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Miami Shores Village
Building DepartmentMAY 49 2016
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION UNE PHONE NUMBER:(30S)762-4949 Sf'4
FBC 201q
BUILDING Master Permit No.
PERMIT APPLICATION Sub Permit No.
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: .71 S'r S's
City: Miami Shores County: Miami Dade Zia: 3313
Folio/Parcel#: Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder): Phone#: c7dJ--f-V 005-
Address: .2-k® A* !&9- &
City: State: - Zip: 33139
Tenant/Lessee Name: -VIA Phone#:
Email: zwwee •C-CA-L,
CONTRACTOR:Company Name: Phone#: ?.f4--qy �
Address: 1103Df 44AWO 7�
City: AW P.t144M State:
Qualifier Name: tAVtie--' UA12Z1?6 0,y0-4d-91 Phone#:. 20y tf
State Certification or Registration#: 64d,w/S--6-fy7 4 Certificate of Competency#:
DESIGNER:Architect/Engineer: s�GVIV d, 404&nl Phone#:.Z
Address: ��' City: 4/w State: Zip:, Q
Value orwork for this Permit:$ Square/Linear Footage of Work:
Tr�eofWork: ❑ Additiop ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work:
S'•
• 5i�:vi'n"lOz-sfldtiS ysLlGe`
a;
Slp tr;4c oi' rgA9�igzs mr�aa °•'�
�o/or a cdlor thru tile:
Submittal Feb'$` Permit Fee CCF$ CO/CC$
Scanning Fee$ Rado $ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$
(Revised02/24/2014)
v
Bonding Company's Name(if applicable) A/1A !
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$250D, 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.
Signatu it Signature
OWNER or AGENT C 01
OR
The foregoing instrument was acknowledged before me this The foreg Ing instrument was a nowledged before me this
d day of 20 d�� .by / day of BALI 20 by
/414f-0—/ 721- . who is p no a own to ---,l Az&S who is
personally known to
me or who has produced as me or who has produced as
identification and who did take an oath. identncatlond ho did take an oath. ,`011 i 111/11%,
NOTARY PUBLIC: NOTI?.•• NOTg9y•.�GSi SignM ►m. ,�'�N
Pri EMPLY 00AK Print: Y�r vh ,(moi\Ys cn: eo"dea
�5 `a►'
• C I FF 10790 ••• A •�
Seal: s9�`
Comm.fEoDira 18.2019 i/ ••••'••�G•'••�� ���,
my 6old�ellran�t�omlNogry►i�m.
APPROVED BY f� ` Plans Examiner Zoning
Structural Review Clerk
(Re,ised02/24/2014)
1�G lS- I&za-
MAY C 9 J 16
National Capital Enterprises,LLC
305 926 3535
May 9,2016
To Miami Shores Village,
We are requesting an extension to permit RC-7=15-1687,for 280 NE 91st Street.
We are 95 percent done ith job,and just have a few final inspections to call in,but will not
make the May 15 deadline.
Respectfully,
te,4,JA,&f— 4,1-
. .. . . . . ... .
.. ... .. . . . ..
. . . . . . . . . .
.. . . . . . . . .. . .
00* 0,00
0.0
••• • • • • ••• • •
• •• •• • • • •• ••
••• • • • ••• • •
t S
Miami Shores Village
`• BuildingDe artment
p JUL 7 201
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel:(305)795-2204 Fax:(305)756-8972
\® INSPECTION UNE PHONE NUMBER:(305)762-4949 LBY:
FBC 201 `f
BUILDING Master Permit No.
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: AT
City: Miami Shores County: Miami Dade zip: 33/3 ' v
Folio/Parcel#: dL 3?-O6'01 i d OV p a is the Building Historically Designated:Yes NO �J
Occupancy Type: ASF Load: Construction Type: d& Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder): ji-fo '414le Sr- 7%YX o Phone#: 19M4.45 3,3
Address:
City: ® State: 14 ziw 3709
Tenant/Lessee Name: aZA Phone#: -3,dS'f116 -3S-367
Email:
CONTRACTOR:Company Name: �C✓ y ��/�, Phone#:�5� 2,1!� qY?&
Address: t'®3o �� � �✓!
City: U,* T� State: X— Zip: .33 9
Qualifier Name: .1VAV CA&L25 4k_-,&4g- Phone#: ±S:y 2.1
State Certification or Registration#: e,4P6 1.50,;'3 7b Certificate of Competency#:
DESIGNER:Architect/Engineer: "/+ Phone#:101y7
Address: �� �7°�4�� ����� J'G City: /AXS State: /!:L— Zip:
Value of work forythls.Permit: Square/Unear Footage of Work: -3,f
Type•of Work: ❑ _Additgorr, ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work; !!V&5P r 411AVO✓S, /NS7_A-AL AJOW r_1' a XJy77='^-5
• �is
Spedlyco'IdeA,-;color thru We.. ��vr"•� ��P�BP Artg2allHCe��} �.
e :
Submittal Fee$ �_` - �� Permit Fee$ CCF$
Scanning Fee$ Radon Fee$ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$
(Re"02/24 )14)
! ' \
Bonding Company's Name(if applicable) t4 • r
Bonding Company's Address
City State Zip
Mortgage Lender's Name(if applicable) AJId .
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.
Signature Signature
OWNER or AGENT CTOR
The foregoing instrument was acknowledged before me this The foregg ng instrument was cknowledged before me this
day of 20 IJ' ,by V-day of 20 by
ac%/ /Oy"'t'X who is pe nail nown to 2ff2 .whp is personally known to
me who has produced as rhe or who has produced ss !o
r ra��rs �Aoz as
identification and who did take an oath. identificatlo and who did take an oath. ``° 11111111%
NOTARY PUBLIC: NOTAR UB 1 L �I
�rJ US e
Sign Sig I •
Print: o
i •. �. •�
Nmy P -StO Of Florida Seal: PV0-��
C •FF 1! �i •'••......•••
my Comm.E>a te,2ot9 TATE
gRetaryAasn. I1#1/11111°°°
* *s * ** ** *** * *s*ss******s******s********s**ssss*sss*s*sss**s**ss***ss*sss******s
G� S 1�
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(RevLsed02/24/2014) r
RtCK•SCOTT GOVERNOR KEN LAWSON,SECRETARY
r STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
CONSTRUCTION INDUSTRY LICENSING BOARD
COCI N5376
The GENERAL CONTRACTOR -'z
Named below IS CERTIFIED
Under the provisions of Chapter 488 FS.
Expiration date: AUG 31,2016
OSORIO,JUAN CARLOS ,4
JC 1 GC iNC
i0344.CL
. "- LAKE�VE?RT'H - .9 ~� '�, •
ISSUED- 08/07/2014 DISPLAY AS REQUIRED BY LAW SEO# L1408070001783
a
0 ANNE :v . G.:N N O N P.O.Box 3353,West Palm Beach,FL 33402-3353 "LOCATED AT"
CONSTITUTIONAL TAX COLUCTOR www.pbctax.cOm Tel:(561)355-2264 10304 CLUBHOUSE TURN RD
s-r.,t,�;ra,��,&•u,':C'ou„'y LAKE WORTH, FL 33467-0000
F,c;rving ou.
TYPE OF BUSINESS OWNER CERTIFICATION# 1 RECEIPT#/DATE PAin AMT PAID sue
23.0051 GENERAL CONTRACTOR OSORIO JUAN CARLOS CGC1505376 I U15.775346-09130r15 527.50 840120507
This document is valid only when receipted by the Tax Collector's Office. STATE OF FLORIDA
PALMI BEACH COUNTY
2016!2016 LOCAL BUSINESS TAX RECEIPT
JC GC INC LBTR Plumber: 200513552
JC GC INC EXPIRES: SEPTEMBER 30, 2016
10304 CLUBHOUSE TURN RD
LAKE WORTH,FL 33449-5454 This receipt grants the privilege of engaging In or
„� u, n�„�,�„)�,�,a(►�n(u�,�,�n(n managing any business profession or occupation
within its jurisdiction and MUST be conspicuously
displayed at the place of business and in such a
manner as to be open to the view of the public.
® CERTIFICATE OF LIABILITY ��
INSURANCE
THIS CERTIFICATE 13 ISSUED AS a n�aTTL�of INFORIinas�t>I�I.Y AND
10/2712015
CERTIFICATE DOES NOT APFLwJAA7IVELY OR NEGATIVELY AIIItW, EXTEND OR ALTERUPON COVERAGE AFFORDED BY THEPOLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S� AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
BlIPORTANT: NOW certificate holder Is an ADDffiaw INSURED,the as)must be andolsed. If SUBROGATI�►I IS WANED
terms and cam of the Policy,certain poUc�mW requk*an er�rsement A std nlerd on thesubject to the
WIS Kok 581624-1166
C:arMcdo holder In fou of such endorsem nt(s). does not confer to the
PRODUCER
A.S.ENTERPRISES,INC. ANNE SCOGGINS
FrW� FAX
784 U.S.HIGHWAY ONE,SUITE 14 M*561624-1118
NORTH PALM BEACH FL 33408
P—AURER(S)AFFORDING GE MAIC#
INIRRED eOWMA:ARCH SPECIALTY INS.CO..
JCIGC INC I INSURERS:
1034 CLUBHOUSE TURN ROAD C:
LAKE WORTH,FL33467 D:
IO)UREiRE:
COVERAGESF'
CERT1FlCATE NUlNBER: 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 DOCS 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.
L TIM OF I SURANCE pOIICY AFF
P
GH�fAL Lffisom POLICY NUS Lam
X GOIYIMERCNIL(LEMfliAL uEACH OCCURF43 CE $1
AeILrTY ��
CLAIMS-MADE a OCCUR PR�dISE3 Ea a $
A MED EXP IAir am pin) $ 5 000
AGL0018831-01 10124/2015 10124/2016 PERSONIAL&ADVINJURY $1000000
AGGREGATE $1,000,000
GHWLAGQI�GATE LIMIT APPLES PER GENERAL
X POLICYLOC PRODUCTS-COMPIOPAGG $1
AUTOMOBLEL FY $
ANYAUTO
ALL OWNED SCHEDULED BODILY INJURY per pW=) $
AUTOS AUTOSONONMVED BODILY INJURY(Per a $
HIRED AUTOS AUTOS PROPBtTY DAMAGE
ffer $ ks
$ ;
UMBRS LA LIAB C f" EACH OCCURRENCE $ i
EXCESS LM f.
AGGREGATE $
DED RETENTION$
INORKERSCOuPENSATION
AND EMPLOYEW L1ABLTTY WC STATU-
ANYPROtNt1EfORIPMn%MlECUTW YIN
OFflCEAAE1deER IXCLUDED? NIA E.L.EACH ACCIDENT $
NM de9ofte under EL DISEASE-EA EMPLOYE $
XOGMMM DE OPERAMONS below 11-7
EL DISEASE-POLICY LIMIT $
DEBCFM4=OFOPEM7MMiLCCAMOWIVEH=M~AtORD1101 Add R S g—spawlar
INTERIOR REMODELING CONTRACTOR
CERTIFICATE HOLDER CANCELLATION
MIAMI SHORES VILLAGE BLDG.DEPT. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE I004RA71ON DATE THEREOF, NOTICE WILL BE DELIVERED IN
10050 NE 2ND AVE. ACCORDANCE WITH THE POLICY PROVISIONS.
MIAMI SHORES VILLAGE,FL 33138
AUTHORIZED REPRESMAME
30.5 756$972
ANNE SCOGGINS
0 198OW10 ACORD CORPORATION, All rights reserved.
