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CC-14-472Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 210602 Scheduled Inspection Date: April 23, 2014 Inspector: Rodriguez, Jorge Owner: PROPERTIES LLC, SHORE SQUARE Job Address: 9099 BISCAYNE Boulevard BURGER w1kif'! Miami Shores, FL 33138- Project: <NONE> Permit Number: CC- 3- 14-472 Permit Type: Commercial Construction Inspection Type: Final Building Work Classification: Alteration Phone Number (305)779 -8040 Parcel Number 1132060110040 Contractor: AMERITECH SERVICES INC Phone: (954)642 -6345 Building Department Comments DIG TRENCH FOR INSTALLATION OF FLOOR DRAIN Infractio Passed comments INSPECTOR COMMENTS False April 22, 2014 For Inspections please call: (305)762 -4949 Page 19 of 37 Inspector Comments Passed. Failed Correction Needed ❑ Re- Inspection ❑ Fee No Additional Inspections can be scheduled until re- inspection fee is paid. April 22, 2014 For Inspections please call: (305)762 -4949 Page 19 of 37 Miami Shores Village Building Department 10050 N.E.2nd, Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 BUILDING PERMIT APPLICATION Permit Type: BUILDING JOB ADDRESS: 9099 BISCAYNE BLVD CY -, ooe om�e� e FBC 20 L0 Permit No. Master Permit No. t �� ROOFING City: Miami Shores County: Miami Dade Zip: Folio/ParceW 11- 3206 - 011 -0040 Is the Building Historically Designated: Yes NO NO Flood Zone: OWNER: Name (Fee Simple Titleholder): SHORE SQUARE PROPERTIES Phone#: 695 NE 125 STREET City: MIAMI TenandLessee Name: BURGER KING State: FLORIDA 33161 Email: CONTRACTOR: Company Name: AMERITECH SERVICES INC Phone#: 321 - 236 -0440 Address: 4100 SILVER STAR ROAD City. ORLANDO State: FLORIDA gip; 32808 Qualifier Name: LARRY NETTI Phone#: 321 - 236 -0440 State Certification or Registration #: CBC 1254092 Certificate of Competency #: Contact Phone#: 321 - 236 -0440 Email Address: lacy @ameritech- services.com DESIGNER: Architect/Engineer: Value of Work for this Permit: $ ,, o Cxa,� Square/Linear Footage of Work: Type of Work: DAddition 01(dteration DNew ORepair/Replace Description of Work: Dig trench for installation of floor drain. Submittal Fee Scanning Fee $ Color thru tile: Permit Fee $ CCF $ CO /CC $ Radon Fee $ Notary $ Training(Education Fee $ Double Fee $ Structural Review $ DBPR $ Bond Technology Fee $ TOTAL FEE NOW DUE $ DDemolition Bonding Company's Nan)e (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 roust 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 inspection fee will be charged J Signature Signature er or Agent Contractor The foregoing instrument was acknowledged before me this day of �, 20 A, by , who is personally known to me or who L produced NOTARY Print: My Commission Expires: APPROVED BY KATYA GONZALEZ ComrriMlon # FF 032722 Expires July 2, 2017 Bonded Tleu T y Fein hmmm MWolg 3 The foregoing instrument was acknowledged before me this day of Whck 20 R by who is personally known to me or w identification and who did take an oath. f Plans Examiner Structural Review (Revised 3 112/2012)(Revised 07 /10/07)(Revised 06/10/2009)(Revised 3/15109) NOTARY PUBLIC: !I_ , E My COMPUSS19n Expires: I(I� (VOTARY PUBLIC STATE OF FLORIDA Comm# EE147053 Expires 11)25/2 5 Zoning TO: Burger King, Inc. FROM: Robert Butts DATE: 1/1412014 RE: Contract for floor drain: Per your request the following shall serve as our contract with you for an additional floor drain at 9090 Biscayne Blvd., Miami Shores, Fl. 33138. Scope Of Work: • Trench floor to install new sink, • Remove and dispose of the damaged quarry floor tile. • Pour concrete into the trench • Install new 6" x 6" quarry floor tile The Monthly Price For Above Is: $ 2,250.00 Terms: Net 10 Days: Price valid for 30 days from date of proposal. This price includes the above equipment and material only. This price does not include electrical changes, engineered drawings, permits, freight charges or sales tax. Any changes or additional work required or requested by the Owners, Owner's Representatives or Inspectors will be done at an additional charge. The Ameritech Companies, Inc. shall be held harmless and will not be responsible for the engineering of this equipment or project. By signing this Acceptance of Proposal, you agree to the price spedlimbons and conditions. I hereby give The Ameritech Companies, Inc. authorization to do the work specified and payment will be made as outlined above. The invoice is subject to a 1.5 % per month interest charge plus a ten - dollar per month billing foe for every month the balance remains unpaid. Acceptance Of Proposal: Approved by: Title: Date: 4100 Silver Star Road, Suite A • Orlando, FL 32808 • Tel: 321- 235 -0440 • Fax: 321- 235 -0442 Page 1 of 1 Detail by Entity Name - L0RIIl I I AR`I I by Entity Name RE SQUARE PROPERTIES, LLC i Information ment Number L11000075982 IN Number 452672348 Filed 06130/2011 FL s ACTIVE Live Date 06/28/2011 NE 125TH STREET tTH MIAMI, FL 33161 1 NE 125TH STREET RTH MIAMI, FL 33161 OBERT A. BRANDT, PA )6 NE 125TH STREET ORTH MIAMI, FL 33161 ame & Address tie MGR :HAK, YORAM 36 NE 125TH STREET ORTH MIAMI, FL 33161 tie MGR PTON, ALAN $9 OCEAN BLVD OLDEN BEACH, FL 33160 Report Year Filed Date 2012 03/2912012 Page 1 of 2 http: // search. sunbiz. org / Inquiry/ CorporationSearch/ SearchResultDetail lEntityName /flal -11... 2/10/2014 Detail by Entity Name 2013 04/04/2013 Page 2 of 2 0 *g 2013 -- REPORtTFllla9 ew image i Forms Help 03/29/2012 -- ANNUAL REPORT View image in PDF format 06/30/2011 -- Florida Limited Liability View image in PDF format Coovriaht p and Privacy Polldes State of Florida, DeDartment of State http: / /search.sunbiz.orgl Inquiry/ CorporationSearch/ SearchResultDetail lEntityName /flal -11... 2/10/2014 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 EXCEMKION) 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. 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: AMERITECH SERVICES BUSINESS ADDRESS: 4100 SILVER STAR ROAD CITY ORLANDO STATE FLORIDA ZIP CODE 32808 BUSINESS PHONE: 3( 21 ) 235 -0440 FAX NUMBER L--j CELL PHONE 4( 07 ) 334 -3729 QUALIFIER'S NAME: LAWRENCE A NETTI QUALIFIER'S LIC NUMBER: CAC 1254092 E -MAIL ADDRESS (IF APPLICABLE): Tarry@ameritech- services.com Created on 3119109 BY MLDV 1 RV 3126(09 MLDV NETTI, LAWRENCE A AMERITECH SERVICES INC ONDSL DRIVE ORLANDO FL 32812 Congratulations! With this license you become one of the nearly one million Floridians licensed by the Department of Business and Professional Regulation. Our professionals and businesses range from architects to yacht brokers, from boxers to barbegue restaurants, and they keep Florida's economy strong. Every day we work to improve the way we do business in order to serve you better. For information about our services, please log onto www.myfloridalieense.com. There you can find more information about our divisions and the regulations that impact you, subscribe to department newsletters and learn more about the Department's initiatives. Our mission at the Department is: License Efficiently, Regulate Fairly. We constantly strive to serve you better so that you can serve your customers. Thank you for doing business in Florida, and congratulations on your new license! (850) 487 -1395 STATE OF FLOR10A A C # 4 0 1 r DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CBC1254092 08/30112 128058368 CERTIFIED BUILDING CONTRACTOR NETTI, LAWRENCE A AMERITECH SERVICES INC IS CERTIFIED wader the provieims of cn.489 FS mtpiratioa date. AIIG 31, 2014 L12083002268 DETACH TH!S DOCUMENT HAS A COLORED BACKGROUND • MICROPRINTiNG - L1NEMARK`° PATENTED PAPER 1 OF 8 _ DEPARTMENT OF BUIINESS AND PROFESSIONAL REGULATION CONSTRUCT ON INDUSTRY LI ENSING BOARD SEQ# L12083002288 LICENSE NBR 08/3 /20121128058368 ICBC1254092 The BUILDING CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2014 NETTI, LAWRENCE A AMERITECH SERVICES INC 3 iB 04ONDL DRIVE ORLAMO FL 32812 'VScott Randolph, Tax Collector Local Business Tax Receipt Orange County, Florida This local business tax receipt Is In addition to and not In lieu of any other tax required by law or municipal ordinance. Businesses are subject to regulation of zoning, health and other lawful authorities. This receipt is valid from October 1 through September 30 of receipt year. Delinquent penalty is added October 1. "'ORIGINAL"" 2013 EXPIRES 9/30/2014 5000- 1059677 BUSINESS OFFICENVARHO $30.00 1 EMPLOYEE TOTAL TAX $30.00 STRICKLAND R A - PRESIDNET PREVIOUSLY PAID $30.00 TOTAL DUE $0.00 AMERITECH SERVICES INC 4100 SILVER STAR RD STE A ORLANDO FL 32808 -4618 4100 SILVER STAR RD #A A - ORLANDO. 32808 PAID: $30.00 099-00609243 9126/2013 Scott Randolph, Tax Collector Local Business Tax Receipt Orange County, Florida This local bobwo tax tit Is In addiyan to arul not In Iteu of any other tax required by law or municipal w0tartm Malnesseis are aftM to rapWan of ; nits, health arld o�t8l lawful authorities. This receipt is valid from October 1 through September 30 of receipt year Delinquent penalty Is added October 1. "'ORti1NAl'"' 2013 EXPI RE®�1 14 - 105?i 5000 BUSINESS OFFICEIWARHO $30.00 1 a TOTAL TAX $30.00 ` .__ TRICKLAND R A - PRESIDNET PREVIOUSLY PAID $30.00 ° TOTAL DUE $0.00 AMERITECH SERVICES INC 4100 SILVER STAR RD e 3 STE A 4100 SILVER STAR RD #A - ORLANDO FL 32808 -4618 A - ORLANDO, 32808 PAID. $30.00 099- 00609243 9/26/2013 This receipt is official when validated by the Tax Collector. T. Ir.. i�� �{i -•�ti AMER113 OP ID: LS CERTIFICATE OF LIABILITY INSURANCE 1 ° 02104 02!041201 "Y' /2014 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 cert(ficats holder In lieu of such endorsement(s). PRODUCER Phone: 770 -512 -5000 Brown &Brown Ins. of Georgia Fax: 770- 512 -5050 3483 Satellite Blvd, Suite 100 Duluth, GA 30096 Clay Collins E cT Tara Denning PHONE 770- 512 -5037 FAX No): T70- 512 -5050 0 aoOREss: tdennin batianta.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : Travelers indemnity Cc 25658 INSURED Ameritech Services, Inc. 1500 Airport Drive Bail Ground, GA 30107 INSURERS: Grua American Insurance Co 16691 INSURER C: Travelers Prop cos of America 25674 INSURER D: $ 1,000,00 INSURER E; is 300,00 INSURER F: X COMMERCIAL GENERAL LIABILITY COVERAGES CERTIFICATE NUMBER_ REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILSR TYPE OF INSURANCE D SUM POLICY NUMBER POLICY ERF MM�10 Y LIMITS Alni°R¢E°REPRESEN'I'ATINE GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 I PREMISES (Ea occurrence) is 300,00 A X COMMERCIAL GENERAL LIABILITY X DT- CO4=737174ND -13 03/11/2013 03/1112014 EXP (Any one person) $ 5,00 CLAIMS -MADE I T, OCCUR . PERSONAL & ADV INJURY $ 1,000,00 GENERAL AGGREGATE ($ 2,000,0 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS -COMPIOPAGG $ 2,000, I POLICY PRO- I LOC JEC iEmp Ben. I $ 1,000,0 AUTOMOBILE LIABILITY Ea SIN%g0m INGLE LIMIT 1,000,0 is BODILY INJURY (Per person) $ C ANY AUTO i OT•8104=737- TIL -13 03/11/2013 03/11/2014 BODILY INJURY (Per accident) $ X �r ALL AUTOS ED ', ^ I AUTOS �y� NON -OWNED HIRED AUTOS �-X AUTOS i PROPERTY DAMAGE Per accident is $ j X UMBRELLA X OCCUR EACH OCCURRENCE $ 5,00,0 AGGREGATE _ $ 5,000,_ B EXCESS U AB CLAIMS MADE X TUU025594701 03/11/2013 03/11/2014 DED X RETENTION$ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETORRARTNERIEXECUTIVE OFFlCERIMEMBEREXCLUDED? (Mandatory In NH) I NYA I i DTUB4DO7371.7 -13 ' 03/11/2013 03/11/2014 X WC STAN- OTH- T r E.L. EACH ACCIDENT is 1,000,0 ! E.L DISEASE - EAEMPLOYE $ 1,00,E E.L. DISEASE -POLICY LIMIT $ 1,000,0 ydescribe DESCRiPTI OF OPERATIONS below C Hues Drag ; 1 5082890038 03/11/2013 03MV20i4 ;Comp Ded 1, Short Term IColl Ded 1,00 F_ d NS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, it more space is required) A � nCOTrerrwre U(11 n=0 - f AWI r_l 1 ATlnM MUaMIS1 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 Bldg Dept 1005 NE 2nd Ave Alni°R¢E°REPRESEN'I'ATINE Miami Shores, FL 33136 ©1988 -2010 ACORD CORPORATION. All n9mS reserVe(1. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD AMER113 OP ID: TIP CERTIFICATE OF LIABILITY INSURANCE ° 031121201 "' 03/12/2014 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 berms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder M lieu of such endorsement(s). PRODUCER Phone: 770 -512 -5000 Brown Brown Ins. Georgia Fax: 770-512 -5050 3483 Satellite Blvd, Suite 106 Duluth, GA 30096 Clay Collins Tara Denning PHONE 770. 512 -5037 Fa� No: 770-512 -5037 ��; tdonning@J)Wanto.com INSURER(S) AFFORDING COVERAGE NAIC S INSURER A: Travelers kniannity Co 25658 INSURED Ameritech Services, Inc. 1500 Airport Drive Ball Ground, GA 30107 INSURER B: Great Amutcan Insurance Cc 16691 INSURER C: EACH OCCURRENCE INSURER D: PREMISES Eaenoe INSURER E: MED EXP (Any are person) IN F: PERSONAL RADVINJURY COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE DL S POLICY NUMBER POLICY EFF PMIDD/I E7U+ LIMITS A GENERAL LIABILITY X COMMERCIAL GENERALLIABILITY CLAIMS-MADE 1*1 OCCUR X Miami Shores, FL 33138 DT- 810 -OD0737174I1.44 03/11/2014 03/11/2015 EACH OCCURRENCE $ 1,000,0 PREMISES Eaenoe $ 300,0 MED EXP (Any are person) $ 5,06 PERSONAL RADVINJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,0 GEML AGGREGATE LIMIT APPLIES PER. POLICY PRO• LOC c r] PRODUCTS - COMPIOPAGG $ 1,000, Emp Ben $ 1,000,0 A AUTOMOBILE X LIABILITY ANYAUTO ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS X NON -OWNED AUTOS DT.810-0=11717 TIL -14 03/11/2014 03/11/2015 COMB NEO SINGLE LIMIT 1,0011, BODILY INJURY (Per person) $ BODILY INJURY (Per aoddent) $ PROPERTY DAMAGE az acddeM $ B X UMMBRELLALUIB X OCCUR EXCESS Lwa CLAIMS-MADE DED X I RETENTION $ 90,000 X TUU025594702 0311112014 0311112015 EACH OCCURRENCE $ 5,000, AGGREGATE $ 5,000, $ • WORKERS COMPENSATION