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RC-14-1050 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-239097 Permit Number: RC-5-14-1050 Scheduled Inspection Date: July 16, 2015 Permit Type: Residential Construction Inspector: Rodriguez,Jorge Inspection Type: Final Building Owner: PATINO, BIBIANA Work Classification: Addition Job Address:95 NW 95 Street Miami Shores, FL 33150- Phone Number (786)252-1343 Parcel Number 1131010330540 Project: <NONE> Contractor: PERPAT CONSTRUCTION, CORP Phone: (786)401-3264 Building Department Comments NEW OPEN TERRACE Infractio Passed Comments INSPECTOR COMMENTS False Inspector Comments Passed Failed Correction ❑ Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. July 15,2015 For Inspections please call: (305)762-4949 Page 25 of 37 INSPECTION RECORD POST ON SITE 0 Permit NO. RC-5-14-1050 Miami Shores Village - - - fi1t`. 9f141�� 1tR�Il�'�QNI! k x r g � 10050 N.E.2nd Avenue Miami Shores,FL 33138-0000 * Phone: (305)795-2204 Fax: (305)756-8972 �ZORi1 ' issue Date 7/31/2014 Expires: 01/27/2015 INSPECTION REQUESTS: (305)762-4949 or Log on at https://bidg.miamishoresvillage.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#:1131010330540 ( Owner's Name: BIBIANA PATINO Owner's Phone:- (786)252-1343 s i Job Address: 95 NW 95 street Total Square Feet: 300 . Mami Shores FL 3.1150- Bond Number: 2443 Total Job Valuation: $ 24,375.00 t„ WORK IS ALLOWED MONDAY THROUGH SATURDAY, 7:30AM-6:00PM.NO WORK IS ALLOWED ON SUNDAY Contractor(s) Phone Primary Contractor OR HOLIDAYS. PIRSA MIAMI CORP (786)252-5732 Yes BUILDING INSPECTIONS ARE DONE MONDAY THROUGH THURSDAY. ROOFING INSPECTIONS ARE DONE MONDAY THROUGH FRIDAY. NO BUILDING INSPECTIONS DONE ON FRIDAY. f��'c`r� ...cf .� ac.,. c` , Ccw ce . O/Z sem/ , /)C$( �ia✓.�_ Gass v.�..��/�`"i o N -� h,.._ 502_ �r��..-c_ �, „ te e ✓, UO.r-S r/�✓ u- i -- , � cJ^ NO INSPECTION WILL BE MADE UNLESS THE PERMIT CARD IS DISPLAYED AND HAS BEEN APPROVED. PLANS ARE READLY AVAILABLE. I r IS THE PERMIT APPLICANT'S RESPONSIBILITY TO ENSURE THAT WORK IS ACCESSIBLE AND EXPOSED FOR INSPECTION PURPOSES. NEIT,-iER THE BUILDING OFFICIAL NOR THE CITY SHALL BE LIABLE FOR EXPENSE ENTAILED iN THE REMOVAL OR REPLACEMENT OF ANY MATERIAL WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT 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 Z• INSPECTION DATE INP INSPECTION DATE INS P MINEMCTION DATE fNSP Foundation Zonin Final Stemwall ;;&G COMMENTS Rough Slab Water Service Columns 1 st Lift .� / /¢ Rough Columns 2nd Lift Top Out Tie Beam Z Fire 5 nnklers Truss/Rafters Septic Tank Roof Sheathing / O /4 Sewer Hook-up Bucks Roof Drains Windows/Doors ELECTRICAL Gas Interior Framing INSPECTION DATE IN LP Tank Insulation Temporary,Pole Well ' Ceiling Grid 30 Day Temporary Lawn Sprinklers Drywall Pool Bonding Main Drain Firewall Pool Deck Bonding Pool Piping Wire Lath Pool Wet Niche Backflow Prevento Pool Steel Underground Interceptor Pool Deck Footer Ground Catch Basins , Final Pool Slab Condensate Drains Final Fence Wall Rough WRS Final Screen Enclosure Ceiling R Driveway Roug 1 PLUMBING COMMENTS Drivewa Base Telephone Rough Tin Cap I Telephone Final Roof in Progress TV Rough Mop in Progress TV Final Final Roof Cable Rough Shutters Attachment Cable Final Final Shutters Intercom Rough Rails and Guardrails Intercom Final MECHANICAL ADA compliance Alarm Rough JINSPECTION 1 DATE1 INSP Alarm Final Underground Pipe DOCUMENTS Fire Alarm Rough Soil ZBearingCert Fire Alarm FinalRou h Soil eatment Cert Service Work Wit Floor Elevation SurveyVentilation Rough Reinf Unit Mas Cert ELECTRICAL COMMENTS Hood Rough Insulation Certificate Pressure Test Spot Survey Final Hood Final Survey Final Ventilation Truss Certification Final Pool Heater STRUCTURAL COMMENTS Final Vacuum • ME HANICALCOMMENTS M!FinalAlarm N DATE INSP ler `1 3 I S — CT1--- Pic' 51►r,� 1I.A. S p f I ffin Miami shores Village i� a�d Building Department XORiD 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 I�( 1� Fax: (305) 756.8972 i CERTIFICATE OF OCCUPANCY/COMPLETION CHECKLIST Building permit card. Surveys (2 copies) Final as built- Required Items: Elevations of buildings showing all intended setback4rom property lines and other existing structures. Ingress+ Egress, required parking spaces, Wheel stops, stripping, and all paving to exterior. Certificate of Elevation—(Sealed by surveyor). Expiration date required on the form. ❑ Certificate of Insulation. ❑ Certificate of Soil Treatment(Final treatment-original)\ 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) X, Final certification letter from the Engineer/Architect(on masonry, trusses, special structure, etc) ❑ Backflow preventor certificate (Required on commercial projects only) ❑ Certificate 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 fee is $150.00 • Commercial CO is $200.00 'R.�S► ��—ri A-� C'� �S V . w ��� P. It U.S.DEPARTMENT OF HOMELAND SECURITY ELEVATION CERTIFICATE - FEDERAL EMERGENCY MANAGEMENT AGENCY OMB No. 1660-0008 National Flood Insurance Program Important: Read the instructions on pages 1-9. Expiration Date:July 31,2015 SECTION A-PROPERTY INFORMATION FOR INSURANCE COMPANY USE Al. Building Owner's Name:EAMON MCERLEAN A2. Building Street Address(including Apt., Unit,Suite,and/or Bldg.No.)or P.O. Route and Box No. Company NAIC Number: 95 N.W.95TH AVENUE City MIAMI SHORES State FL ZIP Code 33150 A3. Property Description(Lot and Block Numbers,Tax Parcel Number, Legal Description,etc.) LOT 16&THE W.%OF LOT 17 BILK 131 OF MIAMI SHORES SECTION NO.6 PB 10 PG 39 FOLIO 11-3101-033-0540 A4. Building Use(e.g.,Residential,Non-Residential,Addition,Accessory,etc.)RESIDENTIAL A5. Latitude/Longitude: Lat. 25°45'09.2" Long.-80°21'51.6" Horizontal Datum: ❑ NAD 1927 E NAD 1983 A6. Attach at least 2 photographs of the building if the Certificate is being used to obtain flood insurance. A7. Building Diagram Number 8 A8. For a building with a crawlspace or enclosure(s): A9. For a building with an attached garage: a) Square footage of crawlspace or enclosure(s) 2.205 sq ft a) Square footage of attached garage N/A sq ft b) Number of permanent flood openings in the crawlspace b) Number of permanent flood openings in the attached garage or enclosure(s)within 1.0 foot above adjacent grade 11 within 1.0 foot above adjacent grade N/A c) Total net area of flood openings in A8.b 2.196 sq in c) Total net area of flood openings in A9.b N/A sq in d) Engineered flood openings? ❑ Yes E No d) Engineered flood openings? ❑ Yes E No SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION B1. NFIP Community Name&Community Number B2.County Name B3.State VILLAGE OF MIAMI SHORES 120652 MIAMI-DADE COUNTY FLORIDA B4.Map/Panel Number B5.Suffix B6. FIRM Index Date B7.FIRM Panel B8. Flood B9.Base Flood Elevation(s)(Zone 12086CO302 L 9/11/2009 Effective/Revised Date Zone(s) AO, use base flood depth) 9/11/2009 X N/A B10. Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in Item B9. ❑ FIS Profile E FIRM ❑ Community Determined ❑ Other/Source: B11. Indicate elevation datum used for BFE in Item 69: E NGVD 1929 ❑ NAVD 1988 ❑ Other/Source: B12. Is the building located in a Coastal Barrier Resources System(CBRS)area or Otherwise Protected Area(OPA)? ❑ Yes E No Designation Date: N/A ❑ CBRS ❑ OPA SECTION C-BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) Cl. Building elevations are based on: ❑ Construction Drawings' ❑ Building Under Construction' E Finished Construction "A new Elevation Certificate will be required when construction of the building is complete. C2. Elevations-Zones Al-A30,AE,AH,A(with BFE),VE,V1-V30,V(with BFE),AR,AR/A,AR/AE,AR/A1-A30,AR/AH,AR/AO.Complete Items C2.a-h below according to the building diagram specified in Item A7. In Puerto Rico only,enter meters. Benchmark Utilized N-658 ELEV.(9.65 FT) Vertical Datum: N.G.V.D.1929 Indicate elevation datum used for the elevations in items a)through h)below. E NGVD 1929 ❑ NAVD 1988 0 Other/Source:N/A Datum used for building elevations must be the same as that used for the BFE. Check the measurement used. a)Top of bottom floor(including basement,crawlspace, or enclosure floor) 12.65 E feet ❑meters b)Top of the next higher floor 13.13 E feet ❑meters c) Bottom of the lowest horizontal structural member(V Zones only) N/A E feet ❑meters d)Attached garage(top of slab) N/A E feet ❑meters e) Lowest elevation of machinery or equipment servicing the building 10.22 E feet ❑meters (Describe type of equipment and location in Comments) f) Lowest adjacent(finished)grade next to building(LAG) 10.4 E feet ❑meters g) Highest adjacent(finished)grade next to building(HAG) 10.6 E feet ❑meters h) Lowest adjacent grade at lowest elevation of deck or stairs, including structural support N/A E feet ❑meters SECTION D-SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION This certification is to be signed and sealed by a land surveyor,engineer,or architect authorized by law to certify elevation information.1 certify that the information on this Certificate represents my best efforts to interpret the data available. I understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001. X Check here if comments are provided on back of form. Were latitude and longitude in Section A provided by a ❑ Check here if attachments. licensed land surveyor? X Yes ❑ No _ Certifier's Name ED PINO License Number 6771c Title PRESIDENT Company Name AMERICAN SERVICES OF MIAMI,CORP. 17/ ';W 7i Address 9370 S ntl ST.,SUITE A-102 City MIAMI State FL ZIP Code 33173 Signature Date June 29,2015 Telephone 305-598-5101 L -^ FEMA Form 086-0-33(7/12) See reverse side for continuation. Replaces all previous editions. C�CY/'111V1Y \+CRI Ir IVMI C, F/Q C L IMPORTANT: In these spaces, copy the corresponding information from Section A. FOR INSURANCE COMPANY USE Building Street Address(including Apt., Unit,Suite,and/or Bldg. No.)or P.O. Route and Box No. Policy Number: 95 N.W.95TH AVENUE City MIAMI SHORES State FLORIDA ZIP Code 33150 Company NAIC Number: SECTION D—SURVEYOR, ENGINEER,OR ARCHITECT CERTIFICATION (CONTINUED) Copy both sides of this Elevation Certificate for(1)community official,(2)insurance agent/company,and(3)building owner. Comments HIGHTEST CROWN OF THE ROAD ELEVATION 10.81 FEET(NGVD 1929) -SHOWN LATITUDE&LONGITUDE WERE OBTAINED WITH A HAND HELD GPS UNIT. -SHOWN ELEV. FOR SHOWN ON C2(e)IS THE ELEV.OF THE LOWEST AIR CONDITIONER HOLDING STRUCTURE Signature r Date June 29,2015 SECTION E—BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED)FOR ZONE AO AND ZONE A(WITHOUT BFE) For Zones AO and A(without BFE),complete Items E1—E5. If the Certificate is intended to support a LOMA or LOMR-F request,complete Sections A,B, and C. For Items E1—E4,use natural grade,if available.Check the measurement used. In Puerto Rico only,enter meters. E1. Provide elevation information for the following and check the appropriate boxes to show whether the elevation is above or below the highest adjacent grade(HAG)and the lowest adjacent grade(LAG). a)Top of bottom floor(including basement,crawlspace,or enclosure)is ❑feet ❑ meters ❑above or❑below the HAG. b)Top of bottom floor(including basement,crawlspace,or enclosure)is ❑feet ❑ meters ❑above or❑ below the LAG. E2. For Building Diagrams 6-9 with permanent flood openings provided in Section A Items 8 and/or 9(see pages 8-9 of Instructions),the next higher floor (elevation C2.b in the diagrams)of the building is ❑feet ❑meters ❑above or ❑below the HAG. E3. Attached garage(top of slab)is ❑feet ❑ meters ❑above or ❑below the HAG. E4. Top of platform of machinery and/or equipment servicing the building is ❑feet ❑meters ❑above or❑below the HAG. E5. Zone AO only: If no flood depth number is available, is the top of the bottom floor elevated in accordance with the community's floodplain management ordinance? ❑Yes ❑ No ❑ Unknown.The local official must certify this information in Section G. SECTION F—PROPERTY OWNER(OR OWNER'S REPRESENTATIVE)CERTIFICATION The property owner or owner's authorized representative who completes Sections A, B,and E for Zone A(without a FEMA-issued or community-issued BFE) or Zone AO must sign here.The statements in Sections A,B,and E are correct to the best of my knowledge. Property Owner's or Owner's Authorized Representative's Name Address City State ZIP Code Signature Date Telephone Comments ❑Check here if attachments. SECTION G—COMMUNITY INFORMATION (OPTIONAL) The local official who is authorized by law or ordinance to administer the community's floodplain management ordinance can complete Sections A,B,C(or E),and G of this Elevation Certificate.Complete the applicable item(s)and sign below.Check the measurement used in Items G8—G10.In Puerto Rico only,enter meters. G1. ❑ The information in Section C was taken from other documentation that has been signed and sealed by a licensed surveyor,engineer,or architect who is authorized by law to certify elevation information. (Indicate the source and date of the elevation data in the Comments area below.) G2. ❑ A community official completed Section E for a building located in Zone A(without a FEMA-issued or community-issued BFE)or Zone AO. G3. ❑ The following information(Items G4—G10)is provided for community floodplain management purposes. G4.Permit Number G5. Date Permit Issued G6. Date Certificate Of Compliance/Occupancy Issued G7. This