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RF-12-2000Miami Shores Village 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 lDt3 ®, Z- BUIL ING PERMIT APPLICATI Permit Type: N JOB ADDRESS: d *A/.a. 931-4 sr. City: rrMiami Shores County: Folio/Parcel##'th " 2.6‘ -CI3• 631 Is the Building Historically Designated: Yes NO ✓ a OCT 2 26 A2 1 FBC 20 Permit No. ! J� I` Master Permit No. )0FINGD- Miami Dade 6dio-ne: OWNER: Name (Fee Simple Titleholder)P 1 c d 1¢ //vC: Vi✓ Phone# 377 /474' Address: 3749 At. E E. 413 M ST. City: /4/4440 SAD,'''S State: ft. Tenant/Lessee Name: ilin Email: Zip:, 213* Phone #: CONTRACTOR: Company Nam A L. Si /•lCr /;40 - e#: 345 77$ 42.5.67 Address: 530. W. 8.217_46, 4**' . D: City ,,ll4J✓4W 5 /dam State: AZ.. Zip: 33L f Qualifier ame: e!! &✓ /g,.,$ E. 1Ai41%d4 phonatieS ?2$ 25-05 State Certification or Registration #: C 9C2'D0 /SIX Certificate of Competency #: Contact Phone #: /Email AddresCh+VG k / � /4.i "ill. C@� DESIGNER: Architect/Engineer:'y 'yam., 64,...J Phon S if/ 4174 4,0/P gri Value of Work for this Permit: $ 3 s60• "" Squarariaeat of Work: DNew r/Re lace Type of Work: DAddition UAlteration Foil? epair/Replace of Work: FLAT i►a0 fr T rpLara.P.. Color thru tile: r7UX DDemolition a.; v x l - fl- ***************** * * * * * ** * * **** Feed************ ** ** ** * * * * * * * * **** ** ****** *** ** /',o Permit Fee $ S 'ng Fee $ Radon Fee $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ CCF $ CO /CC $ DBPR $ Bond $ Technology Fee $ TOTAL FEE NOW DUE $ * Bonding Company's Name (if applicable) Aa /�- Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) „ /l/�' 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 wi not be approved and a pecti o n fee , ill be char ed. Signat 441640164.-.... 7 /1 Owner or Agent The foregoing instrument was acknowledged before met this al day of(I0be; 20 , bythorril L' P fl 1r- ; Contractor The foregoing instrument was acknowledged before me this() day o a r- , 2012 , by a ed y t (Avi1hcQ who is personally known to me or who has produced_" !al_ who is personally known to me or who has produced eta as identification and who did take an oath. As identification and who did take an oath. Sign. Print: My Commission Expires: 05105 /1( APPROVED BY / d30)Ga-- Plans Examiner Zoning Structural Review Clerk (Revised 3 /12/2012)(Revised 07 /10 /07)(Revised 06 /10/2009XRevised 3/15/09) CFN: 20120728380 BOOK 28311 PAGE 9 DATE:10 /12/2012 01:06:32 PM HARVEY RUVIN, CLERK OF COURT, MIA -DADE CTY NOTICE OF COMMENCEMENT A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION PERMIT NO. TAX FOLIO NO. 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, Florida Statutes, the following information is provided in this Notice of Commencement. This Notice of Commencement should be recorded at: The Clerk of Courts Miami -Dade County Recorder Courthouse East, 22 NW First Street, 1st Floor, Miami, FL 33128 1. Legal description of property and street/address: In IGA1 51401-e5 Sx.3� Rip PeIO -oo LOT <�y for �K la- �+ _ t 1c x (z-4- of 456 6 'tz- L r • 2�1't ¢ -i ,t 0 2. Description of improvement: RiCXDF k' 3. Owner(s) name and address: k. 411 '1lil. `i ' . a Leto/ Interest in property: CI_I` ?'V'' - Name and address of fee simple titleholder: /U /Pr 4. Contractor's name and address: i►.. _ c<?4 _aid' 5. Sure : (Payment bond required b owner from contractor, if any) Name and address: Ajlieic- Amount of bond $ /V /A 6. Lender's name and address: nI /4 ►eo 7. Persons with the state of Florida designated by Owner upon whom notices or other documents may be served as provided by Section 713.13(1)(a)7., Florida Statutes. Name and address: 411A 8. In addition to himself, Owners designates the following person(s) to receive a copy of the Lienor's Notice as provided in Section 713.13(1)(b), Florida Statutes. Name and address: N Mr- 9. Ex -tion date of this Notice of Commencement: (the expiration date is 1 year from the date of recording unless a doff = re$t dat- specified) Signature of Owne j �,, Print Owner's Name &tk(r L4 da Pr-4 �. 4 . - Prepared by day ofO , 20 i L. Sworn to and subscribed before e this Notary Public C} Print Notary's a Ire My commission expires: 6 y PAOLA GOMEZ I � )Notary Public - State of Florida %u 4 V4- op Commission • EE 195975 ROOF ASSEMBLIES AND ROOFTOP STRUCTURES Florida Building Code Edition 2010 High- Velocity Hurricane Zone Uniform Permit Application Form. Section A (General information) 1 1�d Master Permit No. Process No. / c71 Contractor's Nam Job Address ,Pfjr J . 11 I nfk I ` reo I36 ROOF CATEGORY VIKLow Slope ❑ Mechanically Fastened Tile ❑ Mortar /Adhesive Set Tile ❑ Asphaltic Shingles ❑ Metal PaneUShingles ❑ Wood Shingles/Shakes ❑ Prescriptive BUR -RAS 150 ROOF TYPE ❑ New Roof ❑ Reroofing ❑ Recovering - epalr 0 Maintenance ROOF SYSTEM INFORMATION Low Slope Roof Area (SF) Total (SF) 45c) -R 1 40&e...1-c{ r sp, Section B (Roof Plat) Sketch Roof Plan: illustrate all levels and sections, roof drains, scuppers, overflow scuppers and overflow drains. Include dimensions of sections and levels, clearly identify dimensions of elevated pressure zones and location of parapets. 18.34 r6 1 2010 FLORIDA BUILDING CODE -- BUILDING AC# 6233943 fHDE )/mtitmr HAS A COLORED BACKOR UND • MICROPRINTING • LINEMARK'" PATENTED PAPER STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD SECVL12073001528 DATE BATCH NUMBER 07/30/2012 120031655 LICENSE NBR CGC001575 The GENERAL CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2014 WALLACE, CHARLES E AMERICAN CONSTRUCTION & REPAIRS LLC 9300 W BAY HARBOR DR BAY HARBOR ISLANDS FL 33154 RICK SCOTT GOVERNOR MIAMI-DADE COUNTY TAX COLLECTOR 140 W. FLAGLER ST. lst FLOOR MIAMI. FL 33130 650913-8 BUSINESS NAME / LOCATION AMERICAN CONSTRUCTION 8 REPAIRS LLC 9300 W BAY HARBOR DR 33154 BAY HARBOR ISLANDS OWNER AMERICAN CONSTRUCTION & REPAIRS Sec. Type of Business Dim WASUCIALTY BUILDING CONTRACTOR 5 BUSINESS TAX RECEIPT. IT DOES NOT PERMIT THE HOLDER TO VIOLATE ANY EXISTING REGULATORY OR ZONING LAWS OF THE COUNTY OR CITIES. NOR COES IT EXEMPT THE HOLDER FROM ANY OTHER PERMIT OR UCENSE REQUIRED BY LAW. THIS IS NOT A CERTIFICATION OF THE HOLDER'S OUALIFICA- nons. DISPLAY AS REQUIRED BY LAW 2012 LOCAL BUSINESS TAX RECEIPT 2013 MIAMI-DADE COUNTY - STATE OF FLORIDA EXPIRES SEPT. 30, 2013 MUST BE DISPLAYED AT PLACE OF BUSINESS PURSUANT TO COUNTY CODE CHAPTER 8A• ART. 9 & 10 KEN LAWSON SECRETARY FIRST-CLASS u.S. POSTAGE PAID MIAMI, FL PERMIT NO. 231 RENEWAL RECEIPT NO. 585297-6 STATE* CGC001575 WORKER/S PAYMENT RECEIVED MIAMI-DADE COUNTY TAX COLLECTOR: 08/24/2012 60020000213 000045.00 SEE OTHER SIDE DO NOT FORWARD AMERICAN CONSTRUCTION 8 REPAIRS LLC CHARLES E WALLACE 9300 W BAY HARBOR DR BAY HARBOR ISLAND FL 33154 W420-145-39-3 CHARLES EDGAR WALLACE 9300 WEST BAY HARBOR DRIVE Y HARBOR ISLAND. FL 33154 P.1 ,K-47 0-01 From:PES 239 543 3053 10112/2012 10:30 #345 P.001/001 A D�' CERTIFICATE OF LIABILITY INSURANCE °A' ;'";z 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 lieu of such endorsement(s). PRODUCER Alliance Insurance Solutions, LLC ID: (PEMCO) C/O Progressive Employer Management Company, Inc. 6407 Parkland Dr Sarasota, FL 34243 CONTACT NAME: Joe Ott PHaNEJA1C NaEld) sa1.92� zgso FAX tArC. Nor. $66477 -3044 EMAIL ADDRESS: J. otttDrogresSlveemDlOyer.COm INSURER(S) AFFORDING COVERAGE NAtC 0 INSURER A: SUNZ Insurance CDmDenv 34762 INSURED gressive Employer Management Company, Inc. Progressive Employer Management Company II, Inc. 29 I1 Pinellas Avenue Tarpon Springs FL 34689 aysuREa s : Aspen Re - London - Be t Rating "A" INSURER C: : i i .,• • : (- - •• • - : _ - .. nl,. • • • EACH OCCURRENCE INSURER D: Brit Stnndicate - Lloyds - Best Rating A° PREMISES (EaErrence) INSURER E: INSURER F : MED EXP (Any one person) 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 POLICES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID IN,SmR TYPE OP INSURANCE �q SUER POLICY NUMBER IN DmYY) ��.tICLAIMS. (MM(DDIYYYY) LIMITS GENE' LIABILITY COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ PREMISES (EaErrence) $ CLAIMS •MADE I OCCUR MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GEM. AGGREGATE LIMIT APPLIES PER: 7 POLICY I- ,T I LOC PRODUCTS • COMP/OP AGO $ $ AUTOMOBILE — LIABILITY ANY AUTO DOWNED HIRED AUTOS SCHEDULED AUTOS NED COMBINED SINGLE LIMIT S BODILY INJURY (Per person) g BODILY INJURY (Per accident) g P er PE E s S $ UMBRELLA LAB EXCESS UM OCCUR CLAIMS-MADE EACH OCCURRENCE $ AGGREGATE $ DED 1 RETENTION $ 5 $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANYFROPRIETORIPARTNERIEXECUTIVE OFFICER/MEMBER EXCLUDED? I (Mandatory In NH) DESIf Under describe CRIPTION OF OPERATIONS *stow N I A WCPE0000005403 WCPEOOOO IX)5402 11/1/2012 11/1/2011 11/1/2013 11/1/2012 WCSTAU• o ✓ CRY LIMITS EL EAG4ACCrDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1.000.000 E.L. DISEASE - POLICY UMIT $ 1,000,000 B C D Workers Compensation Excess Coverage This is for informational purposes and nothing shall create any right under such reinsurance. DESCRIPTION OF OPERATIONS I LOCATIONS !VEHICLES (Attach ACORD 101, Additional Remarks Schedule, R more space to required) Coverage Provided for all leased employees but not subcontractors of: American Construction & Repairs, LLC Client Effective: 11 /1/2010 CERTIFICATE HOLDER CANCELLATION 6111 Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, Fl 33138 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. j AUTHORIZE* REPRESENTATIVE r! // J�� Glen J Distefano ACORD 25 (2010/05) ®1988.2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD CERT NO.: 14386413 CLIENT CODE: PENCO Nick Ciccarello 10/12/2012 7:29:50 AM Page 1 of I CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 10/16/2012 PRODUCER WorkLife Insurance Agency, Inc. 6407 Parkland Dr. Sarasota FL 34243 941-308 -1749 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC # INSURED American Constrution & Repair LLC 9300 W Bay Harbor Drive Bay Harbor Islands FL 33154 INSURER A: Accident Insurance Company INSURER B: INSURER C: INSURER D: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUEDTOTHE 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTRR ADM_ TYPF OF INSIIRANCF POLICY NUMBER fl POLICY frwns EFFECTIVE RATE (MnIT EXPIRATION T) LIMITS A GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY AGP00053 10/01/2012 10/01/2013 EACH OCCURRENCE 1,000,000 X PRFMISFC(FeEn cumnce) $ 100,000 CLAIMS MADE X OCCUR MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,E GENERAL AGGREGATE ___I 2,000,000 GEN'L AGGREGATE OMIT APPLIES PER: POLICY f PRO- T [i LOC PRODUCTS - COMP /OP AGG $ 2,000,000 AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS COMBINED SINGLE UMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY ANY AUTO AUTO ONLY - EA ACCIDENT $ EA ACC $ OTHER THAN AUTO ONLY: AGG $ EXCESS / UMBRELLA LIABIUTY EACH OCCURRENCE _ 7 OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE RETENTION $ $ $ WORKERS AND EMPLOYERS' ANY PROPRIETOR/PARTNER/EXECUTI OFFICER/MEMBER (Mandatory If yes, describe SPECIAL COMPENSATION LIABILITY Y / N WC STATU- OTH- TORV I IMIT5 PR EL EACH ACCIDENT $ EXCLUDED? I l E.L. DISEASE - EA EMPLOYEE $ In NH) under PROVISIONS below E.L. DISEASE - POLICY UMIT $ OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION I Miami Shores Village Building Department 1 0050 NE 2nd Ave. Miami Shores, FL 33138 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN , NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE /�, Z-0.. ACORD 25 (2009/01) ©1988 -2009 ACORD CORPORATIO FC All rights reserved. The ACORD name and logo are registered marks of ACORD