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PL-15-2230BUILDING PERMIT APPLICATION Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 RE Cir== IA 2 8 2016 14 FBC 20h 5 Master Permit No.pu 5 2230 Sub Permit No. BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION PLUMBING ❑ MECHANICAL El PUBLIC WORKS 0 CHANGE OFj CANCELLATION El A' % CONTRACTOR �`'G DRAWINGS Z�%� JOB ADDRESS: �J V ° ! �iE 'Z s City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): Phone#: Address: City: State: Zip: Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name:I R PC- 1 tt _ • Phone#: J • S711— (PW# / Address: 15&405 NAA) SO gr'4:r 014 City: State: Zip: .3I (i 0 Qualifier Name: ELtRD27 -f— /4j4_ Phone#: 3 -G%$cf •-7-3ger State Certification or Registration #1- (142.4441-1 2.-.- Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: $ Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New *. ❑ Repair Replace p❑ Demolition Description of Work: f'Zig-/,( Specify color of color thru tile: Submittal Fee $ Permit Fee $ CCF $ CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Notary $co Technology Fee $ Training/Education Fee $ Double Fee $ Structural Reviews $ Bond $ TOTAL FEE NOW DUE $ (Revised02/24/2014) o ; 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 posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature Signature OWNER or AGENT CO RACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of , 20 by day of , 20 /, , by who is personally known to.✓.(.. 4._ G,. -y -f , who is personally known to me or who has produced 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: Sign: Si Print: Seal: Print: Seal: APPROVED BY Plans Examiner (Revised02/24/2014) `Par P"e RAMON 0. CEBALLOS MY COMMISSION # FF 060780 ..,.� EXPIRES: October 7, 2017 sl..,.:,\ate Zoning Structural Review Clerk ' 7.7 TreSil J JL 2 8 2016_, ze12-nlo fa. -0 17. 4,14er NEt6 alor `Ke72til.kt- "PO -1 S 22SO 49-(46- 4 &e • 44444i4-01, dimketeo nAit7 Dion Miami Shores Village Building Department 10050 N.E. 2nd Avenue Miami Shores, FI 33138 Tel: 305-795-2204 Fax: 305-756-8972 5/19/2016 500 NE 92 Street Miami Shores FL 33138 RE: Process No.PL-9-15-2230 Address: 500 NE 92 Street Dear Owner, Our records indicate that the above referenced permit has expired without obtaining the proper permit approval. In order to serve you better, we need to keep our files up to date. As per section 105.3.2 of the Florida Building Code, "An application for a permit for any proposed work shall be deemed to have been abandoned 180 days after the date of filling, unless such application has been pursued in good faith or a permit has been issued." Please be advised that open permits will hinder your ability to refinance or sell this property. Please contact the Building Department, within 15 days of receipt of this letter in order to take care of this matter. Sincerely, 6Ajakj Ismael Naranjo, CBO Building Department Official 305-795-2204 _—w BUILDING PERMIT APPLICATION Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 IRIS C E\TED SEP X 1 2015 BY: FBC 201`f Master Permit No. PL ' i S-22:50 Sub Permit No. ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS 0 CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: SD® ® �� S City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: /1,7-0 ()O/11 a do Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: ' 4 OWNER: Name (Fee Simpl�e.``Ttle IQr): M LL- Address: I I', I , City: VVI ( Pr}1n C 41 Irkt/ IS, ' State: R - Tenant/Lessee Name: Phone#: Email: Zip: J . / e a CONTRACTOR: Company Name: -bEsnlicir PG • /IyG Phone#: 3 ' n'-&76/ Address. City: State: Zip:- Qualifier Name: EGA? o State Certification or Registration #: DESIGNER: Architect/Engineer: Phone#: Address: Certificate of Competency #: Value of Work for this Permit: $2154, •�— Type of Work: 0 Addition 0 Alteration %� zoijef - i Description of Work: City: State: Zip: Square/Linear Footage of Work: �� ❑ Repair/Replace ❑ Demolition :51:1t'dsC Specify color of color thru tile: ;,. Submittal Fee $ Permit Fee $ if 1.56= AY CCF $ CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Notary $ Technology Fee $ Training/Education Fee $ Double Fee $ Structural Reviews $ Bond $ TOTAL FEE NOW DUE $ f ? ( / o 30 (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 o ommencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is i In the abse4of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signatur OWNER or AGENT The foreg•ing instrum t was? knowledged before me this day of 1 AAA/ iti4At me or who has produced I y4:„,(1 20/5 ,by who is personal) known to identification and who did take an oath. NOTARY PUBLIC: as Seal: Signature CO TRACTOR The foregoing instrum -, was cknowledged before me this day of 20 ! S by 1L. i ILL I ho is perso me or who has pro • uced identification and who did take an oath. NOTARY PUBLIC:(17 Sign: (di /.` '*." --74: LAP'li Print: /1/`!eT4 ' ✓L e -S Seal: 61 °' ' RAMON 0. CEBALI.F ;ar Pue ••••,. , o..;; 4;';';:•• :1.1%. RAMON0.CEBALLOS MY COMMISSION p F * MY COMMISSION # FF 080780 rviDC.TM i, 0 EXPIRES: October 7, 2017 Nl1rfOF P.Op`o' Bonded Thru Budget NotarySle es f1jFOFnoo Bonded Thru Budget Notary Services ********************************************************** *******************t**********int************* *** APPROVED BY Plans Examiner Structural Review (Revised02/24/2014) Zoning Clerk ACORD® CERTIFICATE OF LIABILITY INSURANCE 411.-/ DATE (MM/DD/YYYY) 09/01/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the pollcy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER Pan Am Assurance Agency, Inc 9100 Sunset Drive Miami FL 33173-3433 CONTACT NAME: PHON(A/CC No ). (305) 270-1424 FAX NO): (305) 270-8997 AIL ADDRESS:carlos@panamassurance.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A:We SCO Insurance Company 25011 INSURED Desmar PC, Inc 6405 NW 36 Street STE 124 Suite #124 Miami FL 33166- INsuRERB:Mapfre Insurance Company 34932 INsuRERc:BUSINESS FIRST INS CO 524210 INSURER D: $ 1,000,000 INSURER E: 100 000 $ r INSURERF: 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. INSR LTR TYPE OF INSURANCE ADDL INSR SUBR wvn POUCY NUMBER POUCY EFF (MM/DD/YYYY) POLICY EXP (MM/DD/YYYY) UMITS A GENERAL X UABIUTY COMMERCIAL GENERAL LIABILITY UPP1222391 00 01/05/2015 / / / / / / / / / / / / 01/05/2016 / / / / / / / / / / / / EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES (Ea occurrence) 100 000 $ r CLAIMS -MADE X OCCUR MED EXP (Any one person) $ 5, 000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GGEEN'L AGGREGATE LIMIT APPLIES PER: X I POLICY n JE n LOC PRODUCTS - COMP/OP AGG $ 2,000,000 NOWND $ B AUTOMOBILE _ — UABIUTY ANY AUTO ALL OWNED AUTOS HIRED AUTOS X _ SCHEDULED AUTOS NON -OWNED AUTOS 4150120005323 01/26/2015 / / / / // / / 01/26/2016 / / / / / / / / COMBINED SINGLE LIMIT (Ea accident) _$ 100 000 $ BODILY INJURY (Per person) BODILY INJURY (Per accident) $ PROPERTYDAMAGE PROaccident) $ $ UMBRELLA UAB EXCESS UAB I IF---I(OCCUR I CLAIMS -MADE / / / / / / / / / / / / EACH OCCURRENCE $ AGGREGATE $ DED RETENT ON $ $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? ❑ (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A 0521-03296-0 _ 08/16/201508/16/2016 / / / / / / / / / / / / WCSTATU- OTH- TORY OMITS ER E.L. EACH ACCIDENT $ 500,000 E.L. DISEASE - EA EMPLOYEE $ 500,000 E.L. DISEASE - POLICY LIMIT $ 500,000 / / / / / / / / DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, I1 more space Is required) Plumbing Contractors CERTIFICATE HOLDER CANCELLATION ( ) Miami Shores Villages Building Department 10050 NE 2nd Avenue Miami Shores FL 33138 - SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE .- ACORD 25 (2010/05) INS025 (2oloo5).o1 © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD