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WS-13-105Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 184403 Permit Number: WS -1 -13 -105 Scheduled Inspection Date: February 01, 2013 Permit Type: Windows /Shutters Inspection Type: Final Owner: HELLER, DAVID & JUDE Work Classification: Door Replacement Job Address: 1300 NE 94 Street Inspector: Bruhn, Norman Miami Shores, FL 33138- Project: <NONE> Contractor: HOULIHAN CONSTRUCTION LLC Phone Number 3305 - 757 -8142 Parcel Number 1132050100120 Phone: (954)981 -4852 Building Department Comments REINSTALL EXISTING SECOND FLOOR FRNECH DOOR AND SIDE LITES Infractio Passed Comments INSPECTOR COMMENTS False Inspector Comments Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. February 01, 2013 For Inspections please call: (305)762 -4949 Page 7 of 8 LBU1LD11 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 NUMBER: (305) 762.4949 BUILDING PERMIT APPLICATION Permit Type: JOB ADDRESS: 1300 NE 94th Street City: Miami Shores Folio/Parcel#: 11- 3205 -010 -0120 Is the Building Historically Designated: Yes JAN 17Z013 rrFBC 20 10 W Permit No. .AJ S I 3H Master Permit No. ROOFING County: Miami Dade zip: 33138 NO Flood Zone: OWNER: Name (Fee Simple Titleholder): David Heller phone#. 202- 321 -1855 Address: 1300 NE 94th Street City: Miami Shores State: Florida Zip_ 33138 Tenant/Lessee Name: Nf i Phone#: Finail• CONTRACTOR: Company Name,: Address: 1715 N. 44th Ave. City: Hollywood Qualifier Name: Paul J. Houlihan Houlihan Construction, LLC Phone#: 954 -981 -4852 State: Florida Zip: 33021 Phonet 954-699-6132 State Certification or Registration #: CGC 037722 Certificate of Competency #: Contact phone#: 954 - 699 -6132 Email Address: pauljhouiihan @gmail.com DESIGNER: Architect/Engineer: N/A Phone#: Value of Work for this Permit: $ 500.00 Square/Lhtear Footage of Work: Type of Work: OAddition OAlteratiion QNew C tepair/Replace ODemolition Description of Work: Reinstall existing second floor French doors and sidelites in conjunction with re- roofing permit # RF12 -12 -2311 ON PAS,' .S BF Color thru tile: * * * ** * * * * * * *** * * * * * * *** * * * * * * * *** * * * ** ************ * * ** * ** * * * **t * * * * * * * ** * ** * *** * ** Submittal Fee Scanning Fee $ Notary $ $ , Permit Fee $ l O® A-1 Radon Fee $ Training/Education Fee $ Double Fee $ Structural Review $ CCF $ CO/CC $ DBPR $ Bond $ Technology Fee $ TOTAL FEE NOW DUE $ Bonding Company's Name (if applicable) N/A Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) N/A 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 fir inspection which occurs s en (7) days after the building permit is issued. In the absence of such posted notice, the inspection wi , t be approved and a ret ection fee will be charged Owner . F, The foregoing instrument was acknowledged before me this j� dayo< die ,201 ,byJ)Atu fj6 ✓f EAZ who is personally known to me or who has produced ill,. b As identification and who did take an oath. NOTARY PUBLIC: Sign: po, Print: i 11,44 -11 My Commission Expires: JILL S. TULLY OMMISSION #EE43885 1 11OV21,2014 thro41114 durance * * *** * * * * * * * * * * * * * * * * * ** c + titnuE**** * * * * * * * * ** * * * * * * * * * * * * * * * * * * * ** Signature Contractor The fore: oung instrument was acknowledged before me this �fa� day o 1 L 203 , by AN .fop!!/ ./RAN who s personally known to me or who has produced N/A as identification and who did take an oath. NOTARY PUBLIC: Sign: Print My Commission Expires APPROVED BY JILL S. TULLY MY COMMISSION #EE43885 EXPIRES: NOV 21, 2014 Bonded through 1st State Insurance * ** * * * * * * * * * * * * * * ** Plans Examiner Zoning Structural Review Clerk (Revised 3/12/2012XRevised 07 /10/07)(Revised 06J10t2009XRevised 3/15109) Miami Shores Viiiage 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 $30.00 FEE PER YEAR. IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: A. X COPY OF QUALIFIER'S STATE LIC CARD B. X COPY OF LOCAL BUSINESS TAX RECEIPT C. X COPY OF LIABILITY INSURANCE (CERTIFICATE HOLDER TO BE MIAMI SHORES VIU.AGE BLDG DEPT) D. X COPY OF WORKERS COMPENSATION (EITHER CERTIFICATE OR EXCEMPTION) IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY: A. COPY OF CERTIFICE OF COMPETENCY OF QUALIFIER B. COPY OF MIAMI DADE COUNTY MUNICIPAL CONTRACTORS TAX RECEIPT C. COPY OF LIABILITY INSURACE (CERTIFICATE HOLDER MUST BE MIAMI SHORES VILLAGE BLDG DEPT) D. COPY OF WORKER COMP INSURANCE (EITHER CER1IFICATE OR EXEMPTION) YOUR INSURANCE COMPANY MUST ISSSI IE A CERTIFICATE HOLDER AS FOLLOW: MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES, FL 33138 ■ r••• ftt IOMM/t wte■ t• wt t• tllttt• IMatit ttt. Stt■........ rt/ I .R..ss•.WON•ruIII ••I /••••sr•I•UU •U1 COMPLETE CONTRACTOR'S INFORMATION BUSINESS NAME: Houlihan Construction, LLC BUSINESS ADDRESS: 1715 N. 44th Ave. STATE Florida. CITY Hollywood ZIP CODE 33021 BUSINESS PHONE: ( 954 ) 981 -4852 FAX NUMBER ( 754 ) 2014040 CELL PHONE ( 954) 699 -6132 QUALIFIER'S NAME: Paul J. Houlihan QUALIFIER'S LIC NUMBER: CGC 037722 E -MAIL ADDRESS (IF APPLICABLE): Pauljhouiihan @gmail.com Created on 3119/09 BY MLDV / RV 3126109 MLDV #6179654 STATE OF FLORIDA �9TRQCTION IND6YRLICLNS N$C��+R+' TIO SEQ# L13070100333 DEPAR DATE: BATCH NUMBER 7 01 2012 128000149 he GENERAL CONTRACTOR awed below IS CERTIFIED _ 489 F8. adiraxp tion dates C e AUO 31, Q1g CGC037722 HOULIHAN, PAUL J 1715 T _ r MC N 4CONSTRUCTION, H � HOLLYWOOD PL 3 3 021 RICK DISPLAY AS REQUIRED BY LAW KEN R AR N Y 0°""',, CITY OF HOLLYWOOD TREASURY SERVICES DIVISION gi LOCAL BUSINESS TAX RECEIPTING N. . 2600 HOLLYWOOD BLVD, ROOM 103 HOLLYWOOD, FL 33020 HOULIHAN CONSTRUCTION ,LLC 1715 N 44 AVE HOLLYWOOD FL 33021 _°'"" CITY OF HOLLYWOOD LOCAL BUSINESS TAX RECEIPT a . , .0 THIS IS YOUR LOCAL BUSINESS TAX RECEIPT. PLEASE DETACH AND POST IN A CONSPICUOUS PLACE AT THE BUSINESS LOCATION. PLEASE DO NOT REMIT ANY PAYMENT. THIS IS NOT A BILL, 2567 40249 PRINT DATE: 9/20/12 Business Name:. Business Location: Business Class: Tax Basis: Receipt Number: Receipt Year. Expiration Date: HOULIHAN CONSTRUCTION,LLC 1715 N 44 AVE CONTRACTOR /GENERAL 1 WORKER (OWNER) 13 00049060 10/01/12 09/30/13 NEW CHARGES: (Itemized Below) Base Fee Additional Charges: 190.00 190.00 ITOTAL NEW CHARGES: 190.00 Penalty Amount: .00 Previous Balance Due: .00 TOTAL AMOUNT PAID: 190.00 PURSUANT TO STATE LAW, THE LOCAL BUI[dE�SNSDi IS NON REGULATORY PRIVILEGE N NATURE. DOING BUSINESS WITHIN A CITY'S LIMITS, ISSUANCE OF A LOCAL BUSINESS TAX RECEIT BY THE CITY OF HOLLYWOOD DOES NOT MEAN THAT THE CITY HAS DETERMINED THAT THE EXISTING OR PROPOSED USE OF A LOCATION 1S LAWFUL. ISSUANCE OF A LOCAL BUSINESS TAX RECEIPT DOES NOT LEGALIZE OR CONDONE THE NATURE F THE BUSINESS BEING S,CONDUCTED IF CONTRARY TO ANY LOCAL, STATE O Comments: BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT 115 S. Andrews Ave., Rm. A-100, Ft. Lauderdale, FL 33301 -1895 — 954 - 831 -4000 VALID OCTOBER 1, 2012 THROUGH SEPTEMBER 30, 2013 OBA: Recelpt # :G RAI CONTRACTOR Business Na me: HOULIHAN CONSTRUCTION LLC Business Type: E Owner Name: PAUL a HOULIHAN Business Location: 1715 N 44 AVENUE HOLLYWOOD Business Phone: 554 -981 -4852 Rooms Seats Employees 2 Business Opened :02 /01/2011 State/Cou nty/Cert/Reg :CC3C 0 3 7 7 2 2 Exemption Code: Machines Professionals For Vending Business Only • THIS RECEIPT MUST BE THIS BECOMES A TAX RECEIPT WHEN VALIDATED Mailing Address: HOULIHAN CONSTRUCTION LLC 1715 N 44 AVENUE HOLLYWOOD, FL 33021 POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS This tax Is levied for the privilege of doing business within Broward County and is non - regulatory in nature. You must meet all County andlor 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. Receipt #034 -11- 00001545 Paid 07/18/203.2 27.00 PiumOer OT d1aCrItne5: " Tax Amount Transfer Fee NSF Fee Penalty Prior Years Collection Cost Total Pail - 27.00 0.00 0.00 0.00 0.00 0.00 27.00 THIS RECEIPT MUST BE THIS BECOMES A TAX RECEIPT WHEN VALIDATED Mailing Address: HOULIHAN CONSTRUCTION LLC 1715 N 44 AVENUE HOLLYWOOD, FL 33021 POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS This tax Is levied for the privilege of doing business within Broward County and is non - regulatory in nature. You must meet all County andlor 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. Receipt #034 -11- 00001545 Paid 07/18/203.2 27.00 OP ID: MB diefi °. trio CERTIFICATE OF LIABILITY INSURANCE ,_ OATH' "'I" 01/1 W13 THIS CERTIFICATE 15 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 INSURERS), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: M the certificate holder is an ADDITIONAL INSURED, the policy(es) 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 right( to the certificate holder in I191u of such endorsement(s). PRODS 954- 340 -9551 COAL ANTS, INC. A CE 954-3404456 5461 UNIVERSITY DRIVE 0103 CORAL SPRINGS, FL 331�T : BARRY S. GOLDSTEIN ISSUED TO THE INSURED NAMED ABOVE FOR THE CONTRACT OR OTHER DOCUMENT WITH RESPECT THE POLICIES DESCRIBED HEREIN I3 SUBJECT TO REDUCED BY PAID CLAIMS. fax Mrs. raw, Mt Ate comma w to HOULI'9 INKS) AFFORDING COVERAGE AMA NAIC II ammo HOUUHAN CONSTRUCTION LLC 1716 NORTH 44TH AVE HOLLYWOOD, FL 33021 . INSURER A :WINGS INSURANCE COMPANY 16632 a :ASSOCIATION INSURANCE CO. 11240 INSURER C: 12/20/12 INSURER D: EACH OCCURRENCE $ 1.000,000 INSURER E : $ 100,000 INSURER F : — CLAIMS -MADF COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS Is TO CERTIFY THAT THE INDICATED NOTVVITHSTANDNG CERTIFICATE MAY DE ISSUED EXCLUSIONS AND CONDITIONS POLICIES ANY REQUIREMENT. OR MAY OF SUCH OF INSURANCE PERTAIN, POLICIE& BUNT USTED BELOW HAVE BEEN TERM OR CONDITION OF ANY THE INSURANCE AFFORDED BY LIMITS SHOWN MAY HAVE BEEN POLICY NUMBER ISSUED TO THE INSURED NAMED ABOVE FOR THE CONTRACT OR OTHER DOCUMENT WITH RESPECT THE POLICIES DESCRIBED HEREIN I3 SUBJECT TO REDUCED BY PAID CLAIMS. POLICY PERIOD TO WHICH THIS ALL THE TERMS, Mt TYPE OP IN$URAIN:B AIWA AMA A GENERAL LIABILITY ' X COMMERCIAL GENERA'. !Amory OCCUR _ GLP0098381-02 12/20/12 12/20/13 EACH OCCURRENCE $ 1.000,000 RD P a r Fes} $ 100,000 — CLAIMS -MADF MED EXP (My ore person) PERSONA, A ADV INJURY $ 5,000 S 1,000,000 X BLNICT ADDL INBRD GENERALAGGREiATE S 2,000,000 GENT AGGREGATE LIMIT APPLIES PER. POLICY I X IC¢i i ■ LOC PRODUCTS - COMP/OP AGG $ 2,000,000 $ AUTOMOBILE LIAMLiTY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS COMBINED SINGLE LAST (Easadd®U) $ BODILY INJURY (Par person) $ $ BODILY INJURY (Per ardent) P DAMAGE !6 $ UMBRG4LA LIAR OCCUR CI.AJMS-MADE EACH OCCURRENCE AGGREGATE $ $ EXCESS LIAR . DEDUCTIBLE RETENTION $ S $ B WORKERS COMPENSATION AND EMPLOYERS* UABNJTY ANY PrtOPRETORI ARTNERIEXECUTNH OfP�EXCLUDED? (Mandalwy la NIN ff DES deaa>�under CRIPTION OF OPERATIONS Y U N NUA W rCV0097106�1 G%/�I12 02/08113 X WG 7LAI S X TQ� EL EACH ACCIDENT $ 1,000,000 $ 1,000,000 below EL DISEASE -EA EMPLOYEE EL DISEASE - POLICY LIMIT $ 1,0IN),000 DESCRIPTION OP oPeRATowst LOCATR3NS t VMQCLES (Mash ACIMD 101. AdEttioNA RsanarAs Sdualtile, Yawn spat* la raguUcd) CERTIFICATE HOLDER CANCELLATION MIAMIS1 MIAMI SHORES VILLAGE BLDG DEPT 10060 NE 2ND AVE 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. AUTNDR= REPRESENTATIVE 79 ACORD 25 (2008109) 01988-2009 ACORD CORPORATION, All rights reserved. The ACORD name and logo are registered marks of ACORD