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RC-9-16-2500_1460 NE 103 St Part 114 y ell" DOW IvIe- 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 BUILDING PERMITPP_LICATION QBUILDING ELECTRIC Q'ROOFING ❑PLUMBING ❑ MECHANICAL PUBLIC WORKS F��1'-J BCC 20r I /7 > -Master Permit No. /.� - 17 J , Sub Permit No. �,L I b "-8( 3 ❑ REVISION' ❑ EXTENSION ❑ RENEWAL 2"CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 14 bU N C— I O S� City: Mia"mi Shores W °County: dr ^`Miami Dade - . 't Zip: Folio/Parcel#t' " Is the Building Historically Designated: Yes NO Co Occupancy Type: Load. Construction Type: Flood Zone: BFE: FFE: " f i -4 fi OWNER: Name (Fee Simple Titleholder): ' / ` Phone#: ` Address: �Y ��l� A L� 1 / c City: ` ,c1.�.6,c1�=�' � �i,�l°` � State: �/�� ,Zip���! � O Tenant/Lessee Name: Phone#: Email CONTRACTOR: Company Name: r Address: City: 9 Lf 4 Statq: hone#: Qualifier Name: Phone#: State Certification or Registration #: Certificate of Competency #: _ DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: $ �• ;�%f%� r Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: Specify Submittal Fee $ Scanning Fee $ Technology Fee $ Structural Reviews $ Permit Fee $ CCF $ ` CO/CC $ R Radon Fee $ DBPR $ Notary $ Double Fee $ _ Training/Education Fee $ Bond $ _ TOTAL FEE NOW DUE $ (Revised02/24/2014) Bonding Company's Name (if applicable) Bonding Company's Address City State ' r` - ' Zip Mortgage Lender's Name (if applicable) Mortgage Lender's Address' City State Zip < < r x 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..... :'A' s 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. _ .• C tk a - "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOUANTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." . ' > I ° 4 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. Signatur Signature - OWNER or AGENT CONTRACTOR ' The foregoing instrument was acknowledged beforeme this day ofL_ 2O � c� by wh'o`is personally known to me or who has produced as - identification and who did take an oath. The foregoing instrument was acknowledged before me this ' d of ADQ(_ , 20 _, by ' who is personally known to- me orwho has produced ! 1Jl '-, 'as' o identification and who did take an oath. 7 NOTARY PUBLIC: '-" ' I NOTARY. PUBLIC: Sign: Si n• Print: r Print: Seal: _ a CHARIAINEMIGUEZ Seal• CHARIAiNEMIGUEZ .�..,. r . AIY COMMISSION M GG 176551 1/Y COMMISSION �'�' tTi6s1 o EXPIRES: January 17.2022 EXPIRES Jadtary 1T. 20?2 y f"?�`ggdedThruNofacYPublcUndenttters r_ i'o�': ter: gq�epTlru publicUndetMtit�s �4Y P ��i; Its j r *****s******sss****sss*****s****s**s***s**s*sss******s****s*s***ss************s*********s******************s APPROVED BY - R , Plans Examiner Zoning (Revised02/24/2014) r ` ` Structural Review ' ` Cler'k ' ,' 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 NZ-'05 00 s--/7/-2 i1 I u (8 - 863 Owner's Name (Fee Simple Title Holder):6%y.'z;,,-i� Phone#: Owner's Address: Job Address (Of where work is being done):_ City: Miami Shores State : Zip Code:./�6--1" State: —Florida Zip Code: —3•S/l-r Contractor's Company Name: KeSA f0th,PfS rn r. Phone #: 30 S- 3 Y 5 - 117 Address: 5215 Su-) 103 Av e. City: K64mi State: PC. Zip Code: 33/(or Qualifier's Name:. Rr4uL M,PS'A Lic. Number: LC 13 00 1 f70 Architect/ Engineer of Record Name: Address: City: State: Describe Work: /�yiLAJ�,I 0��� Phone #: Zip Code: I 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 Miami Shores harmless of all legal involvement. Signatur Signature • �or Agent Contractor or Architect The foregoing instrument was aknowledged before me this rd y of 20%Zby`!?�i��.6s� Who is personally known to me or who has produced as indentification. Nota lic. Sign: Seal: c M1o� 0011M1SSIOM / GG 17fi651 WkU The foregoing instrument was aknowledged before me this —X11%ay of 071 og' , 20 �4y who is personally mown to me or who has produced ti=. as indentification. Notary Sea[: .—.. gEMIGUQ ~� M1 E #GG/76551 yOOM Miami Shores Village ocr 4 2 18 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 FBC 20 BUILDING Master Permit No. kS 1-7— 12-71 PERMIT APPLICATION Sub Permit No. BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 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): `'�7OJJ�nGDiI Phone#: 3o�' Address: / TI�� /(// (/Ss% City: State: 0��C4. Zip: Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: , �` '�`' ��✓`�f G ' Phone#: Address: 2l -49 City: 1 �145�ee tate: Zip: 3 30 L IV- QualifierName: Phone#: State Certification or Registration #: G'f C �¢-r7 /Zd Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: (� /l �q City: State: Zip: Value of Work for this Permit: $ V 1 V 0 Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: Specify color of color thru tile: Submittal Fee $ Permit Fee $ CCF $ CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Notary $ Technology Fee $ Training/Education Fee $ Double Fee $ Structural Reviews $ Bond $ a. TOTAL FEE NOW DUE $ I (Revised02/24/2014) Bonding Company's Name (if applicable) Bonding Company's Address City State Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip 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 opproyp4Vnd a reinspection fee will be charged. Signatur Signature NER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this day o120 by �/YY�/1tC S IJ( who is personally known to me or who has produced �/ a as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: Seal: 1 r•r, ************ APPROVED BY The foregoing instrument was acknowledged beforemethis 3� day of 640br P. 20 19 by A�-vt CIO S� Ino who is personally known to me or who has produced as iden NOT Sign Prini mryaeat+r�mza�marx:�ra4+arnoca�.ran c{kqLANEMIGUEz Seal: Hr'Py •. YANADYPRIETO WY COMMLS" # GG V6551 5 MY COMMISSION # FF 214031 E)WIRES:dwwiwY17,2022 - EKFiPFS: M3rgh 25. Xded Public Underwriters .'. Plans Examiner Structural Review Zoning 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 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. Signature: er State of Florida County of Miami -Dade n The foregoing was acknowledge before me this day of , 20-V—. By I "1 a" 1 CIQ &;JV1 S who is personally known to me or has produced as identification. Notary. SEAL: LIZETTE LLORET *_ Commission # GG 118087 FMy Commission Expires June 22, 2021 Miami Shores Village 4 2 18 oc� Q 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.3r1::;-S17U-V Owner's Name (Fee Simple Title Holder): Owner's Address: 111/0 City: W14A-7,1 �Li621? S Job Address (Of where work is being City: Miami Shores State : s Phone #: 710' ?09�5- Zip Code: 3.3/3� /4/6ox�- sT State: Florida Zip Code: 33 / 3 Contractor's Company Name: � /3z!�3e 4 , �. Phone #: -7p,4, Address: xzw --:� %,7 ,--:-,z— City: % / i Qualifier's Name : / l Architect/ Engineer of Record Name: Address: City: State: ;-L Zip Code: 5 Z— Lic. Number: CPC State: Phone #: Zip Code: Describe Work: hereby certify that the work has been abandoned and/or the contractor/architect is unable or unwto complete the contract. I hold the Building Official and the Mi mi Shores harmless of all legal involvem Signature Signature - I; Ow o cto Architect The foregoing instrument was4knowledged before me The foregoing instr ent as aknowledged before me this ( day ofL�M 20-6,by- Y-n1(�A S this day of(-�-201&y /, Who is personally known /to me or who has produced who is personally known to me or who has produced �x as indentification. { �� as indentification. Notary Ppbiic3 Sign: Seal: q{gRWNE MIGUEZ ► y COMMISSION k GG MMI EXPIRES: Jarntary 1T. 2022 •v"< gilded Tlru NMary Public Undermiurs _ RICK SCOTT, GOVERNOR JONATHAN ZACHEM, SECRETARY T FI rda =- r STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD THE RESIDENTIAL POOL/SPA CONTRACTOR HEREIN IS CERTIFIED UNDER THE PROVISIONS OF CHAPTER 489, FLORIDA STATUTES ESTUPINAN, PATRICIO k ODISSEY ENTERPRISES INC 6728 ATLANTA ST ,+... HOLLYWOOD FL 33024 r-- % r LICENSE NUMBER: CPC1457420 EXPIRATION DATE: AUGUST 31, 2020 Always verify licenses online at MyFloridaLicense.com ISE .- 0 N. }'f Do not alter this document in any form. r This is your license. It is unlawful for anyone other than the licensee to use this document. BROWARD COUNTY- LOCAL BUSINESS TAX RECEIPT g s' 115 S_ Andrews Ave., Rm_ A-100. Ft. Lauderdale, FL 33301-1895 — 954-831-4000 VALID OCTOBER 1, 2018 THROUGH SEPTEMBER 30, 2019 ©BA: It ODISSEY ENTERPRISES INC Receipt#'180-269060 Business Name: r CONTRACTOR Business Type: ype: i Owner Name: PATRICIO ESTOPINAN Business Opened:10/01/2014 Business Location: 6728 ATLANTA ST State/County/Cert/Reg:CGC1511963 HOLLYWOOD Exemption Code: Business Phone:95a-709-95I9 Rooms Seats Employees Machines Professionals For vending Business only Number of Machines: FTax A Amount Transfer Fee N5F Fee Vendin T 9 ype: Penalty j 27.00 0.00 0.00 Prior Years Collection Cost Total Paid 2.701. 0.00 0.00 29.70 '€ to i THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS w THIS BECOMES A TAX RECEIPT This tax is levied for the privilege of doing business Broward F within County and is non -regulatory g ry in nature. You muss meet all County and/or Municipality planning j WHEN VALIDATED and zoning requirements_ This Business Tax Receipt must be transferred when ?i the business is sold, business name has changed or you have moved the business location. i This receipt does not indicate that the business is legal or that it is in compliance with State or local laws and regulations. Mailing Address: s PATRICIO ESTOPINAN 6728 ATI,AN`PA ST'�' Receipt 40SA-17-00000253 t -� HOLLYWOOD, FL 33024 Paid 09/12/2016 27.00 ;Y 2018 - 2019 tt� sy� JIMMY PATRONIS CHIEF FINANICAL OFFICER STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION * * CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW * * CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law. EFFECTIVE DATE: 6/30/2017 PERSON: ESTUPINAN FEIN: 260003378 BUSINESS NAME AND ADDRESS: ODISSEY ENTERPRISES INC. 6728 ATLANTA HOLLYWOOD FL SCOPE OF BUSINESS OR TRADE: 33024 Licensed Generat Contractor Licensed Pool Contractor EXPIRATION DATE: 6/30/2019 PATRICIO t4.'PORTANT: Pursuant to Chapter 440.05(14), F.S., an officer of a corporation who elects exemption from this chapter by filing a certificate of election under :1- section may not recover benefits or compensation under this chapter. Pursuant to Chapter 440.05(12), F.S., Certificates of election to be exempt.. apply _ :; within the scope of the business or trade listed on the notice of electron to be exempt Pursuant to Chapter 440.05(13), F.S., Notices of election to be - !mpt and certificates of election to be exempt shall be subject to revocation if, at any time after the filing of the notice or the issuance of the certificate, the - +son named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate. The department shall revoke a :.-'.5cate at any time for failure of the person named on the certificate to meet the requirements of this section. CFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUESTIONS? (850)413-1609 Scanned by CamScanner DATE(MMIDO/YYYY) ACORI7� CERTIFICATE OF LIABILITY INSURANC 08/30/2018 CERTIFICTE HOLDER. THIS THI�RTIFICATE IS ISSUED AS A MAJOR NEGATIVELY AMENDYEXTEND OR ALTERAND CONFERS NO TIGHTS HE CCOVUPON THE ERAGE A FORDEDABY THE POLICIES CERTIFICATE ODES NOT AFFIRMATIVELY BELOW, THIS CERTIFICATE OF INSURANCEERrEFSCA E HOt_DER.uTE A CONTRACT BETWEEN THE ISSUING lNSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND IMPORTANT. If the certificate holder Isc n nDDiT110NAm INect to SURED, quire an endorsement. A statement on this his certifi • to does nottconferDightslto the the terms and conditions Of the Policy, Po licies certay ificate holder in lieu of such endorsement(s). NEE CT Ma ltn Perez 305 41$$413 X--- er -- F No)' 18 PRODUCER (305) 418-8411 PHONE _ .. 305� 418-8411 ___.11 Westward insurance Services, Inc E v�ess. Westwardins bellsouth.net __ 4905 NW 72nd Avenue Nalco INSURFRts) AFFORDING COVERAGE Suite 5 INSURERA: A�atic Casual Insurance Com an t INSURED Odissey Enterprise Inc 6728 Atlantic Street Hollywood, FL 33024 F: OVERAGES GE CERTIFICATIS E NUMBER: 95 NAMED :EIN ) l TED.0 ERTIF HATOTWITHSTANDING ANIYIREQUiREMENT TERM OR CONDwtON OF ANY CONTRALTO OR OTHER TEDDOCUMENT WOiTH RE PELT TOLWHICH THIS IND►CA _ — CERTI TCATE DYCON SSUM OF SUCH ppUCiES LIMITS SHOWN MAY IiOAVE BEEN REDUCEDI BY PAID LAIMSD HEREIN IS SUBJECT 70 ALL THE TERM EXCLUSIONS AN won, .erriiks — _-- ...�.unYr,v1 { tYp WY . LfNUTS � EACH OCCURRENCE ,-DAMAGE TO RENNTEb GENERAL LIABILITY PREMISES [Ea occurrence) S A ' ✓ 7COMMERCIAL GENERAL LIABILITY. 7 OCCUR L230000255-4 12/02/2017 12! 02!2018 `: MED EXP (Any one person) 8 ADV INJURY I S CLAIMS -MADE _PERSONAL 'GENERAL AGGREGATE 5 4--� PRODUCTS - COMPIOP AGG i S GEN'L AGGREGATE LIMIT APPLIES PER, S PRO 71k LOC COMBINED SINGLE LIMIT Is S- ✓ POLICY I k (Ea acci -nt) AUTOMOBILE LIABILITY i BODILY INJURY (Per person) S ANY AUTO ___ —{ BODILY INJURY (Per accident) i S - ALL OWNED E SCHEDULED AUTOS �% OWNED pgpPERTY DAMAGE Is accident -- NON _LPer is HIRED AUTOS ',,__,_! AUTOS EACH OCCURRENCE I s UMBRELLA LIAB OCCUR j AGGREGATE 5 I' EXCESS LtAB CLAIMS -MADE, + -- I S ncn RETENTIONS I WCSTATU- foTN-i TnaYLIMITSL. EE_ AND EMPLOYERS' LIABILITY Y I N ANY PROPRIETORiPARTNERIEXECUTIVE ❑ ; N I A OFFICERIMEMBER EXCLUDED? (Mandatory in NH) If ves. desuibe under --- DESCRIPTION OCOPERATIONS actoLOCATIONS CGC I1 VEHICLES h ACORD tot, Addltfonal Remarks Schedule. if mom space is raqulred) General Certificate Holder is listed as Additional Insured. E.L. EA 5 :ERTi11 ATE HOLDER SHOUtrD }►NY OF THE 9 DESCRIBED POLICIES BE CANCELLED BEFORE THE IRATION HATE EREOF, NOTICE WILL BE DELIVERED IN AC E WITH THE P ICY PROVISIONS. Miami Shores Village Building Deparment r 10050 NE. 2nd Avenue, Miami Shores AUT OR, D I " ' VE Florida 33138. May►in Perez - ---- -- --- -- ----- 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD 08aiss-C -�Y�,rlcts �YIC riv�.Y l � c�,ns� m YANADY Pf IET �O 0% M. S S I UY 131 EXi _& ylarch 25! 2,-) 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 BUILDING PERMIT APPLICATION ❑BUILDING F ELECTRIC F ROOFING FBC 20 Master Permit No. &?p 11 1 2� Sub Permit No. PL Ie4 REVISION EXTENSION ❑RENEWAL 14, PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: ,fFlood Zone: BFE: FFE: r� OWNER: Name (Fee Simple Titleholder):/`9%�it/l�.� S.Q C/%"� —s Phone#: Address: City: ��/n �f� d/t�S State: /—l�� 44- Zip: Tenant/Lessee Name: Phone#: Email: / q CONTRACTOR: Co pany NamPhone#: Address: City: �d� State: T Zip: Z Qualifier Name: Phone#: State Certification or Registration #: G� —� z� Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: (l City: State: Zip: Value of Work for this Permit: $��v O Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New / ❑ Repair/Replace ❑ Demolition Description of Work: <�% -'? S'P A� �ia►l/���`�'� Ana ,�O► iPTQ Specify color of color thru tile: Submittal Fee $ Permit Fee $ Scanning Fee $ Radon Fee $ Technology Fee $ Training/Education Fee $ Structural Reviews $ CCF $_ DBPR $ CO/CC $ Notary $ Double Fee $ Bond $ 1 TOTAL FEE NOW DUE $ J 1 O' b 0 (Revi sed02/24/2014) Bonding Company's Name (if applicable) Bonding Company's Address City State Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip 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 oppcevrfi and a reinspection fee will be charged. SignaturK t/ Signature OWNER or AGENT CONTRAC The foregoing instrument was acknowledged before me this day of �- 20 ���\ , by C�: who is personally known to me or who has produced F(— V L.— as identification and who did take an oath. NOTARY PUBLIC: The foregoing instrument was acknowledged before me this 3r1day of 06-obty , 20 IS by ��fki O hlAup;y�(pY�l who is personally known to me or who has prod,uced X-J�Y iCL(AS-f as identificatiorf arid.who did take -an oath. NOTARY PUBLIC: Sig . �� !� Sign: Gr d Print: / i Print: Q Seal: u+NE M G �tSeal: t •Vy W COMYISSIOM t G655t !. ^ 11.2022 SPIRES: Jamw7 P . Bum APPROVED BY 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 PermitN. ����7/�7/ �l.�b—S64- Owner's Name (Fee Simple Title Holder):/yJdd//CA —5�7%/�/s Phone #: —3y�- 7/0- � ✓ Owner's Address: /ilt�6 41�11117)3'f`r- City: _, 40 zfs State : , , wlc-s Zip Code:—7-J/-Jt Job Address (Of where work is being done): /Vzo'A/2�3 City: Miami Shores State: —Florida Zip Code: Contractor's Company Name: Address: Z City: i irr� Qualifier's Name: % Architect/ Engineer of Record Name: Address: City: Describe Work: State: Z�- Phone #: � -34 .S 3—.38 2 Zip Code: Lic. Number: Y-7' Phone #: Zip Code: hereby certify that the work has been abandoned and/or the contractor/architect is unable or unwilli to complete the contract. I hold the Bui ing Official and the ami Shores harmless of all legal invo ent. Signatur Signature O ent trac or or Architect C The foregoing instrumerrnt was aknowledged before m�e , The foregoing Instru t was aknowledged before me this dayof L� t 20��,b 1 /f J -1 20�rb ( 1 / W( li��(?f=� this day y Who is personally known to me or who has produced who is personally known to me or who has produced t—� T:)(- as indentification. t- -( 1_1 `--- as indentification. N o t a r y'11U-1uuuu WW. - Sign: Seal: _ f;FA^p q{pRtA1NEM'GU[Z 6' My COMMISSION # GG 176551 �z a< EXPIRES: January 17.2022 < Ecnded Thru Notary Public Underernteis Notary c: - Sign:" — Seal: cIAMA1NE MIGUEZ W COMMISSION k GG 176551 UARES: January 17, 2022 t';i«:, 4• B Thu Nobry Publ c Underwriters � Certificate ��u�� Completion �_�� Miami Shores Village 1OO50N.E.2ndAve, Miami Shores, Florida 33138 Tel: 3U57S5-2204Fax: 3U5750-8972 Building Inspection Department Description: INTERIOR ALTERATIONS |N MASTER BATHROOM, DEN .KITCHEN AND ENTRY WAY PLUS OUTDOOR GAZEEBO INDOOR ADDITION 25OSQUARE FEET OUTDOOR ADDITION 824SQUARE FEET. Permit Type Building (Residential) Bldg. Permit No. RC-9-16-2500 Owner CHR|STOPHERLS/V|TS Contractor DISTINCTIVE HOMES Subdivision/Project Date Issued 1001/2019 Construction Type V-B Occupancy Single Family � Type � Square Footage 4.84400 Flood Zone AE-10 Location If the building is located in a special flood hazard area documentation of the as -built |ovvoot floor 1400NE103ST elevation or lowest horizontal structural member has been provided and is retained in the records of Miami Shores, FL Miami Shores Village. This certificate issued pursuant tothe requirements nfthe Florida Building Code certifying that ot the ORE INC. 1932 time of issuance this structure was in compliance with the various ordinances of the jurisdiction regulating building construction oruse. rM (:�L H. Building Officials Approval ^ Not Transferable POST IN ACONSPICUOUS PLACE ' Ismael Naranjo, CBO ~ INSPECTION RECORD Miami Shores Village 10050 N.E.2nd Avenue Miami Shores, FL 33138-0000 Phone: (305)795-2204 Fax (305)756-8972 (_POST ON SITE Permit NO. RC-9-16-2500 Permit Type: Residential construction -; Work Classification:Addition/Alteration issue Date: 4/18/2017 Expires: 1 0 1 5! 7 INSPECTION REQUESTS: (305)762-4949 or Log on at https://bidg.miamishoresvillage.corn/cap REQUESTS ARE ACCEPTED DURING 8:30AM - 3:30PM FOR THE FOLLOWING BUSINESS DAY. Requests must be received by 3 pm for following day inspections. Residential Construction Parcel #:1132050310060 Owner's Name: CHRISTOPHER SAVITS Owner's Phone: Job Address: 1460 NE 103 Street Total Square Feet:. 250 Miami Shores. FL - Total Job Valuation: $ 197,182.00 Bond Number: 3379 Contractor(s) Phone Primary Contractor DISTINCTIVE HOMES (305)279-2088 Yes Cct�cr . dl o a * — Q& J? � i WORK IS ALLOWED: MONDAY THROUGH FRIDAY, 8:OOAM - 7:OOPM. SATURDAY 8:OOAM - 6:OOPM. NO WORK IS ALLOWED ON SUNDAY OR HOLIDAYS. BUILDING AND ROOFING INSPECTIONS ARE DONE MONDAY THROUGH FRIDAY. NO INSPECTION WILL BE MADE UNLESS THE PERMIT CARD IS DISPLAYED AND HAS BEEN APPROVED. PLANS ARE READLY AVAILABLE. IT IS THE PERMIT APPLICANT'S RESPONSIBILITY TO ENSURE THAT WORK IS ACCESSIBLE AND EXPOSED FOR INSPECTION PURPOSES. NEITHER THE BUILDING OFFICIAL NOR THE CITY SHALL BE LIABLE FOR EXPENSE ENTAILED IN THE REMOVAL OR REPLACEMENT OF ANY MATERIAL REQUIRED TO ALLOW INSPECTION. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT. INSPECTION RECORD STRUCTURAL INSPECTION I DATE INSP ill Foundation Stemwall Slab Columns (1st Lift) Columns (2nd Lift) Tie Beam Truss/Rafters Roof Sheathing Bucks Windows/Doors Interior Framing . Insulation Ceiling Grid Drywall Firewall Wire Lath Pool Steel Pool Deck Final Pool Final Fence Screen Enclosure Driveway Driveway Base Tin Cap Roof in Progress Mop in Progress Final Roof Shutters Attachment Final Shutters Rails and Guardrails ADA compliance . Soil Bearing Cert _ Soil Treatment Cert Floor Elevation Survey Reinf Unit Mas Cert Insulation Certificate Spot Survey Final Survey Truss Certification STRUCTURAL COMMENTS INSPECTION DATE INSP Zoning Final ZONING COMMENTS INSPECTION DATE INSP Temporary Pole 30 Day Temporary Pool Bonding Pool Deck Bonding Pool Wet Niche Underground Footer Ground Slab Wall Rough Ceiling Rough Rough Telephone Rough Telephone Final TV Rough TV Final Cable Rough Cable Final Intercom Rough Intercom Final Alarm Rough Alarm Final Fire Alarm Rough Fire Alarm Final Service Work With ELECTRICAL COMMENTS Final Sprinkler Final Alarm INSP INSPECTION DATE INSP 3'0-'Qov k I i Rough Water Service 2nd Rough Top Out Fire Sprinklers Septic Tank Sewer Hook-up _ Roof Drains Gas LP Tank Well Lawn Sprinklers Main Drain Pool Piping Backflow Preventor Interceptor Catch Basins Condensate Drains HRS Final PLUMBING COMMENTS INSPECTION I DATE INSP Underground Pipe Ventilation Rougl Hood Rough Pressure Test Final Hood Final Ventilation Final Pool Heater Final Vacuum JOSE A. MARTINEZ, P.E. CIVIL STRUCTURAL ENGINEER September 11, 2019 Building Official Building Department Miami Shores Village 10050 NE 2nd Ave. Miami Shores, Florida 33138 Re: Monica & Christopher Savits 1460 NE 103 Street Miami Shores Village, Florida 33138 Permit # RC-9-16-2500 Dear Building Official: I Jose A. Martinez, P. E., having performed and approved the final required inspections for terrace, cover entrance , trellis and gazebo; hereby attest that to the best of my knowledge , belief and professional judgement, the structural and envelope components of the above referenced structure are in compliance with the approved plans and other approved permit documents. I also attest to the best of my knowledge, belief and professional judgement, the approved permit plans represent the as -built condition of the structural and envelope component of said structure. This Document is being prepared in accordance with Chapter 1 of the Florida Building Code and must be submitted to the Village of Miami Shores Building Department in conjunction with the application for a Certificate of Completion for the above referenced structure. Should you have any questions or need any additional information, please do not hesitate to contact me. I N•F? Since , ` '•••• ��•r�\ ••%`�il V • i� le ll.i : �+ 0 S CD C Z :•3�509 L;:%pP 24 EAST. 5 STREET - HIALEAH, FLORIDA 33010 - TEL(305) 887-4417 Fax (305) 884-3967 U.S. DEPARTMENT OF HOMELAND SECURITY [OxM Batoo. 1660 0No8ember 30, 2018 Feder0l Emergency Management Agency 'National Flood Insurance Program ELEVATION CERTIFICATE Important: Follow the instructions on pages 1-9. Copy all pages of this Elevation Certificate and all attachments for (1) community official, (2) insurance agent/company, and (3) building owner. SECTION A — PROPERTY INFORMATION FOR INSURANCE COMPANY USE Al. Building Owner's Name Policy Number: MONICA SAVITS & CHRISTOPHER SAVITS A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Company NAIC Number: Box No. 1460 NE 103 ST City State ZIP Code MIAMI SHORES Florida 33138 A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) LOT 15, BLK 5, PB 64, PG 97 A4. Building Use (e.g., Residential, Non -Residential, Addition, Accessory, etc.) RESIDENTIAL A5. Latitude/Longitude: Lat. N25°52'11.82" Long. W80°09'59.86" Horizontal Datum: ❑ NAD 1927 [x] NAD 1983 A6. Attach at least 2 photographs of the building if the Certificate is being used to obtain flood insurance. A7. Building Diagram Number 8 A8. For a building with a crawlspace or enclosure(s): a) Square footage of crawlspace or enclosure(s) 1150.00 sq ft b) Number of permanent flood openings in the crawlspace or enclosure(s) within 1.0 foot above adjacent grade 10 c) Total net area of flood openings in A8.b 1280.00 sq in d) Engineered flood openings? ❑ Yes 0 No A9. For a building with an attached garage: a) Square footage of attached garage 400.00 sq ft b) Number of permanent flood openings in the attached garage within 1.0 foot above adjacent grade N/A c) Total net area of flood openings in A9.b N/A sq in d) Engineered flood openings? ❑ Yes ❑x No SECTION B — FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1. NFIP Community Name & Community Number B2, County Name B3. State VILLAGE OF MIAMI SHORES 120652 MIAMI-DADE Florida B4. Map/Panel B5. Suffix B6. FIRM Index B7. FIRM Panel B8. Flood B9. Base Flood Elevation(s) Number Date Effective/ Zone(s) (Zone AO, use Base Flood Depth) Revised Date 12086CO306 L 09-11-2009 09-11-2009 AE 9.00, B10. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item 139: ❑ FIS Profile ❑x FIRM ❑ Community Determined ❑ Other/Source: _ B11. Indicate elevation datum used for BFE in Item B9: 0 NGVD 1929 ❑ NAVD 1988 ❑ Other/Source: B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? ❑ Yes ❑x No Designation Date: ❑ CBRS ❑ OPA FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 1 of 6 ELEVATION CERTIFICATE OMB No. 1660-0008 Expiration Date: November 30, 2018 IMPORTANT: In these spaces, copy the corresponding information from Section A. FOR INSURANCE COMPANY USE Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. Policy Number: 1460 NE 103 ST City State ZIP Code Company NAIC Number MIAMI SHORES Florida 33138 SECTION C — BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C1. Building elevations are based on: ❑ Construction Drawings* ❑ Building Under Construction* Fx� Finished Construction *A new Elevation Certificate will be required when construction of the building is complete. C2. Elevations — Zones Al—A30, AE, AH, A (with BFE), VE, VI—V30, V (with BFE), AR, AR/A, AR/AE, AR/A1—A30, AR/AH, AR/AO. Complete Items C2.a—h below according to the building diagram specified in Item A7. In Puerto Rico only, enter meters. Benchmark Utilized: B-50 Vertical Datum: NGVD 1929 Indicate elevation datum used for the elevations in items a) through h) below. ❑x NGVD 1929 ❑ NAVD 1988 ❑ Other/Source: Datum used for building elevations must be the same as that used for the BFE. Check the measurement used. a) Top of bottom floor (including basement, crawlspace, or enclosure floor) 6.80 ❑x feet ❑ meters b) Top of the next higher floor 8.90 ❑x feet ❑ meters c) Bottom of the lowest horizontal structural member (V Zones only) N/A ❑x feet ❑ meters d) Attached garage (top of slab) 6.80 ❑x feet ❑ meters e) Lowest elevation of machinery or equipment servicing the building 5.50 ❑x feet meters (Describe type of equipment and location in Comments) f) Lowest adjacent (finished) grade next to building (LAG) 5.40 x❑ feet ❑ meters g) Highest adjacent (finished) grade next to building (HAG) 6.50 ❑x feet ❑ meters h) Lowest adjacent grade at lowest elevation of deck or stairs, including structural support N/A feet ❑ meters SECTION D — SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION This certification is to be signed and sealed by a land surveyor, engineer, or architect authorized by law to certify elevation information. l certify that the information on this Certificate represents my best efforts to interpret the data available, l understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001. Were latitude and longitude in Section A provided by a licensed land surveyor? 0 Yes ❑ No ❑ Check here if attachments. Certifier's Name License Number ADIS N. NUNEZ 5924 Title REGISTERED LAND SURVEYOR �Z� Company Name BLANCO SURVEYORS INC Address 555 N. ORE DR City State ZIP Code MIAM BE CH Florida 33141 Signa ur Date Telephone Ext. -- - 04-23-2019 (305) 865-1200 Copy aIrpages of this Elevation Certificate and all attachments for (1) community official, (2) insurance agent/company, and (3) building owner. Comments (including type of equipment and location, per C2(e), if applicable) LATITUDE AND LONGITUDE OBTAINED USING A GARMIN DEVICE. C2(E) A/C ELEVATON CROWN OF THE ROAD ELEVATION ON CENTERLINE ON CENTER OF ROAD: 5.40' BM# B-50 ELEV. 10.02' LOC# 3250 S rtiwH rorm utoe-u-ji (iii5) Replaces all previous editions. Form Page 2 of 6 rc1JA'r1llA1 f1=0T19:1rAT1= OMB No. 1660-0008 Expiration Date: November 30, 2018 LL IL L-vf-t 11%011 w—... ._... _ IMPORTANT: In these spaces, copy the corresponding information from Section A. FOR INSURANCE COMPANY USE Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P,O. Route and Box No. Policy Number: 1460 NE 103 ST City State ZIP Code Company NAIC Number MIAMI SHORES Florida 33138 SECTION E — BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE) For Zones AO and A (without BFE), complete Items E1—E5. If the Certificate is intended to support a LOMA or LOMR-F request, complete Sections A, B,and C. For Items E1—E4, use natural grade, if available. Check the measurement used. In Puerto Rico only, enter meters. E1. Provide elevation information for the following and check the appropriate boxes to show whether the elevation is above or below the highest adjacent grade (HAG) and the lowest adjacent grade (LAG). a) Top of bottom floor (including basement, crawlspace, or enclosure) is [—]feet ❑ meters ❑ above or ❑ below the HAG. b) Top of bottom floor (including basement, crawlspace, or enclosure) is ❑ feet ❑ meters ❑ above or ❑ below the LAG. E2. For Building Diagrams 6-9 with permanent flood openings provided in Section A Items 8 and/or 9 (see pages 1-2 of Instructions), the next higher floor (elevation C2.b in the diagrams) of the building is ❑ feet ❑ meters ❑ above or ❑ below the HAG. E3. Attached garage (top of slab) is ❑ feet ❑ meters ❑ above or ❑ below the HAG. E4. Top of platform of machinery and/or equipment servicing the building is ❑ feet ❑ meters ❑ above or ❑ below the HAG. E5. Zone AO only: If no flood depth number is available, is the top of the bottom floor elevated in accordance with the community's floodplain management ordinance? ❑ Yes ❑ No ❑ Unknown. The local official must certify this information in Section G. SECTION F — PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION The property owner or owner's authorized representative who completes Sections A, B, and E for Zone A (without a FEMA-issued or community -issued BFE) or Zone AO must sign here. The statements in Sections A, B, and E are correct to the best of my knowledge. Property Owner or Owner's Authorized Representative's Name Address City State ZIP Code Signature Date Telephone Comments ❑ Check here if attachments. FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 3 of 6 M MwnT1nK1 f`CRTICIrATr- OMB No. 1660-0008 Expiration Date: November 30, 2018 IMPORTANT: In these spaces, copy the corresponding information from Section A. COMPANY USE Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. fFORNSURANCE Number: 1460 NE 103 ST City State ZIP Code any NAIC Number MIAMI SHORES Florida 33138 SECTION G — COMMUNITY INFORMATION (OPTIONAL) The local official who is authorized by law or ordinance to administer the community's floodplain management ordinance can complete Sections A, B, C (or E), and G of this Elevation Certificate. Complete the applicable item(s) and sign below. Check the measurement used in Items G8—G10. In Puerto Rico only, enter meters. G1. ❑ The information in Section C was taken from other documentation that has been signed and sealed by a licensed surveyor, engineer, or architect who is authorized by law to certify elevation information. (Indicate the source and date of the elevation data in the Comments area below.) ❑ A community official completed Section E for a building located in Zone A (without a FEMA-issued or community -issued BFE) G2 or Zone AO. G3. ❑ The following information (Items G4—G10) is provided for community floodplain management purposes. G4. Permit Number G5. Date Permit Issued G6. Date Certificate of Compliance/Occupancy Issued G7. This permit has been issued for: ❑ New Construction ❑ Substantial Improvement G8. Elevation of as -built lowest floor (including basement) ❑feet E] meters Datum of the building: G9. BFE or (in Zone AO) depth of flooding at the building site: ❑ feet ❑ meters Datum G10. Community's design flood elevation: ❑ feet ❑ meters Datum Local Official's Name Title Community Name Telephone Signature Date Comments (including type of equipment and location, per C2(e), if applicable) ❑ Check here if attachments. FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 4 of 6 BUILDING PHOTOGRAPHS OMB No. 1660-0008 cvwr�nw� ��cTlGlr'DTF See Instructions for Item A6. Expiration Date: November 30, 2018 GL_V_V 1 IV1'% V1-1\ I IN I-- I — IMPORTANT: In these spaces, copy the corresponding information from Section A. FOR INSURANCE COMPANY USE Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. Policy Number: 1460 NE 103 ST City State ZIP Code Company NAIC Number MIAMI SHORES Florida 33138 If using the Elevation Certificate to obtain NFIP flood insurance, affix at least 2 building photographs below according to the for Item A6. Identify all with date taken; "Front View" and 'Rear View"; and, if required, "Right Side View" and instructions photographs "Left Side View." When applicable, photographs must show the foundation with representative examples of the flood openings or vents, as indicated in Section A8. If submitting more photographs than will fit on this page, use the Continuation Page. Photo One Photo One Caption Clear Photo One It!�` t .a c` t iJ4 r �7 Photo Two Photo Two Caption Clear Photo Two FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 5 of 6 BUILDING PHOTOGRAPHS OMB No. 1660-0008 rl r'%IA"rr%u /�CMTICIf ATG rnntinttatinn Paae Expiration Date: November 30, 2018 GL-L-wr% I will %L*L-I%... .-1.. — - IMPORTANT: In these spaces, copy the corresponding information from Section A. FOR INSURANCE COMPANY USE Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. Policy Number: 1460 NE 103 ST City State ZIP Code Company NAIC Number MIAMI SHORES Florida 33138 If submitting more photographs than will fit on the preceding page, affix the additional photographs below. Identify all photographs "Front View" and "Rear View"; and, if required, 'Right Side View" and "Left Side View." When applicable, with: date taken; photographs must show the foundation with representative examples of the flood openings or vents, as indicated in Section A8. AMP ■ l ski Photo Three Photo Three Caption Clear Photo Three uaut',9lllAs Photo Four Photo Four Caption Clear Photo Four FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 6 of 6 License # JB 1752 Certificate of Compliance for Termite Protection (as required by Florida Building Code (FBC) 1816.1.7) Distinctive Homes (786) 367-2598 1460 N.E. 103rd Street, Miami Shores, Florida 33138-2626 Residence Permit # B 16-2500 Method of Termite Treatment Prevention Treatment- soil barrier, wood treatment, bait system, other (describe) The building has received a complete treatment for the prevention of subterranean termites. Treatment is in accordance with rules and laws established by the Florida Department of Agriculture and Consumer Services AUutt-'h�orized Signature 1020 S. STATE ROAD 7 9 PLANTATION, FLORIDA 33317 9 954-584-8588 • 1-800-749-8588 • FAX: 954-584-61 17 n CONFIRMATION OF COMPLETION OF SUBTERRANEAN TERMITE TREATMENT AS REQUIRED BY FLORIDA BUILDING CODE (FBC) 1816.1.7 Purchaser's Name and Address Distinctive Homes 5535 S.W. 1121' Ct. Miami, Florida 33165-6849 Treatment Site: 1460 N.E. 103`d Street, Miami Shores, Florida 33138-2626 Project: Residence Job: N/A Chemical: Imidacloprid Square Feet: 780 Number of structures treated: 1 Date of Completion: 05/24/19 PERMIT: B 16-2500 Block: N/A Product: Centerfire 75WSP @ .05% Number of Gallons: 78 Lot: N/A Block: N/A Applicator: Devin Kolman Date & Time: 05/24/1912:00 PM Accurate Pest Control, Inc. hereby confirms that this building has received a complete, final treatment for the prevention of subterranean termites. Treatment is in accordance with the rules and laws as established by Florida Department of Agriculture and Consumer Services. Exterior perimeter treatment was completed upon final grade. Guarantee: None 1 Year X (AREA TREATED ONLY) Renewal Yes 5 Year No X LICENSE NO. JB 1752 ACC TE T CONTROL, INC. BY: W, -- ��— Harvey Sma es; President Revised on 06/01/19 1020 S. STATE ROAD 7 9 PLANTATION, FLORIDA 33317 9 954-584-8588 • 1-800-749-8588 • FAX: 954-584-61 17