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DEMO-09-1888 h 3 ,. Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 3313 &0000 T )E .. 3rh £ 1u y Phone: (305)795 -2204 . ;. ARM a .S rr Expiration: 05/171201 r, Project Address Parcel Number Applicant 42 110 Street 1121360030040 Miami Shores, FL 331384319 Block: Lot: JULIET WINT Owner Information Addr Phone Cell JULIET WINT 42 110 Street MIAMI SHORES FL 33138 -4319 Contractor(s) Phone Cell Phone Valuation: $ 1 supreme ceiling & Interiors (305)653 -7033 Total Sq Feet: 250 Type of Demo: Building For Inspections please call: Additional Info: GARAGE PARTITION (305)762 -4949 Classification: Residential Available Inspections: Inspection Type: Final Fees Due Amount Invoice # Total Amt Paid Amt Due CCF $1.20 DEMO- 1I- M36422 $ 112.10 $ 112.10 $ 0.00 Education Surcharge $0.40 Notary Fee $5.00 Permit Fee $100.00 Scanning Fee $3.00 Technology Fee $2.50 Total: $112.10 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 worts stated. November 19, 2009 Authorized Signature: Owner / Applicant / Contractor / Agent Date Building Department Copy November 19, 2009 1 Miami Shores Village Julio- IV g u ding Department m® 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 BY: Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 BUILDING Permit N o. PERMIT APPLICATION Master Permit No.' FBC 20 Permit Type BUILDING ROOFING / Owner's Name (Fee Simple Titleholder) ® + ®� Phone Owner's Address `D City �� State Zip Tenant/Lessee Name Phone # Email � y� , Job Address (where the work is being done) C) City Miami Shores Villaee County Miami -Dade Zip FOLIO / PARCEL # A, - 1_�, — , D Is Building Historically Designated YES NO Flood Zone c Contractor's Company Name unict Cc—i ( It o-.1 G t riiis ex ca Phone # .3 6 !5 3 '733 Contractor's Address C+ 1 1J City 1 ` 1 A. r t 1 State � Zi E> i Qu alifier Name Qu 12t)QwtQ wFa.J Phone# E 3 ©565.3 X033 a' State Certificate or Registration No. t_'—BC.. 4-5 //,E Certificate of Competency No. Contact Phone G jb S :3 1 7 - E) ,? 3 E -mail o pr ra-1 re e I Architect/Engineer's Name (if applicable) Phone # Value of Work For this Permit $ 4IL!6 Square / Linear Footage Of Work: r Type of Work: ❑Addition ❑Alteration ❑New El Repair/Replace `,Demolition Describe Work: �2.1M,v X45 i.. ; � -ur d^I V_,W �.,,✓ t j t �tn,3 �4L C_t,. a-5 U - L D t� l d j. l i U, v Submittal Fee $ '� PermitFee CCF 1♦ 6 L $ CO /CC .$ Notary $ 6 Tralaiiig/Xducati n Fee $ . '7 Technolog Fee $,G. c50 II' Scanning $ ♦ o Radon $ DPBR $ Bond $ it Double Fee $ Violation date: .Structural Review. $ Total Fee Now Due $ ,2. See Reverse side -� �y. Bonding Company's Name (if applicable) Bonding Company's Address City State Zip i 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 YO 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." l r I ' 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`certifaed 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 Bence of such posted notice, the inspection will not be approved and a reinspection fee will be charged.. Signature {, Signature L ewz Owner or Agent Contractor The foreg g i trument�w ac w edg b or me The foreg ing instrument', was ackno lodged before e this O day of, 20 !� by V �v► I day of 20 b who is erson 11 known �� to me or who has produced who is p rsonally known to me or has produced • L identification and who did take an oath. , cation and who did take an oath. NOT Y P LIC: N T Y PUBLIC: i. Sign: 1 Sign: Print:. C a NoTAiff PfJBLIC -STATE OF FLORIDA Print: ill ®s Val My Commission Expires: 101" "®'`•o Z3,�Q g fli t s DD71'7523 aaco C. My Commission Expires: a F of ..�, pros: SF—P.23,2011 Cy BONDED MU Al &WnCBONDVG CO.,1NC. 4rir9e9e: k9eikdc �Y delk �R9FAr FsG* �k� riY& 4 e 4 e 3 e�k9ede�c. �kde9cit�fr9nkdr4r�t�efe9rdnle�k�1e9e9e; stkik4rdcdedetYk��r�te8ede�Ir�rRr3r�lr�inks kieAr�Ie3eieMe9t�n4 APPROVED BY "�7 : Plans Examiner Zoning Engineer Clerk checked (Revised 07 /10 /07)(Revised 06/10/2009) D B _ 21 ,f ?D PT SUBJECT TO COMPLIANCE WI IH ALL FECERA.L STATE P:ND COUNTY Fill r NOW �I II II 8' X7' I I GARAGE _-� AND WALL--, fl i DOOR - - -- 11 ND DOORS II II ix II I I I I � II I I ILL I I I I II I I rF I II II I I II I� i t EXISTING GARAGE FLOOR PLAN ;•• ••; :•: ;•; ;.. SCALE 1/4 " =1' -0" •• ••• •• • k • 9 a `k 11 /11/09 42 NW 110 ST MIAMI SHORES, FL 331 :7:, *H . � ACORD,. CERTIFICATE OF LIABILITY INSURANCE 1 D A E O N ) PRODUCER Phone: 305- 854 -1330 Fax: 305- 854 -3725 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Willis of Florida, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 201 Alhambra Circle, Suite 1100 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR P O Box 141308 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Coral Gables FL 33114 INSURERS AFFORDING COVERAGE NAIC # R43URM INSURER A.- FCC 1 1 178 Supreme Ceiling & Interiors, Inc. INSURER B: 5941 NW 176 Street, Unit 4. Miami FL 33015 INSURERQ 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 CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INS AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. REGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR AOWL POLICYNUM POUCYEFFECTIVE POLICYEXPIRATION LIMITS LTR RM TYPE OF INSURANCE A X GENERALLIABILITY GL0008845 7/1/2009 7/1/2010 EACH OCCURRENCE $1000000 COMMERCIAL GENERAL LIABILITY PREMISES Ea owzence $50000 CLAIMS MADE XX OCCUR MED EXP Anyone pawn) $500 1, 0 0 0 PERSONAL &ADV INJURY $1000000 GENERAL AGGREGATE $ 00.0 GEN'L AGGREGATE LIMIT APPLIES PER:- PRODUCTS- COMP /OPAGG $2000000 ` POLICY lil JE PRO- CT 71 LOC A AUTOMOBILE LIABILITY CA0 01118 5 7/l/`2009 7 / 1 / 2 010 COMBINED SINGLE LIMIT X ANY AUTO (Ea acddent) $ 1, 000,600 ALL OWNED AUTOS BODILY INJURY SCHEDULEDAUTOS (P-P —) $ X HIREDAUT03 BODILYINJURY $ NON- OWNEDAUTOS (PeracddeM) PROPERTYDAMAGE $ (Peraoddent) GARAGE LIABILITY AUTO ONLY- EA ACCIDENT $ ANYAUTO OTHERTHAN EAACC $ AUTO ONLY: AGG $ A EXCESSIUMBRELLALIASILITY UMB0009137 7/1/2009 7/1/2010 EACHOCCURRENCE $5,00 X I OCCUR FI CLAIMS MADE AGGREGATE $5.000,0 $ DEDUCTIBLE $ RETENTION $ $ A WORKERSCOMPENSATIONAND 60119 V 7/1/2009 7/1/2010 X I WC3TATU- Oit EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $1 OFFICER/MEMBEREXCLUDED? E.L. DISEASE -EA EMPLOYEE $ D eess,, describe under ECIAL PROVISIONS below E.L. DISEASE- POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED Miami Shores Village Building Department BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER 5 $ P WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE 10050 N.E. 2nd Avenue CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO Miami Shores FL 33138 SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORDED REPRESENTATIVE ACORD 25 (2001108) GACORD CORPORATION 1988 w � IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the pollcy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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 lieu of such endorsement(s). DISCLAIMER The Certificate of Insurance on the reverse side of this form 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. ACORD 25 (2001108) vF DO NOT FORWARD SUPREME CEILING & INTERIORS INC RONNIE G HEWAN PRES 5941 NW 176 ST �mr MIAMI FL 33015 F. � 1 }} Yj i t )) �fl'� loftily# II Iftaeetst�els(se Of si�a ra tIIIle se a las PeJJd� SEE OTHER SIDE 4 i STATE OF FLORIDA DEPARTMENT OF BUSINESS AND pROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487 -1395 �•� TALLAHASSEEMONROE STRFLT32399 -0783 SW RCEEILING GEORGE INC 5941 NW 176TH STREET BAY #4 MIAMI FL 33015 ratulationsl With this license you become one of the nearly one million DEP I QP' HIISN AU '' . .A fans licensed by the Department of Business and Professional Regulation. PROFE4I ZONAL BU ND rofessionais and businesses range from architects to yacht brokers, from s to barbeque restaurants, and they keep Florida's economy strong. C13CO59118 09/33/08..088b726Q? day we work to improve the way we do business in order to serve you better formation about our services, please log onto www.myflorldaticense.com. CERTIFIED. $1 LDIWQ CONTRACTOR i you can find more Information about our divisions and the regulations that M WAN, .R01 8 GEORGE A you, subscribe to department newsletters and learn more about the SUPRMM CEILING & .INTSRIOR9 INC riment's initiatives. j 9ssion at the Department is: License Efficiently, Regulate Fairly. We antly strive to serve you better so that you can serve your customers. =g C�RTI� =� ss o of r c�►.469 : c you for doing business in Florida, and congratulations on your new licensel r�sraeson �� �vt# 31 solo =o ch aoTi DETACH HERE ) 28 021... . .STATE OF FLORIDA MPARTMENT BD INES:B AND PROFESSIVIAL REGULATION, CON UCT ON IXDUBTRY'- :LI£ENS G BOARD SE L08o92302C91 3 2008 088072603.. JCB C.059lie 3UILD1NG.' CO CTOR 1 below' 19 <�IFXBD the provisions of Chapp-�te X489 FS. ration date:.AUG 3 2010 [SWAN, RONNXE: ;UPREME.CEILING 8e INTERIORS.INC ;941 NW - 176. - 'STREET UNIT''" #4 IIAMT FL 33015 CRARLIE GRIST CHARLES W. DRAGO f�1T3'Ta1»TAL OWNI W AOV 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- 131749 Permit Number. DEMO -11 -09 -1888 Inspection Date: December 29, 2009 Permit Type: Demolition Inspector: Bruhn, Norman Inspection Type: Final Owner: WINT JULIET Work Classification: Building Job Address: 42 NW 110 Street Miami Shores, FL 33138 -4319 Phone Number Parcel Number 112136003004 Project: <NONE> Contractor: supreme ceiling & Interiors Phone: (305)653 -7033 Building Department Comments DEMOLISH INTERIOR PARTITIOIN WHICH WAS USED TO CONVERT GARAGE INTO A ROOM AND NOW MAKE IT BACK TO ITS ORIGINAL USAGE Inspector Comments Passed CREATED AS REINSPECTION FOR INSP- 129303. Remove sink and J9 refridgerator. f� 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 December 28, 2009 Page 1 of 1