The URL can be used to link to this page

ELC-17-966 Miami Shores Village RECEIVED Building Department APR 0 6 201 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 9q (n BUILDING Master Permit No. �(_ ,� .� PERMIT APPLICATION Sub Permit No. h C r-� -q&C0 ❑BUILDING XELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF []CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: Ci Miami Shores County: p t)J Miami Dade Zi 313 I -� Folio/Parcel#: Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: �ry! FFE: q OWNER:Name(Fee Simple Titleholder): J �`� L1 �� S Phone#: gEa l Address: �fl l � ";�,z 5-�U_ h _ City: State: Zip: 3 � Tenant/Lessee Name: Phone#: Email: /1 CONTRACTOR:Company Name: Phone#: Address: ®� 1 � ';ka A4pd' 103 City: �d A��c State: Zip: ix/n y Qualifier Name: ,OA�wn�� ,� (ill, �/70 S Phone#: State Certification or Registration#: WO _Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip:/ Value of Work for this Permit:$ ®C _ ®� Square/Linear Footage of Work: q1 CG Type of Work: ❑ Addition -�' Alteration ❑ New ❑ Repair/Replace ❑ Demolition Descr tion of Work: a Specify color of color thru tile: Submittal Fee$ Permit Fee$ /,! �l CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ ^^ TOTALFEENOWDUE$ �ld�• �® (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." Notice to Applicant. As a condition to the issuance of a building permit with an estimated value exceeding$2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also,a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such postece, the inspection will not be approved and a reinspection fee will be charged. Signature Signature L/ 0 ER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of M arcy) 20 �� by 2 `/ day of 20/ ? by 3C)aln •yOT5 who is personally known to who�tTa y finou�r me or who has produced 1-i V`Q t 1�`F�'� as me or who has produced s identification and who did take a identification and who did take an oath. NOTARY UBL NOTARY PUBLIC: CASSANDRA NEBBIA Sign: ,.�- L Sign: Notary Public-State of Florida Print: QIr1 Print: ! ' oP�°.° MY Comm.Expires Jul 25,2020 Seal -- Bunued roug atonal Notary Assn. •` . YANADY N Seal: 1 c n ft4y comim:S&?(,e. -031 9 h , a ak 8 k ek d,ak k#k ek7R3BtR9ek�FaMKNnF'�Rabk^.k�E3c ekk�&fk ek?iEiiF�k ek$k kk k R�k k M k=k&k&k kk#ek ekk k R kk R'k k k k ik&ak k k k eksk kk k k R k ek ek+k i W$k kkP ffieR&ek ksk=kak sk APPROVED BY Plans Examiner Zoning Structural Review Clerk (ReAsed02/24/2014) MEN D7 Rv1M/DD/YYYY) s CERTIFICATE F LIABILITY ITY INSURANCE R022 3/31/2017 1 THIS CERTIFICATEIS 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 have ADDITIONAL INSURED provisions or 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). PPODUCER CONTACT NAME: AUTOMATIC DATA PROCESSING INS AGCY PHONE FAX (A1C,No.Ext): (A/C,No): 250717 P: F: ADDRESS: PO BOX 33015 INSURER(S)AFFORDING COVERAGE NAIC4 SAN ANTONIO TX 78265 INSURERA: `7win City Fire Ins Co 29459 INSURED INSURER B: INSURER C L. S. CURTIS INC. INSURER D: 20341 NE 30TH AVE APT 108 INSURER E: AVENTURA FL 33180 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. IA'SR TYPE OF Vvsu)".YCE APDL SUBR POLICYNUMBER POLIC'FEFF POLMYEXP LI.LIITS LTRM.M/DD/YY3"Y COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE OCCUR DAMAGE TO RENTED PREMISES(Ea occurrence)$ NIED EXP(Any one person) PERSONAL&ADV INJURY GEN'L AGGREGATE LIMIT A�P'P'L�IES PER: GENERAL AGGREGATE $ Ja I 9 LOC PRODUCTS-COMP/OP AGG POLICY❑ OTHER: L_� $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ ANY AUTO BODILY INJURY(Per person) $ OWNEDSCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY (Per accident) $ S UMBRELLA UAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTIONS $ WORKERS COMPENSATION PER OTH- ANDEMPLOYERS'LIABILITY X STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE YIN EL EACH ACCIDENT $1, 000, 000 OFFICERIMEMBER EXCLUDED? A (Mandatory In NH) F N/A 76 WEG TR4954 05/01!2017 05/01/2018 ELDISEASE-EA EMPLOYEE $1, 000, 000 If yes,describe under E.L DISEASE-POLICY LIMIT $1, 000, 000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Addltlonal Remarks Schedule,maybe attached If more space is required) Those usual to the Insured's Operations. License #EC0003175 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED Miami Shores Village BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE g DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Building Department AUTHORIZED REPRESENTATIVE 10050 NE 2ND AVE MIAMI SHORES, FL 33138 ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD