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RF-6-334 Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)7564972 Inspection Number: INSP-257592 Permit Number. RF-2-16-334 Scheduled Inspection Date:June 01,2016 Permit Type: Roof Inspector: Mesa, Michel Inspection Type: Final Owner: LANSER,CHRISTIAN Work Classification: Gutters Job Address:175 NW 100 Street Miami Shores,FL 33138- Phone Number (305)772-4313 Parcel Number 1131010230320 Project: <NONE> Contractor: WATERTITE GUTTER CO INC Phone:954-563-2207 Building Department Comments ALUMINUM GUTTERS AROUND THE PERIMETER OF ffil� IF ommen ts THE ROOF WITH 5 DOWN SPROUTS INSPECTOR COMMENTS False Inspector Comments Passed CREATED AS REINSPECTION FOR INSP-252336. Provide splash guard. The down spouts should drain a minimum of 12"from the wall. Failed -Tt CW.5t Correction Needed Re-Inspection D Fee No Additional Inspections can be scheduled until re-Inspection fee is paid May 31,2016 For Inspections please call:(305)762.4949 Page 12 of 45 ...... _....._�.___ ......_._ FOAT *'� A6 CERTIFICATE OF 1_1ABIUTY INSURANCE 5I2s12oi6 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. *S CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. I ORTA . : i€ Certylo to hONtler is an ADDITIONAL INSURED,tine poiicy(les)mud be eNuiorsed. if SUBROGATION IS WARNED,subject to the term and conditions of�policy,certain policies may require an endorsemer� A Statement on this certificate does not confer rights to the cer"icate holder in lieu of such s. Judy Pinkney PRODUCER Corporate insurance Advisors (956)315-5000 FAX t984)31s-5050— 1601 B B award BlvdjpinkneY@ciaf1.not suite 103 DOWM481AFFORMGCOVERWE Nmc p It. Lauderdale rL 33301 INSURERABrierfield Insurance Ca 012306 INSURED INSURERBiMiladelphLa insurance CO Tokio Vatertita Gutter COMPanY, Inc. #NEURrRc-sr:Ldgefie1d ftyloyers Ins Co 211 AT.)$. 32 Court INSURER D: INSURER E: Fort Lauderdale rL 33336 F: COVERAGES CERTIFICATE NUMBERAS-•16 GL/Auto REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED) NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH TH{5 CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TYPE OF UISURANCE N LIMITS GENERAL LIABILITY EACH OCCURRENCE 1$X COMMERCIAL 1 r 000,000 � ecdrrenee I$ 300,000 A CLAIMSMADE i x l OCCUR i i .f€� 2 _ OW0172632 10/19/2015 10/1912016 MED EXP(Any S,_,.. 10,000 PERSONAL&ADV INJURY S 1,000,000 II GENERAL AGGREGATE I$ 2,000,000 V G�WL AOMEGATE LIMIT APPLIES PER: j `I 2,000,000 per_ F i I PRODUCTS-COMPIOP AGG S $(POLICY JECT i LOC V S 3�� 3 i OTHER: COMOI LIMIT AUTO! LE LIABILITY s is-- INJURY 1'000,000 V BODILY INJURY(Per perANY AUTO 800ILY (Per fit)i$ALLOWNED 77 SCHEDULED iPHHR1408398 10!1912015 10!1912016, — AUTOS AUTOS ! PR TY) GE $ HIRED AUTOS iAAUT0SWNED d _ $ 10,000 UMERELLA UAB i OCCUREACH OCCURRENCE S I j MCO:ESE LIAR i CLAIMS4AADE AGGREGATE $ t WORKERS COMPENSATION 7t AND EMPWYERV UAMUW YIN I E.L.EACH ACCIDENT $ 1,000,000 ANY PROPRiETORJPARTNERtFXECUTNEimmawAmy I—j C IOFFICIUWMSE gqeessei ExCLL�ED4 (_ J N 1 A s3a16079 4/1!2016 a/1/2017 E,L,DISEASE-EA EPI OYE $ �. 1 t_Q00 ODo IDE FW-.nON OF OPERATIONS Oebw E.L.DISEASE-POLICYLIMB I S 1,000,000 I 1 3 i DESCRW lON O OPERATIONS I LOCATOW I VENICLiM(ACORD 101.Additional RemarM$dmdtde,map bo&Mchod lr apace Is r*dmd) Metal gutter Imbrication and installation Contractor. Contractor Licence #958900051 cornFICATe HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE V1,11age of Miami Shores THE EXPIRATION DATE THEREOF, NOME WILL BE DELIVERED IN Att:n: Building a Zoning Dept. ACCORDANCE WITH THE POLICY PROVISIONS. 10050 ARE 2nd Avenue Miami. Shores, FL 33138 AUTHORIZED REPRESENTATME Mark Schwartz/JUDY 019SS-2014 ACORD CORPORATION. AIR rights reserved. ACORD 20(2014101) The ACORD nam and logo are registered narks of ACORD IN802S r�a�amti o'mte��rpo"Yi ACC> CERTIFICATE OF LIABILITY INSURANCE _ 5/2S/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. WORTA . : If the cerbTaft holder is an ADDITIONAL INSURED,the pailcy(Ies)mud be andorsed. N SUBROGATION IS WAIVED,subject to the term$nd conditions of II*policy,certain policy may require an andomement. A statemant on this certificate does not confer tights In the CaMcaft holder M 11"of such endonam s. PRODUCER € Corporate insuranceAdvierorsl 1954)315-5000 FAX tssa)31s-solo 1601 S S>«oward Blvd �pitikney@ciao net Suit! 103 eisugEgM AFForpme COVERAGE NAIC 0 gt. Lauderdale Bt, 33301 INSURERA SriOrfield Insurance Ca 012306 INSURED INeIRERB:Bhiladel hia Insurance Co Tokio watertito (;Utter Co>epany, Inc. INsuR�cBri efi®1d 10ra Ins Co 211 N.Z. 132 Court INSURERD: 1 IN SURER E Bort Lauderdale B`L 33334 INSURER F: COVERAGE$ CERTIFICATE NUMI3MAS-16 tom,/Auto REVISM NtIltIBER: THIS IS Try 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 V041CH 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 I.IMCC8 x COMMERCIAL L uAarLnY ! EACH OCCURRENCE $ 1,0001000 iFa occurtrtes )_ S ED 300,000 A CLAIMS40ADE F-x l OCCUR i OW0172632 10l19l2015I 10/1912016 MED EXP(Any a m person) $ 10,000 PERSONAL 8 ADV INJURY S 1,000,000 1 GEN'L A(-OGRE SATE LIMIT APPLIES PER: IGENERALAGGREGATE Is 2,000x000 i x POLICY � ,�LOC -PRODUCTS•COMPIOP AGG!S 2,000,000 VS AU1 flJ:LIABILM ,Es m S 1,000,000 $ XX ANY AUTO 1BODILY INJURY(Per Person) $ ANYAUTED 1 �pSCCTHEDULED ggpg1a08398 10/19/2018 10119/2016 BODILY INJURY(Pot ar )� AUTOS ; I SMAGE N-OYoeo S HilHNR�AUTOS AUTOS t PIP $ 10,000 Us1�RELLA UAB I OCCUR FACH OCCURRENCE 3 EXO M LIAS �y j CLAIMS MADE j AGGREGATE _— $ i N E I t WORKERS CD10 4RMTM 8 '$TAT UTE 1 ER AND EMPLOYERW LIAIiNiM ANY PRt RiE70RrPARTNEIMIECUTIVE YIN N i !E.L.EACH ACCIDENT $_� 11000,000 C (Maiddwy KKyyeessin NN) NIA 83016079 4/1/2016 4/112017 1 E,L,DISEA99-EA EMPLOYEE $ 11000 000 DESCRIPTION OPERA W. E.L.DISEASE•POLICY LAHtn $ 1,000,000 i I i V I i DESCRIPTION OF OPERATIONS i LOCATIONS t VEHICLES(ACORD 101.AdtlllO"M R*108ft Ule,MY Hie attsCW If move SPmna Is regWred) Metal Ggtter rabrication and Installation Contractor. Contractor LLoon to 895BS00051 CERTiFICATI=HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Village of Miami Shores THE EXPIRATION DATE THEREOF, NOTICE MILL BE DELIVERED IN Attn: Building & Zoning Dept. Ae:CORDAPltrEVarrHITHE POLICY PRi3V)SIONS. 10650 WE 2nd Avenue Miami Shores, FL 33138 AUTHORED WRESENTATIVE Mark Schwartz/JUDY ®1988-2014 ACORD CORPORATION. AN rights reserved. ACORD 21i(2014101) The ACORD(tante and too are registered marks of ACORD INS025 rmunii � a Miami shores Village 10050 N.E.2nd Avenue NW ' Miami Shores,FL 33138-0000 . ` Phone: (305)795-2204 & €yY ✓/ '� a Expiration: 09/1212016 Project Address Parcel Number Applicant 175 NW 100 Street 1131010230320 CHRISTIAN LANSER Miami Shores, FL 33138- Block: Lot: Owner Information Address Phone Cell CHRISTIAN LANSER 175 NW 100 Street (305)772-4313 MIAMI SHORES FL 33150- 175 NW 100 Street MIAMI SHORES FL 33150- Contractor(s) Phone Cell Phone Valuation: $ 950.00 WATERTITE GUTTER CO INC 954563-2207 - _ - Total Sq Feet: 191 Type of Work:Gutters Available Inspections: Additional Info:ALUMINUM GUTTERS AROUND THE PERIMET Inspection Type: Classification:Residential Final Scanning:3 Review Building Review Building Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $0.60 Invoice# RF-2-16.58603 DBPR Fee $2.00 DCA Fee $2.00 02/05/2016 Credit Card $50.00 $64.60 Education Surcharge $0.20 03/16/2016 Credit Card $64.60 $0.00 Permit Fee-Repairs $100.00 Scanning Fee $9.00 Technology Fee $0.80 Total: $114.60 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 ELECTRICAL,PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work. OWNERS AFFID. I certify that I the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construct and mg. u r ,I authorize the above-named contractor to do the work stated. March 16,2016 Autho gna re:Owner / Applicant / Contractor / Agent Date Building Department Copy March 16,2016 1 Miami Shores Village Building Department MAR �4 1016 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 1BY. INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 2011-t � BUILDING Master Permit No. f2c— 16 — 3SI-i PERMIT APPLICATION Sub Permit No. (BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS 4 CHANGE OF ❑ CANCELLATION ❑ SHOP � ) CONTRACTOR DRAWINGS JOB ADDRESS: I (J L o® s—m5-- ( City: Miami Shores County: Miami Dade Z11): �"atSa Folio/Parcel#: Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: j Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): �I{jZ(SillaCtJ �`'`- -'"C�— Phone#: Address: 1 7;�_ OK) to (7 � City: Ki.6Pc'Kk !S k� State: Zip: Tenant/Lessee Name: Wt k Phone#: Email: �'r'�L-/�1 -- P'C1L' ' C-e'�_i`'► CONTRACTOR:Company Name: V� �����G x e Phone#: Address: ® � 3 City: 1, LA ,*k, /�� State ��' Zi � .3 3 3�'l Qualifier Name:� G�0 V' � � Phone#: 9 jrq ��-3^,2.zP 7 State Certification or Registration#: Certificate of Competency#: 9 5 SDDo 5'/ DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: v J} Value of Work for this Permit:$ r a®� Squar Linear outage of Work: Type of Work: ❑ Addition [--]' Alteration NrNew ❑ Repair/Replace ElDemolition Desai tion of Work: Pi OSS c. AI'k 5 CAx 4S3, /4 u ro��r'h 3A- 19y7�i Rme_. ,; S G Ae4}3 i,v t A ,v tA_S Specify color of color thru tile: Submittal Fee Permlt Fee$ ���i, CCF$ CO/CC$ Scanning Fee$ Radon Fee$ W DBPR$ Q Notary$JQ� Technology Fee$ �, • _Training/Education Fee$ Double Fee$ 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 a reinspection fee will be charged. Sign re Signature r OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before rme this The foregoing instrument was acknowledged before me this Ito day of RPMX .20 b .by I day of ✓"mtAe ,20 UL ,by C 1fQ.tS(i('fin) L.+Ptr.IS� .wh is personally known to D V,iwz KA oala4 who is personally known to me or who has produced as me or who has produced %Jm-t . LAS Nje.C as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: Sign: Print: Print: Seal: .. ME KELLY Seal: 100A, ME KELLY ;�•••• �,� 1 ?r MY COMMISSION#FF064567 MY COMMISSION#FF064567 EXPIRES October 25,2017 ,.