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SGN-12-1238Miami 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) 762.4949 1���fi�tiv�C.t�,uc� PERMIT APPLICATION Permit Type: JOB ADDRESS: City: Folio/Parcel#: Permit No. FBC 20 Master Permit No. S�� 11 -- BUILDING ROOFING 4 Is the Building Historically Designated: Yes OWNER: Name (Fee Simple City: 1 ]AX 1 .ac Y) it (—>r [� Tenant/Lessee Name: Email: CONTRACTOR: Company Name. Address , 10 ( M i aL. City: Qualifier Name: _ County: Zip: v W KIE, _Z_ 4-4 NO Flood Zone: _V,aidt F_•_ �ALM(MW� State: Zip: 3-3 1 Phone#: a 4F ,2b ,4041 rhone#: State Certification ror Roe istration,#: 49i 8� Certificat f Com &n�}l #: y . Contact Phone#: t I a � Email Address ca "�' i p "� �'` C4� DESIGNER: Architect/Engineer: Phone#: Value of Work for this Permit: $ Square/Linear Footage of Work: Type of Work: ❑Addition ❑Altration ❑New ❑Repair/Replace ❑Demolition Description of Work: 4�k i N 1 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 broAa e will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of com enent must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. I�hBence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature Owner or Agent The foregoing.instrument;was acknowledged before me this . day of ao 201k, by I(M t3ftifoum who is erson yknown o me or who has produced As identification and who did take an oath. NOTARY PUBLIC: Sign: Contractor The foregoing instrument w �ackno led ed before me this e� day of 20 ' 4b IBJ 1 who is personally known to me or who has produced / as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: WA U Print: My Commission Expires: `'' : BXWAA A, ESTEP MY COMMISSION# 0955300 My Commission Expires Z. �. "�' , ^' c a5; �� EXPIRES. Marsh 29, 2014 �..Q c�O • � _ �" rn tDC Z SOnded Thr„ Notary Public UndLwrIlefs 'l 0-41--elans APPROVED BYze,40; Examiner Zoning Structural Review (Revised 3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09) Clerk X41 OP ID: TC ACURL?' CERTIFICATE OF LIABILITY INSURANCE � DATE (M28/1 YYY) 06/28/12 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 305-223-2533 iSure Insurance Brokers 2700 SW 137 AVE 305-220-0765 Miami, FL 33175 Teresa R. Carmona, Agent CONTACT NAME: OE AHCNNo, Ext): AIC No): E-MAIL PRODUCER CUSTOMER ID #: RELIA-1 INSURERS) AFFORDING COVERAGE NAIC # EACH OCCURRENCE 1,000,00 INSURED Reliable Concrete Corp-dba INSURER A: Evanston Ins. Co. PERSONAL &ADV INJURY $ 1,000,00 Reliable Construction Group Camilo Mejia 1101 SW 18 Ct. Ft Lauderdale, FL 33315 INSURER B: Florida Citrus, Business (FUB) KGEN'LAGGREGATELIMITAPPLIESPER: POLICY PRO LOC INSURER C: Travelers Property Casualty Co $ INSURERD:American Zurich Insurance Co. AUTOMOBILE X X X INSURER E: INSURER F: 08/24/11 08/24/12 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 OF INSURANCE ADDLSUBRPTYPE POLICY NUMBER MM% DYE XP MM/LDD1YY YY LIMITS A A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE EKOCCUR X Blanket Add'I Ins 3DK1660 FORM # ME00901(01-09) 05/13/12 05/13/13 EACH OCCURRENCE 1,000,00 _$ DAMAGE TO RE= PREMISES Ea occurrence)_ $ 100,00 MED EXP (Any one person) $ 1,00 PERSONAL &ADV INJURY $ 1,000,00 GENERALAGGREGATE $ 2,000,00 KGEN'LAGGREGATELIMITAPPLIESPER: POLICY PRO LOC PRODUCTS-COMPIOPAGG $ 1,000,000 $ C C C AUTOMOBILE X X X LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULEDAUTOS HIRED AUTOS NON -OWNED AUTOS BA5A337096 08/24/11 08/24/12 COMBINED SINGLE LIMIT $ 500,00 (Ea accident) BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ (Per acddent) $ $ UMBRELLA LIAB EXCESS LAB HCLAIMS-MADE OCCUR EACH OCCURRENCE $ AGGREGATE T $ DEDUCTIBLE RETENTION $ _ $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVEY/❑N OFFICER/MEMBER EXCLUDED? (Mandatory in NH) Ifes, describe under DESCRIPTION OF OPERATIONS below N/A 10639768 04/01/12 04/01/13 X VvC STATU- 15T TOR LIMITS ER E.L. EACH ACCIDENT $ 1,000,00 E.L. DISEASE - EA EMPLOYEd $ 1,000,00 E.L. DISEASE - POLICY LIMIT 1 $ 1,000,00 C Equipment Floater EC70839511 01/26/12 01/26/13 �Equiment 58,00 DESCRIPTION OF OPERATIONS/ LOCATIONS /VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) CONCRETE CITYMI1 City of Miami Shores Fax:305-756-8972 10050 NE 2 Ave Miami, 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 ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD a 14 . . t ALUMINUM OR COPPER COVER SEALANT I F THK, TEMPERED GLASS DETAIL B ALL HARDWARE TO BE SCALE- llm-l'—O' STAINLESS STEEL IvPrL. THK, BASE I +- 6## VC THK, PERED GLASS ADVESIVE SEALANT FOR 25 PSI MIN. 4ZWPAP d.-J*OX3"LG. 4. COUNTERSINK 2- rOxg"LG. .4 STAINLESS STEEL STAINLESS MECHANICAL 4 STEEL BOLT. FASTENER 1P V 04 O.C. A . 10 w .44.. A 4 4 DETAIL ALL HARDWARE STAINLESS STEE INGE D W, , =Wf Nic - rA STA PAW:# e v- N DBfi V N- 'j* *t A lr-l�-00� S -I PLAN NOTES: SCAM I. nsm ww" em M =0 EXONK MmAm 7 "m I" wm% 1AIM mm 10 AM ANO SM STMONA1111141 NMIL MW W LAIM MUM IN OF= COO W W 11AT9 OR j= & Ammmw MAO ww IN mw Immm-cm 00"Nomem"NI Or", De oMRBMEM X em WO ON IM 00100 '8r0lNOTI MW IN AMMAIM WIOI AG ML *MUM OW OMMMM FOR AMPNOW CMWW ALL OMMM 111= WALL K 013111111LICIED IN MV AMM WIN ADI 310. 4. ON M WINIX 244L W PINN"1141011D IN A0=R 1117H AG XN. VIUMAINNO I= 6111113111111AL =IMW AS AG 211.". 111100110M PRACM MR fEttCRNO FORIONIN47M RR NOWA MW CMXWW 10 FAMXIE IM FIRIA0111110 L AONMTM- MM MlnhOM AI1M1XNJM-:::W OI,� U vamp-.-. L NNW CONISM WILL BE SAICHED. MUM AM INNOMM IN ACCWAMM W1H A13 301. GNW= 7. 7. MMM WWM 10 ACI 301. OiWrlill IL L =291WIRL COMFOO1111 TO ACI M. SWIXW IIIA4 VE immF av==L=MWM 6. *AO WINIAN NAI (W -dA M"NA=* 111111FWAS W .... symm -:-. R M I T . . L "OhrNAAM eRABE ea Miami. 6 10 ;t to IV 7- '4 7 4 L7—] U 4—j . Al 4 PIBRLATi .......... rASIa APPROVED AM AW. Z=1=NT MKWUM "M OW ON rjm O T mwm pRaff 10 as mm TO tMIL A11) Nfa 10 THE OMMM UK AN "M IN SIM AOINNOMMIZ ORM = MMRn ZONING DEPT rjkf�10111114011m - 0.0 VAION cowomm avina a, = oz;^; IT 16 1/2 WW OR MISAM. MAN [)F�7,T 10 ram I I OIL mwbr1ww.JLw WIA 11M FAII11OLLY EMISIMM IN COMM NULL NOT N Mb Wff MUM OR sme CE Vvi FH ALL FEDERALS U E5 E 11. MUML 00 MDT 110 b U101 MOLM MM OR AMCNM BY ONE ENOM NMN AlliffaM WORINIM TO DIA �-ANL)CC-1�,NierilL-ESAPIDREGIJL-A"TIONS IL PL99 WIS IN AGOOMAINZ IM = %A*W MWORC11111 LVW. KWMI $0 = TO FRUNT FK0JEVI` DeRose Design 911 MEMORIAL BEAM I Consultants Inc. FOR: MIAMI SHORES VILLAGEI LAND PLANNING 0 CIVIL * STRUCTURAL *TffLr- ENVIRONMENTAL 0 ELECTRICAL * MECHANICAL 470 S.StIN SUITE AVENUE HOUSING DETAIL FOR 911 1 BEAM QgRwm,z w 200 #010MMN # 41101 POMPANO BEACH, FLORIDA 33069 DRAW4- DATE:- PRCk1ECT NO usam-mm!"D (W) 942-7703 R.W. 1 04/24/12 1 )00( GLASS STEEL MONUMENT 54mx54*x12'DEEP 3000 PSI CONCRETE PLJN1`H W/4-#5 EACH WAY MID DEPTH.(ADD 4-#5 'Z' BARS 4 SIDES.) 66mx66mx160DEEP 3000 PSI CONCRETE FOOTING W/5-#5 EACH WAY TOP AND BOTTOM ON TAMPED COMPACTED FILL. I S-1 A E 7 1 4 Alf 4 7- '4 7 4 L7—] U 4—j . Al 4 PIBRLATi .......... rASIa APPROVED AM AW. Z=1=NT MKWUM "M OW ON rjm O T mwm pRaff 10 as mm TO tMIL A11) Nfa 10 THE OMMM UK AN "M IN SIM AOINNOMMIZ ORM = MMRn ZONING DEPT rjkf�10111114011m - 0.0 VAION cowomm avina a, = oz;^; IT 16 1/2 WW OR MISAM. MAN [)F�7,T 10 ram I I OIL mwbr1ww.JLw WIA 11M FAII11OLLY EMISIMM IN COMM NULL NOT N Mb Wff MUM OR sme CE Vvi FH ALL FEDERALS U E5 E 11. MUML 00 MDT 110 b U101 MOLM MM OR AMCNM BY ONE ENOM NMN AlliffaM WORINIM TO DIA �-ANL)CC-1�,NierilL-ESAPIDREGIJL-A"TIONS IL PL99 WIS IN AGOOMAINZ IM = %A*W MWORC11111 LVW. KWMI $0 = TO FRUNT FK0JEVI` DeRose Design 911 MEMORIAL BEAM I Consultants Inc. FOR: MIAMI SHORES VILLAGEI LAND PLANNING 0 CIVIL * STRUCTURAL *TffLr- ENVIRONMENTAL 0 ELECTRICAL * MECHANICAL 470 S.StIN SUITE AVENUE HOUSING DETAIL FOR 911 1 BEAM QgRwm,z w 200 #010MMN # 41101 POMPANO BEACH, FLORIDA 33069 DRAW4- DATE:- PRCk1ECT NO usam-mm!"D (W) 942-7703 R.W. 1 04/24/12 1 )00( GLASS STEEL MONUMENT 54mx54*x12'DEEP 3000 PSI CONCRETE PLJN1`H W/4-#5 EACH WAY MID DEPTH.(ADD 4-#5 'Z' BARS 4 SIDES.) 66mx66mx160DEEP 3000 PSI CONCRETE FOOTING W/5-#5 EACH WAY TOP AND BOTTOM ON TAMPED COMPACTED FILL. I S-1