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DS-15-492 I iv Dill - - ° 92 Miami Shores Village Pem*-;yp�. 1 tive'YYcl OMid@1Nt)�.�la � <y 10050 N.E.2nd Avenue NW *Cto tf0n.*A0dltir h4ftera1U,n Miami Shores,FL 33138-0000 �v ter° Phone: (305)795 2204 pem*Y, tus.APPROVED 0 1 .. 41112015 Expiration: /15/201 Project Address Parcel Number Applicant 82 NW 98 Street 1131010330230 NYCE DANIEL Miami Shores, FL 33150- Block: Lot: ) Owner Information Address Phone Cell NYCE DANIEL 82 NW 98 Street (786)517-7915 MIAMI SHORES FL 33150- 82 NW 98 Street MIAMI SHORES FL 33150- Contractor(s) Phone Cell Phone Valuation: $ 2,600.00 PRACTICALITY INC (954)628-4557 Total Sq Feet: 300 Approved:In Review Available Inspections: Comments: Inspection Type: Date Approved::In Review Final Date Denied: Foundation Type of Work:DRIVEWAY-REDO AND EXTEND CONCR Additional Info: Review Planning Bond Return: Classification:Resid Review Building Scanning:3 Fees Due jAmn Pa` Type Amt Paid Amt Due CCF h oiC DS-3-15-54987 DBPR Fee �� DCA Fee 04J..QP2015 Check*1098 $ 117.80 $0.00 Education Surcharge �,Permit Fee Scanning Fee Technology Fee Total: 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: I certify that all the foregoi formation is accurate and that all work will be done in compliance with all applicable laws regulating construction and oning. Fu hermore,1 authorize bove-named contractor to do the work stated. April 01, 2015 Authorized Signature:Owner / Applicant / Contractor / Agent Date Building Department Copy April 01,2015 1 �JIJ 3 (y Miami Shores Village cED Building Department BAR 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 BY:— Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(30S)762-4949 FBC 20 BUILDING Master Permit No. � PERMIT APPLICATION Sub Permit Nou��5 2- -11K UILDING -11KUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL [-]PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: / Flood Zone: BFOE':: FFE: 9 OWNER:Name(Fee Simple Titleholder): ' l t Phone#: !F� )-.5-1 ` /c �/ Address: City: State: Zip: Tenant/Lessee Naar Phone#: Y Email: i a e,1 q2 -� y, Cif e CONTRACTOR:Company Name: Practicality Inc Phone#: Address: 4921 NW 48 Ave City. Coconut Creek State: FI Zip: 33073 Qualifier Name: Yves Lubin Phone#: 954-369-8014 State Certification or Registration M Certificate of Competency#: CGC1508386 DESIGNER:Architect/Engineer: Phone#: Address: City: State: �*y�Zip: Value of Work for this Permit:$ 1 I0 Square/Linear Footage of Work: v V Type of Work: ❑ Addition ❑ Alteration New ^ ❑ Repair/Replace ❑ Demolition Description of Work: e — 40- Kms✓ Specify calor 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$ (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 absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. y Signature Signature } OWNER or AGENT —)77 CONTRACTOR The foregoing instrument was/acknowledged before me this The foregoing instrument was acknowledged before me this day of9'rt^� 20,� by �Z day of 20 by L/(�P rl/ S" who' rsonaIly known t 14,,:_;.s L L,16,, who is personally known to me or who has produced C as me or wh has produced ) as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: Sign Print: Print: L — ':,..�......o Seal: =o. ➢Gg4� Notary Public State of Florida Seal: '= MY COMMISSION#FF035074 Joanna M Feliciano' oma= My Commission FF 082753 ''•'.?Fo?.•'` EXPIRES July 10.2017 ;04 -.3 Expires 01/1212018 (4071398 0153 FloridallotaryService.com � O APPROVED BY3 �rPlans Examiner �'� �J Zoning Structural Review Clerk (Revised02/24/2014) Date CERTIFICATE OF LIABILITY INSURANCE 3/10/2015 Producer: Plymouth Insurance Agency This Certificate is issued as a matter of Information only and confers no 2739 U.S. Highway 19 N. rights upon the Certificate Holder. This Certificate does not amend,extend Holiday, FL 34691 or alter the coverage afforded by the policies below. (727) 938-5562 Insurers Affording Coverage NAIC# Insured: South East Personnel Leasing, Inc. &Subsidiaries Insurer A: Lion Insurance Company 11075 2739 U.S. Highway 19 N. Insurer B: Holiday, FL 34691 Insurer C: Insurer D: Insurer E: Coverages 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. Aggregate limits shown may have been reduced by paid claims. INSR ADDL Policy Effective Policy Expiration Limits LTR INSRD Type of Insurance Policy Number Date Date (MM/DD/YY) (MM/DD/YY) ENERAL LIABILITY Each Occurrence $ Commercial General Liability Damage to rented premises EA Claims Made 1:1 Occur occurrence) $ Mad Exp General aggregate limit applies per: Personal adv Injury Policy11Project 1:1LOC General Aggregate Products-Comp/Op Agg AUTOMOBILE LIABILITY Combined Single Limit (EA Accident) 8 Any Auto All Owned Autos Bodily Injury (Per Person) Scheduled Autos Hired Autos Bodily Injury Non-Owned Autos (Per Accident) Property Damage (Per Accident) EXCESS/UMBRELLA LIABILITY Each Occurrence Occur ❑Claims Made Aggregate Deductible A Workers Compensation and WC 71949 01/01/2015 01/01/2016 X WC Statu- OTH- Employers'Liability I tory Limits fl ER Any proprietor/partner/executive officer/member E.L.Each Accident $1,000,000 excluded? NO E.L.Disease-Ea Employee S1,000,000 If Yes,describe under special provisions below. E.L.Disease-Policy Limits $1,000,000 Other Lion Insurance Company is A.M.Best Company rated A-(Excellent). AMB#12616 Descriptions of Operations/Locations/Vehicles/Exclusions added by Endorsement/Speclal Provisions: Client ID: 92-68-943 Coverage only applies to active employee(s)of South East Personnel Leasing,Inc.&Subsidiaries that are leased to the following"Client Company": Practicality,Inc. Coverage only applies to injuries incurred by South East Personnel Leasing,Inc.&Subsidiaries active employee(s),while working in:FL. Coverage does not apply to statutory employee(s)or independent contractor(s)of the Client Company or any other entity. A list of the active employee(s)leased to the Client Company can be obtained by faxing a request to(727)937-2138 or by calling(727)938-5562. Project Name: ISSUE 03-10-15(TLD) Benin Data 11/3/2014 CERTIFICATE HOLDER CANCELLATION CITY OF MIAMI SHORES Should any of the above described policies be cancelled before the expiration date thereof,the Issuing Insurer will endeavor to mail 30 days written notice to the certificate holder named to the left,but failure to BUILDING DEPARTMENT do so shall impose no obligation or liability of any kind upon the insurer,its agents or representatives. 10050 NE 2ND AVE MIAMI SHORES, FL 33138 f Arlenis Silvera From: Hwang, Mary Ann <MaryAnn.Hwang@tylertech.com> Sent: Thursday, March 26, 2015 4:23 PM To: Arlenis Silvera Cc: Perkins, Larry Subject: Suspicious Transactions Report Good afternoon Arlene, I called you, but unfortunately could not get in touch with you so I left a message. Larry had found an upgraded report that does show the deleted records and who deleted it. We were able to load it and test it, finding the needed information from your call earlier today(deleted permit-DS-3-15-492). I have attached a screenshot below.The report was put into the upgrader, so all the computers with EnerGov should be able to pull the new report. If you have any questions,feel free to phone me or contact me via email. Have a good night. 323/2015 3123115 8:27 am asilvera Adjusted Permit Amount EL-3-15-54884 EL-3-15-635 SYS Int Adjustme 3,+23115 8:27 am asilvera Adjusted Permit Amount EL-3-15-54884 EL-3-15-635 SYS Irn Adjustme 33115 8:27 am asilvera Adjusted Permit Amount EL-3-15-54884 EL-3-15-635 SYS Int Adjustme :e,,Dl5 11:53 am ddac-wuicto Deleted Permk DS-3-15-492 RC-3-14-640 NOT REU TOTAL TRANSACTIONS FOR 0312321 Thank you kindly, Mary Ann Hwang Associate Software Support Analyst Tyler Technologies, Inc. P: 888.355.1093 ext. 763228 www.tylertech.com Mary Ann Hwang, HDI-CSR Associate Software Support Analyst Tyler Technologies, Inc. P: 888.355.1093 ext. 763228 www.tylertech.com Miami Shores Village Building Department artment 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel: (305)795.2204 Fax: (305)756.8972 '- --------- INSPECTION'S PHONE NUMBER:(305)762.4949 FBC 20 BUILDING Permit No. PERMIT APPLICATION Master Permit No.gC—*� Permit Type: BUILDING ROOFING JOB ADDRESS: 2�2 MW cla A 5i- City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: 6l-- :�1®I --®30,?— 0230 Is the Building Historically Designated:Yes NO Flood Zone: OWNER:Name(Fee Simple Titleholder): YG E Phone#: Address: ?2 N W City: 'M I A R I _ ® State: Fls4 Zip: Tenant/Lessee Name: Pho #: Email: CONTRACTOR: Company Name: r Phone#:1 — q 19—G(co 2 Address: 16V NVV 4cb A� y City: C®�I�ld State Zip: 3 3 0 1 3 Qualifier Name: YVEGI �_Vr__7`rll Phone#:1 State Certification or Registration#61�st e°"15,0 (b Certificate of Competency#: Contact Phone#: Email Address: DESIGNER:Architect/Engineer: WA I— AI—I h? Phone#: 79�111— 3702 —0 Value of Work for this Permit: ' Square/Linear Footage of Work: 314 Type of Work: ❑Addition .Alteration. ONew ORepair/Replace ❑Demolition Description of Work: �1•I fill' EX i�T Ct � IIT® aEl� l�' Color thru tile: Submittal Fee$ a00 Permit Fee$ CCF$ CO/CC$^��� ° Scanning Fee$` ,I Radon Fee$ 9 DBPR$Cl •�I ® Bond$ 'I"DW• C2 U Notary$ Training/Education Fee$ 4 . I 0 Technology Fee$ ` Double Fee$ Structural Review$ d()0 1Ez •®0 TOTAL FEE NOW DUE$ ° 112, CS _ 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 ELECTRICAL WORK,PLUMBING, SIGNS, WELLS,POOLS,FURNACES,BOILERS,HEATERS,TANKS and 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 a Signature Owner or Agent Contractor The foregoing instrument was,acknowledged before me this`� The forego' instru ent was acknowledged before me this dayof,& ,201 by eftL`�e� �' �®/'�� day of Z 0�Gby�uL� �u4r who is personally known to me or who has produced who is personally known to m'a or who has produced As identification and who did take an oath. as identification and who did take an oath. NOTARY P LIC: NOTARY PUBLIC: Sign: Sign: C — E�=Aj Print: N a Print: Jnr o ki L(— etie G Dolce �;. My Commission o My Commission EE 166357 My Co °s n �OMMISSION#FF035074 E><pires02/08/2018 sgpo: `''••�orp�o„ EXPIRES July 10.2017 (407)398-0153 FloridallotaryServicexom �YaY4:�•k4r4e4c9F9F�Y�Y k Y9:k4e9e9e�4:4ek�Y4r�Y��9e�3:���4e koY�&��YoY�eF�Y4eeF4:kk4:3:9Yk�Y4r*�YYe�Y�4:4:�Y�&�4e4r4e*4:aY�Ykk�Yde�Y9ek4r��Y k�k�aY•3e4eksf�otoYoY�devY9e4:�Y9F kkkat• ( lL APPROVED BY ` / Plans Examiner l Zoning Structural Review Clerk (Revised 5/2/2012X Revised 3/12/2012)XRevised 06/10/2009)(Revised 3/15/09)(Revised 7/10/2007) i r STATE OF FLORIDA s DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING. BOARD (850)487-1395 WE 1 4101940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 LUBIN,YVES PRACTICALITY INC 4921 NW 48TH AVE COCONUT CREEK FL 33073 Conte Ott,tiriofn,�-nly one million Floridians licensed by the Department of Business and Professional Regulation. Our professionals and businesses rangeSTATE�F fLOR= from architects to yacht brokers,from boxers to barbeque restaurants, - - - "SI SS AND and they keep Florida's economy strong. t01= _ 1A710i�i. Every day we work to improve the way we do business in order to6ca5tT8386 _ 5i21:f2014 serve you better. For information about our services,please log onto r. - www.myfloridaHcense.com. There you can find more Information about our divisions and the regulations that impact you,subscribe131Ef? to department newsletters and learn more about the Departments 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, hS.€ERTIFPfL) Inrdea` he pro0sians df X4A9-F8. and congratulations on your new license! "< r a :"ate.3 tare:. 4 p DETACH HERE RICK SCOTT,GOVERNOR KEN LAWSON,SECRETARY $T'�l`TE'OF"fCOR1!DA- PA 1�IENT�OE B[?Sf{ ESS NN4:1 CEIE:R �O�►L�ICsULkTtON ��t91�3�12Y I SENERAI=CONI CTORt _ Naia�'eelow7S C€RT1FIff)* Cde tlae µ • _ ,n,+„I--- AI M.I MIIAI M100I AV AC OC/111101=n QV 1 AIA/ Qr-n* I iAnr,91Mnn91d BRUYVAIKUMUNifily 115 S. Andrews Ave., Rm. A-100, Ft. Lauderdale, FL 33301-1895—954-831-4000 VALID OCTOBER 1,2014 THROUGH SEPTEMBER 30,2015 'a -180-6107 DBA: Receipt#.GENERAL CONTRACTOR (GENERA PRACTICALITY INC Business Type:CONTRACTOR) Business Name: Owner Name:LUBIN YVES Business Opened:0 2/14/2 0 0 5 Business Location:4921 NW 48 AVE State/County/Cert(Reg:CGC1508386 Mr COCONUT CREEK Exemption Code: Business Phone:954-725-9203 �7 t Rooms Seats Employees Machines Professionals ;r 2 for Vending Business Only din , I ' Number of Machines: Ven9 Tyam' Tax Amount Transfer Fee NSF Fee PeOaitx = _ Prior Years, Collection Cost Total Paid 27.00 0.00 y.r 4 0 0 .Ori? - 000 0.00 27.00 THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS THIS BECOMES A TAX RECEIPT This tax,is levied for the privilege of doing business within Broward County and is non-regulatory in nature.You must meet all County and/or Municipality planning and zoning requirements. This Business Tax Receipt must be transferred when `a WHEN VALIDATED the business is sold, business name has changed or you have moved the k; business location.This receipt does not indicate that the business is legal or that it is in compliance with State or local laws and regulations. Mailing Address: Receipt #13B-13-00008912 PRACTICALITY INC Paid 07/14/2014 27.00 r 4921 NW 48 AVE COCONUT CRK, FL 33073 N 2014 - 2015 ;. 1013012014 16:16 9549560555 COVER ALL INSURANCE PAGE 01101 • DATE(MIIDDIYYYY) .�v CERTIFICATE 4F LIABILITY INSURANCE 11029014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE BOLDER.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 cartiflcate holder is an ADDITIONAL INSURED,the poncy(les)must be endorsed. If SUBROGATION IS WAIVED.subject to the terns and Conditions of the policy,certain policies may require an andoreament.A statement on this certificate does not confer rights to the certificate holder in lieu of such andomemmns. PRODUCER CONTACT MA- REEL INSURANCE AGENCY E54 956-0006 L=ax 956-0555 D/BIA1 COVER ALL INSURANCE "WL REEUNSURANC YAHOO.COM $800 W.ATLANTIC BLVD. INSYSOM AFROODING 00"at CS MARGATE FL 33063 • FEDERATED NATIONAL INSURANCE CO. 10790 INSURED PRACTICALITY,INC. 4921 NW 48TH AVENUE INSU INSURN I, COCONUT CREEK FL 33073.4939 COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TE=RMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INGR TYPE OF INSURANCE O SU PO CY EFF POLICY NxPLTR POLICY IJMITS GENERAL W OCCURR NCE 1 O00 OOO A X COMMERCIAL,GENERAL.L(A LITY DAMAGE TO RENTED 5100,000 CLAMW-MADE a]OCCUR GL40504412681.00 1011912014 10119015 Exp rAm go awagnis5,000 PORWHAL a ADV INJURY 1000 0000 GENERAL s2,00000 OEN'LAGGREGAT'E LIMIT APPLIES PER: FRom .COMPtO Are s2,000,600 POLICYPR0. LOC S AUTOMOBILE LIABILITY W!E ED SINGLE LIMIT ANY AUTO BODILY IN IURY(Per Posen) S ALL OWNED SCHEDULED BODILY INJURY(per acuiddM) S HIRED AUTOS AUTOSAUTOS NON-OWNED PROPERTY DAm%0r- S UMBRELLA LIAGOCCUR FI CCUR E "CMUM HOLAIM% ADE AGGREGATE 5 S WORKERS COMPENSATION WC STATU- OTH AND EMPLOYERS'LIABILITY WFICCF_R erEIA BERR E)CL DE� NIA EL EACH (DENT 9 (M8n"ffl71n NH) L DISEA •EA O E H Aestflbe ur�dar E L DISEASE-POLICY Lima s DESOWTION OF OPERATIONS I LOCATmNS I VEHICLES(Attach ACORD 901,AdeDUanW Rq.i+arke$cmdwla,if nwm spate Is nnwmd) REMODELING-CARPENTRY,ELECTRICAL,PAINTING,DRYWALL,&PLUMBING,DEBRIS REMOVAL,AIR CONDITIONING&HEATING SYSTEMS CERTIFICATE HOLDER CANCEW770N MIAMI SHORES VILLAGE BUILDING DEPT SHOULD ANY OF»A80VW DESCRIOW1 LICIES BE CANCELED BEFORE THE EXPIRATIO TE THEREOF. WILL BE DELIVERED IN 10050 HE 2ND AVE ACCORDANCE WI E POLICY PROVI910 y MIAMI SHORES VILLAGE,FL 33138 f AUTHORED RE FAX11305-7588972 ®1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD : 01-15-2013 J JEFF ATWATER STATE OF FLORIDA CHIEF FNdANCIALOFFICER DEPARTMENT OF FINANCIAL SERVICESDIVISION OF'WORKERS' COMPENSA71ON CERTIFICATE (IF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW r CONSTRUCTION 4NDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law. EFFECTIVE DATE: 03/09/2013 EXPIRATION DATE: 03/09/2015 0 PERSON: LUBIN Y VES FEIN: 650790787 I BUSINESS NAME AND ADDRESS: : PRACTICALITY INC 4921 NW 48 AVE F COCONUT CREEK FL 33073 i SCOPES OF BUSINESS OR TRADE: f- ROOFING.- ALL KINDS AND DRIVER 2- ELECTRICAL WIRING WITHIN BUIL i 3- PI,.l111tBING NOC AND DRIVERS 4- LICENSED GENERAL CONTRACTOR Im pairrAmT, pwsaant to Chapter"a . ailm. F.s., as officer of a eorpoistloa wba areets exemption fraal this chapter by filing a cartlficata of emetdde ander this ' sacttan may nat recover benefits or compensation coder this chapter. pdrseaot to chapter "mast14f. F.s.. Certificates of etedfon to he exempt-. apply only witbin the scope of the buafaesn or trade slated on the notice of election to be exempt, Pursuent'ta Chapter 440.05{13}, 17.8., Notices of election to be exempt and aerttflwtas of ' eleufan io be exempt shatl be sabim to t'tvocatimt it, at.say time after ibe fnrng of the notice or the issuance Of the'eertmaete, Me Perna named on the notfca ar jcertificata an Imager.Monts the nagarremeots of mis section for lesuaace of!a certificate. The depariment saau reaom is ceit,Yfcate at any time for failure of rbc persue inamed on the certificate. to meet Me raquiremeafa of this section. QUE5CI0N57 {$60} 413-1 OWC•-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01-11 PLEASE CUT OUT THE CARD $ELOW AND RETAIN FOR FUTURE REFERENCE STATE FLORIDA O'FFINAN MSERVICES IMPORTANT j DIVISION OF DEPARTMENT COMil WSATION F ftswmt to Chapter 4400504), F.S., an officer of a corporation who CONSTRUCTION INDLISTRY Q elects exemption from'this Chapter by filing a certificate of election i CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDAL under this section may not reoover benefits or compensation under this I WOFOUN ts-COMPENSATION LAW 0 D Chapter. I EFMCTIVE 03/09/2013 EXPIRATION DATE: 03/48/2015 Pursuani to Chapter 441L0511Z, F.S., Certificates of election to be PERsom. YVES LI18IN H exempt apply only within the scope of the business Or trade listed on FEIN: 1150790737 E the notice of election to be'exempt R BUSINESS NAME AND ADDRESS: E Pursuant to Chapter 440.05113}, RS., Notices of election to be oxempt PRACTICALITY INC and Certificates of election to to exempt shall be subject to revoeaflon 4921 NW 48 AVE if, at any time after the filing of the notice or the issuance of the COCONUT CREEK, IL 33073 certificate, the person named on the notice or certificate no longer maul the requirements of this section for issuance of a certificate. The department shall revoke a Certificate at any time for failure of the SCOPE OF BUSINE=SS OR TRADES persco named an the cerdfime to meet the requirements of this I- ROOFING - ALL KINDS AND UFOVOft 2- FJACTRICAL WIRING WHIN NUIL Suwon, 3- PLWON41 NOC AND DRMM 4- LIC08GD OE!M AL CONTRACTOR aUESTI�lS? 1$50) 413-1609 CUT HERE Carry bottom portion on the job, keep upper portion for your records. I DWc-262 CERTIFICATE OF ELECTION TO 6E EXEMPT REVISED 01-111 n AW M..,. Miami shores Village Building Department R 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.In these circumstances,Miami Shores Village does not require verification of workers' compensation insurance coverage from the contractor's company. Therefore,you may be personally liable for the worker compensation injuries of anYperson allowed to work under this permit Please check with your insurance carrier since most property insurance policies DO NOT cover this type of liability. BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. Owner Contractor f Print Name: Print Name: v�S Signature: Signature: State of Florida) State of Florida) County of Miami-Dade) County of Miami-Dade) Sworn to and s b c 'bed before me this Sworn to and subscribed before me this�_ day o :of4 R I, Notary Public State or Florida day of_ /W�/ ,20 . By _ e olce 7 EE 165-457 By Expires op Type of Identification produced Type fAffethfje ti p u e EXPIRES July 10.2017 (407)388.0183 FldridallotaryService.com Miami Shores Village TW 7 Building Department 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 NOV 1 014 I Tel: (305)795.2204 Fax: (305)756.8972 INSPECTION'S PHONE NUMBER: (305)762.4949 ��° FBC 20 r� BUILDING Permit No. 9C /L _ � 7 PERMIT APPLICATION Master Permit No. &- 42Vqf_ Permit Type: PLUMBING JOB ADDRESS: 8 2 N W 9 29 M ST City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: ►I- ;!7t®I - O 3 ' 02,-�)® Is the Building Historically Designated:Yes NO Flood Zone: OWNER:Name(Fee Simple Titleholder): N f(E 9A i-4 I Et- Phone#: 1 tac®-511 - -1!1 �a Address: D 2 �4 W q 9 TD4 4,1_ City: K l &Wt I - 5 F+O RES State: + Zip: Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: f Tl GA L I fae _ P ne#: 72-1co 011 2 5(0 2 Address: 21 r4 vi %/F City: 00490 I,TState: Zip: ?�1 Qualifier Name: \IhU Phone#: State Certification or Registration#: G 2 3 2 Certificate of Competency#: Contact Phone#: (O® ,,Eiitil Address: DESIGNER:Architect/Engineer: IL-1 l GHAl✓'Ir A 1-111?'Js, Phone#:J�- '50 2- D 12� Value of Work for this Permit: $ © 0 Square/Linear Footage of Work: Type of Work: ❑Address Alteration ONew '•LlRepair/Replace- " ODemolition Description of Work: Cwt YW T Submittal Fee$ Permit Fee$ 3C04¢ CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Bond$ Notary$ Training/Education Fee$ Technology Fee$ Double Fee$ Structural Review$ TOTAL FEE NOW DUE$ zr G• C� 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 ELECTRICAL WORK,PLUMBING, SIGNS, WELLS,POOLS,FURNACES,BOILERS,HEATERS,TANKS and 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 X- Signature Owner or Agent Contractor The foregoing instrument was acknowledged before me thisZ - The foregoing instrument was acknowledged before me this 2 day of 41-,or—e i(,20 ,by .GG-e— 6! 4�®/e—Pte, day of �. ,20�,by VL,VL,,,. who is personally known to me or who has produced who is personally known to me or who has produced As identification and who did take an oath. as identification and who did take an oath. NOTARY P NOTARY PUBLIC: Sign: Sign: 1' Print: — Print: Il_ ManeIGDolce :i;' 4': MY13TELLE PERRAULT My Commission for CEE 165357 My Co 5 p es. Expir016 =�.. aQY COMMISSION#FF035074 ''•'Eo:ctiq°•'' EXPIRES JuIY 10.2017 (407)398-0153 FlpridallotarrService.co 3:�9e9nY9ek��k**k���4e9e4ekknYkkoYkkkdeeYeY9e7r9eataY�kk�Y4toY9roY4e�F4e9ek�F,kkaY����Y�Fde�Y�4e9e�Yk3:kk4e4eoYoYo'e4ede:k4ek*aYot� k4roF9e��oY APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised3/12/2012XRevised 07/10/07)(Revised 06/10/2009XRevised 3/15/09) I STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487-1395 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 LUBIN,YVES PRACTICALITY, INC 4921 NW 48TH AVE COCONUT CREEK FL 33073 - on zfnsf-With this-NCO�eyou-iueeame oneof fbe-nearly one million Floridians licensed by the Department of Business and Professional Regulation. Our professionals and businesses ranges -_STAT.E OF-F:L0,RfDA from architects to yacht brokers,from boxers to barbeque restaurants, �3EPAfiA B#;I: kl1tESS and D- and they keep Florida's economy strong. TIf3N Every day we work to improve the way we do business in order to CFG1�428_i24 `241/2014 serve you better. For information about our services,please log onto vrww myfloridalicense.com. There you can find more information about our divisions and the regulations that impact you,subscribe LlfB1N, to departmerd newsletters and learn more about the Department's DRAG CA- 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 C�R;F1F,JED. i-er-tire FS.: and congratulations on your new license! auo�le2°'s �rao�aio�eso DETACH HERE RICK SCOTT,GOVERNOR KEN LAWSON,SECRETARY E.. . .. DEPkR flYFE OF B1iSf�ES$�kND PRDFI SStO�At REGUi::iATI®i�l CONfR ILlCE1Sfl413E� - ,RC1�Afl _CON"RAC tidia�isrons of Ca{�ter SFS - POO\ . •wAle.l�. AG MAIAIAI n1co1 ev AC RGC1111RFrl RV 1 AW SED# L1405210000890 - BROWARD e _ li --111=460 r 115 S. Andrews Ave., Rm. A-100, Ft. Lauderdale, FL 33301-1895—954-831-4000 VALID OCTOBER 1,2014 THROUGH SEPTEMBER 30,2015 DBA: Receipt#:PLU-238LWN SPRNKL/CONTRA OR 90 Business Name:PRACTICALITY INC Business Type: Owner Name:YvEs LUBIN Business Opened:12/30/2010 Business Location:4921 NW 48 AVENUE State/County/Cert/Reg:CFC1428324 COCONUT CREEK Exemption Code: Business Phone:9 5 4-3 6 9-8 0 14, I` Rooms Seats �� Frriplo5ees Machines Professionals_ y„ f For Vending Business Only Number of Machines: j Vending Type: Tax Amount Transfer Fee NSF Fee._ F01° Penalty Prior Years__ Collection Cost Total Paid 27.00 0.00 0.00 27.00 THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS THIS BECOMES A TAX RECEIPT This tax''is levied for the privilege of doing business within Broward County and is F non-regulatory in nature.You must meet all County and/or.Municipality planning WHEN VALIDATED and zoning requirements.This Business Tax Receipt must be transferred when the business is sold, business name has changed or you have moved the business location.This receipt does not indicate that the business is legal or that it is in compliance with State or local laws and regulations. Mailing Address: PRACTICALITY INC Receipt #13B-13-00008912 4921 NW 48 AVENUE Paid 07/14/2014 27.00 COCONUT CREEK, FL 33073 i 2014 2015 ' A Miami Shores Village Building Department AUG 5 2015 g p 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 BY Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 20t 14 BUILDING Master Permit No.M 1 Z(9,G PERMIT APPLICATION Sub Permit No. VU ILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 5J_'03 /V, v<_ City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: / 7 ®b— 6 13 — 3�/Z® Is the Building Historically Designated:Yes NO Occu anc T e: �1 p UNR_"Flo d7Z p y yp [� Load: � Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): ✓f� LC t_ Phone#: Address: /e/D® 7-e l9ile City: x/.10'a,- State: Zip: J'W'y Tenant/Lessee Name: .Sro6 C 0c, k l Phone#: ,-6 Email: C(rv9/Oie I C ,�/o/fiN We,j 7e.,y e v� CONTRACTOR:Company Name: &6 t C tam Phone#: %J` " //�� -- Address: U o Ora"c J, 0v O �I� City: LAA)71( CIAP1 State: Zip: SY 6 7 Qualifier Name: .;Q4Pje,,, ye phone#: State Certification or Registration#: C 6r C O .5" 2 - 'r 0 Certificate of Competency M DESIGNER:Architect/Engineer: Aw Phone#: Address: -7-2® 0 if": qqr-eJJ jyC J City: State:_'�-c Zip: Value of Work for this Permit:$ �3��®� o n Square/Linear Footage of Work: 2 S 6 O $� Type of Work: El Addition L�Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: 46 Jd'5�e'oca., a ?c 00'-2"/3� e- �I��CC Specify color of color thru tile: Submittal Fee$Z0 0;�) Permit Fee$ CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ C) •CO Bond$ TOTAL FEE NOW DUE$ (Revised02/24/2014) s 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 comme7 Jere t and construction lien law brochure will be delivered to the person whose property is subject to attachment-A-1-so,a certified e�¢p�f c�f� recorded notice of commencement must be posted at the job site for the fifsi fnspection which occurs seven t ays after th"b i' permit is issued. In the absence of such posted notice, the insp ion will not be ved a reinspection e will be cha qj� Signature ° Signatu L,4� � OVER or AG CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of 20 by day ofAQ(ZQa� 20 1�9 by who is personally known to —who is personally known to me or who has produced as me or who has produced F u�t Vzz identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: Sign: Print: 1 97 Print: Seal: ';go. ..~ EXPIRES August 12,2019 i(407)3984)159 Pwrldallotary3ervlce.com Seal: ;o�ogrvie� Notary PutNic Stets of Florida Sindia Alvarez v MY Commission FF 150790 o,pd'@ Expires 00 APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) PAGE CONTRACTING, LLC 6060 Branchwood Drive Lake Worth,FL 33647 December 10, 2015 Miami Shores Village 10050 NE 2nd Avenue Miami Shores, FL 33138 ® � p W5 RE: PERMIT#CC-8-15-2186 , I 9503 NE 2nd Avenue n SAGE DENTAL To whom it may concern, Page Contracting submitted plans on August 25, 2015 for an interior build out of Sage Dental at the above referenced address.At this time,the Tenant has decided not to move forward with this project. We hereby request that this Permit Application be voided out in order to allow the Landlord to pursue permits in this space for other Tenants. Thank you in advance for your consideration. Sincerely An 6� d " ,�►' ephen age IZJZ.gIS- Q{ To 5wF4-4c- wuA-r,-%- U4 w to A+n Phone:954.868.4561 �2�12,31+ 1'1�- ib C4-Jr- . License Number Fax:561.370.6378 wrl ( ..r CGC057540 spage@pagecontracting.biz S ` G..a•�� HERTA HOLLY 114C IY32 y, • MAYOR JESSE WALTERS it71 a tnA y Or/VJ^J t llillaqle VICE MAYOR fltltM L {/�GG HUNT DAMS 10050 N.E.SECOND AVENUE COUNCILMAN 00 R1t� MtAMI SHORES,FLORIDA 33138-2382 Jim MccOY �l�V1r'�► TELEPHONE(305)795-2207 COUNCILMAN FAX(305)756-8972 IVONNE LEDESMA COUNCILWOMAN ` TOM BENTON L VILLAGE MANAGER _ SARSARA ESTER, MMC VILLAGE CLERK RICHARD SARAFAN January 8,2014N d15 VILLAGE ATTORNEY i To Whom It May Concern: Re: 9501—9545 N.E.2"6 Avenue Miami Shores Village Please be advised that this block of commercial businesses fronting N.E.2"a Avenue,from N.E.95th Street north to N.E.96th Street,was formerly occupied by the following businesses and corresponds to the plan of existing spaces: A) Mooles Ice Cream/Sandwich Shop B) The Flower Bar C) Primal Fit D) Miss Jane's Music Studio E) Parkshore Pharmacy F) Tri-Village Realty G) Strategic Health Development Please note that I do not have a record of the square footage for each individual business previously occupying the building and due to extensive renovations at the subject location,that data is unavailable. I 1 if you require any additional information,please do not hesitate to contact me and I will do everything I can to assist. I Sincerely, P Barbara A.Estep, MMC Village Clerk i I I