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CC-14-21194 A Miami Permfdoctor.c om 305-962-6728 BUILDING PERMIT APPLICATION 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 SEPrg 9 2014 ��FnnBC 20 ins Master Permit No. - N - ?° I Sub Permit No. ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP Q.�, �' 0CONTRACTOR DRAWINGS JOB ADDRESS: loci Iscl A" 9j1�10 City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: fl � S W,6 '—Cl 8 "— Q 0-7 G" Is the Building Historically Designated: Yes NO C Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): 5 I -10W �LT1�G�d7� PRO Phon e#: Address: 62I Ll �)C Z 'S City: aj 1-0,qA / Stater Zip: ( 61 sit Tenant/Lessee Name: Phone#:.' %fin X07( Email:n��S l ��✓�? r°bCJ� c"eel --j CONTRACTOR: Company Name: �.'CC;%'`"�'� ✓ Phone#: Address: 12 U %2/L/� City: f c?III State: /Z-7 Zip:�� QualifierName: 1 �� l�s �"t-`i Phone#: �/L� �f% V% V-6 State Certification or Registration #: �- 1� /- S j} Certificate of Competency #: DESIGNER: Architect/Ensinew: �G r,��v2/ �:c��r is �� Phone#:7,—�',-7 ;;Sl 7 Address: 32 70 7 OJ 1, Value of Work for this Permit: $�1-� j o o Type of Work: ❑ Addition 2) Alteration Description of Work: ( U k,—Q-(Gott City- eleA /142& State: - Zip: Square/Linear Footage of Work:®y ❑ New 0 'UT Spqc C inn ❑ Repair/Replace C m (-( e Cq -)�Lcz4cflui ❑ Demolition Specify color of color-thru tile;,"*._. Submittal Fee $ a Permit Fee $ ,)j , J M CCF $ CO/CC $ Scanning Fee $ Technology Fee $ Structural Reviews $ (Revised02/24/2014) Radon Fee $ Training/Education Fee $ DBPR $ Notary $ Double Fee $ Bond $ 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 Zip City State A 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 apd-a reinspection fee will be charged. OWNER or AGENT The foregoing° instrument was acknowledged before me this day of S 20 1'5�' , by who is personally known to me or who has produced as identification and who did take an oath. Signature !!jk !� CONTRACTOR The foregoing instrument was acknowledged before me this Z5' day of , 20/YJ by DAVID C. WESTON EC— who is personally known w..+STATE QF—E-LORIDA as ide atio§ like an oath. NOTARY PUBLIC: NOTARY PUBLIC: Si Sign: Print: " Print: Seal:,' Expires Jury 2, 2017 Seal: NOTARY PUBLIC Bmided Um Tmy Fele Gro ammo 8 "19 STATE OF FLORIDA vExplfts C EE2�47 9=16 APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) 115 S. Andrews Ave., Rm. A-100, Ft. Lauderdale, FL 33301-1395 — 954-831-4000 VALID OCTOBER 1, 2014 THROUGH SEPTEMBER 30, 2015 DBA: Receipt#:180-241720 Business Name' DAMICO BUILDING GROUP, LLC Business ,�Ype�GMRAL CONTRACTOR Owner Name: PHILLIP JOHN DAMICO Business Location: 1717 STUTZ DRIVE OUT OF STATE Business Phone: itooms :.... Seats Nuimber of Machines; Emplby�a 4 Business Opened:06/06/2011 StaWCounty1CerI1Reg: CGC151 e 5 51 Exemption Code: Machines �, .- Vendina Tvoe; Tax Amount Transfer Pee I NSF Fee Penalty I Prior YOM I cotlection Cost I Total Paid 27.00 0.00 0.00 0.00 0.00 1 0.00 27.00 THIS RECEIPT MUST BE POSTER 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 transfer ed when the business is sold, business name has changed or you have moved the business location. This receipt does not lndicate that the business Is legal or that it is in compliance with $tete or local laws and regulations. Mailing Address: PHILLIP JOHN DAMICO 1717 STCITZ DRIVE TROY, MI 48084 U.S.A. 2014 -2015 Receipt #05A-13-00010990 Paid 09/11/2014 27.00 115 S. Andrews Ave., Rm. A-100, Ft. Lauderdale, FL 33301-1895 — 954-831-4000 VALID OCTOBER 1, 2014 THROUGH SEPTEMBER 30, 2015 DBA:DAMICO BUILDING GROUP, LLC Business Name: Owner Name: PHILLIP ToHN DAMICO Business Location: 1717 STUTZ DRIVE OUT OF STATE Business Phone: Receipt#:G� 1COYOFTRACTOR Business Type: Business Opened:06/06/2011 State/County/Cert/Req CGC1518551 Exemption Code: Rooms Seats Employees Machines Professionals 4 FarYegding au Only N of chines: Vendinra Tvae: Tax Amount Transfer Fee NSF Fee Penally Prior Years Collection Cost Total Paid 27.00 0.00 0.00 0.00 0.00 0.00 27.00 THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS THIS BECOMES A TAX RECEIPT This to is levied for the privilege of doing business within Broward County and is non -regulatory in nature. You must meet all County andfor 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 [am and regulations. Mailing Address: PHILLIP JOHN DAMICO 1717'STUTZ DRIVE TROY, MZ 48084 U.S.A. 2014 -2015 Receipt #05A-13-00010990 Paid 09/11/2014 27.44 DAMIC-3 OP ID: R1 • ° CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYM 10/06/14 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 Phone: 248-681-2100 The Huttenlocher Group Fax 248-681-0362 1007 W. Huron Waterford, MI 48328E William Basinger ACT CONAME: PHONE c N AIC No): -MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC S INSURER A: Cincinnati Insurance Company 10677 INSURED Damico Building Group, LLC 1717 Stutz Dr Troy, MI 48084 INSURER B: INSURER C: INSURER D: INSURER E: 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 INSURANCE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Miami Shores Village POLICY NUMBER POLICY F MMIDD POLICY EXP MIDD LIMITS A GENERAL LIABILnYEACH X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE Fx—] OCCUR Miami Shores, FL 33138 EPP0011478 02118/14 06/01/15 OCCURRENCE $ 1,000,00 PREMISES Me occurrence)$ 500,00 MED EXP (Any one person) $ 10,00 PERSONAL & ADV INJURY $ 1,000,000 X Per Loc Aggregate GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRO LOC POLICY JECT PRODUCTS - COMP/OP AGG $ 2,000,000 $ A AUTOMOBILE X LU181LnY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS H RED AUTOS NON -OWNED AUTOS EBA0011478 02/18/14 06/01/15 COMBINEe accident) ccid� E $ 1,000,00 BODILY INJURY (Per person) $ BODILY INJURY (Per acdderd) $ (PROPERTY DAMAGE $ Paracddent A X UMBRELLA LIAB EXCESS UAB X OCCUR CLAIMS -MADE EPP0011478 08/28/14 06/01/15 EACH OCCURRENCE $ 3,000,000 AGGREGATE $ 3,000,00 DED X RETENTION $ WORKERS COMPENSATIONWC AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNERIEXECUnVE OFFICERIMEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A STATU- OTH TORY LIA TS ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) Damico Building Group, LLC License #CGC1518551 CFRTIFICATF NAI nr-R CANCELLATION MIAM006 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Miami Shores Village THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN g ACCORDANCE WITH THE POLICY PROVISIONS. Building Department 10050 NE 2 Ave Miami Shores, FL 33138 AUTHORIZED REPRESENTATIVE ACORD 25 (2010105) ©1988-2010 ACORD CORPORATION. All ngnts reserved. The ACORD name and logo are registered marks of ACORD