AND EMPLOYERS' LIABUM ANY PRoPRlEroRiPARTNERJEJ�curnEY /" OFFICER/ME EPRjF�(CLUDE07 F_] (Mandatory In NH) IDESCRI+ PATIO OF OPERATIONS below N/A DTUB4100737w -14 03/11/2014 0311112015 X I WCYSTATT OTH- E.L. EACH ACCIDENT $ 1A00, E.L. DISEASE - EA EMPLOYE $ 1.000,0 EL DISEASE - POLICY LIMB I $ 1,000, • Hmw Phyakel Omg Short Term DT$110-00073717 -M -14 0311112014 03111/2015 Comp Ded 1, Coll Ded 1,0 DESCRIPTION OF OPERATIONS I LOCAnoNs I VEHICLES (ARa¢h ACORD 101, Addlonal Remarks Schedule, H more space Is required) : CSC1254092 CAC1S14971 CERTIFICATF HALDFR CANCFI 1 ATION MUWIS1 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 Bldg Dept 1005 NE 2nd Ave ��fO�_QD,�A� Miami Shores, FL 33138 ®1968 2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD NOTICE OF COMMENCEMENT A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION PERMIT NO. TAX FOLIO NO. 11- 3206 -011 -0040 STATE OF FLORIDA COUNTY OF MIAMI -DADE THE UNDERSIGNED hereby gives notice that improvement will be made to. - -. R certain real property, and in accordance with Chapter 713, Florida Statutes, the following information is provided in this Notice of Commencement. 4": F Ni 2 Cr, I ., - b y ,,, 777 2 �;F OR _o:= P-1 P .:.f: RECORDED 0 1"11.1., �!M+"4`._ Y �% M P CLERK OF "OUR; t f ' .. I. Legal description of property and street address: 6 53 42 ASBURY PARK PB 4 -110 BEG AT X OF E WW /L BISC BLVD & S /R/W /L NE 91 ST ST RUN El90.16FT S124.93FT W290.02FT NELY ALG E RW/L BISC BLVD 160FT TO POB LOT SIZE 29994 SQUARE FEET COC 24432 -4515 112005 4 9099 BISCAYNE BLVD 2. General description of improvement: Install additional floor drain connecting to existing and install new electrical fixtures r 3.Owner(s) name and address: SHORE SQUARE PROPERTIES 696 NE 125 ST. MIAMI SHORES FL.33161 Interest in property OWNER Name and address of fee simple titleholder (if other than owner): 4. Contractor's name, address, and phone number: AMERITECH SERVICES INC 4100 SILVER STAR ROAD, ORLANDO FLORIDA 32808 321 -235 0440 5. surety: (Payment bond required by owner from contractor, if any) Name and address: Amount of bond: $ 6. Lender's name, address, and phone number: 7. Persons within the State of Florida designated by Owner upon whom notices or other documents may be served as provided by Section 713.13(1)(a)7., Florida Statutes: Name, address, and phone number: 8. In addition to himself or herself, Owner designates the following person(s) to receive a copy of the Uenor's Notice as provided in Section 713.13(I)(b), Florida Statutes: Name, address, and phone number: 9. Expiration date of the Notice of Comrience ent (the expiration date is I year from the date of recording unless a different date is Under penalties of per $, I �eclare that I have read the. foregoing and that the facts stated in it are true to the best of my knowledge and belief. Signature of Natural P tyligning Above // Turn Over for Instructions c k G t.:.; T, 43 'J vr- 4 VTR L). I t PATRICIA OBORN NOTARY PueLlc STATE OF FLORIDA Comm# EE147053 Expires 11/2512015 = 5 o Im 1_ `r x. G "Ex zS* Tl PJ G �" aRa Y N i F- S1 7 L= C r gkJAGER KIM& NEW FLOOR DRAIN 90go BzSCMegLV.t M17-NMIj FL 33139 lk ?1.f` X77 � 6' -5" PATRICIA OBORN NOTARY PUBLIC STATE OF FLORIDA Comm# EE147053 FLOOR SINK ROUGH IN SCALE: 1/4"= 1' -0° I I� � III DIV, ON X77 � 6' -5" PATRICIA OBORN NOTARY PUBLIC STATE OF FLORIDA Comm# EE147053 FLOOR SINK ROUGH IN SCALE: 1/4"= 1' -0° I I� �