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DS-14-60Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 205662 Scheduled Inspection Date: March 26, 2014 Inspector: Rodriguez, Jorge Owner: MILITANA, JOHN AND ADRIENNE Job Address: 8900 BISCAYNE Boulevard Miami Shores, FL Project: <NONE> Contractor: ATLANTIC SOUTHERN PAVING & SEALCOATING eunaing Department comments asphalt overlay Permit Number: DS -1 -14-60 Permit Type: Driveways /Sidewalks/Slabs Inspection Type: Final Work Classification: Addition /Alteration Phone Number Parcel Number INSPECTOR COMMENTS False 1132060110160 Phone: (954)581 -5805 Passed Inspector Comments Failed Correction Needed ❑ Re- Inspection ❑ Fee No Additional Inspections can be scheduled until re- inspection fee is paid. March 25, 2014 For Inspections please call: (305)762 -4949 Page 8 of 40 r Miami. Shores Village Building Department �/ 1 ��• 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 l ` Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 BUILDING PERMIT APPLICATION Permit Type: BUILDING JOB ADDRESS: 8900 BISCAYNE BLVD Permit No. JAN 1$ BY: FBC 201® Master Permit No. 'D S) y ,-(eO ROOFING City: Miami Shores County: Miami Dade Zip: Folio/Parcel #: 11- 3206 - 011 -0160 Is the Building Historically Designated: Yes NO Flood Zone: OWNER: Name (Fee Simple Titleholder): JOHN MILITANA Phone#: Address: 8801 BISC BLVD City: Miami Shores Ste: FL gip; 33138 Tenant/Lessee Name: Phone#: (305) 430 -1207 Email: CONTRACTOR: Company Name: Atlantic Southern Paving & Sealcoating phone#: (954) 581 -5805 Address: 1490 NW 65 Ave City: Plantation State: FL gip; 33313 Qualifier Name: Michael Curry Phone#: (954) 581 -5805 State Certification or Registration #: E95105 Certificate of Competency #: Contact Phone #: (954) 581 -5805 Email Address: favian @atlanticsouthernpaving.com DESIGNER: Architect /Engineer: Value of Work for this Permit: $10,890 SquarelUnear Footage of Work: 6,564sf Type of Work: ❑Addition ❑Alteration ❑New ❑Repair/Replace ❑Demolition Description of Work: asphalt overlay Color thru tile: Submittal Fee $ Permit Fee $ CCF Scanning Fee $ Radon Fee $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ CO /CC $ DBPR $ Bond Technology Fee $ TOTAL FEE NOW DUE$ 80' S � Bonding Company's Name (if applicable) Bonding Company's Address City State Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip 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 inspe . n which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will n t b proved and a reinspection fee will be charged. Signatur Signature -_- � Owner or Agent ContrTaor The foregoing instrument was acknowledged before me this The foregoing instrument was ac wl ged before me this day of U�,120 !' J by A l Eve iA 0 f O f CL S day of - t -,20-1q, by , who is personally 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: APPROVED BY as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: GAWRABOM My MY COMMISION #M19M EXPIRES: MAY 15, 2016 Scr*d through 11t SM MMMS Plans Examiner Structural Review (Revised 3 /12/2012)(Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09) r -MA MARIE IDUAW MY cgmwsawo" Zoning Clerk Miami 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. COPY OF WORKERS COMPENSATION (EITHER CERTIFICATE OR EXEMPTION) 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 CONTRACTOR'S TAX RECEIPT C. r COPY OF LIABILITY INSURACE (CERTIFICATE HOLDER MUST BE MIAMI SHORES VILLAGE BLDG DEPT) D. 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 COMPLETE CONTRACTOR'S INFORMATION BUSINESS NAME: ATLANTIC SOUTHERN PAVING & SEALCOATING BUSINESS ADDRESS: 1490 NW65 AVE STATE FL ZIP CODE 33313 BUSINESS PHONE: 9( 54 ) 581 -5805 CELL PHONE () QUALIFIER'S LIC NUMBER: E95105 PLANTATION FAX NUMBER 9( 54 ) 581 -0465 QUALIFIER'S NAME: MICHAEL CURRY E -MAIL ADDRESS (IF APPLICABLE): FAVIAN @ATLANTICSOUTHERNPAVING.COM Created on 3119109 BY MLDV I RV 3126109 MLDV S017902 A 1D'� CERTIFICATE OF LIABILITY INSURANCE °A�;;�014YY' 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 WANED, 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 Commercial Lines - 800 - 868 -8834 Wells Fargo Insurance Services USA, Inc. 6100 Fairview Road CONTACT NAME: ao °NN 888 -572 -2412 ac N. I: ext. 67618 E -MAIL ADDRESS: certs@soi.com INSURERS AFFORDING COVERAGE NAIC # Charlotte, NC 28210 INSURER A : Hartford Fire Insurance Company 19682 INSURED Strategic Outsourcing, Inc. PO Box 241448 INSURERS: $ INSURER C : COMMERCIAL GENERAL LIABILITY CLAIMS -MADE 0 OCCUR Charlotte, NC 28224 INSURER D: INSURER E $ RE: Atlantic Southern Paving & Seaicoating LLC INSURER F: PERSONAL & ADV INJURY COVERAGES CFRTIFICOTF NIIMRFR• 7171295 RFVI_CInkl NI IMRPR• c— 1c1— 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. 1�7R TYPE OF INSURANCE UBR POLICY NUMBER POLICY POLICY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY CLAIMS -MADE 0 OCCUR DAMAGE TO PREMISES Ea occurrence $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ POLICY PRO- F—] LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ HIRED AUTOS NON -OWNED AUTOS UMBRELLALIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS LIABILITY Y / N ANY PROPRIETORIPARTNERIEXECUTIVE OFFICER/MEMBER EXCLUDED? ❑N N I A 22WNG30001 08/2512013 03/01/2014 X WC STATU- OTH- E.L. EACH ACCIDENT $ 1.000'000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 (Mandatory In NH) If es, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1.000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) Workers' Compensation Coverage is limited to employees leased to Atlantic Southern Paving and Sealcoating LLC by Strategic Outsourcing, Inc. %,r-m i irm m i c nvLurm Miami Shores Village Bldg. Dept. 10050 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. AUTHORIZED REPRESENTATIVE 9e 1— The ACORD name and logo are registered marks of ACORD ©1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) OP ID: TG '414. - `�L CERTIFICATE OF LIABILITY INSURANCE DAT 01110D/YYYY) 1wa/14 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 pol)cy(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 954 - 340 -9551 INNOVATIVE INSURANCE 954 - 340 -9456 CONSULTANTS, INC. 6461 UNIVERSITY DRIVE, #103 CORAL SPRINGS, FL 33067 DAVID LEE SCHWARTZ NAME: CT PHONE c No E-MAIL ADDRESS ADDRESS c •ATLAN -4 INSURER(S) AFFORDING COVERAGE NAIC0 - - -.. _...- _--- --_...— ___..— __-----•— INSURED ATLANTIC SOUTHERN PAVING & INSURER A: LIBERTY MUTUAL FIRE INS CO PREMISES Ea SEALCOATING LLC M.A.C. CONTRACTING CORP ATLANTIC TOTAL INTERIORS INC INSURER a: NORTH RIVER INSURANCE CO. 21105 INSURER c:FCC1 COMMERCIAL INSURANCE CO. 33472 - . - — - INSURER D: 6301 SUNRISE, LLC GENERAL AGGREGATE ------ INSURER E: GEML AGGREGATE LIMIT APPLIES PER POLICY X PRO LOG JECT P.O. BOX 15591 INSURER F: T. LAUDERDALE, FL 33318-5591 COVERAGES CERTIFICATE NUMBER_ REVISION NUMBERt 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. IL! R TYPE OF INSURANCE S POLICY NUMBER ISM /LILY vPir POLICY EXP LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAlM3 -MADE L"J OCCUR X CONTRACT -L X B2 Z91- 461253 -023 BLKT ADDL INSD BLKT WAIVER 07/28/13 07/28/14 EACH OCCURRENCE $ 1,000,00 PREMISES Ea $ 300,00 MED EV (Any am person) $ _ 16,00 PERSONAL & ADV INJURY $ 1,000,0 X XCU i BFPD GENERAL AGGREGATE $ 2,000,00 GEML AGGREGATE LIMIT APPLIES PER POLICY X PRO LOG JECT PRODUCTS - COMP /OP AGG $ 2,000,0 $ A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULEDAUTOS HIRED AUTOS NON-OWNEDAUTOS AS2 -z91- 461253 -013 07128113 07128114 COMBINED SINGLE LIMIT (Eaaccident) $ 1,000,0 X BODILY INJURY (Per person) S BODILY INJURY (Per accident) $ ~ ~- X X PROPERTY DAMAGE (Paracaiderd) $ S $ B X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE 561. 