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DEMO-14-443Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 208568 Permit Number: DEMO -3- 14443 Scheduled Inspection Date: April 18, 2014 Permit Type: Demolition Inspector: Rodriguez, Jorge Inspection Type: Final Owner: FREDERIC PUREN, FREDERIC PUREN Job Address: 9179 N BAYSHORE Drive Miami Shores, FL 33138- Project: <NONE> Contractor: THUNDER DEMOLITION INC Building Department Comments TOTAL DEMOLITION OF RESIDENCE Work Classification: Building Phone Number (305)213 -1942 Parcel Number 1132050270600 INSPECTOR COMMENTS False Phone: (305)757 -9444 April 17, 2014 For Inspections please call: (305)762 -4949 Page 7 of 24 Inspector Comments Passed Failed Correction Needed Re- Inspection ❑ Fee No Additional Inspections can be scheduled until re- inspection fee is paid. April 17, 2014 For Inspections please call: (305)762 -4949 Page 7 of 24 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 sue' 044d- BUILDING PERMIT APPLICATION 6W-4, Permit No. MAR 0 7 2014 FBC 20 Master Permit NQQgM Permit Type: BUILDING ROOFING JOB ADDRESS: 1 A N - P q � p&fr by City: Miami Shores �B County: Miami Dade Zip: Folio/Parcel #: It ° 32UJes� — ( � abb Is the Building Historically Designated: Yes NO Flood Zone: OWNER: Name (Fee Simple Titleholder) - Error 1 c rrn Phone#: ° 91 3 ° IC142 City: m 0a f l (1, 011 State: EL Zip: 3el4j Tenant/Lessee Name: Phonek Email: CONTRACTOR: Company Name: is j. Vf Nmd i- mo --m a ° Phonet(=M ° C9 ° Address: —IM 5 NE °-E-31A- CT City: M I Q M'I State: K- Zip : 1�-( � Qualifier Name: .s o �� � � rrya Phone#: State Certification or Registration #: Certificate of Competency #: eg Contact Phone #: (�) ` C1 Email Address: `,1T)U(Al1 tl `-H ooh DESIGNER: Architect/Engineer: Phone #: Value of Work for this Permit: $1 Square/Linear Footage of Work: Type of Work: DAddi tio n DAlteration ONew ORepair/Replace Demolition Description of Work: _ ti D r L �'n-d i"Hon o� � Color thru tile: 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 $ 1110'00 Bonding Company's Name (if applicable) Bonding 1Company's Address City State 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 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 will not be approved and a reinspection fee will be charged. Signature — � Owner o� gent The foregoing instrument was acknowledged before me this day of 20 A, by Fyr6 ouirr who is onally known me or who has produced As i n c tion and who NOTARY PUBLIC: Sign: Print: A My Commission Expires: APPROVED BY ® ?/ l`7(< Signature Contractor The foregoing instrument was acknowledged before me this �r -1 day of , 2016—,by who is nally kno o me or who has produced , $ 6 X n y O M O * Z m Plans Examiner Structural Review (Revised 3 /12/2012)(Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) as identification and who did take NOTARY PUB ��77tt 3 pA N Sign: $ Cc Print: > My Commission Expires: z p 4b Z Zoning Clerk DBPR - HERNANDEZ, OMAR R; Doing Business As: METRO ELECTRIC SERVICE,... Page 1 of 1 3:48:43 PM 31712014 Licensee Details Licensee Information Name: Main Address: County: License Mailing: License Location: County: License Information License Type: Rank: License Number: Status: Licensure Date: Expires: Special Qualifications Additional Business Qualification HERNANDEZ, OMAR R (Primary Name) METRO ELECTRIC SERVICE, INC. (DBA Name) 3314 SW 123 AVE MIAMI Florida 33175 DADE 15050 NE 20TH AVENUE MIAMI FL 33181 DADE Certified Electrical Contractor Cert Electrical EC13005326 Current,Active 05/21/2013 08/31/2014 Qualification Effective 05/21/2013 View Related License Information View License Complaint 1940 North Moarge Stre Tallahassee 9 :: Email: Customer Contaot Center :: Custorner Contact Center: 850,487..1.395 The State of Florida is an AA/EEO employer. Copyright 2007 -2010 State of Florida. Privacy, Statemerxt Under Florida law, email addresses are public. records. 1f you do not want your email address released in response to a public- records request, do not send electronic mail tc> this entity. Instead, contact the office by phone or by traditional mail. If you have any questions, please contact 950.487.1 395. `Pursuant to Section 455.275;1';, Florida Statutes, effective October 1, 2612, licensees licensed under Chapter 455, F.S. must provide the Department with an email address if they have one. The ernails provided may be used for official communication with the licensee. However email addresses are public record. If you do not wish to supply a personal address, please provide the Department with an email address which can be made available to the public. Please see our §110RIer4,U page to determine if you are affected by this change. https:// www. myfloridalicense .com /LicenseDetail. asp ?SID= &id= 617BFC809CA1 DB82F70... 3/7/2014 PERMIT # Ll CONTRACTOR: :IbV SUBMITTAL DATE: �> / ADDRESS: NAME: - fvedri C p +�- RESUBMITAL DATES: PROJECT TYPE: 7 J l ZONING FIRE STRUCTURAL IMPACT FEES e- ELECTRICAL HRS /DERM PLUMBING NOC MECHANICAL 7 � t BLDG Ron ~ r � DEPARTMENT ��� �� RESOURCES .. ncouIA/un` CDRUR 11805 SW 26 STREET ^ ^ , MIAMI, FL 33175-2474 (786) 315 2000 « MISCELLANEOUS RECEIPT '— ---''----'~ HUNDER DEMOLIT 179 N BAYSHORE IAMIj FL 33175 REVIEW FEE TYPE CODE DOH H@07 UNIT FEE DESC AMOUNT 1 80.00 80.00 February 19, 2014 City of Miami Shores BUILDING DEPARTMENT 10050 NE 2nd Ave Miami Shores FL 33138 RE: 9179 NBAYsHoRE DR MIAMI FL Dear Building Official: The purpose of this letter is to inform you that I, jgAjQ(: y" , owner of the property 9179 N Bayshore Dr, give authorization to Thunder Demolition Inc to completely demolish the above referenced property. Please see attached Warranty deed. Sincerely, �� STATE OF FLORIDA, COUNTY OF��"i regoin tatemen sworn to and su seid e this day of (_ )VL 2014 by (� r�� who ' ersonally known me or has produced his/her Driver s License # �� as identification an who did / did not take an oath. IU2 JESSICA GONZALEZ MY COMMISSION # EE8436N ' EXPIRES October 20.2096 This Doenaam Prepared Bys Richard A. Golden Estq. Kramer & Golden P . A. 1175 N.E. 125 ifRELT, SUITE 512 N. MZRMI, FL 33161 KGpA FILE NO.193 -13R t PertdWinatert 11- 3205 -027 -0600 Special Warranty Deed. This Indentnre, Mode this 10 . day of January , 2014 AD.. Between The Bank of New York Mellon, f /k /a The Bank of Now York, as Trustees for the Cert3.ficatreholders CWALT, INC., Alternative, Loan Trust 2006 -29T1, Mortgage Pass- Through Certificates of due County of DALLAS , State of - TEXAS t grantor, and Frederic Puren whose address is 1431 Stillwater Drive, Miami. Beach, FL 33141 or dm Cocmty of Miami. -Dade ! Stara or Florida , grantee. Witnemeth that dte GRANTOR, for ad in cons **don of the sorts of ------------------------ TEN DOLLARS ($10) ----------------- - - - - -- DOUARS. and other good ad VAMWa coastderadon to GRANMR in head paid by GRAN PA rim receipt whomf is hereby admawicdgod. Ina granted, bargained and sold to the said GRANTOC and GRANW -S haim mccuors and aeigas forever•, dw following descrt'bad hand, situate, h iag ami lft l a dw Co,mty of MIAW —DADS Suft of Florida to wit: Lots 7 and 6, Block 4, BAY FURL, acoortling to the map or plat thereof i as recorded in Plat Book 44, Page 63, Public Records of Miami -Dade { County, Florida. Together with an terteatent% l�itamW and appurtenances dwrM belonging or in anywise appcMinin& To Have and to Hold, the same in ro simple roam. And dw pwor y auyenanm with sold WWxG that grnntot is lawtWly selmd of said land in fea simple; Umt grantor bas good fight od iawtirl authority to soli and convoy said l and; that grantor hereby rally warn ms the title to said land and will deomd the son agabtst dw Lawful dshm of an persons cleliniq by, though or MWW grantor. L=W OWWW by Q Dbp* aptum x.2014 (86)T6)•SUS Pa. RX*V -2 k Special Warranty Deed -rags 7. ParcdiDNamben 11 -3205- 027 -0600 In Witness Whereof, the gratttar be bem oo ad its bead and seal th day and year firs► above written. Signed, sealed and delivered in our presence: The Bank of Now York Mellon, f /k /a The Bank of New York, as Trustee for the Certificateholders CMALT,Ino. i Alternative moan Trust 2006 -29T1, Mortgage ; e Pass- Through Certificates t $y • Printed Name: ANIBAL RIVERA AUSTIN ALBURTIS as AVP p r Witness Bank of Auerica, N.A., successor P.O. Addmw. by mwgw to SAC Home Loans Serrkb & LP, as attoraoy la fact Printed N ®. ROCIO F'E Witness TEXAS (Corporate Seal) i STATE OF COUNTY OF DALLAS ' Mw lbngoing iaseumeot was admowkilged bdibm me Uric 10 day of January , 201$ by AUSTIN ALBURTIS as AVP of The Bank of New York Mellon,(FRA The Bank of New York), as Trustee } for the Certificateholders CWALT, INC., Alternative Doan Trust i! 2006 -29T1, Mortgage Pass - Through Celrtifioates by Bank of America, N.A. , successor by merger to BAC Home Loans Serviaing,LP as Attorney in fact i who is petsoaany known to au or who has prodrwal his �..... driver r 'canes as ideatifuwtiun i Pr'A N JENNIFER GREEN No Publ c reo7my'Ec10/ 02/ 2017 y, TATE OF TEXAS n tea► fa�-fr 1 3 193 -13R t.=G..Kdb,oabp%ys)tem%1m..2a14 (863)X1-5155-FwMRAW04 1 t � This Document Prepared Dr. Richard A. Golden, Esq. Kramer & Golden P.A. 1175 N.T. 125 SiRETT, SUITE 512 N. MIAMI., FL 33161 KGPA FILE NO.193 -13R Bill of Sale Know A,ll Men By These Presents, That this 1 o day of 3'anuary , 2014 A.D. , That The Bank of New York Mellon, f /k /a The Sank of New York, as Trustee for the Certificateholders CNALTT, INC., Alternative Loan Trust 2006 -29T1, Mortgage Pass - Through Certificates A of the County of DALLAS , State ?'St of X K3G�L Lxi TEXAS , p rtJ4 and Frederic Puren whose address is: 1431 Stillwater Drive, Miami Beach, FL 33141 of the County of Miami -Dade , stated Florida , second party. W tnesseth that the FIRST PARTY, for and in consideration of the sum of ------------------------ T2V DOLLARS ($10) ----- ------- ----- - - - - -- DoLLARS, i and ather goat and valuable consideration to FIRST PARTY in hand paid by SECOND PARTY, the receipt whereof is hereby .achowledgal, has granted, bargained, sold, transferred and delivered to the said SECOND PARTY and SECOND PARTY'S heirs, successors and assigns forever, i the following goods and chattels: AS PER CONTRACT I Lots 7 and 8. Block 4, BAY LURE, according to the map or -plat thereof as recorded in Plat Book 44, Page 63, Public Records of Miami -Dade County, Florida. AnbcingloonWat; 9179 N. BAYSHORE DRIVE, MIAMI SHORES, FL 33138 To Have and to Hold the same unto second party, and the second party's heirs, personal representatives, successors and assigns forever. And the first party covenants with the second party; and the second party's heirs, personal rapresentatives, successors and assigns that the rust party is the lawful owner of the said goods and chattels, that they are free from all encumbrances; that the first party has goad right to sell and transfer said property, goods and chattels; and that the first party will warrant and dafand the sate and transfer of the said property, goods and chattels hereby made to the second party, and the second party's heirs, personal representatives, successors and assigns, against the lawful claims and demands of all persons whomsoever. This covenuat shun be binding upon the first party and the fast party's heirs, personal representatives, successors and assigns. loser C"n= ad 6y 0 D4ky symmn% lna 2014 (863) 763.3343 Fmm "08-1 Bill Of Sale -Page 2 In Witness Whereof, the first party has hereunto ad its hand and seal the day and year first above written. Signed,.sealed and delivered in our presence: The Bank of New York Mellon, 171A The Bank of New York as Trustee for the Certificateholders CWALTy Inc., Alternative Loan Trust 2005 -29T1, Mortgage C Pass- Through Certificates By. Printed Name: ANIBAL RIVERA AUSTIN ALBURTIS as AVP of Witness Bank of America, N.A., successor by P.O. Address: merger to BAC Home Loamy Servicing, LP iw attorney in fact Printed Witness TEXAS {Corporate Seal) STATE OF COUNTY OR DALLAS The foregoing instnunent was acknowledged before me this 10 day of January 2014 by AUSTIN ALBURTIS as AVP of The Bank of New York Mellon, FKA The Bank of New York, as Trustee for the Certi.fioateholders CWALT, iNC., Alternative Loan Trost 2006- -29T1, Mortgage Pass - Through Certificates by Bank of America, N.A. successor by merger to BAC Howe Loans Servicing,LP as Attorney in fact who is personally known to me or who has produced his N/A driver I s ]4 *'pense as identification. 193-13R t.aWGwigedby0Dtq aySy9WK Inc., 2014 M762 -Sus PermFU09.1 IRMI, FL 33175 REVIEW FEE TYPE CODE DOH H007 UNIT FEE DESC AMOUNT 1 8@.00 "` 80.00 (]ON 1'I Nrr TERMITE AND PEST CONTROL cPCO° b jc'A rr ` .i (786)975 -6461 Feb 26, 2014 To Whom It May Concern Thunder Demolition 7373 N.E 3rd ct Miami fl 33138 Due to the inspection at property 9179 North Bay Shore Dr, Miami FL. There were no evidence of any rodents on property. If you have any questions or concerns please contact me Thank you,j Louis Vasquez Onpointexterminator @gmaii.com VLfi'1ILV ly 1A.Wo IrAQ Thunder Demolition. February 24,'2014 Attn: Jassy Gonzalez 7373 ND a Court Miami, Fl. 33138 Proposed Demo: 0179 N. 03a fshore,DlrNllaI Sucre: F 1 7440 SW 8a' Street., I9ndall, Fl. 33156 (Florida Gas Co). r.w1 1001 After a review of our facilities within the above referenced area, we would like to inform you that TECO Peoples Gas does not have a present, underground natural gas service at said property. (Gas main is active In the front row of address). However, you must contact the Sunshine State One Call of Florida at 1400 -432 -4770 or 811 at least 48 hours in advance, as there might be other underground utilities. By contacting SSOCOF, the risk of personal injury and property damage can be reduced. You can get the latest Information on SSOCOF by visiting their web site at www.calisunshine.com Should you have any additional questions concerning the above, please contact me at 1- 877 -TECO PGS, extension 77238. Sincerely, Gloria Gerard done for Mr. Jesus Vega Local Dade & Broward Division Manager N Miami Division JV /grg PEOPLES GAS 15779 W DWO Hwy. NORTH MIAMI BEACH, FL 33162 AN EQUAL OPPORTUNITY COMPANY 340 Prepared by: Gloria Gerard 305-957 -3867 FAX 305957.3804 HITPJAN M -WCOENERGY.C.OM 02/21/2014 FRI 11159 FAX 3036949337 FLORIDA CITY GAG Florida City Gas'" An AQt. Resources Company 668 Et 2e &ns1 Hailah, FL 33013 305 $916710 phone www.floAftcaymoom February 20, 2014 Thunder Demolition, Inc. 7373 NE 3'd Ct Miami, Florida 33138 RE: Property 7440 SW 881h 8% Miami, FL Folio # 304002467-0020 9179 N Bayshore Dr, Miami Shores, FL Folio 611 -3205- 027.0600 To Whom It May Concern: Please be advised that Florida City Gas does not have gas on the existing or proposed facilities at the above - mentioned addresses and therefore offers No Objection" to the demolitlon/construction of the existing buildings. Please contact Sunshine State One call of Florida at 1.800.432.4770 (611 ) to locate all utilities lines at least 48 hours prior to the demolltion/dlgging. We the law. If you should have any questions please contact me 306- 835 -3648 Sincerely, FLORIDA CITY GAS a De Jesus Operations Department 0001 /001 STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM CONSTRUCTION PERMIT CONSTRUCTION PERMIT FOR: OSTDS Abandonment APPLICANT: Fredric Puren PROPERTY ADDRESS: 9179 N Bayshore Dr Miami, FL 33175 LOT: 8 BLOCK: 4 SUBDIVISION: PERMIT #: 13-SC-1 523459 APPLICATION #: AP1137273 DATE PAID: FEE PAID: RECEIPT #• DOCUMENT #: PR931163 PROPERTY ID #: 11- 3205- 027 -0600 [SECTION, TOWNSHIP, RANGE, PARCEL NUMBER] [OR TAX ID NUMBER] SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF SECTION 381.0065, F.S., AND CHAPTER 64E -6, F.A.C. DEPARTMENT APPROVAL OF SYSTEM DOES NOT GUARANTEE SATISFACTORY PERFORMANCE FOR ANY SPECIFIC PERIOD OF TIME. ANY CHANGE IN MATERIAL FACTS, WHICH SERVED AS A BASIS FOR ISSUANCE OF THIS PERMIT, REQUIRE THE APPLICANT TO MODIFY THE PERMIT APPLICATION. SUCH MODIFICATIONS MAY RESULT IN THIS PERMIT BEING MADE NULL AND VOID. ISSUANCE OF THIS PERMIT DOES NOT EXEMPT THE APPLICANT FROM COMPLIANCE WITH OTHER FEDERAL, STATE, OR LOCAL PERMITTING REQUIRED FOR DEVELOPMENT OF THIS PROPERTY. SYSTEM DESIGN AND SPECIFICATIONS T [ A [ N [ K [ ] GALLONS / GPD ] GALLONS / GPD ] GALLONS GREASE INTERCEPTOR CAPACITY ] GALLONS DOSING TANK CAPACITY [ CAPACITY CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS] ]GALLONS @[ ]DOSES PER 24 HRS #Pumps [ D [ ] SQUARE FEET SYSTEM R [ ] SQUARE FEET SYSTEM A TYPE SYSTEM: [ ] STANDARD [ ] FILLED [ ] MOUND [ ] I CONFIGURATION: [ ] TRENCH N F LOCATION OF BENCHMARK: I ELEVATION OF PROPOSED SYSTEM SITE E BOTTOM OF DRAINFIELD TO BE L D E O T H E R [ ] BED [ ] ][ ABOVE/ BELOW] BENCHMARK /REFERENCE POINT ][ABOVE / BELOW] BENCHMARK /REFERENCE POINT 1.... ^&WUl1V517: _ L U.UU 1 IMUMS5 EXCAVATION REQUIRED: L ] INCHES Have the tank abandoned in accordance with the following procedures:(a) The tank shall be pumped out.(b) The bottom of the tank shall be opened or ruptured, or the entire tank collapsed so as to prevent the tank from retaining water, and(c) The tank shall be filled with clean sand or other suitable material, and completely covered with soil.Have the system inspected by the health department after it has been pumped and ruptured but before it is filled with sand and covered. SPECIFICATIONS BY: TITLE: APPROVED BY: 262-2E TITLE: Engineering Specialist II Dade CHU Erlande Omisca DATE ISSUED: 02/26/2014 EXPIRATION DATE: 05/27/2014 DH 4016, 08/09 (Obsoletes all previous editions which may not be used) Incorporated: 64E- 6.003, FAC Page 1 of 3 v 1.1.4 AP113 "1273 SE -1 i STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM CONSTRUCTION PERMIT CONSTRUCTION PERMIT FOR: OSTDS Abandonment APPLICANT: Fredric Puren PROPERTY ADDRESS: 9179 N Bayshore Dr Miami, FL 33175 LOT: 8 BLOCK: 4 SUBDIVISION: PROPERTY ID #: 11- 3205 -027 -0600 PERMIT #:13 -SC- 1523459 APPLICATION #: AP1137273 DATE PAID: FEE PAID: RECEIPT #: DOCUMENT #: PR931163 [SECTION, TOWNSHIP, RANGE, PARCEL NUMBER] [OR TAX ID NUMBER] SYSTEM MUST BE. CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF SECTION 381.0065, F.S., AND CHAPTER 64E -6, F.A.C. DEPARTMENT APPROVAL OF SYSTEM DOES NOT GUARANTEE SATISFACTORY PERFORMANCE FOR ANY SPECIFIC PERIOD OF TIME. ANY CHANGE IN MATERIAL FACTS, WHICH SERVED AS A BASIS FOR ISSUANCE OF THIS PERMIT, REQUIRE THE APPLICANT TO MODIFY THE PERMIT APPLICATION. SUCH MODIFICATIONS MAY RESULT IN THIS PERMIT BEING MADE NULL AND VOID. ISSUANCE OF THIS PERMIT DOES NOT EXEMPT THE APPLICANT FROM COMPLIANCE WITH OTHER FEDERAL, STATE, OR LOCAL PERMITTING REQUIRED FOR DEVELOPMENT OF THIS PROPERTY. SYSTEM DESIGN AND T [ ] GALLONS / GPD CAPACITY A [ ] GALLONS / GPD CAPACITY N [ ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIM)M CAPACITY SINGLE TANK:1250 GALLONS] K [ ] GALLONS DOSING TANK CAPACITY [ ]GALLONS @[ ]DOSES PER 24 HRS #Pumps [ ] D [ ] SQUARE FEET SYSTEM R [ ] SQUARE FEET SYSTEM A TYPE SYSTEM: [ ] STANDARD [ ] FILLED [ ] MOUND I CONFIGURATION: [ ] TRENCH [ ] BED [ ] N F LOCATION OF BENCHMARK: I ELEVATION OF PROPOSED SYSTEM SITE E BOTTOM OF DRAINFIELD TO BE L D P O T H E R ABOVE /BELOW] BENCHMARK /REFERENCE POINT ][ / ][ABOVE/ BELOW] BENCHMARK /REFERENCE POINT 1LL r.MWU.LxS17: L U.UU 1 1NC:t1Lb UiJU:AVATlUN 2U::WU -LAA J: L 1 .LNurlao Have the tank abandoned in accordance with the following procedures:(a) The tank shall be pumped out.(b) The bottom of the tank shall be opened or ruptured, or the entire tank collapsed so as to prevent the tank from retaining water, and(c) The tank shall be filled with clean sand or other suitable material, and completely covered with soil.Have the system inspected by the health department after it has been pumped and ruptured but before it is filled with sand and covered. SPECIFICATIONS BY: TITLE: APPROVED BY: z1+'�� �..'� TITLE: Engineering Specialist II Dade CHD Erlande Omisca DATE ISSUED: 02/26/2014 EXPIRATION DATE: 05127/2014 DH 4016, 08/09 (Obsoletes all previous editions which may not be used) Incorporated: 64E- 6.003, PAC Page 1 of 3 v 1.1.4 AP1137273 SE -1 NOTICE OF RIGHTS A party whose substantial interest is affected by this order may petition for an administrative hearing pursuant to sections 120.569 and 120.57, Florida Statutes. Such proceedings are governed by Rule 28 -106, Florida Administrative Code. A petition for administrative hearing must be in writing and must be received by the Agency Clerk for the Department, within twenty -one (21) days from the receipt of this order. The address of the Agency Clerk is 4052 Bald Cypress Way, BIN # A02, Tallahassee, Florida 32399 -1703. The Agency Clerk's facsimile number is 850 -410 -1448. Mediation is not available as an alternative remedy. Your failure to submit a petition for hearing within 21 days from receipt of this order will constitute a waiver of your right to an administrative hearing, and this order shall become a 'final order'. Should this order become a final order, a party who is adversely affected by it is entitled to judicial review pursuant to Section 120.68, Florida Statutes. Review proceedings are governed by the Florida Rules of Appellate Procedure. Such proceedings may be commenced by filing one copy of a Notice of Appeal with the Agency Clerk of the Department of Health and a second copy, accompanied by the filing fees required by law, with the Court of Appeal in the appropriate District Court. The notice must be filed within 30 days of rendition of the final order. AMISCAPL DEPARTMENT OF REGULATORY AND ECONOMIC RESOURCES BNZM1142 02/26/2014 ADD MISCELLANEOUS APPLICATION PAGE 1 12:57:93 YALI22 APPLICATION DATE 02/26/2014 PROCESS NO. X2014066949 OTHER DEPT. APPLICATION ## OR BLDG DEPT. PERMIT # /ADDRESS: AP1137273 CONTACT NAME THUNDER DEMOLITION SUB TOTAL $80.00 ADDRESS 9179 N BAYSHORE DR CITY MIAMI STATE FL ZIP 33175 PHONE COUNTY AGENCY SALES FEE UNIT USER PAID TYPE CODE UNITS DESC FEE DESCRIPTION ID FEE IND DOH H007 1 EACH ABANDONMENT YALI22 80.00 AF1 = UPDATE PF9 = MOD MISC APL NEXT SCREEN NEXT KEY MISC APPLICATION ACCEPTED... ENTER NEXT KEY TO CONTINUE 02/28/2014 12:13 9542364443 UPLUMBING PAGE 02 77 q 'TT1 6 Plumbi"ngI AWAUY@w /,eda undNmWo Licensed & Insured CFC 056969 .Septic & Grease Tra Corp. P.O. BOX 268404, WESTON, FL 33326 Nog 1 0359 Dade: (786) 306 -7781 - (305) 305 -6758 Broward: (954) 236 -4442 - Fax: (954) 236 -4443 Plyment Method www.ezplumbingandseptic.com C$ECK - CASH •�"'�� � � / date: i�--' I arl 1 Bill To: i lei" i t`�'� Tel: 20fj -7Si- �44q Addrem:_531 -lq At AjaVrt !fir city: St; Zip 53 158 QTY DESCRIPTION PRICE QTY DESCRIPTION PRICE AMOUNT Full Truck -Clogged Drain Grease Trap Storm Drain Septic Tank T Pressure Cleaning Lit Station Flooding, Parkinagg House u-mp Out Duplex Lid Re air Building Drain Fill Repair Commercial Pie Repair Residential Baffle Repair Restaurant Tank ear Catch Basin Ices Lid Bottom Repair eo amera Bottom Sand Pum p Out Abandon I±fty Duty Jet Pmsion Tank Location No Guaranty No Guarantee I Cables No. Guaran Guarantee I Soakage Pit H.R.S. nspection Night Time Trailer P—ark Hours Gallons Holiida s IF Emergency Labor Months Year Vhank Crou Signature: C10MMEM5• .__...... . --- .___.. _.._ ....... TOTAL$ u TERMS; NET' 10 Days payment is due upon presentstIO of Invoice. If invoice I$ not paid in full within 10 days after its billing date, the customer hereby agrees to Pay Imerest at the rate of 1.5% per month (18% per annurm) upon the unpaid portion of the Invoice, If action or suit is brought by E t PLUMBING to carlect anp amount due or owing under this bill. Customer agrees to pay all costs of collection including arty reasonable attornev's fool THUNDER DEMOLITION, INC. 7373 ME 3rd COURT MIAMI FL 33138 TEL: 305.757.9444 FAX: 305.757.9441 www.thunderdemolition.com March 6, 2014 Miami Shores Village BUILDING DEPARTMENT 10050 N.E 2"d Ave Miami Shores, FL 33138 RE. 9179 NBAYsHoRE DR MIAMI SHORES FL33138 Dear Building Official: The purpose of this letter is to inform you that the project address 9179 N Bayshore Drive is scheduled to commence demolition 24 hours after the Demolition permit is issued. Sincerely, Ronny Herrera STATE OF FLORIDA, @�J p�dd�� COUNTY OF J1 — 1 Vc o and subsc ®fe 6* day of UI �6 , 2014 by Who is rsonally known to a or has produced his/her Driver's License �dentifica ' I did not take an oath F*3Q SSICA GONZALEZ OMMISSIO N # EE843682 PIRES October 20, 2096 t2r .Com Prepared For. Job Site: Ronny Herrera Thunder Demolition Inc 7373 Ne 3rd Court Miami, F133138 Residential Dwelling 9179 North Bayshore Drive Miami, FI Asks Survey — Project Summary Pursuant to your request; ARS Environmental, Inc., has performed an Asbestos Building Survey on 2/26/2014 and limited to the above referenced location. The Interior/Exterior/Roof of the above referenced location was visually inspected to identify building materials that may contain asbestos. Suspect materials were collected and samples sent to laboratory for analysis. UWmWt Results Based On The Laboratory Analysis, Asbestos Was Detected In Amounts Greater Than 1 % In The Secured Bulk Samples. It has been a pleasure working Regards, Environmental, Inc. you. Please call on us again. 10097 Cleary Boatevard * #305 *Plantation, FL 33324 • Phone: 954- 227 -2402 * Fair: 866 -816 -5110 wwal arsenvironmental.com • sales@arsenvironmental.com 1 A,RS Environmental Consulting Services EmiRONMENTAL, INC. Asbestos Business License #ZA- 0000164 Asbestos Consulting • Radon Measurements • Lead Assessments • Indoor Air Oualitg Testing • Mold Investigations Today's Date: 2/26/2014 Project Number: 20140306 Page 2 of 16 Prepared For Ronny Herrera Thunder Demolition Inc 7373 Ne 3rd Court Miami, Fl 33138 Job Site: Residential Dwelling 9179 North Bayshore Drive Miami, FI Asbestos Survey -- Certficatian I hereby certify that this asbestos survey was conducted at the above referenced Job Site on 2/26/2014, and performed by Jeffrey Montalvan, accredited by the EPA as AHERA Inspector(s), utilizing the code of the Federal Regulation Standards, 40 CFR, Part 763, Subpart E, Section 763.80 - 763.99 and the State Asbestos Regulations, Florida Statutes 469.003. STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ASBESTOS LICENSING UNIT, s I ne /eb=b J Vb CUb1K=0a_ W[L�l°W �►at �vN Named be!PW 18 LICENSED _ Under the IuOtllSbnS Of Cha _ +4¢9 FS. -• 9�a *« " RICK SCOTT GOVERNOR Timothy F. Caughey, M.P.H. Florida Licensed Consultant k yi ti ,e q OMAN. MUED: 0910=13 SE0 8 11 KEN LAY RY DISPLAY AS REQUIRED BYLAW 10097 Cleary Boulevard • #305 • Plantation, FL 33324 • phone: 954 -227 -2402 • Fax: 866 -516 -5110 WWW.arsenvirenmental.com • sales@arsenvironmentaLcom AKa EmmumExTAL. INC. Environmental Consulting Services Asbestos Business License #ZA- 0000164 Asbestos Consulting • Radon Measurements • Lead Assessments • Indoor Air Oualfty Testing • Mold Investigations Today's Date: 2/26/2014 Project Number. 20140306 Page 3 of 16 Prepared For Ronny Herrera Thunder Demolition Inc 7373 Ne 3rd Court Miami, Fl 33138 Jeffrey Montalvan Certified Asbestos Surveyor ARS Environmental, Inc. Job Site: Residential Dwelling 9179 North Bayshore Drive Miami, Fl Asbestos Survey — Technician Certification 29- Jan-14 TO 29-Jea -14 M--�eR Id— W(0. -1 NDAAC PWMW "IS1 7�4U: Mk Krda BugoeagW Drees mnAd Ouetl m Aaaso IIame an: 01 IIB/753311 _ F.61omy.COUM This Certlflcate Ei Ifm: Nom_. -�� IM—L4 I #1112 �I R C nuNmlba SE140 10097 Cleary Boulevard a #305 • plantation, FL 33324 • Phone. 954-227-2402 • Fax: 566- 816 -5110 wwwarsenvironmentat corn a sales@arsenctironmental.com AIQO EvaRommEnAL. INC. Envi entai' Consulting Services Asbestos Buusinsin ess License #ZA- 0000164 Asbestos Consulting • Rados Measurements • Lead Assessments • Indoor Air gualitg Testing • Mold Investigations Today's Date: 2/26/2014 Project Number. 20140306 Page 4 of 16 Prepared For Ronny Herrera Thunder Demolition Inc 7373 Ne 3rd Court Miami, Fl 33138 Job Site: Residential Dwelling 9179 North Bayshore Drive Miami, Fl Asbestos Survey Bulk Sample Itemization Sample Sample Physical Water Material Sample Positive Asbestos Nnmher Material C9aca / iamnle neacnntinn / r nratinn Condition Damaee Damage Contact Friability Approximate Size Stop Detected Sample Surfacing Material Good I None I None I High Friable 12,780 Sq. Ft. Asbestos Not Detected LaYer Wallboard / Joint Compound Throughout The Walls And Ceilings Inside Main House And Pool House Sample Surfacing Material Good None None High Friable Included Above Asbestos Not Detected Layer Wallboard / Joint Compound Throughout The Walls And Ceilings Inside Main House And Pool House Sa3 1e Surfacing Material Good None None High Friable Included Above Ash Not Layer Wallboard / Joint Compound Throughout The Walls And Ceilings Inside Main House And Pool House Sam ple Surfacing Material Goad None None High Friable Included Above .' Asbestos Not Detected IAY- Wallboard / Joint Compound Throughout The Walls And Ceilings Inside Main House And Pool House Sample Surfacing Material Good None None High Friable Included Above Asbestos Not Detected Layer Wallboard / Joint Compound Throughout The Walls And Ceilings Inside Main House And Pool House Sample ` 6 Surfacing Material Good None None High Non- friable 3,208 Sq. Ft. Asbestos Not Detected Layer Interior Plaster Coat Throughout Walls And Ceilings In Guest Room Area West Side Of House The following non - suspect materials were observed during the survey (no samples were taken): No insulation observed behind the walls only above ceilings A/C duct fiberglass insulation, ceramic tiles, terrazzo floors. 10097 Cleary Boulevard • #305 • Plantation, R 33324 a Phone: 954 - 227.2402 0 Fax: 866. 816.5110 WWW.arsenvironmental.com • sales@arsenvirenmental.com ARS EmaROMMENTAL, INC. Environmental Consulting Services Asbestos Business License #ZA- 0000164 Asbestos Consulting • Radon Measurements • Lead Assessments • Indoor Air Quality Testing • Mold Investigations Today's Date: 2/26/2014 Project Number. 20140306 Page 5 of 16 Prepared For Job Site: Ronny Herrera Residential Dwelling Thunder Demolition Inc 9179 North Bayshore Drive 7373 Ne 3rd Court Miami, Fl Miami, Fl 33138 The following non - suspect materials were observed during the survey (no samples were taken): No insulation observed behind the walls only above ceilings A/C duct fiberglass insulation, ceramic tiles, terrazzo floors. 10097 Cleary Boulevard • #305 a Plantation, FL 33324 * Phone: 954. 227 -2402 • Fax: 866 - 816.5110 www.arsenvironmental. corn *sales@arsen(lirenmental.com Asbestos Survey -- Bulb Sample itemization Sample Sample Physical Water Material Sample Positive Asbestos Number Material Class / Sample Description / Location Condition Damage Damage Contact Friability Approximate Size Stop Detected Sample i Surfacing Material_ Good 'None None High Non - friable Incli ded"Above " "; Asbestos Not Detected Layer Interior Plaster Coat Throughout Walls And Ceilings In Guest Room Area West Side Of House Sample < 8 Surfacing Material Good None None High Non - friable Included Above ` ;' 1 Asbestos Not Detected Layer Interior Plaster Coat Throughout Walls And Ceilings In Guest Room Area West Side Of House Sample q Miscellaneous Good None None High Non - friable 152 Sq. Ft Layer Black Mastic On Concrete Inside The Hallway To Garage West Side Of House Under Ceramic Tiles Sa �le Miscellaneous Good Noaae FNone High Non - friable Included Above Y1 I LL Layer Black Mastic On Concrete Inside The Hallway To Garage West Side Of House Under Ceramic Tiles Sample Miscellaneous Good None None High Non friable 182 Sq. Ft. j Layer 9" X 9" Floor Tiles; Beige Black Mastic Inside The Guest Room West Side Of House Under Tiles 1st Layer Sample 12 Miscellaneous Good None None` High g Non - friable Inciucled zllve I °{ Layer Black Mastic On Concrete Inside The Guest Room West Side Of House Under Tiles Ist Layer The following non - suspect materials were observed during the survey (no samples were taken): No insulation observed behind the walls only above ceilings A/C duct fiberglass insulation, ceramic tiles, terrazzo floors. 10097 Cleary Boulevard • #305 a Plantation, FL 33324 * Phone: 954. 227 -2402 • Fax: 866 - 816.5110 www.arsenvironmental. corn *sales@arsen(lirenmental.com AIQO EjvOROJVMEJVTAL. INC. F.nviusin es Li ease Consulting Services Asbestos Business License #ZA- 0000164 Asbestos Consulting • Radon Measurements • Lead Assessments • Indoor Air Quality Testing 0 Mold Investigations Today's Date: 2/26/2014 Project Number. 20140306 Page 6 of 16 Prepared For Ronny Herrera Thunder Demolition Inc 7373 Ne 3rd Court Miami, F133138 Job Site: Residential Dwelling 9179 North Bayshore Drive Miami, Fl The following non - suspect materials were observed during the survey (no samples were taken): No insulation observed behind the walls only above ceilings A/C duct fiberglass insulation, ceramic tiles, terrazzo floors. 10097 Cleary Boulevard * #305 # Plantation, FL 33324 • phone: 954. 227.2402 • Fair: 866. 816.5110 wwwarsenvironmental.eom • sales@Orsenvironmental.com Asbestos Survey - Bulk Sample Item =tion Sample Sample Physical Water Material Sample Positive Asbestos Number Material Class / Sample Description ! Location Condition Damage Damage Contact Friability Approximate Size Stop Detected Sample Miscellaneous Good . bone NOtte High Non - friable 182 Sq. Ft. Asbestos Not ii Detected Layer 12" X 12" Floor Tiles; Peel And Stick; Inside The Guest Room West Side Of House Beige Mastic Sample Miscellaneous Good None None High Non friable . Included Above Asbestos Not 14 I I C. Detected Layer 12" X 12" Floor Tiles; Peel And Stick; Inside The Guest Room West Side Of House Beige Mastic Good None None High Non - friable To Be Determined Yes Sample- Miscellaneous 'i Layer Linoleum Floor Sheeting Inside Center Area Of Pool House Under Black Mastic Ceramic Tiles i Sample Miscellaneous Good None None High Non - friable included Above Y j a Layer Linoleum Floor Sheeting Inside Center Area Of Pool House Under Black Mastic Ceramic Tiles r s S a Miscellaneous Good None None Low Non - friable 6,500 Sq. Ft. Asbestos Not i� Detected Layer Roof Material; Membrane Under Gravel Rock Over This House And Pool House S Miscellaneous Good `None None Low Non - friable Included Alcove -' Asbestos Not Sle , Detected Layer Roof Material; Membrane Under Gravel Rock Over This House And Pool, House . The following non - suspect materials were observed during the survey (no samples were taken): No insulation observed behind the walls only above ceilings A/C duct fiberglass insulation, ceramic tiles, terrazzo floors. 10097 Cleary Boulevard * #305 # Plantation, FL 33324 • phone: 954. 227.2402 • Fair: 866. 816.5110 wwwarsenvironmental.eom • sales@Orsenvironmental.com A1QO Emowxmaw. INC. Environmental Consulting Services Asbestos Business License #ZA- 0000164 Asbestos Consulting • Radon Measurements • Lead Assessments • Indoor Air Ouality Testing • Mold Investigations Today's Date: 2/26 /2014 Project Number. 20140306 Page 7 of 16 Prepared For Ronny Herrera Thunder Demolition Inc 7373 Ne 3rd Court Miami, F133138 Job Site: Residential Dwelling 9179 North Bayshore Drive Miami, Fl Asbestos Survey — Bulk Sample Itemization Sample Sample Physical Water Material Sample Positive Asbestos Number Material Class / Samvle Descrimion / Location Condition Damage Damage Contact Friability Approximate Size stop Detected Sample 19 Miscellaneous Good I None I None I High Non - friable 25,000 Sq. Ft. Asbestos Not Detected Layer Concrete Structure On The Floors And Exterior Walls The following non - suspect materials were observed during the survey (no samples were taken): No insulation observed behind the walls only above ceilings A/C duct fiberglass insulation, ceramic tiles. terrazzo floors. 10097 Cleary Boulevard • #305 • Plantation, A 33324 • phone: 954. 227.2402 • Fax: 866.816 -5110 WWW.arsenifironmental.com *sales Carsenvironmental com ARS EmoROMMENTAL, INC. Environmental Co »sulti »g Services Asbestos Business License #ZA- 0000164 Asbestos Consulting • Won Measurements • Lead Assessments • Indoor Air Quality Testing • Mold Investigations Today's Date: 2/26/2014 Project Number. 20140306 Page 8 of 16 Prepared For Ronny Herrera Thunder Demolition Inc 7373 Ne 3rd Court Miami, F133138 Job Site: Residential Dwelling 9179 North Bayshore Drive Miami, Fl I' Friable Asbestos Containing Material Sample Sample Physical Water Material Sample Asbestos Number Description / Material Class Location Approximate Size Condttion Damage Damage Contact Friability Detected NONE DETECTED Recommendations Friable: any material containing more than one percent asbestos which has been applied on ceilings, walls, structural members, piping, duct work, or any other part of a building, which when dry, may be crumbled, pulverized, or reduced to powder by hand pressure. The following work practice should be followed whenever demolition/renovation activities involving RACM occur: Notify EPA of intention to demolish/renovate, remove all RACM from a facility being demolished or renovated before any disruptive activity begins or before access to the material is precluded, keep RACM adequately wet before, during, and after removal operations, conduct demolition/renovation activities in a manner which produces no visible emissions to the outside air, and handle and dispose of all RACM in an approved manner. The above building material is considered friable and must be removed by a Florida Licensed Asbestos Abatement Contractor, prior to any disturbance caused by renovation or demolition. When implementing the response actions, parties responsible for final selection should remember that actions shall be sufficient to protect human health and the environment, but may also be the least burdensome method. Nothing in these recommendations should be construed as prohibiting or discouraging removal. In the event that demolition or renovation is deemed necessary, parties shall comply with all applicable laws, ordinances, rules and regulations of Federal, State and Local Governmental Agencies, including any National Emissions Standard Hazardous Air Pollutants (N.E.S.H.A.P.) Notification requirements 10097 Cleary Boulevard • #305 • Plantation, R 33324 • Phone: 954 - 227 -2402 • Fax': 866 - 816 -5110 ulalwarsenvironmental.com • sates@arsenvironmental.com Environmental Consalting AKZP EmmommExTAL, INC. Asbestos Business License #ZA- 0000164 Asbestos Consulting • Radon Measurements a Lead Assessments a Indoor Air Oualitg Testing a Mold Investigations Today's Date: 2/26/2014 Project Number. 20140306 Page 9 of 16 Prepared For Ronny Herrera Thunder Demolition Inc 7373 Ne 3rd Court Miami, F133138 Job Site: Residential Dwelling 9179 North Bayshore Drive Miami. Fl _ 1 gory.Z - .Non -Fr ably i sb 6s Containing Material Sample Sample Physical Water Material Sample Asbestos Number Description / Material Class Location Approximate Size Condition Damage Damage Contact Friability Detected plc Black Mastic On Concrete Inside The Hallway To 152 Sq. Ft. 9 Garage West Side Of House Under Ceramic Tiles Good None None High Non friable Yes Layer Miscellaneous Sam pl e Black Mastic On Concrete Inside The Hallway To Included 10 i Garage West Side Of House Under Ceramic Tiles Above Good None None High Non - friable Yes !, ayer Miscellaneous Sample ° X 9° Floor Tiles; Beige Inside The Guest Room West 182 S Ft. q 11 Black Mastic Side Of House Under Tiles 1st Layer Good None None High Non - friable Yes Layet Miscellaneous Recommendations The above referenced Asbestos Contained Building Materials may be left in place if deemed to be in good condition and no repairs or renovations are scheduled which would disturb them. Care should be taken to ensure that the materials not be disturbed during repair, renovation or remodelling activities which could possibly release fibers into the air. To reduce the intrinsic liability to the owners, the ultimate solution may be to have the material removed. However, at the minimum, a formal Operations and Maintenance (O&M) Program is recommended to minimize potential fiber releases, monitor any future deterioration, and to ensure proper record keeping. Under the FDEP regulations, Category I non - friable asbestos- containing materials may be left in place during demolition under wet conditions. However, OSHA regulations require that disposal of asbestos- containing materials and debris is disposed of in a leak -tight and labeled container. The container may be plastic bags so long as the holding is leak -tight. All materials must be disposed of in a Class I landfill and manifest as Category I Non - Friable Asbestos containing material. To meet the requirements of a wet demolition, it is the responsibility of the demolition contractor to control any visible emissions by adequately applying water on the structure. Furthermore, the work practices for the demolition of a building containing asbestos must be in regulatory compliance with OSHA 1926.1101. All materials must be kept thoroughly wet or saturated during the demolition to assist in preventing the release of asbestos fibers. A certified asbestos supervisor must perform or supervise the work. If during the demolition process visible emissions are observed, the asbestos- containing materials must then be abated. The regulations of the Occupational Safety and Health Administration (OSHA) applies to any detectable amount of asbestos in building materials or on facility components. This requirement covers worker training, work practices, and disposal methods. In summary, removing asbestos in a commercial setting requires training, specific work practices, and disposal methods for the asbestos and asbestos- containing debris. However, if Category I Materials have become friable or are in poor condition, they must be removed before demolition or renovation begins by a Florida Licensed Asbestos Abatement Contractor. When implementing the response actions, parties responsible for final selection should remember that actions shall be sufficient to protect human health and the environment, but may also be the least burdensome method. Nothing in these recommendations should be construed as prohibiting or discouraging removal. 10097 Cleary Boulevard a #305 a plantation, FL 33324 a Phone: 954- 227 -2402 a Fax': 866 -816 -5110 a ww arsenvironmentaLcom a sales@arsenvironmentaLcom ` Environmental Consulting Services ENVIROMMENTAL, 1NC. Asbestos Business License #ZA- 0000164 Asbestos Consulting a Radon Measurements a Lead Assessments a Indoor Air Quality Testing a Mold Investigations Today's Date: 2126/2014 Project Number. 20140306 Page 10 of 16 Prepared For Ronny Herrera Thunder Demolition Inc 7373 Ne 3rd Court Miami, F133138 Job Site: Residential Dwelling 9179 North Bayshore Drive Miami, Fl - Categolry I Non- Flriable,As1>,est0s Containing Material Sample Sample Physical Water Material Sample Asbestos Number Description ! Material Class Location Approximate Size Condition Damage Damage Contact Friability Detected SaT c Black Mastic On Concrete Inside The Guest Room West Included - Side Of House Under Tiles 1st Layer Above Good None None High Non - friable YeS, Layer Miscellaneous Samp linoleum Floor Sheeting Inside Center Area Of Pool To Be 1S lack Mastic House Under Ceramic Tiles Determined Good None None High Non - friable Yes Y9r: Miscellaneous Sampi Linoleum Floor Sheeting Inside Center Area Of Pool Included 16 Black Mastic House Under Ceramic Tiles Above Good None None High Non friable; Yes Layer Miscellaneous _ The above , .... ., R'oillThlirl'�Ililati01" . referenced Asbestos Contained Building Materials may be left in place if deemed to be in good condition and no repairs or renovations are scheduled which would disturb them. Care should be taken to ensure that the materials not be disturbed during repair, renovation or remodelling activities which could possibly release fibers into the air. To reduce the intrinsic liability to the owners, the ultimate solution may be to have the material removed. However, at the minimum, a formal Operations and Maintenance (O&M) Program is recommended to minimize potential fiber releases, monitor any future deterioration, and to ensure proper record keeping. Under the FDEP regulations, Category I non - friable asbestos- containing materials may be left in place during demolition under wet conditions. However, OSHA regulations require that disposal of asbestos- containing materials and debris is disposed of in a leak -tight and labeled container. The container may be plastic bags so long as the holding is leak -tight. All materials must be disposed of in a Class I landfill and manifest as Category I Non - Friable Asbestos containing material. To meet the requirements of a wet demolition, it is the responsibility of the demolition contractor to control any visible emissions by adequately applying water on the structure. Furthermore, the work practices for the demolition of a building containing asbestos must be in regulatory compliance with OSHA 1926.1101. All materials must be kept thoroughly wet or saturated during the demolition to assist in preventing the release of asbestos fibers. A certified asbestos supervisor must perform or supervise the work. If during the demolition process visible emissions are observed, the asbestos- containing materials must then be abated. The regulations of the Occupational Safety and Health Administration (OSHA) applies to any detectable amount of asbestos in building materials or on facility components. This requirement covers worker training, work practices, and disposal methods. In summary, removing asbestos in a commercial setting requires training, specific work practices, and disposal methods for the asbestos and asbestos- containing debris. However, if Category I Materials have become friable or are in poor condition, they must be removed before demolition or renovation begins by a Florida licensed Asbestos Abatement Contractor. When implementing the response actions, parties responsible for final selection should remember that actions shall be sufficient to protect human health and the environment, but may also be the least burdensome method. Nothing in these recommendations should be construed as prohibiting or discouraging removal. 10097 Cleary Boulevard a #305 . Plantation, FL 33324 a 'hone: 954 -227 -2402 a Fax: 866- 816 -5110 WWwarsenvironmentalxom a sales@arsentlironmental.com AKZP Environmental Consulting Services EmoRommExTAL, INC. Asbestos Business License #ZA- 0000164 Asbestos Consulting • Radon Measurements • Lead Assessments • Indoor Air Quality Testing • Mold Investigations Today's Date: 2/26/2014 Project Number: 20140306 Page 11 of 16 Prepared For Job Site: Ronny Herrera Thunder Demolition Inc 7373 Ne 3rd Court Miami, FI 33138 Residential Dwelling 9179 North Bayshore Drive Miami, FI Category H - Non - Friable Asbestos Containing Material Sample Sample Physical Water Material Sample Asbestos Number Description / Material Class Location Approximate Size Condition Damage Damage Contact Friability Detected NONE DETECTED Recommendations The above referenced Asbestos Contained Building Materials may be left in place if deemed to be in good condition & no repairs or renovations are scheduled which would disturb them. Care should be taken to ensure that the materials not be disturbed during repair, renovation or remodelling activities which could possibly release fibers into the air. To reduce the intrinsic liability to the owners, the ultimate solution may be to have the material removed. The above building materials are considered Category II Non - Friable and are likely to become crushed, crumbled, pulverized or reduced to powder during demolition or renovation therefore must be removed before demolition or renovation begins by a Florida Licensed Asbestos Abatement Contractor. To meet the requirements of a wet demolition, it is the responsibility of the demolition contractor to control any visible emissions by adequately applying water on the structure. Furthermore, the work practices for the demolition of a building containing asbestos must be in regulatory compliance with OSHA 1926.1101. All materials must be kept thoroughly wet or saturated during the demolition to assist in preventing the release of asbestos fibers. A certified asbestos supervisor must perform or supervise the work. If during the demolition process visible emissions are observed, the asbestos - containing materials must then be abated. The regulations of the Occupational Safety and Health Administration (OSHA) applies to any detectable amount of asbestos in building materials or on facility components. This requirement covers worker training, work practices, and disposal methods. In summary, removing asbestos in a commercial setting requires training, specific work practices, and disposal methods for the asbestos and asbestos - containing debris. However, if Category II Materials have become friable or are in poor condition, they must be removed before demolition or renovation begins by a Florida Licensed Asbestos Abatement Contractor. When implementing the response actions, parties responsible for final selection should remember that actions shall be sufficient to protect human health and the environment, but may also be the least burdensome method. Nothing in these recommendations should be construed as prohibiting or discouraging removal. 10097 Cleary Boulevard • #305 • Plantation, A 33324 • phone: 954 - 227 -2402 • Fax': 866 - 816 -5110 a wwwarsenvironmental com a sates@arsenvironmental.com Environmental Consulting Services OWCO ENVIRONMENTAL INC. Asbestos Business License #ZA- 0000164 Asbestos Consulting • Radon Measurements • Lead Assessments • Indoor Air Ouality Testing • Mold Investigations Today's Date: 2/26/2014 Project Number: 20140306 Page 12 of 16 GeI►eml TerMS and COQditiolms Scope of Work ARS Environmental's inspections are limited and non - destructive in nature. Any conditions or materials which were not able to be visually observed on the surface, or in easily accessible areas, were not inspected and may differ from those observed. It was not within the scope of this investigation to remove surface materials to investigate portions of the structure or materials which lay beneath the surface. Our selection of sample locations and frequency is based upon our observations and the assumption that like materials in the same area are homogeneous. This inspection report is the result of a diligent search of the facility for Asbestos Containing Building Materials (ACBM). The purpose of this inspection was to identify those materials which may pose a health hazard to occupants of a building and impart future liability to the owners and insurers of the property. However, we do not claim to have identified all of the asbestos containing building materials present in the facility. Materials such as underground pipes, any material inside walls, ceilings, floors, or other enclosed and inaccessible areas were not sampled and are not covered in this report. This report is designed to aid the building owner, architect, construction manager, general contractor, and potential asbestos abatement contractor in locating asbestos containing building materials. Under no circumstances is this report to be utilized as a proposal or a project specification document. This report is based upon conditions and practices observed at the property and information made available to the surveyor. This report does not intend to identify all hazards or unsafe practices, nor to indicate that other hazards or unsafe practices do not exist at the premises. In the event that demolition or renovation is deemed necessary, parties shall comply with all applicable laws, ordinances, rules, and regulations of federal, state, and local governmental agencies, including any National Emissions Standard Hazardous Air Pollutants (NESHAP) notification requirements. Right of Entry The client will provide for right of entry to ARS Environmental's personnel in order to complete the above referenced work. Invoices ARS Environmental will submit invoices to client upon completion of services. Ownership of Documents All reports, field data, field notes, laboratory tests data, calculations, estimates, and any other documents prepared by ARS Environmental as instruments of service shall remain the property of ARS Environmental. Assumptions and Limitations The results, findings, conclusions, and recommendations expressed in this report are based only on conditions which were observed during inspections by this report. ARS Environmental makes no representation or assumptions as to past conditions or future occurrences. Nether the client nor ARS Environmental may delegate, assign, sublet or transfer his duties or interest in this agreement without the written consent of the other party. Roof Cuts To obtain accurate information in a roof investigation, roof cuts approximately four inch 4" squares, may be deemed necessary. It is the responsibility of our client to make appropriate repairs to these roof cuts, using materials consistent with the roofing system and in accordance with any existing material manufacturer's warranties. A roofing contractor or maintenance personnel selected by our client should be on the roof to make any necessary repairs at the time the samples are being obtained. Although, every attempt will be made to make these repaired areas water tight] ARS Environmental will in no way be responsible for any water damage to the roofing system, building, or it's contents resulting from ARS Environmental temporary repairs. Disclaimer If in the course of a renovation or demolition activity, suspect materials become exposed, ALL FURTHER ACTIVITY SHOULD IMMEDIATELY CEASE AND THE STATUS OF THE MATERIAL SHOULD BE DETERMINED BEFORE PROCEEDING. 10097 Cleary Boulevard • #305 • Plantation, R 33324 0 Phone: 954-227-2402 • Fax': 866 -816 -5110 WWW.arsenvironmentaLcom a sales@arsenctironmental.com ARS EmmommE 1 AL, IA1C. Environmental Consulting SerOices Asbestos Business License #ZA- 0000164 Asbestos Consulting •Radon Measurements • Lead Assessments • Indoor Air Ouality Testing • Mold Inoestigations Today's Date: 2/26/2014 Project Number. 20140306 Page 13 of 16 Prepared For. Ronny Herrera Thunder Demolition Inc 7373 Ne 3rd Court Miami, Fl 33138 C4 Job Site: Residential Dwelling 9179 North Bayshore Drive Miami, H Asbestos Survey — Technician Chain of Custody Forms and Field Notes Paus Opoem" stop � ogre 1 an Fdable 79� 1% WO Projet Locadon: _ 9lqq _ rr' OArsi-oft.F palvr Saner Taken By: 7• MW&c 04-' MW _ �R 1. .&M I � PraE� Number: ?05C- 0 /- ®ROOF San Hng Gate; Z/U//q - z - - ohm �mpte D�w� L oaatlon A ash "n�Ru:.z.t4►s� "�'t -�E wc+1..LS s i �'l /V /v' )+ F pJ 7r:7C f�l+ l3V+� A� tX7t+ti Cis tN5�D(r �MAe�/ 6%0 Poor- igw3v . 3 S A 11 y 5 K P1 As acv �N� ,Kame caija4- A9*A w13rSeVV djv'-~F V S h ✓i ltssiOF 'f�+t� L#�uwsy 'ib �& p 1 M nn�as��� o�/ co�,u+EtE >�as raF vt.oc� em&,,t , t5�' G(( N �( �-1 NF Trawlerred BY: + — Date: Received Date: 1 C�.EaRtr BOULEVARD • #30S • Pu►wrA low, FL 33324 • PHOwE: 2?,�- d02 • Fax: 8x818.5110 10097 Cleary Boulevard a #305 • Plantation, R 33324 • phone: 954- 227 -2402 • Fax. 866 - 816 -5110 www.arsenvironmentat com • sates @arsenvironmentatcom ARS EmoROWMEWTAL, INC. Environmental Consulting Services Asbestos Business License #ZA- 0000164 Asbestos Consulting • Radon Measurements • Lead Assessments • Indoor Air Quality Testing • Mold Investigations Today's Date: 2/26/2014 Project Number. 20140306 Page 14 of 16 Prepared For Ronny Herrera Thunder Demolition Inc 7373 Ne 3rd Court Miami, F133138 M d Job Site: Residential Dwelling 9179 North Bayshore Drive Miami, Fl Asbestos Survey Technician Chain of Custody Forms and Field Notes Project Locatlon: ice- ct>t�ta'c� Du.�feLi iM�i Sampfing oats: z.tzb (t q1-+1 cam: e�sq cDKvt< Samples Taken By: 3 � ►Mtu�Ptyou,/ —IMINT l�t EX7' arfttxW4UU hW— -zcyN -0'3C� ROOF Of -2- Traneterred By: Date, l _ Recelyed BY: 29.VW ° 9 fflMVcLzkRy BOULEVARD • #305 • LmiT 7toK FL 33324 - Pty W: 964- i 24 ' • FAx: 866 -816 5110 10097 Cleary Boulevard • #305 - plantation, R 33324 • phone. 954 -227 -2402 • Fax: $66 -516 -5110 mot..arsenvironmental.com • sales@arsenvirenmental.com Malaria] calm t Location A 0 COMM earnp�a M ®41L�L Xq mat �� 17101 `f /NS I ag iYle &ad-sr -.Aw- S.)?E• ,140.$� „yPeIL WUF3. 19V C7 H /VF lArs, m T ie dr,.£Sr 94a'7 i VO' lit at ?tv- J sfrcA 7703 4 AMA,' i M 41 14 h Sh 8 K /ors, ► p- 0 F 'rte- 1 �tt7L pF0i7b rlwPt- "" TOT M vN MIL 7',aiC4,,:s OV02 i� M r ,)A$ AAP /?IVL 1* 1%f 6 Al L- L L -1 iYtM� 17r61rn% t 77 r� F- lcrr�zs ,a.,o� W*",- 2,000' 6-1 N 1 tli(. vlA3s /�sc/b17�✓ tc�.�tr 'Ili 7i�'Zo 7YY e Traneterred By: Date, l _ Recelyed BY: 29.VW ° 9 fflMVcLzkRy BOULEVARD • #305 • LmiT 7toK FL 33324 - Pty W: 964- i 24 ' • FAx: 866 -816 5110 10097 Cleary Boulevard • #305 - plantation, R 33324 • phone. 954 -227 -2402 • Fax: $66 -516 -5110 mot..arsenvironmental.com • sales@arsenvirenmental.com AK20 Environmental Consulting Services �IV VRommEV T AL. INC. Asbestos Business License #ZA- 0000164 Asbestos Consulting • Radon Measurements • Lead Assessments • Indoor Air Quality Testing • Mold Investigations Today's Date: 2126/2014 Project Number: 20140306 Page 15 of 16 Prepared For Ronny Herrera Thunder Demolition Inc 7373 Ne 3rd Court Miami, F133138 Job Site: Residential Dwelling 9179 North Bayshore Drive Miami, Fl Asbestos Survey - Laboratory Results AIRS SwROmmaTAL. mG A&.,oa. C . a . a l e n g . a a d m M a u m . l . m f . . L e a d A—.. u . l a d o m o g w ft T d g • &1d lwndeatlom Today. Date: Z26'2014 Pftjm Nmtbm 10140" Page 1 d2 Prepazed For. Job Site: Rotmy Heatem ReMmtiat Dwalmg 7Ltmder Deam dM IUC 9179 Notth Bayshmc Drive 7373 Ne 3rd Cmta Miami. H Munro. F133138 Alex FmN. 2! .aoaq'd 10097 Cfear9 8oafevard • 0305 • PWaadon FL 33324 • Phonc 954. 227.2402 • Fwc 866- 818.5110 mmmarseavhvamemf.eom • safesgownWronmentaLeom 10097 Cleary Boulevard • #305 • plantation, FL 33324 • phone: 954 -227 -2402 • Fax': 866- 816 -5110 WWW arsenvirenmental.com 0 sales@arsentfironmental.com 1.81t10P8t -y AndyAs Sempk L ®ned Aahmm Nw -ub�es Noo-fitnom N®6ea am4s Deaupion Pe><emga AFIDen %blmeibts �._.':'] LL : Drycalllloi,Wompowd NoA Detected 30%Callalow SD% 2 Giese Z " Dry-11 11oiat Compo and No A*4 Detected W, C 1111 a -51% ?I' at— : '. Dryaedl I JoitC,,p—d No Asbestos Detected 30 %Ce0plose SO% 20'5 Glma 4 Dry% -AVkmt Compomd No Aste ,Deeded 301a Collnlme 2r. (11— 7 My- 11,MiM Compered No Aebeams D...d 30AGleCe0Nsa w. SO°k 2� Plmer No Aab— Detected 5%C11111— 9S% H9 No Abe wDetected "Ceuolme 9S% :g Placer No Mb.. Detected S°.e Ce1lNose 9S7 �. Caaorote �NuAsbeaAOS- I�eB` -::f 100% bfasac L0%C sonic f:J ]0°b CeOnlose eo°b Ion Maw. 10��n a 10� cenwox eon Alex FmN. 2! .aoaq'd 10097 Cfear9 8oafevard • 0305 • PWaadon FL 33324 • Phonc 954. 227.2402 • Fwc 866- 818.5110 mmmarseavhvamemf.eom • safesgownWronmentaLeom 10097 Cleary Boulevard • #305 • plantation, FL 33324 • phone: 954 -227 -2402 • Fax': 866- 816 -5110 WWW arsenvirenmental.com 0 sales@arsentfironmental.com A,RS &6fironmentat Consatting Services EmmOMMENTAL, INC. Asbestos Business License #ZA- 0000164 Asbestos Consulting • Radon Measurements • Lead Assessments * Indoor Air Oaality Testing • Mold Investigations Today's Date: 2/26/2014 Project Number. 20140306 Page 16 of 16 Prepared For Job Site: Ronny Herrera Residential Dwelling Thunder Demolition Inc 9179 North Bayshore Drive 7373 Ne 3rd Court Miami, Fl Miami, Fl 33138 Asbestos Survey — Laboratory Results assess: C -Wtlag • Padm At ..m.m.ms • Lwd A.wmmem. • lad=Ah Om11tg &.t* q Mad htre.do d m Today's DM: 2/2612014 Project NmIMn 20140306 Page 2 of 2 Plepaced Fm. Job Site: Rtmay licnaa Rend -tial Dcdh g Thimdea 10emolidca Inc 9179 Nmth Beysbmo Div. 7373 Ne 3rdComt Mai. F hfiaati, FI33138 B�Iatedal+ Alex From, 4&2K Aad5,a 10097 Cleary &devard • 0305 • Plalrtativa FL 33324 • Ph= 954 - 227.2402 • Foe 866.816.5110 agvWaraeavlroomeata %eom • sdes@xwWfroamdataL6om 10097 Cleary Boulevard • #305 • Plantation, FL 33324 • phone. 954- 227 -21102 • Fax. 866 - 816 -5110 WWW arsenvironmentat com • sates@arsenvironmental.eom Lab-4-7 AnnlyWs 3mp1e Ea®med Aebeam Neambmas Noo-Lbiom N ber thou Desdpdm PmcmvBe °<I+Aea B�Iatedal+ ji R—riit. P% a."-. 95% bfastic F?'+'0M.W. ]� FlamTde ,3S,7ayeadk `!t 95% 4%cbysomgr 10°O C. S%S 311% „..13 -;: FlamTde No Asbesms Deterred 100% MmdC No Asbesms Detected 10% S. I07 C BO% ,.:. j4::. flomTile No Asbestos Detected 100% Mastic Ne Asbestos Detected 30 %3, 107C 80% 1'.$ I.imlemn (7ieyi.dle ,`: ^al°k(3,5%C, 3 %S 40% Mastic IDL14 „. ':.. t0 %C.5%G.3 %S 75% 1Jaoleam :. Magic ib %ChgwWe :: 10 %C..4 %G..-KS 75% Membmm No Asbesms Deterred 3.5 %0— IS %CCSolou 35% IS %Sy.Ih c 18. h9 ®bmm 11, A,1-- Detected 35°.e Glass IS!a CeSdose AS'o IS %SyvOxtic 19 -. Cmaetc No Aslesms Deterred 1 100% Alex From, 4&2K Aad5,a 10097 Cleary &devard • 0305 • Plalrtativa FL 33324 • Ph= 954 - 227.2402 • Foe 866.816.5110 agvWaraeavlroomeata %eom • sdes@xwWfroamdataL6om 10097 Cleary Boulevard • #305 • Plantation, FL 33324 • phone. 954- 227 -21102 • Fax. 866 - 816 -5110 WWW arsenvironmentat com • sates@arsenvironmental.eom THUNDER DEMOLITION. INC. March 10, 2014 7373 ME 3rd COURT MIAMI FL 33138 TEL: 305.757.9444 FAX: 305.757.9441 www.thunderdemolition.com 1 Miami Shores Village MAR p 20 Attn: Mechanical Reviewer BY: 10050 NE 2"d Avenue Miami Shores, Florida 33138 / Re: 9179 Bayshore Dr. — demolition permit This letter is to inform you that the above referred property has been vandalized. For this reason we are not filling mechanical permit application due to the fact that there is no Freon to remove. Please see attached pictures. Should you have any questions please do not hesitate to contact me. Thank you, V Ronny Herrera, President Thunder Demolition, Inc STATE OF FLORIDA COUNTY OF MIAMI -DARE T is foregoi statement was sworn to and subscribed before me this p0 day of Qafek 2014 by r� ge".. who is personally known to me or has produced his/her Driver's License # as identification and who did / did not take an oath. `,,x%111 #111111, otary Public, State Orj;@Q*W My commission 4piris J= mar \� � � ƒ \� / � � � . �/ � 1"Zi VIN THUND -2 OP ID: GG CERTIFICATE OF LIABILITY INSURANCE 03 X114 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 Phone: 561 - 683 -8383 SLATON INSURANCE Fax: 561 - 684 -5995 P.O. BOX 220637 West Palm Beach, FL 33422 Raul N. Mercader AcT Genheve Lawrence NAM PHONE 561X83 -8383 a No: 561 -684-6995 A/C No ADDRESS: glawrence@slatonrlskservices.com INSURER(S) AFFORDING COVERAGE NAILS INSURER A:Gemini Insurance Company 10833 INSURED Thunder Demolition Inc. 7373 NE 3rd Court Miami, FL 33138 INSURER B: Commerce & Industry Ins. Co. 19410 INSURER C: INSURER D : INSURER E : $ 1,000,00 INSURER F: $ 100,00 COVERAGES CERTIFICATE NUMRFR! 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. NL SR TYPE OF INSURANCE D. POLICY NUMBER POLICY EFF POLICY EXP Lams 10050 NE 2nd Ave GENERAL LIABILITY Miami Shores Village, FL 33138 EACH OCCURRENCE $ 1,000,00 PREMISES Me occurrencel $ 100,00 A X COMMERCIAL GENERAL LIABILITY X VGGP001 I Be 021`08114 02/08/15 CLAIMS MADE I OCCUR MED EXP (Any one person) $ 5,00 PERSONAL & ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 GERL AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP AGG $ 2.000,00 $ POLICY F-xl SPENT- LOC AUTOMOBILE LIABILITY CEO eBBIINdED SINGLE LIMIT $ BODILY INJURY (Per person) $ ANY AUTO BODILY INJURY (Per accident) $ ALL OWNED SCHEDULED AUTOS AUTOS NON HIRED HIRED AUTOS AUTOS PROPERTY DAMAGE accident $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 3,000,00 AGGREGATE $ 3,000,00 B EXCESS LIAR CLAIMS -MADE SE021325010 02/27114 02127115 DED I X I RETENTION$ 0 $ WORKERS COMPENSATION AND EMPLOYERS' LIABLfrY ANY PROPRIETORIPARTNER/EXECUTNE YIN OFFICER/MEMBER EXCLUDED? (Mandatory In NH) NIA TOCY L M U- OTH- E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ H yes, describe under DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (AUach ACORD 101, Additional Remaft Schedule, H more space Is required) Re: License #053SO0348 Miami Shores Village Building Department is included as additional insured with respect to general liability as required by written contract. f_FRTIFIf`ATF FIAT r1FR ('AMC-'Fl I ATIAN MIAMISH 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 NE 2nd Ave AUTHORIZED REPRESENTATIVE Miami Shores Village, FL 33138 ©1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD