DEMO-11-307Scheduled Inspection Date: March 28, 2011
Inspector: Bruhn, Norman
Owner: MASTER, CHRISTINE
Job Address: 273 NE 98 Street
Miami Shores, FL 33138 -2407
Project: <NONE>
Contractor: PRACTICALITY INC
Building Department Comments
March 25, 2011
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 156292 Permit Number: DEMO -2 -11 -307
For Inspections please call: (305)762 -4949
Permit Type: Demolition
Inspection Type: Final
Work Classification: Building
hone Number
Parcel Number 1132060134420
Phone: (954)628 -4557
DEMO WALLS, FLOOR AND CEILING IN GARAGE TO
BRING BACK TO ORIGINAL CONDITION
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
O e4
O CLet
oeio 114°0 CL9
13 of 27
03108/2011 17:47
CERTIFICATE OF LIABILITY INSURANCE
DATE (MMIDOmYY)
0310812011
oDUCER
)VER ALL INSURANCE
00 W. ATLANTIC BLVD.
RRGATE, FL 33083
111(954) 958.0009 FX11 (954) 9504555
3URED PRACTICALITY, INC.
4921 NW 46TH AVENUE
COCONUT CREEK, FL 33073
GEN ERAL LIAISON
COMMERCIAL GENERAL LIABILITY
1 CLAIMS MADE C� OCCUR
GEML PO POLICY AT APPLIES PER;
LICY I 1 .tF .T f l LOC
AUTOMOBILE LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON -OWNED AUTOS
OTHER
GARAGE LIABILITY
ANY AUTO
LX E5S UMBRELLA LIABILITY
OCCUR ❑ CLAIMS MADE
DEDUCTIBLE
RETENTION
WORKERS COMPENSATION AND
EMPLOYERS LIABEIY
OFICE RRIM
OFFICER/MEMBER EXCLUDED, DEcuT1VE
Wyeg, describe under
SPECIAL PROVISIONS bedew
MIAMI SHORES
1150NE 2ND AVE
MIAMI FL 33333
FAX •015- 75S.RC70
ACORD 25 (2001108)
9549560555
521.04549
COVER ALL INSURANCE I 1- 71 PAGE 01/01
ONLY AND�CO CONFERS ISSUED RIGHTS MUPONR INFORMATION CERTIFICA E
HOLDER. THIS CERTIFICATE DOES NOT AMEND EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POL CIES BELOW.
INSURERS AFFORDING COVERAGE
INSURER A AMERICAN VEHICLE INSURANCE CO.
INSURER e: BUSINESSFIRST INSURANCE CO.
INSURER C:
INSURER D.
INSURER E.
0912412010
OVERAGES
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 OF SUCH
POLICIES. AGGREGATE LIMITS. SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LIMITS
Po1.ICY EXPIRATI N
SR ADD'L N.RRn TYPE OF 1NSI! ANCP POLICY NUMBER
EACH OCCURRENCE 9 x000,000
S.
GL- 050400821840 10/1912010 10119/2011 DAM_ RENTED 9 100 000
MED EXP (Any ens Porron $ 5,000
PERSONAL & ADV INJURY S 1,000,000
GENERAL AGGREGATE „$ 2,000,000
PRoDucT - C OMPIOP AGO $ PIX
DESCRIPTION OF OPERATIONS /LOCATIONS 1 VEHICLES I EXCLUSIONS ADDED 19Y ENDORSEMENT 1 SPECIAL, PROVISIONS
REMODELING
CERTIFICATE HOLDER
SNpuLO ANY OF1 EABOVEDESCRIBEDPOUCIESBECANCELLEDBEFORREETHE EXP
DATE THEREOF, THE I ' ' G INSURER WILL ENEEA TOJNAIL 10 DAYS WRIT'T'EN
NOTICE To THE C - + HOLDER NAMED TO . BUT FAILURE TO 00 5D SHALL
IMPOSE NO OSUGATIO LIABILITY OF ANY 1(I " - ON THE INShER, ITS AGENTS OR
REPRESENTATIVE
CANCELLATION
AUTHORIZED REP
09124/2011
COM l SINGLE LIMIT
BODILY INJURY
(Per Fermi
BODILY Y
PROPERTY DAMAGE
(Per accidel9)
EACH OCCURRENCE
AGGGATE
x
3
8
$
AUTO ONLY . EA ACCIDENT $
OTI4ERTHAN EA ACC $
AUTO ONLY;
AGO 9
S
9
S
i
a
OTH-
NAIL #
E.L EACH ACCIDENT $ 1,000,000
E.L. DISEASE - EA EMPLOYEE 3 1,000,000
E.L DISEASE -POLICY LIMIT $ 1,000,000
RD CORPORATION 1988
OTHER
03/08/2011 14:37 9549560555
ACORR, CERTIFICATE OF LIABILITY INSURANCE
PRODUCER
COVER ALL INSURANCE
5800 W. ATLANTIC BLVD,
MARGATE, FL. 33083
PH# (954)S50-0008 FX# (954) 955 -0555
INSURED PRACTICALITY, INC.
COVERAGES
WDRICERS COMPENSATION AND
EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
S yFI P_Eth PROVI$IDNS
: ERTIFICATE HOLDER
FAX• 4 f 1 5- 758.997'1
CORD 25 (2001108)
4921 NW 48TH AVENUE
COCONUT CREEK, FL 33073
MIAMI SHORES
1150 NE 2ND AVE
MIAMI FL 33333
COVER ALL INSURANCE
DATE (MM/DD/YYYY(
03108/2011
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
INSURERS. AFFORDING COVERAGE NA1C #
INSURER A AMERICAN VEHICLE INSURANCE CO.
INSURER BUSINESSFIRST INSURANCE CO.
INSURER C;
INSURER 0;
INSURER E;
k
GENERAL LIABI
COMMERCIA GENERAL LIABILITY
■ CLAIMS MADE El OCCUR
ML AGGREGATE LIMIT APPLIES PER
POLICY I I Pj Ti LOC
AUTOMOBILE LIABILITY
ANY AUTO
ALL OWNED AUTOS
I SCHEDULED AUTOS
HIRED AUTOS
NON -OWNED AUTOS
GARAGE LIABILITY
ANY AUTO
■
E ssIUMBRELLA LIABILITY
R OCCUR E CLAIMS MADE
POLICY NUMBER
DEDUCTIBLE
RETENTI • N s
GL- 0504008218.00
521 -04549
0912412010
10/19/2011
FEB 18, 2011
E.L EACH ACCIDENT
E.L, DISEASE - EA EMPLOYE 1 ' 0 000
E.L. DISEASE • POLICY LIMIT 81,000,000
s 1 000 000
CANCELLATION
SIHOULDANY
DATE THER �1
NOTICE TO
INFO$ r ,
REPR ENTA
000 000
8100 000
S 000
PERSONAL & ADV INJURY 8 1 090 000 000
GENERAL AGGREGATE 8 2 000
PRODUCTS - COMP/OP AGCY 8 000 000
MED EXP A one $
AUTO ONLY - EA ACCIDENT $
EACH OCC RRENC $
EA ACC 8
AOG
THE POLICIES OR 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 15 SUBJECT TO ALL THE TERM$, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES, AGGREGATE LIMIT$ SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR , ■ •'
■.:
POUCY EFFECTIVE
10/19/2010
IESCRIPT /ON OF OPERATIONS / LOCATIONS J VEHICLES / EXCLUSIONS ADDS) Hy ENDORSEMENT / SPECIAL PROVISION$
tEMODELING
REPR
ISSUING INSURER
MATE HOLDER
LIT( OP
LIMITS
8
PAGE 01/01
THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
MAYOR TO MAIL 10 DAYS WRITTEN
THE LEFT. BUT FAILURE TO DO SO SHALL
NY KIND UNA INS INSURER, ITS AGENT OR
@ACORD CORPORATION 198B
BUILDING
PERMIT APPLICATION
FBC 20
Tenant/Lessee Name:
Email: 0.5a IL&CU 6e / /�aw //t7'
u r
f 1-1-1 &cilncrv, r eci l re_
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
M CMIE n
At FEB 23211
BY:
Permit NoW O l -- 3(.71 —
Master Permit No.
Permit Type: BUILDING , kS�' �� )
OWNER: Name (Fee Simple Titleho der): eI/?/6 f ! �. Phone #: gUj 9O ?/-73
Address: 43 /1' b) Sgt? j
City: / ! 0-477 / 5 / oa e S State: Zip: 33 / 3
JOB ADDRESS: c7.1 73 4/ 1 7 �� .1
City: Miami Shores County: Miami Dade Zip: 5/ 3 I:—
Folio/Parcel #:
Is the Building Historically Designated: Yes ✓ NO Flood Zone: NO
Phone #: —! 284S
Phone #:
CONTRACTOR: Company Name: (A C+ fl CCta d�
Address: 4t g 2. 1 NiN `C AVE:
City: C cor\Ler C leek— State: FL Zip: 33 73
Qualifier Name: ‘ t i Ve S I � kAb . Ni G Phone #:
State Certification or Registration #: CC�C 1 508380 Certificate of Competency #: = 1 r
Contact Phone #: Email Address: Ui W� • ?r�tCaic t gp a 6 oil Ti r 4d- ov/J.C.0
DESIGNER: Architect/Engineer: Phone #:
tie of Wo 1 itP ift:4 ` ` " - Square/Linear Footage of Work:
:ra
e of Work: ❑Acldress CIAlt*ation ❑New ❑Repair/Replace =e s emolition
cription of Work: (../... S � )1•=00 4 (` (e I i eete 1 1-,
N rz t �► , - .. h..•� tJlo _ b r+- ► p „.:Q �'.cn - .G'r (-).=. A V d
COLOR THROUGH ROOF TILE IS REQUIRED acknowledged by:
*** ***** * * * * * * ** * * * * * * * * * * * * * * * * *** * * * * F * * * * * * * * * * * * * *** * * * * * * * * * ** * * **
Submittal Fee $5 Q Permit Fee $ /00 agj CCF $ CO /CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $ Technology Fee $
Double Fee $ Structural Review $
TOTAL FEE NOW DUE $ (,S s u
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 reinspection fee will be charged.
Owner or Agent
The foregoing instrument was acknowledg ed before me this 1f
da of _ 20 ��, by _3khd ,- `_ j_ ,
who is personally known to me or who has produced
r,o` 4 As identific
o f y �r;.'
Co , is: DD 928312
NOTARY PUBLIC:
Sign:
Print:
My Commission Expires: / ®�5":-
APPROVED BY
(Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09)(rev6/4/10)
LL GARLAND
Notary Public, State of Florida
My Comm. Expires Oct. 15, 2013
No. DD899098
ur J. Gapaglr & o.
Plans Examiner
Structural Review
NOTARY
Sign:
Print:
My Commission Expires:
ontractor
The foregoing instrument was acknowledged before me this 2
day of Cc- , 20 (�, by
who is personally known me or whoas produced
as identification and who did take an oath.
Zoning
Clerk
Pi ress : x.13 N E 9 ST" ST
H a n Houma
C
0
w
G
v
als IM 98Th5 ti4 fl\k.(
Bee! Roo m cmcf Wtlece
' 1)rniONi 2-
a
q4 (nesard
'ZeNove. Ca WCI h t eS et hct
J
rywcI( on ce1 (9cpd wcr Os. flife
bac `w o r i l �a Cot i +Q 0�1
to br `j
. i'i�, •III
® ernove, av c ca{. Q S( t
ect!ci caL fe8 v brt
al- c 416 t c5
Garsarje
Inspection Number: INSP - 156294
Scheduled Inspection Date: March 24, 2011
Inspector: Devaney, Michael
Owner: MASTER, CHRISTINE
Job Address: 273 NE 98 Street
Miami Shores, FL 33138 -2407
Project: <NONE>
Contractor: PRACTICALITY INC
Building Department Comments
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Permit Number: DEMO -2 -11 -308
Permit Type: Demolition
Inspection Type: Final
Work Classification: Electric
Phone Number
Parcel Number 1132060134420
Phone: (954)628 -4557
BRING BACK TO ORIGINAL CONDITION
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
s,4
2 (' //ip �r
March 23, 2011
For Inspections please call: (305)762 - 4949
Page 5 of 13
BUILDING
PERMIT APPLICATION Master Permit No.
FBC 20
Permit Type ELECTRICAL
4 Owner's Name (Fee Simple Titleholder) h ' /s Q Phone # .5G5 e 3 /
Owner's Address a 73 ilt 9 f7 5i--
Cit ,273 ri • 5 6 9 r State fi Zip 35 / 3
Tenant/Lessee Name Phone #
Email 0 a _kr cc/ ��
Job Address (where the work is being done)
Contact Phone
De+cribe Worif
rwo -4,'
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
X 273
Contractor's Address 4 21 MA-546 AV
Cit Coco n'.-& C r eee State F L_ Zip 33073
Qualifier Name Vfa j L U b 1
State Certificate or Registration No. E C_ 13Gt If p ,
4/
E
Phone #
Certificate of Competency No.
pCnnnEn
AI FEB 2 32011
BY: c-ti --
Permit No.t b I ( - 4 3d a
q r
City Miami Shores Village County Miami -Dade Zip 33/ 3
FOLIO / PARCEL #
Is Building Historically Designated YES NO Flood Zone WO
Contractor's Company Name `t" ra C+ i Cd (l+ Phone # q S 4-- G2-5-4557
E -mail to to (,�1.� . Rr c c 4 iGa( i+ e rtvi,o ff
Y
Architect/Engineer's Name (if applicable) Phone #
Va ue of Work For this Permit $ SO. 00 Square / Linear Footage Of Work:
mow.
Tyi e of Wor}i;„ pion teration
❑New ❑ Repair/Replace
til
******** * * * * * * * * * * * * * * * * * * * * * * * * * * ** * ** F * * * * ** * * * * * * * * * * * * * * * * * * * * * * ***
Permit Fee $ /6',�' CCF $ CO /CC $
Notary $ Training/Education Fee $ Technology Fee $
Scanning $ Radon $ DPBR $ Bond $
Double Fee $ Violation date:
Structural Review. $ Total Fee Now Due $ 6 ((,,,, • `r 0
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 re- inspection fee will be charged.
Signature
2
Owner or Agent
The foregoing instrument was acknowledged before me this
day ofO7t , 20 zL, by eki :S)4nf //3 ICX
who is personally known to me or who has produced
As identification and who did take an oath.
Sign:
Print:
w .1 ii4
ISABEII GARLAND
Notary Public, State of Florida
My Comm. Expires Oct. 15, 2013
No. 00899096
FIclA
SEAL d
0 ��g
NOT ARY PUBLIC:
My Commission Expires / j3' /
* * * * * * * * * * * * * * * * * * * * * * * * * * * * **
APPROVED BY
(Revised 07 /10 /07)(Revised 06/10/2009)
/t
Zo Plans Examiner
Engineer
Signature
Contractor
The foregoing instrument was acknowledged before me this
day of K�
who is rr�sonall kno to me or who has produced
as identification and who did take an oath.
NOTARY11.1NLIK: — — _ _ — •
Sign:
Print:
y Commission Expires:
, 20 It, by __cam ►. t_
MARCEAU MARCELIN
Notary Public - State of Florida
m. Expires Oct 5, 2013
Commission # DD 928312
************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
Zoning
Clerk checked
Inspection Number: INSP - 157647 Permit Number: DEMO -2 -11 -309
Scheduled Inspection Date: March 28, 2011
Inspector: Hernandez, Rafael
Owner: MASTER, CHRISTINE
Job Address: 273 NE 98 Street
Miami Shores, FL 33138 -2407
Project: <NONE>
Contractor: PRACTICALITY INC Phone: (954)628 -4557
Building Department Comments
CAP WATER LINE AND DRAIN FOR SHOWER
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
March 25, 2011
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspector Comment
For Inspections please call: (305)762 -4949
Phone Number
I - 3b1
Permit Type: Demolition
Inspection Type: Final
Work Classification: Plumbing
Parcel Number 1132060134420
Page 27 of 27
BUILDING
PERMIT APPLICATION
FBC 20
Permit Type: BUILDING � `, a'� � 614-
A
OWNER: Name (Fee Simple T Tit tl leho der): e/l/?/5 i '! t<
Address: t /i' 9g
City: ! 2 I /0- / 170/2-e 5 State: f
Tenant/Lessee Name:
Email: 05a /2iG6/ p fie/ /gv vg /t/ -7
K JOB ADDRESS: c 7 -3
City: Miami Shores
Folio/Parcel #:
Is the Building Historically Designated: Yes ✓
Contact Phone #:
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. (, l» '301
Master Permit No.
H 10' G, dv\ (J1r .
Akan
County: Miami Dade
CONTRACTOR: Company Name: �+ �� l ��
MAL
Phone #:
Phone #:
:tte off it is`PPhtft Square/Linear Footage of Work:
r
e of'World ''❑A ❑A1tdtation
❑New ❑Repair/Replace
cription of Work: Q '' W d11 s l e 4 C .e t (i of s
DMCIEEW
FEB 2 3 2111 LUI
dr
Phone #: g '7j0 7`7 9/
Zip:
333 •
Zip: 3 / 3 1 -
NO Flood Zone: T
C ' 64 fi . 28
Address:
9 '2.1 /JL)4 ,AVE:
Cit Cocotyuct Creed State: F � --
Qualifier Name: YJe. 5 L It b 11' J G
State Certification or Registration #: CGC 1 r J' O8 38C
Email Address. ui WtP • PrctO icQ L s
Zip:: 30 73
Phone #:
Certificate of Competency #:
0
0'154- r Kci tolti.C,0 �'►'1
DESIGNER: Architect/Engineer: Phone #:
emolition
COLOR THROUGH ROOF TILE IS REQUIRED acknowledged by:
* * * * * * *** * * * * * ** *err * * ******* * * * * * *** * ** F ees * * * * ** * * *, * * * * * * * * * * * * * * ** * * * * * * ** * * *,r r * **
Submittal Fee $50 •CDFA1D Permit Fee $ / � CCF $ CO /CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $ Technology Fee $
Double Fee $ Structural Review $
TOTAL FEE NOW DUE $
Bonding Company's Name (if applicable)
Bonding Company's Address
City State Zip
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City State Zip
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has
commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating
construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS,
WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all
applicable laws regulating construction and zoning.
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR
IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN
FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
RECORDING YOUR NOTICE OF COMMENCEMENT."
Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the . first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
ignature 1“4.4 i ' a 4 J/
Owner or Agent
The foregoing instrument was acknowledg d before oore methi '
/
day of , 20 /1, by G/. :4276`/
who is personally known to me or who has produced
As identi -
1SABEL. GARLAND
NOTARY PUBLIC: ip / r� Notary Public, State of Florida
My Comm. Expires Oct. 15, 2013
No. D0899096
Sign:
Print:
My Commission Expires:/M� /�� O
APPROVED BY
3-1 --- - // Plans Examiner
Structural Review
(Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09)
Signature
day of 2_1,, , 20 j / , by
NOTARY P
Sign:
Print:
My Commission Expires:
The foregoing instrument was acknowledged before me this 2 O
() Ut
who is ersonally know to me or who has produced
as identification and who did take an oath.
c� . •? MARCEAU MARCEI.IN
Notary Public - State of Florida
�, ' Comm. Expires Oct 5, 2013
. 4 ..
Zoning
Clerk