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RC-15-408 (2)
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 PERMIT APPLICATION BUILDING ❑ ELECTRIC ❑ ROOFING ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS JOB ADDRESS: 6Y N W q3 FE&252015 FBC 20 0 Master Permit No.2,c I; — L4 @ T Sub Permit No ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): �'-...,Phone#:�(�r� Addressi ` S N City: ( C'vt�?"1 �1 �' State: C, Zip: Tenant/Lessee Name: Email: (i�CC � , l`_J t'I r'l c ' , C'r1 /� CONTRACTOR: Company Name: SCI-en4l C ( D (fi e. Phone#: 7eb-sg7,g1a C Address: f o2 S% A/6 City: 114 I`Ct State: FL Zip: 3317! Qualifier Name: �{�'")�{� W _4 em li 1 _ Phone#: 7K6.tVY7- q7-19 � p State Certification or Registration #: C&C Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit- $_4 ZI e950 Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New ' n ❑Repair/Replace ❑ Demolition Description of Work: Specify color of color thru tile:_`.` W AO Submittal Fee $ 4° Permit Fee $ -1W ' 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 Zip Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State ME 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 low 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. � a Signature �� r Signature OWNER or AGENT CONTRACTOR The forego) g i trument was acknowledged before me this day of'UAI;)L 20 by fit l who is personally known to me or who has produced l)y t�/ Le'A(✓ e as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: Seal: ,,ti's Ri MY C 16, FJ 'SRR �r 8c ************************** APPROVED BY (Revised02/24/2014) The foregoing ins umen was acknowledged before me this day 20 by V16C- 1C;ho is pe sonally known to me or who has produced NOTARY PUBLIC: t 1 �, Seal: Plans Examiner Structural Review Notary Public State of Florida Stacey Ann Lavern Ringrose c My Commission FF 048348 �p Expires 08/10/2017 Zoning _r Clerk N oF' J IH! C Ur rLUKIUH ,' =_ °� DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION �.f CONSTRUCTION INDUSTRY LICENSING BOARD 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 HENRI, RAPHAEL HERMANN SCIENTIFIC CONSTRUCTION GROUP INC 1251 NE 209TH TERRACE MIAMI FL 33179 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 (850) 487-1395 Irp a� STATE OF FLORIDA DEPARTMENT OF BUSINESS AND A PROFESSIONAL ROFESSIONAL REGULATION CGC 1505943 ISSUED: 08/26/2014 CERTIFIED GENERAL CONTRACTOR HENRI, RAPHAEL HERM ANN—' SCIENTIFIC CONSTRUCTION.GROUP INC IS CERTIFIED under iilc pr0Visi0;-,5 of Ch.489 FS Expiration date : AUG 31, 2016 L1408260001895 KEN LAWSON, SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD CGC1505943 I The GENERAL CONTRACTOR Named below IS CERTIFIED 0i SEQ # L1408260001895 BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT 115 S. Andrews Ave., Rm. A-100, Ft. Lauderdale, FL 33301-1895 — 954-831-4000 VALID OCTOBER 1, 2014 THROUGH SEPTEMBER 30, 2015 DBA: _ Receipt #:GE GENERAL CONTRACTOR (GENERAL Business Name: SCIENTIFIC CONSTRUCTION GROUP C Business Type: CONTRACTOR) Owner Name: RAPHAEL HERMANN HENRI Business Opened:10/01/2003 Business Location: 2860 SW 4 STREET State/County/Cert/Reg:CGC1505943 FT LAUDERDALE Exemption Code: Business Phone: 786-587-9728 Rooms Seats Employees Machines Professionals 2 For Vending Business Only Number of Machines: Vendina TVDe: Tax Amount Transfer Fee NSF Fee Penalty 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 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 riot indicate that the business is legal or that it is in compliance with Stale or local I rFr; and regulations. Mailing Address: RAPHAEL HERMANN HENRI 2860 SW 4 STREET FORT LAUDERDALE, FL 33311 2014 - 2015 Receipt: #13B-13-00011238 Paid 09/29/2014 27.00 P --,— . .