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FW-10-1316BUILDING PERMIT APPLICATION FBC 20 Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 JOB ADDRESS: VC' 'V E . 91 ' ( e City: Miami Shores County: Miami Dade F o l i o / P a r c e l # : l % 32-6 - b S O 2 3c Is the Building Historically Designated: Yes NO t/ � JUL pammns5 gA 1 2 BY. pennitN;Fv\J 10—)au Master Permit No. Permit Type: BUILDING OWNER: Name (Fee Simple Titleholder): A l-� �C _ c l Phone#: - 73 Z ° g 2 -?- S (b �s Address: t It rL $ . , C I I Sr City: I ( ika4 r 'mil ® IfPC .1% 'State: Zip: 3 3'1 ' Tenant/Lessee Name: Phone# Email: Zip l � Flood Zone: CONTRACTOR: Company Name: J 4 C/e-a 4T pAi e P Phone#: 0 f S 2S 3 a (9.... Address: 3`7 At p, S ca Cit M I i L 4-k State: Zip 3 TO I lo Qualifier Name: R..._ Pia rQ P hone#: 3 B S S ~ �2 -� � p $ State Certification or Registration #: (1 C. 0 ( 7p 0 1 Certificate of Competency #: Contact Phone##: Email Address: DESIGNER: - Architect/Engineer: phone#: Value of Work for this Permit: $ t � 9 a 00 Square/Linear Footage of Work: 7 1-4:: Type of Work: ®Address ®Alteration ONew ORepair/Replace ❑Denmolititfn Description of Work: ®p COLOR THROUGH ROOF TILE IS REQUIRED acknowledged by: *********** ** * * * * * * * * * **** ** ** **R * * * * **Fa***** * * * * * * * **tr**** ********* * ****** 1***** * ** Submittal Fee $ Permit Fee $ �a3" CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ 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 wor 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 F,T.F,CTRJCAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, BEATERS, TANKS and AIR CONDITIONERS, ETC OWN'ER'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 promise in good faith that a copy of the notice of commencement and construction lien law brochure will be deliveredtothe 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 e , , h inspection will not be approved and a reinspection fee will be charged — pflsted notice, the 4110 /:4 P MIW Print: My Commission Expires: APPROVED BY Structural Review (Revised 07 /10107)(Revised 06 /10/2009XRevised 3 /15 /09)(rev6 14/10) Signatur Owner or Agent The foregoing instrument was acknowledged before me this /C The forego instrument was acknow day of J (( ' 20 ta, by At so v, Sco ` , day of who is personally known to me or who has ced /` 1 �e prodU fa who is � ell4NY 11 A+ 2 A As identification and who did take an oath. NOTARY PUBLIC: 20 D, by Contractor me or who has produced before me this ! 1 wit '.:) .e as identification and who did take an oath. NOTARY P ; LIC: Sign: Print: My Commission Expires: usSEr E B. MARTINEZMOLES i - OMMISSION #0D598171 111. �" *'4` ' SEP 24, 2010 * * * **** * * ** * * * * * * * * * •* * * * *6** * ** ***** 1 **************** * * * * * * * * * * * * * ** * * * * * * * * * * * * * - ** *fit * * * * * * * * * * * * * * * * * * ** ** Plans Examiner 7 iy% zonin Clerk Address of Licensee: Miami Lakes 15700 NW 67th Avenue #101 Miami Lakes, FL 33014 (305) 8274015 JEDA CONSTRUCTION GROUP, LLC 8370 NW 159 TER Miami Lakes, FL 33016 License Categories: Contractor - General HOME OFFICE LATE FEE:d r $4.50 LICENSE NO. 2010 -3291 TOTAL FEE PAID: $34.50 11/18/2009 Date of Issue cu Laura Hernandez Certified Licensing Official Miami Lakes This License MUST BE DISPLAYED IN A CONSPICUOUS PLACE IN YOUR BUSINESS ESTABLISHMENT. The Town of Miami Lakes must be notified of any changes of use, address or ownership. This License is not transferable and is subject to revocation. This License must be renewed on or before September 30 of each year. License Effective: From: 10/1/2009 To: 9/30/2010 Licensees: Rafael Padron, Jr. Town Of Miami Lakes Business Tax Receipt (305) 525-3054 (Town Sean $30.00 THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY 'ERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THW CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO AU. THE TERMS, E)OCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSK LTR ADD'L INSRE TYPE OF INSURANCE POUCY NUMBER DA TE ( YY DA TE(MAMIDDIYY)N LIMITS A X GENERAL X UABIUTY TY COMMERCIAL GENERAL UABILITY 04GL000772785 10/28/09 10/28/10 SACH OCCURRENCE $ 1000000 JA MACit 1 V NtN 1 tU 'REMISES(Eaoccurerroe) $100000 CLAIMS MADE X OCCUR IED EXP (My one person) $ Excluded INSURER E: ' ERSONAL & ADV INJURY $ 1000000 3ENERALAGGREGATE $ 2000000 GENT. AGGREGATE LIMIT APPLIES PER: 'RODUCTS - COMP/DP AGO $ 2000000 POUCY JECT fl LOC $mp Ben. 0 AUTOMOBILE UABIUTY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON-OWNED AUTOS 'OMBINED SINGLE LIMIT Ea accident) $ ?cDILY INJURY Per person) S 30DILY INJURY Per accident) S PROPERTY DAMAGE Per accident) $ GARAGE UABIUTY ANY AUTO 4UTO ONLY - EA ACCIDENT $ DTHER THAN EA ACC $ WTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE S OCCUR ( , CLAIMS MADE DEDUCTIBLE RETENTION $ AGGREGATE S $ S S WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? If yes, desaibe under SPECIAL PROVISIONS below WC STATU- R TORY LIMITS E ER -L EACH ACCIDENT $ E.L DISEASE - EA EMPLOYEE $ IL DISEASE - POUCY UMIT $ OTHER DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT 1 SPECIAL PROVISIONS General Contractor - Certificate holder is listed as an additional nsured with respect to the general liability policy. Coverages are subject to the terms, conditions and exclusions shown in the policies. ACORD CERTIFICATE OF LIABILITY INSURANCE OP ID KA JEDALLC DATE(MM/DD/WYY) 07/21/10 PRODUCER Insurance Marketers, Inc. 2600 Douglas Road Suite 712 Coral Gables FL 33134 Phone: 305 - 442 - 9507 Fax: 305 - 447 - 8527 THIS CERTIFICATE IS ISSUED ONLY AND CONFERS NO HOLDER. THIS CERTIFICATE ALTER THE COVERAGE AFFORDED AS A MATTER OF INFORMATIOtt RIGHTS UPON THE CERTIFICATE DOES NOT AMEND, EXTEND OR BY THE POLICIES BELOW INSURERS AFFORDING COVERAGE NAIC # INSURED JEDA CONSTRUCTIO GROUP, LLC 870 NW 159th Miami Lakes FL 33016 INSURER k Mid - Continent Caeaalty Company 23418 INSURER B: INSURER C: INSURER D: INSURER E: COVERAGES ACORD 25 (2001108) 1D --131 CERTIFICATE HOLDER MIAMI SHORES VILLAGE 10050 NE 2ND AVE MIAMI SHORES FL 33138 MLAMISV CANCELLATION REPRESENTATIVES. RESENTATIVE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LUABIUTY OF ANY KIND UPON THE INSURER, ITS AGENTS OR © ACORD CORPORATION 1 ALEX SINK STATE OF FLORIDA CHIEF FINANCIAL OFFICER DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION * * CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW * * CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workars' Compensation law. EFFECTIVE DATE: 08/12/2008 EXPIRATION DATE: 08/12/2010 PERSON: FEIN: PADRON 030451676 BUSINESS NAME AND ADDRESS: JEDA LLC 8370 NW 159TH TERR HIALEAH FL 33016 SCOPES OF BUSINESS OR TRADE: 1- CERTIFIED BUILDING CONTRACTOR IMPORTANT: Pursuant to Chapter 440 . 05(14), F.S., an officer of a corporation who elects exemption from this chapter by filing a certificate of election under this section may not recover benefits or compensation under this chapter. Pursuant to Chapter 440.05112), F.S., Certificates of election to be exempt... apply only within the scope of the business or trade listed on the notice of election to be exempt. Pursuant to Chapter 440.05113), F.S., Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation if, at any time after the filing of the notice or the issuance of the certificate, the person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate. The department shall revoke a certllic Ile at any time for failure of the person named on the certificate to meet the requirements of this section. OWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 09 -06 PLEASE CUT OUT THE CARD BELOW AND RETAIN FOR FUTURE STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION CONSTRUCTION INDUSTRY CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW EFFECTIVE: 08/12/2008 EXPIRATION DATE: 08/12/2010 PERSON: RAFAEL L PADRON FEIN: 030451676 BUSINESS NAME AND ADDRESS: RDA LLC 8370 NW 159TH TERR HIALEAH, FL 33016 SCOPE OF BUSINESS OR TRADE: 1- CERTIFIED BUILDING CONTRACTOR )WC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 09 -06 RAFAEL L CUT HERE IM I 0 Pursuant to Chapter 440.05(14), elects exemption from this cha L under this section may not recc D chapter. Pursuant to Chapter 440.05(12), H exempt.. apply only within the E the notice of election to be ex R E Pursuant to Chapter 440.05(13), and certificates of election to k if, at any time after the filing certificate, the person named or the requirements of this sectior department shall revoke a certif person named on the certificate section. 02 -03 -2009 REFERENCE * Carry bottom portion on the job, keep upper portion for your records. QUESTIONS? (850) 413 -1609 ORTANT F.S., an officer of a corporation who I ter by filing a certificate of election ver benefits or compensation under this F.S., Certificates of election to be cope of the business or trade listed on mpt. F.S., Notices of election to be exempt e exempt shall be subject to revocation of the notice or the issuance of the the notice or certificate no longer meets for issuance of a certificate. The icate at any time for failure of the to meet the requirements of this QUESTIONS? (850) 413 -1609 AC# 01/21/2010 DATE BATCH NUMBER STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD SEQ #1.1001210148: LICENSE NBR 097034663 CBCO57001 The BUILDING CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2010 PADRON, RAFAEL JEDA CONSTRUCTION GROUP LLC 8370 NW 159 TERR MIAMI LAKES FL 33016 CHARLIE CRIST GOVERNOR vc i'-% .ri nt1<t DISPLAY AS REQUIRED BY LAW CHARLIE INTERIM SECRETARY Planning and Zoning Criteria Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Fax: (305)756 -8972 Owner's Name: ALYSON SCOTT! Job Address: 803 91 Terrace Miami Shores, FL 33138- Planning and Zoning Criteria and Comments Approved: Yes Date Approved: 7/19/2010 : Yes Comments: Expires:Not Issued Folio Number:1132060050230 Owner's Phone: (305)751 -0714 Total Square Feet: 72 Total Job Valuation: $ 1,820.00 1 Contractor(s) Phone Primary Contractor • n- • • OAP .. • 2050' 25. 25.00 14.50' 1\ OT- 14 BLOCK- 2 4 140.00' Pia • . f 2130" 140.00' Pet81 LOT - 16 BLOCK - 2 79.70' APPROVED ZONING DEPT BLDG DEPT 72.40' Vi at 5 i Bat -x- • 0 v N 0 W 1.30' Miami Shores Village DATE ST AND CC.UN.Y RULES AND REGULATIONS Inspection Number: INSP - 149587 Permit Number: FW -7 -10 -1316 Scheduled Inspection Date: August 04, 2010 Inspector: Bruhn, Norman Owner: SCOTT!, ALYSON Job Address: 803 NE 91 Terrace Project: <NONE> Contractor: JEDA CONSTRUCTION GROUP LLC Building Department Comments shadow box wood fence ontalled on the sides of the property. Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments CREATED AS REINSPECTION FOR INSP- 148885. Fence must be nailed to post. Fence must not utilize neighbor post. NB August 03, 2010 Miami Shores, FL 33138- Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 For Inspections please call: (305)762 -4949 Permit Type: Fence/Wall Inspection Type: Final Work Classification: Wood Fence Phone Number (305)751 -0714 Parcel Number 1132060050230 Phone: (305)525 -3054 Page 12 of 26