PL-19-309Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Location Address
Issue Date: 03/21/2019
Parcel Number
671 NE 105TH ST, Miami Shores, FL 33138 1122310120100
Contacts
Permit NO.: PL-02-19-309
Permit Type: Plumbing - Residential
Work Classification. Gas
Permit Status: Approved
Expiration: 09/ 17/2019
UNAM 671, INC Owner
MARCO BRUZZI
671
H. BETO'S PLUMBING INC Contractor
SAYDA WALESKA HERNANDEZ
8454 NW 24 PL, MIAMI, FL 33147
Business: 7863681902
Inspection Description: CONNECT GAS LINE FOR METER TO NEW BACK UP Valuation: $ 1,000.00 Inspection Requests:
r55-762-4949
GENERATOR
Total Sq Feet: 2,400.00
Fees
Amount
Application Fee - Other
$50.00
CCF
$0.60
Change of Contractor
$110.00
DBPR Fee
$2.00
DCA Fee
$2.00
Education Surcharge
$0.20
Permit Fee
$50.00
Scanning Fee
$3.00
Technology Fee
$2.50
Total:
$220.30
Payments
Date Paid
Amt Paid
Total Fees
$220.30
Credit Card
03/21/2019
$60.30
Credit Card
02/11/2019
$50.00
Credit Card
07/03/2019
$110.00
Amount Due:
$0.00
Building Department Copy
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 anq zoning. Futhermore, I authorize the above named contractor to do the work stated.
Authorized Sjgmm;Fe: Owner / Applicant / Contractor / Agent
July 03,
Date
Page 2 of 2
Miami Shores Village r
Building Department j U L o 2019
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 20171 (JA
BUILDING Master Permit No. VC—a2-1q_3(�r
PERMIT APPLICATION Sub Permit No.(PL- 0�— tc "3__�`1
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
®PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS N CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 671 NE 105 St.
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: 11-2231-012-0100 Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): UNAM 671, Inc. Phone#:
Address: 671 NE 105 St.
City: Miami Shores
Tenant/Lessee Name:
Email:
CONTRACTOR: Company Name:
Address:
City:
Qualifier
state: FI. Zip: 33138
Phone#:
l
ne#:
State Certification or Registration #: CrC Certificate of Competency #:
DESIGNER: Architect/Engineer: Victor Bruce Phone#: (305) 310-5030
Address: 370 NE 101 St. City: Miami Shores state: FI. Zip: 3313R
Value of Work for this Permit: $ —2600— [Ocz• 'o Square/Linear Footage of Work: 30 L/F
Type of Work: ❑ Addition ❑ Alteration ® New ❑ Repair/Replace ❑ Demolition
Description of Work: Connect gas line from meter to new back up generator
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 $
TOTAL FEE NOW DUE $ 1 V
(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 approved and a reinspection fee will be charged.
Ma6oftlkWA
P- UNAM-671, Inc.)
Signature Uo�� Signature
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this
c9B J _ day of U 1AQ 20 I G by
Marco Bruzzi who is p sonally know to
me or who has produced
oregoing instrument wasacknowledged before me this
2nd day of JUI7`, ,20 19 by
SaNda HfIrli tad ez , who is personally known to
as me or who has produced
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: Sign:
Prin : ,l�X'aQ '� �jC�a`1f Print:
Seal: LUCIAG. ISASI Seal:
VILMA SANCHEZ
1 � my commliSSION i GG 247475
(9
MY COMMISSION ri GG173087
a �� EXPIRES: Decertiber 10, 2022 EXPIRES January 07, 20M
sciiC°,••' P�bicUndeMk rsIc
APPROVED BY
Plans Examiner
Structural Review
as
Zoning
Clerk
(Revised02/24/2014)
Miami shores Village
Building Depais'"tment
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
CHANGE OF CONTRACTOR I ARCHITECT
Permit N.—ek ax— I _Ct� '3O f
Owner's Name (Fee Simple Title Ho!der): NUAM, 671 Inc.
Owner's Address: 671 NE 105 St.
City: Miami Shores State : Ff.
Phone #:
Zip Code_- 33138
Job Address (Of where work is being done): 671 NE 105 St,
City: Miami Shores State:_Florida Zip Code: 33138
Contractor's Company Name: Marino Construction Engineering Phone #: (786) 443-1685
Address: 17082 SW 91 Ave.
