RF-15-47 Miami Shores Village
10050 N.E.2nd Avenue NE
N
Miami Shores,FL 33138-0000 a E sy
Phone: (305)79-1:L2204
Expiration: 0110112999
Project Address Parcel Number Applicant
1032 NE 98 Street 1132050180320
Miami Shores, FL 33138- Block: Lot: 1032 NE 98TH HOLDINGS LLC
Owner Information Address Phone Cell
1032 NE 98TH HOLDINGS LLC 800 CORPORATE Drive
FT.LAUDERDALE FL 33334-
800
3334800 CORPORATE Drive
FT.LAUDERDALE FL 33334-
Contractor(s)
3334Contractors) Phone Cell Phone
Valuation: $ 23,350.00
LATITE ROOFING&SHEET METAL C4 954-772-3446
- Total Sq Feet: 3400
Type of Work:Re Roof � _ Available Inspections:
Additional Info:RE-ROOF NEW TILE R F Inspection Type:
Classification:Residential Twmv-74
�6Scanning:3 ) .� � in Cap
Cap
051 f`1 nal Roof
inal Roof
Ile In Progress
ile In Progress
Tile In Progress
Review Building
Review Roof
Cap Sheet
Fees Due AmountPayDate Pay Type Amt Paid Amt Due
CCF $14.40
DBPR Fee Invoice# RF-10-15-57447 �-� /•�''
DCA Fee $4.88 10/20/2015 Check#:2127 $44.00 $0.00 zts"JALA-
1777
1
$4.88
Education Surcharge $4.80 ,,
Permit Fee-New Roof $325.00 Invoice# RF-1-15-54103 O
Revision Fee $35.00 01/09/2015 Credit Card $50.00 $332.16
Scanning Fee $8.00
Scanning Fee $9.00 09/21/2015 Check#:2749 $332.16 $0.00
Technology Fee $19.20
Total: $426.16
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.
March 29,2016
Authorized Signature:Owner / Applicant / Contractor / Agent Date
Building Department Copy
March 29,2016 1
Miami Shores Village
Building Department artment vus-A
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel:(305)795.2204 Fax:(305)756.8972 B Yo _
INSPECTION'S PHONE NUMBER:(305)762.4949
FBC 20 4O
BUILDING Permit No.
PERMIT APPLICATION Master Permit No. r40'
Permit Type: BUILDING ROOFING
JOB ADDRESS: / 6 $Z IV e I
City: Miami Shores County: Miami Dade Zip: 3 t 3 S
Folio/Parcel#: l- 3 20 S•~M 9 - D 3 Zp
Is the Building Historically Designated:Yes NO Flood Zone:
OWNER:Name(Fee Simple Titleholder):_ i Let on; Phone#: 30f'- "9-5177
Address: 10 3 L Aryt
City: M t AOA S K00-C S State
Tenant&xssee Name: Phone#:
Email: !e. • N
CONTRACTOR:Company Name: AA A 9Z t S c--. Phone#:
Address: qcolr SA-»by,fit*
City: (S 04A KNP"> State: Pc-. MW Zip:
Qualifier Name: A of t c_ 61*"t.- Phone#: SZo t-
State Certification or Registration#: G G L. t 3 Z 74 t Certificate of Competency#: 13 2-74 t S"
Contact Phone#: q S*-Z t 4- 4'01(0 ----Email Address: Pd Qa roo`��n Ser�«t3S a�a�l.Gor.,`
c Y
DESIGNER:Architect/Engineer: Phone#:
Value of Work for this Permit:$ S Sty O • ' Square/Linear Footage of Work: 400 Sr
Type of Work: ❑Addition DAlteration ONew l epair/Replace ODemolition
Description of Work: IgInIA0%4!r ate'` a.. R^-a— �P t 1 to t.tr
. :` asp ry _ r
loo thru We: �t►ase���
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)
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 will be charged.
Signature da"14 �►�"" ignature
Owner or Agent Contractor
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this,
day of ,20 1 Y,by 4'egk.l 654 ��, day of to*n*n=� ,20 LV,by
who is per known to me or who has produced who is perso wn to me or who has produced
As identification and who did take an oath. as identification and who did take an oath.
NOTARY UBLIC: NOTARY PUBLIC:
Aw
)6ign:
et: fit:
My Commission Expire My Commission AMM
ATI NICOLE Omm
MNI� .WPW of ROM NONE►Pubile.-Strlt of H IM
fiQ 18 2M
APPROVED BY Plans xaminer ring
Structural Review Clerk
(Revised 3/1=012)(Reviwd 07/10/07)(Revised 06/10R009)(Revised 3/15/09)
SttOR»s
Miami Shores Village
rim Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
CONTRACTORS' REGISTRATION
ALL CONTRACTORS MUST PROVIDE COPIES OF LICENCES AND INSURANCES EACH TIME A PERMIT IS SUBMITTED.
IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR:
A. COPY OF QUALIFIER'S STATE LICENCES
B. v"O' COPY OF LOCAL BUSINESS TAX RECEIPT
C. COPY OF LIABILITY INSURANCE*
D. COPY OF WORKERS COMPENSATION INSURANCE*
IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY:
A. COPY OF CERTIFICE OF COMPETENCY OF QUALIFIER
B. COPY OF LOCAL BUSINESS TAAl'r"fr4.�qNTXACTOR'S
FIPT
B. COPY OF MIAMI DADE COUNTY TAX RECEIPT
C. COPY OF LIABILITY INSURACE* °
D. COPY OF WORKERS COMPENSATION INSURANCE*
"YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE HOLDER AS FOLLOW:
MIAMI SHORES VILLAGE BLDG DEPT
10050 NE 2ND AVE
MIAMI SHORES, FL 33138
COMPLETE CONTRACTOR'S INFORMATION
BUSINESS NAME:
BUSINESS ADDRESS: CITY
STATE ZIP CODE
BUSINESS PHONE: ( ) FAX NUMBER( )
CELL PHONE (�) QUALIFIER'S NAME:
QUALIFIER'S LIC NUMBER:
Created on 3119109 BY MLDV I RV 3126109 MLDV I RV 6127111 AS
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Thd ,�tOOPI]�TO �bNTlm "0 S
'Nftmicl. below Ia CR17119]D..*.
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�'nider date:
:o�:
r Expiration dte: AUG 31 ' 2014
rV 'fid r-x ¢t • `ar' ,' t�`,�� r + 9
CARLL,
AAA ROOFIN43`SERVICII�fiC: r r.• i
9005 SADDLE- CREEK-:D
D I'VE ,
BOCA RATON FL 33496
Iz RICK $q TT REN LAWSON
GOV ZIMOR . .. SECRETARY
OfSP!AY AS REQUIRED•BY LAW `
i
OAYId(NPtUOD1YYYY}
ACORa CERTIFICATE OF-LIABILITY INSURANCE 3/10/2014
PRODUCER THE CERTIFICATE IS MUM AS A MATTER OF INFORMATION
ASSURE L ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
1531. Manatee Ave H=ER. TM CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POUCIES BELOW.
Bradenton, FL 34205
(941}739-.5121 INSURERS AFFORDING COVERAGE NAIL#
INSURED AAas� ve Ti ;I r nce canp=y 1 3
Quality Servsaes Ilia uOuRBR A:
dba Ahh Roofing Services jZReRa Progressive Sxp ins Co 10193
9005 Saddlecreek Drive mupm C: United. Specialty Ins Co
Soca Raton, FL 33496 ENSURER D ridgef eld lhp dyers
1(561)807-8881 F MRER E:
COVERAGES
THE POLICIES OF INSURANCH USM 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 D0C1JM9ENT WITH RESPBCT TO MMICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLIOMS DSSMORD HEREIN 1S SUBJECT TO ALL THH TERMS,EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES.AGGROATO UMIT'S SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
4Tp POLICY NI.WER .111 1 LIMITS
GENERAL LIABILITY EACH OCOURINCB S 1,000,000
X OOMMERCULGENERAL L&ABILm PR66u8 000uratw 6 100,000
CLAIMSMADE ®OCCUR MCA
EDMWWum ) $ 5,000
A PO•LOOSS83-13 1'1/06/13 11/06/14 PERSONAL&ADVINJURY 0 1,000,000
7
c3FNERAL AGGREGATE $ 1,000,000
GENT.AGGREGATE LIMIT APPLIES PER: M==6-C0W/OPAGG $ 1,000,000
POLICY LOC
AUTOMOBILE L,IABU.TTYtNED BINGL.E LIMIT $ 100,000
X ANYAu ro '— I
ALLOWNBOAUTOS BODILYINJURY
X SCHEDULEDAUY08
(P-0-M) B
B HM AUTOS 08235177-1 09/09/13 09/09/14 tm L RY $
NON-OVVNWAVM
x adem
PIP $10,000 PROPERTY DAMAGE $
(Paraoaldwo
GARAGE LIABILITY AUTO ONLY-RAACCIDENT $
ANYAUTOEAACC S
AUTOONLY: AGG B
EXCESSAAMRdLLA LIABILITY EACH OCCURRENCE $
OCCUR ❑CLA1M$MADE AGGREGATE $
$
DEDUCTIBLE $
RETENTION S $
WORKER$COMPENSATIONAND X O Y A T8
EMPLOYERS'LIABILITY
ANY PRD ELL EACH ACCIDENT $ 1,000,000
D amomwomm mmumE + 830-51315 07/18/13 07/18/14 EJ. OMAN-EAEMPLo $ 1 000 000
d L° E° a`�idNsaal2w F-1-01SEASE•POIJCYLIW 11,000 000
OTHER
C Contractor's USA4024510 11/06/13 11/06/14 $1,000,000
Pollution Liao
DESCIgHMON OFOPERATKMILOCATt=/VENICLSSI EXMUSIONS ADDEDSYMWORSEMWISPEC4ALPROV161ON$
General Contractor-Roofing
CERTIFICATE HOLDER CANC TION
Iyli,ami Whore$ Village Building Dunt. DHOIR.D ANY OFTHBABOVE DMCRIBSD POLICIES BE OANMLED BEFORE THE EXPIRATION
10050 NE Second rive DATE THERMF,THE ISSUING INSURER WILT.ENDEAVOR TO mm 30 DAYS wRrnrm
Miami Shores; FL 33138 NOTICE YO THE CERTTFrAM HOLDER NAMED TO THE LEFT.BUT FAILURE TO DO SO$HALL
IMPOSE No OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,TT$AGENTS OR
REPRE_SENTATNES.
AUTHORIZED
t
ACORD2512001M) OACQRD CORPORATION INIS
ANNEM. G A N N O N P.O.Box 3353,West Palm Beach,FL 33402-3353 "LOCATED AT**
0. CONSTITUTIONAL TAX COLLECTOR wWWpbctax.corn Tei:(561)355-2264 9005 SADDLECREEK DR
Serving Palm Beach County SOCA RATON, FL 33496-1890
Serving you.
TYPE OF BUSINESS OWNER CERTIFICATION>1 RECEIPT#/DATE PAID AMT PAID BILI#
23.0081 ROOFING CONTRACTOR CARLL DANIEL CCC1327914 9-09110/13 $27.80 B40167638
This document is valid only when recelpted by the Tax Collector's Office. STATE OF FLORIDA
PALM BEACH COUNTY
2013/2014 LOCAL BUSINESS TAX RECEIPT
AAA ROOFING SERVICES INC 89-341 LBTR Number: 201012088
AAA ROOFING SERVICES INC EXPIRES: SEPTEMBER 30,2014
9005 SADDLECREEK DR
SOCA RATON,FL 33496-1890 This receipt grants the privilege of engaging In or
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.