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MC-10-391 eR r Miami Shores Village t 10050 N.E. 2nd Avenue ItG?lk Miami Shores, FL 33138 - 0000 Phone: (305)795 -2204y F tl Y Expiration: 09/1 V201 Project Address Parc Number Applicant 10531 3 AVen 1122310130360 Miami Shores, FL 33138- Block: Lot: JUAN PABLO /VERONICA D'ON 5 Own Inform ation Address Phone Cell JUAN PABLO / VERONICA D ONOFRIO / 10531 3 Avenue (305)494-0230 MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone Valuation: $ 250.00 HOME OWNER Total Sq Feet: 0 Tons: Available Inspections: Additional Info: EXHAUST Inspection Type: Classification: Residential Ventilation Approved: In Review Final Comments: Date Approved:: In Review Hood Date Denied: Type of Work: MECHANICAL Rough Duct Underground Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $0.60 Invoice # MG3 - 10 -37260 Education Surcharge $0.20 Permit Fee - Additions /Alterations $150.00 03/22/2010 Credit Card $ 154.60 $ 0.00 Scanning Fee $3.00 Technology Fee $0.80 Total: $154.60 In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Futhermore, I authorize the above -named contractor to do the work stated. March 22, 2010 Authorized Signature: Owner / Applicant / Contractor / Agent Date Building Department Copy March 22, 2010 1 I Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL .- I � Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: I NSP- 137688 Permit Number: MC -3 -10 -391 Scheduled Inspection Date: March 25, 2010 Permit Type: Mechanical - Residential Inspector: Perez, JanPierre Inspection Type: Final Owner: D'ONOFRIO / MEDINA, JUAN PABLO / Work Classification Addition /Alteration 1ir_nnunr- n Job Address: 10531 NE 3 Avenue Miami Shores, FL 33138 - Phone Number Parcel Number 112231013036 Project: <NONE> Contractor: HOME OWNER Building Department Comments EXHAUST FAN IN NEW BATHROOM Inspector Comments Passed Failed Correction Needed Re- Inspection ❑ Fee No Additional Inspections can be scheduled until re- inspection fee is paid. March 24, 2010 For Inspections please call: (305)762 -4949 Page 9 of 21 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL ( /''� L Phone: (305)795 -2204 Fax: (305)756 -8972 � Inspection Number: INSP 120429 Permit Number: RC -4 -09 -634 Scheduled Inspection Date: April 01, 2010 Permit Type: Residential Construction Inspector: Rodriguez, Jorge Inspection Type Final Owner: VONOFRIO / MEDINA, JUAN PABLO / Work Classification Addition /Alteration vc0ntinrn Job Address: 10531 NE 3 Avenue Miami Shores, FL 33138 - Phone Number Parcel Number 112231013036 Project: <NONE> Contractor: HOME OWNER Building Department Comments PARTITION TO ACCOMADATE 2 FULL BATH AS PER DRAWING Inspector Comments Passed CREATED AS REINSPECTION FOR INSP- 111812. An mechanical permit is required with inspections before final. NB Failed Correction ❑ Needed Re- inspection ❑ Fee No Additional Inspections can be scheduled until re- inspection fee is paid. March 31 2010 For Inspections please call: (305)762 -4949 Page 4 of 23 Miami Shores Village Building Department fiFo 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 BUILDING Pert No. 1 PERMIT APPLICATION Master Pert No. C - H 0 9 ^ 3� FBC 20 Permit Type: MECHANICAL c Owner's Name (Fee Simple Titleholder) � 'Q,q d II 0 h101 O Phone # JO 5 – L L n 2 Owner's Address � 0 5 � ( 0 � � 19 7"�v � V Ciry R l � l S� S State t zip 33 t 3 Tenant/Lessee Name rr Phone # W Email �,q fl o" r I q cpw Job Address (where the work is being done) 5 '� 1 "° City Miami Shores Village County Miami -Dade Zip FOLIO / PARCEL # Is Building Historically Designated YES NO Flood Zone r Contractor's Company Name 0 LA) fJ F �. S rL f�l(� Phone # Contractor's Address City State Zip Qualifier Name Phone # State Certificate or Registration No. Certificate of Competency No. Contact Phone E -mail Architect /Engineer's Name (if applicable) Phone # Value of Work For this Permit $ Z J 0 ` — Square / Linear Footage Of Work: Type of Work: ❑Addition ❑Alteration ❑New ❑ Repair/Replace ❑ Demolition Describe Work: 7 F-A j i iJ Ke tom.) I V U U VV -V _� V-A� _0 I VULOA I Z� * *� ** *Fee Submittal Fee $ Permit Fee $ t.� CCF $ CO /CC $ Notary $ Training /Education Fee $ O�oul) Technology Fee $ Scanning $ Radon $ DPBR $ Bond $ Double Fee $ Violation date: r Structural Review. $ Total Fee Now Due $ See Reverse side –� 3()1) 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 ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and 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. Is(o, a certified copy of the recorded notice of commencement must be posted at the job site for the fir spection which occurs seve (7) days after the building permit is issued. In the absence of such posted notice, the inspection wi not b pproved and a reins ction fee will be charged. Signature Signature r or Agent Contractor The foregoing instrument was acknowledged before me this 1 ` The foregoing instrument was acknowledged before me this day of , 20 �, by "e Q r i2t day of , 20 _, by who is personally known to me or who has produced t, t who is personally known to me or who has produced As r' identificati � gp who did take an oath. as identification and who did take an oath. \ \ \ \II !I!/� NOTARY PUBLIC: ���`�� Art� ,,, NOTARY PUBLIC: Sign:( _ Sign: Print: =rn a'afi' GA Print: My Commission Expires: ''�,� 1 ..,.. -• ' ���` My Commission Expires: ' %��OR 1 D A `� APPROVED BY * / I i * Tans Examiner Zoning Engineer Clerk checked (Revised 07 /10 /07)(Revised 06/10/2009) Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: g (305) 795.2204 Fax: (305) 756.8972 BUILDING Permit No. l�V l %0 L) PERMIT APPLICATIO AIR I 1 19 -- Ma r Permit No. FBC 2004 -w -- - Permit Type Mechanical Owner's Name (Fee Simple Titleholder) ryj V A %- 0 r te` 1.�'J Phon # 5 4 - 2 Owner's Address 2�} 64 oqlu f�,j ' Sv `A A 1 City tj l tit State � L_ Zip Tenant /Lessee ame A ho e# E -MAIL: o✓ ' Job Address (where the work is being o ) 0 ( p City Miami Shore lla e C my Miami -Da Zip 37> i 0 FOLIO / PARCEL # Is Building Historically Desi nated S O Contractor's Company Name Phone # Contractor's Address City State Qualifier Name hone # State Certificate or Registration No. Certificat f Competency No. E -MAIL: A chitect /Engineer's Name (if applicab Phone # Value of k For this Permit 0e8quare / Linear Footage Of Work: Type of Work: ition Yp ❑ ❑Alt ration QNew ( Repair/Replace El Demolition Describe Work: FA o 0 A � e7 or 01 y *ic *r• �Fees * " 5 � A Submittal Fee $ 1 5b Per ft Fee $ $ r CCF 1 � $ CO /CC Notary $ Training/ 'ucation Fee $ Technology Fee $ Scanning $ Rad $ DPBR $ Zoning $ Bond $ C e Enforcement $ Double Fee $ Structural Review. $ Total Fee Now Due $ See Reverse side —> 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. 1 understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and 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 r suance of a building permit with an estimated value exceeding $2500, the applicant must promise in good that a copy of the n 'ice o and construction lien law brochure will be delivered to the person whose pro ty is subject to attachment. so, a certified copy of the recorded notice of commencement must be posted at the job site for the first pection which occurs seve (7) days after the building permit is issued. In the absence of such posted notice, the inspection wil t be ap oved and a reinsp lion fee will be charged. Signature Signature ner Agen Contractor The fore of i trument was ac n I dyed before me this The foregoing instrument was acknowledged before me this day of , 20 by day of , 20 by who is perso ally known to me o who s produc who is personally known to me or who has produced As identification who did take an oath as identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: ;►►Y' RICARDO BE Sign: MY COMMISSION Sign: F-XPIRES November 1 ,2012 Print: Print: My Commission Expires: My Commission Expires: YYYX, : XXY] C%%% Y .Y.XY.YY %YX,< %YX %X,FYY.X %Y. %Y,f FX %X'KX]:XYX�.Y.,<'�C]F'1CYlC 1C ]: ,. ,CX %YYX]C �. ,FYX %1F %,CXT� %YtY Y.XX): i:XXXXXK %,YX:F%YY %XX� %YXXY% APPLICATION APPROVED BY: Plans Examiner Engineer Zoning (Revised 02 /08/06) A 7 il1LLA GE OF 111111 J/11 SHORES OWNER BUILDER DISCLOSURE STATEMENT NAME: DATI Ll -I t ' 7 ADDRESS: Do hereby petition the Village of Miami Shores to act as my own contractor pursuant to the laws of the State of Florida, F.S 489.103(7). And I have read and understood the following disclosure statement, which entitles me to work as my own contractor; I further understand that I as the owner must appear in person to complete a!1 applications. State Law requires construction to be done by a licensed contractor. You have applied for a permit under an exception to the law. The exemption allows you, as the owner of your property, to act as your own contractor even though you do not have a license. You must supervise the construction yourself. You may build or improve a one - family or two- family residence. You may also build or improve a commercial building at a cost of $25,000.00 or less. The building must be for your own use and occupancy. It may not be built for sale or lease. If you sell or lease a building you have built yourself within one year after the construction is complete, the law will presume that you built for sale or lease, which is a violation of this exemption. You may not hire an unlicensed person as a contractor. It is your responsibility to make sure the people employed by you have licenses required by state law and by county or municipal licensing ordinances. Any person working on your building who is not licensed must work under your supervision and must be employed by you, which means that you must deduct F.I.C.A and with - holdings tax and provide workers' compensation for that employee, all as prescribed by law. Your construction must comply with all applicable laws, ordinances, buildings codes and zoning regulations. Please read and initial each paragraph. 1. I hold title to the above property and I am planning on doing this co t tion Myself. Initial 2. I understand that as an owner - builder I must abide by all zoning ordinances and building regulations in effect at the time of permit application. Inactive permits for a period of over 180 days will become null and void (expired) and a new permit will be required to be issued for reinstate nt of the permit. 1 Initial 3. I have an understanding of the 2004 FBC & FRC and understand 4h this department and its inspectors are there to help enforce and interpr the ode. There is a copy of the code in this office for review. Initial '1. I understand that the building official and inspectors are not the to design, alter or give advice on how to meet code — only if the structure \i eets the minimum code. tnitiat 5. I understand that as an owner - builder, that any contractor disput s with sub- contractors and myself must be handled in a civil court with the a vice of an attorney. The department will not mitigate any contract disputes. Initial 6. I understand that if I compensate any person or company for work performed they are requited to have a business license in the county. If for an reason they do not posses a business license I will be responsible and liable fo any wrong doing from this unlicensed company or person. Initial 7. I understand that if any person gets injured on my construction project "the are entitled to workmen's compensation. And if they do not posses a workmen's policy I could be held liable for all doctor and related cost which c uId include loss of wages during recovery from injury. Initial 8. I understand that under state and local laws I can not do any E 'cal, Plumbing, Heating, Air & Roof work on my property With out fir, obtaining the proper permits by licensed contractors. Initial Was acknowledged before me this g day of , 20 By � who was personally known to me or who has Produced there License or �Ra i n. T — — -- MY MISSION # DD838934 �X I E November 1 , 2012 Iao�> �o�ss 4 NOTARY .eORSh Inspection Worksheet Miami Shores Village n e urtiM 10050 N.E. 2nd Avenue Miami Shores, FL g Nres ,N F OR Phone: (305)795 -2204 Fax: (305)756 -8972 Scheduled Inspection Date: June 16, 2009 Permit Type: Residential Construction Inspector: Bruhn, Norman Inspection Type: Insulation Owner: VONOFRIO / MEDINA, JUAN PABLO / VE Work Classification: Addition /Alteration Job Address: 10531 NE 3 Avenue Miami Shores, FL 33138- Phone Number Parcel Number 112231013036 Project: <NONE> Contractor: HOME OWNER Building Department Comments Inspector Comments Passed Failed Correction ❑ Needed Re- Inspection ❑ Fee No Additional Inspections can be scheduled until re- inspection fee is paid. June 15, 2009 Page 24 of 31 a OR Inspection Worksheet Miami Shores Village I_ 10050 N.E. 2nd Avenue Miami Shores, FL �IIW Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP 118043 Permit Number: RC -4 -09' - 634 Scheduled Inspection Date: June 30 2009 Permit Type: Residential Construction Inspector: Bruhn, Norman Inspection Type: Drywall Owner: D'ONOFRIO / MEDINA, JUAN PABLO / Work Classification: Addition/Alteration "Wonwrn Job Address: 10531 NE 3 Avenue Miami Shores, FL 33138- Phone Number Parcel Number 1122310130360 Project: <NONE> Contractor: HOME OWNER Building Department Comments PARTITION TO ACCOMADATE 2 FULL BATH AS PER DRAWING Inspector Comments Passed 4�Pff6l&EF Failed El Correction ❑ Needed Re- Inspection ❑ Fee No Additional Inspections can be scheduled until re- inspection fee is paid. ,,,, , )nno For Inspections please call: (305)762 -4949 -4:')A Inspection Worksheet Miami Shores Village - 4-09 _ (0.35 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 I F' t� Scheduled Inspection Date: June 29 2009 Permit Type: Plumbing - Residential Inspector: Levrock, James Inspection Type: Top Out Owner: D'ONOFRIO / MEDINA, JUAN PABLO / Work Classification Addition /Alteration Job Address: 10531 NE 3 Avenue Miami Shores, FL 33138- Phone Number Parcel Number 1122310130360 Project: <NONE> Contractor: Building Department Comments PLUMBING INSTALLATION FOR 2 FULL BATHROOMS AS PER DRAWINGS In to Comments Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. June 29, 2009 For Inspections please call: (305)762 -4949 Page 2 of 19 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, L Phone: (305)795 -2204 Fax: (305)756 -897 Inspection Date: June 09, 2009 Permit Type: Electrical - Residential Inspector: Devaney, Michael Inspection Type: Rough Owner: D'ONOFRIO / MEDINA, JUAN PABLO / Work Classification: Addition /Alteration Job Address: 10531 NE 3 Avenue Miami Shores, FL 33138- Phone Number Parcel Number 1122310130360 Project: <NONE> Contractor: HOME OWNER Building Department Comments Inspector Comments Passed Failed Correction Needed Re- Inspection ❑ Fee No Additional Inspections can be scheduled until re- inspection fee is paid. For Inspections please call: (305)762 -4949 June 09, 2009 Page 1 of 1 Inspection Worksheet UM Miami Shores Village �0 10050 N.E. 2nd Avenue Miami Shores, FL _ R Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP'- 111823 £„ Permit Number. EL -4 =09 -636 Scheduled Inspection Date: June 04, 2009 Permit Type: Electrical - Residential Inspector: Devaney, Michael Inspection Type: Rough Owner: D'ONOFRIO / MEDINA, JUAN PABLO / VE Work Classification: Addition /Alteration Job Address: 10531 NE 3 Avenue Miami Shores, FL 33138 - Phone Number Parcel Number 1122310130360 Project: <NONE> Contractor: HOME OWNER Building Department Comments Inspector Comments r �J Passed �Y co ®e Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. I_— — nnnn n___ � _r wn Inspection Worksheet Miami Shores Village ■n. um 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 y� 'fin �fi r � � ..y ✓5!" - t� w Scheduled Inspection Date: June 09, 2009 Permit Type: Residential Construction Inspector: Bruhn, Norman Inspection Type: Owner: D'ONOFRIO / MEDINA, JUAN PABLO / VE Work Classification: Addition /Alteration Job Address: 10531 NE 3 Avenue 5/!411 Miami Shores, FL 33138 - Phone Number Parcel Number 112231013036 Project: <NONE> Contractor: HOME OWNER Building Department Comments Inspector Comments Passed FLOOR REINFORCEMENT DUE TO NEW PLUMBING PIPES r Failed Correction ❑ Needed Re- Inspection ❑ Fee No Additional Inspections can be scheduled until re- inspection fee is paid. I.— nn nnnn n_._ w• _e wn m 4 sw Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL ' Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 115686 Permit Number: EL-4- Scheduled Inspection Date: June 08, 2009 Permit Type: Electrical - Residential Inspector: Devaney, Michael Inspection Type: Final Owner: D'ONOFRIO / MEDINA, JUAN PABLO / Work Classification Addition /Alteration v�on�urn Job Address: 10531 NE 3 Avenue Miami Shores, FL 33138- Phone Number Parcel Number 112231013036 Project: <NONE> Contractor: MOODY ELECTRIC INC Phone: (305)758 -2000 Building Department Comments Inspector Comments Passed CREATED AS REINSPECTION FOR INSPA 12011. WORK IN PROGRESS SERVICE IS OK. MD 05/28/09 Failed Correction Needed e - C Re- Inspection ❑ ®' �- ®���v' ��- Fee No Additional Inspections can be scheduled until re- inspection fee is paid. 4 n...... nn ..c nn Rh� Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Rte` Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 115625 Permit Number: RC4-09 -634 Scheduled Inspection Date: June 04, 2009 Permit Type: Residential Construction Inspector: Bruhn, Norman Inspection Type: Framing Owner: D'ONOFRIO / MEDINA, JUAN PABLO / VIE Work Classification Addition /Alteration Job Address: 10531 NE 3 Avenue Miami Shores, FL 33138- Phone Number Parcel Number 112231013036 Project: <NONE> Contractor: HOME OWNER Building Department Comments Inspector Comments Passed ®p��,,,. 6r �G �' e-" t e,,,k C.( t� Failed f Correction Needed Re- Inspection ❑ Fee No Additional Inspections can be scheduled until re- inspection fee is paid. 1... -_ — nI1/ P1_-._ A^ _t A^ Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, 4 ` Phone: (305)795 -2204 Fax: (305)756- 894 inspection Number: I'NSP -1 11813 Permit Number: PL- 4 -09435 Scheduled Inspection Date: June 04 2009 Permit Type: Plumbing - Residential Inspector: Levrock, James - Inspection Type: Underground Rough Owner: D'ONOFRIO / MEDINA, JUAN PABLO / VE Work Classification: Addition /Alteration Job Address: 10531 NE 3 Avenue Miami Shores, FL 33138- Phone Number Parcel Number 112231013036 Project: <NONE> Contractor: Building Department Comments POND I pe t r t Passed Failed Correction ❑ Needed Re- Inspection ❑ Fee No Additional Inspections can be scheduled until re- inspection fee is paid. 1 . Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, F Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: 'INSP 112011 Permit Number: EL4 -09 -651 Scheduled Inspection Date: May 28, 2009 Permit Type: Electrical - Residential Inspector: Devaney, Michael Inspection Type: ' d al � Owner: D'ONOFRIO / MEDINA, JUAN PABLO / VE Work Classification Addition /AI a atio Job Address: 10531 NE 3 Avenue Miami Shores, FL 33138- Phone Number Parcel Number 1122310130360 Project: <NONE> Contractor: MOODY ELECTRIC INC Phone: (305)758 -2000 Building Department Comments r- Inspector Comments . n Passed t 'lw l zl"r Failed Correction Needed ; Re- Inspection ❑ Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspection Worksheet .n■ nin Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL F R Phone: (305)795 -2204 Fax: (305)756 -8972 Inspe:' ;tmbe ,'I fir,: : errrlit Number�M -4 09-634 fe fo l,^' Scheduled Inspection Date: June 11, 2009 Permit Type: Residential Construction Inspector: Bruhn, Norman Inspection Type: Framing Owner: D'ONOFRIO / MEDINA, JUAN PABLO / VE Work Classification Addition /Alteration Job Address: 10531 NE 3 Avenue Miami Shores, FL 33138- Phone Number Parcel Number 1122310130360 Project: <NONE> Contractor: HOME OWNER Building Department Comments Inspector Comments Passed CREATED AS REINSPECTION FOR INSP- 115625. Plumb and Elec required first. NB Failed Correction ❑ Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. June 10, 2009 Page 12 of 26 0 . Inspection Worksheet Miami Shores Village tt�� „� 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (306)795-2204 Fax: (305)756-89722to .............. ----------------------------------- ----------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------- .. .................... ...... & ..... ............. . ........ ...... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .................. Inspection Date: May 12, 2009 Permit Type: Demolition Inspector: Bruhn, Norman Inspection Type: Final Owner: D'ONOFRIO I MEDINA, JUAN PABLO VI Work Classification: Building Job Address: 10531 NE 3 Avenue Miami Shores, FL 33138- Phone Number Parcel Number 1122310130360 Project: <NONE> Contractor: HOME OWNER B uilding Department Comments Inspector Comments Passed Failed El Correction Needed ❑ Re-inspection Fee No Additional Inspections can be scheduled until re-inspection fee is paid. May 12, 2009 Page 1 of 1 Inspection Worksheet /r Miami Shores Village ' � n, 10050 N.E. 2nd Avenuc Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 i Inspelrtibn Number: IN:P- 1120'0 q£ Permit tvumber EL -4 -09 61 .. Scheduled Inspection Date: May 12, 2009 Permit Type: Electrical - Residential Inspector: Devaney, Michael Inspection Type: Underground Rough Owner: D'ONOFRIO / MEDINA, JUAN PABLO / VE Work Classification: Addition /Alteration Job Address: 10531 NE 3 Avenue Miami Shores, FL 33138- Phone Number Parcel Number 1122310130360 Project: <NONE> Contractor: MOODY ELECTRIC INC Phone: (305)758 -2000 Building Department Comments ail Inspector Comments Passed El Failed Correction ❑ Needed Re- Inspection ❑ Fee No Additional Inspections can be scheduled until re- inspection fee is paid. AM_.. AA 5 OR � Inspection Worksheet Miami Shores Village . .. - .��.. l g 10050 N.E. 2nd Avenue Miami Shores, FL toRu�' Phone: (305)795 -2204 Fax: (305)756 -8972 o Inspection Number: INSP- 112006 " Permit Number: EL -4-0g -651 Scheduled Inspection Date: May 06, 2009 Permit Type: Electrical - Residential Inspector: Devaney, Michael Inspection Type: W. W. Owner: D'ONOFRIO / MEDINA, JUAN PABLO / VE Work Classification: Addition /Alteration Job Address: 10531 NE 3 Avenue Miami Shores, FL 33138- Phone Number Parcel Number 112231013036 Project: <NONE> Contractor: MOODY ELECTRIC INC Phone: (305)758 -2000 Building Department Comments e® Inspector Comments .� Passed Failed Correction ❑ L //l �� Needed Re- Inspection ❑ Fee No Additional Inspections can be scheduled until re- inspection fee is paid. . ■ _.. AG ..I.I.I� .,___ A _L A ANO RC 44" a y Miami Shores Village PE'lfi Type, R@S I� GcaErl�truCtion 10050 N.E. 2nd Avenue WCNiICCI�I�jlt! A�l�nl .off Miami Shores, FL 33138 -0000 Pe ' j Phone: ( 305 )795 2204 �' � V ED m ; �012fl0 " _ Expiration:1 12712 Project Address Parcel Number Applicant 10531 3 Avenue 1122310130360 Miami Shores, FL 33138 Block: Lot: JUAN PABLO / VERONICA D'ON Owner Information Address Phone Cell JUAN PABLO / VERONICA D'ONOFRIO / 10531 3 Avenue (305)494 -0230 MIAMI SHORES FL 33138- ,, Contractor(s) Phone Cell Phone $ 1,000.00 1 Valuation: HOME OWNER E Total Sq Feet: 150 Approved: In Review Available Inspections: Comments: Inspection Type: Date Approved:: In Review Final Date Denied: Electrical Type of Construction: BATHROOM REMODEL Occupancy: Single Family Stories: Exterior. Front Setback: Rear Setback: Left Setback: Right Setback: Bedrooms: Bathrooms: Plans Submitted: Certificate Status: Certificate Date: Additional Info: Bond Return: Classification: Residential Fees Due Amount Invoice # Total Amt Paid Amt Due CCF $0.60 RC - 4 - 09 - 34570 $ 59.47 $ 9.47 Education Surcharge $0.20 Permit Fee - Additions/Alterations $100.00 RC -4-09 -34570 $ 59.47 $ 59.47 $ 0.00 Scanning Fee $6.00 Check #: 1431 Submittal Fee $50.00 Submittal Reversal Fee ($50.00) Submittal Reversal Fee ($50.00) Technology Fee $2.67 Total: $59.47 In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Futhermore, I authorize the above -named contractor to do the work stated. May 04, 2009 Authorized Signature: Owner / Applicant / Contractor / Agent Date Building Department Copy Mav 04, 2009 1 Miami Shores Village RE _ VV ED Building Department AM11 200 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 BUILDING Permit No. PERMIT APPLI.CATION Master Permit No. FBC Permit Type (circle): Building Roofing Owner's Name (Fee Simple Titleholder) J O AO � o �o"Q Phone # 30 S° Y i q " 0 2 -; 0 Owner's Address I62. ` ClC �- i � lZ.®�- City 11 R State Zip Tenant/Lessee Name W Phone # Aj iA Job Address (where the work is being done) 5 3 9 A4 F- City Miami Shores Village County Miami -Dade Zip X FOLIO / PARCEL # A 1 ® -2 2. ` 1 0 1 - 3 6 0 Is Building Historically Designated YES NO Contractor's Company Name 97 � o tN AI U . Phone # Contractor's Address City State Zip Qualifier Name Phone # State Certificate or Registration No. Certificate of Competency No. Architect/Engineer's Name (if applicable) Phone # Value of Work For this Permit $ Square / Linear Footage Of Work: I I Type of Work: DAddition DAlteration [* A LL - El Repair/Re ❑ Demolition l V b;s cribe Work: Y�Q 1 i 1 , 6 V e A � ACLQ AQ0 { - 2 LL- bA k)Q- l 4 t m & AS 1'�& U A) ,g Submittal Fee $ W Permit Fee $ `'� CCF $ -o CO /CX. Notary $ Training/Education Fee $ Technology Fee $ 401 Sednning $ 6 Radon $ DPBR $ Zoning $ Bond $ Code Enforcement $ Double Fee $ Structural Review. $ Total Fee Now Due $ ° `50 acz 1 Y�flm ui_ G-6 • See Reverse side I i 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- I 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 ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and 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. L°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 I Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first i ection which oc (7) days after the building permit is issued In the absence of such posted. notice, the inspection will n be ap oved anection fee will be charged Signature Signature w r or A t Contractor The foregoing i strumen wl fore me thi The foregoing instrument was acknowledged before me this n .. 9 62� day of 2, by day of . 20 _, by , who is personally known to me or ho has produced wh i rsonally known to me or who has produced As identification and who did take an oath. as identification and who did take an oath. NOTARY PUBLIC: OTARY PUBLIC: �� RICARDO BEBCHI C � A r� :•- Sign: . • MY COMMISSION # DD838 Sign: _ff FIRES ve Mber 17, Print: ' "' com Print: My Commission Expires: My Commission Expires: APPLICATION APPROVED BY: �'" y Pl „ a MJla ar mer Engineer Zoning (Revised 07/10/07) k mm , ub) R CEIVED VILLA GE OF MIAMI SHORE APR 1 009 OWNER BUILD — ER DISCLOSURE STATE NT NAME: ��.�2-� DATE: -� �' l ADDRESS: y n El Do hereby petition the Village of Miami Shores to act as my own contractor pursuant to the laws of the State of Florida, FS 489.103(7). And I have read and understood the following disclosure statement, which entitles me to work as my own contractor; I further understand that I as the owner must appear in person to complete all applications. State Law requires construction to be done by a licensed.contractor. You have applied for a permit under an exception to the law. The exemption allows you, as the owner of your property, to act as your own contractor even though you do not have a license. You must supervise the construction yourself. You may build or improve a one - family or two- family residence. You may also build or improve a commercial building at a cost of $25,000.00 or less. The building must be for your own use and occupancy. It may not be built for sale or lease. If you sell or lease a building you have built yourself within one year after the construction.is complete, the law will presume that you built for sale or lease, which is a violation of this exemption. You may not hire an unlicensed person as a contractor. It is your responsibility to make sure the people employed by you have licenses required by state law and by county or municipal licensing ordinances. Any person working on your building who is not licensed must work under your supervision and must be employed by you, which means that you must deduct F.I.C.A and with - holdings tax and provide workers' compensation for that employee, all as prescribed by law. Your construction must comply with all applicable laws, ordinances, buildings codes and zoning regulations. Please read and initial each paragraph. 1. I hold title to the above property and I am planning on doing this cos ction Myself. Initial 2. I understand that as an owner - builder I must abide by all zoning ordinan and building regulations in effect at the time of permit application. Inactive permits for a period of over 180 days will become null and v 'd (expired) and a new permit will be required. to be issued for reinstaterheat of the permit. Initial 3. I have an understanding of the 2004 FBC & FRC and understan t this department and its inspectors are there to help enforce and interpret the code. There is a copy of the code in this office for review. Initial 4. I understand that the building official and inspectors are not th re to design, alter or give advice on how to meet code — only if the structur meets the minimum code. Initial 5. I understand that as an owner - builder, that any contractor disputes wi ub- contractors and myself must be handled in a civil court with th advice of an attorney. The department will not mitigate any contract disputes. Initial C 6. I understand that if I compensate any person or company for wor per rmed they are requited to have a business license in the county. If for any r on they do not posses a business license I will be responsible and liable or any wrong doing from this unlicensed company or person. Initial 7. I understand. that if any person gets injured on my construction project are entitled to workmen's compensation. And if they do not posses a workmen's policy I could be held liable for all doctor and related cost which could include loss of wages during recovery from injury. Initial 8. I understand that under state and local laws I can not do any E cal, Plumbing, Heating, Air & Roof work on my property with out firyobta* ing the proper permits by licensed contractors. Initial ed before me this g day of Was acknowledged , 20 By who was p ersonally known to me or who has Produced there License r ,, , , identification. ARDO MY COMMISSION # 34 ,,, EXPf ES NOVe 1 12 cm .. O N Now <: This Instrument Prepared 8y: — ca Name 51)A 3 r�P�lN J7�ayC3 no= �-a , c O�j� Address iS '�C1 n1t _[Ij'/aalj Si1',12>°� saran _l Permit No. � Tax Folio No. r®i jg� 1!� U `1 i� i NOTICE OF COMMENCEMENT e� a- STATE OF *f L 0 tic l thy" -1 COUNTY OF THE UNDERSIGNED hereby gives notice that improvement will be made to certain real property, and In accordance with UJ Chapter 713, Florida Statutes, the following information is provided in this Notice of Commencement. �.� AQ—�» mom r V 1. Description of property: (legal description of property, and street address if available) t k A0 �{►eQil� SE�Q�2 S �(. - 3�a��j`3 rass�s 2. General description of improvement: =r C+a cr : ..,.r +'9 C•i cc . 3.Owner information ' X03 ; 4 = a. Name and address: ,J vA Af L-f; - 1>`G-J0 i'a - Q2 An .'ULI, .AJC k JU' 4 Aiki FL. p r o pe rt y: -- i62� C•�_'''�` b. Interest in C i3if'I�r` P�)E 0 120 �bI -F1 1�1 ! 2 S _ a """" -::4 ,-d, U. c. Name and address of fee simple titleholder (if other than owner): ac u 4. Contractor: .Las a, Name and address: I b. Phone number: ?� S __ 1Xt 0:1 ' i 5. Surety r C• F+ a. Name and address: b. Amount of bond $ c. Phone number: , Ia1 4X 6. Lender x Lc t+1 a. Name and address: L t ` `j _j b. Phone number: 7. Persons within the State of Florida designated by Owner upon whom notices or other documents may be served as provided by Section 713.13(1)(a)7., Florida Statutes: a. Name and address: b. Phone number: ,r 6. In addition to himself, Owner designates the following person(s) to receive a copy of the Lienors Notice as provided In Section 113.13(1)(b), Florida Statutes: a. Name and address: b. Phone number: 9. Expiration date of notice of commencement (the expiration date is 1 year from the date of recording unless a different date is specified) WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 13, PART 1, SECTION 713.13, FLORIDA STATUTES, AND CAN RESULT IN YOUR PAYING TWICE FOR IMPROVEM TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND " TED ON THE J TE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT TH YOUR LENDE 0 AN ATTORNEY BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF i;O"ENC ENT. P U _ Signature f Own Ir r Own s Authoriz 1 oveer /Dire Partner/Ma ga � 3 atory's tie /Offl e R P � h f gol stru en a acknowledged before me thl day of ear) by _ (name of person) t e of (type authority, ...e.g. officer, rustee, attorney in fact) for arty on behalf of whom instrument was executed). ' • QFR AH 02DO I SSION # DD8 38934 R9witlikb" 17, 2012 in T t p Com b "otary P blic Com �--- -- ersonally Known _ or Produced Identification Verification Pursuant to Section 92.626, Florida Statutes Under penalties of perjury, I declare that I have read the foregoing and that the facts stated in it are true to the best of my knowledge and belief. Signature of Natural Person Signing Above OF DAM N �: t a 0 ,Z� Qli l ' Li ll N i IN A mv \� \� zs�l\0 \iNv \INS \\\ �0 S M%§& \� \\ \\\ \ \► a SU BJECT + • ••i••• ♦••• •1.11• • •••••• • • • • •••• • k � s r � 1 ° Miami Shores Village `eJ✓t� Typed D� 10050 N.E. 2nd Avenue r U)f01 Glass Miami Shores, FL 33138-0000 ° r r• Phone: (305)795 -2204 p , ; *30 p Expiration:10127/ 00 Project Address Parcel Number Applicant 10531 3 Avenue 1122310130360 I Miami Shores, FL 33138 Block: Lot: JUAN PABLO / VERONICA D'ON( Owner Information Address Phone Cell JUAN PABLO / VERONICA D'ONOFRIO / 10531 3 Avenue (305)494-0230 MIAMI SHORES FL 33138 - Contractor(s) Phone Cell Phone Valuation: $ 1,000.00 HOME OWNER Total Sq Feet: 200 Ma MW� Type of Demo: Building Available Inspections: Additional Info: BATHROOM DEMOLITION Inspection Type: Classification: Residential Final Fees Due Amount Invoice # Total Amt Paid Amt Due CCF $0.60 DEMG4 -09 -34572 $ 50.00 $ 50.00 Education Surcharge $0.20 $ ���� Permit Fee $100.00 Check #: 1430 Scanning Fee $3.00 DEM04 -09 -34683 $ 56.32 $ 56.32 $ 0.00 Submittal Fee $50.00 Check #: 1434 Submittal Reversal Fee ($50.00) Technology Fee $2.52 Total: $106.32 In consideration of the issuance to me of this permit, 1 agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS DOORS, ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Futhermore, I authorize the above -named contractor to do the work stated. May 04, 2009 Authorized Signature: Owner / Applicant / Contractor / Agent Date Building Department Copy Mav 04, 2009 1 Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores,.Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 BUILDING R E ED Permit No. PERMIT APPLICATION Master Permit No. FBC �{ 1 2009 Permit Type (circle): Building oo g Owner's Name (Fee Simple Ti er �� �I�hQ Phone # �I' ®2 Owner's Address 1 `Z T � A �C-� — t IZI City T 1 1- Apoo State pt— Zip Tenant/Lessee Name )V Phone # N / Job Address (where the work is being done) i S 1 6 ? dv City Miami Shores Village County Miami -Dade Zip t FOLIO / PARCEL # 1 1 — 2 2 _5 l ' 0 2, 613 Is Building Historically Designated YES NO Contractor's Company Name aV C iz Phone # Contractor's Address City State Zip Qualifier Name Phone # State Certificate or Registration No. Certificate of Competency No. Architect/Engineer's Name (if applicable) Phone # Value of Work For this Permit $ . Square / Linear Footage Of Work: .2 00 T . e of Work: ❑Addition ❑Alteration []New ❑ Repair/Replace Demolition DeAcribe Work: - b � ;�o l % `®v� d C t 6 - % l &WmS Pwj jD I CxA f1' Q A 2 ° 7 C0 AS - ubmittal Fee $ Permit Fee $ � CCF $ (,C Notary $ Training/Education Fee $ ° %� Technology Fee $ 'Scanning $- Radon $ DPBR $ Zoning $ =fond $ Code Enforcement $ Double Fee $ Structural Review. $ Total Fee Now Due See Reverse side 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 ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and 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 t notice of commencement and construction lien law brochure will be delivered to the person whose p erty is subject to attachme Also, a certified copy of the recorded notice of commencement must be posted at the job site for the t inspection which occurs s verc (7) days after the building perm_ it is issued. In the absence of such posted notice, the inspection ll not be Vroved and a ret p ction fee will be charged Signature Signature w Qwne Age Contractor The for om instrument was by d�ged me this The foregoing instrument was acknowledged before me this day of , 24- t day of , 20— by , who is personally known to me who has produce who is personally known to me or who has produced As identification and who did take an oath. as identification and who did take an oath. NOTARY r , NOTARY PUBLIC: RICARDO BEBCHIK Y COMMISSION # DD838934 Sign: x, PIRES November 17, 2012 Sign: 407 133 Print Print: My Commission Expires. My Commission Expires: APPLICATION APPROVE BY: LlJ 4L�7�� Plans Examiner Engineer Zoning (Revised 07 110107) G3� GENE® VILLAGE OF 1111/1 HI SHORES 1 7 Z 609 OWNER BUILDER DISCLOSURE STATEMENT 7 " � DATE: ADDRESS: 'J �� A L Do hereby petition the Village of Miami Shores to act as my own contractor pursuant to the laws of the State of Florida, RS 489.103(7). And I have read and understood the following disclosure statement, which entitles me to work as my own contractor; I further understand that I as the owner must appear in person to complete all applications. State Law requires construction to be done by a licensed contractor. You have applied for a permit under an exception to the law. The exemption allows you, as the owner of your property, to act as your own contractor even though you do not have a license. You must supervise the construction yourself. You may build or improve a one - family or two- family residence. You may also build or improve a commercial building at a cost of $25,000.00 or less. The building must be for your own use and occupancy. It may not be built for sale or lease. If you sell or lease a building you have built yourself within one year after the construction is complete, the law will presume that you built for sale or lease, which is a violation of this exemption. You may not hire an unlicensed person as a contractor. It is your responsibility to make sure the people employed by you have licenses required by state law and by county or municipal licensing ordinances. Any person working on your building who is not licensed must work under your supervision and must be employed by you, which means that you must deduct F.I.C.A and with - holdings tax and provide workers' compensation for that employee, all as prescribed by law. Your construction must comply with all applicable laws, ordinances, buildings codes and zoning regulations. Please read and initial each paragraph. 1. I hold title to the above property and I am planning on doing this c nstruction Myself. Initial ° 2. I understand that as an owner - builder I must abide by all zoning ord"ned and building regulations in effect at the time of permit application. Inactive permits for a period of over 180 days will become null and NNid (expired) and a new permit will be required. to be issued for reinstate ent of the permit. Initial 3. I have an understanding of the 2004 FBC & FRC and understand %a this department and its inspectors are there to help enforce and interp et the code. There is a copy of the code in this office for review. Initial 4. I understand that the building official and inspectors are not thet to design, alter or give advice on how to meet code — only if the structure -;Sets -the :r minimum code. Initial 5. I understand that as an owner- builder, that any contractor disputes wit sub- contractors and myself must be handled in a civil court with the aVce of an attorney. The department will not mitigate any contract disputes. r Initial 6. 1 understand that if I compensate any person or company for work "fo ed they are required to have a business license in the county. If for a reason they do not posses a business license I will be responsible and liable fo any wrong doing from this unlicensed company or person. Initial ' 7. I understand that if any person gets injured on my construction project a are entitled to workmen's compensation. And if they do not posses a workmen's policy I could be held liable for all. doctor and related cost which c uld include loss of wages during recovery from injury. Initial 8. I understand that under state and local laws I can not do any Plumbing, Heating, Air & Roof work on my property with out fi t obtaining the proper permits by licensed contractors. Initial Was acknowledged before me this g day of , 2 t By who was personally known to me or who has Produced there License or ., MY COMMISSION # DD838934 -' MXPRES Nov 17,201 I'd 0 - W tao�1 �e-o NO ARY Or _r / / % % / / % / / / % / / %%/ •11 i4' - I � I �"'d� �.�I�iiii ♦ iii _ -; —= ii OR livivio I� i� • j r r /• rr, /, 'A 0'i� �. i .s ���� j >> s��f 1 riiiiiii�.it 4 I: r q x j �� 4&vn� I i Mo off :� � I I/� 1. ,�. /:.. % � I ,i � J;, Vii. 1 • . _ �— — -- -- -- — / i 0. r 64 0 %? O % /.V -%e X11, do o il O OVA .'% I J'.. I ^j r i 6 ' 6 . i gel No. PL-4-09435,- : r � u Miami Shores Village �8i t T� P .,� fl #; 10050 N.E. 2nd Avenue U+flevk acl)� OIi Miami Shores, FL 33138-0000 Phone: (305)795 -2204 m* Sys. PPR VEM' it beue Dow 4'Olt1 Expiration: 10/2712009 Project Address Parcel Number Applicant 10531 3 Avenue 1122310130360 Miami Shores, FL 33138 Block: Lot: JUAN PABLO /VERONICA D'ON Owner Information Add ress Phone Cell JUAN PABLO / VERONICA D'ONOFRIO / 10531 3 Avenue (305 )494 -0230 I' MIAMI SHORES FL 33138 - Contractor(s) Phone Cell Phone HOME OWNER Valuation: $ 3,000.00 Total Sq Feet: 150 Type of Work: PLUMBING Available Inspections: Type of Piping: BATHROOM REMODEL Inspection Type: Additional Info: Bond ReReturn Top Out : Re Pipe Classification: Residential Main Drain Underground Rough Heater Water Service Final Water Main Lavatory Fees Due Amount Invoice # Total Amt Paid Amt Due CCF $1.80 PL-4- 09-34571 $ 50.00 $ 50.00 $ 0.00 Education Surcharge $0.60 Permit Fee - Additions/Alterations $225.00 Check #: 1430 Scanning Fee $3.00 PL - 4 - 09 - 34684 $ 137.28 $ 137.28 $ 0,00 Submittal Fee $50.00 Submittal Reversal Fee ($50.00) Check #: 1434 Submittal Reversal Fee ($50.00) Technology Fee $6.88 Total: $187.28 In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Futhermore, I authorize the above -named contractor to do the work stated. May 04, 2009 Authorized Signature: Owner / Applicant / Contractor / Agent Date Building Department Copy Mav 04, 2009 1 I � Mi rni Shores 'pillage F B gilding Dep lent , �I 1.0050 N:EInd Avenue, Miami Shores, Florida 33138 r Tel: (30'5) 795.2204 Fax: (305) 75'18972 Bc JILDING ( CEIVED Permit No. 01 PERMIT APPLICATIO 1 7 �r 0 09 ArAR 1VI','ster Permit No. Fl 2004 it T Pl umb � �. ><ll> Typ w O Name (Fee Simple Titleholder) �9'�►eJ 'Y �A.O�W� p�cQ4' phone # �3QS- t l� 4 - 0 W Owner's Address � �p`�,� 13 AA V C _ &L �' � ('f4_ Cite( stag , �• Zi' 3 i 2 °1 Te ant/Lessee Na'' e + Ph A one # E -Mr AiL: p � ® u/ d Job Address {where the work is being done) - :!71 City Miami Shores Village County Miami -Dade Zip) FOIM�iO / PARCIaL # 1— �Z O 3 G Is uilding tfl$torically Designated YES NO Ca 'tractor s Company Name Phone # � Cdotractor's Address ' City State Zip u: �' l ifier Name: Q hone # StaI Certificate or Registration 1?l0. � Certificate f competency No. ' E -MAIL. Art rh�tect/Engineer's Name (if applicable) Phone # d - Val'oe of Work For this Permit $: Square / Linear Footage Of Work: Ty of Work: ��� ❑Addition 19Alterar on (]New � � 'I ` Re airlRe lace � Demolition J p P CI -- -IDes0' ribe Work: 'QL J RQ j% Si �L11,� l\,0 ^ (� 2. } �' A 1 %A MQ N5; A55 y itt L t I i-" aQaU a4 aY aTc aBaYat ak 'at de & &iuxaYa4ae♦k &s1raBde a4 ar, aSs aY`ka4di x4aaS ar ale de ifrtk 4m aY aY4aaYik 3roY Ye aestxaY 4e deaYaYxar2aY aY aY4r 4eaY 4exuat a4uo:x:Yxxx k � "sUlb ittal Fee $ Permit Fee $ �CF CO /CC [jotary $ Trainifig /Edtweation Fees technology Fee$ ° caning $ Radon $ DPBR $ Zoning '$ 0d $ Code Enforcement $ Double Fee $ tr''etural Review. $ Total Fjee Now Due , '00 C pl . (00l" See Reverse side � `� 'n Ji ��j �•� . _I Bonding Name if applicable) g (I pp cable) Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) Mortgage Lender's Address 'I CrtY State Zi Application is hereby made t 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 ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and 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 ermit with an estimated value exceeding ceedin $2500 the promise in go'o'd faith that a (o o the otice o co g applicant must PY f f commencement and construction lien law brochure will be delivered t • o the erson whose property is subject to a P p �'tachment. lso, a cert copy of the recorded notice of commencement must be posted at the job site for the first tAgpection which 1 occurs sev n (7) days after the building permit is issued In the absence of such posted notice, the inspection will )jb( be roved and a rein ction fee will be charged. Signature N. Signature weer. or Agent Contractor The for going i strument kn a �d efore e this )3 The foregoing instrument was acknowledged before me this day of , 2dD by day of 20 b who is personally known to me�' or ho has produced — who is personally known to me or who has produced As identification and who did take an oath. as identification and who did take an oath. NOTAI It LIC*ICAROO SEBCHIK NOTARY PUBLIC: MY COMMISSION # DDS389 EXPIRES November 17, 2012 Sign: Sign: Print: Print: My Commission Expires: My Commission Expires: xxxsYxxxuxatxxxXxNUfewvtuae sk 4e eYsr •,ti,ti , y • x,'e,x • xx''et 9e oYuxxxxxsY nYxxxxeY &uxYx9c dc� •&•xxatxxxuxxa4xxxaYxaYxxdcxKY :xxxaYxxF k oYtza: rxxxa° APPLICATION APPROV BY: Plans Examiner Engineer Zoning R e v used 02108/06 L A P 8C R 1 ?Opp VILLAGE OF 1l7IAMI SHORES 4 '" "" 0NN'NEIt BUILDER DISCLOSURE STATEMENT NAME: �:,� DATE: y ' 0 ADDRESS: _ �� S ( �� P .-U , E- Do hereby petition the Village of Miami Shores to act as my own contractor pursuant to the laws of the State of Florida, FS 489.103(7). And I have read and understood the following disclosure statement, which entitles me to work as my own contractor; I further understand that I as the owner must appear in person to complete all applications. State Law requires construction to be done by a licensed contractor. You have applied for a permit under an exception to the law. The exemption allows you, as the owner of your property, to act as your own contractor even though you do not have a license. You must supervise the construction yourself. You may build or improve a one - family or two- family residence. You may also build or improve a commercial building at a cost of $25,000.00 or less. The building must be for your own use and occupancy. It may not be built for sale or lease. If you sell or lease a building you have built yourself within one year after the construction is complete, the law will presume that you built for sale or lease, which is a viothition of this exemption. You may not hire an unlicensed person as a contractor. It is your responsibility to make sure the people employed by you have licenses required by state law and by county or municipal licensing ordinances. Any person working on your building who is not licensed must work under your supervision and must be employed by you, which means that you must deduct F.I.C.A and with - holdings tax and provide workers' compensation for that employee, all as prescribed by law. Your construction must comply with all applicable laws, ordinances, buildings codes and zoning regulations. Please read and initial each paragraph. 1. I hold title to the above property and I am planning on doing this ns ction Myself. Initial 2. 1 understand that as an owner - builder I must abide by all zoning ordinan s and building regulations in effect at the time of permit applicati n. Inactive permits for a period of over 180 days will become null and vo d (expired) and a new permit will be required. to be issued for reinstate ent of the permit. Initial 3. I have an understanding of the 2004 FBC & FRC and understand %t this department and its inspectors are there to help enforce and inte ret the code. There is a copy of the code in this office for review. Initial ' CAP 4. I understand that the building official and inspectors are not th re to design, alter or give advice on how to meet code — only if the structur meets the minimum code. , Initial 5. 1 understand that as an owner - builder, that any contractor disputes wi sub- contractors and myself must be handled in a civil court with Advice of an attorney. The department will not mitigate any contract disputeInitial 6. I understand that if I compensate any person or company for rmed they are requited to have a business license in the county. If for any reason they do not posses a business license I will be responsible and liable fo any wrong doing from this unlicensed company or person. Initial 7. I understand that if any person gets injured on my construction project y are entitled to workmen's compensation. And if they do not posses a workmen's policy I could be held liable for all doctor and related cost which c Id include loss of wages during recovery from injury. Initial 8. I understand that under state and local laws I can not do any le trical, Plumbing, Heating, Air & Roof work on my property with out first obtaining the proper permits by licensed contractors. Initial Was acknowledged before me this _ day of , 20 By V who was personally known to me or who has P oduced there License or , , , n. MY COMMIS" # DDSM34 IRES vember 17, 2012 ao .o� O ARY Mi �Y1 �. i Shores Vill g e B ilding Department 10050 &E 2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 750972 1 l i IIU ILDII�TG d � � I 'IVE� Permit No. P' RIVI AP x PLIC.�. " I 'st r ,, . � e Permit No, I C2004,: �1 7tt1 Pe ♦ n. }p I i mtT >< y b �' P e: Plum O»{, er's Name (Fee Simple Titleholder) 300 AFa -V0 hone # �.S— 4 -®2-- Owlner's Address 1 City+ - - L \ State Zip 33 Ten�ant/Lessee Name Phone # V E- PAIL: o+w0 Jo Address (whore the work is being dpi e) �� 1 A9 I C' �> yl am i Shores e '" ` n Cou ty. i i;D de � Zip ��j l Fd IO 1 PARCEL # C ,l I *' 6 /0 is Ouilding Historically Designated YES NO t Contractor's Company Name Phone # Contractor's Address city Stat ZiP Qu Ilifier Name Phone # Sta.. Certificate or Registration N0. Certifi of om tenc N E- AIL: y Ar itec t/Engirle r s Name if a ' lica le � � (ply Va Ph e of Wor l' k'Fbr this h s Per it $ Square Li S a / near oo I E e r. Q g i pe of Work:' E]Addition nAtte ` a New R . ❑ e / e lace molition Cn b�esrtbe Workt 17 flout 1t0 S Fees********** *��esax��r,��sc�,�����eu�c,�,�� x uxrxa �x��xxx nittat Fee i'et snit F $ (Cta $ CO /CC of ry $ Training/Education ee $ Technology Pee $ �Sca�pning $ Radon $ DPBR $ Zoning $ ` onjjd $ e onto, rcemen' $ Double Fee $ Structural Review. $ Total Fee Now Due $ I See Reverse side => I Bonding Company's Name (If applicable) Bonding Company's Address City State Zi 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 ELECTRICAL WORK, PLUMBING, SIGNS WELLS, POOLS, FURNAC �S, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC..... OWNER'S AFFIDAVIT: I certify hat all the foregoing fy a oin information i s accurate g g ate and that all work o k will be done in compliance with all applicable p pp cable laws regulatin g g 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." U Notice to Applicant: its 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 f whose property is subject to attachment. ls(o, a certified copy of the recorded notice of commencement must be posted at the job site or the first inspection whi&l occurs seve (7) days after the building permit is issued. In the absence of such posted notice, the inspection will Wban einsp lion fee will be charged Signature, e g Signature t Contractor The fore oin g de d before me this 1 The foregoing instrument knowledged before me this day of ® day of , 20 _, by who is personally known to me o who has produc who is personally known to me or who has produced As identification and who did take an oath. as identification and who did take an oath. NOTAR : R IWC pp Be HNC r£ NOTARY PUBLIC: '~ MY COM, ISSION # 38831 r PEXPIRE� Novem 7, 012 Sign: Sign: Print: 5 Print: MY Commissioa Expires. My Commission Expires: , 8xxxx,Y,Yx,Ya:,t,Y i'e4c at9r,F B: xi¢tia ae,Yer & &xoc ae,Y,Y • ' j .. • aexde,Y,4 xx Yud : &x,Bxx4e Se,Yx de�,Yxxfe aY ac Btx,Y dcxx uiexxdcue'c,Y,e ae,trx•k &xx4:x APPLICATION APPROVE BY: (• � Plans Examiner Engineer Zoning . g (Revised 02/08/06) I i V : Ap 7 009 VILLA GE OF A11110111 SHORES OWNER BUILDER DISCLOSURE STATEMENT NAME: DATE: ADDRESS: Q � �{� el Do hereby petition the Village of Miami Shores to act as my own contractor pursuant to the laws of the State of Florida, F.S 489.103(7). And I have read and understood the following disclosure statement, which entitles me to work as my own contractor; I further understand that I as the owner must appear in person to complete all applications. State Law requires construction to be done by a licensed contractor. You have applied for a permit under an exception to the law. The exemption allows you, as the owner of your property, to act as your own contractor even though you do not have a license. You must supervise the construction yourself. You may build or improve a one - family or two- family residence. You may also build or improve a commercial building at a cost of $25,000.00 or less. The building must be for your own use and occupancy. It may not be built for sale or lease. If you sell or lease a building you have built yourself within one year after the construction is complete, the law will presume that you built for sale or lease, which is a violation of this exemption. You may not hire an unlicensed person as a contractor. It is your responsibility to make sure the people employed by you have licenses required by state law and by county or municipal licensing ordinances. Any person working on your building who is not licensed must work under your supervision and must be employed by you, which means that you must deduct F.I.C.A and with - holdings tax and provide workers' compensation for that employee, all as prescribed by law. Your construction must comply with all applicable laws, ordinances, buildings codes and zoning regulations. Please read and initial each paragraph. 1. I hold title to the above property and I am planning on doing this c s ction Myself. Initial 2. 1 understand that as an owner- builder I must abide by all zoning ordinances and building regulations in effect at the time of permit applic tion. Inactive permits for a period of over 180 days will become null and 'd (expired) and a new permit will be required to be issued for reinstate ent the permit. Initial 3. I have an understanding of the 2004 FBC & FRC and unde td that this department and its inspectors are there to help enforce and inte et the code. There is a copy of the code in this office for review. Initial , 4. I understand that the building official and inspectors are no `there to design, ,alter or give advice on how to meet code — only if the struce, e the - minimum code. Initial 5. I understand that as an owner - builder, that any contractor disputes wit su`b� ° contractors and myself must be handled in a civil court with t advice of an attorney. The department will not mitigate any contract disputes. a Initial 6. 1 understand that if I compensate any person or company for work per ed they are required to have a business license in the county. If fo any reason they do not posses a business license I will be responsible and liabl or a y wrong doing from this unlicensed company or person. Initial 7. I understand that if any person gets injured on my construction roject y are entitled to workmen's compensation. And if they do not poss a workmen's policy I could be held liable for all doctor and related cost which ul include loss of wages during recovery from injury. Initial 8. 1 understand that under state and local laws I can not do an Electrical, Plumbing, Heating, Air & Roof work on my property with out first b ining the proper permits by licensed contractors. Initial Was acknowledged before me this - J day of �IGd , 20 0 1 n By ® who was personally known to me or who has Produced there License or a on. y COMMISSION # DD8M34 PIRES November 17, 2012 (40» 39"153 aWn O NOTARY T Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 ( - 4— L Inspection Number: INSP- 111829 Permit Number: EL -4 -09 -636 Scheduled Inspection Date: September 10, 2009 Permit Type: Electrical - Residential Inspector: Devaney, Michael Inspection Type: Final Owner: D'ONOFRIO / MEDINA, JUAN PABLO / Work Classification: Addition /Alteration Job Address: 10531 NE 3 Avenue Miami Shores, FL 33138- Phone Number Parcel Number 112231013036 Project: <NONE> Contractor: HOME OWNER Building Department Comments ELECTRICAL NEEDS FOR TOW FULL BATHROOMS Inspector Comments Passed Failed Correction ❑ Needed Re- Inspection ❑ Fee No Additional Inspections can be scheduled until re- inspection fee is paid. no )nno For Inspections please call: (305)762 -4949 0, A of 47 Miami Shores Village 10050 N.E. 2nd Avenue bVt�l C C/ 3S C (11?- Al OWAkerltli Miami Shores, FL 33138 -0000 Pe'r Phone: (305)795 -2204 k : tit ;�� APP IF J 100 Expiration: 10/27/200 Project Address Parcel Number Applicant 10531 3 Avenue 1122310130360 Miami Shores, FL 33138- Block: Lot: JUAN PABLO / VERONICA D'ON Owner Information Address Phone Cell JUAN PABLO / VERONICA D'ONOFRIO / 10531 3 Avenue (30594 -0230 MIAMI SHORES FL 33138 - Contractor(s) Phone . Cell Phone Valuation: $ 300.00 HOME OWNER Total Sq Feet: 0 Type of Work: ELECTRICAL Available Inspections: Additional Info: BATHROOM REMODEL Inspe Type: Classification: Residential Underground Rough Final Meter Box Alteration Relocation Fire Alarm Service Change W. W. Fees Due Amount Invoice # Total Amt Paid Amt Due CCF $0.60 EL- 409 -34574 $ 50.00 $ 50.00 Education Surcharge $0.20 $ 0 •�� Permit Fee - Additions/Alterations $160.00 Check #: 1431 Scanning Fee $3.00 EL -4-09 -34685 $ 67.80 $ 67.80 $ 0.00 Submittal Fee $50.00 Submittal Reversal Fee ($50.00) Check #: 1434 Submittal Reversal Fee ($50.00) Technology Fee $4.00 Total: $117.80 In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Futhermore, I authorize the above -named contractor to do the work stated. May 04, 2009 Authorized Signature: Owner / Applicant / Contractor / Agent Date Building Department Copy Mav 04, 2009 1 Miami Shores Village �� Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 ,,,,� •..•- �- Tel: (305) 795.2204 Fax: (305) 756.8972 BUILDING Permit No. F—L0 �— PERMIT APPLICATION Master Permit No. FBC 2004 Permit Type Electrical Owner's Name (Fee Simple Titleholder) To A kD 0 tq 6iD 7 � 0 VYj (bt, - J Phone # 3® S- 9 4 - 0 30 Owner's Address bKA Ck- CkL- City MR l &n l State �' L, Zip 2,9 Tenant/Lessee Name -k) A Phone # pu � E -MAIL: 30 0"No 1 Job Address (where the work is being one) ® 5 ?> 1 10 E ,T A9 E City Miami Shores Villaee County Miami -Dade Zip FOLIO / PARCEL # 11 - 01 0 3 6 0 Is Building Historically Designated YES NO Contractor's Company Name Phone # Contractor's Address City State Zip Qualifier Name Phone # State Certificate or Registration No. Certificate of Competency No. E -MAIL: Arch itect/Engineer's Name (if applicable) Phone # Value of Work For this Permit $ 3 00 Square / Linear Footage Of Work: r' °j Type of Work: ❑Addition ❑Alteration []New Q Re air /Re lace Repair/Rep p ❑Demolition Describe Work E U e - 1k�C.I - O itO T-011- © fQ �-L gAT4&r 40M s si r. c K,l x4exxxxxx9j�xxx3: Y oY txxxxoYxx4e of Y 4:xxeY�x4c aY oYxxde F' dexx�cade x xK4exxx9c et'k a: drx4r do oYza: xx *vFx9e�K Submittal Fee $ W r Permit Fee $ CCF $ ° �® CO /CC Notary $ Training /Education Fee $ ®- t�� Technology Fee $ Scanning $ ' D - 00 Radon $ DPBR $ Zoning $ Bond $ Code Enforcement $ Double Fee $ Structural Review. $ Total Fee Now Due $ ✓V V� AC' �1i1 �I 09- See Reverse side W 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. 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 ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC..... OWNER'S AFFIDAVIT: 1 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 no 'fie of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Al ;1 a certified copy of the recorded notice of commencement must be posted at the job site for the first ins coon which occurs seven days after the building permit is issued. In the absence of such posted notice, the inspection will no appr ved and a reinspe n fee will be charged.. Signature Signature ner Agent Contractor The fore oing i trument was o le eO before me this) The foregoing instrument was acknowledged before me this day of , 20® , by o r V day of , 20 _, by who is personally known to me or ho has produced I who is personally known to me or who has produced As identification and who 'd take an oath. A as identification and who did take an oath. NOTARY NOTARY PUBLIC: RIICARDO SEBCHIK "e MY COMMISSION # DDSM Sign: I % , • "PIRES November 17,201 Sign: (40 39"1ss Print: Print: My Commission Expires: My Commission Expires: A APPLICATION APPROVED BY- / T//�,�� Plans Examiner Engineer Zoning (Revised 02/08/06) 1 7 2003 VILLAGE OF MIAMI SHORES OWNER BUILDER DISCLOSURE STATEMENT NAME: DATE: ADDRESS: I E. S`A ( �� A �- Do hereby petition the Village of Miami Shores to act as my own contractor pursuant to the laws of the State of Florida, FS 489.103(7). And I have read and understood the following disclosure statement, which entitles me to work as my own contractor; I further understand that I as the owner must appear in pet to complete all applications. State Law requires construction to be done by a licensed contractor. You have applied for a permit under an exception to the law. The exemption allows you, as the owner of your property, to act as your own contractor even though you do not have a license. You must supervise the construction yourself. You may build or improve a one - family or two- family residence. You may also build or improve a commercial building at a cost of $25,000.00 or less. The building must be for your own use and occupancy. It may not be built for sale or lease. If you sell or lease a building you have built yourself within one year after the construction is complete, the law will presume that you built for sale or lease, which is a violation of this exemption. You nay not hire an unlicensed person as a contractor. It is your responsibility to make sure the people employed by you have licenses required by state law and by county or municipal licensing ordinances. Any person working on your building who is not licensed must work under your supervision and must be employed by you, which means that you must deduct F.I.C.A and with - holdings tax and provide workers' compensation for that employee, all as prescribed by law. Your construction must comply with all applicable laws, ordinances, buildings codes and zoning regulations. Please read and initial each paragraph. 1. I hold title to the above property and I am planning on doing this co struction Myself. _ Initial 2. I understand that as an owner- builder I must abide by all zoning ordinances building regulations in effect at the time of permit applicat n. Inactive permits for a period of over 180 days will become null and vo (expired) and a new permit will be required. to be issued for reinstatem t of the permit. Initial 3. I have an understanding of the 2004 FBC & FRC and understand �athis department and its inspectors are there to help enforce and interpret he code. There is a copy of the code in this office for review. Initial 4. I understand that the building official and inspectors are not t ere to design, alter or give advice on how to meet code —only if the struct e, meets the minimum code. Initial 5. I understand that as an owner - builder, that any contractor disputes wi sub- contractors and myself must be handled in a civil court with the vice of a. attorney. The department will not mitigate any contract disputes. Initial 6. 1 understand that if I compensate any person or company for work perfo ed they are required to have a business license in the county. If for any reason they do not posses a business license I will be responsible and liable fo ny wrong doing from this unlicensed company or person. Initial 7. I understand that if any person gets injured on my construction project th e entitled to workmen's compensation. And if they do not posses a workmen's policy I could be held liable for all doctor and related cost which could include- loss of wages during recovery from injury. Initial 8. I understand that under state and local laws I can not do any -cal 'cal, Plumbing, Heating, Air &Roof work on my property with out fir \ob ning the proper permits by licensed contractors. Initial Was acknowledged before me this day of , 20_0L By , • ,� who was personally known to me or who has Produced there License or as identification. ICARDO 996C1.4IIe l - ": •" COMMIS # 38 3 JPA RES OWNE NOTARY PO)MI "X111., Et -4-0 ' 5'l: ,ya+e„�s Miami Shores Village P� 10050 N. E. 2nd Avenue 01 iQ : Miami Shores, FL 33138-0000 ' I t *tts: "PROVED" a Phone: (305)795 -2204 ZeR�tD�' i u 012# ,9 Expiration: 1 /2712 Project Address Parcel Number Applicant 10531 3 Avenue _ 1122310130360 Miami Shores, FL 33138 Block: Lot: JUAN PABLO /VERONICA D'ON Owner Information Address Phone Cell JUAN PABLO / VERONICA D'ONOFRIO / 10531 3 Avenue (305 )494 -0230 MIAMI SHORES FL 33138- . ,. ... Contractor(s) Phone Cell Phone Valuation: $ 2, 000.00 MOODY ELECTRIC INC (305)758 -2000 Total Sq Feet: 0 Type of Work: ELECTRICAL Available Inspections: Additional Info: SERVICE UPGRADE Inspection Typ Classification: Residential Underground Rough Final Meter Box Alteration Relocation Fire Alarm Service Change W. W. Fees Due Amount Invoice # Total Amt Paid Amt Due CCF $1.20 EL -4-09 -34592 $ 209.60 $ 159.60: $ 50,E Education Surcharge $0.40 Permit Fee - Additions/Alterations $200.00 EL -4-09 -34592 $ 209.60 $ 209.60 $ 0.00 Scanning Fee $3.00 Check #: 17906 Submittal Fee $50.00 Submittal Reversal Fee ($50.00) Technology Fee $5.00 Total: $209.60 In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Futhermore, I authorize the above -named contractor to do the work stated. April 30, 2009 Authorized Signature: Owner / Applicant / Contractor / Agent Date Building Department Copy April 30, 2009 1 y Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: 305 756.8972 BUILDING RECEIVE 2 Q ���9 Permit No. 1` �� PERMIT APPLICATIO Master Permit No ° �� FBC 2004 ®® Permit Type Electrical Owner's Name (Fee Simple Titleholder) b v / - 0 n I On M , ® r pho # -- , t� 5 . 1:3 1-1 3133 Owner's Address ® 3 1-j- A v City (�(� I la rte, ^ I Sb 1) V-& S State Zip 3 3 ) 36 1 Tenant/Lessee Name Phone # E -MAIL: Job Address (where the work is being done) � J 1'CI �� I M �� F� 3 1 5 City Miami Shores Village County Miami -Dade Zip 3 13 FOLIO / PARCEL # Is Building Historically Designated YES NO Contractor's Company Name -- M OOD Y F <CT l et O (®Ic # - -3 ® 5 ° 1,5q - 2 Contractor's Address �pp/ �(/ 4i� b1G 9 City M I a State F L Zip 3 EC-) Qualifier Name j (�$ Q • C) D y Phone # 3 015 State Certificate or Registration No. &C, o o of l C1 9 tZ_ Certificate of Competency No. E -MAIL: Arch itect/Engineer's Name (if applicable) Phone # Value of Work For this Permit $ ® 0 Q Q . 0 0 Square / Linear Footage Of Work: Type of Work: ❑Addition. ❑Alteration ONew R Demolition Describe Work: _ aele 2f11:� e CA a " zFxdcxiYxeYxaY : &sY YxsexxknYx kx &4:xx &QeY Y 4cxiYxxe4 de F ees x * aYxa:oYx &xxxxx4exx &xaY kxxxxxkYxF oY 9e dcx: dr oYxxxxsF jS� bm ittY Fee $ Permit Fee $ ,� ® ®o �� CCF $ f • �� CO /CC Notary $ `'^' Training /Education Fee $ - , go Technology Fee $ Scanning $ 5 Radon $ DPBR $ Zoning $ Bond $ Code Enforcement $ Double Fee $ Structural Review. $ Total Fee Now Due $ See Reverse side -> 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 m 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 ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and 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 [N 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 app oved and a reinspection fee will be c arged. • Signature Signatu Owner or Agent Contractor The foregoing instrument was acknowledged before me this A0 The foregoi instrument was acknowledged before me thi day of , 20�, by -tt>"� e_� arc day of , 20®7 , by o,J who is p ersonally known to me or who has produced who is p ersonally know to me or who has produced As identification and who did take an oath. as identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: Sign: Print:* LCb Print: .•�Y¢ NICOLE A BERGERT = +: ::= MY COMMISSION # DD 441715 My Commis _4 a YCO #D My Co ;� 9 xp1 RES:July2,2009 x r. x9e �cx�cxx de �',asIW12SJ:iIIyGN'Rxd. -xx 'Yxx r. do 4exr. do d: xac r. dex rxxx9c do icx9:xxx , Bonded ThNN Public Underwriters Bonded Thru NoUq PubAc Urbenvriters YxxYx xi xx APPLICATION APPROVED B Plans Examiner Engineer Zoning (Revised 02/08/06) �I�lo� e r ' ADDENDUM TO BUILDING PERMIT APPLICATION AN APPLICATION FOR BUILDING PERMIT MUST ACCOMPANY THIS ADDENDUM. IF A MASTER PERMIT HAS BEEN OBTAINED, THE OWNER'S NOTARIZED SIGNATURE NEED NOT BE PRESENT ON SUBSEQUENT APPLICATIONS. PLEASE CIRCLE O DISCIPLINE APPLIED FOR: PERMIT # PLUMBING ELECTRICAL MECHANICAL ITEM UNIT FEE ITEM UNIT FEE ITEM UNIT FEE BATH TUB SWITCH OUTLETS SPACE HEATERS DISHWASHER LIGHT OUTLETS CENTRAL HEATING DISPOSAL RECEPTACLES A/C (WIND) FLOOR DRAIN SERVICE TEMPORARY A/C (CENTRAL) GREASE TRAP SERVICE SIZE IN AMPS I DUCT WORK INTERCEPTOR SERVICE REPAIR/METER CHANGE IREFRIGERATION LAVATORY APPLIANCE OUTLETS IPROCESS AND PRESS PIPING LAUNDRY TRAY RANGE TOP JUNDERGROUND TANKS CLOTHES WASHER OVEN JABOVE GROUND TANKS SHOWER IWATER HEATER IU.F. PRESSURE VESSELS SINK. POT /3 COMP. MOTORS 0 -1 HP ISTEAM BOILERS SINK, RESIDENCE. IMOTORS OVER 1 -3 HP HOT WATER BOILERS SINK, SLOP. MOTORS OVER 3 -5 HP IMECHANICAL VENTILATION TEMPORARY WATER CLOSET MOTORS OVER 5 -8 HP ITRANSPORTING ASSEMBLIES URINAL MOTORS OVER 8 -10 HP ELEVATORS /ESCALATORS WATER CLOSET MOTORS OVER 10 -25 HP IFIRE SPRINKLER SYSTEMS INDIRECT WASTES MOTORS OVER 25 -100 HP ICOOLING TOWERS WATER SUPPLY TO: MOTORS OVER 100 HP IVIOLATION A/C UNIT A/C WINDOW IREINSPECTION FIRE SPRINKLER JAIR CONDITIONERS HEATER -NEW INST. ISTRIP HEATER HEATER - REPLACE IGENERATORS TRANSFORMERS LAWN SPRINKLER -WELL IGENERATORS TRANSFORMERS SWIMMING POOL IGENERATORS TRANSFORMERS WATER SERVICE ISPECIAL PURPOSE. SEWER CONNECTIONS IOUTLETS COMMERCIAL UTILITY -SEWER ISIGN TUBES UTILITY -WATER SIGN TRANSFORMERS SEPTIC TANK ISIGN TIME CLOCK RELAY FIXTURES FAINFIELD, 4" TILE/RES. JANTENNA PUMP & ABANDON SEPTIC TANK TELEVISION OUTLETS SOAKAGE PIT CU. FT. VIOLATION CATCH BASIN REINSPECTION DISCHARGE WELL DOMESTIC WELL AREA DRAIN ROOF INLET SOLAR WATER HEATER FIRE STANDPIPE POOL PIPING LAWN SPRINKLER SYSTEM GAS RANGE METER SET (GAS) GAS PIPING Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 BUILDING RECEIVED Permit No. E1..-. y 1 _� PERMIT APPLICATIO ' zoo9 Master Permit No. FBC 2004 . Permit Type Electrical Owner's Name (Fee Simple Titleholder) 30AA ?A6L0 _'V®a® hone # 30S- Yi � -0290 Owner's Address iLk A4 E City A tiAn L State Zip �3 2 Tenant/Lessee N me 0 A, Phone # e E -MAIL: Job Address (where the work is being one) t05_:�1 ilk 3 City Miami Shores Village County Miami -Dade Zip 1 '2 > `? FOLIO / PARCEL # Is Building Historically Designated YES NO Contractor's Company Name . Phone Contractor's Address City State Z Qualifier Name Ph ne # State Certificate :orr e gistration No. Certificate mpetenc No E -MAIL: Architect/Engineer's Name (if applicab ) Phone # Value of Work For this Permit �� uare / Li r Footage Of Work: �i . 'Type of Work: ❑Addition ❑Altera 'on ❑N El Repair /Replace Demolition Describe Work: i`' - - ` . ; / /r �R3 xxaYx9e 9c Yxx.�xxxx3c �axxxtcotxxY oY �x9:o:xxirxY t Fees'Y 9e 4exxxr.�dtirxr.9czdc4e Be aYx$:xde r. 4e de &xk ie dcxx�rxxoY &4e dcxx�de _Submittal Fee $ Permit Fee $ CCF $ CO /CC f ;Notary $ ining /Education Fee Technology Fee $ Scanning $ Ra $ DPBR $ Zoning $ Bond $ Code En cut $ Double Fee $ Structural Review. $ Total Fee Now Due $ See Reverse side 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'perfonned to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC....: OWNER'S AFFIDAVIT: l 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 $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose prop ty is subject to attachment. rs se lso, a certified copy of the recorded notice of commencement must be posted at the job site for the first ection which occuv o7 days after the building permit is issued. In the absence of such posted notice, the inspection wil t be app ved and a rein ction fee will be charged. e Signature Signature er or :nlletd r Contractor The fore oing,ins ument s a be re me this The foregoing instrument was acknowledged before me this day of , 20® , by day of , 20 _, by , who is personally known to me o has produce who is personally known to me or who has produced As identification and who did take an oath. as identification and who did take an oath. NOTARY PU RICARDO BEBCHIK NOTARY PUBLIC: COMMISSION # DD838934 Sign: , # r l f� P RES No mbe 17, 2012 g Si n: Print: Print: Ill My Commission Expires: My Commission Expires: &x�c e'ez ac icxrxxicxz$x xi:xxnczzie 4cx' xxioxx r. do 4cxd: &x i:rxxicx' dcieux x$x4c$cr. iczi: 9r�cxicxxxxxdexiezxxzxxxxx r. icxicx 9:x�c ac r. is rwx�e dear. 4e r. aYxacxt do APPLICATION APPROVED BY: Plans Examiner Engineer Zoning (Revised 02/08/06) 9 RD 01t3 VILLAGE OF 11111A M1 SHORES R OWNER BUILDER DISCLOSURE STATEMENT APR a 1Z 1009 NA IE: �� � I�U�� � `1�•�,� DATE: ADDRESS: 1 11 W E ?2t-p L Do hereby petition the Village of Miami Shores to act as my own contractor pursuant to the laws of the State of Florida, KS 489.103(7). And I have read and understood the following disclosure statement, which entitles me to work as my own contractor; I further understand that I as the owner must appear in person to complete all applications. State Law requires construction to be done by a licensed contractor. You have applied for a permit under an exception to the law. The exemption allows you, as the owner of your property, to act as your own contractor even though you do not have a license. You must supervise the construction yourself. You may build or improve a one - family or two- family residence. You may also build or improve a commercial building at a cost of $25,000.00 or less. The building must be for your own use and occupancy. It may not be built for sale or lease. If you sell or lease a building you have built yourself within one year after the construction is complete, the law will presume that you built fot sale or lease, which is a violation of this exemption. You tray not hire an unlicensed person as a contractor. It is your responsibility to make sure the people employed by you have licenses required by state law and by county or municipal licensing ordinances. Any person working on your building who is not licensed must work under your supervision and must be employed by you, which means that you must deduct F.I.C.A and with - holdings tax and provide. workers' compensation for that employee, all as prescribed by law. Your construction must comply with all applicable laws, ordinances, buildings codes and zoning regulations. Please read and initial each paragraph. 1. I hold title to the above property and I am planning on doing this co s ction Myself. Initial 2. I understand that as an owner- builder I must abide by all zoning ordinances and building regulations in effect at the time of permit applic tion. Inactive permits for a period of over 180 days will become null and v id (expired) and a new permit will be required to be issued for reinstate ent of the permit. Initial 3. I have an understanding of the 2004 FBC & FRC and unde stand this department and its inspectors are there to help enforce and inte ret the code. There is a copy of the code in this office for review. Initial L 4. I understand that the building official and inspectors are not t e` design alter or give advice on how to meet code — only if the structur ' eets the minimum code. Initial ' 5. I understand that as an owner- builder, that any contractor dispttes with sub contractors and myself must be handled in a civil court with t e advice of an attorney. The department will not mitigate any contract disputes. Initial 6. 1 understand that if I compensate any person or company for work� �er rmed they are requited to have a business license in the county. If for any reason they do not posses a business license I will be responsible and liable or any wrong doing from this unlicensed company or person. Initial 7. I understand that if any person gets injured on my construction pro t ey are entitled to workmen's compensation. And if they do not posses a en's. policy I could be held liable for all doctor and related cost whic could include loss of wages during recovery from injury. Initial 8. I understand that under state and local laws I can not do any Ele trical, Plumbing, Heating, Air & Roof work on my property with out firs o aining the proper permits by licensed contractors. Initial Was acknowledged before me this day of , 200 _�l� � 1� who was personally known to me or who has Produced there License or , . MCA MV WMC*Kti .•: :*= COMMISSION # DD8389 as . PIKES November 17.201 (4071398 0183 •�O R NOTARY I This Document Prepared By: /fl MAX M. HAGEN, ESQ. RETURN TO: HAGEN & HAGEN, P.A. l� 16r 3531 GRIFFIN ROAD FT. LAUDERDALE, FLORIDA 33312 tP 1 J1, Parcel ID Number. 1122310130360 Warranty Deed This Indenture, Made this 31st day of March , 2009 A.D. , Between WRIGLEY CONSORTIUM CO.,A FLORIDA CORPORATION, FORMERLY KNOWN AS WRIGLEY REAL ESTATE, INC., and LAP -MERE INVESTMENT CORP., A FLORIDA CORPORATION of the County of M IAMI —DARE , State of Florida , grantors, and JUAN PABLO D'O1gOFRIO and PAOLA VERONICA MEDINA, HUSBAND AND WIFE whose address is: 10531 N. E. 3RD AVENUE, MIAMI SHORES, FL 33138 of the County of M I AMI -DADE , State of Florida , grantees. Witnesseth that the GRANTORS, for and in consideration of the sum of ---- - - - - -- -TEN DOLLARS ($10)----------------- - - - - -- DOLLARS, and other good and valuable consideration to GRANTORS in hand paid by GRANTEES, the receipt whereof is hereby acknowledged, have granted, bargained and sold to the said GRANTEES and GRANTEES' heirs, successors and assigns forever, the following described land, situate, lying and being in the County of MIAMI —DADE State of Florida to wit: LOTS 13 AND 14, BLOCK 12, OF FIRST ADDITION TO PASADENA PARR, ACCORDING TO THE PLAT THEREOF, AS RECORDED IN PLAT BOOK 6, AT PAGE 82, OF THE PUBLIC RECORDS OF MIAMI -DARE COUNTY, FLORIDA. Subject to taxes and assessments for 2009 and subsequent years, applicable zoning regulations and other regulatory laws and ordinances, and all other covenants, conditions, restrictions, reservations, limitations and easements of record, if any. I i I and the grantors do hereby fiilly warrant the title to said land, and will defend the same against lawful claims of all persons whomsoever. In Witness Whereof the grantors have hereunto set their hands and seals the day and year first above written. Signed, sealed and delivered in our presence: WRIGLEY CONSORTIUM CO. F /K /A G E E, INC. and INVE CORP. // By. (Seal) Pr nte�, Name: DA ID PRIbdAL, President I Wltne P.O. ddress: 78 RNE AVENUE, MIAMI BEACH, FL 33141 Pr 2tr ame : ( / �� By AL ERE, President (Seal) Wi e P.O. : 15841 PINES BLVD., #301, PEMBROKE PINES, FL 33027 ( STATE OF FLORIDA Corporate Seal) COUNTY OF BROWARD The foregoing instrument was acknowledged before me this 31st day of March , 2009 by DAVID PRISCAL, President of WRIGL M CO., A FLORIDA CORPORATION, FORMERLY KNOWN AS WRSTATE, INC., on behalf of the corporation WHO IS PERSONALLY KNOWN 10 ME OR WHO PRODUCED A ' LICENS as identificati . J e: 1 � eYe4,, j0M K GROSS lc *. t t � EXPIRES: July 29, 2009 xpires: Bonded Thru Notary Public Undonar tars ...,.m 1 31119