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PT-10-152 Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 f Expiration: 081031201 Project Address Parcel Number Applicant 26 108 Street 1121360110110 THOMAS STOCKS Miami Shores, FL 33168 -4311 Block: Lot: Owner Information Addk Phone C ell THOMAS STOCKS 26 108 Street MIAMI SHORES FL 33168-4311 Contractor(s) Phone Cell Phone Valuation: $ 2, 400.00 Total Sq Feet: 0 Type of Work: Exterior For Inspections please call: (306)762 -4949 Color. Additional Info: Available Inspections: Classification: Residential Inspection Type: Color: Approved Code Comments: GLIDDEN - WALLS - BELGIAN WA Final Color. Approved_ Color. _Denied Fees Due Amount Invoice # Total Amt Paid Amt Due CCF $1.80 PT -2 -10 -36935 $ 64.80 $ 64.80 $ 0.00 Education Surcharge $0.60 Permit Fee $60.00 Technology Fee $2.40 Total: $64.80 In consideration of the issuance to me of this permit.-9 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 it tormation 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 04, 2010 Authorized Signature: Owner / Applica&.. Contractor / Agent Date Building Department Copy February 04, 2010 1 Miami Shores Village I FEB 1TI Building Department 0 1 2010 1. 0050 N.E.2nd Avenue. Miami Shores. Florida 33133 ]BY . Tel: (305) 795.2209 Fax: (305) 756.8972 + :,++ BUILDING Permit N o. �'i" 1�- 1`J2 PERMIT APPLICATION Master Permit No. FBC#IM Permit Type: PAINT PERMI Owner's Name (Fee Simple Titleholder) �✓1 ��+�5 Phone # Owner's Address -/f� /o r"Y�� ,rte City I1��/� /O�°S State Zip Tenant /Lessee Name o",4Ae Phone # /f Job Address (where the work is being done) SiQAj!* f✓S A City Miami Shores Villa <ge County Miami -Dade Zip 1 4.. FOLIO / PARCEL # Is Building Historically Designated YES NO • r 1 Contractor's Company Name ANT ^S C_ OtiT/".YC7ORS Phone Z6-- Contractor's Address 9 12 0A i 3 e . City_ �r,my% State Zip Qualifier Name Phone # State Certificate or Registration No. Certificate of Competency No. 000 Q rte' cue t! 4- ce - * CC 4 0 0 0062 .7 713 OWNER BUILDER: Value of Work For this Permit $ 25�� 0 Type of Work: ❑ Addition / ❑ Alteration / ❑New /Repair /Replace Describe Work: 07" %- L�� Zoe, M Am Application is hereby made to obtain 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 wort: will be perliormed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate pennit must he secured Ibr EI,FC TRKC'AI. WORK. PLUMBIN0, SIGNS_ WELLS. P00L S', FURNACFS, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC..... "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. I ppl icanl: As a condition to the issuance ofa huilding permit with an estimated value exceeding x?J00. the applicant must promise in gcxrd fault that a c•olry of the notice of connuencement and construction lien law brochure will be delivered to the person whose property is suhjecl to attachment. Also. a certified copy of the recorded notice of c•onrmencenreni must he parted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such listed notice. the inspection will not he approved and a reinspection fee will he charged. Permit Fee $ �� CCF $ Technology Fee: Training /Education Fee $ Notary $ -Code Enforcem G Double Fee $ Zoning $ Total Fee Now Due $ See Reverse side -a 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 color sample. Walls: I 2 ' 4 Attach color samples with name and Fascia: 1 2 3 4 number. Drip Cap /Drip Edge: 1 2 4 -- - Soffit -- _ 1 2 4 < Gl_025 Belc t) V / <f ff I gTrn Roof 1 2 , 4 Flower Bins: I 2 3 4 Shutters: 1 2 3 4 -- Awnings +A 1 ' 3 4 2 I C1111nney: 1 2 3 4 Doors and Door JamsN/ 2 3 4 Gara <re Doors: 1 2 3 4 i Railings* 1 2 3 4 3— - - FencesxU 1 2 3 4 I V� WHITE. All brick (sinurlated or regula I 2 3 4 Stucco Banding - I 2 3 4 Anv other Stucco Features l 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 re ulating construction and zoning°, Signature Sig ,. Owner or Agent Contractor The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before ine this day of F j 2010 , by IN S day of F�3 2011. by C1JiJ�`t± W�►i� who is personally known to me or who ha �r�l� �� who is personally known to me or who has produced As identitic"►tic �th. as identification and who (lid \gke an.olilu III, NOTARY PUBLI Q " � M � r �� NOTARY PUBLIC: _ 2011 ► l,�,p _ Sign: = Sign: Print: Print: -- T .D sz C - -� '9 .. 17 65901 Q. �� M Commission E My Commission ixpires: � J -•... �p \ � N , y p APPLICATION APPROVED BY`: Plans Examiner Preservation Board Code Enforcement (Revised 04/24/0; v ag 3 00 NOT FORWARD EDDYS PAINTING CONTRACTOR INC EDDY LOPEZ PRES 9320 SW 34 ST MIAMI FL 33165 cy } 9 & € jj11 J € g I}11S9t i)l€ 9$iY itY}IY 1Y916t�9Sl� t13I 9t$ €!dt! }I 14� 1 HE $ 01R t L�41DE ......�......,.,... ,..��c....•.... .. ,... r X mma s i t z° E� v a" i i €�O NOT FORWARD y \ E D S PAINTING D Y CONTRACTOR INC EDDY LOPEZ PRES 9320 SW 34 ST MIAM FL 3 16 I 3 5 4 g $$ ppyy yy1 $(( t j j Y F 1 1 I9d $€11111}911391 #b 1!!111 t t9t 9 IbliI bkt�4 d} 9 d8t ¢( t } �3 #@ Client#: 27706 EDDYSPAI DATE ACORD CERTIFICATE OF LIABILITY INSURANCE 011151 O DD PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION USI Insurance Services, LLC /SC ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE P.O. Box 141916 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR Coral Gables, FL 331141916 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 305 669 -6000 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A: Western World Insurance Company 13196 Eddy's Painting Contractors Inc : 9320 SW 34 St INSURER INSURER B B: Miami, FL 33165 -4112 INSURER 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 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. LTR NS TYPE OF INSURANCE POLICY NUMBER POLICY EFFE POLICY EXPIRATION LIMITS A GENERAL LIABILITY NPP1231458 01/19/10 01/19/11 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $100,000 _ CLAIMS MADE 51 OCCUR MED EXP (Any one person) $5,000 X BI/PD Ded 250 PERSONAL & ADV INJURY $1,000,000 GENERAL AGGREGATE $2.000.000 GEN1AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $1,000,000 POLICY PRO LOC AUTOMOBILE accident) LIABILITY COMBINED SINGLE LIMIT $ 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 EA ACC $ OTHER THAN AUTO ONLY: AGG $ EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND WC STATU- OTH- TORY LIMITS 9R EMPLOYERS' LIABILITY ANY PROPMETORMARTNER/EXECUTWE E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $ ff E AL Rye under EJ_. DISEASE - POLICY LIMIT $ SPECIAL PROVISIONS below OTHER DESCRIPTION OF OPERATIONS 1 LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION CITY OF MIAMI SHORE VILLAGE DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30_ DAYS WRMEN 10050 NE 2 AVE NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL MIAMI, FL 33168 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTH RAZED REPRESENTA e ACORD 25 (2001108) 1 of 2 #M4207368 SjMEV o ACORD CORPORATION 1988 . R C ' Construamn Trades Qualifying Board BUSINESS CERTIFICATE OF COMPETENCY '- l 1EIDDrs PAINTING C©NTRACTMMIC D.B.A.: LOPEZ ED Y R ' Is certified under the provisions of Chapter 90 of Miami -I3 ' 4 t s QUALIFYING TRADE(S) 0078 PAINTING ��•.. de.9or�kLn9�e Pa �� Hannlnlo Gonzalez P.E. Secretary of tae} all.`. ri Ma 1�rein.. - NAami -Dade: a Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 134557 Permit Number: PT -2 -10 -152 Scheduled Inspection Date: February 17, 2010 Permit Type: Paint Inspector: Bruhn, Norman Inspection Type: Final Owner: STOCKS, THOMAS Work Classification: Addition /Alteration Job Address: 26 NW 108 Street Miami Shores, FL 331684311 Phone Number Parcel Number 1121360110110 Project: <NONE> Contractor: Building Department Comments Inspector Comments Passed '',:,� Failed Correction ❑ Needed Re- Inspection ❑ Fee No Additional Inspections can be scheduled until re- inspection fee is paid. February 16, 2010 For Inspections please call: (305)7624949 Page 18 of 28