CC-14-1588 (3) �I r
Iaml Shores Village �
SCE
'Iding Department MAR 201
N.E.2nd Avenue,Miami Shores,Florida 33138 7 5
Tel:(305)795-2204 Fax:(305)756-8972 BY:
INSPECTION LINE PHONE NUMBER:(305)762-4949
FBC
ILDING Master Permit No.CG-
PERMIT APPLICATION Sub Permit No.
❑BUILDING ❑ ELECTRIC ❑ ROOFING REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑"CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: -(n"30 E 2. M E
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: ��'S"Lo�� 3�`L1 D Is the Building Historically Designated:Yes NO
Occupancy Type:e: Load: Construction Type:e: Flood Zone: BFE: FFE:
p
OWNER:Name(Fee Simple Titleholder): 6ftp_ !M kO 2,4,w "C_ Phone#: (30,141-104-
Address: lcoa> I&—
City: •M•(Ji. State: '"[.. Zip:
Tenant/Lessee Name: Phone#:�v�
Email: f't VAW O I:Z- & 6A7D I-1tJ V- Go M
CONTRACTOR:Company Name: l�i�� .�bF_•✓ c� Gam. Phone#: ^'
Address: 6q;945 Wa 4(05 S;r�:
City: 0'M- State: _ Zip: 12�B6&2
QualifierName: �TLcL1NG1. Phone#:,(3)
State Certification or Registration#: rf!q . 433 Certificate of Competency#:
A
DESIGNER:Architect/Engineer: An) Phone#:(qvf 4'(*-.at
Address:_&191 /its. Fly AVQI Pv� 44&Z9 CityPP State: 4:,-L Zip: 0531-7
Value of Work for this Permit:$ y�i4Df3 Square/Linear Footage of Work: _7S
Type of Work: ❑ Addition Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work: !7_j2r)is Lel J -TZ> Z _
�'dE19 8®tl�'!•�i a'a a((e� �J.�I,�7 y
ti i ,} 9
Specify color ��, ® `� ;.�,,ale • � �1dim
Submittal Fee$ Permit Fee$ CCF$ °
Scanning Fee$ Radon Fee$ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$
(Revised02/24/2014)
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 YOU WOROPERTY: tI1;'YOU INTEND
TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING
YOUR NOTICF OF COMMENCEMENT."
Notice to Applicant: As a condition to the issuance of a building permit with an estimated value-exceedjrtg_$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 iecorded notice of commencement must tie oosfed at the job site
for the fir1f inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be ap ove nd a reinspection fee will be charged. ,
Signature Signature
OWNER or AGENT CONTRACTOR
The foregoin strument was acknowledged before me this The foregoing instrument was acknowledged before me this
[
ay. of �!/t rr ,20 le> by day'o'f � —� ,20 ,by
who' personally known taiI*�•e c'�. s'�'�t�lu� ho is personally own to
me or who has producedas me or who has produced as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: q Sign:
Print: Print:
Seal: Seal: Mike Vazquez
Milo' Vaqua coiaa�ssioN . FF190M
1 .( " jamm 16.206
EWIRU ary 16,2N MMILAM fpr.Q011
APPR B Plans Examiner Zoning
rL 1� 11� Structural Review Clerk
(Revised02/24/2014)
`, ,,�
_ S014M
ACORD® DATE(MMMD/YYYY)
� CERTIFICATE OF LIABILITY INSURANCE 2126/2015
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(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 WCAOMWOT
Commercial Lines
PHONE 8-b72-242 aJAIC,No, ,88No:
Wells Fargo Insurance Services USA,Inc. E-MAIL
ADDRESS.
Certs@tflnet.com
6100 Fairview Road INSURERIS)AFFORDING COVERAGE NAW#
Charlotte,NC 28210 INSURER A: Indemnity Insurance Company of North America 43575
INSURED
INSURERS:
Strategic Outsourcing,Inc. INSURER C:
F/W/L Gator Development Corp INSURER D:
PO Box 241448
INSURER E
Charlotte,NC 28224 INSURER F
COVERAGES CERTIFICATE NUMBER: 8797564 REVISION NUMBER: See below
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 ADDLISURR POLICY EFF POLICY EXP
LTR TYPE OF INSURANCE POLICYNUMBER MM/DD MMIDD LIMITS
COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S
D TO RENTED
CLAIMS-MADE 0 OCCUR PREMIGSES(Ea occurrence) $
MED EXP(Any one arson) $
PERSONAL&ADV INJURY $
GENII.AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $
POLICY❑JECT El LOC PRODUCTS-COMP/OP AGG $
OTHER: $
AUTOMOBILE LIABILITY M I D NGLE UMIT $
Ea aaident
ANY AUTO BODILY INJURY(Per person) S
ALL OWNED SCHEDULED
AUTOS ALITOS BODILY INJURY(Per accident) $
NON-OWNED PROPERTY DAMAGE $
HIRED AUTOS AUTOS accIdeffl
UMBRELLA LIAB OCCUR EACH OCCURRENCE $
EXCESS LIAB CLAIMS-MADE AGGREGATE $
DED I I RETEWION$ S
WORKERS COMPENSATION03/01/2015 03/01/2018 x rUTPEATR
A AND EMPLOYERS'LIABILITY WLRC48560349
ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N 1,00%0W
OFFICERIMEMBER EXCLUDED? a N/A E.E.L.EACH ACCIDENT $ 00
(Mandatory in NMI E.L.DISEASE-EA EMPLOYEE $ 1,000,000
111"
1 yes,describe under
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1.Otm•�0
DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space is required)
Workers'Compensation coverage is limited to employees leased to Gator Development Corp by Strategic Outsourcing,Inc.
CERTIFICATE HOLDER CANCELLATION
Miami Shore Village Department SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
10050 NE 2 Ave ACCORDANCE WITH THE POLICY PROVISIONS.
Miami Shores,FL 33138
AUTHORIZED REPRESENTATIVE
The ACORD name and logo are registered marks Of ACORD O 1988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25(2014101)
I
Miami Shores Village �S��RFs
Building Department •a. n...�
10050 N.E.2nd Avenue
Miami Shores,Florida 33138
Tel: (305)795.2204 R
Fax: (305)756.8972
.513111,1- arm jt'
Page 1 of 1
Permit No:
Structural Critique Sheet
I Q'vati. -ems IU D*S
e4 kV,, .
( �
L41 /s
IJ —b .-0 2 •0 3 �9-- to)-r'o y
STOPPED REVIEW
Plan review is not complete,when all Items above are corrected,we will do a complete plan review.
If any sheets are voided,remove them from the plans and replace with new revised sheets and include one
set of voided sheets in the re-submittal drawings.
Mehdi As of