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RC-09-2026 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 131128 Permit Number: RC -12 -09 -2026 Scheduled Inspection Date: March 08, 2010 Permit Type: Residential Construction Inspector: Bruhn, Norman Inspection Type: Final Owner: GOMEZ, RODOLFO AND SUSANA Work Classification: Miscellaneous Job Address: 1156 NE 101 Street Miami Shores, FL Phone Number (305)898 -8841 Parcel Number 113205019025 Project: <NONE> Contractor: HOME OWNER Building Department Comments PUTTING UP 2 INTERIOR WALLS A CLOSET AND A POCKET DOOR TO MAKE A ROOM Inspector Comments Passedo/f f Failed Correction ❑ Needed Re- Inspection ❑ Fee No Additional Inspections can be scheduled until re- inspection fee is paid. March 05, 2010 For Inspections please call: (305)762 -4949 Page 6 of 30 r s °R Miami Shores Village - HTf? Italy 10050 N.E. 2nd Avenue f y r r n - A� Miami Shores, FL 33138 -0000 "; oRiv�p Phone: (305)795 -2204 � - ' Expiration: 08/081201 Proje Address Parcel Number Applicant 1156 101 Street 1132050190250 RODOLFO AND SUSANA GOME; Miami Shores, FL Block: Lot: Owner Information ..N _a Address � Phone Cell I RODOLFO AND SUSANA GOMEZ I (305)898 -8841 Contractor(s) Phone Cell Phone Valuation: $ 900.00 JC ELECTRIC INC (305)754 -6949 Total Scl Feet: 0 Type of Work: ELECTRICAL FOR NEW BEDROOM For Inspections please call: Additional Info: ELECTRICAL (305)762 -4949 Classification: Residential Available Inspections: Inspection Type: Fees Due Amount Invoice # Total Amt Paid Amt Due CCF $0.60 EL -2 -10 -37012 $ 229.60 $ 229.60 $ 0.00 Education Surcharge $0.20 Permit Fee - Additions /Alterations $225.00 Scanning Fee $3.00 Technology Fee $0.80 Total: $229.60 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, servants, or employes. I understand that separate permits are required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS 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. Futhermore, I authorize the above -named contractor to do the work stated. February 09, 2010 Authorized Signature: Owner / Applicant / Contractor / Agent Date Building Department Copy February 09, 2010 1 F Miami Shores Village IT Building Department FEB 0 4 Z010 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 BY: ••......... BUILDING Permit No. PERMIT APPLICATION Master Permit No. 0G —� FBC 20 Permit Type: ELECTRICAL S�- i - 6 t 2�5 Owner's Name (Fee Simple Titleholder) J a Ifa a-s� 20 * Phone # ' 7 9 Owner's Address City State Zip Tenant/Lessee Name Phone # Email Job Address (where the work is being done) City Miami Shores Villaize County Miami -Dade Zip 3 3� FOLIO / PARCEL # Is Building Historically Designated YES NO Flood Zone Contractor's Company Name •: C- `�. l Q c.-r .. • --1 N Phone # Contractor's Address ( 4 & o W 1 6 Sy City V�-� , n �n , State �- (' Zip 3 Qualifier Name � `i Phone # G State Certificate or Registration No G c')Oc> c ap Certificate of Competency No. Contact Phone 3 d Architect/Engineer's Name (if applicable) Phone # Value of Work For this Permit $ - t�, Square / Linear Footage Of Work: Type of Work: []Addition ]teration ®New [] Repair/Replace El Demolition Describe Work: �' //�� W /� 1 e / --� n . t� � � r. b e � r Q r o U F'}/ c�S! i�l ti G ►C Q t3 J * ** Fees********: x*����� *��� *�� *����� *� *�� *�� *������� Submittal Fee $ Permit Fee $ 3 /�- 5 CF $ CO /CC Notary $ Training/Education Fee $ Technology Fee $ • Scanning $ Radon $ DPBR $ Zoning $ Bond $ Code Enforcement $ Double Fee $ Structural Review. $ Total Fee Now Due $ See Reverse side s Bonding Company's Name (if applicable) • 4 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. l Signature Signature Owner or Agent Fi B5tzuAxl Contractor �e The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged n before me this T day of , 20 Z, by LFp �LC�Vj (4bnl - day of ✓ l , by e (Za nom ho is personally known tq me or who has produced - who is sonall kno me or who has produced Fj52b 73( • As and who did take an oath. as identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: ►ice(• - -- Si Print: Print: v ANA M.ROJAS M. ROJAS := MY COMMISSION # DD 618973 My Commission Exp' ' MY COMMISSION # DDI 618973 My Commission E EXPIRES: January 29, 2011 EXPIRES: January 29, 2011 ;; ' Bonded Thru Nota Punk under niters 'ti%t f,h.•` Bonded Thru Notary Public underndNrs APPLICATION APPROVED BY Plans Examiner Zoning Engineer Clerk checked (Revised 07/10/07) ;AN ATPl:ICATION FOR BUILDING PERMIT MUST ACCOMPANY THIS ADDENDUM. IF A MASTER PERMIT HAS B. OBTAINED, THE OWNER'S NOTARIZED SIGNATURE NEED NOT BE PRESENT ON SUBSEQUENT' APPLICATIONS.) PLUMBING ELECTRICAL MECHANICAL ITEM UNIT FEE ITEM UNIT ITEM UNIT FEE 3ATH TLB SWITCH CUTLETS SPACE HEATERS 31 OET L I DfT OUTLETS CENTRAL HEAT I W. 31SHWASHER RECEPTACLES A/C (WINO) )ISPOSAL SERVICE TEMPORARY A/C (CENTRAL) )RINKIIC FOUNTAIN SERVICE SIZE IN AJPS DUCT WORK rL00R MAIN SERVICE REPAIWTER CHANGE REFRIGERATION GREASE TRAP APPLIANCE OUTLETS PROCESS AND PRESS PIPIT INTERCEPTOR RANGE TCP UFOERGROJND TANKS LAUNDRY TRAY OVEN ABOVE GROUND TANKS WATER HEATER U.F. PRESSURE VESSELS CLOTHES WASHER MJTCRS 0- 1 tP STEAM BOILERS SEWER MOTORS OVER 1- 3 FP NOT WATER BOILERS OE E SINK, POT SLOP IO COMP. I MOTCRS OVER 3 5 HP MECHANICAL VENTILATION SINK, MOTORS OVER Er- 8 HP TRANSPORTING ASSEMBLIES SINK, SLR' MOTCRS OVER 8- 10 W ELEVATORS/ESCALATORS TEMPORARY WATER CLOSET MOTORS OVER 1D- 25 H? FIRE SPRINKLER SYSTEMS UR I HAL MOOTORS OVER 2_`r 100 FP 'MATER CLOSET COOLING TOWERS AO TORS OVER 100 FP VIOLATION INDIRECT WASTES A/C WINDOW WATER SUPPLY T0: I RE WSPECTION AIR CONDITIONERS A/C UNIT STRIP HEATER FIRE SPRINKLER GENERATORS TRANSFORMERS HEATER -NEW INST, GENERATORS TRANSFORMERS HEATER4EPLACE GENERATORS TRANSFORMERS I. i LAWN SPRINKLER -WELL SPECIAL PURPOSE SWIWING PDOL OUTLETS C04ERCIAL WATER. SERVICE SIGN TUBES SEWER CONNECTIONS *.SIGN TRANSFORMERS UTILITY -SEWER SIGN TIME CLOCK UTILITY -WATER FIXTLRES SEPTIC TANK ANTENNA RELAY I TELEVISION OUTLETS DRAINFIELD, 4' TILE/RES• I V10LATIDN PUAP 8 ABANDON SEPTIC TANK RE INSPECT ION SOAKAGE PIT Gll . FT . CATUI BASIN e DISGE WELL DOMESTIC WELL 4REA CRAM I I 300E INLET )OLAR WATER HEATER, IRS STAND, I I 'OOL PIPINu -AWN SPRINKLER SYSTE6'. ;AS RANGE ETEP, SET (GAS) I ! I j I I I :As PIPIM. I' , AC# v STATE OF FLORIDA DEPARTMENT OF SS AND PROFESSIONAL REGULATION ELECTRICAL COtJTRACTORS LICENSING BOARD SEQ# L08082400212 • LICENSETBR 08/24/1200 088041747 EC000204 The ELECTRICAL CONTRACTOR" Named below IS CERTIFIED Under the provisions of Chapte p,­ ` PS. Expiration date: AUG 31, 2010. s. RODRIGUEZ;, JUAN CARLOS J C ELECTRIC, ? INC 14237 SOUTHWEST 125 AVENUE' t MIAMI FL 33186 CHARLIE CRIST CHARLES W. DRAGO GOVERNOR SECRETARY DISPLAY -AS REQUIRED BY LAW MIAMI -DADE COUNTY 2009 LOCAL BUSINESS TAX RECEIPT 2010 FIRST -CLASS TAX COLLECTOR MIAMI -DADE COUNTY - STATE OF FLORIDA U.S. POSTAGE 140 W. FLAGLER ST. EXPIRES SEPT. 30, 2010 PAID 1s1 FLOOR MUST BE DISPLAYED AT PLACE OF BUSINESS MIAMI, FL MIAMI, FL 33130 PURSUANT TO COUNTY CODE CHAPTER SA - ART. 9 & 10 PERMIT NO. 231 166695-8 THIS IS NOT A BILL - DO NOT PAY RENEWAL BUSINESS NAME / LOCATION RECEIPT NO. 166695-8 J C ELECTRIC INC STATE# EC0002045 14260 SW 136 ST 3 33186 UNIN DADE COUNTY OWNER J C ELECTRIC INC Sec. Type of Business WORKER /S 196 ELECTRICAL CONTRACTOR 1 THIS IS ONLY A LOCAL BUSINESS TAX RECEIPT. IT DOES NOT PERMIT THE HOLDER' TO VIOLATE ANY .EXISTING REGULATORY OR ZONING. LAWS OF THE DO NOT FORWARD COUNTY OR CITIES. NOR DOES IT EXEMPT THE HOLDER FROM ANY OTHER J C ELECTRIC INC PERMIT OR LICENSE REQUIRED BY LAW. THIS IS JUAN CARLOS RODRIGUEZ PRES NOT A THE:. HOLDER'S OUALIFICA- 14260 SW 136 ST 3 TONS. MIAMI FL 33186 - PAYMENT RECEIVED MIAMI- DADE:000NTY TAX COLLECTOR: 09%22/2009 60000000021 000082.50 114 {{ S i 1{yy SEE OTHER SIDE } si111iI�lls tsllltll3i;l t1i111Ytit7111f i1111111111111111till�t �® CERTIFICATE OF LIABILITY INSURANCE OP ID DT F DATE (MM/DD/YYYY) JCELE01 01/25/10 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE FILER INSURANCE, INC. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 9440 S.W. 77 Avenue ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Miami., FL 33156 Phone: 305- 270 -2100 Fax: 305- 270 -2195 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A: Nationwide Mutual Insurance Co INSURER B: J. C. Electric Inc. INSURER C: 14260 SW 136 St Bay 3 INSURER D: Miami FL 33186 INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO 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. IMSK LTR NSR TYPE OF INSURANCE POLICY NUMBER P LI Y D EF P ( M/DD/Y LIMITS DATE MMIDD/YYYY DATE MM /DD /YYYY GENERAL LIABILITY EACH OCCURRENCE $1, 000 , 000 A X COMMERCIAL GENERAL LIABILITY 77PR870239 08/22/09 08/22/10 PREMISES(Eaoxurence) $ 100,000 CLAIMS MADE a OCCUR MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE s2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ 1,000,000 POLICY X PRO LOC JECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) $ HIRED AUTOS BODILY INJURY $ NON -OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS I UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR F-1 CLAIMS MADE AGGREGATE - $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION - - AND EMPLOYERS' LIABILITY Y IN TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE[:�] E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED' (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION VILLA04 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 Village of Miami Shores 10050 N. E. 2 Avenue REPRESENTATIVES. Miami Shores, FL 33138 j DARYL TORRES - A266851 ACORD 25 (2009101) VJ MV VVI�f VI�I111V1 f1111Ia11LJ ICDCI Yr4. The ACORD name and logo are registered marks of ACORD ACORD. CERTIFICATE OF LIABI INSUR AKXU3E5T DATE /2010Y' PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Risk Transfer Programs, LLC ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 219 East Livingston street HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR Orlando, FL 32801 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 866 - 481 -9363 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: SUA Insurance Company 40134 Global Employment Solutions PEO II, Inc. 3350 Bushwood Park Drive INSURER B. Suite 200 - Tampa, FL 33618 INSURER INSURER D D INSURER E COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECTTO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECTTO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, INSR ADVI. POLICY EFFECTIVE POLICY EXPIRATION POLICY NUMBER LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 11 EU COMMERCIAL GENERAL LIABILITY PREMISES Ea occurence $ CLAIMS MADE FI OCCUR MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OPAGG $ POLICY I I PROT LOC AUTOMOBILE UABIUTY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY SCHEDULEDAUTOS (Per person) $ HIRED AUTOS BODILY INJURY NON -OWNED AUTOS (Per accident) $ PROPERTY DAMAGE $ (Per accident) GARAGE UABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY AGG $ EXCESS/UMBRELLA LIABILITY EACHOCCURRENCE $ 7 OCCUR FI CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ $ A WORKERS COMPENSATION AND WSLTHPE 000082 -06 12/31/2009 01/01/2011 X WCSTATU- O _ITS EMPLOYERS' LIABILITY EL EACH ACCIDENT $ 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER /MEMBER EXCLUDED? EL. DISEASE - EA EMPLOYEE $ 1,000, 00 0 It yes, describe under SPECIAL PROVISIONS below E L DISEASE - POLICY LIMIT $ 1 , 000,000 OTHER DESCRIPTION OF OPERATIONS/ LOCATIONS /VEHICLES/ EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS Coverage is extended to the leased employees of alternate employer (Alabama, Colorado, Florida, Georgia, Indiana, Michigan, Mississippi, South Carolina, Tennessee, and Texas Operations Only):JC Electric, Inc N 80050234 (Effective 4/18/09) DISCLAIMER: The Certificate of Insurance does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OFTHE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORETHE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDFAVORTO MAIL30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURETO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPONTHE INSURER, ITS AGENTS OR REPRESENTATIVES. Village of Miami Shores 10050 NE 2nd Ave Miami Shores, FL 33138 AUTHORIZED REPRESENTATIVE;; 03/01/2010 11:03 FAX 1 800 685 7530 DATA SCAN FIELD SERVICES Q0041010 ........... .... . ... ... ............... .. .... . .. __.— ........ .. .... ....... ....... .... Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FIL r2 Phone: (305)795-2204 Fax: (305)756-8972 . ......... Inspection Number: INSPA 36420 Permit Number: EL-2-10-197 Scheduled Inspection Date'. March 01, 2010 Permit Type: Electrical - Residential Inspector: Devaney, Michael Inspection Type: Final Owner: GOMEZ, RODOLFO AND SUSANA Work Classification: Alteration Job Address: 1156 NE 101 Street Miami Shores, FL Phone Number (305)898-8841 Parcel Number 1132050190250 Project: <NONE> Contractor: JC ELECTRIC INC Phone: (305)754-6949 Building Department Comments ELECTRICAL AS PER PLAN FOR NEW BEDROOM BEING ADDED INSIDE HOUSE Inspector Comments Passed A Failed � ��� �,�� Correction Needed Re-Inspection Fee No Additional Inspections can be scheduled until re-inspection fee is paid. February 26, 2010 For Inspections please call: (305)762-4949 Page 11 of 19 *� °Rs Miami Shores Village Sr 9 _�����' T �' , , n •: 10050 N.E. 2nd Avenue�� M fan iami Shores, FL 33138 -0000 x Y 4 d R Pf?rrC#l1:��ig APPROVED .: k Phone: (305)795 -2204 Expiration: /081 1 F . VT Project Address Parcel Number Applicant 1156 101 Street 1132050190250 RODOLFO AND SUSANA GOME; Miami Shores, FL Block: Lot: Owner Information Address Phone Cell RODOLFO AND SUSANA GOMEZ (305)898- 8841 =, i z' Contractor(s) Phone Cell Phone Valuation: $ 1,500.00 HOME OWNER Total Sq Feet: 24 Approved: In Review For Inspections please call: Comments: (305)762 -4949 Date Approved:: In Review Available Inspections: Date Denied: Inspection Type: Type of Construction: WALL PARTITIONS Occupancy: Final Stories: Exterior: Front Setback: Rear Setback: Left Setback: Right Setback: Bedrooms: Bathrooms: Plans Submitted: Certificate Status: Certificate Date: Additional Info: Bond Return : Classification: Residential Fees Due Amount Invoice # Total Amt Paid Amt Due CCF $1.20 RC -12 -09 -36607 $ 231.20 $ 50.00 Education Surcharge $0.40 Permit Fee - Additions /Alterations $225.00 RC - 12 - 09 - 36607 $ 231.20 $ 231.20 $ 0.00 Scanning Fee $3.00 Submittal Fee $50.00 Submittal Reversal Fee ($50.00) Technology Fee $1.60 Total: $231.20 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, servants, or employes. I understand that separate permits are required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS 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. Futhermore, I authorize the above -named contractor to do the work stated. February 09, 2010 Authorized Signature: Owner / Applicant / Contractor / Agent Date Building Department Copy February 09, 2010 1 S Miami shores Village some s � Building Department 10050 N.E.2nd Avenue o �e Miami Shores, Florida 33138 p LOR t oo Tel: (305) 795.2204 Fax: (305) 756.8972 Permit No: !