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BPP-12-2383Miami Shores Village Building Department IIC-1 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 73PI Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 B LD G PERMIT APPLICATION Permit Type: BUILDING FBC 20 Permit No. 17— - Z3 Y3 Master Permit No. ROOFING JOB ADDRESS: (� l(}� Ng (2D City: Miami Shores County: Miami Dade Zip: ; �Z of Foho/Parcel#: Is the Building Historically Designated: Yes OWNER: Name (Fee Simple NO 1�( Flood Zone: '331 - zip: <33 V City: �'�t�.� State: p: Tenant/Ussee Name: Phone#: Email: CONTRACTOR: Co parry Name: 1 ��� �' Phone#: Address: City: Stater Zip: Qualifier ame: jj;��/ 4 Phone#: `�' % State Certification or Registration #: QIB,20 t Certificate of Compe�#t r Contact Phone#: � 600 07� Email Address:��� DESIGNER: chitec ngineer: �"!��? >ee; J Phone#: Value of Work for this Permit: $ 7 Square/Linear Footage of Work: Type of Work: ❑Addition OAllte��ration Description of Work: �.� a Ace- ONeT. ❑Repair/Replace MR'_, ,i � � 1 3 �p E., Submittal Fee $ Permit Fee $ lJ CCF $ CO/CC $ Scanning Fee $ Radon Fee $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ DBPR $ Bond Technology Fee $ TOTAL FEE NOW DUE $ t 1:Zxsh 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 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 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 whyoccurs seven (7) days after the building permit is ,issued. In thr absence of such posted notice, the inspection will not be qppeoveV and a reinspection fee will be charged. /J _11� or Agent The foregoing instrument Qs acknowledged before me this i Z day of 2 , 20 P � , by who is personally known to me or who has produced As idention a d NOTARY PUBLIC:" ••' MY Ii DD1 * * EXPIRES, October 13, 2013 ,gq��polmy8o"a L,L, The foregoing instrument was acknowledged before me this day of Q_ , 201 , by , who is personally known to me or who has produced as identification and who did tJanoNOTARYP •wy ?i'e4�ABEL DAFHO Rt1�V�* • * MYCOMIMISSIDN9DD9WV6 EXPIRES: October 13,201 @i�'0aFAo.�O< Both TlNu 8u Plry S Sign: Sign: Print: Print: My Commission Expires: My Commission Expires: APPROVED BY� Plans Examiner r Zoning Structural Review Clerk (Revised 5/2/2012XRevisgd 3/12/2012) )(Revised 06/10/2009)(Revised 3/15/09)(Revised 7/10/2007) 1 ^ . o� STATE OF FLORIDA -DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION " CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487-1395 1940 NORTH MONROE STREET we TALLAHASSEE FL 32399-0783 GAMBACH, ROBERTO J ALRALI CONSTRUCTION CORPORATION 1132 KANE CONCOURSE LEVEL 2 BAY HARBOR ISLAND FL 33154 STATET. OF FLORIDA` AC# Er '�I P'5 � F7 C Congratulations! With this license you become one of the nearly one million DEPARTMENT. OF $LTSINESS AND;; Floridians licensed by the Department of Business and Professional Regulation. PROFESSIONAL _REGULATION Our professionals and businesses range from architects to yacht brokers, from Q boxers to barbeque restaurants, and they keep Florida's economy strong. CGCA01131 Q 8 1.2r 110434077 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. CERTik ED U`ENE_,1A -OR There you can find more information about our divisions and the regulations that I GAMBAOF r ROBERTO' J impact you, subscribe to department newsletters and learn more about the AT R2T,T •CONS RUG -1,61 CORPORATION Department's initiatives. I Our mission at the Department is: License Efficiently, Regulate Fairly. We constantly strive to serve you better so that you can serve your customers. IS CERTIFIED under tiieT provisions of ca:489 Fs' Thank you for doing business in Florida, and congratulations on your new license! sxpira4loa date: AUG';31.2014 4120618QO708 DETACH HERE The: .GENERAL CONTRACTOR.;' Named below IS CERTIFIED Under' the provisiona of. Chap6dt , 48_9:a . S Expiration date: AUG 314, 2014 TION SEQ#L12061800708 KEN LAWSON SECRETARY THIS LICENSE MUST BE DISPLAYED IN A CONSPICUOUS PLACE A .malty ic imnnspri fnr fniturp tn keen this license exhibited conspicuously at your establishment or place of business. Year: 2012-2013 Mailing Address: ALRALI CONSTRUCTION CORP. 1132 KANE CONCOURSE, 2ND FL. BAY HARBOR ISLANDS, FL 33154 Category: BUSINESS AND PROFESSION OFFICE Tax ID Number: 65-1125806 Nature of Business: GENERAL CONTRACTOR Number: 605 Account Number: 15861 Business Name and Address: ALRALI CONSTRUCTION CORP. 1132 KANE CONCOURSE, 2ND FLOOR BAY HARBOR ISLANDS, FL 33154 Phone Number: 305 - 866-4700 Approval Date: 11/26/2001 Comments: THIS RECEIPT EXPIRES SEPTEMBER 30th OF THE YEAR SHOWN ABOVE. Fee: $121.55 Late Fees: $0.00 Date Issued: 10/1/2012 By JA — MarleneVEIRK me TOWN 04 ' tiF .a a 01-2602012 JEFF ATWATER STATE OF FLORIDA CHIEF FINANCIAL OFFICER 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: 01/26/2012 PERSON: GAMBACH FEIN: 651125806 BUSINESS NAME AND ADDRESS: ALRALI CONSTRUCTION CORPORATION 1132 KANE CONCOURSE LEVEL 2 BAY HARBOR ISLANDS FL 33154 SCOPES OF BUSINESS OR TRADE: 1- GENERAL CONTRACTOR EXPIRATION DATE: 01/25/2014 ROBERTO J IMPORTANT: Pursuant to Chapter 440 . 05(14), F.S., an officer of a corporation who elects exemption from this chapter by filing a certificate of election under this section may not recover benefits or compensation under this chapter. Pursuant to Chapter 440.05(12), F.S., Certificates of election to be exempt.., apply only within the scope of the business or trade listed on the notice of election to be exempt. Pursuant to Chapter 440.05(13), F.S., Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation If, at any time after the .filing of the notice or the Issuance of the certificate, the person named an the notice or certificate no longer meets 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. DWC-252"CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01-11 QUESTIONS? (850) 413-1609 PLEASE CUT OUT THE CARD BELOW AND RETAIN FOR FUTURE REFERENCE STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION CONSTRUCTION INDUSTRY CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW 9 EFFECTIVE: 01/26/2012 EXPIRATION DATE: 01/25/2014 PERSON: ROBERTO J GAMBACH FEIN: 651125808 BUSINESS NAME AND ADDRESS: ALRALI CONSTRUCTION CORPORATION 1132 KANE CONCOURSE LEVEL 2 BAY HARBOR ISLANDS, FL 33154 SCOPE OF BUSINESS OR TRADE:- I- RADE:1- GENERAL CONTRACTOR IMPORTANT Pursuant to Chapter 440.05(14), F.S., an officer of a corporation who elects exemption from this chapter by filing a certificate of election L under this section may not recover benefits or compensation under this D chapter. Pursuant to Chapter 440.05(12), F.S., Certificates of election to be H exempt.. apply only within the scope of the business or trade listed on Rthe notice of election to be exempt E Pursuant to Chapter 440.05(13), F.S., Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation if, at any time after the filing of the notice or the issuance of the certificate, the person named on the notice or certificate no longer meets 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. QUESTIONS? (850) 413-1609 CUT HERE * Carry bottom portion on the job, keep upper portion for your records. DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01-11 Feb 1213 03:03p p.2 ' OP ID: CK CERTIFICATE OF LIABILITY INSURANCE ff02i12J2013 `�"' 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(ies) 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 ofsuch endorsement(s). PRODUCER Tanenbaum Herber of Florida 2900 SW 149th Avenue Miramar, FL 33027-6605 Joseph J. Kiertekles INSURED Attn: Roberto Gambach 1132 Kane Concourse 11 Miami, FL 33154 CERTIFICATE Phone: 954-683-2900 NSE ' Carol Kiertekle Fax: 954-517-7400 rairNN . ,-r,.954-883-2996 da.com INSURERS) AFFORDING COVERT INSURERA:Mid-Continent Casualty Co. D: 954-517-7496 NAIC A 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 TC WHICH TFIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERNS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIM..S. INSK LTR TYPEOFINSURANCE A e POLICYNUMB£R POLICYEFF LI D� LIMITS MM tGGEEgNERAL LIABILITY EACH OCCURRENCE $ 1,000,00 A COMMERCIAL GENERAL LIABILITY CLAMS -MADE 7X OCCUR 04GL000870727 1212912012 ED 12129/2013 . PREMISES<Eaorxurrenco) $ 100,00 MED EXP Anyone person} $ Excluded PERSONAL&ADV INJURY :4 1,000,00 GENERAL AGGREGATE S 2,000,00 PRODUCTS . COMPICP AGG S 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY X PRO F7 LOC _ S AUTOMOBILE LIABILITY avY a.lrD ' COMBINED SINGLE LIMB S n/a (Ea accident) - ------ - SOD LYINJURY(Perperson) $ We A_L OWNED AUTOS i _ BODILY INJURY(Fer accident) $ We SCHEDULED AUTOS HIRED AUTOS I - PROPERTY DAMAGE $ We (Pereccidenl) S NON-OWNEC ALTOS I$ UI�fBRELLALIAB OCCUR EACH OCCURRENCE S_ n1a EXCESS LIAR CLAIMS -MADE; _ AGGREGATE S n/ DEDUCTIBLE S S RETENTION S I WORKERS COMPENSATION Ar STATU- IOTH•' AND EPAPLOYERS' LIABILITY AN PROPRIPYIN OFFCEREMB=R EXCLUDED? NIA.ETOR- — E.L. EACH ACCIDENT $ _n/a E.L. DISEASE -EA EMPLOYE S n/a •• •----•---- •--- E.L. DISEASE - POLICY LIMIT $ n/a (Mandatory In NH) r yes, describe Lncer DESCRIPTION OF OPERATIONS oelow ( w., I T - DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Addhional Remarks Schedule, It more space Is requlred) Fax #305-756-8972 VILLMIA Village of Miami Shores 10050 N.E. 2nd Avenue Miami Shores, 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 d ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD cNgELL&I CANCELLED a