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DGT-15-2571 L � Miami Shores Village I - Building Department 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:{305)M-4949 FBC 2014 BUILDING Master Permit No. 'DG-r Is- 2S:t - PERMIT APPLICATION Sub Permit No. BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑MECHANICAL ❑PUBLICWORKS ❑ CKANGE OF ❑CANCELLATION []SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 102 NE 91st Street City: Miami Shores County: Miami Dade Zip:33138 Folio/Parcel#: 11-3101- 19-0010 Is the Building Historically Designated:Yes NO X Occupancy Type: Load: Construction Type: Rood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): Java Holdings LLC Phonem 305 979-7046 Address: 12555 Biscayne Blvd 9877 City: North Miami State: Flnricia Zip: 33181 Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name: C d A-9,- -r A L a 9 C-CNj'%ui,j&,1Qone#: oS Address• ;?,;� l lJ W. L Cab, d—=. City: W / ALL= 914 State: F L- zip:..-3 7> C-'> l b Qualifler Name: T-w J 1L C-O (-zLt_. f N Phone#:(,�L4t � 7 0 :1 W 0 State Certification or Registration#: C -7 i Certificate of Competency#: DESIGNER--Architect/Engineerz w— ` Phone#: Address:_ -ZL e) .,j City: State:�Y ._Zip:_%10/- Value of Work for this Permit:$ Square/Linear Footage of Work: Type of Work: W Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: (A 7 C7 �"7 C F C 1� C F CLQ C)l--,A Specify color of color thru tile: Submittal Fee$ 0 00 Permit Fee$ 9 06) CCF$ �e�� CO/CC$ (� Scanning Fee$ 4Z Radon Fee$ Z , DBPR$ 2 Notary$ Technology Fee$ A Training/Education Fee$ i ^� Double Fee$ Strueturai Reviewi$ a Bond$ TOTAL FEE NOW DUE$ (Revised42/24/2014) Bonding Company's Name(if applicable) Bonding Compary's Address city State Zip Mortgage lender's Name(if applicable) Mortgage lender's Address City State Zip Application is hereby in, to obtain a permit to du.the wwt;anti ia9faidons inifimted. 1 rfify Chat-no work�or instatfation has commenced prior to the issuance of a permit and that all work WM 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 tate foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. '"WARMNG TO OWIYEIL: YOU , FAILURE TO REtM 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$250D,the applicant must promise m;good falba that a copy of the rmtice of commencement and construction Iden low brochure will be.delivered to the person whom prop"is ubjeet to schment, .Also,a cenVW:cqp of the.mwrded notte of;commencemeot nth a posted at the job site for the first inspection which occurs seven f7)days-after the,building permit Is issued. In-the absence of such pasted notice, the -� inspection will not be approved and a reinspection fee will be charged. Signature Signatur OWNER or AGENT�VA �Idr ,LLQ 4CONT�CrOR The fo. s before me Ns The focegplft Fbstr.umeAt was.ae aaeeiedg A before me this day of 20 e by day of_�� 1��l c'c 20 by who is nersonaliy known to �� who/is personally known to me or who has produced 1V 1W as me or who has produced ✓ as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY-PUBM- S Signmap ' Print: $ t8 of Florida Print: My Comm.Expires Oct 2T,2 Seal: 'oN� -' Commission#EE 214308 Seal: *f `o* EXPIRES:Juty 22,2016 Bw*d TAN BWW Notary Sri= OAEB�O$ifi#�T _ _ @ "e'�i�;f�oiaki{g6k+7Y,aitgffMisTldf�iiiFtbs'Y�k/6[Y[attl�Ff+liAc#a��,�/a.mrat !