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FW-14-2489ire mCA 2-0�� stip BUILDING PERMIT APPLICATION Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 'BUILDING ❑ ELECTRIC ❑ ROOFING FBC 20 a Master Permit Noud — l y - Sub Permit No. ❑ REVISION ❑ EXTENSION ❑ RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 1411 X 104 f4 rtft City: Miami Shores County Miami Dade Zip: Folio/Parcel#: 1/22 320 3-76 o9 0 Is the Building Historically Designated: Yes NO Occupancy Type: 44S Load: Construction Type: Flood Zone: BFE: FFE: // r OWNER: Name (Fee Simple Titleholder): 1417 ✓s 7 i 0 ✓aryil%E L ��/P- Phone#: %30 1-7-9 City: /Vzern"' S'!�!drrJ State: 11� Zip: , 3J12 te Tenant/Lessee Name: Email: v ne#: I- CONTRACTOR: Company Name: v'✓his `��f�rLG��� jaG Phone#: �J ¢� 0 3r, 74¢s Address: /36sp /) w SW City: syhl^/LC State: �L Zip: 3332 Qualifier Name: l�dOvim► AIdt, Ala---- Phone#: 9r¢'&3f- State Certification or Registration #: C&e 16-L Certificate of Competency #: _ DESIGNER: Architect/Engineer: N/A Phone#: Address: City: State: Zip: -- Value of Work for this Permit: $ /2 ,Square/Linear Footage of Work: d' Type of Work: ❑ Addition ❑ Alteration New ❑ Repair/Replace ❑ Demolition Description of Work: ca„s��vetper' 7r If ®� M -4 -(Or W,t/l r., Specify color of color thru tile: Submittal Fee $ Permit Fee Q0 CCF $ a CO/CC $ 92 Scanning Fee $ � Radon Fee $ _ DBPR : = Notary $ Technology Fee $_ Training/Education Fee $ Double Fee $ Structural Reviews $ Bond $ TOTAL FEE NOW DUE $ (Revised02/24/2014) zj P Bonding Company's Name (if applicable) Bonding Company's Address City State Mortgage Lender's Name (if applicable) Mortgage Lender's Address City A11A N �i4 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 ELECTRIC, PLUMBING, SIGNS, POOLS, FURNACES, BOILERS, HEATERS, TANKS, 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. Signature OWNER or A The foregoing instrument was acknowledged before me this day of 20 10 by who is personally known to me or who has produced FL Q L_ as identification and who did take an oath. NOTARY PUBLIC: Signature tNTSRAR The foregoing instrument was acknowledged before me this lIS4k day of 201 Y by r �i !l who is personally known to me or who has produced identification and who did take an oath. NOTARY PUBLIC: as Print: Print: �' ^ ` Seal: ;��+ - � :; • hl • - Seal: LIANA M. RODRIGUEZ Not Public - State of Florida]* \\1 NY11jII 2 :� �� = �: _ ', LIANA M. RODRIGUEZ Notar p Y ublic - State =,: + •` ;,; My Comm. Expires = •3;: of Florida MY Comm Expires Sep 4, 2015 Commission # EE I7T�7 `. ;;;, S C. Sep 4. 2015 **�* ***-0'2�'s� APPROVED BY (I I 111 Plans Examiner Structural Review (Revised02/24/2014) Zoning Clerk 9 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487-1395 W. 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 MACNAIR, CHRISTOPHER JOHN BAYSHORE CONSTRUCTION GROUP LLC 12450 PINE NEEDLE LANE MIAMI FL 33156 Congratulations! With this license you become one of the nearly one mrl ion Floridians licensed by the Department of Business and Professional Regulation. Our professionals and businesses range from architects to yacht brokers, from boxers to barbeque restaurants and they keep Florida's economy strong. Every day we work to improve the way we do business in order to serve you better. For information about our services, please log onto www.myfloridalicense.com. There you can find more information about our divisions and the regulations that impact you, subscribe to department newsletters and learn more about the Department's initiatives. Our mission at the Department 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, and congratulations on your new license! It STATE OF F DEPARTMEI ^_• p PROFESStC CGC1620914 ?A BUSINESS AND EGULATION' Eb � s 08117/2014 DETACH HERE RICK SCOTT, GOVERNOR STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFE CONSTRUCTION INDUSTRY LICEI CGC1520914 to GENERAL CONTRACTOR amed.below IS CERTIFIED ider the provisions of Chapter 489 FS, tpiration date: AUG 31, 2016 :;:loi►��f=i:�BY"61II►®Ill WAIFfiTfiW•® _:'4I;qINI- 115 S. Andrews Ave., Rm. A-100, Ft. Lauderdale, FL 33301-1895 — 954-831-4000 VALID OCTOBER 1, 2014 THROUGH SEPTEMBER 30, 2015 DBA: BAYSHORE CONSTRUCTION GROUP, LLC Receipt :GENOERA3L4 CONTRACTOR Business Name: Business Typee: Owner Name: CHRISTOPHER J MACNAIR (QUAL) Business Opened:07/09/2010 Business. Location: 13680 NW 5 ST STE 220 State/County/Cert/Reg:CBC1251730, QB30069 SUNRISE Exemption Code: Business Phone: 954-838-7445 Rooms Seats Employees Machines Professionals 5 For Vending Business Only Number of Mar_hina_c� Vcnrlinn Tunn• Tax Amount Transfer Fee 1 NSF Fee Penalty Prior Years Collection Cost Total Paid 27.00 0.00 0.00 0.00 0.00 1 0.00 27.00 THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS THIS BECOMES A TAX RECEIPT This tax is levied for the privilege of doing business within Broward County and is non -regulatory in nature. You must meet all County and/or Municipality planning WHEN VALIDATED and zoning requirements. This Business Tax Receipt must be transferred when the business is sold, business name has changed or you have moved the business location. This receipt does not indicate that the business is legal or that it is in compliance with State or local laws and regulations. Mailing Address: BAYSHORE CONSTRUCTION GROUP, LLC Receipt #01A-13-00006897 13680 NW 5 ST STE 220 Paid 09/11/2014 27.00 SUNRISE, FL 33325 2014 -2015 BAYSCON-01 SSIMEON A� R�'1 CERTIFICATE OF LIABILITY INSURANCE DATE 1212 /Y4 11/12/2014 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 Collinsworth, Alter, Fowler 8, French, LLC 8000 Governors Square Blvd Suite 301 Miami Lakes, FL 33016 CONTACT NAME: PHONE FAX AIC No E305xt : ) 822-7800 No: 305 362-2443 E-MAIL ADDRESS: INSURERS) AFFORDING COVERAGE NAIC # INSURERA:Amerisure Mutual Ins Co 23396 4/15/2015 INSURED INSURER B:Amerisure Insurance Co 19488 Bayshore Construction Group, LLC 13680 NW 5th St Suite 220 INSURER C: INSURER D: INSURER E: Sunrise, FL 33325 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 INSURANCEADDLSUBR THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE 2nd Avenue POLICY NUMBER POLICY EFF MM/DD POLICY EXP MM/DD LIMBS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR GL20822970202 4/15/2014 4/15/2015 EACH OCCURRENCE $ 1,000,00 TO RENTED PREMISES Ea occurrence $ 100,000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY X PROLOC PRODUCTS - COMP/OP AGG $ 2,000,00 $ A AUTOMOBILE X LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOSAUTOS X NON -OWNED HIRED AUTOS CA20536320602 4/15/2014 4/15/2015 accINED SINGLE LIMIT $ 1,000,000 (CEO,MBident BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ Per accident A X UMBRELLA LIAR EXCESS LIAB X OCCUR CLAIMS -MADE CU20397360702 4/15/2014 4/15/2015 EACH OCCURRENCE $ 5,000,00 AGGREGATE $ 5,000,00 DED I X I RETENTION $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBEREXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A WC203645808 4/15/2014 4/15/2015 X WC STATU- OTH- TORY LIMITS ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,00 E.L. DISEASE - POLICY LIMIT $ 1,000,00 A Equipment Floater CPP20367270802 4/15/2014 4/15/2015 Ded $1,000 50,00 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, K more space is required) CGC 1520914 CFRTIFICATF HOLnFR CANCFLLATION ACORD 25 (2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Miami Shores Village Building Department THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE 2nd Avenue AUTHORIZED REPRESENTATIVE I C/* 441,11- Miami Shores, FL 33138 I I ACORD 25 (2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD