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CC-13-1574Miami Shores Village RECEIVED Building Department �;AM 3 ® 2013 �f \� 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 if Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 JOB ADDRESS: / /? 0 6 "V'9- City: V'9 City: Miami Shores County: Miami Dade Folio/Parcelt Is the Building Historically Designated: Yes NO Flood Zone: OWNER: Name (Fee Simple Titleholder): ,may (,may[ /yE-4 ury Phone#:,Y6T- o Address: City: M IAM! Stater Zip: _ Z3.1 6 Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name:??406L. >�/S*'� Phone#: ?S'- ke Address: a� l ';26 -e - City: A&4-- s State: 1--Z Zip: Qualifier Name: .�iY�� �' . _ ��, f{,dJe�f_=.� Phone#:_-, State Certification or Registration #: <1:2r-vqCertificate of Competency #: Contact Phone#: Email Address: A& o DESIGNER: Architect/Engineer: 70 Cridl-V- &�A44411P Phone#: Value of Work for this Permit: $ /6.2��C�100 Square/Linear Footage of Work: ?/s—st Type of Work: ❑Addition DAlteration ONew ORepair/Replace ODemolition Description of Work:TO s,oO,0��ejp" --pr J-1 — c z Color thru tile: Submittal Fee $ Permit Fee $ Scanning Fee $ Radon Fee $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ CCF $ CO/CC $ DBPR $ Bond $ Technology Fee $ TOTAL FEE NOW DUE $ Bondiid� Coirip�i y',..s aAe (if applicable) Bonding Company'•s.Address City `t State ortgage 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 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. Signature Signatu Owner or Agent The foregoing instrument was acknowledged before me this day of , 20 _, by , who is personally known to me or who has produced As identification and who did take an oath. NOTARY PUBLIC: Contractor The foregoing instrument was acknowledged before a this day of 120 L?, by /Jce02 , who is onallyto me or who has produced > ntification and who did take an oath. PUBLIC: . Sign' Sign: W=t Print: µ y., Notary Public State of Florida Print: � , 2015 e ', y My Commission Expires: My Co ' es Commission # EE 128810 °,:.`,';, Bonded Through National Notary Assn. W* www gasp sk,i<ski#XaskskskHa�kHisk�k�kXa,k,ksIsaIaak �kikskak�Ia,Isik�Ia ikskd��k�ksksk�k,k�k�kikik ,k,Ia�a dask�ksksksIa�k �k�k�k,ksl�ak�k,ksIa:k,k,k,kskski,ksk*sk**** APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised 3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09) 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 FBC20kk:3 BUILDING 0%.40(. &041 Permit No. 7 u PERMIT APPLICATION Master Permit No.0-1Ck Permit Type: BUILDING ROOFING JOB ADDRESS: //.3oo ALE ?m� AM. (16LAr_449AL I [/FACTO SeiAgr.4 dk&.01gi ) City: Miami Shores County: Miami Dade Zip: 33 /V / Folio/Parcel# /1- 211(6- 044- O &S-0 Is the Building Historically Designated: Yes NO )<1 Flood Zone: OWNER: Name (Fee Simple Titleholder):�,��� rl tai ao� � ��'� Phone#: -3,P f' da Address:.—//3 c, 0 �— «C Ai City: 1/4,44 -4 i Stater _ Zip: (a Tenant/I.essee Name: Email: CONTRACTOR: Company Name: Address: City:o a,,/zo 0o I9 State: Qualifier Name: JGr_ C . ISLM MCK rnuneff: 9V . 9 Zv -33s6 State Certification or Registration #: e & e 028 Y9 G Certificate of Competency #: Contact Phone#: 9Sy- YYY-// Email Address: ?.4N C E RWde o Q A4(. . c o M DESIGNER: Architect/Engineer: KA -c. L jCiG /4LS��G/st T4+�_ Phone# V Y- '% a - S7 y 6' Value of Work for this Permit: $ !!4!0_0, Sgaare/Linear Footage of Work: IS SC Type of Work: OAddition (Alteration ONew ORepair/Replace ODemolition Description of Work: ./A/7' ,eioR o4LT 4v/7f41w 04Aw aFFiGg . _Vx4 G?'i.'E DIF" Submittal Fee Color thm tile: Scanning Fee $ Radon Fee $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ DBPR $ Bond $ Technology Fee $ TOTAL FEE NOW DUE $ ME 11 b v 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 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 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. Signature. �� Signature444 Owner or Agent Contractor The foregoing instrument was acknowledged before me this _l�The foregoing instrument was acknowledged before me this day of ::2' , 20 �, by I [�A Y� f� �StJ i2 day of 20 Q, by who is personally known to me or who has produced who is personally known to me or who has produced As identification and who did take an oath. NOTARY PUBLIC: ®�e`90i tC tea®® ®�1P� Sicasae • a°cob /®�/ � Sip: r,.r Print: 9, e / a �C � � • . _ z / ..� - I ft ®.s My Commission Expires: fl41 'ted' #Do 9M ` Q6 ®7O�a OB-� �C,°ST@e-,*, � APPROVED BY Plans Examiner Structural Review (Revised 3/12/2012)(Revised 07/10/07)(Revised 06/10/2t109)(Revised 3/15/09) as identification and who did take an oath. NOTARY PUBLIC. _•• flay Sign: Print: _ My Commission Exo .3 ...........�\\\ Zoning Clerk BR,OWARD COUNTY LOCAL BUSINESS TAX RECEIPT 115 S. Andrews Ave., Rm. A-100, Ft. Lauderdale, FL 33301-1895 — 954-831-4000 VALID OCTOBER 1, 2012 THROUGH SEPTEMBER 30, 2013 DBA: Receipt #:180-2344 8 0 - 2 3L CONTRACTOR Business Name: RANCO CONSTRUCTION CORP OF SOUTH FLORIDA BUSin@SS Type: CONTRACTOR) Owner Name: RANCE C SHOMAKER Business Opened:06/19/1994 Business Location: 2514 HOLLYWOOD BLVD 501 State/County/Cert[Reg:CGCO28496 HOLLYWOOD Exemption Code: Business Phone: 954-920-3350 Rooms Seats Employees Machines Professionals 2 For Vending Business Only Number of Machines: Vendlna Tvoe: Tax Amount Transfer Fee NSF Fee Penalty Prior Years Collection Cost Total Paid 27.00 1 0.00 1 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 not indicate that the business is legal or that it is in compliance with State or local laws and regulations. Mailing Address: RANCE C SHOMAKER 2514 HOLLYWOOD BLVD #501 HOLLYWOOD, FL 33020 CEIVEI3 SEP 0-A 2012 }3Y: 2012 -2013 Receipt #03B-11-00009499 Paid 08/27/2012 27.00 \nM/. CITY OF HOLLYWOOD LOCAL BUSINESS TAX RECEIPT PRINT DATE: 9/20/12 A -71 THIS IS YOUR LOCAL BUSINESS TAX RECEIPT. PLEASE DETACH AND POST IN A CONSPICUOUS PLACE AT THE BUSINESS LOCATION. PLEASE DO NOT REMIT ANY PAYMENT. THIS IS NOT A BILL. Business Name• Business Location• Business Class: Tax Basis: Receipt Number: Receipt Year: Expiration Date: RANCO CONSTRUCTION CORPORATION 2514 HOLLYWOOD BLVD CONTRACTOR/GENERAL 2 - 4 WORKERS 13 00024299 10/01/12 09/30/13 NEW CHARGES• (Itemized Below) Base Fee Additional Charges: TOTAL NEW CHARGES• Penalty Amount: Previous Balance Due: TnTAI AMn11KIT MAIM. 251.00 251.00 251.00 .00 .00 251.00 PURSUANT TO STATE LAW, THE LOCAL BUSINESS TAX IS LEVIED ON THE PRIVILEGE OF DOING BUSINESS WITHIN A CITY'S LIMITS, AND IS NON -REGULATORY IN NATURE. ISSUANCE OF A LOCAL BUSINESS .TAX RECEIPT BY THE CITY OF HOLLYWOOD DOES NOT MEAN THAT THE CITY HAS DETERMINED THAT THE EXISTING OR PROPOSED USE OF A LOCATION IS LAWFUL. ISSUANCE OF A LOCAL BUSINESS TAX RECEIPT DOES NOT LEGALIZE OR CONDONE THE NATURE OF THE BUSINESS BEING CONDUCTED IF CONTRARY TO ANY LOCAL, STATE OR FEDERAL LAWS OR REGULATIONS. N 17:1: t�?"•3i�•T;7I+�_1il ®� CERTIFICATE OF LIABILITY ski -Tamm IN NCE 013 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(Sh 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 WANED, subject to the terns and conditions of the policy, certain policies may require an endonmrnerrt. A statement on tht ceriflic ate does not confer rights to the certiflc aW holder In Hsu of such endorseme s . PROrIUCER Phone: 04 5 4=I-23 MDW Insurance Group Inc Fax: 30S-044-4�Bd 362 Minorca Ave Corel Gables, FL 33134 Donald W McCartney RC1 No): PHONE E-MAIL AWJIKM 07107/2013 071071 M4 AFFORO= COVERAGE NAIL & 1NSURERA: FCCi insurance Group 10178 MED EV aye S 61084 01SsR® Ranco Construction Corp 2614 Hollywood Blvd. #801 Hollywood, FL 33020 WSORERa:Brid efteld EmPAWers Ins Co HOKUM C: per wive Insurance Co. 10183 INSURER D:National Trust Insurance Co. [VOLUME: s C 9• •1T : a J. . ;. IN ::.: 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 HEREON IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. RMI LTR TYPE OF INSURANCE ADUL SM pOL= NUMBER Miami Shores, FL 33138 AUTHOROW REP.AT, Lem A GENERAL LIASHM X COMMERCIAL GENERAL uAsam CLAWS -MADE ❑X OCCUR X Ind Contractors GL001 X2701 07107/2013 071071 M4 EACH OCCURRENCE S 1 $ 100 MED EV aye S 61084 PERSONAL S ADV INJURY $ 11000,00 GENERALAGGREGATE 5 2,000 GEWLAGGREGATE UWT APPLIES PER: POLICY X LOC PRODUCTS-COMPWAGG s 2,000 s C AUTOM013LE UABU irY ANYAUTO AALL LLOOg® WNX �� X HIRED AUTOS X S� CA042M" 06M412M3 011M412014 SINGLELWT 1;FQ BOE.YINJURY(PerPr w4 s OD BILY INJURY (Par sem) S P g fPor s B X UMBRELLA LIABOCCUR Sites UA13 HCLAIMS-MADE UMBM7M01 0710712013 071071 M4 EACH OCCURRIMM S 4,M,00 AGGRECATE & 400,00 DED RETENTION S B WOR ERS COMPENSKF= AND EMPLOYS UABLFTYTORY ANYPROPR�TORIPA� YEN E%CLUDEDY F-� ( SESw�Wadm in NH) L� d PTM OF ORMT1ONS below NIA 96.33616 11127/2012 1112712M3 X WC STATU- I JOTH- LtMrrS ER , EL EACH ACCIDENT s 9,000 E.L. DiEASE - EA EMPLOYEES 11000 E.L. DISEASE - POLICY LUT S 118111311M DERIPTtON OF OPMMONS t LOCAs SNS / VEH (Atffieh ACORD tot, Ad�Gw�al Rm Sahadule, tF mora apace �+•IW ) CMTIRCATE'HOLCER r_erdr-FI I e'nnM ©1988-2010 ACORD CORPORATIDN. Ali rights reserved. ACORD 26 (2010105) The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Miami Shores Village 9 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE 2nd Ave Miami Shores, FL 33138 AUTHOROW REP.AT, Donald W McCartney ©1988-2010 ACORD CORPORATIDN. Ali rights reserved. ACORD 26 (2010105) The ACORD name and logo are registered marks of ACORD NOTICE OF COMMENCEMENT A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION PERMIT NO. d TAX FOLIO NO. // m 91" -t9Ao - ®o.S'o STATE OF FLORIDA: COUNTY OF MIAMI-DADE: THE UNDERSIGNED hereby gives notice that improvements will be made to certain real property, and In accordance with Chapter 713, Florida Statutes, the following information Is provided in this Notice of Commencement. OR 8i: 28745 Ps 46088 (IDS) RECORDED 07/29/2013 11:41926 HARVEY RUVINP CLERK OF COURT MIAMI-DADE COUNTYr FLORIDA I ALIT DArc Space above reserved for use of recorift office 1. Legal description of property and streaVaddress: //fie /t A-rli sT 9 Od AuA. Ml ® EdwISS; r FL !83/(,/ 2. Description of improvement: 1A(7FWdd A47 ArudA® 9 /�J:As�/1 S-G!,A" �srt®eeJL 3.Owner(s) name and address:a��?� Interest in property: Name and address of fee simple titleholder 4. Contractor's name, address and phone number. 5. Surety: (Payment bond required by owner from contractor, if any) (JIA- Name, address and phone number Amount of bond $ 6. Lender's name and address: 7. Persons within the State of Florida designated by owner upon whom notices or other documents may be served as provided by Section 713.13(1ua)7., Florida Statutes, Name, address and phone number. 8. In addition to himself, Owners designates the following pew*) to receive a copy of the Ltenor's Notice as provided In Section 713.13(1)(b), Florida Statutes Name, address and phone number: 9,404o &at s'P 409p. Z5/N i-10440 " R ,fid® .9-M S SIO - 9. Expiration date of this Notice of Commencement: lot, t 41A (the expiation date is t year from the date of room g w ten a Meat date is specMed) WARNING TO OWNER: ANY PAYMENTS MADE BY THE OMER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART I, SECTION 713.13. FLORIDA STATUTES, AND CAN RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT. K Signature(s) of Owneris) or Owne ' Authorized Offlow/Director/Partner/Manager Prepared 13y_ )71. Prepared By SPS aE` Print Name 14 &14,4 V; � r � Pea Name TIUe(office . V TitialOffice STATE OF FLORIDA COUNTY OF MIAMI-DADE��,®� The foregoing In�t(nent was acknowledged Jz,wledged before me this .. day of Signature(s) Owner(s) or s)'s Authorized Officer/Director/Partner/Manager who signed above: By. 21.. � By 12301-52 FMO era