WS-16-284 Miami Shores Village
�- ` BuildingDepartment i
p FE8 0 2
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tei:(305)795-2204 Fax:(305)756-8972 ; -
INSPECnON UNE PHONE NUMBER:(30S)762-4949 -
FBC 20 t4 s
BUILDING Master Permit No.
PERMIT APPLICATION Sub Permit No.
*BUILDING ❑ELECTRIC ❑ ROOFING ❑ REVISION ❑EXTENSION RENEWAL
❑PLUMBING ❑MECHANICAL []PUBLICWORKS ❑ CHANGE OF ❑CANCELLATIONSHOP
❑ DRAWINGS
CONTRACTOR
JOB ADDRESS: L� -��� I��- �T(2t-t= �" -
9_ Miami Shores County: Miami Dade Zirr �3 d
Folk:/Parcel#: I JQ fM 1 �x� l a Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder): 5LC L thc) { ` `t , L'4hone#:
Address: � �� ` '�O�f��cic Lt►�i�- ii 2c� .9
City: Ls�.'..:�c �e�r��LS+_ State: l rt I &C'- Zip: 21't -y
Tenant/Lessee Name: Phone#:<A5 y--).77
Email: "� '
CONTRACTOR:Company
�N-ame: Stu`������ `J L�
Address: C �'.r�•r�d-Cf?C
City:
' C�,r.c6s- �. a-�' State: � L-c i��i [� Zip:
Qualifier Name l� 'E? Phone#:
State Certification or Registration#: G Q�,C 1 ���jii&i Certificate of Competency#:
DESIGNER:Architect/Engineer. Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ Square/Unear Footage of Work:
Type of Work: ❑ Addition ❑ Alterati ❑ New ❑ Repair/Replace ❑ Demolition
ption of Work:
Specify color of color thru tile:
Submittal Fee$ cS-7�O ` 03 Permit Fee$ B L4 G � cCF$ ^' co/cc$
Scanning Fee$ Radon Fee$ DBPR$ (® Notary S
Technology Fee S QO •(Z Training/Education Fee$. ' 6 Double Fee$
Structural Reviews$ 1.--29 Bond$__
A ell
TOTAL FEE NOW DUE$ 34 9• /
(Revlsed02/24/2014)
e
Bonding Company's Name(if applicable)
Bonding Company's Address
City State Zip
Mortgage Lenders Name(if applicable)
Mortgage Lenders 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 Applicont: As a condition to the issuance of a building permit with an estimated value exceeding$2500, the applic t
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to th
whose property is subiect t ochment. Also,a certified copy of the recorded notice of commencement must be posted at th
for the first inspection ich occurs seven (7) days otter the building permit is issued. In the absence of such posted n ,
Inspection will not be oved and a reinspection fee will be charged. ,
3
3 Go C
r °D g n
Signature Signature <
CD
ca
OWNERorAGENT CONTRACTOR " T y
N C
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before m Sv o
3 day of 'b .r ,20 /5 by day of 20 1
4 0 y who is personally known to ho is personally
MSM who has produced as me or who has produced
identification and who did take an oath. identification and who did take an oath.
W �
NOTARY PUBLIC: NOTARY PUBUC: goo w
ma e' n
Sign: Sign: n
N 'nN
Print: Print: c -5 > " W
S. O
ic
Seal: Cpm FF1207 Seal: N t
Ate. EXPIRES: May 21, 2Q18 �Y P NANCY ENGSTROMCL
yiWW AAMWTARY.COM � `��•, Notary Public-State of
Commissim#FF 2221 5
37;1�
1if�(♦dlAi' *W1t*1k$ f9,.����,,.• g�dthrou9hNaUonail�entAasn.
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(RevisedO2/24/2014)
.q
CERTIFICATE OF LIABILITY INSURANCE L2
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO MGM UPON THE CERTIFICATE HOLDER.THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOE$NOT CONSTITUTE A CONTRACT BETWIVELN THE ISSUING SISURERO),AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
an ,the p~lw)tri
the terms and c o nd�orns of 0w policy,certain Policies may require an endorsement.A . on this oe does not confer �rWft to Clue
cerditde holder In Neu of such enthmsemerift
PRODUCOR
C a C llwlmolk IDs.
1921 IN 150AWJa
Sla 161
FL 3= Axis
INSUIM
CDASTLINEWWONSADOOKINC
1015 FWwada
A LwArMs FL
COVERAGES "MT1FtCATE N BER: REVIS�t+I N ER:
THIS IS TO CERTIFY THAT THE OF I LISTED BELOW HAVE.M ISSIIED TO THE INSUREDNAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERRA OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSLIFD 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.
EDIA WMA Mg TWO REM a
X aaJTtr �
FL AX 017015 10#7' i,!a;,,,,,,...,.,_.,_�
1
LMr�rt:
Baa MONO
s
AMMO
Ilse UNT $
AW AUTO awLY tN iw(par )
AAUTO(EO L M 1.Y NJURY f .' $_. ......
p Y E „$
A „
MRWTOS AM09
H - 8
UA$ LJOCAMAI 9929189= A
'fel
ANDEMKOWiMUARMY
Altar PROPRETORPARTNEREXECWft t4J M
�f >A MmuXUDED? P1a
1629n
ONSORWT
OW JU?CATJ IAcoRa yas. r l Emore a
CIsRTIFRCA HOLDER QA TION
SHOULD AW OF"S ABOVE 0530141010 POLICIES BE CANOE AM BEIME
TM 9XPMTM DATE ISE AR t DAWCE VM Y clVISIO SNOTIM ILL Ma iJ1+BRE0 IN
IOWNEWAVE
%FL=38 AUTHOMM POW418MAWS
619M2014 ACORD{`.ORPOTtAT IL AN Agft reserved.
ACOR3 28(;114101) The AGOR3 name and logo we regisbued marks of ACOIRD
STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
CONSTRUCTION INDUSTRY LICENSING BOARD (850)487-1395
a�VX 1940 NORTH MONROE STREET
TALLAHASSEE FL 32399-0783
BRACKETT, DOUGLAS FORREST JR
COASTLINE WINDOWS&DOORS, INC.
1284 SW 8TH STREET
BOCA RATON FL 33486
Congratulations! With this license you become one of the nearly ..
one million Floridians licensed by the Department of Business and -
Professional Regulation. Our professionals and businesses range
STi�TE DF:FLOR1DA
from architects to yacht brokers,from boxers to barbeque restaurants, DEPARTAIIEN OF-BLISINESS AND .
and they keep Florida's economy strong. pRp ULATION. --
Every day we work to improve the way we do business in order to '� CBMMM .` 0/13/2014
serve you better. For Information about our services,please log onto - r
www.myflorialice.com. There you can find more information
about our divisions and the regulations that impact you,subscribe .. CERFtFIEB
to department newsletters and learn more about the Department's BFtAiC7T, -
initiatives. COASTI_
Our mission at the Department is:license Efficiently,Regulate Fairly.
We constantly strive to serve you better so that you can serve your a
customers. Thank you for doing business in Florida, ��CTRTtr-I`r:1t.� t�
er
and congratulations on your new license! a i,ao+s w metria
DETACH HERE
RICK SCOTT,GOVERNOR KEN LAW$ON,SECRETARY
y.. : STATE OF FI:QRIDA,
SENT"0F,8USINESS AND PROFESSIONAL REGULATION
C-610 T�OI11 ii�lW TRY LICENSING BOAR
TFtEYRjif _j VIM
rc
7
M ..w. :S, hA"' raa^71, y 2 4 Y, ■ ■ ■
INC
�% � ■
r� ✓�,.,�'° ,`'
ISSUED: 0811=014 DISPLAY AS REQUIRED BY LAW SEQ# L1408130001271LL'
v �
' a
BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT
115 S.Andrews Ave., Rm.A-1 00. Ft. Lauderdale, FL 33301-1895—954831-4000
VALID OCTOBER 1,2015 THROUGH SEPTEMBER 30,2016
DBA: Receipt#:18 0-262206
Business Name'COASTLINE WINDOWS & DOORS INC Business T •GENERAL CONTRACTOR (BUILDIL
• ype•CONTRACTOR)
Owner Name:DOUGLAS FORREST BRACKETT JR /QUAL Business Opened:05/09/2014
'y Business Location:1018 FLORANADA RD State/County/Cert/Reg:CBC1259861
OAKLAND PARK Exemption Code:
Business Phone:954-776-5827
r�
Roorns seats Employees Machines Professionals
(' 1 E
For Ve Wh*Business Only y
Number of Machines: Vending Type:
Tax Amount Transfer Fee NSF Fee PenaltyPrior Years Collection Cost Total Paid
t__
27.00 0.00 0.00 0.00 0.00 1 0.00 27.00
ji
r, THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS
{ THIS BECOMES A TAX RECEIPT This tax is levied for the privilege of doing business within Broward County and is
i_ non-regulatory in nature.You must meet all County and/or Municipality planning
1 WHEN VALIDATED and zoning requirements.This Business Tax Receipt must be transferred when
the business is sold, business name has changed or you have moved the h
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.
f
Mailing Address:
f COASTLINE WINDOWS & DOORS INC Receipt #OIA--14-00008705
1018 FLORANADA RD Paid 08/03/2015 27.00
OAKLAND PARK, FL 33334
2015 - 2016 r
�q'
C �t�A\efw t�11 /►At�tatTV ■ M w t Rf rrcMFS
.� --<.. �. _ �
-wv RECEWT
c+rae CERTIFICATE OF LIABILITY INSURANCE
THIS CIUMFICATE 0 ISSM AS A MATTER OF INFORMATION ONLY AND CONFERS NO NO TS UPON THE CERTIFICATE HOLDER.THIS
CERD'IFICATE DOES NOT AFFIRMATIVELY OR WGATtVIEt.Y AMEND, EMD OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTWICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE H
RTANT: E 1h corifflods holler M an ADDITIONAL INSURED,the kyI )mut be endo i. M SUBROGATION IS WAIVED,SUbjed to
tiro Wm wId condfto.of the polity,oortalapolletes may ratluim an wIdorsomft A: *an this ceWt WatP dem not aoM®i TWO tothe
eartIfIC010 holder In tieu Of such
SUNZ Insurance Soiutlons,LLC. ID.(Howard) Ira
do Howard Leasing Inc. 941-761• 941-761-7708
Bradenton,BradellFL 34209
rad
Mira is
7
Howard Leasing,Inc.
a: R °Aa
8302 Ma 'Venue V4te4 Suite K c r Ga81n -Beat Raft AA°
Bradenton FL 34209 awm o: _Bit Rating OX
a:
COVDERAGN CERTIFICATE NU REVISION NUM
THIS IS TO CERTIFY THAT THE PINES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY"PERIOD
INDICATED. NOTVATHS'TAND ING ANY RECtWREMENT,TERM OR CONDITION OF ANY COWRAcT 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 TENS,
EXC LUSIONSAND CONDITIONS OF SUCH POLICIES.u TSSHOWN MAY HAVE SEEN REDUCED BY PAID CLAIMS.
rpe DF um"
EACH OCOURIWOM 5
CI Aarr& ADE ❑OCCUR 4 . ,..._
MED EXP An *w S
PERI s ACV INJURY $
OEM AGORSOATE a. T APPLIES PER. GENERALAGGREeATE $
POLICY E�1W Q Loc AGO S
S
AUTOMOBILE UA=L"Y $
A41Y AUTO
* SCHEDULEDAUTOS
YY{Par
HIRfO AUTOS AAUUT D
S
UAB OCCUR EACH OCCURRENCE S
UASGLA! ABATE $
DED
S
AWOVANSIS 001104MATWIV211644201
Lra rry YIN VVCPEOOOD004005 519412014 SM442015
AW
� N NIA E L EACHACC€DENT ffi 9.C?C 3,
OFFIM� ECumfaits E:LDISEASE-EA +50 $ 1;1 ,000
E.L,DISEASE-PbM"— Is 1
B n This Is for t
C h and nottIlng 9W tie any dgld
D ung such raalroutsance.
r}a SRfP t A710Ft$JLADA1 1' fACQW til,AtASORM RWMM Sdmdft WAY M GMMW Ratan0 W=Is
co"a" X12 but wq*Wmnot Suor m Vftdow Dotes,hie.
TE tgM CANCIELLATION
Miami Shores Village BuildingDepartment SWXIL.D ANY OF THE ABM DIES 09 CANCEILLEo BES
�� THE EXPIRATION DATE THEREOF, NOTICE WILL i 'VELIVERED IN
10060 NE 2nd Avenue ACCORDANCE IM THE air PROVISIO118.
Miami Shores FL 33138
AUTHOSUM 115PRESMAVA
Glen J
01888-2014 AO'M—CC NSORATIO . AN ftft rewat
ACORD 26(21194131) The ACORD nanw w logo are reglebwed manus of ACORD
29500840 16tatat Certificate xwaoaca0444 06 1 receptionist 113!312015 2:38124 M (C") I Page 1 of 3
77777
Illiq3�
I -
� e4-
:H
Miami Shops Village{
10050 N.E.2nd Avenue NE
Miami Shores,FL 33138-0000 "f
Phone: (305)795-2204 ' : N
� x a
Exp
kation: 0 07/2016
Project Address Parcel Number Applicant
1032 NE 98 Street 1132050180320 1032 NE 98TH HOLDINGS LLC
Miami Shores, FL 33138- Block: Lot:
>, =I am rM am am
Owner Information Address Phone Cell
1032 NE 98TH HOLDINGS LLC 800 CORPORATE Drive
FT.LAUDERDALE FL 33334-
800 CORPORATE Drive
FT.LAUDERDALE FL 33334-
Contractor(s) Phone Cell Phone
COASTLINE WINDOWS&DOORS (954)658-5322 Valuation: 24,421.00
Total Sq Feet: 0
Type of Work:REPLACE 21 WINDOWS AND 2 SLIDING DO Available Inspections:
No of Openings:24
Inspection Type:
Additional Info:
Window Door Attachment
Classification:Residential Final
Scanning:3 Review Building
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $15.00 Invoice# WS-2-16-58532
DBPR Fee $5.10 02/09/2016 Check#:7746 $349.20 $50.00
DCA Fee $5.10
Education Surcharge $5.00 02/02/2016 Check#:7747 $50.00 $0.00
Permit Fee $340.00
Scanning Fee $9.00
Technology Fee $20.00
Total: $399.20
In consideration of the issuance to me of this perry t, I agree to perform the work covered hereunder in compli ince with all ordinances and regulations
pertaining thereto and in strict conformity with the plar s,drawings,statements or specifications submitted to the prol 3r authorities of Miami Shores Village. In
accepting this permit I assume responsibility for all i ork done b; ci :.,�e:°, x, :c;.:_ I understand that separate permits are
requires for ELECTRICAL,PLUMBIN ,MECHANICA „WINDOWS,DOORS,ROOFING and SWIMMING POOL wor<.
OWNERS AFFIDAVIT: I certify all the foregoing information is accurate and that all work will be done in com)liance with all applicable laws regulating
construction and zonin he re,I authorize the Ebove-named contractor to do the work stated.
February 09,2016
Authorized i re:Owner / Applicant / Contractor / Agent Jate
Building partment Copy
February 09,2016 1