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DEMO-11-119• Scheduled Inspection Date: March 01, 2011 Inspector: Bruhn, Norman Owner: ESCOBEDO, CARLOS Job Address: 162 NW 108 Street Project: <NONE> Contractor: JA GLOBAL SERVICE GROUP Building Department Comments February 28, 2011 Miami Shores, FL 33168- Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 155231 Permit Number: DEMO -1 -11 -119 For Inspections please call: (305)762 -4949 Permit Type: Demolition Inspection Type: Final Work Classification: Building Phone Number Parcel Number 1121360100060 Phone: (786)236 -6545 REMOVE AWNINGS, DOORS WALLS, SHINGLE ROOF OF THE SCREEN ENCLOSURE ATTACHED TO MAIN STRUCTURE. REMOVE DRYWALL INSIDE OF GARAGE AND ELECTRICAL FIXTURES. BRING GARAGE BACK TO ORIGINAL USE Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments Page 6 of 12 JOB ADDRESS: 16 Ai kJ 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 BUILDING PERMIT APPLICATION Master Permit No. FBC 20 Permit Type: BUILDING C OWNER: Name (Fee Simple Titleholder): Car-An 1 16so,4e Phone #: Address: /6 2 A IV /08.'_ City: ii22 f —hhQYS State: Zip: 3 joie Tenant/Lessee Name: Phone #: Email: City: Miami Shores County: Miami Dade Zip: Folio/Parcel #: Al ° 213 , - 0/0- 0060 Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name: 1 Qerviee5 64,F Phone #: Address: 246/ 7, 7 it 104 City: /11194-ea Lf State: Qualifier Name: 1 A State Certification or Registration #: Cq6 151207 7 Certificate of Competency #: Contact Phone #: Email Address: DESIGNER: Architect/Engineer: Phone #: Value of Work for this Permit: $ �d � � � Square/Linear Footage of Work: Type of Work: Address UAlteration Description of Work: � 0Ye a eer New dao Permit No EHO 1 9 Zip: Phone #: 7 56 - Z --60 j0491910a460 0 r5F) O 2 d ORepair/Replace move., 4 wry teal in 4lJi wv5 ? e/ r, r.. j f iacy 4 'reh.rr, 4-0 v rI v a r7.i j 4 . COLOR THROUGH ROOF TILE IS REQUIRED acknowledged by: ******** x * * * * * * * * * * * * * * * * * * * * * * * * * * * * +* F ees * * * * * * * * ** * * * * * * * * * * * * * * ** * * * * * + * * * * * * * * ** d Submittal Fee $ Permit Fee $ / 3 CCF $ CO /CC $ AN 2 5 2011 7&6 `233--6 J emolition Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ /151 A ot3 Structural Review $ TOTAL FEE NOW DUE $ Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which oc s seven (7) days after the building permit is issued. a a% uch posted notice, the inspection will not be approved a a reinspection fee will p - charged. Signature Ow The fi ' goi g instrument was day o `�i��. �..� 20 11 b who isl:te NOT ' : PUBLIC: Is Sign: Print: My Commission Expires: APPROVED BY o me or who has produced s identification and who did take an oath. (Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09)(rev6/4/10) Signature ontractor as ackn ' t� le ed befo me l ,2t V� ,b' wn to me or who has produced entification and who did take an oath. ) �Q. OT Y PUBLIC: A jj l ,,f °� �, 5'ti Sign: ��t�JQ' ,�4 �1> p4 : 4. '' c l., ' ' 3 �$ ,,., ..: , ` <O My Print: Commission Expires: y�� {q ti` .� g �° �� ....................*...... ............................***********..*.*****.*...:1 7-1 9 1:**.f:**** 'id Plans Examiner Zoning Structural Review Clerk 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 CONDRTONS OISUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR DT. LTR INSRD TYPE OF INSURANCE POUCY NUMBER POLICY EFFECTIVE DATE (MMIDD/YYYY) POUCY EXPIRATION DATE IMMIDD/YYYY) LIMITS A GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY 8GL88353 4/12/2010 4/12/2011 EACH OCCURRENCE $ 1,000,000 X DAMAGE TO RENTED PREMISES occurrence) $ 100,000 CLAIMS MADE X OCCUR MED EXP (Any one person) $ 5,000 PERSONAL BADV INJURY $ 1,000,000 $ 1,000,000 GENERAL AGGREGATE GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP/OP AGG $ 1,000,000 IPOLICY 1 21 LOC AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS COMBINED SINGLE LIMIT (Ea ) $ BODILY INJURY (Pe person) BODILY INJURY (Per ) PROPERTY DAMAGE (Per acddent) $ GARAGE LIABILITY ANY AUTO AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS / UMBRELLA UABIUTY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE RETENTION $ $ $ $ WORKERS COMPENSATION AND EMPLOYERS' LWBILJTY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ OFFICER/MEMBER EXCLUDED? (Mandatory In NH) Kyes describe wider SPECIAL PROVISIONS below WCSTATU- OTH- TORYUMITS ER EL EACH ACCIDENT $ EL DISEASE - EA EMPLOYEE $ EL DISEASE - POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS General contractor. (305) 756 - 8972 Miami Shores Village 10050 NE 2nd Avenue Miami Shores, FL 33138 SHOULD ANY OF THE ABOVE DESCRIBED DATE THEREOF, THE ISSUING INSURER NOTICE TO THE CERTIFICATE HOLDER IMPOSE NO OBLIGATION OR LIABILITY REPRESENTATIVES. POLICIES BE CANCELLED BEFORE THE EXPIRATION WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL OF ANY KIND UPON THE INSURER, ITS AGENTS OR AUTHO�DREPRESENTATIVE A Dopazo CIC /AD ��// ACCORD CERTIFICATE OF LIABILITY INSURANCE PRODUCER (305) 470 -8500 FAX: (305) 470 -0111 Dopazo and Associates 3900 NW 79th Ave Suite 700 Miami FL 33166 INSURED JA Global Services Group Inc 2461 W 76th ST Unit 104 Hialeah FL 33016 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 ►NsuRER A Accident Insurance Company INSURER B: INSURER C: INSURER D: INSURER E DATE (MMIDD/YYYY) 1/21/2011 NAIC # 11573 COVERAGES CERTIFICATE HOLDER CANCELLATION A rmen we fet►nernA� I:.1 •flOO wMfl Af►f F AnfllfnO ATfn &f A11 ip Inspection Number: INSP- 155298 Permit Number: DEMO -1 -11 -136 Scheduled Inspection Date: February 28, 2011 Inspector: Devaney, Michael Owner: ESCOBEDO, CARLOS Job Address: 162 NW 108 Street Miami Shores, FL 33168- Project: <NONE> Contractor: INDUSTRIAL ELECTRICAL SYSTEM CORP Building Department Comments ELECTRICAL DEMOLITION Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Passed Et' Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments February 28, 2011 For Inspections please call: (305)762 -4949 1\ An Permit Type: Demolition Inspection Type: Final Work Classification: Electric Phone Number Parcel Number 1121360100060 Phone: 305/228 -1384 Page 16 of 33 BUILDING PERMIT APPLICATION FBC 2004 Is Building Historically Designated YES NO x Contractor'sAddress 10257 NW 9th St Cir # 205 City Miami State Certificate or Registration No. EC 13002182 Describe Work Electrical Demolition. Miami Shores Village Building Department /0050 N.E.2nd Avenue, Mimi Shores, Florida 33138 Teb (305) 795.2204 Fax: (305) 756.8972 JLC 42 Permit No. Master Permit No. 1 -11 -119 Contractor's Company Name Industrial Electrical Systems Corp Phone # 305 228 1384 State Florida Zip 33172 Qualifier Name Nestor . I. Corvea Phone # 345 228 1384 Certificate of Competency No. JaN a s 2011 Permit Type: Electrical Owner's Name (Fee Simple Titleholder) Carlos Escobedo Phone # Owner's Addy 162 NW 108 St ci Miami State FL Zip 33168 Teuant/Lessee Name Phone # E -MAIL: Job Address (where the work is being done) NW 108 St City Miami Shores Vella egg Co ty m zi 33168 -4313 FOLIO / PARCEL # 11 2136 010 0060 E-MAIL: iesmiami@comcast.net Architect/Engineer's Name (if applicable) Phone # Value of Work For this Permit $ 500.00 Square / Linear Footage Of Work Type of Work ['Addition ['Alteration ❑New ❑ Repair/Replace El Demolition ***************************************F **** * ** *** ********ears ***** **** *s *eaaa**** Submittal F e e $ P e r m i t F e e $ 7 ' ' ( C' c CCF $ CO/CC Notary $ Training/Education Fee $ Technology Fee $ Scanning $ Radon $ DPBR $ Zoning $ Bond $ Code Enforcement $ Double Fee $ Structural Review. $ Total Fee Now Due $ 1 -° (3 • See Reverse side -,1 Bonding Company's Name (if applicable) Bonding Company's Address City State Zip l "T Mortgage Lender's Name (if applicable) Mortg:,:e 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 Wrf'ff 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 exceetling $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 occu seven (7) days after the building permit is issued In the absence of such posted notice, the inspection will not be approved ' , reinspection fee wi I be charged A iiiII A Owner or A instrument was Signature daY who is NOT Sign: Print: My Commission Expires: to me or who has APPLICATION APPROVED BY: (Revised 02108/06) identification and who did take an oath. 4©Cy1'N. $Is Signature Wee Contractor The foregoing instnrrnent was acknowledged before me this 26th day of January , 20 11 , by who is personally known to me or etas as identification ,i ales da NOTARY PUBLIC: Commission # DD 913453 My Commission Expires 11 -17 -2013 Bonded Atlantic Co. Inc. Sign: GGl � PAX-4,6z, Print: Francisco P Morales My CoThat - on Expires: 11/17/2013 Engiceer Zoning •`7 rr 2, Plans Examiner Village of Miami Shores 10050 NE 2 ndAV e Miami Shores, FL. 33138 Fax: 305 756 -8972 ) SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DEUVERED IN ACCORDANCE WITH THE POUCY PROVISIONS. aunt _ 11.1 �' A ' CERTIFICATE ®� LIABILITY INSURANCE 1- 2 ► THIS CERTIFICATEIS 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 POUCIES BELOW. THIS CERTIFICATEOF 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 ADDITIONALINSURED, the policy(ies) must be endorsed. If SUBROGATIONJS WAIVED. subject to the terms and editions of the policy, certain policies may require an endorsement A statementon thb certificate does not confer rights to the certificate holder in IIeu of such endarsement(s). PRODUCER PAYCHEX INSURANCE AGENCY INC 210705 P:()- F:(888)443-6112 P 0 BOX 33015 SAN ANTONIO TX 78265 CON TACT (AtC.t,Ext); IiAIC,Ner. (888)443 -61 E ADDRESS: �T ID// INSURER'S) AFFORDING COVERAGE RAC • Irel�m INDUSTRIAL ELECTRICAL SYSTEMS CORP 10257 N.W. 9TH STREET CIR. APT. 205 MIAMI FL 33172 INSU�i A : Twin City Fire Ins Co UNARY COMMERCIAL GENERAL. LIABILITY INSURER 8 INS C' INSURER D : EACH OCCU1OiE[dCE INSURER E : INSURER F : THIS IS TO CERTIFY THAT 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 dR 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. B LAB TYPE OP INSURANCE INSAD R R POUCY IMMIBER RA YYYYI t1ADr5 GENERAL UNARY COMMERCIAL GENERAL. LIABILITY EACH OCCU1OiE[dCE $ PREMISES (Ea occurrence) $ I CLAIMS -MADE (J OCCUR MED EXP (Any one person) $ PERSONAL & ADV 'AWRY It GENERAL AGGREGATE $ C�1'L AGGR WRIT ABMS ice : PRODUCTS PDUCTS - COMP/OP AGG 8 E GA { ...J POLICY Li LI LOC AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS COMBINED SINGE LIMIT Ma accident) — BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ i PITY DAMAGE (tom accident) $ — _ $ $ urr> to UAB I IOCCUR EACH OCCURRENCE $ EXLESS UAB I 1 �E AGGREGATE $ DEDUCTIBLE RETENTION 8 $ ____I , $ A WORKERS ANY (Mandatory If %-, DESCRIPTION COMPENSATION P ETOR/PARTNEWEXE Y/141 Cl EXCLUDED? ` N/A 76 WEG F06188 01/24/2011 01/24/2012 X I ul I I E T E1. EACH ACCIDENT $ 1, 0 0 0, 0 0 0 EL.DISEASE'- EA EMPLOYEE 9 1, 000 00 0 describe under OF OPERATIONS below E.L. DISEASE - POUCY LIMIT $ 1 , 000 , 000 DESCRIPTION OF OPERATIONS 1 LOcAUDNS 1 V6Additional UCLES (Attach ACORD 101. Additional Remarks Schedule. If mare space le required) Those usual to the Insured's Operations. . ACORD 25 (2009/09) CERTIRCATE NUMBER: CANCELLATION The ACORD name and. logo are registered marks of ACORD REVISION NUMBER: 1988 -2Q09 ACORD CORPORATION. AB rights resew e d. • ACORD. CERTIFICATE OF LIABILITY INSURANCE 1 011 2 01 1 PRINUCER OVERSEAS INSURANCE AGENCY P. O. BOX 1 MIAMI, FLORIDA 33116 THM CERTIFICATE IS ISSUED AS A MATER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE OR AL THE COVER A GE AFFO 7 POLES BELOW. INSURERS AFFORDING COVERAGE . BRED INDUSTRIAL ELECTRICAL SYSTEMS CORP 10297 R.W. 9 ST CIRCLE #205 MIAMI, FLORIDA 33172 I INSURER A. NOVA CASUALTY COMPANY INSURER INSURER C; INSURER O: INSURER E :Village of Miami Shores 9 10050 N E 2ndAVe Miami Shores, FL. 33138 Fax: 305 756 -8972 SHOWMAN/ O�IUEAI POUCESBE I Ttt(w1 tT 6 DATE Tom, THE EBSANKi I WILL ENDEAVOR TO aays WRITTEN NOUN TO MIS CERTIFICANI HOLDER NAKED TO THE LEFT, BUT FAILURE TO DO SO SNALL. IMPOSE NO OBLIGATION OR UABTUTY OF ANY INN UPtI 4 THE INSURER. ITS AGENTS GR RENTENNTATIVES. nwnn ssas AT&E.. . ..... COVERAGES A THE POLICIES OF INSURANCE LISTED BELOW HAVE SEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOT WITYISTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO tM -IlCH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO AU: THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, TYPE ORUNMAKE GENERAL LIABILITY X COMMERCIAL GENERAL . anJTT CLAR S MADE DTI OCCUR - 250 DED con ( UR n AGO AGGREGATE war A PUTS PER n. I POLICY 1 t ,MT El LOC AMMONIA LIABILPIT ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NIIN -OW?D AUTOS GARAGE mourn, iANYAUTO LICCkSS 1./AN 1TY OCCUR CLAD MADE DEDUCTIBLE RENAME $ VICRIUBSS COMPENSATION AND EMPLOYERS* LIMN UTY 09 ALL39093 POLICY NUMBER 05/12110 ONICENTION OF Of T LOCA ADDEOBY ENDORSEINERDEPECIAL DESCRIPTION OF OPERATION ELECTRICAL WIRING: ACORD 254 (7/97) 05112111 EACH OCCURRENCE FIRE DAMAGE (Any meth's) MEDr7IP (Any mammon) PERSONAL & ADN INJURY GENERAL AGGREGATE UNITS PRODUCTS - AGO COMBINED ENGLE LIMnT nt) � 1LY BODILY INJURY (tea PROPERTY DAMAGE (Per ms) AUTO ONLY- EA ACCIDENT OVERMAN AUTO ONLY EACH OCCURRENCE AGGREGATE EA ACC AGG { ( ER Et. EACH ACCIDENT 500 000 $ 100.000 - $ 500,000 1,000,000 $ 1,000,000 $ $ B S $ E.L. ESSEASE - EAEaPLO E $ E.L.OISEADE - FOXY UMIT I $ Inspection Number: INSP- 155232 Permit Number: DEMO -1 -11 -120 Scheduled Inspection Date: February 25, 2011 Inspector: Hernandez, Rafael Owner: ESCOBEDO, CARLOS Job Address: 162 NW 108 Street Miami Shores, FL 33168- Project: <NONE> Contractor: ERKAS CONSTRUCTION Building Department Comments DEMOLITION OF OUTSIDE DRAINAGE PIPE TO BRING IT INSIDE THE HOUSE TO SERVE THE KITCHEN AREA Passed Failed Correction Needed Re- Inspection Fee February 24, 2011 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: (305)756 -8972 Inspector Comments For Inspections please call: (305)762 -4949 Permit Type: Demolition Inspection Type: Final Work Classification: Plumbing Phone Number Parcel Number 1121360100060 Page 7 of 14 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 BUILDING Permit No.P' ) PERMIT APPLICATION FBC 20 Permit Type: PLUMBING Owner's Name (Fee Simple Titleholder) (2M e. ) O v 14. Es co 13 I b a Phone # Owner's Address /6 2. NW /0 g 4 h s r2�;r7 - City 041 A iV) Address. � 140 e•J4 State . Tenant/Lessee Name Email Zip '3 3/60 Phone # Job Address (where the work is being done) /6 2 / IW s 72F'isT City Miami Shores Villa l e County Miami -Dade Zip FOLIO / PARCEL # !j_ 2/ 3 ,6 - o 10 - 00 60 Is Building Historically Designated YES NO Flood Zone Contractor's Company Name 612144 rj CO,&i $ Tl?v C i- i'wwr/ (n *Phone Phone # Contractor's Address 44-60 FArmikeur 5 7e IT T City l4 i yw n ® A State __ Qualifier Name J4r 2 A • (i; z. State Certificate or Registration No. C FC 1 4-a ka 11 Contact Phone 94 ZO 4 - Architect/Engineer's Name (if applicable) Value of Work For this Permit $ Type of Work: DAddition Describe Work: (i4 AA/ 6 Y.::: *eae**** * * * *4,* * ** * * * * * * * * * * * * * * * * * * * ** F ees * * * * * *** * * * * * * * * *** * * * * * ** * * * * * * * * * * * * * * * ** Stib t ttal Fee $ Permit Fee $ /e O ' CCF $ Notary $ Scanning $ Double Fee $ Structural Review. $ Radon $ Square / Linear Footage Of Work: DAlteration ['New )] Repair/Replace [' Demolition 17l? i'i Plk /AJ6 ;Alf f A r Tf4ft f40 C=. /w r/-14t. tiv 4 p,M Training/Education Fee $ Violation date: E -mail J2-1 14 15 CO r p Coy a 0 . Cori DPBR $ Master Permit No. eini ) 1;1-'119 Zip 3 304 Phone #( � . 2p 4 _S-9 5' Certificate of Competency No. Phone # Total Fee Now Due $ - 744-- 2-04-kill( ll' zez vez JAN 2 5 2011 ig CO /CC $ Technology Fee $ Bond $ L Le° 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 ent. Also, a certified copy of the recorded notice of commencement must be posted at the job site rs seven (7) days after the building permit is issued. In the abse e of such posted notice, the d a reins.ection f ' will be charged. whose property is subject to attac for the first inspection which inspection will not be ' .'rov Signature The foregoing instrument was acknowledged before me this Z g� a day of — , 20 1 , by — • PALLn9dZ who is p rsonally o , to me or who has produced �� who is personally kno to me or who has produced A b/I 1 1! ryki identification and who did take an oath. - le t�' ,!1 e.ENSe as identification and who did take an oath. The fo day of wne ... > � mg instrument was a,owl d ed before me this ( i) 0 Si, b LlY f " Print: My Commission Expires: * * * * * * * * * * * * * * * * * * * * APPROVED BY (Revised 07 /10 /07)(Revised 06/10/2009) Plans Examiner Engineer Signature Sign: Print: NOTARY PUBLIC: My Commission Ex Contractor l 040" .v ce. �. Public . s