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RC-14-1291 (2)BUILDING PERMIT APPLICATION BUILDING ❑ ELECTRIC Miami Shores Village fif —C 14— Building Department JUN IS oto 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 BY Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 FBC 20 V-� Master Permit No.c "l �� ❑ ROOFING ❑ REVISION ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF Sub Permit No. ❑ EXTENSION ❑ RENEWAL ❑ CANCELLATION ❑ SHOP p . CONTRACTOR DRAWINGS JOB ADDRESS: -1700 , y l' /0 5 � .7_• 'fo q City: Miami Shores County: Miami Dade Zip: 3-3 / :�8 Folio/Parcel#:I 1 — 2 2: ® -950 (D& 1-0 Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: (� 6 % `U r,I -MeX - f -t OWNER: Name (Fee Simple Titleholder): �� FA `-� H t T� Phone#: ltd2,�K-3 Z9&q Address: I -� 0 ® N C In S177 , 4 7o Ll City: HOjCOS State: F:�t ZIp:-?3/ Tenant/Lessee Name: �y / - Phone#: At/ Email: M o N I Q J 9 H J H r A `r T, /V i✓ 7— CONTRACTOR: Company Name: ; � S �� � /41 C Phone#: � 80027 Address: -7&0 dU W S �� City: %l_ l Aqj I State: FZip: Qualifier Name: X E N/ A S ®,- 7® Phone#: i State Certification or Registration , `� � Ge -`1 Certificate of Competency #: *'"" DESIGNER: Architect/Engineer: SAW ,F1l —04 TE T S Phone#: 3`05 / el ' /0 Address: e o 8o X 5 3 b � -7 f City; M to S *4EI State: FL Zip -33 I -ze Value of Work for this Pecmft $ 1 Square/linear Footage of Work: / 7 S f Type of Work: ❑ Addition � Alteration El New LVJ Repair/Replace . L`�I Demolition Description of Work: k E EN�-A-466 g- I Tc., tf jg AJ e -u 7" 1)r)® R,/oP e Ai / N 6 - Specify color of color thru tile: Submittal Fee $ Scanning Fee $ Permit Fee $ CCF Radon Fee $ Technology Fee $ Training/Education Fee $ Structural Reviews $ (Revised02/24/2014) DBPR $ CO/CC $ Notary Double Fee $ Bond $ TOTAL FEE NOW DUE - �b li A I 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 $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certifie opy of the recorded notice of commencement must be osted at the job site for the fir inspection which occurs se 7) da after Oe building permit is issued. In the absence o uch posted notice, the inspectiorw,ilbe approved and a rep ctio fee will a charged. ! I A 1-1" t� Signatur ER or AGENT The foregoing instrument was acknowledged before me this day of - V NfC JJ . 20 2-01q , by �J 6 g SJ j71'Who is personally known to me or who has produced -Ft DR.IV lit G as r identification and who NOTARY PUBLIC: V4L"DIANA IIMIA MY COMMISS*N # EE02M EXPIRES September 08; 2014 The foregoing instrument was acknowledged before me this � u day of � 20), by ho is personally known to me or who has produced DL. as identification and who did take an oath. NOTARY PUBLIC ,` ' *y DIANA NEM '= MY COMMISSION # EEOC EXPIRES September OQ:2M4 Print: mu.1 Ix" Myltl.t.+a_. !Print: n2QW A(A— u Seal: Seal: *��****�x�x�x* *a**a��x**�xx�w�r �� m�� �***�**�w�**+r��x���*�xffi*��xe���*����x�a������x�x�*�x+x��*�**a��r**��+x�a�**��xw���+a� F - APPROVED BY O � t� Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) # 6.3-22 Q06'_ STATE OF FLOMPD DT�ARBRlT '[JS'TRYRiS1�i�BOGULATION WON L12083003271 LICENSE NB& 8' 3 a 09.9 GOC.1s ` � .i2 /�-/7 •� .aec }1ow�s cmrr 1 it tion Oatq:Aii42r 2dl SORTO. 1A VAS �tBNOVAT�.ON$ INC ;µ , 750 NW 25TH AVE '� MSI.: FL 3:3125. AI*C SCOT' :_ X]INON QOTIATOR STCRo DISPLAY AS REQUIRED BY LAW JEFF ATWATER CHIEF FINANCIAL OFFICER * * 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 low. EFFECTIVE DATE 7/26/2013 PERSON: SORTO FEIN: 205910067 BUSINESS NAME AND ADDRESS: VAS RENOVATIONS INC 750 NW 25 AVENUE MIAMI EXPIRATION DATE: 7/26/2015 KENIA FL 33125 SCOPES OF BUSINESS OR TRADE: LICENSED GENERAL ROOFING - ALL KINDS CONTRACTOR AND DRIVER Pursuant to Chapter 440.05(14), M. an officer of a corporation who elects exemption from this meter by filing a certificate of a ton under We section may not recover benerds 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 fisted on the notice of election to be exempt. Pursuant to Chapter 440.06(13). F.S., Notices of election to be exempt and certificates of election to be exempt shall be su*d to revocation if, at any time after the filing of the note or the issuance of the ceditete, the person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate. The department shah revoke a'ce0c ate at any time for fag" 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? (&W)413-1609 .Jun. 18. 2014 . 9:49AM THE FIRST INS. GROUP CORP No. 6478—P. 1--- -- '_DA181114Y)t"q CERTIFICATE OF LIABILITY INSURANCE O6/ 1 PRODUCER First Insurance Group ! THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION 10967 SW 40 St ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Miami, FL 33165 HOLDER. THIS CERTIFICATE DOES -NOT AMEND; EXTEND OR ALTEi�lHE COVERAGE AFFORDF-D BY THI_OLIC)ES B9LOW;•_„ • ,•-, Phone (305)221-7876 Fax (305)554.7090 - INSURERS AFFORDING COVERAGE MAIC # INSURED VAS RENOVATIONS INC lNgURERA, REPUBLIC -VANGUARD INSURANCE — — 750 NW 25 Ave-INSUREf-g-_ _._-_-_.._._... ..............._.....__-i Miami, FL 33125- INSURER c: 306 lNSURERO: _._..---------- _ - -.... _...._ _. INSURER E COVERAGES __ INSURER R THE POLICIES OF INSURANCE LISTED HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. I OTWITHSTAR6_ ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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 APP'L --- TYPE OF INSURANCE POLICY NUMBER �PDUCY EFFECTIVE POUZrY ID(pIRAT10N I -- _ aalE(MMlOOIYY� DA LIMITS 1 GENERAL LIABILITY EACH OCCURRENCE I 1000 aao © COMMERCIAL GENERAL LIABILITYDAiAAAA�C EET_} RENTj?17 PGLS006263-14 02/10/14 02/10/15 PREMISES(Es 22SE noe) , 1.00,00_0 A ❑ 131:1 CLAIMSMADE El OCCUR MED EXP (Any One parson) --- 51000 ❑ PERSONAL &ADV INJURY 1,000,000 ❑ —,_ _ , _ GENERAL AGGREGATE 11000.000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS • COMP/OP AGG - I 1000100 •-.Cl POLICY Cl PROJECT ❑ LOC AUTOMOBILE LIABILITY - - -- -- ❑ ANY AUTO COMBINED SINGLE LIMIT _ -~ ALL OWNED AUTOS ......... _.___. ❑ ❑ SCHEDULEDAUTOS BODILY INJURY _I ❑ HIRED AUTOS (Per person) ---, ❑ NON OWNED AUTOS BODILY INJURY Cl (Per accident) --� PROPERTY DAMAGE _..._ _ — GARAGE LIABILITY - _ -- AUTO ONLY - EA ACCIDENT ❑ ❑ ANYAUTO - ❑ OTHER THAN �4.�.» .............».... . ---,• _� AUTO.ONLY: G9 G _ EXCIISWUM13RELLA LIABILITY -- EACH OCCURRENCE ❑ OCCUR _ ❑ ❑ CLAIMS MADE AGGREGATE ❑ DEDUCTIBLE ❑ RETENTION $ -----• .._ _. _. _- ..-._ ._.__ WORKERS COMPENSAnON Aivn • .. _- _..__......_—__._.._...._._ FMPLOYERW LIABILITY ❑ WC SVTATU� - Q • !6R ..... ..••.__ •_ ---�- ANY PROPRIETOR / PARTNER / EXECUTIVE OFFICER/ MEMBERE L. EACH ACCIDENT l6R EXCLUDED? —} If yes, describe under E.L. DISEASE - EA EMPLOYEE I _ SPECIAL PROMS!%! below EL DISEASE • POLICY LIMIT OTHER _ DESCRIPTION OF OPERATIONS / LOCATIONS t VEHICLES / �L �ED Y ENDORSEMENT I SPECIAL PROVISIONS GENERAL CONTRACTOR LIABILITY. r 3318 S8 22ilBIS CERTIFICATE HOLDER - CANCELLATION 25 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO WAIL CITY OF MIAMI SHORES BUILDING DEPARTMEN 30 DAYS WRITTEN NOTICE TO THE CERT ICATE HOLDER NAMED TO 10050 NE 2 AVE THE LBPT, BUT FAILURE TO DO SO SHALL 1 POR O NO OBLIGATION OR LIABILITY MIAMI SHORES VILLAGE FL 33138 OF ANY KIND UPON THE INSURER, ITS REPRESENTATIVES. AUTHORIZED REPRESENTATIVE _ RALPH N, RODRIGUEZ 101/08) QF _ __.... • _.. �RORPORATION»1988 Miami shores V Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Notice to Owner — Workers' Compensation Insurance Exemption Florida Law requires Workers' Compensation insurance coverage under Chapter 440 of the Florida Statutes. Fla. Stat. § 440.05 allows corporate officers in the construction industry to exempt themselves from this requirement for any construction project prior to obtaining a building permit. Pursuant to the Florida Division of Workers' Compensation Employer Facts Brochure: An employer in the construction industry who employs one or more part-time or full-time employees, including the owner, must obtain workers' compensation coverage. Corporate officers or members of a limited liability company (LLC) in the construction industry may elect to be exempt if: 1. The officer owns at least 10 percent of the stock of the corporation, or in the case of an LLC, a statement attesting to the minimum 10 percent ownership; 2. The officer is listed as an officer of the corporation in the records of the Florida Department of State, Division of Corporations; and 3. The corporation is registered and listed as active with the Florida Department of State, Division of Corporations. No more than three corporate officers per corporation or limited liability company members are allowed to be exempt. Construction exemptions are valid for a period of two years or until a voluntary revocation is filed or the exemption is revoked by the Division. Your contractor is requesting a permit under this workers' compensation exemption. In these circumstances, Miami Shores Village does not require verification of workers' compensation insurance coverage from the contractor's company. Therefore, you may be personally liable for the worker compensation injuries of anyperson allowed to work under this permit. Please check with your insurance carrier since most property insurance policies DO NOT cover this type of liability. BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS State of Florida ) County of Miami -Dade) I Sworn tobscrib d before me this day of , 20V+ By..... (SEAL) _�```~'� �� • -� �' Type of Identification produced`' //81111161 ,M / Contractor Print Name:- -' ' I Signa State of Florida ) County of Miami -Dade) Sworn to and subscribed before me 's day of ' , 20 DIANA B MY commiSSI • „EXPIRESSept (SEAL) , Type of Identific ' 4 'Red EXPIRES September 06; 2014 Sol U. y � �pp >�t11rt/14A�i11ld APARTMENTS WORK REQUEST APPLICATION Owner's Name �/,2 d % Unit �T I hereby request approval from modification or alteration to my contractor. Electrical work V/ Carpet installation the Board of Directors for the following unit that will be performed by a licensed _ Plumbing work "Windows Tile installation Other wor Description of the work Before you decide to upgrade your apartment ( her than paint or carpet) you must obtain permission from the Board of Directors and/or Miami Shores Village. A copy \of the pians, specifications and permits, and a description of the licensed work to be performed must be submitted for consideration and approval by the Miami Shores Village Building Department (305-795-2204). It is the owner's responsibility to ensure that the contractor removes all excess construction material or building debris. It cannot be placed in the dumpsters. "Window frames must be gray in color to look like aluminum. Windows must be Two (2) panels over Two (2) panels. Glass must be clear color. I, as the unit owner acknowledge responsibility for any damage to the building or personal injuries that may occur