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RC-10-88 L Inspection Worksheet Miami Shores Village A 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 133997 Permit Number: L -1 -10 -106 Scheduled Inspection Date: April 14, 2010 Permit Type: Plumbing - Residential Inspector: Devaney, Michael Inspection Type: Final Owner: ALASHTI, PARANDEH Work Classification: Addition /Alteration Job Address: 10626 NE 10 Place Miami Shores, FL Phone Number (305)891 -0378 Parcel Number 112232028084 Project: <NONE> Contractor: JB WATERWORKS CORP Phone: (305)766 -4306 Building Department Comments MASTHER BATH REPLACE SHOWER PAN REPOSITION MIXING VALVE RESET TOILET LAVATORY SINK REPLACE ANGLE SLOPES. SHARED BATH REPLACE TOILET REPLACE SHOWER MIXING VALVE. Inspector Comments Passed Failed Correction ❑ Needed Re- Inspection ❑ Fee No Additional Inspections can be scheduled until re- inspection fee is paid. April 13, 2010 For Inspections please call: (305)762 -4949 Page 4 of 20 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 133819 Permit Number: RC 1 -10 -88 Scheduled Inspection Date: April 15, 2010 Permit Type: Residential Construction Inspector: Bruhn, Norman Inspection Type: Final Building Owner: ALASHTI, PARANDEH Work Classification: Alteration Job Address: 10626 NE 10 Place Miami Shores, FL Phone Number (305)891 -0378 Parcel Number 112232028084 Project: <NONE> Contractor: CF CONSTRUCTION AND REMODELI INC Building Department Comments DEMOLITIONB OF INTERIOR WALL OF BATHROOM, REPLACE SHOWER PAN, SRYWALL, DUROCK, TOILET, VANITIES AND SINK REPLACE SHOWER DIVERTER Inspector Comments Passed l �G Failed Correction ❑ Needed Re- Inspection ❑ Fee No Additional Inspections can be scheduled until re- inspection fee is paid. April 14 2010 For Inspections please call: (305)762 -4949 Page 6 of 18 Miami Shores Village ;o �''� Building jaw 2 1 2010 g 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 Permit No. t0 c) — 10`5 PERMIT APPLICATION Master Permit No. 1; kO — &3 FBC 20 Permit Type: ELECTRICAL n Owner's Name (Fee Simple Titleholder) P cy on&e1r, , # (7�� `�7 �'" 330 Owner's Address State EL Zip `A 13 W - 1 1 10 4 Tenant/Lessee Name jj / Phone 4 3C:) S a 160L 5330 Email Job Address (where the work is being done) City Miami Shores Village County Miami -Dade Zip 331 `Z Oy FOLIO / PARCEL # - 2 `� 3 2 - Is Building Historically Designated YES NO 1 Flood Zone Contractor's Company Name 1' 3 h a t H �' l � e /1 Phone # �j S�� / Z J Contractor's Address _ ep / 3 eV Fy.4 ,V State , 1 Zip 3 3 ! L-S' Qualifier Name a S c A A_ /7 /2 AIX H L2 4 Z Phone # 3,9,5 1 9 .S/ /a /!1 Spate Certificate or Registration No. Certificate of Competency No. D 2 C ®® ® 6' 2 2- 4y R i t Phclne° E -mail g �k J lte' ngineer's Name (if applicable) Phone # J a Value of Work For this Permit $ $UV &quiiee / Linear Footage Of Work: 6 Fr Type of World ❑Addition nAlteration []New Repair/Replace Demolition Describe Word a f "� tA`o.CQ: ad r pyc.��kel� So 3 Submittal Fee Permit Fee $ 140� i ® g9 CCF $ CO /CC $ Notary $ Training/Education Fee $ Technology Fee $ Scanning $ Radon $ DPBR $ Bond $ Double Fee $ Violation date: II Structural Review. $ Total Fee Now Due $ i� See Reverse side �! l � Bonding Company's Name (if applicable) i v 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. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a re- inspection fee will be charged. O s Cyt 2 114FP- u /1N v KX��1 , Signature N� Signatu Owner or Agent Contractor The foregoing instrument was acknowledged before m�e this AL The fore ing instrument was ackno edged befo me thi el?o day of 20 dO , by ✓ (x day of 20 J&, by who is personally known tome or who as produced A4 tome or who has produced identification and who did take an oath. • ' $ntification and who did take an oath. NOTARY PUBLIC: , MIGWEL TOLEDO N TAR PUBLIC: ?;• ` tr ' Notary Public, State of Florida ;. Commission #DD778988 . Sign: ' My Commission Expires Apt t4,2012 Sign: Print: / �' Print: My Co n Expires: y bb 7" i My Commission Expu • `'�, C .oil 0 `(/p® / d- Jg rt rc1c ff" 801 oYdc4e4ed: sk�YdedeArdrdesYaz k9rk9e�k4ed:nY 8e8ede: k�Y9e9Y9i9e�Y�tr�Y :F�F�Y9F��k9:4e3c�tr8e�9e k9c9e3z4r3edr �c3e9z3e3e3e air�trkt�Yd: �e�Sr�ie* 9r�Ydc�Ydrs t9nY�: YaY�Y9F3r: Y�9r�Y9r�4c9nY�Yd z3e3r�tnY3e9c3c9z�Y�Y9e APPROVED A/� Plans Examiner zoning Engineer Clerk checked (Revised 07 /10 /07)(Revised 06/10/2009) 02 /04 /2010 TEU 14814 FAX 0003 /003 gm j - a ^r+e'.E V :•iS4:.:ti• A`J. ''• . ..: • .Ain•. Jn A`'{:J vA. 4:�`' ° • S}, \`�,, . < ' Y .`•, ►ssuEDATE 0 1/20/201 0 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND G. & E. GONZALEZ INSURANCE CONFERS NO RIGHTS UPON THE CE RTIFICATE HOLDER. THIS 9880 SOUTH WEST 40TH ST I AFFORDED 13Y THE POLICIES BELOW E ND ' OR ALTER THE COVERAGE MIAMI, FL 33165 ' COMPANIES AFFORDING COVERAGE COMPANY LETTER A Underwriters at Lloyd's, of London INSURED ' COMPANY RAVEN ELECTRIC, INC ; LETTER B COMPANY 3913 SOUTHWEST 90TH AVENUE LETTER C MIAMI, FL 33165 COMPANY j LETTER D ! COMPANY LETTER E - . .. .. ..: .•Ztn ... ., -" . . •:° ... , • .� •.:...3`.�:YO . A >y -` , ��x�3: c` k',Z'P- -°,•.Stt�y;:�:;yri^: <�.. THIS IS TO CERTIFY THAT THE POLICIES OF IN URANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HER EIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN RE UCED BY PAID CLAIMS. CO TYPE OF INSURANCE POLICY NUMBER POLICY POLICY LTR BFFEMWEDATE ECPMAYMOATE LIMITS GENERA(, LIABILITY A ARTE025255 September 9.2oos September 9, 2010 GSNERALAGGIEC,ATE $2 M0 000 PRODUCTS COM OPAGG. 7 000 000 PERSOML &AD V.INJURY 11000,W0 EACH OCCURRENOE t FIREDAMAGE onetime 50000 AUTOMOBILE LIABILITY E MED. EXPENSE Ww one son 5,000 j Coma E0 SINGLE LIMIT BODILY JURY ft Person i SWLYINJURY rAecid EXCESS LIABILITY PROPERINIJAMAGE EACH AGGREGATE WORKERS COMPENSATION AND STATUTORY LIMITS EMPLOYERS' LIABILI3Y EACH ACCIDENT { OIASE POLICY LIMIT I %SEEKM EMPLCYEE a I FOF S INSURANCE IS ISSUED PURSUANT TO THE FLORIDA SURPLUS LINES CAW. RSONS INSURED BY SURPLUS LINES ARRIERS DO NOT HAVE THE PROTECTION THE F LORIDA GUARANTY ACT TO TH EXTENT OF ANY RIGHT OF RECOVERY FOR THE OBLIGATION OF AN INSOLVE UNLICENSED INSURER. t I 3 DESCRIPTION OF OPERATIONS / VEHICLES/ SPECIALTy ITE S HI ELECTRICAL WORK WITN ILDINCGS S MIAMI SHORE Shauld any of the shave described poiloies be ca S VILLA ncelled before the ( expiratlan date, the company shall endeaval to mail 30 clays written BUILDING DEP m ! notice to the certlfioate holder named to the left, but failure to mail such 1 0050 NE 2 AVE natiae shall Impose na obligation ar Uabillty of any kind upon the compan Y. agents, o r represent s. MIAMI FT, 3 31 3!3 . AUTHOREDREPRESENTATNE i Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Expiration: 0810312010 Project Address Parcel Number Applicant 10626 10 Place 1122320280840 Miami Shores, FL Block: Lot: PARANDEH ALASHTI Owner Information Address Phone Cell PARANDEH ALASHTI 10666 NE 11 AVE (305)891 -0378 (305)962 -5330 MIAMI SHORES FL 33138 Contractor(s) Phone Cell Phone Valuation: $ 8 00.00 RA ELEC TRIC INC 305 -221 -33 Total Sq Feet: 50 Type of Work: REPLACE SWITCHES For Inspections please call: Additional Info: ELECTRICAL (305)762 -4949 Classification: Residential Available Inspections: Inspection Type: Fees Due Amount Invoice # Total Amt Paid Amt Due CCF $ EL -1 -10 -36868 $ 54.60 $ 54.60 $ 0.00 Education Surcharge $0.20 Permit Fee - Additions/Alterations $100.00 Scanning Fee $3.00 EL -2 -10 -36970 $ 100.00 $ 100.00 Submittal Fee $50.00 $ 0.00 Technology Fee $0.80 Total: $154.60 In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Futhermore, I authorize the above -named contractor to do the work stated February 04, 2010 Authorized Signature: Owner / Applicant / Contractor / Agent Date Building Department Copy February 04, 2010 Copy_ ___._ 1 - - - -- • - -- . . \LV iJ14.:1• IJWL.i♦ 11Yti t"HUC l7A TAX Cl:►ADR Cptl�l��'!f ' ', . • z'r. ` "`' !:(�Ca4'tFi19'IAIES8 TAX Rt;CI:1pP�T' .�� k '1 FIRST CLASS 1 w. E RE : �d... + py, != UNT>r'araTE �1?FI"Llpjpu= z sa ::^ n S. ppsTA 1 FkOO r;(fit S,13EPT.'3Q,'20aQ :• r..':F ° s' #' -•d, : a PAID :!I(il Mt 'Fk '+ ; ; •'M "Al LA j�D'AT W:l►CE Ol�'BI1$INF SIi'" 'w �3° • MIAMI 'FL ; :' � •. .»u.M�:fis:+du'o.:.YRffi4776tt•' A '' �irr�- S- • :: ' ; dv ..;aG�dJ: � . � .., :,.,i,�n+m�a�. " • ` : CHis I -NOT a sIL� — oo,tv PAY , RE NEWAl. t v I I:t3 ' t.: : ' R�CBIRTNO. ' 51,0406 -I AV1 EL CTRIC ' T.NC ' CC 02E00062Z 591 "SW 71. Avg .,. 4 . 341414•••MIAMI ; AWN �: : • ; , • .. ;• ... : RA EAI ;. Busi' :• WORKER /S- .''.,' :' •i96 L�EC ICAL' CONTRACT -OR 1 r yes O - DO NOT FORWARD �'� axn's•'R'° RAVEN ELECTRIC INC • � °igl o y AMY n'r�R +►c+t4tweo►Aw�*we+e : OSCAR HERNANDEZ PRES NOT A GERTWMI7" gp 5 91 5W 71 AVE MIAMI FL 33144 Xi 022304070 1;` j ii !! jj pp jj f( (i (( } ��] F +1 AOQ•0�45::,Q # „.••, J iil B ill 1 1 11 111ilijiil111 f 1111 :�, 11I1 y,.l$ky .. r.W..J iw •. ... • «..(. SEE OTHER 810E MIAMI COUNTY 2009 MUNICIPAL CONTRACTOR'S 2010 FIRST-CLASS TAX COLLECTOR TAX RECEIPT U.S. POSTAGE 140 W. FLAGLER ST. MIAMI.OADE COUNTY - STATE OF FLORIDA P A I D Mat FLOOR PURSUANT TO COUNTY CODE SEC. 10.24 MIAMI, PL 33130' EXPIRES SEPT. 30, 2010 PERMIT NO.231 aEaFrPr Na. 30- 5109061 CC I N OT A BILL 2E000622 Y BUSINESS NAME J LOCATION RECEIPT. MAY DO RAVEN ELECTRIC INC BUSINESS AS A CONTRACTOR S91 SW 71 AVE AS SPECIFIED HEREON. OWNER :RAVEN ELECTRIC INC : ELECTRICAL CONTRACTOR A LIST OF NON PARTICIPATING MUNICIPALITIES Recelo holder must DO NOT FORWARD reglsterintnecity RAVEN ELECTRIC INC w1 re Yro* is to be OSCAR HERNANDEZ PRES ` wia 591 5W 71 AVE MIAMI FL 33144 PAYNBN'r RBG81VQ6 ' M'ZR00070 9 OOO Z 00.00 25 ` i TE OF FLORIDA ^ DEPARTMENT OF FINANCIAL SERVICESm PDtVISION OF WORKERS' COMPENSATION STATE OF FLORIDA CONSTRUCTION INDUSTRY DE(%Rt2 MENT OF FINANCIAL SERVICES CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA DIVISION OF WORKERS' COMPENSATION WORKERS' COMPENSATION LAW CONSTRUCTION INDUSTRY .10 CERTI# t::ATE OF ELECTION TO BE EXEMPT FROM FLORIDA EFFECTIVE 08/12/2009 EXPIRATION DATE: 08/12/ WORKERS' COMPENSATION LAW PERSON: OSCAR HERNANDEZ EFFECTIVE: 08/12/2008 EXPIRATION DATE: 08/12/2011: FEIN. - 481261518 PERSON: OSCAR HERNANDEZ BUSINESS NAME AND ADDRESS: FEIN: 481261518 RA 'EN ELECTRIC INC BUSINESS NAME AND ADDRESS: 3913 SW BOTH AVE RAVEN ELECTRIC INC ' MIAMI, FL 33165 3913 SW 90TH AVE j f MIAMI, Fl 33165 SCOPE OF BUSINESS OR TRADE: I REGISTERED ELECTRICAL CONTRACT SCOPE OF BUSINESS OR TRADE 1- REGISTERED ELECTRICAL CONTRACT E CTQB Cwrstruction Trafti Quai"IV Board "BUSINESS CERTIFICATE ' �OFCOMPETENCY QUALIFYING TRADE .. VZEO!�+Z 0001 ELECTRICAL RAVEN ELECTRIC INC .. - D.B.A.: HioylezP.E. ` oR. - HER NDEZ OSCAR sememy of ft aoara s MWO - Dade caonr mt*m anpope" Heft Is ceffmd under the,provisions of Chapter 10 of Miaimi -Dade County IS 0 r. v Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FIL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 140495 Permit Number: EL-1 -10 -105 Scheduled Inspection Date: April 14, 2010 Permit Type: Electrical - Residential Inspector: Devaney, Michael Inspection Type: Final Owner: ALASHTI, PARANDEH Work Classification: Alteration Job Address: 10626 NE 10 Place Miami Shores, FL Phone Number (305)891 -0378 Parcel Number 1122320280840 Project: <NONE> Contractor: RAVEN ELECTRIC INC Phone: 305 - 221 -3339 Building Department Comments REPALCE SWITCHES TO 3 NOT 2.2 CAN LIGHTS HAT HIGH 1 WATER PROOF AND 1 NON WATER PROOF JUNCTION BOX Inspector Comments Passed Failed Correction ❑ Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. April 13, 2010 For Inspections please call: (305)762 -4949 Page 1.9 of 20 A �sv Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138 -0000 �,. ''� � p ✓��.s. ,tee_ E £k3 �� ���i M,£� Phone: (305)795 -2204 Y r Expiration: 0810312010 Project Address Parcel Number Applicant 10626 10 Place 1122320280840 Miami Shores, FL Block: Lot: PARANDEH ALASHTI Owner Information Address Phone Cell PARANDEH ALASHTI 10666 NE 11 AVE (305)891 -0378 (305)962 -5330 MIAMI SHORES FL 33138 Ma Contractor(s) Phone Cell Phone Valuation: $ 1,5 00.00 JB WATERWORKS CORP (305)766 -4306 Total 5q Feet: 120 Type of Work: MASTERBATH For Inspections please calk Type of Piping: (305)762 -4949 Additional Info: PLUMBING Available Inspections: Bond Return: Inspection Type: Classification: Residential Top Out Re Pipe Main Drain Heater Water Service Final Water Main Lavatory Underground Fees Due Amount Invoice # Total Amt Paid Amt Due CCF $1.20 PL -1 -10 -36869 $ 281.20 $ 50.00 Education Surcharge $0.40 �' Permit Fee - Additions/Alterations $5,00 PL - 1 - 10 - 36869 $ 281.20 $ 281.20 $ 0.00 Scanning Fee $3.00 Submittal Fee $50.00 Technology Fee $1.60 Total: $281.20 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. February 04, 2010 Authorized Signature: Owner / Applicant / Contractor I Agent Date Building Department Copy February 04, 2010 1 Miami Shores Village Building Department Jai 200 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 Permit No. FL 1� — 0 PERMIT APPLICATION master Permit No. �C, — ; FBC 20 Permit Type: PLUMBING �.; Owner's Name (Fee Simple Titleholder) aV Ae k '�• &Z /f hone # 3G; 9 s3_? Owner's Address l Cit (;� �y11 �i7� ha C State f- L Zip 3) 3 Tenant/Lessee Name Phone # Email Job Address (where the work is being done) _ 6 ( 1/t✓= j o � FL City Miami Shores Village County Miami -Dade Zip l 3 14 FOLIO / PARCEL # 0 pZ (� �Lt(3 Is Building Historically Designated YES NO Flood Zone Contractor's Company Name � , 13 