The URL can be used to link to this page

RC-15-2725 INSPECTION RECORD POST ON SIS' Permit NO. RC-10-15-2725 ORELr! Miami Shores Village — ---_._._--__ ePermit Type: Residential Construction 9C 10050 N.E.2nd Avenue Miami Shores,FL 33138-0000 Work Classification:Alteration, ' ��`tiresN�a Phone: {305}795-2204 Fax: (305)756-8972 Issue Date:4/25/2016 �tORID Expires: 10/22/2016 INSPECTION REQUESTS: (305)762-4949 or Log on at https://bldg.miamishoresviIlage.com/cap REQUESTS ARE ACCEPTED DURING 8:30AM-3:30PM FOR THE FOLLOWING BUSINESS DAY. Requests must be received by 3 pm for following day inspections. Residential Construction . 'arcel #:1121360210810 Owner's Name:ROCKSTREAM INVESTMENTS GROUP, LLC Owner's Phone: (305)799-8034 ob Address: 580 NW 113 Street " Total Square Feet: 0 Miami Shores, FL 33168- Total Job Valuation: $ 5,000.00 w��✓','/XF¢.—;G%fs/.. r.. .a. a .F N. a . ... .r�i/,//O�i'O/ld//fG,�/.v/J.Y.r!/.IGO./.'Yl//..v.'f v„� ,. �_, WORK IS ALLOWED: MONDAY THROUGH FRIDAY,8:00AM-7:00PM. Con6ctor(s) Phone Primary Contractor SATURDAY 8:OOAM-6:OOPM. LMS CONSTRUCTION INC (954)703-0184 Yes NO WORK IS ALLOWED ON SUNDAY OR HOLIDAYS. BUILDING AND ROOFING INSPECTIONS ARE DONE MONDAY THROUGH FRIDAY. NO INSPECTION WILL BE MADE UNLESS THE PERMIT CARD IS DISPLAYED AND HAS BEEN APPROVED. PLANS ARE READILY AVAILABLE. IT IS THE PERMIT APPLICANT'S RESPONSIBILITY TO ENSURE THAT WORK IS ACCESSIBLE AND EXPOSED FOR INSPECTION PURPOSES. NEITHER THE BUILDING OFFICIAL NOR THE CITY SHALL BE LIABLE FOR EXPENSE ENTAILED IN THE REMOVAL OR REPLACEMENT OF ANY MATERIAL REQUIRED TO ALLOW INSPECTION. WARNING-TO---OWNER: YOU-R-F-AJLURE ---TO - RECORD A -NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT. ti INSPECTION RECORD PLUMBINGZONING INSPECTION DATErINSP INSPECTION DATE INSP INSPECTION DATE I INSP Foundation Zoning Final Stemwall ZONING COMMENTS Rough Slab Water Service Columns 1st Lift)____ 2"d Rough Columns 2nd Lift Top Out Tie Beam Fire Sprinklers Truss/Rafters Septic Tank Roof Sheathing Sewer Hook-up Bucks Roof Drains Windows/Doors ELECTRICAL Gas Interior Framing INSPECTION DATE INSP LP Tank Insulation TemporaryPole Well Ceiling Grid 30 Day Temporary Lawn Sprinklers Drywall Pool Bonding Main Drain Firewall Pool Deck Bonding Pool Piping Wire Lath Pool Wet Niche Backflow Preventor Pool Steel Underground Interceptor Pool Deck Footer Ground Catch Basins Final Pool Slab Condensate Drains Final Fence Wall Rough HRS Final Screen Enclosure Ceiling Rough Driveway Rough PLUMBING CO ENTS Driveway Base Telephone Rough Tin Cap Telephone Final Roof in Progress TV Rough Mop in Progress TV Final Final Roof Cable Rough Shutters Attachment Cable Final Final Shutters Intercom Rough Rails and Guardrails Intercom Final MECHANICA ADA com liance Alarm Rou h INSPECTION DATE INSP Alarm Final Underground Pipe DOCUMEN Fire Alarm Rough Soil Bearing Cert Fire Alarm Final Rough Soil Treatment Cert Service Work With Floor Elevation Survey 3 Ventilation Rough Reinf Unit Mas Cert ELECTRICAL COMMENTS Hood Rough Insulation Certificate Pressure Test Spot Survey Final Hood Final Surve Final Ventilation Truss Certification Final Pool Heater STRUCTURAL COMMENTS Final Vacuum ■I�.��- MECHANICAL COMMENTS INSPECTION DATE INSP Final Sprinkler Final Alarm 101 ON k MIS 3' E 10050 N.E.2nd Avenue Miami Shores,FL 33138-0000 Issue Date:4/25/2016 Expires: 10/22/2016 Phone: (305)795-2204 Fax: (305)758-8972 Pro ect Address Parcel No.. Tract No. Block No. Lot No. Section Township 580 113 Street 1121360210810 Miami Shores, FL 33168- Owner Information Address Phone Cell ROCKSTREAM INVESTMENTS GROUP, 15 115 Street (305)799-8034 - MIAMI FL 33161- 15115 Street MIAMI FL 33161- Contractor(s) Phone Primary Contractor Required Inspections: LMS CONSTRUCTION INC (954)703-0184 Yes ............._...... 1(866) 701-3365 _..� For Inspections call. Inspection WR Proposed Construction I Details Final PE Certification EXPIRED PERMIT#RC 14645 Valuation: $ 5,000.00 Window Door Attachment REPLACING KITCHEN CABINETS AND UPGRADING GXTS Total Sq Feet: Q Framing Insulation Fees Due Amount Total Amt Paid Amt Due Drywall screw CCF $3.00 Window and Door Buck DBPR Fee $2.25 $171.50 $171.50 DCA Fee $2.25 Fill Cells Columns Education Surcharge $1.00 Review Electrical Permit Fee $150.00 Scanning Fee $9.00 Review Electrical Technology Fee $4.00 Review Electrical Total: $171.50 Review Electrical Review Plumbing Review Plumbing Review Plumbing Review Planning Review Building Review Building Review Building Review Structural Review Mechanical IMPORTANT: APPLICATION IS HEREBY MADE TO THE BUILDING OFFICIAL FOR A PERMIT SUBJECT TO THE CONDITIONS Applicant Copy AND RESTRICTIONS SET FORTH ON THIS APPLICATION AND THE FOLLOWING: 1. Construction activity is prohibited between the hours of 6:00pm and 7:00am and on Sundays and Holidays. 2. The City's approved plans and permit inspection card must remain on the job site for use by City inspection personnel. 3. Final inspection of the work authorized by this permit is required. A Certificate of Occupancy must be obtained prior to use and occupancy of new buildings,structures and remodeling work. This permit/pian review expires by time limitation and becomes null and void If the work authorized by the permit is not commenced within 180 days from the date of permit issuance or if the permit is not obtained within 180 days from the date of plan submittal. This pemdt expires and becomes null and void If any work authorized by this permit is suspended or abandoned for 180 consecutive days or If no progressive work has been verified by a City building inspector for a period of 180 consecutive days. Monday,April 25 2016 1 IVIldf ill JI IUI CJ vilidgC PtECEIVED . r 4 Building Department artment M R:Q3 2016 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 BY: INSPECTION LINE PHONE NUMBER: 305 762-4949 T� 7�1- FBC 2014 S BUILDING Master Permit No. RC-15-2725 PERMIT APPLICATION Sub Permit No. OBUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING MECHANICAL PUBLIC WORKS ❑ CHANGE OF CANCELLATION D SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 580 NW 113th Street � City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: tm nt roupLLC. es e s Group,OWNER:Name(Fee Simple Titleholder):Rock stream Inv Phone#:(305)799-8034 Address: 15 NE 115th Street City: Miami State: Florida Zip: 33161 Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Coman LMS Construction Inc. • (800)526-5986 P YName: Phone#. Address: 1000 5th St. Ste. 200 City: Miami Beach State: Florida Zip: 33139 Qualifier Name: James Edward Lewis Jr. Phone#: (954)703-0184 State Certification or Registration M B 1259926 Certificate of Competency M DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: V ue oWctki#orthis Perrimt:' ��, Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New M Repair/Replace ❑ Demolition Description of @tS. Specify 11,1110 me: Submittal Fee$ Permit Fee$ ( aid° W CCF$ :3, CO/CC$ Scanning Fee$ ! (30 Radon Fee$a- OL` DBPR$.0 - aS Notary$ Technology Fee$ 4-'� 0�) Training/Education Fee$ ` ' � Double Fee$ Structural Reviews$ Bond$ Q TOTAL FEE NOW DUE 5 1: , � 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. 4Signature Signature OWNER or GE C T OR The foregoing instru ent was acknowledged before me this The foregLirument was cknowledged before me this da of U0(�h Hemant Singh 20 u� by ----�__day of Fe b, 20� by who is personally known to James E. Lewis'Jr. — A who is�ersonally known to "'K �'�.nee or who has produced �� ot��5 too t �.•;,,: z l;:• as me or who has produced_�` ��'• � identification and who did take an oath. s identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: r' F Sign: Sign: Print: Print: Seal: L'31'2I soi dw%iti oo An "W:11;uolsspuwo0Seal:OW to GIMS'Wd k N10DVNrl W3ssffiasa•ssw«*seeesars*w�rs*�,�re��swre*�w+ewx�aewsasu*xe�s+ee+�rrteoarx*�a*rw*��ew�ea*:es*erwra� APPROVED BY Plans Examiner Zoning Structural Review Clerk .� �_A Miami Shores Village - ,Y_ _______ .• ; �' Building Department OCT 2 6 2015 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—<!a v PERMIT APPLICATION Sub Permit No. BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: S-rt-Ie-el Ir City: Miami Shores County: Miami Dade Zig: �3 Folio/Parcel#: Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): RCi'C�S'f're�h'► _TNGlt' '`—�/ Phone#: 3a S 1 fir( 0� Address: City: (' �'vl( State: �� zip: 3 l 1 Tenant/Lessee Name: Phone#: Email: 2-1 LLd C pany Name: L M5a 0VjS_ oo-50(o- 9/0 f?b0 `-w► 5-t S f QQuaftiff_ername� .J 4 m E.5 L e7w -5 Phonetb 9 5y- 70 3 Oay Stere #• 8 C o2 ClatevfCampeterncyk DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: V 1 f AjoftAbis P iai $ f5j 000. ®i7 Sc uare/Ur�ear fort °vf lMork: mac, Tye F-1405a W1511 ❑ Alteration ❑ New 10 Repair/Replace ❑ Demolition '`� -- ® G>a C19,8 nHET-5 GAJ /C/TCHeAJ< �EPHIfL� REP�Ace �B(�T+{2CaaYI 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) 9� r 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 reins ction fee will be charged. Signature Signature OWNER or GENT T OR The foregojng instru as a nowledged before me this The foregoing ns ume was acknowledged before me this 7 ,,,.prig day of 20L,0/�by day of 20 by who*!p personally known to pim 6.5 r• L l5v,NS ,who is pers9ricilly Known X02 �'XO me or who has produced � as me or who has produced PUM 6t bl— as identification and who did to entification and who 'd take an oath. NOTARY PUBLIC: A A CiSSMDRAHARRM OTARY PUBLIC: Notary Public.State of Florida Commission 4 EE 198163 a comm.expires May 14,2016 gn• Print: Chi � lJv1--J Print: - Seal: Seal: APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD (850)487-1395 1940 NORTH MONROE STREET