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RC-10-1923Inspection Number: INSP - 155525 Scheduled Inspection Date: February 03, 2011 Inspector: Rodriguez, Jorge Owner: LOCKHART, TONI Job Address: 925 NE 98 Street Miami Shores, FL Project: <NONE> Contractor: February 02, 2011 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 EJD CONSTRUCTION CONSTRACTORS & INVESTMENT CO Building Department Comments For Inspections please call: (305)762 -4949 Permit Number: RC -11 -10 -1923 Permit Type: Residential Construction Inspection Type: Final Work Classification: Alteration Phone Number (786)564 -5796 Parcel Number 1132060143430 BATH RENOVATION Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments CREATED AS REINSPECTION FOR INSP- 152780. Page 18 of 23 BUILDING PERMIT APPLICATION FBC 20 Permit Type: Electrical OWNER: Name (Fee Simple Titleholder): - 10 L.. L h N(4' Phone #: (j &.) 1 ° &aS Address: qa5 E J } City: 1/.\ S State: F t— Tenant/Lessee Name: Phone#: Email JOB ADDRESS: `'Is NC- V ST City: Miami Shores Folio/Parcel #: Is the Building Historically Designated: Yes CONTRACTOR: Company Name: L S 67 .d /C CC , / #'C� Phone#: "7 8t — 3P _ / /7 Address: City: Qualifier Name: ,e2- /Vim 36.5r` Wire- /09 0 L2 c.. State: Fe. 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 County: Miami Dade Phone#: l e67 `30 2. — / /7 Cs 1301.2-c Certificate of Competency #: 0 �f C 00 7 J1,34 anon" &% 6 . 6' i en. Phone#: State Certification or Registration #: Contact Phone#: 1g ° P) / 7 s Email Address: DESIGNER: Architect/Engineer: ATLIZMEWMV � JAN 1 1 2010 11 Permit No. ELI t) s I q Master Permit No. 1 C t V — 19 3 Zip: 3 i3 8 Zip: NO Flood Zone: Value of Work for this Permit: $ SquarelLinear Footage of Work: Type of Work: OAddress UAlteration ON Description of Work: zip: 33/6 * * ** *x•*, x** *** ** *********** **** ********* Fees ****** * *** ** . ***** *rt*********** ********* * *** Submittal Fee $ Permit Fee $ ›:1% ' CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL r 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 F7.F,CTRICAL 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 $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature Owner or Agent The foregoing instrument was acknowledged before me this day of , 20 , by who is personally known to me or who has produced As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commission Expires: *sR**** * *** ***** 4asb* s8 *************s$ * * ** *** * * ** ** s** ** * *** *4 **** ** * * * * * ** * ***sffisa *** * * **** * * * ** kaBds*abHs**** *** *** APPROVED BY Structural Review (Revised 07 /10 /07)(Revised 06/10/2009)(Revised 3/15/09) //J Plans Examiner Signature ( 2( & 4'l 2 ,) Sign: Print: My Co Contractor The foregoing instrument was acknowledged before me this 3 day of , 20 °� , by e / 1 rc Vie) , who is known to me or who has produced aitAi 6(,:k Ntras ' s cation and who did take an oath. NOTARY • :-.EXPIRES October 27, 2013 ( 407) 398 -0153 FlortdallotaryService,com Zoning Clerk Miami Shores Village APPR=VE173 13Y ME ZONING DEPT BLDG DEPT .*/Ao /61L) SUR.IFCT TO COMPLIANCE WITh FEDERAL STATE AND COUNTY RULES REGULATIONS t.egerd Othe ril 1.4q111-;et ktad7 & /Ise Marble- D? 4 n5 room, Rer7OtiCi rn ?la ci E 135 ih* 1i c cr food in2;..vey L, r V TA . S " Stuart founded 1.1'1113 1,inclo PO/L AleNt-‘ ? 1 Ai' 9 5. - w Re 17.0e )1.4. pize /v4 e",t- AA4 /)i'pi. Sc.ofe- work!, ALM- / 4)A' ed-ve,-/te f-frf 16 '1 - c / f / - /r' KI eAcm5e. counter +op cr bc-k 5ef eharlse 1 - A erreC-4C;eck.( 15 Chi/ride Marble. Floor ;15 t r ;i cq5-t. re ckvart marble, etround <>PI ;in. ;`,1er, lteCIAe .3- ?air% ÷ war's rou8k ova- I-005e (etah,eve, 5 0460th -C: O;ON) 1 3 b strac,+; I lel c-Gc 15 15c to scet rborea5t, 306-3 TOV gW3 v 24-2010 . 4, Ci li of Miami , 11.411. ui'din -fib I g Department Friday, October 22, 2010 1 Home - 1,City Directory T City Officials 1= Commission Agendas 1 Employment]' Event * e-Bldg Home Permits by Address or Folio This particular type of inspection must be called in. i ' Plan Status Review Permit Inspections History a . if your Inspection is "On Hold", there is a PENDING FEE in that particular Permit Extension Discipline/Division. Inspection Scheduling User Password Change The following departments require inspection scheduling by phone. Please contact them FAQs at the following phone numbers: Log On .. Log Off Public Works , (305) 416-1200 Fire (305) 416-1600 NET Zoning Inspections NORTH OFFICE (305) 329-4820 444 SW 2 Ave, 7th Floor CENTRAL OFFICE (305) 329-4800 444 SW 2 Ave, 7th Floor SOUTH OFFICE (305) 329-4770 , 970 SW 1 St, Suite 402 Mechanical Elevator Inspections Department requires inspections to be scheduled by EMail. Please contact them at JIVIolina@ci.rniarni.fLus, JMolina©miamigov.com TL If you have not conducted your p;,'- usiteepleaSe pall the following numbers: Building °. Ii J . Inspections Services 36' 5) 416-1180 4 - . r ''.'" ■ kL• ' ' c-,, , [4 - ] . , 4 This Web site is best viewed using Internet Explori ,;', on a resoIuon of 1024 x 768. Copyright co ato3, City of .. , ., City of Miami, Department Page 1 of 1 http://egov.ci.miamill.us/miamibuilding/CallInfo.aspx?ReqDate=&Div=Z&PermitNo=1... 10/22/2010 FBC 20 JOB ADDRESS: 7,2, s l 4T City: Miami Shores Description of Work: v 5C N 1 �t Miami Shores Village Building Department County: COLOR THROUGH ROOF TILE IS REQUIRED acknowledged by: Miami Dade TOTAL FEE NOW DUE $ yVM NOV 2 4 2010 Y. 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 BUILDING Permit No. 2A0 1 .- PERMIT APPLICATION Master Permit No. Permit Type: BUILDING OWNER: Name (Fee Simple �- 05 Titleholder): I }�1 ( Le Aa("1 Phone #: Address: « 7 ! " ` ) A� City. 4 t ict r 5'h .0 (e.6 State: Zip: Tenant/Lessee Name: Email: Zip: Folio/Parcel #: Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name: 1. n Ce )1 "fi ( c-1- 6n Phone #: :505 /33 ti/3 Address: Al // 4:7 Ala- { ti 3 t:7 City: Ai t a' M ; State: 7 ( Zip: '� 3 ( i Qualifier Name: t7, r c c crrbor0 Li i f., Phone #: State Certification or Registration #: C 1..2 G !' ` ' S ' g l �6 Certificate of Competency #: Contact Phone #: Email Address: (' J 4 c 5 D(UC+ o ri • C.o ev DESIGNER: Architect/Engineer: Phone #: Value of Work for this Permit: $ Square /Linear Footage of Work: Type of Work: ❑Address ❑Alteration ❑New ❑Repair/Replace ❑D- .lition Submittal Fee $ Permit Fee $ CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ 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 'e approved and a reinspection fee will be charged. Signature Sign: Print: My Comm APPROVED BY t�- Owner or Agent Contractor The foregoing instrument was acknowledged before me this 4 The foregoing instrument was acknowledged before me this day of fU (2 , 20 ID, by day of 20 b Y _, by who is personally known to me or who has produced who is personally known to me or who has produced As identification and who did take an oath. as identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** ********************************************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** JZ .,9 Plans Examiner Zoning Structural Review Clerk (Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09)(rev6/4/10) Signature Sign: Print: My Commission Expires: CI" v Pin t1' »g.. ''fiNA100 . Re0 'Jiae•to.weT11.1 VI•CoI 311110Y1A)I•ll R {e HALLO AS,o T1L1 C61414b M r + pIAhut Dodo. TO POUT i.u3 !, Ze' B•-cot t ., • ,1\.Rt',ov11,SH■• vtt - z ' . CLee /Y me PART■T 1 _ A..e adamnnLnatr • 10' -8,. „6_p., :!S' 8" . ' !Z4w NO. ,7000✓? i 11 ?alum e. T 4 A. @ .9 i • tt" 'AT O'4 If 14" Mt .r C11 J«' �._... —_. ._. "r""' 3 ^110 RCLC 01 4 k`NV• o" :} . .1 ,'� •ry $IAOV L. \VI•00\V• Ao• \v beo Aa:OUal.lf • 'R14 4.15.,•••••i 'Rliatrie0• i?ocatN knanit%TIGL• .vbo 0/1_9Ttf ,V Re vt6�,.1 A.(ov atl G' ••1r• 4 • titixovI Wm's> esv 4 1,40.11.'OM { •' A6 gLAflT1y6 814 .. 1 lg.ossv • TiTa f rr-s. ■■ .3:414,4a • 1 C1.0841 R1mO40 TAATVI /, A.40 1 wlN i7:4 ¢ Q'2!4 " 44..0002 444.NT. 1 1 *rev 1 '.3L0 • • • 4}'•9kc ' APO ttie5 ;!/rvSly G R O U N D F •1, 0 0 R P L A'N SCALE - - - 4 "a1 FT. En'. PAY 4_ ;...1,,.o,:: E • Z �2 3 •• 5 1 4". -.,• k' p,1j:.., • At. O/wt t 12J l4 E•••. FS AY 11 , R1ao 111161w4 21 .00.a • in CtNIN7!tYP/ W 40d o•- i' • • • 3 `• ibA,:' 17, 6 I 3.36 -16 i .3.- 0' . X 6*- 10 X 1 " 'GLASS ' CYP. 1 LT.. UPPER PAN, • ' 8 .3.- 0' X 6'- 10' X 1 ' SCREEN GYP. - ..... ...•, __ a :.. _, Q 3' 0' X V- 8R X ." ...... COQ..... M - • 0 2' 6' X 6'- 10 X 1' GLASS CYP.2 LT., UPPER PAN E 3'- O' X 6'- 8' X 14' FLUSH F PR.1'- 4' X 6'- 8' X 1 -3/8" " Q • • 2' -6' X 6' - 8" X 1 -3/8" H , 2' -0" X 6'- 8" X 1-3/8' 1 2'-4' X 6'- 0" X i • •3/8" i . F J I .Y-0" X 6' 0" X 1-3/8 K 13• 2'4" X 6' 8" 2 " THREE SLID'S. OVERHEAD TRACK r .. L R.3 -6' X 6' 8' X 1 3/8" " SLIDING. OVERHEAD TRACK <_. _ «...._ ....ter•• .- _...._....__ New CONfr Aucr/0N • 1 lace w•act f . 7wo3 -3. -16 Ywo D -36 -1 6 itT�» 9 P mom .••� - .". -re.- NCW CoNsTRvcT■0• z -- msc —,r~ ,.z .a ., .:::— :�...iz•emaaac.._. ;•a rs• 3arlrcc: 000R .SCHEDULE 41.••0.'2eo P ,t `• Mitt eloo(t P nNLA ...1F • I 1; C4141N6' . in; I1tC 41 P ' Yao. 3.36•td SIZE : TYPE ,REMARKS • 6. 8''. . 7=8 " • • 40'-0'• ..... _......_ • • 1 211 0/ 41 Date f (.:‘9,N• 9 . R GROUND FLOOR PLAN ALT f AA71_gNS_ Cc.AODITION_10 - O ilN� €_:,, LGOR B.. l?O•1,EVI.TZKY 4 Ii • 1.1 1 ' ' T E C T m to W to ' OF 5 . DRAWN er' J C ;", •••Rovi'D 1.9 • . '2"/e D•a6• 16 :6AILet l WAU TO (0641 vt 10 1 -W 1 01/19/2011 09:11 nspection Number: INSP- 153727 Permit Number MC -11-10 -2101 Inspection Date: January 18, 2011 Inspector Perez, JanPierre Owner. LOCKHART, TONI Job Address: 925 NE 98 Street Miami Shores, FL Project: <NONE: Contractor. MAGIC AIR CONDITIONING CORP Building De . rtment Comments INSTALL RANGE HOOD Passed Failed Correction Needed Re- inspection Fee January 10, 2011 3058611302 f 1 ukt, No Additional Inspections can be scheduled until re- inspection fee is paid. Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (306)756 -8972 Inspector Comments TOWN OF SURFSIDE For Inspections please call: (305)762 -4949 -\6■11 PAGE 06/07 Permit Type: Mechanical - Residential Inspection Type: Final Work Classiflsation: Kitchen Hood Phone Number (786)564 -5796 Parcel Number 1132060143430 Phone: (305)898 -6044 12 4 1 1 i \ Page 1 of 1 Miami Shores Village BUILDING PERMIT APPLICATION FBC 20 Permit Type: MECHANICAL '/ OWNER: Name (Fee Simple Titleholder): I 0 1 LO �k ha i --1- Phone#: Address: 1 9, 7 4/ l-:= of 2 c2. r City: /14 , M /tn , 3 f- /J le State: 7 l Zip: Tenant/Lessee Name: Phone #: Email: t c/ a ton ;GO , / r C,eryi JOB ADDRESS: 19,5 /t/ City: Miami Shores Folio/Parcel #: Is the Building Historically Designated: Yes CONTRACTOR: Company Name: Wl/ t& em i/'bNto, GPI Phone #: (9nibae Address: OW SV 24 s r City: AIMS rn/ • / State: f Zip: 10/5.5 Qualifier Name: �J 1i�/P27, 4 ofill 1C° - Phone #: State Certification or Registration #: CSC 042 703 Certificate of Competency #: Contact Phone#: 00 I6z0 Email Address: DESIGNER: Architect/Engineer: Phone#: Value of Work for this Permit: $ 2.0 0 Type of Work: °Address °Alteration Submittal Fee $ Permit Fee $ 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 County: !QV 4 01( Permit No. MC t 0 — 20 b Master Permit No. Miami Dade Zip: NO Flood Zone: Square/Linear Footage of Work: °New Otepair/Replace °Demolition !@ ah r1<,2:^4it, vtA ow 40 ci4,;,opme:,) 0 *r* az ******** **w* ****** * ***** *** Fees***** * * ***** *** * ** ** * ** *w******** * *a ** * * ** ** \ D ,,OV CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ \\ )2 C)()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. 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 pernzit is issued. In the absence of such posted notice, the inspection w, l not be a►proved and a reinspection fee will be charged. Contractor The foregoing instrument was acknowledged before me this 2 The foregoing instrument was acknowledged before me thi day of Io\ , 20 , by who is personally known to me or who has produced who is personally known to me or who has produced As identification and who did take an oath. as identification and who did take an oath. Signa ( Owner or Agent day of /U V , 20 0 ,, by NOTARY PUBLIC: Sign: Print: My Commission *+ x***** ************* ****** +*a:*** ******** �x�xa��x+x *a�*** *�x+x *�x**** :a��x�x�x+x+x�x�n **** * *** x*** * *�xa��x�v *+x�x+xx��x **** *+x�x� *** l � APPROVED BY (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) t 4 2miner Structural Review Signature NOTARY PUBLIC: Sign: Print: My Com ,, `j y ": Alp Carnation Errs Oct tg, �Ot Commission i O0 72113 Motionsitiooro "Mr _ • * Zoning Clerk 9 EFFECTIVE DATE: PERSON: FEIN: BUSINESS NAME AND ADDRESS: MAGIC AIR CONDITIONING CORP 8281 SW 28TH ST MIAMI FL 33155 SCOPES OF BUSINESS OR TRADE: 1- CERTIFIED AC CONTRACTOR RODRIGUEZ ALBERTO 203598500 DWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 09 -06 PLEASE CUT OUT THE CARD BELOW DWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 09 -06 03/29/2010 EXPIRATION DATE: 03/28/2012 CUT HERE 03 -29 -2010 ALEX SINK STATE OF FLORIDA CHIEF FINANCIAL OFFICER DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION * * CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW * * CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law. IMPORTANT: Pursuant to Chapter 440 . 05(14►, F.S., an officer of a corporation who elects exemption from this chapter by filing a certificate of election under this section may not recover benefits or compensation under this chapter. Pursuant to Chapter 440.05(12 ►, F.S., Certificates of election to be exempt... apply only within the scope of the business or trade listed on the notice of election to be exempt. Pursuant to Chapter 440.05(13), F.S., Notices of election to be exempt and certificates of election to be exempt shell be subject to revocation if, at any time after the filing of the notice or the Issuance of the certificate, the person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate. The department shall revoke a certificate at any time for failure of the person named on the certificate to meet the requirements of this section. QUESTIONS? (850) 413 -1609 AND RETAIN FOR FUTURE REFERENCE STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION CONSTRUCTION INDUSTRY CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW EFFECTIVE 03/29/2010 EXPIRATION DATE: PERSON: ALBERTO RODRIGUEZ FEIN: 203598500 BUSINESS NAME AND ADDRESS: MAGIC AIR CONDITIONING CORP 8281 SW 28TH ST MIAMI, FL 33155 SCOPE OF BUSINESS OR TRADE 1- CERTIFIED AC CONTRACTOR 03/28/2012 IMPORTANT F Pursuant to Chapter 440.05(14), F.S., an officer of a corporation who O elects exemption from this chapter by filing a certificate of election L under this section may not recover benefits or compensation under this D chapter. H Pursuant to Chapter 440.05(12), F.S., Certificates of election to be exempt... apply only within the scope of the business or trade listed on E the notice of election to be exempt R E Pursuant to Chapter 440.05113), F.S., Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation if, at any time after the filing of the notice or the issuance of the certificate, the person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate. The department shall revoke a certificate at any time for failure of the person named on the certificate to meet the requirements of this section. QUESTIONS? (850) 413-1609 * Carry bottom portion on the job, keep upper portion for your records. ALEX SINK STATE OF FLORIDA CHIEF FINANCIAL OFFICER DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION * * CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW * CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law. EFFECTIVE DATE: PERSON: FEIN: BUSINESS NAME AND ADDRESS: MAGIC AIR CONDITIONING CORP 8281 SW 28TH ST MIAMI FL 33155 -3010 SCOPES OF BUSINESS OR TRADE: 1- CERTIFIED AC CONTRACTOR SIERRA PABLO 203598500 IMPORTANT: Pursuant to Chapter 440 . 05(14), F.S., an officer of a corporation who elects exemption from this chapter by filing a certificate of election under this section may not recover benefits or compensation under this chapter. Pursuant to Chapter 440.05112), F.S., Certificates of election to be exempt... apply only within the scope of the business or trade listed on the notice of election to be exempt. Pursuant to Chapter 440.05113), F.S., Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation if, at any time after the filing of the notice or the Issuance of the certificate, the person named on the notice or certificate no longer meets the requirements of this section for Issuance of a certificate. The department shall revoke a certificate at any time for failure of the person named on the certificate to meet the requirements of this section. QUESTIONS? (850) 413 -1609 DWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 09 -06 PLEASE CUT OUT THE CARD BELOW AND RETAIN FOR FUTURE REFERENCE STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION CONSTRUCTION INDUSTRY CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW EFFECTIVE 03/28/2010 EXPIRATION DATE: PERSON: PABLO SIERRA FEIN: 203598500 BUSINESS NAME AND ADDRESS: MAGIC AIR CONDITIONING CORP 6281 SW 26TH ST MIAMI, FL 33155 -3010 SCOPE OF BUSINESS OR TRADE: 1- CERTIFIED AC CONTRACTOR 03/28/2012 IMPORTANT F Pursuant to Chapter 440.05114), F.S., an officer of a corporation who elects exemption from this chapter by filing a certificate of election L under this section may not recover benefits or compensation under this D chapter. Pursuant to Chapter 440.05112), F.S., Certificates of election to be H exempt.. apply only within the scope of the business or trade listed on E the notice of election to be exempt R E Pursuant to Chapter 440.05(13), F.S., Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation if, at any time after the filing of the notice or the issuance of the certificate, the person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate. The department shall revoke a certificate at any time for failure of the person named on the certificate to meet the requirements of this section. QUESTIONS? (850) 413 -1609 * Carry bottom portion on the job, keep upper portion for your records. DWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 09 -06 03/29/2010 EXPIRATION DATE: 03/28/2012 CUT HERE 03 -29 -2010 * Insured Copy 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 Lucia Estrella _ ____ •_._..___ f` °® CERTIFICATE OF LIABILITY INSURANCE DATE 01/25/10 PRODUCER Accurate 8300 West Flagler Suite 114 Miami, FL 33144 Phone (305)226 -8727 Fax (305)226 -8767 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND ALTER THE COVERAGE AFFORDED BY THE POLIC OR ES BELOW. INSURERS AFFORDING COVERAGE NAIC # INSURED Magic Air Conditioning Corp 8045 NW 7 Street #205 Miami, FL 33126- INSURER A: American Insurance Co. INSURERS: INSURER C: INSURER D: INSURER E: COVERAGES INSURER F: THE POLICIES OF INSURANCE LISTED HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR L - ADD L TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE MM/DD POLICY EXPIRATION DATE MM/D • LIMITS A • GENERAL V COMMERCIAL ❑ II ❑ LIABILITY GENERAL LIABILITY CLAIMS MADE V OCCUR 01051000000963 01/25/10 01/25/11 EACH OCCURRENCE 1,000,000 DAMAGE TO RENTED PREMISES (Ea occurence) 50,000 MED EXP (Any one person) 5,000 PERSONAL & ADV INJURY 1,000,000 GENERAL AGGREGATE 1,000,000 ❑ PRODUCTS - COMP /OP AGG 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: ❑ POLICY ❑ PROJECT ❑ LOC ❑ AUTOMOBILE LIABIUTY • ANY AUTO ❑ ALL OWNED AUTOS ❑ SCHEDULED AUTOS ❑ HIRED AUTOS ❑ NON OWNED AUTOS ❑ COMBINED SINGLE LIMIT (Ea accident) BODILY INJURY (Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE (Per accident) ❑ ❑ GARAGE LIABIUTY ❑ ANY AUTO ❑ AUTO ONLY - EA ACCIDENT OTHER THAN EA ACC AUTO ONLY: AGG ❑ EXCESS/UMBRELLA LIABIUTY ❑ OCCUR ❑ CLAIMS MADE ❑ DEDUCTIBLE ❑ RETENTION $ EACH OCCURRENCE AGGREGATE WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR / PARTNER / EXECUTIVE OFFICER / MEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below • WC STATU- • OTH- TORY LIMITS ER E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE E.L. DISEASE - POLICY LIMIT OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION ACORD 25 (2001/08) QF BUILDING PERMIT APPLICATION FBC 20 Permit Type: BUILDING JOB ADDRESS: q aZ 5 Al 1 City: Miami Shores Scanning Fee $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ Miami Shores Village Building Department O i 2010 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 County: Value of Work for this Permit: $ 1 'D Square/Linear Footage of Work: Type of Work: ❑Address ❑Alteration Description of Work: F411 (P ❑New tepair/Replace Permit No. 1 O n 23 Master Permit No. OWNER: Name (Fee Simple Titleholder): 1 o el g LO C �� k U (44-- Phone #: 7 h .9 6 '"( S l b Address: 0 0.5 LIE E 0' 5* City: c o r Irt = G Gtp ((S State: I- ( Zip: Tenant/Lessee Name: Phone #: Email: Miami Dade Zip: Folio/Parcel #: Is the Building Historically Designated: Yes NO x Flood Zone: CONTRACTOR: Company Name: s coy) 6 ;(5,0 Phone #: � 00.S 03 ! V 1J Address: 1 7 0 0 // t 1 71 S City: Al Mit l a m a State: Qualifier Name: / r C_ S cOf Cho roU j Lk State Certification or Registration #: C- G C- ( i SC/ 0 Certificate of Competency #: Contact Phone #: Email Address: e .d C®n s -rct/C e D <� // . h e DESIGNER: Architect/Engineer: Phone #: Zip: ', 3 Ia Phone #: SOS t/33 k/3 L ❑Demolition taiici 60 VI itokagelli0 COLOR THROUGH ROOF TILE IS REQUIRED acknowledg ********* * * * * * *t * * *** * * * * * * * * *x * *** * * * *F **71 - 4 4 * nom a: * * * * * * * * ** Submittal Fee $ �i� v� Permit Fee $ (./ CCF $ CO /CC $ Radon Fee $ DBPR $ Bond $ Technology Fee $ TOTAL FEE NOW DUE $ V B 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 pennit 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 ommencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is i :sued.' In ,, ' absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature i c 4,, Owner or Agent The foregoing instrument was acknowledged before me this day of , 20 _, by , who is personally known to me or who has produced Ft-to L La & 3.sQt7 0 77( As identification and who did take an oath. NOTARY PUBLIC: RAGUEL A. BGIWGN Notary Public • Slue 01 tie M COMMISSICEI MOWS OM 18.2011 Cpl t DO 728183 '1El�iliQ6'lt�i1 My Commission Expires: APPROVED BY (Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09)(rev6/4/10) Signature Contractor The foreg . g instrument was acknowledged before me day of ® � who is p rsonally known to me or who has produced `'�- -tp as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: 2 u10, by EWAC, TX \\O" 110.11110o a 03106120 My Commission Expires: = N0 pu�` #c �., C pD165901 •e ®�"� f ��/11l11111 \ \ Plans Examiner Zoning Structural Review Clerk ACORD CERTIFICATE OF LIABILITY INSURANCE DATE(DDIt'YYY) 10/2912010 OF INSURANCE LISTED BELOW TERM OR CONDITION THE INSURANCE AFFORDED (NITS SHOWN MAY a LIABILITY COwAERCRAL GENERAL LURBILT/Y PRODUCER A.B.S. Insurance Consultants 11402 N W 41st Street SURE) 213 Miami FL 33178 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 NAIC 9 INSURED EJD Construction Contractors & Investment Corp. 1700 N.E. 143rd Street North Miami FL 33181 Mimi A MId Continent Insurance Co. $ 1,000,000 INSURER °: ;' " ; VtlGURER C; INSURER D: war ExP truly ono person) INSURER E THE ANY MAY POLICIES. INSR A POLICIES REQUIREMENT. PERTAIN. bp AGGREGATE GENERAL OF INSURANCE LISTED BELOW TERM OR CONDITION THE INSURANCE AFFORDED (NITS SHOWN MAY a LIABILITY COwAERCRAL GENERAL LURBILT/Y HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR BY THE POUCIES DESCRIBED HEREIN 1S SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH HAVE BEEN REDUCE° BY PAID CLAIMS. POLICY 04GL000792153 POLICY rJ=FECTIVE 08/03/10 POLICY . •, 00/03/11 - EA + OCCURREN E $ 1,000,000 X ;' " ; 100.000 CANS MADE X occult war ExP truly ono person) $ EXCLUDED NAL. &ADVINJURY $ 1,000,000 ■ GENERAL AGGREGATE 2,000,000 GEM_ AGGREGATE MOT A PPUE$PER: mice n n PRODu47$ tow/or Ace 1 2,000.000 X AUYOMOBn.E LIANLIY ANYAUTO ALL OWNED AUTOS SCHEAULED AUTO$ HIRED AUTOS NONOWNEDAUTOS COMBINED SINGLE LBBT (Ea 4) $ ■ BODILY INJURY (Per person) $ ■ BODILY INJURY (Per) $ PROPERTY accident) _ GARAGE t ADIUTY ANYAVTO AUTO ONLY -EAACCIDENT $ EA ACC $ ■ OTHER IRAN AUTO ONLY: AGO $ CESSNMBRELIA U*BILJTY °cCRNl 0 CLAIMS MADE DEDUCTIBLE RETENTION _ EACH OCCURRENCE $ ■ AGGREGATE $ $ 3 $ WORKERS COMPENSATION ANO EMPLOYERS' UABIUTY ANY PROPFOETORIPARTNERIEXECNTNE OFFICERIAEMBER EXCLUDED') y� SPECIAL PR VISIONS Delor Ynne l AM* FR EL EACH ACGEkNT $ E.L DISEASE - FA F_MARLO � $ EL DISEASE -POU *UT $ OTNER DESCRIPTION OF OPERATIONS 1 LOCATNDNS if VENICLES R EXCLUSIONS ADDED BY LNDORBEMENTR8PECW{. PROMSMNS General Contractor Oct. 29. 2010 12 :10PM COVERAGES CERTIFICATE HOLDER ACORD 25 (2001108) City of Miami Shores ; 10050 NE 2nd Ave Miami Shores, 33138 CANCELLATION BRtOtp.D ANYOF THE ABOVE DESCRIER) POLICIES BRGANCELL6p DEFOR6 THE BXPNRATION DATE THEREOF. THE (IaUBiO INSURER WILL ENDEAVOR TO MAIL J DAYS WRITTEN NOTICE TO THE CERTIFICATE MOWER NAMED TO THE LEFT. OUT FAILURE TO DO S0 $HALL MOOSE NO °SUGATER OR UABRITY OP ANT KIND UPON THE INSURER. Vs AGENTS OR REPRESENTATIVE°. AUTHDEZED REPRESENTATIVE No. 1853 <DA> NSA RD CORPORATION 1988 NOTICE OF COMMENCEMENT A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION PERMIT NO. TAX FOLIO NO. STATE OF FLORIDA: COUNTY OF MIAMI -DADE: THE UNDERSIGNED hereby gives notice that improvements will be mad property, and in accordance with Chapter 713, Florida Sirs Eg - is provided in this Notice of Commencement I HER WO ° W TH 1 1. Legal description of property and street/address: 2. Description of improvement: Bt f-k r'ir ivk t' ii 6Va.1<- o ° rjts) 3.Owner(s) name and address: T dl c Leis Ic NE' °I A c Ir Interest in property: Name and address of fee simple titleholder. � Y1 1, �7 0 ST 4. Contractor's name, address and phone number. & z b (m tor, . S V C i- v t 1 143 5. Surety: (Payment bond required by owner from contractor, if any) Name, address and phone number. 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, address and phone number 8. In addition to himself, Owners designates the following person(s) to receive a copy of the Lienor's Notice as provided in Section 713.13(1)(b), Florida Statutes. Name, address and phone number. 