-1— cp -1-- cp ® I N I= I 1 0 N IFoodid. JEFF ATWATER CHIEF FINANCIAL 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 certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law. EFFECTIVE DATE: 10/13/2013 EXPIRATION DATE: 10/13/2015 PERSON: HENRI RAPHAEL li FEIN: 753115587 BUSINESS NAME AND ADDRESS: SCIENTIFIC CONSTRUCTION GROUP INC 1251 NE 209 TERRACE MIAMI FL 33179 SCOPES OF BUSINESS OR TRADE: LICENSED GENERAL CONTRACTOR Pursuant Io Chapter 440.05(14), F.S., an officer of a corpora lion who elects exemption from this Cha pier by fling a Cert,ficale of election under In is section may not recover benefits or :ompensation under this cnapler. Pursuant to Chapter 440.05(12), F.S., Certificates of election to be exempt.. aDDb only within the scope of the business or had, listed on the notice of election to be exempt Pursuant to Chaplet 440.05(13), F, Noires No ires of election to be exempt and certificates of electiOn to be exempt snail be subject to revocation if. at any lime after the filing of the notice or the ¢suance of the climficale, the person named on the notice or certificate no longer mems the requirements of this section for issuance of a certificate. The department shall revoke a certificate at any time for failure of the person named on the certificate to meet the requirements of this section. DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 07-12 QUESTIONS? (850)413-1609 https://apps8, fldfs.com/crreportviewer/reportV iewer. aspx?data=kdvpglnc9D7Q 3 gH61'ER6... 10/9/20: 'A UIKU CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 02/11/15 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 — y 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 Briar Bay Insurance Agency 14229 S Dixie Hwy Miami, FL 33176 CONTACT _ NAME: IPPOLITO ROMANO PHONE — x _ _ No. Ertl (305)251-5546 (Faac, Not, (305)251_9947 MaAIC. _AOP_R_ESS: insurance@briarwayinsurance.com--- INSURER(S) AFFORDING COVERAGE NAIC# INSURERA: GRANADA INSURANCE COMPANY— _ Phone (305) 251-5546 Fax (305) 251-9947 INSURED SCIENTIFIC CONSTRUCTION GROUP, INC. INSURER B: - 1,000,000.00 C: o COMMERCIAL GENERAL LIABILITY —INSURER INSURER D :-- 1251 NE 209th Terrace INSURER E: MIAMI, FL 33179- (786) 587-9728 _$ 100,000.00 -- ---- -- ---- _ 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 - TYPE OF INSURANCE — ADD SUBR ,yy� POLICY NUMBER POLICY EFF jMM/DD/YYYYI POLICY EXP MM/DD/YYYY LIMITS — fLT_R GENERAL LIABILITY — --_— `—, EACH OCCURRENCE $ - 1,000,000.00 o COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES /Ea occurrence)_ _$ 100,000.00 ❑ ❑ CLAIMS -MADE Q OCCUR 0185FL00033723 MED EXP (Any one person) $ 5,000.00 A ❑ _ —_ 02/10/2015 02/10/2016 PERSONAL & ADV INJURY $ 1,000,000,00_ — ❑ — GENERAL AGGREGATE $ 2,000,0_0_0,00 I _—_ GEN'L AGGREGATE LIMITAPPLIES PER: — PRODUCTS -COMPJOPAGG $ 1,000,000,00 ❑ ❑ PJL— ❑ $ POLICY LOC AUTOMOBILE LIABILITY _ COMBINED SINGLE LIMIT Ea acclden�`--_ BODILY INJURY (Per person) $ — —� ❑ ANY AUTO ALL OWNED SCHEDULED ❑ AUTOS ❑ AUTOS BODILY INJURY (Per accident $ ❑ HIRED AUTOS ❑ AUTOS NON -OWNED AUTOS PROPERTY DAMAGE _1Peracciderl<—___ $ -- — UMBRELLA LIAR ❑OCCUR ❑ EACH OCCURRENCE $_ ❑ EXCESS UAB ❑ CLAIMS -MADE AGGREGATE — $ _ ❑ DED ❑ RETENTION$_ �— —WC _ $ WORKERS COMPENSATION STATU- 0TH- TORY LIMITS ❑ — — AND EMPLOYERS' LIABILITY Y / N E _--` ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED?N / A -- (Mandatory In NH) � E.L. DISEASE - EA EMPLOYE $ If yes, describe under -� -- --- DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ �._ _..—._._...—--------- ------ -- — -- -------------� -- - --- —------- — DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) GENERAL CONTRACTOR FOR REMODELING CERTIFICATE HOLDER CANCELLATION MIAMI SHORES VILLAGE 10050 NE 2nd AVE MIAMI SHORES FL 33138 FAX 305 756-8972 ACORD 25 (2010105) OF 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 IPPOLITO ROMANO ©1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD