DS-15-743 Miami Shores Village permit T)YIP 10050 N.E.2nd Avenue NE O Miami Shores,FL 33138-0000 r . Pefmit X66 '' ! APPRo Phone: (305)7952204 _,. FcoR.oA Expiration: 11/15/2015 717 Project Address Parcel Number Applicant L9350 NE 12 Avenue 1132050070150 R.ANDREW DE PASS WILLIAM Miami Shores, FL 33138- Block: Lot: Owner Information Address Phone Cell � R.ANDREW DE PASS WILLIAM J. 5701 N BAYSHORE Drive (305)609-3851 •••----- MIAMI SHORES FL 33138- 5701 N BAYSHORE Drive MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone $ 8,400.00 PALMER HOLDINGS, INC 305-310-4673 [Valuation:otal Sq Feet: 980 i Approved: In Review Available Inspections: Comments: Inspection Type: Date Approved: : In Review Final Date Denied: Foundation Type of Work:STONE PAVER DRIVEWAY&SIDEWALK Additional Info: Review Planning Bond Return: Classification:Residential Review Planning Scanning:3 Review Planning Review Planning Review Planning Review Planning Review Building Review Building Review Building Fees Due Amount Pay Date Pay Type Amt Paid Amt Due Review Building CCF $5.40 Invoice# DS-4-15-55021 DBPR Fee $2.00 04/01/2015 Credit Card $50.00 $ 102.40 DCA Fee $2.00 Education Surcharge $1.80 05/19/2015 Credit Card $ 102.40 $0.00 Permit Fee $125.00 Scanning Fee $9.00 Technology Fee $7.20 Total: $152.40 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: ify that all th regoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zo . F herm authorize the above-named contractor to do the work stated. May 19, 2015 orized Sig a ure:Owner / Applicant / Contractor / Agent Date Building Department Copy May 19, 2015 1 �\���� ,bill �✓. I/if Miami Shares Village ' Building Department �cFTVF� 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 ApR 20t� INSPECTION LINE PHONE NUMBER:(305)762-4949 ]BY: pFB l // BUILDING Master Permit No. /2� 7 "13— ick PERMIT APPLICATION Sub Permit No. 1ls— BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP CJ ;0 ^ / CONTRACTOR DRAWINGS JOB ADDRESS:—7 , V City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): ,�?Z � r V J Phone#: �?oS, So2- . 62 2 F� Address: City: State: Zip: Tenant/Lessee Name: Phone#: Email: l' f CONTRACTOR:Company Name: Ey— �1� /N�� Phone#:3orgi:?:-�o •-44 j Address: City: State:���, Zip: Qualifier Name: /Y�� C�// C�� Phone#`S1-, 5/0, State Certification or Registration#:C�d /`�` 2 b Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: _ Value of Work for this Permit:$ Square/Linear Footage of Work: Type of Work: ❑ Addition El Alteration ❑ New ❑ Repair/Replace /D moli on Description of Work: /V - L7-t--Specify color of colo'�r tt hru tile: Submittal Fee$ Permit Fee$ CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TATAI FFF NAU/h11C 4 { 0 )\ Bonding Comp y's Name(if applicable) Bonding Company Address City State Zip Mortgage Lender's Name 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 O NER or AGENT CONTRACTOR The foregoing instrument was ackn wledged before me this The foregoing instrument was acknowledged before me this c day of 20 :S by _day of P 1� 1 20 �� ,by h s personally know to 2(,�'Nwho is personally known to me or who has produced as me or who has produced Tc e. un !\_&S identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUB C: u Sign: MARTIN J.PALMER Sign; Notary Public-State o TTMIlud Print: = Comm.Expires May 23,2016 Print: :s9r Po;' Commission# EE 173842 Seal: „ `° Bonded Through National Notary Assn. Seal: � k Notary Public State of Florida Sindie Alvarez My Commission FF 156750 orNs' Expires 09/03/2018 APPROVED BY t�Plans Examiner Vlod ��� Zoning l Structural Review Clerk h. i y'; ,s'",� � • 1Rf'.�5" a• x;;st Sr'.... ..,fig. .;r { �i...«.�., �d�w3a t.:Y ♦` r ua s x�"SNT M �+� 'i4 ��e ^617 �Ei�S Sfy a�"'.t. �W y A+1 p YyFFf ° K r• �� :•SINS� .P � +�. _ g- ;I yam—' � } :.lrY3�' f '`�4 •f r 9 { '''�� h ' .r £�52{3ti: `� 3[s. '.`-orf z �"� SC. - •�-" ��"'+s�.��. S `ter di:s <.'3 r ; eyl; ♦ d . f3:; �s ` �+<. �•,,�� x ';^�,s?`s7���►.i ;_;�1A5 {�,..4. aver Thickness Paver Patterns MWOMp Ils 13/8"thick pavers are perfect for A 2"thick pavers a great for sand- 3"thick pavers are available for overlaying existing concrete set residential driveways(light sand-set custom residential driveways,walkways and patios,or duty),walkways and patios; driveways(medium duty) sand-set for walkways and patios (most common paver thickness) 9 r olerances ,. _ -.:. lao )mm) a c r t'(100 x 100,, A: Lapn a'x➢"(160 x 225rr.m) Halgl /arlance.o a for a Nat'ual Split-Top 1 aver with a faze 11 link rhl nm) B:f r 4'(200,mon�) Bmai x e°(100 x zoonrm) area, more thar I I square i_hes(9"x 9'1 Helghi /affiance a for a Nati ual Spilt-Tc t,i av-with 1 s� fare v p p l: rI c 11 0 A area 81 squaro shes(9". 1")or less Height variance a for a Cu, fop paver.v, c surface a,. i of s more.!an 81 sgii a inches I-) x 9"). _ l l_,- -®]...... a=. :,..'�_ -- -. - L-- Edge-I.ight varian. a area fol .- Natural Spl�i rop paver � m A: l ® 0"(160 ) Leng,I W)dth ver nee of a Ci:t-Sides pave -_�LJ .°xa^1 oox26o—) r 10 mm(1�E n ➢ x 12"(ape s nmm) Aa a yleox')euro. Smm11;4 f1 xa^(Sooxsnu,In) B a ...fl6oxnemn - 6 - f. s; ,,;,�,,, x )) C e.,I"(Ia0 x 100mn� C'. ➢ 4"(706 x Ilr,nm ]mm I,it tl.fl 1�� 160x11➢urn I Cl : x 1"(100 X i0n.�m )mm I I B ' — — I C In aA ( I �I 1 j L a x a 1 r:fa'x1r7d/e'(44o(x.11mmmm) ) •—rte, �ra'�`a-_�W.:.��-�-^. 9.g ,®b-. - _ 1 x B a'x1Dir .s gra—....•a._—_.__:._ , (� I 6 x C a x a•6/B (7100.x e20mm) 6 x D 11 a"x e-6/6'(440,220mm) A:La.;.4 xa"1160x:=imm) ll 4 x E it &6/fl"(a10x2:nmm) Top Surface Sides Ird Length Thick-, avers Natural Split' Cut Bottom Cut Unfmishcd 4.O,w x 4.0"I 13/8",2.0" Weight varies /•� B:6' +`(160 x 180rtu��i \ (Natural)or 4.0'w x B 1) or 3.0" by sae T mbled 8.0"w x 8.01 Custom thickness and a C t I. (Light or H.=avy) 6.0"w x 60"I the type of - --. --.-- ---- - - - 6.0:'w x 9 0"] natural stone �/ J 9.0"w x 9.0"I selected Cut and Flamed Cut Cut Beveled ❑ — _ O Brushed Top Edges or 12.0"w x 12.0"1 Bu I hammered Tumbled Custom o:Combination (Light or Hr-as'Y) — 'Th,Natural Spli p surface n have ig-f cl fti g up d down v of in thesurface For large paver.-in some stone type.(colors)Revd Stone Source does not recor.tmend this surface.Please check with your sales T epesentative for more details. ✓ 1x A i"x fl"(160 x 10u gym) Ai fx�.,,fl-x➢°(16oxs;imm) 1 x u °x4"(11101 1oim) A: .a°x16"(4o0x 401, xis A"x a"(100 w 1��.1111"o) 1 x C "x a"(70 x 7ami:1 B:.!"x 4"(100 x 213( n) basalt and Granite Cobbles .ACK CRYSTAL ASH BLACK illil ASH BLACK ,pped-Full Rough Chopped-Full Rough Chopped-Tumbled Chopped-Tumbled is �R:' i f?^':.. •, rt . -•..r y � e"i" .r. 5 NER'S PAN *;y` GOLDENTOPAZ MINER'S PAN GOLDEN TO PAZ -pped-Full Rough Chopped-Full Rough Chopped-Tumbled Chopped-Tumbled h VER DUST OLDE PEWTER SILVER DUST ` OLDE PEWTER -peed-Full Rough Chopped-Full Rough Chopped-Tumbled Chopped-Tumbled "F PAM k c �Si _ 1.3C n+ ..�i � �1i te' �:• � � , �� - r I 1 r.� y9'x"` J{.0 '�•3r4 4x ,1"ar. t �' SyF'., 7 "'G� r"` �' A w tEYTAUPE AUTUMN BLUSH GREYTAUPE AUTUMN BLUSH pped-Full Rough ""' Chopped-Full Rough Chopped-Tumbled Chopped-Tumbled obble Thickness il' �..�O ON�,� / 1 3/8"thick cobbles are f 2"thick cobbles can W s t ' ` ` perfect for overlaying -p be sand-set for existing concrete -• residential driveways 's driveways,walkways (light duty),walkways •`.' and patios and patios _a , 3"thick cobbles are 4"thick cobbles are �%• great for sand-set available for sand-set custom residential `1 commercial driveways -- y y driveways(medium (heavy duty) duty),walkways and y i, patios;(most common -�� Accessories cobble thickness) To help complement your green designs,natural stone tiles,pool coping,stair treads,block stairs,palisades,curbing,pillars, detectable warning,and windowsills are also offered as accessories to the versatile ExoGeo line. These are available in olerances matching colors to our cobbles and pavers and will create a seamless transition through the entire application. To discuss Q Height variance area for a Cut-Six-Sides cobble. your needs on a specific project,please contact the Real Stone Source Sales Team today and schedule an appointment for a Length/Width variance of a Cut-Six-Sides coCble. EM Pitch variance area for aChopped-Six-Sides cobble. full presentation. Height variance area for a Chopped-Five-Sides/Cut-Bottom cobble. s _ Height variance area for aChopped-Six-Sides cobble. We welcome your ideas for additional options not listed above.If you let us know about your design ideas,we will work with � Length/Width variance of a Chopped-Four-Sides cobble. -r•+-,`,.� you to make them a reality! +10 mm(3/8'i +3 mm(IIB") -3 mm(I Ip") «specked H,ic,t» +)-6mm(I 14' ExoGEo �~ Cut CobbM CAw '♦1 pptd Cobble Real Stone for Life X DETECTABLE WARNING NATURAL STONETILE • Weight1 4; •imer—r, Thickness :obbles Chopped Chopped Cut Unfinished Natural 3.5"wx3.5"I 1 3/8",2.0", Wei htvaries '�., (Rough Split) (Rough Split) or Tumbled 4.0"w x 4.0' 3.0",or 4.0" by size, (Light or Heavy) '••i;'*`?�: �.��"�i�.�i►+'s �` Custom Custom thickness and - Unfnished Natural the type of Natural Cut Cut ( ) natural stone - �orTumbled Split (Light or Heavy) selected li Cut and Hamed, ' Beveled Top Edges - Brushed,Honed, Cut Cut or Tumbled or Combination (Light or Heavy) '1-. _ _ -_ _______.J POOL COPING STAIR TREAD CURBING ( SUBGRADE COMPACTED TO SOIL (D SUBGRADE COMPACTED TO SOIL Q MORTAR SET ENGINEER RECOMMENDATIONS. Q6 SAND SET ENGINEER RECOMMENDATIONS. J. (2)GEOTEXTILE FABRIC AS REQUIRED. GEDTEXTILE FABRIC AS REQUIRED. 6 03 AGGREGATE BASE 4`TO 6" 4 ,1• —lk� �\ � ©AGGREGATE BASE 4"TO 6" �5 MINIMUM ACCORDING TO PROJECT MINIMUM ACCORDING TO PROJECT ENGINEER RECOMMENDATIONS,IN 4 c e ENGINEER RECOMMENDATIONS c z COMPACTED IN LIFTS NO GREATER ( n a ° a ° ° LIFTS NO GREATER THAN 2". o - - ° ° THAN 2"TO PROCTOR DENSITY NO �9 0 o D O o 0 U EDGE RESTRAINT AS G c ° ° LESS THAN 98%. � o RECOMMENDED BY PROJECT �TT�t7r o D o O o 0 0 ENGINEER. _—_�i,1 I 1 —I —I III—I G — ®CONCRETE SLAB 4"MINIMUM 2 0 SAND BED UN-CDMPACTED, d —III III )I I—III I —III III— ACCORDING TO PROJECT ENGINEER SCREED TO 1". —� 1- -� —� —� —� —� —� RECOMMENDATIONS. III—III -III—III III—)I -III- (6)STONE COBBLE PAVER COMPACTED OO MORTAR BED 1'MINIMUM. - - - - -� —� —� —� STONE COBBLE/PAVER. USING 1/2"PLYWOOD OR EQUAL ® TO MINIMIZE SCARRING OF STONE. ExoGEo (2)FLUSH JOINTS. ExoGEo GGETTED PR[IC"ES W suBXCT TD uxC WILD—cJDES/mD r N swcESTCD INCTr,LLnT1u1 wncr:DJRES WSus.LCT m—MLMM c;ras ARD �► �. [D TO BC ariRPJED BY THE EWIIEER 7 MEDIUMk.