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WS-15-1769 �w.Jl Miami Shores Village �'� 205 Building Department 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Y� f Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 5 r FBC ZO BUILDING Master Permit No. PERMIT APPLICATION Sub Permit No. rM-IBUILDING ❑ELECTRIC ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL F-1 PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS .� JOB ADDRESS.-n264 NE 6th AveRwe• "Z©0 City Miami Shores �� County: Miami Dade Zip: Folio/Parcel#: � ��C—®� '^�Z Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder):Lawrance Stanfll &W Carol Phone#:3057517438 Address:9200 NE 6th Avenue City: Miami Shores State: Florida Zip: 33138 Tenant/Lessee Name: " " Phone#: Email: E W Rem r 305-759-5271 CONTRACTOR:Company Name: Phone#: Address: 13400 NE 17th Avenue city. North Miami State: Florida Zip: 33181 Qualifier Name: Edwin W. Reed III Phone#: 305-218-0900 State Certification or Registration#: CGC-004598 Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ T3 oZ s Square/linear Footage of Work: Type of Work:% ❑ Addition ❑ Alteration ❑ New .Repair/Replace ❑ Demolition Des n-of-Wori. / e / � 4' W/pa oe triRtio Specify color of color thru tile: Submittal Fee$ -.O 0Q)_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) Banding 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 i m be secured for ELECTRIC PLUMBING SIGNS, POOLS, � construction in this jurisdiction. I understand that a separate permit must , 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 I 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. II Signat r Signatur OWNER or AGENT CONTRACTOR j The foregoing instrum1201S s acknowledged before me this The forgoing instrument was acknowledged beforerme this day of --rt{ 18 � •by day of 120 J ,by ,LAUY: ccylCiZ is personally known to ��tA-�ep� Shci�Tvs personally known me or who has produced as me or who has produced as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: ' SUSAN STANFILL CMILSON, Sign: s°• yP Ifc- FIOW. .O Print: _ Print: - , Commissioa i FF 118723 Seal: •. Seal: Notary Public State Florida BotaBdTlaouphl�lonlilrlilerl►lea Adela�I Rio My CommMion EE 193429 rwores 04/30/2016 APPROVED BY u Plans Examiner _Zoning Structural Review Clerk (Revised02/24/2014) WI I NL ... ...p�+ Miami Shores Village Building Department +tOR 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. ''. ■MENNEEMENEww"a��■ ■amu■��t��u��u��a��■ BUSINESS NAME: 1 C. BUSINESS ADDRESS: 1:3 qM / k /7 CITY PX4 h STATE ZIP BUSINESS PHONE:( )-1-S9 Sa'11I FAX NUMBER L--f) 75 �J-1S!S CELL PHONE 4 ),a 1 `"6 9M°QUALIFIER'S NAME: 9?5 � 11) QUALIFIER'S LIC NUMBER: 6C-.--, C Com® 4SZ9 ° STATE OF FLORIDA $. DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487-1395 " 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 REED, EDWIN W III E W REED INC 13400 NE 17TH AVE NORTH MIAMI FL 33181 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 t 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 CGCO04598 ISSUED: 07/30/2014 serve you better. For information about our services,please log onto www.myfloridalicense.com. There you can find more information CERTIFIED GENERAL CONTRACTOR about our divisions and the regulations that impact you,subscribe REED, EDWIN W III to department newsletters and learn more about the Department's E W REED INC 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! Expiration date: AUG 31,2016 L1407300001925 DETACH HERE RICK SCOTT, GOVERNOR KEN LAWSON,SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD CGCO04598 � The GENERAL CONTRACTOR Named below IS CERTIFIED _��r;;b.,: Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2016 REED, EDWIN W III �. E W REED INC 13400 NE 17TH AVE NORTH MIAMI FL 33181 ISSUED: 07/30/2014 DISPLAY AS REQUIRED BY LAW SEQ# L1407300001925 Local Business Tax Receipt Miami--Dade County, State of Florida -THIS IS NOT A BILI. .. DO NOT PAY392209 �ILBT _'/ BUSINESS NAME&OCATION RECEIPT NO. EXPIRES REED E W INC RENEWAL SEPTEMBER 30, 2015 13400 NE 17 AVE 592209 Must be displayed at place of business NORTH MIAMI FL 33181 Pursuant to County Code Chapter 8A--Art.9&10 OWNER SEC.TYPE OF BUSINESS PAYMENT RECEIVED REED E W INC 196 GENERAL BUILDING CONTRACTOR BY TAX COLLECTOR Worker(s) IO CG0004598 $45.00 08/13/2014 CHECK21-14-049851 This Local Business Tax Receipt only confirms payment of the Local Business Tax.The Receipt is not a license, permit,or a ceritticafiun 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 Sec 8a-276. For more information,visit www.mianpt�itfle.ggy�t� I>!4o lector CERTIFICATE OF LIABILITY INSURANCE FDATE(MMONYYYYI 7/14/2015 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,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 NAME:CONTACTErika Vanderbiest NSI Insurance Group PHONE (305)556-1488 1 FAX No:(305)556-3680 8181 Northwest 154th Suite 230 ADORESS:erika@rmi-g.us_ _ INSURERS)AFFORDING COVERAGE NAIC 9 Miami Lakes FL 3301_6 _ INSURER A Kid-Continent Casualty Cc 23418 INSURED INSURER s Commerce 6 Industry Ins CO 19410 E.W. REED, INC INSURER C: 13400 N.E. 17th Avenue INSURER D: INSURER E North Miami FL 33181 INSURER F: COVERAGES CERTIFICATE NUMBER:15/16- GL/WC 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. INBR --- TYPE OF INSURANCE POLICY NUMBER POLICY EFF POLICY EXP LIMITS X COMMERCIAL GENERALLIABILITYLIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED A J CLAIMS-MADE OCCUR PREMISE Ea Occurrence $ -_100,000 04GL000927588 4/13/2015 4/13/2016 MED EXP(Any one person) $ EXCLUDED PERSONAL BADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY jE- LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITYEa accident LIMITSINGLE $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS NON-OWNED PPROPPE ER ERY AMA13E $ HIRED AUTOSr__ AUTOS $ UUMBRELLAOCCUR EACH OCCURRENCE $ XCESS LUU3 _HCLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE Yom(N f A E.L.EACH ACCIDENT $ 500,000 B OFFICEtory in ER EXCLUDED? L_J VC 003-63-7014 1/11/2015 1/11/2016 E.L.DISEASE-EA EMPLOYE $ 500,000 (mandatory In NH) If yes,desc,ibe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1$ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS t VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached 8 more space is required) License #: CGC# 004598 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Miami Shores Village THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Building Department ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE 2nd Avenue Miami. Shore, FL 33138 AUTHORIZED REPRESENTATIVE Oscar Seikaly/JOSETT ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD INS025/man„