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PL-08-1839 4 Miami Shores Village Building Department DECo � 20N 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 BY: Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 20 (C7 BUILDING Master Permit Not(-c)rL-- i �6 o� PERMIT APPLICATION Sub Permit No.PL G BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION FOW116WAI LUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP ^� h CONTRACTOR DRAWINGS JOB ADDRESS: City: Miami Shores '' tC1ounty: Miami Dade Zip: 3 3 3`9 Folio/Parcel#: k I3 L©J©( "3� '4 _`C Is the Building Historically Designated:Yes NO _ Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name(Fee Simple Titleholder): ®�L°r� &D++ r.r Phone#: '�OS^93�)'ob�� Address: \ City: l 4t`M 1 S\®cue S State: T—k ! A Zip: 3 3 J Tenant/Lessee Name: Phone#: Email: 1_ Q 9 CONTRACTOR:Company Name: U N�c� U A 1 Nkci Phone#: IOG 4 a22- Address: 0.�® �.�_• .Z srY C'e e� q ^, rnr� , J City: 1y . t` , 9 State: `A. Zip: 3 3 , Qualifier Name: �l l`l �t'1! ®e. S 5 t'-'e_t- Phone#: State Certification or Registration#: C—i—(1_® J 93 S Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ 4 0—®� Square/linear Footage of Work: Type of Work: ❑ Addition Iteration ❑ New ❑ Repair/Replace Demolition Description of Work: d l I a• 'r�4�1�•a!tfit+�'a60r. '".;r : �Drtol . ,�^+ Specify color coldthpu1i .a Submittal Fee$ Permit Fee$ 'w CCF$5• y Corn - Scanning Fee$ 39 old Radon Fee$ —1 s—)*3 DBPR$ y•� Notary$ Technology Fee$ 7 Training/Education Fee$ I ' Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ Li 1 (Revised02/24/2014) 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." a 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 Signature OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this )-4 day of 20 "T , by 11 .4 \day of (Q®L)'etM �p[- 20�J by (� R �* %tAN e r .who is personally known to 't1` W 6C-S S N'e f who is psonally known to me or who has produced �� a.� I L, as me or who has produced � � � L-,. as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOT Y PUBLIC: '.� Si Sign: S g Print 5 r Prin N >° C ••`"r a�q'i 01 Ft 4 Ne1�y '� Ott 8 =o •��: Nop�btic-State Seal: my•: £ omm fres Jul10�g0/8 Seal: E ,bd 18 2618 y Cfission 1 % Comnasm•FF 140350 • �, Contrn APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) R LICENSE 1fV2 G-939.51-1 tnnu t w�avNE vss � fitOW 6E AVE GAtE F ,330"-000 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD (850)487-1395 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 WOESSNER,WILLIAM W ALL COUNTY PLUMBING CONTRACTORS INC PO BOX 13098 PORT EVERGLADES FL 33316 Congratulations1 Vtfith this license you become one of the clearly - one minion Floridians u=sed by the Department of Business,and Professional Regulation. Our professionals and businesses range STATE OF FLORIDA from architects to yacht brokers,from boxers to barbeque restaurants, DEPARTMENT OF BUSINESS AND and they keep Florida's economy strong. PROFESSIONAL REGULATION Every day we work to improve the way we do business in order to CFC039956 -15SUEO" 08/12/2014 serve you better. For trti3ormation about our services,please log onto www.myfloridalicerme.com. There you can find more information CERTIFIED PL TNG CONTRACTOR about our divisions and the regulations that impact you.subscribe WOESSNER,W t GAAIIW` to department newsletters and learn more about the Department's ALL COUNTY P BiNG CO CTORS IN initiatives. Our mission at the Department is:License ESicieri ft Regulate Fairly. We costrive to serve you better so that you can serve your customers Thank you for doing business in Florida, IS CERTIFIED under the provisions of Ch.489 FS. and congratulations on your new license! date:Aug 3t.2018 u40812OW2MG DETACH HERE RICK SCOTT;GOVERNOR KEN L.AWSON,SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD CFC0399W The PLUMBING CONTRACTOR Named below IS CERTIFIED �s� Under the provisions of Chapter 489 FS. Expiration date: AUG 31,2016 O 3Q WOESSNER,WILLIAM W ALT.COUNTY PLUMBING Ct1NTRACTORS!NC 1870 NE 207 STREET NORTH MIAMI 9tAC- ``FL33179 r ...----— ....,.......... MILIM Av AO M=r%i 110CM OV 1 A\A/ Ccne 14dn1417nnn2nist BROWARD COUNTY LOCAL BUSINESS TALC RECEIPT 115 S. Andrews Ave., Rm. A-100, Ft. Lauderdale, FL 33301-1895—954-831-4000 VALID OCTOBER 1,2014 THROUGH SEPTEMBER 30,201S DBA: Receipt#:182-12722 Business Name: INC Business Type:COUNTY PLUMBING CONTRACTORS PLUMBING/LWN SPRNKL/CONTRACTOR (PLUMBING CONTRACTOR) Owner Name:WILLIAM W WOESSNER Business Opened:11/19/1991 Business Location:701 N E 1 AVENUE State/C0unty1CerW0g:CFC039956 POMPANO BEACH Exemption Code: Business Phone:954-796-6124 Rooms seats Employees Machines Professionals 1 • For Vending Business Only Number of Machines: Vending Type: Tax Amount Transfer Fee NSF Fee Penalty Prior Years Collection Cost Total Paid 27.00 0.001 0.00 1 0.00 1 0.00 1 0.00 27.00 THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS THIS BECOMES A TAX RECEIPT This tax is levied for the privilege of doing business within Broward County and is non-regulatory in nature.You must meet all County and/or Municipality planning WHEN VALIDATED and zoning requirements. This Business Tax Receipt must be transferred when the business is sold, business name has changed or you have moved the business location.This receipt does not indicate that the business is legal or that it is in compliance with State or local laws and regulations. Mailing Address: WILLIAM W WOESSNER. Receipt #30A-13-00013382 PO BOX 13098 Paid 09/30/2014 27.00 PORT EVERGLADES, FL 33316 i 2014 - 201S n 0 o io o iso i tvFt atNelcsNdr$ pit iM +tfi� � a ��. � tt $$ �� � i;� �t Y.