9. Expiration date of this Notice of Commencement: (the expiration date Is 1 year from the date of recording unless a different date is specified) WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART I, SECTION 713.13. FLORIDA STATUTES, AND CAN RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT. Signature(s) of Owner(s) or Owners' Autho rized Officer/Director/Partner /Manager Prepared By L; rr c- 5 c t L., Prepared By Print Name °T? v) 4 ( 1�: ��c{ 1� Print Name TItIe /Office Title /Office STATE OF FLORIDA COUNTY OF MIAMI -DADE The foregoing instrument was acknowledged before me this By ❑ Individually, or ❑ as for Personally known, or ❑ produced the following type of identific Signature of Notary Public: „iaMr Print Name: (SEAL) VERIFICATION PURSUANT TO SECTION 92.525. FLORIDA STATUTES Under penalties of perjury, I declare that I have read the foregoing and that the f -, is statq 1 in it are true, to the best of my knowledge and belief. Signa By 123.01 o r 3/10 s) or (wiaer(s)'s orized Officer/Director/Partner/Man I8s day of /VOt tT) Bele 111111111111111111111111111111111111111111111 CFN 20 10R075947 OR I?k 27483 F's 3541; (lps) RECORDED 11/08/2010 12 %42 :48 HARVEY RUVIN, CLERK OF COURT MIAMI-DADE COUNTY? FLORIDA LAST PAGE O> of the d�to Space above reserved for use of recording office By Scheduled Inspection Date: January 19, 2011 Inspector: Hernandez, Rafael Owner: LOCKHART, TONI Job Address: 925 NE 98 Street Project <NONE> Contractor: NELSON G CLIVE PLUMBING INC Miami Shores, FL Building Department Comments January 18, 2011 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 \O G°19-) Inspection Number: INSP - 152790 Permit Number: PL -11 -10 -1925 For Inspections please call: (305)762 -4949 Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Addition /Alteration Phone Number (786)564 -5796 Parcel Number 1132060143430 Phone: (954)801 -6038 BATH RENOVATION Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments Page 2 of 15 BUILDING Permit No. r L16 --- ,C5 PERMIT APPLICATION Master Permit No. FBC 20 Permit Type: PLUMBING Owner's Name (Fee Simple Titleholder) () y ! L. 0 t: k, Phone # 71/0 S13-/ 57V Owner's Address 9 S it )E q 5 Cit / rof wt 51 (e 5 State ( Zip Tenant/Lessee Name Email Job Address (where the work is being done) q 2, 5 V E T2 9 City Miami Shores Village County Miami -Dade FOLIO / PARCEL # Is Building Historically Designated YES Architect/Engineer's Name (if applicable) Value of Work For this Permit Type of Work: ❑Addition Describe Work: 'bra t h (e n f , r 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 S.Lt� Miami Shores Village Building Department :New ***,*** * * ***** * * *** * * * * * * * * * ** * * * ** * ** *F Submittal Fee $ S a ' (5° Permit Fee $ Qr® Phone # NO Flood Zone Phone # Square / Linear Footage Of Work: e r Zip Contractor's Company Namt - c ---- • ?t' . --f U o'C '-Y- # 7\r-,) -g/ SC/ g/ Contractor's Address /& /c °>c/. Z� co�/f✓T Cit D4. , State s Zip 3,3 622.r Qualifier Name ' o ti<y. g, /Ll��- -S -0 Phone # 7 3 -S7S7 State Certificate or Registration No. e „CO5-e®/, Certificate of Competency No. Contact Phone 7-C 93 — S 17 E -mai /Z -S ,0lec r1 5 Qom r. bl/E 0 Repair/Replace ❑ Demolition issihadls A.i'a ;1 eltiV 10 y�Rr��aa�ri��.sr e sYiH' *',\:•., * aY4e,Yk8e,Y*** CCF $ CO /CC $ Notary $ Training/Education Fee $ Technology Fee $ Scanning $ Radon $ DPBR $ Bond $ Double Fee $ Violation date: Structural Review. $ Total Fee Now Due $ V.,./1\ t c0 See Reverse side -+ Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days afier 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. Signature Owner or Agent Contractor The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this 2 day of ,20,by , day of Q. , 20''c',by who is personally known to me or who has produced ft_ Dt, .j who is personally known to me or who has produced d " .foije identification and who did take an oath. as identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: Print: My Commission Expires APPROVED BY (Revised 07 /10 /07)(Revised 06/10/2009) Plans Examiner Engineer Signature O p,ailigs,, IQflemariam Stefanos :. ;'COMMISSION#DD651774 V Sign: : ° �o " EXPIRES: MAR. 18, ZU11 Print: 2, Oi4 My Commission Expires: t. Zoning Clerk checked LICENSE NO: 01000382 CLIVE G NELSON PLUMBING, INC 10218 SW 23RD CT MIRAMAR FL 33025 BEGINNING 10/01/2010 ENDING 09/30/2011 NAME & LOCATION OF LICENSEE CLIVE G NELSON PLUMBING, INC 10218 SW 23RD CT MIRAMAR FL 33025 CONTACT PERSON: CLIVE G NELSON (954)536- 1839 DESCRIPTION: CONTRACTORS - SPECIALTY_ PRINT DATE: 10/04/2010 BUSINESS TAX RECEIPT (954) 602 -3470 FAX PHONE PHONE: ** BUSINESS TAX RECEIPT MUST BE DISPLAYED ** ** RESTRICTIONS APPLY TO ALL HOME -BASED BUSINESSES ** ** RESTRICTIONS ** MAIL & PHONE ONLY NO EMPLOYEES AT HOME NO WORK ON PREMISES NO CLIENTS AT HOME NO DELIVERIES TO HOME HOME USED FOR OFFICE ONLY This INDICATED. CERTIFICATE EXCLUSIONS INS: A GENERAL X IS TO CERTIFY THAT THE POLICIES NOTWITHSTANDING ANY REQUIREMENT, MAY BE ISSUED OR MAY AND CONDITIONS OF SUCH POLICIES. TYPE OF INSURANCE LIABILITY COMMERCIAL GENERAL LIABILITY OF PERTAIN, 1ii:7 INSURANCE . LISTED BELOW HAVE BEEN TERM OR CONDITION OF ANY THE INSURANCE AFFORDED BY LIMITS SHOWN MAY HAVE BEEN REDUCED POLICY NUMBER 8090011695 ISSUED TO CONTRACT THE POLICIES BY PAID POL[CY EFI 14a.PD 02/13/10 THE INSURED OR OTHER DESCRIBED CLAIMS. POLICY EXP le aj j 02(13/11 NAMED ABOVE FOR THE DOCUMENT WITH RESPECT HEREIN IS SUBJECT TO LIMITS EACH OCCURRENCE POLICY PERIOD TO WHICH THIS ALL THE TERMS, $ 500,00' • .E�,. ' -'� • PREMISES (Ea occurrence) $ 1,000,001 CLAIMS -MADE OCCUR MED EXP (My one person) $ 5,001 PERSONAL & ADV INJURY GENERAL AGGREGATE PRODUCTS - COMP /OP AGG $ 500,00 $ 1,000,00 • $ 1,000,001 ■ GENL AGGREGATE LIMIT APPLIES PER: POLICY El r El LOC AUTOMOBILE ■ ■ LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ $ ■ UMBRELLA LIAB EXCESS LIAB ■ ■ OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ $ ■ DEDUCTIBLE RETENTION $ E WORKERS COMPENSATION AND EMPLOYERS LIABILITY A OERPEXCLWED ECUIIVE Y ❑ (Mandatory In NH) If yes, describe under '- - ` °' N /A FCD00013397 -02 12/02/09 12/02/10 •- X IN x • - E.L. EACH ACCIDENT $ 1,000,00 E.L. DISEASE - EA EMPLOYER $ 1,000,00 E.L. DISEASE - POLICY LIMIT 100000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) . • ' • MIAMISH Miami S Village Building Shores Dept. 10050 NE 2nd Avenue L � _ e SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POUCY PROVISIONS. Miami Shores, FL 33138 I AUTHORREDREPRESENTATIVE CERTIFICATE OF LIABILITY INSURANCE THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In Ileu of such endorsement(s). PRODUCER Carron Insurance Agency 6760 West Linebaugh Avenue Tampa, FL 33625 Janet Sturm INSURED Clive G. Nelson Plumbing, Inc 10218 SW 23rd Court Miramar, FL 33025 813- 962 -6677 813- 962 -6671 CONTACT NAME: C, No): PHONE -M�Lo. Ere: ADDRESS: PRODUCER CUSTOMER ID A• CLIVE -1 INSURERS) AFFORDING COVERAGE NAIC 0 INSURERA: North Pacific Ins Co. INSURER B: INSURER C : INSURER D : INSURERE: Delos Insurance Company INSURER F • I DATE (MM/DD/YYYY) 11/01/10 23892 35408 l 1= ACORD 25 (2009/09) 11/1/2010 10:48 AM FROM: Carrons Insurance Carron insurance Agency TO: 1- 305- 756 -8972 PAGE: 002 OF 002 �l _ OP ID: JAN @ 1988 -2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Inspection Number: INSP - 155353 Scheduled Inspection Date: January 31, 2011 Inspector: Devaney, Michael Owner: LOCKHART, TONI Job Address: 925 NE 98 Street Miami Shores, FL Project: <NONE> Contractor: E & C ELECTRICAL SERVICE INC Building Department Comments January 28, 2011 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: EL -11 -10 -1924 Permit Type: Electrical - Residential Inspection Type: Final Work Classification: Alteration eiLo Phone Number (786)564 -5796 Parcel Number 1132060143430 Phone: 305 -525 -1701 BATH RENOVATION Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments CREATED AS REINSPECTION FOR INSP- 155030. no rough inspection and everything covered. Add smoke detectors, check conductor sizefor bathroom receptacles. - ( Page 20 of 29 BUILDING PERMIT APPLICATION FBC 20 Permit Type: Electrical JOB ADDRESS: 1 o■s / V 1 $ S Is the Building Historically Designated: Yes *********+k***+N**** ********ikds*eks #**+k**** Submittal Fee $ � • (1_) Permit Fee $ /1 Scanning Fee $ Radon Fee $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ 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 �cl {'Pnova-1 r NO DBPR $ Permit No. Ek1 U -lq 2y Master Permit No. OWNER: Name (Fee Simple Titleholder): T ®GL ( 1„0 C k Phone#: 70 6 S 6 ¥5 79‘ Address: g■S /v E l s S r City: ,M C coM P ' h.5 State: 1 l Zip: Tenant/Lessee Name: Phone #: Email: City: Miami Shores County: Miami Dade Folio/Parcel #: Flood Zone: Zip: CONTRACTOR: Company Name: e4 C C ,41Cq/ i.,„6,,, -bete Phone #: --) - °//7c Address: 9 AA) & S -'S hi /01-/ City: afq, State: I- L Qualifier Name: e-V acid State Certification or Registration #: c /2 I3LD /29'tep" n ` / Contact Phone #: 7IXp7 - //7S Email Address: JdQrru &1 @ eQnC1<'eB /P rlAJ CDw7 DESIGNER: Architect/Engineer: Phone#: Value of Work for this Permit: $ 5 00 Square/Linear Footage of Work: g Type of Work: ❑Address ❑Alteration New ARepair/Replace ❑Demolition Description of Work: ,r o1 2010 Zip: 3'1(06 Phone#: -7 // Certificate of Competency #: LY/E/0( ic 4 ht Ate b ma ll= fTthe Ci /CC $ Bond $ Technology Fee $ 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. Signature Owner or Agent The foregoing instrument was acknowledged before me this day of , 20 _, by who is personally known to me or who has produced ��J5 0 � 7O73 ® As identification and who did take an oath. NOTARY PUBLIC: RAQUEL SCARBOROUGH Nall Pulia • &ate of Florida My COarildifiaftlfilsOot 18, 2011 Cocos! M 128183 Sign Print: My Commission Expires: APPROVED BY (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) 7/: Plans Examiner Structural Review Signature L A 11.41,40 Contractor ,�^ The foregoing instrument was acknowledged before me this4 day of cptga7 , 20 fL , bye th (4 .k) who ' ersonally known to m or who has produced ntification and who did take an oath. NOTARY P Sign: Print: My Commis NA COMMISSION DD926081 EXPIRES October 27, 2013 FloridallotaryServIce.eom nk***tkskik+k%kikik k*+ k+ k+ kshsFih*Ni****aa +k*sk*ik*ak=ksk:R**** F�B+ Zoning Clerk COMER ?Almelo Insuance 1909 W. 60Ih Street Meek F133012 Phone INSURED E & C Electrical Sewlce Inc. 15398 SW 19 Tel. Miami, FL 33189 . .coVERAGES THE pOLICE8OF $dsURANCEUSTED HAVE BEEN ISSUED TO THE INSIIN 0 MIMED ABOVE FOR THE Pala PERIOD IMMGATE . NOTW0HSTI AMY REQV IREMENT:TERM OR COMMTION Of ANY RACT OR OTHER DocumENT WITH RESPECT TO WHICH TIIS CIEWIFICATE MAYER !SSUEDOR I MAY PERTAILTHE INSURANCE BYTHE POLICIES =CREED tEF6EI+I SUIDECT TO ALt.THETERMs. ExcLuSioNS AND CONDITIONS OFsucti • PouclEs. AGGREGATE LAM stlOV1 N MAY HAYS sEEN REDUCED SY PAID C Ally. IQSR ADD'I. 4 MEMO 0 TYPE OF INSURANCE csIExAL LIA�IJTY 00 CLAM MADE ® OGCUR ❑ DEo ❑ $500 QED GENT. AGGREGATE UdSTAPPLIES PER ❑ POLICY ❑ PROJECT ❑ LOC AUTOMOBILE LIABILITY ❑ ANY AUTo ❑ Au. OWNED AUTOS ❑• © scHEDIJLED A*UTOs ❑ HIRED AUTos ❑ NoN OWNED AUTOS 0 n • GARAGE LIABILITY ❑ ❑ ANY Auto EXCEsSIUMBRELLA LIABILITY © 0 0 0 U R [] t LANS WADE ❑ oeDUCTiaLE ❑ RETENTION S WORRIERS COMPENSATION AA EMFL0YERS' LIABILITY ANY PROPRIETOR 1 PARTNER IE EclinvE OFFICER /MEMBER EXCLUDED? Byes. describe ander SPEGIAL PROVISIONS balsa 0 OTHER CERTIFICATE HOLDER CERTIFICATE OF LIA,I3ILITY INSURANCE Fax X1- 5 6- 104869 04356403-0 Miami Shores Village Building Department 10050 NE 2' Avenue Miami Shores, (1.33138 ACORD Z5 (01NB) POUGYNUUMBER CUP 2172E THIS CERTIFICA'T'E l0 ISSUED AS AMMEROF INFORMATION , ONLY AND CONFERS NO RIGHTS UPON THE CERTIPICATE UOLDER.TH1S CTRiCNI; KATE DOES NOT AMM63,EXrEND OR ALTRI COVER/ME AFFORl3 ®BY THE POLICES M0W. NATO INSURERS AFFORF3 MO COVERAt A: Tapco / Mount Vernon Flre INSURER En PTOWESEtie Irtsttrnnce maims Q Tepee /Western World Ins. • tusunEn Lk 1NSUR8i i= INSURER F: DATE INBADDlifYI 03/08/10 .09/23/09 03108/10 CANCELLATION 03/08111 03/08/11 DESCRIPTION OF OPERATINNS I LocATIDNS /VffUCIM EXC us cNs ADDED BY EtinonsearmtePEcIALPRovlsoNn AUTHOR Z E5 TATNE EACH se TO RENTEEO PREMISES Ma occwa ce) MED D0' (AIIYona Pam) PERSONAL &ADV INJURY GENERAL AGGREGATE PRODUCTS - 00 PAGG =WNW E NGLE LMT 09/23/10 (Ea +) BODILY INJURY (Per pomp) (Per ) pRDPERIY DAMAGE . per AUTO 0&V ►EAACCIDENT OTtIER THAN EAACO AUTO ONLY: EACH MOURNER= $5.000, 00 0 AGGREGATE S5 000,000 PRODUCTS & COMP /O $5,000,000 Ere EACH ACCIDENT EL DISEASE - EA EMPLOYEE EL. DISEASE- POL ICY LIMW SHOIULDANYOPTM ABOVE DESCRIBED POLICIES BE GAN BEFDRBTHS EXPIRATION DATE THEREOF, THE ISSUING I SURE INILL.ENDEAVORTO MAIL 30 DAYS WRITTEN worm TO THE CERT HOLDERNAMtl ED TO THE EILTf MAW TO DO SO <, . ∎' IMIPOSENO OBLIGATION OR MERRY OP ANY KII�IDU QNTH6 V OR REpRESENTATIVES. DATE (>V / Y) 03111110 . AGO $1,000,000 $50000 $5,000 $1,000,000 $2,000,000 31,000,000 $1,000,000 CORPORATION 1 ACORD CERTIFICATE OF LIABILITY INSURANCE PRODUCER KomrelchINIA of Mlami(MLCL) 14750 Palmetto Frontage Road Suite 120 Miami Lakes, FL 33016 INSURED Client*: 148803 E & C Electrical Services, Inc. 15398 SW 19 Terrace Miami, F133185, CERTIFICATE MOLDER Miami Shores Village Building Department 10050 NE 2 Avenue Miami Shores, FL 33138 ACORD 25 (2001168)1 of 2 #376575511329291 THIS & t1JH-ICATE IS ISSUED AS AMATIER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEI4D, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES_BELOW. INSURERS AFFORDING COVERAGE netiRERA Castle Point Insurance Company I+B: INSURT3t INSURER E INSURER E COVERAGES THE POUCIES OF INSURANCE LISTED BELOW NAME BEEN IVIED TO IRE INSURED NAMEDABOOIE FORME POLICY PERIOD INDICATED. NO WITi? ANY REQUIREMENT. TERM OR CGNDIION OF ANY CONTRACT OR OTHER DOCUMENT WITH TO WHICH THIS CERTIFICATE [SAY BE ISSUE MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT�THE TERMS, EXCLUSIONS AND CORNROWS POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCE BY PAID CLAIMS. DATE E 7r N LT DOM R IMRE TYPE OF INSURANCE A GENERAL LIABILITY COMMERCIAL GERM UABIJTY I cumms MADE a CEEB GEM AGGREGATE EETnP� JEPRa- LOC ANY AUTO AU_ OWNED AU OS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS GARAGE UABILI Y 1 Ano O(CE SSAMEIRELLALIN3IL YY OCCUR El CLAWS MADE DEDUCTIBLE RETENTION $ POLICY NUMBER DESCRIPTION OF OPERATIONS T LOCATIONS/WHIM= /EXCLUSIONS ADDED BY ENDORSEMENT/ SPE8:9ALPROV1OONS LOUIE ENZHOCCURRENCE D R $n , MED DIP (Any arta pamo,) PERSONALS ADV DUCAT GENERALAGGREGATE PRODUCTS- EOMMPIOP AGG COMBINED E UMiT BODILY INJURY rut parson) BO1NLY INJURY (Per PROPERTY DAMAGE (Perms AUTO ONLY- EAACCIDENT AU O EA ACC AGO mot occuRRENcE AGGREGATE x I IER WORKERS cORPE NSATION AND ESRPLOYERS' UABMY i>cma Ilmm desalhe under PROVISIONS OTHER WCP780081500 2/22/2010 2/22/2011 EL. EACH ACEADE NT EL. DISEASE- EAEMPLOYEE EL. DISEASE PDIICY E CANCELLATION ECELECT .77 DATHI(iIIAIDDfYYYYI 5 S 5 1 . E NAIC 0 ST ANDING F OF SUCH $ $ $ $ 5 5 17205 $500,000 $500,000 5500,000 SHOHLOAWYCIPTHEABOVE DESCRIBED Mier= RE CAROM-LEO EIEVORama E3XPIRA1E0 DATETRERBOF, THE ONC, IM MIDISWOR TDMAI. 30 DAYS WRITTEN NUTIcETOTRECDOWicATE ROWER RASED TOME LEFT. our rnuamt TODO SOSHALL WORE NO COUGEDION OR LIABILITY OFANYKINDUPDNTHEINSURE R.ITS AGMs OR ACORD CORPORATION 15 Miami Shores Village ZONI :DEPT TAD , Df=M- j " i !� SUB.) STATF ,T TO COMPLIANCE WITH ALL FEDE ° NI ,OUNTY RULES AND REGULATION' _ _ I5af h roo n► S ; q ; 5 Ai ScaPe 1„/ 9('I< Rerova4-e ),,G-r;^3 bglf'1i rooyy -, JctGVZ x1 1 -to re C:inante. v an; Y; bun9ck t7rywolf 6wa-ter re6;5-ten-f-3y()sum) i Shower area 4- o ce,ir, . ng-rottr Moirbie +o ce■l;45 i„ shower area and ;n.foor, E G -f /O-�r ^d" L. T cth-tS 7 ® rt? ✓nd, n . f work, 10 be co- /vie-Fed f r/f i Q cornpi «trice W r rh f 6e 2_o 07 FT, C.