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MC-16-65 I Shores Village c� � n s� . uildin Department JAN 11, 016 � g p 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 BY: Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 201D B L Master Permit No. PL— ( 4— 9 6 1 PER IT APPLICATION Sub Permit No. hIC-1�` i�'S ❑BUILDING ❑ ELECTRIC ❑ ROOFING REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING 0 MECHANICAL ❑PUBLIC WORKS [:] CHANGE OF [:] CANCELLATION ❑ SHOP p ,/ CONTRACTOR DRAWINGS JOB ADDRESS:_ _ - oZ- J� NE l 7 Sf - City: Miami Shores County: Miami Dade Zig): 3 313 d Folio/Parcel#: Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): "T&n I,n ems' Tck IrPhone#:-36S —6 3 oZ s5 _Eg Address: I eL-15- Al C9 q S+• City: M I,A AA State: r L— Zip: .3,3 0 Ab Tenant/Lessee Name: Phone#: Email: �I Q n tiny. �iG 1 Cz u lel-gays r. ao nq CONTRACTOR:Company Name: Dg6VA1hj G 19,,;4ocr Co/)O Phoned L3&6/o 40/y Address: /3727_61.1 9-t X2/3 City: /YI4 - State:- le, zip:-33/77 Qualifier Name: A ea64 '?�� Phone# State Certification or Registration#: na", �77 ? 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:.,in+ -'^-'rt%Cr, ��/� M-e— non, f"ros= Specify cci!6io,,t�olor�tfiiru:tile: . Submittal Fees n:., t teermtr#be S• • CCF$ ,s :co/cc Scanning Fee$..-_!� �''7'.:.° Radesh'Fee$ ... DBPR.$ ".r Notarv's �C Technology Fee$ Training/Education Fee$ Double Fee$ 0 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 reinspection fee will be charged. Signature 'Q�� tASignature OWNER or AGENT CON R The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this L day of t I QL .20 by _day of a 20 �,Q •by :IPA VC who is personally known to 4fb�'-' .��Cl.� dcjr 1 n� ,who is personally known to 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: Si Sign. Print: .S Ul�l $.Irl Alla h Od-e f Print: �k An� -e.r Seal: Seal: : ''"' r.. Sum MORALES COO 811A N MORALES MY COMMISSION!PF923M MY COMMISII�i i.QF9238% .o3sao+a3 APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) 003464 Local Business Tax Receipt Miami—Dade County, State of Florida -THIS IS NOTA BILL - DO NOT PAY 7170595 BUSINESSNAME&OCATION _> RECEIPT NO. EXPIRES DYNAMIC AIRFLOW CORP RENEWAL SEPTEMBER 30, 2016 13727 SW 152 ST#213 7449410 Must be displayed at place of business MIAMI FL 33177 Pursuant to County Code Chapter BA-Art.9&10 OWNER SEC.TYPE OF BUSINESS PAYMENT RECEIVED DYNAMIC AIRFLOW CORP 198 SPEC MECHANICAL CONTRACTOR BY TAX COLLECTOR Worker(s) 1 CAC1817782 $75.00 09/03/2015 CHECK21-15-120809 This Local Business Tax Receipt only confirms payment of the Laval Badness Tax.The Receipt is not a license, permit or a certification of the holders ValUlchtioms,to do buslao L Holder must comply with any goveremeawl or nongovernmental regulatory leans and requirements which apply to the badness. The RECEIPT N0.above joust be displayed on all commercial vehicles-Miaod-Dade Code Sac go-= For more information,visit www ndamidade.aovhexcollector r CERTIFICATE OF LIABILITY INSURANCE DA-M w'Dawm 01/11/2016 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 CONTACT NAME: FAX Automatic Data Processing Insurance Agency,Inc. aco N Eat): AIC No): 1 Adp Boulevard ADDRESS: Roseland,NJ 07068 INSURER(S)AFFORDING COVERAGE NAIL 0 INSURERA: NorGUARD Insurance Company 31470 INSURED DYNAMIC AIRFLOW CORP INSURERS: 13727 Sw 152 Street INSURER c: 213 INSURER D: Miami,FL 33177- INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER: 433033 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. INSR POLICY LTR TYPE OF INSURANCE D POLICY NUMBER MMID EXP LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE 0 OCCUR PREMISESEa axunerxe $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEML AGGREGATE LIMIT APPUES PER: GENERAL AGGREGATE $ POLICY❑JECT 7 LOC PRODUCTS-COMPIOP AM $ OTHER: $ AUTOMOBILE LIABILITY Ea aBINED INGLE LIMIT $ ANY AUTO BODILY INJURY(Per person) $ ALL AUTOS OWNED AUTOSU� BODILY INJURY(Per accident) $ NON-OWNED PRO PEF AMA E HIREDAUTOS AUT $ O UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAR HCLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORIMRS COMPENSATION X IND EMPLOYERS'LIABILITYY/N TY STATUTE ER A ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 100,000 OFFICER/MEM BEREXCLUDED4 ❑Y NIA N DYWC665869 05/20/2015 05/20/2016 (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ 100,000 Kyes deacrmeander DESG�RIPTION OF OPERATIONS wow E.L.DISEASE-POLICY UMIT 1$ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attaclrad IF mare space is required) Contractor License:CAC1817782 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Miami Shore Village Building ACCORDANCE WITH THE POLICY PROVISIONS. 10050 N E 2nd Ave Miami Shore,FL 33138 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION.All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD A6OZ* DATE(MM/DD/YYY1t7 �,,� CERTIFICATE OF LIABILITY INSURANCE 2/5/2016 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 CONCT Maria Fisk International Insurance Center, Inc. PHONE ,,, (305)279-5446 FAX N ;(305)279-4045 7990 SW 117 AvenueDRL .maria@iic.cc Suite 209 INSURERS AFFORDING COVERAGE NAIC# Miami FL 33183 INSURER A-Scottsdale Insurance Company INSURED INSURER B Ness Carmel LLC, DBA: Ness INSURER C: 15456 SW 117 Lane INSURER D: INSURER E: Miami FL 33196 INSURER F: COVERAGES CERTIFICATE NUMBER-CL162502018 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. INSR TYPE OF INSURANCE ADL BR POLICY EFF POLICY EXP VMS ILTR POLICY NUMBER X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS-MADE OCCUR PREMISESEAMAGE TO RENTED -rrence $ 100,000 CPS2391910 2/4/2016 2/4/2017 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $ 2,000,000 X POLICY jE - F]LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED IN LE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ AALLOOSWNED SACOEDULED BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident $ UMBRELLA UAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ Hes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached H more space Is requlred) License # CBC1252438 James Turk 1275 N.E. 94 Street Miami Shores F1. 33138 CERTIFICATE HOLDER CANCELLATION (305)756-8972 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 2 Ave Miami Shores, FL 33138 AUTHORIZED REPRESENTATIVE Edward Cabassa/CF — ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025 mni4mi Report Viewer htt :Ila s8.fldfs.Com/crreportyiewer/reportViewer.aspx?data... ps Pp I P100% JEFF AIMTER qW CMDF FINANCIAL OFFICER STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DMSION OF WORKERS'COMPENSATION *"CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS'COMPENSATION LAW*" CONSTRUCTION INDUSTRY EXEMPTION This cables that the individual listed below has elected to be exempt from Florida Workers'Compensation low. EFFECTIVE DATE: 11/20/2015 EXPIRATION DATE: 11/19/2017 PERSON: MARTINEZ STEVE J FEIN: 273469549 BUSINESS NAME AND ADDRESS: NESS CARMEL LLC 15456 SW 117 LANE MIAMI FL 33196 SCOPES OF BUSINESS OR TRADE: LICENSED BUILDING CONTRACTOR PureuaMto Chaplet F.S.an after era eorpotatloe t elede axempbon l em flea chapterbbqq rdvlg a m ubcate of alec0on under0ae eeCeoh ms trot reeovarbe�aeonVeaeetho urdbrOda Chapter Pursuant to Chepmr4400%12)..F$..Cergrrogtesotebc0ai t0 be ateept_apply only elempt erlti�amteol Bledlotl to Ue fab9Bd en Aetropte ofek�On toM e>t PurwenttoC r440�tt3).FS Notkea olematloa to he the pereen eamee on the notloe m aemamteei�t� ��tlm revutrags of fM�a�hu,r�or iw re�Coeiamte�T�lare�M�n�eaema rewhe e OFSF2-INNC-262 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED W13 QUESTIONS?(850)413-1M8 I of 2 11/20/15 3:20 PM