>~, .y 11�y�,����yt..� � ,t ywgg`` Fcz � a- t` 5 � �.Li'.!.l�:T d.t k �� a .�r'�tst1 wg 1MK� fR �C , 1H" t s .�-f }fi._�'�p4 �,.r'E`���s � y� � ;i,� �� r,-z'� �i.;`�r� y��s�v:�, y r•.;i �;f p. n � KOM ��a 1 t t rf tFcry 7*� S'i't �. nor - ip �p'� f�(i€ y'q�� f� w'k l�� 'v i KMIEC mom 'r OEM. s �r,��. ,-� SY�� y tt MIN `s �. r ?'v .a• k ,,_> x. P> r y s b �' Y ;_ n �r' `�+�_'��' �.,,. � k.r `' X 1A �? _ ''3 � �5 at uv��'Srr �. ri t�.t `�' i','� Yt � � + -� ��h'�h� .�7�' v. w.,, f fi .,3�-°�"r,� •1 .+� Wil-0 ,.01 v- ..nrfor; � �fi ik.,- ZQ,'� i m'5„ sy.:,:-a, `4 �• 1 Fr. as.r f. �.:' r "` �1 v .,.:,^� }...w h ..��'-� M � �e:y.d ,t.,.k„' 4, �.,. P` �+�*l.;.�fa� as �. H��H t 3 �` .�s d n 'r,Af k - ° ..i -.a i aer�, 1rk �. ,� �5� fS �FFNN' �TM•-�'u'"f'.�.'M tiri,?rc` }3� v f �,ru 1C a r _y sT � �3f�r'n tlti 4 ` A M js h`t 1if �� ri a VA look ion ... , 1 �u� i14Nt `3C��' M 1 tJ t4 X /1 i 8 4th r i CERTIFICATE OF LIABILITY INSURANCE °J'TEI►,m`°�'"> �.,. 111202014 TWO CERTIFICATE 18 ISSUED AS A NATTER OF INFORMATION Ott-Y AND CONFFRS NO RIGHTS UPON THF CFRTIFICA'TI_HOLD17R.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NFGATWI Y AMFND,F.xTI•ND OR ALTER THF COVF,RAGE AFFORDED BY THE POLICIeS BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTIME A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPUTANT: If the cortlticate holder to an WWNAL IRSUA90,dw policy(M)must rm endorsed. It SUBROGATION IS WAIV05.sH ject to the tonm and coriditiono ofthe policy,certahr policies may roquiro an andorsorrient.A Statement on this certificate dorm not rontor rhjhtA to the coMeate holder In Ilou of such ondorsa mnl s. Pto=ER 1&r4', ANVGtt,T.CASTRO t SOUTH FL CO&WERCIAL INSURANCE PLANNERS Pnahk 306 814-8618 __ __ , ) }FQ}130IIj 819-2543 i 15186 NW 17TH AVENUE 01004 AUlra+lsu: l NUAL41 LAKG4 FL 33014 + . 41 INSURC'R A ACCIDENT INSURANCC COMPANY 11573 "LRM INSURER D ALL COUNTY PLUMBING CONTRACTORS INC .. __ 140 NE 214TH STREET • u FR ----- MIAMI FL 33179 tusunPn r COVERAGrS CERTIFICATE NIIMOER: REVISION NUMBER: THIS IS TO CCliilry T!tAT T11C roucICE Or INSJRAN(:E Lth rED dtLUVV HAVE UttGN ISSULU I U I Ht;N!Wkk:-)NAMLUAWJVt-UH lilt:IJUUUY YkW(.}U INIJ1;7A i L-L}. NU 17JI 1113[ANJ;NG ANY HeQU1RLMENT,TERM OR CGNGITION or ANY CCK TRA-,T 013 0T-IFR(3aCUMEN T WITH RFSPFGT TO V441CH THIS r;aRTlFW..ATF MAY RF I;Burr)OR MAY Pr-RTAINI,n lt'IhStjr%AN(.r Arr(lRDCD I3Y"I If F"IC17:i DI-SC.RIB171)I ICREIN 15 SUBJECT TO At l TI tr T[RMS, FXCI USnV S Ani')CONTNTIONS OF 3t1CFI Pot iCiGS.I EMITS SI 10 WN MAY I WVE 31CN REDUCED DY LAID:LAIh1 N}►N AO UeN POLICY EFF P JCY EXP tYPt OF INSURANCE a LJIAl15 + .61k } CENCRAL LIAMUITY 1 Alall 4F ui,r,�.Nt _ s 1 0,000 r k TO A x fnmuirAI�N 4;FNF'RN 1 M5i'.IIrY M@AR.l :,a9.tCA Prc�irM rcr _... 'v 100,000 _....__ IJCLAIr.a+AK uJo:.Un CPP001T18800 1110>3,'2014 1110512018 r,Snex�r 1'C99 rap,;_ . 85,000 — -- .1400.000 I ueraPnALAu�R��ArE X2,000,000 LAcrt I.ur a^y,l? rN n Pa,, ,f.Tz cGa1Pr{IP 1, 12,00,000 p X ..Y PfiC1 1 L. i AUTQk/QGULLWILITY UGSA h}LtLi44I My A,JTO BCiQ'.Y IHJIA3Y I✓c+pn,nu,j e Awk W01LN wHF.rOAKD I H01I1.YIPURJY4�4:'mAu;08 AUIM :kttv} i PAKh,ITK�hv4H) -NMl}dhff I Y t ,AeFt : IIIICWAV C4 Xaan - I LIG194EtLA UAe y flf:l;I1{1 I I ni;Il r';;w'S1KKrl1;1. �$ , CMOs LIAO LAMA&AV* Awn rum 0yew I IAPB rrY Y 1 N I ,4NY i�NUNHIk{iNV'Aklk:Jt�)LtL'dl OFFICN.A! i E4-E�t.h At,Ciik'NT --t-?--- ET WEMEER CXfXUZW? tMata6hury in NHI ,F, IOAI-AFF rA HJA',1,4I s rY.xr CJHBCRPTH3N OF LIPtNAI�4y1 LOGATpIN9F VEHRI.ttl IAlle6llh{:CNjLI tYi,A9Atl10p✓11 Kemahl5clw61fa.d mpry EPaw a roquuv�l PLUMBING CONTRACTOR CERTIFICATE HOLDER CANCELLATION I MIAMI SHORES VILLAGE HHOULU ANY OF 1148 ABOVE DESCRIBED RXICIES BE CANCELLED BEFORE THE 6XPIRAIKM DATE TFERBDF, NOTICre WALL e@ UELIVLRED IN 1 BUILDING DEPARTMENT ACCOROANCL WITH THF:FOLJCY PRWSIONS. 10080 NE 2ND AVENUE MIAMI,FL 33138 AUIr1uu1111eeuHtr►ctytNram�rPA GENIAN --�Qpyys UNDERWRITERS INC U 1988.2010 ACORU CORPORATION. AN rights reserved. ACOkU 25(2010i1D5) Tills ACORD name and logo are rogistemd n1,'trhz of ACORD JEFF ATWATER •�°�`°�" ~ CHIEF 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 certifies that the individual listed below has elected to be exempt from Florida Workers,Compensation law. EFFECTIVE DATE: 4/25/2013 EXPIRATION DATE: 4/25/2015 PERSON: WOESSNER WILLIAM FEIN: 651117368 BUSINESS NAME AND DRESS: ALL COUNTY PLUMBING CONTRACTORS INC PO BOX 13098 PORT EVERGLADES FL 33316 SCOPES OF BUSINESS ORT DE: PLUMBING NOC AND DRIVERS Pursuant to Chapter 440.05(14),F.S.,an officer of a corporation who elects exemption from this chapter by filing a certificate of election under this section may not recover benefits or compensation under this chapter.Pursuant to Chapter 440.05(12),F.S.,Certificatesof election to be exemi¢t...apply only within the scope of the business or trade listed on the notice of election to.be exempt.Pursuant to Chapter 440.05(13),F.S.,Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation if,at any time after the filing of the notice or the issuance of the certfficate,the person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate.The department shall revoke a certificate at any time for failure of the Person named on the certificateto meet the requirements of this section. DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 07-12 QUESTIONS?(850)413-1609 m r JEFF ATWATER CHIEF 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 certifies that the individual listed below has elected to be exempt from Florida Workers'Compensation law. EFFECTIVE DATE: 4/25/2013 EXPIRATION DATE: 4/25/2015 PERSON: WOESSNER WILLIAM FEIN: 651117368 BUSINESS NAME AND ADDRESS: ALL COUNTY PLUMBING CONTRACTORS INC PO BOX 13098 PORT EVERGLADES FL 33316 SCOPES OF BUSINESS OR TRADE: PLUMBING NOC AND DRIVERS Pursuant to Chapter 440.05(14),F.S.,an officer of a corporation who elects exemption from this chapter by filing a certificate of election under this section may not recover benefits or compensation under this chapter.Pursuant to Chapter 440.05(12),F.S.,Certificates of election to be exempt...apply only within the scope of the business or trade listed on the notice of election to.be exempt.Pursuant to Chapter 440.05(13),F.S.,Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation If,at any time after the filing of the notice or the Issuance of the certificate,the person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate.The department shall revoke a certificate at any time for failure of the person named on the certificate to meet the requirements of this section. DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 07-12 QUI=-§TIONS?(850)413-1609 m r .... ..�.� Miami shores V11age Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Notice to Owner - Workers' Compensation Insurance Exemption Florida Law requires Workers' Compensation insurance coverage under Chapter 440 of the Florida Statutes. Fla. Stat. § 440.05 allows corporate officers in the construction industry to exempt themselves from this requirement for any construction project prior to obtaining a building permit. Pursuant to the Florida Division of Workers'Compensation Employer Facts Brochure: An employer in the construction industry who employs one or more part-time or full-time employees, including the owner, must obtain workers' compensation coverage. Corpora elect to be exempt if te officers or members of a limited liability company (LLC) in the construction industry may 1. The officer owns at least 10 percent of the stock of the corporation,or in the case of an LLC,a statement attesting to the minimum 10 percent ownership; 2. The officer is listed as an officer of the corporation in the records of the Florida Department of State,Division of Corporations;and 3. The corporation is registered and listed as active with the Florida Department of State,Division of Corporations. No more than three corporate officers per corporation or limited liability company members are allowed to be exempt. Construction exemptions are valid for a period of two years or until a voluntary revocation is filed or the exemption is revoked by the Division. Your contractor is requesting a permit under this workers' compensation exemption.In these circumstances,Miami Shores Village does not require verification of workers'compensation insurance coverage from the contractor's company. Therefore,you maybe personallyliable for the worker compensation in juries of an erson allowed to work under this ermit. Please check with your insurance carrier since most property insurance policies DO NOT cover this type of liability. BY.SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. Owner Contractor Print Name: r LrlL J t��� Print Name: / �r, �/ ` k Signature: Signature: State of Florida) State of Florida) County of Miami-Dade) 4� � County of Miami-Dade � Sworn to apd subscribed befo e i�� Sworn tod su scribed before me this-1L'I_� y 20 N ' day of By �,(Q\ LOVA- �� r ` By �r �IIA-Ni ujoPs.S' Z'_(- (S+64 'o'"r �;$ DAVID P.NESTER T c1g (SEAI,),';a.'N'''••. T of, alm rpdieed;ta1 It)°f1Aa '•.,;ol��o?� Commission N FF 140350 :Q? My Comm.Expires Jul 18,2018 .�;'� Commission#FF 140350 �lL Miami Shores Village Building Department JUN r2 g RE'_`0 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 No. PERMIT APPLICATION Master Permit No. FBC 20 Permit Type: PLUMBING �y� OWNER:Name(Fee Simple Titleholder): Q__1l - Phone#: w J— t�� Address: 1?1"5 l.. t Is;-(- City: s; (City: rD 14ri-N k qo Z- State: \ L_ Zip: *3 Tenant/Lessee Name: Phone#: Email: JOB ADDRESS: 0ri S-T City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR:Company Name: 3Phone#: Address: City: State: Zip: Qualifier Name: Phone#: State Certification or Registration#: Certificate of Competency#: Contact Phone#: Email Address: DESIGNER:Architect/Engineer: Phone#: Value of Work for this Permit:$ Square/Linear Footage of Work: Type of Work: ❑Address ❑Alteration ❑New ❑Repair/Replace ❑Demolition Description of Work: &A tA�(0IL l l 2 k--CCY?- fU C2- Submittal Fee$ Permit Fee$ CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Bond$ Notary$ Training/Education Fee$ Technology Fee$ Double Fee$ Structural Review$ TOTAL FEE NOW DUE$ 5 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 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 approve and a reih pection fee will be charged. Signature Signature caner or Agent Contractor The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of 20 K,by1L��ECV1 day of ,20_,by who to me or who has produced who is personally known to me or who has produced As identification and who did take an oath. as identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: Sign: Print: Print: My Commission Expires: My Commission Expires: APPROVED BY s� Plans Examiner Zoning Structural Review Clerk (Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09) Miami shores Village logo Building Department 10050 N.E.2nd Avenue ��Ripp► Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CHANGE OF CONTRACTOR/ARCHITECT Permit N. — 1253, 01 Owner's Name(Fee Simple Title Holder): J t)`l C", rt Phone#: i Owner's Address: Al, _ - City: M'r&"rrj State : )CI-110Y Zip Code: 3 -3>. Job Address(OF where work is being done): /d-3 rid=6--' . 9 r City: Miami Shores–Z State:r/Florida Zip Code: Contractor's Company Name: 11 LA--'VfL Phone#: Address: City: State: Zip Code: Qualifier's Name : Lic. Number. Architect/Engineer of Record Name: Phone#: Address: City: State: Zip Code: Describe Work: TLjMj3l4,,= NPPI-T L&cJ I hereby certify that the work has been abandoned and/or the contractorlarchitect is unable or unwilling to complete the contract. I hold the Building Official and the Mi i Shores harmless for all legal involvement. Signature Signature 9 9 owner or Agent Contractor or Architect The foregoing instrument was aknowledged before me The foregoing instrument was aknowledged before me this day of �w" 20 ll,by this day of .20 by Who is personally known to me or who has produced who is personally known to me or who has produced �Ayficalion. as indentification. Notary Public: �� Q Notary Public: Sign: = C , _ Sign: Seal: =�� '•G�6 9� ���,� ��, �� ,� Seal: Miami Shores Village Building Department ti 1'0050 N B 24d Av t ue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 OWNER BUILDER DISCLOSURE STATEMENT NAME: DATE; ADDRESS: Do hereby petition the Village of Miami Shores to act as my own contractor pursuant to the laws of the State of Florida,FS 489.103(7). And I have read and understood the following disclosure statement,which entitles me to work as my own contractor;I further understand that I as the owner must appear in person to complete all applications. State Law requires construction to be done by a licensed contractor.You have applied for a permit under an exception to the law.The exemption allows you,as the owner of your property,to act as your own contractor even though you do not have a license.You must supervise the construction yourself.You may build or improve a one-family or two-family residence.You may also build or improve a commercial building at a cost of$25,000.00 or less(The new form states 75,000).The building must be for your own use and occupancy.It may not be built for sale or lease.If you sell or lease a building you have built yourself within one year after the construction is complete,the law will presume that you built for sale or lease,which is a violation of this exemption.You may not hire an unlicensed person as a contractor.It is your responsibility to make sure the people employed by you have licenses required by state law and by county or municipal licensing ordinances.Any person working on your building who is not licensed must work under your supervision and must be employed by you,which means that you must deduct F.I.C.A and with-holdings tax and provide workers' compensation for that employee,all as prescribed by law.Your construction must comply with all applicable laws,ordinances, buildings codes and zoning regulations. Please read and initial each paragraph. 1. I understand that state law requires construction to be done by a licensed contractor and have applied for an owner-builder permit under an exemption from the law.The exemption specifies that I,as the owner of the property listed,may act as my own contractor with certain restrictions even though I do not have a license. Initial 2. 1 understand that building permits are not required to be signed by a property owner unless he or she is responsible for the construction and is not hiring a licensed contractor to assume responsibility. Initial 3. 1 understand that,as an owner builder,I am the responsible party of record on a permit.I understand that I may protect myself from potential financial risk by hiring a licensed contractor and having the permit filed in his or her name instead of my own name. I also understand that the contractor is required by law to be licensed in Florida and to list his or licens numbers on permits and contracts. Initial 4. 1 understand that I may build or improve a one family or two-family residence or a farm outbuilding.I may also build or improve a commercial building if the costs do not exceed$75,000.The building or residence must be for my use or occupancy.It may not be built or substantially improved for sale or lease. If a building or residence that I have built or substantially improved myself is sold or leased within 1 year after the construction is complete, the law will presume that I built substantially improved it for sale or lease,which violates the exemption. Initia 5. 1 understand that,as the owner-builder,I must provide direct,onsite supervision of the construction. Initial 6. 1 understand that I may not hire an unlicensed person to act as my contractor or to supervise persons working on my building or residence.It is my responsibility to ensure that the persons whom I employ have the license required by law and b county or municipal ordinance. Initial 7 1 understand that it is frequent practices of unlicensed persons to have the property owner.obtain an owner-builder permit that erQneouSly�rriplies that tfu�properly owner is provrding his oP her oukn labor antl natenafs 7; an pvm�tfuitder may be heltf ile attd s4ole 4¢ jk s finandel ds k dor eny tnlurres sustaiged by art a iiltcgnsed person r is of"eti ltoyee :while w6 ng an roy prapi3rty.lVly hameownei"s rrtsuranee•may not prouitle;coverage for hosse'injuties.l:am wil iAly acting as owner-builder and am aware of the limits of my"insurarnce coverage for injuries to workers on my property: Initial 8. 1 understand that I may not delegate the responsibility for supervising work to be a licensed contractor who is not licenses to perform the work being done.Any person working on my building who is not licensed must work under my direct supervision and must be employed by me,which means that I must comply with laws requiring the withholding of federal income tax and social security con*utions-under the Federal-I nsurart.ce Contributions Act(F().and must.provide workers.compensation for the employee.I-understand-that my faifure;to followrthese may subjeet taserious-financial risk. Initial 9. I agree that,as the party legally and financially responsible for this proposed Construction activity,I will abide by all applicable laws and requirement that govern owner-builders as well as employers.I also understand that the Construction must comply with all applicable laws,ordinances,building codes, and zoning regulations. Initial 10. 1 understand that I may obtain more information regarding my obligations as an employer from the Internal Revenue Service,the United States Small Business Administration,and the Florida Department of Revenues.I also understand that I may contact the Florida Construction Industry Licensing Board at 850.487.1395 or hftp:/Avww.mvfloddalicense.com/dbpr/Dro/cilbfindex.,Wml Initial 11. 1 am aware of,and consent to;an owner-builder building permit applied for in my name and understands that I am the party legally and financially responsible for the proposed construction activity at the following address: Initial 12. 1 agree to notify Miami Shores Village immediately of any additions,deletions,or changes to any of the information that I have provided on this disclosure. Initial Licensed contractors are regulated by laws designed to protect the public.If you contract with a person who does not have a license,the Constr4uction Industry Licensing Board and Department of Business and Professional Regulation may be unable to assist you with any financial loss that you sustain as a result of contractor may be in civil court.It is also important for you to understand that,if an unlicensed contractor or employee of an individual or firm is injured while working on your property,you may be held liable for damages.If you obtain an owner-builder permit and wish to hire a licensed contractor,you will be responsible for verifying whether the contractor is properly licensed and the status of the contractor's workers compensation coverage. Before a building permit can be issued,this disclosure statement must be completed and signed by the property owner and returned to the local permitting agency responsible for issuing the permit.A copy of the property owner's driver license,the notarized signature of the property owner,or other type of verification acceptable to the local permitting agency is required when the permit is issued. Was acknowledged before me this day of -- , 20 til, By q4� _7 '9J who was personally known to me or who has Produced there License or as identification. OWNER ;"- AR - i d'� December 15, 2010 Loncus Plumbing Cont. Inc. 1300 S.W. 70th Avenue Miami, Florida 33144 Re: Miami Shores Building Permit PL 08-1839 Dear Sirs, Please accept this as formal notice that your services are no longer required on the above permit for renovation of my home at 123 NE 97th Street, Miami Shores,Florida 33138. This notice will be on file with the Building Department of Miami Shores. Respecftully, Robert Butler =23 NE 97th Street 'Nfiarhi Shores,FL 33138 u.s�.gqPOSTAI MIAMI PSHQfiES., -- 7010 1670 0001 6804 4812 _ t BE 3315? 10 33144 �5' 51 831- Loficus PT- t�mbing Coni~; 1300 5:W 7 avenue Miami FlRECEIPT orida 33]x'44 `x RE TEE / 1 � 3::-i:.4.4Mr+'»- •r•S jls fit it11l71t1f1it,ltlllffllftlftllttlt}Iltlf Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel:(305)795.2204 Fax:(305)756.8972 - BUILDINGPermit No.ster Permit No PERMIT APPLICATION �� �� � cr8 — 3 a .. ! �� FBC 2004 13 Meg Permit Type: Plumbing Owner's Name(Fee Simple Titlehdlder) (. 'Q� Phone# Q p/CS 7 Owner's Address 123 Ai 97 5T City /ulaow State r/ Zip 3?/ Tenant/Lessee Name �✓ Phone# �- E-MAIL: &eexdt &,"Wrv&.^e.A- Job Address(where the work is being done) /23 �? fi— city_ Miami Shores Village County Miami-Dade Zip . FOLIO/PARCEL# ?•d - O/3 Z�SI d Is Building Historically Designated YES NO lr Contractor's Company Name A 0AV-1 Phone# 60S Contractor's Address City f State Zip Qualifier Name �✓lL Phone# State Certificate or Registration No. &f�� Certificate of Competency No. E-MAIL: Architect/Engineer's Name(if applicable)-A0!!4 C.94*-04a Phone# 3dfr-ri-4- 3 0" Value of Work For this Permit$ Square/Linear Footage Of Work: Type of Work: Addition ❑Alteration [-]New ❑ Repair/Replace' ❑Demolition Describe Work: wall 611 Submittal Fee$ Permit Fee$ CCF$ CO/CC Notary$ Training/Education Fee$ Technology Fee$. Scanning$ Radon$ DPBR$ Zoning$ Bond$ Code Enforcement$ Double Fee$ Structural Review.$ Total Fee Now Due$ 9See Reverse sine 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 -wa'rie :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 acculateand that all Work'wilt be done in compliance with all applicable laws regulating construction and zoning. a "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 B1tFORE .RICORDhNG , YOUR NOTICE OF COMMENCEMENT." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding$2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reins fee will be charged Signature Signature Owner or Agent g nt Contractor The foregoing instrument was acknowledged before me this /0'0" The foregoing i ment was ackn `ledged before me thi day of�,200g,by day of y who is personally known to ' 'Q" ARoUp's who ' personally known to a or who roduced v As i4 '1r pJc l�C}.�ja� Md� Me q,qA� n NOTARY PUBLIC: = EXPIRE$ NpVember ,� as ick tification nd ho did take an oath. ,a .. %°q; 'S� lcridaPlotanr�rnca r� NOTAAt� _ (407) C9�088 a04 o (:' - -41JTDA t- , el lo Sign: , we N 3 'r. Si =, ° mis °n DD570527 0ISSIAMAJAM" 14 Print: 010 Print: FOND u ,�ya;prv6 Co:,rn Svul My Commission Expir : My Com ission E ires: sYxa44cde dex4r ezuxx4e�t x' t'sYueex4e 4e9r sYeY icxxa:4e 'xaY aY* 4ca4'f'e oe xxxie dex&xxtt&xxBr�&uxxxY 4c$kar+txx4r'aYu4e aY 4rdrxxxaY d:�k de oHxxot aY YxxeYx ee o:usYxxaY APPLICATION APPROVED B : �® Plans Examiner Engineer Zoning (Revised 02/08/06) Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores,FL C� I Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-97792 Permit Number: PL-10-08-1839 Scheduled Inspection Date:August 03,2016 Permit Type: Plumbing -Residential Inspector. Hernandez,Rafael Inspection Type: Final I� Owner. BUTLER,ROBERT Work Classification: Addition/Alteration Job Address:123 NE 97 Street Miami Shores,FL 33138- Phone Number (786)556-2919 Parcel Number 1132060132440 Project <NONE> Contractor: HOME OWNER Building Department Comments NEW ADDITION Inspector Comments Passed Failed Correction ❑ Needed Re-Inspection Fee No Additional Inspections can be scheduled until reeinspection fee is paid eMiami Shores Villa � g Building Department Ju 2 2016 0 10050 N.E.2nd Avenue,Miami Shores,Florida 33138Y:� `r Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION UNE PHONE NUMBER:(305)762-4949 FBC 2014 BUILDING Master Permit No. f?c a PERMIT APPLICATION Sub Permit No. ❑BUILDING ❑ ELECTRIC ROOFING REVISION ❑ EXTENSION ❑RENEWAL %PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: -3 IV- City Miami Shores County: Miami Dade Zip: -3_3 1 Folio/Parcel#: 1)32,Q4-, 2132 V Q Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): t2d'8 6 Phone#: 7oyi� VS-4 ;L?/f Address: a 3 /V. 9 3 City: &r ') �/°4/ State: p 4 Zip: 331w Tenant/Lessee Name: /- Phone#: Email: CONTRACTOR:Company Name: 0 Phone#: 6 44J. 7d og�6 Address: City: f / State _=/ Zip: 32161 Qualifier Name: 4:4 State Certification or Registration#: C, A 4 W �?/ Certificate of Competency#: DESIGNER:Architect/Engineer:Mh/& Cajml" C Phone#: Address: '�7-7 A,k- I g City: 441, 15PWS State:r L Zip: Value of Work for this Permit:$ &0 Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New EDisepair/Replace ❑ Demolition Description of Work: Specify color of color thru tile: cc Submittal Fee$ 50 Permit Fee$ 15 0--�' CCF$'41D -'-'CO/CC$ Scanning Fee$ Radon Fee$ "1 .-12) DBPR$ eL1.-I Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ 00 `"04A,40& 04 C.L � Bond$ TOTAL FEE NOW DUE$ f ' (Revised02/24/2014) Bonding Company's Name(if applicable) Bonding Company's Address City StateZip Mortgage Lender's Name(if applicable) Af✓JCC ' - A 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$2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also,a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued in the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature�l/r'`ry°�1' , �!� � Signature 7 f la� OWNER or AGENT C NTRACTOR The foregoing instrume t was acknowledged before me this The foregoing instrument was acknowledged before me this _A9,A'day of 20 /Z ,by ZSR day1�^ofv1U 20�J by who is personally known to F,- ' 0 YC-J � Ct ,who i ersonally known o me as me or who has produced as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: gn• Sign: JV4 Print: /s�f // /�S Print: ��l IC' Seal: ao'':`:�u�c LOISWELIS Seal: PKV p`B!�•• .k * MY CON SION$FF 149810 :2, ,n: ANA P-State p $. ? Notary Public-State o]2017 EXPIRE :Attgu5t23,2018 N,: : My Comm.Expires Apr NndedRnBudget NoblyServica ;;rF e.� P P�' Commission#EE 8 APPROVED BY ✓ & Plans Examiner Zoning L I/ Structural Review Clerk (Revised02/24/2014) EDWARD ROJAS PLUMBING 880 N.E. 111 ST BISCAYNE PARK FL 33161 786443-8846 Main Office 306-944-6788 LICENSED•-BONDED- INSURED CC-CFC 049431 DATE: 7/23/116 STATE OF : FLORIDA COUNTRYOF �I f Before me this day personally appeared4L,d who being duly swom, deposes and says: That he or she will be the only person working on the project located 3 E 7 S Sworn to(or affirmed)and subscribed before me. This 23 y of july 2016 by Personally Know : eis OR:Produced IdentificationPro Type of Identification Produced s% ROSE JEREZ 2; },f Notary Public-sige of Florida _- ommission FF 228792 o my Comm.Expires May 10,2019 /r OF F40e"e /rrpjjeee BondedthroughNation or S Na a of Notary MiamishoresVillage Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305)795.2204 Fax: (305)756.8972 Notice to Owner_ Workers Gam ensation Insurance Exem tion Florida Law requires Workers' Compensation insurance coverage under Chapter 440 of the Florida Statutes. Fla..Stat. § 440.05 allows corporate officers in the construction industry to exempt themselves from this requirement for any construction projept o Obtaining a building permit. Pursuant to the Florida Division of Workers'Compensation Employer Facts Bct rior rochure: An employer in the construction industry who employs one or more part-time or full-time employees,including the owner,must obtain workers'compensation coverage. Corporate officers or members of a limited liability company (LLC) n the constru exempt if in industry may elect to be 1. The officer owns at least 10 percent of the stock of the corporation,or in the case of an LLC,a statement attesting to the minimum 10 percent ownership; 2. The officer is listed as an officer of the corporation in the records of the Florida Department of State,Division of Corporations;and 3. The corporation is registered and listed as active with the Florida Department of State,Division of Corporations. No more than three corporate officers per corporation or limited liability co allowed to be exempt. Construction exemptions are valid fmpany members are voluntary revocation is filed or the exemption is revoked by the Division. Your contractor is requesting a permit under this workers'compensation exemption and has acknowledge that he or she will not use day labor,part-time employees or subcontractors for your project.The contractor has provided an affidavit stating that he or she will be the only person allowed to work on your project.In these circumstances,Miami Shores Village does not require verification of workers'compensation insurance coverage from the contractor's company for day labor,parttime employees or subcontractors. BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. Signature: Owner State of Florida County ofMiami-Dade The foregoing was acknowledge before me this day of By� who is p nallyown tome nr 1,ac.TM,,.r„A asidea fWaftn. LOIS WELLS * * MY COMMISSION 3 FF 149810 SEAL: EXPIRES:August 23,2018 0w, 4,,,qceded TAm Budget N it i SdV1M S�oRFs yi Miami 3� shores Village "" Building Department R'pp► 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CHANGE OF CONTRACTOR / ARCHITECT Permit N. L Owner's Name (Fee Simple Title Holder):[, + f BU j I IFS_ Phone#: j76157% qq 11 Owner's Address: NLL 9"1 SL,- City: lrCity: 0 1 alb ib Me a State:_EZ Zip Coder F ,Job Address (Of where work is being done): SiVAL &hRizin ant City: Miami Shores State:—Florida Zip Code: 33131 Contractor's Company Name:��'1 j A;n r0,�7y17T Phone#: ,f OS' q(-Iv Address. 10 4/// SAI e / S( bx z C- . 3 Ila/ City State: Zip Code: 3 3J 6/ Qualifier's Name: Lic. Number: CC Architect/ Engineer of Record Name: Phone#: Address: City: State: Zip Code: Describe Work: -150 CCI 1/ r=1'AJ& ! 1 hereby certify that the work has been abandoned and/or the contractor/architect is unable or unwilling to complete the contract. 1 hold Building Official and the Miami Shores harmless of all legal i o e t. e - Signature��`` / Signature Owner or Agent ontracto or Architect The foregoing instr ent was aknowledged bb fore me The foregoing in tru nt was aknowledged before me thi day of ,20�f?by a��ey7��4 /� � this1� day of , 20��0 by Who is persona kno n to me who is personally kn wn t or who has duced as in—`-dentification. as indent cation. n N i Notary Public: Sign• Sign: Seal: ��.a:Puy --Los Seal: OLGATEPPER * MY COMMISSION#FF 149810 * * MY COMMISSION#FF 044200 EXPIRES:August 23-2018 EXPIRES:September 22,2017 -Ato,� ' BondadThNBudptlNotlrySertikes �f�TFOFFlO��� BondedThruBudgetNotarySewiees Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305)795.2204 Fax:(305)756.8972 BUILDING Permit No. PERMIT APPLICATION Master Permit No.� � FBC 2004 Permit Type: Plumbing Owner's Name(Fee Simple Titlehdlder) ��bOrfi �,1� �. Phone# Owner's Address City State Zip Tenant/Lessee Name Phone# E-MAIL: Job Address(where the work is being done) City Miami Shores Village County Miami-Dade Zip FOLIO/PARCEL# Is Building Historically Designated YES NO Contractor's Company Name �D1JCS "t-AC, G4P-hone# $® C_ Z-1 Contractor's Address C=-*f CityUXI State .� Zip— � 7 Qualifier Name Phone# j 2.\1Q� L L( State Certificate or Registration No. 2 Certificate of Competency No. E-MAIL: Lpt�iGt 1l t4 Ot— • t-A,�.a� Architect/Engineer's Name(if applicable) Phone# Value of Work For this Permit$ Square/Linear Footage Of Work: Type of Work: Addition ❑Alteration New Ej Repair/Replace El Demolition Describe Work: y�d..��`�{ -C�r► qtr ak oYx&:t*xfr nY aY4a'r 9s aYxeYxdr tk k kak#atrx&aY vk ie oYx9z Y oY 4r att Y 4rFee$'Y nYtt9r a:���t�*xeYtaYx�c aYxee+Yux9e Y+txa4 Yxx&sY oY 4e de dr aYxY 4rXx Submittal Fee$ Permit Fee$ CCF$ CO/CC Notary$ Training/Education Fee$ Technology Fee$, Scanning$ Radon$ DPBR$ Zoning$ Bond$ Code Enforcement$ Double Fee$ Structural Review.$ Total Fee Now Due$ See Reverse side-� 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 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$2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature Signature Owner or Agent Contractor The foregoing instrument was acknowledged before me this The foregoing instrument Vcby, nowled before me this�Z day of 20_,by day of� 4e4asA ,20 who is personally known to me or who has produced who is personally known to me or who has produced ' As identification and who did take an oath. as identification d who did take an oath. NOTARY PUBLIC: NOT .S F FLORIDA Bello Sign: Signa n#DD570527 Prjnt: o Pri t: RU 1ICBONDING CO.,INC. My Commission Expires: ommission E ires: it 4exaY 9rxaYYfrxxir eY9t 4e 4rerx4eu 4r sr*mY 4e o4ueY 4cxek sY deudrxse o4ude 4r da s4 iY a1rxu4exaa x,Y druie irx$nx' xir'lr ie drxerxdeua:xsk$ nYx sY se�aY dexsYu*x4cxst$uak Pex Ar 4r,;eYtdc�:�cir aY APPLICATION APPROVED BY: Plans Examiner Engineer Zoning (Revised 02/08/06) Miami Shores Vilfi Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305)795.2204 Fax:(305)756.8972 BUILDING REC(DINED ,no Permit No. PERMIT APPLICATION OCT 16 2006 aster Permit No. FBC 2004 Permit Type: Plumbing Owner's Name(Fee Simple Titlehdlder) �?'Z/� +'� �(�! �,/ Phone# Owner's Address � �� S City_ K1 I A—VU S State �L- Zip 3 J13 Tenant/Lessee Name Phone# E-MAIL: GLA (,Yo V f1.e Job Address(where the work is being done) City Miami Shores Villaee County Miami-Dade Zip 3 � FOLIO/PARCEL# //- Q/ 3— ?i)tKo Is Building Historically Designated YES NO Contractor's Company Name Auto bl one# �dS_J,��� ✓ Contractor's A ress City State Zip Qualifier Name Phone# .� State CertifiqAte or RegistrViarqqow 6 Certificate of Competency No. Architect/Engineer's Name(if applicable) G Phone#_ 3dj Value of Work For this Permit$ (Y� Y . `e8quare/Linear Footage Of Work: J!- Type of Work: ddition ❑Alteration E]New Repair/Replace El Demolition Describe Work: r xnk 4e�*xxx+Y�ncxxxxolr eY oY�anY ie ah�aY�t4rx d?e�e lr"usY&FeesxS aYxJe�rxaY��rx+Y otxY�exYx&ea Yxtr Yxua4 aY fYxxa�a:Y sexdrxx�r�aaY de Submittal Fee$ Permit Fee$_ ,7 CCF$ CO/CC Notary$ Training/Education Fee$ Technology Fee$. Scanning$ Radon$ DPBR$ Zoning$ Bond$ Code Enforcement$ Double Fee$ Structural Review.$ Total Fee Now Due$ See Reverse side- Bonding Company's Name(if appl e) 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 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 Signature Owner or Agent Contractor The foregoing instrument was acknowledged ged before me this The foregoing instrument was acknowled ed before me thi� day of ,20q,by_'�-(/ � P/ day 2 by , who so_ nary known to me or who has produced who is personally known!!:or who has prod 11X•-C�i As identification and who did take aft oath. as identification and who did take an oath. NOTARY PUBLIC: NOT P L 'Y?yd'• E®RGE MARQUES N E OF FLuRIDA Sign: of D616172 Bello �. PiF7S Novern er , Sign: 527 Print: pri st AUG. 17,2010 My Commission Expires: I'Ri—iil 44 Commission Expires: x��x�x��,r�x�x*�,�xK�,�x+�,rx,�xx�rx• �a,.,�x• �:��� xa4eYxuoexeYxdruxatr�u�xSr•�txx��x���ax�x,��x,r,�:,�:xx��r��x�axx���,��:x•�x�x APPLICATION APPROVED B `G �C>�� Plans Examiner Engineer Zoning (Revised 02/08/06)