Loading...
DS-14-1236Miami 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 FBC 201 C� BUILDING Permit No. ILA - 125 G PERMIT APPLICATION Master Permit No. FI --L I" o � Q-1_- Permit Type BUILDING ROOFING JOB ADDRESS: , �s :4 !� r—z. 9 �Z_ s l City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: 1 1 2 0_ 4 0 1:�> --Z, -? (3 Is the Building Historically Designated: Yes NO Zone: OWNER: Name (Fee Simple Titleholder):5 d L SPhone#: Address: 1'5 ) W5 P a 2 - City: City: q/� I& onall 5 4a ,�A 2 k State: ��-- zip: � __3 / 31 r� Tenant/Lessee Name: Email: CONTRACT'-7&__OOR: Company Name: 1�f � � B �`� � �t� � � �-- Phone#30-S n % � Address: z W;0' 0 S C� a/ 2 14-Uf City: State: Qualifier Name: iJ� _ �� ��'� Phone#: 3cf� hr2_ State Certification or Registration #: Certificate of Competency #: Contact Phone#: Email Address: AM d &/V & C_ ® DESIGNER: Architect/Engineer. PrzC_C�(�—, &_ tM,�L k_- Phone#: Value of Work for this Permit: $ Z --S. Square/Linear Footage of Work: l/ Type of Work: DAddition DAlteration ONeew� Offepair/Replace ODemolition Description of Work: S L— A- � (^'�- (AI r-, A AA� Color thru tile: Submittal Fee $ Permit Fee $ CCF $ CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ 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 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 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 will be charged. ff The foregoing ins''' ' " rnowledged before me this Z The fo day ofd V K L-Tn , 20 �, by :;�I, o, 6 "g ra-e-- , day of who is personally known to me or who has produced - &-" identification and who did take an oath. ND•rA 0V 1MTTv7 7r. Sigr Prm My who is before me this -Z, j to me or who has produced ,PM SP„ ty— was identification and who did take an oath. APPROVED BY Plans Examiner Structural Review (Revised 3/1212012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09) My Commission Expiry DAA1��na De7A.- Zoning Clerk STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD 1940 NORTH-MONROE STREET TALLAHASSEE FL 32399-0783 WELLER, EDWARD M AMCON GROUP, INC. P 0 BOX 430097 MIAMI FL 33143 Congrdti.ilatlonsl Vft this license you bownte one of the nearly one n1lillm Floridians licensed by the Department of Business and Professional Regulation. Our professionals and businesses range NATE; 0EPAftl from architects to yacht brokers, from boxers to badxxpje restaurants, PR�' FCE5rlFJE and they keep Florida's economy strong. �F -qGd�15220 '00 Every day we work to IrMrove the way we do business In order to serve you better. For Information about our services, please log onto www.myfloridallicanse.com. There you can find more irdormadon -9- P. about our divisions and the regulations that impact you, subscribe 'Vr'! 'M A W - A 0 W to dementand leam more about the Departments ,niti newsletters Z9. A - - Our mission at the Departnuft Is: License Efficiently. Regulate Fairly. We constantly strive to serve you better so that you can serve your customers Thank you for doing business in Florida, :E4xk6WW*- 1,20 c0n.A* and congratulations on your new license! mhomm (850)487-1395 FFLORIDA A ..Flu! U'' P ftp S' 01 46,f 'S The Department of State is leading the commemoration of Florida's 500th anniversary In 2013. For more irddnymton, please go to www.VivaFladda.org. DETACH HERE 1 RICK.SCOTT, GOVERNOR -STATJEOF FLORIDA! 1�w QCRETAft, OEPARTAM _0P BUCONiSTRIJOTiSMESS AND m6pSokSIRSTLtY ALUtAT = j Thei-GENFRAI-CQNTRACTOR-_�,­ J #r4$ .Fs _45 ........ e -46w lLex ARD VIARDIDAW ISSUeM 01121/2014 SEQ # 1.14011210000804 DISPLAY AS REQUIRED BY LAW 1W k40W ot W 3ROUP WC SEC. TYPE OF %Q*r4ESG 196 PAYMENT LER �� 01 EDWA9" qP004 BuILDsm BV TAX C OR 46WfliETOR tte CGCI%O-M '7m-.00 026-14-O0',€f'i31 Tax lsly tofto L*cnl basinem Tax. UWAocelpt is g6jo fic*awg,— 1dOsamess. Holder mm cooply witj aw, to"ramosul 11. ro" 'w VOW VOPF"We and rlqjjroj� apply NO 0116"41W be displayed an a ct***rclal Code Sor#*4.*. $610M Isferintion, visit 6#4 pt A AMCOBUI-01 CLAUDIA A� CERTIFICATE OF LIABILITY INSURANCE DATE D/YYYY) 6/5/2014 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 endorsement(s). PRODUCER ACrisure, LLC d/b/a InSource 9500 South Dadeland Boulevard CONTACT PHONE FAX A/c No Ext): (305) 670-6111 AIC No): (305) 670-9699 4th Floor Miami, FL 33156-2867 ADDRESS: INSURERS AFFORDING COVERAGE NAIC # X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE T OCCUR INSURER A: Scottsdale Insurance Company 41297 INSURED Amcon Builders, Inc. & Amcon Group, Inc INSURER B INSURER C : EACH OCCURRENCE $ 1,000,000 9800 S.W. 92 Avenue INSURER D: INSURER E: Miami, FL 33176 INSURER F : GENERAL AGGREGATE $ 2,000,00 L;UVtKAUt:S CERTIFICATE NUMRFR- RFVICInkl k1l IMRGa- 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. INSRADDL LTR TYPE OF INSURANCE SUB Jffia POLICY NUMBER POLICY EFF MM/DO POLICY EXP MM/DD LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE T OCCUR CPS1928801 01/22/2014 01/22/2015 EACH OCCURRENCE $ 1,000,000 PREMISES Ea occurrence $ 50,000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY ❑ JECT F—]Lor, OTHER: GENERAL AGGREGATE $ 2,000,00 PRODUCTS - COM P/OPAGG $ 1,000,00 $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS NON -OWNED AUTOS COMBINED SINGLE LIMIT $ Es accident BODILY INJURY (Par person) $ t ) BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ Per accident UMBRELLA LIAROCCUR EXCESS LIAB CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? ❑ (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A I PER OTH- STATUTE ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) General Contractor. CGCO12427, CGC1522000 Miami Shores Village Building Department 10050 NE 2nd Ave Miami Shores, FL 33138 140Ll[yg14 Ill rIs] ,I 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 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD CERTIFICATE OF LIABILITY INSURANCE Date I SM/2014 produce: Lion insurance Company This Icarthicaw is as a marU oaf irda mutlan oak mW awders 2739 U.S. Highway 19 N. Holiday, FL 34691 dgMs upon the CaMade Holder. This CerUflaft does oo tattaetd, eldotd or alter tim axerage mTwded by the pedes below. I Insurars Affording Coverage NAAIC # (727) 938-5562 Insured!* South East Personnel Leasing, Inc. & Subsidiaries 2739 U.S. Highway 19 N. Holiday, FL 34691 Insurer A: Lion bwurance cornpw 11075 Insurers- Inswer C. Insurer D: Insurer E Coverages lire poiNoWthStancing arty regWfw m term orcor0tion of arty corm Grow aoaar�rrt wish respect to wNM 099 certificate may be Issued or may Partin, ttre Insurance afforded by ft potides descobed hervin is ateatban the term, oxcluatone, and conditions of such PaM& Aggregate quits sham may have been reduced by pald dams. *M LTR AWL INSRO Type of Insurance Policy Number � P Exp olicyDate Limits (►2o►YY) (MMDNY) GENERAL LIABILITY Each Ocoarence Commercial General Liability Claims Made 13 Occur Darnago, to rentad prentses (EA Med E Pemnd Adv Injury neral aggregate limit applies per. Policy ❑ P-oct ❑ LOC Aggregate Product -CmWOpAgg UTOMOBILEE LIABILITY combinedShge UMt (EA Accident) Arty Auto awiy " AD Owned Auto$ ScMdulad Autos (Per Parson) '8 Bo* ft" Wed Autos Non-Owned Autos (Per Accident) Propely (ParAcdclant) EXCESSIUMBRELLA LIABILITY Each Occurrence Aggregate Occur 13cleft(Nada A Workers Compensation and Employers' Liability WC 71949 01/01/2014 01/01/2015 X We Ste+- toryLbnata OTH- ER E.L. Each Aardernt S1 000 QOo Any propdetwotflcefterriber E.L. Disuse-Ea Emplempe $1.00000 tded? NO KYes, describe wider spadel pfovislons below. E L Disease- Policy Uffft S1,txxltxl0 other I Lion insurance Company Is A.M. Best ConqmW rated A- ceiletlt AMB # 1"16 Descriptions of Operstdotm/LamtionsNehicles/Exclusions added by Endorsement/Special Provisions: pleat ID. 81-73.013 Coverage only applies to active employee(s) of South East Personnel Leasing, bin & StdxiidWes that are leased to the following "Client Company": Arron (croup, bin Coverage only applies to injuries Incurred by South East Personnel Leasing, Inc & stftdiaries active ernployee(s„ while woeft in: FL Coverage does not aWly to stabAofyr empioyee(s) or Indepe cla t contractor(s) of the Client t ompwry or any other entry. A Obt of the active employee(s) leased to the Client Company can be obtained by faxing a request to (727) 937-2138 or by caSng (727) 938=5562. Karrw Piroject ISSUE 02-18.14 (IdD) REISSUE 02-25-14 (EP) sedo Date U181=2 CERTIFICATENOLDERELLAUCIN MIAMI SHORES VILLAGE d any or the avow descrIM Pouaea be ==Hadberore tlne dffie the rss� irrumwuiondwRwtornau3*409w nrx4mtotreoarggca<eto do so mo knee no o Won or bW[fty of any Idrid upon the Insurer, b "NO Of rapresr*Nve& 10050 NE 2ND AVE MIAMI SHORES, FL 33138 ,