��,AoRr EXPIRES October 25,2017 07 �@ 0153 Fbrl APPROVED BY 3ILd� Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) - BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT 115 S. Andrews Ave., Rm. A-100, Ft. Lauderdale, FL 33301-1895—954-831-4000 VALID OCTOBER 1,2015 THROUGH SEPTEMBER 30,2016 awl DBA: Receipt#:189-143673 Business Name:WATERTITE GUTTER CO BUS1neS5 Type: OTHER TYPES CONTRACTOR !i yp (MISC METALS CONTR) �Y D Owner Name:EDWARD V MOONEY Business Opened:04/01/1984 Business Location:2904 NE CENTER AVE State/County/Cert/Reg:843663MMX e FT LAUDERDALE Exemption Code: `, Business Phone:563-2207 Rooms Seats Employees Machines Professionals 10 a" For Vending Business Only Number of Machines: Vending Type: N Tax Amount Transfer Fee NSF Fee Penalty Prior Years Collection Cost Total Paid r 27.00 0.00 0.00 0.00 0.00 0.00 27.00 " t�{ �e AH z THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS THIS BECOMES A TAX RECEIPT This tax is levied for the privilege of doing business within Broward County and is non-regulatory ry in nature. You must meet all County and/or Municipality planning 't WHEN VALIDATED and zoning requirements. This Business Tax Receipt must be transferred when -'i the business is sold, business name has changed or you have moved the �, business location. This receipt does not indicate that the business is legal or that it is in compliance with State or local laws and regulations. Mailing Address: EDWARD V MOONEY Receipt #ICP-14-00023255 211 NE 32 CT Paid 08/28/2015 27.00 OAKLAND PARK, FL 33334 4 0Z z 2015 2016 Construction Trades Qualifying Board g f BUSINESS CeRTIFICATE OFGrOMPETEN& � 4Z 95BS00051 p V 4 TERTITE G..VTTER CO�INC (f 'D.B:A.: Y OONEY EDWARD V k fl1&qIerlhe provisions of Chapter.10 of Miami-Dar?e Grin+ S 000353 Local Business Tax Receipt ` Miami-Dade County, State of Florida —THIS.IS NOTA BILL — DO NOT PAY LB 3351-053 BUSINESS NAME&OCATION RECEIPT NO. Tj EXPIRES WATERTITE GUTTER CO INC RENEWAL SEPTEMBER 30, 2016 DOING BUSINESS IN DADE COUNTY 3491661 Must be displayed at place of business Pursuant to County Code Chapter 8A--Art.9&10 OWNER SEC.TYPE OF BUSINESS WATERTITE GUTTER CO INC 196 SPECIALTY BUILDING CONTRACTOR PAYMENT RECEIVED C/O EDWARD MOONEY PRES 95BS00051 BY TAX COLLECTOR Worker(s) 9 $75.00 01/29/2016 Acd03-16-000827 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 holders qualifications,to do business. Holder must comply with any governmental or nongovernmental regulatory laws ami 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 miomidad9,agy taxcollector 002987 Municipal Contractor's Receip Miami—Dade County, State of Florida —THIS IS NOTA BILL — DO NOT PAY M C 3351053 BUSINESS NAMEILOCATION RECEIPT NO. EXPIRES WATERTITE GUTTER CO INC NEW SEPTEMBER 30, 2016 DOING BUSINESS IN DADE COUNTY 7479066 Must be displayed at place of business Pursuant to County Code Chapter 8A—Art.9&10 OWNER SEC.TYPE OF BUSINESS WATERTITE GUTTER CO INC MMC SPECIALTY BUILDING CONTRACTOfCAYMENT RECEIVED C/O EDWARD MOONEY PRIES 95BS00051 Y TAX COLLECTOR Category(s) 1 $175.00 01/29/2016 Acct03-16-000827 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 holders qualifications,to do business. Holder must comply with any governmental or nongovernmental regulatory laws end 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 miamidade govftaxcollector 0 i i a r Ac�R V CERTIFICATE OF LIABILITY INSURANCE DATE(MWDDNYYY) 10/13/2015 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 P=PRESENTATIVE OR PRODUCEk,AND THE CERTIFICATE HOLDER. 3RTANT: 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: Judy Pinkney Corporate Insurance Advisors P( 4.FaW (954)315-5000 No):(954)315-5050 1401 E Broward Blvd ADDRESS:]pinkney@ciafl.net Suite 103 INSURERS AFFORDING COVERAGE NAIC# Ft. Lauderdale FL 33301 INSURER A:Brierfield Insurance Cc 1012306 INSURED INSURERB:Philadelphia Insurance (Tokio)_.__._.....' Watertite Gutter Company, Inc. INSURER C:Brid efield Employers Ins. Co. 211 N.E. 32 Court INSURER D: INSURER E: Fort Lauderdale FL 33334 INSURER F: COVERAGES CERTIFICATE NUMBER:15-16 Master 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 D_CONDITIONS_OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR+ TYPE OF INSURANCE IDL UBR POLICY NUMBER MMIDDYYYY MMID YYY I LIMITS X !COMMERCIAL GENERAL LIABILITYEACH OCCURRENCE $ 1,000,000 — I --...----- --- Kt:N A CLAIMS-MADE I X I OCCURi PREMISES(Ea 000urrence.)_.._ $_ _ 300,000 IGL00172632 10/19/2015 110/19/2016i MED EXP(Any one person) $ - 10,000 J j I PER 8 ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: i GENERAL AGGREGATE J. 2,000,0 00 POLICY JEST L LOC I PRODUCTS-COMPIOP AGG t$ 2,000,000 L� f OTHER: I i is UTOMOBILE LIABILITYI I Ea BIKED)SINGLELI $ 1,000,000 ccide ANY AUTO i I BODILY INJURY(Per person) is B 'ALL OWNED SCHEDULED AUTOS AUTOS I ' (PBPK1408398 110/19/2015 10/19/2016 BODILY INJURY(Per accident) $ ! �NON-OWNED i I I PROPERTY DAMAGE $ HIRED AUTOS H AUTOS I Per accident PIP-Basi f$ 10,000 OCCUR EACH OCCURRENCE LIAR $ EXCESS LIAB �CLAIMS-MADE i I � i AGGREGATE �$ DED I RETENTION$ i i $ ;WORKERS COMPENSATION X i!PER TUTE_�___i ERH AND EMPLOYERS'LIABILITY — ...... ,ANY PROPRIETORIPARTNER/EXECUTIVE Y�i N I A EACH ACCIDENT $ 1,000,000 OFFICERIMEMBER EXCLUDED? C I(Mandatory in NH) ( 183016079 4/1/2015 ( 4/1/2016 E.L.DISEASE-EA EMPLOYE $ 1,000,000 If yes,describe under DESCRIPTION OF.OPERATIONS below 1 I I E.L DISEASE-POLICY LIMIT $ 11000,000 I i DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Metal Gutter Fabrication and Installation Contractor. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Village OF Miami Shores THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Attn: Building & Zoning Dept. ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE 2nd Avenue Miami Shores, FL 33138 AUTHORIZED REPRESENTATIVE AFT n Office © • �,I • f 211 N.E. 32nd Court (� . Ft.Lauderdale,FL 333 e o - G� VIN C750 (954 Broward: 563-2207 ) - Established 19 • 6"X7"$eae'tlewmuQtlifum Gutters Dade:.(305)6541140 _ •• C0>#84-3663 MMX Palm Bch.:(561)241-6737 is AngiSs l ist Mprd Wi4f lfP••. Fax: (954}563-9940 2011/2012/2013 WEBSITE:www.watertitegutteayf4ip E-MAIL:watertite®bellsouth.net PBOMMIL. Q.) -7?Z' L/3i 3 PROPOSAL SUBMITTED TO: •• • • plidNLP 000 ••• DATE: -? � NAME: C-��/!}R•Ci l`" A JOB NAME: STREET: STREET: CITY: ® � STATE• CITY: h A,, �- P%� . �d1 r>&- MXjL'4 ! 'f�t:s� STATE: �,IV C.- 1A r Jjo"- We hereby submit specifications and estimates for: qo� 1c i� . 1 I 17 11 d5RE WE, LZ. BY. -ori IDD th ti f7b . , i 5e',Pt Downspo A 1 l �� 216W./ JovTs -Ah 01 4P4 I� INSTALLER COMPLETED PD SB We hereby pro ose to furnish labor and materials—complete in accordance with the above specifications,for the sum of: t9� 0 '�) k' dollars($ )with payment to be as follows: 0WO SPO"� Two year guarantee on Labor,Twenty years on Material. All material is guaranteed to be as spectfled.All work to be completed in a workmanlike manner according to standard practices.Any alteration or deviation from the above specification involving extra costs,will be executed only upon written o ers d will become an extra charge over 3nclgbove the estimate.All agreements contingent upon strikes,accidents or delays beyond our contr .. to acceptance within 40), J days and is void thereafter at the option of the undersigned. Authorized Signature ACCEPTANCE OF PROPOSAL The above prices, specifications and conditions are hereby accepted.You.are authorized to do the work as specified. Payment will be made as outlined above. ACCEPTED: Signature Date Signature • ��\� Miami Shores Village F cF-,JV D �-� FEBFEs 5 2 01 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 Y FBC 201 / BUILDING Master Permit No. PERMIT APPLICATION Sub Permit No. ❑BUILDING ❑ ELECTRIC �OOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL [:]PUBLICWORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP '1 `, , CONTRACTOR DRAWINGS JOB ADDRESS: 1��/ w too City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated:Yes NOy Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:: OWNER:Name(Fee Simple Titleholder): '=S'TZAri L.N .-t5e ' Phone#: 509- /7 3-4313 Address: 0<1 OLA., City: K i "t 5 Xka 'S State: Fl— Zip: Tenant/Lessee Name: 1S A' Phone#: Email: eYC1...PtN' f�i'li�— • 4 CONTRACTOR:Company Name: 1" �-- �y j L���i t � one#: b f. -` 6,72 b75 0 Address: �J' b� C - 5 � City: -State: Zip: 3-3OC) - Qualifier Name: -'�j ()Cj.- &AZ4—U*� Phone#: -I $`� "" i�Lt ' oZt7g0 State Certification or Registration#: Certificate of Competency#: ( C'� b 5 b O (s<- DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ ® • b'D Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration New ❑ �R/e�pair/Replace ❑ Demolition Description of Work: rnVMt n�K GZ� �4{S &-y-o 4 -ioiG�� Coir, Specify color of colorrr>>thru tile: Submittal Fee$ ®y Permit Fee$ ` C'o CCF$ GO CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ l"� ° Training/Education Fee$� Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ 6 (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 t r 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 beue L dtzC da reinspection fee will be charged. Signature Signature ER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this _day of � `T 20 I,b ,by day of :E bRU Pct! ,20 t,;, ,by is pekno Gt{-62 t`-n I_• .sem+ rsonally n to —Jntc'L �r-ft2ta rte- .who is personally known to me or who has produced as me or who has produced—!C:>0.a%f w-9-h, IycRN s tt as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: �� Sign: Print: — Print: d� Seal: =,o ,`'1 ME KELLY Seal: M KELLY _''•Aff MY COMMISSION#FF064567 ��` `•` MY COMMISSION#FF064587 . �s'� ......... o�s `*7'. •--a� EXPIRES October 25,2017 op EXPIRES October 25,2017 [407)39"153 FioridallotServic c Floridallota Service.com ********** ******************** ************** APAPPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) r 3 q �� p"Board .BUSINESS CERTIFICATE OF COMPETENCY 14"00155 INC. ARCiA JOEL G la Como.under the of Clet 10 or ni is neve co v r ' s QUALIFYING TRADE(S) 0049 METAL GUTTER/DWNS 'AmalsRare*BOatd OIe�FOatle Cash m el prcpa here4�. Miami-Dade County -Building and neighborhood Compliance Office Page 1 of 1 - M, Home Product Control Contractors Building Officials I Contact us Contractor License Information Contractor Number: 14BS00155 Contractor name: NATIONAL GUTTERS BEST OPTION INC Address: 366 EAST 7TH STREET City,St,Zip: HIALEAH FL 33010 Phone: (786)546-2080 Other Phone: Fax: Email: JOELCHIN038@YAHOO.ES DB/A: Contractor Status: ACTIVE Class Category Category Description Expiration Date BLDG 49 METAL GUTTER/DWNS ' 09/30/2016 C4 "N`P'0KINWRY COMPI EYTII DCCO Contractor Inquiry am Comwaint Search I BCCO Home Pape I State License Search Menu Home I About I Prone Directory I PtLacy I Disdaimer ®2001 Miami-Dade County.All rights rewrved. http://egvsys.miatnidade.gov:1608/W W WSERV/ggvt/BNZAW941.DIA?CNTR=14B S001... 2/24/2016 Feb 0316 08:26p seminola mini market 3058828132 p.1 Local Business Tax Receipt Miami-Dade Could, State of Florida THIS IS NOT A HILL-DO NOT PAY LBT 7196978 MESS NAMBILOCA71on IMEIPTKM EXPIRES NATIONAL GUTTERS BEST NEW BUSINM SEPTEMBER 30,2016 OPTION INC 7479299 Nwst be displayed at place o1 business 3136 E'7 ST Pursuant to County Code NIALFAN,FL 33010 Chapter SA-Arc.9&10 C Afr4m SEC.TYPE or-SUSINLSS PAYMENT 89CEIVED NAYMAL GUTTERS BEST OPTION 196 SPECIALTY SUHMG BY TAX t0Ut.HCTOH INC CONTRACTOR 021032010vorker(s)rtI t:ARrtn 1 148=155 022416-002773 7bIz Lw dHe a Tau Rea*=11, Ipew d aka Laeal Hcrisess Tau 7be Seeei�t is eot a iieeese, pefflftof a camonr��7�� a'�tbbedoasssvm*WMaMgowwUlnewd UOINCE1PI iJQall�re tledbptePadanaRaoema cialreldei�-Mis�i-Dadsl;odsSao» ACCM CERTIFICATE OF LIABILITY INSURANCE DATE (MW DN n /16 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 WANED,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. Lucia Estrella Accurate PH NE , (305)226-8727 Af No: (305)226-8767 8300 West Flagler Suite 114ADDRESS:Lluciaestrella@belisouth.net Miami,FL 33144 INSURER(S) AFFORDING COVERAGE NAIC# Phone (305)226-8727 Fax (305)226-8767 INSURER A: Granada Insurance Co. INSURED INSURER 8: National Gutters Best Option Inc. INSURERC: 366 E 7 Street INSURER D: Hialeah,FL 33010 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. IS R TYPE OF INSURANCE ADD UBR POLICY NUMBER MadcoY EFF IVON GD EXP LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 500,000.00 © COMMERCIAL GENERAL LIABILITY PREMG ES Ea occurrence)ENTED $ 100,000.00 A ❑ ❑ CLAIMS-MADE © OCCUR 0185FL00056669- 02/12/2016 02112!2017 2 MED EXP(Any one person) $ 5,000.00 ❑ PERSONAL&ADV INJURY $ 500,000.00 ❑ GENERAL AGGREGATE $ 500,000.00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 500,000.00 © POLICY ❑ PB ❑ LOC $ AUTOMOBILE LIABILITY OMBIN�DtSINGLE LIMIT ❑ ANY AUTO BODILY INJURY(Per person) $ ❑ ALL OOWNED ❑ SCHEDULED BODILY INJURY(Per accident $ ❑ HIRED AUTOS ❑ NON-OWNED PF2'ac l j.nJ AMAGE $ ❑ ❑ $ ❑ UMBRELLA LIAB ❑OCCUR EACH OCCURRENCE $ ❑ EXCESS LIAR ❑CLAIMS-MADE AGGREGATE $ ❑ DED ❑ RETENTION$ $ WORKERS COMPENSATION ❑WCRSTLITU- ❑OTH- AND EMPLOYERS'LIABILITY Y/N ER ANY PROPRIETOR/PARTNER/EXECUTIVE EL EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? ❑N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ If yes describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1 $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space is required) License#14BS00155 Job name:Christian Lanser Job Address:175 NW 100 St Miami Shores,FI 33150 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBE LICIES BE CANCELLED BEFORE Miami Shores Building&Zoning THE EXPIRATION DATE THER E LL BE DELIVERED IN 10050 NE 2nd Ave ACCORDANCE WITH THE P R 310 Miami Shores,F133138 AUTHORIZED REPRESENT M.4) Lucia Estrella ®19 C CbRPORATION. All rights reserved. ACORD 25(2010105)QF The ACORD name and logo are registered marks of ACORD s� Miami Shores Village us aur �- Building Department 10050 N.E.2nd Avenue IORV� Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Notice to Owner — Workers' Compensation Insurance Exemption 7777 , 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 Stats,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: Owner State of Florida County of Miami-Dade The foregoing was acknowledge before me this day of e ,201 6. By 1�'— R-YZt v�ft-0 (4 k-t, - who is personally known to me or has produced as identification. Notary: qotety public state of Fiorida pgp�' Joanna M Feliciano SEAL: spy Commission FF 082753 01112!2018 "FotN NATICNAL CUTTERS BEST CUTICN INC 292S NW 95 Street, Miaml, Fl. 33147 (7SCJUC_2CSC February 10, 2016 State of Florida County of Miami-Dade Before me this day personally appeared Joel Gil Garcia, who being duly sworn, deposed and says: That he will be the only person working on the project at 175 NW 100 Street, Miami Shores, F133150. Sworn to (or affirmed) and subscribed before me this 10 day of February, 2016 by Joel Gil Garcia. Type of Identification produced: DL/G426-420-68-462-0 Joel Gil Garcia-Contractor LEDEeMA MY cowKSS nota ., e$ EXPIRES:January 18,2019 Boded Thru WotW Public Undmftra Notary Public CS 4 NATIONAL GUTTERS BEST OPTION, INC. Licensed & Insured CC#14BS00155 366 E. 7 Street, Hialeah, FL 33010• Tel: 786-546-2080 Date:- el _ Name: ��i's•T7ls�/� ,�G, �' El ESTIMATE Address: �� d�� ❑ INVOICE �° .�� r. . . .... ...... Tel: Cell: 36*j— 2.27 �=� .. .. "''r'� •••••• •••• • El! JOB SPECIFICATIONS •.,..• •....a Goes •••s ;....� so*** . .... . ... ..... •• •• .. a •oso•• o •• • ••e• ;Geos• • • • �J I FEB 0 5 2016 1 VBY MIT � Miami Shores Villa e APPR01rED DY DATE d a ZONING DEPT P ` A^ 33 7 BLDG DEPT R/ SUBJECT-ro CCMPL}ANCE W TH ALL FEDERAL STATE ANiS CCUN'IY riULc-:S AMD REGULATIONS GUTTER COLOR aeLl /rte DOWN SPOUT COLOR DOWNS-- SPLASH LEADER , GUTTER :� -7Z +SPOUTS + GUARD + HEAD 7.. TOTAL = $ JOB SUB DOWN BALANCE TOTAL TAX TOTAL PAYMENT DUE Customer Signature Printing Unlimited 305-885-9179 NATIONAL GUTTERS REST OPTION, INC. Licensed& Insured CC#14BS00155 366 E. 7 Street, Hialeah, FL 33010 Tel: 786-546-2080 Date: D�,�l • ❑ ESTIMATE Name: s-17Pte' ❑ INVOICE Address: /� kle," fat�s� �' S .••••9 0 9 0000 9690.. T Cell: �®�` ?-?_2 4� 9 . 0 00 • . . 9 0 TJOB SPECIFICATIONS 0000 :••••: 000000 0200 6 9 666969 6 096 66906 99 66 06 9 969996 999999 • • OPY • 1 • • • 0 • • 6 • 6966 9. 1 9••••6 l • • . • 9 S 6969.6 66 • 6.96 • • 0 0 L Bty: PERMIT o Miami ShCres Village APPROVED BY DATE 33 a 7' ZONING DEPT 2 � r � BLDG DEPT , SUBJECT Y0 CC1vIPUINCE WTFH AL1..FEDERAL /�/ STATE ANv I;C;UN'i°{rll;LiS Aplo REGULATIONS GUTTER COLOR DOWN SPOUT COLOR &e44%& DOWN SPLASH LEADER GUTTER 2®Z +SPOUTS + GUARD + HEAD TOTAL = $- JOB SUB DOWN BALANCE TOTAL TAX TOTAL PAYMENT DUE Customer Signature PrinAng UnUmfted 30SMS-8179