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RC-08-1368 (4) y Miami Shores Village _ , BuildingDepartment DEC 0 3 2014 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 J Tel:(305)795.2204 Fax:(305)756.8972 - -- INSPECTION'S PHONE NUMBER:(305)762.4949 BUILDING Permit No. EL-10-08-1840 PERMIT APPLICATION Master Permit No. — F FBC 20 Permit Type: Electrical OWNER:Name(Fee Simple Titleholder): Robert Butler Phone#: 305-933-0683 Address: 123 NE 97 Street City: Miami Shores State: F1 Zip: 33138 Tenant/Lessee Name: Phone#: Email: JOB ADDRESS: 123 97 Street 33138 City: Miami Shores County: Miami Dade Zip: Folio/Parcew 1132060132440 Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR:Company Name: L S Curtis inc Phone#: 786-486-1961 Address: 20341 NE 30 Ave #108 City: Ayentura State: FL Zip: 33180 Qualifier Name: Lewis S Curtis Phone#: 786-486-1961 State Certification or Registration#- EC 0 0 0 317 5 Certificate of Competency#: Contact Phone#: 786-486-1961 Email Address: as s t eye(]a o 1 Com DESIGNER:Architect/Engineer: Phone#: Value of Work for this Permit:$ 5 0 0 0 . 0 0 Square/Linear Footage of Work: Type of Work: ❑Address DAlteration ❑New ❑Repair/Replace ❑Demolition Description of Work: Line voltage receptacles, switches, lights and appliances 4240 �x�xx�xxxx���xxxx�xx�x�:x���xxxxx�xx�xxxFeesnx�xx�xx�xx�xxxxmx:xxxx�x�xxxx�x�x�xx�xxx�x�x 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$ � ` i 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 S Owner or Agent ►� �, Contractor The foregoing instrument was ac owledgeed before me this z4 The foregoing instrument was acknowledged before me this 20 day of 'v t" 20 A by �10-�\e day of November2o 14,by "All w o is p rsonally known to me or who has produced — . who is personally known me or who has produced J7Al..q As identification and who did take an oath. as identification and who did take an oath. NOTARY PUBLI NOTARY PUBLIC: Sign: Sign: I Print: CASSANDRA N NEEBIA Print: c "to I]m _ . *: MY C®MIV1lSSl®N EE299418 My Co 8fal� ®'� My Commiss: EXPIRES July 25,2018 AAy COMM.EXIita Jul Is.414 (407)398-0153 FbridallotaryS .00m Conunlulm I"14M IL �� APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09) STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD (850)487-1395 ft 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 CURTIS, LEWIS STEVEN L.S. CURTIS INC 20341 NE 30TH AVE APT 10B AVENTURA FL 33180 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 A,� STATE OF FLORIDA from architects to yacht brokers,from boxers to barbeque restaurants, DEPARTMENT OF BUSINESS AND and they keep Florida's economy strong. -P PROFESSIONAL REGULATION Every clay we work to improve the way we do business in order to ECO003175 ISSUED:", 05129/2014 serve you better. For information about our services,please log onto WWW.myfloridalicense.com. There you can find more information CERTIFIED ELECTRICAL CONTRACTOR about our divisions and the regulations that impact you,subscribe CURTIS,LEWIS STEVEN to department newsletters and learn more about the Department's L.S.CURTIS INJd initiatives. Our mission at the Department is:License Efficiently,Regulate Fairly. We constan 17 strive to serve you better so that you can serve your customers. hank you for doing business in Florida, IS C.ERTIFIED under the provisions of Ch.489 FS and congratulations on your new license! ExpititWdato AUG3t,2016 Lt4=91=2874 DETACH HERE RICK SCOTT,GOVERNOR KEN LAWSON,SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD ECO003175 The ELECTRICAL CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31,2016 Lid un CURTIS, LEWIS STEVEN L.S.CURTIS INC 26341NE30THAVE#108 AVENTURA FL 33180 rr ISSUED: 05/29/2014 DISPLAY AS REQUIRED BY LAW SEO# L1405290002874 405419 Local pus ness Tax Receipt Miami—Dade County, State of Florida THIS ;IS NOT"A RILL -"00 NOT PAYTj 5108006 BUSINESS NAME1LOC,ATIOIv RECEIPT NO. EXPIRES LS CURTIS INC RENEWAL SEPTEMBER 302015, 20341 NE 30 AVE 108 2427060 Must be displayed at place of business AVEN URA FIL$3180 Pursuant to County Cosner Chapter$A'=Art.9&10 OWNER SEC.TYPE.OF BUSINESS PAYMENT RECEIVED L S CORTIS'INC 196 ELECTRICAL CONTRACTOR BY TAX COLLECTOR Worker(s) I ECO003176 545.00 07/17/2014 CREDITCARD-14-028306 This Local Business Tax Receipt onlycoutirms payment of the Local Business Tax.The Receipt is not a license, parmi4 or o certification of the holder's unliricutloos,to do business.Holder must comply with any governmental Of 110HI overnmOmal 1`441datery laws requirements which apply to the busio it. The RECEIPT NO.above mast be displayed on tilt commercial vehicles Miami—Dade Cade Sec 8a-276. For more information,visit itIItldtiilt+gt45R ACIDR& CERTIFICATE OF LIABILITY INSURANCE DATE 0126/1/YYY1) 10/26/14 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: If the certificate holder is an ADDITIONAL INSURED,the policy(les)must be endorsed. If SUBROGATION IS WANED,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 CONAME:NTACT STACY PARKS Insurance Industries PHONNo,Fdl E ;LAL, (305)891-2808 aCNo: (305)891-6367 953 N.E.125th St. ADDRE-MAILESSm stacy@insuranceindustriesinc.com N.Miami,FL 33161 INSURER(S)AFFORDING COVERAGE NAIC# Phone (305)891-2808 Fax (305)891-6367 INSURERA: UNITED STATES LIABILTY INSURANCE CO INSURED INSURER B LS CURTIS INC. INSURERC: 20341 NE 30 Ave #108-6 INSURER D: AVENTURA,FL 33180- (305)892-0115 INSURER E: INSURER F: 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. iLTRR TYPE OF INSURANCE ADD U'NSR WB POLICY NUMBER POLICY EFF MPMIDD EXP LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000.00 COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED 100,000.00 —PREMISES Ea occurrence $ ❑ F] CLAIMS-MADE Y] OCCUR CL 1676233 MED EXP(Any one person $ 5,000.00 A F1Y 10/26/2014 10/26!2015 PERSONAL&ADV INJURY $ 1,000,000.00 ❑ GENERAL AGGREGATE $ 2,000,000.00 GEML AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000.00 ❑ POLICY ❑ PRO- ❑ LOC $ AUTOMOBILE LIABILITY Ea aaident INGLE LIMIT $ ❑ ANY AUTO BODILY INJURY(Per person) $ ❑ AAILLL OWNED ❑ SSCOESULED BODILY INJURY(Per accident; $ NON-OWNED PROPERTY DAMAGE $F1 HIRED AUTOS AUTO ( r accident) ❑ ❑ $ ❑ UMBRELLA LIAB ❑OCCUR EACH OCCURRENCE $ ❑ EXCESS LIAB ❑CLAIMS-MADE AGGREGATE $ ❑ DED ❑ RETENTION$ $ WORKERS COMPENSATION ❑WC STATU- ❑OTH- AND EMPLOYERS'LIABILITY Y I N TORY ER ANY PROPRIETORIPARTNER/EXECUTI❑ NIA E.L.EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ If yes describe under DESNIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,K more space Is required) ELECTRICIAN CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE MIAMI SHORES VILLAGE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN 10050 NE 2 AVE ACCORDANCE WITH THE POLICY PROVISIONS. MIAMI SHORES,FL.33138 AUTHORIZED REPRESENTATIVE C 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05)OF The ACORD name and logo are registered marks of ACORD Miami Shores Village Building Department artment JUL 20 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 20 BUILDING Master Permit No. PERMIT APPLICATION Sub Permit No. ❑BUILDING ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION E]RENEWAL PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 9 3 + q-7 City: Miami Shores Ir County: Miami Dade Zip: Folio/Parcel#: tel no y 3 �, y W FIs the Building Historically Designated:Yes NO ')Q _ Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): I'<�7a62Z R u i LAE- Phone#: Mo M VdI� Address: E-� 6 - 9 7 4Z City: n,j 1 74��r 1G a State: Zip:'?>3/ Tenant/Lessee Name: /1 Phone#: Email: ;rJy� ® �/ -tcSdu zxw Sly I CONTRACTOR:Company Name: Address: ` City: u State: 1 Zip: ��_� Qualifier Name: & � I>-- Phone#: State Certification or Registration#: Z-2f 1 nye%;345 ` Certificate of Competency#: DESIGNER:Architect/Engineer: (11�1� 1,t710,964 a r Phone#: Address: ?a3 Al ��� City: /'yt"I 31f S State: r L Zip: '33��+� Value of Work for this Permit:$ Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New epair/Replace ❑ Demolition Description of Work: Specify color of color thru tile: Submittal Fee$ i:)l} Permit Fee$ b CCF$ -ry® CO/CC$ Scanning Fee$ _) ! Radon Fee$ q . DBP cR�$, C �3'1 Notary$ Technology Fee$ Training/Education Fee s COm ?)C� Double Fee$ 1-74-1 Structural Reviews$ �� � r�� `� VT �►'t+/ �' Bond$ p, '—'� TOTAL FEE NOW DUE$ �� I 1 (Revised02/24/2014) ` Bonding Company's Name(if applicable) Bonding Company's Address City State Zip Mortgage Mortgage Lender's Name(if applicable) i✓ � ie Roy prl,i CA- 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 ` Signature OWNER or AGENT CONTRACTOR The foregoing instrum was acknowledged before me this The foregoing instrument was acknowledged before me this ay of 20 /4 .by day of 20 b by who is personally known to ,who ispperson_ally known to me or who has pwduG as me or who has produced as identification and who did take an oath. identification and who did ke an oath. NOTARY PUBLIC: NOTARY PUBLI Si n• Sign: Print: Print: Y OLGATEPPER Seal: t�'; :,°4o LOIS WELLS Seal: a°s ''e;'° *8nnded1bru8udg0N"Senias 00 MY COM) SION#FF 149810 * * MY COMMISSION#FF 0442 EXPIRES:September 22,2017 m EXPIREg:Augeuat23,2018 �f4TFQF�°6BondedThruBudgetNolarySewkes ��'"�`O APPROVED B 62?X4-AY.,Z Plans Examiner Zoning i� Structural Review Clerk (Revised02/24/2014) 5 ORES l? Miami shores Village lose Building Department Lhny� �(pR`�pp► 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CHANGE OF CONTRACTOR I ARCHITECT Permit N. Owner's Name(Fee Simple Title Holder): �� �- Phone#: -7T Q;—Cb1 Owner's Address: 12,3 City: JZ t ko %hcn1z-y C State: Jif Zip Code:133 3 Job Address (Of where work is being done): f-4 City: Miami Shores State:—Florida Zip Code: Contractor's Company Name: 4(,/_ PWF j�r- ,(, Phone#: Address: 7351 IV ik) '7�\ (364 V City: D iprti state: F/ Zip Code: X63)2,6 Qualifier's Name: Lic. Number: Architect/ Engineer of Record Name: Phone#: Address: City: State: Zip Code: Describe World hereby certify that the work has been abandoned and/or the contractor/architect is unable or unwilling to complete'the contract. I hold the Building Official and the Miami Shores harmless of all legal involvement. Si nature C/ • v'7���_ glw� Signature XCVer or Ag nt Contractor or Architect The Toregojng instrument was aknowledged before me The forego�i,�ng"instrumen was aknowledged befo�e me thi day +k�nn ,24�,by �jS• /i, 16® this "day of ,20/Ay Who is person I o me �wh 'p y •is personally kn� to j11cPd n enti ica ion. Notary P N ic: Sign: ign: Seal: 1, a LOISWELLS a .:,"i PY Py Sea: . L019 WELLS' * MY COMMISSION#FF 148810 * * My COMMISSION#FF 1421 * EXPIRES:August 23,2018 EXPIRES:August 23,2018 NO"; "; Bonded TAru Budget is-"Se 1v 0 �''soP wo�`O! TMu Bua�et Y Spvlrae 'k•tid' r Miami Shores Village Building Department JUN 2 9 R[Cgg 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. EL (' , —':6l�D PERMIT APPLICATION Master Permit No. FBC 20 Permit Type: Electrical OWNER:pName(Fee Simple Titleholder): I D k�� Phone#e&S ­75 "0 11 k Address:_. lV-, �--�® c —I c� k � 7��� City: M1 �t 6 A C State: Zip: a) t Tenant/Lessee Name: Phone#: Email: JOB ADDRESS: 1 0` Cn City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR:Company Name: —b� L' Phone#: 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: N(,::, f,—, ®� CON �G—CC_ , C)�-- Submittal Fee$ Permit Fee$ y�'�� CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Bond$ Notary$ Training/Education Fee$ Technology Fee$ Double Fee$ Structural Review$ TOTAL FEE NOW DUE$ �� 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 was acknowledged before me this day of jl, " 20 d l,by �� cUV t� day of 20_,by , who isfE; wn to me or who has produced who is personally known to me or who has produced As identification and Who did t � h, as identification and who did take an oath. NOTARY PUBLIC: �i�oo�` y NOTARY PUBLIC: Sign: O7 c� - :z Sign: Print: '�3 Print: My Commission Expires: ��ii�P "� My Commission Expires: �xx�xx�xxxx�:xx�xxxxx�:xx�:xx •x:xx�x�����:��:�:�xx��x��x�x�xx:�x�x�����x���:�:�:xxxx:�x�x:xxx:�x�xxxx�����:��x�x�x�xxxx��: APPROVED BY Wans Examiner Zoning Structural Review Clerk (Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09) SKoREs y Miami shores Village Building Department 10050 N.E.2nd Avenue �(pR�pp► Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 l CHANGE OF CONTRACTOR/ARCHITECT Permit N.FIL IF6140 Owner's Name (Fee Simple Title Holder): F� I��'�� �� Phone#: .5 o� ® /— Owner's Address: IV, e City: y/h W5�1�� � State : C-- Zip Code: 3-313Y ' Job Address(Of where work is being done): 12-3 Al,6-- . 2 -7 City: Miami ShoresState:i/Florida Zip Code: 3 3 0 Contractor's Company Name: —� k�Ji � L Phone#: Address: City: State: Zip Code: Qualifier's Name : Lic. Number: Architect/Engineer of Record Name: Phone#: Address: City: State: Zip Code: Describe Work: � 1C lC I hereby certify that the work has been abandoned and/or the contractor/architect is unable or unwilling to complete the contract. I hold the Building Official and the i ' Shores harmless for all legal involvement. Signatures Signature owner or Agent Contractor or Architect The foregoing instrument was aknowledged before me The foregoing instrument was aknowledged before me this,'-Pday o 01�bthis day of ,20 by Who is personally known to me or who hppr0dUded,,,, who is personally known to me or who has produced `� S IItiJ� as indentification. �' 0310612012 '' Notary lPublic- Notary Public: Sign: `;��ior t Sign: Seal: '%,`��' ®4- e` Seal: 0F�F�0\\`� �g 0 Miami Shores Village Building Department Ib050;Pl;I~.Zrid`Avenue -Miami Shores, Florida 33138 R Tel: (305) 795.2204 Fax: (305) 756.8972 OWNER BUILDER DISCLOSURE STATEMENT NAME: R 7/7A DATE; ADDRESS: � 3 4/9 7 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 license mbers 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 stantially improved it for sale or lease,which violates the exemption. Initial 5. 1 understand that,as the owner-builder,I must provide direct,onsite supervision of the construction. Initia 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 by 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 { e►zQneouSty;imp6es.that the propeifyo wners provJdtng his*her own labor and TriOn 4s 1;as an owner-builder may bet td >° uatite and sub`6dIpd t Wfts= ngPci*`d*,or tty frljuries su taine3 by an i ij ns .persons �s or mpld ee�<u le r,, :,Work orr' ro M homeowner s insurance ma not provide Covera a-#or those injuries-..[am willfull actin as an 8 m.p perty. Y Y 9Y g owner-builder and am aware of the limits of my insurance 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 cobtributions,under the Federal Insurance Contributions Act(FICA)and must provide workers compensation for the err71tiyee.i understand that my failure to follow-these ray subject#o serious fi�anciai risk Initial 9. 1 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://www.myflodda]iGense.com/dbpr/pro/cilb/indeytftl 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 00 1 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 2SO day of �- , 20�_ By ?" L�—1 � Lac�_ who was personally known to me or who has Produced there License or �1011ifiex3, 0;" //e,x WNER �rii,riuII0%\ � December 15,2010 CPS Electric,Inc. 1315 N.W. 30th Avenue Miami, Florida 33125 Re: Miami Shores Building Permit EL 08-1840 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 i� :rlr: � y:i& `fes' N �.. b' ,• �} ..d.� i "� W 7 -. • a-J 4 _ t �Hy. nx C G� e' i' � +"-dot Ck -. dna t 3 1 is r� gv�5.• '� 'ya- lip- WA'ky.Ny5 ,�"� k „w,.a' i ax ' rU ���� Q1 .`• a Y' �. ;C13 . — r HIM Ft 33144 .JI Postage S fQ. _�_ --"--._._. ._ fU.S4 illi$ r� Certified Fee " .30 Q $280 t• IA.P:i�`°� eo Postage ;. Q Return R rrW as _ lQ is .D fZ F i eceipt Fee (Ertdcrse P, Q merit Required} fry d :a Certified Fere �.. H tmerk r� RgsMctedpelrke etc fZ.'� a ere ti Q (Fndorser"., P,_q Fee s 1 0 Return Receipt Fee N squired) MOO f �-. O (Endorsement Required) t� Total Postage Restricted Delivery Fee r-I Fees c 0 (Endorsement Required) •!'= j 54 Q .Sent ro / fS. r 54 Tota{Postage 8 Fees fJ. Q ,- ttesP,Apt.hiO ...J'G7l .`.J.! _U �y//����.?-•�_ rl tT Z No. / . y!i Q aril To ,� /� ✓ CrtY Savie 7�q............. t�4� l A�� _ r a Al!4� G4� ....... ...,......_ 4(C / ... .... -.. N o P Bo No. J:✓✓. c� -L� i.......<..........._ ~–�- 3i �- 0m State ZIP+A f 1 -**r"F"._.-'.' �� .a. v�.e.,.�` �y 4•'� ��.,s. v"1; "s, r r'`€ aL7 _.,_-... ��- z 5 '�..� }'"�.�,y Ff- p�U ar� r4'€I� t�t�x`'�l���E'(€7 �i�r, t^ y,. 't L, >�t �t3`" ;x t,✓' [^."_ L 'r, { „�• f'� ,�'' 4a - ti p a !{ €7 o a " {'�t IM-MR" f -:a ice"-'�f•aV�y y, =4 Nr- 33125 -011is a ._ Q fU.44 ( Ulii; to Postage Postage f2 �4�,•. co {� _ Certified Fee Gert tied Fee 're O Return Receipt Fee s�. t'R $2.30 !rc�; M (Endorsement Required) s2 Q {?alum Receipt Fee r.._ Q y redl Restdcted Delivery Fee �.� ' © (-ndorsemen,Re4u fi�.0 �t G1 �� 0 (Endorsement Required) { p Resuicted Dj Required) #CJ. t [�- fs�.Ji 1 iZttiVss+10 0 (Endorsement ReG X Total Postage a Fees ] r ,, Tota Postage&Fees ���v� Sent To ,t 5 a 4h 7_U Zi�A S Ct/v[/GC.G /9 G, e---....---'•- entTo L�G'7tt-i' .t.. / - !!. .............. ._... ....... S . -• 6 Stir 5l.Apt.N04 �) �j r or PC Bcx Na t f 7l Q Street.AP t City.State,ZIP+d /y �j` ar PO Boz fdo. _ C(ty State 7172 P `/f,/ ( 9 g X4•:1. h=� a Miami Shores Village Building Department Ize 10050 N.E.2nd Avenue, Miami Shores,Florida 33138 V Tel: (305)795.2204 Fax:(305)756.8972 BUILDING Permit No. lol-0 gs 07 PERMIT APPLICATION Master Permit No. Q 3h FBC 2004 Permit Type: Electrical !�aQ Owner's Name(Fee Simple Titlehol 6)(t6:9-1 Phone# �� vex,y Owner's Address 23 NC V S- City P"f A)%j State 70z Zip Tenant/Lessee Name — — Phone# E-MAIL: Job Address(where the work is being done) tZ3 A41 f? �T City Miami Shores Village_ County Miami-Dade Zip FOLIO/PARCEL# l - ln64, '-"013- Zyy-O Is Building Historically Designated YES NO Contractor's Company Name Cps 6&-71A�,_4 C Phone#—,70 3 '7 Contractor's Address /(000 N4J Z,f 4v-e-- Cit 0?t Avo I State jli Zip_ 941.) S - Qualifier Name An 6-,c z- �Ce to Phone# 3 tsS 63 4 fy�'7® State Certificate or Registration No. e zo®f/cD'7 6 Certificate of Competency No. 00 E-MAIL: Architect/Engineer's Name Cif applicable) � � Phone4_ 30 Value of Work For this Permit$ Square/Linear Footage Of Work: 4 Type of Work: ddition ❑AlterationNew ❑ Re air/Re Iac � p El Demolition Describe Work: � � x9rx9c it Bc aYxxx4c icxoY&xxx4:xxxxxx9e 9ex9c�**9rx Ae oYxx&Fees do oYxxxxek eY dcx ituxxtc it at otxarux'c 4cuxtu�xxaY 9:YtxxY 9e 9cx aY Y is Submittal Fee$ Permit Fee$ 4 �/o®® 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$2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lUen law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. 701 6;e,,:A Signature Signature Owner or Agent Contractor r The foregoing instrument was acknowledged before me this Thefore instrument was acknowl dged before me this day of ,20 W,by r� day of ,204,by , who is personally known to.me or who has produced who is personally known to me or who has produced As identification and who did take an oath. as identification and who did take an oath. NOTARY PUBLIIC: - NOTARY PUBLI • RQU�B MAR'(U OR RIMS► 112 �SIUN 1,tDD61 ;.�'�:' ��;; ON#DD610172 i 9,3010 � em 010 Sign: Sign: ' ,� ,iandaNusryS�roi - v . tetY� Print: �aiti�a ,�' - _ F Print: ar,sda�+�s My Commission Expires: My Commission Expires: rxok nYx is 9:4r aY Yxxuxx9t nuaY 4txxiex4ex 4e ie&dczxxxx xx&ux&xuaY 4e ie dr 4ci:x$cx$ci:xxis ie is aYxiexx$ri:arx ieuxaexxaexx9:xx4a 4:aexxfrxuae ie aYxaY aYxx9e sc vY xYxdaxtiexxY aY APPLICATION APPROVED BY: Plans Examiner Engineer Zoning (Revised 02/08/06) ADDENDUM TO BUILDING PERMIT APPLICATION AN APPLICATION FOR BUILDING PERMIT MUST ACCOMPANY THIS ADDENDUM.IF A MASTER PERMIT HAS BEEN OBTAINED,THE OWNER'S NOTARIZED SIGNATURE NEED NOT BE PRESENT ON SUBSEQUENT APPLICATIONS. PLEASE CIRCLE O DISCIPLINE APPLIED FOR: PERMIT# PLUMBING ELECTRICAL MECHANICAL ITEM UNIT FEE ITEM UNIT FEE ITEM UNIT FEE BATH TUB SWITCH OUTLETS 0 SPACE HEATERS DISHWASHER LIGHT OUTLETS CENTRAL HEATING DISPOSAL RECEPTACLES A/C (WIND) FLOOR DRAIN SERVICE TEMPORARY A/C(CENTRAL) GREASE TRAP SERVICE SIZE IN AMPS DUCT WORK INTERCEPTOR SERVICE REPAIR/METER CHANGE REFRIGERATION LAVATORY APPLIANCE OUTLETS PROCESS AND PRESS PIPING LAUNDRY TRAY RANGE TOP UNDERGROUND TANKS CLOTHES WASHER OVEN ABOVE GROUND TANKS SHOWER WATER HEATER U.F.PRESSURE VESSELS SINK. POT/3 COMP. MOTORS 0-1 HP STEAM BOILERS SINK,RESIDENCE. MOTORS OVER 1-3 HP HOT WATER BOILERS SINK,SLOP. MOTORS OVER 3-5 HP MECHANICAL VENTILATION TEMPORARY WATER CLOSET MOTORS OVER 5-8 HP URINAL TRANSPORTING ASSEMBLIES MOTORS OVER 8-10 HP ELEVATORS/ESCALATORS WATER CLOSET MOTORS OVER 10-25 HP FIRE SPRINKLER SYSTEMS INDIRECT WASTES MOTORS OVER 25-100 HP COOLING TOWERS WATER SUPPLY TO: MOTORS OVER 100 HP VIOLATION A/C UNIT A/C WINDOW REINSPECTION FIRE SPRINKLER AIR CONDITIONERS HEATER-NEW INST. STRIP HEATER HEATER-REPLACE GENERATORS TRANSFORMERS LAWN SPRINKLER-WELL GENERATORS TRANSFORMERS SWIMMING POOL GENERATORS TRANSFORMERS WATER SERVICE SPECIAL PURPOSE. SEWER CONNECTIONS OUTLETS COMMERCIAL UTILITY-SEWER SIGN TUBES UTILITY-WATER SIGN TRANSFORMERS SEPTIC TANK SIGN TIME CLOCK RELAY FIXTURES FAINFIELD,4"TILE/RES. ANTENNA PUMP&ABANDON SEPTIC TANK TELEVISION OUTLETS SOAKAGE PIT CU.FT. VIOLATION CATCH BASIN REINSPECTION DISCHARGE WELL DOMESTIC WELL AREA DRAIN ROOF INLET SOLAR WATER HEATER FIRE STANDPIPE POOL PIPING LAWN SPRINKLER SYSTEM GAS RANGE METER SET(GAS) GAS PIPING Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores,Florida 33138 Tel: (305)795.2204 Fax:(305)756.8972 BUILDING EC IVE® Permit No. ELV$,'1146 PERMIT APPLICATIO 1 zoos Master Permit No. /tet• FBC 2004 r.ra.erss Permit TypeElectrical Owner's Name(Fee Simple Titleholder) gf/7�� Phone# �(s " +?-►Cj�y' Owner's Address ?/S Acs 4 a r CityAjjd,4A,j_State Zip Tenant/Lessee Name Phone# i~ E-MAIL: Job Address(where the work is being done) 3 AAS- 7 7 -5 t— City Miami Shores Village County Miami-Dade Zip FOLIO/PARCEL Is Building Historically Designated YES NO Contractor's Company Name CPS' Phone Contractors Address / City 4744 State �v ZiP_ l Qualifier Name ? 4�) Phone# o (.,;5 1 !S_? � State Certificate or Registration No: 0.4i 0 ?,o Certificate of Competency No. 0000 / -7 E-MAIL: .� �r Architect/Engineer's Name(if applicable) Phone# 3 r�0IF-�Gd" 763-7 Value of Work For this Permit$ Square/Linear Footage Of Work: Type of Work: &Kddition ❑Alteration Ne R•e air/Re lace ` � p p ❑ Demolition Describe Work: (/ WA we 9r ie oY drxeY aYxzxxxa xxxnY at vY Yx4:a°dexxxx9:�&vc dcxxxY dexFeesXat&x�iexxxxxYextiexxx•kxa:aY Se�4ricxYx nYeY aY 9c�t�exdcxxaYxxxx . 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) a 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 ork#nd 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 perf rned 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 reins ec 'on fee will be charged. Signature Signature Owner or Agent Contractor hisdaThe foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this— day y of�,20 Q& by day of &t&1Y' ,20 fi'�,by , who is personally known to me or who has produced_ who is personally known to me or who has produced As identification nd who did take an oath: �• L• as identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: G RG{E SAAR ES +� ;" MY COMM D616172tGF Mc�R - DB Sign: 1D Sign: ri-5z" C' c Es Print: Iwo" (f aN Print: '' ', @ ."r'I tt iJy1'vt3et I)47.r 1;-4,2010 My Commission Expires: My Co sr�ri` ptr rrricr.ie xix isxxzxi:aYzie is is a:9:rxzr.4ca'Y ixxdc xicx9:x�c rx/x�eurirrr.zac ris icx xx xx rr.dcx xaen iexx xd:aY icx�zKic 4c 4:acx4c 4:xxd:xxxxxx x4e Y r.is ac zic 9cxx4exxr.>:xtx APPLICATION APPROVED BY: f� LI .0to- Plans Examiner Engineer Zoning (Revised 02/08/06) Curtis, Im 20341 NE 30 Ave #108 Aventura, FL 33180 Fax 30(5-,9,/32-1009 r app March 22, 2016 BY: Attention: Permit Department /6 (r® tic 7 ST I, Lewis Steven Curtis, Qualifier for L. S. Curtis 6w // //4( 1�16 A e 5 A&c, 4,/ /-c—Aki, / /A I &/ /�k � /Ij ('All C-e/t` li dVI � f �G� � /� cam,-fi-0y L e �a rhe ��� 7114 � �Zl 16 41 C OW,4 Z R Gtr t 11 a / JP�n A /// ij / X ;"?417 If you should have any questions, please call me at 786-486-1961. Thank you for your help. Sincerely, Lewis Steven Curtis ._ z,.� �' �• [ter Lewis Steven Curtis is 4� Personally known to me e .r.. DRANNES MIA { '. :my COMIYIISSION 0 EE 219418 EXPIRES J*25.2096 i e• •• • • • • No .: �.• e. e • • • • • • • e • • 00 ••• • • • • ••• • • • • • • • • • • • • • •• •• • • • •• s• ••• • • • ••• • •