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DS-14-1857Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 inspection Number: INSP-218483 Permit Number: DS -8-14-1857 Inspection Date: October 28, 2014 Permit Type: Driveways/Sidewalks/Slabs Inspector: Rodriguez, Jorge Inspection Type: Final Owner: , Job Address: 9190 BISCAYNE Boulevard Miami Shores, FL Project: <NONE> Contractor: G&G EQUIPMENT RENTAL, INC Building Department Comments Work Classification: Repair Phone Number Parcel Number 1132060100030 RESURFACING ASPHALT Infractio Passed comments INSPECTOR COMMENTS True Passed a— Inspector Comments Failed El Correction Needed Re -Inspection ❑ Fee No Additional Inspections can be scheduled until re -inspection fee is paid. For Inspections please call: (305)762-4949 October 28, 2014 Page 1 of 1 BUILDING PERMIT APPLICATION Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (30S) 762-4949 BUILDING ❑ ELECTRIC ❑ ROOFING AUG 2 5 2014 FBC 20 10 Master Permit No. ro'S �q � 2S Sub Permit No. ❑ REVISION ❑ EXTENSION ❑RENEWAL PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: Com: - Miami Shores County Miami Dade Zip bi- Folio/Parcel#: 11 - wDL, o j n-- off' ?5T) Is the Building Historically Designated: Yes NO X Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: C0 rA-V VCZ00 y OWNER: Name (Fee Simple Titleholder): N( -, IVi�� '���,i°�� J < Phone#: ~ ! ( Address:\,( City: S " jf� State: Zip: Tenant/Lessee Name: Phone#: Email: �� /high Oji CONTRACTOR: Company Name: f fol i�l S Phone#: 3. / / eJ S� / Address: t 5?C0 cski 40 -'4- -Ao all City: X11 CAW11 State: Zip: 33155 � , t Qualifier Name: i Z,/ j'VN Phone#:�%r'7� C - % / /amt°b State Certification or Registration #: _ r lLf , 0 ��� Certificate of Competency #: ' 1L9 DESIGNER: Architect/Engineer: Phone#: Address: n City: State: Zip: Value of Work for this Permit: $ Square/Linear Footage of Work: 2,2-, 00 0 Type of Work: ❑ Addition ❑ Alteration ❑ New DQ Repair/Replace ❑ Demolition Description of Work: rgaon dla atsp6t+ Specify color of color thru tile: Submittal Fee $ i Permit Fee $ - 0' CCF $ CO/CC $ Scanning Fee $ C ° Radon Fee $ DBPR $ �� Notary $ Technology Fee $ �� Training/Education Fee $ ��`'' 0 Double Fee $ Structural Reviews $ 0 Bond $ - TOTAL FEE NOW DUE $ \ . (Revised02/24/2014) �77� 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 ELECTRIC, PLUMBING, SIGNS, POOLS, FURNACES, BOILERS, HEATERS, TANKS, 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 proved and a reinspection fee will be charged. Signature Signature A� OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this L day of UC-,Cdf 20 DV by 'AAJA .+ ,l Ld4 _ JjY- ho is personally kn_o�nrn to meteor who has produced identification and who did take an oath. NOTARY, PUBLIC: Print: Seal: as The foregoing instrument was acknowledged before me this 8 day of 1/0 20 by o er dy & who is personally known to me or who has produced 1F4- O 2 as identification and ho did to oath. NOTARY PU Sign: Print: � (V IAO -e MY COMMISSION #FF001132I Seal: EXPIRES March 20, 2017 1 (407) 39&0153 FloridallotaryService.com J APPROVED BY (! Plans Examiner Structural Review (Revised02/24/2014) WILKIN HERNANDEZ MY COMMISSION # FF056149 BXRM: S01111ndw 22.2017 r /6l/i Zoning Clerk P=ared by and return to: Felix R. Carrillo, Esq. Attorney at Law Law Offices of Carrillo & Carrillo, P.A. 3676 SW 2 Street Miami, FL 33135-1023 305-460-6001 File Number: 14-1751RE Will Call No.: (Space Above This Line For Recording Datal Warranty Deed CFN: 20140239727 BOOK 29094 PAGE 2011 DATE:04/03/2014 01:13:59 PM DEED DOC 14,400.00 SURTAX 10,800.00 HARVEY RUVIN, CLERK OF COURT, MIA-DADE CTY This Warranty Deed made this 28th day of March, 2014 between Ninety One Ninety Biscayne, LLC, a Florida Limited Liability Company whose post office address is 9190 Biscayne Blvd., Suite 201, Miami Shores, FL 33138, grantor, and Brite Stone Investment LLC, a Florida Limited Liability Company whose post office address is 1160 Kane Concourse, Suite 202, Bay Harbor Islands, FL 33154, grantee: (Whenever used herein the terms "grantor" and "grantee" include all the parties to this instrument and the heirs, legal representatives, and assigns of individuals, and die successors and assigns of corporations, trusts and trustees) Witnesseth, that said grantor, for and in consideration of the sum of TEN AND N0/100 DOLLARS ($10.00) and other good and valuable considerations to said grantor in hand paid by said grantee, the receipt whereof is hereby acknowledged, has granted, bargained, and sold to the said grantee, and grantee's heirs and assigns forever., the following described land, situate, lying and being in Miami -Dade County, Florida to -wit: SEE EXHIBIT "A" ATTACHED HERETO AND MADE A PART HEREOF Parcel Identification Number: 11--3206-010-0030 Together with all the tenements, hereditaments and appurtenances thereto belonging or in anywise appertaining. To Have and to Hold, the same in fee simple forever. And the grantor hereby covenants with said grantee that the grantor is lawfully seized of said land in fee simple; that the grantor has good right and lawful authority to sell and convey said land; that the grantor hereby fully warrants the title to said land and will defend the same against the lawful claims of all persons whomsoever; and that said land is free of all encumbrances, except taxes accruing subsequent to December 31, 2013. In Witness Whereof; grantor has hereunto set grantor's hand and seal the day and year first above written. Florida Limited Liabilily Company BRITE STONE INVESTMENT LLC Filing Information Document Number FEUEIN Number Date Filed State Status Effective Date Principal Address L13000177392 NONE 12/27/2013 FL ACTIVE 01/01/2014 1160 KANE CONCOURSE SUITE 202 BAY HARBOR ISLANDS, FL 33154 1160 KANE CONCOURSE SUITE 202 BAY HARBOR ISLANDS, FL 33154 POLIAKOVA, ANNA 1160 KANE CONCOURSE 202 BAY HARBOR ISLANDS, FL 33154 Authorized Person(s) Detail Name & Address Title MGR POLIAKOVA, ANNA 1160 KANE CONCOURSE, SUITE 202 BAY HARBOR ISLANDS, FL 33154 Title MGMR ADVANCE FLORIDA MANAGEMENT LLC 1160 KANE CONCOURSE, SUITE 202 BAY HARBOR ISLANDS, FL 33154 Municipal Contractor's Tax Receipt Miami—Dade County, State of Florida THIS IS NOT ABILL -00 NOT PAY N. M C CC N0: E746 eUBINESs NAq OCATION RECEIPT NO. EXPIRES 1001 G� 2AVE RENTAL INC New w8miliss SEPTEMBER 30l 2014 MIAMI, FL 33125 7436820 Must ba displayed at piece of business Pursuant to County Code Chapter 8A - Art. 9 & 10 OWNER TYPE OF BUSINESS PAYMBNTRECEflrED G & G EQUIPMENT RENTAL INC SPECIALTY ENGINEERING BY TAX COLLECTORCONTRACTOR 175.00 09/05/2013 0229-13-001053 For more bdemation, visit Local Business Tax Receipt Miami—Dade County, State of Florida -THIS IS NOT A SILL -DO NOT PAY 5252309 BUSINESSNAME/LOCATION G & G EQUIPMENT RENTAL INC 1001 NW► 32 AVE MIAMI, FL 33125 OWNER G & G EQUIPMENT RENTAL INC ancowirwo. RENEWAL 18794 "..LeT.) EXPIRES SEPTEMBER 3012014 Must be displayed at place of business Pursuant to County Code Chapter 8A -Art 8 & W SEC. TYPE OF BUSINESS 196 SPEaAL1Y ENGINEERING CONTRACT Worker(s) 10 E746 PAYNIENT RECEIVED BY TAX COLLECTOR 45.00 09/05/2013 0229-13.001053 This Local Badness Tax Receipt only coarses payment of the local Radom Tas. The Receipt Is sat a license, permit ar a cetl6cation dit holders qualification, to do bestows, Haim am c-* With say gevarem aw or Imuosarea s aai repolatcry laws sad raquirsoaft Which apply to the budmew The RECEIPT NO. above seas he displayed an eR commercial vallicles- IlBemi-Dade Code SetOa-M wo for moretafetmatica, vish r� 6uzm� ui,, U -.I -,,D0-- z °10- i PrI I ons C, s1 CERTIFICATE OF LIABILITY INSURANCE DATE08/25DIYYYII) 08/25/14 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: H the certificate holder Is an ADDITIONAL INSURED, the pollcy(tes) must be endorsed. H 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 endorsament(s). PRODUCER CONTACT NAME: Hemisphere Insurance Group 11401 SW 40 St Ste 340 PHONE 305 501-2801 FAX ( C No): (305) 553-9010 LADDRESS., hemispherelnsgrpQaol.com Miami, FL 33165 Phone (305) 501-2801 Fax (305) 553-9010 INSURERS AFFORDING COVERAGE NAIC d INSURERA: TRAVELERS INS COMPANY INSURED INSURER B ACCIDENT INSURANCE COMPANY INSURER C: G & G EQUIPMENT RENTALS INC INSURER D: 6800 SW 40 ST INSURER E: MIAMI, FL 33155 INSURER F GENERAL AGGREGATE $ 2,000,000.00 %.VYCrval7C0 ctKTIFIGATE 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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. ILTR TYPE OF INSURANCE ADDLSUBR na_GENERAL POLICY NUMBER POLICY EFF POLICY EXP LIMITS B LIABILITY © COMMERCIAL GENERAL LIABILITY ❑ ❑ CLAIMS -MADE O OCCUR F -1Y Y CPPOO10569-00 10/27/2013 10/27/2014 EACH OCCURRENCE $ 1,000,000.00 PRAEMNTED IBES Ee o rrence $ 100,000.00 MED EXP (Any one person $ 5,000.00 PERSONAL & ADV INJURY $ 1,000,000.00 ❑ GENERAL AGGREGATE $ 2,000,000.00 GEN'L AGGREGATE LIMIT APPLES PER: ❑ POLICY ❑ PRO ❑ LOC PRODUCTS - COMP/OP AGG $ 2,000,000.00 $ AUTOMOBILE LIABILITY ❑ ANY AUTO ALL ❑ AUTOS NED ❑ SCHEDULED ❑ HIRED AUTOS ❑ AUTOSW NED ❑ ❑ a MBINED INGLE LIMIT acciddent BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PRar so Id DAMAGE $ $ ❑ UMBRELLA LIAB ❑ OCCUR ❑ EXCESS LIAR ❑ CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ ❑ DED ❑ RETENTION $ A WORKERS COMPENSATION LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) ❑ If yes, describe under DESCRIPTION OF OPERATIONS below N / A Y 6FR13UB-2864C57-6-14 07/24/2014 07/24/2015 WC STATU ElEN'EMPLOYERS' E.L. EACH ACCIDENT $ 1,000,000.00 E.L DISEASE - EA EMPLOYE $ 1,000,000.00 E.L. DISEASE - POLICY LIMIT $ 1,000,000.00 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Addalonal Remarks Schedule, If more space is required) LICENSE E746 CERTIFICATE HOLDER CANCELLATION CITY OF MIAMI SHORES VILLAGE 10050 NE 2nd AVENUE MIAMI, FL 33138 305-756-8972 ACORD 25 (2010/05) OF 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 ©1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD