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DEMO-15-1596 (2) y REM� : � °R£s yt Miami Shores Village i #,"'T D+6kt' ,olith n 10050 N.E.2nd Avenue NWr / Miami Shores,FL 33138-0000 a. alay ties Phone: (305)795-2204 ` � l �GORIDP.. r M I' / Expiration: 12126/2015 F :... Project Address Parcel Number Applicant 11004 NW 2 Avenue 1121360020240 � Miami Shores, FL 33168- Block: Lot: LSP HOMES LLC Owner Information Address Phone Cell LSP HOMES LLC 455 NE 210 Circle Terrace (305)527-3643 MIAMI FL 33179- 455 NE 210 Circle Terrace MIAMI FL 33179- Contractor(s) Phone Cell Phone Valuation: _ $ 135.00 KILBY ELECTRIC CO (305)233-2965 _... Total Sq Feet: 1376 Type of Demo:Electric Available Inspections: Additional Info:VERIFY ELECTRICAL DISCONNECTION Inspection Type: Classification:Residential Final Scanning: 1 Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $0.60 DBPR Fee Invoke# DEMO-6-15-56131 $2.00 06/29/2015 Credit Card $58.60 DCA Fee $2.00 $50.00 Education Surcharge $0.20 06/26/2015 Credit Card $50.00 $0.00 Permit Fee $100.00 Scanning Fee $3.00 Technology Fee $0.80 Total: $108.60 In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans,drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL,PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: I certify that all the foregoing information is accurat nd that all work will be done in compliance with all applicable laws regulating construction and zoning. Futhermore, I authorize the above-namyed-eon ko o the work stated. June 29, 2015 Authorized Signature:Owner / Applicant / C / Agent Date Building Department Copy June 29,2015 1 r Miami Shores Village a-0= `- � Building Department JUN 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 20 (b BUILDING Master Permit No.z�lmn `'(0 / PERMIT APPLICATION Sub Permit No."/Q" D I BUILDING KELECTRIC ROOFING ❑ REVISION ❑ EXTENSION ORENEWAL PLUMBING ❑ MECHANICAL PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP / /�/\ / n /. ) CONTRACTOR DRAWINGS JOB ADDRESS: 11 VL/ T 1 J l J J�� City_ Miami Shores County: Miami Dade Zip: :�Aaa Folio/Parcel#: // e2/,�(o 00a DaY6 Is the Building Historically Designated:Yes ram Occupancy Type: f-f5• Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name(Fee Simple Titleholder): te nn r - Phone#: 3aS-Sa`7- �73 Address: D4 10 C�(,-Cle ✓e rG �-28`L City: State: Zip: �/7j Tenant/Lessee Name: Phone#: Email: n / a CONTRACTOR:Company Name: C 00. Phone#:6Z33—c) /Gy (O,� Address: / /o r-7 /-1l� �- City: ►'Q.»-�i State: /_ L- Zip: L L -y� Qualifier Name:__A rv119-S w G✓� Phone#:� State Certification or Registration#: �C OO Ca CC04 Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ Square/Linear Footage of Work: /37 Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: art e -661 C&4P oC 7nr Specify color off collo��r��thru tile: Submittal Fee$ _) , V�J Permit Fee$ 14PO add CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ �/ Q (Revised02/24/2014) /-t 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 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 ved and a reinspection fee will be charged. Signature ., Signatu OWNER or AGENT CONTRACTOR The foregoing instrument w^ass acknowledged before me this The f egoing instrument was acknowledged before me this �D� da 0f L1 U 20 / , by �a day of �,l'� Q 20 , by 4✓ln� 1'liyi who is personally known to W AVJ who is personally known to me or who has produced Pi JPr: t,CA- Q-v as me or who has produced as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY P • Sign: / Sign: Print: l/ Print: Seal: Seal: *my FuNk-No M ram • Coma"a OF mi" of CMIIII flow JIM 1.-20119 OoIIo Ilr■10Afi ry& l APPROVED BY � ,!'L/.��f Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) onto "loot" Miami shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33130 Tel: (305) 795,2204 Fax: (305) 756 8972 CONTRACTORS' REG ISTRA ON IF CONTRACTOR IS A FLORIDA NATE CERTIFIED CONTRACTOR: A "'.COPY OF QUALIFIER'S STATE LICENCES B ?'` COPY OF LOCAL BUSINESS TAX RECEIPT C ._COPY OF LIABILITY INSURANCE* D, ,,,,,, '''COPY OF WORKERS COMPENSATION INSURANCE* (Workers Compensation EXEMPTION must have NOTICETO OWNER form and Contractor Affidavit) IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY: A. __.COPY OF CERTIFICATE OF COMPETENCY OF QUALIFIER B ..........r..... COPT OF LOCAL BUSINESS TAX RECEIPT C, ..... COPY OF STATE REGISTERED CONTRACTOR LICENSE OR MIAMI DACE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT. D ...._._.._ COPY OF LIABILITY INSURACE* E. .__ _ COPY OF WORKERS COMPENSATION INSURANCE* (Workers Compensation EXEMPTION must have NOTICE TO OWNER form and Contractor Affidavit) *YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE AS FOLLOW'; Certificate Holder: MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES,FL 33135 Certificate must specify the description of operations or contractor license number. •�IF M■M!■✓!sR�Rb 6 i M IN M M V♦M litre#Rllli�1N M■••■111 P■�7�✓•Y■•q MY.MAi1ii Y�♦14f �iM�Nt•Y'•II�Rli•• �i•!M r BUSINESS NAME, �,. - .._. _. / r # BUSINESS ADDRESS: ._. .....N /9 CITY.�.f 6:_ LL�STATi* ZIP ' BUSINESS PHONE: { l - FAX NUMBER( } CELL PHONE QUALIFIER'S NAME: . > r . QUALIFIER'S LIC NUMBER: ._ t<IGK bUU1 9, 6()VtKiNL)I-� KtN LAtdV,—U t, t4 tCtINKY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD The ELECTRICAL CONTRACTOR Named below IS CERTIFIED , Under the Prov sions of Chapter 489 FS, Exciratton date AUG 31� 2016 HOWARD, OWARD JAMES L w� Leri KII_SY ELECTRIC CO � '1a i0 SVV 10^AVENUE w e MIAMI Fw 33157 X JSSUED UVO- 5;2014 DISPLAY AS REQUIRED BY LAW 5FQ# L1408050002,17 r t � P =r Is L � ? , F s K�-eerpr racJ. � ' RvA SEPT EM3E`R 4 247 i 1764597 OF t,"sF, TAX GCnA-ECTOR This Looel Susip a� re,ura�urtsrr tate 3ch #�fafer'sgcu tie =u s.,� 3 a -- t 'c 9'.k'airxsrnrreEaf srg,�rG f n Inn,a�ad �! The RECEIPT Wt7: t` 5�dy era€tttarrr.4 f` KILBY-1 OP ID:AD ACRD CERTIFICATE OF LIABILITY INSURANCE DA06/22/201 Y) 06/22/2015 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 of such endorsement(s). PRODUCER CONTACT NAME: Kahn-Carlin&Company,Inc. PHONE 305-446-2271 FAX No),305-448-3127 3350 S.Dixie Highway A/C No Ext Miami,FL 33133-9984 ADDRESS:processing@kahn-cariin.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Hanover American Insurance Co. 36064 INSURED Kilby Electric Co. INSURER B:Bridgefield Employers Ins Co 10701 S 1Avenue Miami, FL 3313157 INSURER C:Hanover Insurance Company 22292 Miami 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 rypE OF INSURANCE ADDL SUBIR POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER MMIDDIYYYY MM/DD/YYYY GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY ZZJ835607009 07/01/2014 07/01/2015 DAMAGE TO RENTED- PREMISES Ea occurrence $ 100+00 CLAIMS-MADE X OCCUR MED EXP(Any one person) $ 10,00 PERSONAL&ADV INJURY $ 1,000,00 X PER PROJECT AGGRE GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PERS PRODUCTS-COMP/OP AGG $ 2,000,00 POLICY PRO LOC $ AUTOMOBILE LIABILITY EOa accide0 SINGLE LIMIT $ 1,000,000 A X ANY AUTO AZJ834843809 07/01/2014 07/01/2015 BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS PER ACCIDENT X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2,000,00 C EXCESS LIAB CLAIMS-MADE UHJ835215710 07/01/2014 07/01/2015 AGGREGATE $ 2,000,00 DED X RETENTION$ 0 $ WORKERS COMPENSATION X WC STATU- OTH- AND EMPLOYERS'LIABILITY TORY LIMITS ER B ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N 83030922 01/01/2015 01/01/2016 E.L.EACH ACCIDENT $ 1,000,00 OFFICER/MEMBER EXCLUDED? ❑ N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,00 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Re: Kilby Electric Co, James Howard, EC 0002064 CERTIFICATE HOLDER CANCELLATION MIAM-04 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Miami Shores Village ACCORDANCE WITH THE POLICY PROVISIONS. Building Department 10050 NE 2 Avenue AUTHORIZED REPRESENTATIVE Miami Shores,FL 33138 ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD