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RC-10-350BUILDING PERMIT APPLICATION FBC 2004 Permit Type (circle): Owner's Name (Fee Simple Titleholder) Owner's Address 7 ��.J / ( F City i M . • State FL. Tenant/Lessee Name e'" Job Address (where the work is being done) 733O / la hofQ City Miami Shores Villa a County / ` Miami -Dade Zip FOLIO / PARCEL # I I 3 b5 - obi - - 0 !fro Is Building Historically Designated YES NO Contractor's Company Name 3.,JV\ef Phone # Contractor's Address City Qualifier Name Phone # Value of Work For this Permit $ Type of Work: ❑Addition L f , dAl era Describe Work: uQ 6e +� W ( y(, iQ lac -�t l e. !6h 7 A rw ( • Submittal Fee Notary $ Scanning $ Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 L 4 coo State Permit Fee $ Roofing Vc,\Ne. Training/Education Fee $ Radon $ 0 ' 35 DPBR $ Bond $ Code Enforcement $ 1 Zip trru- Phone # vakm c ,L 3 - „A ) tNi)vyc)vi,/ o l e .id c2 ora [) 20 BY: . Permit No. i Master Permit No. Phone # 1 - 1 - 7.4 • Zip State Certificate or Registration No. Certificate of Competency No. Architect/Engineer's Name (if applicable) Phone # Square / Linear Footage Of Work: New ❑ Repair/Repl �o P ce ❑ Demolitio MOV (b Q� +o i (e CCF $ 0 WO CO /CC Technology Fee $ Zoning $ Double Fee $ IRO t■ Structural Review. $ Total Fee Now Due $ )2 0 See Reverse side —> 140 _ 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. 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 a d a - inspec fee will be charged. Signature (Revised 07/10/07) Owner or Agent The foregoing instrument was acknowledged before me this LS day of rtle. ,20 1O,by ‘4 n MI iclt who is personally known to me or who has produced As identification and who did take an oath. NOTARY PUBLIC: PIERRE ALFRED DESROCHES �p Pu B�i ( N otary Public - State of Florida Sign: ID�tA.. I/ `I l c • My Commievior Evpirec.Jrrn 9, 2012 Sign: Print: ie.ni. t'I l Q� Oe, i vt "_- oo- Commission # DD 796200 Print: J1 „n • ' Bonded Tfivuyli Ulundi Nutary Assn. i M y Commission Expires: A I Olt ' My Commission Expires: APPLICATION APPROVED BY: Plans Examiner Engineer Zoning Signature Contractor The foregoing instrument was acknowledged before me this day of ,20,by who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: NOTICE OF COMMENCEMENT A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME � OF n FIIRST INSPECTION PERMIT NO. 1. -(6-3E6 TAX FOLIO NO. ` l' alOS-004 - M O STATE OF FLORIDA: COUNTY OF MIAMI -DADE: THE UNDERSIGNED hereby gives notice that Improvements will be made to certain real property, and in accordance with Chapter 713, Florida Statutes, the following information is provided In this Notice of Commencement. 1 . Legal description o f property and s t r e e t / a d d r e s s : C ) NE E L — A e 1avA I Alas - 33 3t 2. Description of improvement: Rao i.. 1r �k Interest in property: Name and address of fee simple titleholder. Q'N t as cp �oQv2 4. Contractor's name and address: 5. Surety: (Payment bond required by owner from contractor, If any) Name and address: Amount of bond $ 6. Lender's name and address: 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(1Xa)7., Florida Statutes, Name and address: 8. In addition to himself, Owners designates the following person(s) to receive a copy of the Uenor's Notice as provided in Section 713.13(1)0), Florida Statutes. Name and address: 9. Expiration date of this Notice of Commencement (the expiration date is 1 year from the date of recording unless a differ d e cified) Sig ture o Owner d'&Y\¼ Prin Owner's Name 3 V \i ^Q [.\ me this ` day of 1C - d e .a. Swom to and subscribed before 1, Notary Public . � . A Print Notary's Name My commission expires: 123.01 -52 PAGE 4 8/022 CFN 2010R021331.3 OR Bk 27233 Ps 1356; tlmask RECORDED 03/31/2010 09:29 =01 HARVEY RUVIN+ CLERK OF COURT i9IAl9I -DARE COUNTY, FLORIDA LAST PACE 0 STATE OF FLORIDA, COUNTY OF DADE I HEREBY CERTIFY that this is a tnt y of the ong�nal bled ►n this office on . day of t4 .AD20 to WITNESS my hand and (Waal Seal. HAR RUVIN CLERK. of Carat and County Courts Sy o'- �'(`t"►9Q 4V2 %4+ D.C. i� II rees uue CCF DBPR Surcharge Education Surcharge Notary Fee Permit Fee - Additions/Alterations Radon Surcharge Scanning Ege Submittal# e Submittal :Reversal Fee TechnologyFee Work without Permit Fee Total: Finance Copy Crl March 31, 2010 Fees Due CCF DBPR Surcharge Education Surcharge Permit Fee - Additions/Alterations Radon Surcharge Scanning Fee Technolo y Fee Work vAthbt±t Permit Fee Total: Amount $1.20 $0.35 $0.40 0225.00 $0.35 $3.00 $1.60 $225.00 $456.90 Finance Copy r...l March 31, 2010 Permit Fee - Additions/Alterations Radon Surcharge Scanning Fee Technoloc,Fee Work withornat Permit Fee Total: !. 1;'1 CD CD CD 4..^j Amount $0.60 $0.35 $0.20 $5.00 $180.00 $0.35 $3.00 $50.00 ($50.00) $0.80 $180.00 $370.30 $455.30 Pay Date Invoice # 03/31/2010 03/08/2010 $22(.00 $3.00 $0.80 $225.00 Pay Date Pay Type Amt Paid Amt Due Invoice # PL -3-10 -37393 03/31/2010 Credit Card $ 456.90 $ 0.00 Pi 10 Pay Type Amt Paid Amt Due RC -3-10 -37214 Credit Card $ 320.30 $ 50.00 Credit Card $ 50.00 $ 0.00 E\1O 0 - 3so NOTICE: In addition to the requin additional restrictions applicable to t public records of this county. AND THERE MAY BE ADDITIONAL GOVERNMENTAL ENTITIES SU' DISTRICTS, STATE AGENCIES, OR ) NOTICE: In addition to the requirem6 additional restrictions applicable to this public records of this county. AND THERE MAY BE ADDITIONAL P GOVERNMENTAL ENTITIES SW/ DISTRICTS, STATE AGENCIES, OR Ceiling Grid Fill Cells Columns Declaration of Use MIAMI SHORES VILLAGE 10050 NE 2ND AVE MIAMI SHORES, FL 33138 (305) 795 -2209 Sale MID: 542929800429 TID: 237828 03/31/10 Batch t:,.37 10:09:17 MASTERCARD 5491231887641437 Ear. 84/12 RoPr Code; 13181P 1nvi; 888884 Total. 41232,58 I agree to Pav above total amount according to card issuer agreement (Merchant agreement if credit voucher) APPR ED 03180P MI CHELL/JOHN R Merchant COPY THANK YOU! MIAMI SHORES VILLAGE EEC 03-3 - 2 0 10 E19o57 G07 MMC801 063939 1 BLDG. PERMIT $456.90 1 BLDG. ,EMIT $455,.3 1 BLDG. PERMIT $320.30 TL 2.- -50 e i ChARCE $11232.50 ,R IT BiC� 140 30 el 250-W? vl 251.90 OWNER BUILDR DISCLOSURE STATEMENT NAME: )J \\A 1 (�fC,V�� DATE: 1 #■ ADDRESS: . d I V Please read and initial each paragraph. 5. I understand that, as the owner - builder, I must provide direct onsite supervision of the construction. Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795:2204 Fax: (305) 756.8972 G ve rt 0.0.1;.t LS . 23 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 fora 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 new form states 75,000). 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. 1. I understand that state law requires construction to be done by a licensed contractor and have applied for an owner- builder permit under an exemption from the law. The exemption specifies that I, as the owner of the properly listed, may act as my own contractor with certain restrictions even though I do not have a license. Initial ) 2. I understand that building permits are not required to be signed by a property owner unless he or she is responsible for the construction and is not hiring a licensed contractor to assume responsibility. Initial V 3. I understand that as an owner builder, I am the responsible party of record on a permit. I understand that I may protect myself from potential financial risk by hiring a licensed contractor and having the permit filed in his or her name instead of my own name. I also understand that the contractor is required by law to be licensed in Florida and to list his or license oumbers on permits and contracts. Initial e) 4. I understand that I may build or improve a one family or two-family residence or a farm outbuilding. I may also build or