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CC-15-501 Miami Shores Village Pit F,C 1941 Building Department MAR7VE 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 FBC 2010 BUILDING Master Permit No. CA- 15- _ O I PERMIT APPLICATION Sub Permit No. .BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL F-1 PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 9& 90 1ELCL)- '1 - VPt' City: Miami Shores Coun : Miami Dade Zi 19 ® Folio/Parcel#: 1 ( " ?(Y�O- 020— d Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): toB IG1.Syio Phone#: Address: fisopICal C-6I/i-ole Int' YffO 9`se'atooe- Mycl �A 6hOr City: '"bi Ct lM la e� 6 State: C 01"I C�� Zip: 1 Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name:.. uctu S ULC_ Phone#: qN-293-2 -6 Address: 2001 61010 d Citic. Pic)M P.4 n V B egci, State: LW I a- Zip: Qualifier Name: Phone#: State Certification or Registration#: C1C 15117 TV Certificate of Competency#: DESIGNER:Architect/Engineer: UWP 6y7gIr7e1er1"t q Irlc• Phone#: � 34i -52.5o Address: S Z S W, 13 �� 5(.l.i to (r Z City: M i�0-U State: F�- Zip: 9 Value of Work for this Permit:$ f�1, 3®4• ®® Squa / near Foot ge of Work: Type of Work: ElAddition ❑ Alteration ElNew /� Repair/Replace ❑ Demolition Description of Work: P_e.sw�n Cdd 66'ev c4lb n Are Cao/- c- cSuypel -rA 9 h'c-1 cky m v_>4k Specify color of color thru tile: Submittal Fee$ Permit Fee$ _ bJ Lf. 12— CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ LL G TOTAL FEE NOW DUE$ J/ 6 2 l (Revised02/24/2014) 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 perm;ip-rs--issue—d,, In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. o Signatur i - `.a ture OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this 3.7}k day of n 20 5 . by �i�p( day of ZO by �A�Z�4 IA Siel!a who is personally known todAL0- ,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 PUBL NOTARY PUBLIC: Sign: Sign: 402 44-1 6 Print: a 61 W.M Print: zelcd.-/io✓ Seal: ,: n' ;, CLAUDLALOPQ EPERO ,, *. MY COMMISSION#EE 184994 Seal: :fi g WILMA C.ROUFKE EXPIRES:April 20,2016 MY COMMISSION#EE 093715 ,RFN Bended Thru Notary Public Undenvrkers � g" EXPIRES:Ssptemb�r 13,2015 ''iilf 0, Bonded Thtu Notary Public Underwiters APPROVED BY l� (, Plans Examiner Zoning Z�l� 14 Structural Review Clerk (RevisedO2/24/2014) struc't' urbl A Structural Group Company STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION,INDUSTRY LICENSING BOARD. h 1111"r CGC1511798 The GENERAL CONTRACTORh `r r Named below IS CERTIFIED . "PRIA .1 Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2016 . " 7•' ,;,�- J. EMMONS PETER HARRIS STRUCTURAL PRESE +.► STEMS. L. C r~ 7455 NEW•RID;G ur* A'a ,•'. s: ~ ~ �., SUITE T .ate = t~K - :- *,. :41` ~. � � r; t�°R ,•a..�,,t..HANOVER r4ik .f �• .•.•^•/�',..t a{IWL '•,p'w J. }uJ•. '�• •y• 5'''�y�a''t�q,t',t:,9.~'•'� •t.~••; ! T 11 •' :, ••. 1� =1 •••t '•a....w....... .. .. ....~... c» ... ... � ...t.9e tr.d...J.✓...tt.6 a».»a.».�...h..�..4...k.b..�'a...�....4,..k.=....�i.7 ISSUED: 08/31/2014 DISPLAYAS REQUIRED BY LAW SEQ# L1408310004648 2001 Blount Road•Pompano Beach,FL 33069•Phone:964-9849666•Fax 964984-9669 www.atructuml.net BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT 115 S.Andrews Ave., Rm.A-100, Ft. Lauderdale, FL 33301-1895—954-831-4000 VALID OCTOBER 1,2014 THROUGH SEPTEMBER 30,2015 DBA: Receipt#.GENERhL CONTRACTOR ((3EDiERAL Business Name- PRESERVATION SYSTEMS Business Type-coNTRACTOR) Owner Name:PETER x EmaNs Business Opened:lo/12/2006 Business Location:2001 BLOUNT RD State/County/Cert/Reg:CGC1511798 POMPANO BEACH Exemption Code: Business Phone:954-984-9555 t Rooms Seats Employees Machines Professionals 131 For Vemling Susfnew.Onfy Number of Machines: -Vending Type: Tax Amount Transfer Fee NSF Fee Penalty Prior Years Collection Cost Total Paid 150.00 0.00 0.00 1 0.00 1 0.00 0.00 150.00 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 In nature.You must meet all County and/or Municipality planning WHEN VALIDATED and zoning requirements.This Business Tax,Receipt must be transferred when the business Is sold, business name has ganged 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: STRUCTURAL PRESERVATION SYSTEMS LIr Receipt #ICP-13-00018934 2001 BLOUNT RD Paid 09/16/2014 150.00 POMPANO BEACH, FL 33069 2014 - 2015 , - ... ... ' AC.CRL7® DATE(MMIDDIY" `40 CERTIFICATE OF LIABILITY INSURANCE 3/2/2015 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 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 endorseme s. PRODUCERCertificates Administrator Construction Risk Solutions, LLC. PHONE 4479&7499 F1471 .443-798-7290 11311 McCormick Road Suite 450 EAMSS-certificates@theersteam.com Hunt Valley MD 21031-8622 INSu S AFFORDING COVERAGE NAICs wsURERA:National Union Fire Ins Co Pittsbur 19445 INSURED INsuRERB:New Hampshire Insurance Co 23841 Structural Preservation Systems,LLC lNsuRERc:XL Specialty Insurance Company 37885 10150 Old Columbia Road Columbia,MD 21046 INSURER° INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER:925410432 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. INTYPE OF INSURANCE IN WVD POLICY NUMBER Po=p EFF POLICY EXP LIMITS A X COMMERCIAL GENERAL LIABILITY 2449508 711=14 /1/2015 EACH OCCURRENCE $2,000,000 DAMAGE TO CLAIMS-MADE 7X OCCUR PREMISES R NTED occurrence) $1,000,000 MED EXP(Any one Person) $10,000 PERSONAL&ADV INJURY $2,000,000 GEMLAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $4,000,000 POLICY�JELOC PRODUCTS-COMP/OPAGG $4,000,000 OTHER: $ A AUTOMOBILE LIABILITY 3506359 /1/2014 !1/2015 Ee acci $2,000,000 X ANYAUTOBODILY INJURY(Per person) $ A�Ur0.S ED SCHEDULED BODILY INJURY(Per accident) $ AOSED —PROPERTY HIRED AUTOS AUTOS (Per accident) $ $ C X UM13REJA LIAR X OCCUR US0006209BLI14A /1/2014 711r2015 EACH OCCURRENCE $10,000,000 riEXCESS LIAB CLAIMS-MADE AGGREGATE $10,000,000 DED I X I RETENTION$10,000 1 $ B WORKERS COMPENSATION 0151IW713 71112014 /1/2015X PER OTH- AND EMPLOYERS'LIABILITY Y/NI STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE ❑N/A E.LEACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? (Mandatory In NH) EL DISEASE-EA EMPLOYEE $1,000,000 It yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101.Additional Remarks Schedule.may be attached ti more space Is required) Re:Contractors Registration-GCG1511798 CERTIFICATE HOLDER CANCELLATION 30 days/10 days for non-payment SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Miami Shores Village Building Department ACCORDANCE WITH THE POUCY PROVISIONS. 10050 NE 2nd Ave Miami Shores FL 33138 AUTHORIED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD Detail by Entity Name Pagel of 3 b �1 Detailtit Florida Profit Corporation TROPICAL CHEVROLET, INC. Filing Information Document Number 366683 FEI/EIN Number 591297497 Date Filed 07/09/1970 State FL Status ACTIVE Last Event NAME CHANGE AMENDMENT Event Date Filed 03/20/1986 Event Effective Date NONE Principal Address 8880 BISCAYNE BLVD MIAMI SHORES, FL 33138-0343 Changed: 05/08/2002 Mailing Address 8880 BISCAYNE BLVD MIAMI SHORES, FL 33138-0343 Changed: 05/08/2002 Registered Agent Name&Address KURKIN, ALEX J 18851 NE 29TH AVENUE SUITE 303 AVENTURA, FL 33180 Name Changed: 08/11/2011 Address Changed: 08/11/2011 Officer/Director Detail Name&Address Title PD WILDSTEIN, LARRY 8880 BISCAYNE BLVD MIAMI, FL 33138-0343 http://search.sunbiz.org/Inquiry/CorporationSearch/SearchResultDetail?inquirytype=Entity... 3/9/2015 Detail by Entity Name Page 2 of 3 Title VP WILDSTEIN, IAN 8880 BISCAYNE BLVD MIAMI, FL 33138-0343 Title S WILDSTEIN, ARI 8880 BISCAYNE BLVD. MIAMI, FL 33138-0343 Annual Reports Report Year Filed Date 2013 01/22/2013 2014 02/24/2014 2015 02/18/2015 Document Images 02/18/2015--ANNUAL REPORT r View image in PDF format 02/24/2014--ANNUAL REPORT F View image in PDF format 01/22/2013--ANNUAL REPORT View image in PDF format 02/08/2012--ANNUAL REPORT F View image in PDF format 08/11/2011 -- Reg. Agent Change View image in PDF format 07/19/2011 -- Reg. Agent Resignation View image in PDF format 02/14/2011 --ANNUAL REPORT View image in PDF format 02/15/2010--ANNUAL REPORT View image in PDF format 01/22/2009--ANNUAL REPORT F View image in PDF format 09/26/2008-- Reg. Agent Change View image in PDF format 05/21/2008--ANNUAL REPORT F View image in PDF format 07/16/2007 --ANNUAL REPORTView image in PDF format 05/05/2006--ANNUAL REPORT F View image in PDF format 05/02/2005--ANNUAL REPORT F View image in PDF format 04/30/2004--ANNUAL REPORT F77View image in PDF format 05/01/2003 --ANNUAL REPORT F View image in PDF format 05/09/2002-- Reg. Agent Change F View image in PDF format 05/08/2002 --ANNUAL REPORT View image in PDF format 04/27/2001 --ANNUAL REPORT F View image in PDF format 05/01/2000--ANNUAL REPORT F View image in PDF format 02/15/1999--ANNUAL REPORT F View image in PDF format 07/06/1998--ANNUAL REPORT r View image in PDF format 01/21/1997 --ANNUAL REPORT F View image in PDF format http://search.sunbiz.org/Inquiry/CorporationSearch/SearchResultDetail?inquirytype=Entity... 3/9/2015