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RC-15-1198 Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INS P-251371 Permit Number: RC-5-15-1198 Scheduled Inspection Date: January 22,2016 Permit Type: Residential Construction Inspector: Rodriguez,Jorge Inspection Type: Final Owner: RANDOLPH,ALAN Work Classification: Alteration Job Address:325 NE 95 Street Miami Shores, FL Phone Number (305)613-2605 Parcel Number 1132060136020 Project: <NONE> Contractor: RED DOOR CONSTRUCTION LLC Phone: (786)256-5158 Building Department Comments RE FINISH EXISITNG WOOD FLOORS REPLACE TILE AT Infractio Passed Comments WALLS AND FLOORS IN BOTH BATHROOMS REMOVE INSPECTOR COMMENTS False AND REPLACE FIXTURES FOR TILE WORK Inspector Comments Passed % Failed Correction ❑ Needed Re-Inspection Fee No Additional Inspections can be scheduled until re-inspection fee is paid. January 21,2016 For Inspections please call: (305)762-4949 Page 29 of 40 JAN-20-2016 18:13 TRIGRAM.GC 305 669 3895 P.01i01 007183 Lo 661 .Business.Tax.:Receipt . Mian-d-Dade County, State of FloridaL.B..T —THIS IS NOTA BILL. — DO NOT PAY 7184872 . OUSINESS NAMEMOCATION 110CEIPT NO. EXPOIIES RED DOOR CONSTRUCTION LLC RSNLWALSEPTEMBER 30. 2016 4044 PARK AVE 746564fa Must be displayed at place of business MIAMI FL 33133 Pursuant to'County Code Chapter 8A—Art.9&10 OWNER $EC.TVPF OF BUSINESS PAYMENT.RECEIVED RED DOOR CONSTRUCTION LLC 196 GEAIERAL BUILDING CON7RACToR BY TAX 000s ECTOR Workers) I CGCI 521017 $45.00 07/07/2015 CREDITCARD-15-034270 Tfi&Local Business Tax Rcceippt only confirms payment of the Local Business Tax,The Receipt is not a license. permit;or a certification of the bolder'sualification.to do busmoss.Bolder must comply with arry governmental or nongovernmental regulatory taws and requiromonts which apply to the business. The RECEIPT NO.above must be displayed an all commercial vehicles—Miami—Dade Code See Sa-276. For more information,visitor ,,miamidadc.aoVAsxc9J14= l � . s TOTAL P.01 REDDOOR CONSTRUCTION JAN 5 2015 January 4,2016 Miami Shore Building and Zoning 10050 NE 2nd Ave Miami Shores,FL 33138 Re: Affidavit for Permit#RC-5-15-1198 at 325 NE 95th Street To whom it may concern: This affidavit is to certify that no existing walls were modified in any way nor were any new walls added. If you have any questions or require additional information, please do not hesitate to contact me at(786) 256-5158 13p5 - Z.)�3- O 3 9$(_, t'7 Ay,). Sincerely, al Bensaadon L,I/ �to Owner ,,t�"1 be�ae . . .... ...... 00 0 00000 0 44;6 PAOLA S.CONCEPCION % MY COMMISSION k EE829487 •••••• • ••• ••••• EXPIRES:August 23,2016 ••'••' '••• i •••••• • so •••••• RED DOOR CONSTRUCTION,LLC •• • 6358 MANOR LANE, SOUTH MIAMI,FL 33143 CGC 1521017 Ar 1141 N& tlV I N� 5 I (oore- . — 771 L- MUTT VVO�4 — IN,954� vv"eL d le"Xie" twm I& "n, LIE S1 Sap rT- . 'n!, IiJ 1 I�laE1N ?.� X 2��� 6ef,2,AMic. n LE A11 T1xNt*6 v Fr* o iAi ' 6 r-I To f-k-vA4I r4 — 9Fo sat t=r 11jp_ _ IODIP-�jA, O M,GiT1P, G✓_' ' oo� fA �� - �w�avFc isfi/�1Lov�2. .�t t (n1s'fti►-t N 7J-f tfx ?,4" >a i 1 i X tv►u� -t� V4,M A►N I 6f rta (moi 1�4 5.10 f�- I^rTV►--i O IP✓ ""A)N h tOPLE �'j f--rF AI 1 - 1��'f�id►z dun-�c� . . . • . • .. ... .. . . . .. . •.• . ... . . . . . . ... ... • boo 0 . . . . • •• . •O boo 00 .•• • . • • ..Y • • • • ••. • • •.• i r. f •• •: ••• • • • ••• • • • • ••• ••••• • i i i• • 4: Y • .� �.rr�..�j�' • 4 • 7--. .....a....,...— _ __�w_cix.. _..,mss .... aex,..-.�.F n.s'ix • V f m-v - •yam -----3cs,.. -. ��* x rmquiy PKA sx 2 LN* sriK.. , 1 i$:a„w„r'�i.+.�.++�'#.v'�:'��& � � - _-•__ - h 1 is `� OF • • ••• • • • ••• • Vo *so go i - -- —--= i i i 000F 09 - 1 I JUN..Tr uT11rr� Pm- Ln up -ZA / - `G ,r Pg G PLAM Approved s Disapproved Date Aauco"A 1.5;r - T2s t� 1 ADD SMOKE/CARBON MONOXIDE DETECTORS ANY AND ALL CLOTH AND RUBBER BATHROOM RECEPTACLE ON 20 AMP CKT INSULATED CONDUCTORS TO BE REPLACED. AND G.F.I PROTECTED J Lu uj Lu 0 Tul J w QW w W U ®• 4t x IZ o CNN 0 p u D � � ul Z ®pp Z m 0 Q u i m .fieL) Ln IL Perrr„f NO, 'RC S" � 198- Miami Shores Village # Pei7T21yB`,Residential gtICs€9rCt; 10050 N.E.2nd Avenue NE c WPe i��CJ stfica ion.Alteration Miami Shores,FL 3313&0000 Phone: (305)79`x2204 Pet7tii�Status:APPROVED �'toRml" 7161015 Expiration: 01/0212016 � �;� . a Project Address Parcel Number Applicant 325 NE 95 Street 1132060136020 ALAN RANDOLPH Miami Shores, FL Block: Lot: Owner Information Address Phone Cell ALAN RANDOLPH 325 NE 95 Street (305)613-2605 MIAMI SHORES FL 33138- 325 NE 95 Street MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone $ 20,000.00 Valuation: RED DOOR CONSTRUCTION LLC (786)256-5158 ..._. _....: _., Total Sq Feet: 2440 Approved:In Review Available Inspections: Comments: Inspection Type: Date Approved::In Review Fill Cells Columns Date Denied: Final PE Certification Type of Construction:RE FINISH EXISITNG WOOD FLOO Occupancy:Single Family Window Door Attachment Stories:2 Exterior: Framing Front Setback: Rear Setback: Insulation Left Setback: Right Setback: Drywall Screw Bedrooms:2 Bathrooms:2 Window and Door Buck Plans Submitted:Yes Certificate Status: Review Planning Certificate Date: Additional Info: Review Structural Review Mechanical Bond Return: Classification:Residential Review Electrical Fees Due Amount Pay Date Pay Type Amt Paid Amt Due Review Electrical CCF $12.00 Review Electrical DBPR Fee $9.00 Invoice# RC-5-15-55635 Review Building DCA Fee $9.00 05/20/2015 Credit Card $50.00 $609.00 Review Building Education Surcharge $4.00 07/06/2015 Credit Card $609.00 $0.00 Review Plumbing Permit Fee $600.00 Review Plumbing Scanning Fee $9.00 Technology Fee $16.00 Total:^ $659.00 cm f-4 6.7 In considWtion of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaininoereto and in strict conformity with the plans,drawings,statements or specifications submitted to the prof er authorities of Miami Shores Village. In accepting5is permit I assume responsibility for all work done by either myself, my agent, servants, or employes I understand that separate permits are required four ELECTRICAL,PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work. OWNER�FFIDAVIT: I certify that all the foregoing i ation is accurate and that all work will be done in compliance with all applicable laws regulating construct' and zo ' r�the-named. Futhe ore.I authocontractor to do the work stated. July 06, 2015 Fthorized S gn tux :Owner / Ap icant / Contractor / Agent Date Building De rtment py rt July 0 015 1 1 • C,�al Miami Shores Village MAY 20 2015 5 Building Department BY: b 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 F�BC 20 1® BUILDING Master Permit Nor=, PERMIT APPLICATION Sub Permit No. BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL F-IPUBLICWORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP �/ J L CONTRACTOR DRAWINGS JOBADDRESS: 3a, rV E �S'i� ST'rt"f City: Miami Shores 33 / County: Miami Dade Zip: 3.3113 Folio/Parcel#: 11- 3206 -013-G02 0 Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): Al-iW c• KAryoy GP I- Phone#: ?®r Address: 32S Ad4G 4?61 A'- -Zi- City: 'TCity: InIWW7 / Sl-('UrQGS State: zip: Tenant/Lessee Name: Phone#: Email: I 1 17 1 q CONTRACTOR:Company Name: RCa Door CpnS ffaec/;ar aG Phone#: %eC/oc.J ic Address: 70$7 ?A-r /( Ayf- City: /4"a" i State: F L Zip: 3113 3 Qualifier Name: 741 Phone#: iNO '��'•r/,�� State Certification or Registration M_C6 e I S 2 1017 Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ ��i D O O Square/Linear Footage of Work: ;Q q o Type of Work: ❑ Addition ❑ Alteration El New New/ Repair/Replgace ❑ Demolition Description of Work: Re.- V,�ni''_ ";3�#L a 0,1,;4 /�f�10ar3. (/��h�p/4t t_ Ti le- o.4 /„r���, d Pl0o<, 1'r, ly 1"l� 6.Cafodrvr . ktagdyc 4 /t®/ace- F,`x "' }or ' ;IL "104. PAL in)1' %/!�,e p� tAIA � 4 CG;YILq, . Specify color of color thru tile: Submittal Fee$ (meq Permit Fee$ b� •W CCF$ V�•�� co/ccs Scanning Fee$ ` � -cx3 Radon Fee$ DBPR$ -�7 Notary Technology Fee$ Q(v -ck-.) Training/Education Fee$ 4•LDL-21 Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ (Revised02/24/2014) s , IABonding Company's Name(if applicable) /M Bonding Company's Address City State Zip Mortgage Lender's Name(if applicable) Mortgage Lender's Address City State Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRIC, PLUMBING, SIGNS, POOLS, FURNACES,BOILERS,HEATERS,TANKS,AIR CONDITIONERS,ETC..... OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding$2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also,a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be appy ed andfirrlinspection fee will be charged. Signature ' Signature OWNER or AGENT CONT+ OR The foregoing instrument was acknowledged before me this The foreoing instrument was acknowledged before me this day of MAM 04)—- -- by (�tS day of M, 20 15 by IMMDOLAwho s personally known.tesl who is personally known to me or who has produced as pqe or who has produced as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: u " '- JLLI!'x, v 1 ' Sign: Print: ��5r� Q � Print: 6`°� �`� PAOLA S.CONCEPCION "��"% ML St►3AN MIWIS Seal: _ Sea .,,;�+A MY COMMISSION k EE829487 W G0MMISSM 9 EE 158312 EXPIRES:August 23,2016 ' EXPIRES:February 3,2010 wA ?!„hThm Notn Pubs Underwhars *********** * ************************************************************************ APPROVED BY Z Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) tet►, OR I yrt .... .....� Miami Shores Village Building Department RNA 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CONTRACTORS' REGISTRATION IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: A. '� COPY OF QUALIFIER'S STATE LICENCES B. `� COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF LIABILITY INSURANCE* D. COPY OF WORKERS COMPENSATION INSURANCE* (Workers Compensation EXEMPTION must have NOTICE TO OWNER form and Contractor Affidavit) IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY: A. COPY OF CERTIFICATE OF COMPETENCY OF QUALIFIER B. COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF STATE REGISTERED CONTRACTOR LICENSE OR MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT. D. COPY OF LIABILITY INSURACE* E. COPY OF WORKERS COMPENSATION INSURANCE* (Workers Compensation EXEMPTION must have NOTICE TO OWNER form and Contractor Affidavit) *YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE AS FOLLOW: Certificate Holder: MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES,FL 33138 Certificate must specify the description of operations or contractor license number. BUSINESS NAME: 12 -019®0- �on�l��v��,o" , /_6 C BUSINESS ADDRESS: �®VIV104'z dQvL- CITY STATE FL ZIP BUSINESS PHONE: OW ) A.'9 4 S r FAX NUMBER( ) CELLPHONE( ) as-." .-Orr QUALIFIER'S NAME: dk/ Z?ep?s ,%Lg/,,, QUALIFIER'S LIC NUMBER: �fd c_ S-x l ®� r? RKEN LAWSON,SECRETARY__.___ ICK SCOTT, GOVERNOR Yr STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ; CONSTRUCTIlpt INDUSTRY IMCG LICENSING BOARD I The GENERAL CONTRACTOR Named below IS CERTIFIED Unde -thepiovisions.of Chapter 489 FS_- - Expiration date: AUG_31.,2016 ■ Urn- ■ BENSAADON, EtED D00R'CQNSTtR11W LICA 4.044-PARK AV€-NUE :7 M�AML FLS � -. ISSUED: .03/12/2015 DISPLAY AS REQUIRED BY LAW SEQ# L1503120000806 000254 Local Business Tax Receipt Miami—Dade County, State of Florida_ —THIS IS NOTA BILL -DO NOT PAY 1 7184872 BUSINESS NAME/LOCATION RECEIPT NO. EXPIRES _ RED DOOR CONSTRUCTION LLC NEW BUSINESS SEPTEMBER 30, 2015 4044 PARK AVE 7465646 Must be displayed at place of business MIAMI FL 33133 Pursuant to County Code - Chapter 8A-Art 9&10 SEC.TYPE OF BUSINESS OWNER PAYMENT RECEIVED RED DOOR CONSTRUCTION LLC 196 GENERAL BUILDING CONTRACTOR BY TAX COLLECTOR CGC1521017 Worker(s) 1 $45.00 04/27/2015 CREDITCARD-15-028769 This Local Business Tax Receipt only confirms payment of the Local Business Tax.The Receipt is not a license, Permit,or a certification of the holders 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 Sac Ba-276. For more information,visit wwwAlamidade nov/taxcollector ACORC)� CERTIFICATE OF LIABILITY INSURANCE DATEPWDD/YYYY) ��- 05/18/2015 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 CNAOME CT Brian Ladd _ Global Insurance Services,Inc PHONE 561-187-6001 c No 561-451-9825 21301 Powerline Road#217 �1 `–�--- -------- Boca Raton,FL 33433 _ADDRESS:_ ____. Brian Ladd _ ------ INSURERS)AFFORDING COVERAGE _ NAIC d INSURERA:United Specialty Insurance Co. -.-.-- INSURED Red Door Construction, LLC INSURERS: 4044 Park Ave INSURERC: Miami, FL 331333 INSURER D_--- ------- ----- -------F--------- INSURER 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. ------ D S� - POUCYEw -POLICY EXP ILTR! TYPE OF INSURANCE POLICY NUMBER MWDD MWDD LINIRS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 CLAVAS-MADE [___,OCCUR USA4082519 03/1PREMISES Ea occurrence $ + 8/2015 03/18/2016 T 100 000 – I— I _ � MED EXP(Any one person) $ — 6,000 I j PERSONAL&ADV INJURY_ $ _ _ 1,000+00 -- -- _EN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE _ $ __- —_ 2+000,00 G POLICY PRO- I LOC ! I PRODUCTS-COMP/OP AGG $ — — 2+000,000 JECT - -- $ OTHER: COMBINED SINGLE LIMIT $ AUTOMOBILE LIABILITY ! Ea accident ANY AUTO ! BODILY INJURY(Per person) $ —�ALL OWNED SCHEDULED � i BODILYINJURY(Peraccdenq $ i....._'AUTOS AUTOS PROPERTY DAMAGE -- HIRED AUTOS I— NON-OWNED j $ ( AUTOS Peracciden, j $ I UMBRELLA LIA131 OCCUR j EACH OCCURRENCE $ 1 EXCESS LIAS CLAIMS-MADE j AGGREGATE $ �...- —"-r -EN [ON 1--'---� _..---- --- --- DED RETENTION$ $ PR WORKERS COMPENSATION STATUTE ER H !AND EMPLOYERS'LIABILITY �ANYPROPRIETOR/PARTNER/EXECUTIVE YIN E_.L.EACH_ACCIDENT $ •OFFICER/MEMBER EXCLUDED9 I N/A; - — (Mandatory In NH) $ -- ------- E.L.DISEASE-EA EMPLOYEE j If yes,dascnbe under E.L.DISEASE-POLICY LIMBS$ i DESCRIPTION OF OPERATIONS below i DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Romarks Schodulo,may be attached If rnorc space Is required) CGC#1521017 CERTIFICATE HOLDER CANCELLATION MIAMSHO SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Miami Shores Village Building Department AUTHORIZED REPRESENTATIVE 10050 NE 2nd Avenue Miami,FL 33138 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD 3/11/2015 Report Viewer 1O/1 � 100% 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: 2/13/2015 EXPIRATION DATE: 2/12/2017 PERSON: BENSAADON GAL FEIN: 472822448 BUSINESS NAME AND ADDRESS: RED DOOR CONSTRUCTION LLC 4044 PARK AVE MIAMI FL 33133 SCOPES OF BUSINESS OR TRADE: LICENSED GENERAL CONTRACTOR Pursuant to Chapter 440.0.5(14),F.S.,an officer of a carpwationwho sleds exemptlon from fids chapter by filing a cgflficate of etecflan order lttis section may rrot recover b�efils or campersatlon oder Ws cFept�.Pias�dto Chaot�440.05(7 ,F.5«CgY6eaies ofelec5an to ba exempt...appy mty witldn the scope of the bisiness or trade listed on fhe rrotice of ectlon to be ezgnpt inrsuardto Chapter 440.05(13),F.S.,Notices selection fo be exemptaM certiflce�s of election to be exempt shell ba suu�ed to revocetlon it at arty time after the fllirg dfhe reodce or the Issuance of the certlflcate,tte person rmrnetl on the notice or cerflficate no longe meeEs the regtdremeds dtids aectlan for Iasuarxe d a cergficate.The department shall revoke a cerflficete at DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUESTIONS?(850)413-1609 hVsJ/apls8.tldfs.com/crreportviewer/reportViewer.aspx?data=kdvpginc9D7Q3gH6TER6eP1 KMZ%2fSz5bXKYfBxkrekeESoPVylv4NPOPN42Xe!rDRGXVW... 1/2 SgoREs C.1932 Miami shores Village Asia , 11311 Building Department p 10 0 � 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Notice to Owner — Workers' Compensation Insurance Exemption Florida Law requires Workers' Compensation insurance coverage under Chapter 440 of the Florida Statutes. Fla. Stat. § 440.05 allows corporate officers in the construction industry to exempt themselves from this requirement for any construction project prior to obtaining a building permit. Pursuant to the Florida Division of Workers'Compensation Employer Facts Brochure: An employer in the construction industry who employs one or more part-time or full-time employees,including the owner,must obtain workers'compensation coverage. Corporate officers or members of a limited liability company (LLC) in the construction industry may elect to be exempt if: 1. The officer owns at least 10 percent of the stock of the corporation,or in the case of an LLC,a statement attesting to the minimum 10 percent ownership; 2. The officer is listed as an officer of the corporation in the records of the Florida Department of State,Division of Corporations;and 3. The corporation is registered and listed as active with the Florida Department of State,Division of Corporations. No more than three corporate officers per corporation or limited liability company members are allowed to be exempt. Construction exemptions are valid for a period of two years or until a voluntary revocation is filed or the exemption is revoked by the Division. Your contractor is requesting a permit under this workers'compensation exemption and has acknowledge that he or she will not use day labor,part-time employees or subcontractors for your project.The contractor has provided an affidavit stating that he or she will be the only person allowed to work on your project. In these circumstances,Miami Shores Village does not require verification of workers'compensation insurance coverage from the contractor's company for day labor,part-time employees or subcontractors. BY SIGNING BE W W YOU ACKNOEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. Signature: Owner � State of Florida County of Miami-Dade The foregoing was acknowledge before me this i�� day of ,20 ahy By , 4-�' ac who i personally known to a or has produced as identification. Notary: SEAL: K StI M MAMS r. MY CONNISSION i EE 15812 , +ih Balled Thm Novy ftk Undenxdars REDDOOR CONSTRUCTION Date: 5/18/15 State of r/o r, CL County of - 09A- Before me this day personally appeared ,lc-( &r»a G do,- who,being duly sworn, deposes and says: That he or she will be the only person working on the project located at: /ULA 9-S S Jac c ' Sworn to (or affirmed) and subscribed before me this day of ,20 `' , by BoA Qer)5gg6on Personally known V Or produced identification Type of ID produced Print, Type or Stamp Name of Notary R PAOPAOLA S.CONCEPCION MY COMMISSION#EES29487 EXPIRES:August 23,2016 HUD-1 OMB Approval No.2502-0265 4`tJ A. Settlement Statement (HUD-1) B.Type of Loan 0 1.FHA 0 2.RHS 0 3.Cone.Unfns. 6.File Number 7.Loan Number 8. Mortg.Ins.Case Num. 0 4.V.A. 0 5.Conv.Ins. 247171-3 2900788309 ID: C. NOTE:Tbis form is furnished to give you a statement of actual settlement costs. Amounts paid to and by the settlement agent are shown.Items marked•(P.o.c r were paid outside the closing;they are shown here for informational purposes and are not Included in the totals. D.NAME OF BORROWER: Alan G.Randolph,a single man Address of Borrower: 1659 SW 19 Street,Miami,Florida 33145 E.NAME OF SELLER: George Va8 and Ashley Vail,husband and wife Address of Seller. eJo 11098 Biscayne Blvd.,Suite 205,Miami,Florida 33161 F.NAME OF LENDER: U.S.Bank National Association Address of Lender: 16 Ninth Avenue North,Hopkins,Minnesota 55343 G.PROPERTY LOCATION: 325 NE 95 Street,Miami Shores,Florida 33138 H.SETTLEMENT AGENT: SUZANNE A.DOCKERTY,P.A. Address: 110 Merrick Way,Suite 3-B,Coral Gables,Florida 33134 Phone: Place of Settlement: 110 Merrick Way,Suite 3-B,Coral Gables,Florida 33134 1.SETTLEMENT DATE: 5/14/15 DISBURSEMENT DATE:5/14/15 'J.Summary of borrower's transaction K.Summary of seller's ira isiction rr rr .Grossamount due to seller: 101.Contrect salas price I 760,000:00 401.Contract sales price 760,000.00 102.Personal property I T4o2.Personal property 103.Settlement charges to borrower(Line 1400) 24,206.6114D3. 104. 1 1404. 105. 1 1405- Adjustments 106.City/town taxes 406.CityRown taxes 107.County taxes 407.County taxes 108.Assessments-Storm Water-Sanitatlan from 05/14/15 to 1: 477.04 408.Assessments-Stone Water-Sanitation from 05/14/15 to 1: 477.04 109. 409. 110. 410. 111. 411. 112. 141F 120.Gross amount due from borrower: 784,683.65 420.Gross amount due to seller: 760,477.04 rr r 1.reductions in amount due to seller: 201:Dep�it or eamest money 50,000.00 601.Excess deposit(see Instructions) 202.Principal amount of new loan(s) 608,000.00 502.Settlement charges to seller pine 1400) 6,500.00 203.Existing loan(s)taken subject to 503.Existing loan(s)taken subject to 204.Principal amount of second mortgage 504.Payoff of first mortgage loan 496,549.45 205. 505.Payoff of second mortgage loan 57,242.31 206. 506.Broker Comm.held from deposit 40,600.00 207. 507. 206.Principal amt of mortgage held by seller 508.Principal amt of mortgage hold by seller 209.Seller Credit Doc Stamp to Buyer 4,560.00 508.Seller Credit Doc Stamp to Buyer 4,560.00 209a. 609a Adjustments'or items unpaid by seller: Adjustments for items unpaid by seller: 210.CltyRown taxes 510.City/town taxes 211.County taxes from 01/01/15 to 05/14/15 3,131.55 511.County taxes from 01/01/15 to 05/14/15 3,131.55 212.Assessments 512.Assessments 213. 513. 214. 514. 215. 515. 216. 516. 217. 517. 218. 518. 219. 519. 220.Total paid by/for borrower. 665,691.55 520.Total reductions in amount due seller: 608,583.31 rr .rr .Cash at settlement tolfrom seller: 301.Gross amount due from borrower Akre 120) 784,683.65 601.Gross amount due to seller (fine 420) 760,477.04 $02.Less amount paid by/for the borrower (line 220) (665,691.55) 602.Less total reductions in amount due seller pine 520) (608,583.31) 303.Cash( Q From [;To )Borrower. 118,992.10 603.Cash( Q To ❑From )Seller. 151,893.73 The Public Reporting Burden for this collection of information is estimated at 35 minutes per response for collecting,reviewing,and reporting the data.This agency may not collect this Information,and you are not required to complete this form,unless it displays a currently valid OMB control number.No confidentiality is assured;this disclosure is mandatory.This is designed to provide the parties to a RESPA covered transaction with information during the settlement process. t3orrower's Ini I( � Seller's Initlal(s): DoubieTime® HUD-1 U.S.Department of Housing and Urban Development Page 2 700.Total Real Estete Broker Fees 546,600.00 Paid from Paid from Borrowers sellers Division of commission(One 700)as follows: Funds at Funds at 701.$22,800.00 to EWM Settlement Settlement 702.$22,800.00 to EWM 703.Commission paid at settlement 5.000.00 704.Amount retained from deposit held$40,600.00 EWM 705.Flat Fee Commisalon to EWM 250.00 250.00 706. to 800.It!MS Payabln in Conn-ectionwith Loan 801.Our origination charge $4,995.00(from GFE#1) 802 Your credit or charge(points)for the specific interest rate chosen ($10,828.48)(from GFE#2) 803.Your adjusted origination charges to U.S.Bank National Association (from GFE A) -833.48 804.Appraisal fee to Auris Appraisal from GFE#3) 440.00 POC(B)' 805.Credit report to See Addendum (from GFE#3) 250 POC(L)' 806.Tax service to U.S.Bancorp Svc Pro from GFE#3 80.00 807.Flood certification to U.S.Bancorp Svc Pro from GFE#3 18.00 808.Credit report to Broker to Credit Plus 16.61 809. to 810. to 811. to 812. to 813. to 900, "arns Reciumd bv I-ende,to Be Paid in Advance 901.Daily Interest charges from 05/14/15 to 06/01/15 ®78.1100 /day from GFE#10 1',405.98 902.Mortgage insurance premium for months to from GFE 03 903.Homeowners Insurance premium 1 years to Lexigton from GFE#11 Bo r r ower 3,183.79 904.Flood Insurance premium for 1 VWM to Lexigton 414.00 POC(B)' 905.Wind 1 veare to Ledgton 5954.00 POC(B)' 1001.Initial deposit for your escrow account from GFE#9) 6;437.93 1002.Homeowners Insurance 4 moths @ $265.32 per month$1,061.26 1003.Mortgage insurance months® Per month 1004.Property taxes 10 months @ $803.00 per month $8,030.00 1005.FloodiWind Insurance 4 months @ $530.67 per month $2,122.68 1006. months 0 per month 1007. months @ per month 1008• months® permorth 1009.Aggregate accounting adjustment ($4,776.03) rr 1101.Title services and lenders title insurance from GFE#4 1,273.28 1102.Settlement or closing fee to SUZANNE A.DOCKERTY,P..$500.00 1103.Owners title insurance to Old Republic Nat.TOIe/SUZANNE A.DOCKEF(trom GFE#5) 3,875.00 OF6-3876.00 1104.Lenders title Insurance to Old Republic Nat.TOIe/SUZANNE A.DOCKERTY $440.00 MF6-25.00;8.1-25;F9-390.00 1105.Lender's title policy limit$608,000.00 1106.Owners tole policy limit$760,000.00 1107.Agents portion of the total title insurance premium$3,020.50 to SUZANNE A.DOCKERTY,P.A. 1108.Underwriters portion of the total title Insurance premium$1,284.50 to Old Republic National Title Insurance Com 1109.Abstract or titre search to SUZANNE A.DOCKERTY,P.$250.00 1110. to 1111. Florida Title Surtax to SUZANNE A.DOCKERTY,P.$3.28 1112.Courier/Fed Ex Fee to SUZANNE A.DOCKERTY,P.$45.00 1113.Wire Fee to SUZANNEA.DOCKERTY,P.$3.5.00 1201.Government recording charges from GFE# 198.50 1202 peed$18.50 Mo e s $180.00 Releases$0.00 $198.50 1203.Transfer taxes (from GFE#8) 7,904.00 1204.City/CountytaWsfamps Dead$0.00 Mortgage(s)$1,216.00 1205.State tax/stamps Deed$4,560.00 Mortgage(s)$2,128.00 206. 1207. 1208. 1301.Required services that you can shop for from GFE#8) 1302.Survey to American Services of Miami,C 395.00 1303.Tax/Uen Search to Reliable Usn Search,Inc. 180.00 1304.Water and sewer Escrow to Suzanne A.Dockerly.PA Trust 250.00 1305.Attorney Fee to Christopher P.Kelley,P.A. 500. 6-0 1306. to 1307.Title Search 250/Wire 70 to SUZANNE A.DOCKERTY,RA 320.0 1308. to 1309. r (Enter on lines 103,Section J and 502,Section K) 24 206.61 6,500.0 *POC(B)=Paid outside of dosing by borrower **The exception rate option was used in this file *FOC(S)=Paid outside of dosing by seller r ars I sellers Irtd I a DoubleTime® SETTLEMENT CHARGES AND LOAN TERMS Page 3 Settlement Charges Our origination charge #801 $9,995.00 $91995.00 Your credit or charge(points)for the specific Interest rate chosen #802 $-10,828.48 $10,828.48 Your adjusted origination charges #803 $-833.48 $-833.48 Transfer taxes #1203 $8,667.00 $7,904.00 V-0110"POW00,00" MY Government recording charges It 1201 $250.00 $198.50 Appraisal tee #804 $500.00 $440.00 Credit report #805 $2.50 $2.50 Tax service #806 $80.00 $80.00 Flood certification If 807 $18.00 $18.00 Credit report to Broker #808 $.00 $18.61 This services and lender's title Insurance #1101 $2,150.00 $1,273.28 Owner's tide Insurance #1103 $3,875.00 $3,875.00 $6,875.50 $51905.89 �7969-61 or Initial deposit for your escrow account #1001 $7,218.00 $6,437.93 Dally interest charges from #901 $1,327.87 $1,405.96 Homeowner's Insurance premium for #803 $4,800.00 $3,183.79 Rood insurance premium for #904 $.00 $414.00 Wind #905 $.00 $5.954.00 Loan Terms Your Initial loan amount Is $608,000.00 Your loan term is 30.0000 years Your initial Interest rate is 4.625 % Your Initial monthly amount owed for principal,interest, $3,125.97 includes and any mortgage Insurance is IV Principal IV Interest r Mortgage Insurance Can your Interest rate rise? 0 No Q Yes ,it can rise to a maximum of .00%.The first change will be on and can change again every after .Every change date,your interest rate can Increase or decrease by .00%.Over the Ice of the loan,your Interest rate Is guaranteed to never be lower than .00%or higher than .00%. Even if you payments on time,can your loan No Q Yes ,it can rise to a maximum of$.00 ce Even If you make payments on time,can your monthly No Q Yes ,the first Increase can be on and the monthly amount amount owed for principal,Interest,and mortgage owed can rise to$ .00 Insurance rise? The maximum it can ever rise to is$.00 Does your loan have a prepayment penalty? 0 No O Yes ,your maximum prepayment penalty Is$.00 Does your loan have a balloon payment? 0 No Q Yes ,you have a balloon payment of$.00 due in years on 00!0010000 . Total monthly amount owed Including escrow O You do not have a monthly escrow payment for items,such as property account payments taxes and homeowner's Insurance.You must pay these items directly yourself. 9 You have an additional monthly escrow payment of$ 1,068.32 that results In a total initial monthly amount owed of$4,194.29 This includes principal,Interest,any mortgage insurance and any Items checked below: Property taxes I'Homeowner's insurance r Flood/Wind Insurance r r r Note:If you have any questions about the Settlement Charges and Loan Terms listed on this form,please contact your lender. Borrowers ln al eea s DoubleTimeO HUD-1 SETTLEMENT STATEMENT ADDENDUM File Number: 247171-3 1 have carefully reviewed the HUD-1 Settlement Statement and to the best of my knowledge and belief,it is a true and accurate statement of all receipts and disbursements made on my account or by me in this transaction. I further certify that 1 have received a copy of the HUD-1 Settlement Statement. w Borrowers) i-17 Raadolph Seller(s) �In eo Vail As ley Vail Settlement Agent The HUD-1 Settlement Statement which I have prepared is a true and accurate account of this transaction. I have caused or will cause the funds to be disbursed in accordance with this statement. SUZANNE A. DOCKERTY, F.A. By: — Date: WARNING:It is a crime to knowingly make false statements to the United States on this or any other similar form. Penalties upon conviction can include a fine and imprisonment. For details see: Title 18 U.S.Code Section 1001 and Section 1010. Double'nmes