improve a commercial building if the costs do not exceed $75,000. The building or residence must be for my use or occupancy. It may not be built or substantially improved for sale or lease. If a building or residence that I have built or substantially improved myself is sold or leased within 1 year after the construction is complete, the law will presume that I built or sybstantially improved it for sale or lease, which violates the exemption. Initial 6. I understand that I may not hire an unlicensed person to act as my contractor or to supervise persons working on my building or residence. It is my responsibility to ensure that the persons whom I employ have the license required by law and by county or municipal ordinance. Initial a J " \ 7. I understand that it is frequent practices of unlicensed persons to have the property owner obtain an owner - builder permit that erroneously implies that the property owner is providing his or her own labor and materials. I, as an owner - builder, may be held liable and subjected to serious financial risk for any injuries sustained by an unlicensed person or his or employees while working on my property. My homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an owner- builder and am aware of the limits of my insurance coverage for injuries to workers on my property. Was acknowledged before me this V day of riQrG V , 20 10 OWNER Initial By a)s 1 I CA-4 ft __L— who was personally known to me or who has Produced there License or as identification. 8. I understand that I may not delegate the responsibility for supervising work to be a licensed contractor who is not licenses to perform the work being done. Any person working on my building who is not licensed must work under my direct supervision and must be employed by me, which means that I must comply with laws requiring the withholding of federal income tax and social security contributions under the Federal Insurance Contributions Act (FICA) and must provide workers compensation for the employee. I understand that my failure to follow these may subject to serious financial risk. Initial 9. I agree that, as the party legally and financially responsible for this proposed Construction activity, I will abide by all applicable laws and requirement that govem owner - builders as well as employers. I also understand that the Construction must comply with all applicable laws, ordinances, building codes, and zoning regulations Initial 3\rN 10. I understand that I may obtain more information regarding my obltgations'as an employer from the internal Revenue Service, the United States Small Business Administration, and the Florida Department of Revenues. I also understand that t may contact the Florida Construction Industry Licensing Board at 850 .487.1395 or htto: /haww.mvforidali tense .com /dbar /orofalb/iindex.htynl initial J ` 11.1 am aware of, and consent to; an owner- builder building permit applied for in my name and understands that I am the party legally and financially responsible for the proposed construction activity at the following address: talk Ast Initial Y 12. I agree to notify Miami Shores Village immediately of any additions, deletions, or changes to any of the information at I have provided on this disclosure. Initial Licensed contractors are regulated by laws designed to protect the public. If you contract with a person who does not have a license, the Constr4uction Industry Licensing Board and Department of Business and Professional Regulation may be unable to assist you with any financial loss that you sustain as a result of contractor may be in civil court. It is also important for you to understand that, if an unlicensed contractor or employee of an individual or firm is injured while working on your property, you may be held liable for damages. If you obtain an owner - builder permit and wish to hire a licensed contractor, you will be responsible for verifying whether the contractor is properly licensed and the status of the contractor's workers compensation coverage. Before a building permit can be issued, this disclosure statement must be completed and signed by the property owner and returned to the local permitting agency responsible for issuing the permit A copy of the property owner's driver license, the notarized signature of the property owner, or other type of verification acceptable to the local permitting agency is required when the permit is issued. Lqi C 1 1 • Sekrit -1 as bAo a Scteit 514' er,t, e 041 et/7r e 5. 1 p ,TA-G te - A-44 e /cam p seereAg e. • to gj- u k .} << (RI F.I.P 1/2" NO ID. CAP 1 1.3' CLEAR 4.3' CIO O 0.5' CLEAR CJ F.I.P 1/2" NO ID. CAP SKETCH OF SURVEY SCALE:V =20' 94.41 110.59' „lq \b /1 � ,y\ c / �f F.I.P 1/2" ,/ NO ID. CAP SURVEYOR'S NOTES: 1) Lands shown hereon were not abstracted for easements, right of way or other instruments of records. 2)There may be additional restrictions not shown in this survey that may be found in public records of Miami Dade County 3) No underground improvements were located. 4) Unless otherwise noted, recorded and measured data are in substantial agreement. 5) Legal description provided by client 6) This survey must, exclusively, be used for mortgage purposes 7) This survey has been prepared for the exclusive use of the entities named hereon and the certification hereon does not extend to any unnamed party. 8) Bearings if shown are based on assumed meridian and Plat of Record. • F.I.P 1/2" NO ID. CAP 1 , CERTIFIED TO: JOHN MITCHELL & THE TITLE PLACE, ATTORNEYS' TITLE BANK OF AMERICA, 15. 0' WEI —EN CHEN, INC., INSURANCE FUND, INC., N.A. LEGEND: ►II II/IIIIi 1 7\7\7\7\7\7 X —x —x— = _ EVE _ = A/C = E.M.= (( S.I.P.= F.I.P.= F. BRICK AREAS TILE AREAS CONCRETE AREAS ASPHALT AREAS LEGAL DESCRIPTION: 5' HIGH CHAIN LINK FENCE OVERHEAD ELECTRIC LINE AIR CONDITIONER ELECTRIC METER WOOD POWER POLE WITH ANCHOR WATER METER SET 1 /2"IRON PIPE FOUND 1/2 "IRON PIPE FOUND 3/4 "IRON PIPE CENTER LINE LOCATION MAP Kris. A PORTION OF THE NORTH 108.00 FEET OF LOT M OF A PLAT OF GOVERMENT LOT 4 OF SECTION 5, TOWNSHIP 53 SOUTH, RANGE 42 EAST, AND OTHER PROPERTY, WHICH PLAT IS RECORDED IN PLAT BOOT{ 5, PAGE 90, OF THE PUBLIC RECORDS OF MIAMI DADE COUNTY, FLORIDA, MORE PARTICULARLY DESCRIBED AS FOLLOWS: BEGINNING AT THE NORTHEAST CORNER OF LOT M, THENCE WEST ALONG THE NORTH LINE OF LOT M FOR A DISTANCE OF 110.59 FEET TO A POINT; THENCE RUN SOUTH 8 °31'12" WEST, ALONG A LINE FOR A DISTANCE OF 109.21 FEET TO A POINT, SAID POINT BEING ON A LINE THAT IS PARALLEL TO AND 108.00 FEET SOUTH OF THE NORTH LINE OF LOT M; THENCE EAST ALONG A LINE PARALLEL TO THE NORTH LINE OF LOT M FOR A DISTANCE OF 94.41 FEET TO THE POINT OF INTERSECTION WITH THE EAST LINE OF LOT M; THENCE IN A NORTHERLY DIRECTION ALONG THE EAST LINE OF LOT M TO THE POINT OF BEGINNING. PROPERTY ADDRESS: 9330 N.E. 12th AVENUE, MIAMI SHORES, FL. 33138. NOT VAUD UNLESS EMBOSSED WITH SURVEYOR'S SEAL REVISED: BOUNDARY SURVEY GARY B. CASTEL SURVEYING, INC I Hereby Certify: That the attached Survey was made under my responsible charge and substantially meets the minimum technical standard as set forth by the FLORIDA BOARD OF LAND SURVEYORS in Chapter 61g17 -6, Florida Admi '. trative 0. pursuant to Section 472.027, d tat GARY B. CASTEL Registered Land Surveyor No 4129 State of Florida FLOOD ZONE: 'G LAND SURVEYORS 12016 S.W. 132nd COURT, MIAMI, FLORIDA 33186 (305) 253 -9720 (305)253 -6767 DATE: JOB No. 02 -08 -09 SCALE: 1 " =20' DWN. BY A.A. 12179 - t2,7 0 1 11 � r 2n�o ytisA B y ; .. FlY Ped rn i- /eC -3 -/o - 30 Ownev: 106 iihicAdi Address: %33o /024 hie still un411 EI ° PI � e m �� to To : I\)oYnnan &kiln 620estioYls regarOtina w'j homeownevfs bailders p �r�� app/ 1 . 1 satin i $ e( wadi ovine by ?vt i ch n a erm; app i catTcn Awn a l iceti Plumber anti A lrteincea( .e (cC can • 2. Scot c In k= - kemD di otitis anti T �d\1Y �1 -to tke stuots. D ill replace, walls trr*L msukektkri. wails coffered by concret¢. board CDurbck - Ora ig1eate 46 karats acrorirg cre,62 and ( ,,n 11 /ay Coil 06- board 0-71 lop 0.0 flu. Rove board. - i I� ye late tvnl and h ,-&b t'in s 45 iekr, 3. ON vtmore t c/o a ,07,,iAea f--e comer el &'d k vvm . „ afe lfed 03/19/2010 17:21 FAX 1 800 685 7530 DATA SCAN FIELD SERVICES Z001. TRANSMISSION OK * * * * * * * * * * * * * * * * * * * ** * ** TX REPORT * ** * * * * * * * * * * * * * * * * * * * ** TX /RX NO 4783 RECIPIENT ADDRESS 93056955379 DESTINATION ID ST. TIME 03/19 17:20 TIME USE 00'21 PAGES SENT 1 RESULT OK Permit No: 10 -350 Job Name: March 18, 2010 M iami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Page 1 of 1 Building Critique Sheet 1) Provide Electrical and Plumbing permits. 2) Provide complete scope of work on plans. Show all work including new sub floor, new drywall, insulation, plumbing and new electric. 3) Layout in submitted plan does not match existing (closet gone)? 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 Permit No: 10 -350 Job Name: March 18, 2010 Norman Bruhn CBO 305 - 795 -2204 M iami Shores Vivage Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Page 1 of 1 Building Critique Sheet 1) Provide Electrical and Plumbing permits. 2) Provide complete scope of work on plans. Show all work including new sub floor, new drywall, insulation, plumbing and new electric. 3) Layout in submitted plan does not match existing (closet gone)? 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. Fa (d S „5--4E-- Inspection Number: INSP- 149849 Permit Number: RC -3 -10 -350 Scheduled Inspection Date: August 10, 2010 Inspector: Bruhn, Norman Owner: MITCHELL, JOHN Job Address: 9330 NE 12 Avenue Project: <NONE> Contractor: HOME OWNER Building Department Comments Passed 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- 145323. NO ACCESS NO ONE HOME JR. August 09, 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: Residential Construction Inspection Type: Final Building Work Classification: Alteration Phone Number Parcel Number 1132050070160 Page 17 of 21 Inspection Number: INSP - 145323 Scheduled Inspection Date: June 07, 2010 Inspector: Rodriguez, Jorge Owner: MITCHELL, JOHN Job Address: 9330 NE 12 Avenue Project: <NONE> Miami Shores, FL 33138- Contractor: HOME OWNER Building Department Comments June 04, 2010 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 Number: RC -3 -10 -350 Permit Type: Residential Construction Inspection Type: Final Building Work Classification: Alteration Phone Number Parcel Number 1132050070160 Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments xd ACS /4 90/0 2% Page 17 of 24 Architect/Engineer's Name (if applicable) Value of Work For this Permit $ 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.—)0 ^ 999 PERMIT APPLICATION Master Permit No. PC tO °� 3 FBC 2004 Permit Type (circle): Building ( Electrical ' umbin Mechanical Roofing Owner's Name (Fe- j n i le Titleholder) 11� (L ' Phone # p " 3 Owner's Address ! 4 NF �� V City A k' State f - Zip Tenant/Lessee Name Phone # � Job Address (where the work is being done) q! 1 / v E t nth City Miami Shores Village County . Miami -Dade Zip FOLIO / PARCEL # Is Building Historically Designated YES NO x �'iu(n Jti p∎ Contractor's Company Name � le.