EL-15-2827 t Miami Shores Village :07-10"
D
Building Department DEC
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949
FBC 20
BUILDING Master Permit No.RC-915-2307
PERMIT APPLICATION Sub Permit No. /�/`1- � 7
❑BUILDING it
ELECTRIC ❑ ROOFING REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING [-] MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 9959 Biscayne Blvd.
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#:11-3205-019-0470 Is the Building Historically Designated:Yes NO X
Occupancy Type: Res Load: Construction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder):Global Real Estate Acquisitions and Investments Phone#:305.979.1781
Address:20817 SW 92nd Court
City: Cutler Bay State: Fl. Zip: 33189
Tenant/Lessee Name: c%Samantha Gardner Phone#:
Email: Samantha8873@hotmail.com
CONTRACTOR:Company Name: Phone#:
Address: -5
City: .��' State. Fl. Zip:
Qualifier Name: u �� Phone#:� 6 � �
State Certification or Registration#: Xfe*2� Certificate of Competency#:0
DESIGNER:Architect/Engineer: Phone#:
Address: *7b City: ____State: Zip:
Yam tartMorkforhh$ .S Square/Linear Footage of Work:
Type of Work ❑ Addit�iioon�, ❑ Alteration ❑ New ❑ Repair/Replace.. Q DeToollition
eestripit� 'f� L(loikk: / / l
Specify color of color thru tile:
Submittal Fee$ Permit Fee$ .41 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)
t I
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$2500, the applicant must
promise In good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property Is subject to attachment. Also,a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is Issued. In of such posted notice, the
Inspection will not be approved and a reinspection fee will be charged.
4 Signature Signature
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
day of 20 by d V of 20 /s .by
v& Q rwho is personally known to yQ%4 who is per naily knowt
me or who has produced ��.. as me or who has produc
Identification and who did take an oath. identification and who did take an oath.' c l � VeQs�—
NOTARY PUBLIC:
Si n• � I
Print: Print: ' A
Seal: Seal: RES;JAN 21,2018
C1,O),
° Notary Public State of Florida Bonded through 1st State Insurance
Joanna M FelicianoMy Commission FF 082753
Expires 01/12/2018
******** * * * * * ** * ****** ******************************************************************
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
......_....
' RICK SCOTT,GOVERNOR
r.w�..___--. -� _ __._«... ...__� _....., .. _... ._. . ._.. ._. _... ._.._....... _ .-..._ .. ........ KEN LAWSON, SECRETARY
DE7�°FI
F A
•&Ar PAF`O$"Al RE6ULATIAW
•tC1�I+l�TtVG'BAA
74.
0-Q. .'E
ISSUED: 06/10/2014 DISPLAY AS REQUIRED BY LAW SEQ# L1406100001578
Local Busisen Tax Receipt
Miami-Dade County, Stete of FlorMa
-THIS IS NOT A BILL - 00 NOT PAY
405779
BUSINESS NAME/LOCATION RECEIPT NO.
MESA BROTHERS INC RENELEXITS
5215 SW 103 AVE 79 SEPTER41RER 30., 2016
MIAMI FL 33165 Must be displayed at place of business
Pursuant to County Code
Chapter 6A-Art.8&10
OWNER 8EC.TYPE OF BUSINESS
MESA BROTHERS INC 196 ELECTRICAL CONTRACTOR PAYMENT RECEIVED
C/O RAUL MESA,QUALIFIER EC13001870 BY TAX COLLECTOR
Worker(s) .10 $75.00 07/15/2015
CHECK21-15-095549
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 holdei i alifications,to do business.Holder must comply With env governmental
Of non9Bvernmental mluh tory laws am requiremsels whichopply to the busittess
The RECEIPT N0.Bbove must be displayed on all commercial vehicles-AIRS Code Sec fig ne.
For more informuton,visit
oRv CERTIFICATE OF LIABILITY INSURANCE DATE(MWD D,YYYY,
,oro,/2o,s
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: ff the certificate holder is an ADDITIONAL INSURED,the policy(les)must be endorsed. If SUBROGATION IS WAIVED,
subject to the terns 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 Acs,
NAME: Risk Management Department
Stonehenge Insurance Solutions,Inc. PHONE FAX
300 Avenue of the Champions,Suite 222 ac No Ext): ass 925 2960 x20934 ac Nc: e sir-seas
Palm Beach Gardens,FL 33418 ADDRESS: carts Proaresameemplover.corn
INSURED INSURERS AFFORDING COVERAGE NAIC i
Progressive Employer Management Co.,Inc.and all its affiliates and subsidiaries INSURER A:Technology Insurance Company,Inc. 42376
INSURER B:
For co-employees of Mesa Brothers Inc INSURER C:
6407 Parkland Drive INSURER D:INSURER E:
Sarasota,FL 34243
INSURER P
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
IS 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. Limits shown are as requested
�� TYPE OF INSURANCE V�YVaDR POLICY NUMBER POLICY EFF POLICY EXPI WN LIMBS
(MMf)D/YYYY) (MMODIYYY1f)
GENERAL LIABILITY EACH OCCURRENCE
rDMMERCIAL GENE ILITY AMAGE TIHR RENTED
REMISES(Ea occurrence)
CLAIMS-MADE CUR ED EXP(Any one pemm)
ERSONAL&ADV INJURY j
ENERALAGGREGATE
QEN'L AGGREGATE LIMIT APPLIES PER: ROOUCTS-COMP AGQ
1-7 POLICY PROJECT LOC
AUTOMOBILE LIABILITY MBINED SINQLE LIMIT
ANY AUTO Eaoh accident)
DILY INJURY(Per person)
ALL OWNED SCHEDULED DILY INJURY(Per
AUTOS AUTOS dent
HIRED AUTOS NON-OWNED ROPER DAMAGE(Per
AUTOS
darn
UMBRELLA LIAR OCCUR CH OCCURRENCE
EXCESS LIAB CLAIMS-MADE GGREGATE
DED RETENTION$
WORKERS COMPENSATION WC STATU. OTH-
�q AND EMPLOYERS'LIABILITY TYVC34982n 10/01!2015 10/01/2016 TORY LIMITS ER
ANY PROPRIETOPoPARTNERJHXECLMVE YIN
N .L.EACH ACCIDENT
OFFICER& M R EXCLUDED? N/A $1,000,000
(Mandatory In Nth
If yes,describe under L.DI5EASE-EA EMPLOYEE $1.000,000
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000
DESCRIPTION OFOPEM71ONS/LOCATIONS IVEHICLES(AttachACORD101,AddidonalRwnarksaohedule,Hmorespaceisrequireo:
Coverage is extended to CO-employees but not subcontractors W Mesa Brothers Inc
0:416802
CERTIFICATE HOLDER CANCELLATION
Miami Shores Village SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED
BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE
DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS.
10050 NE 2nd Ave AUTHORIZED REPRESENTATIVE
Miami Shores, FL 33138-2304a 1988-2010
ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD CORPORATION. All rights reserved.
ACORD
MESAB-1 OP ID:YM
�► sto• CERTIFICATE OF LIABILITY INSURANCE FDATE(MMO&YYYY)
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPONTHE CERTIFICATE HOLDER. HIS
ORDED THE POLICIES
TE
16
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFF
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING ORDERINSURR(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,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 Ileu of such endorsemen s.
PRODUCER
Global Risk LLC ME: Yolanda Mendez
6366 Blue Lagoon Or Suite 101 " " .306.466-7260
Miami FL 33T26 A/ No:306.466-7261
EDUAIiDO R PORTAE AD :mail@globalriskllc.com
INSURER(S) AFFORDING COVERAGE NAIC 0
INSURED Mesa Brothers Inc. INSURER A MOSCO Insurance Company
6216 SW 103 Ave INSURERS:
Miami,FL 33166 INSURER C:
INSURER D:
INSURER E:
INSURER F
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
1NSR TR TYPE OF INSURANCE POLICY NUMBER t}ypp LIMITSA COMMERCIAL GENERAL LU1BILnY
CLAIMS-MADE a OCCUR P122167400 EACH OCCURRENCE $ 1,000,00
01/01/2016 01101/2016 PD TO-RENTEIY—
REMISE Ea occurrence $ 100,00
MED EXP(Any one person) $ 6,00
PERSONAL&ADV INJURY $ 1,000,00
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,0
X POLICY Q JECT Q LOC
00
PRODUCTS-COMP/Op AGO $ 2,000,0
OTHER:
OC
AUTOMOBILE LIABILITY INGLE LIMIT-- $
ANY AUTO BODILY INJURY(Per person) $
AUTOS ALL ED AUTOS LED
BODILY INJURY(Per acdtlenq $
HIRED AUTOS AAUTO.OSINNED MAGE -
Per n DA $
UMBRELLA LU18 OCCUR
EXCESS UAB EACH OCCURRENCE $
CLAIMS-MADE AGGREGATE $
DED RETENTION$
WOF KERS COMPENSATION $
AND EMPLOYERS'LIABILITY
ANY PROPRIETOR/PARTNERIEXECUTIVE Y I N T T TR
OFFICERaAEMSER EXCLUDED? N/A E.L.EACH ACCIDENT $
(Mandatory In NH)
Ues,describe wider E.L.DISEASE-EA EMPLOYE $
RIPTI N OF OPERATIONS below
E.L.DISEASE-POLICY LIMIT $
DESCRIPTION OF OPERATIONS I LOCATIONS f VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached U more space Is required)
Electrical wok within buildings-CO2033&CO2404-Blanket Addl Ins and
Waiver of Subrogation,when required by written contractlagreement
CERTIFICATE HOLDER CANCELLATION
MIAMI11
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Miami Shores Village THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
10060 Northeast 2nd Avenue ACCORDANCE WITH THE POLICY PROVISIONS.
Miami Shores,FL 33138
AUTHORIZED REPRESENTATIVE
ACORD 25(2014/01) The ACORD name and logo are registered marks ofACORDRD CORPORATION. All rights reserved.