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RC-10-21-2666
�s��� , �c� �,�� z � �, � �� ���l ��� �> ���, � i��a�i Sh�ar�s l�illag� � � ���� � `� ' � ` �� '� � � ��c� ��� �oasa��z av� � � � � � � t �a�� !� � ��� �tiarni Shores FG 3313$ �� ����������� �������ti�}3 �r 305-795-22Q4 ,1 �" ��� �� �,, ; � » � ��' �C9Ri��"� �� `� ��������� � ��, � � , ���� ���������; EXp(Cat�or�« 05 f 04 j2022 � x:�... loeation�0.ddress Parcel M1Ee�mber � ���.��m.N�.,. �,�� �_ ,.__.�� __._ � vw. a..�m� �_ _.m..� _��, . �,,,_,� �... ��.�w ��.. , E 1,291�E 94Tl�ST,It�ia�i Si��r�s,FE.33I38 1232050it�0�€�1 � � � ��� ��� .��� � ,��,. � � �ontacts ��.��_�,�,...�N..,.��v.�a,__�_�.._,_,_�__�_�_„__��..__�.��� �.._��._., . ,n_�._ �� ,. .__� w.,_v, e,........... �_._ ...,__ F,._�.__�m.�_. .. �..._.. _.w.w�_....._�..�__..u,ww.__���.._._., ` JONAi'HAN 1EROME Ctwrner M Z DESI�N EIVC C�r�tract�r 1293 NE 9�ST GIL RQN 104 GRANC}C}N BIVLI 401,KEY�ISCAYNE,FL 331491542 mz@mzdesign.com r.� ��F����_�_���_��v�._��..�.�..�. ���__�__... u._�� �� ,.�.��.��w��_.���_�_...���� � C}escriptic��:TWO BATHPcC}OM RE(t�QQE� � �l�luation: $ 2,50Q.0� Ins �cti�n Re uests: 2 �t��������:,:`::::>:. ; : i � FtSt�l Sq Feet: 0,{BO � � i ;. ���a���a;��,•�:�s��sa . � 1. �.�����a����;�� F�es Amount Payrn�nfis �ate Patd Amt Pafd A,pplication Fee-Other $SQ.Ot� '�otal FeeS $22Q.90 CCF 51.80 Check#15757 11J04f2021 $7Q.94 D�PR Fee ��.00 Credit Card 10J24J2022 $50.00 DCA Fee $2.QQ Educatian Sureharge $Q.60 ��o������' ��°�� Fermit Fee $SO.QO Scanning Fee $12.Q0 Technology Fee $2.50 Tqta 1: �120.90 �11� lil � � t Y In consider�tion of the issuance to me af this permit, I agree to perform the work cov�red heeeunder in eompliance with ail ordinances and regu(afiions pertaining thereta and in strict canfarmity with the pl�ns, dr�wings, statements or specifieations submitt�d to the proper aufihariti�s of Mi�mi SP�ar�s Villag�. In �ccepting this permit 1 assume responsibiiity for all work done by eitt�er myself, my agent, servants, or ernpl�yes. E understand that separate permits are requir�d for ELECTRIGAI, F'LUMBING, M�CH�RIICAL,WINDC}W�, DOORS; ROOFIlVG and SWIMMING POO�work. C?WN�RS AFFIC}AVIT: f certify thaf aIl the faregoing information is accurat� t ail wr wiil be done in Gompiiance with al( applic�b(e Iaws regulating ccanstruction and zeaning. Futhermore, i authariz�;the�bove na o tractar t�a d e w rk t�ted. 1 ,�� � � �` �f Authoriz�d Sigr�ature:C?wner 1 �pplicant/ �antractc�r i Agen -�--- Dat Nov�mb�r��d,2021 Pa�e 2 ef 2 � ,. �; -� �� t�.�� �, i�rt � a , I 1 � S 1�� �ui �� �'� � �� '� '� E ,,�� i;�,� . . . .�,, 1 �'i 1 I. �i, � � � �'���.i �, �i � l.,l1� [�1 a�'� Yl� �� � �� � � � �, 1005Q f�.E.2nd Aven�e, Miami Shores, Fl�rida 3313� �� f� :`� q�� �r��:(�o�)�ss-zzoa�ax:(�os)7s�-���2 "� � ����� �� � � INSPE�"F'lON�INE PH�NE R1UM�ER:(3Q5�762-49�9 , ""'� ��---� �.��-"'"��'������ � F�� �Q���� Qi���[���� Mast�r Permit Na.��-.. ��,� ��-� '" ��-'�=� . � L�� �� S�ab Ferrnit IVo. auo��irv� � E��c�R�c � r�ocaFiN� ❑ �Ev�si�N ❑ �x-r�rvs:oN �R��EwA� ❑P�ur�a��� ❑ n�ECN�r��ca� ��u��ecwaR�s ❑ cHa��� o� � c�Nc����T��ry � s�c�� c�����c�ro� ��,�w�r��s JQ�A�DRESS: ��� � �� Cifiv: Miami Shores County: Miami Dade Zip: �� FoliojFarce!#:�� ` ��� � � � � ts the Buildin�HistoricalEy Desegnated:Yes NO Occupancy Type: [�oad: Canstruetion Type: Fload Zone,• BF� ��FFE: �, � �� C�a OWNER:N�me(Fe�Simp(e Titleholder} � �t,;. Phane#� ��� � �ddress; �� �� � ��"�� City: �� �� �� 1°�'� State: ��-- Zip: �� � Tenantf�essee Name: Phone#: Email; C�R � �� � • � � t� �� CG1PtTRACTQR:C�ampany Name: Phone#: � i� Address: �� CitY: � � " �� �.�_._,._�State: Zip: Qualifi�r Name: � C3�. Phone#, State C�rtification or Registration#: �� �G�� Certificat�of Competency#: ��SEGAIER:ArchitectJEngineer: Phane#: Address: City; State: Zip: Vaiu�af Wark far this Permit:$ Squarejlinear Footag�caf W�rk: Typ�af Wark. � Addition [.� Alteratian [� New � RepairjRepEace ❑ Demofitian Descriptian of Work: Specffy colvr�f co/or thrcr tile° �P sut�mMtta��ee��� ° � �errn�t�ee S ecF$ eol�e S Seanning Fee$ 6tadcan Fee$ D�PR� Notary$ T�chr�ofogy F�e§ Trainingf Edueation Fee$ Rtaubl�F�e$ Structural Revievus$ Bond$ TC1TAl FEE NOW DUE$�� �� (Revised02f2�j�OS4) � Bonding Company's Nam�(if applicable) Banding Company's Address _ City Stafie Zip Mc�rtgage l�ender's Name{if applicable) M�rtg�ge Lencier`s Rddress City State Zip Appiication is hereby made to obtain a permi�to dc�the w�rk and installatians as indicated. i certifiy that nc�wc�rk or ins�aflatican has cammenced prior co the issuance of a permit and that all work will be perfarmed to rri�et the standards of all I�urs re�ulating construction in this jurisdiction. I understand that a separate permit m�st be secured for ELECTRIC, RLUR�tBlNG, S(GNS, FU(�LS, FURNACES, BOlIERS,NE�TERS,TA�IKS,RIR CON(3(TIaNERS, ETC..... pWNER'S AFFIDAVIT: 1 certify t�at all the ft�regoing informa�ion is accurate and t�at afl work wi(I be d�ne in camp(iance with all applicable faws regulating construetion and zcaning. „ ARNtNG TQ Q!WNER: Y�UR FAICUF�E TQ I�ECOR� A N�TICE QF C�IVIMENCEMEN`T MAY RESl�CT IN Y�tJR PAYI�IG TWICE F�R IMF�tQVEMENTS °T� YQ�JR PR�FER . IF Y�t� lNTEN� T� Q�T�IN Ft1�ANCING, G�NSl1LT WITN YQUR 1�EN��� C?R �N A ��NEY BEF�RE RECORDING i SJUR t�VTI1rE iJ{" C6�1YRfYE�EM�G1YiE9V I:/B Motree to,4pplicant: As a condrtion to the issuance pf a building permit with an estimated value exceeding$25(?0, the ap�alicant musf prorrtise r`n gocad faith that n copy of the ncrtice of camm�ncement and construc2ion (ien (aw brc�chure wil/6e detivered ta the person whose prop�rty is subjeet ta attaehrrr�nt. A(sa,a certified capy of the recorded nc�tie�a,�commencement rraust 6e posted at the job site for the first inspectian which oecurs seven (7) days after the building permit is Issued. tn the aE�senc� �f such pcasted natfce, the inspectfon will nat be approv�d anc�a reinspectiean�ee will be ehargec?. �� ����'� _. �_�. � _� Signature � Signature & t�WNER c�r A�ENT GONTRACTOR The foregoing instrument w�s aekncawledged before me this The foregoing instrum�nt was acknowled�ed befor�me�his � �day of `� ,.._.�.., 2Q � � _, by � day of ���:�� ' ,2(7 ��� ,bY t^ .� "� �� �a„ ��' who is personai! knowfl to � � �°` ,wh�is personally known to me or who has praduced as me ar wh�a has produc�d as identificati�n and who did take an oath. id�ntifieatian and who did take an oath. z NA'�ARY PUBkfG: lVt�'fARY P4JBtJC: ���°�'"� �� � � „,.«� r � .� +�` � ,� Sign Sign; a�� ,��������� � $�ff����,.�,�$ � �� ���� ��� Print: Rrint: � � ��`r°U.,`' � ����,� :������@ � Se�f: �' 1�;`':. Notary Ps�bHc•Stac�of FMnrlda $eal: '���` Commizs{�n�GG 247642 � � '�` P � �pe��'` My Cc�mre�,Expir�s 5�p 2,2f122 � � s �„ � � �����rR���� �'e" � 6ond�d Cheou h National N�t�ry Assr?, � ; � g � �, � ��� � **��:�*�+ka:*���**�����**��:�x�������*a��**��z����a����������+�*�*������z*�z���r������.� ���s�a�;�;�t�ti������w����**��x�*�m�* '�"�a`<? " � � 1.�� �`�r����,�T��3c���������� ��g����������� APRRQVED BY �� ���"�`�� Plans Examiner Zcaning f� Structural Review Clerk {RevisedQ2/24f 2414) ________________________________ _______________________________________� � Ron UeSantis,�overnor � Halsey Beshears, Secretary , �TAT� � ��.��.� A EPART � �` f USIPJESS Ai � P�t?FE�$1+C3N�L FtEGt1 TIA C+D ST U It) I�,I��JST"RY I�I�EN�ING Bt��R '; LICENSE h�1l.1 ER; C�C1�524�3Q Pi Tl� dATE; ,4 t;UST 31,2022 TNE BUILGIPJG�ONT �TQR 1-IERE1�1 iS CERTIFIED URfDER THE PF�t3VISiQNS 4F CHAPTER 4�9, Fl.C1R6DA STATUTES i' RON, GI� N!Z C}ESiGN IP�C 1 C I�lC3C3P� BCC1�L A#��#4431 , tCEY SI�CAYI�E ��331�9-1542 � #1 lSSUED:OS/29f2020 �rways verify licenses online at MyFloridaLicense.com Do nc�t alter this document in an form. This is your license.1t is unlawful for anyone other than the Gcensee to us€�this dac�sment. a�ar�s � � ' �i��i—������ur�t�ef �t�te c�f �Ic�rid� �tS tU{3Y A�Lf.- Pl�T FAY 6�$3�73 � �cx a�c��� . ���� � �z c��s►�� ��� ����v�a� EP`TE �R 1 C?4 N �1..�/C)4{�1 ��` $ Muse tae:dis{>I�y�d at ptac�;of Psusi�ess t!{l[.f�C"aE 4F kC�'�#� Y{UE FL 331�#� Pursua�t to Cvunty Code Chapt�e�-Arc 9�tQ !�.`i:� 9 t'77' Q � ����� � M�DE�lCeN i� 196 SUB-GENERAL BLQG Ct7NTftACTOR �r��ar nEee�€o ��C125243(7 avr��oG�ectaa 545.00 07J13j202t � er(s) 4 INT-21-33$977 Tkis i Basi T�x Re�eipt a€�ty confirms ��# I.or„ai��si�s�T�x.Th�Rsc�ipt is n�t a kic�n , at��cs �_ .�of ttte� r"s t'' 'v �d��si ss. der erc �mpty 'h I �' e n& cp and r��� w#ic��PPtY ta Dvsi �s. T�RECEIPT 0#U.a�ae�a 9e dispt d gn a!fi c arcis!va�`scles-t�i�mi-O�Ie G�e �-2T6. For�a�rei�sarmation.visit i��id� � xcuftactor ����{��t�� ��: � '� � T`I �1 �` � �1 1�,1 � ��r�s��o�o g���e���r��r���r��s��u�o as a�s,�rr������t��e�e�r�va►�a��.Y,a���c�����s r�����w�rs uw���r����������r�x��c���. r�t�����zr���car� ����r,�����aa,��v��.�o����a��v��.v�a����,��r�ra�a���rE��r���� ���FF���a���v r���oLw�a������w. r�ss��R�t����r�oF lN��1��td��C3��5 Nf3T CL?NST'lTt�TE,4 CAN'T �T�� E�Pi �IS�t�It��tN�E3R�R(�),AtlTN�RiZ����P#t���NTATIVE��@�C}C!El���,�PF�TH� C�RTfFI�AT��i�LD�R. i�dCP�ftT�NT:4f the sar#l�i�t+�hoi��r I�an AD�lT1C3PIAL IP�lJR�i},th�poCi�p(i��}mu�t h�v��C��I7'It�P3,�LL ENSU�E�provEsian��r b��n r��rd. tf �t7��f3�a«41`I�Pi I s�AiV��,subj�ct t�th�term��nd ccandYl��a eri th�pol9cy,certatn p�Eic4��rva�y r�quirm�e��ndar��m�nte �stat �nt an thl�e�artlf��at� �tta�s n�t ccanf�r right�#�th�certific�t�h�lder in Bi�u�f su�h�ndor��m�aat(s}. ���tAl1GE� CONT�G�f NA�E: �H�NE: (�00�2TT-162t3 X 48Q0 F�X: (727)797-Q?Q4 E-MAIL A��QRESS: FrankCrum I�suranc�Agency,Inc. Itd�t�����(�)AFFt?RDING C�V�RA�E NA1 100�vuth Ntissouri�0.v�nu� �t��r�v�t�r,FL 39756 I�St1t?�Ft,A: Frank Winston Crum(nsuran�e Gomp�e�y 11600 lN�UR�� IPt�aUt�ER�� IN�Ut3ER C: I��tJR�R D: Fr�nkGrum tJCiF hA.�.�esign Inc IN�IJ�ER E: 100�cauth P�Issauri�Avanue Glea€xr�t�r,�L 33756 It�#$UR���: �C?VE Cs�� ��R1'#FI�� NUAA��R: T31137 R I�tQN NU�1���e 1 TNI�I$T�G�RTIFY'fHReT°fFS�@�LIG���QF tN�U PlCE Gt�T�R��G.QW H� ���P�1 t��UE�Tt7 THE EN$tJF$��NAFA��Aa�OV�Ft}R TH�i�t�LlCY��ROQ� INRt��T�C?. N{! T'HST�NDtN�ANY R�Qt1Ek2E(+�ENT,T�R��Et�ON�ITI4P1 QF APlY CQN'f �T AR QT'ti�R �U�AENT VYFTM RESP��'T 1°�tfl9N1�H°tFil� C�t2T1Fi��TE RdP�Y�E I�St1�D OR PAAY��RTAEN,°fFtE lN3�U NG�AFFOR�E��Y TMF R�E�E�iE3��S�RB�ECf H�F2EIFd t�SU�J�CT T�Al.�TN�TE�2�5, G4.U�EGINS f4t�t?C�NDiT't4�N8�F�U�H PC?C.IC#�S, t,tPAtT3�NC2 t�M1�Y tiAVE���t�REDUCE[A��'PAIC}C MS. tN'3R TYF�6�tNSURAtdCE A�6�. �Uk3R POUCY NU��@R �QI.FGY EF� PO4fGY EXP LFA9lYS ll't2 INSRR YtVU (tAM14fQCktYYYY) (&7 . Cf3MRAEFdGIAt GENERAL UABILITY EACH OCGUt3ENCE $ GlAtA4S 4AAD� QCCUR DAMAGE TO RENTED Fi?ERRiS�S(Ea $ occurenca} . h4EQ EXP(MY a+t�psrsQn) S PERSQNAL&ARV iNJURY $ (3�MC AOGREt3ATE L1MlT RPPI€E3 PEftc G�N�RAI RCi6REt^+A'fE $ PCN.ICY �PRO,iECT�LOC PFiODUCT5-UOMPtQP AGG $ C7TNER § Ati'F� Eq4E 61A@iL{FY COM6PPd�D SiNt3kE UP�iT(Es act�d�ttt) S ANY kUTC? EY3411Y lNJURY(P�r persun} �m�� $ WNED AUTQS SCHE6ULED MLY AUTQ9 �Op1LY IMIURY(Per acci�nQ) $ NSRtEt?&UYQS NQN-QWNED t,Y ,4UTOS t)#VlY PftOPEFiN RAi�tAGE(F'ee�citlant) ff $ tFRh�RELI.A UAB OCCUR EAGFt QCCUREPdCE $ �XGE33 UA� CLAIWtS AkApE GGR�GATE � Q DEt? REFENTf6N$ $ WORK�Ft5 COMpENSATIQtJ X P�R STATUE pTH�R .ar�o�raw�Qrests�tiaeit�rr YlN AMY RRpPFdIETQ€2tPAftTNEW�XECUTlVE E.l,E.ACH ACGIDEN7 $i3OQp,C}QQ A o�F�c��msEr�aeR�c�.u�Eo7 N!A VUC2Q2160000 01iQ1f2421 01lQ1/2022 .�.�� �"� (&S�ndaFary in NHj E.l.DISEA3E-EA EPAPGC?l`�� St OOQ,�q tf yasr dascvlka und�r D�SGfttPTiON 6F � QF'ERAT40N8 b�ov✓ E_t_DSSEASE-PQ�ICY l[MiT 51,040,QQ0 C���G�iPTIQN{?�QR�RAT1fJNS 1 I.4CAT16NS(YEHI��.�B(1ACC)RE1 901.,M1sfdlUe�n�t€i��rk�ach�elul�,m�}�bt�ai9ach�d i4 moe�a�pace t�requRe�d} Effectiv�47121t2t716,caverage is for 1Q0°fo of the�mp4oyees of FrankCrum I�ased ta P�.�.Design Inc(Gli�r�t)for whom th�di�nt is reporting hours to�rank�rum.Gaverage i�nat�?ctend�d ta statuEaey employees.{R�:Gllent ref�r�nc.�Licens�#C�G1262434) G�R'6'fFlCRT�Htl��.DER CAPt��I.t�TIDN SHQUL��NY C}F THE A�QV�R�SCRIBED P��tCf�S�E C�,NC�E.�.ED BEFORE TH�EXFIRRT'!t>N CtATE 1"N�i�E(>F,NOl'E��Wt��B�E�EIIVER�(�IN ,4�Ct3�DANCE WiThi TNE PC7LECY PRC3VIuIC1Pl5. �UTH��IZ��R�RR�3�NTATIVE h�IAMI�hit�RES VILLAGE B�i�G DEPT 1QQ54 NE 2ND�V� MI�hA1�NOftES,FL 33138 t�1988-2018 ACC7RQ COR��R�TEC3W.�ti rig�sfi� �ro�d. �GC3R�25(2016103j Th�A�Ct�t�a�$m��nd€�ga�r�registere�m�rk��f A�UR� � �, n� ; �,.� �_- -� . _ �,, �J r,�iY.i ..: f�.y. _ (1 ,�_� r "'��r .s .. .:J Y , , P��a: . � J .,,,,.�.,,. `�J, f f 2,`� v f=,..,* �` r 'Sd " C � F+:''�"";f i �.- f _ _ ��� ,��a�.i.��' ... .,�5._.. � ,r r �f.,s., �_ , . �..:i;,',,, .1._.,�. � _ � J.. _ j _ � _ �� �,i �� �^;,. ; �=' ._,_ w� �. �'��"�, - J i� �-- � f� � - ._ % -. ,- _ M r r ;d� � , ��,. � _ '` � �;�,�J �;r,'?;�`�,1 -„�, _i .Wr ,, .,t, ,j r�;: s° z }:, .`, �, �' � � - k r_-�- /- � �, jl �; � ,s ;� i --_�-�._ i t� J � .r., m "' ��� ;�, r � � t � ( .. ,� . f , �'s t,,r.�: f st � ✓ ; _��.. ; , ,l r ,� ; ., F l ,, �,.e,k ��-. � � _, ///� �..,',_..,�. �, ��'?,f Mf'�-�` ��. << • ._-_" i r � : � .m a x ,�.. 1 . *--� ` j� r` I� �-�� , �,..,g,�,�, ., � a�3 r�� ��,� r�, _ ,�- a. � "�e s� t ��, �, , _ " , � ,a/��, � � .�_ . �_,i:..,��`;, aa .a„:.� �"a._,_,. ..,.i!v.:� i � _„ �_ *;., .. .. _.... ,. , . �in;t)- k t r t! � )� r. � �� �"� , : �, � ' � , � � .� � s�� � �; � �� � � �� ,, �� � a� 13 ___ � r ,�;:.,._ ,:����> �,�t,= - ,,.,�� �,_._ .;����, ������ ��1+.���� ��� ____ww_�_ _ _ _ �._ __.____ � _�_, _.__ __..._ c� ��1F�� C}ET��� ��� � ������ ����v� ,i, s„��z�;�i�,.,r.a_r ;:��,`�`, ,��g:^iaatt"rs'��;d�.,���;;� ,A�,a..,; 'dr.%,�� �%�,.s�ra ��r3�.��.a��,� ,�g q'y�B9 .q i Gi '�"°2 � 1�� �,�'r1'%„� -��,-..5�.?'� ��w.�. ,,,���*�.�£fii..,;� �.-�,.��.�'��iw3 '���`� a�' ,.,��,�.+,�^+,�', •� •s• • • i • �+• w s wss i ',��s'�'�����m�'���,�,� �;�,;�i°�, �� �,i€:��t��� h's'�� r; 9E���<��c�so�f���h�j�� ; • s •� • • « a • o •• • • • • •o• • �s � r� �v �i s �,Y� � ��, ��r�i '€ �F�n° �3 $ � a'� � a s • s • • � s �:.��t� E '�"��� t���s,� �Y,.�� � .�.��sa ;,t.=����";.� ,€�.`�a �x��„?`�� • •� •rr •• • • s ss s�;` ��,+� s=r�"s�s�$�"��,i9 � o�;'�' ,; ����1a ���� l����i�, ••• •�• • �s• r •os • • s • r • • s w s • a • • r • • • s o • � s • • •• . � � • e . • s •4 • • s + • s •am v • s • •.. o • • � a • • a • � a • s �or • + �r � s • s • • r o w m • s� s� • r � •• •• +e.s • o • •�r• r w __ - _ __. � .r .. � T.n�.. �.,�� ��. � � � i ,�.�� : ��, � „ ; ; �, � �� ,� � . 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