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MC-15-2088 (2) Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-257760 Permit Number: MC-8-15-2088 Scheduled Inspection Date: May 02, 2016 Permit Type: Mechanical - Residential Inspector: Perez,JanPierre Inspection Type: Final Owner: , Work Classification: A/C Replacement Job Address:40 NW 111 Street Miami Shores, FL 33168-4322 Phone Number (786)251-2263 Parcel Number 1121360030360 Project: <NONE> Contractor: RADER APPLIANCES SERV CORP Phone: (786)546-4331 Building Department Comments A/C EXACT CHANGE OUT 4 TON Infractio Passed Comments INSPECTOR COMMENTS False o Inspector Comments Passed Failed Correction ❑ Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid April 29,2016 For Inspections please call: (305)762-4949 Page 17 of 25 3 3� Is o",Ery Miami Shores Village Pkj/777tt Rets1d0I-,t li M 10050 N.E.2nd Avenue NW wotf� SS1f1Ci1>' ?l1! 10#�tit Miami Shores,FL 33138-000 0 permit5tatu »AP �p' Phone: (305795-2204 0 ;..... �w. Expiration: 04/03/2016 Project Address Parcel Number Applicant 40 NW 111 Street 1121360030360 4040 GROUP CORP Miami Shores, FL 33168-4322 Block: Lot: Owner Information Address Phone Cell 4040 GROUP CORP 40 NW 111 Street (786)251-2263 MIAMI SHORES FL 33168- 9660 SW 72 Street MIAMI FL 33173- Contractor(s) Phone Cell Phone Valuation: $ 3,000.00 RADER APPLIANCES SERV CORP (786)546-4331 Total Sq Feet: 00 Tons:4 Available Inspections: Additional Info: Inspection Type: Classification:Residential Final Approved:In Review Review Mechanical Comments: Date Approved::In Review Date Denied: Type of Work:A/C EXACT CHANGE OUT 4 TON Scanning:3 Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $1.80 Invoice# MC-8-15-56750 DBPR Fee $2.00 10/06/2015 Check#:1014 $67.80 $50.00 DCA Fee $2.00 Education Surcharge $0.60 08/18/2015 Credit Card $50.00 $0.00 Permit Fee $100.00 Scanning Fee $9.00 Technology Fee $2.40 Total: $117.80 Inn compliance all ordinances and regulations Inconsideration of the issuance to me of this 'ermit, I agree to perform the work covered hereunder in cem» ce wi h t 8 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 employesi I understand that separate permits are required for ELECTRICAL,PLUMBING,MECHANICAL,WINDOWS,D, ORS,ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: I certify that all the foregoing inform ion ' ccurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Futhermore,I authorize the above-n ontractor to do the work stated. October 06, 2015 Authorized Signature:Owner / Applicant Vdonlractor / Agent Date iuilding Department Copy ctober 06,2015 1 t `4TVIRD w w Miami Shores Village AUG, 19 2015 Building Department BY: 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 M BUILDING Master Permit Nm. PERMIT APPLICATION Sub Permit N0.9�c45� ❑BUILDING F-1 ELECTRIC ❑ ROOFING ❑ REVISION D EXTENSION ❑RENEWAL ❑PLUMBING X MECHANICAL ❑PUBLIC WORKS [—] CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: AO C N�►V t' v1 City Miami Shores County Miami Dade Zip: 33 KD?-3 I Folio/Parcel#: 1(-rI I - 3�p �� 13 ©'J� Is the Building Historically Designated:Yes NO_ X Occupancy Type:ST Load: Construction Type: Cbs FloodZone: BFE: FFE: 6 OWNER:Name j 1 V(Fee Simple Titleholder): - L�1 o GI VDUD J-I 'G Phone#:I bu Z��- Z'2I Address: �(D® S w 11 &t �/� I City: I' 1) o m I n State: F L Zip: �31- � A _ Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name: Address: City: �=�41 y Jee L State: Zip: Qualifier Name: Phone#: '4 (:�(-3 State Certification or Registration#: C /4aCL�L 4�L5 Certificate of Competency#: DESIGNER:Architect/Engineer: ��� Tc�l- (A ect/Engineer: � • c) Phone#: 3o5 .� -( 5 r1555 Addrds 9: 'i H`"1 1 + S" -I ( A)&i Su('-i to 3 City: M g m i _State: PL Zip: Value of Work for this Permit:$ 3(Q 0 C0 Square/Linear Footage of Work: Type of Work: 0Addition ❑ Alteration �ElNew 21 Repair/Replace Demolition WkQQI Description of Work: Specify color of�f--color thru tile: Submittal Fee$ ,rj�-(002. Permit Fee$ �� CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NPW DUE$ (Revised02/24/2014) 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$2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also,a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will of be approve and a rein ection fee will be charged. Signatu Signature NER JENTT CONTRACTOR The foregoing instru ent was acknowledged before me this The foregoing instrumZwfe- as acknowledged before me this day of r T— 20 �J by �day of20r:;� by -'1 Q41-ude--PrD who is personally known to k6a4r_ 60- /0- who is personally known to me or who has produced U'I'I r° k CfcA W— as me or who has produced /JY � �l�) fl+%�=��=� as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sin: g � � Sign:_ ',- reqPrint: Print: � Seal: EXPIRES February Seal: MY COMMISSION k FF I, , inn:i sse c s3 p �yg ,. . s ?„ EXPIRES February V,..:o i g ,40ti 398•C•b3 F10r10[ GW SerNcc c.. ek Ne k+k=k k ek+$#k k Itk k k k#k ila k kffik k ak k k=k k k sk&k ek��*yak j5PIans APPROVED BY Examiner Zoning Lod, I Structural Review Clerk (Revised02/24/2014) r f Rader Appliances Serv, Corp. CAC 1817949 Date: August 17, 2015 State of. Florida County of. Miami-Dade Before me this day personally appeared Rader Dominguez who,being duly sworn deposes and says: That he or she will be the only person working on the project located at:40 NW 111 St. Miami Shores,FL. 33168 Sworn(or affirmed)and subscribed before me this 17 day of Au 2015,by Rader Do Suez. I Personally know 4 OR Produced Identification Type of Identification Produced MMEM DR.CARMEN GU£A S f •� My coMMISSION a FF,RR;�;s I , , EXPIRES February" 0 t t. Print, Type or Stamp Name of Notary OR i i shores IYI am Village Building Department ��N7'L+8 IN g0 �lOR1pA 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Notice to Owner - Workers' Compensation Insurance Exemption Florida Law requires Workers' Compensation insurance coverage under Chapter 440 of the Florida Statutes. Fla. Stat. § 440.05 allows corporate officers in the construction industry to exempt themselves from this requirement for any construction project prior to obtaining a building permit. Pursuant to the Florida Division of Workers' Compensation Employer Facts Brochure: An employer in the construction industry who employs one or more part-time or full-time employees,including the owner,must obtain workers' compensation coverage. Corporate officers or members of a limited liability company (LLC) in the construction industry may elect to be exempt if: 1. The officer owns at least 10 percent of the stock of the corporation,or in the case of an LLC,a statement attesting to the minimum 10 percent ownership; 2. The officer is listed as an officer of the corporation in the records of the Florida Department of State,Division of Corporations;and 3. The corporation is registered and listed as active with the Florida Department of State,Division of Corporations. No more than three corporate officers per corporation or limited liability company members are allowed to be exempt. Construction exemptions are valid for a period of two years or until a voluntary revocation is filed or the exemption is revoked by the Division. Your contractor is requesting a permit under this workers' compensation exemption and has acknowledge that he or she will not use day labor,part-time employees or subcontractors for your project.The contractor has provided an affidavit stating that he or she will be the only person allowed to work on your project.In these circumstances,Miami Shores Village does not require verification of workers' compensation insurance coverage from the contractor's company for day labor,part-time employees or subcontractors. BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. s� Sig a ' wne State of Florid County of Miami-Dade The foregoing was acknowledge before me this�day of4 ,20 '— By L/lggylaium4 o who is personally known to me or has produced 5 1/41�-3W,-a—54-;eZ as identification. Notary: VERCENS DEL cWMN QMpgS M1'COMMISSION 0 FF198753 SEAL: R.W,x, EXPIRES F�7,11.20t9 SORES D� ..o. U...f Miami shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 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. COPY OF LIABILITY INSURANCE* D. COPY OF WORKERS COMPENSATION INSURANCE* (Workers Compensation EXEMPTION must have OTICE TO OW R Affidavit) 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 DADE 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 Affidavit) *YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE AS FOLLOW: Certificate Holder: MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES, FL 33138 Certificate must specify the description of operations or contractor license number. BUSINESS NAME: BUSINESS ADDRESS: I A zc, w (so CITY J�tc�� eC� NATE Y_ZIP BUSINESS PHONE: ) S'-U- of 3 5 I FAX NUMBER( CELL PHONE QUALIFIER'S NAME: QUALIFIER'S LIC NUMBER: RICK SCOTT,GOVERNOR KEN LAWSON,SECRETARY ST1�TE OF FLORIDA DEPIkRTMENT"OF:BUSIIi�ESS AND PROFESSIONAL REGULATION 66NSTRUCTIO INDUSTRY LICENSING BOARD CAC181794fl ,. "he CLASS Bi�►�RLLCOI�iDI'RONING C Ml ACTQ�,ng � famed below IS CERTIFIED lnder theprt�vismts©f�Chapter 489 FS. xpiration dafe. AUf1,Z016 DOMING UI=DZ,y■yR}y,V,�E� l ` iPPL, 1T WES; S Y atea _e: � issuEo: 09P1112014 DISPLAY AS REQUIRED BY LAW sEct L1409216 001174 e CHIS 1S NE} A�$1[1� �Ek r F : � 63954 susnutEss i�i�cnrtFr� EXPIRE OCAS t77 NO, i RUDER I PUMMaipi SERV CARP ��� At. .1728 M*65 ST Re ,b ' tllfliEllH R 330J2 Pursilanttn coui tar Codi Chaptsr8A-Art &10, I OWNER SEC.TY%E Qlp BUSINESS i�ER APPWNCB SERV CORP 1� SPI»C MECHANICAL CONTRACTOR BY TN _C1ALLER' Wtxker(s) 1 CAC1817849 $75.00 08/29/2014 CRfDRCARD-14-t4428 ills focal Business lax lleceipt Daly confirms�yi�at of ft LOCO Mm®aas Tan.iha pe"At iv-a cu fmapon-of the 6ultWs ualificetfot m.endo 6 �Rt is[WON ortioiq�nreramemaF, It cavy wd6 say Iat#s antl ra9YgpWltuft 4ys1 . Tire N0.eb6vre ant lre ed an au *Ohiotes- r e tic fie-27& For inns�oom�ehm,r`a3iE' I 08/17/2015 15:12 305-820-2038 SONIA Page 2/2 CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 08/17/15 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS 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 DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the pollcypes)must be endorsed. If SUBROGATION IS WV"—D,subject to the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does n¢t confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER CONTACT NAME: SONIA RODRIGUEZ Red Road Insurance&Services PHONE (305)820-2038 AIC No Exti: (305)557-2323 A/C No: 10103 W Okeechobee Road ADDRESS: redroadinsurance@bellsouth.net Hialeah Gardens,FL 33016 INSURERS)AFFORDING COVERAGE NAIC# Phone (305)557-2323 Fax (305)820-2038 INSURER A: GRANADA INSURANCE COMPANY INSURED INSURER B: Rader Appliances Corp INSURER C: 1728 W 65 St INSURER D Hialeah,FL 33012- (786)546-4331 INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION 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 REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BYTHE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR TYPE OF INSURANCE IANSR WVp POLICY NUMBER POLICY f EFF POLICY EXP LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 500,000.00 © COMMERCIAL GENERAL LIABILITY PREMISES E RENTEDoccurrence)TO $ 100,000.00 A ❑ ❑ CLAiMS•MADE © OCCUR 0185FL00057389 03/06/2015 03/062016 MED EXP(Any one person) $ 5,000.00 F-1PERSONAL&ADV INJURY $ 500,000.00 ❑ GENERAL AGGREGATE $ 500,000.00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 500,000.00 ❑ POLICY ❑ JPERO- El LOC $ AUTOMOBILE LIABILITYCOMBINEDCOM INED SINGLE LIMIT Ea ,.;dent ❑ ANY AUTO BODILY INJURY(Per person) $ ❑ �OOWNED ❑ SCHEDULED AUTOS BODILY INJURY(Per accident) $ ❑ HIRED AUTOS ❑ �p QED PF ERTY DAMAGE $ (Per accident ❑ ❑ $ ❑ UMBRELLA LIAR ❑OCCUR EACH OCCURRENCE $ ❑ EXCESS LIAR ❑CLAIMS-MADE AGGREGATE $ ❑ DED ❑ RETENTION$ $ WORKERS COMPENSATION ❑TORY A TI ❑ER AND EMPLOYERS'LIABILITY Y/NLl ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICE(Mandatory In NH) EXCLUDED? ❑ N/A E.L.DISEASE-EA EMPLOYE $ (Mandatory In NH) If yes,describe undo DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1 $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space Is required) AC CONTRACTOR LIC CAC1817949 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE MIAMI SHORES THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN 10050 NE 2ND AVE ACCORDANCE WITH THE POLICY PROVISIONS. MIAMI SHORES,FL 33138 AUTHORIZED REPRESENTATIVE FAX:305-756-8972 SONIA RODRIGUEZ ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05)QF The ACORD name and logo are registered marks of ACORD r PLEASE CUT OUT CARD BELOW AND RETAIN FOR FUTURE REFERENCE MAPORTANT -� STATE OF FLORIDA Pmarantto Claapter440AR14),F.S.,an anter of a owpmason DEPARTL ENT OF FINANCIAL SERVICES +umo n ban this chapW by Mb*a WJ Ie of DIVMM OF WORIERW COMMSATION F 1e eae this tion may not raooerer or CONSTRUCTION INDUSTRY 0036 TION 0 ODnIF sonunderliftchapter. c9Z1 111eOFELBCM ltoaemaMffFROMPLORma L PumuwdloChapter440AN14F.$..Ce esatebm mrto - COMPENSATMLAW D be ems-.apply only vAllft ere scope of the bre ortrade ElvecMDAM esntr4 EXPettrtrorr entry lanamra fisted an Bre nobw of election to be exempt PERBOM DOMMUFz r:aeER IH Peearmd to Chaff 440.05(1 ,F.S.,Noucesof eiecfiare to be FEft 264467958 E Gampt and aero of election to be wampt shall be BUSMIESS NAM AND ADDRESS R subject to ravocallon B;at any tone after the fling of the notice P-43M APPLIANCES SHtV CORP E or On issuance of the oertiftft to perm named an the Room arab no longer meeft am requinunevils of this section for lanae of a omEffoae.The depadment shallnaes:fae acmtfficdoatmwffmfbrtWhmaf&epmm named on lire FRALEAH FL 3I2 cartnicebto"dew r ret of this sin SCOPES OF BUSINESS OR TRA EATING,VENTILATION, AIR-COND DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 07-12 QUESTIONS?(80413-1609 MIAMaDADE MIAMI-DADE COUNTY -STATE OF FLORIDA N/A October 06,2015 no LOCAL BUSINESS TAX RENEWAL 6359574 2015 -2016 APPLICATION RECEIPT:6627062 STATE#CAC1817949 DBA/BUSINESS NAME: BUS.COMMENCEMENT DATE:01/01/2009 RADER APPLIANCES SERV CORP SEC TYPE OF BUSINESS BUSINESS LOCATION: MECHS SPEC MECHANICAL CONTRACTOR 1728 W 65 ST 1 HIALEAH,FL 33012 OWNER/CORR APPLICATION DETAILS RADER APPLIANCES SERV CORP FEE AMOUNT C/O RADER DOMINGUEZ PRES Receipt Fee 30.00 PHONE# 786-546-4331 UMSA Fee 0.00 1728 W 65 ST Beacon Council Fee 15.00 HIALEAH,FL 33012 Bingo Permit Fee 0.00 Nightclub Permit Fee 0.00 Multi-Municipal Contractor Fee 0.00 Restricted Contractor Fee 0.00 Library Fee 0.00 Transfer Fee 0.00 NAICS CODE: 238990 Doing Business without a License Penalty 0.00 Late Penalty 0.00 Collection Cost 0.00 NSF Fee 0.00 Prior Years Due 0.00 Amount Recently Paid - 45.00 TOTAL AMOUNT DUE: 0.00 ................................................................................................................................................................................................................................................................................................................. If no longer in business,please notify us in writing. To pay online go to www.miamidade.00v/taxcollector Review and correct the information shown on this application. To pay by mail, make check payable to: Miami-Dade County Tax Collector A 25%penalty will be assessed to anyone found operating Business Tax without a paid local business tax, in addition to any other 200 NW 2nd Avenue penalty provided by law or ordinance(Sec 8A-176(2)). Miami FL 33128 To pay in person go to: A Certificate of Use and/or City Business Tax 200 NW 2nd Avenue Receipt may also be required. (305)270-4949,fax(305)372-6368 A service fee of not less than$25.00 up to a minimum of 5% will be charged for all returned checks. t RETAIN FOR YOUR RECORDS t ................................................................................................................................................................................................................................................................................................................. MIAMI-DADE COUNTY- + DETACH HERE AND RETURN THIS PORTION WITH YOUR PAYMENT + N/A October 06,2015 STATE OF FLORIDA LOCAL BUSINESS TAX RENEWAL 0 2016 APPLICATION II III I IIIIII IIIII� IIII ulll llll�ll IIIII�IIIIIII�IIII RSTATIE#CAC 0817949 6359574 BUSINESS LOCATION: 'uI 1728 W 65 ST HIALEAH,FL 33012 BUS.COMMENCEMENT DATE:01/01/2009 SEC TYPE OF BUSINESS OWNERICORP. MECHS SPEC MECHANICAL CONTRACTOR RADER APPLIANCES SERV CORP 1 APPLICATION IS HEREBY MADE FOR A LOCAL BUSINESS TAX RECEIPT OR PERMIT FOR THE BUSINESS PROFESSION C/O RADER DOMINGUEZ PRES OR OCCUPATION DESCRIBED HEREON.I HAVE BEEN INFORMED OF ALL ZONING RESTRICTIONS IMPOSED ON THIS RECEIPT. I SWEAR THAT THE INFORMATION IS TRUE AND CORRECT. RADER APPLIANCES SERV CORP C/O RADER DOMINGUEZ PRES 1728 W 65 ST SIGNATURE REQUIRED SEE INSTRUCTIONS ABOVE HIALEAH,FL 33012 Please pay only one amount The amounts due after Sept 30th Include penalties per FS 205.053. if Received By Oct 31,2015 Nov 30,2015 Dec 31,2015 Jan 31,2016 Please Pay $0.00 $0.00 $0.00 $0.00 7000000000000000000000006627062201600000004500000000000004