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RC-16-887 ri l GUIDO (PORTO) ARCHITECTURE November 12, 2016 Miami Shores Village Building Department 10050 NE 2 Ave Miami Shores Village FL 33138 REFERENCE: As-built certification for Work Affidavit of Inspection/Certification y Permit Number: 16-87 Job Address: 689 NE 92nd Street Apt. 11 G Miami Shores FL 33138 To Whom It May Concern: Serve this letter to describe work performed under the above referenced permit number has been completed according to plans prepared by Victor Rodriguez,architect as approved by the Village of Miami Shores Building Department. I hereby state that to the best of my knowledge and belief,construction in the premises has been completed according to approved plans. Inspection: Drywall and screw spacing Method: Inspection was performed by visual means and screw spacing confirmed with a magnetic/metallic MetalliScanner sensor for metal on drywall components. Findings: Bathroom-No new ceiling was constructed.Existing ceiling was found to be constructed of cement board and plaster.New wall sheathing at shower area was found to be 1/2" Durock cement board.Sheathing at the adjoining interior partition dry areas was found to be gypsum wall board and cement plaster. Screw spacing for new work was found to be 6"o.c.at edge of board and 8"o.c.in the field. Work was found to be in accordance with approved plans Kitchen-No new ceiling was constructed.No new wall was constructed. Should you have any questions or need any clarification please do not hesitate to contact me at(786)-468-9555. Thank you for your assistance in connection with the closure of the above referenced permit. Sincerely, 11--rAo Guido Porto,R.A.AR17864 2103 Coral Way,2nd Floor - Miami FL 33145 - 786.468.9555 - guido@portoarchitecture.com - AR0017854 GUIDO (PORTO) ARCHITECTURE November 12, 2016 Miami Shores Village Building Department 10050 NE 2 Ave Miami Shores Village FL 33138 REFERENCE: As-built certification for Work Affidavit of Inspection/Certification Permit Number: 16-887 Job Address: 689 NE 92nd Street Apt. 11 G Miami Shores FL 33138 To Whom It May Concern: Serve this letter to describe work performed under the above referenced permit number has been completed according to plans prepared by Victor Rodriguez, architect as approved by the Village of Miami Shores Building Department. I hereby state that to the best of my knowledge and belief,construction in the premises has been completed according to approved plans. Inspection: Framing Method: Inspection was performed by cut-outs to the wall and ceiling surface. Findings: Framing was found to be in accordance with approved plans; indicated as"existing to remain". Existing framing was comprised of wood studs approximately 2"x4" at 16" o/c., cross braced at waist height. An existing fire-stopping strip was observed at the head of the exterior wall. Should you have any questions or need any clarification please do not hesitate to contact me at(786)-468-9555. Thank you for your assistance in connection with the closure of the above referenced permit. Sincerely, A 0 FCC-) Guido Porto, R.A.AR17864 2103 Coral Way,2nd Floor - Miami FL 33145 - 786.468.9555 - guido@portoarchitecture.com - AR0017854 GUIDO (PORTO) ARCHITECTURE November 12, 2016 Miami Shores Village Building Department 10050 NE 2 Ave Miami Shores Village FL 33138 REFERENCE: As-built certification for Work t Affidavit of Inspection/Certification Permit Number: 16-887 Job Address: 689 NE 92nd Street Apt. 11 G Miami Shores FL 33138 To Whom It May Concern: Serve this letter to describe work performed under the above referenced permit number has been completed according to plans prepared by Victor Rodriguez, architect as approved by the Village of Miami Shores Building Department. I hereby state that to the best of my knowledge and belief,construction in the premises has been completed according to approved plans. Inspection: Insulation Method: Inspection was performed by observation thru removal of tile and performing cut-outs to the wall surface. Findings: Insulation was found to be closed-cell spray polystyrene foam insulation.Thermal Resistant value of installed material is estimated to be R 6.Closed-cell spray polystyrene provides vapor barrier and an air barrier. Should you have any questions or need any clarification please do not hesitate to contact me at(786)-468- 9555.Thank you for your assistance in connection with the closure of the above referenced permit. Sincerely, 1 \0 Guido Porto, R.A.AR17864 2103 Coral Way,2nd Floor - Miami FL33145 - 786.468.9555 - guido@portoarchitecture.com - AR0017854 �sY'° y,� Miami Shores Village "� � 10050 N.E.2nd Avenue NE hii Miami Shores,FL 33138-0000 k Phone: (305)795 2204 � ' � �E ' Expiration: 1210 2016�� tssue;t�ate f+17�1�a, Project Address Parcel Number Applicant 689 NE 92 Street Number: 11-G 1132060430270 Miami Shores, FL Block: Lot: ALEJANDRA LIBONATTI Owner Information Address Phone Cell ALEJANDRA LIBONATTI 10401 NE 6 AVE MIAMI SHORES FL 33138-2048 Contractor(s) Phone Cell Phone Valuation: $ 4,000.00 KADEN CONSTRUCTION COMPANY II (305)979-5221 Total Sq Feet: 75 Approved:In Review Available Inspections: Comments: Inspection Type: Date Approved::In Review Final PE Certification Date Denied: Window Door Attachment Type of Construction:REPLACE KITCHEN CABINETS&B Occupancy: Framing Stories: Exterior: Insulation Front Setback: Rear Setback: Drywall Screw Left Setback: Right Setback: Window and Door Buck Bedrooms: Bathrooms: Fill Cells Columns Plans Submitted:Yes Certificate Status: Review Electrical Certificate Date: Additional Info: Review Electrical Review Electrical Bond Return: Classification:Residential Review Building Fees Due Amount Pay Date Pay Type Amt Paid Amt Due Review Building CCF $2.40Review Planning DBPR Fee $2.00 Invoice# RC-4-16-59260 Review Plumbing DCA Fee $2.00 06/07/2016 Credit Card $89.40 $50.00 Review Plumbing Education Surcharge $0.80 04/01/2016 Credit Card $50.00 $0.00 Review Structural Permit Fee $120.00 Review Mechanical Scanning Fee $9.00 Technology Fee $3.20 Total: $139.40 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. LL -" June 07,2016 Authorized Signature:Owner / Applicant / Contractor / Agent Date Building Department Copy June 07,2016 1 Miami Shores Village � � �-v " P=te \� APR 0 1 2�1� Building Department 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Y:--- Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(30S)762-4949 541j FBC 201 q BUILDING Master Permit No. 2SLg PE MIT APPLICATION Sub Permit No. BUILDING ❑ELECTRIC ❑ ROOFING ❑ REVISION ❑EXTENSION ❑RENEWAL ❑PLUMBING ❑MECHANICAL [:]PUBLICWORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 689 .. 92 rl� ': trree–t * 11 - City: Miami Shores County Miami Dade zip: Folio/Parcel#: 11 - 3206 -D�3 -®z7() Is the Building Historically Designated:Yes NO_ Occupancy Type: Load: _Construction Type: t Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Ttleholder): IO Scz �he,,Ai dc' leiOeO-a Donal Phone#: 3o5-713-0595- UAddress: City: State: Zip: Tenant/Lessee Name: /1) /1)/A Phone#: A I Email: a� I( o a)�aho o C CJr 1'l CONTRACTOR:Company Name: (<-J en 6-5-r L)C )0f1 1;.-►r1anN,7rtCPhone#: 305-- 977-S2Z) Address: X133 0 9-0 A Ve S E- City: ___State: F1 Zip: Zf l J 7 Qualifier Name: 13 r 1?n 8,a,.-rc ZZ): Phone#• 305-- 586- 7-399 State Certification or Registration#. C C 6 05Y661—Certificate of Competency#: DESIGNER:Architect/Engineer. Phone#: Address C•ty: State Zip: Value of Work for this Permit:$ 00 0 Square/Linear Footage of Work: x Type of Work: ❑ Addition El Alteration1 ❑ New_-/ ❑ Repair/Replace ❑ Demolition Description of Work: e D)2 �>d ce 1� e&n Com,n&115 6 z-th ro o m re,,7 oya)o,,) aep) Ce 51g1C Irerooye 40b ins-T-Al Specify color of(color thru We: Submittal Fee$ `° ` (9� Permit Fee$ [ 20 - W CCF$ G CO/CC$ Scanning Fee$ ' cl�, Radon Fee$ g - W DBPR$c-� Notary!' Fee$— f V Training/Education Fee$ 0 . 80 . 8`/ Double Fee$ Structural Reviews$ Bond$ Q TOTAL FEE NOW DUE$ ` (Re0sed02/24/2014) Bantling Company's Name(If applicable) flandiurR Company's Address CRY State _ Zip Mortup UwdWs Name(if applicablef morqW LendeWs Address City state Zip Applitation is hey mWe for obtain a perm k to dna the work and installations as Indk9ted, I certify that no work or Ingallatiera ha cammemW prktr to the Issuance of a permit and Haat all vwk will be performed to nwet the standards of all laws rewistirg toristructi on In this jurisdieftm I understand that a 5eparate permit must be secured fait ELEMC, uLt MJMNG, RGNS, POOLS, FURNACES,BOILERS,HEATER$,TAMM,AIR CONMMNERS, o... t7lllNlr` &AFFIDAVIT: t certify that all ft foreOng Inlixrmation Is a=urMe and that all work will be florae in compliance va kh all applicable laws regula ft consbuclion and craning. "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,CONSULTWITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENaMENto WVice to Appkcrnet_ As o eaxdition to the Rance of a bufkft p vmit wftfe an estimated t"e encs dkg$2500,Mea oppfiica nt must prandse In goad f id'�p that ea Copy of the earrtfce of ramnwe:eaamN aftd c0mVvctkn Neta tow brasdw wield abet efefdvmd to ft person whose prWay is sua cr to a trr himnt Ahp,ra cerWd cW of the mwrded as dm of t rpt he posted ar tf ae Job slate for the fire kqxretton whkh attars wWR(7) days after 00 bu MMS,pa?nWf Is Lgrred4 tfue of swh paged erotAx the enspertfmo wild wt he appmved and a rebopecWn few re N he charged. Signature aCAI , ^1e^- OWWNElt or The fid g Instrument was as t befbre me thks Fo R mit ent was before me this dot of h f CC Q L -by d of 20 bar who is p rnpa`t<Igf k �� now to is Berson tna a to me or who has prod u d �Il�_i►fl� �IAft) as me or who has puWured Identfihcation and who did take an chic_ Iderrttidcatlon and who cid take •NOTA9••�i0��i NWARY pts HWARY =.��' '•moi • (1 Comm.Expires t JanuarY 9.2018 Sign: Sign: o —" -4 Print: EZ Prieot: WmNottalPublic,State of ROrida �i •••••••• Nseatoommieslon#FF2OW1 Seal: O�; OF F`0"%%,omm.expires Mar.12,2019 tt t 11 i 1110 ***r******t*a*seas■sa■■rs*s■ rr a*em eas**ars#*rs***e**s*s4sar.sea■■t+►sasrt**es*#*susaar®saw®m*e*ss**ss**e APPROVED BY Plans bamtner Zonhv struchno Review Claris I l i20 N.XcuM Drive.X 207 RECORDED 10/23/2015 09.46.10 Heim.Fhxide 33176 DEER DOC TAX "90.00 HARVEY RUVINt CLERK OF COURT FileNnisbar 15-0M1s MIAIII-DARE COUNTi`r FLORIDA General Wahl-Mty Deed Made this Se*wbw 30.20iS A.D By C Swede.a at a man.lax�vldaaEy and as tY�tee oifhe Kates 3svedo Revoealde Llsft TmAdamtl NWmb s2. whose sd f I%34M Agple Robin Suer.Suite 101.Lasa Vegas,NV 89129, od the otor.a►Teaea Eyhwabbk arsd Ams t lbom&K whose poa of a addtass is: 6V Ave'-73 3 j —� 3r.� . t «l�gtaate� tWlraacerocaa�iarbe�m•�s�por"a�'�aed' �ate�tsa�t�is$�ro�mtme Z�.&� st�as�so!' isdt s®l tree ammmmasoft"crl Whan"d►doSegr brmdiBamdd=dmcfg*WmOfTeKDONOM(SIO.00)mdo*erval=bbcomMmdom t wbaWnharebyabowledgA hagby8mt4 b .aelhs,alien,sues.adzes,eooveys and congmtees the ems. alt tw*naan lad$bt iU Cly,Flo md%vlz Unit l l-G of Sipes ikm West mu,a C4adGMISIRms stgWdkg to the Dere andiott of C*Bdemhdnt tm+t K ac reotrt"is OgWd Rewash Seek 64426 Pap 1292,of the POW its ofkfland-Dade Comity,Fkdda,and aB amenduants dwret%tom'with its eedivi" faUrat B1 the comum denwntL Pawd ID Mmubw 11-3206.843470 Termer with all the teaaneotsk liffedifemaUts and qpuftnmm thereto beteageg or in aaywise Te Have and to Held,ffie w=w fee shppb foram. And the memo byW98wM with said grantee then the gRUMN k 10MMyseind of said land in the Appig that d,WSOW les good rigid sod hal any to MR and wow said 1=4 that the grabereby f*MR=*da file to said Ind and will defend the same sping tba bwfid chrans of ali penaes whonvower,=d tbat said lend is G=of all M=mbmm maW fazes amuiq ssegmeat to 31,2014. iia ttm said gra�hes elgaed atm seskd Hese pnnpeats the dayamtya�r Snst aboaevvritten. Signed sailed mrd dekmvd in owp ej and as Tsof the Naffierue 3vhsg`19 w r t e ��. ! irF Revoea Lttst Tse of Us"d Mweb 12,2013 Amtrm 3636 Artesia Robin Shea.SWft lot.to vqM NV ,.. 89129 wamm sweor Florida Co®tyofb4 mi Dade The fon*0 tg Wwmsesa was admawleW befam nee this 301h day of Seip,2015.byGtmp Swade,hmgvuhmft ad as Traeee Of the Ka&aioe Swede!mak Liven Trust dated ML-ch JZ 2013.who idare pwansSy hrtown me er—hm produced Dsiva s license as ideadfecatim _ �4✓� .fit 1 , FAWN my cmnmimfto DONNA M.GIERNAC.KI t>�a -��rw; NOTARY PUBLIC,STATE OF NEW YORK NO.OtSIfI OMI QUALIFIED IN NASSAU COUNTY COMMISSION EXPIRES IN/Ot28M )7 i rte+ Miami shores Village Building Deartmen 10050 N.E2W Avenue Miami Shores,Florida 33138 Tela(W6)79 . :(305)756,8972 REGISTRATION IF COWW=OR IS A:F M RATE CEUM CON : ORz A._COPY OF QUALIFIER'S STATE LICENCES E. COPY OF LOCAL BUSINESS TAX RECEIPT r-ODv OF LI. 11-17' INSURANCE* _ _.. COQ `OF WDRKERS COMPENSATION INSURANCE' _ fs��'e? ere r-= n fior EXE IPt VO rnus?have NOTICE�'O 01�N EFR toant CcntT.-A,`a toa,;`, �a4 STAT- REGISTERED ICONITRAvJOR _CENSE OR MIAMI DADS ,-OUN"rY MUNI^iPA, CONTRACTOR' TAX RECEIP` . D, COPY OE I. IL11 Y INSU OE" E COPY OF WORKERS COMPENSATION INSURANCE* TWorkers CornpenseWn EXEMPTtON must have NOTICE TO O ER form and CtSr frac aT Afi lavit "YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE A,S FOLLOW: Cerbfkxk,Noldw: I SNORES VLLAGE BLDG DEPT I OM NE 2ND AVE IMAMI SHORIM FL Certificate must spec4 ft 6=rJpbmopendlims or corftcW louse number. ■waraaa wwrrarw■wrwwdFarwJlMw86NP9 w :"sesame ser rarww rrw irreawwanwrlrrawraararr rrrr aaw•we BUSINESS KANIE: BUSINESS Ate SS: 3�� STATE � P.��l l.� BUSINESS PHONE: �) 5^15 522. 1 _ FAX NUMSCO4—) 556 1*1 CELL PHONE�.a 5 ��Sto 1 S`i q _ R`S QUAL.IFIEWS LIC NISMM. 0'S I L `7 ._. sq STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD (850)487-1395 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 I i BARTCZAK,BRIAN EDWARD KADEN CONSTRUCTION COMPANY INC j 4330 8TH AVE SE NAPLES FL 34117 I I i 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 STATE OF FLORIDA from architects to yacht brokers,from boxers to barbeque restaurants, 4 DEPARTMENT OF BUSINESS AND and they keep Florida's economy strong. PROFESSIONAL-f tEGULATiON Every day we work to improve the way we do business in order to CGCO58867 , j laUE> ; .{8/2812014 serve you better. For information about our services,please log onto www myflorldallcense.00m. There you can find more information CERTIFIED GE" �GtI}t+IT:* "'AOR;. about our divisions and the regulations that impact you,subscribe BARTCZAK,BRt`Ii O Rb r to department newsletters and learn more about the Department's KADEN AK,B. , I t RANY.INC initiatives. ,� �.�• ��f.,,. Our mission at the Department Is:License Efficiently,Regulate Fairly. s ' We constantly strive to serve you better so that you can serve your customers. Thank you for doing business in Florida, iS CERTIFIED under the provisdons or Ch.489 FS. and congratulations on your new kcense! E*StW dW8.-AUG 31,2016 U4062MM441 DETACH HERE RICK SCOTT,GOVERNOR KEN LAWSON,SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD CGCo58867 The GENERAL CONTRACTOR Named below IS CERTIFIED 1 Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2016 i BARTCZAK, BRIAN EDWARD KADEN CONSTRUCTION!CUMPANY INC 4330 8TH AVE SE NAPLES FL 34117 , ... ONAMP ISSUED: 08128/2014 DISPLAY AS REQUIRED BY LAW COLDER COUNTY BUSINESS TAX RU.SINESS fA�FIUAABER: 1011 COLLIER COUNTY TAX COLLECTOR-2800 N.HORSESHOE DRIVE-NAPLES fLORIDA 34104-(2313) 52-2477 VISIT OUR WEBSITE AT:www.colliertax.cbm THIS RECEIPT EXPIRES SEPTEMBER 30, 2016 DISPLAY AT PUKE OF Q1ISINESS poR PUBLIC INSPECTION FAILURE TO DO SO IS CONTRARY TO LOCAL LAWS.., LOCATION:4330 STH AVE SE. gp,L F I ZONED: HOME OCCUPATION - THIS TAXIS NON-REFUNDABLE - ^` CORPO TION� :�,',. BUSINESS PHONE:.305 , .0 STATE LIC: HONE:.687 'e t KADEN CONSTRUCTION COMPANY INC BARTCZAK,BRIAN EDWARD 4330 8TH AVE SE 0 NAPLES FL 34117-0000 EMPLOYEES NUMBER OF EMPLOYEES: 1-10 EMPLO "� i � DATE 03/10/2016 CLASSIFICATION:GENERAL CONTRACTOR - i AMOUNT 28.50 CLASSIFICATION CODE: 05100101 RECEIPT 1775.50 j This document is a business tax only.This is not certification that licensee is qualified. It does not permtt the licensee to Violate.any existing regulatory zoning laws of the state,county or cities s nor does it exempt the licensee from any other taxes or permits that may be required by law. KADEN-1 OP ID:AN ►�CORO CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 03123/2016 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: N the certificate holder is an ADDITIONAL INSURED,the policy(les)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 lieu of such endorsement(s). M W 1 PRODUCER Group Inc ACT Annmarie McCartney F 362 Minorca Ave .305-444-2324 AfC Ne):305444-4980 Coral Gables,FL 33134 E-MAIL Carmelite Concepcion ADDRESS:amccartney@mdwinsurance.com INSURER(S)AFFORDING COVERAGE MAIC# INSURER A•US Specialty Insurance Co. INSURED Kaden Construction Co.,Inc. INSURER B Richard S.Bartczak 4330 0th Avenue SE INSURER C: Naples,FL 34117 INSURER D 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 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 AWL= POLICY EFF POLICYEXP LTR TYPE OF INSURANCE POLICY NUMBER LIMITS A X COMMERCIAL GENERAL LUUMLITY EACH OCCURRENCE $ 1,000,00 CLAIMS-MADE 0 OCCUR DCGO246800 12/30/2015 1213 M16 M $ 100,00 MED EXP(Any one person) $ 5,00 PERSONAL&ADV INJURY $ 1,000,00 GEN L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,00 PRO-POLICY❑JECTT ❑LOCPRODUCTS-COMP/OP AGG $ 2,000,00 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMB(Ea acciderd) $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED OTOS AUTOSULED BODILY INJURY(Per acdderd) $ PRBO DAMAGE $ HIRED AUTOS NON-OWNED AUTOS UMBRELLA UAB _]OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ INICF SATION - AND EMPLOYERS'LIABILITY YIN STATUTE ER ANY PROPRIETORIPARTNERIE(ECUTIVE OFFICERIMEMBER EXCLUDED? F-1 NIA EL EACH ACCIDENT $ MwKblwy ti In be wider1011) DISEASE-EA EMPLO $ DESCRIPTION OF OPERATIONS bek w E.L.DISEASE-POLICY LIMIT S DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remade Schedule,may be aged If mare space reepoled) RE:License#GCO58667 CERTIFICATE HOLDER CANCELLATION MIAMSHV SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Village of Miami Shores THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Building Department ACCORDANCE WITH THE POLICY PROVISIONS. 10050 N.E.2ND AVENUE ALmdoRl>gD REPRESe1TATIVE �w-MIAMI SHORES,FL 33138 A44" ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD R Doffs Miami shores Village Building Department 4ORl 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305)795.2204 Fax: (305)756.8972 Notice toOwner - Workers' Compensation Insurance Exemption -MIFT i"717NEW ,RI�7 R I 77T S 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. Signature: 17 Owner State of FlAaa— County of Miami-Dade The foregoing was acknowledge before me this day of 20 By who is personally known to me or has produced 1A%du Dmij ImAil as identification. "A Notary:_ Ak — SEAL: WLWA CAROUmA a0MEZ Notary ub p 0%State of Flodda Comffdssion#FF 209431 My comm.expires mar.12,2OW Kaden Construction Company Inc. Date.March 23,2016 State of Florida County of Dade Before me this day personal appeared Richard Bantczak who,being duly sworn,deposes and says: That he will be the only person working on the project located at 689 NE 9214 Street Miami Shores pillage,Fla Sworn to(or affirmed)and subscribed before me this day of M44 .20169 By 10�c G �y5 L, �e Produced Identification Type of Ident>lfication Produced �r►aQJs �� Print,Type or Stamp Name of Notary here MARIA CAROLINA OOMEZ Notary Public,SMO Flodda t;oncmissiun#FF 209431 My comm.ex�ree Mar•12,2019 CGC#058667*4330 80,Ave SE*Naples,Florida 34117*(305)979 5221 *We JEFF ATWATER CHIEF FINANCIAL OFFICER STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DMSION OF WORKERS'COMPENSATION **CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS'COMPENSATION LAW CONSTRUCTION INDUSTRY EXEMPTION This cer8ties that the individual listed below has elected to be exempt from Florida Workers'Compensation law. EFFECTIVE DATE: 6/6/2016 EXPIRATION DATE: 6/6/2018 PERSON: BARTCZAK BRIAN FEIN: 651153380 BUSINESS NAME AND ADDRESS: KADEN CONSTRUCTION COMPANY INC 4330 8TH AVE SE NAPLES FL 34117 SCOPES OF BUSINESS OR TRADE: LICENSED GENERAL CONTRACTOR Piasuant m Chapmr 4ao.06(14),F.S.en oi6eer of a eoryomaon who sleets exemptmn from this GmV�er bbyy>�ns a certmcate a eledmn under rn�aecdon may Prot recover benellffi of emnpermatlon underthis�Pureuant m Chapter440.06(12),F.3.,Certificates of election m be exempt..apoN adY w0hm dro stype of tlro buesreas a trade Bsmtl an fhe of emetbn m Da exempt W�suem m Chapter 440.06(13)F.S..NOUces of election 8s bs thepereon nnteo moerlMkacao�� raq�,ire�n orffiwa ,mor ie�auence�8 of a ate 7�ha dei parmient�she6k ae DFS-F2-DWG252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUESTIONS?(850)413-1809 •hke si JSFF AWIAM CHIEF FINARCIALOFFICIM STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WOWMRS'C0MPENSAT10N ••CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA VIAS'COMPENSATION LAW CONSTRUCTION INDUSTRY EXEMPTION i hts cerUm that the mdrvdual bsted below has elesded In be exempt horn FWida WtxkeW Comp tlon law. EFFECTIVE DATE: 7f24f2 S EXPIRATION DATE: 7/24/2016 PERSON: GARCIA BORNEY MAIKEL FEIN: 273276231 BUSINESS NAME AND ADDRESS: NEC ELECTRICAL CONTRACTOR INC 11720 SW 165 ST MIAMf FL 33177 SCOPES OF BUSINESS OR TRADE: LICENSED ELECTRICAL CONTRACTOR eieaati? !t41 'af:VS,atacaawpasScsi.fivadestsseae�r¢taSesaira �t �R+seratiaeLar r:ayYLL:f .$S a....:.. uda 9c da+c+er tMtraA to +aaS ttSt42b F.S, 'S� #a Gem.-.. i�,rf aC?ar ecigr� be;.kr�.rr kaee5+r fe�?e9 m!A`e er.Vy�c�eZ:�-FioeR to De e�eaRCt C'tfSut.'9 k�G�'Z� ,f�41$�,F..�,.ii�asear r6:�1'kn!a M � �d . - attmteaus*ee a''aaasatjeaWrarxa�.ne��tiras�eec�e�, �s�+ ofvsecerv�, 6'ie f.'`�s4n r�'aseQ OrkSrO rt�Ee tx cu Y,ryar neve.Pv ree�s.mrsts rd�,avfSx t+€z43Rt�'.�t L�a t�14�»�Cd�.1?4�C� h�d SP`.83 ear.id,ee a Of$-f24MC-252CEKf1FWATE0F ELECUN TO BE E>r-6IPT ItFv 0 05113 oues7IC msp[K ogj i,rte i 1+t • : •: + �: ••• a. Moon• •• • • ; ; 9 o 0 0 tour 0 #0 T •• -ec 88 APR 0 X616 MW OR FAN FAUCET _ _ _ R/0 0 OUTLET TYP. OF 5 a NK-/I I / I r DRAWER BOX I REF. I I I \\ II \ I L _ \ L — — V BASE/PLASTIC LEGS 1'-3" 2'-6" 1'-3" 2ol" 10 ' 9'-5" (EXTENT OF CABINET REPLACEMENT) 000 RIPM EASENG 100 X-4! sz° R/0 MW " 01 I ° I I REF. I 0 o 1'-1° 2'_ 9'-50 (EXTENT OF CABINET REPLACEMENT) Vol 0 lot J-1 April 12, 2016 n,:,'ner Tosca Eyherabide and Alejandra Libonatti Address 689 NE 82nd st. 11G. Miami Shores FL 33138 INTERIOR RENOVATION SCOPE OF WORK 1. Kitchen: kitchen cabinet, counter, backsplash, sink and faucet replacement. 2. Bathroom: Replace water closet, replace vanity/sink, replace tub with shower, replace mirror, replace accessories. iJ0 STRUCTURAL WORK NO MECHANICAL WORK NO ELECTRICAL UMBING. LIMITED TO REPLACE KITCHEN SINK TOILET - LAVATORY - REMOVE TUB & INSTALL NEW SHOWER PAN