REV-18-3118BUILDING
PERMIT APPLICATION
❑ BUILDING
❑ PLUMBING
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
❑ ELECTRIC ❑ ROOFING
Master Permit No.
REVISION
Sub Permit No.
❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF
CONTRACTOR
JOB ADDRESS: CI? LI(J 'v M M
City: Miami Shores County:
Folio/Parcel#:
Occupancy Type: Load:
i1•-3toI 614-cotb
zJi;
Miami Dade
REC WED
OCT 092018
Ct �
CQ,h
FBC 201�
(2-C. ‘S-i02-
R�y ve-311g
❑ EXTENSION ❑RENEWAL
❑ CANCELLATION ❑ SHOP
DRAWINGS
zip: 33C-3
Is the Building Historically Designated: Yes
Construction Type: Flood Zone:
OWNER: Name (Fee Simple Titleholder): M.
Address: fLt. (3 i\/
city: MickAA,�L�orLS
State:
BFE:
Phone#:
NO
FFE:
Zip:
3'31C-C)
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: I-0(E' mow 6'04110 Pl C,rci p Li-C
Address: 356 Su) J c t
Phone#: 7-PG 9:32 Ecl 3
City: I)vt t a--
Qualifier Name:
State:
State Certification or Registration #:
DESIGNER: Architect/Engineer:
Address: 0 City:
Value of Work for this Permit: $
Type of Work: ❑ Addition n Alteration ❑ New ❑ Repair/Replace
IS
Description of Work: 1 A5?'cUi ND 12,A, Vile
Zip: 00le
Phone#: fig% a[--2- ,ct
32,9 Certificate of Competency #:
Phone#:
State: Zip:
Square/Linear Footage of Work:
❑ Demolition
Specify color,pf :color
of
vu, .`-J oc, ..:
Submittal Fee $ ..d w, ,_..,• .., „Permit Fee.$,.
Scanning Fee $
Technology Fee $ Training/Education Fee $
Structural Reviews $
Radon Fee $
CCF $ 'CO/CC $ u
DBPR.$ Notary $
Double Fee $
Bond $
TOTAL FEE NOW DUE $
(Revised02/24/2014)
Bonding Company's Name (if applicable)
_ . 7
Bonding Company's Address
City State Zip
Mortgage Lender's Name (if'ap;plicable)
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. . , -
ri
"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."
rv•
Notice to Applicant: As a condition to the issuance of a building permit with an estimated 'value exceeding $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature
0 NER o AGENT
The foregoing instrument was a knowledged before me this
day of 0C-- \ , 20 lE2, , by
!v RI , who is personally known to
me or who has produced
identification and ho • id take an oath.
NOTARY PUBLIC:
Print:
Seal:
Signature
CONTRACTOR
The foregoing instrument was acknowledged before me this
day of OC-, 20 %� , by
, wh erscm
as me or who has produce as
6. s
identification and ho did take an oath.
NOTARY PUBLIC:
I
********
IZOZIOVLO ' ! k
6019Zt0A0aaV 3 13
epuold to elel$ o!IQnd NetON
Print:
Seal:
Notary Public State of Florida
FELIPE ARROYO
v My Commission GG 128709
�lapd Expires 07/20/2021
* ********** ***** ************************** *********
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
•1
101 Mobility®
Experts in Mobility and Accessibility Solutions
101 Mobility
DBA 101 Mobility
1000 W Pembroke Rd. Suite 303
Hallandale Beach, FL 33009
Phone: (754) 202-4493
Fax: (754) 263-0238
(
Sales Contract: 0180103001
QUOTE DATE ATTENTION
1/3/2018
Nancy Aquilino 1
Nancy Aquilino
9148 N Miami Ave
Miami Shores, FL 33150
TERMS
50% Down Payment Required
QUOTE NOTES
`Terms are 50% deposit at time of order and balance is due upon completion of delivery and installation.
REF
DESCRIPTION
QUANTITY
PRICE
TOTAL
P1
Modular Ramp/ADA - ADA MOD RAMP
Includes:
22 Feet Of Ramp
5X5 Platform
1.00
$3,890.00
$3,890.00
S1
INSTALL - R - Ramp Installation
Delivery & Installation
Includes initial installation & all service/adjustments
required during the first full year of operation.
101 Mobility Full -Service Warranty included at no
additional charge. Does not cover service charges
attributed to damage from extreme weather, water,
abuse, or vandalism.
1.00
$400.00
$400.00
S2
CONCR - Concrete Labor and Materials
Concrete footers 18 inches deep
1.00
$350.00
$350.00
F1
Permit Fee
Permits Not Included
0.00
$0.00
$0.00
TX
Sales Tax
The sales tax of $272.30 may be waived with a physician's
prescription, tax exempt certificate or reselier
certificate.
1
$272.30
$272.30
Quote Total
$4,912.30
Binding Contract
By signing this Sales quote and making any payments towards the quote amount you are entering into a legally binding contract to purchase goods
(hereinafter "Sales Contract"), under the terms and conditions herein stated.
Right to Cancel
Continued on page 2
Independently owned and operated franchise business
www.101mobillty.com
page 1
Please note that under the law, you have a three (3) day"right to cancel" this Sales Contract for a full refund. You don't have to give us a reason for
canceling your purchase. To cancel this Sales Contract, sign and date one copy of the cancellation form provided by us to you at the time of sale. If no
cancellation form was provided to you by us, you can write s a cancellation letter. Mail the cancellation form or cancellation letter to the following
address 1000 W Pembroke Rd. Suite 303, Hallandale Beach, Florida 33009, making sure the envelope is post -marked before midnight of the third business day
after the contract date. Saturday is considered a business day; Sundays and federal holidays are not. Because proof of the mailing date and receipt are
important, consider sending the cancellation form by certified mail so you can get a return receipt. Keep a copy of the cancellation form or letter sent
for your records.
Please take note that if you cancel your purchase within the three (3) day right to cancel:
A. We shall have 10 days to:
aft Cancel and return any check you signed;
aft Refund all your money and tell you whether any product you still have will be picked up; and
afo return any trade-in.
B. We shall also have up to 20 days, to either pick up the items left with you, or reimburse you for mailing expenses, if you agree to send back the items.
C. Important: If you received any goods from us, you must make them available to us in as good condition as when you got them. If you don't make the items
available to us - or if you agree to return the items but don't - you remain obligated under the contract.
Please take note that if you do not cancel your purchase within the three (3) day right to cancel stablished by law, we may still allow you to cancel your
purchase, but only under the following conditions.
A. Restocking Fee: When cancellation occurs prior to start of installation, you will be subject to a restocking fee of Fifteen (15%) of the total Quote
amount, before tax.
B. Custom Applications: No cancellation will be allowed after the three (3) day right to cancel stablished by law.
a. A 50% non-refundable deposit will be required when final measurements are taken after the three (3) day right to cancel established by law has expired.
No final measurements will be taken during the three (3) day right to cancel period mandated by law.
b. The remaining 50% is to be paid prior to our placing the order with the manufacturer. No Custom Application orders will be placed with the manufacturer
during the three (3) day right to cancel period mandated by law.
C. No Cancellation When Installation Begins. No cancellation will be allowed when installation beings after the three (3) day right to cancel established
by law has elapsed. No work installation shall begin during the three (3) day right to cancel period mandate by law. The 50% balance shall be due and
payable upon completion of the delivery and installation.
Notwithstanding the above, please take note that under the law, you do not have a three (3) day right to cancel the following:
a€Sales Contracts for goods or services not primarily intended for personal, family or household purposes.
a€Sales Contracts made entirely online, or by mail or telephone;
€Sales Contracts which are the result of prior negotiations at the seller's permanent place of business where the goods are sold regularly;
€Sales Contracts needed to meet an emergency;
€Sales Contracts made as part of your request for us to do repairs or maintenance on your personal property (purchases made beyond the maintenance or
repair request are covered).
Choice of Law
This agreement shall be governed, construed, and enforced in accordance with the laws of the State of Florida, without regard to its conflict of laws
rules.
Venue
The parties hereto irrevocably and unconditionally consent to the jurisdiction of the United States District Court of the Southern District of Florida,
otherwise, the parties hereto submit to the jurisdiction of any court of competent jurisdiction in the Courts of Miami -Dade County, Florida.
Fees and Costs
The prevailing party shall have the right to collect from the other party its reasonable costs and disbursements, including but not limited to costs of
collections, legal expenses and attorney's fees incurred in enforcing this Sales Contract.
Other Terms and Conditions:
The terms and conditions of the sale are as follows:
€Before the three days right to cancel this Sales Contract has expired:
Buyer shall make a fifty percent 50% deposit of the value of the purchase (Quote Amount) at the time of signing (accepting) the quote.
€After the three days "right to cancel" has expired:
Buyer shall pay the balance due upon completion of delivery and installation.
Sales Contract: Q1,80103001 Quote Total: $4,912.30
Signature
Warranty
\e- Protection
Date
Independently owned and operated franchise business
www.101mobility.com