City: Palmetto Bay
State: Ff. Zip Code 33157
Qualifier's Name: Fausto E. Guerrero Lic. Number: CFC 1429169
Architect/ Engineer of Record Name: Victor Bruce
Address: 370 NE 101 St.
Citymi MiaShores State: FI.
Describe Work: Install gas line from new generator to meter
Phone #:_(305) 310-5030
Zip Code: 33138
I hereby certify that the work has been abandoned and/or the contractorlarchitect
is unable or unwilling to complete the contract. I hold the Building Official and the
iami Shores harmless of all legal involvement.
o Br Fau E. uer�ro
Signature Signature _ �i
Owner or Agent Contractor or Architect
the forego:ng instrument was aknowledged before me The foregoing instrument was aknowledged before me
thfs a8 dayof ,)Ur,Q 20lq,by YCD YUZZI this ,2 day of 21
y
�Y
Who is p onally kno to me or who has produced who is personally known to me or who h s produced
Notary
Sign
S--al:
IS
MY COMMISSION I GG 247475
EXPIRES: December 10, 2022
Bonded Thru Notary Public Umerwriiere
as indentiBcation.
Notary Public:
Seal:
A as indentification.
PATRICIA ACOSTA
MY COMMISSION * GG005073
EXPIRES July 24, 2020
RICK SCOTT, GOVERNOR JONATHAN ZACHEM, SECRETARY
Floridpr
STATE OF FLORIDA
DEPARTMENT OF BUSINEStS-AN1D.:P_ROFESSIONAL REGULATION
CONSTRUCTION IN,DUSTR (L--tCEN-SI,NG BOARD
THE PLUMBING'CONTRACTOR HEREIN ICERTIFIED UNDER THE
PROVIS10.14I 40- F?CHAPTER 489 FLORIDA STATUTES
HE RN, AID DEZ, tiSi4YDA1ItA;ES {f(A
BETOrS=P UN1BiNG' Wit-
r 'N 8454 NW 24THYLACE
; M IAM I ' tF L,33147
EXPIRATION--QITE:CJ,GUST 31, 2020
Always verify licenses online at MyFloridaLicense.com
Do not alter this document in any form.
This is your license. It is unlawful for anyone other than the licensee to use this document.
i
i
002567
Local Business Tax Receipt
Miami -Dade County, State of Florida
i-THIS IS NOT A BILL - CO NOT PAY
7164646
BUSINESS NAMEAOCA71ON
H BETOS PLUMBING INC
8454 NW 24TH PL
MIAMI FL 33147
OWNER
H BETOS PLUMBING INC
C/O SAYDA W HERNANDEZ
Worker(s) 1
RECEIPT NO.
RENEWAL
7442943
SEC. TYPE OF BUSINESS
196 PLUMBING CONTRACTOR
CFC1428937
SEPTEMBER 30, 2019
Must be displayed at place of business
Pursuant to County Code
Chapter 8A - Art. 9 & 10
PAYMENT RECEIVED
BY TAX COLLECTOR
$75.00 07/16/2018
CREDITCARD-18-054647
This Local Business Tax Receipt only confirms payment of the Local Business Tax. The Receipt is not a license,
permit, or a certification of the holders qualifications, to do business. Holder must comply with any governmental
or nongovernmental regulatory laws and requirements which apply to the business.
The RECEIPT NO. above moat be displayed on all commercial vehicle, ads Code Soc 89-M
For more information, vUit'
ACORh� CERTIFICATE OF LIABILITY INSURANCE
DATE(MM/OD/YYYY)
1
l
07;`01; 2019
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: It 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 Ileu of such endorsements .
PRODUCER
CONTACT
NAME: TUNON
�
! ROYAL CARIBBEAI11 INSURANCE AGENCY II
PHONE FAX
a...Eat) 30i fi42 4541 _ ..(_(rvc. Not, 30a 6 I2 1087
E-MAIL
ADDRESS: JTUNONROYALII@GMAIL.COM
1772 WEST FLAGLER STREET
titIAfV1i, FL 33135
INSURERSS)_AFFORDINGCOYERAGE—_—
NAIC0
INSURER A: UNITED STATES LIABILITY INS. CO.
INSURED
INSURER B:ASSOCIATED INDUSTRIES INS. CO.
INSURERC:
H. BETO'S PLUMBING, INC.
INSURERD:
8454 NV`/ 24 PLACE
INSURER E:
MIAMI, FL 33147
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 REOUIREMENT, 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
LTR
OF INSURANCE
ADDLTYPE
gUBR
POLICY NUMBER
POLICY
YYY
MMLI D YYP
LIMITS
A.._x
................
COMMERCIAL GENERAL. LIABILITY
X
CLAIMS -MADE OCCUR
X
CL17469966
04/15/201904i15/2020
EACH OCCURRENCE
5 1,000,000
PREMISES E rr n
S 100.000
MED EXP (Any oneperson)
S 5,000
PERSONAL & ADV INJURY
S 1 .000,000
_
GEN'L AGGREGATE LIMIT APPLIES PER
GENERAL AGGREGATE
S 2,000,000
POLICY ❑PRO- JECT 7LOC
PRODUCTS - COMPIOP AGO
S 1.000.000
OTHER
S
AUTOMOBILE
LIABILITY
COMBINED SINGLE LIMIT
fEa accidem)
$
__
BODILY INJURY (Per person)
8
ANY AUTO
ALL OWNED SCHEDULED
AUTOS AUTOS
BODILY INJURY (Per accident)
S
PROPERTY DAMAGE
Per ar id
S
NON -OWNED
HIRED AUTOS AUTOS
$
UMBRELLA LIAB
OCCUR
EACH OCCURRENCE
S
` EXCESS LIAe
Cl AIMS -MADE.
AGGREGATE
_
S
L=
I RETENTIONS
S
B
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY N
ANY PROPRIETORlPARTNEAtEXECUTIVE Y 1
OFFICERIMEMBER EXCLUDED? Y
(mandatory in NH)
N/A
AW C 1127147
,
04/ 15i2019
4/15/2020
X STATUTE ERH
E.L. EACH ACCIDENT
— —
E.L. DISEASE - EA EMPLOYEE
S 1 ,000,000.00
$ 1 .000,000,00
II yes, describe under
DESCRIPTION OF OPERATIONS below
E.L. DISEASE - POLICY LIMIT
S 1,000,000.00
DESCRIPTION OF OPERATIONS J LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached it more apace Ie required)
PLUMBING CONTRACTOR,PLUMBING STATE CONTRACTOR LICENSE# CFC1428937 HBETO'S PLUMBING INC.. SAYDA HERNANDEZ
IS COVERED UNDER THIS STATE OF FLORIDA INSURANCE POLICY
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIW ON— QATE THEREOF, NOTICE WILL BE DELIVERED IN
MIAMI SHORES VILLAGE
ACC�E WIT ]H%-1qOLAY PROVISIONS,
10050 NE 2ND AVE
aesENTATIVE
MIAMI SHORES. FL 33138
LAURIZED
0 1988-20D CORPORATION. All rights reserved.
ACORD 25 (20141011 The ACORD name and loco are reaistered marks of ACORD
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 N EDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS
CONTENTS.
LW�..Signature: l
41-mQ oc'A MA/ rilOwner
State of Florida
County of Miami -Dade
The foregoing was acknowledge before me this _X� day of H rA V rl 1 , 20—E-1 -
By E mon1 i 6 GG ►" i c l vo ZZ l who is rsonally ""o to me or has produced
as identification.
Notary:
-L"G.1.S a
WCOMMMM#00247475
E2 MS. Decanter 10, 2022
Marino Construction Engineering, Inc.
DBA Marino Plumbing Solutions
License # CFC7429769
17082 SW 91 Avenue, Palmetto Bay FL. 33757 * PHONES. (786) 4431685 * FAX.' (305) 9710240
GENERAL CONSTRUCTION
Date. -
State of Florida
County of Miami Dade
To whom it may concern:
Before me this day personally appeared �STO �. �U�'22�,�0--_- who being
---------------------- -
duly sworn, disposes and says:
That he will be the only person working on the project located at.Ape --- — ----------------
-
Sworn to affi me a subscribed before me this � 7 ___ day of__r�_%_,
-----------------
Personally Known to me ____-
OR Produced Identification ____`_�
Type of Identification Produced All�� _�1_�
Type, Print or Stamp Name of Notary
; �► �° PATRICIA AC08TA
My COMMISSION # GG005073
EXPIRES July 24, 2020
(407) 8.0153 FkWWgftt8ry3erv1Ce.00M j a
p
Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Location Address
Issue Date: 03/21/2019
Parcel Number
671 NE 105TH ST, Miami Shores, FL 33138 1122310120100
.ontacts
Permit NO.: PL-02-19-309
Permit Type: Plumbing - Residential
Work Classification: Gas
Permit Status: Approved
Expiration: 09/17/2019
UNAM 671, INC Owner MARINO CONSTRUCTION ENGINEERING Contractor
MARCO BRUZZI INC
671 FAUSTO E GUERRERO
17082 SW 91 AVE, PALMETTO BAY, FL 33157
Business: 7864431685
17-
Description: CONNECT GAS LINE FOR METER TO NEW BACK UP Valuation: $ 1,000.00 on Requests:
GENERATOR 4949
TotalSq Feet: 2,400.00
Fees
Amount
Application Fee - Other
$50.00
CCF
$0.60
DBPR Fee
$2.00
DCA Fee
$2.00
Education Surcharge
$0.20
Permit Fee
$50.00
Scanning Fee
$3.00
Technology Fee
$2.50
Total:
$110.30
Payments
Date Paid Amt Paid
Total Fees
$110.30
Credit Card
03/21/2019 $60.30
Credit Card
02/11/2019 $50.00
Amount Due:
$0.00
Building Department Copy
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 dad-4oning. Futhermore, I authorize the above named contractor to do the work stated.
Owner / Applicant / Contractor / Agent
Date
21, 2019 Page 2 of 2
RECEIVED
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: (30S) 762-4949
BUILDING
PERMIT APPLICATION
❑BUILDING ❑ ELECTRIC ❑ ROOFING
F B 11 2019
BY:
fBC 20 I�
Master Permit No. (W- 6 2 " «- 30
Sub Permit No.` — b Z - I q 30
❑ REVISION ❑ EXTENSION [:]RENEWAL
®PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF [:]CANCELLATION [:]SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 671 NE 105 St.
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: 11-2231-012-0100 Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): UNAM 671, Inc.
Address: 671 NE 105 St.
City
Miami Shores
one#:
state: FI. zip: 33138
Tenant/Lessee Name: Phone#:
Email:
cc r T�--++
CONTRACTOR: Company Name: A A R 1 fd 0 a S CEO 1 Ij:t a sy Phone#: �jOJ — Sa - 6 603
Address: 1-1 g IS 0 91 At1E • t
City: t R Yi•t State: r- L , Zip: ,3 3 1 S -1
Qualifier Name: ra[ 5To l fd'cQ g lz Phone#: �3 c.Y �geZ O S a3
State Certification or Registration #: C r C.. 1y A9 I (A 1 Certificate of Competency #:
DESIGNER: Architect/Engineer: Victor Bruce Phone#: (305) 310-5030
Address: 370 NE 101 St. City: Miami Shores State: Fl. Zip: 33138
Value of Work for this Permit: $�_(rr7 O • Square/Linear Footage of Work: *V L/F
Type of Work: ❑ Addition ❑ Alteration ® New ❑ Repair/Replace ❑ Demolition
Description of work: Connect gas line from meter to new back up generator
Specify color of color thru tile:
Submittal Fee
Scanning Fee $
Technology Fee 5
Structural Reviews $
Permit Fee $
Radon Fee $
Training/Education Fee $
CCF $,
DBPR $
Co/CC $
Notary $
Double Fee $
Bond $ _
TOTAL FEE NOW DUE $ 60 3(-)
(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 approved and a reinspection fee will be charged.
Marco ru VP- UNAM-671, Inc.)
Signature GO
OWNER or AGENT
The foregoing instrument was acknowledged before me this
—22— day of s V 20 J C1 , by
Marco Bruzzi A is pe sonally know to
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print: Lur J G
Signature
CONTRACTOR
The foregoing instrument was acknowledged before me this
010 day of � 01 20 / 9 by
Q G• who is personally known to
me or who has produced /WX as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal: I Seal: '-*'-MY COMMISSION it 000050T3
LUCiA G. ISASI �?�;,��e EXPtRES July 24, 2020
,*= MY COMMISSION 4 GG 247475 (407) 3W 1 W FloAdeN016 SOMCCcan
=?; '.: EXPIRES: Neember 10. 2022
******** ... Qr4'l�4f+iId4QP4 ****************r*************************************************
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)