RC-12-1540 INSPECTION RECORD __ __ POST ON SITE
�SNORE s
Permit No. RC-8-12-1540
Miami Shores Village --
10050 N.E.2nd Avenue Permit Type:Residential Construction
Miami Shores,FL 33138-0000 Work Classification:Addition
y�FN7— oe Phone: (305)795-2204 Fax: (305)756-8972
F�0R10A Issue Date:6/19/2013 Expires: 12/16/2013
INSPECTION REQUESTS: (305)762-4949 or Log on at https://bldg.iniamishoresvillage.com/cap
REQUESTS ARE ACCEPTED DURING 8:30AM-3:30PM FOR THE FOLLOWING BUSINESS DAY.
Requests must be received by 3 pm for following day inspections.
Residential Construction Parcel#:1132060143110
Owner's Name:RUTH POLLEY Owner's Phone:
,lob Address: 935 NE 95 Street Total Square Feet: 336
Miami Shor _s FL 33138-
Bond Number: 2245 Total Job Valuation: $ 77,000.00
WORK IS ALLOWED MONDAY THROUGH SATURDAY,
7:30AM-6:OOPM.NO WORK IS ALLOWED ON SUNDAY
(.:ontractor(s) Phone Primary Contractor OR HOLIDAYS.
HOGAN CONSTRUCTION COMPAN' (305)310-7971 Yes
BUILDING INSPECTIONS ARE DONE MONDAY
THROUGH THURSDAY, ROOFING INSPECTIONS ARE
DONE MONDAY THROUGH FRIDAY. NO BUILDING
INSPECTIONS DONE ON FRIDAY.
-ts
NO IN3PECTION WILL BE MADE UNLESS THE PERMIT CARD IS DISPLAYED AND HAS BEEN APPROVED. PLANS ARE READLY AVAILABLE. IT IS
THE PERMIT APPLICANTS RESPONSIBILITY TO ENSURE THAT WORK IS ACCESSIBLE AND EXPOSED FOR INSPECTION PURPOSES. NEITHER
THE BUILDING OFFICIAL NOR THE CITY SHALL BE LIABLE FOR EXPENSE E14TAII-ED IN THE REMOVAL OR REPLACEMENT OF ANY MATERIAL
WANING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
CO IMENCEMENT MAY 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.
INSPECTION RECORD
STRUCTURAL
INSPECTION DATE INP INSPECTION DATE INSP INSPECTION DATE INez.
Foundation 7 ,? y. Zonin Fina? -- -
Stemwall ZONsVG COMMENTS Rough �- < ]
Slab Water Service
Columns 1 st Lift zG 3 2"d Rough
Columns 2nd Lift Top Out
Tie Beam Z LL G 3r Fire Sprinklers
01
Truss/Rafters /3 Septic Tank
Roof Sheathing / 3 Sewer Hook-up
Bucks
3. Roof Drains 1
Windows/Doors / �;
Interior Framin Gas
2 /3 INSPECTION DATE INSP LP Tank
Insulation Z Tem ora F`,)le Well .
CeilingGrid 30 DayTem. gra Lawn Sprinklers -
Drywall Pool Bondin Main Drain
Firewall Pool Deck Bc,ndin Pool Piping
Wire Lath_ Pool Wet Niche Backflow Prevento
Pool Steel Under round Interceptor I
Pool Deck Footer Groun_i Catch Basins TI
Final Pool Slab I Condensate Dr ins
Final Fence Wall Rough I FIRS Final Ql
Screen Enclosure Ceiling rh;
Driveway Rough < PLU INGCOMM T
Drivewa Base Tele hone R;,ui _
Tin Ca Tele hone Final
Roof in Progress TV Rough --
Mo in Progress TV Final
Final Roof Cable Rou V,'—
Shutters
Shutters Attachment Cable Final — -
Final Shutters Intercom Roucfh
Rails and Guardrails Intercom Fina"i ,
NICAL
ADA com liance Alarm Rough INSPECTION DATE IN
7XN /� Alarm Final Underground Pipe
DOCUMENTS Fire Alarm R.��gh
Soil BearingCert 4,CAL
al - Rough
]7
Soil Treatment Cert ' ,Kith
Floor Elevation Survey _?w 'Ventilation Rou
Reinf Unit Mas Cert COMMENTS nod Rough
Insulation Certificate Pressure Test
Spot Survey
_ Final Hood "-
Final Surveyfinal Ventilation
Truss Certification _ Final Pool Heater
STRUCTURAL COMMENTS Final Vacuum
MECHANICAL MENTS
INSPECTI0 4 DATE INSP
Final S rinkl» _
Final Alarm ---@
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151't,0 796 —
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■■■■ ■■ ■■'� Miami shores Village
Building Department
E8 IN$
OR 10050 10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
CERTIFICATE OF OCCUPANCY/COMPLETION
CHECK LIST
Building permit card.
❑ Surveys (2 copies) Final as built- Required Items: Elevations of buildings showing all intended
setbacks from property lines and other existing structures. Ingress+ Egress, required parking
spaces, Wheel stops, stripping, and all paving to exterior. �ist— D L
❑ Certificate of Elevation –(Sealed by surveyor). Expiration date required on the form.
certificate of Insulation.
❑ Certificate of Soil Treatment(Final treatment-original)1 'II U(, _i4 3vV"
CHAPTER 2913-5 TERMITE PROTECTION: "This Building has received a complete treatment
for the prevention of subterranean termites. Treatment is in accordance with the rules and
law as established by the Florida Department of Agriculture and Consumer Services."
❑ Health Department Approval Letter(On septic or private water).
Note: If the house is on septic tank, approval letter is required from Health Dpt.
❑ Soil Compaction Letter(Density report is required)
❑ Final certification letter from the Engineer/Architect (on masonry, trusses, special structure, etc)
❑ E3� ntor ficate (Required on commercial projects only)
❑ Declaration of use. (Recorded in Miami-Dade Clerk of Courts)
PLEASE NOTE THAT THE SAME ITEMS ARE REQUIRED FOR TEMPORARY CO
• Emergency CO (Without 24 Hrs Processing)Additional fee is $80.00.
• Temporary CO (Up to 90 days max) $75.00.
• Residential CO $150.00
• Residential CC $50.00
• Commercial CO and CC $200.00
PERMIT# ' `
CONTRACTOR: N
SUBMITTAL DATE:
ADDRESS: Zs
NAME:
RESUBMITAL DATES:
PROJECT TYPE:
ZONING FIRE
STRYUR IMPACT FEES
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Notice of a Treatments for Termites
(�r�egaieed b9 Florins Code(I+'B[.�194.26) �BUG=A=BUG
PEST AND TERMITES
ELIMINATION
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PERMIT# 12 r �a _
CONTRACTOR: 0
SUBMITTAL DATE: l
ADDRESS:
NAME:
RESUBMITAL DATES:
PROJECT TYPE: i l �� �t
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HOGAN CONSTRUCTION COMPANY
1331 Bristol Avenue Davie, FL 33021
License # - CGC 1507037
TEL (954) 370-6161 FAX (954) 370-6181
Mr. Ismael Naranjo July 7,2015
Building Official, Miami Shores Village
10050 NE 2 Ave
Miami Shores Village FL 33138
REFERENCE BUILDING PERMIT 12-1540
FOLIO:11-3206-014-3110 SUB-DIVISION:MIAMI SHORES SEC 2
OWNER: RUTH S POLLEY-935 NE 95 ST,MIAMI SHORES
INSULATION CERTIFICATE
Mr. Naranjo:
The purpose of this letter is certify that the renovations completed at 935 NE 95th Street included installation of thermal
insulation that is in compliance with the State of Florida Energy Code, the approved energy calculations and plans and in
accordance with good construction practice in use at time of construction. The insulation furnished and installed has the
characteristics shown
1)Exterior CBS Wall installation R-5 Material: Rigid Board- Thickness 5/8 inch
2)Exterior solid concrete walls R-5 Material: Rigid Board-Thickness 5/8 inch
3)Ceiling insulation R-30 Material: Batts:Thickness 10 inches
The owner of the residence was present and witnessed the installing of the insulation. For some inexplicable reason the
building insulation certificate was not completed during the construction.
I thank you in advance for your assistance in solving this problem.
Sincerely
Cl rank a as p ident
General tractor-CGC 1507037
All Material is guaranteed to be as specified. All work to be completed in a professional manner as to standard practices. Any
alterations or deviation involving extra costs will be additional and executed only upon written orders,and will become and
extra charge over and above the estimate. The above is contingent upon strike,accident and/or delays beyond our control.
Owner to maintain insurance to cover fire,tornado and liability for jobsite.
"EXCEDING EXPECTATIONS-NOT JUST OUR MOTTO BUT OUR GOAL"
TerraTeck Consultants, Inc.
•Environmental Consultants • Foundations • Geotechnical Testing • Inspections • Construction Materials Testing • Structures
FIELD DENSITY REPORTS
Client: Ruth Kettaneh Date: 07/01/13
Address: 935 NE 95t"Street, Miami Shores, Florida 33138 Order No.: 13-2731
Project: Addition At 935 NE 95th Street, Miami Shores, Florida 33138
Contractor: Owner
Description: Tan To Brown Silica Sand With Rock Fragments.
Location: EEastEndhe Slab Area For Addition Lab# D-35096
Location: he Slab Area For Addition Lab# D-35097
Test Results of
Field Densities ASTM method: D-2922-81
Description of Test Area Building Slab Densities For the addition at 935 NE 95th Street, Miami Shores, Florida 33138
Lab No. D-35096 D-35097
Test No. 1 2
Depth in inches 12" 12"
Field Density (Ibs/Cft.) 106.5 106.8
Mositure Contents % 7.2 7.5
Maximum Density % ( in the field) 98.1 98.3
LRe . Com action b obspecs 95% 95%
00 % Max. DensityProctor 108.6 108.6
roctor No. P-2752 P-2752
Optimum Moisture- 8.3
[ Remarks The Above Test Complies With Job Specifications —-�
Checked
Respectfully Submitted BY,
Terra
/Tech Consultants, Inc.
FLORIDA REGISTRATION No. 39228 Rafael E.Droz-Seda, P.E.
Date: 07161113
As a mutual protection to clients,the public and ourselves,all reports are submitted as the confidential property of clients,and authorization for publication of 1
statements,conclusions or extracts from or regarding our reports is reserved pending our written approval.
TerraTeck Consultants, Inc.
♦Environmental Consultants ♦ Foundations ♦ Geotechnical Testing ♦ Inspections ♦ Construction Materials Testing ♦ Structures
FIELD DENSITY REPORTS
Client: Ruth Kettaneh Date: 07/01/13
Address: 935 NE 95`h Street, Miami Shores, Florida 33138 Order No.: 13-2731
Project: Addition At 935 NE 95`h Street, Miami Shores, Florida 33138
Contractor: Owner
Description: Tan To Brown Silica Sand With Rock Fragments.
Location: East End Of The Slab Area For Addition Lab# D-35096
Location: West End Of The Slab Area For Addition Lab# D-35097
Test Results of
Field Densities ASTM method: D-2922-81
Description of Test Area Building Slab Densities For the addition at 935 NE 95`h Street, Miami Shores, Florida 33138
Lab No. D-35096 D-35097
Test No. 1 2
Depth in inches 12" 12"
Field Density lbs/Cft. 106.5 106.8
Mositure Contents % 7.2 7.5
Maximum Density % in the field 98.1 98.3
Reg. Compaction by jobspecs 95% 95%
100 % Max. Density Proctor 108.6 108.6
Proctor No. P-2752 P-2752
Optimum Moisture% 8.3
Remarks The Above Test Complies With Job Specifications
[Checked By R.E.D.S. Report By A.M.
