013 -2014 Reosipt 006A-12-00000268 Paid 08/01/2013 27.00 110 S. Andrews Ave., Rm. A-100, Ft. Lauderdale, FL 33301-1895 — 954-831-4000 VALID OCTOBER 1, 2013 THROUGH SEPTEMBER 30, 2014 DBA: Receipt #-* x:80-234257 Business Mame: MG3 DEVELOPER 011O�, LLC Business fypq:QMU3ML cDx�rit CT.Iax Owner Name: ortsmo Bowmom BWSIVOS OPOnSCI-06/24/20.0 Business LoCetion:19.15 HIMISON STREET StateMou*1Cert1Reg:Ct3C1S08870 HOLLYWOOD Exemption Code: SW IROSS iPh,One: 954-929-5229 Reoms seats Employs" tiAac(clnss hrotesslouai:3 7 a Ac'oR�i� CERTIFICATE OF LIABILITY INSURANCE `•� DATE(MM/DDIYYYI) 06/17/2014 PRODUCER IeCC International eCommerce Consultants, Inc. PO Box_ 222978 Hollywood FL 33022 (954)806-9892 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. INSURERS AFFORDING COVERAGE NAIC# INSURED MG3 DEVELOPER GROUP LLC 1915 HARRISON STREET 2ND FLOOR HOLLYWOOD FL 33020 wsURERA: FIRST MERCURY INSURANCE COMPANY 10657 INSURER B: TORUS SPECIALTY INSURANCE CO 44776 . INSURER C. EVANSTON INSURANCE COMPANY 35378 INSURER D: SCOTTSDALE INSURANCE COMPANY 41297 INSURER E: *91,1A :1:I-TN:W THEPOLICIESOFINSURANCELISTEDBELOWHAVEBEENISSUEDTOTHEINSURED NAMEDABOVEFORTHEPOLICYPERIOD 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 INSURANCEAFFORDED BYTHE POLICIES DESCRIBED HEREIN IS SUBJECTTO ALL THE TERMS, EXCLUSIONSAND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR IrL 3F INSURANCE POLICY NUMBER POLICY EFFECTIVE TIN MOM LIMITS GENERAL LIABILITY EACH OCCURRENCE 7 $ 1,000,00.0. RENTED D 100 000.. A X X COMMERCIAL GENERAL LIABILITY IL -CGL -0000008497-03 04/01/2014 04/01/2015 CLAIMS MADE X❑ OCCUR- MED EXP onepersord 15,000. 000. PERSONAL a ADV INJURY t000,000. X $$,000. DEDUCTIBLE GENERAL AGGREGATE $ 2,000,000. GML AGG TE LIMIT APPLIES PER: P ODU Ts - COMP/ P A 2,000,000. X POLICY PRO• LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000: A X ANY AUTO IL -CGL -0600008497-03 04/01/2014 04/01/2015 (Ea acddent) BODILY INJURY $ ALL OWNED AUTOS SCHEDULED AUTOS (Plar Pn) BODILY INJURY $ X HIREDAUTOS X : NON-0WNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per acddent) GARAGE LABILITY AUTO ONLY - EA ACCIDENT OTHERTHAN EAACC ANYAULO AUTO ONLY: GG $ EXCESS I UMBRELLA LIABILITY EACH OCCURRENCE 10,000,000. B X X OCCUR 7 CLAIMS MADE 03344B110ALI 04/01/2014 04/01/2015 AGGREGATE 10 000 000. WIC Em to ers' Liab $ 10 000 000. DEDUCTIBLE $ RETENTION $ WORKERS COMPENSATION WC STATU X O : Em IO @Ts Liab C AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNER/EXECunvM 0334413110ALI 04101/2014 04/0112015 E.L EACH ACCIDENT See Above OFFICERIMEMBER EXCLUDED? (Mandatory in NH) : E.L. DISEASE - EA EMPLOYEd $ Excess: of E L DISEASE - POLICY LIMIT $1,000,000. I describe rider I OTHER D CONTRACTORS EQUIPMENT CPS1707711 11/21/2013 11/21/2014 POLICY LIMIT $1,000,000. DESCRIPTION OF OPERATIONS I LOCATIONS i VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS AS PER INSURED'S OPERATIONS AS GENERAL CONTRACTOR TH ROUG HOUT FLORIDA CG2037 (07104) & CGL1686 (01/06) ADDITIONAL INSURED -OWNERS LESSEES OR CONTRACTORS -COMPLETED OPERATIONS ADDITIONAL INSURED (PERSON{S) OR ORGANIZATION(S): AS REQUIRED BY WRITTEN CONTRACT -10 DAY NOTICE REGARDING CANCELLATION FORNON-PAYMENT OF PREMIUMS APPLIES rFRTmf,aTF 41n1 nFp - ramr-M 1 ATInfd - ACORD 25 (2009101) ©1988-2009 ACORD CORPORATION: All Tl9mS 1`880`1`90. The ACORD name and logo are registered marks of ACORD SHOULD ANYOF THEAFOVE DESCRIBEDPOLICIES BE CANCELLED BEFORE THE EXPIRATION Miami Shores Village Building Department DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS NIRITTEN 10050 NE 2nd Avenue NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE UEFA, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION_ OR LIABILTY.OF ANY [OND UPON THE INSURER, ITS AGENTS OR Miami Shores, FL 33138 REPRESENTATIVES. AUTHORIZED REPRESENTATIVE <DA> ACORD 25 (2009101) ©1988-2009 ACORD CORPORATION: All Tl9mS 1`880`1`90. The ACORD name and logo are registered marks of ACORD 25 IIJi12073L1►ki If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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). DISCLAIMER This Certificate of Insurance does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage affordedby the policies listed thereon. * * 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: 8/28/2013 EXPIRATION DATE: 8/28/2015 PERSON: BOGOMOLNI GUSTAVO B FEIN: 364529901 BUSINESS NAME AND ADDRESS: MG3 DEVELOPER GROUP LU 1915 HARRISON STREET HOLLYWOOD FL 33020 SCOPES OF BUSINESS OR TRADE: LICENSED GENERAL CONTRACTOR 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 withhin the scope of the business or trade fisted 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