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BP-04-1672Miami Shores Village JUL 0^�p Building Department 2 e�n, 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 „_--,-_--_-- , Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 FM 20BUILDINGbYInnPermit No. � 4 0-7 o, PERMIT APPLICATION Master Permit No. Permit Type: BUILDING ROOFING JOB ADDRESS: In �_C) k1ba-4 a� City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated: Yes NO Flood Zone: OWNER: Name (Fee Simple Titleholder): /qVr,dLond", A ('Py4_;'A Phone#: Address: 115-0 . M awe_ 9,o& - A City: o moi i aim . 44, State: L Zip: -3 -3 t I Tenant/Lessee Name: Email: CONTRACTOR: Company Name: Phone#: � �� �10�-1-7 Address: °� 1✓, S Li -I-;- Y City: /-I i iA Qualifier Name: J State Certification or Registration #: Certificate of Competency #: Contact Phone#: Email Address: DESIGNER: Architect/Engineer: Value of Work for this Permit: $ 1Square/Linear Footage of Work: Type of Work: ❑Addition ❑Alteration Description of Work: Color thru tile: -33 1-5 ew ❑Repair/Replace I I ❑Demolition Cl Submittal Fee $ Permit Fee $ CCF $ CO/CC $ Scanning Fee $ Radon Fee $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ DBPR $ Bond $ Technology Fee $ TOTAL FEE NOW DUE $ fid 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 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 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 s 'ect to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the just inspe io which occ rs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not bef roved an a reinspection fee will be charged. Signature Signature Owner or 4ntCca�ctor The foregoing ins ment was ackn wledged befo a me this The foregoing instrument was acknowledged before me this' 9 day of , 20 1 , by w�.M day of 'S�� , 20 % 3 , by :5 e g V�l�tr, -e who is personally known to me or who has produced who is personally known to me or who has produced As identification and who did take an oath. NOTARY/RUBLIC: T �fYPV�• YNOSVANY MARTINEZ Sign: =•f ((@@g'=MY COMMISSION # EE080681 Print: �tir�� ,may EXPIRES April 04, 2015 My Commission Expires: APPROVED BY Plans Examiner as identification and who did take an oath. NOTARY PUBLIC: o'�g YI;OSVANY MARTINEZ •*_ M COMMISSION # EE080881 Sign: :y, 2015 Print: Jy ',,��� 8 0 'd otary5ervioo.com My Commission Expires: Zoning Structural Review Clerk (Revised 5/2/2012)(Revised 3/12/2012) )(Revised 06/10/2009)(Revised 3/15/09)(Revised 7/10/2007) Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CHANGE OF CONTRACTOR/ ARCHITECT Permit N. Owner's Name (Fee Simple Title Holder):14mna 0- ok- 1�ve+Phone #: Owner's Address: dY1 �_O VtC J e. �� A City: EA State : Zip Code: 1 -5 13 Y Job Address (Of where work is being done):. 5-6 V 5 q c Z i12r c k . City: Miami Shores State:_Flodda Zip Code: '3 Contractor's Company Name: Ovig !Mp Phone #: Address: 14 X1 u SW ;L —Tyr City: M i 0L Qualifier's Name: Architect/ Engineer of Record Name: Address: City: Describe Work: S to a State: Zip Code: 33 13 14 Lic. Number: (f &C 15O 5 OT Phone #: Zip Code: I hereby certify that the work has been abandoned and/or the contractor/architect is unable or unwilling to pomplete the contract. I hold the Building Official and the Miami hores harmless for all legal involveWt. Signature Signature owner orAgent Contractor or Archftect The foregoing Iment was aknowle ed before me The foregoing ' trument was aknowledge efore me this 2C-dayof'Svc 20/5,by_4•ro*+J.a N` 6 .arthis AV day of Jv% 20nbY has. Q Who is personally known to me or who has produced as indentification. '�►"°' YHOSVANY MARTINEZ Not p MY COMMISSION # EE080681 Sign: � � �� EXPIRES April 04, 2015 4 7) P 8 -P153 FlorideNoteryServioe.00m Seal: who is personally known to me or who has produced as indentification. NotaJ�W) YHOSVANY MARTINEZSign:? MY COMMISSION # EE080681 �•: EXPIRES p.Seal:ril FlorldeNotaryseMee.com0183 OCT E 8 2010 October 27, 2010 CERTIFIED MAIL/RETURN RECEIPT REOUESTED Mr. Frank Vazquez President Blue Water Pools 4811 N.W. 35h Avenue Miami, Florida 33142 Re: 9950 N.E. 4TH AVENUE ROAD, MIAMI SHORES, FLORIDA 33138 Dear Mr. Vazquez: I am writing to you as the owner of the residence referenced -above to confirm that on October 27, 2010, I have sent a certified letter to Thomas Benton of the Miami Shores Building Department giving him notice that I am hereby terminating your services relati to my property for failure to timely obtain final approval and closure of the ope at, oval permit. AMM/bjs Certified Mail Provides: ■ A mailing receipt ■ A unique identifier for your mailplece ■ A record of delivery kept by the Postal Service for two years InrportaW Reminders: s Certified Mail may ONLY be combined with First -Class Mail® or Priority Mails. ■ Certify Mail is not available for any class of international mail. s NO INSURANCE COVERAGE IS PROVIDED with Certify Mail. For valuables, pleass.c onsider Insured or Registered Mail. ra For an additional fee, a Retum Receipt may be requested to provide proof of delivery. To obtain Return Receipt service, please complete and attach a Return Receipt (PS Form 3811) to the article and add applicable postage to cover the fee. Endorse mailpiece Return Receipt Requested". To receive a fee waiver for a duplicate return receipt, a USPS® postmark on your Certified Mail receipt is required. ■ For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent Advise the clerk or mark the mallplece with the endorsement Restricted Delivery: ■ if a postmark on the Certified Mail rec.s is desired, pplease.present the arta- PJ the post office f9r postmarking..1 a postmark.ort tho'Cerflflsd Mail receipt is not needed, detach And affix label wit} postage and mail. IMPORTANT; Sante this.re9dipt'aad present it When making an inquiry. PS Form WW, Aogust 21108 (Reverse) PSN 7530-0240- 7' . a ca W M W P M C C M CD J O Q.tL V .0 W M a Z CO) Q � � N > V- a) 0QM Cr O N O toM N a .a C N3�LL Z LL 'N N r E m � (6 2(Lm4 rq ri ,. CE) CE) - Ln Ln 0 F F I tocc Postage $ -0.-0 m ' m CerMW Fee O O ReLim Receipt Fee QQ (Endotsemetd R.qu�ec!) Restricted DeBveiy Fee r3 O (Endommem RegUk4 r9 rl TOW Postage & Fees ri ' ri �.� rq cp O O 0 Q l� r% - ca •� M m co � co O O M >�.LL O Q (7 �, cc C co LU 'OZfA Postmark Here R 3NI1031.1001tl 010dSS3H00tl Ntlf113H 3H1 d0 I.HOW 3H1013dO13AN3 d0 dOl 1V H3N3IlS -13V-1d ■ Complete items 1, 2, and 3. Also complete I Item 4 if Restricted Delivery is desired. I ■ Print your name and address on the reverse I so that we can return the card to you. I ■ Attach this card to the back of the mailpiece, I or on the front if space permits. 1. Article Addressed to: 24 -MK w� &k A/W 4,6- I I 12. Article Number 7008 114 0 A. Signature X ❑ Agent I ❑ Addressee I B. Received by (Printed Name) C. Date of Delivery , D. Is delivery address different from Item 1? 13'Yes If YES, enter delivery address below: ❑ No �nAce type I 3 '❑ Rertifled Mail ❑ Express Mail I 6 egistered ❑ Return Receipt for Merchandise I ❑ Insured Mail ❑ C.O.D. I 4. Restricted Delivery? (Extra Fee) ❑ Yes i (transfrom service label) 0003 6 8 41 15 81 fer I PS Form 3811, February 2004 Domestic Return Receipt 102596.02-M-16401 q� .. n o L1: o c 10 m O� Him! WA111 oL L2 � Y i ___00014 . .d►CORn CERTIFICATE OF LIABILITY INSURANCE . �✓ D 08/116/20161201 YYf7 083 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(ies) 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 ALL CITY INSURANCE INC - ACI 275 FONTAINEBLEAU BLVD. SUITE 190 MIAMI FL 33172 INSURED ONE STOP CONSTRUCTION, INC. 4214 SW 2ND TERR MIAMI FL 33134- CONTACT JAVIER GUTIERREZ PHDNE (305) 463-9431 FOXNo).(305) 436-6797 _ E-MAILD"r��,;� IERRr?@ALLCITYINS.COM PRODUCER 9.201549 INSUURER(STAFFORDINGCOVERAGE NAICS_ INSURER A: MID-CONTINENT CASUALTY CO INSURER B: A NSURER D, !NSURER E: INSURER F, COVERAGES CERTIFICOTF NIIMRFR• 37 17FVICIr1N NI IMRFR• 00 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 TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXPJZB- ln'N= LIMITS A GENERAL LIABILITY 04GLB69617 02/18/2013 02/18/2014 EACH OCCURRENCE $ 1+000,000 DAMAGE TO RENTED 100,000 $ PREMISES (Ea occunence�- ____ MED EXP (Any one arson $ EXCLUDED X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE FX1 OCCUR PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OPAGG $ 1,000,000 X POLICY PRO -LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO _ BODILY INJURY (Per person) $ ALL OWNED AUTOS BODILY INJURY (Per accident) $ SCHEDULED AUTOS HIRED AUTOS PROPERTY DAMAGE $ (Per accident) $ NON -OWNED AUTOS $ UMBRELLA LIAB OCCUR EACH OCCURRENCE AGGREGATE - $ EXCESS LIAB CLAIMS -MADE DEDUCTIBLE $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS' LIABILITY N ANY PROPRIETOR/PARTNER/EXECUTIVE OFRCER/MEMBEREXCLUDED? NIA 7Orav i noirFP E.L. EACH ACCIDENT $ (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE -POLICY LIMIT If yes, describe under DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) GEHTIFIGATE HOLDER CANCELLATION VILLAGE OF MIAMI SHORES BUILDING DEPT. 10050 NE 2 AVE MIAMI SHORES SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. FL 33138- I AUTHORIZED REPRESENTATIVE ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD Miami Shores Village Building Department 90050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fag: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 BUILDING PERMIT APPLICATION Permit Type: PLUMBING JUL ® 2 26 '5 FBC 20 ®�� Permit No. Master Permit No. tet' JOB ADDRESS:. 41 S+® �/ �`I Gtyf— City: Miami Shores County: Miami Dade Zip: 73 i 111 Folio/Parcel#: Is the Building Historically Designated: Yes NO Flood Zone: OWNER: Name (Fee Simple Titleholder): /4iM&jn. 0� ®`�'� t� r�t�w Phone#: Address:. !101 �—o dwo_ Kac A City:i of e S 1y"e Stater Zip: Tenant/Lessee Name: Phone#: .' 8 q ' % 7 Email: Company Name: Address: City: %y6';�-aq>i71(o _ ��jj Qualifier Name: Keyk�2. Phonek State Certification or Registration #: Certificate of Competency #: Contact Phone#: Email Address: DESIGNER: Architect/Engineer: Phone#: '7 6 )-4t Q' 7 7 1.6o Value of Work for this Permit: $ Square/Linear Footage of Work: Type of Work: ,❑Address ❑Alteration ❑14ew ❑Repair/Replace ❑Demolition Deserintion of Work: Submittal Fee $ Permit Fee $ 7z 'jr $ CO/CC $ Scanning Fee $ Notary $ Radon Fee $ DBPR $ Bond $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ 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 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 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 s ect to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspe io which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will no be approved and einspection fee will be charged. Owner or Signature0:� 6�� Contractor The foregoing instrument was acZwledged befo a me/�this The foregoing instrument was acknownledged before me thisday of J✓ - , 20 1 , by / ` �o vB� day of �1 , 20 l -- by - I °�- e �y z,AAA!n who is personally known to me or who has produced who is personally known to me or who has produced As identification and who did take an oath. as identification and who did take an oath. NOTARY UB `�"•'%t-, YHOSVANY MARTINEZ MY COMMISSION # EED80681 Sign: • o' 'EXPIRES Print: (607) 398-0153 Floddallotary3ervice.com My Commission Expires: APPROVED BY Plans Examiner Structural Review (Revised3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09) NOT YHOSVANY MARTINEZ MY COMMISSION # EE080681 .qI�1,.`' EXPIRES April 04, 2015 Sign: a o ce.rxm Print: My Commission Expires: Zoning Clerk Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CHANGE OF CONTRACTOR / ARCHITECT Permit N. Owner's Name (Fee simple Title Holder): A�Phone #: Owner's City: A State : rL. Zip Coder Job Address (Of where work is being done): �_O W_r J-( 4o�e_ I��d City: Miami Shores State:—Florida Zip Code: 3'7 119 Contractor's Company Name: R r P tPhone #: -7 Y(.J ag 1-i'7 3 Address: -73? '1'? V f-7 JI-( -rev, City: " 0.w,.,' State:_ 1--:- Zip Code: Qualifier's Name: RmZvt e- %.iou e,a, Lic. Number: ® 3 ? 0 ® 0 0 � �{ Architect/ Engineer of Record Name: Address: City: Describe Work: State: Phone #: Zip Code: I hereby certify that the work has been abandoned and/or the contractor/architect is unable nwilliD to complete the contract. I hold the Building Official and the Mi mi Shores harmless for all legal involvement. Signature SignatureF(;A 0, owner or Agent Con or Architect The foregoing instrument was aknowledged before me The foregoing instrument was aknowledged before me this JTday of S crn 20 11b Who is personally known to me or who has produced as indenlifi ' r► YHOSVANY MARTINEZ: Notary Publi •: MY COMMISSION # EE080681 EXPIRES April 04, 2015 Sign: rvica.com Seal: this °2.4-- day of . 20 fby who is personally known to me or who has produced as indentification. YHOSVANY MARTINEZ Notary Pu I*' MY COMMISSION # EE080681 EXPIRES April 04, 2015 Sign: (407)398-0153 Fb a o ennce. m Seal: .LCO �� OCT /�2 8 2410 sNaN.y — October 27, 2010 CERTIFIED NLuL/RETURN RECEIPT REQUESTED Mr. Frank Vazquez President Blue Water Pools 4811 N.W. 35' Avenue Miami, Florida 33142 Re: 9950 N.E. 4TH AVENUE ROAD, MIAMI SHORES, FLORIDA 33138 Dear Mr. Vazquez: I am writing to you as the owner of the residence referenced -above to confirm that on October 27, 2010, I have sent a certified letter to Thomas Benton of the Miami Shores Building Department giving him notice that I am hereby terminating your services relat' to my property for failure to timely obtain final approval and closure of the ope at, onal permit. V 'ry anda AMM/bjs i Ceriifled Mail Provides: ■ A mailing receipt ■ Aunique identiHerfor your maiipiece ■ A record of delivery kept by the Postal Service for two years important Reminders: ■ Cerdfled Mail may ONLY be combined with First -Class Mails or Priority Mails. ■ Certified Mail Is notavailable for any class of international mail. ■ NO INSURANCE COVERAGE IS PROVIDED with Certified Mali. For. valuables, please.constder Insured or Registered Mail. ■ For an additional fee a Retum Receipt may be requested to provide proof of delivery. To obtain Qe rn Receipt service, please complete and attach a Return Receipt (PS Form 38111 to the article and add applicable postage to cover the adfor duppli retuEndorse rn reecceeiptt Return PS postmarReceipt k on y your reed Mail receipt Is ■ For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent. Advise the clerk or mark the matipteoe with the endorsement 1Restnded7Jeliv . ■ if a postmark on the Certified Mail receJpt ie desired, tease .prespnt the arti- cle at the post office fqr postmarking:.1 , ppsbnark.arf �"CertMed Mait receipt is not needed. detaotr jind affix label wl* postage and mail. tmponTAMT: save tbis'factipt'aad present it When making an inquiry. PS Form 3800, August 2Q08 (Reverse) PSt M"2400-9047., t6 M r i M C C M � J O Q.LL i U . � LLl t vZ� coo E < 45 m N >Nt Q� Cr O O Co > OL M .a Y N O N N LL LL '2 Z •E N L r �a`oovM M v m & M c•) c c m O a.LL � can) caL4M -aZW C O F E � Q C 2 i OCT 8 " 9p i i5r 1 CERTIFIED MAIL�M RECEIPT �-�°� ��: (Domestic,INail Only; No Insurance Coverage Provided) Ln m Fordelivery information visit our ,ca ras OFFICIAL website at www.usps.com�m Cc , cc 1 Postage �� m m WOW Fee Rae Postinark_ C3 C3 • f , . -- _o _• C C � C3 C3 • _ - -<L v m & M c•) c c m O a.LL � can) caL4M -aZW C O F E � Q C 2 ----------------- 3NIl 03ll001V (3'lOd 'SS3llOOV NuniaH 3H1 d0 1J901H 3H.L 019dO13AN3 d0 dO3-1V t13N011S 30tnd I ■ Complete Items 1, 2, and 3. Also complete I Item 4 If Restricted Delivery is desired. I ■ Print your name and address on the reverse I so that we can return the card to you. ■ Attach this card to the back of the malipiece, or on the front if space permits. 1. Article Addressed to: P.t M,4XIN U4:L&xz &/.ve IVA7&t �%k jp// IV uj 35 41,* - Aff4ml , , 331�� A. Signature X 0 Agent I 0 Addressee I B. Received by (Printed Name) C. Date of Delivery , D. Is delivery address different from item 1? 0• Yes If YES, enter delivery address below: 0 No , Xcii&tered Mail 0 Express Mail 0 Return Receipt for Merchandise 1 0 Insured Mail ❑ C.O.D. I 4. Restricted Delivery? (Extra Fee) 0 Yes 1 2. Article Number7 0 0 8 114 0 0 0 0 3 6 8 41 15 81 (T ansfer from service label) PS Form 3811, February 2004 Domestic Return Receipt 102696 -02 -M -ISO .. a � am 32 to Cy _ B vii o e f.. P+i p!�"�`�.y � as vcia LL u°o � ��E C '".A �+ o Aug 1213 01:26p World of insurarance A+ 4 CERTIFICATE OF LIABIL THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CO CERTIFICATE DOES NOT AFFIRMA7lVELY OR NEGATIVELY AMEND, EXTEND i 1i3ELOW- THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONT REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: tf the eerdfiwte holder Is an ADDITIONAL INSURED, the policy(ies) must be ei the ternts and conditions of the Policy, certain policies may require an endorsement. A state certificate holder in lieu of such endorsement{s). PRODUCER - - CONTAC World Of insurance Agency [WPHCME 18600 NW 87Ave Unit 113 Miami Lakes, FL 33015 � Phone _ (305) 231-1111 Fax (305) 231-0711 I IN US�RED INSURER R & I PLUMBING SERVICE CORP INSURER 7898 NW 174 TARRACE INSURER Miami Lakes, FI 33015 305 INSURER L^ COVERAGES NUMBEINSURER CERTIFICATE R: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEERY ISSU INDICATED. NOTWITHSTANDMG ANY REQUIREMENT, TERM OR CONDITION OF ANY CONI CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POL EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REIN rLNR .-_ TYPEOFINSURANCE AOB UBR F 11" AND. POLICY NUMBER M GENERAL LtABiLrlY _ .- 0 COMMERCIAL GENERAL LIABIUIY A D D CLAIM -MADE d OCCUR GL-37683-1 Of IG-E-N'LAGGREGATELIWTAPPLESPER: - :..J POLICYO' 0 LOC �... — ...._ — AUTOMOBILE LIA8833Y I- ANYAUTO ALL AUTOS�ED AUTOS -I J HIRED AUTOS AS QED -- _� UANBRELLA LIAR I-- -- `.00CUR EXCESS LL" _ '_,I CLAVAS MADa --LEI-PEO C RETENTIONS, WORKERS COMPENSATION -- - AND EMPLOYERS' LIABILITY Y I N ANY PROPRIETOR/PARTNERIEXECUTNE OFPICERIMEMBEREXCL.UDED? NIA' (Olandatory In NH) If yy� daeeribe u�dar DES�RP7ION OF OPERATIONS below DEBCRIPTtON OF OPERATIONS I LOCATIONS ( VEMcLES JAMM ACORD 101, Additional RemarksgdnShc In, CERTIFICATE HOLDER — MIAMI SHORES VILLAGE 10050 NE 2ND M"I SHORES FLORIDA 33138 ACORD 25 (2010105) OF THE JORGE 3052310711 p.1 rY INSURANCE I DAM (MV0WYY n 08/12/13 ERS NO RIGHTS UPON THE CERTIFICATE HOLDER Tbi1S ALTER THE COVERAGE AFFORDED BY THE POLICIES CT BETWEEN THE ISSUING INSURER(S), AUTHORIZED Id. It SUBROGATION IS kVE0, subject to - on this C9011011te does not eorlfer rlgtlts to the (305)231-11 11 waldolinsuran[datLnet INSURER jS1 AFFORDING COVERAGE SECURITY INSURANCE - 231-0711 REVISION NUMBER: TO THE INSURED NAMED ABOVE FOR THE POUCY PERIOD - • CT OR OTHER DOCUMENT WITH RESPECT TO wHiCH THIS I ES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, ED BY PAID CLAIMS. CY EFF Ad00 FXP y UMns - EA CH OCCURRENCE_ S DAMAGE i0 RENTED -- PRMIFSF1.000P,000,Q0 2 ' 08/072014 IUEo ExP (Anyoneperson) $ 1,00 PERSONAL &ADV INJURY $ 5,00 GENERAL AG ATE .GATE .1 1,00 PRODUCTS-CONP/OP�s 2,00 $ BODILY INJURY (Per person) 1 $ � BODILY BVJUpRY (Per ecdaent $ _(�r©PEacGRdTMentIAMAGE $ EACH OCCURRENCE - $ AGGREGATE_ - g ''-1 a 57RYLMIT3 C�°T}{_ E.L. EACH ACCIDENT $ I EL. DISEASE -EAEMPLOYE $ FELDISEASE _ PourV I IMaT e spate Is requiredl OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE ON DATE THEREOF, NOTICE WILL BE DELIVERED IN E WITH THE POUCY PROVISIONS, tESENTATIVE - -- ®1588-2010 ACORD CORPORATION. All rights reserved.' The ACORD name and logo are registered marks of ACORD Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-220193 Permit Number: BP2004-1672 Scheduled Inspection Date: September 25, 2014 Permit Type: Imported Permit Inspector: Rodriguez, Jorge Inspection Type: Final Owner: ORTEGON, AMANDA Job Address: 9950 NE 4 Avenue Road Miami Shores, FL 33138-2451 Project: <NONE> Work Classification: <NONE> Phone Number Parcel Number 1132060171160 Contractor: ONE STOP CONSTRUCTION INC Phone: (786)299-7209 comments NEW SPA owner came to do a chenge of contractor and renew the permit 11/5/10 (pending el renewal and paper work in order to release the permit renewed) change of contractor made on 8/1/13 INSPECTOR COMMENTS False September 24, 2014 For Inspections please call: (305)762-4949 Page 30 of 34 Inspector Comments Passed �- Failed Correction Needed ❑ Re -Inspection ❑ Fee No Additional Inspections can be scheduled until re -inspection fee is paid. September 24, 2014 For Inspections please call: (305)762-4949 Page 30 of 34