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CC-12-2850,9 B IL I N G 4r - $50 Z 0 1-i-( Miami 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 PERMIT APPLICATION Permit Type: BUILDING JOB ADDRESS: F1? 6 B iS Co -t-, U e 6 14 4 DEC 12 2012 FBC 201 10 Permit Noc r Master Permit No. ROOFING City: Miami Shores County: Miami Dade Zip: 3 / z?X Folio/Parcel#: / % -3d O is -()It -O tS'V Is the Building Historically Designated: Yes NO ✓ Flood Zone: OWNER: Name (Fee Simple Titleholder): M , o (I i -dsl t r,, Phone#: 3 S' �1LEL f Address:_ k 'z6 9" SC�. (vc '61 v d City: tA% B -+'w R eC State: Zip: � _3 13 t Tenant/Lessee Name: Phone#: -6 Y - S/ 5_/26 Email: CONTRACTOR: Company Name: Phone#: I ��' Address: M1 T (,'iVA4G-W,- City: fCity: 4 - State: Zip: d Qualifier Name: __ _ Phone#: State Certification or Registration #: 00.50bise Certificate of Competency #: Contact Phone#: Email Address: DESIGNER: Architect/Engineer: f Value of Work for this Per 't: $ f` Square/Linear Footage of Work: Type of Work: ❑Addition ❑Alteration ,, ❑New f ❑Repair/Repplace ❑Demolition Description of Work: b ell n r-1' ►+` c+ o J 4V /'✓T�z-* Color thru tile: Submittal Fee $ _ Permit Fee $ CCF $ CO/CC $ Scanning Fee $ Notary $ Radon Fee $ Training/Education Fee $ Double Fee $ Structural Review $ DBPR $ Bond $ Technology Fee $ TOTAL FEE NOW DUE $ r Bonding Company's Name (if applicable) _ . Bonding Company's Address City State Zip 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 cons .action lien law brochure will be delivered to the person whose property is subject to attachme o, a certified copy of th corded notice of commencement must be posted at the job site for the first inspection which o rs seven (7) days after th ilding permit is issued. In the absence of such posted notice, the inspection will not be appro and a rei ection fee wj e charged. ,.yr or Agent The forego' g instrument was ackn—o�wlledged before me this day of m4— 20 12=:; by f J om ! Lt f A,„Jg , who is personally known to me or who has produced As identification and v,4r did take an oath. NOTARY Sign: Signature Contractor The foregoing instrument was acknowledged before me this day of JN"e(tj 20 JZ, by FrW\%L C%A2C ► 2 , who is personally known to me or who has produced_ htf\, "% L QAjn&e as identification and who did take an oath. NOTARY PU IC: Sign: Print: 1G0 & J A Q tir%*t [itAcj_;� My (commission Exp1r s •tii� °!RUTH A. SYDASH My Commission E KARINA I': RODRIGUEZ °.; hfYC3MIt�ESS10N # DD956017 MY COMMISSION # DD975651 ExpIRES: March 28, 2014 ?C 6RcS March 27, 2014 or 114omr ntAssmCO. t aoarnxv APPROVED BY _ Plans Examiner /� Zoning Structural Review Clerk (Revised 3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09) STATE OF FLORIDA - DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487-1395 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 GONZALEZ, FRANCISCO JAVIER TERRA GROUP INTERNATIONAL INC 1310 S GREENWAY DR MIAMI FL 331344767 Congratulations! With this license you become one of the nearly one million 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! DETACH HERE RICK SCOTT, GOVERNOR _...., .,. STAT DEPARTMENT OF BUSINE: CONSTRUCTIONII CGCO50888 The GENERAL CONTRACTOR" Named below IS CERTIFIED Cfnder the provisions of Chapter 489 FS. Expiration date: AUG 31; 2016 GONZALEZ;""FRANCISCO J" TERRA GROI.IP INTER INC. 1390 S GREENWAY DRV y w COAL GABL���-= 3134"` KEN LAWSON, SECRETARY E OF FLORIDA IS AND PROFESSIONAL REGULATION IDUSTRY LICENSING BOARD ` i .` ISSUED: 09/07/2014 DISPLAYAS REQUIRED BY LAW sEQ# L1409070003118 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND ~' PROFESNAEGULATION CGC050888 UiE� 09/07/2014 CERTIFIED G GONZALEZ TERRA GROt1 ow a is ciwri=IED under the roi"f`sio"ns of Ch.488 FS W= " Expiration date AUG 31, 2016 L1409070003118 KEN LAWSON, SECRETARY E OF FLORIDA IS AND PROFESSIONAL REGULATION IDUSTRY LICENSING BOARD ` i .` ISSUED: 09/07/2014 DISPLAYAS REQUIRED BY LAW sEQ# L1409070003118 STATE OF FLORIDA *%N DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 GONZALEZ, FRANCISCO JAVIER TERRA GROUP INTERNATIONAL INC 1310 S GREENWAY DR MIAMI FL 33134-4767 Congratulations! With this license you become one of the nearly one million 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! RICK SCOTT, GOVERNOR LICENSE NUMBER DETACH HERE STATE OF FLORIDA a, STA DEF b f PR( CFC 1426856 (850) 487-1395 t)F FI ORIDA 1S CERTIFIED under the n 'Expiration date ;-AUG 39, 2016 IF BUSINESS AND ULATION Z. Z,G 11 U w09/0712014 G1• " isiohs of Ch.489 FS u - 41409070002982' KEN LAWSON, SECRETARY ENT OF BUSINESS AND PROFESSIONAL REGULATION DNSTRUCTION INDUSTRY LICENSING BOARD Expiration date: AUG 31, 2016 " H t, e GONZALEZ- FRANCISCO J�V �, 4 TERRA,GR(3UP INTERN AL INC '134'0,,S GREE W' Y,, }°1 ]AMI FL4,767­ 'Y .. R ms,µ �, , .�' „��", � y �,. r : m .. '. --7 - m �1 ISSUED: 09/07/2014 DISPLAY AS REQUIRED BY LAW SEQ# L1409070002982 STATE OF FLORIDA wvwmzDEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487-1395 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 GONZALEZ, FRANCISCO JAVIER TERRA GROUP INTERNATIONAL INC 1310 S GREENWAY DR MIAMI FL 33134-4767 Congratulations! With this license you becorne one of the nearly one million 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! RICK SCOTT, GOVERNOR DEPARTMENT CON: CMC1249566 The MECHANICAL CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 48f DETACH HERE KEN LAWSON, SECRETARY STATE OF FLORIDA SINESS AND PROFESSIONAL REGULATION ION INDUSTRY LICENSING BOARD FS. ! Expiration date: AUG 31,2016 GONZALEZ, FRANCISCO I TERRA GROUP INTER A I �131.0:S.GREENWA�,aDR ":,MIAMI F 3? 4767 W » ❑ "� ❑ rtll�.. ISSUED: 09/07/2014 DISPLAY AS REQUIRED BY LAW SEQ# L1409070003313 STATE OF FLORIDA DEPARTME T -OF BUSINESS AND ' PROFEz A GULATION CMC1249566. :;49 /07/2014 h x4 CERTIFIED )TOR 30NZALEZ, TERRA GRO I rtn r .... yamy.. • n r �Y IS C8RTI,FIEP:underthe..provisions of Ch.489.FS. _Expuaiiorwt�.te : AUG3t,2016 L1409070003313 KEN LAWSON, SECRETARY STATE OF FLORIDA SINESS AND PROFESSIONAL REGULATION ION INDUSTRY LICENSING BOARD FS. ! Expiration date: AUG 31,2016 GONZALEZ, FRANCISCO I TERRA GROUP INTER A I �131.0:S.GREENWA�,aDR ":,MIAMI F 3? 4767 W » ❑ "� ❑ rtll�.. ISSUED: 09/07/2014 DISPLAY AS REQUIRED BY LAW SEQ# L1409070003313 STATE OF FLORIDA - DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD W9 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 GONZALEZ, FRANCISCO JAVIER TERRA GROUP INTERNATIONAL INC 1310 S GREENWAY DR MIAMI FL 33134-4767 Congratulations! With this license you become one of the nearly one million 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! RICK SCOTT, GOVERNOR DETACH HERE ATATF InF FI ARIDA STATE C DEPART ,r PROFEF& EC0001218 x (850) 487-1395 ORIDA IT OF BUSINESS AND NA - ULATION 09/07/2014 ® OR TERRA GRO r ' "• Wit« � �, ,. IS CERTIFIED under ttte.provisions of Ch.489 Fs Exprarwndate,' k6G31,2016' L1409070003471 ISSUED: 09/07/2014 DISPLAY AS REQUIRED BY LAW KEN LAWSON, SECRETARY SEQ # L1409070003471 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 GONZALEZ, FRANCISCO JAVIER TERRA GROUP INTERNATIONAL INC 1310 S GREENWAY DR MIAMI FL 33134-4767 Congratulations! With this license you become one of the nearly one million on 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! DETACH HERE (850) 487-1395 0STATE OF FLORIDA DEPARTMENT:OF BUSINESS AND .r PROF GULATION PCCO56705 U °.09/07/2014 CERT POLLUX ONTR GONZALEZ, v ; TERRA GROU3' CC iNC 4� IS, CERTIFIED'vhder-thesp visions of fh.489 FS ppirati6n6aie : AUG 31; 2016 L140407000344f v ` RICK SCOTT, GOVERNOR KEN LAWSON, SECRETARY 3 _. STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING' BOARD PCC056705 I Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2016 w k ❑. i❑ N ter,, ■ ■ GONZALEZ FRANCISCO TERRA GROUP ITER 13'10 S,GREENW,4Y ptlVl 'a `g CQRAL GABLES" IL, , 3134 4 � ' S3 ' MEISSUED: 09/07/2014 DISPLAY AS REQUIRED BY LAW SEQ # L1409070003448 003710 003712 OWNS SEC TYPE`C:'BUBITIES AYMENTtECENE P INTERNATIO t SIC 196 GE MECh ANICA TAX C6 IECTO* 1 . MC1249 X5.00 003/2014 �� ? CHECK -14176 m a Thrs $usmess '0icBeceipt ar4Jwr> — payident of tha Loral Business Tax The Re as not a li , pe ! cerMica4# the hol* alrfdois ica, to do business Holder nagt any gone maentervi�torylavi"' regmremeatyebq � IECEIPT Nii ZAbove m4 6n played on iel vehicleM s Sec Ak F .,_ For.rnation,vhEit At 003711 _. SEC OWN TIE.OF BUSINESS TERRA. P INTERNATI , :F 4 ,-J}NC jT96 PLLJMB#k CONTRAC , �FC74265Ali 6'. t X2 This,466USusmessiax#teceiptoniyiwdirmspayientoftheU6alBusiness Tax. The P' certficaliethe holder %�ealiiieatiou8,to do business. HoldetfpNat or � nment8 il.laws an renuiremeets which anuly to the hu aik,� .' 001076 TAX CS31 LECTOR ;; WO 0 03/2014 *CK 3;4-141736 mot a Ileaeas, ny gov sec 8846. JEFF ATWATER CHIEF RNANCIAL. OFFICER STATE OF FLORIDA DEPARTMENT of FINANCIAL SERVICES DIVISION OF WORKERS` COMPENSATION * * CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW *' CONSTRUCTION INDUSTRY EXEMPTION This cedes that the individual lister} below has elected bu be exempt from Florida Workers' CompensaIian law. EFFECTIVE DATE: 7tlWM14 E=XPIRATION DATE: 7/15/2016 PERSON: GONZALEZ FRANCISCO J PEIN: 850173759 BUSINESS NAME AND ADDRESS: TERRA GROUP INTERNATION 1310 S. GREENWAY DR CORAL GABLES FL 33134 SCOPES OF BUSINESS OR TRADE: LICENSED GENERAL LICENSED PLUMBING LICENSED ELECTRICAL CONTRACTOR CONTRACTOR CONTRACTOR Pi to der 440.05(14). F S., an officer of a eWIon urdw ilk wctbn may not reomw beneftoromnparmallon underthis chapter Pessrad to Chapter 4C05(12). F.S.. Caffades of ewtw to be exempt-. apply cey wtihin the Scope of the business ortrade Wed on the notice of eleoft to be exenVL Pu wart hr Chapter 440.05(13), F.S., Notices of election to beftwaptandcertilcaiesof election to be exempt shag be subioct to ravocabon ir, at anytime atter tits1 ft of the notice or the mance of the cert the person named on On notice or oerltiioate no longer meets to regWrementa of Sris secdon forWwance of a owhocate, The depmunerx shall revoke a owhicete at any tine for tadure of the person named an Vve certificate to meet the requkements of the semen. 01`8-F2 [)Wr✓ 252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 07-12 QUESTIONV W50)4134 W9 . Miami shores Village ZjAe Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305)795.2204 Fax: (305) 756.8972 Notice to Owner — Workers' Compensation Insurance Exemption Florida Law requires Workers' Compensation insurance coverage under Chapter 440 of the Florida Statutes. Fla. Stat. § 440.05 allows corporate officers in the construction industry to exempt themselves from this requirement for any construction project prior to obtaining a building permit. Pursuant to the Florida Division of Workers' Compensation Employer Facts Brochure: An employer in the construction industry who employs one or more part-time or full-time employees, including the owner, must obtain workers' compensation coverage. Corporate officers or members of a limited liability company (LLC) in the construction industry may elect to be exempt if: 1. The officer owns at least 10 percent of the stock of the corporation, or in the case of an LLC, a statement attesting to the minimum 10 percent ownership; 2. The officer is listed as an officer of the corporation in the records of the Florida Department of State, Division of Corporations; and 3. The corporation is registered and listed as active with the Florida Department of State, Division of Corporations. No more than three corporate officers per corporation or limited liability company members are allowed to be exempt. Construction exemptions are valid for a period of two years or until a voluntary revocation is filed or the exemption is revoked by the Division. Your contractor is requesting a permit under this workers' compensation exemption. In these circumstances, Miami Shores Village does not require verification of workers' compensation insurance coverage from the contractor's company. Therefore, you may be personally liable for the worker compensation injuries of any person allowed to work under this permit Please check with your insurance carrier since most property insurance policies DO NOT cover this type of liability. BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. Print Nam( Signature: State of Florida ) County of iami-Dade ) Sworn to d scribed before me day of , 20 1 ' BY RUTH A. dVOASH Commission # FF 097")5 ladblMa�N�Ifoinl Assn. Contractor Print N State of Florida ) County of Miami -Dade) Sworn to and subscribed before me this jLIM day of (�(, , 20 lLI . o"":..'uk. KARINA P. RWRK BY ✓�' ��i9vf„ _ MY COMMISSION # FF (SEAL)_ Tvpe of M ACCAR©® CERTIFICATE OF LIABILITY INSURANCE ' DATE (MM/°D/YYYY) 1 11/03/2014 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 CONTANAME: Tony Cannizzaro Aic "N Exi): (386) 775-1781 Fvc Nol: (386) 775-3666 First Commercial Insurance Agency E-MAIL insurance u cfl.rr.Com ADDRESS: g yG P.O. Box 295 INSURER(S) AFFORDING COVERAGE NAIC q INSURERA: Accident Insurance Company 11573 Cassadaga FL 32706 INSURED INSURER B INSURER C: Terra Group International Inc. INSURER D: 3191 Coral Way INSURER E: Suite 648 INSURER F: Coral Gables FL 33145 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 ADDL I SUBR POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000.00 CLAIMS -MADE � OCCUR DAMAGE TII PREMISESEa occur ante $ 100,000.00 MED EXP (Any one person) $ 5,000.00 PERSONAL BADV INJURY $ 1,000,000.00 A N N CPP000499502 08/11/2014 08/11/2015 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000.00 RO-LOC X POLICY ❑ PJ PRODUCTS -COMP/OP AGG $ 2,000,000.00 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ Per accident HIRED AUTOS NON -OWNED AUTOS UMBRELLA LIAB HOCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED RETENTION $ $ WORKERS COMPENSATIONPER AND EMPLOYERS' LIABILITY Y / N OTH- STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? ❑ N / A E.L. DISEASE - EA EMPLOYE $ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT I $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) General contractor: CGCO50888 Electrical contractor: EC0001218 Plumbing contractor: CFC1426856 CERTIFICATE HOLDER CANCELLATION ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Miami Shore Villages ACCORDANCE WITH THE POLICY PROVISIONS. 10050 N.E 2nd Ave AUTHORIZED REPRESENTATIVE Miami Shore FL 33138 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD 6 Viviana Cubillos From: dolores rosaz <framingreflections@gmail.com> Sent: Tuesday, September 10, 2013 4:31 AM To: Viviana Cubillos Subject: Framing Reflections Permit# CC -12-12-2350 Good afternoon, Viviana. We received on the mail, a postcard with the expiration date on our permit process. We are working the FIRE and DERM. This Thursday we have another appointment with the inspector in order to get aproved. We need and extension on our permit here with the village. A soon as we have any news we let you know. escusse my writing. Thank you Dolores Rosaz 305-751-5120 8990 Biscayne Blvd Miami Shores FI 33138 framingreflections@gmail.com 60 � �xT��s>d 1✓ G�T� . S� 1 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-230355 Permit Number: CC -12-12-2350 Scheduled Inspection Date: March 17, 2015 Permit Type: Commercial Construction Inspector: Rodriguez, Jorge Owner: MILITANA, JOHN AND ADRIENNE Job Address: 8980 BISCAYNE Boulevard Miami Shores, FL 33138 - Project: <NONE> Inspection Type. Final Work Classification: Alteration Phone Number Parcel Number 1132060110150 Contractor: TERRA GROUP INTERNATIONAL INC Phone: 305-774-9405 :0u11w11y ueparLrnent %.vrnrrrents OPEN WALL CONNECTING Adjacent STORE Infractio Passed Comments INSPECTOR COMMENTS False March 16, 2015 For Inspections please call: (305)762-4949 Page 29 of 38 Inspector Comments Passed , Failed Correction Needed ❑ Re -Inspection ❑ Fee No Additional Inspections can be scheduled until re -inspection fee is paid. March 16, 2015 For Inspections please call: (305)762-4949 Page 29 of 38