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RC-15-615 (2) Porr»Jf Idtn, C 31� ,ygoaEs Miami Shores Village `` f t3• ype: o"t 0,10111 10050 N.E.2nd Avenue NE jlUgrk € S do j 'teration " Miami Shores, FL 33138-0000 `\\ tie Phone: (305)795-2204 a FGOR1Dp' `' due fad, Expiration: 09/22/2015 Project Address Parcel Number Applicant 296 NE 99 Street 1132060134300 Miami Shores, FL 33138- Block: Lot: JEFF KAMP BARBARA KAMP Owner Information Address Phone Cell JEFF KAMP BARBARA KAMP 296 NE 99 Street MIAMI SHORES FL 33138- 296 NE 99 Street MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone _..._•._ _.__.__._•_•_ __.._._.._• EJD CONSTRUCTION CONSTRACTOF 305 433-4843 Valuation: $ 6,500.00 ( ) (305)318-4978 Total Sq Feet: 0 Approved:In Review Available Inspections: Comments: Inspection Type: Date Approved: : In Review Final PE Certification Date Denied: Window Door Attachment Type of Construction: REMOVE WINDOW AND INSTALL: Occupancy:Single Family Framing Stories: Exterior: Insulation Front Setback: Rear Setback: Drywall Screw Left Setback: Right Setback: Fill Cells Columns Bedrooms: Bathrooms: Window and Door Buck Plans Submitted:Yes Certificate Status: Review Planning Certificate Date: Additional Info: Review Electrical Review Building Bond Return: Classification:Residential Review Structural Fees Due Amount Pay Date Pay Type Amt Paid Amt Due Review Plumbing CCF $4.20 Review Mechanical DBPR Fee Invoice# RC-3-15-54862$2.93 03/19/2015 Credit Card $50.00 $251.06 DCA Fee $2,93 Education Surcharge $1.40 03/26/2015 Credit Card $251.06 $0.00 Permit Fee $195.00 Plan Review Fee(Engineer) $80.00 Scanning Fee $9.00 Technology Fee $5.60 Total: $301.06 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 accurate and that all work will be done in compliance with all applicable laws regulating construction�zon' g. Futhermore, I authorize the above-named contractor to do the work stated. March 26, 2015 h z d Signature:Owner / Applicant / Contractor / Agent Date Ix Building Department Copy March 26,2015 1 Miami ShQtes Village i t F Building Department MR 19 2015 r 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(30S)762-4949 FBC 20 BUILDING Master Permit No. 'S PERMIT APPLICATION Sub Permit No. QBUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 296 NE 99th St. City: Miami Shores County: Miami Dade Zip: Folio/Parcel#:11-3206-013-4300 Is the Building Historically Designated:Yes NO ^ Occupancy Type: Load: Construction Type: g Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder):Jeff& Barbara Kamp Phone#:305-401-2822 Address:296 NE 99th St. City, Miami Shores State: FL Zip: 33138 Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name: EJD Construction Contractors Phone#: 305-433-4843 Address: 1700 NE 143 St. City: North Miami State: FL Zip: 33181 Qualifier Name: Eric Scarborough Phone#: 305-318-4978 State Certification or Registration#: C C(`. 15/5 Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ — (Or��Q-0�� Square/Linear Footage of Work: Type of Work: ❑ Addition a Alteration ❑ New ❑ Repair/Replace ❑ Demolition x Description of Work:_ J r—'eC Lf 0')LP'j 1,nA ,. � ,�� # "e"C�v,e vk;tc� SAL Specify color of color thru tile: Q Submittal Fee$-&w Permit Fee$ ( CCF$ CO/CC$ Scanning Fee$ , Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ � (Revised02/24/2014) r �L�� � ��� .0� �� C� . � � ti 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 approved and a reinspection fee will be charged. Signature - ry Signature O NER AGENT rinstrument CTOR The foregoing instrumen as acknowledged before/me this The ff oregnowledged before me this day oflry)b.tj7L 20 �Y by b 20 /� . by �� /r fiM/0 whois personally known to Gnli� CG?/z[�D/e[ who�����a me or who has produced j�•,( �()•y,Ag•(e7 P).As me or who has produceds identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: Print: Nuuq, Print: �. Seal: Notary Public-State of Florida Seal: My Comm.Expires Oct 18.2015 ,t• ? Commission#EE 132379 ot►Ar n�dG Notary Public State of Florida Joanna M Feliciano oR n. x�ire�u ff1J1�/r�.0'I� APPROVED BY (� Plans Examiner Zoning Vi ti Structural Review Clerk (Revised02/24/2014) / ACORD CERTIFICATE OF LIABILITY INSURANCEDATE(MM/DD/YYYY) 02/17/2015 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION A.B.S.Insurance Consultants ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 11402 N W 41st Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Suite 213 Miami FL 33178 INSURERS AFFORDING COVERAGE NAIC# INSURED EJD Construction Contractors&Investment Corp. INSURER A: Essex Insurance Company 1700 N.E.143rd Street INSURER B: INSURER C: North Miami FL 33181 INSURER D: INSURER E: COVERAGES 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR IkDD'L POLICY EFFECTIVE POLICY EXPIRATION OF INSURANCE POLICY NUMBER LIMITS GENERAL LIABILITY EACH OCCURRENCE $1,000,000 A X COMMERCIAL GENERAL LIABILITY 3DU7644 06/13/14 06/13/15 DAMAGE TO RENTED $100,000 —17 CLAIMS MADE OCCUR MED EXP An one on $5,000 PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 X POLICY 7 PRO LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY NON-OWNED AUTOS (Per accident) $ PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO EA ACC $ OTHER THAN AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR EICLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND WC STATU- OTH- EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $ yes,describe under ECIAL PROM 1 N below E.L.DISEASE-POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS General Contractor CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Village of Miami Shores DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN 10050 NE 2nd Avenue NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER ITS AGENTS OR Miami Shores,FL 33138 REPRESENTATIVES. AUTHORIZED REPRESENTATIVEz <DA> ACORD 26(2001/08) ©ACORD CORPORATION 11988 A,,,,I,,,,, '"'�' CERTIFICATE OF LIABILITY INSURANCE DATE(MMID14YYY) 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 CONTACT NAME: Hemisphere Insurance Group PHON o Ext): (305)501-2801 AIC No): (305)553-9010 11401 SW 40 St Ste 340 E-MAIL s. hemisphereinsgrp@aol.com Miami,FL 33165 INSURERS AFFORDING COVERAGE NAIC X Phone (305)501-2801 Fax (305)553-9010 INSURER A: FWCJUA INSURED INSURER B: EJD CONSTRUCTION CONTRACTORS INSURER C: 1700 NE 143 ST INSURER D: N MIAMI,FL 33181 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 TYPE OF INSURANCE ADDLSUBR POLICY EFF POLICY EXP LIMITS LTR I S POLICY NUMBER MM/DD/VYYY MM/DD/YYYY GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED ❑ COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ ❑ ❑ CLAIMS-MADE D OCCUR MED EXP(Any one penmen $ ❑ PERSONAL&ADV INJURY $ ❑ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ ❑ POLICY C-] JECT PRO- ❑ LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ ❑ ANY AUTO BODILY INJURY(Per person) $ ❑ AALL UTOS OWNED D SCHEDULED AUTOS BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE F-1HIREDAUTOS ❑ AUTOS Per accident $ ❑ D $ ❑ UMBRELLA LIAB ❑OCCUR EACH OCCURRENCE $ D EXCESS LIAB ❑CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATIONWC SSTATN 1:1ETH AND EMPLOYERS'LIABILITY Y/NLIM ANY PROPRIETOR/PARTNER/EXECUTIVE 5743B01A E.L.EACH ACCIDENT $ 1,000,000.00 A OFFICERIMEMBER EXCLUDED? ❑ N/A 08/29/2014 08/29/2015 (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ 1,000,000.00 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000.00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) GENERALCONTRACTOR CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE VILLAGE OF MIAMI SHORES THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN 10050 NE 2nd Ave,Miami Shores,FL 33138 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 26(2010/05)QF The ACORD name and logo are registered marks of ACORD V fi STATE OF FLORIDA DEPARTMENT OF BUSINESS AND h " PROFESSIONAL REGULATION , "SAB" -�S ` CGC1515901 ISSUED: 08/10/2014a CERTIFIED GENERAL CONTRACTOR # , SCARBOROUGH,ERIC JASON ` EJD CONSTRUCTION CONTRACTORS&INV IS CERTIFIED under the provisions of Ch.489 FS. Expiration date: AUG 31,2016 L14081000C2641 I . RICK SCOTT, GOVERNOR KEN LAWSON,SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD CGC1515901 s The GENERAL CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2016 ' gift. SCARBOROUGH, ERIC JASON EJD CONSTRUCTION CONTRACTORS& INVESTMENT CORP 1700 NE 143RD ST MIAMI FL 33181 ISSUED: 08/10/2014 DISPLAY AS REQUIRED BY LAW SEQ# L1408100002641 003759 Local Business Tax Receipt Miami—Dade County, State of Florida —THIS IS NOTA BILL — DO NOTPAY 5608816 LBT BUSINESS NAME/LOCATION RECEIPT NO. EXPIRES EJD CONTRUCTION CONTRACTORS&INVESTMEWINIIAIEWAL SEPTEMBER 30, 2015 1700 NE 143 ST 6849717 Must be displayed at place of business NORTH MIAMI FL 33181 Pursuant to County Code Chapter 8A—Art.9&10 OWNER SEC.TYPE OF BUSINESS EJD CONTRUCTION CONT& INV CORP 196 SUB—BUILDING CONTRACTOR PAYMENT RECEIVED j worker(s) 1 CGC7515901 BY TAX COLLECTOR $45.00 07130/2014 CHECK21-14.038355 This Local Business Tax Receipt only confirms payment of the Local Business Tax.The Receipt is not a license, permit or a certification of the holder's qualifications,to do business.Holder must comply with any governmental or nongovernmental regulatory laws and requirements which apply to the business,