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CC-15-2964 ". '" a €x9, r d 4 z VLX �sK° L,� Miami Shores Village Y Vzet pet11tlC `il) ttlSLi��C 10050 N.E.2nd Avenue NE nm nmMiami Shores,FL 33138-0000 ' p APIPR�' *0 Phone: (305)795-2204 �� - F. iiut+ ll 7C2 ' Expiration: 11113/2016 Project Address Parcel Number Applicant 9475 NE 2 Avenue 1132060133760 BANK OF AMERICA NA Miami Shores, FL 33138- Block: Lot: Owner Information Address Phone Cell BANK OF AMERICA NA 13510 BALLANTYNE CORP Place CHARLOTTE NC 28277- 9475 NE 2 Avenue MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone Valuation: $ 2,500.00 ASSOCIATED CONSTRUCTION AND 1 (239)567-3293 (954)892-0634 _. . ,..w_...... _ _... . Total Sq Feet: Approved:In Review Available Inspections: Comments: Inspection Type: Date Approved::In Review Final Date Denied: Review Building Type of Construction:REPAIR FASCIA ON THE SECOND Occupancy Load: Review Building Stories: Exterior: Review Structural Front Setback: Rear Setback: Left Setback: Right Setback: Plans Submitted:No Certification Status: Certification Date: Additional Info: Bond Return: Classification:Residential Scannin :1 Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $1.60 DBPR Fee InvojCe# CC-11-15-57869 $2.25 05/17/2016 Credit Card $232.30 $50.00 DCA Fee $2,25 Education Surcharge $0.60 11/24/2015 Check*1259 $50.00 $0.00 Permit Fee $150.00 Plan Review Fee(Engineer) $120.00 Scanning Fee $3.00 Technology Fee $2.40 Total: $282.30 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: _Lcertify-#kit-�sFegnipginformation is accurate and that all work will be done in compliance with all applicable laws regulating construc' oning. Futhermore,I authorize the aboJe-n�med contractor to do the work stated. May 17, 2016 Authoriz c gna ure: Contractor / Agent Date Bui in Department Copy May 17,2016 1 Miami Shores Village - �� Building Department NOV 2 4 20, L` 10050 N.E.2nd Avenue, Miami Shores,Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 __ . _ INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 20 BUILDING Master Permit NO. 0 S PERMIT APPLICATION Sub Permit No. 9BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS:_c1qci N�Y*,ast 2nd Ave_ (q q� KIG 2 A\/,F, City: Miami Shores County: Miami Dade Zip: 3 3 l 3 $ Folio/Parcel#:11-32Din-OIS-3'1(oO Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name(Fee Simple Titleholder): )C l Anmy1 rA NR Phone#: Address: OV41 5 NE 2nd AyR, City: Char I01i State: b)G zip: g8Z'1-) Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name: Associatm conmyuchen and ave-iop=%4lvnt_ Phone#:290-OM-8299 Address: '119clq Mevcan-tile Sf_ jjn;} 15 City: �hr+vl w'E. err. State: FL zip: 33q 1"1 G de,l cimia Phone#: 2-9A-IM-92,93 _Qualifier Name:Ak _ State Certification or Registration#: CGN5 I(oOD3 Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ Z, SOO • O Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New ® Repair/Replace ❑ Demolition Description of Work: qP Da i r !RASGL&- CA `I;hf- .5-44 Sforu . Specify color of color thru tile: Submittal Fee$ Permit Fee$ CCF$ PO/CC$ Scanning Fee$ �� Radon Fee$ a' DBPR$ Notary$ 0 Technology Fee$ 0 Training/Education Fee$ Q GO Double Fee$ Structural Reviews$ /" Bond$ TOTAL FEE NOW DUE$ 2,32 . (Revised02/24/2014) 4 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 a v and a reinspection fee will be charged. Signature SignatureWM�IA g g OW R or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this ttl 44, day of 9vOl��(`(1 O- 20 1 S , by day of Ce D6.f Y 120 1'5 by t-C''C�0,who is personally known to Mims tl Aleprin who is Qersonally 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 PUBLIC: NOTARY PUBLIC: Si Sign: IA>Aj-- YP nt: Z- ` Print: CY GUTIERREZ MATOS Seal: r Seal: ........ •i BAY COMMISSION#FF127876 ,o ,h KRYSTAL N GREEN a. .o. EXPIRES Jung 9, 2018 a Qi MY COMMISSION#FF143949 '•.; ✓'F! dd1 39"153 PlorldeNot4 fMce• •'•�• d�;.•' EXPIRES November 4,2018 •� � ��, 16(407)398-0153 FloridallotaryService.com APPROVED BY Plans Examiner Zoning ,e°`' / Structural Review Clerk (Revised02/24/2014) 11/12/2015 THU 1: 13 FAX ACD sroWgrd ®001/004 Miami shores Village Building Department . ` 8 (V►I 10050 N.E.2nd Avenue Miami Shores, Florida 33136 • Tei: (305)795.2201 Fax: (305)756.8972 CONTRACTORS' REGISTRATION IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: A. +� COPY OF QUALIFIER'S STATE LICENCES B. COPY OF LOCAL BUSINESS TAX RECEIPT C. i/ COPY OF-LIABILITY INSURANCE* D. COPY OF WORKERS COMPENSATION INSURANCE* (Workers Compensation EXEMPTION must have NOTICE TO OWNER form and Contractor Af 1davlt) IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY: A. COPY OF CERTIFICATE OF COMPETENCY OF QUALIFIER B. COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF STATE REGISTERED CONTRACTOR LICENSE OR MIAMI RADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT. D. COPY OF LIABILITY INSURACE* E. COPY OF WORKERS COMPENSATION INSURANCE* (Workers Compensation EXEMPTION must have NOTICE TO OWNER form and Contractor Affidavit) ,=,Q�j,NSURN.GE-COMPANY MUST ISSUE A CERTIFICATE AS LLO-W. .Certflgate Holder. MIAMI SHORESVILLAGE BLDG DEPT 90050 NE 2ND AVE MIAMI SHOT , FL 119138 i 06"310b must specify tate gescrlption of Womflons.or contractor 11cehae number. rrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrr■rrrrrrrr■■■�■■■■rrrrrrrrrrrrrrrrrrrrrrrrr BUSINESS NAMin-i-ed roataidibnud I 'vt lopioxnt, The . BUSINESS ADDRESS: 2ls'UR . A- 104 CITY—&jrd (j STATE _ZIP 9M IZ BUSINESS PHONE: (24q 1 qfn-,AZAR FAX NUMBER(%Uei 1.667-97-99 CELL PHONE(��)_��12 -f } QUALIFIER'S NAME: M j*(1 hr A AI r nvr► QUALIFIER'S LIC NUMBER: CArl 1-61 toCloS 11/12/2015 THU 1: 14 FAX ... ACD Sroward 2004/004 3TA,TE,GF IlLOAM ' DEPARTMENT'OF BUBI IESS AVID PROPLOSI.ONAL REGULATION 1 CONSTRUCTIOINDU'8'�RY LIRENSINO BOARD •COC 1If 1800 �� ''�'' � 'rhe a NERAL, QNTRACTOR' Nomad-,OoIgW IS'CERTIFISQ. Uh r'the;pFovl�loclia'of Cha tnr q89 FS. 4.. � pp N. �•b..,,;, , i 'EKpi.rotid�dOtb,-AUG•31:•,2Qla T�EdKK' ((Q��NS'TR Q% ...D�VELGMO� NT 1N �`� -&' � urAV '.'.i;=e.:r v, ; ';n J,'4� r,'aT.M�' 1r ��'p'!'.''`'``4tif ',`�i%,^•.`y�,��' 1 4 a' ' • +,.1 /11 L/ 1: al'.�� ,,' • i \I Y.1 � AIR — +...r' *�„.5,��. ,�;c;� }h`' ''q a 0.'•. ''a'� `'' � •. �• + � 1'1 f .M�i.. 4' .._�I:RIM... N�•lf%a!:>;' '.'�..- N" �. `.T� 1, ,� �.�+} L� �, '` '►. `I 'f�7 ISSUED: 06/20/2014 DISPLAY AS REQUIRED BY LAW SRO 040620=791 ,. .. .. ................. . . .. .. .. . �_�.,w.u",�...,�,z..,,�,;,V�t,°di�'lth°i•d,nr,r:�n�iy+lr.ay.t,�O°.,�rl�,nlii.�-cd".,,,w,.t,v.. 11/12/2015 THU 1: 13 FAX ACD sroward 0002/004 . Fax Server 11/12/2015 8;51 ; 15 AM PAOE 1/001 Fax Server BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT 115 S. Andrews Ave., Rm.A-100. Ft. Lauderdale, FL 33301-1895—954831-4000 VALID OCTOBER 1,2015 THROUGH SEPTEMBER 30,2016 O13A.AOSOCIATED CONSTRUCTION AND Receipt>f#:a�M?CDNT1tACTOR (a=="Business Nance:DEV>�LOPNITsNT,INC. Business Type:cONSRAt:loA) Owner Name:ALcORN mrcHAEL w Business Opened:20/28/2010 Business Location-,500 SW 21ST TERRACE:,#A-104 State/Countl#Cert/Rog:CGMB:L6003 VT LAMERDALE Exemption Code: Business Phone:239-997-3293 Rooms beats Employs" Machines Professionals 2 For Ventlln4 Business Only NumbervrMachines: Ventding Typo; Tax Amount Transfer Fee N$F Fee Penaity Prior Years Coliecdon Cosi Total Paid 27.00 0.00 0.001 0.00 0.00 1 0.00 77.00 THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS THIS BECOMES A TAX RECEIPT This lox Is levied for the privilege or doing business wlINn Broward County and is non-regulatory In nalure.You must meet all County andior Muniotpallly planning WHSN VALIDATED and zoning requiremerss. This Business Tax Receipt must be transferred when 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. Meiling Address: ASSOCIATED CONSTRUCTION & DEVELOPNC ReceLpt #OTA-14-0 00 09 24 7 P O SOX 3443 paid 09/14/2010 27.00 NORTH FORT MyRus, FL 33919 1015 . 2016 BROWARD COUNTY LOCAs. BUSINESS TAX RECEIPT 115 S.Andrews Ave., Rm.A-100, Ft. Lauderdale, FL 33301-1695—954831.4000 VALID OCTOBER 1, 2015 THROUGH SEPTEMBER 30, 2016 OBA;AGROCIATE'D CONSTRUCTION AND Receipt#:180-237033 Business Nance:DEVBLOPM$NT,INC. Susines8 Type:COMMM�ACTORt+MCTOR glia" Owner Name:ALmRN Mza=L w Business Opened:10/28/2010 Business Locatton:50O 8W 21ST TERRACE,#A-104 gtgte/County/Cwt/Rog:C©C7516003 FT LAtWERDALE Exemption Code: Business Phone:239-997-3293 Rooms waft Employees Machines Prollesslonats 2 Signature Por Vending Musinves Only Number of Machines: Vendin . Tex mount Transfer Fee NSF Fee Penalty Prlor Years A Collection Cost Total Paid 77.00 0.001 0.00 0.001 0.001 0.00 27.00 Receipt (#e3A-14-00009247 Paid 06/94/9013 27.00 11/12/2015 THU 1: 14 FAX ACD Broward ®003/004 CERTIFICATE OF LIABILITY INSURANCE 17- ER-195 TE IMIetODIYYYYI THIS G@ 18188U D AB A MATTER�F INFORMATION ONLY AND CaIVPEiiB 810 qlb uHTB ppN T'H' �ERTIRCATE H 6BR,TM 86— CBRTIPICATE DOER NDT AFFIRMATnfELY OR NECiATIvELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES 81:LOW. III CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(8),AUTHORIZED RE1RiE88NTATIVE OR PRODUCER,AND THE CERTIFICATE HO1 —IM efor s III c the oe'rgtiof t hallo(o en 7 MAL Mho, �cy1y,"�'n�u:r bs enao`n.�"rr�§ubR-"+o `a1TioN IS AwBD�bublec� — _the terms and eondlNons al the Polley,99"n Psllaln may require 6n endorsement.A statement an this certiflaws,,toes rot corder rights to the 96"1119916 holder In lieu of such sndareemsrdi PRODUOER T Dente Insurance InTiffany Cents •—.......-----».,.—....�—__._.._ Ing). 238 888. 16066 MCpreoer Blvd Suite 109 Ft.Myers, FL 83908 — PhoneN RSR a ad or`OVE INeURID�23A�039.7887__ �_.. hex( f� „7781 ,._..r_.._ , .�euR[gAUnited Speololly Inewsrroe CoMrAmy I IIypgg,E,l_Proyreselve 1311 fess Ins Com Assooleted Construction a Development Ino. 18lRef�' Sa9ltsdete In ranee Com~” -- - `-- RO Box 3443 u III- Bouthero lnwreno.--.....�"r - ccmPetly N FI Myers,FL 35816 (238), _ 1IleFR`: Orasr Amsrlosn PId6IHy In9unsnoe company "" COVERAGEiGERTIFICA'M NUMB@": . REV19ION NU'�ilB1:R�— THI819 T 4@R 1°II'Y THAT THE POLICIES OF INSURANOE LIS1'6p Bi MAyE gE6N 188UHU TO THE INK lN DEMA D A96VE FOIL WCTH Po-' 'pY PERIOD INDICATED. NOTWITHSTANDING ANY ROQUIREMLNT,TERM OR CONDITION OP ANY CONTRAOT OR OTHER DOCUMENT WITH RESPI TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORQL'D BY THE POLICIt:S DEBCR{Bl:D HHREIN IS SUBJECT TO ALL THE T6ItttAS, EXOLUBIONS AND CONDITIONS OF SUCH POLICIES,I.(IaTS SHOWN MAY HAVE BWN REDUCED WaBY PAID CLAIMS. il — TVPD op INSuRANOe A - kT WNeRAL LIABILITY �] �C�O1MMERCIALOR40AL 1iA81Lf1Y H RR�� 1. t CLA .MAOE r!/ OCCUR E6cglNtteRVJtL_ S tSO,000.00 A IIdSN N USA-4106616 MEDEKone�+erson _ i 6-000-00 �� ,.-„„_•.__ 10/96120!6 1011812018 PERAONAL&ADVIN�URY. s I Q00'gw.QC_ _.. cI” NeRa�AoaAevATe : URI 011i AOBREOATB LIMIT APPLIES PSR ..�. -•- �. �.JFECT r.�L„L� PRODUCTa�COMnlOPAGO i 2ODD 000,00 AUTOMOIXGLUteILITY - -- - _ — __—_�_ e [� ANY AUTO BODILY INJURY IPsr n•tson) e ALL owweD sq�cH�Os3ouLED N N 038353380 H ALITo9 6-01*1r 0411=015 04/10/2018 BbftY*MY1Pm HIpEgAUTOB C�•��, NF.D pLp�•ryd AUTOSRAMAN �— ---------�---- UMOMILLA LIA9 CUR C r•� ■xOEsti LIAR XB900tS6823 .�• 11ACH GCC JIIIII tP:•. •�._ e 6 000.00 IemA .CLAIMS.MA N N ...rP��..... 1a18fZ01S 10/18/2018 Ar}t�REOATE s 5 000 000.00 LVORxeRe COtiPSN8ATi0N .�• .�•�.'— -•.^•.•—_. -,.�•_..— 6 ANNYYD��BMPLOYERS'LIABILITY YIN ^` TH p MEM N 1387971818 - -- TOA/PART pGpiYYQp enl►.taylnNNj @%Gl T Y�NIA ry 01/07!2016 01/07/2016 ��GH---Aecl�eNT^-» = tu000000.00r L 019688@•EA EMPLOYE 6 1.0001000.00 w III ASE•POLjOY LIMrr �1 ,Q00.00 E Employee Dlahonesty/Ci t s SAA Oa81164 0000 01/08/2015 01108/2016 1,000,000 per Oc*umwm oeticRlPrtaN OP OPSRAT10Na r t.00BnON®I v'Ll�ntA.11S(Alt„oh IIGOIto AOe1�01, ItRlgl Ron�i s9hstluM,if srors sprKs I.rea„lht►} -'"'. ."'-`•_. '0OC1510 003 General Contractor OERTIFIOATE HOLDER- -'�'- --•-- -_r..._.C .r�.��..- ...-�.._ .- ANCELLATION MIenU Shores VIIIeg6 8u0dlrlp DepertmeM TME EXPMTIo TbHA7E'S TTHH41818DO�NOTICe�p N B9pose I DOD Northeast 2nd Ave ACCCRDANCE WITH THE POLICY RWVIBIONB. MINI 19horea,FL 93138 tPlighi Iva ,r (CORD 24(2010106)QF The ACORD nems logoO AT ON, A Il rights rewrV d. ASSISTANT SECRETARY'S CERTIFICATE OF BANK OF AMERICA, NATIONAL ASSOCIATION The undersigned, Allison L. Gilliam, an Assistant Secretary of Bank of America, National Association (the "Association"), a national banking association organized and existing under the laws of the United States of America and having its principal place of business in the City of Charlotte, County of Mecklenburg, State of North Carolina, does hereby certify that: 1. The following person has been duly elected or appointed to the office in the Association as indicated; and that such person holds such office at this time. Name Title Felipe Izquierdo Senior Vice President 2. The following is a true and complete copy of an excerpt from the Bylaws of said Association, and the same is in full force and effect as of the date hereof. Section 5.2. Execution of Instruments. All indentures, mortgages, deeds, conveyances, contracts, notes, loan documents, letters of credit, master agreements, swap agreements, guarantees, discharges, releases, satisfactions, settlements, affidavits, bonds, undertakings, powers of attorney, and other instruments or contracts may be signed, executed, acknowledged, verified, attested, delivered or accepted on behalf of the Association by the Chairman of the Board, the Chief Executive Officer, the President, any Vice Chairman of the Board, any Division President, any Managing Director, any Director (as described in Section 4.7 of these Bylaws), any Principal, any Executive Vice President, any Senior Vice President, any Vice President, any Assistant Vice President, any Officer, or any individual who is listed on the Association's personnel records in a position equal to any of the aforementioned officer positions, or such other officers, employees or agents as the Board of Directors, the Chief Executive Officer or any officer reporting directly to the Chief Executive Officer may direct in a written delegation kept in the minute book of the Association. The provisions of this Section 5.2 are supplementary to any other provision of these Bylaws and shall not be construed to authorize execution of instruments otherwise dictated by law. IN WITNESS WHEREOF, I have hereupon set my hand and affixed the seal of said Association this 1St day of April, 2015. (SEAL) Allison L. Gilliam Assistant Secretary AC"R0 R0 CERTIFICATE L'J1 Lf INSURANCE DATEi51166YYY) 056f16 THIS CERTIFICATE IS ISSUED ASA MATTER OF IkF®RMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS iCERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. _ _ ..... ...-.____...._-....._..� IMPORTANT: If the certificate -holder is an ADDITIONAL INSURED,the policy(ies)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 Ilett of such endorsements). ___._......—_.... —._._--------. CONTACT PRODUCER Tiffany Danis HONE (239}939 7697 talc No (239)939- Danis Insurance inc. - 15065 Mcgregor Blvd Suite 1091 : bffany@danisinsurance.not Ft.Myers,FL 33908 INSURE„i�S)AFFORDING COVERAGE __..._— -...., NAIL# United Specialty Insurance Company Phone (239)939-7697 Fax (239)939-7781 INsuRERA: .._. � � _�. �.._.............__-_......__..._. INSURED "SU Express ins Company Scottsdale Insurance Company E Associated COnStI'i1Cti0n$Development Inc, INSURERC: .. __ :._.__.-..__...___......�.__:.._.._.._....... — INSURER D; Southern Insurance Company PO Box 3443 J._.. - Great American Fidelity insurance Company INSURER E:_—. —.... —_ —_.__ .-..._ __..._..._...._......._I N Ft Myers,FL 33918 (239) INSURER f..:—_.. ....-- __.. — 046- REVISION-.---. -- -_._-...__, - — REVISION NUMBER• COVERAGES CERTIFICATE 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 REOUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN;THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. _ - ....-,.._. - INSR ADD UB -- POLICY EFF POLICY EXP » LIMITS L ;; TYPE OF INSURANCE_ tN R _POLICY NUMBER J IMMIDOmYYs (AIM/DDtYYY) GENERAL LIABILITY EACH --T i OCCURRENCE 8 1 000 OOO.00 DAMAGE TO RENTED 50 QQQ.QB COMMERCIAL GENERAL LIABILITY Fcurrence 3 E MED IXP(Any one person S 5. • 00 A E' E, CLAIMS-MADE [% j OCCUR USA-4105616 —. -_.._... N N 410116/2015 10/161.2016 -1 PERSONAL&ADV INJURY S 15 ,000,000.00 I GENERAL AGGRE ATE s 2,000,000.00 GEN L AGGREGATE LIMIT APPLIES PER: PRODUCTS_COMft0P AC OW.00 S 2,txI0, — g L j POLICY i_..J PRO' El LOC -- —.._. ......�......_—_. _----- — — COMBINED StM1rl LIMIT 1 000'00o.00 AUTOMOBILE LIABILITY I IG Ea acc dent),._ ] t ' BODILY INJURY(Per person) 3 1 ANY AUTO _ ALL OWNED i- SCHEDULED 0363933&0 Q4tgQf2016 04/1012017 BODILY INJURY(Pet accident) ¢ B I _! AUTOS ✓ ALrTOS N N 4 P ER Y DAMAGE g HIRED AUTOS Imo; NON-OWNED 4 eracc�dent I �S L.... ❑ .t__ —__._.. ........ T.. -- .....—._ —_ _E _... — UMBRELLA LIAR OCCUR XBS0056623 AGGREGATE ACH OCCURRENCES-5 fl0O 000 OO ._ 10/1612015 1 10/16/2016 1 s 5 000 .00 EXCESS LWB ❑CLAIMS-MADE N N �._... ..,-__.........._. 000 .._...� _DED RETENTION S WC57ATtJ- 0TH WORKERSCOMPENSATION7-4 AND EMPLOYERS'LIABILITY YIN i E.L.EACH ACCiDEN7 $ 1 000 00000 ANY PROPRIETOWPARTNERIEXECUTIVEHNI.A. 1367971'8-1ry01107!2016 01r`0712017D OFFrER1MEMBER IXCLUDED? ir' N EL DISEASE EA EM.. 1,0G0,000.00 ..... _j If DESCRIPPTTI N underOF OPERATIONS below _— E.L DISEASE POLICY LIMITS 1000,000 00 E j Employee Dishonesty/Crime SAA 0661164 00 00 01/06/2016 01106/2017 1,0OO,Ot>0 Per Occurrence __..... ._.. — i...__....._.—...... _, DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space is required) I(GC)and/or ficense#(CGC1516003). l l _.._......_........... __._..__....... 1 CANCELLATION CERTIFICATE HOLDER _ ---.._.._.__..... __ _ .._.._-_ j SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Miami Shores Village Building Department THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. i 10050 Northeast 2nd Ave ; —_ ...._....._ -__ __....._____......—_. --......... ....... -i Miami Shores,FL 33138 AUTHO REPRESENTATIVE � I ___....... - c 8 - 10 ACORD CORPORATION. All rights reserved. ACORD 25(2010105)QF he ACO name and logo are registered marks of ACORD i s 4. cc-xr -�s-210 J Juan Fernandez-Barquin, P.E. 61101f;ft--Y Structural Engineers 40114 2520 N.W.97tb Avenue,Suite#240 Thresbold Inspectors 0947 Doral,Florida 33172 State Plans Examiner PX 1305 PH:786-336-0881 Fax:786-336-0884 State Building Inspector BN 3318 Email:jfbengCbellsouth.net mvw.j uanfernandezbarquinpe.com DATE: 6/8/2016 CITY OF MIAMI SHORES VILLAGE BUILDING DEPARTMENT 10050 N.E.2ND AVENUE MIAMI SHORES,FLORIDA 33138 Address of Project: 9499 N.E.2ND AVENUE MIAMI SHORE Building Official: I Juan Fernandez-Barquin, P.E.,having performed and approved the required structural inspections,as indicated in the attached inspection log,hereby attest that to the best of my knowledge, belief and professional judgment,the structural and envelope components of the above referenced structure are in compliance with the approved plans and other approved permit documents.The scope of work was concrete repair to west side at the roof overhang. If you have any questions please call. A E Respectfully, E N SF ••.p ��I No 40114 :yZ �-D-33; •� . Juan Fe andez quin,P.E. STATE OF •J�ll� Threshold Inspector No..®9474 �� i1S1ONAr-� % 11111111 State Building Inspector No..BN3318 Plans Examiner No... PX1305 DOCS\SNAPP INDUSTRIES\9499 NE MIAMI SHORE\LETTERS\CITY OF MARGATE SIGN OFF.DOC J Juan Fernandez-Barquin, P.E. Structural Engineers 40114 2520 N.W.9711,Avenue,Suite#240 Threshold Inspectors 0947 Doral,Florida 33172 Eu State Plans Examiner PX 1305 PIT 786-336-0881 Fax:786-336-0884 State Building InspectorBN 3318 Email:jfbengCbellsouth.net wvvw.jnanfernandezbarqulnpe.com STRUCTURAL INSPECTION /SPECIAL INSPECTION LOG PROJECT: BANK OF AMERICA. ADDRESS: 9499 NW MIAMI SHORE DATE DESCRIPTION APPROVED 6/3/2016 PREPARATION OF CONCRETE REPAIR OF WEST SIDE OF ROOF OVERHANG APPROVED 6/7/2016 FINAL INSPECTION AFTER REPAIR. APPROVED �%%j%j11111/III 0 ��yAIVDE �bi'0 '�6q . 0 EINi i Jam:• No 40114 Juan Ferneez-B uin, STATE OF .'4U Structua 01o.. 40114 i3O�.• A Q�.•'.��*` Threshold Inspector No. ...0947 ��S*' R �'�•C?� State Building Inspector No..BN3318 �i �0NA' S0�� Plans Examiner No. ...PX130S O:\(FERNANDEZ,JUAN)\DOCS\INSPECTION RECORD\INSPECTION LOGS\SNAPP\9499 NW MIAMI SHORE BANK OF AMERICA.DOC cc-kl-ks --L9 N Miami Shores Village Building Department xg 10050 NE 2nd Ave. �A. Miami Shores, FL 33138 305-795-22041 Fax 305-756-8972 NOTICE TO MIAMI SHORES BUILDING DEPARTMENT OF EMPLOYMENT AS SPECIAL INSPECTOR UNDER THE FLORIDA BUILDING CODE. I(We)have been retained by MIKE ULLOA to perform special inspector services under th Florida Building Code 5th Edition(2014)and Miami Dade County Administrative Code at the 9499 NE 2nd AVENUE project on the below listed structure as of (date).I am a registered architect/professional engineer licensed in the State of Florida. Process Number: _Special Inspector for Reinforced Masonry,Section 2122.4 of the FBC 5th Edition(2014) _Miami Dade County Administrative Code,Article II Section 8.22 Special Inspector for —Trusses>35 ft.long or 6 ft.high _Steel Framing and Connections welded or bolted _Soil Compaction _Precast Attachments _Roofing Applications,Lt.Weight.Insul.Conc. _X Other CONCRETE REPAIR. Note:Only the marked boxes apply. The following individual(s)employed by this firm or me is authorized representative to perform inspection* 1. JUAN FERNANDEZ-BARQUIN P.E. 2. 3. RICARDO SOLANO 4. 'Special inspectors utilizing authorized representatives shall insure the authorized representative is qualified by education or licensure to perform the duties assign by Special Inspector. The qualifications shall include licensure as a professional engineer or architect:graduation from an engineering education program in civil or structural engineering, graduation from an architectural education program;successful completion of the NCEES Fundamentals Examination; or registration as building inspector or general contractor. I(we)will notify the Miami Shores Building Department of any changes regarding authorized personnel performing inspection services. I(we),understand that a Special Inspector inspection log for each building must be displayed in a convenient location on the site for reference by the Miami Shores Building Department Inspector. All mandatory inspections,as required by the Florida Building Code,must be performed by the Miami Shores Building Department.Inspections performed by the Special Inspector hired by the owner are in addition to the mandatory inspections performed by the department. Further,upon completion of work under each Building Permit,I will submit to the Building Inspector at the time of the final inspection the completed inspection log fo and a sealed statement indicating that,to the best of my knowledge,belief and professional jud ent those portions of the project outlined above meet the intent of the Florida Building Code and are ins tial accordance with the approval plans. / Engineer/Architect Name JUAN FERNANDEZ-BARQUIN P.E. Signed d eale Print Date:4/2 / 016 Address 2520 NW 97 AVE SUITE#240 786-336-0881 APR' Z `i