(1 S I�'v[CC5 Phone # 3S - -• 33 Contractor's A dress q3(% NWT JTiCe, City Wl l • StateL, Zip g3/33_. CS Qualifier Name 1 ( l P k QS IC4$ + j C � Phone # State Certificate or Registration No. C ` I ' vV J JJ Certificate of Competency No. Phone # Square / Linear Footage Of Work: - 7 0 ipECTERYLJ 3cs� scia. -3t Type of Work: ClAddit' [J4lteration ['New ! J Repair/Replace ❑ Demolition Describe Work: ' i 1 i I ID�h . L' V J ' ` ett6 fg.,L, ro P � pvt P ******** * * * * * * * * * * * * * * * * * * *** * * * * * * * * ** F * ** * * * * * * * * * * * * * * *** *** * * * * * * ** Submittal Fee $ Permit Fee $ 225 ----- 3 -ri CCF S i • (9Q CO /CC Notary $ Training/Education Fee $ 0 -40 ^ Technology Fee $ 1-� O� Scanning $ 3-00 Radon $ () -AO 41 DPBR $ . Zoning $ Bond $ Code Enforcement $ ► ouble Fee " Structural Review. $ otal Fee Now Due $ 45 1 See Reverse side -4 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 world Twill be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate perthit 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 reinsp tion fee will be charged. Signature Owner or Agent The foing instrument was acknowledged b o e me this t day of 1r (, C , 20 0 , by �"} R , fore who is personally known to me or who has produced Ft 1 0 As identification and who did take an oath. NOTARY PUBLIC: Sign: My Commission Expires: APPLICATION APPROVED BY: (Revised 02/08/06) ` ��t111 i1 //// Print: ? ,p ° 2 _ -n . = '' iia o - SO e- `+ - 0o C o 0• •••• . Signature r Con I • ctor The foregoing instrument was acknowledged before me this 15 d a y of n°1 G l r c i t i , 20 lo , by who i4ersonally known bo me or who has produced as identific tion and who did take an oath 4 ar P , Notary Public State of Florida NOTARY PUBLIC: 4, Susan Coloma A l My Commission DD602120 "Q Expires 10/04/2010 Sign: _ t5�' -- Print: DV I C.Ok or) CA My Commission Expires: - 1•I 1111i (e, Plans Examiner Engineer Zoning 1* Inspection Number: INSP - 145525 Scheduled Inspection Date: June 09, 2010 Inspector: Hernandez, Rafael Owner: MITCHELL, JOHN Job Address: 9330 NE 12 Avenue Miami Shores, FL 33138- Project: <NONE> Contractor: PLUMBTECH SERVICES INC Building Department Comments PUT ALL PLUMBNING UP TO CODE RE- INSTALL NEW FIXTURES WILL MAKE PLUMBING PVC IN PLACE OF CAST IRON. Passed 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- 145325. June 08, 2010 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 Number: PL- 3- 10-499 Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Addition /Alteration Phone Number Parcel Number 1132050070160 Page 12 of 26 Inspection Number: INSP - 145325 Scheduled Inspection Date: June 07, 2010 Inspector: Hernandez, Rafael Owner: MITCHELL, JOHN Job Address: 9330 NE 12 Avenue Project: <NONE> Miami Shores, FL 33138- Contractor: PLUMBTECH SERVICES INC Building Department Comments June 04, 2010 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 Number: PL- 3- 10-499 Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Addition /Alteration Phone Number Parcel Number 1132050070160 PUT ALL PLUMBNING UP TO CODE RE- INSTALL NEW FIXTURES WILL MAKE PLUMBING PVC IN PLACE OF CAST IRON. Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments /1, '5z 0 22,, Page 19 of 24 Tel: (305) 795.2204 Fax: (305) 756.8972 BUILDING Permit No. VA_ ®a ( 23 PERMIT APPLICATION -76 r Master Permit No. (2.C.. 10 — 35 0 FBC 2004 Permit Type: Electrical Owner's Name (Fee Simple Titleholder) Owner's Address City (\. 1 S •�� State Tenant/Lessee Name E -MAIL: Job Address (where the work is being done) Notary $ Scanning $t 'OD Bond $ Training/Education Fee $ Radon $ Code Enforcement $ Miami Shores Village glEOMIV3 Building Department Mk ' 5 201 '" 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 BY l r rl \ M\ triq FL 'l { City ° ? State f L_ Qualifier Name /j " ✓ ��" G State Certificate or Registration No. Cr- / it 0 ! 2 E -MAIL: / /22 az (.? Submittal Fee $ Permit Fee $ 0-90 City Miami Shores Village County FOLIO / PARCEL # l 3 aOS Q G O (EtG Is Building Historically Designated YES NO x Contractor's Address /L)Z 7 (.e 0 If 9 Zip Miami -Dade Phone # °O 1 1463 Phone # tat6 4ve, Zip � CCs Contractor's Company Name !mi ` ' l / Phone # %� 1 /3;9 Zip 3/ 72. Phone # m -0 72,,f' / Certificate of Competency No. Architect/Engineer's Name (if applicable) Phone # �1 Value of Work For this Permit $ / Square / Linear Footage Of Work: / U Type of Work: ['Addition ['Alteration ❑New jZ1 Repair/Replace ❑ Demolition / � 4; / e :� 2 ll / Gl7L � 1X/), # Z is c<' 7le. /e5 Describe Work: /J° / ��:wG�.1�L� �� 6'� • -� * * * * * * * * * * * * * ** * * * * * * ** * * * * * * * * * * * * ** Fees***** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * CCF $ o' Technology Fee $ CO /CC QcQ DPBR $ Zoning $ Structural Review. $ Total Fee Now Due $ ' a(Q See Reverse side -4 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. 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 r inspecti fee will be charged. Signature NOTARY PUBLIC: APPLICATION APPROVED BY: (Revised 02/08/06) ( Owner or Agent 17 1-‘'‘. The foregoing ( instrument was acknowledged bef o_r(e� this I day of 1( ,CCC , 20 10 , by Jc k t k Q\ who is personally known to me or who has produced `�- -1 D As identification and who did take an oath. / Signature s � , a' Contractor The foregoing instrument was acknowledged before me this day of NO rc 4 , 20/ O , by AO */ Cordes who is personally known to me or who has produced as identification and who did take an oath. o miu►n ulo. / A r / Sign: % �o �tPs '_ Print: ` rn o� , y ..< 0 . �i % - Ii' '-' 3 My Commission Expires: ''-• o � c' � q / / � , id►/ III% N �� NOTARY PUBLIC: Francisco P. Morales 48tY Public - State of Florida Sign: 7� - � Cornmiss(on # DO 913453 pay commission Expires 11 -17 -2013 Print: �r0�clS co 7 I'1oxilgi T rough AdwdIc Bond Co . Ir c. My Commission Expires: / / -/7 - 7-013 Plans Examiner Engineer Zoning CORVEA NESTOR I INDUSTRIAL ELECTRICAL SYSTEMS CORP 10257 NW 9TH ST CIR # 205 MIAMI FL 33172 AC# 3821633 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD (850) 487 -1395 1940 NORTH MONROE STREET TALLAHASSEE FL 32399 -0783 CEN 06/18/2008.078168061:7 EC3:.30021=0- The ELECTRICAL CONTRACTOR Named below IS CERTIFIED Under the provisions of - Chapte ' • Expiration date: AUG 31, 2010 y CORVEA, NESTOR = -I INDUSTRIAL -- ' ELECTRICAL . SYSTEMS 10257 NW -9TH ST CIR, #. 205 - MIAMI FL 33172 DETACH HERE CHARLIE'CRIST GOVERNOR REQUIRED BY LAW STATE OF FLORIDA AC# 3` 82111,233 DEPARTMENT OF- BUSINESS -AND PROFESSIONAL REGULATION EC13002182 06/18/08 078168061 CERTIFIED ELECTRICAL CONTRACTOR CORVEA, NESTOR I INDUSTRIAL ELECTRICAL SYSTEMS"•CO IS: _ CERTIFIED under the provisions of ch 489_ss Expiration date: AUG 11, 2010. L08061801298 ; - 2/fJJ»i 4rat CHUCK DRAGO INTERIM SECRETARY DO NOT FORWARD SEE OTHER SIDE INDUSTRIAL ELECTRICAL SYSTEM CORP NESTOR 1 CORVEA PRES 10257 NW 9 ST CIR 205 MIAMI FL 33172 11111111111111181,1II't1lIt1 111111SIU,ii1{1111r11ll5ir1 THE POLICIES OF INSURANCE LISTED ANY REQUIREMENT, TERM OR CONDITION MAY PERTAIN, THE INSURANCE AFFORDED POLES. AGGREGATE LIMITS SHOWN BELOW BEEN ISSUED TO THE1NT:GREI) GAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH MAY HAVE BEEN REDUCED BY PAID CLAIMS. OISR UR TYPE OF INSURANCE POLICY NUM 1 E Para A L�IITB INSURER A: Twin City .Fire Ins Co GENERAL UMULITY COMMERCIAL GENERAL UABIUTY INSURER D: INSURER E: EACH OCCURRENCE 8 FIRE DAMAGE (Any one fuel 8 CLAIMS MADE 1 I OCCUR MED EXP (Any one person) $ PERSONAL & ADV INJURY 8 GENERAL AGGREGATE 8 GEM. AGGREGATE LIMIT APPLIES PER PRODUCTS - COMPIOP AGG 8 I POLICY 1 II .M 1 I LOC AUTOMOBILE LMBt1Y ANY AUTO AU. OWNED AUTOS SCHEDULED AUTOS RED AUTOS NON - OWNED AUTOS COMBINED SINGLE UMIT 8 BODILY INJURY (Per person) 8 BODILY INJURY (Per accident) 8 PROPEFITY DAMAGE oft) 8 GARAGE UABIL17Y ANY AUTO AUTO ONLY - EA ACCIDENT 8 OTHER THAN EA ACC 8 AUTO ONLY AGO 8 EXCESS LABR.11"Y EACH OCCURRENCE 8 _ OCCUR u CLAIMS MADE DEDUCTIBLE RETENTION $ AGGREGATE - 8 8 _ 8 $ A WORTS COMPENSATION AND E UWE ' UABILGY 76 WEG P06188 01/24/10 :01/24/11 X 1 TQ Y I ER E.L.EAcm-Acc1DENr $100, 000 E.L. DISEASE - EA EMPLOYEE . 