during the project. The Shores Condominium Inc. its officers and employees are in no way responsible for damage or theft to my apartment or my belongings. (A $200.00 deposit is required and will be refunded if no damage to the property is reported.) I fully unierstan,4nd ree to the statements made above. Unit owner'snat re Date 1 . ........... P, -.1 1 . - I t - Approved by: Date: if& Y DURABLE POWER OF ATTORNEY FOR FINANCIAL MANAGEMENT WARNING TO PERSON EXECUTING THIS DOCUMENT - THE POWERS YOU GRANT BELOW CONTINUE TO BE EFFECTIVE SHOULD YOU BECOME DISABLED OR INCOMPETENT CAUTION: This is an important legal document and upon proper execution will create a Durable Power of Attorney. This gives the person whom you designate as your agent broad powers to handle your property during your lifetime, which may include powers to mortgage, sell, or otherwise dispose of any real or personal property without advance notice to you or approval by you. These powers will continue to exist even if you become disabled or incompetent. You do have the right to terminate or revoke the Power of Attorney and any or all powers granted within at any time up to the point of your incapacity. This document does not authorize anyone to make medical or other health care decisions. You may execute a health care proxy (also known as a health care or medical power of attorney) to do this. If there is anything about this document that you do not understand, you should ask a lawyer to explain it to you. THIS DURABLE POWER OF ATTORNEY for financial management is given by me, Orfa Smith (the "Principal'), presently of. 151 SW 134 Way Unit 111N, Pembroke Pines, in the State of Florida, on this 28th day of May, 2014. Nature of Power 1. This durable Power of Attorney is not terminated by subsequent incapacity of the Principal except as provided in chapter 709, Florida Statutes. Previous Power of Attorney 2. I REVOKE any previous durable power of attorney granted by me. Agents 3. I APPOINT Monique Smith, of 1235 NE 100 Street, Miami shores, Florida, and Louis de Thomas, of 1235 NE 100 street, Miami shores, Florida, to act jointly and independently as my Agents. Upon the death, refusal or inability of Monique Smith , or Louis de Thomas to act or continue to act as my Agent, the remaining Agent will continue to act as my Agent in sole capacity. My "Agent" 4. I will refer to my Agents as my "Agent". Governing Law 5. This document will be governed by the laws of the State of Florida. Further, my Agent is directed to act in accordance with the laws of the State of Florida at any time he or she may be acting on my behalf. Liability of Agent 6. My Agent will not be liable to me, my estate, my heirs, successors or assigns for any action taken or not taken under this document, except for willful misconduct or gross negligence. A successor Agent will not be liable for acts of a prior Agent. Effective Date 7. Power of Attorney will start immediately and will continue notwithstanding my mental incapacity or mental infirmity which may occur after my execution of this Power of Attorney. Powers of Agent 8. My Agent will have the following power(s): Initials a. X t� Real Estate Transactions To deal with any interest I may have in real property and sign all documents on my behalf concerning my interest, including, but not limited to, real property I may subsequently acquire or receive. These powers include, but are not limited to, the ability to: i. Purchase, sell, exchange, accept as gift, place as security on loans, convey with or without covenants, rent, collect rent, sue for and receive rents, eject and remove tenants or other persons, to pay or contest taxes or assessments, control any legal claim in favor of or against me, partition or consent to partitioning, mortgage, charge, lease, surrender, manage or otherwise deal with real estate and any interest therein; and ii. Execute and deliver deeds, transfers, mortgages, charges, leases, assignments, surrenders, releases and other instruments required for any such purpose. b. X—q— Maintain Property and Make Investments To retain any assets owned by me at the date this Durable Power of Attorney becomes effective, and the power to reinvest those assets in similar investments. In addition, my Agent may invest my assets in any new investments, of his or her choosing, regardless of whether or not they are authorized by any applicable legislation. C. X� Banking Transactions To do any act that I can do through an agent with a bank or other financial institution. This power includes, but is not limited to, the power to: i. Open, maintain or close bank accounts (including, but not limited to, checking accounts, savings accounts, and certificates of deposit), brokerage accounts, retirement plan accounts, and other similar accounts with financial institutions; ii. Conduct any business with any banking or financial institution with respect to any of my accounts, including, but not limited to, making deposits and withdrawals, negotiating or endorsing any checks or other instruments with respect to any such accounts, obtaining bank statements, passbooks, drafts, money orders, warrants, and certificates or vouchers payable to me by any person, firm, corporation or political entity; iii. Borrow money from any banking or financial institution if deemed necessary by my Agent, and to manage all aspects of the loan process, including the placement of security and the negotiation of terms; iv. Perform any act necessary to deposit, negotiate, sell or transfer any note, security, or draft of the United States of America, including U.S. Treasury Securities; v Have access to any safe deposit box that I might own, including its contents; and vi. Create and deliver any financial statements necessary to or from any bank or financial institution. d. X t A Business Operating Transactions To take any action my Agent deems necessary with any business that I may own or have an interest in by doing any act which can be done through an agent. This power includes, but is not limited to, the power to execute, seal and deliver any instrument; participate in any legal business of any kind; execute partnership agreements and amendments; to incorporate, reorganize, consolidate, merge, sell, or dissolve any business; to elect or employ officers, directors and agents; and to exercise voting rights with respect to any stock I may own, either in person or by proxy. e. X— AL Insurance Transactions To do any act that I can do through an agent with any insurance policy. This power includes, but is not limited to, the power to pay premiums, start, modify or terminate policies, manage all cash payouts, borrow from insurers and third parties using insurance policies as collateral, and to change the beneficiaries on any insurance policies on my life. Unless my Agent was already a beneficiary of any policy before the signing of this document, my Agent cannot name himself or herself as a beneficiary of such policy. f. X 1� Claims and Litigation Matters To institute, maintain, defend, compromise, arbitrate or otherwise dispose of, any and all actions, suits, attachments or other legal proceedings for or against me. This power includes, but is not limited to, the power to: appear on my behalf or retain an attorney and any other professional personnel necessary to defend or assert any claim before any court, board, or tribunal, and the power to settle any claim against me in whichever forum or manner my Agent deems prudent, and to receive or pay any resulting settlement. g. X 6A Tax Matters To act for me in all matters that affect my local, state and federal taxes and to prepare, sign, and file documents with any governmental body or agency, including, but not limited to, authority to: i. Prepare, sign and file income and other tax returns with federal, state, local and other governmental bodies, and to receive any refund checks; and ii. Obtain information or documents from any government or its agencies, and represent me in all tax matters, including the authority to negotiate, compromise, or settle any matter with such government or agency. h. X 4 Government Benefits, To act on my behalf in all matters that affect my right to allowances, compensation and reimbursements properly payable to me by the Government of the United States or any agency or department thereof. This power includes, but is not limited to, the power to prepare, file, claim, defend or settle any claim on my behalf and to receive and manage, as my Agent sees fit, any proceeds of any claim. i. X Retirement Benefit Transactions To act for me and represent my interests in all matters affecting any retirement savings or pension plans I may have. This power includes, but is not limited to, the power to continue contributions, change contribution amounts, change investment strategies and options, move assets to other plans, receive and manage payouts, and add or change existing beneficiaries. My Agent cannot add himself or herself as a beneficiary unless he or she is already a designated beneficiary as of the signing of this document. j. X tA Family Care To make whatever expenditures are required for the maintenance, education, benefit, medical care and general advancement of me, my spouse and dependent children, and other persons that I have chosen or which I am legally required to support, any of which may include my Agent. This power includes, but is not limited to, the power to pay for housing, clothing, food, travel and other living costs. k. X0 Chattel and Goods Transactions To purchase, sell or otherwise deal with any type of personal property I may currently or in the future have an interest in. This includes, but is not limited to, the power to purchase, sell, exchange, accept as gift, place as security on loans, rent, lease, to pay or contest taxes or assessments, mortgage or pledge. 1. X �& Estate Transactions To do any act that I can do through an agent with regard to all matters that affect any trust, probate estate, conservatorship, or other fiord from which I may receive payment as a beneficiary. This power includes the power to disclaim any interest which might otherwise be transferred or distributed to me from any other person, estate, trust, or other entity, as may be appropriate. However, my Agent cannot disclaim assets to which I would be entitled, if the result is that the disclaimed assets pass directly or indirectly to my Agent or my Agent's estate. M. X a Living Trust Transactions To transfer any of my assets to the trustee of any revocable trust created by me, if such trust is in existence at the time of such transfer. This property can include real property, stocks, bonds, accounts, insurance policies or other property. n. X Gift Transactions To make gifts to my spouse, children, grandchildren, great grandchildren, and other family members on special occasions, including birthdays and seasonal holidays, including cash gifts, and to such other persons with whom I have an established pattern of giving (or if it is appropriate to make such gifts for estate planning and/or tax purposes), in such amounts as my Agent may decide in his or her absolute discretion, having regard to all of the circumstances, including the gifts I made while I was capable of managing my own estate, the size of my estate and my income requirements. o. X 0 Charity Transactions To continue to make gifts to charitable organizations with whom I have an established pattern of giving (or if it is appropriate to make such gifts for estate planning and/or tax purposes), in such amounts as my Agent may decide in his or her absolute discretion, having regard to all of the circumstances, including the gifts I made while I was capable of managing my own estate, the size of my estate and my income requirements. P. X ---O Employ Required Professionals To appoint and employ any agents, servants, companions, or other persons, including nurses and other health care professionals for my care and the care of my spouse and dependent children, and accountants, attorneys, clerks, workers and others for the management, preservation and protection of my property and estate, at such compensation and for such length of time as my Agent considers advisable. Agent Compensation 9. My Agent will receive no compensation except for the reimbursement of all out of pocket expenses associated with the carrying out of my wishes. Co -owning of Assets and Mixing of Funds 10. My Agent may continue to co-own assets and have any funds owned by him or her mixed with my funds to the same extent that the co -owning of assets and mixing of funds existed before operation of this Power of Attorney. Personal Gain from Managing My Affairs 11. My Agent is not allowed to personally gain from any transaction he or she may complete on my behalf. Delegation of Authority 12. My Agent may not delegate any authority granted under this document. Nomination of Guardian or Conservator 13. In the event that a court decides that it is necessary to appoint a guardian or conservator for me, I hereby nominate my Agent to be considered by the court for appointment to serve as my guardian or conservator, or in any similar representative capacity. Agent Restrictions 14. This Power of Attorney is not subject to any conditions or restrictions other than those noted above. Notice to Third Parties 15. Any third party who receives a valid copy of this Power of Attorney can rely on and act under it. A third party who relies on the reasonable representations of my Agent as to a matter relating to a power granted by this Power of Attorney will not incur any liability to the Principal or to the Principal's heirs, assigns, or estate as a result of permitting the Agent to exercise the authority granted by this Power of Attorney up to the point of revocation of this Power of Attorney. Revocation of this Power of Attorney will not be effective as to a third party until the third party receives notice and has actual knowledge of the revocation. Severability 16. If any part of any provision of this document is ruled invalid or unenforceable under applicable law, such part will be ineffective to the extent of such invalidity only, without in any way affecting the remaining parts of such provisions or the remaining provisions of this document. Acknowledgment 17. I, Orfa Smith, being the Principal named in this Durable Power of Attorney hereby acknowledge: a. I have read and understand the nature and effect of this Durable Power of Attorney; b. I recognize that this document gives my Agent broad powers over my assets, and that these powers will continue past the point of my incapacity; C. I am of legal age in the State of Florida to grant a Durable Power of Attorney; and d. I am voluntarily giving this Durable Power of Attorney and recognize that the powers given in this document will become effective as of the date of my incapacity or as specified within. IN WITNESS WHEREOF I hereunto set my hand and seal at the City of Miami in the State of Florida, this 28th day of May, 2014. SIGNED, SEALED, AND DELIVERED in the presence of: Address: Witness: (Sign) r Orfa Smith Acipa NOTARY ACKNOWLEDGMENT STATE OF FLORIDA COUNTY OF2?Z4a,f U The foregoing instrument was acknowledged before me this 28 day -of May, 2014, by Orfa Smith, who is personally known to me or who has produced t8x&aftseas identification. (print name) BARBARA B. GIMMEZ MY COMMISSION # EE 152090 t EXPIRES: January 21, 2016 °4-4�a1`O Boned Ttn BWW N*y so= ACCEPTANCE OF APPOINTMENT STATE OF: FLORIDA COUNTY OF: I-' (A" ►- OA b Before me, the undersigned authority, personally appeared Monique Smith ("Affiant"), who swore or affirmed that: 1. Affiant is the agent named in the Durable Power of Attorney executed by Orfa Smith ("Principal') on this 28th day of May, 2014. 2. This Durable Power of Attorney is currently exercisable by Affiant. The Principal is domiciled in Pembroke Pines, Florida. 3. To the best of the Affiants knowledge after diligent search and inquiry: a. The Principal is not deceased; and b. There has been no revocation, partial or complete termination by adjudication of incapacity or by the occurrence of an event referenced in the durable power of attorney, or suspension by initiation of proceedings to determine incapacity or to appoint a guardian. 