RF-13-1455Miami Shores village
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
BUILDING
PERMIT APPLICATION
7
FBC 20 ( 0
Permit No.
Master Permit No.'' 13 — I `Q s5
Permit Type: BUILDING ROOFING
JOB ADDRESS: 9-? iU c 'i-, ` A ve tL e, 4 Ce
City: Miami Shores County:.�Miami Dade zip: 331.3 -`—
Folio/Parcelk.
Is the Building Historically Designated: Yes NO Flood Zone:
OWNER: Name (Fee Simple
6 Jt 'I �.!' -1 1 6
Address: i i C> ! k,� & 4 A '-® e-, 4 c (Z& e Q
City: a/L1: �� ®tee
—State: 1.;t_ Zip: ?/3
Tenant/Lessee Nam: —Phone*-.---,
Email:
CONTRACTOR: Company Name:
Address: �K_9__O Stec
City.
Qualifier Name:
zip: 33/$x"
0 qR zopfzCP
State Certification or Registration #: Certificate of Competency #: �Q� �� cr 09
Contact Phone#: Email Address:
DESIGNER: Architect/Engineer: Phone#:
Value of Work for this Permit: $ Z_'00 • D t7 Square/Linear Footage of Work:
Type of Work: OAddition DAlteration ONew ORepair/Replace L&molition
Description of Work: %Asa✓
Color thru tile:
Submittal Fee $��j-Permit Fee $ �/� U CCF $ CO/CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Edncation Fee $ Technology Fee $
Double Fee $ Structural Review $
TOTAL FEE NOW DUE $
M
Bonding Company's Name (if applicable)
Bonding Company's Address
City State Zip
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, BORERS, 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 absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged. ,
SignatureZIZZ �i Signature_p
Owner or Agent e ,
The foregoing instrument was acknowledged before me this
day of , 20 1!? by G I LJ— S << fz C
who is cnov a or who has produced t�: LQ
As identification WKhc 14161in oath.
NOTARY PUBLIC:
Sign:
Print:
My Commission Expires:
APPROVED BY
Contractor
The foregoing instrument was acknowledged before me this
day of '9J --C— . 20S byAt —7e -,S T LZ
who is personally known to me or who has produced—C"--A
as identification and who did take an oath.
My Commission Expires:
Zoning
Structural Review Clerk
(Revised 3/122012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09)
ACORO`� CERTIFICATE OF LIABILITY INSURANCE
' v
DATE(MMIDD/YYY1r)
06/26/2013
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 pollcy(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
ROYALTY INSURANCE GROUP
8846 SW 129 TERR 2nd Floor
MIAMI FL 33176
CONNAME:TACT Tony Iglesias
PHCNNO Ext): 305-233-5333 AX NO 1305-359-5117):
EA IESS: Tony@roya"nsurancegroup.com
INSURER(S) AFFORDING COVERAGE NAIC #
INSURERA: GRANADA 0
INSURED
CLASSIC GUTTER AND PAINTING
4890 SW 75 AVE.
Miami FL 33155
INSURERS:
INSURER C :
INSURER D:
INSURER E.
INSURER F:
COVERAGES CERTIFICATE NUMBER: REVISION 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.
INSR
LTR
TYPE OF INSURANCE
ADDL
INSR INS
SUBR
WVD
POLICY NUMBER
POLICY EFF
M/DD
POLICY EXP
MIDD
LIMITS
A
GENERAL LIABILITY
COMMERCIAL GENERAL LIABILITY
CLAIMS MADE ® OCCUR
0185FL00035630
04/20/2013
04/20/2014
EACH OCCURRENCE $ 1.000,000
O RENTED
PREMISES _a occurrence $ 100,000
MED EXP (Any one person) $ 5,000
PERSONAL & ADV INJURY $ 1,000,000
GENERAL AGGREGATE $ 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY PRO- LOC
JECT
PRODUCTS- COMP/OP AGG $
$
AUTOMOBILE
LIABILITY
ANY AUTO
ALL OWNED SCHEDULED
AUTOS AUTOS
NON -OWNED
HIRED AUTOS AUTOS
COMBINED SINGLE LIMIT
Ea aoddent)
BODILY INJURY (Per person) $
BODILY INJURY Per accident) $
( )
PROPERTY DAMAGE
Per acddent $
UMBRELLA LIAB
EXCESSLJAB
OCCUR
CLAIMS -MADE
EACH OCCURRENCE $
AGGREGATE $
DED I I RETENT70N $
$
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y / N
ANY PROPRIETORIPARTNEWEXECUTIVE
OFFICERIMEMBER EXCLUDED?
(Mandatary in NH)
If es, describe under
DESCRIPTION OF OPERATIONS below
N / A
WC STATU- OTH-
TORY LIMITS ER
E.L. EACH ACCIDENT $
E.L. DISEASE - EA EMPLOYE $
E.L. DISEASE - POLICY LIMIT $
DESCRIPTION OF OPERATIONS i LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, K more space is required)
Miami Shores Village
10050 NE 2nd Avenue
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
ACORD 25 (2o70/U5) @ 1988-2010 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
The Shore Villas Condominium
Building 9001-9041 NE 4 Ave Rd. Miami, FL.
East Side
Parking Lot
Wool Fence
West Side
!UPJ 2 7 2013
12F t3- NL.'1 5S
Miami Shores Village
APPROVED
BY
DATE
ZONING DEPT
BLDG DEPT
SUBJECT (O CCNIPLIPNCE WITIH ALL, FEDERAL
STATE ANL) Cr I.jNh Y r1UI_ES AND REGULATIONS
0
CLASSIC GUTTERS, and Painting
CONDOMINIUMS
4890 SW 75 Ave Suite 107 Miami Fl, 33155
Phone: 305-298-2848
BUILDING 9000
Floor Plan
to I
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kjoot> 'FeKIC&
14 IV &A#_'&;S7-6 S091461 06VAkb.
SignaturZ�� Date v 2—el
THE -SHORE VILLAS
Ref: Building 9000
JUN 2 7 2013
T�
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