V" �� 2- wU�� Phone # e3 6 `" 7 � 6 T a Contractor's Address /�J /,; ��( S City - State �� Zip 3 Z Qualif�NZ� J 1 /J State Certificate or Registration No. 6F 6 1 'f 2 7 0 - 9 © Certificate of Competency No. Contact Phone 3 (I ,S"- 7 6 6 3 1 4 E -mail Architect /Engineer's Name (if applicable) Phone It Value of Work For this Permit $ r %G o Square / Linear Footage Of Work: 1 ® S2 or)- t Type of Work: ❑ c Addition ❑Alteration ❑New ( Repair /Replace ❑ Demolition Describe Work: v r r Jko w++r'' P �, ( EE Rakh • f�061Co. TO "Id re V.0 a Submittal Fee $ Permit Fee $ ® CCF $ CO /CC $ Notary $ Training /Education Fee $ Technology Fee $ Scanning $ Radon $ DPBR $ Bond $ Double Fee $ Violation date: Structural Review. $ Total Fee Now Due $ See Reverse side -� Bonding Company's Name (if applicable) X rl 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. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature Signature Owner or Agent Contractor The foregoing instrument was acknowledged before me this 0 i The foregoing instrument was acknowledged before me this2—d) day of � , 20 Lo_, by _ lfie' 7l`ect4J day of:!� , 20 07 by "51 a D-R ' �'( who is personally known to me or who has produced .Z who is personally known to me or who has produced r.-L /� �1►1 + +)irur /� �{ As identification and who did take an oath. as identification artio 9i�61 oath. NOTARY PUBLIC: iv Sk 'CL i"7LECO NOTARY PUBLIC: 0 N 4;*. �Q °� '�•� ' 0 2 ` tr •..� Notary Public, State of Florida *° j I Q 14612 12 �OFFI�IAL w . EAL,ip Commission #DD778986 Si , n- __.� yr OFR My Commission Expires Apr 14, 2072 Sign: o Print: CC Print: ppi659 ® t...... �'O)F My Commission Expires: #6 A D 7 �CY My Commission Expires: � � Ft�`��� APPROVED BY / h Examiner Zoning Engineer Clerk checked (Revised 07 /10 /07)(Revised 06/10/2009) Frome Rene E. Samayoa Rooeptanoe Insurance Services 305- 740 -0518 Dates 1/21/2010 Times 05138 pm Pages 1 of 1 k. i°- CEPM F1 TE OF LIABILITY IN SUPANCE DATE 01/21110 PRODUCER Acceptance Insurance Services THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 6887 S.W. 40th St HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR Miami, FL 33155 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Phone (305)740 -0515 Fax (305)740 -0518 INSURERS AFFORDING COVERAGE NAIC# INSURED J.B. WATERWORKS CORP. INSURER A: AMERICAN VEHICLE INS. CO. 668 NE 161 ST INSURER B: INSURER C: MIAMI, FL 33162 INSURERD INSURER E: COVERAGES INSURER P THE POLICIES OF INSURANCE LISTED HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADVI. POLICY EFFECTIVE POLICY EXPIRATION LTR INSRD TYPE OF INSURANCE POLICY NUMBER DATE MMMO DATE offma" LIMITS GENERAL LIABILITY EACH OCCURRENCE 1,000,000 U COMMERCIAL GENERAL LIABILITY GL- 0510026820 -01 03/17/09 03/17/10 PREMISES Ea occurence 100,000 E10 CLAIMS MADE[/ OCCUR MED EXP (Any one person) 5,000 A C ❑ PERSONAL & ADV INJURY 1,000,000 ❑ GENERAL AGGREGATE 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG 2,000,000 Q POLICY ❑ PROJECT 7 LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT U ANYAUTO (En accident) ❑ ALL OWNED AUTOS BODILYINJURY L ❑ SCHEDULED AUTOS (Per person) ❑ HIRED AUTOS ❑ BODILY INJURY NON OWNED AUTOS (Per accident) n PROPERTY DAMAGE El (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT C L ANY AUTO OTHERTHAN EAACC ❑ AUTO ONLY: AGG EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE C ❑ OCCUR ❑ CLAIMS MADE AGGREGATE ❑ DEDUCTIBLE U RETENTION $ WORKERS COMPENSATION AND ] W,TPT-S D ER V EMPLOYERS LIAMLITY TO L M ANY PROPRIETOR / PARTNER / EXECUTIVE E.L. EACH ACCIDENT OFFICER I MEMBER EXCLUDED? It yes, describe under EL. DISEASE -EA EMPLOYEE SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT OTHER DESCRIPTION OF OPERATIONS/ LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS Electrical contractor Request policy for complete details on endorsements and exclusions. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL Miami Shores Village 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO Building Department THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY 10050 NE 2 Ave OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. Miami Shores, FL 33138 AUTHORIZED REPRESENTATIVE 305 - 756 -8972 ACORD 25 (2001108) OF V ACORD CORPORATION 1988 From: Rene E. Samayoa Acceptance Insurance Services 305 - 740 -0518 Dates 1/21i2010 Times 03:13 pm Page# 1 of 1 ACO�� DATE (MM /DD/YY) CERTIFICATE OF LIABILITY INSURANCE 01/21110 PRODUCER Acceptance Insurance Services THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION 6887 S.W. 40th St. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR Miami, FL $3155 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Phone (305)740 -0515 Fax (305)740 -0518 INSURERS AFFORDING COVERAGE NAIL # INSURED J.B. WATERWORKS CORP. INSURER A: AMERICAN VEHICLE INS. CO. 668 NE 161 ST INSURER B: INSURER C: MIAMI, FL 33162 INSURER D: INSURER E: COVERAGES INSURER F: THE POLICIES OF INSURANCE LISTED HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAUS. INGR ADD'L TYPE POLICY NUMBER POLICYEFFECMVE POLICYEXPRATION L7R INSRD DATE (MMM13frf) DATE (MMIDONY) LIMITS GENERAL LIABILITY EACH OCCURRENCE 1,000,000 0 COMMERCIAL GENERAL LIABILITY GL- 0510026820 -01 03/17/09 03/17110 PREMISE Ea RENT 100,000 OF] CLAIMISMADE - V OCCUR MED EXP (Any one person) 5,000 A C n PERSONAL& ADV INJURY 1,000,000 H GENERAL AGGREGATE 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS- COMPIOPAGG 2,000,000 ® POLICY ❑ PROJECT ❑ LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ❑ ANYAUTO (Ea accident) ❑ ALL OWNED AUTOS BODILY INJURY ❑ ❑ SCHEDULEDAUTOS (Per person) ❑ HIRED AUTOS ❑ BODILY NON OWNED AUTOS (Per accident) ❑ PROPERTY DAMAGE (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT F ❑ ANYAUTO OTHER THAN EAACC ❑ AUTO ONLY: AGG EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE C ❑ OCCUR ❑ CLAIMS MADE AGGREGATE ❑ DEDUCTIBLE LJ RETENTION $ WORKERS COMPENSATION AND ❑ WC STATU- ❑ 0 TH- EMPLOYERS' LIABILITY TORY LIMITS ER ANY PROPRIETOR/ PARTNER 1 EXECUTIVE E.L. EACH ACCIDENT OFFICER /MEMBER EXCLUDED? H yes, describe under E.L. DISEASE - EA EMPLOYEE SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT OTHER DESCRIPTION OF OPERATIONS LOCATIONS VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT !SPECIAL PROVISIONS Electrical contractor Request policy for complete details on endorsements and exclusions. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL Miami Shores Village 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO Building Department THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY 10050 NE 2 Ave OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. Miami Shores, FL 33138 AUTHORIZED REPRESENTATIVE � 305 -756 - 8972 ,— ACORD 25 (2001108) QF ®ACORD CORPORATION 1888 PLEASE CUT OUT THE CARD BELOW AAD RETAIN FOR FUTURE REFERENCE STATE OF FLORIDA IMPORTANT =DIVIS ON of WOR KERS! COMPENSATION aN � Pursuant to Chapter 440.05 {14 }, F.S., an officer of a corporation who CONSTRUCTION INDUSTRY elects exemption from this chapter by filing a certificate of election CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA I, under this section may not recover benefits or compensation under this WORKERS' COMPENSATION LAW 0 E) chapter. EFFECTIVE: 08/27/2008 EXPIRATION DATE: 08/27/2010 Pursuant to Chapter 440.05 {12 }, F.S., Certificates of election to be PERSON: JAKE A ROADWAY exempt.. apply only within the scope of the business or trade listed on FEIN: 204641735 I: the notice of election to be exempt 1< BUSINESS NAME AND ADDRESS: Pursuant to Chapter 440.05 {13), F.S., Notices of election to be exempt J.B. WATERWORKS CORP and certificates of election to be exempt shall be subject to revocation 668 NE 161ST STREET if, at any time after the filing of the notice or the issuance of the NORTH MIAMI, FL 33162 certificate, the person named on the notice or certificate no longer mee the requirements of this section for issuance of a certificate. The department 'shall revoke a certificate at any time for failure of the SCOPE OF BUSINESS OR TRADE: person named on the certificate to meet the requirements of this 1- CERTIFIED PLUMBING CONTRACTOR section. "• QUESTIONS? {850} 413-1609 CUT F �I_ Carry bottom portion on the job, k upper portion for your records. DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 09 -06 ;b r�.g r � s c C' DO NOT FORWARD _ JB WATERWORKS CORP JAKE BROADWAY PRES 668 NE 161 ST N MIAMI FL 33162 t yy{} yy gy gyt ggaa yy yy { } g}g ��� �;- "?� -= • tti��.i811� ° +tb 64t��f78 t�fli B/ 7tH 11f77719177.1511��31�i1iiY!# STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION' CONSTRUCTION INDUSTRY LICENSING BOARD (850). 487 ®1395 1940 NORTH MONROE STREET \� TALLAHASSEE FL 323990783 BOADWAY, JAKE AUSTIN JB WATERWORKS CORP 668 NE 161ST ST MIAMI FL 33162 -3662 ' 3 STATE OF FLOMDA AG# 39:6531 Congratulations! With this license you become one of the nearly one million DSPAATX9ft # BUSINESS - =AND Floridians licensed by the Department of Business and Professional Regulation. PgpggSSIaNAIr REGULiT.ICSN:- Our professionals and businesses range from architects to yacht brokers, from boxers to barbeque restaurants, and they keep Florida's economy strong. CFC142"7090 09J0.7/08 '08.80523:3 Every day we work to improve the way we do business in order to serve you better For information about our services,.please log. onto www.myfloridaiicense.conn. CERTIFIED: PIN' CONTRACTOR There you can find more information.about our divisions And the regulations that BOADWAY, :. dAgft -AUSTIN impact you, subscribe to department newsletters and learn more about the JB W 'T:ERWORiS CORD° Department's initiatives. Our mission at the Department is: License Efficiently, Regulate Fairly. We constantly strive to serve you better so that you can serve your customers. IS. CERTIFIED ,bay tii6 provis9.ons ct ch. 489 & Thank you for doing business in Florida, and congratulations on your new licensel rzpiration date: AUa- 3Z, ; 2.010 L08090160209 L. I Y\Vl 11 Z ' AC# S kT �'�L 7 D.A. DEPAR 8 t iFtt?`SSIONAAL REGULATION _ kY L CENS.ING.BOARD* Q# L080901002Oa SE "MENSE''NB2�'�' 09';:' :B$45334 T e' PLt7Ati COiac0 ti s x { ¢' +' Named belo�+r T$ 3`IF L 3' s, . Vii-der . the p bvl.s:.ons c} °Clxa r Expiration date: AVG :31 2 10 x i BOADWAY, JAKE AU8N �4 J& WATERWORKS* 668 .NE' 161ST. ST = MIAMI GHARLI CHARLES W. DRAGO GOE1NbR A${;2UIRtIY SECRETARY PL LAW PLAN OF SURVEY SCALE V 4, i - Ursa 7Z- bTt �' �dEs� WoO� �$.ut. j ♦ <Sl `� i I ce 7 _ . 0 - Yt 4 G°"`G- 0 kD "- 3 to 14 io xA;t 5 , 'V- � 6 R 0 r4 � 0 1 t A let - 14 23 { S @ Gout ReaF � ° ` E y �l N /� 9330 • �s� K ti o a. DtsrANr.� AfC „AAR CARS„ CONCRETE AriAM snn=rURE C —ovemm D U►IL w UNE CL -.cam CA- XVMUM RAO • - RW-J GKTCF WAY- Fw j;oulw 8m PEE O -OVB{ mmo VI A.._1 A7M MEM C.f —CHdRD DWAKVE P...PROP UNE CO 7E Nr —C F.ALFMHYDRAW UP- AnUJTYPOLE R -.RACM LLE «UMnYEA ff &..CMTRAA.AKME R-AADW K- ..PLANTER T TANGW CJl --QATC MMM II JOB :05 -6134 LOCATION SKETCH l idALE 2 ©6J dou w. ��� ��� � y I t • r LEGAL DESCRIMOF• lot 13,Block 5,XUM ORES ,according to the Plat thereof as recor- ded in Plat Book 47,Page 58 of the Public Records of Dade Couuty,Florida. GEIVERAI. N OTES 1) Off' IS SUBJECT TO OPINION OF TITLE. BygT Rig, W ANY. AFFECTINGi 2) EXAMMATION OF THE ABSTRACT OF TITLE WILL HAVE TO BE MADE TO DETEFdMVE RECORDED THIS PROPERTY. N/A DATUI L 3) ( ?..22 ) DENOTES THOSE ELEVATIONS ROERED TO 4) LOCATION AND IDENTMAIM OF UTEJTIES ON ANDIOR ADJACENT TO THE PROPERTY WERE NOT SECURED AS SUCH NATION WAS NOT REQUESTED AE S) THIS PROPERTY IS vWM THE LUMTS OF THE FLOOD ZONE 6) No UNDERGROUND LOCATIONS WERE DONE BY THIS COMPANY. CERTIFIED TB): - ,Home anc g cen er, nc • , e D e c A er 14,2005 Home Title Agency,Inc.,Fidelity National Title Insurance Comp• panadesh A. Alashti Ap .E ZOPUN% UNDERGROUND, ZONE AND IEi SET BA0M TRUST WCAD BY OWNER. ARcwmcT OR BUILDER BEFORE DELI aR CONSTrwcr" THE PROPERnr. i F�EBY c RTiF1P: Ti�at tlar aid PIS � �Y of � abosu �° � true W auai t w Y and platted undw m „ cm, ,wewn am 6 ncrwchm 9 n f x cam "M tttaw stwmL uN TIb sur%W Ow + :af surveyor pursuant to 61Gi744 FIorMa A*ddsbuMN Cam. !IT2-lCY; FIB stagy. w, SURVEYING. INC L.B. NO. 3333 t fi7.74tanso. Praassi+s t.d curve jor 6157 M 167 STREET, F15 Certiflcata Nb. 359Q; MIAMI. FLORIDA 33015 Stae.of Plorlda 305x512 -4940 THIS IS A BOUNDARY SURVEY ��vA �s - - • ... .w . aen nG•c► O=A9 r-n WaT14 AN EMBOSSED SUR E i OW SEAL s a Miami Shores Village � t10", 10050 N.E. 2nd Avenue � a Miami Shores, FL 33138-0000 Phone: (305)795 -2204 y r , Expiration: [ 3 Project Address Parcel Number Applicant 10626 10 Place 1122320280840 Miami Shores, FL Block: Lot: PARANDEH ALASHTI Owner Information Address Phone Cell PARANDEH ALASHTI 10666 NE 11 AVE (305)891 -0378 (305)962 -5330 MIAMI SHORES FL 33138 Contractor(s) Phone Cell Phone Valuation: $ 8,0 CF CON AND REMODELIP Total Sq Feet: 300 Approved: In Review For Inspections please call: Comments: (305)762 -4949 Date Approved:: In Review Available Inspections: Date Denied: Inspection Type: Type of Construction: KITCHEN REMODEL Occupancy: Single Family Drywall Stories: Exterior: Final Front Setback: Rear Setback: Framing Left Setback: Right Setback: Insulation Bedrooms: Bathrooms: Plans Submitted: Certificate Status: Certificate Date: Additional Info: Bond Return: Classification: Residential Fees Due Amount Invoice # Total Amt Paid Amt Due CCF $4.80 RC -1 -10 -36851 $ 264.80 $ 50.00 DBPR Surcharge $1.50 Education Surcharge $1 RC -1 -10 -36851 $ 264.80 $ 264.80 $ 0.00 Permit Fee - Additions/Alterations $240.00 Radon Surcharge $1.50 Scanning Fee $9.00 Submittal Fee $50.00 Submittal Reversal Fee ($50.00) Technology Fee $8.40 Total: $264.80 In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Futhermore, I authorize the above -named contractor to do the work stated February 04, 2010 Authorized Signature: Owner / Applicant / Contractor / Agent Date Building Department Copy February 04, 2010 1 s Miami Shores Village JAN 2.0 2010 Building Department 10050 N.E1nd Avenue, Miami Shores, Florida 3313$ Tel: (305) 795.2204 Fax: (305) 756.8972 BUILDING Permit No. _ PERMIT APPLICATION Master Permit No. FBC 2004 Permit Type (circle): Building Roofing p Owner's Name (Fee Simple Titleholder) PA AN "PeR A X _ f1 Phone # Owner's Address (Wo 2-(. tj 0� I'D IN. City 1% Or M! 6 _ State zip 3 '° Z Tenant/Lessee Name : Phone # Job Address (where the work is being done) l�j tr tA3, Pi.. City Miami Shores Village _ County Miami -Dade zip 3:5 i 3 k FOLIO / PARCEL # j - Z.Z»3 Z.°' ,0Z9- ®,8 q 0 Is Building Historically Designated YES Contractor's Company Name C-iF Co X`5: 4?-t C7i 00 kOD Phofie # 7 66 - Z..3 i " - 7 c ?O Contractor's Address 3 - 5 - -3 Z g l '1 3 C - 7 - City oK M A-t : state r . zip 3 :� 1 Qualifier Name C-L-A 0 D .P VCOd� A-N D C'_-- Phone # 7 9; 4 2. 1 s - - 7 9 o Swe.Cg,et fil Bate or P,,egistration No ifC C S ° Z Ao S f Certificate of Competency No. ' � T Architect/Engineer's Name (if applicable) Phone # Value of Work For this Permit $ Z Square ! Linear Footage Of Work: 3O O 80 00-0-%(Q -0, Type of Work: ❑Addition `' []Alteration:' []New Repair/Replace F1 Demolition Describe Work ' 9 Zk e.�� T�� AJ 0 F ( l� l'''i'U's e$-. p t i .�® ice K--* ®� k s� G f G �`�al� Q �a cam% ® IP✓� 1' DPJra� a6ty G e-A) oil; �,an. L4`►4 0 __ d ` Submittal Fee $ Permit Fee $ o CCF $ 4 CO /C Notary $ Training/Education Fee $ Technology Fee $ Scanning $ Radon $ DPBR $ Zoning $ Bond $ Code Enforcement $ Double Fee $ Structural Review. $ Total Fee Now Due $ See Reverse side r Bonding Company's Name (if applicable) A Bonding Company's Address City State Zip Mortgage J,.wder's- NameXif applicable) Mortgage Lender's Address a +' 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 $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged // Signature Y Signature Owner or Agent Contractor The foregoing instrument was acknowledged before me this O f The foregoing instrument was acknowledged before me this / day of ! q , 2010 , by AAJ Ae�h& „�44r i¢/�f 'day of , 204 by who is personally known to me or who has produced who is personally known to me or who has produced At- identification and who did take an oath. �/� Z' as identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Y MIGUEL TOLEDO Notary Public, State of Flo Sign: v r \ Print: ; seu 7: Commission #rffl ��7 l /OI�GCU Y ommissionUpiresApr Ott Print: g My Commission Expires: Af- b �. Gam: y Commission Exp u„„ �rtr *A * it �r�r fraY,x *,Pr Ur,tA &8t t aisYtati �itrt9rSrarar & srsY& sr�irw� te t8raY444!¢ ait kt RaeQesY,t$eo� 4rft r$ter APPLICATION APPROVED BY: Plans Examiner Engineer Zoning (Revised 07110107) ire r (Ze- - 6kxcQck \AeAr (A"A NOTICE O COMtNEA10EMElVT F '�''�'�''- AR E� �.4 BE Ek 271 F's X {1, } POSTED ON � JOB SnE AT T�1E OF FlRS"!' IIdS�TNDN RECORDED �:J� ��l�a1.13 15:11:00 HARVEY Rump* CLERK 01 COURT PERMIT tiTAKI - DADS CoofltY, FLtlRI A TAX FOLIO NO. I1 -- Z.: (� ljt AST PAGE STATE O• FLORIDA: COUNftiOF MIAMI -DADE. THE UN RSIGNED hereby gives notim that improvements will be made to Main read pr , in accordance with Chapter 713, Florida Statutes, the fdloWng inforrrrattion Is prov in this Nopoe of Commencanent. N tv 1 • Lj Ption of property and steed ! address: IrV trsc, -e x• ption Improvement: 31 s) time ari address: N k ,9 +� S I to propertjr: address of shple tlttehdder: 4• of . pam and • (Payment 1 HEREBY R_TIF that ! ��v co � requl d by owner from actor, w any) ® fnal fi din ua� ofiu�a an da �� "`R` N e and Address: N of bond $ rn+r SS oy nand �r S. s name sr>d address: HARVEY RLIVl Ci u and County courts �� ® W2 MUR � 7. Puns wdtwn the state of Florid designated by Owrw ulm whin noticer . or other ants Pr9+ided by Section 713.13(9xa }7., Florida Stakes. maybe served as Names and Address: 8. In n 793.to himw,.Ow ws designates the fdbwing persan(s) to r+ecelve a dopy of the Lleno s Nattoe as providded In = 13(1Kb), Florida Statutes. 1 . Nano and Addrm: g• $� this r of Crome anent: (the e� m*m date Is t year from► the data of ring ur dess a S� of Owner i'firrt Opher`s Na m �'�;� Q�� Prepared by / wt �tt swam 1 subscribed beftme me 0s d ( day of 20 . Nary Addis: Prim Notary's Nam r .P I My mvimission s-- MIGUEL TOLEDO (Votary Public, State of Rcwida + L Commission #0077sM nova Mr COM"'138100 EXAIMS Aar 14. 2017 rAx I- o Miami shores Village ,,,, Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 R Tel: (305) 795.2204 Fax: (305) 756.8972 Permit No: 10- Job Name Page 1 of 1 Building Critique Sheet QQ 4FCLb, l C loC21L en/ z--L1,e Xos. nL L , Plan review is not complete, when all items above are corrected, we will do a complete plan review. If any sheets are voided, remove them from the plans and replace with new revised sheets and include one set of voided sheets in the re- submittal drawings. Norman Bruhn CBO 305 - 795 -2204 jj E P I I OU wo CA A vi JN r I , �►�) _ ..:.. Fbo ocr -to li I t� 2, R \�.�. ►-e � ear F i 106116 m k %ot ` PL- FbR Sv�f�>r r�,�� Co%J I venlf S ll NAV GI _ _ a_. �........ k °� 3 ht�r t� FAN C COYLG , \Nr°►1.1. If RAM%w �N S C 1 2--rlL- PT A wtm.)... Am P�Lx I� lit f l c' ( i3 iA) ceaz Iry . Z.y- v \ 10616 Nlk mvO� fL M i Gn%�y S4,�s 3bi`4 m + 01 A Irq L A � Fl, A PQ•r /MokCA Or IMfm sV\-. s w 4 x 1 5) N F9 ,i tc�626 AJ� t�t�, P L Gtr Zia ss Ic. f5�xt SAP } i PT .� . 5 C5 2fe C Fh 12°• 2w,r�a. cal G c�k�c� t- ,L--� S� , Door, x ISA r -, w4Q4f } s am z !, s I CA,p G� kiag l 1 PERMIT m MIAMI SHORES VILLAGE APPROVED BY DATE ZONING STRUCTURAL ELECTRICAL SAX- PLUMBING � to � 1 MECHANICAL SUBJECT TO COMPLIANCE WITH ALL rrt,?ERAI- STATE AND COUNTY RULES AND RM !LAl;(. -;, : t ACV W AT p y 4 01/19/2010 00:03 3052671576 SAFE INS PACE 01x'01 CERTIF OF LIABILITY INSU RANCE DA ii19/201 D 0 PRODUCER Phone THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION SAFE INSURANCE INC. 305.264.8964 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 7901 NW 2 ST HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR MIAMI, FL,. 33128 Fax ALTER THE COVERAGE AFFORDED BY THE POLIGIES BELOW. 305.267 -1576 INSURERS AFFORDING COVERAGE NAIC # INSURED IN&URERA$UA INSURA COMPANY CF CONSTRUCTION AND REMODELING INC INSURERS!'ROGRESSIVE� 3532 SW 113 CT INSURER 0: MIAMI, FL 33165 IN$URSR b; INBURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEE 4 ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CC 4TRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POI :CIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMIT SHOWN MAY HAVE SEE? REDUCED BY PAID CLAIMS. IN9R PquCY EPFECTNE i POW BXPIRATION QE IN01 So= P6 JOY NUMBER LIMITS A GENERAL LIABILITY IOAUTA01 13853 -02 2/14/2009 2/14/2010 EACH OCCURRENCE S 1,000,000 X COMMERGALGENERAL LIABILITY PREMIS S Ee oa VMP S 100,000 X CLAIMS MADE 7 OCCUR MED EXP (Any orre Peron) 5 51000 PERSONAL & ADV INJURY S 1,000,000 MENF-AAL AGGREGATE S 2 1000,000 GERL AWREGATE LIMIT APPLIES PER: PRODUCTS - OOMP/OP AGG S 2000000 POWOY I PR4f Loa AUTOMOWLS LIABILITY 465226191 7/25/2009 7/25/2010 13 ANY AUTO (MA a lao S INGLE LIM1T X ALL OWNED AUTOS BODILY INJURY S M_ 1001000 SCHEDULED AUTOS (Par parson} X HIREDAUTpB aDMILY INJURY i$ 300 X NON -OWNED AUTOS IPdI 9CCt09nt} -- — PROFRRTY DAMAGE S 50 , 000 1 ( ?M aEGldeny i GARAGE LIABILITY AUTO ONLY - EA ACCIDENT a ANYAUTO OTHER THAN E4 A C S AUTO ONLY. app 5 LESS r UMBRELLA UA21LITY EACH OCCURRENCE 3 OCCUR OLAIMSMADE AGGREGATE s s ' DEDUCTIBLE .. S ' RETENTION S $ WORKERS COMPENSATION WC 5 107 - O AND EMPLOYERS` LIABILITY : ;Y LIMITS DER- ANY PROPRtETORA- ARYNMrXECUTIVE E.L EACH ACCIDENT S OFFICERIMEMDER EXCLUDED? (mmmWory In NH) 9.L DISEASE- FA EMPLOYEE 8 ityyoocc daawbo under SPEG FRCMam $ twom E.L. DISEASE. POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES ? EXCLUSIO S ADDED BY ENDORSEMENT / SPECIAL I mmrtONs SUBJECT TO POLICY FORM, CONDITIONS, ENDC RSEMI:NTS, LIMITATIONS AND EXCLUSIONS PREMISES General Contractor Form CERTIFICATE HOLDER CANCELLATION SHOULD ANYOP THS ABOVE DESCRIBED POLICIES BE OANCELLE0e6FORE THE EXPIRATION CITY OF MIAMI SHORES DATE THEREOP, THE ISSUING INSURER VILL ENDEAVOR TO MAR 10 DAYS WRITTEN 10050 N. E , 2ND AVENUE NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FALL.URE TO OS =.4 MHALL MIAMI $H ORES,FLORIDA 33138 IMPOSE NO OMLIGATION OR LJABILnYOF ANY KIND UPON THE INSURER, ITS AGENTS OR FAX: 305 - 758.8972 REPRESENTATIVES, AWHORIMP REPRESENTATIVE ACORD ZS (2008101) 9 10 0 TKO r g reserved. The AC, KRD name and logo are ragista of ACORD