HUNG Public � My Co �e 01 F(ortda :�,;;. Commission oExpires Jul 12, 2014 00 991888 * Zoning Clerk checked -'`� ° CERTIFICATE OF LIABILITY INSURANCE "" "`'�""" 01/20!11 PRODUCER Acceptance tnsvrenoe Services 6887 Miami, FL 33155 Phone (305)740 -0515 Fax (305)740-0518 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 • : NM* maws ERICA'S CONSTRUCTION CORP, 7460 FARRAGUT ST HOLLYWOOD, FL 33024 8 r (954) 93 -8175 � Insurance COmpa INSURER & INSURER C- INStIRERlJ INSURER E COVERAGES INSURER. F: POLICIES OF THE POL INSURANCE LISTED HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATH3 NOTWITHSTAN3WG ANY REQUIREMENT T9 M ND aR COm0N OFANY CONTRACT OR OTHER DOCUVIEM WrN RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OF MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECTTO ALL THE TERMS. EXCLUSIONS AND COMMONS CIF SUCH POLICIES-AGGREGATE LIMBS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TYPE OF INSURANCE POLICY NUMBER caw r s" A • GENERAL LIABILITY `'i COMMERCIAL GENERAL LIABILITY 00 CLAIMS MADE n OCCUR ■ A90775 01110111 01110/12 EACH OCCURRENCE 1,000,000 PREMISES TO 100,000 MED EXP (AnYcp) 5,000 PERSONAL & ADV INJ RY 1,000,00 • GENERAL AGGREGATE 2,000.000 GENL AGGREGATE MIT APPLIES PER PRODUCTS- COMP/OP AGG 2.000,000 M POLICY ■ PROJECT • LOC El AUTOMOBILE LIABIUTY • ANY AUTO 0 ALL OWNED AUTOS . ❑ Sc n r-n AUTOS ❑ HIRED auras • • NON OWNED AUTOS ❑ . CO IBINED SINGLE LIMIT (Ea) BOOLY INJURY (` rPr3's°") BODILY INJURY PROPERTY DAMAGE (Per eceldcmg D GARAGE LIABILITY Ell ANY AUTO ❑ AUTO ONLY- EA ACCIDENT OTHER THAN EA ACC AUTO ONLY AGQ 111 IECCESSIUMBRELLA LIABILfiY OCCUR III CLAIMS MADE ❑ DEDUCTIBLE ❑ REIN S EACH OCCURRENCE AGGREGATE WORKERS �t EMPLOYERS' COIIPENSAT)aN AND Lu►e1Lrn ❑TR ET ANY PROPRIETOR/ PAR1NER OFFICER f MEMBER EXCLUDED? If yes. *mein der SPECIAL PROVISIONS bellow EL. EACH ACCIDENT EL DISEASE - EA EMPLOYEE EL DISEASE - POUCY LIMIT OTHER DESCRIPTION OF OPERATIONS! LOCATIONS f VEHICLES t EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS GENERAL AND PLUMBING CONTRACTOR Feb 0811 03:07p bilipayoorp CERTIFICATE HOLDER Miami Shores Village Budding Department 10050 NE 2 Ave Miami Shores, FL 33138 i Fax: 305-756 -8972 AOORD 25 (2DOi1D8) OF A 3�5 7569 _ cp9 72 CANCELLATION AUrHORt2F8REPRESENTATIVE 786 -362 -5218 p.1 SHOULD ANY OF THE ABOVE DESCRIBED POLKBES BE CANCELLED ED BEE E THE EXPIRATION DATE THEREOFF, THE ISIRING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN Hance TO THE CERTIFICATE HOLDER fraw D TO THE LEFT, BUT FAILURETO DO SO SHALL IMPOSE NO OBUGAT1ON OR LIAIRUTY OF ANY KIND UPON THE@15URER, ITS AGENT'S OR REPRESENTATIVES. ® ACORDCORPORATION 1888 •1 ZONING DEPT BLDG DEPT s cv _ Miami Shores Ilac e PUANCE WITH ALL FEDERAL. ES AND REGUlA L e -� 1--- 0 L _ 2. 3o Q WIRCS I G8ragen : - be dembl 4404 pav4N&on (D''y wall) u'aU,r' WO oc/lei PIS -/w0 by*. % be. 40 ./frAvh,sheek r ado and r' / _ y , / � 5ar-'� eg o co-O I use. -' ep x°. ; 4errwre hoe oak? 4` f L 7, Pe" re 436.}91 11- doo r, wall ' Abo G ,. w , ' re . / r ' , i go _ ++ppt 5 • 122 r I 22 74 , z r /f • 68i 3 j ••• • • • •• S • • 37, S ••• • • • • •••_• • • • • • • • • • • • • ••• • • • • • • • • • • • • • • •• •• • • • •• •• ••• • • • ••• • • • • • • • • • • • • • PROPERTY OF: Calmo Gladis Not valjd unless embossed _ a►it Suritey ci Sea l: This property described as: Lot 6, Block 212, DUNNING'S MIAMI SHORES EXTENSION NO. 6, according to the Plat thereof, as recorded in Plat Book 51, Page 31 of the Public Records of Dade County, Florida. Note: Underground encroachments and utilities, if any, not located. Fence ownership by visual means only, legal ownership not determined. Escobedo, Carlos, and A BOUNDARY SURVEY L hereby certify that the survey repre- sented hereon meets .the adrdanan sechtdof'ds set forth by the Board of Land Surveyors it chapter 6107 -6 Code", „ to are ao LOGA'TION • ... m . • ar • 0) A o k • Lz • • • .... •. \-11..0 ‘00:2 - 7 ' c, • • ... • • • • • •••• • . .. ..• •••• • • • •.•• . . •••• "15 11. • 4 162 N.W. 108th Street, Miami Sho Flori LANNES and GARCIA, INC.3„ ENGINEERS - LAND SURVEYORS - LAND PLANNERS L.B. #2098 — BEALE SMITH #5238 Office address: 359 Alcazar Avenue, Coral Gables, Florida 3: Mailing address: P.O. Box 561131, Miami, Florida 331! (305) 666 -7909 ' 3 z 7 DATE I y . . 4W WW1 00q- Z� -$j SCALE = W I DRAWN BY VR • 1 DRWG. 23300 7-21-01 "Recertified ", Name, Certified'To And Flood Information revised and Zip Code added. /�''i nnd 1Y747 13001 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 made to certain real property, and in accordance with Chapter 713, Florida Statutes, the following information is provided in this Notice of Commencement. /Legal description of property and street/address: Description of improvement: Section 713.13(1)(a)7., Florida Statutes, Name, address and phone number 9. Expiration date of this Notice of Commencement: 123.01 -52 PAGE 3 3/10 /6 2. Owner(s) name and address: AiL.0 0 'Interest in property: X C.&i493 S-' ti .lr) Name and address of fee simple titleholder. ContLa s name, address and phone number. �.. 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: N �-- 7. Persons within the State of Florida designated by Owner Upon whom notices or other documents may be served as provvil b Om 0 di 8. In addition to himself, Owners designates the following person(s) to receive a copy of the Lienor's Notice as provided in io 713.13(1)(b), Florida Statutes. 0 Name, address and phone number. N LL� LL p? . \J (the expiration date is 1 year from the date of recording unless a different date Is s 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. a s) of OW±tne • • / r(s)' A": riz- % c�, r Prepared By er sir Print Name • i- ��_ri i 2 Tdfe /Office STATE OF FLORIDA COUNTY OF MIAMI -DADE The for oing instrument was ackn wl ed before me this day of By d , G o ❑ Individually, or ❑ as for ❑ Personally known, or ❑ produced the following type of identificat Signature of Notary Public: Print Name: (SEAL) VERIFICATION PURSUANT TO SECTION 92.525. FLORIDA STATUTES Under penalties of perjury, 1 declare that I have read the foregoing and that the facts stated in it are true, to the best of my knowledge and belief. 111111 11111 11111 11111 11111 11111 11111 1111 111 1 Space above reserved for use of recording office (O - sr irector/Partner/Manag / Prepared By e -ids 6C G0 Lie) Print Name >! �4, Z A/ Cote t0 S f ,t.�" •' l 1 Title/Office CFN 201180088150 OR SI; 275801 Ps 3412; Ups) RECORDED 02/08/2011 14 :13:03 HARVEY RUVII4t CLERK OF COURT MIAMI -DADE COUNTY, FLORIDA LAST PAGE u4 TAIT PUBLIC E. CP,' D pmiSS%on # Signature(s) of Owner(s) or Owner(s)'s Authorized Officer/Director/Partner/Manager who signed above: i `\\` By By