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SGN-14-1342Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-214720 Scheduled Inspection Date: October 08, 2014 Inspector: Rodriguez, Jorge Owner: PROPERTIES LLC, SHORE SQUARE Job Address: 9099 BISCAYNE Boulevard BURGER rru rr± Miami Shores, FL 33138 - Project: <NONE> Contractor: AMERICAN TROPICAL SIGNS AND SERVICES LLC auilaing Department comments 3 ROUND LOGOS 36 SQ FT 1 O. C. U SPEAKER FOR DRIVE THREW REVERSE CHANNEL LETTERS Passed Failed Correction ❑ Needed Re -Inspection ❑ Fee No Additional Inspections can be scheduled until re -inspection fee is paid. Permit Number: SGN-6-14-1342 Permit Type: Sign Inspection Type: Final Work Classification: Addition/Alteration Phone Number (305)779-8040 Parcel Number 1132060110040 INSPECTOR COMMENTS False Inspector Comments Phone: (305)512-1223 October 07, 2014 For Inspections please call: (305)762-4949 Page 5 of 25 f ' t �t Nfiami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 7952204 Faw. (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 Permit No. JUN 2 4 2014 BY.; — - X2016 !; DING ROOFTKG OWNER: Name (Fee Tenanta.escee Nom: Email: I 1102 done#: V�=—�_ %f O t City: Qualifier Name: State Certification or Registration #: Contact Phone#. v DESIGNER: Architect/«•pine ll Value of Work for this Permit: $"areJi wear Footage of Work: Type of Work: ®Addition ®Alteration ❑New LIDernolition DescrkMon of Work: n ` P Submittal Fee $ Permit Fee $ CCF $ MCC $ Scanning Fee Fee $ DBPR $ Bond $ Notary $ TraininglEdueat'son Fee $ Technology Fee $ Double Fee $ Struetural Review $ TOTAL FEE NOW DUE $ �• . V, Winding Company's Name (if applicable) Bonding Company's Address City State MortgW Lender's Name (if applicable) Mortgage Lender's Address City State Tap 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. 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 duct a copytheice of commencement andconstruction lien law brochure will be delivered to the person whose prop subject toattaro, acemf' red copy of the recorded notice of commencement must be posted at the job site for the fustion which oc(7) days after the building permit is issued In the absence of such posted notice, the inspection will t e appiAved ancoon fee will he charged C�wner or Agent The f g ing instrument w acdged thi� da of 0 �Y ho is Wally known to me r who has produced ^� ` As identifi, ,®, ca#ion and who did take an oath. My Commission Expires: APPROVED BY MY COMM SSION # °�Q EXPIRES: Juri� 9 20j7 n40d 7hru Signature -kk�4t--� Contractor The fore f9g instrument was acknowled before me day of 20 f, y .. who y known to or who has produced as identification and who did take an oath. Plans Examiner Structural Review (Revised 311212012)(Revised 07110/07)(Revised 06non")(Reviud 3115/tl g) PUBLIC: P �. MARIA ELENAGOMEZ My Commission #. My COMMISSION # FF 015920 o;= EXPIRES: June 9,2017 Bonded Thru Notary Public Underwriters W6' Zoning Clerk Miami shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CONTRACTORS' REGISTRATION FORM ALL CONTRACTORS MUST PROVIDE COPIES OF LICENCES AND INSURANCES EACH TIME A PERMIT IS SUBMITTED OR THE VILLAGE MAY MAINTAIN A FILE WITH YOUR INFORMATION FOR A $30.00 FEE PER YEAR. A. 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 DADE 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 DEPTI D. COPY OF WORKER COMP INSURANCE (ElTHER CERTIFICATE OR 99PTIONt1 YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE HOLDER AS FOLLOW: MIAIM SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES, FL 33138 ........................................................................................... BUSINESS NAME: 2/1 11 BUSINESS ADDRESS: ITS(-__ STATE PE, ----ZIP CODE BUSINESS PHONE: FAX NUMBER OMKa - 6 q 4 CELL PHONE QUALIFIER'S NAME:779&�6 LZ2�6 Y,9-,5 QUALIFIER'S LIC NUMBER: E-MAIL ADDRESS OF APPU ca on 3Hsmn sr roaoviRv S12sam.,. THIS DOCUMENT HAS A COLORED! BACKGROUND• MICROP,RINTING • LINEMAW" PATENTED PAPER f! A C#6292548 ...•4: STATE OF FLORIDA E7 DEAR OF BUSINESS PROFESSIONAL REGULATION TRICAL CONTRAC ORS LICENSTNG BOARD SEWL12082202993 bICENSE NBR 0047 The ELECTRICAL CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter---4-Rk Chapter---4-RFS. Expiration date: AUG 31, 2014 IGLESIAS, THOMAS JOSE AN TROPICAL SIGNS 7675 WEST 2ND AVENUE HIALEAH FL t AND SVTC,i L.L.C. 33014 RICK SCOTT GOVERNOR DISPLAY AS REQUIRED BY LAW__ ification KEN LAWSON SECRETARY 002603 Locg I ftwiness Tax Beceip# Kja i—[fie C��ty, State of Florida THIS IS NOT A BILL — DO NOT PAY FLBT 32F8935 RECOUrr NO. EXPIRES 13USOMSSN„IWCATON LLC REIIIEWAL SEPTEMBER 30, 2014 gl~JIf R[ifiC111 TROPICALSIGNS & SERVICES 590;6400 Must be displayed at Place of business 7675 W 2 CT Pursuant to County Code HLAMIJ FL 33014 Chapter 8A — Art. 9 & 10 SEC. TYPE OF (IBUSINESS PAYMENT RECEIVED OWNER196 ELECTRICAL. CONTRACTOR BY TAX COLLECTOR AppERIM TROPICALSIGNS & SERVICES EC13004721 $45.00 09/16/2013 Worker(s) 3 TXHS1-13- 0661 27 cense. TIdSLocal Busi�ssTtix Receipt ooiycortfinns peymatrt of.glte local Business Tax. The Receipt is not a license.f it or a certfc#tlon of the holder's qualificahops, to dp business. Holder nst comply with any 9oveal or ttiingoaernme='Flatory laws end requvements which apply to the business Edo Code Sec 8a -2i6. The RECEIPT NO. above mast be displayed on all commercial vehicles —rAt For more information, visit�h •^v m__ ia� midaft ;ai B/24/14 06:22AM PDT Permit Source, Inc. -> Miami Shores Village 13057568972 Pg /3 AC�"NGIF CERTIFICATE OF LIABILITY INSURANCEDATE(MWDD/YYYY) 16� 1 6/23/2014 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 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 andorsamantrAt_ PRODUCER MaTtGT Nallace Welch & Willingham, Inc. PHONE 727-522-7777 a No; 727-521-2902 100 1 st Ave. So., 5th Floor Writ Petersburg FL 33701 ADDRESS, cortificates@w3ine.com INSURERA:Amerisure Ins. Co. 19488 INSURED AMERTRO-01 INSURERB:AmsrIsvre Mutual Ins. CO. 23396 American Tropical Signs & Service, LLC INSURER C 1 American Signs & Services Inc All Tropical Signs & Service Inc INSURER D! 540 West 83rd St INSURER E: Hialeah FL 33014 INSURER F: CAVFRAr:FS reerIel&Are uusson10077999 r�r.rww�� as �iw�n. 