Respectfully Submitted BY,
Terra Tech Consultants, Inc.
FLORIDA REGISTRATION No. 39228 Rafael E.Droz-Seda,P.E.
Date: 0 7/0///3
As a mutual protection to clients,the public and ourselves,all reports are submitted as the confidential property of clients,and authorization for publication of 1
statements,conclusions or extracts from or regarding our reports is reserved pending our written approval.
TerraTeck Consultants, Inc. �*
♦Environmental Consultants ♦ Foundations ♦ Geotechnical Testing ♦ Inspections ♦ Construction Materials Testing ♦ Structures
FIELD DENSITY REPORTS
Client: Ruth Kettaneh Date: 07/01/13
Address: 935 NE 95`h Street, Miami Shores, Florida 33138 Order No.: 13 2731
Project: Addition At 935 NE 95`h Street, Miami Shores, Florida 33138
Contractor: Owner
Description: Tan To Brown Silica Sand With Rock Fragments.
Location: East End Of The Slab Area For Addition Lab# D-35096
Location: West End Of The Slab Area For Addition Lab# D-35097
Test Results of
Field Densities ASTM method: D-2922-81
Description of Test Area Building Slab Densities For the addition at 935 NE 95`h Street, Miami Shores, Florida 33138
Lab No. D-35096 D-35097
Test No. 1 2
Depth in inches 12" 12"
Field Density lbs/Cft.) 106.5 106.8
Mositure Contents % 7.2 7.5
Maximum Density % in the field 98.1 98.3
Reg. Compaction by jobspecs 95% 95%
100 % Max. Density Proctor 108.6 108.6
Proctor No. P-2752 P-2752
Optimum Moisture% 8.3
Remarks The Above Test Complies With Job Specifications 1
Checked B R.E.D.S. Re ort B A.M.
Respectfully Submitted BY,
Terra Tech Consultants, Inc.
FLORIDA REGISTRATION No. 39228 Rafael E. Droz-Seda,P.E.
Date: 1710/11j
As a mutual protection to clients,the public and ourselves,all reports are submitted as the confidential property of clients,and authorization for publication of 1_
statements,conclusions or extracts from or regarding our reports is reserved pending our written approval.
Charles C. Mitchell P.E.CONSULTING ENGINEER,CIVIL,STRUCTURAL
STATE OF FLORIDA P.E.REG.#11127,924 North Federal Hwy Hollywood,Florida 33324
"CERTIFICATE OF COMPLETION"
April 08, 2015
PERMITTING CITY:
Miami Shores PERMIT#RC12-1540
Building Department
10050 N.E. 2ND Avenue
Miami,Shores Fl.33138
SUBJECT PROPERTY:
935 N.E. 95TH Street.
Miami, Shores Fl. 33138
Dear Building Official,
This is to certify that I have performed and approve inspected the addition located at the subject
property mentioned above on December 17, 2014. 1 hereby attest to the best of my knowledge,
and belief and professional judgment,the structure and the envelope components of the above
reference renovation are in compliance with the approved plans and other approved permit
documents. I also attest that to the best of my knowledge, and belief and professional judgement,
the approved permit plans represent the as-built condition of the structure and envelope
components of the said structure.
This document is being prepared in accordance with Chapter 1 of the Florida Building Code and
must be submitted to the Village of Miami Shores Building Department in conjunction with the
application for a certificate of completion for the above reference structure.
The best of my knowledge and ability, this report represents an accurate appraisal of the present
condition of the building based upon careful evaluation to the extent reasonably possible.
If you have any questions regarding this inspection please do not hesitate to contact my office.