4. Affiant agrees not to exercise any powers granted by the Durable Power of Attorney if Affiant attains knowledge that it has been revoked, partially or completely terminated, suspended, or is no longer valid because of the death or adjudication of incapacity of the Principal. Dated: �" 1 Name of Affian Flo ' e Smith Signature of A t:r Address: S A16- /00 S7- 41A lot- -311 3 e" Sworn to (or affirmed) and subscribed before me this 014Y day ofCZ0- by Monique Smith. (Affiant) o,�pRY P�BIi BARBARA B. GMENEZ (Signature o otary Pub is -State of Florida) MY COMMISSION 6 EE 152090 * EXPIRES: January 21, 2016 �lerFOP �0¢`°4 801WW TM Binet NO" Serous Print, Type, or Stamp Commissioned Name of Notary Public Personally Known OR Produced Identification ,f, ) (Type of Identification) Of 41 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-216492 Permit Number: RC -6-14-1291 Scheduled Inspection Date: August 06, 2014 Permit Type: Residential Construction Inspector: Rodriguez, Jorge Owner: SMITH, ORFA Job Address: 1700 NE 105 Street 404 Miami Shores, FL Project: <NONE> Contractor: VAS RENOVATIONS INC Department comments Inspection Type: Final Work Classification: Alteration Phone Number (786)253-2869 Parcel Number 1122300500610 Phone: (786)306-8027 REPLACE KITCHEN CABINETS AND BATHROOM ""'---- CABINETS AND FIXTURES ENLARGE KITCHEN ENTRY INSPECTOR COMMENTS False DOOR Inspector Comments Passed CREATED AS REINSPECTION FOR INSP-216438. Shower enclosure glass missing stamp Failed Correction ❑ Needed Re -Inspection ❑ Fee No Additional Inspections can be scheduled until re -inspection fee is paid. August 05, 2014 For Inspections please call: (305)762-4949 Page 20 of 37 JUN 8 2014 Environmental Services, LLC June 2, 2014 EE&G Project No. 2014-2423 Ms. Monique Smith 1235 NE 100th Street Miami, FL 33138 Subject: Asbestos Pre -Renovation Survey The Shores Condominium: Smith Residence 1700 NE 105th Street #404 Miami, Florida Dear Ms. Smith, 5751 Miami Lakes Drive East Miami Lakes, Florida 33014 Tel (305) 374-8300 Fax (305) 374-9004 www.eeandg.com EE&G Environmental Services, LLC (EE&G) conducted an asbestos renovation survey at 1700 NE 105 St #404 located in Miami Shores, Florida. The purpose of this asbestos survey was to identify the presence, extent, and condition of asbestos -containing materials (ACM) in the surveyed areas of the unit only. The area surveyed has included the interior as instructed by the owner. Observed suspect materials were either sampled to determine asbestos content or assumed to contain asbestos. SUMMARY EE&G collected a total of six samples of the plaster system. None of the materials sampled were found to contain asbestos. See Appendix A for Laboratory Results. SURVEY METHODS The accessible interior areas were inspected for suspect ACM, unless otherwise noted. Each observed suspect material was assigned a homogenous area number, described, and measured. Each observed suspect material was either sampled or assumed to be asbestos - containing. Samples of suspect ACM were collected using procedures established by the United States (US) Environmental Protection Agency (EPA) Code of Federal Regulations (CFR) Title 40 Part 763 Subpart E, Asbestos -Containing Materials in Schools. Samples were sent to EMSL in Pompano Beach, Florida for analysis. Upon arrival at the laboratory, the samples were logged -in and stored for analysis. Analyses were performed using the polarized light microscopy (PLM) method of asbestos detection using guidelines and procedures established in the Method for the Determination of Asbestos in Bulk Building Materials (EPA -600/R-93-116 July, 1993). LIMITATIONS OF SURVEY This asbestos inspection report has been prepared by EE&G in a manner consistent with industry standards exercised by members of the profession practicing under similar conditions. No other warranty, expressed or implied is made. The intent of this survey report is to assist the owner or client in locating ACM. Under no circumstances is this survey to be utilized as a proposal or a project specification document without the expressed written consent of EE&G. Miami Melbourne Orlando Tampa Ms. Monique Smith June 2, 2014 Page 2 The survey was conducted to identify suspect ACM in accessible interior areas of the above noted building space only. Some ACM may not have been discovered due to inaccessibility or missing/incomplete plans. Any suspect materials discovered subsequent to the issue of this survey report should be sampled and analyzed to determine asbestos content and to initiate appropriate responses. Analyses were carried out by PLM. While the most commonly accepted analytical method for detecting asbestos in bulk materials, PLM is known to have limited resolution and may not detect extremely small asbestos fibers. Certain materials, notably vinyl floor tiles, may contain extremely fine asbestos fibers that are beyond the resolution of PLM. EE&G's interpretations and recommendations are based upon the results of sample collection and analyses in compliance with environmental regulations, quality control and assurance standards, and the scope of work as indicated in EE&G's proposal. The results, conclusions, and recommendations contained in this report pertain to conditions observed at the time of the survey. Other conditions elsewhere in the subject building(s) may differ from those in the inspected/surveyed locations and, such conditions are unknown, may change over time, and have not been considered. This report was prepared solely for the use of EE&G's client, and is not intended for use by third party beneficiaries. The client shall indemnify and hold EE&G harmless against any liability for any loss arising out of or relating to reliance by any third party on any work performed thereunder, or the contents of this report. EE&G will not be held responsible for the interpretation or use by others of data developed pursuant to the compilation of this report, or for use of segregated portions of this report. SURVEY AREA DESCRIPTION AND OBSERVATIONS The structure was observed to be constructed of concrete block and steel. Interior walls were finished with drywall. Ceilings were finished with drop in ceiling tiles. Floors were finished with 12°x12" vinyl floor tile, or ceramic tile. The HVAC duct was fiberglass flex -duct. Plumbing components were located within walls; no thermal insulation was observed. RESULTS The results of the PLM analyses and assessment of suspect ACM are as follows: Asbestos-containina materials Asbestos was not identified in any of the materials sampled: Nonasbestos-containing materials Asbestos was not detected in the following material: lk Plaster wall system. The original laboratory report is included as Appendix A. SMITH RESIDENCE - 1700 NE 105 ST SURVEY LETTER Ms. Monique Smith June 2, 2014 Page 3 CONCLUSIONS AND RECOMMENDATIONS Asbestos was not detected in any of the plaster samples collected from the subject unit. No further asbestos-related action is required at this time. See Appendices for laboratory results and photographs. If other speck areas at this location are to be impacted during planned renovations or renovation, an asbestos survey of these areas will be required. Suspect materials discovered after this inspection should be sampled and analyzed to determine asbestos content and to initiate appropriate responses. Notification to the Miami -Dade Department of Regulatory and Economic Resources (DRER) of intent to renovate is not necessary; however, the general contractor should have a copy of this survey at the site during the entire project as proof of compliance with 40 CFR 61 (NESHAP). EE&G appreciates the opportunity to provide environmental consulting services. If you have any questions or require further clarifications, please do not hesitate to contact us at (305) 374-8300. Sincerely, Richard Grupenh ff Senior Project Professional, EE&G Attachments: Appendix A: Laboratory Report Appendix B: Figures Appendix C: Photographs Appendix D: Certificates SMITH RESIDENCE -1700 NE 105 ST SURVEY LETTER Reviewed by Daniel J. Cottref Ph.D., P.G. Senior Technical Advisor, EE$G Asbestos Consultant #DD0000010 Ms. Monique Smith June 2, 2014 Appendices APPENDIX A PLM LABORATORY RESULTS SMITH RESIDENCE - 1700 NE 105 ST SURVEY LETTER EMSL Analytical, Inc. 2700 West Cypress Creek Road, Suite &111, Fort Lauderdale, FL 33309 Phone/Fax (954)786-9331/(954)941-4145 htto://www.EMSL.com pomoanobeachlab(demsl.com Attn: Rich GrupenhofF EE$G 5751 Miami Lakes Drive East Miami Lakes, FL 33014 #404 Phone: (305) 374-8300 Fax % Non -Fibrous % Tvoe Received: 05/30/14 3:20 PM Analysis Date: 6/2/2014 Collected: 5/30/2014 EMSL Order. 561401602 CUstomerlD: EEG50 CustomerPO: ProjectlD: Test Report: Asbestos Analysis of Bulk Materials via EPA 600/11-93/116 Method using Polarized Light Microscopy Non -Asbestos Asbestos Sample Description Appearance % Fibrous % Non -Fibrous % Tvoe 053014SN-1-Skim Plaster Wall White 2% Cellulose 98% Non-fibrous (other) None Detected Coat System Non -Fibrous White 100% Non-fibrous (other) None Detected 561401602.0001 Plaster Wall Gray 100% Non-fibrous (other) None Detected Coat System Homogeneous 053014SN-1-Base Plaster Wail Gray 100% Not -fibrous (other) None Detected Coat System Non -Fibrous 100% Non-fibrous (other) None Detected 561401602-0001A Homogeneous 053014SN-2-Sldm Plaster Wall White 100% Non-fibrous (other) None Detected Coat System Non -Fibrous 561401602-0002 053014SN-4-Sldm Homogeneous White 100% Non-fibrous (other) None Detected 053014SN-2-Base Plaster Wall Gray 100% Non-fibrous (other) None Detected Coat System Non -Fibrous 561401602-0W2A Homogeneous 053014SN-3-Sldm Plaster Wall White 100% Non-fibrous (other) None Detected Coat system Non -Fibrous 561401602-0003 Homogeneous 053014SN-3-Base Plaster Wall Gray 100% Non-fibrous (other) None Detected Coat System Non -Fibrous 561401602-0003A Homogeneous 053014SN-4-Sldm Plaster Wail White 100% Non-fibrous (other) None Detected Coat System Non -Fibrous 561401602.0004 Homogeneous Analyst(s) Anne Paul (2) Catalina Lachowski (10) N4WP(&j'..0 Amrita Paul, Laboratory Manager or other approved signatory EMSL maintains liability limited to cost of analysis. This report relates only to the samples reported and may not be reproduced, except In full, without written approval by EMSL EMSL beets no responsibility for sample cotlection activities or analytical method limitations. Interpretation and use of test results are the responsibility of the client This report must not be used by bre client to claim product certification, approval, or endorsement by NVLAP, NIST or any agency of the federal government. Non -friable organically bound materials present a problem matrix and therefore EMSL recommemis gravimetric reduction prior to analysis. Samples received in good condition unless otherwise noted. Estimated accuracy, precision and uncertainty data available upon request Unless requested by the client, building materials manufactured with multiple layers O.e, linoleum, wallboard, etc.) are reported as a single sample. Reporting limit is 1% Samples analyzed by EMSL Analytical, Inc. Fort Lauderdale, FL. I Initial report from 06102/2014 13:06:11 Test Report PLM -7.28.9 Printed: 6/2/20141:06:11 PM 1 EMSL Analytical, Inc. EMSL Order. 