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RC-10-1386Scheduled Inspection Date: October 07, 2010 Inspector: Bruhn, Norman Owner: HAILE, GREGORY & CHAE Job Address: 410 NE 94 Street Miami Shores, FL 33138- Project: <NONE> Contractor: SPECIALIZED COSNTRUCTION INC Building Department Comments October 06, 2010 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 149593 Permit Number: RC -8 -10 -1386 For Inspections please call: (305)762 -4949 Permit Type: Residential Construction Inspection Type: Final Work Classification: Addition /Alteration Phone Number Parcel Number 1132060140360 Phone: (786)251 -5691 bathroom remodel. re -tile floors and tile and fixtures change out. Passed fd CS Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments WORK ALREADY INSPECTED BY MC INSP, AS PER COMMENTS FROM FRAMING INSPECTION. PERMIT CLOSED (MC 10 -1518) Page 8 of 31 Inspection Number: INSP- 150383 Scheduled Inspection Date: September 02, 2010 Inspector: Perez, JanPierre Owner: HAILE, GREGORY & CHAE Job Address: 410 NE 94 Street Miami Shores, FL 33138- Project: <NONE> Contractor: FROSTY FROG A/C & REF INC Building Department Comments September 01, 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: MC -8 -10 -1518 Permit Type: Mechanical - Residential Inspection Type: Final Work Classification: Addition /Alteration Phone Number Parcel Number 1132060140360 Phone: (305)607 -7289 ADD 2 4" AC DROPS TO CLIMATE BATHS AND INSTALL TWO EXHAUST FANS 80 CFMS Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments Page 11 of 20 '_ °® CERTIFICATE OF LIABILITY INSURANCE DATE / 0/ PRODUCER Insurance Professional Consult 10481 SW 88 St Ste. D - 204 Miami, FL 33176 Phone (305) 273 - 4530 Fax (305) 273 - 4409 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 POUCIES BELOW. INSURERS AFFORDING COVERAGE NAIC # INSURED Frosty Frog A/C & Refrigeration 6551 SW 18 Terrace Miami, FL 33155- INSURER A: NOVA INSURER B: INSURER C: INSURER D: INSURER E: COVERAGES INSURER F: THE POUCIES 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 OH 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 [NERD T YPE OF INSURANCE POLICY NUMBER POUCY EFFECTIVE DATE (MMIDDIYY) POLICY EXPIRATION DATE (MMSDDIYY) LIMITS A GENERAL LIABILITY 09AL067997 - 1 10/26/09 10/26/10 EACH OCCURRENCE 1,000,000 M COMMERCIAL GENERAL LIABILITY PREMISES (Ea ocure ce) 100,000 • • CLAIMS MADE n OCCUR IVIED EXP (Any one person) 5,000 PERSONAL & ADV INJURY 1,000,000 • GEN'L • GENERAL AGGREGATE 2,000,000 AGGREGATE LIMIT APPLIES PER POLICY • PROJECT • LOC PRODUCTS - COMP/OP AGG 2,000,000 • AUTOMOBILE li • II • • • n LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON OWNED AUTOS COMBINED SINGLE UMIT (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 II LIABILITY EACH OCCURRENCE ■ OCCUR • CLAIMS MADE AGGREGATE III DEDUCTIBLE • RETENTION $ 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 EL. DISEASE - EA EMPLOYEE E.L. DISEASE - POLICY UMIT OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT! SPECIAL PROVISIONS 08/30/2010 11:07 Page 2/3 CERTIFICATE HOLDER CANCELLATION VILLAGE OF MIAMI SHORES 10050 NE 2ND AVENUE 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 TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE • • ACORD 25 (2001/08) QF @ACORD CORPORATION 1988 1. AL64 qt- Miami Shores Village Building Department §MaERWZ11 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 AUG 4 )O1 J Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 BY: ... BUILDING Permit No.mf 1 613 PERMIT APPLICATION Master Permit No. FBC 20 Permit Type: MECHANICAL Owner's Name (Fee Simple Titleholder) ( rHOO OA e G g ( L- Phone # Owner's Address L- 3 ID ICE q + - eedl - City ( almt S hD'es State * FL Zip :331 ,85 Tenant/Lessee Name N /P4, Phone # Email 0)nGte ha i le .sirocti I . CO(v Job Address (where the work is being done) II f 0 Mb ?;o5- - 323 -9823 (cha City Miami Shores Villa. e County Miami -Dade Zip 33 FOLIO / PARCEL # Is Building Historically Designated YES NO Flood Zone 0 0 Contractor's Company Name F R_ 5 Ty Irv. o e .64- k G Contractor's Address `p S S 1 5 VJ t. 'U 1 City WI t A M' State Zip 33165 5 Qualifier Name - LE% .. v �42. 0 e t Phone # 3 o6 • 9 4s 3 - • 601-/s State Certificate or Registration No CA C. I 15(p 15 Certificate of Competency No. Contact Phone E -mail F2.p5ly FRtD(( AC„ 6 m A- t . c...ONA Architect/Engineer's Name (if applicable) Value of Work For this Permit $ 550. O0 Type of Work: ❑Addition ❑Alteration Describe Work: ,# 1 b 2. TtW uSx_. C.� t. a s - A Nth tJ 54- 6 - 1-1.- +Ala o -C 1n A�sT ***************** * * * * * * * * * * * * * * * * * *; Submittal Fee * * * * * * * * ** e$ �. C Permit Fee $ Phone # 30 Phone # Square / Linear Footage Of Work: New ❑ Repair/Replace ❑ Demolition * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** CCF $ Notary $ Training/Education Fee $ Scanning $ Radon $ DPBR $ Double Fee $ Violation date: Structural Review. $ Total Fee Now Due $ I 04- CO /CC $ Technology Fee $ Bond $ See Reverse s 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 even (7) days after the building permit is issued. I ; x1li of such posted notice, the inspection will not be approve i n i a,!einspection fee will be charged. Signature l f Owner or Agent The fore • ing instrument was acknowledged before me this& day of Lyt ,20 /J,b Ae— is pgrso 0//``y known to me or who has produced 1 .- As identification and who did take an oath. *** * * * * * * * * * * * * * * * *4 * * * * * * *; * * * * ** APPROVED BY ans Examiner Engineer (Revised 07 /10 /07)(Revised 06/10/2009) Signature ontractor The fore oing ' ent was ackno a ged before me this day of t / �, 20 C), by ( i— `,(,- o is Trsonally known to me or who has produced ( .-- i identification and who did take an oath. NOT ' •'' IC: Sign: Print: My Co 1 P I h • • p MN O PMMISSION # PD 64'' 24 • : 'EXPIRES: April 5, 2011 • i v Bonded Thru Notary Public Underwriters * ************************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Zoning Clerk checked UNIT BEING REPLACED DATA NEW UNIT MANUFACTURER AHU or PKG. UNIT MODEL # COND. UNIT MODEL # KW HEAT NOM TONS AHU CU PKG 1) M.C.A AHU CU PKG AHU CU PKG 2) M.O.P AHU CU PKG AHU CU PKG 3) VOLTS AHU CU PKG PKG UNIT . 1 / PKG UNIT / / EER/SEER YES NO REPLACING DUCTS YES NO YES NO REPLACING THERMOSTAT YES NO YES NO NEW 4 °CONCRETE SLAB YES NO YES NO NEW ROOF STAND YES NO YES NO NEW RETURN PLENUM BOX YES NO Signature AIR CONDITIONING REPLACEMENT DATA Miami Shores Village Building Department 10050 N. E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 PERMIT NUMBER: MC This form must accompany ALL air conditioning replacement permit applications. Each unit change -out must be on its own data sheet. Multiple units on single sheets are not acceptable. Job Address (where the work is being done): `410 N E ( ILO 9 , rc City: Miami Shores Village County: Miami Dade Zip Code: ,31 ALL CONDENSING UNITS MUST BE ON A 4 INCH SOLID CONCRETE SLAB ALL UNITS MUST COMPLY WITH F.E.M.A MINIMUM FLOOD ELEVATION A COPY OF THE CONTRACT IS REQUIRED WITH ALL SUBMITALS ARI (AHRI) DATA SHEET REQUIRED Change Disconnecting means: YES ❑ NO ❑ ARHI Sheet Attached: YES ❑ NO ❑ Contract Attached: YES ❑ 1. Minimum Circuit Ampacity (Wire Size): 2. Maximum Overcurrent Protection (Fuse /Breaker Size): 3. Voltage of Circuit (208/240/480): 4. Size Disconnecting Means: Contractor's Company Name: Phone: State Certificate or Registration N. Certificate of Competency N. (Qualifier's signature only) Date: -troth w 1 hapta Al 1 i cent I/04e' /s o CONTRACT / Estimate N,o.082010 Proposal submitted to : Chae H, Project: 410 NE 94 Street Miami Shores, Fla. 331,8 We hereby submit specification and estimates for: Two (2) A/C Drops of Four inc es (4) to climate Bathrooms. And Two (2) Exhaust Fans to Bathrooms for Ventillation. le FRDSTY FROG AIC & REFRIGERATION INC. State Certified & insured, CAC 1815618 6551 SW 18 Terr., Miami, FL. 33155 Phone: (305) 607 -7289 Fax: (305) 264 -1969 Any alteration or deviation from the above specification, involving additional materials and /or labor costs, will be executed only with approval of eneral Contractor with written orders, and if there any charge for such alteration or deviation additional charge 11 be added to the price of this proposal. Existing original plans for this job used for this project in time of quote specified, in case of any change will be authorized or originated in the Feld when installation are in progress, and existing substantial changes from original plans approved by City, the new' plans and revision process in the city shall be the responsibility of General Contractor in coordination with the Owner, Architect or Engineer, and inspections will not be made until plans correction are approved. In the event General Contractor shall fail to pay any periodic or installment payment due hereunder, Frosty Frog A/C may cease work without br ach pending payment or resolution of any dispute. if payments are not made when due, Frosty Frog A/C may suspend work on the job until such time as all payments due h ve been made. A failure to make payments for period in excess of 10 days from due date of the payment shall be deemed a material breach of this contract Frosty Frog A/C shall not be liable for any delay due to circumstances beyond its control including strikes, casualty or general unavailability of materials or equipments. Contract Price $550.00 The General Contractor shall pay Frosty Frog A/C for the equipments, materials, and labor to be performed under this contract the sum of $ subject to additions and deducti ns pursuant to authorized change order. Terms of Payment: 35% Upon i itiation of contract, 55% in progress of job (ordering a/c units), balance due Qa completion of final inspection Page 2 of3 ACCEPTANCE OF I CONTRACT The above prices, specificatio s and conditions are hereby accepted. You are authorized to do the work as specified. Payments will be m e as outlined above , 20 10 Page 2 of 3 NOTICE OF COMMENCEMENT A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION PERMIT NO.) 0 1 $ C) TAX FOUO NO. 1% o rY - 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 of property and street/address: 41 a N 2. Description of improvement: Ma de. 1 TW h r�aMs 3. Owner(s) name and address: Grdq And C Ii he, 14 y NE 9 M o res' 4 7flSi Interest in property: 0VNntt rJ' el vols. Name and address of fee simple titleholder 4. Contractor's name and address: S P(C / 01 / - Q. d cons- trv<1 1 °, `1335 C t F 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(1)(a)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)(b), Florida Statutes. Name and address: Sig Print Owner's Name Sworn to and subscribed before me this day of Notary Public Print Notary's Name My commission expires: 123.01 -52 PAGE 4 8/02 Commencement: (the expiration date is 1 year from the date of recording unless a a - Notary Public, Slate of Rorida ' Corn sion# DD847074 L l kfl IIM I.I. Mgcomm. expires Dec. 21, 2012 Y 20 / 0 StA''1 O fthiltalk COLIMTY fF EsittiE 1 NP'!tt'Y" COMA' MA** Is s py of fiv a�rlglft ,; dbi ` is office an cf of 111111111111111111111111111111111111111111111 CFI4 201080532662 OR Sk 27379 Ps 3396; (113s) RECORDED OS /06 /2010 14 :18 =54 HARVEY RJJVIN? CLERK. OF COURT MIAflI -DADE COUNTY? FLORIDA LAST PAGE r9 . M i as,; ri7oref 77133 Address: .Sho't 394V g BUILDING Permit No. _� )O a0 PERMIT APPLICATION Master Permit No. FBC 20 Permit Type: BUILDING OWNER: Name (Fee Simple Titleholder): f'e `�' C� �' Q Address: City: --D ( Tenant/Lessee Name: Email: 'ht. t ie 9 0i r-, m fir, D r�►orts State: JOB ADDRESS: rI d 0 M E i, r 4/ City: Miami Shores County: Miami Dade Zip: 3 in Folio/Parcel #: (1 - 3A d (CI '.. 0 1 • 0 360 Is the Building Historically Designated: Yes NO . Flood Zone: no CO•a3 +r rC-f ?o, CONTRACTOR: Company Name: f P e C lK r r ze 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fag: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 Address: 1 33 5 S' ' � C City: / V % R State: Qualifier Name: 0) u l 0 T r r State Certification or Registration #: C6 C i s ® 64 6 �. Miami Shores Village Building Department Isanm AUG n 2 nio BY: ......... ..... Certificate of Competency #: Contact Phone#: Email Address: DESIGNER Architect/Engineer: Phone#: Value of Work for this Permit: $ 5 S ° ° Square/Linear Footage of Work: Type of Work: °Address °Alteration °New ®Repair/Replace , °Demolition Description of Work: 0 t'"t ' 9 0 1S? ra ?e ti) r*' en. 5 U e (Q I- r w r a rt `i"r4 (if ateRiztt silet` r Ot n.7, C ice. aF Ifs It 6eft+CpaA.► rt.P ,0 c-Ow a , 4 d`E (-41411 Fay,¢ 6 e(.4 l' i'. P onl CC(4,t,tc training/Education Fee $ F otary $ Double Fee Structural Review $ Phone#: CAE Phone#: 3e r' l 500 Zip: 171 9 �ti Phone#: 11 6 ( 'DAVID (9) CO 00 — ?r41 zip: '57 r X13 Phone#: 1 5 6• r V11 COLOR THROUGH ROOF TILE IS REQUIRED acknowledged by: Submittal Fee $ Permit Fee $ /6 j CCF $ CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Technology Fee $ TOTAL FEE NOW DUE $.1-1 Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip Application is hereby made to obtain a permit to do the work and installations as indicated. 1 certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC OWNER'S AFFIDAVIT: 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 en ;) days after the building permit is is the abb a of each posted notice, the inspection will o b/ # ,+ ' a n fee will be charged Sign, ir '1 1111. Con ( or\ The foregoing instrument was acknowledged before ire this c9 The foregoing instrument was acknowledged before me this s day of �, 20 a, by Uh'(CI. @ 'kik , day o 20\1__V, by \'\ ` S ZN , i who is personally known to me or who has produced who is perso y own to me or who has produced I �.. lai- it0 identification and who did take an oath. NOTARY PUBLIC: Signature Owner or Agent My Commission Expires: (2- .0"4'4N SANDREAN MORGAN I P tr. Notary Public - State of Florida *******1 > rOr tgtird�P8M010 *** * * * * * * * *** * * ** 0 Commission 0 DD 922035 0v ) L '° Bonded Through National Notary APPRO 07 /10107)(Revised 06110/2009)(Revised 3/15/09) 'f a ) 4 Plans Examiner Structural Review identification and who did take an oath. NO ARY P C: Sign: Print: My Commission Expires: \ \C .51` '1' " • ASHAKI S. = ' ON ON **Ii ••pr45 •� c■y Commission Expires Oct 18. 2010 Commission U DD 606661 * **** *** **** Zoning Clerk Inspection Number: INSP - 149626 Permit Number: EL -8 -10 -1388 Scheduled Inspection Date: October 06, 2010 Inspector: Devaney, Michael Owner: HAILE, GREGORY & CHAE Job Address: 410 NE 94 Street Miami Shores, FL 33138- Project: <NONE> Contractor: Building Department Comments Passed E' Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments RELOCATE FIXTURE AND OUTLEST,RGRADE OUTLETS TO GFI. ADD GFI AND HIGH HAT, ADD SWITCH. October 05, 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: Electrical - Residential Inspection Type: Final Work Classification: Addition /Alteration Phone Number Parcel Number 1132060140360 Page 9 of 25 BUILDING PERMIT APPLICATION FBC 20 Permit Type: Electrical OWNER: Name (Fee Simple Tiitleho Address: ki c E 7 City: t!, ) S Tenant/Lessee Name: Email: Value of Work for this Permit: S Type of Work °Address °Alteration Description of Work: t o E h i+ e t e.`-,- +0 (7 rt 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 Dre pJ CT41 AUG 0 7 t,i )) Permit No. t. / ) 1 - % It Flood Zone: Master Permit No ACUB Phon 3 `..3 6 g 1 13 State: ft Zip: '33 Phone#: ft JOB ADDRESS: ®� Zip: /1 P3 City: Miami Shores County: Miami Dade Folio/Parcel#: (1 - 3 A - 0 1 . 0 3 Is the Building Historically Designated: Yes NO J CONTRACTOR: Company Name: 3 ' �J Ted., f a (©ci (ie. f �' Address: 1531 W 4 /We 3, 1, City: h 14[0,4k State: F l Tap: 5 t b Qualifier Name: S Q. ¢ 0 Lo e °� . 0q, /'1 e r e Phone#: 'I 0 3" , 3 7 i . l T� State Certification or Registration #: EC o ° 0 1+ O ° Certificate of Competency #: Contact Phone#: Email Address: DESIGNER: Architect/Engineer.. Phone#: Phone#: "3 s � � P ° $ Square/Linear Footage of Work: ONew ORepair/Replace F" *vre c d avfrets v ?lroz 'NCO ( t u Wr lk.b .A t r``N.-% °Demolition ********* * * * * * *** * * * *** * * * * * * *** * * * ****F ******eM r**ae *e*** **•s******* **********•**** Submittal Fee $ Permit Fee $ 7... / e'® CCF $ �� COO CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ 444. 1 41 o 8(a Bowling Company's Nance (if applicable) �.. Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Application is hereby made to obtain a permit to do the work and hlatallations as indicated. I certify that no work or installation halt 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 fiction 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 o commencement and construction lien law brochure wil be delivered to the person whose property is subject to attac , ' A o, '; certified copy of the recorded notice of commencement must be posted at the job site. for the first inspec 'on, which oc urs s (7) days after the building permit is issued In the absence of such posted notice, the inspection will 't ' e «i proved /ft r ' ' 1 n fee will be charged / d d A / Signature d , Signature Owner or Agent The foregoing instrument was acknowledged before me this " day of �� 20/2_, by V'in`e who is personally known to me or who has produced N/ identification and who did take an oath. NOTARY PUBLIC: Sign: Print My Commission Expirgsf 1 lJ * * * * * * * * *** * * * * * ** APPROVED BY (Revised 07 /10107)Revised 06110/2009)(Revised 3/15/09) ANDREAN MORGAN Diary Public - State of Florida • . My Comm. Expires Dec 28, 2013 4- Commission # DD 922035 Bonded T h .: Iona of /. .: ..j r fir Plans Examiner Structural Review ing instrument w ac !edged befo me 20tV, b a 4/1,4 el y known to me or who i . produced i dentification and who did take an oath. OTARY PUBLIC: Sign: Print: Contractor . ). Ciitui .lei V Cnkilin0 'Commissiom P10717923 My Commission Expires: LX,, I . ms. SEP 2011 BoNU! D r! HILT ATI ANTIC BONDING CO,,INC. * * * *** ****** * ** *** **** ****** *iii ******* ** *** *********** Zoning Clerk IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY: M iami Shores Viiiage Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CONTRACTORS' REGISTRATION FORM ALL CONTRACTORS MUST PROVIDE COPIES OF LICENCES AND INSURANCES EACH TIME A PERMIT IS SUBMITTED OR THE VILLAGE MAY MAINTAIN A FILE WITH YOUR INFORMATION FOR A $30.00 FEE PER YEAR. IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: A. ./ COPY OF QUALIFIER'S STATE LIC CARD B. COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF LIABILITY INSURANCE (CERTIFICATE HOLDER TO BE MIAMI SHORES VILLAGE BLDG DEPT) D. 6/ COPY OF WORKERS COMPENSATION (EITHER CERTIFICATE OR EXCEMPTION) A. COPY OF CERTIFICE OF COMPETENCY OF QUALIFIER B. COPY OF MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT C. COPY OF LIABILITY INSURACE (CERTIFICATE HOLDER MUST BE MIAMI SHORES VILLAGE BLDG DEPT) D. COPY OF WORKER COMP INSURANCE (EITHER CERTIFICATE OR EXEMPTION) YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE HOLDER AS FOLLOW: MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES, FL 33138 COMPLETE CONTRACTOR'S INFORMATION BUSINESS NAME: �3 -0N �V C ;,`. anrAQa∎,C- , \v't BUSINESS ADDRESS: R f � t2_ CITI( 7 STATE ZIP CODE X324 BUSINESS PHONE: ) 4X, FAX NUMBER CELL PHONE e 2 QUALIFIER'S NAME: QUALIFIER'S LIC NUMBER: E -MAIL ADDRESS (IF APPLICABLE): Created on 3119109 BY MLDV 1 RV 3126109 MLDV ASK— VKL O 4 ,.....--- 4,.....--- DATE DO/YYY1ry I (MM/ 4/14/2010 PRODUCER (305) 551 - 0590 FAX: (305) 551 -0857 Casualty Systems 3331 SW 107 Ave Miami FL 33165 THIS CERTIFICATE IS ISSUED AS A MATTER ONLY AND CONFERS NO RIGHTS UPON THE HOLDER. THIS CERTIFICA - E DOES NOT AMEND, _ ALTER THE COVERAGE AFFORDED BY THE OF INFORMATION CERTIFICATE EXTEND OR POLICIES BELOW, INSURERS AFFORDING COVERAGE NAIC g INSURED Saw Technologies, Inc. P. O. Box 296 Plantation FL 33324 INSURER A. Granada Insuralce Company INSURER INSURER C. INSURER 0: INSURER E COVERAGES THE POLICIES OF INSURANCE LISTED BELOW 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 WHI 3H THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERM $, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR IAOD'L LTR INSRD TYPE OF INSURANCE POUCY NUMBER PO LIC Y EF FECTIVE DATE /MM/DDIYYX'H POLICY gqpp DATE IMM/D YYI TK1N LIMITS P► GENERAL UABIUTY X COMMERCIAL GENERAL LIABILITY 01851 L00004947 12/10/2009 12/10/2010 ACH OCCURRENCE $ 1,000,000 $ 50,000 DAMAGE TO RENTED ±RA I•.S Ea • -. - MED EXP (Any one person) CLAIMS MADE .. OCCUR $ 1,000 PERSONAL a ADV INJURY GENERAL AGGREGATE F RODUCTS - CCMAP/OP AGG s 1,000,000 $ 2,000,000 $ 2 000, 000 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY n PFCOT- 7 LOC AUTOMOBILE UABIUTY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS COMBINED SINGLE LIMIT (:a accident) *OILY INJURY (per person} $ BODILY INJURY ('et accident) $ FROPERTY DAMAGE ('er accident) $ GARAGE LiaBIUTY ANY AUTO r.UTO ONLY - EA ACCIDENT $ C THER THAN EA ACC $ / UTO ONLY AGO $ EXCESS / UMBRELLA UABIUTY OCCUR C CLAIMS MADE DEDUCTIBLE RETENTION $ EACH OCCURRENCE $ AGGREGATE $ 1 $ $ WORKERS COMPENSATION AND EMPLOYERS' UABIUTY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatary in NH) If yes describe under SPECIAL. PROVISIONS below I W STMT 'S 1 E Bi 6.L EACH ACCIDENT $ 1 .L DISEASE - EA EMPLOYE $ 1 L DISEASE - POLICY LIMIT S OTHER DESCRIPTION OF OPERATIONS / LOCATIONS 1 VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS electriai inside buildings CERTIFICATE HOLDER CANCELLATION (305) 756 -8972 Miami Shores village Building Department 10050 N E 2nd Avenue Miami Shores, FL 33138 SHOULD ANY OF THE ABOVE DESCRIBED POLICES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING IN " , ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE 'SOLDER ED TO THE LEFT. BUT FAILURE TO 00 SO SHALL IMPOSE NO OBUGATION O f LIA = . • ANY KIND UPON THE INSURER. ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRE , Ethel Gruntrer,,' -' - APR -13 -2010 14:45 casua systems ACORD 25 (2009/01) IN5025 (200901) The ACORD name and logo are regis X8. 2009 ACO rks of ACORD 3055510857 P.001 D CORPORATION. All rights reserved. Inspection Number: INSP - 149618 Scheduled Inspection Date: October 06, 2010 Inspector: Hernandez, Rafael Owner: HAILE, GREGORY & CHAE Job Address: 410 NE 94 Street Miami Shores, FL 33138- Project: <NONE> Contractor: NCH PLUMBING INC Building Department Comments October 05, 2010 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, F Phone: (305)795 -2204 Fax: (305)756 -8972 For Inspections please call: (305)762 -4949 Permit Number: PL -8 -10 -1387 Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Addition /Alteration Phone Number Parcel Number 1132060140360 Phone: (786)848 -7713 REMOVE AND REPLACE EXISTING TOILETS AND VANITY. REPLACE SHOWER VALVES AND INSTALLATION OF SHOWER PAN Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments Page 8 of 25 BUILDING PERMIT APPLICATION FBC 20 Permit Type: PLUMBING OWNER: Name (Fee Simple Titleholder): Address: Is t 0 OE 94 - "' xt . Submittal Fee $ Permit 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 G rep. d Value of Work for this Permit: s Type of Work: Address ❑Alteration Description of Work: C C /NM J. r e PI Wee rnsfi�I rLi -' e. Paia -!- Scanning Fee $ Radon Fee $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ Permit No. Master Permit No. TOTAL FEE NOW DUE $ CCF $ COICC EMEXCE Au(( 22w By: ....................... Phone#: "SC £ .. f3 C i S City: M) ©M n J do r QS State: FL Zip: — 3 - 317 C3 Tenant/Lessee Name: Phone#: Email: JOB ADDRESS: 4 g 0 1`41 FV y 't' City: Miami Shores County: Miami Dade Folio/Parcel#: % I -1 ?9 o p °i a 9 36 0 Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name: 11 C H 1 ) 4 OA tb 1 ^ ) X") C Phone#: Address: 1 ® 3 ' ter `ear 114 PI- P. City: N t 1 State: r t. Zip: 1 1 1 0 6 Qualifier Name: 4" 66,411 * C N ! CO kr 4 Vt t Phone#: State Certification or Registration #: C F C ©3 ( 101 Certificate of Competency #: Contact Phone#: Email Address: DESIGNER: Architect/Engineer: Phone#: $ Square/Linear Footage of Work: DNew ®Repair/Replace UDemolition e Jrt , f Pi Ceti and WOf y l peal AO k qtr I a Vt ris a v. t t '' d Nt.P ***************************************F *****************************************4411 DBPR $ Bond $ Technology Fee $ eac, 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 seve (7) ' s after the building permit is issued In the absence of such posted notice, the inspection will n • ' e roved ti ' n fee will be charged Signature j i Si Owner or Agent instrument was acknowledged before me this A The foregoing ' t was acknowledged before me this 7 7 20 r 0 , b y e i h Q e. (-'� , d a y of ' ' f..' 7 , 20 /0, by who is personally known to me or who has produced A L - The forego day of , - If who is person -) y kno to me or who has produced 04 1 7 - 1 1 ( and who did � 7d'i take an oath. NOTARY PUBLIC: Sign: Print My Commission F 4iker _ I( EAN MORGAN sr t Nor Public - State of Florida • . My Comm. Expires Dec 28, 2013 4 Commission • D 9420 * * * * * * * * * * * * ** * ' v ** i tfi 1y otary Assn * * * * * * * * * * * * * * * * * * * * ** APPROVED BY Pi L f? /ci Plans Examiner (Revised 07 /10 /07)(Revised 06110/2009)Revised 3 /15/09Xrev6/4110) Structural Review NOTARY P Si asi on and who did take an oath. 1au1 • ft RICAF �.-,`, % Notary Public - State of Florida s �` '� s'Mglomm. Expires Jul 27, 2013 � 1 : 1 Commissions DD 911349 •,46A' Bonded Through National Notary Assn. * * * * * * * * * * * * * * * * * * * * * * * * * * ** Zoning Clerk EACH OCCURRENCE $ 1 , 00 000 DAMAGE TO RENTED PREMISES (Ea occurrence) $ 100,000 MED EXP (Any one person) $ 5,C00 PERSONAL 8 ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 1 , 000 000 PRODUCTS - COMP /OP AGG $ 1 , 0000 ACCo OR PRODUCER (305) 595 -3323 FAX: (305) 595 -7135 Eastern Insurance Group, Inc. 9570 SW 107 Avenue Suite 104 Miami FL 33176 INSURED N.C.H. Plumbing, Inc. 1045 NW 134 Street Miami COVERAGES OTHER GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY PRO.: I j LOC AUTOMOBILE UABIUTY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS GARAGE LIABIUTY ANY AUTO EXCESS /UMBRELLA UABIUTY OCCUR CLAIMS MADE — 1 DEDUCTIBLE — 1 RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under SPECIAL PROVISIONS below Plumbing Contractor CERTIFICATE HOLDER ACORD 25 (2009/01) INS025 (200901) (305)756 -8972 Village of Miami Shores Building Department 10050 NE 2 Avenue Miami Shores, FL 33138 CERTIFICATE OF LIABILITY INSURANCE FL 33168 Y WF9200096900 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE INSURER A: Granada Insurance Company INSURER B: CastlePoint Florida Insurance INSURER C: INSURER D: INSURER E: THE POLICIES OF INSURANCE LISTED BELOW 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 OFSUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADM. POLICY EFFECTIVE POLICY EXPIRATION I _ILHaiNSRD TYPE OF INSURANCE POLICY NUMBER DATE (MM/DD/YYYYr) GENERAL LIABIUTY X COMMERCIAL GENERAL LIABILITY A CLAIMS MADE X OCCUR 0185FL00009462 5/24/2010 5/24/2011 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS CANCELLATION DATE (MM/DD/YYYYI 1 9/23/2009 9/23/2010 COMBINED SINGLE LIMIT (Ea accident) BODILY INJURY (Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE (Per accident) AUTO ONLY - EA ACCIDENT OTHER THAN AUTO ONLY: EACH OCCURRENCE AGGREGATE UMITS $ $ EA .ACC $ AGG $ $ DATE (MM/DDIYYYY 7/27/2010 NAIC # X TORY LIM I OTH- ER E L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE $ ? 0 E.L. DISEASE - POLICY LIMIT $ 53C ( ( SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS 1•'vRiTTE NOTICE 10 THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGE': S '.T. ! REPRESENTATIVES. AUTHORIZED REPRESENTATIVE David Lopez /ANA - c © 1988-2009 ACORD CORPORATION. All rights re Y-e •. The ACORD name and logo are registered marks et ACORD " AUG' 0 2 2010 w . 5/ ter, 6 Pc7 j2-i 7-e2 c- , &e7 mss' a'r 9/2- 1.7/e) Rive obi tiro / Rolm web needle Remove old fixture/ web new (mna [oaten) Add WI mind Remove / butte Wi tom /entail irepwa on Remove exigent fan/ Rom welt new (manes ion) Remove and Replica pock-al obit Rive obi told / Replace yak now (mine *melon) Install titwww pan Repine shower vein add mat* str • • • • • • • •• ••• • • • • •••• • • • •• • • • • ••• • • • • • • • • • • • • Remove old tM / R with new Rebuts mdid and more& to G14 Add (on mane ) auditor GR oiet Ramses Exhaust Fat / Repine welt nwr (sue. ) Rolocidtm fixture from coats to .bova vy Rename old vanity / Rte, hi vane leadion new may R old toe / new (tea toatlon) Rephee shower nil tob wive ,�e o & 2ki 1- L 1 Q ) c l4 1 - 6, Yireet m;Ofill j S1/19YQS( `3S 136 Ntahni Shows Village APPROVED ZONING DEPT BLDG DEPT BY A S Ne3-p fir. 5/Y4 t t 111,4 , OIL) 8-1.1 eve% L18 e.,1 $tl i,S 6 1.--ioV 1.S 6 SUBJECT 10 COMPLIANCE WITH ALL FEDERAL STATE AND Gr,UN,y RULES AND REGULATIONS