Loading...
EL-17-1905Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 Project Address P mit Permit NO. EL-7-17-1905 Permit Type: Electrical - Residential Work Classification: Pool - Private Permit Status: APPROVED Issue Date: 12/5/2017 Expiration: 06/03/2018 Parcel Number Applicant 1050 NE 107 Street Miami Shores, FL 33161-7374 Owner Information Address 1122320280520 Block: Lot: Phone GABRIEL MARTIN KUSKUNOV Cell GABRIEL MARTIN KUSKUNOV 1050 NE 107 Street MIAMI SHORES FL 33161-7374 1050 NE 107 Street MIAMI SHORES FL 33161-7374 Contractor(s) Phone SS POWER & LIGHT ELECTRIC INC (305)607-5636 CeII Phone Valuation: Total Sq Feet: $ 1,800.00 0 Type of Work: Additional Info: Classification: Residential Scanning: 1 Fees Due CCF DBPR Fee DCA Fee Education Surcharge Permit Fee - Additions/Alterations Scanning Fee Technology Fee Total: Amount $1.20 $4.50 $3.00 $0.40 $300.00 $3.00 $1.60 $313.70 Pay Date Pay Type Amt Paid Amt Due Invoice # EL-7-17-64685 12/05/2017 Check #: 105 $ 313.70 $ 0.00 Available Inspections: Inspection Type: Final Light Niche Bonding Review Electrical Alarms 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 ELECTR L, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS AFFIDAVedify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zo thermore, I authorize the above -named contractor to do the work stated. December 05, 2017 Authorized Signat e: wner / Applicant / Contractor / Agent Building Department Copy Date December 05, 2017 1 BUILDING 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 --LCI52( ktfIcl 0 Master Permit No. - PERMIT APPLICATION Sub Permit No. —1 10� El BUILDING tEl ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF CONTRACTOR JOB ADDRESS: 1050 RE ID -7 S T City: Miami Shores County: Miami Dade Zip: 33 I 1 Folio/Parcel#: % 3a 0a 5 a 0 Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): UubYie l MGr1- r) RVSkVh0V Phone#: Address: 10 S U N i- 1 pi ST City: 11IGrni S4ore5 State: FL Zip: 33I/, I Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: NEWAL ❑ CANCELLATION ❑ SHOP DRAWINGS SS Pow ex- a- Lit c kits Oeci &C. .T-)c Address: -7-7 (PO S U) a (0 57 City: M 1 a Irn 1 State: f`L Zip: 3 31 CS Qualifier Name: Q r'(O S 6 0y)[e 2 _ Phone#: 305-- Co..5- 5100 State Certification or Registration #: bC. 1300 3i R ( Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: $ O0;a6 Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration Description of Work: POOL .Q I Q c h'i C ( Phone#: 305- 5-o s— 58 0 6 ® New ❑ Repair/Replace ❑ Demolition Specify color of color thru tile: Submittal Fee $ IIIFC) `4°. Permit Fee $ l©O i11e CCF $ CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Notary $ p Technology Fee $ Training/Edu ion Fee $ Double Fee $ Structural Reviews $ Bond $ 7 (Revised02/24/2014) TOTAL FEE NOW DUE $ 3I' 20 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 whi occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be appr.ve and a reins. ion fee will be charged. Signature Signature 0 NER or AGEN The foregoing ins rument was acknowledged before me this L) day of <TV 1.( xJo k,e_vZ►,Gt.rr () , who is personally known to me or who has produced IG?.S1 ' Zei 3 — �S 36ts O as me or who has produced identification and who did take an oath. NOTARY PUBLIC: Sig Prifif .'. n= M Comm. Expires Jan 21. 2019 Bonded through National Notary A CAROONA ary Pubic - State of Florida Commission # t-F CONTRACTOR The foregoing instrument was acknowledged before me this , 20 , by /3 day of "gri)1Y , 20 /7 , by C,# d (0S 6O,T 4Z- , who is personally known to A identification and who did take an oath. NOTARY PUBLIC: Sign: Print: Seal: ill �l as rie e ***************************************************************** APPROVED BY OLBIA MAND EY MY COMMISSION # FF959976 ', s: EXPIRES February 19, 2020 ********* 470-,7212y0° Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 / Tel: (305) 795.2204 Fax: (305) 756.8972 CHANGE OF CONTRACTOR / ARCHITECT Permit N. EL-8-15-2182 Owner's Name (Fee Simple Title Holder): GABRIEL MARTIN KUSKUNOV Owner's Address: 1050 NE 107 ST Phone #: 786-488-8315 City: MIAMI SHORES State : FL Job Address (Of where work is being done): 1050 NE 107 ST City: I Miami Shores Contractor's Co State: Florida any Name:'XTREME POWER ELECTRICAL INC. Address: 611 'NW 59 C Zip Code:33161 Zip Code:33161 Phone #: 786-255-1182 City: MIAMI Qualifier's Name : SUAREZ, IHOSVANY State: FL Zip Code: 33126 Lic. Number:7-ERi30I'19M7 Architect) Engineer of Record Name: JUAN FERNANDEZ BARQUIN P.E Address: 2520 NW 97TH AVE Phone #: 786-336-0881 City: DORAL Describe Work: NEW POOL, WITH EQUIPMENT State: FL Zip Code: 33172 1 hereby certify that the work has been abandoned and/or the contractor/architect is unable! or unwilling to complete the contract. 1 hold the Building Official and the is ' Sh .harmless of all legal involvement. Signature ent The foregoing "ins ument was aknowledged before ``m.• me this 13 day of �JLS ,2017 ,by(,cNorvc\ V'ICn�f,n Kvskvr.oV Who is personally known to me or who has produced Notary Pub Sign: Seal: Signature t^--; as indentification. GUEZ Notary Public - State of Florida Commission Ar FF 225758 My Comm. Expires Aug 18.2019 Bonded through National Notary Assn r t/'- ctor or Architect The foregoing instrument was aknowledged before me this I3i`"t day of 71)1u) , 2017 by 1hQsv� Sc.2=: e Z who is personally known to me or who has produced drtvers \►�� Notary Pu Sign: Seal: as indentification. Notar 'ublic - S1;,te• rlorida •? Commission # FF 2?5; 58 � My Comm. Expires Aug 18 1019, '"",° ,,� Bonded through Nation! Nu! t Miami Shores Village Building Department 10050 N.E. 2ND Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Change of Contractor/Architect or Engineer A change of contractor, architect or engineer must be done under a permit number. There is a $75.00 charge for a change of contractor. • The owner will submit a Change of Contractor Form completed with notarized signatures. If the signature of the previous contractor cannot be obtained the owner must send a certified letter/return receipt notifying the previous contractor, architect or engineer the reason for the change. The owner must allow 10 business days for the contractor, architect or engineer to respond. A permit application must accompany the change of contractor form, with the information and signature of the new contractor. The new contractor must be registered with the Village or must submit the required documents to register with the Village. I. Change of Contractor form completed, signed and notarized. 2. Permit application by new contractor. 3. Required fees. 4. Copy of original letter sent via certified mail along with the returned receipt. In addition to the requirements above the architect or engineer of record must authorized the new architect or engineer to reproduce his documents. The authorization must be in writing and must be signed and sealed. 13t1iNSG7fl ►� Yfl 3 " 4 0.,,ii !0 9'51?. Oik4aR ytr.10A w • t.A. IPO, =3t Q. to— 10 y►t , rt. '. ,,, Detaif by Entity Name http://search.sunbiz.org/Inquiry/CorporationSearch/SearchResultDetail... Detail by Entity Name Florida Profit Corporation XTREME POWER ELECTRICAL INC. Filing Information Document Number P10000027535 FEI!EIN Number 27-2225008 Date Filed 03/30/2010 Effective Date 03/29/2010 State FL Status ACTIVE Principal Address 611 NW 59 CT MIAMI, FL 33126 Mailing Address 611 NW 59 CT MIAMI, FL 33126 Registered Agent Name & Address GARCIA, BIANCA 611 NW59CT MIAMI, FL 33126 Name Changed: 03/10/2014 Officer/Director Detail Name & Address Title S FERANDEZ, CARLOS 2611 SW 117 AVE MIAMI, FL 33175 Title Secretary SUAREZ, IHOSVANY 3394 W 80 STREET 101 HIALEAH, FL 33018 Title President GARCIA, BIANCA 611 NW 59 CT MIAMI, FL 33126 Annual Reports Report Year Filed Date ')n1A n1/'I nion1A 2 of 3 7/14/17, 11:10 AM New a'c8 Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CONTRACTORS' REGISTRATION IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: A. COPY OF QUALIFIER'S STATE LICENCES B. 'COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF LIABILITY INSURANCE* D. COPY OF WORKERS COMPENSATION INSURANCE* (Workers Compensation EXEMPTION must have NOTICE TO OWNER form and Contractor Affidavit) IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY: A. COPY OF CERTIFICATE OF COMPETENCY OF QUALIFIER B. COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF STATE REGISTERED CONTRACTOR LICENSE OR MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT. D. COPY OF LIABILITY INSURACE* E. COPY OF WORKERS COMPENSATION INSURANCE* (Workers Compensation EXEMPTION must have NOTICE TO OWNER form and Contractor Affidavit) *YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE AS FOLLOW: Certificate Holder: MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES, FL 33138 Certificate must specify the description of operations or contractor license number. BUSINESS NAME: .$ - Po wen 51., 31,-T' BUSINESS ADDRESS: O SLJ CITY ri' Awl I STATE f - -ZIP 3 3 S BUSINESS PHONE: (305 ) S Va 0 FAX NUMBER ( ) CELL PHONE ( 3 b5) SOS Sec() QUALIFIER'S NAME: 6 y'(os C)orzia(e/es QUALIFIER'S LIC NUMBER: G 13 fl 03 ! 1 RICK SCOTT. GOVERNOR KEN LAWSON, SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL `CONTRACTORS LICENSING BOARD The ELECTRICAL CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2018.. GONZALEZ CARLOS R SS POWER & UGC j 7760 SW 26TII 5T:. MIAMI STATE OF FLORIDA DE PAIR M . N1" F; BUSINESS AND PROF S GULATION EC13003181 8/02/2016 CERTIFIED E� GONZALEZ C'... SS POWER &"Ll IS. CERTIFIED and Ahe provisions of Ch 488:fS: paKQf_c3Bh <tA1J£i.,37 2p18 ., .,.is^a;x. ,..a .:aL16080 0001844.:.:-: Local Business Tax Rchi,pt Miami -Dad eCounty , State of'Florid:a '-TH(S IS NQT A OIIL -DO NOT PAY, `,BU Sl E SSNAMEILO CA T ION SS POWER &.LIGHT ELECTRIC � r�INC F 7,7 O '26 r .. :°MI4MI, F'L 3 95:5 RECEIPT NO. RENEWAL 6130017 EXPIRES SEPT.EMBER 30, 2017 Must be displayed at place of hu5me5s Pursuant to County Code Chapter BA - Art. 9 & TO SEC. TYPE .OF BUSINESStiP AY MENT RECEIV E� 'SMANE L ICAL ,SY•Trr%COLLECTOR S S R & L1GHT ELECfiPt1C INr 196 CONTRACTOR 7500 09101120%6`•.': ��pi:�AgRERA'SERGIOA EC13003181 022A-16-005593..' flier(sj a wtahcanse tax RaCCIpl only corOrmspaymenbot thelocai Buss ness Tax,lhq:Reetpti Tep*, ii pern Weal Business Holder0ustcQIT ywlthanygova ' . pefm t,'oI a.certf iC?tlon of ine kidder's quail "cations to do busit�esso the twsiness �•' . - o riongoverrtIT t1al,regulatory.raw'sandrequirerrlentswhichapply 0a-Z6 •Thee F;Oabove !mslliedisplayedonall corr*Tarcialvehictes :Miaiii DadeCodeSec Formdreinformation,viStwww:.•an"idade 104-zsg.4.1- 1 ..� HATE /MMrnnNYVY) CERTIFICATE OF LIABILITY INSURANCE 07/12/2017 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 First Class Insurance Market 4101 NW 9th Street Miami, FL 33126 Phone (305)441-2997 INSURED , S&S POWER & ELECTRIC CORP 7418 NW 8TH STREET MIAMI, FL 33126 COVERAGES Fax (305)441-6443 CONTA T NAME: PH NE.Ext). (305)441-2997 ADDRESS. fcimc®aol.com INSURER A : INSURER B : INSURER(S) AFFORDING COVERAGE WESTERN WORLD INS COMP FAX (MC, No): (305)441-6443 NAIC M INSURER C : INSURER D : INSURER E : INSURER F : CERTIFICATE 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. _.__—_. ..I. INSR LTR TYPE OF INSURANCE ADDLUBR KUL POLICY NUMBER POLICY EFF MD IYYYY POLICY EXP MM/DD LIMITS. A GENERAL LIABILITY (�' LJ COMMERCIAL GENERAL LIABILITY ❑ III CLAIMS -MADE Ej OCCUR NPP1457505 01/20/2017 01l20/2018 EACH OCCURRENCE $ 1,000,000.00 DAMAGE TO RENTED PREMISES (Ea occurrence) $ 100,000.00 MED EXP An one person) $ 5,000.00 PERSONAL & ADV INJURY $ 1,000,000.00 r❑ u GENERAL AGGREGATE $ 2,000,000.00 GEN'LI—AGGREGATE LIMIT APPLIES PER: El POLICY El 78- Li LOC PRODUCTS - COMP/OP AGG $ 1,000,000.00 $ AUTOMOBILE LIABILITY Li ANY AUTO UALL OWNED SCHEDULED AUTOS AUTOS tr--�� NON -OWNED I_i HIRED AUTOS Li AUTOS lj Ea aB ldetnl) SINGLE LIMIT BODILY INJURY (Per person) $ BODILY INJURY (Per accident $ PROPERTY DAMAGE Per accident) $ $ 1--1 I I UMBRELLA LIAB U OCCUR EXCESS LIAB ❑ CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ $ $ h_DED IIIII RETENTION WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y I N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) I N I A r-.1 WC SQ AT - f1 OTH- L--, • EL. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE: $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, ELECTRICAL CONTRACTOR LIC #EC13003181 If more apace Is required) CERTIFICATE HOLDER CANCELLATION MIAMI. SHORES VILLAGE_ BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES,FL 33138 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE TH RAT s ' + TE THEREOF, NOTICE WILL BE DELIVERED IN Ar ORD • • WIT THE POLICY PROVISIONS. s AU O-IZEDREPR SENT'TI _ ACORD 25 (2010/05) OF (O 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD CERTIFICATE OF LIABILITY INSURANCE I .07/12/2017 Producer: Plymouth Insurance Agency 2739 U.S. Highway 19 N. Holiday, FL 34691 This Certificate is issued as a matter of information only and rights upon the Certificate Holder. This Certificate does not or alter the coverage afforded by the policies below. confers no amend, extend (727) 938-5562 Insurers Affording Coverage NAIC # Insured: South East Personnel Leasing, Inc. & Subsidiaries Insurer A: Lion Insurance Company 11075 2739 U.S. Highway 19 N. Insurer B: Holiday, FL 34691 Insurer C: Insurer D: Insurer E: Coverages The policies with respect limits 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 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. Aggregate shown may have been reduced by paid claims. INSR LTR ADDL INSRD Type of Insurance Policy Number Policy Effective Date (MM/DDIYY) Policy Expiration Date (MM/DD/YY) Limits GENERAL LIABILITY Commercial General Liability Each Occurrence $ Damage to rented premises (EA occurrence) $ Claims Made Occur Med Exp $ Personal Adv Injury $ General DPolicy aggregate limit applies per: ❑ Project ❑ LOG General Aggregate $ Products - Comp/Op Aga $ /ME- AUTOMOBILE NM LIABILITY Any Auto All Owned Autos Scheduled Autos Hired Autos Non -Owned Autos Combined Single Limit (EA Accident) $ Bodily Injury (Per Person) $ Bodily Injury (Per Accident) $ Property Damage (Per Accident) $ EXCESS/UMBRELLA ROccur LIABILITY Claims Made Deductible Each Occurrence Aggregate A Workers Compensation and Employers' Liability Any proprietor/partner/executive officer/member excluded? NO If Yes, describe under special provisions below. WC 71949 01/01/2017 01/01/2018 x I WC Statu- tory Limits I 1OTH- ER E.L. Each Accident $1,0og0oo E.L. Disease - Ea Employee $1p00,000 E.L. Disease - Policy Limits S1.000,000 Other Lion Insurance Company is A.M..Best Company rated A- (Excellent). AMB # 12616 Descriptions of Operations/LocationsNehicies/Exclusions added by Endorsement/Special Provisions: Client ID: 91-68-441 Coverage only applies to active employee(s) of South East Personnel Leasing, Inc. & Subsidiaries that are leased to the following "Client Company": SS Power & Light Electric Inc EC13003181 Coverage only applies to injuries incurred by South East Personnel Leasing, Inc. & Subsidiaries active employee(s;, while working in: FL. Coverage does not apply to statutory employee(s) or independent contractor(s) of the Client Company or any other entity. A list of the active employee(s) leased to the Client Company can be obtained by faxing a request to (727)-937-2138 or by calling (727) 938-5562. Project Name: ISSUE 04-13-17 (DV) Begin Date 6/10/2015 CERTIFICATE HOLDER CANCELLATION MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES,FL 33138 Should any of the above described policies be cancelled before the expiration date thereof, the issuing insurer will endeavor to mail 30 days written notice to the certificate holder named to the left, but failure to do so shall impose no obligation or liability of any kind upon the insurer, its agents or representatives IVIld1 I11 al 101 CS 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 NOV 3 �016 r ' FBC 20;�0_ 3oO I BUILDING Master Permit No. 13? P ^ ts' - Ll g PERMIT APPLICATION Sub Permit No. 6 / to-3cO? El BUILDING 14 ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ID RENEWAL ❑PLUMBING ❑ MECHANICAL El PUBLIC WORKS ❑ CHANGE OF CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: / 0 SO -City: N iv7s-f_ 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): G i (-- 1 ,, I P1/4� l`j` ') k LIS k 0 NOir Phone#: Address: I OSO N E I£ 7 City: M ; G VVl i ' k b Y Stat 1 DY c l el Zip: -Z 10 Tenant/Lessee Name: Phone#: Email: CONTRACTOR:: Company Name: X%r�' ry e Address: \ \ IA) Ste( City: \\\ \ CA r\ State: P 3 3 1 Zip: x-co Qualifier Name: - 4 OS V' 01 N 1 0 y" `° Phone#: State Certification or Registration #: A; _ i ate of Competency #: DESIGNER: Architect/Engineer: kr D 1V c C. G% l 1q` Phone#: -0-S- - Z1 -. 0 S Z.-1Address: 7 0 I z-• 1J . v' :-r I l i City: o y`^ State: '- Zip: 3 3 IS S Val f Work for this Permit: $ (a 0 Squ :.re/Linear F • • • ge of Work: Type of Work: ❑ Addition ❑ Alteration FI New d Repair/Replace ❑ Demolition Description of Work: �C 14ect" EGG I �yfl� io-em Specify color of color thru tile: Submittal Fee $ Permit Fee $ 3O69'''‘› CCF $ 1 • 20 CO/CC $ Scanning Fee $ /3 Radon Fee $ Li . 50 DBPR $ `1 • S D Notary $ --- Technology Fee $ 1 Training/Education Fee $ O (--i n Double Fee $ Structural Reviews $ Bond $ ZZ) TOTAL FEE NOW DUES 2 (.05 • Bonding Company's Name (if applicable) Agonding 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. 1 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 n OWNER or AGENT The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this QI Z— day of Q 0 V `a'-> , 20 1 („o , by day of , 20 1 , by SW.)YlOI%w h personally nown to ��/aS✓4�tJlf SI,LA L, who is personally known to CQ N O-c� me or who has produced as me or who has produced a....."..\,,,„.. as identification and who did take an oath. NOTARY PUBLIC: identification and who did take an oath. NOTARY PUBUC: Sign: Print: Seal: Sign: Print: Seal: CARY M RODRIGUEZ •% = Cununission # FF 225/58 • tt' 3 MyComm. Expires Aug 18, 2019 "41g,;. °` Bonded through National Notary Assn. APPROVED BY 924 �>ie-- 7'%'l,/0 Plans Examiner Zoning Structural Review Clerk