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PT-10-175 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 I nspection Number: INSP- 134770 Permit Number: PT -2 -10 475 Inspection Date: May 26, 2010 Permit Type: Paint Inspector: Bruhn, Norman Inspection Type: Final Owner: , CAV HOLDINGS, LLC Work Classification: New Job Address: 58 NW 104 Street Miami Shores, FL 33150- Phone Number Parcel Number 1121360131060 Project: <NONE> Contractor: G/F PAINTING SPECIALIST Phone: (954)709 -3113 Building Department Comments PAINT EXTERIOR OF THE HOUSE Inspector Comments Passed r Failed El Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. For Inspections please call: (305)762 -4949 May 27, 2010 Page 1 of 1 Miami Shores Village fy 10050 N.E. 2nd Avenue�h Miami Shores, FL 3313 8-0000 f � h Phone: (305)795 -2204 y ' Expiration: 08/081201 t Project Address Parcel Number Applicant 58 104 Street 1121360131060 CAV HOLDINGS, LLC Miami Shores, FL 33150- Block: Lot: Owner Information Address Phone Cell CAV HOLDINGS, LLC 91 64 Street HIALEAH FL 33012 -2663 Contractor(s) Phone Cell Phone Valuation: $ 1,000.00 G/F PAINTING SPECIALIST (954)709-3113 Total Sq Feet: 0 Type of Work: Exterior For inspections please call: Color: (305)762.4949 Additional Info: Available Inspections: Classification: Residential Inspection Type: Color. Approved Code Comments: SHERWIN WILLIAMS - WALLS - F Final Color: Approved_ Color. _Denied Fees Due Amount Invoice # Total Amt Paid Amt Due CCF $0.60 PT -2 -10 -36962 $ 66.60 $ 66.60 $ 0.00 Education Surcharge $0.20 Notary Fee $5.00 Check #: 1267 Permit Fee $60.00 Technology Fee $0.80 Total: $66.60 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 \° a Miami Shores Village sw��' �. g o Building Department ° 10050 N.t2nd Avenue. Miami Shores, Florida 33138 ...........::J:::: Tel: (_',05) 795.2204 Fax: (305) 756.8972 !! y'•• cc BUILDING Permit Nopr I -� v • PERMIT APPLICATION Master Permit No. FB� Permit Type: PAINT PERMITiY /�U Owner's Name (Fee Simple Titleholder) ] _ Phone Owner's Address City 11 �� C"q,4,d State Flo a4 W 4± Zip Tenant /Lessee N //ame v4, Phone # T ZZD G E- MAIL:0._v c,'�_�' I" Job Address (where the work is being done) Z -' City — _ Miami Shores Villa <_ye County Miami -Dade Zip — FOLIO / PARCEL # Is Building Historically Designated YES NO Conti—actor's Company Name (. tGl \ )`Phone # Contractor's Address q L \ Cit y - i :.� _ \�� C�� State r L. - Zip 3 `� G t2 l 1 �-� Qualilier Name Phone # State Certificate or Regis - tion No. Certificate of Competency No. OWNER BUILDER Value of Work For this Permit Type of Work: ❑ Addition / ❑ Alteration / ❑New ! Repair /Replace Describe Work: Application is hereby oracle to olxain a permit to do the work and installations ae indicated. I certify_thatno work or installation has Commenced prior to the issuance of a permit and that all work will be pet ormed to meet the standards of all taws regulating construction in this jurisdiction. I understand that a separate permit must be wpured litr ELI C•TRIC "AL. WORK. PLUMBING. SIGNS WELLS- POOLS, I- URNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETf'.'.... "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAV RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR 1410I'ERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER AR AN ATTORNEY BUORG RECORDING YOUR NOTICE OF CONIMENCEMEN'C Notice to. I pplicarn: .4.s it condition to the issuance qfa building permit with an estimated value exceeding $2560. !lte applicant rnust pionri.se in gtxxtdfailh dial a copv of the notice of coinruencenteni and canstruction lien law brochure will be delivered to the person whose properly is subject to attachment. Also. a certified copy of the recorded notice gftonnttencenteni Hurst 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 Bach posted notice. the inspection mill not he approved and a reinspection fee will be charged. Technolo Fee: Permit Fee $ ��'l7lJ CCU $ Technology Fee: Fee $ Notary $ Code Enforcement $ Double Fee $ Zoning $ Total Fee Now Due $-- See Reverse side --> PAINT COLOR APPROVAL AND AGREEMENT All elements on the site must be listed and indicate the color to be painted Directions: Please circle corresponding number to appropriate.' Walls: I 2 ; 4 98 Iles with name and Fascia: 1 2 3 4 fiber. Drip Cap /Drip Edge: 1 2 3 4 O �; SW 6679 SoffiC_ I 2 4 Full Moon Roof 1 2 3 4 Flower Bins: 1 2 3 4 56 Shutters: 1 2 3 4 Awnin 1 2 3 4 2 Chimney: I 2 3 4 SW 6385 Doors and Door.lams: 1 2 3 4 Dover White Garage Doors: 1 2 3 4 -- Railings: 1 2 3 4 3 Fences: 1 3 4 All brick (simulated or re(ular I 2 3 4 Stucco Banding: l 2 3 4 Any other Stucco Features: 1 2 3 4 4 Accessory Buildings Other: OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. I L Signatu Signature ' Owner or Agent _ ,r �' Contractor i The fore U 'ng, instrument was a c ledg h ore fi� s The f ng instrument was k owledged b for me this day of _01 V day o 20 �b who is rsonally kno •n to e or who has pit) uced hY is rs al kno vn t r e or who has produced O �!l ti _ ie al X did take at) ��b 1 (J � i icaticy� ttncl who d take an oath. NOTAR f U ' G'1 V$ N AR 1 0 'tip o� c.• on Sign: c�ti Sign:�c.., �•��c . �G Print: - - - -- � Print: My Commission I-xpires: �' G �• , My Commission Expires: Off'. • ° .u., 4 „q„ � • ,�, �Y��• x *� * *x *,: *x� *��,�x�,t�� * *� **�* *� �*, t* t, t• ��, r�** x��* �*** tr* �**** t��*** �x*** ��• �**• x�e� * * * *��x /BN APPLICATION APPROVED BY: Plans Examiner f Preservation Board Code Enforcement (Revised 04/24/0 Feb 08 10 01:11p Insurance 561 - 736 -6151 p.1 CERTIFICATE OF LIABILI IN 02m61;o °`�'""' THIS CERTIFICATE IS ISSUED AS A 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($), AUTHORIZED REPRESENTAT OR PRODUCER, AND THE C H OLDER. IMPORTANT: It the Certificate holder to an ADDITIONAL INSURED, the po6cy(tes) must he andomed. if SU13ROGATION IS WAIVER, suD)oct 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 certlflcate holder In lieu of such endorsement(s). PRODUCER • CONTACT '•-•••- •- •--- •� -••'- E: Freddy Britos Ali City Bird Rd. Insurance Agency PHONE (305} 552 -1758- T N •'• (305 226 418 8475 Bird Road .MAN - ADDRESS:.._...._. lreddVbrltOS(�yAh00.00111 Miami, FL 33155 PROOUCrdR Phone (305)552 Fax (305)226 -6418 INSURE S AFFORDING COVERAGE NAIC I tnsuRED INSURER A: MID- CONTINENT CASUALTY COMPANY GiF HINTING SPECIALIST, INC, INSURER 8; .. ........... _...... 2618 SW 14th. Drive INSURER G: • - . .................... _....._._— Deerfield Beach, FL 33442 INSURER D s,_ _•,_,__,,,,____• -- __ 954 - 709 -3113 IN Bl7 RER E s __ _._ -....__ .........._ ..................._ I COVERAGES CERTIFICATE NUMBER: INSURE : I - .._....._.. REVISION NUMBER: ~ THtS - IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED Ab1ED ABOVE FOR THE POLICY PERIOD - INDICATED. NOTWITHSTANDING ANY REOUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WwH 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. LWITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TR TYPE OFfNSU RANCE IRSIi�`HLVR_ - -_ pOUGYNUNB� _ P OLIC Y YWYj O LI O 1fYYY2 L IMITS GENERAL LIABILITY I EACH OCCURRENCE S 1 I COMMERCIAL GENERAL LIAHLrTY OdM�1CF REN'WO - ❑ L] CLAIMS-MADE r.� OCCUR PROM .S Cd omrmncd III 100, A 04 -OL- 787955 MEDIZt jL— S 5,000 02I05r2070 021 05120 71 P ERSONAL B ADV INJURY $ t,000.000,j ❑ _ GFNFRAL AWAFGATF _ ..$ CEN'L ACCR£CATE U1MrrAPPLIEES PER _ PRODUCTS - COMPIOP At;C, S 2,666 ,000 [, ] rppgC . Q ' PRO, U LOC __.._....,....... AUTOMOBILE LIABILITY COMDINCD SIN LIMIT ANYAUTO (Eo ncc cant) $ ❑ ALL OWNED AUTOS BODILY (Per person; $ ❑ SCHEDULED AUTOS 80DILY INJURY IPerawkw t $ PROPERTY DAMAGE L] HIRGDAUTDS (Paraawident) (_ 1 NON-OWNtV A U T O S - - _- - -- - -- $ - ^--- -- - -•.__ D _ $ UMBRELLA LUIS I f OCCUR EACH OCCURRENCE S n)tCE33 Wan mAt)E ACpCQAFRnlF ❑ OBDUCTBLE - a YtORKERti COMPENSATION WC STATU- I • I �R - AND EXPLOYERW LIABILITY YIN ❑ LJ .TORYLovirr, _._.._.......____ ANY PROPRIETORMARATNENfEXtCUTNE -- OI+IUEH/MEMftKEXCLUO:01 NIA C.L. EACH ACCIDENT x__........ Ims"datuty In NH) E_L. DISEASE - EA EMPLOYE $ N 7ypemm dnsoriba und9r _ DE$L OF OPERATIONS below E.L. DISEASE - POLICY LIMIT II - DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, A44140M I Raqurlu UhsdWq, N murs dpass is rsquirsd) CERTIFICATE HOLDER CANCELLATION SHOULD ANY O HE ABO CRIBED POLIC19S BE CANCELLED BEFORE MIAMI SHORES VILLAGE THE EXPIRAT TE T RE( NOTICE WILL 9E DELIVERED IN ACCORDANCE TH POLICY PROVISIONS. 10050 NE 2nd. AVENUE MIAMI SHORES, FL. 33138 AUTHORMCD RE NT r - -- - -- - -- - - - -- - - FAX #305.756.8972 ATTN: V IVIANA 4, ` ACORD 2512009/091 OF 968 - 2009 ACORD CORPORATION. All rights reserved. he ACORD rime and logo are registered marks of ACORD