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857 NE 98 St (12)MIAMI SHORES VILLAGE, FLORIDA TILING n, DATE � - 195/ LECTRICAL iI PERMIT IT? 11 017 Contractor's 'LUMBING ❑ License No 'OOFING ❑ Wort to be performed under this Permit O wner of ��. rchitect / :ontractdr T Builder .egal 'Description ddress of ' uilding ,6 Lot ' P _ � CONTRACTOR OR BUILDER y': C am' 6 BL BY Subdi- vision Value of Project $ This permit is grante to the contractonfor builder named above to construct the building or to install the equipment or device described in the application ,erefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any plans, lrawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked at any me if the work is not done in compliance with such ordinances or if the plans are changed without authorization. A further condition upon which this permit is anted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and regulations ,ertaining to the work covered hereby whether shown on the plans or drawings or ,in the statemen : or specifications and that he assumes responsibility for work one by his agents, servants or employees. Signed • f � t `,� r , BY � I�T9P . R ' Amt. of Permit $ In consideration of the issuance to me of this permit I agree t9G perform the work covered hereunder in compliance with all ordinances and regulations rtaining thereto and in strict conformity with the plans, drawings, ,statements or specifications submitted to the proper authorities of Miami Shores Village. accepting this permit I assum responsibility for all work done , eitjier, myself, my agent, servant or employee. AUTHORITY BUILDING p MIAMI SHORES VILLAGE, FLORIDA w c } A ief Date > 19 =;% ELECTRICAL PLUMBING ❑ PERMIT RMIT N9 9784 Contractor's ROOFING ❑ License No Owner of Building _7/ ''G-f;'? 9 Architect Contractor r y or Builder - - r -_ Legal Lox Description _ ❑ Work to be performed under this Permit Subdi- vision Sq. Ft. Address of L r , Value of I I Amount of Building C �_� ` I Project Permit $ CONTRACTOR or BUILDER B1 J This permit is granted to the contractor or builder named above to construct the building or to install the equipment or device described in the applica- tion herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any plans, drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked at any time if the work is not done in compliance with such ordinances or if the plans are changed without authorization. A further condition upon which this permit is granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and regulations pertaining to the work covered hereby whether shown on the plans or drawings or in the statements or specifications and that ho assumes respon- sibility for work done by his agents, servants or employees. Signed /G7 % (INSPECTOR) BY In consideration of the issuance to rrje of this permit/A agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee. a • BY AUTHORITY BUILDING ❑ ELECTRICAL PLUMBING ROOFING Owner of Building ' Architect - Contractor or Builder Legal . Description Address of Building Lot PERMIT IT? 11704 Work to be performed under this Permit CONTRACTOR OR BUILDER MIAMI SHORES VILLAGE, FLORIDA Bl. Subdi- vision Value of Project $ DATE 195 Contractor's License No Amt. of Permit $ This permit is granted to the contractor or builder named above to construct the building or to install the equipment or device described in the application herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any plans, drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked at any time if the work is not done in compliance with such ordinances or if the plans are changed without authorization. A further condition upon which this permit is granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and regulations pertaining to the work covered hereby whether shown on the plans or drawings or in the statements or specifications and that he assumes responsibility for work done by his agents, servants or employees. Signed: BY INSPECTOR In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee, BY AUTHORITY ELECTRICAL � TYPE Minimum Fee QTY. TYPE Dryer 1 QTY. TYPE Outlet, fl plian.e .' • e rvice • dip. QTY. TYPE Repair QTY. A/C Central 1 -3 Ton Dryer Vents, Number of Fan Outlet, Wall Ductwork, Cost of Service, Temporary Barbecue A/C Central 4 -7 Ton Process/Pressure Piping li7/ !j 7J Outlet, Switch Pressure Vessel Signs Pool Piping A/C Central 8 -15 Ton Sprinkler Repair Fixture - Fluorescent Oven Space Heater (kw) A/C Central 16-20 Ton Fixture Light Parking Lot Lights Cap - Water Spas/Hot Tubs Gas - Appliance A/C Central 20+ Ton Pump, Domestic cUl :gs mi FPL - Load Central wa1 Plugmold/Strip Subfeeds, No. of Amps A/C Window Posts Pump, Fire Stand Swim Pool, Commercial Temporary Toilet Air Conditioners Catch Basin Garbage Disposal Range/Range Top Swim Pool, Residential Chiller Generators, etc. Receptacles Gas Piping Switchboards Pump, Replace - Pool Clear Violations Urinal Heat Recovery Refrigerator, Comm. (p/PH) Temp Serv., Construction Compactor ow -vo , 1 ur:lar Refrigerator, Domestic Discharge Well Temp for Test - 30 days Ice Maker Deep Freezer Pump, Sump Relay Repair Roof Inlet Low -volt, Fire Renew - Temp Service Dishwasher Demolition Disposal Low -volt, Intercom/Teleph. Repair Circuits Domestic Well Laundry Tray Dishwasher Septic Connection Low -volt, Television Service, Number of Amps Drainfield, 4" Tile/Res. MECHANICAI TYPE, I Minimum Fee QTY. TYPE II Condensate Drain r 1 QTY, TYPE: Generator QTY. TYi'E QTY. Refrigeration, Tons A/C Central, Tons Cooling Tower Heating Strips, each Vent Hood, Cost A/C Wall/Win. Tons Dryer Vents, Number of Paint Booth Ventilation, Cost Air Handler, Tons Ductwork, Cost of Piping, Flammable Liquid Periodic Inspections Barbecue Fire Sprinkler System Process/Pressure Piping Bath Fan - Vented, # Fireplaces, Number of Pressure Vessel PLUMBING i TYI'E: I A/C Condensate QTY. TYPE J Drains, Roof QTY. TYPE Miscellaneous Fixture QTY. TITE Soakage Pit QTY. Bath Tub Drinking Fountain Miscellaneous Repairs Solar Water Heater Bidet Filter Replace Pool Piping Sprinkler Repair Cap - Fixture Fountain Pump and Abandon Sprinkler System Cap - Water Gas - Appliance Pump, Domestic Supply, AC Well Cap - Sewer Gas - Natural Pump, Fire Stand Temporary Toilet Catch Basin Gas - Propane Pump, Re- circulate Temporary Water Closet Clothes Washer Gas Piping Pump, Replace - Pool Urinal Dental Chair Grease Trap Pump, Sprinkler Utility - Sewer Discharge Well Ice Maker Pump, Sump Relay Repair Roof Inlet Utility - Water Vacuum Pump Water Closet Dishwasher Indirect Wastes Disposal Interceptor Domestic Well Laundry Tray Septic Connection Water Heater Drainfield, 4" Tile/Res. Lavatory Septic Tank Water Ileater New Drains, Area Meter Set (Gas) Sewer Connection Water Re -pipe Drains, Floor Minimum Fee Shower Water Service Drains, French Miscellaneous Equipment Sink Well, Supply Page 3 • • . PERMIT APPLICATION . . •; • ..' .. •.. INSTRUCTIONS: Please indicate the type of work being perfor toad bpd qu2tgt tyfi.