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RC-16-2898 (2)
Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 Project Address Parcel Number 7111 Permit NO. RC-10-16-2 98 Permit Type: Residential Construction Work Ctassifrcation: Alteration Permit Status: APPROVED 2017 Expiration: 01/15/2018 Applicant 89 NE 109 Street Miami Shores, FL 33161-7039 1121360040550 Block: Lot: JAGRUTI & HEMENDRA PATEL Owner Information Address Phone Cell JAGRUTI & HEMENDRA PATEL 89 NE 109 Street MIAMI SHORES FL 33161-7039 89 NE 109 Street MIAMI SHORES FL 33161-7039 Contractor(s) LUIS YI Phone (305)244-9991 Cell Phone Valuation: Total Sq Feet: $ 30,000.00 510 Approved: In Review Comments: Date Approved:: In Review Date Denied: . Type of Construction: INTERIOR Stories: Front Setback: Left Setback: Bedrooms: Plans Submitted: Yes Certificate Date: Bond Return : REMODELING KITCHEN Occupancy: Exterior: Rear Setback: Right Setback: Bathrooms: Certificate Status: Additional Info: Classification: Residential Fees Due Bond Type - Owners Bond CCF CO/CC Fee DBPR Fee DCA Fee Education Surcharge Permit Fee Plan Review Fee (Engineer) Plan Review Fee (Engineer) Plan Review Fee (Engineer) Plan Review Fee (Engineer) Scanning Fee Technology Fee Amount $500.00 $18.00 $50.00 $13.50 $13.50 $6.00 $900.00 $120.00 $120.00 $80.00 $120.00 $30.00 $24.00 Total: $1,995.00 Pay Date Invoice # 10/25/2016 07/19/2017 Bond #: 3460 Pay Type RC-10-16-61776 Credit Card Check #: 566 Amt Paid Amt Due $ 200.00 $ 1,795.00 $ 1,795.00 $ 0.00 Available Inspections: Inspection Type: Final PE Certification Window Door Attachment Framing Insulation Drywall Screw Window and Door Buck Fill Cells Columns Review Electrical Review Electrical Review Electrical Review Electrical Review Planning Review Planning Review Structural Review Structural Review Structural Review Structural Review Plumbing Review Plumbing Review Plumbing Review Plumbing Review Building Review Building Review Building Review Building Review Building Review Mechanical Review Mechanical 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, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS 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. Futhermore, I authorize the above -named contractor to do the work stated. July 19, 2017 1 • Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 Project Address Permit Parcel Number Permit NO. R i-1'0-16-2898 Permit Type: Residential Construction Work Classification: Alteration Permit Status: APPROVED issue Date: fl19/2017 Expiration: 01/15/2018 Applicant 89 NE 109 Street Miami Shores, FL 33161-7039 1121360040550 Block: Lot: JAGRUTI & HEMENDRA PATEL Owner Information Address Phone Cell JAGRUTI & HEMENDRA PATEL 89 NE 109 Street MIAMI SHORES FL 33161-7039 89 NE 109 Street MIAMI SHORES FL 33161-7039 Contractor(s) LUIS YI Phone (305)244-9991 Cell Phone Valuation: $ 30,000.00 Total Sq Feet: 510 Approved: In Review Comments: Date Approved: : In Review Date Denied: Type of Construction: INTERIOR Stories: Front Setback: Left Setback: Bedrooms: Plans Submitted: Yes Certificate Date: Bond Return : REMODELING KITCHEN Occupancy: Exterior: Rear Setback: Right Setback: Bathrooms: Certificate Status: Additional Info: Classification: Residential Fees Due Bond Type - Owners Bond CCF CO/CC Fee DBPR Fee DCA Fee Education Surcharge Permit Fee Plan Review Fee (Engineer) Plan Review Fee (Engineer) Plan Review Fee (Engineer) Plan Review Fee (Engineer) Scanning Fee Technology Fee Total: Amount $500.00 $18.00 $50.00 $13.50 $13.50 $6.00 $900.00 $120.00 $120.00 $80.00 $120.00 $30.00 $24.00 $1,995.00 (/12?----lerized Signature: Owner Applicant Pay Date Invoice # 10/25/2016 07/19/2017 Bond #: 3460 Pay Type RC-10-16-61776 Credit Card Check #: 566 Amt Paid Amt Due $ 200.00 $ 1,795.00 $ 1,795.00 $ 0.00 Building Department Copy / Contractor / Agent Available Inspections: Inspection Type: Final PE Certification Window Door Attachment Framing Insulation Drywall Screw Window and Door Buck Fill Cells Columns Review Electrical Review Electrical Review Electrical Review Electrical Review Planning Review Planning Review Structural Review Structural Review Structural Review Structural Review Plumbing Review Plumbing Review Plumbing Review Plumbing Review Building Review Building Review Building Review Building Review Building Review Mechanical Review Mechanical July 19, 2017 Date July 19, 2017 2 Dmipie, Paid (34- (032-(066/ `21 to\-. t � �\ Miami aml Shores Village -34kq Building Department artment BUILDING PERMIT APPLICATION 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 RECEIVEff OCT 2,4 2017 FBC 20 I9, Master Permit No. R L l O I to 2 IN 8 Sub Permit No. BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION 0 RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS CHANGE OF JOB ADDRESS: 8g xi& log °`` i- rc(M- ❑ CANCELLATION ❑ SHOP DRAWINGS City: Miami Shores County: Miami Dade Zip: 33 (A. ) Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): ,,) ruj -t' peA - J Phone# oS) 24 1 -6-CS 9 Address: 89 ('J (c094-",c1- t - 't ;SOS - (P ,2 _ o(O(p I City: WI( O v\ i' State: t C Zip: 3 3/ (o Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: Lu S r 1 Address: toe b 1 Pearl -wce -Dr • Phone#(3DS) ZyW -q9R / City: f'Ij C,ryii State: flL Zip: ' ,3/ (v / Qualifier Name: / f pZ J 3'J Phone#: State Certification or Registration j#: Certificate of Competency #: DESIGNER: Architect/Engineer: J LL4c \ (- -)cXv t' Phone# O) - 285- 43,43 Address: / '5 (oroL,t S(1t (�•i-e � 07 City: �J(Ct 4VIr State: F1- Zip: 3 /415 3 Value of Work for this Permit: $ Square/Linear Footage of Work: Type of Work: ❑ Addition �❑ Alteration ❑ New 1.+ Description of Work: 4 £ V7 C9 • o-f tti cht,l + c4 ❑ Repair/Replace i 6.1AFi4sd, ❑ Demolition 1 Specify color of color thru-tile: _• Submittal Fee`$""°' -;"-T"'";"'"'"'"_`"""m" Permit Fee $ 1 S ' 0D Scanning Fee $ Radon Fee $ Technology Fee $ Training/Education Fee $ Structural Reviews $8 • CCF $ CO/CC $ DBPR $ -ANGE, -e\11 (ACT; aO (Revised02/24/2014) Notary $ Double Fee $ Bond $ TOTAL FEE NOW DUE$ 438. GO it l.4Q k. a. Bonding Company's Name (if applicable) Bonding Company's Address a v.� tCitsf ` 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 undei-stand 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 instrument was acknowledged before me this The foregoing instrument was acknowledged before me this 2 LA day of OCk0 SID.Q;_, ( , 20 , by 2A day of in CO\0.21si , , 20 n , by jrO s -t' ? , who is personally known to LkA S l l , who is personally known to me or who has produced . I (n as me or who has produced -iI I 1 .as identification and who did take an oath. NOTA PUBLIC: identification and who did take an oath. NOTARY PUBLIC: Sign: Print: Seal: ##############################(M'###****#3k################################# d.h APPROVED BY (Revised02/24/2014) Plans Examiner Structural Review MAHARAI K. GONZALEZ MY COMMISSION # GG 044602 EXPIRES: November 2, 2020 "':FOF {;,Qt` Bonded Thru Notary Public Underwriters # Zoning Clerk MiamiShores Viiiage Building Department 10050 N.E.2nd Avenue Miami `Shores, _Florida 33138' Tel: (305) 795.2204 Fax: (305) 756.8972 CHANGE OF CONTRACTOR 1 ARCHITECT Permit N.Rc t014 ? T Owner's Name (Fee Simple Title Holder): \9 (Gutk: Parr?Q Phone # 305 2(� $(-5s- q Owner's Address: 8 q t3 l Oee�@- City: rV\ . cuvv ( S ho re-s Job Address (Of where work is being done): State : et_ Zip Code: 33 i fO ( 8c1 IQ toced City: Miami Shores State: Florida Zip Code: 33 1 6 1 Contractor'sCornpany_Narrme: Phone #: Address: City: State: Zip Code: 'Qualifier's Name: Lic. Number: Architec Engineer f Record Name: / , ./1/X) Phone #(3O5» 78 - Address: Set) ,ST- , (/ City: // / State: Zip Code: 713 Describe Wor•lc 1 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 harthless of all legal ira rower ent. Signature'Signatu Oiwn�n>or' ttt"--~ - The foregoing instrument was aknowledged before1me this�day of OC-io�A..P�!2011,by.)0 (l,4( 9 Who is personally know") to me or who as produced -�-f 1 l CQ-n e Notary, Pull Stiv: ..Nuomai'Ml/ Seal: as indentification:: �,. LEZ MY COMMISSION # GG 044602 EXPIRES: November 2, 2020n'ters Bonded Thro NotaryPublic Contractor or', rchitect /Pk/(7 The foregoing instrument was aknowledged before me ,^ , 20() by eel,"!` this 9 day of OGtohe refMlvl r} • /Vtar}iwtz who is personally known to me ,or who has produced,• /L/CP 5 — Z' /- �5 37/4 inde,»fcat;ion., Notary Public: Seal: • LETICIA NORAT Y COMMISSION 0 430053033 EXPIRES February 14, 2021 Miami Shores Village J US�,wA,' o�� Building Department G \`\� \`\ '10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 BUILDING \V PERMIT APPLICATION AUILDING ❑ ELECTRIC ❑ ROOFING ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS JOB ADDRES we loamy v rT 7ED OCT 2 5 2016 FBC201K cr Master Permit No. 6 - .8 9q S Sub Permit No. ❑ REVISION ❑ CHANGE OF CONTRACTOR City Miami Shores County: Miami Dade Folio/Parcel#: //- Z/alp _opi 5 2 Is the Building'Historically Designated::Yes v NO Occupancy Type: Load: Construction Type: Flood Zone: ❑ EXTENSION ❑RENEWAL ❑ CANCELLATION ❑ SHOP DRAWINGS OWNER Name (Fee Simple Titleholder): �r e o i.d r a Add :' vl k) e l,�"'�rCQ.-iC ,Gity:1Y1 (CONY State:*B- Tenant/Lessee Name: Phone#: Email: P&) u ,Zip: 3) (0 I BFE: FFE: Phone#:-3 753114 ) 3/ CONTRACTORrGompany;Name _7e2S`- Gi ,g��/l ,dd Aress' 7" <c"- e-- //7 -0.e /7� /n4Z2E.e % /-441,0,4 ' �Q/2ey 16 'o l io6J3 42� City:: /t/iaiw%. Qu.atifier_Name: ��/, s I , State=Certificationror-Registration:#: DESIGNER: Architect/Engineer: Address: a;(:/5?/.7/‘-/ Value of-Work=forthis Permit:1$ •=-/-7, 000 • CO City: dip:a.7 3/K'/ ? 9/ CeTtificateoofiGompetencyt#: Phone#: State: Zip: Square/Linear•Footage of-Work:i Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace DescriptionYof Worke' /JJ7 /c 2, /ZQe-//- 6' ( ft/5T 4/7Cbh%AA) /O .& oc,//-a. -, ,.5_7 �3ff77/.��•r'l /� 0.:.,:,_,,,�7i (z.0)6� - '/ . c. aC- vecv o aat-c': ccr . JL5. u ,3f�/E�1de5 R fiA` l.)6.S QS-i7 -' i, 3:it4.us' EK/s7 :" 5T %LIS,QE/-IOG p Specify color of colnG thru��tile:: 7X_e ,v7 << i�� ED/4xis7 s�,e4GE 70719e 4,uv&e Submittal Fee $ / � e �. ,- a^il rtfYit"Fee'$ CCF $ <! oo CO/CC $ Scanning Fee $ 3 L ' ~� Radon Fee $ !. - -i (3 DBPR . 5� Notary $ 0 Technology Fee $ 2L` ' CU Training/Education Fee $ (:;:• - 03 Double Fee $ Structural Reviews $'20 .0z) 1213'CYD 12CJ'C:' 'b. CO Bond $ ' O • 00 TOTAL FEE NOW DUE $ (i 29 B . 00 ,1�cj5' 0l..J (Revised02/24/2014) ."7O -fT ❑ Demolition Bonding Company's Name (if applicable) • Bonding Company's Address v• 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_ tOWNER or AGENT /The foregoing instrument was acknowledged before me this ZC day of 0 Ce.re-ixr---Z 3,20 ,—/4,. , by who is personally known to me or who has produced lP_— entification an rho did take an oath. NOTARY PUBLIC: Sign: Print: Seal: at, '- ************* APPROVED BY (Revised02/24/2014) .CANDIDL. MEANA Notary Pubirc - State of Florida My Comm. Expires Mar 5, 2018 mm�ss .m # FF 098597 **************** as CONTRACTOR The foregoing instrument was acknowledged before me this _Z5 day of O.C1D_?Crit _ , 20 , by GU/Sl , who is personally known to me or who has produced__%2—sr..._. d who did take an oath.. NOTARY PUBLIC: Sign: i//`'%✓'�, Print: Seal: L CANDID0 . MEANA s ;1 Notary Puftic State of Florida ,1111, MyTComm. Expires Mar 5, 2018 t.FIa.gt``' Commission * FF,098597 **************** Plans Examiner Structural Review as ********** Zoning Clerk RICK SCOTT, GOVERNOR KEN LAWSON, SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD LICENSE NUMBER CGC1521314 The GENERAL CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 FS, Expiration date: AUG 31, 2018 YI, LUIS INDIVIDUAL 10801 PEACHTREE DRI, MIAMI FL331C ISSUED; 08/23/2016 DISPLAY AS REQUIRED BY LA SEQ # L1608230003076 A C C5 R CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDNYTY) 6/12/2017 Fax (305) 267-4543 CONTACT TIAME: MARY URREGO , PHONE (305) 267-4541 —1 FAX i_tt,VC, No): . (306) 267-4543 — . -E-MAIL quoles@gmarinsurance COM INSURER(S) AFFORDING COVERAGE NAIC rt INSURER A: • UNITED SPECIALTY INSURANCE COMPANY I „ I INSURER B ' LUIS YI I INSURER C : ! : 10801 PEACHTREE DR INSURER D i INSURER E : _ MIAMI ' FL 33161 I 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 ! ADDLTSUBRI I POLICY EFF POLICY EXP I (MM/DDMYY) 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(ies) 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 G-Mar Insurance 8200 W 33 Ave #7 Hialeah, FL 33018 Phone (305) 267-4541 INSURED LTRI TYPE OF INSURANCE INSR wv0;_ POLICY NUMBER (MM,DD/YYYY). LIMITS COMMERCIAL GENERAL LIAILI EACH OCCURRENCE I $ 1,000,000.00 CLAIMS-MAOE OCCUR DAMAGE TO RENTED - 50 000.00 PREMISES (Ea occurrence) 1 MED EXP (Any one person) I s 5,000.00 09/29/2016 09/29/2017 pERsoNALa AOV INJURY r'$ 1,000,000.00, A C,ENL_ AGGREGATE LIMiT APPLIES PEn GENERAL AGGREGATE t 2,000,000.00 SI11004819417 . k POLICY :,'--- Z.P.,-1' ......„ PRODUCTS - COMP/OP AGG it' $ 2,000,000.00 OTHER $ COMBINED SINGLE LIMIT .1Ea accident) BODILY INJURY (Per person) LOC AUTOMOBILE LIABILITY El) ANY AUTO ALLOWNED,TE-2 SCHEOULED 111 HIRED AUTOS Auros 00..0sW NED UMBRELLA LIAB (1.1.:_j OCCUR I EXCESS LIAB • BODILY INJURY (Per accident $ PROPERTY DAMAGE $ (Per accident) „ 1.... _ CLAIMS -MADE ... LI DED 0 RETENTIONS 71 OTH- 5 .---1---1 SPLE91.-R VIE i—,,.! ER : E.L. EACH ACCIDENT i $ 1,000,000.00 WORKERS COMPENSATION .• AND EMPLOYERS' LIABILITY Y / N • ANY PROPRIETOR/PARTNER/EXECUTIVE---.! • A OFFICER/MEMBER EXCLUDED? I liN/A (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS bolOw DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101. Additional Remarks Schedule, if more space is required) EACH OCCURRENCE AGGREGATE 5 09/29/2016 09/29/2017 E L DISEASE EA EMF'LOYEfi, z, 1,000,000.00 E L. DISEASE - POLICY LIMIT s 1,000,000.00 LIc# CGC1521314 CERTIFICATE HOLDER MIAMI SHORES, VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES, FL 33138 ACORD 25 (2014/01) QF WC200821819 CANCELLATION 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 REPRESENTATI E MARY URREGO CCIVV © 1988-2014 ACO D CORP ATION. All rights reserved. The ACORD name and logo are registered marks of ACORD