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CC-11-586 (5)Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMB ER: (305) 762.4999 Permit Nod '� m BUILDING PERMIT APPLICATION FBC 20 Permit Type: BUILDING OWNER: Name. (Fee Simple Titleholder): Address: I1 IS 0 1'J City. MIAOW' 1/1006 Tenante Name: Email: beekuareht ROOFING r 1.ris -tc state: Flari APR 042011 Li BY: Master Permit No. wiry. eel JOB ADDRESS: 11300 we 2n4 Avenue., Qty: Miagni Shores Foiio/Parcel#: 11- 21510 �: • ,, s Is the Building Historically Designated: Yes CONTRACTOR: Company Name: County: Phe ): - 305 33.1& 1 Phone#: 4. MEW; 0O S Miami Dade Zip: 331671 NO Ve 4 iatai 2101 1.1- P Avenue. , v0.f�. Flood Zone: e#: , -, 7 --7_, , + " S i of rp: 53111 City: rI Lkty rely State: I# tL f�. Phones: q 410 •.s' Certificate of Competency #: Qualifier Name: l State Certification or •+fit "on #: Contact Phony #: '10141107 DESIGNER: Architect/Engineer ` " ti: ' ! a L .f l ` . iL i Phone.#: tO3 O7 2 az s'61 ss� Value of Work for this Permit: $ -� ® Square/Linear Footage of Work: 72l = Type of Work: ()Addition ()Alteration OD of Work: S) LIM CI Pt ao avidol nz viefifew ()Repais/Replace A, ()Demolition W ! ? id' s I ! V; B,n # sss***ssss*s *s** * **s *F s* Submittal Fee $ R"I ' TR dPermit Fee $ Scanning Fee $ Radon Fee $ *******4*********** witsimiummontsounp.44, CCF $ CO/CC $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee Double Feat $ Structural Review $ TOTAL FEE NOW DUE $j. _ �! : 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 occ .f s seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved/4 a reinspection fee will be charged. Signature Altai Owner or Agent The foregoing instrument was acknowledged before me this JO day of )1/. ell , 20 /1 , by 3.2i'e OEdw/ .s who is personally known to or who has produced As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: (014441L 73') -- My Commission Expires: * * * * * * * * * * * * * * * * * * * ** ,�°� Notary Public State of Florida +r Cheryl Baida Gerber LJMy Curettes onpDD988126 ilidu4,6", ractor The foregoing instrument was acknowledged before me this,1 day of NY �� , 20`� , by 51\efC I�tr who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: APPROVED BY Plans Examiner Structural Review (Revised 07 /10107)(Revised 06/I0/2009)(Revised 3/15/09) Sign: Print: My Commission Expire June 2P,2014 Zoning Clerk MIAMI -OADE COU!`ITY TAX COLLECTOR 140 W. FLAGLER ST. 1st FLOOR MIAMI, FL 33130 2011 LOCAL BUSINESS TAX RECEIPT 2012 FIRST -CLASS MIAMI -DADE COUNTY - STATE OF FLORIDA U.S. POSTAGE EXPIRES SEPT. 30, 2 012 PAID MUST BE DISPLAYED AT PLACE OF BUSINESS MIAMI, FL PURSUANT TO COUNTY CODE CHAPTER 8A . ART. 9 & 10 PERMIT NO. 231 595524 -1 THIS IS NOT A BILL - DO NOT PAY RENEWAL BUSINESS NAME / LOCATION RECEIPT NO. 621251-8 MOSS & ASSOCIATES LLC 150 SE 2 AVE 807 33131 MIAMI OWNER MOSS 8 ASSOCIATES LLC Sec2Tyee SERVICE THIS IS ONLY A LOCAL NOT A CONTRACTORS RECEIPT BUSINESS TAX RECEIPT. IT EMPLOYEE /S BUSINESS 2 DOES NOT PERMIT THE HOLDER TO VIOLATE ANY EXISTING REGULATORY OR ZONING LAWS OF THE COUNTY OR CITIES. NOR DOES IT EXEMPT THE HOLDER FROM ANY OTHER PERMIT OR LICENSE REQUIRED BY LAW. THIS 15 NOT A CERTIFICATION OF THE HOLDER'S QUALIFICA- TIONS- PAYMENT RECEIVED MIAMI-DADE COUNTY TAX COLLECTOR:. 08/05/2011 09010045001 000045.00 SEE OTHER SIDE DO NOT FORWARD MOSS & ASSOCIATES LLC BOB L MOSS 2101 NORTH ANDREWS AVE FORT LAUDERDALE FL 33311 illik.11l lIli,)I IIi, LIIiIIIi,f,i.j.1ii.i111i,hhedli NOTICE OF COMMENCEMENT A RECORDED II COPY MUST BE POSTED ON THE J08 SITE AT 14 TIME OF FIRST INSPECTION NO. 1 - �LQ TAX FOUO NO. 1 1% 0000040 STATE OF FLORIDA COUNTY OF MIAMI -DADE: THE UNDERSIGNED hereby gives notice that improvements will be made to certain real property, and in accordance with Chapter 713. Ftonda Statutes, the following Information is provided in this Notice of Commencement. 1. L • p of p Ae IL Description • improvement 0 E 111111111111111111111111111111111111111111111 CFN 2011R03`91.71381 OR Bk 27703 P9 45036 (fps) RECORDED 05/27/2011 15:23:13 HARVEY RUVINr CLERK OF COURT MIAMI -DADE COUNTYr FLORIDA !.AST PAGE seep reserved for use of recording office �l ! 'f '11!�� l! / ~1 i/w' .. r7 jR // 471-74 t ; 1T 7q i . -kai71TFT7 ='X111 C: • I t.l r •7•AU- 1711.r'is'i'* ".' il'''t ,1 `. ■, 'T ; r . .,.. 7,1101115117;61171111 �.01ZA LI{ s !; ir.; 'f w71a t 3. Owner(s) name and add Interest in property: Name and address of fee simple titleholder: 4. Contractor's name address • phone num 0 .� �1 rt . '; L'1((. I 711i 17?! - x'71*1! riI r '";' r_7:C2I/S-t'r'?L".'Z#_'__ • cam.11':Q. 77L? IWITT,!7%nNF1 J a. 5. Surety: (Payment bond required by owner from contractor, if any) Name, address and phone number. Amount of bond $ 8. Lender's name and address: NA 7. Persons within the State of Florida designated by Owner upon whom notices or other documents may be served as provided by Section 713.13(1)(x)7., Florida Statutes, Nam = :..,. ress and rr error •9R.R e _ , , 414 -f Io1 �74=71 !AIWA P1II J _^ v[ ! ! �_ : 'f.niqs LCD udtl& lowing person(s) to receive a copy of the n i3nor'S Notice as provided in Section _ sa!� 8. In addition to himself, Owners designates the 713.13(1)(b), Florida Statutes. N = e. ad.:., and .;1; = nu • er..ir r ' - i' -r:- *--:.:1-t- s arri.P'.Tr:74 umarrgra i- .T) 9. Expiration date of this Notice of Commencement: 11%P. llffr-f!•11 W ndi (the expiretto date is 1 year from the due of recording lydess a (Afferent date is specified) WARNING TO OWNER ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART I, SECTION 713.13. FLORIDA STATUTES. AND CAN RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT. Signature(s) of Owner(s) or • 2.........".1..,, 1.' Authorized Officer /Director /Partner/Managek \\ Prepared By - Prepared By i��S Print Name _CcI ill ta Print Name tK Yee r" Title/Office (d' A/s/;C5,1R7J »4J ,7[C Title/Office V t� �4c S_c�j�t .Cer STATE OF FLORIDA v V COUNTY OF MIAMI -DADE The foregoing Instrument was acknowledged before me this 3° day of /1-✓t �-�- By i3 A UL LF ,$ dt4,2M+ -� S p ll ividually, or 0 as for 4QPersonally known, or 0 produced the following type of identific • Signature of Notary Public: � ess Print Name: No s. or`.sn- at-,.d34'4_ • / • (SEAL) VERIFICATION PURSUANT TO SECTION 82.528. FLORIDA STATUTES Under penalties of perjury, I declare that I have read the foregoing and that the facts stated in it are true, to the best of my knowledge and belief. Signature(s) of Owner(s) or Owner(s)'s Authorized Officer /Director/Partner/Ma BY By .n.r42 PACE V•3 IVI iami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CONTRACTORS' REGISTRATION FORM ALL CONTRACTORS MUST PROVIDE COPIES OF LICENCES AND INSURANCES EACH TIME A PERMIT IS SUBMITTED OR THE VILLAGE MAY MAINTAIN A FILE WITH YOUR INFORMATION FOR A $30.00 FEE PER YEAR. IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: A. COPY OF QUALIFIER'S STATE LIC CARD B. COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF LIABILITY INSURANCE (CERTIFICATE HOLDER TO BE MIAMI SHORES VILLAGE BLDG DEPT) D. 1 COPY OF WORKERS COMPENSATION (EITHER CERTIFICATE OR EXCEMPTION) IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY: A. B. C. D. COPY OF CERTIFICE OF COMPETENCY OF QUALIFIER COPY OF MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT COPY OF LIABILITY INSURACE (CERTIFICATE HOLDER MUST BE MIAMI SHORES VILLAGE BLDG DEPT) COPY OF WORKER COMP INSURANCE (EITHER CERTIFICATE OR EXEMPTION) YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE HOLDER AS FOLLOW: MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES, FL 33138 M COMPLETE CONTRACTOR'S INFORMATION BUSINESS NAME: 1 ' ®J6 + Asso6 )ctie6 LL BUSINESS ADDRESS: 2101 w • Andre W6 \taITY F(y+. STATE PL ZIP CODE BUSINESS PHONE: �`y1 ) 7f41" g 107 FAX NUMBER d --' I) 7 _' 1 O ' CELL PHONE �t ±1' 4104091 QUALIFIER'S NAME: a Intr - Weir (V, r "61itraj‘‘ QUALIFIER'S LIC NUMBER: C. CI 6 0 f 7 7 E -MAIL ADDRESS (IF APPLICABLE): 6Lutrnet e r5sera 1 1. corm Created on 3119109 BY MLDV 1 RV 3126109 MLDV STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD 1940 NORTH MONROE STREET TALLAHASSEE FL 32399 -0783 MOSS & ASSOCIATES LLC 2101 N ANDREWS AVE SUITE 300 FORT LAUDERDALE FL 33311 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 from architects to yacht brokers, from boxers to barbeque restaurants, and they keep Florida's economy strong. Every day we work to improve the way we do business in order to serve you better. For information about our services, please log onto www.myflorldalicense.com. There you can find more information about our divisions and the regulations that impact you, subscribe to department newsletters and leam more about the Department's initiatives. Our mission at the Department is: License Efficiently, Regulate Fairly. We constantly strive to serve you better so that you can serve your customers. Thank you for doing business in Florida, and congratulations on your new license! DETACH HERE (850) 487 -1395 STATE OF FLORIDA -DEPARTMENT OF BUSINESS AND -- PROFESSIONAL REGULATION' AC# 44227%. 4338328 -. 05/30/09 088224190 QUALIFIED BUSINESS ORGANIZATION MOSS & ASSOCIATES LLC (NOT:iA LICENSE TO PERFORM WORK. ALLOWS COMPANY TO DO BUSINESS IF ;,,IT..HAS A LICENSED QUALIFIER.) I5 QIIALIFIED wader the provieione of 01.489 F8 ;ESyisn loa,- datae'-AUG: 31, 2011 _L09053000139 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD 1940 NORTH MONROE STREET TALLAHASSEE FL 32399 -0783 WERNER, CHERYL LYNN MOSS & ASSOCIATES LLC 2101 NORTH ANDREWS AVENUE #300 WILTON MANORS FL 33311 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 from architects to yacht brokers, from boxers to barbeque restaurants, and they keep Florida's economy strong. Every day we work to improve the way we do business in order to serve you better. For Information about our services, please log onto www.myflorldalicense.com. There you can find more information about our divisions and the regulations that impact you, subscribe to department newsletters and learn more about the Departments initiatives. Our mission at the Department is: License Efficiently, Regulate Fairly. We constantly strive to serve you better so that you can serve your customers. Thank you for doing business In Florida, and congratulations on your new license! DETACH HERE (850) 487 -1395 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487 -1395 1940 NORTH MONROE STREET TALLAHASSEE FL 32399 -0783 HARRIS, JOSEPH L MOSS & ASSOCIATES LLC 2101 N ANDREWS AVE # 300 WILTON MANORS FL 33311 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 from architects to yacht brokers, from boxers to barbeque restaurants, and they keep Florida's economy strong. Every day we work to improve the way we do business in order to serve you better. For information about our services, please log onto www.myfloridallcense.com. There you can find more information about our divisions and the regulations that impact you, subscribe to department newsletters and team more about the Department's initiatives. Our mission at the Department is: License Efficiently, Regulate Fairly. We constantly strive to serve you better so that you can serve your customers. Thank you for doing business in Florida, and congratulations on your new license! DETACH HERE Ar § NUK:S 1 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487 -1395 1940 NORTH MONROE STREET TALLAHASSEE FL 32399 -0783 ATKINSON, BRETT TEAVIS MOSS & ASSOCIATES LLC 150 5 E 2ND AVENUE SUITE #807 MIAMI FL 33131 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 from architects to yacht brokers, from boxers to barbeque restaurants, and they keep Florida's economy strong. Every day we work to improve the way we do business in order to serve you better. For information about our services, please log onto www.myfloridalicense.com. There you can find more Information about our divisions and the regulations that impact you, subscribe to department newsletters and learn more about the Department's initiatives. Our mission at the Department is: License Efficiently, Regulate Fairly. We constantly strive to serve you better so that you can serve your customers. Thank you for doing business in Florida, and congratulations on your new license! DETACH HERE MOSS & ASSOCIATES LLC 2101 N ANDREWS AVE 300 WILTON MANORS FL 33311 City of Wilton Manors, Florida LOCAL BUSINESS T Date: September 21, 2010 THIS LICENSE IS ISSUED P CODE OF THE CITY OF ISIONS OF THE CITY MENTS THERE TO. License Number 03,' Expiration Date a, ; • : 'er 30, 2011 -. . Name of Business MOSS & AS SOCRATES Business Location 1 Q,';'1 ,R ,r�� License Type ' a A' i. I- CONTRACTORS -GEI+i SIGN RENEWAL FEE FIRE INSPECTION CLASS $ 125.00 $ 19.00 $ 400.00 Total Fees: $ 544.00 BY IcAtc Director of Community Services :: THIS 'IS NOTA BtL - DO NOT PAY RENI�F1• ... .&21251 -8 FIRST- CLASS; US. I,OSTA E Pte.. MIAMI, FL.;. PERMIT NO . SEE OTHER SIDE DO NOT FORWARD MOSS & ASSOCIATES LLC BOB L MOSS 150 SE 2 AVE 807 MIAMI FL 33131 i.1.11.it .11:t+t}}t9Ahhi /hiiLhAll/ A.41tl44 115 S. Andrews Ave., Rm. A -100, Ft. Lauderdale, FL 33301 -1895 — 954 - 831 -4000 VALID OCTOBER 192010 THROUGH SEPTEMBER 30, 2011 DBA: Business Name: MOSS & ASSOCIATES LLC Owner Name: JOSEPH LABODE HARRIS Business Location: 2101 N ANDREWS AVE 300 FT LAUDERDALE Business Phone: 954 -524 -5678 Rooms Receipt #:180 -7396 Business Type:GENERAL CONTRACTOR (G CONTRACTOR) Business Opened:11/01/2004 State/Cou my /CertIReg : cac o 4 216 0 Exemption Code :NONEXEMPT Professionals For Vending Business Only Number of Machines: Tax Amount Transfer Fee NSF Fee :, Pena , Prior ;Years Collection Cost Total Paid 81.00 0.00 _° - - 0.00 ` 0 00 00 0.00 81.00 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 non - regulatory in nature. You must meet all County and/or Municipality planning and zoning requirements. This Business Tax Receipt 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. WHEN VALIDATED Mailing Address: JOSEPH LABODE HARRIS 2101 N ANDREWS AVE #300 FORT LAUDERDALE, FL 33311 2010 - 20 Receipt #13A -09- 00009674 Paid 08/25/2010 81.00 i Miami Shores Village, Florida i/2.2/ ct BUILDER'S BOIL J I iI D LL\\ KNOW ALL MEN BY THESE PRESENTS, that I, CHERYL LYNN WERNER of MOSS & ASSOCIATES LLC at 2101 ANDREWS Avenue 300 FORT LAUDERDAL in consideration of the issuance to me by Miami Shores Village, Florida, of a permit or permits to construct or repair a building or buildings at the following address: 11300 2 Avenue NEW DOORM Miami Shores FL 33138 -0000 C9pY qoept Issued: 07/21/2011 Amount: $ 10,000.00 Bond #: 2052 Permit #: CC -4 -11 -586 do hereby deposit with Miami Shores Village, Florida, the sum of: $10,000.00 and I agree with Miami Shores Village that, when such construction has been completed by me, within the meaning of the ordinances of Miami Shores Village, I will clear all premises and repair any Village property damaged by me, used for the deposit of material or equipment in the construction or repair and that, if I do not so clear and repair such premises immediately upon the completion of such construction within the meaning of such ordinances, the Village may clear and repair the same and pay the cost of such clearance and repairs out of the aforesaid Builder's Bond, and return the remainder to me; and that, if I shall clear and repair said property immediately, as aforesaid, then said Builder's Bond shall be returned to me,.. WITNESS MY HAND and Seal at Miami Shores Village, Florida this date: 07/22/2011 Signature INSTRUCTIONS TO BUILDER: When the above mentioned construction is completed and the premises are cleared and repaired, take this bond to the Village Building Inspector and obtain his approval, after which Miami Shores Village will refund your money in accordance with the above agreement. VILLAGE BUILDING INSPECTOR'S APPROVAL I hereby certify that the construction contemplated under this Bond, has been completed and that the builder thereof has caused the surrounding premises to be cleared and repaired in as good condition as they were before commencing said construction. WHEN CLEARED AND REPAIRED BY THE VILLAGE: Amount of Bond: Cost of clearing and repairs done by Village: Balance due Builder: $ Cancelled: Village Building Inspector, Miami Shores By: Bond refund payable to applicant only. ($10.00 CHARGE IF BOND IS LOST OR DAMAGED) Date Miami Shores Village Building Department 1050 N:E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 BUILDING PERMIT APPLICATION FBC 20 Permit Type: BUILDING ROOFING OWNER: Niune (Fee Simple Titleholder): LA ver6aq n City: M1 V 0norts State: Florida.. Address: 1 I`OQ' Permit No. JUL U 1 2011 Y : ............... Master Permit No. Tenant/Lessee Name: Email: 1 it ) - 3050 zip 33t'4l Phone#. JOB ADDRESS: 11300 iV Avenue.- City: briami-Shores - ,Cody: Miami Dade Folio/Parcel#: I 1' 2134 _ Zip: 331fo.1 Is the Building Historically Designated: Yes ACOddNreTsRs 0: 1 pW City Purl (d I Lvtirl Qualifier Name: Ott State Certification or R. on :#: Contact Pho DESIGNER: Architect/Engineer: NO ✓ Flood Zone: AerzotiettesiLIC, phone. 4- 71fi - Sate: Pt i 31 ! W,tr,ncr Phone* 954-410-5019 1I 7 Certificate of Co #: 5t4errtere mossermit. taw) 12/415n-Artd ail Phone#: E0 -407.23az N Value of Work for this Penult: $ i : , p: 1 000 Square/Linear Footage of Work: 12 i Type of Work: ]Addition °Alteration Wifew ORepairlReplace A UDemolition don of 'Work: : �t • / / I iLW 1 a I i 47 WI R1451diezed i IL a i d t i s****** ** ** as *******************Fees*********************** *********** Mass**** 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. 1 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 Fr.F.CTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC OWNER'S AkTiDAVIT: 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 Ls issued. In the absence of such posted notice, the inspection will not be approved reinspection fee will be charged. Signature Owner or Agent The foregoing instrument was acknowledged before me this 30 day of MA -4-eA , 20 11 , by 13.2 ,d„,./. et s , who is personally known to me or who has produced As identification and who did take an oath. NOTARY PUBLIC: Sign: Signature ntraetor The foregoing instrument was acknowledged before me this°[ day of 01\ , 20 ., by 51,Nalievieknor who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Print: (144,/i My Commission Expires: * * * * ** * * * * * * * * *** * * * ** APPROVED BY Sign: �,Q Print: ttld,COOt My Commission Expires: TICA MYCOMMISSION i DD 997283 EXPIRES: June 29, 2014 Banded Thru Nmsiy Public Underwriters ******************* * * * * * ** ** * * * * * * * * * * * * * * * * *** * ** Plans Examiner Structural Review (Revised 07 /10/07)(Revised 06/10/2009)(Revised 3/15/09) Zoning Clerk RO® CERTIFICATE OF LIABILITY INSURANCE ° I DA 0329/2011 '''' 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 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 Ileu of such endorsement(s). PRODUCER Aon Risk Services Northeast, Inc. Boston MA Office One Federal Street Boston MA 02110 USA CONTACT NAME: (AHIC No. . �); (866) 283 -7122 I (Fa. No.): (847) 953 -5390 E -MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC 5 INSURED Moss & Associates, LLC 2101 N. Andrews Avenue Suite 300 Wilton Manors FL 33311 USA INSURER A: Zurich American Ins Co 16535 INsuRERB: American Guarantee & Liability Ins Co 26247 INSURER C: Commerce & Industry Ins Co 19410 INSURERD: X _ INSURER E: DAMAGE TO RENTED PREMISES (Eaoaurrence) INSURER F: MED EXP (Any one person) COVERAGES CERTIFICATE NUMBER: 570041943918 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. Limits shown are as requested L R TYPE OF INSURANCE WBR VWD POLICY NUMBER �PVI p/YEYFYFt� �nPtnOmortrrro LIMITS A GENERAL LIABILITY GL0914084704 -01/ 01/2011 01/01/2012 EACH OCCURRENCE $1,000,000 X _ COMMERCIAL GENERAL LIABILITY CLAIMS -MADE X OCCUR DAMAGE TO RENTED PREMISES (Eaoaurrence) $300, 000 MED EXP (Any one person) $10,000 PERSONAL & ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES POLICY n JECT PRO- pi PER LOC PRODUCTS - COMP /OP AGG $2,000,000 B AUTOMOBILE LIABILITY BAP5918170 -05 01 /01 /£01101 /01 /2012 COMBINED SINGLE LIMIT (Ea accident) $1,000,000 X X X X ANY AUTO BODILY INJURY ( Per person) ALL OWNED AUTOS HIRED AUTOS Comp Ded $1,000 — _ X _ X SCHEDULED AUTOS NON -OWNED AUTOS C01100081,000 BODILY INJURY (Per ac dent) PROPERTY DAMAGE (Per accident) C X UMBRELLAUAB EXCESS MB X — OCCUR CLAIMS -MADE BE33106208 SIR applies per policy terms 01/01/201101/01 & conditions /2012 EACH OCCURRENCE $1,000,000 AGGREGATE $1,000,000 DED I X IRETEN110N A WORKERS COMPENSATION AND EMPLOYERS' LABILITY N I A wC591944005 01/01/201101/01 /2012 X ITIORYSTTIATS -I IER ANY PROPRIETOR! PARTNER / EXECUTIVE YIN OFFICERIMEMBER EXCLUDED? N (Mandatory In NH) E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE -EA EMPLOYEE $1,000,000 If DESCRIPTION IPTION under DESGtRIPT10N OF OPERATIONS below E.L. DISEASE -POUCY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, H more space is required) Project: Barry University Residence Hall. CERTIFICATE HOLDER CANCELLATION Holder Identifier : Certlflcate No : 570041943918 �7 Miami Shores Village Building Department 10050 NE 2nd Avenue Miami shores, FL 33138 USA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POUCY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010 /05) The ACORD name and logo are registered marks of ACORD Jul. 21. 2011 3:36PM butler, buckley, Beets ACORD. CERTIFICATE OF LIABILITY INSURANCE PRODUCER BOTI,ER, SCCKLEY 6 AEETS 6161 BUTT, LAGOON DRIVE NIwI, SL 33126 Phone: (30512E2-0086 Fax: (3051262 -0187 INSURED ATLANT1 ELECTRICAL CORD 12803 SW 20TH TERRACE FL 33175 Phone (7861395-6790 RAGE No. 0354 P. 1 DATE paragon yy) D7/21/11 IS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHT UPON THE CERTIFICATE HOLDER THIS CERTIFIGATE DOES NOTAMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW INSURERS AFFORDING COVERAGE INSURER A: North Pointe Insurance C013p3.71y INSURER & INSURER C: INSURER in INSURER Es "MituCtEs 0FINSURAN0a-usI'E'D SF10W HAVE MEN ISSUED • E 1 Eil -1.4 0-1i lg. F - - _ 01. - — - • D INDICATED, NOTHWITHSTANDING 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. 114311 8 name 0R' IRANCe A ALLWILOY COMMERcuAL GENI LUABILITY Was uxoe p prom AGGREGATE MU PPUES PERI II POLICY P, AUTOMOBILE Wow. • AIJYAUTO ALL OWNED AUTO/ L 0CHEDULEDAUr ` HARED AUTOS NDISOWNED AUI 8 &WADE LIABILITY 1 ANYAUTO EXCEss tlitEILtrr 0 olAms mum ceouc91E RETENTION ----WORKERS STy A'RdNAND EMPLOYERS LIAINLI LOC POLICY NUMBER POLICY !IKEDTIVE DATE I: BDW ausaiNVOIVYTJ _ 9?S0001333 02/10/2011 02/10/2012 LIMITS LIN?rMyOnne Oecumm y) MEo EXPL4ny w. ponanl PERBONACANDAOV war GENERALAtsGREGATR PRODUCTS. COM ?/OP AGC, $ 1,000,000 e 100,000 8 3,000 $ 1.000,000 $ 2,000,000 3 2,000,000 COMBINED ,t T GLE UM OM =We DULY INJURY (Par pram BODILY INJURY IPer scamp ` ROFtERTY DAMAGE eCc!43nt AUTO ONLY -EA =DENT =Ttea7}IAN EA AGO ONLY: EACH =OCUW NCE TE OPERATIONS/LCDATIoNS EH� ELECTRICAL CONTRACTOR A D OIVe11.IN S 8 $ 3 3 3 WC STA'I'UYCRY uMTS OMER e- L- EACH ACCIDENT 8 3 3 $ $ LOISEASE.8AEMPLOYEE $ DISEASE- POLKA* LIM 15 ADDED BY ENPROYSMENIIBPECIALPROV SWNY RED LETTER: MIAMI SHORES VILLAGE BUII,AIAiG 6 ZONING 10050 NE 2ND AVRNDE MIAMI sHOAFS, FL 33138 Faxed to: 305 - 756 -11972 ACCORD 28-S (7187) I TION SHOULD ANY OP THBABOVE D1SCR1RIW POUCHES DEOANDELLED BEFORE-RIB 3IPIRARON DATE TNEREOP, 'me mum mISLiRERWIU . ENDEAVOR TO3131_5A DATE minx NOTICE TO THE DERTQICATE HOLDER NUM 10 TEE LEFT. BUT PA 70 bp 50 MALL KOBE N0 OSLIGATlOT{ ON LIABILITY OP ANY BOND UPON THE INBIpER [r8 AM OS OR REPINGIG ITATIWES. _ AUTHORGED REFRE$ENTA7IVE ACORU CORPORATION 191313 Miami Shores Village 30EF lit AUG 2 208 i Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 BUILDING M APPLICATION FBC 20 Permit Type: BUILDING ROOFING Permit No. BY: Master Permit No. (, (o ( —55(6 OWNER: Name (Fee Simple Titleholder): (3a/`' (-1 v [�� Rs i r j` Phone #: 3 Address: 1 77 00 Ai -6 2 / OF Ai ✓L City: ,441, M I 5tfoR (.75 Tenant/Lessee Name: Email: . 4 5.4iv►L: State: FL 5, 5(act- 3050 Zip: 3516/ Phone #: S A-M JOB ADDRESS: l 3 t')t it/ 2'1 ,4 (/ f✓i ' i City: Miami Shores Folio/Parcel #: 11— M3&0000010 Is the Building Historically Designated: Yes CONTRACTOR: Company Name: Address: ?- City: Et,r Qualifier Name: State Certification or Registration #: County: Miami Dade Zip: 3 3 161 NO Flood Zone: N 1 0625 `-- 15S o ►'c t -P5 , L1LL 4 7i v Phone #: G SG, —746(... Sfl 07 Cor_d.P/d c (C State: - (, (16- C. 150 crif 7 Contact Phone #: 5 t t— I o -9 DESIGNER: Architect/Engineer: 1 0' 4 Email Address: of a.,L -oat/ p'°5IA- A. ' Zip: 33 3/( Phone #: Sc/ _ t 10— S off' Certificate of Competency #: 5 IAA: c Mys5L LP Cv�1 Phone #: 7d 3— 10.7-7 3 Z Z -4A r5Mit1 Value of Work for this Permit: $ t I Pa 000 = Square/Linear Footage of Work: 7? IT OO Type of Work: UAddition UAlterationf 1;a,41 or ONew ORepair/R.eplace ❑Demolition Description of Work: A r pi 4.✓ Ta t 1 050. AJ IA1 1461 4 ve. 0 .0‘e 4/30 / (/ of ppfr )cfmare(y 3`e78 p-41, * * * ** * * ** * * * ** * ** * * * * * ** * ** * * * * ** ** Fees************* * * * * * * * * * * * * ***** * * * * * * * * * *** ** Submittal Fee $ Permit Fee $ CCF $ CO /CC $ Scanning Fee $ Radon Fee $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ DBPR $ Bond $ 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 0 + s er or Agent 1' Contractor �j The foregoing instrument was acknowledged before me this .3 The forego g instrument was acknowledged before me this A& day of ,, , 20 IL, by /) 6i �re....,4 --46 day of , 20 /0 , by 6hej rLf Wee/lee-3 whutersonally known to me or who has produced who is personally known to me or who has produced As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commission Expires: as identification and who did take an oath. NOTARY PUBLIC: Print: My Commission E ********************************* ************ * * * * * * * * * * * * * * * * * * ** * * ** * * * * * ** APPROVED BY i '- ill \III�►1 i�r� e .•�� �e " LLE A. BAGLEY �_ Notary public - State of Florida _' My Comm. Expires Jul 6, 2014 0,4 Commission # DD 972411 Bonded Through National : n. Plans Examiner Zoning Structural Review Clerk (Revised 07 /10 /07)(Revised 06 /10 /2009XRevised 3/15/09) MOSS & ASSOC. JASON RAMUNNO 954.769.8109 ,3 0 rP wA a. w. ,,, 4444 .w a3SOl3 WON ui , r NW 5th Ave & NW 1f1th'St Mia`r NW 111TH ST. w -0 NW 1,10tIvSt M _ 9 +,. 0 mapery`6ote 3i27r2011: C9 2011∎Goople 2.5.1W 89 N8142 '04 "70 W eIev Al 1, /ED CONFORM M188, MUTCD STANDARDS AMERICAN TRAFFIC SAhi SERVICES ASSOCIATION A11 Rob Ihlrs b't d • •71ta L *-S INC. E AL p � NCE WIT SUBJEC ' STATE AND COUNTY RULES AND RF(UI_ATInNS „ 2011