$) in:tht $pace provided below. • RECEIVED AND REVIEWED BY: DATE: SECTION BY DATE Zoning Electrical ,-, Mechanical Plumbing Fire Public Works Structural Building Official Page 4 OFFICE USE ONLY ❑ OWNER - BUILDER FORM (Attach) .. ••• • ❑ FIRE DEPARTMENT • • • • • • APPROVAL (Commercial f "' multi - family) ❑ CONCURRENCY (New Construction) O OTHER (Specify & Attach) REVIEWED AND PREPARED BY •. • • • • • • • • • ••• • • • • • • • • • ' • • • • ••• • ••• • • • • • • • • • • • • •• • ••• • •. • C}IECKLIST ••• ❑ PROOF OF OWNERSHIP •. • (.Atta°h • • • • • • • • . • • • • • • • •[J • P �6 % D M APPROVAL (Septic / Sewer) O IMPACT FEE (New Construction) O OTHER (Specify & Attach) $3.00 per page (Scanning Fee) $ Miami Shores Village Bond Metropolitan Dade County (C.C.F.) Inspector State Educational Fund $ State DCA (Radon) $ Code Enforcement Fine $ Zoning Review $ 60 , 0 (sq.ft. = x/I000 x ¢.60) (¢.005 / sq.ft.) (¢.0I /sq.ft.) PERMIT APPLICATION ❑ CONDO ASSOCIATION APPROVAL (Attach) ❑ BPR APPROVAL (Restaurants) ❑ CONTRACTOR REGISTRATION (On File) PERMIT FEES TOTAL $ a , 0 ISSUING OFFICIAL DATE: CONDITION OF APPROVAL Revised July 2001 10050 N.E. 2ND AVE., MIAMI SHORES, FL • (305) 795 -2207 • FAX (305) 756 -8972 • http : / /www.miamishoresvillage.com CONTRACTOR N f AJ D L1'11 !1" -1 21/0 1-12._.0 20Y-4 Name ■ DAP • L o '+� 6 es 6 / t,71 33di1 Address /'gip -- 4 , Telephone .. isp / -y s � v ✓ Fax Qualifier Name 6 v , / ,Q PROPERTY OWNER N f AJ D L1'11 !1" -1 21/0 1-12._.0 20Y-4 Addr s 3 A f1,{0 Ste► 9 r S c,. 3335 Home Telephone 3 743 4 . 7 , as 6f3 TIV roi -- q Do / (S-2)) o-ga5 Fax TYPE OF MANAGEMENT (./ ) New Construction Enclosure Alteration Exterior Re 1 air Alteration Interior Demolish Relocation of Structure Shell Only Foundation Only Add'I Attachment Other Add'I Detachment Other 4'1 : i :!❑ lib r1:Mxau l [l INSTRUCTIONS u 'The following steps must be taken to :I'obqin permit from the Miami S Village: '1 Step 1. Step 2. Submit the completed application with all necessary documents to the Building, Planning and Zoning Department for processing. During the processing of your application, you may be asked to submit additional information. APPLIICATION Job Address: Folio Number 1 1 3aoW 01 Description of Work Lot 1 Z t I ci Block 4'P q#17z- ✓ deL! C$t- Subdivision 1111011)1 „Nwr'P$ p I N OPG 39 Zoning Linear Feet n Current Use of Property K -s cde..iC -t Square Feet Units Floors Proposed Use of Property R es �C. Value of Work g Bldg Value Tenant Information Tax Assessed/Appraised Value Flood Zone Base Floor Elev. PERMIT TYPE Building Electrical Mechanical Plumbing LPGX Roofing Fence Other ARCHITECT Name License No. Address Telephone Fax • • •. Complete the attached permit application which must be signed by the proPejt w c�a:fil. Bo* si gnatures must be notarized. Please print or type to allow for a more accurate processing of your application.. Iftoo l v ort wtlt tone, a roofing application must be submitted • along with this permit application. ' • • • • • • •. . F57 AJE?8 S&+ ft z(Sh e -i l 3� Address Apt. City State SyS44 M = 4v, ( ✓) PERMIT CHANGE (a/ ) Chg. Contractor Renewal Revision Extension Supplement Reinspection Mister hermit NQ • •_ Subsidialy P etrritt N. ••• ••• ENGINEER Name License No. Address • • • •• • • • • • • • ••• • : •PERMIT APPLICATION Telephone Fax • .. • ••. .• • ••. Page 2 1. •. • • • • • • • • • • • • • • ••• • • • • • •• •••. • • • • • • • • • • PERMIT APPLICATION I11l'(RTANT NOTI DO NOT BEGIN ANY WORk•WPTHO UT 11.t(1t G f2ECEPVE'D • ?&bR VALIDATED PERMIT AND PERMIT CARD. Applying for a permit does not grant the right to begin constructio?? T{OLhkS OF CONSTRUCTION are limited to: Monday through Friday from 7:30 a.m. to 6:00 p.m., and Saturday from 8:00 a.m. to 5:00 p.m. No inspections will be conducted on weekends or holidays: 2. All construction of demolition arms M11ST BE •MAIrfT�ICIEc IVA•CLEAN, NEAT AND SANITARY CONDITION free from construction debris. 3. STREETS AND NEIGHBORING) OPPTtES•S4AIlL lr KE''1' .FREE FROM DIRT AND DEBRIS. 4. SWALES MUST BE PROTECTED FROM BelIttG:DpMIGCD'13,Y OR VEHICLES, AND MAY NOT BE USED FOR STORAGE. A bond is required for work in or near the stnet/sitiesOalr. • ' 5. CONSTRUCTION TRAILERS ARE PROHIBITED ON SINGLE FAMILY RESIDENTIAL CONSTRUCTION SITES. Other construction may have a trailer which requires a separate permit. 6. PORTABLE TOILETS for a construction site require a separate permit. 7. DO NOT DISCHARGE WATER INTO THE RIGHT OF WAY OR STORM DRAINS without approval from the Building, Planning and Zoning Department. 8. EQUIPMENT AND MATERIALS SHALL BE STORED at least 10 feet from the edge of pavement. 9. Department of Health and Rehabilitative Services (HRS) approval is , required for applications involving septic tanks. Department of Environmental Resources Management (DERM) and/or Miami -Dade Water and Sewer Department (MDWASD) approval is required for applications involving sewers. AFFIDAVIT - Please read carefully. Application is hereby made to obtain a permit to do work and installation as indicated. I, the OWNER of the property, certify that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that separate permits are required for ELECTRICAL, PLUMBING, POOL, EXTERIOR DOOR, MECHANICAL, WINDOW, FENCE, DRIVEWAY, ROOFING and SIGNS and there may be additional permits required from other governmental agencies. I, the OWNER of the property, have disclosed all information related to any work at the property performed in the prior twelve months to the Building Official. Further, I am fully aware that if the cumulative cost of work to my home or business under this and any other permit equals or exceeds fifty percent (50 %) of the fair market value of the structure, the entire structure must meet the present federal flood criteria for finished floor elevation. I am also fully aware that if the total cost of work to my home or business under this and any other permit exceeds fifty percent (50 %) of the replacement cost of the structure, then the entire structure must conform to the current code requirements of the Building Code. WARNING 0 OWNER: Your failure to record a NOTICE OF COMMENCEMENT may result in you paying twice for improvements to your property. If you are spending more than $2,500 or intend to obtain financing, you may wish to consult with your attorney or lender before recording your Notice of Commencement. The Notice of Commencement must be recorded at: 22 N.W. 1st Street, 1" Floor, (305) 679 -1078. Once recorded, the Notice of Commencement must be POSTED AT THE JOB SITE in accordance with Section 713 -35 of Florida Statutes. Review the brochure at Village Hall on Construction Lien Law and Choosing a Contractor. ST OF FLO 'gn�� IDA, LINTY OF MIAMI -DADE [h1 J'dL z- 6 40_A. Print Name Sworn to and subscribed before r this r/ day of " �*•, JULIO ROBLES SEAL: MY .OMMISSION # CC 921872 t , EXPIRES: June 4, 2004 . fi4 2 . Borcd30 Thu Notary Public Underwruura • • • -- Personally known OR, Produced Identification Type of Identification Produced: STATE OF FLORIDA Signature nt Name Sworn to and subscribed before me this 4, day o Signature o SEAL: Personally known OF MIAMI - DADE Publics State of Flori ..... JUDO ROBLES MY COMMISSION # CC 921872 EXPIRES: June 4, 2004 r Bonded Tin Notary Publk Undcrwrttera OR, Produced Identification Type of Identification Produced: Miami Shores Village 10050 NE 2nd Avenue Phone: 305- 795 -2204 Permit Number: EL2002 -405 Printed: 12/3/2002 Applicant: ALEXANDER Owner: GRAU JOB ADDRESS: 857 NE 98 Contractor BRINKS HOME SECURITY INC Local Phone: 305 - 558 -6625 Parcel # 1132060142500 Permit Status: Approved Permit Expiration: 6/1/2003 Work: BURGLAR ALARM Electrical Permit GRAU ALEXANDER ST Contractor's Address: 5765 NW 158 ST Construction Value: $350.00 Page 1 of 1 Legal Description: MIAMI SHORES SEC 3 PB 10 -37 LOTS 18 & 19 BLK 72 LOT SIZE Fees: Description Amount FEE2002 -6871 Building Permit Application Fee $60.00 FEE2002 -6873 CCF $0.60 Total Fees: $60.60 Total Fees: $60.60 Total Receipts: $0.00 If there is no permit package accessible on the job -site for inspectors to verify, there will be no inspections. Re- inspection fee is $50.00, which must be paid in advance before calling for another inspection. This Permit is granted to the contractor or builder named above to construct the building or to install the equipment or device described in the application herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any plans, drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked at any time if the work is not done in compliance with such ordinances or if the plans are changed without authorization. A further condition upon which this permit is granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and regulations pertaining to the work covered hereby whether shown on the plans or drawings or in the statements or specifications and that he assumes responsibility for work done by his agents, servants or employees. (INSPECTOR) BY: In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responisibility for all work done by either myself, my agent, servants or employes. Signed: (Contractor or Builder) BY: Grau 001 This Document Prepared By and Return to: Charles Z. Kalchman, Esq. 17071 W. Dixie Highway North Miami Beach, FL 33160 Tel. (305) 945 -1851 Parcel ID Number: 11- 3206 -014 -2500 Grantee #1 TIN: Grantee #2 TIN: Warr,. my Deed This Indenture, Made this 31st day of October , 2002 A . , Between Lori F. Grau a /k /a Lori B. Grau, an unremarried widow, individually and as Guardian of the property of Lauren Katherine Grau, Charles Franklin Grau, and Benjamin Franklin Grau, of the County of Broward , state of Florida Edward G. Roach and Cindy M. Kim, husband and wife whose address is: 857 NE 98 Street, Miami Shores, FL 33138 of the County of Miami -Dade Witnesseth that the GRANTOR, for and in consideration of the sum of TEN DOLLARS ($10) and other good and valuable consideration to GRANTOR in hand paid by GRANTEES, the receipt whereof is hereby acknowledged, has granted, bargained and sold to the said GRANTEES and GRANTEES' heirs, successors and assigns forever, the following described land, situate, lying and being in the County of Miami-Dade State of Florida to wit: Lots 18 and 19, Block 72, of MIAMI SHORES SECTION 3, according to the Plat thereof, as recorded in Plat Book 10, Page 37, of the Public Records of Miami -Dade County, Florida. SUBJECT TO: (1) Real Estate Taxes for the year 2002 and thereafter; and (2) Conditions, restrictions, limitations, and easements of record, if any, without reimposing same. and the grantor does hereby fully warrant the title to said land, and will defend the same against lawful claims of all persons whomsoever. In Witness Whereof, the grantor has hereunto set her hand and seal the day and year first above written. Signed, sealed and delivered in osr Printed Name: Witness Q\1 GfaY10,in L in Printed Name: L' mt1rt • /.(.�f 1—C 4 1 4,4 11 1 j Witness t : CHARLES CHARLES Z KALCHMAN * MY COMMISSION * DD 057565 ni EXPIRES: September 22, 2005 Bonded Thru Budget Notary SerVICOS State of Florida , grantees. Grau ividually P.O. Address: 1311 St Tropez Circle, #1608 Weston, FL 33326 , grantor, and DOLLARS, `— `— (Seal) a /k /a Lori B. Grau, and as guardian STATE OF Florida COUNTY OF Miami -Dade The foregoing instrument was acknowledged before me this 31st day of October , 2 0 0 2 by Lori F. Grau a /k /a Lori B. Grau, individually and as Guardian of the property of Lauren Katherine Grau, Charles Franklin Grau and Benjamin Franklin Grau, she is personally known to me or she has produced her Florida driver ' s license as identification. Laser Generated by t Display Systems, Inc., 2000 (863) 763 -5555 Form FLWD -I l f� }- 1� L 1 C�l.t ✓`�` Printed Name: C LCtf k le,j Notary Public My Commission Expires: Grau 0 Bill of Sale Know All Men By These Presents, That this 31st day of Oc tober , 2 0 0 2 A . , That Lori F. Grau, an unremarried widow, individually and as Guardian of the property of Lauren Katherine Grau, Charles Franklin Grau and Benjamin Franklin Grau, State of Florida first party, of the County of Broward , Edward G. Roach and Cindy M. Kim, husband and wife whose address is: 857 NE 98 Street, Miami Shores, FL 33138 of the County of Miami -Dade All being located at: 857 NE 98 Street, Miami Shores, FL 33138 Signed, cea!ed and dole o::r ;;ces2rx:e: Printed Name: Witness 9 Printed Name: Cr./fyt1,_LE/ .91-40-44%04.01A/ Witness Laser Generated by © Display Systems, Inc., 2000 (863) 763 -5555 Form FLBOS -I and State of Florida , second parties. Witnesseth that the FIRST PARTY, for and in consideration of the sum of TEN DOLLARS ($10) DOLLARS, and other good and valuable consideration to