The URL can be used to link to this page

ELC-13-755U BUILDING Miami Shores Village APR 12 2013 Building Department 90050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 FBC 20 p Permit No. Fy L -C 13 " PERMIT APPLICATION Permit Type: JOB ADDRESS: Master Permit No. � f l t 6 j Z-7.777 1_ City: Miami Shores County: Miami Dade Zip: ii .1 J/ ?f Folio/Parcel#: Is the Building Historically Designated: Yes NO )C Flood Zone: OWNER: Name (Fee Simple Titleholder): !t�5e 4Phone#: 3-0y6? Address: 6494, .�J` ;z 5- b i` City: AJ®g T `t -t J'✓1 J I'w i State: Tenant/L.essee Name: Email: CONTRACTOR: Company /Name: Address: /�©/ W& 9 .�ae4- r City State L� Zip: I —K> 4— Name: State Certification or Registration #: C �7Certficate of Competency 4f: Contact Phone#�,� 1,0 G`11��r 17i DESIGNER: Architect/Engineer: Value of Work for this Permit: $ cS V Square/Linear Foo a of Work: Type of*..ark: ❑Address DAlteration ONew epair/Repl ce ODemolition Description of Work: .� ,C G � . AO-� ate.• t Submittal Fee $ Permit Fee $ / ® el 06P 40 CCF $ CO/CC $ Scanning Fee $ Notary $ Radon Fee $ DBPR $ Bond $ TraininglEducation Fee $ Technology Fee $ TOTAL FEE NOW DUE $ Double Fee $ Structural Review $ Bonding Company's Name (if applicable) Bonding Company's Address City State Mortgage Lender's Name (if applicable) Mortgage Lender's Address Zip 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 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 o urs seven (7) days after the building permit is issued In the absence of such posted notice, the inspection will not be approve7and a reinspection fee will be charged s e o Agent fh The foregoing instrument knowledged before me this day of x,20 y�'1a , who is personally known to me or who has produced As identification and who did take an oath. NOTARY PUBLIC: Sign: 4° Print: a My Commission Expires: APPROVED BY My Cornn*wbn EE 189537 Expires 04/1512018 day of j who is O/W Plans Examiner Structural Review (Revised 3/1212012)(Revised (Y7/10/07)(Revised 06/10/2009)(Revised 3115109) OF was acknowledged before me thi ) may M fume or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commission Notary Public State of Florida Denise M Blaine My Commission DD940284 Expires 12/1012013 Zoning Clerk r --W% MITCH-4 OP ID' DP .4CC>R�l `....,.- CERTIFICATE OF LIABILITY INSURANCE DATE (MWDDNYYY) 11/05/12 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 policy(les) 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: 800-538-0487 Atlantic Pacific Insurance-PBGPHONE 11382 Prosperity Farms Rd 4123 Fax: 561-626-3153 Palm Beach Gardens, FL 33410 A.Peace CONTACT NAMF_ FAX Al No ; No ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A:Old Dominion Insurance Co. 40231 08/11/13 INSURED Mitch Joseph Inc 1101 NW 95th Ave Plantation, FL 33322 INSURERB:Travelers Indemnity Company of 25666 INSURER C;Star Insurance Co. 18023 PERSONAL BADV INJURY $ 1,000,0 GENERAL AGGREGATE $ 2,000, INSURER D: INSURER E: $ INSURER F AUTOMOBILE LIABILITY X ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS r+n'kieowr_ee PCDTICH%ATC Lll lMOCo- RFV19110M 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. ILTR TYPE OF INSURANCE DL SU POLICY NUMBER PO M EFF EXP IMMIDDIYYYYI LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE ❑X OCCUR MPG8575D 08/11/12 08/11/13 EACH OCCURRENCE $ 1,000, ow DAMAGIE TO RE PREMISES ocamence $ 500, 00 MED EXP (Arty one person) $ 5, 00( PERSONAL BADV INJURY $ 1,000,0 GENERAL AGGREGATE $ 2,000, GEML AGGREGATE LIMIT APPLIES PER: X POLICY PRO- JECT LOC PRODUCTS - COMP/OP AGG $ 2,000,000 $ B AUTOMOBILE LIABILITY X ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS BA -1A893097 09/07/12 10/07/12 LIMIT $ 100,00 C a BIN accident BODILY INJURY (Per Person) $ 130DILY INJURY (Per accident) $ PROPERTY DAMAGE $ A UMBRELLA UAB EXCESS UAB X OCCUR CLAIMS -MADE CUG8575D 08/11/12 09/18/12 EACH OCCURRENCE $ 1,000,0 00 AGGREGATE $ 1,000,0 00 DED I X I RETENTION $ 10000 $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNERIEXECUTIVE Y� OFFICERIMEMBER EXCLUDED? (Mandatory In NH) I yes describe under- DESCRIPTION OF OPERATIONS belay NIA C0741003 08/05/12 08/05/13 X TAY LIAN X I ER E.L. EACH ACCIDENT $ 1,000,0 1 000. EL DISEASE - EA EMPLOYEE $ 1 POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101. Additional Renaft Schedule, ff more apace to "Wry ,.�., !`A W!`GI 1 e !nN VGRI IrIVNIG IlV1..VG1� � �� - ' MIAMISH C of Miami Shore City SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Building 81 Zoning 10050 N.E. 2nd Avenue Miami Shores, FL 33132 AUTHORIZED REPRESENTATIVE %%�%%�l /'—zLo- �T,A\, •11 -IwL.M www na %W i V00 -GV IV MVVIW VV,v V,v -... .-.....a...,� . ACORD 25 25 (2010105) The ACORD name and logo are registered marks of ACORD r i 'T} . BLIi;C 'RICAL CONTRACT01t . I ,Etted:r�e: EDW IS Cr3RiIFIE#).: ,�..��_� tet.•_ ...._____ �.s �..,.. .,� r+,,�.,:;�d.w:xsic��`�ro? 115 S. Andrews Ave., Rm. A-100, Ft. Lauderdale, FL 33301-1895 — 954-831-4000 VALID OCTOBER 1, 2012 THROUGH SEPTEMBER 30, 2013 Receipt #:��icAL/Ar ARMs/CONT A• Lame:BA: MITCH JOSEPH INC Business Type: (ELECTRICAL CONT CTOR) Business Name: Business Opened:o3 /10 / 1994 OWnerName: r�ITC�T•7• M JOSEPH EC1,3pp2559 Business Location: 10593 NUJ 53 ST StatelEX@ ption Cod : ' SUNRISE Business Phone: 954-345-8372 Rooms Seats Employees Machines Protessionsts 1 For Yertdng Business Only pe: Number of Machines: Vending TyTotal Paid ' Penalty Prior Years Collection Cost Taxgmount Transfer Fee NSF Fee 0.00 0.00 27.00 27.00 0.00 0.00 0.00 THIS RECEIPT MUST; BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS THIS BECOMES A TAX RECEIPT This tax is levied for the privilege of doing business within Broward countyd is an non -regulatory in nature. You must meet all County and/or Municipality planning j WHEN VALIDATED and zoning requirements. This Bustness Tax Receipt must be transferred when the business is sold, business name has changed or you have moved the business location_ This receipt does not indicate that the business is legal or that it is in compliance with State or local laws and regulations. mailing Address: Receipt #032-11-0()003680 MITCH JOSEPH INC Paid ()9/04/2012 27.00 j 1101 NW 95 AVE ' PLANTATION, FL 33322 i 2012 - 2013