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DS-12-1813PERMIT # ),- ----16 13 CONTRACTOR: biad<hy )1Au SUBMITTAL DATE: t (05 Pa 4(.._ )9( ADDRESS: 6711 (03 'COI, k--) or NAME: RESUBMITAL DATES: PROJECT TYPE: ZONIN I /r ill FIRE STRUCTURAL IMPACT FEES ELECTRICAL HRSIDERM PLUMBING NOC MECHANICAL BLDG • 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 I 1110142- LDING PERMIT APPLICATION Permit Type: BUILDING JOB ADDRESS: 91( PaR.K• OR; vt.e.., City: Miami Shores Folio/Parcel #: d/"32 Oi1i-/.,56 County: MCMEWEEr-ii al OCT O j. 2612 FBC 20 Q Permit No. i . —! 3 . Master Permit No.Cf l �(� ROOFING .oK..es i z. Miami Dade Zip: 03138 Is the Building Historically Designated: Yes NO Flood Zone: OWNER: Name (Fee Simple Titleholder): D6i/ e./ f A-7 C.e..Ld Phone #: Address: &&44 'W lNrCS 0 L "ova" at. City: flh /A,li F2.--- State: /5-- ° Tenant/Lessee Name: Email: Zip: 3? / 41 Phone#: CONTRACTOR: Company Name: Address: j2.s"-1 It)_ Ailr,.. C Alt, City: P o. t- % v State: F t A Qualifier Name: 1 `t a S S k A -J t& , cation or Registration #: k C (1-- -/-`i (e 6 (p Certificate of Co e#: Email Address: S : Architect/Engineer: l U �-(0 A 6-c ct-- 0--TtA C Phone#: " 54 y 3 `% -7 Vitt$ of V'rk for this Permit: $ W trk: ❑Addition 1i io>Fof Work: i e- ct, ro 19, �b 5a e 12 Square/Lin ONew Zip: �J� U Phone#: ' � `{ v mpetency #: C ( () tv4- t do . 4 ****** * ** ** *** * * * ** ** * * * * * * * * * ** ** *** Submittal Fee $ Permit Fee $ Scanning Fee $ Radon Fee $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ • * * * * * ** * * * * * * * * * * * ** CCF $ CO /CC $ DBPR $ Bond $ Technology Fee $ TOTAL FEE NOW DUE $ p • 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 FT.ECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC OWNER'S AF'FIJAVIT: 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. 1 absence of such posted notic inspection will not be approved and a reinspection fee will be charged. Signature Owner or Agent The foregoing instrument was acknowledged before me this day otit/ : , 20 larby 1' gkeh tee ic.,L. who is personally known to me or who has produced bjL As identification and wh NOTARY PUBLIC: Print: My Commission Expires: ******* * * * * * * * * * * * * * ** * * * * * * * * * * * * * * ** Signatur Contract The for going instrument was acknowledged before me this J7 day ofjegkinirec. 2042_, by EZ i 5 S,itaavly who is6ersonally known to meer who has produced as identification and who did take an oa NOTARY PUBLIC: Sign: Print: 11 C %e A-t l�•,QnQ't My Commission Expires: *a * ** * * * * * ** *** **** *****F ,( *********t** *****A * 9°' Structural Review (Revised 3 /12/2012)(Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) Clerk • CT B Construdiori Trades Quai ing Board BUSINESS CERTIFICATE OF COMPETENCY E606 NC. SHAOU, s certi �ed under Ett •a provisions of Chapter 1 0,of ' i'I' �V ylpp i i VI ➢I" i I I '� i Ii 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 DBA: Business Name: Owner Name: Business Location: Business Phone: Rooms Tax Amount 54.00 FLORIDA BLACKTOP INC ELIAS SHAOUY 1287 W ATLANTIC BLVD POMPANO BEACH 954 - 979 -5757 Seats Number of Machines: 0.00 0.00 Employees 20 Receipt # :�9 OTHER TYPES CONTRACTO Business Type;MAJOR ROADS ASPH & CONCRE Business Opened:03 /01 /1984 State /County /Cert/Reg :84 - 859 Exemption Code: For Vending Business Only 0.00 Machines Vending Type: Prior Years 0.00 Professionals Collection Cost 0.00 Total Paid THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS THIS BECOMES A TAX RECEIPT s WHEN VALIDATED Malting Address: FLORIDA BLACKTOP INC 1287 W ATLANTIC BLVD POMPANO BEACH, FL 33069 54.00 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. 201.2 - 2013 r. ..,........., ......M.. _ 44 • Receipt #138 -11- 00008573 Paid 08/07/2012 54.00 (3A A`°R °® CERTIFICATE OF LIABILITY INSURANCE 9�2��2012 ) 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 Brown & Brown of Brevard 7341 Office Park Place Suite 2 02A Melbourne FL 32940 CONTACT Maureen Harvey PHONE g, (321) 757 -8686 FAX Not: (321)757 -8687 E.MAILss:mharvey @bbbrevard. com INSURER(S) AFFORDING COVERAGE NAIC # INsuRERA:Valley Forge Insurance Co. 20508 INSURED Florida Blacktop, Inc. & Leroge Group, Inc. & Harvest Moon Center, LLC 1287 W. Atlantic Blvd. Pompano Beach FL 33069 INSURER B :Montgomery Insurance Company 14 613 INSURER C:Torus Specialty Insurance Co. 44776 INSURERD: $ 1,000,000 INSURERE: 30O 000 $ r INSURER F: $ 5,000 CERTIFICATE NUMBER- CL125210364 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 INSR SUER WVD POLICY NUMBER POLICY EFF (MMIDDIYYYY) POLICY EXP (MM/DDIYYYY) LIMITS A GENERAL X LABILITY COMMERCIAL GENERAL LIABILITY 5084401107 5/1/2012 5/1/2013 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES (Ea occurrence) 30O 000 $ r MED EXP (Any one person) $ 5,000 CLAIMS- MADE ][ OCCUR PERSONAL &ADVINJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP /OP AGG $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES 31 POLICY JC JET PER: LOC $ B AUTOMOBILE X X LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS PIP 10,000X X SCHEDULED AUTOS NON OWNED AUTOS UN 300,000 01CI604025 -01 5/1/2012 5/1/2013 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ Medical payments $ 5,000 UMBRELLA UAB EXCESS LAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ $ DED RETENTION $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE (Mandatory n H) EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y / N N / A 5084401138 5/1/2012 5/1/2013 x WC STATU- TORY LIMITS OTH- ER E.L. EACH ACCIDENT $ 500,000 E.L. DISEASE - EA EMPLOYEE $ 500,000 E.L. DISEASE- POLICY LIMIT $ 500,000 A Inland Marine Leased & Rented Equipment 5084401107 5/1/2012 5/1/2013 $500,000 Limit DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) CANCELLATION ACORD 25 (2010/05) INS025 ninnn\ n1 ©1988 -2010 ACORD CORPORATION. All rights reserved. The Annan name anr1 Innn .re renic4ererl market of sortno l SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Miami Shores Village Building Department 10050 Northeast 2nd Avenue AUTHORIZED REPRESENTATIVE Miami Shores, FL 33138 Robert Willis /MAUREE "1_ -- -.�-» ' - ACORD 25 (2010/05) INS025 ninnn\ n1 ©1988 -2010 ACORD CORPORATION. All rights reserved. The Annan name anr1 Innn .re renic4ererl market of sortno l PERMIT # X12 -1813 1, /rbee, grey &.cif Contractor Owner Architect ed up 2 sets of plans and (othe Address: Miami Shores Viiiage Building Department RECEIPT DATE: 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 IOIIC�Iy ,10 mqkv C€ckQviS airs \WL, From the building department on this date in order to have corrections done to plans And /or get County stamps. I understand that the plans need to be brought back to Miami Shores Village Building Department to continue permitting process. Acknowledged by: ate-, -,- PERMIT CLERK INITIAL: g�� RESUBMITTED DATE: PERMIT CLERK INITIAL: Miami Shores Viuiage Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Permit No: DS12 -1813 Page 1 of 1 P &Z Critique Sheet 1. WORK IN RIGHT OF WAY NOT APPROVED BY ZONING AS PART OF THIS APPROVAL. 2. WORK IN RIGHT OF WAY REQUIRES PUBLIC WORKS APPROVAL. 3. Based on review by planning and public works, parking should be at a 45 degree angle with the appropriate dimensions adjusted. 4. Please check site plan the dimension to center line of road appears to be incorrect. David Dacquisto P&Z Director Building Critique Sheet 1. The plans submitted have notes that do not pertain to this scope of work. 2. Identify the slope of accessible parking and route to building. 3. An accessible route to the public way is required. 4. Village spaces must be angled as existing. Provide an existing plan of Village property. Norman Bruhn Bldg Director Stopped Review Plan review is not complete, when all items above are corrected, we will do a complete plan review. If any sheets are voided, remove them from the plans and replace with new revised sheets and include one set of voided sheets in the re- submittal drawings. Miami Shares Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Permit No: DS12 -1813 Page 1 of 1 P &Z Critique Sheet Li,---WORK IN RIGHT OF WAY NOT APPROVED BY ZONING AS PART OF THIS APPROVAL. 61 Yt, `-2 WORK IN RIGHT OF WAY REQUIRES PUBLIC WORKS APPROVAL. ased on review by planning and public works, parking should be at a 45 degree angle with- the appropriate- di- mensions adjusted. lease check site plan the dimension to center line of road appears to be incorrect. (43 C David Dacquisto P &Z Director Building Critique Sheet 1. The plans submitted have notes that do not pertain to this scope of work. identify the slope of accessible parking and route to building. S cw-L, o r rc, ccessible route to the public way is required.. — th o x -'t i sc,-►) c. et 4 illage spares must be angled as existing. Provide an existing plan of Village property. �c s11 a , i (1-45 3-ti.— VO Lf 'Vk ' nr f 4 Norman Bruhn Bldg Director Stopped Review Plan review is not complete; when all items above are corrected, we will do a complete plan review. If any sheets are voided, remove them from the plans and replace with new revised sheets and include one set of voided sheets in the re- submittal drawings. Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Permit No: DS12 -1813 Page 1 of 1 P &Z Critique Sheet WORK IN RIGHT OF WAY NOT APPROVED BY ZONING AS PART OF THIS APPROVAL. } (S1 ' vAvi V6 ci �-Z WORK IN RIGHT OF WAY REQUIRES PUBLIC WORKS APPROVAL. Based on review by planning and public works, parking should be at a 45 degree an a• •ro•r s ad'usted. lease check site plan the dimension t o center ine • ' ; d-app s to be incorrect. 3 (" Cov David Dacquisto P&Z Director Building Critique Sheet p 1. The plans submitted have notes that do not pertain to this scope of work. identify the slope of accessible parking and route to building. 3 ems: -w" O ' s 11b A ccessible route to the public way is required. ks0c5E,0 SI id s L '11f' 4 illage spaces must be angled as existing. Provide an existing plan of Village property. c. ail uc 41 (A 4-r— t✓O tA'�v{ _. i ,r Norman Bruhn Bldg Director Stopped Review Plan review is not complete, when all items above are corrected, we will do a complete plan review. If any sheets are voided, remove them from the plans and replace with new revised sheets and include one set of voided sheets in the re- submittal drawings.