TALLAHASSEE. FL 32399.0783 LEWIS,JAMES EDWARD JR LMS CONSTRUCTION INC 5207 GRANT STREET HOLLYWOOD FL 33021 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 from architects to yacht brokers,from boxers to barbegue restaurants, and they keep Florida's economy strong. Every day we work to improve the slay we do business in order to serine you be9W. FW kftmatiort about our services.plea"log orrto AY le e.aam. There you can find mw iftmiaon about our divisions and the regulations that impact you,subscribe to department rA wsletters and learn more about the Department's initiatives. Our mission at the Department is:license Efficiently,Regulate Fairly. We coir strive to serve you better so that you can serve your customers. Thank you for doing business in Florida, and congrabAstio s on your new liicensel DETACH HERE RICK SCOTT,GOVERNOR KEN LAWSON,SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD _. „ CW125S928 � ,r �z The BUILDING CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31,2016 LEWIS,JAMES EDWARD JR 0 • LMS CONSTRUCTION INC 1000 STH STREET,STE 200 R5 MIAMI BEACH FL 33139 ISSUED: 10/05/2014 DISPLAY AS REODIRED HY I AW RFr,s r 1ennngvvm7na V ' MIAMI-DADE COUNTY- STATE OF FLORIDA N/A October 26,2015 MIAMM ® LOCAL BUSINESS TAX RENEWAL 7183896 2015 -2016 APPLICATION RECEIPT,7464579 STATE#CBC1259926 DBA/BUSINESS NAME: BUS.COMMENCEMENT DATE:10/10/2013 LMS CONSTRUCTION INC SEC TYPE OF BUSINESS BUSINESS LOCATION: BLDG2 SUB-GENERAL BLDG CONTRACTOR 1000 5 ST 200 R5 2 MIAMI BEACH,FL 33139 OWNER/CORP. APPLICATION DETAILS LEWIS MITES&SMITH CONSTRUCTION INC FEE AMOUNT C/O JAMES LEWIS PRES Receipt Fee 30.00 PHONE# 800-526-5986 UMSA Fee 0.00 1754 NW 192 ST Beacon Council Fee 15.00 MIAMI GARDENS,FL 33056 Bingo Permit Fee 0.00 Nightclub Permit Fee 0.00 Multi-Municipal Contractor Fee 0.00 Restricted Contractor Fee 0.00 Library Fee 0.00 NAICS CODE: 238990 Transfer Fee 0.00 Doing Business without a License Penalty 0.00 Late Penalty 4.50 Collection Cost 0.00 NSF Fee 0.00 Prior Years Due 0.00 Amount Recently Paid - 49.50 TOTAL AMOUNT DUE:.. 0.00 ................................................................................................................................................................................................................................................................................................................. If no longer In business,please notify us in writing. To pay online go to www.miamidade;govAaxcollector Review and correct the information shown on this application. To pay by mail,make check payable to: Miami-Dade County Tax Collector A 25%penalty will be assessed to anyone found operating Business Tax without a paid local business tax,in addition to any other 200 NW 2nd Avenue penalty provided by law or ordinance(Sec 8A-176(2)). Miami FL 33128 To pay in person go to: A Certificate of Use and/or City Business Tax 200 NW 2nd Avenue Receipt may also be required. (305)270-4949,fax(305)372-6368 A service fee of not less than$25.00 up to a minimum of 5% will be charged for all returned checks. t RETAIN FOR YOUR RECORDS t ................................................................................................................................................................................................................................................................................................................. MIAMI-DADE COUNTY- DETACH HERE AND RETURN THIS PORTION WITH YOUR PAYMENT + N/A October 26,2015 STATE OF FLORIDA LOCAL BUSINESS TAX RENEWAL 2016 APPLICATION WI��IIIIII�III�II�I��I�II��IIIIII��I��I RSTATE#7464579 CBC1259926 71838 I� BUSINESS LOCATION: 1000 5 ST 200 R5 MIAMI BEACH,FL 33139 BUS.COMMENCEMENT DATE:10/10/2013 SEC TYPE OF BUSINESS OWNER/CORP. BLDG2 SUB-GENERAL BLDG CONTRACTOR LEWIS MITES&SMITH CONSTRUCTION INC 2 APPLICATION IS HEREBY MADE FOR A LOCAL BUSINESS TAX RECEIPT OR PERMIT FOR THE BUSINESS PROFESSION C/O JAMES LEWIS PRES OR OCCUPATION DESCRIBED HEREON.I HAVE BEEN INFORMED OF ALL ZONING RESTRICTIONS IMPOSED ON THIS RECEIPT. I SWEAR THAT THE INFORMATION IS TRUE AND CORRECT. LEWIS MITES&SMITH CONSTRUCTION INC C/O JAMES LEWIS PRES 1754 NW 192 ST SIGNATURE REQUIRED SEE INSTRUCTIONS ABOVE MIAMI GARDENS,FL 33056 Please pay only one amount.The amounts due after Sept 30th Include penalties per FS 205.053. lfPaid By Oct 31,2015 Nov 30,2015 Dec 31,2015 Jan 31,2016 Please Pay $0.00 $0.00 $0.00 $0.00 7000000000000000000000007464579201600000004500000000000007 a & CERTIFICATE OF LIABILITY INSURANCE °�'� THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: if the certificate holder Is an ADDITIONAL INSURED,the poNcy(les)must be endorsed. H SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement A statement on gNe certificate does not confer rights to the certificate holder In Neu of such endorsement($). PRODUCER Lucts E*efla Accurate (305)228-8727 (305)226-8767 8300 West Flagler Suite 114 th.nat Miami,FL 33144 INSUREIM AFFORDING COVERAGE MAIC# Phone (305)226-8727 Fax (305)226-8767 INSURER A: United Specially h:suance Company INSURED INSURER Lewis Mites&Smith Construction Inc.d/b/a LMS Construction Inc INSURERC: 1754 NW 192 Street INSIRERD: I Miami,FL 33144 INWRER E: ENSURER 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. TYPE OF INSURANCE IADDLSUBR POLICY NUMBER POLICY EFF EXP LIMITS GENERAL LIABILITY j H E E $ 1,000 000.00 ® COMMERCIAL GENERAL LIABILITY ! DAMAGE TO RENTED $ 100,000.00 A ❑ ❑ CLANAS4=E ® OCCUR1+ Y CGDO0004112-01 05/07/2016 05/07/2016 �D ExP one reon s 5,000.00 ❑ PERSONAL&ADVINJURY s 1,000,000.00 ❑ GENERALAGGREGATE s 2,000,000.00 GENT.AGGREGATE LEST APPLIES PER: PRODUCTS-COMPIOP AGG I s 1,000,000.00 ®POLICY ❑ MOT ❑ LOC s J AUTOMOBILE UAwLnY pN tNOLE LIMIT 13 { ❑ ANY AUTO — BODILY INJURY(Per per)I$ ALL OWNED SCHEDULED ❑ AUTOS E] AUTOS BODE-Y INJURY(Per aad s t ❑ HIREDAUTOS ❑ AtOTI.J."rD P s ❑ UMBRELLA LIAR ❑OCCUR EACH OCCURRENCE is EXCESS LIAR ❑CLAIMS-MADE AGGREGATE is DED 0 RETENT $ $ WORKERS COMPENSATION A 1• I—I OTH AND EMPLOYERS'LIABILITY Y r N ER ANY PROPRETORIPARTNERIEXECUTNE E.L.EACH ACCIDENT s OFFICERry9EM8inK"EXCLUDED? ❑N/A EL DISEASE-EA EMPLO $ OF OPERATIONS below ELL DISEASE-POLICY LEST s DESCRIPTION OF OPERATIONS t LOCATIONS r VEHICLES(Attach ACORD 101,Additional Remreks Schedule,if more space is required) Miami Dade County is also an additional insured with respect to general I1abiltty. Florida License#CBC 1259926 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Miami Dade County THE EXPIRATION DATE THEREOF,NOTICE WILL B D IN 111 NW 1 at Street ACCORDANCE WITH THE POLICY PR ^ Suite 2340 AUTHORIZED REPREIENTATNe Miami,FL 33128 Lucia Estrella VVW ®1988-2010 ACORD CORPORATION. All rights reserved. ACORD 26(2010105)QF The ACORD name and logo are registered marks of ACORD 9/29/2015 Report Viewer '• � `�t 1 �� 100% JEFF ATWATER CHIEF FINANCIAL OFFICER STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS'COMPENSATION CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS'COMPENSATION LAW" CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers'Compensation law. EFFECTIVE DATE: 10/8/2014 EXPIRATION DATE: 10!//2016 PERSON: LEWIS JAMES E JR FEIN: 464477986 BUSINESS NAME AND ADDRESS: LEWIS MITES&SMITH CONSTRUCTION INC LMS CONSTRUCTION INC 1754 NW 192ND STREET MIAMI GARDENS FL 33056 SCOPES OF BUSINESS OR TRADE: LICENSED BUILDING CONTRACTOR pwatreMto dmp0er 440.05(14).F.3.,an otHc�of a aorporatlon who azemptlon fnxn 0�oha��a of a utberthk aeo5on rtmY naT reoaaer barreftls ori wbertlds olmp�r.PurauaM to Chap6ar 440.05(12),F.8., of elec5on to be� ...a only wAh6�tlrescopo.oflhebuafi+ess�tradelkUedonMemlke�elactl��tobeexatmA.WfsuanttoCr440.05(1�.F.8..t �e�ctlrn be ttre men named on tiwa or%mcea� �regniremeMeortl�Ba of a�oe .7f�re I e�11 revo0os e OFS-F24Mr-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 OUEs n0NS?(850)413-1SW httpc//apps8.fldfs.emWcrrep"iewer/reportVieweraspx?data=kdvpginc9D7Q3gH6TER6eP1ICvIZ%2fSz5bXKYfBxkrekeRSoPVylv4NPOPN42XeirDRGXVWIx.. 1/2 gN�r�s Miami shores Village ■m ami Building Department t Jt►'yr'�n1 10050 N.E.2nd Avenue ZORII 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 and has acknowledge that he or she will not use day labor,part-time employees or subcontractors for your project.The contractor has provided an affidavit stating that he or she will be the only person allowed to work on your project In these circumstances,Miami Shores Village does not require verification of workers'compensation insurance coverage from)fie contractor's company for day labor,part-time employees or subcontractors. BY SIGNING BELOW YOU ACKNOWLVDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. Signature: Own r State of Florida County of Miami-Dade p The foregoing was acknowledge before me this day of U ad -,20 By fl EM At f r St t f6 H who is personally known to me or has produced T1014k %'46 Il WAk as identification. Notary: Q SEAL: a MAFU CAROLINA GONMEZ Notary POD%State of Florida Commissioral FF 209431 oamm.expr a-� t � ,�, L. S• Corastrxxctiora Trac_ Adakirs.Sr Y.®ser Lri.iora.A Ra alitwl October 26,2015 State of and County of 0406 Before me this day personally appeared James Edward Lewis Jr. who,being duly sworn,deposes and says: That he will be the only person working on the project located at: 580 NW 113th Street Miami,FL. 33168 Sworn to r affi and subscribed before me this day of 2015,by --� Personally know Or Produced Identification Type of Identification Produced b L bft Print,Type or Stamp Name of Notary 10�21°�Z . . . .. �taA� �� Prope Search Application- Miami-Dade County Page 1 of 1 D OF FICE OF THF PROPERTY APPRAISFF Summary Report Generated On:2/29/2016 Property Information Folio: 11-2136-021-0810 580 NW 113 ST Property Address: Miami Shores, FL 33168-3321 m �ROCKSTREAMINVESTMENTS Owner GROUP LLC . � 15 NE 115 ST Mailing Address MIAMI,FL 33161 USA r � ` Primary Zone 5700 DUPLEXES-GENERAL Primary Land Use 0101 RESIDENTIAL-SINGLE f WOO FAMILY: 1 UNIT Beds/Baths/Half 2/1/0 t a Floors 1 P Living Units Actual Area Sq.Ft � Living Area Sq.Ft Adjusted Area 1,132 Sq.Ft Taxable Value Information Lot Size 8,178 Sq.Ft 2015 2014 2013 .......... Year Built 1948 County Exemption Value $0 $0 . $0 ._.___.....___.......... Assessment Information Taxable Value 1 $95,196 $86,542 $86,6491 Year 2015 2014 2013 School Board Land Value $36,696 $18,047 $18,047 Exemption Value $0 $0 $0 Building Value $72,784 $67,279 $67,384 Taxable Value $110,693 $86,542 $86,649 XF Value $1,213 $1,216 $1,218 City Market Value $110,693 $86,542 $86,649 Exemption Value $0 $0 $0 Assessed Value $95,196 $86,542 $86,649 Taxable Value $95,196 $86,542 $86,649 Regional Benefits Information Exemption Value $0 $0 $0 Benefit Type 2015 2014 2013 Taxable Value $95,196 $86,5421 $86,649 Non-Homestead Cap Assessment Reduction 1 $15,4971 1 Note:Not all benefits are applicable to all Taxable Values(i.e.County, Sales Information School Board,City,Regional). Previous OR Book- Sale PricePaQualification Description 9e Short Legal Description 29639- 05/27/2015 $79,900 963Qual by exam of deed WEST SHORES PB 42-18 2109 LOT 2 BILK 5 14031- Sales which are disqualified as a result of LOT SIZE 58.000 X 141 03/01/1989 $0 2312 examination of the deed OR 14031-2312 0389 5 FAU 30-2136-021-0810 The Office of the Property Appraiser is continually editing and updating the tax roll.This website may not reflect the most current information on record.The Property Appraiser and Miami-Dade County assumes no liability,see full disclaimer and User Agreement at hftp://www.miamidade.gov/info/disclaimer.asp Version: http://www.miamidade.gov/propertysearch/ 2/29/2016 Detail by Entity Name Page 1 of 2 Detail by Entity Name Florida Limited Liabilitv Company ROCKSTREAM INVESTMENTS GROUP, LLC Filing Information Document Number L14000099550 FEI/EIN Number 47-1177647 Date Filed 06/23/2014 State FL Status ACTIVE Last Event LC AMENDMENT Event Date Filed 06/30/2014 Event Effective Date NONE Principal Address 15 NE 115TH ST MIAMI, FL 33161 Mailing Address 15 NE 115TH ST MIAMI, FL 33161 Registered Agent Name &Address SINGH, HEMANT 15 NE 115TH ST MIAMI, FL 33161 Name Changed: 06/30/2014 Authorized Person(s) Detail Name &Address Title MGR SINGH, HEMANT 15 NE 115TH ST MIAMI, FL 33161 Title MGR SINGH, ANTHONY 15 NE 115TH ST MIAMI, FL 33161 http://search.sunbiz.org/Inquiry/CorporationSearch/SearchResultDetail?inquirytype=Entity... 2/29/2016 Detail by Entity Name Page 2 of 2 Title MGR SINGH, ANTONETTE 15 NE 115TH ST MIAMI, FL 33161 Annual Reports Report Year Filed Date 2015 04/30/2015 Document Images 04/30/2015--ANNUAL REPORT View image in PDF format 06/30/2014-- LC Amendment View image in PDF format 06/23/2014-- Florida Limited Liability View image in PDF format Copyright O and Privacy Policies State of Florida,Department of State http://search.sunbiz.org/Inquiry/CorporationSearch/SearchResultDetail?inquirytype=Entity... 2/29/2016