FIRST PARTY in hand paid by SECOND PARTIES, the receipt whereof is hereby acknowledged, has granted, bargained, sold, transferred and delivered to the said SECOND PARTIES and SECOND PARTIES' heirs, successors and assigns forever, the following goods and chattels: All improvements and attached items, including fixtures, built in appliances, ceiling fans, light fixtures, attached wall to wall carpeting, rods, draperies, and other window coverings. To Have and to Hold the same unto second parties, and the second parties' heirs, personal representatives, successors and assigns forever. And the first party covenants with the second parties, and the second parties' heirs, personal representatives, successors and assigns that the first party is the lawful owner of the said goods and chattels; that they are free from all encumbrances; that the first party has good right to sell and transfer said property, goods and chattels; and that the first party will warrant and defend the sale and transfer of the said property, goods and chattels hereby made to the second parties, and the second parties' heirs, personal representatives, successors and assigns, against the lawful claims and demands of all persons whomsoever. This covenant shall be binding upon the first party and the first party's heirs, personal representatives, successors and assigns. In Witness Whereof, the first party has hereunto set her hand and seal the day and ear first above written. (Seal) i F. Grau, individually and as Guardian P.O. Address: 1311 St Tropez Circle, #1608 Weston, FL 33326 STATE OF Florida COUNTY OF Miami - Dade The foregoing instrument was acknowledged before me this 31st day of October , 2 0 0 2 by Lori F. Grau, individually and as guardian of the property of Lauren Katherine Grau, Charles Franklin Grau and Benjamin Franklin Grau, minors, she is personally known to me or she has produced her Florida driver's license as identification. P�e0c CHARLES Z KALCHMIW e (j( Gtr r/`-r i ✓w� (GC? MY COMMISSION # DD 057565 Printed Name : EXPIRES: September 22, 2005 14i� / d>4, Banded TIw Budget Notary SNOODS Notary Public My Commission Expires: OWNER'S AFFH)AVIT NON - FOREIGN CERTIFICATE AND REQUEST FOR TAXPAYER IDENTIFICATION NUMBER STATE OF Florida COUNTY OF Miami -Dade BEFORE ME, the undersigned authority, personally appeared Lori F. Grau, individually and as guardian of the property of Lauren Katherine Grau, Charles Franklin Grau and Benjamin Franklin Grau, minors, (the "Seller "), ( "Seller" :refers to singular or plural as context requires) who, first being duly sworn, deposes and says: A. OWNER'S AFFIDAVIT 1. Seller is the owner of the following described property (the "Property "): Lots 18 and 19, Block 72, of MIAMI SHORES SECTION 3, according to the Plat thereof, as recorded in Plat Book 10, Page 37, of the Public Records of Miami -Dade County, Florida. Street Address:857 NE 98 Street, Miami Shores, FL 33138 2. There is no outstanding contract for the sale of the property to any person or persons whomsoever, nor any unrecorded deed, mortgage or other conveyances affecting the title to the Property. 3. There are no liens, encumbrances, mortgages, claims, boundary line or other disputes, demands or security interests in, on or against the Property or any goods, furnishings, appliances, fixtures or equipment now installed in or which are to be affixed to the Property; (except for mortgages described in the deed given by the undersigned); that there are no unpaid taxes, levies, assessments, paving liens or utility liens against the Property (other than real estate taxes for the current year). 4. There have beer no improvements made upon the Property within the past ninety (90) days for which there remain any outstanding and unpaid bills for labor, materials or supplies for which a lien or liens might be claimed by anyone. 5. There are no matters pending against Seller which could give rise to a lien that would attach to the Property during the period of time between the effective date of the title insurance commitment and the time of recording of the instruments evidencing the Buyer's fee simple or other interests in the Property; and that the Seller has not executed and will not execute any instrument that would adversely affect the title to the Property from the date of this Affidavit forward. 6. There are no judgments, claims, disputes, demands or other matters pending against Seller that could attach to the Property. Seller has complied with the Florida Sales Tax laws where applicable. Seller acknowledges responsibility for water, sewer and electrical consumption charges through date of closing or occupancy by Buyer, whichever first occurs. 7. Seller is in sole constructive or actual possession of the Property and no other person has any right to possession of the Property, or asserts any claim of title or other interests in it. 8. Seller represents there are no violations of governmental laws, regulations or ordinances pertaining to the use of the Property. Laser Generated by © Display Systems, Inc., 2000 (863) 763 -5555 Form FLAFF -5 Owner's Affidavit -Pa 2 B. NON- FOREIGN CERTIFICATE AND REQUEST FOR TAXPAYER IDENTIFICATION NUMBER Section 1445 of the Internal Revenue Code provides that a transferee ( "Buyer ") of a U.S. real property interest must withhold tax at a rate of 10% of the amount realized on the disposition if the transferor ( "Seller ") is a foreign person. To inform the Buyer that withholding of tax is not required upon the disposition of a U.S. real property interest by the Seller, the undersigned hereby swears, affirms and certifies the following as or on behalf of the Seller: 1. Seller's Legal Name Is: Lori F. Grau, an unremarried widow, Charles Franklin Grau and Benjamin Franklin Grau. 2. Seller's Home Address or Office Address if Corporation, Partnership or Trust: 1311 St Tropez Circle, #1608, Weston, FL 33326 3. Seller is not a non - resident alien (if individual) or a foreign corporation, foreign partnership, foreign trust or foreign estate (as those terms are defined in the Internal Revenue Code and Income Tax Regulations). In connection with the sale or exchange of the Property you are required by law to provide Siedman, Prewitt & Dibello, Attorneys at Law with your correct taxpayer identification number (TIN). If ycu do not so provide your TIN, you may be subject to civil or criminal penalties imposed by law. 4. Seller's Taxpayer Identification Number: (TIN or SSN for Individuals) NAME SOCIAL SECURITY NUMBER Lori F. Grau 068 -54 -9375 Charles Franklin Grau 590 -25 -6862 Benjamin Franklin Grau 590 -25 -6861 5. For purposes of reporting this transaction to the Internal Revenue Service on Form 1099 -S, the property is Seller's (check one) : Principal Residence Other Real Estate This taxpayer identification number is being provided in connection with a real estate transaction. The undersigned understand that this Certificate may be disclosed to the Internal Revenue Service by the Buyer and that any false statement contained herein could be punished by fine, imprisonment or both. Under penalties of perjury, I declare that I have examined this certification and to the best of my knowledge and belief it is true, correct and complete, and I further declare that :I have authority to sign this document as or on behalf of the Seller, and that the number shown on this statement is Seller's correct TIN. Seller states that this instrument is given for the express purpose of inducing Edward G. Roach and Cindy M. Kim, husband and wife to purchase Lhe Propercy and to cause Siedman, Prewitt & Dibello, Attorneys at Law as agents for Stewart Title Guaranty Company to insure title to said property. This Affidavit is made under the full understanding of the law regarding liability for any misrepresentation herein. DATED this 31st day of October guardian Laser Generated by C Display Systems, !nc., 2000 (863) 763 -5555 Form FLAFF -5 ri F. Grau, individually and as Grau 001 Owner's Affidavit - Page 3 STATE -OF ' Florida COUNTY OF Miami - Dade Sworn to and subscribed before me this 31st day of October , 2002 by Lori F. Grau, individually and as guardian of the property of Lauren Katherine Grau, Charles Franklin Grau and Benjamin Franklin Grau, minors, she is personally known to me or she has produced her Florida driver's license as identification. t r Laser Generated by C Display System, Inc ., 2000 (863) 763 -5555 Form FLAFF -5 Printed Name: (^ h .- •�/{,,,.t4-cfdx -cngnJ Notary Public My Commission Expires: k, CHARLES Z KALCHMAN * MY COMMISSION # DD 057565 EXPIRES: September 22, 2005 d'i4P o F ! S Balled Thru Budget Notary Service Permit: No - 9 C I-1fT e Amount of Permit $ STATE OF FLORIDA, } COUNTY OF DADE. MIAMI SH • RES VILLAGE ELECTRICAL INSPECTION DEPARTMENT APPLICATION FOR ELECTRICAL PERMIT Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building of other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Fio:ida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at building during progress of work. J�� `(' Z1 /G� �7 �/� No Jr L ' -tree / Owner's Name and Address Registered Architect and/or Engineer `� A k // �/ x) • (Signed) E loyin Electrician's Name 6e41217/'4 / A XE-' C �R / C No z .,--? // ,19 / /1 _ Lo and i ga Block eerpd n Lot ``�� ` Street and Number where work is to be performed —No i.�7 ... : . //...I T A State work to be performed and purpo of building (By Floors) New Building Remodeling Addition Repairs Overhead Feeders service e Underground -- Size eeders Conduit Main Sw Type of Installatiob Conduit Tubing B.X.L Metal Moulding � 4 - YL c- Fe _ 73R E:v9_ l( Amps (Signed) M, Date /,t " `'Street `- d J J Subdivision ...�... S.46- _ -,3 S , t✓!...C. `^` 3 / 4 7-1 No. of Stories Main Fuses Amps Electrical Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor under the Florida Workmen's Compensation Act. being Section 5966, Compiled General Laws of Florida Permanent Supplement, and has complied with the provisions thereof, and will require similar compliance from all contractors or sub-contractors employed by him in the work to be performed under this permit; and will post or cause to be posted for inspection on the site of the rk such public notice or n cea as are required by the Act. The undersigned agrees to employ only such subcontractors, on work to be per ed under thisit, a )L re licensed by Miami Shores Village. Master Electrician. ss. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the of the above described construction, and he has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated are true. My Commission Expires Notary Public, State of Florida NOTE: A re-inspection fee of $1.00 will be made when such re• inspection is made necessary by improper notice for inspection, or faulty materials and /or workmanship. SWITCH OUTLETS LIGHT OUTLETS PLUG RECE'P'T'S FIXTURES NO LAMPS R[FRIG. OUTLET IRON OUTLET RANGE OUTLET RANG[ CONN. WATER HEATER W. HEAT. CONN. SPACE H STRIP HEATER TOTAL CONTR. LIST CHECK ENT. SW. DIST. CAB. SERVICE TEMP. SERVICE PERM. MOTORS 0.1 MP MOTORS 1.5 HP NEON TRANS. RADIO TOTAL CONTR. LIST CHECK Permit: No - 9 C I-1fT e Amount of Permit $ STATE OF FLORIDA, } COUNTY OF DADE. MIAMI SH • RES VILLAGE ELECTRICAL INSPECTION DEPARTMENT APPLICATION FOR ELECTRICAL PERMIT Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building of other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Fio:ida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at building during progress of work. J�� `(' Z1 /G� �7 �/� No Jr L ' -tree / Owner's Name and Address Registered Architect and/or Engineer `� A k // �/ x) • (Signed) E loyin Electrician's Name 6e41217/'4 / A XE-' C �R / C No z .,--? // ,19 / /1 _ Lo and i ga Block eerpd n Lot ``�� ` Street and Number where work is to be performed —No i.�7 ... : . //...I T A State work to be performed and purpo of building (By Floors) New Building Remodeling Addition Repairs Overhead Feeders service e Underground -- Size eeders Conduit Main Sw Type of Installatiob Conduit Tubing B.X.L Metal Moulding � 4 - YL c- Fe _ 73R E:v9_ l( Amps (Signed) M, Date /,t " `'Street `- d J J Subdivision ...�... S.46- _ -,3 S , t✓!...C. `^` 3 / 4 7-1 No. of Stories Main Fuses Amps Electrical Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor under the Florida Workmen's Compensation Act. being Section 5966, Compiled General Laws of Florida Permanent Supplement, and has complied with the provisions thereof, and will require similar compliance from all contractors or sub-contractors employed by him in the work to be performed under this permit; and will post or cause to be posted for inspection on the site of the rk such public notice or n cea as are required by the Act. The undersigned agrees to employ only such subcontractors, on work to be per ed under thisit, a )L re licensed by Miami Shores Village. Master Electrician. ss. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the of the above described construction, and he has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated are true. My Commission Expires Notary Public, State of Florida NOTE: A re-inspection fee of $1.00 will be made when such re• inspection is made necessary by improper notice for inspection, or faulty materials and /or workmanship. a Permit No Ready Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at building during progress of work. Owner's Name and Address Howe N S 4 Registered Architect and /or Engineer Employing Electrician's t.Z':LQ... .C.Q.A No. 6444. Street N • E ° Lfth Ave Location and Legal Description Lot Block Subdivision s + Street and Number where work is to be performed —No 8 57 1' ° E , 98th Y Street State work to be performed and purpose of building (By Floors) New Building Remodeling Addition Repairs XX.X 1 -60 / Service Underground aoX 2 Sets Amps Size Feeders 2 ± 0 Conduit 2 1 j 40 fain Sw 1-100 Amps 200 Main Fuses Under Type of Installation— Conduit X Tubing B.X.L .Metal Moulding Amount of Permit $.. Y a 00 STATE OF FLORIDA, COUNTY OP DADE: f 8A ' MIAMI SHD[RES VILLAGE ELECTRICAL INSPECTION DEPARTMENT APPLICATION FOR ELECTRICAL PERMIT Date January 28 1955 857 Street ' ° � ' ° 9 St No. of Stories (Signed) Electrical Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 3966, Compiled General Laws of Florida Permanent Supplement, and has complied with the provisions thereof, and will require similar compliance from all contractors or subcontractors employed by him in the work to be performed under this permit; and will post or cause to be posted for inspection on the site of the work such public notice or notices as are required by the Act. The undersigned agrees to employ only such subcontractors, on work to be performed under this permit, as are licensed by Miami Shores Village. (Signed„ Master Electrician. Before me, tbk undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the of the above described construction, and he has carefully read the foregoing application, and that he did sign the same, and that all fach, therein by him stated are true. My Commission Expires Notary Public, State of Florida NOTE: A re•inspection fee of $1.00 will be made when such re• inspection is made necessary by improper notice for inspection, or faulty materials and /or workmanship. SWITCH OUTLETS LIGHT OUTLETS PLUG RECe'P'T'S FIXTURES NO. LAMPS RCPRI0. OUTLET IRON OUTLET RANG! OUTLET RANGE CONN. WATER HEATER W. HEAT. CONN. SPACE HEATER STRIP HEATER TOTAL CONTR. LIST CNaCK ENT. SW. DIST. CAS. SERVICE TEMP. SERVICE PERM. MOTORS 0.1 HP MOTORS 1.5 HP NE 9N TRANS. RADIO TOTAL CONTR. LIST - 7 / CHECK a Permit No Ready Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at building during progress of work. Owner's Name and Address Howe N S 4 Registered Architect and /or Engineer Employing Electrician's t.Z':LQ... .C.Q.A No. 6444. Street N • E ° Lfth Ave Location and Legal Description Lot Block Subdivision s + Street and Number where work is to be performed —No 8 57 1' ° E , 98th Y Street State work to be performed and purpose of building (By Floors) New Building Remodeling Addition Repairs XX.X 1 -60 / Service Underground aoX 2 Sets Amps Size Feeders 2 ± 0 Conduit 2 1 j 40 fain Sw 1-100 Amps 200 Main Fuses Under Type of Installation— Conduit X Tubing B.X.L .Metal Moulding Amount of Permit $.. Y a 00 STATE OF FLORIDA, COUNTY OP DADE: f 8A ' MIAMI SHD[RES VILLAGE ELECTRICAL INSPECTION DEPARTMENT APPLICATION FOR ELECTRICAL PERMIT Date January 28 1955 857 Street ' ° � ' ° 9 St No. of Stories (Signed) Electrical Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 3966, Compiled General Laws of Florida Permanent Supplement, and has complied with the provisions thereof, and will require similar compliance from all contractors or subcontractors employed by him in the work to be performed under this permit; and will post or cause to be posted for inspection on the site of the work such public notice or notices as are required by the Act. The undersigned agrees to employ only such subcontractors, on work to be performed under this permit, as are licensed by Miami Shores Village. (Signed„ Master Electrician. Before me, tbk undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the of the above described construction, and he has carefully read the foregoing application, and that he did sign the same, and that all fach, therein by him stated are true. My Commission Expires Notary Public, State of Florida NOTE: A re•inspection fee of $1.00 will be made when such re• inspection is made necessary by improper notice for inspection, or faulty materials and /or workmanship. Permit No Owner's Name and Address MIAMI SHORES VILLAGE ELECTRICAL INSPECTION DEPARTMENT APPLICATION FOR ELECTRICAL PERMIT 'f Date r- Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at building during progress of work. o Registered Architect and /or Engineer e Employing Electrician's Name 4 /... .. .. .'la. . e :.i�..: ,0 C. No te^ n Street. y(. 1 .. 9J.. Location and Legal Description Lot Block Subdivision C y Street and Number where work is to be performed —No ? L 2 Street 4 4 C d S' <.... f State work to be performed and purpose of building (By Floors) New Building Remodeling Addition Repairs No. of Stories No t S ! Street Service Overhead Size Feeders Conduit Main Sw. Amps Main Fuses Amps Underground Type of Installation— Conduit Tubing B.X.L Metal Moulding Amount of Permit $ (Signed) Electrical Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supplement, and has complied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work to be performed under this permit; and will post or cause to be posted for inspection on the site of the work such public notice or notices as are required by the Act. The undersigned agrees to employ only such sub-contractors, on work to be performed under this permit, as are licensed by Miami Shores Village. STATE OF FLORIDA, COUNTY OF DADE. Il Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the..... of the above described construction, and he has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated are true. SS. My Commission Expires Notary Public, State of Florida OTE: A re-inspection fee of $1.00 will be made when such re-inspection is made necessary by improper notice for inspection, or faulty erials and /or workmanship. (Signed) ti r �vl aster Electrician. SWITCH OUTLETS LIGHT OUTLETS PLUG RECE•P•T'S FIXTURES NO. LAMPS REFRIG. OUTLET IRON OUTLET RANGE OUTLET RANGE CONN. WATER HEATER W. HEAT. CONN. SPACE HEATER STRIP HEATER TOTAL CONTR. LIST CHECK ENT. SW. DIST. CAB. SERVICE TEMP. SERVICE PERM. MOTORS 0.1 HP MOTORS 1•3 HP N EON TRANS. RADIO TOTAL CONTR. LIST or ' ) ' CHECK Permit No Owner's Name and Address MIAMI SHORES VILLAGE ELECTRICAL INSPECTION DEPARTMENT APPLICATION FOR ELECTRICAL PERMIT 'f Date r- Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at building during progress of work. o Registered Architect and /or Engineer e Employing Electrician's Name 4 /... .. .. .'la. . e :.i�..: ,0 C. No te^ n Street. y(. 1 .. 9J.. Location and Legal Description Lot Block Subdivision C y Street and Number where work is to be performed —No ? L 2 Street 4 4 C d S' <.... f State work to be performed and purpose of building (By Floors) New Building Remodeling Addition Repairs No. of Stories No t S ! Street Service Overhead Size Feeders Conduit Main Sw. Amps Main Fuses Amps Underground Type of Installation— Conduit Tubing B.X.L Metal Moulding Amount of Permit $ (Signed) Electrical Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supplement, and has complied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work to be performed under this permit; and will post or cause to be posted for inspection on the site of the work such public notice or notices as are required by the Act. The undersigned agrees to employ only such sub-contractors, on work to be performed under this permit, as are licensed by Miami Shores Village. STATE OF FLORIDA, COUNTY OF DADE. Il Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the..... of the above described construction, and he has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated are true. SS. My Commission Expires Notary Public, State of Florida OTE: A re-inspection fee of $1.00 will be made when such re-inspection is made necessary by improper notice for inspection, or faulty erials and /or workmanship. (Signed) ti r �vl aster Electrician. ELECTRICAL INSPECTION DEPARTMENT APPLICATION FOR ELECTRICAL PERMIT Permit No. .......w T Date 3 — \ — Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at building during progress of work. Owner's Name and Address Deggan Service Overhead Amount of Permit $ STATE OF FLORIDA, } COUNTY OF DADE. ss. MIAMI SHORES VILLAGE (Signed) N 857 N.E. Registered Architect and /or Engineer .. Employing Electrician's NameSun- ..S.ta-te...ELe..Ctric, Inc. No10.L47....N..WI.....27$ ]St..Ave.. Location and Legal Description Lot Block Subdivision Street and Number where work is to be performed —No Street State work to be performed and purpose of building (By Floors) New Building Remodeling Addition Repairs No. of Stories Underground Site Feeders Conduit Main Sw Amps Type of Installation — Conduit Tubing B.X.L .Metal Moulding. (Signed).....L .. �1 The undersigned applicant for this building permit does hereby certify that he understands and a labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws has complied with the provisions thereof, and will require similar compliance from all contractors or work to be performed under this permit; and will post or cause to be posted for inspection on the site as are required by the Act. The undersigned agrees to employ only such sub-contractors, on work to licensed by Miami Shores Village. Main Fuses Amps Street 98 ri Electrical Inspector. cce s his obligations as an employer of of Florida Permanent Supplement, and sub - contractors employed by him in the of the work such public notice or notices be performed under this permit, as are Master Electrician. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the of the above described construction, and he has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated are true. My Commission Expires Notary Public, State of Florida NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faulty materials and /or workmanship. SWITCH OUTLETS LIGHT OUTLETS PLUG RECE'P'T'S FIXTURES NO. LAMPS REFRIG. OUTLET IRON OUTLET RANGE OUTLET RANGE CONN. WATER HEATER W. HEAT. CONN. SPACE HEATER STRIP HEATER TOTAL CONTR. LIST 6 3 /. SO Do ,. ' ,e 1 S-- CHECK ENT. SW. DIST. CAB. SERVICE TEMP. SERVICE PERM. MOTORS 0.1 HP MOTORS 1.5 HP N EON TRANS. RADIO TOTAL CONTR. LIST CHECK ELECTRICAL INSPECTION DEPARTMENT APPLICATION FOR ELECTRICAL PERMIT Permit No. .......w T Date 3 — \ — Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at building during progress of work. Owner's Name and Address Deggan Service Overhead Amount of Permit $ STATE OF FLORIDA, } COUNTY OF DADE. ss. MIAMI SHORES VILLAGE (Signed) N 857 N.E. Registered Architect and /or Engineer .. Employing Electrician's NameSun- ..S.ta-te...ELe..Ctric, Inc. No10.L47....N..WI.....27$ ]St..Ave.. Location and Legal Description Lot Block Subdivision Street and Number where work is to be performed —No Street State work to be performed and purpose of building (By Floors) New Building Remodeling Addition Repairs No. of Stories Underground Site Feeders Conduit Main Sw Amps Type of Installation — Conduit Tubing B.X.L .Metal Moulding. (Signed).....L .. �1 The undersigned applicant for this building permit does hereby certify that he understands and a labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws has complied with the provisions thereof, and will require similar compliance from all contractors or work to be performed under this permit; and will post or cause to be posted for inspection on the site as are required by the Act. The undersigned agrees to employ only such sub-contractors, on work to licensed by Miami Shores Village. Main Fuses Amps Street 98 ri Electrical Inspector. cce s his obligations as an employer of of Florida Permanent Supplement, and sub - contractors employed by him in the of the work such public notice or notices be performed under this permit, as are Master Electrician. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the of the above described construction, and he has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated are true. My Commission Expires Notary Public, State of Florida NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faulty materials and /or workmanship. MIAMI SHORES VILLAGE ELECTRICAL INSPECTION DEPARTMENT APPLICATION FOR ELECTRICAL PERMIT Date 3-7— Permit No / Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at building; during progress of work. Owner's Name and Address .4 No Street Registered Architect and /or in er f� r 1, Employing Electrician's Name ! ° No Street Location and Legal Description Lot Block S division �d Street avid Number where work is to be performed —No Street.. r. /l 7 > a State,aork to be performed and purpose of building (By Floors) Ned Building Remodeling Addition Repairs No. of Stories Service Overhead Size Feeders Conduit Main Sw Amps Main Fuses Amps Underground Type of Installation— Conduit Tubing B.X.L Metal Moulding Amount of Permit $ (Signed) Electrical Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supplement, and has complied with the provisions thereof, and will require similar compliance from all contractors or subcontractors employed by him in the work to be performed under this permit; and will post or cause to be posted for inspection on the site of the work such public notice or notices as are required by the Act. The undersigned agrees to employ only such sub•contractors, on work to be performed under this permit, as are licensed by Miami Shores Village. STATE OF FLORIDA, COUNTY OF DADS I SS. (Signed) Master Electrician. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the of the above described construction, and he has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated are true. My Commission Expires Notary Public, State of Florida NOTE: A re•inspection fee of $1.00 will be made when such re•inspection is made necessary by improper notice for inspection, or faulty materials and /or workmanship. SWITCH OUTLETS LIGHT OUTLETS PLUG RECE'P'T'S FIXTURES NO. LAMPS REFRIG. OUTLET OUTLET IRON RANGE OUTLET RANGE CONN. WATER HEATER W. HEAT. CONN. SPACE HEATER STRIP HEATER TOTAL IONTR. LIST / CHECK ENT. SW. DIST. CAB. SERVICE TEMP. SERVICE PERM. MOTORS 0.1 HP MOTORS 1.5 HP NEON TRANS. RADIO TOTAL CONTR. LIST G' <d - II 1f '1 J ,%A ..; .rte % t° 11 C ? ^�, /�, Q G CHECK MIAMI SHORES VILLAGE ELECTRICAL INSPECTION DEPARTMENT APPLICATION FOR ELECTRICAL PERMIT Date 3-7— Permit No / Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at building; during progress of work. Owner's Name and Address .4 No Street Registered Architect and /or in er f� r 1, Employing Electrician's Name ! ° No Street Location and Legal Description Lot Block S division �d Street avid Number where work is to be performed —No Street.. r. /l 7 > a State,aork to be performed and purpose of building (By Floors) Ned Building Remodeling Addition Repairs No. of Stories Service Overhead Size Feeders Conduit Main Sw Amps Main Fuses Amps Underground Type of Installation— Conduit Tubing B.X.L Metal Moulding Amount of Permit $ (Signed) Electrical Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supplement, and has complied with the provisions thereof, and will require similar compliance from all contractors or subcontractors employed by him in the work to be performed under this permit; and will post or cause to be posted for inspection on the site of the work such public notice or notices as are required by the Act. The undersigned agrees to employ only such sub•contractors, on work to be performed under this permit, as are licensed by Miami Shores Village. STATE OF FLORIDA, COUNTY OF DADS I SS. (Signed) Master Electrician. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the of the above described construction, and he has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated are true. My Commission Expires Notary Public, State of Florida NOTE: A re•inspection fee of $1.00 will be made when such re•inspection is made necessary by improper notice for inspection, or faulty materials and /or workmanship. Permit No Servi ,Overhead Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at building during progress of work. Owner's Name and Address Registered Architect and /or v , Employing Electrician's Name [` ' ^ No q Street Location and Legal Description Lot a Jl.q Block {) Subdivision Street and Number where work is to be performed —No Street.... E, State work to be performed and purpose of building (By Floors) New Buildin g Remodeling Addition Repairs No. of Stories Amount of Permit $. STATE OF FLORIDA, COUNTY OF DADE. Size Feeders Type of Installation— Conduit ELECTRICAL INSPECTION DEPARTMENT APPLICATION FOR ELECTRICAL PERMIT Date A t�l O (Signed) Electrical Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supplement, and has complied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work to be performed under this permit; and will post or cause to be posted for inspection on the site of the work such public notice or notices as are required by the Act. The undersigned agrees to employ only such sub - contractors, on work to be performed under this permit, as are licensed by Miami Shores Village. s s. MIAMI SHORES VILLAGE No Street 41 Conduit d.. Main Sw Amps Main Fuses Amps B.X.L Metal Moulding (Signed). Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the of the above described construction, and he has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated are true. Notary Public, State of Florida My Commission Expires NOTE: A re-inspection fee of $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faulty materials and /or workmanship. Master Electrician. SWITCH OUTLETS LIGHT OUTLETS PLUG RECE'P'T'S FIXTURES NO. LAMPS REFRIG. OUTLET IRON OUTLET RANGE OUTLET RANGE CONN. WATER HEATER W. HEAT. CONN. SPACE HEATER STRIP HEATER TOTAL CONTR. LIST �� ;)6 . 3 ( � � ev � 11f ,mss =_ XVS / -� a !/ Q CHECK ENT. SW. DIST. CAB. SERVICE TEMP. SERVICE PERM. • MOTORS 0.1 HP MOTORS 1.5 HP NEON TRANS. RADIO TOTAL CONTR. LIST / g ��' 0 ��,� CHECK Permit No Servi ,Overhead Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at building during progress of work. Owner's Name and Address Registered Architect and /or v , Employing Electrician's Name [` ' ^ No q Street Location and Legal Description Lot a Jl.q Block {) Subdivision Street and Number where work is to be performed —No Street.... E, State work to be performed and purpose of building (By Floors) New Buildin g Remodeling Addition Repairs No. of Stories Amount of Permit $. STATE OF FLORIDA, COUNTY OF DADE. Size Feeders Type of Installation— Conduit ELECTRICAL INSPECTION DEPARTMENT APPLICATION FOR ELECTRICAL PERMIT Date A t�l O (Signed) Electrical Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supplement, and has complied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work to be performed under this permit; and will post or cause to be posted for inspection on the site of the work such public notice or notices as are required by the Act. The undersigned agrees to employ only such sub - contractors, on work to be performed under this permit, as are licensed by Miami Shores Village. s s. MIAMI SHORES VILLAGE No Street 41 Conduit d.. Main Sw Amps Main Fuses Amps B.X.L Metal Moulding (Signed). Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the of the above described construction, and he has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated are true. Notary Public, State of Florida My Commission Expires NOTE: A re-inspection fee of $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faulty materials and /or workmanship. Master Electrician.