permit has been issued for: ❑New Construction ❑Substantial Improvement G8. Elevation of as-built lowest floor(including basement)of the building: ❑feet ❑meters Datum G9. BFE or(in Zone AO)depth of flooding at the building site: ❑feet ❑meters Datum G10.Community's design flood elevation: ❑feet ❑ meters Datum Local Official's Name Title Community Name Telephone Signature Date Comments ❑Check here if attachments. FEMA Form 086-0-33 (7/12) Replaces all previous editions. E I ELEVATION CERTIFICATE, page 3 Building Photographs See Instructions for Item A6. IMPORTANT: In these spaces, copy the corresponding information from Section A. FOR INSURANCE COMPANY USE Building Street Address(including Apt., Unit,Suite,and/or Bldg. No.)or P.O. Route and Box No. Policy Number: 95 N.W.95TH AVENUE City MIAMI SHORES State FL ZIP Code 33150 Company NAIC Number: If using the Elevation Certificate to obtain NFIP flood insurance, affix at least 2 building photographs below according to the instructions for Item A6. Identify all photographs with date taken; "Front View' and "Rear View'; and, if required, `Right Side View" and "Left Side View." When applicable, photographs must show the foundation with representative examples of the flood openings or vents, as indicated in Section A8. If submitting more photographs than will fit on this page, use the Continuation Page. FRONT VIEW(6/25/2015) SLIDE VIEW(6/25/2015) Atff f is 1,.f r J, ft J. "V .; ti. r , V"t is REAR VIEW(6/25/2015) ."k-14 FEMA Form 086-0-33(7/12) Replaces all previous editions. aguQm )o U0 08AD6D consulting engineers, p.a. 7220 sm. 39th terrace , miami, florida 33155 �1��' 15 phone: 305-262-6225 fox: 305-262-2014 orlandofortun@bellsouth.net June 30th., 2015 14-016-029 MIAMI SHORES VILLAGE, Building and Zoning Dept., 10050 N.E. 2nd. AVENUE, Miami Shores, FI. RE: TERRACE ADDITION FOR: MR. ROLANDO HERNANDEZ, 95 N.W. 95TH. STREET, MIAMI SHORES, FL. PERMIT No: RC-5-14-1050 CERTIFICATE OF COMPLIANCE Dear Sirs: This is to advise you that after having revised the inspection logs prepared your Inspectors, we are hereby certifying that the addition captioned in the reference above has been built in accordance with the structural plans prepared by our offices, with the F.B.0 2010 Edition and also with good construction practices. If you have an%�� �rtitr�questions, please do not hesitate to call on us at (305)-262;b �►, Elle'1j05)-262-2014 or by electronic mail (e-mail) at UTH.NET. truly ! 2249 •: - . * STATE OF ;•wa Orlandar�UP,�of�fi 1OP•'.��,' P.E. No.2 ''•• ••'' ' SON L E� Special InspFt4or,j, 6p OMF/vr2/14-016-029 cc. T Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 nspection Number: INSP-212865 Permit Number: RC-5-14-1050 Inspection Date: July 02, 2015 Permit Type: Residential Construction Inspector: Dacquisto, David Inspection Type: Survey Final Owner: PATINO, BIBIANA Work Classification: Addition Job Address: 95 NW 95 Street ,, Miami Shores, FL 33150- t ,' Phone Number (786)252-1343 Parcel Number 1131010330540 Project: <NONE> Contractor: PERPAT CONSTRUCTION, CORP Phone: (786)401-3264 Building Department Comments NEW OPEN TERRACE Infractio Passed Comments INSPECTOR COMMENTS False Inspector Comments Passed g Failed Correction ❑ Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. For Inspections please call: (305)762-4949 July 02, 2015 Page 1 of 1 r T L ABREVIATION(IF ANY APPLIED) A-CUM P/01.PAtOEWY F.I.P. 15' A L L E Y "M�Ctlpil01M0 UW :=:POW QF ULAIM W , COMMONSOff 2•� F.I.P. HOUSE PICTURE LOCATION MAP `°°`�°°'"'1 PP.L Pow.L-PONTPROM,CIF r °'"An"` "�3 30.00' no cap)EAST-WEST 81.30' M&R) (no cap) �G ,�NIM f1R11C111RE P --POM Mz \ .a•\ .'•:.••:• a-6FM Pit Ma PgINE t1R IIFFFIO4 /J 1O••,• )O C O ., OOIIC._�Iltll[IEMUM _ P.T.-POR K TNXOW 9- 4' C.B.S. o — uI u*oaltr at>E>r�rT VA RACIAL am 00 1oZrNgoo ry C Wall M c - pp J CJ 0 W 25' mix:llEYA71011 It/I_IOW►or MY 44 co Y 11.9' EM am Q r M-ENCROACHMENT ac -Orr alu Ha< 0.75' Tiled rx-POI N10R"ff ulp_SET Nw A00 NON 3 n line ii' a 15 14 13 12 rAA FUM 1111.AM 0100 als.-NLT"PPE 17 FAP.-MW00011 PM SAA.SET 1RNMI •° M q r1_FMW WINE m-STOW ••'•• .•••. (n J C "'� 31 ML%940 LW/Om TAP.. P..1a.or SAM C I 1N1-MAN CIZ UL-VIL E43OMT On line C.B.S. o�+� MONUlENr r1r.-Ooa0D1 Poll C3�::..: to ,Wall O>2 r` a�'p'NANgr 10 Nra i i-ic11W LM . a'M ;9l�. <, , 1 18 19 . ....... 2.5' 17.0' �m •••• .... •• ••••••• o_vC 5' C.B.S. ,. a ,: SURVEYOR'S LEGEND(IF ANY APPLIED) •::. 25 16.2;� 21.2' / O v Wall i 3 . .:.-N.• C4 Utility ^10.0' �� ,,'� a', 4rx a ,,P qy Z O BOUNDARY LINE ® MANHOLE CATCH IN ry : . ,:... : ::T...:. 15.0' Of .. 11.9' f "'' t� STRUCTURE BLDG. O ............. : r° o / 15.0' r fi� , (BLDG.).:... Y f 4 »: — W •,• '•• t •- � •:•C.W;;;; 117 t` j xx{ ;Ry, CONCRETE BLOCK WALL O.E. OVERHEAD ELECT. :: nq '..o : > .... a / , v r.1 r. N,W, 95th ST. Q ,::.Q .,:M ...C . METAL FENCE AP POWER POLE '.'•"" N'- Car Port Terra Ce CV O WOODEN FENCE �• LIGHT POLE Z :'.'::.'.'.:'::..':. .'. N.0 TIC. :: c '. ':.'::.'.'.:':.'::. ''20.� ' Fl or aoE�E CHAIN LINK FENCE z d � j � �� HANDICAP SPACE W N :• ® 13.20 1 0.10' ® WOOD DECK/COCK -— •,. ° ASPHALTED AREAS 17 HANDICAP SPACE > MH �.�, Q CONCRETE - EASEMENT LINE D_ : tD m i ® BRICKS OR PAVERS N WATER VALVE 1 STY.a . C.B.S. C4 I = 1 ® ROOFED AREAS N TV-CABLE BOX RESIDENCE X: ^ .–i ' 1 JOB SPECIFIC SURVEYOR NOTES: ® WATER(EDGE OF WATER) WM WATER METER O -C 3 S O O NO. 95 O N O .-� m i (D THE PROPERTY DESCRIBED ON THIS SURVEY DOES NOT LIE WITHIN A SPECIAL HAZARD AREA AS DEFINED BY THE FEDERAL EMERGENCY MANAGEMENT AGENCY;THE PROPERTY LIES WITHIN A ° N O a 4 �``I44 FLOOD ZONE"X"OF THE FLOOD INSURANCE RATE MAP IDENTIFIED AS COMMUNITY PANEL No. 120652-302L.WITH AN EFFECTIVE DATE OF SEPT.11,2009. BASE FLOOD ELEVATION OF }, a : D_ Highest F.F. Elev. 13f.13 ,N Cn �0 v � N A(NGVD)— /A CO :: = Lowest F.F. Elev. 1 1..65 Ih \X� _ ";,j i (� (D LAND AREA OF SUBJECT PROPERTY: 11,626 SF V/ N , .v. I �— •• � O � 14.00' Q" (D ELEVATIONS ARE BASED ON THE NATIONAL GEODETIC VERTICAL DATUM(NGVD)OF 1929,AS PER MIAMI-DADE COUNTY BENCH MARK No.�,WITH AN ELEVATION OF N/A FEET. O c� o gLTJIed- O L`' O Z In 0O 1 i In Z ! Q BEARINGS SHOWN HEREON ARE BASED ON AN ASSUME MERIDIAN OF NORTH-SOUTH.,BEING THE RECORDED BEARING FOR THE CENTERLINE OF N.W 1St AVE.,AS SHOWN ON PLAT BOOK 10 AT ••••••• (p 1 8.60' 18,60' aD PAGE 39 OF THE PUBLIC RECORD OF MIAMI-DADE COUNTY FLORIDA. M 20.00 � 6.5 1 GENERAL SURVEYOR NOTES: i N :•:�'y, F.I.P. •C THE SHOWN LEGAL DESCRIPTION USED TO PERFORM THIS BOUNDARY SURVEY WAS PROVIDED BY THE CLIENT. U 1/2'4 0 +' • (n0 Cap) U'� J J _ SURVEY IS BASED ON RECORDED INFORMATION PROVIDED BY CLIENT.NO SPECIFIC SEARCH OF THE PUBLIC RECORD HAS BEEN MADE BY OUR OFFICE. O ••••••• O UNLESS OTHERWISE NOTED,AN EXAMINATION OF THE ABSTRACT OF TITLE WAS NOT DONE BY THE SIGNING SURVEYOR TO DETERMINE WHICH INSTRUMENTS,IF ANY ARE AFFECTING THE SUBJECT PROPERTY. n d ::Asph.: :::... o C ::Drivewa THIS SURVEY IS EXCLUSIVELY FOR THE USE OF THE PARTIES TO WHOM IT WAS CERTIFIED. .: t = W PURSUANT TO RULE 61G17-6 OF THE FLORIDA ADMINISTRATIVE CODE THE EXPECTED USE OF LAND IS SUBURBAN,THE MINIMUM RELATIVE DISTANCE ACCURACY FOR THIS TYPE OF SURVEY IS 1 FOOT IN 7,500 1.v ••O.•.•.••••••• •• Q.. ` FEET.THE ACCURACY OBTAINED BY MEASUREMENT AND CALCULATIONS OF CLOSED GEOMETRIC FIGURES WAS FOUND TO EXCEED THIS REQUIREMENT. ••.... r OJ• •:• N ... F,1 P. I , I (,;; THERE ARE NO VISIBLE,ABOVE GROUND ENCROACHMENTS(a)BY THE IMPROVEMENTS OF THE SUBJECT PROPERTY UPON ADJOINING PROPERTIES,STREETS OR ALLEYS,OR(b)BY THE IMPROVEMENTS OF THE NPlanter R=25.00r \Jt. 1/ 4 c I j ADJOINING PROPERTIES,STREETS OR ALLEYS UPON THE SUBJECT PROPERTY OTHER THAN THOSE SHOWN ON THIS BOUNDARY SURVEY. r n A=39.27 _ : 22.6' :• ( L j THERE ARE NO VISIBLE EASEMENTS OR RIGHT-OF-WAY OF WHICH THE UNDERSIGNED HAS BEEN ADVISED OTHER THAN THOSE SHOWN ON THIS SURVEY. Cn 6=90'00'00 :' EAST-WEST 56.30' M&R :5' Sidewalk THE MAP OF SURVEY IS IMENDED TO BE DISPLAYED AT THE SHOWN GRAPHIC SCALE IN ENGLISH UNITS OF MEASUREMENT.IN SOME CASES GRAPHIC REPRESENTATION HAVE BEEN EXAGERATED TO MORE %i,,a P• j CLEARLY ILLUSTRATE A PARTICULAR AREA WHERE DIMENSIONS SHALL HAVE PREFERENCE OVER GRAPHIC LOCATION. F . 1 5' P/W THE ELEVATIONS(IF ANY)OF WELL-IDENTIFIED FEATURES AS DEPICTED ON THIS SURVEY AND MAP WERE MEASURED TO AN ESTIMATED VERTICAL POSITIONAL ACCURACY OF yip FOOT FOR NATURAL GROUND SURFACES AND XW FOOT FOR HARDSCAPE SURFACES,INCLUDING PAVEMENT,CURBS,SIDEWALKS AND OTHER MANMADE STRUCTURES. •,•;;;,',•© �, ::15.0`• •••17.0'•• THE SURVEYOR MAKES NO REPRESENTATION AS TO OWNERSHIP,POSSESSION OR OCCUPATION OF THE SUBJECT PROPERTY BY ANY ENTITY OR INDIVIDUAL ` .................. ...........................................:... ,0 ''''•''''''' ANY FEMA FLOOD ZONE INFORMATION PROVIDED ON THIS SURVEY IS FOR INFORMATIONAL PURPOSE ONLY AND IT WAS OBTAINED AT WWW.FEMACOM. r ............. :.....,... ... .. A ..::... :.'::.'.'.'.'.'::.'::::.'.'.'.:.'. ' 2 C & Gutter •:•:•::•:•:.......:........:.•. •:.•::.•:.'.'::.•.•. ti .,�, IF YOU ARE READING THIS BOUNDARY SURVEY IN AN ELECTRONIC FORMAT,THE INFORMATION CONTAINED ON THIS DOCUMENT IS ONLY VALID IF THIS DOCUMENT IS ELECTRONICALLY SIGNED AS SPECIFIED .... ............ ••• r IN CHAPTER 51-17.062(3)OF THE FLORIDA ADMINISTRATIVE CODE,IF THIS DOCUMENT IS IN PAPER FORMAT,IT IS NOT VALID WITHOUT THE SIGNATURE AND ORIGINAL RAISED SEAL OF THE PROFESSIONAL f. 48 Asphalt Pavement : LAND SURVEYOR AND MAPPER OF RECORD. :: ` . . :::•p :..• /"j *� �' 80' TOTAL CERTIFIED TO: ENCROACHMENTS AND OTHER POINTS OF INTEREST: 1za -THERE.................... . ......... r '�t'<�Sc µ. .. , ERE ARE NO VISIBLE ENCROACHMENT OF THE SUBJECT PROPERTY .:. :: .''!' PUBLIC R W EAMON McERLEAN -THE SUBJECT PROPERTY IS WITHIN A FLOOD ZONE X(SEE NOTE 1) i f............. ..... .,.....8 .. :'.'.':.'.':.'.'.'.'.'.'.'.'.':.':.'.'.'.'.'.'.'.'.'.'.':.'.'.'.'.'.':.'.'.'.'.'.':.'.'.':.'.'.'.'.':.'.'.'.'.'.'.'.'.'.'.'.'.'.'. -THERE ARE NOT PLATTED UTIL.EASEMENT ON THE SUBJECT PROPERTY fi r = I HEREBY CERTIFY THAT THE ATTACHED SKETCH OF 'BOUNDARY SURVEY AND THE SURVEY MAP RESULTING THEREFROM OF THE ABOVE DESCRIBED PROPERTY IS A + { �� ` 9 5th STREET :::'•" :::: TRUE AND CORRECT REPRESENTATION OF A FIELD SURVEY MADE UNDER MY DIRECTION AND MEETS THE INTENT OF THE APPLICABLE PROVISICVHS OF TIE "MINIMUM S° .. a: TECHNICAL STANDARDS FOR LAND SURVEYING IN THE STATE OF FLORIDA" PURSUANT TO RULE 5J-17 OF THE FLORIDA ADMINISTRATIVE CODE MAD 11%_ IMPLEMENTED J'. r': LAW, CHAPTER 472.027, OF THE FLORIDA STATUTES. LEGAL DESCRIPTION: - SITE ADDRESS: 95 N.W. 95th AVE., MIAMI SHORES, FL. 33150 American Services Of Miami, Corp. LOT 16 AND THE WEST 1/2 OF LOT 17,BLOCK 131,OF MIAMI SHORES JOB NUMBER: 13-619 Consulting Engineers . Planners . Surveyors z J SECTION No.6 ACCORDING TO THE PLAT THEREOF AS RECORDED IN PLAT DATE OF SURVEY JUNE 12, 2013 0; Ed-Pho ;a BOOK 10 AT PAGE 39,OF THE PUBLIC RECORDS OF MIAMI DADE COUNTY, DECEMBER 5. 2013 JANUARY 16. 2015 9370 S.W. 72nd Street, Suite A-102 P :SSI ND�$ VEYOR FLORIDA. REVISED DATE / gM�1�DkA . Miami, Florida, 33173 J�jiD. k�.Ap R..No; 771 FOLIO NUMBER: 11-3101-033-0540 PH: 305 598-5101 FAX: 305 598-8627 �T i�. . LB 6683 ( ) ( ) ��SI;RVF-� 'OA NOT VALID WITHOUT THE SIGNATURE AND RAISED SEAL OF A FLORIDA LICENSED SURVEYOR AND MAPPER ASOMIAMLCOM DATE: UARY 16, 2015 NOT VAUD WITHOUT THE SIGNATURE AND RAISED SEAL OF A FLORIDA LICENSED SURVEYOR AND MAPPER iami Shores Village ilding Department M" 050 N.E.2nd Avenue,Miami Shores,Florida 33138 JUN 1.2 2015 Tel:(305)795-2204 Fax:(305)756-8972 BY: INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 2016 ILDING Master Permit No.RC-5-14-1050 PERMIT APPLICATION Sub Permit No. ❑BUILDING ❑ ELECTRIC ❑ ROOFING Q REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING F-1 MECHANICAL [:]PUBLIC WORKS CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 95 NW 95th Street City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: 1131010330540 Is the Building Historically Designated:Yes NO X Occupancy Type: SF Load: Construction Type: CBS Flood Zone: NO BFE: FFE: OWNER:Name(Fee Simple Titleholder):Bibiana Patino Phone#:(786) 252-5732 Address:95 NW 95th Street City: Miami Shores State: Florida Zip: 33150 Tenant/Lessee Name: N/A Phone#: Email: CONTRACTOR:Company Name: Perpat COstruction Corp Phone#: (786)401-3264 Address: 13715 SW 84th Street#B City. Miami State: Florida Zip: 33183 Qualifier Name: Alejandro Perez Phone#: (786) 252-5732 State Certification or Registration#: CGC 1508748 Certificate of Competency#: DESIGNER:Architect/Engineer: N/A Phone#: Address: City: State: Zip: Value of Work for this Permit:$400 Square/Linear Footage of Work: 300 Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of work: Exterior Terrace Ceiling Specify color of color thru tile: C r� Submittal Fee$ Permit Fee$ CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ 4 qNr�;E TOTAL FEE NOW DUE$ (Revised02/24/2014) Bonding Company's Name(if applicable) N/A Bonding Company's Address City u State Zip Mortgage Lender's Nami of 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$2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also,a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature Signature OWNER AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of -Ae,7?e 20 /S by /d day of �, � 20 /S by who is personally known to /�.CQ/Z geleC •who is personally known to m or who has produced as me or who has produced as identification and who i tS IQ gab, identification and who did take an oath. NOTAA PUBLIC: ,�•,y,� MERCEDEBB'ES:Fr29]704 �` ` MY COMMISSION t NOTARY P LIC: #� MEtaCEDESB EEXPIRES:Juror MY COMAMSSIONt FF 129704 Bonded Thru Notary Publ = EXPIRES:June 16,2018 Bonded Thru Nouuy PuW UndenwiMn Si Print: Print: Seal: Seal: APPROVED BY Plans Examiner Zoning l i Structural Review Clerk (RgvisW2124/2014) L$bU-bll-b.3tSl 't/ Gl/ GV1J 1L .1V .ir r., ••...- -• --- - April 21, 2015 FLORIDA DEPARTMENT OF STATE Division of Corporations PERPAT CONSTRUCTION, CORP 13715 SW 84 STREET B MIAMI, FL 33183 Re: Document Number P04000048968 The Articles of Amendment to the Articles of Incorporation of PIRSA MIAMI, CORP. which changed its name to PERPAT •CONSTRUCTION, CORP, a Florida corporation, were filed on April 20, 2015. This document was electronically received and filed under FAX audit number H15000096402. Should you have any questions regarding this matter, please telephone (850) 245-6050, the Amendment Filing Section. Tracy L Lemieux Regulatory Specialist II Division of Corporations Letter Number: 415A00007960 P.O BOX 6327—Tallahassee,Flonda 32314 � i .spoo o 16 L(c ARTICLES OF AMENDMENT OF PIRSA MIAMI, CORP. P04000048968 A pursuant provision of section 60 7.1006, Florida Statutes, this Florida profit corporation adopts the following articles of amendment to its articles of incorporation: FIRST: Amendment(s) adopted: (indicate article number(s) being amended added or Deleted. ARTICLE I -NAME: The Corporation Name is being changed to: PERPAT CONSTRUCTION, CORP ARTICLE VI - DIRECTORS: This Article is being changed in the following way: DELETE: Pirsa Developers Group as Vicepresident SECOND: If an amendmentp rovides for an exchange, reclassification or cancellation of issued shares, provisions for implementing the amendment if not contained in the amendment itself, are as follows: 04/17/2015 THIRD: The date of each amendment's adoption: FOURTH: Adoption of Amendment(s) (CHECK ONE) _ The amendment(s) was/were approved by the shareholders. The number of votes cast for the amendment(s)was/were sufficient for approval. Y _ The amendment(s)was/were approved by the shareholders through voting groups. The following statement must be separately provided for each voting group entitled to vote separately on the amendment(s): Y» "The number of votes cast for the amendment(s) was/were sufficient For approval by Voting group Y.. _ The amendment(s) was/were adopted by the board of directors without shareholder action and shareholder action was not required. _ The amendment(s)was/were adopted by the incorporators without shareholder action and shareholder action was not required. 17 April 2015 Signed this day of (By the Chairman or Vice Chairman of the Board of Directors,President or other officer if adopted by the shareholders) OR (By a director if adopted by the directors) Y OR (By fin-incorporator if adopted by the incorporators) r � r Signature: Alejandro Perez - President Y» M Y.., N 1 .-0400 q6 Yo L STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD (850) 4.87-1395 "" -- 1940 NORTH MONROE STREET OOD WE t TALLAHASSEE FL 32399-0783 PEREZ,ALEJANDRO PERPAT CONSTRUCTION, CORP 13715 SW 84TH STREET B . MIAMI FL 33183 Congratulations! With this license you hecome one of the nearly , . ,ww-..■ one million Floridians licensed by the Department of Business and Professional Regulation. Our professionals and businesses range STATE OF FLORIDA from architects to yacht brokers,from boxers to barbeque restaurants, DEPARTMENT OF BUSINESS AND and they keep Florida's economy strong. PROFESSIONAL REGULATION Every day we work to improve the way we do business in order to CGC1508748 UFt; 04/30/2015 serve you better. For information about our services, please log onto s. www.myfloridalicense.com. There you can find more information CERTIFIED "CONTRACI`OR about our divisions and the regulations that impact you, subscribe PEREZ,ALEJANtif3 to department newsletters and learn more about the Department's PERPAT CONSJCTtDhk;Q t initiatives. Our mission at the Department is: License Efficiently, Regulate Fairly. We constantly strive to serve you better so that you can serve your customers. Thank you for doing business in Florida, IS CERTIFIED under the provisions of Ch.489 FS. and congratulations on your new license! Expiration date . V,,G 31,2016 L1504300001164 DETACH HERE RICK SCOTT, GOVERNOR KEN LAWSON, SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION,.INDUSTRY LICENSING BOARD CGC1508748 "zra The GENERAL CONTRACTOR- Named below IS CERTIFIED IGO Under the,provisions of Chapter 489 FS. Expiration, date: AUG 31,2015 :. roan",g. 71111 N,. Mb� ' ❑ ■ a .r sfs ' A� ■ PEREZ,ALEJANDRO t - PERPAT CONSTRUGTI 4,3715 $W 84TH ST < • ' ' �' :„ w MIAMI ay'h 7s`,�" ' ti {';i ■ ■ kX Local Business Tax Receipt Miami--Dade County, State of Florida -THIS IS NOTA BILL-00 NOT PAY 5535423 LBT BUSINESS NAME/LOCATION RECEIPT NO. EXPIRES V�'D S aft- t++ PERPAT CONSTRUCTION, RENEWAL SEPTEMBER 2015 CORP 5775888 13715 SW 84 ST:8 Must be displayed at place of business MIAMI, FL 33183Pursuant to County Code Chapter BA-Art.9&10 OWNER SEC.TYPE OF BUSINESS w' PAYMENT RECEIVED PERPAT CONSTRUCTION,CORP 196 GENERAL BUILDING BY TAX COLLECTOR CONTRACTOR 82,50 05/05/2015 Worker(s) 1 CGC1508748 0235-15-004342 This Local Business Tax Receipt only confirms payment of the Local Business Tax.The Receipt is nota 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. The RECEIPT N0.above must be displayed on all commercial vehicles-Miami-Dade Code Seoft-276. MIAMI, For more information,visit www.miamidade govRaxcollector as MMIDDi `'+ 0_ CERTIFICATE OF LIABILITY INSURANCE °"'0 46/12/2015/12/2015 THIS CERTIFICATE IS ISSUED ASA 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 endomement(s). PRODUCER CONTACT_..... MART NAME:. AALONSO .. ....... ....._. FAX Florida Bankers Insurance PNa, ) (305)266-6493 Na); (305)262.0679 _117278 SW 8 Street ADDRESS;, mike0flondabankersinsurance.com Miami,FL 33144 INSURER(S)AFFORDING COVERAGE NAIC# Phone (305)266-6493 Fax (305)262-0679 INSURER A_,_ FEDERATED NATIONAL INSURED INSURED INSURER B PERPART CONSTRUCTION CORP INSURER C; 13715 SW 84 St B INSURER o_:,-_ INSURER E: 'Miami Fi. 33183- _ ------. INSURER F COVERAGES CERTIFICATE NUMBER- REVISION NUMBER., THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BEISSHE LOW HAVE BEEN UED TO TINSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACTOR 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. WSR ADOLSUBRi POLICY EFF i POLICY EXP LIMITS LTR ._., TYPE OF INSURANCE iINSR INVD.j. _ POLICY NUMBER [WWDDM'YY)jMM/DDIYYYYZ, ..... -_.__ GENERAL LIABILITY - EAC H.OCCURRENCE $ 1,000,000,00 DAMAGE TO RENTED 1 00,000.00 ® COMMERCIAL GENERAL LIABILITY PREMISES,(Ea occurrence) $ A F] F-1CLAIMS-MADE ® OCCUR MED EXP(Any one person) $ 5,000.00 GL-0504013497-00 06/12/2015 !06/12/2016 — PERSONAL&ADV INJURY $ 1,000,000.00 GENERAL AGGREGATE $ 1,000 OOO.00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ 1,000 000.00 -: ®POLICY ❑__ECT. ❑---LOC _ $ AUTOMOBILE LIABILITY COMBINED INED SINGLE LIMIT ❑ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED !I--�I SCHEDULED BODILY INJURY(Per accident) $ ❑ AUTOS LJ AUTOS - ❑ HIRED AUTOS ❑ AUTOS NON-OWNED - Pf�2ar acc "IIAMAGE ._._$. r---_ _ _�--- $ ❑ UMBRELLA LIAB ❑OCCUR EACH OCCURRENCE $ ❑ EXCESS LIAR _❑CLAIMS-MADE_ AGGREGATE $ DED__Ca RETENTIONS r- - -----__ ...__......----_ .—____ .. .._._. '---- WORKERSCOMPENSATION -- PER 0TH- AND EMPLOYERS'LIABILITY Y f N ❑�7ATUTE... ANY PROPRIETORIPARTNERIEXECUTNEE L.EACH ACCIDENT $ OFFICERIMEMBEREXCLUDED'� 'NIA ._.._. (Mandatory in NN) E L.DISEASE-EA EMPLOYEE$If yes,describe under E.L.DISEASE-POLICY LIMIT DESCRIPTION OF OPERATIONS below _ $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Ansch ACORD 101.'A'dditional Remarks Schedule,it more space Is required) - ATTN: CINDIA ALVAREZ LIC#CGC1508748 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 ACCORDANCE WITH THE POLICY PROVISIONS. BUILDING DEPARMENT 10050 NE 2 AVE AUTHORIZED REPRESENTATIVE MIAMI SHORES,FL. 33138 ©1988-2014 ACORD CORPORATION. AN rights reserved. ACORD 26(2014101)OF The ACORD name and logo are registered marks of ACORD of JEFF ATWATER CHIEF FINANCIAL OFFICER STATE OF FLORIDA 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: 5/5/2015 EXPIRATION DATE: 5/4/2017 PERSON: PEREZ ALEJANDRO FEIN: 201289530 BUSINESS NAME AND ADDRESS: PERPAT CONSTRUCTION CORP 13715 SW 84TH ST,APT B MIAMI FL 33183 SCOPES OF BUSINESS OR TRADE: LICENSED GENERAL CONTRACTOR 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 on the notice or certificate no longer meets the requirements of this section for issuance of a certificate.The department shall revoke a DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUESTIONS?(850)413-1609