561401602 2700 West Cypress Creek Road, Suite &111, Fort Lauderdale, FL 33309 CustomerlD: EEG50 Phone/Fax (954) 786-9331 / (954) 941-4145 CustomerPO: httn://www.EMSL.com oomoanobeachlabdblemsl.com ProjectlD: Attn: Rich Grupenhoff Phone: (305) 374-8300 EE & G Fax 5751 Miami Lakes Drive East Rived: 05/30/14 3:20 PM Miami Lakes, FL 33014 Analysis Data. 6/2/2014 Collected: 5/30/2014 The Test Report: Asbestos Analysis of Bulk Materials via EPA 600/R-93/116 Method using Polarized Light Microscopy Non -Asbestos Asbestos Sample Description Appearance % Fibrous % Non -Fibrous % Tvoe 053014SN-4-Base Plaster Walt Gray 100% Not -fibrous (other) None Detected Coat System Non -Fibrous 561401602-0004A Homogeneous 053014SN-5-Sidm Plaster Wall White 100% Non-fibrous (other) None Detected Coat System Non -Fibrous 561401602-0005 Homogeneous 053014SN-5-Base Plaster Wall Gray 100% Non-fibrous (other) None Detected Coat System Non -Fibrous 561401602-6005A Homogeneous 053014SN-6-Sldm Plaster Wall White 100% Non-fibrous (other) None Detected Coat System Non -Fibrous 561401602-0006 Homogeneous 053014SN-6-Base Plaster Wall Gray 100% Non-fibrous (other) None Detected Coat System Non -Fibrous 561401602-0006A Homogeneous Analyst(s) Anne Paul (2) Catalina Lachowski (10) N,44�d aAA-o Amrita Paul, Laboratory Manager or other approved signatory EMSL maintains liability limited to cost of analysis. This report relates only to the samples reported and may not be reproduced, except in full, without written approval by EMSL. EMSL bears no responsibility for sample collection activities or analytical method limitations. Interpretation and use of test results are the responsibility of the client. This report must not be used by the client to claim product certification, approval, or endorsement by NVLAP, NIST or any agency of the federal government. Non -friable organically bound materials present a problem matrix and therefore EMSL recommends gravimetric reduction prior to analysis. Samples received in good condition urdess otherwise noted. Estimated accuracy, precision and uncertainty data available upon requesL unless requested by the cilent, building materials manufactured with multiple layers O.s. linoleum, wallboard, etc.) are reported as a single sample. Reporting limit Is 1% Samples analyzed by EMSL Analytical, Inc. Fort Lauderdale, FL Initial report from 06/02/2014 13:06:11 Test Reoart PLM -7.28.9 Printed: 6/2/20141:06:11 PM THIS IS THE LAST PAGE OF THE REPORT. 2 " CHAIN OF CUSTODY: DATElY ME PINNY I+IAMEISIGNATUM SWIM. 1 Page 1 Of 1 Ms. Monique Smith June 2, 2014 Appendices APPENDIX B FIGURES SMITH RESIDENCE - 1700 NE 105 ST SURVEY LETTER ' i v TF" --j . ' ago. 1 fir' .g Ms. Monique Smith June 2, 2014 Appendices APPENDIX C INSPECTION PHOTOGRAPHS SMITH RESIDENCE - 1700 NE 105 ST SURVEY LETTER que Smith 014 es Photo 1: Exterior of building at 1700 NE 105 Street, Miami SMITH RESIDENCE - 1700 NE 105 ST SURVEY LETTER Ms. Monique Smith June 2, 2014 Appendices M Photo 3: Typical nonACM plaster wall system SMITH RESIDENCE - 1700 NE 105 ST SURVEY LETTER Ms. Monique Smith June 2, 2014 Appendices APPENDIX D CERTIFICATES SMITH RESIDENCE -1700 NE 105 ST SURVEY LETTER United States Department of Commerce National Institute of Standards and Technology 0 KV D Certificate of Accreditation to ISO/IEC 17025:2005 NVLAP LAB CODE: 500085-0 EMSL Analytical, Inc. Fort Lauderdale, FL is accredited by the National Voluntary Laboratory Accreditation Program for specific services, listed on the Scope of Accreditation, for.• BULK ASBESTOS FIBER ANALYSIS This laboratory is accredited in accordance with the recognized International Standard ISO/IEC 17025.2005. This accreditation demonstrates technical competence for a defined scope and the operation of a laboratory quality management system (refer to joint ISO-ILAC-IAF Communique dated January 2009). Ne oP�� 2013-05-17 through 2014-06-30 a � jIYAMA� Effective dates y�o ��� For the National Institute of Standards and Technology A?ES of P NVLAP-01C (REV. 2009-01-28) t .eNT OP c0� MM o ® National Voluntary lJV� Q Laboratory Accreditation Program y ON res of SCOPE OF ACCREDITATION TO ISO/IEC 17025:2005 EMSL Analytical, Inc. 2700 West Cypress Creek Road Bldg. B, Suite 111 Fort Lauderdale, FL 33309 Ms. Kim Wallace Phone: (954) 786-9331 Fax: (954) 941-4145 E -Mail: kwallace@emsl.com URL: www.emsl.com BULK ASBESTOS FIBER ANALYSIS (PLM) NVLAP LAB CODE 500085-0 NVLAP Code Designation /Description 18/A01 EPA 600/M4-82-020: Interim Method for the Determination of Asbestos in Bulk Insulation Samples 18/A03 EPA 600/R-93/116: Method for the Determination of Asbestos in Bulk Building Materials 2013-05-17 through 2014-06-30 Effective dates . ''Q For the National Institute of Standards and Technology Page 1 of 1 NVLAP-01S (REV. 2005-05-19) 0 0 z4f 1111W. I t: -m MIP -4 glitz @I 1 :41:4 0 Mr. 0 F. Stump, Course Sp ST-ATF-..OF;PLORtDA 4376' REGULATION SEQOL12100303316