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RC-15-2737 (2) INSPECTION RECORD ON L TE .. - P4;lrmn n►o: RC�-10-15-2737 Miami,Shores Village x � 3g - 4 N.E.2nd Avenue �- mjar 11 Sh6ms,FL33138wW00 s r Phone: (305)795.2204 Fac (305)758.6872 Issue 3/2f2076 Exp, :08129/2016 I INSPECTION REQUESTS: (305)782.4!9149 or Log on at https libldg.miiimishoresaillage.com/carp REQUESTS ARE ACCEPTED'DURING 8:30AAA-3 30PM FOR THE FOLLOWING BUSINESS DAY. Requests must be received by pm for following day Inspections. Residential-Construction Parcel#A 121360130690 Owna~sName;SUSAN TREVISA to Owner's_Phone: ' (305)992-3134 Job Address: Total Square Feet: -250 Nam'Shorafi FL 3 Bond Number. 3000 Total Job Valuation: $J25,000.00 VORK IS ALLOWED MONDAY THROUGH SATURDAY, iltra tOr g Phon or 7:30AM-6100PM.NO WORK IS ALLOWED ON SUNDAY OR HOLIDAYS. A3 CONSTRUCTION LLC (788)942-1 BUILDING INSPECTIONS ARE DONE MONDAY THROUGH THURSDAY. ROOFING INSPECTIONS ARE ` DONE MONDAY THROUGH FRIDAY: NO BUILDING INSPECTIONS DONE ON FRIDAY. NO INSPECTION WILL:BE.MADE UNLESS THE PERMIT CARD IS DISPLAYED AND.HAS BEEN APPROVED. PLANS ARE READLY AVAILABLE-._IT IS THE PERMIT APPLICANTS 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: YOUR FAILURE " TO RECORD A NOTICE OF COMMENCEMENT MENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS -., TO YOUR PROPERTY. , A NOTICE. OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB IN . SITE BEFORE THE, FIRST SPECTION; IF YOU INTEND TO ,:OBTAIN FINANCING, CONSULT- WITH YOUR LENDER -OR AN ATTORNEY BEFORE, COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT. INSPECTIONRECORD , INSPECTION DATE INSP INSPECTION DATE INSP INSPECTION DATE INSP Foundation Zoning Final temwall ZONING COMMENTS ough • Slab Water Service Columns(1st Lift) " e Rough Columns(2nd Uft) To Out Tie Beam Fire Sprinklers Truss/Rafters, ` Septic Tank Roof Sheathing Sewer loo .: Bucks Roof Drains Windows/Doors ELECTRICAL Gas interior Framing INSPECrION ' -DATE INSP LP Tank �•insulation .1 Temporary Pole Well Ceiling,Grid 30 Day Temporary Lawn Sprinklers Drywall Pool Bonding Main Drain Firewall Pool Deck Bonding Pool Pining Wire Latif Pool Wet Niche Backflow Preventor Pool Steel Underground Interceptor Pool Deck footer Ground Catch Basins Final Pool Slab Condensate Drains Final Fence Wall Roug HRS Final Screen Enclosure Ceilingpath Driveway Rou PLUMBING f-A"r;jr'pjfS Driveway Base Telephone Rou h - 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 MECHANICAL ADA compliance Alarm Rough INSPECTION DATE NSP 3'2Alarm Final Underground Pipe DOCUMENTS Fire Alarm hough Soil Bearing Cert Fire Alarm Final Rough SoiiTreatment Cert Service Work With Floor Elevation Survey Ventilation Rough Reinf Unit Mas Cert ELECTRICAL COMMENTS Hood Rough Insulation Certificate Pressure Test ' Spot Survey �+ W Final Hood Ficial Survey - Final Ventilatio Truss Certification. Final Pool Heate STRUCTURAL COMMENTS Final Vacuum MECHANICAL C ME INSPECTION DATE INSP Final Sprinkler. 'dta' F inal Alarm May 23,2016 Miami Shores Village 10050 NE 2nd Avenue Miami Shores, Florida 33138 USA Ref:Certificate of Occupancy—Permit#: RC-10-15-2737—CERTIFICATE OF INSULATION Attention Building Department By this letter we certify that we have installed sound insulation on internal new partition fiberglass un- faced R-19 and we have also installed R-5.0 radiant insulation on existing exterior wall in the second bathroom that was renovated. We also confirm that the master bathroom had existing insulation and we have not removed it. Yours truly, Hernan Santarcangelo Certified General Contractor CGC1513671 A3 CONSTRUCTION LLC 1800 SW 1n AVENUE-SUITE 307-MIAMI-FLORIDA-33129-TEL 786 302 5236 �e Miami Shores Village • �\'��� � 9OCTS 7 1015 Building Department 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 2014 5+11 BUILDING Master Permit No. PERMIT APPLICATION Sub Permit No. X UILDING ❑ ELECTRIC F1 ROOFING ❑ REVISION ❑ EXTENSION RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: I oo Mr 1,05 S'r City Miami Shores County Miami Dade Z)o: Folio/Parcel#: 41 " 21'3(- O6 o Is the Building Historically Designated:Yes NO_> Occupancy Type: Load: Construction Type: Flood Zone:)_BFE: FFE: 2 OWNER:Name(Fee Simple Titleholder): N� t {Q�e �� Phonek 3 I a Address: lk—� 0 G :S-T City: 4 t 05tA \ efe State: Zip: Tenant/Lessee Name: Phone#: Email: �(.� 1 CONTRACTOR:Company Name: +/�fJ > CNSTW CCAA LkC Phone#: =1 �'�- Address: 49,oto s%/Ij 7IT AAx +30 1 City: AM#/U`t —State: FL Zip: 33al Qualifier Name: rj4xt'C;' Phone#: "3'Z=5234• State Certification or Registration#: R 5, 3!p,:)- Certificate off�Competency#: DESIGNER:Architect/Engineer: 40 3AIOT*WA&j40W Phone#: 3bt 5Z" Address: ISQO �j1 �� 1/E City: P^'tW A41• State: Zip: 331't9 Value of Work for this Permit:$ Square/Linear Footage of work: Type of Work: ❑ Addition Alteration ❑ New Repair/Replace ❑ Demolition Description of Work: 1"?VO4 it ftna'K"0-4 MD OMAN 7**%l Ori toots 4241 NAL K- - iAI Specify color of color thru tile: (� Submittal Fee$ ae Permit Fee$ 1 `�CCF$ L-::;`tt _ CO/CC$ =. Scanning Fee$ f C-r_Radon Fee$ :�� DBPR$ I < Notary$ Technology Fee$, L_Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ 10;3--C k TOTAL FEE NOW DUE$ C S a ';:C) (Revised02/24/2014) o 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$2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment Also,a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charge(( Signature OWNER or AGENT CONTRACTOR The foregoing instrument -was acknowledged before me this The foregoing instrument was acknowledged before me this day of l'y' 20 ST .by day of 20by tJ 1 -• ,who is personally known to Yl - !26'4Iio is personally known to me or who has produced S e-6 Q-XA—Ar*-as me or who has produced) d t Cie as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign Sign: + Print: �-QZU'R7 Print: Aleida J.Guevara Seal: Aleida J.GUM a Seal: anon, o°�4r?�'•. °°*.n �.rk °s'� COMMISSION#FF025143 .... COMMISSION#FF025143 33 = � EXPIRES:JUN.O6,2017 DARES:JUN.06,2017 NZ wWW.AARONNOTAB1S�= Oma`aa``° WWW.AMONNOTARY. 1 �ren� APPROVED BY Plans Examiner o //A211,e/Zoning Structural Review Clerk (Revised02/24/2014) CFN:20I50669413 BOOK 29820 PAGE 758 DATE:10(19/2015 03:32:54 PM Preamd IW an-d Return to., DEED DOC 0.60 Thomas Q.Shehnan,P.A. SURTAX 0.45HARVEY RUMN,CLERK OF COURT,MWDADE CTY 90 Almeria Avenue Corral:Gables,FL 33134 SPACZ480$W- yVIUNTYPI.EED Made:thisJ.'-day of October,2015,A.D.by John E-Duobwk a married=4 whose:pod officer.addiess is:6 Overlook Drj,,%Warren,NJ 07059.(herainafter called the"anintell to Susan Trevz4 whose post office address b: too NE I 05Stree4 Miami Shores,Florida 33139(her4paftor*W the"Granteel- PAwewimdher#IWIhe-r&*"VWMMI"dnd"WaWee Indu*allikepwOes to this Insthaw0-sid4he hft legal rqpra9W4dVe9,PW4WVV 0fI&6kbd4 and.diesmmsm andaysigm-ofmperallow) WITNESSEM that the Gmator,for and in.consideration of the sum of Ton Dollars(510:00)and other good and valuable-consideration to Grantor in hand paid by Grantee.the receipt whereof is hereby admowleft0d, hereby Vents,bargains,sells,aliens,remises,TWORM conveys,and confum-unto the said Grantee and Grantees heirs,successors and gWps forever,all-of that certain.land;.sMi#k lying and being in the County of hrmni- Dade.Stow of Florida to wit: Lots Thirteen(13)and Fourteen(14)In Block One Hundred Tweh"ike,(111), of A-MEMI 'M PLAT OF MEAM SHO RM SEM- ON..FJvF0 according to the Plat thereof,as recorded in Plat Book Ik.at Page 47,of the Public AecOrds-Of Mawl-Dade County,Florida. AMR 180 14E 185 Streeti Miami Shores,Florida Pared Identiocation.Nawber.114136-9134M This Deed b being recorded to amend the Quit Claim Deed recorded in 02M._2WJ at pap M to provide warranties of tide from ft Grantor. This Deed Is.being prepared without examination of Title and by the request of the Grantor. Said PM"is not the hmestead-ofthe Grantor under the laws and-constitution-of the-State of Florida. This conveyance is.made subject to:the following. f. Esswnen%rights of way,Ifinitations,reservations,covenants and mwetionsof remxk if any, which are Wing re-imposed.,,and. 2. 74nbg or.other regulatory laws and ordinances affecting theland,itany. TOGETFM with sit the tenewerts,hereditaments and appurtenances thereto belonging or in anywise apperteinh* CFN:20150669413 BOOK 29820 PAGE 759 ToUveand.to•lyolk:t 6 mm`h+t"*DWMPtef*tGv Aiadt •Gzeatvrb Eby.covenants: said Qran%egm&t0 Qirdcr is.boMysqbcdl otsddlad in he simopte;:tl�t tb Granter: s$void:t% t<a�ad hitt airthorsty io felt convey said :that Gator h+areby Willy the tltie to:ss�td:lat►d and wits c#e iid th 'atiame agafnst [awfut c of stt p :wlio vec; nzd-tWoddland isfineof40wc=braumcuca t==w4oft sWmquatto DmObwk,.2M4. +`�` N�ik���L W:��OF,the F l�im Na Riff w 'dped and saW. .. :*10.x- ` =d•7'O Aut above-VAOM $I�'1,1e�,> �'a>t�de�lYCnd'�IIIOiIti' S3e« -. WNane: S�A►TE t?F 1 dJ�X �. t QUNT.-Y OF.M4 S }: RWM MX•a Wotqty Ptiblc-duly. M&Oiza:to:ai MW*roaft and stoke ad' #t*0 •County sod r at ,abm►e6 pmwa -aP d E V&o n icy awn`tg ice airy io :bas. l,, m!!M . sa Iden ti fang hey ac cwIectgad bn*e mm .that be �:the s�aiane. JN Wd717M Et7F,I.ilav'e hommto;m t W :and sfited my oMOM seat;is-the-location sforvwK—Ws jday of o ,:24 5. -sS S 3f dr, b ° My Co mmtiss on •`,•'t._ ::^ .�¢�^^ti .Y4t `SL rAR mw oF•"yw�s�4y.�!�wfi!Fr� 603291 � OR— a"�`�� �naw`� ,y r r 0, n 'a .y I_ - .�fit"' X, �'��>s` •_. i�}"� Y ¢ y T &� OWN , SEG EE OF PAYME ECE AUCTION`LLC G RAL B NLEC � �� w � CGC15'P71 f � � �� TAX 5.00 0,7103/2V, 5 $� $} 5 tEDITC It?-1 2688 g r Bu hNimm"1a>G The is Mt s a the any 90 I ; - 1 � 6i N0. ust 5e on all idles—M 8a—Zl6 F E' RICK SCOTT,GOVERNOR KEN LAWSON,SECRETARY t PARTM�NT QF 1 54 essto I fSI t NQ#�RCIf Nle �6ti TION MIC Mk NMMM- y Viriol y 4 ISSUED: 03/12/2015 DISPLAY AS REQUIRED BY LAW SEQ# L1503120003007 J Aco II CERTIFICATE OF LIABILITY INSURANCE DATE(MM,DD"YYY' 164. 10/2/2015 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 pollcy(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 NC%E cT Maria Martinez Coastal Insurance Group PHONE 305-887-5999 FAx 305-887-7809 (AiC No E4-150 Westward Drive E-MAIL Miami Springs FL 33166-1660 .mmartinez@coastalinsgroup.com INSURER(S)AFFORDING COVERAGE NAIL o INSURERA:Colony Insurance Company 39993 INSURED A3CON-1 INSURER 8: A 3 Construction,LLC INSURER C: Haman Santarcangelo 1800 SE 1 st Ave#307 INSURERD: Miami FL 33129 INSURERE: INSURER F: COVERAGES CERTIFICATE NUMBER:525077632 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 INSURANCEADDLISUBIR POLICY EFF POLICY EXP LTR INSD POLICYNUMBER MMMD MMQ LIMITS A X COMMERCUU.GENERAL LIABILITY GL4030813 1/30/2015 1/30/2016 EACH OCCURRENCE $1,000,000 DAMAGE RENTED CLAIMS-MADE X❑OCCUR PREMISET Ea occurrence $100,000 MED EXP(Any one person) $5,000 PERSONAL&ADV INJURY $1,000,000 GEITL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY❑jE60T El LOC PRODUCTS-COMP/OPAGG $1,000,000 OTHER: COMBINED SINGIM-M $ AUTOMOBILE LIABILITY Ea accident $ ANY AUTO BODILY INJURY(Per perm) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ HIRED AUTOS ANUOTN-OWNED PR PERTY DAMA E $ AUTOS (Per, UMBRELLA LIAB HOCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY YIN N STATUTE ER _ ANY PROPRIETOR(PARTNER/EXECUTIVE ❑N/A E.L.EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ If yes,de�aibe under DESCRIPTION OF OPERATIONS below I E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached H more space is required) General Contractors License#CGC1513671 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Miami Shores Village Hall ACCORDANCE NTH THE POLICY PROVISIONS. 10050 N.E.2 Avenue Miami Shores FL 33138 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD 10/9J2015 Report Viewer ' • I �11 100% 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: 9/21/2015 EXPIRATION DATE: 9/20/2017 PERSON: SANTARCANGELO HERNAN FEIN: 472464016 BUSINESS NAME AND ADDRESS: A 3 CONSTRUCTION LLC 1800 SW 1ST AVENUE#307 MIAMI FL 33129 SCOPES OF BUSINESS OR TRADE: LICENSED GENERAL CONTRACTOR Pursuam toCt 440.06(14).F.3.,mi officer da corparatlon who sleds ezempfl°n from dds cheptc br fllirga oertlficata deleclla+utxler tHs aecdm may not recast berreflisacampertseflan to'Wer tMsd .Pur�uant to Chapter 440.05(1 ,F.3.,C cotes delec6an to beex�npt...apply�Y wiUdn ita>acopa dOre htsirrese a trade listed m the ncOce deleeflm to be mrempt.Purauerdfo Cts 440.05(13).F.3..Ndices delectlm toba e�cempt and catlflcatesdelec6on to beexanpt ehafi be suhjedto raocatlon if.at arryflmeaRer tliefllirg dtle no6ceathe issuancedthecerfl6cate, the person rremed m the rg5cea cerflflra0erq lager meds the reoylremer4s dOds aectlm far I d e cer5flrx5e.The danertrnerd�rell revdrea DFSF2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUESTIONS?(850)113-1809 httpsJ/apps8.flcb.com/Crreportviewer/reportViewer.aspx?data=kdvpginc9D7Q3gH6TER6eP1IWZ%2fSzSbXKYfBxkrekeESoPVylv4NPOPN42XeirDRGXVW... 1/2 ' AIS October 2"d 2015 State of Florida County of Miami Dade Before me this day personally appeared Hernan Santarcangelo,who being duly sworn,deposes and says: That he will be the only person working on the project located at: 100 NE 105st,Miami Shores, Florida 33138. Sworn to(or affirmed)and subscribed before me this 2nd day of October,2015, by Hernan Santarcangelo o� Personally known Or Produced Identification Type of Identification Produc ,,rp vaara, Public Notary ` 4P�YPliB��ip Aleida,I.GUB�lafa 'd�T(W#FF025143 JUN.06,2017 WWW-MR0NNoTAffu= A3 CONSTRUCTION LLC—1800 SW 1ST AVE SUITE 307—MIAMI FLORIDA 33129—TEL 786-942-1755 . . ' SOR Irl iami hores Villagegoal S Building Department CpR�► 10050 N.E.2nd Avenue 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 the contractor's company for day labor,part-time employees or subcontractors. BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. Signature:,�--� v Owner State of Florida County of Miami-Dade The foregoing was acknowledge before me this day of&10��� ,20(S By -��\ ��ey b`ate who is personally known to me or has produced A Cin�.�-E�✓� as identification. Notary: A& _0_ . SEAL: ,�,•;�'"y'!!,-' Aleida J. Guevara `z� MISSION#FF 025143 1:' IBES:JUN,06,2017 From:Maria.Martinez FaxID: Page 2 of 2 Date:=J2016 01:07 PM Page:2 of 2 A3CON-1 OP ID: MM AcoRvg CERTIFICATE OF LIABILITY INSURANCE FDA021261D016 02/26/2016 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($), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER NCONTACT AME: THOMAS L WEBB Coastal Insurance Group,Inc. ac No):305887809 150 Westward Drive wa .305-887-5998 Miami$prings,FL 33166-1660 -MAIL3058877809 Coastal Insurance Group,Inc. ADDRESS: INSURER(11)AFFORDING COVERAGE MAIC A INSURERA:Colony Insurance Company 39993 INSURED A 3 Construction, LLC INSURERB: 1800 SE 1st Ave#307 Miami,FL 33129 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. NaR 00L NUOK -POLICY EFF POLICY UP LTR TYPE OF INSURANCE POLICY NUMBER MMIDDIYYYYI (MM1OD1YYYYI LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE 0 OCCUR 101 GL 0048343-00 02/26/2016 02/26/2017 PREMISES Ea occurrence) $ 100,000 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 %_r71 POLICY 0 JECT FILOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINEDNGL UN I $ Ea flcddant ANY AUTO BODILY INJURY(Per person) $ AUTOS NED AUTOSU�D BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED OP RTY 0 `E AUTOS $ Per accident $ UMBRELLALIAB IOCCUR EACH OCCURRENCE $ EXCESS L1AB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ Is WORKERS COMPENSATION _ AND EMPLOYERS'LIABILITY Y I w STATUTE ER ANY PROPRIErORIPARTNERIEXECUIIVE OFFICERIMEMBEREXCLUDED? NIA E.LEACH ACCIDENT $ (Mandatory in NH) EL DISEASE-EA EMPLOYEE $ Dyes desvibe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,Maybe attached It more space Is required) HERNAN SANTARCANGELO A3 CONSTRCUTION LLC LICENSE#CGC1513671 CERTIFICATE HOLDER CANCELLATION MIAMISH SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE MIAMI SHORES VILLAGE HALL THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 10050 NE 2nd Avenue ACCORDANCE WITH THE POLICY PROVISIONS. Miami Shores,FL 33138 AUTHORIZED {REPRESENTATIVE O 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD " z _ � � t rs 17 iii� d Miami Shores Village a 10050 N.E.2nd Avenue NE '' .. Miami Shores,FL 33138-0000 a Tr T Phone: (305)795-2204 Expiration: 08/29/2016 � .; 011 �,. Project Address Parcel Number Applicant 100 NE 105 Street 1121360130690 Miami Shores, FL 33138-2033 Block: Lot: SUSAN TREVISA Owner Information Address Phone Cell SUSAN TREVISA 100 NE 105 Street (305)992-3134 MIAMI SHORES FL 33138- 100 NE 105 Street MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone Valuation: $ 25,000.00 A3 CONSTRUCTION LLC (786)942-1755 _ - Total Sq Feet: 250 Approved:In Review Available Inspections: Comments: Inspection Type: Date Approved::In Review Final PE Certification Date Denied: Drywall Type of Construction:INTERIOR ALTERATION AND ADDI Occupancy: Miscellaneous Stories: Exterior: Window Door Attachment Front Setback: Rear Setback: Tie Beam Left Setback: Right Setback: Final Bedrooms: Bathrooms: Framing Plans Submitted:Yes Certificate Status: Insulation Certificate Date; Additional Info: Truss Insp Bond Return: Columns Classification:Residential Foundation Fees Due Amount Pay Date Pay Type Amt Paid Amt Due Window and Door Buck Bond Type-Contractors Bond $500.00 Fill Cells Columns CCF $15.00 Invoice# RC-10-15.57570 Wire Lathe CO/CC Fee $50.00 03/02/2016 Check*1098 $607.76 $907.74 Review Structural DBPR Fee $11.25 10/27/2015 Check#:1232 $50.00 $857.74 Review Electrical DCA Fee $11.25 03/02/2016 Check#:1221 $357.74 $500.00 Review Electrical Education Surcharge $5.00 03/02/2016 Check#:1012 $500.00 $0.00 Review Building Permit Fee $750.00 Bond#:3000 Review Mechanical Plan Review Fee(Engineer) $120.00 1 Review Mechanical Scanning Fee $33.00 Review Plumbing Technology Fee $20.00 Review Plumbing Total: $1,515.50 F.Termite Letter F.Elevation Certificate Review Planning Declaration of Use 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 ELEC I ,PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work. OWNERS AFFI I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating constructi n n' Futhermore,I authorize the above-named contractor to do the work stated. March 02,2016 Authorfzed Oignature:OwnerApplicant / Contractor / Agent Date Buildirfg departme t Copy March 02,2016 1 PREPARED BY. i}Ne fin St E9i i V ® r tom sl _< ® r E) CACTA e Land Surveyors Inc. NE 1"M r www.exactaland.com __ D Toll Free 866-735-1916 • F8"-744-2882 NS 102FW sal " PROPERTY ADDRESS: 100 NE 105TH STREET MIAMI SHORES,FLORIDA 33138 SURVEY NUMBER: 1508.3031 FIELD WORK DATE:ammis REVISION DATE(S):(REv.o anis) ; BOUNDARYSURVEY M"ADE COUNTY /Zz f M r,PIP NO I%M2,go,E 79.72'(M), 105.10 Q O/A NO ID 9;; ,e:: s r:«s j.•s•: .. v a B.C.: •I �I t:' 1J2°PB' k - NO ID 30.0, LOT 14 m LOT 13 BLK 121 BLK 121 I NOI NO IDD f 4.TO 6 Ln r r Q i ON LOT 12 LQ19.4' a 3' 13. � : � BLK 121 W 1 1.7 I I ad 18.6' � — ST�r. 9.2' Q 145#100 AAC W W N (n 12.4'm 35.4' 3 � LLJ I so n m to Z 3 1O.2' 1 ( WM O'ON N a4j ;I 1N Iv O NOTM: s LOT APPEARS TO BE 5P RV M 1W CITY WATER AND SEWER PENCE OWNERS41112 NOT DETERMINED I ht;reby cewdly the hamm desaAwd pmt wife and>o B1e beg t Iso bw andaorxua meets Me 40 0 20 ao nwn 1 b Flodda Bowd of profesabiws I 5J-17of Akbrfttis GRAPHIC SCALE (In Feet) i i inch 40' ft. N KEITH A.sTEPHEN30N snaeaaftaattft Pratxmt Strareywtmd mamer U00m No.021 NIL Use oMfs Survey for Purposes otherthan Intended,W*"x Wrt m VertficWm will be at Ow User's Sole Risk and Without UaW tyto die Surveyor. Nothing hereon shag be Construed to On ANY fthft or Benefits to Anyone Other than ftm Certified. FLOOD INFORMATION: '. POINTS OF INTEREST BY PERFORMING A SEARCH WITH THE LOCAL GOVERNING NONE VISIBLE MUNICIPALITY OR WWW.FEMA.GOV,THE PROPERTY APPEARS TO BE LOCATED IN ZONE X.THIS PROPERTY WAS FOUND IN THE VILLAGE OF MIAMI SHORES,COMMUNITY NUMBER 120652,DATED 09/11/09. •• ••• • • • • • •• CLIENT NUMBER •x,. AFFILIATE CL � •� � � � U4T�: 8/Q�/2015 � � 1 / MEMBERS BUYER:Susan Trevisa SELLER: • • • • • • • • , . , , �r7=j7La CERTIFIED TO:SUSAN 2REVCS'A M"- � Land Surveyors inc. °4 6This is e 1 2f ^d is otb ho all es.` f P.B66735-t�te•F.�-;•4� 2 ' tag QF •�1d t¢ P1g LBtt337 11WFsk%WLaWD"W&I-Ft MymFL33M3 < ... . . . ... . . s- REPORT OF SURVEY 1508.3031 This is page 2 of 2 and is not valid without all pages LEGAL DESCRIPTION: LOTS THIRTEEN(13)AND FOURTEEN(14),IN BLOCK ONE HUNDRED TWENTY-ONE(121),OF AMENDED PLAT OF MIAMI SHORES,SECTION FIVE,ACCORDING TO THE PLAT THEREOF,AS RECORDED IN PLAT BOOK 10,AT PAGE 47,OF THE PUBLIC RECORDS OF MIAMI-DADE COUNTY,FLORIDA. JOB SPECIFIC SURVEYOR NOTES: THE ASSUMED BEARING REFERENCE OF SOUTH 0 DEGREES 00 MINUTES 32 SECONDS EAST IS BASED ON THE EASTERLY PROPERTY UNE OF LOT 13 AND 14,BLOCK 121,LOCATED WITHIN AMENDED PLAT OF MIAMI SHORES,SECTION FIVE,ACCORDING TO THE PLAT THEREOF, AS RECORDED IN PLAT BOOK 10,PAGE 47 OF THE PUBLIC RECORDS OF MIAMI-DADE COUNTY,FLORIDA. GENERAL SURVEYOR NOTES. 1. The Legal Description used to perform this survey was supplied by othemThis survey does not determine or imply ownership. 2. This survey only shows improvements found above ground.Underground footings,utilities and encroachments are not located on this survey map. 3. Ifthere is aseptic tank or drain field shown on this survey,the location is approximate as the location was either shown to Exacta by a third party or It was estimated by metal detection, probing rods,and visual above ground inspection only.No excavation was performed in order to determine the exact and accurate location. 4. This survey Is exclusively for the use of the parties to whom It is certified S. Additions or deletions to this survey map and report by other than the signing party or parties is prohibited without written consent of the signing party or parties. 6. Dimensions are in feet and decimals thereof. 7. Due to varying construction standards,house dimensions are approximate. & Any FEMA flood zone data contained on this survey is for informational purposes only.Research to obtain such data was performed at www.fema.gov. 9. All comers marked as set are at a minimum a+h'dlameter,l8'Bron Taber with a cap stamped LB47337. 10.if you are reading this survey In an electronic format the information contained on this document is onlyvalid Ifthis document is electronically signed as specified in Chapter 51-17AIS2(3)of the Florida Administrative Code and Florida Statute 472.025.The Electronic Signature File related to this document is prominently displayed on the invoice for this survey which Is sent under separate cover.Manually signed and sealed logs of all survey signature files are kept in the office of the performing surveyor.If this document is in paper format it is not valid without the signature and original raised seal of a Florida Licensed Surveyor. 11.Unless otherwise toted,an examination of the abstract of tide was NOT performed by the signing surveyor to determine which instruments,if any,are affecting this property. 12.The symbols reflected in the legend and on this survey may have been enlarged or reduced for clarity.The symbols have been plotted at the center of the field location,and may not represent the actual shape or size of the feature. 13.Points of Interest(POrs)are selected aboveground improvements which may be in conflict with boundary,building setback or easement Imes, as defined by the parameters of this survey.There may be additional POPS which are not shown,not called-out as POrs,or which are otherwise unknown to the surveyor.These P01's may not represent all items of interest to the viewer. 14.Utilities shown on the subject property may or may no indicate the existence of recorded or unrecorded utility easements. 15.The Information contained on this survey has been performed exclusively,and is the sole responsibility,of Exacta Surveyors.Additional logo or references to third party firms are for informational purposes only. I&Pursuant to FS 558.0035,an individual employee or agent may no be held individually liable for negligence. 17.House measurements should not be used for new construction or planning.Measurements should be verified prior to such activity. LEGEND: 5UKVEYOR15 LEGEND uMI:IVP�t�,,,ta,�ltaml Ac aARINGR fEREN m• �iIAly roti std. 90ctan t apN' a� BR BWNXi ML aJP&&P 9M 91IFTICTMQ &G aWKIWINP= MET. D19awmliT also. SETGL S BBB. BACIO'IOWPRLYEETN'TOR W � 9X,V 9Cf CMUC DMIC am IN= L LZINIMI BMG Wr IAV ROD 4 W CEJI BLDG. BIAlDiNG Let UtZM#-KONM am ser 1"4 DMIC ' C11AD0.tM rYYMCPENCC am anic"MAlak 19! UCENBCi-9URV&M gp,pr. SQUARE FEET �. B.R.L BUIUMiGR YNCIION tea' " MFASURm STY. STORY C0.90M@Nf 89MT. BASOM MS. MAP BOOK S,T.I. BLINVEYTICt1NC ®GC OF WAYM HW DAVOOMINDOW MES. Mtn=ED 5000ON 9V BE=VALVE (Cd CALCUTAIW M.P. WI LLPENCE aid, SDN" am PENCE c CURVE N.R. NON RADIAL S.W. 9PAWAU. CATV CABLE TV.la9CR N.T.S. NOTTOSCAU! iBAA TZINCRANYBEINCIINAM OVEICTAD LABS G.B. CONCRETE BLACK O.CS. ON CONCRETE 91.0E IE. YZIM"Dtle PACIUnl9 CCDM. Cts' O.G. ON atom T.O.B. Tw Or s" 9URVE'71E 1a@ C.I.P. OINN UIakFENCE o4 OUTSDE OF SU8R6T PAF= TWE. TOWNSW WALL ORPAIOYWALL C.O. CUMCQY OK. ovatil i TX TRAM CONE. CONCRETE OM OVaa1FAD LM TEP. TYPICAL MOODMNCE COR. colum ON somor..Aa Trmm U.R. Unr1YR19ER Vain PBaS CSW& GONCIMSMVAW L OAa OFF= B00K NBC WITNI98OOMM C.V.G. CONCREMMIBYGUITEt O.R.V. Ora& vO me NBP wATIRITI Et CA. CEO UNE CIA OVERALL W.P. WOODEN F@OE 9URPACC TYPES,«rmmoamtssexvw Gr COVERED POFM CO OM'8Ef WAi WATIFtNIM MALVE BOX CONCRETEA9PIIALT® ® (La 91.0E 01) PLAT .r VALVE am PSPAT BdV. vamreifY DhoB. DItADIM19D P.C. POINT OF COMFOU ID CONCRC2 3'•. ggpq ":. OORVENMY P.C.C. PDDR OrCOMPOUlD CURVATURE ® ® 9". ELEVATION P.C.P. PBGiANENTWNFROLPOINf AE. AOOC99 EASEMENT EMO. BIpG81Nt M POd.381WMOiT AN.G ANCIORMCNIENr SYMB019t(•umonm••emma• �• MGfCR MFADE ItR90CfWt( CAM IT. MaRANCE WIN ® C.U.C. COUNTY Urany raw. CAB. EDGE Of PAVEMEir fly FROVISSIGMIAL IACD SUFIVEM DE. txtARM(RMOMENT CENiCRIIt@ GO.W. EDGE OF WIM PLT ygNTCR D.U.C. DRAINAGE AND UTILITY WW. A CENINLLANdE or DETA no ELCTWCurturram PAS. POINTOPBE6vemG WINIT. EASEMENT p,11 COMMONN OWNERSHIP 09 FIELD PA.C. PDXIf OrODA•A IT IX f-r- a raw. • CONTI ,PO1Nr PCM Elm.CONCRETE MONUNIEtr PB. PINQf®PRC aw t. IRRIGATION 09311a Nr ■ CONCRLTEMONamif rw POUND ORDL MOLE P.RC. POINT Or MOM CLONAFUNZ LAG UMM!D ACOM Mr. �_Immm �T� F.F. RXIS D ROM PJLAI. PEMAtQYJf AJC IIDNIANEIr tax- iMO9CAPE IRIN'ELE%(r. '`CICO' El"ATCA( RP FOUND IRAN PIPE PSM P NALSURVM7R LE. IAND9CAPC WW.PRC POLAND WON PIPEt CAP AM MAPPER. I.M.E. tWORIANDSCAPC 1Y MRC r1YDRANT PM POUND DICK ROD P.T. POINT OrTANGE/C1' • PND OMI'MfONUMENT PMC FDUXD 61ON ROD 4 CAP R R40M o RADIAL MAINTP.IVANCC PASOMI1' IW POUND MNL ME. I`USUCMAMnUnUT C ASENIE r E- WAVIOEORANCNOR two PtXAD NAIL4DI9C RA P.U.r ROM T. TI MIOIE MND. to= REB. R1�EICE RO.G smem EtNANGi`3Mf. .tom PMN POUND PAM=-IiAIDN NAIL RAV RDNTOPNMY B.W.C. SIDEVNXPA9EAEi1' UfD.1TYORLIGt1TPOU! MOM PDUNVMNAM$MKI% SURVEY 9.W.MP.STORM WATER. Wim, FWISPK PgNND PADJmAD 9M1� 9.A- 9011NXU NC MANAt�IENf Mr. r, GAR, GARAGE S.C.I. SURVn•pDaM UNE T.UP. 715CIWOLOGICALUMMYeShAT. GM GAS MEM SCR SCREEN U.E. UraKYPASE LENT ELECTRONIC SIGNATURE: PRINTING INSTRUCTIONS: OFFER VALID ONLY FOR: Susan Trevisa in complete accordance with Florida Statute 472.025 and Pursuant to 1.While vlewirg the survey in Adobe Reader,select the the Electronic Signature Act of 1996 or Florida Statute TITLE XXXIX, , "bLttOn "fie" Chapter 669,if this document was received electronically via PDF, then it has been lawfully Electronically Signed.Therefore,this survey 2.$elect a will I s¢ed r. r ----- --- - - PDF,Ifauthenticiscompletelyotficialand insurable.In ordertovaUdate pNlter �� the•FJectronicSignatureofPDF surveys sent via www.surveystars_corn 3.Under-PrintRang;dick select the-All"toggle. you must use a hash calculator.A free hash calculator is available for downloadat 4.Underthe"Page Handling'section,select the nurnber _ www-u,lly�+iia.Num/yeVSyslemlFle-Maneye•�enl/Ha+h I dawn Kiril srtml I - Of COpMXi that you would like t0 pont. In order to validate the Electronic Signature ofany survey PDF sent via wwwsurveystamoom 5.Urlderthe"Page Scaling"select ocant n drop demenu, L Duwnbad the Hash Cakulatoravagabie at select"Nene." F •• •� OO Oa 2.Save the Survey PDF onto your computer from wwwwrveysmmoom 6. Undtedk the"Auto Rotate and Center"checkbo. i i i •, 0:500) or from the email sent from wwwsurveystarscom. 7.Check the"Choose Paper.by PDF"checkbox• •• • •) • • • 3.Click the square Browse button to the upper right hand comer of the X . . . . . . N 'FUTURE Hash Calculator tofirWaid select the saved Survey POF document arid dIck 8.ClickOKtoprint •• • • the CDMSJTE button in the bvw right hard comer ofthe Hash Calculator = � � + ALRWYI�I• G SERVICES 4.Compare the 40 digit string of characters in the SHA-t line to the 40 digit SI-WI characters for the survey In the job&in wowsurveystamccrin wkds - 1. In the main print screen,choose'Properties". ON THIS PROPERTY Is also printed on the invoice for that survey. ••• • ••• S.Ifthe40d(g[stM9 of SHA-1 dwactesareeracdydmsameon the invoice 2.Choose-Quality'from the options..- - (or nthesu rcy tueatwwwsmta skvNastixyarentl,eHashcakulato 3.Change from"Auto Color"or"Full Color"to • • • Q� then this PDF is authentic Ifthe 40dfgtstring of characters does not match • • •• exactly,then this PDF has been tampered with and it is not authentic "Gray Scale". •• • • ?' • ,� • • • 4ro Trr •�tii- Exacta Land Surveyors,Inc �t�f�+ „ ® i i •i• i i iPMIS-15-fa1S•FZW744-2882 10" A® Leff 7337 • 1 1P M{yert FL 33913 • • ••• • • • •••