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RC-17-1023 Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores,FL Phone:(306)796-2204 Fax: (305)75"972 Inspection Number INSP-300490 PerrnjtNum ber RC-4-17-1023 I Scheduled,Inspection Date:April 0%,20118 Permit Type: Rest dentist C6,h6truction Inspector Naranjo,Ismael Inspection Type: Final Owner DOWSON.,ALFRED&NANCY Work Classification: Alteration Job Address:289 NE 102 Street Miami Shores,FL 33138-2426 Phone Number' Parcel Number 1132060134970 Project: <NONE> Contractor: bAVID HESTERC INC. Phone.(786)246-6429 Build ng Department Comments tiaPassed Comments GUT BATHROOM RETILE AND NEW VANITY 114VrCT6IR COWM—ENTS False 10/1 x2017 REVISION REMODEL BATH Inspector Comments Passed Ed Failed Correction Needed. Re-Int pection Fee tftAddWacal Inspedons can be scheduled until M-�stGon fee is paid. April 06,2018 For Inspections please call:(305)762-4949 Page 13 of 27 Permit N©. RC-4-17-1023 `sKORes o,� Miami Shores Village Permit Type:Residential Construction 10050 N.E.2nd Avenue NE : ,'t Work Classification.Alteration Miami Shores,FL 33138-0000 Per Permit Status:APPROVED "ytNO Phone: (305)795-2204 ficoR.vA Issue Date:4/17/2017 Expiration: 09/25/2018 Project Address Parcel Number Applicant LM!ia E 102 Street 1132060134970 ALFRED&`NANCY DOWSON i Shores, FL 33138-2426 Block: Lot: f Owner Information Address Phone Cell ALFRED& NANCY DOWSON 305 NE 91 ST MIAMI SHORES FL 33138-3129 Contractor(s) Phone Cell Phone Valuation: $ 6,000.00 DAVID HESTER, INC. (786)246-6429 Total Sq Feet: 72 Approved:In Review Available In Comments: Inspection Type: Date Approved::In Review Final PE Certification Date Denied: Window Door Attachment Type of Construction:GUT BATHROOM RETILE AND NEV Occupancy:Single Family Insulation Stories: Exterior: Drywall Screw Front Setback: Rear Setback: Window and Door Buck Left Setback: Right Setback: Fill Cells Columns Bedrooms: Bathrooms: Framing Plans Submitted:Yes Certificate Status: Framing Certificate Date: Additional Info: Review Building Review Building Bond Return: Classification:Residential Review Plumbing Fees Due Amount Pay Date Pay Type Amt Paid Amt Due Review Electrical CCF $3.60 Review Planning Change of Contractor Fee $110.00 Invoice# RC-3-18-66972 Review Structural DBPR Fee $2.70 03/29/2018 Credit Card $ 110.00 $0.00 Review Mechanical DCA Fee $2.70 Education Surcharge $1.20 Invoice# RC-4-17-63680 Notary Fee $5.00 04/17/2017 Check#:3508 $ 159.00 $50.00 Permit Fee $180.00 04/12/2017 Check#:3503 $50.00 $0.00 Scanning Fee $9.00 Technology Fee $4.80 Total: $319.00 In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans,drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand,that separate permits are required for ELECTRICAL MBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work. OWNERS AFFI lY certify that all the for in formatio _is ccurate and atf; z; e in compliance with all applicable laws regulating construction d zo uthe ore uthorize th b ve-na ntractor to d the ( March 29, 2018 a Au a ig ure:0 ner_, / pplic t / Contractor / Agent Date Building Department Copy I March 29, 2018 1 C3 r, Miami Shores Village M R 29 2018 Building Department ]BY, 10050 N.E.2nd Avenue,Miami Shores, Florida 33138 i7 � . Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 20 11 BUILDING Master Permit No. Re- PERMIT APPLICATION _ Sub Permit No. BUILDING ❑ ELECTRIC ROOFING Nn REVISION ❑ EXTENSION [:]RENEWAL PLUMBING ❑ MECHANICAL PUBLIC WORKS F-1 CHANGE OF ❑ CANCELLATION F-1 'SHOP ` f � CONTRACTOR DRAWINGS JOB ADDRESS: /`j /f�r A � i City: Miami Shores County: Miami Dade Zip: a Folio/Parcel#: / �Qs the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone:' BFE: �j /FFE OWNER:Name(Fee Simple Titleholder): /`e Xi 1 V S Ph6 e#: /�C 5,5& Address: c- f-- // r City: State: Zip: Tenant/Lessee Name: Phone#: Email: ` r'L ,� / [/ CONTRACTOR:CompanyName: cv4� !7`�57�e�- phone#: Tp� Address: City: f49a2ti State: �� Zip: �f Qualifier Name: �V I -� - Phone#: ; [ � 13�v State Certification or Registration#: ,,[ Certificate of Competency#: DESIGNER:Architte"ct/En iijne/er. Al41 /`CI b•i e / Phone#: Address: / / !y �� y� City: State:�Zip: - a �� /�- Value of Work for this Permit:$ t- , � ��Square/Linear Footage of Work: yc0 _�'!� /-2 I Type of Work: ❑ Addition E�-Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: /?e, Ln eY � r,} �..... «r .aa=.cx.a'.vm C -.u+;�r� tie:. s.�R;.'.aa`.Yd..:.•.a'^.i7.-f.§:a^-}/._ts:as ,. -.-.. rq a .I =t MJ if s9 a Specify color of color thru tile.!:, z, r t r y ' P�$ CCF e Submittal F ee Permit Fee ,,..x, •�. $ w / $ $ `` '*` $:.: : .a CO CC Scanning Fee$ Radon Fee$ DBPR$' t Notary$ + Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ (Revised02/24/2014) rt ^PL iR 7{ir s, 1 Bonding Company's Name(if applicable) Bonding Company's Address _ 'City State Zip Mortgage Lender's Name(if applicable) s Mortgage Lender's Address r 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 b{e posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of uch posted notice, the inspection will not be approved and a reins tion fee will be charged _ t Signature` Signature O NER or AGENT CONTRACTOR The foreECA oing instrurri aas ackno ledged before m Is The foregoing instrument was acknowledged before me this day of .cG 1 20 by - --day,of �u VG 20 � by V> -AJSo-(-� who is personally known to 4 w^ who is personally known to me or who has produced asR4 me or who`hA prnducecl as identification and who did take an oath. identification and who did take an oath. t , NOTARY PUBLIC: NOTARY PUBLIC: Sign: OVA fWa ` ` *Sign: Print: V�l Print: <n"Y 'i;'' RRILLA ANA LUISA PARRILLA ;.401 r r+i�.• ANA LUISA PA Seal: ::� Seal: •n Notary Public-stateofFlorida �. Notary Public-State of Florida • • .` Commission N GG 090452 • Commission N GG 090452 • ' My Comm.Expires Apr 21,2021 My Comm.Expires Apr 21,2021 a'1 rµFi y� throughNationalNotaryAssn. Bonded through NotionalNotoryAssn, "" APPROVED BY v' Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) ORE s� Miami Shores Village "" Building Department 10050 N.E.2nd Avenue FLORIDA Miami Shores, Florida 33138 Tel: (305) 795.2204 t Fax: (305) 756.8972 r 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. Corporate officers or members of a limited liability company (LLC) in the construction industry may elect to be exempt if: 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 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,part-time employees or subcontractors. BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. 1 Signature: Ov er State of Forida County of Miami-Dade I,� The foregoing was acknowledge before me this 2-6 day of NCAVC V I ,20_[K. By Pf 1!Y pd. DOW 7"__Who is personally known to me or has produced as identification. Notary: SEAL: ,,°iiu"i1;,,, ANA WISA PARRILLA at Notary Public-State of Florida Commission M GG 090452 �,N• My Comm.Expires Apr 21,2021 dr Bonded through National Notary Assn.. 1 David Hester, Inc. 420 NE 115th Street Miami, FL 33131 CBC 1261342 To whom it may concern: March 26, 2018 I am requesting a revision on Master Permit# RC-4-17-1023, since I originally pulled the permit I have up graded my license to a Builder. Any questions ,please call y David Hester 786-246-6429 i .x STATE.OF FLORIDA DEPARTMENTZOIF BUSINESS AN" PROFESSIONAL`'REGULATION �: ; "tea ISSUE 10/23/2016. CBC1261342 CERTIFIED BIJI 11�G� N ,. JOR HESTER, DAV,IVPPAUL h DAVID HESTER`I�IGA. F w VI IS CERTIFIED ~� y under th`e provisions of Ch 488 FS r. Expiration date.:AUG 31 2018 .116102300012'34 k , r7AC# 01032234 5�I .f � a `f # _'` SIGNATURE, ooa767 Local Business Tax Receipt Miami-Dade County, State of Florida -THIS IS NOT A BILL--DO NOT PAY 6919741 1 \ LB. I/ 13USINESSNAME/LOCATION RECEIPT NO ; '- EXPIRES T DAVID HESTER INC RENEWAL _r SEPTEMBER 30, 2018- 420 NE 115 ST 7195829 _ Must be displayed at place of business MIAMI FL 33161 Pursuant to County Code Chapter 8A-Art.9&10 OWNER SEC.TYPE OF BUSINESS DAVID HESTER INC 196 SUB—GENERAL BLDG CONTRACTOR PAYMENT RECEIVED C/O DAVID HESTER PRES CBC1261342 By TAX COLLECTOR 'Vf i ter(s)` 3" - $79M1 .07/3112017. FPPU 10---17-015654. This Local Business Tax Receipt only confirms payment of the Local Business Tax.The Receipt is not a license, permit,or a certification of the holders qualifications,to do business.Holder must comply with any governmental or nongovernmental regulatory laws and requirements which apply to the business. The RECEIPT NO.above must he displayed on all commercial vehicles-Miami-Dade Code Sac Be 276. For more information,visit www.miamidedeguy/tagcollector t ��® DATE(MM/DD/YYYY) ��. CERTIFICATE OF LIABILITY INSURANCE F03/16/2018 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 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). PRODUCER CONTACT Sarai Medina NAME: Emmanuel Insurance&Associates,Inc. A/CNNo xt: (305)693-0003 FAX No): (305)691-4381 2370 E 8TH AVE E-MAIL sarai@emmanuelinsurance.com ADDRESS: INSURERS AFFORDING COVERAGE NAIC# HIALEAH FL 33013-4236 INSURER A: Preferred Contractors Insurance Co. 12497 INSURED INSURER B: INSURER C: DAVID HESTER,INC. INSURER D: 420 NE 115TH ST INSURER E: MIAMI FL 33161-6660 1 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. INSR ADDLSUBRPOLICTYPE OF INSURANCE INSD WVD POLICYNUMBER MMIDDY EFF POUCYEXP LTR /YYYY MM/DD/YYYY ' LIMITS X COMMERCIALGENERALLIABILITY EACH OCCURRENCE $ 1,000,000.00 DAMAGE N CLAIMS-MADE NOCCUR PREMISES Ea occurrence $ 50,000.00 MED EXP(Any one person)• $ 5,000.00 A PCA5026-PC244991 10/06/2017 10/06/2018 PERSONAL&ADV INJURY $ 1,000,000.00 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000.00 X POLICY JELOC PRODUCTS-COMP/OP AGG $ 2,000,000.00 OTHER: $ ' AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea aaident ANY AUTO BODILY INJURY(Per person) $ ` OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE , $ EXCESS LIAB HCLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION OT AND EMPLOYERS'LIABILITY Y/N STATUTE ERH ANYPROPRIETOR/PARTNER/EXECUTIVEE.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? ❑ N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ • I DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) t GENERAL CONTRACTOR. r Any Changes or alterations Done to this document after being issued shall constitute it null and void. CERTIFICATE HOLDER CANCELLATION Miami Shores Village Building Dept. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL t BE DELIVERED IN 10050 NE 2nd Ave. ACCORDANCE WITH THE POLICY PROVISIONS. Miami Shores, Florida 33138 AUTHORIZED REPRESENTATIVE s ©1988-2015 ACO D CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD k 3/2212018 Insurance Services Amo o® CERTIFICATE OF LIABILITY INSURANCE DATE(U"'D°"NYM 031222018 THIS CERTFICATE 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. BIPORTANT: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 net confer rights to the certificate holder in lieu of such endmsem ags). PRoeU CONTACT NAME I Automatic Data Processing insurance Agency,Inc PHONE FAX No 1 Adp Boulevard ADDS, Roseland,NJ 07068 1MRER(S)APFORDNGODVERA(.'E NAIL: 1 INSURER A: NorGIIAM Irs,r<a,ra CeawwT 31470 INSURED DAVID HESTER INC NliURER B. 420 NE 115TH ST SMC: WamL FL 33161 raUItElt D. NSUItER E: NSUIER F COVERAGES CERTIFICATE NUMBER: 861466 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, E(CLUSIONSAND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. am PAKIL UMN POLICY EFF LTR TYPE OF YrSI1tANfF MSD WVD POLICY NUMBERPOLICYExp Lam Y i. COMMERCIAL GENERAL LIABLM EACH OCCURRENCE $ CLAIMS-MADE F—I OCCUR PREMISES{Ea oetunence $ { MED EXP WW One pertan) $ PERSONALEADVwURY S GEHL AGGREGATE LIMIT APPLES PER: GENERAL AGGREGATE S PRO- POLICY JECT ❑LOC PRODUCTS-COMPADPAGO S OTHM. S AUrOMDBLE LNBILRY S - (Ea aadi�t ANY AUTO BODILY INJURY(Pa pssoo) S ALL OINNED SCHEDULED BODILY INJURY AUTOS AUTOS (Pa accident) S {pia ' HIRED AUTOS O ED s, I H $' UMBRELLA LIAB OCCUR EACHOCCURRENCE $ EXCESS UM . Ll CLAIMS-MADE AGGREGATE $I DED I I RETENTIONS $ WORKERS COMPENSAI DON AND EMPLOYERS'LULBLHY Y/N X STATUTE I Flt ANY PROPRETORJPARTNERIE)MUTWE EL.EACHACCDDEWT $ 100,000 A OFFICERILEMSERExCLUDEDIJ a NIA N DAWC849415 0928/2017 09/28/2018 (yyeett ,min EL DISEASE-FA EMPLOYE S 100,000 DES�RLP'TION OF OPERATIONS below' Fl DISEASE-POLICY UMunder I. S 500.000 DESCRPTION OF OPERATIONS/LOCATN)IIS/VEHICLES(ACORD 101,AdcRonel A marks Schedule,MW be aftdod i more is raIpmed) Contractor License:CBC126130 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Miami Shores Vigo"Building Dept. ACCORDANCE WITH THE POLICY PROVISIONS. 10050 N.E.2nd Ave. Miami,FL 33138 AUTHORED REPRESEIrTATTVE t 1988-2014 ACORD CORPORATION.Ati rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD t https://adpia-adp.cornl[SExtemal/appriindex.html?clientid=3022825&requestFrom=njrW/home 1/1 J i I Permit N©. RC-4-17-1023 ,gNOR£s yet Miami Shores Village Permit Type:Residential Construction �S. 10050 N.E.2nd Avenue NE Work Classification:Alteration F r 11� Miami Shores,FL 33138-0000 ' Phone: (305)795-2204 Permit Status:APPROVED F�ORtDp' Issue Date:411712017 Expiration: 10/14/2017 Project Address Parcel Number Applicant 289 NE 102 Street 1132060134970 Miami Shores, FL 33138-2426 Block: Lot: ALFRED& NANCY DOWSON Owner Information Address Phone Cell ALFRED&NANCY DOWSON 305 NE 91 ST MIAMI SHORES FL 33138-3129 Contractor(s) Phone Cell Phone Valuation: $ 6,000.00 DAVID HESTER INC (786)294-0954 (786)246-6429 Total Sq Feet: 72 Approved:In Review Available Inspections: Comments: Inspection Type: Date Approved::In Review Final PE Certification Date Denied: Window Door Attachment Type of Construction:GUT BATHROOM RETILE AND NEV Occupancy:Single Family Framing Stories: Exterior: Insulation Front Setback: Rear Setback: Drywall Screw Left Setback: Right Setback: Fill Cells Columns Bedrooms: Bathrooms: Window and Door Buck Plans Submitted:Yes Certificate Status: Review Planning Certificate Date: Additional IAfo: Review Building Review Plumbing Bond Return: Classification:Residential Review Electrical Fees Due Amount Pay Date Pay Type Amt Paid Amt Due Review Structural CCF $3.60 Review Mechanical Invoice# RC-4-17-63680 DBPR Fee $2.70 04/17/2017 Check#:3508 $ 159.00 $50.00 DCA Fee $2.70 Education Surcharge $1.20 04/12/2017 Check#:3503 $ 50.00 $0.00 Notary Fee $5.00 Permit Fee $180.00 Scanning Fee $9.00 Technology Fee $4.80 Total: $209.00 In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans,drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done`by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL,P MBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: certify that the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction o i . Fu r I authorize the above-named contractor to do the work stated. April 17, 2017 AuthkrriSignatGfe-15w-ner / Applicant / Contractor / Agent Date l d Building Department Copy April 17, 2017 1 FL '. 109 . 10 � a i a 1 f { t Miami Shores Village Building Department gpRI E° 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 204`ff BUILDING Master Permit No. 2 CII-7 -- I C)23 PERMIT APPLICATION Sub Permit No. BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION E] EXTENSION ❑RENEWAL PLUMBING F-] MECHANICAL [:]PUBLICWORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: City: Miami Shores County: Miami Dade Zip: 31 Folio/Parcel#: ! I I R�a dz 3 �7 U Is the Building Historically Designated:Yes NO_ Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name(Fee Simple Titleholder): All.s4 Phone#: Address: `" City: MgIQ NG State: Zip: Tenant/Lessee Name: IY/L ,fel Q P Phone#: Email: ' CONTRACTOR:Company Name: U't� �� -2ST'°L� ,Phone#: Address: City: \ 1 State: Zip- •� I �/ Qualifier Name: J �s�� r ri (� 1` Phone#: 4 ` 0 . State Certification or Registration#: , 1'] .��"f�— Certificate of Competency#: i DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ Square/Linear Footage.of Work: 7/ Type of work: ❑ Addition ❑ Alteration ❑ New Itep'it/Replace;,/, ❑ Demolition + Description of Work•,,, l P,- IN tom Specify-idlor of 61or'thru tile: Submittal Fee APermit Fee te• $ W c3z) CCF$ E7b CO/CC$ Scanning Fee$' ,Q Radon Fee$ a• �0 DBPR$ �' � Notary$ C� Technology Fee$T Training/Education Fee$ t Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ �-[ •v`> (Revised02/24/2014) yai ;. � ' Bonding Company's Name(if applicable) ,_-N,` , 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. > s; "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY E 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 r YOUR NOTICE OF COMMENCEMENT.11 Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding$2500;'th'e 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 6e"posted'at,ihe 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 approv and a reinspection fee will be charged. , w s Signatur Signature - ( 0 NEW E o AGENT - 'GONTRACTOR a r w .The foregoing instrument.was acknowledged before me this The foregoing instrument was'acknowledged before me this day of f �HL 20 by '. C� day ofy� L--F r 20��J by �^�✓ I C7 iris pers� a ly kno o ., n 10 5T( is perso �ykn 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: �\\\\11N{{{Il��►�//// NOTARY PUBLIC: �� *••.....A• i Sign: = m •< i Sign: 1P Print: ok•�� Print: �~ '• ;. a:• $ .-Au�. , ,,ab, c,i �r ' c4 i l Seal: ��'•' Seal: a a'• fr�i�iA/O�ItID11�1N�\*\\\\ ��•� :9sQ`� :cg,�?�a' �� FL APPROVED BY, Plans Examiner yN 1101110 \\\\\\ Zoning Structural Review Clerk (Revised02/24/2014)