810 0 , 0 0 0 E.L. DISEASE - POLICY LIMIT 85 0 0 0 0 0 OTM OWN OF OPERATION$IWCAT)DNS ADDED BY !BPEDIAL PROVISIONS Those usual to the Insured's Operations. ACORD. CERTIFICATE OF LIABILITY INSURANCE • 1 DATE 03 /0 INFORMATION . maxim PAYCHEX AGENCY INC 210705 P:() F : () - PO BOX 33015 SAN ANTONIO TX 78265 THIS CERTIFICATE IS ISSUED AS A MATTER OF -ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. HTHIS �G A RDEED NOT POUCJESSBBEBELOw ALTER INSURERS AFFORDING COVERAGE INSURED INDUSTRIAL ELECTRICAL SYSTEMS CORP 10257 N.W. 9TH STREET CIR. APT. 205 MIAMI FL 33172 INSURER A: Twin City .Fire Ins Co INSURER B: INSURER C: INSURER D: INSURER E: Village of Miami 10050 Ne 2nd Ave Miami Shores, Fl 33138 Fax: 305 756-8972 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF. THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE (10 DAYS FOR NON - PAYMENT) TO THE CERTWICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO 00 SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AOTRO TRIE COVERAGES ACORD as-s (7/97) NAL INSURED( INSURER LETTER: CANC ACORD CORPORATION 198111 Village of Miami Shores 1 WJ:JU NE 2ndAVe Miami Shores, FL. 33138 Fax 305 756 -8972 S ANYOF ,[EAf> DESCRIBED POLIf POLICIES t THE EXPIRATION DATE TL, THEWRING vl U ENDEAVOR 10 DAFL 30 DAYS warm , NINICE TO THE CERTIRCATE HOLDER NAMED TO THE LEFT, BUT PNLURIETO 00 SO SHALL IMPOSE NO OBUGATION OR UA8IUTY OF ANY RIND UPON THE IN R. ITS AGADITS OR REpREsurnannia T AWE . • AGO, CERTIFICATE OF LIABILITY INSURANCE PRODUCER OVERSEAS INSURANCE AGENCY P. O. BOX 1432936 MIAMI, FLORIDA 33115 THIS CERTIFICATE IS ISSUED AS A ONLY AND CONFERS NO RIGHTS HOLDER. THIS CERTIFICATE DOES NOT ALTER THE COVERAGE AFFORDED BY THE PO INSURERS AFFORDING COVERAGE . ' INSURED INDUSTRIAL ELECTRICAL SYSTEMS CORP 10257 W.W. 9 ST CIRCLE W205 MIAMI, FLORIDA 33172 INSURER A: NOVA CASUALTY COMPANY INSURER tS INSURER C: BAR RER IR INSURER E: COVERAGES THE POUCIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIRNT, 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 POLIO DESCRIBED HEREIN 18 SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE Lows SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. 57Fi T YPE OF AL. UABLIaY A X CO?AMERCPAL GENERAL LABILITY I CLAIMS MADE I X OCCUR -250 DED GEM AGGREGATE L 1T APPLIES PER !tI POLICY Fr I I LOC AUTOMOBILE LIABILITY ANY AUTO ALL GAMED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS GARAGE LdAIUTY ANY AUTO DBDUCTNLE RETENTION $ EXCESS LIABILITY `—I OCCUR n Cllr MADE WORKERS Cf DdSATION AND EMPLOYERS` LTAMLITY DESCRIPTION OF OPERATTINISALOCATIONSNERICLESIEXCIXSIONSAIDDED BY ITNOCEISIDIENDSPECIAL DESCRIPTION OF OPERATION ELECTRICAL WIRING; ACORD 25-5 (7197} 09 ALL39093 POLICY NUMBER nAw YV 05/12109 05/12110 EMI OCCURRENCE FIRE DAMAGE (Any oft ) MD EXP (Any are a) PERSONAL& INJURY GENERAL AGGREGATE PRODUCTS - COMP/OP AGG OOIIaINED atom LLRRT (Ea BODILY INJURY (Per paean) (Pet acaisisrd) BODILY PROPERTY DAMAGE Iwo) AUTO ONLY - E'AACCIDENT EA ACC AGG OTHER THAN MAO ONLY EACH OCCURRENCE AGGREGATE IT YJAIS I ER E.L EACH ACCIDENT EL DISEASE -EA EMPLOYEE E.L. DISEASE -POLL Y LSAT a $ $ a 1 S a a S $ $ a a $ 800,000 100.000 5.000. 500,000 1,000,000 1,000,000 Inspection Number: INSP - 145976 Permit Number: EL- 3- 10-498 Scheduled Inspection Date: June 14, 2010 Inspector: Devaney, Michael Owner: MITCHELL, JOHN Job Address: 9330 NE 12 Avenue Project: <NONE> 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 Contractor: INDUSTRIAL ELECTRICAL SYSTEM CORP Building Department Comments June 11, 2010 For Inspections please call: (305)762 -4949 Permit Type: Electrical - Residential Inspection Type: Final Work Classification: Alteration Phone Number Parcel Number 1132050070160 Phone: 305/228 -1384 REMODELING BATHROOM 2 LIGHT FIXTURES AND 2 OUTLETS AND 2 SWITCHES AND 1 EXHAUST FAN. Passed 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- 145324. No one home 5:15 P.m.. OK PER NB TO DELETE RE -INSP. FEE ?/./ r'v/ Page 28 of 29