305-336-5069
�1
Charles Mitchell F.E. #11127
COUNTY-WIDE LAND SURVEYORS INC. ` �` �
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LAND SURVEYORS'- PLANNERS /Y,:". s=. r+r.
'P.O. BOX 823271 SOUTH FLORIDA, FL. 33082-3271 (305) 772-0766
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LEGAL DESCRIPTION
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Lot 20 and 21 in Block 76 of MIAMI SHORES4
according to the plat thereof, L0CA�/0/� SKE�'H /V-91 �0 Scr�c�' poo`
SECTION NO. 3
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as recorded in Plat Book 10 at Page 37 of the Poul
Public Records of Miami-Dade County, Florida. 33.4'
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SURVEYORS NOTES: 3 ra/c
1 ) . Legal description provided by client.
2 ) . Only record plat easements are shown. 4-
3) . Right of way, information obtained from record plat. ls,�&' Thr * v
4 ) . IN Federal Flood Zone X, Panel 0306 last revised 9-11 -2009. ¢. A/c
d- cat•
5 ) . Benchmark used-Dade County BM# B-62 Elev. 8.65 ' NGVD1929.
6 ) . Elevations are referenced to National Geodetic Vertical Datum 1 929x�ELo✓ 1Z.73
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BOUNDARY & IMPROVEMENTS SURVEY
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vElr FOR: Ruth Polley 935 N.E. 95 St. Miami Shores F1 3
11 6970k
CERTIFICATE NOTE: NOT VALID UNLESS SEALED WITH AN EMBOSSED SURVEYORS SEAL." � \
I HEREBY CERTIFY T11AT THE SURVEY REPRESENTED HEREON COMPLIES WITH THE ASPH•
HINIHUM TECiiNICAL STANDARDS ADOPTED BY THE FLORIDA BOARD OF SURVEYORS AND
MAPPERS IN CHAPTEM 61G 17-6, FLORIDA ADMINISTRATIVE CODE, PURSURANT TO
SECTION 972.027, lorida Statutes.
REVISIONS BY DATE
WASE Su2vE )(.� ?-31ZolZ ?VH-7-
JOSEPH L. MARTIN Z'
�PROFESSIONAL LAND suRvEYOR ,* 4368 DRAWN BY SCJALE DATE F.B./PG. J08# (�,Iti /V+ 1' 9"s S'
STJ17E OF s LORIDA -
COUNTY-WIDE LAND SURVEYORS INC. .,
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' P.O. BOX 823271 SOUTH FLORIDA, FL. 33082-3271 (305) 772-0766IN
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LEGAL DESCRIPTION
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Lot 20 and 21 in Block 76 of MIAMI SHORES
SECTION NO. 3, according to the plat thereof, Lc�CA7/�/J SK��'�! N�7 7� Sc�I� y
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recorded in Plat Book 10 at Page 37 of the
Public Records of Miami-Dade County, Florida.
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SURVEYORS NOTES: ^ = pp va " Y
3' A/c j
1 ) . Legal description provided by client. ti
2 ) . Only record plat easements are shown. '' 1
3 ) . Right of way. information obtained from record plat,
4 ) . IN Federal Flood Zone X, Panel 0306 last revised 9-11 -2009. 4' Nc R
5 ) . Benchmark used-Dade County BM# B-62 Elev. 8.65 ' NGVD1929.
6 ) . Elevations are referenced to National Geodetic Vertical Datum 1929 ti Iz-3� "'EL6✓.
Adjustment (NGVD1929 ) .
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BOUNDARY & IMPTtOVEMENTS SURVEY � ; '- _
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61JRVEY FOR: Ruth Polley 935 N.E. 95 St. Miami Shores F1 /00N
CERTIFICATE NOTr: • NOT VALID UNLESS SEALED WITH AN EMBOSSED SURVEYORS SEAL." 7Z`(�R/ SS `
I ITEREBY C$iTI •Y THAT THE SURVEY REPRESENTED HEREON COMPLIES WITH THE ASPM 9 2
HINIMUM TfiCil.`J AI, iA.1DARDS ADOPTED BY THE FLORIDA BOARD OF SURVEYORS AND J
MAPPrkS IN CH, TER 61G 17-6, FLORIDA ADMINISTRATIVE CODE, PURSURANT TO
SECTION 972.0 Florida St3tUte9. �7
REVISIONS By OATE
---_______ I WW`16 vP.'j l )�,� -31 Zeit ?Wl
1QS�PN L. riARTIN j
t_ANO su»mR * 4368 DRAWN BY SCALE DATE FBI PG. JO@#701r"SIONAL
ATE OF
_
RUTH POLLEY KETTANEH
935 NE 95 STREET
MIAMI SHORES, FLORIDA 33138
TELEPHONE:786-521-1243
March 5, 2015
Miami Shores Building Dept.
10050 NE 2"d Avenue
Miami Shores, FL 33138
Permit Number: RC-8-12-1540
Dear Sir,
Please extend my Permit which expires March 12, 2015 as I try and finish all the open
permits that need to be closed and letters that need to be submitted.
Sincerely,
2ut?-) c V1
Ruth Polley Kettaneh �- ��I 10`
Ruth Polley Kettaneh
935 NE 95th Street
Miami Shores,FL 33138
May 5t", 2014
The Village of Miami Shores
To the Building Inspector,
I am requesting an extension on our building permits because the counter tops that we ordered
from Italy have not arrived yet. We just need a little more time to finish the kitchen project.
Thank you for your consideration.
?DMollye e
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61
OR Fk 28690 Py 24.99°v (1.pa)
RECORDED 06/21/20113 11°21.:1-1;
HARVEY RUVINr CLERK OF COURT
NOTICE OF COMMENCEMENT MIAMI-DADE C:OUNTYr FLORIDA
A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OpRRST UMECTION L ASl' PAGE
PERMIT NO. — S TAX FOLIO NO.�, 32 i01A1, //6
STATE OF FLORIDA:
COUNTY OF MIAMI-DADE:
THE UNDERSIGNED,hereby gives notice that Irdprovamefits 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,
p Spec°above reserved for use of recording office
1.Legal description of property and street/address: l ��f 2-e,r
2.Description of improvement:
3.Owner(s)name and address: .. C
Interest in property:
Name and address of fee simple titleholder: he_°/
4.Contractor's name,address.and phone number: 7 0• Co / 7 ,��,
_D!_a U[-e- `/_
5.Surety:,(Payment bond required by owner.from contractor,U any
Name,address and phone number: a �<9
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(1)(x)7.,Florida Statutes,
Name,address and phone number
8.In addition to himself,Owners designates the following person(s)to receive a copy of the Lienor's Notice as provided in Section
713.13(1)(b),Florida Statutes.
Name address and ohone'number. {�
A � �
9,Expiration date of this Notice of Commencement: 2
(the ex0ration date is 1 year from the date of recording unless a dt fereM date Is specified)
WARNING t0 OWNER:ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATIONOF 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 COMMENCEMENTMUST 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.
Signatures) na(s r Opvaer( 'At thorized faltect artner/ManaQgP
j1-Prepared By, . red By. �SC
Print Name eh PrI Name r-P L
Title/Office CO CAN r->r(A Title/Office,C e
STATE'6F FLORIDA
COUNTY OF MIAMI-DADE t
The foFggoi ingmgnt was a kknoMrleddgged before rile this 2�S,day.of �UBy U 7-CS„1 3
0 liw vl6tially or Uas for
Peri.tkiiBy known,'or"0 educed file following type of'identtfication: ems,
Signature of Nol$ry isublic:
Print Name:
(St-AWSAI EDSHA ARJAWAID
VERIFICATION PUR$UANt TO SECT�DN 926 FLORIDA KIDNotary Public,State of Florida
Under penalties of perjury,I declare that 1 have read the f6regoing and Commission#EE 107495
that the facts stated in It are true,to the best of my knowledge and belief. MY Omtri:egoires June 2812015
Signature(s)of Owners)or Owner(s)1s Authorized Officer/Director/Partner/Mana .r who sig11 ned above:
By By
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RECEIVED 01/07/2011 22:34 yb4JtUb1bi ruxxin IAW'M I FILA,I I LA`!
86/24/2813 11:30 9543409540 INNOVATIVE INSLRANCE PAGE 01/01
OP ID:CT
ACp C)" Mn�oomm
CERTIFICATE Of LIABILITY INSURANCE 0=4113
THIS CERTIFICATE 13 L43UED AS A MATTM OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS
CERTIFICATE DOES NOT AFFummELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
om w. THIS CeRTwIcATE OF INSURANCE DOES NOT CONSI1TUTis A CONTRACT BE:TwEEN THE ISSUING INSURER(S). AUTHORIZED
M --- OR PRODUCE!,AND THE CERTIFICATE HOLDER
IMPORTANT- If Ow oerdilcalle holder Is an ADDITIONAL INSURED,the policy(les)must be endorsed if SUBROGATION IS WAIVED,suOpwt to
the tlerrlra and conditIm of the p0q,eorWn policies may rerlalre an endorsement A sh"nent on thts cerdficet a does not canter rlghts to the
cardliicate hetder in lieu of such s
PaoDlreet 95440-0561
INNOVATIVE INSURANCE 954-340-0406 p e I o
CONSULTANTS INC. 6rAd
5161 UNIVERSITY DRIVE,0103
CORAL SPRINGS,FL 33067 ro r;HOGAN-1
BRIAN J.MAMO ------, ----
A1�GftDe16 cpm wAlc s
aISUIM HOGAN CONSTRUCTION CO.,INC. RM"IMA:VININGS INSURANCE COMPANY 16632
408 N DIXIE HWY pe;MARYLAND CASUALTY COMPANY 19356
HOLLYWOOD,FL 33020c:GUARANTEE INSURANCE CO
lour"9:
COVERAGES CER71FICATE NUMWR: 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. NOTwIT STANoM ANY REQUIREMENT.TERM OR OONDMON OF ANY CONTRACT OR OTHER DOCUMENT vWTH RESPECT TO WHICH THIS
CERTIFICATE MAY BE MUM 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.
Mw tYPEOFeINIrtANosPouCYwimew .� uwTS
004EPAL UAI&M EACH OCCUIMEHM S 1,000.
0001
A X 00MMUtCIAL GENERAL L"LITY LPOOSS048-04 07107M3 07107M4 S 300.0
CAANA34AADE 191 OCCUR MED EV uvwan& I $ _ _10,00
X 81.KT ADDL NSD PERSONAL A AOV RJURY S- 1+000.0.
X Bt ANF�T wANER GHiEM A00RMTE + 6 2,000,00
GEN_AGGREGATE LWT APPLIES PLIC PRODUCTS-COW1OP AM $ _ __2,000,00
17 Pa1cr X PR° 7Loc
AUTpwpWLp UAMU" CtwmN®SIrGLE ow 300,00
B X my&ITo P049642M 02r21M3 02121M4 ")
MDILY INJURY(Per PSleon) S
ALL gARQO AUTOS BOOILY INXAY(Per 8=0") s
SCHEDULED AUTOS PROPEITTY mwor; S
HIRED AUTOS (Per exJaer+t)
S
NON.000MO AUTOS -
s
Ueel18LA JYIB OCCUR EACH OCCURRENCE 6
FXCE6SLIAB ��,OµOE AGGREGATE _—. S-- . .__
S
omucnmrs
RE ENIM S X wC STATLL )( 0TH-
YYONQ5t8 OOIIPET GATM
AND ENPLaVOtrIlAI ITY YIN 334002895-112 0=1/12 09101/13 E.L.EACHA=murr _--__ f1,000,00C
C ANY PROPRINIA A
00(
EMLUDW? E.L.DISFASE•EA 901L S 1 e000+
K Ah001le utNd WONE.L.DISEASE-POLICY LMR E 1,000,0
OE90NIPTIOw OF OPERATION$ WCAl10N31 7
tl[0MAS lA ACORD 101.AdMO M RenurRs Se"Oft.H mere eF Is eequHeA)
PHObiB: 305-795-2207
rM. : 305-756-8972
CERTIFICATE HOLDER CANCELLAMN
MIAMI.6 SHOULD ANY OF THE ABOVE DESCRMED POLICIES BE CANCVLLED BEFORE
TH6 I)MUTION DATE 1HEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE 1A1IT1H THE POLICY PROM$IONS.
MIAMI SHORES VILLAGE
10050 NE 2 AVENUE AunwiazwRepnesmul"
MIAMI SHORES,FL.33132 1 J
®1!186-2009 ACORD CORPORATION. AN Fghts reserved.
ACORD 25(201191109) The ACORD name and logo are mglstazred marls of AC ORO
BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT
115 S. Andrews Ave., Rm. A-100, Ft. Lauderdale, FL 33301-1895-954-831-4000
VALID OCTOBER 1,2012 THROUGH SEPTEMBER 30,2013
DBA: Receipt#:18 0-5671
Business Name:HOGAN CONSTRUCTION COMPANY INC Business Type:GENERAL CONTRACTOR (GENERAL
yp CONTRACTOR)
Owner Name:FRANCIS x HOGAN Business Opened:04/15/2004
Business Location:1331 BRISTOL AVE State/County/CerVReg:QB3 019 6/CGC1 5 0 7 0 3 7
DAVIE Exemption Code:
Business Phone:954-370-6161
Rooms seats Employees Machines Professionals
5
For Vending Business Only Number of Machines: Vending Type:
Tax Amount Transfer Fee NSF Fee Penalty Prior Years Collection Cost Total Paid
27.00 0.00 0.00 0.00 0.00 0.00 27.00
THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS
THIS BECOMES A TAX RECEIPT This tax is levied for the privilege of doing business within Broward County and is
non-regulatory in nature. You must meet all County and/or Municipality planning
WHEN VALIDATED and zoning requirements. This Business Tax Receipt must be transferred when
the business is sold, business name has changed or you have moved the
business location. This receipt does not indicate that the business is legal or that
it is in compliance with State or local laws and regulations.
Mailing Address:
FRANCIS X HOGAN Receipt #05A-11-00012799
1331 BRISTOL AVE Paid 09/21/2012 27.00
DAVIE, FL 33325
1
2012 - 2013
- — — — nanweun rni i iTv i nrei Ri Iciluccc TeY Q_pr_>Ela�_.._._
THIS DOCUFlIENT HAS A COLORED BACKGROUND-riicROPRINTING LINEMARK PATENTED PAPER
4C# 62435- 84 = STATE IF FL.ORIpA::
DEP�iRTM$NT OCI'0B3SNBDSTRYRLSS B ARD�TION
CO(QS,T
SEQ#L12080201955
LICENSE NBRV
08/02'/2012]X?802729# :s=CGE153
The GBNBRAL GONTRAOTOR;„
Named below IS CB1tT3FI$D - _
Under the 'provisans of 'Chapt
Expiration date AUG, 31, 2014
HOGAN,, C14 $AgI$R
BEYOND, C014SftVCTION Skim
-ICE'S.
1331 BRISTOL„AVB
DAVIE FL_33325 �rr,r� =,<
RICK ,SCOTT REN LAWSON
Gb'fT$RNOR `e ~' SECRETARY
DISPLAY AS REQUIRED BY LAW