ACORD 25(201010 The ACORD name and logo are registered marks of ACORD
JEFF ATWATER STATE OF FLORIDA
CHEF FBfAIt�IAL OFFICER
DEPARTMENT OF FINANCIAL.SERVICES
DIVISION OF WORKERS!COMPENSATION
CERTIFICATE OF ELECTION TO 13E EXEMPT FROM FLORIDA WORKERS'COMPENSATION LAW
C014STRUCTION INDUSTRY EXEMPTION
This cer i8es that the individual listed below has elected to be exempt from Florida Workers Compensation few.
EFFECTIVE DATE: 6/10/2014 EXPIRATION DATE: 6/912016
PERSON: OSORIO JUAN C
FEIN: 200093428
— 91USINEW NAiMEiANtti19DRE36:
JC/GC INC
10304 CLUBHOUSE TURN ROi
LAKE WORTH FL 33449
SCOPES OF BUSINESS OR TRADE:
LICENSED GENERAL
CONTRACTOR
Ptatatem fo fbapW 440.05(141.F.S..an diioer of a oorporetlon Wto elects 6gemption front ttds dtapNr by faV 8 certificate d etedw Under thiS section ff"
not ron,-m bolt I M or corrtpertadfort Under this dtapter.Punwant to Chapter 440.05(12).F.S..Certificates d eteefion to be exempt...appy only Within the SOWO
d Me hwktaae or trade Mid an the notice of etacd n to be axempL Pursuant to Chapter 440.05(131,F.S..Noibes OF ateetion to be exempt and addiCtctes Of
election to be exempt dW be s AWd to remeatiort U,at any tkne alter Ota aft of the nowe or the laauarm d the cUwicaw Me persa►named cn the ncttos or
oerlNede no ivrw meets the retptirernw is d Ods secdon for Isattartoo da oertf ew.The department shat ravoke a oars at any time for faits d the
patsort na m d on the oma to meet the reclriernents dtMs section.
DFS-F24DWIr252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 07-12 QUESTIONS?(850)413-1809
IROS Miami �7hores Village
a...
Building Department
LpgQ�► 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: Z ���rl
Owner
State of Florida
County of Miami-Dade
The foregoing was acknowledge before me this_C�"J day of ,20j5_.
By i �N. l tm on who is personally known to me or has produced
as identification.
Notary: (::-
SE
NMI Pdb-am N Fly
• Cain•FF to M
,y
�m BandedN �,
0
Jog
Inc.
Date:
State of CA
County of
Before me this day personally appearsl`)�e� `'' Owivfq"o,being
duly sworn,deposes and says:
That he or she will be the only person working on the project at: '2B0
Sworn to (or affirmed) and subscribed before me this day of 2015
By --,9'YL3CAy-\ r'\or--� �Y k b
Personally Known
Sheanell Garcia Or produced identification
Notary Public r
State of Florida Type of Identification Produced Fl, !b/L
My Commission Expires 03/13/2017
COMMI11IOH N0:FF 104199
type ors p name of Notary
10304 Clubhouse Turn Road, Lake Worth,FL 33449 9547214-4488
STATE OF'NEVADA
.ROSS MILLER SC07T W ANDERSON
5e ret +of Slate Do"SecrefftY
far Ca+nnmereia!Recwdlre�s
OFFICE OF THE
SECRETARY OF STATE
Filing Acknowledgement
September 2,2008
Job Number Limited Liability
Company Number
020080903 80560112008-2
Fifg Descrlpbion int FRIng DatelTimte of Film
Number
Articles of Organization 20080585896-81 September 2,2008 06:37:18
AM
Limited LittbiW Company Name Registered Agent.
NATIONAL CAPITAL ENTERPRISES, INCORP SERVICES,INC.
LLMC
The attached document(s) were filed with the Nevada Secretary of State., Commercial
Recordings Division. The filing date and time have been affixed to each document,
indicating the date and:time of filing. A filing number is also wed and can be used to
reference this mat in the future.
Restfully,
ROSS MILLER
Se, tary of State
Commearckd Recording Division
202 N.Carson Street
Carson city,Nevada 897014069
Telephm(775)6945708
Fax(775)684-7138
Fmm.unktm vn _Pop,?l2 Dete:9x 811:18:22 RM r.
I
I
kited in the offiiCe of Dow—me N—b-
2008058589"1
Nil It WAVWO#MW41W •y/I r Fd lac ate Tkw
Ross Hitler 0910212008 6:37/AM
t� C Nwubw
E05601.12008-2
f `
t r
�Rr1�M+<��i1O119Z1 Jv010 �. -
1�Ra�A.Y 4
X&TWK#,.CAWAL LLC4�oea 3
13
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J bs+sm.ans<. �.,�a�yereor.��ae�e
EXHIBIT A
CAPITAL CONTRIBUTION AND VOTING PERCENTAGE OF MEMBERS
AS OF
September 2,2008
National Capital Enterprises,LLC
MEMBER'S MEMIIER$S
MEM REWS VOTING
A+IIE�!iBER'S NAME ADDS CAPITAL PERCENTAGE
CONTRIBUTION INTEREST
1480 Curlew Avenue $100 1000/u
Michael A.Tommy Naples, FL 34102
TOTALS: $100 100°/a
r�
OPERATING .AGREEMENT
FOR
National Capital Enterprises, LLC
Recital
This Operating Agreement is entered into effective as of the r4 day of September,
2008 among the persons who are signatories to this Agreement and shall govern the relationship
among Members of Company and between Company and Members,pursuant to NRS Chapter 86
and the Articles, as may be amended from time to time. In consideration of their mutual promises,
covenants, and moments,the parties as signatories to this Agreement do hereby promise, covenant,
and agree as follows:
ARTICLE I
INTRODUCTORY MATTERS
1.1 FORMATION,REQUIRED NUMBER OF MEMBERS,TERMS.AND
PURPOSES
A. Formation
Pursuant to the Act, Michael A. Tomany acknowledges he is the initial
Member of this limited liability company organized under the laws of the State of Nevada known as
National Capital Enterprises,I.I,C,whose Articles of Orman were filed, effective September
2, 2008.A copy ofthe Articles is attached.
B. Number Of Members
The companyc an have:a single member.
C. Tenn.
The period of duration of the Company shall be perpetual unless sooner
terminated. The Company shall begin on the date its Articles of Orrganization is filed with the State
of Nevada and shall continue until terminated or dissolved in accordance with the provisions of this
Agreement.
D. Purpose
The purposes for the organization of this Company is to provide centralized
mwanagement of investments and business activities.The Company may,as provided in its Articles
10
EXHWIT B
9
PERCENTAGE INTEREST IN NET PROFITS AND NET LOSSES
AS OF
September 2,2008
National Capital Enterprises,LLC
NAME OF ME1ViBER NET PROFITS NET LOSSES
PERCENTAGE PERCENTAGE
100•/0 $100
Michail A.Tomany
TOTALS: 1000/0 $100
STATE OFNEVADA
ROSS MILLER SC07T W.ANDERSON
secretary of store lyety Secretary
for CommmwRecardmss
o�lceoF
SECRETARY OF STATE
Ming Admawledtement
September 2,2008
Job Number Limited Liability
Company Number
C20080903- M60112008-2
Filing Doerlption Document Filing DatePIYme of Filing.
Number
Articles of Organization 20080585896481 September 2,2008 06:37:18
AM
LWtW Lability Company Name Registered Agent
NATIONAL CAPITAL ENTERPRISES, INCORP SERVICES,INC.
LLC
The attached documeWs) were filed with the Nevada Secretary of State, Commercial
Recordings Division. The fdwg date and time have been affixed to each dot:ufnertt,
indicating the date and time of filing. A filing number is also affixed and can be used to
reference this document in the future.
Respectfully,
/;A,,+
ROSS M LLER
Secretary of State
Cwt Reot►rding D1vlafon
22 N.Carson Street
Carson City,Nevada$97014069
Telepbow(775)684-5708
Fax MS)694-7138
,...� ........ ,.��. From:unknown.,._ i 2lZ Date:9V2f200811:t8:22I1Ni
r-
I
i
ft OLLM
- oom=1 40rD$4m Film in the oil of vat
20080585896-81
•�+' '�-^— Fdie81M and Tmw
• Ross lv[itier 09/02/2008 6:37 AM
Secretary of State ERkN bw
Afflobs 0f Cwgwdadkm Stat®of Nevada E05M 12008-2
tP1�L1i8iR1�i�4 -
. a�oia•rsprsar•voaar � g
CAPUAL LLC t rat rQrfi► s
�mea,nwn �
NM
aerran.e�, asedsanal _ .nem
�� .._.._....-._�.-__..._...�.. ....__.�..:�..�^lam`Zb�•
Law da vaawaaevia ►gots .c� _
owsm"bomweswIF OR pa.
t� - - T ' Al
-- EXHIBIT A
CAPITAL CONTRIBUTION AND VOTING PERCENTAGE OF MEMBERS
AS OF
September 2,2008
National Capital Enterprises,LLC
p p MEMBER'S MEMBERS
MEMi7ER'7 VOTING
�1.71A
MEMB'�R S NAME ADDRESS PERCENTAGE
PERCENTAGE
CONTRIBUTION INTST
1480 Curlew Avenue $100 100%0
Mchael A.Tomany Naples, FL 34102
TOTALS: $100 1000/0
OPERATING AGREEMENT
FOR
National Capital Enterprises, LLC
Recital
This Operating Agreement is entered into effective as of the 2"`t day of September,
2008 among the persons who are signatories to this Agreement and shall govern the relationship
among Members of Company and between Company and Members, pursuant to NRS Chapter 86
and the Articles, as may be amended from time to time. In consideration of their:mutual promism
covenants, and agreements,the parties as signatories to this Agreement do hereby promise, covenant,
and agree as follows:
ARTICLE I
INTRODUCTORY MATTERS
1.1 FORMATION,REQUIRED NUMBER OF MEMBERS,TERMS AND
PURPOSES
A. Formation
Pursuant to the Act, Michael A. Tomany acknowledges he is the initial
Member of this limited liability company organized under the laws of the State ofNevada Known as
Nathaal Capital Enterprises,LLC,whose Articles of Organization were filen, effective September
2, 2008. A copy of the Articles is attached.
B. Number Of Members
The company can have a single rte.
C. Term.
The period of duration of the Company shall be perpetual unless sooner
terminated. the Company shall begin on the date its Articles of Organization is filed with the State
of Nevada and shall due until terminated or dissolved in accordance with the provisions of this
Agreement.
D. purpose
The purposes for the organization ofthis Company is to provide centralized
management of investments and business activities.The Company may, as provided in its Articles
10
EXHIBIT B
PERCENTAGE INTEREST IN NET PROFITS AND NET LOSSES
AS OF
September 20 2048
National Capital Enterprises,LLC
NAME OF MEMBER NET PROFITS NET LOSSES
PERCENTAGE PERCENTAGE
1000/0 $100
Michael A.Tomany
$140
TOTALS. 100%0
CFN:20150259620 BOOK 29588 PAGE 2388
DATE:04/2312015 09:12:48 AM
DEED DOC 2,565.00
HARVEY RUVIN,CLERK OF COURT,MIA DADE CTY
THIS INSTRUMENT PREPARED BY:
Seaviery Title Company,LLC
John P.White
1575 Pine Ridge Road,Suite 10
Naples,FL 34109
RECORD AND RETURN TO:
Seaview Title Company,LLC
1575 Pine Ridge Road,Suite 10
Naples,FL 34109
RE PARCEL M#:11-3206-019-0410
CONTRACT SALES PRICE:$427,500.00
WARRANTYDEED
THIS WARRANTY DEED made this m'day of April, 2015 by GG Property
Holdings,LLC, a Florida limited liability company,hereinafter referred to as Grantor, whose
address is 1255 Libson Street, Coral Gables, FL 33134, to National Capital Enterprises,
LLC, a Nevada limited liability company as Trustee of the 280 91st Street Land Trust,
hereinafter referred to as Grantee, whose address is 1575 Pine Ridge Road, #10, Naples, FL
34109
(Whorover used resin the term"grantor"and"grantee"include all the parties to this inshumant amt the halts,
legal representatives and assigns of individuals,and the mtccessois and assigns of corporations.)
WITNESSETH:
THAT Grantor,for and in consideration of the sum of Ten and N011 00 Dollars and other
valuable considerations, in hand paid by Grantee, the receipt whereof is hereby acknowledged,
hereby grants, bargains, sells, aliens, remises, releases, conveys and confirms unto Grantee the
following described land situate,lying and being in the County of Miaml-Dade, State of Florida
to wit:
Lot 5, Block 3, EL PORTAL SECTION ONE, according to the map or plat
thereof, as recorded in Plat Book 9, Page(s) 101, of the Public Records of
Miami-Dade County,Florida.
SUBJECT TO taxes accruing subsequent to December 31, 2014, covenants and
restrictions common to the subject property, oil and gas mineral interests, if any, and easements
of record,if any;however,this reference thereto shall not operate to re-impose same.
TOGETHER with all tenements,hereditaments and appurtenances thereto belonging or
in anywise appertaining.
TO HAVE AND TO HOLD the same in fee simple forever.
Page 1 of 2 Form software by:Automated Real Estate Services,Inc.-MO.330.1295 Ffle-ZM
CFN:20150259620 BOOK 29888 PAGE 2389
AND Grantor hereby covenants with Grantee that Grantor is lawfully seized of said land
in fee simple;that Grantor has good right and lawful authority to sell and convey said land; that
Grantor hereby fully warrants the title to said land and will defend the same against the lawful
claims of all persons whomsoever, and that said land is free of all encumbrances.
IN WITNESS WHEREOF, Grantor has signed and sealed these presents the day and
year first above written.
Signed,sealed and delivered in our presence:
(Two S , Witnesses Required)
GG Property Holdings,LLC,a
Florida 'liability company
wiun Ir-
By-
`t CC i A 8in1781
wlutuss ` ] `—
(2nd Witness may also be the notary public)
STATE OF Florida
COUNTY OF Miami-Dade
The foregoing instrument was acknowledged before me this 19*h day of April, 2015 by Greg
Goldstein, as Managing Member of GG Property Holdings, LLC, a Florida limited liability
company on behalf of the company. He is [ ] personally known to me, or [ xJ has produced
EL Driver's Licemse(s)as identification.
II
Notary Public Si I
NU 0t't oy 8,&
Notary Public Print �� sm of Flora
My Corrirrlis M E)Ores 100 018
My commission expires: ba 4l �'' COIrIrrlW*M No.FF 167360
Page 2 of 2 Form software by:Automated Real Estate Services,Inc.-800.330.1295 File:15092
M!"ST STMET LANG TRW&ANO MW AQMWW
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t�trid"i'sust"' =t�► ttyy tt18t K p :'1 .C,�' mtit d f Ry 1 Y�
a ddress X57AW .1 N 30 0.4, frOmrt t*Ao
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a to reri� A raw e �pvWWO,�-.#0 .c�'#�► . : . 18d Yii t tte_!�r��y left
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or YA be
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t to Vms4 WOO Oft"WS ��!�!g4�Mot lilt� A Y9 t�-!
ft
t0 ttt� o. r t t tQ. t hold As1 1 IN
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.bensttri�.�rtd tt .
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tQ ttieir #it oppi ls; li .•
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WOR
7r A*W 3lftV.Mtmec#..:LC le" COOK
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lnWeift of ftneflowl"-ps Ponmolty
�tw�n#te T y p�rti�:ae 'stt�p-t -
wor ntsy ttno to t ty trot ti that thhy bwoawy tzanplt
may. 0 Pour . to dent ivm# to- ttudt pip Y,*' tt or.dk th+a�,
spY tpre. ftgm nd' it m -fit r !>Q11!tt
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tin tiffs t1s fid:proms a�#too properly ti- -` "tie Pelt pro"'
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hij. -h ,ist br. No ti , r r ham,s shd t ►1 r Mast kt°ot'
��- t �.Of t o w ,: '. +�`. awy k�tsre�t 10 the+aautiln�,
)am p. - K bft tk�in#entW or its k mem p Vit$to:ifis
p"OftinihOThow
t)4!dhqfsw- wrmlwy
4.IU deafta any bemt shy apt k n#*e.tt bust&to any mgr'~Um pawt Of
th�r"f'r�tstee,
Wodc80ASA%P Mt 0 86noftW Wireaft.
If: (a) No McWwW Of Ind 110bw~ taterto bpm an 00 T remit the
; -nal or&apH sa
copy of Ow sbvmtd lay Ow fam.an to Tutee mt y app m.b deice to the
Thiefes wW thaTruwi -Any aWCw so d*mw to.dte T hates. l
t�wotd #o.�! stata�gtnent. i � v�t#�t . The'�'t .8itail rr
duiw**Ae d I t bust to r Laity dvw4win Ownemilp.
{b)OsAl4icatos Ov #x of Um bwwfi*W a iney be Imed by the"tortes.in to
for 9S It, In~vvW an t.of a mat shd be mW Wy an the.eurr+srtt
of 1tt8 mWoft artd the OrA be snWW to reoopOn wo bend tmtO go oftirW
t��ered#ai#ta°I"rust�e tvldt =�op�r tter�t e�t,�tl a raw �has
heart . ,
'#"MReturrrs
o.I-ra Teal*Ow not be to ft*anyot+c�, or .to repo*:o whedulse,
TIS ► ca:eta tndivtdry t Owgra ply r"ON wM on It wmhpf.ems„
wO ploceads d root party or'ftm of it worsts. no 1'rue1
malm eve. on rquest by #0 WnOdpft. fa r of to 11w brad pertain lo 0)*
respite ktows.
Relmlutreamettlt:an d InclamnifIcatkm urTrustes
'. If the lhnfte eltali pay or Inwr any IMAly to pay any money on vormt of#tf Thak or kxw
arty liability to pay anyn=w on so="of bad ma a,p to ww ikon a r t of hoMln#*10
to the treat property o ..0"W"Aw In mtr n'%th this TOok w a of ixceeolt Of M
*004
h 1my to Person of prapekty;flnes or peneldes unde+r ww taw,*rrathe Mw,the Ben rtap, sOmw got
on demand h vrill pay to the Tbalft.wMi InWreg at lbo tat*-Of W WOW(90%)per cru, eb Mich
prtec� m ar i��iiee 1nCUn'�Kt by t� , :Wl#h taxpet>s�: Irk tr�bin
aw >ia fees,aril the It will ttWmni y.and hold t> ThWn hw mIw 40 snd:IWm wWwW all ppwo
at NabMtW&.k=vW by 8 for oilyressora�whatttevsr-n army afthle AwaameftvW all AW tents
®o:�id by T e8 o�ttperi trr>derr ►�ertt,:sheit+���art trt�t
prey. the Tnrstan Ad reit be;requbod to try or other deal o► ft ft*p umV 1*tw V as-
my
money Is due to the TrAlse wWor t shall fa Tree to adve rm
pay wA any mond an. of thls.Trrot or to provecuts or defer aW ieppd promOokwalft t
YMM or aw property or Interest under thIsAweenent unlos bbl be frttMed with aAiderd fundaw
he kW mnVW for tEs Mon.
Ronan"byM*d ParUes an AuUWft e;Tnufte
13, No party.dear with-tib TWO*Ira rqWW tt the.tAW pro# lyr ht miner whalsoeve_ ,
andtua pity yrho»t property o eery t or tnkmt b eyed, o9d to be d,Wood,or
0imby Tit�fse,X11 0011*tQt to .h 61,: t�,d�lstr rr 9 of
Y +mid r to In4u"bft tr ay p�dl ►of for sny, 4I'tli+h TWelm `
as to'the*' vW."s-ef Inks Ina0wheM.
Ptohlblftn AgWnitfteOW401 t
9.716 Awwmnt Wren not bo:Omd an reed In Ov~vxA dwWa affice of IN fitly In
wt tit pr petlyd .:+ `. '' , emelt riot bo=M*RA So MUM Oft
Um4146A on t? uta OfteivefthNW.
dedow 90.In the:errant���f�on Ttte�e:ett�,y,tlme,tha`t' :r�r In clst�n
to the. Wier Wla to.any papeading the l of ft.behO MAY w
bei lolarles of . MW Tam rot tlwWO t 00" *y this
t WAXOt WMft a sect"am moyy be by lawler.on a Md fw -
oer this bust:
�ea�tott a»d�t+.�p►lent ofF�'nmt+B�
il. (a) The TftL*s-.mV raMp A any fter by tuft no tte+df b WelOn 10,60 so.by
roa d and to#w esneMvi9t thle AOesnwt atm aWroo lam Mwm to to-Thatm.ftch
t l sn-slel bewmw die ten(10)d to fndkv of such notes to the O"M Of WAh
r graatlort.or upon Ove deal.h or Rmptd" etft°l`rtrstee,John P.WW% PA is h
wocum� a "r'n M tl°m:evmtt dt'five 't`rust�s teat, death or. �
lruefise 011 bo ted by the awme and holes of to
i sstr+ a�f t 1`n r* Fmid",w o"ne pmt of the Invests of " TAW may
V*sumew Trusteo�s fly v"%d with OR fly No. estato, tots,.powms, trtWo,
mid shell be ssbOd to the dudes.and abbIttort til lira pr ..
(b'In the event no smasor hotowls;op d.to prov t W*M sixty days frm tbe.siate of
the reef mwn, Ow rostrJog T oonM the bust pmpwty to tha. t'►OcWA a in o0dordwm
with their rebpftdwI 0mots and 96 tW,BW Wwik % or Ole TPJWAS may,A tta OP%% Soply ft
qvwpdaw fWW in anymat ofoomp M*Wdon.
{tt)N*A*WW r a ft . . ft— of*0 Taft-s#; the Thaws lit stud tci ht :�IWon t any fat voy. e .
tamable cov naa n.
(d)every MweessorTMW axr Thin ' t+�_00 W=iw fuV VOMW Wth 0 V
f :rt�hts,Aow .. � Carta :gr' - tyr,
P"WO god
Outt"ollh os
12. Tae T es and eamo to p arm :tolhawft:at". d WSmsWe duties:
tea To Exectile fnstromenW. When'atul 0.d tbd todo ate by ttm hakka ti ns OwtNit
(M)of.the bensWel Wwrast of this't'hal.the-_t tP es i iftuft a-d dow Such IWnttrt�nts iW
t be mossury to protW asM mom ft trust *,to W,owos�b.W sol Ond W.W 604oris to
pwvhm the proWy wW any r .ts:to or Merest in ft on any tuns:.b 04004a party ok wy
terms;to convey the p"erW by dam.at 00w reyari I*any .w4h ar.wftut s#Wat kvv
to rrWt pa.VIWQO or othsrwts+s a MMIW1ha:pto jr Or IMY"d Of P4 to. t"tp W4M
r_
options to.less e. renew,mtt4nd and otherwhe:mollfy an ft or soy t ttft-from
tlnss to flute; for any,period of th>tre: br:ww terosi.and qw any other twm and oamdOom arm to
convroy of assign mW adw OgK NO or tntstset Whatsoever ln,to.or about the t W.ar'.
padofft. No raor rt sd` eyan+�►.t►r truer exited by firs any o4Vettants
oftarity,
(b) To OMWe-hof; ll*TMbft #WrWW tom°OW dWIver:dill oi`th*_ �'
Atte'fruef 0�-Be lldwm In ripe propor4lmmsto kg id.any.l Ow the -id tM
taS Tc� ii�h.lnformatlan CoQ Tia �m�rrmarW4: T1te Tirtmst 'Id ,a�t'� dve
No enib tr 10 eaf osrh y,r,: doWagAe Aha.envurd of d . a ei� Flo
kmmprovernermle"may be IaVls i O"'Ar t nO Ahe prawty .to fiMftwjw 0 im
Must of lheirr4t nwi t;#wds* #**" lmtble dlwountlbr their pm�ontpt*Mont
(d)To Flo My mtm Tont Riw nm the lO leM 0.1011 toy.fil 'y 0-0,101 VaknM OW
owhi%any reel px+operly.held lh-t W wli* I&A001nent W.W4 W by SAY tsar,
t unidpa iY br cow- to beady.
(a)To Keep Rem&of Tomb Mis T6tw shmmll keep vW wdwAA ertd Camd Mma with
moot*lhs°aidrtt *OfftThAw
(f) To IWwM Wit. B+ Revtonfrt# and Condemr m: Tho Tramtee Is W maivlee tFm
SwaVo m aw=wft Ove antr4'famft or cwWemniWon of Atte p w*or any 9W Ol L.
fig)TO AVv#4 wwanos on:Tiust Propedp. The Truates;e *wpm the of thlo
TA*tO fm*h,pey for a nd:kep inforcce .tlm.rw me.wW lbr U benaft.cif tltet"t'hW" to
+ ►:without Amltekoni v tmid'A wrap rodon ami publio IWky lr rroa)se#to Tr :may
nAltmwmlk In with:oom .In ash bmtw end miske W�pe#�as may be
Al__TnMfte. If ft 9enelMerlea.+ems fak maW or Ohm to do-a*.the Trustee"I obW
wahlniawoe bmf ehd notbe regudred Ae.t�eorS#hs 44 telmt>wse the T
lar the on sewh lanai mm*.
(h)To letabileb i t.of 1 6m1p: ThaThow.M cam of the►death of any 90i_ .is to
War an lnquky asto ft.he ship atft da
RWft mad Oma of lkne lanes
93 They Senek "I Mob maks oorllr ullone to to Tryast, from Um to time, an-a
PWW taw►in- w* t of rest%w~ n Irl Alda A reememnt.In the amounts
ra rtt to mMM'0090ons 4f.Vw tit llai: of operallm of the t ual paperty, pr+ovlde
09"'"P9 Mommeuita 4 to
Ow"U mt of to tom' thul haw-mstt 4 wiv all pwinoft due lot#mer Wolmo pice of the-iftAt
O tYJ.doslw aNK idei t� fry BAf, PSBl as*ef-bm OW MWWOWS an tl'e popedy.
hmd lVal Beft.fWays llzblli y is lingad to life pwWa.0weillhe lWft vt elf 13onoitr rias: The.
8OJr^%Wwto rnnWy ft-TW Rom- !W.voas oral supwiwwIfth ft Tna may
krow as-o r of bebV Trustee Of.ft Tfust.
'T+srrmilny i Of TtwIst
1e. if ft trwat pWwW or any part Mrnaft In Aha- wte*yMo:y its-Ate lhls tnat vM
wevAoi, -Tnow'mf alk ova ~ raim to fly bourimy nr bs% of v* Proposed
wwwo s of ft vult. Tio"OWA am bo rat ti er r the t meati wmmwmy
Via. Ift Ow Ow 9*an ' : bn int+dao term et Alia Iwai m .b w geed to by`41 pWfiw wlt
days from the dft of the At hon..Alma.'Tnei- Davey V*bw prop"to the
r~e s tri ncowdepin with tiver 1 m`,on wow dkodlonr of M"ltd to pWOW
of the merles in Int t,veli t}te"M at PAIC we.m1 r+ on$trler low OMft 0*pmee*
of SO the MadIn With#'tear MpeW"it is.
i ►utsrttce
I& The bw at:all ting to wry pWI* Rawly kwm(*..
Ir mummer as ftTnwtsw*fWI:d6m naossawy,btsur Trttal r kt tca d tent!. tape to
the,Tnmmea, In.#le went of this Ulure to.Ariiniott liar+. a! the Trdstebi kv Ite dW=*r4 �S+
ft tf .._ end ft bowfWaft do Jndy-widy ' _ that #*V1 fw MIh an
lapet�{ pay the per�ttte.amount of premum cat-ft�� tnt t at fire off"rete of
oarnpe*ftn of Trad"
i$.Th(&I$jotn shy ren® e-ampwaWo t for Its servbw wKh to this.irust
wW vh&O be ..wWW to r8lnlbtitWOOrA at b NWMM MWOMMy kw.MW. Tho-Thwise 9W hoe no
oiittn wadvance any on- at ft ifuet big may Oe so in ft,&m#m TheTwvWe eW
hate N+err i ltt.tt'e; iy pr erty tdftrUW to its t4" ,iia IN*,.WAVOMM.M.W
Pw wat'tt" W4 qtyee went " M% -e*any bi nc lary
to p�py ft few MW to r+ i :lhe T for t* oz�w%d..e io to.�;ttm
p ttonttq be ,pro rate bisad on-each berwtWs=to
�. Notw tartdit:eny t
pmvt�art of Agrewwt�Me Th*w bs no make.any deed,morigaA lease,
ort"wmtff rel a ,-or to enter Wo mty a*Mrwctuai aWWft YAMrespet to the real estat%
tn._As too we peId wW No extremw relinbureed, or unM ft fees and 4xperm,m+e secured to its
sa�r�ct:
)Binding fMet on Suovessors
17.Thaterms wf amWillonofft rut WW hwtar ttmbanott of mW be bhrding an ony
orTfimUw 4nd on all swcaiwore in Ifitembd go b0+r►Woft.
Governing taw
I& This:.Aveement Od be mmftvd. and. rested and Its tratidlly AW 000 shall be
del wWried by Wo`Mwidess such Imismayfkam One to#me mit.
Valid Notios it"rtrsmente
12.Any wtice in wAftrWbvd w pence to be l to.dw Wahlom of ern by
the Thotam WM be OwAd to hm b"A. . 91a pdawWy delivered & M d to en
etty e.ed to Wo peOw at the addmss~*pelts tltet pepows mae in oph g of
thisentor as�at 1116 person tt
by w "r to#wTWMw Any nom.
m wry ngvhd or pw~ to be. to the,Tfustee be nUy Ott d defto
Trustee al ksp"pal offla orOt oto ft Twame may fir,
Mwendment Moditetlon,or Tsrmina*m of Agr"metrt
D
This Agreemwd wfths do entire understan ft between ft.partlss, and nay be.
ran d, ravoW, fs tarn in ated act► by a wrhten spreement Wwted by the Trustee and.e!I of the
beraWarlasm'Hi*desk. lh at bmtaet m mayremAtfim the operatimof PwWaph 14d
Oft Aervemert and.sxceptthat Ute Aweitent maybe wwmWaMely as to the Wiry cf
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Miami Shores Village
10050 N.E.2nd Avenue NE
Miami Shores,FL 33138-0000 £ `
Phone: (305)795-2204 E, • „
c EES 4 ?rid A u£, 7 b
Expiration: 1112016
Project Address Parcel Number Applicant
280 NE 91 Street 1132060190410
Miami Shores, FL 33138- Block: Lot: NATIONAL CAPITAL ENTERPRI:
Owner Information Address Phone Cell
FN�AITIONAL CAPITAL ENTERPRISES 9500 N MIAMI Avenue
MIAMI SHORES FL 33138-
9500 N MIAMI Avenue
MIAMI SHORES FL 33138-
Contractor(s) Phone Cell Phone $ 50,000.00
JC/GC INC (954)214-4488 Valuation:
Total Sq Feet: 2500
Approved:In Review Available Inspections:
Comments:
Date Approved::In Review Inspection Type:
Fill Cells Columns
Date Denied: Final PE Certification
Type of Construction:INTERIOR RENOVATION,NEW KIT Occupancy:Single Family Window Door Attachment
Stories: Exterior: Framing
Front Setback: Rear Setback: Insulation
Left Setback: Right Setback: Drywall Screw
Bedrooms: Bathrooms: Window and Door Buck
Certificate Status: Review Planning
Plans Submitted:
Certificate Date: Additional Info: Review Mechanical
Bond Retum: Classification:Residential Review Structural
Review Structural
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due Review Structural
CCF $30.00 Review Electrical
DBPR Fee $22.50 Invoice# RC-7-15-56251 Review Electrical
DCA Fee $22.50 11/13/2015 Check#:1583 $1,797.00 $200.00 Review Electrical
Education Surcharge $10.00 07/07/2015 Check#:1486 $200.00 $0.00 Review Building
Permit Fee $1,500.00 Review Building
Plan Review Fee(Engineer) $120.00 Review Building
Plan Review Fee(Engineer) $120.00 Review Building
Plan Review Fee(Engineer) $120.00 Review Plumbing
Scanning Fee $12.00 Review Plumbing
Technology Fee $40.00 Review Plumbing
Total: $1,997.00
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 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. Futhermore,I authorize the above-named contractor to do the work stated.
November 13,2015
Autho S1 ature:Own / Applican Contractor / Agent Date
Building Department Copy
November 13,2015 1
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Date: August 18 2015
To: Miami Shores Village
10050 NE 2nd Avenue
Miami Shores FL 33138
308 795 2204
Re: Plan Review.Comments
Building:
1.Permits submitted on or after June 30 2015 should comply with the requirements of the 5th Edition of the 2014 FBC
Response:Cate data corrected.
2.Provide a Code legend.Code-in effect,level of alteration,construction type use and occupancy.
Response:Code data corrected.AO.O
3.Provide design pressures Wwindows and doors.
Response:See Sheet A0.0
Plumbing: •• •
1.FBC 107.2.1 Provide the following criteria in legend. •
Correct code and year to be referenced for design. ' .• ••
Provide level of alteration as per Existing Building Code Sections 405
...... .... ......
Response:See Sheet AO.0 •'•••' :....:
.... .... . .
2. FBC 107.1 As per miami dade Ordinance chapter 8-10 show the applicable Utilities. This shall int4baO but not tiHft to se%W,
sewer lateral,water meter,water service and any gas lines or tanks on property. : 00000
Response:Utility locations added.See Sheet A1.0 • •
3. FBC 107.2 & Miami-Dade Chapter 8-10 permits. Construction documents to be of sufficient dartty to indicat¢�taV;itmensRihb'••
location, nature and proposed and show in detail that it conforms to the provisions of this code.4ApplWoon slates only kitft •;
however the plans show work in the bathroom and does not specify. .• • • ••• •
Response:Drawings revised. '••'
Electrical:
1.Add smoke/carbon monoxide detectors.
Response:Interconnected smoke ICO detectors added. A1.2
2.Need riser diagram,load calculation and panel schedule.
Response:Provided See A1.2
3.Show circuit numbers.
Response:See A1.2
4. Recessed fixtures to be IC rated.
Response:All recessed shall be Insulation Contact rated.See 1/A1.2
5.Put DW receptacle under sink
Response:DW receptacle shown under sink A1.2
W.Scott Anderson AIA
W.Scott Anderson AIA Architect
5385 Andover Drive#101
Naples FL 34110
239 398 4830
5385 Andover Drive#101 Naples FL 34110 FL Lic.#AR93467