&- 09 --da Job Name Page 1 of 1 Building Critique Sheet LU &006,k r U I Z A e, J _ I L Plan review is not complete, when all items above are corrected, we will do a complete plan review. If any sheets are voided, remove them from the plans and replace with new revised sheets and include one set of voided sheets in the re- submittal drawings. Norman Bruhn CBO 305 - 795 -2204 4' Miami Shores Village 4 Building Department s f0050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Y� --------- BUILDING Permit No. It - - � 4 PERMIT APPLICATION Master Permit No. FBC 2001 Permit Type (circle) Building Roofing Owner's Name (Fee Simple it eholder) 0 1-120 a p ✓Y1 e Phone # J R (P , S Z S D (D q ? Owner's Address / /SC- NE /o/ City Mi ? i Sh 0Y4j State t Zip 331 Tenant /Lessee Name Phone # Job Address (where the work is being done) 5 (p A/6 / p / S7`a City . Miami Shores Village County Miami -Dade Zip 33 1S(, FOLIO / PARCEL # Is Building Historically Designated YES NO Contractor's Company Name Se Phone # Q�� �� �— (Ole Contractor's Address City State Zip Qualifier Name Phone # State Certificate or Registration No. Certificate of Competency No. Architect /Engineer's Name (if applicable) N/} Phone # /ll� Value of Work For this Permit $ /, 50 D. U O Square / Linear Footage Of Work: i2- X 0 Type of Work: ❑Addition RAlteration ❑New ❑ Repair /Replace ❑ Demolition Describe Work: Q i r�i c� �Q i f�r1 D lnI 11J ti `gin 6 ke- - r © c yin er tb •x ��xxxxFnxxxxxnxxxxxxxxxxxxxxxxxxxxx xFeesxxxxxxx xx x�xx xxFnxFxn� xxxxxx�xxxxxx Sub iftal Fee x (7� Permit Fee $ �� CCF $ CO /CC Notary $ Training/Education Fee $ i.,..i { Technology Fee $ �L( Scanning $ ` iJ Radon $ DPBR $ Zoning $ Bond $ Code Enforcement $ Double Fee $ Structural Review. $ Total Fee Now Due $ See Reverse side —� Bonding Company's Name (if applicable) /ol lr Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) N �' 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 .lpplicanfi As a condition to the issuance of a building permit 3rith an estimated value exceeding $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien lmr brochure gill be delivered to the person irhose property is subject to attachment. .41so, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection irhich occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection frill not be approved and a reinspection fee gill be charged. Signature Signature �,..� ( O ner or A ent O Contractor TtC f� g g ins�trerlt a ac o led bef me this The foregoing instrument was acknowledged before me this day ofu� , 20 (q b day of , 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. NOTAR PUBLIC: NOTARY PUBLIC: rig- -- ��� ovti S Sign: >�,�� Sign: Print: x`.. � Print. My Commission Expires: A q� ti 's` My Commission Expires: APPLICATION APPROVED BY: Z/ 0 Plans Examiner Engineer Zoning (Revised 07/10/07) VILLAGE OF MIAMI SHORES OWNER BUILDER DISCLOSURE STATEMENT NAME: go do I �0 9 vrr1 c ?:� DATE: ADDRESS: N� / ;Sf" Do hereby petition the Village of Miami Shores to act as my own contractor pursuant to the laws of the State of Florida, F.S 489.103(7). And I have read and understood the following disclosure statement, which entitles me to work as my own contractor; I further understand that I as the owner must appear in person to complete all applications. State Law requires construction to be done by a licensed contractor. You have applied for a permit under an exception to the law. The exemption allows you, as the owner of your property, to act as your own contractor even though you do not have a license. You must supervise the construction yourself. You may build or improve a one - family or two- family residence. You may also build or improve a commercial building at a cost of $25,000.00 or less. The building must be for your own use and occupancy. It may not be built for sale or lease. If you sell or lease a building you have built yourself within one year after the construction is complete, the law will presume that you built for sale or lease, which is a violation of this exemption. You may not hire an unlicensed person as a contractor. It is your responsibility to make sure the people employed by you have licenses required by state law and by county or municipal licensing ordinances. Any person working on your building who is not licensed must work under your supervision and must be employed by you, which means that you must deduct F.I.C.A and with - holdings tax and provide workers' compensation for that employee, all as prescribed by law. Your construction must comply with all applicable laws, ordinances, buildings codes and zoning regulations. Please read and initial each paragraph. 1. I hold title to the above property and I am planning on doing this construction Initial 2. I understand that as an owner- builder I must abide by all zoning ordinances and building regulations in effect at the time of permit application Initial 3. 1 have an understanding of the 2004 FBC & FRC and understand that this department and its inspectors are there to help enforce and interpret the code. There is a copy of the code in this office for review. Initial 4. I understand that the building official and inspectors are not there to design, alter or give advice on how to meet code — only if the structure meets the minimum code. Initial 5. I understand that as an owner - builder, that any contractor disputes with sub- contractors and myself must be handled in a civil court with the advice of an attorney. The department will not mitigate any contract disputes. Initial 11Y, 6. I understand that if I compensate any person or company for work performed they are required to have a business license in the county. If for any reason they do not posses a business license I will be responsible and liable for any wrong doing from this unlicensed company or person. Iq Initial ` 7. I understand that if any person gets injured on my construction project —they are entitled to workmen's compensation. And if they do not posses a workmen's policy I could be held liable for all doctor and related cost which could include loss of wages during recovery from injury. A Initial � 8. I understand that under state and local laws I can not do any Electrical, Plumbing, Heating, Air & Roof work on my property with out first obtaining the proper permits by licensed contractors. Initial , Was acknowledged before me this day of .1 By CJM was personally known to me or who has Produced there License or `0 as identification. OWNER NOTARY ATE OF �giAA aTAtY �'jI77 IGCo.,I C. Do, A ♦ $ORES Li I.,. milli" Miami shores Village C Building Department FLORIDA 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 RECEIPT PERMIT #: .,. ' �•., � C DATE: ! I C" _ - �to4"san0' ❑ Contractor ¢ -Owner ❑ Architect Picked up 2 sets of plans and ( other) -- Address: � I S ( '0 N G D ( 9f r � to Yn 1 V`ov - c : �L 3 3 13 From the building department on this date in order to have corrections done to plans And /or get County stamps. I understand that the plans need to be brought back to Miami Shores Village Building yDep to continue permitting process. Acknowledged by: k , PERMIT CLERK INITIAL: RESUBMITTED DATE: r t1 'lip PERMIT CLERK INITIAL: 1 S NORES. I� �C1 ■n■ ,� umM �LORiDp CUMULATIVE SUBSTANTIAL IMPROVEMENT VERIFICATION WORK SHEET In accordance with FEMA regulation and Miami Shores Village Flood Damage Prevention Ordinance the costs of all improvements must be monitored. The costs of any improvements in the past 12 months and the costs of any proposed improvements must be shown on the worksheet. The cost of improvements must include demolition, raw and finished materials (include those donated), labor (including volunteer and self- performed), construction supervision and management, and overhead and profit. A list of items the costs of which are to be included as well as those excluded is attached for your reference. (A Copy of the Contract must be attached) PROPERTY OWNER- 4 0,60 PERMIT # �L�-- ' R- - 0 2 - 0 - 2—(, ADDRESS: �'� �v 4f , d ( ST FOLIO NUMBER: 3'� C) �'� �'� �� FLOOD ZONE: BASE FLOOD ELEVATION: FREEBOARD: EAST OF FL.CCCL: COST OF PAST IMPROVEMENTS (12 MONTHS): COST OF PROPOSED IMPROVEMENTS: (ATTACH COPY OF CONTRACT) TOTAL CUMULATIVE COST OF IMPROVEMENTS (past and proposed): VALUE OF PRINCIPAL STRUCTURE (attach appraisal): OWNERS SIGNATURE: DATE: PLANREVIEWER: PLAN REVIEWER SIGNATURE: DATE: I Created on June 2009 i c r ♦ 5t!ORES Li << soon & P XORIDp' SUBSTANTIAL IMPROVEMENT / DAMAGE LIST (NOTE. THIS LIST IS INTENDED FOR GUIDANCE ONLY AND IS NOT ALL INCLUSIVE) ITEMS TO BE INCLUDED ALL STRUCTUAL ELEMENTS, INCLUDING ALSO: Foundations including; Spread footing, Continuous footing, All Labor and other Costs associated with isolated footing, piles and pile caps Demolition, Removing, Replacing, Slabs including; Monolithic, floating, Installing Building or Altering Building elevated Components Walls including; Exterior walls, Bearing Construction Management / Supervision walls, Shear walls Overhead and Profit Beams, Tie Beams, Columns and Posts Equivalent cost for: Wood decking, Floor and Roof Sheathing Donated Materials Trusses, Joist Volunteer Labor (including owners and Windows /Doors friends) ALL BUILDING ELEMENTS, INCLUDING Any Improvements Beyond Pre - damaged Condition, including; Interior Partitions, Walls, Columns Utility Upgrades Drywall, Ceilings, Code Upgrades Built in Furniture, Cabinets, Vanities All Fixtures ITEMS TO BE EXCLUDED Flooring, Tile, Carpet, Stone, Linoleum, ect. Plans and Specifications All Finishes including Drywall, Paint, Survey Costs Stucco Plaster, Paneling, Tile, Marble, Elevation Certificate Costs and Moldings Permit fees Roofing Material Debris Removal ALL HARDWARE Items not considered to be REAL Property Rugs, Furniture, Refrigerator, ALL UTILITY and SERVICE Appliances not Built -in EQUIPMENT Outside Improvements, Including; HVAC Landscaping i Electrical System and Equipment Sidewalks Plumbing System and Equipment Patios Security System and Equipment Fences Central Vacuum System Yard lights I Plumbing Fixtures Sheds Lighting Fixtures and Ceiling Fans Gazebos Water Systems including Irrigation I Softeners /Filtration P000l t 4 Created on June 2009 i i FLORIDA DEPARTMENT OF HEALT Charlie Crist Ana M. Viamonte Ros, M.D., M.P.H. Governor State Surgeon General January 25, 2010 Rodolfo Gomez 1156 NE 101 St Miami, FL 33138 RE: Contingency Letter Application Document No: AP949465 Centrax Permit Number: 13 -SC- 1117688 OSTDS Number: 1156 NE 101 St Miami, FL 33138 Lot: 2 Block: 177 Subdivision: Dear Applicant: This will acknowledge receipt of an application dated 01/21/2010 for a permit to use an existing onsite sewage treatment and disposal system located on the above referenced property. 1. -There is no increase in sewage flow, change in characteristics compromising the integrity or function of the system installation. 2. -This project entails: "NEW BEDROOM ADDITION " From a review of your completed application, it has been determined that your existing system is adequate for the proposed use : " APPROVED ". G/P If you have any questions on this matter, please call our office at (786) 315 -2444. Sincerely,. Josp iverger, Engineer Specialist II Enclosures cc: Miami -Dade County Health Department 1765 NW 167 St, Opa Locka, FL 33056 Phone: (786) 315-2444 Fax: (786) 315-2090 l2f Cet ( o G. OR C. s Miami shores Village E,,, 11111 Building Department 10050 N.E.2nd Avenue '.' Miami Shores, Florida 33138 p Tel: (305) 795.2204 OR Fax. (305) 756.8972 Permit No: 09 -,)od6 Job Name: 2009 Page 1 of 1 Building Critique Sheet v . /�n odrQ� /�'fLl c <c P ®/i1 '1 `® 0-1:� Plan review is not complete, when all items above are corrected, we will do a complete plan review. If any sheets are voided, remove them from the plans and replace with new revised sheets and include one set of voided sheets in the re- submittal drawings. Norman Bruhn CBO 305 - 795 -2204 J iLL 00 S • • • . 0 . 60 . • • �V • • ..0 . i f •• • • ••• •• • • •i. i•. ••• ••• • • •� o fi 5� L s `� r� � 321 - 3 �'