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RC-15-2407 Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-262311 Permit Number: RC-9-15-2407 Scheduled Inspection Date:July 01,2016 Permit Type: Residential Construction Inspector: Inspection Type: Final Building Owner: LEVY, RAPHAEL Work Classification: Alteration Job Address:10276 NE 12 Avenue Miami Shores,FL 33138- Phone Number 3051758-9065 Parcel Number 1132050190020 Project: <NONE> Contractor: BUILDWORKS, INC Phone: (786)615-2828 Building Department Comments BATHROOM AND KITCHEN REMODEL, MISC. REPAIRS. Infractlo Passed comments SOME PARTITIONS SHALL BE REARRANGED, EXISTING INSPECTOR COMMENTS False A/C SHALL BE REPLACED, PLUMBING FIXTURES SHALL BE REPLACED BUT NO NEW PLUMBING IS TO BE ADDED. Inspector Comments �1 91 Passed k1`v Failed Correction ❑ Needed Re-Inspection Fee No Additional Inspections can be scheduled until re-inspection fee is paid June 30,2016 For Inspections please call: (305)762-4949 Page 28 of 31 { �6, SHIP SHAPE PEST CONTROL 4624 North Powerline Road,Pompano Beach,FL 33073 Phone:954-429-9906 FAX:954-429-9907 Toll Free:800-543-1319 11 Certified Environmental Inspectors and Remediation Specialists to Balancing Life in the Soil, the Foundation of Life "Intelligent Termite Control" TERMITE CONTROL A NOTICE OF THIS TREATMENT HAS BEEN AFFIXED TO THE FUSE SERVICE AGREEMENT BOX OR HOT WATER TANK UNLESS OTHERWISE INDICATED lv Residential r-Commercial Date of Treatment 3-29-16 Tues 3-4 pm LIMITED RE-TREATMENT ONLY GUARANTEE Levy Residence PURCHASER NAME NAME 10276 NE 12th Avenue BILL TO-STREET ADDRESS STREET ADDRESS Miami Shores FI 33138 CITY STATE ZIP CODE CITY STATE ZIP CODE 786-443-4704 Juan Soil Pre Treat 20 sq ft BUSINESS PHONE SERVICE PHONE TYPE NUMBER STRUCTURES METHOD OF PAYMENT Payment upon completion F Terms-Stated Below DEV: GRID LOC: i�At Closing-Title Co. T Title Co-Add F 1. Subterranean Pre Treat— $ 75.00 50%Deposit Terms 2. Fumigation SHIP SHAPE PEST CONTROL IS HEREBY AUTHORIZED TO TREAT 3. Tax THE PREMISES DESCRIBED ABOVE FOR THE CONTROL OF: f- Drywood Termites f-Control of 4. Total Price $ 75.00 5-1 Subterranean Termites f- Presumptive Evidence Of �-Other I✓ Prevention of 5. Less Cash Down payment Fumigation Clean Heat r I ncali7A Traatmant 6. Unpaid Balance Due (to be paid as stated below) SERVICE AGREEMENTS: 1. THIS CONTRACT CONTAINS EXCLUSIONS,LIMITATIONS r- Lifetime Retreatment Renewable Service Agreement AND DISCLAIMERS LISTED ON THE REVERSE SIDE f-5 Year Renewable Service Agreement 2. YOU THE BUYER MAY CANCEL THIS TRANSACTION ANY r- No Guarantee Issued PRIOR TO MIDNIGHT OF THE THIRD(3RD)BUSINESS DAY F 1 Year Guarantee Limited AFTER THE DATE OF THIS TRANSACTION F-Damage Guarantee Additional $ 3. YOU ARE ENTITLED TO AN EXACT EXECUTED COPY OF THIS AGREEMENT Ship Shape Pest Control will retreat the structure(s)for covered Termites 4. ALL OR PART OF THIS WORK MAY BE SUBCONTRACTED at no cost to the Customer should an infestation be found. A CERTIFIED AND LICENSED COMPANY Initial Buyer agrees to pay a late charge the greater of$25.00 or 10% of the amount of any installment which is not paid within 10 days of date due. Accepted by(Print): 3/28/2016 In case of default in the payment of any installment for more than 30 BUYER OR BUYER'S AUTHORIZED AGENT SIGNATURE DATE days, Ship Shape Pest Control, or its assignee, may elect to declare the A. Kravitsky(SG) entire balance to be immediately due and payable together with all costs of Collections,including reasonable attorneys fees. SHIP SHAPE PEST CONTROL-INSPECTOR 'Notice of Treatment has been affixed: OPTIONAL-AFTER 1 ST YEAR CONTINUOUS PROTECTION AGREEMENT c;omments: Annual Renewal payment is currently: $ NA plus tax where applicable. Ship Shape Pest Control reserves the right to change the renewal amount at any time without prior notice or terminate this agreement if terms and conditions are not complied with. A transfer fee of$35 will be charged to transfer this agreement.Change In Law:In PHONE: 954.933.0782/1.800.543.1319 the event of a change in applicable Federal,State,or Local Law,material in the manner in which Ship Shape Pest Control delivers its services or discharges its obligations under this agreement, www.pestdepot.com*www.wholesaletermite.com Ship Shape Pest Control reserves the right to Increase the Annual Renewal Fee,without the www.wholesalefumigation.com*www.wholesalemold.com" above mentioned limitation,or terminate this agreement. www.wholesalerodents.com GENERAL TERMS AND CONDITIONS By specific reference hereto,the Purchaser understands that General Terms and Conditions are hereby made a part of the Service Order and apply without exception.Purchaser further understands that their signature on this Agreement accepts the terms offered by Ship Shape Pest Control, hereby referred to as'The Company;'for good and valuable rnmiripratinn rpraint of whirh i¢hprphv arknnwiprinpri 1. If moisture and/or structural conditions which are conducive to Termites are subsequently found to exist without ground contact,then The Company shall be relieved of any and all liability. 2. Structural or mechanical defects which result in water leakage in interior areas or through the roof or exterior walls of the premises may destroy the effectiveness of The Company's treatment,thereby permitting infestation to continue after the date of initial treatment. If such a condition is discovered, it is agreed that the customer will be responsible for making such repairs as are necessary to correct the structural or mechanical defect(s)immediately upon discovery of such defect.Should a re-treatment of any affected area(s)be needed,the expense of such will be charged to the customer as a condition of a continuation of the warranty,or warranty may be terminated unless full re-treatment is purchased by purchaser, 3.The Company's liability shall be terminated should The Company be prevented from fulfilling its responsibilities under the terms of this Service Order of the Guaranty by reason of Acts of War,whether declared or undeclared,Acts of any duly constituted Government Authority,strikes,or Acts of God. 4,This Agreement covers the premises diagramed on the Graph and Specifications Sheet as of the date of actual treatment,and in the event the premises are structurally modified,altered,or otherwise changed after the date of initial treatment,this Agreement shall terminate unless a prior written agreement shall have been entered into by the Purchase for The Company unless alteration or changes in writing and executed by a corporate officer of The Company under the corporate seal. 5. It is understood and agreed between the parties that this Contract,the Graph and Specifications Sheets which bear this Contract Number,and,upon issuance,the Guaranty constitute the complete agreement between parties and that said agreement may not be changed or altered in any manner,oral or otherwise,by any representative of The Company unless alteration of change be in writing and executed by a corporate officer of The Company under the corporate seal. 6.This Agreement is a limited control guarantee,which is limited to re-treatment only.The Company shall not be liable for any consequential damage as a result of treatment to the subject property.Re-inspection will be done if requested or will be done annually at the time of renewal. 7. It is understood and agreed between the parties that should it be necessary for The Company to institute legal proceedings to recover damages from the Purchaser for the breach of this Agreement or for non-payment under its terms the Purchaser shall be responsible for and shall pay all of The Company s attorney's fees,court costs,pre and post iudament interest,and anv and all collection fees. 8. Payment shall be made within thirty(30)days from the date of services rendered.Any account with an unpaid balance at the end of said term will be charged interest on the unpaid portion of the rate of 1.5%(one and one half percent)interest per month until such time the account has been paid in full. 9. It is understood and agreed between the parties that the Purchaser's signature on this agreement acknowledges notice of lien on the structure(s)which form the subject matter of this agreement,in the event that legal or collection measures are necessary to enforce the terms of this agreement. 10.The Company's liability under this contract shall terminate when access to the premises for the purpose of carrying out the terms and conditions of the contract is refused by the Purchaser or its agent. 11.The Company will exercise reasonable care in its treatment procedures but will not accept responsibility for broken roof tiles,gutter,solar heater,landscape foliage,puncture and subsequent leakage of undetectable buried or hidden water pipes,electrical conduits,TV cables,and A/C or Heating ducts or plumbing,or any other inadvertent damage occasioned by properly performed procedures. 12. Notwithstanding that the serviced property is the subject of real estate transfer,refinance,etc.,payment for services rendered shall be made within the stated time. 13.This agreement shall be governed by the laws of the State of Florida and venue with respect to any legal action to enforce,interpret,or otherwise deal with any provision hereof shall be maintained exclusively in Broward and Palm Beach Counties,Florida. 14.All or part of this work may be contracted to a Certified and Licensed Company. 15. Postponement of job must be received by 9:00 AM of the prior day prior to the date of the scheduled job.Fee for postponement without required notice:20%of fumigation fee. 16. SUBTERRANEAN TERMITE WARRANTY DOES NOT INCLUDE FORMOSAN TERMITE TREATMENT(COPTOTERMES FORMOSANUS) UNLESS SPECIFICALLY NOTED ON THE FRONT OF THIS CONTRACT. SUBTERRANEAN TERMITE LIMITED CONTROL GUARANTEE SUBJECT TO THE GENERAL TERMS AND CONDITIONS, THE COMPANY WILL ISSUE A LIMITED CONTROL GUARANTEE AND,AT NO EXTRA COST, APPLY ANY NECESSARY ADDITIONAL TREATMENT TO THE PREMISES IF RE-INFESTATION IS FOUND THEREIN DURING THE PERIOD OF THE GUARANTEE.THE PURCHASER FURTHER UNDERSTANDS THAT THE COMPANY'S LIABILITY UNDER THIS AGREEMENT IS LIMITED TO RETREATEMNT ONLY AND IS IN NO WAY IMPLIED OR OTHERWISE IS RESPONSIBLE FOR DAMAGES OR REPAIRS TO THE STRUCTURE OR CONTENTS. DRYWOOD TERMITE,POWDER POST BEETLE AND WOOD BORER LIMITED GUARANTEE SUBJECT TO THE TERMS AND CONDITIONS THE COMPANY WILL RETREAT THE STRUCTURE FOR THE CONTROL OF DRYWOOD TERMITES OR POWDER POST BEETLES AND WOOD BORERS,AND WILL ISSUE A LIMITED CONTROL GUARANTEE WHICH WILL PROVIDE FOR RETREATMENT AT NO EXTRA COST,SHOULD A RE-INFESTATION BE DISCOVERED DURING THE PERIOD THE GUARANTEE IS IN FORCE.COMPANY'S LIABILITY UNDER THIS AGREEMENT IS LIMITED TO RETREATMENT ONLY AND IN NO WAY,IMPLIED OR OTHERWISE,IS RESPONSIBLE FOR DAMAGES OR REPAIRS TO THE STRUCTURE OR CONTENTS. Ship Shape Pest Control 4624 N. Powerline Rd Deerfield Beach, Fl 33073 Phone: (954) 429-9906 Fax: (954) 429-9907 Toll Free Number: (800) 543-1319 www.pestdepot.com Date of Treatment(s): March 29`h 2016 This notice is regarding the property located: 10276 NE 12th Avenue, Miami Shores, F133138 The addition to this structure has received a treatment for the prevention of subterranean termites. This treatment is in accordance with the rules and regulations established by the Florida Department of Agriculture, Consumer Services and Broward County Codes. If you have any questions or concerns please feel free to contact us at the number above. Kind Regards, 7anravitsky e Pest of New Construction Subterranean Termite OMB AWOVal No.W.M Soil Treatment Record (evt5) This form is completed by the licensed Pest Control Company Public reporting burden for the collection of Information is estimated to average 15 minutes per response,including the time for reviewing instructions,searching existing data sources,fathering and maintaining the data needed,and completing and reviewing the collection of information. This information is mandatory and is required to obtain benefits. HUD may not collect this information,and you are not required to complete this form,unless it displays a current valid OMB control number. Section 24 CFR 200.926d(b)(3)requires that the sites for HUD insured structures must be free of termite hazards. This information collection requires the builder to certify that an authorized Pest Control company performed all required treatment for termites,and that the builder guarantees the treated area against infestation for one year. Builders, pest control companies,mortgage lenders,homebuyers,and HUD as a record of treatment for specific homes will use the information collected. The information is not considered confidential. This report is submitted for information purposes to the builder on proposed(new)construction cases when soil treatment for prevention of subterranean termite infestation is specified by the builder,architect,or required by the lender,architect,FHA or VA. All contracts for services are between the Pest Control Operator and builder,unless stated otherwise. Section 1: General Information(Pest Control Company Information) Company Name: Ship Shape Pest Control Company Address: 4624 N.Powerline Road City: Pompano Beach State:FL Zip: 33073 Company Business License No.: JB123241 Company Phone No.: 954429-9906 FHA/VA Case No.(if any): Section 2: Builder Information Company Name: Levy Residence Phone No.: Section 3: Property Information: Location of Structure(s)(Street Address,or Legal Description,City,State and Zip) 10276 NE 12th Avenue,Miami Shores,FI 33138 Type of Construction: (More than one box may be checked):❑ Slab ❑ Basement ❑Crawl S Other Soil Approximate Depth of Footing: Outside Inside 20 SF Type of Fill Soil Section 4: Treatment Information Date(s)of Treatment(s): March 29,2016 Type of Construction: (More than one box may be checked): ❑ Slab ❑ Basement ❑Crawl S Other Soil Check all that apply S A. Soil Applied Liquid Termiticide Brand Name of Product(s)Used: Premise EPA Registration No. 432-1331 Approximate Dilution(%):0.05_Approx.Total Gallons Mix Applied 2 Treatment completed on exterior S Yes ❑No ❑B. Wood Applied Liquid Termiticide Brand Name of Product(s)Used EPA Registration No. Approximate Dilution(%): Approx Total Gallons Mix Applied ❑C. Bait system Installed Name of System Attach installation information(required) ❑ D. Physical Barrier System Installed Name of system Attach installation information(required) Service Agreement Available: S Yes ❑No Note: Some state laws require service agreements to be issued. This form does not preempt state law. Attachments(List): Contract Comments: Name of Applicator(s): Mike Sciortino Certification No(if required by State law): JE132342 The applicator has used a product in accordance with the product label and state requirements. All treatment material and methods used comply with state and federal regulations. i Authorized Signature: 3 � Date: March 29,2016 Warning: HUD will prosecute false claim and atements. Convickjay result in criminal and/or civil penalties(18 U.S.C.1001,1010,1012;31 U.S.C.3729,3082 Form NPCA-99-A may still be used Form HUD-NPCA-B(11/30/12) "Mt""_ i- Miami Shores Village 10050 N.E.2nd Avenue NE Miami Shores,FL 33138-0000 sir E� 3 r � Phone: (305)795.2204 Expiration: 1212016 Project Address Parcel Number Applicant 10276 NE 12 Avenue 1132050190020 RAPHAEL LEVY Miami Shores, FL 33138- Block: Lot: Owner Information Address Phone Cell RAPHAEL LEVY 10276 NE 12 Avenue 305/758-9065 305/812-3637 MIAMI SHORES FL 33138 Contractor(s) Phone Cell Phone BUILDWORKS,INC (786)615-2828 Valuation: $ 10,000.00 _.,, _,,... . . Total Sq Feet: 500 Approved:In Review Available Inspections: Comments: Inspection Type: Date Approved::In Review Final PE Certification Date Denied: Window Door Attachment Type of Construction:BATHROOM AND KITCHEN REMOE Occupancy. Framing Stories: Exterior: Insulation Front Setback: Rear Setback: Drywall Screw Left Setback: Right Setback: Fill Cells Columns Bedrooms: Bathrooms: Window and Door Buck Plans Submitted:Yes Certificate Status: Review Planning Certificate Date: Additional Info: Review Plumbing lBond Retum: Classification:Residential Review Plumbing Review Mechanical Fees Due Amount "Date Pay Type Amt Paid Amt Due Review Mechanical Bond Type-Contractors Bond $500.00 Review Mechanical CCF $600 Invoice# RC-9-15-57167 Review Structural DBPR Fee $4.50 03/16/2016 Check*4157 $793.00 $50.00 Review Electrical DCA Fee $4.50 09/22/2015 Check*702 $50.00 $0.00 Review Electrical Education Surcharge $2.00 Bond*3016 Review Electrical Permit Fee $300.00 Review Building Scanning Fee $18.00 Review Building Technology Fee $8.00 Review Building Total: $843.00 Review Building 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 wo done in compliance with all applicable laws regulating construction and zoning. Futhermore,I authorize the above-named contractor t%do t wo t /r/ March 16,2016 Authorized Signature:Owner / Applicant / Contractor / Agent V Date Building Department Copy March 16,2016 1 Miami Shores Village Building Department SEP 2 zo�5 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 1 ' INSPECTION LINE PHONE NUMBER:(305)762.4949 -= %, X7 FBC 20t BUILDING Master Permit iVo.�C. PERMIT APPLICATION Sub Permit No. BUILDING ❑ELECTRIC ❑ ROOFING ❑ REVISION ❑EXTENSION ❑RENEWAL PLUMBING ❑MECHANICAL PUBLIC WORKS ❑ CHANGE OF [-]CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 10 2 7 b QC I Z f 1.,, 4V67- City: VIsCity: Miami Shores County: Miami Dade Zip: 33 I.3 r Folio/Parcel#: 11-3"5-..DA i-00 2.0 Is the Building Historically Designated:Yes NO Occupancy Type: JZ-3 Load: Construction Type: .w Flood Zone:�_BFE: FFE: OWNER:Name(Fee Simple Titleholder): Kikif tol 467L LEVY Phone#: 6+-r) 2.11 -? 0 S 8 Address:_ I d Z 76 ME I Z AYIF City: r it"I Sso z cs State: FL Zip: 3317 d' Tenant/lessee Name: t Phone#: Email:x`19 C1�ayc.�.��'e a-+'S. Cok, CONTRACTOR:Company Name:�t°�i (�1 YY�+� Phone#: Address: Patti�t cid " City: I State: T zlo: 331311 Qualifier Name: nn 1 Phone#: �W(3-q� j State Certification or Registration#: V J 19 5 _Certificate of Competency#: DESIGNER:Architect/Engineer. f!A?t4A 6:L C.EV( &LF A f-Wt I T EC,TS Phone#: 405 S 3,r . f i t Address: f4L.S $t SC AY N e B t.ley; 4 TE• z.o i City: Miami State:—r-&- Zip: 3 3 r Value of Work for this Permit:$ =E!X#" (61-V,-D Square/Unear footage of Work: s o 0 S!t H. Type of Work: ❑ Addition 0 Alteration ❑ New Repair/Replace ❑ Demolition Description of Work: I V4 X00 M -% KI T&I46k) 90el,0 D 6L _M I S C- Rf P Al V-S. SOME fAR.*TI-ito0S SRkt.L be JC 6eD. 9C(t*Cf0 ?LVf1&1Pj& p%KYVjLC5 S-t&Lc. fif 4,!6D Bu't ao rjCv Pt,tlrtoty(, 15 To bf AD®ED- Specify color of color thru tile: Submittal Fee$ St) Go Permit Fee$ -ad U' Ck-) CCF$ 6 CO/CC$ Scanning Fee$ 19'0-3Radon Fee$ 4 ' ` DBPR$ Notary$ Technology Fee$ Fi • Training/Education Fee$ oZ _ GZJ Double Fee$ 0 Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ `3° `� —41913 86nding 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 jab 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 CONTRACTOR The foregoing inst ment was acknowledged befor is The foregoingio, tru ent was acknow ged before me this day o� 20�by da f / - by ,24 kum Ts L{- w o is onally known h is personally know o me or who has produced as me or who as produced Identification and who did take an oath. identifi ion a d who did take an oath. NOTA P BLIC: NOT Y PU Sig g ALMA i QUEST Pri PH =� •= " AMIIA 1 GUEST EXPWS Manch 2S.2018 Seal: MY COMMOSION#FFISM Seal: •... 153 EXPgM:S Mareh 2S.2018 153 APPROVED BY Plans Examiner Zoning Structural Review Clerk STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD (850)487-1395 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 WOODWORTH,JOEY M BUILDWORKS, INC. 335 NE 59 TERRACE MIAMI FL 33137 Congratulations! With this license you lime one of the nearly one million Floddlans licensed by the Department of Business and Professional Regulation. Our professionals and businesses range STATE OF'F4:�lRIDA from architects to yadrt brokers,from boxers to barbeque restaurants. r DSP S NESS AND and they keep Flora's economy strong. OR, „ ULATI Every day we work to improve the way we do business in order to t''( 9553�. /3'I120a4 serve you better. For information about our services,please log onto , www.myfloridalicense.com. There you can find more information ED about our divisions and theulation that impact you,subsc dbe reg to department newsletters and learn more abut the Department's initiatives. Our mission at the Department Is:License Efficiently,Regulate Fairly. We constantly strive to serve you better so that you can serve your customers. Thank you for doing business in Florida, orb trn aa�r-s and congratulations on your new licensel ' DETACH HERE RICK SCOTT,GOVERNOR KEN LAWSON,SECRETARY $T-A OF-K RDA OEP O >13L $N MQ 'R Ir E�S`W*LREt3U4A'Ct�?1 t !t y�i „ N CTI. e � _9 ..p--_ 1�(19111 101A 60 A m y VI� '.ti� "'�CW '�.y ':, •yyxa'iF �' max". -4L'M� � ;u b Y VR Yt`+Msyy �� ',�"",,,, � a ❑ ,�, <. q �y r s '\X. a . 6` N � x � D 1Name FiQdda profit Cot oration BUILDItRKS, INC. Flung Information Document Number P13000021246 FEIIEIN Number 900946181 Date Filed 03106/2013 state • FL Statue ACTIVE Last Event AMENDMENT Event Date Filed 04110/2013 Event Effective Date NONE PrincWW Adotes 335 NE 59TH TERRACE MIAMI, FL 33137 Chard:01/28/2014 Wiling Address 335 NE 59TH TERRACE MIAMI, FL 33137 Changed: 01127/2014 Realslared Agent Name-&Address WOODWORTH, JOEY M 800 WEST AVENUE PHH29 MIAMI BEACH, FL 33139 Name&Address Tide P WOODWORTH,JOEY M 800 WEST AVENUE- PH29 MSI BEACH, FL 33139 Tide VP �- GABALDON, JUAN 1111 LINCOLN RD#400 MIAMI BEACH, FL 33139 Annual- pp No Annual Rem Hied Document:imam f1 Q2 --Amendment view mage in Kw bmat 03/0-6120-13-- Domestic Praf� \Crew image in POF Rwrrw 03/06 13 --Off1Dir I pginn:mtinn View a in PRF fDrIY18t Miami shores V Building Department 10050 N.E.2nd Avenue ;Miami Shores, Florida 33138 Tel: (305) 795.2204 CONTRACTORS' REGISTRATION Fax: (305)756.8972 *tON'T"WTOICIS A. COPY OF QUALIFIER'S STATE LICENCES B. COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF LIABILITY INSURANCE* D. COPY OF WORKERS COMPENSATION INSURANCE* r� EE1tiRTfiDN mastav�N(TiCE TQ OWNER form and ContwbrA"vjj NTRA_C RM�HAS-i - rAtKanK-COUNTY-CERT1F1CATE_(W=WETE _Y:'. A. COPY OF CERTIFICATE OF COMPETENCY OF QUALIFIER B. COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF STATE REGISTERED CONTRACTOR LICENSE OR MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT. D. COPY OF LIABILITY INSURACE* E. COF�Y-f3F-WORK-E1�S=CSP€-�#BAT1( -�1SUR�IVCE* . (V�odcers Coxttp�nsatior� EIt�P fON rriusf-baY i OTICE TO-OWNE#�-firm attd Cbn r. AffklA-vd)_ `' bUR-tNSUitA VCC l 7FNYMUST ISSU CERTIFICATE AS FD OW: Certificate i er.- MIAMI SHORES VILLAGE BLDG`MOT 10050 NE 2ND AVE _ MIAMI SHORES,FL 33138 onofa ratla»s 0,f0"bwW license nutrdw. f/■/tff■///f/f//////// ///f//f///////f////f/ff///////f/////f//\/fff/////. LEa��/BUSINESS NAME: BUSINESS ADDRESS: 1.33s, TrX CITY I i STATE ,RZIP--�� BUSINESS PHONE: lY� FAX NUMBER � tol 3 CELL PHONE� QUALIFIER'S NAME: Vim T QUALIFIER'S LIC NUMBER:ILCUS _C(S,