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. LTR TYPE OF INSURANCE INSD WVD POLICY NUMBERMMIDD M LIMITS A X COMMERCWI.GENERALLUIBILITY L2092336 /1/2014 /1/2015 EACH OCCURRENCE »;1,000,000 CLAIMS MADE X❑ OCCUR PREMISES Es oomirrellwl $100,000 MED EXP (Any one person) $5,000 . PERSONAL& ADV INJURY 57,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY FX7 71 GENERAL AGGREGATE $2,000,000 PRODUCTS - COMP/OP AUG $2,000,000 JJC-CT Lou OTHER: $ B AUTOMOBILELIARILITY CA2092335 /1/2014 1/2015 Eaecctdent $1,x00,000 x AUTO UODILY INJURY (Perperron) $ )( pA�NY AUTOdS1MED AUTESULEO cni BODILYINJURY(Pnradrsu) $ X HIREOODAl1TO4 X NON -OWNED AUTOS $ PerACddent B x UMBRELLA LIAO Xd OCCUR CU2092337 1/2014 1/2015 EACH OCCURRENCE $2,000,000 EXCESS LIAR CLAIMS -MADE At30RECiATE $2,000,000 DED I X I RETENTION$0 WORKERS COMPENSATION $ AND EMPLOYERS' UA9ILITY Y / N _ 8TATUTE ER ANY PROPRIEB R/PARLUDEDXECUTME ❑ EXCLUDED? NIA E.L. EACH ACCIDENT $ (Mandatory (Mandatory in NN) N yyeege tleeCJlbe under E.L. DISEASE- EA EMPLOYEE S E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Ramarks Schedule, may be attachad if "tom space is mquk") EC13004721 Sign manufacture, installation and service. ceQrielCAre Unr nme Miami Shores Village 10050 N.E. 2nd Ave. Miami Shores FL 33138 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE m 1988-2014 ACORD CORPORATION. All riahts reserved m-umU za tzulalu7) The ACORD name and logo are registered marks of ACORD B/24/14 08:22AM PDT Permit Source, Inc. -> Miami Shores Village /3 1 13057588972 Pg co��® CERTIFICATE OF LIABILITY INSURANCE DATE (MM0WYYYr 6/23/2014 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 Risk Management Underwrlters, Inc. 1420 Kensington Road Suite 114 Oak Brook IL 00523 INBR PH91 f FAX E-MAIL ADDRESS: INSURERS AFFORDING COVERAGE MAIC 8 INSURERA: POLICY EXP YM/D INSURED 1227 Cohesive Networks, Inc Alt. Empl: American Tropical Signs and Services LLC 4224 West Henderson Blvd INSURER B., INSURER C: INBURERD: INSURER E: Tampa FL 33629 INSURER F 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. NN INSI TYPE OF INSURANCE INBR WYD POLICY NUMBER POL�CY EFF MMID POLICY EXP YM/D LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY Ifro PREMISES(Ea occurrence)$ F-1 MED EXP (Anyone parson) CLAIMS -MADE OCCUR PERSONAL d ADV INJURY $ GENERAL AGGREGATE $ GE N1 A00REGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ POLICYF71 PRS LOCJEUT $ AUTOMOBILE LIABILITY Ea era dant $ ANY AUTO BODILY INJURY (Per parson) $ ALL OWNED SCHEDULED BODILYINJURY (Per accident) $ AUTOS AUTOS NON -OWNED HIRED AUTOS PROPERTY DAMAGE $ Par arcitk nt UMBRELLA LIAB OCCUR SACH OCCURRENCE $ EXCE88 LM CLAIMS •MADE AGGREGATE $ DED RETENTION $ $ A WORKERS COMPENSATION N 33923 1/2094 1/2095 X AND EMPLOYERS'LIABILITY YIN TORY LIMITS ANY PROPRIET=PARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? NIA E.L. EACH ACCIDENT $1,000,000 (Mandatory In if ddescribebe undand er yyeeaa DORRIPTION OF OPERATIONS holow E.L. DISEASE - EA EMPLOYE $1,000,000 E.L. DISEASE - POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS! VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) Location Coverage Period: 3/1/2014 - 3/1/2015 Coverage IS provided for only those employees leased to but not subcontractors of: American Tropical Signs and Services LLC 540 W. 83rd St,Hialeah,FL,33014 -Client #29350 EC13004721 Sign manufacture, Installation and service @COT 1=1A�ATL ue�r nLe, Miami Shores Village 10050 NE 2nd Avenue Miami Shores FL 33138 ACORD 25 (2010/05) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED w 'f Sias-su7 u AGUKU COKFORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD