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WS-06-2041 Miami Shores Villa �� Village � f' g FEB 17 2016 r Building Department BY: 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 Is-CIA FBC20o� BUILDING Master Permit No. l—C,(iJi — a04 PERMIT APPLICATION Sub Permit No. ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION [:]RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF CANCELLATION ❑ SHOP s-5 0a *� ,�1 1�, CONTRACTOR DRAWINGS JOB ADDRESS: �� 14`� yv E �� V'71�� City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: t Building Historically Designated:Yes NO Occupancy Type: Load: Constructio ype: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): a RQl soon Phone#: —� o'_ Address: SGl i1r'1 S cx V Ci ty: State: Zip: 1 . Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name: ,done#: Address: City: State: Zip: Qualifier Name: one#: 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 ❑ Repair/Replace ❑ Demolition Description of Work: C 'OA ct I �e.('rvl I + 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$ (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$2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also,a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature Signature OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of ,�,�� '20 16 by day of ,20 by --�--Fs P ( 1i(`is personally known to who is personally known to me or who has produced tlL— --h'P1\- a— (°JE rJ me or who has produced as identification and who did take an oath. identification and who did take an oath. NOTARY P BL C: NOTARY PUBLIC: ti Sign Sign: Print: � �`�1C°� ��c -� Print: Seal: Seal: e� Notary Public State of Florida Sindia Alvarez My Commission FF 156750 Bpp�`O Expires 09/03/2018 �k�k�k4�k#�k�kak�k�k�k�kN � �k�k�k#�k�k#�k�k�k�k�k�k$o*N��Rb�k�ka►M�M�4�k#�k##�k&�k�k#�k�k�k•�k�k#�k�k�k�k�k�k�k#y,tk 9tN��k�k�k M��k�k�k APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) FEB 17 Q16 byi .1�. February 17,2016 Miami Shores Village Building Department 10050 NE 2 Ave Miami Shores,FL 33138 Dear Building Department, Please be advised that Permit#WS-8-06-2041 should be canceled. Sincerely, Wade Patterson 8927 NE 4P Ave Rd Miami Shores FL 33138 Page 2 of 5 02/16/2016 https://edocs.ncl.com/edoes/edoc.aspx 2/16/2016 Miamir Sho es Village Building Department 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel: (305)795.2204 Fax:(305)756.8972 BUILDING1'!�OM"VMMaster Permit No.PERMIT APPLICATION AN ® � �� Permit No. FBC 2004 Permit Type(circle):(;;) circle): Building 1 ,t Electrical Plumbing Mechanical Roofing Owner's Name(Fee Simple Titleholder) W ade ?CL'�'""I-er%Ofd Phone# 300 wner's 0Owner's Address l,Z� /V G erL4* A-y e P.d City_A!G M L 5 6 rA State F7L— Zip 3 313, Tenant/I.essee Name Phone# Job Address(where the work is being done) 4f'Ay e City Miami Shores Village County Miami-Dade Zip 33 1'J FOLIO/PARCEL# Is Building Historically Designated YES NO >< Contractor's Company Name 5Gi-P ow Phone# Contractor's Address CityState Zip Qualifier Name ode, State Certificate or Registration No. Certificate ozeteiy No. Architect/Engineer's Name(if applicable) Phone# Value of Work For this Permit$ low Square/Linear Footage Of Work.- Type ork:Type of Work: ❑Addition ❑Alteration ew ❑ Repair/Replace ❑Demolition Describe Work:I(�S`�A l110 A rF Z G F —t-(kCI< �0rf t CG 11 e— $hd-tm , tn,x acs Pa neLs Submittal Fee$ Permit Fee$ 120•OCI CCF$ . 6�0 CO/CC Notary$ S.Q0 Training/Education Fee$ 710 Technology Fee$ Scanning$ (p•yU Radon$ DPBR$ Zoning$ Bond$ Code Enforcement$ Double Fee$ Structural Review.$ Total Fee Now Due$ ::Al I/c See Reverse side-� i Bonding Company's Name(if applicable) Bonding Company's Address r 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 Signature Owner or Agent �r Contractor The foregoing instrument was (Das acknowledged before me this 1 ` The foregoing instrument was acknowledged before me this day of:11 2000by day of_ .20__,by , who is personall known to me or who has produced who is personally known to me or who has produced identification and who did take an oath. as identification and who did take an oath. NO"TAR; NC)TARY PUBLIC: SignSign: Pru► Print: My My Commission Expires: &vtr atat+t irir9rArdr 4eatat 3ret4r 9eatr4&at et9e4eatat 4e atatr4r9r4e 9r vt 9eet 4rat4r3e 9cut&atntatat43r 9i at*,rir*.tat et at4r at&at ate acvt�ea'ift 9i 4nt 4r statat APPLICATION APPROVED BY: 9717o Plans Examiner Engineer Zoning (Revised 02/08/00 Miami Shores Village - c Building Department APR 2 4 201 A10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel: (305)795.2204 Fax: (305)756.8972 By: INSPECTION'S PHONE NUMBER:(305)762.4949 FBC 20 BUILDING Permit No. PERMIT APPLICATIONAmsten Permit No.(o S A/ CANmEo Permit Type: BUILDING ROOFING JOB ADDRESS: A/W ( o S Tt^ S1 City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated:Yes / NO Flood Zone: OWNER:Name(Fee Simple Titleholder): CA? 6i241&i`7 Phone#: 3®5i -779 � ) � Address: I Z ®t ea F>1% CAsj,,_r City: /4-14": State: Zip: 3 3 t Tenant/Lessee Name: Al fi4 Phone#: Email: A'1A CONTRACTOR: Company Name: CAE a�'r�i,' , Phone#: D 5� -7 7 3 2" > Address: 2 bta c� i S mid,,, —ir City: State: Zip: 733)'91 Qualifier Name: X4(A"e2 Cry Phone#: `�L S_ 7 7 3 3)� State Certification or Registration#: Certificate of Competency#: Contact Phone#: Email Address: V a 2 99 C/f PC,a--,per Qom,,,'. DESIGNER:Archite t/Engineer: e✓��. M mL�A- Phone#: S 0 Z-7!El 2�� Value of Work for this Permit: $ Square/Linear Footage of Work: 1 f T--, Type of Work: ❑Addition ❑Alteration ❑New Aepair/Replace ❑Demolition Description of Work: nn, Color thru die.- Submittal ile.Submittal Fee$ r6 Permit Fee$ CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Bond$ Notary$ Training/Education Fee$ Technology Fee$ Double Fee$ Structural Review$ TOTAL FEE NOW DUE$ �C� Bonding Company's Name(if applicable) tk • Bonding Company's Address City State Zip Mortgage Lender's Name(if applicable) Mortgage Lender's Address �j y City State Zip Application is hereby made to obtain a permit to do,Pe work apo ulst9ffiftons as indicated. I certify that no work or installation has commenced prior to the issuance of a permit 16" d. A worlE�vvi-# bei performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that zte peinnt 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 Signature caner or Agent Contractor The foregoing instrument was acknowledged before me thi� The foregoing instrument was acknowledged before me thi�� day of/ ,20 ,by Tom/' I�o(C��/, �/�day of ,�1�-Q 4 by Kq whhoo is personally known to me or who has produced 3�e jLt/ who is personally known to me or who has produced q y 3�F As identification and who did take an oath. ��j Q: 6 e5 as identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign Sign: �27 P Prin My Commissionue "" q Btu oft®I F'>orma My Commission Expires: Mg M F01daim sxeca of Ronda BARIA�1®R f ®s2ts3 1 F-I 109l14i® M FSA OBV53 APPROVED BY L� Plans Examiner Zomig Structural Review Clerk (Revised 5/2/2012)(Revised 3/12/2012))(Revised 06/10/2009)(Revised 3/15/09)(Revised 7/10/2007) 08/16/2013 11:00 2396747324 STATEWIDE INSLRANCE PAGE 08/15 CERTIFICATE OF LIABILITY INSURANCE1 081162013 ""www"" THIS CERTIFICATE 18 ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, WaEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CON13MM A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:H the cartllicate holder Is an ADDRWM INSURED,the polcy(im)mwt be endorsed.It SUBROGATION WANED,subject to the corms and Conditions of the poley,CErtatn P011 may require an endorsemeft A 9totneat on this cert does not Co., r rights to the Cartiflcate holier In leu otsuah endorspine a. PRODUCER YuleldvAlonso Statewide Insumce Market 033 s $�9�37.8A44 n, 239437.8444 bce�Ir�ma . _- atForrolNacove�I:ase TM awca Fort Mysrs FL 33912 A; ESSEOX INSURANCE COMPANY ^ msulum 6 GENERAL IMPACT GLASS&VYINDOWS,CORP. J maurERC,s 290 West 78th Road INm mn o: INSIRER tr: Hialeah FL =74- mom R s COVERAGES LERIIFICATB 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 THUS 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 R6DUC1?D BY PAID CLAIMS, M. TYP6OR msURANes anPOLICY NU P t� LlA1tr8 OENEM UAbn.rY eAeH oOOURRHNCB s 1,000,000 P$2,51XIDEDUCTIBLE MIMAL C�SNWAL LIAMUTY PRM see eau res mens s 60,000.00 ouuMSAIAD6 ❑OCCUR MED 0P(Arsy seat prion) s 6,000.00 A BINDE:WZ013-7188 08114/2013 0811412014 pMgS0NAL&ADVINURY Is 1,00,000-- Ger EW AGGREGATE s 2,004,000 CENT.AGGReUTL LM APPLIES PER PRODUCTS-CoU�AGG s 2,000,000 POLICY PRO- LOC S ME aurOK0BWUAVUffalr�t ANY AUTO BODILY D4IURY(Pa pecan) a 3 AUTOS ED A� 13011RrINJURYtPerawld a HIRED AUTOS AUTOS 8 9 UMBRBUA UAe [JOCOUR EAOH ODC fumoll S Exoess UAB rJA MS.MADE AOMOATE s _ CED I I RETINMONS a WORKERS OOIN WATKIN 0 ANo EMPLOYM LU"flY AANY PROPRIETOWPARTNEREMCUTIYE r I N NIA 6 L,64H ACCIDENT ANY - [Mw tEXCLUDED?wq EXCLUDED? ELL DISEASE-PAt:MPLOYE a IIyM,el�rle soma Orsm O OP TTON9 be E L DISEASE-POLICY LENT S DESCRIPM OF OPMtATIONB I LOCITIONS IVEKICIEB(AUM AD="ll,AddMW W I Waft%u mm AFM Is m*m" OPERATIONS:MANUFACTURE-RETAIL,&INSTALLATIONS OF SHUTTERS,WINDOINA,DOORB THIS GENERAL LLA UTY POLICY CONTAINS A DECUCTIBLE OF$2,500.00 PER ANY CLAIM- CERTIFICATE HOLDER CANCELLATION SKQULD ANY OF TKE ABOVE OESCRIBED POLICIES BE CANGELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BR Pm-AfER® IN MIAMI SHORES VILLAGES ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE 2 AV AUMONZED REMOSWArVE MIAMI SHORES VILLAGE Fl.33138 ! ACORD-9(2010!05) Q 1988.2410 ACORD CORPORATION.AN rights reserved. The A0OR0 name and logo are registered marks of ACORD Page 1 of 1 ACERTIFICATE OF LIABILITY INSURANCE DA02/12/201TE YY) 02/1a/ao14 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 an this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). ONT PRODUCER Willie of Florida, Inc. CNAMeCT c/o 26 Century Blvd. PHONE 1-877-945-7378 aC No:1-888-467-2378 P.O. Boz 305191 -MAIL .oertificates®willis.ccm Nashville, TN 372305191 USA INSURER(S)AFFORDING COVERAGE MAIC 0 INSURER A:Technology Insurance Company, Inc. 42376 INSURED General Impact Glass S Windows Corp 6 General Duct Glass 6 INSURER B: Hurricane Shutter Parts Inc INSURERC: 290 West 78th Road Hialeah, FL 33014 INSURER D: INSURER E: INSURER F; COVERAGES CERTIFICATE NUMBER:W205243 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. wTSRR OFINSURANCEADDL SUER POLICY EFF POLICY EXP TYPE POLICY MM10 MM1D LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMDAMAGE TO MERCIAL GENERAL LIABILITY PRE SES Ea $ CLAIMS-MADE F—I OCCUR MED EXP one ) $ PERSONAL 8 ADV INJURY $ GENERAL AGGREGATE $ GEML AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ POLICY �O LOC $ AUTOMOBILE LIABILITY FeeMdED INGLE UMIT ANY AUTO BODILY INJURY(Per person) $ ALS.IED CHEDULED BODILY INJURY(Per amt) $ HIRED AUTOS AUTOSS PROa1 R�DAMAGE $ $ UMBRELLA LIMB OCCUR EACH OCCURRENCE $ EXCESSLIAB HCLAIMS-MADE AGGREGATE $ ED I I RETENTIONS $ WORKERS COMPENSATIONX WC STATLI I OTH- AND EMPLOYERS'LIABILITY YIN TORY LIMITS EEL A ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBEREXCLUDED? Y NIA TWC3399799 02/07/2014 02/07/2015 (Mandatory In NH) EL DISEASE-EA EMPLOYEE $ 1,000,000 0 es describe under DESCRIPTION OF OPERATIONS glow E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES(Attach ACORD 101,AddRlonW Remarks SchedWe,U more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORMM REPRESENTATIVE Miami Shores Villages 10050 NH 2 Av ami Shores Village , FL 33138 ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD SR IDr2816049 BATCHrBatch @r 28417