➢1MENSIORS ME•PP;D%UMTE MTs. —'�—' HEED TO BE nPPReVED BY TK EN:ilIEER 6.—D. K'.DDEMSIIBD:PRE RWROIMOTE MT.S. WE_W BOBBLE & PAVER SUGGESTED INSTALLATION DETAILS ♦ COBBLE & PAVER SUGGESTED INSTALLATION DETAILS AND SET: MORTAR SET: xcavation:Excavate project to appropriate depth. Edge Restraint: Use appropriate edge restraint, Excavation:Excavate project to appropriate depth.Consider Concrete Slab:Minimum 4"(typical),or as appropriate onsider depth requirements for aggregate base,sand bed, according to use and desired aesthetics. Surface mounted depth requirements for aggregate base,mortar bed,paver and for intended use,including corresponding compressive aver and settling under compaction, restraints should be applied directly to aggregate base settling under compaction. strength of concrete mix. ubgrade:Compacted,according to soil type and stability. surface.Imbedded restraints should be anchored to a depth Subgrade:Compacted,according to soil type and stability. Mortar Bed:Minimum I"in depth. Allow for mortar onsult compaction equipment manufacturer and/or soil appropriate for the form ofthe restraint. Consult compaction equipment manufacturer and/or soil bed to set,mimmum 24 hours prior to grouting. Tgineer for appropriate equipment to compact specific soil Sand Bed: Washed,dry concrete sand,un-compacted. engineer for appropriate equipment to compact specific soil Pavers:Set pavers in desired pattern,keeping grout joints 'pes.Achieve no less than 98%proctor density. Screed to nominal I"_ types.Achieve no less than 98%proctor density. evenly spaced.Maintain flush joints. :eotextile Fabric: As required.Consult soil or project Pavers: Set pavers in desired pattern. Compact pavers Geotextile Fabric:As required. Consult soil or project Grouting: Grout joints using standard grouting igineer. using a vibratory plate and Vi"sheet ofplywood orequal to engineer methods, according to the specific conditions and ,ggregate Base: Conforming to typical under asphalt minimize scarring of stone. Run compactor in overlapping Aggregate Base: Conforming to typical under asphalt road volumes of the project;including the use of grout bags Dad base, runs to ensure even settling. base. or field spread mortar,cleared flush with a squeegee joint Sand:Sp y read dr concrete,ora appropriate I oint sand and cleaned using wet burlap sacks or blankets,dragged Minimum 4"-6"(typical)for pedestrian traffic over paver surface,sweeping it into joints.ro - Minimum 4"-6"(typical)for pedestrian traffic over the grouted pavement and rinsed frequently with - Minimum 6"-B"(typical)for light vehicular traffic Re-Compact: Sweep joint sand clear and re-compact, Minimum 6%8"(typical)for light vehicular traffic clean water. Compact to proctor density no less than 98%and in lifts using/x"plywood or equal to minimize scarring of stone. - Compact to proctor density no less than 98%and in lifts no more than 2"each. Run compactor in overlapping runs to ensure even settling. no more than 2"each. mnilation suggestions appropriate for residential pedestrian and light residential vehicular traffic only. For commercial and heavy vehicular traffic *Installation suggestions appropriate for residential pedestrian and light residential vehicular traffic only.for commercial and heavy vehicular traffic )plica[ions,consult a qualified engineer It is recommended that an experienced,licensed contn.,ctor be used forinsrallation.Stone pavers and cobble applications,consult a qualified engineer.It is recommended that an experienced.licensed contractor be used for Installation.Stone pavers and rabble e natural materials with varied characteristics and may performlreact differently under varied conditions. Installation suggestions are general are natural materials with varied characteristics and may perform/react differently under varied conditions. Installation suggestions are general xommendations and need to be reviewed and approved by the engineer of record. recommendations and need i o be reviewed and approved by the engineer of record. ANTONIO CANELAS,P.E. oto + ` LIC.No. 74099 7805 SW 24 ST SUITE 106 MIAMI FL, 33155 _ 305 261 0321 SUN 7015 Village of Miami Shore Building and Zoning Department Miami,Florida. Date 6-1-15 Reference: Wood Decking Willian J.Jurgberg 9350 NE 12 AVE Miami Shore, FL. 33134 To Whom It May Concern: Wood Decking, (walk way) Referring to the original design of the joist, the direction was reversed. We have reviewed the new condition and decided to add three new footings (2'-0"X 2'-0" by 12") bellow three new wood girder Joist.After this the new design has been approved by Us. i If you should have any questions regarding this matter,please do not hesitate to contact us. Sincerely, oN��• Cry�` Q : EN No. 74099 ' �'•• STATE OF : 4s per. <v • A'4 OR\V,.• 6-1-15 Antonio Canelas,P.E. Lic #: 74099 o ` k Nw ANEW % L� ti •� 4 1 RS "�' yt. ' �� '':� b4 PS:� r.1 37 ,1R1 IJ 20 • Aqk y 16�t'd k. nay� •� w t Vol Jr molt • �. A0.,, From:Jill Ojeda Fax: 786-573-2224 To: Fax: +1 (305)766-8972 Page 1 of 1 0612612015 2:16 PM, --Ia nilly ivuniUci. %-L, "U_L, 00 w Udte oncled: 06/23/2015 ACORO TE CERTIFICATE OF LIABILITY INSURANCE FD 6//25/201525/2015 Y) 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 The World Of Insurance, Inc. NAME: Jill Ojeda 18495 S.Dixie Hwy IAIC.PHONE .(786)573-2221 ac No:(786)573-2224 E-MAIL ill@ theworldofins urance.com 260 ADDRESS:j MTAMT, FL 33157 INSURERIS)AFFORDING COVERAGE NAIC# INSURERA:ACCIDENT INSURANCE COMPANY INSURED PALMER HOLDINGS, INC INSURER B: DBA MARTIN PALMER INSURER C: 1900 South Bayshore Drive INSURER D: Coconut Grove, FL 33133 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 MAYHAVE BEEN REDUCED BY PAID CLAIMS. QS_ 3161W 19-W LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MMLICYYFF MOMILODYEXP LIMBS (7j COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE Sl' 00,000 CLAIMS-MADE OCCUR CPP0014768 00 /21/2015 /21/2016 PREMISES Ea occurrence S 100,000 MED ERCP(Anyone person) S 5,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY❑JE0. LOC GENERAL AGGREGATE s2,000,000 PRODUCTS-COW/OP AGG S Included OTHER: S AUTOMOBILE LIABILITY COMBINED NGLE LIMIT S Ea accident SI ANYAUTO N/A BODILY INJURY(Per person) S ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) S HIRED AUTOS NON-OWNED PROPERTY DAMAGE AUTOS Per accident $ S JF LA LIAB OCCUR EACH OCCURRENCE S LIAB CLAIMS-MADE N/A AGGREGATE $ RETENTION S WORKERS COMPENSATION $ PER OTH- AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N STATUTE ER OFFICER/MEMBER EXCLUDED? N/A N/A EL.EACH ACCIDENT S (Mandatory In NH) C Ifyes,describe under EL.DISEASE-FA EMPLOYE S DESCRIPTION OF OPERATIONS below N/A E.L.DISEASE-POLICY LI MIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached V more space is required) GENERAL CONTRACTOR. 30 DAY NOTICE OF INTENT TO CANCEL ISSUED TO ADDITIONAL INTEREST. CERTIFICATE HOLDER CANCELLATION CITY OF MIAMI SHORES SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 10050 NE 2ND AVE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN MIAMI SHORES, FL 33138 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ] O 1988-2014 ACORD CORPORATION. All rights reserved ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD -oduced using Forms Boss Plus software www.FormsBoss.com.Impressive Publishing 800-208-1977 EPBU2.E307078 - Direct-plug-in and Cord-connected Class 2 Power Units- Co... 1 iE 1 U� ONLINE CERTIFICATIONS DIRECTORY EPBU2.E307078 ✓ 2 Direct-plug-in and Cord-connected Class 2 Power Units - Component 2 1$ Paae Bottom Direct-plug-in and Cord-connected Class 2 Power Units - Component See General Information for Direct-plua-in and Cord-connected Class 2 Power Units-Component MEAN WELL ENTERPRISES CO LTD E307078 28 WU-CHUAN 3RD RD WUGU INDUSTRIAL PARK TAIPEI HSIEN,248 TAIWAN Class 2 power supplies,Model(s)CLy-100-z,where y can be G(for with Glue)or N(for without Glue),z can be 12,15,20,24,27,36,or 48. Class 2 power supplies,Model(s)CLy-60-z,where y can be G(with potting compound)or N(without potting compound),z can be 12,15,20, 24,27,36,48. Class 2 power supplies,Model(s)ELN-30-xy,where x can be 5,9,12, 15,24,27 or 48,y can be D,P or blank.,ELN-60-xy,where x can be 9, 12,15,24,27 or 48,y can be D,P or blank.,LPC-20-350, LPC-35-1050,LPC-35-1400,LPC-35-700,LPC-60-1050,LPC-60-1400, LPC-60-1750,LPV-20-12,LPV-20-15,LPV-20-24,LPV-20- PV-35-1 LPV-35-15,LPV-35-24,LPV-35-36,LPV-35-5,LPV-60-12,LPV-60-15,LPV- 60-24,LPV-60-36,LPV-60-48,PLC-100-12,PLC-100-15,PLC , LC-100-24,PLC-100-27,PLC-100-36,PLC-100-48,PLN-100-12,PLN-100- 15,PLN-100-20,PLN-100-24,PLN-100-27,PLN-100-36,PLN-100-48,PLN-30-9 Class 2 power supplies,Model(s)PLN-60-z,PLC-60-z,PLN-45-z and PLC-45-z,where z can be 12,15,20,24,27,36,48. Class 2 power supplies,Model(s)PLX-30-Y,X=N(for cord type)or C(for terminal block type),Y=12,15,20,24,27,36,48 Marking:Company name and model designation. Last Updated on 2009-I1-11 Ouestions? Notice of Disdaimer Pace Too Copyriaht?2010 Underwriters Laboratories Inc.@ The appearance of a company's name or product in this database does not in itself assure that products so identified have been manufactured under UL's Follow-Up Service.Only those products bearing the UL Mark should be considered to be Listed and covered under UL's Follow-Up Service.Always look for the Mark on the product. UL permits the reproduction of the material contained in the Online Certification Directory subject to the following conditions: 1.The Guide Information,Designs and/or Listings(files)must be presented in their entirety and in a non-misleading manner,without any manipulation of the . data(or drawings).2.The statement'Reprinted from the Online Certifications Directory with permission from Underwriters Laboratories Inc"must appear adjacent to the extracted material.In addition,the reprinted material must include a copyright notice in the following format:"Copyright 2010 Underwriters Laboratories Inc.®" uuhng far a safIr :,11 11 i9!"I ir. �,c ,�c. ana knn;;le c9e http://database,ul.com/cgi-bin/XYV/template/LISEXT/1 FRAME/showpage.htmI9name=... 2010/2/5 EPBU8.E307078- Direct-plug-in and Cord-connected Class 2 Power Units Cert... M 1 1 u` ONLINE CERTIFICATIONS DIRECTORY EPBU8.E307078 Direct-plug-in and Cord-connected Class 2 Power Units Certified for Canada - Component Paae Bottom Direct-plug-in and Cord-connected Class 2 Power Units Certified for Canada - Component See General Information for Direct-plue-in and Cord-connected Class 2 Power Units Certified for Canada-Component MEAN WELL ENTERPRISES CO LTD E307078 28 WU-CHUAN 3RD RD WUGU INDUSTRIAL PARK TAIPEI HSIEN,248 TAIWAN Class 2 power supplies,Model(s)CLy-100-z,where y can be G(for with Glue)or N(for without Glue),z can be 12, 15,20,24,27,36,or 48. Class 2 power supplies,Model(s)CLy-60-z,where y can be G(with potting compound)or N(without potting compound),z can be 12, 15,20, 24,27,36,48. Class 2 power supplies,Model(s)ELN-30-xy,where x can be 5,9,12,15,24,27 or 48,y can be D,P or blank.,ELN-60-xy,where x can be 9, 12,15,24,27 or 48,y can be D,P or blank.,LPC-20-700,LPC-35-1050,LPC-35-1400,LPC-35-700,LPC-60-1050,LPC-60-1400,LPC-60-1750, LPV-20-12,LPV-20-15,LPV-20-24,LPV-20-5,LPV-35-12,LPV-35-15,LPV-35-24,LPV-35-36,LPV-35-5,LPV-60-12,LPV-60-15,LPV-60-24,LPV- 60-36,LPV-60-48,PLC-100-12,PLC-100-15,PLC-100-20,PLC-100-24,PLC-100-27,PLC-100-36,PLC-100-48,PLN-100-12,PLN-100-15,PLN-100- 20,PLN-100-24,PLN-100-27,PLN-100-36,PLN-100-48,PLN-30-9 Class 2 power supplies,Model(s)PLN-60-z,PLC-60-z,PLN-45-z and PLC-45-z,where z can be 12,15,20,24,27,36,48. Class 2 power supplies,Model(s)PLX-30-Y,X=N(for cord type)or C(for terminal block type),Y=12,15,20,24,27,36,48 Marking:Company name,model designation and Recognized Component Mark for Canada,C%. Last Updated on 2009-11-11 Ouestions? Notice of Disclaimer Pace Top Copyright?2010 Underwriters Laboratories Inc.® The appearance of a company's name or product in this database does not in itself assure that products so identified have been manufactured under UL's Follow-Up Service.Only those products bearing the UL Mark should be considered to be Listed and covered under UL's Follow-Up Service.Always look for the Mark on the product. UL permits the reproduction of the material contained in the Online Certification Directory subject to the following conditions: 1.The Guide Information,Designs and/or Listings(files)must be presented in their entirety and in a non-misleading manner,without any manipulation of the data(or drawings).2.The statement"Reprinted from the Online Certifications Directory with permission from Underwriters Laboratories Inc."must appear adjacent to the extracted material.In addition,the reprinted material must include a copyright notice in the following format:"Copyright 2010 Underwriters Laboratories Inc.®" http://database.ul.com/cgi-bin/XYV/template/LISEXT/1 FRAME/showpage.html?name=... 2010/2/5 Miami Shores Village 1(9V Building Department JU ; 11 2015 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 e: Fax:(305)756-8972 Rcm l(JIV I N N O NU R:(305)762-4949 _- FBC 20 t / BUILDING Master Permit No. I�C. ���' & SSC PERMIT APPLICATION Sub Permit No. ❑BUILDING ❑ ELECTRIC ❑ ROOFING REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS [:] CHANGE OF ❑ CANCELLATION ❑ SHOP t /y�� CONTRACTOR DRAWINGS /V JOB ADDRESS: /cJ E��ly� City: Miami Shores County: Miami Dade Zip: ��lV Folio/Parcel#: Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name(Fee Simple Titleholder):, Phone#: Address: C , J a,, 62- .�V/0 City: J��(o State: Zip: Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name: �u2� Phone 0 Address: City: zz' State: Zip: Qualifier Name: Phone#: State Certification or Registration#: � Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ RAair/Replace ❑ Demolition Description of Work:_ZA/MD'�J -70 Specify color of color thru tile: Submittal Fee$ 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$ A (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 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 ab ence of such posted notice, the inspection will not be approved a 'nspectio will be charged. Signature Signature or AGENT CONTRACTOR ZoT,hnerfore,,ing instrument a acknowledged before me this The foregoing instrument was acknowledged before me this day of 20 by r1�[--I day of 20 ( � , by who i personally kno o 1 ' X7114 12&-4V1rwho is pek! y cno to me or who has produced _ Q as 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: g �.•' � � •. 6- , Notary Public-State of Florida o= Print: = Print:MY fes May 23,2816 Seal: Commission # EE 173842 Seal: Bonded Through National Notary Assn ....... t` SjP�\\\� ####APPR###########OVED BY Examiner ############## ######### ############################################################### `J � � l Zoning W1 I Plans Structural Review Clerk (Revised02/24/2014) From:Jill Ojeda Fax: 786-573-2224 To: Fax: +1 (305 756-8972 Page 1 of 1 06/25/2015 9:38 AM ® rviwy wunwci. k.r&vv.Lq 100 vv Udic cniCied: 06/23/2015 ACORD DATE(MMIDD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 6/25/2015 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 : Jill Ojeda The World Of Insurance, Inc. NAME PHONE (786)573-2221IFAX 18495 S.Dixie Hw ('C No):(786)573-2224 y E-MAIL 260 ADDRESS:J111@theworldofinsurance.com MIAMI, FL 33157 INSURERS)AFFORDING COVERAGE NAIC# INSURERA:ACCIDENT INSURANCE COMPANY INSURED PALMER HOLDINGS, INC INSURERB: DBA MARTIN PALMER INSURER C: 1900 South Bayshore Drive INSURERD: Coconut Grove, FL 33133 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. NSR LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER POLI CY EFF POLICY EXP (Mli YYYY MM/Dli LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S1,000,000 CLAIMS-MADE OCCUR CPPOO14768 00 /21/2015 /21/2016 PREMISES Ea occurrence $ 100,000 MED EXP(Any one-person) $ 5 000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY❑JECOT LOC GENERAL AGGREGATE s2,000,000 OTHER: PRODUCTS-COMP/OP AGG s Included AUTOMOBILE LIABILITY $ COMBINED SINGLE LIMIT S Ea accident ANY AUTO N/A ALL OWNED SCHEDULED BODILY INJURY(Per person) S AUTOS NON-OWNED BODILY INJURY(Per accident) S HIRED AUTOS AUTOS PROPERTYDAMAGE Per accident $ UMBRELLA LIAB S OCCUR EXCESS LIAR EACH OCCURRENCE S CLAIMS MADE N/A AGGREGATE DED RETENTION S S WORKERS COMPENSATION S AND EMPLOYERS•LIABILITY _ ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N PER OFFICER&13T ER EXCLUDED? N/A STATUTE ER (Mandatory In NH) N/A E.L.EACH ACCIDENT $ Ifyes,describe under E.L.DISEASE-EA EMPLOYEE S DESCRIPTION OF OPERATIONS below N/A E.L.DISEASE-POLICY LIMIT S DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,maybe attached V more space Is required) GENERAL CONTRACTOR. 30 DAY NOTICE OF INTENT TO CANCEL ISSUED TO ADDITIONAL INTEREST. CERTIFICATE HOLDER CANCELLATION CITY OF MIAMI SHORES SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 10050 NE 2ND AVE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN MIAMI SHORES, FL 33138 ACCORDANCE VHITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 252014/01 O 1988-2014 CORPORATION. All rights re�servCe�d ( ) The ACORD name and logo are registered marks of ACORD ACORD 'oduced using Forms Boss Plus software.www.FormsBoss.com,Impressive Publishing 800-208-1977