RC-10-17BUILDING
PERMIT APPLICATION
FBC 20
JOB ADDRESS: /7d fl l/o�= �O.S 57
City: Miami Shores County:
Folio/Parcel#: 1 /' o9.? 0 .Sc p- 00 0/
Is the Building Historically Designated: Yes
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
Permit No. 10 \ 1
Master Permit No.
)
BY :...
Permit Type: BUILDING
% OWNER: Name (Fee Simple Titleholder): Phone #:
Address: /200 �el /®S S71 ,I S M 1# S'o ?
t Zip: 3,..? / 3 cr
City: �l�Il'dfi Shire State: /�
Tenant/Lessee Name: Phone #:
Email:
COLOR THROUGH ROOF TILE IS REQUIRED acknowledged by:
,.S ,- So 3
Miami Dade
Zip: 3.3/3
NO Flood Zone:
CONTRACTOR: Company Name: `} C3 O O (7,,,,m J'/�/a`rr hone #( 3 ®5) �K- 40
Address: • Ge)
�
City:
/� J � Zip: a3 7,
��A, �1 4 vl (i State: � �
Qualifier Name: igf , '/ Q,7 — 2_ Phone #: cNe.),l q/ -mil :2 8)-
State Certification or Registration #: Certificate of Competency #:
Contact Phone #: Email Address:
DESIGNER: Architect/Engineer: Phone #:
Value of Work for this Permit: $ Square/Linear Footage of Work:
Type of Work: ❑ Addres DAlteration ❑New ❑ pair lace
Ge
❑Demolition
Description of Work:
•r ********* ***** *** r * * * * *e ******* * **** p ees ** *** ******* *** **e ** ** ** •** **** * *e * * * *e ****
Submittal Fee $ Permit Fee $ 110 CCF $ CO /CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $ Technology Fee $
Double Fee $ Structural Review $
TOTAL FEE NOW DUE $ 1 CEO . CJCJ
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 ce -d copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven ,) s after the building permit is issued In the absence of such posted notice, the
inspection will not be '''roved and a r -' . ��jr ee will be charged.
er or Agent or
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this MI)
day of c9 . 20 IQ, by day of ra g , 20 j by 1.„1:5 to t 'p./
who is personally known to me or who has produced who is personally known to me or who has produced
C2-C45:8.1R7(34O As identification and who did take an oath. 664,607/ Cpilas identification and who did take an oath.
NOTARY PUBIC: r. t 1 NOTARY PUBLIC:
Sign:
Print: lie' i1C.4
My Commission Expires:
APPROVED BY
I., 4,
YOHANCA GONP.ALEZ
1�i P ' !
4 ,tY COMMISSION # DD 730170
EXPIRES: October 30, 2011
• Bonded Thor Notary Public underwriters
Plans Examiner
(Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09Xrev6 /4/10)
Nnatur
Structural Review
Sign:
Print:
My Commission
*** * * * * * * * * * * * * * ** * * ** * * * * * * * * * * **
Zoning
Clerk
Inspection Number: INSP - 153607 Permit Number: RC- 1 -10 -17
Scheduled Inspection Date: November 24, 2010
Inspector: Bruhn, Norman
Owner: GUALANO, ANTONIO
Job Address: 1700 NE 105 Street 503
Project: <NONE>
Miami Shores, FL
Contractor: JOSE M CUNHA SERVICES INC
Building Department Comments
November 23, 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 Type: Residential Construction
Inspection Type: Final
Work Classification: Alteration
Phone Number
Parcel Number 1122300500790
Phone: (305)986 -3985
REMOVE EXISTING FLOOR TILES AND INSTALL NEW
TILES WITH SOUND CONTROL
Passed0i#J
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
evC_
Page 23 of 27
BUILDING
PERMIT APPLICATION
FBC 20
Email
Contractor's Company Name --1 OS e 14- - J i✓ n a k CS
Contractor's Address 10 S 0/ 7 £4 #2/
City /4 ' /4- State
Qualifier Name .Ti`s S e l.t/ 1.4 �1
State Certificate or Registration No.
Contact Phone k o s) $ k 3'
Submittal Fee $
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
Permit Fee $
/o o
Jai 0 6 aalik
Permit No. pcie,
Master Permit No.
Permit Type: BUILDING ROOFING
Owner's Name (Fee Simple Titleholder) Liu 11,04 (p4ne//G .. Phone # 6 ®°}�) $ 8 j 4 L
Owner's Address , ®p „ / () T s -I � 31- 3
City /` 4; S OirS State /Art' QA Zip 3 3 /3 6
` ,4
Tenant/Lessee Name , i Sloes r G r m cr 1n 5 Phone # C3 S) $qA -O 3 3 8
1- Glioneik C 't
Job Address (where the work is being done)
City Miami Shores Village County Miami -Dade Zip
FOLIO / PARCEL #
Is Building Historically Designated YES NO 1 - °' Flood Zone
Phone # ( s ) 9 9 3 ) .
Zip 33i)2•
Phone # (-S/ 6 3 86 3 6 3 4 �.
Certificate of Competency No. D S rb S 0 1 i f '
E -mail ��c7S Q l.<, ti ye}'T r e 'ET
Architect/Engineer's Name (if applicable) Phone #
Value of Work For this Permit $ J O C) C' Square / Linear Footage Of Work: 7/ ?8* s &4 /
Type of Work: ['Addition ['Alteration ONew IN Repair/Replace [' Demolition
Describe Work: em ode i'S4in y f1» t O -t'; `e 5, 4 ,t cl -/ 54,E y/ Alec.) 4.-hr
C .Yfot - 61 1 41 c0
* * * * * * * * * * * * * * * *** * * * * * * * * * ** * * ** Fee * * * * * * * * * * * * * * * * * * * * * * ** * * * * * **
CCF $ - ) CO /CC $
Training/Education Fee $ V to Technology Fee $ a'40
Radon $ 5.(Q9 DPBR $ 5 • (j g Bond $
Violation date:
Notary $
Scanning $ 3
Double Fee $
Structural Review. $ Total Fee Now Due $ ( 2t r6,
See Reverse side —*
Bonding Company's Name (if applicable)
Bonding Company's Address
City State Zip
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City State Zip
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has
commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating
construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS,
WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all
applicable laws regulating construction and zoning.
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR
IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN
FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
RECORDING YOUR NOTICE OF COMMENCEMENT."
Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must
promise in good faith that a copy of 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) d after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspects a9 will be charged.
Signature
Owner or Agent Contractor
The foregoing instrument was acknowledged before me this (; The foregoing instrument was acknowledged before me this $
day of ° flaW /, 20 IQ, by iilt)l�e J ( q' '114 /// , day of l� tda y / , 20 j, by r®S& 1. aL. t1 7
who is personally known to me or who has produced /)r, ,,v of l''ems( &vho is personally known to me or who has produced arum
CA464 q / As identification and who did take an oath. °Poo _ e i33 t/ identification and who di take an oath.
NOTARY PUBLIC: /" r NOTARY PUBLIC:
Sign:
Print:
My Commission Expires:
0 030, 1 1
APPROVED BY
(Revised 07 /10 /07)(Revised 06/10/2009)
& Plans Examiner
Sign:
Print:
My Commission
Zoning
Engineer Clerk checked
NMI
CO
N. Ii -,t. � j' I `
i 1 E 2 Name 1. ( N. This Instrument Prepa ed ",(1197'7
4.
;721E3 Name ` 3 Oj
ails aY ms CC
rd sem
D. it 5 Permit No.
nom Is w • a STATE OF j ,/ .I t/ NOTICE OF COMMENCEMENT
woo +-�
n ��'= - COUNTY OF
, o CH —11--
simi -1 ra11-:
MN 0 '- Z
s-1 Ca- x ,
�w r3¢ P properly: (9 P properly, ) ' d0
aNMI u-• Ca r:c ¢ 1. Description of le al descrt on of end street addr ss if available) C p iQ /LM
IMO
NMI r•••• t:3 1 /Pao Nc /DS , x rrri s ' dmy 4/ 33/3r 6 rr,
Z _„ O r j 2. General description o improvement:
ono I�,c =J ee #1due iS JrtQ ( _" cider z%le s, err d- 5 •ue�,, r
v at 3. Owner information n
maw a. Name and address :G//XJrB�'/ ` ,3.A0e14 /2da "/C /O S' /t/4I4/!!1 fiofe'S f/ 3 3 13 e
b. Interest in property: CIC M E r1, /
c. N e and address co( f e�Stm pI itleriader Mother than owner)10/ (,S 51,01
t y dve- la S (: cnKr+a /murk y
4. Contractor: 375,5e ail /] .�, /� O - ! ,/
a. Name and addre Si r°l 1 LJ f ,(f(tj ,., whom; f 33/ >a 7r1r/AA 1
b. Phone number. �
a S ?86' ?8 Y
cdi
Tax Folio No. _
THE UNDERSIGNED hereby gives notice that improvement wilt be made to certain real property, and in accordance with
Chapter 713, Florida Statutes, the following information is provided in this Notice of Commencement.
5. Surety
a. Name and address:
b. Amount of bond $
c. Phone number.
6. Lender
a. Name and address:
b. Phone number.
7. Persons within the State of Florida designated by Owner upon whom notices or other documents may be served as
provided by Section 713.13(1)(a)7., Florida Statutes:
a. Name and address:
b. Phone number.
8. In additien to himself, Owner designates the following person(s) to receive a copy of the Lienor's Notice as provided In
Section
7.T3.13(1)(b), Florida Statutes:
a. Name and address:
b. Phone number.
9. Expiration date of notice of commencement (the expiration date is 1 year from the date of recording unless a different date Is
specified)
WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF
COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART I, SECTION 713.13,
FLORIDA STATUTES, AND CAN RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A
NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST
INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
COMMENCING WORK OR RECORDING YOUR NOTICE OF COMM _ MENT.
Th j oiW,instrumer 4vas acknowledged before me this
� 1 � ' `� (name of
/ " >�CA � ( person) as
arty, ...e. officer, trustee, attorney in fact) for
ehalf of whom instrument was executed).
gnature of Owner
Partner /Manage
Signatory's Title/Office
I tf day of -.J ° ,2010(year) by
uth z ffjcer
rector
(type of
(name of party on
re of Notary P c tate of FI.,,, a
Type, or Stam .•' • m _A= toned Name of Notary Public
Ission Numb
Personally Known fr<r7roduced Identification
Verlficatlon Pursuant to Section 92.625, Florida Statutes
i Under penalties of perjury, I declare that I have read the foregoing and• that the facts stated In It are true to the best of my
'R knowledge and belief.
uJ
1-
t i
Signature of Natural Person Signing Above
CONDOMINIUM APARTMENTS
1700 NORTHEAST 105TH STREET ON BISCAYNE BAY • MIAMI SHORES, FLORIDA 33138 • PHONE (305) 893 -6741
To Whom It May Concern.:
THE SHORES
Date:
JAN 0 6 RECD
Sincerely:
Permission has been granted to
Unit # for the purpose 'f
Treasurer
Board of Directors
X X X X X X X X X X* X X X X X X X X
MIAMI -DADE COUNTY TAX COLLECTOR
140 N. Flagler Street
Miami, Florida 33130
Please keep your receipt for
future reference.
Thank you and have a nice day.
1/15/2010 1300/230/001DLR043 0001 -0001
Last Seq. #:0001 WI LBT #:11 593583 -9
Local'Business Tax $37.50
CK $37.50
CHANGE .
MIAMI -DADE COUNTY TAX COLLECTOR
LOCAL BUSINESS TAX SECTION
140 W. Flagler St. - 1st Floor
Miami, Florida 33130
TEMPORARY RECEIPT
2009 -2010
MUNICIPAL CONTRACTOR TAX
Local Business Tax #:11593583 -9
State /CC #:05BS01193
Issued to:
JOSE M CUNHA SERVICES INC
Type of Business:
SPECIALTY BUILDING CONTRACTOR
RESTRICTED TO
MIAMI SHORES
THIS RECEIPT IS ISSUED AS EVIDENCE OF
PAYMENT FOR YOUR LOCAL BUSINESS TAX
OR PERMIT.
YOUR OFFICIAL RECEIPT WILL BE MAILED
TO YOU WITHIN 10 DAYS FROM THE
VALIDATION DATE ON THIS RECEIPT.
Payment Received as Certified Above
Miami -Dade County Tax Collector
MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
10050 NE 2 AVE
MIAMI SHORES, FL 33138
�` I.
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO
.>
UT OR LIABILITY
FT ,UT FAILURE TO DO SO SHALL IMPOSE N•
o .UPON THE INSURER, ITS AGENTS OR - _ �' SENTATIVES.
• - .4_ • EPRESENTATIVE
NAIC #
..4 4C °® CERTIFICATE OF LIABILITY INSURANCE
DATE
PRODUCER South Pacific Professional Ins.
500 K W. 49th Street
Hialeah, FL 33012
Phone (305)825 -3535 Fax (305)825 -5694
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERT FICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
INSURERS AFFORDING COVERAGE
NAIC #
INSURED JOSE CUNHA SERVICES, INC.
10801 NW 7 Street #21
MIAMI, FL 33172-
INSURER k. ASCENDANT UNDERWRITERS, LLC
INSURER B:
INSURER C:
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 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
LTR
ADD'L
NM
TYPE OF INSURANCE
TYPE
P OLICY NUMBER
GL -50481
POLICY EFFECTIVE
(MMIDDIYY)
09/23/09
POLICY EXPIRATION
DATE (MMIDDIYY)
09/23/10
LIMITS
EACH OCCURRENCE
1,000,000
N
GENERAL LIABILITY
d COMMERCIAL GENERAL LIABILITY
❑ ❑ CLAIMS MADE ❑ OCCUR
❑
DAMAGE TO RENTED
PREMISES (Ea occurence)
100,000
MED EXP (Any one person)
5,000
PERSONAL & ADV INJURY
1,000,000
GENERAL AGGREGATE
1,000,000
❑
PRODUCTS - COMP /OP AGG
1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
❑ POLICY ❑ PROJECT ❑ LOC
❑
AUTOMOBILE LIABILITY
❑ ANY AUTO
❑ ALL OWNED AUTOS
❑ SCHEDULED AUTOS
❑ HIRED AUTOS
❑ NON OWNED AUTOS
❑
COMBINED SINGLE LIMIT
(Ea accident)
BODILY INJURY
(Per person)
BODILY INJURY
(Per accident)
PROPERTY DAMAGE
(Per accident)
❑
❑
GARAGE LIABILITY
❑ ANY AUTO
❑
AUTO ONLY - EA ACCIDENT
OTHER THAN EA ACC
AUTO ONLY: AGG
EXCESS/UMBRELLA LIABILITY
❑ OCCUR ❑ CLAIMS MADE
❑ DEDUCTIBLE
❑ RETENTION $
EACH OCCURRENCE
AGGREGATE
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
ANY PROPRIETOR / PARTNER / EXECUTIVE
OFFICER / MEMBER EXCLUDED?
If yes, describe under
SPECIAL PROVISIONS below
❑ WC STATU- ❑ OTH-
TORY LIMITS ER
E.L. EACH ACCIDENT
E.L. DISEASE - EA EMPLOYEE
E.L. DISEASE - POLICY LIMIT
OTHER
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
CERTIFICATE HODER IS ALSO ADDITIONAL INSURED
CERTIFICATE HOLDER
ACORD 25 (2001/08) CIF
CANCELLATION
PERMIT #: RUO ® 0 1 DATE: (o I ( 0
1, A -0 Cj N �t
❑ Contractor
❑ Owner
❑ Architect
Picked up 2 sets of plans and (other) 7 $e CiJ1
Address: 11 JO Nli ® c3T
From the building department on this date in order to have corrections done to plans
And /or get County stamps. I understand that the plans need to be brought back to Miami
Shores Village Building Department to continue permitting process.
Acknowledged
RESUBMITTED DATE:
PERMIT CLERK INITIAL:
PERMIT CLERK INITIAL: P
RECEIPT
Miami Shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
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ANA) Vril
111111113131111111111
Derm Number: 2010-0106-1221-4523
Contact Name: MISAEL GONZALEZ
Contact Phone: (766)291-2526
Folio: 11-2230-050-0790
Project Name: CRGIRNELLO RESIDENCE
Date Received: 01/06/2010
Reviewer Name:
CORFi
SIGNATURE
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DEPARTMENT OF ENV141--g777-71;
RESA G n7,f-71-0 4,PinA%r,s7
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