WS-14-1287 r }
5
IF Shores Village
� _ � JuN 18 2014
q 'jlb Building Department
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel:(305)795.2204 Fax:(305)756.872
INSPECTION'S PHONE NUMBER:(305)762.4949
FBC 201
BUILDING �_ - , �
�'erm�t No.
PERMIT APPLICATION Master Permit
Permit Type: BUILDING ROOFING
JOB ADDRESS: 1®� cam. L)
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#. 11 r 3;R��� 0/ R_-O_
Is the Building Historically Designated:Yes NO Flood Zone:
�b 2,a-d 9 C- ng L�-G
OWNER:Name(Fee Simple Titleholder):Mf CLapk 40-7-��� �
Address: P3 0Q 99YA % 7'
City: M1Am/ OA Stater Zip:
Tenant&,essee Name: Phone#:
Email:
CONTRACTOR:Company Name:CM-V A)F- Win )c Y- Phone#: '/—
Address: A l�
City: State: �.% Zip:
Qualifier Nam: . SAIAN n Phone#.
State Certification or Registration#: C'GCC X7� 62i� Certificate of Competency#:
Contact Phone# -- :7 -7 Email Address:
DESIGNER:Architect/Engin Phone#. - e
Value of Work for this Permit:$ V Cf I ear Footage of Work:
Type of Work: DAddition DAlteration w ORepair/Replace ODemolition
Description of Work:
Color thru tile:
Submittal Fee$ Permit Fee$ CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Bond$
Notary$ Training/Education Fee$ Technology Fee$
Double Fee$ Structural Review$
TOTAL FEE NOW DUE$
Bonding Company's Name(if applicable)
M
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 ELECTRICAL WORK,PLUMBING,SIGNS,
WELLS,POOLS,FURNACES,BOILERS,HEATERS,TANKS and 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 ill be charged
14&
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Signature Signature
Owner or Agent �f Contractor
The foregoing instrument w acknowl before me th !/ The foregoing instrument was knowledged before me thiQ-
day of .20.q,by-!"t day o ,by Y� I
who is personally known to me or who has produced w s personally known me or who has produced
.�1 As identification and who did take an oath. as identification and who did take an oath.
NOT PUBLIC: N91AJRY PUBLIC:
gn Si
Print:
My Commission Expires: " ., XMI'A J SHU E 8378
i7,X014
MY OOMMmSt®l�#E161018318E161018318 y S
CO aor ses ot8s
EXP VIES August 17,X014 cam
$
APPROVED BY [S e� Plans Examiner Zoning
Structural Review Clerk
(Revised 3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09)
Certjfied'Copy
I certify the attached is a true and correct copy of the Articles of Organization of 1032 NE 98TH
HOLDING LLC,a limited liability company organized under the laws of the state of Florida,
filed electronically on November 15,2013,as shown by the records of this office
I further certify that this is an electronically transmitted certificate authorized by section 15.16,
Florida Statutes,and authenticated by the code noted below.
The document number of this limited liability company is L13000160878.
Authentication Code: 131118090315-300253893693#1
Given under my hand and the
Great Seal of the State of Florida
at Tallahassee,the Capital,this the
Eighteenth day of November,2013
Electronic Articles of Organization � fflg. JA
For November 15, 2013
Florida Limited Liability Company Sec,y M State
kasal
Article I
The name of the Limited Liability Company is:
1032 NE 98TH HOLDING LLC
Article II
The street address of the principal office of the Limited Liability Company is:
800 CORPORATE DRIVE
SUITE 208
FORT LAUDERDALE, FL. US 33334
The mailing address of the Limited Liability Company is:
800 CORPORATE DRIVE
SUITE 208
FORT LAUDERDALE, FL.US 33334
Article III
The purpose for which this Limited Liability Company is organized is:
ANY AND ALL LAWFUL BUSINESS.
Article IV
The name and Florida street address of the registered agent is:
VINCENT J HANDAL JR.
800 CORPORATE DRIVE
SUITE 208
FORT LAUDERDALE, FL. 33334
Having been named as reeggi�stered agent and to accept service of process for the above stated limited
liability company at the place designated in this certificate, I hereby accept the appointment as registered
agent and agree to act in this capacity. I further agree to comply with the provisions of all statutes
relating to the proper and complete performance of my duties, and I an familiar with and accept the
obligations of my position as registered agent.
Registered Agent Signature: VINCENT J. HANDAL, JR.
Article V FILED 8:00 AM
The name and address of managing members/managers are: IVovem 15, 2013
Title: MORM SeC W 5 to
MICHAEL ASHKIN icasa�y
800 CORPORATE DRIVE, SUITE 208
FORT LAUDERDALE, FL. 33334 US
Signature of member or an authorized representative of a member
Electronic Signature: VINCENT J. HANDAL, JR.
I am the member or authorized representative submitting these Articles of Organization and affirm that the
facts stated herein are true. I am aware that false information submitted in a document to the Department
of State constitutes a third degree felony as provided for in s.817.155, F.S. I understand the requirement to
Ste an annual report between January 1 st and May I st in the calendar year following formation of the LLC
and every year thereafter to maintain"active"status.
QUOTATION U CONTRACT'
Coastline Windows & rSN,Inc. LEGAL OWNER OF PROPERTYtttn
JOB SITE ADDRESS '� -0
ZIP.` !�6$
B3
u�
CITY
1018 Floranada Rd. F JOB SITE#
Ft. Lauderdale, FL 33334 _
Phone: 954WORK#
776-5827 a
Fax: 954-776-5829 .` CELLULAR# �� q FAX#
coastlinewindow@bellsouth.net ;3'fb - 5� t-� coo I - (301
LAID
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sb\g�-n.
—70 . S 1 - C^4 GkK k Co n0
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c1 Pt1 #+�ry
PERMIT& ENGINEERING ARE INVOICED SEPERATELY
REA
BEFORE SIGNIN .ON WRITUEP AGREEMENT WILL BE HONORED.
I HAVE READ AND UNDERSTAND THIS CONTRACT
y COMPLETELY,INCLUDING THE REVERSE SIDE,
oC AND AG T TERMS.
LEGAL OWNER OF PROPERTY ONLY pytTg
S
BUYER'S INITIALS X Z
A
B ®� -']141 MATERIAL&INSTALLATION t
BY
COASTLINE WI ei DOORS,INC. TE 50%DEPOSIT 1 .
25ok DUE ON DELIVERY
BUYER'S RIGHT TO CANCEL
°tf Oft is a home 9011dtetion sale,and If you do not went the goods or servioas,you may card thia agreement by OTHER
providing written notice to the seller In person, or by nil. Tlds notes must indicate that you do not want
the goods or des and must be dem or pftww gate midni8td third W� OftYOr Oda BALANCE DUE ON COMPLETION
agreetrtent If you cancel this agreement(witlrin the three days)the seller may not keep all or part of any cash dawn
por
Please make all checks
ON REAR NOT=OF COtYStJMER RKiNT Payable to:Coastline Windows&DOtxs,Inc .-•
WHITE-OFFICE/YELLOW-CUSTOMER
dF rATE OF FLORIDA
DEPARTIVIENT OF BUSINESS AND PROFESSIONAL REGULATION
(;ONSTRUCTION INDUSTRY LICENSING BOARD (850}487^1395
1940 NORTH MONROE STREET
TALLAHASSEE FL 32399-0783
BRACKETTDOUGLAS FORR=STJR
COASTLINE WINDOWS& DOORS, INC.
1284 8 M 8TH STREET
BOCA FtATON FL 33486
Congratulationsl VVlth this license you become one of the nearly
one million Florldlclr s licensed by the Department of Business and
Professional Regl.li tion. Our professionals and businesses range STATE OF FLORIDA
from architscts to ysicht brokers,from boxers to barbeque restaurants, DEPARTMENT OF BUSINESS AND
and they keep Flo 44Is's economy strong. � PROFESSIONAL-REGULATION
Every day we work•,o improve the way we do business In order to CBC1259861 •.fSSUEO:' •04/20/2014
serve you better. -or information about our services,please log onto
www,myfloiidWitense.corn. There you can find more information CERTIFIED BUIL:13ING CONTRA&. OR
about our divislona,and the regulations that impact you,subscribe BRACKECT,bOUGCAS fORR1rST'J
to department newsletters and learn more about the Department's COASTLINE WIM1�t7tIVS'&D REST' R
Initiatives. I
Our mission at the Department Is:License Efficiently,Regulate Fairly.
We constantly strbm to serveu better so that you can some your
customers. Thank you for doing business in Florida, IS CERTIFIED under the provislons of Ch.488 Fs.
and congratulations on your new license! Gip Nbn date;AUG 31,=4 t1404�OQ�75
DETACH HERE
RICK SCOTT,-tr.OVERNOR KEN LAWSON,SECRETARY
STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
CPNSTRUCTION INDUSTRY LICENSING BOARD
i
CBC4259881
The BUILDING t;t)NTRACTOR
Named below IS CERTIFIED
Under the pr'ovis a ns of Chapter 489 FS.
Expiration date: AUG 31,2014
BRACKE°", DOUGLAS I`ORREST JR
a• swim
COASTLI4E WINDOWS&•DOOR'S, INC. `
1921 NW8RNDAVENUE-
HOLLYM)OD FL 33024
Wr PT
y 15 S.Andrews Ave., Rm.A-100. Ft. Lauderdale, FL 33301-1895—954-8314000
VALID OCTOBER 1,2013 THROUGH SEPTEMBER 30,2014
Receipt M 8 0-2 2 C".O TRACT.OR t BUI C4
Btr<sintms Nam:COASTLINE WINDOWS & DOORS INC Business Type:OOFMACTOR3
Owvor Name:DOUGLAS Foxxgs'r RRAC E Tr J• /Q Stote/Gou Busin�/CerrffRog:cBC1259B61
Business k.ocation:1018 )+LORANADA RD l
OAicL= PARK Exemption Code:
Business Phone:954-776-5827
Rooms Seats Employees Machines Professionals
1
For vending usMass onlyNumber of Machines: Vending Type:
Tax Amrn_Mt Transfer Fee NSF Fee Penalty Prior Years Coilectlon Cost Total Paid
;.3 .60 0.00 0.00 0.00 0.00 0.00 ]3.50
THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS
THIS B 5+'•0MES A TAX RECEIPT This taxis levied for the privilege of doing business within Broward County and is
non-regulatory in nature.You must most all County and/or Municipality planning
WHEN 9/ALIDATED and zoning requirements.This Business Tax Recelpt 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.
11Aailinyl,Address:
COA37LINE WINDOWS & DOORS INC 8soe4�b #03�►-13 00007903
1018 FLOEANADA RD Paid 05/09/2014 23.50
QMC[jiND PARR, FL 33334
_ _ _ 2013
Ac-�
` _ CERTIFICATE OF LIABILITY INSURANCE °A 50=14
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMA110N ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS
CERTIFICATE P)ES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED 13Y THE POUCf£S
BELOW. TH"'r`EIMFICA' a OF INSURANCE DOES NOT CONSTITUTE A CONTRACT 13FTMEN THE ISSUING INSURd7(9), AUTHORIZED
REPRRS84TAIT B OR PRODUCER,AND THE CERTIFICATE HOLDER.
THIS
ANTS F;8 certteioete holder Is an ADDITIONAL.INSURED,the pollcy(rom)MUSt be endorsed. If SUB ON IS WANED,subJttt t to
Ire W NS and aro MWOM of the pollcy,t:efbM pOIW"may require an ondonlafnent A stoWnent On thk certVkm%doss not confer rights to the
coruncab holdor In NSG of such W dorserne9
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THIS IS TO CI3 Tft
HAT THE POLICI INSURANCE LISTED B11LOW HAVE BEEN ISSUED TO TI(E INSURED NAMED ABOVE FOR TME POLICY 0
INDICATED. NolutTHSTANDINc+�ANY REQLIICiEIN,THE
TERM OR CONDMO14 OF ANY CONTRACT OR OTHER DOCUMENT WTTM RESPECT TO VmIOHH THIS
CERTWIOATE WY BE ISSWED OR MAY PERTAIN,THg INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO A!L THE TER�A.S,
EXCLUSIONS ANIJ t XNDrnONs OF SUCH POU IClRa LIMITS SHOWN MAY WIVE BEEN REDUCED SY PAID CLAIMS.
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Lm Eg,7gimma(empbyoaa but not oubconbaftrs of. CoWne Windows Dcors,Inc.
ow CERTIFICATE H :.[rte CANCELLATION
1032 NE )l qt gding LLC SHOtrLD ANY OF THS ABOVE 0=14fosp pOLW=an CANCIL 8
1032 NE LttliF1 thoet THE EXPIRATION DATE TmmvoF, NOTICE VWj_ > DEI.tIDMW M
Malml Shoms M. 33138 ACCORDANCE WITH THE POLICY PROVISIONg, IN
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ACORD 20(2014101) The ACORD name an61 «X014 ACORD CORpORAfEN. All rlghta reserved
d logo are Mgldbmd moft Of ACORD
=2 IOD., 24132-4 )Qmm WA]d 9/11/2014 1s,oe,SA An (cer) ,fie s ea 7.
• • DATE{ DPM
A _ CERTIFICATE OF LIABILITY INSURANCE 03/05/14
PRODUM JW Irwjrence S8rvio88 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
100 Nart11 State Road 7,d 106 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXPEND OR
MalgaUa,FL 33093 TE ggAM• ORD • RY THE P.Q,EL. _ BELOY�
Phone(084)8K.7213 Fax (864)583-2041; INSURERS AFFORDING COVERAGE NNAIC S
INsuRED Coastinel Windows&Doors,Inc, IN8 R R,:_ Canal Indemnity,
1018 Fier$nada Road INSU ER B.
Ft Laudsnclale,FL 33334 1N. R R C:
INSURER D:
_ INSURER E:
COVERAGES INSURER F:
THE POLICIES OF INIA RANCE LISTED HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
ANY REQUIREMENT.T cRM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN.THE 144 iURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES.AGGREGA,T 1 LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS,
INN AWL OF INSURJWCC • POLffiY NUMBER f Ygmcm POLI�RA7mN qr Lon
GENERAL LIABLITY E EACH OCCURRENCE _ 1,000,000
COMMIcR DIAL GENERAL UABILnYGL105257 10/17/13 10/17/14 PREMISES fee ootwr,P�ga]
1:10 CLAWS MADE ® OCCUR MED EXP(Any cne Pence) 5,000
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® ❑ PERSONAL&ADV INJURY 1,000,000
❑ GENERAL AGGREGATE 2,000,000
GEN'L AGOR ELATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG 1,000,000
R PoUC r ❑PROJECT 0 Loc Fire Damage Liability 50,000
AUTCl1R011111'B LIABILITY COMBINED SINGLE LIMIT
ANY Al ATO a-ldent)
ALL 4hMED AUTOS BODILY INJURY
❑ SCHIK ULED AUTOS (Por nwn
❑ HIRID AUTOS
BODILY INJURY
❑ NON O ovNED AUTOS (Pe,aoddew)
❑ PROPERTY DAMAGE
a Per awd&M
GARAGE Lt WL" AUTO ONLY-EA ACCIDENT
❑ ❑ ANY A JTO OTHER THAN EA AW
❑ AUTO ONLY: �qQ
EXCLISM16MELLA LIABLI Y EACH OCCURRENCE
❑ ❑ OCCUR ❑ CLAIMS MADE AGGREGATE
❑ DEDL C PIBLE ^"'^'"
❑ RETEN"ION 81
WIMP,OY6RS'LIABILITY NAND W A - ❑ TH-
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ANY PROPRIETOii,PARTNER/RXE:CUTIVE E.L.EACH ACCIDENT
OFFICER/MEMBIIF EXCLUDFD?
yyo9,deser>be untel E.L.DISEASE-EA EMPLOYEE
SPECK}.PROMs O 48 bdow E.L.DISEASE-POLICY LIMIT
OTHER -
DESCRIPTION OF OPQR,ITIONS/LOCATIONS/VEHICLES 1 EXCLUSIONS ADDEO tlY ENDORSEMEjdT t SPECIAL PROVISION$
*'*WINDOW&CICIOR INSTALLATION
CERTIFICATE NFL BR CANCELLATION
SHOULD ANY OF THE ABOVE ORSoNagn POUoM BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF,THE ISBURM INSURER W LL ENDEAVOR TO MAIL
103;! 4E 98tlt Holding LLC 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO
C/o Salon Marrow Dyckman&Newman Tfi€LEFT,BUT FALURE TO DO$O$HALL IMPOSE NO ORI WTION OR UABnM
801)C Drpomts Drive Ste 208 OF ANY KIND UPON THE INSURER,ITS AQWM OR REPRESENTATIML
Ft Lilt derdale,FL 33334 AUTHORIZED R@PRE88NTA71VE
ADE,I'70NAL INSURED
rcaRID 25(20Q1/4D1 QF -
®ACORD CORPORATION 1988