1019875 07/28/13 07/28114 EACH OCCURRENCE $ 2,000,0 AGGREGATE $ 4,000, DEDUCTIBLE RETENTION $ $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABI ITY ANY PROPRIE70R/PARTNER'W CUT' YIN OFFICERIMEM�R EXCLl117E09 � (Mandatory in NH) If yyos, describe under DESCRIPTION OF OPERATIONS below MIA I WC STATU- I OTH- OB IMLT E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ E.! DISEASE - POLICY LIMIT $ C C PROPERTY INLAND MARINE CP000141911 CM000121711 07128/13 07/28113 07/28/14 07/28114 RENTED EQ 100,00 LEASED EQ 100,00 DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (Attach ACORD 101, Additional Remarks Schedule, H more space is required) CERTIFICATE FOLDER IS ALSO KNOWN AS ADDITIONAL INSURED WITH RESPECT TO GENERAL LIABILITY MIAMI SHORES VILLAGE BUILDING DEPARTMENT 10050 NE 2 AVENUE MIAMI SHORES, FL 33132 MIAMI -6 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 ©1988 -2009 ACORD CORPORATION. All rights reserved. ACORD 26 (2009109) The ACORD name and logo are registered marks of ACORD CTQB Construction Trades Qualifying Board BUSINESS CERTIFICATE OF COMPETENCY E95105 ATLANTIC SOUTHERN PAVING AND SEALCOATING LLC. D.B.A.: CURRY MICHAEL J Is certified under the provisions of Chapter 10 of Miami -Dade County • QUALIFYING TRADE(S) 0007 PAVING ENGINEERING 0018 ASP SEAL EXCLU RD PVMT J: MIAMF aMrlea Danger P E �r gim � vrww .. goNdevebpment Local Business Tax Receipt Miami -Dade County, State of Florida -THIS IS NOT A BILL - DO NOT PAY 3496320 LBT BUSINESS NAMEMOCATION RECEIPT NO. EXPIRES ATLANTIC SOUTHERN PAVING & SEALCOATING CO RENEWAL SEPTEMBER 30, 2014 DOING BUS IN DADE CO 3652519 Must be displayed at place of business MIAMI FL 33000 Pursuant to County Code Chapter SA - Art. 9 & 10 OWNER SEC. TYPE OP BUSINESS PAYMENT RECEIVED ATLANTIC SO PAVING&SEALCOATING 196 SPECIALTY ENGINEERING CONTRACT By TAX COLLECTOR CO E95105 $75.00 07/02/2013 Worker(s) 9 CREDITCARD -13- 000779 This Local Business Tax Receipt only confirms payment of the Local Business Tax The Receipt is not a license, permit, or a certification of the holder's qualifications, to do business. Holder must comply with any governmental or nongovernmental regulatory laws and requirements which apply to the business. The RECEIPT NO. above'must be'displayed on all commercial vehicles — Miami —Dade Code Sac 8a -27b. For more information, visit www.miamidadegov/texcollector 001768 Municipal Contractor's Tai Rocel Miami —Dade Count�yr, State of Florida —THIS IS NOT A BIL ,— DO. NOT PAY 3496320 BUSINESS NAMWLOCATION RECEIPTNO., ATLANTIC SOUTHERN PAVING & SEALCOATINGEXPIRES " XXONEW DOING 'BUS IN DADE.CO .7 "0865 SEPTEMBER 30, 2014 MIAMI FL 33000 Must be displayed at place of business Pursuant to County Code Chapter8A -Art n 10 OWNER SEC. TYPE OF BUSINESS ATLANTIC SO PAVING&SEALCOATING MMC SPECIALTY ENGINEERING CONTRACTOR PAYMENT RECEIVED CO E95105 BY TAX COLLECTOR Category (S) 2 $200.00,11/14/2013 TXHSi -14- 007342 This Loral Business Tax Receipt on confirms license. Y Payment of the Local Business Tax. The Receipt is not a permit to a certification of the holders quanowtions, to do business, 'Holder must comply with any governmental or nongovernmautai reguhd dry laws and requirements ss. H apply to the business, The RECEIPT NO. above must be displayed onall commercial vehicles - Miami —Dade Code Sec ea-276 For more Information, visit vwvw,miamidadegov /texcollector The RECEIPT NO. above must be displayed on an co..n..e...a..,.._— .. _.__... For more Information, visit www.julamidade.gov/texcalledor