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DGT-14-840Miami Shores Village Building Department �. 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 7�2.494 BUILDING PERMIT APPLICATION Permit Type: BUILDING Permit No. APR 2 4 2014 FBC 20 Permit No. 007/--/Y— U 0- JOB ADDRESS: -453 IV bA t ILS+ 1, S'I- I City: Miami Shores County: _ Miami Dade lip: 331 3 $ Folio/Parcel# I I — 3 ZD lD — l7 1 LA — 02.1-p O Is the Building Historically Designated: Yes OWNER: Name (Fere Simple Address: 45 3 N E' 4 NO Flood Zone: City:. 2Lt1flL State: Zip: TenantlLessee Email: - 1z5 -o33 9 33138 305 -`7 2. S* - 663 9 CONTRACTOR: Company Name: nel+-i DPS 96.r q.g! t- Phone#: 309 `fes 10200 Address: 12 -2 -SS S � 12S 5+ Su i � Ou City: Irl I A m I State: r—Lm Zip: 3 3 l iS Qualifier Name: NA a A-tVn&.6 v 'PJ c'\/e_ I 1 Phone#: tCY5,-2I3 x-11 Ld 1 State Certification or Registration #: C F1 G 19- 1 '69) -1 Certificate of Competency #• Contact Phone#: 2605"l -A000200 Email Address: mboQe 1112 F I®Q, claap:ga 801 o,_ ( nryn DESIGNER: Architect/Engineer: li \Mane— mrjelc.t,"rn li�Pnne A Phone#.01S4- W6 . SS 2S Value of Work for this Permit: $ I D i W S D . 0 0 Square/Linear Footage of Work: Type of Work: DAddition UAlteration )qNew ORepair/Replace ODemolition Description of Work: T3 u < < c1 'lam ¢c olok Color thru tile: Submittal Fee $ 52f -d"4' Permit Fee $ Senning Fee $ CCF $ CO/CC $ Radon Fee $ DBPR $ Bond $ Notary $ Tndning/Eduetion Fe $ Double Fee $ Structural Review $ Technology Fee $ TOTAL FEE NOW DUE $ Bonding Company's Name (if applicable) Jy 1 A Bonding Company's Address City State Mortgage Lender's Name (if applicable) _ (J 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 EMPROVEMENTS 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 wilapproved and a reinspection fee will be charged Signature or Contractor The fare m n was acknowledged before me this The foregoing instrument was acknowledged before me this 21 day of = , 2 1 , by 7TI,NWj 214e1114.1 day of AeR i 1 .20 , by who is personally known to me or who has produced who ' rsonally kno me or who has praiuced As identification and who did take an oath. NOTARY PUBLIC: My Commission Expires: V gtls ,a�� � NOTARY PUBLIC: :. 6W0u 94e of Florida Print: ' ZU-'f31 ekr-t c u Commission # EE 198163 My comm. expires May K 2016 MY Commission Expires: I 1 J J. BLANCO Notary Public - State of Florida -My Comm. Expires Jul 8. 2017 CommissW * FF 34395 Plans Examiner ' 3, &-Z !:� / /`/ / I / Zoning Structural Review Clerk (Revised 3/12/2012)(Revised 07/1007)(Revised 06110nM)(Revised 3/15/09) GOR CERTIFICATE OF LI IL IT i U RAN ATE MMIDDIM 04/2212014 PRODUCER 305„227_0082 CAROLINA INSURANCE CONSULTANTS, INC 8250 W FLAGLER STREET, STE 916 MIAMI, FL 33144 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE. DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE INSURED FLORIDA PERGOLA, INC 12255 SW 128 ST, SUITE 406 MIAMI, FLORIDA 33186 INsuRERA: SENECA SPECIALTY INSURANCE COMPANY INSURER 8: INSURER C: INSURER D: INSURER E: nnucoAr_rc THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERGA 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSRWIPE OF INS POLICY NUMBER Pa LICY EFiECTIVS POLICY PIRATION DATE (MMfQQW9 LIMBS A GENERALUABILITY X COBAMERCIAL GENERAL LIABILITY CLAIMS MADE ® OCCUR 1 BAK-13561165 04/11/2014 04111/2015 EACH OCCURRENCE S 1,000,000 FIRE DAMAGE (Any one bra) S 100,000 AHED EXP (Airy one person) S 5,000 PERSONAL S ADV INJURY $ 1,000,000 GENERAL AGGREGATE S 2,000,000 GEML AGGREGATE LIMIT APPLIES PER X POLICY pOE LOC PRODUCTS - COAMPBDP AGO S 2,000,000 AUTOMOBILE LIABILITY ANY AUTO ALL OWNEDAUTOS SCHEDULEDAUTOS HIRED AUTOS NON -OWNED AUTOS COMBINED SINGLE LIAUI' S (Ea aceMenq SOOILY INJURY (Perperson) S BODILY INJURY (Pera=wo* S PROPERTY DAMAGE S (Peracddant) GARAGE LIABILITY ANY AUTO AUTO ONLY - EA ACCIDENT S OTHER THAN EA ACC S AUTO ONLY: AGO S EXCESS LIABILITY OCCUR E]CLAIMS MADE DEDUCTIBLE RETENTION S EACH OCCURRENCE S AGGREGATE S S S S WORKERS COMPENSATION AND EMPLOYERS' LIABILITY WC ATU- TORY UMITS ER EL EACH ACCIDENT S E.L. DISEASE - EA EMPLOYEE S E.L. DISEASE - POLICY LIMIT S OTHER DESCRIPTION OF OPERATIONSILOCAT=SIVEHICLESIEXCLUSIONS ADDED BY ENDORSEMENTMPECIAL PROVISIONS MATTHEW BOVELL: CGC1518817 cin. ncm 1 V 1 rALIrCI 1 ATIAAI ACORD 25-5 (7187) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOP, THE ISSUING INSURER WILL ENDEAVOR TO MAI DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SD SHALL MIAMI SHORES VILLAGE IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR 10050 NW 2 AVE MIAMI SHORES, FL. 33138 REPRES'dNTATIVES. ` AUTHORIZED REPRESENTATIVE ACORD 25-5 (7187) .'. NOTICE OF COMMENCEMENT RECORDED CopyTBE PWTEOON THE JOB SITE AT TIME OF iii. FLIO NO. '320L, rq W00 PERMIT NO�, STATE OF FLORIDA: COUNTY OF MIAMI-DADE: THE UNDERSIGNED hereby gives notice that improvements will be made to certain real property, and In accordance with Chapter 713, Florida Statutes, the following information is provided In this Notice of Commencement. OR Ni, 29129 F's 1349; Qps) RECORDED 04/29/2014 13902:24 HARVEY RUVINP CLERK OF COURT i`IAMI-DADE iOUNTYP FLORIDA AC -T MAA. Asia— mauve reservee Tor use of recording office 1. Legal description of property and street/address: U 5 B �-j � �t � �. �. tis : �.,. � � ,- � 2. Description of improvement: 1, LA i % IP -C --)I -,, ;i. vwner(s) name and address: _ bin �� ::_. �E_g n@� is6 a e , ":'A f; � P_ e t��U Interest In property: �0 L"i -_'L� t Name and address of fee simple titleholder: 4. Contractor's name, address and phone number. 5� t 4-C LAD LO 5. Surety: (Payment bond required by owner from contractor, If any) Name, address and phone number: Amount of bond $ 6. Lender's name and address: _ & 7. Persons within the State of Florida designated by Owner upon whom notices or other documents may be served as provided by Section 713.13(1)(a)7., Florida Statutes, Name, address and phone number 8. In addition to himself, Owners designates the following person(s) to receive a copy of the Lienor's Notice as provided in Section 713.13(1)(b), Florida Statutes. Name, address and phone number. 9. Expiration date of this Notice of Commencement: tore expiration date is 4 year from the date of recording unless a different date is specUiaq WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT ARE CONSIDER® IMPROPER PAYMENTS UNDER CHAPTER 713, PART I, SECTION 713.13. FLORIDA STATUTES, AND CAN RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SiTE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT. Signature(s) of Owner(s) or Owner(s)' Authorized Officer/Director/Partner/Manager Prepared By Prepared By Print Name TV!DeAr%az� '2-a Print Name Title/Office Title/office STATE OF FLORIDA COUNTY OF MiAMI-DADE The foregoing Instrument was acknowledged before me this day of By 1] Individually, or as for Personally known, or educed the following type of identification: Signature of Notary Public: Print Name: (SEAL) �R1FiOATi1®IiQ P1111SLIBil6a4T TOSf€C1"Q®1�9 923�5 FFEI ORl®A S'PrirF R 1 Under penalties of pet)ury, I declare that i have read the for oin FLORIDA, COUNT OF DAD that the facts stated in it are true, to the best of B,Y CERTIFY that this is a true copy Lf_'31 My knowledge ai'� 4&Id in this office on Signa e(t� s) of 6wns o day of f',�wn )'s,�todzed Officer/Director sl npd ✓e: BY ,�� ".' �.,�' t _,'�� r?v N._S d Official Seat. 123_01 -re PAOE3 8M2 / e4Z ��' 1� ' u Notary Pubfic. State of Florida Co ' E 198163 I t_V 14,2016 V " � f':_ /��) • • ••• • • • ••• : ! Wil-- . AO 2�2�;' " • • • •• • Zt age -moi G _u • • • ��'' • ` .j .3g 1 • •� • • • • �., 14 Z-07 !8 LGiT 20 I'll T vv ,l ` /Z z 2 e7od �3 7� 4/� � �• / t.' .' 1�' Ste- ftp' �N 67 Sz � . • -rte s,.a�uc� - -- v .�� � v - 02ea Me ,O yea LT`. e'X it 2 •( 77GE �i1. , O Peva oQtL.G 'Q N riszt `V ,0 :t'` 46 sever • . • .CO �' •• �s iirle��e7ei' '_. _ _ T '• --__ _ � U PRS' R f• !/n7c7 lk �• qty --- ",- OMMAM Certified To: Rapid. Title Services Company; Commonwealth Land. 'Title insurance Company; Thomas Zibelli and Any Zibelli and Metlife Bank, N.A., its successors and/or assigns as their interest map appear. EGD S74 WCAM 00cm a-- aRDirJtfls Svc= .rest LOM 06$giJ . The East I of Lot 18 and all of Lots 19 and 20, ]Block 5G..NIAMI SHOnS SECTION 2, aecording to the Plat thereof, as recorded in Plat Book 10, Pago.37 of the Public Records of Miami -Dade County, Florida. -A HUN Mb I Gn MA CAMS v 9 OiA' a/2 at /4 er 8 7 /4$ AW 09*0 :Si wo AD-) .rest LOM 06$giJ . The East I of Lot 18 and all of Lots 19 and 20, ]Block 5G..NIAMI SHOnS SECTION 2, aecording to the Plat thereof, as recorded in Plat Book 10, Pago.37 of the Public Records of Miami -Dade County, Florida.