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PT-16-1910ivimanu 'Jiiui GJ v iiiagc Building Department IP1k 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 ttTel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 BUILDING PERMIT APPLICATION FBC 20 Permit No. Master Permit No. RC -1-16-105 Permit Type: PAINT OWNER: Name (Fee Simple Titleholder): Each Morning LLC Phone#: (786) 247-5226 Address:11527 SW 64 Street # D City: Miami State: FL Zip: 33173 Tenant/Lessee Name: Phone#: NO) La —52Z (p Email `D 14 ��Q�I�F.Ll��t2L1=�taw Sk1, co ti JOB ADDRESS: 118 NW 103 Street City: Miami Shores Folio/Parcel#: 1131010220030 County: Miami Dade Zip: Is the Building Historically Designated: Yes NO X Flood Zone: CONTRACTOR: Company Name: Pi—s ' KG /w C' CC ',IP / C. t45 $ t�pv ePhone#: '4 P6, 51 t' Lit/2- Address: goo c, U l—k) -A t .J e /P—*? t.t G v G #' / O y City: ,C -.0l a) State: i/�--t l'( (-e... Zip: 3 J( ? Z Qualifier Name: >~, ,' h fr , .) (o c, G (cc s S orf - Phone#: _7/3' ..5—( (( 4- 72 State Certification or Registration #: L-12- (7 i) Z i, b zt9 c(ertificate of Competency #: Contact Phone#: ---7,1), S--- / Y l a' e/L Email Address: Value of Work for this Permit: $ - # `5 v O Square/Linear Footage of Work: 3 // 0 �� Description of Work: Pi r1., -1 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 "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 an inspection fee will be charged. **************.*************************Fees******************************************** Permit Fee $ CCF $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ TOTAL FEE NOW DUE $C2I Gc) All elements on the site must be listed and indicate the color to be painted DIRECTIONS: Please circle corresponding number to appropriate color sample. Walls: 1 Fascia: 1 Drip edge: 1 Soffit: 1 Roof: 1 Flower Bins: 1 Shutters: 1 Awnings: 1 Chimney: 1 Doors & Jambs:1 Garage Doors: 1 /�► 2 3 4 2 3 4 2 3 4 2 3 4 2 3 4 2 3 4 2 3 4 2 3 4 2 3 4 2 3 4 2 3 4 Railings: 1 Fences: 1 All Brick: 1 Stucco Bands: 1 Other Stucco Feature: 1 2 3 4 2 3 4 2 3 4 2 3 4 2 3 4 Accessory Bldg: 1 2 3 4 Attach c 1. 2. 3. 4. Natural Gray PPU1 8-1 Ou fir ne and number 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 cons i•. ctio . ning. Signature: Owner or Agent The foregoing instrument was acknowledged before me this 1 day of J Jti Q— , 20 I Ip , by PM -6U- j -000,1l 6 44.1N , who is personally known to me or who has produced WtcZ 5 IA (si' i Le-- As identification and who did take an oath. NOTARY PUBLIC: •'", f -/x/ AKA, • . My t...jrrrnt+o3.Gn FF 930848 Of OF Expires 1113o/2019 Notary Fut)ttc State of Florida CtenstoutK;t Robert Suarez My Commission Expires: If Signature. Contractor The forego t g instrument was acknowledged before me this )3 day of )\)N---- , 20 1 (p, by4114'4 J 4STM who is personally known to me or who has produced tr►ctl t:- as identification and who did take an oath. NOTARY PUB ntota•y Nutwc State at Florida ' Cnttytc ne, Robert eLen Suarez ¢ My LllnT15,.un ff la3848 E.pre. ,ti.t1ji20t4 Print: My Commission Expires: ) /is —/ i ************************************************************************** **** ********************** APPROVED BY:� tSCode Official Preservation Board LIMITED POWER OF ATTORNEY KNOW ALL MEN BY THESE PRESENTS: That I, Andres Willa, as Managing Member of Each Morning LLC, have made, constituted and appointed, and by these presents do make, constitute and appoint Daniel Korzeniewski, my true and lawful Attorney -in -Fact for me and in my name, place and stead, to execute any and all documents in my behalf with the purpose of obtain permits, sign documents, attend meetings and conduct renovations of the following described property: GOLD CRESTA SUB PB 21-56 LOTS 7 TO 9 INC BLK 1 LOT SIZE 75.000 X 103 OR 13338-2934 0287 5 COC 21809-1379 11 2003 4 a/k/a: 118 NW 103 Street, Miami Shores, FL 33150 Including, but not limited to, contracts, hiring contractors, and such other documents as may be necessary to carry out the purposes expressed herein. Giving and granting unto my said Attorney -in -Fact power and authority to convey and do and perform all and every additional act and thing whatsoever requisite and necessary to be done in and about the premises as fully, and to all intents and purposes as I might or could do if personally present, and I hereby ratify and confirm all that my said Attorney -in -Fact shall lawfully do or cause to be done by virtue hereof. IN WITNESS W'' REOF, Andres Willa Signed, sealed a •eliver- e • -sence of: Wi ess #1 Signature unto executed this Power of Attorney th•is day of 40X111\4015. ire't u1�? WiSneespill& ted Name STATE OF 4,--4"06(J� COUNTY OF 14 AM( ` 0 AOS" in instrument was acknowledged before me this day of 1 f pd , 2015, by Andres Willa, who is The foregoing g personally known to me or who has produced ?A -s ` iRr's-- as identification and who did/did not take an oath. SEAL My cot mi Notary Public 0 t ow/4%k, Notary Public State of Florida e.. • Christopher Robert Suarez , MYCommisson FF 930848 7 w E ires`1 VJd@019 Printed Notary Name ACGRC%® `� CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 07/01/2016 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: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) 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 Okay - Insurance Exchange Of America 7293 W Fla g ler Street Miami FL 33144 CONTNAMEACT Brian Reilly (HG No. Ext): (305) 267-7232 /c No): (786) 388-0492 SS: ieaunderwriting@bestrate-insurance.com ADDDREADRE eaunerwrg@ INSURER(S) AFFORDING COVERAGE I NAIC # INSURERA: ENDURANCE INSURANCE INSURED FRANKLIN GC & GLASS CORP 9110 FOUNTAIN BLU BLVD #104 Miami FL 33172 INSURER B : ACI655660PC INSURER C : 06/04/2017 INSURER D : INSURER E : INSURER F : $ 100 000 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 LTR TYPE OF INSURANCE ADDL''SUBR W INSD VD POLICY NUMBER POLICY EFF (MMIDDYYY) /Y POLICY EXP (MM/DD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY ACI655660PC 06/04/2016 06/04/2017 EACH OCCURRENCE $ 300.000 DAMAGE TO RENTED PREMISES (Ea occurrence) $ 100 000 CLAIMS -MADE I I OCCUR MED EXP (Any one person) $ 5.000 PERSONAL & ADV INJURY $ 300.000 GENERAL AGGREGATE $ 300.000 GE 'L AGGREGATE POLICY OTHER: LIMIT APPLIES PER: PRO JECT 1 I LOC PRODUCTS - COMP/OP AGG $ 300.000 $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS SCHEDULED AUTOS NON -OWNED AUTOS COMBINED SINGLE LIMIT LEa accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ UMBRELLA LIAB_ EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE 1 $ AGGREGATE $ $ DED RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y / N N /A PER I 1 OTH- STATUTE LER $ E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) General Contractors CERTIFICATE HOLDER CANCELLATIO I Miami Shores Village Building Department 10050 NE 2 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. AUTHORIZED REPRESENTATIVE '-----nS 1 ACORD 25 (2014/01) © 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD