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CC-15-1925 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-244206 Permit Number: CC-7-15-1925 Scheduled Inspection Date: September 25, 2015 Permit Type: Commercial Construction Inspector: Rodriguez,Jorge Inspection Type: Final Owner: HERMELEE, BRUCE Work Classification: Alteration Job Address:9020 BISCAYNE Boulevard Miami Shores, FL Phone Number Parcel Number 1132060110120 Project: <NONE> Contractor: TONKA CONSTRUCTION INC Phone: (407)947-0386 Building Department Comments REPLACE TILE AND PARTITIONS Infractio Passed Comments INSPECTOR COMMENTS False Inspector Comments Passed 1. Failed Correction ❑ Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid September 24,2015 For Inspections please call: (305)762-4949 Page 33 of 34 s ' Miami Shores Village " Ino 10050 N.E.2nd Avenue µ �ler�ltl� irk� ltt # tlt€ Miami Shores,FL 33138-0000 n - Phone: (305)795-2204 orleiExpiration: 03114/2016 Project Address Parcel Number Applicant 9020 BISCAYNE Boulevard 1132060110120 WAL MIAMI LLC Miami Shores, FL Block: Lot: Owner Information Address Phone Cell WAL MIAMI LLC 275 MADISON Avenue NEW YORK NY 10016- 275 MADISON Avenue NEW YORK NY 10016- Contractor(s) Phone Cell Phone Valuation: $ 10,000.00 TONKA CONSTRUCTION INC (407)947-0386 Total Sq Feet: 00 Approved:In Review Available Inspections: Comments: Inspection Type: Date Approved::In Review Final PE Certification Date Denied: Window Door Attachment Type of Construction:REPLACE TILE AND PARTITIONS Occupancy Load: Tie Beam Stories: Exterior: Slab Front Setback: Rear Setback: Termite Letter Left Setback: Right Setback: Framing Plans Submitted:Yes Certification Status: Store Front Attachment Certification Date: Additional Info: Insulation Bond Return: Classification:Commercial Drywall Screw Window and Door Buck Scannin :4 Gelling Grid Fees Due Amount Pay Date Pay Type Amt Paid Amt Due Fill Cells Columns CCF $6.00 Review Electrical DBPR FeeInvoice# CC-7-15-56536 Review Planning $4.50 07/30/2015 Credit Card $50.00 $367.00 DCA Fee $4.50 Review Mechanical Education Surcharge $2.00 09/16/2015 Credit Card $367.00 $0.00 Review Structural Permit Fee $300.00 Review Plumbing Plan Review Fee(Engineer) $80.00 Review Building Scanning Fee $12.00 Review Building Technology Fee $8.00 Total: $417.00 In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans,drawings,statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL,PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction ano zonin Futhermore,I authorize the above-named contractor to do the work stated. September 16,2015 Authorized Sig re:0 er p scant / Contractor / Agent Date Building D ment Copy September 16,2015 1 4 /'� Miami Shores Village �EID Building Department JUL 9 0 2015 1 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 .') Tel:(305)795-2204 Fax:(305)756-8972 BYo INSPECTION LINE PHONE NUMBER:(30S)762-4949 FBC 2 BUILDING Master Permit No(V f PERMIT APPLICATION Sub Permit No. t+t1BUILDING ❑ELECTRIC ❑ROOFING ❑REVISION ❑EXTENSION ❑RENEWAL [-]PLUMBING ❑MECHANICAL ❑PUBLIC WORKS ❑CHANGE OF ❑CANCELLATION ❑SHOP Q CONTRACTOR DRAWINGS JOB ADDRESS: [ 2 V 47/Ye-C) Gtr: Miami Shores County Miami Dade Zia: Folio/Parcel#: Is the BuRding Historically Designated:Yes NO Occupancy Type: Load: Construction Type: /Fll000ddZZone: BFE: FFbE: �a OWNER:Name(Fee Simple Titleholder): ! Ilrt",$ Phonet2z "y719 ®owo Address:,�{{ /'!�!�'/ /900 City: thew Arx Stater Zip: p®y �y ^� Tenant/Lessee dlName: /� �a ew C®< Phone#: 2". 9 M 1M Email: �V e.p i�� ^` ) wcle ypAf"��c'/�,q�f j�s� p�� CONTRACTOR:Company Name:!(0/'S Qd+/ V�6-V4� Phone#: 7��o / Address: ©© d karwe c— aAe- WP. City: 2 ® State:_ A4 Zip: w Qualifier Name:—gin K / Y 01% Phone#: State Certification or Registration#: Ga C 1,2,r&W Certificate of Competency#: DESIGNER:Architect/Engineer. Phone#: Address:_ �' Gty: State: Zip: Value of Work for this Permit:$ :' ®U h lam'z Square/Unear-F�000ttage of Woric Type of Work: El Addition ❑ Alteration F-1t�New Repair/Replace El Demolition Description of Work0®: ]"°�- 4,L@�pajr&jy Specify color of color thru tile: Submittal Fee$ Permit Fee$ CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Educadon Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ (ReWsed02/24/2014) Bonding Company's Name(if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name(if applicable) Mortgage Lender's Address City State Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for 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 pasted notice,the inspection will not be approved and a reinspectio fee will be charged. Signature Signaturi"�_ OWNER or AGENT CONTRA The foregoing instrument was acknowledged before me thisThe foregoing instrument was acknowledged before me this ��day of 20 l� by 2—�-t�. day of 1 �.20 by is perso y known t Tonkin , 1ph�6 /w,ho is personally known to me or who has produced as me or who has 13L produced PL as identification and who did take an oath. identification and who did take an oa �_�� NOTARY PUBLIC: NO U IC��+�1� o e, MARK BELEW a * e Notary Public-State of Florida OFFICIALS '• .•- Sign Sign: %"y �o, MY Comm.Expires Dec 27,2)t 6 Prin ub•C�-Sta s" 1J,,,,;, ommisslon#EE 860951 rint: Gj � Seal. my Coffossiofl Expires APF Seal: •&!!!p!!!!!!!!!!!!!!t!!i!!!!!!!! tq s�Y!}�M►t!!!4M!lMllk+b!ll94tlM!!!!!!!!!!!!8►tfi®HbMiilMUilt9slt8i APPROVED BY Plans Examiner Zoning G Structural Review Clerk (Revissedo2n412014) VThe Pharmacy America Trusts-Since 1901" 200 Wilmot Road 847-315-4318 Deerfield,IL 60015 Date: March 16,2010 Florida Department of Business and Professional Regulation/CILB 1940 Monroe Street Tallahassee,FL 32399 To Whom It May Concern: This letter is authorizing Mike E. McGill as the qualifying agent for Walgreens Co.to be legally and financially qualified to act for the business entity, and will have the authority for approving checks,payments, drafts,and contracts on behalf of the business organizations. Gre . Was Direct / EO Walgre Co. Notary STATE OF: t Y?f}I s COUNTY OF: axe, SWORN TO (or Affirmed)AND SUBSCRIBED BEFORE ME THIS Ie DAY OF 111 6YCJ t , 2010 No i at��ureaWc"Sw ,P Print,Type or Stamp Namy of Notary two,,PURA• ED Personally Known ✓ Or Produced Identification Type of Identification Produced Walgreen Co. Corporate Offices • 106 Wilmot Road • Deerfield, IL 60015 www.walgreens.com ♦5 0 . . ® nn." Miami shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CONTRACTORS' REGISTRATION IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: A. COPY OF QUALIFIER'S STATE LICENCES B. COPY OF LOCAL BUSINESS TAX RECEIPT C. ��OPY OF LIABILITY INSURANCE* D. COPY F E* - C 0 WORKERS COMPENSATION INSURANCE (Workers Compensation EXEMPTION must have NOTICE TO OWNER form and Contractor Affidavit) IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY: A. COPY OF CERTIFICATE OF COMPETENCY OF QUALIFIER B. COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF STATE REGISTERED CONTRACTOR LICENSE OR MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT. D. COPY OF LIABILITY INSURACE* E. COPY OF WORKERS COMPENSATION INSURANCE* (Workers Compensation EXEMPTION must have NOTICE TO OWNER form and Contractor Affidavit) *YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE AS FOLLOW: Certificate Holder: MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES, FL 33138 Certificate must specify the description of operations or contractor license number. BUSINESS NAME: BUSINESS ADDRESS: I� aft CITY, ofi STATE-Cl ZIP �AO BUSINESS PHONE: &0 qY?--O Zk FAX NUMBER s I)—C/ CELL PHONE&0j: 9 Y QUALIFIER'S NAME: QUALIFIER'S LIC NUMBER: STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATIONS CONSTRUCTION INDUSTRY LICENSING BOARD , CBC1258888 The BUILDING CONTRACTOR Named below IS CERTIFIED WE Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2016 JOHNSON,TONKARAY � TONKA CONSTRUCTION.W 1700 OAK GROVE CHASE C)R1VE ORLANDO FL 32820-2255 i -S ISSUED: ISSUED: 07/29/2014 DISPLAY AS REQUIRED BY LAW SEQ# L1407290001305 ------r-r•v--��vv—vvvv'w000Tw—"moo Florida ~�an+�i h,-Tax Collector . Local Business Tax Receipt Orange COUIn y, ICO p to regulation of zoning,health and oh .,Is local business tax receipt is in addition to and not iniieu of any otW tax required by law or municipal ordinance.Is Businesses are r 1. e9 wful authodlies.This reoeipt is valid from October 1 through September 30 of receipt year.Dellnquent penalty is added October 1 2014 EXPIRES 9/30120SINESS OFFICE $30.00 1 EMPLOYEE 18o1-1105635 1801 CERTIFIED BUILDING CO $30.00 1 EMPL TOTAL TAX $60•00 0,10 NSON TONKARAYPREVIOUSLY PAID $60.00 ' TOTAL DUE $0.00T NKA CONSTRUCTION iNC OHNSON TONKARAY 1700 OAK GROVE CHASE DR 1700 OAK GROVE CHASE DR (MOBILE) , e ORLANDO FL 32820 U-ORLANDO,32820 PAID: $60.00 0099-00653705 9/26/2014 This receipt is officiel when validated by the Tax CoNeotor. A 4 07/28 ® CERTIFICATE OF LIABILITY INSURANCE ° '/°°'Y o7�2a/ 015 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 pollcy(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 CONTA T Caple Howden Insurance Agency,Inc. PPS° Linneli Burton FAX 407)857.8808 No):(407)657-1710 10222 E.Colonial Dr. MAIL ORLANDO,FL 32817 ADDRESS: Lburton@howdeninsuranmcom License#:A124292 INSURER(S)AFFORDING COVERAGE NAIC S INSURER A: Atlantic Casuafty INSURED INSURER B: TORUS INS.CO. TONKA CONSTRUCTION INC. INSURER C: 1700 OAK GROVE CHASE DR. INSURER D: ORLANDO,FL 32820 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 00009948-275317 REVISION NUMBER: 36 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 L SUOR POLICY EFF POLICY EXP LIMITS POLICY NUMBER D D A GENERAL LIABILITY M030000192-1 11/1412014 1111412015 EACH OCCURRENCE $ 1,000,000 DAMAGE TO X COMMERCIAL GENERAL LIABILITY p ISES Me occIgRENTEDrence) $ 100000. CLAIMS MADE I 511�OCCUR MED EXP Arty one person $ 5000. PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER, PRODUCTS-COMP/OP AGO $ X POLICY p JECT F-1 PRO LOC Deductible $ 500 AUTOMOBILE LIABILITY MBINED SINGLE LIMIT a a c dem ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS HIRED AUTOS NO"WNED PROPERTY DAMAGE $ AUTOS r e B X UMBRELLA"As X OCCUR 75738J140ALI 04/1612015 04/16/2016 EACH OCCURRENCE $ 1,000,000 EXCESS LIAR CLAIMS-MADE AGGREGATE $ 1,000,000 DED I I RETENTION $ WORKERS COMPENSATION WC STATU- I OTH- AND EMPLOYERS'LIABILITY Y/NTORY LIMITA FR ANY PROPRIETOR/PARTNERIEXECUTNE E.L.EACH ACCIDENT $ OFFICERIMEMBFR EXCLUDED? El N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ If yyrereaa describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Addrdonal Remarks Schedute,If more space Is required) LICENSE#CBC1258888. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN MIAMI SHORES VILAGE BLDG.DEPT. ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE 2ND AVE. MIAMI SHORES,FL 33138 AUTHORIZED RESENTATIVE (Lai) © 988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD Printed by LB1 on July 28,2015 at 12:10PM JEFFATWATER CHtEF FINANCIAL OFFICER STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS'COMPENSATION "CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS'COMPENSATION LAW CONSTRUCTION INDUSTRY EXEMPTION This certiflea that the individual listed below has elected to be exempt from Florida Workers'Compensation law. EFFECTIVE DATE 4/18/2014 EXPIRATION DATE: 4/17/2018 PERSON: JOHNSON TONKARAY FEIN: 453131443 BUSINESS NAME AND ADDRESS: TONKA CONSTRUCTION INC 1700 OAK GROVE CHASE DR. ORLANDO FL 32820 SCOPES OF BUSINESS OR TRADE: LICENSED GENERAL CONTRACTOR Pumuanite Chspter440.08(14),F.$.,enulfteroremrperaftnwh9eWffi6%6mplbe ftmM ahepte bya ecattl8cate ofafte on undwthb a�km amy aotreearmlmne}Bsaarmpeneoaonue�erNechepta.PnmuantloChepter440.06(12},F. CMi6aat�otolectlonrobemtmnpC»apidyo�ywAh)ngmseopa oliha budnesa ortrede asmd vn the rl�of eleo6on to be exempt FuleuanitoChapW 44Q 13L F.si tdotlees ote0aolion to ho azempt aid of ebakn to ba exanw Blma be adr�tto mmoeaon a.et eiyttrrm e9er are 0m mam�mtiee m Isareiiee oltlm aar�mte.Me perwn nsmetl as Ow m�e m oe rw b�ernmeb Om requtrementa of ihb mo�+torlcaearca�e as .Tim dePertman+alma rovolce a mrtlRoaoa ai an�re tmmmue olnre pecan anoe8�tha cacticale ro�6m mgntrenronb oltlda a,dbn. DFS-R-DWG252 CERTMATE OF ELECTION TO aE EXEMPT REVOM 07-12 aUESTIMM(0%03-1808 haps://apps8.fldfs.com/cTreporMewer/reportViewer.aspx?data.=kdvpginc9D7Q3 gH6TER6... 4/17/2014 ...� Miami shores Village Building Department 10050 KE-2nd Avenue Miami Shores,Florida 33138 Tel:(305)795.2204 Fax:(305)756.8972 Notice to Owner—Workers'Compensation Insurance Exempdon Florida Law requires Workers,Compea5mion insurance Coverage under Chapter 440 of dx Florida Statutes. Fla.Stat§440.0$ allows Corporate Oflh s in the eons"Ction industry to'tempt themselves front this requirement for any conaftaction preys prior to obtaining a building permit. Pursuant to the Florida Division of workers'Commiadon Employer Facts Brochure: An employer in the Construction industry who employs one or mora part-time or fuu.tea Cmployees,including the owner,most obtain workers'compensation Coverage• Corporate oiga, or members of a limited liability company(LLC)in dig consmwdw industry may elect to be exempt iF. 1. The officer owns at least 10 percent Cf the stock of the corporffiiem,or in the can of an LLC,a statersent anafing to the tm nom 10 peroeat ownemh* 2. The Mer is listed as an officer of the corpmadan in the records of the Florida Departruent of State.Division of Corporations;and 3. Tho corporation is registered and listed as Rod"with the Florida Dcpwtntout of State,Division of Cwporatione. No mare than lbrea cmWrate ofiliceis per corporadon or li®ted liability company members are aik>wW to be exempt. Construction arCmptiaas are valid for a period of two years or until a voluntary revocation is filed or the exemption is revoked by the Division. Year Corrba.-tor is"questing a Pv=h utuler thio workers'or Wa satiar exCntption and has acknowkdge that he or she will tet uta day labor,part-time employees or sabaonitaCIM for your project.The contractor has provided an affidavit stating that he or she will be the only person allowed to work on you projw.In these circumatgMW,Miami Shores Village does wt nuluire verification of workors'compensation msuraacc coverage fiom the corrQames campmry or tluy labor,part-time employees or subcontractors. BY SIGNING BELOW YOU ACKNOWLEDGE THAT Y HA READ THIS Nt)TICE AND UNDMWAND ITS CON7'bMS. Q /� Sigrmdua /`/�J .State of Florida CosatyofM auxi--Dade The foregoingknout before me this day of >�0 v BY __wag _who 11 y known mew has produced as la-94 cation. sue OFFICIAL SEAL i N INGRID M HOFFMANN SEAL: NOTARY PUBLIC•STATE OF ILLiNO1S ` MY ComMSS1ON S53IRES:013103 6 Tonka Construction Inc. Date: -�^,;LC1'/5- State of County of jk4e- Before me this day personally appeared I��g�=-� rwho,being duly sworn,deposes and Says: That he or she will be the only person working on the project located at- �� *ftht�re� Sworn to or affirmed)and subscribed before me this day of "----�----.20-!�,by ®10 -=M-- �"- Personally Know Or Produced Identification Type of Identification Produced L` Print,Type or Stamp Name of Notary 4 RYAN M.COLE )NOTARY PUBLIC STATE OF FLORIDA CaffM FF16W18 . Expires 9/26/2018 I CERTIFICATE OF LIABILITY INSURANCE 7/291 oi'5' THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder In Neu of such endorsement(s). PRODUCER CONTACT Melanie Hill E: Roe Insurance Inc. PHONE (727)376-0030 FAX N,1:(727)376-2262 9851 State Road 54 '11 .melanie@roeins.cam INSU S AFFORDING COVERAGE MAIC 4 New Port Richey FL 34655 INSURER A Association Insurance Company 1240 INSURED INSURER B Tonka Construction Inc INSURER C: 1700 Oak Grove Chase Drive INSURER D: INSURER E: Orlando FL 32820 INSURER F: COVERAGES CERTIFICATE NUMBER:2015-2016 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. IEXP LTBR AODLSUOR TYPE OF INSURANCE POLICY NUMBER MMMD EFF POLICY LD D UMC GENERAL LIABILITY EACH OCCURRENCE $ -DAMAGE RERFEff- COMMERCIAL GENERAL LIABILITY PRE 1 ET Ea Cal $ CLAIMS-MADE F-1 OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ POLICY 7 PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY D G HIRED AUTOSAUTOS Per aociden $ UMBRELLA LAB OCCUR EACH OCCURRENCE $ EXCESS LAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ A WORKERS COMPENSATION X WC STATU AND EMPLOYERS'LABILITY Y/N ANY OFFICERIMEMBER�t�DEEDD??MCUTFVE� NIA E.L EACH ACCIDENT $ 500,000 (Mandatory In NH) CV016641001 /15/2015 /15/2016 E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space Is required) Workers Compensation applies to Florida operations only. RE: Tonkaray Johnson Lic#CBC1258888 CERTIFICATE HOLDER CANCELLATION (305)756-8972 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN MIAMI SHORES VILLAGE BLDG DEPT. ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE 2ND AVE, AUTHORIZED REPRESENTATIVE MIAMI SHORES, FL 33138 Melanie Hill/MH ACORD 25(2010105) ©1988.2010 ACORD CORPORATION. All rights reserved. INS025 r9mraKi ni Tho Af'non name and Inn^aro raniaforord marlra of ACf1Rr1 Miami Shores Village uildin Deprtment 10050 N.E.2nd Avnue,Miami Sires,Florida 33138 rel:(30S) S-22 34 Fax:( 5`7S6-8972 INSPECTION LINE 0HO1 iE NUMB :(305)762.4949 FBC 20 BUILDING Master Permit No. PERMIT APPUCATION sub Permit No. fia/sUILDING ❑ELECTRIC' ❑ ROOFING REVI ION ❑EXTENSION ❑RENEWAL, ❑PLUMBING ❑MECHANICAL ❑PUBLIC WORKS CHAtVGE OF 0 CANCELLATION ❑SHOP n .� CONTRACTOR DRAWINGS JOB ADDRESS: Ll, City; Miami ores CounDade Zi 3 Fallo/Parcel#: s the Bui ding Historically Designated:Yes NO Occupancy Type: Load: Construction hype: Flood Zone: SFE: FFFE: OWNER:Name(Fee Simple Titleholder):00i A,&YD' Phone$P �2•#V r- O Address: �!B' t/� Qui . City: ��1 State• 6� Zip: WOO Tenant/Lessee Name:' C-0 r Phone#: 7t �gCIS Email:groe /"elf' �L CONTRACTOR:Company Name: L ►} Phone#:j'2_W_J Address: t d City:-ol lsy4Q State: 0 Zip: oa9rs) CLualifier Name: f1 k4VAJ State Certification or Registration M A rtificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: —city: _State: Zip: Value of Work for this Permit: 01000.9 SquareAUnear Footage of Work: Type of Work ❑ Addition ❑ Alteration 0 Pew I ❑ Repair/Replace ❑ Demolition Description of Work: 0 i) ® ,g Specify color of color thru tile: Submittal Fee$ Permit Fee CF$ CO/CC$ Scanning Fee$ Radon Fee$ BPR$ Notary$ Technology Fee$ Training/Education Fe $ Double Fee$ structural Reviews$ Bond$ TOTAL FEE NOW DUE$ iRev[sed0al24/2oi4i Iry-) %)6.. o t 5 c 11 ) � (4 NOTE: ALL SHEET MUST BE REVIEWED MIAMI-DADE COUNTY DEPARTMENT OF REGULATORY AND ECONOMIC RESOURCES Herbert S.Saffir Permitting and Inspection Center 11805 SW 26th Street(Coral Way) • Miami, Florida 33175-2474 O (786)315-2000 APPLICATION FOR MUNICIPAL PERMIT APPLICANTS THAT REQUIRE PLAN REVIEW FROM MIAMI-DADE FIRE RESCUE AND/OR ENVIRONMENTAL SERVICES PROVIDE MUNICIPAL PROCESS NUMBER HERE N Job Address .)Q Contractor No. U.F- & J l ady 0 6 /��ee�c�f �Z C.5 Folio �� ® — 0 (4® v a Last four(4)digits of Qualifier No. + Contractor Name O o Lot Block 9 M Qualifier Name IT2el 3011njej oc Z2 a. Subdivision PBpg v z Address .20 xh- im-a2 r`� ✓. Metes and bounds Clty.Q%f� r,,,, State Zip [ ] New Construction on [ ] Demolish Current use of property �� cn Vacant Land [ ] Shell Only t- C W [O Alteration Interior [ ] Addition Attached [ ] Alteration Exterior W [ ] Addition Detached Description of Work pg [ ] Relocation of Structure [ ] Re-Roof a [ ] Enclosure [ ] Foundation Only Tent 2 Repair Sq.Ft. Units Floors q '�� [ ] P [ Repair Due to Fire Value of Work P MBLD` y [ ] Chg.Contractor W Owner Category F [ ] Re-Issue a Address [ ] MELE [ ] Re-Stamp z City State Zi ®0 If [ ] MLPG [ ] Revision Wd [ ] Phone flW MMEC Not Applicable for Last four 4 digits of [ ] FIRE of Fire O Owner's Social Security No. cc Name Owner z a Address17a). Get?udt (� n %W n s- w w Address 9 sees a O1_Z , • •••• • ••• W Y citt _� Staten. Zip � ' � v z City 'State:_Z • '. dVO:W ••—r �s•s•s ii Phone4 5� /Vj 03f 7 a Phonevwge ��r•,� • • z c I am requesting a Special Request Plan Review(SRI)to be scheduled as soon as possible at the rN'o?$209 for:•he f jst hou g and$71.50 per each additional hour in addition to the review fees.Minimum charge one-hour. . : •• • ,•.. Wam .• •. a W� 111 Request: Date:�;•• • ..:. M ' 2"a Request: Date: . •M?c cc + • • 31'Request: Date: •• • • '�' • I am requesting Optional Plan Review(OPR)to be scheduled as soon as possible at the rate of$75 for each discipline. a Additional review fees may apply. a 0 0 111 Request: Date: o 2"d Request: Date: Iaro Request: Date: CL 123_01-192 4/14 BUILDING PERMIT CATEGORIES CATEGORY DESCRIPTION PERMIT TYPE BUILDING 01 GENERAL BUILDING—COMMERCIAL MBLD 02 SUB—GENERAL BUILDING—RESIDENTIAL MBLD 08 CANVAS AWNING MBLD 10 COMMUNICATION TOWER MBLD 15 DEMOLITION MBLD 29 METAL AWNING &STORM SHUTTER MBLD 48 SCREEN ENCLOSURES MBLD 55 SWIMMING POOL MBLD 56 TENNIS COURTS(SURFACE PAVING) MBLD 86 TRAILER TIE DOWN MBLD 88 WALK-IN COOLER MBLD ' 91 MARINAS MBLD 92 LOW SLOPE APPLICATIONS(GRAVEL, SMOOTH MODIFIED,SINGLE PLY) MBLD 95 SHINGLES (ASPHALT, FIBERGLASS) MBLD 96 SHINGLES(METAL ROOFS/WOOD SHINGLES&SHAKE) MBLD 97 STAGE 2 VAPOR RECOVERY SYSTEM MBLD 99 SOIL IMPROVEMENT MBLD 0100 BULK STORAGE PROPANE TANK MBLD 0101 REMOVABLE STORM PANELS MBLD 0107 TILE ROOF MBLD 0110 WATER MAIN MBLD 0111 SITE PLAN MBLD 0112 INDOOR EVENT/EXHIBIT MBLD ELECTRICAL 04 FIRE ALARM SPECIALTY MELE 16 SPECIALTY WIRING MELE 38 GENERATORS MELS PLUMBING 0024 INTERCEPTOR/GREASE TRAPS.(REPLACEMENT OR • INSTALLATION THAT IS NOT PART OF A BUILDING PERMIT) MPLU LPGXe• •••••• • 01 '••"• ee L40V•0 .FIED PETROLEUM GAS MLPG 02 ••••% McMELLANEOUS MLPG • 04 •• LJOUMIED PETROL. GAS/STATE MLPG • • ••••• •• • e•eo s ••••• • Goo Reoee• r MEGNANCAL :.• • 00 09 •• A13AV•F/BELOW GROUND TANKS/PUMPS ••••• •:•••: 9 POLLUTANT STORAGE SYSTEM MMEC y 38 COMMERCIAL HOODS MMEC 43 ' •. FIFiE`i•HEMICAL MMEC 46 • •' SPRAY BOOTHS MMEC 48 SMOKE CONTROL MMEC 52 RESIDENTIAL ELEVATOR MMEC FIRE 32 FIRE SPRINKLER FIRE