#+Ft«9PR4�#' APPROVED BY Plans Examiner /t/ 6 !/ Zoning lStructural Review perk (Revised02/24/2014) STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL'REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487-1395 "et 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 p COELLO,ARTHUR COASTAL GROUP CONSULTANTS LLC 2210 WEST 10TH COURT HIALEAH FL 33010 Congratulations! With this license you become one of the nearly one million Floridians licensed by the Department of Business and Professional Regulation. Our professionals and businesses range 4 STATE OF FLORIDA from architects to yacht brokers,from boxers to barbeque restaurants, DEPARTMENT OF BUSINESS AND and they keep Florida's economy strong. ��.��' PROFESSIONAL REGULATION Every day we work to improve the way we do business in order to CGC1514271 ISSUED: 09/15/2014 serve you better. For information about our services, please log onto I I w wwmyfloridalicense.com. There you can find more information CERTIFIED GENERAL CONTRACTOR about our divisions and the regulations that impact you,subscribe COELLO,ARTHUR. to department newsletters and learn more about the Department's COASTAL GROUP CONSULTANTS LLC 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 CERTIFIED under the provisions of Ch.489 FS. and congratulations on your new license! Expdate:AUG 31,201e L1409150002058 DETACH HERE RICK SCOTT,GOVERNOR KEN LAWSON,SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD 1W114111MIXOr,MEN CGC1514271 The GENERAL CONTRACTOR Vamed below IS CERTIFIED Jnder the provisions of Chapter 489 FS. xpiration date: AUG 31, 2016 a• - a COELLO,ARTHUR •• COASTAL GROUP CONSULTANTS LLC 2210 WEST 10TH COURT HIALEAH FL 33010 ■ ISSUED: 09/15/2014 DISPLAY AS REQUIRED BY LAW. SEQ# L1409150002058 e 004349 Local Business Tax Receipt ('LB T' �' Miami Dade County, State of Florida ' -THIS IS NOTA BILL - DO NOT PAY 7175882 BUSINESS NAME/LOCATION RECEIPT NO. EXPIRES EASYWAY ALUMINUM RENEWAL 2210 W 10 Cr 7455568 SEPTEMBER 30, 2016 HIALEAH FL 33010 Must be displayed at place of business' Pursuant to County Code Chapter 8A—Art.9&10 OWNER SEC.TYPE OF BUSINESS COASTAL GROUP CONSULTANTS LLC 196 GENERAL BUILDING CONTRACTOR PAYMENT RECEIVED Worker(s) 4 CGC1514271 BY TAX COLLECTOR $45.00 09/22/2015 CREDITCARD-15-048168 This Local Business Tex Receipt oaly coufirms payment of the Local Business Tax.The Receipt is not a license, perodt or a certification of the holder's gualificatioru:,to do busiaess.Holder must comply with airy govemmamaI or uongovwnmemal regulatory lows and requiremer�which apply to the business. The RECEIPT N0.above must be displayed on all commercial vehicles-Miami-Dade Coda Sec Ba-276. i For more Information,visitWM miamidode govltaxcolLwor ACC>cP CERTIFICATE OF LIABILITY INSURANCE °ATE`MM1°°"""'' 90/08/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER: IMPORTANT: If the certificate holder IS an ADDITIONAL INSURED,the policy(les) must be endorsed. if SUBROGATION IS WAIVED, submit to the teens 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 Lars Erickson Skylake Insurance Agency PHONE . (305)933-2344 F 788 802-3134 1810 N.E.Miami Gardens Dr. . 1 akeinsuranco.com INSURERM AFFORDING COVERAGE NAIL N.Miami Beach FL 33179 INSURERA: GRANADA INSURANCE COMPANY 16870 INSURED INSURER 8: COASTAL GROUP CONSULTANTS LLC INSURER C: 2210 W.1 Oth Ct pNSURER D: INSURER E Hialeah FL 33010 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. owAUM DUNK TYPE OF INSURANCE Lam X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE ❑OCCUR PREMISES rlr $ 100,000 MED EXP(AM one $ 5,000 A 0185FL00063212 09/27/2015 09/27/2018 PERSONAL a ADv INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE s 2,000,000 POLICY❑QCT LOC PRODUCTS-COMPIOPAGG s 0 OTHER: $ AUTOMOBILE LIABILITY $ OW ANY AUTO BODILY INJURY(Per Person)ALL s USED SCHEDULED AUTOSBODILY INJURY(Per soddent) $ NON&NED PWOPERTYDAMAGE $ HIRED AUTOS AUTOS UMBRELLA LIM OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION $ WORKERS COMPENSATION A X AND EMPLOYED'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTTVE Y/N E. EACH ACCIDENT $ 100,000 B OFFICERIMEMBER EXCLUDED? ❑Y N/A 34 WEC BN8947 10/25/2014 10/25/2015 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 H yes,describe under DESCRIPTION OF OPERATIONS EL DISEASE-POLICY LIMIT 100,000 MWMPM OR OPERATKINS 1 LOCATK)NS I VEIMM OCOM ftM,Ad ftW Rmnarrat SONaduK myM MWW N MN apace is required) General Contractor License# CGC1514271 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Miami Shores Village Building Dept. ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE 2nd Ave AUTHORIZED REPRESENTATIVE Miami Shares,FL 33138 ®1988-1014 ACORD CORPORATION.All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD OR �rr �. Miami Shores Village Building Department 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* 7 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. ■■rrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrr■ BUSINESS NAME: �� 1 �c-�,D —G�n s Ce .C�: C BUSINESS ADDRESS:o2"?, j Gtys-S STATE ZIP_33D (� BUSINESS PHONE:(3 ) 2 — � C�FAX NUMBERS ✓� 7 CELL PHONE O q')® -/GYZ� QUALIFIER'S NAME: QUALIFIER'S LIC NUMBER: (s'Ca2,z/ P � I�CGT='I o-�l x-2671 ; Miami Shores Village Pe yt ,ksl�pbowTrellisew 10050 N.E.2nd Avenue NE r n '� � _ �'q�{�6gS� /O;�<D [ Miami Shores,FL 33138-0000 PeixtljJSfa�fuS:APROV� Phone: (305)795-2204 -- F`° Expiration: 7/13/201 Issue l3ae iyot � p. Project Address Parcel Number Applicant 102 NE 91 Street 1131010190010 JAVA HOLDINGS LLC Miami Shores, FL Block: Lot: Owner Information Address Phone Cell JAVA HOLDINGS LLC 102 NE 91 ST Miami Shores FL 33138 12555 BISCAYNE Boulevard NORTH MIAMI FL 33181- Contractor(s) Phone Cell Phone Valuation: $ 5,800.00 COASTAL GROUP CONSULTANTS LL (305)477-9030 Total Sq Feet: 0 Approved:In Review Available Inspections: Comments: Inspection Type: Date Approved::In Review Final Date Denied: Foundation Type Const:Wood Deck Additional Info:WOOD DECK/PERGOLA Framing in Progress Classification:Residential Scanning: 1 Review Building Scanning:1_ Review Building Review Building Review Planning Review Planning Review Planning Review Structural Review Structural Fees Due Amount Pay Date Pay Type Amt Paid Amt Due Review Structural CCF $3.60 Invoice# DGT-10-15-57377 DBPR Fee $2.00 DCA Fee $2.00 02/03/2016 Check#:5001 $558.60 $50.00 Education Surcharge $1.20 10/09/2015 Check#:4880 $50.00 $0.00 Permit Fee $100.00 Plan Review Fee(Engineer) $120.00 Plan Review Fee(Engineer) $120.00 Plan Review Fee(Engineer) $120.00 Plan Review Fee(Engineer) $120.00 Scanning Fee $15.00 Technology Fee $4.60 Total: $608.60 In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans,drawings,statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL,PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Futhermore,1 authorize the above-named contractor to do the work stated. February 03,2016 e gnature:Owner Applicant / Contractor / Agent Date Building Department Copy February 03,2016 1 02103/2016 13:18 3054779142 EZ PAINT PAGE 01101 �p�® CERTIFICATE OF LIABILITY INSURANCE1 . 11!02/2015 T1*S CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER,THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURIER(S), AUTHORIZED REPIMSENTA-RVE OR PRODUCER,AND THE CERTIFICATE HOLDER. N'ORTANT_ If the cr((flcale(o( is an ADDITIONAL INSURED,fink•policypes) must be endorsed. IFS RROGATION IS WAIVED, subject to the terms and eondltlone of the poticy,caft in policies may require an endomment,A statement on this cwtfiicata dyes rlol confer rights to the •cartlficast t%Oldar in lieu of such endomament(s). PrrODUCgt Lem Edcksen Sitylalte Insuranes'Agency wloen< edk (365)933-2344 __ [Ares)802-3434 1810 N,E.K1160 Gardens Dr. Iar &kyftIcsinsurance,ODM IN AFFG o,Nr;c4+►eRAoe pace fusulwo N.Miami BEadi FL 3317$ INBURBIA: GRANADA INSURANCE COMPANY 16870 INSURER131 COASTAL.GROUP CONSULTANTS LLC 2210 W.I Oth Ct INBgIRsrla t,s Hialeah FL 33010 mom •' RAGES CNf?71rI[erg NIrElllRon- i�CVr>irON NUMQCRc THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED M0.49 FOR THE POUCY PER1oD INDICATED. NOTNflTI WAND1NG ANY REQUIREMENT, TERM OR CONDTr(QN OF ANY CONTRACT OR OTHER DOCUMENT Vd'H RESPECT TO NMICN THIS CERTMr-ATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED By THE:POLICIES tW=R EXCLUSIONS AND CONDITIONS OF S 1CH POLICES.LIMITS SHOVM MAY HAVE BEEN REDUBED HEREIN 18 SUBJECT TO ALL THE TERMS, OgD BY pglD�]B IYPEOF*=RANGE POLICY Numem X COM MMOA GOWEAL r.MMM CLAIMSMADEL_J OCCURETON earwnwFnt/F ! 4fYY1.tNit1 tl Fa ooameaoe S 100,000 A neEa race tAfty one petam0 5,000 01gSFLOOO63212• 091271201 S 09/27/2016 Pt R30NAL&ADV NjuRY S 1000,000 GENIKXJCV'AGGRTELU1UTA17 P. GENERALAWRWATO 8 2,000,000 MOH ER- LOC PRopuum-cowmP AC3f3 $ 0 OTNE�t� IT All7plOa,ELJASI.fry $ MrAtr117 _ O1 D SCHEDULED BDDILYKx%Y(Per'Pmw)AVrOS S NON-DWMED BODILY MURY(Per awl6my 2 NREDA TTS AUTOS PIZ PERTY S >rABREW►LUIB OGCI3R I E EACH OCCUlVRE%CE �. 1110ESSLUIB j CLAAJI$•MADE i � I AGGREGA� �� g - tED RE'r'EN7•ION$ -----�I'--•-^ Mill NERS COMMNSA•nDN 3 AND LVLOYEW UARfIm YINANr I STATUTE X �R B OF COMeMEeIR EXC uL PeLP ECUTNE N/A _.. I ya 3�V1/EC 8iV8947 10/2*/2015 1025/2016 SL EACH ACCIDENT $ 100,000 DES TIIO�N p�P80PERATHINS Debw EL DISEASE-Eq ENIM S SOO,O= EJ DiSEASS_PCILICY LIMIT $ 1o0,000 013"K-W OF OPERAIrONS I LOCATONS r v plIrAES(ACORD 141.Ad",Md w,w.ke 8whadulp,emY bo les a Mo,**p.ee Ia wauhea! License # ^GG1514271 Con$t'ruction; CERnFIt TE•HOLDER CANCI&ATION • >SHIOULD AkT OF 7M ABOVE 11ESCRiM POLIM IN CANClE1LFD B� WOTICE MWft Shores VWago Building Dept. ACCOROANCE wart 111E pOL=y F�VISyMS. WL I 8E OELIVERm OV 10050 NE 2nd Ave Miami Shara,FL 33138 AUM01111010 / t rArnrE 1 ACORD 1V198B 1N4 Atop,CORP- ATION.ill t9"reserved. X04) Tris ACORD trema and IoW aro 1109MelOMMOdw of ACORD